Objective To evaluate the role of routine delayed percutaneous coronary intervention (PCI) after thrombosis in the management of patients with ST-segment elevation myocardial infarction. Methods Ninety-eight patients with STEMI who underwent routine delayed PCI after thrombosis and other 82 patients with STEMI who were given conservative strategy after thrombolysis were enrolled in this study and were investigated during their in-hospital period and 6-month follow-up regarding major adverse clinical events (MACE) and the cardiac structure and function by echocardiography. The patients were divided into the control group (conservative strategy after thrombolysis), therapy group 1 (routine delayed PCI after successful thrombolysis), and therapy group 2 (routine delayed PCI after unsuccessful thrombolysis). Results Compared with conservative strategy after thrombolysis, routine delayed PCI after thrombosis decreased in-hospital mortality (4.9% vs 0%, 0%), shortened average hospital stay (25.3 days vs 13.5 days, 15.1days), decreased the need for revascularization for target lesion (7.3% vs 0%, 0%) and lowered the incidence of thrombosis or infarction (7.3% vs 0%, 0%), and also produced lower mortality (13.4% vs 1.4%, 0%), prevented reinfarction (12.2% vs 4.2%, 4.5%) and stroke (2.4% vs 0%, 0%), decreased the need for revascularization for target lesion (28% vs 4.2%, 4.5%) and prevented further left ventricle remodling. Conclusion Routine delayed PCI after thrombosis may to prevent recurrent ischemia, reinfarction, and reocclusion, so as to improve immediate results and 6-month prognosis.

Objective Partial hepatectomy, liver transplantation, and radio frequency ablation for hepatocellular carcinoma (HCC) were compared to select the most suitable method for HCC. Methods 1198 patients with HCC in 3 hospitals in Guangzhou were divided into 3 groups: group Ⅰ , small HCC; group Ⅱ > HCC without vascular invasions and group Ⅲ , HCC with vascular invasion. The patients either received partial hepatectomy, transplantation or ablation. The 1-, 2- or 3-year survival rates, the 3-year recurrent rates and Child-Pugh grades in the 3 groups were compared. Results For small HCC, there was a significant increase in the 3-year survival rate (P<0. 05) and a significant decease in the recurrent rate (P<0. 05) in patients who received transplantation, compared with those who received hepatic resection. Patients who received ablation had a higher 3-year survival rate and a lower recurrence (P<0. 05) in comparison with those who received hepatectomy. There was no significant difference(P<0. 05) between transplantation and ablation, but there were more Child A patients who received hepatectomy and ablation, and more Child B and C patients who received transplantation. For advanced HCC, there was no significant different in the 3-year survival rates for the 3 therapies, but the 3-year recurrence was lower (P<0. 05) in the transplantation group. Conclusions For small HCC, superiority of transplantation versus resection was obvious. Ablation (diameter <3 cm) was also superior to resection, whereas ablation was as effective as transplantation. There were more Child B and C patients in the transplantation group than the ablation and resection groups. Therefore, small HCC with hepatic decompensation should receive liver transplantation. Transplantation was advantageous in having less tumor recurrent but there was no difference in the 3 therapies for advanced HCC.

Objective To evaluate the safety and the feasibility of hypophysin injection for hemostasis during laparoscopic stripping of ovarian endometrioma.Methods Retrospective analysis of 86 cases with ovarian endometrionm.Forty-two patients with prophylactic dilute hypophysin injection into cornua uterus and mesosalpinx(study group),and 44 patients without vasopressin(control group).The operative time,intraoperative blood loss,the highest postoperative temperature,postoperative stay and the rate of recurrence were compared.Results The operative time in the study group and the control group were(51.24±22.58)min and(67.02±25.14)min,the intraoperative blood loss were(42.16±26.10)ml and (68.23±28.21)ml,respectively.There was significantly different between two groups(P＜0.01).The rates of recurrence in the study group and the control group were 4.76% and 11.36%,respectively.But it was no significantly different between two groups(P＞0.05).Both the highest postoperative temperature and postoperative stay was no difference between two groups(P＞0.05).Conclusions Hypophysin can reduce the operative time and intraoperative blood loss during laparoscopic stripping of ovarian endometrioma,and it is possible to reduce the rate of recurrence.It is a safe,feasible,cheapand convenient method,and worth using in clinic.

