Objective To calculate the volume and to study the correlated risk factors of hidden blood loss after artificial hip or knee joint replacement. Methods From July to November in 2008, 38patients with age of (65.11±13.51) years old were treated with artificial hip or knee joint replacement, and were divided by age into four groups. Using Gross formula, total blood loss was calculated depending on height, weight and pre- and post-operation hematocrit, and the hidden blood loss was acquired by subtracting the visible blood loss from the total blood loss. The correlation between age,body mass index( BMI),gender and hidden blood blood loss was observed. Differences of hidden blood loss of artificial hip or knee joint replacement were compared. Results The total blood loss of all arthroplasties was ( 1563.52 ± 693.10) ml,and the hidden blood loss was (538.70 ± 529.77) ml,the percentage of hidden blood loss was 33%. The hidden blood loss was inversely related to age (P＜ 0.05 ). There was no correlation between BMI and hidden blood loss (P＞0.05). The percentage of hidden blood loss in total blood loss in woman was significantly higher than that in man. With age and gender paired, the percentage of hidden blood loss in total blood loss in artificial hip joint replacement was significantly higher than that in artificial knee joint replacement (P＜0.05 ). Conclusions Both of age and gender are risk factors influencing hidden blood loss after artificial hip or knee joint replacement. And compared with artificial knee joint replacement, the percentage of hidden blood loss in artificial hip joint replacement is higher.

To meet the need of cultivating the high-quality medical personnel,we have ad-justed and reformed the content of the "Clerkship" teaching in obstetrics and gynecology and conducted the survey and research among teaching philosophy,training mode and management mechanism,and have obtained more satisfactory teaching result.

Clinical practice was an important part in the medical education.To improve the clinical education quality of obstetrics and gynecology,several methods were chosen to settle the problems such as setting up and perfecting the management mechanism,strengthening the construction of teachers and the cultivation of students’overall quality.

Objective To evaluate the efficacy in treatment with transurethral electrocision for prostatic cyst.Methods A total clinical documents of 15 cases prostatic cyst treated with transurethral electrocision were analyzed retrospectively.All the cases were diagnosed confirmly by ultrasonography and CT,all the cysts closed to the prostatic urethra or intrude urinary bladder and all the patients underwent transurethral electrocision.Results All operations were performed successfully with operative time of 18-60 (36 ± 13) min.No blood transfusion during and after the operation and postoperative hospital stay was (5.2 ± 2.6) d.All the patients had been followed up for 6-24 months,the clinic symptom disappeared and no complications happened.Three months after the operation,IPSS decreased from (27.2 ±5.6) scores to (7.5 ± 1.6) scores and QOL decreased from (4.5 ± 1.1 ) scores to ( 1.6 ± 0.6) scores (P＜ 0.01 ),respectively.Qmax increased from (6.8 ±2.3) ml/s to (22.4 ±4.8) ml/s (P ＜0.01).Conclusion Transurethral electrocision is an effective therapeutic measure of prostatic cyst close to the prostatic urethra or intrude urinary bladder without so many complications.

Medicine is a practical subject,which requires medical students to deepen and expand the understanding of the theory by clinical training,and establish clinical thinking.In our noviciate reform of obstetrics and gynecology,we have established the new problem-based teaching mode,which is an effective method in fostering the ability of information collection,innovation and practice,and have obtained more satisfactory results.

ObjectiveTo observe the effects of sodium ozagrel on nail microcirculation and hemorrheology in patients with myocardial infarction (MI).Methods128 MI cases were randomly divided into the treatment group (group A, n=68) and control group (group B, n=60). On the base routine treatment, patients of group A were treated with sodium ozagrel (80～160 mg/d) and those of group B were treated with glucose-insulin-potassium solution (250～500 ml/d). The changes of nail microcirculation and hemorrheology were measured in pre-treatment and post-treatment.ResultsThe nail microcirculation and hemorrheology in group A were significantly better than group B (P<0.01).ConclusionSodium ozagrel can markedly improve nail microcirculation and hemorrheology in patients with MI.

Objective: To compare the safety between cervical conization (CC) alone and hysterectomy for patients with adenocarcinoma in situ (AIS) of the cervix. Methods: Patients diagnosed with AIS after CC during 2007–2021 were identified by computerized databases at Women’s Hospital of Zhejiang University School of Medicine. A total of 453 AIS patients were divided into 2 groups according to uterus preservation: hysterectomy group (n=300) and CC(s) alone group (n=153). The prevalence of residual disease and disease recurrence was compared between patients treated by CC(s) alone and hysterectomy. The prevalence of residual disease in specimens from women who had a hysterectomy and repeat CC were compared between positive and negative margins of CC. The factors influencing residual disease and disease recurrence were assessed. Results: Among 310 specimens from women who had a hysterectomy or repeat CC, the prevalence of residual disease was 50.6% (45/89) for a positive margin and 2.3% (5/221) for a negative margin (p=0.000). Four patients had recurrence of vaginal intraepithelial neoplasia in those treated by hysterectomy and one had recurrence of cervical squamous intraepithelial neoplasia in those treated by CC(s) alone. The prevalence of recurrence was 0.7% (1/153) for CC(s) alone and 1.3% (4/300) for hysterectomy (p=0.431). Hysterectomy did not influence residual disease or disease recurrence. Conclusion CC is an efficacious and safe option for patients with AIS of the cervix provided the margin is negative.

