Objective To explore prognostic factors of the uterine papillary serous carcinoma (UPSC).Methods Twenty eight patients with UPSC in Cancer Hospital of Shantou University Medical College from January 2002 to August 2013 were analyzed retrospectively.Prognostic factors were analyzed by univariate analysis.Results Twenty eight cases of UPSC with 6.3％ occurrence in the endometrial carcinoma admitted in the same period,including 14 cases of staging Ⅰ ～ Ⅱ,and 14 cases of staging Ⅲ.The univariate analysis showed that lymph-node metastasis and operative-pathological staging were significantly associated with the prognosis (P ＜ 0.05),but were not associated with the menopausal,postoperative treatment,operation style,deep myometrial invasion,cervical involvement,and annex invasion (P ＞ 0.05).Two cases of Ia-staging without myometrial infiltration and without added postoperative treatment were still alive.Conclusions Operative-pathological staging and retroperitoneal lymphadenectomy were independently prognostic factors of UPSC.The Ia-staging without myometrial infiltration might be without added postoperative treatment.

Objective To analyze the characteristics of hospitalized patients with systemic lupus erythematosus (SLE) in Ningxia Hui Autonomous Region,and to characterize the epidemiology of SLE.Methods The data of 184 patients admitted to Ningxia Medical College Hospital during January 2008 to December 2013 were retrospectively analyzed.The data analysis included the initial symptoms,system involvement and clinical situations.Chi-square test,t test,Mann-Whitney U test and Logistic analysis were used for statistical analysis.Results ① The ratio of male and female was 1∶9.8.The most common clinical symptoms was rash in 72 cases (39％),and followed by joint pain in 61 cases (33％),swelling in 28 cases (15％) and fatigue in 21 cases (11％).② Eighteen percent (33/184) patients were late-onset SLE patients.Compared with regular SLE patients,the interval was longer in late-onset SLE patients between clinical symptoms onset and the time when they saw the doctor.③ Blood and kidney were the most commonly affected organs.④ The highest diagnosis rate occurred in rheumatology department,the highest diagnosis rate occurred in the kidney department for patients with dropsy as starting symptom.Conclusion SLE primarily occurs in childbearing aged women.The reason of misdiagnosis of SLE is mainly due to the incorrect hospital selection for the first visit.Delayed diagnosis will lead to delay in the treatment.

Objective To investigate the serum level of anti N-methyl-D-aspartate (NMDA) receptor antibody in patients with cognitive dysfunction of systemic lupus erythematosus (SLE) and its clinical significance.Methods The levels of anti NMDA receptor antibody in blood samples from 36 patients with cognitive dysfunction of SLE,30 cases with normal cognitive function of neuropsychiatric lupus erythematosus (NPSLE) groups,64 patients with no-NPSLE,100 patients with other connective tissue diseases and 30 healthy controls were measured by enzyme linked immunosorbent assay,and the reports of Mini-Mental State Examination and the laboratory indexes were recorded in those groups,then these index were measured again when patients were treated for 2 weeks.The comparison of multi-group was conducted by means of single factor analysis of variance or rank test,the Pearson or Spearman correlation analysis was used to analyze the correlation between variables.Results ① The level of anti NMDA receptor antibody in the patients with cognitive dysfunction of the NPSLE group (1.30±0.27) was higher than those with normal cognitive function of NPSLE group (0.47±0.08),No-NPSLE group (0.47±0.07),the other connective tissue disease (0.42±0.04) and the healthy controls (0.35±0.06) (P＜0.05),the difference was statistically significant.The levels of anti NMDA receptor antibody before treatment were higher than those after the treatment,and the difference was statistically significant (t =2.296,P＜0.05).② The serum levels of anti NMDA receptor antibody in patients were negatively correlated with the intelligent score (r=-0.330,P＜0.01),and were positively correlated with the levels of IgG (r=0.684,P＜0.05).Conclusion The anti NMDA receptor antibody can be used as a new autoantibody in the early diagnosis of cognitive dysfunction in patients with SLE,and can be used for monitoring the activity of disease in cognitive dysfunction of SLE.

Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test.X-ray films of different period were compared to confirm the prosthetic loosening.Results Seventeen patients were followed up 8-10 years.There were no significant differences both in Harris score and most of the SF-36 scores at the median follow-up of 10 years.The item mental healthy of SF-36 expressed significant difference.Five patients required revision.There were 10 cases suffered with polyethylene wear,6 cases with severe osteoporosis in greater trochanter,and 3 cases with osteolytic reaction.Conclusion There are no significant differences between the two surgical method in the survival rate of prosthesis and the joint function in the median follow up.The satisfaction of the control groups is lower than the trial groups both at the early stage after the operation and the median follow up.The revision rate between the two groups is similar but the reason is different.

