[Analysis of population attributable risk of large for gestational age]

Objective: To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods: A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results: (1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions: Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.

Vascular Health of Children Conceived via In Vitro Fertilization

OBJECTIVE

To evaluate whether in vitro fertilization (IVF) has an effect on the cardiovascular health of offspring.

STUDY DESIGN

This was a cross-sectional pilot study. We performed vascular health assessment for 17 children aged 10-14 years who were conceived via IVF with autologous oocytes at Stanford University. Carotid artery ultrasound evaluated intima-media thickness and stiffness, carotid-femoral pulse wave velocity determined segmental arterial stiffness, and endothelial pulse amplitude testing assessed endothelial function. We compared IVF offspring with control adolescents assessed in the same laboratory, with all comparisons adjusted for age, sex, and race/ethnicity.

RESULTS

All participants had normal body mass index and blood pressure. Compared with controls, IVF children had thicker common carotid artery intima-media thickness (0.44 ± 0.03 mm vs 0.38 ± 0.03 mm; P < .01), higher elastic modulus (395.29 ± 185.33 mm Hg vs 242.79 ± 37.69 mm Hg; P = .01), higher βstiffness (2.65 ± 0.38 vs 2.28 ± 0.23; P < .01), and higher peak velocity (142.29 ± 31.62 cm/s vs 117.71 ± 32.69 cm/s; P = .04). The mean endothelial pulse amplitude testing reactive hyperemia index was not significantly different between IVF and controls. The mean pulse wave velocity was 4.69 ± 0.51 m/s compared with the controls 4.60 ± 0.57 m/s (P = .11), with 8 (47%) having abnormal values.

CONCLUSION

In an assessment of endothelial function and arterial properties of children conceived via IVF, we found that children conceived via IVF seem to have evidence of abnormal vascular health. Further studies with larger sample size and long-term follow-up are warranted.

[Effect of induced labor on delivery outcome of pregnant women undergoing vaginal trial of labor after cesarean section]

Objective: To explore the effect of induced labor on delivery outcome of pregnant women undergoing vaginal trial of labor after cesarean section. Methods: Totally, 173 pregnant women undergoing vaginal trial of labor after cesarean from April 1st, 2016 to October 31st, 2017 were involved. According to whether or not induced labor, pregnant women were divided into induced labor group (n=47) and natural labor group (n=126). The two groups of the general situation, the situation of delivery and delivery outcome were compared. Further more, the induced labor group were divided into cesarean section patients (n=20) and vaginal delivery patients (n=27) based on pregnancy outcomes, induction situation and delivery situation were analyzed. Results: (1) The gestational weeks was 39.2±1.1 in induced labor group, 38.7±1.0 in natural labor group. The 1-minute Apgar score was 9.98±0.15 in induced labor group, and 9.87±0.60 in natural labor group. The neonatal weight was (3 497±426) g in induced labor group, and (3 288±350) g in natural labor group. The thickness of lower uterine segment at 36-39 weeks of pregnancy was (2.4±0.6) mm in induced labor group, (2.1±0.6) mm in natural labor group. There were obviously differences in the gestational week, the 1-minute Apgar score, the neonatal weight and the thickness of lower uterine segment at 36-39 weeks of pregnancy between the two groups (all P<0.05). There were no significant differences in 5-minute Apgar score, the interval between previous cesarean delivery, postpartum hemorrhage, fetal distress, and intrauterine infection, secondary uterine inertia, placental abruption and uterine ruption between the two groups (all P>0.05). (2) In induced labor group, the cervical score of cesarean section patients was 3.8±1.7, while the cervical score of vaginal delivery patients was 5.2±1.7. The induced labor days of cesarean section patients was (1.6±0.9) days, while the induced labor days of vaginal delivery patients was (1.2±0.4) days. There were obviously differences in the cervical score and the induced labor days among the two subgroup patients (all P<0.05). There were no significiant differences in Apgar score, neonatal weight, the thickness of lower uterine segment at 36-39 gestational weeks and the interval times of previous cesarean delivery between the two subgroup patients (P>0.05). Conclusion: Induction of labor does not reduce neonatal Apgar score, and does not increase the incidence of postpartum complications, and eliminats the increase of cesarean section rate caused by increased gestational weeks and fetal enlargement, and increases the vaginal delivery rate of pregnant women undergoing vaginal trail of labor after cesarean section.

