Fast track surgery(FTS) can reduce the patients' surgery stress response, maintain the physiological state of the patients, decrease the risk of postoperative complications and then accelerate recovery after surgery.At present, the FTS protocol in laparoscopic radical gastrectomy for gastric cancer is still in a preliminary stage, and its safety and validity remains to be verified.This systemic and comprehensive review focused on the concept of rapid rehabilitation surgery, the program of perioperative treatment, the economic benefit and its future outlook.

Epidemiologic Methods ; Models, Statistical

The animal models for pharmacologic assessment of drugs against premature delivery arereviewed, which include the measure of spontaneous delivery time between the first and the second pups in term pregnancy rats, the delay in the onset of labor in rats and premature delivery artificially induced by lipopolysaccharide, interleukin 1 ? and prostaglandin F 2? in mice.

Objective To estimate the expression of ER and PR in the endometrium of both intrauterine adhesions (IUA) and non-IUA specimens. Methods The endometrium specimens from patients undergoing hysteroscopy for confirmed moderate IUA (n=20: 10 in proliferative phase, and 10 in secretory phase) were enrolled as the IUA group in Beijing Obstetrics and Gynecology Hospital from October 2014 to August 2015. The specimens scheduled for hysteroscopy due to infertility were recruited into the control group (n=26: 13 in proliferative phase, and 13 in secretory phase). Immunohistochemistry and quantificational real-time PCR (qRT-PCR) were used to detect the expression of ER-α, ER-β and PR in endometrium with different menstrual period in both groups. Results (1) Location: in both groups, the expression of ER-α, ER-β and PR appeared in the endometrial glandular epithelial cells and the stromal cells of the endometrium. The positive brown granules of ER-α, ER-β and PR appeared mainly in cell nucleus. (2) ER-α and ER-β in the endometrium:the protein expression of ER-α and ER-β in IUA group (proliferative phase: 0.657 ± 0.028, 0.493 ± 0.023; secretory phase: 0.537 ± 0.020, 0.365 ± 0.031) were significantly higher than those of control group (proliferative phase: 0.586 ± 0.025, 0.437 ± 0.022; secretory phase:0.459 ± 0.025, 0.323 ± 0.017;all P<0.01). And the ER-αand ER-βmRNA expressions in IUA group were 2.524 ± 0.296, 1.947 ± 0.339, higher than those of control group in the proliferative phase (all P<0.01), and in the secretory phase (1.977±0.333, 1.345±0.292) were also higher than those in the control group (all P<0.01). (3) PR in the endometrium: the protein expression of PR was not significantly different between IUA group (proliferative phase:0.248±0.025, secretory phase:0.194±0.024) and control group (proliferative phase: 0.234 ± 0.019, secretory phase: 0.186 ± 0.020; P=0.162, 0.359). Meanwhile, there were no statistical differences in the mRNA expression of PR in both groups with different menstrual period (proliferative phase: 1.144 ± 0.384 versus 0.981 ± 0.306, secretory phase: 0.763 ± 0.237 versus 0.631 ± 0.203; P=0.270, 0.166). (4) ER and PR expression in menstrual cycles: the expression of ER-α, ER-β and PR in the IUA group changed with the menstrual cycles, and their expression in the proliferative phase were higher than those in the secretory phase (all P<0.05). Conclusions The expression of ER-α and ER-β in the endometrium of IUA patients changes with menstrual cycle, and are higher compared with those in normal endometrium. No difference is found in the PR expression between the two groups.

Objective: To identify corticotropin releasing hormone(CRH) positive cells from the human placenta. Methods: Using immunohistochemistry to show the cellular expression of placental CRH. Results: During human pregnancy, placental CRH level rose markedly from undetectable amounts prior to 20 weeks gestation to nearly the peak level. Conclusion: The presence of CRH in maternal plasma is attributed to the placental production and subsequent release of this hormone into the maternal circulation. [

Objective To compare the clinical and radiological outcomes between hybrid and total pedicle screw instrumentation in adolescents undergone posterior spinal fusion (PSF) for thoracic scoliosis secondary to Chiari malformation..Methods A total of 75 patients undergone PSF were included and divided into two groups:the all pedicle screw group (Group A,n=44) and the hybrid group (Group B,n=31).Patients were evaluated before surgery,immediately after surgery,and at the 2-year follow-up in radiographic changes in curve magnitude,apical vertebral translation (AVT),apical vertebral rotation (AVR),trunk shift,thoracic kyphosis (TK),lumbar lordosis (LL),and sagittal vertical axis (SVA).These parameters were further analyzed with respect to preoperative TK in both groups.Results After surgery,the average correction of the thoracic curve was 60.2％ and 51.3％ in Group A and B,respectively (t=2.372,P=0.023).The average lumbar curve correction was 61.7％ in Group A,representing a significant increase compared to Group B (51.1％,t=2.431,P=0.020).At the final follow-up,loss of the thoracic curve correction was less in Group A (0.3％) than in Group B (1.7％),however,there was no statistical significance (t=-0.468,P＞0.05).AVT of the thoracic curve improved in Group A from 25.0 mm to 6.9 mm,while in Group B it changed from 24.1 mm to 7.4 mm.For patients with a preoperative TK greater than 40°,the proximal junctional angle was found to be significantly larger in Group A (10.0 degrees versus 4.5 degrees,t=-2.031,P=0.052) by the final follow-up,along with a significantly increased incidence of proximal junctional kyphosis (20％ versus 9％).Conclusion Total pedicle screw instrumentation provided a significantly better correction of the major and minor curves than hybrid constructs for the operative treatment of thoracic scoliosis secondary to Chiari malformation.However,for patients with thoracic hyperkyphosis,all-screw instrumentation had a higher risk of adjacent level proximal kyphosis.

