Objective：To further demonstrate the interaction of a new 14-3-3 interaction protein hematopoietic progenitor kinase 1［HPK1］-interacting protein (HIP-55) and 14-3-3 proteins and its potential biological function in HEK293 cells. Methods: PDEST-N-Venus-HIP-55WT (wild type)，PDEST-N-Venus-HIP-55AA （mutants, S269A/T291A, abolishing the binding of HIP-55 to 14-3-3），PDEST-GST-HIP-55WT and PDEST-C-Venus-14-3-3τ plasmids were constructed by gateway system. Their expressions were demonstrated by Western blotting method. Then we used Bimolecular Fluorescence Complementation (BiFC) and co-immunoprecipitation (co-IP) methods to demonstrate the interaction of HIP-55 and 14-3-3 in HEK293 cells. Moreover, the 14-3-3 antagonist peptide, R18 and HIP-55 protein mutant plasmid HIP-55AA were used to detect the protein synthesis of HIP-55 at different time points induced by puromycin, an inhibitor of protein production. Results:The HEK293 cells expressed HIP-55 protein respectively, after being transected with PDEST-N-Venus-HIP-55WT，PDESTNVenus-HIP-55AA，PDEST-GST-HIP-55WT plasmids and expressed 14-3-3 protein after being transected with PDEST-C-Venus-14-3-3τ plasmids. We could detect venus fluorescence of venus-HIP-55 protein  via confocal microscopy in HEK 293 cells transfected with N-Venus-HIP-55 and C-14-3-3τ plasmids by BiFC, butnot  in HEK 293 cells transfected with N-Venus-HIP-55 AA （mutants S269A/T291A） and C-14-3-3τ plasmids. The results of BiFC suggested that 14-3-3 interacted with HIP-55 through HIP-55 S269/T291 sites.  At the same time, the data of co-IP showed that there were endogenous interactions between 14-3-3 and HIP-55. Furthermore, puromycin had no influence in HIP-55 protein synthesis  at  hours 0, 4, or 8 in HEK 293 cells expressing GST- HIP55WT and 14-3-3 plasmids, while puromycin blocked HIP-55 protein synthesis in HEK 293 cells transfected with N-Venus-HIP-55AA （mutants S269A/T291A） and C-14-3-3τ plasmids. The results indicated that the 14-3-3/HIP-55 complex could contributed to the stability of HIP-55.Conclusion: HIP-55 forms a complex with 14-3-3 and 14-3-3/HIP-55 interaction increases the stability of HIP-55.

Objective：To analyze effect on the CD154-CD40 signaling pathway and Th1/Th2 polarization by deficient inducible co-stimulator (ICOS)-ICOS ligand (ICOSL) signaling in mice infected with Schistosoma japonicum. Methods:ICOSL knockout (ICOSL-KO) mice and wild-type C57BL/6J mice were used as experimental Schistosomiasis model infected with Schistosoma japonicum. The expressions of CD154 and CD40 on splenocytes and on inflammatory cells around granulomatous infiltration of liver in mice infected with Schistosoma japonicum were analyzed by flow cytometry,immunohistochemical staining, respectively, on the day before infection (0 week)and at the end of 4, 7, 12, 16 and 20 weeks post-infection. The splenocytes of the mice were stimulated with soluble egg antigen(SEA) for 72 hours, then the concentrations of interferon gamma(IFN-γ) and interleukin-4 (IL-4) in the culture supernatants were measured by sandwich enzyme-linked immunosorbent assay (ELISA) kits. The levels of SEA-specific antibodies of IgG and IgG1 and IgG2a were measured in the mice sera by ELISA. The granulomatous pathology in the mice liver was dynamically observed by hematoxylin and eosin (HE) staining.Results:Compared with the wild-type C57BL/6J mice, the expressions of CD154 on CD4+ T splenocytes ［(18.62±4.76)% vs.(27.91±3.94)%, (22.44±4.67)% vs.(40.86±5.21)%, (25.50±6.81)% vs.(43.81±8.41)%, (20.22±5.28)% vs.(40.95±7.34)%, (17.87±4.59)% vs.(33.16±6.31)%, all P<0.01］ and of CD40 on CD19+ B splenocytes ［(19.43±3.26)% vs.(24.37±3.59)%, (23.00±4.47)% vs.(31.80±5.86)%, (24.46±5.01)% vs.(35.85±5.32)%, (23.42±4.69)% vs.(33.30±6.14)%, (22.85±3.78)% vs.(30.88±5.94)%, all P<0.05］ in the ICOSL-KO mice significantly decreased at the end of 4, 7, 12, 16 and 20 weeks post-infection. Moreover, the expressions of CD154［(0.319±0.066) vs.(0.488±0.086), (0.389±0.067) vs.(0.596±0.082), (0.378±0.064) vs.(0.543±0.072), (0.348±0.069) vs.(0.523±0.076), all P<0.01］ and CD40［ (0.398±0.066) vs.(0.546±0.079), (0.461±0.085) vs.(0.618±0.076), (0.453±0.087) vs.(0.587±0.074), (0.449±0.065) vs.(0.565±0.082), all P<0.05］ on inflammatory cells around granulomatous infiltration in liver from the ICOSL-KO mice were significantly lower than those of the wild-type C57BL/6J mice at the end of 7, 12, 16 and 20 weeks post-infection. The levels of IFN-γ of the ICOSL-KO mice were significantly higher than those of the wild-type C57BL/6J mice at the end of 4, 7, 12, 16 and 20 weeks post-infection (P<0.05). However, the levels of IL-4 of the ICOSL-KO mice were significantly lower than those of the wildtype mice (P<0.05). Compared with the wildtype C57BL/6J mice, the levels of SEAspecific antibodies of IgG and IgG1 and IgG2a in the sera of the ICOSL-KO mice significantly decreased (P<0.01). Moreover, The Th2 differentiation index of the ICOSL-KO mice was significantly lower than that of the wild-type mice in post-infection (P<0.01). Also, the ratio of IgG1/IgG2a of the ICOSL-KO mice were significantly lower than that of the wild-type mice at the end of 7, 12 and 16 weeks post-infection (P<0.05). And the vo-lume of liver egg granulomas of the ICOSL-KO mice was significantly smaller than that of the wild-type mice (P<0.01).Conclusion: These findings suggest that there is obvious down-regulation in the expressions of CD154 and CD40 and impairment of Th2 immune response in the ICOSL-KO mice infected with Schistosoma japonicum, accompanying with notedly reduced hepatic granulomatous pathology. The ICOS-ICOSL signaling has a regulatory effect on CD154-CD40 signaling pathway, and may play an important role in the hepatic egg granuloma formation of Schistosomiasis.

