Objective To find out the clinical outcomes of twin-twin transfusion syndrome (TTTS) after aminioreduction. Methods Twenty-nine pregnancies with TTTS delivered in Beijing Gynecological and Obstetric Hospital from Nov. 1, 2002 to Sept. 30, 2007 were recruited. The effect of gestational age at the onset, the degree of TTTS and amnioreduction therapy on the fetal outcomes were compared. Results All of the 8 cases with the onset of TTTS before 26 weeks without treat- ment were lost, but 4 out of the 6 with the onset after 26 weeks survived (P=0. 015). Among the 9 cases received amnioreduction, 4 out of the 5 with onset before 26 weeks survived, and significant difference was found compared to those untreated ones (P= 0. 007), but no difference was shown when compared with those developed after 26 weeks(4/4)(P= 1. 000). The average delivery weeks in the untreated ones was earlier than those received treatment E(28.7±4.7)weeks vs (33.2±4.9) weeks, P=0. 001]. Amnioreduction improved the umbilical cord blood flow. For severe TTTS(stage Ⅲ～Ⅳ) with the onset before 26 weeks, the survival rate after amnioreduction was significantly high- er than those untreated ones[4/5 vs 0/5, P=0. 048)]. Conclusions Aminioreduetion is effective in improving the cord blood flow, prolonging the pregnancies, and achieving a higher fetal survival rate.

Objective To explore the value of magnetic resonance cholangiopancreatography (MRCP) and MRI in the diagnosis and differential diagnosis of periampullary carcinoma. Methods Plain and dynamic multi-phase enhanced MRI data of 54 patients with periampullary carcinoma proved by pathology were retrospectively analysed. χ~2 test and two independent samples t test were used to examine the relative results. The results of MRI were compared with that of pathology. Results Of 32 cases with carcinoma of head of pancreas, 7 cases (21.9%) exhibited "four-duct sign". 16 cases were carcinomas of the lower part of common bile ducts, 9 cases (56.3%) showed "three-duct sign". The difference between carcinomas of head of pancreas and carcinomas of the lower part of common bile ducts was significant (P<0.05). Additionally, the ratio of the largest area of masses and the diameter of com-mon bile duct in pancreatic cancer tumors was larger than that in common bile duct cancer (P<0.05) for whether the intraoperative or MRI measurement. Conclusion MRI and MRCP are very helpful in diagnosis of periampullary carcinoma.

BACKGROUND:Knee joint function limitation often occurs after internal fixation of complex femoral condyle fractures, but the mechanism and its influencing factors are also unclear.
OBJECTIVE:To screen and analyze the relevant factors of knee joint function limitation after internal fixation of complex femoral condyle fractures.
METHODS:We retrospectively summarized postoperative fol ow-up data of 6 and 12 months from 121 patients with complex femoral condyle fractures. Knee joint function recovery was evaluated according to Merchan criteria. A multiple stepwise regression analysis was carried out in terms of gender, age, causes, concomitant injuries, skin and soft tissue injury, fracture type, fixed method, operation time, postoperative plaster fixed situation, healing of postoperative incision, bone healing and postoperative functional exercises, to summarize the relevant influencing factors for knee joint function limitation.
RESULTS AND CONCLUSION:Whether the knee joint function after internal fixation was limited acted as the dependent variable Y, and factors with statistical significance of the single factor analysis served as the independent variable X. We used the multiple stepwise regression analysis for multiple factors analysis. Results showed that the gender of patients (X1), with or without concomitant injuries (X3), soft tissue damage (X4) and operation time (X6), a total of four factors, could not be introduced into the model, suggesting that these four factors had no significant correlation with postoperative knee joint function limitation. Another eight factors could be introduced into the factor analysis model, showing that the cause of injury (X2), fracture type (X5), the choice of internal fixation (X7), with or without bone graft (X8), with or without postoperative plaster cast (X9), postoperative knee joint functional exercise or not (X10) and postoperative wound healing (X11), the degree of postoperative bone healing (X12) are closely related to postoperative knee joint function limitation in complex femoral condyles fractures.

Objective To discuss protein marks expressed differentially in placenta of Down's syndrome by means of proteomics. Methods We collected placenta of 18 patients(from March 2009 to December 2009 at Beijing Obstetrics and Gynecology Hospital), and divided them into two groups, one was 10 patients with fetal Down's syndrome, the other was normal pregnancies (normal chromosome) with other diseases. We separated proteins expressed in placentas of two groups by two-dimensional difference gel electrophoresis (2D-DIGE), and then analyzed the differential protein spots by software Decyder 6. 5, then,spots differentially expressed by 1.5 fold or more were analyzed by matrix assisted laser desorption ionizationtime of flight-mass spectrometry (MALDI-TOF-MS). In the end, the differential expressional levels of partially identified proteins were validated by western blot analysis. Results (1) Differential proteins of two groups protein spots of placentas separated by 2D-DIGE were analyzed by software Decyder 6. 5 (these colored lights scattered in the image were protein spots), a total of 56 spots out of 352 were differentially expressed (P<0. 05) in two groups. We analyzed 17 protein spots(12 protein spots were over-expressed and 5 protein spots were down-expressed) differentially expressed by 1.5 fold or more by MALDI-TOF-MS.(2) Protein matching after searching protein database, 17 protein spots turn out to be 10 proteins. Four kinds [superoxide dismutase 1 (SOD1), peroxiredoxin 6 (PRDX6), heat shock protein 27 (HSP27),endoplasmic reticulum protein 29 (ERP29)] of them were validated by western blot analysis, the group of fetal Down's syndrome were 0.74 ±0. 12,0.29 ±0. 10,0.53 ±0. 16,0.20 ±0. 09,the group of normal pregnancies were 0. 51 ±0. 08,0. 34 ± 0. 16,0. 18 ± 0. 07,0. 35 ± 0. 09, the results confirmed the observed changes in proteomics. Conclusions Compared with normal pregnancies, there were differential proteins expressed in placenta of Down's syndrome. This approach might provide new screening markers in use for prediction of Down's syndrome, however, further study should be done to make these 4 proteins (SOD1,HSP27, ERP29, PRDX6) be new screening markers.

Objective To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Methods Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups; the favorable pregnancy outcome group (control, n=101)and the adverse pregnancy outcome group (n=35).The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed.Results (1)General clinical information; more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs.57.1 %,P< 0.05).No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI),proportion of women who had regular antenatal checks(P > 0.05).(2) Pregnant outcomes; the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 ± 8.2) days vs.(6.8 ±10.0) days, P > 0.05].The main complications in the adverse outcome group included placental abruption (n=13), heart failure and pulmonary edema (n=10),hemolysis, elevated liver enzymes and low platelet syndrome (HELIP syndrome, n=5),and no eclampsia was reported.However, none of these complications was reported from the control group.(3)Blood pressure and proteinuria; the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 ± 3.4) weeks vs.(33.0 ± 4.9) weeks, (32.1 ± 3.0) weeks vs.(34.0 ± 3.6) weeks, P< 0.05],the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+ + +)were also much higher in the adverse outcome group (all P<0.05).(4) Hemodynamics and routine blood tests; the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P< 0.05 ).But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P >0.05).The adverse outcome group showed lower platelet(PLT) level and higher red blood cell(RBC) count and hematocrit compared with those of the control(all P<0.01).(5)Liver and renal function; the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH),blood urea nitrogen(BUN) in the adverse outcome group were significantly higher than those of the control group (all P<0.05), but the plasma level of total protein (TP),albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups(P>0.05).(6) Risk factor analysis: RBC count (OR =3.68, 95% CI: 1.90-7.13 ),PLT count (OR=0.99,95% CI:0.98-1.00) and the gestations at delivery (OR=0.87, 95% CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.Conclusion Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.

