Preoperative retrograde portography for children with cavernous transformation of the portal vein: clinical application in 8 cases / 浙江大学学报·医学版

OBJECTIVE@#To assess the clinical application of preoperative retrograde portal venography for children with cavernous transformation of the portal vein (CTPV).@*METHODS@#The clinical data of 8 cases of CTPV admitted in the Children's Hospital of Zhejiang University from January 2018 to September 2019 were retrospectively analyzed. Preoperative retrograde portography was performed to determine the corresponding vascular morphology and size of portal vein system. If the retrograde portography showed that the left branch of the shadow portal vein was unobstructed and its diameter was greater than 3 mm, Rex shunt would be performed after anatomic exploration of Rex recess; if retrograde portography showed that the diameter of left portal vein was less than 3 mm, but the diameter of left renal vein dissected during shunt operation was greater than 5 mm, Warren operation was selected. The patients were followed up for 1, 3 and 6 months after discharge, and then were followed up every 6 months.@*RESULTS@#Retrograde portal venography was successfully performed in 8 child patients.The anatomical position and size of main portal vein and its left and right branches, left renal vein and other important vessels were determined. Among them, there was the well-developed left and right branches of portal vein in 4 child patients, in which the left and right branches of portal vein converged together, but did not communicate with the main portal vein. In addition, the left branch diameter of the portal vein was greater than 3 mm, and the anatomical exploration results during shunt were consistent with it, so Rex shunt was performed. In the other 4 cases, the left branch diameter of the portal vein was small (less than 3 mm) in 3 cases, and the right branch was not clearly developed. Moreover, the left branch of the portal vein was poorly developed and almost occluded in 1 case. However, the left renal vein in these 4 child patients was well developed, the blood flow was unobstructed and the diameter was greater than 5 mm, so Warren operation was performed. Seven patients recovered well after the operation, and the other one had digestive tract rudimentary one year after operation, and the condition was stable after conservative treatment.@*CONCLUSIONS@#The preoperative retrograde portal venography can be used to evaluate the portal vein system in children with CTPV, which provides important clinical basis for making appropriate treatment plan before surgery.

Comparison between KeyPort access and traditional transanal endoscopic microsurgery in the treatment of rectal tumors / 中华普通外科杂志

Objective:To compare the efficacy and safety of KeyPort access and traditional transanal endoscopic microsurgery(TEM) in the treatment of rectal tumors.Methods:In this study, 36 cases of rectal tumors were treated by KeyPort TEM access and 52 cases by traditional TEM. Tumor type, size, distance from anal edge, operation time, intraoperative blood loss, postoperative hospitalization time, specimen quality and complications were compared between the two groups.Results:There were no significant differences in tumor type, size, operation time, intraoperative blood loss, postoperative hospitalization time, complications, recurrence and metastasis rate between the two groups. The distance between lower cutting edge to the anus in KeyPort access group was significantly greater than that of traditional TEM group[(6.7±1.9) vs. (5.1±1.8) cm , t=3.901, P<0.001]. All the surgeries in the KeyPort access group were completed. While two cases of in traditional TEM group were coverted to other surgical approaches. All patients in the KeyPort group had normal anal function in the early postoperative period, while 2 patients in the traditional TEM group suffered anal function impairment. Conclusion:TEM by KeyPort access is safer and more effective then traditional TEM, as well as more generous indications.

Application of enhanced recovery after surgery in the treatment of children with congenital choledochal cyst / 浙江大学学报·医学版

OBJECTIVE@#To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst.@*METHODS@#One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (=65) and control group (=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups.@*RESULTS@#Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation,time required for the volume of peritoneal drainage fluid to be less than 50 mL,time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (<0.05 or <0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (<0.01), but the incidence of edema after operation was lower (<0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (<0.05) and the total cost of hospitalization was reduced (<0.01).@*CONCLUSIONS@#ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.

Clinical analysis of annular pancreas in neonates / 浙江大学学报·医学版

OBJECTIVE@#To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates.@*METHODS@#Clinical data of 114 neonates with annular pancreas admitted in the Children's Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters (gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed.@*RESULTS@#One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography (UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was (7.8±2.7) d, and the mean length of hospital stay was (16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group (<0.05); the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group (<0.05).@*CONCLUSIONS@#Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.

