To observe the changes in hemorheology, endotoxin and TNF ? in blood after hemoperfusion(HP) with adsorbent immobilized polymyxin B (PMB) on sepsis in rats. Wistar rats were randomly divided into three groups:LPS+HP+PMB,LPS+HP and LPS. All the rats received intravenously injection of lipopolysaccharide (LPS, Escherichia coil O111:B4,1mg/kg). Plasma of the rats in the group of LPS+HP+PMB was passed through a column containing sepharose coated activated charcoal immobilized polymyxin B at the 4th hour after LPS injection. The treated plasma was transfused bak after being mixed with blood cells. In LPS+HP group, the column did not contain immobilized polymyxin B. The animals of LPS group received LPS only. Quantitative endotoxin determination in blood was done with limulus amebocyte lysate test,TNF ? of the plasma assayed with ELISA, and hemorheology parameters were also observed after hemoperfusion. In LPS+HP+PMB group, the concentration of plasma was significantly decreased after hemoperfusion, but it was still significantly higher than the baseline value, and there was a decrease of blood cell ratio after hemoperfusion. The results suggest that specific adsorbent could remove endotoxin in the circulation and improve hemorheology.

Response surface analysis (uniform precision of central composite design, SAS 9.1.3 software) was applied to optimize the four major factors (ratio of soybean meal to water, enzyme quantity, fermentation time and inoculation quantity) for soybean meal solid fermentation. According to the change of the hydrolyzation degree of soybean protein, the equation of polynomial regression was established between those factors and the response. The result showed that the optimum condition included as follows: ratio of soybean meal to water 1∶1.00,enzyme quantity 2.55%, fermentation time 65h and inoculation quantity 1.00%. Under the optimum level, the degree of hydrolyzation reached 13.3%, which increased 56% over pre-optimization.

Objective To investigate the effect of sumical resection in the management of gestafional trophoblastic neoplasia(GTN)patients with pulmonary metastases.Methods A retrospective review of the medical records of 62 GTN patients who underwent pulmonary resection was carried out.The cases were divided into recurrent group(group A,,l=10),drug-resistant group(group B,n=28),and the group with satisfactory response to chemotherapy but residual pulmonary lesion(s)(group C,n=25).One patient underwent lobectomy twice,and she was allocated simultaneously to groups A and B.The patients'median age,antecedent pregnancy,International Federation of Gynecology and Obstetrics(NGO)risk score,number of preoperative chemotherapy courses,preoperative β-human chorionic gonadotrophin (β-hCG)titer,lesion size,number of lobes affected,positive rate of histology,follow-ups and prognosis were compared between the three groups.Results The proportion of hish-risk patients in the three groups wag 90%,82%and 44%,respectively.The complete remission rates of the three groups were 90%,79%and 100%,with relapse mtes of 2/8,15%and zero,respectively.Positive histology of the resected specimen wasmore frequently recognized in recurrent and drug-resistant groups(A 60%,B 36%,C 12%).In the drug-resistant group there were more preoperative chemotherapy 8essiorls(A 3,B 7,C 5)and more patients with abnormal preoperative B-hCG titer(A 50%,B 61%,C 12%).Conclusions Surgical resection is effective in the treatment of pulmonary metastases of GTN.Surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug—resistance and the lesions are relatively localized.Surgical resection is not recommended for patients with satisfactory response to chemotherapy but residual pulmonary lesions.

Objective To discuss the efficacy of the modified subinguinal approach for the treatment of acetabular anterior column and wall fractures.Methods A clinical retrospective study was performed of the 5 patients who had been treated at our department from January 2011 to April 2015 for acetabular anterior column and wall fractures and conformed to follow-ups.They were 3 males and 2 females,aged from 19 to 45 years (mean,35.6 years).The duration from injury to surgery averaged 7.6 days (range,from 4 to 10 days).The subinguinal ligament approach was adopted in the 5 cases,through which the inguinal ligament was preserved intact after sharp dissection of its insertion at the anterior superior iliac spine and medial-upper advancement,the advantage of expanded exposure of the first window by the Farid sub-ilioinguinal approach was retained,and additional lesions due to iliac osteotomy were avoided.The operation time,intraoperative bleeding,postoperative reduction and time for fracture union were documented.Merle d' Aubigne and Postel scoring system was used to assess the hip joint function of the affected limb at the final follow-ups.Results The operation time ranged from 110 to 150 minutes (mean,125 minutes);the intraoperative bleeding ranged from 415 to 550 mL (mean,450.2 mL).By the Matta's criteria,the postoperative reduction was rated as excellent in 4 cases and good in one.The 5 patients were followed up for an average of 32.4 months (range,from 6 to 43 months).Their fractures united clinically after an average of 4.6 months (range,from 3 to 6 months).The hip joint function was rated as excellent in 2 and good in 3 by the Merle d' Aubigne and Postel scoring system at the final follow-ups.Follow-ups observed no serious complications like inguinal hernia,internal fixation failure,myositis ossificans,or avascular necrosis of the femoral head.Conclusions As the modified subinguinal approach can provide a broad surgical exposure,lead to minimal injury to the inguinal ligament,avoid lesions caused by iliac osteotomy,and decrease operation time and bleeding,it may be a better approach for acetabular anterior column and wall fractures.

