Objective To discuss the significance of the diagnosis of hypothyroidism or subclinical hypothyroidism and evaluate the correlation of adverse pregnancy outcomes and the intervention effects of levothyroxine in early pregnancy .Methods 500 pregnant women who from April 2015 to April 2016 came to our hospital obstetrics do prenatal outpatient service were served as the objects in our study, at the same time, all the pregnant women received the five items of thyroid function screening.The statistically analyzed the results and followed up the pregnant women who with hypothyroidism and subclinical hypothyroidism to learn the treatment and adverse pregnancy outcomes, so as to evaluate the correlation and the intervention effects. Results In 500 cases of pregnant women,there were 6 cases of hyperthyroidism (1.2%),55 cases of hypothyroidism or subclinical hypothyroidism (11%),includeing four cases of hypothyroidism and 51 cases of subclinical hypothyroidism.The values of TSH,T3, T4,FT3 and FT4 in the group of hypothyroidism pregnant women were significant different to the normal control group (P<0.05), the values of TSH, T3, T4 and FT4 in the group of subclinical hypothyroidism pregnant women were significant different to the normal control group (P<0.05).Then the 25 cases of pregnant women with hypothyroidism or subclinical hypothyroidism received the treatment with levothyroxine, and the incidence rate of adverse pregnancy outcomes in treatment group was significantly lower than the untreated group ( P<0.05 ) .Conclusion The diagnosis of hypothyroidism or subclinical in early pregnancy and then treated with levothyroxine has important significant in decreasing the adverse pregnancy outcomes .

Objective To investigate the clinical forensic assessment on cases of suspected medical malpractice and the other related aspects concerning the assessment in clinical forensic expertise. Methods Clinical data from 25 cases expertized for suspicion of medical malpractice were retrospectively analyzed. Results 16 cases were due to the medical muff (10 cases of 16 medical muff had a bad consequence and happened in the department of operation, 6 cases had not ones); 9 cases were non-medical muff. Conclusion Though the medical muff recognized is basic, but the relationship between the medical muff and the following bad results of medical muff is the best key for the forensic expertise. Otherwise, the scientific and practical value must be considered in the forensic expertise.

Objective To evaluate the efficacy of metformin(MTF) in treatment of clomiphene (CC)-resistant patients with polycystic ovary syndrome (PCOS).Methods The published articles of randomized controlled trial (RCT) of comparison of MTF combined with CC and CC alone in treatment of CC-resistant PCOS were searched in PubMed,EMBASE,OVID,EBSCO databases and Cochrane Library,and these studies were screened under inclusion and exclusion criteria.The quality of included studies and extract data of comparison of ovulation rates and pregnancy rates were evaluated.And the Meta-analysis using statistic software RevMan 5.0 was completed.ResultTotal of 333 patients in total 8 trials were included.Meta analysis showed that MTF plus CC led to a significantly higher clinical ovulation rate ( OR =7.31,95 ％ CI:2.57 - 20.76,P ＜ 0.05 ) and pregnancy rate ( OR =7.93,95 ％ CI:2.45 - 25.63,P ＜ 0.05 ) than that of CC alone.Conclusion MTF can increase ovulation and pregnancy rates of CC-resistant PCOS women.

