Objective To investigate the clinical efficacy and safety of recombinant human B-type natriuretic peptide(rhBNP)in treatreat of patients with acute myocardial infarction(AMI).Methods 80 patients with AMI were randomly divided into control and treatment group.The two groups were accepted the standard foundation treatment(ABCDE)defined by the WHO and PCI therapy.The treatment group was added the rhBNP on the basis.The rhBNP was uniformly injected by intravenous with 1.5 μg/kg in 90s,and then with 0.0075 μg · kg-1 · min-1 in 48h; To investigate the BNP and myocardiolysis maker(Troponin I,cTnI)levels in blood-serum before and after the treatment;To evaluate left cardiac functions and left ventricular remodeling by left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF);To investigate the major cardiovascular events after treatment within 30 days.Results RhBNP could significantly reduce the concentration of the BNP and cTnI in blood-serum after treating one week(all P ＜ 0.05); It could remarkably deflate LV EDV and LVESV,improve LVEF(allP ＜0.05); It could reduce the incidence of major cardiovascular events(P ＜0.05)within 30 days(P ＜ 0.05).Conclusion The rhBNP could improve left ventricular pressure-phore and volume-phore,improve ventricular remodeling,improve myocardial ischemia and reduce major cardiovascular events within 30 days.It was proved that the rhBNP could improve AMI clinical prognosis.

Pulmonary fibrosis is an interstitial lung disease caused by different pathogenic factors. It has the characteristics of high morbidity and poor prognosis, which seriously affects the quality of life of patients. However, its pathogenesis has not yet been fully elucidated. Surfactant protein(SP)-A and SP-D are lipoprotein complexes distributed at the air-liquid interface of alveoli, synthesized and secreted by alveolar type Ⅱ epithelial cells and bronchiolar cells. They are important parts of the innate immune system, which participate in the host defense process through a variety of regulatory methods, and play an important role in regulating cell apoptosis and lung inflammation, promoting the process of epithelial repair and maintaining the stability of alveolar structure. The disorder and mutation of SP-A and SP-D may be the influencing factors of the pathogenesis of pulmonary fibrosis. Serum SP-A and SP-D levels are differentially expressed in patients with pulmonary fibrosis and normal healthy individuals, and are related to the severity of pulmonary fibrosis. They are considered to be a class of biomarkers that sensitively reflect lung epithelial cell damage and can be used in the diagnosis, treatment and prognostic evaluation of pulmonary fibrosis.

Objective To evaluate the prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy ( VRT ) in combination with laparoscopic pelvic lymphadenectomy.Methods The surgical data , disease recurrences and fertility outcomes were analyzed retrospectively for 51 patients who received VRT in Peking Union Medical College Hospital from Dec.2003 to Nov.2013.Results Forty-eight patients succeeded in preserving fertility.The median age was 29 years.International Federation of Gynecology and Obstetrics ( FIGO ) stage: 5 cases Ⅰa1 with lymph vascular space invasion (LVSI),4 cases Ⅰa2 and 39 cases in stage Ⅰb1.Tumor size: 20 cases with no visible lesion, 20 cases with tumor size ≤2 cm, 8 cases with tumor size >2 cm.Histological type:42 cases with squamous carcinoma , 6 cases with adenocarcinoma or adeno-squamous carcinoma.The mean excised cervical length and parametrial width was ( 2.6 ±0.6 ) cm and ( 1.9 ±0.5 ) cm, respectively.Six recurrences ( 12%) were observed after following up for a mean duration of ( 35 ±21 ) months.The recurrent rate in patients with tumor size >2 cm was 3/8, which was significantly higher than that of the
patients with tumor size ≤2 cm (8%, 3/40;P<0.01).Of the 35 patients who desired to conceive after the surgery, 13 women had 17 pregnancies and the pregnant rate was 37% (13/35).Nine women obtained 10 healthy live birth babies.The fertility rate was 26%( 9/35 ).Conclusions VRT in combination with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes.Tumor size ≤2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor size >2 cm.

