ObjectiveTo investigate the outcome and repregnancy after different laparoscopicsurgical treatments for tubal pregnancy,and analyse the influential factors. MethodsIn 56 tubal pregnancypatients,28 cases performed laparoscopic salpingostomy (group A) and 28 cases peoformed laparoscopicsalpingectomy (group B). The perioperative condition, the rate of repregnancy and re-ectopic pregnancy was compared and analyzed. Logistic regression analysis was used to detect the effect on subsequent repregnancyof influential factors such as pelvic adhesion. ResultsMore bleeding and longer operative time were needed in group A than group B, there were significant differences between two groups (P ＜ 0.05 ). In follow-up of 6months to 6 yeats,the rate of repregnancy in group A and group B was 46.4％(13/28) and 32.1％(9/28)respectively,there was no significant difference between two groups (P ＞0.05). The rate of re-ectopic pregnancy in group A and group B was 10.7％ (3/28) and 28.6％ (8/28) respectively,there was significant difference between two groups (P ＜0.05). In the single factor analysis,the repregnancy in group A was significantly associated to pelvic adhesion and patency of the contralateral oviduct (P ＜ 0.05 ). Conclusions The rate of repregnancy of laparoscopic salpingostomy is higher than laparoscopic salpingectomy for tubal pregnancy. Each of pelvic adhesion and the patency of the contralateral oviduct is a factor that affects the postoperative fertility. The conservation operation is not recommended for those patients with extensive pelvic adhesion or seriously destroyed tube but normal contralateral oviduct.

Objective To compare the efficacy and toxicity of neoadjuvant chemotherapy with venous and arterial way in patients with locally advanced cervical cancer( LACC ). Methods A retrospective study was carried out on 70 patients suffering from tumor diameter≥4 cm and FIGO stage Ⅰ B- Ⅱ B disease of LACC. Among 70 patients, 36 were given venous chemotherapy ( venous group ) and 34 were given arterial interventional chemotherapy(arterial group). All patients received platinum-based neoadjuvant chemotherapy.The therapeutic toxic and adverse effects of the two groups were analyzed and compared. Results Clinical response to neoadjuvant chemotherapy occurred in 54 patients with a total effective rate of 77.1% (54/70),that of venous group was 72.2% (26/36) and that of arterial group was 82.4% (28/34),there was no significant difference between two groups (P ＞ 0.05 ). The number of the occurrence of gastrointestinal tract reaction and bone marrow depression in venous group (43,32 pieces) was more than that in arterial group (23,17 pieces)(P ＜ 0.01 ). Conclusion The results suggest that the therapeutic effects of venous and arterial interventional chemotherapy be similar,but the adverse effects of venous chemotherapy is more serious than that of arterial interventional chemotherapy.

Objective To evaluate the strategies and effect of surgical treatment for concomitant abdominal aortic aneurysm (AAA) and colorectal cancer (CRC). Methods Literatures on concomitant AAA and CRC published from January 1988 to December 2008 were retrieved from Pubmed, Sciencedirect, Ovid, CBMdisc, CNKI and et al, and correlated indexes were extracted for analysis. Differences among the groups were analyzed using the t test, chi-square test and fisher's exact test. Results A total of 367 cases of concomitant AAA and CRC treated by operation were retrieved. The length of operation delay of patients who received radical resection of CRC first was (115 ± 21 )days, which was significantly longer than (42 ± 8 )days of patients who received open abdominal aortic aneurysm repair (OAAR) first (t = 18. 9, P <0.05). The 30-day complication rate and accumulative length of hospital stay of patients who received one-stage radical resection of CRC + OAAR were 10.5% ( 12/114 )and (23 ±6) days, and 26.0% (47/181) and ( 16 ±4)days of patients who received two-stage radical resection of CRC + OAAR, with a significant difference ( χ2 = 10.42, t = 12. 01, P <0.05 ). The accumulative length of hospital stay of patients who received radical resection of CRC + endovascular aneurysm repair (EVAR) was (12 ±4) days, which was significantly shorter than that of patients who received radical resection of CRC + OAAR [ ( 19 ±5 ) days ] ( t = 9.48, P < 0. 05 ). The 4-year survival rate of patients who received two-stage radical resection of CRC + OAAR was 43.5% (27/62), which was significantly lower than that of patients who received two-stage radical resection of CRC + EVAR [69.2% (18/26) ] or one-stage radical resection of CRC + OAAR [73.7%(14/19) ] (χ2 =4.83, 5.28, P<0.05). Conclusions If the diameter of AAA is under 5 cm, radical resection of CRC should be firstly carried out; but if the diameter of AAA is above 5 cm, OAAR should be firstly carried out to prevent the rapture of tumors. One-stage surgery is better than two-stage surgery if patients could tolerate it.

The resident standardized training is an important stage in clinical medical personnel training sys-tem. Medical ethics education and accomplishment is one of the main training contents in this stage is, the necessa-ry requirement for physician growth, and the effective guarantee for training organization and implementation. Learning for relevant theory of medical ethics is the basis of medical ethics education, and the medical practice is the fundamental way of medical ethics accomplishment. In medical practice, the inner perception is the gradual sublimation of medical ethics accomplishment. The formation of residents′ medical ethics quality is dominated by heteronomy and guided by medical morality code. It emphasizes more on self-regulating the ethical behaviors and abiding by medical ethics faith and standards.

Objective: To study clinical application value of dobutamine stress echocardiography (DSE) and nitroglycerin stress single photon emission computed tomography (SPECT) for evaluation of restenosis after percutaneous coronary intervention (PCI). Methods: A total of 39 patients after PCI were examined by DSE and SPECT one week before coronary angiography (CAG). Dose incremental program of dobutamine included five levels：5μg•kg-1•min-1, 10μg• kg-1• min-1, 20μg•kg-1•min-1, 30μg•kg-1•min-1, 40μg•kg-1•min-1, and each level maintained for three minutes. Sensitivity, specificity and accuracy of DSE and SPECT were determined according to CAG examined result and examined results were compared between DSE and SPECT. Results: Compared with CAG, SPECT and DSE were no significant differences （P>0.05）in sensitivity (83.3% vs. 75.0%) and accuracy (71.8% vs. 87.2%) for evaluating restenosis after PCI, but compared with SPECT, DSE possessed higher specificity (66.7% vs. 92.6%). Conclusions: Dobutamine stress echocardiography is accurate, and its specificity is better than that of SPECT for evaluating restenosis after percutaneous coronary intervention.

Objective:This study aimed to clarify the correlation of SPRY4-IT1 expression with the clinicopathological character-istics and prognosis of patients with esophageal squamous cell carcinoma (ESCC), as well as the role of SPRY4-IT1 in promoting ES-CC cell growth. Methods:Quantitative real-time polymerase chain reaction for SPRY4-IT1 expression was performed on 50 paired can-cerous and adjacent non-cancerous esophageal specimens. Small interfering RNA was used to suppress SPRY4-IT1 expression to fur-ther explore its role in tumor progression. Cell viability was tested in vitro by MTT assay (OD=490 nm), and cell apoptosis and cell cy-cle were investigated by flow cytometry. Results:We found markedly elevated SPRY4-IT1 expression in cancerous tissues compared with adjacent non-cancerous tissues (90%, P<0.01). Relative SPRY4-IT1 expression levels were correlated with some clinicopathologi-cal characteristics, such as tumor size (χ2=5.333, P=0.021), elevated TNM (2009) stage classi fi cation (χ2=5.556, P=0.018), and de-creased overall survival rates (χ2=5.296, P=0.021). SPRY4-IT1 expression level was not correlated with patient age, gender, smoking status, or alcohol consumption (all P>0.05). Further experiments showed that SPRY4-IT1 expression levels were significantly higher in three ESCC cell lines than in the normal human esophageal epithelial cell line Het-1A. In vitro assays of the ESCC cell line KYSE30 demonstrated that knockdown of SPRY4-IT1 expression by small interfering RNA reduced cell growth, mediated cell cycle arrest at the G0-G1 phase, and promoted cell apoptosis (all P<0.01). Conclusion:SPRY4-IT1 was overexpressed in ESCC tissues and ESCC cell lines and promoted the growth of ESCC cells. The dysregulated expression of long non-coding RNA SPRY4-IT1 may play an important role in the process of ESCC development and may be developed as a useful biomarker for the diagnosis and prognosis of ESCC.

