Objective To explore the efficacy and safety of methotrexate combined with hysteroscopic in treatment of cervical pregnan-cy. Methods The data of 14 patients with cervical pregnancy were analyzed retrospectively. Results All patients were given combination therapy of mifepristone and methotrexate firstly,and they were discharged after bloodβ-HCG logarithmically decreased for further observation. Hysteroscopic surgery were applied whenβ-HCG level decreased to 100 mIU/mL. Conservative treatment received success in all 14 cases. It required 14~35 days,averagely (26. 5 ± 2. 7) days, methotrexate dosage of 50~150 mg,averagely (75. 5 ± 15. 0) mg, and mifepristone of volume 150~450 mg,averagely (275. 0 ± 54. 5) mg to make the bloodβ-HCG level decreased to 100 mIU/mL. The bleeding volume during hysteroscopy surgery was 5~50 mL,an average of (35. 6 ± 5. 2)mL. Conclusion Methotrexate combined with hysteroscopy is safe and fea-sible for treatment of cervical pregnancy.

Objective To examine the frequency of coexisting endometrial carcinoma with preoperative diagnosis of endometrial atypical hyperplasia (EAH).Methods From Apr 2002 to Apr 2007,61 consecutive patients diagnosed as EAH who underwent total hysterectomy in our department were retrospectively analyzed.Patients were stratified as 44 premenopausal cases and 17 menopausal cases.The patients were divided into 2 groups depending on whether or not cancer cells were found by histology in removed uterus (cancer group vs EAH group) to explore valuable predictive risk factors for concomitant endometrial carcinoma through reviewing the clinical data.Logistic regression analysis and logistic regression equation are used to evaluate the risk of coexisting endometrial carcinoma with preoperative diagnosis of endometrial atypical hyperplasia.Results Endometrial thickness and the type of EAH were selected into the equation in premenopausal cases,showing statistically significant differences(P ＜ 0.001) and the overall accuracy was 86.4％.Menopausal years and the type of EAH were selected into the equation in menopausal women,also showing statistically significant differences (P ＜ 0.04)and the overall accuracy was 82.4％.Conclusions Endometrial thickness and the type of EAH are valuable in predicting the risk of endometrial carcinoma in premenopausal women.Menopausal years and the type of EIN are valuable in prediciting the risk of coexistance with endometrial carcinoma in menopausal women.

Objective:To analyze the effect of Doula delivery combined with labor analgesia on the delivery process and delivery outcomes of primiparas.Methods:Retrospectively selected 200 primiparas treated in Beijing Friendship Hospital, Capital Medical University from January 1, 2019 to September 30, 2019 as the research objects.All patients underwent labor analgesia, and were divided into 100 cases in the Doula group and 100 cases in the control group (without Doula delivery) according to whether or not Doula delivery was performed.T test of two independent samples and chi square test were used to compare the labor process and delivery outcome of the two groups.Results:The natural delivery rate in the Doula group was 76%(76/100), which was significantly higher than the control group (61%(61/100)), and the difference was statistically significant (χ 2=5.214, P=0.022). The time of the first, second and third stage of labor in Doula group was (8.35±3.59), (1.07±0.26), (0.54±0.19) h, and that in the control group was (10.94±4.76), (1.86±0.63), (0.78±0.21) h, respectively.There were significant differences between the two groups (t value were 10.354, 5.312 and 8.169, respectively; P value were 0.016, 0.042 and 0.039, respectively). The neonatal asphyxia rates of Doula group and control group were 1% (1/100) and 3% (3/100) respectively, and there was no significant difference between the two groups ( P=0.621). The incidence of postpartum hemorrhage in the Doula group and the control group was 3% (3/100) and 10% (10/100) respectively, and the incidence of postpartum urinary retention was 0 (0/100) and 6% (6/100), respectively.The success rate of early sucking was 98% (98/100) and 90% (90/100) respectively, and the difference between the two groups was statistically significant (P value were 0.045, 0.029 and 0.017, respectively). The hospitalization time of Doula group was (3.17±0.85) d, which was significantly shorter than that of the control group (5.64±1.29) d)( t=6.359, P=0.031). The visual analogue pain score of 2 h postpartum in Doula group was 3.49±0.98, which was significantly lower than the control group (5.82±1.06)( t=9.327, P<0.001). Conclusion:Doula delivery combined with labor analgesia can effectively reduce the pain of uterine contraction, promote natural delivery, reduce the rate of cesarean section, help to improve the quality of obstetric medical service, improve patient satisfaction, it is worth promoting in the condition of the hospital.

Objective]Summary of the role of adipokineson insulin resistance and the effective components and mechanisms of traditional Chinese medicine and its extract in recent years to improve insulin resistance.[ Methods]Consulting CNKI, VIP database, PubMed database about adipokines to improve insulin resistance and effective components of traditional Chinese medicine research literature, summarize the main adipokines and traditional Chinese medicine for improving IR by interfering with the adipokines.[Result]Leptin, adiponectin and resistin and other factors play a key role in the formation of insulin resistance and diabetes.The research on the effect of Chinese herbal medicine extract and its active components on the improvement of insulin resistance by the intervention of the adipokines is also increasing.[Conclusion]The inflammatory reaction mediated by the adipokines is one of the important factors that lead to insulin resistance, traditional Chinese medicine can effectively improve the type 2 diabetes insulin resistance caused by adipokines.

Objective To examine the effect of carbon dioxide pneumoperitoneum on local pancreas pathological changes, serum levels of amylase, IL-6, E-selectin and P-selectin in rats with severe acute pancreatitis (SAP). Methods Fifty healthy male SD rats were randomly divided into 3 groups: CO2 experiment group ( n =20): SAP was induced by injecting 5% sodium taurocholate through retrogradely common biliopancreatic ducts via duodenal papilla,and then CO2 pneumoperitoneum was established at a pressure of 12 mmHg for 30 min; SAP group ( n = 20): The rats were treated as same as CO2 experiment group, excepting CO2 pneumoperitoneum; Control group (n = 10): Abdomen was incised and nothing was done to duodenum and pancreas except for moving them softly. The blood samples were gathered for examining serum levels of amylase, IL-6, E-selectin and P-selectin, and histopathologic examination of pancreas was done.Results Compared with control group, the pancreatic pathologic histology score, serum levels of amylase,IL-6, E-selectin and P-selectin were significantly higher in the CO2 experiment group and SAP group (P =0.000). The levels of IL-6 were significantly lower in CO2 experiment group compared to SAP group (P =0. 000). There was no significant difference between CO2 experiment group and SAP group in pancreatic pathologic histology score( P =- 0.294), the levels of serum amylase ( P = 0.073 ), E-selectin and P-selectin. Conclusions CO2 pneumoperitoneum has no adverse effect on the changes of pathological histopathology and the levels of IL-6, E-selectin and P-selectin in SD rats with SAP.

Objective To explore the effect and adverse reaction of priming regimen CAG in treatment of acute myeloid leukemia in elderly.Methods 32 elderly patients with acute myelogenous leukemia were treated with CAG regimen and 25 cases with standard chemotherapy regimen( DA regimen). The effect and adverse reaction were compared between the two groups. Results There was no significant difference of the complete remission rate and effective rate between the two groups. The recovery time of bone marrow and death rate of CAG the regimen group were superior to those of the DA group. Conclusion CAG regimen was effctive and safe for elderly patients with acute myeloid leukemia.

