Optimization of Formulation of Fufang Huangqi Cream by D-optimal Mixture Design Based on AHP-CRITIC Analysis / 中国实验方剂学杂志

Objective::To optimize the matrix prescription of Fufang Huangqi cream and evaluate its rheological properties. Method::With appearance, spreadability and stability as evaluation indexes, the weighting coefficient of each evaluation index was determined by analytic hierarchy process (AHP), criteria importance through intercriteria correlation method (CRITIC) and AHP-CRITIC mixed weighting method. The formulation of Fufang Huangqi cream was optimized by D-optimal mixture design and its rheological properties were evaluated. Result::The weight coefficients of appearance, spreadability and stability according to AHP-CRITIC mixed weighting method were 0.185, 0.282 and 0.532, respectively. According to D-optimal mixture design based on AHP-CRITIC analysis, the optimized formulation of Fufang Huangqi cream was liquid paraffin of 3.70 g, vaseline of 2.00 g, stearic acid of 2.00 g, sodium dodecyl sulfate of 5.90 g, glycerin of 6.00 g and extract of 20.40 g. The rheological parameters of Fufang Huangqi cream was non-newtonian index<1, storage modulus>loss modulus. Conclusion::The preferred matrix formulation is stable and feasible. Fufang Huangqi cream has good appearance and is a shear thinning non-newtonian fluid. Its viscosity and ductility meet the needs of industrial production and clinical application.

Application prospect of organoids and 3D-cell models in evaluation of cardiotoxicity of traditional Chinese medicine / 药学学报

Cardiotoxicity is one of the main causes of failure in new drug development or drug withdrawal from the market. However, current methods for evaluation of drug cardiotoxicity suffer the shortcomings such as low clinical relevance, low reproducibility and lack of high throughput screening capacity. Therefore, there is an urgent need for establishing more accurate and reliable methods for cardiotoxicity evaluation of drugs. As a new generation of drug cardiotoxicity evaluation, cardiac organs in culture retain the biological characteristics and functions of heart cells in the body, and can realistically and accurately respond to the effects of drugs. This article reviews recent progress of in vitro culture of cardiac organs and 3D-cell models, with focuses on application and development potential of cardiac organs for evaluation of cardiotoxicity of traditional Chinese medicine. The advantage and future prospective of such cell- and organ-based models for unique challenges in evaluation of cardiotoxicity of traditional Chinese medicine have been discussed.

Regularity of traditional Chinese medicine prescriptions for same treatment for cardiovascular and cerebrovascular diseases / 中国中药杂志

To explore the regularity of traditional Chinese medicine(TCM) prescriptions for cardio-cerebrovascular diseases,the core drug groups with common therapeutic effects on cerebrovascular diseases represented by stroke and cardiovascular diseases represented by coronary artery disease were extracted,and their consistency and difference in the treatment of different diseases were analyzed.A total of 388 Chinese patent medicines were collected for the treatment of cerebrovascular diseases,cardiovascular diseases and cardio-cerebrovascular diseases.The dominant and recessive patterns of Chinese patent medicines in clinical use were found by "frequency analysis","compatibility analysis" and "network analysis" respectively.According to the findings of the three parts,Salviae Miltiorrhizae Radix et Rhizoma,Chuanxiong Rhizoma,Carthami Flos and Astragali Radix have a high frequency of use in the treatment of brain disease,heart disease and both,with frequent combined medication.Data mining confirmed the core drug combinations for the treatment of cerebral and cardiac vascular diseases,so as to reveal the similarities and differences in the drug use of Chinese medicine for these diseases,and provide a basis for the rational use of traditional Chinese medicine in clinical practice.This analysis also defines a new direction for the future development of prescription combinations for different indications of cerebral and cardiac diseases.

Effect and mechanism of essential oil from Zanthoxylum bungeanum in microemulsion gel preparation on percutaneous delivery of complex components / 中国中药杂志

