Objective To study the surgical treatment of left colon cancer complicated with acute abdo-men.Methods From January 2000 to Dcember 2008,the clinic data of 36 patients with left colon cancer complicated by acute abdomen were analyzed retrospectively.All cases have been chosen emergency opera-tion.One-stage colectomy and annstomosis were performed in 28 cases,Hartmann in 5 cases and palliative colostomy in 3 cases.Results Anastomic leakage was found in one case after operation,infection of inci-sion happended in 4 cases,infection of lung happened in 2 cases,the times of defecation rised in one case,one patient died.Conclusion More attention shoud be paid to left colon cancer complicated by acute abdo-men.According to the patients'status,different operative manners were chosen.One-stage operation should be chosen firstly to improve quality of life and avoid staged operation.

Objective To explore the diagnostic value of MSCT in tumors of intra-abdominal cryptorchidism in children.Methods MSCT findings of 8 children with tumors of intra-abdominal cryptorchidism confirmed by surgery and pathology were analyzed retrospectively.Results Six tumors located in the right,2 (1 tumor of left cryptorchidism turned to the right abdominal) in the left.Eight children showed ovoid soft tissue tumor in abdomen.Three children displayed the long axis of the tumors consistent with regular descending course of embryonic testes.Six teratomas manifested as the cystic and solid mass with fat,calcification (ossification) insidey.Two yolk sac tumors manifested as the large cystic and solid mass with irregular necrosis and abundant tumor vessels.Conclusion The pathologic types of tumors for intra-abdominal cryptorchidism in children are different from adult.Most of them are teratomas or yolk sac tumors,and have some characteristics in MSCT.MSCT is helpful in diagnosis of tumor for intra-abdominal cryptorchidism with medical history.

Objective To evaluate the efficacy and safety of 650 nm,810 nm diode laser on the treatment of moderate to severe acne.Methods A total of 87 patients with moderate to severe acne were divided into diode laser group (group A) and medication group (group B).In group A,the patients were irradiated with 650,810 nm diode laser at the fluence of 400-450 mW distance of 2-3 cm.In group B,the patients were treated with roxithromycin combined with vitamin B6 and gel lincomycini.Clinical follow-up was performed every week for 4 months.All the adverse effects were recorded.Results There was no significantly statistical difference in the cure rate between the two groups (group A versus group B at 2 weeks:65.0 ％ versus 42.6 ％,P＞0.05; at 4 weeks:92.5 ％ versus 76.5 ％,P＞0.05).However,the recurrence rate of group A was much lower than that of group B (30.0 ％ versus 61.7 ％,P＜0.01).There were no severe adverse effects in both groups during the period of the follow-up.Conclusions Compared to the medication,650,810 nm diode laser appears to be associated with lower recurrence rate in the treatment of moderate to severe acne.

Timely reporting, effective analyses and rapid distribution of surveillance data can assist in detecting the aberration of disease occurrence and further facilitate a timely response. In China, a new nationwide web-based automated system for outbreak detection and rapid response was developed in 2008. The China Infectious Disease Automated-alert and Response System (CIDARS) was developed by the Chinese Center for Disease Control and Prevention based on the surveillance data from the existing electronic National Notifiable Infectious Diseases Reporting Information System (NIDRIS) started in 2004. NIDRIS greatly improved the timeliness and completeness of data reporting with real time reporting information via the Internet. CIDARS further facilitates the data analysis, aberration detection, signal dissemination, signal response and information communication needed by public health departments across the country. In CIDARS, three aberration detection methods are used to detect the unusual occurrence of 28 notifiable infectious diseases at the county level and to transmit that information either in real-time or on a daily basis. The Internet, computers and mobile phones are used to accomplish rapid signal generation and dissemination, timely reporting and reviewing of the signal response results. CIDARS has been used nationwide since 2008; all Centers for Disease Control and Prevention (CDC) in China at the county, prefecture, provincial and national levels are involved in the system. It assists with early outbreak detection at the local level and prompts reporting of unusual disease occurrences or potential outbreaks to CDCs throughout the country.

