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Objective:To investigate the risk factors of birth weight discordance in dichorionic diamniotic (DCDA) twins.Methods:This study retrospectively analyzed 1 757 cases of DCDA twin pregnancies from 11 Chinese hospitals from January 1, 2014, to December 31, 2017. Birth weight discordance was defined as ≥ 20% difference between the twins. All cases were divided into two groups: the concordant group ( n=1 520) and discordant group ( n=237). General information was compared and the high-risk factors of birth weight discordance were analyzed. Mann-Whitney U test, Chi-square test or Fisher's exact test, and logistic regression analysis were used as statistical methods. Results:Compared with the concordant group, the discordant group showed a higher incidence of hypertensive disorders of pregnancy [24.5% (58/237) vs 12.8% (194/1 520), χ2=22.882, P<0.05], fetal structural malformations [4.2% (10/237) vs 1.0% (15/1 520), χ2=15.160, P<0.05], fetal distress [6.3% (15/237) vs 1.4% (21/1 520), χ2=22.602, P<0.05], umbilical cord abnormalities [3.8% (9/237) vs 1.2% (18/1 520), χ2=7.607, P<0.05] and abnormal placental cord insertion [3.8% (9/237) vs 1.4% (21/1 520), χ2=34.904, P<0.05], but lower incidence of premature rupture of membranes [11.0% (26/237) vs 16.5% (250/1 520), χ2=4.645, P=0.034]. Logistic regression analysis showed that the independent risk factors of birth weight discordance in DCDA twins were hypertensive disorders of pregnancy ( OR=2.258, 95% CI: 1.620-3.184, P<0.001), fetal structural malformations ( OR=4.268, 95% CI: 1.892-9.631, P<0.001), umbilical cord abnormalities ( OR=2.889, 95% CI: 1.245-6.705, P=0.014) and abnormal placental cord insertion ( OR=2.318, 95% CI: 1.012-5.311, P=0.047). Conclusions:Hypertensive disorders of pregnancy, fetal structural malformations, umbilical cord abnormalities and abnormal placental cord insertion may be the risk factors of birth weight discordance in DCDA twins.
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Objective To study the regulation of microRNA - 22(miR - 22)on glycometabolism of hemato-poietic stem cell TF - 1 and its molecular mechanism. Methods TF - 1 cells were cultured for 2 h under hypoxic con-ditions. The expression levels of Glut4 and miR - 22 was detected by quantitative real-time PCR(qRT - PCR). The sgRNA vector of the miR - 22 gene was constructed and miR - 22 gene of TK - 1 cells was knocked out by the CRISPR/ Cas9 technique. Overexpression vectors were constructed,and miR - 22 knocked - out cells were introduced to overexpress miR - 22,the expression of miR - 22 was detected by qRT - PCR and the expression levels of Glut4 and PPAR - γ were detected by qRT - PCR and Western blot. Results Compared with the control group,the expression of miR - 22 in TF - 1 cells decreased (0. 015 ± 0. 000 vs. 0. 056 ± 0. 001)and the expression of Glut4 (0. 351 ± 0. 038 vs. 0. 152 ± 0. 005)and PPAR - γ (0. 421 ± 0. 017 vs. 0. 248 ± 0. 008)increased,when TF - 1 cells were cultured for 2 h under hypoxic conditions,and the differences were statistically significant (all P < 0. 05). Compared with the control group,the expression levels of Glut4 (0. 019 ± 0. 00 vs. 0. 008 ± 0. 000)and PPAR - γ (0. 038 ± 0. 001 vs. 0. 019 ± 0. 000)were significantly increased after miR - 22 gene silencing,and they were significantly decreased (Glut4:0. 005 ± 0. 000 vs. 0. 008 ± 0. 000;PPAR - γ:0. 137 ± 0. 000 vs. 0. 019 ± 0. 000)after overexpression of miR - 22,and the differences were statistically significant (all P < 0. 05). Conclusions It suggests that miR - 22 ex-erts a negative regulation on glycometabolism of hematopoietic stem cell TF - 1 by downregulating the expression of PPAR - γ. A new regulatory factor of TF - 1 glycometabolism and the mechanisms are identified,which has provided new ideas for the targeted medication of diseases induced by hematopoietic stem cell dysfunction.
