Objective To explore the diagnostic value of transvaginal ultrasound in endometrial polypoid lesions.Methods Three hundred and forty-four cases with endometrial polypoid lesions diagnosed in Hankou Hospital of Wuhan from April 2012 to December 2016 were selected as the research objects.All patients underwent color Doppler ultrasonography before surgery.The image features were analyzed,and the specificity, sensitivity and accuracy of ultrasound diagnosis of endometrial lesions were analyzed and pathological results served as the gold standard.Results According to the postoperative pathological diagnosis,142 cases were with endometrial polyps,Including 136 cases with simple endometrial polyps and 6 cases with endometrial polyps combined with endometrial carcinoma; 160 cases were diagnosed with endometrial polyps via transvaginal ultrasound,38 cases were misdiagnosed(11.05%,38/344),20 cases were missed diagnosis(5.81%,20/344), using the postoperative pathological results as the gold standard,the sensitivity of transvaginal ultrasonography in the diagnosis of endometrial lesions was 85.92%(122/142),the specificity was 81.19%(164/202),the accuracy was 73.14%(286/344),and the diagnostic accuracy of ultrasonography was consistent with the pathological diagnosis(Kappa>0.75).Conclusion The value of transvaginal ultrasound is to observe the presence of uterine lesions, the identification of benign and malignant lesions still need hysteroscopy examination.

Objective To investigate the clinical effect of internal fixation(IF)and total hip replacement(HA)for treatment of displaced femoral neck fracture in elderly patients.Methods Sixty-three cases with femoral neck fracture hospitalized in Chaoyang Central Hospital from January 2010 to January 2015 were selected as research subjects and were divided into IF group(33 cases)and HA group(30 cases) according to the different treatment methods.The patients in IF group were treated with internal fixation and the patients in HA group were treated with hip replacement.The duration of operation,intraoperative blood loss, length of hospital stay,incidence of postoperative complication and reoperation rate in both groups were recorded.The hip function was evaluated by Harris score,and the hip function of the two groups was compared in 1 year,2 years after operation.Results Compared with HA group,the patients in IF group had shorter operation time,less intraoperative blood loss and shorter hospitalization time((0.8± 0.3)h vs.(1.7± 0.2)h;(110.9 ±9.9)ml vs.(587.2±35.7)ml;(16.4±2.0)d vs.(24.8±3.7)d),the differences among the two groups were statistically significant(P=0.041,0.000,0.038).Th incidence of long term postoperative complication was 27.3%(9/33)in IF group and was 10.0%(3/30)in HA group.The reoperation rate was 24.2%(8/33)in IF group and was 6.7%(2/30)in HA group.The differences between the two groups were statistically significant (P=0.045,0.039).The excellent and good rates of hip joint function in HA group after 1 and 2 years after operation were 83.3% and 80.0%,and 63.6% and 57.6% in IF group in 1 and 2 years after operation respectively.The differences between the two groups were statistically significant(P = 0.043,0.042) .Conclusion Internal fixation and hip replacement in the treatment of displaced femoral neck fractures in the elderly effect have their own advantages and disadvantages.Internal fixation has the advantages of less trauma, less blood loss and rapid recovery,but the long-term complications and reoperation rates are higher than those in HA.The long-term clinical effect of HA for the treatment of femoral neck fracture in elderly patients is better than that of internal fixation and it is worthy of clinical promotion.

