Objective To evaluate the safety and feasibility of hysteroscopy in the treatment of endogenous type cesarean section scar pregnancy (CSP). Methods Clinical data of 58 cases of CSP from August 2012 to February 2014 in our hospital were analyzed retrospectively.Thirty-one cases were treated by hysteroscopy,while 27 cases were treated by laparoscopy.The intraoperative blood loss,operation time,postoperative hospital stay,postoperative drainage of uterine cavity,β-hCG level resolution time and time to menstruous restoration were compared between the two groups. Results The intraoperative blood loss,operation time,length of hospitalization after operation,and time to menstruous restoration were statistically lower in the hysteroscopy group than those in the laparoscopy group [(109 ±59)ml vs.(143 ±63)ml,t =-2.121 ,P =0.038;(43.7 ±17.5)min vs.(100.8 ±18.8)min,t =-1 1 .974,P =0.000;(3.8 ±0.7)d vs.(4.5 ±0.6)d,t =-4.057,P =0.000;(43.8 ±3.9)d vs.(45.9 ±3.8)d,t =-2.070,P =0.043].There were no significant differences in postoperative drainage of uterine cavity and β-hCG level resolution time between the two groups [(22.1 ±2.8)ml vs.(23.6 ±3.2)ml,t =-1 .904,P =0.062;(20.5 ±7.7)d vs.(22.9 ±9.3)d,t =-1 .075,P =0.287]. Conclusion Hysteroscopy has advantages of less intraoperative blood loss,shorter hospitalization time and quicker recovery in the treatment of endogenous type CSP.

Anesthesia ; methods ; Child ; Child, Preschool ; Female ; Foreign Bodies ; surgery ; Humans ; Infant ; Male ; Muscle Relaxants, Central ; therapeutic use ; Respiratory System

Objective To explore the therapeutic effects of Ni-Ti memory alloy embracing fixator on the multiple fracture of ribs and flail chest. Method From January 2006 to December 2009, the effects of operation and long-term follow-up after internal fixation operation with memory alloy embracing fixator in patients with multiple fracture of ribs and flail chest were observed. Results The hospital stay of patients treated with memory alloy embracing fixator was 10.31 ± 3.14 days and pain was significantly reheved after treatment ( P= 0.02) .The rate of post-operative complications was 17.65% such as atelectasis, pulmonary infection, etc. There were fewer longterm complications and less influence to daily activity of life. Conclusions It is a advanced and practical method for patients with the multiple fracture of ribs by using Ni-Ti memory alloy embracing fixator with slighter trauma,simple, safe, reliable, good histocompatibility and fewer post-operative complications.

Objective:To clone the RC-RNase gene and prepare its recombinant prokaryotic construct, and then to express RC-RNase protein using Escherichia coli system. Methods: RC-RNase cDNA was obtained by RT-PCR from liver of Rana catesbeiana, and cloned into pUCm-T plasmid for nucleotide sequencing. Its expression construct was prepared using the 6?His vector pRSET-A, and induced to express by IPTG in Escherichia coli BL21(DE3). Western blotting identified the expression product. Results: A 380 bp long cDNA was obtained from liver of Rana catesbeiana, restriction sites and sequence being consistent to those reported for RC-RNase. After introducing the gene into Escherichia coli and through the induction by IPTG, it was observed a new peptide at the expected position (Mr 16000) on SDS-PAGE gel. This product was proved to be the target protein via Western blotting. It existed in a form of inclusion body and its efficiency reached 12.5% of total bacterial proteins. Conclusion: RC-RNase gene was cloned and expressed in Escherichia coli. The protein could be used for characterizing the biological activities and function of RC-RNase.

It is significant to enhance the doctor-patient communication ability for medical graduates during clinical practice stage and establish appropriate doctor-patient communication sense,which is also important to promote medical education quality and cultivate qualified medical talents.This paper analyzed the common problems in doctor-patient communication for medical graduates.For example,patients did not trust the intern students;the students were nervous when faced with patients;some did not pay attention to their images;some called patients improperly.Then,it put forward some measures:to set up the communication and training courses,to carry out the communication skill training in clinical practice,and to attach importance to the doctor-patient communication skill practice.

Background Experimental data have shown tnat polymorpnisms in tne angiotensm-converting en- zyme 2(ACE2)gene are related to echocardiographically determined parameters of left ventricular mass,structure or function in the general population whether ACE2 genotype influences the effect of angi0tensin Ⅱ receptor blocker which improve left ventricular remodeling and function is unknown.Objective To investigate the association be- tween ACE2 gene G9570A polymorphism and the effect of irbesartan on left ventricular structure and function in hy- pertensive patients.Methods Two hundred and five male patients and 190 female patients who were preliminaryly diagnosised with mild and moderate essential hypertension were treated with irbesartan for 48 weeks with initial dose of 150 mg/d and titrated to 300 mg/d to reach the targed BP.Gene polymorphisms of ACE2 G9570A were detected by PCR-RFLP methods.The association between changes in the SBP,DBP,parameters of left ventricular struc- ture and function and genotypes of the ACE2 gene locus were analyzed.Results Irbesartan reducted in blood pres- sure in all patients(P

