Objective　In order to predict or exclude early ectopic pregnancy.Methods　Endomertrium of 49 early intrauterine and 52 ectopic pregnancy were observed by transvaginal ultrasonography. Trophoblastic artery flow were investigated surrounding the intrauterine embryo or within the endometrium.Results　An endometrial three-line pattern resembled late proliferative endometrium of the normal menstrual cycle were seen in 42 ectopic pregnancy(80.8%). An endometrial three-line pattern were not seen in 49 early intrauterine pregnancy. Thirty-nine early intrauterine pregnancy had trophoblastic artery flow surrounding the intrauterine embryo or within the endometrium. None of ectopic pregnancy had trophoblastic artery flow within the endometrium.Conclusion　Observation of endometrial three-line pattern and trophoblastic artery flow by transvaginal ultrasonography were useful for diagnosing eraly ectopic pregnancy.

The chiral separation of three triazole pesticides, i.e. diniconazole, triadimefon and triadimenol was studied on a Chiralcel OJ-H and a Chiralcel OD-H HPLC chiral columns. The optical rotation quality of diniconazole and triadimefon enantiomers was measured and the absolute configurations of individual enan-)tiomers) were further concluded. On this basis, the absolute configurations of the four triadimenol stereoisomers were deduced via the reductive experiment of triadimefon to triadimenol. Furthermore, the chiral stability of the three triazole pesticides in organic solvents and buffer solutions was investigated. The results showed the obvious enantiomerization was observed as for triadimefon in methanol, ethanol and water, whereas dinicona-)zole) and triadimefon were chiral stable in organic solvents and water. The enantiomerization of triadimefon would be accelerated at higher temperature and in alkaline media.

Objective To optimize the process of extracting total saponins from Platycodon grandiflorum by orthogonal experimental design and central composite design-response surface method. Methods Independent variables were concentration of ethanol, reflux extraction time, reflux time and solvent fold. Dependent variables were extraction rate of total saponins in Platycodon grandiflorum and the yield of dry extract.Linear or nonlinear mathematic models were used to estimate the relationship between independent and dependent variables. Results The result of the orthogonal experimental design was 70%ethanol, 180 min for reflux, 6 fold of solvent and 2 times for extraction. The result of central composite design-response surface method was 70% ethanol, 140 min for reflux, 10 fold of solvent and 2 times for extraction. Conclusion The central composite design-response surface method is better than orthogonal experimental design in studying extraction process of Platycodon grandiflorum, which provides basis for feasibility of application of central composite design-response surface method in optimization of extraction process of Chinese traditional medicine.

Objective To study the changes of soluble intercelluar adhesion molecule-1 (sICAM-1) in serum of neonates with hy-poxic-ischemic encephalopathy (HIE),and significance of changes of serum sICAM-1 in HIE pathogenesis. Methods There were 17 controls of neonates and their sICAM-1 concentrations in serum were detected with enzyme-linked immunosorbent assay (ELISA) at the critical stage and at the beginning of convalescent stage in 36 cases of HIE neonates and 17 normal neonates. The data were analyzed with analysis of variance, Newman-Keuls q test. Results The concentrations of sICAM-l[(216.64?85.32)?g/L] at the critical stage of 36 cases HIE neonates were significantly higher than those [(6. 16?4.05) ?g/L ] of control group (q = 17. 42 P

Objective:To investigate the application of in vitro fenestration endovascular aortic repair(fEVAR) in the juxtarenal abdominal aortic pseudoaneurysm and its up to mid-term results.Methods:The clinical data of 5 cases of juxtarenal abdominal aortic pseudoaneurysm from Oct 2016 to Jul 2019 at the Department of Vascular Surgery, Henan Provincial People′s Hospital was retrospectively analyzed, including therapy options, accesses, techniques of fenestration, bundle of the stent-graft, near to medium-term effects.Results:All patients were treated with fEVAR, the technical success rate was 100%. Stent modify time ranged from 50 to120 minutes, fEVAR time ranged from 75 to 210 minutes. The follow-up period was 15~42 months. All of the stents are in good position, there is no stent-related complications, and no deaths. Primary diseases are well controlled.Conclusion:The treatment for juxtarenal abdominal aortic pseudoaneurysms with fEVAR , as a full-intraluminal method, is of minimal invasion, few perioperative complications, low mortality. Result of up to mid-term follow up is satisfactory.