Objective To study the clinical features,treatment and prognosis of struma ovarii.Methods From January 1990 to January 2012,a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology,Peking Union Medical College Hospital.Clinical data of these patients were studied retrospectively.Results (1) Characteristics of patients:the median age of patients was 42 years old (17-81 years).Of those patients,64 cases (94％) were diagnosed begin struma ovarii and 4(6％) were malignant struma ovarii.(2) Clinical feature:32(47％,32/68) patients were identified with pelvic mass by ultrasonic test,28 cases(41％) had clinical abdominal pain,8(12％) touched a mass from abdominal wall.Preoperative CA125 were tested in 54 patients,but only 8 cases(15％) had moderate elevation.All patients receive ultrasound examination,and 51 cases (75％) were mulitcystic lesions with many septi,3(4％) solid lesions and 14(21％) solid-cystic tumors.The mean diameter of tumors was(8 ± 3) cm.Ascites was present in 4 (6％,4/68)patients.Sixty-seven patients had unilateral lesions,and 1 patient had bilateral lesions.No patient had hyperthyroidism presentation.Nineteen cases underwent thyroid function test after operation,and the results were normal.(3) Treatment:all patients underwent surgical treatment.Among patients with begin struma ovarii,25 cases underwent cystectomy,15 cases unilateral,2 bilateral salpingo-oophorectomy,22 cases hysterectomy + unilateral or bilateral salpingo-oophorectomy.Four malignant struma ovarii,1 patient underwent fertility-sparing staging surgery,2 patients unilateral salpingo-oophorectomy,1 case hysterectomy + bilateral salpingo-oophorectomy.Two patients received chemotherapy after surgery.(4) Prognosis:all patients were followed up in Peking Union Medical College Hospital.The median follow-up time of benign struma ovarii was 5.4 years (6 months-21 years) and there were no recurrence.The median follow-up time of malignant struma ovarii was 11.5 years (9-20 years).Three cases had long-term recurrence at 2,7 and 16 years respectively after surgery.They were received surgical treatment after recurrence and all were alive.Two cases were given by thyroidectomy and 131I treatment.Conclusions Struma ovarii is a rare ovarian monodermal teratoma.Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii.The incidence of malignant struma ovarii is low,and there are no standard treatments.Because of higher long-term recurrence rate,these patients need close follow-up.

ObjectiveTo retrospectively analyze the clinical characteristics and outcomes of endometrial carcinoma patients aged 45 years and younger MethodsFifty-two cases of endometrial carcinoma aged 45 years and younger were treated in Peking Union Medical College Hospital They were further divided into group A (35 years of age and younger) and group B (older than 35 years) Clinical data of these patients were reviewed and the two groups were compared ResultsPatients aged 45 years and younger accounted for 12 7% of all the endometrial carcinoma cases About 50% of the patients were nulliparous, infertile or had irregular menstruation and endometrial hyperplasia, 29% were obese, 23% had polycystic ovaries Eighty-three percent of the patients were stage [ Int ernational Federation of Gynecology and Obstetris (FIGO),1988] Group A had mo re polysystic ovaries and atypical endometrial hyperplasia than group B (53% v s 9%, 59% vs 26% respectively, P

Objective To investigate the clinical characteristics,diagnosis and treatment of vaginal intraepithelial neoplasia(VAIN).Methods A retrospective study was made of 6 patients with VAIN.who were hospitalized at Peking Union Medical College Hospital from 1980 to 2006.Results Five cases had a history of hysterectomy,two of whom were because of cervical intraepithelial neoplasia(CIN)or invasive cervical cancer.Four cases had the infection of high-risk oncogenic human papillomaviruses detected with hybrid capture Ⅱ(HC-Ⅱ),the other two had no record.In all patients the VAIN lesions were within the upper one third of the vagina.They were all diagnosed by colposcopic examination and directed biopsy after the abnormal cytology by thinprep cytology test(TCT).Six cases of VAIN Ⅱ-Ⅲ were treated by excisional surgery.One case had residual lesion and had another surgery 3 months after the first one.Two patients obtained remission at one-year follow-up,three had abnormal cytology by TCT 6 months after surgery,and one had abnormal cytology by TCT at six-month follow-up but normal at one-year follow-up.Conclusions A history of CIN is the main risk factor for VAIN,so routine vaginal cytology is needed for the patients after hysterectomy due to CIN.Cytology,colposcopic examination and directed biopsy are the mainstays of VAIN diagnosis.Excisional surgery is recommended for the patients with VAIN Ⅱ-Ⅲ.Long term follow-up is necessary after treatment.

Objective To study the clinical characteristics, diagnosis, treatment and its effectiveness of vulvar intraepithelial neoplasm Ⅲ(VIN Ⅲ).Methods Clinical data, including age of the patients, mode of surgical operation, pathological features, results of post-operation follow-up, of 12 cases of VIN Ⅲ admitted to the Peking Union Medical College Hospital(PUMCH)during January 1984 to December2006 were retrospectively analyzed.Results Mean age of the 12 cases was 40.3(ranging from 23 to 56)years.All the patients had symptoms of vulvar itching, three with VUlVar ulcer and one with vulvar pain.There was single neoplasm focus in two cases and multiple focuses in 10 cases, five cases with neoplasm in other sites and five with human papilloma virus(HPV)infection.All the 12 patients received surgical operation, three with simple vulvectomy(one with some residue at perianal incisal edge)and other nine with lumpectomy(four with some residue at incisal edge).Eight cases were followed-up for 9.0 months in average(ranging 1～22 months)after surgical operation, including three with some residue at incisal edge.Relapse was found in two cases three and 11 months after operation, respectively, who received re-operation, including one with residue at incisal edge and one without residue.Conclusions It is necessary to attach more importance to biopsy for the cases of suspected VIN Ⅲ, as well as colposcopic diagnosis for those with vaginal or vulvar neoplasm and testing for HPV infection.Surgical operation, including simple vulvectomy and lumpectomy with or without adjunctive measures, are main treatment for patients of VIN Ⅲ and follow-up is also important for all those with VIN Ⅲ.

