Recurrent cerebral infarction (RCI) is very common in clinical practice. Intracranial and extracranial vessels diseases closely associate with the recurrence of cerebral infarction. Hypertension, diabetes, high homocysteine, etc., result in vascular stenosis and more in-farction recurrence by atherosclerosis and arterial plaque formation. Study of the etiology of RCI is important for the secondary prevention of cerebral infarction.

ObjectiveTo observe the clinical effect of laparoscopic intrafascial supracervical hysterectomy.Methods The complications during and after the operation of laparoscopic intrafascial supracervical hysterectomy of 46 patients were reviewed and summarized retrospectively. Results Laparoscopic intrafascial supracervical hysterectomy of 46 cases had been done well without significant complications,such as injury of intestine,bladder and ureter.Four cases had complications in short term,one was pelvic hematoma,one was pelvic infection,and two were hematocele in cervical canal.There were five cases had complications in long term.Residual cavity periodic hemorrhage in two cases,cervical gland cyst,pelvic parcel effusion and cervical polypoid hyperplasia each in one case.ConclusionsThere are less complications during the laparoscopic intrafascial supracervical hysterectomy,while much more after the surgery.Therefore,the surgical method needs to be improved.

Objective:To investigate the relationship between tumor necrosis factor-α (TNF-α)-308A/G gene polymorphism and mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM),and their correlative risk factors thereof.Methods:Forty cases of T2DM with MCI and 80 cases of T2DM without MCI were selected for this study.The polymorphism of the TNF-α-308A/G was detected by PCR-restriction fragment length polymorphism (PCR-RFLP).According to the clinical data,such as course of disease,plasma glucose,plasma fat and body mass index(BMI),the independent risk factors of T2DM and MCI were analyzed by non-conditional logistic regression.Results:The frequency of TNF-α2 allele was significantly higher in the group of T2DM with MCI than that without MCI (P＜0.01).The indexes of the statistical significant difference between the two groups were the age,course of disease,postprandial blood glucose(P2BG),glycosylated hemoglobin,body mass index,family history of T2DM,hypertension,diabetic retinopathy,diabetic peripheral neuropathy and TNF-α.The independent risk factors included TNF-α,diabetic peripheral neuropathy,diabetic retinopathy,age and P2BG.Conclusion:There is a significant relationship between TNF-α2 allele and T2DM with MCI.There is a significant relationship between the age,control of plasma glucose and microvaseular complication of T2DM with the cognitive funotion.

Objective To investigate the relationship between apolipoprotein E(Apo E) gene poly-morphism and mild cognitive impairment (MCI) in patients with type 2 diabetes mellitus (T2DM), and e-valuate the correlative risk factors. Method 40 cases of type 2 diabetes with MCI and 80 cases of type 2 diabetes without MCI were enrolled in this study. The polymorphism of the Apo E gene was detected by PCR-restriction fragment length polymorphism(PCR-RFLP). According to the clinical data such as course of disease, plasma glucose, plasma fat and body mass index (BMI), the independent risk factors of T2DM and MCI were analyzed by non-conditional logistic regression. Results The frequency of Apo E ε_4 allele in the group of type 2 diabetes with MCI was higher than that without MCI ( 25.0% vs 10. 0% ), and the difference had statistical significance( P < 0. 01 ). The indexes of the statistical significant difference be-twcen the two groups were age, course of disease, postprandial blood glucose ( P2BG), HBA1C, BMI,family history of T2DM, hypertension, diabetic retinopathy, diabetic peripheral neuropathy, Apo E gene. The independent risk factors included diabetic retinopathy ( OR = 3. 452, P < 0. 05 ), diabetic peripheral neuropathy( OR = 3. 252, P <0. 05), Ape E gene( OR = 2. 441, P < 0.01 ), HBA1C ( OR = 1. 372, P <0.05), P2BG(OR = 1. 194, P <0.05), age(OR = 1. 194, P <0.01) and course of disease(OR =1. 142, P <0. 05). Conclusion Apo E ε_4 allele has significant relationship with T2DM and MCI. The age, course of disease, control of plasma glucose, and microvascular complication of diabetes have relation-ship with the cognitive function.

Objective To research expression changes of COX-2 gene in Barrett′s esophageal mucosa before and after argon plasma coagulation (APC)operation and to explore it′s clinical curative effect and possible mechanism .Methods 66 barrett′s e-sophageal diagnosed with gastroscope and pathology were randomly divided into normal esophageal group (the negative control group ,group A) ,the APC with acid suppression therapy group(group B) ,Acid antimicrobial drug treatment group(group C) .Ob-serve symptom relief condition ,barrett esophagus epithelium ablation under gastroscope before and after treatment ,esophageal mu-cosa tissue samples was detected by real-time fluorescent quantitative PCR technique .Expression of COX-2 gene in barrett′s esoph-ageal mucosa were compared among groups .Results Compared with group A ,both Group B and group C could effectively relieve symptoms (P<0 .05) .Symptom remission rate had no no statistically significant difference in Group B and group C .Barrett esopha-gus epithelium was not significantly narrowed under gastroscope follow-up Group A and group C ,while Barrett esophageal mucosal occurred ablation with pink mucous covered in Group B .The expression of Cox-2 mRNA in group B decreased ,which was similar to group A .The expression of Cox-2 mRNA in group C also decrease ,but there was no significant differences before and after treat-ment .Conclusion APC with acid suppression therapy could effectively relieve symptoms ,melting Barrett esophagus epithelium ,and is of a safe and effective treatment on Barrett′s esophagus .

AIM: To construct pVAX1-GrB. METHODS: Lymphocytes from human laryngeal carcinoma tissue were separated from tumor tissue. The fragment of granzyme B (GrB) was amplified by RT-PCR and was recombined to the downstream of T7 promoter in the vector pVAX1. The construction was transfected into Hep2 cells with lipofectamine 2000. The expression of protein was identified by indirect immunofluorescent antibody assay. RESULTS: It has been proved that the sequence of the RT-PCR product was totally consistent with the data of GenBank by DNA sequencing analysis. The GrB cDNA fragment was cloned into the vector of pVAX1 in the right direction and the open reading fragment of GrB was maintained. The target protein was detected in the transfected Hep2 cells. CONCLUSION: The pVAX1-GrB plasmid was successfully constructed and expressed. [

Immune deficiency of the host caused by allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the initial factor of reactivation of latent human cytomegalovirus (HCMV). The risk factors of reactivation of HCMV in allo-HSCT recipients consist of the serological status of HCMV in donors and recipients, the matching degree of human leukocyte antigen (HLA) and pretreatment patterns, etc. The reactivation of HCMV is associated with the expression of a series of viral cleavage and proliferation proteins induced by the overexpression of major immediate early promoter/enhancer (MIEP) in the viral genome. In this article, the risk factors of reactivation of HCMV after allo-HSCT, the molecular changes related to maintaining latent infection of HCMV, the key role of MIEP overexpression in reactivation of HCMV, and the molecular pathways involved in reactivation of HCMV after allo-HSCT were reviewed and the major molecular events of reactivation of HCMV after allo-HSCT were elucidated, aiming to provide reference for the prevention and treatment of cytomegaloviral disease (CMVD) after allo-HSCT.

Objective:To explore the application of multi-modal digital massive open online courses (MOOCs) mode in the standardized residency training of obstetrics and gynecology.Methods:A total of 40 residents who entered the training program of obstetrics and gynecology from September 2018 to February 2020 were selected as the control group, and 40 residents from March 2020 to August 2020 were selected as the study group. The control group adopted the traditional teaching method, and the study group adopted the multi-modal digital MOOCs teaching method. The scores of theoretical examination and skill operation examination after the standardized training, clinical ability examination before and after the standardized training and teaching satisfaction were compared between the two groups. SPSS 22.0 was performed for t test and chi-square test. Results:After the standardized training, the scores of theoretical knowledge [(88.53±6.04) vs. (79.67±5.52)] and skill operation [(85.52±6.33) vs. (71.15±7.86)] in the study group were significantly higher than those in the control group ( P < 0.05). After the standardized training, the scores of all kinds of clinical ability of the two groups were higher than before ( P < 0.05), and the scores of all items in study group were higher ( P < 0.05). The satisfaction of all aspects of teaching in the study group was higher than that in the control group ( P < 0.05). Conclusion:The application of multi-modal digital MOOCs teaching mode in the standardized residency training of obstetrics and gynecology can strengthen the learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and significantly improve the quality of teaching with high teaching satisfaction.

ObjectiveTo explore the value of color Doppler ultrasonography (CDU) in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC) in infants.MethodsA total of 54 infants diagnosed with hepatic portal cystic lesion in the First Affiliated Hospital of Sun Yat-sen University from January 2012 to July 2014 who were going to receive surgical treatment were included in this prospective study. Of the 54 cases, 35 were baby boys and 19 were baby girls with a mean of (63±19) d old. According to the results of pathological examination, the patients were divided into the CBA group and the CC group.All guardians of the infants signed the informed consent and the local ethical committee approval had been received. Preoperative TB level and DB level were recorded. CDU was used to observe the incidence of hepatic portal ifbrous mass, intrahepatic bile duct dilation and biliary sludge sedimentation in the cyst. In addition, the length diameter and width diameter of gallbladder and the inner diameter of hepatic artery were measured. The observed parameters of two groups were compared byχ2 test ort test.ResultsThe incidence of hepatic portal ifbrous mass in CBA group was 96% (25/26), which was signiifcantly higher than 0 (0/28) in CC group (P<0.05). The incidence of intrahepatic bile duct dilation and biliary sludge sedimentation in the cyst in CBA group were both 0 (0/26), which were signiifcantly lower than 75% (21/28) and 54% (15/28) in CC group (P<0.05). The width diameter of gallbladder in CBA group was (5±1) mm, which was signiifcantly less than (8±2) mm in CC group (t=-38.68,P<0.05). The inner diameter of hepatic artery in CBA group was (2.4±0.4) mm, which was significantly greater than (1.8±0.3) mm in CC group (t=28.40,P<0.05). ConclusionsThe hepatic portal ifbrous mass, intrahepatic bile duct dilation, biliary sludge sedimentation in the cyst, width diameter of gallbladder and inner diameter of hepatic artery are effective indexes for CDU to differentiate CBA and CC, thus, CDU may be used in the preoperative differential diagnosis.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.