The application of measles specific IgM and IgG antibody detection in classification measles vaccine failure, Tianjin / 中华预防医学杂志

Objective@#To study the application of measles specific IgM and IgG antibody detection in classification of primary vaccination failure (PVF) and secondary vaccination failure (SVF).@*Methods@#Measles surveillance information system was used to collect measles confirmed cases in Tianjin, 2013-2015, and their blood specimens were collected, totally 284 cases were enrolled. Measles IgM and IgG were detected with enzyme-linked immunosorbent assay (ELISA), and the relative avidity index (RAI) was used to express the result of measles avidity. Measles IgM, IgG and IgM/IgG was analyzed with receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC) as evaluation indicators. In addition, compared with a measles outbreak (26 cases) of a middle school in Tianjin in 2016, for making further verification on the diagnostic value of vaccination failure with IgM, IgG and IgM/IgG.@*Results@#The age of cases ranged was 0-58 years old, the interval median (P25, P75) of serum collection after rash onset was 2 (1, 4) days. The positive rate of measles IgM and IgG in acute phase specimens were 76.06% (216 cases) and 88.38% (251 cases). According to the ROC curve analysis, the area under the ROC curve (AUC) of IgM, IgG and IgM/IgG were 0.753, 0.891 and 0.952, indicating that IgM/IgG was the best index to distinguish PVF and SVF. The best cut off value for IgM/IgG was 0.06, the sensibility and specificity were 88.75% and 86.63%. When IgM/IgG >1, 96.30% cases were low-avidity (RAI <40%), only 1 case was equivocal response (RAI: 40%-60%). 97.14% cases were high-avidity (RAI >60%) when IgM/IgG <0.01, only 3 cases were equivocal response (RAI 40%-60%). The threshold of IgM/IgG was used to verify the measles outbreak of a middle school in Tianjin, 2016. In the acute phase specimens, 100% (26 cases) of IgM/IgG were <0.06, 84.62% (22 cases) of IgM/IgG were <0.01.@*Conclusion@#The detection of measles IgM and IgG with ELISA, and IgM/IgG is a valuable diagnostic tool to distinguish PVF and SVF.

Application of KeyPort access to transanal endoscopic mircrosurgery / 中华胃肠外科杂志

Objective@#To explore the effectiveness of KeyPort access in transanal endoscopic mircrosurgery (TEM).@*Methods@#A descriptive case series study was performed. Clinicopathological data of 20 patients undergoing KeyPort access TEM in Beijing Chaoyang Hospital of Capital Medical University from December 2016 to April 2018 were collected and analyzed retrospectively. Procedure of KeyPort access TEM: general anesthesia or combined spinal epidural anesthesia (CSEA); lithotomy or prone jack-knife position; anal dilation; placement of the KeyPortaccess; connection of TEM pneumoperitoneum device, light source and imaging equipment; placement of 5 mm dedicated endoscope; insufflation of CO2 with pressure of 1.6-2.0 kPa (12-15 mmHg); after rinsing the intestinal lumen, circular resection marginlabeled by the needle-shaped electrocautery;electric coagulation or ultrasonic knife used to perform a full-thickness resection with a 0.5 cm-1 cm margin along the marking line. Indications of KeyPort access TEM: (1) benign large sessile polyps which were difficult to resect under colonoscopy; (2) submucosal lesions with diameter <2 cm; (3) Tis and T1 stage rectal carcinoma without lymph node metastasis; (4) palliative resection of T2 stage rectal carcinoma without lymph node metastasis. Contraindications: (1) accompanying serious diseases without the tolerance of anesthesia and operation; (2) distance from lesion to anal verge >20 cm.@*Results@#There were 10 males and 10 females with age of (63±15) years old and BMI of (24.5±3.3) kg/m2. The diameter of the lesions was (2.0±1.3) cm, and the distance from lesion to anal verge was (6.2±2.2) cm. One patient had 3 lesions at different positions in rectum with diameters of 0.5 cm, 0.5 cm, and 1 cm, respectively. All operations were accomplished through the KeyPort access TEM and no case was transferred to other methods. The duration of surgery was 75 (30-220) minutes; intraoperative blood loss was 10 (0-30) ml. Two patients with rectal anterior wall lesions underwent full-thickness resection of the intestine wall reaching the peritoneal reflex with penetration into the peritonealcavity, and received suture closure immediately. For the patient with 3 rectal lesions, the 1.0 cm lesion received a full-thickness resection and the other 2 lesions received submucosal resection. No postoperative complication occurred. Postoperative pathology showed that there were 1 case of chronic inflammatory lesion, 4 cases of benign tumor, 3 cases of carcinoma in situ, 4 cases of neuroendocrine tumor, 6 cases of pT1 rectal cancer, 2 cases of pT2 rectal cancer (both invading the superficial muscle layer). The median hospital stay was 6 (3-7) days. The postoperative follow-up was (7.2±3.8) months. No postoperative complication or recurrence was observed.@*Conclusion@#TEM with KeyPort access is safe, rapid and effective in the treatment of rectal tumors.

