China ; Health Facilities ; statistics & numerical data ; Humans ; Occupational Diseases ; prevention & control

Objective To investigate the value of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma.Methods The clinical data of 10 patients with hilar cholangiocarcinoma who were admitted to Chenggong Hospital of Xiamen University from January 2012 to September 2012 were retrospectively analyzed.The two-dimensional computed tomography images were converted to three-dimensional images with the three-dimensional visualization system,and then the volume of liver and tumor size,volume of liver to be resected,remnant liver volume were measured.Surgical procedure was planned based on the three-dimensional images,and the difference between the actual and planned surgical procedures was analyzed.The correlation between actual liver resection volume and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.Results The mean liver volume,tumor size,predicted liver resection volume and remnant liver volume of the 10 patients detected by the three-dimensional visualization system were (1496 ± 162) ml,(67 ± 18) ml,(335 ± 241)ml and (1140 ± 197)ml,respectively.The average error rate of predicted liver resection volume was 6.4％.Surgical plan was made in accordance with the principle of curative hepatectomy,including 4 cases of left semihepatectomy,2 cases of right semihepatectomy,3 cases of partial liver resection and 1 case of palliative liver resection.The coincidence rate between the planned and actual surgical procedures was 9/10.R0 resection was performed on 7 patients,R1 resection on 1 patient and palliative resection on 2 patients.One patient received restrictive portal vein arterialization.Preoperative evaluation of the anatomy of blood vessels,bile ducts and tumors based on three-dimensional images was confirmed with operative findings.The accuracy of tumor typing by the three-dimensional visualization system was 8/10.The actual liver resection volume was (325 ± 258) ml,which was positively correlated with the predicted liver resection volume (r =0.902,P ＜ 0.05).Conclusion The three-dimensional visualization system is helpful in the treatment of hilar cholangiocarcinoma.

Objective To explore the application value of three-dimensional (3D) visualization combined with portal vein (PV) arterialization technologies in pancreaticoduodenectomy.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with duodenal cancer who was admitted to the Chenggong Hospital of Xiamen University in August 2015 were collected.The preoperative plain scan images in the upper abdomen and enhanced scan images in the arterial and PV phases using 320-slice spiral CT were converted to the 3D images by 3D visualization technology.The 3D data were used for detecting tumor invading pancreatic head and organizational structure surrounding hepatic hilus,and making a preliminary surgical plan.Open exploration found that tumor involved pancreatic head and didn't invade superior mesenteric artery and vein,and then pancreaticoduodenectomy was applied to the patient during operation.Intraoperative proper hepatic artery-PV end-to-side anastomosis was used for increasing R0 resection rate.Operation time,volume of intraoperative blood loss,result of postoperative pathological examination,liver function and complication and vascular patency at postoperative week 1 and vascular patency at postoperative month 1 were observed.The patient underwent color Doppler ultrasound and digital subtraction angiography (DSA) at postoperative month 1 in order to detect blood vessels,and was followed up by outpatient examination for observing tumor till November 2015.Results There was a clear and solid 3D reconstruction model between anatomical position of tumor and blood vessels,and preoperative assessment was consistent with intraoperative finding.Operation time and volume of intraoperative blood loss were 6.5 hours and about 1 500 mL.The patient was confirmed as intestinal diffuse large B-cell lymphoma by postoperative pathological examination.The patient had normal liver function at postoperative week 1 and discharged from hospital at postoperative week 2,without abdominal secondary hemorrhage,infection,pancreatic fistula,intestinal fistula and other severe complications.PV blood flowing was normal by color Doppler ultrasonography at postoperative week 1 and month 1.DSA examination showed that there was no proper hepatic artery images and visible compensatory liver artery at postoperative month 1.During follow-up,no tumor recurrence was detected.Conclusion 3D reconstruction model can provide an accurate preoperative assessment,and PV arterialization technology for unreserved hepatic artery has a certain degree of clinical value in pancreaticoduodenectomy.

Objective To compare the clinical efficacy of herbal ion application and penetration therapy applied in the dog days, or in both of the dog days and coldest days for the treatment of recurrent respiratory tract infection (RRTI) in children. Methods This intervention was designed as a multi-center, randomized, single-blind, repeated-measurement design. A total of 240 RRTI children were randomly divided into Sanfu group (N=120, herbal ion application and penetration therapy applied in the dog days) and Fujiu group (N=120, herbal ion application and penetration therapy applied in both of the dog days and coldest days). Each group was treated for one year and then was followed up for one year. Before and after the treatment, we observed the frequency of respiratory tract infection, the period of onset, signs and symptoms of traditional Chinese medicine (TCM), and detected the salivary secretory immunoglobulin A (sIgA) at different time points. Results (1) The therapeutic effect of Fujiu group was better than that of Sanfu group, and the difference was significant (P<0.05). (2) The frequency of respiratory tract infection was reduced, the period of onset was shortened, and TCM signs and symptoms were improved in both groups, and the effect of Fujiu group was superior to that of Sanfu group (P<0.05). (3) Salivary sIgA showed a continuous upward trend in Fujiu group while a mild downward trend in Sanfu group at different time points (P<0.05). Conclusion Herbal ion application and penetration therapy applied in both of the dog days and coldest days shows better effect for the treatment of children RRTI than that applied only in the dog days.

Objective To evaluate the narrow-band imaging (NBI) in differential diagnosis of colo-rectal proliferative lesions. Methods Suspected lesions in colon were examined with white light and NBI colonoscopy, respectively. The ensitivity and specificity in diagnosing colorectal inflammatory hyperplasia, adenoma, early cancer and advanced cancer were compared between NBI and conventional colonoscopy with reference to pathology as gold standard. The pit patterns and the surface microvessels of the lesions were also determined and scored with NBI combined with magnifying endoscopy, and were compared with pathological diagnosis. Results (1) A total of 368 lesions were detected in 280 patients with conventional colonoscopy and NBI. The sensitivity and specificity of NBI in differential diagnosis of colorectal lesions were superior to those of conventional colonoscopy. (2) The pit patterns of colorectal inflammatory hyperplasia were mainly type Ⅰ and Ⅱ , while in adenomas were mainly type Ⅱ and Ⅲ (94. 2%). The pit patterns of early cancer were type Ⅲ (18. 8%), Ⅳ (56. 3%) and Ⅴ (25.0%), and those of advanced cancer were mainly type Ⅴ (94. 0%). (3) The average scores of surface microvesseis of colorectal inflammatory hyperplasia, ade-noma, early cancer and advanced cancer were 1.35 ± 0. 72, 3. 86 ±1.07, 6. 52±2. 59 and 11.42 ± 3.59, respectively. Scores over 6. 5 was a strong indicator of malignant lesions. Conclusion NBI is superior to conventional eolonoscopy in differential diagnosis of colorectal lesions. Observing pit patterns and microves-sels of the lesion with combination of NBI and magnifying endoscopy is helpful in diagnosis.

Objective: To analyze the status of personnel in occupational disease prevention and treatment institutions in Hunan Province, China, from 1996 to 2015, to predict staff composition using grey model (GM) (1, 1) , and to provide a scientific basis and reference for optimizing human resource planning of occupational disease prevention and treatment in other provinces and regions and promoting the service capacity of the institutions. Methods: The data of the staff in occupational disease prevention and treatment institutions in Hunan Province, China, from 1996 to 2015 were obtained from the established basic information management system. The descriptive analysis method was used to analyze the dynamic changes in number and composition of the staff and the GM (1, 1) was used to predict the staff composition. Results: The numbers of the staff members in 1996 and 2015 in occupational disease prevention and treatment institutions in Hunan Province, China were 1591 and 1429, respectively. In the twenty years, the main education level of the staff transformed from "technical secondary school education and non-academic qualifications" to "bachelor degree or above and college degree"; the main major of the staff transformed from "other majors" to "public health and clinical medicine"; the proportion of the staff members without professional titles changed from >1/3 to 5%; and the proportions of the staff members with senior, intermediate, and junior professional titles were steadily rising. GM prediction showed that the proportions of highly educated staff members in 2018 and 2020 would be up to 41.00% and 45.61%, respectively; and the proportions of the staff members with a major in public health in 2018 and 2020 would be up to 44.15% and 46.60%, respectively. Conclusion The staff in occupational disease prevention and treatment institutions in Hunan Province, China, in the twenty years have slight changes in staff size and great improvement in staff quality, which is beneficial to sustainable development of the occupational disease prevention and treatment undertakings. The education level and major will be further optimized in the next five years.

Objective To investigate the prevalence of occupational diseases and treatment implementation in migrant workers in Hunan,China,and to provide a scientific basis for related departments to develop preventive and treatment measures and social security system for migrant workers.Methods A retrospective investigation was performed in 2015 to collect the information of occupational diseases in migrant workers,and age,type of work,type of occupational disease,and implementation of employment injury insurance for occupation diseases were analyzed.Results The migrant workers with occupational diseases accounted for 50.43％ (11 280/22 368) of all patients with occupational diseases in Hunan,among whom 99.4％ (11 212/11 280) were male workers.The mean age of migrant workers with occupational diseases was 55 years.The types of occupational diseases involved 6 categories such as occupational pneumoconiosis and occupational skin diseases,totaling 42 legal occupational diseases;98.31％ of all migrant workers (11 089/11 280) had occupational pneumoconiosis.The main types of work were underground coal miners (62.42％),heading drivers (29.79％),and haulage workers (2.20％) in coal mines and non-coal mines.A total of 27.25％ migrant workers with occupational diseases (2 072/7 605) enjoyed employment injury insurance,and 20.84％(1 585/7 605) did not receive any medical or life compensations.Conclusion The occupational diseases in migrant workers in Hunan are mainly pneumoconiosis,and a large proportion of those with occupational diseases do not enjoy implementation of treatment.Coal mines and non-coal mines are the high-risk areas for occupational diseases in migrant workers and should be the focus of prevention and control.

