Objective: To investigate the value of first-trimester ultrasound parameters in predicting complicated monochorionic diamniotic (MCDA) twins. Methods: In this retrospective study, pregnant women diagnosed as MCDA twins by ultrasound in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to January 2018 were recruited and divided into the following four groups: non-complicated MCDA twins group, twin-twin transfusion syndrome (TTTS) group, selective intrauterine growth restriction (sIUGR) group and twin anemia-polycythemia sequence (TAPS) group. Thickness of nuchal translucency (NT), crown-rump length (CRL), umbilical cord insertion (UCI) and ductus venosus (DV) flow at 11-14 weeks of gestation were recorded. The predictive value for complicated MCDA twins was analyzed using t-test, Chi-square (or Fisher's exact) test, multivariate logistic regression analysis and receiver operating characteristic (ROC) curve. Results: (1) A total of 430 MCDA twin pregnancies were included in this study with 152 in the TTTS group, 142 in the sIUGR group, seven in the TAPS group and 129 in the normal MCDA twins group. No further analysis was performed on the TAPS group due to the small sample size. (2) NT discordance in twins of the TTTS group was significantly greater than that in the normal MCDA twins group[(21.5±16.0)% vs (14.6±13.5)%, t=-3.533, P<0.001]. The area under ROC curve (AUC) of TTTS predicted by NT discordance was 0.649. Stratified analysis showed that TTTS was best predicted when NT discordance was 20% with the sensitivity of 57.9% and specificity of 70.6%. (3) The sIUGR group had greater discordance in CRL and NT and higher UCI discordance than the normal MCDA twins group [NT: (27.8±21.3)% vs (14.6±13.5)%, t=-5.556, P<0.001; CRL: (8.6±6.9)% vs (5.4±4.4)%, t=-3.144, P=0.002; UCI: 47.9% (68/142) vs 13.9% (18/129), χ²=35.929, P<0.001]. The AUC of sIUGR was 0.675 predicted by NT discordance and 0.649 by CRL discordance. Stratified analysis showed that NT discordance of 20% and CRL discordance of 10% were the best prediction for sIUGR with the sensitivity of 53.1% and 34.7% and specificity of 72.1% and 83.8%, respectively. Multivariate logistic regression analysis suggested that UCI discordance was the risk factor for sIUGR (OR=7.165, 95%CI: 2.637-19.472). Conclusions MCDA twins with NT discordance greater than 20% during early pregnancy are at increased risk for TTTS. CRL discordance greater than 10%, NT discordance greater than 20% and abnormal UCI are risk factors for sIUGR.

Objective To observe the effect of stomach dampness decoction combed with quadruple therapy in the treatment of Hp related peptic ulcer .Methods 80 patients with Hp related peptic ulcer were randomly divided into two groups according to randomized block design , with 40 cases in each group .The control group received the quadruple therapy ,inculding orally pantoprazole enteric -coated tablets ,bismuth potassium citrate granules ,amoxicil-lin capsules,levofloxacin tablets.The study group was given Hewei Huashi decoction on the basis of the control group . The duration of treatment was 14 days and the effect was assessed after 1 month,the healing of ulcer and the improve-ment of clinical symptoms were observed .Results The ulcer healing rate in the study group ( 82 .5％) was higher than that in the control group (62.5％),the difference was statistically significant (χ2 =4.013,P=0.045).There was no statistically significant difference in total effective rate between the two groups ( 95.0％ vs.87.5％,χ2 =0.626,P=0.429).Before treatment,there were no statistically significant differences in the integral and the total integral of the imultaneous phenomenon between the two groups (all P>0.05).After treatment,the accompanying symptom scores and the total integral of the study group significantly reduced ,and the fullness[(0.28 ±1.03)points vs.(0.62 ±0.87)points,Z=-2.022],ructus[(0.40 ±0.67)points vs.(0.88 ±1.04)points,Z=-2.054],noisy [(0.25 ±0.49)points vs.(0.60 ±0.78)points,Z =-2.135],diarrhea[(0.25 ±0.49)points vs.(0.62 ± 0.71)points,Z=-2.642]and the total score[(2.52 ±1.71)points vs.(4.35 ±2.76)points,Z=-3.073]were better than those of the control group,and the differences were statistically significant (all P <0.05).The total effective rate of imultaneous phenomenon in the study group (97.5％) was higher than that of the control group (75.0％),and the difference was statistically significant (χ2 =6.746,P =0.009).Conclusion The stomach dampness decoction combined with quadruple therapy in the treatment of Hp related peptic ulcer has better curative effect,and it can more effectively improve the quality of healing and clinical symptoms .

