Objective To compare the efficacy and complications of the two surgical methods (between type Ⅰ hysterectomy and type Ⅱ hysterectomy),and to explore the feasibility of type Ⅰ hysterectomy in stage ⅠA cervical cancer.Methods The study group,92 cases(48 cases of stage ⅠA1,44 cases of stage ⅠA2) were performed with type Ⅰ hysterectomy plus selective pelvic lymph node dissection;the control group,93 cases (49 cases of stage ⅠA1,44 cases of ⅠA2) were performed with type Ⅱ hysterectomy plus selective pelvic lymph node dissection.Results The survival rate of 5 years and 10 years in study group were 100 ％ (92/92),100 ％ (74/74) and that in control group were 100 ％ (93/93),100 ％(66/66),respectively.There were no signicant difference between the two group (both P ＞ 0.05).When compared with the control group,the urinary tract infection of the study group was significantly reduced (0 versus 13.99 ％,P ＜ 0.05).Moreover,there were a shorter surgical duration [(96.14±17.20) min vs (116.82±16.30) min].The hemorrhage [(117.35±39.61) ml] and blood transfusion (0 ml) in study group was less common than those in control group [(201.74±46.25) ml,(82.07±16.32) ml] (all P ＜ 0.01).Conclusion There are no difference of 5-year and l0-year survival rate in stage ⅠA patients with type Ⅰ or type Ⅱ hysterectomy,however,the rate of the postoperative urinary tract infection in the former is lower than that in the latter,and also there are a shorter surgical duration,less hemorrhage and reduced blood transfusion requirements in study group.Therefore,type Ⅰ hysterectomy can be effective and applicable for the patients of stage ⅠA cervical cancer.

Objective To explore the surgical extent and to improve the surgical techniques of the Piver class Ⅲ hysterectomy on invasivc cervical cancer,so as to reduce the urinary tract complications,shorten the surgical duration,decrease the hemorrhage and blood transfusion.Methods The study group,196 cases with stages Ⅰ b and Ⅱ a carcinoma of the cervix underwent the modified Piver class Ⅲ hysterectomy from June 2000 to May 2005.The control group,176 cases of the same stages underwent the Pivet class Ⅲ hysterectomy between June 1994 and May 1999.The modified Piver class Ⅲ hysterectomy mainly include the surgical extent and some surgical techniques as follows.The cervicovesical and vesicovaginal space are separated with assistance of electrotome.Half of the uterosacral ligaments are removed with electrotome.The tunnel of the ureters is separated and penetrated or not. The anterior leaf of the cervicovesical ligaments is removed and the uterine artery are removed at the same time.while the ureter branch from the uterine artery are preserved.When the ureters aIe drawn to the lateral side of the body with an "S" hook and the urocyst lateral recessus are expanded.the cardinal ligaments can be exposed and be removed of 3/4.But part of the inferior of these ligaments should be preserved.The paracolpium are resected about 2 cm.2-3 cm tissue of the vagina is removed.Results Compare with the control group,the urinary tract complications of the study group were significantly reduced(51.1%versus 23.0%,P<0.01).There were a shorter surgical duration[(132±20)min],less of the hemorrhage[(322±100) ml]and blood transfusion[(154±79)ml] in the study group than those in the control group(all P<0.05).While,there was no significant difference at the survival rates of 5 years between the two groups (87.8% versus 88.6%.P=0.793).Conclusion The modified Piver class Ⅲ hysterectomy is effective and applicable for patients with cervical cancer.

BACKGROUND: Bone defect difficult to manage clinically and it is a big challenge to repair it. Secondary metabolites source from herb has shown potential for the treatment of bone defect. METHODS: Mesenchymal stem cells (MSCs) were isolated from mice and incubated with urolithin A (UA) (10, 25, and 50 lg/mL). 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was performed to estimate apoptosis and mineralisation was evaluated by alkaline phosphatase assay and alizarin red S staining. A middle femoral defect was induced in mice and bone tissue was prepared for endochondral ossification by treating with UA. The effect of UA was estimated by determining markers of osteoblast proliferation in serum and micro-computed tomography to analyse bone defects. RESULTS: UA enhanced mineralisation of MSCs and osteogenic gene markers in MSCs in vitro. Also, the bone defect score and bone mineral density were improved by UA. Moreover, UA ameliorated the altered Wnt3a protein and histopathological changes in bone defect mice. CONCLUSION Presented report conclude that UA enhances osteoblast proliferation in bone-defect mice by activating the Wnt pathway.

As China has not yet established a sound regional trauma treatment system and standardized trauma centers at all levels, the trauma treatment capability in China is poorer than that in the developed countries. At present, Shaanxi Province has not established a regional trauma treatment system and standardized trauma centers at all levels. Based on the analysis of the characteristics of geography, population and social environment in Shaanxi Province, the authors explore the concept of the trauma treatment system and the construction of trauma centers at all levels in Shaanxi Province on the platform of the trauma center of Shaanxi People's Hospital ( Grade I trauma center) . The authors clarify the respective hardware facilities, team structure, treatment process and quality control goals, training and management system of professional trauma teams in trauma centers at all levels, so as to provide reference for improving the overall level of trauma treatment in Shaanxi Province.

Objective:To investigate the thyroid function changes and clinical significance after acute traumatic and infectious abdominal surgery.Methods:The clinical data of patients admitted to the intensive care unit (ICU) for acute traumatic and infectious abdominal surgery during the period from January 1, 2012 to December 31, 2021 in the First Medical Center of People′s Liberation Army General Hospital were retrospectively analyzed using retrospective case-control study. Eligible cases were obtained according to the inclusion and exclusion criteria, and an observation group was set ( n=65). According to the factors such as gender, age, body mass index, and surgical site (organ), a 1∶1 propensity score matching method was used to match the same number of non-traumatic non-infectious abdominal surgery patients admitted in the same time interval, and they were set as the control group ( n=65). The preoperative white blood cells, neutrophils, interleukin -6, c-reactive protein, and procalcitonin were collected, and the thyroid function index for the first time after operation was calculated. The incidence of postoperative thyroid dysfunction was calculated. The thyroid function changes of patients with thyroid dysfunction after exogenous thyroid hormone replacement therapy and the effects on complications and mortality within 30 days were observed. Measurement data of normal distribution were expressed as mean standard deviation( ± s), and t-test was used for comparison between groups. Enumeration data were compared between groups using chi-square test. Results:In the observation group, there were 50 patients with thyroid dysfunction (76.9%). After a 1∶1 match, the baseline of the observation group and the control group was level and comparable. The preoperative inflammatory indexes such as leukocyte, neutrophil ratio, interleukin -6, C-reactive protein and procalcitonin in the observation group were (23.7±5.7)×10 12/L, 0.86±0.13, (66.7±16.3) ng/L, (365.8±77.9) mg/L and (17.9±3.5) μg/L, respectively. Those in the control group were (12.3±2.7)×10 12/L, 0.71±0.04, (8.5±4.7) ng/L, (14.3±6.5) mg/L and (1.3±0.6) μg/L, respectively. The elevations in the observation group were different from those in the control group( P<0.05). In the first postoperative thyroid function test, T3 and FT3 in the observation group were (1.07±0.54) nmol/L and (2.23±1.02) pmol/L, respectively, and those in the control group were (1.61±0.34) nmol/L and (4.36±1.25) pmol/L, respectively. These values in the observation group were significantly lower than those in the control group( P<0.05). On the 10th day after surgery, T3 and FT3 levels in the exogenous thyroid supplementation group rapidly increased and gradually returned to the normal level. In addition, the total hospitalization time of patients in the observation group was significantly shortened, and the incidence and mortality of postoperative complications were reduced. The results in the observation group were (13.47±4.66) d, 17.6% and 11.8%, respectively. The corresponding results in the control group were (16.33±5.18) d, 36.4% and 21.2%, respectively. The difference between the two groups was statistically significant( P<0.05). Conclusion:The incidence of thyroid dysfunction after acute traumatic and infectious abdominal surgery is high, and exogenous thyroxine supplementation can improve the outcome of patients.

