Objective:To evaluate color doppler ultrasound diagnosis value of cesarean scar pregnancy.Methods: Using color doppler ultrasound probe belly and vaginal probe, faceted searches in patients with suspected scar pregnancy, observe suspicious gestational sac or clutter echo of the location, size, shape, and presence of complications, and radiography, video records, follow-up.Results: The abdominal and vaginal color to exceed cesarean scar pregnancy can make a definite diagnosis.Conclusion: Color doppler flow imaging (CDFI) in cesarean scar pregnancy has a characteristic ultrasonographic performance, ultrasound can accurately make a clear diagnosis. It is the first choice for clinical diagnosis.

ObjectiveTo evaluate the effect of interventional endovascular treatment for Budd-Chiari syndrome. MethodsIn 15 cases of Budd-Chiari syndrome, repatency of the obstructive inferior vena cava was successfully carried out by percutaneous transluminal balloon dilatation first, and then self-expanding stents was placed in 13 patients. In 4 patients with complete obliteration of the hepatic veins, "H" graft mesocaval shunts were performed one week later. ResultsMild heart dysfunction occurred in one case after endovascular intervention.Patients were followed-up from 2 to 42 months postoperatively. Except one re-stenosis distal to the stent, no stent migration and thromboembolization in shunting grafts occurred. The symptoms of portosystemic hypertension were relieved significantly. Conclusions Budd-Chiari syndrome could be effectively treated by interventional endovascular procedures.

3 months) were involved in this study PV electrogram was divided into disorganized and organized patterns Segmental PV isolation was performed during AF guided by the earliest PV potential recorded on the basket catheter determined by the lone pause during disorganized pattern or organized PV electrogram The sites with the most disorganized activity during fast and irregular fibrillatory activity had been regarded as ablative target Elimination of PV potential in all PVs during AF, and confirmed by remapping of PV during sinus rhythm or atrial stimuli after cardioversion had been considered as the ablative end point (segmental PV isolation was performed repeatedly if PV potential still existed during sinus rhythm) Results Of the total 76 PVs in 20 patients who achieved PV isolation, 68 (89 5%) PV isolations were performed during AF Reappearance of PV potential occurred in 23(33 8%) during sinus rhythm after cardioversion, and isolation was achieved during sinus rhythm Procedure duration was 5 3?3 7 hours Fluoroscopy time was 2 7?3 8 minutes Recurrence of AF occurred in 11 (55%) patients during the 8?9 month follow up No operation related complication occurred Conclusion Segmental PV isolation for chronic AF is feasible, safe and effective Ablation guided by electrophysiological mapping can result in the elimination of PV potential Remapping of PV and repeated ablation during sinus rhythm after cardioversion is essential

Objective:To explore the feasibility of using Hirsch index(H index) to evaluate the performance of academic papers published by medical talents.Methods:67 medical talents of Wuxi People′s Hospital Affiliated to Nanjing Medical University were enrolled in the study. The numbers of papers published and citations of these talents which have been included by PubMed, Chinese Citation Database, CNKI, Wanfang, and Baidu Scholar. The H value of these talents was calculated according to the list method proposed by Rousseau R. The H index was compared with the traditional evaluation indexes of scientific research performance, such as the number of papers published, the total number of citations and the average number of citations. Pearson test was used to explore the correlation between H index and traditional evaluation index.Results:The H value of 67 talents ranged from 1 to 14. Pearson test showed that the H index was significantly correlated with the total number of papers, the total number of citations and the average number of citations at the level of 0.01, and their Pearson value was 0.746, 0.932, and 0.648 respectively.Conclusions:As a new scientific research performance evaluation system, the H index is recommended in the evaluation of medical personnel, but it needs further and sustained optimization in terms of database inclusion timespan, research work timespan, and authors ranking limit among others.

Objective To investigate the therapeutic effect of the complicated fracture of tibial plateau treated by open reduction and internal fixation. Methods Surgical treatment in 68 cases with complicated fractures of the tibial plateau were analyzed retrospectively, T type plate, L type buttress plate, double plates, anatomical plate,locking plate and less invasive stabization system were adopted for different fractures,iliac or artificial bone grafted in the reconstruction of bone defect after the depression replaced. The time of operation and the effect of functional exercise in the postoperative patients to recover the function of the knees were analyzed at the same time. Results 52 patients of 68 cases were followed-up. Based on Rasmussen rating system,the recovery of knee joint function were excellent in 42cases(67%) ,good in 12 cases(19%) ,fair in 6 cases(10%) and poor in 2 cases(4%) ,the excellent-and-good rate was 86%. Conclusion Surgical treatment of the complicated fractures of the tibial plateau depended on the kind of fracture, therapeutic principles by stages. Moreover, bone grafte after the depression replaced in bone defect was neeassary,good internal fixtion oould meet functional exercise,soft tissue injuries like ligament and meniscus should be well treated,follow the principles of early exercise and delay weightbearing.