Objective To compare the causes of poor effects after surgical treatment for severe cervical spondylotic myelopathy,and to analyze the clinical value of posterior surgery in the treatment of severe cervical spondylotic myelopathy.Methods From September 2013 to November 2016,ninety-two patients with severe cervical myelopathy in Shiyan Medical Hospital were selected as the research object,the patients were divided into the observation group and the control group,50 cases in each group,according to the different surgical methods,the control group received anterior cervical discectomy and interbody fusion and internal fixation treatment,the observation group was treated with cervical posterior decompression surgical treatment,the prognosis and the changes of cervical vertebra function in the two groups were recorded.Results There were statistically significant differences between the two groups in terms of operation time,intraoperative blood loss and postoperative hospital stay(t=5.392,7.114,4.552,P<0.05).The intervertebral height at 1 month after surgery in the observation group and the control group were(4.92 ± 1.51)mm and(4.26 ± 1.32)mm,significantly lower than those before the operation((3.72±0.42)mm,(3.78±0.93)mm)(t=10.495,6.114,P<0.05) .At 1 month after operation,the intervertebral height of the observation group was significantly higher than that of the control group(t=4.521,P<0.05).The excellent and good rate of JOA score of the observation group and control group at 1 month after operation were 97.6% and 84.0%,respectively,and the rate of the observation group was significantly higher than that of the control group(χ2=4.797,P<0.05).In the observation group and the control group,there were 1 case of throat pain after operation,and they were relieved after suitable treatment.Conclusion Compared with the anterior approach,the posterior treatment of severe cervical spondylotic myelopathy can reduce the trauma of patients,promote the recovery of intervertebral height and improve the function of the cervical spine,so as to achieve better results.

Objective To investigate the influence of the speed of body mass growth in gestational diabetes mellitus(GDM)patients on the growth and development of neonatal body.Methods All of the one hundred and thirty-three pregnant women with GDM diagnosed by OGTT and hospitalized in Suining Cental Hospital for delivery were involved in the study.heir fasting plasma glucose,total cholesterol and HbAlc during a week before delivery and the speed of body mass growth at 3 weeks before childbirth were recorded.According to the body length at 1 week after delivery and body quality standards,all infants were divided into the good group and the poor group.Then,independent samples t test analysis was applied to analyze the effect of the fasting plasma glucose,total cholesterol,HbAlc and the speed of body mass growth in mother on the growth and development of neonatal body in two groups.The influence of factors which has statistically significant on neonatal body was analyzed by Multiple factors Logistic regression analysis and the association between those factors and the growth and development of neonatal body was showed on scatter diagram.Meanwhile,ROC curve was used to evaluate The effect degree of various factors on the growth and development of newborns and their best diagnostic points were calculated.Results The fasting plasma glucose((7.44 ± 2.27)mmol/L),total cholesterol((6.05±1.57)mmol/L),HbAlc((5.18±0.53)%)and the speed of body mass growth at 1st week ((0.35±0.20)kg/w),2nd week((0.28±0.21)kg/w)and 3rd week((0.36±0.18)kg/w)before delivery in good group were lower than those in the poor group((8.61±3.25)mmol/L,(6.78±1.84)mmol/L,(5.62 ±0.76)%,(0.71± 0.16)kg/w,(0.84 ± 0.11)kg/w,(0.76 ± 0.13)kg/w))(t=2.222,2.413,5.575, 11.617,20.183,14.321,P<0.05).Multivariate logistic regression analysis showed that the content of HbAlc (OR=2.391),the speed of body mass growth at 2nd week before delivery(OR=3.045)and the speed of body mass growth at 1st week before delivery(OR=4.081)had significant effect on the growth and development of neonatal body and the speed of body mass growth at 1st week before delivery had the greatest influence(P<0.05); There were negative correlation among HbAlc,neonatal length and the increase in body mass(r=-0.490,-0.481,P<0.05); at 2nd week before delivery,HbAlc,neonatal length and the increase in body mass were negatively correlated(r=-0.353,-0.396,P,<0.05); at 1st week before delivery,HbAlc,neonatal length and the increase in body mass were negatively correlated(r=-0.495,-0.474,P,<0.05).At the same time,ROC analysis showed that the AUC of HbAlc was 0.566 while the speed of body mass growth at 1st week and 2nd week before delivery were 0.723 and 0.796,respectively and the AUC of the speed of body mass growth at 1st week before delivery was the highest.Conclusion The speed of body mass growth at 1st week before delivery can slow down the increase of neonatal length and body mass,and can be used as a therapeutic target for the clinical control of neonatal dysplasia in GDM patients.

