One hundred and ninety-three patients undergoing transvaginal hysterectomy for cicatrix uterus (study group), 200 patients receiving transabdominal hysterectomy for cicatrix uterus (control group Ⅰ), and 200 patients having transvaginal hysterectomy for non-prolapsed uterus (control group Ⅱ) were retrospectively analyzed. In comparison with the control group Ⅰ, the study group showed a significantly reduced operation time and the average volume of blood loss (P < 0.01). Moreover, patients in the study group had shorter postoperative recovery time (P < 0.01) . The incidence of postoperative fever was decreased in the study group. There was no significant difference in complications of the vaginal wound between the three groups (P 0.05). This investigation demonstrates that transvaginal hysterectomy might be feasible and safe in removing cicatrix non-prolapsed uterus.

Objective To establish an evaluation index system for Shanghai urban general practice service team to improve standardized and scientific management. Methods The evaluation index system for Shanghai urban general practice service team was established using two rounds of Delphi consultation. Results The established system consisted of 5 fast-grade indicators and 56 second-grade indicators. The 5 first-grade indicators were staffing, infrastructure, quality and quantity of service, continuing education and satisfaction degree of suppliers and demanders, with weight of 0.2153, 0.1978, 0.2087, 0.1869 and 0.1923 respectively. The active coefficient for two rounds of Delphi consultation was both 100%. The authoritative coefficient of the two rounds was 0.852 and 0.883 respectively. The harmonious coefficient of importance of the evaluation index was 0.251 and 0.411 respectively. Conclusion Through using Delphi method scientifically and reasonably, we set up the evaluation index system for Shanghai urban general practice service team, with integral contents, strong operability and easy application.

Objective To explore the relationship between high-risk human papillomavirus (HPV) DNA and biological behavior of cervical carcinoma. Methods Sixty-six patients of cervical carcinoma with cytological examinations and 103 patients of cervical carcinoma followed-up after surgical operation were selected for high-risk HPV DNA test with second-generation hybrid capture technique (HC2 Ⅱ). Results ①HPV DNA was positive in 62 and negative in four of 66 patients of cervical carcinoma with an overall prevalence of 94%. ②There was no significant difference in positive HPV DNA of patients with cervical carcinoma between their varied clinical stages and pathologic grades. But, HPV positivity and HPV DNA load in patients with myometrial invasion were higher than those in patients without invasion (P < 0. 05).③ HPV DNA conversed to negative in 99 of 103 patients (96%) with cervical carcinoma after surgical operation from positivity before operation. Conclusions High-risk HPV infection may correlate with angiogenesis, invasion and metastasis of cervical carcinoma and HC2 Ⅱ can be used as an effective method to detect HPV DNA.

Fifty-six patients with abdominal wall endometriosis(AWE)were assigned into the proliferous group or the secretory group and the expression of estrogen receptor(ER)in the entopie,ectopic and normal endometrium was investigated.In the proliferous group,the positive ER expression rate on the entopie endometrium(85%)was significantly higher than that on the normal(60%)or ectopie endometrium (58%)(P<0.05).In the secretory group,the positive ER expression rate on the eetopie endometrium (57%)was significantly higher than that on the entopic (26%) or normal endometrium(25%)(P< 0.05).There was significant difference in the entopie and normal endometriilm between the two groups (P<0.01):however,there was no significant diffeFence in the ectopic endometrium.Abnormal ER expression on the entopic or ectopic endometrium may play a role in the pathogenesis of AWE.

Data were collected from 236 patients with advanced ClllllCerB through questionnaire survey,home visit,oncology clinics and counseling service.The data were evaluated and classified according to VAS and NCCN aduh cancer pain practice guidelines.Two hundred and eleven in 236 advancad cancer patients(89.4%)Suffered from Cancer pain,with mild pain in 31,moderate in 83 and severe in 97.One hundred and seventeen patients(49.6%)received therapy for pain relief,among whom 78(66.7%)had complete remission(CR),26(22.2%)partial remission(PR)and 13 cages(11.1%)noremission.The main reason for declining pain relief wag being scared of morphine addiction.

Objective To study effectiveness and safety of lung volume reduction surgery(LVRS) in treatment for severe chronic emphysema(chronic obstructive pulmonary disease).Methods Clinical data of 24 patients of severe chronic emphysema undergone with LVRS during January 2004 to June 2007 were analyzed retrospectively.LVRS was performed for the patients after respiratory tract preparation based on their pulmonary function,results of blood gas analysis,cardiac function,as well as physical activity capacity.and surgical incision Was selected based on"target"location of emphysema with chest computerized tomography and isotope lung perfusion scanning,22 cases with standard unilateral LVRS via outer post-lateral incision and two with bilateral LVRS via mid-sternal incison.A linear device for cutting and stitching was used in surgical operation to excise the lung tissues of severe emphysema with strips of bovine pericardium to prevent air leakage.Results All the patients were followed-up for 19 months in average and complications occurred in seven of them after operation,including four with leakage of the alveoli.two with cardiac arrhythmia and one with pneumonia,and no death was observed.Pulmonary function and symptoms of dyspnea improved obviously in all the patients after operation,and they all could care for themselves,in general,with scales of dyspnea increased to grade Ⅰ in one case,to grade Ⅱ in 10 cases and to grade Ⅲ in three cases.Conclusions LVRS can improve pulmonary function of selected patients with severe emphysema,to certain extent,and its safety will depend on strict selection of the patients and correct peri-operative care.

