Objective To study the clinical efficacy of robotic sacral hysteropexy in treatment of uterine prolapse.Methods From January 2012 to December 2013,3 patients undergoing robotic sacral hysteropexy in treatment of uterine prolapse in General Hospital of People's Liberation Army were studied retrospectively.Operation time,blood loss and postoperative recovery exhaust time and pelvic organ prolapse quantification (POP-Q) staging were evaluated.Results Three patients were treated by robotic sacral hysteropexy successfully.The mean operation time was 221 minutes (210-240 minutes),mean blood loss was 45 ml.One case with Ⅱ degree perineal laceration patients simultaneously perineal repair,neither intranor post-operative complications occurred.The mean postoperative recovery exhaust time was 16 hours.At three months of follow-up,all 3 patients got satisfaction.Although one patient at the first six months of postoperation had leakage of urine when coughing,instruct exercise pelvic floor muscle function and acupuncture one month their symptoms disappear.Conclusion Robotic sacral hysteropexy pave the way for an effective option in the management of uterine prolapse.

Objective To analyze the characteristic and the clinical application of high -frequency stimulation ABR for the patients with unilateral sudden deafness .Methods 40 patients aged 17~45 with unilateral sudden deaf-ness(40 health ears ,subject group)and 20 normal volunteers (40 ears ,control group)were selected to receive high and low frequency stimulation ABRs and pure tone audiometry .Results There were no statistical differences be-tween subject group and control group in pure tone audiometry .The wave Ⅰlatency of high -frequency ABR was longer in the subject group than that in the control group(P<0 .001) .The abnormal rate of Ⅰ - Ⅴ interval between high and low frequency stimulation ABRs was 62 .5% (25/40) in the subject group ,and 5% (2/40) in the control group .There were statistical differences between the two groups (χ2 =29 .574 ,P<0 .001) .Conclusion The waveⅠlatency of high-frequency ABR was longer and the abnormal rate of Ⅰ - Ⅴ interval markedly increased in the health ear of patients with unilateral sudden deafness .This may suggest that the contralateral ear may have an ab-normal blood supply of the inner ear when single side sudden deafness happened .High frequency stimulation ABR can be used to detect the potential changes of contralateral ear before the hearing loss occurred .

Objective To produce a novel tool for breaking off the ampoule bottles,which can protect the nurses from wounding their fingers by the glass fragment so as to guarantee the safety for the nurses. Methods We design a mould with the self curing plastic and leave some space in the end to insert the ampoule bottle,then fix the bistrique and spring to break off the bottles. Results This tool can break off several kinds of ampoule bottles with any bottles cracked and has achieved good clinical effect. Conclusion This mulfunctional tool is scientificly designed,easy to make,and it is very helpful for the medical staff in protection and enhancing working efficiency,so it is very valuable to be popularized in hospitals.

Multiple myeloma is common in the older population and is treated mainly with chemotherapy. However, chemotherapy-related side effects imitate the clinical manifestations of Sheehan's syndrome, which leads to misdiagnosis and missed diagnosis, particularly for older patients without a clear history of postpartum hemorrhage. Therefore, when older women with malignant myelomas show refractory hyponatremia and gastrointestinal disorders while under chemotherapy, a diagnosis of Sheehan's syndrome should be considered. The early detection of the disorder will guarantee timely individualized treatment.

Objective To apply robotic surgery of early ovarian malignancy tumors clinically and evaluate its feasibility in management for early ovarian cancer. Methods Using the da Vinci robotic surgical system, seven patients with early ovarian malignancy tumors (stage Ⅰ) underwent robotic surgery from April 2012 to September 2013. The average age was 45.7 years. Robotic surgeries approaches contained salpingo-oophorectomy,para-aortic lymphadenectomy, pelvic lymphadenectomy, omentectomy and appendectomy. Perioperative and follow-up clinical data were recorded. Results All robotic surgeries were successfully completed without the conversion to laparotomy. The mean operative time was 225 minutes (100-330 minutes). The average estimated blood loss was 171 ml (20-600 ml). No patients received blood transfusions. No intraoperative and postoperative complications were observed. The average number of pelvic lymph node dissected were 18.3 (11-34). The average number of para-aortic lymph node dissected were 3.7 (3-4). The mean follow-up time was 26.0 months after surgery (20-36 months). Currently, all patients had no tumor recurrence and survived. Conclusion Robotic surgery is feasible as a novel alternative approach in the treatment of early ovarian malignancy tumors.