Objective To explore the value of cytological and histological noninvasive methods in the screening of endometrial cancer(EC).Methods Seventy-six cases of suspected EC high risk patients diagnosed in the gynecological outpatient department of the People Hospital of Longhua from January 2015 to May 2017 were selected as the research object,the endometrial cells and tissues were collected for cytological and histological examination,the diagnosis of curettage or hysteroscopy performed as a "gold standard" to determine the effect of cytology,histology and combined examination on the ensitivity,specificity,positive coincidence rate of EC diagnosis.Results 76 patients with suspected EC high risk factors were diagnosed as EC 48 cases(63.16%)via "gold standard".The sensitivity,specificity and positive coincidence rate of cytology were(75.00%,89.29%,80.26%,χ2=1.0105,P=0.6033),histology were(79.17%,92.86%,84.21%,χ2=0.3117,P=0.8557)and combined examination in EC were(83.33%,92.86%,86.84%,χ2 =1.2260,P=0.5417).Conclusion Cytological and histological noninvasive screening has high sensitivity,specificity and positive coincidence rate in EC and has a high diagnostic value for individual or combined exams and can be used as a routine screening for EC in clinical practice.

Objective To assess the significance of the right paraesophageal node(Ⅵb area) dissection in cN0 stage papillary thyroid microcarcinoma(PTMC)central lymph node dissection.Methods The clinical data of three hundred and five cN0 PTMC patients who underwent radical thyroidectomy from 2010 to 2015 was retrospectively analyzed.The metastasis rate of central compartment(Ⅵa area.Ⅵb area)and the clinical data were collected and analyzed.Results 305 cN0 stage PTMC patients underwent total thyroidectomy and bilateral central compartment dissection or right lobectomy combined with ipsilateral central compartment dissection,the mean diameter of the tumors was 6.75 mm.The incidence rate of central compartment metastasis was 35%.The incidence rate ofⅥb area metastasis was 11.1%.The status ofⅥb area metastasis was correlated with major clinicopathologic parameters such as sex,age<45,tumor diameter≥0.8 cm,bilateral multiple lesions, capsule invasion,VI a lymph node metastasis≥3 were all related risk factors of PTMC VIb area metastasis(χ2=6.913,4.241,4.517,5.185,12.400,34.745,P<0.05).Conclusion Because of the high rate of central lymph node metastasis in patients with PTMC and the poor efficiency in the evaluation for central lymph node metastasis before operation,the right paraesophageal lymph nodes(Ⅵb area)dissection is needed to be done in cN0 stage PTMC patients with tumor size≥0.8 cm,multifocal lesions,membrane invasion,Ⅵa area metastasis≥3,especially male patients.

