Objective To explore the clinical value of the Luo’s fornix cup in laparoscopic total hysterectomy. Methods A total of 7 patients with indications for hysterectomy from October 2004 to February 2005 was given laparoscopic total hysterectomy. During the operation, the Luo’s fornix cup was used for the orientation and dilatation of the vaginal fornix. Then the anterior vaginal fornix was circlewise incised by using a harmonic hook to extract the Luo’s fornix cup. Afterwards the posterior fornix was opened to remove the uterus by way of the vagina. And finally the vaginal stump was closed. Results All the operations were successfully completed. The operation time was 90~250 min. With the use of the Luo’s fornix cup, the operator could easily identify the top of the vaginal fornix, and avoid the damage of important neighbouring organs. No injuries of bladder, ureter, and rectum were noted. Conclusions The Luo’s fornix cup is a rational accessory instrument in laparoscopic hysterectomy, being worthy of recommendation.

Objective To investigate the effects of Pravastatin on serum oxidative modified LDL (ox-LDL), tumor growth factor ?1 (TGF-?1), vascular cell adhesion molecule-1 (VCAM-1) and lipid levels in patients with acute cerebral infarction(ACI).Methods 114 cases with ACI were randomly divided into two therapy groups: (1) 56 cases were given Pravastatin combined with Aspirin;(2) 58 cases were treated with Aspirin only. The serum levels of ox-LDL, TGF-?1, VCAM-1 and lipid were detected 72 h after the onset of the disease and 3 months following the treatment. Meanwhile, the same were detected in the control group (50 healthy people). Results Within 72 h, the serum levels of ox-LDL, VCAM-1, cholesterol and LDL were higher in patients with ACI than those in control group(all P

Objective To clarify the role of claudin-4 in endometrial tumorigenesis and explore claudin-4 be as potentially useful agent in the treatment of endometrial carcinoma.Methods The expression of claudin-4 in 62 endonetrioid endometrial carcinoma (EEC),30 atypical hyperplasia endometrial tissue and 60 human normal endometrium was determined using immunohistochemistry and realtime PCR.Ninety female BALB/c mice were transplanted with Ishikawa endometrial cancer cells,which were divided into three groups with different intraperitoneal treatments with cisplatin,paclitaxel and saline solution.After the observation period,the tumors were extracted and stained with monoclonal antibody against claudin-4.The messenger RNA expression of claudin-4 was also detected using real-time PCR.Results Among the EEC samples,34％ (21/62) showed medium staining for claudin-4 and 66％ (41/62) showed intense staining.In atypical hyperplasia group,27％ (8/30) showed weak staining,53％ (16/30) showed medium staining and 20％ (6/30) showed intense staining for claudin-4.Of the normal endometrial tissue,47％ (28/60) showed weak staining and 53％ (32/60) showed no staining for claudin-4.According to real-time PCR,the relative quantity of claudin-4 was 170 ± 12 in EEC group,89 ± 15 in atypical hyperplasia group and 18 ± 3 in normal endometrium.Compared with those in atypical hyperplasia group and normal endometrium group,the protein and mRNA expression of claudin-4 were significantly increased in the group of EEC (all P ＜ 0.05).In the study of Ishikawa xenografts,no significant changes in tumor volume and claudin-4 expression were shown in paclitaxel group compared with that in the control group.Nevertheless,a significant reduction of the tumor growth and a significant decrease in claudin-4 expression were observed in cisplatin group.After cisplatin treatment,the tumor volume was significantly decreased [(0.51 ±0.21) versus (0.73 ±0.12) cm3],and the mRNA expression of claudin-4 was also significantly decreased (153 ± 35 versus 273 ± 27).Conclusion These results demonstrate that claudin-4 is strongly expressed in EEC,which may be a useful biomarker to monitor the effects of chemotherapy in patients with endometrial carcinoma.

Objective To investigate the changes in histological characteristics and collagen content in uterosacral and cardinal ligaments of pefimenopausal women in relation to relaxation of pelvic supports.Methods Twenty-eight subjects undergoing hysterectomies were selected,in which 14 cases were perimenopausal women with relaxation of pelvic support as the relaxation group and 14 women at perimenopansal age with leomyoma,cervical cancer,adenomyosis as the control group.Samples of cardinal ligaments and uterosacral ligaments were obtained at hysterectomies,and the tissues were shced and stained bv Masson's trichrome technique.Histological characteristics of the samples were studied and immunohistochemistry assay was applied to demonstrate the contents of collagen types I andⅢ.Results (1)The collagen in uterosacral ligaments and cardinal ligaments were stained blue by tlle MaSson's trichome technique.In comparison to the control group,the relaxation group had milder positive stains of the collagen and the stains were distributed in unequal intensities.Collagen content was arranged in loose pattern.Focal arrangement of the collagen was dense but fragmented.Collagen fibers were atrophic. (2)In immunohistochemistry assay and image analysis,collagen was positive in light to deep brown areas.In the relaxation group,positive units of collagen types I and III in cardinal ligaments were 13.8±2.1 and 9.6±2.4 respectively.Positive units of coHagen types I and Ⅲ of cardinal ligaments in the control group were 27.4 ±3.5 and 17.7 ±4.0 respectively.Difierences between these two groups were statistically significant (P

