High-risk human papillomavirus negative cervical lesions in the cervical cancer screening population / 中国医师杂志

Objective:To investigate the incidence of high-risk human papillomavirus (hrHPV) negative cervical lesions in the screening population, and based on this, to preliminarily evaluate the potential harm (missed diagnosis) and benefits (reduced colposcopy referral) of HPV primary screening compared to combined screening so as to provide reference for the selection of cervical cancer primary screening methods.Methods:This study was a single center cross-sectional study. Women who underwent joint screening [hrHPV typing test combined with cervical liquid based cytology test (LCT)] at the Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to December 31, 2019 were included in the cervical cancer screening. The proportion of hrHPV negative cytological abnormalities and cervical lesions in the population was analyzed and the theoretical colposcopy referral rate of the combined screening and HPV initial screening protocol was calculated. In the population with cervical pathological results, the number of colposcopy examinations required for the diagnosis of cervical intraepithelial neoplasia grade 2 and above (CIN2+ ) was calculated.Results:A total of 35 321 screened women were included. The overall incidence of hrHPV infection, LCT abnormalities and severe LCT abnormalities in the population was 17.13%(6 051/35 321), 18.07%(6 384/35 321), and 3.97%(1 402/35 321), respectively. The negative rate of hrHPV in women with severe cervical cytology abnormalities was as high as 51.28%(719/1 402), and in CIN2+ lesions diagnosed by cervical biopsy, hrHPV negative accounted for 7.15% (49/685). The theoretical colposcopy referral rates for combined screening and initial HPV screening were 11.28%(3 985/35 321) and 8.33%(2 943/35 321), respectively, with an average diagnosis of CIN2+ requiring 3.51 and 2.81 colposcopy examinations, respectively.Conclusions:In the opportunistic screening population, the proportion of hrHPV negative CIN2+ lesions cannot be ignored, and the HPV initial screening strategy may cause missed diagnosis of these lesions. However, compared to combined screening, HPV initial screening has the potential to improve the efficiency of colposcopy. These results suggest that we should carefully choose the HPV initial screening plan.

Challenges in screening and early detection of gynecologic malignancies / 中国医师杂志

The cancer burden caused by gynecological malignancies poses a serious threat to the health of women in China. Screening and early diagnosis are the key means to reduce the incidence rate and mortality of cancer. This article aims to briefly summarize the current status and challenges of screening and early diagnosis of three common female reproductive tract malignancies (cervical cancer, endometrial cancer, and ovarian cancer), in order to clarify the current stage and future direction of efforts.

Minimizing complications during surgical management of cervical cancer / 中国医师杂志

Radical hysterectomy combined with pelvic lymphadenectomy is the mainstream management for early-stage cervical cancer. However, the high radicality of such procedures is accompanied by high risk for complications. How to reduce the complications while ensuring the extent of surgical resection represents a dilemma faced by gynecological oncologists. Besides surgical techniques, multiple aspects during patient management should be involved in the measures for preventing surgery-associated complications in cervical cancer patients. By strictly grasping the surgical indications, being familiar with the use of instruments, paying attention to the application of surgical operation details and skills, strengthening postoperative management, and paying attention to the learning curve of surgeons, the incidence of surgical injury can be controlled at a low level.

The prognostic value of blood urea nitrogen/albumin ratio in patients with acute non-variceal upper gastrointestinal bleeding / 中华急诊医学杂志

