Objective To evaluate surgical therapy for recurrent rectovaginal fistula.Methods In this study.two patients were treated by endorectal advancement flap repair and one patient was treated by vascular pedicled segment of small bowel.Results All patients were cured and followed up from 4 to 20 months.During the period of follow-up there was no recurrence.Conclusions The procedures and timing of operation are important factors for a successful repair.Both the endorectal advancement flap and patch of intestine provide an effective methods in repairing recurrent rectovaginal fistula.

Objective:To optimize the extraction technology of radix scutellariae. Methods: The extraction of radix scutellariae was scanned by ultraviolet spectrophotometry from 200 to 400nm. The content of baicalin was determined by HPLC. The ultraviolet ab-sorption, baicalin content and extraction rate were used as the indices, and the optimal extraction conditions were investigated by single factor experiments and orthogonal design tests. Results: The optimal extraction conditions were as follows: the ethanol concentration was 60%, the solid-liquid ratio was 1∶40, ultrasound extraction time and temperature was 40 min and 60℃, respectively. Conclusion:The extraction of radix scutellariae has good sunscreen with promising ultraviolet absorption in UVB. Ultrasound extraction has high ex-traction yield with short time, which can be used to extract sun-screening constituents from radix scutellariae.

Objective To understand the clinical distribution situation of streptococcus penumoniae (SP) and drug susceptibility test results to provide a basis for the clinical diagnosis,treatment and prevention of SP infection.Methods Totally 416 nonrepeat strains of SP were isolated during 2010 to 2015.Their identification and drug susceptibility test were performed by using the ATB Express bacterial identification system.The results were interpreted according to the standard of CLSI 2014 edition.Results In these 6 years,SP showed the isolation peak in spring and winter;the detection rate of respiratory tract specimens reached more than 90 ％;the young children and elderly people were predominant;SP maintained high sensitivity to penicillin,amoxicillin,etc.,the difference in the sensitivity rate and non-sensitivity rate had statistical significance(P＜0.05);but SP showed high level non-sensitivity to clindamycin,erythromycin,etc.,the difference in the sensitivity rate and non-sensitivity rate had no statistical significance (P＞0.05).Conclusion Although β-lactam antibiotics such as penicillin can still be used as the first choice of therapy,but PISP and PRSP show the increasing trend year by year;therefore the antibacterial drugs should be selected according to the drug susceptibility test results.

Purpose To investigate the clinicopathologic changes of the lung epithelial tumor with epithelioid granuloma. Methods E-leven cases of lung malignant tumor with epithelial epithelioid granuloma reaction were studied according to the histological changes of lung epithelial tumor, immunophenotype, acid-fast staining, and tuberculosis PCR test results combined with follow-up data. Results The mean age was 62. 3 years, and male to female ratio was 10∶ 1. The main clinical manifestations displayed a cough, chest pain, fever and hemoptysis or bloody sputum. Nine cases were malignant tumors, tuberculosis or inflammatory lesions was 1 case each in pre-vious surgery. The tumor with epithelioid granuloma formation of the 11 cases displayed in the same site ( mixed) . The histopathologic changes of the lesions showed a epithelioid or typical tuberculous granulomas formation, including 4 cases of adenocarcinoma, 5 cases of squamous cell carcinoma and 2 cases of neuroendocrine tumors. The acid-fast bacilli staining was positive in 3 cases;6 cases were positive for PCR detection of mycobacterium tuberculosis. 5 patients died within 2 years due to various causes. Conclusions The lung epithelial tumors with epithelioid granuloma is more commonly found in the middle-aged, The signs and symptoms of the patients are similar to primary epithelial malignant tumors of the lung . The biological behavior was progressive with poor prognosis. The diagnosis of the lesions depends on pathological examination. It is very important to pay more attention to the pathological examination, especially in lung puncture samples, and the differential diagnosis for a definate diagnosis and treatment.

In order to better play an important role of pathology consultations in the routine work of clinical pathology,and to solve the problems presented during consultation,we comprehensively analyze the reasons that cause pathology consulation,the pathological data management,patient-physician dispute,medical liability,as well as other aspects involved in consulation.Meanwhile,measures to resolve these problems are also proposed.

Objective: To establish the composition-activity relationship (CAR) model based on study of chemical composition and relating proliferation inhibitory rate of Corydalis soxicola and recognize the anti-hepatic fibrosis active compounds of C. soxicola. Methods: Nine orthogonal C. soxicola extract were analyzed by HPLC, and 21 characteristic peaks were profiled. Anti-hepatic fibrosis activity was investigated by MTT assays on HSC-T6, and the potential active components were identified by scores plot and variable importance in projection (VIP) values by means of orthogonal partial least squares (OPLS) analysis, and the activities of identified components were verified by MTT and flow cytometry. LDH kit was used to detect the effect of dehydrocavidine, palmatine, and berberine on LDH activity. Results: The results showed that six peaks including peaks 13, 14, 16, 18, 19, and 20 were significantly related to anti-hepatic fibrosis activity among nine orthogonal extract from C. soxicola. Peaks 18, 19, and 20 were characterized as dehydrocavidine, palmatine, and berberine, respectively. MTT assay showed that dehydrocavidine, palmatine, and berberine with various concentration significantly inhibited the proliferation of HSC-T6 cells. It was also found in flow cytometry that the apoptotic rates of dehydrocavidine, palmatine, and berberine (0.10 mg/mL) on HSC-T6 were 42.12%, 42.22%, and 36.73%, respectively, which were obviously higher than that of control (1.69%, P < 0.01). No obvious cytotoxic effect was found when the final concentration of dehydrocavidine, palmatine, and berberine were less than 0.15, 0.10, and 0.10 mg/mL, respectively. Conclusion: In this study, it was for the first time found that dehydrocavidine, palmatine, and berberine in C. soxicola extract can effectively inhibit the proliferation and induce apoptosis of HSC-T6 based on composition-activity relationship, and there was no obvious cytotoxic effect of the effective concentration, which showed that they may be the active components with potential anti-hepatic fibrosis effect and have a certain security in the application in C. soxicola. At the same time, it also suggests that the research ideas based on CAR can provide an effective method for the identification of active components in natural plants.

Human ScFv against botulinum neurotoxin serotype A(BoNTa) was modified by fusing human IgG1 Fc to C terminal of ScFv. ScFv-Fc fusion protein was expressed at high level over 30% of total host cell proteins in E.coli. Recombinant protein existed in inclusion body form. Renatured ScFv-Fc was purified to 90%~95% by Protein G Sepharose column. In vitro ScFv-Fc could bind specific to toxiod BoNTa in ELISA. Recombinant ScFv-Fc had similar relative affinity to parent ScFv and had improved stability.

Objective To evaluate the effect of the collaboration care model on posttraumatic growth and resilience in patients with breast cancer.Methods 70 patients who were diagnosed with breast cancer in department of Breast Surgery of the First Affiliated Hospital of Dalian Medical University were assigned into two groups by random number table.32 patients who completed the research in the experimental group received collaboration care while 31 patients who completed the research in the control group received routine care both for there months.The patients were investigated with the Posttraumatic Growth Inventory (PTGI) and Connor-Davidson Resilience Scale (CD-RISC) before and after intervention.Results After the intervention,there were significant differences in scores of posttraumatic growth [(63.83±11.87) scores vs.(60.33±10.09) scores,t=2.384] and resilience [(66.52±15.23) scores vs.(61.33±10.09) scores,t=2.472] between the two groups (P＜0.05).And also there were significant differences of posttraumatic growth scores before and after intervention in the experimental group [(56.24±10.01) scores vs.(63.83±11.87) scores,t=-3.988,P＜ 0.01] and the control group [(56.68±10.32) scores vs.(60.33±10.09) scores,t=-2.426,P＜0.05].Differences of resilience also existed in the experimental group [(61.28±14.40) scores vs.(66.52±15.25) scores,t=-3.225,P＜0.01] and the control group [(63.97±17.66) scores vs.(61.33±10.09) scores,t=-2.370,P＜0.05].Conclusions Collaboration care model can significantly improve the level of patients' posttraumatic growth and resilience.

Objective When pathologists from hospitals at various levels encounters pathological sections diffcult to make clear diagosis, it is necessary to invite pathologists from higher hosiptals or special hospitals for pathologic consultation.In the study, we compared the pathological diagnosis of cases sent to other hospitals for pathological consultation with the original diagnostic result to analyze the differences by the evaluation on the impact of these differences on the treatment and prognosis of these patients, which would provide an effective evidence for the quality control of pathological diagnosis. Methods Cases initially diagnosed at the de-partment of Nanjing General Hospital and later sent to other hospitals for pathological consultation from 2010 to 2014 were collected. All the diagnostic results were examined by at least 3 senior pathologists to find exact diffrences between consultation results and origi-nal diagnostic results. Results Among 2055 cases, it was found that there were 1813 cases (88.2%) without diagnostic discrepan-cy, while 218 cases (10.6%) with minor diagnostic discrepancy and 24 cases (1.2%) with completely distinct diagnostic results. Conclusion The diagnostic results of the vast majority of consultation cases are in accordance with the original results, despite of di-agnostic discrepancies in some cases due to the complexity of disease. Expert consultation has reference for the pathological diagnosis of complicated cases, which also plays a potent supervisory role on the quality control of original pathologic results.

Objective Acrysof IQ Restor multifocal toric intraocular lens ( IOL) is a new product , which allows a single sur-gical procedure for presbyopia correction and corneal astigmatism management .This study was to evaluate the early clinical effects of phacoemulsification cataract surgery with implantation of a diffractive multifocal toric IOL . Methods We retrospectively analyzed 7 cases (9 eyes) of corneal astigmatism ≥1.0 diopter (D) treated by phacoemulsification with implantation of an Acrysof IQ Restor toric IOL.The patients were followed up for 3 months for observation of uncorrected distance visual acuity ( UDVA) , best corrected distance visual acuity ( CDVA) , uncorrected near visual acuity ( UNVA ) , best corrected near visual acuity ( CNVA ) , spherical equivalent (SE) refraction, focal depth, residual astigmatism, rotational stability of the IOL, contrast sensitivity (CS), and spectacle independ-ence preoperatively and at 1 week, 1 month, and 3 months after operation . Results At 3 months after surgery , the UDVA ( log-MAR), CDVA, UNVA, and CNVA were 0.07 ±0.10, 0.02 ±0.11, 0.12 ±0.06, and 0.08 ±0.07, respectively, with an SE re-fraction within ±0.50 D of the attempted spherical correction in 8 eyes (88.9%) and a focal depth of (5.32 ±1.78) D.The residual astigmatism at 3 months was significantly reduced as compared with the baseline ([0.25 ±0.28] vs [1.55 ±0.39] D, P<0.05), but showed no statistically significant differences from the preoperative an-ticipated residual astigmatism (P>0.05).At 3 months, the mean IOL axis rotation was (3.11 ±1.61)°and CS was remarkably im-proved ( P<0 .05 ) , while CS with or without glare was not significantly different from that at 1 month at all spatial frequencies ( P>0.05) except at 18.0 cpd (P<0.05). Conclusion Implantation of the Acrysof IQ Restor multifocal toric IOL provides excellent overall quality of vision, spectacle independence, visual quality, and rotational stability for patients with cataract and corneal astigmatism.