At present,reports at home and abroad suggest a low probability of successful preservation of ovarian endocrine function after ovarian shift radiotherapy.After radiotherapy for cervical carcinoma,the ovarian function is associated with various factors,such as radiotherapy dose and method,patient's age,shift position,and concurrent chemotherapy drugs.Therefore,as for each patient,the dose to the ovarian tissue should be controlled within the individual dose limit to effectively preserve the ovarian function.

Objective To observe the effects of blood pressure by intravenous infusion of different doses ofoxytocin in cesarean section.Methods Sixty full-term pregnant women undergoing cesarean section with continuous epidural anesthesia were divided into three groups by random digits table method with 20 cases each:group A,B and C.Three groups were injected 10 U oxytocin in uterine muscle after infant delivery.Group A,B and C received 5,10 and 20 U oxytocin (sodium lactate ringer,500 ml) continuous intravenous infusion at the speed of 10 ml/min.If happened uterine contractions bad,they were sublingual administering 0.2 mg misoprostol.If happened severe hypotension,they were intravenous injected 5 mg ephedrine.The change of mean arterial pressure (MAP) and heat rate before anesthesia (T0),after fetal childbirth (T1),5 m in (T2),10 min (T3),30 min (T4) after infusion of oxytocin and the dosage of ephedrine and misoprostol were recorded.Results There were no significant differences in MAP and heart rate at every time point between group A and B (P＞ 0.05).MAP decreased and heart rate increased in group C at T2,T3 compared with those in group A and B,and there were significant differences (P＜ 0.05).The number of cases of sublingual misoprostol were increased in group A (7 cases) compared with that in group B (2 cases) and group C(1 case).The 8 patients injected ephedrine in group C were more than group A(1 case) and group B (3 cases).Conclusion Cesarean section after the delivery of the fetus in the uterus muscle injection of oxytocin 10 U,after 10 U of oxytocin added 500 ml sodium lactate ringer injection at the speed of 10 ml/min intravenous infusion has little effect on the blood pressure and heart rate,and has good uterine contractions.

Objective:To study magnetic resonance imaging (MRI) in differential diagnosis between benign and malignant gallbladder diseases.Methods:A retrospective study was conducted on 115 patients with gallbladder diseases managed at Nankai Hospital from August 2017 to August 2019. There were 50 males and 65 females, with the age of (57±12) years. Patients who underwent MRI and surgery were studied and the surgical histopathological examination was used as the gold standard. The MRI imaging findings in differentiating between benign and malignant gallbladder diseases were evaluated.Results:Of 115 patients, histopathological examination showed 70 patients had benign lesions, which included 24 gallbladder polyps, 19 adenomyomatosis of gallbladder, 18 gallstones or bile duct stones, and 9 gallbladder adenomas. Of the 45 patients with malignancies, there were 37 gallbladder adenocarcinomas and 8 squamous cell carcinomas of gallbladder. MRI examination on these 115 patients showed 64 benign and 42 malignant lesions. The overall compliance rate was 92.2% (106/115). The sensitivity, specificity, positive predictive and negative predictive value of MRI in the differential diagnosis between benign and malignant gallbladder diseases were 93.3% (42/45), 91.4% (64/70), 87.5% (42/48) and 95.5% (64/67), respectively. The Kappa value of MRI compared with the gold standard was 0.838, showing good consistency.Conclusion:MRI was useful, in the differential diagnosis between benign and malignant gallbladder diseases.

In order to investigate the molecular evolution and spatio-temporal migration of Getah viruses (GETV) isolated around the world,the nucleotide and deduced amino acid sequence of GETVs were analyzed and phylogenetic trees were constructed by using informatics software including ClustalX1.83,MegaAlign,GeneDOC and Mega6.0.The Bayesian Stochastic Search Variable Selection (BSSVS) program in the BEAST v 1.8.1 software package was used to analyze the spatial dynamics of the Getah virus.Results showed that the full-length of Getah virus E2 gene consists of 1 266 nueleotides,encoding 422 amino acids.And the homology of nucleotide and amino acid were 94.5％ 100％ and 96.4％ 100％ respectively.The molecular evolution analysis revealed that there were no species and geographical distribution difference existing among GETV host animals (e.g.horses and pigs) and vectors (e.g.mosquitoes).Bioinformatics analysis showed that GETV originated in Malaysia,then it was spread to Japan,China,South Korea,Mongolia,Russia,etc.GETV E2 gene was relatively stable since GETV was first isolated in 1955.The differences of species and geographical distribution did not exist among GETV host animals and vectors,and the virus has spread from tropical regions to Eurasian continent.Thus,strengthening the detection and monitoring of GETV and its infections in humans and livestock is critical.

OBJECTIVE To explore validity and reliability of proton pump inhibitors (PPI) in adult patients with laryngopharyngeal reflux disease(LPRD). METHODS Randomized and placebo-controlled clinical trials regarding the effectiveness of PPIs on LPRD patients were systematically extracted from PubMed, Cochrane Library, and EMBASE, Web of Science, CNKI, CBM, VIP and WANFANG from the beginning of indexing to August 2017. After selection and quality assessment, data were extracted from eligible studies meeting the exclusion and inclusion criteria. The Review Manager software(version 5.2, The Cochrane Collaboration) was performed for all of the statistical analysis in this meta-analysis. The level of evidence was assessed by the GRADE (Grades of Recommendation, Assessment, Development and Evaluation). RESULTS The sample comprised 14 RCTs including a pooled total of 821 LPRD patients were eligible for this meta-analysis, of which 447 and 374 patients took PPIs and placebo, respectively. Pooled results demonstrated that total RSI significantly improved for patients who received PPI therapy by comparing with those receiving placebo [SDM=2.12, 95％CI(0.80; 3.45), P<0.05]. PPI treatment group showed effective in response rate [OR=1.62, 95％CI (0.89, 2.95), P>0.05], but the differences between PPIs and placebo groups was not statistically significant. CONCLUSION PPI treatment could significantly improve reflux symptoms in LPRD patients, therefore, should be taken into consideration for LPRD management with other strategies, such as lifestyle modification.

Objective:To investigate the feasibility of optimization of coronary computed tomography angiography (CCTA) with pre-scan size-specific dose estimate(SSDE).Methods:Ninety patients from Quzhou People′s Hospital during March and May 2018 who underwent CCTA were defined as modelled patients, the regression equation of body mass index (BMI) and water-equivalent diameter ( dw) were conducted and upper quartile of CTDI vol values was calculated. Other 67 patients were divided into two groups: control group (CCTA scan protocol, based on CTDI vol) and study group (CCTA scan protocol using SSDE). The image quality and radiation dose including breast dose (Dose bre) in two groups were assessed. Results:The positive correlation was found between BMI and dw with a linear regression equation of dw=9.241 + 0.644×BMI( r=0.823, P<0.05), and the upper quartile of CTDI vol was 7.92 mGy. The proportions of high-level image quality were 94.10% (367/390) and 93.93% (402/428) in the control and study groups, respectively ( P>0.05). The median signal to noise ratio (SNR) and contrast to noise ratio (CNR) were 21.08/24.39, 17.24/19.94 in the control and study groups, respectively ( P>0.05). The CTDI vol, SSDE and Dbreof the study group were reduced by 37.04%, 35.77% and 37.37% compared with the control group, and statistically significant differences were found( z=-7.041, t=18.479, 15.079, P<0.05) among them. Conclusions:The CCTA scan protocol based on the pre-scan SSDE can significantly reduce the radiation dose and provide the diagnostic image quality.

ObjectiveTo investigate the clinical features of liver function and coagulation function in patients with Alongshan virus (ALSV) infection. MethodsClinical data were collected from 27 patients with ALSV infection who were admitted to Inner Mongolia General Forestry Hospital from May 2018 to September 2019, among whom there were 18 male patients and 9 female patients. Related data were extracted, and a database of relevant case reports was established. The descriptive epidemiological method was used to analyze the clinical features of liver function and coagulation markers, and the features of liver injury caused by ALSV infection were analyzed. ResultsFor the 27 patients, the abnormal rates of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), cholinesterase, and total bile acid were 25.9%, 33.3%, 25.9%, 40.7%, 8%, and 8%, respectively; among the 27 patients, 4 (14.8%) had an ALT level of ＞2×upper limit of normal (ULN), 3 (11.1%) had an AST level of ＞2×ULN, 1 (3.7%) had an ALP level of ＞2×ULN, and 5 (18.5%) had a GGT level of ＞2×ULN. Among the 27 patients, 25 (17 male patients and 8 female patients) had the results of bilirubin test, among whom 1 had a reduction in total bilirubin (TBil) (3.30 μmol/L) and 3 had an increase in TBil (23.7 μmol/L, 26.2 μmol/L, and 32 μmol/L, respectively). The abnormal rates of the coagulation markers international normalized ratio, activated partial thromboplastin time, and fibrinogen were 3.7%, 11.1%, and 22.2%, respectively. ConclusionThere is a certain degree of liver injury in patients with ALSV infection, generally with mild symptoms.

