Objective To study safety and values of laparoscopic surgery in the management of gynecological diseases in senile women.Methods Clinical data between 27 cases of laparoscope surgery(Laparoscopic Group) and 25 cases of open surgery(Open Group) from January 2001 to December 2006 were retrospectively compared.Results The operation time in the Laparoscopic Group(20.0?7.9) min was significantly shorter than that in the Open Group(44.0?7.2) min(t=-11.419,P=0.000);the blood loss in the Laparoscopic Group(21.9?20.0)ml was distinctively less than that in the Open Group(62.6?29.4)ml(t=-5.875,P=0.000);the postoperative pyrexia in the Laparoscopic Group(3 cases) was significantly less than that in the Open Group(12 cases)(?2=8.606,P=0.001);the time to first flatus in the Laparoscope Group(13.9?2.9)h was significantly shorter than that in the Open Group(23.4?4.3)h(t=-9.404,P=0.000);hospital stay in the Laparoscope Group(7.6?0.9) d was significantly shorter than that in the Open Group(10.2?1.2) d(t=-8.882,P=0.000).Conclusions On the basis of intensive treatment of preoperative complications and perioperative monitoring,laparoscopic surgery is an ideal procedure for benign gynecological diseases in senile women.

Objective To determine the efficacy and safety of hysteroscopic resection with dipolar electrodes for submucous myoma of the uterus. Methods By hysteroscopy combined with B-ultrasonography,totally 456 cases of submucous myoma of the uterus were confirmed in our hospital from January 1998 to December 2007. Among the patients,241 cases showed type 0,138 patients were type Ⅰ,and 77 cases were type Ⅱ. In 341 of the cases,the myoma sized 1.0 to 2.0 in diameter,86 cases from 2.1 to 4.0 in diameter,and the other 29 cases had the myoma ranged from 4.1 to 6.0 cm in diameter. Hysteroscopic resection with dipolar electrodes were performed on all the cases,among which microelectrode was used in 341 patients,and ring electrode was employed in 115 cases. Results The operation time ranged from 9 to 55 min with a mean of (32.9?16.7) min. The removed tissues weighed (30.2?8.2) g in average (ranged from 5 to 55 g). During the operation,the patients had 5 to 100 ml blood loss [mean,(48.1?12.7) ml]. No complications occurred during and after the operation. The patients were followed up for three months,during which 431 (94.5%) showed reduced menstruation and decreased menstrual blood loss,only 5 patients (1.1%,all were type Ⅱ) had residual myoma. In this series,totally 42 patients wished pregnancy,15 of them became pregnant in 24 months postoperation. After the treatment,anemia was corrected in 206 patients with the level of Hb increased to a normal range;before the operation,81 patients had menstrual pain,42 of them were relieved and 19 were improved by the operation,while the other 20 showed no changes in the symptoms. Conclusion Hysteroscopic resection with dipolar electrodes is safe and effective for uterine submucous myoma.

Objective To explore the clinical value of total laparoscopic hysterectomy(TLH).Methods Retrospective analysis was conducted on clinical data of 38 cases of TLH(Laparoscopic Group)and 40 cases of total abdominal hysterectomy(Open Group)from November 2005 to October 2006 in our hospital,to compare operative time,intraoperative blood loss,the incidence of postoperative pyrexia,recovery time of bowel movement,and hospital stay in both groups.Results The operative time in the Laparoscopic Group(85.8?13.8)min was significantly shorter than that in the Open Group(99.3?9.3)min(t=-5.923,P=0.000).The blood loss was significantly less in the Laparoscopic Group(105.8?32.4)ml than that in the Open Group(166.0?67.4)ml(t=-4.930,P=0.000).The incidence of postoperative pyrexia was distinctively lower in the Laparoscopic Group(3 cases)than that in the Open Group(15 cases)(?2=9.270,P=0.002).The time to first flatus was significantly shorter in the Laparoscopic Group(26.2?4.2)h than that in the Open Group(40.5?4.9)h(t=-13.601,P=0.000).The postoperative hospital stay in the Laparoscopic Group(6.8?0.9)d was distinctively shorter than that in the Open Group(10.6?0.8)d(t=-19.612,P=0.000).Follow-up examination for six months showed that two cases of poor healing of incision and two cases of vaginal residual granulation in the Open Group and one case of vaginal residual granulation in Laparoscopic Group,and no other complications were found.Conclusions TLH gets the advantage over total abdominal hysterectomy.If surgeons are familiar with the laparoscopic operative skills,TLH can be an ideal procedure for hysterectomy.

