Objective:To explore the clinical characteristics of pregnancy complicated by primary Sj?gren's syndrome (pSS) and the related factors of adverse outcomes in pregnant women with pSS.Methods:A retrospective analysis was conducted on the clinical data of 32 pregnancies complicated by pSS treated in the Department of Obstetrics at the Third Affiliated Hospital of Guangzhou Medical University from February 2017 to August 2022. The patients were divided into two groups according to whether they had perinatal adverse outcomes: an adverse outcome group ( n=20) and a favorable outcome group ( n=12). The clinical characteristics of the two groups were compared with two independant sample t-test, Mann-Whitney U test, and Fisher's exact test, and multivariate logistic regression analysis was used to analyze the related factors of adverse outcomes in pregnant women with pSS. Results:(1) The average maternal age of the 32 pSS pregnancies was (32.9±4.6) years, the pre-pregnancy body mass index was (21.1±3.8) kg/m 2, and the median gestational age at delivery was 37.8 (35.4-38.5) weeks. There were 18 women (56.3%, 18/32) were diagnosed before pregnancy and 14 women (43.7%, 14/32) during pregnancy. Out of the 32 pregnancies, 25 (79.1%, 25/32) received therapy with glucocorticoids and/or hydroxychloroquine during pregnancy, whereas seven (21.9%, 7/32) had no medication during pregnancy. (2) The main adverse maternal outcomes included oligohydramnios (25%, 8/32), hypertensive disorder of pregnancy (18.8%, 6/32), preterm birth (18.8%, 6/32), fetal growth restriction (15.6%, 5/32), miscarriage (12.5%, 4/32), gestational diabetes mellitus (9.4%, 3/32), and postpartum hemorrhage (3.1%, 1/32). (3) Adverse neonatal outcomes included low birth weight infants in seven cases (25.0%, 7/28), neonatal asphyxia in seven cases (25.0%, 7/28), and two cases of congenital heart block (7.1%, 2/28). (4) The rate of diagnosis before pregnancy in the favorable outcome group was higher than the adverse outcome group [10/12 vs. 40.0%(8/20), Fisher's exact test, P=0.028]. There were no significant differences between the two groups concerning maternal age, pre-pregnancy BMI, weight gain during pregnancy, parity, rates of positivity for autoantibodies (antinuclear antibody, Sj?gren-specific antibody A, Sj?gren-specific antibody B, anti-Ro-52), and proportion of drug treatment (glucocorticoids, hydroxychloroquine) (all P>0.05). (5) Multivariate logistic regression analysis showed that diagnosis before pregnancy ( OR=0.02, 95% CI: 0.00-0.62, P=0.024) and positive Sj?gren-specific antibody B ( OR=0.01,95% CI: 0.00-0.75, P=0.038) were the protective factors. Conclusions:The clinical manifestations of pSS among pregnant women are varied and atypical,often with insidious onset. For pregnant women with pSS, being diagnosed before pregnancy, positive Sj?gren-specific antibody B may reduce adverse outcomes. It is important to address pre-pregnancy examination, early diagnosis and timely intervention to reduce the occurrence of adverse outcomes in pregnant women with pSS.

Objective:To investigate the clinical effect of the transverse rectus abdominismuscle (TRAM) on reconstruction of the breast.Methods:The clinical data of 23 patients receiving TRAM breast reconstruction in our department from Jan. 2018 to Dec. 2019 were retrospectively analyzed.Results:The operation time of 23 patients ranged from 240 to 360 mins, andthe average time was about 300 mins. Intraoperative bleeding was about 120 to 200 ml, with an average of 170 ml. All the flaps survived successfully, but 2 cases were complicated with local fat necrosis. The postoperative period was between 6 and 12 months. No local tumor recurrence or metastasis was found inall patients during postoperative follow-up, and the breast shape was maintained in good condition.Conclusion:TRAM can make up for the regret of breast loss caused by breast cancer in female patients. It can bring confidence in life and work to female patients, and the technology is safe and reliable, which is worthy of promotion.