Objective To investigate the clinical characteristics, management and prognosis of gestational trophoblastic disease in women aged 50 years or more. Methods Thirty-eight cases of gestational trophoblastic disease in women aged 50 years or more, who were treated in Peking Union Medical College Hospital between 1992 and 2002, were reviewed retrospectively. Results The median age was 52 years (range from 50 to 58 years ). The lesions included 5 hydatidiform moles (13%), 19 invasive moles (50%), 12 choriocarcinomas (32%) and 2 placenta site trophoblastic tumors (5%). All of 38 cases presented with abnormal vaginal bleeding. Twenty-three cases of hydatidiform moles were diagnosed at their first visit to the hospital, and 15 of them received prophylactic chemotherapy, of whom 10 progressed to invasive mole, 3 developed lung metastasis. All of the other 8 cases without prophylactic chemotherapy progressed to malignant changes with metastasis of lung. The use of prophylactic chemotherapy reduced the incidence of subsequent metastasis. All of 38 cases received chemotherapy. Thirty-two cases underwent hysterectomy, complete remission was achieved in 91% of patients; complete remission was achieved in 2 of 6 patients without hysterectomy. Conclusions The diagnosis of pregnancy and pregnancy-related disease should be considered in the elderly women presenting with abnormal vaginal bleeding. Once gestational trophoblastic disease in women aged 50 years or more is diagnosed, chemotherapy should be given as soon as possible. Hysterectomy is frequently required to improve the prognosis of gestational trophoblastic disease in the elderly women.

Objective To analyze prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole. Methods Twenty-three patients who were diagnosed as high-risk hydatidiform mole and undergone prophylactic chemotherapy in our hospital were retrospectively analyzed.After prophylactic chemotherapy, 11 patients didn't develop to gestational trophoblastic neoplasia (GTN),while the other 12 patients developed to GTN and needed a regimen change to combination chemotherapy.The clinical characteristics of these patients and outcome of prophylactic chemotherapy were compared between two groups. Results There was no significant difference between the two groups on patients' age,weeks of delayed menses, enlarged uterine size excessive for gestational age, and incidence of theca-lutein cysts of ovaries. However,the median levels of pre-evacuation serum β-hCG in two groups were 469 144 U/L and 768 044 U/L respectively, and median days needed for β-hCG declining to normal(≤2U/L) at the first time were 71 and 120 days respectively, which were both significantly different between two groups.Analyzed with receiver operating charactristic(ROC), the level of serum β-hCG could be a predictor for prognosis. Choosing 750 000 U/L as the cut-off value, we could expect the serum β-hCG to have a specificity of 91% and a sensitivity of 58% to predict whether prophylactic chemotherapy will be successful.Conclusions For those patients who have to receive prophylactic chemotherapy because of risk factors and unavailable hCG assessments for follow-up, it's better to use double-agent or combination chemotherapy if the level of serum β-hCG reached 750 000 U/L so as to reduce therapy duration and prevent relevant chemoresistance.

