Objective To study risk factors with the occurrence of the mesh exposure after pelvic floor reconstruction.Methods From Mar.2007 to Mar.2011,a retrospective study was made on the clinical data of 353 patients undergoing vaginal mesh pelvic floor reconstruction.The related complications of the mesh were surveyed,and risk factors associated with the mesh's exposure were studied by single factor and multiple factors logistic regression.Results It was found that the exposure rate was 9.6％ (34/353) after 1 year postoperative follow-up.Single factor analysis showed that patients who were not less than 70 years old,patients who were on their menopause stage,the occurrence of not less than three parturition,history of pelvic surgery,diabetes and smoking had a significant correlation (all P ＜ 0.05) with the occurrence of the mesh exposure after pelvic floor reconstruction.Multiple factors logistic regression analysis showed that patients who were not less than 70 years of age (OR =2.389),the occurrence of not less than three parturition (OR =2.688),the history of diabetes (OR =3.545),the history of pelvic surgery (OR =5.385) were the independent risk factors,and the operation experience was the protection factors (OR =0.134).Conclusions Mesh exposure is a common complication after pelvic floor reconstruction.Old age,multiple delivery,history of diabetes and history of pelvic surgery are the risk factors of mesh exposure.Preoperative full assessment and the quality of training contribute to reduce the incidence.

Objective To investigate the effect of ethanol on level of the main hippocampal subtype of muscarinic receptor(M1)in mice,and evalu?ate whether the content change on this receptor could be linked with alterations in cognition,so as to further reveal the mechanism of brain damage in?duced by ethanol. Methods Sixty female mice were randomly divided into four groups. The model mice were induced by intragastric administration of ethanol at dose of 8%,16%,and 32%respectively of 0.2 mL/10 g for 8 weeks according to the protocol,and control group were treated with intra?gastric administration of distilled water. The capability of learning and memory were examined by Morris water maze,and ELISA method was used to measure the M1 receptor content in hippocampus in each group of mice. Results Compared with first day,the mean escape latency period on the fifth day was significantly shortened in each group. There was no significant difference between ethanol and control group for the mean escape latency period on the fifth day. Compared with the control group,the active time in the target quadrant was significantly shortened in 16%and 32%ethanol group. M1 receptor content in hippocampus formation was significantly decreased in all the ethanol group mice. The ethanol concentration was nega?tive correlated with the M1 receptor content. Conclusion Chronic alcoholism can induce the memory impairment in mice,which might be associat?ed with the low level of M1 receptor subtype in hippocampus of mice.

Objective To investigate the effect of intraperitoneal injection of thalidomide on pain behaviors in a mouse model of bone cancer pain. Methods 36 male C3H/HeJ mice were divided randomly into tumor group (n= 18) and sham group (n= 18) ,six mice from each group were chosen to examine the time course of changes in behavior after tumor cells inoculated to the bone. 2 × 105 osteosarcoma NCTC 2472 cells were implanted into the intramedullary space of the right femurs of mice to induce ongoing bone cancer related pain behaviors. The sham group was inoculated by α-MEM without any cells. On the day before inoculation,the tumor mice were divided randomly into tumor + thalidomide group and tumor + vehicle group. The sham group mice were further divided randomly into sham + thalidomide group and sham + vehicle group. Pain ethology indexes such as paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were observed on 1 d before inoculation and on 3 d ,5 d ,7 d, 10 d, 14 d after inoculation. Results ( 1 ) At day 7 after the operation, compared with sham mice ( 1. 70 ± 0. 33 ) g, PWMT of tumor mice decreased to ( 1.07 ± 0. 30) g (P ＜ 0. 05 ). At day 10, PWTL shortened to ( 12.60 ± 1.69 ) s (P ＜ 0. 05 ) compared with sham mice ( 17.70 ± 1.54 ) s. And the pain behaviors of tumor mice were aggravated along with the development of cancer pain. (2) At day 7 after the operation, compared with tumor + vehicle group ( 1. 07 ± 0.39 ) g, PWMT of tumor + thalidomide group increased to ( 1. 53 ± 0. 39 ) g (P ＜0.05). At day 10, PWTL extended to ( 16.48 ± 1.13 ) s compared with sham mice ( 12.64 ± 1. 56) s (P ＜0. 05 ). Conclusion Intraperitoneal injection of thalidomide can efficiently relieve mechanical hyperalgia and thermal hyperalgia in a mouse model of bone cancer pain.

Objective To analyze the impact of the comprehensive reform of public hospitals in Tianjin on the cost structure of inpatients at a tertiary general hospital.Methods Homepage data of the medical records from January 2015 to June 2018 were selected from a tertiary general hospital in Tianjin.The Beijing version of diagnosis related groupings(BJ-DRGs) was used to compare the expense structure of these inpatients before and after such a reform.Wilcoxon signed rank sum test,Z test and Pearson correlation analysis were performed for each index.Results Since the reform,the number of hospital discharges and that of DRGs had remained basically stable,while the case mixed index(CMI) weight increased slightly(from 1.0065 to 1.0386);the total hospitalization expenses,medical expenses,nursing expenses,management expenses and consumables expenses had increased.On the other hand,the expenses of medication and medical technology decreased,and the differences of these expenses were statistically significant (P ＜0.05).The time consumption index (0.87) and drug consumption index (0.80) were always lower than average,but the cost consumption index (1.38) remains above average with a slight rise.Conclusions The reform of public hospitals in Tianjin has encouraged such hospitals to improve their service procedures by adjusting such measures as pricing of medical services,and promoted their proactive management of hospitals.Hence the initial goal of "controlling costs,adjusting structure,and reducing costs" has been met.However,cost rise control still deserves major attention.

Objective:To understand the screening of cervical cancer in our county and provide epidemiological data for the prevention and control of cervical cancer.Methods:A total of 3 034 healthy women with 30~65 years old in Chun'an county were recruited in this prospective study from June 2015 to January 2016.All of the subjects received cervical cancer screening.The respondents were randomly divided into non-typeable HPV screening group (2018 cases) and the vision inspection with acetic acid and visual inspection with Lugol's iodine screen (VIA/VILI) group (1016 cases). Direct colposcopy or VIA/VILI visual examination was performed for those with positive HPV, and then colposcopy was performed for those with positive visual examination.The suspicious lesions tissues were applied for pathology detection.From September 2017 to February 2018, 2 363 patients who were initially negative received VIA/VILI combined with unclassified HPV examination, and those who were positive received colposcopy and pathological biopsy.The positive rate of primary screening and cervical squamous intraepithelial neoplasia disorders level 2 and above (CIN Ⅱ + ) lesion detection rate were analyzed in the two-stage screening.Results:From June 2015 to January 2016, the preliminary screening positive rate of unclassified HPV group was 11.60% (234/2 018). A total of 150 patients with positive results were recalled for colposcopy, with a recall rate of 64.10% (150/234). Among the 150 cases, 119 cases (79.33%) were positive in the unclassified HPV preliminary screening, and 31 cases (20.66%) were positive in VIA/VILI examination after HPV preliminary screening.The positive rate of VIA/VILI initial screening group was 20.28% (206/1 016), and the recall rate of colposcopy was 99.51% (205/206). A total of 108 cases underwent colposcopy with abnormal pathological biopsy examination in the two groups, and the pathological biopsy rate was 30.34% (108/356), and the pathologic biopsy CIN Ⅱ+ lesion detection rate was 297/100 000 (9/3 034). In the second round of screening from September 2017 to February 2018, 2 363 subjects were recruited back to the baseline, with a recall rate of 77.89% (2 363/3 034). In the 2 363 cases, the early screen VIA/VILI anomalies or HPV positive early screening positive rate was 17.01% (402/2 363), and the colposcopy examination the recall rate was 80.10% (322/402), and 80 cases received vaginal lens suspicious pathological biopsy, the pathological biopsy rate was 24.84% (80/322), the pathological results showed that CIN Ⅱ+ detection rate of 296/100 000 (7/2 363).Conclusion:The detection rate of precancerous suspicious lesions in cervical cancer screening in our county is lower than the national average level.On the one hand, we should strengthen the propaganda and education of active screening, improve the compliance and cooperation degree of screening objects, and improve the recall rate of suspicious cases.On the other hand, the government should invest more efforts to select the screening technology with high sensitivity, improve the screening technology of doctors at the basic screening point, and improve the detection rate of cervical cancer prelesions.

Objective To observe the influence of different tilt positions for laparoscopic hysterectomy on intraocular pressure and patients’ postoperative comfort.Methods Totals of 80 patients with laparoscopic surgery with grade-I anesthesia ( American Society of Anesthesiologists, ASA) were chosen and divided into group A(15°T) and group B (30°T) by using the random table methods, with 40 cases in each.Intraocular pressure of patients at baseline ( T0 ) , 30 minutes ( T1 ) and 60 minutes ( T2 ) of pneumoperitoneum and after changing the position, and 10 minutes after pneumoperitoneum were monitored.The follow-up of the patients was within 24 hours asking the comfort of them.Results The intraocular pressure of patients at T1 and T2 in group A were (18.16 ±2.16) and (19.60 ±2.18) mmHg, which were significantly lower than group B [(19.21 ± 2.17) and (20.87 ±2.17) mmHg] (t =2.168 9, 2.611 3, respectively;P <0.05).The incidences of postoperative ocular discomfort and back pain in group A were 2.5% and 7.5%, respectively, which were significantly lower than group B (20.0%, 25.0%) (χ2 =4.507 5, 4.500 6, respectively;P<0.05).The incidences of nausea, vomiting, and leg pain had no significant differences (χ2 =0.238 1, 0.000 0, respectively;P>0.05).Conclusions 15°head-down position laparoscopic surgery has less effect on the patient’ s intraocular pressure than 30°head-down position laparoscopic surgery, besides, patients have more comfort.

