Objective To analyze the characteristics of epidemic situation of HIV/AIDS in Yongzhou from 1993 to 2014,and provide evidence for HIV/AIDS prevention and control strategy.Methods Descriptive epidemiological analysis was conducted on HIV/AIDS epidemic situation in Yongzhou from 1993 to 2014.Results A total of 2 917 HIV/AIDS cases were reported,the reported cases increased year by year;the ratio of male to female cases was 2.30∶1 ;52.04% were aged 20-49 years old,46.76% were aged ≥50 years old,the percentage of population ≥50 years old increased obviously in recent years;the major transmission route was sexual contact (88.48% ),gay transmission accounted for 2.64%.Conclusion The knowledge about AIDS in Yongzhou should be strengthened, intervention in high risk population should be implemented,scope of detection should be expanded,so as to prevent the transmission of AIDS effectively.

Objective To explore the modulation of chlorogenic acid (CGA) on glucose metabolism in HepG2 cells pretreated with high insulin and high oleic acid (OA). Methods Cultured HepG2 cells induced by high insulin and oleic acid for insulin resistance and steatosis respectively, were co-cultured with different concentrations of CGA (10,20,40,80 mg/L) for 24h. The morphological changes were observed and glucose consumptions of cells were measured by glucose oxidase method. Results Compared to control group, CGA could significantly increase glucose consumption of normal HepG2 cells and the dosedependent effect was noted between 10-40 mg/L(P

Objective To analyze clinical manifestation and identify prognostic factors in patients with acute respiratory distress syndrome (ARDS) caused by cytomegalovirus (CMV) pneumonia after kidney transplantation.Methods Fifty five kidney transplant recipients' data were analyzed in a case-control study of patients with a primary discharge diagnosis of ARDS caused by CMV pneumonia.Results The mortality of ARDS after kidney transplantation was 56.4%;when association with mechanical ventilation,it was 72.5%.In multivariate Logistic regression analysis,numbers of complications (odds ratioOR2.60,95% confidence intervalCI1.00~6.76),severity of diffuse infiltrates in chest X-ray (OR 11.83,CI 1.14~123.07),mechanical ventilation (OR 11.83,CI 1.14~123.07) were independent risk factors to death.Conclusion Even in modern era,kidney transplant recipients with ARDS after kidney transplantation are still at high risk for death.Numbers of complications,severity of diffuse infiltrates in chest X-ray,mechanical ventilation are associated with poor outcomes.

Objective: To evaluate the role of the deep radioulnar ligament in the stability of the distal radioulnar joint (DRUJ).Methods: In the study, 14 fresh cadaver upper extremities were randomly divided into two groups.After exposuring the palmar and dorsal deep distal radioulnar ligament, one group was marked as palmar deep radioulnar ligament, and the other group was marked as dorsal deep radioulnar ligament.The pronator teres and the supinator were exposed.A Kirschner wire perpendicular to the bone on Lister tubercle of radius was inserted, then another Kirschner wire on the same level of ulnar inserted when the forearm was in neural position, which was kept parallel to the first Kirschner wire.These specimens were mounted on a specially designed jig which held the limb rigidly, keeping the elbow fle-xion and the ulnar fixation.The radius could freely rotate around the ulnar.Then 50 N force on the pronator teres was applied to simulate the active pronation, and 60 N force on the supinator to simulate the active supination.The active pronation was stimulated, and the displacement of the distal radius was measured with respect to the ulna.The active supination was atimulated, and the displacement of the distal radius was measured with respect to the ulna.The palmar deep radioulnar ligament in one group was cut, then the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.The dorsal deep radioulnar ligament in the other group was cut, and the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.Results: After resection of the palmar deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was statistically significantly different when the forearm was in pronation (t=5.591, P=0.001), but there was no difference when the forearm was in supination (t=0.433, P=0.680).After resection of the dorsal deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was not different when the forearm was in pronation (t=1.000, P=0.356), but there was statistically significant difference when the forearm was in supination (t=6.225, P=0.001).Conclusion: DRUJ is unstable when the forearm is in pronation after resection of the palmar deep ra-dioulnar ligament, and DRUJ is unstable when the forearm is in supination after resection of the dorsal deep radioulnar ligament.