Objective To observe the effects of angiotensin Ⅱ( Ang Ⅱ) blockade on renal function, renal blood flow and renal oxygen consumption in chronic renal failure ( CRF) rats induced by 5/6th kidney ablation /infarction (5/6A/I).Methods Sprague-Dawley rats were randomly divided into 3 groups:the normal group (group A, n =14), mod-el group (group B, n=14) and angiotensin II blockade (Cozaar with Monopril) treatment group (group C, n =14).The chronic renal failure ( CRF) rat models were induced by 5/6th kidney ablation/infarction.The tail artery systolic pressure (SBP), diastolic blood pressure (DBP) and tail vein serum creatinine (Scr), blood urea nitrogen (BUN), hemoglobin ( Hb) and creatinine clearance rate ( Ccr) were assessed before and after intervention.The course of treatment was sixty days.The renal blood flow ( RBF) , blood gas analysis of abdominal aortic and renal vein, left renal vein pressure ( RV-pO2 ) were detected and remnant renal oxygen consumption ( QO2/TNa ) was calculated, and the pathological changes of remnant kidney were observed after the 60 d intervention.Results (1) Compared with the group A, the levels of Scr, BUN and tail artery SBP, DBP were significantly increased ( P<0.01 for all) , and the levels of Ccr and Hb were signifi-cantly decreased ( P<0.01) in the groups B and C, demonstrating the successful modeling.(2) Compared with the group B, the levels of Scr, tail artery SBP, DBP and QO2/TNa were significantly decreased (P<0.01 for all), the levels of BUN were decreased (P<0.05), the levels of Hb, Ccr and RVpO2 were significantly increased (P<0.01 for all), the level of RBF was increased ( P<0.05) in the group C after intervention.(3) The histopathological examination of the remnant re-nal tissue showed that the pathological changes in the group C were apparently reduced, better than those of the Group B. Conclusions Angiotensin II blockade can increase RBF, reduce renal oxygen consumption, improve renal function, and reduce the renal pathological changes in CRF rats.The mechanism of renal protection may be related to the regulation of cellular energy metabolism and improvement of renal oxygen consumption.

China ; Esophageal Neoplasms ; Humans ; Length of Stay ; Malnutrition ; Mass Screening ; Postoperative Complications ; ROC Curve ; Sensitivity and Specificity

BACKGROUND:For the replacement treatment of long-segment tracheal defects,although tissue engineering research has made some progress in recent years,it is still not perfect,and one of the biggest difficulties is that the hemodynamic reconstruction of the tracheal replacement cannot be achieved rapidly. OBJECTIVE:To preliminarily explore the potential of polycaprolactone scaffolds modified with exosome-loaded hydrogels to construct a rapidly vascularized tracheal substitute. METHODS:Exosomes were extracted from bone marrow mesenchymal stem cells of SD rats.After preparation of hyaluronic acid methacrylate solution,the exosome solution was mixed with hyaluronic acid methacrylate solution at a volume ratio of 1:1.Hyaluronic acid methacrylate hydrogels loaded with exosomes were prepared under ultraviolet irradiation for 5 minutes.The degradation of exosome-unloaded hydrogels and the controlled release of exosome-loaded hydrogels were detected.Polycaprolactone scaffolds were prepared by 3D printing.The pure hyaluronic acid methacrylate solution and the exosome-loaded hyaluronic acid methacrylate solution were respectively added to the surface of the scaffold.Hydrogel-modified scaffolds and exosome-modified scaffolds were obtained after ultraviolet irradiation.Thirty SD rats were randomly divided into three groups with 10 rats in each group and subcutaneously implanted with simple scaffolds,hydrogel-modified scaffolds and exosome-modified scaffolds,respectively.At 30 days after surgery,the scaffolds and surrounding tissues of each group were removed.Neovascularization was observed by hematoxylin-eosin staining and Masson staining and the expression of CD31 was detected by immunofluorescence. RESULTS AND CONCLUSION:(1)As time went by,the hydrogel degraded gradually,and the exosomes enclosed in the hydrogel were gradually released,which could be sustained for more than 30 days.The exosome release rate was faster than the degradation rate of the hydrogel itself,and nearly 20%of the exosomes were still not released after 30 days of soaking.(2)Under a scanning electron microscope,the surface of the simple polycaprolactone scaffold was rough.After hydrogel modification,a layer of gel was covered between the pores of the scaffold,and the scaffold surface became smooth and dense.(3)After 30 days of subcutaneous embedding,hematoxylin-eosin staining and Masson staining showed that more neovascularization was observed inside the scaffolds of the exosome-modified scaffold group compared with the hydrogel-modified scaffold group.The hydrogels on the scaffolds of the two groups were not completely degraded.Immunofluorescence staining showed that CD31 expression in the exosome-modified scaffold group was higher than that in the hydrogel-modified scaffold group(P<0.000 1).(4)These results indicate that hyaluronic acid methacrylate hydrogels can be used as controlled-release carriers for exosomes.The 3D-printed polycaprolactone scaffold modified by hyaluronic acid methacrylate hydrogel loaded with exosomes has good biocompatibility and has the potential to promote the formation of neovascularization.

Objective To explore the feasibility of the deep convolutional neural network (DCNN) judging the indications and prognosis of the total knee arthroplasty based on the trained DCNN computer learning system.Methods C1FAR-10 DCNN model based on TensorFlow (an open source system,Google,USA) optimized by Alex Krizhevsky were constructed.There were 400 cases with knee osteoarthritis from different databases used for analysis.Three hundred patients underwent total knee arthroplasty,while 100 did not.X-ray of 200 preoperative cases from the 400 cases and their enlarged image (50 times) were applied for training DCNN,while the enlarged images from other 200 cases were used to test the DCNN.The correlation and the regression between judgment of the DCNN and clinical truth were analyzed.The clinical truths were rechecked three times and were confirmed by treatment results.Pearson correlation and linear regression analysis were used.The relation test of the software was only used as a reference.Results There was no significant difference between the baseline of cases for learning and test.After learning 200 cases,the DCNN judged the 10 000 cases enlarged from remaining 200 cases.The correlation between the DCNN judgment and the clinical truth was not significant (r=0.000,F=0.001,P=0.970).False positive was observed in 1 681 cases,false negative in 3 296.After enlarged to 10 000 images,the correlation between the two judgments was significant (F=11 228.735,P=0.000,r=0.727 and R2=0.529).The software detection precision was 0.860.Conclusion DCNN can be applied in judging the indications of the total knee arthroplasty.Large sample size can improve the accuracy of the judgment significantly.