Through the voluntary participation of subjects， strictly designed clinical trials have generated new generalizable scientific knowledge to benefit more future populations. However， subjects participating in clinical trials often cannot distinguish between trials and clinical treatments， and they expect clinical trials to be able to treat their diseases. This phenomenon is called therapeutic misunderstanding， which needs to be prevented because it cannot meet the requirements of research ethics. With the advent of precision medicine， the scenario of clinical trials has changed significantly， manifested as the integration of trials and clinical treatments， and the prominent clinical benefits of subjects. The new treatment-oriented design scheme blurs the boundary between trial and treatment， giving subjects participating in clinical trials more opportunities for clinical treatment while increasing the risk of therapeutic misunderstanding， changing the connotation of therapeutic misunderstanding， and triggering more ethical thinking. Ethics committees should pay more attention to content related to the review of the design scheme of clinical trials， the opportunities for patients to participate in trials and enrollment of subjects， changes in communication and informed consent between researchers and subjects， the definition of roles for clinicians and researchers， and other aspects， to ensure that clinical trials better protect the rights， safety， and well-being of subjects while generating new knowledge.

OBJECTIVEThe purpose of this current investigation was to describe the distribution characteristics of pesticides poisoning in Hangzhou during 2006-2013.

METHODSThe registration data of pesticide poisoning in Hangzhou during 2006-2013 were collected from health disserve surveillance information system which was part of China information system for disease control and prevention. The statistical analysis method included Pearson Chi-square test and Cochran-Armitage trend test.

RESULTSThere were totally 6232 cases with pesticide poisoning during 2006-2013, of which 414 cases died. The fatality rate of poisoning patients was 6.64%. The pesticides, especially organophosphorus pesticides, were the main poison that caused poisoning, and patients with pesticide poisoning accounted for 80.60% of all the poisoning patient. There was more female patients than male patients among non-productive pesticide poisoning, but on the contrary among productive pesticide poisoning. The incidence of pesticides poisoning had significant increase in the third season.

CONCLUSIONSOccupational pesticide poisoning and non-occupational pesticide poisoning had the different distribution character. Non-occupational pesticide poisoning was the chief reason of pesticide poisoning. The pesticides, especially organophosphorus pesticides, were the main poisons threatening the health of people in Hangzhou, and the effective prevention and control measures should be taken immediately.

Air Pollutants ; China ; epidemiology ; Female ; Humans ; Incidence ; Male ; Organophosphate Poisoning ; epidemiology ; mortality ; Pesticides ; poisoning

Objective: To propose an automatic skeleton thinning algorithmfor accurate extracting the center line of coronary artery from CT images. Methods The region of coronary artery on CT images were segmented, and complete 3D data of coronary artery were obtained after 3D reconstruction. Then the center line of coronary artery was extracted using skeleton thinning algorithm. Dijkstra algorithm was introduced according to the characteristics of coronary artery to improve the accuracy of extraction. Results Compared with the skeleton thinning algorithm which didn't remove mini branches, the rate of overlap was increased by 2%, the average distance was reduced by 38.2%, and the average running time was 0.48 s. Conclusion Using improved skeleton thinning algorithm could effectively extract the center line of coronary arteries.

Objective: Study the clinical significance of HBX gene detection, sequence analysis in peripheral blood mononuclear cell(PBMC) of chronic hepatitis B(CHB) patients with serum HBV DNA negative conversion after treatment by nucleoside analogues(NAs). Methods: Detected and analyzed the HBX gene sequence by real time PCR in PBMC of 60 patients with CHB including some with cirrhosis or hepatocellular carcinoma(HCC), all the serum HBV DNA had turned negative after treatment by NAs, and explore the clinical significance of the HBX gene. Results: HBX genes were detected in 37 cases(61.67%, 37/60). HBX positive rates of PBMC in HCC and cirrhosis patients were higher than that of CHB patients(P=0.000, P=0.010). HBX △120, HBX△129, HBX△131 truncations were detected in two HCC and one CHB cases. Two hotspot mutation including A389T/G391A, T380C had been found, and A389T/G391A double mutation in HCC patients was significantly higher than that in CHB patients(P=0.021). In cirrhosis and HCC patients, T380C mutation rate in HBeAg(-) cases was higher than that in HBeAg(+ ) cases(P=0.035). Conclusions In patients with serum HBV DNA negative conversion after treatment by NAs, PBMC HBX gene positive rates in cirrhosis or HCC cases are higher than that in CHB cases. A389T/G391A double mutation rate in HCC cases is significantly higher than that in CHB cases. In cirrhosis and HCC patients, T380C mutation rate in HBeAg(-) cases is higher than that in HBeAg(+ ) cases.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Blood Sedimentation ; Blood Viscosity ; Female ; Hematocrit ; Hemorheology ; Humans ; Male ; Middle Aged ; Sex Factors

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Blood Viscosity ; China ; Female ; Humans ; Male ; Middle Aged ; Reference Values ; Sex Factors

OBJECTIVETo summarize the experience with duodenal perforations to determine a systematic management approach.

