Volume 94  ·   Issue 13  ·  2014

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease prototype. Clinically, it can involve important organs such as heart, brain, lung and kidney, resulting in a significant reduction in the quality of life and death of patients. A large number of studies have revealed that early diagnosis and treatment can significantly improve the long-term prognosis of SLE. In 2012, the SLE Clinical International Collaborative Research Group (SLICC) proposed a new classification standard for SLE^[1]The new criteria are divided into clinical criteria (11 items) and immunological criteria (6 items), emphasizing that SLE diagnosis needs to meet 4 criteria, and must contain at least 1 clinical criteria and 1 immunological criteria, or renal biopsy confirms lupus nephritis and is positive for antinuclear antibodies or anti-dsDNA antibodies. The application of new classification criteria can improve the sensitivity of diagnosis. Before the 1980s, the main cause of death in SLE was organ failure and infection caused by the disease itself. However, by the 1990s, with the improvement of clinical treatment level, the prognosis of patients improved significantly, and their 10-year survival rate reached more than 80%. However, the long-term cause of death has become increasingly prominent. Many studies have shown that 10% to 40% of SLE patients die of coronary artery disease, and the age of atherosclerosis is also significantly earlier. Female SLE patients before menopause have a 52-fold risk of atherosclerosis than normal women^[2,3]。 Clinically, the mortality of SLE presents a bimodal pattern^[4]。 Therefore, the treatment of SLE should aim at inducing remission of SLE in the early stage of the disease, and should aim at reducing organ damage and improving the long-term prognosis and quality of life of patients in the long term.

Since Hench et al. discovered that glucocorticoids have anti-inflammatory and immunosuppressive effects in 1949, they have greatly improved the survival rate and prognosis of patients with systemic lupus erythematosus (SLE). The 3-year survival rate of SLE patients has increased from 50% in 1953 to 92% in 2003^[1,2]。 Intravenous methylprednisolone (MP) shock treatment of severe SLE in the 1970s saved many lives. Undoubtedly, for more than half a century, hormones have brought gratifying therapeutic effects on rheumatism patients and improved the quality of life of patients. However, at the same time, countless patients have also paid a heavy price for its adverse reactions, such as death due to severe infection, disability due to aseptic osteonecrosis, severe osteoporotic fractures, childhood growth and development disorders, cardiovascular and cerebrovascular diseases, etc. Before the 1990s, infection caused by hormone and/or immunosuppressant therapy was one of the main causes of death in SLE, suggesting that the amount of hormone used was even worse. Therefore, it is necessary to reorient the dosage, course of treatment and status of hormones in the treatment of SLE.

To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in pregnant patients with systemic lupus erythematosus (SLE).

A total of 48 pregnant patients with SLE were prospectively recruited from January 2010 to December 2012 at Peking Union Medical College Hospital. Diseases were stable, functions of important organs normal and immunosupressants were discontinued for at least 6 months. Predisone (≤15mg qd) and HCQ (0.2 bid) were taken during the whole pregnancy. SLE disease activity before, during and after pregnancy and pregnancy outcome were analyzed.

SLE relapsed in 9(18.8%) patients during pregnancy and 2(4.2%) cases relapsed after delivery. There was no mortality. And 44 cases (91.7%) had successful pregnancy with 12(27.3%) preterm infants and 13(29.6%) infants with low birth weight. All neonates grew healthily, except one with hypoevolutism because of premature growth. Neither visual field nor fundus showed any abnormality.

HCQ may be effective in improving the pregnancy and fetal outcomes in SLE patients. And it is safe for pregnant women and fetuses. The patients should be regularly monitored and followed up.

To evaluate the serum level of anti-Müllerian hormone (AMH) in female patients with systemic lupus erythematosus (SLE) and identify its correlations with age and cyclophosphamide (CYC) therapy.

A total of 77 SLE female patients and 38 control healthy women with regular menstrual cycles were recruited. AMH was measured by enzyme linked immunosorbent assay (ELISA) kit. Follicle-stimulating hormone (FSH), estradiol (E2) and antral follicle count (AFC) of bilateral ovary were detected at the third day of menstrual cycle.

Their mean age was (29±5) years (range, 20-40) and the mean duration (2.7±2.4) years. The mean serum level of AMH was (1.5±1.3) μg/L and AFC 10±7. Linear regression revealed AFC ( r=0.9, P<0.01) was associated with the level of AMH. The mean levels of AMH and AFC were significantly higher in patients naïve to CYC therapy than in those under exposure, but lower than that in healthy control (P<0.01). No difference existed in FSH and E2 among 3 groups. Compared with those above 30 years old, the patients aged 30 years and younger had significantly higher level of AMH (P<0.01). The Spearman's correlation analysis indicated that each 5 gm of CYC exposure were independently associated with a lower level of AMH (r=-0.4, P<0.01).

As a more sensitive marker of ovarian reserve, AMH is associated with age and the cumulative dose of CYC. SLE patients aged >30 years and under exposure to CYC >10 g should be closely monitored for potential adverse events.

To explore the clinical features and prognosis of patients with lupus nephritis (LN) in a large multicenter lupus cohort of Jiangsu Province.

Medical records of 2 078 systemic lupus erythematosus (SLE) inpatients from 15 hospitals at the first admission from 1999 to 2012 were reviewed and classified into two groups with LN or without. The clinical features between two groups were compared with Mann-Whitney U or Chi-square test and potentially associated factors tested by Cox regression.

A total of 883 (42.5%) hospitalized lupus patients were diagnosed as LN. And the median age at disease onset of LN patients was lower than that of those without LN [(30±11) vs (32±12) years, P<0.01]. Cardiopulmonary involvement, neuropsychiatric disorder, gastrointestinal dysfunction, hematologic disease, ophthalmopathy, SLEDAI score > 9 at admission and SLE disease activity index (SLEDAI) score > 9 at discharge were more often seen in patients with LN compared to those without LN (31.5%, 7.9%, 13.9%, 69.0%, 1.5%, 77.4%, 29.8% vs 18.8%, 5.1%, 6.8%, 63.1%, 0.3%, 43.1%, 8.1%, allP<0.01). The mortality rates at 1 or 5 years after first admission were both significantly higher in LN patients than those without LN (7.2%, 15.0% vs 3.1%, 6.3%,P<0.01). Independent predictors for mortality in patients with LN were neuropsychiatric involvement[hazard ratio (HR) 2.46], SLEDAI score > 9 at discharge ( HR 2.34), increased serum creatinine (HR 2.21) and elevated alanine aminotransferase and (or) aspartate transaminase (HR 2.09) whereas glucocorticosteroid therapy (HR 0.18) was a protective factor.

LN is one common complication of SLE patients during an early stage. And LN patients are more prone to present other vital organ involvement, higher disease activity and worse treatment outcomes. When accompanied with neuropsychiatric involvement, increased serum creatinine or elevated transaminase, worse prognosis is expected. Glucocorticosteroid treatment may offer some benefits.

To explore the clinical characteristics and therapeutic efficacy of systemic lupus erythematosus (SLE) associated pulmonary arterial hypertension (PAH).

A total of 91 cases of SLE-PAH from 2007 to 2011 were reviewed and followed up. They were divided into 2 groups: group A: New York Heart Association (NYHA) functional class 1 and 2; group B: NYHA functional class 3 and 4.

There were 2 males and 89 females with a mean age of 37±11 years. The mean duration of SLE disease process was 7±6 years. PAH was the primary symptom of SLE onset in 10 cases. Pulmonary arterial systolic pressure (PASP) as measured by ultrasonic cardiography (UCG) were between 40 to 128 mmHg. Eighteen cases (19.78%) underwent right heart catheterization (RHC). There were good parallels of PASP value between RHC and UCG. The main characteristics included Raynaud's phenomenon (53.8%), pericardial effusion (51.6%) and a high titer of anti-RNP antibody (57.1%). PASP was positively associated with SLE disease activity in mild and moderate cases. Among 27 mortality cases, there were 4 in group A(14.8%)and 23 in group B(85.2%). And the causes of immortality were mostly non-cardiac in group A and right heart failure in group B. Cyclophosphamide was effective in mild and moderate cases. Forty-four cases received PAH target treatment and it could decrease the PASP in mild and moderate cases and significantly prolong the survival for severe cases.

The major clinical characteristics of SLE-PAH patients include Raynaud's phenomenon, pericardial effusion and positivity of anti-RNP antibody. PASP is positively associated with SLE disease activity in mild and moderate cases for whom intravenous pulse cyclophosphamide therapy may be effective. For severe cases, concomitant PAH target therapy may significantly improve the prognosis.

To observe the long-term effects of hydroxychloroquine treatment on blood lipids and left ventricular function of systemic lupus erythematosus (SLE) patients.

A total of 72 SLE patients were randomly divided into 2 groups of hydroxychloroquine treatment (n=36) and non-hydroxychloroquine (n=36). The serum level of lipids, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), fractional shortening rate (FS), left ventricular ejection fraction (LVEF) and E/A ratio were measured before, 6 month, 12 month and 2 years after treatment.

After long-term use of hydroxychloroquine, there were statistically differences in the levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). And LVEDD, LVWPT and E/A were statistically different (P<0.05) before and after hydroxychloroquine dosing.

The long-term use of hydroxychloroquine may improve lipid metabolism and left ventricular function in SLE patients.

To access the feasibility of reducing tracheostomy rates in patients with complete cervical spinal cord injury through a systemic respiratory management mode.

A retrospective review was performed for 239 patients on a systemic respiratory management mode after complete cervical spinal cord injury in Shanghai Changzheng Hospital from 2006 to 2012. Their demographic and clinical data, including age, gender, cause of injury, level of cervical spinal cord injuries, surgical approaches, tracheostomy rates and mortality rates, were collected and analyzed. Tracheostomy rates were compared with those of patients with complete cervical spinal cord injury. Tracheostomy rates were compared with those patients with complete cervical spinal cord injury from 1991 to 2005. The new respiratory management mode for patients with severe cervical spinal cord injury included maintaining adequate energy and water for patients, relieving bronchospasm, loosening phlegm, strengthening body-turning and backslapping, sputum aspiration with suction tube through nasal cavity or bronchofibroscope, strengthening deep breath and cough training, strict control of tracheostomy indications and short-term postoperative intubation reserving if necessary.

32 patients were implemented tracheostomy. The tracheostomy rate was 13.4%. 10 patients died, the mortality rate was 4.18%. However, the tracheostomy rate was 19.1% and mortality rate 21.4% from 1991 to 2005. The tracheostomy rate was significantly lower than before and survival rate improved significantly.

The systemic respiratory management mode can effectively reduce tracheostomy rate of patients with complete cervical spinal cord injury and improve their survival rate.

To evaluate the improvement of clinical septic shock guideline of bundle therapy by key points of control strategies and its impact on the outcomes of septic shock patients.

The quality control team and sepsis steering committee were established to apply key points of control strategies to improve the clinical septic shock guideline of bundle therapy. The time to resuscitation, antibiotics and cultures, the implementation rate of 6-hour resuscitation goals, glucose control and lung protective ventilation strategies were recorded during the plan-do-check-act (PDCA) steps. And the changes of length of ICU stay and hospital mortality were analyzed.

Between July 2009 and December 2012, a total of 563 sequential septic shock patients were admitted. Demographics included median age, gender ratio, initial Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score and sources of infection showed no significant differences during this period. Compared with 2009, the time to resuscitation(65.1±10.3 vs 99.7±10.5 min, P<0.01), the time to cultures (55.9±5.2 vs 71.5±7.9 min,P<0.01) and the time to antibiotics (58.1±5.8 vs 152.8±16.1 min,P<0.01) significantly decreased in 2012. The implementation rate of 6-hour resuscitation goals (68.7% vs 28.7%,P<0.01), the implementation rate of glucose control (79.6% vs 40.0%,P<0.01) and the implementation rate of lung protective ventilation strategies (74.1% vs 51.4%,P=0.004) improved significantly form 2009 to 2012. The length of ICU stay (7.2±1.5 vs 9.8±2.7 d, P<0.01) decreased. And hospital mortality decreased from 40.0% in 2009 to 23.1% in 2012 (P=0.015).

The key points of control strategies can improve the clinical septic shock guideline of bundle therapy performance so that there are significant decreases of length of ICU stay and hospital mortality of septic shock patients.

To explore the correlation between serum levels of homocysteine (Hcy) and folate and cognitive function in first-episode drug-naïve schizophrenics.

