Objective By population survey,to explore the epidemiological characteristics of gastric precancerous lesions in Lishui District of Nanjing and provide objective basis for the prevention and treatment of early gastric cancer.Methods From July 2021 to December 2022,21 977 patients who received endoscopy and/or 13C-UBT in Lishui District People's Hospital and 6 medical community units in Nanjing City were retrospectively analyzed for demography characteristics,detection rate of gastric precancerous lesions,and H.Pylori infection rate.Results(1)590 cases of gastric precancerous lesions were detected(detection rate 2.68%);(2)The total detection rate of precancerous lesions and three pathological types in males were all higher than those in females(all P<0.001);(3)The minimum age for the total detection rate of precancerous lesions in males and the mini-mum age for each pathological type were lower than in females(P<0.001,0.009,0.005,0.002);(4)The popu-lation total H.pylori infection rate was 23.10%,the H.pylori infection rate in patients with precancerous lesions was higher than that in non-precancerous lesions(P<0.001),both H.pylori infection rate of male and female in precancerous lesions were all higher than those of non-precancerous lesions of the same sex(all P<0.001),in addition,the H.pylori infection rate of male whether in precancerous or non-precancerous lesions was higher than that of female(all P<0.001);(5)The precancerous lesions detection rate in male,female,and the overall age range of 20～29 to 70～79 years is positively correlated with age growth(P<0.001),and rapidly decreases after the age of 79,the of H.pylori infection rate was also positively correlated with age growth(P<0.001),and the trend of age change(P<0.001)was parallel to the precancerous lesions detection rate.Conclusions The detec-tion rate of gastric precancerous lesions in this region is above the average level in China;the total H.pylori infec-tion rate is at a relatively low level in China;the H.pylori infection rate is parallel to the age trend of the detection rate of gastric precancerous lesions,and increases with age.

Deterministic method is a numerical calculation method based on photon-electron coupled transport with high computational accuracy and speed, which has been widely applied in photon radiotherapy dose calculation in recent years. However, this method has been introduced into radiotherapy for only a short period of time, which has been rarely studied in China, and systematic understanding of its characteristics is still lacking. In this article, the principles of deterministic method, current development state and clinical application were reviewed, aiming to provide reference for carrying out relevant research.

Objective:To explore the changes of estrogen, androgen and progesterone in serum of male patients with primary gouty arthritis (pGA) and their possible role in the pathogenesis of gout.Methods:The serum, clinical data and laboratory parameters of 266 patients with PGA [including 93 patients with acute gout (AG), 118 patients with intermittent gout (IG), 55 patients with chronic gout (CG)] and 129 healthy controls (HC) were collected. The serum estradiol (E 2), progesterone (P), testosterone (T) and E 2/T were detected by CMIA Expression level. SPSS 17.0 statistical software was used for analysis, Wilcoxon rank sum test was used for comparison of measurement data between groups, and Spearman correlation analysis was used for correlation analysis between variables. Results:① The level of E 2 and T level in the serum of PGA, AG, IG and CG group was lower than that of the HC group [(30±8) pg/ml, (27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml, (35±10) pg/ml; F=17.770, P<0.05] and [(4.4±1.6) ng/ml, (3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml, (5.8±1.9) ng/ml; F=23.314, P<0.05], but there was no significant difference between HC group and CG group ( P>0.05), The serum E 2 and T levels in AG group were lower than those in IG and CG groups [(27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05] and [(3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml; F=23.314, P<0.05], andthe serum E 2 level in IG group was lower than that in CG group [(31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05). The levels of P and E 2/T in HC group were lower than those in pGA and AG group [(0.24±0.10) ng/ml, (0.27±0.11)ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05] and [(0.006 6±0.002 2) ng/ml, (0.007 6±0.003 2) ng/ml, (0.008 0±0.003 8) ng/ml; F=3.787, P<0.05), while those in IG and CG group were lower than those in AG group [(0.25±0.09) ng/ml, (0.26±0.08) ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05]; ② Spearman correlation analysis showed that E 2 level in pGA group was positively correlated with T and CysC( r=0.310, P<0.01; r=0.164, P=0.008), negatively correlated with MO ( r=-0.133, P=0.030), P level was positively correlated with MO ( r=0.139, P=0.023), T level was positively correlated with Crea and CysC ( r=0.179, P=0.003; r=0.162, P=0.008), negatively correlated with WBC, GR and MO ( r=-0.140, P=0.022; r=-0.173, P=0.005; r=-0.149, P=0.015), E 2/T was positively correlated with apob1 and Glu ( r=0.131, P=0.032; r=0.140, P=0.023). In AG group, E 2 level was positively correlated with T and Crea ( r=0.234, P=0.024; r=0.245, P=0.018), T level was positively correlated with Crea ( r=0.349, P=0.001), and negatively correlated with apob1 ( r=-0.250, P=0.016), and E 2/T was positively correlated with apob1 ( r=0.276, P=0.007). In IG group, E 2 level was positively correlated with T ( r=0.269, P=0.003), and negatively correlated with MO ( r=-0.183, P=0.048), while P level was positively correlated with MO( r=0.204, P=0.027). Conclusion:The expression of E 2 and T in the peripheral blood serum of gout patients decreases significantly, the expression of P and E 2/T increases significantly, and there is a positive correlation between E 2 and T, as well as the inflammatory and glycolipid metabolism indexes of gout patients, suggesting that estrogen, androgen and progesterone may participate in the pathogenesis of gout by regulating the inflammation and metabolism of gout.

