Abstract:Complete atrioventricular conduction block, a significant complication of many heart diseases, is a serious threat to human health, and the biological pacemaker is a research focus in this area. In this paper, we discussed the current obstacles of biological pacemaker from laboratory to clinical application and summarized our practice. We put forward the following considerations for establishing a new atrioventricular conduction pathway:(1) engineered conduction tract or tissue (ECT) is a relatively ideal way to treat atrioventricular conduction block with biological pacing; (2) a transgene-independent method for the generating pacemaker or conduction cells from adult stem cells makes it easy for the biological pacemaker or ECT application; (3) the conduction velocity regulation is important to achieve the physiological atrioventricular conduction in clinical application with ECT; and (4) the feasible solutions of regulating the conduction velocity depend on the cell types and connexins expressions in ECT. It is believed that ECT will soon have a significant impact on the clinical transformation of biological pacing application.

Abstract:In January 2017, China issued Guidelines for Prevention and Treatment of Chronic Diseases in China (2017-2025) (hereinafter referred to as the Guidelines). Based on the reality and trends of China's chronic diseases, the Guidelines clarifies the goals and priorities for prevention and treatment of chronic diseases in the next 8 years and plan the works for prevention and treatment of chronic diseases in the next 5-10 years to reduce the burden caused by diseases, improve the health expectancy of residents and ensure people's health from start to end. The Guidelines focuses on strengthening the education and prevention of chronic diseases to reduce the burden caused by medical care; the difficulty lies in the establishment of hierarchical medical system and optimization of medical resource distribution.

Abstract:Human assisted reproductive technology has brought hope to the growing infertility population, but also has increased the risk of birth defects and even adult disease incidence. Here we discussed the gametes, embryos and maternal factors which affect eugenics and assisted reproductive safety. With the help of the new genomics technology such as the next generation sequencing, we can greatly reduce the incidence of hereditary birth defects, and prevent and control embryonic developmental risk of adult diseases.

Abstract:Objective To explore the effect of chromosomal polymorphic variations on the outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) treatment for infertile couples. Methods In this retrospective study, 1 108 infertile couples, who received their first IVF/ICSI-ET treatment cycles in Reproductive Medicine Center of Changhai Hospital of Second Military Medical University from Mar. 2015 to Jun. 2016, were included and divided into two groups:normal chromosomal group (the infertile couples with normal chromosome) and chromosomal polymorphic group (with chromosomal polymorphic variations). The embryo implantation rate, clinical pregnancy rate (CPR), early abortion rate and live birth rate (LBR) after IVF/ICSI-ET treatment were compared and analyzed. Results A total of 1 108 infertile couples received IVF/ICSI-ET treatment were enrolled, with 69 in the chromosomal polymorphic group, and 1 039 in the normal chromosomal group. There were no significant differences between the two groups in embryo implantation rate (34.91% vs 34.62%, P>0.05), CPR (49.09% vs 50.72%, P>0.05), early abortion rate (11.37% vs 8.57%, P>0.05) or LBR (41.67% vs 43.47%, P>0.05). Conclusion Chromosomal polymorphisms appear to have no effect on the outcome of IVF/ICSI-ET treatment for infertile couples.

Abstract:Objective To explore the relevant parameters and clinical outcome of frozen-thawed blastocyst transfer compared with fresh blastocyst transfer. Methods A historic cohort study was conducted to analyze the blastocyst implantation rate and clinical pregnancy rate of 61 patients receiving fresh blastocyst transfer and 372 receiving frozen-thawed blastocyst transfer from Mar. 2015 to Dec. 2016 in Changhai Hospital of Second Military Medical University. And then the clinical outcomes of day five (n=308) or day six (n=64) embryo were analyzed in the frozen-thawed blastocyst transfer group. Results There was no significant difference in age or number of the transferred blastocysts between the two groups. Blastocyst implantation rate in frozen-thawed blastocyst transfer group was significantly higher than that in fresh blastocyst transfer group (40.2% vs 29.6%, P=0.036), while no significant difference was found in clinical pregnancy rate between the two groups (57.8% vs 47.5%, P=0.134). Blastocyst implantation rate and clinical pregnancy rate of day five embryo were significantly higher than those of day six (42.3% vs 30.1%, P=0.016, and 60.7% vs 43.8%, P=0.012, respectively). Conclusion The pregnancy outcome of frozen-thawed blastocyst transfer is better compared with fresh blastocyst transfer, especially when transferring on day five.

