Objective To analyze the anesthetic effects of propofol ,fentanyl and midazolam dose clinical ap-plications in obstetrics and gynecology .Methods 120 cases were treated in our hospital obstetrics and gynecology outpatient surgery in accordance with the order of treatment ,who were randomly divided into control group and obser-vation group,control group were treated with propofol and fentanyl anesthesia ,observe group were treated with propo-fol,fentanyl and midazolam anesthesia small doses .During surgery,contrast-detected the patient′s respiratory groups (RR),heart rate(HR),pulse oxygen saturation(SaO2) and mean arterial pressure(MAR),recorded the onset time of anesthesia,recovery time,propofol and adverse reactions and so on .Results In the control group of patients after an-esthesia RR,HR,SaO2 ,MAR before anesthesia compared with the lowest value ,and the difference were statistically significant(t=6.328,P<0.01;t=9.917,P<0.01;t=9.476,P<0.01;t=4.458,P<0.01);observation group were anesthetized RR,HR,SaO2,MAR lowest values before anesthesia,the differences were statistically significant (t=4.467,P<0.01;t=9.351,P<0.01;t=2.999,P<0.01;t=3.979,P<0.01);observation group were drug onset time with propofol were significantly lower than the control group (t=4.435,P<0.01;t=6.017,P<0.01), there were statistically significant difference;groups incidence of adverse reactions after surgery was not significantly different.Conclusion In obstetrics and gynecology outpatient surgery anesthesia ,propofol,fentanyl and midazolam with a small dose of anesthetic is better ,analgesic sedative effect is significant ,fewer adverse reactions occurs .

Objective To analyze the epitopes of anti-hepatitis C virus(HCV)antibodies by peptide library biopanning. Methods Phage random peptide library of 12 amino acids was immunoscreened with purified IgG from the sera of hepatitis C patients. Positive clones which were obtained after 3 rounds of biopanning were detected by ELISA and 4 of them were sequenced. Results After 3 rounds of screening, the radio of output to input increased from (4.6×10~(-4))% to (5.3×10~(-2))%, meaning the enrichment was effective. At the third round of screening, all the selected clones proved to specifically react with the sera for immunoscreening. Four positive phage clones were sequenced, which shared a very conservative sequence and was named as C1. Its inserting sequence in the coat protein III was deduced to be GSMSPYVRWYTP, and the positive rate of C1 reacted with 20 cases of HCV patients was 85%.Conclusion The antigen-mimic peptide C1 is successfully screened from 12 random phage peptide library and it has some diagnostic value.

Objective To observe the effect of electroacupuncture (EA) on intestinal vitamin D receptor (VDR) mRNA and protein expression in ovariectomized rat model,and to explore the possible mechanism of acupuncture treatment for postmenopausal osteoporosis.Methods Sixty 3-month-old female SD rats were randomly divided into operation group and sham group.3 months after osteoporosis model was successfully produced,rats in operation group were randomly divided into model group,EA sham group,EA group and drug group.12 weeks after intervention,bone mineral density (BMD) of lumbar spine and femur were detected,then rats were all sacrificed to extract the small intestinal mucosa.VDR mRNA and protein expressions were determined by real-time quantitative PCR and Western blotting.Results The model of postmenopausal osteoporosis was successfully established.The bone mineral density was significantly improved in EA group and drug group as compared with the model group at 12 weeks after intervention.Western blotting and realtime quantitative PCR showed that small intestinal VDR mRNA and protein expressions were increased in EA group and drug group,but the increment of VDR mRNA expression was less in EA group than in drug group.Conclusions One of the mechanisms of acupuncture treatment for postmenopausal osteoporosis may be related with increasing the intestinal VDR mRNA and protein expression levels and enhancing the bioactivity of vitamin D.

Autoimmune encephalitis(AE)is a kind of newly discovered autoimmune disease of the central nervous system.The cause of autoimmune encephalitis is complex and symptoms are lacking in specificity.There are many difficulties in diagnosis of AE.The clinical diagnosis of AE should be combined with its clinical characteristics, the detection of AE-related autoantibodies and laboratory-related tests, electroencephalogram, head imaging, et al.AE-related autoantibody detection is more helpful in the diagnosis,some of the autoantibodies also have a strong hint of potential tumor in the body,and can help to determine the treatment and prognosis.

Objective To investigate the clinical value of hemostatic silk in prevention of wound bleeding and wound healing after endoscopic submucosal dissection (ESD). Methods Experiment group: animal model was made by rabbit underwent ESD simulation in its' stomach and laying hemostatic silk on its' wound;control group: animal model was made by pig underwent ESD simulation in its' colon without any healing management. All the ulcers sites were endoscopically and pathologically examined to evaluate the hemorrhage and healing of the wound on 3 days, 1 week, 2 weeks and 4 weeks after the procedure. Results The blood loss in experiment group was significantly lower than that in control group. The wounds of all the experimental pigs underwent colon ESD successfully covered with hemostatic silk postoperatively. Endoscopic pathological examination shown better healing procedure in experiment group. No procedure-related adverse event occurred in both groups. Conclusions Hemostatic silk has potential application value in healing the wound after ESD demonstrated by animal experiment.

Objective To evaluate the feasibilities and advantages of different concentrations of sodium alginate (SA) solutions as a submucosal injection solution for endoscopic submucosal dissection (ESD). Methods In vitro study, different concentrations of sodium alginate solutions and normal saline were injected into submucosal of resected porcine esophagus and stomach respectively, then observe and measure the heights of each injection induced mucosal elevations, and their changes over time. In vivo study, the mimic ESD were conducted in healthy pigs to evaluate the mucosal elevation effect and other assistant effects of sodium alginate as a submucosal injection solution. Results The elevation heights of the experiment groups injected with SA solutions were much higher than the control group injected with normal saline. Specially, the elevation created by 1 % SA in porcine esophagus was significantly higher than that of normal saline (P < 0.01) and the elevation created by 3 % SA was significantly higher than that of normal saline in porcine stomach (P < 0.001). In the mimic ESD experiment, mucosal elevation with clear margin occurred immediately after injection with SA solution. And the durable submucosal fluid cushion created by SA protected deeper tissues while facilitating ESD procedure. Conclusion The elevation heights created by SA solutions were greater and more durable than that created by normal saline, which were crucial for ESD. The viscosity property enabled SA to form a stable protective cushion and prevent bleeding by squeezing tissue around the wound, which may decrease perforation and bleeding rate during ESD procedure. Therefore, sodium alginate can be an ideal clinical submucosal injection solution.

Objective: To study the prevalence and antimicrobial susceptibility of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in Changsha, and provide laboratory evidence for clinical drug use. Methods: A retrospective study was conducted to analyze 53 006 specimens of suspected genital mycoplasma infection in Xiangya Second Hospital of Changsha District and Hunan Wangwang Hospital from 2010 to 2017, and to analyze the infection rate and drug resistance rate of Uu and Mh. Results: From 2010 to 2017, a total of 53 006 specimens were detected, where there were 16 830 cases of Uu infection, the infection rate was 31.75%; 2 471 cases of Mh infection, the infection rate was 4.66%; and 1 071 cases of Uu and Mh mixed infection, the infection rate was 2.02%. Male Uu infection rate was 19.48%(5 989/30 749), which was lower than the female infection rate 48.71%(10 841/22 257) (χ²=5 091, P<0.001); male Mh infection rate was 3.16%(973/30 749), lower than female infection rate 6.73%(1 498/22 257) (χ²=369,P<0.001). The population of genital mycoplasma infection is concentrated between 20 and 40 years old, accounting for 71.76% (12 077/16 830). The drug resistance rates of Uu and Mh to doxycycline and minocycline were less than 2%, while the drug resistance rate to quinolones was higher; The resistance rate of Uu to macrolide antibiotics such as erythromycin, josamycin and clarithromycin were less than 2%, while the resistance rate to azithromycin, erythromycin and roxithromycin were higher, 29.74%(5 006/16 830) and 53.74%(9 045/16 830), respectively, and the resistance rate of Mh to macrolide antibiotics (except josamycin) was higher than 90%.Between 2010 and 2017, a gradually increasing resistance of ureaplasmas to azithromycin, from 3.81% (46/1 206) in 2010 to 53.15% (1 503/2 828) in 2017, and decreasing resistance to gatifloxacin and thiamphenicol were observed, from 76.78% (926/1 206) and 60.28% (727/1 206) in 2010 decreased to 34.23% (968/2 828) and 37.87% (1 071/2 828) in 2017, respectively. The resistance rate of Mh to gatifloxacin and thiamphenicol were decreased, from 68.93% (122/177) and 41.81% (74/177) in 2010 to 53.54% (159/297) and 21.21% (63/297) in 2017, respectively. Conclusions Doxycycline, minocyclinum and josamycin are good treatment options for genital mycoplasma in Changsha. The resistance rate of Uu to azithromycin is increasing, suggesting that the abuse of azithromycin is present in Changsha, and indicating that better management of antibiotics is necessary.

