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ObjectiveTo investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). MethodsA retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P＜0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. ResultsAfter PTBS, 55 patients (221%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio ［OR］=2.2, 95% confidence interval ［CI］: 1.07-4.52, P=0033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-1405, P＜0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-3403, P＜0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. ConclusionHyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS.
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This article reported a case of malignant insulinoma which recurred as liver metastasis 12 years after the initial pancreatic insulinoma resection. The patient was a 48-year-old woman who was firstly diagnosed as pancreatic insulinoma in 2006 and underwent the surgery involved complete resection of a 1.9 cm×1.3 cm tumor located in pancreas. No signs of either invasion or metastasis was detected according to preoperative imaging examination and intraoperative exploration. The tumor was diagnosed as a benign insulinoma according to histopathological results. The patient had no hypoglycemia and the fasting blood glucose was normal during the subsequent 12 years. The patient underwent a fasting blood glucose of 2.8 mmol/L in 2018, and gradually experienced palpitation and cold sweats, which was relieved by eating. She was hospitalized in May 2018 with blood glucose of 1.73 mmol/L and insulin of 1 128 pmol/L. CT and MRI revealed morphologic changes of postoperative pancreas and abnormal liver signal, the liver tumor was finally identified as insulinoma by modified selective intra-arterial calcium stimulated venous sampling (ASVS). Partial liver resection was performed and the histopathological result was neuroendocrine tumor. Therefore, the disease was diagnosed as liver metastatic malignant insulinoma.
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Objective:To identify human infection with Brucella suis, analyze its biological and molecular characteristics, and to provide basis for prevention and control of brucellosis. Methods:Brucella suis strains were isolated from the body of the first case of human Brucella suis infection in Jiangsu Province. Serum agglutination test was used for serotyping. The specific gene bcsp-31 of Brucella was detected by PCR. AMOS-PCR was used to identify IS-711. The species and biotypes were identified by multiplex PCR. The wboA gene products were sequenced and phylogenetic tree was constructed. Multilocus sequence analysis (MLSA) was used for molecular typing, and cluster analysis was performed with reference strains. Results:The strain was confirmed to be Brucella suis biotype 3 by serum agglutination test and PCR. After sequencing the wboA gene, cluster analysis of the reference sequence showed that the wboA gene was closest to the biotype 3 strain Brucella suis str. 686 (CP007719). MLSA was typed into ST17(1-6-4-1-5-3-5-2-4). Conclusions:Brucella suis biotype 3 is reported in Jiangsu Province for the first time. The MLSA type is ST17. In the future, the prevention and control of human brucellosis should be carried out. We should actively cooperate with the animal husbandry and veterinary department to increase the quarantine, immunization and other control measures.
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Objective:To explore the epidemic situation and brucellosis in key occupational populations of brucellosis monitoring sites in Jiangsu Province, and provide a basis for development of prevention and control strategies against brucellosis.Methods:From 2013 to 2017, according to the requirements of the "National Brucella Surveillance Programme", two brucellosis monitoring sites in Yixing City of Wuxi and Huaiyin District of Huai'an, Jiangsu Province were established to monitor brucellosis. Brucellosis epidemic data were collected and analyzed of the two monitoring sites in Yixing City and Huaiyin District from 2013 to 2017 (data were from Jiangsu Provincial Legal Infectious Disease Reporting System). Blood samples were collected from the general occupational populations (health check-up population) and the key occupational populations (people engaged in livestock trading, livestock slaughtering, and the fur, milk and meat processing) in the monitoring sites. Tiger red plate agglutination test (RBPT) and serum tube agglutination test (SAT) were used for serological examination. Results:From 2013 to 2017, a total of 18 cases of brucellosis were reported at the two monitoring sites in Yixing City and Huaiyin District, Jiangsu Province, including 13 males and 5 females, with a male to female sex ratio of 2.6∶1.0; the age of onset was mainly 35 - 64 years, accounting for 72.22% (13/18); the time of onset was mainly from January to June, accounting for 94.44% (17/18); and the occupational distribution was mainly farmers, accounting for 77.78% (14/18); there was no epidemic and outbreaks of brucellosis. A general occupational populations survey was conducted in 17 743 cases, serological tests were negative, no infection and no signs and symptoms were found in the two monitoring sites. In 2013 - 2017, a total of 113 cases of serological tests were positive in the key occupational populations of brucellosis in Jiangsu Province, with a positive rate of 7.83% (113/1 444), and the overall trend was downward year by year ( t = 6.463, P < 0.05). Among them, the positive rates in Yixing City and Huaiyin District were 11.79% (106/899) and 1.28% (7/545), respectively. The difference between different regions was statistically significant (χ 2 = 51.926, P < 0.01). The positive rates of occupational groups engaged in livestock trading, livestock slaughtering, and the fur, milk and meat processing were 5.10% (20/392), 9.74% (49/503), and 8.01% (44/549), respectively. The differences were statistically significant between different occupations (χ 2 = 6.618, P < 0.05); and the positive rates of livestock slaughtering occupations and the fur, milk and meat processing occupations were higher than that of livestock trading occupations ( P < 0.05). Conclusions:The positive rate of brucellosis in key occupational populations has showed a general downward trend, the livestock slaughtering occupations and the fur, milk and meat processing occupations are more susceptible to Brucella infection. It is still necessary to strengthen the health education for the key occupational populations of brucellosis and inspection and quarantine work for prevention of the epidemic of brucellosis in humans.