[Construction and application of immunization information system based on children cases collected by vaccination clinic clients in Shandong Province, China]

Construction and application of immunization information system is an important part of health information, which is very useful to improve the quality, efficiency and safety of vaccination. The background, system architecture, functions and applications, working conditions and characteristics of Shandong province Immunization Information System (IIS) are introduced in this article. It is expected to provide experiences for the development of immunization information system of other provinces.

Maternal and neonatal outcomes associated with trophectoderm biopsy

OBJECTIVE

To assess whether pregnancies achieved with trophectoderm biopsy for preimplantation genetic testing (PGT) have different risks of adverse obstetric and neonatal outcomes compared with pregnancies achieved with IVF without biopsy.

DESIGN

Observational cohort.

SETTING

University-affiliated fertility center.

PATIENT(S)

Pregnancies achieved via IVF with PGT (n = 177) and IVF without PGT (n = 180) that resulted in a live birth.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Maternal outcomes including preeclampsia and placenta previa and neonatal outcomes including birth weight and birth defects.

RESULT(S)

There was a statistically significant increase in the risk of preeclampsia among IVF+PGT pregnancies compared with IVF without PGT pregnancies, with an incidence of 10.5% versus 4.1% (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [95% CI], 1.10, 8.29). The incidence of placenta previa was 5.8% in IVF+PGT pregnancies versus 1.4% in IVF without PGT pregnancies (aOR = 4.56; 95% CI, 0.93, 22.44). Similar incidences of gestational diabetes, preterm premature rupture of membranes, and postpartum hemorrhage were observed. IVF+PGT and IVF without PGT neonates did not have a significantly different gestational age at delivery or rate of preterm birth, low birth weight, neonatal intensive care unit admission, neonatal morbidities, or birth defects. All trends, including the significantly increased risk of preeclampsia in IVF+PGT pregnancies, persisted upon stratification of analysis to only singleton live births.

CONCLUSION(S)

To date, this is the largest and most extensively controlled study examining maternal and neonatal outcomes after trophectoderm biopsy. There was a statistically significant three-fold increase in the odds of preeclampsia associated with trophectoderm biopsy. Given the rise in PGT use, further investigation is warranted.

[National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version)]

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts' clinical experience, national experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

[The effect of miR-155 on HBV replication and PTEN expression in vivo]

Objective: To construct the mmu-miR-155 eukaryotic overexpression vector pmR-155 and to investigate its effect on HBV replication and expression of PTEN in vivo. Methods: The mmu-mir-146a precursor gene fragment pre-mmu-mir-146a was amplified by PCR, then connected to the pmR-mCherry plasmid vector after double enzyme digestion, the accuracy of recombinant vector was verified by colony PCR、double enzyme digestion and sequencing; then the recombinant vector was transfected HBV transgene mice(Experimental Group)with hydrodynamics-based injection via vena caudalis, and pmR-mCherry plasmid、PBS were respectively transfected into the mice as Empty plasmid Group、Blank Group. The concentration of IFN-γ in the serum was detected by ELISA. The expression of SOCS1、PTEN mRNA in the liver was detected by qPCR at 30d post-transfectioned. The Western blot was performed to detect the changes in SOCS1、PTEN、HBX in the liver tissue at 30 d post-transfectioned. The results were analyzed with Student's t-test, or one-way analysis of variance and the least significant difference test. Results: the colony PCR、double enzyme digestion and sequencing verified that the gene was inserted into the pmR-mCherry vector. Compared with Blank Group, the expression of miR-155 in the Experimental Group was significantly increased(t = 8.90, P < 0.01); the concentration of IFN-γ in the Experimental Group was significantly increased(F = 26.58, P < 0.01); the mRNA(F(SOCS1 mRNA) = 19.72, P < 0.01; F(PTEN mRNA) = 7.38, P < 0.05) and protein(F(SOCS1) = 50.30, P < 0.01; F(PTEN) = 129.00, P < 0.01) expression of COCS1、PTEN was significantly decreased in the Experimental group and the protein of HBX was also significantly(F(HBX) = 77.97, P < 0.01). Conclusion: The pmR-155 eukaryotic overexpression vector is successfully constructed, this recombinant vector can express miR-155 stably; miR-155 can down-regulate cocs1、PTEN gene expression and up-regulate the expression of IFN-γ, it can inhibit the replication of HBV and a potential targets to treating hepatocellular carcinoma.