Objective To evaluate the effect of cesarean section (CS) and vaginal delivery (VD) on postpartum stress urinary incontinence (SUI) and pelvic floor muscles strength and to find out the correlated obstetric factors and preventions for postpartum SUI. Methods Totally, 788 women, who visited the antenatal clinics, delivered and had the follow-up at 6-8 weeks after delivery in Beijing Obstetrics and Gynecology Hospital in the year of 2008, were enrolled in this study and were divided into 3 groups: CS group (n=212); normal vaginal delivery (NVD) group (n=534) and forceps delivery (FD) group(n=42). Women in the NVD and FD group were merged into one VD group and then divided into SUI and non-SUI group. Information of delivery mode and the correlated obstetric factors were obtained through questionnaires and medical records. Femiscan pelvic floor muscle examine system was applied to measure the pelvic floor muscle strength to understand the relationship between postpartum SUI and pelvic floor muscle strength. Results (1) Incidence of SUI: The overall proportion of women who complained of urinary incontinence (UI) during pregnancy was 15.4% (121/788), and it was 15.9% (85/534), 11.9%(5/ 42) and 14.6% (31/212) in the NVD, FD and CS group, respectively(P>0.05). The overall incidence of postpartum SUI was 17. 1% (135/788), and it was 19.1% (102/534), 26.2% (11/42) and 10.4% (22/212) in the NVD, FD and CS group, respectively, with significant difference between the NVD and FD group, and between the CS and NVD group (all P < 0.01). (2) The associated obstetric factors of postpartum SUI: Among the VD group, 113 women were in the postpartum SUI group and 463 in the non-SUI group. Univariate analysis and logistic multivariate analysis showed that delivery mode, neonatal birth weight and UI during pregnancy were risk factors of postpartum SUI. CS decreased and higher neonatal birth weight and UI during pregnancy increased the risk of postpartum SUI. In the VD group, neonatal birth weight, forceps delivery and UI during pregnancy increased the incidence of postpartum SUI(P<0.01), but no correlation was found with labor analgesia, duration of labor, episiotomy, breast feeding, volume of postpartum bleeding, gestational weeks at delivery, induction and pre-pregnant BMI, etc (all P>0.05).(3) Pelvic floor electromyogram: Pelvic floor muscles strength in the CS group was significantly higher than that of the VD group [activity value: (19. 7±9.9) μv vs (14. 8±8.4) μv; work value: (84. 5±37.2) μv vs (78. 8±28.2) μv; peak value: (25.5±12. 5) μv vs (19. 7±11.8) μv, all P<0.01]. Among women in the VD group, the relaxation value and the ratio of relaxation value over activity value (r/a) in the postpartum SUI group were significantly lower than those in the non-SUI group [relaxation value: (1.7±1.8) μv vs (3.0±3.9) μv; r/a ratio: 0. 2±0. 2 vs 0. 3±0. 5, all P <0.01]. The r/a ratio in the VD group showed no difference compared to that in the CS group (0. 2±3.5 vs 0. 2±0. 2, P>0.05).Conclusion Women experienced vaginal delivery, either NVD or FD, have a higher incidence of postpartum SUI than those delivered through CS. UI during pregnancy, forceps delivery and neonatal birth weight are risk factors of postpartum SUI.

Objective To explore the role of cytokines on the pathogenesis of hypoxic-ischemic en-cephalopathy (HIE). Method The levels of peripheral blood interleukin (IL)-6, IL-8, tumor necrosis factor-alpha (TNF-α) in 40 HIE and 40 healthy neonates were detected at the 1st, 3rd and 7th day after birth by using radioimmunoassay. Results Compared with healthy neonates, at the 1 st, 3rd after birth, the level of peripheral blood IL-6 was decreased [(52.3±24.5)ng/L vs (80.1±28.6)ng/L and (56.9±28.5) ng/L vs (78.6±28.9)ng/L, respoctively], but IL-15 and TNF-α were increased [IL-8:(0.68±0.23)ng/L vs (0.47±0.13)ng/L and (0.63±0.22)ng/L vs (0.40±0.16)ng/L, TNF-α: (1.17±0.30)ng/L vs (0.91± 0.30) ng/L and (1.14±0.29)ng/L vs (0.96±0.34)ng/L]in HIE infants. Conclusion The changes of plas-ma levels of IL-6, IL-8 and TNF-α in neonatal HIE possibly play an important role in the pathophysiologic mechanisms of HIE.

