Objective To investigate the peripheral blood Th17 and CD4 + CD25 + regulatory T cell levels and their correlations in patients with primary hepatocellular carcinoma (PHC).Methods Peripheral blood samples were collected from 30 PHC patients and 25 healthy controls in the First Affiliated Hospital of Zhejiang University from June 2008 to May 2009.Mononuclear cells were isolated and the Th17 and CD4 + CD25 + regulatory T cells were detected by flow cytometry and compared between patients and controls by t test.Spearman test was performed to analyze the correlation of Th17 with CD4 + CD25 +regulatory T cell concentrations.Results The levels of Th17 and CD4 + CD25 + regulatory T cells in peripheral blood in healthy controls were (2.10 ± 0.87) ％ and (7.10 ± 2.32) ％ ; while those in PHC patients were (3.38±1.68)％ and (11.78±5.62)％ (t=3.640 and 4.162,P＜0.01).The level of Th17 cells was positively associated with that of CD4 + CD25 + regulatory T cells in PHC patients (r =0.821,P ＜0.01).Conclusion The levels of Th17 and CD4 + CD25 + regulatory T cells in peripheral blood are high in PHC patients and positively correlated with each other,which indicates that CD4 + CD25 + regulatory T cells may contribute to the disease progression and pathogenesis of carcinoma through inducing Th17 cells differentiation.

Objective To investigate clinical efficacy and safety and complications of transurethral plasmakinetic resection of prostate ( PKRP) for benign prostatic hyperplasia ( BPH) .Methods Totally 186 BPH patients were underwent PKRP .Comparison of clinical parameters before and after operation .Results Following-up at 3 and 6 months after the operation showed that international prostate symptom score ( IP-SS),quality of life(QQL),residual urine volume(RUV) scores increased and maximal urinary flow rate ( Qmax) scores decreased .The incidence of complications was 8.2%.Conclusion PKRP have efficacy in the treatment of BPH , and PKRP is safer and less complications .

Objective To study the treatment of acute renal failure induced by uretericobstruction . Methods Twenty-five cases of acute renal failure induced by uretericobstruction were emergent managed with ureteroscope pneumatic lithotripsy .Results All the renal function resumed well , BUN,Cr in serum was natural or near natural .Conclusion Ureteroscope pneumatic lithotripsy should be used for acute renal failure induced by uretericobstruction as first-line.

Objective To investigate the mode and effects of clinical pharmacists participating in clinical treatment and providing pharmaceutical care. Methods The clinical pharmacists participated in the treatment of the case of thymoma complicated with pulmonary infection in respiratory intensive care unit (RICU),associated with the myasthenia gravis (MG), pure red cell aplasia (PRCA) and lower extremity deep vein thrombolysis (LEDVT),through adjustment of drug regimen, observation of curative effect,monitoring blood drug concentration and adverse reaction and interaction monitoring,which could give full play to the professional expertise of pharmacy,and contribute to the clinical rational drug use. Results For patients with impaired immune function complicated with pulmonary infection,the opportunistic infections require special attention,during the initial anti-infective therapy.When the patient was unable to tolerate high doses of sulfamethoxazole and trimethoprim (SMZ-TMP),the clinical pharmacist recommended to use caspofungin for the combined treatment of pneumocystis pneumonia.When voriconazole and cyclosporine A (CsA) were used at the same time,the blood drug concentration of CsA would be increased,due to drug interactions probably.To solve the problem,clinical pharmacists recommended a temporary reduction in CsA dose. Conclusion Clinical pharmacists use pharmaceutical expertise to help optimize clinical treatment regimens,can improve the safety and effectiveness of drug treatment.

Objective:To investigate the characteristics of urinary microflora in women with type 2 diabetic peripheral neuropathy without lower urinary tract symptoms.Methods:By completing nerve conduction function and the American Urological Association Symptom Index questionnaire (AUA-SI), a total of 30 cases of women hospitalized with type 2 diabetes and no symptoms of lower urinary tract from May 2017 to August 2018 were included. 17 patients with diabetic peripheral neuropathy were assigned to the DPN group, and 13 patients without diabetic peripheral neuropathy were assigned to the nDPN group. Urine specimens were collected from clean catch midstream urine and processed for extracting DNA. Microbial diversity and composition were analyzed using the Illumina sequencing platform targeting to 16S rDNA gene. Sequencing reads were processed by QIIME. LEfSe algorithm was used to analyze the flora with significant differences between the two groups.Results:The duration of diabetes in the DPN group was lower than that in the nDPN group [(4.12 ± 3.28)years vs.(8.03 ± 6.11)years, P = 0.03], and the retinopathy cases were more in the DPN group than those in the nDPN group (6 vs. 0, P=0.03). Except for above two indicators, there was no significant difference in demographic characteristics between DPN group and nDPN group( P>0.05). The urinary microenvironment of DPN was characterized by increased bacterial richness(sobs index, chao index and aec index, 67.24±40.25 vs.108.69±57.18; 81.36±47.99 vs.122.55±55.70; 88.58±55.03 vs.125.78±53.03, all P<0.05) and by the enrichment of Mycoplasmataceae(Metastats value: 0.52±0.01vs.0.01±0.00001, P=0.02). Beta diversity showed that no significant difference of bacterial composition was found between these two group( P>0.05). LEfSe analysis showed that at the genus level, the relative abundance of eight genera(e.g., Bacillus, Duganella, Leptotrichia, Proteus, Propionibacterium, Pseudoxanthomonas, Bdellovibrio and uncultured_soil_bacterium) in DPN group decreased at the level of genus( P<0.05). Conclusions:Female patients with type 2 diabetes without lower urinary tract symptoms of peripheral neuropathy exhibit a different microbial community compared to nDPN controls. Mycoplasmataceae may be a potential biomarker for patients with DPN.

Objective:To analyze the clinical characteristics of nephrogenic adenoma of the bladder.Methods:The clinical and pathological data of 8 patients with bladder nephrogenic adenoma, during the period from July 2016 to June 2019, were retrospectively analyzed. Patients’ age were 33 to 71 years old and the average age was 55, including 5 males and 3 females. The clinical manifestations were hematuria in 7 cases, urinary tract irritation in 6 cases, and no obvious symptoms in 1 case. There were 7 cases with cystitis, 3 cases with urolithiasis, 2 cases with bladder cancer, 1 case with invasive colonic mesentery fibroma, and 1 case without other complications. 5 cases had the history of urological operation. The predilection site was the lateral wall with 5cases; 5 cases were solitary; the average maximum diameter of the tumor was 0.9 cm (range 0.1-1.8 cm). Under cystoscope, papillary mass can be seen, the surface is bright red, the pedicle is not obvious, the papilla is thick and short, easy to bleed when touching; some of them are scattered and lichen like changes. All patients received transurethral resection of bladder mucosa.Results:Pathological examination shows that the bladder mucosa showed chronic inflammation, interstitial edema, granulation tissue hyperplasia, eosinophil infiltration and metaplasia of mesonephroid epithelium. All of the 8 patients were followed up by telephone for 2 to 38 months, with an average of 17.1 months. So far, neither recurrence has been detected.Conclusions:The diagnosis of nephrogenic adenoma of the bladder depends on pathological examination. It must be totally removed during operation. The recurrence and malignancy should be treated in time after operation.

Objective:To investigate the relationship between number of daily steps and insomnia in patients with chronic insomnia using "WeChat Sports" program.Methods:A total of 190 patients with insomnia who received treatment in Department of Neurology, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital between October 2017 and October 2019. General data (age, sex, body mass index, history of smoking and alcohol use) and the number of daily steps recorded by "WeChat Sports" program were collected. Patients whose average number of daily steps was greater than 7500 were assigned to the sufficient exercise group ( n = 68), and the remaining patients were assigned to the insufficient exercise group ( n = 122). Patient symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), The Patient Health Questionnaire-9, and generalized Anxiety Disorder scale-7. Scale evaluation and data collection were performed by two trained investigators. Data were compared between the two groups. The correlation between average number of daily steps and each scale score was analyzed. Results:Total PSQI score in the sufficient exercise group was significantly lower than that in the insufficient exercise group [(12.94 ± 3.14) points vs. (14.93 ± 2.99) points, t = 4.31, P < 0.001]. Scores of subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleep medication, and daytime dysfunction were significantly lower in the sufficient exercise group than those in the insufficient exercise group ( P = 0.011, 0.008, 0.025, 0.039, 0.006). The Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7 scores in the sufficient exercise group were significantly lower than those in the insufficient exercise group ( P = 0.011, P = 0.002). The average number of daily steps was significantly negatively correlated with total PSQI score, Patient Health Questionnaire-9 score, Generalized Anxiety Disorder Scale-7 score, and score of each PSQI component (subjective sleep quality, sleep latency, habitual sleep efficiency, and daytime dysfunction) ( r = -0.29, -0.16, -0.19, -0.24, -0.15, -0.18, -0.23). Conclusion:Insomnia patients with insufficient daily exercise have more serious insomnia and emotional symptoms than those with sufficient daily exercise. Daily average exercise is correlated with the severity of insomnia and emotional symptom.

Objective To investigate the antimicrobial resistance in the A cinetobacter baumannii strains in different parts of China during 2012 .Methods A total of 8 739 clinical isolates of Acinetobacter were collected from 13 general hospitals and two children’s hospitals ,of which most were A . baumannii (89 .6% , 7 827/8 739 ) . Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer method according to the unified protocol . The susceptibility testing data were analyzed by WHONET 5 .6 software according to CLSI 2013 breakpoints .Results Majority (85 .4% ) of the Acinetobacter strains were isolated from inpatients .The remaining 14 .6% were from outpatients and emergency room patients .Of the 7 827 strains of A .baumannii , 10 .9% ,35 .2% ,35 .7% and 43 .4% were resistant to tigecycline ,minocycline ,cefoperazone-sulbactam and amikacin , respectively .The percentage of A .baumannii resistant to imipenem and meropenem was 63 .5% and 68 .2% ,respectively . The antimicrobial resistant pattern varied in different hospitals . The resistance of A . baumannii varied between different clinical departments .A number of pandrug resistant (PDR) (20 .0% ,1 567/7 827) and multidrug-resistant (MDR) (45 .0% , 3 521/7 827 ) A . baumannii were identified . Conclusions A . baumannii is the most popular pathogenic bacteria among Acinetobacter .The antibiotic resistance of A .baumannii is still increasing .Cefoperazone-sulbactam and minocycline has good in vitro antibacterial activity against A .baumannii .The antibiotic resistance of A .baumannii varies greatly with hospital and department .

Objective: To study the best time of early feeding in patients with acute oral organophosphorus pesticide poisoning. Methods: A prospective study was conducted on 123 patients with acute oral organophosphorus poisoning admitted from January 2018 to May 2019 in Department of Emergency, the Affiliated Hospital of Binzhou Medical University. The patients were divided into four groups, A(<6 h), B(≥6 h-<12 h), C(≥12 h-<24 h) and D(≥24 h), according to the time of poisoning at the time of admission. All the patients in the four groups were fed immediately upon admission with the same method. The cholinesterase activity at 24, 48, 72, 120 h after poisoning, the incidence of rebound after poisoning, the disappearance time of clinical poisoning symptoms were compared among the four groups. Results: Compared with the other three groups, group A had a statistically significant difference in the cholinesterase activity at 24, 48, 72, 120 h after poisoning (H value was 9.466-24.933, P<0.05 or 0.01). There was no significant difference between the two groups in B, C, D group (P>0.05). The incidence of rebound after poisoning in A, B, C, D group was 3.448%(1/30), 7.407%(2/29), 6.452%(2/33), 6.897%(2/31), respectively, with no statistically significant difference (χ² value was 0.431, P>0.05). Compared with the four groups, the disappearance time of clinical poisoning symptoms in group A was shorter than that in the other three groups, and the difference was statistically significant (H value was18.199, P<0.05). Conclusions The earlier the patients ate, the faster the recovery of cholinesterase activity, the earlier the improvement of poisoning symptoms, and the incidence of gastrointestinal reaction and rebound after poisoning is not increased.The best time for early feeding is less than 6 h after poisoning.