Objective To assess the operation time of laparoscopic operation for acute cholecystitis by Meta analysis.Methods The methods of computer literature retrieval and manual search were used to collect the research on the timing of laparoscopic surgery for acute cholecystitis in recent years,and the random effects model was used to conduct the Meta analyze.The quality of the literature was evaluated,and then the RevMan5.0.21 software was used to calculate the RR value and 95%CI of the operation time,bleeding volume and postoperative complications.Results A total of 13 articles were included in the Meta analysis,9 in Chinese,4 in English,2535 for a total number of cases,1401 in the early operation group,1134 in the delayed operation group,and 10 papers for low risk of bias,3 papers for bias risk.Meta analysis of the random effects model showed that the operation time of the early operation group was significantly shorter than that of the delayed operation group(P=0.00,RR=-20.25,95%CI=-24.97~15.33),and the intraoperative blood loss was also significantly reduced(P=0.00,RR=-12.58,95%CI=-29.36~5.78),then the postoperative complications were also significantly reduced(P=0.00,RR=0.63,95%CI=0.47~0.84).Conclusion The use of laparoscopic operation in the treatment of acute cholecystitis in patients with 72h could not only shorten the operation time and reduce the amount of bleeding,but also had a significant effect on reducing postoperative complications.

Objective:To study the health equity and explore the influencing factors of health inequities among those insured in New Rural Cooperative Medical System and to provide theoretical and factual basis for improvement of medical insurance system through .Method:Using concentration index decomposition to explore the sources of inequity in health outcomes and the degree of horizontal inequity in health outcomes .Results:Economical level leads that the concentration indexes of two week prevalence favor the poor , i.e.the worse the health outcome of the rich is.Economical level leads that the concentration indexes of chronic disease prevalence and self -reported health defective rate favor the rich , i.e.the worse the health outcome of the poor is .Conclusion:Economic level is the primary factors affecting two weeks prevalence , age, culture level, the employment situation is the factors al-leviate health outcomes unfair .Increase people′s economic level and cultural level , improve the situation of em-ployment is important to the health equity .

Objective To assess the safety and effect of intraoperative cell salvage (ICS) during cesarean section.Methods This was a case-control study in which 60 gravidas who received ICS (ICS group) and 60 gravidas who received allogenic transfusion (control group) during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled.Subjects in the two groups were matched in age,gestational age,gestational complications (placenta increta,placenta previa,scarred uterine,leiomyomas and anemia) and hemorrhagic volume during cesarean section.Several indicators including complications of transfusion,postoperative recovery,expense of transfusion,as well as the complete blood count and body temperature before and after operation were compared between the two groups.T,rank-sum or Chi-square test was used for statistical analysis.Results (1) No significant difference in age,gestational age,twin gestation,complications,preoperative body temperature,or the volume of hemorrhage or transfusion was observed between the two groups (all P＞0.05).(2) The autotransfusion volume was 385 (161-583) ml in the ICS group.Fifteen cases (20.0％) in the ICS group also received additional transfusions of leukocyte-reduced red blood cell (RBC) suspension,fresh frozen plasma and cryoprecipitate and two cases (3.3％) received additional transfusions of leukocyte reduced RBC suspension and fresh frozen plasma.The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate.However,the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M(P25-P75),1.9 (1.5-4.5) vs 4.1 (2.8-6.2) U,Z=-2.800,P=0.005].(3) There was no significant difference in complete blood count or coagulation function between the two groups before the operation.White blood cell (WBC) counts in the two groups were elevated following operation.Postoperative WBC count in the control group was higher than that in the ICS group,while the levels of RBC and hemoglobin were lower than those in the ICS group following operation (all P＜0.05).(4) No amniotic fluid embolism was reported in the two groups.Only one case of rash was reported in the ICS group,which was fewer than the transfusion reactions occurred in the control group [1.7％ (1/60) vs 13.3％ (8/60),x2=5.886,P=0.016].(5) The two groups showed no significant difference in preoperative temperature,the highest temperature within three days after operation or incision healing.Compared with the patients in the control group,those in the ICS group had shorter hospital stay [(4.7± 1.1) vs (6.3 ±1.8) d,t=3.341,P＜0.05].Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section.

Accurate placement of pedicle screws is a key factor of spinal surgery. Investigation of a new real-time intra-operative monitoring method is an important area of clinical application research which makes a contribution to planting pedicle screw accurately. Porcine spines were chosen as experimental objects. The changes of reduced scattering coefficient (μ'(s)) along normal puncture path, medial perforation path and lateral perforation path were measured and studied. A conclusion is drawn that there are two distinct peaks throughout the puncture process, appearing at the junction of cancellous bone and cortical bone, at the beginning and at the end, respectively. The reduced scattering coefficient is proved to be a good monitoring factor which can identify whether the screw is about to reach the critical position of the spine puncture. Moreover, the variation provides an important reference for spinal surgical navigation process.
Animals ; Biomedical Research ; Bone Screws ; Monitoring, Intraoperative ; Punctures ; Spectroscopy, Near-Infrared ; Spine ; surgery ; Surgery, Computer-Assisted ; Swine

Objective: To study the impacts of the new medical reform on the utilization equity of gynecological examination services for women in economically underdeveloped regions of western China. Methods: Based on the data of the 4th and 5th National Health Service Survey in Shaanxi Province, we used concentration index and decomposition of concentration index to explore the inequality of women's gynecological examination service utilization and its sources; we also used horizontal inequity index to analyze the horizontal equity of the women's gynecological examination service utilization. Results: The concentration index of gynecological examination rate of the women surveyed in 2008 and 2013 was 0.0882 and 0.0640, respectively. The horizontal inequity index was 0.0894 and 0.0463, respectively. The factors that contributed most to the inequality of the women's gynecological examination service utilization were the economic level and contribution which accounted for 54.49% and 61.86%, respectively. Conclusion: The implementation of basic public health and major public health services in the new medical reform policy has increased women's gynecological examinations rate and plays a positive role in improving the equity in utilization of women's gynecological examination services.

Objective To evaluate uterine cavity of the patients who accept the treatment in vitro fertilization‐embryo trans‐fer(IVF‐ET)and determine the clinical value of hysteroscopy for the patients .Methods Between January 2012 and May 2014 ,539 cases who accepted the IVF‐ET and hysteroscopy ,were divided into two grops ,group A(258 patients examinated before IVF‐ET cycle) and group B(281 patients after the IVF‐ET failure) ,and retrospective analysis was performed for their uterine cavity and cervix canal data .Results The total incidence of abnormal hysteroscopic findings was 49 .54% ,and group B was significantly high‐er than that in group A(54 .10% vs .44 .57% ,χ2 =4 .5 ;P=0 .043) .The percent of abnormal cervix canal was 18 .74% ,and there wasn′t significant difference between the two groups .Conclusion The incidence of abnormal hysteroscopic findings in IVF‐ET is higher than that in normal patients ,so hysteroscopy has an important clinical value for diagnosis and evalution ,especially for pa‐tients with failure of IVF‐ET .

OBJECTIVETo investigate the protective effect of monoside against triptolide-induced liver injury and explore its molecular mechanism.

METHODSBALB/C mice treated with gastric lavage with triptolide and monoside, either alone or in combination, were examined for changes of hepatic biochemical parameters using the serological method. The growth inhibition rate of HepG2 cells treated with triptolide or monoside or both was assessed with MTT assay, and the cell morphological changes were observed using laser confocal microscopy; the expressions of the target proteins in the antioxidative stress pathway were detected using flow cytometry and Western blotting.

RESULTSIn BALB/C mice, gastric lavage of triptolide induced obvious hepatic damage. In HepG2 cells, treatment with triptolide significantly inhibited the cell growth, resulting in a cell viability as low as 72.83% at 24 h; triptolide also induced obvious cell apoptosis and cell nucleus deformation, causing an apoptosis rate of 43.1% in the cells at 24 h. Triptolide significantly reduced the expressions of Nrf2 and HO-1 proteins related with the oxidative stress pathway. Combined treatment with morroniside obviously reversed these changes, resulting in significantly decreased hepatic biochemical parameters and the liver index in BALB/C mice and in significantly lowered cell apoptosis rate, improved cell morphology, and increased Nrf2 and HO-1 protein expressions in HepG2 cells.

CONCLUSIONSMonoside protects against triptolide-induced liver injury possibly by relieving oxidative stress.

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.