Objective To evaluate the effect of amniotic products after transcervical resection of uterine adhesions (TCRA). Methods This study was carried out in 57 patients with intensive degree of intrauterine adhesions (IUA) who had been treated by TCRA between Jun. 2013 to Jun. 2014. These patients were devided into two groups randomly. In group amnion, 29 patients were placed amniontic scaffold balloon after TCRA;in group balloon, 28 patients were placed Foley′s balloon after TCRA. The two groups′balloons were taken out after TCRA 7 days. All patients were taken artificial cycle treatment. The uterine cavity form and the menstruation of 2 groups were observed in 3 months after TCRA. Results In group amnion, IUA score dropped from 10.1±0.5 preoperatively to 3.2±1.5 postoperative (P<0.01), in group balloon, IUA score dropped from 10.1 ± 0.5 preoperatively to 6.3 ± 2.5 postoperative (P<0.01). In group amnion, the menstrual score increased from 13.3 ± 4.4 preoperatively to 32.6 ± 5.5 postoperative (P<0.01), in group balloon, the menstrual score increased from 11.1±5.8 to 26.5±5.6 (P<0.01). The menstrual improvement of group amnion was better than that of group balloon significantly (P=0.002). In group amnion, the recurrence rate of adhesion was 21%(6/29), in group balloon, the recurrence rate of adhesion was 36%(10/28). There was no significant difference (P=0.248). The pregnancy rate of group amnion was 28%(8/29), the pregnancy rate of group balloon was 21%(6/28). The difference of pregnancy rate in two groups was not significant (P=0.760). Conclusion This small sample observation indicate that amniotic products used in the treatment of intensive IUA could improve menstrual, reduce the recurrence of adhesion, but the impovement of the pregnancy rate should be confirmed by large sample observation.

GRP78/Bip,which was first identified by scientists in 1977,is a major endoplasmic reticulum (ER)chaperone that has a variety of function.In tumor tissue,GRP78 is high expression and ectopic expression;participate in the development of tumor,ER-stress state and ectopic distribution on the cell surface,in the form of receptors involved in signal transduction. Therefore,GRP78 as an tumor therapeutic targets,biomarkers of tumor and prognosis of tumor biological markers,plays an important role in the tumor research.In recent years,domestic and foreign scholars have found that in the non-cancer disease (viral infectious disease cardiovascular disease diabetes neurodegenerative disease etc),GRP78 is high expression,indicate its application prospect.This article makes a brief overview on the molecular biological characteristics of GRP78,role in tumor pathogenesis and therapeutic significance and application prospect in non-tumor disease.

Objective To explore the value of echocardiography in patients with aortic stenosis who underwent transapical aortic valve implantation (TAAVI).Methods Fifteen high-risk patients with severe aortic stenosis were chosen in the present study,all of which received TAAVI in Fuwai Hospital Chinese Academy of Medical Sciences from June 2014 to March 2015.The left ventricular end-diastolic diameter (LVEDD),left atrial diameter (LAD),left ventricular ejection fraction (LVEF),effective orifice area (EOA),mean aortic pressure gradient (MPG),as well as artificial valve function of patients were measured at different time points (before operation,discharge,1 month and 3-6 months after operation) by echocardiography.The data were analyzed using one-way ANOVA analysis with SPSS software,and multiple comparisons were done using LSD student t test.Results The data from preoperative echocardiography indicated severe aortic stenosis in the 15 patients,with the average level of EOA as (0.55± 0.28) cm2 and MPG as (58.93± 14.96) mmHg (1 mmHg=0.133 kPa).Moderate paravalvular aortic regurgitation was observed in one patients,who was then received a second implantation.There was no significant difference between LVEDD,LAD,and LVEF when the patients were at discharge,1 month and 3-6 months after operation.The prosthetic valves were stable and conformed by echocardiography,while paravalvular leak regurgitation (1-2 mm) was observed in 7 patients.One patient died of other reasons.Compared with preoperative data,the EOA increased while MPG decreased when the patients were at discharge,1 month and 3-6 month after operation (t=6.619,7.357,6.401,all P ＜ 0.001;t=9.523,9.687,5.932,all P ＜ 0.001).Conclusion With careful patient screening and selection,TAAVI can be an effective treatment for high-risk severe aortic stenosis patients,in which echocardiography plays an important role during the surgery and follow up.

Objective To investigate the preoperative management and the clinical effeciency of Lichtenstein tension-free hernioplasty in adult patients with inguinal incarcerated hernia.Methods Clinical data of 86 patients with inguinal incarcerated hernia were analyzed retrospectively.Hernia was repaired with Lichtenstein tension free after reposition.Results There were 59 male patients and 27 female patients with median age of (63 ± 18) years.There were 8 patients with liver cirrhosis.The operation was performed successfully in all patients.Segmental bowel resection with end-to-end anastomosis was performed in 38 emergency cases.Operative time was 20-120 min,with an average time of 54 min.The postoperative hospitalization was 5-17 d,with an average of 8 d.There were 7 cases of skin ecchymosis at the scrotum,there were no intestinal perforation,hepatic encephalopathy and upper gastrointestinal hemorrhage after operation.In early series of 24 cases without drainage tube left in place,there were 10 cases of fat liquefaction,10 cases of hydrops of hernial sac,6 cases of seroma and 3 cases of wound infection after operation.After 12 to 48 months of follow-up,there was no mortality after 2 years,no hernia recurrence.Conclusions Tension free repair in the treatment of incarcerated inguinal hernia is safe and feasible.

Objective To evaluate sacral nerve stimulation (SNS) in the treatment of spastic pelvic floor syndrome (SPFS).Method In this study,36 patients of spastic pelvic floor syndrome who received SNS treatment from 2011.3 to 2011.12,were reviewed in terms of clinical curative effect,changes of anal pressure and defecography.Result After a course of SNS treatment,patients were followed up for 3 months,12 cases were cured,22 cases improved and 2 cases were ineffective,the total effective rate was 94.4％.The symptoms such as endless defecate feeling,difficulty in defecation,anal pain and anal obstruction feeling improved significantly (P ＜0.01 ).After the therapy,rectal anal reflex( RAR)threshold value volume rose,anal maximum contraction pressure (AMCP),anal rest perssure (ARP) decreased (P ＜ 0.01 ).While the anal longest contraction time (ALCT)and rectal rest pressure (RRP) did not change significantly (P ＞ 0.05 ).After treatment,when patient defecate the anorectal angle (ARA) increases,the puborectal muscle spasm notch (PMSN)attenuates (P ＜ 0.01 ).Conclusions SNS is effective and minimally invasive in treating spastic pelvic floor syndrome.

Objective To analyze the correlation between 18F-FDG SUV and immunohistochemical index including GLUT1, Ki-67, MVD, survivin and cyclinA in non-snall-cell lung cancer. Methods Thirty-three patients with NSCLC underwent preoperative PET/CT examination and surgical operation. All patients were divided into two groups according to the size of tumor (cutoff=3 cm), metastasis of mediastinal or hilar lymph nodes or not, and histological types of the cancer, respectively. The expression of GLUT1, Ki-67, MVD, survivin and cyclinA were estimated with SP immunohistochemical technique, and were analyzed statistically to reveal the correlation to FDG SUV. Results The rate of positive expression of GLUT1, Ki-67 and CD34 were 66.67%, 72.73% and 100%, respectively. The mean value of CD34 in all 33 patients was 12.6±2.9 (12-56). The rate of positive expression of survivin was 84.85%, and the corresponding data of cyclinA was 27.27%. Conclusion There is linear correlation between FDG PET SUV and GLUT1, but not between FDG PET SUV and Ki-67, MVD, survivin and cyclinA. The expressions of GLUT1, Ki-67, MVD, survivin and cyclinA are not related with the size of tumor, nor metastasis of lymph nodes. The expression of GLUT1 and Ki-67 is related with histological types of the cancer, but not with MVD, survivin and cyclinA.

Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.

Objective To describe and analyze the distribution of medical expenditure of Liaoning province in 2014 in terms of population beneficiary based on the System of Health Accounts 2011(SHA 2011).Methods By means of multistage and stratified sampling, a total of 252 medical institutions were selected from four cities in Liaoning province according to their economic status and geographical distribution.Macro data including the outpatient income and hospitalization income were taken into account, to calculate the beneficiary population of the province in 2014 according to SHA2011.Results GBD classification found that the highest medical expenditure category was non-communicable diseases, accounting for 63.02% in total medical expenditure.ICD classification found that respiratory disease as consuming the highest medical expenses (43.76%).The average medical expenditure of the elderly population was the highest per person, up to 3 041.70 yuan per person.Conclusions Medical expenses of non-communicable diseases, respiratory disease and elderly population were still high.Thus we need to emphasize disease prevention, and take efficient measures against such key diseases to curb the medical expenses.The elderly population calls for specific and effective measures to reduce their medical expenses.

Objective To review our clinical experience on 12 patients with retroperitoneal infection who were treated with retroperitoneal laparoscopic debridement.Method This retrospective study included 12 patients with retroperitoneal infection who were treated with retroperitoneal laparoscopic dehridement and drainage.Results All the 12 patients recovered well and were finally discharged home.Conclusions Retroperitoneal laparoscopic debridement and drainage for retroperitoneal infection is a mini-invasive procedure.It was found to be safe,produced minimal bleeding and resulted in rapid postoperative recovery.It can be used as the first choice treatment in properly selected patients.

Objective To investigate the pollution of endotoxin in drinking water and the removal efficiency of endotoxin through the conventional drinking water treatment in Wuhan city,Hubei Province.Methods In Mar 2008,the water samples of Pinghumen and Zongguan drilking water plants which sourced from the Yangtze River and Hanjiang River respectively,were collected.The samples were tested by Limulus amebocyte lysate test recorded by Chinese Pharmacopoeia(2005 edition).Results The endotoxin content in raw water of the Yangtze River was(100.98?2.75)EU/ml and in tap water was(18.53?0.01)EU/ml.The endotoxin concent in the raw water of the Hanjiang River was(86.40?1.69)EU/ml and in tap water was(41.68?1.94)EU/ml.The removal rates of two drinking water plants were 81.65% and 51.76% respectively.Conclusion The conventional drinking water treatment can remove the endotoxin in dgreeds,but the content of endotoxin in the product water is still higher.