Objective To investigate the clinicopathologic features of Chinese patients with early gastric cancer (EGC) according to the World Health Organization(WHO) diagnostic criteria,and to explore the risk factors of lymph node metastasis (LNM) in EGC.Methods From 2002 to 2017,at the Second Affiliated Hospital of Nantong University,and from 2014 to 2017,at the People's Hospital of Qidong City,the People's Hospital of Haimen City and the People's Hospital of Rugao City,315 EGC patients with complete clinicopathological data were enrolled.The clinicopathologic features were analyzed including gender,age,tumor location,tumor size,macroscopic type,histological type (WHO),differentiation degree,depth of tumor invasion,Lauren subtype,infiltration pattern,ulceration,lymphoid follicles,lymphovascular invasion and perineural invasion.Chi-square test and Fisher's exact test were performed for univariate analysis and the logistic regression was used for multivariate analysis.Results The ratio of EGC was 10.0％ (315/3 140) of patients with gastric cancer and received surgery during the same period.Among the 315 EGC,the ratio of well-differentiated tubular adenocarcinoma was 11.7％ (37/315),which was lower than 24.8％(2 752/11 104) in Japan and 19.9％(41/206) in South Korea,and the differences were statistically significant (x2 =28.208,P＜0.01;x2 =6.51 0,P =0.011),however there was no statistically significant difference when compared with Western countries (11.9 ％,8/67;x2 =0.002,P=0.964).Among the 276 patients who underwent radical gastrectomy,49 (17.8 ％) patients had with LNM.The results of univariate analysis showed that tumor size,macroscopic type,differentiation degree,depth of invasion,infiltration pattern,ulceration and lymphovascular invasion were related with LNM(x2=9.327,6.038,6.381,34.983,19.309,52.297 and 5.058;all P＜0.05).The results of multivariate analysis revealed that lymphovascular invasion and ulceration were the independent risk factors of LNM (odd ratio (OR)=7.028 and 2.566,both P＜0.05).Conclusions There is obvious difference in pathological diagnostic standard of well-differentiated tubular adenocarcinoma between China,Japan and South Korea,which may influence the therapeutic strategy of EGC.Lymphovascular invasion and ulceration are independent risk factors of LNM in EGC.

Objective To explore clinieopathologieal features and prognosis in a high grade malignancy group of colorectal mueinous carcinoma, signet-ring cell carcinoma and low-differentiated carcinoma. Methods Retrospective analysis and follow-up were made on 148 patients with colorectal mucinous carcinoma, 55 patients with signet-ring cell carcinoma and 281 low- differentiated carcinoma treated in our hospital from 1988 to 2006. Obtained data were analyzed by SPSS13.0. Related factors underwent x2 analysis, survival analysis were estimated using Kaplan-Meier method and compared using the Log-rank test. Results Coloreetal signet-ring cell carcinoma were significantly different from mucinous carcinoma and low- differentiated carcinoma in gender, age, tumor location, bowel obstruction, operative modus, tumor embolism, tumor infiltration and lymph node metastasis(x2 = 7, 67,38.4,86.0,14.5,93.7,17.3,62. 1,24. 4,56.17 ,P <0.05). Median survival time was 24 months in signet-ring cell carcinoma, 47 months in mueinous carcinoma and 49 months in low- differentiated carcinoma. The difference is of significance(x2 = 21.3, P < 0.05). Conclusions Clinicopathological characteristics and prognosis of colorectal signet-ring cell carcinoma, mueinous carcinoma and low- differentiated carcinoma is of significant difference(P < 0.05). Malignancy of signet-ring cell carcinoma is higher with worse prognosis.