Objective Excision repair cross-complementing gene-1(ERCC1) are key regulatory enzymes whose expression patterns are associated with overall survival(OS) in several malignancies.Their expression patterns and prognostic value in resected gastric adenocarcinoma(GAC) are not known and need to investigate.Methods A total of 109 patients who underwent resection for GAC in Liu′an People′s Hospital from January 2010 to June 2013 had tissue available for analysis.The primary objective was to assess for the differential expression of ERCC1 using by immunohistochemistry.The secondary objective was to assess for the association between OS and the expression of ERCC1.Results The median follow-up was 21.2 months,and the median OS was 28.8 months.Resected GAC exhibited differential expression of ERCC1(high expression,n=25(23%)).ERCC1 expression was not associated with OS(18.9 months vs.27.7 months,P=0.72).In a subset analysis of patients who received chemotherapy(n=73),high ERCC1 expression was associated with decreased OS(16.7 months vs.53.8 months,P=0.03).After controlling for known adverse pathologic features,high ERCC1 expression persisted as a negative prognostic factor in multivariate Cox regression analysis(HR=2.22,95% CI1.05-4.98,P<0.05).Conversely,in patients who underwent resection only(n=35),high ERCC1 expression demonstrated a trend toward improved OS(40.4 months vs.12.7 months,P=0.10).A positive prognostic influence also was present on multivariate analysis(HR=0.20,95% CI0.05-0.84,P=0.03).Conclusion Resected GAC exhibited differential expression of ERCC1.Among all patients,ERCC1 expression levels were not associated with OS.High ERCC1 tumor expression is associated with decreased OS in the patients who received chemotherapy but is associated with increased OS in those who underwent surgery alone.ERCC1 expression have prognostic value in resected gastric cancer,and further investigation is needed.

Objective To evaluate the correlation between multi-slice spiral CT(MSCT)perfusion imaging parameters and gastric carcinoma differentiation.Methods MSCT perfusion parameters including blood flow(BF),patlak blood volume(PBV),time to peak (TTP)and patlak permeability surface(PPS)were obtained in 44 patients with pathologically confirmed gastric carcinoma before sur-gery.Patients were divided into two groups;26 well differentiated and 18 poorly differentiated.According to the extent of cell differ-entiation ,BF,PBV,TTP and PPS were investigated in two groups.Results Parameters in the well differentiated gastric carcinoma group BF 101.8±6.7 (mL·min-1 ·100 mL-1 ),PBV 85.9±3.4 (mL/1 000 mL ),TTP 121.6±1 1.5(0.1 s),PPS 82.7±1 1.0 (0.5 mL·min-1 ·100 mL-1 )respectivily,Parameters in the poorly differentiated gastric carcinoma group,BF 105.3 ±7.7,PBV 92.1±7.1,TTP 113.0±10.5,PPS 94.3±22.9 respectivily.There was no statistic difference in BF value between the two groups(P >0.05). There were statistic differences in TTP、PBV and PPS between the two groups(P <0.05).Conclusion MSCT perfusion parameters may reflect the degree of differentiation of gastric carcinoma or a certain extent in vivo.

Background One of the features of the pathogenesis of primary angle-closure glaucoma(PACG) is anterior synechia of peripheral iris.Goniosynechialysis and combination of phacoemulsification and goniosynechialysis have been applied for the treatment of the disease recently,but the selection of operative types has great impact on clinical efficacy.Objective This study was to investigate the long-term efficacy of goniosynechialysis and combination of phacoemulsification and goniosynechialysis for the management of chronic PACG.Methods A non-randomized clinical controlled trial was designed.This clinical trial complied with Declaration of Helsinki and was approved by Medical Ethic Committee of Nanjing Medical University.Written informed consent was obtained from each patient.One hundred and ten eyes of 110 patients with chronic PACG were assigned to the goniosynechialysis group and combined operative group from March,2008 to February,2011 in Wuxi People's Hospital.180° goniosynechialysis was performed on 34 patients in the goniosynechialysis group,and phacoemulsifieation +intraocular lens (IOL) implantation + goniosynechialysis were carried out in 78 patients of the combination operative group.All the patients were followed-up for 2 years.Vision acuity,intraocular pressure (IOP),anterior chamber depth(ACD),unltrasound biomicroscopy and perimetry were recorded and compared between before and after operation.Results No significant difference was found in vision acuity between preoperation and postoperative 2 years in the goniosynechialysis group ([0.65 ± 0.15] vs.[0.45 ± 0.15]) (t =1.57,P＞0.05),but in the combination operative group,the vision acuity was significantly different between the before and after operation ([0.25±0.15] vs.[0.85 ±0.05]) (t =9.12,P＜0.001).The lOPs at 2 years after operation were (14.2±4.1) mmHgand(13.7±4.8) mmHg,respectively in the goniosynechialysis group and combination operative group and were significantly lower than(47.2 ±6.3) mmHg and(46.9±7.0) mmHg before operation(t =4.95,P＜0.001 ;t=5.03,P＜0.001).The ACD values in the goniosynechialysis group and combination operative group were(3.38±0.02)mm and (3.54±0.03) mm 2 years after operation,which were significantly increased in comparison with (1.33 ±0.24)mm and (1.56±0.37) mm before operation(t=7.65,P＜0.001;t=6.76,P＜0.001).Conclusions Both combination of phacomulsification with goniosynechialysis or 180° goniosynechialysis are effective for the treatment of PACG.Suitable operation should be alternated depending on the indicators of PACG patients.

Objective:To investigate the therapeutic efficacy of double-J catheter in treatment of renal tuberculosis(TB)and in rescuing the structure and function of the kidney.Methods:Thirty-four patients with renal TB(22 combined with single side hydronephrosis)were divided into 2 groups randomly.Group A were treated with antituberculous therapy and group B with antituberculous therapy combined with pre-treatment with double-J catheter.All 34 patients were followed up for 3 months and were re-examined.Results:The results of B ultrasound,intravenous urogram(IVU),CT and isotope nephrogram were comparable between the 2 groups before treatment,and the results were significantly different between the two groups after 3 months'drug treatment(P