【Objective】 To identify the main factor or factors w hich contribute to recurrent early spontaneous abortion for clinical diagnosis a nd treatment. 【Methods】 69 cases received the screening examination including inherent, endocrine, anatomical, infective, immunological and contamination hist ory poison metabolic factors, then analyses all factors. 【Results】 Analysing the single factor effecting th e recurrent early spontaneous abortion in the above 7 factors, we found the immun ological factor was 86.2%. Furthermore the immunological factor had significant difference in the various aged groups. 【Conclusion】 Immunological factor is a main factor in recurrent early spontaneous abortion. The immunological factor b ecomes significantly important as the times of spontaneous abortion increasing.

Currently,the environment for establishing anesthesiologic undergraduate education no longer exists,and the side-effects of its narrow professional content are more and more apparent,so canceling undergraduate education of anesthesiology is becoming imperative.The education of anesthesia must be reformed.However,the direction of reform is not clear.Anesthesia long-term system education and Anesthesia and preoperative medical education are two optical reform directions with its own advantages and disadvantages.Comparing these two directions,the Anesthesia and preoperative medical education seems to be the better one.

Objective To compare the clinical effects of hemiarthroplasty and dynamic hip screw (DHS) in treatment of unstable femoral intertrechanterie fractures in the elderly. Methods A total of 62 elderly patients with unstable femoral intertrochanteric fractures treated from January 2004 to April 2007 were randomly divided into DHS group and hemiarthroplasty group, with 31 patients in each group. The patients were foLlowed up to compare the clinical effects between two groups. Results Of all, 58 patients ( including 28 patients in the hemiarthroplasty group and 30 in DHS group) were followed up for 13-49 months. The mean operation time was ( 76.07 ± 6.29 ) minutes in hemiarthroplasty group and ( 117.50 ± 8.88 ) minutes in DHS group ( P < 0.05 ). The mean blood loss during operation was (305.36±34.26) ml in hemiarthroplasty group and (431.67±53.31) ml in DSH group (P<0.05). The postoperative complications occurred in three patients in hemiarthroplasty group and 10 in DHS group, with statistical difference ( P < 0. 05 ). The Harris score for hip function was ( 85.46 ± 3.05 ) points in hemiarthroplnsty group and ( 79.73 ± 2.57 ) points in DHS group, with no statistical difference between two groups ( P > 0.05 ). Conclusions DSH is still one of effective methods for patients with unstable femoral intertrochanterie fractures. Hemiarthroplasty can diminish bleeding during operation, help walk earlier and reduce complications and is a better selection for the elderly patients with osteoporosis and unstable femoral intertrochanteric fractures. However, hemiarthroplasty can not replace DHS.

Objective To discuss the diagnosis and treatment of splenic harmatoma(SH). Methods The clincial data of three cases of SH treated in our hospital from January 1997 to December 2007 were collected,and the other 17 cases which were published from January 1997 to December 2007 in the Chinese biological and medical lit-erature database were reviewed. The clinical manifestation,pathological findings,diagnosis and treatment of these 20 patients were analyzed. Results The main symptoms were abdominal pain or discomfort and abdominal mass in 13 cases(13/20). All 20 patients underwent surgical treatment with good recovery without severe complications and re-currence. Conclusions The definite diagnosis of SH depends on postoperative pathological findings. Complete surgi-cal resection is the best treatment for SH with favourable prognosis.

Objective To study the clinical characteristics of primary hypoparathyroidism in adults.Methods The clinical data of 200 cases with adult-onset primary hypoparathyroidism in Peking Union Medical College Hospital during December 1987 to December 2015 were collected and analyzed retrospectively.Among them, 128 cases were followed up for a median period of 3 years.Results The major manifestations at their first visits were tetany and numbness in the distal extremities (81.5%,163/200 and 62.0%, 124/200).Thirty-two percent of the cases (62 cases) had history of seizures, and 60.9%( 98/161 ) and 74.4% ( 96/129 ) of them were with intracerebral calcifications and cataracts , respectively.Most of subjects(155/200)had more than one year delay in diagnosis.Hypercalciuria occurred in 67.2%( 86/128 ) of the cases during the follow-up.No significant differences in the clinical characteristics and biochemical markers between the hypercalciuria subjects and the non -hypercalciuria subjects.Renal nephrocalcinosis or stones were found in 6.5%( 5/77 ) of the cases , and kidney function decreased in 6.6%(6/91) of the patients.Kidney function was negatively associated with age and duration of disease.Conclusions The predominant manifestations of primary hypoparathyroidism in adults included tetany and numbness in the distal extremities and seizures .It is often misdiagnosed.Calcium supplement combined with vitamin D or its metabolites effectively relieve clinical symptoms and signs.The serum and urinary calcium levels should be monitored frequently to reduce renal complications .