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Objective To compare the advantage and disadvantage of peroral endoscopic myotomy (POEM)and pneumatic dilation(PD)for the treatment of achalasia of cardia(AC). Methods Patients with confirmed AC undergoing endoscopic therapy in Southwest Hospital, Third Military Medical University between January 2011 and September 2014 were divided into POEM treatment group(n=56)and PD treatment group(n = 30), according to the decision of the patients and their families. Postoperative improvement of clinical symptoms, changes in the maximum esophageal diameter, complications, hospital stay,and inpatient expenses were compared between the two groups. Results No significant differences were observed in general preoperative data between the two groups,including gender,age,body mass index (BMI),maximum esophageal diameter, Eckardt score and disease duration(all P>0.05). The Eckardt score showed a significant decrease in 1, 6, and 12 months after operation compared to the pre?operation score in both groups(P<0.05). No matter 1 month or 6 months after operation, the Eckardt score had no significant difference between the two groups(P>0.05). Six months after operation, the response rate between the two groups was no significantly different[93%(52/56)VS 80%(24/30), χ2=0.115, P=0.076],but the maximum esophageal diameter of the POEM group was smaller than that of the PD group (25.39±7.12 mm VS 32.12±9.99 mm,t=3.612,P=0.001). Twelve months after operation,the Eckardt score of the POEM group was lower than that of the PD group(0.44±0.85 score VS 1.26±1.74 score,t=2.940,P= 0.004), and the response rate was higher in the POEM group[93%(52/56)VS 80%(24/30),χ2=0.115, P=0.076]. The incidence of pneumatic complications was 32%(18/56)in the POEM group,but none occurred in the PD group(χ2=12.195,P=0.000). The hospital stay of the POEM group and the PD group was 12.33±4.13 days and 6.50±2.28 days, respectively(W=616, P=0.000). The inpatient expense of the POEM group and the PD group was 8 013.283± 4 322.695 yuan, and 1 571.018±1 590.193 yuan,respectively(W=505,P=0.000).Conclusion Both POEM and PD showed good short?term efficacy for AC.POEM is more effective,and its treatment outcome lasts longer,whereas PD has more widely indications because it is easier to operate with less complications,shorter hospital stay,and lower costs.Trail registration Chinese clinical trial registry,ChiCTR?OOC?15005889.
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Objective:To investigate the efficacy and safety of bevacizumab combined with chemotherapy in patients with retreated advanced non-squamous non-small cell lung cancer (NSNSCLC) and analyze its prognostic factors. Methods:Forty-one patients with previously treated advanced NSNSCLC in Beijing Chest Hospital from February 2013 to June 2017 were recruited. Clinical data of the patients were retrospectively analyzed. There were 38 cases of adenocarcinoma and 3 cases of other pathological types. Bevacizumab combined with chemotherapy served as second-line treatment for 19 patients, and it served as beyond second-line therapy for 22 pa-tients. Eighteen patients harbored epidermal growth factor receptor (EGFR) gene mutations, while the other 23 patients harbored wild-type EGFR gene. The efficacy and safety of bevacizumab combined with chemotherapy were evaluated. To evaluate the prognos-tic factors, single and multiple factor analyses were conducted. Results:All patients received bevacizumab combined with chemothera-py and could be evaluated for response. The mean number of cycles of chemotherapy and chemotherapy combined with bevacizumab were 3.1 and 5.0, respectively. The objective response rate (ORR) of all recruited patients was 12.2％. The disease control rate (DCR) was 82.9％. Regarding the effect of second-line and beyond second-line therapy in patients, data were similar. The ORRs were 10.5％and 13.6％, respectively (P=0.572), and DCRs were 89.5％and 77.3％, respectively, without significantly statistical difference (P=0.271). The median progression-free survival (PFS) and overall survival (OS) were 4.6 months [95％confidence interval (CI) 3.619-5.581] and 11.9 months (95％CI 9.797-14.003), respectively. In the single factor analysis, patients with EGFR mutations, those who received>4 cy-cles of bevacizumab administration, and women had longer OS (χ2=19.673, P=0.000;χ2=6.820, P=0.009;andχ2=6.374, P=0.012;respec-tively). The Cox regression analysis showed that EGFR mutation status and number of cycles of bevacizumab administration were inde-pendent prognostic factors [hazard ratio (HR)=0.129, P=0.001 and HR=0.336, P=0.012;respectively]. The common adverse reactions in-clude bone marrow suppression, bleeding, hypertension, and proteinuria. Most of them were grade 1-2. Conclusions:Bevacizumab combined with chemotherapy provides good efficacy and controllable safety in patients with retreated advanced NSNSCLC. Patients with EGFR mutations and>4 cycles of bevacizumab administration have superior prognosis.
