Objective:To evaluate the security, efficacy and side effects of E_2 transdermal patch (Fem-7) in the treatment of menopausal syndrome. Methods:A total of 60 cases with menopausal syndrome (blood serum FSH >30 U/L,E_2 <109.8 pmol/L) were randomly divided into treatment group ( Fem-7 group) and control group (estrodiol valerate (E_2V) group) for 12 weeks treatment. Fem-7 group changed patch every 7 days and took the 2 mg medroxyprogesterone (MPA) every day. While the E_2V group took the 2 mg MPA and 1.5 mg E_2 V every day. Serum E_2, FSH, lipoprotein and coagulation function were evaluated at baseline and at the 12th week of the treatment. In addition, menopausal symptoms and some other index of security and side effects were also observed. Results:Kupperman indix in both groups was decreased and the mean value of E_2 was increased obviously. Hepatic function, renal function, coagulation function and blood glucose were no obvious change. Lipoproteina was descended markedly in Fem-7 group. Other index of security in both groups was no obvious change. Conclusions:Fem-7 patch is secure and valid for relieving symptom of menopause, especially for the women who is not sutable for oral medication.

Through genetic recombination technique, the rat glial cell line-derived neurotrophic factor (rGDNF) cDNA was in-serted into polylinker site of retroviral vector pLXSN, to generate a recombinant plasmid pLXSN-GDNF as transfer vector. Therecombinant plasmid was verified with restriction analysis, PCR, dot blot hybridization and Southern blot hybridization. The re-sults showed that GDNF cDNA was cloned correctly into retroviral vector pLXSN, recombinant retroviral vector was construct-ed. It is concluded that the eukaryotic cell expression vector was constructed successfully for gene therapy of Parkinson's,Alzheimer's and other central nervous system diseases.

Objective To explore the effect of inhibiting Akt phosphorylation on tumor necrosis factor related apoptosis inducing ligand (TRAIL)-induced apoptosis of human non-small cell lung cancer (NSCLC) H1299 cells with wild type EGFR and KRAS.Methods The TRAIL-induced apoptosis was examined by the Annexin V-FITC/PI.The expressions of TRAIL-activated Akt phosphorylation and p-Akt were measured by Western blot.After cells were treated with LY294002, an inhibitor of PI3K-Akt pathway, Annexin V-FITC/PI and Western blot were used to analyze the alteration of TRAIL-induced apoptosis and Akt phosphorylation, respectively.Results H1299 cells were not sensitive to TRAIL-induced apoptosis.When TRAIL concentration was 100 ng/ml, the apoptosis rate of the test group was significantly higher than that of the control group [(15.06±1.29) ％ vs (3.56±0.50) ％, t =66.953, P =0.000].When TRAIL concentration was 500 ng/ml, the difference was not statistically significant compared with apoptosis rate of 100 ng/ml TRAIL group [(18.65±2.09) ％ vs (15.06±1.29) ％, t =2.423, P =0.136].The expression level of Akt phosphorylation in H1299 cells was increased by TRAIL in a time-dependent way.When cells were pretreated with LY294002, TRAIL-induced Akt phosphorylation was suppressed to baseline level.At the same time, the apoptosis rate in LY294002-treated group was significantly higher than that in TRAIL group [(41.65±4.62) ％ vs (15.82±0.61) ％, t =39.028, P =0.001].Conclusions TRAIL-induced Akt phosphorylation can antagonize TRAIL-induced apoptosis.Inhibition of Akt phosphorylation can significantly enhance the sensitivity of NSCLC H1299 cells with wild type EGFR and KRAS to TRAIL-induced apoptosis.

