Introduction of pertussis surveillance system and evaluation of its operational effect in Tianjin / 中国当代儿科杂志

The pertussis surveillance system has been established since 2009 in Tianjin, and continuously improved over the past 10 years. This system determines the definition and classification of pertussis, establishes simple and feasible sampling methods and laboratory detection methods in clinical practice, standardizes the report management of pertussis cases and the treatment of epidemic situations. After the implementation of the surveillance system, the number of reported pertussis cases increased from 26 in 2009 to 802 in 2017, the number of diagnosed cases increased from 19 in 2009 to 662 in 2017, the reported incidence rate of pertussis increased from 0.16/100 000 in 2009 to 4.28/100 000 in 2017, and the number of medical institutions of reporting perutssis cases increased from 2 in 2009 to 53 in 2017. The specimen collection rate of the reported cases reached up to 93.66%. These results show that the sensitivity of pertussis surveillance has been improved and show that the data from the surveillance system may reflect more precisely the epidemical characteristics of perutssis in Tianjin.

Preliminary Outcome of Individualized Abdominoperineal Excision for Locally Advanced Low Rectal Cancer / 中华医学杂志(英文版)

<p><b>Background</b>The introduction of individualized abdominoperineal excision (APE) may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer.</p><p><b>Methods</b>Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin (CRM) involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0.</p><p><b>Results</b>Fifty (89%) patients received preoperative chemoradiotherapy: 51 (91%) patients were treated with the sacrococcyx preserved; 27 (48%) patients with the levator ani muscle partially preserved bilaterally; 20 (36%) patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 (13%) patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 (4%) patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction (12%), perineal wound complications (13%), urinary retention (7%), and chronic perineal pain (5%). A positive CRM was demonstrated in 3 (5%) patients, and intraoperative perforations occurred in 2 (4%) patients. On multiple logistic regression analysis, longer operative time (P = 0.032) and more intraoperative blood loss (P = 0.006) were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months (range: 30-74 months).</p><p><b>Conclusion</b>With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.</p>

Endoscopic analysis of early esophageal cancer and precancerous lesions in Kazakh patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the value of endoscopic narrow-band imaging in the diagnosis of early-stage esophageal cancer and precancerous lesions in Kazakh patients.</p><p><b>METHODS</b>A total of 106 Kazakh patients with esophageal mucosa lesions diagnosed by routine endoscopy in our hospital from January 2014 to July 2016 were enrolled in this analysis with 30 randomly selected patients with normal endoscopic findings of the esophageal mucosa as the control group. The morphological changes of papillary capillary loop (IPCL) of the esophageal epithelium in the two groups were observed by narrow-band imaging magnifying endoscopy. Pathological examinations were performed for all the patients with esophageal mucosa lesions.</p><p><b>RESULTS</b>In patients with esophageal mucosa lesions, 10 were diagnosed to have early esophageal cancer, 16 had low-grade tumors, 11 had high-grade tumors and 69 had esophagitis. IPCL typing results showed IPCL type I in all the control subjects, predominantly type IV in patients with early esophageal carcinoma, type II and III in patients with low-grade tumor, type III in patients with high-grade tumor, and type II in patients with esophagitis.</p><p><b>CONCLUSION</b>The location and size of the esophageal lesions can be observed clearly by narrow-band imaging magnifying endoscopy. The histopathology of the esophageal mucosa can be analyzed with IPCL classification for diagnosis of early esophageal cancer and precancerous lesions in Kazakhs.</p>

Epidemiological Characteristics and Risk Factors of the Pertussis in Infants < 12 Months of Age in Tianjin, China / 生物医学与环境科学（英文）

The epidemiologic characteristics of 631 infant pertussis cases < 12 months, which accounted for 57.42% of the total cases, were analyzed by descriptive epidemiology in Tianjin, between 2010 and 2015. The incidence of infants was 104.66/100,000, which was 118 times higher than in other age groups (P < 0.001). The primary type of pertussis simultaneously presented in households was adult-to-infant (70.51%). The parents were identified as the source of infection in 80.18% of cases for infants. The positive rate of placental antibody transfer was 31.06% and 3.13% for 3-month-old infants. Infants presented the highest age-specific pertussis incidence. The most important reason was parents were the important sources of infection, and secondly the lower level of antibodies in neonates and the rapid waning of maternal antibody titer.

Technical improvements and results of individual cylindrical abdominoperineal resection for locally advanced low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of individual cylindrical abdominoperineal resection (CAPR) for locally advanced low rectal cancer.</p><p><b>METHODS</b>From June 2011 to February 2012, 11 patients with locally advanced low rectal cancer underwent individual CAPR. There were 7 male and 4 female patients, aged from 32 to 74 years with a median of 64 years. Forty-seven patients underwent classic CAPR from January 2008 to February 2012. Preoperative and postoperative parameters such as clinical information of patients, tissue morphometry and complications were compared.</p><p><b>RESULTS</b>In the individual surgical group, 6 patients were treated with one side levator ani muscle totally or partially reserved, 3 patients with sacrococcyx reserved, and 2 patients with dissection close to the anterior rectal wall. Compared with classical surgery, the individual surgical specimens of horizontal section area ((2197 ± 501) mm(2)) and intrinsic muscle layer outer area ((1722 ± 414) mm(2)) were small, but the difference was not statistically significant (P = 0.150 and 0.167). The operative time, intraoperative blood loss, circumferential resection margin, total cross sectional tissue area, cross sectional tissue area outside the muscularis propria and bowel perforation rate between the two groups were not significantly different. Individual CAPR showed less incidence of chronic perineal pain (2/11, χ(2) = 6.116, P = 0.013) and sexual dysfunction (2/9, χ(2) = 4.412, P = 0.036) compared with classic CAPR.</p><p><b>CONCLUSIONS</b>Individual CAPR has the potential to reduce the risk of chronic perineal pain and sexual dysfunction without influencing the radical effect when compare with classic CAPR for the treatment of low rectal cancer.</p>

Safety and immunogenicity on three lots of influenza split vaccines among adults / 中华流行病学杂志

Objective To evaluate the irnmunogenicity, safety and stability of the manufacture process regarding three consecutive lots of influenza split vaccines (Anflu ). Methods A double-blind, randomized and controlled clinical trial was conducted in healthy volunteers. A total of 566 subjects aged 18 to 60 years were recruited and stratified into four age groups before randomly assigned into four groups. Each group would receive one dose of influenza vaccine from either one of the three lots ofAnflu or one lot of the licensed control vaccine. Each dose of the vaccines contained 15 μg of each of the H1N1, H3N2 and B type antigen. Safety was assessed through 30-minute observation for immediate allergic reaction and three-day observation after vaccination. HI antibody titers were determined before vaccination and on day 21, after vaccination. Results Mild adverse reaction was reported and the overall incidence rates on fever of the four groups were from 1.4% to 2.8% but no significant difference was observed between groups. Seroconversion rates of the three viral strains in four groups were 80.3% and above with fold increase as≥11.1 and protection rate was≥93.4%. For the three lots of investigated vaccines, all of the indexes of the three viral strains in four groups exceeded the standards on EMEA and FDA for influenza vaccine. Conclusion The three consecutive lots of Anflu appeared to be good, with both consistent immunogenieity and safety, indicating the stability of manufacture process.

Evaluation on the role of hepatitis A vaccine in the prevention and control of hepatitis A in Tianjin city / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the effects of prevention and control strategies on hepatitis A.</p><p><b>METHODS</b>Surveillance data on hepatitis A from 1990 to 2006 in Tianjin was analyzed, and the coverage rate of hepatitis A vaccine among targeted population was estimated, to compare the anti-HAV IgG level of children younger than 15 years old in 1999 and in 2005.</p><p><b>RESULTS</b>Results showed that a) the morbidity of hepatitis A decreased from 25.26/10(5) in 1990 to 0.82/10(5) in 2006; b) the ratio of hepatitis A in viral hepatitis decreased from 30.43% in 1990 to 1.05% in 2006; c) the estimated coverage rate was 72.7%; d) the positive rate of anti-HAV among children younger than 15 years old in 2005 was distinctly higher than that in 1999.</p><p><b>CONCLUSION</b>Positive results showed that it was successful to use hepatitis A vaccine as the strategy to prevent and control hepatitis A in the past five years in Tianjin.</p>

Early results of per anus intersphincteric rectal dissection and direct coloanal anastomosis: sphincter-preserving surgery for patients with very low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the safety and curative effect of per anus intersphincteric rectal dissection and direct coloanal anastomosis (PIDCA) for patients with very low rectal cancer.</p><p><b>METHODS</b>Nineteen patients were prospectively studied from June 2002 to October 2004. There were 11 males and 8 females, with a median age of 56 (range, 41 - 74) years. Nineteen patients had T(1) to T(4) tumors (T(1), n = 4; T(2), n = 10; T(3), n = 4; T(4), n = 1) located between 3.5 and 5.0 cm above the anal verge.The rectum, including the entire width of the internal analsphincter, was transected circumferentially via the anal route to secure the surgical margin of safety under direct vision and was mobilized proximally as far as possible through the intersphincteric plane. Per anus coloanal anastomosis was performed following transabdominal resection of the rectum.</p><p><b>RESULTS</b>There was no operative mortality. Of nineteen patients, two (10.5%) had anastomotic leakage. Median follow-up duration was 16 (range, 3 - 29) months. Up to now, one patient developed recurrence (5.3%). Acceptable anal function results were obtained in most patients.</p><p><b>CONCLUSIONS</b>Curability and anal function was obtained by PIDCA combined with preoperative or postoperative radiotherapy and postoperative chemotherapy. PIDCA is ideal and safe for selected patients with tumor located below 5 cm from the anal verge.</p>

Postoperative mortality after gastrectomy for gastric cancer: analysis of 1142 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze postoperative morbidity and mortality after gastrectomy for gastric carcinoma and identify main risk factors influencing mortality.</p><p><b>METHODS</b>A total of 1142 patients with gastric cancer received gastrectomy between January 1989 and April 2004. The patients were divided into three groups according to different period, the first group (n=405): from January 1989 to January 1994; the second group (n=377): from February 1994 to January 1999; the third group (n=360): from February 1999 to March 2004. Postoperative morbidity and mortality were compared among three groups, the risk factors influencing postoperative mortality were determined by multiple logistic regression analysis.</p><p><b>RESULTS</b>The total postoperative morbidity and mortality for all patients were 11.2% (128/1142) and 3.6% (41/1142), respectively. The postoperative morbidity was 13.1%, 10.1%, and 10.3% in the first, second, and third group respectively, there was no significant difference in morbidity among the three groups (P > 0.05). The postoperative mortality was 4.7%, 3.4%, and 2.5% respectively (P > 0.05), there was no significant difference in mortality among the three groups (P > 0.05). The most common postoperative complication was anastomotic leakage (24.2%, 31/128). The following clinicopathologic factors were found to be correlated with postoperative mortality: stage IV; palliative excision; multivisceral resection; and preoperative complications (P< 0.05). Multivariate analysis revealed that the extent of lymph node dissection or surgical procedure were not main risk factors influencing mortality.</p><p><b>CONCLUSION</b>Patients with advanced gastric cancer have a high risk of postoperative mortality. Unnecessary lymph node dissection or multivisceral resection should be avoided for patients with stage IV gastric cancer.</p>

Modulation effects of recombinant human growth hormone on postburn hypermetabolism in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the effects of recombinant human growth hormone (rhGH) on postuburn hypermetabolism in burn patients and its mechanism.</p><p><b>METHODS</b>Thirty-two patients inflicted with burn of 50% to 90% TBSA admitted to our department during past 5 years (1998-2002) were enrolled in the study and randomly divided into A (with 0.25 U.kg(-1).d(-1) of rhGH treatment on 7-10 PBD, n=16) and B (with 0.25 U.kg(-1).d(-1) of normal saline as control, n = 16) groups. The changes in the rest energy expenditure (REE), non-protein respiratory quotient (NPRQ), glucose metabolism, nitrogen balance as well as plasma levels of endocrines and inflammatory mediators were determined before and after the administration of rhGH.</p><p><b>RESULTS</b>rhGH was given to patients in group A during 7 - 10 PBD. The NPRQ in group A began to increase at the 7th PBD, raised to 0.80 +/- 0.09 in the 21st PBD. The plasma levels of PGE2, TXB2, TNF-alpha and IL-6 significantly decreased and insulin, rhGH and IGF-1 obviously increased when compared with those in group B. The accumulated nitrogen loss in group A was also much lower than that in group B. The plasma levels of adrenaline, cortisol, glucagon in group A were significantly higher than those in group B (P < 0.05).</p><p><b>CONCLUSION</b>The postburn administration of rhGH timely could regulate postburn hypermetabolism in severely burned patients by increasing the plasma levels of GH, IGF-1 and insulin, which was beneficial to the improvement of nutrition state and to the promotion of protein synthesis and wound healing.</p>

Epidemiological characteristics of severe acute respiratory syndrome in Tianjin and the assessment of effectiveness on measures of control / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the epidemiologic characteristics of severe acute respiratory syndrome (SARS) and to evaluate the effectiveness on its major control measures in Tianjn.</p><p><b>METHODS</b>Adopting two case reports 1 and 2, designed by the Tianjin Centers for Disease Control and Prevention to develop a unified case-tracing table including the map of the distribution of close contacts to SARS patients. With those methods, investigation on patients and their close contacts at hospital wards, families, communities and institutions of the patients were carried out.</p><p><b>RESULTS</b>From April 13 through May 8, 2003, there were 175 SARS cases including imported ones, were identified with an incidence rate of 1.9 cases per 100,000. Among them, 14 died with a fatality of 8.0%. The whole process of epidemic in Tianjin was less than one month with the following features: (1) 93.7% of the total SARS cases in Tianjin were directly or indirectly transmitted by a super-spreader. (2) 68.6% of the total SARS patients were concentrated in 3 hospitals A, B and C which was menifastated in 'clustering'. Through study on the rest of the SARS patients, results showed that 16.8% of them were transmitted through family close contact and 2.3% due to contact to colleagues. However, 12.6% of the patients were not able to show evidence that they had any contact to a diagnosed SARS patient. At the early stage of the epidemic, a number of medical practitioners were infected, taking up 38.2% of the total SARS cases. Among the total number of 1 975 medical workers who participated in the SARS medical cares and treatments, 3.4% of them got infected. During the outbreak, all index cases and chains of transmission seemed to be clear, with only 3 patients not able to be traced for the source of infection, taking up 2% of the total SARS patients in Tianjin. Among the 10 index cases, only the super spreader and another one index case transmitted the virus to their contacts but the rest of index cases did not cause any secondary infection.</p><p><b>CONCLUSION</b>Though SARS is clinically severe and can be spreaded quickly, the epidemic can be under control within a short period of time if chains of SARS transmission are broken down and effective measures as isolation and quarantine against patients as well as underscoring awareness among the publics in a scientific way, being carried out.</p>