Abstract:Objective To explore the influence of modified super-long hormone replacement protocol on pregnancy outcome of previous embryo implantation failure patients who underwent frozen-thawed embryo transfer (FET). Methods A total of 669 women who underwent FET with a failed history of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) were enrolled in Changhai Hospital of Second Military Medical University from Jan. 2015 to Jan. 2017. Based on different endometrial preparation protocols for FET, the patients were assigned to receive either modified super-long hormone replacement protocol (Modified super-long group, n=184) or conventional hormone replacement protocol (Conventional group, n=485).The pregnancy outcomes were retrospectively analyzed in the two groups. Results Patients in the two groups had similar baseline characteristics, including age, body mass index, duration of infertility, number of transferred embryo, endometrial thickness on transformation day and transplantation day (P>0.05). The good-quality embryo transfer rate in the Modified super-long group was significantly lower than that in the Conventional group (50.9% vs 64.8%, P<0.01), while the blastocyst transfer rate was significantly higher (57.4% vs 18.3%, P<0.01); compared with the Conventional group, the embryo implantation rate and clinical pregnancy rate in the Modified super-long group were both significantly increased (29.8% vs 23.8%, 46.7% vs 35.9%, respectively; both P<0.05). The logistics regression multivariate analysis in clinical pregnancy rate showed that the blastocyst transfer rate and good-quality embryo transfer rate were the influence factors for clinical pregnancy rate. Further subgroup analysis of different stage of transferred embryos showed that, in the cleavage embryo transferr cycles, the good-quality embryo transfer rate in the Conventional group was significantly higher than that in the Modified super-long group (67.5% vs 58.0%, P<0.05), but the embryo implantation rate and clinical pregnancy rate showed no significant difference between the two groups (23.0% vs 16.7%, 34.9% vs 32.0%, respectively; both P>0.05); however, in the blastocyst transfer cycles, although the good-quality embryo transfer rate had no significant difference between the two groups (45.5% vs 52.7%, P>0.05), the embryo implantation rate and clinical pregnancy rate in the Modified super-long group were significantly higher than those in the Conventional group (39.6% vs 27.2% and 56.9% vs 40.2%, respectively; both P<0.05). Conclusion The modified super-long hormone replacement protocol can improve the embryo implantation rate and clinical pregnancy rate of the patients undergoing FET with a history of embryo implantation failure, and is worthy of clinical popularization.

Abstract:Objective To explore the impact of gonadotropin-releasing hormone agonist (GnRH-a) super-long protocol on embryo implantation rate and clinical pregnancy rate of in vitro fertilization and embryo transfer (IVF-ET) in patients with moderate-to-severe endometriosis. Methods This retrospective study included 120 women with endometriosis who received IVF-ET from Jun. 2012 to Jul. 2016 in Reproductive Medical Center of Changhai Hospital of Second Military Medical University. Among the 120 patients, 42 received super-long GnRH-a protocol, 38 received long GnRH-a protocol, and 40 received short GnRH-a protocol during IVF-ET. We compared:(1) The patients' age, infertility years, basal serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E₂), and the levels of FSH, LH, E₂ and progesterone on the human chorionic gonadotropin hCG day; (2) the average number of retrieved oocyte, fertilization rate, cleavage rate, number of available embryos, embryo implantation rate and clinical pregnancy rate. Results (1) There was no significant difference in general characteristics between three protocols. (2) Compared with the short GnRH-a protocol group, the super-long GnRH-a protocol and long GnRH-a protocol had significantly decrease serum LH and progesterone levels on the hCG day (all P<0.05). (3) The fertilization rate, cleavage rate, embryo implantation rate and clinical pregnancy rate of super-long GnRH-a protocol were significantly higher than those of the short GnRH-a protocol (P<0.05). Conclusion The IVF-ET using super-long GnRH-a protocol can improve the embryo implantation rate and clinical pregnancy rate of the patients with moderate-to-severe endometriosis compared with using long or short GnRH-a protocol.