Objective To analyze the relations between obstructive sleep apnea and bradyarrhythmia.Methods From 1999 to 2005,203 patients who came from Bering Tongren Hospital and Fuwai Hospital were found to have sleep apnea in an ambulatory study. A Hoher electrecardiogram was recorded for 24 hours within 2 weeks after patients were diagnosed as obstructive sleep apnem Results Nocturnal episodes of bradyarrhythmia were identified in 12(5.9%)of 203 patients.Body mass index and respiratory disturbance index in patients with bradyarrhythmia(n=12)were higher than those in patientswithour bradyarrhymia(n=191)(34±5 735.24±6 and 63±15 vs.25±5,respectively,both P<0.01).There was a significant difference in end-apneic oxygen saturation in apnea/hypopnea episodes with and without bradyarrhythmia(63%±15% vs.75%±11%,P<0.05).A linear relation between end-apneic oxygen saturation and number of sinus arrests and heart blocks was not found.Conclusions Patients with apnea-associated bradyarrhythmia have higher body mflgB index and higher respiratory disturbance index than patients without bradyarrhythmi&Bradyarrhythmia occurres independently from decrease in oxygen saturation.

Objective To evaluate the valRe of Geneva score,plasma D-dimer lUmitel,lower extremity compressive ultrasonography and transthoracic echocardiography,as well a8 their combination,in diagnosis for suspected pulmonary thmmboernbolism(PTE)and its exclusion.Methods In total,139 confirmed FrrE patients were enrolled in the study,with 50 patients with suspected PTE at admission but excluding PTE after testing as controls,Geneva scores and plasma level of D-dimer were determined,and deep vein uhrasonography in the lower extremity and transthoracic echocardiography were performed for all the confirmed cases of PTE and controls.Diagnostic values were evaluated with each teat index alone or in combination,to confirm or exclude PTE.Results FrrE could be diagnosed by hish Geneva score,with a positive likelihoed ratio more than 10 and it could not be excluded by a negative likelihood ratio more than 0.1 with Latex semi.quantitative method and quantitative methed Latex method P,rE could be excluded by a multi-tests in parallel with negative likelihoed ratio less than 0.1.High Geneva scores,in combination with ultrasonography of the lower extremity and transthoracic echoeardiography in combination with Youden index greater than 0.6 could indicate PTE.Sensitivity and specificity of P1'E diagnosis could be improved by multi-tests in parallel or in series.Conclusions Geneva SCOre is more objective indicator and hish score has diagnostic value for PTE.PTE could be excluded reliably by negative result of multi-diagnostic tests in paralleL Misdiagnosis and under-diagnosis for PTE can be reduced by Geneva score,blood D-dimer level,lower extremity compressive ultrasonogaphy and transthoracic echocardiography,as well as their combination,in parallel in hospitals without ECT or spiral CT.

Objective To investigate blood level of triglyceride(TG)in community residents of urban and rural Beijing.Methods A total of 10 054 community residents were recruited by cluster samphng for investigation using questionnaire,as well as physical examinations and fasting plasma TG determination for diagnosing hypertriglyceridemia,during June to August,2007.Results Median of plasma level of TG of the participants was 1.17 mmol/L,ranging(0.81-1.78)mmoVL Totally,1234 people were diagnosed as borderline hypertriglyceridemia and 15 12 as hypertriglycefidemia.with prevalence of 12.27%and 15.04%,respectively.There was no significant difference in plasma level ofTG between men andwomen[1.16(0.80-1.84)mmol/L vs.1.18(0.81-1.75)mmol/L,P:0.187].Age-adjusted prevalence of borderline hypertriglyceridemia and hypertriglyeeridemia was higher in men than those in women(11.60% vs.10.90%and 20.32% vs.10.88%,respectively),and the same results were obrained in those less than 50 years old,however,reveraw outcomes were got in those more than 50 years old.Plasma level of TG,as well as prevalence of hypertriglyceridemia,were higher in those living in urban areas than those in rural areas[1.31(0.89-1.95)mmol/L vs.1.05(0.73-1.58)mmol/L].Awareness,proportion of people with hyperglycefidemia under treatment and proportion of those with TG under coutrol were 13.95%.35.92%and 38.51%,respectively.Standardized prevalence of borderline hyperglycefidemia and hyperglycefidemia were higher in those with coronary heart disease than those without it(24.79% vs.11.22%and 25.31% vs.15.35%,respectively).Conclusions Awareness,proportion of treatment and proportion of those under control for hyperglyceridemia were all lower in community residents of Beijing.Education and monitoring on hyperglyeeridemia should especially be strengthened for urban residents,women aged more than 50 years,and these with coronary heart disease.

Clinical data of 15 patients with penetrating injury in the distal segment of the common bile duct during biliary tract exploration were retrospectively analyzed.Nine injuries were found during the surgical procedures and successfully treated with common bile duct T tube and peritoneal drainage before discharged from the hospital (mean hospitalization time 16 days).Six penetrating wounds were found post-operatively, and underwent another operation.Four patients were fully recovered at 8 to 12 weeks, and 2 died from multiple organ failure caused by infectious shock.Our investigation suggests that for the penetrating injury in the distal part of the common bile duct, early diagnosis, proper management and effective draining may improve the survival of the patients and avoid serious complications.