Antitumor effect of matrine in human hepatoma G2 cells by inducing apoptosis and autophagy

AIM: To study the antitumor effect of matrine in human hepatoma G2 (HepG2) cells and its molecular mechanism involved in antineoplastic activities. METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect viability of HepG2 cells. The effect of matrine on cell cycle was detected by flow cytometry. Annexin-V-FITC/PI double staining assay was used to detect cellular apoptosis. Cellular morphological changes were observed under an inverted phase contrast microscope. Transmission electron microscopy was performed to further examine ultrastructural structure of the cells treatedwith matrine. Monodansylcadaverine (MDC) staining was used to detect autophagy. Whether autophagy is blocked by 3-methyladenine (3-MA), an autophagy inhibitor, was evaluated. Expression levels of Bax and Beclin 1 in HepG2 cells were measured by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR).RESULTS: Matrine signif icantly inhibited the proliferation of HepG2 cells in a dose- and time-dependent manner, and induced G1-phase cell cycle arrest and apoptosis of HepG2 cells in a dose-dependent manner. The total apoptosis rate was 0.14% for HepG2 cells not treated with matrine. In contrast, the apoptosis rate was 28.91%, 34.36% and 38.80%, respectively, for HepG2 cells treated with matrine at the concentration of 0.5, 1.0 and 2.0 mg/mL. The remarkable morphological changes were observed under an inverted phase contrast microscope. Abundant cytoplasmic vacuoles with varying sizes were observed in HepG2 cells treated with matrine. Furthermore, vacuolization in cytoplasm progressively became larger and denser when the concentration of matrine was increased. Electron microscopy demonstrated formation of abundant autophagic vacuoles in HepG2 cells after matrine treatment. When the specif ic autophagic inhibitor, 3-MA, was applied, the number of autophagic vacuoles greatly decreased. MDC staining showed that the fluorescent density was higher and the number of MDC-labeled particles in HepG2 cells was greater in matrine treatment group than in control group. Fewer autophagic vacuoles were observed in the combined 3-MA and matrine treatment group when 3-MA was added before matrine treatment, indicating that both autophagy and apoptosis are activated when matrine-induced death of hepatoma G2 cells occurs. Real-time quantitative RT-PCR revealed that the expression levels of Bax gene, an apoptosis-related molecule, and Beclin 1 gene which plays a key role in autophagy were higher in matrine treatment group than in control group, indicating that Beclin 1 is involved in matrineinduced autophagy and the pro-apoptotic mechanismof matrine may be related to its upregulation of Bax expression. CONCLUSION: Matrine has potent antitumor activities in HepG2 cells and may be used as a novel effective reagent in treatment of hepatocellular carcinoma.

Pathological differential diagnosis of solid-pseudopapillary neoplasm and endocrine tumors of the pancreas

AIM:To investigate differential points of solid-pseudo-papillary neoplasm (SPN) of the pancreas and pancre-atic endocrine tumor (PET).METHODS:Ten cases of SPN and fourteen cases of PET were studied in this retrospective study. Clinical and pathologic features,immunostaining reactions and β-catenin gene mutations were analyzed.RESULTS:The mean age of SPN patients was 25.6 years and these patients had no specific symptoms. The mean diameter of the tumors was 11.0 cm,9/10 cases were cystic or a mixture of solid and cystic structures,and there was hemorrhage and necrosis on the cut surface in 8/10 (80%) cases. Characteristic pseudo-papillary structure and discohesive appearance of the neoplastic cells were observed in all 10 (100%) cases. The results of immunostaining showed that nuclear expression of β-catenin and loss of E-cadherin in all the cases,was only seen in SPN. Molecular studies discov-ered that 9/10 (90%) cases harbored a point mutation of exon 3 in β-catenin gene. On the other hand,the mean age of PET patients was 43.1 years. Eight of 14 cases presented with symptoms caused by hypoglyce-mia,and the other 6 cases presented with symptoms similar to those of SPN. The mean size of the tumors was 2.9 cm,most of the tumors were solid,only 3/14 (21%) were a mixture of solid and cystic structures,and macroscopic hemorrhage and necrosis were much less common (3/14,21%). Histologically,tumor cells were arranged in trabecular,acinar or solid patterns and demonstrated no pseudopapillary structure and discohesive appearance in all 14 (100%) cases. The results of immunostaining and mutation detection were completely different with SPN that membrane and cytoplastic expression of β-catenin without loss of E-cadherin,as well as no mutation in β-catenin gene in all the cases. CONCLUSION:Both macroscopic and microscopic features of SPN are quite characteristic. It is not difficult to distinguish it from PET. If necessary,immunos-taining of β-catenin and E-cadherin is quite helpful to make the differential diagnosis.