Objective:To determine whether the blood urea nitrogen to serum albumin (B/A) ratio was a useful prognostic factor of mortality in the patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB).Methods:Totally 1 120 patients with acute upper gastrointestinal bleeding (VUGIB) admitted to the Emergency Department from January 2019 to December 2021 were prospectively and continuously collected and 449 eligible patients with acute non-varicose upper gastrointestinal tract were finally enrolled. The clinical data, laboratory tests and endoscopic results of the patients were recorded, and the data from the 30-day survival group and the non-survival group were compared and analyzed.Results:Significant differences were observed in age, mean arterial pressure, pulse rate, albumin levels, total protein levels, blood urea nitrogen levels, glucose, Glasgow-Blatchford score (GBS), Rockall, and AIMS65 scores between the survival and non-survival groups (all P <0.05). The B/A ratio in the non-survival group was significantly higher than that in the survival group [(24.9 ± 16.4) vs. (9.0 ± 8.6) mg/g, P<0.001]. Receiver operating characteristic (ROC) curve showed that the best cutoff value of B/A ratio for predicting 30-day death was 32.08 mg/g, with a sensitivity of 0.776 and specificity of 0.823. There was a significant difference in the 30-day Kaplan-Meier survival curve between patients with B/A ratio ≥32.08 mg/g and those with B/A ratio <32.08 mg/g (Log Rank 32.229, P<0.001). Multivariate logistic regression analysis revealed that the B/A ratio (≥32.08 mg/g) was associated with 30-day mortality ( OR=4.87, 95% CI: 1.94-6.85, P<0.001). Area under the ROC curve (AUC) for B/A ratio, GBS, Rockall and AIMS65 scores for predicting 30-day mortality were 0.855 (95% CI: 0.807-0.902), 0.849 (95% CI: 0.796-0.901), 0.657 (95% CI: 0.576-0.737), and 0.828 (95% CI: 0.774-0.883), respectively. Conclusions:The B/A ratio is a simple but potentially useful prognostic factor of mortality in the ANVUGIB patients.

Tie2 Expressing Monocytes/Macrophages in Human Tumors / 肿瘤防治研究

Tie2 expressing monocytes/macrophages (TEMs) are a subtype of monocytes or macrophages which expressing tyrosine kinase receptor Tie2. They can exist in peripheral blood and tissues of both human and mouse. TEMs can participate in the formation of tumor microenvironment by accelerating tumor angiogenesis, lymphangiogenesis and immunosuppression. At present, TEMs have been found to have potential diagnostic and prognostic guiding significance for a variety of tumors, and they are expected to provide new directions and strategies for tumor therapy. This paper reviews the research progress of TEMs in tumor.

The feasibility and effectiveness of sentinel lymph node detection in ovarian neoplasms: a systematic review / 中国医师杂志

Objective:To evaluate the feasibility and effectiveness of sentinel lymph node (SLN) detection in the ovarian neoplasms.Methods:A search of the literature describing ovarian SLN was performed using China National Knowledge Infrastructure (CNKI), WANFANG DATA, VIP, PubMed, Embase, web of science, Cochrane library from 2000.01.01 to 2020.07.29. The quality evaluation and data extraction of the included literature were conducted, and the development rate, sensitivity and negative predictive value of SLN were calculated.Results:Eight prospective single-arm studies were included, with heterogeneity I2=57.41%>50%, and the P<0.1. A total of 96 patients with ovarian cancer [Stage International Federation of Gynecology and Obstetrics (FIGO)Ⅰ-Ⅱ] were included, of whom 93 completed systematic pelvic and para-aortic lymphadenectomy after SLN detection. The most common tracers were technetium-99m radioactive colloid ( 99Tc m), blue dye or indocyanine green (ICG), and the most common injection sites were the infundibulopelvic ligaments and the proper ovarian ligaments. The SLN detection rate was 88.5%(85/96) and the average number was 2-3. SLN was found in the ipsilateral or contralateral regions of the tumor, 40.8%(31/76) was found only in the para-aortic, 14.5%(11/76) was found only in the pelvic, and 44.7%(34/76) was found only in the para-aortic and pelvic region. The sensitivity was 90.9%(10/11) and the negative predictive value was 98.8%(82/83) of lymph node metastasis. Conclusions:SLN detection for ovarian neoplasms is feasible, and whether it can effectively predict lymph node status of ovarian cancer still needs large sample, multi-center, prospective clinical studies to further verify.

