OBJECTIVE:To observe short-term efficacy and ADR of nedaplatin concurrent chemoradiotherapy combined with thermotherapy in the treatment of middle and advanced esophageal cancer. METHODS:64 patients with middle and advanced esophageal cancer were randomly divided into control group and treatment group,with 32 cases in each group. Control group was given nedaplatin concurrent chemoradiotherapy,nedaplatin 30 mg/m2,ivgtt,every week during chemotherapy;treatment group re-ceived thermotherapy by high frequency heating machine before chemoradiotherapy,60 min/time,twice a week;received chemora-diotherapy 30 min after thermotherapy. Short-term efficacy and ADR were observed in 2 groups. RESULTS:The short-term total effective rate of treatment group(84.4%)was higher than that of control group(62.5%),with statistical significance(P<0.05). The incidence of bone marrow suppression,radioactive esophagitis and gastrointestinal reactions in treatment group vs. control group were(21.9%)vs.(46.9%),(18.8%)vs.(56.3%),(31.3%)vs.(59.4%),with statistical significance(P<0.05). CONCLU-SIONS:Nedaplatin concurrent chemoradiotherapy combined with thermotherapy is better than concurrent chemoradiotherapy in the treatment of middle and advanced esophageal cancer with low incidence of ADR.

Gas gangrene is an emergency condition, which usually develops after injuries or surgery. This study was designed to investigate clinical characteristics, appropriate therapy, and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims. Data on diagnosis, treatment, and prevention of confirmed, suspected, or highly suspected gas gangrene were collected. Sixty-seven (2.41%) cases of suspected gas gangrene were found, in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens. Thereof, injury sites were mainly located on the limbs, and typical indications, including crepitation, severe localized pain, swelling, wound discoloration, dark red or black necrotic muscle, foul smell as well as different degrees of systemic toxic performance were common among them. After hospitalization, all patients were isolated and had surgery quickly to remove dead, damaged or infected tissue. The wounds were also exposed for drainage and washed or padded with 3% liquid hydrogen peroxide for disinfection before all diagnostic test results were available. Additionally, high doses of antibiotics (mainly penicillin) were given for the prevention of infection, and supportive therapy was applied for corresponding symptoms control. Among those cases, no fatality was reported. In summary, in post-disaster emergency relief, the diagnosis of gas gangrene should be primarily based on clinical manifestations; while patient isolation, wound debridement and disinfection, as well as antibiotics treatment, is the main measures for proper treatment and control of nosocomial infection for gas gangrene.

Objective To explore the reasons for lateral and basal incomplete resection of precancerous lesions or cancer from upper digestive tract by endoscopic submucosal dissection (ESD).Methods Data of 295 patients undergoing ESD for upper gastrointestinal precancerous lesions or cancer from November 2006 to October 2011 were collected,and reasons of basal or lateral incomplete resectin confirmed by postESD pathology were analyzed.Results The total incomplete resection rate after ESD was 3.05％ ( 9/295 ).Among 95 cases of esophageal ESD,there was 1 case of lateral margin incomplete resection because of the retraction of normal tissue after dissection.Among 200 cases of gastric ESD,there were 5 cases of lateral margin incomplete resection,in which 2 cases were signet ring carcinoma with submucosal infiltration and spreading,2 were due to retraction of normal tissue after dissection,and 1 was due to inaccurate judgment on cancer demarcation.There were 3 cases of basal incomplete resectin in gastric ESD,which was caused by incorrecte invasion depth estimation before ESD.Conclusion The rate of basal or lateral incomplete resection in upper gastrointestinal ESD was low,which is related to pathological type,ESD procedure and estimation of invasion depth before ESD.

Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt ( SGRS ) and spontaneous splenorenal shunt ( SSRS ) . Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients' clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 ( 84. 8%) cases and splenorenal shunt was found in 5 ( 15. 2%) cases. After the balloon blocking technique, 24 cases ( 72. 7%) were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.

Objective: o investigate the features of pathogenic bacteria for community-acquired bloodstream infection due to Gram-negative bacilli in patients with liver cirrhosis and optimal therapeutic strategy. Methods: A retrospective analysis was performed for the clinical data of patients with liver cirrhosis who were admitted to 302 Hospital of PLA due to community-acquired bloodstream infection from January 2010 to December 2015, and a statistical analysis was performed for their clinical features, pathogenic bacteria, and results of drug sensitivity test. The Pearson chi-square test was used for comparison of rates, and the Wilcoxon rank sum test was used for comparison of ranked data. Results: A total of 240 patients (including 178 male patients) with liver cirrhosis caused by various reasons were enrolled, with a mean age of 51.7 ± 11.1 years, an overall clinical remission rate of 80.42%, and an ineffective/mortality rate of 19.58%. The patients who used sensitive antibiotics within 12 hours after the onset of community-acquired bloodstream infection achieved a significantly higher improvement rate than those who used such drugs at more than 12 hours after onset (88.2% vs 58.1%, P < 0.001). The improvement rate achieved by the application of sensitive antibiotics at more than 12 hours after onset decreased with the increase in the Child-Pugh grade (P < 0.05). A total of 245 strains of Gram-negative bacilli were isolated, among which the six most common ones were 135 strains of Escherichia coli (55.1%), 62 strains of Klebsiella pneumoniae (25.3%), 16 strains of Aeromonas (6.5%), 4 strains of non-typhoidal Salmonella (1.6%), 3 strains of Enterobacter cloacae (1.2%), and 2 strains of Acinetobacter baumannii (0.8%). These Gram-negative bacilli had the highest sensitivity to meropenem (98.5%), followed by imipenem (97.9%), amikacin (97.5%), piperacillin/tazobactam (94.7%), cefmetazole (93.7%), and cefoperazone/sulbactam (93%). Different bacteria had different sensitivities to antibiotics. Conclusion Once community-acquired bloodstream infection occurs in patients with liver cirrhosis, highly sensitive antibiotics should be used as early as possible. Cefoperazone/sulbactam, piperacillin/tazobactam, imipenem, and meropenem can be used as first-line empirical antibiotics, and drug combination should be considered when necessary.

Objective To evaluate the relationship between the effect of peroxisome proliferator-activated receptor-γ (PPARγ) in pulmonary vascular remodeling and NADPH oxidase 4 (NOX-4) in rats with pulmonary hypertension.Methods Thirty-two healthy adult male Sprague-Dawley rats,aged 2 months,weighing 200-250 g,were divided into 4 groups (n =8 each) using a random number table method:control group (group C),pulmonary arterial hypertension group (group PH),PPARγ agonist rosiglitazone treatment group (group R),and PPARγ antagonist GW9662 treatment group (group G).In group PH,monocrotaline 60 mg/kg was injected subcutaneously in the neck and back to induce pulmonary hypertension.The suspension of rosiglitazone and normal saline 5 mg · kg-1 · d-1 and GW9662 solution 2 mg · kg-1 · d-1 were administered by intragastric gavage after injecting monocrotaline,in group R and group G,respectively,for 4 consecutive weeks.The mean pulmonary arterial pressure (mPAP) was measured at 4 weeks after establishing the model.The animals were then sacrificed,and the lungs were removed for microscopic examination of the pathological changes (with a light microscope) and for determination of the expression of PPARγ and NOX-4 protein and mRNA in lung tissues (by real-time polymerase chain reaction or Western blot).The percentage of media thickness of pulmonary arterioles was calculated.Results Compared with group C,the mPAP and percentage of media thickness of pulmonary arterioles were significantly increased,the expression of PPARγ protein and mRNA was down-regulated,and the expression of NOX-4 protein and mRNA was up-regulated in PH,R and G groups (P＜0.05).Compared with group PH,the mPAP and percentage of media thickness of pulmonary arterioles were significantly decreased,the expression of PPARγ protein and mRNA was up-regulated,and the expression of NOX-4 protein and mRNA was down-regulated in group R,and the mPAP and percentage of media thickness of pulmonary arterioles were significantly increased,the expression of PPARγ protein and mRNA was down-regulated,and the expression of NOX-4 protein and mRNA was up-regulated in group G (P＜0.05).Conclusion The mechanism of endogenous protective effect of PPARγ in the development of pulmonary hypertension and pulmonary vascular remodeling may be related to down-regulating the expression of NOX-4 in rats.