OBJECTIVES: Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children. METHODS: A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes. RESULTS: The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation. CONCLUSIONS: To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.
Appendicitis ; Bayes Theorem ; Child ; Diagnostic Tests, Routine ; Emergency Medicine ; Expert Testimony ; Humans ; Methods ; Pediatrics ; Prospective Studies ; Ultrasonography

Objective:To evaluate the clinical value of nanopore targeted sequencing (NTS) in pathogens detection in urinary tract by comparing the results of different tests performed on the same urine sample.Methods:The results of NTS and urine culture test collected from 326 patients in the Department of Urology of People's Hospital of Wuhan University from July 2020 to June 2021 were retrospectively analyzed. There were 224 males and 102 females. The average age was (56.88 ± 14.58)years old. χ 2 test and Student’s test and Wilcoxon's sign rank test were used to analyze the differences of the pathogen detection rate, pathogen types results and detection time consuming between NTS and urine culture. The clinical value of the NTS in rapid detection of urinary pathogens was evaluated. Results:Among 326 hospitalized patients, the urinary tract microbes’ detecting rate of NTS was significantly higher than that of urine culture[67.80%(221/326)vs. 23.93%(78/326), χ2=130.25, P<0.01]. The uropathogens detecting rate of NTS was significantly higher than that of urine culture[54.29%(177/326)vs. 23.31%(76/326), χ2=38.95, P<0.01]. The number of urinary tract microbes detected by NTS was significantly higher than that of urine culture ( Z=11.49, P<0.01), the number of uropathogens was significantly higher than that of urine culture ( Z=9.67, P<0.01). The detection time of NTS and urine culture positive samples was (24.29±2.65) h and (49.28±11.30) h, the difference was statistically significant ( t =39.48, P<0.01). The results obtained by using NTS and urine culture were consistent in 135 (41.41%) samples. In 150 (46.01%) samples, NTS could detect the urinary tract microbes while urine culture cannot find, of which 112 cases (34.36%) were uropathogenic. In 27 cases (8.28%), more pathogens were detected by NTS except those from urine culture. In 6 cases (1.84%) re-detecting NTS after antibiotic therapy, the number of reads of primary uropathogen decreased gradually with the growth of colonizing bacteria or opportunistic pathogens appeared in the end. Re-examinations of urine culture could verify the results of NTS detection on admission in 5 cases (1.53%). NTS in 2 cases (0.61%) could cover the uropathogens of subsequent several urine cultures. Conclusions:NTS has the advantages of rapid, sensitive and comprehensive detection of urinary tract infection pathogens. When urine culture is not yet reported or even negative, NTS already has a certain clinical reference value and can be used as an effective supplement to urine culture, which is conducive to the comprehensive judgment of the patient's condition.

OBJECTIVE: To evaluate the effect of the combined application of dissociate skin flap and vacuum sealing drainage (VSD) for the repairing for defect after surgical management of huge neck neoplasms. METHOD: Nineteen patients with huge neck malignant tumor involving the skin of the neck were given radical operation, making use of VSD covering the wound surface. After giving 6.65-7.98 mm Hg continuous negative pressure drainage for 72 h, the patients turned to be treated by intermittent negative pressure therapy with 2 min free interval after each treatment period for 5 min. After dismantling the VSD at 7th to 10th day postoperatively, the good wounds covered by granulation tissue were treated by the skin graft operation with dissociate skin flap from thighs; as for the wounds of which the granulation tissue didn't grow well and important cervical tissues was not fully covered by the granulation tissue, VSD was applied again for 1 week, followed by the skin graft operation. RESULT: Nineteen patients have received a total of 23 times of VSD wound treatment, one-stage operation time was significantly shortened. The granulation tissue grew faster on the wound after VSD treatment, and the important cervical tissues such as great vessels could be well covered. The infection and tumor recurrence were observed directly after dismantling the VSD. The skin graft transplantation would be performed after 1-3 weeks. CONCLUSION The treatment by vacuum sealing drainage combined with skin graft for surgical wounds of huge neck tumor postoperatively has the advantages of simple operation, little injury and promotion of the wound healing, which is an effective way for treatment of neck skin defect by surgical operation for the huge tumor.
Adult ; Aged ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Skin Transplantation ; methods ; Soft Tissue Injuries ; etiology ; surgery ; Surgical Flaps