Abstract:Objective To investigate the performance of Orem's self-care theory application in the patients with a tendency of ovarian hyperstimulation syndrome (OHSS). Methods A total of 307 patients with a tendency of progressing OHSS, who were treated in Reproductive Medicine Center of Changhai Hospital of Second Military Medical University from Oct. 2015 to Oct. 2016, randomly received routine nursing management in combination with Orem's self-care theory (Orem's self-care theory group, n=165) or routine nursing management (routine group, n=142). The incidence and severity of OHSS of the patients in the two groups were compared and analyzed. Results Sixty-eight of 307 OHSS tendency patients finally developed OHSS, with 38 in the routine group (16 mild OHSS, 18 moderate and four severe), and 30 in the Orem's self-care theory group (20 mild, nine moderate and one severe). There was no significant difference in OHSS incidence between the two groups (P>0.05); while the reduction of OHSS severity in the Orem's self-care theory group was more obvious than that in the routine group, and the difference was statistically significant (P<0.05). Conclusion Orem's self-care theory nursing management has an advantage in reducing the severity of OHSS over routine nursing and is worthy of clinical use.

Abstract:Reproductive medicine center in military research hospital is a guarantee to implement the national population and family planning of eugenics policy, and can also meet the needs of the service support of the officers and soldiers under the new situation and enhance the strong support for the combat effectiveness. In recent years, our hospital has been deepening the connotation of military service, enhancing the talent training echelon, achieving the development of cutting-edge technology, promoting innovation in medical technology and improving the individual treatment model. In this review, we summarized and shared some experiences in the construction and exploration of reproductive medicine center in the military research hospital.

Abstract:Objective To establish and assess a rat model of benign prostatic hyperplasia (BPH) complicated with late-onset hypogonadism (LOH). Methods A total of 80 SD rats were randomly divided into 4 groups:control group, BPH complicated with LOH (model) group, BPH group and LOH group, with 20 rats in each group. In the model group, intraperitoneal injection of cyclophosphamide (20 mg/[kg·d]) was continuously administered for 5 days, followed by continuous intraperitoneal injection of testosterone propionate (50 mg/[kg·d]) for 28 days; the rats in the BPH group were treated the same as that in the model group, except with the same volume normal saline instead of cyclophosphamide; in the LOH group with same volume lucca oil instead of testosterone propionate; and in the control group, the rats were treated with same volume normal saline instead of cyclophosphamide and lucca oil instead of testosterone propionate. Two days after drug withdraw, serum testosterone was detected and weight loading swimming test, tail suspension test and sexual behavior test were performed. Then prostate weight and pathology were determined after the rats were sacrificed by cervical dislocation. Results The mean prostate indexes of rats in the LOH, model, control and BPH groups were 1.58±0.13, 2.93±0.19, 2.33±0.13 and 3.23±0.11, respectively; serum testosterone levels were (4.91±1.06), (9.52±1.02), (12.59±0.70) and (19.69±0.56) ng/mL, respectively; the tail suspension struggling times were 97.40±15.86, 120.40±14.06, 223.83±16.51, and 235.29±18.77, respectively; the weight loading swimming times were (74.27±9.29), (167.47±23.35), (302.33±30.10) and (261.59±35.13) s, respectively; the times of olfactory sensation were 1.53±0.52, 3.07±0.88, 9.17±1.30 and 9.59±1.12, respectively; the mean ride across times were 0.33±0.49, 0.47±0.52, 2.11±0.47 and 2.29±0.47, respectively. Statistical analyses showed that there were significant differences among the four groups in mean prostate index, serum testosterone level and tail suspension struggling time (P<0.05, P<0.01), in weight loading swimming time and time of olfactory sensation (P<0.01) except between control group and BPH group, and in mean ride across time (P<0.01) except between control group and BPH group, and model group and LOH group. Conclusion A BPH complicated with LOH rat model was successfully established with intraperitoneal injection of cyclophosphamide and testosterone propionate.