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Objective To analyze the molecular characteristics of Brucella strains isolated from Nanjing,understand strains genotying and clustering,and to provide a basis for prevention and treatment of brucellosis.Methods Multilocus sequence typing (MLST) and multiple locus variable-number tandem repeat analysis (MLVA) were used to analyze and characterize Brucella ovis strains isolated from 7 cases of sporadic cases in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,from 2011-2016,and cluster analysis was did with reference strain data from Jiangsu Province.Results The results showed that 7 strains were defined as sequence type (ST) 8 by MLST.They were typed into 7 subtypes and clustered in the "Middle Mediterranean Cluster" by MLVA.Strain NJ-2011-1 and two strains isolated from other cities in Jiangsu had the same MLVA genotype.Conclusions The results reveal ST8 is the predominant genotype in Nanjing.They have clustered in the "Middle Mediterranean Cluster" by MLVA.The 7 strains are sporadic.The transmission routes and risk factors are more complicated in the city.Various departments should strengthen the cooperation to control the source.
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Objective To understand the epidemiological and clinical characteristics of human brucellosis in Huai'an of Jiangsu Province, and to provide evidence for the formulation of prevention and control measures. Methods Relevant data was collect through "Infectious Disease Report Information Management System". Descriptive epidemiology (population distribution, time distribution, regional distribution) and clinical characteristics analysis of brucellosis were conducted in Huai'an City from 2013 to 2018. Results Totally 704 cases of brucellosis had been reported in Jiangsu Province, with an average annual incidence of 0.1467/100000, among which 32 cases (4.55％) had been reported in Huai'an, with an average annual incidence of 0.1100/100000 from 2013 to 2018. The annual outcomes (incidence rates) were 2 (0.0416/100000), 4 (0.0834/100000), 6 (0.1247/100000), 6 (0.1232/100000), 8 (0.1636/100000) and 6 (0.1221/100000), respectively. Most of the cases were males (20 cases, 62.5％), and aged mainly focused from 40 - < 60 years old (20 cases, 62.5％). The occupation was mainly farmers (21 cases, 65.6％). The contact with animals was mainly sheep, and the contact mode was feeding and slaughtering. The cases mainly occurred from March to September (26 cases), and all districts had cases except Hongze. The main clinical manifestations were fever, fatigue, hyperhidrosis and arthromyalgia, with 30 cases (93.8％), 28 cases (87.5％), 25 cases (78.1％) and 22 cases (68.8％), respectively. Some cases showed enlargement of liver, spleen, lymph nodes and testis. Conclusions The incidence of brucellosis in Huai'an City is on the rise, and the characteristics of population distribution, time distribution and regional distribution are obvious. The clinical features are mainly fever, fatigue, and hyperhidrosis. We should strengthen the monitoring of brucellosis, carry out health education for high -risk groups, and reduce the occurrence of brucellosis.
