Clinical microbiology should participate the infectious diseases consult.There is no guideline about this topic in the professional field so far.The professional recommendations are given to the different items including definition,professional,prerequisite,pre-consult phase,consult phase,post-consult phase,and etc.It is hoped that our recommendations are conducive to the consult task and can promote the development of clinical microbiology and infectious diseases.

Objective To explore the nutritional status of vitamin D among healthy adults lived in Fuling district of Chongqing .Methods A total of 718 healthy adults aged 23-90 years old undergoing the physical examination in the physical ex‐amination center of our hospital from March 2012 to December 2013 were selected and divided into the 23-44 years old group and the ≥45 years old group .The tandem mass spectrometer was adopted to detect the level of serum 25(OH) vitamin D for evaluating the nutritional status of vitamin D .Results The proportions of lack ,insufficiency ,normal and excess of vitamin D in the 23 -44 years old group were 80 .79% ,19 .21% ,0% and 0% respectively ;which in the ≥45 years old group were 77 .91% ,18 .20% ,3 . 89% and 0% respectively .The average level of serum 25(OH) vitamin D in 23-44 years old group was lower than that in the ≥45 years old group ,the difference was statistically significant (P=0 .002 ,t=1 .98) .In these two groups ,the difference in serum 25 (OH) vitamin D level between males and females had no statistical significance (P>0 .05) .Conclusion The healthy adults in Ful‐ing district are lack of vitamin D in different degrees .

Objective To analyze the reaction in rabbit's esophagus after inserting metallic nitinal stent and obtaining suggestion for the clinical application.Methods The selfexpanding nitinal stent was placed in each of eight rabbits's esophagus. The rabbits were killed at 2,4,6,8 weeks after implantation. Tissue around the stent was investigated with naked eye and microscopy. Results Chronic inflammation and edema were seen in the submucous tissue 2 week after stenting. Slight stenosis occurred at the regions of two ends of the stent and scattered vegetations like polyp were seen with naked eye at 4 weeks, with inflammatory cell infiltration, partial mucous polypoid hyperplasia under microscopy. The pathological changes were more obvious at 6 weeks comparing with the 4 weeks. The lower end of one stent was embedded in esophageal wall. Two rabbits of 8 weeks' group died of obstruction with food tarried inside the stents.Conclusions The restenosis after stenting were mainly seen at the region of terminals of stent. Thus reformation of stent should be taken place urgently especially at the terminals for the prevention of restenosis.

Objective To explore the therapeutic effect of different postoperative chemotherapy and administration pathways in primary hepatocellular carcinoma (PHC) patients with portal vein tumor thrombus (PVTT). Methods 60 PHC patients with PVTT were divided into A, B, C and D groups. A group was treated by transcatheter arterial chemo-embolization (TACE); B group was treated by TACE and portal vein intubation(PVI) with quick intravenous injection; C group was treated by TACE and PVI with slow infusion controlled by computer; and D group was treated by hepatic arterial intubation chemo-embolization (HAI) and PVI with slow infusion controlled by computer. Results The survival rate among groups A, B and C had a significant difference (P0.05). Conclusion PHC patients with PVTT could be treated by both hepatic arterial chemotherapy and portal vein chemotherapy throug portal vein continuous infusion. TACE or HAI was suitable for postoperative chemotherapy.

