Purpose To study the clinicopathologic feature, classification, benign or malignant histological features and differential diagnosis of extra-adrenal paraganglioma.Methods We performed a retrospective analysis of 21 cases of extra-adrenal (sympathetic and parasympathetic) paraganglioma. Histological, immunohistochemical findings, and follow-up data were reported with review of the relative literatures.Results There were 10 male and 11 female patients aged from 9 to 81 years (mean 46.5 years).Ten tumors occurred in the retroperitoneum, seven in the neck, and one case in the mediastinum, urinary bladder, spermatic cord and kidney, respectively.There were 3 cases of functional and 18 cases of non-functional paragangliomas.Histologically, the tumor was composed of chief cells and sustentacular cells. The chief cells were arranged in nests, alveolAR~-like and stereo-like structures.They were surrounded by sustentacular cells partly or completely.There was one malignant case, in which tumor cells had significant cell atypia and nuclear mitosis, and focal or diffuse necrosis, regional lymph node metastasis and blood vessel involvement were also observed.Immunohistochemical investigations revealed chief cells were intensely positive for neuroendocrine markers such as NSE, CgA, Syn and NF, but negative for CK, EMA and SMA.Sustentacular cells were positive for S-100 protein.The malignant cells were only positive for NSE and weakly positive for CgA.Eighteen cases were followed up.One patient developed to multi-organ metastasis and died.One patient was diagnosed as benign extra-adrenal paraganglioma that recurred and involved adjacent organs after 3 years.Conclusions It is generally considered that malignant potential, local invasiveness and distant metastasis are not correlated with the histological appearances of the extra-adrenal paraganglioma.So,further follow-up will be needed. It is necessary to emphasize the differential diagnoses of extra-adrenal paraganglioma from other pleiomorphic tumors.

Objective To investigate the role of muhiplex ligation-dependent probe amplification(MLPA) in identifying fetal aneuploidy of chromosomes 13,18,21,X,and Y. Methods From June 2007 to December 2008,263 samples(prenatal diagnosis group),including amniotic or umbilical cord blood from pregnant women who required prenatal diagnosis,were processed in parallel by MLPA and conventional karyotype to detect fetal aneuploidy.Another 26 samples(fetal death group).ineluding retained abortion and fetal death,were also processed bv MLPA. Results Five cases of 21-trisomy,4 eases of 18-trisomy,1 case of 13-trisomy and 3 cases of 45,X were identified among the prenatal diagnosis group by MLPA,and the results were consistent with karyotype.Two cases of 45,X and 1 case of 18-trisomy were identified among the retained abortion and fetal death group. Conclusions MLPA is a rapid,efficient,simple,reliable and economical technique in detecting most common chromosomal aneuploidies and have important clinical value.

Objective To evaluate the efficacy and reliability of intraoperative microvascular Doppler uhrasonography (IMDU)in urgent clipping surgery of ruptured aneurysms,and assess the impact of this method on the surgical procedure itself.Methods For 62 patients who underwent urgent clipping surgery for the treatment of ruptured aneurysms,both blood flow velocities in the aneurismal sac and in the adjacent vessels and alterations of the Doppler spectrum were determined by IMDU before and after aneurysm clipping.The findings of IMDU were analysed and compared with those of visual inspection of the surgical site and postoperative angiography. Results A relevant stenosis of an adjacent vessel induced by efip position that had escaped detection by visual inspection was identified by IMDU in 12 out of 62 patients.In addition, IMDU demonstrated a primarily incomplete clipping aneurysm in 4 out of 62 patients.The clipping aneurysm was repositioned on the basis of the IMDU findings in 16 out of 62 patients.The findings from IMDU equated with those from angiography in 38 eases.Conclusion IMDU is a safe,instantaneous,effective and reliable technique for the urgent dipping surgery of raptured aneurysms.