A total of 60 first-episode schizophrenics (schizophrenia group) from our hospital and 60 healthy individuals (control group) were enrolled. Serum levels of folate and Hcy were measured with electrochemical luminescence method and enzymatic cycling assay respectively. Positive and Negative Syndrome Scale (PANSS) was used to evaluate the mental symptoms and Matrics Consensus Cognitive Battery (MCCB) was used to evaluate the cognitive function.

Serum level of folate in schizophrenia group (4.1±1.9 ng/ml) was lower than that in control group (7.5±1.9 ng/ml) (P<0.001). And serum level of Hcy in schizophrenia group (27±9 μmol/L) was significantly higher than that in control group (18±6 μmol/L) (P=0.006). Serum level of folate in schizophrenia group had negative correlations with Hcy level (r=-0.38, P=0.002) and negative symptoms (r=-0.25, P<0.05) while Hcy level was negatively correlated with cognitive function scores (r=-0.38, r=-0.33, r=-0.30, r=-0.30, P<0.05).

Serum level of folate decreases while serum level of Hcy increases in first-episode schizophrenics. Both have some relevance with mental symptom and cognitive dysfunction.

To explore the characteristics of cognitive impairment of cerebral ischemia in adults to provide rationales for proper diagnosis and targeted treatment.

A battery of standardized neuropsychological tests including mini-mental state examination (MMSE) and memory and executive screening (MES) was administered in a cohort of consecutive patients with cerebral ischemia. According to the screening results, they were divided into 3 subgroups of vascular dementia (VaD), vascular mild cognitive impairment (VaMCI) and non-vascular cognitive impairment (VCI). The general profiles of 3 subgroups were compared and the characteristics of VaMCI subgroup examined. Then the relationship between the composition of cognitive impairment and the type of ischemia (stroke and transient ischemic attack) was analyzed.

Fifty-six patients and 48 healthy subjects (normal control group) matched with regards to age, gender and education were recruited. Compared to normal control group, there was a decline in the scores of MMSE [(25.0±5.6) vs (28.0±1.4); t=2.695, P=0.007] and MES [(67±21) vs (84±7); z=3.860, P=0.000] in case group. There were 33 cases (58.9%) of VCI in case group, including 11 (19.6%) in VaD subgroup, 22 (39.3%) in VaMCI subgroup and 23 (41.1%) in non-VCI subgroup. And the rate of VaD/VaMCI was 1/2. The percentage of males (36.4% vs 78.3%; χ²=5.720, P=0.017) and education [(8±3) vs (12±4); P=0.010] of VaD subgroup were significantly lower than that of non-VCI subgroup; the education of VaMCI subgroup was significantly lower than that of non-VCI subgroup [(7±3) vs (12±4); P=0.001]; a positive correlation existed between scores of MMSE/MES and cognitive impairment. The neuropsychological tests were both sensitive and specific. In VaMCI subgroup, 22 cases (100%) presented with a deficit of at least 1 certain executive function/attention index, 21(95.5%) with at least 1 certain memory index, 17(77.3%) with at least 1 certain language index and 16(72.7%) with at least 1 certain visuospatial function index; all VaMCI cases presented with comprehensive cognitive impairment: 11 (50%) in 4 domains, 10 (45%) in 3 domains and 1 (5%) in 2 domains. No significant difference existed among 3 subgroups with regard to type of ischemia (χ²=1.111, P=0.574). In the case group, 30 patients suffered stroke and 17 (56.7%) had an onset of VCI with a rate of VaMCI/VCI at 58.8%; transient ischemic attack occurred in 26 patients and 16 (61.5%) suffered VCI with a rate of VaMCI/VCI at 75.0%.

Our study not only profiles the prevalence and peculiarity of cognitive impairment in patients with cerebral ischemia, but also provides concrete rationales for further diagnosis and classification of VCI.

To evaluate the performance effect of short-term catheter-directed thrombolysis with different dosage of rt-PA allied with endovascular interventional therapy for patients with acute lower limb ischemia.

To separate 84 consecutive patients suffered from acute lower limb ischemia into two groups at random, then adopt catheter-directed thrombolysis for each group of patients injected 20 mg(Group A) or 10 mg(Group B) rt-PA into the occlusive lesion correspondingly, and subsequently perform endovascular intervention on significant underlying lesions on the base of angiography results. Adopt statistical methods to assess treatment effectiveness, rates of complication and amputation rates within 30 days, 6 months or 12 months. The statistic analysis was performed under SPSS 16.0 format, and adopts t test and χ ² test.

There was no statistical difference on patient characteristics and lesions between both groups (P>0.05). Procedural success rates as well clinical success rates were all 100%. Not incur any diversity on thrombolysis effectiveness between both groups injected different dosage of rt-PA (P>0.05). Not found major differences on ratios of PTA or implant stent between both groups (P>0.05). During the follow-up period of 30-day, 6-, 12- months, there were no statistical differences on the amputation-free survival rates and complication rates between both groups.

Whereas short-term catheter-directed thrombolysis combined with endovascular interventional therapy won good operation effectiveness on patients with acute lower limb ischemia, moreover the dosage of rt-PA did not impact on thrombolysis, it is worthy to be applied in the clinical practice.

To evaluate the changes of ADC value on renal parenchyma at different age groups in healthy adults.

One hundred healthy adults were divided into five groups based on age: namely 18-29 years, 30-39 years, 40-49 years, 50-59 years and 60-69 years. All adults underwent diffusion-weighted magnetic resonance(MR) imaging of the kidneys with b values of 800 s/mm². ADC values of renal parenchyma were measured by the manufacturer's software.

With the increasing of age, the renal parenchyma ADCs decrease. The ADCs of renal parenchyma in five age groups were (2.07±0.10) ×10^-3mm²/s, (2.06±0.12) ×10^-3mm²/s, (2.03±0.10) ×10^-3mm²/s, (1.98±0.17) ×10^-3mm²/s and (1.94±0.12) ×10^-3mm²/s, which had statistically significant different(F=3.375, P<0.05).

(1)The ADCs of renal parenchyma may be influenced by age, with the increasing of age, ADCs of normal kidney presented tenuous decreasing tendency especially the people aged≥40 years; (2)in clinical application, we ought to pay attention to the influence of age factor. Income data of this study can be took as normal reference value in other more study.

To explore the feasibility of making a preoperative diagnosis of lung adenocarcinoma shown as ground-glass nodule (GGN) on computed tomography (CT).

A total of 143 GGN lesions proved pathologically were divided randomly into A and B groups. Then each group was further divided pathologically into preinvasive lesion, minimal invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) subgroups. Group A (n=101), size of lesion, proportion of ground glass opacity (GGO) composition of lesion, long diameter, longest diameter and size of solid component in lesion were measured on CT so as to establish the CT diagnostic standard of lung adenocarcinoma shown as GGN on CT. Group B (n=42) was employed to evaluate the accuracy of the above CT diagnostic standard. SPSS 17.0 software was used for statistical analysis.

Significant statistic significance existed in all parameters among all groups(P<0.05). All parameters were correlated the pathologic type of lesion. The differences were statistically significant (P=0.000). Through the receiver operating characteristic (ROC) curve, between groups of preinvasive lesion and MIA, each parameter had a medium diagnostic value of 0.70-0.90; between groups of MIA and IAC, size of lesion and long diameter of solid component in lesion had a medium diagnostic value of 0.70-0.90, longest diameter of solid component, size of solid component in lesion and proportion of GGO composition of lesion had a high diagnostic value with an AUC of >0.90. The CT diagnostic standard, derived from group A, was used to analyze the pathologic type of group B. And t no significant statistic significance existed between CT preoperative diagnosis and operative pathologic diagnosis(P>0.05). The correct diagnosis rates of size of lesion, proportion of GGO composition of lesion, long diameter, longest diameter and size of solid component in lesion were 71.43%, 76.19%, 90.05%, 90.05% and 88.10% respectively.

Based upon size of lesion, proportion of GGO composition of lesion, long diameter, longest diameter and size of solid component in lesion, preoperative CT examination may be used to determine the pathological types of lung adenocarcinoma shown as GGN.

To compare the effects of volume-controlled ventilation (VCV) and pressure-controlled volume-guaranteed (PCV-VG) mode during one-lung ventilation (OLV) on circulation, pulmonary function and lung injury.

2012 February to 2013 March in Ningbo No2. Hospital cardiothoracic surgery, 30 patients aged 52 to 76 years (ASA grade Ⅱ-Ⅲ) undergoing elective thoracoscopic lobectomy were randomly divided into VCV group and PCV-VG group, with 15 cases in each group. After anesthesia induction and endotracheal intubation, endobronchial blocker was inserted to start OLV. Heart rate (HR), mean arterial pressure (MAP), measured tidal volume (TV), peak airway pressure (Ppeak), airway resistance (Raw), chest compliance (Cdyn) and the end-tidal carbon dioxide pressure (PetCO₂) were recorded at the time point of 15 minutes after turning to the lateral position, 15 minutes and 60 minutes after OLV, and 15 minutes after the resumption of two lung ventilation. In the meanwhile, arterial blood gas analysis was conducted to measure indicators of pH, oxygen tension (PaO₂) and carbon dioxide partial pressure (PaCO₂). Blood was drawn before induction, 1 hour after OLV and 1 hour after the end of surgery, and the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA).

HR, MAP, TV, PetCO_2,pH and PaCO₂ in two groups at the time point of 15 minutes after turning to the lateral position, 15 minutes and 60 minutes after OLV, and 15 minutes after the resumption of two lung ventilation showed no significant difference (P>0.05). At the point of 15 minutes after turning to the lateral position and 15 minutes after two lung ventilation, Ppeak and Cdyn of two groups were significantly different (P<0.05) (Ppeak: 16±3 cmH₂O, 16±3 cmH₂O for VCV group and 14±2 cmH₂O, 14±2 cmH₂O for PCV-VG group; Cdyn: 43.5±5.9 ml/cmH₂O, 43.8±6.7 ml/cmH₂O for VCV group and 49.7±7.1 ml/cmH₂O, 53.3±9.6 ml/cmH₂O for PCV-VG group). Compared with VCV group, PCV-VG group showed a lower Ppeak 15minutes and 60 minutes after OLV[(17±2 cmH₂O) vs (22±4 cmH₂O) and (18±4 cmH₂O) vs(23±3 cmH₂O) with a higher Cdyn at the same point (38.6±6.3 ml/cmH₂O) vs (29.6±3.2 ml/cmH₂O) and 37.3±6.0 ml/cmH₂O) vs (30.3±3.8 ml/cmH₂O)](P<0.01). Compared with VCV group, IL-6 and TNF-α of PCV-VG group 1 hour after OLV and 1 hour after the end of surgery were significantly lower (P<0.01) (IL-6: 52.32±3.59 vs 62.65±4.17 pg/ml and 63.57±4.98 vs 82.38±4.10 pg/ml; TNF-α: 3.23±0.27 vs 4.19±0.38 pg/ml and 4.01±0.28 vs. 5.49±0.31 pg/ml).

During one-lung ventilation in thoracoscopic lobectomy, PCV-VG mode has a competitive advantage over VCV mode in terms of pulmonary function and lung protection.

To assess the efficacy and prognostic factors of preoperative radiation therapy in patients of elbow arthrolysis.

From October 2008 to September 2010, 43 patients with heterotopic ossification (HO) history at elbow were studied retrospectively. Radiation therapy was given in single fraction of 8 Gy within 1-4 h pre-operation. The elbow HO classifications at preoperation and the last follow-up were analyzed and their efficacy and related prognostic factors evaluated.

The median follow-up period was 34 (23.24-46.26) months. The elbow function of 19 (44.2%) cases returned to normal. One case was ineffective. Only one case had vulnus swelling. Graham and Hastings HO classification scores were significantly different between pre-operation and the last follow-up (Z=-5.899, P=0.000). Logistic analysis showed that age and time between diagnoses and treatment had a significant influence of elbow HO.

Preoperative radiation therapy of 8 Gy within 1-4 h of elbow arthrolysis is both safe and effective. And greater age, milder wound and longer time between diagnoses and treatment have better outcomes.

The patient was a 42-year-old female. Due to decreased menstruation for 4 months, increased leucorrhea with peculiar smell and contact bleeding for 1 month, he was admitted to Suining Central Hospital of Sichuan Province on December 24, 2012. Four months ago, the patient had obvious decrease in menstruation, prolonged cycle, no obvious change in menstrual period, mild symptoms, and did not see a doctor. One month ago, the patient had increased leucorrhea, yellow color, occasionally accompanied by pale red blood and peculiar smell. More than 20 days ago, the patient had bleeding in the same room, which was dripping endlessly. He went to the local hospital for treatment. Colposcopy showed cervical neoplasms. For further treatment, he came to Suining Central Hospital of Sichuan Province. Physical examination: Hysteroscopy showed that the mucosa of the cervical mouth was not smooth and congested, and a large bulge was visible. After applying acetic acid, the edema turned white, so a biopsy was taken. Under the microscope, the tumor cells were sheet-like and nest-like, small but consistent, round or oval, with less cytoplasm, translucent cytoplasm in some areas, round or oval nucleus, deep stain, fine chromatin, and not obvious nucleolus (Figure 1)； Immunophenotype CD99 (+) (Figure 2), Vimentin (+), Bcl-2 (+), CgA focal (+), Syn focal (+), NSE (-), P63 (-), LCA (-), desmin (-), CD10 (-), CK (-), TTF-1 (-) and Ki-67 were positive about 98%, and the pathological diagnosis was primitive neuroectodermal tumor of the cervix. Extensive hysterectomy plus pelvic lymph node dissection was performed under general anesthesia on 16 Jan 2013. The pathological diagnosis was primary primitive neuroectodermal tumor (PNET) of the cervix with no involvement of the pelvic lymph nodes. Adjuvant therapy such as radiotherapy and chemotherapy was given postoperatively, and PET-CT whole body scan was performed. No positive findings were found, and he was discharged from hospital. The patient is still alive after follow-up.

To investigate the ameliorative effect of curcumin pretreatment against impaired spatial working memory on global cerebral ischemia-reperfusion rats and to explore its mechanism.

After trained on a modified T-maze, 120 adult SD rats were randomly divided into 5 groups: sham group (S group), cerebral ischemia-reperfusion group (IR group), curcumin group (C group), LPS group (L group) and curcumin+ LPS group (C+ L group). Rats were treated with drugs or vehicles 1 h before 10 min global cerebral ischemia. Six rats in each group 7 days after reperfusion were tested in T-maze. Six rats in each group were sacrificed at 2 h, 1, 3 and 7 d after reperfusion and their serum or brains were harvested. Brain sections were stained with HE or toluidine blue and neuronal damage was quantified by the average neuronal density of CA1 area. Imunohistochemical staining for hippocampal IL-1β and TNF-α was carried out, levels of serum IL-1β and TNF-α was detected using ELISA procedure.

Compared with S group, percentage of T-maze correct responses was decreased (88%±12% vs 69%±8%, P<0.05), an extensive pyramidal neurons loss in CA1 area was observed, level of IL-1β (0.26±0.04 vs 0.53±0.06,P<0.05; 48±13 vs 161±31,P<0.05) and TNF-α (40.244±0.025 vs 0.418±0.036,P<0.05; 33±4 vs 85±15,P<0.05) in hippocampi or serum was increased in IR group. Compared with IR group, percentage of T-maze correct responses was increased (78%±13%) and average pyramidal neuronal density in CA1 area was increased with an decrease in hippocampi or serum IL-1β(0.44±0.09, 72±19)and TNF-α (0.307±0.047, 57±14) in C group(P<0.05). Compared with IR group, percentage of T-maze correct responses (61%±6%) was decreased with IL-1β (0.86±0.13, 331±51), TNF-α (0.735±0.059, 185±20) in hippocampi and serum was increased in L group(P<0.05). Compared with L group, percentage of T-maze correct responses (69%±12%) and average pyramidal neuronal density in CA1 area was increased with IL-1β(0.69±0.09, 246±24), TNF-α(0.586±0.047, 105±25) in hippocampi and serum was decreased in C+ L group(P<0.05).

Curcumin pretreatment improves the impaired spatial working memory in global cerebral ischemia-reperfusion rats by inhibiting proinflammatory cytokines.

To explore the role of Notch signaling pathway and the effect of γ-secretase inhibitor (DAPT) on the apoptosis induced by 1-methyl-4-phenylpyridinium (MPP ⁺) in differentiated SH-SY5Y cell.

SH-SY5Y cell were incubated with various concentrations (0, 0.5, 1, 1.5, 2 mmol/L) of MPP⁺ for 0, 24, 48 and 72 h respectively. Flow cytometry with Annexin V-FITC/PI double staining was used for apoptotic analysis. The protein expressions of Notch-1, Jagged-1 and Hes-1 were detected by Western blot. SH-SY5Y cell were preincubated with 10 μmol/L DAPT for 15 min before 1.5 mmol/L MPP ⁺ treatment for 48 h. Flow cytometry and Western blot were performed to analyze the cell apoptosis and protein expressions of Notch-1, Jagged-1 and Hes-1.

MPP⁺ induced the apoptosis of SH-SY5Y cell in a dose (3.20%±0.19% vs 10.00%±1.72%, 20.60%±3.76%, 32.80%±5.12%, 46.00%±5.06%, all P<0.05) and time- (2.80%±0.21% vs 12.30%±1.82%, 19.60%±2.89%, 35.00%±4.78%, allP<0.05) dependent manner. MPP⁺ up-regulated the expressions of Notch-1, Jagged-1 and Hes-1 in a dose- and time-dependent manner in SH-SY5Y cell. DAPT treatment decreased MPP⁺-induced apoptosis (3.10%±0.21% vs 35.50%±4.98%, 19.20%±2.98%, both P<0.05) and the expressions of Notch-1, Jagged-1 and Hes-1 in SH-SY5Y cell.

The activation of Notch signaling pathway plays an important role in MPP⁺-induced apoptosis of SH-SY5Y cell. DAPT inhibits Notch signaling pathway and protects SH-SY5Y cell from MPP⁺-induced apoptosis.

To examine the feasibility and efficacy of using superparamagnetic iron oxide nanoparticles coated with polyethylene glycol-grafted polyethylenimine (PEG-g-PEI-SPION) as a carrier for gene delivery into human adipose derived mesenchymal stem cells (hADMSCs) and in vitro cellular magnetic resonance imaging (MRI).

PEG-g-PEI-SPION was synthesized as previously reported. Gel electrophoresis was performed to assess the pDNA condensation capacity of PEG-g-PEI-SPION. The particle size and zeta potential of PEG-g-PEI-SPION/pDNA complexes were determined by dynamic light scattering. Cytotoxicity of PEG-g-PEI-SPION was evaluated by CCK-8 assay with hADMSCs. Gene transfection efficiency of PEG-g-PEI-SPION in hADMSCs was quantified by flow cytometry. The cellular internalization of PEG-g-PEI-SPION/pDNA nanocomplexes was studied by confocal laser scanning microscopy and Prussian blue staining. MRI function of PEG-g-PEI-SPION was studied by in vitro cellular MRI scanning.

PEG-g-PEI-SPION condensed pDNA to form stable complexes of 80-100 nm in diameter and showed low cytotoxicity in hADMSCs. At the optimal N/P ratio of 20, PEG-g-PEI-SPION/pDNA obtained the highest transfection efficiency of 22.8%±3.6% in hADMSCs. And it was higher than that obtained with lipofectamine 11.2%±2.6% (P<0.05). Furthermore, hADMSCs labeled with PEG-g-PEI-SPION showed sensitive low signal intensity on MRI T₂-weighted images in vitro.

PEG-g-PEI-SPION is an efficient and MRI-visible nano-vector for gene delivery into hADMSCs.

In-depth research on pelvic biomechanics is helpful to improve the surgical treatment effect of pelvic trauma. In solid biomechanics research, it is difficult to obtain cadaveric pelvic specimens and it is difficult to collect or make enough specimens, which easily leads to large errors in solid biomechanics experiment results due to insufficient sample size; At the same time, solid biomechanical experiments cannot measure the internal biomechanical characteristics of bones, which makes the pelvic biomechanical research urgently need new means to further improve. The finite element analysis method adopts the basic idea of dividing the whole into parts and gathering the zero into the whole, and uses the multi-morphological grid to divide each region and arrange the required nodes according to the needs, which has good applicability to various complex object structures; At the same time, the finite element method can understand the internal stress and strain changes of each part of the model when it is stressed^[1,2]。 These make finite element has unparalleled advantages in biomechanical research, making it an effective research method for pelvic biomechanics.