[Research on the trend of the decrease of human chorionic gonadotropin in the treatment of cesarean scar pregnancy by different surgical treatments].

OBJECTIVE: To explore the clinical effect of different surgical methods in the treatment of cesarean scar pregnancy, the decline trend of human chorionic gonadotropin (hCG) and the indications of different treatment methods. METHODS: This study was a prospective cohort study. The clinical data of 120 patients with cesarean scar pregnancy who were treated with four different surgical methods in the Beijing Obstetrics and Gynecology Hospital from June 2013 to December 2014 were collected. Seven cases ultrasonic curettage, 63 cases uterine arterial embolization (UAE) with hysteroscopic pregnancy embryo removal surgery, 41 cases UAE + B-ultrasound or laparoscopic monitoring hysteroscopic pregnancy embryo clearance surgery and 9 cases UAE + hysteroscopic and laparoscopic removal of pregnancy scar and uterine repair. The clinical efficacy of different surgical methods and the decrease trend of serum HCG in postoperative period were analyzed. RESULTS: (1)The levels of serum beta hCG in patients with cesarean scar pregnancy after different surgical treatments decreased (84.5±9.7)%, (97.7±3.2)% and (99.6±1.2)% after the 2 days, 7 days and 14 days respectively. The average time of blood beta hCG level dropped to normal was (22.4±6.7) d. (2)There was a significant difference in the amount of bleeding and the time of hospitalization among the patients treated with different surgical methods. (3)There was a significant difference in the analysis of the decline percentage rate of serum beta hCG under the interactive effect between different surgical methods and postoperative recovery time (P<0.01). CONCLUSION: The level of serum beta hCG in patients with cesarean scar pregnancy were reduced to normal range after 3 weeks of operation. The choice of surgical approach should be based on the degree of implantation of embryo sac scar, the thinnest muscle thickness, local blood flow, serum beta hCG levels, gestational sac size, process to the bladder and fertility desire to determine.

Emergence of NDM-producing non-baumannii Acinetobacter spp. isolated from China.

One hundred and thirty-six bla OXA-51-negative strains were identified from 1,067 Acinetobacter calcoaceticus-A. baumannii complex (ACB complex) isolates, which were collected during October 2010 to March 2013 from 15 general hospitals in 10 cities throughout Zhejiang Province, China. Seven of the 136 bla OXA-51-negative ACB complex isolates were New Delhi metallo-ß-lactamase-1 (NDM-1)-positive, among which three were identified as A. nosocomialis and four were identified as A. pittii strains using 16S-23S rRNA gene intergenic spacer (ITS) sequencing and partial RNA polymerase ß-subunit (rpoB) sequencing. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) analysis showed that the seven NDM-positive isolates belonged to three clonal strains with three novel sequence types (STs). Polymerase chain reaction (PCR) assays and DNA sequence analysis of the carbapenemase and other ß-lactamase genes indicated that all the isolates harbored the bla NDM-1 gene, and that only one strain of A. nosocomialis isolates harbored both bla NDM-1 and bla OXA-23. All of them were positive for bla ADC, from which three novel bla ADC genes (designated as bla ADC-69, bla ADC-70, and bla ADC-71) were detected for the first time. The presence of ISAba125 upstream of bla NDM-1 was identified through genetic environment analysis. Carbapenem resistance can be transferred from A. nosocomialis and A. pittii to Escherichia coli EC600 by the conjugation experiment. Plasmid analysis, DNA hybridization, and extraction experiments indicated that bla NDM-1 was located on a plasmid of approximately 50 kb. In conclusion, we characterized the dissemination of NDM-1-positive A. pittii strains in Zhejiang Province, China, and reported the NDM-producing A. nosocomialis for the first time.

Effects of invariant sympathetic activity on cutaneous circulatory responses to heat stress.

