To introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.

Objective: Under the intervention of modern holistic medical model, the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years. Methods: A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017. The patients were divided into control group and experimental group by completely randomized grouping, there were 1 006 cases in each group. The children in the control group were treated with a single biomedical model, which was completed according to the conventional flow-type operation. The children in the experimental group adopted the modern holistic medical model, and the full modern holistic medical model intervention was performed before, during and after the operation. The medical treatment process highlighted the overall humanistic care for the children. The age of the control group was (4.19±1.75) years old, and the age of the children in the experimental group was (4.26±1.68) years old. The operation time, the degree of surgical pain [with the pain visual analogue scale (VAS)], the postoperative complications (including postoperative hemorrhage, penile edema, infection, wound rupture), wound healing time, surgery satisfaction rate and fear level of children were compared between the two groups. Measurement data were expressed as mean±standard deviation (Mean±SD), t-test was used for comparison between groups; Chi-square test was used to compare the count data. Results: In the control group, the operation time was (9.26±1.87) min, the surgical pain VAS was (2.59±0.72), postoperative bleeding was 38 (3.8%), severe penile edema was 78 (7.8%), and infection was 12 (1.2%), wound rupture was 32 cases (3.2%), the wound healing time was (20.4±2.56) d, and the surgical satisfaction rate was 67.4%. In the experimental group, the operation time of was (6.15±1.23) min, the surgical pain VAS was (1.71±0.54), postoperative bleeding was 6 cases (0.6%), severe penile edema was 12 cases (1.2%), and infection was 8 cases (0.8%), wound rupture was 2 cases (0.2%), the healing time was (15.2±3.16) d, and the operation satisfaction rate was 98.8%. The operation time, surgical pain VAS, postoperative bleeding, severe penile edema, wound splitting rate, healing time and surgical satisfaction rate were statistically significant (P<0.05), and there was no statistical difference in wound infection rate between the two groups (P>0.05). The fear level of children in the experimental group was superior to the control group at levels 0, 1, 2 and 3, the difference was statistically significant (P<0.05). Conclusions Under the intervention of modern holistic medical model, the child′s operation process is smooth, the children and parents have good subjective feelings, no obvious fear, good compliance, high satisfaction, good objective clinical effect, and positively improve the relationship between doctors and patients. The society has won a good reputation and deserves to be promoted clinically.

Objective To compare the clinical outcomes of low-dose rabbit antithymocyte globulin (rATG ) vs basiliximab as induction therapy in recipients of ABO-incompatible kidney transplantation (ABOi-KT) .Methods Retrospective analysis was conducted for e the clinical data of 40 ABOi-KT recipients between March 2017 and March 2019 .17 recipients of them received induction therapy with basiliximab (basiliximab group) while another 23 recipients received low-dose rATG (rATG group ,rATG 25 mg/d × 3 d) .During a median follow-up period of 282 days , the data of serum creatinine and eGFR at 1 week and 1 month ,graft survival rate and complication rate of two groups were compared .Results No significant difference existed in age ,gender ,dialytic modality/ duration , blood groups of recipients , HLA mis-match , blood group antibody titers , dose of rituximab ,blood groups of donors or donor age ( P > 0 .05 ) . The times of double filtration plasmapheresis in Basiliximab group were more (P< 0 .05) .No significant difference existed in serum creatinine and eGFR at 1 week or 1 month ( P > 0 .05 ) . No significant difference existed in graft survival rate . No significant difference existed in rate of acute rejection ,parvovirus B19 infection , urinary tract infection or hematoma .Conclusions Low-dose of rATG is as effective as basiliximab for ABOi-KT recipients .And rATG does not increase the rate of infection .