Objective To analyze and compare the clinical characteristics and the treatment outcome of the patients with chemo-resistant and relapsed gestational trophoblastic neoplasia (GTN).Methods The clinical records of the patients with refractory GTN treated at the Peking Union Medical College Hospital (PUMCH) from Jan 2005 to Dec 2007 were retrospectively reviewed.According to the reasons for referral, all cases were classified as chemo-resistant GTN group who had never a normal serum human chorionic gonadotropin-beta subunit (β-hCG) level during their previous treatment, relapsed GTN group who had elevated serum β-hCG levels in the absence of the pregnancy after finished treatment 3 months or more, and undetermined GTN group who had elevated serum β-hCG levels in the absence of the pregnancy less than 3 months after completed treatment.The clinical features and treatment outcomes were compared between undetermined GTN group and chemo-resistant GTN group and also between undetermined GTN group and relapsed GTN group, respectively.Results Of 81 patients with refractory GTN, 32 cases were defined as undetermined GTN, 38 cases as chemo-resistant GTN and 11 cases as relapsed GTN.The median number of previous chemotherapy regimens, the rate of serologic complete remission ( SCR), the patients who needed to change regimens due to resistance, and the patients who needed to change regimens in the undetermined GTN group and the chemo-resistant GTN group were 2.3 versus 3.1 ( P = 0.010),100% (32/32) versus 66% (25/38, P ＜ 0.01 ), 22% (7/32) versus 58% (22/38, P = 0.002) and 28% (9/32) versus 63% (24/38, P = 0.003 ), respectively.No significant difference were observed between undetermined GTN group and relapsed GTN group in clinical features, previous and current treatment or treatment outcome ( all P ＞0.05 ).Conclusions In order to evaluate accurately the treatment outcome of refractory GTN, it seems more appropriate for the patients who had reached the normal value of serum β-hCG when completed treatment to be defined as patients with relapsed GTN, while whose serum β-hCG levels elevated in the absence of the pregnancy after the completion of treatment, irrespectively of duration of stopping treatment.Comparing with the patients with chemo-resistant GTN, the outcome of patients with relapsed GTN is better.

Objective To measure the quality of life (QoL) of gestational trophoblastic neoplasia ( GTN ) survivors after chemotherapy by using a self-invented scale, and to explore the factors associated with QoL Methods The design of questionnaire was based on a series of internationally valid QoL scales,which was tested by epidemiology and showed good reliability and validity. A total of 100 survivors of GTN patients from Peking Union Medical College Hospital participated in this survey from December 2008 to May 2009. Results Patients with disease-free more than three months after chemotherapy enjoys a good QoL,while only 16% (16/100) of survivors feel general overall QoL, but no one feels bad Qol. As refer to sexual function, more than half of these patients (70%, 70/100) satisfied with their sexual life, while there were still 47% (47/100) and 45% (45/100) of the patients complaining of decreased sexual desire and dryness of vagina. 66% (66/100) of the GTN survivors expressed depression, and 50% (50/100) of patients complained anxiety, which were potential factors influencing QoL of GTN survivors. Relevant analysis explored the possible predictors of QoL for GTN patients, including physical function ( r = 0. 609,P ＜0. 01 ), sexual function ( r = 0. 473, P ＜ 0. 01 ), and social psychology ( r = 0. 294, P ＜ 0. 01 ).Conclusions GTN survivors have an overall good QoL after chemotherapy, the possible predictors of QoL for GTN patients include physical function, sexual function and social psychology. The sexual dysfunctions mostly present with short of sexual desire and dryness of vagina. Fear of recurrence may be a potential factor influencing QoL a long term after remission.

