Objective To analyze the causes of residual gallbladder disease after claparoscopic cholecystectomy. Methods From Feb-ruary 2006 to February 2013, there were 30 patients with residual gallbladder disease after laparoscopic cholecystectomy, and they were given second surgery in our hospital. Results The residual gallbladder lesions were successfully removed. Symtoms before operation were relieved or disappear. The average duration of hospital stays was 8. 2 d. The difference between before and after surgery was statistically significant(P<0. 05). There were 2 cases of delayed wound healing, and the others were of good curative effect. And blood test indicators of all the pa-tients recovered to normal when they leave hospital. Conclusion The surgery was carried out strictly accordding to the relevant procedure to prevent the occurrence of residual cystic lesions. If the patients were found to have obvious symptoms of residual gallbladder disease,they should be early diagnosed and recieved second surgery as soon as possible so as to cure disease and improve quality of life after surgery.

The evaluation of the immunosuppression state in liver transplanted recipients is vital for a correct posttransplantation management and a major step towards the personalized treatment of the immunosuppression.To date,immunological monitoring after liver transplantation relies mainly on clinical judgment and pathological examination of the graft,without a proper assessment of the actual state.Previous studies have ever identified many markers for acute rejection(AR) and immune tolerance after liver transplantation.Many markers for AR are pro-inflammatory or immunoregulatory cytokines and other proteins related to inflammation.However,many markers have been proved to be also able to predict other diseases and only a few of the markers for AR have been validated.Standard liver tests cannot be used as markers for graft rejection due to the low sensitivity and specificity.This review summarized the potential markers for AR and immune tolerance after liver transplantation based on published literatures in recent years and to provide evidence for clinical application.

ABSTRACT:To explore the feasibility of DNA barcoding in the identification of sandflies ,the mitochondrial cytochrome c oxidase subunit I (COI) genes of 9 dominant species in China from three genera in the Phlebotominae were studied .The in‐traspecies and interspecies genetic distances were calculated using the Kimura‐2‐parameter model ,and the phylogenetic trees were reconstructed by neighbor‐joining (NJ) method .Results showed that all of sandflies species were successfully distinguish‐ed by the phylogenetic trees .The average intraspecific genetic distance (0 .8% ) was much less than the average interspecific ge‐netic distance (11 .2% ) .The study based on COI sequences indicates that the sandflies from China could be well distinguished with the commonly used COI barcodes ,which are potentially well utilized in sandflies species identification .

Objective To compare the diversity of mitochondrial genomes of Angiostrongylus cantonensis in the mainland of China. Methods According to the population genetic of A. cantonensis,seven female worms were selected to characterize the mi-tochondrial(MT)genomes. Twelve primer pairs based on known MT genome(GQ398121)were used for PCR. The target frag-ments were sequenced and aligned. The gene localization,genome structure,composition of nucleotide,distribution of variable sites,and phylogeny were analyzed by employing multiple softwares. Results Five distinct types were identified from seven com-plete MT genomes. They were similar in size and structure,i.e.,ranging 13 491-13 502 bp,including 12 protein-coding genes,2 ribosomal genes,22 tRNA genes,and 2 major non-coding regions. All the genes were localized at the same strand and had the same transcription direction. A total of 745 variable sites were identified,accounting for 5.5%. Among the variable sites,59 were deletion/insert mutations,105 transversions,and 581 transitions. The variable sites distributed evenly at the complete genome. Conclusion The study reveals the mutation profile in the whole MT genome of A. cantonensis and thus will facilitate the develop-ment of intraspecific differential diagnosis.

Objective To assess the efficacy, safety and surgical strategies of clipping without coil removal in recurrent aneurysms after previous coil embolization. Methods Five patients with recurrent embolized aneurysms underwent microsurgical treatment in our hospital from May 2012 to July 2014 were chosen. Posterior communicating aneurysms were noted in two patients and anterior communicating ones in three patients. The initial sizes ranged from 3-10 mm in diameter; in these aneurysms, the initial coiling results indicated complete occlusion in 5 patients. The mean recurrence latency was 14 months (ranged from 0.7-30 months). Surgical treatment without coil removal in recurrent aneurysms was performed and their clinical data and treatment efficacy were retrospectively analyzed. Results Microsurgical clippings without coil removal were used in all 5 patients. No postoperative morbidity was observed (one had left arm monoparesis, one had psychiatric symptoms, and one had blepharoptosis and recovered soon); postoperative imaging studies revealed complete occlusion of the aneurysms. There were no recurrent aneurysms during the follow-up period (6 and 12 months after surgery) by CT scan. Conclusion The microsurgical clipping without coil removal for recurrent lesions of embolized aneurysms is effective and safe when it is technically feasible.

Objective To analyze the safety of renal transplant from donors with primary central nervous system (CNS) tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about (21.8± 46.4) months (range:0.5 to 192.0 months).The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments (craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy),14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of (15.9 ± 8.2) months (range:2.7 to 35.5 months),one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.

