Objective To study the value of hysteroscopy and laparoscopy in the diagnosis and treatment of the complication of intrauterine device (IUD). Methods 55 patients with IUD complications who had previous (1～12) times of unsuccessful operations were performed by hysteroscopy and laparoscopy. The results were retrospectively analyzed. Results 45 abnormal IUD of deformed or broken or remained in uterus were successfully taken out under hysteroscope, and 1 case converted into open operation. 9 ectopic IUD in abdominal and pelvic cavity were successfully taken out under laparoscope. No operative complication occurred. Conclusions Hysteroscopic and laparoscopic operations have the advantages of clear diagnosis, higher successful rate and minimal invasion for the diagnosis and treatment of IUD complications. Abnormal IUD and ectopic IUD out of uterine cavity had better choose hysteroscopic and laparoscopic operations.

Objective To evaluate the short-term and long-term efficacy of conservative laparoscopic surgery combine with goserelin in treatment of severe ovarian endometriosis.Methods From January 2004 to December 2008,206 patients with severe ovarian endometriosis underwent laparoscopy surgery in Nanjing Drum Tower Hospital,Affiliated Nanjing University Medical School were enrolled in this retrospective study.According to the revised classification American Fertility Society (r-AFS), 123( 123/206,59.7％ ) cases were at stage Ⅲ and 83 ( 83/206,40.3％ ) patients were at stage Ⅳ.Among 138 cases presented pelvic pain.All the patients underwent laparoscopic cystectomy,of which 117 patients with childbearing preserving underwent hysteroscopy and hydrotubation examination,including 7 cases with bilateral salpingectomy,2 cases with bilateral tubal obstruction and 108 cases with normal reproduction.After surgery,all cases were administered by goserelin treatment at dose of 3.6 mg per 28 days for 3 to 6 months.At 1 to 5 years following up,pelvic pain,pregnancy and recurrence were observed,those factors associated with pregnancy rate and endometriosis recurrence were analyzed.Results (1)Pelvic pain:complete remission rate of pelvic pain was 76.1％ ( 105/138 ) at 1 to 5 years after surgery.(2) Pregnancy:total pregnancy rate was 70.4％ (76/108),spontaneous pregnancy rate was 68.8％ (66/96) and pregnant rate of in vitro fertilization and embryo transfer (IVF-ET) was 10/12.Pregnancy rate at 1 year was 57.3％( 55/96 ) and accounting for 83.3％ ( 55/66 ) in all pregnant womon.Live birth rates of spontaneous pregnant and IVF-ET were 86.4％ ( 57/66 ) and 9/10,respectively.( 3 ) Recurrence:the total recurrence rate was 8.3％ ( 17/206 ) at 1 to 5 years.The recurrence rates and the cumulative recurrence rates were 3.9％(8/206) and 3.9％ (8/206) at the first year after operation,2.0％ (3/149)and 6.7％ ( 10/149 )at the second year,1.0％ (1/99) and 8.0％ (8/99) at the third year,10.9％ (5/46)and 17.4％ (8/46) at the fourth year,0 and 2/18 at the fifth year,respectively.Conclusion It was suggested that conservative laparoscopic surgery combined with goserelin in treatment of stage Ⅲ or Ⅳ ovarian endometriosis could reduce the recurrence risk of severe ovarian endometriosis and improve the pregnant rate of endometriosisassociated infertility.