Background:Mediastinoscopy is an effective method for the treatment of early esophageal cancer with minimal invasiveness and lower risk. Preoperative accurate staging of esophageal cancer is the key for the choice of mediastinoscopic operation as the treatment modality. Aims:To evaluate the value of combination of endoscopic ultrasonography(EUS)with CT for the treatment of esophageal cancer under mediastinoscopy. Methods:Sixty patients with esophageal cancer were enrolled. The TN staging results of esophageal cancer by EUS and CT examination were compared with the results of postoperative TN staging. Patients were divided into mediastinoscopic operation group and conventional operation group, and the operation time,intraoperative bleeding volume,postoperative pleural drainage flow and postoperative hospitalization time of the two groups were compared. Results:The accuracy rates of preoperative EUS examination in assessing T and N stage were 81. 7% and 83. 3% ,respectively;accuracy rates of preoperative CT examination were 60. 0% and 53. 3% , respectively;and accuracy rates of EUS combined with CT were 85. 0% and 86. 7% ,respectively. Compared with conventional operation group,intraoperative bleeding volume[(178. 2 ± 30. 1)mL vs.(232. 0 ± 48. 2)mL,P ﹤ 0. 05], postoperative pleural drainage flow[( 142. 8 ± 22. 5 ) mL vs. ( 256. 0 ± 42. 3 ) mL,P ﹤ 0. 01 ],postoperative hospitalization time[(12. 1 ± 2. 5)days vs. (14. 3 ± 3. 6)days,P ﹤ 0. 05]in mediastinoscopic operation group were significantly decreased,and no significant difference in operation time was found between the two groups[(152. 4 ± 13. 2) minutes vs.(163. 3 ± 25. 5)minutes,P ﹥ 0. 05]. Conclusions:Combination of EUS with CT examination can improve the accuracy of preoperative staging,thus provides an important reference for the choice of treating esophageal cancer by mediastinoscopic operation.

OBJECTIVE To estimate the distribution of pathogens of nosocomial infection in intensive care units,the sites where infections often taken place and the related antibiotic-resistance of bacteria.METHODS Various samples of bacteria from intensive care units have been examined by applying half-automatic analyzer ATB Expression,with bacteria inspecting cards and drug-sensitivity cards,all from Bio-Merieux,France.RESULTS Totally 153 strains of nosocomial pathogens have been found,where Acinebacter baumannii,fungi and Pseudomonas aeruginosa ranked top three,with rates of 32.0%,16.3%,and 15.0%,respectively.About 45.8% of pathogens were found in samples from the lower respiratory tract.Approximately 4.3% of A.baumannii showed drug-resistance to imipenem.However,more than 50.0% of A.baumannii presented its strong drug-resistance to rest of eight regular antibiotics.CONCLUSIONS A.baumannii is a dominating pathogen to cause nosocomial infection in intensive care units,and has shown strong multi-drug-resistance,which should incur high clinical attention.It comes to be crucial to highlight sanitization and sterilization operation,applying proper antibiotics in order to reduce appearance of bacteria with drug-resistance.

Objective To evaluate the effect of preoperative oral finasteride on patients with benign prostate hyperplasia (BPH) undergoing holmium lasterenucleation of prostate (HoLEP).Methods A total of 156 BPH patients from Department of Urology in Shanghai Ninth People's Hospital from Sep.2010 to Mar.2012 was analyzed retrospectively.79 patients receiving oral 5 mg/d finasteride before operation were selected as medication group,and the 77 patients without taking finasteride were selected as control group.The perioperative data,including operation time,amount of washing fluid during operation,preoperative and postoperative changes of hemoglobin level and postoperative bladder washing time were compared between two groups.Results Compared with control group,the changes of hemoglobin level after HoLEP,amount of washing fluid during operation,and postoperative bladder washing time with normal saline were significantly decreased in experimental group[(1.08±0.27) g/L vs.(1.55±0.32) g/L,(27.51±3.67) L vs.(36.89±6.47) L,(24.85±4.17) h vs.(35.87±5.10) h,all P＜0.05].Conclusions Oral finasteride before HoLEP can reduce perioperative bleeding and the volume of bladder irrigation with normal saline.

Competency-based medical education and personnel training isbecoming a global trend, and the United States has developed a set of competence evaluation system to evaluate a pack-age of emergency, orthopedics, thoracic surgery physicians etc. in 26 specialties. This paper introduces the development background of the evaluation system, the structure of specialist competency evaluation form, content and methodologies , and uses emergency physicians for further evaluation to illustrate this. American physician competency evaluation system provides a unified framework for the country's medical graduates after graduating from medical education training. It helps tocombine process control withthe results ofthe evaluation, self-evaluation with the evaluation of others to makethe evaluation more objective and comprehensive . It can provide new reference to the evaluation and training of physicians in our country.

Objective:To investigate the validity and the outcome of a new surgery method that utilizes lateral great toe flap to decoratively reconstruct the thumb pulp loss.Methods:From Jan.2009 to Jan. 2014 , 22 cases with unilateral thumb pulp defect were included, for whom, lateral great toe flap was de-ployed to reconstruct the thumb.Blood circulation was re-established by the anastomosis of the digital vessels of toes and fingers in 18 cases, the other 4 cases were conducted by a dorsal metatarsal artery and vein anastomosed to the deep branch of the radial artery and the dorsal metacarpal vein respectively; as for the nerve repair, toe-to-finger digital nerve anastomosis was performed.The donor sites were covered by full-thickness inguinal skin grafts.Results:All the 22 flaps survived without complications.With 6 to 12 months follow-up, the surviving fingers all presented aesthetically pleasant appearance with vivid loops and whorls.Normal functions like sweating were restored as well, and the two-point-discrimination ranged 3.0 to 6.0 mm (4.2 mm in average).The skin grafts to the donor sites healed uneventfully, the appearance and functions of the feet were unaffected.Conclusion: Lateral toe flap should be the first-line choice for reconstructing thumb defect, as it conveniently restores both functions and outlook.

Objective To observe the role of brain-derived neurotrophic factor (BDNF) in the plasticity of enteric nervous-smooth muscle system,and to investigate the effects of BDNF induced plasticity on gastrointestinal motility in mice.Methods Male hybrid BDNF knockout (BDNF+/) mice and wild type (BDNF+/+) mice were selected,eight in each group.Gastrointestinal motility of BDNF+/+ mice and BDNF+/ mice were tested and compared.Longitudinal muscle strips of mice colon smooth muscle were prepared.The effects of carbachol (1 × 10 5 mol/L) and BDNF (1 × 10 7 mol/L) on contractile function of muscle strips were observed.And the effects of tetrodotoxin (TTX,1 × 10-6 mol/L) on BDNF induced contractile function of muscle strips were also studied.The changes of the density of mice intestinal myenteric plexus and the expression of smooth muscle α-actin (α-SMA) in colon smooth muscle were detected by immunohistochemical techniqne.The ultrastruetural alterations of myenteric plexus,neuromuscular junction (NMJ) and smooth muscle cells were detected by transmission electron microscope (TEM).T-test or Rank sum test was performed for comparison between groups.Results Number of feces particles and water content in feces of BDNF+/-mice ((3.80±0.75) and (39.60±1.47)％) were both lower than those of BDNF+/+ mice ((6.30± 1.03) and (51.00± 1.61) ％),and the differences were statistically significant (t=4.792,12.827;both P＜0.05).Carbachol (1 × 10-5 mol/L) could significantly increase contraction activity of smooth muscle of BDNF+/+ mice (R =3.26 ± 0.43) and BDNF+/-mice (R=2.15 ± 0.36),and the difference was statistically significant (t=15.754,9.632;both P＜0.05).The effects on contraction exciting of smooth muscle strips of BDNF+/+ mice were more significant than BDNF+/ mice,and the difference was statistically significant (t =5.972,P＜0.05).BDNF could significantly increase contraction of muscle strips of BDNF+/+ mice and R value increased from 1 to 1.41±0.09,and the differences were statistically significant (t=13.674,P＜0.05).TTX could obviously inhibit the excitatory effects of BDNF,R value decreased from 1.41 ± 0.09 to 1.03 ± 0.04 (t=11.692,P＜0.05).The density of myenteric plexus of BDNF+/ mice (median 5.8％,interquartile range 4.2％-7.0％) was significantly lower than that of BDNF+/+ mice (median 9.0％,interquartile range 7.1％-10.8％),and the difference was statistically significant (Z =3.730,P＜ 0.05).The expression of α-SMA of BDNF+/-mice (median 33.4％,interquartile range 28.8％-38.5％) was significantly lower than that of BDNF+/+ mice (median 44.6％,interquartile range 39.2％-48.8％),and the difference was statistically significant (Z=4.565,P＜0.05).The results of TEM indicated ultrastructural alterations of myenteric plexus,NMJ and smooth muscle in BDNF+/-mice.Conelusionss BDNF could induce the plasticity of morphology and function in enteric nervous-smooth muscle system,which may play an important role in mice gastrointestinal motility.