Objective To study the relationships between neutralizing antibody response against heterologous virus and disease progression in Chinese HIV-1 B'/C infected individuals. Methods Plasmas from HIV-1-infected individuals, grouped as HIV chronically infected or AIDS according to CD4+ count and clinical symptom, were tested for neutralizing activity against the three HIV-1 isolates with very low homology in vitro. Six two-fold dilutions of each plasma sample (from 1/10 to 1/320) were tested against each virus from the panel. Giving a 50% reduction in p24Ag compared with normal human plasma control wells was defined as positive. The breadth of the cross-neutralizing response was defined based on the number of viruses that were effectively neutralized by any given patient-derived plasma sample. The magnitude of the crossneutralizing response was defined based on the average neutralizing titer against all heterologous viruses. Resuits We found that there revealed a significant difference between HIV chronically infected and AIDS group in the breaths and magnitudes of neutralizing heterologous virus. There was higher prevalence for the frequency of neutralizing heterologous virus in HIV chronically infected than AIDS. The results showed that there was positive correlation between the breadths and magnitudes of neutralizing response against heterologous virus and the plasma HIV RNA level in HIV chronically infected group, while not in AIDS group. There was no association between the breadth of the neutralizing responses against heterologous virus and CD4 T cell counts. Conclusion The capacity of neutralizing antibodies against heterologous virus varied among different disease stage. There were higher titers of neutralizing antibodies in HIV chronically infected than AIDS group. The loss of neutralizing antibodies in plasma from AIDS group appears to be associated with a narrowing of the antibody response during disease progression. These suggest that the presence of neutralizing antibodies against hetreologous virus was associated with disease progression.

Objective To evaluate the clinical presentation,pathologic features,diagnosis and treatment of hepatic angiomyohponm(HAML).Methods Retrospective analysis was made on 22 HAML cases in terms of clinical finding,images,pathologic examination and surgical treatment.Results Of the 22 patients,6 were male and 16 were female.The average age was 48.2 years.Seventeen patients had no clinical symptoms.None had the history of hepatitis virus infection.None of them was complicated with renal AML.None had tlle history of taking oral contraceptives in the sixteen female patients.Serum AFP、CEA、CA19-9、CA242 levels were all within normal limits.The correct diagnostic rate of BUS.CT and MRI was 2l%(4/19)、23.5%(4/17)and 25%(2/8),respectively.All tumorts were single nodule with a diameter of 4～17 cm,without complete capsula.All these 22 patients underwent tumor resection,including partial liver resection in 17 patients,left hemihepatectomy in 5.One patient died of postoperative complication,one patient suffered from temporary bile leak.The HMB45 positive rate by immunohistochemical method was 100%.Extramedullary hemopoiesis was found in 4 patients.Follow up of 6 months to 17 years in 91%(20/22)patients found no tumor recurrence. Conclusions HAML had no specifiC symptoms.The preoperative imaging diagnosis is difficult.Surgical resection is the therapy of choice for HAML.

Objective To explore the clinicopathological characteristics as prognostic factors in patients with colorectal signet-ring cell carcinoma. Methods Clinical data of 62 patients of colorectal signet-ring cell carcinoma and 281 patients of colorectal low-differentiated adenocarcinoma were retrospectively analyzed. COX Proportional Hazards Model was used in multivariate analysis. Results Colorectal signet-ring cell carcinoma occurred more frequently in young patients and most of them located in the rectum. Gender, preoperative CEA, pathological type and liver metastasis were not statistically different from low-differentiated adenocarcinoma (X2=0.07,0.04,0.06,1.79,P>0.05).Bowel obstruction, operative modalities, tumor embolism, infiltration depth, lymph node metastasis were statistically different from low-differentiated adenocarcinoma (X2=8.96,75.1,18.5,72.0,7.44,P<0.05). Median survival time was 28 months in patients of colorectal signet-ring cell carcinoma and 49 months in patients of colorectal low-differentiated adenocarcinoma. The difference was statistically significant (X2=12.51,P<0.05). Infiltration depth, lymph node metastasis, operative modalities and postoperative adjunctive therapy were independent prognostic factors based on a multivariate analysis of the COX Proportional Hazards Model. Conclusions The biological malignancy of colorectal signet-ring cell carcinoma is higher than that of low-differentiated adenocarcinoma in colorectal carcinoma. Radical resection and postoperative adjunctive therapy were effective treatment methods.

Objective To investigate the surgical treatment for patients with isolated recurrence and metastasis of colon cancer after primary curative-intent resection. Methods In this stuay,58 cases suffering from postoperative recurrence of colon cancer between the year of 1996-2005 were analyzed retrospectively.Data were analyzed using statistical package for the social sciences(Release 11.5,SPSS,Inc).x2 analysis was used to determine the related factors,survival analysis was estimated using the Kaplan-Meier method and compared using tlle log-rank test. Results In this reoperative group radical resection was achieved in 81%(47/58)cases,and palliative operation in 11 cases,with median survival time of 48 months and 12 months respectively(x2=12.30,P=0.0005). Conclusion Postoperative isolated recurrence and metastasis of colon cancer usually allows radical resection in most cases with favorable long-time survival.

Objective To investigate the killer cell lg-like receptors (KIR) gene frequency of HIV-1 infected slow progressors(SP) and typical progressors(TP), and to analyze the interaction between KIR alleles and the progression of HIV-1 infection in Chinese population. Methods Eighty-one HIV-1 posi-tive individuals including 43 SPs and 38 TPs were recruited. Carriage of KIR genes was assessed using poly-merase chain reaction sequence-specific primers (PCR-SSP) assays. Results KIR2DS3 gene frequency was significantly lower in SP group (3.6%) than that in TP group (14.2%), P =0. 018 ,OR =0. 210,95% CI =0.053-0.833. The number of activating KIR genes was less in SP group than that in TP group, but was not significant (P = 0. 208). Conclusion Lower KIR2DS3 gene frequency may potentially be associated with slower progression to AIDS in Chinese population.

OBJECTIVETo develop bioluminescence method to measure DNA adducts in human peripheral lymphocytes and study the factors that affect the level of DNA adduct, in order to use it in studying the relationship between water pollution and human DNA adduct levels.

METHODThe measurement of DNA adduct in peripheral lymphocytes was carried out in 234 normal persons, and the relationship between DNA adducts levels and age, smoking and eating habit etc. was analyzed.

RESULTS(1) The level of DNA adduct in males was higher than that in females, but without significance (P > 0.05); (2) The level of DNA adduct was significantly correlated with age, smoking, tea drinking, eating habit and alcohol drinking. Among them, age plus smoking were the most important factors affected the DNA adduct levels (P < 0.01). The level of DNA adduct increased with age. The more cigarette smoked, the higher was the level of DNA adduct.

CONCLUSIONThe level of DNA adduct is affected by many factors, so it needs further research to apply it in the biomonitoring and risk assessment of environment chemicals.

Adult ; Age Factors ; Aged ; DNA Adducts ; analysis ; Female ; Humans ; Luminescent Measurements ; Lymphocytes ; chemistry ; Male ; Middle Aged ; Sex Factors ; Smoking ; metabolism