Objective To investigate the safety and clinical effect of laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer . Methods A retrospective analysis was made on clinical characteristics of 15 patients who were diagnosed as unexpected cervical cancer from January 2008 to December 2014.The age of the patients was between 29 and 67 years old, with an average of 43.9 years old.The indications for hysterectomy were cervical intraepithelial neoplasia (CIN) grade 2-3 in 7 cases, uterine myoma in 3 cases, dysfunctional uterine bleeding in 2 cases, uterine prolapse in 2 cases and adenomyosis in 1 case. Pathological results after the hysterectomy included 13 cases of cervical squamous carcinoma and 2 cases of adenocarcinoma .The lesions were all confined to the cervix , with 4 cases of stage ⅠA2 disease and 11 cases of stage ⅠB1 .The lymph-vascular space invasion was found in 4 cases.The operation interval between the two operations was 3-7 d (mean, 4.6 d).They were all given laparoscopic radical parametrectomy . Results The operation time was 212-285 min (mean, 249.6 min), and the blood loss was 250-500 ml ( mean, 376 ml) .Postoperative pathological findings showed no residual disease .Only one patient had left pelvic lymph node mestastasis .Two patients had intraoperative complications , including 1 bladder injury and 1 ureteral injury .There were 3 cases of postoperative complications , including 2 cases of uroschesis and 1 case of lymphocyst .The follow-up time was 6-84 months ( median, 48 months).No recurrence was seen.The 1-, 3-, 5-year survival rates were 100%, 93.3%, 86.7%, respectively. Conclusions Laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer is difficult to perform and has more complications . This surgical method is applicable to those who refused postoperation radiotherapy or required retaining ovarian function .

Objective To investigate the significance of haman epididymis protein 4(HE4)as a tumor marker combined with CA125 in diagnosis of epithelial ovarian cancer.Methods Serum levels of HE4 and CA125 were examined by ELISA and electrochemiluminescence method in 31 patients with ovarian cancer,68 patients with benign pelvic masses(36 benign ovarian tumor,23 ovarian chocolate cyst and 9 pelvic abscess were included) and 40 normal women as controls.Results Serum levels of HE4 and CA125 in ovarian carcinoma group were significantly higher than those in the benign pelvic masses group and healthy women group(P<0.01), and the difference of these levels between benign pelvic masses and normal ones have no statistical meaning(P>0.05).The sensitivity and the specificity of HFA were 74.2% and 95.0% respectively,of CA125,were 80.6% and 87.5%.respectively,and if the two markers combined,were 93.5% and 82.5%.Conclusions HFA is an ideal tumor marker and it has certain values in accessory diagnosis and differential diagnosis of ovarian cancer.The clinical value call be improved by combined detection of HE4 and CA125.

Objective To discuss the feasibility and the effects of percutaneous vertebroplasty (PVP) in the treatment of the osteoporotic compression fracture in theupper and middle thoracic vertebrae.Methods The study included 101 patients.55 cases were treated with PVP (observation group) and 46 cases were treated with conservative treatment (control group).The clinical efficacy of those two different treatment methods was evaluated by the changes of VAS score,ODI score,vertebral height and Cobb angle before versus after treatment.Results VAS and ODI scores at 48 hours and 6 weeks after treatment was significantly lower in observation group than in the control group (all P＜0.05).Although there was no significant difference in VAS and ODI scores between the two groups after 6 months of treatment (both P＞0.05),the anterior and middle vertebral height was decreased and Cobb angle of spine was increased in control group as compared with observation group (both P＜ 0.05).Conclusions PVP is an effective and safe method in the treatment of osteoporotic vertebral compression fractures in upper and middle thoracic vertebrae.The short-and long-term evaluation indexes are better in PVP than in conservative treatment.But the surgery should be proceeded under highly clear perspective equipment by the surgeons with highly level professional technology.Because the surgery is highly risky,surgery should be proceeded with cautions.

Objective To observe the fusion rate by using cage filled with osteophyte in anterior cervical disectomy and fusion.Methods From January 2010 to July 2012,81 patients receiving anterior cervical disectomy and spine fusion underwent treatment with cages containing exclusively autologous osteophyte collected from both anterior and posterior vertebral edges adjacent to the intervertebral space.There were 52 males and 29 females,aged from 55 to 78 years,average 64.1 years in this study.46 patients received one-level fusion,and 35 patients received two-level fusion respectively.Patients were followed up at 3 months,6 months and 1 year after operation.The fusion was evaluated by X-ray film and reconstructive CT.Results The total fusion rate after 3 months of operation was 76.5％ (62/81),the one-level and two-level fusion rate were 78.3％ (36/46) and 74.3％ (26/35),respectively.The total fusion rate after 6 months of operation was 93.8％ (76/81),the one-level and two-level fusion rate were 95.7％ (44/46) and 91.4％ (32/35),respectively.The total fusion rate was 100％ (81/81) after 1 year of operation.No statistically significant difference in fusion rate was found between the two groups.Conclusions The method of using cage filled with osteophyte can acquire ideal fusion rate in one-and two-level anterior cervical disectomy,fusion and plate fixation.