[Application of chromosomal analysis for 29 cases of fetuses with nasal bone absence or hypoplasia]

Objectives: To explore the chromosomal analysis for fetuses with nasal bone absence or hypoplasia. Methods: This was a retrospective study on 29 pregnancies nasal bone absence or hypoplasia which underwent prenatal diagnosis, including chorionic villi (CV), amniotic fluid or cordocentesis.The indication of the procedures and results were evaluated. Result: Fifteen (51.7%, 15/29) of chromosome abnormities were diagnosed with indication of fetal nasal bone absence or hypoplasia, including eight with trisomy 21, two with trisomy 13, two with X chromosome aneuploidy and three with pathogenic copy number variations (CNVs) respectively.The incidence of chromosomal abnormalities in fetus with nasal bone hypoplasia (2/5, 40%) was lower than that in fetus with nasal bone absence (13/29, 54.2%). The incidence of chromosomal abnormalities in fetus with non-syndromic nasal bone absence or hypoplasia (4/13) was lower than that in fetus with syndromic nasal bone absence or hypoplasia (11/16). Conclusion: The incidence of chromosomal abnormalities in fetus with nasal bone absence or hypoplasia was higher and prenatal diagnosis was recommended for all types of the disease.For the fetus with nasal bone absence or hypoplasia, it is recommended to give priority to CNVs for prenatal diagnosis.

[Diagnostic and therapeutic values of interphase fluorescence in situ hybridization in B-cell lymphomas: a clinicopathologic analysis of 604 cases]

Objective: To investigate the feasibility and value of interphase fluorescence in situ hybridization (FISH) in the pathological diagnosis, differential diagnosis and therapeutic assessment of B-cell lymphomas. Methods: The cohort included 604 cases of B-cell lymphoma which were collected at West China Hospital from May 2010 to December 2016.And all were subjected to interphase FISH using 11 break apart or fusion probes (MYC, bcl-2, bcl-6, IRF4, MYC/IgH, bcl-2/IgH, CCND1/IgH, IgH, API2/MALT1, p53/ATM, and D13S319/CEP12). Results: The median age of the 604 B-cell lymphoma patients was 47.7 (aged 2-90) years including 372 men and 232 women. All the cases was divided into 463 large B cell lymphomas(LBL) and 141 small B cell lymphomas, and the total interphase FISH positive rate was 59.8% (361/604). Among the 463 LBL, 12.5% (58/463), 9.5% (44/463) and 2.2% (10/463) of cases showed MYC, bcl-6 and bcl-2 gene rearrangements respectively; and 363 diffuse large B cell lymphoma (DLBCLs) were reclassified as germinal center B-cell (GCB) subtype (38.6%, 140/363) and non-GCB subtype (61.4%, 223/363) by Hans algorithm. The rearrangement rates in GCB and non-GCB DLBCL were 45.7%(64/140)and 21.5%(48/223; P=0.001), respectively. Compared to the non-GCB DLBCL, GCB DLBCL showed higher MYC and bcl-2 gene rearrangements (P=0.001). Eleven (2.4%, 11/463) cases had MYC and bcl-6 or bcl-2 gene rearrangement (double-hit lymphoma); one (0.2%, 1/463) case had MYC, bcl-6 and bcl-2 gene rearrangements (triple-hit lymphoma); two (0.4%, 2/463) cases had bcl-2 and bcl-6 gene rearrangements. MYC translocation and MYC/IgH fusion were detected in 94.2%(81/86) and 83.7%(72/86) cases of Burkitt lymphomas. IRF4 rearrangement was detected in two cases of IRF4+ LBCL. Genetic abnormalities were detected in 9/19, 100%(29/29), 30.8%(12/39) and 68.5%(37/54) cases of follicular lymphoma, mantle cell lymphoma, MALT lymphoma and chronic lymphocytic leukemia, respectively. Conclusions: Interphase FISH can rapidly and accurately detect the genetic changes in B-cell lymphomas. Different genetic changes are specifically valuable to the diagnosis, differential diagnosis, prognosis evaluation and treatment guidance of various B-cell lymphomas.

