Preeclampsia is a leading cause of maternal and infant morbidity and mortality. It is very important to explore the biomarkers for the early prediction of preeclampsia. Some peptides released from placenta, such as soluble Flt-1 and placenta growth factor (PlGF), have been revealed for definite prospects of application. Meanwhile, the recent advances in proteomics, metabolomics and microRNA shed light on searching of new biomarkers for preeclampsia prediction.

Objective To investigate the features of familiar facial palsy,ophthalmoplegia and dysphagia characterized by autosomal dominant inheritance in a family and to discuss the classification and pathogenesis of the disease.Methods Clinical,electrophysiological,pathological examinations were performed and blood samples were obtained from 5 patients and 26 family members.PCR protocol was used to identify a certain gene. Results In the 5 patients receiving physical examination,all had ptosis,external ophthalmoplegia,facial paralysis,dyphagia,hoarseness,decreased pharyngeal reflex;4 had amyotrophy of muscle of tongue,temporal nuscle,masseter and muscles of distal lower limbs;3 had proximal limb asthenia and distal limbs amyotrophy.Compared to those of oculopharyngeal muscular dystrophy(OPMD)with similar symptoms and signs,both electrophysiological manifestation and pathological findings of the family members supported the diagnosis of muscular dystrophy,but the(GCG)6(GCA)3GCG in the first exon of PABPN1 mutated neither in normal family members nor in patients.Conclusions This family presents clinical manifestations somewhat resembling to those of OPMD and distinctive to other disorders,but has a totally different genetic background from OPMD.It may be a new subtype of muscular dystrophy.

The blood-brain barrier (BBB) provides both anatomical and physiological protection for the central nervous system ( CNS), strictly regulating or impeding the entry of many substances and blood-borne cells into the nervous tissue. Three cellular elements of the brain microvasculature compose the BBB-endothelial cells, astrocyte end feet, and perivascular cells (PCs). Tight junctions (TJs) , present between the cerebral endothelial cells, form a diffusion barrier, which is a very important part of BBB. The astrocytes and other cells can release chemical factors that modulate endothelial permeability. Dysfunction of the BBB, for example, impairment of the TJ seal, complicates a number of neurological diseases including stroke, infection, brain tumor, multiple sclerosis and Alzheimer disease. We review here the recent developments in our understanding of the BBB and the role of BBB dysfunction in CNS diseases.

OBJECTIVETo determine the independent prognostic factors of primary synovial sarcoma.

METHODSThe clinical data of 52 patients followed up from 66 patients with synovial sarcoma treated between September 1997 and September 2008 was analyzed retrospectively. There were 28 male and 24 female patients aged from 11 to 71 years old. Three and five-year overall survival (OS), recurrence rate and 9 prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors of OS.

RESULTSFifty-two patients were followed up with the follow-up time ranged from 6 to 88 months (median 32 months). The 3-, 5-year overall survival rate and local recurrence rate were 52.8%, 30.3% and 32.7% respectively. Univariate showed tumor size < 5 cm, tumor located at extremities, adequate surgical margin and radical resection combined with radiotherapy had better survival rate (P < 0.05). Multivariate analysis demonstrated that tumor size, primary site and adequate surgical margin were independent prognostic factors for OS. Patients received radical resection combined with radiotherapy have longer median relapse time (25 months) compared with marginal resection combined with radiotherapy (18 months) and single radical resection (12 months). Thirty-five (67%) patients were treated with chemotherapy and seventeen (33%) patients received no chemotherapy for the primary tumor. Treatment with chemotherapy was not associated with an improved OS (P = 0.52).

CONCLUSIONSThe independent prognostic factors of synovial sarcoma are tumor size, primary site and adequate surgical margin. Doxorubicin and ifosfamide based chemotherapy was not associated with an improved OS in patients with synovial sarcoma. Radical resection combined with radiotherapy can best control local condition.