Objective:To investigate the diagnosis and management of partial or complete hydatidiform mole with coexistent intrauterine pregnancy.Methods:Clinical data of 10 cases of hydatidiform mole with coexistent intrauterine pregnancy admitted to the Third Affiliated Hospital of Guangzhou Medical University, from September 2009 to May 2019 were retrospectively described.Results:(1) During the same period, 65 960 women were delivered at our hospital, and hydatidiform mole with coexistent intrauterine pregnancy was accounted for 1/6 596, among which complete hydatidiform mole and coexisting fetus (CHMCF) and partial hydatidiform mole and coexistent fetus (PHMCF) were found in four and six cases, respectively. The mean age of the ten patients were (30.9±4.1) years old, ranging from 26 to 35 years old, with 2.5 (1-4) times of pregnancies. Nine cases were identified at 22 +3 (12 +3-32 +3) gestational weeks and one at 9 + weeks. (2) Recurrent vaginal bleeding during pregnancy occurred in six cases, nausea and vomiting in three cases, and hyperthyroidism in mid- and late pregnancy in two cases. One patient developed preeclampsia and one case of severe mitral regurgitation with mild pulmonary hypertension. (3) In the 10 patients, the summit serum β -hCG level was 139 935 (16 990-546 033) U/L, and CHMCF and PHMCF patients were 212 500 (200 000-546 033) U/L and 60 768 (16 990-225 000) U/L, respectively. (4) The ultrasound results revealed a dark honeycomb area of the placenta in five cases, placental thickening in two cases, and vesicular placenta in one case. One case was found with bilateral giant luteinized ovarian cyst by ultrasound, multiple metastases in the left lower lobe of the lung by chest CT, multiple nodules in the pleural wall of the left lung by lung MRI, and CHMCF by pelvic MRI. In one case, ultrasound at 14 weeks of gestation showed interrupted fetal abdominal wall, visible mass, gastric bubble, liver, part of the intestinal echoes, and omphalocele. One case was found with embryo arrest. (5) The karyotype analysis of one case through amniocentesis was 46,XX with no anomalies, and chromosome microarray analysis was arr[hg19](1-22)×2. Prenatal diagnosis was refused in the remaining cases. (6) Among the ten patients, three were terminated by rivanol intra-amniotic injection, two received drug abortion, and uterine evacuation, and two with spontaneous abortion followed by curettage with a visible fetus and hydatidiform tissue. Total hysterectomy was performed in one patient due to partial invasion of the uterus by hydatidiform mole. One patient underwent a cesarean section on account of the left lower lung metastasis. One case developed preeclampsia at 33 +4 weeks of gestation and delivered two premature infants by cesarean section. Pathology examination found a complete and partial vesicular fetal mass in four and six cases, with P57 (－) and P57 (+), respectively. (7) During the follow-up, two women developed the persistent trophoblastic disease and received chemotherapy, while the remaining eight cases did not. Conclusions:When hydatidiform mole with coexistent intrauterine pregnancy is found, a timely differential diagnosis between CHMCF and PHMCF is needed. CHMCF is at a higher risk of abortion, intrauterine death, premature delivery, preeclampsia, and other maternal complications. Therefore, termination of CHMCF should be individualized. Most PHMCF patients have fetal malformation or fetal loss; thereby, timely termination is recommended.

Objective To investigate the acute adverse reactions of craniospinal irradiation with helical tomotherapy in medulloblastoma patients and its risk factors. Methods A total of 20 patients with medulloblastoma who received craniospinal irradiation with helical tomotherapy between October 2012 and September 2016 in Air Force General Hospital were selected. The acute adverse events of 20 patients during the treatment were record. According to National Cancer Institute Common Terminology Criteria Adverse Events (NCI-CTCAE) version 4.0, the adverse reactions were divided into the mild group (grade 0-Ⅱ) and severe group (grade Ⅲ-Ⅳ) adverse reactions. And the risk factors were also analyzed. Results The non-hematological adverse reactions included fatigue (55％), vomiting (45％) and headache (25％). The hematological adverse reactions included leukopenia (95％), thrombocytopenia (55％) and lower hemoglobin (45％), and the incidence of severe adverse reactions was 35％ (7/20), 20％ (4/20) and 0 ( 0/20 ) , respectively . Leukopenia occurred in 18 patients ( 90％) at the beginning of radiotherapy within 2 weeks, and thrombocytopenia occurred in 8 patients (40％) at the beginning of radiotherapy after 2 weeks. Single factor analysis showed that there were no statistical differences in hematological adverse events of gender, age and radiation dose of spinal cord (all P>0.05). The incidence of leukopenia for the patients who received the chemotherapy before the radiotherapy was higher than that for the patients without the chemotherapy before the radiotherapy (P< 0.05). Conclusions The hematological adverse reactions were the major acute adverse events during the craniospinal irradiation with helical tomotherapy in patients with medulloblastoma. Theincidence of leukopenia and thrombocytopenia is common, and the incidence of hematological adverse reactions is higher after the chemotherapy. Thus, the close monitoring of hemogram change and treatment of hematological adverse reactions in time during the radiotherapy should be taken into the consideration.