Objective To explore the clinical value of MRI in diagnosing and treating cesarean scar pregnancy (CSP).Methods A retrospective analysis was conducted on the clinical manifestations of 54 patients diagnosed with CSP between January 2009 to January 2013 in Peking University Third Hospital.Based on the patients' MRI image and other clinical datas,we did transvaginal operation on patients with CSP1,and transvaginal combined with abdominal operations on patients with CSP2.The intraoperative blood loss,operation time,postoperative hospital stay,and the length of time required for of serum hCG dropping to normal of the patients were analyzed.Results The average age of the 54 patients was (34±5) years and the average duration of gestation was (56± 16) days,all patients' vital sign were stable,the hCG level was 23-142 962 U/L before treatment.Twelve patients were diagnosed with CSP1 by MRI,and 5 of them had focus of 1-2 cm in diameter,the 5 patients' serum hCG level was 436-1 159 U/L and 23-32 days after drug administration,their hCG level returned to normal; the other 7 patients had focus of 2.0-4.4 cm in diameter,and their hCG level was 2 218-63 446 U/L,lesion resection was done on the 7 patients by hysteroscope or under B-uhrasound monitor.Forty-two patients were diagnosed with CSP2,and their focus were 1.0-7.1 cm in diameter,and serum hCG level were 23-142 962 U/L.We did bilateral uterine artery occlusion by laparoscope or laparotomy during operation for 22 patients or bilateral uterine artery embolization (UAE) before operation for 20 patients,then we did lesion resections.The blood loss during operation of CSP1 or CSP 2 was 50.1,267.2 ml; operation time was 30,128 minutes; postoperative hospital stay was 4.6,6.7 days;their serum hCG returned to normal 13-30 days after the surgery.All the 54 patients' uterus were preserved,and the patients undergoing operations were all cured without the second operation.Conclusion MRI is an effective method to conduct clinical treatment in CSP.

Objective To analyze the ultrasonic features of gynecological emergency and severe cases.Methods To analyze 431 cases in clinical,ultrasonic images and examination data of gynecological emergency and severe patients in Peking University Third Hospital from September 2014 to September 2015,and to study clinical pathological and ultrasonic imaging examination.Results In 431 severe cases of gynecologic emergency,the clinical symptom were shown as acute abdominal pain or and vaginal bleeding.They were divided into seven types by clinical examination,operation or conservative treatment under dynamic observation.There were 137 cases of fracture disease,accounting for 31.8％,with corpus luteum rupture in 67 cases,ectopic pregnancy burst in 59 cases and tumor rupture in 11 cases.There were 114 cases of pelvic inflammatory disease,accounting for 26.5％,with hemorrhagic disease of department of gynaecology in 67 cases (15.5％),dysfunctional uterine bleeding in 39 cases,cervical cancer in 11 cases,submucosal myoma in 7 cases,endometrial carcinoma in 6 cases,carcinosarcoma in 4 cases.There were 58 cases of early pregnancy related diseases,accounting for 13.5％.Among them,32 cases were incomplete abortion,and 21 cases were inevitable abortion and 5 cases were hydatidiform mole.Forty-six cases were torsion of pedicle (10.6％).Five cases were genital tract malformation,accounting for 1.2％,with vaginal septum obliquumevery 4 cases and cervical atresia in one case.There were damages after the operation in 4 cases (0.9％),uterus perforation in 2 cases,abdominal wall hematoma in 1 case after cesarean section,and false aneurysm in 1 case after cesarean section.In the 431 cases,there was emergency surgery oroperation after symptomatic treatment in 329 cases,interventional treatment in one case and non-operative treatment in 101 cases.Conclusions There are corresponding typical ultrasonographic characteristics in different diseases of emergency and severe gynaecologic cases,combined with clinical symptoms and medical history.The right diagnosis can be made.Therefore,there are important clinical values of ultrasound in the treatment of emergency and severe gynecologic cases.