Objective To assess the risks of complications of loop colostomy and loop ileostomy.Methods The databases of Medline,Embase,Cochrane Library,Google Scholar and Wanfang were retrieved to identify the published studies comparing the advantages between loop colostomy and loop ileostomy.All the articles retrieved were published before April 15,2011.The incidence of complications was analyzed by Meta-analysis.The data were analyzed by the Z test and the heterogeneity of the data was analyzed by the Q test.Results Five randomized controlled trials and 8 non-randomized controlled trials with 1752 cases were included in the Meta-analysis.Compared with loop ileostomy,loop colostomy was associated with significantly increased risk of stoma prolapse ( OR =3.46,95％ CI:1.81-6.63,P ＜ 0.05 ).There were no significant differences in the incidences of stoma hemorrhage and stenosis,wound infection,stoma necrosis,parastoma dermatitis and hernia between patients who received loop ileostomy and those who received loop colostomy.Compared with loop ileostomy,loop colostomy was associated with increased risk of wound infection following stoma closure(OR =3.44,95％ CI:1.95-6.05,P ＜0.05).Compared with loop colostomy,loop ileostomy was associated with increased risk of postoperative bowel obstruction following stoma closure(OR =0.43,95 ％ CI:0.20-0.91,P ＜ 0.05 ).There was no significant difference in the risk of anastomotic leak between loop ileostomy and loop colostomy.Conclusion Compared with loop ileostomy,loop colostomy is associated with increased risk of stoma prolapse and wound infection after stoma closure,while a higher risk of bowel obstruction following stoma closure is observed after loop ileostomy.

Objective To study the effect of thrombin on proliferation and invasion of esophageal cancer cell line Eca109, and to explore its possible mechanism. Methods The proliferation and invasion of Eca 109 cells treated with thrombin were detected by MTT and Transwell assay, respectively. The activity of matrix metalloproteinase 2 (MMP-2) and MMP-9 in the supernatant of Eca109 cells was detected by gelatin zymography. Reverse transcription polymerase chain reaction (PCR) and immunocytochemistry were used to study the mRNA expression of protease-activated receptor 1 (PAR-1), the important receptor of thrombin, and subcellular localization of PAR-1 protein in Eca109 cells, respectively. Results Thrombin could promote Eca109 cells proliferation in a dose-dependent manner. Cell proliferative rates of 0.5 U/ml and 1.0 U/ml thrombin were 34.38 % and 57.19 %, respectively (P< 0.05). Compared to that of control group, the number of Eca109 cells incubated with 1.0 U/ml thrombin invading through the basement membrane of Transwell was increased (303.33 ±6.66 vs. 116.33 ±11.51, P< 0.05). When treated with various concentrations of thrombin for 24 h, the activities of MMP-2 and MMP-9, especially MMP-9, in the supernatant of Eca109 cells were increased in a dose-dependent manner. Eca109 cells expressed PAR-1 mRNA, and PAR-1 protein was mainly located on the cellular membrane. Conclusion Thrombin increases proliferation and invasion of esophageal cancer Eca109 cells and enhances the activities of MMP-2 and MMP-9 in cells supernatant, which might be induced by activation of PAR-1 located on cellular membrane.

Pediatric drug accessibility has become a global problem,pediatric drug shortages and off-label uses are very seri?ous. In China,lack of suitable varieties,appropriate dosage forms and specifications,weak foundations on clinical trials,irregular prescribing behavior and irrational drug use and other issues on pediatric drugs are still outstanding. To improve pediatric drug accessi?bility,it may need all aspects work together,that is,cooperation of the national macro-policy support,participation of enterprises and medical institutions,to establish realistic goals and programs to address pediatric drug problem. This paper studies the foreign pediat?ric regulation measures and policies and by comparing foreign policies to China′s current situation,we can find out the problems and defects,give appropriate advice,in order to provide advice and reference to promote the development of pediatric drug.

Objective To investigate the time and implant selection in conversion from external fixation to internal fixation of tibial shaft fracture.Methods Data of 57 cases of tibial shaft fracture fixed externally followed by internal fixation from February 2003 to February 2012 were analyzed.Internal fixation (intramedullary nails or plates) initiated within 2 weeks (Group A,n =.35) and over 2 weeks (Group B,n =22) were compared in outcomes.Results One infection (3％) and four poor bone healing (11％) were observed in Group A.Five infections (23％) and three poor bone healing (14％) occurred in Group B.For intramedullary nail fixation,no infection was observed in Group A but infection rate of44％ was found in Group B.For plate internal fixation,infection rate was 8％ for both groups.Conclusions The conversion from internal fixation to internal fixation had better start within 2 weeks,with better resuhs,lower rate of infection and safer in comparison with that over 2 weeks.In addition,pin-tract infection is the high risk factor for infection after the conversion of the fixation.