目的 探讨宫颈上皮内瘤变患者术后高危型人乳头瘤病毒(HR-HPV)持续感染的影响因素.方法 选取2018年1月-2019年12月华中科技大学同济医学院附属武汉儿童医院260例宫颈上皮内瘤变(CIN)合并HR-HPV感染患者,所有患者均行宫颈环形电切术(LEEP)治疗,并于手术后1年通过门诊复查的方式,进行HR-HPV复查,观察患者HR-HPV持续感染情况,并分析持续感染的影响因素.结果 术后1年发生HR-HPV持续感染31例,发生率为11.92％(31/260),多重感染转阴率为71.79％(28/39)低于单一感染90.95％(201/221),HPV16感染转阴率为69.33％(52/75)低于其他型别95.68％(177/185)(P<0.05);术前HR-HPV负荷量为1～10 RLU/CO、10～100 RLU/CO、100～300 RLU/CO患者,术后1年HR-HPV持续感染发生率低于负荷量300～500 RLU/CO、>500 RLU/CO患者(P<0.05);术前HR-HPV负荷量对术后1年HR-HPV持续感染预测受试者工作特征(ROC)曲线分析结果显示,当以341 RLU/CO作为截点值时,ROC曲线下面积为0.747,敏感度80.00％、特异性70.00％;术前HR-HPV多重感染、术前HR-HPV16感染、术前病毒载量是患者术后1年HR-HPV持续感染发生的影响因素(P<0.05).结论 LEEP对宫颈HR-HPV清除有一定作用,持续性HR-HPV的发生与单一或多重感染、感染型别、病毒载量有关.

Objective:To observe the effect of microRNA (miR)-1973 targeting suppressor of cytokine signaling 2 (SOCS2) on proliferation, apoptosis, invasion and migration of breast cancer cells.Methods:BT-483 cells were cultured in vitro, transfected and divided into blank control group (NG group), negative transfection group (NC group) and inhibition of miR-1973 expression group (miR-1973 inhibitor) group. The transfection efficacy was observed under inverted fluorescence microscope. The level of miR-1973 was detected by real-time fluorescence quantitative polymerase chain reaction (PCR). The cell proliferation, apoptosis, migration ability and invasion ability were detected by MTT assay, flow cytometry, scratch test and Transwell assay respectively. The expression of human proliferating cell nuclear antigen (Ki-67), B-cell lymphoma-2 (bcl-2), bcl-2-associated protein X (bax), E-cadherin, N-cadherin, Vimentin and SOCS2 was detected by Western blotting. The targeting relationship between miR-1973 and SOCS2 was predicted by TargetScan database and verified by double luciferase reporter gene experiment. Results:BT-483 cells were successfully transfected. After miR-1973 expression was inhibited, the inhibition rate of BT-483 cell proliferation in miR-1973-inhibitor group [(18.69±2.80)%, (45.55±13.61)%] was significantly higher than that in NG group [(12.78±2.07)%, (17.62±2.65)%] and NC group [(13.77±2.06)%, (18.53±2.77)%] ( F=11.018, 22.673, P<0.05) after 24 h and 48 h. As compared with those in NG group [(11.03±1.65)%, (48.25±7.23)%, (237.53±35.63)] and NC group [(12.12±1.82)%, (46.73±7.01)%, (228.98±34.35)], the apoptosis rate of BT-483 cells in miR-1973-inhibitor group [(26.68±4.00)%] were significantly increased ( F=62.370, P<0.05), the wound healing rate [(22.77±3.42)%] was significantly reduced, the number of invasive cells [(115.77±17.37)] was significantly decreased ( F=32.507, 30.222, P<0.05). As compared with those in NG group and NC group, the protein expression of bax and E-cadherin in BT-483 cells in miR-1973-inhibitor group was significantly increased ( F=32.918, 28.574, P<0.05), the protein expression of Ki-67, bcl-2, N-cadherin and Vimentin was significantly reduced ( F=8.805, 15.085, 37.065, 15.097, P<0.05). TargetScan database prediction showed that SOCS2 was a potential target gene of miR-1973, dual luciferase reporter gene experiment confirmed that there was a targeted relationship between them, and miR-1973 could negatively regulate SOCS2 expression. Conclusion:Silencing miR-1973 may inhibit the proliferation, invasion and migration of breast cancer BT-483 cells and induce apoptosis by up-regulating SOCS2 expression.

