Objective To investigate the effect of laparoscopic hysterectomy and open hysterectomy on ovarian hemodynamics.Methods Selected 132 patients who underwent hysterectomy,among them,76 cases (laparoscopic group)underwent laparoscopic hysterectomy,56 cases(open group)underwent open hysterectomy.The preoperative and postoperative ovarian artery hemodynamic parameters,T cell subsets and serum hormone index of the two groups were observed.Results In the observation group and the control group postoperative 48h,the pulsatility index(PI), resistance index (RI),systolic blood flow velocity maximum (Vmax)and diastolic stage blood velocity minimum (Vmin)decreased(all P <0.05),which of postoperative 2 weeks increased(all P <0.05).The RI,Vmax and PI in the observation group postoperative 48h and 2 weeks were (1.17 ±0.16)and (1.30 ±0.14),(0.66 ±0.11)and (0.70 ±0.06),(11.80 ±3.10)m/s and (12.17 ±3.26)m/s,(3.01 ±0.19)m/s and (2.98 ±0.20)m/s,which were all higher than those in the control group(t =-10.637 and -7.609,-5.880 and -2.583,-5.084 and -3.271,-13.660 and -4.826,all P <0.05).The CD +4 and CD +3 T cells levels of the observation group and control group postoperation were increased(all P <0.05),and the CD +8 T cells levels were decreased(all P <0.05).The CD +4 and CD +3 T cells levels of the observation group postoperative 48h and 2 weeks were (43.50 ±3.50)% and (47.20 ±3.16)%, (73.50 ±6.17)% and (80.06 ±9.20)%,which were higher than those in the control group(t =-6.859 and -5.599,-5.515 and -4.853,all P <0.05),while the CD +8 T cells were (37.52 ±5.10)% and (34.10 ±3.20)%,which were lower than those in the control group(t =3.007 and 3.214,all P <0.05 ).The estradiol(E2 )levels of the observation group and control group were significantly decreased(all P <0.05),follicle stimulating hormone(FSH) levels were significantly increased(all P <0.05).The E2 levels of the observation group postoperative 1 month and 3 months were significantly lower than those of the control group(all P <0.05),FSH levels were significantly higher than those of the control group (P <0.05).Conclusion The effect of laparoscopic hysterectomy on ovarian hemodynamics, ovarian function and immune function is small,and it is worth to be popularized in clinical application.

The purpose of this paper is to study the pattern of change which are age associated,so as to provide a new method of age estimation by bone for forensic medicine and anthropology.The middle one third of right ribs were collected from 67 Chinese females living in North China.Decalcified cross section slides were histomorphometrically examined by using an image analyzer.Then the parameters were subjected to multiple stepwise regression analysis to produce an equation:=31 264+0 868X 2+286 693X 4+0 689 X 7-778 874X 8-0 006X 9.The multiple correlation coefficient and standard error of estimate were 0 923 and 4 08,respectively.When the formula was checked by 25 specimens,84% of the estimated ages fall within ?5 years of actual ages,and 100% of the estimated ages fall within ?8 years of actual ages.This showed that female ages could be deter mined by the histomorphometry of ribs.

[Summary] Activating transcription factor 4 (ATF4) is an alkaline leucine zipper transcriptional factor ,which is involved in many physiological metabolism processes such as stress response ,inflammation and tumor growth. Moreover ,recent studies have shown that ATF4 also plays a key role in regulating lipid and glucose metabolism ,insulin secretion and insulin sensitivity ,which may related to pathways such as endoplasmic reticulum stress (ERS ) ,peroxisome proliferator‐activated receptor gamma coactivator (PGC1α) and target of rapamycin (TOR). This article summarized the recent research progress of ATF4 in regulating glucose and lipid metabolism.

OBJECTIVE:To determine the concentration of dehydroisoandrosterone sulfate (DHEAS) in human plasma by LC-MS.METHODS:With estrogen sulfate (ES) served as an internal standard,the plasma samples were deproteinized with acetonitrile,extracted by solid phase,hydrolyzed and derivatized.Then the concentration of DHEAS was determined by HPLC-MSD on Agilent SB C18 with column temperature kept at 40℃.The mobile phase consisted of acetonitrile-water (in gradient elution).Atmosphere pressure chemical ion source in negative ion detection model was employed.The ions selected for SIM (selected ion monitoring) quantitative analysis included m/z 490.0 (DHEAS ) and m/z 472.1(ES)[M-H]-.RESULTS:The linear range of DHEAS was 250.0～320.0 ng?mL-1(r=0.999 4).The extraction recovery of the simulated human albumin samples ranged from 71.1%～78.9% and its relative recovery ranged from 98.3%～101.4%.Both the intra-day RSD and inter-day RSD were less than 10%.The mean concentration of DHEAS in 15 health aged male volunteers was (981.6?353.4) ng?mL-1.CONCLUSION:The method is simple,practical,accurate and sensitive,and it is applicable for the determination of plasma concentration of DHEAS.

Objective Right ventricular outflow tract septum has become widely used us an electrode placement site. However, data concerning lead performances and complications for lead repositioning with this technique were scant. The purpose of this study was to observe long-term lead performances and complications of right ventricular outflow tract septal pacing and provide evidences for choosing an optimal electrode implantation site. Methods Thirty-six patients with septal active electrode implantation and 39 with apical passive electrode implantation were enrolled in this study. Pacing threshold, R-wave sensing, lead impedance, pacing QRS width and pacing-related compli-cations for two groups at implantation and follow-up were compared. Results There were higher pacing threshold and shorter pacing QRS width at implantation in the septal group compared with the apical group. There were no differences between the septal and the apical groups in pacing threshold, R-wave sensitivity, lead impedance and pace-related complication during a follow-up. Conclusions Right ventricular outflow tract septum could be used as a first choice for implantation site because it had long-term stable lead performances and no serious complications compared with the traditional apical site.

AIM: To evaluate the case-based learning ( CBL ) in ophthalmology teaching practice.
METHODS: A total of 88 students were taught by the combination of lecture-based teaching with CBL form of sensory organs in Jinzhou Medical Teaching Classes. After class, the questionnaire was filled by each student to evaluate the CBL teaching mode.
RESULTS:The description of the data was analyzed as a percentage of each option. All the students were taught by CBL at the end of the class, most of the students could accept the teaching mode, it was helpful for students to understand the principle of clinical treatment, increased the interest in the process of teaching. And it was conducive to review the knowledge and exercise clinical case analysis ability. And it could recognize the ophthalmic diseases and special auxiliary examination. CBL teaching mode could stimulate students' interest in learning ophthalmology, it was beneficial to the cultivation of theory combined with practice and clinical thinking.
CONCLUSION: CBL teaching mode can be used as an auxiliary teaching lecture-based learning teaching.

Objective Atrioventricular block (AVB) is a common and serious arrhythmia. At present, there is no perfect method of treatment for this kind of arrhythmia. The purpose of this study was to regenerate cardiac atrioventricular conduction by autologous transplantation of bone marrow mesenchymal stem cells (MSCs), and explore new methods for therapy of atrioventricular block. Methods Eleven Mongrel canines were randomized to MSCs transplantation (n=6) or control (n=5) group. The models of permanent and complete AVB in 11 canines were established by ablating His bundle with radiofrequency technique. At 4 weeks after AVB, bone marrow was aspirated from the iliac crest. MSCs were isolated and culture-expanded by means of gradient centrifugal and adherence to growth technique, and differentiated by 5-azacytidine in vitro. Differentiated MSCs (1ml, 1.5×107cells) labeled with BrdU were autotransplanted into His bundle area of canines by direct injection in the experimental group, and 1ml DMEM in the control group. At 1-12 weeks after operation,the effects of autologous MSCs transplantation on AVB models were evaluated by electrocardiogram, pathologic and immunohistochemical staining technique. Results Compared with the control group, there was a distinct improvement in atrioventricular conduction function in the experimental group. MSCs transplanted in His bundle were differentiated into analogous conduction system cells and endothelial cells in vivo, and established gap junction with host cardiomyocytes. Conclusions The committed-induced MSCs transplanted into His bundle area could differentiate into analogous conduction system cells and improve His conduction function in canine AVB models.