Objective To evaluate the safety and efficacy of 125I radioactive seeds implantation combined with postoperative chemotherapy as a treatment option for thoracic advanced esophageal squamous cell carcinoma(ESCC). Methods A prospective cohort study was carried out between 2000and 2005. According to preoperative CT staging criteria,298 patients in phase Ⅱ-Ⅲ of ESCC, who had were admitted to Oncology Center Surgery of Nanjing First Hospital Affiliated to Nanjing Medical University and Thoracic Surgery of YanCheng Oncology Hospital, were randomly divided into three groups: intraoperative 125I seeds implantation combined with postoperative chemotherapy (group A, 98cases), postoperative chemoradiotherapy (group B, 100 cases) and surgery alone (group C, 100cases). All patients received radical resection of esophageal cancer. According to pTNM staging criteria after operation, 233 patients in phase Ⅱb-Ⅲ of ESCC were finally enrolled in the study (78 in group A, 75 in group B, and 80 in group C). With 0. 5 m Ci of single seed, total activity of 5-11 mCi and matched peripheral dose in 60-70 Gy, 10-22 125I seeds were implanted into the target of patients in group A under direct vision in accordance with treatment planning system. The validation and quality assessment of radioactive seeds were demonstrated according to CT scan or X-ray imaging. The postoperative complications were observed. The local recurrence of the cancer was demonstrated using CT scan. The survival rate of patients was followed up for 1-,3-,5- and 10 years. Results The satisfied quality assessment of 125I seeds was observed. There was no displacement or loss of seed. The local recurrence in group A, B and C was 11. 5%, 13. 3% and 38. 8%, respectively, with statistical significance (P ＜ 0. 05). There was no significant difference among three groups with respect to complications and 1-year survival (P＞0. 05). However, the overall survival rate 3-, 5- and 10-years was 64.8%,37. 7% and 25. 1% in group A respectively; 63.3%, 36.9% and 24.9% in group Brespectively; 43. 6i%, 25.0%, and 12.6% in group C, respectively (all P＜0. 05). The 3-,5- and 10-year progression free survival rates were 63.5 %, 37.4 % and 15.1% in group A respectively; 62.5 %,36.6% and 14. 4% in group B respectively; 42.5%, 25.6% and 6.2% in group C respectively (all P＜0. 05). Conclusions It is a safe, effective and simple method for intraoperative 125I seeds implantation combined with postoperative chemotherapy in treatment of advanced ESCC, which may reduce the local recurrence and improve survival rates in patients with ESCC.