Background: The use of molecular categorisation is shifting paradigm towards the use of molecular information to refine risk stratification in endometrial cancer (EC). To date, evidence to support molecular-guided therapies is limited to retrospective studies and secondary molecular analyses of patients receiving standard treatment. The PROBEAT study is the first randomized phase III trial to evaluate tailored adjuvant treatment based on WHO-endorsed molecular classification in Chinese EC patients. It is expected to provide a clinical decision-making tool for adjuvant treatment of patients with high-intermediate risk (HIR) or intermediate risk (IR) EC to better optimise and personalise patient care and increase relapse-free survival. Methods The PROBEAT trial is a prospective, multicentre study led by Women’s Hospital of Zhejiang University Gynaecologic Oncology Group. Recruitment started on January 24, 2022, and 590 patients with HIR or IR endometrioid EC are expected to be recruited from 13 clinical centres in China. All tumor tissues will be classified into four molecular subtypes (POLEmut, MMRd, p53abn, or NSMP) based on WHO-endorsed molecular classification. Patients will be randomly assigned at a 2:1 ratio to either experimental arm and will receive molecular profile-based adjuvant treatment (observation in the POLEmut subgroup, vaginal brachytherapy in the MMRd or NSMP subgroup, or chemoradiotherapy in the p53abn subgroup) or to standard arm and will receive preferred adjuvant radiotherapy as recommended by the recent National Comprehensive Cancer Network guidelines version 1 (2022). The primary outcome is 3-year rates of recurrence. Secondary outcomes are relapse-free survival, overall survival, adverse events and health-related cancer-specific quality of life.

Objective The aim of this study was to investigate the aquaporin-4(AQP4) expression in the ischemic penumbra tissues.Methods Thirty-six Wistar rats were divided into 7 groups randomly, including control group(n=6) and occluded groups(n=30). The occluded groups were studied after the right middle cerebral artery of the rats unilaterally occluded(MCAO) at an interval of 15 min, 30 min, 1 h, 3 h, 6 h and 24 h, respectively(n=5 for each group). The operation process of the control group was the same as the occluded group except occluded MCAO. Then all rats were imaged with T_1WI, T_2WI and diffusion weighted-imaging(DWI). The brain tissue, according to the method by LIU Meili reported, was regarded as the area of the graphic penumbra. The relative apparent diffusion coefficient of the graphic-penumbra (rADC_1) and the center infarction(rADC_2)(ratios between the values of the occluded side and the opposite side) were calculated. The animals were sacrificed and perfused with the mixture solution consisting of TTC at different time intervals. The graphic-penumbra of the biggest layer of the ischemic cerebral tissue which corresponded to the DWI was examined with immunohistochemistry and RT-PCR. Meanwhile, histologic examination was performed at same site of the lesion. Results There were no significant changes on MRI, the relative apparent diffusion coefficient and the expression of the AQP4. The abnormal high intensity was found on DWI at 15 min after MCAO. T_2WI detected the lesion at 1 h after MCAO. The value of the rADC_1 decreased within 24 h after MCAO in ischemic penumbra, especially, it descended quickly within 1 h after MCAO, from(70.4?6.9)% at 15 min to(53.5?10.9)% at 1 h. Whereas, in the infarct tissue, the changes of the rADC_2 had a rule of decrease from(71.5?6.6)% at 15 min to(45.7?10.5)% at 3 h at first time, and then follow an increasing up to(78.7?11.5)% at 24 h after MCAO. The expression of AQP4 increased gradually within 24 h after MCAO, from 0.42?0.05 at 15 min to 1.18?0.12 at 24 h, it showed negative relationship with the rADC_1 in the ischemic penumbra (r= -0.966,P

Objective To explore the effect of first-line anti-tuberculosis treatment on vitamin D level in patients with pulmonary tuberculosis,and to master the changes of vitamin D level in the course of treatment,so as to provide a scientific basis for tuberculosis and nutrition health education in Shenzhen.Methods A total of 100 patients diagnosed as smear-positive pulmonary tuberculosis and receiving initial treatment in 2016 were enrolled and all the patients were treated with the standardized short-course chemotherapy regimens.The blood samples were extracted before treatment and at the ends of intensive and continuation phase.The 25-hydroxyvitamin D [25-(OH) D] concentrations were determined by chemiluminescence (CLIA) at each time point.The change of 25-(OH) D concentrations during anti-tuberculosis treatment was analyzed and the differences of vitamin D levels between different time points were identified.Results 79 (79.0％),94 (94.0％) and 96 (96.0％) patients were found vitamin D deficiency before treatment and at the end of the intensive and continuation phases respectively,which showed an upward trend (x2=15.543,P＜0.001) and the 25-(OH)D concentrations were (15.74±6.54) ng/ml,(12.56±5.15) ng/ml,(11.51±4.28) ng/ml,respectively.During the whole course of treatment,the 25-(OH) D concentration decreased by 26.9％ or (4.23 ± 6.75) ng/ml (t =6.257,P＜0.001),wherein it decreased (3.18 ± 5.24) ng/ml in intensive phase (t =6.069,P＜ 0.001) and (1.05±4.86) ng/ml in continuation phase (t =2.154,P =0.034).The former had a greater decreased value (t=2.836,P=0.006).There were 77 (77.0％) and 55 (55.0％) patients with 25-(OH)D concentration reduction in intensive and continuation phases respectively (x2 =9.680,P =0.003),of which 41 patients (41.0％) continued to decline.Conclusion Once anti-tuberculosis treatment is conducted,the vitamin D level will decrease rapidly in the intensive phase and continue decreasing throughout the course of treatment,which leads to a general lack of vitamin D in patients with primary pulmonary tuberculosis.First-line anti-tuberculosis drugs may be the main cause for vitamin D level reduction.Therefore,it is necessary for clinicians to strengthen vitamin D health education for each patient throughout the treatment period,especially for those at high risk of vitamin D deficiency who should be recommended adjuvant vitamin D supplementation therapy.