Objective To investigate the impact of the different mode of delivery on postpartum lactation.Methods 1 678 pregnant women in our hospital were divided into cesarean section group(798 cases) and natural delivery group(880 cases).Open milk after delivery,breast fullness,the number of neonatal sucking and post-natal self-assessment milk water were compared between the two groups of pregnant women,and the impact of the mode of delivery on postpartum lactation was analyzed.Results Whether or not began to lactation (721/77cases),and the time of labor to beginning to lactation [(33.45 ± 9.68) h],and whether or not having breast fullness feeling (512/286 cases),and the time of labor to breast fullness feeling[(57.12 ± 13.90) h] in cesarean section group had significant difference with those of spontaneus labor group [(845/35 cases),(30.12 ± 10.25) h,(690/190 cases),(52.98 ±15.09) h] (x2 =21.613,t =2.452,x2 =41.813,t =2.818,all P ＜ 0.05).There was no significant difference in selfrating milk score [(2.02 ± 0.45) points vs (2.45 ± 0.51) points],and newborn sucking times 4 ～ 6d postpartum [(5.21 ±1.21) times vs (5.89± 1.82)times](t =2.012,2.532,all P ＜0.05).Conclusion Efficiency of the breast-feeding was affected by the impact of the mode of delivery.Rationalized breastfeeding guidance was necessary to strengthen for pregnant women by cesarean section.

Objiective:to summarize the early treatment of severe bifrontal intraparenchyma contusion associated with central herniation. Mehthod:clinical presentation of 41 cases of secere bifrontal contusion associated with central herniation were analyzed retrospectively. Resolts:12 cases had good overcome,13 mild morbidty,2 severe mordity,1 were in persistent vegetative state,3 mortality.Conclusions: Attaches great importance to patients with severe bifrontal brain contusion associated with central herniation,close observation of patients with their consciousness,pupil and changes in vital signs;attend that it is premature to stop dehydrating agent,too fast,to review the head dynamic CT,the right to master surgical indications.Early removal of necrotic brain tissue and cranial decompressive craniectomy to be effective in improving the cure rate of patients.

Objective To systematically analyze therapeutic effects of extracorporeal photopheresis (ECP) on refractory steroid-resistant,-dependent or-intolerant graft-versus-host disease (GVHD),to compare remission rates of skin GVHD in detail.Methods Databases were searched for studies concerning remission rates of GVHD after the treatment with ECP,and relevant data were extracted and pooled by using meta-analysis with STATA 12.0 software.Results A total of 22 literatures were reviewed,including 787 patients with refractory GVHD.Meta-analysis showed that the pooled complete remission (CR) rate and overall remission (OR) rate were 57％ (95％ CI:47％-66％) and 79％ (71％-86％) respectively in patients with acute GVHD,27％ (21％-33％) and 63％ (58％-69％) respectively in patients with chronic GVHD,77％ (71％-82％) and 87％ (82％-91％) in patients with acute skin GVHD,as well as 39％ (30％-48％) and 70％ (63％-77％) in patients with chronic skin GVHD.Conclusion ECP is an effective therapy for refractory GVHD,especially for skin GVHD.

In recent years,postoperative mortality rate of pancreatic resection has dropped below 5％,while the complication rate still remains as high as 30％ ～ 50％.Postoperative pancreatic fistula and abdominal abscess are two serious complications after pancreatic resection,with the incidence of 10％ ～28％.Deep understanding of the physiological functions of the pancreas together with the research and development of new medications has improved the prognosis of patients with pancreatic fistula.This article gave a brief overview on the progress in this regard.

Objective To determine the risk factors for postoperative acute kidney injury (AKI) in the patients undergoing cardiac transplantation.Methods Forty patients with end-stage heart failure (both sexes) , aged 13-66 yr, weighing 45-84 kg, of ASA physical status Ⅳ or Ⅴ (NYHA Ⅲ or Ⅳ), undergoing heart transplantation, with normal kidney function before operation, were selected.According to whether or not AKI occurred within 7 days after operation, the patients were divided into either AKI group or non-AKI group.Factors including age, gender, body weight, complications (including hypertension and diabetes mellitus), preoperative blood glucose, hemoglobin, serum creatinine, cardiac output, ejection fraction, pulmonary arterial systolic pressure, intraoperative cardiopulmonary bypass (CPB) time, transfusion of allogeneic red blood cells, and urine volume within 24 h after operation were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify postoperative AKI-related risk factors for this type of patients.Results A total of 39 patients were enrolled in this study.Of the 39 patients, 14 patients suffered from AKI after operation, and the incidence was 36％.The results of logistic regression analysis showed that preoperative pulmonary hypertension and CPB time ＞ 180 min were the independent risk factors for AKI after cardiac transplantation.Conclusion Preoperative pulmonary hypertension and CPB time＞180 min are the independent risk factors for postoperative AKI in the patients undergoing cardiac transplantation.

In recent years,with the continuous development of endoscopic and interventional techniques,many new devices and methods have been used in clinical practice,and the application of endoscopic retrograde cholangiopancreatography (ERCP)in biliary and pancreatic diseases has developed rapidly.This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases,including those with altered gastrointestinal anatomy,pregnant patients,patients with benign and malignant biliary strictures,and patients with pancreatic pseudocysts,as well as the application of SpyGlass,photodynamic therapy,and radiofrequency ablation,the man-agement of ERCP-related duodenal perforation,and the prevention of post-ERCP pancreatitis.All the progress has made a great contribu-tion to the diagnosis and treatment of biliary and pancreatic diseases.

