Expert consensus on antiviral therapy of COVID-19 / 中华临床感染病杂志

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

Association between transjugular intrahepatic portosystemic shunt and sarcopenia in patients with liver cirrhosis / 临床肝胆病杂志

Sarcopenia is a common complication of liver cirrhosis and is significantly associated with poor prognosis. Transjugular intrahepatic portosystemic shunt (TIPS) is an important method for the treatment of portal hypertension and its complications. Based on current studies, this article analyzes the association between sarcopenia and the outcomes (hepatic encephalopathy and mortality) of patients with liver cirrhosis after TIPS and the value of improving the predictive ability of existing prognostic models for sarcopenia, as well as the improvement in sarcopenia after TIPS and its significance in the clinical management of patients with liver cirrhosis. A comprehensive analysis of existing reports show that baseline sarcopenia is associated with poor prognosis after TIPS, and it is thus recommended to evaluate nutritional status before TIPS based on radiological examination; TIPS can improve nutritional status and help to achieve reversal or improvement of sarcopenia to a certain extent, and it can also be translated into survival benefit. Therefore, for patients with sarcopenia and a relatively stable disease, TIPS can be performed as soon as possible after comprehensive evaluation.

Efficacy of partial nephrectomy in patients with localized renal carcinoma: a 20-year experience of 2 046 patients in a single center / 中华外科杂志

Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.

Internal Persistence and External Support-What Makes Chinese Teachers of the Mathematically Gifted Stick to Their Post?

Mathematically gifted students are precious human resources, educators of which make a great difference in helping them realize their potential. The retention of qualified teachers of mathematically gifted students is an issue worthy of in-depth exploration. In China, mathematics competitions are an important part of mathematics gifted education, and the teaching of the Mathematical Olympiad is a challenging profession with a high attrition rate. This qualitative study takes four seasoned and outstanding Chinese teachers as cases, collects data through individual semi-structured interviews, and uses the thematic analysis method based on Herzberg's two-factor theory to analyze why they can persist in the field of Mathematical Olympiad teaching for more than 20 years. The results show that the motivation factors affecting retention are recognition, achievement, possibility of growth, work itself, and responsibility, and the hygiene factors are policy and interpersonal relationships. Motivation factors are the main reason for their long-term persistence, while hygiene factors are conducive to their persistence as a whole. Finally, enlightenment to educational policy and school management and suggestions for retention and development of teachers of the mathematically gifted are provided.

Effect of underdilated stent on the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation / 中华内科杂志

Objective:To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.Methods:A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results:During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE ( P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups ( P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95% CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion:Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.

Efficacy of amiodarone in preventing reperfusion ventricular fibrillation in patients undergoing cardiac surgery / 中华胸心血管外科杂志

Objective:To evaluate the efficacy of amiodarone in preventing reperfusion ventricular fibrillation (RVF) in patients undergoing cardiac surgery.Methods:This study searched the databases of CNKI, Wanfang, Weipu, Cochrane, Embase, Web of Knowledge and PubMed, and searched the related research of amiodarone to prevent RVF in cardiac surgery patients, the time was until December 2019. Meta analysis was performed using Revman 5.3 software according to established standards.Results:The study included six studies (incorporating 514 patients). According to different intervention methods, 514 patients were divided into three groups, 196 in the amiodarone group, 153 in the lidocaine group, and 165 in the placebo group. The incidence of RVF was significantly lower in the amiodarone group than in the control group ( RR: 0.64, 95% CI: 0.47-0.86, P=0.003, I2=49%), but there was no significant difference between the amiodarone group and the lidocaine group( RR: 1.03, 95% CI: 0.48-2.22, P=0.94, I2=74%). Compared with the control group, amiodarone reduced the defibrillation frequency of RVF, but the difference was not statistically significant ( RR: 0.90, 95% CI: 0.68-1.20, P=0.48, I2=0). There was no difference in the number of defibrillation of RVF between the lidocaine group and the amiodarone groups ( RR: 1.50, 95% CI: 0.90-2.52, P=0.12, I2=38%). Conclusion:Compared with the control group, amiodarone can significantly reduce the incidence of RVF in patients undergoing cardiac surgery.

Advances in the study of metastatic renal carcinoma / 中华泌尿外科杂志

Renal cancer is a common malignant tumor in urology, with complicated pathogenesis and no obvious clinical symptoms. Metastatic renal cancer accounts for 20%-30% of the newly diagnosed renal cancer. The 5-year survival rate for metastatic patients is less than 10%.At present, the main non-surgical treatment means of mRCC include cytokines and targeted drug therapy, and immunotherapy has also become a research hotspot of mRCC. The current status and research progress of mRCC therapy were reviewed. The medical treatment methods of metastatic renal cancer, such as receptor tyrosine kinase inhibitors and mTOR inhibitors; immunotherapies, such as immunosuppressants for PD-1/PD-L1 were also discussed.

Comprehensive Evaluation of Rehabilitation Medical Service Quality in Tertiary General Hospitals in Gansu, China / 中国康复理论与实践

Objective:To investigate the quality of rehabilitation medical service in tertiary general hospitals in Gansu Province. Methods:Stratified sampling was used to sample tertiary general hospitals in Gansu Province for on-site surveys in 2017. A quality evaluation index system was established in the view of medical service providers, including 17 indicators, based on Donabedian model and experts' opinions. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) and Rank-sum Ratio were applied to make a comprehensive evaluation on the overall service quality of the hospital rehabilitation medical service. Results:A total of 27 tertiary general hospitals were sampled, in 13 cities/prefectures of Gansu Province. For the structure quality, the compliance rate of the business operation area and the number of beds in the rehabilitation medicine department were 77.78% and 51.85% respectively; while the compliance rates of the physicians, therapists and nurses were all less than 50%. For the process and results quality, the compliance rates were all more than 85%. For the overall quality of rehabilitation medical service, five hospitals were classified as Good, located in Lanzhou, Tianshui and Jiayuguan; 18 hospitals were classified as Medium, located in Longnan, Longdong, Lanzhou and surround, Linxia and Hexi regions; four hospitals classified as Poor, located in Lanzhou and Tianshui. Conclusion:The overall quality of rehabilitation services in the tertiary general hospitals of Gansu Province needs to be improved, and the development of rehabilitation services is uneven in various regions. Comprehensive evaluation provides an important reference to promote the rational distribution of rehabilitation medical resources and improve the quality of rehabilitation medical services.

Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: A multicenter cohort study

BackgroundPatients with pre-existing cirrhosis are considered at increased risk of severe coronavirus disease 2019 (COVID-19) but the clinical course in these patients has not yet been reported. This study aimed to provide a detailed report of the clinical characteristics and outcomes among COVID-19 patients with pre-existing cirrhosis. MethodsIn this retrospective, multicenter cohort study, we consecutively included all adult inpatients with laboratory-confirmed COVID-19 and pre-existing cirrhosis that had been discharged or had died by 24 March 2020 from 16 designated hospitals in China. Demographic, clinical, laboratory and radiographic findings on admission, treatment, complications during hospitalization and clinical outcomes were collected and compared between survivors and non-survivors. FindingsTwenty-one patients were included consecutively in this study, of whom 16 were cured and 5 died in hospital. Seventeen patients had compensated cirrhosis and hepatitis B virus infection was the most common etiology. Lymphocyte and platelet counts were lower, and direct bilirubin levels were higher in patients who died than those who survived (p= 0{middle dot}040, 0{middle dot}032, and 0{middle dot}006, respectively). Acute respiratory distress syndrome and secondary infection were both the most frequently observed complications. Only one patient developed acute on chronic liver failure. Of the 5 non-survivors, all patients developed acute respiratory distress syndrome and 2 patients progressed to multiple organ dysfunction syndrome. InterpretationLower lymphocyte and platelet counts, and higher direct bilirubin level might represent poor prognostic indicators in SARS-CoV-2-infected patients with pre-existing cirrhosis.

Analysis of Pulmonary Microbial Diversity in Patients with Advanced Lung Cancer Based on High-throughput Sequencing Technology / 中国肺癌杂志

BACKGROUND@#The pulmonary microbiome is closely related to the occurrence of pulmonary diseases. The morbidity and mortality of lung cancer are relatively high in the world. It has been confirmed that lung microecology changes in lung cancer patients compared with healthy individuals. Furthermore, the abundance of some bacterial species shows obvious changes, suggesting their potential use as a microbial marker for the detection of lung cancer. The composition of the pulmonary microbiome in patients with different histological types of lung cancer has not been determined. We aim to study the correlation and difference of microbiome between different histological types of lung cancer.@*METHODS@#Illumina HiSeq high-throughput sequencing technology was used to sequenced the 16S rDNA V3-V4 region of bacterial in sputum samples of patients with advanced lung cancer.@*RESULTS@#It was found that Streptococcus, Neisseria and Prevotella were the main bacteria of lung cancer patients. Advantage bacterium group differ between different histological types of lung cancer. Adenocarcinoma (AD) group was dominated by Streptococcus and Neisseria, followed by Veillonella. Small cell lung cancer (SCLC) group was dominated by Neisseria, followed by Streptococcus. Squamous carcinoma (SCC) group was dominated by Streptococcus, followed by Veillonella. Combined small cell lung cancer (C-SCLC) group was dominated by Streptococcus, followed by Prevotella.@*CONCLUSIONS@#The pulmonary bacterial microbiome of lung cancer of different histological types is different. This experiment enrichs the pulmonary bacterial microbiome data of lung cancer and fills the gap of pulmonary microbiome of small cell lung cancer.

Recent advances in synthesis of paclitaxel antitumor pharmaceutical raw materials / 中草药

Paclitaxel, a diterpenoid alkaloid, is known as one of the most effective plant antitumor drugs. At present, paclitaxel products are mainly obtained by semi-chemical synthesis, extraction from Taxus spp. plant and bark cell culture synthesis. This study emphatically analyzed the research progress in the production of paclitaxel. The identification of genes related to paclitaxel biosynthesis was summarized. Furthermore, it was assessed that the possibility of using the bark cell culture of Taxus chinensis, endophytic fungi fermentation and the synthetic biology heterologous synthesis to produce paclitaxel compounds. The review can provide theoretical reference for the establishment of green and sustainable industrial production methods of the paclitaxel active products and their precursors.

Overexpression of miR-150 Inhibits the NF-κB Signal Pathway in Intervertebral Disc Degeneration through Targeting P2X7.

OBJECTIVE: To elaborate the mechanism of miR-150 in the regulation of the NF-κB signal pathway in intervertebral disc degeneration (IDD) by targeting P2X7. METHODS: The degenerative and normal intervertebral disc tissues were collected to detect the expressions of miR-150 and P2X7. Nucleus pulposus cells were transfected and divided into different groups. Cell apoptosis was determined by flow cytometry and TUNEL staining. The expressions of IL-6, TNF-α, MMP-3, MMP-13, Cox-2, iNOS, collagen II and aggrecan, as well as NF-κB-associated proteins were measured by qRT-PCR and Western blotting. Furthermore, IDD rat models were established to validate the role of miR-150 in vivo. RESULTS: miR-150 was down-regulated but P2X7 was up-regulated in the degenerative intravertebral disc tissues. The apoptosis of nucleus pulposus cells in the IL-1ß-induced group with the transfection of miR-150 mimic and siP2X7 was significantly decreased, with reduced levels of IL-6, TNF-α, MMP-3, MMP-13, Cox-2 and iNOS, increased levels of collagen II and aggrecan, as well as decreased P2X7, p-p65/p65 and cleaved caspase-3. However, the above factors showed an opposite tendency after treatment with miR-150 inhibitor. Furthermore, the P2X7 siRNA transfection could reverse the effects caused by miR-150 inhibitor. Simultaneously, pcDNA P2X7 transfection also inhibited the function of miR-150 mimic in IL-1ß-induced nucleus pulposus cells. In vivoexperiments further verified the protective role of miR-150 in IDD rats. CONCLUSION: miR-150 may alleviate the degeneration of the intervertebral disc partially since it could restrict the NF-κB pathway by targeting P2X7, and thereby inhibiting IL-1ß-induced matrix catabolism, inflammatory responses and apoptosis of the nucleus pulposus cells.

Effect of Berberine on HCCLM3 Cells Apoptosis and Autophagy Under High Glucose Condition / 中国实验方剂学杂志

Objective:To explore the anti-tumor molecular mechanism of berberine (BBR)by observing and analyzing its effect on proliferation, apoptosis and autophagy-related gene expression for HCCLM3 cells under high glucose condition. Method:HCCLM3 cells were added into low, medium or high-concentration groups of glucose. It was found in cell counting kit-8(CCK-8)that the high concentration of glucose had the most obvious effect on HCCLM3 cells proliferation. Based on the above experimental result, HCCLM3 cells treated with high concentration of glucose was selected and then different concentrations of berberine (5, 10, 20, 30, 40, 50 μmol·L-1) was added for in vitro intervention for 24 h. Then the effect of each drug group on the proliferation of HCCLM3 cells were studied. At the same time, the control group of metformin was arranged. After that, the changes of apoptosis rate were observed by flow cytometry, and the expression levels of B-cell lymphoma-2(Bcl-2)and autophagy genes Atg5, Beclin1 were detced by Real-time polymerase chain reaction (Real-time PCR). Result:With the increase of glucose concentration, HCCLM3 cell had the strongest migration and proliferation ability in high glucose group (P-1), and the inhibition rate was 33.86%, 40.75% (PPPP PConclusion:BBR could inhibit the proliferation of HCCLM3 cells in high glucose environment. Its inhibition effect for HCCLM3 cells might be achieved by inducing apoptosis of the cells, regulating Bcl-2 and up-regulating the expression levels of autophagy gene Beclin1 and Atg5.Thus BBR plays an anti-tumor role through promoting autophagy in high glucose environment.

Eleven cases of DEB-TACE comprehensive interventional strategy for stage Ⅲa hypo-vascular hepatocellular carcinoma / 中国肿瘤临床

Objective: To evaluate the efficacy and safety of portal vein stenting combined with 125I particle strand implantation followed by drug-eluting beads transarterial chemoembolization (DEB-TACE) and molecular-targeted therapy for the treatment of stageⅢa liv-er cancer lacking a blood supply. Methods: A retrospective analysis of 11 patients who had stageⅢa liver cancer lacking a blood sup-ply combined with portal vein tumor thrombosis (PVTT) was conducted from October 2016 to October 2018. All the patients under-went portal vein stenting combined with 125I particle strand implantation, DEB-TACE, and comprehensive treatment containing molecu-lar-targeted drugs. During the follow-up period, all patients were evaluated for stent patency after the implantation and tumor re-sponse after DEB-TACE treatment. The liver function and blood routine changes before and 1 month after the surgery were completed, and the complications were summarized. Results: All 11 patients were judged as stageⅢa liver cancer based on the Chinese staging criteria (2017), Child-Pugh classification grade A and B. The imaging findings indicated that these tumors were hypovascular. The maxi-mum diameter of these lesions was (8.4±4.1) (2.8-14.1) cm, and all patients had PVTT. Among them, there were 4 cases of Cheng's typeⅡand 7 cases of typeⅢ: 6 cases of main PVTT≥50% and 1 case of PVTT<50%. All patients underwent portal vein stenting com-bined with 125I particle strand implantation, DEB-TACE, and comprehensive treatment containing molecular-targeted drugs. Three and 6 months after stent implantation, the patency rate was 100%; 3 months after DEB-TACE treatment, complete response was achieved in 4 (36.4%) patients, partial response was achieved in 5 (45.5%) patients, and stable disease was achieved in 2 (18.2%) patients. No patients exhibited progressive disease. Therefore, the objective response rate was 81.8% and disease control rate was 100%. As for the liver and kidney function and blood routine tests, there were no significant differences between baseline and 1 month after the sur- gery. In addition, no patient had any serious complication during the perioperative period. Conclusions: For patients with stageⅢa liv-er cancer lacking a blood supply and PVTT, a comprehensive treatment strategy including portal vein stenting combined with 125I parti-cle strand implantation, DEB-TACE, and molecular-targeted therapy can restore portal vein blood flow and maintain mid-and long-term stent patency, while effectively killing tumors and controlling tumor growth, which is a safe and effective treatment strategy.

A quasi-coaxial HV rolled pulse forming line.

A quasi-coaxial high-voltage (HV) rolled pulse forming line (rolled PFL) is researched in this paper. The PFL is rolled n circles on a support cylinder simultaneously by two layers of copper foil electrodes and two layers of insulation dielectrics. The first circle of the two electrodes are elicited in opposite directions along the axis, acting as the quasi-coaxial output structure of the PFL, and the left n - 1 circles of the PFL form a complete rolled strip line of n - 1 circles. The rolled PFL is convenient to realize HV insulation and is able to output a pulse with good quality. Characteristic parameters of the PFL are designed theoretically. Besides, the pulse discharge process of the PFL is simulated by computer simulation technology (CST) modeling, and the simulation result verifies the correctness of theory design. Furthermore, a rolled PFL with a characteristic impedance of 4.4 Ω is developed. The test characteristic impedance of the developed PFL by the incident pulse method confirms to the theory design. The discharge voltage waveform with a full width at half maximum of 57 ns of the PFL is acquired, which has a rise time of 6.8 ns. The HV test of the rolled PFL is carried out, and a discharge current pulse with an amplitude of 7 kA is acquired when the PFL is charged to 70 kV. It is calculated that the developed PFL has an energy storage density of 2.5 J/l. A Tesla generator based on 13 stages of rolled PFLs is designed, which is expected to output a 450 kV pulse with a duration of 100 ns on a 40-Ω match load. The discharge waveform of the generator is simulated by the CST software. The simulative output pulse has a rise time of 5 ns, with a flattop jitter less than 5%.

Comparison of patient outcomes with and without stenting tube in pancreaticoduodenectomy.

Objective To evaluate the clinical effect of different pancreaticojejunostomy techniques in the treatment of pancreaticoduodenectomy and investigate the applicability of pancreaticojejunostomy without pancreatic duct stenting. Methods From January 2012 to December 2015, 87 patients who underwent pancreaticoduodenectomy were randomly assigned to either Group A (duct-to-mucosa anastomosis with pancreatic duct stenting, n = 43) or Group B (pancreas-jejunum end-to-side anastomosis without stenting (n = 44). The operative duration of pancreaticojejunostomy, postoperative hospital stay, and incidence of postoperative complications were compared between the two methods. Results The operative duration of pancreaticojejunostomy without use of the pancreatic duct stent was significantly shorter in Group B than in Group A (t = 7.137). The postoperative hospital stay was significantly shorter in Group B than in Group A (t = 2.408). The differences in the incidence of postoperative complications such as pancreatic fistula, abdominal bleeding, abdominal infection and delayed gastric emptying were not significantly different between the two groups (χ2 = 0.181, 0.322, 0.603, and 0.001, respectively). Conclusion Pancreaticoduodenectomy without pancreatic duct stenting is safe and reliable and can reduce the operative time and hospital stay. No significant differences were observed in the incidence of postoperative complications.

Prophylactic uterine artery chemoembolization combined with sequential ultrasound-guided curettage of uterine cavity for the treatment of cesarean scar pregnancy: clinical observation of 231 patients / 介入放射学杂志

Objective To evaluate the clinical application of prophylactic uterine artery chemoembolization (UACE) together with sequential ultrasound-guided curettage of uterine cavity for the treatment of cesarean scar pregnancy (CSP). Methods The clinical data and follow-up results of 231 CSP patients who were treated with UACE together with sequential ultrasound-guided curettage of uterine cavity were retrospectively analyzed. Results After UACE together with sequential ultrasound-guided curettage of uterine cavity, successful termination of pregnancy was achieved in all 231 patients, neither hemorrhagic shock nor death occurred. The median amount of blood loss during curettage of uterine cavity was 10 ml. After curettage of uterine cavity, the median values of RBC, HGB and HCT were 3.53×1012/L, 105 g/L and 32％ respectively, the preoperative median values of which were 4.04×1012/L, 121 g/L and 36％ respectively, indicating there were a slight reduction in RBC, HGB and HCT after UACE, the differences were statistically significant (P＜0.001). The median values of β-HCG measured before UACE and after curettage of uterine cavity were29 069.0 U/ml and 1723.5 U/ml respectively, the difference was statistically significant (P＜0.001). According to the gestational age, the patients were divided into group A (gestational age ≤56 days) and group B (gestational age 57-81 days). Further stratified analysis showed that no statistically significant differences in blood loss during curettage of uterine cavity and in reduction degree of RBC, HGB and HCT after UACE existed between group A and group B. Conclusion Prophylactic UACE before CSP can effectively reduce the occurrence of massive bleeding during uterine curettage. For the treatment of CSP, UACE together with sequential ultrasound-guided curettage of uterine cavity is safe and reliable. Therefore, this therapy can be used as a routine treatment strategy for CSP.

Endovascular repair of Standford type B thoracic aortic dissection complicated by type A intramural hematoma: preliminary results in 3 patients / 介入放射学杂志

Objective To evaluate the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in treating Standford type B thoracic aortic dissection complicated by type A intramural hematoma.Methods From October 2015 to January 2017,a total of 3 patients with Standford type B thoracic aortic dissection complicated by type A intramural hematoma were admitted to authors' hospital to receive treatment.After admission,conservative treatment such as stabilizing blood pressure and heart rate,symptomatic medication,etc.were carried out for 14 days,then,TEVAR was performed.Results Successful TEVAR was accomplished in all 3 patients,no serious complications,such as reverse tear,occurred.One month after TEVAR,reexamination of total aortic CT angiography revealed that the rupture of dissection was completely closed with no internal leakage,the blood flow in the true lumen was obviously improved,the intramural hematoma was remarkably absorbed and faded away,and the wall thickness of ascending aorta returned to normal range.The clinical symptoms were greatly improved,no serious complications such as paraplegia or death occurred.Conclusion For the treatment of Standford type B thoracic aortic dissection complicated by type A intramural hematoma,TEVAR performed at 14 days after the onset of disease is safe and effective if the ascending aorta intima is intact and the clinical symptoms are relived after medication of lowering blood pressure and heart rate.

The expression and prognostic significance of Fibulin-5 in gastric carcinoma / 中华普通外科杂志

Objective To study the expression of Fibulin-5 in gastric cancer and its correlation with the prognosis of gastric cancer.Methods Tissue chips from 90 gastric cancer cases were used to study the expression of Fibulin-5 protein in cancer tissue and para-carcinoma tissue by immunohistochemistry,and analyze the correlation of Fibulin-5 expression and clinical pathological characteristics.Results The expression of Fibulin-5 in gastric cancer tissue was higher than that of para-carcinoma tissue [cytoplasm:(6.2±4.2) vs.(5.1 ±3.7);nucleus:(7.2 ±3.8) vs.(4.9 ±2.5),all P＜0.05],which was positively related with patient's age (r =0.213,P =0.044) in the cytoplasm of cancerous tissue.The expression of Fibulin-5 in the cytoplasm of cancerous tissue was negatively related with patient's overall survival (25％ vs.56％,P =0.027),which was an independent predictor (P =0.037).Conclusion Fibulin-5 is an independent prognostic factor of gastric cancer,its expression might be related with shortend patient's survival time.