Objective To discuss the main reason of re -pregnant patients'delivery mode selection after cesarean delivery and to guide the future clinical work.Methods Retrospectively analyzed the 181 cases of re -pregnancy after cesarean delivery and compare the clinical data of 140 cases of reselecting cesarean delivery with 41 cases of selecting vaginal trial production.Results Calculated the risks of vaginal trial production and cesarean delivery of scarred uterus by Smith formula.There was no statistically significant difference in two groups (P >0.05). Reselection of cesarean delivery accounted for 77.0% among the cases of re -pregnancy after cesarean delivery.In the investigation on the reason for re -pregnant patients reselecting cesarean delivery,38 patients chose cesarean delivery for the first time owing to social factors,accounted for 27.1%,taking the first place.While in the investiga-tion on the reason for re -pregnant patients selecting vaginal trial production,10 patients were operated on cesarean section for the first time due to fetal distress,accounted for 24.4%,coming first.Conclusion In the investigation on the reason for re -pregnant patients reselecting cesarean delivery,the result shows that the high possibility of reselect-ing cesarean delivery lies on those who chose cesarean delivery for the first time owing to social factors.While those who were transferred to cesarean section due to abnormal fetal heart rate during the first vaginal trial production,may have high possibility to select vaginal trial production when re -pregnancy.As a result,the key is to decrease the rate of cesarean delivery for the first time.

Objective To investigate the correlation between serum soluble epithelial cadherin (sE-cad) and postoperative recurrence and prognosis in patients with advanced gastric cancer.Methods The level of serum sE-cad in 85 patients with advanced gastric cancer (advanced gastric cancer group) was detected by ELISA technique preoperative and postoperative 1 month,and compared with 30 healthy controls(control group).The patients in advanced gastric cancer group were followed up for 3 years,the level of serum sE-cad in recurrent patients and non-recurrent patients was compared.Results The level of serum sE-cad in advanced gastric cancer group preoperative was significantly higher than that in control group [(24.3 ± 14.8) μ g/L vs.(9.4 ± 3.8) μ g/L,P ＜ 0.01].The level of serum sE-cad in advanced gastric cancer group was significantly decreased postoperative 1 month [(12.5 ± 6.4) μ g/L vs.(24.3 ± 14.8) μ g/L,P ＜0.01].The level of serum sE-cad in recurrent patients was significantly higher than that in non-recurrent patients and postoperative 1 month [(20.7 ±9.8)μg/L vs.(12.5 ±6.4),(14.8 ±6.2) μg/L,P＜0.01].Univariate analysis revealed that preoperative high serum sE-cad level was related with tumor size,differentiated degree,lymph node metastasis ratio,depth of tumor invasion (P ＜0.05),but had no relationship with histological type(P＞ 0.05).Elevated preoperative serum sE-cad level negatively affected the postoperative survival rate and recurrence rate.Multivariate Logistic regression anaiysis revealed that preoperative serum sE-cad level was an independent risk factor for postoperative 3 years survival rate in advanced gastric cancer (HR =2.068,P =0.013).Conclusions Preoperative elevated serum sE-cad level is related with pathologic features in patients with advanced gastric cancer,and may be an important prognostic factor.Postoperative monitoring the level of serum sE-cad is useful for evaluating the prognosis and recurrence.

Objective To evaluate the endoscopic features and treatment of gastrointestinal carciholds. Methods Data of 44 patients diagnosed as gastrointestinal carcinoid from 2002 to 2009, including clinical manifestation, endoscopic findings, treatment and follow-up, were analyzed retrospectively. Results Most common presentations were abdominal pain and changes in bowel habits, while some patients (n = 7 ) did not have any symptoms. Most lesions were elevated submucosal ones with normal mucosal pit pattern of type Ⅰ . Larger lesions appeared as polyps with mucosal pit pattern of type Ⅲ and 1 malignant carcinoid as type Ⅴ. Endoscopic ultrasonography were performed in 29 patients and all lesions were presented as submucosal hypoechoic masses with distinct borders. Endoscopic fulguration with high frequency current was applied in 12 patients and endoscopic mucosal resection (EMR) in 32. One patient with malignant carcinoid accepted multiple EMRs and died from lung and liver metastasis 6 months after last procedure. No recurrence was observed in other 43 patients during the follow-up visit of 3 months to 5 years. Conclusion Gastrointestinal carcinoid is lack of specific symptoms, and the diagnosis is made by endoscopic and pathologic findings.

Objective To study the characteristics of heterotopic pancreas (HP) in upper gastrointestinal tract (UGIT) under endoscopy and endoscopic sonography ( EUS), and its endoscopic managements. Methods Data of 67 patients with pathologically confirmed HP in our hospital from March 2004 to November 2009, including clinical and endoscopic manifestations and sequelae after endoscopic resection,were retrospectively studied. Results Heterotopic pancreas were most commonly found as a single lesion in gastric antrum (62/67, 92. 5% ) and in gastric angle and duodenum as well, which were characterized by protrusion, with intact mucous membrane and centrally umbilicated. Of the 67 patients, 59 underwent EUS before endoscopic resection. Findings were heterogeneous and mixed echogenic lesions with indistinct borders involving both the second and third layers of the gastrointestinal wall, sometimes even involving the first and fourth layers. Most lesions (n =60) were removed by endoscopic mucosal resection (EMR), with basal residues in 25 cases, in which fourth layer involvement was observed in 23 cases (92. 0% ). Delayed bleeding occurred in 1 case at 3rd day after the procedure, and no other complications were observed. Complete removal was achieved in 8 cases ( including one receiving EMR previously ) with endoscopic submucosal dissection (ESD) , and there was no such severe complications as perforation. Postoperative pathological examinations revealed that the consistent rate of preoperative diagnosis with EUS was 91.5% (54/59). Conclusion Endoscopy combined with EUS is critical in diagnosis of HP in UGIT. EMR, especially with cap assistance, is the best method for those without involvement of muscularis propria, while ESD or endoscopic surveillance is a better alternative for those with 4th layer involvement.

OBJECTIVE: Nasopharyngeal Carcinoma (NPC) can be successfully treated by radiotherapy, if the tumor is confined to nasopharynx, but clinical onset is usually delayed to more advanced stages, when prognosis is poor. The objective is to determine efficacy of a new program for early NPC detection, which entails stratification of the NPC risk of target population according to serum levels of 3 Epstein Barr Virus (EBV) antibodies. METHOD: The sera of 1373 healthy adult residents from Zhongshan were collected and analyzed in this study from Mar 16, 2007 to Dec 31, 2007. The levels of EBNA1/IgA, zta/IgG and EBNA1/IgG were tested by ELISA. To stratify the subjects of 1373 adults into high, moderate and normal NPC risk groups by regression analysis of the levels of the EBV antibody. The high-risk groups of nasopharyngeal carcinoma risk could be followed-up every 3-6 month. RESULT: NPC risk of 1379 adults was stratified according to serum levels of the 3 EBV antibodies. Eleven (0.8%) were identified to be of high risk for NPC, having high levels of all three antibodies and/or IgA EBNA level > 3 rod. Clinical examination of high risk subjects detected 5 NPC cases, 3 cases detected in the first instance and 2 in follow-up examination 3 to 6 months hence. Three cases were diagnosed with UICC Stage I tumor (60%), one in the first instance and 2 in follow-up, and the 5 cases account for all NPC cases detected from the entire cohort over 28 months(100%). CONCLUSION The new program affords an efficient and efficacious means for early NPC detection.
Antibodies, Viral ; blood ; China ; epidemiology ; Early Detection of Cancer ; methods ; Epstein-Barr Virus Nuclear Antigens ; immunology ; Humans ; Male ; Middle Aged ; Multiphasic Screening ; Nasopharyngeal Neoplasms ; blood ; diagnosis ; epidemiology ; virology ; Risk Assessment