Objective To explore the potential applications of a chamber for in vivo tissue engineering,and to establish a novel model for in vivo tissue-engineered cartilage.Methods Auricular chondrocytes were isolated,cultured and identified from the ears cartilages of New Zealand white rab bits; rabbit auricular chondrocytes(RACs) were seeded into the scaffolds:(1) RACs were seeded into collagen gel scaffold; (2) RACs were seeded into PLGA/collagen gel scaffold in vitro,and the compos ites were placed into the chambers and implanted in the donor rabbit.As control groups,the composites were implanted directly subcutaneously in the donor rabbit without using chambers,and the contents were harvested at 8 weeks after implantation.Gross examination,histologic and immunohistochemical staining and RT-PCR test were performed to evaluate the harvested contents.Results Under the same conditions inside the chambers,the contents formed into new cartilage-like tissue by histo logical and immunohistochemical staining and RT-PCR.In contrast,in the control groups without chambers displayed vascular invasion and inflammatory reaction in the subcutaneous layer of skin,which eventually led to fibrous tissue or absorption.Conclusions Cartilage is successfully constructed in an immunocompetent animal model using a bioinert perforated chamber.This method is effective in creating a relatively favorable environment for cartilage regeneration,which may provide a valuable reference for the clinical application of tissue regeneration.

Objective To investigate the efficacy of precise hyperthermic intraperitoneal perfusion chemotherapy (HIPEC) in the treatment of advanced pancreatic cancer.Methods Thirty-six patients with advanced pancreatic cancer were analyzed retrospectively.Eighteen patients who received HIPEC combined with radiotherapy and chemotherapy were assigned as the treatment group and the other 18 patients who received chemotherapy and radiotherapy were assigned as the control group.Recent curative efficacy,Karnofsky Performance Status (KPS) score,postoperative complications and survivals between the two groups were analyzed,respectively.Results Significant differences were found between two groups in total short-term effective rate (P ＜ 0.05).The total short-term effective rate of treatment group and control group were 66.67％ (12/18) and 27.78％ (5/18),respectively.The increment of KPS score of treatment group was significantly higher than that of control group (P ＜ 0.05).There was no significant difference between two groups in postoperative complications (P ＞ 0.05).The median overall survival time (OS) of treatment group was 11 months (7 ～ 31 months),and the median OS of control group was 7 months (4 ～ 18 months).The survival of the treatment group was longer than the control group (P ＜ 0.05).Conclusions HIPEC treatment improved significantly the survival and life quality of advanced pancreatic cancer patients.With acceptable morbidity and mortality rates,HIPEC regime was an effective treatment modality for patients with advanced pancreatic cancer.

OBJECTIVETo reconstruct a simpler and reliable composite tissue transplantation model-the femur osteomyocutaneous flap for the replacement of hindlimb transplantation.

METHODSTen femur osteomyocutaneous flaps from 5 Lewis rats were transplanted into 10 syngeneic recipients' inguinal region. Their nutrient vessels were anastomosed with recipients vessels. The graft of this model was consisted of the groin flap and partial femur. To verify the feasibility of this model, gross and histological appearance were studied after transplantation to evaluate the viability of grafts.

RESULTSThe operative time was (159.0 +/- 8.3) min with the harvesting time of (68.0 +/- 4.8) min and the ischemia time of (55. 8 +/- 6.8) min. The methylene blue injection showed rich blood supply of transplanted femur osteomyocutaneous flap. All the 10 flaps survived completely with pink skin color and hair regrowth. The histologic examination of the flaps also revealed the normal appearance of the viable skin and bone marrow.

CONCLUSIONSThe femur osteomyocutaneous flap is a simple and reliable model for composite tissue transplantation, and its establishment will provide a new tool for the study of composite tissue allografts.

Animals ; Bone Transplantation ; Femur ; transplantation ; Male ; Models, Animal ; Muscle, Skeletal ; transplantation ; Rats ; Rats, Inbred Lew ; Skin Transplantation ; Surgical Flaps ; Tissue Transplantation

Objective To investigate the measurement , feasibility and clinic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) guided by B ultrasound in the treatment of malignant ascites from peritoneal carcinomatosis. Methods From July 2011 to June 2013, B ultrasound-guided approach was used to perform HIPEC on 36 patients affected by malignant ascites secondary to peritoneal carcinomatosis. Every patient underwent HIPEC for three times , by way of continuous circulatory perfusion into peritoneal cavity with saline at 400 ~ 600 mL/min and intraperitoneal perfusion with 5-FU mitomycin-C and cisplatin for 90 minutes with an inflow temperature of (43 ± 0.2)℃. These patients were followed up for a long term. Results Intraoperative course was uneventful in all cases. Complete clinical regression of ascites and related symptoms was achieved in all the 26 patients, partial regression achieved in 8 patients, and no curative effect achieved in 2 cases. The acquired total clinic effectiveness was 94.44%. No postoperative deaths and complication related to the procedure occurred in this study. The KPS grades of patients rose (P < 0.001), the level of tumor markers decreased, including CA199 (P < 0.001), CEA (P < 0.001), CA125 (P = 0.003). Conclusion HIPEC guided by B ultrasound appears to be a safe, feasible and effective procedure for the treatment of debilitating malignant ascites from unresectable peritoneal carcinomatosis , which would have a clinic good perspective in future.

Objective To investigate the long-term oncological outcomes of laparoscopic radical hysterectomy (LRH) plus lymph node dissection (LND) and abdominal radical hysterectomy (ARH) plus LND for patients with stage Ⅰ a2-Ⅱ a2 cervical cancer.Methods A retrospective review of stage Ⅰ a2-Ⅱ a2 cervical cancer patients who underwent LRH + LND (n=372) and ARH + LND (n=434) at the First Affiliated Hospital of Sun Yat-sen University from Jan.2005 to Aug.2013 was performed.Individual patient matching was performed by the risk factors for recurrence [tumor size,lymph vascular space invasion (LVSI),depth of cervical stromal invasion,lymph node metastasis,parametrialinvolvement,and resection margin involvement] between two groups.After matched,a total of 203 patient pairs (LRH-ARH) were enrolled.The survival data,surgery data,intraoperative and postoperative complications were compared between the two groups.To assess the prognosis factors,the univariate and multivariate Cox's proportional hazards modelanalysis were conducted.Stratified analysis was performed based on the independent prognosis factors to investigate the survival data between the two surgery groups.Results (1) Surgery data:The operating time [(239±44) vs (270±42) minutes],estimated blood loss [(210± 129) vs (428±320) ml],the duration of bowel motility return [(2.0±0.8) vs (3.0± 1.6) days] and hospital stay [(11 ±6) vs (13±6) days] in the LRH group were significantly shorter than those in ARH group (all P＜0.01).(2) Intraoperative and postoperative complications:The intraoperative complications rate was similar betweentwo groups [6.4％(13/203) vs 6.9％(14/203),P=1.000].The rate of postoperative complications (excluded bladder dysfunction) in the LRH group were significantly lower than those in the ARH group [9.4％ (19/203) vs 20.2％ (41/203),P=0.002].While there was no significant difference in the rates of bladder dysfunction between two groups [36.5％ (74/203) vs 37.4％ (76/203),P=0.910].(3) Recurrence and survival data:There was no significant difference in the recurrence rates between the LRH group and ARH groups [7.9％ (16/203) vs 9.4％ (19/203),P=0.850].There were similar 5-year recurrence-free survival (RFS;92.1％ vs 91.1％,P=0.790) and 5-year overall survival (OS;93.7％ vs 96.1％,P=0.900).(4) Prognosis factor:In univariate analysis,the results showed that tumor size,International Federation of Gynecology and Obstetrics (FIGO) stage,adjuvant therapy,LVSI,stromal invasion,parametrium invasion,pelvic lymph node metastasis,and para-aortic lymph node metastasis were significantly associated with poor prognosis (all P＜0.01).However,age,body mass index (BMI),surgery type,histological type,grade were not significantly associated with poor prognosis (all P＞0.05).The multivariate analysis results,showed that tumor size,pelvic lymph node metastasis,and para-aortic lymph node metastasis were significantly associated with poor prognosis (all P＜0.01).Stratified analysis showed that,even in patients with tumor size ＞4 cm,pelvic lymph node metastasis positive,and para-aortic lymph node metastasis positive in all subgroups,there were not significant difference for the estimated 5-year RFS and 5-year OS between LRH and ARH group (all P＞0.05).Conclusion For patients with stage Ⅰ a2-Ⅱ a2 cervical cancer,LRH plus lymph node dissection is an oncologically safe and surgical feasible alternative to ARH.

