Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio

Research based learning (RBL) is a brand new teaching mode implicated by Shanghai Jiaotong University School of Medicine specifically designed for clinical undergraduates.The nature of RBL is about exploring unknown knowledge and designing and executing comprehensive experiments.RBL aims at creating an open,active student participation,and close student-mentor interaction teaching mode.IBL includes literature study,research aim selection,experiment design and implementation,statistical analysis,results and conclusions,final report writing and defense of the report.Our experience indicates that RBL can substantially improve students' scientific logic and critical thinking and experimental skills,and develop the spirit of a team-player.This scientific training enables students to receive more comprehensive scientific training,facilitate their subsequent clinical research and practice,and assist them to participate in more international scientific exchanges.We propose that the RBL mode should be adopted for clinical student education in other universities.

Objective To investigate the effect of meridian-unblocking and mind-regulating acupuncture pretreatment on neurobehavioral functions and cerebral water content and explore its mechanism for modulating miRNA664 and MMP9 expressions in cerebral ischemia/reperfusion rats.Methods One hundred and thirty Wistar rats were randomized into group A (electroacupuncture pretreatment) of 30 rats, group B (moxibustion pretreatment) of 30 rats, group C (aspirin pretreatment) of 30 rats, group D (model) of 30 rats and group E (blank control) of 10 rats. Group A received electroacupuncture; group B, suspended moxibustion with moxa sticks; group C, an oral gavage of aspirin 10 mg/kg. A model of cerebral ischemia/reperfusion was made in every group after seven days. Rat neurobehavioral functions were observed and cerebral water content and relative miRNA664 and MMP9 expressions in the cortical region were determined at 24 hours after reperfusion.Results There was a statistically significant difference in the neurobehavioral score between group A, B, C or D and group E (P<0.01), between group A or B and group C (P<0.01) and between groups A and B (P<0.01). There were statistically significant differences in cerebral water content and relative miRNA664 and MMP9 expressions between group A, B, C or D and group E (P<0.01,P<0.05), between group A, B or C and group D (P<0.01), between group A or B and group C (P<0.01,P<0.05) and between groups A and B (P<0.01,P<0.05).Conclusions Meridian-unblocking and mind-regulating acupuncture pretreatment can effectively decrease the neurobehavioral score and cerebral water content and reduce relative MMP9 expression through modulating miRNA664 expression in cerebral ischemia/reperfusion rats. One of the mechanisms of Du meridian-unblocking and mind-regulating acupuncture pretreatment for protecting the brain may be reducing relative MMP9 expression, inducing tolerance to cerebral ischemia and relieving cerebral edema by the modulation of miRNA664 expression.

Objective To study the MR imaging characteristics of benign cerebellar astrocytomas(BCAs) in children. Methods The clinical and MR imaging data of twelve patients with BCAs were reviewed and analyzed retrospectively.Results Of 12 tumors, 7 cases were located in the cerebellar hemisphere, 4 in the vermis, and 1 in the IV ventricle. All children were in company with hydrocephalus rated as extensive (n=9) or moderate (n=3). The tumors ranged in diameter from 23 mm to 68 mm, mean diameter 42 mm. Solid tumors were found in 5 children, and cystic areas occurred in 7 of 12 patients.BCAs were hypointense on T 1-weighted in 10 cases, and hyperintense on T 2WI in 9 cases compared with that of normal brain parenchyma. After contrast injection, BCAs marked (n=2), moderate (n=5), or absent (n=5) enhancement. Hemorrhage and calcification were not common (n=1,0, respectively).Conclusion BCAs has relative characteristic features on MRI in children, and MRI plays an important role in diagnosing and evaluating these tumors preoperatively.

AIM:To study the effects of sesamin (Ses) on attenuating renal injury in spontaneously hyperten-sive rats (SHR) and its relationship with PI3K/AKT/mTOR signaling pathway.METHODS:Spontaneously hypertensive rats were randomly divided into 4 groups:model (SHR) group, Ses low-dose (80 mg/kg) group, Ses high-dose (160 mg/kg) group and captopril (30 mg/kg) group.Another 7 WKY rats were given 0.5%sodium carboxymethylcellulose ( CMC-Na, the solvent was used to dissolve the drugs) as control group.Meanwhile, the rats in drug treatment groups were given the corresponding drugs.All animals were administered intragastrically once a day, and the blood pressure was measured every 2 weeks before and after the beginning of the administration.After 12 weeks, blood urea nitrogen ( BUN) , serum creatinine ( SCr ) , urine micro-albumin ( U-mAlb ) , malondialdehyde ( MDA ) and superoxide dismutase ( SOD ) were measured.The pathological changes of the renal tissues were observed under microscope with HE and Masson staining.Ap-optotic rate of nephridial tissue was determined by TUNEL method.The protein levels of p-AKT, p-mTOR, 4EBP1, S6K1, Bcl-2 and Bax were detected by Western blot.RESULTS:Ses decreased the diastolic blood pressure of SHR, significantly ameliorated the pathological damage in the nephridial tissues.Compared with model group, Ses was obviously reduced the contents of SCr, BUN, U-mAlb, MDA and apoptotic rate of the kidney, decreased the protein levels of p-AKT, p-mTOR, 4EBP1, S6K1 and Bax, and increased the protein expression of Bcl-2 and SOD activity.CONCLUSION:The protective effects of Ses against renal injury in SHR may be related to decreasing blood pressure, increasing anti-oxidative stress, re-straining apoptosis and inhibiting over-activated PI3K/AKT/mTOR signaling pathway.

AIM: To explore the association of single nucleotide polymorphisms of promoter G~ -597 -A, G~ -572 -C, G~ -174 -C and T~ 15 -A, C~ 132 -T in exon 5 of interleukin 6 and lumbar intervebral disc disease. METHODS: The single nucleotide polymorphisms of interleukin 6 gene, including polymorphisms of G~ -597 -A, G~ -572 -C in promoter, G~ -174 -C and T~ 15 -A, C~ 132 -T in exon 5 were analyzed by the polymerase chain reaction and sequencing methods in 81 cases with lumbar intervebral disc disease and 101 healthy controls. The association of single nucleotide polymorphisms of interleukin 6 gene with lumbar intervebral disc disease in two groups was measured. The association of single nucleotide polymorphisms of interleukin 6 gene with lumbar intervebral disc degeneration in those younger than 45-year-old were also measured. RESULTS: The G~ -572 -C polymorphism of interleukin 6 gene was observed, but no single nucleotide polymorphism of G~ -597 -A, G~ -174 -C in promoter and T~ 15 -A, C~ 132 -T in exon 5 in two groups was detected. There was no difference between the distribution of the G~ -572 -C polymorphism of interleukin 6 gene in two groups. In those younger than 45-year-old the association of the single nucleotide polymorphism of interlukin-6 gene and lumbar intervebral disc degeneration was not significant. CONCLUSION: There is G~ -572 -C polymorphism in Chinese. No relation between G~ -572 -C polymorphism of interleukin 6 with lumbar intervebral disc disease and lumbar intervebral disc degeneration was observed.

Objective:To explore the application value of X-ray tomographic fusion technique in assessing bone healing and osteotylus growth after femoral neck system(FNS)internal fixation of femoral neck fracture.Methods:A total of 18 patients with femoral neck fracture who admitted to the Department of Orthopedics of Beijing Haidian Hospital from October 2019 to June 2020 were selected.All of them were treated with FNS internal fixation,and conventional X-ray and X-ray tomographic fusion imaging were performed respectively at 1 month and 12 months after operation for them.The displays of the two imaging techniques for the bone healing and osteotylus growth after FNS internal fixation of femoral neck fracture were evaluated,and the relevant parameters of the two imaging techniques for the process of image detection of FNS internal fixation of femoral neck fracture were counted by statistical method.Results:The detection rate of X-ray tomographic fusion technique for osteotylus at 1 month after surgery was significantly lower than that at 12 months after surgery.The detection rates(94.44% and 61.11%)of X-ray tomographic fusion technique for osteotylus at 1 month and 12 months after surgery were significantly higher than those(61.11% and 33.33%)of X-ray(x2=5.100,5.790,P<0.05),respectively.The rank-sum test indicated there were significant differences in the distribution of the scores of the image qualities of osteotylus growths at 1 month and 12 months after surgery for patients with femoral neck fracture between two imaging techniques(Z=2.113,2.018,P<0.05),and there were significant differences in the image qualities of bone healing at 1 month and 12 months after surgery between two imaging techniques(Z=2.868,2.258,P<0.05).The display effect of the detection image of fracture site before treatment under the guidance of X-ray tomographic fusion technique was ideal,which images were clear and could display more fully and clearly the fracture line of patient.After 12 months of surgery,the continuous osteotylus that passed fracture line could be found at the anterior lateral position of X-ray,which has reached to clinical healing.In the process of detecting image of FNS internal fixation of femoral neck fracture,the air Kerma,dose area product and effective dose of X-ray tomographic fusion technique were significantly lower than those of conventional X-ray imaging(t=5.900,2.466,32.255,P<0.05),respectively.Conclusion:In the diagnosis and evaluation of bone healing of patients with FNS internal fixation after femoral neck fracture,the use of X-ray tomographic fusion technique can better detect the osteotylus growth of patients and judge the degree of bone healing,especially the judgment effect of that for the postoperative recovery with longer time of patients is more better.In addition,this technique has better safety,which would cause less radiation damage in the process of detection.

Objective Clinical study on the treatment of bilateral lumbar spinal stenosis with percutane-ous fixation combined with unilateral open-ended spinal canal decompression. Methods 126 patients with bilater-al lumbar spinal stenosis admitted to our hospital were randomly divided into two groups.The observation group was treated by percutaneous nail combined with unilateral laminar fenestration,and the control group was treated by open reduction combined with bilateral hemi laminectomy and spinal canal decompression.The two groups of pa-tients with general surgical complications after treatment,index,lumbago and leg pain VAS score and ODI score were compared.Results The operation time of the observation group,the amount of bleeding,the time of hospital-ization and the cost of hospitalization were less than those of the control group.There were no complications such as incision infection after operation in the two groups.The two groups were statistically significant postoperative pain and leg pain VAS score and ODI score compared with preoperative difference.The two groups had statistical signifi-cance between low back and leg pain VAS score and ODI score after 6 and 12 months and last follow-up phase dif-ference.But the two groups after 3 months of lumbago and leg pain VAS score and ODI score had no significant dif-ference.Conclusions Percutaneous minimally invasive nail combined with unilateral laminar fenestration and de-compression for bilateral lumbar spinal stenosis has the advantages of less trauma,less bleeding,shorter hospitaliza-tion time and quicker recovery.It is worthy of clinical promotion.

Colorectal cancer is a disease with high morbidity and mortality. Colorectal cancer has a poor prognosis, duing to the current limited treatment methods and can not achieve satisfactory treatment results. Therefore, how to diagnose colorectal cancer patients early and improve the prognosis has always been one of the problems in the medical and scientific research circles. As researchers gradually learn more about the intestinal flora including Fusobacterium nucleatum, the targeted treatment has been applied to the experimental research and clinical treatment of colorectal cancer. This paper reviews the research progress of Fusobacterium nucleatum on the pathogenesis, early diagnosis, prognosis and treatment of colorectal cancer in recent years.

Objective:To investigate the safety and efficacy of individualized sunitinib schedule for patients with metastatic renal cell carcinoma (mRCC) according to the monitoring results of plasma drug concentration.Methods:The clinical data of patients with mRCC who received sunitinib treatment in our center from January 2014 to December 2020 were retrospectively analyzed, including 20 patients who underwent monitoring of plasma drug concentration (monitoring group), and 45 patients, matched by propensity score matching, received sunitinib but did not undergo monitoring of plasma drug concentration during the same period (unmonitored group). In the monitoring group, there were 12 males and 8 females. The mean age was 52.9 years, and ECOG score ≤1 in 16 cases (80%). Three patients were in the IMDC favorable-risk group, 15 patients were in the intermediate-risk group, and 2 patients were in the high-risk group. There were 18 cases of clear cell carcinoma and 2 cases of non-clear cell carcinoma, 5 cases of ISUP grade 1-2 and 11 cases of grade 3-4. In the unmonitored group, there were 31 males and 14 females. The mean age was 57.7 years, and 30 patients had ECOG score ≤1, 15 cases ≥2. There were 10 cases in IMDC favorable-risk group, 23 cases in intermediate-risk group, and 12 cases in high-risk group. Thirty-seven cases were clear cell carcinoma and 8 cases were non-clear cell carcinoma, 8 cases were in ISUP grade 1-2 and 28 cases in grade 3-4. There were no statistically significant differences between the two groups in the above parameters ( P>0.05). The monitoring group used the regimen of taking sunitinib for 4 weeks and stopping for 2 weeks (4/2 week) in the first cycle. The blood concentration of sunitinib was monitored before the first cycle and on days 4, 7, 10, 14, 21 and 28, and personalized medication plan was formulated according to the curve of the blood concentration. The 4/2 week scheme was adopted in the undetected monitoring group.The two groups were compared in the incidence of adverse events (AEs), progression-free survival (PFS), overall survival (OS), tumor treatment response and other clinical outcomes. Results:In the monitoring group, 90% (18/20) of patients receiving sunitinib had a steady-state plasma concentration of more than 150ng/ml, of which 10 patients (50%) had a plasma concentration of 150-200 ng/ml and 8 patients (40%) had a plasma concentration of more than 200 ng/ml. Meanwhile, all patients with plasma concentration higher than 150 ng/ml developed severe AEs (grade 3 and above) after treatment. The other two patients' plasma concentration were 100-150 ng/ml, and did not have severe AEs.All patients in the monitoring group received individualized medication schedule adjustment according to the plasma drug concentration and the occurrence point of severe AEs, ensuring that the peak plasma drug concentration was maintained at about 100-150 ng/ml. Among them, 6 patients were changed to take 2 weeks and stop for 1 week (2/1 week schedule), 4 patients were changed to take 10 days and stop for 5 days (10/5 d schedule), 7 patients were changed to take 7 days and stop for 3 days (7/3 d schedule), and 3 patients were changed to take 5 days and stop for 2 days (5/2 d schedule). The incidence of severe AEs significantly decreased from 90% (18/20) to 35% (7/20), and the difference was statistically significant ( P=0.003), while the incidence of grade 3 and higher AEs was 55.6% (25/45) in the standard group, which was statistically significant compared with the incidence of severe AEs before adjustment in the monitoring group ( P=0.006). Further analysis of the efficacy difference between the two groups showed that the overall objective response rate in the monitoring group (40%, 8/20) was higher than that in the standard group (20%, 9/45), although the difference was not statistically significant ( P=0.09). Median PFS and OS were significantly longer in the monitored group than in the standard group (PFS: 23 vs. 10 months, P=0.002; OS: not reached vs.25 months, P=0.005). Conclusions:The bioavailability of sunitinib is high in mRCC patients, which may lead to higher plasma drug concentration, adjustment of medication regimen based on blood concentration monitoring significantly improved patient safety and clinical outcomes. However, further validation by larger-scale, multi-center and prospective studies is needed.