Objective: To compare incidence and clinical features of hemorrhage cystitis (HC) after haploidentical donor (HID) allogeneic hematopoietic stem cell transplantation (HSCT) and matched sibling donor (MSD) HSCT. Methods: Medical records of 609 (including 406 HID-HSCT and 203 MSD-HSCT cases) hematologic malignancies patients treated with HSCT undergoing myeloablative conditioning regimen from January 2011 to December 2012 were analyzed retrospectively. Results: HC occurred 183 in HID and 17 ones in MSD respectively. The cumulative incidence of HC in HID group was higher than in MSD group[ (45.6±2.5) % vs (8.5±2.0) %, χ²=77.331, P<0.001], and the cumulative incidence of severe HC (grade 3-4) in HID cases was also higher than in MSD ones[ (11.2±1.9) % vs (2.1±1.1) %, χ²=12.883, P<0.001]. All HCs were occurred within 180 days in both groups. The median time to onset in two groups were 27 days after HSCT (range 0-177 days) and 29 days after HSCT (range 6-72 days) respectively (P=0.766) . The median duration of HC in two groups were 21 days (range 3-157 days) and 13 days (range 5-67 days) , respectively (P=0.182) . The total efficiency of treatment in two groups were 69.9% and 70.6% respectively (χ²=0.003, P=1.000) . Conclusion The cumulative incidences of HC and severe HC were higher in HID cases than in MSD ones. The median time to onset and median duration of HC and therapeutic outcome between HID and MSD were comparable.

Objective: To analyze the clinical characteristics of oral and maxillofacial space infection between the diabetic and non-diabetic patients and to explore the common pathogenic bacteria and antibiotic sensitivity of diabetic patients, to guide the clinical medication. Methods : A retrospective study was conducted on 61 patients who received treatment in Qingdao municipal hospital affiliated to Qingdao university, between December 2014 and December 2016 with Oral and maxillofacial space infection. The 61 patients were divided into diabetic group and non-diabetic group. The research contented the patients'age, sex, source of infection, pathogenic bacteria, antibacterial drugs sensitivity, fasting blood glucose levels, white blood cell total and neutrophils percentage, and days of hospitalization. T test and chi-square test in SASS.19.0 software was used. Results : In the 2 groups of patients, the most common etiological factor was odontogenic infection; the most easiest affected space was submandibular space. The most common pathogenic bacteria were streptococcus. Vancomycin was the most sensitive drug, then levofloxacin and cefotaxime. In addition, the diabetes patients'age, fasting blood glucose levels and hospitalization days were significantly higher than non-diabetic patients'. Conclusion For the diabetic patients with maxillofacial space infection, levofloxacin and cefotaxime was first used for the conservative treatments when the results of the bacterial culture and drug susceptibility test are not obtained. Meanwhile, according to the oral and maxillofacial anatomy, combination of anti-anaerobic agents such as Tinidazole is also suggested. But the final situation of medication is based on the result of the drug susceptibility test.

From January 1, 2013, to March 1, 2024, nine patients with hematological malignancies complicated by Gilbert’s syndrome in Peking University People’s Hospital underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). The patients comprised seven male and two female cases, with a median age of 38 (13-60) years old. Among them, three cases were acute myeloid leukemia, three cases were acute lymphocytic leukemia, two cases were myelodysplastic syndrome, and one case was chronic myelomonocytic leukemia. None of the patients had viral hepatitis. Of the nine cases, seven cases received the Bu-Cy+ATG regimen, while the other two cases received the TBI-Cy+ATG regimen (Bu, busulfan; Cy, cyclophosphamide; ATG, antithymocyte immunoglobulin; and TBI, total body irradiation). All patients achieved neutrophil engraftment, and eight received platelet engraftment. The median total bilirubin level was 45.4 (22.5-71.2) μmol/L before transplantation and 22.0 (18.0-37.2) μmol/L on -1d of preconditioning. The total bilirubin level on +20d after the transplantation of eight patients decreased compared with the baseline level before transplantation. Moreover, one patient had a transient increase in the total bilirubin level on +5d after transplantation, which was considered to be attributed to the toxicity of Bu. No patients were complicated by hepatic veno-occlusive disease. The median follow-up time was 739 (42-2 491) days. During the follow-up period, one patient died of recurrence, and the remaining eight patients had disease-free survival events.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.