Objective To study the natural history of HIV infection among paid blood donors(PBD).Methods Two thousand three hundred and sixty four individuals infected with HIV/AIDS via blood donation in twelve villages of Henan province were included in this study,Retrospective data were analyzed in combination with a cross-sectional survey.Results The number of deaths were 709 among these 2 364 subjects under study by the end of 2004,with a mortality rate of 30.1%.Among 712 deaths,32.8% were companied with serious lung infections,18.1% were complicated with serious diarrhea,8.2%-with central nervous infections,8.2%-with cirrhosis,6.6%-with various types of cancers,3% died of suicide and 23% died with unclear cause.Of them 544 AIDS patients died before the ARV treatment was available in rural areas of Henan at the end of 2002,with a mortality rate of 23.0%.The median survival period for individuals with HIV infection was 9.5 years,and the median incubation period was about 8.5 years.Conclusion The median aurvival period for individuals with HIV infection via blood donation in rural areas of Henan was 9.5 years and the median incubation period was about 8.5 years among them.

Refractory glaucoma is one of the main blinding diseases in ophthalmology.Glaucoma drainage device implantation has become one of the main methods of refractory glaucoma.It has been widely used in clinic because of its advantages of safety,effectiveness and less complications.After a large number of clinical applications and innovative development of minimally invasive glaucoma surgery,glaucoma drainage device implantation shows its good treatment prospects.In this paper,the structural features of glaucoma external drainage device (Molteno,Schocket,Baerveldt,Human aqueous drainage,Krupin,Ahmed,Joseph,Whites,Optimed drainage device) and microin vasive glaucoma surgery (MIGS) (Ex-PRESS drainage device,Xen Gel Stent,CyPass Micro-Stent,Ab interno trabeculectomy trabectome,Hydrus Schlemm canal scaffold,iStent trabecular micro-bypass stent,SOLX Gold Shunt) were summarized.The drainage device implantations for glaucoma in the role of the refractory glaucoma were reviewed.

Objective To assess the effects and side effects of ropivacaine combined with sulfentanyl in epidural anesthesia for caesarean section. Methods Two hundred ASA Ⅰ- Ⅱ patients scheduled for elective caesarean section were randomly divided into 2 groups (100 cases each):group S received 0.75% ropivacaine and 0.75 μg/ml sulfentanyl; and group R received 0.75 % ropivacaine. Epidural space L2-3 was punctured and the catheter was put upward 3 cm in all patients. Local anesthetic agents were administered until a complete sensory block was established extending upper T4-T6. In the operation, Bp, HR,SpO2, ECG were observed and the onset time, the upper spread and duration of sensory block were recorded.Assessed anesthetic efficacy and side-effects on newborn. Results The onset time [(4.5±1.2) min], the time needed to reach the highest sensory level [ ( 13±5) min ] were significantly shorter and the duration of sensory block [ (402±150 ) min ] was significantly longer in group S than those in group R (P < 0.05 ). There was no significant difference in the side effects such as tachycardia, nausea, vomiting, and shivering. Apgar score in newborn was not affected. Conclusion The anesthetic efficacy of epidural 0.75% ropivacaine is significantly enhanced which also has smaller local anesthetic requirements and low incidence of side-effects,in epidural anesthesia for caesarean section when sulfentanyl is added.

With the development of medical theory and technology, the traditional teaching patterns have fallen behind the requirements for the training of medical students. Recently, virtual reality techniques have been proved to be effective in the practice of medical education. Through sum-marizing the experience of building simulation systems of eye anatomy, clinical features of eye and simulation practice, the author has elaborated the role of virtual reality technology in ophthalmology teaching theory and practice, which is of profound significance to improve the overall level of ophthal-mology teaching.

Objective To explore the surgical indexes, therapeutic efficacy and prevention of complications in treatment of some blood diseases by splenectomy (including laparoscopic splenecto- my). Methods The clinical data of 27 patients with blood diseases receiving splenectomy in our hospi-tal were retrospectively analyzed. Results The effective rate of splenectomy was 100% in 4 cases of hereditary spherocytosis, 76.47% in 17 cases of ITP and low in 6 cases of Non-Hodgkin's lymphoma.The postoperative incidence of complications was 7.41% (2/27). Conclusion Splenectomy is of the first choice for treatment of hereditary spherocytosis. Meanwhile, it is effective for most of the patients with ITP. It is an important approach for comprehensive of malignant lymphoma. Proper choice of indications and perioperative management are helpful for decreasing incidence of postoperative complications.

Antiretroviral therapy(ART)has been started in an increasingly earlier period in clinical practice.However,owing to the failure of immunological reconstitution or maintenance of latent HIV-1 reservoir in present antiviral treatment,interleukin-2(IL-2)is widely used as an adjuvant to ART with a view to intensifying immunological reconstitution and to activating latent HIV-1 infections.Some conclusions could be drawn as follows,1)IL-2 can extend the half-life of CD+4 T cells and increase the number of CD+4 T cells.2)Compared with ART alone,IL-2 and HAART combination can not reduce HIV-1 related opportunistic infection or death.IL-2 clinical usage is mainly focused on purging HIV-1 reservoir.3)IL-2 combined with ART could increase out flow rate of HIV-1 latent reservoir to reduce HIV-1 infected quiescent memory cells in peripheral circulation even to an undetectable level.4)IL-2 is supposed to be used periodically and for a long period of time.

Objective To explore the causes of occupational exposure and methods of personal protection from occupational exposure.Methods Twenty seven cases with occupational exposure to HIV hospitalized in our hospital from 2003 to 2008 were analyzed retrospectively.Results Of the 27 cases with occupational exposure to HIV,8 were policemen,4-physicians,12-nurses and 3-laboratory technicians.Of them 4(3 medical workers)were of skin exposure,17(16 medical workers)were injured by sharp devices,and 6(all policemen)were injured by scratch or bite.Post exposure prophylactic interventions were provided for all of them,and no infection was identified after 12 month medical observation.Conclusion Regular training of occupational exposure to HIV for medical workers and judicial staff will be needed.

〔Abstract〕 Taking Wuxi People′s Hospital Affiliated to Nanjing Medical University as an example, the paper introduces the constitu-tion, software architecture and main functions of Clinical Decision Support System ( CDSS) .The system is integrated with Electronic Medical Records ( EMR) system, providing scientific and acurate information support for clinicians in the whole diagnosis process.It has positive significance to improve the work quality and reduce medical errors.

Objective To analyze the curative effect used the common urokinase thrombolysis combined with topo-guide-wire fragmentation and low molecular heparin in the treatment of hemodialysis patients with arteriove-nous fistula embolization and explore the prospects of its application.Methods 30 hemodialysis patients with arterio-venous fistula embolization were divided into 15 cases of thrombolysis group and 15 cases of thrombectomy group ac-cording to the voluntary.The thrombolysis group was given simple urokinase thrombolysis,and the thrombectomy group was given thrombectomy combined with anticoagulant therapy.The curative effect and the difference in complication were compared.Results In curative effect,the recanalization rate,using time after recanalization,and dosage of uro-kinase of the thrombectomy group were better than those of the thrombolysis group[13cases vs.7cases,(22.13 ± 17.51)months vs.(11.05 ±10.55)months,(40.48 ±22.26)ten thousands IU vs.(60.29 ±15.81)ten thousands IU,χ2 =5.40,t=2.10,all P<0.05,t=2.81,P<0.01].In complication,there was no difference in the number of bleeding cases between the two groups(2cases vs.3cases,χ2 =0.24,P>0.05).For the thrombectomy group,there were fewer cases of re -embolization after recanalization (2 cases/13 cases vs.4 cases/7 cases,χ2 =3.85,P <0.05),but more cases of organ embolism(4 cases vs.0 cases,χ2 =4.62,P<0.05).Conclusion Compared with the traditional urokinase thrombolytic therapy,the guide wire fragmentation combined with low molecular weight hepa-rin anticoagulant therapy has a higher fistula recanalization rate and a lower re-embolization rate.It does not increase the incidence of bleeding complications.Besides,it can extend the use of internal fistula.However,it may cause the serious organ embolism,so it is necessary to strictly grasp the indications,applying only to the patients who are in the poor efficiency of thrombolytic and unable to have another operation.

Objective To study the clinical effect of Zhenqifuzheng granule combined with Tegafur gimeracil oteracil potassium capsule in treating advanced carcinoma of gastric cardia in aged patients.Methods 52 cases of aged patients with advanced carcinoma of gastric cardia were randomly divided into the observation group and the control group.The observation group was treated with zhenqi fuzheng granule combined with tegafur gimeracil oteracil potassium capsule,and the control group was given Tegafur gimeracil oteracil potassium capsule only.The curative effect,adverse reaction and cellular immune function were evaluated after two treatment cycles.Results There was no statistically significant difference in the objective efficacy rate between observation (46.2％) and control group (50.0％) (P＞0.05).The rate of adverse reaction was higher in the control group than in observation group (P＜0.05).The rate of gastrointestinal adverse reactions in the control group was 50.0％,but 15.4％ in observation group.The rate of bone marrow suppression was 26.9％ in control group,but 11.5％ in observation group.The cellular immune function was better in observation group than in the control group (P＜0.05).Conclusions Zhenqifuzheng granule can improve immune function and reduce toxic side effects when combined with Tegafur gimeracil oteracil potassim capsule in treating advanced carcinoma of gastric cardia in aged patients.