Objective To explore the changes of the levels of CA-125 antigen(CA125) and vascular endothelial growth factor (VEGF) in serum and peritoneal fluid in patients with endometriosis (EMT), and the relationship with EMT. Methods One hundred and twenty patients with EMT (EMT group)and 98 patients with uterine fibroids (control group) were enrolled in this study. The levels of CA125 and VEGF in serum and peritoneal fluid were detected by enzyme linked immunosorbent assay (ELISA), and the results were compared. Results The levels of serum CA125,VEGF in EMT group were significantly higher than those in control group:(40.31±11.14) kU/L vs.(24.71±9.19) kU/L,(59.75±6.87) ng/L vs. (36.38±8.12) ng/L, there were significant differences(P<0.05). The levels of serum CA125,VEGF inⅠ-Ⅱphase andⅢ-Ⅳphase in EMT group had no significant differences ( P>0.05). The levels of peritoneal fluid CA125,VEGF in EMT group were significantly higher than those in control group:(311.46± 107.29) kU/L vs.(158.17± 55.42) kU/L,(73.28 ±10.40) ng/L vs. (40.21 ±9.84) ng/L, there were significant differences (P<0.05). The levels of peritoneal fluid CA125,VEGF in Ⅲ-Ⅳ phase were significantly higher than those in Ⅰ-Ⅱ phase in EMT group:(387.41±70.91) kU/L vs. (308.42±81.21) kU/L, (69.22±7.13) ng/L vs. (55.44±8.23) ng/L, there were significant differences (P<0.05). In EMT group, the levels of CA125 and VEGF in serum were significantly lower those in peritoneal fluid:(40.31±11.14) kU/L vs. (311.46±107.29) kU/L, (59.75±6.87) ng/L vs. (73.28 ±10.40) ng/L, there were significant differences (P<0.05). Conclusions The levels of CA125 and VEGF in serum and peritoneal fluid are closely related to EMT. Peritoneal fluid in monitoring of EMT may be more sensitive and reliable than serum.

Osteoarthritis (OA) is the most common form of arthritis, and is the major cause of pain and chronic disability worldwide, causing enormous social and economic burden.Once OA was considered as a 'wear-and-tear' condition and obesity is considered to be one of the most powerful predisposing factors of OA in the weight-bearing joints.However, studies have also linked obesity to OA in non-weightbearing areas, suggesting systemic effects exerted by metabolic factors other than simple local biomechanics perhaps play a role in the high prevalence of osteoarthritis in obese population.Recent studies have shown that systemic metabolic abnormalities, including obesity, diabetes, hypertension, lipid metabolism disorders, atherosclerosis and cardiovascular disease, play an important role in OA pathological process.Metabolic diseases promote the incidence and development of OA through a variety of ways, inducing causing low-grade systemic inflammation, increasing release of adipokines, anabolic cytokines and inflammatory mediators, leading to glucose and lipid metabolism disorders of chondrocytes, upregulating of cartilage extracellular matrix degrading enzymes, raising oxidative stress injury, increasing apoptosis of articular chondrocytes and reducing the cartilage and subchondral bone nutrition supply.These metabolic changes ultimately accelerate the damage of cartilage and promote the incidence and development of OA.Further research on OA and metabolic diseases, has the potential to provide new ideas and methods for the prevention and treatment of OA.

Objective To systematic evaluate the prevalence of secondhand smoke among Chinese mainland rural residents by meta?analysis,so as to provide reference for making relevant smoking control regulations and the carry out of targeted tobacco control action. Methods The related stud?ies were searched and collected from PubMed,CNKI,Wanfangdata,VIP and CBM database,which were published between 2001 and 2015 about the prevalence of secondhand smoke among Chinese mainland rural residents. Meta?analysis was tested by software CMA V2. Results The pooled prevalence of secondhand smoke among Chinese mainland rural residents was 46.6%(95%CI 40.5%?52.8%). Stratified analysis showed that the prevalence of secondhand smoke were 45.7%and 47.5%for male and female,45.7%and 51.1%for eastern and midwest China,22.1%、34.2%and 71.3%for public place,workplace and family,respectively. The prevalence among sex,regions,and places were statistically significant. Conclusion The prevalence of secondhand smoke among Chinese mainland rural residents was relatively high,and the prevalence of secondhand smoke was higher in women than in men,in midwest area than in eastern area,and at family than at public place and at workplace.

Infectious necrosis is one of severe local complications caused by acute pancreatitis,and the mortality rate was reported to be up to 10％ ～ 20％.Traditional open surgical debridement used to be the sole option for this disease.Nevertheless,this approach is associated with poor outcome.Currently,conservative treatment and minimally invasive procedures are more favorable.The treatment for infectious necrosis caused by acute pancreatitis can be summarized as 3D,representing delay,drain,debride.The patients usually receive initial treatment in ICU division,and surgical intervention is then delayed.Percutaneous drainage can be firstly performed in the early course of the disease,followed by necrotic tissue debridement with laparoscopic or video-assisted retroperitoneal procedures.Open surgical debridement is now rarely used,which is merely performed for certain refractory cases.The management of acute pancreatitis infected necrosis therefore is a clinical question that requires a multiple disciplinary team rather than a simply surgical disease.This paper reviewed the relevant issues.