Toll-like receptor 4 (TLR4), a type Ⅰ transmembrane protein, has been extensively studied in the Toll-like receptor family at present. TLR4 ligands include lipopolysaccharides ( LPS) present in the outer membrane of gram-negative bacteria and monophosphoryl lipid A ( MPLA) which is a derivative of LPS. TLR4 agonists, alone, as a major component of compound adjuvants or in combination with other TLRs agonists, have been widely used as adjuvants in various vaccines and demonstrated great potential in vaccine development. This review addressed the discovery, application, features and prospect of novel vac-cine adjuvants based on TLR4 agonists, aiming to provide reference for rational use of adjuvants and further development.

Objective:This study analyzes COVID-19 prevention and treatment technology patents from 103 countries and regions worldwide, in order to have a good grasp of the most-current trends in COVID-19 prevention and treatment technology research worldwide, discuss the research directions of such technologies, provide theoretical foundations for interdisciplinary and multi-team cooperation.Methods:The retrieval strategies were constructed utilizing the retrieval and analysis system by the Regional Patent Information Service (Nanjing) Center of The State Intellectual Property Office and IncoPat's scientific and technological innovation platform, using third-level branches as the unit and separating the retrieval and proof processes, the queries built using IPC classification numbers and key words; the search was limited to invention patents, with utility models and designs excluded.Results:On February 14, 2020, there had been a total number of 136 087 invention patent applications for COVID-19 prevention and treatment technologies globally. In terms of the country of origin, the U. S. ranked first with 56 095 patents, followed by China (18 096). In terms of technical field, the top three were chemical therapeutic agents (47 634), vaccines (47 248) and diagnostic tests (12 991), with the U. S. possessing absolutely advantageous patent portfolios in all three fields. The applicants were mainly comprised of large enterprises abroad and universities and research institutes in China.Conclusions:China′s COVID-19 related patent applications are relatively scattered. In the field of chemotherapy, there is room for improvement compared with the advanced countries, and cooperation between scientific institutions and enterprises is insufficient. Therefore, China should further increase investment in chemical drug research and development and seize the opportunity to actively promote the research and development of vaccine technology. On the other hand, we need to consolidate the technical advantages and product advantages of epidemic prevention and control which are already accumulated, and strengthen the protection and layout of intellectual property rights. Furthermore, the technological innovation system combining production, education and research is the breakthrough point to encourage enterprises to become the subject of technological innovation.Last but not least, we should build a service platform for the transfer and transformation of scientific and technological achievements to enhance intellectual property rights and promote the transformation of scientific and technological achievements.

Objective: To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder, and to summarize the experiences. Methods: The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed. All patients were male, aged 33 to 77 years, with an average of 64.4 years. Body mass index ranged from 18.0 to 31.8 kg/m^2, with an average of 23.2 kg/m². One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor, with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma. No case underwent neoadjuvant therapy, and all cases were clinically staged as cT_2a-3bN_0-2M₀. Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed. The specific procedures were described as follows. After bladder resection, the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve, with the proximal part retaining 15 cm lumen as the input loop, and the distal part of 40 cm ileum being folded in 1∶1 ratio. The folded intestinal segment was made into a allantoic sac by using a linear incision closure device, forming a "ρ" shape with the input loop, bilateral ureters and the input loop. Anastomosis of wall, distal end of allantoic and urethra was performed.Record the perioperative data such as operation time, estimated bleeding, postoperative recovery, complications, and follow-up results. Result: All of the 11 cases underwent successfully operation, and no cases were transferred to open surgery. The operation time ranged from 320 to 440 minutes, with an average of 357.1 minutes. The estimated amount of bleeding ranged from 100 to 300 ml, with an average of 207.1 ml. The total time of intestinal tract procedure was 80-100 minutes, with an average of 89.3 minutes, and the time of allantoic preparation was 14-19 minutes, with an average of 16.1 minutes. The pain score was 2-5 points at 4 hours after operation, with an average of 3.8 points, and 1-4 points at 24 hours after operation, with an average of 2.3 points. Postoperative exhaust time ranged from 2.5 to 3.5 days, with an average of 3.0 days.Catheter removed 21 days after operation, with 9 cases of urinary incontinence, including mild in 6 cases, moderate in 2 cases and severe in 1 case, with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks. Postoperative hospital stay ranged from 7 to 13 days, with an average of 10.4 days. The drainage removal time was 4-11 days, with an average of 6.7 days. Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma, 3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma. The tumors invade the prostate in adenocarcinoma patient, with left (3/13) and right (1/9) positive lymph nodes. One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes, and the other cases were negative. The margin were negative in all patients. Pathological staging was pT_2a-4aN_0-2M₀. Postoperative adjuvant chemotherapy with gemcitabine+ cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks, with an average of 17.4 weeks, the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation, and the other cases have no recurrence or metastasis. Dual J-tube was removed in 9 cases in the last follow-up, and the new bladder volume was estimated 300-350 ml, with residual urine of 0-43 ml and 19 ml of average. There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated. Conclusions Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time. The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.