Objective: To analyze the epidemiological characteristics of pulmonary tuberculosis among students in Wuhan from 2011 to 2020, and to provide a basis for the scientific development of interventions and strategies. Methods: Epidemiological distribution, time of onset and treatment, as well as treatment outcomes of student tuberculosis in Wuhan from 2011 to 2020 registered in the national tuberculosis information management system were described. Results: During 2011-2020, 4 337 student tuberculosis patients in Wuhan were registered. The average annual incidence rate was 22.44/10 million, and the annual decreasing rate of 7.86% The incidence of male and female patients was 1.76:1, and the incidence rate of male was higher than that of female( χ 2=184.18, P <0.01). Most of patients aged 19-22 years old, accounting for 47.89%; Tuberculosis reports were highest during March to May, and September to November, and lowest during January to February, and July to August. Student patients were mainly concentrated in Hongshan District, Jiangxia District and Wuchang District, where schools were more distributed in Hongshan District, Dongxihu District, Wuchang District and Xinzhou District. The median duration from tuberculosis onset to treatment was 9(3, 21) days, which varied significantly by region, age, nationality, and patient residence ( Z =-9.25, 47.14, 9.88,43.96, P <0.01). The treatment and outcome of student tuberculosis patients were varied significantly by year and nationality( P <0.05). Conclusion The incidence of student tuberculosis in Wuhan City showed a slow downward trend. Most of student tuberculosis are college and high school students. Time and place of case detection are relatively fixed. The time of treatment and the outcome of treatment vary significantly. Tuberculosis prevention and control strategies should be formulated according to the local conditions according to the tuberculosis distribution characteristics, as well as enhancing surveillance, health promotion, active discovery and supervision management of tuberculosis in school settings.

Objective To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports .Methods A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017 .She had a low level of donor specific antibody (DSA ) against human leucocyte antigen (HLA ) B62 due to severe acute rejection (AR) after her first kidney transplantation .For desensitization , plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day .Clinical data and outcomes were retrospectively analyzed .Results Renal graft regained immediate function after transplantation .Preformed DSA could be detected at 1 week .However ,there was no de novo DSA .At 1 year post-transplantation ,preformed DSA turned negative .During a follow-up period of 2 years ,renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1 .73m2 .No AR episode or proteinuria occurred .DSA stayed negative .Simultaneously physical development also caught up .Her height of 93 cm tall and weight of 13 .5 kg at month 24 & 8 months corresponded to normal grow th curve of her age .Conclusions Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes .With surgical precisions and optimized managements ,kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors .

Objective To determine the genotype and clustering characteristics of multidrug-resistant (MDR) mycobacterium tuberculosis in Wuhan City. Methods A total of 149 mycobacterium tuberculosis strains from MDR tuberculosis (MDR-TB) patients were genotyped by DTM-PCR, mycobacterial interspersed repetitive unit–variable number tandem repeat typing (MIRU-VNTR) and sequencing of drug-resistant associated genes. The Hunter-Gaston discriminatory index (HGDI), clustering rate and recent minimum estimated infection rate were calculated. Results The cumulative HGDI of all MIRU loci was 0.9944. Gene locus with the highest HGDI（0.6467）was QUB11b. Combing MIRU-VNTR and DTM-PCR, 111 unique genotypes and 11 clustered genotypes（38 strains）from 149 isolates were identified. The clustering rate was 25.50%, and the recent minimum infection rate was estimated to be 18.12%. After further genotyping by sequencing of drug-resistant associated genes, the results showed that 17 (44.74%) strains in each cluster shared the same mutation sites, while the other strains had different mutation sites. Conclusion The combination of DTM-PCR, 24 locus MIRU-VNTR typing and drug resistance gene sequencing demonstrates a relatively high discriminatory power, which is suitable for the genotyping of multi drug resistant mycobacterium tuberculosis in Wuhan. The epidemic of MDR-TB in Wuhan is mainly caused by reactivation, and the recent transmission rate is not high.

Objective To analyze and evaluate the implementation effect of tuberculosis prevention and control program in Wuhan, and to provide reference for scientific formulation of tuberculosis prevention and control measures. Methods Using the National Tuberculosis Information Management System, descriptive statistical analysis was carried out on the medical record information of pulmonary tuberculosis patients registered in Wuhan , 2016 - 2021. Results A total of 34 937 cases of pulmonary tuberculosis were registered in Wuhan , with an average annual incidence rate of 49.85/100 000. The incidence rate showed a downward trend year by year, with a statistically significant difference in 2016—2021 (χ²_trend = 708.387, P<0.001). The patients mainly came from referrals, accounting for 71.86%, and the proportion of referrals varied significantly among different years (χ²=355.541, P<0.001). The diagnosis type was mainly pathogenic negative, accounting for 49.12%. The proportion of pathogenic negative had statistically significant difference among different years (χ²=1 354.830, P<0.001). The proportion of patients cured and completed the course of treatment reached 93.98%, with statistically significant differences in the proportions among different years (cured, χ²=1 080.252, P<0.001; completed the treatment course, χ²= 933.655, P<0.001). The sputum examination rate of newly diagnosed patients in each year reached over 90%, and the overall completion rate reached over 95%. The proportion of positive pathogens showed an increasing trend year by year. Conclusion The overall epidemic situation of tuberculosis in Wuhan is declining year by year, and tuberculosis prevention and control work has achieved remarkable results. Active screening in key areas and populations should be strengthened, and prevention and control strategies should be formulated by emphasizing the key and difficult points.