Due to the latent and highly invasive characteristics of liver carcinoma,a majority of patients are frequently not diagnosed until moderate or advanced stage in the disease process,and usually complicate with cirrhosis.Only 15％ -30％ of the patients are eligible for radical resection.The overall survival time is about 3-4 months.Therefore,on the basis of early diagnosis and treatment of liver carcinoma,how to improve the treatment effect of the moderate and advanced liver carcinoma,ameliorate the quality of life and prolong the survival time,becomes the focuses and difficulties both at home and abroad.

Objective To evaluate the effectiveness and predictive value of high-resolution manometry(HRM) for POEM in treating achalasia. Methods A total of 84 achalasia patients categorized into subtypes by HRM, who also underwent POEM, were enrolled in our study. Eckardt score, Barium esophagogram and HRM were performed before, 6 months and 1 year after POEM. Results POEM was successfully performed in all 84 patients. No perforation occurred in any patient. The Eckardt scores and esophageal diameter after POEM significantly reduced compared with those before(P<0. 05). The 4s-IRP decreased from 33. 4±9. 0 mmHg (1 mmHg =0. 133 kPa) to 14. 6±3. 8 mmHg six months after POEM (P<0. 05) and to 16. 4±3. 9 mmHg one year after POEM (VS preoperate, P<0. 05). The LESP before treatment was 41. 8±15. 4 mmHg, decreasing to 18. 4±7. 1 mmHg six months after POEM (P<0. 05) and 20. 7±7. 6 mmHg one year after POEM (VS preoperate, P <0. 05) . When categorizing patients into 3 subtypes by HRM, 4s-IRP of type II showed the most dramatic decrease six months after POEM(62. 8%), followed by typeⅠ(53. 5%), while type III had the least decrease(41. 8%). The mean decreasing rate of LESP in type III was 42. 3% six months after POEM, followed by typeⅠ(55. 3%) , while type II showed the highest rate(57. 8%). Conclusion POEM is a safe treatment for achalasia and has significant short-term efficacy with Type II responding best to POEM. HRM plays a vital role in typing AC and predicting the effectiveness of POEM and can be useful in selecting an appropriate treatment.

Objective To compare the efficacy of weight loss,metformin and rosiglitazone in women with polycystic ovary syndrome(PCOS).Methods A randomized controlled trial(RCT)was carried out in Peking Union Medical College Hospital(PUMCH),one hundred and six women with PCOS were assigned to three intervention groups:weight loss,weight loss and metformin,weight loss and rosiglitazone group.Patients were treated with weight loss(diet and exercise),weight loss and mefformin (500 mg three times daily),weight loss and rosiglitazone(4 mg once daily)for three months.Sixty patients completed treatments.Basal body temperature(BBT),total testosterone as well as fasting serum insulin levels and lipid were measured and compared in all patients before and after weight loss.Results No significant differences were found in the baseline characteristics among three groups.In weight loss group 51%(22/43)patients completed treatment,and 23%(5/22)patients resumed ovulation.In weight loss and mefformin group 58%(21/36)patients completed treatment,and 43%(9/21)patients resumed ovulation.In weight loss and rosiglitazone group 63%(17/27)patients completed treatment,and 59% (10/17)patients resumed ovulation.Ovulation rate was significantly higher in weight loss and rosiglitazone group than in weight loss group.There was no significant difference among three groups in body mass index (BMI),waist circumference,waist-hip ratio(WHR),sex hormone,serum fasting insulin and lipid level after treatment.Conclusion Weight loss,metformin and rosiglitazone all can improve ovulation each.

Objective To explore the perinatal outcome of vaginal birth after cesarean (VBAC) in women with advanced age.Methods Totally 2 587 women delivered after one or two prior cesarean sections (gestational age≥28 weeks) in the First Affiliated Hospital of Kunming Medical University from July 2013 to February 2017.909 trial of labor after cesarean(TOLAC) cases of singleton pregnancy with one prior cesarean section were studied retrospectively.According to the age,of the 909 TOLAC cases,237 were the advanced age group,and 672 cases were the low age group.The maternal and neonatal outcomes between the two groups were compared.Results The percentage of TOLAC in women with advanced age was 32.4％ (237/731),and VBAC rate was 88.2％ (209/237).The percentage of TOLAC in younger women was 36.2％ (672/1 856),and VBAC rate was 82.4％ (554/672).The difference of the TOLAC rate between the two groups was not significant (P＞0.05),and the VBAC rate of the advanced age group was higher than the low age group (P＜0.05).In the comparison of the two groups,the proportion of bachelor degree or above(55.7％,132/ 237),the prepregnancy BMI (22.4±3.0) kg/m2,pregnant interval time (68.5±38.3) months,the proportion of gestational hypertension (8.4％,20/237),the proportion of gestational diabetes(34.6％,82/237) and the rate of the neonatal ICU admission (18.1％,43/237) in the advanced age group were higher than those of the low age group (P＜0.05),respectively.And there were no significant differences in the rate of postpartum hemorrhage,the rate of postpartum hemorrhage≥1 500 ml,the rate of postpartum transfusion,puerperal morbidity,neonatal birth weight,neonatal 5 min Apgar score＜7 score,umbilical artery blood pH＜7.0,neonatal tracheal intubation and respiratory distress syndrome (all P＞0.05).In all TOLAC cases,the rate of uterine rupture was 0.11％(1/909) and there was no maternal and neonatal death.Conclusion VBAC is a safe and feasible way of delivery for singleton pregnancy after one prior cesarean section in women with advanced age.

