目的 探讨食管癌根治术中肾脏区域组织氧饱和度(rSO2)与术后肾功能异常的相关性.方法 选择拟行食管癌根治术的患者 116 例,男 93 例,女23 例,年龄18～64 岁,BMI＜24 kg/m2,ASA Ⅱ或Ⅲ级.术中连续监测左侧肾脏rSO2.设定麻醉诱导后肾脏 rSO2 为基础值,当术中肾脏rSO2 绝对值≤50％或低于基础值的 75％时,定义为肾脏rSO2 异常下降.记录术前及术后 24h尿素氮(BUN)、血清肌酐(SCr),术后肾功能异常定义为术后 24h 血浆 SCr＞130 μmol/L 或 BUN＞7.5 mmol/L.根据术后是否出现肾功能异常将患者分为两组:肾功能正常组和肾功能异常组.采用列联系数分析术中肾脏rSO2 异常下降与术后肾功能异常的相关性.结果 有40 例(34.5％)患者术中出现肾脏rSO2 异常下降,有45 例(38.8％)患者术后出现肾功能异常.二元Logistic回归分析显示男性是术后肾功能异常的危险因素(OR=5.490,95％CI 1.526～19.754,P=0.009).食管癌根治术中肾脏rSO2 的异常下降与术后肾脏功能异常呈正相关(rs =0.587,P=0.009).结论 食管癌根治术中肾脏rSO2 异常下降与术后肾功能异常呈正相关.

Objective:To observe the effects of ultrasound-guided transverse abdominal muscle plane block (TABP) on neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in the peripheral blood of patients undergoing radical gastrectomy.Methods:A total of 100 patients who were scheduled for radical gastrectomy were selected. According to the random number table method, they were randomly divided into two groups ( n=50): a TAPB combined with general anesthesia group (group TAP+GA) and a general anesthesia group (group GA). Group TAP+GA and group GA underwent ultrasound-guided TABP assisted with general anesthesia, and routine general anesthesia, respectively. Both groups were compared for operation time, anesthesia time, blood loss, and the dosages of fentanyl and remifentanil. Their counts of neutrophils, platelets and lymphocytes, NLR and PLR in the peripheral blood were recorded before and 24 h and 72 h after surgery. Their Visual Analogue Scale (VAS) scores 24 h and 48 h after operation, adverse reactions and the length of hospitalization stay were recorded. Results:There were no significant differences in operation time, anesthesia time, blood loss and fentanyl dosage between the two groups. Compared with group GA, the dosage of remifentanil in group TAP+ GA was significantly reduced ( P<0.05). There were no statistical differences in the counts of neutrophils, platelets and lymphocytes, PLR and NLR in the peripheral blood between the two groups ( P>0.05). Compared with group GA, group TAP+GA presented remarkably reduced counts of neutrophils in the peripheral blood 24 h and 72 h after operation ( P<0.05). There were no statistical differences in the counts of lymphocytes and platelets and PLR between the two groups 24 h and 72 h after operation ( P>0.05). No statistical difference was found in the value of NLR between the two groups 24 h after operation ( P<0.05). The value of NLR in the peripheral blood of group TAP+GA was significantly lower than that in group GA 72 h after operation ( P>0.05). The VAS score 24 h and 48 h after operation in group TAP+GA were lower than that in group GA ( P<0.05). Postoperative nausea and vomiting were significantly reduced in group TAP+GA, compared with group GA ( P<0.05). There were no statistical differences in the length of hospitalization stay, postoperative pulmonary infection, anastomotic fistula, and postoperative intestinal obstruction between the two groups ( P>0.05). Conclusions:Ultrasound-guided TABP assisted general anesthesia is useful for reducing the counts of neutrophils and NLR in patients. It also improves postoperative pain, and reduces the occurrence of postoperative nausea and vomiting.

