Objective To discover the diagnosis and treatment rules of metrorrhagia and metrostaxis by analyzing the relevant papers published in the past 10 years.Methods Papers on diagnosis and treatment rules of metrorrhagia and metrostaxis written by well-known doctors were retrieved.The types of metrorrhagia and metrostaxis syndrome,diagnosis and treatment rules of metrorrhagia and metrostaxis syndrome,application of prescriptions in treatment of metrorrhagia and metrostaxis syndrome were analyzed by content analysis,frequency analysis and clustering analysis,respectively.Results One hundred and thirty-three papers on the diagnosis and treatment rules of metrorrhagia and metrostaxis were included in this paper with 35 types of metrorrhagia and metrostaxis syndrome involved,including 15 single syndromes,such as blood stasis,blood heat,Qi deficiency,spleen deficiency,kidney deficiency,blood deficiency,kidney-yang insufficiency.Metrorrhagia and metrostaxis was treated according to the differentiation of its symptoms and signs in combination with the menstrual cycle,age and bleeding of the patients.A total of 221 prescriptions were used in the treatment of metrorrhagia and metrostaxis.Conclusion Metrorrhagia and metrostaxis is usually occurred in spleen and kidney.lood stasis is its common pathogenesis.Metrorrhagia and metrostaxis is treated by well-known doctors according to the differentiation of its symptoms and signs,and prescriptions are used in a flexible way.

Objective:To compare the clinical effects and improvement of serum hormone levels of kidney tonifying and blood circulation recipe and mirena in the treatment of perimenopasual dysfunctional uterine bleeding.Methods:92 cases of perimenopausal patients with dysfunctional uterine bleeding in our hospital from July 2013 to November 2016 were selected and divided into group A and group B with 46 cases in each group.Group A was orally administered with kidney tonifying and blood circulation recipe,and group B was administered with mirena.Both groups were treated for 3 periods.The efficacy and incidences of adverse effect in two groups were observed.The levels of serum hormones and hemoglobin (Hb),and endometial thickness (ET) were detected in two groups.The indices of serum hormone included follicle-stimulating hormone (FSH),luteinizing hormone (LH),progestone (P) and estradiol (E2).Results:No significant difference was found in the total effective rate between two groups (P＞0.05).After treatment,the levels of serum FSH,LH,E2 and P as well as ET and Hb in both groups were all significantly lower than those before treatment (P＜0.01),and the levels of serum FSH,LH,E2 and P as well as ET of group B were significantly lower than those of group A (P＜0.01),no significant difference in the Hb level between two groups (P＞0.05).The incidence of adverse reactions of group B (15.22％) was significantly higher than that of group A(0％) (P＜0.01).Conclusions:The kidney tonifying and blood circulation recipe had similar effect as mirena in the treatment of perimenopasual dysfunctional uterine bleeding,while mirena had strong improving effect in serum hormone level and ET,kidney tonifying and blood circulation recipe had higher security.