Beginning with an introduction to overseas practices of privilege management, this paper analyzed the current privilege management of medical qualifications in China. On such basis, the authors introduced their insights and specific recommendations for the design and implementation of such management in China. These include: a platform for privilege management, a classified catalogue for medical qualifications, a procedure for the application, approval, examination and dynamic management of the qualifications, and an informatization platform for privilege management.

OBJECTIVE:To explore the cultivation method for community pharmaceutical care talents in higher vocational colleg-es. METHODS:According to the talent training aims to meet the demand of community pharmaceutical service positions in higher vo-cational colleges,the teaching reform was carried out for talent cultivation mode,course structure system,training base construction and teaching methods. RESULTS:In terms of talent cultivation mode,the work-integrated learning mode was built;in terms of course structure system,“Medicine,Pharmacy,Humanities and Expansion”course module was constructed to further optimize it;in terms of training base construction,the capital investment was increased to improve the school training base,meanwhile,cooperation between schools and enterprises was carried out to strengthen the construction of out-of-school training bases;in terms of teaching methods, PBL,case teaching model and situational teaching method were implemented. CONCLUSIONS:The quality of pharmaceutical talents has been significantly improved by implementing reform of the talent cultivation mode,the course structure system and teaching meth-ods,together with constructing training bases.

Objective To investigate prevalence HPV infections in cervix among HIV-infected Chinese women.Methods From September 2009 to May 2011,293 women with positive HIV underwent cervical cancer screening as study group matched with 200 women with negative HIV as control group.Questionnaires including demographic information and HIV associated information were collected,Pap smear and 23 subtype of HPV were performed in those women.The women with positive HPV were followed up per 6 months,and the period of following up were more than 12 months.Binary logistic analysis was used for high risk factors of HPV persistent infection.Results Prevalent HPV infection was 44.4％ (130/293) in study group and 20.0％ (40/200) in control group,respectively,which reached statistical difference( P ＜0.05).The most common genotype of HPV was HPV 16,which prevalence was 13.7％ (40/293)in study group and 7.0％ (14/200) in control group.The other HPV subtype prevalence was HPV-58,HPV-52,HPV- 43 and HPV-18,which was 9.2％ (27/293),8.2％ (24/293),8.2％ (24/293),6.8％ (20/293) in study group and 3.0％ (6/200),2.5％ (5/200),1.5％ (3/200),2.5％ (5/200) in control group.At time point of 12 months following up,the persistent prevalence of HPV was 47.5％ (48/101) in study group and 21.1％ (8/38) in control group,which reached statistical difference (P＜0.05).Multiple HPV infections ( OR =6.4,95 ％ CI:1.6 - 25.6),abnormal cytology ( OR =18.1,95 ％ CI:4.5 - 76.9 ) and lower CD4 T cell count (compaed with CD4 ＞3.5 × 108/L,if 2.0 × 108 ≤CD4 ≤3.5 × 108,OR =8.1,95％ CI:1.3 -56.3 ; if CD ＜ 2.0 × 108/L,OR =9.1,95％ CI:1.8 - 46.9 ) were independently associated with HPV persistence among HIV-positive subjects.Conclusions Prevalence and persistence of HPV infections were more common among HIV-positive Chinese women than those in HIV-negative Chinese women.Improving immune function,decreasing multiple HPV infections,treating abnormal cervical cytology could decrease prevalence of HPV infection.

Objective To evaluate the prevalence and risk factors of human papillomaviruses (HPV)infection among human immunodeficiency virus(HIV)-positive women.Methods Totally 178HIV-positive and 122 HIV-negative women were enrolled.Structured interviews,peripheral CD4 + T cells counts and cervical specimens were obtained.Polymerase chain reaction(PCR)assay was used to identify HPV types. SPSS 16.0 was used for statistical analysis,and logistic regression was used to identify independent prognostic factors for high-risk HPV infection. Results HPV positive rate,high-risk and multiple HPV infection rates were 38.2% vs.12.3% ,35.4% vs.8.2% ,and 13.5% vs.3.3% in HIVpositive women and HIV-negative women,respectively,and the differences were of statistical significance (x2 =24.77,29.08 and 8.91,P ＜0.05).The common types of high-risk HPV were similar between HIV-positive and HIV-negative women(HPV16,52,58 and 18).CD4 + T count ＜ 350/pL,HIV-positive in husband,and HIV infection through sexual contact were risk factors for high-risk HPV infection in HIV-positive women.Conclusion sThe prevalence of HPV infection in HIV-infected women is high,especially for high-risk HPV infection and multiple infection.High-risk HPV infection usually occurs in HIV-positive women with low immune status,HIV infection through sexual contact and HIV-positive husband.

Objective To explore the surgical extent and to improve the surgical techniques of the Piver class Ⅲ hysterectomy on invasivc cervical cancer,so as to reduce the urinary tract complications,shorten the surgical duration,decrease the hemorrhage and blood transfusion.Methods The study group,196 cases with stages Ⅰ b and Ⅱ a carcinoma of the cervix underwent the modified Piver class Ⅲ hysterectomy from June 2000 to May 2005.The control group,176 cases of the same stages underwent the Pivet class Ⅲ hysterectomy between June 1994 and May 1999.The modified Piver class Ⅲ hysterectomy mainly include the surgical extent and some surgical techniques as follows.The cervicovesical and vesicovaginal space are separated with assistance of electrotome.Half of the uterosacral ligaments are removed with electrotome.The tunnel of the ureters is separated and penetrated or not. The anterior leaf of the cervicovesical ligaments is removed and the uterine artery are removed at the same time.while the ureter branch from the uterine artery are preserved.When the ureters aIe drawn to the lateral side of the body with an "S" hook and the urocyst lateral recessus are expanded.the cardinal ligaments can be exposed and be removed of 3/4.But part of the inferior of these ligaments should be preserved.The paracolpium are resected about 2 cm.2-3 cm tissue of the vagina is removed.Results Compare with the control group,the urinary tract complications of the study group were significantly reduced(51.1%versus 23.0%,P<0.01).There were a shorter surgical duration[(132±20)min],less of the hemorrhage[(322±100) ml]and blood transfusion[(154±79)ml] in the study group than those in the control group(all P<0.05).While,there was no significant difference at the survival rates of 5 years between the two groups (87.8% versus 88.6%.P=0.793).Conclusion The modified Piver class Ⅲ hysterectomy is effective and applicable for patients with cervical cancer.

Small cell carcinoma of cervix (SCCC) is a rare disease with highly aggressive behaviour and is pathologically hard to diagnose. In this study, the clinicopathological features, diagnosis,treatment and prognosis of the condition were examined. Clinical records and follow-up data of 7 cases of SCCC were retrospectively studied. Our results showed that five non-recurrent cases initially presented irregular vaginal bleeding or increased apocenosis of varying degrees. Pathological examination revealed that the stroma was diffusely infiltrated with small monomorphous cells ranging from round to oval shape. Three cases were immunohistochemically confirmed. One case was accompanied with squamous cell cancer. Of the 7 cases, one case was classified as stage Ⅰ bl, two stage Ⅰ b2,one stage Ⅱ a, one stage Ⅱ b, and one stage Ⅲb. On the basis of their stages of condition, one subject with stage Ⅲ b underwent chemotherapy, and one with stage Ib2 received extensive hysterectomy plus pelvic lymphadenectomy, while the other 5 cases were treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy. Of the 7 patients, 4 had relapse-free survival of 14, 14, 16 and 28 months respectively.It is concluded that SCCC is an aggressive tumor with propensity for early pelvis lymph node metastases. Early-stage patients should be treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy.

Small cell carcinoma of cervix (SCCC) is a rare disease with highly aggressive behaviour and is pathologically hard to diagnose. In this study, the clinicopathological features, diagnosis, treatment and prognosis of the condition were examined. Clinical records and follow-up data of 7 cases of SCCC were retrospectively studied. Our results showed that five non-recurrent cases initially presented irregular vaginal bleeding or increased apocenosis of varying degrees. Pathological examination revealed that the stroma was diffusely infiltrated with small monomorphous cells ranging from round to oval shape. Three cases were immunohistochemically confirmed. One case was accompanied with squamous cell cancer. Of the 7 cases, one case was classified as stage I b1, two stage I b2, one stage IIa, one stage IIb, and one stage IIIb. On the basis of their stages of condition, one subject with stage III b underwent chemotherapy, and one with stage Ib2 received extensive hysterectomy plus pelvic lymphadenectomy, while the other 5 cases were treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy. Of the 7 patients, 4 had relapse-free survival of 14, 14, 16 and 28 months respectively. It is concluded that SCCC is an aggressive tumor with propensity for early pelvis lymph node metastases. Early-stage patients should be treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy.