Objective To explore the relationship among the changes of five coagulation indexes and clinical stage,metastasis in pre-operative patients with gastric carcinoma,and to investigate the coagulation in patients with different clinical stages and its clinical significance.Methods Eight hundred and sixty-eight gastric carcinoma patients( carcinoma group) who were firstly diagnosed and 213 patients ( control group) who were diagnosed as inguinal hernia in the same hospital during the same period were enrolled.Levels of rothrombin time (PT),activated partial thromboplastin rime (APTT),fibrinogen (FBG),plasma thrombin time (TT) and platelet count (PLT)were observed and compared in these two groups.Results (1)Compared with health control group,PT( [ 11.51 ± 1.21 ] s vs [ 11.27 ± 0.91 ] s,t =- 3.226,P ＜ 0.01 ),FBG( [ 3010.0 ±470.4] mg/L vs [ 2307.1 ± 651.8 ] mg/L,t =- 4.240,P ＜ 0.01 ) and PLT ( 238.57 ± 78.50 ) x 109/L vs (206.79 ±61.01 ) x 109/L,t =-5.514,P ＜0.01 )were significantly increased in gastric carcinoma group.(2)PT,FBG and PLT were significantly different between control group and different clinical stages of gastric carcinoma group ( P ＜ 0.05 or P ＜ 0.01 ).The levels of APTF,TT exhibited no significant difference between control group and different clinical stages of gastric carcinoma group ( P ＞ 0.05 ).( 3 ) Compared with gastric carcinoma without metastasis group,preoperative blood PT extended significantly ([ 11.41 ± 0.99] s vs [ 11.57 ± 1.32 ]s,t =- 2.095,P ＜ 0.05 ),FBG concentration increased significantly ( [ 2639.1 ± 748.6 ] mg/Lvs [ 3233.2 ± 591.60 ] mg/L,t =- 2.307,P ＜ 0.05 ) and PLT count increased significantly ( [ 224.02 ±76.94] x 109/L vs [ 247.32 ± 78.37 ] x 109/L,t =- 4.299,P ＜ 0.01 ) in gastric carcinoma with metastasis group.(4) Correlation analysis on four coagulation and PLT count with clinical stage:PT ( r =0.071,P ＜ 0.05 ),FBG ( r =0.271,P ＜ 0.01 ) and PLT( r =0.166,P ＜ 0.01 ) were positively correlated with clinical stage of gastric carcinoma and TT( r =- 0.077,P ＜ 0.05 ) was negatively correlated with clinical stage,among the total,the correlation coefficient of FBS with clinical stage was maximum.Conclusion Most patients with gastric cancer present state of blood coagulation and bleeding tendency,particularly in advanced gastric cancer,and with increased clinical stage of gastric cancer,some coagulation indicators showing a rising trend.Detection of coagulation index indirectly indicates the incidence,invasion and metastasis of gastric carcinoma.

Objective To explore the relationship between placental thickness,MRI signs and postpartum hemorrhage in placenta accreta(PA)patients.Methods 28 PA patients with postpartum hemorrhage and 3 9 PA patients without postpartum hemorrhage were analyzed retrospectively.We compared the clinical features and MRI signs between the two groups,and analyzed the correlation between placental thickness and PA related postpartum hemorrhage.Results The mean placental thickness was significantly higher in the hemorrhage patients (62.04±13.826)mm than that in the patients without hemorrhage (39.72±11.362)mm.Among the clinical features, there were no correlations between age,previous intrauterine operation history,previous cesarean section history and occurrence of the PA related postpartum hemorrhage.The following MRI signs were related to the occurrence of the PA related postpartum hemorrhage,including placenta previa,local bulging of the uterine,heterogeneous signal intensity in the placenta,intraplacental hypointensity bands,intraplacental abnormal vascularity,scar covered by placenta,abnormal signal intensity around the cervix,thinning of myometrium.Conclusion Measurement of placental thickness by MRI combined with placenta previa,local bulging of the uterine,heterogeneous signal intensity in the placenta,intraplacental hypointensity bands,intraplacental abnormal vascularity,scar covered by placenta,heterogeneous signal intensity around the cervix, thinning of myometrium are valuable in predicting PA related postpartum hemorrhage.

Objective To observe the clinical effects of magnified pedicle subtraction osteotomy (mPSO) via the posterior approach combined with biomimetic bone graft fusion and internal fixation for the treatment of thoracolumbar Kummell's disease and kyphosis.Methods A total of 11 patients with thoracolumbar Kummell's disease and kyphosis deformity were treated at our department from March 2012 to June 2016.They all underwent mPSO via the posterior approach combined with biomimetic bone graft fusion and internal fixation.They were 3 men and 8 women with an average age of 61.2 years.The clinical effects were evaluated according to visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) scoring,American Spinal Injury Association (ASIA) grading,cobb angle correction and rate of bone graft fusion at preoperation and 2 weeks,1,3,6 and 12 months after operation.Results All the patients were followed up for an average of 11.4 months (from 10 to 13 months).The VAS scores (2.1 ±0.5 points and 1.1 ±0.2 points),JOA scores (23.6 ±3.8 points and 25.5 ±3.2 points) and cobb angles (8.1°± 1.5° and 13.8°±2.1°) at 2 weeks after operation and final follow-ups were significantly improved from their preoperative values (8.1 ± 0.6 points,12.1 ± 3.6 points and 51.3° ± 9.8°,respectively) (P ＜ 0.05).However,there were no significant differences between 2 weeks after operation and the final follow-up in terms of the above values (P ＞ 0.05).The ASIA grading was improved from preoperative grade C to postoperative grade D in one case,and from preoperative grade D to postoperative grade E in 3 cases.At final follow-ups,bony fusion was observed at all the bone graft sites,with a fusion rate of 100％.Conclusion mPSO via the posterior approach combined with biomimetic bone graft fusion and internal fixation is a good treatment for patients with thoracolumbar Kummell's disease and kyphosis deformity.

Objective To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK) .Methods Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018 .During a follow-up period of 6 to 29 months ,we summarized the efficacy and complications of the technique .Results Up to now ,38 patients achieved an exceelent clinical efficacy with no major surgical complications .However ,two patients died of severe pneumonia .The postoperative serum levels of creatinine at 3 ,6 ,12 ,24 months were 107 ,102 ,107 ,110 umol/L ;creatinine clearance rate 64 ,67 ,64 ,63 ml/min;fasting glucose 4 .6 ,5 .1 ,4 .6 ,5 .2 mmol/L ;glycated hemoglobin 4 .8％ , 5 .4％ ,4 .9％ ,5 .2％ respectively .And 1/2-year pancrea and kidney graft survival rates both were 92％ . Complications included kidney graft rejection (n= 11) ,pancreas graft rejection (n= 12) ,simultaneous renal & pancreas graft rejection (n=6) ,renal graft DGF (n=1) ,pulmonary infection (n=14) ,urinary tract infections (n=18) ,gastrointestinal bleeding (n=10) diarrhea (n=6) ,splenic venous thrombosis (n=2) ,incomplete ureteric obstruction of renal allograft (n=3) ,urine leakage (n=1) and pancreas allograft dysfunction (n= 2) .There were no severe surgical complications .After aggressive interventions ,all postoperative complications were cured and none required excision of kidney or pancreas .Conclusions Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization .

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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