Expression discordances and clinical values of ER, PR, HER-2 and Ki-67 in primary and metastatic breast cancer / 中华肿瘤杂志

Objective@#To investigate the expression discordances of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor2 (HER-2) and Ki-67 in primary and metastatic breast cancer specimens and explore the clinical significances.@*Methods@#Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and/or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER-2 and Ki-67 in primary and metastatic lesions, their relationships with prognosis were also analyzed.@*Results@#Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER-2 and Ki-67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER-2 and Ki-67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P<0.001). The disease-free survival (DFS) of patients with ER, PR positive, HER-2 negative and low expression of Ki-67 in metastatic lesion was much longer (P<0.05).@*Conclusions@#The expressions of ER, PR, HER-2 and Ki-67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

An improved peak extraction method for heart rate estimation / 生物医学工程学杂志

In order to solve imperfection of heart rate extraction by method of traditional ballistocardiogram (BCG), this paper proposes an improved method for detecting heart rate by BCG. First, weak cardiac activity signals are acquired in real time by embedded sensors. Local BCG beats are obtained by signal filtering and signal conversion. Second, the heart rate is estimated directly from the BCG beat without the use of a heartbeat template. Compared with other methods, the proposed method has strong advantages in heart rate data accuracy and anti-interference, and it also realizes non-contact online detection. Finally, by analyzing the data of more than 20,000 heart rates of 13 subjects, the average beat error was 0.86% and the coverage was 96.71%. It provides a new way to estimate heart rate for hospital clinical and home care.

Application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision for advanced low rectal cancer / 中华消化外科杂志

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

Clinical diagnosis and treatment of Meckel's diverticulum in children / 中华普通外科杂志

Objective To evaluate the clinical characteristics and pathological features of Meckel's diverticulum(MD) in children.Methods 244 MD cases admitted between January 2010 and December 2014 were retropectively analyzed.Results In fifty patients,MD was an incidental finding at laparotomy or laparoscopy for unrelated entities.Among the remaining 194 symptomatic patients,there were 76 patients presenting GI bleeding,forty eight patients were identified with perforated Meckel's diverticulum,thirty six patients suffered from intestinal obstruction.34 patients had MD caused severe complications such as volvulus and intestinal necrosis,diverticular perforation and peritonitis.61 out of 76 GI bleeding patients underwent a 99mTc scan,and positive tracer was found in 42 patients.Among the 19 negative 99mTc scan patients,8 received capsule endoscopy and only 3 patients were suspected of diverticulum.242 patients underwent one stage resection of the diverticulum.Histology revealed ectopic gastric mucosa or ectopic pancreatic tissue in 128 patients.One patient died of volvulus and intestinal necrosis postoperatively,and two suffered from adhesive intestinal obstruction during one to five year's follow up.Conclusions It is necessary to maintain a high suspicion of MD in the pediatric age group with symptoms of abdominal pain,gastrointestinal hemorrhage or intestinal obstruction.Ectopic mucosa assumes the ultimate responsibility for major complications of MD.

Innovative Analysis on KY3H Health Care Service Model / 世界科学技术-中医药现代化

Vigorously development of the health service industry has received great attention,but the health service industry faces many difficulties.By analyzing the current predicament,this paper put forward the KY3H health care service model and systematically analyzed its six innovations:from "disease as the center" to "health as the center",from "homogenized group health service" to "Personalized and Humanized Health Service",from "Extensive Health Service"to "Precise Intervention of Individual Health Status",from "Single Health Service" to "Trinity Service of Health,Culture,Health Management and Health Insurance",from the "seeking medical" service model to "seeking one's own"service model,as well as from the "fixed (fixed-time,fixed-point,fixed-mode) service" to "anytime,anywhere full-time service".This model has achieved initial success in practice.It is an important way to solve the dilemma.