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This study was aimed to investigate the effects of Si-Wu mixture on the secretion of E2 and the expression of CYP19al gene in granulosa cells after cell injury.Ovarian granulosa cells of SD rats were treated with cisplatin (CDDP).And the expression levels of E2 and CYP19a1 were determined by different testing methods.The results showed that the level of E2 induced by radioimmunoassay of the Si-Wu group was significantly higher than that of the CDDP group.Meanwhile,the group which added TGF-β3 protein pathway blocker was lower than others.The results of immunohistochemistry and western blotting showed that the expression level of CYP 19a1 of the Si-Wu group was higher than that of the CDDP group.In the western blotting,the group which added blocker was significantly lower than the non-blocking group.It was concluded that the pharmacological serum of Si-Wu mixture can enhance the level of E2 in CDDP cells through TGF-β3 protein pathway.And the effect is accomplished by the intervention of CYP 19a1.
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Objective To explore the diagnosis value of narrow-band imaging magnifying endoscopy (NBI-ME) in the early esophageal cancer and precancerous lesions while estimating the quality,depth and treatment strategy.Methods One hundred and eleven cases of patients with suspected early esophageal cancer and precancerous lesions,who underwent ESD treatment,were selected as the study subjects.To estimate the diagnosis value of NBI-ME in the quality,depth and treatment strategy with pathological histology as gold standard.Results While estimating quality,there was no low grade intraepithelial neoplasia(LGIN) cases with NBI-ME.A total of 33 cases were diagnosed as high grade intraepithelial neoplasia(HGIN),including 30 cases of HGIN and 3 cases of LGIN after ESD treatment,and the other 78 cases were diagnosed as early esophageal cancer,including 5 cases of LGIN,22 cases of HGIN,and 51 cases of early esophageal cancer.Compared with the pathology results,the quality consistency of NBI-ME is general:K=0.498.While estimating depth,there was no LGIN cases with NBI-ME.A total of 33 cases were diagnosed as HGIN,including 30 cases of HGIN and 3 cases of LGIN after ESD treatment,67 cases were diagnosed as intramucosal carcinoma,including 5 cases of LGIN,22 cases of HGIN,30 cases of intramucosal carcinoma,and 10 cases of submucosal carcinoma after ESD treatment,and 11 cases were diagnosed as submucosal carcinoma.Compared with the pathology results,the depth consistency of NBI-ME is general:K=0.469.Most of the patients shoud be treated by ESD except 8 cases of LGIN.Conclusion The study shows general diagnosis value of NBI-ME in estimating quality,depth and treatment strategy of early esophageal cancer and precancerous lesions.
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Abstrac Objective:To investigate the clinical efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of squamous-cell lung cancer patients with EGFR mutations. Methods:We screened out seven patients who were diag-nosed with EGFR mutations and received EGFR-TKIs, such as gifitinib or erlotinib, from 2,317 squamous-cell lung cancer patients treat-ed at the Beijing Chest Hospital from January 2010 to July 2016. Results:After using EGFR-TKIs, the objective response rate was 42.9%, the disease control rate was 100%, and the median progression-free survival was 6.1 months. Conclusion:EGFR-TKIs exert a certain clinical curative effect on patients with EGFR mutations in squamous-cell lung cancer. However, given that only seven cases are pre-sented in this research group, more cases are needed for further research to verify the above conclusion.
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Objective To observe the efficacy of growth hormone ( GH) co-treatment in poor responders undergoing IVF-ET.Methods To analyze all the ovaries low response patients treated by IVF/ICSI,80 cases were ran-domly divided into two groups:40 patients in GH group were given GH along with Gn daily until the HCG administra-tion.40 patients in the control group received the same treatment protocol except the GH co -treatment.The catching spawn number and MⅡova,fertile rate,the number of perfect embryos ,pregnant rate were observed .The serum con-centrations of IGF-I,IGFBP-3 were detected by ELISA and compared between the two groups .Results The number of oocytes retrieved ,number of MII oocytes ,cleavage ,number of embryos available of GH group were increased without statistical significance(all P>0.05 ).The serum IGFBP-3 level of 2 groups had no statistical significance .The fertile rate,pregnant rate ,serum IGF-I level were significantly higher in GH group than those in the control group ( all P<0.05).Conclusion GH co-treatment in poor responders could improve the outcome of IVF-ET,which imply that GH could improve the quality of oocytes and embryos related to the elevated IGF-1 level in serum .
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Objective To compare the effect of two different treatment approaches on femoral shaft fractures in polytrauma patients.Methods One hundred and forty-eight polytrauma patients were selected as our subjects,who were hospitalized from Jan.2000 to Dec.2009.They were randomly divided into cast group and external fixation group.Patients in cast group were fixed with cast within the first 24 h after the injury and patients in external fixation group were stabilized with a unilateral external fix stent within the first 24 h after the injury.Results In cast group,71 of 75 patients were followed up and follow up periods was 26.4 months.Follow up data showed that 18 patients developed multiple organ failure (MOF) and 26 patients developed ARDS.The average healed periods was 5.9 month.Three patients developed nonunion and 4 cases developed wound infection.The average of the knee motion angle was 107 degrees (60 to 110 degrees).In external fixation group,68 patients were followed up and the follow-up period was 27.5 months.Of which,13 patients developed MOF and 12 patients developed ARDS.The average healed periods was 5.6 months.2 patients developed nonunion and 3 cases developed for.wound infection.The average of the knee motion angle was 120 degrees (60 to 140 degrees).Conclusion The damage control orthopedics surgery was proved as a safe and effective treatment approach for fractures of the shaft of the femur in selected multiply injured patients compared with cast methods.
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We optimized the randomly combined specimens of limb bones into paired specimens of limb bones and used optimized (paired) specimens in systemic anatomy experimental teaching to strengthen the practical ability of medical students.Results showed that the teaching effect was better by using optimized (paired) specimens than by using randomly combined specimens.Applying optimized (paired) specimens was conducive to training students' practical ability and increasing the using efficiency of specimens.
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Objective To study the superiority and safety of cup-shaped womb manipulator auxiliary peritoneoscope in entire womb excision. Methods 180 cases with hysterectomy were randomly divided into cup-shaped womb manipulator auxiliary peritoneoscope group(treatment group) and tradition into the abdominal group( control group) ,and the amount of bleeding and postoperative complications,and patient recovery were observed in the two groups. Results Compared with the control group, the quality of life of patients with anal exhaust time, average length of staying, postoperative recovery daily time were significantly improved, and there were statistically significant differences between two groups ( P ＜ 0. 05 ). There was no serious complication in the two groups. Conclusion Cup-shaped womb manipulator auxiliary peritoneoscope hysterectomy was a safe and feasible operation,and could relieve harm and improve patients quality of life.
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【Objective】To compare different approaches and their effectiveness on the treatment of the femoral neck fracture in children,in order to provide a reliable and effective way for the treatment of the disease.【Methods】Clinical data of 21 cases with femoral neck fracture from 1983 to 1993 were analyzed retrospectively.【Results】21 cases were divided into three groups:① group Ⅰ:14 cases underwent closed reduction and internal fixation with multiple Kirscher′s pins or cannulate compression screws under C-arm X-ray monitor.Of the 14 cases,11 cases were healed,3 cases developed ischemic necrosis of femoral head;② group Ⅱ:4 cases was treated with skin traction and hip spica cast plaster fixation,3 cases was healed,1 case developed ischemic necrosis of femoral head;③ group Ⅲ:3 cases underwent opened reduction and internal fixation with multiple pins or cannulate compression screws,1 case was healed,2 cases developed ischemic necrosis of femoral head.【Conclusion】Closed reduction and multiple pins internal fixation under C-arm X-ray monitor may be the best choice of treatment of femoral neck fracture in children.
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Objective To investigate the relationship among paraoxonase-1 (PON 1) activity in serum,PON 1 Q192R polymorphism and chronic renal failure disease ( CRF ) in the hans of Hunan.Methods PON 1 activity in serum and PON 1 Q192R polymorphism of 79 patients with CRF and 90 healthy subjects as control were measured.Results PON 1 activity in serum of patients with CRF (372 6?150 6)U was significantly lower than that in control group (537 8?172 2)U(P