Objective To investigate the clinical significance of serum transforming growth factor-β( TGF-β),tumor necrosis factor-α( TNF-α) and interferon-γ( IFN-γ) levels in patients with pre-eclampsia. Methods Thirty-two cases of maternal pre-eclampsia( 22 cases were mild pre-eclampsia,10 cases were severe pre-eclampsia),30 cases of gestational hypertension and 30 cases of normal mothers were selected as our subjects. Serum TGF-β,TNF-α IFN-γ levels were detected. Adverse pregnancy outcomes in patients were collected and analyzed. Results Serum TGF-β,TNF-α,IFN-γlevels in patients with severe pre-eclampsia were (90. 4 ± 23. 4)μg/L,(84. 5 ± 13. 6)μg/L and(146. 5 ± 13. 4)μg/L respectively,significantly higher than that in normal mothers((11. 3 ± 3. 7)μg/L,(5. 6 ± 1. 2)μg/L and(82. 5 ± 19. 4)μg/L),the gestational hypertension group(( 35. 3 ± 8. 4 )μg/L,( 10. 4 ± 2. 9 )μg/L and( 96. 4 ± 15. 8 )μg/L ),and mild pre-eclampsia group((76. 5 ± 15. 4)μg/L,(26. 5 ± 3. 2)μg/L and(120. 4 ± 20. 5)μg/L),and the difference were significant(F=11. 363,15. 982,7. 431;P﹤0. 001). Serum TGF-β,TNF-α and IFN-γ levels in mild pre-eclampsia were significantly higher than those in normal mothers and gestational hypertension patients( P﹤0. 05). Incidence of preterm delivery in patients with high TGF-β,TNF-α,IFN-γ expression was significantly higher than patients with low expression(7 cases vs. 2 cases;χ2 =4. 037,P=0. 044). Incidence of in patients with high FGR,TGF-β,TNF-α expression was significantly higher than patients with low expression( 6 cases vs. 1 case;χ2 =4. 969,P =0. 025 ). Conclusion Detection of maternal serum cytokines can evaluate the severity of pre-eclampsia to a certain extent and predicted adverse pregnancy outcomes.

Most of the current experiments are obsolete and verified,the students are not interested in and the experiments are out of touch with the actual work.These are the common problems in the experiment teaching of occupational health and occupational medicine.By taking the students who majored in preventive medicine as the subjects,this study aimed to explore the effects of independent designed experiment teaching mode,which was based on dividing the groups before class,choosing the projects by students themselves,deciding the design of the program via the discussion of teacher and students and doing the experimental reports and sharing the experience.The results showed that,in the premise of the preliminary master of the theory and basic skills of occupational health and occupational medicine,carrying out independent designed experiments in the last three weeks of semester,to a certain extent,could arouse students' interest in learning,cultivate their abilities of independent thinking,practice,problem analysis and solution,and team cooperation.However,restricted by lack of teachers,inadequate equipment and high cost and other factors,this teaching mode is only suitable for small class.

Objective To compare the value of transvaginal ultrasound and MRI in diagnosis of the first-trimester cesarean scar pregnancy (CSP).Methods The transvaginal ultrasound and MRI data of 28 patients who were initially diagnosed as CSP were analyzed. Regarding the surgery and postoperative pathology as a gold standard,the differences between transvaginal ultrasound and MRI were compared in the sensitivity,specificity,diagnostic coincidence rate and the ability in showing the internal structure of gestational sac and its relationship with the surrounding tissue.Results 22 CSP patients were confirmed by surgical pathology in a total of 28 patients,while 20 CSP patients using transvaginal ultrasound and 1 9 using MRI were correctly diagnosed respectively,and the sensitivity,specificity and diagnostic coincidence rate were 90.9%,50.0%,82.1% vs 86.4%,83.3%,85.7%,respectively,exhibiting no statistical difference in the coincidence rates between two methods (χ2 =0.132,P=0.72 ).The pregnant bursa in 20 patients was found by pathology in 22 CSP patients,and 19 pregnant bursa with transvaginal ultrasound and 17 with MRI were confirmed respectively,exhibiting no statistical difference between two methods (χ2 =1.11,P =0.29).The yolk sac in 12 patients,embryos in 8,original heart tube in 5 and local scar pregnancy sac infiltration in 3 were found with transvaginal ultrasound,meanwhile those in 2,2,0 and 9 respectively were also found with MRI,exhibiting significant differences between the two methods (χ2 =13.8,P =0.000;χ2 =7.7,P =0.006;χ2 =7.2,P =0.007;χ2 =7.1,P=0.008).The pregnancy capsule hemorrhage in 7 patients and hemorrhage in uterine cavity in 9 were found with transvaginal ultrasound, meanwhile those in 14 and 1 5 were found with MRI,exhibiting significant differences (χ2 =6.6,P =0.01;χ2 =5.0,P =0.026). Conclusion The coincidence rate in diagnosis of CSP using transvaginal ultrasound or MRI is higher.Transvaginal ultrasound is superior to MRI in showing the yolk sac,embryos and original heart tube,while MRI is better than transvaginal ultrasound in showing the hemorrhage of uterine cavity or gestational sac and the relationship between pregnant bursa and the surrounding tissue.Combination of the two methods shows more value in early diagnosis of CSP.

