Objective To evaluate the effectiveness of cervical intraepitheliar neoplasia grade Ⅰ (CIN Ⅰ) after treated by high intensity focused ultrasound (HIFU) Ⅰ.Methods 155 CIN Ⅰ cases in treatment group started following after HIFU method,548 cases in control group started following after cervical biopsy under the colposcope.The following intermissions were 6 months,12 months,24 months,36 months,Liquid based cytological test (LCT) and hybrid captured-Ⅱ for high rate-humanpapilomavirus (HR-HPV)test were used in every following test,and if the LCT result was atypical squamous cells (ASC-US) and HR-HPV positive,or the LCT result was greater than or equal,cervical biopsy was undergone by the colposcope to make sure the CIN Ⅰ diagnosis.Results (1) The lost rates of treatment group and control group in 36 months were 18.66％ and 10.22％.(2) The inversion rates in 6 months,12 months,24 months and 36 months were 77.51 ％,80.38 ％,86.12 ％ and 88.28 ％,inversion cases were rose up by the treatment gradually,succession rates were 33.01 ％,22.97％,9.33％ and 1.44％,and descended down gradually.(3)The inversion rates in treatment group and control group increased with observation time,there were significant differences during the 6 months,12 months,24 months and 36 months (P ＜ 0.05) ; the succession rates in treatment group and control group descended with observation time,there were significant differences during the 6 months,12 months and 24 months (P ＜ 0.05),and there were not significant differences in the 36 months,but significant differences between treatment group's and control group s progressive rate.Conclusions No solid scar,improving lesions inversion,reducing succession rate,guarding against the canceration were the advantages of HIFU in treatment for CIN I.

Situational teaching method was implemented in clinical teaching of obstetrics and gynecology. The basis of situational teaching was established through the establishment of a typical teaching case library. Students' impression of disease diagnosis and treatment was strengthened by simulation. The students' enthusiasm was improved by their own diagnosis and treatment through the teacher's guidance. With the method of situational teaching, students had better knowledge of obstetrics and gynecology, and their clinical diagnosis and treatment capacity was improved. Situational teaching method can improve the quality of teaching and it is worthy being popularized in clinical teaching of obstetrics and gynecology.

OBJECTIVE To analyze for mutations of the PDS gene in patients with sensorineural hearing loss associated with enlarged vestibular aqueduct and analyze the molecular pathogenesis of enlarged vestibular aqueducts. METHODS Eighteen sporadic cases of large vestibular aqueduct syndrome and twelve control individuals with normal hearing were included in this study. Exons 6 and 9 of the PDS gene in all subjects were amplified by polymerase chain reaction and analyzed by direct DNA sequencing. RESULTS Analysis revealed 2 single base changes in exon 6 of one patient with large vestibular aqueduct syndrome. One was a G→C transversion at nucleotide position 611, and the other was a T→G transversion at nucleotide position 612, resulting in a predicted Gly→Ala substitution at position 204. No mutation in exons 6 and 9 of the PDS gene was found in the PDS gene of the control individuals. CONCLUSION Mutations of the PDS gene are responsible for the large vestibular aqueduct syndrome. Analysis of the PDS leftover sequence in patients with large vestibular aqueduct syndrome is the next step in elucidating the complicated causes of this disease.