Objective To investigate the changes of serum diamine oxidase(DAO) levels in patients with severe acute pancreatitis(SAP) and their relationship with computed tomography severity index(CTSI) score and gastrointestinal dysfunction.Methods A total of 60 SAP patients were recruited into group SAP,the other 40 healthy people were recruited into control group,DAO,lactic acid,tumor necrosis factor-α(TNF-α),intestinal trilobites factor(ITF),cream ball epidermal growth factor 8(MFG-E8) were compared in the two groups.Results DAO,lactic acid,TNF-α in SAP group with onset within 72 hours were(3.09±1.33)U/mL,(928.50±69.37)ng/mL and (269.41±31.85)pg/mL,which were significantly higher than(1.20±0.58)U/mL,(311.64±38.25)ng/mL and (38.24 ± 3.03)pg/mL in the control group,the differences were statistical significant(P<0.05).The serum levels of ITF,MFG-E8 in SAP group were(3.60±0.35)ng/mL,(81.49±27.32)pg/mL,which were significant lower than(4.39±0.26)ng/mL,(234.17±49.08)pg/mL in the control group,the differences were statistical significant(P<0.05).In the SAP group,the serum levels of DAO showed significant positive correlations with D-lactate,TNF-α levels,CTSI score,APACHEⅡ score,gastrointestinal dysfunction score(P<0.05),but had significant negative correlation with ITF,MFG-E8(P<0.05).Conclusion Serum DAO level evaluated significantly in patients with SAP,and closely related to the severity of the disease and the dysfunction of the gastrointestinal tract.

Objective To compare the clinical efficacy and prognosis between classical infra-patellar (IP) and supra-patellar (SP) intramedullary nailing in the treatment of tibial shaft fractures.Methods A retrospective analysis was conducted of the 68 patients with tibial shaft fracture who had been treated from June 2012 to December 2014 and completed follow-ups.They were 59 males and 9 females,18 to 87 years of age (mean,43.7 years).Of them,38 were treated through the SP approach and 30 through the IP approach.The 2 groups were compared in terms of surgery-related indexes,The Hospital for Special Surgery (HSS) knee function score and Johner-Wruhs evaluation for clinical efficacy at 1,3,6,and 9 months postoperation.The 2 groups showed no significant differences regarding preoperative general data(P ＞ 0.05).Results The 68 patients obtained an average follow-up of 6 months (range,from 1 to 9 months).Intra-operative accumulative fluoroscopy time in the IP group(2.1 ± 1.1 s) was significantly less than in the SP group(3.3 ± 1.8 s) (P ＜ 0.05).The number of limited open reduction (1),intra-operative bleeding volume (128.6 ± 164.1 mL) and number of second intra-operative shifting (4) in the SP group were significantly smaller than in the IP group(7,216.2 ± 195.9 mL and 10,respectively) (P ＜ 0.05).The HSS score in the SP group at 9 months (80.8±7.Spoints) was significantly higher than in the IP group (74.0±5.4points)(P ＜0.05).The clinical good to excellent rate at 9 months for the SP group (97.4％) was significantly higher than for the IP group (70.0％) (P ＜ 0.05).There were also significant differences between the 2 groups in postoperative adverse events like knee pain(P ＜ 0.05).No wound infection,limb shortening,internal fixation loosening or rupture,fracture nonunion or mal-union happened in either of the 2 groups.Conclusions In the treatment of tibial shaft fractures with intramedullary nailing,the supra-patellar surgical approach may effectively reduce the incidence of postoperative knee pain so that it can prevent degenerative changes of the knee joint in the long term.It may also lower the incidence of intraoperative second shifting.It also has the advantages of limited incision,simplicity,and limited scaring.In short,it may be superior to the classical infra-patellar approach.

Objective To investigate the characteristic of intelligence of children with attention deficit hyperactivity disorder (ADHD).Methods 60 ADHD children were estimated with Wechsler Intelligence Scale for Children-fourth edition (WISC-Ⅳ). Results The full scale intelligence quotient (FSIQ) and 4 indices of ADHD children were lower than the average (P<0.05). All the subtests scores of ADHD children were lower than the average (P<0.05) except decoding. Conclusion The general intelligence and abilities of verbal comprehension, reasoning,working memory and operation speed are in the normal range in ADHD children, but poorer than normal children.