Objective To study the clinical characteristic, the optimal treatments and the prognosis for the recurrence and failure of primary treatment in malignant ovarian germ cell tumors (MOGCT).Methods The clinical data of 17 recurrent and failure of primary treatment in MOGCT cases treated in Pecking Union Medical College Hospital from January 1983 to May 2008 were analyzed retrospectively to evaluate failure of primary treatment and second treatment. Results Only the 4 eases of recurrent and failure of primary treatment of MOGCT were underwent comprehensive surgical staging. After primary surgery in 1 -8 months, 16 cases received the non-standard chemotherapy were found the lesion again. The secondary debulking surgery was done for the 15 cases and also received the standard chemotherapy. Among of them, 8 cases were survival during follow up, 5 cases gave up the treatment and 4 patients were lost following up during the treatment. Conclusions The standard primary treatment is the most important for the MOGCT. Even for the recurrence and failure of primary treatment of MOGCT, the satisfied cytoreduetive surgery plus the standard chemotherapy also show the significant impact on the prognosis.

Objective To compare the effect between intra-arterial and intra-venous neoadjuvant chemotherapy(NACT)in stage Ⅰb2-Ⅱ b cervical carcinoma.Methods A retrospective analysis Was done on 52 cases of intra-venous NACT and 95 eases of intm-arterial NACT for stage Ⅰ b2-Ⅱ b cervical carcinoma treatad in Peking Union Medical College Hospital from 1999.ResulIs The response rate of intraveHous NACT and intra-arterial NACT was 88%(46/52)and 79%(75/95).and the operative rate after NACT Was 81%(42/52)and 72%(68/95)respectively(P>0.05).There were no significant differences in surgery time,blood loss and pest-operative morbidity between these two groups.Pathological parametrial positive rate after NACT in arterial group(6%)Was significantly lower than that of venous group (50%,P>0.05).The venous group had very similar recurrence rates(13%vs 17%)and death rates (9%VS 12%)when compared with the arterial group(P>0.05).Conclusions The intra-arterial and intra-venous NACT for stage Ⅰ b2-Ⅱb cervical carcinoma show similar response rate.operative rate and surgical difficulties.Arterial NACT shows a better effect on parametrial infiltration.

Objective To analyze the clinical characters,treatment and prognosis of primary malignant tumor in vagina.Methods A retrospective analysis of 42 patients diagnosed with primary malignant tumor in vagina in Peking Union Medical College Hospital(PUMCH)between Jan 1984 and Aug 2006 was performed.Results Primary malignant tumor accounted for 0.98%(42/4286)in the total gynecological malignant tumors during that period in PUMCH.According to the International Federation of Gynecology and Obstetrics(FIGO)staging system,19 cases were at stage Ⅰ,12 cases at stage Ⅱ,5 cases at stageⅢ,and 6 cases at stage Ⅵ.Thairteen cases were squamous carcinoma,13 cases were malignant melanoma,8 cases were adenocarcinoma.3 case8 were yolk sac tumor and 5 cases were other types.The majority of patients were treated with surgery combined with radiotherapy and chemotherapy.Up to August 2007,19 cases survived.18 cases were dead and 5 casefl were lost.The longest follow up was 10 years,with the median time of 2 years.The overall 2-year SUrvival rate was 60.6%.For stage Ⅰ,stage Ⅱ, and stage Ⅲ-Ⅵ,the 2-year survival rates were 71.3%.58.3%and 29.6%respectively.The 2-year survival rate of patients with squamous carcinoma Was 46.8%,malignant melanoma 72.9%,adenocarcinoma 20.0%and patients with yolk sac tumor were all alive tumor-free after 6-10 years'follow up.Conclusions The prognosis of primary malignant tumor in vagina is affected by clinical stage and histological type.A8 to malignant melanoma,radical surgery combined with chemotherapy and immunotherapy produce good effects.Patients with yolk sac tumor can be cured only with chemotherapy.As to other types,more treatment experiences are needed.