Objective Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding. The purpose of this study was to recognize the clinical characteristics of gastric Dieulafoy and to identify possible predictive factors of rebleeding. Methods Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion from January 2009 to June 2016. We analyzed the clinical data and endoscopic findings and the correlated with rebleeding risk factors with Dieulafoy's lesion. Results 111 patients were included in the study, 97 (87.4%) patients were male; the most common location of the bleeding lesions were Proximal stomach of 53 cases (47.7%); According to the Forrest type, 46.8% of the cases were arterial (spurting), 52.3% of the cases were arterial (oozing), there were 101 (91.0%) patients treated by endoscopic combined drug therapy. The success rate of Endoscopic hemostatic treatment was 84.2%, endoscopic hemostatic treatment success rate was as follows: single endoscopic, 85.0%; two endoscopic, 84.8%; three endoscopic, 75.0%. The hemostatic treatment success rate of 101 patients with endoscopic combined drug was as follows: Proximal stomach, 83.7%; mid-stomach, 82.1%; and distal stomach, 88.9%. Age (P = 0.002) and blood transfusion (P = 0.004) were risk factors for rebleeding in the study. Blood transfusion was associated with a higher recurrence rate for bleeding (P = 0.018, OR=37.77, 95% CI = 1.86~766.47) for 101 patients with endoscopic in combination with drug. Conclusion Endoscopic therapy is effective for treating Dieulafoy's lesion. The blood transfusion was associated with a high rate of bleeding recurrence. There were no significant differences between the rebleeding and non-rebleeding groups with respect to bleeding location or hemostatic methods.

Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of (50±12) years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali-zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no typeⅠendoleak; complications included pulmonary infection (n=1), strokes (n=1), reversible abnormal renal function (n=6) and retrograde aortic arch dissection (n=1). No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.

Objective To evaluate the benefit of radical prostatectomy (RP) in patients with lymph node-positive prostate cancer.Methods A systematic review of the studies about radical prostatectomy for the prognosis of node-positive prostate cancer was performed.An electronic search was completed on the basis of PubMed,Embase,Cochrane library,China Biology Medicine disc (CBM),China National Knowledge Infrastructure (CNKI),VIP and Wanfang database from inception up to November 2018.The outcomes are overall survival (OS) and cancer-specific survival (CSS).Results Six studies incorporating 7 890 patients were eligible for the present meta-analysis.6 247 patients underwent RP,the remaining 1 643 patients did not undergo RP.Lymph node-positive patients treated with RP had improved OS (HR =0.55,95％ CI 0.49-0.62,P ＜0.001) and CSS (HR =0.49,95％ CI 0.42-0.57,P ＜ 0.001).Conclusions Radical prostatectomy may be a beneficial option for patients with lymph node metastases at initial diagnosis,which also improve the OS and CSS.More randomized controlled trials are needed to give more evidence further.