Objective： To elucidate the correlation between the single nucleotide polymorphism of CKLF-like MARVEL transmembrane member 5 (CMTM5) gene rs723840 and the occurrence of high on aspirin platelet reactivity (HAPR). Methods:The present study is a case-control study. A total of 210 hospitalized patients in Peking University First Hospital were enrolled. Aspirin response was assessed by 0.5 g/L arachidonic acid (AA)-induced platelet aggregation ratio (PR), and ≥3/4 quartile of PR of the population was defined as HAPR. Accordingly all the enrolled 210 coronary artery diseases (CAD) patients were divided into HAPR group and No-HAPR group. The genotypes were determined by polymerase chain reaction (PCR) and sequencing analysis for rs723840 of CMTM5 gene. Results:The genotype frequencies in rs723840 C>T of CMTM5 gene conformed well to the Hardy-Weinberg equilibrium in both HAPR group and No-HAPR group. Between the two groups, the genotypes frequencies in HAPR and No-HAPR groups were 48.4%, 51.6%, 0.0% and 73.7%, 22.9%, 0.034%, respectively (P=0.004). The C, T allele frequencies were significantly different in the two groups (P=0.031,OR=0.501, 95%CI： 0.264-0.947). Conclusion:Our study finds a significant correlation between CMTM5 gene rs723840 polymorphism and high on aspirin platelet reactivity.

Objective：To study the metabolism of high density lipoprotein cholesterol (HDL-C) and apolipoprotein A-Ⅰ (ApoA-Ⅰ) in different thyroid function status during pregnancy. Methods:This study recruited thirty cases of euthyroid, with nineteen cases of subclinical hypothyroid and eight cases of subclinical hyperthyroid pregnancy. The concentrations of fasting serum HDL-C and ApoA-Ⅰ were detected and analyzed from 9-12, 14-17, 23-26, and 37-40 gestational weeks. Friedman repeated measures ANOVA on ranks was adopted to analyze the changes of serum HDL-C and ApoA-Ⅰ at different stages. General linear model (GLM) was adopted to analyze the differences of serum HDL-C and ApoA-Ⅰ in different thyroid function status during pregnancy.Results:There were no significant differences of maternal serum HDL-C among different stages (χ2=5.428，P=0.143, χ2=2.027，P=0.567, χ2=2.885，P=0.410). There were significant differences of serum ApoA-Ⅰ during euthyroid and subclinical hypothyroid pregnancies (χ2=46.343， P＜0.001, χ2=35.984， P＜0.001), and no significant difference during subclinical hyperthyroid pregnancy (χ2=6.750， P=0.080). There were significant differences of serum HDL-C and ApoA-Ⅰ between euthyroid and subclinical hyperthyroid pregnancies (P=0.025，P=0.027), and no significant differences between euthyroid and subclinical hypothyroid pregnancies (P=0.378，P=0.549). Conclusion:Subclinical hyperthyroidism affected the metabolism of maternal serum HDL-C and ApoA-Ⅰ, which could affect the fetal growth and development. Subclinical hypothyroidism (after treatment with drugs) had no obvious effect on the metabolism of maternal serum HDL-C and ApoA-Ⅰ.

Objective： To determine the prevalence of Salmonella paratyphi C phage (SPC-P1) in different Salmonella serovars and to identify the integration sites in host genome. Methods: Based on the complete genome of SPC-P1 in S. paratyphi C RKS4594, 6 pairs of primers were designed and used to amplify the fragments of SPC-P1 in 11 S. typhi, 11 S. paratyphi A, 12 S. paratyphi B and 23 S. paratyphi C strains. At the same time, 100 complete genomes of Salmonella including 20 serovars available in National Center for Biotechnology Information (NCBI) database were downloaded and aligned by Mauve 2.3.1 to determine the prevalence of SPC-P1 in these serovars. Primers were designed according to the integration sites of SPC-P1 in the genome of RKS4594, and used to amplify ten strains having SPC-P1 in the genome. The PCR products were sequenced to investigate the integration sites of SPC-P1. Results:SPC-P1 was widely distributed in S.paratyphi C genome. In the study, 14 strains had all 6 fragments and 2 strains had 3-5 fragments. All the amplified fragments showed expected sizes. In contrast, in the genomes of S. typhi, S. paratyphi A and S. paratyphi B, no or only 1-2 fragments could be amplified, and the sizes were smaller than expected. The results from Mauve showed that only in the genome of S.choleraesuis, which was a close relative of S. paratyphi C, there existed an almost complete genome of SPC-P1. The insertion site of SPC-P1 in all the ten S. paratyphi C strains tested was between pgtE and yfdC genes. Conclusion: SPC-P1 is a unique virulence factor of S. paratyphi C. It may play roles in the host range and pathogenicity of S.paratyphi C.

Objective：To elucidate the correlation between urinary 11-dehydro-thromboxane B2 (11dhTxB2) and clinical efficacy of aspirin treatment in patients with type 2 diabete and coronary artery disease (CAD). Methods:In this prospective cohort study, 169 aged patients with type 2 diabete accompanying CAD in Peking University First Hospital were enrolled. The level of urinary 11dhTxB2 was detected using enzyme-linked immuno-sorbent assay. Low aspirin response or high on aspirin platelet reactivity (HAPR) was defined as urinary 11dhTxB2>1 500 ng/g. All the included patients were divided into two groups based on the results, HAPR group and No-HAPR group. Results:Baseline urinary 11dhTxB2 of the patients with type 2 diabete accompanying CAD was (3 687±3 052) ng/g, while the urinary 11dhTxB2 was (1 954±859) ng/g in patients after 100 mg/d aspirin treatment (P<0.001). Prevalence of HAPR in patients with type 2 diabete accompanying CAD were 32.5%. Within a mean follow-up time of 12 months, the outcomes occurred more frequently in HAPR group than in NoHAPR group (P<0.05).Conclusion: Urinary 11dhTxB2 can be recognized as an effective indicator in evaluating aspirin clinical efficacy of patients with type 2 diabete accompanying CAD.

