Objective To explore the correlation between vitamin D and antiphospholipid antibody(APLa)level in the patients with recurrent spontaneous abortion(RSA).Methods A total of 157 patients with RSA visiting the RSA outpatient department of RSA of Hangzhou Municipal First People's Hospital from January 2022 to April 2023 were selected by the prospective clinical study as the study subjects.Among them,34 RSA cases of vitamin D deficiency complicating APLa abnormality(the study group)conducted the vitamin D supplement intervention and their vitamin D and APLa levels were dynamically monitored;27 RSA patients with vitamin D deficiency and APLa abnormality without vitamin D supplement intervention before intervention or at the same time visiting the department of non-RSA outpatient of this hospital served as the control group.The general data and the relationship between vitamin D and APLa level were compared be-tween the two groups.The pregnant outcomes in the two groups were analyzed.Results There were no differences in the general data such as age and BMI between the two groups(P＞0.05).In the study group,the vitamin D was negatively correlated with the APLa level(P＜0.001);after treatment,the vitamin D level was significantly increased and the APLa level was significantly decreased(P＜0.001).The adverse pregnan-cy outcomes had statistical difference between the two groups(P=0.043).Conclusion Among the patients with RSA,the vitamin D may be negatively correlated with the APLa level.Monitoring and evaluating the vi-tamin D and APLa levels,and adopting the vitamin D intervention before pregnancy as early as possible could prevent the occurrence risk of adverse pregnant outcomes in RSA,thus improve the pregnant outcome.

Objective:To explore the preventive value of "integrated prevention strategy" for nipple and areola ischemia after single-port endoscopic subcutaneous mastectomy.Methods:The clinical data of 72 patients with breast cancer who received single-port endoscopic subcutaneous mastectomy in Beijing Friendship Hospital, Capital Medical University from July 2019 to July 2021 were retrospectively analyzed, they were all female. The follow-up period was up to July 2022. According to the perioperative treatment methods, the patients were divided into observation group ( n=40) and control group ( n=32). The patients in the observation group who adopted the "integrated prevention strategy" scheme, and patients in the control group who adopted the conventional treatment scheme. The incidence of postoperative nipple and areola ischemic was compared between the two groups, and the postoperative cosmetic effect, quality of life and satisfaction of patients were evaluated. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the data groups. Results:The postoperative drainage volume in the observation group was significantly lower than that in the control group [(632.40±226.37) mL vs (774.91±239.85) mL], and the difference was statistically significant ( P=0.013). Two weeks after operation, there was 1 case of nipple and areola ischemia in the observation group, and 7 cases in the control group, the difference was statistically significant between the two groups ( P=0.019). Twelve months after operation, the score of breast satisfaction (83.93±11.64 vs 67.28±11.52), chest satisfaction (89.63±8.06 vs 83.03±9.49) and psychosocial well-being (89.43±12.42 vs 78.88±10.40) in the observation group were better than those in the control group, the differences were statistically significant ( P<0.05). Conclusion:"Integrated prevention strategy" can effectively prevent the occurrence of nipple and areola ischemic after single-port endoscopic subcutaneous mastectomy and improve patient satisfaction, which has certain promotion value.

Objective:To investigate the surgical method and clinical application value of single-port inflatable endoscopic prepectoralis prosthesis implantation for breast reconstruction (external prosthesis wrapping Off-Label).Methods:From September 2021 to February 2022, 7 breast cancer patients who underwent single-port inflatable endoscopic prepectoralis prosthesis implantation breast reconstruction (Off-Label) in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Statistical analysis of surgical complications, postoperative movement deformities, postoperative chest wall pain, postoperative quality of life and satisfaction scores of patients were conducted.Results:All 7 patients successfully completed the operation. There were no complications such as postoperative bleeding, infection, ischemic necrosis of nipple-areola complex or skin flap, postoperative movement deformity, postoperative chest wall pain, capsular contracture, prosthesis exposure or removal. The BREAST-Q scale was used to evaluate the quality of life and satisfaction after breast reconstruction. Postoperative breast satisfaction (55-100 points), chest wall status (52-89 points), and social psychological status (62-100 points) can be compared High rating.Conclusion:The single-port inflatable endoscopic prepectoral prosthesis implantation breast reconstruction (Off-Label) can achieve better radical effect and cosmetic effect through a shorter operation time, and the postoperative quality of life and satisfaction of patients are higher.

Objective:To explore the significance of exposing the circummammary ligament under endoscopy and the effect of membrane anatomy in breast reconstruction.Methods:The case data of 49 breast cancer patients who underwent endoscopic nipple-sparing mastectomy combined with one-stage breast reconstruction with prosthesis implantation in Beijing Friendship Hospital, Capital Medical University from February 2014 to December 2021 were retrospectively analyzed, there were 44 cases of posterior pectoralis prosthesis implantation, 5 cases of anterior pectoralis prosthesis implantation. The anatomical structure of the circummammary ligament was observed under endoscopy during operation, and the annular mammary ligament was used as an anatomical marker to complete subcutaneous glandectomy and prosthesis implantation for breast reconstruction, the BREAST-Q scales were used to evaluate the postoperative effect.Results:The medial sternal ligament, sub clavicular ligament, lateral confluence ligament and triangular ligament condensation could be clearly exposed in all 49 cases. Breast reconstruction module of BREAST-Q were used to evaluate the surgery effect after breast cancer surgery, the scores of postoperative breast satisfaction, chest wall status, psychosocial status and sexual health status were 81.43±12.57, 88.39±10.61, 88.04±13.70, 74.82±15.93.Conclusion:The endoscopic technique is beneficial to expose the circummammary ligament during operation, and surgical resection and reconstruction can better restore the appearance of the breast and improve postoperative satisfaction according to the principle of membrane anatomy.

Objective To explore the shielding effects of 1-4 layers of lead aprons (LPs) and body shielding devices (BSDs) against stray radiation (SR) outside the electron beam field of 6-15 MeV.Methods JR-115B LiF TLDs were used to measure the stray radiation doses (SRDs) to the patient undergoing treatment,before and after being shielding,for different distances,different energies,different applicators,variable layers of LPs,and different thickness of body shielding devices (BSDs),respectively,along long calculating and comparing the shielding ratios of LPs and BSDs against SR.Results When the applicator (10 cm × 10 cm) is unchanged,the shielding ratio increased with the increased distance from measuring point (r =0.717,P ＜ 0.05) and decreased with the increased electron energy (r =-0.678,P ＜ 0.05);when the energy was constant,there was no correlation between the shielding ratio and the size of applicator (P ＞ 0.05);For lower energy electron beam of 6 and 9 MeV,the shielding ratio for 1 mm Pb-BSD was slightly higher than that for 2 layers of LA (t =2.519,2 662,P ＜ 0.05),ranging from 81.5％ to 95.3％ and 55.4％ to 84.6％,respectively.For 12 and 15 MeV higher energy electron beam,the shielding ratio for 2 mm Pb-BSD was slightly higher than that for 4 layers of LA (t=3.768,7.934,P＜0.05),ranging from 64.6％ to 93.4％ and 51.1％ to 92.4％,respectively.Conclusions LAs or BSDs are availavle for effectively reducing the doses from stray radiation,and may help reduce the secondary risks from stray radiation.BSDs have more obvious advantages than LPs with regard to shielding effect.

