Establishment of a risk model of placental accreta spectrum by ultrasound combined with clinical high risk factors / 中华超声影像学杂志

Objective:To establish a risk model of placenta accreta spectrum(PAS) based on the clinical risk factors and ultrasound signs of patients with placenta accreta, and identify severe placenta accreta prenatal.Methods:A retrospective analysis was performed on 121 PAS patients admitted to Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to June 2022 who were clinically classified or pathologically diagnosed during delivery. The two groups were divided into light and severe groups according to the implantation type. The clinical risk factors and ultrasound signs between the two groups were compared. A risk model of PAS was established based on the clinical risk factors and ultrasound signs to predict the perinatal complications.Results:A total of 130 cases of PAS were clinically diagnosed or pathologically diagnosed with placenta, 9 cases with incomplete clinical data or irregular ultrasound images were excluded, and the remaining 121 cases were included in the study. Among the 121 patients, 64 cases were placental accreta, 39 cases were placental increta, and 18 cases were placenta percreta. The placental accreta was defined as mild group, and the combination of placental increta and placenta percreta were referred to as severe group. There were no significant differences in placenta previa, and the number of uterine cavity operations (all P>0.05). There were significant differences in the number of cesarean section, myometrium thinning, placental lacunae, abnormal vascularization at the utero-bladder junction, bridging vessels at the utero-bladder junction, placental protuberance and cervical involvement (all P<0.05). Binary logistic regression analysis showed that placental lacunae, abnormal vasculization of the utero-bladder interface and the number of cesarean sections were independent risk factors for severe PAS. Based on this, a risk model was established and the ROC curve of each independent risk factor and risk model was plotted respectively. The AUC of the risk model was 0.826, which had better diagnostic efficacy than other independent risk factors. Conclusions:In the prenatal ultrasound classification diagnosis of high-risk patients with PAS, the placental lacunae, abnormal vascularization of utero-bladder interface and the number of cesarean section are combined to establish the risk model of PAS, which has a good diagnostic efficacy for severe placenta accreta.

Application of preoperative three-dimensional reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis / 中华骨科杂志

Objective:To investigate the clinical efficacy of preoperative three-dimensional (3D) reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis.Methods:A total of 80 patients with osteoarthritis secondary to Crowe I-III developmental dysplasia of the hip who underwent primary unilateral total hip arthroplasty from October 2019 to March 2021 were retrospectively analyzed, including 18 males and 62 females and the mean age was 55.7±10.4 years (range 41-72 years). Forty patients in the 3D group, the prosthesis type and installation angle were planed on the 3D reconstruction software based on the full-length CT scan data of the lower limbs, and the length difference of the lower limbs and hip offset were calculated. Forty patients in the control group underwent preoperative planning using conventional film measurement, and lower limb length was judged based on the preoperative measurement data and intraoperative comparison of both lower limbs. The difference of postoperative leg length, hip offset, hip function score, operating time, intraoperative blood loss, and incidence of complications were compared between the two groups.Results:All 80 patients completed the surgery successfully and the follow-up time was up to 3 months after operation. The 3D group was better than the control group in operation time (70.9±7.7 min vs. 81.6±13.3 min, t=-4.91, P<0.001), the difference of postoperative lower limb length (2.78±1.31 cm vs. 5.35±2.15 cm, t=-5.74, P<0.001), and hip function score at 1 week after operation (75.67±3.35 vs. 67.35±4.21, t=12.33, P=0.002), with statistically significant differences. In the 3D group, 95% of acetabular prosthesis and 90% of femoral stem components were consistent with the planned model, while the rate were only 75% and 68% in the control group, and the difference was statistically significant (χ 2=7.51, P=0.023; χ 2=14.92, P=0.005). There were no intraoperative complications such as vascular and nerve injury, and no postoperative complications such as dislocation or periprosthetic infection in all 80 patients. Conclusion:3D preoperative planning assisted total hip arthroplasty in the treatment of Crowe I-III developmental dysplasia of the hip secondary to osteoarthritis can improve the accuracy of the operation, and has a good clinical effect on restoring the leg length and hip offset.

