In the light of requirements of medical equipment simulation system, the overall framework of joint control system of medical equipment integrated support in the theater is designed in this paper. Such modules are developed with Delphi as communication module, module for equipment basic information, module for equipment video information and module for medical faculty information. A joint control system suiting integrated support simulation sand table for medical equipment is complteted,which provides a multidimensional informational platform for integrated demonstration of medical equipment.

Objective To introduce the technique and treatment outcome of the fingertip soft tissue defect with improved transverse palmar island flap.Methods From January 2011 to February 2013,15 cases(17 fingers) fingertip defect were repaired by improved transverse palmar island flap,the vascular pedicled of flap was a side of the neurovascular bundle,the flap revolved 90° to coversoft tissue defect.Defect area:1.2 cm × 0.8 cm to 1.7 cm × 1.6 cm.The time between the injury and admission was 40 minutes to 27 hours.Five cases were repaired defection with flap immediately,10 cases were repaired defection in stage Ⅱ.Results The wounds of injury in 15 cases get primary healing,and all the flaps were successfully survived.The 13 cases were followed up for 6 months to 14 months.The blood circulation of flap was fine,and the fingertip shape as well.The two point discrimination of the skin pulp was 6 mm to 11 mm.Conclusion The improved transverse palmar island flap for repairing transverse finger pulp defect and a small area of skin defect in patients.The procedure has a simple surgery,donor area don't skin graft,postoperative appearance and hand finger satisfactory functional recovery,etc.

Background Many methods are widely studied to improve the therapeutic effect of trabeculectomy for glaucoma,and the clinical effectiveness of the amniotic membrane application during trabeculectomy is one of the research hotspots.Objective This study was to evaluate the efficacy and safety between trabeculectomy with (TE-AMT) and without amniotic membrane transplantation (TE-noAMT) for treating glaucoma.Methods Articles published from 1965 to December 2010 were searched from The Cochrane Library,PubMed,EMBASE,CNKI,Chinese Biomedicine Database,internet by computer,and manual search then was performed according to the predetermined strategy.Randomized controlled trials (RCT) on TE-AMT and TE-noAMT were included.The quality of included articles were scored based on Jadad table,and the relative parameters and information were extracted,including author,design of the trials,country,number of eyes and patients,gender,follow-up duration,age,classification of glaucoma,baseline IOP and loss rate.The main analysis indicators were the percentage of IOP reduction,completely operative successful rate,qualified success rate and adverse events.The pooled estimates were carried out with RevMan version 5.0 software.Results Nineteen RCTs documents were reviewed by meta-analysis with the Jaded scores ≥3 in 2 papers and ＜3 in 17 papers.Total 977 eyes of 818 patients were included.The weighted mean differences (WMD) of the percentage of IOP from baseline were (WMD =8.47％,95％ CI:5.20-11.75) at 6 months and (WMD=9.37％,95％ CI:4.97-13.77) at 12 months postoperatively.Relative risk (RR) of complete success rate and qualified success rate at postoperative 6 months were (1.40,95％ CI:1.19-1.65) and (0.47,95％ CI:0.22-1.00),respectively.RR values of adverse event such as shallow anterior chamber,hyphema,hypotony and choroidal detachment,failed filtering blebs at 6,12 months were 0.51 (95 ％ CI:0.30-0.85),0.43 (95％ CI:0.20-0.92),0.51(95％CI:0.26-1.00) and 0.57(95％CI:0.14-2.31),0.31(95％CI:0.20-0.47),0.31 (95％ CI:0.17-0.55),respectively.Conclusions TE-AMT appears to have better efficacy in lowering IOP,increasing complete success rate and reducing adverse event I in comparison with TE-noAMT.

Objective To analyse the efficacy of lamivudine(LAM) combined adefovir dipivoxil(ADV) and entecavir(ETV) in the treatment of naive patients with chronic hepatitis B (CHB) .Methods Cochrane Library ,MEDLINE ,Web of Science ,CNKI (China National Knowledge Infrastructure ) ,WANFANG database and VIP database were searched and the references of eligible studies were screened .All relevant literatures published before March 6th ,2012 were reviewed .Comparison of the efficacy of lami-vudine combined adefovir dipivoxil and entecavir in the treatment of naive patients with chronic hepatitis B was included and Rev Man 5 .1 software was used for Meta analysis .Results Four eligible studies (587 patients in all) were included for the analysis .In the entecavir monotherapy group ,the serum ALT normalization rate was a little higher at the 12 weeks and 24 weeks of the treat-ment compared to the combination group[OR=0 .52 ,95% CI(0 .28 ,0 .97) ,Z=2 .04 ,P=0 .04] ,[OR=0 .45 ,95% CI(0 .22 ,0 .95) , Z=2 .11 ,P=0 .04] ,respectively .But after 36 weeks there was no significance between the two groups .For HBV DNA undetect-able rate ,there were no significant differences between the two groups at the 12 weeks ,24 weeks ,36 weeks ,48 weeks ,18 months , 24 months and 30 months of the treatment (P=0 .22 ,P=0 .30 ,P=0 .86 ,P=0 .31 ,P=0 .93 ,P=0 .84 and P=0 .83 respectively) . At the 48 weeks ,HBeAg negative rate has no significant difference between the two groups [OR=0 .93 ,95% CI(0 .29 ,2 .95) ,Z=0 .13 ,P=0 .90] .Conclusion Both LAM+ADV combination therapy and ETV monotherapy are effective in the treatment of naive patients with CHB ,but further studies are still needed to obtain long term results and safety by high quality ,large scale randomized controlled trials .

Objective　To analyze the survival status and influencing factors among HIV/AIDS transmitted through homosexual contact from 2004 to 2022 in Nan'an District, Chongqing, China. Methods　HIV infected/AIDS patients transmitted through homosexual contact in Nan'an District, Chongqing from 2004 to 2022 were selected for analysis. The survival rate was calculated using the life table method, the median survival time was calculated using the Kaplan-Meier method, and the survival curve was plotted. The Cox regression model was performed to identify factors influencing survival. Results　A total of 3 110 subjects were included in the study, of which 1 199 individuals (38.55%) were transmitted through homosexual contact. The majority of patients were under 30 years old (694, 57.88%), unmarried (917, 76.48%), and had a higher education level of college or above (724, 60.38%), mainly belonging to the Han ethnicity (1 160, 96.75%). Students accounted for 10.43% of occupational status. The majority of patients were initially diagnosed with HIV (1 104, 92.08%), with 71.45% having a CD4+T lymphocyte count >350 cells/μL at the time of initial testing. The primary source of samples was from testing and consultation (52.88%), and the vast majority (93.16%) underwent antiviral treatment. The median survival time for patients transmitted through homosexual contact was 191.45 months, which was higher than 158.37 months of patients transmitted through other routes, demonstrating statistical significance (P<0.001). Multivariate analysis showed that among patients transmitted through homosexual contact, those with CD4+T lymphocyte count≤200 cells/μL had a higher risk of death compared to those with CD4+ T lymphocyte count>350 cells/μL. HIV infected/AIDS patients who did not receive antiviral treatment also had a higher risk of death. Conclusions　From 2004 to 2022, the reported incidence level of HIV/AIDS in Nan'an District showed an overall upward trend, with a slight decrease influenced by respiratory infectious diseases.The risk of death for individuals infected through same-sex transmission routes had not yet been found to be significantly lower than that of other transmission routes, which may be influenced by the late diagnosis time and short follow-up time of individuals infected through same-sex transmission routes.

Background:It is commonly recommended that patients should refrain from driving for 24 hours after sedation for endoscopy,however,this recommendation has been queried recently. Aims:To investigate the effect of sedation on early postoperative cognitive function in patients undergoing endoscopy. Methods:One hundred adult patients undergoing sedative esophagogastroduodenoscopy ( EGD ) were randomly recruited, and another 100 adult patients undergoing conventional EGD were served as controls. All patients had an education level more than 9 years. Cognitive function was assessed by number connection test-A( NCT-A),number cancellation test and digit symbol test( DST)before propofol sedation or the beginning of endoscopic procedure and was reassessed when the discharge criteria were met. If the results obtained were inferior to those before EGD,a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels. Results:All patients completed the first and second assessment,and 124 patients had taken the third assessment. When the discharge criteria were met,result of number cancellation test was inferior to that before EGD in sedation group( P =0. 000 ). Furthermore,the results were analyzed by grouping with age,number cancellation test in young patients and NCT-A in elderly patients were inferior to that before EGD,respectively(P=0. 000 and P =0. 025 ). In control group,none of the results were inferior to those before EGD. The results of the third assessment recovered or being superior to the baseline levels. Conclusions:Early postoperative cognitive dysfunction at discharge is common in patients undergoing endoscopy using propofol sedation,but the impairment will recover by a prolonged staying calm before discharge. The optimal time for discharge and resuming driving remains to be further studied.