Objective:To investigate the techniques of digit-tip replantation with anastomosis of superior digital arch artery in children and to evaluate the clinical effects.Methods:From January 2020 to September 2022, 62 children (62 digits) with completely severed digit-tips were admitted to the Department of Paediatric Orthopaedics, Suzhou Ruihua Orthopaedic Hospital. All the injury planes were distal to the nail root. All arterial dissections were distal to the digital arterial arch with the vessel calibre from 0.15 mm to 0.35 mm. The superior arch arteries of the digital arterial arch were successfully anastomosed. After surgery, a significant blood flux to the replanted digit body were observed. Postoperative necroses or failures were analysed for the causes. All children with survived digit-tips were entered into scheduled follow-ups through a combination of visit of outpatient clinics or via WeChat and telephone reviews. Postoperative follow-up included digit body fullness, motion of distal interphalangeal joint, nail growth, scarring, and response of the replanted digit-tips to needling. Clinical outcomes were evaluated according to the evaluation criteria for finger replantation function.Results:Of the 62 replanted digit-tips, 56 survived after replantation. Two digits had wound infection after surgery, and survived by dressing change and applying sensitive antibiotics. Necrosis occurred in 6 replanted digit-tips, of which 2 necrotic digit bodies were amputated, and the stumps at the distal interphalangeal joint were repaired. The other 4 necrotic digits were healed after dressing change under the scab due to a smaller digit body. A total of 52 children (including 2 survivals from postoperative infection after dressing changes and 4 survivals with healing underneath-eschar after necrosis) and with 10 lost during follow-up (including 2 with stump repairs after necrosis). The follow-up period ranged from 2 to 30 months, with an average of 6 months. The shape and function of replanted digit-tips recovered well. According to the evaluation criteria for finger replantation function, 44 digits were of excellent, 6 of good, and 2 of fair.Conclusion:In children, the superior arch arteries of digital arterial arches of the digit-tips are small in diameter. However, the vessels in smaller calibres can be anastomosed, should proper surgical techniques are applied. Therefore, due to the satisfactory outcomes, microsurgeons should try the best efforts to replant a digit severed at the plane of digit-tip.

Objective To discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy (RARC) with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Methods Between October 2014 and April 2019,71 patients(59 males and 12 females)with MIBC (Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic "U" shaped ileal neobladder in Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College) were studied retrospectively.They had an average age of (65.2 ± 5.6)y and BMI of (22.18 ± 3.75) kg/m2.The median age-adjusted charlson comorbidity index (aCCI) was 4,median ASA score was 2.All patients underwent these inspections pre-RARC:chest Xray,vascular ultrasound (jugular vein included),abdominal ultrasound,CT urography,cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour).All patients were pathological diagnosed with MIBC,with no evidence of systemic metastasis and no history of radiotherapy,systemic chemotherapy and open abdominal surgery before RARC.All 71 patients received RARC with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Between October 2014 and September 2016,37 cases (29 males and 8 females) were managed without ERAS protocols perioperatively.They had an average age of (65.3 ±5.7)y and BMI of (23.66 ± 3.47)kg/m2.The median aCCI was 4,median ASA score was 2.Between October 2016 and April 2019,another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment,thrombosis prevention,pain assessment and management,perioperative diet management etc.They had an average age of (64.5 ± 4.3) y and BMI of (21.87 ± 4.85) kg/m2.The median aCCI was 4,median ASA score was 2.There were no statistical significance between the two groups with regard to general information.Surgical and follow-up data were collected for all patients.Results Surgeries were successful in all 71 cases with postoperative follow up for 3-51 months.In ERAS group,there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours:with 2 cases of incidental prostate cancer (IPCa).In non-ERAS group,pT2 in 25 cases and pT3 in 12 cases:with 1 case of IPCa.Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5 ± 18.7) h vs.(29.9 ± 17.4)h,P =0.032],the first defecation time [(72.6 ±27.1)h vs.(88.7 ±35.8)h,P =0.004],length of hospital stay after surgey [(14.1 ± 3.3) d vs.(16.2 ± 4.8) d,P =0.037],numeric rating scales (NRS) Pain Score 8.0,24.0,48.0 h after surgery [(3.2 ±0.5)vs.(3.6 ±0.8),P =0.015;(1.9 ±0.3) vs.(2.2 ± 0.6),P =0.011;(1.3 ± 0.4) vs.(1.6 ± 0.7),P =0.032],respectively.There were no significance between groups with regard to operating time [(290 ± 65) min vs.(282 ± 46) min,P =O.549],intraoperative blood loss [(190.5 ± 235.6) ml vs.(221.1 ± 250.3) ml,P =0.438],transfusion rate [5.9％ (2/34) vs.8.1％ (3/37),P =0.922],readmission within 30 days after surgery [2.9％ (1/34) vs.5.4％ (2/37),P =0.940],early severe complications(within 30 days) [2.9％ (1/34) vs.2.7％ (1/37),P =0.940],late severe complications (after 30 days) [5.9％ (2/34) vs.8.1％ (3/37),P =0.922].Conclusions The implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic "U" shaped ileal neobladder using STAPLER technique is safe and effective.It can reduce postoperative pain and hospital stay,shorten bowel recovery time,improve early functional recovery without increasing major complications.This adoption should be encouraged.

Objective:To discuss the effect and experience of laparoscopic vesicovaginal fistula repairs though inferior of bladder longitudinal incision.Methods:54 patients were included in this study. Clinical data of patients collected from our hospital since January 2010 to October 2019 who underwent laparoscopic vesicovaginal fistula repair. The median age is 49.5 (8-80) years old. Main complaints were urine flows out through the vagina. 14 cases (25.9%) and 23 cases (42.6%)were post-hysterectomy of benign lesions and gynecological malignant tumors. The symptoms presented at 11 (1-20) days post urinary catheter removal. There were 11 cases (20.4%) of cervical malignant tumors, symptoms presented at 10 (5 to 25) months after radiotherapy. The symptoms of rest of cases 6 (11.1%)presented at 21 (3 to 50) days. One of them had rectal fistula, another had ureteral injury, 6 had bladder contracture, 2 patients had bilateral hydronephrosis. Preoperative CT examination revealed that 4 cases had no obviously hydroureter at upper urinary tract, and 2 cases had mild hydronephrosis in bilateral kidneys. The diameter of the fistula was 0.5-4.0 cm. There were 50 cases of single fistula and 4 cases of multiple fistula. The urine pad test evaluated the degree of urine leakage in patients reveals that 7 and 42 cases with mild and moderate, rest of 5 cases presented with severe result. 37 cases performed with vesico-vaginal fistula repair for the first time; 13 and 2 cases had once and twice vesico-vaginal fistula repair history and there were other two patients had vesico-vaginal fistula repair history for three and four times. All patients underwent general anesthesia under the laparoscopic bladder bottom longitudinal incision bladder vaginal fistula repair, 8 cases performed with Da Vinci robotic assist surgery system. Main steps of the operation include: ①search for bladder and vaginal fistula, assessed the size, number, and location of the fistula; ②To set single J stents in the bilateral ureter; ③Fully separated the bladder and vaginal wall, remove scar tissue, and suture the bladder incision with low or no tension way; ④To use great omentum; for patients with low, complex, and mixed bladder vaginal fistulas, recommend to use bladder wall flaps (6 cases), bladder enlargement (3 cases), and ureteral replantation (6 cases). The clinical data of the patients were collected, and a univariate analysis was performed on the cure rate.Results:The mean of blood boss and duration in operation were (33.3±26.5) ml and 85 (60-240) minutes. Mean of hospitalization was (11.3±8.2)days. The postoperative urinary indwelling time were (20.8±8.3)days. 50 cases were completed recovered and 4 cases failed, the curative ratio was 92.6% (50/54). It revealed that the curative ratio of vesicovaginal fistula repair had correlation with history of surgical interventions before operation. The curative effect was reduced ( P=0.00) when the patient had previous laparoscopic vesicovaginal fistula repairs. Patients with multiple fistulas (≥2) had a lower cure rate than single fistulas ( P=0.00). In addition, patients with fistulas above the triangle of the bladder had a higher cure rate than fistulas outside the triangle of the bladder and the urethra ( P=0.00). There was no statistically significant difference in the cure ratio of Age ( P=0.79), operation time ( P=0.06), intraoperative bleeding ( P=0.78), post-operative hospitalization ( P=0.73), indwelling catheterization time ( P=0.30), and size of fistula ( P=0.31). Conclusions:The operation could be effective with fewer complications procedure, which could fix mixed fistula and bladder contracture at the same time.