OBJECTIVETo investigate the predictors that reduced the survival time on HIV positive TB patients during their first year's anti-TB therapy.

METHODSA retrospective study was conducted to review 519 TB/HIV co-infection patients from an Internet based TB surveillance system. We collected information of demography, HIV status, CD4+ lymphocytes count, antiretroviral therapy (ART), sputum smear results of diagnosis and around 2 months' initiation of anti-TB therapy, et al. Wilconxon rank sum test was used to compare the difference of age and CD4+ lymphocytes, count and Cox Uni-variable, and Multi-variable analysis were used to compare the different distribution of rest of risk elements between the groups of death and survival; survival function also has been used to evaluate the top 4 risk elements that have made negative impact on the survival time of HIV positive TB patients during their first year's anti-TB therapy.

RESULTSAmong 519 TB/HIV patients, 84 (16.18%) were dead, 435 (83.82%) survived. Median age (P50 (P25-P75)) in survival was 51.0 (41.0-65.0), while in death was 45.0 (35.0-60.0) (U=-2.68, P=0.007). There was significant difference between survival and death. Median CD4+ lymphocyte count in survival and death (P50 (P25-P75)) were 69.00 (26.00-131.20) and 114.50 (35.00-245.00), respectively, significant difference also has been observed. Based on the Cox analysis, patients with less than 2 months' intensive anti-TB therapy, poor treatment adherence, less than 4 months continue anti-TB therapy and sputum smear positive around 2 months initiation of anti-TB therapy had higher risk of death, the Relative Risk value (RR) were 1 100.40 (95% CI: 105.62-11,470.00), 52.91 (95% CI: 27.42-102.13), 49.43 (95% CI: 6.38-382.81), and 15.83 (95% CI: 2.55-98.40), respectively. Log-rank test results showed that there were significant difference between survival and death groups with anti-TB intensive therapy duration (Log-Rank value was 236.0, P<0.001), adherence (Log-Rank value was 302.9, P<0.001), and sputum smear results around 2 months' anti-TB initiation (Log-Rank value was 7.55, P=0.006).

CONCLUSIONKnown HIV positive, less CD4+ lymphocyte count, not initiation of ART, sputum smear positive, around 2 months' initiation of anti-TB therapy, not enough anti-TB therapy duration of intensive and continue period and poor treatment adherence were the predictors of death of HIV positive TB patients in the first year's anti-TB therapy.

Anti-HIV Agents ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes ; Coinfection ; Factor Analysis, Statistical ; HIV Infections ; Humans ; Life Expectancy ; Retrospective Studies ; Survival Rate ; Tuberculosis

Objective To evaluate the value of postmastectomy radiotherapy (PMRT) in locally advanced breast cancer patients treated with neoadjuvant chemotherapy (neoCT) and modified radical mastectomy, and to investigate the possibility of individualized radiotherapy according to the response to neoCT.Methods We analyzed 523 patients with stage ⅢA and ⅢB breast cancer who received neoCT and modified radical mastectomy in our hospital from 1999 to 2013.Of all patients, 404 received PMRT, and 119 did not.The locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method, survival difference analysis and univariate prognostic analysis were performed using the log-rank test, and multivariate prognostic analysis was performed using the Cox regression model.Results Compared with those not treated with PMRT, the patients treated with PMRT had a significantly lower 5-year LRR rate (13.9% vs.24.8%, P=0.013), a significantly higher DFS rate (64.1% vs.53.9%, P=0.048), and an insignificantly higher OS rate (83.2% vs.78.2%, P=0.389).In the patients with ypT3-T4, ypN2-N3, or pathologic stage Ⅲ disease, those treated with PMRT had a significantly reduced 5-year LRR rate (P<0.05) and a significantly increased 5-year OS rate (P<0.05), as compared with those not treated with PMRT.Among the 158 patients with ypN0 disease, the 5-year LRR rate was significantly lower in those treated with PMRT than in those not treated with PMRT (P=0.004).Of 41 patients who achieved a pathologic complete response, 2 patients, who did not receive PMRT, developed LRR.The multivariate prognostic analysis indicated that PMRT was an independent prognostic factor associated with reduced LRR in all patients and ypN0 patients.Conclusions In patients with stage ⅢA and ⅢB breast cancer treated with neoCT and modified radical mastectomy, PMRT can significantly reduce LRR for all patients and can reduce both recurrence and mortality for those with ypT3-T4, ypN2-N3, or pathologic stage Ⅲ disease.There is no sufficient evidence that PMRT can be omitted safely for ypN0 or pCR patients according to their response to neoCT.

Objective To investigate the clinical efficacy of endoscopic resection,laparoscopic resection and open resection in the treatment of gastric stromal tumor (GIST).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 254 GIST patients who were admitted to the First Affiliated Hospital of Army Medical University between January 2007 and June 2017 were collected.The endoscopic submucosal dissection (ESD) and laparoscopic or open wedge resection of GIST were performed according to the patients' conditions.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to June 2017.Measurement data with normal distribution were represented as-x±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery situations:of 254 patients,112 underwent ESD,including 111 with successful operation and 1 with intraoperative conversion to open surgery due to excessive bleeding-induced blurred operating view,93 underwent successful laparoscopic wedge resection of GIST and 49 underwent successful open wedge resection of GIST.The operation time,volume of intraoperative blood loss,time for initial fluid diet intake,duration of hospital stay and hospital expenses were respectively (75±21) minutes,(6.9±0.5)mL,(2.8±0.9)days,(5.5 ± 0.2)days,(22 167±1 364) yuan in patients with ESD and (137±65) minutes,(48.1±2.6)mL,(3.9±1.4) days,(8.3 ± 2.2)days,(32 937±1 823) yuan in patients with laparoscopic operation and (168± 60) minutes,(157.2± 10.3) mL,(5.8± 1.7) days,(11.3 ± 3.5) days,(38 462± 1 961) yuan in patients with open operation.Two patients with ESD had subcutaneous emphysema and didn't receive special treatment,and then emphysema disappeared after 2 days.No complication was detected in patients with laparoscopic or open operations.(2) Postoperative pathological examination:tumor diameter in patients with ESD,laparoscopic operation and open operation was respectively (2.6± 1.6)cm,(6.1 ±2.2)cm and (6.4±2.3) cm.The cases with positive CD117,discovered on GIST-1 (DOG1),CD34 and smooth muscle actin (SMA) were 106,105,86,17 with ESD and 89,87,59,11 with laparoscopic operation and 46,47,30,8 with open operation,respectively.The extremely low risk,low risk,medium risk and high risk were respectively detected in 67,42,3,0 patients with ESD and 16,36,23,18 patients with laparoscopic operation and 7,20,14,8 in patients with open operation.(3) Follow-up and survival situations:210 of 254 patients were followed up for 6.0-120.0 months,with an average time of 36.0 months,including 86 with ESD,82 with laparoscopic operation and 42 with open operation.During the follow-up,of patients with ESD,3 patients with medium risk respectively received imatinib therapy for 7.0 months,1.5 years and 2.0 years,and postoperative gastroscopy reexaminations every 6 months,without tumor recurrence;81 with extremely low risk and low risk received postoperative gastroscopy reexaminations every 6 months and didn't receive targeted therapy,without tumor recurrence;2 died of non-stromal tumor.The postoperative average survival time,1-,3-and 5-year survival rates were respectively 56.3 months,98.8％ (81/82),91.5％ (75/82),74.4％ (61/82) in patients with laparoscopic surgery and 52.4 months,97.6％ (41/42),85.7％ (36/42),81.0％ (34/42) in patients with open surgery.Conclusions According to patients' conditions,endoscopic resection,laparoscopic resection and open resection are safe and feasible in the treatment of GIST.Endoscopic resection of GIST should be selectively applied to patients with smaller diameter,with advantages of lower hospitalization expenses and better long-term prognosis.