Volume 91  ·   Issue 45  ·  2011

The term "family planning" originated from "family planning" (planned parenthood), that is, to have children in a planned manner. In our country, family planning is one of the basic national policies, and its meaning is to implement the planned production of human beings within the social scope under the socialist condition. As a national policy, family planning in our country is to make the population, economy, society, resources and environment achieve coordinated development through the planned regulation of the birth process, so as to promote economic development and social progress. The implementation and implementation of this national policy of family planning, policy formulation and administrative management are very important, which has been recognized and accepted by everyone.

Objective To explore the clinical diagnosis and treatment of cesarean scar pregnancy (CSP).Methods The clinical data of 100 CSP patients during the period of January 2003 to March 2011 were collected for a retrospective analysis.Results Among 100 cases of CSP,there were cases of asymptomatics(45％,n =45),vaginal hemorrhage(55％,n =55)and lower abdominal pain(7％,n =7); among first diagnosed(n =81),the cases were diagnosed(n =75)or misdiagnosed(n =6); among19 hospital referrals,18 were confirmed and 1 case was misdiagnosed as choriocarcinoma.Treatments included ultrasound monitoring curettage after UAE(uterine artery embolism)(n =56),pure ultrasound monitoring curettage(n =30),laparoscopic lumpectomy after UAE(n =2),laparoscopic Iumpectomy(n =2),methotrexate only(n =3),hysterectomy(n =2),UAE hemostasis(n =3)and Foley catheter balloon compression hemostasis(n =2).No significant difference was found in the average duration of pregnancy,average operative hemorrhage volume and operative duration between 2 management groups of curettage after UAE or pure curettage(P ＞ 0.05).But sac diameter and serum level of β-HCG were obviously less in the pure curettage group than those in the UAE group.And the distance between gestation sac and bladder significantly was greater than that in the UAE group; in the pure curettage group,96.7％ existed as an endogenous type and only 36.7％ yielded small flow signals.One hundred patients recovered before discharge.A follow-up of patients with curettage after UAE(n =43)and pure curettage(n =26)had similar recovery of menstruation.Eight cases(4 in each)were pregnant again during the follow-up.One case of recurrent CSP was treated with curettage after methotrexate.Conclusion Early diagnosis and early treatment remain the key for a successful treatment of CSP.Color Doppler ultrasound is important in its early diagnosis and treatment.Different therapeutic modalities may be selected according to specific patient conditions.

Objective To explore the distribution and factors associated with female infertility in 3 areas in Xinjiang Uygur Autonomous Region so as to provide rationales for the prevention,diagnosis and treatment of infertility.Methods A total of 1895 women of reproductive age were enrolled with a cluster random stratified sampling method.A questionnaire survey and pelvic examinations were conducted.The collected data were statistically analyzed.Results The prevalence of infertility in these three areas ranged from 7.5 ％(76/1014)to 26.2％(144/550)with an average of 15.2％(279/1835).The prevalence of infertility was the highest in Shan shan and it was related with its unique geographical environment and life style.The lower levels of education and income,the higher prevalence of infertility.The occurrence of infertility was also correlated with their residence,premarital sex,body mass index and some concurrent diseases.Conclusion It is necessary to carry out further studies on healthful life styles and those factors associated with the morbidity of infertility.The prevalence of infertility may be reduced and local reproductive health improved by avoiding or reducing the adolescent premarital sex and unmarried abortion.

Objective To compare the different effects of taking different kinds and doses of estrogen and progestogen after medical abortion on reducing vaginal hemorrhage time.Methods A total of 188 women undergoing medical abortion were recruited and randomized into 3 groups:group A(n =41)starting marvelon(30 μg ethinylestradiol and 150 μg desogestrel)on the day of abortion for 21 days; group B(n =53)starting progynova 2 mg/d on the day of abortion for 21 days and taking depogeston 10 mg/d on the last 5 days; and group C(n =94)as controL The vaginal hemorrhage time,days to onset of next menses and the outcome of medical abortion were compared.Results There was no significant difference in the duration of hemorrhage between groups A and C[(20 ± 13)vs(19 ± 11)d,P ＞ 0.05].But the duration of hemorrhage in group B was significantly shorter than that in group C[(14 ±7)vs(19:±11)d,P＜0.01].There was no significant difference in the amount of hemorrhage among 3 groups(P ＞ 0.05).The time to onset of first menses was similar between groups A and B[(34 ± 13)vs(30 ±7)d].And both were significantly shorter than that in group C[(39 ± 11)d,P ＜ 0.05].There were 3(7.32％)incomplete abortions in group A,4(7.55％)in group B and 12(12.77％)in group C(P ＞ 0.05).Conclusion The sequential therapy of estrogen and progestogen after medical abortion may effectively reduce the duration of hemorrhage.And the combined oral contraceptive pills fail to significantly alter the duration of hemorrhage after medical abortion.But both can promote menstrual recovery significantly.

