Objective To investigate the safety and clinical effect of laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer . Methods A retrospective analysis was made on clinical characteristics of 15 patients who were diagnosed as unexpected cervical cancer from January 2008 to December 2014.The age of the patients was between 29 and 67 years old, with an average of 43.9 years old.The indications for hysterectomy were cervical intraepithelial neoplasia (CIN) grade 2-3 in 7 cases, uterine myoma in 3 cases, dysfunctional uterine bleeding in 2 cases, uterine prolapse in 2 cases and adenomyosis in 1 case. Pathological results after the hysterectomy included 13 cases of cervical squamous carcinoma and 2 cases of adenocarcinoma .The lesions were all confined to the cervix , with 4 cases of stage ⅠA2 disease and 11 cases of stage ⅠB1 .The lymph-vascular space invasion was found in 4 cases.The operation interval between the two operations was 3-7 d (mean, 4.6 d).They were all given laparoscopic radical parametrectomy . Results The operation time was 212-285 min (mean, 249.6 min), and the blood loss was 250-500 ml ( mean, 376 ml) .Postoperative pathological findings showed no residual disease .Only one patient had left pelvic lymph node mestastasis .Two patients had intraoperative complications , including 1 bladder injury and 1 ureteral injury .There were 3 cases of postoperative complications , including 2 cases of uroschesis and 1 case of lymphocyst .The follow-up time was 6-84 months ( median, 48 months).No recurrence was seen.The 1-, 3-, 5-year survival rates were 100%, 93.3%, 86.7%, respectively. Conclusions Laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer is difficult to perform and has more complications . This surgical method is applicable to those who refused postoperation radiotherapy or required retaining ovarian function .

The information security and privacy protection of electronic health records (HER) are greatly con-cerned by healthcare administrators, healthcare providers and patients in the era of big data and cloud computing. The concepts of information security and privacy protection of HER wre defined according to the systematic investi-gation of related literature, the keys to the information security and privacy protection of HER were summarized, and the advances in research on information security and privacy protection of HER were described.

Objective To probe the etiology and management of restenosis after artificially grafting bypass for chronic ischemia of the lower extremities. Methods In this study 52 cases suffering from postoperative restenosis and obliteration were compared with 32 cases whose artificial grafts remain patent during the same postoperative follow-up period of 3～62 months.Possible risk factors that lead to restenosis were evaluated.Resuits FIB(4.48±1.68)g/L,CRP(9.5±2.6)mg/L and LDL(4.5±1.7)mmol/L were significantly higher in the restenosis group than FIB(3.50±0.72)g/L,CRP(4.0±3.2)mg/L and LDL(2.8±0.9)mmol/L in the patent group(P＜0.01).There were no significant difference between HDL(1.02±0.32)mmol/L in the restenosis group and HDL(1.12±0.28)mmol/L in the patent group (P＞0.05).Reoperation in these 52 cases found severe intima hyperplasia and secondary thrombosis within anastomosis in 42 cases and the remaining 10 cases were found with artificial vessel primary thrombosis.After reoperation,artificial graft remain patent in 28 cases,limb amputation was performed in 10 cases,the grafted bypass were removed due to infection in 3 cases. Five patients died postoperatively.Conclusion The main reason for restenosis after artificially grafting bypass is intima hyperplasia in vascular anastomosis.Higher levels of FIB,CRP and LDL maybe the major high risk factors that lead to intima hyperplasia and artificial graft obliteration.