Objective To investigate the predisposing locations of active hemorrhage in patients with esophageal variceal bleeding. Methods Data of 823 patients with acute esophageal and gastric variceal hemorrhage receiving emergency gastroscopy diagnosed from January 2003 to December 2013 were retrospectively studied. The location and site of active hemorrhage or stigmata were analyzed and its relationship with active hemorrhage was discussed. Results A total of 372(45. 2%,372/823) patients with active bleeding and stigmata were found under emergency endoscopy. Among 372 patients, 190 got accurate hemorrhage and stigmata location and site description. Bleeding or stigmata in 58(30. 5%) patients was 28-32 cm from incisor in group A, and that in 132 (69. 5%) patients was more than 35 cm in group B ( χ2＝57. 642, P＜0. 000 1). In 190 cases, the proportion of bleeding or stigmata at 3:00 point was the highest (37%,70/132), followed by those at 12:00 point(30%,58/132),6:00 point(24%,45/132),and 9:00 point (9%,17/132). The change trend of the percentage of each point in group A and group B was the same as that in all cases. The percentage of almost all points in group B was significantly higher than that in group A except that at 9:00 point ( P＜0. 000 1).Conclusion Esophageal variceal bleeding in cirrhosis is more common at 3:00 point, 6:00 point and 12:00 point of esophagus, and the high risk area is 35 cm below the incisors.

Objective:To investigate the clinical outcomes of patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection.Methods:Patients who undergoing radical surgical resection for ICC from Jan 2015 to Apr 2021 at the Department of General Surgery, the First Affiliated Hospital of Anhui Medical University were included in this retrospective cohort study.Results:There were 67 patients in the final analysis, The median follow-up duration was 14 months (range: 1-60 months). Firty three patients (79.1%) had tumor recurrence, 52 patients (77.6%) died, Among them, 49 patients (73.1%) died from tumor recurrence. The 1-、2-、and 3-year accumulated disease-free and overall survival rate were 35.6%, 19.6%, 16.8% and 53.7%, 32.4%, 20.8%. respectively. The overall survival rate of the group without microvascular invasion was significantly better than those of the group with microvascular invasion ( χ2=5.916, P=0.015). CA19-9≥1 000 U/ml was the only independent risk factor for the disease-free survival. CA19-9≥1 000 U/ml、blood loss≥600 ml、microvascular invasion and tumor recurrence were the independent risk factors for the overall survival. Conclusion:For ICC patients with single tumor, when the tumor diameter is less than 5 cm and has no microvascular invasion, surgical resection is recommended, and a satisfactory prognosis could be achieved.

Objective:To investigate the iodine nutritional status of children in Qingdao City and the effects of prevention and treatment measures on iodine deficiency disorders (IDD), and to provide a scientific basis for guiding residents to scientifically supplement iodine, taking timely targeted prevention and control measures, and scientifically adjusting intervention strategies.Methods:According to "National Iodine Deficiency Disorders Surveillance Program (2016 edition)" and "Iodine Deficiency Disorders Surveillance Program of Shandong Province", from 2018 to 2020, using the cluster sampling method, children aged 8-10 years in Qingdao City were chosen to test their household salt iodine content and random urinary iodine content, and to examine their thyroid volume by B-ultrasonography, and the correlation between thyroid volume and physical development indexes was analyzed.Results:From 2018 to 2020, a total of 6 057 children were monitored, including 3 068 boys and 2 989 girls. The median of salt iodine and iodized salt iodine of children was 23.50 and 24.10 mg/kg. The qualified rate of iodized salt was 89.95% (4 832/5 372), the coverage rate of iodized salt was 88.69% (5 372/6 057), and the consumption rate of qualified iodized salt was 79.78% (4 832/6 057). There were significant differences in the qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt between different years (χ 2 = 135.26, 314.71, 342.87, P < 0.001). A total of 6 057 urine samples were collected from children, and the median of urinary iodine was 193.92 μg/L, of which 16.2% (979/6 057) were < 100 μg/L, and 22.5% (1 361/6 057) were ≥300 μg/L. There were statistically significant differences in the medians of urinary iodine between different years, gender and whether eating iodized salt ( H/Z = 37.25,-3.89,-5.69, P < 0.001), the median of urinary iodine in boys was higher than that of girls, and the median of urinary iodine in eating iodized salt group was higher than that of eating non-iodized salt group. There was no significant difference in the median of urinary iodine between different age ( H = 4.33, P = 0.119). The rate of goiter in children was 3.45% (71/2 057), and the difference between different years was statistically significant (χ 2 = 42.68, P < 0.001). The incidence of goiter in 2020 [7.31% (45/616)] was significantly higher than that in 2018 and 2019 [2.81% (18/641), 1.00% (8/800), P < 0.001]. Thyroid volume of children was positively correlated with height and weight ( r = 0.20, 0.22, P < 0.001). Conclusions:The iodine nutritional level of children aged 8-10 years in Qingdao City is appropriate. However, the incidence of goiter in children in some years is relatively high. The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt are all lower than the national standard for elimination of IDD, which should be paid attention to.

Objective:To investigate the iodine nutritional status of pregnant women in Qingdao and the effect of prevention and treatment of iodine deficiency disorders (IDD), so as to provide a basis for residents to supplement iodine scientifically, and take targeted prevention measures and adjust intervention strategies.Methods:In accordance with the requirements of the "National Iodine Deficiency Disorders Surveillance Program (2016 edition)" and "Shandong Iodine Deficiency Disorders Surveillance Program", the cluster sampling method was adopted to select pregnant women from 10 districts (cities) in Qingdao from 2018 to 2020, to investigate their basic information and thyroid disease history. Meanwhile, household edible salt samples and random urine samples were collected to detect iodine content.Results:A total of 3 000 pregnant women were monitored from 2018 to 2020, the median age was 31 years, and the median gestational age was 18 weeks. There were significant differences in the distribution of age, gestational age, whether senile puerpera, and pregnancy in different years ( H/χ 2 = 29.35, 81.03, 65.62, 77.34, P < 0.001). The median salt iodine of edible salt ( n = 3 000) and iodized salt ( n = 2 700) in pregnant women's homes were 23.02 and 23.70 mg/kg, respectively. The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt were 89.59% (2 419/2 700), 90.00% (2 700/3 000) and 80.63% (2 419/3 000). The comparison of qualified rate of iodized salt, coverage rate of iodized salt and consumption rate of qualified iodized salt among different years was statistically significant (χ 2 = 48.09, 36.62, 61.08, P < 0.001), the coverage rate of iodized salt and the consumption rate of qualified iodized salt showed a downward trend year by year (χ 2trent = 35.54, 29.50, P < 0.001). A total of 3 000 urine samples were collected from pregnant women and the median urinary iodine of pregnant women was 147.85 μg/L. The urinary iodine level in the third trimester was lower than that in the first and second trimesters ( P < 0.001). The urinary iodine level in the non elderly group was higher than that in the elderly group ( Z = - 6.66, P < 0.001). The urinary iodine level in the group without thyroid disease was higher than that in the group with thyroid disease ( Z = - 1.99, P = 0.047). The urinary iodine level in iodized salt group was higher than that in non-iodized salt group ( Z = - 2.42, P = 0.015). Conclusions:The iodine nutrition of pregnant women in Qingdao is generally at an insufficient level, and the risk of iodine deficiency is high, which needs attention. In recent years, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in Qingdao have shown a downward trend, and have failed to meet the requirements of national standards. In the future, we should strengthen the monitoring and health education of IDD in pregnant women.