Objective To compare the contraceptive efficacies and side effects of Mirena (levonorgestrel-releasing intrauterine system,LNG-IUS)inserted immediately after artificial abortion and in the period of regular menstruation.Methods A total of 166 female subjects volunteered for the insertion of LNG-IUS.They were divided into 2 groups.Eighty-six female subjects inserted right after artificial abortion were selected as the observation group and 80 female subjects inserted during the period of regular menstruation as the control group.Follow-up was performed at one year after insertion.Contraceptive efficacies and side effects were compared between two groups.Results No pregnancy was found in both groups.No mirena expulsion occurred in neither groups.The continuation rates were 100％ and 95％ in the observation and control groups respectively(P ＞0.05).The rates of abnormal hemorrhage were 27.5％ and 36.2％ in observation and control groups respectively during the first three months(P ＜0.05).And 22.7％ and 23.3％ subjects suffered amenorrhea respectively in the first year.No significant difference was found in such side effects as amenorrhea,weight gain,acne and swollen breasts between two groups(P ＞ 0.05).Conclusion Mirena is proved to be an excellent choice for contraception after artificial abortion.Secondary intrauterine surgery may be avoided.And its insertions immediately after artificial abortion or during the period of regular menstruation share the same efficacies.

Objective To assess the safety and effectiveness of intrauterine device in Chinese women.Methods In this multicenter randomized controlled trial,a total of 24 000 women were randomly (1∶1∶ 1)into 3 groups of Yuangong Cu 365(YCu365),Copper T 380A(TCu380A)and Multiload Cu 375 (MLCu375).Clinical outcomes were assessed at 12 months post-insertion,including discontinuation due to pregnancy,expulsion,hemorrhage and downward displacement,etc.The overall and causal-specific discontinuation rates for adverse events were calculated.Results At the end of the first year,the discontinuation rate of YCu365(4.21％)was the lowest,followed by TCu380A(8.42％)and MLCu375 (13.91％)(P ＜0.01).The differences of discontinuation rates for pregnancy,expulsion,hemorrhage and downward displacement between these IUDs were also significant.MLCu375,side effect without medical treatment,fewer follow-ups,deeper uterine cavity and previous IUD failure were significantly associated with an increased risk of IUD discontinuation.Conclusion The newly developed indomethacin-releasing YCu365 IUD appears to perform the best.However,its long-term safety and cost-effectiveness should be further evaluated.

Objective To evaluate the clinical efficacy of intralesional excision and immediate postoperative adjuvant radiotherapy in the treatment of keloids.Methods Eighty-one patients with a combined total of 86 keloids were treated with 6 MeV electron beam radiotherapy after surgical intralesional excision of keloids.All received a total dose of 15-20 Gy for 5 consecutive days beginning the day of surgery.The time interval between keloid excision and the delivery of first fraction of radiotherapy was ＜ 6 h.The post-operative follow-up period was 12-31 months.Results Forty-three cases yielded excellent outcomes and there were 18 fair cases.The overall effective rate was 85.9％.There were 10 recurrent cases.Only adverse effects such as delayed wound-healing and telangiectasias(11.3％)were found.Neither severe complications nor secondary malignancies occurred.Conclusion Intralesional excision of keloid and postoperative electron radiotherapy are well-tolerated and efficacious in the prevention of keloid recurrence.