Objective To discuss the characteristics of extended-spectrum beta-lactamases(ESBLs)-producing Shigella and the relation between them and drug-resistance plasmid. Methods The suspicious ESBLs-producing isolates were screened by K-B disc diffusion method, and the ESBLs-producing strains were confirmed by confirmatory test recommended by the National Committee for Clinical Laboratory Standards. Furthermore, the partial blageneof these isolates were detected by PCR using universal primers for TEM, SHV, CTX-M-1 group, CTX-M-2 group and CTX-M-9 group, respectively. The entire blaCTX-M-9 and blaTEM were amplified by PCR using the primers outside the open reading frame (ORF) of these β-1actamases and products were directly sequenced. The conjugation experiment was performed to determine whether the resistance was transferable. Minimal inhibitory concentration (MIC) was detected with double agar dilution method. Results Of the 275 isolates, 12 strains were identified as ESBLs producers. Among them, 8 strains were CTX-M-14 carriers and 4 strains were CTX-M-3 carriers. All ESBLs-producing isolates are positive for plasmid conjugative transfer test. The transconjugants are only resistance to betalactams. Conclusions High resistance to beta-laetams in Shigella is caused by production of ESBLs in the local area. The ESBLs-produeing isolates can transfer the drug resistance through lateral transfer of plasmid.

Objective To investigate the predictive value of pregnancy-associated plasmaprotein-A (PAPP-A) and GRACE risk score for death and nonfatal myocardial infarction (combined endpoint) in AMI patients.Methods All AMI patients hospitalized in our department during July 2011 to July 2015 were included consecutively in this prospective study.Plasma PAPP-A were measured at admission.GRACE risk score was acquired with the application of GRACE risk score calculator.Patients were followed up for at least 1 year for any nonfatal myocardial infarction or MACE.Kaplan Meier survival study was analysed according to PAPP-A and GRACE score risk stratification respectively.A cutoff value of 3.0 ng/ml of PAPP-A was chosen from pilot work in this cohort.Results A total of 220 patients were enrolled in the study.The death and nonfatal myocardial infarction during follow-up were significantly higher in patients with PAPP-A≥3.0 ng/ml compared to patients with PAPP-A<3.0 ng/ml (15.7% vs.6.0%, log-rank χ2=5.684, P=0.017).The area under ROC curve of PAPP-A was 0.796(95%CI 0.696-0.896, P<0.01) and the ROC curve of PAPP-A GRACE risk stratification was 0.715 (95%CI 0.567-0.863,P<0.01).Subgroup analysis showed that death and nonfatal myocardial infarction during follow-up was significantly higher in patients with PAPP-A≥3.0 ng/ml compared to patients with PAPP-A<3.0 ng/ml in intermediate and low risk group by GRACE risk stratifcation (log-rank χ2=14.63,P<0.001).Conclusions PAPP-A could predict mortality and nonfatal myocardial infarction in patients with AMI.PAPP-A combined with GRACE risk score can better predict outcome than GRACE risk score alone in intermediate and low risk patients by GRACE risk stratifcation.

OBJECTIVETo optimize the extraction technology and determine the immune activity of polysaccharides from Marsdenia tenacissima.

METHODThe optimum extraction technology of polysaccharide from M. tenacissima was detected by orthogonal experiments with the extraction rate of polysacchride and the total sugar content as indicators. The immunocompromised mice model was established by intraperitoneal injection cyclophosphamide to detected the content of IL-2, IL-6 in serum, CD4+, CD8+ in the peripheral blood by ELISA and flow cytometry, respectively.

RESULTBy the extraction rate of polysaccharide, the sequence of seriousness of all affecting factors from high to low was extracting times, temperature, heating time and water ratio. By the total sugar content, the sequence was temperature, extracting times, water ratio and heating time. Compared with the model group, the pleen index, IL-2, IL-6, CD4/CD8+ were increased significantly (P < 0.05) in the 0.14 g x kg(-1) group and 0. 28 g x kg(-1) group.

CONCLUSIONT he optimum extraction condition was as follows: extraction three times/1.5 hours at 100 degrees C with 1:8 ratio of M. tenacissima to water. The polysaccharide of M. tenacissima can enhance the cellular immune and humoral immune.

Animals ; Body Weight ; drug effects ; CD4-CD8 Ratio ; Chemical Fractionation ; methods ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Marsdenia ; chemistry ; Mice ; Polysaccharides ; immunology ; isolation & purification ; pharmacology ; Spleen ; immunology ; Temperature ; Time Factors