BACKGROUND: Autophagy of osteocytes has been found to be implicated in the pathogenesis of steroid-induced necrosis of the femoral head and closely related to apoptosis.OBJECTIVE: To summarize the research progress of autophagy in the pathogenesis of steroid-induced necrosis of the femoral head by studying the interaction between cell autophagy and cell apoptosis as well as osteocytes.METHODS: A computer-based online retrieval of PubMed, Embase and CNKI databases was performed for relevant literatures published from October 1996 to October 2016 with the keywords of steroid, necrosis of the femoral head, cell apoptosis, cell autophagy, osteocyte in Chinese and English, respectively. The articles concerning steroid-induced necrosis of femoral head and cell autophagy were collected, and the redundant and old researches or Meta analysis were removed.RESULTS AND CONCLUSION: Mammalian target of rapamycin, Beclin-1, microtubule-associated protein 1 light chain 3, bone morphogenetic proteins, fork box protein and transcription gene family and transcription factor 4 are closely related to autophagy. The interaction between autophagy and osteocytes is correlated with steroid dose: the autophagy shows protective factor under the low dose corticosteroids; however, with the increase of the dosage, a large number of apoptotic cells, and the phenomenon of bone loss can been observed. Furthermore, the relationship of cell autophagy with apoptosis and bone mass maintenance is still controversial, which needs to be explored in depth via a series of rational experiments.

Objective To establish the fingerprints of 20 batches of Lavandula Angustifolia by HPLC. Methods The determination was performed on a Phenomenex ODS-A column (250 mm× 4.6 mm, 5 μm). The mobile phase was in gradient elute mode with a mixture consisting of acetonitrile and 0.036 mol/L phosphate acid solution. The flow rate was 1.0 mL/min. The temperature was 30 °C. The determine wavelength was 350 nm. The fingerprints of 20 batches of Lavandula Angustifolia were compared and classified by similarity evaluation, cluster analysis, and principal composition analysis. Results Totally 10 chromatographic peaks were extracted as the common peaks of Lavandula Angustifolia, and 2 peaks were identified. The similarity degrees of the 20 batches of Lavandula Angustifolia were above 0.9. All the batches of Lavandula Angustifolia were classified into 3 categories. Conclusion The method is simple and reproducible, and can be used for the standardization and quality control of Lavandula Angustifolia.

Objective:To investigate the dynamic changes of the luminal microbiota in the jejunum following administration of proton pump inhibitors (PPIs) in a rat model.Methods:Rats were randomized into six groups (n =6 each group).A group of rats were sacrificed just after anesthesia as normal control (0 d) and,other five groups were continuously administered with omeprazole (10 mg/kg twice daily,intraperitoneally) and were euthanized at 5,9,14,21,28 days following the treatment,respectively.Total DNA in the luminal contents of jejunum was extracted and was used for polymerase chain reaction (PCR) amplification with the primer set targeted the hypervariable V3 region of 16S ribosomal RNA genes.Subsequently,the amplicons were separated by denaturing gradient gel electrophoresis (DGGE).After the gels were stained and photographed,the bands were cut out and sequenced to determine the closest bacterial relatives with the BLAST.The DGGE profiles were analyzed to evaluate the shifts of the microbiota composition and diversity following treatments.Results:Changes of the jejunal microbiotas in rats were observed at 5 and 9 days post PPI administration,as characterized by outgrowth of Streptococcus pneumonia,Clostridium saccharolyticum and Lactococcus garvieae compared to those of the controls (0 d).With time extension of PPI treatment,the mictobiotas significantly shifted toward dysbiotic state,in which the opportunistic pathogens,including Ertterococcus faecalis and Clostridium difficile,were strikingly expanded,especially 21 days later.However,the commensals such as Lactobacillus reuteri and Weissella koreensis were markedly declined in PPI-treated animals compared with the controls.The similarity of the jejunal microbiotas between PPI-treated animals and controls was markedly reduced following PPI treatment,reaching (56.1 ± 16.7) ％ at 28 days.Conclusion:Our data demonstrate that the gastric acid suppression could induce shifts of the jejuna microbiota in a rat model.More importantly,long-term use (＞ 14 d) of PPI could lead to the dysbiosis of the jejunal microbiota,which might be related causally to increased susceptibility to enteric infection.