Objective To explore the application of propofol combined with midazolam intrave-nous anesthesia in pediatric upper gastrointestinal endoscopy, Methods A total of 497 ASA Ⅰ～Ⅱ patients who received sedative upper gastrointestinal endoscopy were assigned to a children group (2～14 years) and an adults group (18～65 years). The 2 groups were treated with midazolam (0.02～0.03 mg/kg, iv) and propofol (0.6～0.7 mg/s, iv) with an interval of 3～5 minutes. Enterseopy was inserted at light sleep, relaxing muscles, and disappearance of eyelash relaxation. Combining of pro-endoscopy, reaction to intravenous administration, dose of propofol, reaction to en-doscopy, time of returning to consciousness, changes of SpO2, R, HR, and BP, and sedative quali-ty were evaluated. Results Good sedation of the 2 groups after intravenous administration was ob-served. Rate of combining of pro-endoscopy in children was lower (42%) than that in adults (100%). The incidence of restlessness, hyperphasia, temporary decreasing of SpO2, dose of propofol of per kilogram weight, time of returning to consciousness in the children were 82.7%, 17%, 2.4 mg/kg, and (17.5±3.2)min, respectively, which were all higher in the adults [9%,4%,1.4 mg/kg, and (9.5±1.3)min, P<0.01]. HR and BP decreased in the 2 groups, and recovered rapidly after the endoscopy. There was no significant difference between the 2 groups (P>0.05). Conclusion It is safe and effective to use propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy.

Objective To explore the safety and the efficacy of the two-stage sedation administration method for the elderly in gastroscopic examination. Methods 128 elderly patients were divided into two groups according to age and body mass index (BMI), and were given sedation treatment before gastroscopic examination by two-stage administration method(group TSAM, n= 64)and continual administration method (group CAM, n= 64) of analgesics respectively. The following major data were recorded : ( 1 ) mean artery pressure (MAP) ;( 2 ) Blood oxygen saturation ( SpO2 ) ;(3)sedation level;(4) recovery time;(5) the amount of propofol used for sedation;(6) electrocardiogram (ECG) ;(7)the degree of pharyngeal malaise;(8) the oblivion degree of malaise. Results There was no significant difference in MAP alteration between two methods(P>0. 05). Compared with group CAM, the decreased degree of SpO2 was slighter and no patient's SpO2 was lower than 90% in group TSAM (P<0. 05). Fifty-seven patients in group TSAM fell into sedative state for gastroscopy with OAA/S score 2, while sixty patients in group CAM with OAA/S score 2, which represented a deeper sedation level in group CAM (P<0. 01). The recovery time was shorter and the amount of propofol used was significantly less in group TSAM than in group CAM (P<0. 01). During the process of gastroscopic exmaination, ST-T change and arrhythmia in ECG were not seen in either of these two groups. The pharyngeal malaise of patients in group TSAM was more severe than in group CAM (P<0. 01). However, there was no difference in the oblivion degree of malaise between two methods(P>0.05). Conclusions The two-stage sedative administration method is safer and more effective for gastroscopic examination for the elderly.

This study is to investigate the effect of ferulic acid on learning and memory impairments of vascular dementia (VD) rats and its mechanism of action. VD rats model was replicated by permanent bilateral common carotid artery occlusion (2VO). The learning and memory capability of VD rats was evaluated by Morris water maze. The activity of acetylcholinesterase (AChE) and superoxide dismutase (SOD) and the content of glutamic acid (Glu) and malondialdehyde (MDA) in hippocampus of VD rats' brain were determined, separately. The results showed that ferulic acid could alleviate learning and memory deficits of VD rats significantly. Ferulic acid was found to inhibit the activity of AChE and increased the activity of SOD in rat hippocampus. In addition, ferulic acid could also decrease the content of Glu and MDA in rat hippocampus. These results suggested that ferulic acid could alleviate VD rats' learning and memory deficits, which might be due to antioxidation, the improvement of cholinergic system in brain, or the inhibitory of nerve injury by excitatory amino acids.