The Key Problems and Technology Strategies of KY3H Health Care Service Model / 世界科学技术-中医药现代化

KY3H is a traditional Chinese medicine health care service mode based on the existing problem,focusing on an interconnected and continuous integration of four key technological innovation,which promotes the service model transformation from passive "doctor-searching" to "asking yourself ".There are four features on KY3H mode.First,based on traditional Chinese medicine meridian and viscera theory,it can accurately identify the health status and take risk assessment of individuals through digital quantitative model.Then,the mode realizes the personalized health status recognition and precisious intervention through integrated technology products of dynamic monitoring and identification,assessment and intervention with independent intellectual property rights.The third is to improve the intelligence,realtime and accessibility of KY3H health care services through developing the Chinese-western medicine informationalized software system about health status identification,assessment and intervention.The last one is formulating traditional Chinese medicine health care standards,industry standards and service package design,which drive KY3H health service model spreading effectively and practical applying,achieving remarkable social and economic benefits.

Construction of KY3H Health Care Service Model / 世界科学技术-中医药现代化

This paper systematically summarized the core problems in the field of medical and health services and did the root analysis.It is concluded that the current domestic and international related medical service modes deviated from the essence of health services and led to difficulties in the idea and method,bringing people to new problems and new crises.KY3H health care service model,set innovative ideas,innovative technical methods,innovative products,innovative processes,standards and standards into one,by providing a full range and the whole cycle of people-oriented,self-help,"diagnosis and treatment of security" integration of health careservice,improve people's health status,fundamentally change the traditional passive "seeking medical treatment" service mode,to active "seeking one's own" health service mode,so as to achieve "health status continues to rise,the medical costs continue to decline,"which is the social development aims.The paper systematically analyzes the idea,operational logic,goal,mode structure,characteristics of the model,and its significance to individuals,industries,society,countries and even the international community in order to make a positive contribution to the healthy development strategy in China and provide a Chinese case for global Health.

Laparoscopy combined with transperineal extralevator abdominoperineal excision for locally advanced low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.</p><p><b>METHODS</b>Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.</p><p><b>RESULTS</b>All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.</p><p><b>CONCLUSION</b>Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.</p>

An improvement for synthesis of ceftriaxone sodium / 中国药科大学学报

@#To develop new synthetic process of ceftriaxone sodium, 7-amino-3-［(2, 5-dihydro-6-hydroxy-2-methyl-5-oxo-1, 2, 4-triazin-3-yl)thiomethyl］-3-cephem-4-carboxylic acid(7-ACT)was synthesized from 7-aminocephalosporanicacid(7-ACA)by reaction with 2, 5-dihydro-6-hydroxy-2-methyl-3-mercapto-5-oxo-1, 2, 4-triazine(TTZ)under the catalysis of BF3/C2H3N. Ceftriaxone was prepared from 7-ACT by condensation with 2-(2-amino-4-thiazolyl)-2-methoxyiminoacetic thiobenzothiazole ester(AE)using triethylamine as catalyst. After removing the by-product 2-mercaptobenzothiazole(M)through filtration, the filtrate was treated with sodium acetate to give ceftriaxone sodium. This improved process eliminates the working procedure for separating compound M from the mother liquor, and has the advantages of less solvent consumption and convenient operation, and has been successfully used in commercial production.

Analysis of adverse events following immunization in Tianjin (2011-2013) evaluated by active surveillance and passive surveillance / 天津医药

Objective To analyze the occurrence features of the active surveillance of adverse events following immu?nization (AEFI) in Tianjin, and evaluate the sensitivity of passive surveillance systems over the same period. Methods The layered eight vaccination clinics of four counties were selected as active surveillance points. The data of active surveillance AEFI were collected through telephone investigation in 2011-2013. The data of passive surveillance was collected through the national AEFI information management system. The descriptive methodology and chi square test were used. Results A total of 235 cases were collected through active surveillance in 2011-2013. The AEFI incidence rate was 718.70 per 100 000 doses,no difference in the incidence between three years(χ2=5.07). A total of 4164 cases were collected through passive sur?veillance. The incidence rate was 34.09 per 100 000 doses,the incidence increased year by year(χ2=572.02,P<0.05). In ac?tive surveillance cases, 95.32%was the common vaccine reaction, 3.83%was the rare vaccine reaction, no serious vaccinereaction. In passive surveillance cases, the common vaccine reaction, the rare vaccine reaction were 85.09%and 13.32%. The serious vaccine reaction was found in 44 cases. Conclusion The more slightly common vaccine reaction can be found by active surveillance. The sensitivity of Tianjin passive surveillance system is increasing year by year, which can meet the requirements for job. The classification and diagnostic criteria of the serious vaccine reaction need to be established.