Objective To analyse the changes of metabolic parameters and condition of metabolic syndrome(MS)in females with obstructive sleep apnea-hypopnea syndrome(OSAHS),and explore the interaction between OSAHS and MS.Methods Sixty females undergoing polysomnography were included,and were divided into simple snorer group(n=19),mild OSAHS group(n=21)and moderate to severe OSAHS group(n=20).Epworth sleepiness scale(ESS)scores and metabolic parameters were compared among groups.Forty-one patients with OSAHS were subdivided into group with MS(MS group,n=15)and group without MS(non-MS group,n=26).ESS scores,apnea hypopnea index(AHI),oxygen desaturation index(ODI)and lowest pulse oxygen saturation(LSpO_2)were compared between MS group and non-MS group.Results There was no significant difference in age,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low density cholesterol(LDL),high density cholesterol(HDL),apolipoprotein A-I(apoA-I)and apolipoprotein B(apoB) among simple snorer group,mild OSAHS group and moderate to severe OSAHS group(P>0.05).Correlation analysis revealed ESS was positively related to AHI(r=0.327,P=0.011).ESS scores and proportions of hypertension,fasting plasma glucose(FPG)and MS were significantly higher in moderate to severe OSAHS group than those in simple snorer group(P<0.05).BMI,FPG,TG,proportion of hypertension,ODI and ESS score in MS group were significantly higher than those in non-MS group(P<0.05),while there was no significant difference in AHI and LspO_2 between these two groups(P>0.05). Conclusion ESS score may reflect the severity of OSAHS in females.Females with OSAHS matched for age and BMI have no difference in blood fat.With the increase of severity of OSAHS,glycometabolism can be impaired,the prevalences of hypertension and MS increase.MS can exacerbate the severity of OSAHS,indicating that MS and OSAHS interact with each other.

BACKGROUND:Inhibiting the apoptosis of intervertebral disc cel s can postpone the degenerative process of intervertebral disc. Survivin has a strong function of regulating cel proliferation and anti-apoptosis.
OBJECTIVE:To construct and identify the lentiviral vector encoding survivin gene of human.
METHODS:The survivin gene of human (BIRC5) was synthesized through the gene synthesis technology, amplified by PCR and analyzed by electrophoresis. The target gene was cloned into lentiviral expression plasmid to obtain the recombinant lentiviral vector Lenti-BIRC5. After transformation into competent E. coli cel s, the candidate clones were identified by PCR firstly. The positive clones were identified by gene sequencing. The lentivirus plasmid containing target gene was transfected into 293T cel s, and the expression of recombinant lentiviral vector Flag-Survivin fusion protein was detected through western blot analysis.
RESULTS AND CONCLUSION:The PCR results of electrophoresis and DNA sequencing showed that lentiviral vector containing human survivin gene was constructed successful y. Western blot analysis results showed that the target gene was transfected successful y and over-expressed in cultured cel s. The lentiviral expression vector of human survivin gene Lenti-BIRC5 was constructed successful y, which lays a foundation for the study addressing the anti-apoptotic effects of survivin on human nucleus pulposus cel s.

Objective To investigate the effect of aldehyde-free fixation solution and aldehyde fixation solution on DNA and cytoplasm of nucleus.Methods The DNA quantification (IOD),discrete coefficient (CV),DNA index (DI) and nucleus area (area) were measured by DNA quantification system (ICM) in 8 different fixation solution;combined with cytological staining,the effects of different fixative solution on nuclear DNA and cytoplasmic staining were analyzed.Results Aldehyde fixation solution was better than aldehyde free fixation solution,the formaldehyde in fixtion solution has important influence on Feulgen-eosin staining.Conclusion Aldehyde fixation solution combined with cytological staining can obtained good dyeing effect,which provides the basis for the subsequent multi-technique joint diagnosis.