Objective To explore the feasibility and clinical efficacy of modified transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis with lumbar instability in the elderly.Methods Retrospective study was done on 45 elderly patients diagnosed as lumbar spinal stenosis with lumbar instability treated by modified transforaminal lumbar interbody fusion from June 2011 to December 2012.There were 25 males and 20 females aged from 65 to 78 years [mean (70.64.0) years].The operation time,blood loss,and complications were recorded and analyzed.The visual analog scale (VAS) score,and Japanese Orthopaedic Association (JOA) score were used to assess clinical outcomes before and 3 months after treatment and at the last follow-up.According to the criteria of Brantigan-Steffe,intervertebral fusion was evaluated.Results The operation of 45 patients was successful,and there were no severe complication.The average operative time was (126 23) min,(range,100～ 185 min),and the average amount of blood loss was (272±89) ml (range,180-550 ml).There was no injury of nerve root,dural tear,or deep infection.All patients were followed up for 12 months to 30 months with an average of (20.6±5.8) months.The VAS score of low back pain was decreased from (4.8 ± 1.7) before operation to (1.6 ± 0.5) at 3 months after operation and (1.3±0.3) at last follow-up.The VAS score of leg pain was decreased from (6.7±1.6) before operation to (1.2±0.5) at 3 months after operation and (0.6±0.3) at last follow-up.The JOA score was increased from (13.2±4.9) before operation to (23.8±4.0) at 3 months after operation and (24.1 4.2) at last follow-up.There were significant differences in the VAS score and JOA score between pre-and post-operation (F=68.35,98.58,89.73,all P＜0.05),but no significant difference between 3 months after operation and final follow-up (all P ＞ 0.05).We observed no pedicle screw loosening,breaking,orany pullingout of intervertebral fusion cage.All patients showed evidence of fusion in each operated segment according to the criteria of BrantiganSteffe.Conclusions Modified transforaminal lumbar interbody fusion has the advantages including less invasion,sufficient decompression,and less interference to neural structures,and it may provide an ideal surgical method for lumbar spinal stenosis with lumbar instability in the elderly.

OBJECTIVE: To investigate the efficacy and security of different administrations of propofol on the sedation in upper gastrointestinal endoscopic procedures in snoring patients. METHODS: A total of 1,117 patients with snoring in ASA I-II level, who underwent gastroscopy and received propofol as sedation, were assigned to Group A, Group B, and Group C.These groups had different administration methods of propofol. The dose of propofol, response to endoscopic procedures, changes of oxygen saturation of arterial blood (SPO₂), incidence of severe respiratory depression and sedation quality assessed by operators were observed. RESULTS: The incidence of transient decline in SPO₂ in Group A, B, and C were 50.4%, 3.1%, and 18.5%, respectively. The doses of propofol of Group A, B, and C were (108.50±18.02) mg, (57.50±7.50) mg, and (79.80±10.02) mg, respectively, with significant difference (P<0.05). The incidence of severe respiratory depression in Group A was 1.2%, but Group B and C were 0%. Compared with Group A(100%) and C(100%), the satisfaction rate of sedation quality in Group B was 74%, with significant difference (P<0.05). CONCLUSION During the upper gastrointestinal endoscopic procedures, snoring patients are premedicated with propofol in various uses by steps or one slow administration. Both methods are safe and effective to reduce the incidence of severe respiratory depression, and patients have no memory of the procedure.
Adult ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastrointestinal Diseases ; complications ; diagnosis ; Humans ; Hypnotics and Sedatives ; administration & dosage ; adverse effects ; Male ; Middle Aged ; Propofol ; administration & dosage ; adverse effects ; Snoring ; complications

OBJECTIVE: To determine the efficiency and safety of capsule endoscopy for patients with intestinal diseases. METHODS: Given M2A capsule endoscopy (CE) was performed on 81 patients with obscure gastrointestinal bleeding and obscure abdominal pain, and the clinical data were analyzed. RESULTS: In the 81 patients, 9 showed negative finding, CE didn't reach the small intestine in 1 patient. In the other 71 patients, 132 intestinal lesions were detected, and the total positive rate of CE for intestinal diseases was 88.75%. The findings consisted of 36 intestinal inflammation, 24 angiopathy, 16 protuberant lesions, 15 mutipolypi in the intestine, 12 blood in the intestine, 11 single or multiple ulcers, 6 ascarid in the intestine, 5 diverticula, 1 ankylostomiasis, 1 intestinal dysplasia with internal fistula, and the 5 intestinal Crohn's disease. Ten patients with protuberant lesion were verified by surgical operation and pathology, and the 5 stromal tumors diagnosed by CE were confirmed by pathological examination, while no one of Crohn's disease, lymphoma and angioma was diagnosed correctly by CE. All images of CE were good. All the patients had no complications. CONCLUSION Capsule endoscopy is a safe and effective procedure, with a high positive rate, but the diagnostic yield is limited, which can be used for intestinal diseases.
Abdominal Pain ; diagnosis ; Adult ; Aged ; Aged, 80 and over ; Capsule Endoscopy ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; Humans ; Inflammatory Bowel Diseases ; diagnosis ; Intestinal Diseases ; diagnosis ; Intestine, Small ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult