Epidemiological characteristics and spatial clustering of scrub typhus in Nanjing from 2011 to 2020 / 中华地方病学杂志

Objective:To understand the reported incidence level, change of the trend, epidemic characteristics and spatial clustering of scrub typhus in Nanjing, to explore key seasons, populations and areas for prevention and control, and to guide formulation of scientific and precise prevention and control strategies and measures.Methods:The reported data of scrub typhus in Nanjing from January 1, 2011 to December 31, 2020 were collected in the "Infectious Disease Surveillance System" from Chinese Center for Disease Control and Prevention. The reported incidence level and change of the trend were analyzed, and the seasonal, population and spatial distribution characteristics were described. Global spatial autocorrelation analysis was carried out by ArcGIS 10.3 software, and the spatial clustering scanning was carried out by using FleXScan 3.1.2 software.Results:A total of 192 cases of scrub typhus were reported in Nanjing from 2011 to 2020. Median annual reported incidence was 0.21/100 000 (0.12/100 000 - 0.49/100 000). Totally 87.5% (168/192) of cases were reported from October to November, and the peak occurred in November (57.8%, 111/192). Among these cases, males accounted for 64.1% (123/192); and the median age was 59 years old (6 - 84 years old). The groups ≥60 years old and 45 - 59 years old accounted for 47.9% (92/192) and 31.2% (60/192), respectively, which accounted for 79.2% (152/192) in all groups. Farmers accounted for 43.8% (84/192), household chores and unemployed people accounted for 16.7% (32/192), retired persons accounted for 15.6% (30/192) and workers accounted for 6.8% (13/192), which accounted for 82.8% (159/192) in all occupations. The top four areas in the total number of reported cases were Jiangning District (23.4%, 45/192), Luhe District (22.9%, 44/192), Gulou District (10.4%, 20/192) and Jiangbei New Area (8.9%, 17/192), which accounted for 65.6% (126/192) in all districts. According to global spatial autocorrelation analysis, Moran's I = 0.34 ( Z = 5.90, P < 0.001). FlexScan 3.1.2 software scanned and detected two spatial clusters areas, the first-class of cluster area covered three streets in Jiangning District, one street in Yuhuatai District and two streets in Pukou District [restricted log likelihood ratio ( RLLR) = 26.91, P < 0.001]. The second-class of cluster area included six townships/streets in Luhe District and four streets in Jiangbei New Area ( RLLR = 26.48, P < 0.001). All the cluster areas were agriculture-related. Conclusions:The reported incidence level of scrub typhus in Nanjing is low and stable which belongs to a typical autumn epidemic area. The middle-aged and elderly population is the key population and the agriculture-related area is key area. It is suggested that scrub typhus should be included in the management of statutory or regional key infectious diseases in Nanjing. Additionally, training on diagnosis and treatment technology and information report management of scrub typhus need to be carried out, and comprehensive prevention and control interventions such as health education, personal protection, rodent prevention and control and vector control should be strengthened and implemented in the high incidence season.

Analysis of chyle leakage after central lymph node dissection for thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the clinical characteristics, treatment and prognosis of chyle leakage after central lymph node dissection for thyroid cancer.@*Methods@#A retrospective analysis was made of 985 patients who underwent surgical for thyroid carcinoma plus central lymph node dissection from January 2017 to June 2018 in Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. Patients were divided into those without (group A, n=973) and with (group B, n=12) chyle leakage. Patients with chyle leakage who underwent left central lymph node dissection were divided into group B1 (n=5) and right central lymph node dissection into group B2 (n=7). Patients with chyle leakage were treated with fat-free diet and negative pressure drainage. SPSS 20.0 software was used to analyze the general condition, surgical pathology, postoperative drainage, hospitalization days, treatment and prognosis of patients in B1 and B2 groups.@*Results@#The incidence of chyle leakage after central lymph node dissection for thyroid cancer was 1.2% (12/985). There were no significant differences in age, sex, size of primary lesion, number of lymph node dissection in central area and number of lymph node metastasis in central area between group A and group B (all P>0.05). The drainage volume on the first day after operation [((51.7±26.7)) ml] and the average hospitalization days [(3.4±0.8) d] in group A were significantly lower than those in group B ([131.3±56.0)]ml, [10.4±2.6)]d). The differences were statistically significant (t value was -5.442, -11.238, respectively, both P<0.001). There were no significant differences in age, size of primary lesion, number of lymph node dissection, number of lymph node metastasis, drainage volume on the first day after operation and average hospitalization days between group B1 and group B2 (all P>0.05). All chyle leakages in group B stopped after conservative management without surgical intervention.@*Conclusion@#The occurrence of chyle leakage after central lymph node dissection is a rare complication. It can be cured by conservative treatment such as diet control, pressure bandaging and negative pressure drainage, and generally does not require secondary surgery.

Development and validation of an HPLC-MS/MS method to determine clopidogrel in human plasma

A quantitative method for clopidogrel using online-SPE tandem LC-MS/MS was developed and fully validated according to the well-established FDA guidelines. The method achieves adequate sensitivity for pharmacokinetic studies, with lower limit of quantifications (LLOQs) as low as 10 pg/mL. Chromatographic separations were performed on reversed phase columns Kromasil Eternity-2.5-C18-UHPLC for both methods. Positive electrospray ionization in multiple reaction monitoring (MRM) mode was employed for signal detection and a deuterated analogue (clopidogrel-d 4) was used as internal standard (IS). Adjustments in sample preparation, including introduction of an online-SPE system proved to be the most effective method to solve the analyte back-conversion in clinical samples. Pooled clinical samples (two levels) were prepared and successfully used as real-sample quality control (QC) in the validation of back-conversion testing under different conditions. The result showed that the real samples were stable in room temperature for 24 h. Linearity, precision, extraction recovery, matrix effect on spiked QC samples and stability tests on both spiked QCs and real sample QCs stored in different conditions met the acceptance criteria. This online-SPE method was successfully applied to a bioequivalence study of 75 mg single dose clopidogrel tablets in 48 healthy male subjects.

Therapeutic evaluation of surgical procedure in treatment of secondary hyperparathyroidism / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism.</p><p><b>METHODS</b>Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively. Patients were divided into three subgroups, including subtotal parathyroidectomy (group I), total parathyroidectomy with autotransplantation (group II) and intraoperative ⁹⁹Tc(m)-MIBI radioguided total parathyroidectomy with autotransplantation (group III). Their serum calcium, phosphorus, serum iPTH results in the pre-operation, short-term (≤ 6 months) and long term (> 6 months) of post-operation were collected and compared. The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed.</p><p><b>RESULTS</b>The symptoms of all patients were improved after the operation.The short-term postoperative serum calcium, serum iPTH and recurrence rate of Group I and group II were all not statistically significant. The short-term postoperative serum calcium, iPTH and recurrence rate of group III were significantly lower than those of group I and group II (P < 0.05). Postoperative serum phosphorus values of the three groups had no statistical difference. The operation time of group III was significantly shorter than that of group II ((77 ± 13) vs (108 ± 17) min, P < 0.05). The positive rates were more accurate in group III than in group II (98.5% vs 88.7%, P < 0.05). For the long term follow-up, the postoperative serum calcium, phosphorus, serum iPTH and recurrence rate of group I and group II were not statistically different. The postoperative recurrence rate of group III was lower than that of group I and group II (3.6% vs 31.6% and 21.4% respectively, P < 0.05).</p><p><b>CONCLUSIONS</b>Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism. The intraoperative ⁹⁹Tc(m)-MIBI radioguided total parathyroidectomy with autotransplantation can find the ectopic and supernumerary glands to improve the success rate of operation. And it also can permit omission of frozen section to reduce the operative time.In the postoperative follow-up, the recurrence rate is low, so it is a safe and effective treatment.</p>

Management of the sentinel lymph node of papillary thyroid carcinoma in surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the value of sentinel lymph node of papillary thyroid carcinoma exploring and measuring in the metastasis of the cervical lymph node of thyroid carcinoma.@*METHOD@#The sentinel lymph node were investigated by injecting the methylene blue around 25 cases of thyroid tumors. The lymph nodes dyed in blue and obtained from selective lymph node dissection were examined by pathology, respectively. The value of the sentinel lymph nod were evaluated.@*RESULT@#The sentinel lymph nodes dyed in blue were identified in 22 cases which account for 88.0% of all the 25 cases. Nineteen cases of the sentinel lymph node were positive by pathology, of whom 13 cases were verified positive in other area. Six cases were negative.@*CONCLUSION@#It is of great value that sentinel lymph node of thyroid carcinoma can indicate the metastasis of the cervical lymph node of thyroid carcinoma.