Objective:To analyze the risk factors on soft birth canal laceration in normal delivery and discuss the reasonable prevention and control measures.Methods:A follow-up study among the mothers, who delivered vaginally at our hospitals during 9-12 months in 2014, and investigate the risk factors on soft birth canal laceration.Results: In this study, the incidence of soft birth canal laceration in normal delivery was 66.12%, by the single factor unconditioned Logestic regression analysis found that emergency birth, primiparity, pregnancy induced hypertension syndrome, macrosomia, malposition, the short gel time, turn the hips to the fore, rotary fetal head, obstructed labor, oxytocin, cervical inflammation, obstetric forceps'application 12 factors were associated with soft birth canal laceration; On the alpha=0.05 level, multiariable unconditioned Logistic regression analysis showed seven factors: emergency birth, macrosomia, malposition, turn the hips to the fore, rotary fetal head, oxytocin, obstetric forceps'application. Conclusion: Emergency birth, macrosomia, malposition, turn the hips to the fore, rotary fetal head, oxytocin, obstetric forceps'application, the seven factors were closely related to the occurrence of soft birth canal laceration, corresponding measures should be taken to reduce and control the incidence of soft birth canal laceration effectively.

Objective To explore the sonographic features of intrascrotal adenomatoid tumor.Methods The sonographic features of 21 cases with intrascrotal adenomatoid tumor confirmed by surgery and pathology were retrospectively analyzed.Results Twenty-one cases with intrascrotal adenomatoid tumor could be typed into 3 ultrasonic patterns:(1) The homogeneous echo type:15 cases,their ultrasonic features were homogeneous echo,including 5 cases with low echo,8 case with equal echo,and 2 case with high echo;5 cases with testicular albuginea adenomatous tumors were also homogeneous echo,2 cases of equal echo,2 cases of low echo and 1 case of high echo that was posterior echo attenuation slightly.(2) The edge halo type:4 cases,they showed the epididymis or testis sheath round or oval nodules,of which the middle was low echo and the edge is high echo halo ring.(3) The mixed echo type:2 cases,they showed cystic mixed echo of epididymis nodules,1 case with irregular cystic areas and poor sound transmission,while the other one with good sound transmission cystic areas and a small papillae on the wall.Conclusions Sonography is a valuable method for diagnosis of intrascrotal adenomatoid tumor.The edge halo type has sonographic features.

Objective: To explore the anesthetic effect of low dose remifentanil in patients undergoing sequential painless gastroscopy and painless colonoscopy in accordance with intravenous induction of propofol. Methods: From July 2017 to January 2018, 86 patients who needed painless gastroscopy and painless colonoscopy in sequence were selected as observation objects in the Second Hospital of Jiaxing and were divided into control group and observation group according to random number table method, with 43 cases in each group.The control group was anesthetized with propofol only, while the observation group was anesthetized with low dose remifentanil in accordance with propofol.The occurrence of adverse reactions and recovery were compared between the two groups. Results: The incidence rate of adverse reactions of the control group was 20.93%(9/43), which of the observation group was 13.95%(6/43), there was no statistically significant difference between the two groups (χ²=0.272, P=394). The recovery time and the observation time after awakening in the observation group were (7.19±1.98)min and (6.94±2.04)min, respectively, which were significantly shorter than those in the control group [(10.33±2.42)min and (11.69±3.21)min], the differences were statistically significant (t=6.585, 8.190, P=0.000, 0.000). Conclusion Intravenous induction with low dose remifentanil combined with propofol in patients undergoing painless gastroscopy and painless colonoscopy in sequence has less adverse reactions, good anesthesia persistence and short recovery time, which is worthy of clinical popularization.

Background Bardet-Biedl syndrome (BBS) is a genetically heterogeneous disease,and information about BBS in Chinese populations is very limited.The purpose of the present study was to determine the genetic cause of BBS in a Chinese Han family.Methods Clinical data were recorded for the 4-year-old female proband and the available family members.The proband was screened for mutation by Sanger sequencing for a total of 142 exons of the 12 BBS-causing genes (BBS1-BBS12).The variants detected in the proband were further confirmed in the other family members.Results We identified a novel homozygous nonsense mutation (c.70A＞T,p.K24X) in the BBS4 gene exon 2 in the proband.Such mutant allele was predicted to cause a premature truncation in the N-terminal of the BBS4 protein,and probably induced the nonsense-mediated decay of BBS4 messenger RNAs.The proband's parents and brother were heterozygous for the nonsense mutant allele.It was absent in 50 Chinese control subjects.An additional rare heterozygous missense single nucleotide polymorphism (SNP) named rs200718870 in BBS10 gene was also detected in the proband,her father and her brother.Some manifestations of the proband including atypical retinitis pigmentosa,choroidal sclerosis,high myopia,and early onset of obesity might be associated with this mutation in BBS4 gene.The proband's father also reported surgical removal of an extra finger during childhood.Conclusions The present study described a novel nonsense mutation in BBS4 gene in a Chinese family.This homozygous mutation was predicted to completely abolish the synthesis of the BBS4 protein.We also detected a rare heterozygous missense SNP in BBS10 gene in the family,but did not find sufficient evidence to support the triallelic inheritance.

