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Objective To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods From June 2016 to June 2017,47 patients were diagnosed placenta previa in Union Hospital,Tongji Medical College of Huazhong University of Science and Technology.Posterior wall breakwater-like suture technique was used preferentially,as for cases with poor myometrium layer,lower anterior wall stitch suture was used at the same time.Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results Thirty cases(63.8, 30/47)were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively.Senventeen cases were diagnosed as placenta accreta(36.2%,17/47).Thirty-four cases had the previous history of cesarean section.The average cervical canal length of 47 patients was(2.8±0.9)cm. There were 19 cases(40.4%,19/47)with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47)with 2 or 3 times posterior wall breakwater-like sutured; 12 cases(25.5%,12/47)were treated with anterior wall stitch suture simultaneously.Ten cases(21.3%, 10/47)underwent uterine artery ligation, 17 cases(36.2%, 17/47)underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml,the percentiles 25 was 500 ml,and the percentiles 75 was 1 200 ml.The blood loss≥1 000 ml in 18(38.3%,18/47)patients,and the most serious one was 2 500 ml. The median blood transfusion volume(including allogenetic transfusion and autotransfusion)was 450 ml, the percentiles 25 was 228 ml,and the percentiles 75 was 675 ml.The average vaginal bleeding volume was (150 ± 63)ml first day after operation. The mean hospitalization time was(4.7 ± 1.0)days. The mean gestational weeks of pregnancy termination was(36.1±1.5)weeks,and the mean birth weight of newborns was(2 817±492)g.Apgar score:1-minute 7.8±1.1,5-minute 8.9±0.8.No neonatal death, 16 cases were transferred to neonatal ICU(34.0%, 16/47)mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions Uterine posterior wall breakwater-like suture technique is a simple,safe and effective way in controlling intraoperative bleeding of placental previa. Lower anterior wall stitch suture could effectively stop bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of postpartum hemorrhage and hysterectomy,and improve maternal and fetal prognosis.
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OBJECTIVE: To discuss the effects of single dose of cisplatin on renal interstitial fibrosis indicators in rats dynamically. METHODS: 72 SD rats were randomly divided into normal group and cisplatin group, with 36 rats in each group. Normal group and cisplatin group were given equal volume of normal saline and cisplatin 5 mg/kg intraperitoneally on the first day, respectively. Each 6 rats were sacrificed on 8th, 14th, 30th, 50th, 60th, 90th day. The serum levels of blood urea nitrogen (BUN) and creatinine (Cr) were determined, and the degree of renal tubulointerstitial injury and relative area of renal tubulointerstitial fibrosis were evaluated. The expression of α-smooth muscle actin (α-SMA), type Ⅰ collagen (Col Ⅰ) and transforming growth factor β1 (TGF-β1) were determined in renal tissue. RESULTS: Compared with normal group, the serum levels of BUN and Cr, renal tubulointerstitial injury indexes, relative area of renal tubulointerstitial fibrosis, and the expression of α-SMA, Col Ⅰ and TGF-β1 in renal tissue were increased significantly (P<0. 05 or P<0. 01). In cisplatin group, within the 8th-90th days, serum level of BUN in rats had no significant change; serum level of Cr, renal tubulointerstitial injury indexes, renal tubulointerstitial fibrosis, the expression of a-SMA, Col Ⅰ and TGF-β1 in renal tissue increased first and then decreased. CONCLUSIONS: A single dose of clinical dose of cisplatin can induce renal interstitial fibrosis in rats, and its mechanism may be related to the expression of TGF-β1 in renal tissue.
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OBJECTIVE:To investigate the effects of Shenfukang capsules on clinical efficacy and renal function indexes of patients with renal insufficiency. METHODS:Totally 100 inpatients with renal insufficiency treated by Shenfukang cap-sules in the First Affiliated Hospital of Guangxi Medical University during Feb. to Mar. 2015 were analyzed retrospectively in respects of general information of patients,therapy plan,renal function indexs before and after treatment and clinical effica-cy. The relationship of clinical efficacy with age and duration was also analyzed. RESULTS:There were 33 cases of acute re-nal insufficiency and 67 cases of chronic renal insufficiency. The route of administration of Shenfukang capsules was oral ad-ministration(97 cases,97.00%),the main dosage was 6 capsule/d(36 cases,36.00%),and treatment duration were 0-0.05);among patients with chronic renal insufficiency,the total response rate of patients elder than 60 years old was significantly better than that of patients with ≤60 years old,with statistical significance (P<0.05). With the extension of treatment duration,the total response rate of patients with acute renal insufficiency was on the rise,and that of patients with chron-ic renal insufficiency increased first and then decreased. No obvious ADR was found during treatment. CONCLUSIONS:Shenfu-kang capsules can improve renal function in patients with renal insufficiency,and has definite curative effect on acute and chronic renal insufficiency with good security. The clinical efficacy may be related to age and treatment course.
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Gynecology and obstetrics is a theoretical and practical subject. It is an important goal for the medical students to develop the clinical thinking ability and operating skills and apply them in the diagnosis and treatment of disease. To overcome the limited teaching resources, the rare clinical skills opportunities caused by doctor-patient relationship tension, virtual patient (VP) combined with clinical teaching was applied in clinical teaching, which can reproduce the real, and bring the students to the role of the clinician , enrich the content of the obstetrics and Gynecology clinical teaching. Along with the reform the teaching faculty with high quality was established, their clinical teaching experiences and innovative thinking were improved significantly. The results were evaluated by means of clinical comprehensive ability test. The present study aimed to establish virtual patients of OBGYN (virtual patient, VP) learning to promote learning of basic knowledge, clinic skills, and thinking ability.