Objective To study the feasibility,safety,and efficacy of hysteroscopic treatment of submucous leiomyomas and endometrial polyps.Methods Hysteroscopic resections were performed in 38 cases of submucous leiomyomas and 40 cases of endometrial polyps from January 2002 to July 2004,including 31 cases of transcervical resection of myoma(TCRM),7 cases of TCRM combined with transcervical resection of the endometrium(TCRE), 35 cases of transcervical resection of polyp(TCRP),and 5 cases of TCRP combined with TCRE.Results The operation was completed smoothly on one session in all the 78 cases.The intraoperative blood loss was ≥ 400 ml in 2 cases.There were 1 case of overhydration.No uterine perforation or infection occurred after operation.The patients were followed at 1,3,6,and 12 months after operation,respectively,and the surgical outcomes were assessed at 12 postoperative months.Follow-up findings revealed 8 cases of amenorrhea(10.3%),12 cases of irregular spotting(15.4%),33 cases of hypomenorrhea(42.3%),22 cases of normal menstrual flow(28.2%),and 3 cases of no improvement(3.8%).Conclusions Hysteroscopic resections for submucous leiomyomas and endometrial polyps offer advantages of good reliability and fewer complications,being worthy of recommendation.

Objective To develop a knee joint impact device to produce animal model of subchondral bone micro-fracture in rabbits.Methods A knee joint impact device was designed. 12 New Zealand rabbits were divided into group A (n=6) and Group B (n=6). In the group A, 6 patellar-femoral joints of the 6 rabbits were impacted (1.74 kg from height of 30 cm). In the group B, 6 femoral condyles of the 6 rabbits were impacted (1.14 kg from height of 28 cm). All the rabbits were evaluated with X-ray and MRI post injury. The femora of all the rabbits were observed with HE staining. Results No fracture line was found in all the animals with X-rays. The MRI of the 6 knee joints in the group A showed low signal intensities on T1 weighted, T2 weighted and fat suppression images. Histopathology demonstrated integrated cartilage and sunchondral bone plate, micro-fractures of cancellous and bleeding in marrow. The MRI of the 5 knee joints in the group B showed low signal intensities on T1 weighted images and high signal intensities on T2 weighted and fat suppression images. Histopathology demonstrated integrated cartilage and sunchondral bone plate, micro-fractures of cancellous and bleeding in marrow. No disorder was found with MRI and histology in the contral sides. Conclusion The impact device of the knee joint can produce controllable and reproducible subchondral bone micro-fracture in rabbits.

Objective To analyze the risk factors of hypoxemia after coronary artery bypasses grafting (CABG) along with cardiopulmonary bypasses and to understand the regular pattern and characteristics of hypoxemia after CABG. Methods The risk factors of hypoxemia were studied by one way analysis and multivariate logistic regression analysis in 86 patients with hypoxemia after CABG along with cardiopulmonary bypass. Results One way analysis indicated that hypoxemia after CABG along with cardiopulmonary bypass was related to senility ( ≥ 65 years ), smoking history, diabetes mellitus, chronic obstructive pulmonary disease ( COPD), left ventricular ejection fraction ( LVEF ＜ 45 % ), obesity before operation, transfusion ( ≥ 1000 ml );multivariate analysis indicated that pulmonary dysfunction before operation, longer extracorporeal circulation time ( ≥2 h), hypoalbuminemia and pulmonary infection were independent risk factors of hypoxemia after CABG along with cardiopulmonary bypass. Conclusion Multiple risk factors contributed to hypoxemia after CABG along with cardiopulmonary bypass. Increase the awareness of risk factors of perioperative hypoxemia may guide the prevention and treatment, even alleviate or avoid the hypoxemia postoperatively.

ObjectiveTo investigate the characteristics of knee stiffness and the results of rehabilitation after the fractures of distal femur （DF）, tibial plateau （TP） or patella （PF）. Methods70 cases with knee stiffness after DF, TP or PF were analyzed retrospectively. ResultsNo significant difference was observed in passive range of motion (PROM) among three groups (F=1.671，P=0.196) before rehabilitation. The differences were significantly different (F=19.264, P=0.000) 8 weeks after rehabilitation. Further LSD analysis revealed that there was significant difference between DF and TP (P=0.000) as well as DF and PF (P=0.000), but no significant difference was observed between TP and PF (P=0.114). ConclusionThe outcome of rehabilitation is associated with the locations of fracture, and the distal femoral fractures is the worst.