Objective To investigate the relationship between the homocysteine,sperm DNA fragmentation index and sperm counts of male with severe impaired spermatoqenesis.Methods From December 2015 to February 2017,56 male patients with severe impaired spermatoqenesis were enrolled in the study.The patients were divided into two groups according to the WHO criteria:severe oligozoospermia and azoospermia group (n =25) and oligoasthenoteratozoospermia group (n =31),and the control group was a male with no reproductive impairment (n=27).The sperm parameters were analyzed by using the computer automatic semen analyzer,sperm DNA fragmentation index and serum Hcy level were detected by sperm chromatin diffusion method and enzyme colorimetric method.Results The median of Sperm DNA fragmentation index and homocysteine level in control groups were 33％ [95％CI(29.0％ ～34.4％)] and 13.2 μmol/L [95％CI(12.4 μmol/L～14.2 μmol/L)],and in severe spermatogenesis groups in these two indicators were 21％ [95％CI(19.0％ ～24.0％)] and 8.9 mol/L [95％CI(8.4 μmol/L～ 9.4 μmol/L)],respectively.The results of these two items were higher than the control group,the difference was statistically significant (t=6.793～7.543,P=0.000).Sperm survival rate in normal control group and severe spermatogenesis group was 71％ [95％ CI(67.8％ ～75.1％)] and 57％[95％CI(52.3％ ～58.0％)],respectively,and the difference was statistically significant (t=-8.475,P=0.000).Sperm DNA fragmentation index was positively correlated with serum Hcy level and sperm concentration,Passing-Bablok regression analysis was:Y=10.705 +0.053X,Y=21.071+0.286X,and Hcy level was negatively correlated with sperm concentration.Conclusion The increase of Hcy level and sperm DNA fragmentation index may be an importantcause of male with severe impaired spermatoqenesis,but the specific mechanism remains to be further studied.

Objective To explore the impact of healthcare-associated septicemia (HAS)on hospitalization expense as well as length of hospital stay,so as to optimize the allocation of healthcare resources,and provide scientific basis for reducing the economic burden caused by septicemia.Methods Hospitalized patients with confirmed HAS in a tertiary first-class teaching hospital between June 1 ,2012 and May 31 ,2015 were investigated retrospectively,con-trol group was set up in a 1 :1 ratio,hospitalization expense and length of hospital stay between two groups were compared.Results A total of 285 cases and 285 controls were enrolled in the study,the median of hospitalization expense in case group was higher than control group (￥19 718.39 vs ￥9 289.04,P <0.05);the median of length of hospital stay in case group was longer than control group (14.89 days vs 9.22 days,P <0.05).The disease bur-den caused by septicemia in different age groups and departments were different.The improvement rate of case group was lower than control group (76.49% [218/285 ]vs 83.51 % [238/285 ],χ2 = 2.562,P = 0.009 ). Conclusion As the common blood stream infection in hospitalized patients,septicemia not only increased the ex-pense of diagnosis and treatment,but also affected turnover rate of hospital bed.Rapid and effective diagnosis and treatment is significant o prevent and control septicemia.

OBJECTIVETo investigate the effects of acute hypervolemic hemodilution (AHH) and intraoperative blood salvage (IOBS) on the morphology and biomechanics of erythrocytes using atomic force microscopy (AFM).

METHODSBlood samples were collected from 20 patients undergoing orthopedic surgery before operation (T1), immediately after AHH (T2), and after blood salvage (T3). AFM at nanometer resolution was used to examine the morphology and biomechanics of the collected erythrocytes.

RESULTSThe blood samples collected at T1 showed a significantly lower ratio of heteromorphous erythrocytes than those collected at T2 and T3 [(2.6∓1.3)% vs (19.3∓1.6)% and (17.6∓1.4)%, P<0.05]. AFM revealed significant differences in the morphology and biomechanics of the single erythrocyte in salvaged blood and blood after AHH compared with those of venous blood.

CONCLUSIONAHH and IOBS may cause significant changes in the morphology and biomechanics of erythrocytes in the salvaged blood.

Objective To study the value of serum human epididymal protein 4 (HE4) ,cytokeratin 19 frag-ment (CYFRA21-1) ,neuron-specific enolase (NES) and gastrin release precursors (Pro-GRP) in the diagnosis of female lung cancer .Methods A total of 100 cases of female lung cancer patients in the hospital were select-ed as the research object ,100 cases of benign lung diseases and 100 female health examiners as the control ,the serum levels of HE4 ,CYFRA21-1 ,NES and Pro-GRP were measured ,and the related statistical analysis was carried out .Results The serum levels of HE4 ,CYFRA21-1 ,NES and Pro-GRP in patients with lung cancer were significantly higher than those of benign lung disease and healthy control group (P<0 .05) ,and there was no significant difference between the benign lung disease group and the healthy control group (P>0 .05) . There was no significant difference in serum HE4 expression in different stages and pathological types of lung cancer (P>0 .05) .The ROC curve analysis showed that the area (AUC) of HE4 ,CYFRA21-1 and NES/Pro-GRP w ere 0 .927 ,0 .758 ,0 .652 and 0 .799 respectively ,and the best critical values w ere 63 .38 ,2 .05 ,14 .05 and 58 .50 respectively ,and the sensitivity was 88 .0％ ,80 .0％ ,60 .0％ ,71 .0％ respectively ,and the speci-ficity was 96 .0％ ,73 .0％ ,87 .0％ and 89 .0％ respectively .HE4 was obviously better than the other 3 items . Combined detection of HE4 ,CYFRA21-1 ,NES and Pro-GRP could also improve the diagnostic sensitivity of lung cancer ,which was 89 .0％ ,but the specificity had decreased by 88 .0％ .Conclusion The level of serum HE4 in female patients with lung cancer is significantly higher ,which can be used as a candidate marker for differential diagnosis of pulmonary benign and malignant diseases .The combined detection of these 4 markers has a high sensitivity for the diagnosis of female lung cancer ,which is suitable for the survey of female lung cancer in clinical .

Objective To explore the clinical significance of abnormal fetal genitalia detected by routine prenatal ultrasound. Methods In Peking University Third Hospital from January 2014 to January 2016, the ultrasonic diagnosis and sonographic features in 14 suspected cases of abnormal fetal genitalia were analyzed retrospectively and compared with postpartum morphological and pathological characteristics. Results The fetal ultrasound findings and clinical outcomes in 14 cases were: (1) There were 4 cases of partial penoscrotal transposition (28.6%, 4/14), in which all fetus hadshort penis and hypospadias. In 2 termination cases, unilateral hydronephrosis and anal atresia was found in one case, while ventricular septal defect was found in the other case. In 2 term-birth cases, there was one case of recessive spina bifida. In the 4 cases, prenatal ultrasonographic manifestation showed that the short penis was located between the division of the scrotum, named as ″tulip sign″. (2) There were 2 cases (14.3%, 2/14) of complete penoscrotal transposition, in which all the pregnancies were terminated. On prenatal ultrasound of external genitalia, the location of the penis and scrotum was reversed. In one case, anal atresia and small eye malformation were found. In one case, the tetralogy of Fallot, duodenal atresia and anal atresia were found. (3) There were 4 cases of the micropenis (28.6%, 4/14). On prenatal ultrasound, the penis was difficult to demonstrated and was shown merely as an echoic dot. Among 2 cases of FGR, one infant dies for unexplained reasons after birth, and one infant has hypospadias after birth. The pregnancy was terminated in two cases of 18-trisomia and microdeletion in chromosome 9. (4) There were 2 cases of penis absence (14.3%, 2/14), in which all pregnancies were terminated. The sonographic manifestations show the absence of penis and bladder eversion. (5) In 2 cases, sex couldn`t be identified (14.3%, 2/14). In one case, the 46 xy infant showed a female external genitalia appearance after birth. In one case, the clitorism and congenital adrenal cortical hyperplasia were found in a 46 xx infant after birth. Conclusions Prenatal ultrasonography is effective and feasible in detecting genitalia abnormalities, especially for penis scrotal transposition and penis absence. When the fetal gender cannot be identified on ultrasound, chromosome examination is warranted. For indeterminable cases, ultrasound follow-up in 2nd and 3rd trimester is necessary.