Objective To investigate the effects of different BIS values on postoperative cogni-tive dysfunction (POCD)and S100βprotein(S100β)in the early stage of postoperation.Methods Fifty patients who were scheduled for selective abdominal surgery under general anesthesia (male 34 cases, female 1 6 cases,aged 65 to 75 years,ASA Ⅰ or Ⅱ)were randomly divided into two groups:light anesthesia group (group L,n =25,BIS value was maintained at 50 to 59)and deep anesthesia group (group D,n =25,BIS value was maintained at 30 to 39).BP,HR,SpO 2 ,ECG,PET CO 2 ,inhaled anes-thetic concentration and BIS values were recorded on time points of 5 minutes after the patients ente-ring the operating room (T0 ),before endotracheal (T1 ),intubation (T2 ),incision (T3 ),two hours after incision (T4 ),three hours after incision (T5 )and at the end of surgery (T6 ).The procedure du-ration,anesthesia time,dosages of propofol,fentanyl,midazolam and VAS scores on 1 d after sur-gery were also recorded.Blood samples were collected on time points of 10 min before anesthesia,im-mediately after surgery and 24,48 h after operation.S100β concentration were detected.Mini-mental State Examination (MMSE)score and Trail Making Test (TMT)completion time were recorded on 1 d before surgery and 1,3,7 d after surgery.Results BIS value of group D were lower than group L on T2 ,T3 and T4 .The propofol dosage of group D was significantly greater than that in group L (P <0.05 ).The concentration of serum S100βincreased significantly immediate and 48 h after operation in both groups compared with 10 min before anesthesia(P < 0.05).It was still higher 24 hours after op-eration than before anesthesia.But there was no statistic difference.Compared with the end of surger-y,the concentration of serum S100βin two groups on 24 h after surgery were significantly decreased (P < 0.05 ).The concentration of serum S100β in group L on the end of surgery and 24 h after surgery were higher than that in group D significantly (P <0.05).Compared with 1 d before surgery, postoperative 1 d MMSE scores in two groups and postoperative 3 d MMSE score in group L de-creased significantly (P <0.01).Compared with postoperative 3 d,postoperative 7 d MMSE score in group L increased significantly (P <0.01).Postoperative 1,3 d MMSE score in group D were signifi-cantly higher than group L (P <0.05).Compared with 1 d before surgery,TMT completion time in two groups on 1 d after surgery were significantly prolonged (P <0.01 ).Compared with 1 d after surgery,TMT completion time in two groups on 3 d after surgery were significantly shortened (P <0.01).Compared with 3 d after surgery,TMT completion time in group L on 7 d after surgery was significantly shortened (P <0.01 ).TMT completion time in group D on 1,3 d postoperative were significantly shorter than group L (P <0.05).POCD incidence of group D on 1 d after surgery was lower than that in group L (P < 0.05).Conclusion Different depth of anesthesia can ensure hemo-dynamic balance in old patients during surgery and after surgery.When BIS value was maintained at 30 to 39,it had lower S100βprotein levels,lower incidence of early POCD and a lesser degree of post-operative cognitive dysfunction.

Objective To summarize the clinical characteristics of primary pigmented nodular adrenocortical disease (PPNAD).Methods Eight patients with PPNAD from 2001 to 2009 in PUMC Hospital were reviewed,their clinical data were collected.Results PPNAD often occurred in adolescents.62.5% of patients with PPNAD were complicated with Carney complex(CNC).In addition to general features of Cushing's syndrome,amenorrhea and growth retardation in stature were very frequent in clinical manifestations of PPNAD.Plasma ACTH was undetectable,circadian rhythm of plasma cortisol was disappeared,glucocorticoid excretion was increased paradoxically during the dexamethasone suppression test in 50% patients with PPNAD.Adrenal imaging from 75% patients revealed normal-sized adrenal glands or suspectable micronodular changes.Adrenal pathologic analysis revealed numerous brown cortical nodules containing lipofuscin pigmentation.Unilateral adrenalectomy may relieve symptoms of Cushing's syndrome,but plasma ACTH and circadian rhythm of plasma cortisol were difficult to recovere.Hypercorticoidism might re-occure after unilateral adrenalectomy.Conclusion PPNAD should be bewared in ACTH independent Cushing's syndrome patients without apparent adrenal mass,and CNC should be screened and followed up.

OBJECTIVETo investigate the diagnostic value of serum Golgi protein-73 (GP73) combined with the AFP-L3% test for hepatocellular carcinoma.

METHODSComprehensive electronic and manual searches were performed to retrieve relevant studies on GP73 combined with AFP-L3% for diagnosis of hepatocellular carcinoma. After screening of the studies according to inclusion criteria and extraction of the data,meta-analysis was performed in Meta-disc 1.4 and Stata 12.0.

RESULTSEleven studies that met the inclusion criteria were selected from the total 138 references with potential relevance.The threshold effect was not found in the GP73 combined with AFP-L3% for the diagnosis of liver cancer.However,heterogeneity was found in this meta-analysis. The pooled sensitivity and specificity of GP73 combined with AFP-L3% was 0.853 and 0.960 respectively. The area under summary receiver operating characteristics curve was 0.948, and the Q index was 0.888.

