Objective To explore the correlation between simple thyroid peroxidase antibody (TPOAb) positive (higher than the normal reference value) and the adverse pregnancy outcomes;and to discuss the necessity of clinical intervention on TPOAb positive and the characteristic of gestational thyroid peroxidase antibody changes.To study wether clinical intervention affects its direction.Methods Subjects were selected from TPOAb positive pregnant women during June 2012 to February 2015.They were registered regularly for thyroid function during pregnancy and 6 weeks postpartum,and timely treated for abnormal thyroid function.They were grouped according to the thyroid function:Group 1 (n =122),simple TPOAb positive group;Group 2 (n =67),patients with elevated TSH and positive TPOAb who accept the levothyroxine (L-T4) intervention;Group 3 (n =120),TPOAb negative healthy pregnant women.They were regularly tested for thyroid function during pregnancy,and with follow-up until 6 weeks postpartum.Results When Group 1 compared with Group 3:the risk of premature rupture of membranes,abnormal amniotic fluid,and fetal distress rate increased,the relative risk (RR) were 3.066,4.782,2.605,all P ＜0.01,while the gestational diabetes,gestational hypertension,preterm birth,abnormal gestation and birth showed no statistical differences (P＞0.05).When Group 2 compared with Group 3,the risk of premature rupture of membranes,abnormal amniotic fluid,and fetal distress increased (RR were 3.830,5.537,3.600 respectively,all P ＜ 0.01).While gestational diabetes,gestational hypertension,preterm birth,abnormal gestation and birth did not show any statistical difference (P＞0.05).Compared with Group 2,Group 1 had no statistical difference between the above observational parameters.The levels of TPOAb from stage T1 (the first trimester) to T3(the third trimester) showed a overall downward trend in Group 1 and Group 2,rise again six weeks after child birth.Comparison of the two groups (Group 1 and Group 2),the median value during this period did not reveal any significantly statistical differences (P＞ 0.05).Conclusion In simple TPOAb positive pregnant women,premature rupture of membranes,abnormality in amniotic fluid,and fetal distress were significantly higher than those in healthy pregnant women;even with thyroid function correction the TPOAb positive pregnant women still cannot reduce the adverse pregnancy outcomes.Levels of TPOAb from T1 to T3 presented the overall downward trend and to rise again six weeks after pregnancy.L-T4 intervention for TPOAb positive pregnancy did not show any significant effect.

Objective To investigate safety and efficacy of hysteroscopy in treatment of cesarean scar pregnancy(CSP).Methods From Aug.2003 to Dec.2011, 33 cases with CSP treated by hysteroscopy guided by transabdominal ultrasound or laparoscopy were studied retrospectively in Women's Hospital,School of Medicine, Zhejiang University.The clinical characteristics including gestational age, myometrial thickness anterior to the CSP, β-hCG level before treatment,success rate, cure rate, operative time, blood loss, time of serum β-hCG resolution and CSP mass clearance, and complication were collected and analyzed.Results Median gestational age was 54 days (range, 37 - 140 days).Median level of β-hCG before treatment was 15 000 U/L( range,3.3 - 151 747 U/L).Mean thickness of anterior myometrium was 3.3 mm.Twenty-nine cases underwent uterine artery embolism (UAE) before hysteroscopy.Pouch in the anterior uterine isthmus with gestation masses implanted were observed in 30 cases (91%, 30/33 ).CSP masses progressed toward the pouch or uterine cavity in all cases was removed by cutting wire loop electrode combined with curettage.The mean operative time was (34 ± 10) minutes.Both success rate and cure rate were 94% ( 31/33 ) .Salvage methotrexate ( MTX ) therapy was administrated in one case.Complication occurred in three cases (9%, 3/33 ).Both massive hemorrhage rate and hysterectomy rate were performed in two cases (6%, 2/33).No uterine perforation occurred.The mean time of hCG resolution was (22 ± 10)days.The mean time of CSP mass clearance was (21 ± 12) days.Four pregnancies were achieved in four cases:one term pregnancy and three abortions.No recurrent CSP occurred.Conclusion Management of CSP by hysteroscopy combined with UAE is safe and effective.

AIM:This study was concerned with the effect of Alexipharmie Capsule(Flos Lonicerae Japonicae,Fructus Forsythiae,Radix Scutellariae,Radix Isatidis,Herba Ephedrae,Radix et Rhizoma Glycyrrhizae) on fever,inflammation,pain and cough. METHODS: We adopted ear swelling mouse model induced by xylene and foot swelling mouse model induced by carrageenan to observe the anti-inflammatory effects;took 15% beer yeast and bacterial endotoxin as pyrogen to study the antipyretic effects on rats and rabbits;used acetic acid stretching method to observe the analgesic effects;adopted strong aqua ammoniae spraying and sulfur dioxide stimulus method to study the antitussive effects. RESULTS: Alexipharmic Capsule could obviously inhibit ear and foot swelling of mouse model(P