Objective To compare the differential phosphorylation level of proteins between relapsed nasopharyngeal carcinoma(rNPC)and primary nasopharyngeal carcinoma(pNPC).Methods Total protein was extracted from 4 pNPC tissue and 4 rNPC tissue samples from January 2003 to September 2005.Then it was analyzed by antibody microarray with 656 antibodies.The differential phosphorylation level of proteins was screened and clustering analysis conducted.The phosphorylation status of the protein sites and its functional pathways were analyzed via an online database of PhosphoSite Plus.The protein expressions were detected by immunohistochemistry.Results Relapsed and primary nasopharyngeal carcinomas had differential phosphorylation level of proteins.And 6 differentially expressed proteins were identified.The phosphorylation levels of KIT,ATP1A1,Synapsin,SEK1 and histone H2AX were up-regulated in rNPC (P =0.007-0.048)while c-Jun was down-regulated(P =0.030).The expression of P-H2AX in rNPC was significantly higher than that in pNPC[0.390(0.175)vs 0.290(0.155)],but p-c-Jun was significantly lower in rNPC than that in pNPC[0.625(0.145)vs 0.725(0.178)](both P＜0.05).Among them,the changes in the phosphorylation levels of c-Jun,histone H2AX,SEK1 and KIT might play important roles in the relapse of NPC through improving DNA damage repair ability,inhibiting apoptosis and promoting tumorigenesis.Conclusion The changes of protein phosphorylation may help to explain the recurrent mechanisms of NPC and provide new therapeutic anti-recurrence targets.

Objective To evaluate the effects of hyperbaric oxygen(HBO)therapy in the management of chronic wound and observe the correlation between wound healing and CD34 + endothelial progenitor cells(EPCs).Methods A total of 119 patients with chronic wound in lower extremities lasting ＞3 months were recruited for this randomized,single-center,placebo-controlled clinical trial.The changes of CD34 + average count before and after HBO therapy were detected by flow cytometry(FACS).There were 97 patients on long-term HBO therapy and in 22 patients on hyperbaric air therapy as control group.The CD34/Scal-1 + and CD34/CXCR4 dual-positive populations of gated cell were determined respectively by FACs.The outcomes of two groups were compared.Treatment was administered within a single-place hyperbaric chamber for 90-main daily(session duration 120 main)for 5 days a week for 4 weeks (20 treatment sessions).Results The wound size decreased at the4-week end point(62.7％ +22.3％ in the HBO group vs 34.4％ +20.6％ in the control group,P ＜0.05).Mter 10 episodes of HBO therapies for chronic non-healing wound,the peripheral CD34 + EPCs average count rose from 0.24％ + 0.03％ at pretreatment to 1.32％ ±0.05％ while the number was 1.75％ + 0.17％ after 20 episodes of HBO(P ＜ 0.05)Both were significantly different from that of the patients at pre-treatment.However the overall circulating white cell count was not significantly elevated.The CD34/Scal-1 + and CD34/CXCR4 dual-positive populations of gated cell in HBO group were 5.8 and 5.2 folds than those at pre-treatment respectively.The number of EPCs was positively correlated with wound healing in lower extremities(correlation coefficient 0.84 ; P ＜ 0.01).Conclusion Adjunctive treatment of HBO facilitates the healing of chronic non-healing wound in selected patients through the mobilization of EPCs.

Objective To evaluate the diagnostic values of 99mTcO4-thyroid imaging plus ultrasonography in the differentiation of benign and malignant thyroid nodules.Methods 99mTcO4-thyroid imaging and ultrasonography were performed for 114 patients with 125 thyroid nodules.And the examination results were compared with the post-operative pathological findings.Results(1)Among 125 thyroid nodules,there were thyroid adenoma(n =64,51.2％),thyroid cancer(n =30,24.0％)and other thyroid diseases(n =31,24.8％).On thyroid images,73.6％ of them were of cold nodules.And among these cold nodules,25.0％ were of thyroid cancer.Among the ultrasonic results,125 nodules were predominantly of solid nodules and mixed solid and cystic nodules while the malignant rate of solid nodules was the highest.(2)The malignant rate of solid cool or cold nodules was greater than those of mixed solid and cystic cool or cold nodules(P ＜0.005).(3)In solid cool or cold nodules with a diameter of ≥2.0 cm,thyroid cancer accounted for 62.5％.Conclusion The combination of 99mTcO4-thyroid imaging and ultrasonography may help to evaluate the 99mTcO4-uptaking functions of thyroid nodules so that it plays an important role in the differentiation of benign and malignant thyroid nodules.

Objective To evaluate the clinical efficacies of restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA)for ulcerative colitis(UC).Methods A total of 115 UC patients underwent the procedure of RP-IPAA during the period of 1989 to 2010.The data of surgical procedures,complications and long-term outcomes were collected.Stool frequency during the 24-hour period and the night were recorded at months 3 and 12 post-operation.Anal continence functions were evaluated by the Kirwan grading scale and the fecal characteristics identified by Bristol stool form scale.The patients' quality of life was objectively accessed by the Cleveland Global Quality of Life(CGQL)index.Results No perioperative death was reported.The mean follow-up period was for at least 12 months.The postoperative complication rate was 20.9％(24/115),including infectious complications,wound infection and(or)abdominal abscess,anastomotic leak,pouch hemorrhage,pouch-vaginal fistula,pouchitis,terminal proctitis,urinary calculi and male sexual dysfunctions.Stool frequency per 24 hours and night was ＜ 3 to 12 month post-operation(3.9 ± 1.7 vs 6.1 ± 2.6,1.3 ± 0.7 vs 2.8 + 1.8,both P ＜ 0.05).No significantchanges in anal continence functions existed between the above two time points[Grade Ⅰ:87.0％(n =100)vs 92.2％(n =106),Grade Ⅱ:7.8％(n =9)vs 4.3％(n =5),Grade llⅢ:5.2％(n =6)vs 3.5％(n =4),all P ＞0.05].The postoperative CGQL results showed a much better quality of life than preoperative one.Conclusion As the first-choice operation for UC,RP-IPAA is safe and it offers satisfactory long-term outcomes and improved quality of life.

Objective To present our initial experiences with pulmonary high-definition multidetector computed tomography(HDCT)in patients with acute venous thromboembolism(AVTE)to evaluate their corresponding clinical manifestations.Methods Since December 2009 to March 2010,23 AVTE patients underwent HDCT at our hospital.Pulmonary embolism(PE)was diagnosed based on the 3Dreconstructed images of computed tomography pulmonary angiography(CTPA).The postprocessed data were collected by spectral imaging system software to detect the iodine distribution maps.Perfusion defects,calculated as the values of iodine content,were compared with those of normal lung parenchymal perfusion in the absence of PE.Results Among them,14 AVTE patients were definitely diagnosed with PE.Prior to anticoagulant therapy,their values of iodine content in defective perfusion area were significantly lower than those in normal perfusion area.After a 3-month anticoagulant therapy,the values of iodine content for the defective perfusion area increased significantly(P ＜ 0.05).There was no significant correlation between the values of iodine content for segmental/subsegmental filling defect area and clinical risk score of DVT(r =2.68,P ＞ 0.05).But there was a significant negative correlation between the values of iodine content for segmental/subsegmental filling defection area and clinical probability score of PE(r =0.78,P ＜ 0.05).Conclusion HDCT is a promising modality of visualizing pulmonary microvasculature as a correlative manifestation of regional perfusion.PE results in hypoperfusion with decreased values of iodine content in affected lung parenchyma.Hemodynamic changes in affected areas correlate with the severity of clinical manifestations of PE.

Objective To explore the feasibility and efficacy of carotid endarterectomy(CEA)in the treatment of atherosclerotic carotid artery stenosis(ACAS).Methods From January 2002 to December 2010,126 ACAS patients undergoing carotid endarterectomy at our hospital were retrospectively analyzed.There were 92 males and 34 females with an average age of 65.5 years old(range:48-75).Among them,25 had sequelae of cerebral infarction,69 symptomatic cerebral ischemia and 32 asymptomatic.Sixty-two patients were monitored intra-operatively with transcranial Doppler(TCD).Among them,5 patients underwent arterial shunt due to a reduced b,ction of blood flow in middle cerebral artery for over 50％.The other 64 patients without TCD monitoring underwent intra-operative arterial shunt.And 22 patients underwent patch angioplasty with autologous or prosthetic vascular patch.Intracranial hyperperfusion was prevented by a compression of common carotid artery or control was successful without perioperative mortality.All patients with cerebral ischemic symptoms and some patients with cerebral infarction sequelae had much post-operative improvement.Deviated tongue protrusion occurred in 10 patients and 8 of them recovered at Week 2 postoperation.And 118 patients were followed up for a mean period of 46.5 months(range:6-96).Twopatients with deviated tongue protrusion had slight improvements; 2 patients with severe carotid artery stenosis underwent stent angioplasty; 4 patients with moderate carotid artery steno,sis received conservative treatment; among 7 deceased patients,two died of cerebral infarction.Conclusion CEA is effective in the treatment of carotid artery stenosis with a high success rate.TCD monitoring during CEA is valuable for preventing cerebral ischemia and intracranial hyperperfusion.Arterial shunt and arterial patch angioplasty should be considered according to certain conditions during CEA.

Objective To determine the correlations between metabolic syndrome(MS),its individual components and mild cognitive impairment(MCI).Methods We selected 168 MS patients and 150 healthy control subjects from our hospital from June 2009 to June 2010.Socio-demographic characteristic data including gender,age,education level,height,weight waist circumference and blood pressure,past history of coronary heart disease,stroke,diabetes mellitus,hypertension,hyperlipoidemia and unhealthy habit of smoking and drinking,were investigated.The patient levels of fasting plasma glucose,fast insulin glycated,hemoglobin and blood lipids were measured on the next day.All subjects were evaluated with regards to the scores of Montreal cognitive assessment(MoCA),clinical memory scale(CMS),daily living skills assessment(ADL)and Hamilton depression scale(HAMD).Result(1)MCI was more frequently detected in MS subjects than that in the healthy controls(24.4％ vs 1.2％);(2)the scores of general MoCA and several parts of MoCA were lower in the MS subjects(scores of general 26.8 ± 0.5,EF4.40 ± 0.04,NAM2.60 +0.06,MEM3.60 +0.20,ATT5.60 ±0.09,LANG2.60 +0.08,ABSI.50 ±0.10,ORT5.40 ±0.13)than those of the controls(scores of general 27.6 ± 0.4,EF4.50 ± 0.05,NAM2.70 +0.08,MEM4.20+0.11,ATT5.70 ±0.08,LANG2.60 +0.09,ABS1.60±0.07,ORT5.40 +0.10).No statistically significant differences existed in the scores of general MoCA and several parts except for memory and abstract(P ＞ 0.05).The scores of general CMS and several parts of CMS were lower in the MS subjects (scores of general 72 + 8,memory function reflected in memory 14 ± 2,associating study 14 ± 3,free image memory 14 ±4,recognition of meaningless figure 16 ±3,recollection ability of human figure 14 ±3)than those in the controls(scores of general 85 ±7,memory function reflected in memory 16 ±2,associating study 16 ±3,free image memory 17 ± 3,recognition of meaningless figure 18 ± 3,recollection ability of human figure 17 ±3).And the differences had statistical significance(P ＜0.05);(3)a high degree of education was a protective factor of MCI(OR =0.512,P =0.011)while diabetes,insulin resistance and metabolic syndrome were the independent risk factors of MCI(OR1 =4.240,P1 =0.014; OR2 =7.230,P2 =0.023 ;OR3 =8.620,P3 =0.001).Conclusion Diabetes mellitus and metabolic syndrome are the independent risk factors of MCI.

Objective To examine the efficacies and adverse events of low-dose tacrolimus in intractable myasthenia gravis(MG)patients during a long-term follow-up.Methods Tacrolimus was administered at 0.1 mg· kg-1 · d-1 to 36 generalized or ocular MG patients at our department from November 2008 to December 2010.The efficacies of tacrolimus were assessed by the myasthenia gravis activities of daily living(MG-ADL)profile and the classification of Myasthenia Gravis Foundation of America(MGFA).And the adverse events of tacrolimus were monitored in each patient.Results(1)All patients were followed up for 7-23 months.Adverse events occurred in 6 patients(16.67％).(2)The myasthenic symptoms improved up to the levels of MG-ADL and MGFA in 24 patients(66.67％).There was notable statistical significance in the comparison of clinical status at pre-and post-treatment(P =0.000).(3)The efficacies in patients with generalized MG were better than those with ocular MG(P =0.032).(4)The average blood trough levels of tacrolimus were lower than the recommended maintenance range from other countries in 24 effective patients.Conclusion The administration of tacrolimus induces symptomatic improvements in MG patients especially in generalized type.And the adverse events should be closely monitored.

Objective To explore the biological characteristics of immature and mature murine bone marrow-derived dendritic cells(DCs).Methods The murine bone marrow cells were cultured and induced in vitro into immature DCs(imDCs).Then ImDCs were incubated with TNF(tumor necrosis factor)-αt to obtain mature DCs(mDCs).The DCs were purified by mutine CD11c microbeads.The morphologies of DCs were observed by electron microscopy(EM).Such surface markers as MHC-Ⅱ,CD80 and CD86 were tested by flow cytometry(FCM).The proliferation capacity of allogeneic T cells stimulated by DCs was examined by Cell Counting Kit-8(CCK-8)in mixed lymphocyte reaction(MLR).The expressions of cell factors in mRNA of DCs were tested by real-time polymerase chain reaction(QPCR).The cytokines in supernatant were measured by ELISA(enzyme-linked immunosorbent assay).Results As compared with mDCs,fewer,shorter spines and more phagocytic vesicles and lysosome were observed in imDCs under EM.The expressions of cell surface molecules in imDCs were significantly lower than those of mDC by FCM,[MHC-Ⅱ(27.2％)vs(97.7％); CD80(27.6％)vs(97.2％); CD86(29.5％)vs(96.4％)].In MLR,the capacity of same-reaction ratio imDCs group for stimulating the proliferation of T-cells was remarkably lower than that of mDCs group,[1∶ 5(1.63 ± 0.04)vs(2.21 ± 0.09); 1∶ 10(1.50 ± 0.08)vs(1.92 ±0.02); 1∶20(1.28 ±0.07)vs(1.64±0.01); 1∶40(1.19±0.04)vs(1.45±0.06),P＜0.01].In imDCs,the relative mRNA expressions of IL12p35(0.66 ±0.13),IL12p40(0.57 ±0.10)and IFN-γ (0.74 ± 0.08)were lower than those of mDCs(1.00 ± 0.00),(P ＜ 0.05),but the expression of TGF-β (1.35 ±0.09)was higher than that of mDCs by QPCR(1.00 ±0.00),(P＜0.05).The expressions of IL12p70 and IFN-γin supematants from imDCs were lower than those of mDCs[IL12p70:(6 ±4)vs(120 ±22); IFN-γ:(56 ± 15)vs(90 ± 15),P ＜ 0.05]while the expression of TGF(transforming growth factor)-β was higher than that of mDCs by ELISA[TGF-β:(176 ± 23)vs(55 ± 18),P ＜0.05].Conclusion ImDCs can induce anergic T cells and immune tolerance through a down-regulation of costimulatory molecules,MHC-Ⅱ and Thl cytokines and an up-regulation of Th2 cytokine(TGF-β).And MDCs may activate naive T cells and stimulate immune responses by an up-regulation of co-stimulatory molecules,MHC-Ⅱ and Th1 cytokines.

The patient was a 51-year-old female who was admitted to the First Bethune Hospital of Jilin University for "nausea and vomiting for 9 months, intermittent abdominal pain and diarrhea for more than 3 months". The patient had nausea and vomiting without trigger 9 months before admission, and the vomiting was non-jetting, independent of body position. The vomit was mainly undigested food at meal, and occasionally every other day. Gastroscopy showed duodenitis, chronic gastritis with bile reflux (pathology showed gland atrophy), and colonoscopy showed chronic colonic inflammation and colonic polyps. More than 3 months before admission, she had paroxysmal falling pain in the middle and lower abdomen without trigger, and defecated yellow watery stool more than 10 times a day, containing some undigested food, a small amount of mucus, no pus and blood, no foul smell, accompanied by tenesmus, and abdominal pain was relieved after defecation. Another gastroscopy showed chronic erosive gastritis, and colonoscopy showed colitis and proctitis. After antidiarrheal treatment, there was no improvement. There was no fever or night sweats during the course of the disease. Slight weight loss.