Objective：To evaluate the cure effectiveness and safety of sucrose gel in the treatment of bacterial vaginosis through a multi-center, randomized, doubleblind, parallel controlled clinical study. Methods: A clinical research method of multi-center, randomly double-blind, and dose group parallel comparison was adopted. In the study， 533 patients with bacterial vaginosis were randomly divided into two groups, which included 214 cases in the control group (5.0 g metronidazole gel) and 319 cases in the trial group (5.0 g sucrose gel ). The patients were treated with different medication according to the group where they were. All the cases in these two groups were treated with drugs vaginally twice in a day, morning and evening separately, for 5 days. The curative effect and safety evaluation were assessed from 7 to 10 days and 21 to 30 days after treatment respectively. Results: The efficacy of the comprehensive clinical treatment showed that the cure rate of metronidazole gel group and sucrose gel group were 70.53% and 80.83% respectively 7 to 10 days after treatment. The recovery rate of Nugent score for vaginal smear were 71.50% and 81.15% respectively. The differences in the efficacy between these two groups were significant statistically (P<0.05). However, the cure rates of metronidazole gel group and sucrose gel group were 63.29% and 61.98% respectively 21 to 30 days after treatment. No statistically significant difference (P>0.05) could be found in the cure rates of the two groups. Conclusion: The clinical comprehensive efficacy and recovery of vaginal bacteria of sucrose gel group in the treatment of bacterial vaginosis were obviously superior to those of metronidazole gel 7 to 10 days after treatment. The susucrose gel could improve the clinical efficacy index and laboratory index of bacterial vaginosis. Other effects included the release of clinical symptoms, and the recovery of the normal micro-environment in the vagina according to the Nugent score. The curative efficacy of sucrose gel was equal to that of metro-nidazole gel 21 to 30 days after treatment. In the future, sucrose gel treatment can be a new strategy for the treatment of bacterial vaginosis. Various advantages can be taken to improve the cure rate of bacterial vaginosis and reduce the shortcomings produced by this disease.

Objective：To investigate the female vaginal Lactobacillus crispatus biofilm by using confocal laser scanning microscopy (CLSM)，thus revealing the formation of biofilm. Methods:The cover slide biofilm culture approach in vitro was employed for induction of the vaginal Lactobacillus crispatus biofilm formation．Following the culture for 2， 4， 8， 12， 16， 20, 24， 48, 72, 96 and 120 hours, the cover slide was removed for subsequent staining with the fluoresce in isothiocyanate-conjugated concanavalin A(FITC-ConA) and propidium (PI).This was followed by determination of the formation and characteristics of the vaginal Lactobacillus crispatus biofilm by using CLSM. Results:The CLSM images of biofilm formation at different time points were captured, suggesting that the vaginal Lactobacillus crispatus adhesion occurred at h 4， which was in reversible attachment, then more and more Lactobacillus crispatus aggregated at h 8  to h 20, which was in irreversible attachment．Lactobacillus crispatus clustered at h 20, with early development of biofilm architecture．Then the biofilm with extracellular matrix around the bacteria was set up at h 24，with gradual matureation at h 24 to h 48．The biofilm dispersed at h 72. The biofilm density of cultivating for 20 hours was 42.7×10-3±6.8×10-3，and for 24 hours increased to 102.5×10-3±23.1×10-3, suggesting a significant difference, P<0.05. This meant that mature biofilm was formed at h 24. Conclusion:The vaginal Lactobacillus crispatus is able to form typical biofilm with distinct developmental phases and architecture characteristics．Mature biofilm is formed at h 24 to h 48, then the biofilm begins to disperse.

Objective： To study the clinical and pathological characteristics of sporadic cutaneous infections due to nontuberculous mycobacteria (NTM), and investigate the diagnostic criteria and therapeutic principal. Methods: Totally 37 cases of sporadic cutaneous infections due to NTM were confirmed in the Department of Dermatology, Peking University People’s Hospital from January 2000 to March 2014. The microbiologic and clinical data were reviewed, and their skin biopsy specimens were reassessed. Results: Of all the 37 patients, 30 cases were Mycobacterium marinum infection, 6 were Mycobacterium abscessus infection, and one was Mycobacterium chelonea and Mycobacterium fortuitum infection. Identification of mycobacterial species by analysis of hsp65 gene in tissue DNA was more sensitive than traditional bacterial culture. The most common risk factors were traumatic injuries (21 of 37) and aquarium or fish-related job (21 of 37). One case of Mycobacterium abscessus infection occurred after autologous fat filling. Nodule and plaque were most common lesions in Mycobacterium marinum infection. Twenty-four of the 30 cases of Mycobacterium marinum infection presented with multiple lesions or sporotrichoid spread lesions. Ulceration, papules, abscess, and purulent discharge were observed in cases of Mycobacterium abscessus infection. Infective granuloma was most common histopathological appearance. For the treatment of Mycobacterium marinum infection, rifampin, ethambutol, and clarithromycin were commonly used (combination of two antibiotics, or three antibiotics), with the cure rate 90.00%. Four of the six Mycobacterium abscessus infections cases were cured, and one patient died. Conclusion: The most common species of sporadic cutaneous infections due to NTM is Mycobacterium marinum. Traumatic injuries, aquarium or fish-related job, and cosmetic surgeries are common risk factors. Mycobacterium marinum infection often presents with nodules, plaques, and sometimes sporotrichoid spread lesions. Lesions of Mycobacterium abscessus infection may vary. Pathological changes were not species specific, final diagnosis must be made depending on the identification of the microorganism. For the treatment of Mycobacterium marinum infection, excellent outcomes can be achieved by the combination of rifampin and ethambutol, and the combination of clarithromycin and rifampin or ethambutoland. Treatment regimens of Mycobacte-rium abscessus infection should be decided according to the results of antibiotic susceptibility testing.

Objective：To evaluate the clinical outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in a single center in China. Methods:We performed a retrospective ana-lysis of the patients with single EGC lesion who received ESD in Peking University Cancer Hospital from January 2011 to December 2013.Their clinicopathologic data, resectability, curability, complications and follow-up data were assessed. Results:A total of 116 patients were enrolled in the study. The patients included 88 men and 28 women, with a median age of 63 years (range: 25-80 years).The post-operative histology of the lesions included 28 (24.1%) high grade intraepithelial neoplasia, 35 (30.2%) well differentiated adenocarcinoma, 35 (30.2%) moderated differentiated adenocarcinoma and 18 (15.5%) poorly differentiated adenocarcinoma. Of all the lesions, 75.0% (87/116) were confined into mucosa, 15.5% (18/116) invaded SM1 (<500 μm from the muscularis mucosae) and 9.5% (11/116) invaded SM2 (≥500 μm from the muscularis mucosae). The mean tumor size was (1.49±0.96) cm, and the rate of ulceration was 14.7% (17/116). The en bloc resection rates were 96.7% (111/116), complete resection rates were 93.1% (108/116) and curative resection rates were 77.6% (90/116). According to the curability, 62 (53.4%) cases were classified into the standard curative resection (sCR) group, 28 (24.2%) into the expanded curative resection (eCR) group and 26 (22.4%) into thenoncurative resection (nCR) group. The mean tumor size of the sCR group was smaller than that of the eCR and nCR group (t=－4.121, P<0.001 and t=－3.420, P=0.001). In the nCR group, the portion of type 0-Ⅲ  lesion and ulceration were significantly higher (χ2=10.287, P=0.006 and  χ2=17.737, P<0.001). In multivariate analysis, EGC with ulceration and submucosal invasion were the risk factors for non-curative resection (OR=6.634, P=0.006 and OR=12.735, P<0.001). The ESD-related complications included 4 (3.4%) post-operative bleeding, 3 (2.6%) intra-operative perforation, 2 (1.7%) cardiac stenosis and 1 (0.9%) heart failure. In the study, 106 of the 116 patients received periodic follow-up, during a median follow-up of 22 months(12-47 months), Local tumor recurrence developed in 1 patient of the eCR group 8 months post the ESD.Conclusion:ESD is a safe and feasible option for EGC in China, ulceration and submucosal invasion are associated with noncurative resection, and post-operative bleeding and intra-operative perforation should be concerned as the main complications.