Objective:Combined laparoscopy and hysteroscopy in the diagnosis and therapy of the female infertity is and advanced means in the gynecologcial field.We analysed the causes and the treatments of the 71 infertile patients.Pelvic adhesions,endometrosis and salpingtis were the main causes of infertity in our 71 cases.Of 71 cases,29 cases were primary infertity,in whichc endometriosis,PCOS and anatomic uterine defect were the main causes,and 42 cases were secondary infertity,in which 35 cases (83%) had previous intrauterine operations.All the patients were treated for the causes.We concluded that combined laparoscopy and hysteroscopy can diagnose the causes of infertity and can observe the tubal patency by hysteroscopic tubal cathertetization and hydrotubation,which will direct the treatments and estimate the results of the therapy.Methods:Infertity;Combined Laparoscopy and Hysteroscopy.

Cerebral arteriovenous malformation (AVM) is a common cerebrovascular disease in clinical practice. Although the treatment of AVMs has been w idely studied, the prognosis of the patients does not get significantly improvement. The main therapeutic purpose of AVMs is to reduce the risk of bleeding. This article review s the risk of bleeding and treatment modalities of AVMs.

Objective To investigate the prevalence of chronic heart failure in the adult hospitalized population and to analyze the related disease burden. Methods A total of 326 chronic heart failure samples from adult inpatients in Yanliang District, Xi'an City from 2019 to 2021 were selected for analysis. The three-year epidemic situation was described and analyzed, and the information on the disease burden (hospitalization and cost, quality of life) caused by heart failure was collected, and the disease burden was preliminarily analyzed. The study used the Chinese version of the Minnesota heart failure quality of life questionnaire (Minnesota lving with heart failure questionnaire, MLHFQ) to measure the quality of life of patients during hospitalization. Results Among the patients in this study, there were 196 male patients (60.12%) and 130 female patients (39.88%), with an average age of (57.14±13.64) years, and the highest incidence was in the age group of 60-69 years. The highest proportion of cardiac function grades I to IV is grade III, and the lowest is grade I; coronary atherosclerotic heart disease is the first cause, followed by hypertensive heart disease, cardiomyopathy and rheumatism. Sexual heart valve. In addition, the patients' primary disease duration was on average (7.14±3.05) years. 26.99% of patients had blood pressure exceeding the standard during hospitalization. The average length of hospitalization of the subjects was (12.97±4.52) d, and there were significant differences in the length of hospitalization between patients with different age groups, different cardiac function grades, different primary diseases, and different primary disease durations (all P<0.05). The median medical expenses of the subjects during hospitalization were 31 373.70 (15 250.65, 47 005.15) yuan. The quality of life scores of the patients with heart failure in this study were (44.65±14.47), (35.91±12.58) in the physical domain, and (53.66±19.81) in the emotional domain. And the quality of life of male patients is lower; the quality of life of heart failure caused by dilated cardiomyopathy and hypertension is lower; the level of cardiac function increases, and the quality of life score decreases. Conclusion In recent years, the elderly inpatients with chronic heart failure in Yanliang District, Xi'an City, the middle-aged, the high-level cardiac function, the patients with cardiomyopathy and hypertensive heart disease, and the patients with the normal course of the primary disease have longer hospitalization time and higher medical expenses. Male patients, patients with heart failure caused by dilated cardiomyopathy and hypertension, and patients with higher cardiac function grades have lower quality of life.

