Objective To investigate the surgical strategy of recurrent rectuvaginal fistula. Methods Retrospectivly analyzed the clinical data of 13 patients with recurrent rectovaginal fistula from December 2001 to December 2008. The etiopathogenisis and the ways of treatment were analyzed. Results All the 13 patients with a transverse colostomy surgical repaired with Mason operation in the secondary intention,and recepted closure of colostomy in the third intention for treatment, all patients were cured. No recurrent fistula was identified with postoperative follow-up 4 - 84 months. Conclusions After recurrent rectovaginal fistula with multiple surgical treatment,the blood supply of local tissue is poor,the scar is serious. Selecting the appropriate timing of operation, adequate preoperative preparation, the application of transverse colostomy and Mason operation in different period could significantly enhance the successful operation rate.

The Rh blood grouping system is a critical standardized test in transfusion medicine,espe-cially for the cases related to haemolytic transfusion reactions and neonatal haemolytic disease caused by clinical RhD blood group incompatibility.In the present case report,we presented two cases with the un-common RHD gene variation RHD*DEL37.The blood samples of the two subjects were mistakenly iden-tified as RhD-negative through conventional serological testing.Firstly,both blood samples were tested negative for the RhD antigen using traditional tube test and gel microcolumn methods.The phenotyping of RhCE were identified as ccEe and ccee for each sample,respectively.Secondly,genetic analysis was performed using polymerase chain reaction-sequence specific prime(PCR-SSP)which revealed that nei-ther sample belonging to the several common RHD gene variants which was found in Asia.Moreover,they turned out to be positive for the RHD haplotype,which indicated that exons 1-10 on one of the RHD al-leles were entirely absent.In addition,a T＞C mutation was observed at bases 1154-31 in intron 8 of the other allele,which was located at the intron 8 breakpoint.This result was obtained after further Sanger sequencing of exons 1-10 of the RHD gene.The mutant allele was designated as RHD*DEL37 by the International Society of Blood Transfusion(ISBT)and was identified as D-elute(Del)by phenotype ana-lysis.Both samples were genotyped as RHD*DEL37 and showed positive results.In summary,the true genotype of the two blood samples,of which the screening results only using serological testing method was negative,were RHD*DEL37/RHD-(RHD*01N.01).Notably,this kind of genotype was reported for the first time in Chinese population.Moreover,the two individuals did not have ties of consanguinity,indicating that some of the Chinese individuals could be carriers of the genetic mutation.Therefore,it might be necessary to further confirm the frequency of this mutation in the Chinese population and the possibility of homozygosity for this mutation.This report identifies infrequent RHD gene mutation samples by coupling molecular biology and serological methods to prevent misclassification of blood groups.Com-bining serological and molecular biology test results to determine blood group is critical in protecting pa-tients during clinical transfusion procedures.

Objective To investigate the effect of continuous 4C nursing model on coronary heart disease rehabilitation and provide basis for nursing intervention.Methods From January to June 2015, 90 patients with coronary heart disease hospitalized in Shaoxing People's Hospital were selected as the research object by convenient sampling method. Patients were divided into two groups according to the sequence of hospital admission, with the single number as the control group and the even number as the observation group, each group had 45 patients. Patients in the control group received conventional care model. Patients in the observation received continuous 4C intervention model. The quality of life of two groups of patients and readmission rates were compared.Results All dimensions of quality of life in observation group were higher than those of control group 6 months after discharge, the differences were statistically significant (t=4.159, 3.373, 2.150, 2.162, 3.597, 2.042, 3.913, 2.144;P<0.05). There was no significant difference in readmission rates between the two groups (χ2=0.714,P=0.398).Conclusions The continuous 4C nursing model can improve the quality of life of patients with coronary heart disease, which is worth popularizing and applying.