OBJECTIVE:To investigate the relationship of Cytochrome P450 (CYP)3A4* 18 gene polymorphism with therapeutic efficacy and ADR of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) in non-small cell lung cancer (NSCLC) patients receiving primary treatment.METHODS:A total of 46 advanced NSCLC patients receiving primary EGFR-TKI (gefitinib or edotinib) treatment until disease progression or intolerance were selected from our hospital during Jan.2013-Mar.2016,and (gefitinib of erlotinib) treatment until disease progression or intolerance.CYP3A4*18 genotype was detected by PCR and direct sequencing.Clinical efficacies,progression-free survival (PFS) and the occurrence of ADR were compared among differ ent genotypes.RESULTS:Among 46 patients,there were 17 cases of CYP3A4*18 wild-type and 29 cases of CYP3A4*18 mutation-type,with mutation frequency of 63.0％.The objective response rate (ORR) of CYP3A4*18 wild-type patients was 23.5％,and disease control rate (DCR) of them was 70.6％.For CYP3A4*18 mutation-type patients,ORR and DCR were 27.6％ and 69.0％.There was no statistical significance in the proportion of patients with partial response,stable disease or progressive dis ease,ORR or DCR among different genotypes (P＞0.05).PFS of female patients were significantly longer than male patients;those of patients without smoking history were significantly longer than those with smoking history,with statistical significance (P＜0.05).There was no correlation between patients' age,therapy drugs,Eastern Oncology Collaboration scores,EGFR mutation types,CYP3A4*18 genotypes and PFS (P＞0.05).Patients'gender and smoking history were independent prognostic factors for PFS [odds ratios were 3.438,0.205,95％ CI were(1.393,8.488),(0.088,0.481)].Among CYP3A4* 18 wild-type patients,6 patients suffered from rash (35.3％) and 3 diarrhea (17.6％).Among mutation-type patients,26 patients suffered from rash (89.7％) and 15 diarrhea (51.7％),with statistical significance (P＜0.05).There was no statistical significance in the incidence of liver function injury and interstitial dermatitis among different genotypes (P＞0.05).CONCLUSIONS:CYP3A4*18 gene polymorphism may be not associated with therapeutic efficacy of EGFR-TKI in advanced NSCLC patients receiving primary treatment,but it is correlated with the occurrence of ADR.Mutation type patients are more likely to suffered from rash,diarrhea and other ADR.

Objective:To observe the expression of sirtuin 3 (Sirt3) and mitochondrial damage-associated proteins in lipopolysaccharide (LPS)-induced acute kidney injury mouse model and renal tubular epithelial cells, and to explore the role of Sirt3 in LPS-induced abnormal mitochondrial dynamics in renal tubular epithelial cells.Methods:Eighteen specific pathogen free (SPF) male C57BL/6 mice were randomly assigned to control group, LPS 24 h group and LPS 48 h group. The control group was intraperitoneally injected with physiological saline (0.1 ml/10 g), and LPS 24 h group and LPS 48 h group were intraperitoneally injected with LPS (10 mg/kg) solution. Renal functional indexes of mice were analyzed by automatic biochemical analyzer. The pathological change of the kidney was observed by HE staining, and the expressions of dynamin-related protein-1 (Drp1), optic atrophy type 1 (Opa1) and Sirt3 were evaluated by Western blotting. Expression and distribution of Sirt3 in kidney was assessed by immunohistochemistry. Human renal tubular epithelial cells (HK-2) were exposed to 10 μg/ml LPS for 24 h, and the expression of Drp1, Opa1 and Sirt3 were detected by Western blotting. Cell apoptosis was assessed by Hoechst-33342 staining. After transfection to HK-2 cells with pcDNA3.1-Sirt3 recombinant plasmid, the expressions of Sirt3, Drp1, Opa1 and cell apoptosis were detected by the same methods as above.Results:(1) The levels of blood urea nitrogen and serum creatinine in LPS group were significantly higher than those in control group (both P<0.05), and the pathological changes of kidney were obvious. (2) Compared with the control group, the expression of mitochondrial fission-associated protein Drp1 in renal tissue of LPS group was significantly higher ( P<0.05), and the expression of mitochondrial fusion associated protein Opa1 was significantly lower ( P<0.05). (3) Compared with the control group, the expression of Sirt3 in LPS group was significantly lower ( P<0.05), and immunohistochemistry results showed that Sirt3 was mainly expressed in glomerular vascular endothelial cells and renal tubular epithelial cells. (4) In vitro, LPS stimulation induced increased Drp1 expression in HK-2 cells ( P<0.05), decreased Opa1 and Sirt3 expression (both P<0.05), and increased apoptosis ( P<0.05). (5) LPS-induced mitochondrial dynamics disturbance and apoptosis were alleviated by pcDNA3.1-Sirt3 recombinant plasmid transfection. Conclusions:LPS can induce down-regulation of Sirt3 expression and disturbance of mitochondrial dynamics, and Sirt3 may play a protective role in LPS-induced acute kidney injury by regulating mitochondrial dynamics.