Thinking about lymphadenectomy for gynecological malignant tumor / 中国医师杂志

Lymph node metastasis represents a common way of distant spread of gynecologic malignancies and an independent risk factor of poor prognosis of patients. The pelvic and paraaortic lymphadenectomy is a critical part of the surgical treatment of gynecologic cancer, which potentially improves the survival outcomes of patients through clarifying the node status to guide the subsequent management and/or removal of positive nodes to reduce the tumor burden. However, when we make a decision about lymphadenectomy, we should balance the related survival benefits and morbidities impacting the long-term quality of life. It is noteworthy that the principles of lymph node management are varied between different types and different stages of tumors characterized with different clinical features. Moreover, the sentinel lymph node biopsy, which has been emerging as a promising alternative to traditional systematic lymph node dissection, provides new options while bringing new issues. Here, based on the latest progress in relevant fields, we attempt to figure out the distinct features and unanswered questions in the management of lymph nodes of patients with cervical cancer, endometrial cancer, and ovarian cancer, which may trigger meaningful thoughts regarding related clinical decision.

Current status and future direction of medullary thyroid cancer in the era of precision therapy / 国际外科学杂志

Medullary thyroid carcinoma(MTC) is a rare neuroendocrine neoplasm caused by the malignant hyperplasia of thyroid parafollicular cells, accounting for 4% of all diagnosed thyroid cancer. Patients with MTC have a relatively poor outcome. Distant metastasis, especially in liver, is usually found at the time of diagnosis and the effect of chemotherapy is unsatisfactory in most cases. Due to its highly progressive characteristic and poorer prognosis compared with other subtypes of thyroid cancer, MTC has always been the focus and difficulty of clinical research. In the era of precision therapy, the classification of MTC is more accurate with the application of genetic testing technology and various kinds of individual treatments, such as targeted therapy and peptide receptor radionuclide therapy have been developed. This review will describe the latest development in MTC in the era of precision therapy.

Comments on the debate about laparoscopic surgery for early-stage cervical cancer / 中国医师杂志

In the past two decades,laparoscopic surgery has been increasingly used in the treatment of early-stage cervical cancer because of equal survival and faster recovery compared to abdominal surgery.Recently,a phase Ⅲ randomized controlled clinical trial revealed unexpected results that minimally invasive surgery was associated with significantly increased risks for tumor recurrence and death in patients with early-stage cervical cancer,causing a great debate worldwide.Herein,we highlighted the key points in the debate and tossed out several ideas on how to face and deal with the controversy.

Clinical effect of Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of chronic pelvic inflammatory disease / 中国基层医药

Objective@#To explore the clinical effect of Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of chronic pelvic inflammatory disease.@*Methods@#From November 2016 to November 2018, a total of 216 patients with chronic pelvic inflammatory disease admitted to the Maternal and Child Health Care Hospital of Lishui were enrolled.The patients were divided into control group and observation group according to the digital table, with 108 cases in each group.The patients in the control group were treated with quinolone antibacterial agent moxifloxacin hydrochloride tablets.The patients in the observation group were treated with Kangfu Xiaoyan suppository and moxifloxacin hydrochloride tablets.The disappearance time of clinical signs, clinical treatment effects and adverse reactions in the two groups after treatment were observed and compared.@*Results@#The disappearance time of fever[(5.15±2.46)h], lower abdominal pain[(7.62±2.77)h], leucorrhea abnormality[(9.16±3.13)h], and pain[(6.38±2.03)h] in the observation group were significantly shorter than those in the control group[(8.09±2.28)h, (10.45±2.68)h, (12.20±2.96)h, (9.49±2.27)h](t=8.231, 7.631, 7.334, 10.613, all P=0.000). The total effective rate of the observation group (93.51%) was significantly higher than that of the control group (86.11%), the difference was statistically significant (χ2=6.983, P=0.008). The overall incidence of adverse reactions of the observation group (3.70%) was significantly lower than that of the control group (11.11%), and the difference was statistically significant (χ2=4.32, P=0.038).@*Conclusion@#Compared with the simple use of moxifloxacin, Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of gynecological chronic pelvic inflammatory disease has a better clinical treatment effect and a lower incidence of adverse reactions.It is recommended to apply in clinical treatment in the future.

Clinical effect of Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of chronic pelvic inflammatory disease / 中国基层医药

Objective To explore theclinical effect of Kangfu Xiaoyansuppositorycombined with moxifloxacin in the treatment of chronic pelvic inflammatory disease.Methods From November 2016 to November 2018,a total of 216 patients with chronic pelvic inflammatory disease admitted to the Maternal and Child Health Care Hospital of Lishui were enrolled .The patients were divided into control group and observation group according to the digital table , with 108 cases in each group .The patients in the control group were treated with quinolone antibacterial agent moxifloxacin hydrochloride tablets .The patients in the observation group were treated with Kangfu Xiaoyan suppository and moxifloxacin hydrochloride tablets .The disappearance time of clinical signs ,clinical treatment effects and adverse reactions in the two groups after treatment were observed and compared .Results The disappearance time of fever [(5.15 ±2.46)h],lower abdominal pain[(7.62 ±2.77)h],leucorrhea abnormality[(9.16 ±3.13)h],and pain [(6.38 ±2.03) h] in the observation group were significantly shorter than those in the control group [(8.09 ± 2.28)h,(10.45 ±2.68)h,(12.20 ±2.96)h,(9.49 ±2.27)h](t=8.231,7.631,7.334,10.613,all P=0.000). The total effective rate of the observation group (93.51％) was significantly higher than that of the control group (86.11％),the difference was statistically significant (χ2 =6.983,P=0.008).The overall incidence of adverse reactions of the observation group (3.70％) was significantly lower than that of the control group (11.11％),and the difference was statistically significant (χ2 =4.32,P =0.038).Conclusion Compared with the simple use of moxifloxacin ,Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of gynecological chronic pelvic inflammatory disease has a better clinical treatment effect and a lower incidence of adverse reactions .It is recommended to apply in clinical treatment in the future .

SIRT7 antagonizes human stem cell aging as a heterochromatin stabilizer

SIRT7, a sirtuin family member implicated in aging and disease, is a regulator of metabolism and stress responses. It remains elusive how human somatic stem cell populations might be impacted by SIRT7. Here, we found that SIRT7 expression declines during human mesenchymal stem cell (hMSC) aging and that SIRT7 deficiency accelerates senescence. Mechanistically, SIRT7 forms a complex with nuclear lamina proteins and heterochromatin proteins, thus maintaining the repressive state of heterochromatin at nuclear periphery. Accordingly, deficiency of SIRT7 results in loss of heterochromatin, de-repression of the LINE1 retrotransposon (LINE1), and activation of innate immune signaling via the cGAS-STING pathway. These aging-associated cellular defects were reversed by overexpression of heterochromatin proteins or treatment with a LINE1 targeted reverse-transcriptase inhibitor. Together, these findings highlight how SIRT7 safeguards chromatin architecture to control innate immune regulation and ensure geroprotection during stem cell aging.

SIRT7 antagonizes human stem cell aging as a heterochromatin stabilizer

SIRT7, a sirtuin family member implicated in aging and disease, is a regulator of metabolism and stress responses. It remains elusive how human somatic stem cell populations might be impacted by SIRT7. Here, we found that SIRT7 expression declines during human mesenchymal stem cell (hMSC) aging and that SIRT7 deficiency accelerates senescence. Mechanistically, SIRT7 forms a complex with nuclear lamina proteins and heterochromatin proteins, thus maintaining the repressive state of heterochromatin at nuclear periphery. Accordingly, deficiency of SIRT7 results in loss of heterochromatin, de-repression of the LINE1 retrotransposon (LINE1), and activation of innate immune signaling via the cGAS-STING pathway. These aging-associated cellular defects were reversed by overexpression of heterochromatin proteins or treatment with a LINE1 targeted reverse-transcriptase inhibitor. Together, these findings highlight how SIRT7 safeguards chromatin architecture to control innate immune regulation and ensure geroprotection during stem cell aging.

Olaparib induced senescence under P16 or P53 dependent manner in ovarian cancer / 부인종양

OBJECTIVE: Poly (ADP-ribose) polymerase (PARP) is an important molecule in the early stress response of DNA damage, which is involved in DNA damage repair and cellular senescence. Olaparib, as PARP inhibitor, has an anti-tumor effect on high grade serous ovarian cancer, but its effects on cellular senescence have not been reported. This study intends to explore the role of olaparib in the regulation of senescence in ovarian cancer cells. METHODS: The effects of olaparib on the senescence of ovarian cancer cells were detected by using the senescence-associated β-galactosidase (SA-β-Gal) and senescence-associated heterochromatin aggregation (SAHF). Quantitative real-time polymerase chain reaction was used to analyze the senescence-associated secretory phenotype (SASP). Cell cycle and apoptosis were detected by flow cytometry. The effect of olaparib on tumor growth was analyzed in a nude mouse xenograft transplantation model. RESULTS: Long-term (6 days) treatment with olaparib (5 μM) significantly inhibited the growth of ovarian cancer cells, leading to arrest the cell cycle at G0/G1 phase, significant increase the number of positive SA-β-Gal stained cells and positive SAHF cells. The expression of P16 and retinoblastoma protein (p-RB) were significantly enhanced in SKOV3 cells under olaparib treated, meanwhile, the expression of P53 and p-RB were upregulated in A2780 cells. In OVCAR-3 cells, the expression of P53 was downregulated and p-RB was upregulated. Mice with SKOV3 xenograft transplantation was given olaparib (10 mg/kg/day) via abdominal cavity administration, the tumor volume was reduced (p < 0.01). CONCLUSION: Continuous low dosage administration of olaparib induced senescence under P16 or P53 dependent manner in ovarian cancer.

Clinical evaluation of pelvic floor rehabilitation training for patients with pelvic floor dysfunction after delivery via vagina / 中国基层医药

Objective@#To observe the clinical effect of pelvic floor rehabilitation training on patients with pelvic floor dysfunction after delivery through vagina.@*Methods@#From January 2017 to December 2017, 96 patients with pelvic floor dysfunction treated in the Maternal and Child Health Hospital of Lishui were randomly selected for clinical study.The patients were divided into observation group and control group by random number method, with 48 cases in each group.The control group was given pelvic floor dysfunction knowledge education, psychological counseling and general treatment methods such as guiding patients to perform functional exercises.The observation group received pelvic floor rehabilitation training on the basis of the treatment plan of the control group.The symptoms related to pelvic floor dysfunction, pelvic floor contraction ability before and after treatment, pelvic floor function and sexual quality of life were compared between the two groups.@*Results@#The incidence rates of clinical symptoms such as organ prolapse, urinary incontinence, asexuality and sexual intercourse pain in the observation group were 8.33%, 6.25%, 8.33% and 10.42%, respectively, which were significantly lower than those in the control group (25.00%, 27.08%, 22.92% and 27.08%) (χ2=4.800, P=0.028; χ2=7.500, P=0.006; χ2=3.872, P=0.049; χ2=4.376, P=0.036). There was no statistically significant difference between the two groups in grade I-V before treatment(P>0.05). After treatment, there were 2 cases, 4 cases, 8 cases, 18 cases and 17 cases in the observation group with grade I-V, which were significantly better than those in the control group (8 cases, 7 cases, 10 cases, 16 cases and 7 cases), and there was statistically significant difference (χ2=8.102, P=0.044). After treatment, the pelvic floor muscle tension of the observation group was higher than that of the control group[(4.16±0.33)grades vs.(3.84±0.27)grades], the difference was statistically significant(t=5.200, P=0.000). The sexual life quality score of the observation group was (87.33±10.24)points, which was significantly higher than (78.62±8.29)points in the control group(t=4.580, P=0.000). The total effective rate of the observation group was 95.83%, which was significantly higher than that of the control group (83.33%, χ2=4.019, P=0.048).@*Conclusion@#Pelvic floor rehabilitation training has good clinical effect on pelvic floor dysfunction after vaginal delivery.It can significantly improve pelvic floor function and sexual life ability, improve pelvic floor muscle tension and reduce visceral prolapse.It has important clinical application value.

Clinical evaluation of pelvic floor rehabilitation training for patients with pelvic floor dysfunction after delivery via vagina / 中国基层医药

To observe the clinical effect of pelvic floor rehabilitation training on patients with pelvic floor dysfunction after delivery through vagina.Methods From January 2017 to December 2017,96 patients with pelvic floor dysfunction treated in the Maternal and Child Health Hospital of Lishui were randomly selected for clinical study.The patients were divided into observation group and control group by random number method ,with 48 cases in each group.The control group was given pelvic floor dysfunction knowledge education , psychological counseling and general treatment methods such as guiding patients to perform functional exercises .The observation group received pelvic floor rehabilitation training on the basis of the treatment plan of the control group .The symptoms related to pelvic floor dysfunction,pelvic floor contraction ability before and after treatment ,pelvic floor function and sexual quality of life were compared between the two groups.Results The incidence rates of clinical symptoms such as organ prolapse ,urinary incontinence ,asexuality and sexual intercourse pain in the observation group were 8.33%, 6.25%,8.33%and 10.42%,respectively,which were significantly lower than those in the control group (25.00%, 27.08%,22.92%and 27.08%) ( χ2 ＝4.800,P＝0.028;χ2 ＝7.500,P＝0.006;χ2 ＝3.872,P＝0.049;χ2 ＝4.376,P＝0.036).There was no statistically significant difference between the two groups in grade I -V before treat-ment(P＞0.05).After treatment,there were 2 cases,4 cases,8 cases,18 cases and 17 cases in the observation group with grade I-V,which were significantly better than those in the control group (8 cases,7 cases,10 cases,16 cases and 7 cases),and there was statistically significant difference (χ2 ＝8.102,P＝0.044).After treatment,the pelvic floor muscle tension of the observation group was higher than that of the control group [(4.16 ±0.33) grades vs. (3.84 ±0.27) grades],the difference was statistically significant ( t ＝5.200,P＝0.000).The sexual life quality score of the observation group was (87.33 ±10.24)points,which was significantly higher than (78.62 ±8.29)points in the control group(t＝4.580,P＝0.000).The total effective rate of the observation group was 95.83%,which was significantly higher than that of the control group (83.33%,χ2 ＝4.019,P＝0.048).Conclusion Pelvic floor rehabilitation training has good clinical effect on pelvic floor dysfunction after vaginal delivery .It can significantly improve pelvic floor function and sexual life ability ,improve pelvic floor muscle tension and reduce visceral prolapse. It has important clinical application value.

Effects of different anesthesia methods on cognitive function and inflammatory factors in elderly patients with lung cancer during perioperative period / 中国基层医药

Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin-6 ( IL -6), interleukin -8 ( IL -8) levels in elderly patients with lung cancer during perioperative period.Methods From March 2015 to March 2017, ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research.According to the different anesthesia methods,they were divided into inhalation anesthesia group( A group),general intravenous anes-thesia group(B group) and epidural block anesthesia group(C group),with 30 cases in each group.The minimum mental state examination(MMSE) scores,cognitive dysfunction rate,serum IL-6 and IL-8 levels of the three groups before operation,one day after operation and three days after operation were compared.Results One day and three days after operation,the MMSE scores of C group were (25.62 ± 2.11) points,(27.12 ± 2.04) points,respectively, which were higher than those of group A[(22.61 ± 2.75) points,(25.78 ± 2.68)points] and B group[(22.34 ± 2.01)points,(25.81 ± 2.42) points],the differences were statistically significant(tA group =4.756,2.179,tB group =6.165,2.267,all P<0.05).One day and three days after operation,the cognitive dysfunction rates of C group were 26.67% (8/30),6.67% (2/30),respectively,which were lower than those of A group[50.00% (15/30),26.67% (8/30)] and B group[66.67% (20/30),30.00% (9/30)],the differences were statistically significant(χ2A group =3.455,4.320,χ2B group =9.643,5.455,all P<0.05).One day and three days after operation,the serum IL-6 and IL-8 levels of C group[IL-6:(99.53 ± 16.82)ng/mL,(83.24 ± 8.34) ng/mL,IL-8:(50.43 ± 7.84)ng/mL, (42.15 ± 5.25)ng/mL] were lower than those of A group[IL-6:(122.43 ± 18.41)ng/mL,(88.51 ± 10.42)ng/mL, IL-8:(64.53 ± 8.94)ng/mL,(55.62 ± 6.78) ng/mL] and B group[IL-6:(124.52 ± 20.10) ng/mL,(87.95 ± 9.34)ng/mL,IL-8:(63.27 ± 9.03)ng/mL,(54.62 ± 6.30) ng/mL],the differences were statistically significant (IL-6:tA group =5.030,2.163,tB group =5.222,2.060,all P<0.05;IL-8:tA group =6.495,8.604,tB group =5.881, 8.329,all P<0.05).Conclusion The influence of epidural block anesthesia on postoperative cognitive dysfunction in elderly patients with radical resection of lung cancer is minimal,which can inhibit the expression of inflammatory factors.It is better than the other two anesthesia methods,and it is worthy of radical operation for elderly patients with lung cancer.