Objective To evaluate the diagnostic and therapeutic value and safety of transcatheter arterial angiography and embolization in patients with endoscopic refractory gastrointestinal bleeding.Methods Thirty-one cases of endoscopic refractory gastrointestinal bleeding were performed DSA and treated with transcatheter arterial angiography and embolization.The safty and efficacy was evaluated.Results Angiographic positive rate of bleeding was 80.65％ (25/31);28 cases was treated with embolization.The success rate of first embolization was 75.00％ (21/28),and the total success rate was 82.14 ％ (23/28) by the second embolization.Seven patients received surgical resection after interventional therapy,including 2 cases of jejunal stromal tumors and 5 cases of gastric malignant tumors.Four cases of gastric cancer patients underwent rebleeding within 30 days after interventional therapy,of which 2 died of heart or lung function failure due to basic diseases.Except for 1 patient of anastomotic bleeding after gastrointestinal anastomosis occurred anastomotic fistula after embolization,who recovery with the support treatment,no other cases occurred serious gastrointestinal ischemic necrosis.Conclusion Interventional diagnosis and treatment for gastrointestinal bleeding hemostasis is effective and safety,and also can achieve good results especially for malignant gastric tumor hemorrhage,which can be used for endoscopic refractory gastrointestinal bleeding patients.

OBJECTIVETo investigate whether breastfeeding can reduce the risk of childhood overweight in the offspring of mothers with gestational diabetes mellitus (GDM).

METHODSFollow-up was performed on 1189 offspring of mothers with GDM between January 2003 and December 2009. The influence of the manner and duration of breastfeeding between 0 to 3 months after birth on the risk of childhood overweight in the offspring of mothers with GDM was analyzed by logistic regression.

RESULTSAfter correcting confounding factors such as pre-pregnancy BMI, gestational weight gain, gestational blood sugar, sex, birth weight, age and farther's body weight, it was found that the risk of childhood overweight in the offspring who received exclusive breastfeeding during the first 3 months after birth was lower than in the artificial feeding group (OR: 0.479, 95%CI: 0.256-0.897). Offspring who were breastfed for 0 to 3 months, 4 to 6 months and over 6 months had a lower risk of childhood overweight than the artificial feeding group (OR: 0.456, 95%CI: 0.233-0.827; OR: 0.29, 95%CI: 0.103-0.817; OR: 0.534, 95%CI: 0.280-0.970), offspring who were breastfed for 4 to 6 months had a lower risk of childhood overweight than those who were breastfed for 0 to 3 months (OR: 0.372, 95%CI: 0.129-0.874), and offspring who were breastfed for more than 6 months did not show significantly lower risk of overweight than those who were breastfed for less than 6 months (OR: 0.769, 95%CI: 0.470-1.258).

CONCLUSIONSWithin 3 months of birth, breastfeeding, especially exclusively, may reduce the risk of childhood overweight in the offspring of mothers with GDM. Within 6 months of birth, the risk of childhood overweight decreases as the duration of breastfeeding increases, but prolonging the duration of breastfeeding cannot necessarily reduce the risk of childhood overweight after postnatal six months.

Birth Weight ; Breast Feeding ; Diabetes, Gestational ; metabolism ; Female ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Overweight ; prevention & control ; Pregnancy ; Risk

Objective To explore the clinical outcomes of locking plate fixation of intertrochanteric fractures in patients with deformed proximal femur.Methods A retrospective review was made of the 25 patients with intertrochanteric fracture and deformed proximal femur who had been treated from January 2009 to July 2015.They were 17 men and 8 women,from 22 to 76 years of age (mean,45.2 years).The proximal femoral deformities were postpoliomyelitis syndrome in 6 cases,fibrous dysplasia in 4,malunion in 13,and hip varus caused by implant breakage following intramedullary nailing in 2.By AO classification,there were 4 cases of type 31-A2.1,3 ones of type 31-A2.2,16 ones of type 31-A3.1,and 2 ones of type 31-A3.2.All the patients were treated by open reduction plus locking plate fixation.At the final follow-up,function of the affected hip was evaluated by the Hip Disability and Osteoarthritis Outcome Score (HOOS),and quality of life of the patients was evaluated using the SF-36 health survey questionnaire.Results The 25 patients were effectively followed up for 12 to 24 months (mean,17.4 months).No infection,pneumonia,fat embolism,or deep venous thrombosis of lower limb was observed.The fractures healed without nonunion or refracture after a mean time of 5.9 months (range,from 3 to 6 months) in the 25 patients.By the HOOS evaluation at the final follow-ups,the 25 patients scored,on average,83.7± 15.6 in pain,55.6± 14.1 in symptoms,53.6 ± 9.5 in daily living function,52.7 ± 8.9 in sports and recreational activities and 62.4 ± 12.3 in quality of life;by SF-36 evaluation,they had a mean total score of 71.2 ± 13.8.Both the HOOS and SF-36 scores were not significantly different from the pre-injury values (P ＞ 0.05).Conclusion Locking plate fixation is a simple and effective way for the intertrochanteric fractures complicated with deformed proximal femur because intramedullary nailing is difficult or infeasible.