Objective To explore the modified mesh in female pelvic floor reconstruction for pelvic organ prolapse and clinical effects of the application.Methods 78 patients with pelvic organ prolapse,line modified mesh pelvic floor reconstruction surgery(study group)and vaginal hysterectomy and vaginal repair of anterior and posterior wall(control group)treatment,clinical efficacy was compared.Results The mean operating time,blood loss,average body temperature,catheter indwelling time,residual urine volume,and postoperative hospital stay showed no significant difference(P＞0.05).No postoperative infection,vaginal hematoma,mesh erosion occurred.Two groups of patients before discharge degree of POP-Q points are 0°or Ⅰ degree,to cure the standard.Vaginal length of the control group was significantly shorter than after treatment(P＜0.05),while no significant change in the observation group(P＞ 0.05).Control group,the recurrence rate was significantly higher than the observation group(P＜0.05),while the observation group of sexual satisfaction was better than the control group(P＜0.05).Conclusion The modified mesh treatment of female pelvic floor reconstruction is an effective method of pelvic organ prolapse,the surgical curative effect is better,the recurrence rate is lower,worthy of clinical application.

Objective To study the effect of self-efficacy on learning effect of medical students.Methods Self-efficacy scores of the questionnaire to clinical medical students who practice in our hospital from September 2012 to April 2013 were measured.Students with score lower than the average were recruited into group A,and the others were recruited into group B.Then the scores of both-group students in the process of clinical practice,the theoretical knowledge,and triguaiacyl tests were gotten for statistical analysis.Results Group B (88.02 ± 3.902; 89.02 ± 3.902; 89.94 ± 3.794) were significantly better than group A (67.07 ± 5.131,66.02± 5.866,65.23 ±6.741) in the scores of the theory of knowledge,operation skills and triguaiacyl test.The correlation analysis showed that self-efficacy was positively related to these three aspects (P=0.032,0.024,0.001).Conclusion Clinical teachers should consciously improve students' self-efficacy in the process of their clinical practice,in order to improve the learning effect of the clinical medical students preferably.

Objective To evaluate the feasibility,safety and short-term outcome of laparoscopic-assisted surgery for colorectal cancer.Methods From August 2001 to November 2004,laparoscopic resection of colorectal carcinoma were performed in 112 cases,including right hemicolectomy(n=23),left himicolectomy(n=7),radical resection of sigmoid cancer(n=15),Dixon procedure(n=49),and Miles procedure(n=18).Results One hundred and five patients underwent laparoscopic resection successfully,7 cases were converted to open surgery because of hemorrhage,obesity or adhesion with adjacent organ,6 of which were left colon or rectal cancer.The mean operating time was(161.2?48.6)min,and the mean operative blood loss was 78.5 mL.There were 8 cases occurred postoperative complications,and no mortality during perioperative period.The length of upper and lower segment of resection for colonic cancer was (14.5?3.2)cm and(11.0?2.6)cm respectively.The length of upper and lower segment of resection for rectal cancer was(15.3?2.7)cm and(2.8?1.6)cm,respectively.The mean number of lymph nodes dissected was(8.2?4.6),and lymph node metastases were found in 49 cases.One hundred and seven cases(95.5%) were followed up for 8-44 months,of which,7 cases had local recurrence and 6 cases had distant metastases.No case of trocar port tumor implantation was observed.Conclusions Laparoscopic surgery for colorectal cancer is feasible and safe,can result in the same outcome as open radical surgery,and has the advantages of mini-invasive procedure.