[National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version)]

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, national experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

[Meta analysis of fetal lateral ventriculomegaly and prognosis]

Objective: To explore the neurological development of fetal with ventriculomegaly at 1 year after birth by systematically reviewing the domestic and international literature about prognosis of fetal ventriculomegaly. Methods: Wanfang database, CNKI, CBM, PubMed, EMBASE and the Cochrane Library were online searched to collect relevant literature published from January 1st, 1980 to November 22th, 2017. Literature were extracted based on the Newcastle-Ottawa Scale (NOS) , and analyzed by R software for meta-analysis. The corresponding model was selected according to the results of heterogeneity test to comprehensively analyze the prognosis of the fetus with ventriculomegaly. Results: Five studies were included in the meta analysis, all of them were of high quality (scores>5) . (1) The good prognosis rate of nervous system was 88% (95%CI:0.77-0.95) in fetus with mild ventriculomegaly, was 57% (95%CI:0.18-0.91) in those with moderate ventriculomegaly, and was 36% (95%CI:0.16-0.59) in those with severe ventriculomegaly. (2) The good prognosis rate of the nervous system was 86% (95%CI:0.75-0.94) in fetus with the isolated ventriculomegaly, while was 58% (95%CI:0.20-0.91) in those with non-isolated ventriculomegaly. The incidence of chromosomal abnormalities was 7% (95%CI:0.05-0.09) in ventriculomegaly. The improvement rate of lateral ventricle width in pregnancy was 41% (95%CI:0.27-0.57) . Conclusions: The prognosis of nervous system with mild ventriculomegaly is better than that of moderate and severe ventriculomegaly. The prognosis of nervous system with isolated ventriculomegaly is better than that of non-isolated ventriculomegaly. Fetal ventriculomegaly may be associated with fetal chromosomal abnormalities and intrauterine infection. The variation of fetal lateral ventricular width should be monitored regularly during pregnancy, the risk of poor prognosis should be informed, and pediatrician should be asked for evaluation.

[Effects of glycyrrhizic acid on ERK1/2 and p38 MAPK signaling pathway in a murine model of asthma]

Objective: To explore the effects of glycyrrhizic acid (GA) on Extracellular regulated protein kinases (ERK1/2) and p38 mitogen-activated protein kinases (p38 MAPK) signaling pathways in a murine model of asthma. Methods: Sixty female BALB/c mice were randomly divided into 6 groups (n=10 each): a control group, an asthmatic group, two treatment groups with low and high doses of GA, U0126 group and SB203580 group. Within 24 hours after the last OVA challenge, histological studies of lung were conducted with the hematoxylin and eosin staining (HE) and alcian blue-periodic acid-Schiff (AB-PAS), the relative protein expression of ERK1/2 and p38 MAPK were detected by immunohistochemistry and Western blotting in vivo. CD4(+) T cells were purified from spleens of OVA-sensitized and challenged mice by using the Mouse CD4 Cell Positive Isolation Kit and incubated with anti-CD3 mAb (1 μg/ml) in the presence of various concentrations of GA (10 and 100 μg/ml), U0126 (10 μmol/L) or SB203580(10 μmol/L). After 72 h of incubation, the relative protein expression of ERK1/2 and p38 MAPK of CD4(+) T cells were detected by Western blotting in vitro. Results: The asthmatic mice induced infiltration of inflammatory cells around airways and blood vessels, airway goblet cell hyperplasia and mucus production. Administration of GA at a dose of 100 mg/kg, U0126 or SB203580 significantly reduced the infiltration of inflammatory cells in the peribronchial areas and goblet cell hyperplasia compared with the asthmatic mice. The protein expressions of p-ERK1/2 were lower in GA at a dose of 100 mg/kg (0.090±0.022) and U0126 group (0.072±0.017) than those in asthmatic group (0.143±0.022) (all P<0.05). The protein expressions of p-p38 MAPK were lower in GA at a dose of 100 mg/kg (0.072±0.019) and SB203580 group (0.061±0.015) than those in asthmatic group (0.121±0.022) (all P<0.05) by immunohistochemistry. Compared with asthmatic group (0.783±0.133, 0.649±0.095), the protein expressions of p-ERK1/2 and p-p38 MAPK in GA at a high dose group (0.385±0.186, 0.275±0.089) and in U0126 group (0.117±0.051) or in SB203580 group (0.108±0.043) were decreased by Western blotting (all P<0.05). The expressions of p-ERK1/2 in CD4(+) T cells after 72 h incubation were lower in 100 μg/ml concentrations of GA (0.579±0.184) and group U0126 (0.249±0.082) and the expressions of p-p38 MAPK were much lower in 100 μg/ml concentrations of GA (0.445±0.081) and group SB203580 (0.249±0.082) compared with those in group CD3 (1.028±0.147, 0.902±0.107) (all P<0.05). Conclusion: ERK1/2 and p38 MAPK signaling pathways are activated in asthmatic mice and GA may negative regulate this activation.