Predictive value of ultrasound signs of the involvement of the cervix in the adverse pregnancy outcomes of placenta accreta spectrum / 中华超声影像学杂志

Objective:To explore the the predictive value of ultrasound signs of the involvement of the cervix in the clinical grade diagnosis of placenta accreta spectrum(PAS) with placenta previa and adverse pregnancy outcomes.Methods:A retrospective analysis was performed on PAS patients with placenta previa diagnosed during delivery or by cesarean section in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to March 2021. According to the signs of cervical involvement on prenatal ultrasound, the patients were divided into cervical involvement group and cervical non-involvement group. Logistic analysis was performed on clinical data between the two groups. The clinical data, hysterectomy rate, intraoperative blood loss and clinical diagnosis were compared between the two groups.Results:There were 1 455 patients with PAS diagnosed by clinical diagnosis or placental pathology, of which 170 were with placenta previa, 24 with incomplete clinical data or non-standard ultrasound images, and the remaining 146 patients were included. In the cervical involvement group, all of 6 cases had placenta percreta. Of the 140 cases in the unaffected cervical group, 89 cases (63.6%) had placental accreta, 48 cases (34.3%) had placental increta, and 3 cases (2.1%) had placenta percreta. There were no significant differences of the age and uterine operation history between the two groups. There was significant difference in the number of cesarean sections between the two groups ( P<0.05). There were significant differences in intraoperative blood loss, hysterectomy rate and placenta accreta grade diagnosis between the two groups(χ 2/ Z=4.203, 11.165, 95.248, all P<0.05). Conclusions:The ultrasonographic signs of cervical involvement have a good predictive value for the pregnancy outcome of PAS.

Comparison of stent-assisted and non-stent-assisted coils in the treatment of ruptured wide-necked anterior communicating artery aneurysm in acute stage / 中国基层医药

Objective:To compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of anterior communicating ruptured wide-necked aneurysms in acute phase.Methods:The clinical data of 76 patients with anterior traffic rupture wide-necked aneurysm treated by interventional embolism from January 2014 to December 2018 were collected in the People's Hospital of Dezhou.According to whether or not stents were assisted during the operation, 76 cases were divided into stent group (41 cases) and non-stent group (35 cases). The stent group selected the Solitaire AB neurovascular remodoring device or the LVIS support for the corresponding size according to the diameter of the patients’ artery, and the non-stent group used a single catheter, a double catheter, or a balloon assist.The perioperative complications, mortality and clinical prognosis between the two groups were compared.Results:There were no statistically significant differences in bleeding complications, symptomatic vasospasm, mortality and clinical prognosis between the two groups (all P>0.05). The incidence of ischemic complications in the stent group was 17.07%(7/41), which was significantly higher than that in the non-stent group[2.86%(1/35)](χ 2=4.052, P<0.05). The overall complication rate of the stent group was 21.95%(9/41), which was significantly higher than 5.71%(2/35) of the non-stent group (χ 2=4.021, P<0.05). Conclusion:Both stent-assisted and non-stent-assisted coils can achieve good clinical results in the treatment of anterior communicating ruptured wide-necked aneurysms in acute phase.Stent-assisted embolism has a high incidence of ischemic complications and needs caution in clinical application.

Pathological characteristics of inflammatory diseases in the fallopian tube / 中国实用妇科与产科杂志

The fallopian tube has received more andmore attention.In addition to neoplasms,the fallopiantubal inflammatory diseases are relatively common.Thefallopian tube has an important physiological function in reproductive process.Inflammatory diseases causedby tubal infection are also an increasingly seriousproblem.It is very necessary to be familiar with thediagnosis and differential diagnosis of tubal inflam-matory changes,which will increase the rate of correctdiagnosis and help the patients with infertility.In-flammatory lesions of the fallopian tube mainly includeinfectious salpingitis and other non-neoplastic lesionsaccompanied by inflammatory cell infiltration.

Efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms in acute stage / 中国医师进修杂志

compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms. Methods Data were collected from January 2014 to December 2018 in Dezhou People′s Hospital where patients with ruptured posterior communicating artery wide- necked aneurysm were treated by interventional embolization. All patients were admitted to hospital for subarachnoid hemorrhage, and the diagnosis of posterior communicating artery aneurysm of internal carotid artery was confirmed within 7 d of admission, and the patients were treated with interventional embolization. To compare the perioperative complications, mortality and clinical prognosis between stent-assisted embolization group (stent group , 45 patients) and non-stent-assisted embolization group(non-stent group , 38 patients) was analyzed. Results The incidence of ischemic complications in stent group was 20.0% (9/45), in non-stent group was 5.3% (2/38), and there was significant difference (χ2＝3.892, P < 0.05). The overall complication rate in stent group was 28.9%(13/45), in non-stent group was 10.5%(4/38), and there was significant difference (χ2＝4.265, P < 0.05). There was no significant difference in bleeding complications, symptomatic vasospasm, mortality and clinical prognosis between the two groups (P >0.05). Conclusions In the acute stage of posterior communicating artery aneurysm rupture, stent-assisted embolization has a high rate of thrombotic complication, and the clinical application needs to be cautious. Both the stent-assisted and non-stent-assisted embolization have a good clinical outcome in the treatment of wide-necked posterior communicating aneurysms in the acute phase.

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis / 中华医学杂志(英文版)

BACKGROUND@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*METHODS@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*RESULTS@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P  0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*CONCLUSIONS@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis / 中华医学杂志(英文版)

Background@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*Methods@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*Results@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P < 0.001), PT (14.7 ± 1.8° vs. 29.1 ± 3.4°, t = -13.277, P < 0.001), and SS (39.8 ± 7.2° vs. 26.1 ± 3.3°, t = 6.175, P < 0.001) between the long and short fusion groups. All patients had improved ODI, JOA, and VAS scores post-operatively (all P < 0.001), with no significant difference between the groups (all P > 0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*Conclusions@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.

Efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms in acute stage / 中国医师进修杂志

Objective@#To compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms.@*Methods@#Data were collected from January 2014 to December 2018 in Dezhou People′s Hospital where patients with ruptured posterior communicating artery wide-necked aneurysm were treated by interventional embolization. All patients were admitted to hospital for subarachnoid hemorrhage, and the diagnosis of posterior communicating artery aneurysm of internal carotid artery was confirmed within 7 d of admission, and the patients were treated with interventional embolization. To compare the perioperative complications, mortality and clinical prognosis between stent-assisted embolization group (stent group, 45 patients) and non-stent-assisted embolization group(non-stent group, 38 patients) was analyzed.@*Results@#The incidence of ischemic complications in stent group was 20.0% (9/45), in nonstent group was 5.3% (2/38), and there was significant difference (χ2=3.892, P < 0.05). The overall complication rate in stent group was 28.9%(13/45), in non-stent group was 10.5%(4/38), and there was significant difference (χ2=4.265, P < 0.05). There was no significant difference in bleeding complications, symptomatic vasospasm, mortality and clinical prognosis between the two groups (P > 0.05).@*Conclusions@#In the acute stage of posterior communicating artery aneurysm rupture, stent-assisted embolization has a high rate of thrombotic complication, and the clinical application needs to be cautious. Both the stent-assisted and non-stent-assisted embolization have a good clinical outcome in the treatment of wide-necked posterior communicating aneurysms in the acute phase.

Stent-assisted coil embolization for ruptured anterior circulation intracranial aneurysms:comparison with non-stent-assisted coil embolization / 国际脑血管病杂志