Objective To study the clinical characteristics of chronic active Epstein-Barr virus (EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV.Methods Clinical data,laboratory serology,pathological examination,treatment and follow-up results of 10 cases with CAEBV infection who were treated in Xijing Hospital of the Fourth Military Medical University from January 2008 to January 2016 were analyzed retrospectively.Results CAEBV major manifestations were continuous or intermittent fever,hepatomegaly,splenomegaly and lymphadenopathy,and others,including general fatigue,cough,hematemesis,diarrhea,skin rash,jaundice,sore throat,muscle joint pain,and so on.And with liver dysfunction,hematologic abnormality,and so on.All patients in anti-EB virus capsid antigen IgG (EBVCA-IgG)antibodies and EBEA-IgG antibodies had positive,while all patients in EBVCA-IgM antibodies had negative.The median load of EBV-DNA detected by real-time polymerase chain reaction(PCR) in the peripheral blood was 7.15× 105 copies/ml.Six of 10 cases CAEBV patients presented a poor clinical course,1 case died from intracranial hemorrhage,2 cases from respiratory failure,1 case from gastrointestinal bleeding,1 case from liver failure,1 case from severe multiple pathogens infection,rest 3 cases showed an improvement and 1 cases had a recurrence.Conclusion CAEBV infection has varieties of clinical features,with poor prognosis and high mortality.If the patients had unexplained fever,hepatomegaly,splenomegaly and lymphadenectasis,we should be timely detect virology and histopathological to diagnosis as early as possible.

Objective To explore the availability and safety of conducting low-pressure TURP assisted by a home-made cystometry and warning system.Methods 167 benign prostatic hyperplasia (BPH) patients admitted from Jan 2014 to Jan 2016 were randomly assigned into cystostomy group (group A) and non-cystostomy group (group B). In group A (n = 85), 42 patients (group A1) were performed percutaneous cystostomy + TURP, and 43 (group A2) were performed continuous flushing sheath TURP. In group B (n = 82), 42 patients (group B1) were received percutaneous cystostomy + TURP, and 40 (group B2) were received continuous lfushing sheath TURP. In group A, bladder pressure was monitored in real time with a cystometry and was monitored by bladder puncture using a home-made siphon, ensuring low bladder pressure throughout TURP. Serum Na+ levels were measured before and after operation in all four groups. The operation time, the intraoperative bleeding, the weight of resected prostates and the time before which urine turned clear were recorded. The IPSS, maximum lfow rate (Qmax), postvoid residual volume (PVR) and life quality score (QOL) were evaluated.Results While no significant differences were found between group A1 and A2, there were significant differences between group B1 and B2, indicating cystostomy group was safer than non-cystostomy group. When compared group A1 with B1, or group A2 with B2, it showed that the safe operation time to perform prostate tissue resection was longer in cystostomy group; the weight of the resected prostates was heavier; the time before which urine turned clear were shorter; and the IPSS improvement was better. These findings presented better therapeutic effects in cystostomy group than in non-cystostomy group.Conclusions This home-made cystometry and warning system could timely detect high bladder pressure state during TURP, making it possible to avoid of high pressure, ensuring low bladder pressure lfushing during the operation, lengthening the safe operation time, increasing tissue resection ratio, reducing transurethral resection syndrome, thus helping TURP to be safer.

ObjectiveTo evaluate the inter-and intra-fractional clinical target volume (CTV) positioning errors of patients receiving postoperative simplified intensity-modulated radiotherapy (SIMRT) using cone beam computed tomography (CBCT).MethodsTwelve patients with liver tumors underwent postoperative SIMRT.CBCT images were acquired before and after the treatment.The clipbox volume for registration included the fiducial markers in the tumor bed and excluded the ribs and vertebral bodies.If any translational parameter of setup error before treatment exceeded 3 mm or rotational parameter exceeded 3°,the treatment couch was adjusted and a verification CBCT was acquired to assess residual setup error.Automatic bone match was used.A total of 214 acquisitions of CBCTs in 111 groups were analyzed.Inter-fractional translational CTV positioning errors in left-right (x),superior-inferior (y) and anterior-posterior (z) axis were calculated in 111 groups,and intra-fractional translational CTV positioning errors in 70 groups.Clinical to planning target volume (PTV) margins were calculated according to the formula:margin =2.0 ∑ + 0.7σ ( ∑ is systematic error,σ is random error).ResultsInter-fractional translational CTV positioning errors in x,y and z axis were -0.03 mm,-0.43 mm,1.02 mm,with systematic error ( ∑ ) of 1.50 mm,5.89 mm,1.97 mm,and random error (σ) of 1.76 mm,4.13 mm,2.42 mm,respectively.Intra-fractional translational CTV positioning errors in the x,y,z axis were 0.04 mm,0.86 mm,- 0.46mm,with systematic error (∑) of 0.46 mm,1.14 mm,0.31 mm,and random error (σ) of 0.95 mm,1.38 mm,0.91 mm,respectively.The calculate CTV to PTV margins were 4.5 mm,15.0 mm,5.8 mm in the x,y,z axis,respectively.ConclusionsThe CTV errors were inevitable when patients with liver tumors received SIMRT.Fiducial markers placed in tumor bed during operation were helpful for accurate positioning error analysis.

Objective To evaluate the risk of locoregional recurrence ( LRR ) and role of radiotherapy for patients with estrogen receptor?negative and human epidermal growth factor receptor 2?overexpressed ( Rec?/HER?2+) locally advanced breast cancer ( LABC ) . Methods A retrospective analysis was performed on the clinical data of 294 patients with Rec?/HER?2+LABC from 1999 to 2011. All patients were treated with modified radical mastectomy ( MRM ) . Of them, 239 patients received postmastectomy radiotherapy and 55 patients did not. Locoregional recurrence?free survival ( LRRFS) and overall survival ( OS) , as well as LRR, were compared between the two groups. The Kaplan?Meier method was used to estimate survival and recurrence rates, and the log?rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate prognostic analysis was performed using the Cox regression model. Results The 5?year sample size was 162. Fifty?six patients developed LRR. The 5?year LRRFS and OS rates were 79. 7% and 70. 0%, respectively. Postmastectomy radiotherapy significantly increased the 5?year LRRFS rate ( 85. 1% vs. 56. 0%, P=0. 000) , but did not significantly increase the 5?year OS rate ( 71. 3% vs. 64. 2%, P= 0. 441 ) . Multivariate analysis indicated that postmastectomy radiotherapy was the only independent prognostic factor associated with increased LRRFS ( RR=0. 303, 95% CI:0. 166?0. 554, P=0. 000). Conclusions Patients with Rec?/HER?2+ LABC treated with MRM alone appear to be at a significantly increased risk of LRR compared with those treated with MRM followed by radiotherapy.

Objective To study levonorgestrel intrauterine system on insulin-like growth factor-1 (IGF-1) in endometri-um tissue for patients with endometrial polyps. Methods All 182 patients with endometrial polyps in our hospital from January 2010 to December 2011 were selected as research object, and randomly divided into control group(routine treatment group)94 cases and observation group(levonorgestrel intrauterine system in uterus group)88 cases. The IGF-1 expression of endometrial biopsy specimens during intraoperative and rechected after 6 months were measurd by im-munohistochemistry. Patients were followed up for 2 years to analyse endometrial polyp recurrence. Results The ex-pressions of IGF-1 decreased significant in endometrium tissue of observation group with operation. But there were no significant differences in control group. Followed up for 2 years, the endometrial polyp recurrence was 8.05% in control group and without recurrence in study group. Conclusion Levonorgestrel intrauterine system may be involved in the in-hibiting of the expression of IGF-1 then to induce the recurrence of endometrial polyps.

erall survival.

Objective To analyze the outcomes and the role of radiotherapy in breast cancer pa-tients with T1-T2 and one to three positive axillary nodes treated with modified radical mastectomy, and to investigate the prognostic factors for loco - regional recurrence in patients without radiotherapy . Methods Three hundred and seventy breast cancer patients with T1-T2 and one to three positive axillary lymph nodes treated with mastectomy and axillary dissection were retrospectively analyzed. Kaplan-Meier method was used to calculate the overall survival (OS) and loco-regional recurrence-free survival (LRFS) rates. The Logrank test was used for the comparison of the survival curves of patients with or without radiotherapy. Univariate analyses of potential prognostic variables for LRFS were performed. Results The 5-year OS and LRFS rates were 85.4% and 91%. Radiotherapy significantly improved the 5-year LRFS rate ( 100% vs. 89.5% ;x2 = 5.17, P=0.023). However, there was no significant difference in overall survival rate between patients with and without radiotherapy. In univariate analyses, T stage, the number of positive axillary nodes, C-erbB-2 and PR status were the significant predictive factors for LRFS. Conclusions For breast cancer pa-tients with T1-T2. and one to three positive axillary nodes, radiotherapy improves the LRFS, but not OS. T stage, the number of positive axillary nodes, C-erbB-2 and PR status are predictive factors for loco-regional recurrence in patients without radiotherapy.