Atlantoaxial complex fracture accounts for only 3% of all acute cervical injuries, 43% of atlas fractures and 16% of axial fractures [1]. Although the incidence of this type of disease is low, the incidence of nerve injury is higher than that of simple atlas or axial fracture [2]. Because there is no unified treatment plan for atlantoaxial complex fracture, there are many controversies about the diagnosis and treatment of this type of disease.

Cesarean scar pregnancy (CSP) refers to the pregnancy in which fertilized eggs are implanted in the cesarean scar. Once CSP is misdiagnosed as intrauterine pregnancy and pregnancy termination surgery is performed, massive bleeding often occurs, sometimes even life-threatening [1]; If CSP continues the pregnancy, the risk of placental implantation increases by 3 to 5 times, and there is a possibility of abdominal pregnancy [2].

The 6-month-old male was admitted to Hangzhou First People's Hospital on April 10, 2010. The child developed paroxysmal crying, irritability, less eating, drowsiness, no fever, no vomiting and diarrhea 3 days ago. He went to the hospital for frequent crying 3 times, and abnormalities were found by abdominal B-ultrasound 2 times. He was given "cefotaxime sodium" intravenous drip once; He suddenly appeared in coma 0.5h before admission, with pale complexion and no twitching of limbs. There was no history of convulsions in the past. The child was the first birth and first delivery, full-term cesarean section, with a birth weight of 3.31 kg. He was breastfed for 2 months after birth, and then fed formula milk. He would raise his head for 3 months, but could not turn over or sit alone.

A 59-year-old female was seen on January 21, 2011 because of "abnormal liver function for more than 2 years and fatigue for 1 month". The patient found elevated liver enzymes during health examination in 2009: alanine aminotransferase (ALT) 86 U/L, aspartate aminotransferase (AST) 90 U/L, no skin and sclera yellowing, no skin itching, no rash and ecchymosis, no nausea and vomiting, no anorexia and anorexia, no pain in the liver area, no diarrhea and blood in the stool. After treatment with hepatoprotective drugs, the liver enzymes could return to normal. However, after stopping the drug, the liver enzymes increased again (generally about 2 times the high limit of normal), and many etiological examinations of viral hepatitis were negative. One month ago, the patient felt general fatigue and found swollen cervical lymph nodes.

A 3-year-old female was admitted to the First Hospital of Jilin University due to chopsticks inserted into the mouth for 6 hours with nausea and vomiting.Physical examination: The child was conscious and crying, with a Glasgow score of 14 scores. An ordinary yellow-brown bamboo chopstick was inserted into the skin of the right maxilla and obliquely stabbed into the skull base through the oral cavity.The end and body of the bamboo chopstick were visible outside the skin and in the oral cavity.The length of the bamboo chopstick was about 12 cm. The abnormalities were found by physical examination of nervous system function.The three-dimensional CT reconstruction image of the skull base showed that a stripe-shaped low-density shadow was seen at the midline of the right maxillofacial region, which penetrated the sphenoid body and winglets from the right face, submandibular and infratemporal fossa to the intracranial temporal region, cavernous sinus region and right side of suprasellar cistern, and the lesion was immediately adjacent to the cavernous sinus segment of the right internal carotid artery; A few high-density shadows were found at the end of the low-density shadow (Figure 1). Computed tomography angiography (CTA) of the head showed a circular low-density shadow on the lateral side of the right cavernous sinus and the internal carotid artery, and the nearby blood vessels were intact (Figure 2). Clinical diagnosis: skull base fracture and intracranial foreign body.

Spleen injury is easy to occur during gastric cancer surgery, which causes uncontrollable bleeding, and it is difficult to deal with it [1-2]. In recent years, we have applied five methods of treating spleen injury, such as hemostatic gauze compression, blood-free electrocoagulation, net bag suture, partial splenic infarction and partial splenectomy, and achieved good clinical results, which are summarized and compared as follows.