Objective Toevaluatea modified Ziehl-Neelsen(Z-N) stain in the diagnosis of tuberculous meningitis. Methods Cerebrospinal fluid specimens from 35 patients were stained by using the modified Ziehl-Neelsen staining. Re-sults The positive rate was 94.29% in 35 patients with tuberculous meningitisand the intracellular acid-fast bacilli was detected in 53.40%of all specimens. One case was stained positive in 15 patients with non-tuberculous meningitis. Con-clusion The modified Ziehl-Neelsen stain not only significantly improves the detection rates of tuberculous meningitisbut alsois able to identify intracellular M.tuberculosisin cerebrospinal fluidspecimen.Thus, the modified Z-N stain can be a convenient tool for diagnosing tuberculous meningitis.

·AIM: To study the expressive variation of Nogo-A on rat retina in the process of chronic ocular hypertension. · METHODS: Thirty-six healthy adult male Wistars were randomly divided into control group (6 rats) and chronic hypertension group (30 rats). Chronic hypertension was created by cauterizing the superficial scleral veins. Immunohistochemistry technique was used to evaluate the expressive varieties of Nogo-A at different time points during the course of chronic ocular hypertension. · RESULTS: The success of the model was indicated by over 40% of increase in the IOP as compared with normal rats. Compared with control group, as time passed chronic hypertension group gradually had detectable morphology changes in the retina. At the 21st day of chronic ocular hypertension, retinas became thinner and the quantity of retinal ganglion cell (RGC) decreased (P<0.05). Assoicated with the morphological changes, the expression of Nogo-A was strongly increased (P<0.05).CONCLUSION: Myelin associated protein Nogo-A plays a part in the process of chronic ocular hypertension.

AIM: To study the effects of geranylgeranylacetone(GGA) on the expression of heat shock protein70(HSP70) on retinal ganglion cells(RGC) in rats with chronic intraocular pressure(IOP) elevation.METHODS: Seventy Wistars were divided into blank control group(10 rats), chronic hypertension group(30 rats) and GGA group(30 rats). Chronic hypertension was created by cauterizing the superficial scleral veins. 800mg/(kg·d)GGA was given by oral daily after cauterization. Immunohistochemistry was used respectively to observe the changes of expression of HSP70 in the model rats and GGA interference rats at different time points during the course of chronic IOP elevation.RESULTS: The successful model was identified as the IOP over 40% of normal rats. The retinal thickness was significantly reduced in model group and model+ GGA group compared with normal rats from 21 days through 28 days after cauterization(P<0.05), and that of model rats was obviously decreased in comparison with model+ GGA rats(P<0.05). The number of ganglion cells was significantly decreased in model rats and model+ GGA rats compared with normal rats from 21 days and 28 days. The stronger expression intensity(IOD) value was seen for HSP70 in the model+ GGA rats by immunochemistry(P<0.01).CONCLUSION: Systemic administration of GGA protects retina from chronic IOP elevation by regulating the expression of HSP70.

Objective Toinvestigatetheclinicalsignificanceofplasmamatrixmetalloproteinase9 (MMP-9)intheformationofdelayedcerebraledemaafterintracerebralhemorrhage.Methods The clinical data of 107 patients with spontaneous intracerebral hemorrhage treated with conservative medical treatment were analyzed retrospectively. According to the clinical features and imaging changes,they were divided into either a delayed cerebral edema group (case group n=39)or a non-delayed cerebral edema group (control group n =68 ). The plasma MMP-9 level was detected with enzyme-linked immunosorbent assay within 24 h after onset. The patients performed head CT scan again at day 7 and 14 after admission. The changes of hematoma and edema volume were detected. All the possible factors associated with the formation of delayed cerebral edema were firstly analyzed by the univariate analysis. Univariate analysis showed that the variables with significant differences were enrolled into multiple logistic regression analysis. Results TheplasmaMMP-9levelofthedelayedbrainedemagroupwassignificantlyhigherthanthatof the control group,they were 189 ± 51 and 118 ± 27 mg/L respectively (P<0. 01). The result of univariate analysis showed that age,history of smoking,blood glucose level,baseline hematoma volume,and National Institute of Health stroke scale (NIHSS )score on admission might be associated with the formation of delayed cerebral edema after intracerebral hemorrhage. Logistic regression analysis showed that MMP-9 level (OR,9. 745,95%CI 6. 754-15. 466,P<0. 01),baseline hematoma volume (OR,2. 411,95%CI 1. 190-2. 728,P =0. 018),blood glucose level on admission (OR,1. 327,95%CI 1. 133 -1. 850,P =0.004),and NIHSS score (OR,1. 867,95%CI 1. 272-2. 364,P=0. 020)were the independent risk factorsfortheformationofdelayedcerebraledemaafterintracerebralhemorrhage.Conclusion Theamount of bleeding,NIHSS score,and hyperglycemia are the risk factors for the formation of delayed cerebral edema in patients with spontaneous intracerebral hemorrhage,while high MMP-9 level on admission indicated that the risk of the formation of delayed cerebral edema is high.