[Molecular mechanisms and relationship of M2-polarized macrophages with early response in multiple myeloma]

目的

探讨替代活化型巨噬细胞（M2 MΦ）和多发性骨髓瘤（MM）早期治疗反应的关系及其在发病机制中的可能作用。

方法

采用免疫组化法标记240例MM患者骨髓标本中的MΦ；建立体外M2 MΦ诱导培养体系，构建Transwell共培养模型与RPMI 8226和U266细胞共培养，CCK-8法检测M2 MΦ对细胞增殖的影响，流式细胞术检测对地塞米松（1 µ mol/L）诱导骨髓瘤细胞凋亡的影响，ELISA法检测对TNF-α和IL-6表达的影响，real time PCR法检测对趋化因子、血管内皮生长因子（VEGF）及其受体表达的影响。

结果

①依据骨髓组织M2 MΦ浸润程度将患者分为高浸润组（92例）和低浸润组（148例），高浸润组患者早期治疗有效率明显低于低浸润组，差异有统计学意义（23.9%对73.0%，χ²=60.31，P<0.001）。②培养24、36 h，共培养组细胞增殖能力较对照组显著上升：M2 MΦ+RPMI 8226细胞组与对照组比较，P值分别为0.005、0.020；M2 MΦ+U266细胞与对照组比较，P值分别为0.030、0.020。③地塞米松诱导后，共培养组与对照组比较，RPMI 8226细胞凋亡率下降（29.0%对71.0%，t=4.97，P=0.008），U266细胞凋亡率也下降（24.9%对67.7%，t=6.99，P=0.002）。④共培养48 h后，与对照组比较，加入M2 MΦ后可促进RPMI 8226和U266细胞分泌IL-6、TNF-α，促进表达CCL2、CCL3、CCR2、CCR5、VEGFA、VEGFR-1和VEGFR-2。

结论

MM患者骨髓组织M2 MΦ浸润程度和早期治疗反应相关。M2 MΦ通过促进骨髓瘤细胞分泌系列炎症因子、趋化因子和相关受体的表达，从而促进骨髓瘤细胞增殖以及保护骨髓瘤细胞免于凋亡。

[Clinical application of partial cystectomy with augmentation cystoplasty for invasive bladder cancer in elderly patients]

OBJECTIVE

To evaluate the clinical effect and safety of biological patch applied in elderly patients with invasive bladder cancer who underwent massive partial cystectomy with augmentation cystoplasty.

METHODS

The clinical data of 2 patients with invasive bladder cancer from October 2016 to March 2017, who underwent the massive partial cystectomy with augmentation cystoplasty were retrospectively reviewed. Case one was an 87-year-old man, with tumor located on the bladder anterior wall, ranging from 5.5 cm×2.5 cm, and the grade of American Society of Anesthesiologists (ASA) being III. Case two was a 77-year-old female, whose lesion was located on the right anterior wall, ranging from 5.2 cm×4.0 cm, and the grade of ASA being II. Both of the patients received a massive partial cystectomy with augmentation cystoplasty. The operative time, estimated blood loss, perioperative and postoperative data and follow-up data, including cystoscopy and urodynamics were recorded and compared. When the P value was less than 0.05, it was statistically significant.

RESULTS

All the operations were successfully performed. The average operative time was (155.0+35.4) min, mean estimated intraoperative blood loss was 20 to 100 mL, and the mean postoperatively hospital stay was eight days. During the 10 to 14 months' follow-up periods, no local recurrence or distant metastasis occurred. Urodynamic data: the maximum urinary flow rate was 16.5 mL/s, and the maximum bladder capacity was 303 mL. The two patients urinated 3-4 times in the day time, 0 to 3 times in the night, 200-300 mL each time, on average. The American Urological Association symptom score was 3 to 5. Partial cystectomy, applied to aged patients with multiple complications and high risk of surgical anesthesia, was able to reduce surgery related complications. For patients with tumor of small size, the normal bladder wall would be enough to recover functional capacity for urine storing after partial cystectomy. For patients with large lesions range and small normal bladder tissues, augmentation cystoplasty would help recover bladder capacity on the condition of negative margin.

CONCLUSION

Massive partial cystectomy with augmentation cystoplasty is safe and effective. It could decrease perioperative morbidity and keep the quality-of-life benefits of bladder preservation, which is worthy of further application for some selected invasive bladder cancer in elderly patients.