Objective To study the safety and effectiveness of polymer-free sirolimus-eluting Nano stent in patients with unstable angina pectoris. Methods Three hundred and twenty-one patients with unstable angina pectoris were divided into Nano stent group(group A,n=157)and Endeavor resolute stent group(group B,n=164). The cardiovascular events were compared postoperative 12 months. The minimal intima cavity area and mini-mum bracket section area and neointimal area were compared postoperative 12 months by intravascular unltrasound (IVUS). Results There were 7 cases of cardiovascular events in group A and 6 in group B postoperative 12 months(P=0.727)and 2 patients in group A and 3 in group B were re-implanted stent because of restenosis post-operative 12 months(P=0.672). The neointimal area were(0.31 ± 0.11 mm2)in group A and(0.29 ± 0.12 mm2) in group B postoperative 12 months(P = 0.985). The minimal intima cavity area(P = 0.921)and the minimum bracket section area(P=0.934)were narrower postoperative 12 months than immediately after the operation in two groups. Conclusion With less cardiovascular events and being safe and reliable,the clinical effect of polymer-free sirolimus-eluting Nano stent implantation is similar to that of Endeavor resolute stent implantation.

Objective To investigate the perioperative complications of stenting with symptomatic intracra-nial artery stenosis and study the mechanism and prevention of complications. Methods 63 patients were collect-ed from Stroke Center of Guangxi. They were proved intracranial artery stenosis and performed intracranial stents. Patients′ age,with hypertension,diabetes and hyperlipidemia or not,smoking or not,types and occurrence time of complications were registered. Results 63 patients were registered and 2 patients terminated operation due to blood vessels circuity or serious vessel spasm. Operation success rate reached 96.83％. 5 patients had complications among 63 cases,with complication incidence of 8.20％. 3 patients experienced cerebral hemorrhage and two cere-bral infarction in peri-operation period. 2 patients died of complications and mortality rate was 3.28％. Conclu-sions The incidence rate of complications of intracranial stenting with symptomatic intracranial artery stenosis is relatively high and it can be reduced by preoperative sufficient assessment and prudent selection ,careful operation and strict management after operation.

Objective To explore the risk factors of poststroke infection after cerebral infarction. Methods We consecutively included 283 patients with acute ischemic infarcts confirmed by diffusion-weighted imaging (DWI) within 72 hours from Guangxi stroke center. Based on infection status, patients were divided into Not infection group(n=198) and infection group (n=85). The serum cortisol and plasma IL-4 were assessed using chemiluminescent system and double antibody sandwich enzyme linked immunosorbent assay at admission and seventh day later,respectively. Results Compare to no infection group, smoking, mechanical ventilation, diabetes mellitus, dysphagia, COPD,level of consciousness, cortisol and IL-4 at admission, NIHSS, middle area and large area infarction, large atherosclerosis and cardiogenic infarction, left side,both side and subtentorial infarction are more liable to infection(P<0.05);After a Single-factor and Multivariate analysis,we found that cortisol(OR 3.26)and IL-4(OR 2.83)at admission,large area infarction(OR 2.67),left side(OR 3.78)and subtentorial infarction(OR 3.12)were significant correlated with infection, suggesting that they might be the independent risk factors for infection after cerebral infarction. Conclusion Immunological factors and different regional cerebral infarction may increase susceptibility to infection after stroke.

Objective To discuss the effects of the classification of psychological guidance on the emotion and prognosis of patients with cerebrovascular stenosis disease undergoing intravascular interventional therapy and to investigate effective interventions.Methods A total of 101 patients with cerebrovascular stenosis disease who underwent intravascular interventional treatment from June 2014 to September 2016 were selected and divided into experimental group (n=52) and control group (n=49) using random number method. Patients in the control group accepted conventional preoperative education instruction, while patients in the experimental group received additional postoperative classified psychological guidance. The Hamilton Anxiety Scale (HAMA), pain scores, postoperative blood pressure changes and adverse reactions were compared between the two groups before and after surgery.Results The number of preoperative patients who were not anxiety, possible anxiety and anxiety were 5, 20, and 27 respectively in the experimental group, and were 3, 19, and 27 in the control group. There was no statistic difference between two groups (Z=0.444,P=0.657). The number of postoperative patients who were not anxiety, possible anxiety and anxiety were 29, 17, and 6 respectively in the experimental group, and were 14, 24, and 11 in the control group. There was a statistically significant difference between two groups (Z=2.710,P=0.007). There were significant differences in pain score, blood pressure, dysuria and insomnia between the two groups after operation (P<0.05).Conclusions The classification of psychological guidance can effectively stabilize the patients' psychology and emotion who underwent the cerebral vascular interventional operation, relieve the pain, help to control the blood pressure, reduce complications and adverse reactions, and improve the prognosis of patients.

