Objective To observe the effect and safety of helicobacter pylori eradication by doxycycline, levofloxacin,bismuth potassium citrate combined with omeprazole.Methods 240 patients who infected helicobacter pylori were selected,and were randomly divided into four groups:treatment group(doxycycline,levofloxacin,bismuth potassium citrate,omeprazole),control group A(doxycycline,levofloxacin,omeprazole),control group B(amoxicillin, clarithromycin,bismuth potassium citrate,omeprazole),control group C (amoxicillin,clarithromycin,omeprazole), 60 patients in each group.Helicobacter pylori eradication treatment for 7 days,patients with gastritis stop after the course of the treatment,peptic ulcer patients continue taking omeprazole 5 weeks after 7 days treatment.All patients stopped medicine 2 weeks accepted 14 carbon breath test.And adverse events were investigated.Results In the treatment group and the control group A,B,C,the helicobacter pylori eradication rates were 93.3%,80.0%,91.7%, 75.0%.Compared with group A,the treatment group helicobacter pylori eradication rate increased significantly(χ2 =4.61,P <0.05 ).Compared with group C,the treatment group helicobacter pylori eradication rate increased significantly(χ2 =7.57,P <0.05).But compared with group B,the treatment group helicobacter pylori eradication rate had no significant difference(χ2 =0.12,P >0.05).Compared with the treatment group,group B had high inci-dence of oral odor(χ2 =6.56,P <0.05).Compared with the treatment group,group C had high incidence of oral odor (χ2 =5.46,P <0.05).Conclusion Doxycycline,levofloxacin,bismuth potassium citrate combined with omeprazole can improve the helicobacter pylori eradication rate significantly,and with low price,has little side effect,no need of penicillin skin test,can used for the patients poverty or allergic to penicillin.

Objective To understand the distribution of intestinal microflora in different types of IBS,and to observe the effect of intestinal microecological intervention. Methods According to the inclusion criteria,the patients were divided into diarrhea group (IBS-D group) and constipation group (IBS-C group),and the normal control group was also set up. The start of the three groups took gastroscopy examinination and took duodenal fluid for intesti-nal bacteria culture and counting,and electronic colonoscopy to retrieve the terminal ileum fluid for bacteria culture and count. Diarrhea and constipation type IBS patients were given Bifidobacterium triple viable capsules,2 capsules each time,3 times a day,treatment for 4 weeks. After treatment for 4 weeks,took electronic gastroscopy to retrieve the duodenal fluid for bacteria culture and counting,and took electronic colonoscopy examination to retrieve the intestinal fluid for terminal colon intestinal bacteria culture and count. Before and after treatment,IBS patients filled in intestinal symptoms rating scale and the intestinal symptoms were graded. After the test,compared the distribution differences of different segments of bacterial flora with diarrhea type IBS,constipation IBS and normal people. And the differences of intestinal flora bacterial distribution and IBS sympotoms were compared among the three groups after the Bifidobacterium triple viable capsules treatment. Results In the duodenal fluid of the three groups, the culture rate of Escherichia coli,Bacteroides,Bifidobacterium,Enterococcus,Lactobacillus was low,the difference was not statistically significant (all P>0. 05). Compared with the normal group,Enterobacter cultured in terminal ileum intestinal in the IBS-D group increased,Bifidobacterium and Lactobacillus decreased significantly[(2. 17 ± 0. 26)Log10 CFU/g vs (3. 26 ± 0. 44)Log10 CFU/g,(1. 46 ± 0. 25)Log10 CFU/g vs (2. 22 ± 0. 25)Log10 CFU/g] (t=4. 42,8. 98,all P<0. 05), the Bacteroides in the IBS-C group increased significantly (t=14. 27,P<0. 05). After the use of Bifidobacterium triple viable capsule oral treatment,the number of Bifidobacterium in duodenal fluid was increased,but the difference was not statistically significant. The terminal ileum intestinal bifidobacteria culture in the IBS -D group increased significantly (t=4. 42,P=0. 00),Enterobacter decreased significantly (t=20. 30,P<0. 05),the quasi bacterial content in the IBS-C group decreased (t=14. 27,P<0. 05). After 4 weeks of Bifidobacterium triple viable capsule treatment,21 cases were effective in the IBS-D group,the total effective rate was 70. 00%. 13 cases were effective in the IBS-C group,the total effective rate was 43. 33%. The total symptoms scores of the IBS-D group decreased significantly (t=10. 36,P<0. 05). Conclusion IBS type of diarrhea and constipation both have intestinal flora disorder,mainly in ileum. The results showed that the effect of intestinal microecological treatment is obvious in diarrhea and constipation type IBS,especially in diarrhea type IBS.

Objective:To investigate the clinical effect of the transverse rectus abdominismuscle (TRAM) on reconstruction of the breast.Methods:The clinical data of 23 patients receiving TRAM breast reconstruction in our department from Jan. 2018 to Dec. 2019 were retrospectively analyzed.Results:The operation time of 23 patients ranged from 240 to 360 mins, andthe average time was about 300 mins. Intraoperative bleeding was about 120 to 200 ml, with an average of 170 ml. All the flaps survived successfully, but 2 cases were complicated with local fat necrosis. The postoperative period was between 6 and 12 months. No local tumor recurrence or metastasis was found inall patients during postoperative follow-up, and the breast shape was maintained in good condition.Conclusion:TRAM can make up for the regret of breast loss caused by breast cancer in female patients. It can bring confidence in life and work to female patients, and the technology is safe and reliable, which is worthy of promotion.

Objective:To investigate the diagnosis and management of partial or complete hydatidiform mole with coexistent intrauterine pregnancy.Methods:Clinical data of 10 cases of hydatidiform mole with coexistent intrauterine pregnancy admitted to the Third Affiliated Hospital of Guangzhou Medical University, from September 2009 to May 2019 were retrospectively described.Results:(1) During the same period, 65 960 women were delivered at our hospital, and hydatidiform mole with coexistent intrauterine pregnancy was accounted for 1/6 596, among which complete hydatidiform mole and coexisting fetus (CHMCF) and partial hydatidiform mole and coexistent fetus (PHMCF) were found in four and six cases, respectively. The mean age of the ten patients were (30.9±4.1) years old, ranging from 26 to 35 years old, with 2.5 (1-4) times of pregnancies. Nine cases were identified at 22 +3 (12 +3-32 +3) gestational weeks and one at 9 + weeks. (2) Recurrent vaginal bleeding during pregnancy occurred in six cases, nausea and vomiting in three cases, and hyperthyroidism in mid- and late pregnancy in two cases. One patient developed preeclampsia and one case of severe mitral regurgitation with mild pulmonary hypertension. (3) In the 10 patients, the summit serum β -hCG level was 139 935 (16 990-546 033) U/L, and CHMCF and PHMCF patients were 212 500 (200 000-546 033) U/L and 60 768 (16 990-225 000) U/L, respectively. (4) The ultrasound results revealed a dark honeycomb area of the placenta in five cases, placental thickening in two cases, and vesicular placenta in one case. One case was found with bilateral giant luteinized ovarian cyst by ultrasound, multiple metastases in the left lower lobe of the lung by chest CT, multiple nodules in the pleural wall of the left lung by lung MRI, and CHMCF by pelvic MRI. In one case, ultrasound at 14 weeks of gestation showed interrupted fetal abdominal wall, visible mass, gastric bubble, liver, part of the intestinal echoes, and omphalocele. One case was found with embryo arrest. (5) The karyotype analysis of one case through amniocentesis was 46,XX with no anomalies, and chromosome microarray analysis was arr[hg19](1-22)×2. Prenatal diagnosis was refused in the remaining cases. (6) Among the ten patients, three were terminated by rivanol intra-amniotic injection, two received drug abortion, and uterine evacuation, and two with spontaneous abortion followed by curettage with a visible fetus and hydatidiform tissue. Total hysterectomy was performed in one patient due to partial invasion of the uterus by hydatidiform mole. One patient underwent a cesarean section on account of the left lower lung metastasis. One case developed preeclampsia at 33 +4 weeks of gestation and delivered two premature infants by cesarean section. Pathology examination found a complete and partial vesicular fetal mass in four and six cases, with P57 (－) and P57 (+), respectively. (7) During the follow-up, two women developed the persistent trophoblastic disease and received chemotherapy, while the remaining eight cases did not. Conclusions:When hydatidiform mole with coexistent intrauterine pregnancy is found, a timely differential diagnosis between CHMCF and PHMCF is needed. CHMCF is at a higher risk of abortion, intrauterine death, premature delivery, preeclampsia, and other maternal complications. Therefore, termination of CHMCF should be individualized. Most PHMCF patients have fetal malformation or fetal loss; thereby, timely termination is recommended.