Purpose Based on the WHO(5th edition)classification of cervical adenocarcinoma and Silva infiltra-tion pattern classification,this study explores the value of etiological classification and Silva classification in the clinical treatment and prognosis prediction of cervical adenocarcinoma.Methods The clinical and pathological features of 112 cases of cervical invasive adenocarcinoma were reviewed.Through HE morphological classification,immunohistochemi-cal detection,and Silva classification of infiltration pattern,the related factors and prognosis of patients were statistical-ly analyzed.Results The median age of 112 patients was 46.5 years(30-80 years),with a maximum tumor diame-ter of 0.35-9.0 cm and an average diameter of 3.2 cm.Most patients showed vaginal bleeding after sexual inter-course.89 cases were HPV-associated adenocarcinoma(HPVAs),18 cases were non HPV-associated adenocarcinoma(NHPVAs).There were 5 cases of other types of adenocarcinomas of the uterine cervix,including 4 cases of endome-trial adenocarcinoma and 1 case of serous adenocarcinoma.There were 5 cases(4.5％)of Silva A pattern,30 cases(26.8％)of Silva B pattern,and 77 cases(68.7％)of Silva C pattern.112 cases were followed up for a median time of 34 months(15-78 months),with 16 deaths and 20 metastases.The progression-free survival(PFS)(P＜0.001)and overall survival(OS)(P=0.001)in the NHPVA group were significantly lower than those in the HPVA group.All cases with Silva A and Silva B pattern had a favorable prognosis and survived without tumor.Of the cases with Silva C pattern,16 died after recurrence.The PFS and OS of patients with Silva C type were lower than those of Silva A type and B type(P＜0.05).Conclusion The fifth edition of WHO classification of cervical adenocarcinoma revealed the correlation between etiology and morphology.Silva classification is of great significance for accurately predicting progno-sis and guiding treatment.

Purpose Based on the WHO(5th edition)classification of cervical adenocarcinoma and Silva infiltra-tion pattern classification,this study explores the value of etiological classification and Silva classification in the clinical treatment and prognosis prediction of cervical adenocarcinoma.Methods The clinical and pathological features of 112 cases of cervical invasive adenocarcinoma were reviewed.Through HE morphological classification,immunohistochemi-cal detection,and Silva classification of infiltration pattern,the related factors and prognosis of patients were statistical-ly analyzed.Results The median age of 112 patients was 46.5 years(30-80 years),with a maximum tumor diame-ter of 0.35-9.0 cm and an average diameter of 3.2 cm.Most patients showed vaginal bleeding after sexual inter-course.89 cases were HPV-associated adenocarcinoma(HPVAs),18 cases were non HPV-associated adenocarcinoma(NHPVAs).There were 5 cases of other types of adenocarcinomas of the uterine cervix,including 4 cases of endome-trial adenocarcinoma and 1 case of serous adenocarcinoma.There were 5 cases(4.5％)of Silva A pattern,30 cases(26.8％)of Silva B pattern,and 77 cases(68.7％)of Silva C pattern.112 cases were followed up for a median time of 34 months(15-78 months),with 16 deaths and 20 metastases.The progression-free survival(PFS)(P＜0.001)and overall survival(OS)(P=0.001)in the NHPVA group were significantly lower than those in the HPVA group.All cases with Silva A and Silva B pattern had a favorable prognosis and survived without tumor.Of the cases with Silva C pattern,16 died after recurrence.The PFS and OS of patients with Silva C type were lower than those of Silva A type and B type(P＜0.05).Conclusion The fifth edition of WHO classification of cervical adenocarcinoma revealed the correlation between etiology and morphology.Silva classification is of great significance for accurately predicting progno-sis and guiding treatment.

Objective To observe and explore the effects of different tidal volume (VT) ventilation on right ventricular (RV) function in patients with critical respiratory failure.Methods Consecutive respiratory failure patients who were treated with invasive ventilator over 24 h in the Department of Critical Care Medicine at the Fourth Hospital of Hebei Medical University from June to December in 2015 were enrolled in this study.Clinical data including patients′ vital signs, ventilator parameters and RV echocardiography were collected within 6 h (D0), day1(D1), day2 (D2) and day3 (D3) after ventilation started.According to the VT, patients with acute respiratory distress syndrome (ARDS) were assigned to low VT group [S6, ≤6 ml/kg predicted body weight (PBW)] and high VT group (L6, >6 ml/kg PBW), while non-ARDS patients were also assigned to low VT group (S8, ≤8 ml/kg PBW) and high VT group (L8, >8 ml/kg PBW).Results A total of 84 patients were enrolled in this study.44.2% ARDS patients and 58.5% non-ARDS patients were in low VT groups.After ventilation, tricuspid annulus plane systolic excursion(TAPSE)decreased progressively in S6 [from 18.30(16.70,20.70) mm to 17.55(15.70,19.50) mm, P=0.001], L6 [from 19.50(17.00,21.00) mm to 16.30(15.00,18.00) mm P=0.001], S8[from 18.00(16.00,21.00) mm to 16.50(15.50,18.00) mm, P=0.001] and L8 [from 19.00(17.50,21.50) mm to 16.35(15.15,17.00) mm, P=0.001] groups.However, TAPSE decreased less in small VT groups (S6 and S8) than those of in large VT groups (S8 and L8) without significant differences.There were not statistical differences between different VT groups in terms of ventilation days, including right ventricle area/left ventricle area (RVarea/LVarea),TAPSE,peak mitral flow velocity of the early rapid filling wave (E),peak mitral flow velocity of the late rapid filling wave (A),early diastolic velocity of the tricuspid annulus (e′),pulmonary artery systolic pressure,inferior vena cava diameter (all P>0.05).Compared to L6 group, low VT (S6 group) resulted in decreased mortality at 28 days [1/19 vs 37.5%(9/24), P=0.014].There were not statistical differences between different VT groups in terms of ventilation days, length of intensive care unit stay, length of hospital stay (all P>0.05).Logistic regression analysis showed that VT could be the independent factor of TAPSE (OR=1.104,95%CI 0.100-1.003,P=0.049).Conclusions Positive pressure mechanical ventilation resulted in RV systolic dysfunction.Lower VT may have the protective effect on RV function.Trial registration Chinese Clinical Trial Registry,ChiCTR-POC-15007563.

Objective To investigate the molecular biological mechanism of deposition of triglyceride(TG)in hepatocytes in alcoholic fatty liver disease(AFLD)and the pathogenesis of this condition by detecting the contents of serum tumor necrosis fac-tor-α(TNF-α),liver triglyceride(TG),peroxisome proliferator-activated receptorα(PPARα)and acyl-CoA oxidase(Acox1)mR-NAs,and liver PPARαprotein after intervention with bezafibrate,a PPARαagonist.Methods Sixty Wistar rats were randomly divided into three groups:control group(n=20),AFLD group(n=20),and bezafibrate group(n=20).Animals in control group were given distilled water by gavage once a day for 8 weeks.Those in AFLD group were given ethanol and fish oil(2.5 mL/kg) by gavage daily for the same period of time.In bezafibrate group,rats were treated by gavage with ethanol and fish oil(2.5 mL/kg)for the first 4 weeks and then with bezafibrate(100 mg/kg)for another 4 weeks.TG in the liver was measured by colorimet-ric method,serum TNF-αlevels by enzyme linked immunoabsorbent assay (ELISA),the mRNA expression of PPARαand Acox1 in hepatocytes by reverse transcription polymerase chain reaction(RT-PCR)and the expression of PPARαprotein in hep-atocytes by Western blot.Results A significant increase in TG[AFLD group(0.72±0.09)mmol/L vs.control group(0.28± 0.07)mmol/L,P<0.01]and TNF-α[AFLD group(3.01±0.31)ng/mL vs.control group(1.07±0.28)ng/mL,P<0.01]was found in AFLD group when compared with control group.After bezafibrate intervention,the contents of liver TG and serum TNF-αwere significantly decreased.The mRNA expression of PPARα[AFLD group(0.22±0.08)vs.control group(0.68± 0.13),P<0.01]and Acox1[AFLD group(0.43±0.12)vs.control group(1.14±0.21),P<0.01]was suppressed in AFLD group,which was significantly reversed by bezafibrate treatment[bezafibrate group(0.59±0.13)for PPARαmRNA vs.AFLD group,P<0.01;bezafibrate group(0.83±0.17)for Acox1 mRNA vs.AFLD group,P<0.01].The expression of PPARαpro-tein in hepatocyts was also found to decrease in AFLD group[AFLD group(0.19±0.07)vs.control group(0.48±0.11),P<0.01].After bezafibrate intervention,it was profoundly increased.Conclusion The down-expression of PPARαand Acox1 in the liver of rats with AFLD may suppress the fatty acid metabolism and lead to the TG deposition in the liver.The increase in serum TNF-αcontents also contributes to the development of AFL.Bezafibrate can prevent and treat AFL by activating PPARα,increasing the expression of PPARαand Acox1 ,promoting the metabolism of fatty acids,decreasing the TG deposition and the serum TNF-αcontents.

Objective To compare the acceptance of 2 different teaching modes－physicians and therapists teaching together and separately in continuing education students of rehabilitation medicine. Methods A questionnaire was filled by the students who attended the lectures of both Rehabilitation of Elbow Injury and Rehabilitation of Wrist Injury in the 9th National Orthopedic Class. The former lecture was taught by the rehabilitation physician and physical therapist together (together mode), and the latter lecture was taught by the rehabilitation physician and physical therapist separately (separate mode). The questionnaire included the choices and text questions. Results There were 45 copies of effective questionnaire all together. The satisfaction of both lectures were above 90%. As to teaching modes, 77.8% students liked together mode better, and 22.2% students preferd the separate mode. 93.9% students would or maybe use together mode in their future work, and 88.9% in separate mode. Conclusion The mode of physician and therapist giving lectures together is well accepted by students.