This study investigated the role of sympathetic withdrawal on blood flow responses in cutaneous arteriovenous anastomoses (AVAs) and capillaries to direct and indirect heat stress. This was achieved by clamping sympathetic activity (SC) to the tail of anesthetized rats so that constrictor tone remained invariant during exposure of either the animal's tail (direct heating) or body (indirect heating) to a 35 degrees C environment. Flow through the AVAs in the tail was evaluated by laser-Doppler flowmetry (LDF), while capillary flow was investigated by videodensitometry measurements of blood cell velocity (CBV) in single capillaries within the subepidermal vascular plexus. Both direct and indirect heating significantly increased LDF and CBV. In comparison to blood flow responses in sham-operated control rats, the SC procedure resulted in significantly lower LDF responses to both direct and indirect heat stress. By contrast, the response of CBV was not significantly affected by SC during either mode of heating. These results indicate that the withdrawal of sympathetic constrictor tone plays a role in the response of cutaneous AVAs, but not precapillary arterioles, to direct as well as indirect heat stress. Additional studies on unanesthetized animals showed that superimposing body heating on a base of local heating elicited a further increase in LDF, suggesting that local heating does not deplete neural mediated dilatory reserve.

[Observation on the fluidity of human erythrocyte membranes in patients with blood stasis syndrome].

In order to approach the relationship between the TCM typology of blood stasis syndrome and the fluidity of human erythrocyte membrane, the fluidity of human erythrocyte membrane was examined in 14 healthy volunteers, 21 patients with coronary heart disease and 14 patients with cancer by measuring the degree of fluorescence polarization using DPH as a fluorescent probe. The patients with coronary heart disease and the cancer patients were all of the TCM typology of blood stasis syndrome. The results showed: (1) The fluorescence polarization (P) of normal group was 0.294 +/- 0.007, and the microviscosity (pi) was 3.656 +/- 0.237. (2) The P of the group of coronary heart disease with blood stasis syndrome was 0.328 +/- 0.013, and the pi was 6.787 +/- 1.028. Both were significantly higher than those of the normal group (P less than 0.05). (3) The P of the group of cancer with blood stasis syndrome was 0.333 +/- 0.011, and the pi was 6.698 +/- 1.357. Both were significantly higher than those of the normal group (P less than 0.05). (4) Yet no significant difference was noticed between the group of coronary heart disease and the group of cancer (P greater than 0.05). The higher the pi of erythrocyte membrane, the lower the fluidity of erythrocyte membrane. The lower fluidity of erythrocyte membrane in patients with blood stasis syndrome can result in the declined ability of erythrocytic deform which can accelerate the disturbance of microcirculation. This accords with the TCM theory about blood stasis syndrome.

[Study on the mechanism of denuded tongue coating due to yin deficiency].

Denuded tongue coating is an important sign of serious Yin deficiency. The total number of exfoliated cells increased in the imprint of a Yin-deficient tongue. Not only the cells of the superficial layer but those of the middle layer appeared. Many necrotic cells could also be seen. This picture showed that the cell exfoliation rate of a Yin-deficient tongue was faster than in a normal tongue, caused chiefly by the degeneration and necrosis of the epithelial cells. It is believed that cell necrosis is the principal feature of the Yin-deficient tongue. This is in accordance with the TCM theory that denuded tongue coating is due to exhaustion of Yin fluid. Study on lingual morphology: The filiform papillae disappeared in slices of Yin-deficient tongue. The fungiform papillae had atrophied, the number of strata of epithelial cells reduced, and there were no complete keratinocytes or granules, tonofilaments and membrane coating granules in the cytoplasm. Observation of the microcirculation of fungiform papillae of a Yin-deficient tongue showed: the structure of vessels was abnormal, blood flowed slowly, red blood cells aggregated and the vessels dilated. Microcirculation of the blood was stagnant. The disturbance of microcirculation could accelerate the abnormal metabolism of lingual epithelial cells and cell necrosis, resulting in denuded tongue coating. Analysis of salivary zinc level: The salivary zinc level (0.232 micrograms/ml) of the patients with Yin-deficient tongue was significantly higher than that of healthy subjects (0.099 micrograms/ml). Zinc can affect the formation and function of nuclear spindle in cellular mitosis. The change of zinc level may be a pathogenic factor in Yin-deficient tongue.