BACKGROUND: Scar hypertrophy is always followed by the wound healing in burn and trauma. Endothelial cells play a key role in scar hypertrophy, so inhibitory growth of endothelial cells can relieve scar hypertrophy to a certain degree. OBJECTIVE: To construct a recombinant adenovirus vector expressing human endostatin (Ad/hEnd), and to investigate the cooperative effect of Ad/hEnd and keratinocyte on endothelial cell proliferation. DESIGN, TIME AND SETTING: Observational study, which was performed in the State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital of the Third Military Medical University of Chinese PLA between September 2006 and May 2007. MATERIALS: pAdTrack-CMV and pAdEasy-1 were obtained from Stratagene Company, USA; 293 cell and Ecoli.DH5α were stored in our laboratory. METHODS: The endostatin gene sequence was obtained by reverse transcription-polymerase chain reaction (RT-PCR) and polymerase chain reaction (PCR) based on mRNA of human fetal hepatic tissue and inserted into the adenovims shuttle plasmid pAdTrack-CMV to obtain recombinant plasmid pAdTrack-ES. After identification, positive recon was transformed into pAdeasy 1 recipient virus to screen positive clones. The adenovirus Ad/hEnd was generated from 293 cells and identified by PCR and fluorescence microscope. Then the keratinocytes were infected with Ad/hEnd, and co-cultured with endothelial cells by nest dish culture method. The content of endostatin was detected, and the non-transfection keratinocytes were used as the controls. MAIN OUTCOME MEASURES: Homologous recombination and identification of pAd/hEnd; generation and identification of Ad/hEnd; endostatin expression after 293 cell transfection; purification and titer measurement of Ad/hEnd; content of endostatin in culture solution; apoptotic percentage of endothelial cells; inhibitory ratio of endothelial cells. RESULTS: Ad/hEnd was constructed and the virus titer was generally up to 1.65×1012 PFU/L. Ad/hEnd-infected keratinocytes could effectively express and secrete endostatin of which the content reached 226 μg/L after 3 days of co-culture. The apoptotic percentage and inhibitory ratio of the endothelial cells co-cultured with Ad/hEnd-infected keratinocytes were significantly higher than those in control group (P<0.05). CONCLUSION: Ad/hEnd-infected keratinocytes co-cultured with endothelial cells can promote apoptosis and inhibit proliferation of endothelial cells through excretion of endostatin.

Objective To evaluate the applicability and security of transpancreatic precut sphincterotomy vs double guidewire technique for cannulation in difficult bile duct cannulation in endoscopic retrograde eholangiopancreatography (ERCP). Methods Retrospective analysis of 158 cases difficult bile duct cannulation in ERCP from January 2012 to January 2014, according to the intubation tube method, we divided all the cases into 3 groups, transpancreatic precut sphincterotomy group (group A); double guide wire technique group (group B); single guide wire technique group (group C). Then compare the intubation success rate and the incidence of complications among the 3 groups. Results 54 of 58 patients in group A intubation successful, the success rate is 93.1%, 50 of 56 patients in group B intubation successful, the success rate is 89.3%, 26 of 44 patients in group C intubation successful, the success rate is 59.1%, there was no significant difference between group A and B(P > 0.05), group A and group C, group B and C have significant difference (P < 0.05). In group A, 4 cases were complicated with acute pancreatitis, hemorrhage in 6 cases, infection in 2 cases, the complication rate is 20.7%; In group B, 5 cases were complicated with postoperative pancreatitis, 4 cases of infection, incidence of complications is 16.1%; 7 patients were complicated with pancreatitis in group C, hemorrhage in 2 cases, infection in 4 cases, complication rates is 29.5%, 3 groups were no perforation occurred.The complication rate of group B is lower than in group A, but no significant difference (P > 0.05), group A and group C, B and C complication rates had significant difference (P < 0.05). Conclusions When selective bile duct intubation is difficulty and guide wire thread into the pancreatic duct, continue to single guide wire have low intubation success rate and higher incidence of complications,transpancreatic precut sphincterotomy and double guide wire technique can effectively improve the success rate of intubation, and complication rates are relatively low, no significant difference between the two.