ObjectiveTo investigate the influence of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on lipid variations of first and third trimester.MethodsA retrospective analysis was conducted on 2 593 singleton pregnant women without diabetes from 15 hospitals in Beijing from June 20 to November 30 in 2013. Serum lipid levels were determined in all of these women at the first trimester (<14 weeks) and the third trimester (≥28 weeks). Demographic data and medical information were collected individually through questionnaires. The recruited gravidas were divided into normal pre-pregnant BMI group (BMI<25) and pre-pregnant overweight and obese group (BMI≥25) according to recommendations of the Institute of Medicine (IOM). Based on the same recommendations on normal GWG, the pregnant women in the two groups were further assigned to two subgroups including normal GWG and over GWG group. The serum lipid levels in both first and third trimester and the increases from first to third trimester were compared between the normal and abnormal BMI groups with two independent samplet-test.Results(1) The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) in the third trimester were all significantly higher than those in the first trimester in the normal BMI group [(6.47±1.17) vs (4.63±0.80), (3.14±1.19) vs (1.22±0.70), (1.94±0.44) vs (1.85±0.49) and (3.56±1.00) vs (2.29±0.67) mmol/L,t=-61.250,-65.909,-6.448 and-49.952, allP<0.01]. And the same results were shown in the abnormal BMI group [(6.20±1.14) vs (4.75±0.88), (3.31±1.20) vs (1.44±0.70), (1.86±0.44) vs (1.65±0.37) and (3.30±0.89) vs (2.51±0.82) mmol/L, t=-18.756,-25.165,-6.905 and-12.191,allP<0.01]. Significant differences were identified between the normal and abnormal pre-pregnant BMI groups both in first and third trimester (allP<0.05). (2) The increases of TC from early to late pregnancy in the abnormal BMI group was lower than that in the normal BMI group [(1.45±1.01) vs (1.84±1.02) mmol/L,t=6.664,P<0.01], but the increase of HDL-C was higher [(0.21±0.39) vs (0.09±0.51) mmol/L,t=-4.301,P<0.01]. (3) In the normal BMI group, the increase of TC and HDL-C between the third and the first trimester was lower in the over GWG subgroups than in the normal GWG subgroups [(1.77±0.96) vs (1.89±1.05) mmo/L,t=-2.802,P=0.005; (0.06±0.41) vs (0.12±0.58) mmo/L,t=-2.588,P=0.010], but the increase of TG was higher [(2.00±1.07) vs (1.86± 1.18) mmo/L,t=3.015,P=0.003]. While in the abnormal BMI group, smaller increase of HDL-C was found in the over GWG subgroup than in the normal GWG subgroup [(0.17±0.35) vs (0.29±0.44) mmo/L,t=-2.664, P=0.008].ConclusionsThe lipid levels during pregnancy are significantly higher in late pregnancy than in early pregnancy. Pre-pregnancy BMI has much more effect on lipid variations during pregnancy than GWG, which primarily affect the lipid levels of women with normal pre-pregnancy BMI.

Objective To evaluate the impact of three to four cycles of neoadjuvant chemotherapy (NACT) on the survival of patients with N2-N3 nasopharyngeal carcinoma (NPC).Methods The clinical data of 915 patients with T1-4N2-3M0 NPC from 2007 to 2010 were retrospectively analyzed.A total of 179 patients treated with 3-4 cycles of NACT (NACT≥3 group) were matched with 358 patients treated with 2 cycles of NACT (NACT=2 group) and 179 patients treated without NACT (NACT =0 group,concurrent chemoradiotherapy group) for age,N stage,pathological subtype,and NACT regimen.The Kaplan-Meier method was used to calculate overall survival (OS),disease-free survival (DFS),recurrence-free survival (RFS),and distant metastasis-free survival (DMFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox proportional hazards model was used for multivariate prognostic analysis.Results For the NACT≥ 3,NACT =2,and NACT =0 groups,the 5-year OS rates were 89.4％,81.6％,and 73.7％,respectively (P=O.000),the 5-year DFS rates were 83.2％,69.8％,and 64.2％,respectively (P=O.000),the 5-year RFS rates were 86.0％,76.0％,and 69.3％,respectively (P=0.001),and the 5-year DMFS rates were 86.6％,76.0％,and 68.3％,respectively (P=0.000).Three to four cycles of NACT was an independent protective factor for OS,DFS,RFS,and DMFS in patients with N2-N3 NPC.Conclusion Three to four cycles of NACT can significantly improve the survival of patients with N2-N3 NPC.