Objective:To study and compare the prognosis of different pathological subtypes of renal cell carcinoma (RCC).Methods:Clinicopathological and prognostic data of 1 346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females, aged (55.1±13.4)years, including 1 120 cases of clear cell RCC, 62 cases of papillary RCC, 79 cases of chromophobe RCC and 85 cases of the other pathological types respectively. ECOG 0 and ≥1 were 911 and 435 cases, with; T 1, T 2, T 3 and T 4 of 1 019, 177, 102 and 48 cases respectively; WHO nuclear grade for well, intermediate, poor differentiation and unknown were 587, 530, 85 and 144 cases separately.Tumor size <5cm, 5-10cm, ≥10cm and unknown were 685, 541, 104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1 146 and 27/1 319 cases separately. Meanwhile, data of 80 439 cases from Surveillance, Epidemiology, and End Results Program (SEER) were also collected.There were 51 371 males and 29 068 females, aged (60.9±12.4) years; , with 66 261, 8 680, 5 022 and 476 cases of White, Black, Asian, American native, or unknown race separately. There were 62 600 of clear cell RCC, 12 170 of papillary RCC, 4 354 of chromophobe RCC and 1 315 of other pathological types, with T 1, T 2, T 3 and T 4 of 55 332, 8 687, 15 516 and 904 cases respectively; WHO nuclear grade for well, intermediate and poor differentiation were 52 323, 22 700 and 5 416 cases separately.Tumor size <5cm, 5-10cm, ≥10cm were 46 741, 25 760 and 7 938 cases respectively. Kaplan-Meier survival analysis were performed on these two group of cases, with different factors between subgroups (gender, age, pathological types, tumor stage, size and nuclear grade) evaluated by log-rank test. To evaluate accuracy of outcome prediction models of SSIGN, Leibovich and UISS score, concordance index of these models were evaluated. Results:In 1 346 cases of our cohort, those with chromophobe RCC were well prognostic, survival were relatively better in clear cell RCC than that of papillary RCC, and worst prognosis were demonstrated in those with other types of RCC (5 year overall survival rate: 97.5%, 87.9%, 79.7% and 68.4% separately). Poor prognosis were seen in those older than 50 years, with poor T stage or nuclear grade, large tumor size and tumors with necrosis or sacromatoid differentiation ( P<0.05). In 80 439 seer cases, the best prognosis was also seen in chromophobe RCC and the worst in other type of RCC separately (5 year overall survival rate: 96.3% and 85.3%). In addition, longer survival was seen in papillary RCC than clear cell RCC (5 year overall survival rate: 92.5% and 88.9%). However, similar results with our cohort were seen in Asian and American native subgroup of SEER cases (95.1%, 88.6%, 86.7%, 80.2% for chromophobe, clear cell, papillary and other types of RCC respectively). Poor prognosis were seen in those older than 50 years, males, Asian/ American Indian, poor T stage or nuclear grade and large tumor size ( P<0.05). Concordance index for SSIGN, Leibovich and UISS models in our cohort were 0.763-0.781, 0.725-0.752 and 0.641-0.660, respectively. The chromophobe RCC subgroup was relative better based on predictive value of prognosis models(c-index of UISS of 0.670-0.781, SSIGN and Leibovich of 0.733-0.903). Conclusions:In Asian RCC population, prognosis of chromophobe RCC is best, clear cell RCC is slightly better than papillary RCC, and the prognosis of other types of RCC is the worst. Concordance index of SSIGN and Leibovich in our cohort were higher than that of UISS, and the use value for predictive model was better in the chromophobe RCC subgroup.

Objective: Toexplore work process-oriented theory nursing ward round, research work process-oriented theory nursing ward round on critical thinking capacity of nursing undergraduates. Methods: Totally 80 Elective nursing ward round courses of nursing undergraduates were divided into the experimental A group and the experimental b group with 40 cases in each group. The experimental A group select the beginning of 9 weeks on Until, the experimental B group select the after of 9 weeks on Until. The nursing undergraduates were assessed by CTDI-CV on first, ninth, eighteenth weeks to evaluate the effect of the two groups. Results: Main effect of group factor and time factor of CTDI-CV had statistical significance (P<0.05) . There were significant interaction in the scores of CTDI-CV. Simple effect analysis demonstrated the scores of CTDI-CV in the experimental A group were higher than those of the experimental b group after the intervention (P<0.05) . Two groups of on first, ninth, eighteenth weeks measured values compared the effect of amount of F_B<F_A, the experimental group A intervention effect was better than in the experimental group B intervention. Conclusions For nursing undergraduates guided based on the working process of the curriculum of nursing ward round the critical thinking ability had good practice guidance, and on the start time to choose university grade three semester two on 9 weeks before commencement of nursing undergraduates promotes higher critical thinking ability.