Objective To investigate the in-hospital death-related factors for acute encephalocele in patients with craniocerebral injury for craniotomy in order to provide evidence for clinical treatment and prognosis determina-tion.Methods The clinical data of 105 patients with craniocerebral injury occurring acute encephalocele during cra-niotomy were analyzed retrospectively.The correlations of the factors including sex,age,preoperative Glasgow coma scale(GCS)scores,preoperative intracranial pressure(ICP),postoperative pupil status,causes of encephalocel,post-operative GCS scores,postoperative ICP,coagulation mechanism,brain swelling,preoperative hypoxia,preoperative blood pressure and blood glucose were analyzed.Results The prognosis was assessed according to the Glasgow out-come scale(GOS)scores after procedure.There were 77 patients in death group(namely death cases)and 28 patients in survival group.Logistic regression analysis showed that postoperative GCS scores (Wald =14.127,Exp(B)=0.044,95%CI:0.032,0.448),causes of encephalocel(Wald =7.748,Exp(B)=8.183,95%CI:1.825,10.251), postoperative ICP(Wald =7.637,Exp(B)=7.637,95% CI:1.969,8.028),postoperative pupil status(Wald =4.001,Exp(B)=2.499,95%CI:1.019,5.122)and blood glucose(Wald =7.915,Exp(B)=8.891,95% CI:1.790,9.337)were closely associated with the in-hospital death in patients with acute encephalocele in craniocere-bral injury operation(P <0.05).Conclusion The postoperative GCS scores,causes of encephalocel,postoperative ICP,postoperative pupil status and blood glucose could be used as the important indexes for predicting in-hospital death of acute encephalocele in craniocerebral injury for craniotomy.To prevent the intraoperative encephalocele and reduce the intracranial pressure are the important measures to reduce the mortality rate of the patients with acute encephalocele.

Objective To explore the clinical safety of peroral endoscopic cardial constriction for gastro-esophageal reflux.Methods Clinical data of 47 patients with gastro-esophageal reflux who underwent peroral endoscopic cardial constriction in Chinese PLA General Hospital were retrospectively studied from August 2013 to August 2016.Results A total of 47 patients underwent peroral endoscopic cardial constriction successfully with no perforation or fever.Retrostemal vague pain and discomfort occurred in 7 cases,mild dysphagia occurred in 2 cases,and mild hemoptysis occurred in one patient the day after the operation.No special measures were taken and all 10 patients showed symptom remission in less than two days.As for the postoperative treatment,22 (46.8％) patients were given a liquid diet on the day of operation,39(82.9％) patients were given semi-or liquid diet on the first day after the operation,and two days later,43 (91.5％) resumed semi-or liquid diet.Only 9 cases were given antibiotics for prophylaxis for infection.Conclusion Peroral endoscopic cardial constriction is safe and effective for gastro-esophageal reflux.The hospitalizing time is short and postoperative recovery is quick.