To dynamically investigate the distribution and antimicrobial resistance profiles of bacteremia pathogens isolated from different regions in China in 2011, 2013 and 2016. Non-repetitive isolates from nosocomial bloodstream infections were retrospectively collected and detected for antimicrobial susceptibility tests (AST) by agar dilution or microbroth dilution methods. Whonet 5.6 was used to analyze the AST data. Among 2 248 isolates, 1 657 (73.7%) were Gram-negative bacilli and 591 (26.3%) were Gram-positive cocci. The top five bacteremia pathogens were as follows, Escherichia coli (32.6%, 733/2 248), Klebsiella pneumoniae (14.5%, 327/2 248), Staphylococcus aureus (10.0%, 225/2 248), Acinetobacter baumannii (8.7%, 196/2 248) and Pseudomonas aeruginosa (6.2%, 140/2 248). Colistin (96.5%, 1 525/1 581, excluding innate resistant organisms), tigecycline (95.6%, 1 375/1 438, excluding innate resistant organisms), ceftazidine/clavulanate acid (89.2%, 1 112 /1 246), amikacin (86.4%, 1 382/1 599) and meropenem (85.7%, 1 376/1 605) showed relatively high susceptibility against Gram-negative bacilli. While tigecycline, teicoplanin and daptomycin (the susceptibility rates were 100.0%), vancomycin and linezolid (the susceptibility rates were 99.7%) demonstrated high susceptibility against Gram-positive cocci. The prevalence of extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriaceae were 50.6% (206/407), 49.8% (136/273) and 38.9% (167/429) in 2011, 2013 and 2016 respectively; carbapenem-non-susceptible Enterobacteriaceae were 2.2% (9/408), 4.0% (16/402) and 3.9% (17/439) in 2011, 2013 and 2016 respectively; The prevalence of multidrug-resistant A. baumannii (MDRA) was 76.4% (55/72) in 2011, 82.7% (43/52) in 2013 and 87.5% (63/72) in 2016, respectively. The prevalence of multidrug-resistant P. aeruginosa (MDRP) was 9.8% (5/51) in 2011, 20.0% (7/35) in 2013 and 13.0% (7/54) in 2016, respectively. The prevalence of methicillin-resistant S. aureus (MRSA) was 51.9% (41/79) in 2011, 29.7% (19/64) in 2013 and 31.7% (26/82) in 2016, respectively. The prevalence of high level gentamicin resistance (HLGR) of Enterococcus faecium and Enterococcus faecalis were 43.2% (48/111) and 40.9% (27/66), respectively. The predominant organism of carbapenem-non-susceptible Enterobacteriaceae was K. pneumoniae with its proportion of 57.1% (24/42). Among 30 tigecycline-non-susceptible Enterobacteriaceae, K. pneumoniae was the most popular organism with 76.7% (23/30). Among 39 colistin-resistant Enterobacteriaceae, E. coli, Enterobacter cloacae and K. pneumoniae were constituted with the percent of 43.6 (17/39), 35.9 (14/39) and 15.4 (6/39), respectively. The Gram-negative bacilli (E. coli and K. pneumoniae were the major organisms) were the major pathogens of nosocomial bacteremia, to which tigecycline, colistin and carbapenems kept with highly in vitro susceptibility. Whereas, among the Gram-positive cocci, S. aureus was the top 1 isolated organism, followed by E. faecium, to which tigecycline, daptomycin, linezolid, vancomycin and teicoplanin kept with highly in vitro susceptibility. Isolation of colistin-resistant Enterobacteriaceae, tigecycline-non-susceptible Enterobacteriaceae, linezolid- or vancomycin-non-susceptible Gram-positive cocci suggests more attention should be paid to these resistant organisms and dynamic surveillance was essential.