Objective: To develop a conceptual framework for prevention intervention plans through a series of case studies, so as to provide inspiration for the design of services to help adolescents form healthy mobile phone use habits. Methods: Convenient sampling method was used to investigate 20 students in grade 8 from 3 schools in Shanghai. Through the research on teenagers use of mobile phones, parents intervention on mobile phone use and comprehensive intervention program on mobile phone use, the evolution process model of parent child conflict in the context of teenagers use of mobile phones is formed, and the comprehensive intervention program on teenagers use of mobile phones is determined. Results: Adolescents motivations for using mobile phones were mainly social fun (37.14%), leisure activities (34.61%) and information search (28.25%). Unilateral intervention methods could not meet the needs of adolescents with different motivations. In most cases, parents make rules without considering children s characteristics and family background, resulting in different degrees of parent child conflict, resulting in invalid rules and repeated negative emotions of teenagers. Conclusion It is very necessary to adopt the activity design of online and offline integrated service system, so as to promote the healthy mobile phone use habits of teenagers.Comprehensive online and offline intervention methods can help teenagers to obtain other resources and promote the formation of healthy mobile phone use habits.

Objective To investigate the therapeutic effect and safety of the clip with the flossmethod during endoscopic submucosal dissection for early gastric angle cancer. Methods A total of 27 gastric angle lesions diagnosed as early gastric cancer were treated by ESD. They were randomized to two groups, routine ESD group and clip with the flossgroup. The procedure time, complication events, en-block resection rate and complete resection rate were compared between the two groups. Also,the learning time was divided to two stages and the learning curve was studied according to the resected specimen areas per minute. Results The en block rate was 85. 7%(12/14) in the routine ESD group and 100. 0%(13/13) in the clip with the floss group. The procedure time in the clip with the flossgroup was significantly less than that in the routine ESD group (the median time 30 min VS 40 min, P =0. 011) . Perforation and the post operative bleeding did not occur in either group. The ESD learning curving during the first learning period and the mean resected specimen (area/min) in theclip with the floss group were larger than routine ESD group(30±6 mm2/min VS 20±5 mm2/min,P=0. 01). However, no difference presented during the second learning period between the two groups. Conclusion Clip with the flossmethod during endoscopic submucosal dissection for early gastric angle cancer as a novel procedure is safe, efficacious and worthy to recommend to beginning learners.

Objective:To evaluate the clinical significance of expression of proliferation cell nuclear antigen(PCNA),P16 and P27genes in adenoid cystic carcinoma of salivary glands.Methods:The expressions of PCNA,P16and P27were detected by immunohistochemical staining (SP)in 55 patients with adenoid cystic carcinoma of salivary glands.Results:The higher and lower expressions of PCNA were 45.5%(19/55) and 65.5%(35/55) respectively;of P16 were 45.5%(25/55) and 54.5%(30/55)respectively.And the positive and negative expressions of P27 were 34.5%(19/55) and 65.5%(36/55),respectively.The correlation of expression of PCNA gene with local recurrence and tumor site showed significant (P=0.0317,P=0.0186);but the expression of P16was no any significant correlation in all of the variables.The expression of P27 was significant on the regional lymph node metastaisis (P=0.0083).When higher expression of P16was 45.5%(25/55),the P27positive expression was 56.0%(14/25),which showed a significant positive correlation (P=0.0025).Conclusion:In adenoid cystic carcinoma of salivary glands,the PCNA gene should be one of the biological target predicting local recurrence,and P27gene should be one of the biological target justifying regional lymph node metastasis.

BACKGROUND:There is little evidence on the use of al ogeneic tendon graft in the reconstruction of ankle joint.
OBJECTIVE:To explore the clinical outcome of anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft in patients with chronic ankle instability.
METHODS:Twenty-six patients with chronic lateral instability underwent anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon. There were 18 cases of simultaneous injury or chalasia in calcaneofibular ligament and anterior talofibular ligament, and 8 cases of anterior talofibular ligament injury or chalasia. The ankle joint function was evaluated according to AOFAS scale and Good classification. The affect ankle and healthy ankle were compared in the extension, plantar flexion activity, and metaleg activity.
RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 9-24 months with a mean of 15 months. No cases appeared recurrent ankle lateral instability. The mean AOFAS score in the group of calcaneofibular ligament and anterior talofibular ligament was improved from (48.4±3.7) points preoperatively to (88.2±3.8) postoperatively, while that in the group of anterior talofibular ligament was improved from (50.0±6.4) points preoperatively to (89.5±3.4) points postoperatively. According to Good score, there were excellent in 19 feet, good in 6 feet, fair in 1 foot, with an excellent and good rate up to 96%. No serious complication was occurred in this group. Anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft can increase the tendon-bone contact area, improve the rate of tendon healing, and enhance the stability of ankle joint in patients with chronic ankle instability. Further studies are needed to verify its long-term efficacy.

Objective: Based on the core elements of plysical and health literacy and related sports work guidelines, the study aims to build a dimensional evaluation system of students’ healthy behaviors. Methods: Literature review, questionnaire survey, Delphi expert method and analytic hierarchy process were used in the study. Results: The three level of indicators evaluating students’ healthy behaviors were constructed, including exercise habits, emotional regulation, and adaptive ability as primary indicators, as well as class attendance and participation(9.80%), competition participation(8.29%), weekly exercise frequency(3.77%), participation in extracurricular leisure sports(7.65%), and self-expression in class, joy(10.06%), challenges and breakthroughs in class(8.74%), attitudes to sports(11.45%), healthy and civilized lifestyles(6.56%), conscious improvement of physical fitness and status(7.22%), mental health(8.49%) and interpersonal skills(7.98%). The ANP method was used to construct a dimensional evaluation model of student health behavior, and the analytic hierarchy process was used to analyze the weights of various indicators. The results showed that the weights of exercise habits, emotional regulation, and adaptive ability of the primary indicators of student health behavior assessment were 39.50%, 30.25%, and 30.25%, and the weights of related secondary indicators. Conclusion The most important indicator evaluating students ‘healthy behaviors is the students’ attitude towards sports and the actual situation of participating in sports. It reflects the true demands of students’ healthy behavior development. The student health behavior dimension evaluation system is scientific and reasonable, and it is developmental.

Objective To evaluate the effect of pre-cut-endoscopic mucosa resection of colorectal laterally spreading tumor. Methods 65 patients with LST were enrolled from January 2014 to February 2014. LST was detected by chromoendoscopy and NBI combined with magnifying endoscopy technique. The size, site, morphological features, were observed and the histopathological features of the specimen of LST was analyzed. All the 65 LSTs were resect by pre-cut-EMR. The clinical results including enbloc resection rate, all bloc resection rate, procedure time, complication and recurrence rates were retrospectively evaluated. Results All the 65 LSTs lesions ranged from 2.0 cm to 5.0 cm, with a mean diameter of (2.4 ± 1.7) cm. The site of 65 LSTs was in rectum 28 (43.1 %), 11 LSTs in sigmoid colon (16.9 %), 6 LSTs in descending colon (9.2 %), 2 LSTs in splenic flexure of colon (3.1 %), 9 LSTs in transverse colon (13.8 %), 4 LSTs in Hepatic flexure of colon (6.2 %), 2 LSTs in ascending colon(3.1 %), and 3 LSTs in cecum (4.6 %). Morphology of 23 LSTs were homogeneous granular type (35.4 %), 27 LSTs were mixed non-granular type (41.5 %), 13 LSTs were flat elevated type (20.0 %), and 2 LSTs were pseudo-depressed type (3.1 %). The histopathological diagnoses of LST included 12 tubular adenoma (18.5 %), 19 villous-tubular adenoma (29.2 %), 26 villous adenoma (40.0 %), 7 advanced intraepithelial tumor (10.7 %), 1 intramucosal carcinoma (1.5 %). Enbloc resection was achieved in 65 patients (100.0 %) with a mean operation time of (18.0 ± 11.7) min. 5 cases were bleeding during the operation (7.7 %), 1 case was bleeding 7 days after operation (1.5 %), no perforation was happened. 65 patients were followed up for 3 ~ 12 months, and no local recurrence was found. Conclusion Pre-cut-endoscopic mucosal resection an effective and safe therapy for colorectal LST larger than 2.0 cm.