Objective To analyze the effect of laparoscopic minimally invasive surgery on the immune function of patients with gastric cancer and its clinical efficacy.Methods A total of eighty patients with gastric cancer treated in the First Affiliated Hospital of Hainan Medical University from February 2012 to February 2017 were retrospectively selected.According to the different surgical methods the patients were divided into laparoscopic group and laparotomy group.The laparotomy group was treated with open radical gastrectomy,and the laparoscopic group was treated with laparoscopic radical gastrectomy.The operation and postoperative condition,complications,immune indexes and changes of gastrointestinal hormone levels in the two groups were observed.Results The operation time of the endoscopic group was(198.64±43.89)min,longer than that in the laparotomy group((152.01 ± 42.11)min),the incision size((5.79 ± 1.54)cm),blood loss((75.20 ±11.36)ml)and hospitalization time((8.12±1.58)d)were less than those in the control group((15.96 ±1.55)cm,(129.21±12.03)ml,(12.33±1.85)d)(t=4.849,29.428,20.645,10.944; P<0.05).There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).The CD3,CD4,CD8 and CD4 /CD8 in the laparotomy group three days after the treatment were lower than those after treatment in the endoscopic group((51.90 ± 3.66)% vs.(62.01 ± 3.02)%;(30.25 ± 3.98)% vs.(41.13 ±4.79)%;(23.01±4.02)% vs.(28.20 ± 4.15)%;(0.93 ± 0.21)% vs.(1.19 ± 0.20)%)(t=13.475, 11.049,5.681,5.670,P<0.05).No significant difference was showed between the levels of immune indexes before and after treatment in the endoscopic group(P>0.05).The VIP in the laparotomy group 3d after the treatment was higher than those before treatment and in the laparoscopic group after treatment,MTL and SS were lower than those before treatment and in the endoscopic group after treatment(t=1.707,2.713,4.409,1.756, 2.488,3.969;P<0.05).There was no significant difference in the levels of gastrointestinal hormones before and after treatment in the endoscopic group(P>0.05).The complication rate in the endoscopic group was 10% and 27.50% in the laparotomy group,and the complication rate in the endoscopic group was lower than that in the laparotomy group(χ2=4.021;P<0.05).Conclusion Laparoscopic radical gastrectomy has the advantages of less trauma,less bleeding loss and less complications.It also has little effect on the immune function and gastrointestinal hormones,which is beneficial to the recovery of postoperative patients.

Chronic heart failure(CHF)is the performance of end-stage cardiovascular disease and the leading cause of death in recent years.With the rapid development of medical care,the mortality rate of heart failure is still high.This is one in the two major challenges in the cardiovascular field in the 21st century.The new drug LCZ696 is a dual inhibitors of angiotensin receptor blockers(ARB)and neprilysin(NEP),which may lead to new hope for patients with heart failure.In order to determine the efficacy and safety of LCZ696 in the treatment of heart failure,foreign countries have carried out some large-scale trials,such as PARAMOUT, PARADIGM,TITRATION and so on.The results of these studies reflected the superiority of LCZ696 compared with enalapril,valsartan and other drugs in the treatment of chronic heart failure.ARB/antiotensin converting enzyme inhibitors(ACEI)targets the angiotensin receptor to dilate blood vessels and inhibits the sympathetic nerve,but their effects on sodium withdrawal and diuresis are weak.The sacubitril in LCZ696 prevents natriuretic peptide from degrading,strengthens the natriuretic diuretic and further expansion of blood vessels.Thereby it improves water and sodium retention and cardiac function.It can play a better synergistic role combined with valsartan.

Objective To investigate the effect of recombinant human interleukin 11(rhlL-11)in the treatment of idiopathic thrombocytopenic purpura(ITP)on the levels of Th1,Th2 and the expression of their transcription factors T-bet mRNA,GATA-3 mRNA.Methods Fifty-six cases adult ITP patients hospitalized in the department of hematology of the Second People's Hospital of Datong from May 2015 to December 2016 were collected,including 21 males and 35 females,aged 29~73 years; 10 healthy people in the same period were enrolled as control group,4 males and 6 females,aged 20~52 years.Th1 and Th2 cell ratio and Th1/Th2 ratio of ITP patients were detected by flow cytometry before and after treatment.The expression levels of transcription factor T-bet and GATA-3 were measured using real-time fluorescence quantitative reverse transcription polymerase chain reaction(RT-PCR)before and after treatment.Results The effective rate of rhlL-11 in ITP treatment was 76.8%(43/56).For the effective patients,the median PLT after treatment increased(25.0(15. 0,36.0)×109/L vs.68.0(49.0,108.0)×109/L,Z=-5.712,P<0.001); Th1 cells decreased,compared with that before the treatment(14.8 %(12.6%,17.6%)vs.10.6 %(9.8%,12.6%),Z=-4.825,P<0.001);Th2 cell increased,compared with that before the treatment(0.4%(0.3%,0.5%)vs.1.2%(0.9%,1.4%), Z=-5.720,P<0.001); Th1/Th2 decreased,compared with that before the treatment(40(30,49)vs.10.6(7.8,12.0),Z=-5.711,P<0.001];the expression level of T-bet mRNA decreased(0.36(0.18,0.51)vs 0.09(0.05,0.13),Z=-2.668,P=0.008);the expression level of GATA-3 mRNA increased,compared with that before treatment(0.04(0.03,0.05)vs.0.12(0.09,0.15),Z=-2.366,P=0.018).For ineffective patients,the median PLT before treatment was(11.0(8.0,15.5)×109/L),and the median PLT after treatment was(15.0(10.0,19.5)×109/L)(Z=-3.027,P=0.002); there was no significant difference in Th1,Th2, ratio of Th1/Th2 and T-bet and GATA-3 mRNA expression level before and after treatment in patients with ITP (P>0.05).Conclusion rhIL-11 can effectively correct the imbalance in Th1 and Th2 cells and the imbalance of T-bet and GATA-3 in ITP patients,but it has no obvious therapeutic effect on a small number of patients