Objectives To compare endovascular aortic repair (EVR) and medical therapy for acute type B aortic dissection (AD) in terms of treatment results.Methods From January 2004 to October 2010 116 cases were collected and were divided into two groups,with treatment of EVR (n =60)and medical therapy (n ＝ 56).Treatment outcomes were assessed.Results Clinical manifestations of AD are complex and variable,with the most common symptom being pain on chest and back (74.1％).CTA is the most valuable method in confirming the diagnosis of aortic dissection.In conservative group of 56 patients admitted to hospital,30-day mortality rate was 16.1％.In EVR group of 60 patients with grafts successfully released,the 30-day mortality was 1.7％.There is significant difference between the two groups on mortality rate during 30-day(P ＜0.05).Follow-up rate in conservative group and the EVR group was 71.4％ and 86.7％,with average follow-up time of (38 ± 16) months and (35 ± 14) months.The 5-year survival rates were 87.5％ and 88.5％ respectively in conservative group and EVR group (P ＞ 0.05).Conclusions EVR is considered to be the first choice for acute Stanford type B dissection.EVR can improve patients' 30-day survival,though long term result is comparable with that of conservative treatment.

Objective To study the impacts of white matter ischemic lesions in various regions on the different cognitive domains of the patients. Methods 120 patients with white matter ischemic lesions were divided into subcortex,semi oval center,peri-ventricle,mixed regions according to MRI imaging (n=30 cases for each group). The 30 healthy control subjects were enrolled.Cognitive functions were evaluated by mini mental status scale (MMSE), montreal cognitive assessment (MOCA),object memory test (FOM),rapid verbal retrieve (RVR),block design (BD)and digit span (DS). Results The score of language in subcortical group (0.36±0.49) was lower than in control group (1.00±0.00) (P=0.011).There was no significant difference in RVR scores between mixed regions group and peri- ventricle group [(27.00 ± 9.22) vs. (32.30 ± 7.78) P =0.067],while RVR scores in mixed regions group (27.00± 9.22) were increased as compared with subcortex,semi oval center and control groups [(38.21±11.93),(35.94=9.53) and (37.00±3.16),respectively] (F=3.462,P=0.013).There was no difference,in BD scores between mixed regions group and semi- oval center group [(21.20± 9.21) vs.(25.63±12.10).P 0.070] but the mixed group scores were decreased as compared with subcortex, peri-ventricle, control groups [(37.14±10.43),(36.80± 14.27),(40.30±6.29),F=7.795,P=0.000].The scores of immediate verbal memory,calculation,short-term memory,visual spatial ability and executive were reduced in mixed regions group than in other groups (P=0.034,0.030,0.016,0.000).There was no difference in orientation score in MOCA and MMSE among the groups (P=0.256 and P=0.325).Conclusions Ischemic white matter lesions may lead to cognitive impairments depending on different region lesions. The obvious impact of peri-ventricle lesion is on memory, subcortex lesion on language,semi-oval center lesion on recognition and construction of images,while wide range of cognitive impairment may be attributed to the lesion in mixed regions.The scale of the MOCA is helpful and sensitive for identifying the presence of early cognitive impairment.

Objective To assess the treatment of splenic artery aneurysms (SAA) and prognosis.Methods Clinical data of 18 SAA patients treated in our hospital from 1999 to 2011 were retrospectively analyzed. Results There were 18 patients diagnosed as SAA,including 7 males and 11 females.The average age was 53.8 ± 7.3 years.8 patients were asymptomatic found by routine physical examination,7 patients complained upper left abdominal pain,3 cases suffered from aneurysm rupture. Diagnosis was established by three-dimensional computed tomography angiography (3DCTA) in 14,Digital subtraction angiography (DSA) in 3 and magnetic resonance angiography (MRA) in 1 patient.Three patients with ruptured splenic artery aneurysm underwent emergent operations,11 patients underwent elective surgery or interventional therapy.Surgical procedures included aneurysmectomy and splenectomy in 4 patients,distal pancreatectomy in 5 cases; aneurysmectomy and splenic artery ligation in one patient; and aneurysmectomy with splenectomy and colon resection in 1 case.Interventional embolization by coils of the splenic aneurysm in 3 patients.The remaining 4 being asymptomatic and with tumor diameter less than 2 cm were put on a close follow-up.There was no perioperative mortality.Two were lost to follow-up.16 cases were followed-up for averaging 3.2 years. 1 patient died of cerebral hemorrhage after four years. Conclusions Splenic artery aneurysms was a rare disease and with usually occult symptoms,but rupture can leads to abdominal apoplexy.Open surgery and minimally invasive endovascular treatment is effective and offers a good prognosis.