Objective To study the results of splenectomy for patients with idiopathic thrombocytopenic purpura(ITP), which refractory to medical therapy or with repeat recurrence of symptoms. Methods 58 ITP (patients) who failed to respond to conservative management were treated with splenectomy and the clinical (outcome) was observed. Postoperatively, 52 cases were followed up for 6 months to 12 years, and in 48 of these cases the followup was more than 1 year. Results Platelet count recovered to normal(≥100?10~9/L ) two weeks after operation in 47 cases(81.03%). The total effective rate was 79.31% when (followed-up) for 2 months, 78.85% when followed-up for 6 months and 11 cases had recurrence. (Conclusions) Splenectomy is a safe and effective therapy for patients with ITP who failed to respond to (conservative) management or have relapse of ITP. Patients who showed temporary response to preoperative (steroid) therapy and those who had an early or a high amplitude of increase of platelet count after operation have better prognosis.

OBJECTIVE To study the isolation rate,distribution characteristics and antimicrobial resistance of Acinetobacter baumannii infection.METHODS Surveillance data of A.baumannii infection,distribution and resistance rates to 12 kinds of antibiotics in our hospital for 3 years were analyzed.RESULTS During the 3-year infection surveillance,194 strains of A.baumannii were isolated in our hospital.The isolation rate was 7.8% in 2006,though 2.4% in 2004.Eighty strains(41.2%) of A.baumannii were from intensive care unit;95 strains were from over 60-year-old sufferers;compared with 2004 and 2005,the resistance rates of A.baumannii in 2006 to 12 kinds of antibiotics were increasing at different degree.The antibacterial susceptibility to imipenem/meropenem was the highest.CONCLUSIONS The isolation rate of A.baumannii and antimicrobial resistance rate are increasing year by year.The A.baumannii strains shows obvious multiple antibacterial resistance.We must keep monitoring of A.baumannii infection and drug-resistant changes in order to prevent nosocomial infections.

OBJECTIVE To study the clinical species distribution and drug resistance of Enterococcus.METHODS We had collected 201 isolates of Enterococcus by cultured in normal methods in our hospital from July 2005 to June 2008,and analyzed the characteristics of species distribution,drugsensitive test,drug resistance of high concentration aminoglycoside antibiotics and measured the ?-lactamase.RESULTS There are 106 E.faecalis strains(52.7%),76 E.faecium strains(37.8%) and 19 the other Enterococcus strains(9.5%).There were 102 Enerococcus strains separated from urine and 46 separated from sputamentum.The drug resistance rate of Enterococcus faecalis to erythromycin,tetracycline,rifampin and ciprofloxacin were more than 75.0% and the resistance rate of E.faecium to penicillin,ampicillin,erythromycin,rifampin,ciprofloxacin and nitrofurantoin were more than 93.0%;the total resistance rate of Enterococcus to vancomycin and teicoplanin were 14.4% and 10.4%,respectively.The number of the isolates resistant to high concentration aminoglycoside antibiotics was 151(75.1%);Enterococcus with positive ?-lactamase were 74(36.8%).CONCLUSIONS The infection in urinary system and respiratory system were mainly caused by E.faecalis and E.faeciumwith multidrug resistance.

Objective To investigate the ground glass appearance of solitary nodules of bronchioloalveolar carcinoma of the CT imaging features.Methods A retrospective analysis of 20 cases with pathologically proved with a ground glass appearance of solitary nodules of bronchioloalveolar carcinoma of the clinical and imaging data of CT.Results 20 cases of solitary nodules of bronchioloalveolar carcinoma without obvious clinical symptoms ;location:the upper lobe of the left lung in 10 cases,right upper lobectomy in 5 cases,3 cases of the right middle lobe,lower lobe of the left lung in 2 cases; all lesions were located at the lung periphery,both ground glass opacity nodules,14 of them patients with lesions of the peripheral see spiculation in 5 cases,vacuole sign,8 cases with air bronchogram,16 cases with pleural indentation,10 cases of vascular convergence sign etc..In 20 cases the lesion enhancement scan after the lesion showed no enhancement.In all cases,through the CT dynamic observation,no obvious change in lesion size,lesion slightly higher density,finally performed lobectomy pathologically diagnosed non mucoid alveolar cell carcinoma.Conclusion the ground glass appearance of solitary nodules of bronchioloalveolar carcinoma progress is slow,dynamic imaging observation helps to confirm the diagnosis.

