Objective To evaluate the clinical characteristics of epithelioid trophoblastic tumor (ETT).Methods Six cases of ETT treated in Women's Hospital,School of Medicine,Zhejiang University from 2005 to 2007 were retrospectively analyzed,together with a literature review.Results Six cases of ETT were diagnosed pathologically after surgery.The age of patients ranged from 27 to 46 years.The most common presentation was abnormal vaginal bleeding(5/6).The preceding gestational events were hydatidiform mole in 1 case,abortion in 2 cases,and term delivery in 3 cases.The interval between the preceding gestation and the diagnosis of ETT ranged from 15-48 months.The serum human chorionic gonadotropin(hCG)level was 46-121 147 IU/L.Four cases presented with metastasis,including lung metastasis in all of the 4 cases,liver metastasis in 1 case,and pancreas metastasis in another 1 case.The main therapies were surgery combined with chemotherapy.All of the 6 cases received total abdominal hysterectomy.and 1 case also had lung lobectomy.One ease had a recurrence but refused any treatment again,and was lost to follow up;the therapy of 1 case unfinished;another 4 cases were without evidence of disease 9 to 19 months after surgery.Condusions The confirmation of ETF diagnosis is difficult before surgery.Surgical management is mostly recommended in ETT. The role of chemotherapy in ETT is not clear yet.

Objective To investigate the expression of low molecular mass polypeptide-2 (LMP2)and protein phosphatase 1A (PPM1A) in gestational trophoblastic disease and elucidate their predictive value in malignant transformation of hydatidiform mole. Methods The expressions of LMP2 and PPM1A protein in 196 complete hydatidiform moles (in which 28 cases with malignant transformation) , 7 invasive moles, 5 choriocarcinomas and 20 normal chorionic villus were detected with the method of En Vision immunohistochemistry. Their clinicopathologic data were retrospectively analyzed. Results LMP2 and PPM1A protein expressed in cytotrophocytes, syncytiotrophoblast and extravillous trophoblast. The level of LMP2 expression in deteriorative hydatidiform mole was significantly higher than that in non-deteriorative hydatidiform mole or normal chorionic villus (6. 79 ±2. 38, 5.26 ±2.63 and 3. 10 ±1.65, all P <0. 01),while there were no difference compared with gestational trophoblastic neoplasms (6. 42 ±2. 68, P=0. 113).The level of PPM1A expression was highest in normal chorionic villus, and decreased gradually in hydatidiform mole (non-deteriorative and deteriorative) and gestational trophoblastic neoplasms (6. 30 ±2. 98, 4. 93 ± 2. 50, 4. 43 ± 2. 04 and 3. 33 ± 2. 06, all P < 0. 01); the level of PPM1A expression in deteriorative hydatidiform mole was significantly lower than that in non-deteriorative hydatidiform mole (P=0.001). The expression of LMP2 protein was correlated to theca lutein ovarian cyst, the expression of PPM1A protein was related with uterine size (P < 0. 05) . While, there was no correlation between the expressions of the two proteins (P >0. 05). Conclusions High expression of LMP2 and low expression of PPM1A might play an important role in the motility and invasiveness of trophohlast cells and malignant transformation of hydatidiform mole. Testing the expression of LMP2 and PPM1A in hydatidiform mole tissues of initial uterine evacuation might be have some reference significance in judging outcomes of hydatidiform mole.

Literatures on arrhythmia induced by acute organophosphorous pesticide poisoning published in domestic journals from 1979 to 2010 were searched. Total 3468 cases of acute organophosphorous poisoning were collected and analyzed. The average abnormal ECC rate was (53 ±15)%(35. 4% -68. 4% ) in acute organophosphorous poisoning, the most common ECG abnormalities were ST-T segment changes (26. 5% ) and sinus tachycardia (16. 6% ). The rate and severity of ECG abnormalities were increased with the severity of organophosphorous poisoning(x2 = 33. 253,P < 0. 01). The most common causes of death in acute organophosphorous poisoning were ventricular tachycardia and ventricular fibrillation (26.2%).

At present, there are many effective ways to achieve high performance in cluster system storage management, including server-end disk, server-end caching, local caching and cooperative caching. The cooperative caching mechanism shares caches among different clients so as to avoid expensive disk access costs and to improve overall throughput of cluster system. In this paper, a Single Copy Cooperative Cache model is proposed together with block lookup algorithm, block replacement algorithm and the consistency algorithm based on the model. Meanwhile, the prototype system of the model is implemented in PVFS file system. Finally, the performance of this system is tested in InfiniBand Framework, the result of which shows that in contrast to the original PVFS system, read performance of PVFS file system is improved by about two times, while write performance is reduced by nearly ten percent.

