Objective To investigate the clinical characteristics of nosocomial infections in senile inpatients(≥75 years old) and to propose the control strategy according to the analysis. Methods A total of 2675 senile inpatients(≥75 years old) from 2007 to 2008 were prospectively evaluated and retrospectively reviewed. The infection incidence rate, infection fatality rate, average length of stay in hospitals, location of infections, main pathogenic bacteria and common protopathy were analyzed. Results Among 2675 senile inpatients, 222 senile inpatients suffered from nosocomial infection. Among all age groups in this hospital during the same period, the infection incidence rate and the infection fatality rate were higher in the senile group than in the general group(8.3% vs. 1.9%, 0.8% vs. 0.1%,both P<0.01). The average length of stay in our hospital was 54.0 days. The lower respiratory tract infections were most common, and the urinary system infections, and the blood infections. Gram-negative bacteria was the major source of nosocomial infection(47.0%, 110/234), while infection rate of Gram-positive bacteria was 32.9% (77/234) and fungus was 20.1% (47/234). The cerebral vascular disease was the most common protopathy, then malignant tumor was in 45 cases (20.3%), kidney disease was in 31 cases(14.0%), cardiac disease was in 29 cases(13.1%) and respiratory disease was in 21 cases(9.5%). Conclusions There are higher infection incidence rate, higher infection fatality rates,longer length of stay in hospitals in senile inpatients(≥75 years old). The lower respiratory tract infections were most common and Gram-negative bacteria was the major source of nosocomial infection. We should adopt active management to control the nosocomial infections.

Objective To discuss the clinical value of ~(18)F-FDG PET-CT fusion imaging in hepatocellular carcinoma after transcatheter arterial chemoembolizationTACE)with lipiodol. Methods 15 cases of hepatocellular carcinoma diameter 4～10 cm) were investigated with ~(18)F-FDG PET-CT imaging within three months after TACE. The findings of imaging were compared with the results of anteriography and clinical follow-up.Results After TACE, regions of absent~(18)F-FDG uptakes could be found in all 15 patients. Increased ~(18)F-FDG uptakes could be found in liver of 11 cases. The other 4 patients had no increased~(18)F-FDG uptakes in liver. The regions of increased ~(18)F-FDG uptakes were residual viable tumor confirmed by anteriography and clinical follow-up , and most of them locate around region of absent ~(18) F-FDG uptakes.~(18)F-FDG PET-CT fusion imaging showed that there were no correlation between increased ~(18)F-FDG uptakes and lipiodol dense distribution. After another TACE given or radiotherapy based on ~(18)F-FDG PET-CT fusion imaging, the areas of increased ~(18)F-FDG uptakes reduced or disappeared. In 4 patients without Increased ~(18)F-FDG uptakes ,DSA showed that there were still viable tumor in the peripheral zone of tumor.Conclusion Residual viable tumor can still be found in patients with hepatocellular carcinoma after TACE.~(18)F-FDG PET-CT imaging can characterize and locate the most residual viable tumor, monitor response and be a guide in following therapy, but some viable tumor can not be found by ~(18)F-FDG PET-CT imaging.

OBJECTIVE To evaluate the medical instrument′s cleaning effect and bacterial elimination result by using multi-enzyme cleaning agent.METHODS The total 229 pieces of moderate contaminated medical instrument were randomly divided into 2 groups:control group and experiment group.The effects after routine water immersion and processing of multi-enzyme cleaning(including hand cleaning and machineone were observed and the bacteriological examination in the sample was checked.RESULTS 96% of the medical instruments in experiment group were cleaned,while only 35% of them in control group were cleaned.It was showed the cleaning effect of multi-enzyme was better than routine water immersion.In the experiment group,the contaminated rates of blood pincers and tweezers after hand cleaning with multi-enzyme were 33.7% and 25.5%,respectively,while the contaminated rates of blood pincers and tweezers after machine cleaning with multi-enzyme were 0.It indicated that the bacterial eliminate rate of machine cleaning with multi-enzyme was higher than hand cleaning with multi-enzyme.CONCLUSIONS Multi-enzyme agents are better for medical instrument cleaning.