Objective： To evaluate the six-degree setup errors of tumors of cervical vertebra, thoracic vertebra and lumbar vertebra by image guided radiotherapy. Methods: From May 2013 to June 2014, 30 patients with spinal malignant tumors(10 patients of cervical vertebra, thoracic vertebra and lumbar vertebra respectively) were treated with Elekata Synergy accelerator（Elekta company，Sweden）. Sixdegree set up errors were corrected using HexaPODTMevoRT bed under image of on board cone beam computed tomography (CBCT) guided. All the patients received kilovoltage CBCT before receiving radiotherapy and after correction. The acquired images were co-registered with planning CT with bone window. The data of 838 CT images were analyzed and the errors of translational directions X(lateral), Y（lngitudinal）,Z（vertical）and rotational directions RX（pitch）, RY（roll）, RZ（yaw） were recorded. The data were compared by t-test using SPSS 13.0. Results:The absolute translational setup errors in X, Y and Z axes of cervical vertebra before correction were (1.71±0.10) mm, (1.81±0.11) mm and (1.94±0.09) mm respectively: (3.17±0.19) mm, (4.26±0.28) mm and (2.18±0.12) mm for thoracic vertebra, and (2.69±0.24) mm, (3.33±0.26) mm and (2.86±0.21) mm for lumbar vertebra. The residual setup errors in X, Y and Z axes of cervical vertebra were （0.5±2.4） mm,（0.01±2.4） mm and （2.4±1.4） mm, respectively after correction;（1.17±0.11） mm,（0.26±0.30） mm and （0.08±0.12） mm for thoracic vertebra and （1.09±0.24） mm,（2.03±1.26） mm and （0.06±0.51） mm for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed significant difference in three translational directions of cervical vertebra and thoracic vertebra, only Z（t=－3.518,P<0.001） for lumbar vertebra. The absolute rotational setup errors in RX,RY and RZ axes of cervical vertebra before correction were 0.67°±0.04°，1.06°±0.06°and 0.78°±0.05°respectively. 0.62°±0.05°, 0.75°±0.06°, and 0.84°±0.06° for thoracic vertebra, 0.59°±0.06°, 0.80°±0.07°, and  0.73°±0.06°for lumbar vertebra. The rotational directions RX, RY and RZ axes of cervical vertebra were 0.27°±0.14°, 1.20°±0.04° and 0.28°±0.05° respectively; 0.02°±0.20°, 0.05°±0.26°and 0.64°±0.16°for thoracic vertebra and 0.09°±0.26°, 0.50°±0.05°，and 0.03°±0.16°for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed significant difference in three rotational directions of cervical vertebra and lumbar vertebra, only RY（t=7.106,P<0.001）for thoracic vertebra. All the patients acquired pain relief and there was no radiation-induced toxicity detected clinically during a median follow-up of 6 months. Conclusion:Six-degree set up errors of spine tumors were corrected effectively with HexaPODTMevoRT bed under CBCT image guided and its feasibility in day-to-day clinical practice has been demonstrated.

Objective：To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC Ⅱ（trans-atlantic inter-society consensus Ⅱ） C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans. Methods:One hundred and three patients(119 limbs)accepted bypass surgery or endovascular therapy for TASCⅡ C/D femoropopliteal artery lesion between January 2002 and December 2012 at our institution were retrospectively assessed.All the patients were diagnosed with arteriosclerosis obliterins, and all their Rutherford classifications were from 2 to 5 degrees.Among them there were 71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery.We evaluated the short term clinical effect according to the condition when patients left the hospital, and evaluated the long term clinical effect according to the results of the patients’ latest follow-up in 2014. Their clinical data before treatment, complication rates, death rates, hospital stays, short term and long term effects, reoperation rates, 1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared.Results:There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment ［(67.1±7.1) years(51 to 80 years） vs. (68.0±9.4) years (49 to 91 years），P=0.561；(0.41±0.23) vs. (0.40±0.26)， P=0.928］. There were more TASCⅡ D patients in the bypass group than those in the endovascular group (P<0.001), and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant［(41.7±23.6) months vs. (59.5±41.6) months，P=0.065］. Five peri-operative complication cases occurred in the bypass group, including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure, and only 1 complication case occurred in the endovascular group that was heart failure.The complication rate was higher in the bypass group than that in the endovascular group ［10.4% vs. 1.4%, P=0.039］. And there was no death in both the groups.Compared with the endovascular group, the bypass group had a longer hospital stays ［(13.2±4.7) d vs.(6.5±3.1) d，P<0.001］,a higher reoperation rate (58.3% vs.31.0%，P=0.003), a better short term, obvious, and effective rate (25.0% vs. 9.9%， P=0.027）,a worse long term deterioration rate (37.5% vs. 18.3%，P=0.019) and higher 1 to 10 years primary and secondary accumulative patency rates（P=0.001, P=0.001）.There was no significant difference between the two groups on the increase of ankle brachial index［(0.34±0.28) vs. (0.31±0.23)， P=0.371］, and short term and long term total effective rates (89.6%  vs.84.5%， P=0.426； 45.8% vs. 56.3%， P=0.260), and limb salvage rate (83.3% vs.94.4%,P=0.051).Conclusion:Endovascular therapy is a safe, effective and minimally invasive therapy for TASCⅡ C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.

Objective：To investigate the clinical features of patients with ankylosing spondylitis (AS) and malignancies.Methods: In the study, 31 AS patients with malignancies in Peking University First Hospital from January 2006 to July 2014 were enrolled, and their clinical features were compared with AS patients without malignancies at the same time in the hospital. Then their general characteristics, clinical and imaging findings of AS, characteristics of malignancies and prognosis were retrospectively analyzed. Results:The 31 cases of AS with malignacies accounted for 11.8% of all AS patients admitted to the hospital in the same period. They comprised of 27 males (87%) and 4 females (13%). Their mean ages at diagnosis of AS were 43±17 years (range: 16-76 years), and their mean ages at diagnosis of malignancy were 60±12 years (range: 31-87 years) respectively. Malignancy was diagnosed after the establishment of AS in 27 of our patients. Furthermore, imaging changes typical of AS were found in all the 31 patients at the diagnosis of AS, but the majority of them had never received any proper treatment for AS. The malignancies of 31 AS patients included bladder cancer (7 cases), hematological malignancy (6 cases), lung cancer (5 cases), renal cancer (5 cases), prostate cancer (2 cases), carcinoma of renal pelvis (2 cases), breast cancer (2 cases), gastric carcinoma (2 cases), rectal cancer (2 cases), neuroendocrine carcinoma (2 cases), colon carcinoma (1 case), and esophagus cancer (1 case).Conclusion:There is risk of malignancy in AS. Malignancy is not rare in patients with AS. Bladder cancer is the most common one followed by hematological malignancy. In consequence, close attention should be paied to the conditon of AS with malignancy in clinical practice.