Abstract:Objective To construct a risk score for predicting high on-treatment platelet reactivity (HTPR) in patients with acute myocardial infarction after percutaneous coronary intervention, so as to guide individualized antiplatelet therapy. Methods A total of 547 patients with acute myocardial infarction undergoing percutaneous coronary intervention in Fuwai Hospital from Jan. 2013 to Dec. 2013 were enrolled in this study, and their general clinical data and post-operative thrombelastograms (TEG) were collected. The HTPR was defined as ADP-induced platelet-fibrin clot strength (MA_ADP) by TEG (TEG-MA_ADP)>47 mm. Clinical factors available in daily routine were analyzed to screen the related risk factors of HTPR. Clinical factors with a significance level of P<0.05 related to HTPR by multivariate logistic analysis were included in risk score model. The scores of variables were determined based on the odds ratio (OR) values. Results Among 547 patients, 230(42.05%) had HTPR, the TEG-MA_ADP was significantly higher than that of non-HTPR patients ([56.16±6.57] mm vs[26.43±13.88] mm, P<0.001). Univariate and multivariate logistic regression analysis showed that the three following factors were independent risk factors of HTPR:older age (>75 years) was weighted by score 3, female and diabetes mellitus both by score 2 according to OR values, thus a score ranging from 0 to 7 was developed to predict HTPR. The platelet reactivity (TEG-MA_ADP) was (37.79±18.45) mm, (50.04±15.91) mm and (56.50±15.78) mm for score 0-2, 3-5 and 6-7 patients, respectively, and it showed a significant difference among three score ranges (P<0.001). Receiver operating characteristic curve analysis showed that the score>2 was the best cut-off value to predict HTPR (area under the curve was 0.627,95% CI 0.579-0.675,P<0.001). Conclusion Clinical risk score can help to identify patient with high risk of HTPR, so as to guide intensified antiplatelet therapy.

Abstract:Objective To screen the differentially expressed genes (DEGs) between multiple myeloma (MM) patients and the healthy controls, to explore the pathogenesis of MM, and to provide a theoretical basis for gene diagnosis and gene therapy. Methods Gene expression profiles of MM patients were obtained from GEO database. Morpheus Online (https://software.broadinstitute.org/morpheus/) was used to determine the chip-data quality control and DEGs screening; DAVID Online (https://david.ncifcrf.gov/) was used to perform the gene ontology and pathway enrichment analysis; STRING Online (https://string-db.org/) was used to integrate the protein-protein interaction (PPI) network, and Cytoscape was used to screen the modules of PPI. Results A total of 16 211 DEGs (7 586 up-regulated genes and 8 625 down-regulated genes) were identified (P<0.05). The up-regulated DEGs enriched in biological process terms mainly involved 30 functional categories, like glycosphingolipid metabolic process, and the down-regulated mainly involved 163 functional categories, like cell division; the up-regulated DEGs enriched in molecular function terms mainly involved 29 functional categories, like protein binding, and the down-regulated mainly involved 59 functional categories, like histone binding; the up-regulated DEGs enriched in cellular component terms mainly involved 27 functional categories, like cytosol, and the down-regulated mainly involved 78 functional categories, like nucleoplasm. The KEGG analysis showed that the up-regulated DEGs mainly involved 26 pathways, like lysosome related pathway, and the down-regulated were mainly related to 27 pathways, like DNA replication. Ten genes, including CDK1, TOP2A, AURKB, BRCA1, CHEK1, PTEN, RAD51, GMPS, CDC45 and CDKN2A, were the hub DEGs with highest enrichment. Module analysis showed that the three most significant DEGs were mainly related to nuclear division, DNA replication and nucleic acid metabolism process. Conclusion A series of DEGs between MM patients and the healthy controls have been screened with a variety of bioinformatics methods, and gene and expression features of MM pathogenesis have been explained in various perspectives, which may provide the basis for targeted diagnosis therapy of MM.

