Objective To evaluate the safety and effect of embryo aspiration and fetal cardiac activity area injection of transvaginal pregnancy multi -fetal reduction for women with early pregnancy.Methods Retrospective a-nalysis of 120 cases with transvaginal early pregnancy multi -fetal reduction was conducted.The pregnancy outcome of the two ways was analyzed and evaluated.Results Among 120 cases,55 cases were treated with fetal cardiac activity area injection,65 cases were treated with embryo aspiration.Fetal cardiac activity area injection group:gestational age (48.7 ±9.1)d,postoperative infection abortion rate:12.7% (7 cases),rate of premature babies:5.5% (3 cases). Embryo aspiration group:gestational age (46.9 ±4.2)d,postoperative infection abortion rate:6.2% (4 cases),rate of premature babies:3.1% (2 cases),the difference between postoperative infection abortion rate was statistically sig-nificant (P =0.02).Virgiria Apgar score (P =0.41),neonatal weight(P =0.70),fetal malformation rate (P =0.24),neonatal move to NICU rate (P =0.83),the differences were not statistically significant.Conclusion During the early stage embryo aspiration is a safe method for the multi -fetus reduction,the pregnancy outcome is better than fetal cardiac activity area injection.

Objective To compare the effects of different blood purification methods on the removal of large and medium molecular toxins in patients with maintenance hemodialysis(MHD), and to provide the clinical basis for selecting suitable dialysis modalities to prevent or delay the long term complications of uremic patients.Methods60 MHD patients with long term and stable hemodialysis were enrolled in this study.All of them were selected from the patients with insufficient hemodialysis.According to the digital table,60 patients were randomly divided into high flux hemodialysis (HFHD)group and hemodiafiltration (HDF) group,30 cases in each group.And before,3 months and 6 months after dialysis, the serum β2-MG,PTH and Cys C after dialysis were tested.Results The clearance of PTH in the HFHD group[(286.34±127.33)pg/mL] was significantly higher than that in the HDF group[(376.04±141.74)pg/mL],the difference was statistically significant(t=2.45,P<0.05).The clearance of β2-MG in the HDF group[(11.34±1.96)mg/L]was significantly higher than that in the HFHD group[(15.41±3.02)mg/L],the difference was significant(t=5.88,P<0.05).The clearance of Cys C in the HFHD group[(263.67±98.72)μg/dL]was significantly higher than that in the HDF group[(345.63±105.00)μg/dL],the difference was statistically significant(t=2.96,P<0.05).Conclusion Both two dialysis methods are very effective in the removal of large and medium molecular uremic toxins in patients.In the removal of patients with increased PTH,HFHD is more effective.In the removal of patients with increased β2-MG,HDF is more effective.In the removal of Cys C,HFHD is better.

The mesenchymal stem cell ( MSC ) is an important component of the hematopoietic microenvironment .In the process of stem cell transplantation (SCT), MSC can restore the hematopoietic microenvironment , improve the capacity of hematopoiet-ic reconstitution, reduce the incidence of graft versus host disease (GVHD).MSC has been widely used in hematopoietic stem cell transplantation, immune therapy, tissue engineering and many other fields .The distribution and colonization of MSC in vivo directly af-fect the effectiveness of transplantation .Improving the homing and engraftment of MSC may obtain a better therapeutic effect .Further research on the mechanism and influential factors of MSC homing may lead to the development of therapies and promote clinical applica -tions of MSC.This paper reviews the recent progress in homing mechanism of MSC .

Objective To analyse the effect of different blood purification methods on serum cardiac troponinc T (cTnT), cardiac troponinⅠ(cTnI), β2-microglobulin (β2-MG) and interleukin-6 (IL-6) levels in patients with maintenance hemodialysis.Methods 60 uremic patients treated with maintenance hemodialysis were collected.All patients were randomly divided into conventional hemodialysis group (HD group) , hemodialysis and hemoperfusion group (HD+HP group) and hemodiafiltration group (HDF group) , 20 cases in each group.Corresponding dialysis treatment was given, then the serum levels of cTnT, cTnI,β2-MG and IL-6 were detected in all patients post-treatment.Results After treatment, the serum cTnT, cTnI,β2-MG and IL-6 levels in HD+HP group and HDF group were lower than those in HD group (P<0.05).Conclusions Different blood purification methods have different effects on serum cTnT, cTnI, β2-MG and IL-6 levels in patients with maintenance hemodialysis, HDF and HD +HP have better scavenging effect, which has the guiding significance to clinical application.

Covered in the paper are the significance of rural doctors′professional development and their professional characteristics,as well as systematic insights on such key factors of professionalism of these doctors,as their professional qualifications,functional positioning,practicing approach,professional guarantee,professional development,social identity,professional stability,and professionalism.Based on such thoughts,the authors recommend on reforms of professional development for rural doctors by stages and levels.

Studies showed that low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) diet can improve the symptoms of gastrointestinal dysfunction of inflammatory bowel disease (IBD) patients, the mechanism may be related to decrease of secretion of intestinal liquid and production of gas.Specific carbohydrate diet and paleolithic diet may be suitable for IBD patients.This article reviewed the advances in study on effects of different diets on gastrointestinal dysfunction in patients with IBD.