Objective To compare and analyze the clinical effects of different local anesthetics on continuous epidural anesthesia for percutaneous enucleation of nucleus pulposus. Methods A total of 40 patients underwent lumbar intervertebral discoscopy (PTED) from November 2015 to November 2016, according to the choice of anesthesia is divided into group A and group B, 20 cases in each group. Group A used 0.5％lidocaine local anesthesia, group B treated with continuous epidural anesthesia (1 ％ lidocaine 3 mL+0.5％ ropivacaine).Analysis of two groups before operation, the curative effect, VAS score, modified Bromage score, intraoperative pain perception includes four criteria, namely, mild, moderate and severe, the former two satisfactory anesthetic effect; the latter two are not satisfied with the anesthesia. Results Two cases without postoperative cerebrospinal fluid leakage occurred, nerve root injury and other complications; two groups of patients with pain satisfaction difference was statistically significant (P<0.05); compared with group A, the levels of HR and MAP in group B were more stable (P<0.05). Conclusion Continuous epidural anesthesia is more suitable for PTED than local anesthesia. It can reduce the pain and the occurrence of cardiovascular and cerebrovascular accidents in patients, and does not affect the patients' lower limb movement score.

Objective To explore body mass index(BMI),glucose and lipid metabolism status of high -nor-mal blood pressure that selected Uygur,Kazak and Han nationalities in parts of Xinjiang.Methods Some representa-tive regions were selected,including Fuhai County of Altay,Xinyuan County of Yili,Yanqi County of Korla and Pasto-ral of Urumqi South Mountain in August 2012 -2014 August,each region was randomly selected two survey points respectively,400 -450 people were expected to conduct on -site investigations in every survey point,and 1 046 cases were collected containing Uygur,Kazak and Han nationalities who were conformed to diagnostic standard,206 cases in which the Kazak (115 men and 91 women),Han 518 cases (277 men and 241 women),322 cases of Uygur (174 men and 148 women).in order to realize the BMI,waistline,lipid metabolism and fasting glucose status.Results (1)BMI was descending:Kazak >Uygur >Han,between the three groups respectively were statistically significant differences[(26.07 ±3.23)kg/m2 ,(25.85 ±4.09)kg/m2 ,(24.63 ±3.00)kg/m2 ,F =19.829,P <0.05],sub-group analyzes:BMI for men descending:Kazak >Uygur >Han,comparison between groups of Han,Uygur and Kazak provided results which were statistically significant(F =6.752,P <0.05);but statistical significance merely existed in Han and Kazak female comparison(F =2.248,P <0.05).Waist comparison showed a decreasing sequence:Uygur>Kazak >Han,there were no statistically significant difference between every three groups[(86.32 ±8.63)cm, (85.50 ±10.11)cm,(84.06 ±7.57)cm,F =1.675,P >0.05],gender comparison was found the same characteristics. (2)Blood fat comparison between different ethnic:Descending order of serum TG:Kazak >Han >Uygur,comparison among groups of Han,Uygur and Kazak differences were statistically significant(F =5.829,P <0.05),comparison among groups of Han,Uygur and Kazak differences were statistically significant(F =5.829,P <0.05).Comparison of Serum TC:Han >Uygur >Kazak.Statistical significance indwelled in Han,Uygur and Kazak comparison (F =5.298, P <0.05);The result of comparing serum HDL -C,LDL -C in different ethnic groups:there was no statistically significant difference between different group (F =1.026,0.744,all P >0.05).Descending order was presenting in fasting glucose:Han >Uygur >Kazak.Statistical significance appears in Han,Uygur and Kazak comparison (F =8.989,P <0.05).Conclusion High -normal blood pressure of Uygur,Kazak and Han nationalities who appeared glucose metabolic disorders,BMI and waistline increase(overweight and obesity),combined with the characteristics of different national regional life,it is of great significance to prevent and delay the occurrence of hypertension through strengthening the management and intervention of high -normal blood pressure crowd,giving medical care to the people suffering from overweight,obesity,and glucose metabolic disorders,and making full preparation for the primary of hypertension.

Objective To investigate the expression of two long non-coding RNAs ( lncRNAs ) during HIV-1 infection, which were nuclear-enriched autosomal transcript 1 (NEAT1) and metastasis asso-ciated lung adenocarcinoma transcript 1 ( MALAT1 ) , and their relationships with disease progression . Methods Fifty-nine patients with HIV-1 infection and 21 healthy subjects were recruited in this study , of which 31 patients were highly active antiretroviral therapy ( HAART)-na?ve and 28 patients received HAART for more than one year with undetectable viral loads .Total RNAs were extracted from PBMC and plasma samples, respectively.The levels of NEAT1 and MALAT1 were detected by quantitative real time polymer-ase chain reaction .Results The levels of NAET1 and MALAT1 in PBMC from HAART na?ve patients were 3 to 5 times higher than those in healthy subjects (P<0.01).The levels of NAET1 and MALAT1 in PBMC from HAART treated patients were similar to those in healthy subjects .The levels of NEAT1 in plasma sam-ples from patients with HIV-1 infection were lower than those in healthy subjects , and were positively corre-lated with CD4+T cell counts (P<0.01).No significance differences in the levels of MALAT1 in plasma samples were found between those with and without HIV-1 infection (P>0.05).Conclusion This study suggested that NEAT 1 and MALAT1 might be involved in the disease progression in patients with HIV-1 in-fection.The level of NEAT1 in plasma could be used as a potential biomarker of HIV-1 infection.

Objective To investigate the effect of iodine-125 seed implantation in the treatment of unresectable pancreatic carcinoma.Methods A total of 26 pancreatic carcinoma patients were retrospectively analyzed.Patients undergoing palliative operation in combination with iodine-125 seed implantation.jundice recovery,objective tumor response,pain relieved,clinical benefit response,median survival time and complication were investigated.Results Half of cases with jundice has reduced and totally normal in 3 weeks.Abdominal pain was relieved in 94.7％ patients,average recovery duration was (5.0 ± 1.5) d.18 cases had gastroenterol function disorder (69.2％),gastroparesis in six cases (23％) and average recover time was (16 ± 5.1) d.24 of 26 cases were follow up study,median survival time was (12 ± 5.1) months,objective tumor response was smaller than preoperation in 9,no change in 10 and 5 cases became larger than before.Conclusions Palliative operation in combination with iodine-125 seed implantation is safe and effective in the treatment of unresectable pancreatic carcinoma.

ObjectiveTo discuss the treatment of complications post-pancreticoduedenectomy by reviewing the experiences from 62 cases.MethodsSixty-two cases of pancreticoduedenectomy from March 2001 to April 2011,mean age 59.3 ±4.1 years,were reviewed.All cases were divided into early group 24 cases and recent group (38 cases) by the difference in following aspects:perioperative management,the way of pancreatic bowel anastomosis and material choice,the vessels management,materials using in preventing leakage and bleeding.The differences in leakage,bleeding,infection,the stomach retention,biliary infections,liver abscess and incision infection in two groups were compared.ResultsThe early group showed pancreatic leakage in 10 cases,bleeding in 4 cases,celiac infection in 10 cases,gastric retention in 9 cases,biliary infections in 11 cases,liver abscess in 6 and infection of incision in 7 cases,respectively.Recent groups were in 4,0,0,0,1,2 and 3 cases,respectively.The comparisons showed the complications had reduced significantly in recent group than in the early group (x2 =77.08,P ＜ 0.001 ).ConclusionsMinimally invasive and high quality materials use,strengthening the perioperative management are the effective measures to reduce the postoperative complications.

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

Objective To study the morphological changes of the cyctic duct in bile duct stones secondary to choledocholithiasis.Methods The results of imaging examinations before cholecystectomy and biliary exploration with laparoscopy and cholechodoscopy were respectively analyzed in 108 patients.Meanwhile, the cystic duct morphology, diameter and dilatation during the operation were determined to investigate the features of changes in its morphology.Results Gallstones were confirmed in all of the 108 cases by B-model ultrasonography preoperatively.The gallstone was positive in common bile duct in 76 cases.Common bile duct dilatation was seen in 75 cases and cystic duct dilatation in 21.Common bile duct dilatation was found in 81 cases by MRCP and in 45 by CT.Cystic duct dilatation was found in 36 cases by MRCP and in 19 by CT.Cystic duct variety was found in 9 cases by MRCP.Laparoscopic transcyctic common bile duct exploration(LTCBDE)was performed in those patients with short and wide cystic duct.Conclusion MRCP is the effective method for considering the outlooks of the cystic duct in bile duct stones secondary to choledocholithiasis.