Hypoxia environment plays an important role in the pathogenesis of multiple myeloma such as stimulating angiogenesis,increasing bone destructiong,epithelial-mesenchymal transition and drug resis-tance.Thus,there are many therapeutic strategies targeting the hypoxic environment of multiple myeloma,such as hypoxia-activated prodrug and molecular targeting inhibitors.Targeting the hypoxic environment is a promis-ing therapy for multiple myeloma in the future.

Objective To investigate the incidence and pregnancy outcomes of premature rupture of membranes (PROM) in pregnant women in Beijing.Methods A retrospective multicenter study of 18 534 cases delivered in Beijing Obstetrics and Gynecology Hospital,Beijing Friendship Hospital,Daxing MCH Hospital and Tongzhou MCH Hospital from January 2011 to December 2011,was conducted.Results Among 18 534 cases,PROM occurred in 4 504 cases (24.30％),including 3 910 cases of in term PROM (21.10％) and 594 cases of preterm PROM (3.20％).The incidence of premature delivery was 6.17％ (1 144/18 534),and among 1 144 cases of premature delivery 547 cases were PROM (47.81％);the incidence of PROM was 22.75％ (3 957/17 390) in term delivery.The overall cesarean section (CS) rate was 48.50％ (8 989/18 534) and that in pregnant women with PROM was 35.55％ (1 601/4 504),but the CS rate in pregnant women without PROM was 52.66％ (7 388/14 030).The rate of postpartum hemorrhage was 13.12％ (210/1 601)in CS cases and 4.17％ (121/2 903) in vaginal delivery cases (x2 =121.361,P=0.000).The mean hospital stay for PROM was (5.3±2.9) d in CS cases and (4.3±2.3) d in vaginal delivery cases (t =-12.136,P =0.000).Conclusions Without severe maternal or fetal complications,the incidence of PROM is relatively high in Beijing region and PROM may not increase the maternal or fetal complications.Vaginal delivery is the main mode of delivery for PROM.Cesarean section may not cause less neonatal complications,but may lead to more postpartum hemorrhage and longer hospital stay.

Objective To study the biocompatibility of carboxymethyl chitosan (CMCS) membrane with melanocytes from healthy human skin,and to investigate the feasibility to transport and carry melanocytes by using CMCS membrane.Methods CMCS membrane was prepared by a casting method combined with a glutaraldehydebased cross-linking method.Melanocytes were isolated from the foreskin of healthy men,and subjected to primary culture and subculture.The third-passage melanocytes were classified into two groups to be cultured on the CMCS membrane (test group) or traditional culture plates (control group).Methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferative activity of melanocytes,and a sodium hydroxide-based lysis method to determine melanin content.HMB45 staining was conducted,and tyrosinase activity was estimated for melanocytes.Results Inverted microscopy showed that melanocytes were evenly distributed on the CMCS membrane with a normal shape.The melanocytes adherent to the CMCS membrane stained positive for anti-HMB45 monoclonal antibody.The growth curve of the melanocytes on the CMCS membrane,which was obtained from MTT assay,demonstrated that CMCS membrane could support the normal growth of melanocytes.No significant difference was observed between the test group and control group in melanin content (0.083 ± 0.015 vs.0.066 ± 0.008,t =2.38,P ＞ 0.01) or tyrosinase activity (0.234 ± 0.083 vs.0.241 ± 0.061,t =0.23,P ＞ 0.05).Conclusion CMCS membrane can maintain the normal biological activity of melanocytes and have good biocompatibility with skin melanocytes.