To study the anticancer activities of curcumin on human hepatocarcinoma cell line Sk-hep-1 and its related molecular mechanism which has not been elucidated. In the present study,we showed that curcumin inhibited proliferation of Sk-hep-1 cells in a dose-dependent manner through MTF assay. The effect of curcumin on apoptosis in Sk-hep-1 cells was investigated by DAPI staining and the various apoptosis was observed in hepatocarcinoma cell lines Sk-hep-1, HepG2 and Hep3B, but not in normal liver cell line Chang's liver with curcumin treatment. Cell cycle analysis results showed that curcumin treatment resulted in dramatic accumulation of Sk-hep-1 cells at the G0/G1 or G2/M phase. The effect of curcumin on the expression of anti-apoptosis genes (Survivin and BCl-xL) and drug resistance genes (DRG2 and MDR1) was studied by reverse transcription-polymerase chain reaction (RT-PCR). The expression of MDR1 mRNA was significantly decreased in Sk-hep-1 cells treated with curcumin, while no alterations in the amount of DRG2 and anti-apoptosis genes' mRNA levels were found. These results indicate that curcumin is able to inhibit proliferation and induce apoptosis in Sk-hep-1 cells and it may cause by down-regulating the expression of MDR1 mRNA.
Antineoplastic Agents, Phytogenic ; pharmacology ; Apoptosis ; drug effects ; Carcinoma, Hepatocellular ; drug therapy ; genetics ; metabolism ; physiopathology ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Curcumin ; pharmacology ; Gene Expression Regulation, Neoplastic ; drug effects ; Humans

BACKGROUND: Recent studies indicate that bone marrow messenchymal stem cells (MSCs) can repairinjured myocardium and improve cardiac functions. However, there are still no effective non-invasive methods to detect ventricular wall motion, survival status of transplanted cells, and microcirculation improvement after MSCsimplantation. OBJECTIVE: To detect the effects of MSCs implantation on the cardiac function of ischemic myoeardium and investigate changes of tissue acoustics characteristics by using integrated backscatter (IBS) and Doppler tissue imaging (DT1). DESIGN, TIME AND SETTING: Completely randomized grouping design, and randomized controlled study, which was carried out in the Department of Cardiology, Renmin Hospital of Wuhan University from December 2004 to June 2005 (important laboratory of 211 government). MATERIALS: Forty-eight male rabbits with irrespective of gender were used for study. Anti-troponin T (TnT) antibody was provided by Maxim Company, USA; anti-bromodeoxyuridine (BrdU) antibody by Sigma Company, USA; Sonos 5500 echocardiography by HP Company, USA.METHODS: Forty-eight rabbits were randomly divided into model group and implantation group. Model of myocardium infarction was created in rabbits by left anterior descending coronary artery (LAD) ligation. Three days after modeling, autologous bone marrow MSCs were injected into crossed myocardium between infarction and non-infarction regions based on 5 injected points.MAIN OUTCOME MEASURES: Indicators including ventricular size, ventricular wall thickness, and ejection fraction (EF) in the left ventricle (LV) were measured with routine echocardiography one day before myocardial infarction, two weeks after myocardial infarction, and four weeks after implantation. IBS and DTI might detect the anterior backscatter parameters (AII, or IB) and ventricular wall motion parameters (PPI, or CVIB) to calculate the average backscatter scores and backscatter cycle changes. DTI was used to measure peak systolic flow velocity (VS), peak early diastolic flow velocity (VE), and peak late diastolic flow velocity (VA) of the middle and basal segments of the anterior wall of left ventricle. Finally, animals were sacrificed by anesthesia, and myocardial infarction region was stained with 5-Brdu immunohistochemical staining, and anti-TnT staining. RESULTS: Twelve rabbits were excluded because of death after operation.① Echocardiography: Imaging of 36 rabbits were clear in 1 day before myocardial infarction, 2 weeks after myocardial infarction, and 4 weeks after implantation. The sizes and systolic function of LV in 36 rabbits were normal before operation. Two weeks after operation, the sizes of LV became larger, the anterior wall of LV became thinner, and systolic range became weaker even disappeared. EF, CVIB, Vs, and Ve were lower (P < 0.05) and All was higher in both groups than pre-operation (P < 0.05). Four weeks after implantation, compared with control group, left ventricular diastolic diameter (LVDd) was smaller and systolic range became larger, All descended. EF, Vs, Ve and CVIB increased (P < 0.05).② Myocardial immunohistochemical detection: Numerous of Brdu-labeled positive cells were scattered, and anti-TnT was positive, which clearly showed horizontal stria of myocardium. However, normal myocardium was negative. CONCLUSION: Bone marrow MSCs after implantation can survive in ischemic myocardium and improve cardiac function. IBS and DTI can real-timely and exactly detect functional changes of infarction myocardium after bone marrow MSCs implantation.