Vesicovaginal fistulas are the common complications of gynecologic and obstetric procedure,which could be repaired through vaginal approach (Laztko procedure) or abdominal approach (O'Conor procedure).However,the vaginal approach of vesicovaginal fistulas repair should be the preferred one,because the transvaginal repairs is mini-invasive and achieve comparable success rates compared to abdominal repairs.In addition,surgeon could transvaginal repair recurrent fistula easily.Now,most vesicovaginal fistulas are iatrogenic with sever scar tissue surrounding fistulous tract.Therefore,based on the previous experience of transvaginal operation,we recommend usingShen Modification of Laztko's Procedure to improve the success rate of first transvaginal repair.

New conception of first-aid in battlefield stress that medical service should be with wound soldiers. Moreover the primary principle is save and rescue lives. The traditional drugs and methods of resuscitation are approved and re-evaluated on their effect evidence based on clinical practice, such as the comparison between vasopressin and epinephrine on the effect of resuscitation, the elimination of lidocaine from preventive use in acute myocardial infarction, and the confirmation of amiodarone as the initial drug for the arrhythmic patients with heart failure and for the patients of cardiac arrest failed to be resuscitated with defibrillation and epinephrine. The traditional treatment of quick fluid replacement for hemorrhagic shock has been reassessed with the concept of limited fluid resuscitation. The application should be further evaluated of crystalloid, colloid or hypertonic saline in critical and trauma patients.

China ; Goiter, Endemic ; prevention & control ; Humans ; Iodine ; deficiency

OBJECTIVE To explore the role of Tn5281 in high-level gentamicin resistance(HLGR) of Enterococcus faecalis. METHODS Fifty four strains of HLGR E.faecalis were tested for Tn5281 by PCR method.The PCR products were confirmed by dot blot hybridization and sequencing.Filter mating method was used to investigate the conjugative plasmid transfer.Antimicrobial susceptibility test was performed by agar dilution method of CLSI/NCCLS. RESULTS Of 54 HLGR E.faecalis strains,27(50.0%) carried different types of Tn5281,with 6 strains carrying complete type,17 strains carrying truncated type Ⅰ(lacked IS256 in the right flanking extremity) and 4 strains carrying truncated type Ⅱ(lacked IS256 in the left flanking extremity).All types of transposons were loaded on plasmids. Among four HLGR E.faecalis in which Tn5281 was successfully transferred to recipient strains by filter mating method,one carried complete type and three carried truncated type Ⅰ.Tn5281 carrying strains had higher resistance rates to penicillin and ampicillin and lower resistance rates to tetracycline and chloramphenicol compared to the strains not carrying Tn5281.(CONCLUSIONS Tn5281) is commonly carried by HLGR E.faecalis.It may integrate into conjugative plasmids and play an important role in the dissemination of HLGR among E.faecalis.

Objective To determine the sensitization of Nicotinamide (NA) on None Focused Ultrasound (NFU) on GLC-82 cells in vitro. Methods The subjectives were divided into A、B、C and D four groups, group A was negative control, group B was treated with NA, group C was irradiated with NFU, group D was treated with both NFU and NA; MTT assay was used to evaluate the cytotoxicity of NA and its sensitivity for NFU on GLC-82 cells quantified by calculating the sensitive enhancement ratios (SER); Morphologic change of cells was observed with light microscope, fluorescence microscope and scanning electron microscope;Flow cytometry was performed to determine the percentage changes of apoptosis and distributional percentage of the cell cycle of GLC-82 cells in response to NFU, NA and the effect of its intervention to NFU. Results The cytotoxicity of NA increased in a dose-dependent manner after 24-hour treatment, with the optimal dose range of 1 mg/mL～5 mg/mL. A sub-toxic dose of NA at 3 mg/ml was used in the subsequent experiments; After treatment with NA plus NFU, microvilli and filipodium of GLC-82 cells reduced, shortened and shrunk into corpuscule-shape; The apoptosis rate of group D was more than that in group B and C, with cell cycle arrested at phase S and G2.Conclusion NA can significantly enhance the effect of NFU on GLC-82 cells, which provides evidence for NA as a sensitization to NFU in clinic.