Objective To study the biodistribution of 131 I-2'-deoxy-1-β-D-arabinofuranosy1-5-iodouracil (FIAU) in the rat middle cerebral artery occlusion model and the expression of thymidine kinase (TK) gene in brain tissue after gene-modified stem cell transplantation,and thus evaluate the possibility of further noninvasive monitoring of stem cell transplantation therapy in cerebral infarction.Methods Adenovirus recombinant Ad5-TK-intemal ribosome entry site-brain derived heurotrophic factor-enhanced green florecent protein(IRES-BDNF-EGFP) carrying TK-IRES-BDNF gene was prepared.Cerebral infarction model was established in rats by intraluminal middle cerebral artery occlusion with nylon monofilament.Gene modified bone marrow mesenchymal stem cells were transplanted via intraparenchymal route,lateral ventricle,carotid artery and tail vein,respectively.The normal rats were used as controls.131 I- FAU was prepared to be the tracer for biodistribution study and the ％ ID/g was calculated based on measurement of the tissue radioactivity counts.The expression of TK gene was evaluated by quantitative real-time PCR (QR-PCR) and Western blot analysis.Data were analyzed with independent-samples t-test,one-way analysis of variance (ANOVA) test,and Pearson linear correlation test.Results The ％ ID/g of infarcted brain tissue in the intraparenchymal group was 0.124 ± 0.013,which was significantly higher than that in lateral ventricle group (0.052 ±0.004),carotid artery group (0.061 ±0.002),tail vein group (0.059 ±0.005) and control group (0.005 ±0.001) (t =2.913 - 5.652,all P＜0.05),while there were no statistically significant differences among the other route transplanted groups ( t =0.694 - 1.448,all P ＞ 0.05 ).The differences of ％ ID/g between the infarcted and contralateral sides of brain tissue in all transplanted groups were statistically significant (t =9.004 - 15.734,all P ＜ 0.05 ),while there was no statistically significant difference of this parameter between both sides of brain tissue in control group (t =1.511,P =0.182).The expression of TK gene in intraparenchymal group was significantly higher than other groups (t =7.482 -12.371,all P ＜0.05).The expression levels ofTK gene on QR-PCR showed a positive correlation with ％ID/g of the brain tissue ( r =0.971,P ＜ 0.001 ).Similarly,the ratio of TK/β-actin by the Western blot analysis correlated with the ％ ID/g ( r =0.899,P =0.002 ).Conclusion Intraparenchymal route may be the way of choice for cell transplantation therapy of cerebral infarction.If suitable radionuclide tracer is available,PET or SPECT may be potentially used for noninvasive monitoring of stem cell transplantation in cerebral infarction in vivo.

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To explore the most accurate T staging and optimal surgical method of lung adenocarcinoma of trans-lobe type, and to provide supportive diagnosis as well as therapeutic evidences for this disease. Methods A total of 192 postoperative patients, hospitalized in Tianjin Medical University General Hospital from January 2008 to June 2013, who were diagnosed with lung adenocarcinoma were recruited. Patients were divided into three groups according to the 7th edition of TNM staging criteria issued by the IASLC in 2009. A total of 163 patients with T2 stage were selected as Group T2, and 12 patients with T3 stage were selected as Group T3, both of which were considered as control groups. Other 17 pa?tients who were diagnosed as trans-lobe type of lung adenocarcinoma, were Group trans-lobe. The clinical data and progno?sis were compared between three groups. The trans-lobe type of lung adenocarcinoma was diagnosed based on imaging and pathological examination. Subtypes of trans-lobe lung adenocarcinoma were identified by referring to 2011 international mul?tidisciplinary classification standard of lung adenocarcinoma. Kaplan-Meier method was used to analyze the prognosis of dif?ferent subtypes and surgical modus in patients with lung adenocarcinoma of trans-lobe type. Results By comparison, the postoperative survival rate was significantly lower in patients diagnosed with trans-lobe type of lung adenocarcinoma than that of Group T2 (P<0.05), and no significant difference in survival rate compared with Group T3 (P>0.05). There were no significant differences in survival rates between different surgical modus (P<0.05). Seventeen patients with trans-lobe type of lung adenocarcinoma consisted of four subtypes, including 8 solid predominant, 5 acinar predominant, 3 papillary predomi?nant and 1 invasive mucinous adenocarcinoma. There were no statistical significances in postoperative survival time and sur?vival rates between four subtypes. Conclusion The clinical stage of trans-lobe type of lung adenocarcinoma should be clas?sified as stage T3. Both pulmonary bilobectomy and lobectomy combined with resection of proximal invaded lobe can be used as effective surgical therapies for trans-lobe type of lung adenocarcinoma.

Objective To investigate and compare the effect and safety of levocetirizine and cetirizine for the treatment of chronic idiopathetic urticaria (CIU). Methods A multi-center, randomized and double-blind comparative clinical trial was employed. The patients with CIU were divided into levocetirizine group and cetirizine group. Levocetirizine (5mg/day) or cetirizine (10mg/day) were taken once daily for 28 days, and were followed up on the 7th day, 14th day and 28th day after starting treatment. Results One hundred and thirty cases were evaluable for the effect and safety at the end of the study. The effective rates in levocetirizine group and in cetirizine group were 73.44% and 77.27% on the 7th day after treatment, 82.81% and 81.82% on the 14th day, and 89.06% and 81.82% at the end of the therapy respectively. There was no significant difference between the two groups. The drug adverse reaction for levocetirizine group and cetirizine group were 14.06% and 18.18% respectively, which include mouth dryness, dizziness etc. Conclusion Levocetirizine is an effective and safe agent for the treatment of CIU.