This study aimed to investigate the transdermal enhancing effect of essential oil from Zanthoxylum bungeanum(Z. bungeanum oil) in microemulsion gel(ZO-ME-gel) on permeation of different components,and reveal the transdermal enhancing mechanism of ZO-ME-gel. A series of components with different log P values were selected as model drugs and encapsulated in ZO-ME-gel to simplify and characterize the complex components of traditional Chinese medicine. The transdermal behavior of the model drugs was further examined using the improved Franz diffusion cell method. Then attenuated total reflection Fourier transform infrared spectroscopy(ATR-FTIR),differential scanning calorimetry(DSC) studies and hematoxylin-eosin(HE) staining were used to investigate the effects of Z. bungeanum oil and ZO-ME-gel on keratin,intercellular lipids and microstructure of the stratum corneum(SC). The results showed that Z. bungeanum oil and ZO-ME-gel had a good transdermal enhancing effect on both hydrophilic and lipophilic drugs,and the best effect was achieved when log P value was-0. 5. The transdermal enhancing mechanism of Z. bungeanum oil and ZO-ME-gel was related to affecting the order of the SC lipids,changing lipid fluidity and protein conformation,and disrupting the integrity of the SC structure. 5% Z. bungeanum oil had greater transdermal enhancing effect and destruction of SC structure than ZO-ME-gel. These results suggested that Z. bungeanum oil loaded in microemulsion gel still had a good transdermal enhancing effect although the effect was not as great as Z. bungeanum oil itself,in addition,ZO-ME-gel was less irritating to the skin and safer to use,which had a guiding role in the development and clinical application of Z. bungeanum oil-containing traditional Chinese medicine topical preparations.

Establishment and preliminary evaluation of multiple drug delivery system of effective components of Angelica sinensis / 药学学报

The multiple drug delivery system of components of traditional Chinese medicine is a system composed of multiple components and multiple units. According to the characteristics of each component, different drug delivery units are designed and combined to achieve the purpose of improving bioavailability and enhancing drug efficacy. In this study, supercritical extracts, phenolic acids, and polysaccharides derived from Angelica sinensis were examined as research objects, and a pellet-based vehicle was applied to construct a multiple drug delivery system for the treatment and chemoprevention of colitis and colorectal cancer. The extrusion-spheronization method was used to prepare pellets of Angelica polysaccharides which should be released in the stomach. The yield in 18-24 mesh and plane critical angle served as the index. The Box-Behnken design and the orthogonal design were used to optimize the formulation and parameters of pellets. According to a previous study, the colon specific pellets loading supercritical extracts and phenolic acid extracts were prepared by the optimized process. These two units of pellets were combined into the multiple drug delivery system of effective components of Angelica sinensis, and the quality evaluation and in vitro release study were conducted. The dynamic observation of pellets in mice was evaluated using small animal in vivo imaging system. The prescription of the Angelica polysaccharides gastric releasing pellets was:microcrystalline cellulose 6.5 g, polysaccharide 3.3 g, silica 0.2 g and 7 mL of 60% ethanol as wetting agent. The process parameters were as follows:extrusion rate at 75 r·min-1, rounding rate at 1 800 r·min-1, and rounding time for 3 min. Both in vivo and in vitro studies indicate that the prepared multiple drug delivery system of effective components of Angelica sinensis produced good release properties. The polysaccharide pellets could be rapidly released in the artificial gastric fluid and in the stomach. The colon specific pellets showed good targeting. They released little in the artificial gastric fluid within 2 hours, released less than 20% in the artificial intestinal fluid for 4 hours, and released more than 90% in artificial colon fluid for 6 hours.

Relationship between Intrauterine Bacterial Infection and Early Embryonic Developmental Arrest / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Early embryonic developmental arrest is the most commonly understudied adverse outcome of pregnancy. The relevance of intrauterine infection to spontaneous embryonic death is rarely studied and remains unclear. This study aimed to investigate the relationship between intrauterine bacterial infection and early embryonic developmental arrest.</p><p><b>METHODS</b>Embryonic chorion tissue and uterine swabs for bacterial detection were obtained from 33 patients who underwent artificial abortion (control group) and from 45 patients who displayed early embryonic developmental arrest (trial group).</p><p><b>RESULTS</b>Intrauterine bacterial infection was discovered in both groups. The infection rate was 24.44% (11/45) in the early embryonic developmental arrest group and 9.09% (3/33) in the artificial abortion group. Classification analysis revealed that the highest detection rate for Micrococcus luteus in the early embryonic developmental arrest group was 13.33% (6/45), and none was detected in the artificial abortion group. M. luteus infection was significantly different between the groups (P < 0.05 as shown by Fisher's exact test). In addition, no correlation was found between intrauterine bacterial infection and history of early embryonic developmental arrest.</p><p><b>CONCLUSIONS</b>M. luteus infection is related to early embryonic developmental arrest and might be one of its causative factors.</p>

Cognitive Training in Older Adults with Mild Cognitive Impairment / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>We investigated the feasibility and efficacy of cognitive training for older adults in rural settings and with low education levels, who have mild cognitive impairment (MCI).</p><p><b>METHODS</b>Forty-five older adults (ages >65 years) with MCI were assigned to treatment or control groups, at a 2:1 ratio. Cognitive training occurred in the treatment group for 2 months. The cognitive abilities of the participants were assessed at pre-training, metaphase, and post-training time points, using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Hamilton Depression Scale (HAM-D).</p><p><b>RESULTS</b>Following training, cognitive abilities improved in the treatment group, based on the total scores of all 4 measures, as well as specifically on the MoCA and LOTCA. There were differences in the main effects of group and time point on some subscales, but these differences had little, if any, effect on the overall analyses.</p><p><b>CONCLUSION</b>The present study demonstrated that cognitive training has beneficial effects on attention, language, orientation, visual perception, organization of visual movement, and logical questioning in patients with MCI. Furthermore, the observed effects are long-term changes.</p>

Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean.</p><p><b>METHODS</b>We conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture.</p><p><b>RESULTS</b>The total rate of successful abortion was 93.9% (62/66). Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%). The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05). The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2-2106.1) after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%).</p><p><b>CONCLUSIONS</b>Both the mifepristone-misoprostol and the EL regimens were effective and safe for the termination of mid-trimester pregnancy in women with prior cesarean. A thinner LUS is associated with a relatively high risk of uterine rupture.</p>

Management options of caesarean scar pregnancy / 中国医学科学院学报

Cesarean scar pregnancy is an uncommon ectopic gestation. Without timely and proper management, it may cause major bleeding, uterine rupture, and other life-threatening complications. The causes of this condition remain unclear, and no standardized management has been available, although some medical and surgical treatment modalities have been suggested. The main treatment objectives include preventing massive blood loss, preserving the uterus function, and maintain the women's health and quality of life. Current data do not support expectant management. After early diagnosis, single or combined medical and surgical treatment options should be provided to avoid uterine rupture and haemorrhage, so as to preserve the uterus and thus the fertility.

Comparison of combination of dinoprostone suppository and ethacridine and ethacridine alone for induction of mid term pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness and safety of using the combination of dinoprostone suppository and ethacridine and ethacridine alone for the induction of mid-term pregnancy.</p><p><b>METHODS</b>The clinical data of 96 patients at 16-27+6 gestational weeks in Peking Union Medical College Hospital from March 2008 to December 2009 were retrospectively analyzed. Patients were divided into combination group (n=54) and ethacridine alone group (n=42) based on their induction methods. The efficacy and side effect were compared between these two groups after the induction.</p><p><b>RESULTS</b>The effectiveness rate was 70.4% (38/54) in the combination group,which was significantly higher than that in ethacridine alone group (4.8%) (2/42) (P=0.001). The durations of the first and second,and total stage of labor were found to be significantly shorter in combination group [(287∓39) and (513∓39) min)] when compared with ethacridine alone group [(546∓84) and (661∓82) min] (P=0.01). The bleeding volume in the combination group was (69∓4) ml, which was significantly less than that in control group (96∓7) ml (P=0.02). The two groups had no significant differences in terms of in-labor duration (P=0.45), postpartum placenta remnants (P=0.91), and fetal membrane remnants (P=1.31).</p><p><b>CONCLUSION</b>The combination of dinoprostone suppositories and ethacridine is more effective and safer than ethacridine alone for induction of mid-term pregnancy.</p>

Application of ultrasonic monitoring in induced abortion during the first trimester / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the value of ultrasonic monitoring in induced abortion during the first trimester.</p><p><b>METHODS</b>Totally 110 healthy women with a singleton pregnancy between 9 and 11 gestational weeks were enrolled. All the procedures of induced abortion were performed routinely. Ultrasonography was performed when the procedure of induced abortion was completed. Patients with normal ultrasonographic results were assigned in the control group, while patients with abnormal ultrasonographic findings were enrolled in the study group,in which these patients underwent further operations until the ultrasonography showed clear endomembrane line. All the recurretaged tissue in the study group were sent for pathological examinations.</p><p><b>RESULTS</b>Of these 110 patients, 28 (25.5%) entered study group and 82 (74.5%) entered control group. In the study group, trophoblastic cell or chorion was found in the recurretaged tissue in 11 patients (39.3%), in which 3 had trophoblastic cell embedded in smooth muscular tissue, 6 had pathologic deciduas, and 11 had pathologic secretory endometria. In this control group,1 patient (0.9%) had retained products of conception. The operation duration [(20.6∓2.1) min vs.(11.5∓3.5) min, P0.05].</p><p><b>CONCLUSIONS</b>Ultrasonic monitoring in induced abortion during the first trimester can decrease the incidence of retained products of conception and will not induce endometrial damage. It is especially useful for women whose fetuses were at older gestational ages.</p>

Diagnosis and treatment of cervical ectopic pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of cervical ectopic pregnancy.</p><p><b>METHODS</b>The clinical data of 27 patients with cervical ectopic pregnancy who were treated in Peking Union Medical College Hospital from January 1990 to November 2009 were retrospectively reviewed. The clinical effectiveness of three fertility-preserved treatment modes were compared.</p><p><b>RESULTS</b>Of these 27 patients,one underwent hysterectomy, while all the other 26 patients selected fertility-preserved treatment,which included curettage after uterine artery embolization (UAE) (n=14), curettage directly (n=8), and curettage after methotrexate (MTX) injection (n=4). The effectiveness rates of these three methods were 100%,75.0%,and 50.0%, respectively,which was significantly higher in curettage after UAE group than in curettage after MTX group (P=0.005). The duration of hospitalization was (17.0∓3.2) days in curettage after MTX group,which was significantly longer than that in curettage after UAE group (6.1∓2.9) d (P=0.004) and curettage directly group (4.9∓3.4) d (P=0.001). The mean hospitalization cost showed no significant difference among three groups (P=0.104).</p><p><b>CONCLUSION</b>Curettage after UAE is safe and effective for patients diagnosed or highly suspicious of cervical pregnancy.</p>

Relationship between the colonization of Group B Streptococci, Mycoplasma, and Chlamydia trachomatis infections and spontaneous abortion due to early embryonic death / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the relationship between the colonization of group B streptococci (GBS), mycoplasma,and Chlamydia trachomatis (CT) infections and spontaneous abortion due to early embryonic death.</p><p><b>METHODS</b>Totally 74 patients (study group) who experienced the missed abortion during their first or second trimester and 62 women (control group) who underwent induced termination of normal pregnancy during the first or second trimester were enrolled in this study. The vaginal secretions, intrauterine aspirates, and amniotic fluids were collected for GBS culture. Cervical mycoplasma (UU+MH) and CT were detected at the same time.</p><p><b>RESULTS</b>Positive results of GBS culture of vaginal secretions were detected in 9 patients (12.16%) in the study group, but in only 6 patients (9.68%) in control group (P=0.662). The intrauterine aspirate samples (as well as the amniotic fluid samples) of all cases were negative in GBS culture. The positive rates of UU and MH were 32.43% (24/74) and 16.22% (12/74) in the study group, but were only 10.35% (12/62) (P=0.0103) and 6.45 (4/62) (P=0.042) in the control group. The positive rate of CT was 8.11% (6/74) in the study group and 8.06 % (5/62) in the control group (P=0.905). The rate of concurrent infection of GBS and mycoplasma was 4.05% (3/74) in the study group and 6.45% (4/62) in the control group (P=0.743). The rate of concurrent infection of GBS and CT was 0 in the study group and 1.61% (1/62) in the control group (P=0.475). The rate of concurrent mycoplasma and CT infection was 2.70% (2/74) in the study group and 0 in the control group (P=0.325). Furthermore, no one was positive for poly infection of all these three pathogens.</p><p><b>CONCLUSIONS</b>GBS may be positive in the genital tract of some pregnant women but is not related with early abortion. The mycoplasma infection may be one of the reasons leading to arrested intrauterine pregnancy.</p>

Diagnosis and treatment of placenta accreta in the second trimester of pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize our experiences in the diagnosis and treatment of placenta accreta in the second trimester of pregnancy.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 31 patients were admitted to Peking Union Medical College Hospital with placenta accreta in the second trimester of pregnancy from January 2002 to January 2010.</p><p><b>RESULTS</b>Among 31 cases, one case (3.2%) was suspected to be with placenta accreta by ultrasound examination and 30 cases (96.8%) were normal before delivery. Placenta accreta was identified during follow-up in 12 cases (38.7%) after delivery. Fourteen patients underwent curettage again after delivery,which was effective in 6 patients (42.9%) and failed in 8 patients,in whom uterine artery embolization (UAE) was further applied. Thirteen patients underwent UAE without curettage. In total,21 cases underwent UAE, which was effective in 19 patients (90.5%); one patient with abnormal β-human chorionic gonadotropin (β-HCG) 5 months after embolization underwent lesion resection and one case with slightly increased β-HCG were lost to follow-up. Hysteroscopy was effective in 3 patients,of whom two patients underwent lesion resection by hysteroscopy and one case who was suspected to be with trophoblastic disease by ultrasonography before surgery and confirmed to be placenta accreta during hysteroscopy examination underwent lesion resection. One case experienced hemorrhagic shock during vaginal delivery and underwent emergency laparotomy. Among all these 31 patients,massive hemorrhage occurred in 13 cases during delivery and hemorrhagic shock in 2 cases. Three cases had postpartum hemorrhage and stopped bleeding after UAE. None needed hysterectomy.</p><p><b>CONCLUSIONS</b>Placenta accreta in the second trimester of pregnancy is usually diagnosed after childbirth,which may be delayed in some cases. Therefore,special attention should be paid to this disease during follow-up. Conservative treatment was the main therapy of placenta accreta in the second trimester of pregnancy. UAE is effective in stopping bleeding.</p>

Treatment and prognosis of malignant ovarian neoplasms complicating pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the clinicopathological features and prognosis of malignant ovarian neoplasms complicating pregnancy and explore the rational treatment.</p><p><b>METHODS</b>The clinical data of 38 patients with malignant ovarian neoplasms complicating pregnancy were retrospectively analyzed,and the intra-surgical pathological sections were reviewed. International Federation of Gynecology and Obstetrics (FIGO) staging system (1988) was applied.</p><p><b>RESULTS</b>Of these 38 patients,the malignancies included epithelial ovarian cancer (n=9, 23.7%), epithelial borderline ovarian tumor (n=13, 34.2%),ovarian malignant germ cell tumors (n=11, 28.9%), sex cord stromal tumors (n=3, 7.9%), and metastatic tumor from gastrointestinal tracts (n=2, 5.3%). Twenty-seven patients (71.1%) were at stage I. The pregnancy outcomes included termination in the first trimester (n=8), full-term vaginal delivery (n=6), full-term Cesarean section (n=15), and therapeutical Cesarean section for premature birth (n=9). One newborn died,and the remaining 29 survived in a healthy status. All patients underwent surgical treatment,among whom two patients received surgeries during pregnancy. Patients were followed up for (40.5±38.5) months,during which one patient was lost to follow-up, 7 died, 1 survived with tumor, and 29 (76.3%) survived free of tumors.</p><p><b>CONCLUSIONS</b>The management of ovarian malignancies complicating pregnancy should be individualized. Both surgical treatment and chemotherapy are relatively safe in the second and third trimesters. Satisfactory prognosis can be expected after appropriate treatment.</p>

Effectiveness of intravenous immunoglobulin therapy in treating unexplained recurrent spontaneous abortion and its effect on the level of serum soluble human leucocyte antigen G / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the effectiveness of intravenous immunoglobulin (IVIG) in treating patients with unexplained recurrent spontaneous abortion (URSA) and the effect of IVIG on the level of soluble human leucocyte antigen G (sHLA-G).</p><p><b>METHODS</b>This prospective trial conducted at PUMC Hospital between 2004 and 2008 included 60 women with URSA. The patients were allocated into IVIG group (30 cases) and control group (30 cases). IVIG was intravenously used before conception at a dose of 0.2g/kg; once pregnancy was confirmed,IVIG was continued every 4 weeks till the 20th gestational week. Traditional Chinese medicine or/and progesterone were used in control group. The outcome of pregnancy was evaluated by live birth rate and effective rate(defined as the embryo living 4 week longer than previous pregnancy). Serum samples were collected randomly before pregnancy and in the 6th-8th gestational week from IVIG group (15 samples),control group (15 samples),and healthy women (20 samples). The levels of sHLA-G,interferon γ (IFN-γ), interleukin-2 (IL-2), and interleukin-10 (IL-10) were determined by enzyme-linked immunosorbant assay (ELISA).</p><p><b>RESULTS</b>The pregnancy rate was 93.3% in IVIG group. The live birth rate and effective rate were 85.7% (24/28) and 92.9% (26/28) in IVIG group,which were significantly higher than those in control group [56.7% (17/30) (P=0.021) and 63.3% (19/30) (P=0.011)]. Emesis occurred in one woman (3.3%) in IVIG group had during IVIG infusion but was relieved by lowering the speed of infusion. The mean sHLA-G level was (61.37∓35.57) U/ml in control group and (62.70∓37.24) U/ml in IVIG group (P>0.05); both of them were significantly lower than that of healthy women (88.49∓25.37) U/ml (Pü0.05). After pregnancy was achieved, the levels of sHLA-G and IL-10 were (34.19∓14.21) U/ml and (11.71∓2.75) pg/ml, respectively in the IVIG group, which were significantly higher than those in control group [(23.71∓12.83) U/ml and (8.71∓3.01) pg/ml, respectively] (P=0.008).</p><p><b>CONCLUSIONS</b>Low-dose IVIG before and after pregnancy is a safe and effective in treating URSA. IVIG improves the development of fetus by up-regulating sHLA-G and IL-10 levels.</p>

Diagnosis and treatment of cesarean scar pregnancy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the early diagnosis and treatment of cesarean scar pregnancy (CSP).</p><p><b>METHODS</b>Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed.</p><p><b>RESULTS</b>CSP constituted 1.05% of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1:1221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging (MRI). The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies.</p><p><b>CONCLUSIONS</b>CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.</p>

Risk factors in the living environment of early spontaneous abortion pregnant women / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the relationship between early spontaneous abortion and living environment, and explore the risk factors of spontaneous abortion.</p><p><b>METHODS</b>We conducted analysis based on the interview of 200 spontaneous abortion cases and the matched control (age +/- 2 years) by using multifactor Logistic regression analysis.</p><p><b>RESULTS</b>The proportions of watching TV > or =10 hours/week, operating computer > or =45 hours/week, using copycat, microwave oven and mobile phone, electromagnetism equipment near the dwell or work place, e. g. switch room < or =50 m and launching tower < or =500 m in the cases are significantly higher than those in the controls in single factor analysis (all P < 0.05). After adjusted the effect of other risk factors by multifactor analysis, using microwave oven and mobile phone, contacting abnormal smell of fitment material > or =3 months, having emotional stress during the first term of pregnancy and spontaneous abortion history were significantly associated with risk of spontaneous abortion. The odds ratios of these risk factors were 2.23 and 4.63, respectively.</p><p><b>CONCLUSION</b>Using microwave oven and mobile phone, contacting abnormal smell of fitment material > or =3 months, having emotional stress during the first term of pregnancy, and spontaneous abortion history are risk factors of early spontaneous abortion.</p>

Transvaginal ultrasound assessment of physiological changes of Chinese women's cervix / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe Chinese women's cervical physiological changes by transvaginal ultrasound.</p><p><b>METHODS</b>637 normal female volunteers were studied. Cervical length, width and canal width were measured by transvaginal ultrasound. Cervical length multiplied by width was the biggest vertical section area of cervix(cervical area).</p><p><b>RESULTS</b>The cervical length, width, area and canal width in the menopausal women were significant smaller than that in the un-menopausal women (P < 0.0001). Multinomial logistic regression showed that cervical changes were mainly affected by menopause year, gestation and para. The cervical length, width, area and canal width were negative correlated with menopause year significantly. The cervical and canal width were positive correlated with gestation. The regressive equation was Cervical area (cm2) = 3.69 + 0.23 Gastation -0.16 Menopause year.</p><p><b>CONCLUSIONS</b>Cervical physiological changes are mainly affected by the menopause year, gestation and para. The menopause year is the most important factor in the cervical physiological changes.</p>

Study on mutation of presenilin-1 gene in familial Alzheimer's disease / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the role of the mutation of presenilin-1 exon 6 in pathogenesis of Alzheimer's disease(AD) patients.</p><p><b>METHODS</b>Exon 6 of presenilin-1 was analyzed by use of polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and DNA analyzer technique in 2 patients with familial AD, 53 patients with sporadic DA, 60 patients with vascular dementia(VD) and 90 normal controls.</p><p><b>RESULTS</b>Mobility shift of SSCP in exon 6 of presenilin-1 was detected in 2 cases with FAD, 4 cases with SDA and 1 case with VD. Two missense mutations were found in the patients by DNA sequence analysis, one mutation was 1123 nt C-->G(Cys 23 Trp) and the other was 1300 nt A-->C(Asp 200 Ala).</p><p><b>CONCLUSION</b>Mutations in exon 6 of presenilin-1 existed in the patients with FAD and SDA, and the two missense mutations were probably pathological by nature.</p>