METHODSA total of 11 250 patients who received endoscopic retrograde cholangiopancreatography(ERCP) in The First People's Hospital of Hangzhou from January 2005 to December 2011 and 15(0.13%) patients developed duodenal perforation. The clinical data of these 15 cases were analyzed.

RESULTSThere were 6 males and 9 females. The age ranged from 45 to 87 years. Seven patients developed perforation after sphincterotomy of the duodenal papilla. Five patients perforated due to the endoscope, and 3 due to guide wire and net basket. All the patients presented varying degree of abdominal pain and distention. CT scan of the upper abdomen showed peripancreatic and retroperitoneal air or fluid. Diagnosis was confirmed in 7 patients using abdominal X-ray. Eight patients developed postoperative abdominal pain and distention, subcutaneous emphysema, and fever 3 hours to 5 days after surgery, and diagnosis was confirmed using plain abdominal X-ray or upper abdominal CT scan. Nine patients were managed conservatively, 4 of whom were diagnosed within 3 hours after perforation and were managed by endoscopic metal clip and nasobiliary drainage and no abdominal abscesses developed. The length of hospital stay ranged from 10 to 15 days. Five patients were diagnosed 10 hour to 5 days after perforation, of whom 2 had intestinal fistula, 4 had abscess, and one died, the length of hospital stay ranged from 15 to 105 days. Six patients were managed surgically, 4 received surgery within 4 to 8 hours after perforation and no abscess developed, and the length of hospital stay ranged from 18 to 21 days. The other 2 patients were operated at 24 hours and 30 hours after perforation respectively, one of whom had recurrent intra-abdominal bleeding after surgery and one died from intra-abdominal abscess and multiple organ failure.

CONCLUSIONSFor duodenal perforations related to ERCP, early diagnosis can be made by prompt intraoperative identification and postoperative CT scan. Endoscopic metal clip and nasobiliary drainage should be considered aside from surgical intervention.

Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde ; adverse effects ; Duodenal Diseases ; diagnosis ; etiology ; therapy ; Female ; Humans ; Intestinal Perforation ; diagnosis ; etiology ; therapy ; Male ; Middle Aged ; Retrospective Studies

Objective: To study the incidence, influencing factors and corresponding treatment of complications of endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreaticobiliary diseases. Method: Clinical data of 172 children aged under 16 years with pancreaticobiliary diseases receiving ERCP between January 2008 and December 2017 in Hangzhou First People′s Hospital were studied retrospectively. Anesthesia type, diagnosis, therapeutic methods and postoperative complications were analyzed. Results: A total of 375 ERCP procedures were performed on 172 patients, among whom there were 210 cases (56.0%) of bile duct diseases and 245 (65.3%) pancreatic diseases. Dissection of pancreatic duct and biliary duct, calculus removal, insertion of endoprosthesis and drainage of pancreatic duct or biliary duct were performed. The success rate of ERCP was 99.5% (373/375). The incidence of complications was 6.7% (25/375) including 13 cases (3.5%) of post-ERCP pancreatitis, 8 cases (2.1%) of bleeding, and 6 cases (1.6%) of postoperative cholangitis. All the complications were cured. No severe pancreatitis, perforation or ERCP-related death occured. The first ERCP procedure and repeated cannulations were the risk factors of post-ERCP pancreatitis (P<0.05). Children had higher risk of post-ERCP bleeding after endoscopic sphincterotomy (P<0.05). Conclusion The incidence of post-ERCP complications in children is similar to that of adults and is related to therapeutic methods. More attention and timely treatment should be given to those children. ERCP can be effectively and safely for children operated by an experienced endoscopic physician with appropriate therapeutic methods.

At present, we are fighting against the outbreak of novel coronavirus pneumonia (NCP) in China. For the purposes of diagnosis and treatment of NCP patients, Hangzhou Xixi Hospital, as a designated hospital, make available the wards quickly, initiated the management system of public health emergencies, and established a "tolerate admission- strict discharge" patients management program. Meanwhile, the hospital has established an emergency supply and coordinated distribution mechanism for medical protection materials, and a full-system and multi-model training system, ensuring smooth progress of the diagnosis and treatment work.

The disposable photophobic infusion was used to simulate clinical infusion under different conditions. The simulated liquid was collected every 30 min (total 4 h),and detected the additives (Fe, MDA and antioxidant 1076) in simulated liquid by spectroscopic method and chromatography method. The method is simple and stable, and can be used for the technical monitoring of the disposable photophobic infusion set in the future.
Disposable Equipment ; Photochemical Processes