Objective To investigate the effects of dienogest on pain relief and inflammation in endometriosis(EMs),as well as its impact on the brain-derived neurotrophic factor(BDNF)/tropo-myosin receptor kinase B(TrkB)and nuclear factor kappa-B(NF-κB)/NOD-like receptor protein 3(NLRP3)inflammatory pathways.Methods An allograft method was used to establish an EMs rat model.The rats were randomly divided into sham-operated group(n=16),model group(n=16),low-dose dienogest group(n=16),medium-dose dienogest group(n=16)and high-dose dienogest group(n=16).After 7 days of treatment,the implantation volume and writhing response frequency were recorded.Enzyme-linked immunosorbent assay(ELISA),reverse transcription-polymerase chain reaction and Western blotting were employed to measure the expression levels of vascular endothelial growth factor(VEGF),inducible nitric oxide synthase(iNOS),interleukin(IL)-6,IL-1β and tumor necrosis factor(TNF)-α in the EMs rat models.Serum levels of BDNF,TrkB,NF-κB and NLRP3 were detected.Results Compared with model group,dinorgestrel significantly reduced ectopic endo-metrial volume and torsion response of EMs(P＜0.05).Compared with model group,dinorgestrel significantly decreased the expression of VEGF,iNOS,IL6,IL-1 β and TNF-α in EMs model(P＜0.05).In addition,compared with model group,dienogest significantly decreased the expressions of BDNF,TrkB,NF-κB and NLRP3 in ectopic endometrium(P＜0.05).Conclusion Dinorgestrel can relieve EMS-related dysmenorrhea and inflammation,and its mechanism of action may be partly mediated by BDNF/TrkB pathway and NF-κB/NLRP3 pathway.

Objective To investigate the clinical prognosis value of the positivity rate of oligoclonal bands(OCB)and immunoglobulin G(IgG)level of cerebrospinal fluid(CSF)in severe encephalitis.Methods A total of 699 cases of encephalitis patients admitted to the Department of Neurology of the First Affiliated Hospital of Air Force Military Medical University,and Xijing 986 Hospital from January 2016 to October 2020 were enrolled.According to the severity of their diseases,these patients were divided into a mild(n=360)group and a severe(n=339)group.CSF and serum samples were collected from the patient at the time of admission,and the differences in cerebrocyte count,glucose contem,glucose content,chlorine content,IgG of CSF and OCB of CSF and serum were compared.According to the GOS score of patients with severe encephalitis at discharge,the patients were divided into good prognosis group(n=259)and poor prognosis group(n=80),and multivariate Logistic regression analysis was used to analyze factors that affected the prognosis of severe encephalitis patients,and the correlation between the OCB and IgG of CSF and prognosis of patients with severe encephalitis.The predictive value of CSF IgG for the prognosis of patients with severe encephalitis was tested,and receiver operating characteristic(ROC)curve was plotted.Results Compared to patients with mild encephalitis,patients with severe encephalitis had a higher proportion of fever,pulmonary infection,status epilepticus,and mechanical ventilation,and were more likely to be complicated by stroke and hydrocephalus,and the differences were statistically significant(χ2=5.319～245.179,all P<0.05).There were significant differences in the positive rate of cerebrocyte count,chlorine content,IgG content and OCB in cerebrospinal fluid between the two groups(Z=-3.623,-4.875,-3.518,χ2=6.581,all P<0.05).CSF OCB and CSF IgG were independent risk factors for poor prognosis in patients with severe encephalitis(Wald χ2=7.295,0.001,all P<0.05).A restrictive cubic spline plot showed a linear relationship between CSF IgG and poor prognosis.The AUC(95%CI)of CSF IgG was 0.754(0.632～0.876).Conclusion The CSF IgG content and positive rate of CSF OCB in patients with severe encephalitis with poor prognosis are higher than those in patients with good prognosis,and detecting these two indicators has certain reference value for the prognosis prediction of patients with severe encephalitis.