Purpose To investigate the value of low dose CT combined with iterative model reconstruction (IMR) technique for evaluation of both breast lesion and pulmonary metastasis in patients with breast cancer,and compare the effects of IMR,hybrid iterative reconstruction (HIR) and filtered back projection (FBP) techniques on image quality.Materials and Methods Twenty-one patients with solitary tumor confirmed by mammography and/or ultrasonography at Navy General Hospital from January to May in 2016 were enrolled,and the related breast imaging reporting and data system reached to level 4 and above.All patients underwent dynamic contrast-enhanced CT with different tube current for breast (scanning 6 times within 6 minutes) and chest scans;the conventional tube current (61 mAs) was used at the 2 minutes phase after injection,and the low tube current (10 mAs) was used at the other 5 phases.CT images were reconstructed with FBP,HIR and IMR techniques,respectively.The images of breast lesions and chest in 2 minutes scans were evaluated objectively and subjectively.Results The mean effective radiation dose was (2.15 ± 0.39) mSv.The images of 3 reconstruction techniques at the 2 minutes phase were compared,and the IMR images showed the lowest image noise and the optimal contrast to noise ratio (P＜0.05).The images quality of 3 kinds of reconstruction techniques was acceptable,of which IMR was better than HIR and FBP (P＜0.05).Conclusion Low dose CT scan combined with IMR technique can remain low radiation with dose of 2 mSv,while maintaining good image quality,which can be used for preoperative evaluation of both breast lesion and pulmonary metastasis in patients with breast cancer.

Objective To study dose-response relationship and screen the optimized fractionated irradiation schedules in subclinical tumors of malignant glioma.Methods Balb/c-nude mice bearing human malignant glioma xenograft were assigned randomly into control group,fractionated irradiation schedules group and nimotuzumab-conventional fraction group.The fractionated schedules were 200 cGy x 5f/w,300 cGy ×5f/w,160 cGy ×2f/d x5 d and 400 cGy ×3f/w with total dose of 40 Gy and 60 Gy,respectively.Measurement indexes were tumor-forming rate,average recurrence time and maximum diameter of the tumor bottom.The observation lasted 24 weeks.Results With the total dose of 40 Gy,none of the significant long-term tumor regression were detected in any fractionated irradiation schedules; 400 cGy x 3f/w with complete tumor response at the end of treatment showed a better short-term curative effect.With the total dose of 60 Gy,long-term control rate of each fractionated irradiation schedule group was improved with prolonged average recurrence time of varable degrees,except 200 cGy x 5f/w fractionated schedule (tumor formation rate was 100％ at the end of treatment and average recurrence time was the poorest of 108 d).160 cGy × 2f/d × 5 d fractionated schedule showed the best curative effect with no tumor formation in 2 of 8 mice and longest recurrence time of 143 d.300 cGy x 5f/w fractionated schedule ranked second with no tumor formation in 1 of 8 mice and average recurrence time was 137 d.400 cGy x 3f/w fractionated schedule produced the poorest outcome with no case cured.There were no significant changes in the tumor-forming rate or average recurrence time when nimotuzumab was concurrently used for subclinical tumors of malignant glioma with total dose of 60 Gy.Conclusions Conventional fractionated irradiation is not the best option to control the sustained growth.160 cGy ×2f/d ×5 d and 300 cGy × 5f/w might be the optimized fractionated irradiation schedules for subclinical tumors of malignant glioma.

Objective To explore the feasibility and efficacy of the selective portal vein embolization (SPVE) before radiofrequency ablation(RFA) for liver tumor large than 3 cm.Methods 63 patients with 63 liver tumor (＞3 cm) located in single liver segment completely or mostly underwent RFA.21 patients (21 lesions) were randomly assigned to receive SPVE before ablation (SPVE + RFA group),other 42 patients were treated with RFA only (RFA group).The complications and treat results of two groups were collected and compared.Results SPVE were achieved in 20 of 21 patients,and no critical complication were happened in both group.During a observation period of median 14.2 months,local tumor progression were observed in 17 of 42 patients (40.5％) in RFA group and in 3 of 20 patients (15.0％) in SPVE+ RFA group,there were significant difference between two groups(P =0.043).Conclusions SPVE can safely and effectively improve the efficacy of RFA for the liver tumors which large than 3 cm and located in single liver segment.

Objective:To investigate the effect of Yinertong antibacterial fluid combined with Yintshu antibacterial gel on puncture wound infection in pleural catheter drainage.Methods:A total of 80 patients who underwent pleural catheter drainage in Gulou Hospital Affiliated to Medical College of Nanjing University from January 2018 to December 2019 were enrolled. They were divided into the control group and the experimental group by random digits table method, with 40 cases each. The control group was given alcohol disinfection and traditional iodophor. The experimental group was given Yinerong antibacterial fluid combined with Yintshu antibacterial gel. The infection of puncture wound, degree of edema, incidence of catheter displacement, colonization rate of catheter pathogens, pain, and nursing satisfaction were observed and compared between the two groups.Results:The wound infection rate was 15% (6/40) in the control group, and 0(0/40) in the experimental group, the difference was statistically significant ( χ2=4.50, P<0.05). There was no significant difference in colonization rate of catheter pathogens between the two groups ( P>0.05). There were 28, 6, 4 and 2 cases of no edema, mild, moderate and severe edema in the control group and 38, 1, 1 and 0 cases in the experimental group, the difference was statistically significant ( Z=8.19, P<0.05). There was no significant difference in the scores of Visual Analogue Scale (VAS) of immediate pain of puncture between the two groups ( P>0.05). The score of VAS after 24 hours of puncture and at the time of extubation was (3.10 ± 1.34), (1.50 ± 1.36) points in the experimental group, and (3.83 ± 1.28), (2.38 ± 1.28) points in the control group, the differences were statistically significant ( t=2.48, 2.97, both P<0.05). The satisfaction rate after discharge was 97.5% (39/40) in the experimental group, and 80.0% (32/40) in the control group, the difference was statistically significant ( χ2=8.31, P<0.05). Conclusions:The combined application of Yinertong antibacterial fluid and Yintshu antibacterial gel can significantly reduce the wound infection rate of pleural catheter drainage, reduce wound edema and pain, and improve patients′ satisfaction with nursing work, which is worthy of popularization and application.