Pathologic research update of colorectal neuroendocrine tumors

Colorectal neuroendocrine tumors (NETs) originate from neuroendocrine cells in the intestinal tract, and represent a small area within oncology, but one which has provided increasing new data during the past years. Although the World Health Organization has determined clinical and histological features to predict prognosis for such tumors, they may not be valid on an individual basis. We aim to give an overview of the recent findings with regard to pathology, molecular genetics and diagnosis of NETs.

Synthesis and morphology of triangular pyramid-shaped puerarin microparticle with nanostructure

A type of triangular pyramid-shaped microparticles of puerarin was synthesized by using oil-in-oil microemulsion approach which is simple and economical under the action of copper substrate.The pyramid-shaped microparticles would be made up of deposit of nanospheres or nanorods and have two significant characters.One is its complex surface morphology like coral reef.The other is a lot of nanopores in existence in the microparticle body.Two possible formation routes were speculated.

LOH analysis of genes around D4S2964 identifies ARD1B as a prognostic predictor of hepatocellular carcinoma

AIM:To investigate genes around the locus D4S2964 affected by loss of heterozygosity(LOH) and their clinical implications.METHODS:Four hundred and forty single nucleotide polymorphisms(SNPs) located at 49 genes around D4S2964 were selected from the National Center for Biotechnology Information website for the SNPs microarray fabrication.LOH of SNPs markers in 112 cases of hepatocellular carcinoma(HCC) tissues and paired adjacent liver tissues were investigated by the SNPs microarray.The correlation between allelic losses with clinicopathological features and overall survival was analyzed.RESULTS:A f ine map of LOH of SNPs in genes around D4S2964 was plotted.The average frequency of LOH in genes was 0.39.A correlation between cirrhosis and the FAL index(fractional allelic loss) was found(P = 0.0202).Larger tumor size was found to be signif icantly associated with LOH in genes ADP-ribosyltransferase 3(ART3),nucleoporin 54 kDa(NUP54),scavenger receptor class B,member 2(SCARB2) and coiled-coil domain containing 158(CCDC158)(P = 0.043,P = 0.019,P = 0.001,P = 0.037,respectively).Kaplan-Meier analysis showed that patients with LOH in ARD1 homolog B(ARD1B) and septin 11(SEPT11) had a significantly lower survival rate than those with retention(P = 0.021 and P = 0.004,respectively).A Cox regression model suggested that LOH in ARD1B and SEPT11,respectively,were predictors of the overall survival in HCC(P = 0.006 and P = 0.026,respectively).CONCLUSION:LOH in genes around D4S2964 may play an important role in HCC development and progression.LOH in ARD1B and SEPT11 could serve as novel prognostic predictors in HCC patients.

唐氏综合征妊娠中、晚期胎儿一种新的心脏影像学征象——右锁骨下动脉异位

The right subclavian artery arises normally as the first vessel from the brachiocephalic artery of the aortic arch. An aberrant right subclavian artery arises as a separate vessel from the aortic isthmus and crosses to the right, behind the trachea. This variant is present in <1% of the normal population; however, in subjects with Down syndrome, an incidence between 19% and 36% was reported. The purpose of this study was to assess the possibility of the detection of an aberrant right subclavian artery in fetuses with Down syndrome. Fourteen consecutive fetuses with prenatally detected Down syndrome were examined between 18 and 33 weeks of gestation. The presence of an aberrant right subclavian artery was determined by visualization of the transverse 3- vessel trachea view of the upper thorax with color Doppler ultrasonography. The right subclavian artery was visualized in 100% of fetuses (14/14) with Down syndrome. An aberrant right subclavian artery was identified in 35.7% of trisomy 21 fetuses (5/14). In 1 fetus, the aberrant right subclavian artery was the only abnormal ultrasound finding. In 3 fetuses, an aberrant right subclavian artery was associated with an intracardiac echogenic focus plus additional extracardiac markers. In the fourth fetus, an aberrant right subclavian artery was associated with an atrioventricular septal defect. All 9 fetuses with Down syndrome with a normal origin of the right subclavian artery had additional cardiac and/or extracardiac abnormalities. In 12 cases, pregnancy was terminated; 2 fetuses were live born. This preliminary study suggests that the in utero identification of an aberrant right subclavian artery may be a new ultrasound marker to be found in fetuses with Down syndrome. Further studies are required to assess the incidence of aberrant right subclavian artery in normal fetuses.

儿童咬汽车轮胎引起的罕见类型严重气压伤1例

The authors report a rare case of a barotraumatic pneumothorax and pneumomediastinum associated with esoph-ageal perforation and orbital emphysema. A 4-year-old boy presented with sudden respiratory distress after blowout of a defective tire that he bit. Computed tomography scan showed right pneumothorax and bilateral orbital emphysema. A linear rupture has been detected in the cervical esophagus in esophagoscopy. Stamm gastrostomy and tube thoracostomy were performed,and broadspectrumantibiotics have been introduced. Oral feeding started 23 days after blowout of tire, and the patient was discharged 50 days after injury.

6-巯基嘌呤治疗炎症性肠病的单中心10年治疗经验

Goals: To report the 10- year experience of a single center in treating pati ents with refractory inflammatory bowel disease (IBD) with relatively lower dose of 6- mercaptopurine (6- MP). Study: The charts of 285 patients with IBD (Cro hn’ s disease 160 and ulcerative colitis 125) receiving 6- MP were reviewed. C linical response, subsequent breakthrough while taking 6- MP, and relapse rates when 6- MP was discontinued and side effects were assessed. Results: Ninety- three percent of the patients were taking 50 to 75 mg/day of 6- MP. Complete re mission was achieved in 62% , partial remission in 14.5% , and failure to achi eve remission in 23.5% of the patients. Of complete responders, 27.5% had br eakthrough while continuing 6- MP. Nine percent of those that achieved a comple te remission experienced a relapse after 6- MP was discontinued. Side effects i ncluded leukopenia (11.2% ), abnormal liver function tests (3.8% ), various in fections, including pneumonia (3.1% ), pancreatitis (2.5% ), nausea (2.1% ), headache (2.8% ), fever (1.4% ), hair loss (1% ), and rash (0.7% ). Two canc ers occurred while taking 6- MP: melanoma on the finger and a fatal colonic lym phoma. Four patients continued 6- MP throughout pregnancies and had normal outc omes. Conclusions: In our experience 6- MP is relatively safe and appears to be as effective at a lower dosage (0.84 mg/kg per day) compared with the recommend ed higher dosage (1- 1.5 mg/kg per day), when leukopenia was more frequent. Ser ious side effects, although rare, need to be monitored.

经腹胎儿脉冲血氧测定法:近红外线分光镜

The purpose of this study was to determine the feasibility of noninvasive fetal pulse oximetry in the human fetus with transabdominal continuous- wave near- infrared spectroscopy. The instrument has 3 wavelength light- emitting diodes (735, 805, and 850 nm) as light sources and a photomultiplier tube as a detector. This instrument was used in 6 pregnant women (>36 weeks of gestation). First, a fetal heart rate was obtained with a fetal heart rate monitor. Then, the depth of fetal tissue (head) from the maternal abdomen was determined by ultrasound examination; the distance between the optodes (light source and the detector) was set to be approximately twice the depth of the fetus (7- 11 cm). The data analysis was based on the modified Beer- Lambert law and the use of optical densities at 735 and 850 nm to obtain the concentration changes of the oxyhemoglobin and deoxyhemoglobin. The saturation was expressed as the percent of oxygen saturation equal to 100× oxyhemoglobin/ (oxyhemoglobin + deoxyhemoglo- bin). We recorded the spectroscopy data and the fetal heart rate for approximately 3 to 10 minutes in each patient. The mean oxygen saturation values of each of the 6 individual fetuses ranged from 50% to 74% (overall mean saturation, 61% ± 14.8% [SD]). This preliminary data indicate that transabdominal fetal pulse oximetry is feasible for human patient application. The measured values were similar to those that are obtained with transvaginal pulse oximetry. Future studies should correlate transabdominally obtained measurements with those measurements that are obtained by transvaginal fetal pulse oximetry.