Objective To ascertain the dose levels to personnel from the activation products in the radiotherapy place of a proton acceterator and to provide technical basis for protection design of the treatment place and the personnel's radiation protection.Methods A PROTEUS 235 proton therapy system was analyzed for the potentials to produce activated nuclides in the air during its operation.The concentrations of the main radionuclides and the resultant personnel doses were estimated.Results The activity concentrations of activated nuclides were 15O 4.1 × 10-2,13N 3.3 × 10-2,41 Ar 6.2 × 10-3 and 11 C 2.0 × 10-2 Bq · cm-3,respectively,in proton accelerator hall,whereas those in the proton beam radiotherapy room were only about 5％ of the corresponding values in the proton accelerator hall.The annual doses to the radiation workers from immersion external exposure due to air activation were less than 1 and 0.1 mSv,respectively,when entering the proton accelerator hall 5 and 30 min after beam stopping;whereas those were 1.3-2.0,0.7-1.2 and 0.3-0.6 mSv,respectively,when entering the therapy hall 0,5 and 15 min after beam stopping.Conclusions The personnel doses received from activated nuclides in the air in the radiotherapy place of a proton acceterator are unignorable.The contribution to doses from immersed external exposure of 15O,13N,41Ar and 11C should be taken into full considerations,with necessary protection measures needed.

Objective To assess the efficacy and safety of the Nuss procedure in the treatment of pectus excavatum in children. Methods The Nuss procedure was performed in 38 patients.Under thoracoscopy,a convex steel bar was inserted under the sternum through small bilateral thoracic incisions,with the convexity facing posteriorly.When the bar was in position,it was turned over,thereby correcting the deformity.Two lateral stabilizing bars were employed.Out of the 38 patients,imported bars were used in 5 patients and China-made bars were used in 33 patients.Results The procedure was completed under thoracoscopy smoothly in all the 38 patients.The operating time was 40~80 min(mean,50 min) and the intraoperative blood loss was 5~30 ml(mean,16 ml).A single bar was utilized in 36 patients,and a second bar was required in 2.Complications included postoperative pneumothorax in 4 patients,subcutaneous emphysema in 16 patients,bar displacement in 1 patient,and lateral stabilizer dislocation in 1 patient.The length of postoperative hospital stay was 7~21 days(mean,8 days).Follow-up checkups in the 38 patients for 3~22 months(mean,11 months) showed excellent outcomes in 36 cases and good outcomes in 2 patients,the rate of excellent or good results being 100%. Conclusions The Nuss procedure is safe and reliable for the treatment of pectus excavatum in children.The best age range for surgery was 3~12 years old.

Objective To assess the middle-term results of laparoscopy in resection of congenital choledochal cyst,hepaticojejunostomy,and extra-abdominal Roux-en-Y anastomosis. Methods We retrospectively studied 50 patients who had undergone laparoscopic choledochal cyst excision in our institute from 2005 to 2008.For large cysts,we dissected and separated the cyst at the middle portion,and then opened the inferior wall of the cyst to dissect the posterior wall of the cyst from the portal vein.For small cysts,we divided the cysts circumferentially and then completely excised the dilated bile duct.When the cyst was intensely inflamed,excision of the cysts was performed as Lilly's technique.Roux-en-Y jejunojejunostomy was performed extracorporeally through an umbilical incision(1.5 cm),afterwards,end-to-side anastomosis was carried out intracorporeally.The conversion to open surgery,and morbidity and mortality rates of the patients was analyzed.Results The cysts were completely excised in 16 cases,and Lilly's technique was performed on 34 cases.One patient was converted to open surgery due to hemorrhage resulted from recurrent inflammatory-caused tight adhesion between the cyst and surrounding tissues.The mean operation time was 226 minutes(range: 190 to 450 minutes).Eight patients received blood transfusion during the operation.The children were discharged from hospital in 6 to 16 days after the surgery(mean,8 days).A mean of 26 months follow-up was achieved in 49 patients(ranged 3 to 39 months).Four patients developed complications: one of them showed bile leakage and then were cured by intra-abdominal drainage;one patient developed acute pancreatitis and one suffered from adhesive small bowel obstruction,both recovered after conservative treatment;intestinal necrosis was detected in one patient,who received another operation for resection of the necrotic bowel and anastomosis of the bile duct and intestine.In the other 45 patients,no abdominal pain,fever,jaundice,etc.were detected.No patient showed bile duct stenosis or reflux gastritis,no one died because of the surgery.Conclusions Laparoscopic approach is effective for congenital choledochal cyst,hepaticojejunostomy,and extra-abdominal Roux-en-Y anastomosis.Dissection of the posterior cyst wall to avoid injury to the portal vein is the key to the procedures,while extra-abdominal Roux-en-Y anastomosis is one of the most difficult steps.

Acupuncture Therapy ; Adult ; Aged ; Anesthetics ; administration & dosage ; Combined Modality Therapy ; Female ; Humans ; Intervertebral Disc Displacement ; drug therapy ; physiopathology ; therapy ; Male ; Middle Aged ; Nerve Block ; Spinal Nerve Roots ; drug effects ; physiopathology

Objective To validate the association between genetic polymorphisms of nucleotide binding oligomerization domain 2 (NOD2) gene and the risk of tuberculosis in Chinese population.Methods A validation case-control study was performed with a total of 1043 pulmonary tuberculosis patients and 808 healthy controls.All controls had no history of tuberculosis or malignancy,and were matched with cases by sex and age.Genomic DNA from the peripheral blood samples of participant was extracted.Single nucleoside polymorphisms (SNP) of rs3135499,rs7194886,rs8057341,and rs9302752 in the NOD2 gene were genotyped using a TaqMan-based allelic discrimination system.The chi-square test was used to analyze categorical data and Logistic regression model was used to calculate the odds ratio (OR) and 95％ confidence interval (CI).Results When all patients as the cases were included in the analysis,no significant association was found between the four SNP of NOD2 gene and the risk of pulmonary tuberculosis.In a subgroup analysis by restricting cases to sputum culture positive patients,the variant genotypes of rs7194886 were significantly associated with an altered risk of tuberculosis.Compared with the CC genotype,individuals carrying the CT/TT genotype of rs7194886 had an increased risk (OR =1.35,95％ CI:1.05-1.72) for sputum culture positive tuberculosis.After adjusted for potential confounders,the increased risk of CT/TT genotype was still observed (OR=1.35,95％CI:1.05-1.73).Stratification analysis revealed that the effect of the SNP rs7194886 (CT/TT vs TT) was significant among men (OR=1.44,95％CI:1.08-1.92),individuals with age ＜55 years (OR=1.51,95％CI:1.05-2.16),smokers (OR=1.53,95％CI:1.07-2.18),and alcohol drinkers (OR=1.84,95％CI:1.01-3.33).But the heterogeneity test was not significant.Haplotype analysis showed that the rs9302752C-rs7194886T haplotype was associated with an increased risk of sputum culture positive tuberculosis (x2 =4.27,P=0.039).Conclusion In summary,genetic polymorphisms of rs7194886 in the NOD2 gene may be associated with the risk of pulmonary tuberculosis in the Chinese population.

Objective To evaluate the value of laparoscopic-assisted cholangiography in diagnosing prolonged jaundice in infants.Methods Through an umbilical troear,an laparoscope was placed into the abdominal cavity to detect the gallbladder and liver.After confirming that the choleeyst is normal,we pulled out the fundus of the gallbladder through the right subcostal trocar,and then inserted a catheter into the gallbladder for cholangiography.If the fundus could not be exteriorized because of gallbladder atresia, the patient would be converted to an open surgery.Results Cholangiography showed infant hepatitis syndrome or cholestasis in 8 cases,biliary hypoplasia in 2,and biliary atresia in 2.In 5 patients,the gallbladder was dissected from the liver bed before cholangiography,2 of them had biliary hypoplasia and 3 showed biliary atresia.Cholangiography was given up in 21 children because of liver cirrhosis.These patients were diagnosed with biliary atresia and then were treated by Kasai portoenterostomy. Conclusions Laparoscopic-assisted cholangiography is a simple,accurate,and safe method in the diagnosis of prolonged jaundice in infants.By using the procedure,the whole biliary tree can be shown clearly without leading to serious injuries.