Abstract:Objective To explore the effect of serotonin 1A (5-HT_1A) receptor agonist 8-OH-DPAT on pathological aggressive behavior, brain-derived neurotrophic factor (BDNF) and glial cell-derived neurotrophic factor (GDNF) in prefrontal cortex and hippocampus in pubertal rats. Methods Forty-two 21-day-old male SD rats were randomly divided into 6 groups:model group, normal group, model+8-OH-DPAT group, model+normal saline (NS) group, normal+8-OH-DPAT group and normal+NS group, with 7 rats in each group. The rats in the model, model+8-OH-DPAT and model+NS groups were given a series of early chronic stresses to establish the pathological aggressive animal model, and the other 3 groups were fed normally. Then the rats in the model+8-OH-DPAT and normal+8-OH-DPAT groups were injected intraperitoneally with 8-OH-DPAT (0.5 mg/kg), while the rats in the model+NS and normal groups were administered with 2 mL of NS. We determined the aggressive behaviors of the rats through resident-intruder test and detected the protein expressions of BDNF and GDNF in prefrontal cortex and hippocampus by Western blotting. Results (1) Compared with the normal group, the latency in the first attack in the model group was significantly shorter (P<0.01), while duration of attack manifestations and total attacks were significantly higher (P<0.01). The latency of the first attack in the model+8-OH-DPAT group was significantly higher than that in the model+NS group (P<0.05); the duration of attack manifestations in the model+8-OH-DPAT group was significantly increased compared with the normal+8-OH-DPAT group (P<0.05); and there was no significant difference in the total attacks among the groups (P>0.05). (2) The protein expressions of BDNF and GDNF in the prefrontal cortex and hippocampus in the model group were significantly lower than those in the normal group (P<0.01), but they were significantly decreased in the model+NS group compared with the normal+NS group (P<0.05, P<0.01) and were significantly increased in the model+8-OH-DPAT group compared with the model+NS group (P<0.05, P<0.01). Conclusion The expressions of BDNF and GDNF in the prefrontal cortex and hippocampus may be related to the pathological aggressive behaviors induced by early chronic stress in puberty rats. 5-HT_1A receptor agonist can reduce the pathological aggressive behaviors induced by early chronic stress and increase the expressions of BDNF and GDNF in prefrontal cortex and hippocampus in puberty rats.

Abstract:Objective To explore the effect of simulated hypoxic environment on proliferation, cell cycle, apoptosis and the protein and mRNA expressions of SOX2 and OCT4 in tongue squamous cell carcinoma SCC-15 cells. Methods SCC-15 cells was cultured in vitro, and the hypoxia mimetic agent desferrioxamine (DFO) was added to simulate hypoxic condition (simulated hypoxia group, HOX group) and normoxia was designed as control group (NOX group). CCK-8 assay was performed to measure the proliferation ability of the SCC-15 cells; flow cytometry was used to measure the apoptosis rate and cell cycle of the SCC-15 cells; Western blotting was applied to measure the expressions of HIF-1α, SOX2 and OCT4 protein in NOX and HOX groups; qPCR was used to measure the expressions of HIF-1α, SOX2 and OCT4 mRNA in NOX and HOX groups. Results DFO effectively simulated the hypoxic condition. Compared with the NOX group, the proliferation ability of the cells in HOX group was significantly inhibited by DFO (P<0.05), the proportion in G₁ cells was increased and that in S+G₂ was decreased; while no significant difference was found in the apoptosis rate of SCC-15 cells; the expressions of HIF-1α, SOX2 and OCT4 proteins were significantly increased in HOX group, and the expressions of HIF-1α and OCT4 proteins were significantly higher than SOX2 (P<0.05). There was no significant difference of mRNA expression of HIF-1α in NOX and HOX groups (P>0.05); the mRNA expressions of SOX2 and OCT4 in HOX group were significantly higher than those in NOX group (P<0.05). Conclusion DFO can effectively simulate hypoxic environment, and hypoxia can promote the expressions of SOX2 and OCT4 proteins and mRNA.