Objective To explore the clinical efficacy and safety of complex splenectomy.Methods The retrospective cohort study was adopted.The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,67 from Shanghai Jiaotong University Affiliated First People's Hospital,26 from Shanghai Jiaotong University Affiliated Sixth People's Hospital,7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected.All the patients received total splenectomy after splenic artery ligation.The observation indexes included:(1) surgical situations,(2) major complications including intraperitoneal hemorrhage,pulmonary complication,left subphrenic abscess and peritoneal effusion,(3) follow-up situations:portal vein (PV) complications (splenic venous thrombophlebitis,thrombosis of splenic vein and main portal vein thrombosis),survival of patients.The follow-up using outpatient examination and telephone interview was performed up to March 2016,and patients received regularly ultrasound reexamination,computed tomography (CT) rescan,routine blood retest and coagulation function.Measurement data with normal distribution were presented as-x ± s,and count data were analyzed using the chisquare test.Results (1) Surgical situations:of 235 patients,200 patients underwent secondary spleen pedicle severance and 35 patients underwent non-secondary spleen pedicle severance.Volume of intraoperative blood loss and duration of splenic resection were (268 ± 103) mL and (82 ± 29) minutes.(2) Major complications:of 31 patients with postoperative complications,intraperitoneal hemorrhage was detected in 12 patients,pulmonary complication in 17 patients,left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients.Some patients were combined with multiple symptoms.The patients with above complications were cured after reoperations and non-operative treatments.(3) Follow-up situations:PV complications:splenic venous thrombophlebitis was detected in 16 patients,thrombosis of splenic vein in 17 patients,thrombosis of splenic vein combined with main portal vein thrombosis in 7 patients,and they were improved after the treatments of antiinflammation,anti-coagulation and thrombolysis.The thrombi rate after splenectomy was 32.4％ (12/37) in patients with schistosoma-related cirrhosis and 8.1％ (12/149) in patients with HBV-related cirrhosis,with a statistically significant difference (x2 =10.9,P ＜ 0.05).Survival of patients:of 235 patients,228 were followed up for (7.9 ± 4.2) years,with good survival.Conclusion Complex splenectomy is safe and effective,and the key procedure determining the safety of complex splenectomy includes careful preoperative evaluation,delicate surgical technique,proper splenic pedicle severance and peritoneal wounds.

Objective To investigate the clinical significance of silent mating-type information regulation 2 homologue 1 (SIRT1) in hepatocellular carcinoma (HCC).Method We analyzed p53 mutation by gene sequencing and activation of SIRT1 and AMP-actived protein kinase (AMPK) using western-blot in 252 patients with hepatitis B virus-positive HCC.Results A higher proportion of tissues with mutant p53 were demonstrated to harbor activated SIRT1 (64.8％ vs 31.8％ ; P ＜ 0.01).Activated SIRT1 predicted a longer relapse-free survival.On multivariate analysis,activated SIRT1 remained significant (OR:0.339,CI:0.160-0.720,P =0.005).Analysis of 252 paired specimens revealed a significant correlation between activated SIRT1 and activated AMPK in HCC tissues harboring mutant p53 (P =0.007).Conclusion SIRT1 exerted anti-carcinogenic effects through the AMPK pathway in HCC in the context of mutant p53.

Objective To evaluate the outcome of surgical approaches in patients of gastric cancer with portal hypertension.Methods The clinical data of 80 patients with portal hypertension undergoing curative surgery for gastric cancer or simultaneous surgery for portal hypertension were retrospectively analyzed.Results The radical gastrectomy alone had no tremendous impact on postoperative liver function.But simultaneous surgery for portal hypertension affected patients' liver function dramatically (P =0.018).For those who underwent surgery for portal hypertension simultaneously,the incidence of complications in Child B patients was much higher than that in Child A patients (P =0.018).However,the incidence of complications did not differ between Child A and B patients who underwent radical gastrectomy alone.In addition,patients undergoing simultaneous surgery for portal hypertension had more severe complications than those who underwent radical gastrectomy only (P =0.042).Age ＞ 50 (P =0.012),tumor stage (P =0.015),and simultaneous surgery for portal hypertension (P =0.007) were the independent risk factors for postoperative liver dysfunction.The survival time of patients undergoing simultaneous surgery for portal hypertension was significantly shorter than that of patients undergoing radical gastrectomy only (in Child A patients,P =0.009,in Child B patients,P =0.000).Conclusions Individualized surgical approaches for the treatment of gastric cancer with portal hypertension should be decided by preoperative liver function.Simultaneous management of portal hypertension was not recommended.

Objective To investigate the effects of peritoneal injection of cobaltic protoporphyrin Ⅸ chloride(CoPP)to induce heme oxygenase-1(Ho-1)upregulation in rat islet cells.Mthods Forty rats were divided into 5 groups by management 24 h before islets isolation:group A received inlzaporitoneal injection with 2.5 ms/ks CoPP,group B with 5 ms/ks CoPP,group C with 7.5 ms/kg CoPP,and group D with 10 mg/kg CoPP.In control group NS was used instead.A modified Goth approach was used for islet isolation.the yield and purity of the islets were assessed.The expression of Ho-1 mRNA and protein were detected by real time-PCR and Western blotting respectively.Islet function was tested by glucose stimulation test.Result Severe damage was found in tlle rats in group C and D.There was no difference in islet yield and purity for group A、B、C and control(P＞0.05).Group B had the highest Ho-1 mRNA and protein expression among the 4 groups.Though there was no difference in insulin secretion by low glucose challenge for group A、B and control's islets(P＞0.05),when challenged by hish level of glucose,significant deviation was observed.The imulin secretion level was(172.37±16.4)、(187.68±19.93)and(91.25±Conclusion Peritoneal iajection of 5 mg/kg CoPP can significantly enhance the expression of Ho-1 mRNA and protein in tat islet safely and enhance the function of islet when challenged by hish concentration of glucose.