Objective To investigate the relationship between interleukin (IL)-34 and bone erosions in psoriatic arthritis (PsA) patients.Methods Forty PsA patients,20 psoriasis (Ps) patients and 20 healthy volunteers were recruited into this study.The levels of IL-34 and osteoclast related cytokines [including tumor necrosis factor (TNF)-α,receptor activator of nuclear factor-κB ligand (RANKL),osteoclast precursors (OPG)] were detected in the serum samples of all subjects.The correlations among IL-34,the number of osteoclast precursors (OCP),disease activity and imaging scores were analyzed.All data were analyzed by graphpad prism 6.Differences between groups was analyzed with One-way analysis of variance,q tests,and Spearman's correlation was used to explore the relation between disease activity/radiographic scores and laboratory results and followed by linear regressions.Results The serum level of IL-34 in patients with PsA [(328±476) pg/ml] was higher than that in Ps [(33±52) pg/ml,q =3.92,P＜0.01] and healthy controls [(32±32) pg/ml,q =3.93,P＜0.01],the erosive PsA group were higher than the non-erosive PsA group [(449±527) pg/ml and (47±24) pg/ml,q=4.04,P＜0.01].The levels of TNF-α,RANKL and OCP in patients with PsA [(125±79) pg/ml,(488± 475) pg/ml and (17.7±4.8) 5 sigh views] were higher than those in PS [(40±22) pg/ml,(26±3) pg/ml and (5.2± 0.8),q=7.32,6.14 and 2.94,P＜0.01] and healthy controls [(41±19) pg/ml,(65±8) pg/ml and (6.2±1.8),q=6.67,5.62 and 2.71,P＜0.01],whereas the OPG/RANKL ratio in PsA patients (0.5±0.4) was significantly lower than Ps patients (4.3±2.7,q=-3.30,P＜0.01) and healthy controls (1.8±0.6,q=-1.72,P＜0.01).IL-34,TNF-α and RANKL levels were all positively correlated with OCP (r=0.10,P＜0.05;r=0.12,P＜0.05;r=0.13,P＜0.(5,respectively).Conclusion The level of IL-34 is not only high in patients with PsA but also positively correlates with the number of OCP.In PsA,IL-34 is probably related to the OCP and osteoclast differentiation,and further participates in the process of bone destruction.Therefore,IL-34 is promising to become a new target or alternative choice for the treatment of PsA.

ObjectiveTo observe the short-term efficacy of treatment with the diclofenac diethylamine emulge import by pulsed ultrasound, massage therapy and quadriceps muscle strengthen training to the patients with knee osteoarthritis for elderly.MethodsOn the basis of health education, 30 elderly patients with knee osteoarthritis were accepted treatments with 10 times of diclofenac diethylamine emulge import by pulsed ultrasound, 6 times of massage therapy and then they completed quadriceps muscle strengthen training once or twice a day.ResultsThe pain, walking ability, sit-to-stand ability and lower extremities muscle strength improved significantly for the patients after treatments (P<0.05 or P<0.001). ConclusionThe diclofenac diethylamine emulge import by pulsed ultrasound, massage therapy and quadriceps muscle strengthen training have a good short-term efficacy to the elderly patients with knee osteoarthritis.

Objective To evaluate clinical outcomes of treating displaced intra-articular calcaneal fractures with Orthofix external fixation (EF) in comparison with open reduction and internal fixation (ORIF).Methods Between February 2013 and December 2014,39 patients with 41 calcaneal fractures were treated operatively and fully followed up at our department.They were 27 men and 12 women,aged from 27 to 56 years(average,42.5 years).The left foot was affected in 15 cases and the right in 26.By the Sanders classification,there were 11 cases of type Ⅱ,22 ones of type Ⅲ and 8 ones of type Ⅳ.The 5 open fractures were Gustilo type Ⅰ (2 cases) and Gustilo type Ⅱ (3 cases).Of the 11 fractures complicated with soft tissue injury,4 were Tscherne-Oestern type Ⅰ and 7 Tscherne-Oestern type Ⅱ.The patients were divided into group EF (25 cases) and group ORIF (16 cases) according to the operation they had received.The 2 groups were compared in intraoperative indexes and follow-up radiological data.The American Orthopaedic Foot and Ankle Society (AOFAS) scores for ankle and hindfoot were recorded at the final follow-up for every patient.Results The mean duration of surgery,intraoperative bleeding,time for hospitalization and bone healing in group EF were significantly less than in group ORIF (P ＜ 0.05).There were no significant differences between the 2 groups in follow-up duration,AOFAS score,Bthler angle,Gissane angle,calcaneal axis,calcaneal horizontal length,tuberosity height,hillock calcaneal height,calcaneal width,or talar inclination angle (P ＞ 0.05).According to the AOFAS scores at the final follow-ups,15 cases were rated as excellent,8 as good and 2 as fair in group EF while 10 were rated as excellent,5 as good and one as fair in group ORIF.Conclusions All types of calcaneal fracture can be treated using Orthofix external fixation which may lead to advantages of earlier surgery regardless of soft tissue condition,minimal invasiveness with less devascularization to the calcaneus and decreased risk of complications,and good clinical outcomes.