Abstract:Objective To explore the orientation relationships and changing rules of pedicle screw entry point (PSEP) on the posterior bony landmarks in middle-upper thoracic vertebrae in adults by measuring parameters of 3-D reconstruction CT images. Methods CT images of the middle-upper thoracic vertebrae from 30 healthy adults were used for 3-D reconstruction to observe the anatomical characteristics of posterior bony landmarks, including transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina. The following basic parameters, including PSEP-to-midline distance (PMD), transverse process-lamina concave-to-midline distance (CMD) and half lamina width (HLW), and target parameters, including PSEP-to-transverse process-lamina concave distance (PCD), entry point location ratio (EPLR) and PSEP-to-superior ridge of transverse process distance (PRD) were determined on reconstructed CT images from T₁ to T₁₀. The differences of bilateral measurements of all parameters and the differences of basic parameters were analyzed, and the changing rules of target parameters measurements from T₁ to T₁₀ were summarized. Results The transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina of middle-upper thoracic vertebral characterized by obvious and constant anatomical marks with less proliferative. The left and right PMD, CMD, HLW, PCD, EPLR, and PRD were (14.14±2.63) mm and (14.59±2.58) mm, (10.45±2.12) mm and (10.51±2.02) mm, (16.30±1.48) mm and (16.39±1.61) mm, (4.56±1.03) mm and (4.47±0.94) mm, 0.35±0.26 and 0.33±0.30, and (-1.62±1.90) mm and (-1.63±1.44) mm, respectively. There was no significant difference in the measured values between the two sides of the above parameters (P>0.05). Except that the difference between PMD and HLW in T₂ was not significant (P>0.05), the differences between basic parameters in the other segments were statistically significant (P<0.05). PCD of T₁ to T₁₀ showed a trend of decrease first and then significant increases in T₁, T₂, T₉, and T₁₀ compared with in T₃-T₈ (P<0.05). EPLR of T₁-T₁₀ showed a trend of increase first and then decrease, in which EPLR in T₁, T₂ and T₃ were significantly lower than in the following any segments (P<0.01), and in the T₄-T₆ and T₁₀ were significantly lower than in T₇-T₉ (P<0.01). PRD of T₁-T₁₀ showed a trend of increase first and then decrease, in which the PRD in T₁, T₂ and T₃ were significantly lower than in the following any segments, and in the T₄-T₆ were lower than T₇-T₁₀ (P<0.01). Conclusion There is constant orientation relationship and changing rules of PSEP in the middle-upper thoracic vertebrae on the posterior bony landmarks, such as transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina, and it can serve as a new clinical choice.

Abstract:Electronic pacemakers has become the preferred treatment for arrhythmia, especially for severe bradycardiac arrhythmia. Although the technology of electronic pacemaker was gradually improving, it still has some shortcomings. Over the past 10 years, research has confirmed that biological pacemaker can be created by gene therapy and cell therapy; with the development of molecular biology and cell biology, biological pacemaking technology has been continuously broken. Currently there are two approaches to construct biological pacemakers:one is to introduce pacemaker genes into mesenchymal stem cells, and the other is to induce pluripotent stem cells to sinoatrial node cells. In this paper, we reviewed the latest research progress of biological pacemakers, so as to analyze the existing problems in biological cardiac pacing and future research directions.

Abstract:Malignant glioma is a kind of highly malignant tumor. Since routine therapeutic approaches can only improve the total survival time of the patients with malignant glioma and delay the tumor progression, so the investigation of novel therapies is urgent. With the development of nanotechnology, the nanocarriers for delivering drugs make it possible to transport drugs across the blood brain barrier. Nano drugs delivery system can allow the drugs directly act on the specific targets of malignant glioma combining with rapidly developing targeted therapy strategies, which has improved the therapeutic efficacy of tumor. In this review, we focused on the advances of several nano drug delivery strategies for targeted treating of malignant glioma.