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Objective@#To understand the epidemiological and clinical characteristics of human brucellosis in Huai'an of Jiangsu Province, and to provide evidence for the formulation of prevention and control measures.@*Methods@#Relevant data was collect through "Infectious Disease Report Information Management System". Descriptive epidemiology (population distribution, time distribution, regional distribution) and clinical characteristics analysis of brucellosis were conducted in Huai'an City from 2013 to 2018.@*Results@#Totally 704 cases of brucellosis had been reported in Jiangsu Province, with an average annual incidence of 0.146 7/100 000, among which 32 cases (4.55%) had been reported in Huai'an, with an average annual incidence of 0.110 0/100 000 from 2013 to 2018. The annual outcomes (incidence rates) were 2 (0.041 6/100 000), 4 (0.083 4/100 000), 6 (0.124 7/100 000), 6 (0.123 2/100 000), 8 (0.163 6/100 000) and 6 (0.122 1/100 000), respectively. Most of the cases were males (20 cases, 62.5%), and aged mainly focused from 40-< 60 years old (20 cases, 62.5%). The occupation was mainly farmers (21 cases, 65.6%). The contact with animals was mainly sheep, and the contact mode was feeding and slaughtering. The cases mainly occurred from March to September (26 cases), and all districts had cases except Hongze. The main clinical manifestations were fever, fatigue, hyperhidrosis and arthromyalgia, with 30 cases (93.8%), 28 cases (87.5%), 25 cases (78.1%) and 22 cases (68.8%), respectively. Some cases showed enlargement of liver, spleen, lymph nodes and testis.@*Conclusions@#The incidence of brucellosis in Huai'an City is on the rise, and the characteristics of population distribution, time distribution and regional distribution are obvious. The clinical features are mainly fever, fatigue, and hyperhidrosis. We should strengthen the monitoring of brucellosis, carry out health education for high-risk groups, and reduce the occurrence of brucellosis.
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Objective To explore the epidemiological situation and characteristics of human brucellosis in Jiangsu Province from 2006 to 2017,and to provide scientific evidences for its prevention and control.Methods Using a retrospective study,data of brucellosis epidemic in Jiangsu Province from 2006 to 2017 were collected.The epidemic data of brucellosis and the population data were derived from China Disease Prevention and Control Information System,etiological data of brucellosis from 2011 to 2017 were derived from the surveillance report of brucellosis in Jiangsu Province.The overall incidence of brucellosis,pathogen research and regional,seasonal,and population distribution characteristics of cases were analyzed.Results A total of 607 prevalent cases of brucellosis were reported in Jiangsu Province from 2006 to 2017,with an average annual incidence rate of 0.065/100 000,including 595 incident cases.The number of reported case showed a sharp upward trend in 2011-2017,the incidence rates were in an increasing trend (t =5.623,P ＜ 0.01).A total of 132 Brucella strains were isolated from serum samples in Jiangsu Province in 2011-2017,all of the strains were sheep breeds,of which sheep type 3 accounted for 84.85％ (112/132).The top five cities with annual incidence of brucellosis from 2006 to 2017 were Xuzhou,Lianyungang,Suzhou,Huai'an and Suqian,with the incidence rates of 0.223/100 000,0.210/100 000,0.128/100 000,0.108/100 000 and 0.102/100 000,respectively.Brucellosis cases were distributed in each month,with the 540 cases (90.76％,540/595) from January to September.There were 446 males and 161 females in 607 cases of brucellosis,the sex ratio was 2.77:1.00.A total of 579 cases were reported in the age group of 20-74 years old,accounting for 95.39％.The occupational distribution was mainly peasants,which accounting for 60.13％ (365/607).Conclusions The epidemic situation of human brucellosis in Jiangsu Province is becoming increasingly serious recently.Males and peasants are main incidence population.Thus,we should pay more attention to the livestock quarantine and the surveillance and control of brucellosis cases in high risk population so as to control the epidemic situation of brucellosis effectively.
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Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.
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Objective To evaluate the feasibility and safety of establishing benign proliferative esophageal stenosis model by using stent implantation in experimental rats.Methods A customized self-expanding,metallic and straight tubular stent was used in this experiment (5 mm in diameter and 15 mm in length),on both sides at the stent's middle part there was a protruding barb that was used as a fixation device.Twelve healthy Sprague Dawley (SD) rats were randomized divided into group A (blank control group) and group B (stent implantation group),with 6 rats in each group.Esophageal stent implantation was employed in the rats of group B,and esophageal radiography was separately performed immediately,one and 4 weeks after stent implantation.All the experimental rats were sacrificed 4 weeks after stent implantation.The normal esophageal tissue of the rats in group A and the esophageal tissue at stent site of the rats in group B were collected and sent for pathological examinations,including gross morphology,light microscopy,etc.Results Successful stent implantation was achieved in all rats of group B,and the esophageal radiography performed immediately,one and 4 weeks after stent implantation showed no esophageal stent displacement;no severe complications occurred during the operation or follow-up period.Compared with group A,esophageal radiography reexamination performed 4 weeks after stent implantation in group B revealed that esophageal stricture at stent segment,caused by benign tissue hyperplasia,could be observed.The esophageal stent segment was taken out,its lumen was obviously narrowed under gross observation,and typical benign hyperplasia could be seen under optical microscope examination.Conclusion Using esophageal stent implantation to establish esophageal stenosis model is safe and feasible in experimental rats.The use of esophageal stent with barbs can significantly reduce the incidence of stent displacement.