[Changes of distal-less homeobox genes 5 and Msh homeobox 1 in a rat model of bisphosphonate related osteonecrosis of the jaw]

Objective: To further study the effects of distal-less homeobox gene 5 (Dlx-5) and Msh homeobox 1 (Msx-1) in the pathogenic mechanism of bisphosphonate related osteonecrosis of the jaw (BRONJ) . Methods: Twenty-four SD rats were divided into two groups, the experimental group was injected intraperitoneally with zoledronic acid for 12 weeks (0.2 mg/kg, three times a week), and the control group was injected with saline solution for 12 weeks. The first mandibular molars were extracted after 12 weeks. All of the animals were sacrificed eight weeks after teeth extraction. The BRONJ was diagnosed by gross observation, X-ray examination and histopathlolgical examination. Through real-time PCR, the expression level of Dlx-5 and Msx-1 were detected in the mandible of BRONJ samples and normal samples. Results: X-ray examination and histopathlolgical analysis showed the presence of BRONJ. The results of real-time PCR showed that the expression levels of Dlx-5 were increased (P=0.001) and the expression level of Msx-1 was decreased (P=0.001) in the experimental group compared with the control group. Conclusions: Dlx-5 and Msx-1 genes play roles in the pathogenic mechanism of BRONJ.

[Spatial-temporal analysis on pulmonary tuberculosis in Beijing during 2005-2015]

Objective: To analyze the spatial distribution and identify the high risk areas of pulmonary tuberculosis at the township level in Beijing during 2005-2015. Methods: Data on pulmonary tuberculosis cases was collected from the tuberculosis information management system. Global autocorrelation analysis, local indicators of spatial association and Kulldorff's Scan Statistics were applied to map the spatial distribution and detect the space-time clusters of the pulmonary tuberculosis cases during 2005-2015. Results: Spatial analysis on the incidence of pulmonary tuberculosis at the township level demonstrated that the spatial autocorrelation was positive during the study period. The values of Moran's I ranged from 0.224 3 to 0.291 8 with all the P values less than 0.05. Hotspots were primarily distributed in 8 towns/streets as follows: Junzhuang, Wangping, Yongding and Tanzhesi in Mentougou district, Yancun in Fangshan district, Wangzuo town in Fengtai district, Tianqiao street in Xicheng district and Tianzhu town in Shunyi district. Spatiotemporal clusters across the entire study period were identified by using Kulldorff's spatiotemporal scan statistic. The primary cluster was located in Chaoyang and Shunyi districts, including 17 towns/streets, as follows: Cuigezhuang, Maizidian, Dongfeng, Taiyanggong, Zuojiazhuang, Hepingjie, Xiaoguan, Xiangheyuan, Dongba, Jiangtai, Wangjing, Jinzhan, Jiuxianqiao, Laiguangying, Sunhe towns/streets in Chaoyang district, Houshayu and Tianzhu town in Shunyi district, during January to December 2005. Conclusion: Incidence rates of pulmonary tuberculosis displayed spatial and temporal clusterings at the township level in Beijing during 2005-2015, with high risk areas relatively concentrated in the central and southern parts of Beijing.

Diagnosis with spiral CT imaging before gastric carcinoma surgery

This study was carried out to study multi-slice spiral CT imaging for patients with gastric carcinoma and explore the values of multi-slice spiral CT imaging in staging prior to gastric carcinoma (GC) surgery. Forty-eight patients with GC underwent multi-slice spiral CT, and the scanning results were compared with the pathological results. The similarity of the results was observed, and the accuracy was calculated. Of 48 patients, 8 did not undergo surgery because of metastasis. In the diagnosis of the remaining 40 patients, the sensitivity of multi-slice spiral CT in the diagnosis of staging of invasive depth of GC was 77.5%; κ = 0.642 in the analysis of consistency; there was no significant difference with the pathological results (p >0.05). The overall accuracy of diagnosis for stage N was 80%. The accuracy of multi-slice CT in detecting distant metastasis of GC was 87.5%. Multi-slice spiral CT can determine and evaluate various metastases of GC. The diagnostic results obtained using multi-slice spiral CT was probably consistent with the pathological results.