Adolescent ; Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Child ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Prognosis ; Regression Analysis ; Retrospective Studies ; Sarcoma, Synovial ; diagnosis ; drug therapy ; radiotherapy ; surgery ; Young Adult

Objective To investigate the feasibility and reliability of the measurement of critical anatomic landmarks of endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa using multislice spiral computed tomography (MSCT), and to illustrate the spatial relationship of the surgical landmarks in pterygopalatine fossa and infratemporal fossa through an endoscopic endonasal view and radiological images. Methods Included in this study were eleven fixed cadaver heads (22 pterygopalatine fossa and infratemporal fossa), which were prepared from MSCT scans for establishing a spatial coordinates system to calculate the radiological anatomic data and attaining 3D reconstruction image, and also were anatomically dissected to get anatomic data. The anatomic data in two groups were compared, the endoscopic and radiological images of the same regions acquired during the endoscopic endonasal approaches observed.Results The distance ((-x) ± s) from nasal columella to sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, carotid canal, foramen lacerum in radiological group were:(68.83±3.00), (72.49±2.88), (75.26 ±3.14), (88.55±5.00), (95.19±4.31), (106.76±3.77), (88.16 ±2.87) mm and in anatomic group were: (68.90 ±3.04), (72.73 ±3.08), (75.44 ±3.07), (89.75 ±4.13), (96.22±3.37), (106.68 ±3.75), (88.47 ±2.64) mm. There was no statistical difference between two groups(t value were -0.856, -1.134, -0.920, - 1.923, - 1.903,2.820 and 1.209, respectively, all P > 0.05 ). Sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, foramen lacerum, carotid canal were the corresponding anatomic structures in endoscope and radiology, which provided the surgeons with anatomic landmarks to identify the spatial relationship of the surgical structures in pterygopalatine fossa and infratemporal fossa.Conclusions MSCT measurements of anatomic landmarks are feasible and reliable, can be used in clinical individualized surgery. The corresponding anatomic structures of endoscopic and radiological landmarks provide useful reference to surgeons when operating in these areas through an endoscopic endonasal approach.

Objective To summarize the surgical experiences of treating the frontal sinus cerebrospinal fluid rhinorrhea (FS-CSFR) via combined transfrontal and intranasal endoscopic approaches. Methods We retrospectively analyzed the clinical data of 17 patients with FS-CSFR,received surgery in our hospital from 1996 to 2009, with emphasis on postoperative complications,clinical outcomes and key technology involved in surgery via combined transfrontal and intranasal endoscopic approaches. Results Of the 17 patients, 9 were successfully repaired after 1 surgery via combined transfrontal and intranasal endoscopic approaches; the other 8 were initially treated by endoscopic intranasal approach alone, of which 5 (62.5%) were successful and 3 failed. And then, the 3 patients subsequently underwent the surgery via combined transfrontal and intranasal endoscopic approaches and succeeded. These 12 patients with FS-CSFR, performed surgeries via combined transfrontal and intranasal endoscopic approaches were successfully repaired with quick recovery, mild complications, and no significant facial scars. Follow up was performed for 6 to 10 y and no CSFR recurrence was noted. Conclusion Surgery via combined transfrontal and intranasal endoscopic approaches offers advantages not only in overcoming the difficulty and defects of intranasal endoscopy but also in providing a few traumas and an easy approach, which helps the recovery.

Objective To investigate the therapeutic efficacy of endoscopic optic nerve decompression (EOND) on patients with traumatic optic neuropathy (TON) and their related prognostic factors. Methods The clinical data of 103 eyes with TON,admitted to our hospital from January 1995 to February 2001 (n=53) and from March 2001 to December 2009 (n=50),were retrospectively analyzed; the clinical outcomes of these patients after being performed EOND were observed. Univariate analysis (Chi-square test) and logistic regression were performed to analyze the prognostic factors of TON underwent EOND therapy. Results The total effective rate of 103 eyes was 37.86％ (39/103); the effective rate of eyes with residual vision was 83.3％ (20/24),which was significantly higher than that of those without residual vision (24.05％,19/79,P＜0.05).Univariate analysis and multiple factor logistic regression,respectively,showed that 3 variables significantly increased the risk of the visual acuity:no residual vision, interval from injury to surgery for more than 3 d and ethmoid and/or sphenoid sinus hematocele after injury.Other factors such as age,disturbance of consciousness,optic canal fracture,performing of sheathotomy,hormone level and interval from injury to surgery for more than 7 d were not correlated with the efficacy (P＞0.05).Comparing fractures at different sites and with different severities,the efficacy of surgery was also different. The logistic regression equation is P (1)=1/ [1+e-(-2139+2.839X3+1.372X5+2.263X9)]. Conclusion The total therapeutic efficacy of EOND on patients with TON is not satisfactory, especially for those without light perception. The prognostic factors of TON were very complex and interactive; no light perception, interval from injury to surgery for more than 3 d,hemorrhage within the ethmoid and/or sphenoid sinus and lateral or multiple fracture of optic canal are factors affecting the prognosis of EOND for patients with TON. The indication for EOND must be individualized.