CONCLUSIONGP73 combined with AFP-L3% can significantly improve the diagnostic sensitivity and specificity to a high level, and can improve the diagnosis rate of hepatocellular carcinoma.

Objective To observe the effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation (rSO 2 )in the elder patient undergoing one-lung ventilation. Methods Fifty-eight patients scheduled for esophagus cancer resection(44 males,14 females,aged 65-79 years,ASA physical status Ⅱ or Ⅲ),were randomly divided into two groups (n =29 each)u-sing a random number table:conventional fluid therapy group (group C)and goal-directed fluid ther-apy group (group G).Implementing radial artery puncture and internal jugular vein puncture under local anesthesia in order to monitor BP and CVP.The Flotrac/Vigileo system was used to monitor cardiac output (CO),stroke volume variation (SVV)and cardiac index (CI)in the both group.As mentioned all above,group C received conventional fluid therapy based on MAP,CVP and urine vol-ume,whereas group G received goal-directed fluid therapy (GDFT)based on SVV with the goal of CI at 2.5-4.0 L·min-1·m-2 .Intraoperative continuous monitoring of rSO 2 was performed and the sur-gery rSO 2 average (rSO 2 ),the minimal surgery rSO 2 (rSO 2min )and the maximal percentage of the decreased rSO 2 compared to baseline values (rSO 2%max )were calculated in the both group.The varia-tion of MAP,HR,CVP,SVV and CI at the onset of the monitoring (T1 ),the momment before one-lung ventilation (T2 ),30 min after one-lung ventilation (T3 ),1 h after one-lung ventilation(T4 )and the end of the surgery (T5 )were recorded.The requirement for crystalloid and colloid,total volume of fluid infused,bleeding volume,urine volume,and requirement for vasoactive agents were recorded during operaton.Results Compared with group C,MAP at T3 ,T4 and CI at T3-T5 in group G were increased significantly,while CVP at T3-T5 and SVV at T2-T5 in group G were decreased (P <0.05). The rSO 2%max in group G was significantly lower than that in group C (P <0.05).No statistically sig-nificant difference was observed in the rSO 2 and rSO 2min between the two groups.Compared with group C,the requirement for crystalloid [(668±187)ml vs (1052±221)ml and total volume of fluid infused [(1212±318)ml vs (1519±329)ml],urine volume [(211±47)ml vs (278±54)ml]and vasoactive agents [4 cases (14%)vs 14 cases (48%)]were significantly decreased (P <0.05),the requirement for colloid were increased [(544±103)ml vs (467±94)ml,P <0.05].Conclusion The goal-directed fluid therapy based on SVV stabilizes the hemodynamic effectively,improves the CI and the perfusion of brain,and maintains the cereral oxygen metabolism in the elder patient undergoing one-lung ventilation.

Objective To clarify the efficacy and safety of cyclosporine A CsA) as salvage therapy in patients with severe active ulcerative colitis (UC) and refractory to steroids.Methods A total of 24 severe active UC patients refractory to steroids and hospitalized from 2006 to 2012,were retrospectively enrolled.Data including demographic features,clinical manifestations,laboratory tests and medications were collected.Results CsA was effective in 15 (62.5％) patients,who did not receive colectomy during 12-week administration.This regimen was tolerable in most patients.Twelve (50.0％) patients reported 16 adverse events,but only one patient withdrew CsA due to intolerance.The rates of adverse events in initial intravenous CsA including 4 mg · kg-1 · d-1,3 mg · kg-1 · d-1 and 2 mg· kg-1 · d-1 were 2/2,9/17 and 1/5 respectively.Responders had higher white blood cell count compared with non-responders (P =0.045).Conclusions CsA could be an effective alternative regimen to colectomy in severe active UC patients who are refractory to steroids.

Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8％ (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P＞0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P＜0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1％ (22/129),P＜0.05].In the TOLAC group,99.3％ (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P＜0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.

This study was aimed to review literatures on the treatment of metrorrhagia and metrostaxis using acupuncture and moxibustion in recent 30 years.Database retrieval on literatures using acupuncture and moxibustion for treating metrorrhagia and metrostaxis was carried out.Statistical methods,such as frequency distribution and cluster analysis were employed in terms of frequently used medians,acupoints and methods.The results showed that there were a total of @@65 articles included in this study.The frequently used methods were acupuncture,moxibustion and auricular acupuncture.The frequently used meridians were the Spleen Meridian of Foot-Taiyin,the Ren meridian,the Bladder Meridians of Foot-Taiyang,and the auricular acupoints.The frequently used acupoints were related with the liver,spleen and kidney.Most acupoints were the meeting acupoints.Selections of auricular acupoints were related to the combination of disease differentiation and syndrome differentiation.The frequently used acupoints were clustered into four groups.Different group reflected different acupoint selection laws.Group 1,such as SP-6 (Sanyinjiao) and SP1 (Yinbai),circling along the Spleen Meridian,had effect on tonifying the spleen and kidney,nourishing blood,preventing bleeding and regulating menstruation.Group 2,such as RN-4 (Guanyuan) and ST-36 (Zusanli),in the upper and lower positions,were used for nourishing qi and blood.Group 3 and group 4 were mostly auricular acupoints,acupuncture and moxibustion in combination with syndrome differentiation.Group 3 had the effect on notifying kidney yin,reinforcing the spleen,regulating Chong and Ren meridian.Group 4 played a role in tonifying the kidney,activating blood,and soothing liver qi.It was concluded that the study on quantitative analysis of literatures on the treatment of metrorrhagia and metrostaxis using statistical method had inspirational effect on clinical treatment in terms of acupoint selection and combination.

Objective To evaluate the effect of electroacupuncture preconditioning on postoperative delirium ( POD) and early outcomes in the patients undergoing cardiac valve replacement with cardiopulmo-nary bypass. Methods Sixty American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes, of New York Heart Association Ⅱ or Ⅲ, aged 28-64 yr, scheduled for elective cardiac valve re-placement with cardiopulmonary bypass, were divided into 2 groups ( n=30 each) using a random number table method: control group ( group C ) and electroacupuncture preconditioning group ( group EA ) . In group EA, Baihui, Yintang and Renzhong acupoints were stimulated for 30 min with an electric stimulator ( sparse-dense wave, frequency 2/15 Hz, intensity 1 mA) before skin incision. rSO2 was continuously mo-nitored during operation, and the mean rSO2 ( rSO2 mean ) , the minimal rSO2 ( rSO2min ) and the maximal percentage of decrease from baseline in rSO2 ( rSO2％max ) were calculated. Blood samples were collected be-fore the electroacupuncture, at the end of surgery, and at 6, 24 and 72 h after surgery for determination of serum tumor necrosis factor-alpha, interleukin-6 ( IL-6) , IL-10, neuron-specific enolase and S100β pro-tein concentrations by enzyme-linked immunosorbent assay. POD was assessed by Confusion Assessment Method for Intensive Care Unit, and the postoperative recovery was evaluated by Quality of Recovery-40 Questionnaire. The occurrence of POD, duration of stay in intensive care unit and length of hospital stay were also recorded. Results Compared with group C, the rSO2％max , serum concentrations of tumor nec-rosis factor-alpha, IL-6, neuron-specific enolase and S100βprotein and incidence of POD were significant-ly decreased, the rSO2min , serum IL-10 concentration and Quality of Recovery-40 Questionnaire score were increased, and the duration of stay in intensive care unit and length of hospital stay were shortened ( P＜0. 05) , and no significant change was found in rSO2mean in group EA ( P＞0. 05) . Conclusion Electroacu-puncture preconditioning decreases the occurrence of POD and improves early outcomes in the patients un-dergoing cardiac valve replacement with cardiopulmonary bypass.