Objective To investigate the application of peripheral perfusion index (PPI) in early diagnosis and goal-directed therapy of septic shock, and to provide reference for the early clinical diagnosis and treatment of septic shock. Methods A prospective single-blind randomized controlled trial (RCT) was conducted. Adult patients with sepsis admitted to emergency medical department and intensive care unit (ICU) of the First People's Hospital of Lianyungang City in Jiangsu Province from January 2013 to December 2016 were enrolled. The patients were randomly divided into two groups (n = 46). The PPI group was defined using PPI < 1.4 as diagnosis of septic shock standard, and PPI > 2 as treatment guide target. Control group was defined according to the traditional diagnostic criteria of shock which systolic blood pressure was less than 90 mmHg (1 mmHg = 0.133 kPa) or systolic blood pressure value decrease> 40 mmHg baseline and bundle treatment was performed. The volume of fluid resuscitation, organ dysfunction, the sequential organ failure score (SOFA), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score,continuous renal replacement therapy (CRRT) time, mechanical ventilation (MV) time, the length of ICU stay and 28-day mortality were observed. Results There were 39 and 27 septic shock patients in PPI group and control group respectively. The diagnostic criteria of traditional septic shock with blood pressure as "gold standard", the sensitivity of PPI < 1.4 for septic shock was 94.3%, the specificity was 28.2%, the authenticity was 66.3%, the positive predictive value was 64.1%, the negative predictive value was 78.6%, the positive likelihood ratio was 1.31, the negative likelihood ratio was 0.18. The per capita fluid replacement within 24 hours in the PPI group was significantly higher than that in the control group (mL: 4 601±1 250 vs. 3 458±1 006, P < 0.01), but there was no significant difference in the per capita volume of the patients diagnosed as septic shock (mL: 4 596±1 320 vs. 4 205±1 058, P > 0.05). Compared with the control group, the PPI group treated patients within 48 hours with less vascular active drugs (cases: 6 vs. 15), APACHE Ⅱand SOFA score were lower (48 hours: APACHE Ⅱ was 10.2±2.1 vs. 12.0±3.2; 72 hours: SOFA was 5.1±1.8 vs. 6.0±2.1, APACHE Ⅱ was 8.9±1.8 vs. 9.8±2.2), the period of CRRT and the length of ICU stay were shorter [the period of CRRT (days): 3.0±0.9 vs. 3.6±1.4, the length of ICU stay (days): 5.2±2.1 vs. 6.3±2.9), the difference was statistically significant (all P < 0.05). There was no significant difference in the liver and kidney function index, arterial blood lactic acid (Lac), MV time (days: 3.3±1.4 vs. 3.5±1.2) and 28-day mortality (15.22% vs. 19.57%) between two groups (all P > 0.05). Conclusions The inadequacy of microcirculatory perfusion by oximetry-derived PPI is more sensitive to the diagnosis of septic shock than hypotension of systemic circulation. With PPI guiding the fluid resuscitation of septic shock patients, vasopressors can be withdrawn earlier and the duration of the CRRT and ICU can be decreased.

ObjectiveTo assess the specificity of P50 auditory-evoked potential in schizophrenic patients with violent and aggressive behaviors， so as to provide objective biological markers for predicting violent behaviors of schizophrenic patients. MethodsA total of135 schizophrenic patients who met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） were divided into aggressive group （n=70） and non-aggressive group （n=65） according to the assessment results of the Modified Overt Aggression Scale （MOAS）， meantime， another 60 healthy individuals matched for age and gender were set as healthy group. Then the P50 auditory-evoked potentials of all selected individuals were measured using EP/EMG system （MEB-9200， Nihon Kohden， Japan）. ResultsAmp S2 of the aggressive group was significantly higher than those of the non-aggressive group and healthy control group， with statistical differences ［（9.86±6.04）μV vs. （7.06±3.88）μV， P=0.004； （9.86±6.04）μV vs. （7.82±3.87）μV， P=0.031］. The proportion of S2/S1 ratio ≥0.5 was 72.88%， 43.86% and 30.00% in aggressive group， non-aggressive group and healthy group， which was the highest in aggressive group， with statistical differences （P<0.01）. The amplitude difference of P50 （S1-S2） of the aggressive group was lower than those of the non-aggressive group and the healthy control group， the differences were of statistical significance ［（4.35±9.39）μV vs.（9.89±8.48）μV， P=0.001； （4.35±9.39）μV vs.（13.42±9.81）μV， P<0.01］. ConclusionThe violent and aggressive behaviors in schizophrenic patients may be related to the sensory gating deficit.