Objective To compare the clinical efficiency of endoscopic thyroidectomy by breast approach with conventional open thyroidectomy in patients with benign thyroid tumor. Methods Ninety-one patients of thyroid adenoma or adenomatous goiter underwent endoscopic thyroidectomy (group endoscopy) , Ninety-nine patients underwent conventional open thyroidectomy (group open). Operative time, blood loss, the volum of drainage, time of hospital stay and postoperative stay, postoperative complications and analgesic requirements, time taken to return to normal activity and total fee were compared. Results There were no significant differences in operative time, time of stay and postoperation stay between the two groups. Blood loss was significantly less in group endoscopy (27. 7?17. 4) ml than in group open [ (96. 8?84. 8) ml, P

Objective To study the impact of the off-pump coronary artery bypass compared to the on-pump coronary artery bypass technique on the rate of acute kidney injury.Methods A retrospective analysis of 824 patients accepted coronary artery bypass surgery in FuWai Hospital Surgical ICU from March 2011 to January 2013.Patients were divided into two groups according to the surgical approach,597 patients in on-pump group and 227 patients in off-pump group.Then compared the difference of acute kidney injury incidence in the two groups.Results 92 patients in the on-pump group occurred AKI,the incidence of AKI was 15.4％.32 patients in the off-pump group occurred AKI,the incidence of AKI was 14.1％.Two groups of patients had no statistical difference in the incidence of AKI,x2 =0.222,P =0.638.Based on the preoperative baseline creatinine clearance levels.We defined normal creatinine clearance (SCR ≥ 60 ml/min),mild renal insufficiency (45 ml/min ＜ SCR ＜60 ml/min),moderate renal dysfunction group(31 ml/min ＜ SCR ＜45 ml/min).Decline with the preoperative creatinine clearance rate,the AKI incidence was elevated significantly,P ＜0.05.Patients with moderate renal insufficiency,offpump patients had lower incidence of AKI than those in on-pump group,P ＜ 0.05.The incidence of renal replacement in the two group patients had no statistical differences.Conclusion The incidence of AKI after coronary artery bypass surgery had no statistical differences with or without pump.In the patients with preoperative moderate renal insufficiency,off-pump can reduce the incidence of AKI,but could not change the kidney the incidence of renal replacement treatment.

Objective: To isolate and identify exosomes from human serum, explore the feasibility of exosomal CEA for the diagnosis of colorectal cancer. Methods: Retrospective study.64 cases with colorectal cancer patients(41 cases with normal CEA results and 23cases with high CEA results), 20 cases with benign colorectal diseases patients and 40 cases with healthy people of department of physical examination from October 2015 to December 2016 in Tongji Hospital of Tongji University. Exosomes were isolated from these serum using ExoQuick, and then identified by using transmission electron microscopy, and Western Blot for morphology and molecular phenotype.The serum level of CEA and exosomal CEA was measureed by enzyme linked immunosorbent assay (ELISA). The diagnostic efficacy of serum Exosomal CEA concentration in the colorectal cancer by using U test and the subject work characteristic curve (ROC). Results: Exosomes in human serum was successfully extracted with ExoQuick kit.Exosomal CEA concentration in 64 cases with colorectal cancer patients (1 056.36-28 637.78)pg/ml was significantly higher than in cases with benign colorectal diseases patients (394.61-2 437.83)pg/ml and healthy controls(610.89-2 076.70)pg/ml(U=124.000, U=119.000, P<0.01). Exosomal CEA concentration in 41 colorectal cancer patients with normal serum CEA concentration(1 056.36-5 832.07)pg/ml was significantly higher than in benign colorectal diseases patients and healthy controls(U=113.000, U=119.000; P<0.01). ROC analysis of exosomal CEA yielded an AUC(area under the ROC curve)of 0.954(95% CI=0.919-0.988), which was higher than the serum CEA.The area under the ROC curve of serum Exosomal CEA concentration for colorectal cancer diagnosis is 0.954(95% CI=0.919-0.988), which is superior to the serum CEA concentration[0.636 (95% CI=0.531-0.742)]. Conclusions Isolation and detection of serum Exosomal CEA concentrations have a good diagnostic efficacy in colorectal cancer. It′s possible to be a marker for early diagnosis of colorectal cancer.(Chin J Lab Med, 2018, 41: 503-508)