Prolonged survival of transplanted stem cells after ischaemic injury via the slow release of pro-survival peptides from a collagen matrix

Stem-cell-based therapies hold considerable promise for regenerative medicine. However, acute donor-cell death within several weeks after cell delivery remains a critical hurdle for clinical translation. Co-transplantation of stem cells with pro-survival factors can improve cell engraftment, but this strategy has been hampered by the typically short half-lives of the factors and by the use of Matrigel and other scaffolds that are not chemically defined. Here, we report a collagen-dendrimer biomaterial crosslinked with pro-survival peptide analogues that adheres to the extracellular matrix and slowly releases the peptides, significantly prolonging stem cell survival in mouse models of ischaemic injury. The biomaterial can serve as a generic delivery system to improve functional outcomes in cell-replacement therapy.

[Diagnostic significance of lymph node core needle biopsy for lymphoproliferative disease: a clinicopathologic study of 1 013 cases]

Objective: To study the clinicopathologic features of lymphoproliferative disease by lymph node core needle biopsy(CNB)and to evaluate the diagnostic significance of CNB for lymphoproliferative disease. Methods: The annual distribution, entity constitute, clinical finding, gross feature, morphologic change, affiliate study and repeat biopsy diagnosis of 1 013 cases of lymph node CNB diagnosed at West China Hospital of Sichuan University from January 2009 to December 2015 were investigated. Results: (1) Proportion of lymph node CNB in total amount of biopsy specimens increased from 0.2% in 2009 to 0.8% in 2015.(2) The study cohort included 471 lymphomas, 12 atypical lymphoid hyperplasia (ALH), 136 suspected lymphomas, 372 benign lesions, and 22 cases of descriptive diagnoses. The most common types were diffuse large B cell lymphoma and T-lymphoblastic lymphoma. (3) Majority of patients were adolescents and children younger than 20 years or the elderly older than 60 years. 53.1% CNB tumor specimen consisted of ≥4 tissue cores and 40.5% were >2 cm in length. (4) 104 CNB cases with previous history of excision biopsy was included 45 carcinomas(no metastatic carcinoma was found), 32 lymphomas for treatment observation.1/14 suspicious lymphomas, 1/1 ALH and 3/22 cases benign lesions were diagnosed as lymphoma by repeat biopsy respectively. (5) 217 CNB cases were diagnosed as lymphoma by subsequent CNB (70), or subsequent excision biopsy (147) including 78.5%(73/93) suspected lymphomas, 5/7 ALH and 32.3%(20/62)benign lesions. Conclusions: Lymph node CNB has certain clinical indications, although limited for the diagnosis of lymphoproliferative disorders. Suspected lymphomas and ALH diagnosed by CNB should be followed by repeat tissue biopsy. For the benign lesions by CNB it does not rule out additional biopsy to further investigate the lesion.

[Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain]

Objective: To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain. Methods: A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1(st), 2014 to September 30(th), 2015 were recruited. They were divided into two groups, the vaginal delivery group (92.88%, 6 416/6 908) and the emergency cesarean section group (7.12%, 492/6 908). According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI, the 6 908 women were divided into three groups, the underweight group(BMI<18.5 kg/m(2); 17.39%, 1 201/6 908), the normal weight group(18.5-24.9 kg/m(2); 73.00%, 5 043/6 908), the overweight and obese group (≥ 25.0 kg/m(2); 9.61%, 664/6 908). According to the guidelines of Institute of Medicine (IOM) , they were divided into three groups, the inadequate gestational weight gain (GWG) group (16.72%, 1 155/6 908), the appropriate GWG group (43.11%, 2 978/6 908), the excessive GWG group (40.17%, 2 775/6 908). Unadjusted and adjusted odds ratio (OR) and confidence interval (CI) of the risk of emergency cesarean section were calculated by bivariate logistic regression. Results: (1) Comparing to the vaginal delivery group, women in the emergency cesarean section group were older, with a lower education level. Their prepregnancy BMI was higer and had more gestational weight gain. They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus. Comparing to the vaginal delivery group, the neonates in the emergency cesarean section group were elder in gestational week, with higher birth weight. More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P<0.05) . (2) Overweight and obesity were associated with the increased risk of emergency cesarean section for nullipara, with the unadjusted OR of 1.98 (95%CI: 1.54-2.54), adjusted OR (aOR) of 1.66 (95%CI: 1.27-2.16). In the inadequate GWG group and the excessive GWG group, overweight and obese women had increased risk of emergency cesarean section, with adjusted OR of 2.33 (95%CI: 1.06-5.14) and 1.62 (95%CI: 1.44-2.28), respectively. In the appropriate GWG group, there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women, with aOR of 1.54 (95%CI: 0.94-2.54). The underweight group was associated with decreased risk of emergency cesarean section (OR=0.55, 95%CI: 0.40-0.74; aOR=0.66, 95%CI: 0.48-0.90). While no significant difference in the risk of emergency cesarean section was found between the underweight women, the overweight and obese women, with the aOR of 0.31 (95%CI: 0.07-1.32), 0.73 (95%CI: 0.48-1.10), 0.66 (95%CI: 0.38-1.12), respectively. (3) Absolute value of gestational weight gain was associated with the increased risk of emergency cesarean section, (aOR=1.03, 95%CI: 1.01-1.05). GWG above IOM giudelines did not independently affect the risk of emergency cesarean section (OR=1.30, 95%CI: 1.07-1.58; aOR=1.01, 95%CI: 0.82-1.24). In the underweight group, the normal weight group and the overweight or obese group, the excessive GWG women and the appropriate GWG women had no significant difference in the risk of emergency cesarean section (aOR=1.03, 95%CI: 0.55-1.12; aOR=1.02, 95%CI: 0.80-1.30; aOR=1.03, 95%CI: 0.59-1.78) , respectively. GWG below IOM giudelines was associated with decreased risk of emergency cesarean section (OR=0.62, 95%CI: 0.45-0.85; aOR=0.64, 95%CI: 0.46-0.88). In the underweight group and the overweight or obese group, there was no significant difference in the emergency cesarean section risk between the inadequate GWG women and the appropriate GWG within women (aOR= 0.24, 95%CI: 0.06-1.01; aOR= 0.90, 95%CI: 0.40-2.04) . In the normal weight group, the inadequate GWG women had lower risk of emergency cesarean section (aOR=0.65, 95%CI: 0.45-0.95). Conclusions: Overweight and obese women have increased risk of emergency cesarean section. The prepregnancy BMI is supposed to be an appropriate level. Absolute value of gestational weight gain is associated with increased risk of emergency cesarean section. There is no correlation between the excessive GWG and the risk of emergency cesarean section.