Objective To investigate the prevalence of occupational diseases and treatment implementation in migrant workers in Hunan,China,and to provide a scientific basis for related departments to develop preventive and treatment measures and social security system for migrant workers.Methods A retrospective investigation was performed in 2015 to collect the information of occupational diseases in migrant workers,and age,type of work,type of occupational disease,and implementation of employment injury insurance for occupation diseases were analyzed.Results The migrant workers with occupational diseases accounted for 50.43％ (11 280/22 368) of all patients with occupational diseases in Hunan,among whom 99.4％ (11 212/11 280) were male workers.The mean age of migrant workers with occupational diseases was 55 years.The types of occupational diseases involved 6 categories such as occupational pneumoconiosis and occupational skin diseases,totaling 42 legal occupational diseases;98.31％ of all migrant workers (11 089/11 280) had occupational pneumoconiosis.The main types of work were underground coal miners (62.42％),heading drivers (29.79％),and haulage workers (2.20％) in coal mines and non-coal mines.A total of 27.25％ migrant workers with occupational diseases (2 072/7 605) enjoyed employment injury insurance,and 20.84％(1 585/7 605) did not receive any medical or life compensations.Conclusion The occupational diseases in migrant workers in Hunan are mainly pneumoconiosis,and a large proportion of those with occupational diseases do not enjoy implementation of treatment.Coal mines and non-coal mines are the high-risk areas for occupational diseases in migrant workers and should be the focus of prevention and control.

Objective:To investigate the causal relationship between trimethylamine N-oxide (TMAO) and its precursors (betaine, carnitine, and choline) and pancreatic diseases based on the Mendelian randomization (MR) method.Methods:Genome-wide association study data of TMAO, betaine, carnitine, choline, acute pancreatitis (AP), chronic pancreatitis (CP), pancreatic cancer (PC), and circulating immune cell characteristics (white blood cell, lymphocyte, monocyte, neutrophil, eosinophil and basophil) were collected. According to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-MR reporting guidelines, the available genetic variants [single nucleotide polymorphism (SNP)] were strictly screened. The causal relationship between exposure (TMAO and its precursors) and outcomes (pancreatic diseases and circulating immune cell characteristics) was evaluated using inverse variance weighting (IVW), MR-Egger regression and weighted median. The reliability of the results was evaluated by sensitivity analysis based on MR-Egger regression, MR-PRESSO, Cochrane's Q test and leave-one-out method. Results:A total of 36 SNP associated with TMAO and its precursors were included. Five of these were associated with TMAO, 13 with betaine, 12 with carnitine, and 6 with choline. ① MR analysis showed that TMAO may increase the risk of AP [odds ratio ( OR) = 1.100, 95% confidence interval (95% CI) was 1.008-1.200, P = 0.032], and choline may reduce the risk of alcoholic acute pancreatitis (AAP; OR = 0.743, 95% CI was 0.585-0.944, P = 0.015). The analysis results of MR-Egger regression and weighted median were consistent with the IVW results. There is no evidence to support a causal relationship between TMAO and its precursors and the risk of CP and PC. Sensitivity analysis indicated that SNP analyzed by MR showed no heterogeneity and low pleiotropy. The leave-one-out method analysis determined that after excluding any SNP, the effect intervals of the remaining SNP on the results were similar to the overall effect intervals, which suggested the robustness of MR results. ② There was a positive causal relationship between plasma TMAO level and circulating monocyte count ( OR = 1.017, 95% CI was 1.000*-1.034, P = 0.048, * represented that the data was obtained by correcting to 3 decimal places from 1.000 1). The causal effect obtained by MR-Egger regression and weighted median analysis was consistent with the results of IVW. Sensitivity analysis illustrated SNP analyzed by MR showed no heterogeneity and pleiotropy. The leave-one-out method analysis determined that after excluding any SNP, the effect intervals of the remaining SNP on the results were similar to the overall effect intervals, which suggested the robustness of MR results. Conclusion:TMAO and choline may change the risk of AP, and TMAO may contribute to the increase of circulating monocyte count in AP.