Objective To investigate the association between the nutritional status and related factors in patients with Parkinson's disease (PD).Methods Seventy-two patients with PD (PD group) and 71 age-and sex-matched healthy controls (control group) were enrolled in this study from September 2014 to November 2017 at the First Affiliated Hospital of Sun Yat-sen University.Their serum nutritional indices,including serum albumin,prealbumin,transferrin,free fatty acid and retinol conjugated protein,were collected.The PD participants were interviewed and assessed using motor and non-motor scales,including Hoehn and Yahr stage,Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS),Non-Motor Symptoms Questionnaire for Parkinson's Disease (NMSS),Mini-Mental State Examination (MMSE),Unified Dyskinesia Rating Scale (UDysRS) and 39-item Parkinson's Disease Questionnaire (PDQ-39).Their medication dosage was indicated by daily levodopa equivalent doses (LEDD).Body mass index (BMI) was used to determine their nutritional status,with abnormal nutritional status defined as BMI lower than 20 kg/m2.Results Levels of serum albumin (41.60 (40.28,43.98) g/L vs 44.00 (42.30,46.20) g/L,Z=4.500,P＜0.01),transferrin ((2.32±0.34) g/L vs (2.51±0.34) g/L,t=-3.305,P=0.001),and free fatty acid (418.00 (289.75,637.25) μmol/L vs 547.00 (386.00,699.00) μmol/L,Z=2.079,P=0.038) of the PD group were significantly lower than those of the control group.There was a significant negative correlation between serum albumin and MDS-UPDRS-Ⅱ score (r=-0.254,P=0.031),MDS-UPDRS-Ⅳ score (r=-0.256,P=0.030),years of dyskinesia (r=-0.240,P=0.043),years of motor fluctuation (r=-0.304,P=0.009) and LEDDs (r=-0.321,P=0.006).Disease duration was negatively correlated with serum albumin (r=-0.285,P=0.015) and transferrin (r=-0.275,P=0.019),and age (r=-0.252,P=0.032) was negatively correlated with prealbumin.The forward binary Logistic regression model indicated that abnormal nutritional status was closely associated with rigidity (OR=1.171,95％CI 1.013-1.354,P=0.032),akinesia (OR=1.070,95％CI 1.000-1.144,P=0.048),UDysRS score (OR=1.051,95％CI 1.004-1.099,P=0.032),MDS-UPDRS-Ⅳ score (OR=1.177,95％CI 1.018-1.360,P=0.027) and MMSE score (OR=0.821,95％CI 0.678-0.994,P=0.043),but not correlated with tremor and axial symptoms.Compared with PD patients with abnormal nutritional status,PD patients with normal nutritional status had higher MMSE scores (28.00 (27.00,29.00) vs 28.00 (25.00,28.00),Z=-2.060,P=0.039),lower rigidity (9.60±3.83 vs 12.00±4.29,t=-2.264,P=0.027),akinesia (19.98 ± 8.00 vs 24.42:±:8.06,t=-2.071,P=0.042) and MDS-UPDRS-Ⅳ scores (8.00 (5.00,11.00) vs 10.00 (9.00,13.00),Z=2.642,P=0.008).Conclusions PD patients tend to have a lower serum nutritional indices.PD patients with lower levels of serum nutritional indices are characterized by more severe motor complication,longer disease duration,older age and higher LEDD.PD patients with abnormal nutritional status have worse cognition and more severe motor symptoms (rigidity,akinesia and motor complication).

Objective To investigate the epidemiological information of patients in pre-hospital medical care for our large and medium-sized cities and probe the patients' characteristic. Method The data in 2008 were exported from the computer databases of 8 large and medium-sized cities' emergency medical centers in our country.The thorough records of data were conducted to statistical analysis. Results ( 1 ) The scheduling time, running time, rescue time, returning time, total time and service radius in the pre-hospital medical care group were 2.16± 1.10(min), 14.01 ±6.82(min), 12.12±5.96(min), 14.08± 6.85(min), 42.34± 20.21(min)and 8.50±4.18(km), and the above parameter in the non-death group were 2.19 ± 1.13(min), 14.15 ± 7.14(min),11.60±6.72(min), 14.92 ±6.89(min), 41.86± 19.53(minutes) and 8.63±4.31(Km), and the above parameter in the death group were 2.10± 1.08(min), 13.68 ± 7.14(min), 25.25 ± 12.34(min), 13.75±6.48(min), 54.74 ± 25.47(min) and 7.86± 3.91(Km), and the above parameter in the non-sudden cardiac death group were2.09± 1.03(min), 13.58±6.78(min), 25.53± 12.34(min), 13.60± 6.54(min), 53.79±23.77(min) and 7.67 ± 3.86(Km), and the above parameter in the sudden cardiac death group were 2.12 ±1.02(min), 14.10±7.05(min), 24.79± 12.08(min), 13.79±6.61(min), 54. 80 ± 25. 36( min) and 7.90±3.92(Km) respectively. The scheduling time, running time, returning time and service radius in the death group were less than those of the non-death group, but the rescue time and total time of the former were more than those of the latter respectively ( P ＜ 0.05 or P ＜ 0. 001 ). The scheduling time and returning time didn' t have significant difference between the sudden cardiac death group and the non-sudden cardiac death group respectively ( P ＞ 0.05), but the running time, total time and service radius of the sudden cardiac death group were more than those of the non-sudden cardiac death group, and the rescue time of the former was less than that of the latter respectively ( P ＜ 0.05 or P ＜ 0.001 ). (2)The patients' amount in pre-hospital medical care group, the non-death group, the death group, the non-sudden cardiac death group and the sudden cardiac death group were at most in first quarter, and the least time slice of patients' amount were 4:00～ 6:00, 4:00～6:00, 4:00～ 6:00, 22:00～ 24:00, 2:00～4:00 respectively, and the most time slice of patients' amount were 20:00～ 22:00, 20:00～22:00, 8:00～ 10:00, 2:00 ～ 4:00, 8:00 ～ 10:00 respectively. (3)In 241 876 cases of pre-hospital medical care group, the patients' amount of trauma was at most, whose age grades was by far among21 ～50, and the others in sequence were nervous system, circulatory system, other group, digestive system, respiratory system and poisoning group respectively, whose age grades in nervous system, circulatory system and respiratory system was by far above 51, especially above 70. The patients' age grades in other group and digestive system had two climax age groups, which the one was 21 ～ 30, and the other was above 70. The patients' age grades in poisoning group was by far among 21 ～ 50, which the patients' amount of acute alcoholism was at the most. (4) In 12 568 cases of death group, the death amount of circulatory system, other group, respiratory system, nervous system and digestive system ranked at the lst,2nd,4th,5th 8th respectively, whose age grades was by far above 51, especially above 70,and the patients' amount of sudden cardiac death was at the most in the death amount of circulatory system. The death amount of trauma and poisoning group ranked at the 3rd, 6th respectively, whose age grades was by far among 21 ～ 50. (5)The total amount, the death amount and the sudden cardiac death amount of male patients were more than those of female patients. (6)The percentage of the death group to the pre-hospital medical care group was 5.20%, and the percentage of the sudden cardiac death group to the pre-hospital medical care group was 1.29%,and the percentage of the sudden cardiac death group to the death group was 24.87 %, and the percentage of the sudden cardiac death group to the circulatory system group was 67.33 %. Conclusions ( 1 )The trauma and the sudden cardiac death are the overriding reason of disease and the overriding reason of death in our large and medium-sized cities respectively. (2) It is very important to cut the death rate of the middle-old age patients by strengthening prevention and cure of cardiovascular and cerebrovascular diseases, discerning the critical illness early and improving the level of pre-hospital medical care. (3)It is a strong method to decrease the total amount and the death amount of the trauma, especially in traffic accident, by strengthening safety in production, observing traffic regulation and enhancing the legal awareness.

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
Abdomen ; surgery ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; General Surgery ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; prevention & control ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; prevention & control