Objective：To study the relative factors of type Ⅱ endoleak after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Methods: Twenty-eight cases of abdominal aortic aneurysms treated by EVAR were retrospectively analyzed. The characteristics of the inferior mesentery arteries (IMA), the arc Riolan and the lumbar arteries of the cases with or without type Ⅱ endoleak were analyzed. Results: Type Ⅱ endoleak was found in 8 (28.6%) cases, of which, 2 were type Ⅱa and 6 were type Ⅱb. The diameter of the IMA originating part of the cases with type Ⅱ endoleak ［(4.03±1.00) mm］ was significantly bigger than that without endoleak ［(2.89±0.50) mm, P=0.007］. The number of the lumbar arteries originating from the aneurysm sac in cases with type Ⅱ endoleak (3.4±0.8) was significantly more than that without endoleak (1.9±1.5, P=0.017). However, type Ⅱ endoleak was irrelevant to the diameter of originating part of the lumbar arteries and the form of the arc Riolan. After the average 14.5 months follow-up, the aneurysm sac was found with shrinkage in 1 case, no change in 2 cases, and augment in 5 cases. Secondary transarterial embolization was performed for only 1 case. Conclusion: Type Ⅱ endoleak was much easily found in cases with bigger diameter of originating part of the IMA, or in cases with more lumbar arteries originating from the aneurysm sac.

Objective：To examine the effect of CaCl2, a sodium alginate crosslinker, to stimulate cells for a short time period on human adipose-derived mesenchymal stem cells (hASCs) proliferation and osteogenic differentiation ability, and to determine the appropriate concentration of CaCl2 for post three-dimensional biological experiments. Methods: hASCs stimulated with or without CaCl2 at various concentrations were seeded and cultured in control medium and osteogenic medium, respectively. The cell counting kit-8 (CCK8) was used to estimate the cell proliferation level of each group. After 7 days of osteogenic induction, alkaline phosphatase (ALP) staining and activity assays were performed using an ALP kit. After 14 days of osteogenic induction, alizarin red staining and quantitative detection were used to determine the calcium mineral density. The results were analyzed using analysis of variance (ANOVA) and Student-Newman-Keuls (SNK) tests for pairwise comparisons implemented in the SPSS 17.0 software. Results: The CCK-8 assays showed that the differences between the control groups and experimental groups were not statistically significant, so different concentrations of CaCl2 had no significant effect on hASCs proliferation. The ALP staining and activity assays showed that ALP activity first increased and then decreased as the CaCl2 concentration increased. Furthermore, the differences between all the groups were statistically significant (P<0.05), except the difference between the 50 mmol/L CaCl2 group and the 100 mmol/L CaCl2 group, and between the osteogenetic medium(OM) group and the 200 mmol/L CaCl2 group. Alizarin red staining and quantitative detection showed that the differences between all pairwise combinations of the groups were statistically significant (P<0.05). As the CaCl2 concentration increased, the calcium deposition increased, initially in the form of a scattered sheet and eventually a laminated sheet. Conclusion: Stimulation by a high concentration of CaCl2 over a short time period can enhance hASCs osteogenic differentiation ability, but has no effect on hASCs proliferation.

Objective：To detect the degree of oxidative stress in the process when Porphyromonas gingivalis (P. gingivalis) stimulates human vascular endothelium, And to investigate the effect of peroxisome proliferator-activated receptor（PPAR）γ on oxidative stress during this process.Methods:Human vascular endothelial cells (HVECs) line EA.hy926 (American Type Culture Collection ,United States) was cultured in high glucose Dulbecco’s modified eagle medium (DMEM). Four groups were designed: control group, P. gingivalis infected group, PPARγ activated group and PPARγ blocked group. In control group HVECs were cultured with only DMEM. In P. gingivalis infected group, HVECs were time-dependently stimulated by P. gingivalis W83 from 0 to 12 h. In PPARγ activated group or PPARγ blocked group, PPARγ was pre-activated or blocked by a representative PPARγ agonist(15dPGJ2 10 μmol/L) or antagonist (GW966210 μmol/L) 30 minutes before the cells were stimulated by P. gingivalis. At 0, 0.5, 1, 1.5, 2, 4, 8, and 12 h, the culture medium was collected individually and centrifuged, and the supernatant was stored for assay. Glutathione peroxidase (GSHPX) and malondialdehyde (MDA) were analysed by enzyme-linked immunosorbent assay. Cellular reactive oxygen species (ROS) were detected through 2’,7’-dichlorofluorescin diacetate (DCFA-DA) fluorescent probe at various time points of the different groups.Results: In P. gingivalis infected group, the levels of GSH-PX ［(5.56±0.97) μmol/L］ and MDA ［(0.84±0.18) nmol/L］ were significantly higher than those in control group ［GSH-PX(4.71±0.64) μmol/L, MDA (0.59±0.18) nmol/L)］. The levels of GSHPX and MDA in PPARγ activated group ［GSH-PX (5.38±0.84) μmol/L, MDA (0.84±0.22) nmol/L］ and in PPARγ blocked group ［GSH-PX (5.37±0.76) μmol/L, MDA (0.85±0.14) nmol/L］ were signi-ficantly higher than those in control group (P<0.05). In the PPARγ activated group, the levels of GSH-PX at 0.5 and 8 h were significantly higher than those from 1.5 h to 4 h (P<0.05), while no difference was observed on the MDA levels at  different time points. There was no significant difference at various time points for the levels of GSH-PX and MDA in PPARγ blocked group. The level of cellular ROS detected by DCFHDA in P. gingivalis infected group was significantly higher than that in control group (10 108.65 ± 1 805.18 vs. 6 049.06 ± 1 199.19，P<0.05). No difference was observed between PPARγ activated group (7 120.94±1 447.30) or PPARγ blocked group (6 727.35±1 483.68) and control group.Conclusion:Oxidative stress happens when P. gingivalis stimulates human vascular endothelium. PPARγ may involve in modulating oxidative stress during this process.

Objective：To investigate the prevalence of volatile sulfur compounds(VSC) in oral cavity of preschool children, and to analyze related factors, thus to provide scientific basis for the prediction and treatment of halitosis. Methods:The VSC content (hydrogen sulfide, methyl mercaptan, dimethyl sulfide) of 170 preschool children (4 to 6 years old) was detected by a portable gas chromatograph OralChromaTM. The status of the oral health was evaluated. The living habits and other aspects were obtained through questionnaires from the children’s parents. A soft package for social statistics version 13.0 (SPSS 13.0) was used in which univariate analysis and multivariate analysis were utilized to analyze the related factors of halitosis in children. Results:In the study, 34.4% of the total subjects had excessive VSC. Hydrogen sulfide (H2S) ［(1.59±2.41) ng/10 mL］ and total VSC concentration ［(2.14±4.42) ng/10 mL］ in the girls were significantly higher (P<0.05) than those in the boys. The tongue coating score had a significant positive correlation with H2S ［tongue coating area (1.68±2.48) ng/10 mL，tongue coating thickness (2.18±2.69) ng/10 mL］ and total VSC concentration ［tongue coating area, (2.26±4.31) ng/10 mL，tongue coating thickness (2.41±3.02) ng/10 mL , P<0.01］. The site number of DIS≥2 had a significant positive correlation with methyl mercaptan (CH3SH) and dimethyl sulfide ［(CH3)2S］ concentration (P<0.01). The concentration of H2S ［(1.19±1.62) ng/10 mL］ in children, whose mother had a higher degree of education, was statistically lower (P<0.01). The children who took dessert or sweat drinks more frequently had lower H2S ［(1.04±1.55) ng/10 mL, P<0.05］ concentration, while CH3SH and (CH3)2S concentration ［(0.29±1.92) ng/10 mL, (0.37±2.06) ng/10 mL, P<0.05) were higher in the children with mouth breath habit. Conclusion:A high prevalence of halitosis was noted in preschool children. Gender, tongue coating index, debris index-simplified, status of the mother’s education, frequency of eating dessert or sweat drinks and dry mouth breath were related with halitosis of preschool children. The different related factors resulted in changes of each VSC concentration.

Objective： To find absorbable adhesives with suitable bonding properties for the absorbable polylactic acid root canal post. To test and compare the bond strengths of absorbable polylactic acid root canal post with three different adhesives.  Methods: The absorbable polylactic acid root canal posts were used to restore the extracted teeth, using 3 different adhesives: cyanoacrylates, fibrin sealant and glass ionomer cement. The teeth were prepared into slices for micro-push-out test. The bond strength was statistically analyzed using ANOVA. The specimens were examined using microscope and the failure mode was divided into four categories: cohesive failure between absorbable polylactic acid root canal posts and adhesives, cohesive failure between dentin and adhesives, failure within the adhesives and failure within the absorbable polylactic acid root canal posts. Results:The bond strength of cyanoacrylates ［（16.83±6.97） MPa］ and glass ionomer cement ［（12.10±5.09） MPa］ were significantly higher than fibrin sealant ［(1.17±0.50) MPa］, P<0.001. There was no significant difference between cyanoacrylates and glass ionomer cement (P=0.156). In the group of cyanoacrylates, the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives was 25.0%, the cohesive failure between the dentin and the adhesives was 16.7%, the failure within the adhesives was 33.3%, and the failure within the absorbable polylactic acid root canal posts was 25.0%. In the group of fibrin sealant, the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives was 66.7%, the cohesive failure between the dentin and the adhesives was 22.2%, the failure within the adhesives was 11.1%. In the group of glass ionomer cement, the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives was 87.5%, the failure within the adhesives was 12.5%. The major failure mode in fibrin sealant and glass ionomer cement was the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives. No  major failure modes were found in the group of cyanoacrylates. Conclusion: The bond strength of fibrin sealant is low, which cannot meet the requirement of clinical use. The bond strengths of cyanoacrylates and glass ionomer cement are suitable for clinical use. The cyanoacrylates are a kind of absorbable adhesive which has suitable bonding properties for the absorbable polylactic acid root canal post.

Objective： To evaluate dimensions of the nasopalatine canal and the relationship between the canal and the central incisors, and the canal and the crest, by using cone-beam computed tomography (CBCT). Methods: This study included 129 CBCTs, and the sagittal slices were used to measure the lower diameter (Sda), median diameter (Sdb), and higher diameter (Sdc), for calculating the average sagittal diameter (Sd); the coronal slices through canals were used to measure the lower diameter (Hda), median diameter (Hdb), and higher diameter (Hdc) for calculating the average horizontal diameter (Hd), length (H); the sagittal slices were used to measure the buccal bone thickness off the canal (Bt), and the distance to the crest off the lowest point (At), the horizontal slices were used to measure the distance between the canal and the central incisors (Id). These subjects were divided into two groups by gender; and divided into three groups by ages: (1) ≤30 years old, (2) 31-50 years old, and (3) ≥51 years old. SPSS 17.0 statistical software was used for statistical analysis. Results: The overall Sd was (3.41±0.87) mm, the Hd was (5.16±0.93) mm, and the difference was statistically significant. The H was (14.29±3.27) mm, the Bt was (7.49±1.05) mm, the At was (8.25±1.71) mm, and the Id was (2.71±0.89) mm. Of the male and female, the Sd were (3.64±0.90) mm and (3.28±0.82) mm, P=0.017; the Hd were (4.98±0.89) mm and (5.27±0.94) mm, P=0.081; the H were (15.47±2.75) mm and (13.59±3.32) mm, P=0.001; the Bt were (7.90±0.96) mm and (7.25±1.03) mm, P=0.001; the At were (7.41±1.86) mm and (8.44±1.90) mm, P=0.001; the Id were (2.71±0.87) mm and (2.72±0.91) mm, P=0.983. Among the groups, no statistically significant differences were detected of the Sd (P=0.325), of the Hd (P=0.636), of the H (P=0.292), and of the Bt (P=0.116); statistically significant differences were detected of the At (P=0.010), and of the Id (P<0.001). Conclusion: The nasopalatine canal anatomy is highly variable. Gender is related to the nasopalatine canal length, Bt width, and At distance. While age was related to At, and Id, but no effect on nasopalatine dimensions. The CBCT is a useful device for studying the nasopalatine canal in three dimensions, prior to dental implant placement.

Objective：To measure the resting pressure of the tongue body on the sagittal and vertical dimensions of the tongue anchorage pad (TAP), and to investigate the proper position of TAP as an anchorage. Methods: Nineteen volunteers with individual normal occlusion (4 males and 15 females, age 23-33 years) were recruited in the study. Individualized TAP was designed and made for each subject. On the sagittal dimension, the pressure along the midline at the level of the distal of the second premolar (PM2), the first molar (M1) and the second molar (M2) were measured. On the vertical dimension, pressures on TAPs with height of -3 mm, 0 mm, and 3 mm were measured, with 0 mm standing for the reference point recorded by the tongue position record. The tongue resting pressure of the volunteers in the upright position was measured by miniature sensors (FSS1500NS, Honeywell, USA) embedded in TAP. Nonparametric analysis was applied with the significant level of 0.05. Results: On the vertical dimension, the pressure obtained at the height of -3 mm, 0 mm, and 3 mm were 105.83 Pa, 167.75 Pa, and 254.25 Pa, respectively (P<0.001). On the sagittal dimension, the pressure detected at the level of PM2, M1, and M2 were 177.64 Pa, 126.72 Pa, and 109.37 Pa, respectively (P<0.001). Conclusion: Tongue pressure rises significantly with the increase of TAP height. On the sagittal dimension, pressure decreases along the palatal midline in an anteroposterior direction. But in the clinical practice, we should also put comfort into consideration.

Objective： To evaluate the micro-push-out bond strengths of prefabricated glass fiber posts with poly-dopamine functionalized to root dentin using resin cements, contrasted with silane treatment. Methods: In the study, 30 glass fiber posts were randomly divided into 3 groups (10 posts in each group) for different surface treatments. Group 1, treated with poly-dopa; Group 2, treated with silane coupling agent for 60s; Group 3, no surface treatment (Control group). The 30 extracted human, single-rooted teeth were endodontically treated and a 9 mm post space was prepared in each tooth with post drills provided by the manufacturer. Following post cementation, the specimens were stored in distilled water at 37 ℃ for 7 days. The micro-push-out bond strengths were tested using a universal testing machine (0.5 mm/min), and the failure modes were examined with a stereomicroscope. The data of the three groups were statistically analyzed using the one-way ANOVA test(α= 0.05).Results: The bond strengths were (7.909±1.987) MPa for Group 1, (5.906 ±0.620) MPa for Group 2, and 4.678 ±0.910 MPa for Group 3. The bond strength of poly-dopamine group was significantly higher than that of the silane group (P<0.05). Conclusion: Contrasted with silane treatment, surface poly-dopamine functionalization was confirmed to be a more reliable method for improving the bond strength of resin luting agents to fiber posts.

Objective： To access the feasibility and safety of application of flexible laryngeal mask airway (FLMA) in oral & maxillofacial day surgery.Methods:Retrospective study was conducted of 40 oral & maxillofacial day surgery patients (3 to 61 years of age) using FLMA under general anaesthesia in Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology. All the patients were with American Society of Anesthesiologists(ASA) physical status Ⅰ-Ⅱ，including 19 males and 21 females. The patients’vital signs were recorded at five different time points: baseline before anesthesia (T0), time right after the FLMA insertion (T1), time at incision (T2), 15 min after incision (T3) and time at the end of the operation (T4). The first attempted FLMA insertion successful rate and the number of timed of changing to endotracheal intubation were recorded. During operation, frequencies of movement, hypoxia and obstruction of airway were noted and the operation time, anesthesia time, time from the end of the operation to extubation, movement and coughing following extubation and sore throat within 24 h were taken down. Operation-related complications of bleeding, hematoma and injury of local nerves were recorded within 24 h as well. Results:  The operations of all the 40 patients were successfully done under general anaesthesia. The 36（90%， 36/40）patients using FLMA successfully were under steady process,  including 16 males and 20 females. The first attempted successful rate of FLMA insertion was 80% (32/40), and the second 50% (4/8). Three out of the 4 failed FLMA patients were changed to endotracheal intubation after the second attempt failed. The other patient was changed to endotracheal intubation before operation because of leak. The average operation time was (46.58±22.57) min, the anesthesia time was (77.97±26.82) min and the time from the end of operation to extubation was (8.31±3.33) min. All the patients were recorded without obvious body movement during the operation procedure. There were 4 patients (11.11%, 4/36) with slight body movement during extubation. The incidence of sore throat was 13.89% (5/36) within 24 h postoperatively. There were no complications of bleeding, hematoma and injury of local nerves. The vital signs of baseline T0 were significantly different from those at other time points T1, T2, T3, and T4 (P<0.01). As to the hearts rate after anesthesia, the values at T1, T2, T3 and T4 for two-two comparison, there was no statistical difference (P>0.05). As to the values of systolic blood pressure and diastolic blood pressure after anesthesia at T1 and T4, T2 and T3, for two-two comparison, there was no statistical difference (P>0.05). As to the respiratory rate from the start of the surgery, the values at T2, T3 and T4 showed no statistical difference (P>0.05).  Conclusion: Flexible laryngeal mask airway is a supraglottic airway management method. It is suitable and safe for securing the airway in oral & maxillofacial day surgery. The advantages of fewer haemodynamic changes and postoperative complications are confirmed.

Objective： To construct the finite element models of maxillary central incisor and the simulations with crown lengthening surgery and post-core restoration in management of different crown-root fracture types, to investigate the stress intensity and distributions of these models mentioned above, and to analyze the indications of crown lengthening from the point of view of mechanics. Methods: An extracted maxillary central incisor and alveolar bone plaster model were scanned by Micro-CT and dental impression scanner (3shape D700) respectively. Then the 3D finite element models of the maxillary central incisor and 9 simulations with crown lengthening surgery and postcore restoration were constructed by Mimics 10.0, Geomagic studio 9.0 and ANSYS 14.0 software. The oblique static force (100 N) was applied to the palatal surface (the junctional area of the incisal 1/3 and middle 1/3), at 45 degrees to the longitudinal axis, then the von Mises stress of dentin, periodontal ligament, alveolar bone, post and core, as well as the periodontal ligament area, were calculated. Results: A total of 10 high-precision three-dimensional finite element models of maxillary central incisor were established. The von Mises stress of models: post＞dentin＞alveolar bone＞core＞periodontal ligament, and the von Mises stress increased linearly with the augmentation of fracture degree (besides the core). The periodontal ligament area of the crown lengthening was reduced by 12% to 33%. The von Mises stress of periodontal ligament of the B2L2c, B2L3c, B3L1c, B3L2c, B3L3c models exceeded their threshold limit value, respectively. Conclusion: The maxillary central incisors with the labial fracture greater than three-quarter crown length and the palatal fracture deeper than 1 mm below the alveolar crest are not the ideal indications of the crown lengthening surgery.

We described 1 case of autoimmune lymphoproliferative syndrome (ALPS), first diagnosed in our hospital, and reviewed the recent literature. The 11-month old male patient presented with a history of splenomegaly and hepatomegaly since 1 month after birth. He suffered recurrent infectious diseases including cytomegalovirus infection, parvovirus B19 infection and chronic diarrhea disease. Besides, his symptoms included hemolytic anemia and thrombocytopenia. The laboratory abnormality indicated an expanded population of alpha/beta double-negative T cells (DNTs) (27.18% of lymphocytes, 35.16% of CD3+ T lymphocytes) in peripheral blood, and autoantibodies including antinuclear antibody, double-stranded DNA and rheumatic factor were positive. Hyper gamma globulinemia and positive direct Coombs tests were seen in the patient. His parents were both healthy and denied autoimmune diseases. We identified a heterozygous point mutation in exon 3 of the FAS gene carrying c.309 A>C, resulting in a single base pair substitution in exon 3 of FAS gene which changed the codon of Arg103 to Ser103. Unfortunately, we were unable to obtain the gene results of the child’s parents. The patient was treated with glucocorticoids in our hospital and with mycophenolatemofetil in other hospital. And we were informed that his anemia condition relieved through the telephone follow-up, but he still suffered recurrent infections, hepatomegaly and splenomegaly still existed. As we all know ALPS is characterized by defective lymphocyte apoptosis, and thus cause lymphoproliferative disease and autoimmune disease, and increase the risk of lymphoma. It is more likely to be misdiagnosed as other diseases. ALPS should be suspected in the case of chronic lymphadenopathy, splenomegaly and autoimmune features. Flow cytometry approach is helpful for the diagnosis. Immunosuppressive drugs are the necessary treatment.

The male patient reported here presented as gangrene and central diabetes insipidus (CDI), who had characteristics of vasculitis. The patient complained about polydipsia and polyuria half a year ago, and then developed tingling, pain and blackish discoloration of some fingers and toes 3 month ago. He also had Raynaud’s phenomenon. After admission, his laboratory examination showed the rise of erythrocyte sedimentation rate, C-reactive protein, immunoglobulin, β2-glycoprotein Ⅰ and the activity of rheumatoid factors, lupus anticoagulant test. his pituitary gland showed loss of posterior signal on magnetic resonance imaging. In addition, his vasopressin test was active. However, there was no sufficient evidence to diagnose any specific disease; as a consequence the patient was diagnosed as idiopathic systemic necrotizing vasculitis (SNV). For SNV, the patient was treated with glucocorticoid 40 mg/d and impact therapy of cyclophosphamide 0.4 g every 2 weeks. He also received symptomatic treatment for gangrene and CDI. Cutaneous involvement leading to gangrene was widely reported in SNV, however pituitary involvement in SNV leading to CDI was rare. The prognosis of this patient was poor.

When placenta previa complicated with placenta percreta, the exposure of operative field is difficult and the routine methods are difficult to effectively control the bleeding, even causing life-threatening results. A 31-year-old woman, who had been diagnosed with a complete type of placenta previa and placenta percreta with bladder invasion at 34 weeks gestation.  Her ultrasound results showed a complete type of placenta previa and there was a loss of the decidual interface between the placenta and the myometrium on the lower part of the uterus, suggestive of placenta increta. For further evaluation of the placenta, pelvis magnetic resonance imaging was performed, which revealed findings suspicious of a placenta percreta. She underwent elective cecarean section at 36 weeks of gestation. Firstly, two ureteral stents were placed into the bilateral ureter through the cystoscope. After the infrarenal abdominal aorta catheter was inserted via the femoral artery (9 F sheath ),  subarachnoid anesthesia had been established. A healthy 2 510 g infant was delivered, with Apgar scores of 10 at 1 min and 10 at 5 min. Immediately after the baby was delivered, following which there was massive haemorrhage and general anaesthesia was induced. The balloon catheter was immediately inflated until the wave of dorsal artery disappeared. With the placenta retained within the uterus, a total hysterectomy was performed. The occluding time was 30 min. The intraoperative blood loss was 2 500 mL. The occluding balloon was deflated at the end of the operation. The patient had stable vital signs and normal laboratory findings during the recovery period and the hemoglobin was 116 g/L. She was discharged six days after delivery without intervention-related complications. This case illustrates that temporary occlusion of the infrarenal abdominal aorta using balloon might be a safe and effective treatment option for patients with placenta previa complicated with placenta percreta, who were at high risk for peripartum hemorrhage. Early removal of the endovascular catheter and close postoperative surveillance of the vascular system are required with this procedure to minimize the risk of vascular complications. However, further studies are needed to determine whether the potential benefits of temporary occlusion of the infrarenal abdominal aorta using balloon outweigh the potential risks.

To demonstrate the clinical manifestation, diagnosis and treatment of myoclonus epilepsy with ragged-red-fibers (MERRF), a case of MERRF was presented with review of the literature. A 4-year-7-month-old girl was diagnosed with MERRF. She had tremor, fatigue and developmental delay for more than 2 years. Laboratory tests showed that the serum and urine lactic acid and pyruvic acid increased significantly. Electroencephalogram showed diffuse and focal spike slow wave and slow wave in right central and parietal regions. Electromyogram showed neurological damage. Gene mutational analysis showed mtDNA 8344 A>G mutation. The mutational rate was 78%. Mitochondrial disease MERRF syndrome was diagnosed.  Cocktails therapy with vitamins B1, B6, B12, L-carnitine, and coenzyme Q10 was administrated to the patient. MERRF is a rare disease. The diagnosis can be made by gene mutational analysis. Cocktail therapy may slow down the deterioration of the disease. Gene therapy is still experimental.

Hemophilia A is aninherited bleeding disorder, lack of coagulation factor Ⅷ (FⅧ), and if combined with intracranial malignant tumor, the operation risk is very high. Department of Pediatric Surgery in Peking University First Hospital used coagulation factor replacement therapy, succeeded in the operation of 2 cases of intracranial malignant tumor with hemophilia A in children, with no abnormal bleeding events. The establishment of the multi subject cooperation group before operation, good preoperative preparation, enough alternative factors, and close postoperative monitoring, are the key to the successful treatment.

Intravesical bacillus Calmette-Guérin (BCG) was a common treatment for non-muscle invasive urothelial carcinoma of the bladder. The complication of prostatic abscess was rare. We reported a case of tuberculous prostatic abscess after BCG therapy. A 65-year-old man was diagnosed as bladder cancer and accepted transurethral resection of bladder tumor (TURBT) treatment. He received a 6-week induction course without any infection complication. Following the second BCG maintenance instillation, he complained of fever and dysuria. Transrectal ultrasound (TRUS) demonstrated a well-defined complex mass in the right lobe of his prostate. The diagnosis of tuberculous prostatic abscess was considered after excluding other bacterial infection. The patient was treated with an anti-tuberculous regimen of isoniazid, rifampicin, and ethambutol. The symptoms were relieved after 4 weeks of anti-tuberculous therapy. Because of the good response to the medicine, no further aspiration or drainage of prostatic abscess was carried out. The anti-tuberculous therapy had to be stopped for serious drug induced liver injury after 6 weeks of anti-tuberculous therapy. Eight weeks later of stopping anti-tuberculous therapy, the follow-up TRUS showed the disappearance of the prostatic abscess and the test of his liver function was normal. Considering the virulence of BCG is weaker than that of common tuberclebacillus, the shorter course of anti-tuberculous therapy maybe an alternative choice， and surgical drainage is not always necessary.