Objective:To determine the safety of prophylactic irradiation dose CTV 60Gy optimized to CTV 50Gy for II b region in patients with stage N 0-N 1 nasopharyngeal carcinoma (NPC) and the dose advantage and clinical value for parotid gland protection, and to understand the diagnostic value of PET-CT and diffusion-weighted imaging (DWI) for suspicious positive lymph nodes in the neck (5 mm≤maximum short diameter<10 mm). Methods:Clinical data of 157 patients with primary non-metastatic NPC (N 0-N 1) admitted to our hospital from June 2015 to March 2017 were retrospectively analyzed. 104 patients underwent II b clinical target volume optimization guided by multimodal imaging system. Survival analysis was performed by Kaplan - Meier method. Univariate/multivariate regression analysis was performed to analyze the pattern of cervical lymph node recurrence. Paired t-test was used to compare the differences in target volume and parotid gland dose parameters before and after dose optimization. Results:Sixty patients underwent single-neck optimization in stage N 1, 25 patients received double-neck optimization (only those with retropharyngeal lymph node metastasis), and 19 patients underwent double-neck optimization in stage N 0. Three patients had cervical regional recurrence, all in-field. The 5-year overall survival rate was 93.3%. The lymph node recurrence-free survival rate, local recurrence-free survival rate, distant metastasis-free survival rate and disease-free survival rate were 97.1%, 91.3%, 88.5% and 80.8%, respectively. Cervical lymph node recurrence was associated with local recurrence in the nasopharynx, regardless of retropharyngeal lymph node status. Fourteen patients had suspicious positive cervical lymph nodes in II b region, with a mean maximum short diameter of 7.1 (5~9) mm on the largest cross-sectional plane, and 11 of them were positive on PET-CT, with a mean SUV max of 2.96 (2.5~3.3). There was no significant difference in GTV after optimization ( P>0.05). D mean, D max, D 50% and V 26Gy of parotid gland were significantly lower than those of conventional plan (all P<0.01). Conclusions:It is safe to optimize CTV 60Gy to CTV 50Gy in II b region in patients with N 0-N 1 NPC, and the exposure dose to normal tissues around the parotid gland and neck is significantly reduced. For small lymph nodes that do not meet the diagnostic criteria, it needs to be individualized in combination with multimodality imaging systems, such as PET-CT and DWI.

目的 分析胃癌根治术后肝功能异常(LA)的相关影响因素.方法 回顾性收集2018年6月至2020年12月择期行胃癌根治术的1013例患者临床资料,男699例,女314例,年龄24～92岁,ASAⅡ或Ⅲ级.根据术后第1天是否发生LA将患者分为两组:肝功能正常组(NLA组)和肝功能异常组(LA组).LA定义为血清中以下任一肝酶浓度升高:谷丙转氨酶>40 U/L,谷草转氨酶>40 U/L,γ?谷氨酰转移酶>49 U/L,碱性磷酸酶>135 U/L,总胆红素>17.1μmol/L,直接胆红素>6.8μmol/L.比较两组临床资料,将P<0.15的指标纳入二元Logistic回归模型分析.结果 术后第1天有577例(57.0％)患者发生LA.与NLA组比较,LA组肥胖、吸烟史、贫血、腹腔镜手术、输血、使用其他血管活性药物、使用酮咯酸氨丁三醇、高PETCO2比例明显升高,晶体输注量、出血量、尿量、总入超量明显增多,输液速度明显减慢,多巴胺使用比例明显降低,手术时间明显延长(P<0.15).二元Logistic回归分析显示,肥胖(OR=2.149,95％CI 1.241～3.720)、吸烟史(OR=1.913,95％CI 1.012～3.616)、使用酮咯酸氨丁三醇(OR=1.771,95％CI 1.025～3.060)、手术时间(每延长10 min,OR=1.148,95％CI 1.083～1.217)是术后LA的独立危险因素,总入超量(每增加100 ml,OR=0.872,95％CI 0.806～0.944)、尿量(每增加100 ml,OR=0.999,95％CI 0.998～1.000)、使用多巴胺(OR=0.500,95％CI 0.291～0.860)是术后LA的保护因素(P<0.05).结论 肥胖、吸烟史、酮咯酸氨丁三醇的使用、手术时间延长是术后LA的独立危险因素,合理的围术期输液管理及适量使用多巴胺以维持稳定的循环及尿量有利于保护肝功能.

自身免疫性胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)星形细胞病是一组累及脑膜、脑、脊髓及视神经的综合征,其影像学特点为侧脑室旁放射状线样强化病灶[1-2],该病于 2016 年由梅奥诊所首先报道并命名[3].近年来,该疾病的报道日益增多.现对南京医科大学附属淮安第一医院诊断的两例自身免疫性GFAP星形细胞病的临床资料总结并结合文献复习,以提高神经科医师对该病的认识.

Objective:To explore the significance of the clinical target volume (CTV) dose optimization in the upper and middle neck in protecting the laryngopharynx, anterior and posterior rings during intensity-modulated radiotherapy (IMRT) and multimodal imaging system for nasopharyngeal carcinoma.Methods:Clinical data of 298 nasopharyngeal carcinoma patients admitted to Jiangsu Cancer Hospital from 2016 to 2018 were retrospectively analyzed. According to the following five strategies of CTV dose optimization in the upper and middle neck: group A, complete optimization of bilateral cervical lymph nodes (CLNs), that is, the CTV doses of bilateral CLNs were 50.4 Gy; group B, complete optimization of unilateral CLNs, that is, the CTV dose of unilateral CLNs was 50.4 Gy and the contralateral CLNs was 60 Gy; group C, incomplete optimization of bilateral CLNs, that is, the CTV doses of bilateral CLNs were 50.4 Gy, while the suspicious positive CLNs were selectively boosted to 60 Gy; group D, incomplete optimization of unilateral CLNs, that is, the CTV dose of unilateral CLNs was 50.4 Gy and the suspicious positive CLNs were selectively boosted to 60 Gy, and the CTV dose of contralateral side was 60 Gy; group E: no optimization, that is, the CTV doses of bilateral CLNs were 60 Gy.Results:Among 298 patients, 215 patients received dose optimization and 83 cases did not receive dose optimization. In the dose optimization schemes, 114 cases were assigned in group A, 36 cases in group B, 60 cases in group C and 5 cases in group D. The median (range) follow-up time was 28.5(6.0-46.3) months. The overall survival rate was 95.6%, the progression-free survival rate was 84.2% and the locoregional control rate of CLNs was 98.0%. Local relapse of CLNs occurred in six patients, including 1 case of retropharyngeal lymph node, 4 cases of Ⅱ area and 1 case of Ⅳ area. The P values of average dose of laryngopharynx in group A, group B, group C and group D compared with that in group E were<0.001, 0.016, 0.001 and 0.572, respectively. The P values of the average dose of the anterior ring in group A, group B, group C and group D compared with that in group E were<0.001, 0.011, <0.001 and 0.805, respectively. The P values of the average dose of the posterior ring in group A, group B, group C and group D compared with that in group E were<0.001, 0.004, <0.001 and 0.252, respectively.Conclusions:Combined with the metastatic rules of CLNs and multimodal imaging system, it is safe to optimize the CTV dose of the upper and middle neck during IMRT in nasopharyngeal carcinoma patients, which can significantly reduce the doses of laryngopharynx, anterior and posterior rings, thereby providing evidence for reducing the CTV dose in the upper and middle neck.

[目的]探讨鼻咽癌N2期患者行Ⅳ区靶区范围缩减的可行性以及对甲状腺保护的剂量优势.[方法]选取2015年3月至2017年4月收治的目前仍生存的鼻咽癌N2患者40例作为研究对象,其中根据甲状腺周围颈动脉鞘淋巴结分布以及Ⅲ区淋巴结状态进行Ⅳ区靶区内界和/或下界优化的34例患者纳入优化组.收集全部患者的一般临床特征、影像学资料、甲状腺功能资料及放疗剂量参数,分析靶区范围优化对甲状腺功能的影响.[结果] 40例患者中位随访时间为63个月,放疗后甲状腺功能减退(简称甲减)发生率为45.0％(18/40),其中亚临床型甲减15例(37.5％),临床型甲减3例(7.5％),出现时间为放疗后4～48个月(中位时间13个月);优化组甲减发生率为35.3％(12/34),均为亚临床型甲减.仅有2例(5.0％)患者甲状腺周围颈动脉鞘前方有可辨认淋巴结;分别有29例(72.5％)及38例(95.0％)患者颈动脉鞘后方及外方有可辨认淋巴结,颈动脉鞘后方、外方最内侧淋巴结距甲状腺外侧缘的中位距离分别为9.5(5～21) mm、18(10～34)mm;优化组甲状腺Dmean及V30均低于非优化组,Ⅳ区内界及下界均优化患者与未优化组患者的Dmean及V30有显著性差异(P＜0.01),全部病例均未出现颈部淋巴结复发.[结论]对鼻咽癌晚N分期患者进行合理优化颈部Ⅳ区临床靶区范围,在无淋巴结分布区域免除照射是安全可行的,可以更好地保护甲状腺功能.

目的 探讨血清中性粒细胞/淋巴细胞比值(NLR)预测老年胃癌根治术患者术后认知功能障碍(POCD)的价值.方法 选择择期行胃癌根治术患者100例,男67例,女33例,年龄≥65岁,ASA Ⅱ或Ⅲ级.患者手术均在气管插管全麻下进行,在术前及术后第7天通过Z计分法评估患者认知功能,根据评分结果将患者分为两组:POCD组和NPOCD组.记录术前1 d、术后1、3 d血清中NLR的变化.应用受试者工作特征(ROC)曲线,分析各时点血清NLR对老年胃癌根治术患者发生POCD的预测价值.结果 术后7 d发生POCD患者22例(22％).与术前1 d比较,术后1、3 d两组NLR明显升高(P＜0.05).术后1、3d POCD组血清NLR明显高于NPOCD组(P＜0.05).术后3 d血清中NLR预测老年胃癌根治术患者发生POCD的最佳界值为6.986,预测POCD发生的AUC为0.818(95％CI 0.728～0.888),敏感性和特异性分别为88.5％和68.2％,高于术后1 d NLR的AUC为0.799(95％CI 0.707～0.872).结论 老年胃癌根治术患者术后3 d NLR对术后7 d POCD发生的预测价值较高,血清中NLR的升高可能与术后POCD的发生相关,术后NLR升高是发生POCD的危险因素.

Objective To observe the safety and efficacy of fecal microbiota transplantation (FMT) in treatment of Parkinson′s disease (PD) with constipation. Methods From September 2017 to April 2019, 22 PD patients with serious constipation in the Department of Neurology, the Affiliated Huaian No. 1 People′s Hospital of Nanjing Medical University were treated with FMT and followed up for 12 weeks. Spontaneous bowel movement (SBM) per week and scores of Wexner Constipation Scale (Wexner), Constipation Quality of Life Scale (PAC-QOL) and Parkinson′s Disease Quality of Life Questionnaire (PDQ-39) were recorded before and after transplantation. Results Compared with the number of independent defecation and scores before treatment, the number of independent defecation per week (4.63± 2.25, 5.38 ± 1.23, 5.75 ± 1.29, 5.54 ± 1.30 vs 1.57 ± 0.74), Wexner score (7.92 ± 2.61, 5.67 ± 1.78, 5.08 ± 1.83, 4.92 ± 1.78 vs 16.67 ± 4.31), PAC-QOL score (62.3 ± 3.2, 58.8 ± 2.8, 57.1 ± 3.9, 59.6 ± 4.4 vs 110.3 ± 14.7) and PDQ-39 score (44.8 ± 14.8, 37.8 ± 12.8, 32.8 ± 12.3, 31.9 ± 9.2 vs 58.7 ± 16.7) were significantly improved by FMT treatment at two, four, eight and 12 weeks (P<0.01). After 12-week treatment, the effective rate was 100% (22/22), and the clinical cure rate was 86% (19/22). No serious adverse reactions occurred during treatment. Conclusion FMT is effective and safe in treating PD with constipation.

To observe the efficacy of fecal microbiota transplantation instead of dopaminergic drugs in the treatment of Parkinson’s disease (PD) and explore the potential mechanism. Methods A patient with PD who refused to take drugs because of hallucination of dopaminergic drugs was treated with fecal microbiota transplantation. Scales of Hamilton depression scale ( HAMD), Hamilton anxiety scale ( HAMA), the 39-item PD questionnaire (PDQ39), Pittsburgh sleep quality index (PSQI), Bristol constipation score and unified PD rating scaleⅢ(UPDRSⅢ) were used to evaluate the relevant symptoms before transplantation and 4, 8 and 12 weeks after transplantation. Meanwhile, microbiota communities in the feces before transplantation and 4, 12 weeks after transplantation were investigated using high-throughput sequencing targeting the 16 s ribosomal RNA ( rRNA) gene. Results Scores of HAMD, HAMA, PDQ39, PSQI, Bristol’s constipation and UPDRS Ⅲ decreased significantly after transplantation. The 16 s high-throughput sequencing of the feces showed that the abundance of Bacteroides decreased after transplantation, while the abundance of Ruminococcus, Blautia and Prevotellaceae increased. Conclusion Fecal microbiota transplantation displays obvious effects on non-motor symptoms and motor symptoms in PD patients, and its mechanism may be closely related to the reconstruction of normal intestinal flora.