Objective To study the efficacy and safety of ibutilide for AF and atrial flutter.Methods Thirty-two AF and atrial flutter patients with arrhythmia ≤3 months were randomly divided into ibutilide treatment group (n=17) and amiodarone treatment group (n=15).The patients in ibutilide treatment group were treated with 10 ml 5％ glucose injection containing 1 mg ibutilide,which was repeated after 10 min if it was ineffective and those in amiodarone treatment group were treated with 10 ml 5％ glucose injection containing 150 mg amiodarone,which was repeated after 10 min if it was ineffective.Results The total recovery rate of AF and atrial flutter was significantly higher in ibutilide treatment group than in amiodarone treatment group (64.7％ vs 40.0％,P＜0.05).The mean recovery time of AF and atrial flutter was significantly shorter in ibutilide treatment group than in amiodarone treatment group (29.28±12.57 min vs 70.59±16.83 min,P＜0.01).Conclusion Ibutilide can rapidly recover AF and atrial flutter with a high success rate and a reliable safety.The therapeutic effect of ibutilide is better than that of amiodarone for AF and atrial flutter.

Objective:To investigate the knowledge and compliance status of prevention and control of brucellosis among high-risk populations in counties and districts with high incidence of brucellosis in Xinjiang Uygur Autonomous Region (Xinjiang for brief), and to provide scientific basis for prevention and control of brucellosis and health education for high-risk populations.Methods:Huocheng County, a high incidence county of brucellosis in Xinjiang, was selected as the survey site. Three to six townships were selected, and two to three administrative villages were selected from each township as the survey villages. People over 18 years old and engaged in livestock breeding such as cattle and sheep breeders, livestock product processors, veterinarians and medical personnel were selected as the survey subjects. Face-to-face surveys were conducted by professional trained investigators in autumn and winter (December 2019 to January 2020) and spring and summer (April to July 2020). The survey included general demographic information, awareness of brucellosis prevention and control knowledge and the use of protective equipment.Results:A total of 600 people were surveyed, and 597 people completed the questionnaire, with an effective response rate of 99.50% (597/600). The overall awareness rate of brucellosis prevention and control knowledge was 68.23% (10 184/14 925), among which the awareness rate of clinical symptoms of human infection with brucellosis was high, at 73.53% (3 073/4 179). There were statistically significant differences in the awareness rate of main source of infection, main transmission route and clinical symptoms of human infection with brucellosis among people of different gender, age, nationality, education level and occupation ( P < 0.05). Among them, the awareness rate of clinical symptoms of human infection with brucellosis among veterinarians and medical personnel was 85.38% (514/602). The utilization rate of protective equipment such as rubber shoes and work clothes was high, which was 63.48% (379/597) and 60.97% (364/597), respectively. There were statistically significant differences in the utilization rate of protective equipment among different nationality, education level and occupation ( P < 0.05). Among them, The utilization rate of work clothes was the highest among people with college education or above, veterinarians and medical personnel, which was 82.61% (57/69) and 93.02% (80/86), respectively. Conclusions:The overall awareness rate of brucellosis prevention and control knowledge in high-risk groups in Huocheng County of Xinjiang is low, especially among high-risk groups such as those who are illiterate or have little literacy, and farmers, the awareness rate is low and the awareness of prevention and control is weak. There is a risk of brucellosis infection. It is necessary to further strengthen the education of brucellosis prevention and control knowledge among these groups.

Objective:To understand the current status of personal protection in occupational population at high risk for brucellosis in China and provide evidence for the evaluation of implementation of National Brucellosis Prevention and Control Plan (2016-2020).Methods:Four counties in Shanxi Province and Xinjiang Uygur Autonomous Region were selected to conduct a questionnaire survey in occupational population at high risk for brucellosis from December 2019 to July 2020 by using cross-sectional survey methods.Results:A total of 2 384 persons at high risk for brucellosis were surveyed, and the standardized utilization rate of personal protective equipment (PPE) was 20.13% (480/2 384). The utilization rate of glove, mask, rubber shoe, and work cloth were 38.26% (912/2 384), 31.80% (758/2 384), 32.01% (763/2 384) and 30.87% (736/2 384),respectively. There were significant differences in the utilization rate and standardized utilization rate of the four types of PPE among populations in different age, occupation, educational level and area groups (all P<0.001). The utilization rate and standardized utilization rate of PPE were lower in people over 60 years old, women, farmers, and those with lower educational level. The results of multivariate analysis showed that occupation and area were the influencing factors for the standardized utilization of PPE, the standardized utilization rates of PPE were higher in herdsmen and veterinarians. The standardized utilization rate of PPE in Yanggao County and Huocheng County was significantly higher than that in Zuoyun County and Hunyuan County. Conclusions:The utilization rate of the four types of PPE in occupational population at high risk for brucellosis was not high in China, and the standardized utilization rate was low, lower than the requirement in National Brucellosis Prevention and Control Plan, and there were significant differences among different areas. It is urgent to distribute PPE to occupational population at high risk for brucellosis and carry out health education about PPE utilization. Meanwhile, it is necessary to strengthen information exchange or sharing among different areas.