Objective To investigate the clinical effect on incomplete spinal injury by ganglioside intravenous injection combined with intrathecal injection.Methods From January 2011 to January 2015, seventy-nine cases with irreducible articular process interlocking of cervical spine fracture with dislocation of cervical spinal cord injury,underwent one stage anterior and posterior surgical treatment,postoperative routine use of antibiotics to prevent infection,and the hormone,dehydration to promote bone cell growth and neurotrophic drugs treatment.The patients were randomly divided into the intravenous injection group(42 cases),given intravenous injection of monalsialic acid four hexose ganglioside sodium(GM-1)40 mg/d,mecobalamin tablets 0.5 mg/time,3 times/d,30 d oral;the combined intrathecal injection group(37 cases)was given GM-1 40 mg/d,intravenous injection at 15 d after intrathecal injection,1 time a week 40 mg,with a total of 4 weeks.The degree of spinal cord injury was evaluated according to Frankel classification; cervical function was evaluated according to JOA score; bone graft fusion,stability of cervical spine and degree of spinal cord injury were evaluated by imaging.Results The operation time in the intravenous injection group and the combined intrathecal injection group were(4.15 ± 0.65)h and(4.10 ± 0.85)h,and the intraoperative blood loss was(850.50±35.10)ml and(858.60±25.20)ml,respectively,and there were no significant differences between the two groups(t=1.375,1.452,P>0.05).The total dose of GM-1 in the combined intrathecal injection group was(785.20 ± 3.28)mg,significantly higher than that in the intravenous injection group((610.55 ± 5.28) mg),the difference was statistically significant(t=12.542,P<0.05);79 patients were followed up for 12-24 months,with an average of(15.2 ± 1.3)months.The improvement rate of nerve function of the combined intrathecal injection group was(64.35±4.33)%,significantly higher than that in the intravenous injection group (55.50±5.44)%,the difference was statistically significant(t=8.813,P<0.05);the postoperative JOA scores of the intravenous injection group((13.55 ± 1.75)points)and combined intrathecal injection group((12.85 ±1.97)points)were significantly higher than those before the surgery((7.25± 0.83)points,(7.19± 0.93) points),the differences were statistically significant(P<0.05).There was no significant difference in the JOA scores between the two groups before and after the operation(P>0.05).At the last follow-up,X-ray showed bone fusion at the bone graft site,and the internal fixation was good and firm.MR showed that the degeneration signal area of the cervical spinal cord decreased in varying degrees,and edema and inflammatory reaction disappeared.Conclusion Postoperative treatment of ganglioside intravenous injection combined with intrathecal injection is safe and feasible in the treatment of incomplete cervical spinal cord injury caused by cervical fracture dislocation with irreducible articular process interlocking.