Objective To analyze the protection supplied by HSCs in vivo after islet cells homotransplantation. Method Diabetic mice were randomly divided into three groups as diabetic group,islet-transplant group and co-transplant group. 300 islets alone or mixed with HSCs were transplanted under the capsule of the kidney of the diabetic recipients respectively. Blood glucose and the length of normal blood glucose level were recorded and we collected the blood and tissue of islet graft 7 days after transplantation in each group. Blood concentration of TGF-β, TNF-α, IL-1β and IFN-γ were detected by ELISA. The infiltration of lymphocytes was observed by HE staining and immunohistochemieal examination.Result Co-transplant group had a prolonged islet allograft survival for (23.75 ± 8. 96) days, compared with the islet alone of (11.9 ± 6. 92) days. Blood concentration of TGF-β in co-transplant group was (2292.31 ± 5.87) pg/ml, significantly higher than those in simple transplant group (1246.55 ±38.91) pg/ml(P <0.05), there was no differentence in the two groups for TNF-α,IL-1β and IFN-γ.Conclusion HSCs may prolong the islet graft survival by expressing higher level of TGF-β and form a capsule around the graft.

Objective To analyze the dose-effect relationship between cobalt protoporphyrin (CoPP) and heme oxygenase-1 (HO-1) expression in islets and to investigate the protective effect of strongly expression of HO-1 in islet xenotransplantation. Methods Donor islets isolated and purified from SD rats were randomly divided into 5 groups and incubated with different doses of CoPP for 24 h.Group A: 0 mmol/L; Group B: 5 mmol/L; Group C: 25 mmol/L; Group D: 50 mmol/L; Group E:75 mmol/L. The expression of HO-1 mRNA and protein in islets was detected by RT-PCR and Western blot respectively. Glucose of low and high concentrations was added to islets in vitro to test insulin-releasing function. The optimal dose of CoPP which could induce the strongest HO-1 expression was chosen according to the results. Recipients were randomly divided into 2 groups. Control group received untreated xeno-islets, and the experimental group received islets incubated with optimal CoPP close in vitro. Glycemia and rejection were observed after transplantation daily. Results The expression of HO-1 mRNA and protein in xeno-islets of group D was significantly higher than in other groups (P＜0.05). After stimulation of glucose, the insulin concentration in group D was significantly higher than in other groups (P＜0.05). The optimal dose of CoPP which could induce the strongest HO-1 expression was 50 mmol/L. The time for normoglyeemia in experimental group was (14.63±1.19) days, significantly longer than that in control group (9.88±2.17)days (P＜0.01). Conclusion The strongest expression of HO-1 induced by CoPP in vitro promotes the glucose-stimulated insulin secretion of islets and prolonged the survival of xeno-islet grafts by protecting them from rejection.

Objective To assess the indication and safety of surgical resection of the pregnancy by hysterotomy (SRPH) and hysterectomy for cesarean scar pregnancy (CSP). Methods A retrospective study of women with CSP was conducted at the Women′s Hospital, School of Medicine, Zhejiang University, from Jan. 2003 to Mar. 2016. The women underwent SRPH (SRPH group, n=35) and hysterectomy (Hysterectomy group, n=14) were included. The gestational age (GA), size of gestational mass(GM), level of serum β-hCG, previous treatments and clinical outcomes were analyzed. Results The median GA, the mean size of GM, median serum β-hCG level, median amount of blood loss, rate ot blood transfusion, rate of persistent CSP, and rate of motal status in SRPH group versus Hysterectomy group were 66 versus 84 days, (65 ± 22) versus (92±36) mm, 23755 versus 802 U/L, 400 versus 650 ml, 11%(4/35) versus 13/14, 49%(17/35) versus 12/14, 20% (7/35) versus 14/14, respectively (all P<0.05). In SRPH group, median amount of blood loss was 500 ml in patients with GA≥10 weeks versus 300 ml in patients with GA<10 weeks (P<0.05). Serious complication occurred in 7 patients: severe pelvic inflammation in 1 patient and hematomas in the uterine isthmus in 1 patient in SRPH group; severe pelvic inflammation in 2 patients and hemorrhagic shock and DIC in 3 patients in Hysterectomy group. No blaader damage occurred. Conclusions SRPH is effective and safe for patients with CSP with GA of 9-10 weeks, a diameter of 60-90 mm and stable hemodynamics. Hysterectomy is an alternative to SRPH for patiens in motal status with advanced GA more than 12 weeks.