Objective To investigate significance in changes in level of platelet monocyte aggregates (PMA) associated with acute respiratory distress syndrome (ARDS) in patients with sepsis and discuss the role of PMA in the genesis of ARDS in order to evaluate the its diagnostic value and the significance in the severity of damage of lung in patients with sepsis. Methods This study was carried out in the Guizhou Provincial People's Hospital and 123 sepsis patients admitted from July 2014 to December 2015 were enrolled according the 2012 ARDS Berlin diagnostic criteria. The patients were divided into ARDS group (n=62) and non-ARDS group (n=61). The ARDS group were further divided into 3 subgroups according to Berlin criteria, namely mild group (n=22), moderate group (n=21), and severe group (n=19). Of all patients, blood samples were collected to determine the level of PMA using fl ow cytometry (FCM) and the level of IL-6 using enzyme linked immunosorbent assay (ELISA) method. Acute physiology and chronic health status (APACHEⅡ)score in each group were recorded at admission. Comparisons of PMA, IL-6 and APACHE Ⅱ score were carried out among groups. Receiver operating characteristic (ROC) curve were used to evaluate the signifi cance and value of PMA in predicting ARDS. Results Compared with non-ARDS group, APACHE Ⅱ score, IL-6 level, PMA level in ARDS group were signifi cantly higher with statistically signifi cant differences (P<0.01). When the severity of ARDS increased, the level of each biomarker increased with statistically significant differences (P<0.01). Correlation analysis showed that peripheral blood PMA positively correlated with IL-6 (r=0.791, P<0.01) and APACHE Ⅱ score (r=0.641, P<0.01), while it negatively correlated with PaO2/FiO2(r=-0.857, P<0.01).Area under the ROC curve of PMA was 0.833 for predicting ARDS, and when the optimal cutoff value was 8.8%, the specifi city was 82%, and sensitivity was 71%, which were higher than those of APACHE Ⅱ score and IL-6. Conclusions The increase of PMA in patients with sepsis is closely associated with the severity of ARDS. The PMA has correlation with IL-6 and APACHE II, and it is superior to IL-6 and APACH II score for predicting ARDS. PMA can be used as an adjuvant indicator to judge the sepsis severity and to predict the occurrence of ARDS.

Objective To explore the relationship between ultrasonic appearances of epididymal spermatic granuloma and its pathologic characteristics. Methods The sonographic features of 32 cases of epididymal spermatic granuloma confirmed by pathology were retrospectively analyzed. Results A total of 34 epididymal spermatic granuloma nodules in 32 cases included 4 located in caput epididymidis and 30 located in cauda epididymidis,and maximum diameter of nodules were about 0.5-2.3 cm.Sonographic and pathologic appearances of nodules were: ① mostly low echo type,21 nodules mostly showed the obscure boundary and quite abundant blood flow signals,early granulomas formed with interstitial fibrosis inapparently under-microscope; ② inhomogeneous echo type,12 nodules mostly showed the barely clear boundary and blood flow signals from small amount to abundant amount,granulomas of different maturites distributed dispersedly with interstitial fibrosis of varying degrees under-microscope or single giant lesions formed;③mostly high echo type,1 nodule showed the obscure boundary and inapparent blood flow signals, center of the nodules distributed by a large amount of dense fibrous tissue under-microscope. Anechoic ethmoid sinus seen in 29 nodules was section of dilated epididymal ductus.Dotted strong echoes seen in 6 nodules were calcification of sperms in dilated epididymal ductus and necrotic tissue. Conclusions Ultrasonic appearances of epididymal spermatic granuloma are closely related to its pathologic characteristics.To recognize both relations contributes to improve the diagnostic value of ultrasound.

Aim To explore the possibility of the multiple epitope DNA vaccines of hepatitis C virus (HCV). Methods A synthetic multiple epitope antigen gene PCX of HCV was cloned into vector pREP9(RSV promoter) and pcDNA3 (CMV promoter) to construct eukaryotic expression vectors pREP9/PCX and pcDNA3/PCX, then they were used to immunize mice and rabbits, the titer of specific humoral and cellular responses were detected and their safety were observed. Results In mice, specific anti-GZ-PCX antibody(IgG) was lower than 1∶ 1 000 and did not persist well. In rabbits, the highest titer of anti-GZ-PCX IgG reached at 1∶ 3 200 and remained for about one month. Delayed type hypersensitivity reactions (DTH)and proliferation response of peripheral lymphocytes were induced by GZ-PCX antigen. Body weights of immunized mice were normal and no obvious toxic reaction was observed. Conclusion The multiple epitope antigen gene of HCV could induce specific immune responses without obvious toxicity and it might be able to serve as an effective HCV vaccine candidate.

Objective:Numerous miRNAs have been found to be abnormally expressed in hepatocellular carcinoma(HCC).However,clinical significance of miR-5010-3p in HCC is not elucidated.This study aims to explore the prognostic value and role of miR-5010-3p in HCC.Methods:The differential gene expression analysis of miR-5010-3p in HCC was performed based on the Cancer Genome Atlas(TCGA)database.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of miR-5010-3p expression level for HCC prognosis.The Kaplan-Meier,Cox univariate,and Cox multivariate analysis were used to predict its role in the prognosis of HCC.The downstream target genes were predicted.Gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis were performed to predict the potential functional pathways they may participate in.Finally,methyl thiazolyl tetrazolium(MTT)assay and 5-ethyl-2'-deoxyuridine(EDU)incorporation experiment were carried out to prove its effect on proliferation.Results:The expression of miR-5010-3p was associated with histological grade(P=0.019),vascular invasion degree(P=0.049),TP53 level(P=0.004),and alpha fetoprotein(AFP)level(P=0.012).A moderate ability to distinguish between tumor and paracancerous tissues of miR-5010-3p in HCC was perceived by ROC curve(AUC:0.712,95%CI 0.649 to 0.776).High expression of miR-5010-3p was associated with shorter overall survival(OS)(P=0.003).The results of functional enrichment analysis showed that miR-5010-3p was related to the tumorigenesis process.In vitro experiments verified that miR-5010-3p promoted the proliferation of hepatocellular carcinoma cells.Conclusion:MiR-5010-3p promotes the proliferation of liver cancer cells,and its high expression is associated with poor prognosis,which may be a potential prognostic marker.

Objective: To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA) combined with detection of BRAF V600E and thyroid imaging reporting and data system(TI-RADS) in diagnosis of benign and malignant thyroid nodules. Methods: In this study, 123 operative thyroid nodules from 114 patients who underwent US-FNA and detection of BRAF V600E were enrolled. TI-RADS was apply for the classification of each nodule before surgery. Specimens from each nodule were subjected for hematoxylin and eosin (HE) staining and cytological diagnosis and detection of BRAF V600E mutation. Results: ①BRAF V600E mutation was found in 71 (71/123) nodules with histologic confirmation of papillary-thyroid carcinoma, 58 of which were cytologically diagnosed as carcinoma and 13 were indeterminate. Compared with the postoperative pathological results, US-FNA combined with BRAF V600E could improve the sensitivity and accuracy of diagnosis to thyroid nodules compared with individual US-FNA, and the difference was statistically significant(P<0.001). ②The mutation rate of BRAF V600E was associated with thyroid capsular invasion(χ²=8.44, P=0.004), and combined with TI-RADS could indicate the high-risk of this invasion. ③Among 123 operative nodules, 18 nodules were BRAF V600E negative and cytologically diagnosed as indetermination, 10 of which were TI-RADS 3b or above. After thyroidectomy, 6 nodules were confirmed as papillary-thyroid carcinoma, 1 nodule was thyroid follicular carcinoma, and 3 nodules were benign ones. Conclusions US-FNA combined with detection of BRAF V600E and TI-RADS can improve the diagnostic accuracy and decrease the misdiagnosis in indeterminate nodules.

Objective:To analyze the clinical characteristics and risk factors of rheumatic diseases complicated with Pneumomediastinum (PnM).Methods:A retrospective analysis of 94 inpatients with rheumatic diseases associated PnM from Peking Union Medical College Hospital and Shanxi Bethune Hospital between January 1998 and October 2018 was carried out. Patients were divided into idiopathic inflammatory myopathies (IIM) and the non-IIM group. Clinical features, laboratory examinations and treatment were compared between the two groups. Cox proportional hazard model was used to investigate the risk factors for prognosis.Results:A total of 94 patients were included in the study, with an average age of (45±14) years. Forty-five (48%) of them were male. There were 62 patients in the IIM group and the other 32 were in the non-IIM group. Sixty-nine patients had predisposing factors before PnM. Severe cough and assisted mechanical ventilation were the most common causes. Compared with the non-IIM group, the incidence of digital vasculitis (29% vs 6%, χ2=6.540, P=0.008), arthritis (60% vs 28%, χ2=8.409, P=0.004), interstitial lung disease (ILD)(98% vs 78%, χ2=11.129, P=0.002) were higher in the IIM group, treatment with cyclophosphamide was higher in the IIM group ( χ2=4.458, P=0.035). There was non-significant difference in mortality between the two groups during hospitalization (50% vs 59%) and 6 months after PnM (64% vs72%) ( P>0.05). Pulmonary infection was the only risk factor for poor prognosis [ HR=3.131, 95% CI (1.025, 9.561), P=0.045], in which bacteria infection was the most common cause (65/75, 86.7%). Conclusion:PnM is a severe complication of rheumatic diseases. To get a good prognosis, rheumatol-ogists should balance the benefit and risk of infection of immunosuppressive therapy.