Objective To summarize the clinical experience of treatment of frontal sinus diseases via combined transfrontal and intmnasal endoscopic approaches, and to explore its indications. Methods A retrospective study of 24 patients was conducted. All patients were underwent combined transfrontal and intranasal double approaches because of different kinds of frontal sinus diseases, including 16 cases with frontal sinus cerebrospinal fluid rhinorrhea caused by traumatic comminuted fractures located in posterior wall of frontal sinus, 5 cases with osteoma, 3 cases with inverted papilloma (cancer was confirmed in one case). Results All sixteen cases with frontal sinus cerebrospinal fluid rhinorrhea were cured after the first attempt. All cases with osteoma and inverted papilloma (including the patient with canceration) were resected completely after the first attempt. Postoperative follow-up lasted from 3 to 132 months in frontal sinus cerebrospinal fluid rhinorrhea, 8 -38 months in osteoma, 7 -42 months in inverted papilloma and canceration, the median follow-up period was 36 months. No recurrence was found. Operations were successful in all the patients and frontal sinus outflow tracts were unobstructed. No intraoperative or post-operative complications occurred and no disfigurement was found. Condnsions The potential indications frontal sinus with their lateral boundaries or operative site beyond the plane of the lamina papyracea.

AIMTo study the chemical constituents of the stems and leaves of Aconitum coreanum (Lèvl.) Rapaics.

METHODSThe constituents of Aconitum coreanum were isolated by using various kinds of modern chromatographic methods. The new alkaloid was identified on the basis of spectral analysis.

RESULTSTwo compounds were isolated and identified as: 13-dehydro-1beta-acetyl-2alpha,6beta-dihydroxyhetisine (I) and Guanfu base G (II).

CONCLUSIONCompound I is a new alkaloid.

Aconitum ; chemistry ; Diterpenes ; Heterocyclic Compounds, Bridged-Ring ; chemistry ; isolation & purification ; Molecular Conformation ; Molecular Structure ; Plant Leaves ; chemistry ; Plant Stems ; chemistry ; Plants, Medicinal ; chemistry

BACKGROUNDAs the Shanghai Obstetrical Cardiology Intensive Care Center, our hospital has accumulated a large number of clinical data of pregnant women with heart disease. This paper is a retrospective analysis of 1142 pregnancies in women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.

METHODSA retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.

RESULTSIn this study, main heart diseases in pregnancy were arrhythmia (n = 359, 31.4%), congenital heart disease (CHD; n = 291, 25.5%), and myocarditis and its sequelae (n = 284, 24.9%); based on the functional classification criteria of New York Heart Association (NYHA), more than half (n = 678, 59.4%) of patients were classified NYHA Class I; pregnant women in NHYA Class I-II (n = 951, 83.3%) commonly had arrhythmia, myocarditis and its sequelae, while those in NHYA Class III-IV (n = 191, 16.7%) mainly had CHD, rheumatic heart disease (RHD), cardiopathy induced by hypertensive disorders complicating pregnancy, and peripartum cardiomyopathy (PPCM). Cardiac failure occurred in 97 (8.5%) patients, and 8 (0.7%) maternal deaths and 12 (1.1%) perinatal deaths were reported in this study. Compared with those in NHYA Class I-II, women in NHYA Class III-IV had a significantly lower gestational age at birth (P < 0.05), lower birth weight (P < 0.01), and higher incidence of preterm delivery, small for gestational age and perinatal death (P < 0.01). The incidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM was relatively high, with a rate of 80% and 52.2%, respectively. After cardiac operation, 131 (90.3%) women were in classified NHYA Class I-II and 14 (9.7%) in NHYA Class III-IV.

CONCLUSIONSArrhythmia is the type of heart disease that has a highest incidence in patients with heart disease in pregnancy, while main types of heart disease that impair cardiac function are CHD and RHD; cardiac failure is more frequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM; impaired cardiac function increases perinatal morbidity; cardiac surgery before pregnancy could improve the cardiac function.

Adolescent ; Adult ; Female ; Heart Diseases ; complications ; physiopathology ; surgery ; Hemodynamics ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; surgery ; Pregnancy Outcome ; Retrospective Studies