Objective To assess the high risk factors associated with the positive margin of conization in patients with cervical intraepithelial neoplasia (CIN). Methods From January 2000 to February 2008, 1699 consecutive patients with CIN undergoing conization was reviewed retrospectively in order to analyze the relationship between the positive margin of conization with clinical prognostic factors,such as patients age, disease grade, size of lesion, the procedure of excision and menopause. X<'2> tests was used to compare the different frequencies of factors in groups of positive and negative margin conization, then seven factors with positive margin were processed into unconditional logistic regression analysis. Results The rate of the positive margin in 1699 patients was 14.01% (238/1699). The mean age of patients with positive margins was (39±9 ) years old, while patients with negative margins was ( 39±8 ) years old, which didn't reach statistical difference(P>0.05). The rate of the positive margin was 8.63% in cold knife cone (CKC) and 18.66% in loop electrosurgical excision procedure (LEEP), which showed significant difference( P<0.01 ). Among 1699 patients, 90 patients were with CIN Ⅰ ,339 patients were with CIN Ⅱ ,1113 patients were with CIN Ⅲ [ including 972 with severe dysplasia and 141 with cancer in situ(CIS) ],87 patients were with cervical cancer stage Ⅰ al, 70 patients were with stage Ⅰ a2 or advanced stages. The rate of positive margin was 1.11% ( 1/90), 3.83% ( 13/339), 10.70% (104/972), 26.24% (37/141),35. 63% (31/87) and 74.29% (52/70),respectively. There was statistic difference among them, except CIN Ⅰ and CIN Ⅱ . When combined CIN Ⅰ with CIN Ⅱ , then compared with CIN Ⅲ, cervical cancer withⅠ al and Ⅰ a2, it also showed statistical difference (P<0.05 ) . The rate of positive margin in postmenopausal women was 21.54% (28/130), which was significantly higher than 13.38% (210/1569)in premenopausal women (P=0.010 ). The logistic regression analysis showed that the procedure of excision, grade of disease, size of lesion, surface of cervix, and menopause were high risk factors associated with the positive margin, the risk ratio were 5.147, 3.048, 1.271, 1.905 and 1.860, respectively.Conclusions High grade, the extent of CIN disease, LEEP and postmenopausal age are high-risk factors associated with positive margin in patients treated by conization. It should be warranted in those patients when designing conization treatment.

ObjectiveTo explore the effect of osteoclasts and osteoprotegerin/receptor activator of nuclear factor-kappa B ligand (OPG/RANKL) system on bone destruction of psoriatic arthritis.MethodsThe peripheral blood mononuclear cells from 41 psoriatic arthritis (PsA) patients,20 osteoarthritis (OA) patients and 24 healthy controls were cultured to become osteoclasts.After 14 days,cytochemistry method was used to detect tartrate-resistant acid phosphatase (TRAP) expression.At the same time,enzyme-linked immuno sorbent assay(ELISA) was used to measure the levels of serum OPG and RNAKL for all cases.At the same time,the clinical and laboratory examinations of the PsA were collected.Statistical analysis was conducted with one-way ANOVA and Spearman's correlation.ResultsSignificantly higher OC production was observed in the peripheral blood of PsA patients[(17.7±4.8)/view field] than that of the healthy controls[(6.4±1.6)/view field] and OA patients [(6.5±l.6)/view field].The levels of RANKL were significantly higher in PsA patients [(178±38) pg/ml] than those in the other two groups [(32±4) pg/ml and (67±17) pg/ml].There was significant difference between the PsA group with bone destruction and without destruction in the levels of OC and RANKL [(17.6±0.9) /view vs(7.9±1.3) /view and(199±72) pg/ml vs(128±44) pg/ml,P＜0.01].Imaging scores was positively correlated with the levels of OC and RANKL in PsA patients (P＜0.05).ConclusionIn PsA,there are significantly more OC and higher RANKL in the peripheral blood than those of the controls.The high levels of OC and RANKL are closely related with bone destruction.OC and RANKL are useful in identifying bone destruction.

Objective The aim of the study was to observe the features of nail fold microcirculation in systemic sclerosis (SSc) patients and to compare these findings in SSc patients with patients with other connective tissue diseases.Methods Forty patients with SSc and thirty-seven patients with other connective tissue diseases were included in the study and all the patients reported symptoms of Raynaud's phenomenon in the hands were also included.Nail fold capillaroscopy (NFC) was performed and the abnormality of nail fold microcirculation between the two groups were compared.The relations between nail fold capillaroscopic findings and clinicolaboratory parameters in SSc patients were analyzed.Statistical analysis were carried out by t-test and Chi-square.Results The loss of capillaries and dilated and giant capillaries and hemorrhage as well as neoangiogenesis were hallmarks of the scleroderma capillary findings,which could be detected by nail fold capillaroscopy.The abnormalities of nail fold microcirculation in SSc patients were more severe and more specific than those in other connective tissue disease patients.The total scores of nail fold capillaroscopy test were obviously higher in SSc patients with lung or esophagus involvement than those patients without these organ involvement,meanwhile,the total scores of nail fold capillaroscopic findiugs were elevated in SSc patients with anti-Scl70 antibody than those with negative group.Conclusion The nail fold capillaries of patients with SSc have specific abnormalities,and nail fold capill-aroscopy could distinguish between SSc and other connective tissue diseases,therefore it could be used as a promising tool for early detection of patients who may have the potential to develop scleroderma and it is also helpful in assessing disease severity.