[Research advances on the application of free flaps in repairing diabetic foot ulcers].

Free flaps have been successfully used in the repair of diabetic foot ulcers (DFUs), which can reduce amputation rate, maintain normal gait of patients, and improve life quality of patients. However, there are still many challenges in the repair of DFUs with free flaps, and many problems need to be solved. This paper summarizes the selection of patients, preoperative cautions, types of flaps, methods of vascular anastomosis, clinical effects, and existing problems in using free skin flaps for repairing DFUs.

[Optimizing biopsy procedures during colposcopy and detection of high-grade cervical lesions].

Objective: To investigate the value of biopsies on diagnosing cervical intraepithelial neoplasia of grade 2 or worse (CIN Ⅱ+), and optimize biopsy procedures of risk-based colposcopy practice. Methods: A prospective study was performed on 346 women referred to colposcopy following abnormal cervical cancer screening results at the First Affiliated Hospital of Nanjing Medical University, from April 2017 to December 2019. Up to 4 cervical biopsies were taken during colposcopy and each biopsy specimen was evaluated separately in histology. CIN Ⅱ+ identified by any biopsy was the reference standard of disease used to evaluate the diagnostic value of targeted biopsy and random biopsy, and to quantify the improved detection of CIN Ⅱ+ by taking multiple biopsies. Cervical cytology, HPV genotyping, and colposcopic impression were used to establish different risk strata to select various multiple biopsies procedures during colposcopy to improve accuracy and efficiency of CIN Ⅱ+ detection. Results: In total 346 women, 190 (54.9%, 190/346) cases of them were diagnosed as CIN Ⅱ+. (1) In total 346 women, 96.8% (184/190) CIN Ⅱ+ were detected by targeted biopsies, 27.9% (53/190) CIN Ⅱ+ were detected in biopsies targeted grade 1 abnormal colposcopic findings (G1) on the cervix, and 68.9% (131/190) CIN Ⅱ+ were detected in biopsies targetrd grade 2 abnormal colposcopic findings (G2) on the cervix. Colposcopy had a sensitivity of 68.9% when the biopsy threshold was G2, sensitivity increased to 96.8% when the biopsy threshold was defined to be G1. Among women with G1, adding 2 targeted biopsies to the first biopsy were sufficient to detect all CIN Ⅱ+, among women with G2, adding 1 targeted biopsy was sufficient. (2) Among 270 women, random biopsies targeted normal colposcopic findings on the cervix were performed in addition to targeted biopsies and in total 3.2% (6/190) additional CIN Ⅱ+ were detected. As the number of cervical quadrants involved by abnormal colposcopic images increased, random biopsy detected fewer CIN Ⅱ+ that would have otherwise been missed by targeted biopsies (P=0.010). (3) Women with atypical squamous cells,cannot exclude high grade squamous intraepithelial lesion (ASC-H), high grade squamous intraepithelial lesion (HSIL) or atypical glandular cell (AGC) referral cytology, HPV 16-positive, G2 were more likely to have CIN Ⅱ+(P<0.01); for those meeting only one category, the yield of CIN Ⅱ+ increased from 34.0% for one biopsy to 51.0% for two biopsies, the absolute increase in CIN Ⅱ+ yield increased from the first to the second biopsy was 17.0%, two biopsies were sufficient to detect all CIN Ⅱ+; for those meeting at least two categories, the yield of CIN Ⅱ+ increased from 90.7% for one biopsy to 92.6% for two biopsies, the absolute increase in CIN Ⅱ+ yield increased from the first to the second biopsy was 1.9%, two biopsies were sufficient to detect all CIN Ⅱ+; for those not meeting any category, the yield of CIN Ⅱ+ increased from 8.8% for one biopsy to 17.6% for two biopsies, to 23.5% for three biopsies, the absolute increase in CIN Ⅱ+ yield increased from the first to the second biopsy, from the second to the third biopsy was 8.8%, 5.9%, three biopsies were sufficient to detect all CIN Ⅱ+. Conclusions: Performing multiple targeted biopsies could improve efficiency of CIN Ⅱ+ detection. Adding random biopsies to multiple targeted biopsies showed very limited additional benefit for detection of CIN Ⅱ+. The biopsy procedures undertaken during the colposcopy visit could be modified based on various colposcopic impressions and reasons for referral.