Objective To investigate the incidence of gestational diabetes mellitus (GDM) and perinatal outcome in Beijing in 2013. Methods Fifteen hospitals in Beijing were selected by systematic and cluster sampling method. Clinical data of 15 194 pregnant women who attended prenatal care and delivered in these hospitals between June 20 and November 30, 2013 were collected. And 2 987 pregnant women were diagnosed with GDM (GDM group), and 11 999 had no diabetes (non-GDM group). The incidence of GDM, perinatal outcome and complications in mother and infant were compared between the two groups. Two independent samples t-test and Chi-square test were used for statistical analysis. Results The incidence of GDM in Beijing was 19.7%(2 987/15 194). The average age was much higher in GDM group than in non-GDM group [(29.4±4.5) vs (28.0±4.2) years, t=285.705, P<0.05]. The pre-pregnancy weight was much higher in GDM group than in non-GDM group [(59.5±10.2) vs (56.1±8.6) kg, t=352.565, P<0.05]. The incidence of GDM in pre-pregnancy overweight and obese women [29.9%(664/2 230) and 38.8%(250/664)] was much higher than in normal pre-pregnancy weight and low pre-pregnancy weight women [18.0%(1 777/9 890) and 12.9%(273/2 118)] (χ2=296.843, P<0.05). The incidence of GDM in pluripara was higher than in primipara [21.2% (910/4 298) vs 19.4%(2 077/10 688),χ2=5.813, P<0.05]. The incidence of GDM in gradeⅢhospitals was higher than in grade Ⅱ hospitals [21.1% (1 654/7 849) vs 18.7% (1 333/7 173), χ2=13.440, P<0.05]; and the incidence in urban areas was higher than in rural areas [21.3%(2 028/9 521) vs 17.1%(896/5 249),χ2=39.137, P<0.05]. The rate of cesarean section was 47.1%(1 407/2 987) in GDM group, significantly higher than in non-GDM group [39.8% (4 782/11 999)] (χ2=72.204, P<0.05). The incidences of preterm labor [7.3%(217/2 987)], hypertensive disorders [6.3%(185/2 987)], large-for-gestational-age infants [9.2%(275/2 987)], macrosomia [9.5%(283/2 987)] and neonatal ward admission [8.6%(258/2 987)] were all significantly higher in GDM group than in non-GDM group [5.7%(686/11 999), 3.9%(454/11 999), 5.8%(694/11 999), 7.2%(861/11 999), and 6.5%(778/11 999), respectively] (χ2=10.117, 34.371, 79.378, 20.346 and 17.236, respectively, all P<0.05). Conclusions The incidence of GDM is still high in Beijing, and advanced maternal age and pre-pregnancy overweight or obesity are high risk factors for GDM. The rate of preterm labor, hypertensive disorders, and macrosomia in GDM group is higher than in normal fasting glucose group. Systematic obstetric care for GDM should be intensified in Beijing.

This study was aimed to compare the effects of acupuncture stimulation on different acupoints, which included LR14-Qimen, ST25-Tianshu, GB34-Yanglingquanand CO11-pancreas and gallbladder (auricular vagus nerve intensively distributed areas) on gallbladder pressure and Oddi sphincter function of guinea pig, in order to discuss acupuncture effect on different acupoints in the regulation of motor function of extrahepatic biliary system. A total of 20 adult guinea pigs of both sexes were randomly divided into two groups, with 10 in each group. The detection was made on changes of Oddi sphincter electromyography and gallbladder pressure before and after acupuncture. A double-hook electrode was implanted into the Oddi sphincter for the detection of Oddi sphincter electromyography. And one small artificial balloon was put into the gallbladder to measure the intrabiliary pressure. After the guinea pig was anesthetized, changes of gallbladder pressure as well as the electromyography frequency and amplitude index of Oddi sphincter of the normal guinea pig were recorded. When the guinea pig was stabilized, acupuncture was given on LR14, ST25, GB34 and CO11 for 1 min. Observations were made on acupuncture effects of gallbladder pressure and Oddi sphincter function of guinea pig. The results showed that after acupuncture on LR14 and ST25, the electromyography frequency of Oddi sphincter was obviously increased compared with before acupuncture (frequency:P < 0.01, amplitude:P < 0.05); the gallbladder pressure was obviously decreased (P < 0.05). After acupuncture on CO11 and GB34, the electromyography frequency and amplitude index of Oddi sphincter were obviously decreased compared with before acupuncture (P < 0.05); the gallbladder pressure was obviously increased (P < 0.01). It was concluded that acupuncture on LR14 and ST25 can obviously inhibit the movement of gallbladder and promote the myoelectricity release of Oddi sphincter. Acupuncturing on CO11 and GB34 can apparently promote the shrinking movement of gallbladder and inhibit the myoelectricity release of Oddi sphincter.

