e the individual choice depending on their different conditions.

Objective To analyze the changes in epidemiology and treatment of hospitalized patients with cervical cancer during 1990-2007.Methods Overall.4648 patients witIl cervical cancer were diagnosed in our hospital from Jan 1990 to Nov 2007.but only 4223 patients with initial treatment in Oily hospital were studied retrospectively.Pearson Chi-square test was used to compare tlle age,stage,histopathologie type and treatment metheds between different times.Results (1)The meal]age of cervical cancer patients gradually decreased over the past 18 years,from 54.4 years during 1990-1999 to 47.2 years during 2000-2007:the proportion of young patients aged≤35 years increased from 4.77%(89/1865)during 1990-1999 to 11.75%(277/2358)during 2000-2007.(2)The proportion of patients with cervical cancer(stage I a-H a)increased from 14.32%(267/1865)during 1990-1999 to 40.75%(961/2358)during 2000-2007,whereas the proportion of patients with cervical cancer(stage Ⅱ b-lV)decreased from 85.68%(1598/1865)during 1990-1999 to 59.25%(1397/2358)during 2000-2007.(3)There was no significant change in histopathologie type of cervical cancer,and squamous cell careinoma of cervix remained the main type of cervical cancer.(4)The treatment pattern of cervical cancer changed significantly:radiotherapy was the main method(75.28%)for eervical cancer during 1990-1 999.but during 2000-2007.it was replaced by concurrent chemoradiotherapy(35.79%).Conclusions The proportion of young women with cervical cancer was increased during 1990-2007.and at the same period early stage cervical cancer increased.but late stage cervical cancer decreased.It is obvious that chemotherapy has become the important therapy in cervical cancer.

BACKGROUND: Lower limb motion is complex.Proper human motion parameters detection is important for knee prosthesis control.Current lower limb prosthesis control information source is physical quantity related to motion information,which can directly reflect biomechanical characteristics of human motion.It is simple to collect and applicable for real-time control.The lower limb prosthesis utilizes one or several sensors to detect human motion information.OBJECTIVE: To develop a sensor system that can collect human motion information controlled by intelligent lower limb prosthesis.METHODS: Relationship between pivot axis installation potentiometer and knee joint flexion angle was acquired from analysis of four-bar linkage with a fixed pneumatic cylinder.In addition,the proper hall sensor installation position was selected to solve the two-solution problem.A sensor signal acquisition experiment was designed.The treadmill ensure that walking speed was completely under control.Knee joint flexion angle at toe-off in different walking speeds was measured.Curve fitting process provided the correspondence between them.RESULTS AND CONCLUSION: Knee joint flexion angle at toe-off increased with increasing walking speed.Quadratic curve fitting obtained a good effect.Results show that under horizontal walking state,potentiometers and Hall-sensors can be used to detect walking speed of lower limb prosthesis,and distinguish support phase and swing phase.

Objective To evaluate the value of bypass graft in the treatment of critical lower limb ischemia with distal single outflow artery.Methods Forty-nine lower limbs in 42 patients with single outflow artery were collected and underwent arterial bypass graft.The operation methods included femoropopliteal artificial graft to single outflow artery with autograftand popliteal artery to calf vessel and so on.The results were analyzed finally.Results All of 42 patients,postoperative grafts occlusion occured in 1 case,the occlusion rate was 2.4％(1/42) and the success rate was 97.6％(41/42),1 case died of respiratory failure 4 d postoperatively,the mortality was 2.4％(1/42).The patency rate of graft was 100.0％(41/41) on discharge.Healing rate of foot ulcer was 33.3％ (11/33).Conclusions It's difficult to reconstruct blood flow for critical ischemic limb with single outflow artery,but good result is still expected by distal lower limb bypass graft.Distal bypass can provide a better nutritional support for the healing of foot ulcer and result in a lower limb salvage or lowering of amputation level.