目的:探讨右美托咪定(Dex)对患儿七氟醚全麻苏醒期躁动和术后不良反应的影响.方法:选取2017年9月～2019年8月期间在武汉儿童医院接受择期手术的84例患儿,年龄2～7岁,美国麻醉医师协会(ASA)I～Ⅱ级.采用简单随机分组法分为Dex组和对照组,每组各42例.Dex组患儿气管插管后首先静脉注射Dex 1μg/kg负荷量,然后以0.2～0.4μg/kg·h的速率持续泵入Dex,对照组气管插管后静脉输注等容量生理盐水,均在10 min内注完.患儿术中吸入2％～4％七氟醚维持麻醉,监测并保持脑电双频指数(BIS)值40～60,心率(HR)和平均动脉压(MAP)变化幅度在基础值的±20％内,酌情调整七氟醚吸入浓度,术毕停止给药送至麻醉苏醒室(PACU).观察两组患儿麻醉诱导后(T0)、术毕(T1)、拔管即刻(T2)、拔管5 min后(T3)和拔管后10 min(T4)时点HR和MAP水平,记录两组患儿拔管时间、苏醒时间、全麻苏醒期躁动量表(PAED)评分、苏醒期躁动(EA)和恶心呕吐发生情况.结果:对照组T2～T4时点HR、MAP均明显高于T0时点,Dex组T1～T4时点HR、MAP波动比较稳定,与T0时点比较差异均无统计学意义,Dex组T2～T4时点HR、MAP均明显低于对照组,差异有统计学意义.两组患儿拔管时间和拔管时间比较均无显著差异,Dex组全麻苏醒期PAED评分显著低于对照组,差异有统计学意义;Dex组EA发生率4.76％显著低于对照组19.05％,差异有统计学意义;两组术后仅出现恶心、呕吐和呼吸抑制等不良反应,症状均较轻,组间不良反应率比较无显著差异.结论:气管插管后给予Dex能有效稳定患儿血流动力学,不延长拔管和苏醒时间,能显著降低患儿七氟醚吸入全麻苏醒期EA发生率,术后不良反应少,值得临床推广应用.

OBJECTIVE To study the causes and control of excessive planktonic bacteria in the air of laminar flow operation room so as to reduce infection rates .METHODS A total of 100 consecutive operation of laminar flow op‐eration from Jul .2012 to Jul .2014 were detected .Multi‐point sampling in different time period in operation rooms was conducted by planktonic bacteria sampler and dust particle calculating instrument in different areas ,including the operation area and non operation area (peripheral regions) .The planktonic bacteria and dust particle were counted and the causes for excessive planktonic bacteria and dust particle were analyzed to come up with some measures .RESULTS Before surgeries ,numbers of planktonic bacteria and dust particles in laminar flow operation room met the standards .But w hen the operation began ,numbers of planktonic bacteria and dust particle increased rapidly and reached the maximum at the end of the surgery .After that ,the numbers started to reduce and 30 mi‐nutes later regained to the standard .The difference had significance (P<0 .05) .CONCLUSION In the operation room ,the causes for excessive number of dust particles and planktonic bacteria are dynamic operation ,personnel walking ,and surgery operations .The key point to keep a clean operation room is to disinfect strictly and take pre‐ventive measures .

OBJECTIVE To compare the effects of the air purification and disinfection methods in operating rooms and choose the optimal one so as to effectively reduce the infection rate .METHODS A total of 3 000 patients who underwent surgeries in different operating rooms from Jan 2012 to Dec 2014 were enrolled in the study ,then the epidemiological characteristics and incidence of infections were investigated , the participants were divided into three groups according to the way of disinfection :the laminar flow group ,the air purification machine group ,and the simple ultraviolet disinfection group ,with 1 000 cases in each .RESULTS The incidence of infections was the lowest in the laminar flow group (0 .9% ) ,followed by the air purification disinfection machine group (3 .4% ) and the ultraviolet disinfection group (9 .5% ) ,and the difference was significant (P< 0 .05) .The incidence of the typeⅡ incision infections was the lowest (0) in the laminar flow group ,the highest (6 .3% ) in the ultraviolet disinfec‐tion group ;the incidence of the type Ⅲ incision infections was the lowest (5 .4% ) in the laminar flow group ,the highest (6 .1% ) in the ultraviolet disinfection group .In case of the control of a variety of factors ,the disinfection and purification of operating rooms remain the independent influencing factors .CONCLUSION The use of air purifi‐cation machine for disinfection of laminar flow operating rooms is an ideal way of air purification and disinfection of operating rooms ,and it can effectively reduce the incidence of surgical site infections .

儿童门诊手术室即为不住院患儿施行择期手术.2001年8月~2003年8月小儿日间门诊共施行手术5 965例.通过加强院内感染、安全意识、安全措施3方面的规范化管理,切实做好"五防",即防止接错患儿,防止患儿坠床,防止手术部位错误,防止用药错误,防止缝合针和纱布遗留在体腔内,更好地杜绝了各种意外的发生,保证所有患儿围手术期的安全,避免因手术小、工作量大而产生麻痹大意思想.