Objective To evaluate the clinical value of the real-time three-dimensional ultrasound in the diagnosis of the fistula-in-ano.Methods One hundred and eighteen fistula-in-ano patients were examined using conventional and three-dimensional ultrasound,the stereotaxis of interal opening and the shape of the fistula-in-ano were analyzed.Then the diagnosis results of ultrasound were compared with the surgery and pathology.Results In 1 1 8 patients,the accuracy of preoperative identifying internal opening by two-dimensional ultrasound was 85%,and 95% for three-dimensional ultrasound with statistically significant difference (χ2 =6.679,P <0.05).For complex anal fistula,the diagnostic accuracy rates of main fistula tract by three-dimensional ultrasound (100%,82/82 )was higher than that by two-dimensional ultrasound(95%,78/82),the difference was statistically significant (χ2 =4.100,P <0.05 ).In 82 cases of complex anal fistula,the diagnostic accuracy of branch fistula tract by two-dimensional ultrasound was 70%(57/82 ),the accuracy using three-dimensional ultrasound was 89% (73/82 ),there was statistically significance (χ2 =9.499,P < 0.05 ).Conclusions Three-dimensional ultrasound can accurately locate the interal opening of fistula-in-ano and determine the shape of fistula-in-ano,which provided the most intuitive information for clinical treatment and had high practical value.

Objective:To identify the epitope of mAb15A11 which is specific against RA associated autoantigen cartilage oligomeric matrix protein ( COMP ).Methods: A filamentous phage library displaying random linear dodecapeptides was used to mapping the epitope of mAb15A11.After three rounds of screenings,40 phage clones were selected at random and sequenced.The specificity of phages was confirmed by enzyme immunoassays.Homology search by ClustalW2 and structure analysis by PyMol to identified the epitope amino acid sequence.Western blot analysis of COMP and ELISA analysis of COMP-derived peptides were used to confirm epitope′s characterization.Results: After repeated screenings using bio-panning method, 2 clones were identified, which interacted specifically with mAb 15A11.Homology search did not find succession consensus sequence within COMP molecular,which indicated that the epitope was not linear.PyMol Structure analysis identified the rationality of conformational epitope.Western blot analysis and ELISA of EDTA-treated COMP further prove an conformational structure of the epitope recognized by mAb 15A11.ELISA analysis of COMP-derived peptides demonstrated both disulfide bonds between 229 C-243 C and 237 C-253 C and every epitope amino acid of 232 G,238 H,240 H,241 A,244 V,247 R and 251 R were essential to the binding of mAb 15A11 with COMP.Conclusion: In this study, the potential B cell antigentic epitopes of mAb 15A11 was identified by phage display library.The epitope amino acids sequence and char-acterization were also recognized.It may have important theoretical value for the study of reaction mechanism of COMP antibody and antigen and may also show application significance in the detection of rheumatoid arthritis.

Objective To understand the current development situation and the existing problems and deficiencies of the exercise cardiopulmonary rehabilitation development in Level 2 and above the general hospitals in Chongqing, and to analyze and find out the factors restricting the development of cardiopul-monary rehabilitation in Chongqing, and put forward suggestions for reform and development. Methods Through literature research, field visits and questionnaire survey, the condition of 115 Level Two compre-hensive hospital's rehabilitation and exercise cardiopulmonary rehabilitation development in Chongqing was understood. Among them, 500 questionnaires were sent to 6 hospitals concerned with cardiopulmonary rehabilitation service, and 483 questionnaires were received with 351 valid questionnaires. Epidata3.1 and SPSS 13.0 statistical software were used to gather research data. Results The settings rate of 115 secondary general hospital rehabilitation was 41.7％, while only 6 hospitals carried out cardiac rehabilitation and cardio pulmonary rehabilitation. There were few rehabilitation beds, the basic staffing was inadequate and the medical staff ratio was only 2 to 2.6. Besides, there is a severe shortage of full-time health instructors.Conclusion The clinical sports cardiopulmonary rehabilitation in Chongqing is as following: The construc-tion of hospital related policies is lagging behind, the overall development of rehabilitation therapy is unbal-anced, the development is late and the level of operation is low. While the lack of professional health movement means that instructors and medical staff have cognitive impairment, residents have low accep-tance of sports rehabilitation therapy and there are insufficient pathogens, which are the main factors that restrict the development of cardiopulmonary rehabilitation.