Objective By comparing the effects of different combined therapy,to explore the best therapy in prevention of intrauterine adhesions (IUA)after Transcervical resection of adhesions (TCRA).Methods Eighty patents with serious or moderate IUA were randomly divided into four groups.Group A:Artificial cycle combined with ball pouch,sodium hyaluronate gel.Group B:artificial cycle combined with intrauterine device(IUD),sodium hyalur-onate gel.Group C:large doses of estrogen drugs combined with ball pouch,sodium hyaluronate gel.Group D:large doses of estrogen drugs combined with IUD,sodium hyaluronate gel.Postoperative patients of TCRA were treated by the four therapies respectively for three months.All patients came back for hysteroscopy in one month and three months after operation.Results Following -up period was 6 -12 months.After three months treatment,the total endometrial cavity cure rate was 21.3%(17 /80),the total effective rate was 67.5%(54 /80).The cure rate of group C was 45.0%,which was obviously higher than those of the other three groups,the differences were statistically insig-nificant(group C vs.group A,χ2 =4.29,P <0.05;group C vs.group B,χ2 =6.14,P <0.05;group C vs.group D,χ2 =4.27,P <0.05).After three months treatment,the endometrial thickness were measured during ovulatory period. The thickness of group C was obviously thicker than those of the other three groups,the differences were statistically insignificant(group C vs.group A,t =10.28,P <0.01;group C vs.group B,t =12.80,P <0.01;group C vs.group D,t =5.02,P <0.01).Five months after the operation,in the aspect of menstrual blood volume,the total cure rate was 23.8%(19 /80),the total effective rate was 71.3%(57 /80).And the cure rate of group C was 45.0%,which was obviously higher than those of the other three groups,the differences were statistically insignificant(group C vs. group A,χ2 =4.29,P <0.05;group C vs.group B,χ2 =6.28,P <0.05;group C vs.group D,χ2 =4.27,P <0.05).Conclusion The therapy of large doses of estrogen drugs combined with ball pouch and sodium hyaluronategel can significantly improve the prognosis of serious or moderateIUA,and better than other combined therapies.

Objective:To investigate the role of serum inflammatory cytokines in the development of acute coronary syndrome (ACS). Methods: All of enrolled patients were diagnosed by clinical and coronary angiographic features and divided into four groups, the acute myocardial infarction (AMI) group, unstable angina pectoris (UAP) group, stable angina pectoris (SAP) group and control group. The values of high-sersitivity C-reactive protein(hs-CRP), matrix metallopeptidase 9(MMP-9) and tumor necrosis factor-a (TNF-a) in serum were measured by cytokine detection equipment system (B10-RAD Biological Technology Co.Ltd, USA) and analysed in four groups with statistics. Results: Compared with SAP and the control groups, the levels of TNF-a and MMP-9 were increased significantly in AMI group(P <0.01). The level of serum hs-CRP was significantly higher in AMI group than that in UAP, SAP and control groups (P < 0.05). There were no differences in the levels of hs-CRP and MMP-9 between UAP, SAP and control groups (P> 0.05). It was found that there was positive relation between hs-CRP, MMP-9 and TNF-a by Pearson correlation analysis. Conclusion:There was obvious relation between coronary heart disease and inflammation. The cytokines characterized by the increases of hs-CRP, TNF-a and MMP-9 were involved in the formation and progression of atherosclerosis and served as markers of unstable plagues.

Objective:To study the risk factors of massive bleeding in patients with acute Stanford type A aortic dissection undergoing moderate hypothermic circulatory arrest repair.Methods:From January 2016 to October 2017, 486 consecutive patients with acute type A aortic dissection were included in the study. All operations were performed with moderate hypothermic circulatory arrest. The basic clinical data of patients were collected retrospectively. Massive bleeding was defined according to definition of Universal Definition of Perioperative Bleeding(UDPB) 4 class and the Blood Conservation Using Antifibrinolytics in a Randomized Trial(BART). Significant variables in univariate analysis were included in multivariate logistic regression analysis. Results:Thirty-four patients(7.00%) died in hospital. A total of one hundred and eighty-seven patients(38.48%) fulfilled criteria of the definition of BART massive bleeding. Forty-five patients(9.26%), 8 patients(1.65%), 114 patients(23.46%), 147 patients(30.25%) and 172 patients(35.39%) were in grade 0, grade 1, grade 2 and grade 4, respectively. With BART as the end point, the result of multivariate logistic regression showed that female gender( OR=3.32, P<0.001), anemia( OR=2.24, P=0.04), clearance creatine≤85 ml/min( OR=1.93, P=0.01), D-dimer level(every 500 ng/ml increase, OR=1.02, P=0.003), cardiopulmonary bypass(CPB) time( OR=1.01, P<0.001), total arch replacement(TAR, OR=2.40, P=0.02) were independent risk factors for massive bleeding, and the time from onset to operation( OR=0.86, P=0.01) was protective factor. With UDPB 4 class as the end point, multivariate logistic regression showed that creatinine clearance≤85 ml/min( OR=2.05, P=0.001), CPB time( OR=1.01, P=0.04) were independent risk factors for massive bleeding. The time from anset to operation( OR=0.85, P=0.002) and Bentall procedure( OR=0.65, P=0.04) were the protective factors. Conclusion:Massive bleeding was more common in acute Stanford type A aortic dissection. Female gender, poor preoperative renal function, high D-dimer level, early time accepting surgical operation and long CPB were independent risk factors. For high-risk patients, simple and effective surgical methods should be taken to reduce the risk of bleeding.

Objective To explore the risk factors of renal replacement therapy for acute Stanford A aortic dissection patients with acute renal injury (AKI) after Sun's operation.Methods From January 2016 to October 2017,144 patients with Stanford A aortic dissection who underwent Sun's procedure were enrolled in the study.Univariate analysis and logistic regression analysis were used to analyze the risk factors of continuous renal replacement therapy (CRRT).Variables with statistical difference from univariate analysis were included in multivariate logistic regression analysis.Results 8 patients (5.55％)died in hospital.16 patients (11.11％) needed CRRT for AKI.5 of them (31.25％) died in hospital.Of the 11 surviving patients,5 had complete recovery of renal function within 2 weeks after operation and stopped renal replacement therapy.The remaining 6 patients recovered their renal function within 3 months and stopped renal replacement therapy.Univariate analysis showed that there were significant differences in preoperative age,creatinine clearance,peripheral white blood cell count,D-dimer,myoglobin,double renal arteries in false lumen,aortic cross clamp time and red blood cell transfusions between the two groups.The above risk factors were included in multivariate logistic regression.The results showed that double renal arteries in false lumen (OR =24.64,P =0.002),serum creatinine clearance ＜ 85 ml/min (OR =4.99,P =0.02) and red blood cell transfusions (OR =1.17,P ＜ 0.001) were independent risk factors.Conclusion Double renal arteries in false lumen,serum creatinine clearance ＜ 85ml/min and red blood cell transfusions were independent risk factors for CRRT after Sun's procedure for acute Stanford A aortic dissection.For high-risk patients with double renal arteries in false lumen,and markedly decreased creatinine clearance before operation,red blood cell transfusions should be reduced as much as possible to reduce the risk of AKI after operation.