Postoperative asymptomatic patients with early cancer (lung cancer) have dormant disseminated tumor cells (DTCs) in their metastatic target organs, and the proliferation of these DTCs is the key link leading to clinical metastasis. The development of therapeutic agents to maintain DTCs dormant or eradicate dormant DTCs will prevent tumor metastasis and break through the bottleneck of improving the overall efficacy of treating malignant tumors. This paper reviews the methods of establishing in vitro and in vivo research models of DTCs with dormant characteristics to promote the understanding of dormant DTCs and improve the research and development efficiency of anti-tumor metastasis drugs.

Objective: To analyze the morbidity, clinical characteristics, therapeutic outcomes and prognosis of cardiac lymphoma. Methods: Individual patient data were obtained from pathology defined 10 cases of cardiac lymphoma from Jan 2000 to Jun 2016. The patient’s general information, clinical manifestation, pathological diagnosis, laboratory examination, cardiac involvement feature, cardiac complications, treatment, therapeutic effect and prognosis were analyzed. Results: Of 3 918 cases of lymphoma patients, 10 cases of cardiac involvement were identified, including primary cardiac lymphoma (PCL) in 1 case, secondary cardiac lymphoma (SCL) in 9 cases. Of the 10 patients in our analysis, the male-to-female ratio was 3∶2, with a median age of 55 (19-88) years old. The most presenting complaints were dyspnea in 7 cases, followed by chest pain in 5 cases, fatigue in 2 patients and edema in 2 cases. Pathological types included diffuse large B cell lymphoma (DLBCL) in 7 cases, T cell lymphoma (T-LBL) in 1 case, Hodgkin’s lymphoma (HL) in 1 case, and Burkitt lymphoma (BL) in 1 case. The sites of the heart affected by lymphoma in the PCL patient were right and left atriums with multiple nodules; and for SCL, the sites were mainly pericardium associated with a pericardial effusion in 5 cases, a pericardial mass in 2 cases. Congestive heart failure affects 7 patients and cardiac arrhythmias were identified in 4 cases mainly sinus tachycardia, atrial fibrillation and atrioventricular block. Except one untreated because of old age and poor performance, the rest of 9 patients were treated by either chemotherapy in 4 cases or chemotherapy combined radiotherapy (including the extracardiac sites) in 5 patients. With the median follow-up of 9 months, the one PCL patient achieved partial response (PR) , progress free survival (PFS) for 6 months and the overall survival (OS) for 21 months; in the cohort of 6 SCL patients cardiac involved at diagnosis, complete response (CR) was achieved in 1 case (16.7%) , PR in 3 cases, progressing disease (PD) in 2 cases, with the median PFS for 5 months and the median OS for 19 months; and for the other 3 SCL patients cardiac involved at progression, PR was achieved in 2 case and death in 1 case, with the median PFS for 4 months and the median OS unavailable because of censored data. Conclusion Cardiac lymphoma represents a rare subset of lymphoma, the most common type is DLBCL, and the main clinical manifestations are dyspnea and chest pain, always combined by arrhythmia and congestive heart failure. The main therapeutic regimen for cardiac lymphoma includes combined chemotherapy and the prognosis for patients with either PCL or SCL is usually poor.

Objective: To investigate the risk factors of poor graft function (PGF) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia (SAA) . Methods: Clinical data from 111 SAA patients who received allo-HSCT were analyzed retrospectively. Factors including age, gender, interval to transplantation, the level of serum ferritin before transplantation were analyzed by Cox multivariate regression analysis. Results: Among the 111 patients who underwent allo-HSCT, 16 developed PGF (14.4%) . Multivariate analysis showed donor type (HR=2.656, 95%CI 1.204-5.858, P= 0.016) and the level of serum ferritin before tansplantation (HR=3.170, 95%CI 1.400-7.180, P=0.006) were significant risk factors for PGF. Conclusion Unrelated donor transplantation and the high level of serum ferritin before transplantation are risk factors for PGF.