Objective To investigate the relationship between adhesion molecule CD44v6,intercellular adhesion molecule-1 (ICAM-1) and lymph node metastasis in early stage of cervical squamous cell carcinoma.Methods Seventy-four specimens of cervical cancer stage Ⅰ b1,20 specimens of normal cervical tissue and 20 specimens of cervical squamous cell in situ carcinoma were collected from Jiangxi Provincial Maternal and Child Health Care Hospital.The expression of CD44v6 and ICAM-1 in cervical tissue was detected by real-time PCR and immunohistochemistry.The lymphatic vessel density (LVD) labeled by D2-40 was detected by immunohistochemistry.The relationship of CD44v6,ICAM-1 and LVD with the differentiation degree and lymph mode metastasis was investigated.Results The positive expression rate of CD44v6 and ICAM-1 in normal cervix,cervical squamous cell carcinoma in situ,and cervical carcinoma tissues was gradually increased,which were 0,75.00％,87.84％ and 10.00％,45.00％,81.08％ respectively.Their mRNA expression amount was gradually increased,which were 0,0.24±0.02,1.02±0.11 and 0.10 ± 0.00,0.19±0.02,1.03 ± 0.10 respectively,the differences were statistically significant (P＜0.01).LVD was gradually increased in normal cervix,cervical squamous cell carcinoma in situ,and cervical carcinoma (P＜0.01).The expression of CD44v6,ICAM-1 and LVD in low differentiated cervical carcinoma tissue was higher than that in high and middle differentiated cervical carcinoma (P＜0.01).The expression of CD44v6,ICAM-1and LVD in lymph node metastasis was higher than that in non-lymph node metastasis (P＜0.01).The expression of CD44v6,ICAM-1 and LVD in cervical cancer tissue had each two positive correlation (P＜0.01).Conclusion CD44v6 plays a promoting role in the progression of cervical cancer,which with ICAM-1 and LVD synergically promote the cervical cancer development,and could be used as an effective indicator for judging lymph node metastasis and diagnosis of cervical cancer.

Objective To systematically review the efficacy and safety of drug-eluting stent(DES) versus coronary artery bypass grafting(CABG) in the treatment of left anterior descending coronary artery(CAD) stenosis.Methods Literature about the efficacy and safety of DES versus CABG for LAD stenosis was retrieved from digital databases of MEDLINE, EMbase, PubMed, and the Cochrane Library by November 2016.Data extraction and quality assessment of included studies were conducted by two independent reviewers.RevMan 5.3 software was used to perform meta-analysis.Results Ten studies involving 9771 patients were finally included.The results of meta-analysis showed that there was no significant difference in mortality [RR=0.88,95%CI(0.70,1.11),P=0.28],major adverse cardiovascular events[MACE,RR=1.04,95%CI(0.88,1.24),P=0.63] or myocardial infarction [MI,RR=0.92,95%CI(0.56,1.53),P=0.75], but PCI-DES significantly increased the risk of TVR [OR=2.43,95%CI(1.61,3.69),P<0.0001].Conclusion For LAD stenosis, PCI-DES strategy causes as high a rate of mortality, MACE and MI as CABG or DES, but PCI-DES can significantly increase the risk of TVR, so we should be cautious clinically.

