Objective To explore the safety and feasibility of blocking blood flow in interstitial tubal pregnancy treated with laparoscopic opening-taking embryo operation.Methods The clinical data of 98 patients with lump interstitial tubal pregnancies (requesting reserve procreate function) from January 2006 to December 2013 were chosen.Among them,56 patients were in study group (January 2010-December 2013) and 42 patients were in control group (January 2006-December 2009).All patients were treated with opening-taking embryo by laparoscopic operation.In study group,we first blocked the uterine artery and ovarian artery blood supply of pregnancy lump,secondly opened pregnancy lump and stripped gestation sac with hydraulic pressure separation during operation.Whereas,in control group,we opened pregnancy lump and taken out pregnancy tissues according to convention method without blocking blood flow.Operation success rate,operation blood volume,operation time,persistent ectopic pregnancy (PEP) happening rate,fallopian tube unobstructed information,and pregnancy information after operation were compared between two groups.Results In study group,operation success rate was 96.4％,which was significantly higher than that in control group (61.9％) (P ＜0.01) ; operation blood volume was[(20.7 ± 10.4)ml],which was significantly less than that in control group [(60.7 ± 18.4) ml] (P ＜ 0.01) ; operation time [(46.6 ±14.2) min] was significantly shorter than that in control group [(66.5 ± 19.4) min] (P ＜ 0.01) ; there was no PEP in study group,while there were 5 PEPs (11.9％) in control group.Fallopian tube unobstructed rate after operation in study group (76.9％) was significantly higher than that in control group (41.7％) (P ＜ 0.05).Conclusions Application of blocking blood flow in opening-taking embryo by laparoscopic operation on lump interstitial tubal pregnancies is safe and effective.

Myelin of the adult mammalian central nervous system(CNS)has been attributed to affect nerve structural plasticity and suppress regeneration of nerve fibers.Nogo-A is possibly the best characterized of a variety of neurite growth inhibitors in CNS myelin.Neutralizing its activity results in improved axon regrowth and functional recovery in experimental spinal cord injury(SCI)models of animals.Nogo-A and its receptors,especially Nogo-66 receptor(NgR),p75 neurotrophin receptor(p75NTR),and LINGO-1 increasingly become the hot spot in the study of SCI repair,and have become the major targets for therapeutic intervention to promote axon regeneration after SCI.Inhibition of Nogo-A and its receptors NgR/p75NTR/LINGO-1 may be promote the regeneration of axon and maximize functional recovery after SCI.

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To study the vancomycin-resistant genes and the virulence factors genes in vancomycin-resistant Enterococci (VRE),and to analyze the drug-resistance character and epidemic characteristics of VRE strains and provide the basis for clincal selection of drugs and infection control.Methods VRE were screened by agar dilution sieving plate (ADSP) containing 6 μg/ml of vancomycin,drug resistance of VRE to other common antibiotics were detected by VITEK-60 automatic microbial analyzer.The gene types and virulence factor genes of VRE were determined by PCR.And the genetic relationships among VRE were determined by multilocus sequence typing.Results Seven vancomycin-resistant Enterococcus faecium strains were found in 360 enterococcus strains.All the VRE strains exhibited high-level vancomycin resistance ; some of them were medium or senstive to teicoplanin.They all carried vanA gene and esp gene and one of them carried 4 kinds of virulence factor genes.The ST type of the 7 VRE strains were diffused distribution.Conclusion We found vanB phenotype vanA genotype vancomycin-resistant Enterococcus faecium isolates in Wenzhou; these VRE strains were multidrug resistance and carried various virulence factor genes.Linezolid could be used as a recommend drug for treatment of VRE infection.The protection of antibiotics sensitivity should be strengthened.