目的 探讨模拟与临床相结合的喉罩置入通气教学法在麻醉科规培医师带教中的教学效果.方法 随机选取2016年1月—2017年12月在我院麻醉科参加规范化培训的住院医生40名,分为两组,模拟组和非模拟组,每组20例.记录两组规培医生喉罩置入的时间和成功率.结果 非模拟组喉罩置入的时间为(28.8±9.3)s,模拟组喉罩置入的时间为(21.3±7.5)s,模拟组短于非模拟组,并且成功率升高(45％vs.80％).结论 为提高带教效果,临床模拟训练是很好的选择.利用患者上呼吸道矢状面解剖图进行喉罩置入通气的模拟训练,让规培医生在进入临床操作前即可进行反复操作和练习,对熟练掌握该项临床技能和操作效果显著.

目的 了解维持性血液透析(MHD)患者中脑梗死的发生率及其相关危险因素.方法 选择2011年1月1日～2016年6月31日在我院行MHD的尿毒症患者327例,将发生急性脑梗死的34例患者作为脑梗死组,未发生脑梗死的293例患者作为非脑梗死组.回顾性分析MHD患者的临床资料,并进行单因素及多因素logistic回归分析.结果 327例MHD患者中,脑梗死发生率为10.4％.脑梗死组糖尿病(58.8％ vs 38.6％)和冠心病(29.4％ vs 8.5％)比例、透析前收缩压[(160.38±23.50)mm Hg(1 mm Hg=0.133 kPa) vs (136.81±21.05)mm Hg]、舒张压[(91.76±13.74)mm Hg vs (78.90±13.19)mm Hg]和白蛋白水平[(39.75±5.47) g/L vs(37.88±5.10)g/L]明显高于非脑梗死组(P＜0.05,P＜0.01).logistic回归分析显示,糖尿病(OR=3.420,95％CI:1.355～8.632)、冠心病(OR=7.860,95％CI:2.753～22.437)、透析前收缩压(OR =1.029,95％CI:1.004～1.055)、透析前舒张压(OR=1.059,95％CI:1.015～1.106)是发生脑梗死的影响因素.结论 糖尿病、冠心病、透析前收缩压及舒张压是MHD患者发生脑梗死的危险因素.

Objective To study the relationship of serum uric acid (UA) and 25 hydroxyl (OH) vitamin D3 levels with Parkinson's disease (PD).Methods One hundred and six PD patients admitted to our hospital from August 2014 to August 2016 served as a PD group and 108 healthy persons undergoing physical examination served as a control group in this study.Their baseline data (including age,gender,serum UA and 25 OH vitamin D3 levels) were recorded and compared.Results The serum UA and 25 OH vitamin D3 levels were significantly lower in PD group than in control group (263.24±105.02 μmol/L vs 304.11±79.31 μmol/L,P=0.002;27.14±6.45 μg/L vs 36.96±11.62 μg/L,P=0.001).Logistic regression analysis showed that age and serum levels of UA and 25 OH vitamin D3 were closely related with PD (OR=1.024,95 ％ CI:1.001-1.081,P =0.028;OR=0.996,95％CI:0.992-1.000,P=0.001;OR=0.890,95％CI:0.852-0.929,P=0.000).Conclusion The serum UA and 25 OH vitamin D3 levels are significantly lower in PD patients,high UA and 25 OH vitamin D3 levels are thus a protective factor for PD.

Objective To understand the necessity of the joint inspection of cervical cytology and high risk -human papilloma virus ( HR-HPV) .Methods 235 cytology-negative/HR -HPV positive women who took gynecological examination in Nanjing Maternity and Child Health Hospital Affiliated Nanjing Medical University from December 2013 to December 2014 were selected . Colposcopy and cervical histopathological examination were carried out and the results were analyzed .Results In 235 cases,85 cases were infected with HPV 16/18, and 19 cases (22.35%) were found to have cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ,150 cases were infected with other HR -HPV types and 16 cases ( 10.67%) were found to have CIN Ⅱ -Ⅲ.The difference was statistically significant(P﹤0.05).Conclusion Joint inspection of cytology and HR -HPV improves the detection ratio of CIN and cervical cancer .The detection of HR-HPV 16/18 helps to recognize women with highest risk of CIN ,and is beneficial to discover and treat cervical cancer .

Objective To evaluate the effectiveness of simvastatin for patients with aneurysmal subaraehnoid hemorrhage.Methods Systematic literature retrieval was carried out to obtain randomized controlled trials of simvastatin in patients with aneurysrnal subarachnoid hemorrhage before October 2015.Methodological quality assessment and data collection were performed by two individual reviewers.A Meta-analysis was performed by RevMan 5.1 software.Results Five studies,a total of 951 patients,were included.Meta-analysis showed that simvastatin could not reduce cerebral vasospasm (RR=l.26,95％ confidence interval [95％CI]:0.9-1.75,P=0.170),delayed cerebral ischemia (RR=1.06,95％CI:0.88-1.26,P=0.000),poor outcome (RR=1.05,95％CI:0.90-1.23,P=0.540),or mortality (RR=0.95,95％CI:0.62-1.44,P=0.800).Conclusion Simvastatin could not prevent cerebral vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage,and could not improve the prognosis.

Objective:To compare the efficacy of two different routes of administration of progesterone in threatened abortion caused by corpus luteum insufficiency and the correlation between the serum progesterone levels and pregnancy outcomes. Methods:A total of 301 pa-tients were divided into two groups, 217 patients received oral micronized progesterone 2í100mg. 84 patients received intramuscular injection of progesterone 20mg daily. Review proges-terone serum levels,β-HCG and ultrasound weekly. Two groups of patients were treated for 2 to 3 weeks,follow-up to 12 weeks of pregnancy. Results:No differences were found in terms of progesterone serum levels and the rate of successful treatments(P﹥0. 05). When the thresh-old value was set at 10ng/ml,in the oral progesterone group,the sensitivity was 11. 43% and specificity was 97. 25% for predicting miscarriage. In the intramuscular injection of progester-one group,the sensitivity was 41. 67% and specificity was 97. 22%. When the threshold value was set at 15ng/ml,in the oral progesterone group,the sensitivity was 85. 71% and specificity was 95. 60%. In the intramuscular injection of progesterone group,the sensitivity was 91. 67%and specificity was 94. 44%. When the threshold value was set at 20ng/ml,in the oral proges-terone group,the sensitivity was 91. 43% and specificity was 23. 08%. In the intramuscular in-jection of progesterone group,the sensitivity was 91. 67% and specificity was 41. 67%. Conclu-sion:For threatened abortion caused by corpus luteum insufficiency in the first trimester,both o-ral and intramuscular injection of progesterone are effective luteal support methods and easy to accepted by vaginal bleeding patients, oral progesterone is more convenient. Although luteal support can increase serum progesterone levels,the value of serum progesterone is still a rela-tively reliable index to predict pregnancy outcomes. Serum progesterone level<15ng/ml for pre-dicting miscarriage is better.

A total of 218 outpatients with first-episode and high-risk ischemic strokes were randomly divided into management and control groups.Management group received multidisciplinary disease care mode while control group common disease care mode.The results showed that the functional independent measures (FIM) score of management group improved dramatically (89 ± 28 vs.81 ± 26,P =0.04).The National Institutes of Health Stroke Scale (NIHSS) score changed significantly (13.9 ± 5.6 vs.16.1 ± 6.9,P =0.02).Systolic blood pressure significantly changed [(131 ± 17) vs.(137 ±23) mmHg(1 mmHg =0.133kPa),P=0.04].Diastolic blood pressure significantly changed [(81 ± 10) vs.(85 ± 15) mmHg,P =0.03] ; Low density lipoprotein decreased [(2.54 ± 0.75) vs.(2.81 ± 0.65) mmol/L,P =0.01].The number of readmitted patients also decreased significantly (P =0.04).Thus muhidisciplinary disease care mode could enhance the qualityof-life,control risk factors and improve patient prognosis.

Objective To analyze the etiological factors of peri -menopausal and post -menopausal abnormal uterine bleeding . Methods The clinical data of 366 patients with peri -menopausal or post -menopausal abnormal uterine bleeding in Nanjing Medical University affiliated Nanjing Maternity and Child Health Hospital during 2013 were retrospectively analyzed .Results Among the pathological diagnosis of 366 patients, 50(13.66%) cases were organic diseases , 145(39.62%) cases were dysfunctional diseases , 171(46.72 %) cases were of normal endometrium .Maximum number(70.49 %) of cases were from 40~<45 and 45~<50 age groups .In 40~<45 age groups proliferative endometrium was the predominant histopathological pattern followed by simple hyperplasia and secretory endometrium .In 45~<50 and 50~<55 age groups simple hyperplasia was the predominant histopathological pattern followed by proliferative endometrium and atrophic endometrium .In 55~<60 and ≥60 age groups atrophic endometrium was the predominant histopathological pattern followed by endometrial carcinoma .As the age increased , the composition of dysfunctional diseases and normal endometrium decreased , the composition of organic diseases increased (χ2 =8.38,P﹤0.05).Conclusion&nbsp;Anovulatory dysfunctional uterine bleeding was the main cause of peri -menopausal uterine bleeding , and endometrial carcinoma was the main cause of post-menopausal uterine bleeding .

目的：了解南京市已婚女性宫颈上皮细胞中HPV感染和基因型分布情况。方法：选择2012年1月1日至2012年12月31日在我院妇科门诊行妇科检查的2686例患者的宫颈上皮细胞标本,采用基因扩增及基因芯片检测技术对26种HPV基因进行检测和分析。结果：2686例已婚女性中 HPV 阳性者711例(26.47%),其中高危型 HPV (HR-HPV)感染者617例,感染率22.97%,占86.78%(617/711)；单一基因型感染556例,感染率20.70%,占78.20%,多重基因型感染155例,感染率5.77%,占21.80%。52型148例,占20.82%,其余依次为16型(18.57%)、58型(14.63%)、61型(8.58%)、56型(8.16%)。167例感染16和18型中一种或两种基因型,感染率6.22%(167/2686),占23.49%(167/711),240例感染52和58型的一种或两种基因型,感染率8.94%(240/2686),占33.76%(240/711)。结论：南京市已婚女性宫颈上皮细胞中HPV 52和58型感染率高于宫颈癌疫苗基因型(16和18型)；第二代宫颈癌疫苗,如包含HPV52和58型可能会给中国和其他亚洲国家女性提供更高的保护力。

Objective To conduct a meta-analysis based on relevant, up-to-date published randomized trials to further examine the effect of folic acid supplementation on the risks of stroke. Methods We searched all randomized trials in the Pubmed, Embase, Cochrane Libarary, OVID, Sinomed, Wanfang database and CNKI from 1966 to 2013.Relative risk (RR) was used as a measure of the effect of folic acid supplementation on the risks of stroke with a fixed effect model. The analysis was further stratified by the influencing factors of treatment efficacies. Results The data were collected from 15 randomized trials of folic acid in which stroke was reported as one of endpoints. Folic acid supplementation significantly reduced the risk of stroke by 8% (RR=0.92, 95%CI: 0.80-0.99, P=0.03). In stratified analyses, greater beneficial effect was seen in those trials with no fortification grain of 0.92(95%CI: 0.80-0.99, P=0.04), a treatment duration of >36 months (RR=0.92, 95%CI: 0.85-1.00, P=0.05), low dosage of folic acid (RR=0.92, 95%CI: 0.85-1.00, P=0.05). RR for the trials with reduced homocysteine concentration of 20% or more was 9%(RR=0.91, 95%CI: 0.83-0.99, P=0.03) Conclusions Folic acid supplementation is effective in stroke prevention. In addition, greater beneficial effect may be obtained with a lower long-term dosage of folic acid. Key words: Folic acid; Stroke; Meta-analysis