Objective To determine CD+4CDnull28 T cells and their relationship with the microinflammatory state and left ventricular hypertrophy in end-stage renal disease (ESRD) patients.Methods One hundred and twenty ESRD patients were selected,including sixty non-dialytic stage 5 chronic kidney disease patients(CKD5 stage) and thirty maintenance dialysis patients(CKD5D stage).In addition,thirty healthy adults from the hospital medical center were selected as the control group.Flow cytometry was used to detect the frequencies of T lymphocyte subsets in peripheral blood.All enrolled subjects underwent Doppler echocardiography investigations.Results(1)Compared with the control group,the high sensitivity C-reactive protein and the frequency of CD+4CDnull28 T cells were significantly expanded in CKD5 and CKD5D paients (F=14.887,9.659,all P<0.05).(2)In ninety ESRD patients,the incidence of LVH increased in CKD5 and CKD5D patients (76.67% vs.86.67%).(3)Linear correlation in CKD5 patients showed that:LVMI was positively correlated to duration of hypertension,SBP,P3+,lg(CRP+1),lgiPTH,lg(CD+4CDnull28+1) (r=0.332,0.291,0.269,0.310,0.304,0.396,all P<0.05),as well as negatively correlated to Hb(r=-0.285,P<0.05).Multiple linear regression analysis showed that LVMI was independently associated with lg(CD+4CDnull28+1) and duration of hypertension(F=6.589,P<0.000).ConclusionThere is microinflammatory state in the ESRD patients regardless of whether or not they have dialysis treatment,and they have the high incidence of LVH and exhibit a substantially increased frequency of circulating CD+4CDnull28 T cells.The frequency of CD+4CDnull28 T cells and duration of hypertension are the independent predictors of LVH in non-dialytic stage 5 CKD patients,indicates that these cells may play a critical role in the development of cardiovascular disease.

AlM:To explore the efficacy and safety of mitomycin C used in trabeculectomy by analyzing intraocular pressure and blood flow.METHODS:A total of 103 patients with glaucoma were divided into 2 groups randomly, and all patients were treated with trabeculectomy, while patients in the observation group were given mitomycin C extra. At 6~12mo follow-up were completed after operation, and the clinical efficacy, complications and hemodynamic characteristics of central retinal artery were compared between groups.RESULTS: The clinical efficacy of the observation group was higher than that of the controls (P<0. 05). There was no significant difference in complication rate between groups (P>0. 05), but the complication type was differentiate to some extent. Low intraocular pressure and photophobia symptoms occurred mostly in the observation group, while cicatricial obstruction occurred mostly in the controls. Before treatment, there was no significant difference in hemodynamic characteristics between groups (P>0. 05). One month after treatment, the peak systolic velocity ( PSV) and end diastolic velocity ( EDV ) of the observation group were obviously lower, while resistance index ( Rl ) and pulsatility index ( Pl ) were higher than those of the controls, the difference was statistically significant ( P<0. 05). Six months after treatment, the PSV and EDV of the observation group were obviously higher, while Rl and Pl were lower than those of the controls, the difference was statistically significant (P<0. 05).CONCLUSlON:Mitomycin C has a short-term harmful effect on glaucoma patients after trabeculectomy, but its long-term effect is safe and reliable.

Objective]To summarize professor SHEN Hong’s clinical experience in treating ulcerative colitis with enema prescription.[Method] By following the teacher clinic and sorting out the related cases, the author summarizes professor SHEN Hong’s academic experience of treatment of ulcerative colitis with enema prescription, and for proven cases. [Result]On the base of disease stage, Professor SHEN Hong uses the advantages of external therapy of Chinese medicine, and combines the syndrome differentiation and disease differentiation by the reference to the treatment of abscess,carbuncle. On the acute stage, he uses the elimination method to relieve heat and toxic material, cool blood and eliminate carbuncle. On the remission stage, he uses reinforcing method to support sore and drainage of pus and heal wound and promote tissue regeneration in case of recrudescence. Meantime, he focuses on the different locations of lesions by reasonable enema ways. The medication he uses is concise and the prescription changes flexibly with permitted addition and subtraction. The clinical curative effect is satisfactory. [Conclusion] Professor SHEN Hong’s experience is effective and worthy of inheritance and promotion.

Objective To research the efficacy of different dose botulinum toxin A in the treatment of patients with neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis.Methods The datas of 43 patients with neurogenic detrusor overactivity caused by spinal cord injury or multiple sclerosis which accepted treatment in our hostipal were analyzed.And 38 patients were followed up for 12 weeks,of which 20 cases were treated with 200 U botulinum toxin A,and 18 cases received 100 U botulinum toxin A.The average age of 38 patients was 45.3 years old,and the ratio of famale was higher.The incontinence quality of life(I-QOL)changed from baselin after 6 weeks and 12 weeks was recorded.Resluts The final outcomes showed that the efficacy of botulinum toxin A with 200U was better than that with 100 U according to I-QOL score,and the difference was statistical significance(P <0.05).Conclusion The botulinum toxin A has positive effect on neurogenic detrusor overactivity,and the efficacy of 200 U injection is better than that of 100 U.