[Immune characteristics of Plasmodium reinfections in mice following chloroquine cure of primary Plasmodium infections].

OBJECTIVE: To investigate the disease progression and immunoprotective characteristics in mice re-infected with homogeneous/heterogeneous Plasmodium strains following cure of Plasmodium infections with chloroquine at the peak of parasitemia. METHODS: C57BL/6 mice were infected with the non-lethal P. yoelii 17XNL strain, and half of mice were given treatment with chloroquine at the peak of parasitemia (9 days post-infection), while the other mice were self-cured naturally. Then, all cured mice were re-infected with the equivalent lethal P. yoelii 17XL or P. berghei ANKA strain 90 days following primary Plasmodium infections. The parasitemia levels during primary infections and reinfections were measured by microscopic examinations of Giemsa-stained thin blood films, and the levels of the IgG antibody in sera and the percentages of memory T cell subsets in spleen cells were detected in mice using ELISA and flow cytometry before and after parasite reinfections, respectively. RESULTS: Following primary infections with the P. yoelii 17XNL strain, the serum IgG antibody levels were (5.047 ± 0.924) pg/mL in the selfcured mice and (4.429 ± 0.624) pg/mL in the chloroquine-treated mice, respectively (t = 0.437, P > 0.05), which were both significantly higher than that in the uninfected mice (1.624 pg/mL ± 0.280 pg/mL) (F = 22.522, P < 0.01). There was no significant difference in the serum IgG antibody level among self-cured and chloroquine-treated mice re-infected with the P. yoelii 17XL strain or the P. berghei ANKA strain (F = 0.542, P > 0.05); however, the serum IgG antibody levels were all significantly higher in selfcured and chloroquine-treated mice re-infected with the P. yoelii 17XLstrain[(15.487±1.173)pg/mLand(15.965±1.150)pg/mL] or the P. berghei ANKA strain [(14.644 ± 1.523) pg/mL and (15.185 ± 1.333) pg/mL] relative to primary infections (F = 67.383, P < 0.01). There was no significant difference in the proportion of CD4+ [(34.208 ± 2.106), (32.820 ± 1.930), (34.023 ± 2.289), (35.608 ± 1.779) pg/mL] or CD8+ T memory cells [(17.935 ± 2.092), (18.918 ± 2.823), (17.103 ± 1.627), (17.873 ± 1.425) pg/mL] in self-cured and chloroquine-treated mice with primary infections with the P. yoelii 17XNL strain followed by re-infections with the P. yoelii 17XL strain or the P. berghei ANKA strain (F = 0.944 and 0.390, both P > 0.05); however, the proportions of the CD4+ or CD8+ T memory cells were significantly greater in self-cured and chloroquine-treated mice with primary infections with the P. yoelii 17XNL strain followed by re-infections with the P. yoelii 17XL strain or the P. berghei ANKA strain than in mice with primary infections (F = 50.532 and 21.751, both P < 0.01). CONCLUSIONS: The cure of murine Plasmodium infections with chloroquine does not affect the production of effective immune protections in mice during parasite re-infections. Following a primary infection, mice show a protection against re-infections with either homogeneous or heterogeneous Plasmodium strains, and a higher-level resistance to re-infections with homogeneous parasite strains is found than with heterogeneous strains.

Metabolic regulation of polyamines and γ-aminobutyric acid in relation to spermidine-induced heat tolerance in white clover.