Objective To study different test positions on vestibular evoked myogenic potentials (VEMPs) in youth ,and to find a suitable position and provide a guidance for clinical practice .Methods Thirty normal young vol-unteers were tested by vestibular evoked myogenic potentials ,using three different positions :supine with the head held straight up(SHU),supine with the head held up and turned away from the test ear(SHT),sitting with the head turned away from the test(SIT) ,the derivation rate ,latency and amplitude were analyzed .Results The deri-vation rate of SHU ,SHT and SIT were 100% ,100% and 63 .3% ,respectively .The derivation rate ,p13 ,n23 la-tency and p13 n23 inter-latency between SHU and SIT ,and between SHT and SIT had statistical differences (P<0 .05) .No statistical significant differences were found in derivation rate ,p13 ,n23 latency and p13n23 inter-latency between SHU and SHT (P>0 .05) .The amplitude was significantly different among the three positions (P<0 .05) . No statistical significant difference were found in derivation rate ,p13 ,n23 latency ,p13 n23 inter -latency and am-plitude between men and women of the three positions (P> 0 .05) .Conclusion The derivation rate of SHT was 100% with maximum amplitude .SHT is the most recommended position for clinical test in youth .The derivation rate of SHU was 100% ,and no statistical significant difference were found in p13 ,n23 latency and p13n23 inter-la-tency between SHU and SHT (P>0 .05) .SHU can be used in clinical test .SIT is not recommended for using in clinical test .Gender does not affect VEM Ps test .

Objective To discuss the relationship of congenital choledochus cyst(CCC)with occurrence of pancreatitis in adults and methods of surgical treatment.Methods The clinical data of 17 adult patients with congenital choledochus cyst who underwent surgical treatment from 1997-2005 were analyzed retrospectively.Results Clinical diagnosis was made mainly by B-ultrasound,MRCP,intraoperative cholangiography,ERCP and CT scans.Among 17 cases,10 cases were congenital choledochus cyst typeⅠ,4 cases type Ⅱ,1 case type Ⅲ,1 case type Ⅳ and 1 case type Ⅴ;and associated with cholelithiasis in 14 cases(bile pigment stone in 11cases,cholesterol calculus 3cases),chronic cholecytitis 5 cases,polypoid lesions of gallbladder 1 case,anomalous pancreaticobiliary junction(APBJ)10 cases,and pancreatitis 10 cases.Resection of extrahepatic cyst with Roux-y hepaticojejunostimy was performed in 15 cases,preserving pylorus pancreatoduodinectomy in 1 case,and cholecystectomy and T tube drainage in 1 case.Excellent and good results were achieved on follow-up in 14 out of the 17 CCC cases undergoing surgical treatment,while pancreatitis occurred in 2 cases and unexpected death in 1 case.Conclusions Pancreatitis is apt to occurr in CCC with APBJ and bile pigment stone in choledochus.The incidence of pancreatitis in CCC and APBJ(P-B)can be decreased by resection of extrahepatic cyst and Roux-en-Y hepaticojejunostimy and cholecystectomy.

Glutathione S-transferases (GSTs) are enzymes which play an important role in the neutralization of toxic compounds and eradication of electrophilic carcinogens. Genetic polymorphisms within the genes encoding for GSTs may therefore cause variations in their enzyme activity, which may in turn influence the interindividual susceptibility to cancers. In this study, we aimed to investigate the association between genetic polymorphisms of GSTT1, GSTM1, and GSTP1 and the risk of colorectal cancer (CRC) in 264 cases and 317 controls in a Chinese population. Genotyping was performed by using multiplex PCR (for GSTT1 and GSTM1) and PCR-RFLP (for GSTP1) methods. The association between the polymorphic genotypes and CRC risk was evaluated by deriving odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression analysis. Our results showed that individuals with GSTT1 and GSTM1 null genotypes exhibited a higher risk of CRC (GSTT1, OR,1.66; 95% CI, 1.20-2.31, P=0.003; GSTM1, OR,1.57; 95% CI,1.13-2.18, P=0.007), while no association was observed for GSTP1 (P(heterozygous)=0.790 or P(variant)=0.261). Furthermore, individuals who simultaneously carried the null genotypes for both GSTT1 and GSTM1 showed a stronger risk association (OR, 1.95; 95% CI, 1.33-2.85; P<0.001). In conclusion, the GSTT1 and GSTM1 polymorphisms, but not GSTP1, may modulate the CRC risk among Chinese.
Aged ; Alleles ; Colorectal Neoplasms/*enzymology/*genetics/pathology ; Female ; *Genetic Predisposition to Disease ; Genotype ; Glutathione S-Transferase pi/*genetics ; Glutathione Transferase/*genetics ; Humans ; Male ; Middle Aged ; Odds Ratio ; Polymorphism, Genetic ; Risk

Objective:To investigate the clinical value of radiomics based on computed tomography (CT) examination in preoperative differential diagnosis of pancreatic serous cystadenoma (SCA) and mucinous cystadenoma (MCA).Methods:The retrospective case-control study was conducted. The clinicopathological and imaging data of 154 patients with pancreatic cystic neoplasms who were admitted to the First Affiliated Hospital, Zhejiang University School of Medicine from January 2012 to December 2019 were collected. There were 24 males and 130 females, aged (50±13)years. Of the 154 patients, 99 cases were diagnosed as SCA and 55 cases were diagnosed as MCA. All the 154 patients underwent plain and enhanced CT scan of pancreas before operation. The clinical characteristics, radiology features and radiomics features of all patients were collected to construct the clinical characteristics model, radiology model, radiomics model and fused model. The receiver operating characteristic (ROC) curve of each model was drawn, and those constructed models were evaluated by area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value and negative predictive value. Based on the optimal model, the nomogram was constructed. Observation indicators: (1) establishment and validation of clinical characteristics model; (2) establishment and validation of radiology model; (3) establishment and validation of radiomics model; (4) establishment and validation of fused model; (5) nomogram of fused model. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results:(1) Establishment and validation of clinical characteristics model: 3 clinical characteristics, including age, symptoms and preoperative serum CA19-9, were selected using multinomial logistic linear regression analysis to construct the clinical characteristics model. Result of the multinomial logistic linear regression analysis was expressed by formula ①: clinical characteristics model score=0.635-0.007×age+0.054×clinical symptoms+0.108×preoperative serum CA19-9. The ROC curve for the test dataset of clinical characteristics model was drawn. The AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of clinical characteristics model were 0.611(95% confidence interval as 0.488?0.734, P<0.05), 56.6%, 66.7%, 56.3%, 41.5%, 78.4% for the training dataset and 0.771(95% confidence interval as 0.624?0.919, P<0.05), 77.8%, 63.1%, 88.5%, 80.1%, 76.7% for the test dataset, respectively. (2) Establishment and validation of radiology model: 5 radiology characteristics, including tumor location, the number of tumors, tumor diameter of cross section, lobulated tumor and polycystic tumor (more than 6), were selected using multinomial logistic linear regression analysis to construct the radiology model. Result of the multinomial logistic linear regression analysis was expressed by formula ②: radiology model score=?0.034+0.300×tumor location+0.202×the number of tumors+0.014×tumor diameter of cross section?0.251×lobulated tumor?0.170×polycystic tumor (more than 6). The ROC curve for the test dataset of radiology model was drawn. The AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of radiology model were 0.862(95% confidence interval as 0.791?0.932, P<0.05), 78.8%, 81.8%, 77.5%, 62.8%, 90.2% for the training dataset and 0.853(95% confidence interval as 0.713?0.994), P<0.05), 88.9%, 89.4%, 88.5%, 85.0%, 92.0% for the test dataset, respectively. (3) Establishment and validation of radiomics model: 4 categories of a total 1 067 radiomics features were extracted from 154 patients with pancreatic cystic neoplasms, including 7 first-order histogram features, 53 texture features, 848 wavelet features and 159 local binary pattern features. A total of 896 stable radiomics features were retained to construct the model, based on the condition of intraclass correlation coefficient >0.9. After selected by variance threshold and correlation coefficient threshold, 350 radiomics features were retained. Fifty synthetic radiomics features were constructed based on the original features in order to obtain potential radiomics features, and the total number of radiomics features was 400. After analyzed by the five-fold recursive feature elimination, 22 radiomics features were screened out, including 13 wavelet features, 7 synthetic radiomics features and 2 local binary pattern features. The support vector machine algorithm was used to construct the radiomics model. The penalty coefficient 'C' and parameter 'γ' of the radiomics model were 35.938 and 0.077, respectively. The kernel function of the radiomics model was 'radial basis function kernel'. The ROC curve of radiomics model using 5-fold cross validation was drawn. The average AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the radiomics model were 0.870 ( P<0.05), 83.1%, 81.8%, 83.8%, 73.8% and 89.2%, respectively. (4) Establishment and validation of fused model: the fused model was constructed after selecting the tumor location and lobulated tumor of radiology characteristics and radiomics score. Result of the multinomial logistic linear regression analysis was expressed by formula ③: fused model socre=?0.154+0.218×tumor location?0.223×lobulated tumor+0.621×radiomics score. The ROC curve for the test dataset of fused model was drawn. The AUC, accuracy, sensitivity, specificity, positive predictive value and negative predictive value of fused model were 0.893(95% confidence interval as 0.828?0.958, P<0.05), 83.7%, 81.8%, 84.5%, 71.1%, 90.9% for the training dataset and 0.966(95% confidence interval as 0.921?0.999, P<0.05), 91.1%, 84.2%, 96.2%, 94.1%, 89.3% for the test dataset, respectively. (5) Nomogram of fused model: the nomogram of fused model was illustrated with the Youden index of 0.416. Conclusion:The prediction model based on the radiomics signature and radiological features extracted from preoperative CT examination can make the differential diagnosis of pancreatic SCA from MCA.

