Objective To study the related factors of hemorrhage of uterine scar again after cesarean section,available for peer exchange.Methods A retrospective analysis of clinical data of 650 patients with scar uterus again cesarean section patients,analysis of postoperative hemorrhage patients,the causes of bleeding.They were divided into placental group (n =6),incision dehiscence group (n =7),uterine atony group (n =17)according to the causes of hemorrhage,and related factors of postoperative bleeding were analyzed.Results The bleeding volume of the placental group in operation[(2 500 ±500)mL]was higher than the uterine atony group[(1 300 ±400)mL] and the incision dehiscence group[(700 ±200)mL].The bleeding volume of the uterine atony group was higher than the incision dehiscence group (t =10.29,5.56,4.33,all P <0.05).The bleeding volume of the uterine atony group after operation[(100.09 ±36.45)mL]was higher than the placental group[(90.71 ±20.31)mL]and the uterine atony group[(81.23 ±30.34)mL].The bleeding volume of the placental group after operation were higher than the uterine atony group (t =3.94,3.02,2.78,all P <0.05).4 cases of hysterectomy,3 cases of conservative surgery in placental group.1 case of hysterectomy,16 cases of conservative surgery in uterine atony group.7 cases conservative surgery in incision dehiscence group.Conclusion placental factors,uterine atony,incision dehiscence all can lead to scar uterus again cesarean section hemorrhage.We should also strengthen the clinical prevention work,and actively take relevant measures,reduce postoperative bleeding risk,to ensure the safety of the mother and infant.

The postoperative management of papillary thyroid microcarcinoma (PTMC) is one of the most important parts of management for PTMC,and it includes the initial management and long-term management of PTMC.The initial management of thyroid cancer is based on initial recurrence risk stratification system.The initial risk stratification system can be used to guide initial TSH suppression therapy,RAI assistant therapy and management of follow up.Initial risk assessment of recurrence,as a static representation of the patient in the first few weeks post-operatively,could not be continually updated during follow up.In order to account for the changes of the recurrence risk and disease specific mortality,re-stratification of risk should be performed during follow up,using all the clinical,biochemical,imaging (structural and functional),and cytopathologic findings obtained during follow up.Re-stratification of risk can inform clinicians on degree of ongoing TSH suppression,frequency and intensity of follow-up,and need for additional therapies were recommended in guideline.Adjustment of TSH suppression therapy should incorporate the impact of side effects and set TSH targets to ensure the benefits of TSH suppression outweigh against the potential risks.

OBJECTIVE:To facilitate Chinese pharmaceutical industry's understanding and application of the new "Patent Law".METHODS:The amendment of the "Patent Law" related to 3 aspects of medicine,i.e.specifying regulations on the information disclosure in the utilization of genetic resources,adding the clause of forced permission for the patent drugs for the purpose of public health,and introducing the Bolar exception clause was analyzed using law hermeneutic.RESULTS & CONCLUSIONS:The medicine-related amendment of the new "Patent Law" generally reflects an international tendency of restricting pharmaceutical patents so as to maintain public interests,which is in line with the status quo of low technological level of pharmaceutical industry in China.

Objective To evaluate the effect of meglumine cyclic adenosine (MAC) on heart rate variability (HRV) in aged-patients with coronary heart disease (CHD).MethodsSeventy six aged-patients with CHD were randomly divided into control group (n =36) and treatment group (n =40).The patients in control group were treated with nitrate,ozagrel,calcium antagonist,aspirin enteric-coated tablets,low molecular heparin,angiotensin-converting enzyme inhibitor ( ACEI ) or angiotensin receptor antagonist ( ARB ) and lipidlowering agents according to patients' conditions.Based on this,the patients in treatment group were treated with MAC 90 mg intravenous injection once a day for two weeks.The 24 h dynamic electrocardiogram was recorded.pre-ard post-treatment,and the changes of HRV indexes were observed.Results There was no statistical significance in HRV between the two groups before treatment ( P ＞ 0.05 ).However the HRV in two groups improved significantly after treatment ( P ＜0.01 ).The improvement of HRV was more significant in MAC group than that in control group (P ＜0.01 ).Conclusion MAC can significantly improve HRV in aged-patients with CHD.