Heat stress decreases crop growth and yield worldwide. Spermidine (Spd) is a small aliphatic amine and acts as a ubiquitous regulator for plant growth, development and stress tolerance. Objectives of this study were to determine effects of exogenous Spd on changes in endogenous polyamine (PA) and γ-aminobutyric acid (GABA) metabolism, oxidative damage, senescence and heat shock protein (HSP) expression in white clover subjected to heat stress. Physiological and molecular methods, including colorimetric assay, high performance liquid chromatography and qRT-PCR, were applied. Results showed that exogenous Spd significantly alleviated heat-induced stress damage. Application of Spd not only increased endogenous putrescine, Spd, spermine and total PA accumulation, but also accelerated PA oxidation and improved glutamic acid decarboxylase activity, leading to GABA accumulation in leaves under heat stress. The Spd-pretreated white clover maintained a significantly higher chlorophyll (Chl) content than untreated plants under heat stress, which could be related to the roles of Spd in up-regulating genes encoding Chl synthesis (PBGD and Mg-CHT) and maintaining reduced Chl degradation (PaO and CHLASE) during heat stress. In addition, Spd up-regulated HSP70, HSP70B and HSP70-5 expression, which might function in stabilizing denatured proteins and helping proteins to folding correctly in white clover under high temperature stress. In summary, exogenous Spd treatment improves the heat tolerance of white clover by altering endogenous PA and GABA content and metabolism, enhancing the antioxidant system and HSP expression and slowing leaf senescence related to an increase in Chl biosynthesis and a decrease in Chl degradation during heat stress.

[Discussion on the diagnosis and treatment of high-grade squamous intraepithelial lesions in post-menopausal women].

Objective: To analyze the performance of colposcopy and investigate the diagnosis and treatment characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in post-menopausal women. Methods: A retrospective study was performed on 1 449 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by loop electrosurgical excision procedure (LEEP) or extrafascial hysterectomy as the primary therapy at the First Affiliated Hospital of Nanjing Medical University, from November 2015 to October 2017. In order to investigate the diagnosis and treatment of HSIL in post-menopausal women, a case-control study was conducted to compare the difference in performance of colposcopy and treatment modality between 213 post-menopausal patients (14.7%, 213/1 449) and 1 236 pre-menopausal patients (85.3%, 1 236/1 449). Results: (1)The proportion of cases pathologically upgraded to cervical cancer was significantly greater in post-menopausal patients (9.4%, 20/213) compared with pre-menopausal patients (3.8%, 47/1 236; P<0.05). (2) The proportion of ≥HSIL diagnosed by colposcopy showed no significant difference between post-menopausal patients (76.1%, 162/213) and pre-menopausal patients (78.2%, 967/1 236; P=0.479). The proportion of type Ⅲ transformation zone (TZ) was significantly greater in post-menopausal patients (91.1%, 194/213) compared with pre-menopausal patients (59.1%, 731/1 236; P<0.05). The rate of missed diagnosis of cervical cancer was significantly higher in type Ⅲ TZ (6.4%, 59/925) compared with type Ⅰ and(or) Ⅱ TZ (1.5%, 8/524; P<0.05). The proportion of HSIL detected by endocervical curettage alone was greater in post-menopausal patients (9.9%, 21/213) compared with pre-menopausal patients (2.6%, 32/1 236; P<0.05). (3)Initial treatment with LEEP: the positive rate of endocervical margin was significantly greater in post-menopausal patients (20.5%, 36/176) compared with pre-menopausal patients (10.5%, 130/1 236;P<0.05); in patients who were diagnosed as HSIL after LEEP, the positive rate of endocervical margin and the residual rate were both greater in post-menopausal patients compared with pre-menopausal patients [15.4% (25/162) versus 8.8% (105/1 189), P=0.008; 52.0% (13/25) versus 26.7% (28/105), P=0.014]. (4)Thirty-seven post-menopausal patients were treated by extrafascial hysterectomy as the primary therapy, 5 cases (13.5%, 5/37) were diagnosed as cervical cancer (stage Ⅰa1) after the surgery. Conclusions: (1) The lesions of HSIL in post-menopausal patients still have definite features under colposcopy as same as pre-menopausal patients. Endocervical curettage could help detect more HSIL in post-menopausal patients. Compared with pre-menopausal patients, post-menopausal HSIL patients have an increased risk of cervical cancer and are more likely missed by cervical tissue sampling. (2) LEEP has the dual effects of diagnosis and treatment, and is still the recommended treatment for post-menopausal HSIL patients. However, the increase in positive rate of endocervical margin and residual rate requires further active intervention. (3) Considering those post-menopausal HSIL patients who cannot accept conization as the initial treatment, the selection of hysterectomy type requires more thorough study.

[Clinical application of cartilage replantation in situ from amputated ear in the reconstruction of ear in secondary stage].

Objective: To investigate the feasibility and clinical effect of reconstruction the ear using cartilage from amputated ear. Methods: 30 patients (22 males, 8 females, age 22-50, 18 cases right ear, 12 cases left ear) with partial auricles defects received replantation of amputated ears using the cartilages from the amputated ears from January, 2013 to June, 2017.Firstly, an advancements postauricular skin flap was made.Secondly, the skin of the amputated ear was removed and its cartilage was retained, then the cartilage was sutured in situ to form cartilage bracket.Finally, the postauricular crimp scalp flap was sutured to form the helix structure.After three months, the back of the reconstructive ear was repaired with the full thickness graft to restore the cranio-auricular angle. Results: Thirty cases were applied with this method to repair the defects.The sizes of auricle contour were good, and the cranio-auricular angles were restored after skin-grafting.The ear shape was stable in 3-6 months' follow-up.VAS was used to evaluate patients satisfaction.All parameters before and after the procedure had significant difference (P<0.05). Conclusions: Patients with partial auricles defects can receive replantation of amputated ears using the cartilages from the amputated ears which has the advantage of short treatment period, satisfactory clinical effect and avoidance using the costal cartilages.Its long-term effect is stable.

Radiation-enhancing effect of sodium glycididazole in patients suffering from non-small cell lung cancer with multiple brain metastases: A randomized, placebo-controlled study.

PURPOSE: Median survival of patients with brain metastases from non-small cell lung cancer is poor. This study was to investigate the radiation-enhancing effect of sodium glycididazole combined with whole-brain radiotherapy of multiple brain metastases from non-small cell lung cancer. PATIENTS AND METHODS: Sixty-four patients with multiple brain metastases from non-small cell lung cancer were included: the study group (n=32) received whole-brain radiotherapy combined with sodium glycididazole at a dose of 700mg/m(2) intravenous infusion 30minutes before radiotherapy, three times a week; the control group (n=32) only received whole-brain radiotherapy. The primary end point was central nervous system (CNS) progression-free survival and overall survival. The treatment-related toxicity was also recorded. RESULTS: The CNS disease control rate was better (90.6% vs 65.6%, P=0.016) in the study group than in the control group at 3 month of follow-up. The median CNS progression-free survival time was longer in the study group than in the control group (7.0 months vs 4.0 months, P=0.038). There was no significant difference of the median overall survival time between the study group and the control group (11.0 months vs 9.0 months, P=0.418). On the other hand, the treatment-related toxicity showed no statistically significant difference between these two groups (P>0.05). CONCLUSIONS: The study indicated that sodium glycididazole was an effective, promising radiation-enhancing agent that improved CNS disease control rate, extended the median CNS progression-free survival time and was well tolerated in patients suffering from non-small cell lung cancer with multiple brain metastases.

Strength of donor-specific antibodies with the use of Luminex single-antigen beads is a reliable predictor of acute rejection in living-relative kidney recipients.

BACKGROUND: Luminex single-antigen assay is a promising technique for determination of donor-specific antibodies (DSAs) in renal transplantation. METHODS: Serum samples from living-relative renal recipients before and after renal transplantation were examined with the use of Luminex single-antigen assay. The impact of de novo DSAs on the early clinical outcomes of renal allograft was analyzed. RESULTS: Of the 61 patients included, 15 patients (24.6%) presented de novo DSA (4 class I, 4 class II, and 7 both classes) after transplantation, and the average (median) cumulative strength of DSA was 1,283 (range, 0-10,802) mean fluorescence index (MFI) for class I versus 1,324 (range, 0-14,985) MFI for class II (P > .05). Twelve (19.7%) of the 61 patients experienced a clinical/subclinical acute rejection (AR) episode within the 1st 2 years after transplantation. A clinical/subclinical AR episode was diagnosed in 40% of DSA(+) patients and 13.0% of DSA(-) patients (P < .05). DSA(+) patients who developed an AR episode had a higher mean cumulative MFI value (8,118.3 ± 5,287.4; range, 1,785-14,985) than patients who did not develop an AR episode (3,283.7 ± 2,601.0; range, 786-8,113; P < .05). Serum creatinine levels in the DSA(+) group were significantly higher than in the DSA(-) group at 12 and 24 months after transplantation. The graft survival rates at 2 years in the DSA(+) and DSA(-) groups were not different (86.7% vs 91.3%; P > .05). CONCLUSIONS: Patients with de novo DSAs at high strength may suffer a high risk of developing an AR episode. Therefore, careful monitoring of de novo DSAs with the use of Luminex single-antigen beads may help in early intervention for AR in renal allografts and to minimize renal damage caused by the antibodies.

Optimal Size AMBU® Laryngeal Mask Airway Among Asian Adult Population.

AIM: This was a randomized single blinded study to determine optimal size for Ambu®LMA (ALMA) among Malaysian adult population. METHODS: One hundred and twenty six non-paralyzed anaesthetized adult patients were block randomized into size 3, 4 and 5 Ambu®LMA. Optimal size is defined primarily by oropharyngeal pressure (OLP). Pharyngeal injury and ease of insertion are also taken into consideration. RESULTS: Mean OLP was significantly higher for Size 4 and 5 compared to size 3 (p<0.001) but similar between size 4 and 5. Number of insertion attempts and insertion time were similar between sizes. Size 5 required more manipulations during insertion (p<0.005) and had higher pharyngeal injury (p=0.001) compared to size 3 and 4. DISCUSSION: We recommend size 4 ALMA as the optimal size for Malaysian adults in view of the higher OLP compared to size 3, yet less pharyngeal injury than size 5 in spontaneously breathing patients.

Geniculate neuralgia: a systematic review.

OBJECTIVE: To systematically summarise the peer-reviewed literature relating to the aetiology, clinical presentation, investigation and treatment of geniculate neuralgia. DATA SOURCES: Articles published in English between 1932 and 2012, identified using Medline, Embase and Cochrane databases. METHODS: The search terms 'geniculate neuralgia', 'nervus intermedius neuralgia', 'facial pain', 'otalgia' and 'neuralgia' were used to identify relevant papers. RESULTS: Fewer than 150 reported cases were published in English between 1932 and 2012. The aetiology of the condition remains unknown, and clinical presentation varies. Non-neuralgic causes of otalgia should always be excluded by a thorough clinical examination, audiological assessment and radiological investigations before making a diagnosis of geniculate neuralgia. Conservative medical treatment is always the first-line therapy. Surgical treatment should be offered if medical treatment fails. The two commonest surgical options are transection of the nervus intermedius, and microvascular decompression of the nerve at the nerve root entry zone of the brainstem. However, extracranial intratemporal division of the cutaneous branches of the facial nerve may offer a safer and similarly effective treatment. CONCLUSION: The response to medical treatment for this condition varies between individuals. The long-term outcomes of surgery remain unknown because of limited data.

Development of breast muscle and meat quality in Arbor Acres broilers, Jingxing 100 crossbred chickens and Beijing fatty chickens.

The objective of this experiment was to examine development of breast muscle and myofiber of M. pectoralis superficialis in three chicken breeds. Commercial broiler chickens (Arbor Acres broilers, AA), crossbred chickens (Jingxing 100 crossbred chickens, JXC) and Chinese native chickens (Beijing fatty chickens, BJF) were grown up to 98d to estimate myofiber density, and size (area, and diameter of myofibers) in P. superficialis. At 42, 56, 70, 84, and 98d of age, Pectoralis muscle was used to evaluate breast muscle weight, breast yield, and tenderness (shear force value). Results indicate that commercial broilers have higher breast weight, and higher shear force value than crossbred chickens and Chinese native chickens, that may be due to an increased myofiber diameter and area in Pectoralis muscle. It is suggested that histological properties of myofibers play an important role in increasing the shear force value of meat.

Delayed spinocerebellar ataxia in transgenic mice expressing mutant ubiquitin.

Spinocerebellar ataxia type 1 (SCA1) is an incurable neurodegenerative disease resulting from loss of Purkinje neurones within the cerebellum. The ubiquitin proteasome pathway (UPP) has been implicated in SCA1 but the role of proteolysis in the disease is still poorly understood. To further investigate this issue in vivo, genetic crosses were performed between an established mouse model of SCA1 and novel strains expressing elevated levels of wild type or mutant isoforms of ubiquitin. The K48R mutant isoform of ubiquitin (a dominant negative inhibitor of proteolysis) was found to significantly delay the deterioration of Purkinje neurones as evidenced by behavioural, morphological, and molecular indicators. This delay was accompanied by stabilization of p300/CBP, transcriptional mediators whose abundance and activity would otherwise decline in the course of the SCA1 disease, and persistence of protein kinase C gamma (PKCgamma), a protein involved in Purkinje cell dendritic development that is mutated in one form of spinocerebellar ataxia. Whereas the stabilization of p300/CBP was found to occur at the post-translational level the modulation of PKCgamma was at the level of transcription. These results are consistent with transcriptional dysregulation as a key mechanism in neurodegeneration through loss of p300/CBP. Further, the results suggest that the UPP is a potentially useful target for the development of novel therapies for the treatment of neurodegenerative disease.

Incidence of Listeria spp. in vegetables in Kuala Lumpur.

From April 1992 to September 1992, 280 samples of 10 different fresh vegetables, bought from four different market outlets in Kuala Lumpur were examined for the presence of Listeria spp. Most of the market produce were locally grown with the exception of carrots. The isolation procedure was based on the Food & Drug Administration method (modified) used for the detection of Listeria spp. Isolation media used were Listeria Selective medium and LiCl- phenylethanol-Moxalactam agars. The identification of isolates was by means of conventional biochemical tests and API Listeria identification system. Five out of the 280 samples showed Listeria contamination, Listeria monocytogenes was isolated in lettuce, sengkuang (Pachyrrhizus erosus) and selom Oenanthe javanica) and Listeria innocua was isolated from sengkuang (Pachyrrhizus erosus) and pegaga (Hydrocotyle asiatica).

[Immunoregulatory role of thyroid hormone].

The immunoregulatory role of thyroid hormone was investigated in mice weighing 20-30 g. The experimental results showed that the antibody production, transformation of lymphocytes, DTH response (delayed-type hypersensitivity response) and phagocytosis of the peritoneal macrophages were all markedly enhanced when the animals were fed with a daily dose of 2 mg thyroid hormone for 14-18 days. The number of mature T cells in peripheral blood was also increased significantly by the thyroid hormone. When mice were administered with antithyroid drug (methylthiouracil), the antibody production, the transformation of lymphocytes and DTH response were inhibited. Thyroidectomy could also suppress the antibody production. The results suggest that thyroid hormone is involved in the regulation of immune function.

Treatment of malignant ovarian germ cell tumors with preservation of fertility: a report of 28 cases.

Preservation of fertility was carried out in 28 young patients with malignant germ cell tumors of the ovary from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7, dysgerminoma in 2, and germ cell tumor of mixed type in 3. At laparotomy, 16 patients were proved to have stage I disease, 1 had stage II disease, 9 had stage III disease, and 2 had stage IV disease. The tumor was confined to one ovary in all 22 cases treated for the first time, and the preserved ovary and uterus were normal in all 6 referred cases with recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. Persistent remission was achieved in 22 patients; 5 patients died and 1 was lost to follow-up. The duration of follow-up was more than 1 year for all surviving patients, more than 3 years in 16 cases (72.7%), and more than 5 years in 13 cases (59.1%). The menstrual periods were normal in all except 3 cases, of whom 2 were below the age of 12 and one failed to menstruate at the age of 21 with a hypoplastic uterus and underdeveloped secondary sex characters. Among 12 married patients, 7 of 10 desirous of child-birth became pregnant during follow-up. Of these, 6 had a normal term delivery and 1 is currently pregnant. The preliminary conclusion is that preservation of fertility for young patients with malignant germ cell tumors of the ovary, regardless of the stage of the disease, is a safe and practicable procedure in the absence of involvement of the contralateral ovary and uterus.

