Objective To observe the effect analysis of inverting suture and 8-character-pattern suture after laparoscopic myomectomy for the operation and postoperative complications. Methods The data of of 142 patients with laparoscopic myomectomy were analyzed retro-spectively. According to the different suture methods,they were divided into inverting suture group (85 cases) with straight mattress inverting suture and 8-character-pattern suture group (57 cases). The operation time, intraoperative bleeding, postoperative complications between two groups were compared. Results The operation time and intraoperative bleeding of varus suture group were less than those of 8-character-pat-tern suture group, single tumor posterior uterine wall parts of operation time and intraoperative bleeding than patients with the anterior wall of the uterus and uterine bottom, 1 cases of pelvic related operation infection after operation in eight suture group,abdominal and pelvic mucosa adhesion in 2 cases,the complication rates between two groups were statistically difference (P<0. 05). Conclusion Laparoscopic myomec-tomy with direct mattress inverting suture can shorten operation time, play a good hemostasis in the operation and reduce the incidence of pel-vic infection and abdominal and pelvic mucosa adhesion.

Objective To investigate the mechanism of glucocorticoid resistance in patients with systemic lupus erythematosus(SLE) and the effects of Panax Notoginseng Saponins(PNS) on reversing glucocorticoid resistance in lymphocytes. Methods The relevance between P-glycoprotein (P-gp, %) and SLEDAI integrals or clinical effects was analyzed by linear correlation analysis. The lymphocytes from SLE patients were intervened with PNS or verapamil. P-gp of the lymphocytes and Rhodamine 123 (Rh123, %) accumulated in the lymphocytes were assayed by flow cytometry. The percentage of the apoptosis of the lymphocytes stimulated with PNS or verapamil combined with methylprednisolone was identified by double-tagging with Annexin V and propidium iodide (PI) and detected by flow cytometry. Variance analysis or Student's t test was used for statistics. Results The P-gp in the peripheral blood lymphocytes of SLE patients was significantly related to SLEDAI integrals. The difference of P-gp between lymphocytes in the completely remission cases (12.2±2.5)% and lymphocytes in the partial remission or non-effective cases (16.5±4.0)% was statistically significantce. The difference of P-gp and Rh123 between lymphocytes treated with PNS [(11.2±3.1)%,(70.1 ±5.8)% respectively ] and lymphocytes of the control group [ (15.3±2.9)%, (53.9±5.2)% respectively ]was statistically significant. The lymphocytes apoptosis rate in the lymphocytes stimulated with methylprednisone combined with PNS increased significantly compared to the lymphocytes stimulated with methylprednisolone only. Conclusion The action of PNS in suppressing both the expression and the transfer activity of P-gp is possibly the important mechanism to increase the effects of methylprednisolone in inducing lymphocytes apoptosis.

Objective To compare the changes of antrum and fundus cross‐sectional area ( CSA ) measured by bedside ultrasonography on gastric insufflation during anesthesia induction in non‐obese female patients and analyze the relationships between these changes as well as postoperative nausea and vomiting ( PONV ) . Methods Fourty‐six patients scheduled for elective gynecological laparoscopic operations were enrolled in the study . T he patients w ho appeared the comet‐tail artifacts were defined as gastric insufflation positive group( GI+ group) ,w hile the ones without comet‐tail artifacts were defined as gastric insufflation negative group( GI‐ group) . Blood oxygen saturation ( SPO 2 ) ,end‐expiratory partial pressure of CO 2 ( PET CO2 ) ,tidal volume( T V ) were recorded after 180 seconds ventilation in both groups . T he longitudinal and anteroposterior diameters of gastric antrum and fundus were measured before and after facemask ventilation respectively and the corresponding CSA were calculated . T he cutoff values of prediction of gastric insufflation were determined according to the ROC curve and the corresponding sensitivity and specificity were calculated . PONV of the two groups were also recorded . Results T he analysis was based on the remaining 41 data sets actually . T here were 13 patients in GI‐group and 28 ones in GI+ group . Compared with GI‐group ,the changes of T V and fundus CSA in GI+ group had significantly differences( P ＜0 .05) ; w hile compared with before mask ventilation ,the changes of antrum and fundus CSA in both groups had significantly differences ( P ＜0 .05).T he areas of antrum and fundus CSA under the ROC curve (95% CI) were 0 .67 and 0 .80 ,with cut‐off value 3 .19 cm2 and 24 .90 cm2 ,sensitivity 0 .93 and 0 .93 and specificity 0 .39 and 0 .69 ,respectively .T he incidence of PONV in GI+ group was higher than that in GI‐group( P ＜0 .05). Conclusions Changes of fundus CSA by ultrasonography might be superior to antrum CSA in gastric insufflation caused by 20 cm H2 O peak airway pressure of facemask ventilation during anesthesia induction . Gastric insufflation caused by positive pressure ventilation is related with PONV for young female patients undergoing gynecological laparoscopic operation .

One case of Listeria monocytogenes bacteremia in third trimester of pregnancy admitted in Zhongnan Hospital was reported .And 25 cases of maternal listeriosis were retrieved from domestic literature search up to March 2017.The clinical features of 26 cases were analyzed .The newly reported case was a 27-year-old primigravida at 37 weeks 5 days of gestation presenting with fever for 23 days. Listeria monocytogenes was identified in blood culture .She was treated with intravenous piperacillin sodium and tazobactam sodium for 3 weeks and recovered .At 39 weeks 4 days of gestation, she gave birth of a male baby by vaginal delivery .The newborn baby was healthy with negative Listeria monocytogene in blood culture.The age of onset of all 26 cases was (30.2 ±4.7)years.There were 1, 13 and 12 patients with listeriosis diagnosed in the first, second and third trimester of pregnancy , respectively.The median time from onset to symptom presentation was 2 days.Clinical manifestations included fever (92%,24/26), leukocytosis (75%,18/24), abdominal pain (27%,7/26), fetal movement decrease or lose (23%,6/26) and vaginal bleeding (15%,4/26).Listeria monocytogenes were isolated from blood (11 cases), uterus swab (7 cases), amniotic fluid (2 cases) and so on.High proportion of adverse pregnancy outcomes occurred (88%,22/25).All gravidae recovered well after the termination of pregnancy .The empirical antibiotics did not cover those sensitive to listeria in all patients .Patients with maternal listeriosis often presented with acute fever and a high incidence of adverse pregnancy outcomes , however, empirical antibiotics can hardly cover Listeria monocytogene.Thus, clinicians should improve awareness of listeriosis to avoid missed diagnosis and misdiagnosis .

Objective: To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF). Methods: Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 (n=350), were randomly divided into intervention group (n=175) and control group (n=175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively. Results: Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P>0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P<0.01). Meanwhile, the LVEF and 6 minutes walk distance were significantly increased, while NT-proBNP was significantly reduced at 6 months post discharge compared to one day before discharge in the intervention group (all P<0.01). The LVEF was also significantly improved (P=0.035), but the NT-proBNP and 6 minutes walk distance were similar (P were 0.328 and 0.807 respectively) at 6 months after discharge compared to one day before discharge in the control group. The NYHA classification was significantly lower in intervention group and in control group at 6 months after discharge compared to one day before discharge (Z=5.154, P<0.01 and Z=10.497, P<0.01), and the NYHA classification improved more in the intervention group than in control group at 6 months after discharge (Z=9.235, P<0.01). The re-hospitalization rate of CHF patients in intervention group was 11.83% (20/169), which was significantly lower than the control group (33.14% (56/169), χ²=21.99, P<0.01). At 6 months follow up, body weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge. Conclusion The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.

Objective To study the application of autoregressive integrated moving average(ARIMA)model to predict the monthly reported malaria cases in China,so as to provide a reference for prevention and control of malaria. Methods SPSS 24.0 software was used to construct the ARIMA models based on the monthly reported malaria cases of the time series of 2006-2015 and 2011-2015,respectively. The data of malaria cases from January to December,2016 were used as validation data to compare the accuracy of the two ARIMA models. Results The models of the monthly reported cases of malaria in China were ARIMA(2,1,1)(1,1,0)12 and ARIMA(1,0,0)(1,1,0)12 respectively. The comparison between the predictions of the two models and actual situation of malaria cases showed that the ARIMA model based on the data of 2011-2015 had a higher ac-curacy of forecasting than the model based on the data of 2006-2015 had. Conclusion The establishment and prediction of ARIMA model is a dynamic process,which needs to be adjusted unceasingly according to the accumulated data,and in addi-tion,the major changes of epidemic characteristics of infectious diseases must be considered.

Objective To evaluate the effect of facemask ventilation with different pressures on perioperative complications in the patients undergoing gynecological laparoscopic surgery. Methods Seven-ty-five American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-60 yr, with body mass index of 18-24 kg∕m2 , scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 3 groups ( n=25 each) using a random number table method: 10 cmH2 O group ( group P10) , 15 cmH2 O group ( group P15) and 20 cmH2 O group ( group P20) . The pres-sure for facemask ventilation was 10, 15 and 20 cmH2 O during induction of anesthesia in group P10, group P15 and group P20, respectively. Before facemask ventilation ( T0 ) and at 180 s of facemask ventilation ( T1 ) , longitudinal and anteroposterior diameters of the antral area in the supine position were measured u-sing ultrasonography, the antral cross-sectional area was calculated, and the development of serious flatu-lence was recorded. The development of hypoxemia, tidal volume and end-tidal pressure of carbon dioxide in each group were recorded at T1 . The operation time and occurrence of postoperative flatulence and nausea and vomiting were recorded. Results Compared with group P10, the incidence of serious flatulence and postoperative flatulence and nausea and vomiting was significantly increased, and the incidence of hypox-emia was decreased in group P15 and group P20, and tidal volume was increased at T1 in group P20 ( P<0. 05) . Compared with group P15, the incidence of serious flatulence was significantly increased ( P<0. 05) , and no significant change was found in the incidence of hypoxemia and postoperative flatulence and nausea and vomiting in group P20 ( P>0. 05) . There was no significant difference in the end-tidal pressure of carbon dioxide at T1 or antral cross-sectional area at T0 and T1 among the three groups ( P>0. 05) . Con-clusion Pressure of 10-15 cmH2 O for facemask ventilation is optimal during induction of general anesthe-sia and can ensure adequate oxygen supply and reduce perioperative complications in the patients undergoing gynecological laparoscopic surgery.

Objective:To construct an evaluation the index system of entrustable professional activities for resident training doctors in psychiatric department,and to provide reference for formulating training strategies and assessment standards.Entrustable professional activities refers to the ability of trainees to perform and complete spe-cific clinical tasks independently after they have been trusted.Methods:Through documental analysis and semi-structured interviews,the item database of entrustable professional activities for psychiatric resident training physi-cians was established.Delphi consultation was conducted among 63 experts in the field of psychiatry from 7 national resident training bases and 3 medical colleges in China.Indicators were comprehensively screened and sorted out,and indicators at all levels and their weights were determined by the analytic hierarchy process.Results:A hierarchi-cal evaluation index system of entrustable professional activities for psychiatric resident training doctors was con-structed,including 4 first-level indicators,17 second-level indicators and 68 third-level indicators.The weights of the first-level,second-level and third-level indicators were determined.Conclusion:The evaluation index system of en-trustable professional activities is comprehensive and systematic,which is suitable for clinical work and convenient for practical application.It could provide quantitative standards for the assessment of psychiatric residents and pro-mote the improvement of training quality.

Objective To conduct hazard vulnerability analysis(HVA)in a blood bank,aimed to identify high-risk e-vents and optimize emergency management measures.Methods The risk event evaluation index system was established by referring to the Kaiser model and the situation of Guangzhou Blood Center,and risk events were ranked by risk matrix and Borda count.Results The top five events with the highest risk values identified by Kaiser model were information system e-mergencies(39.61％),extreme weather(38.03％),major public sentiment(37.86％),public health events(37.37％)and policy changes(37.24％).The results of risk matrix and Borda count revealed 1 extremely high-risk indicator as information system emergency,5 high-risk indicators with the highest risk being major public sentiment,11 medium-risk indicators with the highest risk being major medical disputes and 1 low-risk indicator as external fires.Conclusion Conducting HVA in combination with the actual situation of blood banks can effectively identify high-risk events and provide theoretical basis for improving emergency management measures.

Objective:To investigate the clinical phenotype and genetic characteristics of patients with Fabry disease caused by a GLA variant, IVS4+919G>A.Methods:It was a prospective study. Fabry disease screening was conducted among high-risk population in Ninghai from October 2021 to August 2023. Those children with decreased α-galactosidase enzyme activity<2.40 μmol/(L·h) or elavated Lyso-GL-3 level>1.10 μg/L in dried blood spot (DBS) method underwent GLA genetic testing for diagnosis confirmation. Meanwhile, family screening was carried out. A proband and his family members diagnosed with Fabry disease were research subjects. The clinical and genetic characteristics of patients with Fabry disease caused by the GLA variant (IVS4+919G>A) were analyzed.Results:The female proband aged 9.8 years with pain in both lower limbs as the initial symptom was found to have a heterozygous GLA variant IVS4+919G>A among 102 patients. In family screening, there were 4 family members (proband's father, elder sister, elder male cousin and elder female cousin) with Fabry disease and a family member (proband's fifth aunt) with a GLA variant. Among these 4 diagnosed family members, the elder male cousin of the proband, a boy aged 13.2 years had a heterozygous GLA variant, IVS4+919G>A with intermittent pain in both lower limbs as the initial symptom. The proband′s father had knee joint pain. The proband′s elder sister had decreased vision and his elder female cousin had no obvious symptoms. The proband′s fifth aunt with a GLA variant had decreased vision.Conclusions:High-risk screening in children and family screening are helpful for early diagnosis and treatment of Fabry disease. Neuropathic pain may be a early symptom in children with Fabry disease caused by the GLA variant, IVS4+919G>A.