Objective To observe the influence of renal sympathetic denervation (RSD) on renal interstitial fibrosis and transforming growth factor beta 1(TGF-β1) and microRNA-21 (miR-21) in rats with unilateral ureteral obstruction(UUO).Methods 40 male Wistar rats were randomly divided into UUO group (A group,n=10),sham UUO group (B group,n=10),RSD+UUO group (C group,n=1O) and RSD + sham UUO group (D group,n=10).Rats in A group and C group underwent unilateral ureteral ligation,while those in B group and D group underwent sham operation.Rats in C group and D group were followed by RSD.Rats were sacrificed at 21 days after the operation to evaluate the fibrosis by Masson staining.Immunohistochemical staining and Western blotting were used to detect the expressions of collagen I (COL-Ⅰ),collagen Ⅲ (COL-Ⅲ) and TGF-β1 in four groups.The expression of miR-21 was detected by fluorescence in situ hybridization (FISH) and quantitative real-time PCR (RT-qPCR).Results A large amount of collagen deposition was observed in the renal interstitial area in A and C group compared to either B or D group (P ＜ 0.05),but the change in C group was decreased significantly than that in A group (P ＜ 0.05).Similarly,the expressions of COL-Ⅰ,COL-Ⅲ,TGF-β1and miR-21 were obviously higher in A and C group compared to either B or D group (P ＜ 0.05),but those change in C group were decreased significantly than those in A group (P ＜ 0.05).The above indexes were not significantly different between B group and D group (P ＞ 0.05).Conclusion RSD may relieve the renal interstitial fibrosis in UUO rats,and down-regulate the expression of TGF-β1 and miR-21.

Objective:To investigate the development of health management (physical examination) institutions in 2018 and provide supporting data for the development of the industry.Methods:Using the method of questionnaire survey, the data of 348 health management institutions in 30 provinces in 2018, including institution scale (area, number of people served, income), Manpower (number of medical staff, number of medical staff with Graduate Education), scientific research ability and level (number of published papers, number of scientific research projects undertaken), appropriate technology application, etc., were obtained. Then according to the province and city where the institution is located and the property of ownership, the institutions were classified and their data were analyzed.Results:In 2018, the area of health management (physical examination) institutions was 3 000 (2 000, 4 434) m 2, the annual number of people served was 5.00 (3.37, 7.97) ×10 4, the annual income was 37.91 (23.91, 61.68) million yuan RMB, and the average cost of subjects was 788 (550, 1 046) yuan RMB. There was a positive correlation between the average cost of subjects and the local per capita GDP ( r=0.438, P<0.05). The top five provinces are Beijing, Zhejiang, Chongqing, Guangdong and Sichuan. The differences of number of people served, the annual income, the average cost of subjects, number of medical staff, number of medical staff with Graduate Education, number of scientific research projects undertaken, proportion of group examination in provincial capital city, prefecture city and county city were statistically significant (all P<0.05). There was no significant difference between the excellent independent private physical examination institutions and the excellent public physical examination institutions ( P>0.05) in the above indexes, but the number of excellent independent private physical examination institutions was relatively small ( n=28, 8.05%). Conclusions:In 2018, China′s health management (physical examination) institutions have a good development momentum, the service scale continues to expand, and the quality and efficiency continue to improve. However, the development of health management (physical examination) institutions is still uneven, and there are regional differences. Some excellent independent private health examination institutions are close to or reach the level of excellent public health examination institutions, but the number is still small.