Objective To study the effect of hyperbaric oxygen on cognitive dysfunction in patients with leukoaraiosis (LA). Methods 48 cases of moderate or severe LA with cognitive dysfunction were divided into 2 groups: the experimental group accepted hyperbaric oxygen (HBO) besides routine therapy, while the control group accepted routine therapy only. Both groups were assessed with Montreal cognition assessment (MoCA). Results The scores of MoCA in patients in the experimental group improved after treatment（P<0.05）, and was more than that of the control group（P<0.05）. Conclusion HBO can improve the cognitive function in patients with LA.

Objective To explore the characteristics of cognitive function in patients with leukoaraiosis(LA)at different extent.Methods The cognitive function of 66 patients with different extent of LA and 49 healthy controls were measured using the MoCA scale,and the relationship between the cognitive function and the extent of LA was evaluated.Results The LA was more severe,the cognitive function of patients was more poor.The cognitive function of patients with type Ⅳ LA significantly decreased than the patients with type Ⅰ LA and the controls,especially in the language,memory,visuoconstructional and executive functions(P<0.05).While the function of naming,attention,abstraction and orientation showed no significant difference between the patients with LA and the controls(P>0.05).Conclusion Moderate and severe LA may cause impairment of cognitive function.

Objective To explore the diagnosis and surgical treatment of ileosigmoid fistulas (ISF) complicated by Crohn's disease (CD).Methods 13 CD patients with ISF were collected.Patients' clinical data,diagnostic methods,surgical procedures and outcomes were reviewed.Results Suspected or definite diagnosis was suggested by preoperative imaging in 12 patients.All 13 patients received surgery.Ileal lesions were all removed,while sigmiod fistula were repaired in 11 patients and partially resected in 2 patients.11 patients had a temporary ileostomy.All the patients recovered well,with 3 cases suffering from postoperative complications.Conclusions The diagnosis of ISF can be established preoperatively,and treatment should be individualized to patient' condition.

Objective To explorer the application in detection the position accuracy of the multileaf collimator of Varian accelerator with dynamic therapy log files. Methods A pre-designed MLC format files named PMLC for two Varian accelerators, the dynamic treatment log files were recorded 10 times on a different date, and be converted into the MLC format files named DMLC, compared with the original plan PMLC, so we can analysis two files for each leaf position deviation. In addition, we analysis the repeatability of MLC leaves position accuracy between 10 dynalog files of two accelerators. Results No statistically significant difference between the average position of the 10 times leaf position of the two accelerators,their were 0. 29 -0. 29 and 0. 29 -0. 30(z = -0. 77, P=0. 442). About 40% ,30% ,20% and 10% of the leaf position deviation was at ≤0. 2 mm, 0. 3 mm,0. 5 mm and 0. 4 mm,respectively. the maximum value was 0. 5 mm. More than 86% of the leaf position are completely coincident between 10 dynamic treatment files of two accelerators,The rate of position deviation no more 0. 05 mm was 96. 6% and 97.3%, respectively.And the maximum value was 0. 09 mm. Conclusions Dynamic treatment log file is a splendid tool in testing the actual position of multi-leaf collimator. The multi-leaf collimator of two accelerators be detected are precise and stabilized.

Objective To assess the relationship between type 2 diabetes and the risk of kidney cancer. Methods PubMed, Medline, CNKI and VIP were used to identify studies which regarded the relationship between type 2 diabetes and risk of kidney cancer up to July 2014. The relative risks (RRs) and the corresponding 95% confidence interals (CIs) were used to estimate the association between type 2 diabetes and the risk of kidney cancer through software STATA. Results 8 studies were included in this analysis. Compared to the popula-tion without type 2 diabetes, there was an increased risk of kidney cancer in the type 2 diabetes patients, the pooled RR (95%CI) was 1. 55 (1. 24,1. 92),P<0. 05. Conclusion Our meta-analysis suggestes that type 2 diabetes can increase the risk of kidney cancer.

Objective: To learn the genotypic drug resistance of men who have sex with men ( MSM ) with HIV who failed in antiviral therapy in Yunnan Province, in order to provide basis for improving the effect of antiviral therapy. Methods: The patients who were infected with HIV-1, homosexual transmitted and failed in antiviral therapy in Yunnan Province from 2014 to 2019 were recruited. Their plasma samples were tested by reverse transcription nested polymerase chain reaction ( RT-nPCR ) , the fragments were spliced using ContigExpress, and the resistance to 8 protease inhibitors ( PIs ) , 7 nucleoside reverse transcriptase inhibitors ( NRTIs ) and 5 non-nucleoside reverse transcriptase inhibitors ( NNRTIs ) were obtained from the HIV drug resistance data website of Stanford University. Results: A total of 205 HIV/AIDS cases were included, 169 positive plasma samples were amplified, 112 cases were drug resistant, and the rate of drug resistance was 66.27%. The patients who were aged 30-49 years ( 76.09% ) , had genotype of CRF01_AE ( 76.34% ) or treated by AZT+3TC+NVP ( 77.08% ) had higher resistance rate. The resistance rates of NNRTIs, NRTIs and PIs were 62.72%, 49.70% and 2.96%, respectively; the resistance rates of NVP and EFV in NNRTIs were 62.72% and 61.54%. The main mutation site associated with NNRTIs was K103, accounting for 21.89% ( 37 cases ) ; the main mutation site associated with NRTIs was M184, accounting for 39.64% ( 67 cases ) ; the main mutation sites associated with PIs were M46L/K, accounting for 2.96% ( 5 cases ) , resulting in high resistance to NFV. Conclusions The drug resistance rate of HIV-infected MSM with failure of antiviral therapy in Yunnan Province is relatively high, with CRF01_AE as the main gene subtype of drug resistance. The drug resistance rate of NNRTIs is relatively high, especially NVP and EFV.

Objective To evaluate the feasibility and safety of laparoscopy in complex Crohn's disease.Methods A retrospective study of patients with complex Crohn's disease from Jan 2013 to Dec 2015 was conducted.The clinical data and the surgical outcome were evaluated.Results 137 patients with complex Crohn's disease were involved in the study.81 patients underwent laparoscopic procedure,the conversion rate was 30％.56 patients underwent conventinal laparotomy.The blood loss (50ml vs.100 ml,Z =-4.84,P ＜ 0.001),stoma rate (28％ vs.45％,x2 =6.03,P =0.05),interval to bowel movement (3 d vs.4 d,Z=-3.69,P =0.001) and postoperative hospital stay (8 d vs.14 d,Z=-5.41,P＜0.001) were more favourable in laparoscopic surgery group than in laparotomy group.Conclusion Laparoscopy is feasible and safe in complex Crohn's disease.In well indicated patients,preoperative optimization and surgical expertise can improve the outcome of Crohn's disease.

Objective To investigate the predictive factors for postoperative intra-abdominal septic complications (IASCs) after intestinal resection in patients with Crohn's Disease (CD).Methods Clinical data from patients who underwent intestinal resection for CD at Sir Run Run Shaw Hospital between June 2011 and July 2016 were retrospectively analysed.The patients were divided into IASCs group and non-IASCs groups by whether suffering from postoperative IASCs.Univariate analysis and multivariate logistic regression analysis were performed to identify the predictive factors for postoperative IASCs,and the receiver operating characteristic curve (ROC) was used to analyse the diagnostic value of the results.Results Among one hundred and seventy-three patients who underwent intestinal resection for CD,15(8.7％) patients experienced postoperative IASCs.The results of univariate and multivariate analysis showed that preoperative CRP ≥ 10 mg/L (OR =4.920,95％ CI:1.137-21.287,P =0.033) was an independent trisk factor for postoperative IASCs,and the laparoscopic surgery (OR =0.070,95％ CI:0.007-0.701,P =0.024) was the independent protective factor for postoperative IASCs.By analyzing ROC curve,preoperative CRP level had the diagnostic value of predicting the postoperative IASCs.The areas under the ROC curves of preoperative CRP for postoperative IASCs were 0.729 with an optimal diagnostic cut-off value of 10.75 mg/L,and with sensitivity of 80.0％ and a specificity of 67.1％.Conclusions Preoperative CRP level is an independent risk factor for postoperative IASCs,and laparoscopic surgery is an independent protective factor for IASCs.

Objective:To explore the effects of dexmedetomidine (DEX) on postoperative pain, oxidative stress and adverse reactions in patients undergoing radical mastectomy.Methods:A total of 90 patients with breast cancer who received radical surgical treatment in our hospital from Jun. 2022 to Jun. 2023 were prospectively included as research objects and randomly divided into 3 groups with 30 patients in each group. DEX group was applied before, during and after surgery, respectively. The levels of pain visual analogue scale (VAS), Richmonation sedation score (RASS), superoxide dismu-tase (SOD) and malondialdehyde (MDA) were recorded.Results:The recovery time and extubation time in preoperative and intraoperative DEX group were significantly lower than those in postoperative DEX group, and the awakening time and extubation time in preoperative DEX group were significantly lower than those in intraoperative DEX group ( F value was 48.62 and 53.98, respectively, P<0.001). At 1 h, 6 h and 12 h after surgery, the VAS and RASS scores of patients in the preoperative and intraoperative DEX group were significantly lower than those in the postoperative DEX group, compared with those in the intraoperative DEX group. The VAS and RASS scores in the DEX group were significantly decreased ( F value: 62.34, 55.24, 69.26, 36.82, 24.20, 39.97, P<0.001). At 24h after surgery, there was no significant difference in VAS and RASS scores among the three groups ( F value was 0.45 and 0.81, respectively, P value was 0.613 and 0.418). Immediately after surgery, 24 h after surgery, 72 h after surgery, the SOD level of DEX group was significantly higher than that of DEX group before and during surgery ( F value was 29.37, 33.24, 10.35, P<0.001). MDA levels were significantly lower than those in postoperative DEX group ( F value was 30.52, 41.27, 8.26, P<0.001). There was no significant difference in the incidence of postoperative adverse reactions among all groups ( P>0.05) . Conclusion:Preoperative and intraoperative application of DEX can reduce postoperative pain and oxidative stress in breast cancer patients, help patients recover quickly after surgery, and preoperative application is superior to intraoperative application.

The infectious disease outpatient service as a frontier is an important fulcrum of public health service. Its standardized construction is an important support for ensuring medical safety, reducing nosocomial infections, and controlling the epidemic of infectious diseases. The sub-specialty outpatient service of infection diseases includes fever outpatient service, intestinal outpatient service, tuberculosis outpatient service, AIDS outpatient service, liver disease outpatient service, etc. According to the characteristics of each subspecialty outpatient service and combining with clinical practice, we elaborated the setting norms of subspecialty outpatient service for common infectious diseases from the perspective of planning and design, building layout, equipment and facilities configuration, staffing, daily management and demonstration.