Objective To observe conditioned enhancement of antibody production against influenza vaccine. Methods 36 female BALB/c mice were injected with 3 μg/mouse influenza virus hemagglutinin (HA) as the unconditioned stimulus (UCS),and camphor odor was served as the conditioned stimulus (CS). After a CS/UCS pairing was made,animals were re-exposed to the CS at Weeks 6. Results Through one conditioned stimulus,the optical density of anti-HA antibody of the conditioned group (Weeks 9:0.68±0.06; Weeks 10:0.60±0.06)was significantly increased compared with the unconditioned group (Weeks 9:0.53±0.06; Weeks 10:0.48±0.04) ( P <0.01). The level of anti-HA antibody of the conditioned group was also significantly greater than other controlled groups( P <0.05). Conclusion Through a single exposure to camphor odor which was paired with immunization of influenza virus HA in a single trial learning protocol,a significant conditioned anti-HA IgG production occurred.

Objective To explore the mechanism of shengmai injection on relieving ischemia reperfusion injury and antagonizing systemic inflammatory response syndrome by regulating cytokines when it was applied at the early stage of cardiopulmonary resuscitation(CPR).Methods 40 cases suffering from cardiac arrest and had their heart beat recovered through CPR for more than 24 hours were randomly divided into SMI group and control group(20 cases for each).The patients in the two groups were treated with common therapeutics based on the CPR,but the patients in SMI group were intravenously dropped with SMI in the early period of PLS phase,then the changes of serum concentration of TNF-α and IL-81h,2h,6h,12h and24h after CPR in the two groups was compared.Results The concentrations of serum TNF-α and IL-8 stepped up gradually after resuscitation and the levels of TNF-αand IL-8 in SMI group were lower than that of the control group at 1h,2h,6h,12h and 24h after resuscitation(P＜0.05).Conclusion SMI functions to relieve ischemia reperfusion injury by regulating cytokines and antagonizing systemic inflammatory response syndrome.

Malignant tumors still threatens the human's health seriously. Metastasis and recurrence lead to the failure of treatment, and multidrug resistance adds the difficulty of therapy of to malignant tumors. But the mechanism is yet unclear. Nowadays, it is found that there's a small group of cells with selfrenewal and indefinite potency in the tumors, and they are the sources of metastasis and recurrence. This small group of cells is called cancer stem cells. Subsequently, the cancer stem ceils were separated and determined from hematological system tumor and solid tumor respectively. The cognitions for metastasis and recurrence and muhidrug resistance of malignant tumor have changed with proposal and verification of the cancer stem cell theory, which provides a new clue to the treatment of tumor and prevention for the metastasis and recurrence.

Objective To separate and screen components with fibrinolytic enzyme activity from twelve Chinese herbal medicines. Methods The components were extracted with water and precipitated with salt, and they were tested by fibrinolytic protein plates method. The active components with fibrinolytic activity were separated and screened which were compared with urokinase. Results Eleven of the twelve extracts showed fibrinolytic activity, while Trichosanthes kirilowii got the biggest fibrinolytic zone after 36 hours, followed by Alisma plantago-aquatica and Leonurus japonicus, and the Radix Astagali got the smallest one. According to the concentration of the protein, the area of the fibrinolytic zone and the specific activity of the components, the extract from Angelica sinensis exhibited the best specific activity at level of 48.46U/mg. Conclusion The extracts from Chinese herbal medicines except Semen Persicae exhibit fibrinolytic enzyme activity which can dissolve the fibrin in different degrees.

Objective To explore the applied value of static and dynamic of virtual defecography technology in the etiological diagnosis of constipation.Methods 50 patients with constipation were included.Conventional cleaning enema was performed firstly.Then they were injected the virtual defecography agentwith lateral position,filling the rectum,sigmoid and descending colon.Thirdly,siting on the qualities commode,adjusting height coincides with the left and right femur,displaying the pubic symphysis and coccyx dynamic acquisition image acquisition with the speed of 4/s,the dynamic changes of the rectum and anal canal were analyzed and measured.Results Among 50 patients,32 cases with rectocele,1 case with rectal bend,2 cases with anal canal stenosis,7 cases with rectal prolapse,4 cases pelvic floor spasm syndrome,and 4 cases with no cause.Conclusion Static and dynamic virtualdefecography was an important method in the etiological diagnosis of patients with constipation.

Objective To investigate into the indications and related anatomic foundation of transjugular intrahepatic portosystemic shunt(TIPS) creation by direct transcaval approach in patients with portal hypertension cirrhosis suffering unusual anatomy between the hepatic veins and portal bifurcation; and to evaluate the security, feasibility and clinical significance. Methods Direct transcaval approach TIPS were performed in 65 patients including active variceal bleeding (n=52), intractable ascites (n=12), and as a bridge to liver transplantation (n=1). Results Technical and functional success were achieved in all patients. The success rate was 100% without related complications including the technique and primary patency rate is obvious higher than classical TIPS. Conclusion In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is secure and feasible. The results suggest that the direct transcaval approach offering favorable primary patency because the shunt has a straight line in construction.