Objective To investigate the protective effects of bone marrow mesenchymal stem cells transplantation (MSCT) and mobilization on severe acute pancreatitis (SAP) with acute renal injury.Methods A total of 240 SD rats were randomly divided into sham operation group ( n =48 ),model control group ( n =48 ),MSCT group ( n =48),bone marrow mesenchymal stem cells mobilization (MSCM) group ( n =48) and MSCT +MSCM group ( n =48 ) according to the random number table.Rat models of SAP were made by peritoneal injection of L-arginine.Rats in the MSCT group were injected with 1.2 ml of bone marrow mesenchymai stem cells via femoral vein at 6 hours after SAP model establishment; rats in the MSCM group were subcutaneously injected with 40 μg/kg of granulocyte-colony stimulating factor (G-CSF) at 3 days before SAP model establishment; rats in the MSCT + MSCM group were injected with 1.2 ml of MSC and 40 μg/kg of G-CSF simultaneously; rats in the sham operation group were injected with equal volume of normal saline.According to different time points after operation,rats in each group were subdivided into 12 h,24 h,48 h and 72 h groups (n =12).At each time points after operation,the mortality rate,pathological changes of renal tissue,expression of Bax protein,Bcl-2 protein and apoptosis indexes of renal tubular epithelium cells were observed.The contents of tumor necrotic factor-α (TNF-α),interleukin-6 (IL-6),blood urea nitrogen (BUN),creatinine (Cr),lactate dehydrogenase (LDH) and C-reactive protein (CRP) were determined.All data were analyzed by using SNK-q test,Fisher exact probability and analysis of variance.Results All rats in the sham operation group were survived.The numbers of rats in the model control group survived at postoperative 48 hours and 72 hours were 11 and 8,respectively.No rat died at postoperative 48 hours in the MSCT group,MSCM group and MSCT + MSCM group.The numbers of rats survived at postoperative 72 hours in the MSCT group,MSCM group and MSCT + MSCM group were 11,10 and 11,which were not significantly different from the number of survived rats in the model control group (P ＞0.05).The pathological injuries of renal tissues were relieved in the MSCT group,MSCM group and MSCT + MSCM group when compared with model control group.The expression of Bax protein,Bc1-2 protein,renal tubular epithelium cell apoptosis indexes at 12-72 hours were 12.80 + 1.78-20.30 + 2.40,4.34 + 1.20-3.03 ± 1.06,12.65％ ±2.31％-35.10％ ± 5.54％ in the model control group,9.68 ± 2.11-17.01 ± 2.54,5.57 ± 1.35-4.13 + 1.05,6.20％ ± 1.53％- 17.50％ ± 2.80％ in the MSCT group,10.05 ± 2.17-16.81 ± 2.55,5.49 ± 1.48-4.19 ±1.05,6.41％± 1.64％-17.14％±2.27％ in the MSCM group,8.33 ±2.06-14.03 ±2.27,6.60 ±2.11-5.63 ±1.52,5.80％ ± 1.52％-12.30％ ±2.43％ in the MSCT + MSCT group.There were significant differences in the expressions of Bax protein at 24 and 72 hours,Bcl-2 protein at 48 and 72 hours,renal tubular epithelium cell apoptosis index at 24,48 and 72 hours between the MSCT group,MSCM group and MSCT + MSCM group ( P ＜0.05 ),but no significant difference was found between the MSCT group and the MSCM group ( P ＞ 0.05 ).The contents of TNF-α,IL-6,BUN,Cr,LDH,CRP in the MSCT group,MSCM group and MSCT + MSCM group were decreased when compared with those in the model control group,and a significant decrease of the 6 factors was observed in the MSCT + MSCM group.There were significant difference in the content of TNF-α at 72 hours,IL-6,BUN and Cr at 48 and 72 hours,LDH at 24,48 and 72 hours and CRP at 72 hours between the MSCT group,MSCM group and MSCT + MSCM group (P ＜0.05),while no significant difference was observed between the MSCT group and the MSCM group (P ＞ 0.05).Conclusion MSCT and MSCM can significantly protect acute renal injury in the progress of SAP,the probable mechanisms are pathological regeneration,anti-inflammatory effect and apoptosis inhibition of mesenchymal stem cells.

Objective To analyze the effects of Ileus tube (IT) along with somatostatin (SS) used for treatment of patients with severe acute pancreatitis (SAP).Methods Under conventional treatment,75 patients with SAP were divided into three groups as per different additional treatments,namely group A (IT and SS),group B (nasogastric decompression tube and SS),and group C (IT alone),and the therapeutic efficacies of those treatments were evaluated in respects of improvement of physical signs and symptems,dynamic changes in decompression drainage and prognosis.Results Therapeutic efficacy was 100％ in group A,84％ in group B and 80％ in group C.The difference between group A and B was x2 =8.26 (P ＜0.01) ; group B vs.C was x2 =0.38 (P ＞ 0.05).The physical signs and symptoms in group A were improved more rapid than those in group B and C (P ＜ 0.05),but there was no significant differences in those signs and symptoms between group B and group C (P ＞ 0.05).In comparison of decompression drainage,the t value of group A vs.group B was 2.14,group B vs.group C was 3.83,and group A vs.group C was 2.23 (P ＜ 0.05).As cure rate of patients with SAP in hospital on the 14th day,rate of transferring to surgical treatment as a last resort and mortality in group A were compared with group B and C,the differences were statistically significant (P ＜ 0.05),while group B vs.C,the difference was not statistically significant (P ＞ 0.05).Conclusions Application of IT combined with SS can significantly improve the condition of patients with SAP,thereby reducing the operation rate,shortening hospital stay,lowering mortality and improving the outcome,and it is worthy of clinical popularization.