Uterine Radial Artery Resistance Index Predicts Reproductive Outcome in Women with Recurrent Pregnancy Losses and Thrombophilia.

Uterine radial artery resistance index (URa-RI) by Doppler ultrasound may reflect the changes in the uteroplacental circulation and be associated with adverse events in early pregnancy. Recurrent pregnancy losses (RPL) are associated with thrombophilia, and anticoagulation treatment with low molecular weight heparin improves pregnancy outcome in women with RPL and thrombophilia. A retrospective cohort study was conducted in 139 pregnant women with 3 or more RPL and thrombophilia. The relationship between pregnancy outcome and dynamic changes of URa-RI was analyzed in 116 women who delivered a liveborn infant and 23 who miscarried the index pregnancy. Patients were on preconception low molecular weight heparin, low-dose aspirin (81mg per day), and prednisone treatment. URa-RI was measured during periovulation time, at the time of positive pregnancy test, and then repeated every two weeks until 32-week gestation or the time of miscarriage. The URa-RI at 8-week gestation was significantly higher in women who miscarried the index pregnancy than those who delivered alive born infant (0.51±0.08 vs. 0.42±0.03, P<0.001). Receiver operating characteristic curve analysis demonstrated that URa-RI of 8 wk gestation effectively distinguished women who miscarried from those who had a live birth with an area under the curve of 82.6% (95% CI 69.01-97.17). After adjusting for covariates including age, BMI, and number of miscarriages, multiple logistic regression models showed that each 0.1 unit increase of URa-RI of 8 wk gestation was associated with 18.70-point increase in the risk of miscarriage (OR19.70, 95%CI 4.26-91.1, P<0.001), and women with an URa-RI≥0.45 had an OR of 49.48 (95% CI 8.01-307.95; P<0.001) for miscarriage compared to those who had URa-RI<0.45. In women with RPL and inherited thrombophilia, increased URa-RI at 8-week gestation was associated with spontaneous abortion independent of other risk factors while they were on anticoagulation treatment.

[Analysis of prognostic factors of portal hypertension treated with devascularization].

Objective: To explore the prognostic factors of portal hypertension treated with devascularization. Methods: A total of 397 patients with portal hypertension underwent devascularization in Nanjing Drum Tower Hospital from February 1993 to April 2014, among which there were 242 male and 155 female patients with median age of 48 years. The perioperative data were retrospectively collected. Logistic regression was used to find the risk factors which affect the operative complications. Follow-up evaluation was in progress regularly. Kaplan-Meier survival curve, Log-rank test and Cox regression model were used to find out factors which affect the long-term results. Results: All together 397 patients underwent devascularization, in whom 8 patients died perioperative, 389 patients discharged successfully. Logistic regression showed that age (≥48 years) (χ2=4.559, OR=2.048, P=0.033), red color sign before surgery (χ2=4.959, OR=2.129, P=0.026) and without portosystemic collateral vessels reserved (χ2=13.348, OR=5.122, P=0.000) were risk factors of perioperative complications. The follow-up time was (5.7±4.6) years. Totally 27 patients were lost from follow-up, 103 patients died for the disease during follow-up. The survival rate at 1-, 3-, 5-, 10-, 15- and 20-years was 93.6%, 86.9%, 80.1%, 59.3%, 54.1% and 38.5% respectively.Univariate analysis showed that gender (male), age (≥48 years), hemorrhage before surgery (≥500 ml per time), hepatitis virus and without portosystemic collateral vessels reserved were risk factors of the long-term survival (P<0.05). Cox regression analysis showed that age (≥48 years) (χ2=9.850, RR=1.904, P=0.002), hemorrhage before surgery (≥500 ml per time) (χ2=34.402, RR=3.273, P=0.000), hepatitis virus (χ2=7.573, RR=2.525, P=0.006) and without portosystemic collateral vessels reserved (χ2=5.905, RR=1.889, P=0.015) were independent risk factors that affect the long-term survival. Conclusion: Devascularization with portosystemic collateral vessels reserved has favorable perioperative and long-term outcome, and it definitely is a very safe and effective technique for portal hypertension.

Increased Dickkopf-1 expression in patients with unexplained recurrent spontaneous miscarriage.

Wnt pathways play an important role in pre-implantation embryo development, blastocyst implantation, and post-implantation uterine decidualisation. However, little is known about the potential role that Wnt signaling plays in patients with unexplained recurrent spontaneous miscarriage (URSM), and no single biomarker with a high predictive value of maternally caused URSM has been identified. We aim to study the molecular mechanisms by which the Wnt pathway controls the progression of early pregnancy by investigating the expression of Dickkopf-1 (DKK1), one of the Wnt agonists, in URSM patients. Plasma and fresh decidual tissues samples were collected from 59 subjects (29 patients with URSM and 30 patients with normal, early pregnancy). Time-resolved immunofluorometric assay system and quantitative real-time RT-PCR were used to determine the serum levels of DKK1 and DKK1 mRNA in the deciduas, respectively. Western blot and immunohistochemistry were used to measure DKK1 protein levels in the deciduas. Serum DKK1 levels were significantly higher in URSM patients compared to the control group (P < 0·001); the expression of DKK1 mRNA and protein in URSM patients were higher relative to healthy controls (P = 0·013). Glandular epithelium from decidual tissues demonstrated cytoplasmic signals for DKK1 in URSM patients, and DKK1 did not stain in healthy controls. Furthermore, serum DKK1 levels significantly correlated with those in the decidual tissues. Our study suggests that DKK1 may be a valuable biomarker of URSM; it can be reliably and conveniently detected in serum, thus obviating the need for decidual tissue analysis.

Development of time-resolved immunofluorometric assays for vascular endothelial growth factor and application on plasma of patients with gastric tumours.

A highly sensitive and accurate time-resolved immunofluorometric assay (TR-IFMA) has been developed, for the first time, to measure plasma vascular endothelial growth factor (VEGF) in patients with gastric tumours. A monoclonal anti-hVEGF antibody and a biotinylated anti-hVEGF antibody were used to develop a non-competitive 'sandwich'-type assay. Fluorescence can be measured by a time-resolved fluorometer after binding of europium (Eu)(3+)-labelled streptavidin to the biotinylated immunoglobulin. Plasma VEGF concentrations were measured by TR-IFMA in 92 healthy controls, in 36 benign stomach disease patients and in 92 gastric cancer patients before surgery. The association between plasma VEGF levels and clinicopathological features was evaluated. A standard curve for VEGF TR-IFMA has been developed with good sensitivity (0.37 pg/ml). Accuracy studies, specificity, parallelism and precision data were determined and all were found to be satisfactory. The validity of the VEGF assay was confirmed by the good correlation between the results obtained by TR-IFMA and commercial enzyme-linked immunosorbent assay (ELISA) (ELISA result = 1.862 + 0.953 (TR-IFMA result), r = 0.944]. The plasma levels of VEGF are higher in gastric cancer patients than in healthy controls. VEGF levels were associated significantly with the presence of distant metastases, as well as invasion depth of the tumour and tumour stage, but not with tumour location, tumour histology, differentiation or the presence of lymph node metastases. At the cut-off of 217.79 pg/ml, the diagnostic sensitivity, specificity and accuracy of the TR-IFMA were 40.2%, 93.7% and 69.9%, respectively. A highly sensitive and reliable TR-IFMA for VEGF has been developed. The determination of plasma VEGF levels may be clinically useful.

Pancreatic secretion after anterior gastric wall stapling with posterior truncal vagotomy in dogs.

Anterior gastric stapling with posterior truncal vagotomy has previously been investigated for its effect on canine gastric acid reduction and motility. Posterior truncal vagotomy could, however, induce reduced pancreatic function, which has been observed after total abdominal vagotomy. In this study, pancreatic secretion has been investigated after anterior gastric stapling with posterior truncal vagotomy in a series of canine experiments by means of a stimulation test. On the long term, no significant postoperative reduction of exocrine pancreatic secretion was observed.

Immunological status and pathology of coxsackie B viral myocarditis and dilated cardiomyopathy.

The changes in 15 cases of viral myocarditis and 28 cases of dilated cardiomyopathy were reported and compared, which were the pathological changes of endomyocardial biopsy; NK cells activity; % of peripheral T lymphocytes and its subsets determined by using OKT3,4,8 (OKT3-peripheral total lymphocytes; OKT4-helper cells; OKT8-suppressive cells) monoclonal antibody; values of immunoglobulin IgG, IgA, IgM; titer of coxsackie B antibody neutralization test. And a discussion on their relationship was included.

Assessment of Nd:YAG laser via metal cap and sapphire tip delivery system. An experimental and clinical investigation.

Sixteen segments of normal human aorta were irradiated by Nd:YAG laser beam delivered via domestically made metal cap and sapphire tip fibre systems. It was found that the metal tip fibre caused more target tissue damage and adhesion than the sapphire tip fibre. The sapphire tip fibre caused an ablation crater with a smoother edge, less carbonization layer and smaller thermal necrotic zone than the metal tip did. The metal cap and sapphire tip fibre were applied to 2 cases of iliac artery stenosis and 5 cases of coronary stenosis, all showing an immediate ablation.

[Integrated traditional and Western medicine treatment of severe viral myocarditis].

33 patients divided into 2 groups for treatment. Group A (18 cases) early use of adrenal cortico-steroid treatment in combination with traditional Chinese medicine; group B (15 cases): early use of adrenal cortico-steroid treatment is combination with interferon, then compared the therapeutic effects of these 2 groups. The results showed that, in these 2 groups, the sinus-atrial block, atrial ventricular block, ventricular tachycardia, acute pump failure as well as the EKG changes were relieved and improved to the same degree. In group A, after therapy, the parameters of OKT3 (%) was elevated from 51 +/- 15.22 to 55.23 +/- 8.53; OKT4(%) was elevated from 30.06 +/- 11.47 to 47.32 +/- 10.87; ratio of OKT4/OKT8 was elevated from 1.11 to 1.53; all of their P values were < 0.01. NK cell activity was elevated from 8.36 +/- 3.75 to 13.08 +/- 5.77, P value < 0.05. In group B, the parameters of OKT3 (%) was elevated from 50.91 +/- 8.12 to 56.75 +/- 8.29; OKT4 (%) was elevated from 32. 55 +/- 6.78 to 45.13 +/- 10.85; ratio of OKT4/OKT8 was elevated from 1.00 +/- 0.21 to 1.37 +/- 0.16; P value < 0.05, < 0.05 and < 0.01 respectively. NK cell activity (%) was elevated from 8.20 +/- 3.08 to 14. 0.3 +/- 4.89, P value also < 0.01. Hence, not only in group A but also in group B, after therapy, the parameters of OKT3,4,8, OKT4/OKT8 and NK cell activity (%) were all improved. But there was no significant statistical difference between group A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors influencing ablation of atherosclerotic plaque with argon laser.

The ablative effect of argon laser delivered fibreoptically in vitro on 234 segments of atherosclerotic human aorta was studied. The variables such as energy density, type of atheroma and immersion media were included, and all irradiated specimens were subsequently submitted to histological examination and crater volumes in mm3 to micrometer measurements under light microscope. The results showed 1) a linear relationship between energy dose and crater volume in fibrous atheroma, 2) significantly greater damage or surrounding in the higher energy dose groups, 3) a lower dose response in calcified tissue than in fatty streaks or fibrous atheroma, and 4) immersion of tissue in blood during ablation resulted in a significantly greater dose response than immersion in plasma or saline, and the corresponding surrounding tissue damage was greatest when immersed in blood. Thus, argon laser is both effective and predictable in response during ablating of atheromatous tissue. The efficacy of the process is dependent on immersion medium, while the degree of surrounding tissue damage is dependent on energy dose.

[Outcome of the mother and baby delivered by cesarean section in pregnancy induced hypertension. Analysis of 487 cases].

We analyzed the outcome of mother and baby in 487 cases of pregnancy induced hypertension (PIH) delivered by Cesarean section (CS). The indication for CS in 70 cases was simply PIH (14.4%) and 6 out of 9 antepartum eclampsia had CS. There was no maternal or fetal death. The authors suggest that CS should be done whenever eclampsia could not be put under control in order to save both mother and baby. The incidence of postpartum hemorrhage (PPH) was lower in the CS group than in the vaginally delivered group. No late PPH occurred in our CS cases. The incidence of IUGR was 30.4%. Of these IUGR cases 43 were delivered by CS. No stillbirth occurred. The number of neonatal anoxia was less than in the vaginally delivered group (P less than 0.10).

[Color-Doppler for predicting vascular resistance to feto-placental blood flow and fetal well-being].

Aloka Color-Doppler, model SSD-860, was used to observe the blood velocity waveforms in the umbilical artery and in the fetal descending thoracic aorta in 139 normal pregnant women from 16th to 40th week and 30 patients suffering from pregnancy induced hypertension (PIH syndrome). The ratio of systolic to diastolic peak flow (A/B) reflected the fetoplacental vascular resistance and peripheral resistance. The results demonstrated that the placental resistance in PIH syndrome and IUGR were much higher than that in normal pregnancy. The placental resistance decreased when patients condition improved after treatment and vice versa. This suggests that fetal blood velocity waveforms (FVW) is of great value in the intensive monitoring of IUGR fetuses. The blood velocity FVW was also of great value in evaluating the curative effects on PIH patients.