Abstract:Vector-borne diseases are caused by pathogens transmitted through vectors. Vector-borne diseases can lead to the non-combat depletion of strength and even lead to cancellation or failure of the military operations. In this article, we introduced a "Leishmaniasis Control Program" (LCP) at Tallil Air Base (TAB), Iraq established by the U.S. armed forces, which summed up and expounded vector-borne diseases prevention and control strategies of U.S. armed forces. Furthermore, our army should learn from successful experience of foreign armies, and make protective projects and measures against vector-borne diseases according to our local conditions, so as to improve the fighting capacity.

Abstract:Objective To assess the safety and efficacy of endoscopic submucosal dissection (ESD) in the treatment of early gastric cancer and precancerous lesion, so as to provide basis for its clinical application. Methods Clinical data of 214 patients with gastric mucosal lesion, who underwent ESD treatment in Digestive Endoscopy Center of Changhai Hospital of Second Military Medical University from Oct. 2012 to Aug. 2014, were retrospectively analyzed to assess the features such as the preoperative evaluation, pathology, ESD treatment and post-operative follow-up. Results Among 214 patients, 67 (31.3%) received narrow band imaging (NBI) examination, 39 (18.2%) NBI combined with magnifying endoscopy (ME), 50(23.4%) endoscopic ultrasonography (EUS), 50(23.4%) CT, and 192 (89.7%) biopsy during the pre-operative evaluation. Pathological results showed that, among all included patients, low-grade intraepithelial neoplasia accounted for 39.3%(84 cases), high-grade intraepithelial neoplasia 25.7%(55), well differentiated carcinoma 21.0%(45), moderately differentiated carcinoma 8.9%(19), and poorly differentiated carcinoma 5.1%(11). The en bloc resection rate of ESD was 96.3% and the complete resection rate was 92.1%. The operation time of ESD ranged from 14 min to 290 min, a mean of (59.9±49.6) min. There were two cases (0.9%) had severe intra-operative hemorrhage, two (0.9%) intraoperative perforation, five (2.3%) delayed hemorrhage, 0 delayed perforation and five (2.3%) recurrence. Conclusion ESD is a safe and effective method in the treatment of early gastric mucosal lesion. Comprehensive pre-operation evaluation is needed to avoid unnecessary or excessive ESD treatment. Regular follow-up after operation is effective to monitor residual tumor and recurrence.

Abstract:Objective To explore the clinical effect of ulinastatin combined with recruitment maneuver on extrapulmonary acute respiratory distress syndrome (ARDS). Methods Forty-two patients with extrapulmonary ARDS, who received ulinastatin combined with recruitment maneuver in Eastern Hepatobiliary Surgery Hospital of Second Military Medical University from Jun. 2014 to Jun. 2016, were assigned to experimental group; and 45 patients with extrapulmonary ARDS, who were treated by recruitment maneuver without ulinastatin at the same time, were taken as control group. The blood gas analyzer was used to record radial arterial oxygen partial pressure (PaO₂), carbon dioxide partial pressure (PaCO₂) and oxygenation index (OI) before and after treatment in the two groups; the breathing machine was used to record the inspiratory peak pressure (PIP), plateau pressure (Pplat), static lung compliance (Cs) and dynamic lung compliance (Cd); and ELISA was used to detect the serum levels of IL-6, TNF-α and IL-10. Results PaO₂ on 2^nd, 3^rd, 5^th, 6^th and 7^th day after treatment, PaCO₂ on 1^st, 3^rd, 5^th and 7^th day after treatment, and OI on 6^th and 7^th day after treatment in the experimental group were higher than those in the control group (all P<0.05). After treatment, PIP and Pplat in the two groups were significantly decreased (P<0.05), and Cs and Cd were significantly increased (P<0.05); the changes in the experimental group were significantly greater compared with the control group (P<0.05). In the experimental group and the control group, IL-6 and TNF-α levels were significantly decreased (P<0.05), and IL-10 levels were increased (P<0.05) after treatment; the changes in the experimental group were significantly greater compared with the control group (P<0.05). Conclusion Ulinastatin combined with recruitment maneuver can more effectively reduce lung injury and improve pulmonary ventilation of the patients with extrapulmonary ARDS compared with simple recruitment maneuver.

Abstract:Objective To explore the risk factors and to develop the management methods of massive perihepatic blood accumulation after liver transplantation. Methods Clinical data of 117 patients, who received performed orthotopic liver transplantation in the Department of Biliary Tract Surgery (Ⅰ) of Eastern Hepatobiliary Surgery Hospital of Second Military Medical University from Mar. 2004 to Apr. 2007, were retrospectively studied to analyze the independent risk factors associated with the occurrence of massive perihepatic blood accumulation by univariate analysis and multivariate analysis, and to summarize the corresponding treatment methods. Results Twelve of 117 cases died in the perioperative period, and 105 cases were included in this study. Among 105 cases, 9 (8.57%) had postoperative massive perihepatic blood accumulation accompanied by aggravated yellowing of the skin and sclera, elevated whole blood leukocyte count and neutrophil proportion in a short period of time, and impaired liver function. Univariate analysis showed the massive perihepatic blood accumulation was associated with a history of upper abdominal surgery (P=0.001), pre-operative hemoglobin (P=0.031), pre-operative leukocyte count (P=0.001), pre-operative platelet count (P<0.001) and post-operative bile leakage (P=0.001); Multivariate analysis showed a history of upper abdominal surgery (P=0.008, OR=15.000) and post-operative bile leakage (P=0.034, OR=20.770) were independent risk factors for massive perihepatic blood accumulation. Conclusion The main methods to prevent massive perihepatic blood accumulation include knowing the history of upper abdominal surgery in patients, strictly protecting the blood supply of bile duct, accurate anastomosis and preventing bile leakage. Puncture or removal of hematocele timely is effective for massive perihepatic blood accumulation.

Abstract:Objective To explore the clinical value of trans-umbilicus two-port laparoscopic operation on the treatment for special kinds of incarcerated inguinal hernias in children. Methods A retrospective analysis of the clinical data of 11 children underwent transumbilicus two-port laparoscopic operation for a special kind of incarcerated inguinal hernia from Dec. 2012 to Nov. 2015 in Wuhan Children's Hospital of Tongji Medical College of Huazhong University of Science & Technology. Then we analyzed the general data, operative methods, hospital stay and postoperative complications of the children. Results Four children with Amyand's hernia were cured by laparoscopic surgery. A Meckel's diverticulum was found in 3 children, 2 of them underwent the laparoscopic resection of Meckel's diverticulum, and one was Litter's hernia and was cured with transumbilical incision for Meckel's diverticulum resection and anastomosis. One case had direct inguinal hernia with greater omentum hernia and was cured by laparoscopy. Three cases had seromuscular tear of incarcerated intestine and were cured by aparoscopic intestinal repair surgery. The average hospital stay of all cases was (5.9±2.4) d, and no incision infection or postoperative scrotal hematoma were found. All the children were followed up for 10 months to 3 years, and recurrence or testicular atrophy were not seen. Conclusion Transumbilical two-port laparoscopic operation is safe, minimally invasive and quick has recovery for the special kinds of incarcerated inguinal hernias, making it of worthy popularizing widely.

Abstract:Objective To compare the effects of TRIzol and magnetic beads methods on quantitative detection of hepatitis C virus (HCV) RNA. Methods Serum samples and genotype information of 117 patients with positive HCV infection were collected. HCV RNA was extracted from serum samples by TRIzol method and magnetic bead method, respectively. And then the viral load of HCV RNA was detected by quantitative PCR to compare the difference between the two methods. Results qPCR results showed that a good linear correlation existed between TRIzol and magnetic beads methods:y=0.978x+0.063 (R²=0.973). Bland-Altman statistical analysis showed that the average logarithmic value of viral load of HCV RNA extracted by TRIzol method was slightly lower than that of magnetic beads method, without significant difference (P>0.05). There were no significant difference among the genotypes 1a, 1b, 2a, 3a or 6a between the two methods (P>0.05). Conclusion TRIzol method is comparable to magnetic beads method in HCV RNA quantitative detection, with less sample volume and lower cost, indicating that it might be widely used for developing kit and HCV RNA clinical detection in China.

Abstract:

Abstract: