Fast track surgery(FTS) can reduce the patients' surgery stress response, maintain the physiological state of the patients, decrease the risk of postoperative complications and then accelerate recovery after surgery.At present, the FTS protocol in laparoscopic radical gastrectomy for gastric cancer is still in a preliminary stage, and its safety and validity remains to be verified.This systemic and comprehensive review focused on the concept of rapid rehabilitation surgery, the program of perioperative treatment, the economic benefit and its future outlook.

Epidemiologic Methods ; Models, Statistical

Objective To estimate the expression of ER and PR in the endometrium of both intrauterine adhesions (IUA) and non-IUA specimens. Methods The endometrium specimens from patients undergoing hysteroscopy for confirmed moderate IUA (n=20: 10 in proliferative phase, and 10 in secretory phase) were enrolled as the IUA group in Beijing Obstetrics and Gynecology Hospital from October 2014 to August 2015. The specimens scheduled for hysteroscopy due to infertility were recruited into the control group (n=26: 13 in proliferative phase, and 13 in secretory phase). Immunohistochemistry and quantificational real-time PCR (qRT-PCR) were used to detect the expression of ER-α, ER-β and PR in endometrium with different menstrual period in both groups. Results (1) Location: in both groups, the expression of ER-α, ER-β and PR appeared in the endometrial glandular epithelial cells and the stromal cells of the endometrium. The positive brown granules of ER-α, ER-β and PR appeared mainly in cell nucleus. (2) ER-α and ER-β in the endometrium:the protein expression of ER-α and ER-β in IUA group (proliferative phase: 0.657 ± 0.028, 0.493 ± 0.023; secretory phase: 0.537 ± 0.020, 0.365 ± 0.031) were significantly higher than those of control group (proliferative phase: 0.586 ± 0.025, 0.437 ± 0.022; secretory phase:0.459 ± 0.025, 0.323 ± 0.017;all P<0.01). And the ER-αand ER-βmRNA expressions in IUA group were 2.524 ± 0.296, 1.947 ± 0.339, higher than those of control group in the proliferative phase (all P<0.01), and in the secretory phase (1.977±0.333, 1.345±0.292) were also higher than those in the control group (all P<0.01). (3) PR in the endometrium: the protein expression of PR was not significantly different between IUA group (proliferative phase:0.248±0.025, secretory phase:0.194±0.024) and control group (proliferative phase: 0.234 ± 0.019, secretory phase: 0.186 ± 0.020; P=0.162, 0.359). Meanwhile, there were no statistical differences in the mRNA expression of PR in both groups with different menstrual period (proliferative phase: 1.144 ± 0.384 versus 0.981 ± 0.306, secretory phase: 0.763 ± 0.237 versus 0.631 ± 0.203; P=0.270, 0.166). (4) ER and PR expression in menstrual cycles: the expression of ER-α, ER-β and PR in the IUA group changed with the menstrual cycles, and their expression in the proliferative phase were higher than those in the secretory phase (all P<0.05). Conclusions The expression of ER-α and ER-β in the endometrium of IUA patients changes with menstrual cycle, and are higher compared with those in normal endometrium. No difference is found in the PR expression between the two groups.

Objective: To identify corticotropin releasing hormone(CRH) positive cells from the human placenta. Methods: Using immunohistochemistry to show the cellular expression of placental CRH. Results: During human pregnancy, placental CRH level rose markedly from undetectable amounts prior to 20 weeks gestation to nearly the peak level. Conclusion: The presence of CRH in maternal plasma is attributed to the placental production and subsequent release of this hormone into the maternal circulation. [

The animal models for pharmacologic assessment of drugs against premature delivery arereviewed, which include the measure of spontaneous delivery time between the first and the second pups in term pregnancy rats, the delay in the onset of labor in rats and premature delivery artificially induced by lipopolysaccharide, interleukin 1 ? and prostaglandin F 2? in mice.

Objective To assess the safety of early subcutaneous injection of a low-dose low molecular weight heparin (LMWH) nadroparin for prevention of deep vein thrombosis (DVT) in patients with spontaneous intracerebral hemorrhage (sICH).Methods The patients with sICH who early using nadroparin or lower limb intermittent pneumatic compression (IPC) for prevention of DVT were enrolled.A nadroparin group continuously injected nadroparin 0.4 ml/d subcutaneously for 10 days at day 4 after admission and an IPC group used lower limb IPC.Head CT was reexamined and hematoma volume changes were evaluated at day 3,5,and 14 after admission.The hemorrhagic events during the course of treatment were documented,and the lower limb DVT was examined by color Doppler sonography.Results A total of 94 patients with acute sICH (n =41 in the nadroparin group,n =53 in the IPC group) who early use of nadroparin or IPC for prevention of DVT were enrolled.Fourteen patients had lower limb DVT,5 (12.2％) of them were in the nadroparin group and 9 (17.0％) of them were in the IPC group.However,there was no significant difference in the incidence of DVT between the two groups (x2 =0.418; P =0.518).During the treatment,no patient experienced increased intracranial hematoma and rebleeding.Conclusion Early subcutaneous injection of low-dose nadroparin for the prevention of DVT in patients with sICH is safe.

