Objective This study aimed to evaluate the interaction between antiretroviral drug efavirenz and anti-tuberculosis 1H3P3(isoniazid plus rifapentine)in people living with HIV.Methods HIV-positive individuals on efavirenz-containing(600 mg)antiretroviral therapy(ART)received 1H3P3 regimen containing rifapentine(450 mg)plus isoniazid(400 mg)3 times a week for 1 month.Efavirenz concentrations were measured at weeks 0,2,4,8.Rifapentine concentration was determined at weeks 2 and 4.HIV RNA load was determined at weeks 0 and 8.Treatment target was efavirenz concentration＞1 mg/L.The anti-TB prevention was considered acceptable if the target of efavirenz concentration was achieved in more than 80％of participants.The participants were followed up for 18 months to evaluate the efficacy of treatment.Results Thirty-one participants living with HIV were enrolled in the study.Two participants were excluded from PK analysis because his/her baseline efavirenz concentration＜1 mg/L,suggesting poor treatment adherence.Evaluable PK data were available for 29 participants,including 23(79.3％)males.The median[interquartile range(IQR)]age of the participants was 43.0(32.5,53.5)years.The median(IQR)efavirenz plasma concentration was 2.33(1.96,2.34)mg/L at week 0,2.32(1.90,3.28)mg/L at week 2,2.07(1.83,3.09)mg/L at week 4,and 2.71(2.14,3.33)mg/L at week 8.Efavirenz concentration did not show significant difference between the 4 time points(P＞0.05).Median(IQR)rifapentine concentration was 9.36(6.23,16.47)mg/L at week 2,and 9.36(6.41,15.56)mg/L at week 4.Rifapentine concentration did not show significant difference between week 2 and week 4(P＞0.05).Efavirenz concentrations was＞1 mg/L in all participants at weeks 2,4,and 8.Furthermore,efavirenz concentration was significantly higher in females and patients with body weight＜60 kg compared with males and those with body weight ≥60 kg(P＜0.05).None of the participants had symptoms or signs of active tuberculosis during 18-month follow-up.Conclusions Isoniazid plus rifapentine(1H3P3 regimen)did not have significant effect on the plasma concentrations of efavirenz.

Objective This study aimed to evaluate the interaction between antiretroviral drug efavirenz and anti-tuberculosis 1H3P3(isoniazid plus rifapentine)in people living with HIV.Methods HIV-positive individuals on efavirenz-containing(600 mg)antiretroviral therapy(ART)received 1H3P3 regimen containing rifapentine(450 mg)plus isoniazid(400 mg)3 times a week for 1 month.Efavirenz concentrations were measured at weeks 0,2,4,8.Rifapentine concentration was determined at weeks 2 and 4.HIV RNA load was determined at weeks 0 and 8.Treatment target was efavirenz concentration＞1 mg/L.The anti-TB prevention was considered acceptable if the target of efavirenz concentration was achieved in more than 80％of participants.The participants were followed up for 18 months to evaluate the efficacy of treatment.Results Thirty-one participants living with HIV were enrolled in the study.Two participants were excluded from PK analysis because his/her baseline efavirenz concentration＜1 mg/L,suggesting poor treatment adherence.Evaluable PK data were available for 29 participants,including 23(79.3％)males.The median[interquartile range(IQR)]age of the participants was 43.0(32.5,53.5)years.The median(IQR)efavirenz plasma concentration was 2.33(1.96,2.34)mg/L at week 0,2.32(1.90,3.28)mg/L at week 2,2.07(1.83,3.09)mg/L at week 4,and 2.71(2.14,3.33)mg/L at week 8.Efavirenz concentration did not show significant difference between the 4 time points(P＞0.05).Median(IQR)rifapentine concentration was 9.36(6.23,16.47)mg/L at week 2,and 9.36(6.41,15.56)mg/L at week 4.Rifapentine concentration did not show significant difference between week 2 and week 4(P＞0.05).Efavirenz concentrations was＞1 mg/L in all participants at weeks 2,4,and 8.Furthermore,efavirenz concentration was significantly higher in females and patients with body weight＜60 kg compared with males and those with body weight ≥60 kg(P＜0.05).None of the participants had symptoms or signs of active tuberculosis during 18-month follow-up.Conclusions Isoniazid plus rifapentine(1H3P3 regimen)did not have significant effect on the plasma concentrations of efavirenz.

Objective:To investigate the application value of mixed reality (MR) technology in reconstruction of soft tissue defect of extremities with free anterolateral thigh flap(ALTF).Methods:From December 2019 to November 2021, a retrospective analysis was performed on 10 patients who had undergone ALTF reconstruction of soft tissue defects in extremities in Department of Orthopaedics, the First People's Hospital of Yunnan Province. Four patients had the defects in hand and 6 patients in foot and ankle. For the 6 patients in emergency surgery, the time from injury to admission was 4.0-15.0 hours, with an average of 7.3 hours. Four patients with soft tissue defects caused by chronic infection and ulcers were given debridement, and the soft tissue defects were reconstructed by flap transfer at the second stage. The defect area were from 8.0 cm×5.0 cm to 22.0 cm×8.0 cm. Preoperatively, 3D bone-vessel-flap model was established based on the lower extremity CTA scans. Intraoperatively, MR technology was used to project the 3D model on the flap donor site to observe the virtual profile of vessel shape in real time, to locate the perforator and the course of the perforator, and observe the consistency between the virtual image and the actual anatomy of the perforator. The appearance, texture and colour of the flap were recorded at the last follow-up. Hand function was evaluated by the total activity movement (TAM), and foot and ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS).Results:The position location and course of perforator vessels were reconstructed successfully in all patients before surgery. The MR technology was used to locate the perforator, and the course of the virtual perforator was consistent with the actual anatomy, and the matching reached 100%. The length of vascular pedicle measured before surgery was at 11.02 cm±1.37 cm. And that measured during surgery was at 11.21 cm±1.23 cm ( P=0.748, t=-0.326). The difference was not statistically significant ( P>0.05). The flap area was at 9.0 cm×6.0 cm to 23.0 cm×9.0 cm. The donor site was sutured directly in one stage. All patients were entered postoperative followed-up for 1 to 24 months, with an average of 13.5 months. All the flaps survived after surgery. The flap with good appearance, colour and texture, and only one linear scar was left in the donor site. According to the TAM of the hand function, 3 cases were excellent and 1 was fair. Foot and ankle function were evaluated according to the AOFAS, 5 cases were in excellent and 1 was good. Conclusion:MR technology applied to the surgery of ALTF can locate the course of the flap vessels in real time, guide the operation, improve the operation efficiency and reduce the risk in surgery.

Objective:To explore the expression and clinical significance of immunosuppressive receptor T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) on the peripheral blood mononuclear cells (PBMC) in silicosis patients with Mycobacterium tuberculosis infection. Methods:August 2018, a total of 78 patients with silicosis (all were quarry workers in Sanmen County, Zhejiang Province) were enrolled and divided into silicosis combined with active pulmonary tuberculosis group (APTB group), silicosis combined with latent tuberculosis infection group (LTBI group), and simple silicosis with non-tuberculosis infection group (non-TB group). Flow cytometry was used to analyze the expressions of TIGIT, programmed death-1 (PD-1) and transcription factor T-bet on PBMC from patients. Mann-Whitney U test and Pearson correlations analysis were used for statistical analysis. Results:Among the 78 patients, eight were in the APTB group, 24 in the LTBI group, and 46 in the non-TB group. The expressions of PD-1 and TIGIT on CD8 + T cells in the APTB group (29.45%(16.78%) and 65.40%(12.12%), respectively) were significantly higher than those in the LTBI group (17.40%(11.17%) and 48.30%(28.75%), respectively; U=23.500 and 43.500, respectively, P=0.000 8 and 0.020 5, respectively) and non-TB group (15.95%(12.46%) and 45.30%(19.75%), respectively; U=64.000 and 69.000, respectively, P=0.002 3 and 0.003 8, respectively), and the differences were all statistically significant. The expression of TIGIT was positively correlated with PD-1 on CD8 + T cells in silicosis patients ( r=0.434 3, P<0.01). The proportion of PD-1 + TIGIT + CD8 + T cells in the APTB group (19.90%(22.67%)) was significantly higher than those in the non-TB group (11.55%(11.29%), U=76.500, P=0.007 1) and LTBI group (11.55%(10.53%), U=41.000, P=0.015 4), while the proportion of PD-1 -TIGIT -CD8 + T cells in the APTB group (30.60%(12.90%)) was significantly lower than non-TB group (48.90%(18.98%), U=58.000, P=0.001 3) and LTBI group (47.20%(24.59%), U=41.000, P=0.015 4). The differences were all statistically significant. The expression of T-bet on the peripheral blood CD8 + T cells in the APTB group (29.45%(16.78%)) was higher than that in the non-TB group (15.95%(12.46%)) and the LTBI group (17.40%(11.17%)), and the differences were both statistically significant ( U=46.500 and 46.000, respectively, P=0.000 3 and 0.028 3, respectively). The expression of T-bet on CD8 + T cells was positively correlated with TIGIT on CD8 + T cells ( r=0.456 7, P<0.01). The expression of T-bet on PD-1 + TIGIT + CD8 + T cells in the APTB group (65.40%(12.12%)) was higher than those in the LTBI group (48.30%(28.75%), U=23.500, P=0.000 8) and non-TB group (45.30%(19.75%), U=65.000, P=0.002 6), and the differences were both statistically significant. Conclusion:The immunosuppressive receptor PD-1 and TIGIT are highly expressed on CD8 + T cells in silicosis patients with active pulmonary tuberculosis, which indicates CD8 + T cells exhaustion in these population, while the highly co-expression of T-bet suggests the exhausted subsets may have reversed potentiality.

Objective To discuss the selection of different operation methods for cesarean scar pregnancy ( CSP ) . Methods A retrospective analysis was made on clinical data of 71 CSP patients treated in our hospital from January 2010 to January 2015.All the patients were accurately diagnosed by transvaginal color ultrasound examinations.Hysteroscopic evacuation was performed in 45 endogenous CSP patients, while in 26 exogenous CSP patients, 15 of them were treated by hysteroscopy and the other 11 patients were given laparoscopic operation. Results For the 45 endogenous patients, the success rate of hysteroscopic therapy was 92%( 41/45 ) .For the 26 exogenous patients, the success rate was 80% ( 12/15 ) for hysteroscopic and 82% ( 9/11 ) for laparoscopic therapy. Conclusions Preoperative categorizing of CSP is important for choosing different surgery methods. Hysteroscopic evacuation is the first choice for endogenous CSP.For exogenous patients, both hysteroscopic evacuation and laparotomy can be chosen.Therefore, the two minimally invasive procedures have limits, and transvaginal and laparotomy resection of lesion is still necessary sometimes.

The role of Military Medical University featuring both battlefield and market service determines the necessity to seek balance between military and civilian planning for scientific and technological innovation.In the management of scientific and technological achievements,Third Military Medical University sticks to the development mode of military-civil integration.First,it establishes the management concept suit for its roles and characteristics,organizational strategy,policy and system.Secondly,it implements transitional development.Thirdly,it serves social development and military medical services.As a result,a series of outstanding scientific and technological achievements have been obtained,and remarkable progress and results have been achieved.

Objective To investigate the effect of chemotherapy drugs on the expression of carci-noembryonic antigen (CEA) in the gastric tissue with precancerous lesions in ectopie cancer. Methods There were 45 cases of cancer patients (precancerous lesions group), the pathological biopsy showed that there were atypical hyperplasia or intestinal metaplasia by gastroscope before chemotherapy. Gastruscope was done before chemotherapy and after six cycles of chemotherapy. Gastric tissue was taken respectively in the same site. The expression of CEA was measured in the gastric tissue. Normal gastric tissue taken from 10 cases of cancer patients was served as control. Compared respectively the expression of CEA in the gastric tissue in control group and precancerous lesions group, in precancerous lesions group between before and after treatment. Results CEA expression in the gastric tissue was (27.76±9.67), (3.32±0.60)μg/L in precancerous lesions group and control group respectively, there was significant difference between two groups(P<0.05). CEA expression in the gastric tissue was (27.76±9.67), (26.60±10.80)μg/L before and after treatment in precancerous lesions group respectively, P<0.05. CEA expression in the gastric tissue before treatment was (23.11±4.11), (17.10±1.66)μg/L, after treatment was (21.11±5.66), (15.10±3.31)μg/L in the mild to moderate atypical hyperplasia, mild to moderate intestinal metaplasia respectively, there was significant difference between before and after treatment in the mild to moderate precancerous lesions. There was no significant difference between before and after treatment in the severe precancerous lesions. Conclusions Chemotherapy drugs can significantly reduce the expression of CEA in the gastric tis-sue in the mild to moderate precancerous lesions. The results suggests that mild to moderate precancerous lesions can be reversed.

Objective　To identify the mutation characteristic of STK11 gene in Chinese with Peutz-Jeghers syndrome(PJS) and establish the base of the gene diagnosis of PJS.Methods　STK11 germline mutation was analysed by DNA sequencing in 18 unrelation patients with PJS.Results　Six novel mutations of STK11 gene were detected in six unrelation patients. These mutations will lead to production of truncated protein.Conclusion　STK11 gene mutation accounts for one third of the Chinese with PJS. The content of mutation includes single base substitution or deletion and one or two bases insertion. The mutations were widely found in different regions of the whole coding sequence, and 2/3 of those concentrate in exon 1. Mutation frequency is 66.7% in the family suffering PJS in two or more generations, and 16.7% in the disseminated cases.