Objective To investigate genetic characteristics of Neisseria gonorrhoeae (N.gonorrhoeae) isolates from Guangzhou city in 2014,and to analyze the relationship of N.gonorrhoeae multi-antigen sequence typing (NGMAST) sequence types (STs) with ciprofloxacin resistance.Methods An agar dilution method was used to determine the minimal inhibitory concentration (MIC) of ciprofloxacin in 97 N.gonorrhoeae isolates from Guangzhou city.PCR was performed to amplify the gyrA,parC,porB and tbpB genes from these isolates,followed by gene sequencing and determination of NG-MAST STs.Results Of the 97 N.gonorrhoeae isolates,95 (97.9％) were resistant to ciprofloxacin,including 41 high-level (MIC ≥ 16 mg/L) and 54 low-level (1 mg/L ≤ MIC ＜ 16 mg/L) resistant strains.Mutations were detected at codons 91 and 95 encoding serine in the gyrA gene of all the 95 ciprofloxacin-resistant strains,and in the parC gene of 93 resistant strains.The frequency of the mutation at codon 87 in the parC gene was 85.4％ (35/41) in high-level resistant strains,significantly higher than that in low-level resistant strains (59.3％[32/54],x2 =7.64,P ＜ 0.05).MAST STs were successfully determined for all the 97 N.gonorrhoeae isolates except 1 isolate with incorrect PCR amplicons.Of the 96 genotyped isolates,50 were assigned to 35 known STs by using the NG-MAST website (www.ngmast.net),among which,10 STs each contained 2 to 4 isolates.The most common ST was ST5309.Phylogenetic tree analysis revealed that the 96 genotyped N.gonorrhoeae isolates could be classified into 2 groups,and the proportion of isolates with MIC ≥ 16 mg/L is 46.4％ (39/84) in group 1,but only 1/12 in group 2 (x2 =6.27,P=0.012).Conclusions High-level resistance of N.gonorrhoeae to ciprofloxacin may be mainly associated with the mutation at codon 87 in the parC gene.NG-MAST STs may be related to the degree of ciprofloxacin resistance.

Purpose To study the malignant transformation after treating rat oval cell line ( WB-F344 ) with chemical carcinogen N-methyl-N′-nitro-N-nitrosoguanidine ( MNNG) . Methods WB-F344 cells were cultured with MNNG for severe times. The biological characteristics of induced cells were detected through the following methods:to check proliferation activity by flow cytometry analysis, to examine malignant transformation degree of induced cells by soft agar assay and tumor formation in NOD/SCID mice, and to investi-gate the transcriptional and protein levels of hepatocellular carcinoma marker GGT, GST-P by real time-PCR. Results Oval cells in-duced by MNNG showed changes in biological characteristics and malignant molecular markers. Conclusion Hepatic oval cells model is successfully established, which can be confirmed by tumor formation in NOD/SCID mice.

Objective To analyze the clinical effects of the diverse prevention strategies on donation after citizen's death (DCD) donor fungal infection.Methods A retrospective study was performed on the clinical data of the antifungal preventive scheme to 261 DCD donors from January 2015 to August 2015 (the first period) and September 2015 to December 2016 (the second period) in Tongji Hospital.During the first period,the donors were administrated by ICU doctors and the antifungal agents were not applied as routine.The processes of organ procurement and trim were in accordance with the past experience.During the second period,the donor maintenance was reinforced,including antifungal preventive scheme,aseptic manipulation of organ procurement and rinsing and immersing allografts with broad-spectrum antibiotics or diluting povidone-iodine solutions during organ trim.Microbial culture specimens were performed in 1 574 samples including blood samples,perfusion fluids and arterial tissues and the pathogen distribution at the different periods was identified.Result In the microbial culture specimens of 1 574 samples,907 strains of pathogens were detected,including 799 strains of bacteria and 108 strains of fungi.The positive rate of fungi was 12.0％ (108/907) of all pathogens,and 17.3％ (108/626) of fungal cultures specimens.The fungi positive rate in the second period (13.6％,59/433) was significantly lower than that in the first period (25.4％,49/193,P＜ 0.05).Conclusion It is essential to reduce the incidence of donor fungal infection by increasing the microbial cultures and antifungal preventive scheme.And it is necessary that the organ procurement organization team enhances the risk awareness of donor-derived fungal infection and improves the aseptic manipulation of organ procurement.Additionally,rinsing and immersing allografts with broad-spectrum antibiotics or diluting povidone-iodine solutions may be a better option for preventing the donor-derived fungal infection during the allograft trim.

Medical device management has become a key to medical quality management, medical risk prevention and medical cost control. Continuous innovation is needed to realize the refinement of device management, ensure the safety of patients and improve medical quality. The authors take MRI as an example to monitor the medical devices based on the data platform support in combination with hospital specifics, so as to provide references for the rational use of medical devices.