[Effect of probucol on preventing contrast-induced nephropathy in patients undergoing percutaneous coronary intervention]

Objective: To investigate the preventive effect, possible mechanism and safety of probucol on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: A total of 641 patients with coronary heart disease were consecutively enrolled from Department of Cardiology, in Tianjin Chest Hospital, Tianjin TEDA International Cardiovascular Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital. They were randomly divided into probucol group (n=321) and control group (n=320). The probucol group was given oral probucol 500 mg twice daily for day 0 to day 3 after PCI; the control group was given only conventional therapy. All patients were given intravenous drip 0.9% sodium chloride solution before 12 to 24 hours of operation. The levels of serum creatinine (Scr), blood urea nitrogen (BUN), evaluate glomerular filtration rate (eGFR), cystatin C (Cys-C), and high-sensitivity C-reactive protein (hs-CRP), neutrophil gelatinase associated lipocalin (NGAL), superoxide dismutase (SOD) and glutathione (GSH) were measured before and 72 h after the PCI operation in both groups. The incidence rates of CIN, the adverse events during hospitalization and postoperative 14-day follow-up were recorded in two groups. Results: There was no statistically significantly difference in the levels of Scr, BUN, eGFR, Cys-C, hs-CRP, NGAL, SOD and GSH between the two groups before PCI (P>0.05). The levels of serum Scr, BUN, Cys-C, hs-CRP, NGAL, SOD and GSH after operation in the two groups were higher than those before the operation (P<0.05). The levels of hs-CRP and NGAL in the probucol group were lower than those in the control group [(10±4) vs (11±4)mg/L, (25±8)vs (34±7)U/ml, P<0.05]. The levels of eGFR, SOD and GSH in probucol group were higher than those in control group [(80±27) vs (72±26) ml·min(-1)·1.73 m(-2,) (67±9) vs (58±8)U/ml, (4.6±0.9) vs (3.9±0.8)U/ml, P<0.05]. The incidence of CIN was 4.0% in the probucol group and 10.9% in the control group, and the difference was statistically significant (P<0.05, χ(2)=-3.31). Multivariate Logistic regression analysis showed that probucol was an independent protective factor for CIN (OR=0.334, 95%CI 0.172-0.648, P=0.001). There were no adverse events such as myasthenia gravis, abnormal liver function and cardiovascular events during the hospitalization and 14-day follow-up. Conclusions: Probucol can reduce the incidence of contrast-induced nephropathy after PCI. The protection mechanism is related with its anti-inflammatory and anti-oxidative stress effects, and it has good safety.