The diagnosis, treatment and prevention of cesarean scar pregnancy / 中国医师杂志

Objective To remind the attention to contraceptive in cesarean section group by analyzing the treatment of 104 cases cesarean scar pregnancy (CSP).Methods From April 2009 to November 2012,104 patients with CSP treated in Department of Obstetrics and Gynecology,Wuhan Union Hospital were studied retrospectively.The incidence,treatment,and average in hospital days and average cost of hospitalization were analyzed.Results From 2009 to 2012,the number of CSP was 10,19,29,and 46 cases annually which accounted for the proportion of the corresponding period of gynecological patients were 0.33％,0.63％,0.97％,and 1.53％.Bilateral uterine artery embolization plus curettage was the most effective treatment.The average transfusion rate was 25％.The average amount of in-hospital days were (14 ± 8) days,the average cost of hospitalization were (12954.97 ± 3888.89) yuan.Conclusions The CSP incidence was increasing sharply in China.Although the current treatment methods could greatly reduce complications of CSP,it did harm to the patients and their family.The key to reduce the occurrence of CSP included reducing the rate of cesarean section,and strengthening contraceptive education after cesarean section.

Tie-1: A potential target for anti-angiogenesis therapy / 华中科技大学学报（医学）（英德文版）

The tyrosine kinase system angiopoietin (Ang)/Tie interacts with vascular endothelial growth factor pathway and regulates vessel quiescence in adults as well as later steps of the angiogenic cascade related to vessel maturation. Since all Angs are able to bind to Tie-2 but none binds to Tie-1, the function of Tie-2 and its ligands have captured attention. However, emerging evidence indicates unique roles of the orphan receptor Tie-1 in angiogenesis under physiological and pathological conditions. It is required for maintaining vascular endothelial cell integrity and survival during murine embryo development and in adult and may be involved in modulating differentiation of hematopoietic cells in adult. Tie-1 exhibits poor tyrosine kinase activity and signals via forming heterodimers with Tie-2, inhibiting Tie-2 signaling mediated by Angs. This inhibition can be relieved by Tie-1 ectodomain cleavage mediated by tumor- and inflammatory-related factors, which causes destabilization of vessels and initiates vessel remodeling. Up-regulated Tie-1 expression has been found not only in some leukemia cells and tumor related endothelial cells but also in cytoplasm of carcinoma cells of a variety of human solid tumors, which is associated with tumor progression. In addition, it has pro-inflammatory functions in endothelial cells and is involved in some inflammatory diseases associated with angiogenesis. Recent research indicated that Tie-1 gene ablation exhibited significant effects on tumor blood- and lymph-angiogenesis and improved anti-Ang therapy, suggesting Tie-1 may be a potential target for tumor anti-angiogenesis treatment.

The main causes for the missed and delayed diagnosis of endometrial carcinoma / 中国医师杂志

Objective To investigate the main causes of the missed and delayed diagnosis of endometrial carcinomas.Methods Endometrial carcinoma and missed and delayed diagnosis were used as key words to search in the Chinese National Knowledge Infrastructure and Wanfang Data.Results There were 37 cases with details.Among these,10 cases were caused by false negative D&C (27.0％ of the total);14 cases were caused by misdiagnosis as uterine benign disease (37.8％ of the total);13 cases were caused by the overlooking of the primary symptoms because of the advanced diseases.Conclusions Paying more attention to the symptoms of endometrial carcinomas is necessary to reduce the missed and delayed diagnosis of endometrial carcinoma.