ObjectiveTo find specific biomarkers related to HAART treatment in plasma samples of AIDS patients for clinical therapeautic efficacy evaluation and guidance for the prognosis of HIV treatment.MethodPlasma samples of AIDS patients were collected from Infectious Disease Department 1 of Shanghai Public Health Clinical Center in June of 2008 to February of 2009,including 11 successfully HAART treated cases (HIV load ＞ 50 copies/ml) and 11 unsuccessfully HAART treated cases (HIV load ＜50 copies/ml).Patients' age ranged from 22 to 63.Plasma samples were treated by Bio-rad AurumTM Serum Protein Mini Kit to remove high abundant proteins:albumin and immunoglobulin were removed.The treatedplasmaproteinswereseparatedbytwo-dimensionalelectrophoresisandanalyzedby electrophoretogram using Imagemaster software to find differentially-expressed proteins related to therapeutic efficacy.After digestion by trypsin,the differentially-expressed proteins were identified by online reversed-phasenano-flow liquid chromatography coupled with electrospray ionization ion trap mass spectrometry.ResultsLow abundant proteins were efficiently enriched after the AurumTM Serum Protein Mini Kit treatment.Six differentially-expressed proteins were detected while comparing successfully and unsuccessfully HAART treated group.These proteins were accurately identified by tandem Mass spectrometry (MS), including serum transferrin, serum β-fibrinogen, etc.ConclusionsOur proteomic research revealed that the differentially-expressed proteins such as transferrin,which is related to plasma virus loading in AIDS patients in the process of treatment,might be potential biomarkers evaluating HAART therapeutic efficacy.

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.

Objective To identify the success rate of peripheral indwelling needle puncture in pediatric patients, and analyze its influencing factors. Methods A survey was conducted in a sample of 902 pediatric patients.Personal information table of pediatric patients who receive infusionwas adopted to collect data. Results The success rate of first puncture was 85.37%(770/902), the success rate of two punctures was 95.34%(860/902). The success rate was affected by several factors, such as department, ages of the patients, condition of the veins, years of working as a nurse(OR=1.128, 2.308, 2.351, P <0.05). Conclusions Success rate of peripheral indwelling needle puncture in children still can be improved. When formulate management program, the influencing factors should be considered for management standard.

Objective To evaluate the value of miniprobe sonography (MPS) in diagnosing gastrointestinal submucosal protrusive lesions and selecting the indicated manual for treatment. Methods According to the sizes, properties, and depth of SMTs in the gastrointestinal tract detected by the MPS, different methods of resection were performed. Results Of 24 cases, 11 SMTs lying in submucosa under 2cm in diameter (2 benign gastrointestinal stromal tumors, 3 lipomas, 5 cysts, 1 granular cell tumor) were attempted with EMR or argon plasma coagulation (APC) ; there were no complications of hemorrhage or perforation. Thirteen SMTs lying in muscularis propria or with size of SMTs above 2 cm in diameter (4 malignant GISTs, 6 benign GISTs, 1 lipoma, 2 aberrant pancreas) were performed by surgical resection. Preoperative diagnoses of SMTs by MPS were consentient with their histological diagnoses. Conclusion MPS may detect the size, property, and depth of SMTs in the gastrointestinal tract and is helpful in selecting indicated cases for endoscopic resection. Endoscopic therapy of SMTs lying in mucosa or submucosa under 2cm in diameter is a safe and effective procedure.

A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method was developed for the determination of lopinavir and ritonavir in human plasma. Analytes were separated from plasma by a combination of alkalinized protein precipitation and liquid-liquid extraction with ethyl acetate. Chromatographic separation was performed on a Agilent ZORBAX Eclipse XDB-C18 column with the mobile phase consisted of methanol-0.1% formic acid in water (80:20). A tandem mass spectrometer equipped with electrospray ionization source was used as detector and operated in the positive ion mode. Quantification was performed using multiple reaction monitoring (MRM) of the transitions m/z 629.6 --> 155.2, m/z 721.4 --> 268.2, and m/z 515.2 --> 276.2 for lopinavir, ritonavir and telmisartan (internal standard), respectively. The method showed a good linearity in a concentration range of 62.5 - 10000 ng mL(-1) for lopinavir, and 12.5 - 2000 ng mL(-1) for ritonavir. The lower limits of quantification were 15 pg mL(-1) and 8 pg mL(-1) for lopinavir and ritonavir, respectively. The intra- and inter-day precision was less than 15% and the absolute recovery was above 75%. This method was selective and rapid, sensitive for investigating blood drug concentrations in clinics.

Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95%, 74% and 56%, respectively. The mean patient survival was 7. 9 months ( 1-14 months).Postoperative survival rates at 3,6 and 12 months were 91.0%, 81.3% and 17. 2%, respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible,safe and effective.