Objective To discuss the nonoperative management strategy to prevent the conversion of acute pancreatitis to the severe form.Methods In recent 4 years,286 patients with mild acute pancreatitis admitted to our hospital were divided into control group and treatment observation group;routine conservative management was performed in control group,and the strategy of improving pancreatic microcirculation and preventing cell Ca~2+ overload and inhibiting pancreatic protease was added to the treatment observation group.Results Among the 144 patients with mild acute pancreatitis in control group,conversion to severe acute pancreatitis occurred in 20 patients,and 14 of the 20 patients with severe acute pancreatitis developed systemic complications.Among the 142 cases in treatment observation group,the conversion of mild to severe acute pancreatitis occurred in 8 patients,and 2 of the 8 patients developed systemic complications.Serum C-reactive protein levels and Balthazar CT severity index were significantly decreased at each time point in treatment observation group compared to control group.Conclusions In addition to routine management,improving pancreatic microcirculation,preventing cell Ca~2+ overload and inhibiting pancreatic protease might serve as a benificial strategy for preventing the progression of mild acute pancreatitis to the severe form.

OBJECTIVE:To study the effect of alcohol extract of Toddalia asiatica on the inflammation-associated cytokines of model rats with adjuvant arthritis(AA). METHODS:70 SD rats were randomly divided into a normal control group,a model con-trol group,a positive control chemical medicine group(Leflunomide tablets,0.012 g/kg),a positive control TCM group(Tripter-ygium glycosides tablets,0.012 g/kg)and the groups of low,medium and high-dose [1,4,6 g(crude drug)/kg] alcohol extract of T. asiatica,with 10 rats in each group. The rats in all groups except for the normal control group were given complete Freund’s complete adjuvant id for the establishment of AA models. At the same time,the rats in the drug administration groups were given corresponding drugs ig,while those in the normal control group and the model control group were given isometric normal saline ig,twice a day,for 28 consecutive days. The degree of toe swelling,arthritis index and the levels of interleukin(IL)-1β,IL-6, IL-10,tumor necrosis factor α(TNF-α)and prostaglandin E2(PGE2)in serum and synovial membranes of all groups of rats were determined. RESULTS:Compared to the normal control group,the model control group demonstrated higher degree of primary and secondary toe swelling,arthritis index and levels of IL-1β,IL-6,TNF-αand PGE2 in serum and joint synovial membrane,and low-er level of IL-10 therein(P<0.01). Compared to the model control group,all the above-mentioned indexes of the rats in drug ad-ministration groups significantly improved(P<0.05 or P<0.01). CONCLUSIONS:The alcohol extract of T. asiatica. has a preven-tive and therapeutic effect on the model rats with AA by regulating the expression of anti-inflammatory and proinflammatory cyto-kines in serum and synovial membrane.

Objective To evaluate catheter-directed thrombolysis through popliteal vein for the treatment of lower extremity deep venous thrombosis (DVT). Method A total of 62 patients with single symptomatic lower limb DVT were analyzed. The popliteal vein of symptomatic limb was punctured, under Doppler guidance a 5-F sheath was advanced into the deep vein. A catheter was advanced beyond the thrombus. After a bolus of 200 000 IU urokinase, 100 000 IU/h urokinase was infused for up to three days, meanwhile 400 IU heparin was administered subcutaneously every 12h. Clinical efficacy grade was evaluated by measuring the perimeter of legs and lysis grade was calculated based on venographic results. Results In addition to total or partial removal of the thrombus collateral circulation increased, the limbs edema reduction rate was 78% and the thrombolysis rate was 67%. Thrombolysis rate in acute, and relapsing cases was significantly higher than in chronic group (75%,and 71% vs. 49%,P