Objective This study was to investigate the value of CT guided 125iodine implantation combining transcatheter arterial chemoembolization(TACE) to prevent digestive tract bleeding in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods Forty patients with portal vein tumor thrombus which were diagnosed to have primary hepatocellular carcinomas by diagnostic criteria of Chinese Anti-Cancer Association were collected prospectively. They were divided into the treatment group and the control group, with 20 patients in each group. The treatment group was treated by TACE for hepatic tumor and 125iodine seed implantation for portal vein tumor thrombus, while the control group was treated by TACE for hepatic tumor and only given β-blockers medicines after treatment. Intraoperative and postoperative surgery-related complications were observed. Three months after surgery, enhanced abdominal CT scanning was performed to evaluate treatment effects which were divided into complete response (CR), partial response (PR), and progressive disease (PD) and stable of disease (SD), and the local tumor control rates were calculated. The bleeding rates and mortality after 3 months, 6 months, 12 months were recorded. Treatment effects of the two groups were compared with continuously correction Chi-square test, bleeding rates were compared with Fisher test, and survival rates were analyzed with Kaplan-Meier survival curve and compared with Log-rank test. Results Overall the 40 patients were treated successfully without serious surgery-related complications. In the treatment group, there were 8 patients with PR, 6 with SD and 6 with PD, and the local control rates were 40% (8/20). In the control group, there were 1 patient with PR, 6 patients with SD and 13 with PD. The difference of the local control rates was statistically significant (χ2=5.161, P=0.023).The bleeding rates at 3, 6 and 12 months were 2, 2 and 3 cases in the treatment group, for control group they were 2, 6 and 10 cases respectively. There was no statistical difference between the 3 months and 6 months bleeding rates (P values were 1.000 and 0.235), but for 12 months bleeding rates, the difference was statistically significant (P=0.041).The 1 year cumulative survival rates of the treatment group and control group were 70% (14/20) and 40% (8/20), and the difference was statistically significant (χ2=4.675, P=0.031). Conclusion The treatment of 125iodine implantation combining transcatheter arterial chemoembolization in patients with portal vein tumor thrombus in primary hepatocellular carcinoma can reduce variceal bleeding rate and improve survival rate.

Objective To investigate the pathophysiological features of rat hemorrhagic shock under high temperature conditions.Methods A total of 128 SD rats were assigned to high temperature group and normal temperature group according to the random number table,with 64 rats per group.Rats in high temperature group were pretreated at 342 for 12 h,and in normal temperature group were kept at 25℃.Hemorrhagic shock models in rats were produced by withdrawing 40％ of the total blood volume via the femoral artery.Parameters of the two groups were measured including blood electrolytes (Na +,K +),plasma osmotic pressure,liver function [aspartate aminotransferase (AST),alanine aminotransferase (ALT)],kidney function [creatinine (CREA)],arterial blood gases (pH,PO2 and PCO2) and cardiac function [heart rate (HR),cardiac output (CO),cardiac index (CI) and DO2].Animal survival time and survival rate were detected.Results Before shock,high temperature group versus normal temperature group showed higher detections of Na+ concentration [(142.3 ± 2.2) mmol/L:(139.1 ±1.5) mmol/L],plasma osmotic pressure [(304.8 ± 4.7) mmol/L:(300.0 ± 1.9) mmol/L],HR [(462 ±30) times/min:(402 ± 44) times/min],CO [(0.892 ± 0.190) L/min:(0.713 ± 0.090) L/min] and CI [(0.0030±0.0006)L·min-1 · cm-2:(0.0023 ±0.0002)L· min-1 · cm-2] (P＜0.05).After shock,normal temperature group showed further increased concentrations of Na + and K + and significantly enhanced AST,ALT and CREA compared to normal temperature group (P ＜ 0.05).After shock,CO,CI and DO2 in high temperature group were decreased by 63％,63％ and 69％ respectively compared to those before shock,but less decrease was observed in normal temperature group.Rat survival rate and survival time were significantly reduced in high temperature group compared to normal temperature group (P ＜ 0.05).Conclusion Pathophysiological changes of hemorrhagic shock in rats under high temperature are mainly manifested as impaired cardiac function,significantly increased concentrations of Na + and K + and significantly shortened survival time.

Objective To study the clinical efficacy of tolterodine tartrate combined with transcutaneous electrical nerve stimulation(TENS)in the treatment of elderly female patients with overactive bladder(OAB).Methods 30 patients with OAB were randomly divided into single treatment with tolterodine tartrate and combination treatment of tolterodine tartrate and TENS for 10d.The efficacy was evaluated by overactive bladder symptom score(OABSS),patient perception of bladder condition(PPBC),quality of life(QOL),visual analogy scale(VAS)and 5 grade pain scores.Results The post-treatment symptoms of urgent urination and urinary incontinence,OABSS,PPBC,QOL,VAS and 5 grade pain scores in single treatment group[(1.67±1.45)times /d,(1.53±1.25)times /week,(6.67±2.55)scores,(2.07±0.96)scores,(2.07±1.03)scores,(3.67±0.90)scores and(4.07±0.80)scores]were improved as compared with pre-treatment[(6.40±1.45)times /d,(3.93±1.03)times/week,(13.00±1.00)scores,(4.20±0.68)scores,(3.80±0.68)scores,(7.13± 1.19)scores and(9.40± 1.55)](t=8.94,5.74,8.94,7.03,5.44,9.01 and 11.85,all P＜0.01).The above indexes in combination treatment group after treatment[(1.27±0.80)times/d,(1.20±0.77)times/week,(5.33±1.72)scores,(1.67±0.62)scores,(1.47±0.52)scores,(2.93±0.80)scores and(3.40±0.99)scores]were also improved as compared with pretreatment[(6.20±1.26)times/d,(4.00±1.25)times/week,(12.73±1.03)scores,(4.07±0.80)scores,(4.00±0.65)scores,(7.47±0.74)scores and(9.67±1.35)scores](t=12.77,7.36,14.29,9.21,11.77,16.09 and 14.55,all P＜0.01).The VAS and 5 grade pain scores were higher in combination treatment group than in single treatment group(t=4.879 and 2.746,P＜0.01).Conclusions Tolterodine tartrate combined with TENS is safe and effective for the treatment of elderly female patients with OAB,and may alleviate pain and improve quality of life.

Objectives To evaluate the method and short-term result of endovascular repairing for distal tears of Debakey type Ⅲ dissecting aneurysm. Methods In this study the continously existing distal intima tears were repaired using different method in 15 Debakey type Ⅲ dissections after previous successful repair of the proximal entry.All patients have symptoms caused by unclosed distal tears or increased false lumen in abdominal aorta.7 visceral artery tears ( 1 celiac and 6 renal),4 abdominal aorta and 7 iliac artery tears were repaired (3 cases have both viscera and iliac tears).All abdominal aorta entries were repaired by bifurcation stent grafts.Blocking umbrella was used in 1 renal tear,and all other viscera and iliac tears were repaired by small covered stents. Results All endovascular procedures were successfully completed.No any endo-leak occurred in abdominal and iliac entry repairs.One near renal tear was totally blocked by an umbrella which also blocked blood flow from false lumen to right renal artery.One major endo-leak and 2 minor endo-leak occurred in visceral artery tearing repair,all other visceral tears were completely repaired.All patients were followed up from 2 to 10 months (average 5.0 ± 2.0 months).Follow-up CTA revealed false lumen thrombosis in non-endo-leak cases.Three endo-leak cases still have blood flow in false lumen with partly thrombosis. Conclusions In selected patients,salvage endovascular repair for left over distal tears in Debakey Ⅲ dissecting aneurysm after initial repair is feasible and safe.