Objective To investigate the after cardiopulmonary resuscitation in patients with serum cell adhesion molecule -1 (ICAM-1) changes and the clinical significance. Methods The patients were divided into cardiac arrest cardiopulmonary resuscitation was 5 minutes, 5-10 minutes inner CPR group, 10-30 minutes inner CPR group, and in healthy people as control group, a total of 4 groups, in each group were measured in venous blood ICAM-1 level by ELISA method. Results The level of cardiopulmonary resuscitation in patients with serum cell adhesion molecules in -1 were higher than those in healthy control group (P<0.05) ; and the longer the cardiopulmonary resuscitation in pa-tients with venous serum intercellular adhesion molecule -1 is higher(P<0.05). Conclusion The level of serum in pa-tients with cardiopulmonary resuscitation of cell adhesion molecule -1 will increase obviously, cardiopulmonary resus-citation earlier implementation, the levels of ICAM-1 were lower, the better the prognosis(P<0.05).

OBJECTIVETo observe the therapeutic effect of calming the liver and restraining the Yang formula in treating patients with mild or moderate degree of essential hypertension (syndrome of hyperactivity of liver-Yang), and to explore its mechanism in lowering blood pressure.

METHODThe 348 patients with EH of stage I , II were randomly divided into two groups, the 174 patients in the treated group were treated with the calming the liver and restraining the Yang formula, and the 174 patients in the control group were treated with amlodipine. The treatment course for them all was 12 weeks. The related clincial symptoms score and quality of life score estimated before and after treatment at 4th week, 8th week and 12th week were observed. Before and after treatment, the ambulatory blood pressure (AMBP), heart rate, blood lipid, serum livels of high-sensitivity C-reactive protein (Hs-CRP), Angiotensin-II (Ang II) and calcitonin gene-related peptide (CGRP) were measured respectively in 40 patients of the treared group and 40 patients of the control group.

RESULTAfter treatment, the treatment in the treated group showed an effect better than that in the control group in terms of nigh-time blood pressure reducing rate (P < 0.05). The reducing blood pressure variability and total effective rate in the treated group were no significant than that in the control group. In respect of reducing symptomatic scores on dizzy, soreness and weakness of the waist and knees, disturbed and dry and bitter of mouth, ameliorating quality of life score, decreasing the levels of heart rate, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol(HDL-C) in the treated group were showing marked improvement as compared with that in the control group (P < 0.05 or P < 0.1). The improvement in the level of Ang II , Hs-CRP and CGRP before treatment in two groups were more significant than that after treatment (P < 0.05). However There were no difference in after treatment between the treated group and the control group.

CONCLUSIONThe calming the liver and restraining the Yang formula shows favorable efficacy in lowering blood pressure on the patients with mild or moderate degree of essential hypertension. It can reduce the clincial symptoms, improve the quality of life, regulate blood lipid metabolism. Its mechanism may be related to the functional relieving inflammatory reaction and inhibition the activity of renin-angiotensin-aldosterone system (RAAS).

Adult ; Aged ; Amlodipine ; therapeutic use ; Antihypertensive Agents ; therapeutic use ; Anxiety ; chemically induced ; physiopathology ; Blood Pressure ; drug effects ; Cholesterol ; metabolism ; Cholesterol, HDL ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart Rate ; drug effects ; Humans ; Hypertension ; drug therapy ; physiopathology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Triglycerides ; metabolism