Pathologic analysis of preterm delivery placentas.

198 preterm delivery placentas of 28 weeks to less than 37 weeks pregnancy were analyzed. Gross examination revealed that the differences of placenta previa and low implantation (2.91%), bipartate placenta and rupture of marginal sinus (0.97% respectively), large placenta (2.91%), short cord (4.85%), velamentous insertion of cord (3.88%), etc in comparison with those of term delivery placentas were statistically significant. Microscopic examination of 165 placentas showed that in 19 cases (11.52%) of infection of membranes and umbilical vessels, 11 were due to premature rupture of membranes or cervical interventions and 8 to preterm delivery. Among 72 cases of PIH, 65 (90.28%) had arteriopathy of decidua capsularis. 18 cases (25%) which had not been diagnosed clinically as PIH were found to be neglected after discovery of arteriopathy of decidua capsularis by pathologic examination. Placental examinations showed that preterm delivery may be attributable to the factors of placenta, amniotic fluid and umbilicus. 20 cases (27.78% of total PIH) of premature rupture of membranes were complicated by PIH. Whether the cases of decidual arteropathy are liable to have rupture of membranes awaits further investigation.

[Malignant Brenner tumor and transitional cell carcinoma of the ovary].

The clinical and pathologic features of 2 malignant Brenner tumors (MBT) were compared with those of 13 primary ovarian transitional cell carcinomas (TCC). Though histologically both tumors were invasive transitional cell carcinoma, TCC differed from MBT by the absence of benign Brenner component and stronger aggressiveness in behavior. Among tumors of both types in similar clinical stage, most of TCC (6/9) died within 1 to 2 years after the operation, but one of MBT died 4 years postoperatively. The distinction between MBT and TCC bearing on therapeutic as well as prognostic implications is discussed.

[Pathologic analysis of the placenta in preterm deliveries].

The results of pathological analysis of 198 placentae from preterm deliveries of 28-37 week pregnancy in year 1985-1988 were presented Grossly there were: placenta previa and low implantation 2.91%, bipartate placenta and rupture of marginal sinus 0.97%, large placenta 2.91%, short cord 4.85%, velamentous insertion of cord 3.88, etc; all significantly different from those from term deliveries statistically. Microscopic, 165 placentae showed: infection of membranes and umbilical vessels in 19 (11.52%), of which 11 cases were with premature rupture of membranes or cervical interventions and 8 could be regarded as the cause of preterm delivery. Among 72 PIH cases, 65 (90.28%) had arteriopathy of decidual capsularis. Notably 18 cases (25%) of PIH were not diagnosed as such clinically until the discovery of arteriopathy of decidual capsularis microscopically and upon reviewing the case history. Combining with placental examinations, it is possible to tell the cause of preterm delivery whether in placenta, amniotic fluid or umbilical cord. In 20 PIH cases (27.78% of total PIH) with premature rupture of membranes, whether the decidual arteriopathy makes it liable to have membranes ruptured needs further study.

Clinicopathological analysis of causes of perinatal death.

The perinatal mortality rates and causes of deaths in our hospital within the three 5-year periods (1955-1959, 1976-1980, 1981-1985) were reported as well as the total number of births (16,846), deaths (457), and autopsies (393, autopsy rate 85.9%). The perinatal mortality for the three 5-year periods was 44.5%, 23.8%, and 17.2% respectively; it declined more significantly in 1981-1985 than in 1976-1980. Anoxia was the first cause of death for the three 5-year periods. Other causes in sequence in 1955-1959 were traumatic intracranial hemorrhage and pulmonary diseases, in 1976-1980 malformation and pulmonary diseases, and in 1981-1985 anoxia, pulmonary diseases and hyaline membrane disease. Results suggest that accurate analysis of causes of deaths depends on meticulous systematic fetal and neonatal autopsy, including macerated fetuses, extensive discussion by pathologists, obstetricians and neonatalogists, and indispensable placental examination.