Objective To compare the effect of brain unilateral and bilateral antegrade selective cerebral perfusion (ASCP) during a hybrid approach to DeBakey type Ⅰ aortic dissection and to provide the clinical evidence for the selection of cerebral perfusion methods of aortic dissection surgery.Methods Among the 56 patients undergoing a hybrid approach to DeBakey type Ⅰ aortic dissection from January 2009 to June 2011,24 were enrolled in the study.They were randomly divided into a unilateral ASCP group (n =11) and a bilateral ASCP group (n =13).The patients in both groups underwent cognitive ability test,brain CT scan,cerebrovascular and aortic CTA examinations before and after procedure.The general information,intraoperative conditions and neurological function in the patients of both groups were compared.Results There was no difference in the general data between the unilateral and bilateral ASCP groups.There were no significant differences among the intraoperative cardiopulmonary bypass time (125.2 ± 34.4 min vs.132.1 ± 45.4 min; t =- 0.278,P =0.784),aortic cross-clamping time (54.5 ± 23.6 min vs.61.6 ± 27.5 min; t =-0.149,P =0.883),cerebral perfusion time (30.9 ± 13.2 min vs.31.7 ± 14.5 min; t =- 1.283,P =0.213),right radial artery pressure (57.6 ± 15.5 mm Hg vs.60.7 ± 14.3 mm Hg; t =0.758,P =0.457),and arterial oxygen pressure (465.6 ± 62.4 mm Hg vs.488.4 ± 72.5 mm Hg; t =- 1.894,P =0.071 ).There were no surgery and recent death in both groups.There were no significant differences among the mechanical ventilation time (33.5 ± 14.6 h vs.37.8 ± 12.3; t =- 1.009,P =0.162),time awake after surgery (5.2 ± 2.4 h vs.5.5 ± 3.1 h; t =0.876,P =0.195),and intensive care unit stay time (7.5 ± 3.1 d vs.8.2 ± 3.5 d; t =-0.186,P =0.427).There was no new permanent neurological dysfunction in both groups.One patient had transient neurological impairment in each group.The cognitive function scores after surgery in the unilateral ASCP group (50.1 ± 14.8 vs.47.3 ± 15.2; t =1.005,P =0.126) and in the bilateral ASCP group (52.1 ± 13.7 vs.48.6 ± 16.5; t =0.576,P =0.254) were slightly lower than those before procedure,however,there was no significant difference; there was also no significant difference in the unilateral and bilateral ASCP groups before (t =-0.887,P =0.385) and after procedure (t =-0.953,P =0.351).Conclusions Under the circumstance of complete circle of Willis,the brain protective effect of the unilateral and bilateral ASCP in patients undergoing a hybrid approach for DeBakey type Ⅰ aortic dissection had no significant difference,and more simple and convenient unilateral ASCP can be used.

Objective The present study aims to summarize the clinical experience and methods of nervous system protection in the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure.Methods From Jan 2009 to Jun 2011,56 patients suffering from DeBakey Ⅰ aortic dissection underwent hybrid procedure.The ascending aorta part were replaced under conventional cardiopulmonary bypass,and the0 aortic arch branch vessels were reconstructed,and then a stent graft was implanted to cover the aortic arch and part of the descending aorta.The unilateral antegrade cerebral perfusion(UACP) and/or bilateral antegrade cerebral perfusion (BACP) combined with femoral artery perfusion was used,and the left subclavian arteries were selectively reconstructed according to cerebral arteries and aorta computed tomography angiography scan.Results All the patients went through the procedure successfully.BACP combined with femoral artery perfusion was applied in 16 patients,UACP combined with femoral artery perfusion in 33 patients,and 7 were perfused with only femoral artery cannulation.Of all the patients,19 underwent the innominate artery and left common carotid artery reconstruction and the other 37 patients underwent the innominate artery,the left common carotid artery and the left subclavian artery reconstruction.The cardiopulmonary time was 44 -95 min,mean (65 ±24) min; aortic clamping time was 32 -71 min,mean (48 ±29)min; the cerebral perfusion time was 24 -44 min,mean (32 ± 13) min.One ( 1.8％ ) patient,who was perfused with only femoral artery cannulation,suffered from permanent neurological dysfunction,and 5 (8.9％) had transient neurological dysfunction.One patient died from severe infection,1 patient was given up because of permanent neurological dysfunction,and the rest 54 patients recovered and discharged.The patients were followed up 1 to 25 months,and there was no newly occurred neurological dysfunc tion.The CTA examination 3 months post-operative revealed that the branch bypass vessels were unobstructed.There was no subclavain steal symptom occurred in the 19 patients whose left subclavian arteries were not reconstructed.The left upper limb strength was slightly lessened in 3 patients and recovered 6 - 12 months later.Conclusion In the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure,the selective use UACP and/or BACP combined with femoral artery perfusion can avoid deep hypothermic and circulatory arrest and provide the continuous cerebral and spinal perfusion.This perfusion strategy in hybrid procedure can decrease the morbidity of post-operative nervous system disorders with satisfactory nervous system protection effect.

Objective To review the clinical experience in the surgical treatment of infective endocarditis,and to summarize the key points of how to elevate therapeutic effect.Methods From Jan 2001 to Dec 2010,106 patients with infective endocarditis who underwent operative therapy were retrospectively analyzed.All patients underwent cardiac operation in conventional hypothermic cardiopulmonary bypass.Vegetations and suspicious infective focus were thoroughly cleaned.Endocardium was swabbed with normal sodium repeatedly and with high concentration antibiotic solution.Combined anomalies were rectified and the affected valves were replaced.Artificial valves were preconditioned with antibiotics before implantation.All patients were treated with full dose of sensitive antibiotics for 6-8 weeks after operation.Results Two patients(1.8％) died perioperatively,1 died of severe pulmonary infection 5 days post operation,and 1 died of multisystem organ failure.Other 104 patients recovered smoothly,95 of whom were followed up for 6 months to 10 years.One patient died,and the other patients recovered with Ⅰ-Ⅱ grade heart function(NYHA).Three patients had anticoagulation related complications.There was no relapse of endocarditis occurred during the period of follow-up.Conclusion Early diagnosis and timely operation on infective endocarditis can achieve satisfactory effect.The thorough sterilization,prosthetic valves precondition and post operative regular antibiotics therapy were the key points of successful surgical treatment.

Objective Some major procedures for DeBakey type Ⅰ aortic dissection used to be performed with deep hypothermic circulatory arrest, which had been associated with more complications than seen with standard extracorporeal circulation. We reviewed the cases who received the treatment for DeBakey type Ⅰ aortic dissection by hybrid procedure without deep hypothermic circulatory arrest. The procedure consisted of ascending aorta replacement, ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion. Methods From January 2009 to June 2010, 39 patients [mean age (55 ±16) years] who had DeBakey Ⅰ aortic dissection underwent hybrid procedure without deep hypothermic circulatory arrest. The femoral artery and right axillary artery were cannulated for perfusion. The ascending aorta and/or aortic valves were replaced under conventional extracorporeal circulation with Bentall procedure or Wheat procedure. The aortic arch branch vessels were dissected and the proximal part was sealed. Then the ascending aorta-aortic arch branch vascular bypasses were constructed with 4-bifurcation vascular grafts, Y-shape bifurcated vascular grafts or artificial vessels. Finally the endovascular grafts were deployed via the femoral incisions monitored dynamically with DSA, or via the ascending aortic bifurcated vessels monitored with transesophageal echocardiography. Results The operation succeeded in all 39 patients. Eight patients underwent ascending aorta replacement without aortic valve replacement or prosthesis, 20 patients underwent Bentall procedure ( Carbrol procedure were used in 11 cases), and 11 underwent Wheat procedure. For ascending aorta-aortic branch vascular bypass reconstruction, sequential anastomoses were performed in 8, Y-shaped bifurcated grafts were used in 15, and 4-bifurcated grafts were employed in 16 patients. The endovascular stent grafts were deployed via the former femoral incisions in 36 patients and via ascending aortic bifurcated vessels in 3. The cardiopulmonary bypass time was (61 ±22) minutes, the aortic crossclamp time was (48 ±18) minutes, and the post-operative intubation time was (30 ±9) hours. The thoracic drainage from each patient was less than 300 ml in 24 hours. No complication, such as hemiplegia, paraplegia, severe infections, renal failure or coagulation disorder, was observed. The duration of hospitalization was (21 ±6) days. No hospital death occurred. Follow-up was performed 1 to 15 months [mean (8.4 ±7.2) months] postoperatively. All patients survived without any organ dysfunction at follow up. The CTA examination 3 months after operation revealed that the false lumens had been closed in 91.2% of the patients. Conclusion Our findings indicated that the hybrid procedure, which combining ascending aorta replacement,ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion under conventional extracorporeal circulation, may be an option for avoiding the possible complications associated with profound hypothermic circulatory arrest. The novel hybrid operation may improve the surgical outcomes and provide a simplified surgical approach for the treatment of DeBakey Ⅰ aortic dissection.

Objective: The present study aims to summarize the clinical experience in the surgical treatment of thoracic aortic dissecting aneurysm.Methods: We retrospectively analyzed the clinical data of 115 cases of thoracic aortic dissecting aneurysm treated by surgery from December 1995 to December 2006.Thirty-eight of them were DeBakey type I aortic dissection,18 type Ⅱ,and 59 type Ⅲ.Of the 38 DeBakey type I patients,30 underwent ascending aorta with total aortic arch replacement(2 cases of total thoracic aortic artificial vessel replacement,25 Wheat procedure and 3 aortic valvuloplasty) and the other 8 received ascending aorta with semi-aortic arch replacement.Of the 59 DeBakey type Ⅲ patients,36 underwent descending aortic aneurysm resection with artificial vessel replacement via left posterolateral thoracic incision by left heart bypass or aorta to artery bypass(using Cott tubes),while the other 23 received endovascular stent-graft exclusion in descending aorta via the femoral artery.Results: All the patients were successfully treated except 5 that died during the perioperative period.The survivors were followed up for 3-118 months,among whom 2 died long-term death after the operation and the others were living healthy.Conclusion: Surgical treatment improves the clinical outcome of thoracic aortic dissecting aneurysm.Bilateral perfusion via the carotid artery in aortic arch replacement has a definite cerebral protective effect.Surgical procedures can be simplified by using the modified elephant trunk technique.Endovascular stent-graft exclusion is safe and effective in the treatment of DeBakey type Ⅲ aortic dissection.

OBJECTIVE Congenital aural atresia repair is difficult owing to unpredictable anatomy. Benefits may be gained from image-guided surgery(IGS) . its exact role and surgery indication were def ined. METHODS From 2001 to 2004,36 ears with bony type C(Schuknecht classification) congenital atresia were performed. In the IGS group(n=18) ,repair surgery was performed with IGS,while in the control group(Non-IGS,n=18) ,similar intervention was applied without IGS. IGS group:aged from 12-29 years,follow-up from 6 months to 1 year. Non-IGS group:aged from 10-27 years,follow-up from 6 months to 3 years. Intra-and post-operative clinical and audiometric findings were compared. RESULTS All of the patients had congenital bony aural atresia,ossicles malformation,tympanic cavity hypoplasia and facial nerve malformation. IGS revealed a malformed horizontal semicircular canal hidden in the bony atresia plate during the operation while computed tomography(CT) did not show preoperatively. IGS computed tomography images correlated well with intra-operative findings,gave the surgeon more securityand reduced operative time(2 hours and 24 minutes) by 25 minutes. The prepare time increased 20 minutes(15-30 minutes) ,but total time decreased 5 minutes in IGS group. The registration accuracy was 0.6-1.3 mm,average 0.84 mm,which was suitable for the otologic surgery. There were 1 case in IGS group and 3 cases in Non-IGS group happened local aural restenosis after operation. But there were no facial nerve paralysis and hearing injury happened in both groups,and all of the patients got the satisfactory hearing after the hearing reconstruction(the air-bone gap with an average of IGS is 31.8dB,Non-IGS is 30.5dB) . CONCLUSION In our estimation,IGS is valuable for type C congenital aural atresia repair. It serves as an educational tool and a guide both for the experienced and inexperienced surgeons in critical situations where anatomical landmarks are distorted and approach is limited. There is no statistically significant between two groups on hearing improvement after operation.

The effects of nanometer realgar suspension on proliferation and apoptosis of human uterine cervix cancer cell line SiHa cells and oncogenic genes HPV16E6/E7 were investigated. A "micro-jet efflux" strategy was used for the preparation of nanometer realgar suspension. SiHa cells were treated with nanometer Realgar suspension in various concentrations (6.25,12.5,25 and 50mg/L) for different durations (12,24,48 and 72h). The inhibitive effect of nanometer realgar suspension on growth of SiHa cells was detected by MIT method. Special morphological changes of apoptosis were observed by transmission electron microscopy (TEM) and DNA fragments electrophoresis. The apoptotic rate was quantified by flow cytometry (FCM). The expression of HPV16E6/E7 mRNA and protein was assayed by RT-PCR and Western blot respectively. The results showed after being treated with 25-50mg/L nanometer realgar suspension for 48h, the survival rate of SiHa cells was decreased, and apoptotic rate markedly increased in a time- and concentration-dependent manner. TEM and DNA electrophoresis revealed the special morphological changes of apoptosis. The apoptotic rate of SiHa cells treated with nanometer realgar suspension was significantly higher than in the control group (P<0.01), and G0/G1 phase arrest appeared following treatment with nanometer realgar suspension in 25 and 50mg/L for 48h.RT-PCR and Western blot assay indicated that nanometer realgar suspension reduced the HPV16E6/E7 gene expression. Nanometer realgar suspension could inhibit the proliferation and induce apoptosis of SiHa cells. The mechanism may be related to the down-regulation of the HPV16E6/E7 gene expression.