Objective:To understand the current status of knowledge of brucellosis prevention and control among occupational groups at high-risk of brucellosis, and to provide a scientific basis for assessing the effectiveness of brucellosis prevention and control in China.Methods:A total of four counties in Shanxi Province and Xinjiang Uygur Autonomous Region were selected as survey counties from 2019 to 2020, and 600 people from the occupational groups at high-risk of brucellosis in each survey county were selected as survey respondents, and basic information and knowledge of prevention and treatment were collected through questionnaires. Single-factor and multi-factor logistic regression models were used to analyze the factors affecting the population's knowledge of prevention and treatment.Results:A total of 2 411 people participated in the survey and 2 384 valid questionnaires were obtained, including 1 405 males and 979 females, with the youngest age being 18 years old, the oldest being 91 years old, and the median being 57 years old. The overall knowledge of brucellosis prevention and control was 17.74% (423/2 384). The knowledge rate was lower among people over 60 years old, farmers, and people with less than elementary school education (13.99%, 14.50%, and 13.78%), and higher among women, herders, and people with elementary school education (20.02%, 36.33%, and 19.58%); the knowledge rate was lower in Hunyuan County (0.51%), and the differences in overall knowledge rates by age, occupation, education level, and region were statistically significant (χ 2 = 18.25, 87.18, 11.05, 197.43, P < 0.001). Multi-factor logistic regression analysis showed that gender, occupation, literacy and region were associated with knowledge of prevention and treatment ( P < 0.05). Conclusions:The overall knowledge of prevention and treatment among high-risk occupational groups in the key areas of China's brucellosis prevention and treatment program is low, with a large gap with the goals of the national brucellosis prevention and treatment program, and gender, occupation, literacy level, and region are the influencing factors of the knowledge of prevention and treatment. There is an urgent need to carry out a variety of health education activities for high-risk occupational groups and to strengthen the exchange of experience on brucellosis prevention and treatment between regions.

Objective:To understand the drug treatment status of echinococcosis patients in Jimusar County, Changji Prefecture, Xinjiang, and to explore the construction of medical cooperation system for echinococcosis patients, and to provide reference for optimization and popularization of medical cooperation system.Methods:Data of echinococcosis patients registered in Jimusar Center for Disease Control and Prevention from 2009 to 2018 were collected. The data of patients' medical records and follow-up information were collected by the principle of double entry. The research methods of combining quantitative and qualitative methods were applied to investigate the baseline of patient prevention and treatment system (including regional distribution, education level, recurrence, follow-up medication, etc). Follow-up was conducted on the whole treatment process of echinococcosis patients in the pilot counties, and comparative analysis was made on the treatment situation before and after the use of medical cooperation system. Logistic regression model was used to analyze the indicators that might affect the follow-up effect. Semistructured questionnaire survey was used to analyze the implementation effect of the medical cooperation system.Results:Patients were mainly distributed in rural areas (81.48%, 154/189), mostly in high schools and below (94.18%, 178/189), 39.68% (75/189) were relapsed and treated again, and 68.25% (129/189) were treated with non-standard medication. Influencing factors of effective follow-up medication in echinococcosis patients showed that patients with no side effects, abnormal liver function during follow-up, two or more times of B-ultrasound examination and multiple cysts had higher effective follow-up medication rate ( P < 0.01 or < 0.05). After the implementation of the integrated medical cooperation system, the proportion of unknown stages of diagnosis of cystic echinococcosis in Jimusar County decreased by 60.18%. The pilot counties initially formed a management model of echinococcosis patients based on outpatient, disease control and health centers. Conclusions:Echinococcosis patients have high recurrence rate in Jimusar County, and the effective follow-up medication rate is low. The medical cooperation system for echinococcosis patients in Xinjiang is explored, and the working mechanism of medical institutions linked with disease control institutions is formed. The working model suggestion is put forward, which could provide a scientific basis for further promotion and comprehensive evaluation of the medical cooperation system.