Purpose To investigate the expression and significance of ArhGAP29 and E-cadherin in endometrial tissue of intrauterine adhesions (IUAs) and to explore their roles in the pathogenesis of IUAs.Methods The expression of ArhGAP29 and E-cadherin was detected by immunohistochemical PV 9000 two-step method.The correlation between ArhGAP29 and E-cadherin expression and clinical features was analyzed.Results (1) The immunoreactive score (IRS) of ArhGAP29 and E-cadherin in normal endometrial tissue were higher than those in IUAs endometrial tissue (P =0.017,P =0.004).(2) IRS of ArhGAP 29 and E-cadherin in moderate IUAs patients were higher than that in severe IUAs patients (P =0.020,P =0.026).In IUAs patients without amenorrhea,the IRS of ArhGAP29 and Ecadherin were higher (P =0.019,P =0.031) than that in IUAs patients with amenorrhea.(3) The decrease of ArhGAP29 expression had a significantly parallel relationship with the negative expression of E-cadherin (r =0.725,P ＜ 0.001).Conclusion The expression of ArhGAP29 and E-cadherin decreases in endometrial tissue of IUAs patients,which is related with degree of IUAs severity.ArhGAP29 and E-cadherin may participate in the IUAs formation.

Objective Intrauterine adhesions cause serious damage to women′s reproductive health, to establish animal dis?ease mode, pure mechanical damage is the most similar cause to human pathogenesis, that is very necessary to conduct prospective studies. The study aimed to investigate the efficiency and significance of different mechanical damage methods to establish intrauterine adhesions model in rats. Methods 45 female SD rats were randomly( random number table) divided into three groups:pure scratch group (n=15), 2 mm diameter curet was used to scrape endometrial tissue; Incision?suture group (n=15), a longitudinal incision was made in the uterus, a blade was used to scrape endometrial tissue, the incision was then sutured with absorbable thread;Control group ( n=15) , sham operation, then the abdomen was closed after exposed to air for 20 minutes, the uterus were not injured. Endometri?al keratin immunohistochemical staining, Intrauterine AFS score, fi?brosis semi?quantitative score and pregnancy outcomes were observed to compare the injury of the two methods in establishing the model. Results ( 1) The degree of endometrial glandular epithelium keratin staining decreased significantly in both pure scratch and incision?su?ture groups compared to the control group. (2) AFS scores in pure scratch group and incision?suture group[3.0 (2.0-3.8), 5.0 (3.8-8.0)] were higher than control group[0 (0-0)], the difference was statistically significant (P<0.017); Incision?suture group was higher than pure scratch group, but the difference was not statistically significant(P>0.017). Endometrial fibrosis semi?quantitative scores in pure scratch group and incision?suture group[5.0 (4.0-5.3), 6.5 (5.8-8.0)] were higher than control group[0 (0-0)], the difference was statistically significant ( P<0.017);Incision?suture group was higher than pure scratch group, but the difference was not statistically significant (P>0.017). (3) Embryo number in pure scratch and incision?suture group side [0.5 (0-3.3), 0 (0-2.3)] was lower than the normal side [7.6 (6.8-8.0), 8.0 (7.8-9.0)],the difference was statistically significant (P<0.05) Conclusion Pure mechanical damage including pure scratch and incision?suture method to establish IUAs model were feasible. Both of the two methods could help to do research about pathogenesis and pathophysiological mechanisms of IUAs. Incision?suture method maybe can cause heavier fibrosis degree.

Objective To compare the clinical and radiological outcomes between hybrid and total pedicle screw instrumentation in adolescents undergone posterior spinal fusion (PSF) for thoracic scoliosis secondary to Chiari malformation..Methods A total of 75 patients undergone PSF were included and divided into two groups:the all pedicle screw group (Group A,n=44) and the hybrid group (Group B,n=31).Patients were evaluated before surgery,immediately after surgery,and at the 2-year follow-up in radiographic changes in curve magnitude,apical vertebral translation (AVT),apical vertebral rotation (AVR),trunk shift,thoracic kyphosis (TK),lumbar lordosis (LL),and sagittal vertical axis (SVA).These parameters were further analyzed with respect to preoperative TK in both groups.Results After surgery,the average correction of the thoracic curve was 60.2％ and 51.3％ in Group A and B,respectively (t=2.372,P=0.023).The average lumbar curve correction was 61.7％ in Group A,representing a significant increase compared to Group B (51.1％,t=2.431,P=0.020).At the final follow-up,loss of the thoracic curve correction was less in Group A (0.3％) than in Group B (1.7％),however,there was no statistical significance (t=-0.468,P＞0.05).AVT of the thoracic curve improved in Group A from 25.0 mm to 6.9 mm,while in Group B it changed from 24.1 mm to 7.4 mm.For patients with a preoperative TK greater than 40°,the proximal junctional angle was found to be significantly larger in Group A (10.0 degrees versus 4.5 degrees,t=-2.031,P=0.052) by the final follow-up,along with a significantly increased incidence of proximal junctional kyphosis (20％ versus 9％).Conclusion Total pedicle screw instrumentation provided a significantly better correction of the major and minor curves than hybrid constructs for the operative treatment of thoracic scoliosis secondary to Chiari malformation.However,for patients with thoracic hyperkyphosis,all-screw instrumentation had a higher risk of adjacent level proximal kyphosis.

Objective Toevaluatea modified Ziehl-Neelsen(Z-N) stain in the diagnosis of tuberculous meningitis. Methods Cerebrospinal fluid specimens from 35 patients were stained by using the modified Ziehl-Neelsen staining. Re-sults The positive rate was 94.29% in 35 patients with tuberculous meningitisand the intracellular acid-fast bacilli was detected in 53.40%of all specimens. One case was stained positive in 15 patients with non-tuberculous meningitis. Con-clusion The modified Ziehl-Neelsen stain not only significantly improves the detection rates of tuberculous meningitisbut alsois able to identify intracellular M.tuberculosisin cerebrospinal fluidspecimen.Thus, the modified Z-N stain can be a convenient tool for diagnosing tuberculous meningitis.