The Assistive Devices Program was funded and supported sufficiently, and improved the qulity of life of the disabled persons significantly (scores of SF-36). Most disabled users were satisfied with the Program. Some problems, such as inefficient way of working,undefined screening standards, lack of integrity of the assessment content, limited categories of assistive devices and home modifications,unavailable follow-up services, needed to be improved.

Objective To conduct a survey on the status of noise hazards in Tianjin in 2020, to analyze the main distribution characteristics of noise hazards, and to put forward corresponding preventive and control measures. Methods A unified questionnaire was used to investigate the city-wide enterprises with more than 5 employees, normal production and operation, and noise hazards. The χ² test was used to analyze the survey results. Results There were 8 560 enterprises with noise hazards, which were concentrated in the five outer suburban districts, the four districts around the city and the Binhai New Area, mainly small and medium-sized enterprises. Totally, 223 800 people were exposed to noise. The rates of noise hazard detection and physical examination of workers were 25.88% and 17.66%, and the rate of over standard detection and the rate of abnormal physical examination were 13.09% and 1.62%, respectively. The differences in noise detection rate, over standard detection rate and physical examination rate were significant in different administrative regions, enterprise scales and industries. The detection rate and physical examination rate of enterprises in the five outer suburban districts, micro-scale enterprises, and paper products industries were the lowest, while the rate of exceeding standards was the highest in the railway, shipping, aerospace and other transportation equipment manufacturing industries. Conclusion Noise is a common occupational hazard in enterprises in Tianjin. There are a large number of people who are exposed to noise. The detection rate and physical examination rate of noise are at a low level. Individual industries have a high rate of exceeding the standard. The current situation of noise hazard prevention and control is not optimistic. It is recommended to pay attention to it and take effective intervention measures.

Endothelial cells in the inner wall of blood vessels respond to physical and chemical signals of the body by regulating vascular homeostasis， vascular tension， cell adhesion， cell proliferation， coagulation resistance and inflammatory factors， to maintain the stability of blood vessels. Angiogenesis is the key condition for tumor evolution， and the pathological mode of tumor angiogenesis provides nutrients and oxygen for tumor growth and promotes its proliferation. In recent years， endothelial cells have participated in tumor vascular infiltration and driven angiogenesis， which is considered to be the point link in tumor metastasis. By regulating metabolic remodeling， vascular endothelial cells provide the materials and energy needed in the process of tumor angiogenesis， and their abnormal metabolic characteristics facilitate their adaption to the changes of tumor microenvironment， which is often regarded as an important basis for tumor angiogenesis. The ''Yin fire'' theory in traditional Chinese medicine， originating from Huangdi's Internal Classic （Huang Di Nei Jing）， originally meant Yin deficiency generates internal heat， and belonged to the category of fire of internal injury. After the deduction and changes by physicians over the ages， the pathogenesis of ''spleen and stomach Qi deficiency-Yin fire rising-Qi and fire disharmony'' was gradually formed. The pathogenesis of metabolic remodeling of endothelial cells manifests the pathological characterization of Yin fire in an objective way， which is consistent with the disease state of uncontrolled and hyperactive tumor neovascularization. Changes in spleen and stomach Qi deficiency as well as imbalance of Qi movement lead to the failure of water and food in distribution， and thus metabolic disorders occur. Long term retention turns in phlegm and blood stasis， which combat with blood vessels， and result in abnormal local environment （formation of tumor microenvironment）， adverse pulse channel （imbalance of endothelial cell metabolism）， and tumor neovascularization. Under the guidance of ''Yin fire'' syndrome elements and by focusing on the correlation between Qi and fire， prescriptions are made based on the treatment method of ''strengthening the body and regulating Qi'' to regulate the metabolic function of endothelial cells， thus achieving a relatively balanced state of the body and inhibiting tumor angiogenesis. As a result， this study， centering on the metabolic remodeling of endothelial cells and ''Yin fire'' theory， elucidated the academic ideas， with the purpose of providing some theoretical support for the intervention of tumor vascularization by Chinese medicine.