Objective To study the structural features and anticoagulant activity of the polysaccharide isolated from Aeodes orbitosa.Methods Sugar composition analysis,methylation analysis and IR were used to characterize the structural features.The anticoagulant activity of the polysaccharide was evaluated by cutting tail and capillary methods.Results The polysaccharide was composed of 3,6-anhydrous-galactose,6-methyl-galactose,2-methyl-galactose,galactose,xylose and glucose in the molar ratios of 6.4∶0.9∶5.8∶1.6∶84.1∶1.2.The content of Sulfate group was 37.5%. The main linkage model of the polysaccharide were 1,3 and 1,4 linkages,branch point located at O-2 and 6 of galactose residues.Sulfate group located at 2 and 6 position of 1,4 linked galactose residue and 2 position of 1,3 linked galactose residue.The polysaccharide showed significant activities to extend bleeding time and coagulation time in mice.Conclusion The polysaccharide from Aeodes orbitosa was a sulfate galactan with strong anticoagulant activity.

Objective To know the masons of delaying to receive medical treatment among patients with breast cancer, and then reference to related health education. Methods 13 patients with breast cancer were selected in this research, interviewed them by phenomenological method to know their reasons of delaying to receive medical treatment, analized the results of interview by Clolaizzi method. Results The were five themes for patients with breast cancer about delaying to receive medical treatment, they were not understand breast cancer-related knowledge, shortage of method of self-examination, psychological factors, working pressure and family factors, social environment factors. Conclusions We should strengthen breast cancer-related health education when changed women's traditional ideas and ameliorated their family and social environment.

Depression is a common complication after stroke.It is often associated with disability,cognitive impairment,and increased mortality.This article reviews the epidemiology,risk factors,predictive factors,and pathophysiology mechanisms of post-stroke depression.

ObjectiveTo introduce the operative technique of pedicle evolution from isolated perforator to perforator-plus-adipofascial,and investigate its clinical results in venous drainage and safety in distallybased sural flaps.MethodsAfter identifying the proper viable perforators,the whole flap was designed in an eccentric propeller shape,with the perforating vessels corresponding to the pivot point.The proximal larger blade was a fasciocutaneous flap, while the distal smaller blade was a subdermal vascular plexus flap,preserving at least a quarter area of adipofascial tissue around the perforator.From January 2008 to December 2010,we performed distally perforator-adipofascial pedicled sural fasciocutaneous propeller flap in 12 patients,with 180 degrees rotation to cover foot and ankle defects.Postoperatively,flap swelling,survival and functional recovery were evaluated. Results There were 7 posterior tibial artery perforator flaps from the posteromedial and 5 peroneal artery perforator flaps from the posterolateral sural region. The proximal fasciocutaneous flap measured 4 cm × 8 cm-6 cm × 18cm, and the distal cutaneous flaps measured 2 cm × 2cm-4 cm × 4 cm.Flap swelling was noted under grade 2 in 9 cases,grade 3 in 2 cases,and grade 4 in 1case with some distal superficial skin necrosis,which occurred in the largest flap in our series.All flaps survived eventfully.After average 13 months follow up,the wound were cured successfully,and all patients recovered walking and shoe wearing function. ConclusionPedicle evolution by keeping some adipofascial tissue around the pivot perforator, can preserve more venous return routes and relieve flap swelling. This technique should be recommended in perforator pedicled propeller flaps,as it enhances flap safety,and without increasing the difficulty of 180 degrees rotation.

BACKGROUND: Previous studies demonstrated that construction of eoexpression plasmid containing multiple genes on the same vector could improve transfection and expression rates.OBJECTIVE: To construct eukaryotic expression plasmid pcDNA3.1 (+)-MUC1 -GM-CSF by human polymorphic epithclial mucin (MUC 1) and granulocyte macrophage colony stimulating factor.(GM-CSF) and to observe expression of recombinant plasmid in COS-7 cells.DESIGN,TIME AND SETTING: Gene recombination design,which was carried out in the Animal Central Laboratory,the Fourth Military University of Chinese PLA from September 2005 to December 2006.MATERIALS: Eukaryotic expression vector pcDNA3.1 (+) was presented by Pro.Taylor-Papadimitriou;pGEM-3zf()-GM-CSF plasmid,COS-7 cells,pUCI 8 vector,and E.coli DH5α were made in the center; female BALB/c mice were provided by Experimental Animal Center of the Fourth Military University of Chinese PLA.METHODS: Signal peptide was synthesized with encoded MUCI gene sections to obtain repeated sequence coneatemer after renaturation.Next,the accepted concatemer was cloned with GM-CSF following enzyme identification and sequencing analysis,and then they were put in eukaryotic expression vector pcDNA3.1(+) to construct eukaryotic coexpression plasmid pcDNA3.1 (+)-MUCI -GM-CSF in order to transform COS-7 cells.MAIN OUTCOME MEASURES: Gene expression was detected by indirect immunofluorescence and enzyme linked immunosorbent assay (ELISA).RESULTS: Enzyme identification and sequencing analysis showed that recombinant plasmid contained a fusion gene encompassing human MUC1 repeated sequence concatemer and GM-CSF; moreover,MUC1 expression was detected in COS-7 cells,while recombinant plasmid could induce the production of anti-GM-CSF antibody.CONCLUSION: The recombination between human MUC1 repeated sequence concatemer and GM-CSF gene successfully constructs eukaryotic coexpression plasmid.