Objective To explore the efficacy and safety of 980 nm diode laser therapy for treatment of benign prostatic hyperplasia (BPH). Methods Data of 170 patients with BPH treated with 980nm diode laser system were reviewed. The mean operative time, blood loss, surgical complications, the international prostate symptom score (IPSS), bladder residual urine volume and flow rate changes were collected and analyzed. Results One hundred and seventy cases were safe during the perioperative period. The average operation time was (74 ± 11) min, surgical removal of prostate tissue mass of (54±12) g, blood loss (72±11) ml. There was no TUR syndrome occurred. 170 patients were followed up 2 to 24 months. The IPSS decreased from preoperative 25.0±5.5 to 9.0±2.5. The maximum flow rate increased from preoperative (6.2±2.3)ml/s to post-operative (17.4±3.5) ml/s. The residual urine volume decreased from preoperative (210.0±25.6) ml to postoperative (25.2±4.6) ml. All the differences were statistically significant (P＜0.05). Conclusion Transurethral vaporization of 980 nm diode laser could be a safe and effective treatment modality for BPH.

OBJECTIVETo establish a cell line with human NADH-cytochrome b5 reductase (b5R) deficiency via RNA interference (RNAi).

METHODSTwo siRNA expressing vectors targeting the b5R mRNA were designed and constructed. Hepatocellular carcinoma BEL-7402 cells were transiently transfected with the two recombinants by lipofectamine (TM) 2000, and semi-quantitative RT-PCR was carried out to analyze the suppression of b5R mRNA; BEL-7402 cells stably transfected with the two siRNA expressing vectors were selected in the media with G418. By analyses of the mRNA, enzymatic activity and protein level of b5R, several cell clones with deficiency of b5R were established. The cell growth curve of BEL-7402 cells with b5R deficiency was detected by MTT assay.

RESULTSTwo siRNA expressing vectors targeting b5R mRNA were obtained, namely pSib5R-1 and pSib5R-2. When BEL-7402 cells were transfected transiently with pSib5R-2, the expression of b5R mRNA was significantly suppressed with a suppression ratio of 68.3%, indicating that pSib5R-2 could trigger the degradation of b5R mRNA effectively. Eighteen clones stably integrated exogenous plasmids were obtained. In two clones from pSib5R-2 transfection, the expression of b5R mRNA was suppressed by up to 48.2% and 56.2%, and the enzymatic activity was inhibited by up to 54.6% and 63.5%, respectively. The protein levels also decreased significantly. The defect of b5R did not change the cell growth rate.

CONCLUSIONThe expression of b5R in BEL-7402 could be suppressed by vector-based RNA interference effectively. We established a cellular model with defect of b5R successfully, which can be used as a tool in investigation of the biological function of b5R and molecular mechanism of type II recessive congenital methemoglobinemia.

Cell Culture Techniques ; Cell Line, Tumor ; enzymology ; Cells ; enzymology ; Cytochrome-B(5) Reductase ; deficiency ; genetics ; Gene Expression ; drug effects ; Genetic Vectors ; Humans ; RNA Interference ; physiology ; RNA, Messenger ; metabolism ; RNA, Small Interfering ; pharmacology ; Transfection