Objective To study the microbial strains,risk factors and resistance profiles of lower respiratory tract fungal infection in hospital of Zhoushan archipelago area.Methods A total of 204 patients who were hospitalized for lower respiratory tract infection were retrospectively analyzed from May 2008 to April 2011 in Zhoushan archipelago area,and collected 204 fungal strains isolated from confirmed lower respiratory tract fungal infection cases.Chi-square test and Logistic regression analysis were performed.Results Among the 204 fungal strains isolated from lower respiratory tract specimens,110 (53.8％) strains of Candidaalbicans,32 (15.7％) strains of Candida tropicalis,24 (11.8％) strains of Candida glabrata,12 (5.9％) strains of Candida krusei,14 (6.9％) strains of other Candida,and 12 (5.9％) strains of Aspergillus were detected.Logistic regression analysis showed that chronic obstructive pulmonary disease,bacterial pneumonia,long-term use of broadspectrum antibiotics and corticosteroids,endotracheal intubation or incision,old age,exposure in intensive care unit (ICU),and hospitalization ≥7 days were major risk factors (P=0.000,0.001,0.000,0.000,0.012,0.000,0.000,0.000).The resistance rates of isolated Candida against amphotericin B,5-flucytosine,voriconazole,itraconazole and fluconazole were 0,2.1％,4.2％,14.8％ and 22.9％,respectively.Conclusions Candida albicans is the major pathogen of lower respiratory tract fungal infection in hospital of Zhoushan archipelago area,and Candida is sensitive to amphotericin B,5-flucytosine and voriconazole.

Objective To examine supine fulcrum pressurized radiograph to predict spinal flexibility in adolescent idiopathic scoliosis (AIS). Methods 1. Empirical study: put two points (A and B) on one side of the plastic stick and one point on the other side ( C), pressurize on the plastic stick when point C is in the middle of A and B, and then measure the projection shifting of point A. Repeat the pressure test when the distance between A and C doubled. Analyze the effect of increasing distance on diminishing pressure. 2.Clinical study :45 patients ( 16 males and 29 females) underwent standing anteroposterior radiograph ,fulcrum lateral flexion radiograph, supine lateral flexion radiograph. The Cobb's angles were measured and the flexibility ratio was determined on preoperative fulcrum radiograph. Results (1) If the length of A and C was 25 cm, pressurize on point C, when pressure quantitative scale number located 1 scale and 2 scale of the rule, projection shifting of point A were 5 cm and 10 cm. If the length of A and C was 50 cm, pressurize on point C, when pressure quantitative scale number located 1 scale and 2 scale of the rule, projection shifting of point A were 8 cm and 15 cm. The longer the distance, the lesser the pressure force of plastics stick. (2)The Cobb angles and curve flexibility provided by fulcrum lateral flexion radiograph had significant difference from that provided by supine lateral flexion radiograph in male group and female group. Cobb angles of male group was 28. 6°± 4. 1 °, 16. 7°± 4. 6° respectively (t= 7. 438, P ＜ 0. 01 )and curve flexibility was 47. 6% ±8. 1% ,69. 4% ± 8. 5% respectively( t = 7. 438, P ＜ 0. 01 ). Cobb angles of female group was 24.5°± 2. 7°,12. 6°±2. 4° respectively(t = 17. 540,P ＜0. 01 )and curve flexibility was 53.4% ±5.2% ,76. 0% ±4. 7% respectively(t = 17. 54, P ＜ 0. 01 ). The flexibility of spinal main curve of female patients was obviously higher than male patients. Conclusions Supine fulcrum pressurized technique can make up for the insufficiency of supine lateral flexion technique, and provide a convenient, safe, precise and useful method for evaluation of spinal flexibility in AIS.

Objective To investigate the efficacy and safety of percutaneous patent ductus arteriosus (PDA) closure via femoral vein solely under transesophageal echocardiography guidance.Methods From May 2014 to May 2015,28 patients(13 boys,15 girls) were selected in Dalian Children's Hospital Affiliated to Dalian Medical University with PDA closure via the femoral vein under transesophageal echocardiography guidance,with mean age (3.5 ± 2.6)years and mean body weight (16.0 ± 6.5) kg.The mean diameter of PDA was (7.1 ± 3.9) mm.Patients were all treated by percutaneous PDA closure solely by transesophageal echocardiography via the femoral vein.The effect of the procedures was evaluated by echocardiography.The transthoracic echocardiography,chest X-ray film,cardiogram at 1 month,3 months and 6 months after procedure were followed up.Results Twenty-seven cases were successfully treated with percutaneous PDA closure via the femoral vein solely under transesophageal echocardiography guidance,while 1 patient was closed by surgical closure with on-pump beating-heart because PDA occluder strayed into the left pulmonary artery on 1-month follow-up.The procedural time was (48.5 ±8.7) min.The mean diameter of PDA occluder was (8.2 ± 4.1) mm.Twenty-seven patients survived without peripheral vascular injury or complications such as residual shunt,arrhythmia and cardiac perforation.One patient was transformed to surgical closure.Hospitalization time was (2.5 ± 0.5) days.At one month follow-up,no complications such as residual shunt or pericardial effusion occurred.Conclusion Transesophageal echocardiography guided percutaneous PDA closure via the femoral vein approach is safe and effective without the damage from radiation and contrast agents,and aviods the use of femoral artery puncture.