Effect of salbutamol aerosol combined with magnesium sulfate on IL-2, IL-4, IL-5, IFN-γand T lymphocyte subsets in pediatric asthma patients / 中国生化药物杂志

Objective To investigate the effect of salbutamol aerosol combined with magnesium sulfate on IL-2, IL-4, IL-5, IFN-γand T lymphocyte subsets in pediatric asthma patients.Methods 38 pediatric asthma patients were selected and randomly divided into control group and experimental group.Control group was treated by clinical routine method.Experimental group was treated by salbutamol aerosol combined with magnesium sulfate.The IL-2, IL-4, IL-5, IFN-γ, T lymphocyte subsets, blood pressure, heart rate, respiratory and clinical effects were observed and compared.ResuIts Compared with control group, the serum levels of IL-2 and IFN-γwere higher(P<0.05).The IL-5, IL-4 level were lower(P<0.05).The CD3 +, CD4 +, CD4 +/CD8 +level were higher(P<0.05).The serum CD8 +were lower(P<0.05).The total efficiency were higher(P<0.05).ConcIusion Salbutamol aerosol combined with magnesium sulfate can effectively regulate T lymphocyte subsets proportion and cytokine levels in asthmatic children, enhance immunity, and improve the clinical symptoms.

A prospective multicenter clinical trial of extralevator abdominoperineal excision for locally advanced low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.</p><p><b>METHODS</b>A prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.</p><p><b>RESULTS</b>All patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).</p><p><b>CONCLUSIONS</b>ELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.</p>

Risk factors associated with incisional surgical site infection in colorectal cancer surgery with primary anastomosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the incidence of surgical site infection (SSI) and risk factors in colorectal cancer surgery patients.</p><p><b>METHODS</b>Between October 2003 and October 2013, 1 381 consecutive patients with colorectal cancer managed surgically with primary anastomosis were included in the study. There were 762 male and 619 female patients with mean body mass index (BMI) was (27.7 ± 3.7) kg/m², aged from 20 to 90 years with a median of 67 years. Patients undergoing emergency surgery and requiring stoma creation were excluded. The patients' characteristics, surgical conditions and prognosis were recorded. Univariate and multiple logistic regression analysis were used to identify any variable predictive factors of SSI.</p><p><b>RESULTS</b>One hundred twenty-six (9.12%) cases developed incisional SSI. The occurrence time for SSI was from 2 to 20 days, mean (6.7 ± 2.9) days. According to multivariable logistic regression analysis, BMI (OR = 1.058, P = 0.030), intraoperative contamination (OR = 10.549, P = 0.000) and open operation as compared with a laparoscopic procedure (OR = 2.111, P = 0.001) were significant independent predictors of incisional SSI. There was a significant decrease in incisional SSI in wound protectors group (OR = 1.646, P = 0.012).</p><p><b>CONCLUSION</b>BMI and intraoperative contamination are independent predictors of incisional SSI, and wound protectors and laparoscopic surgery are associated with a lower incidence of incisional SSI following colorectal cancer surgery.</p>

Evaluation on the hepatitis A vaccine in preventing hepatitis A infection in Tianjin, from 2000 to 2011 / 中华流行病学杂志

<p><b>OBJECTIVE</b>Hepatitis A immunization strategies were carried out in 2001 in Tianjin. We wanted to evaluate the effectiveness of the strategies related to hepatitis A control programs and to provide the basis for further modification of the strategies.</p><p><b>METHODS</b>Descriptive epidemiology study was used to analyze the hepatitis A epidemic situation in 2000-2011 in Tianjin and to evaluate the disease reporting system. Hepatitis A vaccine coverage of target population and serum epidemiological study were carried out in 1999, 2005 and 2010 to check on the hepatitis A antibody levels so as to evaluate the immuno-barrier condition in the normal population. Cox-Stuart test was used to analyze the epidemic trend of hepatitis A and other intestinal infectious diseases in Tianjin.</p><p><b>RESULTS</b>The incidence rate of hepatitis A decreased from 2.89/100 000 in 2000 to 0.12/100 000 in 2011, and the percentage of hepatitis A in all types of viral hepatitis decreased from 8.02% in 2000 to 0.48% in 2011 in Tianjin. The positive rates of hepatitis A antibody also increased in the residents.</p><p><b>CONCLUSION</b>The hepatitis A vaccination program was successful in the programs on prevention and control of hepatitis A in Tianjin, China.</p>