Objective To analyze the clinicopathologic features of mucinous cervical adenocarcinoma (ADC) and supply some reference for its diagnosis,treatment and prognosis.Methods Totally 88 cases with primary mucinous ADC diagnosed between January 2003 and December 2007 in Jiangxi Maternal and Child Health Hospital were retrieved.Their clinical and pathological data were reviewed and analyzed.Results Among 88 patients,70 cases of them were endocervical ADC,11 cases were minimal deviation adenocarcinoma (MDA),2 cases were intestinal subtype and 5 cases were villoglandular ADC.The positive rate of cervical Pap smear cytology was only 28％ (10/36).There were 10 cases were performed several times of cervical Pap smear cytology test and biopsies,while still no abnormality was found.Finally,7 cases of them were diagnosed by cervical excisional biopsy and endocervical curettage,including 5 cases with endocervical ADC and 2 cases with MDA; 2 cases (1 case with stage Ⅰ b1 endocervical ADC and 1 case with Ⅰ b1 MDA) were diagnosed by cold knife conization,and 1 case with stage Ⅰ b1 endocervical were diagnosed by uteroscopically directed biopsy.The overall 5-year survival rate was 60.0％.Using univariate analysis results showed that age (P =0.046),stage (P =0.007),tumor size (P =0.007) and therapeutic methods (P =0.009) were significant prognostic factors.Multivariate analysis showed that therapeutic methods was an independent predictor for survival (P =0.013).Stage Ⅱ b-Ⅲ b MDA patients occupied 7/11 of all MDA patient,while there was only one such patient of 5 cases with villoglandular ADC.The overall HPV infection rate was 65％ (57/88),and there was no obvious differences about the HPV infection rates among different types of mucinous ADC.Conclusions Cervical smear cytology is of little significance to the diagnosis of mucinous cervical adenocarcinoma.Early stage mucinous ADC is difficult to be detected,especially for MDA.Cervical excisional biopsy,endocervical curettage,cold knife conization,uteroscope are beneficial to its diagnosis.Therapeutic methods is an important prognostic factor for mucinous ADC and comprehensive treatment should be given to those patients with risky postsurgical factors.

Objective Compare the complications between laparoscopic and abdominal cervical cancer surgery, and investigate the safety of laparoscopic cervical cancer surgery and complications classified by Clavien-Dindo classification, then analyze the risk factors. Method Clinical data of 215 cases of cervical cancer received surgery from March 2011 to October 2014 was collected, which include intraoperative, postoperative and postoperative fol﹣low-up data. All the cases were divided into two groups: LRH group (n= 116) and ARH group (n= 88), then ana﹣lyze and compare the difference of intraoperative, postoperative complications and postoperative follow-up data be﹣tween the two groups, assess the safety of the two groups, and statistically concluded related independent risk factors. Results The complications of 204 patients were classified into 4 grades. The criticality and morbidity of intraopera﹣tive and postoperative complications have no significant difference between the two groups (P> 0.05). Logistic re﹣gression analysis show that over criticality grade Ⅱ of LRH intraoperative complication related to operating time, over criticality grade Ⅱ of ARH intraoperative complication related to aged over 50 yr, over criticality grade Ⅱ of ARH intraoperative complication related to BMI> 25. Conclusions Through the analysis of laparoscopic operation and the criticality of complications, the safety of the two groups were no difference. The patients with high risk fac﹣tors should be evaluated comprehensively. And strictly grasp the contraindication and indication.

American medical insurance is mainly composed of public medical insurance borne by the government and private medical insurance. The main cause of death in this country are ischemic heart disease, Alzheimer’s disease, and lung cancer. The motality rate mainly caused by drug use disorders, chronic kidney disease and Alzheimer’s disease. The development of Chinese herbal medicine is relatively slow and difficult. The education system has covered Traditional Chinese Medicine (TCM). However, there still exist certain challenges of the development of TCM acupuncture faces the challenge of localization; Chinese herbal medicine still lacks standardization and TCM education needs to be standardized. Based on the current situation, it is suggested to focus on the development of acupuncture and moxibustion, to promote the registration and declaration of Chinese herbal medicine products for treating difficult diseases, and to strengthen the international exchange of TCM education, so as to promote the development and spread of TCM in the United States.

Recently , the country actively explores the pattern of an integrated healthcare which enables the as-sociation among hospitals of different levels , aimed to achieve maximum utilization of medical resources and lead a reasonable distribution of the patients .By reviewing the practices related to the integration of healthcare in Beijing , Shanghai , Zhenjiang and Wuhan city , this paper sums up in five typical mechanisms , i.e.organization and manage-ment mechanism , human resource management mechanism , interest distribution mechanism , service continuity and resources sharing mechanism .The effects of these practices were analyzed and the faced challenges were discussed . The following points were made clear during analysis and discussion:the sustainability of the collaboration mode and organization structure , human resource supports and incentive methods , health insurance guidance for hospitals and patients , two-way referral system and supporting measures , and building of information system .Then we put forward some suggestions , hoping to offer some references to the establishment of integrated healthcare in other regions .