Objective:To summarize the experience in diagnosis and treatment of primary cardiac tumors in pediatric patients.Methods:Retrospectively analyzing 7 pediatric patients who were suspected as primary cardiac tumors and diagnosed and treated in Department of Heart Center, Children′s Hospital of Dalian Medical University from August 2013 to February 2019.All patients underwent echocardiography and other examinations, so as to confirm the diagnosis and the treatment plan was chosen based on the size and location of the tumor.All patients were followed up after discharge.Results:A total of 7 patients were diagnosed as primary cardiac tumors by echocardiography, among which 5 cases underwent surgical treatment, and 2 cases were diagnosed with tuberous sclerosis without surgery.In children undergoing surgery, 1 patient underwent autologous heart transplantation to remove the tumor, 1 patient had arrhythmia, 1 patient had mitral regurgitation after surgery, and the mitral regurgitation was corrected again.The remaining children had no adverse complications and were discharged successfully.Histologic examination revealed rhabdomyoma in 4 patients, and fibroma in 1 patient.The patients were followed up for 2-66 months after discharge, and no tumor recurrence was observed in the children who performed surgery.There was a trend of spontaneously regress of cardiac tumor in 2 patients without surgery.Conclusions:Echocardiography is the first choice for the diagnosis of primary cardiac tumors in Pediatric patients.Rhabdomyoma is the most prevalent histologic type of primary cardiac tumors, and tuberous sclerosis should be excluded during the diagnosis process.Patients with tuberous sclerosis selected conservative treatment, and surgical treatment was selected for children with obvious symptoms.According to the location and size of lesion, therapy strategies should be chosen and autologous heart transplantation can be adopted to remove the tumor for children with large tumors.Autologous heart transplantation to remove the tumor is a good surgical treatment.

Objective To compare the clinical value of two kinds of imaging methods including CT and MRI in early diagnosis of acute multiple cerebral infarction. Methods The imaging data of CT and MRI of 108 patients with acute multiple cerebral infarction were analyzed. The total detection rate, the detection rate in different time periods,the number and area of detected lesions and the inspection time of CT and MRI in early diagnosis of acute multiple cerebral infarction were compared. Results The total detection rates of patients with acute multiple cerebral infarction by CT and MRI were 57. 41%,96. 30%,respectively. The total detection rate of MRI was significantly higher than CT(χ2 =9. 73,P<0. 05). The detection rates of patients with acute multiple cerebral infarction for onset within 24h and 24-72h by MRI were significantly higher than CT(χ2 =18. 54,16. 20,all P<0. 05). There was no significant difference in detection rate of patients with acute multiple cerebral infarction for onset >72h between CT and MRI(P>0. 05). The number of detected lesions of patients with acute multiple cerebral infarction by MRI was significantly more than CT(t=2. 39,P<0. 05). The area of detected lesions and the inspection time of patients with acute multiple cerebral infarction by MRI were significantly less than that by CT(t =2. 43,2. 60,all P <0. 05). Conclusion Compared with CT, MRI in the early diagnosis of acute multiple cerebral infarction can effectively improve the detection rate in early stage, avoid the missed diagnosis of small lesions and is helpful to shorten the examination time.

Objective To study the prevalence of common infections with soil-borne intestinal nematodes amongst kindergarten children aged 3 to 6 years in Hangzhou,Zhejiang Province to provide evidence for determination of the priority of disease prevention and control.Methods Totally,1667 preschool children were selected from 14 kindergartens of Classes A,B and C in east,middle and west Hangzhou.Perianal skin Scotch Tape(a short strip of sealing cellophane pressure-sensitive tape)specimens were collected for detection of eggs of Enterobius vermicularis,and stool specimens for eggs of Ascaris lumbricoides,Ancylostoma duodenale and Trichuris trichiura by Kato-Katz method and saturated brine floatation,as well as questionnaire interview,for all the children.Results Two hundred and sixteen of 1667 children examined were found infected with common soil-borne intestinal nematodes,with an overall prevalence of 12.96%,4.44% for Enterobius vermicularis,8.28% for Ascaris lumbricoides,0.54% for Trichuris trichiura and 0.24% for Ancylostoma duodenale.Prevalence of infection of common intestinal nematodes was 7.31% in children of the Class A kindergartens,12.60% of Class B,and 21.47% of Class C,with statistically significant difference(?~2 = 49.95,P