Objective To analyze re-treatments of recurrence after the pelvic floor repair surgery.Methods The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above),who had received the pelvic floor repair surgery from January 2011 to January 2016.Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy,respectively.Results Among 81 recurrent patients who were followed up for a median of 35 months (10-69 months),78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100％ (78/78);3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback,and 1 case among the three cases had the vaginal foreign body sensation,the subjective satisfaction was 2/3.The methods of surgical operation for the 78 recurrent patients included:total pelvic floor reconstructive surgery (55 cases;3 of which involve trachelectomy),anterior pelvic reconstructive surgery (2 cases),posterior pelvic reconstructive surgery (3 cases),Y-mesh sacral colpopexy (2 cases),colpocleisis (11 cases),vaginal hysterectomy combined posterior fornix forming (3 cases),and vaginal hysterectomy combined posterior pelvic reconstructive surgery (2 cases).Conclusion The extent of recurrence,the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery,and then an appropriately individualized re-treatment protocol could be designed for each of the patients.

Objective To evaluate the safety and efficacy of modified Prolift pelvic floor reconstruction with improving the placement of Prolift-A in treatment of severe pelvic floor dysfunction and stress urinary incontinence (SUI).Methods From July 2008 to September 2010,170 cases with severe pelvic organ prolapse(POP) treated by modified Prolift pelvic floor reconstruction surgery in Fuzhou General Hospital were enrolled in this study.The Prolift-A was laid tension-free under the mid-urethra with the position of Prolift-A displaced from the neck of bladder to the mid-urethra.No concomitant tension-free urethra suspender via vagina was performed.Primary outcomes were assessed with POP quantitation ( POPQ) system to evaluate the postoperative anatomical replacement stage.Secondary outcome measure were:urogenital distress inventory 6 ( UDI-6),the incontinence impact questionnaire 7 ( IIQ-7 ) and the pelvic floor incontinence questionnaire 7 (PFIQ-7) to evaluate the impact on life quality at the follow-up of 1,6,12 months.Results At 6 and 12 months after surgery,168 cases and 163 cases were followed up.The anatomical cure rates were 98.8％ (166/168) at 6 months and 97.5％ (159/163) at 12 months,respectively.One case with bladder injury and 1 case with rectum injury were observed.Five cases with recurrence were observed,including 2 cases with anterior vagina prolapse,2 cases with uterine prolapse and 1 case with posterior vagina prolapse.Meanwhile,3 cases with hematoma and 7 cases with mesh erosion were observed.Quality of life of all patients were improved significantly by UDI-6,IIQ-7 and PFIQ-7 scoring system evaluation.Among 79 POP patients with SUI,the cure rate of SUI was 93.7％ (74/79).Of 5 cases with symptomatic SUI,2 cases were needed surgical intervention.Twenty-three cases were found with minimal SUI symptoms and subjective satisfaction without objective influence on quality of life.Seven patients presented dysuria after surgery,5 cases recovered urination with 10 days,1 case recovered with 1 months,and 1 case with 6 months by bladder drainage.Eleven cases with discomfort urination and 3 cases with slow urination were found.Conclusions The modified Prolift pelvic reconstructive surgery was safe and efficacy intervention in treatment of POP and prevention of SUI.

Objective To study risk factors with the occurrence of the mesh exposure after pelvic floor reconstruction.Methods From Mar.2007 to Mar.2011,a retrospective study was made on the clinical data of 353 patients undergoing vaginal mesh pelvic floor reconstruction.The related complications of the mesh were surveyed,and risk factors associated with the mesh's exposure were studied by single factor and multiple factors logistic regression.Results It was found that the exposure rate was 9.6％ (34/353) after 1 year postoperative follow-up.Single factor analysis showed that patients who were not less than 70 years old,patients who were on their menopause stage,the occurrence of not less than three parturition,history of pelvic surgery,diabetes and smoking had a significant correlation (all P ＜ 0.05) with the occurrence of the mesh exposure after pelvic floor reconstruction.Multiple factors logistic regression analysis showed that patients who were not less than 70 years of age (OR =2.389),the occurrence of not less than three parturition (OR =2.688),the history of diabetes (OR =3.545),the history of pelvic surgery (OR =5.385) were the independent risk factors,and the operation experience was the protection factors (OR =0.134).Conclusions Mesh exposure is a common complication after pelvic floor reconstruction.Old age,multiple delivery,history of diabetes and history of pelvic surgery are the risk factors of mesh exposure.Preoperative full assessment and the quality of training contribute to reduce the incidence.

Quality variation and ecotype classification of Chinese herbal medicine are important scientific problems in Daodi herbal medicine research. The diversity of natural environmental conditions has led to form unique multi-Daodi, multi-product areas that produce particular Chinese herbal medicine. China is one of three big American ginseng (Panax quinquefolium L.) producing areas worldwide, with over 300 years of application and 40 years of cultivation history. Long-term production practice has led to the formation of three big advocate produce areas in China: Northeast province, Beijing and Shandong. P. quinquefolium L. grown under certain environmental conditions will develop long-term adaptations that will lead to more stable strains (different ecotypes). P. quinquefolium L., can vary greatly in quality; however, the ecological mechanisms causing this variation are still unclear. Root samples were collected from four-year-old cultivated P. quinquefolium L. plants in the three major genuine (Daodi) American ginseng-producing areas of Northeast province, Beijing and Shandong province, China. Ultra-performance liquid chromatography was used to analyze the contents of eight ginsenosides (Rg1, Re, Rb1, Rb2, Rb3, Rc, Rd, Rg2). Data for nine ecological factors, including temperature, moisture and sunlight, were obtained from the ecological database of Geographic Information System for Traditional Chinese Medicine. Soil samples from the sampling sites were collected. Effective boron and iron, available nitrogen and potassium, as well as other trace elements and soil nutrients, were determined by conventional soil physicochemical property assay methods. Analytical methods of biostatistics and numerical taxonomy were used to divide ecotypes of the three main Panax quinquefolium L. producing areas in China based on ginsenoside content, climate, soil and other ecological factors. To our knowledge, this is the first time that ecological division of P. quinquefolium L. producing areas in China has ever been conducted. The results show that there are two chemoecotypes of P. quinquefolium L. in China: ginsenoside Rb1-Re from outside Shanhaiguan, and ginsenoside Rg2-Rd from inside Shanhaiguan. Similarly, there are two types of climatic characteristics: inside Shanhaiguan (Beijing, Shandong) and outside Shanhaiguan (Northeast). This suggests that the formation and differentiation of chemoecotypes of P. quinquefolium L. is closely related to variability of the climatic and geographical environment. Additionally, ecological variation of the three main producing areas, characteristics of two climatic ecotypes, and soil characteristics are also discussed and summarized. These results provide experimental scientific evidence of the quality variation and ecological adaptation of P. quinquefolium L. from different producing areas. They also deepen our understanding of the biological nature of Daodi P. quinquefolium L. formation, and offer novel research models for other multi-origin, multi-Daodi Chinese herbal medicines ecotypes. In addition, the results demonstrate the critical need for improving quality, appropriate ecological regionalization and promoting industrialized development of P. quinquefolium L.

Objective To analyze the risk factors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence.Methods Clinical data of 573 consecutive patients undergoing midurethral sling surgery from January 2003 to December 2010 were collected and analyzed retrospectively.All relative risk factors were evaluated by univariate and multivariate Logistic analysis to identify risk factors of voiding dysfunction.Results Voiding dysfunction occurred in 28 patients,with an incidence of 4.9％ (28/573).Univariate analysis showed that age,previous pelvic surgery,pre-operative postvoid residuals,maximum flow rate,average urine flow rate,Valsalva leak point pressure,concomitant anterior pelvic repair and operator performing＜50 procedures were the relative risk factors (P＜0.05) for voiding dysfunction.Multivariate logistic regression analysis revealed that the maximum flow rate (Qmax) ≤ 15 ml/s (OR=3.782,P=0.003) was an independent risk factor for voiding dysfunction and surgery experience was its protection factors (OR=0.295,P=0.016).Conclusions Qmax ≤ 15 ml/s on preoperative urodynamic study is an independent risk factor for voiding dysfunction after mid-urethral sling procedure.Improving skill of surgery and strengthening technical training will help to reduce the incidence of this complication.

Objective:To evaluate the discrimination, reliability and validity of the evaluation system of clinical nurse training based on post competency in hospitals of traditional Chinese and Western medicine.Methods:From August 2018 to January 2019, 271 clinical nurses from a three-A hospital were selected by convenient sampling method. The competency of clinical nurses was assessed on the spot by case tracking method. The discrimination, reliability and validity of the evaluation system were tested by item analysis, Cronbach's α coefficient and confirmatory factor analysis.Results:The evaluation system had good discrimination, reliability and validity. Among the four scales of the evaluation system, there were significant differences in the high score and the low score of all items ( P < 0.05). The Cronbach's α coefficient of each dimension of the four scales was 0.769-0.898. Four structural equation model diagrams were established, the AVE (average variance extracted) of each dimension was 0.51-0.74, factor load was 0.53-0.93, C.R. (composite reliability) was 0.79-0.91, and the discrimination validity was up to the standard. Conclusion:This system provides a reference for the establishment of scientific, objective, measurable and homogeneous clinical nurse training evaluation tools.

Objective:This study aimed to evaluate the safety and efficacy of humanized CD19-targeted chimeric antigen receptor T-cell (CAR-T) in patients with relapsed/refractory acute B cell lymphoblastic leukemia (R/R B-ALL) .Methods:The clinical data of 41 patients with R/R B-ALL treated with humanized CD19-targeted CAR-T cells in the First Affiliated Hospital of Zhejiang University School of Medicine from February 2020 to July 2021 were analyzed.Results:Cytokine release syndrome occurred in all patients, and 63.4% (26/41) were grades 1-2. Immune effector cell-associated neurotoxicity syndrome developed in three patients. On median day 15 (9-47) , the complete remission rate was 95.1% (39/41) , of which 38 patients tested negative for bone marrow minimal residual disease detected by flow cytometry. Among the 39 patients with complete remission, 17 patients did not receive further treatment, and 70.6% (12/17) remained in remission at the end of follow-up, with a progression-free survival of 11.6 months of the two patients with the earliest infusion. Another 17 patients underwent consolidation allogeneic hematopoietic stem cell transplantation (10 cases) or CD22 CAR-T cell sequential therapy (seven cases) after remission, and 76.5% (13/17) of the patients were still in remission at the end of follow-up. The remaining five patients who did not receive consolidation therapy relapsed at a median of 72 (55-115) days after CAR-T cell therapy.Conclusion:In patients with R/R B-ALL, the humanized CD19-targeted CAR-T cells had a high response and manageable toxicity.

ObjectiveTo observe the effectiveness and safety of the Chinese herbal medicine Mingshi Granules （明视方颗粒） for low myopia in children with heart yang insufficiency. MethodsA multicentre， prospective， double-blind randomised controlled study was conducted， in which 290 children with low myopia from 8 centres were randomly divided into 145 cases in the treatment group and 145 cases in the control group， and the treatment group was given education， dispensing glasses， and Chinese herbal medicine Mingshi Granules， while the control group was given education， dispensing glasses， and granules placebo. Both Mingshi Granules and placebo granules were taken orally， 1 bag each time， twice daily， 4 weeks of oral intake and 2 weeks of rest as 1 course of treatment， a total of 4 courses of treatment （24 weeks）. Equivalent spherical lenses， best naked-eye distance visual acuity， ocular axis， corneal curvature K1， adjustment amplitude， traditional Chinese medicine （TCM） symptom scores， calculate the amount of progression of equivalent spherical lenses， were observed at the 12th and the 24th week of treatment， at the 36th week and 48th week of follow-up， resectively， the control rate of myopia progression was evaluated at the 24th week， and safety indexes were observed before treatment. ResultsThe amount of progression of equivalent spherical lenses was lower in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The control rate of myopia progression at 24 weeks after treatment in the treatment group was higher （57.60%， 72/125） than that in the control group （44.63%， 54/121） （P＜0.05）. The best naked-eye distance visual acuity at 36-week follow-up in the treatment group was higher than that in the control group （P＜0.05）. Equivalent spherical lenses were significantly lower in both groups at all observation time points compared with pre-treatment （P＜0.05）， and were higher in the treatment group than in the control group at the 48-week follow-up （P＜0.05）. The ocular axes of both groups were significantly higher at each observation time point after treatment and at follow-up compared with before treatment （P＜0.05）. The amount of eye axis growth in the treatment group was lower than that in the control group at 24 weeks after treatment and at the 48-week follow-up （P＜0.05）. Corneal curvature K1 was significantly lower in the treatment group at the 24th week of treatment compared to pre-treatment （P＜0.05）. The magnitude of adjustment in the treatment group was significantly higher at the 36-week follow-up and at the 48-week follow-up than before treatment （P＜0.05）. The scores of white/dark complexion， white coating thin pulse， fatigue and total TCM symptom scores of children in both groups at the 12th， 24th， 36th and 48th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； the scores of blurred vision at the 24th and 36th weeks of follow-up were significantly lower than those before treatment （P＜0.05）； and the scores of blurred vision in the treatment group at the 48th week of follow-up were signi-ficantly lower than those before treatment （P＜0.05）. In the treatment group， the score of fatigue was higher than that of the control group at the 36-week follow-up， and the score of blurred vision was lower than that of the control group at the 48-week follow-up （P＜0.05）. No adverse reactions or obvious abnormalities of the safety indexes were observed of the two groups during the treatment. ConclusionChinese herbal medicine Mingshi Granules showed the effect of controlling the progression of low myopia， improving the best naked eye distance visual acuity， slowing down the growth of the eye axis， improving some of the TCM symptoms， with good safety.

Objective: To construct the objective and quantifiable model for evaluating clinical nurses' competency in hospital of Integrated Traditional Chinese and Western Medicine. Methods: From December 2016 to August 2017, preliminary formulation of evaluation indicators was constructed through semi-structured interviews, combined with literature analysis. 21 experts from five hospitals of Traditional Chinese Medicine and medical universities were selected using Delphi method for performing two rounds of consultations and weight assignment of indexes. Data was logged and processed using SPSS 16.0. Results: The preliminary system of the competency model included four items of Level one and 20 items of Level two. The weight coefficients of the first level indicators were 0.260 9, 0.259 8, 0.257 0 and 0.222 4. The positive coefficients from consulations of experts were 100.00% and 95.24%, respectively. Authority coefficient was 0.88. The coefficients of variation were 0.092 3 to 0.162 8 and 0.043 0 to 0.182 7, respectively. Conclusions This model can provide guidance for the training objective of nurses' competency and serve as an instrument for hospital managers to evaluate nurses in hospital of Integrated Traditional Chinese and Western Medicine.