Objective To compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization for the treatment of ruptured anterior circulation aneurysms. Methods From January 2014 to September 2018, patients with ruptured anterior circulation aneurysms treated with interventional embolization in Dezhou People ' s Hospital were enrolled retrospectively. The incidence of perioperative complications, mortality, and clinical outcome at 30 d after coil embolization were compared between the stent-assisted embolization group and the non-stent-assisted embolization group. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes. Results A total of 115 aneurysms were included in 115 patients. There were 47 patients in the stent-assisted embolization group (16 males, aged 56. 81 ±10. 16 years) and 68 in the non-stent-assisted embolization group (27 males, aged 52. 38 ± 9. 60 years ). There were no significant differences in the demographic and baseline data between the stent-assisted embolization group and the non-stent-assisted embolization group. There were no significant differences in the incidence of bleeding complications, ischemic complications, and symptomatic cerebral vasospasm as well. However, the overall complication rate (34. 04％ vs. 17. 65％; P = 0. 044), poor outcome rate (27. 66％ vs. 10. 29％; P = 0. 016 ), and mortality (14. 89％ vs. 2. 94％; P = 0. 046 ) in stent-assisted embolization group were significantly higher than those in the non-stent assisted embolization group. Multivariate logistic regression analysis indicated that hypertension (odds ratio [OR] 6. 000, 95％ confidence interval [CI] 1. 361-27. 363; P = 0. 021), diabetes (OR 6. 000, 95％ CI 1. 548-23. 255; P = 0. 010), stent-assist technique (OR 12. 201, 95％ CI 2. 588-102. 002; P = 0. 002), perioperative bleeding complications (OR 40. 286, 95％ CI 4. 508-360. 032; P = 0. 001), and ischemic complications (OR 46. 000, 95％ CI 10. 716-197. 460; P < 0. 001) were the independent risk factors for poor outcomes. Conclusion Stent-assisted coil embolization for ruptured anterior circulation aneurysms has a high incidence of complications and poor clinical outcomes, and should be avoided as much as possible.

Clinicopathological features of ovarian Brenner tumors / 中华病理学杂志

Objective@#To investigate the clinicopathological characteristics and diagnosis of ovarian Brenner tumors.@*Methods@#Forty-seven cases of ovarian Brenner tumors were enrolled from January 2012 to May 2018 at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Clinical data, imaging examination, histopathological characteristics and immunohistochemical phenotype were analyzed.@*Results@#The age of the patients ranged from 30-73 years and the mean age was 55 years. Thirty-nine patients (83.0%) were postmenopausal. Forty cases (85.1%) of the Brenner tumors were benign, five (10.6%) borderline and two (4.3%) malignant. Usual tumor markers of ovarian carcinoma, including CA199 and CA125 were normal or mild elevated in the 47 cases. Imaging before surgery was not specific to Brenner tumors. Microscopically, benign Brenner tumors were composed of nests of bland, transitional-type cells within a fibromatous stroma. In our 5 cases of borderline Brenner tumors, mildly atypical transitional-type cells were projected into the cyst lumens and lack of stromal invasion. In 2 cases of malignant Brenner tumors, different degrees of nuclear atypial transitional-type cells exhibited stromal invasion. Immunohistochemical stains for CK7, GATA3, p63 and CK5/6 were positive in all cases. Ki-67 was less than 5% in Brenner tumors, and up to 20%-30% in malignant Brenner tumors.@*Conclusion@#Brenner tumors are mostly seen in postmenopausal patients and are usually benign. Imaging examination and usual ovarian tumor markers do not provide diagnostic value. Diagnosis and classification of Brenner tumors depend on histopathological evaluation.

KRAS mutations analysis in mucinous epithelial lesions of the endometrium / 中华病理学杂志

Objective@#To investigate the frequency of KRAS mutation in mucinous epithelial lesions of the endometrium, and analyze the correlation between KRAS mutation and the clinicopathologic features.@*Methods@#The cohort included forty-three cases of mucinous epithelial lesions of the endometrium selected from July 2015 to October 2017 from Beijing Obstetrics and Gynecology Hospital, and 22 control cases. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue sections. Polymerase chain reaction amplification for KRAS exons 2 and 3 was performed, followed by sequencing using capillary electrophoresis. The Fisher exact test was used to compare the prevalence of KRAS mutation among the different groups.@*Results@#The patients′age ranged from 33 to 77 years [mean (55.12±9.34) years, median 55 years]. None of the eight cases of endometrial hyperplasia with mucinous differentiation without atypia showed KRAS mutation. The frequency of KRAS mutations was 1/10 in endometrial atypical hyperplasia, 1/12 in endometrioid carcinoma, 4/11 in endometrial atypical hyperplasia with mucinous differentiation (EAHMD), 6/15 in endometrioid carcinoma with mucinous differentiation (ECMD) and 8/9 in mucinous carcinoma (MC), respectively. The differences were statistically significant between MC versus EC (P<0.01) and MC versus ECMD (P<0.05).@*Conclusion@#The high frequency of KRAS mutation in EAHMD, ECMD and MC indicates that KRAS mutational activation is implicated in the pathogenesis of endometrial mucinous carcinoma.

Practice and Exploration of the Maternity Insurance Management Based on DRG / 中国卫生经济

Based on management ideas for DRG disease grouping,it targeted at comparing the differences and maternity insurance control status of different medical groups within the same disease,provided data support on internal standard practical medical treatment and effectively controlling expenses;based on data analysis,the communication with the medical insurance management department was improved to provide suggestion on further implementation for maternity insurance.

Placental site nodule: a clinicopathological study of 20 cases / 临床与实验病理学杂志

Purpose To investigate the clinical manifesta-tions and morphologic features of placental site nodules (PSNs), and its clinical significance. Methods Twenty patients diag-nosed as PSNs were collected, then a retrospective analysis was conducted, and the characteristics of clinical data and follow-up results were analyzed,including of clinical manifestations, ultra-sonographic evaluation, morphologic and immunohistochemical features. Results The age of patients ranged from 25 to 41 years (32. 48 ± 4. 77 years in average). Three fifths of patients had pregnancy history for at least two times and the interval time to the last pregnancy ranged from 5 to 37 months (15. 33 ± 8. 05 months on average). 15 (75% ) patients went to the hospital because of abnormal vaginal bleeding. In our study, most of the samples showed a membrane-like structure without definite nod-ule. Microscopically, single or multiple, well-circumscribed and oval small nodules were found in endometrial tissue. In most ca- ses, the hyalinization was generally uniform in the center of the nodules, more or less intermediate trophoblasts appeared on the edge of the nodules. Immunohistochemically, the strong diffuse expressed CK (AE1/AE3), CAM5. 2, EMA, GATA-3, Cyclin E and p63 were detected in most of all cases, and PLAP showed strong focal expression, α-inhibin and hPL showed faint focal expression, Ki-67 staining for proliferative index was less than 4% . Conclusion PSN is a benign lesion of the intermediate trophoblast at the chorionic leave. Some diseases including hya-linized decidua, epithelioid trophoblastic tumor, and squamous cell carcinoma with hyalinization need to be identified. Some im-munohistochemical markers may be certain helpful in distinguis-hing as necessary.

Clinicopathological analysis of 5 cases of placental mesenchymal dysplasia / 临床与实验病理学杂志

Purpose To explore the clinicopathological features, diagnosis, differential diagnosis and prognosis of placental mesenchymal dysplasia. Method The clinicopathological data of 5 cases with placental mesenchymal dysplasia were retrospectively analysed and related literatures were also re-viewed. Results All of 5 patients were consciously fetal movement disappeared or found abnormal ultrasound results at routine examination of the pregnancy. The placentas were enlarged, partly with oedematous "grape-like" cysts. On histologic exami-nation, enlarged villi with varying degrees of edema contained abnormal thick walled fetal blood vessels. The chorionic vessels were expanded and congested, and some chorionic villi showed mesenchymal cell hyperplasia. In immunohistochemical staining, p57 was positive, and Ki-67 showed low expression. There was no the trophoblastic proliferation. It's mainly differential diagnosis was hydatidiform mole.2 cases were accompanied with stillbirth. Conclusion The diagnosis of placental mesenchymal dysplasia can be confirmed by pathology examination. When a cystic placenta is detected by ultrasound examination, placental mesenchymal dysplasia should be considered in the differential diagnosis.

Diagnosis and differential diagnosis of cotyledonoid dissecting leiomyoma of the uterus on sonography / 中华医学超声杂志（电子版）

Objective Cotyledonoid dissecting leiomyomawas a rare type of uterus tumors. Because of the lack of knowledge about the ultrasonic patterns of this kind of disease, misdiagnosis frequently happens. Reviewing the cases and relevant researches was helpful to understand the disease and figure it out in ultrasonic images. Methods Six cases of patients with dissecting leiomyoma were reviewed which were hospitalized in Beijing Obstetrics and cotyledonoid Gynecology Hospitalduring 2011 to 2016. All of the patients underwent ultrasound examinations before surgery. The ultrasound findings, clinical presentations and pathological features of the 6 patients were evaluated. Results In 6 patients with CDL, 5 cases were typical intramural dissecting leiomyomas, the inhomogeneous solid masshad irregular boundaries with muscle, color Doppler revealed intenseblood flow signals in the mass. One case exophytic component was in continuity with a lobulated, multinodular myometrial tumor with an irregular border, resembling cotyledon of the placenta. Conclusions Cotyledonoid dissecting leiomyoma was found to be inhomogeneous solid masswith irregular boundariesin some cases, exophytic component was multinodular myometrial tumor, resembling cotyledon of the placenta. Due to bizarre, sarcoma-like gross appearances. Thusit is hard to be diagnosed before surgery by ultrasonography, this type of lesion should be subjected tocareful ultrasonic examination in order to avoid over treatmentand preserve the fertility in young women.

Finite element analysis of the effects of individual extralevator abdominoperineal exci-sion of rectal neoplasms in the low posterior wall on the pelvic floor / 中国肿瘤临床

Objective:To evaluate the effects of individual extralevator abdominoperineal excision (ELAPE) of rectal neoplasms in the low posterior wall on the pelvic floor by finite element analysis. Methods:MIMICS 10.01, Geo Magic Studio 12, and ANSYS Workbench 14.0 were used to analyze the magnetic resonance data obtained from the pelvic region of 27 healthy nulliparous volunteers. Three types of finite element models (intact model, ELAPE model, and individual ELAPE model) were developed. The maximal stress on non levator ani tissues were analyzed using the three models, while the maximal stress on levator ani tissues were analyzed using the in-tact model and the individual ELAPE model. Their stress distributions under the same pressure were analyzed and compared. Results:The maximal stress on non levator ani tissues obtained using the intact model, ELAPE model, and individual ELAPE model were (1.963± 0.061), (5.127 ± 0.070), and (3.667 ± 0.126) MPa, respectively, with P<0.01. High-stress zones were obtained at the joints with pelvic walls on both sides using the three models, while the maximal stresses were obtained at the joints with pubis on both sides. The maxi-mal stress on levator ani tissues obtained using the intact model and individual ELAPE model were (0.812 ± 0.042) MPa and (1.437 ± 0.043) MPa, respectively. Thus, the individual ELAPE model yielded higher values of maximal stress compared to the intact model. Both models generated high-stress zones at the joints with tendinous arch of levator ani tissues on both sides, and maximum stresses at the joints with pubis on both sides. Conclusion:Individual ELAPE decreases the stress on non levator ani tissues. This suggests that the risk of postoperative pelvic floor hernia is relatively reduced.

Effect of extract ethanol and water decoction of Psoralea corylifolia L.on bone development and their toxicities in zebrafish / 中国药理学与毒理学杂志

OBJECTIVE To investigate the bone development activity and differences in safety of ethanol extract (EE) and water decoction (WD) of Psoralea corylifolia L.efficiently.METHODS Zebrafish larvae were co-exposed to prednisolone 25 μmol· L-1 and different concentrations of EE and WD (0.1,1.0,10 and 100 mg crude drug· L-1),and etidronate disodium (ED) 30 mg·L-1.All these groups were incubated at 28.5℃ until 9 dpf.The medium solution was changed every other day.Zebrafish skeleton at 9 dpf was stained with alizarin red and inspected under an optical microscope,in addition,the death toll and organ toxicity of zebrafish were also observed.The mRNA expression of osteoprotegrin (OPG) and receptor activator of NF-κB ligand (RANKL) in 9 dpf zebrafish were determined with fluorescence quantitative PCR.Zebrafish embryos (1 dpf) were exposed to various concentrations of EE (10,20,30,35,40,50 and 60 mg crude drug· L-1),WD (10,50,100,125,150,175,200 and 500 mg crude drug· L-1),psoralen (12.5,25.0,50.0,100.0,200.0 and 400.0 μmol·L-1) and bakuchiol (1,5,10,25 and 50 μmol· L-1).Embryonic morphology of zebrafish (3 dpf) was inspected with an optical microscope and the death toll of embryos or larvale was counted from 2 dpf to 9 dpf and LC50was calculated.Components of EE and WD ware analyzed by HPLC method.RESULTS Both EE (0.1 mg crude drug· L-1) and WD (1.0 mg crude drug· L-1) groups could increase the staining area and optical density values of zebrafish skeleton compared with prednisolone group (P＜0.01),indicating the increase in bone mineralization;the OPG mRNA expression in both EE and WD (1.0 mg crude drug· L-1) groups increased,while the RANKL mRNA expression decreased (P＜0.01) and the ratio of OPG/RANKL improved obviously (P＜0.01).Embryos exposed to EE,WD,psoralen and bakuchiol showed swelling of the heart and yalk sac,and decrease in GOT.The LC50 of WD and psoralen was 5～8 and 5～21 times that EE and bakuchiol,respectively.The composition and relative content of EE and WD also varied considerably.CONCLUSION Bone development activity and toxicity of EE are both stronger than those of WD.The lipid soluble characteristic components of Psoralea corylifolia L.,may be critical components of toxicity.

Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography / 中华医学超声杂志（电子版）

Objective Uterine intravenous leiomyomatosiswas a rare type of uterus tumors.Because of the lack of knowledge about the ultrasonic patterns of this kind of disease,misdiagnosis frequently happens.Reviewing the cases and relevant researcheswas helpful to understand the disease and figure it out inultrasonic images.Methods Six cases of patients with uterine intravenous leiomyomatosis were reviewed which werehospitalized in Beijing Obstetrics and Gynecology Hospital during 2014 to 2016.All of the patients underwentultrasound examinations before surgery.The ultrasound findings,clinical presentations and pathological features of the 6 patients were evaluated.Results In 6 patients with uterine intravenous leiomyomatosis,3 cases were solid tumors,located in the cervix region and para uterine region,withirregular veinvascular inside;3 cases performance as multiple tumorlocated in dilated uterine vein,active tumor embolus were found in inferior vena cavain one of the 3 cases.Conclusions Uterine intravenous leiomyomatosisis found to be a solid mass located in the cervix region and para uterine region.The internal fissure of solid tumor is an important feature.Tumor extending to the iliac vein and inferior vena cava in some cases.Thusit is hard to be diagnosed before surgery by ultrasonography.Moreover,transvaginal ultrasound combined with inferior vena cava ultrasonography and echocardiography has a more obvious advantage in the diagnosis of the uterine intravenous leiomyomatosis.

Comparison of cutaneous buckle and conventional cutaneous suture in artistic appearance of anterior cervical incision / 局解手术学杂志

Objective To compare the effect of cutaneous buckle and conventional suture on the suturing time and the artistic appear -ance of postoperative incision with patients who underwent anterior cervical spinal surgery .Methods The patients were randomly divided in-to cutaneous buckle group(50 patients) and conventional suture group(50 patients),the suturing time and artistic appearance of postopera-tive incision of two groups were observed .Results Buckle group and conventional suture group both got good wound healing ,the same heal-ing rate of two groups(100％) showed that there was no statistical difference in healing rate (P>0.05).The mean time of buckle group and conventional group were 7.3 minutes and 13.5 minutes,respectively,the suturing time of cutaneous buckle group was much shorter than con-ventional suture group (P<0.05).The satisfactory degree for artistic appearance of the former was higher than the latter (9.1 vs.6.8 points),the difference was significant(P<0.05).Conclusion Compared with conventional suture ,cutaneous buckle has the advantages of shorter suturing time ,better artistic appearance of incision and higher satisfactory degree in the anterior cervical spinal surgery .