Objective To evaluate the efficacy and safety of modified and simplified transumbilical laparoscopic technique in the treatment of varicocele.Methods Modified and simplified transumbilical laparoscopic technique was applied in the treatment of 5 6 patients with primary varicocele from July 2011 to January 2013.Then analyzing the operation time,amount of bleeding,hospitaliza-tion time and evaluating scrotal ultrasonography,semen quality and symptoms.Results All surgeries were successful,and the oper-ative time was 15-50 min,an average of(25.7±9.2)min;average amount of bleeding was less than 10 mL;hospital stays was 2~5 days,an average of(3.5±1.2)days.Patients were followed up for 3-24 months after operation.All patients′symptoms and sign significantly alleviated and semen quality in 46 patients was improved,no serious complications occurred during the follow-up peri-od.Conclusion Modified and simplified transumbilical laparoscopic technique is safe and effective in the treatment of varicocele. Moreover,it can reduce the cost of equipment and the difficulty of operation.

Objective To investigate infection rate of human papillomavirus as well as the correlation between cervical precancerous lesions and co-infection of human HPV,herpes simple virus-2 (HSV-2) and cytomegalovirus (CMV) in Chinese women of childbearing age in Kunming,Yunnan province.Methods A total of 2128 women (18-24,25-34,35-49 years of age),who had healthy care examination in our institute from January 2010 to March 2011,were selected prospectively in this study.The infection of HPV,HSV-2 and CMV were detected by real-time fluorescence quantitative polymerase chain reaction (FQ-PCR) and cervical precancerous lesions were determined by the ThinPrep liquid-based cytology test (TCT).Results The overall infection rates of high risk HPV (HR-HPV),HSV-2,CMV were 11.04％(235/2128),3.52％ (75/2128) and 5.26％ (112/2128),respectively.The HR-HPV infection rates in groups of Negative for Intraepithelial Lesion or Malignancy (NILM),Atypical Squamous Cells of Undetermined Significance (ASCUS),Low grade Squamous Intraepithelial Lesion (LSIL),High grade Squamous Intraepithelial Lesion(HSIL),and Squamous Cell Carcinoma (SCC) were 4.29％ (82/1912),55.93％ (66/118),84.62％ (44/52),93.19％ (41/44) and 2/2,respectively.HR-HPV infection rates was increased with the development of cervical lesion (r =0.644,P =0.000).No significant difference on the infection rates of HR-HPV and HSV-2 was identified between different age groups (x2 =2.979,P =0.226; x2 =0.798,P =0.671).The peak age groups for CMV infection (7.62％) were 18 to 24 years old and the infection rates of CMV decrease with age.No significant difference of HSV-2 and HR-HPV coinfection was found between the TCT-abnormal (3.24％,7/216) and control groups (2.41％,46/1912,x2 =0.557,P=0.455),and no relationship was found between HSV-2 and HR-HPV infection groups (OR =0.56,95％ CI:0.17-1.82).The infection of HR-HPV were related significantly with CMV infection (OR =3.14,95％ CI:1.25-7.86).Conclusion HR-HPV infection appears to be the key risk factor for cervical cancer and synergistic interaction may occur between CMV and HPV infections in the development of cervical lesion.

The core of hospital management is to strengthen and upgrade medical quality and secure satisfactory medical service through the mobilization of manpower,fund and materiel.The Lanzhou Aumy Hospital has gradually perfected the medical quality control system of a general hospital in combi- nation with the hospital's management system and in consideration of the development of modern hospi- tal administration in recent years.The operational law of the system is also studied and formulated.

ObjectiveTo explore the effect of guided learning in the eye optical applied optics teaching.Methods30 students of Grade 2013 were chosen as experimental group which was given guided learning teaching, and other 30 students of Grade 2013 were chosen as control group which was given used traditional teaching. In the guided learning teaching, self-study and practice students were re-quired to master the key and found the difficulties in the course firstly, answering questions after the group discussion. Then teachers focused on parsing the teaching materials. By the repeated communication and practice students mastered knowledge finally. The control group used the traditional teaching method which was based on the teacher's lecture. Through comparing the theory examination scores, practical as-sessment grades and questionnaire of the students self-assessment, teaching effect based on guided learn-ing was evaluated. Normal distribution measurement data was showed by standard deviation, T test was used in two independent sample measurement data; The count data was showed by rate, using Chi-squared test whichα=0.05.ResultsIn experiment group,the theoretical examination average score was(78.35±7.14) points, while in control group, the average score was(69.15±8.88)points. There were significance differ-ences between the two groups(t=-4.339,P=0.000). The experimental group practical assessment grades and the self-assessment score were superior to control group, and the difference has statistical sig-nificance (P<0.05).ConclusionGuided learning teaching can guide the students to obtain and master relevant knowledge independently, fully arouse their initiative of learning and improve their ability to analyze and solve problems, which can help reach a good teaching effect.

Macrovascular complications are the main death or disabling causes of diabetic patients.In recent years,the results of a number of clinical trials aimed at preventing diabetic macrovascular complications have been unveiled.Comprehensive and systemic analysis of these results may give great enlightenment to the clinicans,as well as promote the work in preventing diabetic macroangiopathy in China.

Objective To customize the optimal plans for radioactive 125I seeds volumetric implants in selected regular target volumes.Methods 125I seeds were symmetrically and uniformly implanted into 3 spherical targets with the diameters of 1,2 and 3 cm and 7 ellipsoidal targets with the 3 dimensions of 1 cm×1 cm×2 cm,1 cm×1 cm×3 cm,1 cm×2cm×2cm,1 cm×2 cm×3 cm,1 cm ×3 cm×3 cm,2 cm×2 cm×3 cm and2 cm×3 cm×3 cm.The activity and inter-space of seeds were adjusted to obtain the conformal and uniform dose distribution,with the prescribed D90 (the dose delivered to 90％ of the targets) greater than 145 Gy.The inter-space of seeds was changed from 1 cm to 0.75 cm,to improve the conformity and uniformity of dose distribution.Plan quality was assessed using homogeneity index (HI),external index (EI) and conformal index (CI).The activity and number of seeds implanted were also recorded and compared.Results For the spherical target with the diameter of 1 cm,when seeds were implanted with the inter-space of 1 cm and 0.75 cm,the HI were 40.0％ and 55.9％,the EI were 98.3％ and 95.1％,the CI were 0.44 and 0.44,respectively.For the spherical target with the diameter of 3 cm and the target with the 3 dimensions of 1 cm × 2 cm × 2 cm,the implant with the inter-space of 1 cm provided better indices of HI,EI and CI than those with the inter-space of 0.75 cm.For the other targets,the implants with the inter-space of 0.75 cm provided better indices of EI and CI than those with the inter-space of 1 cm,although they displayed a little worse homogeneity in terms of HI.The activity per seed was 17.0-27.8 MBq and 30.0-58.8 MBq in the implants with the inter-spaces of 0.75 cm and 1 cm,respectively.2-10 more seeds were needed in the implants with the inter-space of 0.75 cm.Conclusions For the studied targets except the spherical targets with the diameter of 1 cm and 3 cm and the ellipsoidal target with the dimension of 1 cm × 2 cm × 2 cm,125I seeds implanted with the inter-space of 0.75 cm could provide more conformal dose distribution.It could be the better customized plans for uniformly spaced seed implantation.

Objective To study the dosimetric characteristics of thermoluminescent dosimeter (TLD).Methods A total of 350 pieces of TLD 2000 type TLDs having the same sensitivity within ± 3.0％ were selected.The TLDs were irradiated to study the repeatability and dosage effect of TLDs by using 6 MV X-rays and 125I seeds.In order to study the dose response,the TLDs were irradiated at different dosages by using 137Cs (662 keV γ-rays),125I seeds and 6 MV X-rays.In order to study the energy response,the TLDs were exposed to the same dose,from 125I seeds,137Cs and X-rays(48,65,83,118,250 keV and 6 MV).Results The maximum deviations of the repeatability were 2.7％ and 4.0％ for 6 MV X-rays and 125I seeds,respectively,and there was no effect of dose rate observed.The dose response of TLDs to 137Cs and 125I seeds were linear.For 6 MV X-rays,the linear response was within the range of 0.74-10 Gy and non-linear range was beyond 10 Gy.The energy response to 125I seeds,48,65,83,118,250 keV and6 MV X-rays,relative to the energy response of 137Cs,were 1.70,1.25,1.08,0.99,0.91,0.96 and 1.22,respectively.Conclusions TLD 2000 has a good repeatability and linear dose response for 137Cs,125I seeds and 6 MV X-rays with no dose rate effects,but the dose response is energy dependent.

Objective To investigate the change of T-lymphocyte subgroup in children with infectious mononucleosis (IM).Methods Sixty young children with IM caused by Epstein-Barr virus (EBV) were recruited for this study in Jiaxing First Hospital from Jan 2005 to Dec 2010.Thirty-six normal children were chosen as control group.Both of the two groups were detected blood test,blood smear,T-lymphocyte subgroup ( including CD3,CD4,CD8,CD4/CD8 ),liver and kidney function test,IgM antibodies of EBV,cytomegalovirus,adenovirus,and hepatitis virus.Results Compared with the control group (53.58％ ± 5.97％,31.22％±8.72％ ),the ratio of CD3 (81.55％ ±9.04％ ) and CD8(58.13％ ± 13.35％ ) were significantly higher in IM group( P ＜0.05 ).And the ratio of CD4 ( 18.19％ ± 7.61％ ) and CD4/CD8 (0.37 ± 0.33) were significantly lower in IM group,compared with the control group (36.98％ ± 5.32％,1.98 ± 0.41 )(P ＜ 0.05 ).While the leukocyte count,the ratio of abnormal leukomonocyte,and alanine transaminase had no correlation with the decrease of CD4/CD8 ( P ＞ 0.05 ).Conclusion Children with IM caused by EBV have bad immunocompetence,and we can treat them with immunotherapy early.

Objective To study the etiology of comumunity acquired pneumonia (CAP) in children of Jiaxing city and provide the basis for the clinical diagnosis and treatment.Methods An etiological study was performed on 800 young children with CAP in Jinxing First Hospital from Jan 2008 to Dec 2010.Sputum samples were collected for isolating bacteria and checking the antigen of respiratory syncytial virus ( RSV),adenovirus ( ADV),influenza virus (IV) and parainfluenza virus ( PIV ).IgM antibodies of mycoplasma pneumoniae (MP),ADV,W and PIV paired serum samples were detected.The 202 cases with positive etiology were divided into three groups:bacteria group ( 109 cases),virus group (54 cases) and MP group (39 cases).The leukocyte,C-reactive protein (CRP) and procalcitonin (PCT) were detected.Results The etiology of CAP was identified in 202 (25.25％) children of all the 800 cases,the distribution of causal agents was as follows:Streptococcus pneumoniae in 46 cases (22.77％,46/202 ),Haemophilus influenzae in 32 cases (15.84％,32/202),Staphylococcus in 5 cases (2.48％,5/202),Klebsiella pneumoniae in 8 cases (3.96％,8/202),Escherichia coli in 12 cases (5.94％,12/202),MP in 39 cases ( 19.31％,39/202),RSV in 48 cases (23.76％,48/202),ADV in 1 case (0.50％,1/202),IV in 3 cases ( 1.49％,3/202),and PIV in 2 cases ( 0.99％,2/202 ),Streptococcus pneumoniae and RSV mixed infection in 3 cases ( 1.49％,.3/202),Streptococcus pneumoniae and MP mixed infection in 3 cases ( 1.49％,3/202).RSV infection occured mainly in infants less than 1-year-old,Streptococcus pneumoniae oceured in all ages but was mostly in 1 ～ 3years,Haemophilus influenzae infection occured mainly in infants less than 3-year-old,MP infection occured mainly in infants more than six years.The PCT levels of the three groups were (7.78 ±6.14) ng/ml,(0.39 ±0.56) ng/ml,and (0.20 ±0.34) ng/ml,respectively.There were significant differences among the three groups ( P ＜ 0.05 ).Conclusion RSV infection occurs mainly in infants of age less than 1 year,Streptococcus pneumoniae and Haemophilus influenzae infection occur mainly in infants of age 1 ～3 years,while MP is the leading cause of pneumonia in children of age more than 6 years in Jiaxing city.We can decide pathogen on ages,clinical manifestation and PCT level to guide the rational use of drugs.

Objective To compare the dosimetric differences of permanent prostate braehytherapy utilizing 131Cs,125 I and 103 Pd seeds.Methods Twenty-five patients with T1-T2c prostate cancer who had previously implanted with 125I seeds were randomly selected in our study.The patients were re-planned with 131 Cs,125 I and 103 Pd seeds by using the Prowess Brachytherpay 3.1 planning system to the prescription doses of 115 Gy,145 Gy and 125 Gy,respectively.The seed strengths were 1.8 U,0.5 U and 1.8 U,respeetively. The prostate,prostatic urethra and anterior wall of the rectum were contoured on trans-rectal ultrasound ima ges.PTV was outlined based on the prostate volume with no margin applied.The attempted planning goals were that V100(tbe percentage volume of the prostate receiving at least 100% of the prescription doses)= 95%,D90 (the minimum percentage dose covering 90% of the prostate volume) ≥100% ,and prostatic ure thra UD10 (the maximum percentage dose receiving by 10% of the contoured urethra)≤150%.For the plan comparison,we also computed prostate V150,prostatic urethra UV120,rectum RV100,and the number of implan ted seeds and needles.The significance of the differences was tested using one way analysis of variance. Results The average V200 in the 103pd,125 I and 131 Cs plans were 28.7% ,20.9% and 19.6% (F=42.50, P =0.000) ;the average V150 were 51.9% ,42.1% and 39.4% (F=26.15,P =0.000) ;the average UV120 were 26.9% ,29.5% and 23.8% (F = 0.37,P =0.691) ; and the average rectum RV100 were 0.31 cm3, 0.22 cm3 and 0.19 cm3(F=0.43,P=0.652).For 103 Pd,124 I and 131 Cs,the average number of implanted seeds per cm3 prostate were 2.02,2.01 and 1.87(F = 1.92 ,P =0.154) ,and the average number of needles were 33.6,32.9 and 31.6(F=0.26,P=0.772). Conclusions Comparing to 124 I and 103 pd seeds used in permanent prostate brachytherapy ,131 Cs seeds has better dose homogeneity,and possible better sparing of the urethra and rectum,with comparable or less implanted seeds and needles.