Objective To investigate the distribution of hepatitis B virus (HBV) genotypes in patients with chronic HBV infections and the correlations of genotypes with liver fibrosis and hepatocellular carcinoma (HCC).Methods Serological,virological and pathological data of 190 patients with chronic HBV infections admitted to Hangzhou First People's Hospital during June 2007 and June 2012 were retrospectively analyzed.The series included 62 cases of chronic hepatitis B (CHB),60 cases of liver cirrhosis and 68 cases of HCC.HBV was genotyped by multiplex PCR,and subgenotyped by restriction fragment length polymorphism (RFLP).SPSS 11.0 was used for statistical analysis.Results Among 190 patients,61 were HBV genotype B (32.1％),126 were genotype C (66.3％),and 3 were B + C hybrid.HBV B2 (61/61,100.0％) and C2 (123/126,97.6％) were the major subgenotypes.HBV genotype B was more prevalent in CHB patients (46.8％,29/62) than in liver cirrhosis (20.0％,12/60) and in HCC patients (29.4％,20/68) (x2 =8.73 and 4.16,P＜0.01 or P＜0.05),whereas the prevalence of genotype C was higher in liver cirrhosis and HCC than that in CHB (x2 =9.54 and 4.17,P ＜0.01 or P ＜ 0.05).Patients with genotype C2 had higher serum hyaluronic acid level than with genotype B2 in 3 groups (t =2.685,2.433 and 2.015,P ＜ 0.01 or P ＜ 0.05).CHB patients with C2 infections had higher liver fibrosis grade than those with B2 (x2 =6.726,P =0.010),while there was no statistical difference in liver inflammation grade (x2 =0.601,P ＞ 0.05).HCC patients with B2 infection tended to have larger tumor diameter (≥5 cm) (x2 =7.231,P ＜ 0.01) and those with C2 infection were prone to be more serious cirrhosis (x2 =4.910,P ＜ 0.05).Conclusions HBV genotypes C2 and B2 are predominant in patients with chronic HBV infections in Hangzhou.HCC patients infected with HBV C2 may be complicated with more severe liver fibrosis,and those with HBV B2 infections may tend to have larger liver tumor.

Objective To evaluate hepatitis B virus large surfsce protein(LHBs) in monitoring of antiviral treatment.Methods LHBs.HBV serum markers and HBV DNA loads in 46 patients with adefovir dipivoxil(ADV) therapy were monitored for the whole course(60 weeks).Enzyme linked immunosorbent assay(ELISA),time differentiate immunofluoresence assay and real.time polymerase chain reaction(RT-PCR)were performed to detect LHBs,HBV serum markers and HBV DNA loads,respectively.And correlation analysis was also performed.Results Both LHBs and HBV DNA declined during the ADV treatment.and the correlation coefficient was 0.97.but LHBs declined after HBV DNA.There were 20 patients with HBV DNA<5×102/mL at 60th week.in which 8 were LHBs negative;in 14 recurrent patients,the HBV DNA turned to negative and became positive again,3 with negative LHBs;while in 12 patients resistant to the ADV therapy.2 were LHBs negative.Conclusion Dynamic monitoring of LHBs is useful in the evaluation of antiviral treatment.

OBJECTIVE To investigate macrolide resistance and main molecular mechanisms in Mycoplasma pneumoniae. METHODS Thirty two throat swabs from children infected with M. pneumoniae were cultured by modified Hayflick medium. Antibiotic susceptibility test was used to screen the macrolide-resistant M. pneumoniae. The 23S rRNA gene sequences of the strains were determined with polymerase chain reaction and sequencing. RESULTS Nineteen strains were isolated from 32 throat swabs successfully.Fifteen strains were resistant to macrolide antibiotics according to the results of antibiotic susceptibility test. Once the strain was resistant to one of macrolide antibiotics,it would be resistant to the others. Sequencing results of the sensitive strains and the standard strain FH were completely same. Fifteen resistant strains presented A2063G point mutation in 23 SrRNA region Ⅴ, in which 2 examples showed the coexistence of the sensitive strain and the resistant strain. CONCLUSIONS Macrolide-resistant M. pneumoniae is common and serious at present. The antibiotic resistant isolate carries point mutations of the 23S rRNA region Ⅴ.