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Objective To evaluate the safety and efficacy of peripheral chemoembolization by using ethanol-soaked gelatin sponge (ESG) combined with chemotherapeutic drugs and/or iodized oil in treating patients with hepatocellular carcinoma (HCC) complicated by moderate-to-severe hepatic arterio-portal shunts (APS).Methods The clinical data of 106 HCC patients associated with moderate-to-severe APS,who were treated with ESG chemoembolization during the period from June 2008 to December 2015,were retrospectively analyzed.The postoperative improvement of APS,the procedure-related complications,the tumor response,the survival time,the prognostic factors,etc.were statistically analyzed.Results In the 106 HCC patients associated with moderate-to-severe APS,the median survival time was 278 days,and the 6-,12-and 18-month cumulative survival rates were 70.8％,36.1％ and 16％,respectively.Univariate analysis showed that sex,total bilirubin level,maximal tumor diameter,history of previous treatment,tumor response and postoperative improvement of APS were closely correlated with the patient's prognosis.Multivariate regression analysis indicated that tumor response and postoperative improvement of APS were the independent protection factors,while the female sex and the maximal tumor size ≥5 cm were the independent risk factors.Conclusion For the treatment of HCC complicated by moderate-to-severe hepatic APS,transarterial chemoembolization by using ESG combined with chemotherapeutic drugs and/or iodized oil is safe and effective.The presence of tumor response to treatment and the postoperative improvement of APS indicate a better prognosis.The female sex and the maximal tumor size ≥5 cm are the independent prognostic risk factors.
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Objective To investigate the cause and related risk factors of an outbreak caused by Brucellosis. Methods Epidemiological investigation and laboratory test were carried out among occupationally invloved population including sheep slaughters and sellers in the village. Results 18 people were serology positive among the 129 occupationally involved persons under survey. Seven of them were confirmed cases,11 were latent infection,to make the overall attack rate as 14%. 90%of the sheep were from high-risk areas of Brucella. Among the occupationally involved persons,89%of them never wore face masks,84%never wear overalls and 70%never wear gloves. Factors as:work but wearing no gloves(RR=7.4,95%CI:1.1-53.0),with hand wound(RR=3.4,95%CI:1.1-11.0) could increase the risk of Brucella infection. Conclusion The cause of this outbreak was due to the plentiful influx of unchecked sheep from the northern part of China and the employees in the process of sheep slaughtering or trading were lack of effective prevention programs.
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Objective To investigate the cause and related risk factors of an outbreak caused by Brucellosis. Methods Epidemiological investigation and laboratory test were carried out among occupationally invloved population including sheep slaughters and sellers in the village. Results 18 people were serology positive among the 129 occupationally involved persons under survey. Seven of them were confirmed cases,11 were latent infection,to make the overall attack rate as 14%. 90%of the sheep were from high-risk areas of Brucella. Among the occupationally involved persons,89%of them never wore face masks,84%never wear overalls and 70%never wear gloves. Factors as:work but wearing no gloves(RR=7.4,95%CI:1.1-53.0),with hand wound(RR=3.4,95%CI:1.1-11.0) could increase the risk of Brucella infection. Conclusion The cause of this outbreak was due to the plentiful influx of unchecked sheep from the northern part of China and the employees in the process of sheep slaughtering or trading were lack of effective prevention programs.