OBJECTIVE To study the roles of iron and zinc in the pathogenesis of recurrent tonsillitis and tonsillar hypertrophy.METHODS In total,40 patients who underwent a tonsillectomy to treat chronic tonsillitis or tonsillar hypertrophy were included in the study.Patients were divided into 2 groups,chronic tonsillitis or tonsillar hypertrophy group.The levels of iron and zinc elements were measured for each tonsillar tissue sample.RESULTS There was a significant difference in the iron and zinc level (P＜0.001) between the tonsillar hypertrophy and chronic tonsillitis groups.The levels of iron and zinc were significantly lower in the chronic tonsillitis group.CONCLUSION The results suggest that low tissue concentration of iron and zinc may lead to chronic tonsillitis.

The prescription of Xiangsu Powder （香苏散） reflects the exquisite balance in treating both the superficial and deep layers， harmonizing the body's vital energy and blood， and addressing the functions of the triple energizer simultaneously. Its application in treating cold epidemics has been a long time， yet its importance in modern disease treatment is often overlooked. Based on the treatment principles demonstrated by Xiangsu Powder in treating cold epidemics， it is proposed that in the treatment of modern epidemic diseases， the dual principles of cold and heat should not be neglected. When cold pathogens stagnate at the surface， they should be dispersed and detoxified， using methods that induce sweating to expel them from the surface. When cold and dampness coexist， efforts should be made to regulate the flow of vital energy， blood， and body fluids to restore the proper functioning of the three burners. When cold-induced pathogenic factors are severe and toxic， aromatic herbs should be utilized to dispel turbidity and avoid contamination. Throughout the entire course of treating epidemic diseases， attention should be paid to inducing sweating without damaging the body's vital energy， while also protecting the body's righteous qi， with the aim of providing refe-rence for the treatment of modern epidemic diseases.

This paper summarized professor XUE Boshou's clinical experience of using Fangfeng （Radix Saposhnikoviae）. Firstly， Fangfeng is used to scatter wind and release the exterior， disseminate and penetrate the pathogens， and can treat the early-staged externally contracted heat diseases with exterior qi constraint and blocking， and serious internal heat through Xiaodu Xijiao Beverage （消毒犀角饮） from Beneficial Formulas from the Taiping Imperial Pharmacy （《太平惠民和剂局方》）combined with Yinqiao Powder （银翘散）， Shengjiang Powder （升降散） and Zhizichi Decoction （栀子豉汤） in their modifications. Secondly， it eliminates wind and dispels dampness， relieves itching， and heals sores， with self-made Xue's Guomin Decoction （薛氏过敏煎） in modification being formulated to treat allergic skin diseases caused by pathogenic wind attacking the exterior. Thirdly， it disperses liver qi and soothes the spleen， lifts yang and stops diarrhea， and can be used in modified Tong Xie Yao Formula （痛泻要方） from Teachings of ZHU Danxi （《丹溪心法》） when treating diarrhea caused by liver constraint and spleen deficiency. Fourthly， it can disperse stagnated qi throughout the body and unblock the meridians of the five zang （脏） organs， commonly in formulation of modified Huangqi Chifeng Decoction （黄芪赤风汤） from Correction of Errors in Medical Works （《医林改错》） to treat patients with qi deficiency and blood stasis after radiotherapy and chemotherapy of tumors， as well as alopecia areata or even alopecia universalis， chronic rhinitis and others.