Objective To analyze the cause of postmenopausal vaginal bleeding and diagnostic method. Methods The clinical and pathological data of 196 patients with postmenopausal vaginal bleeding were retrospectively analyzed. Results The benign diseases accounted for 46.94% (92/196), dysfunctional uterine bleeding accounted for 34.69% (68/196), malignant tumor accounted for 18.37% (36/196).Menopausal time 1--4 years, 5-9 years, 10-14 years, ≥ 15 years of malignant tumor incidence was 2.53%(2/79), 9.38% (6/64), 48.39% ( 15/31 ), 59.09 % (13/22). The age of onset in patients with malignant tumors was (61.28 ± 8.76) years old, menopausal time was (9.38 ±6.73) years, benign disease and dysfunctional uterine bleeding was (54.73 ± 6.72) years old and (4.12 ± 3.54) years, the differences were statistical significance (P ＜ 0.01 ). Conclusion The cause of postmenopausal vaginal bleeding bases mainlyon benign disease and dysfunctional uterine bleeding, but the older, longer menopausal time, which also increase the incidence of malignant tumors.

OBJECTIVE: In China, there are little literatures about nonspecific low back pain(NLBP) and no standardized diagnostic classification of it. This paper reviews the clinical and basic studies on NLBP, and discusses the clinical features and progress in related studies. It is necessary for rehabilitation and intervention of NLBP science norm.DATA SOURCES: Medline, China Wanfang, China Biomedicine (CBM),China Academy Journal(CAJ) and its VIP database.STUDY SELECTION: By searching "nonspecific" and"low back pain" for all data and information about NLBP, we obtained 163 English articles and 22 Chinese ones. These documents were further restricted by "in title" and "2000-2004" to obtain subject documents in the latest 5 years(28 English and 9 Chinese documents) . The main references of important documents were manually searched for full-text articles. Types of these documents were basic study, clinical study.DATA EXTRACTION: All the related information about NLBP in the full-text documents was classified and extracted.DATA SYNTHESIS:Low back pain is generally classified into 3 types according to the present clinical guidelines: NLBP, specific low back pain and sciatica. NLBP constitutes 85% of low back pain and its cause is not clear although it is related to many risk factors. Of the treatment methods for NLBP, all are selective ones.CONCLUSION: Standard classification of diagnosis of low back pain needs to be established to guide clinical practice. Prevention is better than treatment. Tertiary prevention combined with multidisciplines is a promising way to relieve pain and prevent recurrence and disability.

Objective To evaluate the efficacy and safety of three operational strategies for the management of elliptical-like benign skin lesions such as nevus,verrucous nevus,tattoo,cutaneous scar,and so on.Methods Seventy-one patients with elliptical-like benign skin lesions were included in this study,and randomly divided into three groups to be treated by three operational strategies respectively:single spindle-shaped excision and direct suture,one or more times of star-shaped excision within lesions followed by final spindle-shaped excision and suture,one or more times of S-shaped excision within lesions followed by final spindle-shaped excision and suture.The efficacy of operational strategies was evaluated by the ratio of the length of postoperative scar to that of the corresponding preoperative lesion.The clearance capacity was determined by repeated histopathological examination of lesions removed.Results Of the 71 patients,23 were managed by spindle-shaped excision and direct suture with the average ratio of the length of postoperative scar to that of preoperative lesion being 2.34,25 by star-shaped excision and suture with the average ratio being 0.90,and 23 by S-shaped excision and suture with the average ratio being 1.10.No evidence of malignancy was shown by the repeated pathological examination of resected tissues.Conclusions Both star-shaped and S-shaped excision can result in satisfying cosmetic outcomes with favorable clearance capacity in patients with elliptical-like benign skin lesions,but repeated operations are required.

ObjectiveTo explore the moderating effects of self-efficacy between perfectionism and depression.MethodsUsing a convenient sampling method,a sample of 570 university students completed almost perfect scale-revised ( APS-R),general self-efficacy scale (GSE),beck depression inventory (BDI).ResultsCorrelational analyses indicated maladaptive perfectionism was positively correlated with depression ( r =0.47,P ＜0.01 ),and negatively correlated with self-efficacy ( r =- 0.24,P ＜ 0.01 ).In contrast,adaptive perfectionism was positively correlated with self-efficacy ( r =0.26,P ＜ 0.01 ),and was not correlated with depression ( r =0.05,P ＞ 0.05 ).Hierarchical regression analyses indicated the moderation effects of self-efficacy was significant (β =-0.12,P＜ 0.01 ) in that maladaptive perfectionism has closer relationship with depression when self-efficacy was low,suggesting that self-efficacy enhances the influence of maladaptive perfectionism on depression ( β =0.536,P =0.000 ),whereas high self-efficacy reduces the corresponding influence (β=0.239,P=0.018 ).ConclusionSelf-efficacy moderate the relation between maladaptive perfectionism and depression.

ObjectiveTo analyze the impact of combined use of motherwort injection with oxytocin on hemorrhage in cesarean section and postoperative stage.Methods512 pregnant women after processing cesarean section were randomly divided into an experimental group (n=256) and a control group (n=256).The experimental group used motherwort injection and oxytocin,and the other group only used oxytocin.Intraoperative and postoperative bleeding and adverse drug reactions were observed.ResultsBleeding volume in the experimental group was less than the control group [ (210.43 ± 50.38)ml,(35.84 ±29.24)ml,(61.62 ±35.32) ml vs (234.14 ±16.91) ml,(52.37 ± 32.15) ml,(86.18 ± 36.67) ml],P＜0.05).There were no significant adverse reactions.ConclusionMotherwort injection and oxytocin used together can be more effective in reducing bleeding in cesarean section and postoperative stage.

Objective To compare the efficacy of postoperative chemotherapy in combination with radiotherapy and simple radiotherapy in malignant glioma.Methods 82 patients with malignant glioma resection patients were randomly divided into observation group and control group,there were 41 patients in each group.The control were treated with simple three-dimensional conformal radiotherapy.The observation group were given temozolomide chemotherapy on the basis of three-dimensional conformal radiotherapy.The effects and adverse reactions were observed.Results Total effective rate of observation group was 63.4％ (26/41),significantly higher than that in the control group 34.1％ (14/41) (x2 =8.2439,P ＜ 0.01);gastrointestinal adverse reaction rates of the observation group was 100.0％,significantly higher than 58.5％ of the control (P ＜ 0.01),the difference of bone marrow suppression in two groups had no statistically significant (P ＞ 0.05).Conclusion Although with a higher incidence of gastrointestinal reactions,postoperative chemotherapy with radiotherapy have reliable effect,it is worth using in the condition of appropriate and timely symptomatic and supportive treatment.

Sepsis is currently a challenge in the pediatric intensive care unit.Especially septic shock and multiple organ dysfunction syndrome have become the main causes of death in patients from pediatric intensive care unit,and the mortality rate is up to 30％ ～ 70％.At present,procalcitonin is undoubtedly the best sepsis indicator.This article summarized the application of procalcitonin in children with sepsis.

Parkinson's disease (PD) caused by the deficiency of DA in the substantial nigra-striatum system in the brain is a chronically progressive disease. Early diagnosis and prompt treatment PD can prolong work time and improve life quality of the patient. There are three primary approaches to increase activity of dopaminergic system:vicarious treatment to compensate DA; promote releasing DA in nerve endings of dopamine neurons and to prevent decreasing DA metabolism,as well as application of agonists that stimulate dopamine receptors. Some specialists suggest that application of dopaminergic agonists in the initial stage can not only delay the occurrence of syndrome on side effects with long-term use of levodopa,but also prevent the damage of dopaminergic cell caused by levodopa or its metabolite,and delay the development of PD. There are positive and adverse effects with DA agonists. This paper discussed the usage and side effects of classic and new dopaminergic agonists.

Objective To discuss the application of minimally invasive peritoneal lavage in treating the perforation of the upper part of the gastrointestinal tract.Methods The clinical data of 120 patients suffered with upper digestive tract perforation treated from 2005 to 2012 were reviewed retrospectively.86 cases received peritoneal lavage as therapy group,in which 26 cases received saline lavage,33 cases received antibiotic lavage,27 cases received dermacyn lavage.34 cases without peritoneal lavage as control group.The improved clinical indicators and postoperative complications were analyzed in two groups.Results The time of improved clinical indicators,peritonitis releasing,stomach resuming,food taken and being in hospital in therapy group were shorter than those of control group.The incidence of intraabdominal abscess of receiving salin lavage group and control group was the same,the intestinal adhesion rate in receiving peritoneal lavage group and the saline lavage group had no obvious difference,the incidence of intraabdominal abscess and intestinal adhesion in dermacyn lavage group was significantly lower than those of other groups.Conclusion Minimally invasive peritoneal lavage is a treatment of upper digestive tract perforation method,intestinal function recovers rapidly,abdominal complications are few,the effect of dermacyn peritoneal lavage on treatment of peforated ulcer of upper digestive tract is better than antibiotic lavage,which is suitable for clinical application.

Objective To investigate the effects of different anesthesia methods on cerebral oxygen metabolism in patients with severe traumatic brain injury.Methods Forty-five patients with severe traumatic brain injury from March 2011 to March 2013 were divided into propofol intravenous anesthesia group(group A),sevoflurane inhalation anesthesia group(group B) and intravenous inhalational anesthesia group (group C) by random digits table method with 15 cases each.The mean artery pressure (MAP),heart rate (HR) before anesthesia,immediately after tracheal intubation,2 minutes after intubation,10 min and 30 min after operation set and operation end were observed.The oxygen content of jugular venous (SjvO2),jugular bulb venous oxygen content (Da-jvO2) and cerebral metabolic rate for oxygen (CERO2) before anesthesia induction,immediately finish anesthesia induction,30 min and 1 h after operation set and operatin end were calculated.Results The SjvO2 values in three groups were at 30 min,1 h after operation set and operation end was higher than that before anesthesia induction (group A:0.662 ±0.077,0.689 ±0.067,0.685 ±0.066 vs.0.623 ±0.083; group B:0.661 ±0.074,0.681 ±0.072,0.661 ±0.069 vs.0.598 ±0.092; group C:0.715 ± 0.072,0.743 ± 0.070,0.713 ± 0.075 vs.0.631 ± 0.078),and there was significant difference (P ＜ 0.05).The Da-jvO2 values,CERO2 at 30 min,1 h after operation set and operation end was lower than that before anesthesia induction in three groups [group A:Da-jvO2:(41.2 ± 6.3),(41.6 ± 8.1),(44.2 ± 6.3) ml/L vs.(49.2 ± 9.2) ml/L,CERO2:(33.0 ± 1.9)％,(32.7 ± 2.0)％,(32.3 ± 1.9)％ vs.(36.0 ±2.3)％; group B:Da-jvO2:(41.8 ± 5.6),(40.2 ± 6.9),(41.8 ± 5.6) ml/L vs.(51.3 ± 8.6) ml/L,CERO2:(33.2 ±2.1)％,(33.0 ±2.6)％,(32.8 ±2.1)％ vs.(34.7 ±3.1)％ ; group C:Da-jvO2:(39.5 ±6.8),(38.7 ±7.0),(40.2 ±6.8) ml/L vs.(48.8 ±9.7) ml/L,CERO2:(31.8 ±2.9)％,(31.5 ±3.1)％,(32.9 ±2.3)％ vs.(35.1 ± 2.9)％],and there was significant difference (P ＜ 0.05).And group C was decreased more significantly (P＜0.05).There was no significant difference in MAP,HR among three groups (P＞0.05).Conclusion Propofol intravenous anesthesia and sevoflurane inhalation anesthesia can effectively reduce perioperative cerebral metabolic rate of oxygen,and the balanced anesthesia has better cerebral protection with the stable hemodynamic.