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<p><b>OBJECTIVE</b>To investigate the cause and related risk factors of an outbreak caused by Brucellosis.</p><p><b>METHODS</b>Epidemiological investigation and laboratory test were carried out among occupationally invloved population including sheep slaughters and sellers in the village.</p><p><b>RESULTS</b>18 people were serology positive among the 129 occupationally involved persons under survey. Seven of them were confirmed cases, 11 were latent infection, to make the overall attack rate as 14%. 90% of the sheep were from high-risk areas of Brucella. Among the occupationally involved persons, 89% of them never wore face masks, 84% never wear overalls and 70% never wear gloves. Factors as:work but wearing no gloves (RR = 7.4, 95%CI:1.1-53.0), with hand wound (RR = 3.4, 95%CI:1.1-11.0) could increase the risk of Brucella infection.</p><p><b>CONCLUSION</b>The cause of this outbreak was due to the plentiful influx of unchecked sheep from the northern part of China and the employees in the process of sheep slaughtering or trading were lack of effective prevention programs.</p>
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Animals , Humans , Abattoirs , Brucella , Brucellosis , Epidemiology , China , Epidemiology , Commerce , Disease Outbreaks , Incidence , Occupational Diseases , Epidemiology , Risk Factors , Sheep , MicrobiologyABSTRACT
Objective To explore the ideal choice of feeding artery which is used for regional arterial infusion (RAI) in severe acute pancreatitis. Methods Forty-five patients with SAP were treated with RAI. The ideal feeding artery was that can supply entire pancreas according to arteriography and can maximize concentration of drug at pancreatic tissue. The pancreatic arteriography was considered as the final objective evidence for choice. Results (1)Gastroduodenal artery was chosen as feeding artery in forty-four cases, and superior mesenterlc artery was chosen in only one case because of vascular abnormity. (2)According to splenic arteriography, blood of splenic artery was supplied to spleen chiefly, and only partial tail of pancreas was applied by splenic artery. (3)According to celiac trunk arteriography, blood of celiac trunk could be supplied to entire pancreas, but a considerable proportion of the total blood was supplied to spleen through splenic artery and liver through hepatic artery proper.Therefore, the drug utilization index was lower. (4)According to gastroduodenal arteriography, blood of gastroduodenal artery could be supplied to entire pancrea, and almost all of the blood that contains drug flowed into pancreas. Therefore, the drug utilization index was higher. Conclusions Gastroduodenal artery is the ideal choice of artery which is used for regional intra-arterial infusion in sever acute pancreatitis. Pancreatic arteriography should be applied routinely when yever acute pancreatitis was treated with RAI.
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Objective Acute massive pulmonary embolism(PE)is a clinical emergency requiring rapid and supportive measures.With the development of interventional technology and devices,percutaneous mechanical thrombectomy(PMT)is considered to be an alternative for the treatment of PE,though there is still relative lack of clinical experience.The purpose of this study is to evaluate the clinical efficacy and safety of PMT in the management of acute massive PE.Methods The clinical data of massive PE patients treated with interventional methods were collected and analyzed in a retrospective way.From Jan.2003 to Jan.2008,6 patients(5 males and one female,with a mean age of 62 years)with acute massive PE,which was initially diagnosed by computed tomography and finally confirmed by pulmonary angiography,were treated with percutaneous catheter fragmentation and/or Straub Rotarex thrombectomy device.Results The improvement of clinical status and restoration of blood flow in the main branches of pulmonary artery were obtained in all patients.Oxygen saturation(SaO2)increased from preoperative(79.5±5.3)%to postoporative (92.8±3.4)%,with P＜0.01.Partial arterial oxygen pressure(PaO2)increased from preoperative(58.0±9.8)mmHg to postoperative(88.7±4.1)mmHg(P＜0.01).After PMT treatment,the mean pulmonary artery pressure(PAP)decreased from preoperative(40.8±7.8)mmHg to postoperative(29.8±8.0)mmHg (P＜0.01).Miller index decreased from preoperative 0.54±0.03 to postoperative 0.18±0.07(P＜0.01).During a clinical follow-up period ranged from 1 to 5 years,four patients showed no recurrence of PE,the other two patients lost touch with the authors.Conclusion The preliminary experience in onr series suggests that PMT is an easy,effective and safe therapy in the clinical management of acute massive PE,especially when thrombolysis is contraindicated.
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Objective To evaluate the safety and immunogenicity of Shigella flexneri 2a conjugate vaccine.Methods A random and double blind study were carried out to compare the safety sero conversion rates and geometric mean titer(GMT)increase of Shigella flexneri 2a conjugate vaccine with phosphate-buffered saline used as control.Results The results showed that no severe systemic and local reaction rates occurred in trial group,which were not statistically significant compared with the control group.The seroconversion rate of both two weeks and twelve weeks after two doses(increased by 4 folds) were 86.27% and 79.74%;for GMT were 1∶361.83 and 1∶326.21 and increased averagely 1.08 and 0.98 times,which showed significant difference with those of the control group.Conclusion Shigella flexneri 2a conjugate vaccine was safe and its immunogenicity was good in group over 2 years old.Trialregistration National food drugs surveillance administrative bureau,"Medicine Clinical Experiment Written directive from a superior"2003L03808 number.