Objective To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy (CSP). Methods From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate (MTX) 50 mg/m2 intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5 - 10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β(β-hCG) descent less than 30% in every 48 hours for 3 times after curettage, then MTX (50 mg/m2) intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage.Group C: 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss( M), lesion diameter (-x±s), blood β-hCG level (M)before treatment, the number of cases with myometrial thickness anterior to the CSP ≤3 mm, the resistant index (RI) ≤0. 5,expense(-x ± s), hospital days(-x ±s) in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied. Results ( 1 ) Clinical manifestation: bleeding loss were 20 ml in MTX +curettage of group A, 10 ml in curettage + MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B ( P ＜ 0. 01 ).The lesion diameter were ( 23 ± 15 ) mm in curettage + MTX of group A and ( 30 ± 14 ) mm of group B ,which were higher than ( 16 ± 8 ) mm of MTX + curettage of group A (P ＜ 0. 01 ). The lesion diameter of (52 ± 7 )mm in group C were significantly bigger than those in the other groups ( P ＜ 0. 01 ). The level of blood β-hCG levels were 21 592 U/L in MTX + curettage of group A, 979 U/L in curettage + MTX of group A,which reach statistical difference ( P ＜0. 05). The level of blood β-hCG levels were 11 312 U/L in group B and 101 U/L in group C. Among 28 cases with Rl≤0. 5,there was 8 cases in group A (24% ,8/33),18 cases in group B ( 30%, 18/60) and 2 cases in group C (2/3). Among 23 cases with myometrial thickness anterior to the CSP ≤ 3 mm, there was 21 cases in group B (35%, 21/60 ), which were significantly higher than 2 in group A (6%, 2/33 ) and none in group C ( P ＜ 0. 05 ). The expense were ( 5578 ± 3679) yuan in MTX + curettage of group A and (5346 ± 2765 ) yuan in curettage + MTX of group,which did not reach statistical difference (P＞0. 05). The expense were (7860 ±2104) yuan in group B,which were significantly higher than those in group A and (5004 ± 421 ) yuan in group C (P ＜ 0. 05 ). The hospital days were ( 15 ±8) days and ( 19 ± 14) days of group A, ( 16 ± 10) days in group B and ( 17 ±8)days in group C, there was no significant difference among those treatments ( P ＞ 0. 05 ). (2) Correlatin:there was positive correlation between bleeding loss and lesion diameter( r = 0. 31, P ＜ 0. 05 ) or blood β-hCG level ( r = 0. 35, P ＜ 0. 05). Conclusions MTX intravenously guttae, MTX uterine artery injection and embolization, and laparotomy lesion excision were all properly used in treatment of CSP. MTX uterine artery injection and embolization was recommended for those with big lesion, high β-hCG level, less myometrial thickness anterior to the CSP or plentiful blood supply of the lesion but the expense might be high.

Objective To study the effect of IGF-1 gene therapy and electric stimulation therapy on the rat models of postpartum stress urinary incontinence, and explore the ideal treatment for this disease.Methods 240 SD female rats were used to establish the model of postpartum stress urinary incontinence by water sac vaginal dilation.148 model rats were randomly selected from 185 successful models and divided into 5 groups:IGF-1 gene therapy, clenbuterol treatment, electric stimulation therapy, injection of empty vector plasmid, and untreated groups.Besides, 20 non-modeled rats were used as blank control group.Urodynamic test was performed, pelvic floor pubococcygeus muscle/muscle weight ratio was calculated, and serum biochemical indices (LDH, CK) were detected, and the morphological changes of pubococcygeus muscle fibers were observed by light microscopy at 1, 21, 42 and 63 days after treatment.Results At 21 days after treat-ment, the maximum bladder capacity, leak point pressure, the contractile force/muscle weight ratio in the IGF-1 group and electric stimulation treatment group were significantly better (P>0.05), and the differences between the IGF-1 group and electric stimulation group were not significant ( P>0.05 ) .Conclusions The effect of IGF-1 gene therapy and electric stimulation on the rat models of postpartum stress urinary incontinence is better than that in the drug therapy group and oth-er groups.

Objective To study effects of palm pressing peripherally inserted untral catheter(PICC) and mandible-pressing-on-shoulder on PICC′s misplacement in jugular veins during intubation. Methods Seventy-six patients undergoing intubation with PICC were randomized into observation group and control group equally by random digital table. The palm pressing PICC method was used in the observation group and the mandible-pressing-on-shoulder method was used in the control group. The two groups were compared in terms of the incidence of PICC misplacement. Result The misplacement rate of PICC in the experiment group was significantly lower than that in control group (P<0.01). Conclusion Palm pressing method is much effective in prevention of PICC misplacement in jugular veins and worth promoting especially in hospitals of basic level.

A detailed review is given in this paper on various current 3D display methods for sequential 2D medical images and the new development in 3D medical image display. True 3D display, surface rendering, volume rendering, 3D texture mapping and distributed collaborative rendering are discussed in depth. For two kinds of medical applications: Real-time navigation system and high-fidelity diagnosis in computer aided surgery, different 3D display methods are presented.
Algorithms ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods

Objective: Numerous studies have shown that bone marrow-derived mesenchymal stem cells (MSCs) enhance neurological recovery after cerebral ischemia. However, the mechanisms are still not clear. The present study aimed to investigate the beneficial effects of MSCs on global cerebral ischemia induced by cardiac arrest (CA) and the underlying mechanisms. Methods: Rats subjected to asphyxial CA were injected intravenously with MSCs (5×106 ) at 2 hours after resuscitation. Whole brain histopathologic damage scores (HDS) were assessed by histopathology at 3 and 7 days after resuscitation. The distribution of donor MSCs in the brain was evaluated. The expression of tumor necrosis factor-α-induced protein 6 (TSG-6) and pro-inflammatory cytokines in cerebral cortex was assayed. After intravenous infusion of TSG-6 siRNA-MSCs, HDS and pro-inflammatory cytokines were reevaluated at 7 days after resuscitation. Results: Intravenously administered MSCs significantly reduced whole brain HDS after global cerebral ischemia. Immunofluorescence microscopy revealed that donor MSCs were primarily found in cerebral cortex and expressed TSG-6. MSCs treatment significantly increased the expression of TSG-6 and reduced the expression of pro-inflammatory cytokines in cerebral cortex. In addition, intravenous infusion of TSG-6 siRNA-MSCs failed to attenuate brain inflammation. Conclusion: Systemically administered MSCs reduced inflammatory damage to brain in rats with global cerebral ischemia via secretion of TSG-6.
Heart Arrest ; Mesenchymal Stromal Cells

Objective To evaluate the gene mutation of RANTES and CCR5 in SLE and its significance. Methods One hundred and forty-six definitive SLE patients and 159 controls were collected. SNPs of RANTES promoter and polymorphism of CCR5 were performed by PCR or PCR/RFLP assay, and further confirmed by direct DNA sequencing. Results The frequence of RANTES-403G/G compounded with 28C/C and CCR5/CCR5 was significantly different between SLE and control groups (72.6% vs 58.5%, P 0.05). Conclusions These results indicate that the two SNPs are linkage disequilibrium. Interaction of two SNPs in RANTES and CCR5 is related with SLE. RANTES-403G/G compounded with 28C/C and CCR5/CCR5 may be one of risk factors of SLE. RANTES-403A is probably related with renal damage of SLE.

Objective To detect the number of peripheral blood Treg cells and secreted IL-35 expression level in the patients with rheumatoid arthritis(RA) and to explore their correlation with RA occurrence.Methods Peripheral blood was collected from 45 cases of RA,22 cases of osteoarthritis(OA) and 26 persons undergoing healthy physical examination(control group).The number of CD4+ CD25+ foxp3+ regulatory T cells was determined by flow cytometry,while plasma IL-35 level was determined by ELISA.Then the relationship between Treg and expressed IL-35 with clinical indicators was analyzed.Results The percentage of peripheral blood Treg ceils to total CD4+T cells in the RA group was (5.65 ± 2.33)％,which was significantly increased compared with (4.12 ± 1.75) ％ in the control group(P＜0.05);the difference between the OA group and RA group was not statistically significant(P=0.086).The average fluorescence intensity of foxp3 had no statistical difference among 3 groups(P＞0.05).The higher the DAS28 score,the lower the peripheral blood Treg cells number and foxp3 fluorescence intensity.The plasma IL-35 level in the RA group [(34.22± 14.35)ng/L] was significantly lower than that in the OA group[(78.63± 24.58)ng/L] and control group [(67.56±25.43)ng/L],the difference was statistically significant(P＜0.05).The Treg number in RA patients was negatively correlated with ESR and DAS28 score(r=-0.223,-0.343,P=0.023,0.011),but had no correlation with rheumatoid factor,C-reactive protein and anti-CCP antibody.Conclusion The peripheral blood Treg cells number in RA patients is elevated,while the IL-35 level is decreased,the negative regulation ability in the patients with Treg cell function deficit is attenuated.

Objective To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital ( MPFR ) in treatment of severe pelvic organ prolapse (POP) by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures: traditional total vaginal hysterectomy with anterior-posterior colporrhaphy (TVH-APC) and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy (TVH-LC-SSLFVBR-EP). Methods Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients (group A) were treated by MPFR with polypropylene mesh application, 58 (group B) were treated by TVH-APC, and 29 patients (group C) were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied. Results (1) No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery ( P ＞ 0.05). ( 2 ) Cost hospitalization was ( 11 448 ±3049) Yuan in group A, which was significantly higher than (7262 ± 1607) Yuan in group B and (7140 ± 1817 ) Yuan in group C (P ＜ 0.05 ). (3) The length of vaginal cuff of (7.5 ± 1.4) cm in group A and ( 5.6 ± 1.1 ) cm in group C were significantly longer than (7.1±0.6) cm in group B ( P＜0.05). The width of vaginal cuff of (4.3±0.3) cm in group A was larger than (3.4±0.3) cm in group B and (3.3±0.4) cm in group C (P＜0.05). (4) The recurrence rate at 12 months after surgery was 12.8% (11/86)in group A, which was similar with 17.2%(5/29) in group C (P＞0.05) and significantly less than 36.2% (21/58) in group B (P＜0.05). The rate of active sexual life of 16.3% (14/86) in group A was significantly higher than 1.7% (1/58) in group B and 0 in group C ( P ＜ 0. 05 ). The index of life quality improvement at 12 months after surgery was 48±12 in group A, which was no less than 53±16 in group C ( P＞0.05) and higher than 27 ± 9 in group B ( P＜0.05). (5 ) Mesh rejection was observed in 6 patients in group A within 3 months after surgery, while the posterior vaginal wall was exclusively involved. No difference was found in urinary retention or urinary incontinence among three groups (P ＞0. 05 ). (6) The severe degree of POP, type of surgical procedure ( TVT-APC), anterior compartment defect of pelvic floor,and early days of performing pelvic floor reconstruction surgeries were high risk factors for POP recurrence (P＜ 0.05). Conclusions MPFR has a better curative effect and lower recurrence rate on patients with POP. It can help patients regain integrity of anatomical structure and functions of pelvic floor. TVH-LCSSLF-VBR-EP is also effective.

PURPOSE: Transvaginal mesh (TVM) results in a greater anatomic cure but more complications. We aimed to compare laparoscopic sacrocolpopexy (LSC) plus colporrhaphy with the small intestine submucosa (SIS) graft versus TVM for advanced pelvic organ prolapse (POP).
Cohort Studies ; Humans ; Intestine, Small ; Pelvic Floor ; Pelvic Organ Prolapse ; Polypropylenes ; Prolapse ; Retrospective Studies ; Transplants

Objective To investigate the clinical efficacy of bone filling mesh bag combined with pedicle anchoring for the treatment of Stage Ⅲ reducible Kummell disease.Method The 35 paients with Stage Ⅲ reducible Kummell disease were treated with bone filling mesh bag combined with pedicle anchoring from January 2018 to December 2022.The operation Time,intraoperative blood lose,bone cement injection volume and surgical complications were recorded.The VAS score,ODI value,kyphosis Cobb angle and midline height of the injured vertebral were compared at preoperative,postoperative 1 day and last follow-up.Results All patients were followed up for 12-24 months[(15±3.5)months].Operation time was 35-63 min[(45±5.8)min],intraoperative blood loss was 10-35 ml[(20±5)ml],bone cement injection volume was 4.5-7.8 ml[(5.5±1.8)ml].There were 4 cases of bone cement leakage,there were 1 case of intervertebral leakage,2 cases of lateral leakage,1 case of anterior leakage and no patient with intracanal leakage.All bone cement leakage did not lead to clinical symptoms,bone cement poisoning and pulmonary embolism.No cement mass slip.All patients were followed up for 12 to 24 months[(15±3.5)months].VAS scores and Oswestry Disability Index(ODI)values were significantly lower on the first day after surgery than before surgery,with statistical significance(P＜0.05).The 3-month follow-up was slightly higher than that on the first day after surgery,and the difference was not statistically significant(P＞0.05).The midline height and Cobb Angle of the injured vertebra were measured by imaging.The height of the injured vertebra recovered significantly on the first day after operation,and the Cobb Angle decreased significantly,the difference was statistically significant(P＜0.05).The midline height of the injured vertebrae decreased and the Cobb Angle increased slightly at 3 months after the operation,but the difference was not statistically significant(P＞0.05).Conclusion In the the treatment of Stage Ⅲ reducible Kummell disease,Bone filling mesh bag combined with Pedicle anchoring have good clinical efficacy,which can significantly reduce the pain of patients,relieve clinical symptoms,improve spinal function,improve quality of life,and reduce the incidence of bone cement leakage and slippage.