Objective To investigate the clinical prognosis value of the positivity rate of oligoclonal bands(OCB)and immunoglobulin G(IgG)level of cerebrospinal fluid(CSF)in severe encephalitis.Methods A total of 699 cases of encephalitis patients admitted to the Department of Neurology of the First Affiliated Hospital of Air Force Military Medical University,and Xijing 986 Hospital from January 2016 to October 2020 were enrolled.According to the severity of their diseases,these patients were divided into a mild(n=360)group and a severe(n=339)group.CSF and serum samples were collected from the patient at the time of admission,and the differences in cerebrocyte count,glucose contem,glucose content,chlorine content,IgG of CSF and OCB of CSF and serum were compared.According to the GOS score of patients with severe encephalitis at discharge,the patients were divided into good prognosis group(n=259)and poor prognosis group(n=80),and multivariate Logistic regression analysis was used to analyze factors that affected the prognosis of severe encephalitis patients,and the correlation between the OCB and IgG of CSF and prognosis of patients with severe encephalitis.The predictive value of CSF IgG for the prognosis of patients with severe encephalitis was tested,and receiver operating characteristic(ROC)curve was plotted.Results Compared to patients with mild encephalitis,patients with severe encephalitis had a higher proportion of fever,pulmonary infection,status epilepticus,and mechanical ventilation,and were more likely to be complicated by stroke and hydrocephalus,and the differences were statistically significant(χ2=5.319～245.179,all P<0.05).There were significant differences in the positive rate of cerebrocyte count,chlorine content,IgG content and OCB in cerebrospinal fluid between the two groups(Z=-3.623,-4.875,-3.518,χ2=6.581,all P<0.05).CSF OCB and CSF IgG were independent risk factors for poor prognosis in patients with severe encephalitis(Wald χ2=7.295,0.001,all P<0.05).A restrictive cubic spline plot showed a linear relationship between CSF IgG and poor prognosis.The AUC(95%CI)of CSF IgG was 0.754(0.632～0.876).Conclusion The CSF IgG content and positive rate of CSF OCB in patients with severe encephalitis with poor prognosis are higher than those in patients with good prognosis,and detecting these two indicators has certain reference value for the prognosis prediction of patients with severe encephalitis.

Objective The combined application of X-ray photography and various ultrasound examination techniques to evaluate the clinical outcome of developmental dysplasia of the hip (DDH) in early diagnosis and treatment. Methods A retrospective analysis of the data of 296 hips in 148 infants with DDH risk factors from September 2017 to September 2018 was classified by Graf method. Harcke method was applied to evaluate the stabilities of the hips. Ottobock harnesses was used for treatment depending on the classification. Human position spica cast would be given if no efficacy was seen and Novick method was applied to observe the location of femoral head and acetabulum. X-rays were given to the infants underwent treatments when they were above 1 year old and the developments of the hips were evaluated. Results There were 207 type Ⅰ hips, 76 type Ⅱ hips, 3 type D hips, 6 type Ⅲ hips and 4 type Ⅳ hips as Graf classification at first examination. 248 hips were stable, 27 hips were relaxed, 5 hips were dislocated when compressed, 13 hips were reducible and 3 hips were irreducible as Harcke classification. 81 hips were treated in all. All the hips turned to be in normal range at age of 1 year. Conclusion The combination of X-ray scan and three ultrasound tools are effective to comprehensively assess the hip joint and precisely diagnose DDH, which may benefit more infants.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.