Aim To investigate the mechanism of high mobility group protein B1(HMGB1)and tumor necrosis factor α-induced protein-3(TNFAIP3)involved in cell proliferation in lupus nephritis(LN)patients and human mesangial cells(HMC).Methods Immunofluorescence and immunohistochemistry technique were employed to detect HMGB1,TNFAIP3 and IκBα expression levels in glomerular cells of type Ⅳ LN patients.BrdU incorporation technology was used to detect cell proliferation level in HMC after stimulated by recombinant HMGB1.TNFAIP3 and IκBα expression levels in HMC were detected after HMGB1 stimulation by Western blot.Results The expression levels of HMGB1 and TNFAIP3 were increased in LN patients,while IκBα was decreased.HMC proliferation levels increased significantly after HMGB1 stimulation.At the same time,30 minutes after HMGB1 stimulation,the expression level of TNFAIP3 was significantly increased(P<0.05),while IκBα decreased(P<0.05)and then p65 increased significantly(P<0.05),compared with control group.Conclusion HMGB1 and TNFAIP3 are probably involved in mesangial cell proliferation by activating of NF-κB signaling pathways in LN pathogenesis.

Objective: To explore the effectiveness of multidisciplinary cooperation model-based preoperative visit on the and psychological stress of patients who undergo surgery for the first time. Methods: A total of 100 patients who undergo surgery for the first time in the Central Hospital of Xiaogan between July 2018 and December 2018 were enrolled in the present study. Fifty patients were assigned to the research group and another 50 patients to the control group according to the random number table method. Patients in the control group received traditional one-to-one peroperative visit, while multidisciplinary cooperation model-based preoperative visit was carried out in the research group. The changes of fear scores, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, stress and coping mode as well as knowledge related to operation were compared before and after visit intervention. Results: VAS scores in the research group after preoperative visit (6.05±1.11) and enter the operating room (7.32±1.09) were significantly higher than those in the control group (6.77±0.67 and 8.22±1.37), the difference was statistically significant (t=3.881, 3.527, P<0.05). After preoperative visit, the socres of SAS (38.65±4.42), SDS (40.38±3.87), avoidance and resignation (10.53±1.37 and 6.09±0.80) in the research group were lower than those in the control group (45.25±3.08, 46.49±4.62 and 12.68±1.98, 7.37±0.84), (t=6.129-8.453, P<0.05). The scores of confronce (22.61±3.87) and knowledge related to operation (44.00±5.36) in the research group were higher than those in the control group (18.70±2.97 and 40.02±6.30), there were significant differences between the two groups (t=5.518, 3.313, P<0.05). Conclusion Multidisciplinary cooperation model-based might be a useful preoperative visit model in decreasing the levels of psychological stress and promoting surgical cognition in patients undergoing surgery for the first time.

With the aggravation of aging and the increasing demand of the elderly for pension and medical services,the old-age model of medical care combined with nursing emerges as the times required.Traditional Chinese medicine medical institutions have the advantages and opportunities in the process of developing integrated medical and nursing services,such as the treatment and prevention of chronic diseases,the increasing demand of the elderly for integrated medical and nursing institutions,and the strong support of the state for integrated medical and nursing institutions.However,they are also facing challenges and difficulties such as imperfect team,weak market competition and low payment ability.Through the analysis of opportunities and challenges for TCM medical institutions,this paper provides corresponding counter measures and suggestions for their development.

Objective: To study on the mRNA expression level of IN1 gene associated with the clinical efficacy and prognosis of hepatoblastoma(HB) in children and to elucidate the early warning value of IN1 gene for prognosis and chemotherapy sensitivity. Methods: Forty HB patients were selected based on primary diagnosis and treated from January 2015 to May 2018 in Tongren Hospital Affiliated to Capital Medical University. The expression level of INI1 gene was detected by using fluorescence immuno-PCR. Clinical data of children with HB were collected, including staging, grouping, risk, efficacy and prognosis of chemotherapy. The relationship between the mRNA expression of IN1 gene and clinical data was analyzed by SPSS 21.0 software. Results: (1)Clinical characters: the medium age of 40 HB patients was(30.50±2.39) months, male 29 cases (72.5%), and female 11 cases (27.5%). There was 1 case (2.5%) of stage Ⅱ HB, 13 cases (32.5%) of stage Ⅲ HB, and 26 cases (65.0%) of stage Ⅳ. The low-and intermediate- risk group had 12 cases (30.0%) of HB, and the high-risk group had 28 cases (70.0%) of HB.(2)Clinical efficacy and prognosis: by July 1^st, 2018, the medium following-up time was (12.2±10.1) months, 4 patients (10%) were treated by chemotherapy without surgery, and 36 patients (90%) were treated by surgery .All patients (100%) received chemotherapy.The average cycle of chemotherapy lasted(13.17±0.02). Ten patients were dead and 30 patients survived till following-up.The overall survival (OS) rates were 75% and the event-free survival rates were 50% (20 patients with HB). (3) IN1 gene mRNA expression: The average PCR quantitative of IN1 gene mRNA of 40 HB patients(2^-ΔCT)was 0.31±0.70.The average mRNA quantitative of HB patients (2^-ΔCT)with high-risk and low/intermediate-risk group was 0.23±0.43 and 0.48±1.13(t=6.363, P=0.05). According to histology diagnosis, the average mRNA quantitative of small cell undifferentiated (SCU) type (12 cases)and other type (25 cases) was 0.09±0.11 and 0.43±0.86(t=4.533, P=0.04). The average mRNA quantitative of patients with or without radical surgery was 0.04±0.03 and 0.34±0.74 (t=2.935, P=0.022). The data of children with poor chemotherapy sensitivity(19 cases)and those sensitive to chemotherapy (21 cases) were 0.03±0.04 and 0.30±0.82, and the difference was statistically significant (t=5.688, P=0.018). Conclusions Poor therapeutic effect results in low mRNA expression of IN1 gene in children of HB.The IN1 gene expression could be an early warning factor for treatment sensitivity and prognosis.

Objective: To investigate the clinicopathologic features of patients with high-grade B-cell lymphomas (HGBL) that have rearrangements of MYC, bcl-6 and bcl-2. Methods: One hundred and fifty-eight B-cell lymphomas patients from Institute of Hematology and Blood Diseases Hospital from January 2016 to April 2017 were detected by fluorescence in situ hybridization (FISH) with double color split-apart probes. Results: Among 158 B-cell lymphomas, 3 cases with MYC, bcl-2 and bcl-6 rearrangements were identified, 1 of which also had CCND1/IgH translocation. All three patients were of older age, with poor prognostic parameters, multiple organs involvements, elevated LDH and advanced-tumor stage. Two of the three patients were treated with high-intensity chemotherapy and had no remission with an overall survival of 9 months and 11 months respectively. One patient had follow-up with no treatment. Histologically, all three cases showed a spectrum of morphologic features. Although initially categorized as lymphoblastic lymphoma, diffuse large lymphoma and mantle cell lymphoma respectively, two cases were associated with germinal center B-cell (GCB) immunophenotype and 1 case with non-GCB immunophenotype. They had a high proliferation index as assessed by immunostaining for Ki-67 (60%-90%). Conclusions MYC⁺ bcl-2⁺ bcl-6⁺ HGBL is an aggressive disease with multiple organ involvement, high serum LDH levels, advanced stage disease, poor prognosis and shorter patient survival. The diagnosis should be made by histopathology combined with FISH analysis. Its separation from other types of B cell large cell lymphoma is of clinical importance.