Up to now postpartum hemorrhage is still the major reason for maternal death. This paper focuses on definition, etiology, diagnosis and treatment of postpartum hemorrhage according to the Guideline on the Prophylaxis and Treatment of Postpartum Hemorrhage 2009 and 2014, to help gynecology and obsterics clinicians recognizing, diagnosing and treating postpartum hemorrhage timely, in order to reduce the maternal mortality.

Cervical cancer is one of the most common cancers among women worldwide. The distribution of the disease burden of cervical cancer is uneven in different regions and populations. The comprehensive prevention of cervical cancer has been taken as a seriously issue worldwide. Nowadays, the most effective ways to prevent cervical cancer include primary and secondary preventions. Many countries have approved human papillomavirus (HPV) vaccines to prevent HPV infection as primary prevention. Early detection and diagnosis of cervical cancer and precancerous lesions through population based on screening programs of women in appropriate age group has been proved to be effective in reducing incidence and mortality rates. By establishing comprehensive prevention strategies according to different conditions in each country, and applying it to target population, cervical cancer is hopefully to be the first human malignancy tumors defeated by overall prevention and practice.

Influenced by low productivity and limitation of technique, the early 20th century medicine was in its slow progression time and physician diagnosis ability was limited, who had struggled in empiricism and drugs application. With the innovation of human anatomy and the application of X-ray, CT, MRI and other advanced inspection technique, medicine has seen great changes. A variety of instruments provide more effective ways for diseases diagnosis and treatment, and to physicians who relied on personal experience, offer a powerful technique support, broaden their view and extend the function of human senses, what′s more, accelerate transform form empiricism medicine to modern medicine and make physicians more skillful in diseases diagnosis and treatment. With the rapid development and application of science, people have a better understanding of disease. Nevertheless, there are some potential unintended problems in the progress of advanced technique application in clinical treatment. Given all above, it is essential and important to evaluate these innovations objectively and accept them rationally now when current advanced diagnosis and treatment techniques are playing an ever increasingly important role in the development of medicine. In this review, we will introspect upon the defects in medicine science development and in the combination of medicine and humanities.

To summarize the characteristics of pernicious placenta previa (PPP) disease complex with placenta implantation, and analyze the reason of ultraound misdiagnosis and missed diagnosis in placenta implantation proved by surgical pathology and clinically follow-up.

Fifty-one cases clinically diagnosed PPP disease patients were examined by both transabdominal and transperineal ultrasounography.

Out of 51 PPP patients, 42 cases (82.4%, 42/51) were proved as placenta increta disease and 9 cases were confirmed with no placenta implantation complication. By transabdominal ultrasound (TAS) combined transperineal ultrasound (TPS) method: 40 cases were correctly diagnosed with placenta implantation (78.4%, 40/51), while 7 cases (13.3%, 7/51) were confirmed without placenta increta, 2 cases (3.9%, 2/51) were mis-diagnosed, 2 cases (3.9%, 2/51) were missed diagnosed. The goup of abdominal ultrasound findings: the placental thickening, diffuse or focal placenta essence lacuna in 25 cases, the gap disappeared after the placenta and placental uterine muscle layer becomes thin (less than or equal to 2 mm) 44 cases, uterine flesh layer arcuate artery arranged in disorder in 34 cases, placental uterine serosa layer bladder junction rich in blood vessels at 18 cases of disorder. Perineal sonography of performance: swelling of lower uterine segment lung, placenta thickening in 25 cases, cervical enlargement, placenta local to the cervical extends into the 6 cases, lower uterine segment and cervical tube placenta cover flow was rich in 8 cases.

PPP disease complex with placenta implantation can be prenatally diagnosed by characteristic ultrasonic features. The combination of TAS and TPS can further improve the diagnostic accuracy of PPP.

Diagnostics is the study of diagnosis related theory and knowledge , principles and rules, skills and methods . It's a clinical medicine professional discipline. It is very important for clinical doctors to research and study of theoretical knowledge of diagnostics incessantly, understand correctly the connotation of diagnostics, master and use the skills and methods of diagnostics . In this article, the content, task , and developmental direction of the diagnostics are discussed.

With the gradual popularization and application of laparoscopic surgery in colorectal cancer and other gastrointestinal tumor, minimally invasive surgery concept flourished in the surgical oncology.One of the directions of the surgical oncology is functionalization, minimally invasive concept and function of surgical requirements are complementary, functional surgery requirements based on operation treatment, organs retain function.In order to ensure the interests of patients, doctors should be innovative in the standardization.The future of minimally invasive surgery has no limits, also is the inevitable trend of functional surgery.

To analyze the causes of reoperation in patients with hepatolithiasis and to investigate the choice of surgical approach.

The data of 136 patients (men 60, women 76) who underwent reoperation due to hepatolithiasis from January 1997 to December 2007 were reviewed. The classification of hepatolithiasis were: type Ⅰ101 cases (74.3%), type Ⅱa 5 cases (3.7%), type Ⅱb 27 cases (19.8%) and type Ⅱc 3 cases (2.2%).

The causes of reoperation included remnant bile stone (22.8%), recurrence of bile stone (38.3%), failed to correct the stricture of intrahepatic bile duct(16.9%) or dilatation of extrahepatic bile duct (13.2%), and emergent cases of primary operation(8.8%). The procedures of reoperation were choledochotomy+ "T" tube drainage (24.3%), hepatectomy(2.2%), choledochotomy+Oddis sphincteroplasty(3.7%), choledochotomy+hepatectomy+ "T" tube drainage(21.3%), choledochotomy+ choledochojejunostomy(29.4%), and choledochotomy+hepatectomy+ choledochojejunostomy(19.1%). The main perioperative complications included bile leakage (4.4%), subphrenic abscess (2.2%), bleeding of bilio-enteric anastomosis (0.7%), pulmonary infection(1.5%), and infection of incision(5.1%). The perioperative mortality was 0.7%. Fourteen patients had remnant bile stones after reoperation. The recurrent rate of bile stone was 18.8% during follow up.

Full estimation of the status of hepatolithiasis and ample preparation should be done before reoperation. In order to decrease the recurrent rate of hepatolithiasis, hepatectomy may be choosed as far as possible.

To investigate the delivery of repeated pregnancy after cesarean section. Evaluate the likelihood of vaginal birth after caesarean(VBAC).

There were 116 pregnant women with previous cesarean section delivery who would delivery again from March 2009 to December 2011 in Nanjing Maigaoqiao Hospital.Their outcomes were analyzed by retrospective analysis method. Informed consent was obtained from all participants.

Among 116 pregnant women of 15 cases (12.9%)of vaginal trial production, 10 cases(66.6%, 10/15) were successful. Once again the cesarean section rate was 91.4%(106/116). There were 27 cases(23.3%) who had vaginal production conditions but chose elective cesarean section. Formerly medical history of previous cesarean section delivery were not clear of 13 cases (11.2%) who also chose elective cesarean section. There had significance difference between actual cesarean section rate and indication for caesarean section rate(P<0.05).

Repeated pregnancy after cesarean section delivery is not absolute indications for cesarean section.To meet the requirements of the pregnant women can vaginal delivery in intensive care.

To explore the diagnosis and treatment of pernicious placenta previa complicated with placenta accrete, in order to decrease operation hemorrhage and hysterectomy rate.

We conducted a retrospective study at 52 pregnant women with pernicious placenta previa, who were treated at the Maternity and Child Health Care Hospital of Foshan City from January 2008 to October 2012. This study reviewed the incidence rates, diagnosis and treatment.

(1) Among the 52 patients, 19 were diagnosed pernicious placenta praevia with placenta implantation; the incidence rate was 36.5%; while 8 patients were pernicious placenta praevia with placenta percreta, which incidence rate was 15.4%. (2) Ten patients were diagnosed by color Doppler ultrasound before operation; the diagnosis rate was 52.6%. (3) Vascular hyperplasia expansion of bladder mucosa were seen through cystoscopy in placenta accrete invade in the bladder. (4) Hysterectomy was used in 4 cases(7.7%), and 48 cases(92.3%) were preserve utero.

(1) Color Doppler ultrasonography and cystoscopy can improve the diagnosis rate of pernicious placenta previa. (2) It is the effective way to reduce bleeding and hysterectomy rate of pernicious placenta previa cases applying appropriate incision of cesarean section on placental edge combining ligating ascending uterine artery, internal iliac artery and B-Lynch suture.

原发性胆囊癌是胆道常见恶性肿瘤，恶性程度高，早期诊断困难，预后极差。掌握原发性胆囊癌的流行病学特征，对改善胆囊癌的诊断、预防及治疗都有着重大的意义。

To study the relation between nodular goiter and thyroid cancer.

Immunohistochemical method was used to detect expression of p27 protein in 58 cases of nodular goiter, 15 cases of nodular goiter with hyperplastic nodule, 44 cases of thyroid cancer and 20 cases of normal thyroid tissue.

The positive expression rate of p27 protein was 60.5% in normal thyroid tissue, 38.6% in nodular goiter, 34.1% in thyroid cancer and 0 in nodular goiter with hyperplastic nodule. The positive expression rate of p27 protein in both nodular goiter and thyroid cancer was significantly higher than this in nodular goiter with hyperplastic nodule (P<0.01).

Nodular goiter with hyperplastic nodule may be a premalignant lesion, nodular goiter had malignant potential.

There have been a lot of researches indicated that commonly used postoperative analgesia may far from having negative effects on maternal postpartum lactating function, it may promote lactation function and improve the successful rate of breastfeeding. However, there are also a few studies showed that postoperative analgesia cesarean section can affect the babies' breast behavior and maternal postpartum lactation behavior. This paper reviews research progress of influences of postoperative analgesia on maternal lactation, in order to provide reference information for clinical use..

To evaluate the safety and efficacy of precise hepatectomy techniques in hepatolithus.

Ninety-two patients with hepatolithus undergoing hepatectomy from January 2008 to October 2012 were reviewed retrospectively. Thirty-two patients received irregular hepatectomy (control group) and 60 received precise hepatectomy (experimental group), and the intraoperative and postoperative indexes such as operative time, intraoperative blood loss, postoperative liver function, length of hospital stay, incidence of complications and clearance rate of calculus were analyzed.

In experimental group, the operative time was longer [(262.2±54.2)min vs (174.8 ±54.8)min, t=30.727, P<0.01], but the patients had reduced intraoperative blood loss [(438.5±89.6)ml vs (680.6±74.7)ml, t=-86.465, P<0.01], faster recovery of liver function [ALT value on POD 7, (50.1±7.4) U/L vs (320.7±11.8) U/L, t=-96.470, P<0.01], less postoperative complications(11.7% vs 40.6%, χ²=10.227, P<0.01), higher clearance rate of calculus(100.0% vs 75.0%, χ²=16.429, P<0.01)and shortened length of hospital stay [(15.9±5.4) d vs(23.4±4.3) d, t=-50.103, P<0.01].

Precise hepatectomy is safe and effective in the treatment of hepatolithus without much injury to patients. Precise hepatectomy can significantly decrease postoperative complications, length of hospital stay, and accelerate the early rehabilitation.

To determine the accuracy of biological markers expression in core needle biopsies(CNB) compared with surgically excised specimens(SES) and the influence of preoperative chemotherapy on these markers expression.

One hundred and fifty-two of 170 patients were analyzed. Ninty-nine women received neoadjuvant chemotherapy, and 53 patients underwent immediate surgery. Estrogen(ER) and progesterone receptor(PR), Her2, Ki67, p53 and Topo Ⅱ in biopsy tissue and surgically removed specimens were assessed using immunohistochemistry staining and calculated accuracy and kappa value.

The assessment of biological markers expression can be performed on CNB and correlated well with subsequent SES regardless of patients with or without preoperative chemotherapy (K > 0.6), although the concordance rate in patients without preoperative chemotherapy was found to be higher for biomarkers expression compared to women with preoperative chemotherapy. The accuracy of CNB was 87%-91% in patients without neoadjuvant, and 78%-95% with neoadjuvant. No significant deference was observed about the effect of neoadjuvant chemotherapy on ER, PR, Her2, Ki67and p53, except Topo Ⅱ.

The agreement of breast cancer biomarkers expression detected in CNB and SES is high. The accuracy of biomarkers measurement in CNB is good. The effect of neoadjuvant chemotherapy on biological markers is small.

探讨腹腔镜下保胆取石术治疗有功能的胆囊结石的安全性及有效性。

2006年4月至2009年1月采用腹腔镜下保胆取石术治疗经严格筛选的有功能胆囊结石80例，术后随访3~39个月，对消化道症状及胆囊壁厚度、胆囊功能的主观和客观指标进行分析。

腹腔镜下保胆取石术后消化道症状完全消失，胆囊壁厚度由术前的（2.30±0.40）mm，变为术后6个月的（1.50±0.30）mm(P<0.05），术后1年为（1.40±0.30）mm（P<0.05），较术前明显变薄，胆囊收缩面积由术前的（0.32 ±0.05）cm³，提高到术后6个月的（0.39±0.06）cm³（P < 0.05），术后1年的（0.40±0.07）cm³（P < 0.05），无术中副损伤或术后严重并发症,无中转开腹及死亡病例。

与以往公认的腹腔镜胆囊切除术和开腹胆囊切除术相同,腹腔镜下保胆取石术治疗有功能的胆囊结石是一种安全、有效的术式,并且副损伤少。

To evaluate the clinical features of children with bronchiolitis, and compared their treatment response between different dosage of nebulised budesonide suspension for inhalation.

From January to December 2011, a total of 157 cases of children with bronchiolitis were recruited. Related clinical data of children diagnosed and administrated were collected and analyzed by soft ware SPSS 19.0. The patients were randomly divided into low dose group(n=78) and high dose group(n=79), they were nebulised budesonide suspension for inhalation 0.5 mg once and 1.0 mg once, respectively. Informed consent was obtained from the parents of each participating child. There had no significance difference between two groups among age, gender ratio and classified of bronchiolitis evaluated(P>0.05).

At treatment 30 minutes, children with mild bronchiolitis, Beck score, respiratory frequency in high dose group were much lower than those in low dose group(P<0.001, P=0.01), pulse oxygen saturation in high dose group was statistically higher than that in low dose group(t=3.596, P<0.001). The same result could be seen in children with severe bronchiolitis. At treatment 60 minutes, children with mild bronchiolitis, Beck score, respiratory frequency in high dose group were much lower than those in low dose group(P=0.003, P=0.001), pulse oxygen saturation in high dose group was much higher than that in low dose group(t=4.593, P<0.001), The same result could be seen in children with severe bronchiolitis. There had no significance difference between high and low dose group in hospitalization time and expenses (P<0.05), and those in high dose group were much shorter and less cost.

Treatment by 1.0 mg budesonide suspension, response of children with bronchiolitis are much better than that of 0.5 mg group. Related clinical data include faster changing in Beck clinical score, respiratory frequency, pulse oxygen saturation; shorter hospitalization time and less cost of hospitalization expenses.

To investigate the clinical, etiological and epidemiological characteristics of acute lower respiratory tract infection (ALRI) in Kunming region. The etiological agents, including bacteria, virus and atypical pathogens were studied in order to determine different characteristics of age distribution of respiratory infectious agents.

From October 2005 to October 2007, a total of 1402 hospitalized children with ALRI were included into this study (study group). Meanwhile, another 50 healthy children who underwent regular physical examination were recruited into control group. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Children's Hospital of Kunming. Informed consent was obtained from each participate. There had no significant difference between two groups on ages and so on. The nasal secretion samples were collected from study group for the bacterial agents culture and identification; viral antigens were detected by direct and indirect immunofluorescent analysis.

The etiological agents were detected in 402 of 1402 patients (28.79%), of which 9.1%(127/1402) were mixed infections. The bacterial-, viral-, and non-typical etiological agents were identified in 402 (28.79%), 365 (26.0%) and 259 (18.5%) of 1402 patients with ALRI, respectively. Total positive rate of respiratory pathogens was 82.2% (1153/1402). The bacterial agents identified from the 402 positive samples mainly consisted of the Gram-negative(G^-) bacteria(73.1%) [E.coli (41.3%), Klebsiella pneumoniae (15.4%), Haemophilus inflenzae (6.0%)], and the G⁺ bacteria (mainly Streptococcus pneumoniae) was detected as causative agents responsible for ALRI, for incidences of 14.4%. Of 365 virus positive samples, 312 samples (85.5%) were tested as positive for the respiratory syncytial virus (RSV) antigen, 12 samples testing positive for influenza A virus(IVA), 7 samples for parainfluenza virus type (PIV)Ⅱ, 24 samples for PIVⅢ and 7 samples for adenovirus (ADV). No samples testing positive for influenza B virus (IVB). Non-typical pathogens identified were Mycoplasma pneumoniae(MP), Legionella pneumoniae type 1(LP1), and Chlamydia pneumoniae(CPn), accounting for 11.6%, 6.3%, and 0.6% of the total samples, respectively. Bacteria, virus were two main causative agents responsible for ALRI in younger children, whereas non-typical pathogens were frequently observed in elderly children. Bacteria and atypical pathogens infection incidences showed seasonal differences during a year, but the RSV was the main causative agent during a year, especially in autumn.

G^- bacteria and respiratory syncytial virus are the two main local causative agents which were responsible for ALRI in children; the younger the children are, the higher incidence there is. The etiological agents' patterns vary from place to place.