Objective To assess the clinical efficacy of perforators positioning technique in anterolateral thigh perforator sub lobe flap transplantation for reconstructing soft tissue defects of forearm or hand.Methods A retrospective case series study was performed to analyze 24 patients with forearm and hand soft tissue defects admitted from January 2013 to August 2017.There were 18 males and six females,aged 31-68 years (mean,52.3 years).The wound defect areas ranged from 11 cm × 10 cm to 18 cm× 14 cm.The anterolateral thigh sub lobe perforator flaps were used for repair.CT angiography (CTA) combined with color Doppler ultrasound (CDS) was used to determine the perforator position before operation.After the appropriate thigh side was selected according to the perforator position and the wound area,the lobed flaps were designed to ensure all the flaps for the stage I suture after the length was converted into width.All patients obtained stage Ⅱ repair,and the repair time was 5-29 days,with an average of 13 days.The accuracy of perforation positioning was observed during operation (the error was not more than 1 cm for accurate positioning).The flap survival and complications were recorded within 2 weeks after operation.Follow-up was performed using the seven indicators of flap function to evaluate the efficacy.Results The positioning accuracy rate was 99％.One case was seen necrosis about 2 cm at the proximal end of flap.Two cases had arterial crisis after flap operation and survived after active exploration.In two nonunion cases because of wound infection around the flap,one case was healed after dressing change,and another case was healed after debridement.The donor site of the flap obtained stage Ⅰ direct suture,and one case was seen obvious scar hyperplasia at the donor site.Flaps were made thinner in two patients with hand defects at the later stage.All 24 patients were followed up for 7-33 months,with an average of 18.3 months.According to the seven indexes of the flap function,the results were excellent in seven cases,good in 13,fair in three,and poor in onee,with an excellent and good rate of 83％.The flaps appeared soft with good color at the last follow-up.Conclusions In the treatment of soft tissue defects of forearm or hand using anterolateral thigh flap,conversion from length to width and direct suture of donor site can cover the wound well and reduce complications.Perforators positioning technique can facilitate precise preoperative planning and intraoperative accurate cutting.

Objective To explore the clinical application of antcrolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel,when anterior or posterior tibial vessel could not be utilized.Methods From January,2015 to May,2017,free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients,after preoperative color Doppler sonography ultrasound (CDU) for precise positioning.There were 4 males and 3 females,with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm.All of the donor sites were sutured directly.Postoperative followedup was done termly.Results All the patients were followed-up for 6 to 14 months,with an average of 8.9 months.Typically,2 cases had large defect areas,with distal flap necrosis of 6.0 cm and 4.0 cm,respectively,which were resected and achieved secondary skin graft healing on the residual surface.Additionally,4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface.The remaining 1 case had completely survived flap,but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis.As a result,the patient received gastrocnemius myocutaneous flap to repair the wound.Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee,with descending genicular artery as the recipient vessel,can achieve satisfactory clinical efficacy,which can serve as one choice for flap repair in wound around the knee.

Objective: To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods: Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results: The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion: Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.

This study was aimed to observe the curative effect and safety of Danzhi Jiangtang Capsule ( DJC ) combined with atorvastatin on carotid artery intima-media thickness (IMT) in diabetes patients without hyper-tension . A total of 196 diabetes patients without hypertension with incrassate carotid artery IMT were randomly divided into the control group ( 98 cases ) and the treatment group ( 98 cases ) . The conventional diabetes thera-py was given to both groups . The atorvastatin of 20 mg/night was given to the control group . And the atorvas-tatin 20 mg/night added with DJC 9 . 0 g/night were given to the treatment group . The treatment course was
12 months . Carotid artery IMT , carotid atherosclerotic plaque area , FPG , FIns , HOMA-IR , HbA1c , blood lipids , hepatorenal function and etc . were examined before and after the treatment respectively . The results showed that there was a significant positive correlation between carotid artery IMT and FIns , HOMA-IR , HbAlc , LDL-C . After 12-month treatment , the total effectiveness is 85 . 87% in the treatment group . And there was significant difference compared with the control group ( P < 0 . 05 ) . The levels of FPG , FIns , HOMA-IR , HbAlc of the treatment group had no difference compared with the control group . Compared with the control group, TC and LDL-C of the treatment group was obviously decreased (P < 0.05). And HDL-C was significantly increased ( P < 0 . 05 ) . The carotid artery IMT of the treatment group decreased from ( 0 . 11 ±0 . 01 ) cm to ( 0 . 08 ± 0 . 01 ) cm . And compared with the control group , there was statistical significance ( P <0 . 05 ) . The carotid atherosclerotic plaque area of 58 cases in the treatment group decreased from ( 0 . 37 ±0.56) cm2 to (0.21 ± 0.25) cm2. However, there was no statistical significance compared to the control group. There were 5 adverse events in the control group and 9 adverse events in the treatment group . And there was no difference between two groups. It was concluded that DJC combined with atorvastatin can regulate lipid metabolism and reduce carotid artery IMT .