单纯气道损伤或格拉斯哥昏迷评分<8分的小儿创伤患者:患者到达医院后,外科主治医师能否及时到达是否会造成不同结果

Optimal trauma care requires an attending pediatric surgeon to head a trauma team for the most severely injured patients. Recently, the American College of Surgeons-Committee on Trauma has added “Glasgow Coma Scale (GCS) <8”and “airway compromise”to the existing anatomical and physiological criteria for immediate attending presence. This report analyzes the outcome of children who met these isolated criteria and were treated before the change in guidelines was made. The trauma registry of this level I trauma center was queried for all pediatric patients with GCS < 8 or airway compromise. Age, sex, initial GCS, Revised Trauma Score, Injury Severity Score, outcome, and probability of survival (TRISS methodology) were recorded. The subgroup of patients for whom an attending surgeon was not immediately present was further analyzed. Over a 5-year period, 2895 trauma patients (aged 0-16 years) were admitted. One hundred fifteen patients had a GCS < 8 and/or airway compromise. In 61 cases, an attending surgeon was not present upon patient arrival. Of these patients, 24 died (group D), 15 were discharged to a rehabilitation facility (group R), and 22 were discharged home (group H). Ten patients with a probability of survival of lower than 0.5 survived. Only 4 of the 24 patients who died had a probability of survival of > 0.5 (mean, 0.697). All 4 had an Injury Severity Score > 25 and a GCS ≤4. All deaths were reviewed through a quality improvement program and were deemed nonpreventable by objective reviewers. Patient outcome was not affected by the presence or absence of an attending surgeon upon patient arrival. Outcome of severely injured children with GCS < 8 or airway compromise met and, in some cases, exceeded expectations of survival according to the TRISS methodology. The lack of immediate attending surgeon’s presence does not appear to have negatively influenced the outcome in these children. Based on this series, there is no evidence to justify mandatory immediate presence of an attending surgeon for these 2 criteria alone.

活动性炎症性肠病患者缺乏未成熟的外周血浆细胞样和髓样树突状细胞

Background: Breakdown of tolerance against the commensal microflora is believ ed to be a major factor in the pathogenesis of inflammatory bowel disease (IBD). Dendritic cells (DC) have been implicated in this process in various animal mod els, but data on human DC in IBD are very limited. Aim: To characterise plasmacy toid DC (PDC) and myeloid DC (MDC) in patients with active versus inactive IBD a nd healthy controls. Patients and Methods: Peripheral blood was obtained from 10 6 patients (Crohn’ s disease (CD) n = 49, ulcerative colitis (UC) n = 57) and h ealthy controls (n = 19). Disease activity was scored using themodified Truelove Witts (MTWSI) for UC and the Harvey Bradshaw severity indices (HBSI) for CD. Fo ur colour flow cytometric analysis was used to identify, enumerate, and phenotyp e DC. DC from patients with acute flare ups and healthy controls were cultured a nd stimulated with CpG ODN 2006 or lipopolysaccharide (LPS). Results: IBD patien ts in remission (PDC UC, 0.39% ; CD, 0.35% ; MDC- 1 UC, 0.23% ; CD, 0.22% of PBMC) have slightly lower numbers of circulating DC compared with healthy con trols (PDC 0.41% , MDC- 1 0.25% of PBMC). In acute flare ups IBD patients ex perience a significant drop of DC (PDC UC, 0.04% ; CD, 0.11% ; MDC- 1 UC, 0.1 1% ; CD, 0.14% of PBMC) that correlates with disease activity (correlation co efficients: PDC MTWSI, 0.93; HBSI, 0.79; MDC- 1 MTWSI, 0.75; HBSI, 0.81). Moreo ver, both express α l4β 7 integrin and display an immature phenotype. Freshly isolated PDC and MDC- 1 from untreated flaring IBD patients express higher base line levels of CD86 which increases further in culture and upon stimulation comp ared with healthy controls. Conclusion: IBD patients lack immature blood DC duri ng flare ups which possibly migrate to the gut. An aberrant response to microbia l surrogate stimuli suggests a disturbed interaction with commensals.

研究婴儿视杆光反应的恢复

PURPOSE. To study deactivation of the rod photoresponse in infants using a paired-flash procedure. Rhodopsin content increases and scales the parameters of the activation of rod phototrans duction as rods develop. However, little is known about the kinetics of deactivation in the rods of young infants. METHODS. ERG responses to pairs of flashes were used to study the recovery of the rod response in 4- and 10- week-old infants and mature control subjects. The amplitudes of rod isolated a-wave responses to a probe flash (+ 3.3 log scot tds) presented 2 to 120 seconds after an equal-intensity test flash were measured. The interstimulus interval (ISI) at which the amplitude was half that of the response to the probe flash alone (t50) was determined by linear interpolation. RESULTS. Recovery time (t50) was significantly longer in infants than in adults (F=18.9, df 2, 32; P<0.01). The shape of the recovery function did not vary with age. The t50 values were inversely proportional to the parameters of activation of rod phototransduction. CONCLUSIONS. These results are evidence that the kinetics of deactivation in infants are slower and may be set by the proportion of rhodopsin isomerized.

小儿外伤患者发生肺检塞危险人群

Deep vein thrombosis and pulmonary embolism (DVT/PE) are rare in pediatric trauma patients, and guidelines for prophylaxis are scarce. The authors sought to identify subgroups of patients who may be at higher risk of developing DVT/PE. Case-control study of pediatric trauma patients with DVT/PE. Odds ratios (ORs) and confidence intervals (CIs) were calculated for known risk factors of PE using matched trauma controls (χ2 analysis). A total of 3637 pediatric trauma patients was admitted over the last 7 years. Three patients developed DVT/PE (overall incidence, 0.08%). There were 2 girls and 1 boy, aged 15, 15, and 9 years, respectively. All 3 had an Injury Severity Score (ISS) ≥25 and an initial Glasgow Coma Score (GCS) ≤8. None of the known and potential risk factors significantly increased the OR for developing DVT/PE: age 9 years or older (OR, 3.6; CI, 0.4-26), presence of head injury (OR, 2.9; CI, 0.3-22), female sex (OR, 1.2; CI, 0.15-9.1), GCS ≤8 (OR, 9.2; CI, 0.9-230), except ISS ≥25 (OR, 82; CI, 7.6-2058). The OR for a combination of age and GCS was 106, and the OR for the 3 risk factors (age, ISS, GCS) common to all 3 patients was 114 (CI, 10-5000; P < .001). The overall incidence of DVT/PE in pediatric trauma patients is < 0.1%and routine prophylaxis is not recommended. Children aged 9 years or older with an initial GCS ≤8 and patients with an estimated ISS ≥25 may constitute a high-risk group in which prophylaxis could be considered.

影响家用儿童心肺监测仪使用的影响因素:协作性家用儿童监测仪评价

Background: As part of the Collaborative Home Infant Monitoring Evaluation, a home monitor was developed to record breathing, heart rate, other physiologic va riables, and the time the monitor was used. Objective: To determine the frequenc y of monitor use, factors that influence use, and validity of a model developed to predict use. Design: We developed a model to predict monitor use using multip le linear regression analysis; we then tested the validity of this model to pred ict adherence for the first week of monitoring and for the subsequent 4-week pe riod (weeks 2-5). Setting: Clinical research centers in Chicago, Ill; Cleveland , Ohio; Honolulu, Hawaii; Los Angeles, Calif; and Toledo, Ohio. Patients: Preter m infants, infants younger than 1 month with a history of autopsy-confirmed sud den infant death syndrome in a sibling, and infants with an idiopathic apparent life-threatening event were divided into 2 cohorts based on enrollment date. Ma in Outcome Measure: Mean hours of monitor use per week. Results: In cohort 1, th e variables available before monitoring were only weakly associated with total h ours of monitor use in weeks 2 to 5 (total model r 2 = 0.08). However, when hou rs of monitor use in week 1 were included as a variable to predict monitor use i n weeks 2 to 5, the r2 increased to 0.64 for hours ofmonitor use perweek. Concl usions: Our data show that monitor use in the first week was the most important variable for predicting subsequent monitor use. The study suggests that a major focus of home monitoring should be adherence in the first week, although it rema ins to be tested whether this adherence can be altered.

卵巢上皮癌脑转移对顺铂和吉西他滨联合化疗的反应:病例报道及文献回顾

Background. Brain represents a rare site of metastasis in patients with epithe lial ovarian carcinoma (EOC).Case report. We observed a case of multiple brain m etastases in an EOC patient after complete response of a pelvic recurrence to pl atinum/paclitaxel chemotherapy. Complete response of brain metastases was observ ed after whole brain radiotherapy and subsequent chemotherapy by combination of cisplatin and gemcitabine. Three subsequent recurrences of brain metastases were controlled by re-treatment by the combination of 5-fluorouracil, cisplatin an d gemcitabine. Methods. Because of limited information on the outcome of EOC bra in metastases in reported case series, a pooled analysis of the published report s in patients with EOC brain metastases was performed. Data were extracted from 46 reports that contained sufficient details on 189 individual patients. The sur vival was analyzed by the Kaplan-Meier method. Univariate and multivariate anal yses were performed by the log-rank test and Cox method, respectively. Results. The most favorable outcome was observed in patients treated by surgery combined with radiotherapy and/or chemotherapy. The survival was significantly better in reports describing only one or two cases, in patients diagnosed after 1992, in patients who received therapy in addition to symptomatic treatment, in patients treated by radiotherapy, chemotherapy and surgery, in patients without extracran ial metastases and with single brain metastases. On multivariate analysis, the a bsence of extracranial metastases, treatment by chemotherapy, surgery and radiot herapy were independent positive predictors of survival. Conclusions. EOC brain metastases are responsive to chemotherapy. An aggressive multidisciplinary thera peutic approach including chemotherapy may lead to prolonged survival.

自身免疫性肝病中CD4^+及CD25^+调节性T细胞的损伤

Background/Aims CD4+ lymphocytes constitutively expressing the IL-2-receptor α-chain (CD25) regulate the activation of CD4 and CD8 autoreactive T-cells by suppressing their proliferation and effector function. The aim of this study is to:(1) measure the percentage of CD4+ CD25+ T-cells (T-regs)in patients with autoimmune liver disease at presentation and during remission, (2) correlate their frequency with disease activity, (3) determine their ability to expand and (4) to inhibit interferon-gamma (IFNγ ) production by CD4+ CD25-T-cells.Methods 41 patients were studied. Percentage of T-regs was determined on peripheral blood mononuclear cells (PBMCs) by triple-colour flow cytometry; their ability to expand by exposing PBMCs to a T-cell expander (CD3/CD28 Dynabeads); their immunoregulatory function by measuring their ability to suppress IFNγ production by CD4+ CD25-T-cells. Results T-regs were significantly less in patients than in controls, and at diagnosis than during remission. Their percentage was inversely correlated with titres of anti-liver kidney microsomal and soluble liver antigen autoantibodies. T-regs ability to expand was significantly lower in patients than in controls, but that to suppress IFNγ production by CD4+ CD25-T-cells was maintained. Conclusions Decreased T-regs numbers and ability to expand may favour the emergence of liver-targeted autoimmunity, despite preserved suppressor function. Treatment should aim at increasing T-regs number.

胎盘早剥的危险因素:早产胎膜早破、子宫内感染和羊水过少

OBJECTIVE: To examine whether preterm premature rupture of membranes (PROM), intrauterine infection, and oligohydramnios are risk factors for placental abruption. METHODS: Data for this retrospective cohort study were derived from the 1988 National Maternal and Infant Health Survey (N=11,777). Association between abruption and these clinical risk factors was expressed as relative risk (RR) and 95%confidence interval (CI), with multivariate adjustment for potential confounders. RESULTS: The overall incidence of abruption was 0.87%. The risk of abruption was 3.58-fold higher (95%CI 1.74-7.39)among women with preterm PROM (2.29%) compared with women with intact membranes (0.86%). The rates of abruption among women with and without intrauterine infection were 4.81%and 0.83%, respectively (RR 9.71, 95%CI 3.23-29.17). However, oligohydramnios was not associated with abruption (1.46%compared with 0.87%; RR 2.09, 95%CI 0.92-5.31). Compared with women with intact membranes, the RR for abruption among preterm PROM and whose membranes were ruptured for 24-47 hours and 48 hours or more before delivery, respectively, were 2.37 (95%CI 0.99-9.09), and 9.87 (95%CI 3.57-27.82). When preterm PROM was accompanied by intrauterine infections, the RR for abruption was 9.03 (95%CI 2.80-29.15) compared with women with intact membranes and no infections. Similarly, preterm PROM accompanied by oligohydramnios conferred over a 7.17-fold risk (95%CI 1.35-38.10) for abruption compared with women with neither of these 2 conditions. CONCLUSION: Women presenting with preterm PROM are at increased risk of developing abruption, with the risk being higher either in the presence of intrauterine infections or oligohydramnios. Physicians managing patients with preterm PROM should be aware that these patients are at increased risk of developing abruption after 24 hours following preterm PROM.

全结肠的先天性巨结肠:28年的治疗经验

The aim of this study was to review outcomes after surgical treatment of total colonic Hirschsprung’s disease (TCH). Twenty-five records of patients with TCH treated between 1974 and 2002 were reviewed. Follow-up data were collected using a standardized questionnaire. Objective functional outcome was assessed using a scoring system. Twenty patients had aganglionosis of the colon and distal ileum, 5 of whom had a more extensive condition. One of these 5 patients underwent an endorectal pull-through (ERPT), 1 underwent intestinal transplantation, and 3 died. Four of the remaining 20 patients underwent a primary ERPT, 16 received a stoma as neonates followed by ERPT in 12, and a Martin-Duhamel procedure or Swenson’s operation in 3 (median age, 10.5months); 1 remains with an ostomy. Postoperative complications included enterocolitis (55%), anal stricture (25%), and perineal excoriation (20%). Mean follow-up were 17.5 years (±11.1 years). Eightynine percent were free of recurrent enterocolitis. Frequency of bowel movements is 1 to 5 per day in 82%of the patients, 18%have 6 or more bowel movements per day. Occasional soiling is noted in 40%(one third of those requiring nighttime diapers). Overall functional outcome was good in 83%. Those patients with the longest follow-up periods had the best stooling scores (P =.04). Surgical treatment of TCH is associated with a number of complications including recurrent enterocolitis and anal strictures. Long-term outcome is quite favorable.

阈下重复经颅磁刺激前运动皮层对抽动秽语综合征的抽搐无控制作用

Objective: A previous study showed no effect of 1 Hz repetitive transcranial m agnetic stimulation (rTMS) on tics in Gilles de la Tourette Syndrome (GTS). We m odified the rTMS protocol in order to investigate some of the possible methodolo gical reasons for the negative outcome in that study. Methods: In a single blind ed placebo-controlled cross-over study in five GTS patients without obsessive compulsive disorder we probed whether longer trains (1800 stimuli) of 1 Hz pre- motor cortex rTMS at 80%of active motor threshold and application to both hemis pheres can improve tics in GTS. This was measured with the Yale Global Tic sever ity rating scale, the MOVES self-rating scale and video analysis. Results: We f ound no significant effect of either left pre-motor cortex stimulation alone, o r left pre-motor followed by right pre-motor cortex stimulation. Conclusions:T hese results suggest that the rTMS protocol used in this study is not useful for the treatment of tics in GTS. Significance: rTMS protocols need to be modified substantially in order to explore their potential for the treatment of tics in G TS.

前置血管的产前诊断对妊娠结局的影响

OBJECTIVE: To evaluate outcomes and predictors of neonatal survival in pregnancies complicated by vasa previa and to compare outcomes in prenatally diagnosed cases of vasa previa with those not diagnosed prenatally. METHODS: We performed a multicenter study of 155 pregnancies complicated by vasa previa. Cases were obtained from the Vasa Previa Foundation and 6 large hospitals. Comparisons were made between groups based on prenatal diagnosis status and neonatal survival. RESULTS: The overall perinatal mortality was 36%(55 of 155). In 61 cases (39%), vasa previa was diagnosed prenatally; 59 of 61 (97%) infants from these pregnancies survived compared with 41 of 94 (44%) in cases not diagnosed prenatally (P < .001). Median 1and 5-minute Apgar scores in cases diagnosed prenatally were 8 and 9, respectively, compared with 1 and 4 among survivors in cases not diagnosed prenaially (P < .001). More than half (24 of 41) of surviving neonates born to women without prenatal diagnosis required blood transfusions compared with 2 of 59 diagnosed prenatally (P < .001). Multivariable logistic regression analysis showed that the only significant predictors of neonatal survival were prenatal diagnosis (P <.001) and gestational age at delivery (P = .01). CONCLUSIONS: Good outcomes with vasa previa depend primarily on prenatal diagnosis and cesarean delivery at 35 weeks of gestation or earlier should rapture of membranes, labor, or significant Heeding occur.