Child ; Humans ; Respiratory Syncytial Virus Infections ; immunology ; virology ; Respiratory Syncytial Virus, Human ; immunology ; pathogenicity

Introduction: Gallstones disease is a common disorder and symptomatic disease is usually managed with surgery while those with common bile duct stones are usually managed with endoscopic intervention before proceeding to surgery. This study was intended to assess the rate of cholecystectomy among patients who had undergone ERC interventions, the reasons for not proceeding to cholecystectomy and related complications. Materials and Methods: Patients who had intact gallbladder and had undergone ERC for stones related complications over a two year period were retrospectively identified from the Endoscopic Unit Registry. Detailed case note reviews were conducted. Results: The overall cholecystectomy rate post-ERC interventions was 36.9% (48/130). Cholecystectomy was offered to 59.2% (n=77) and the uptake was only 58.4% (n=45/77). Among those who agreed for cholecystectomy, 11.1% (n=5/45) failed to turn up for their scheduled surgery. Three patients (6.7%) had symptoms recurrence before their scheduled surgery: two subsequently underwent cholecystectomy without ERC intervention and one who was pregnant was managed conservatively with holecystectomy. Among the patients who had declined cholecystectomy, 18.8% (n=6/32) had symptoms recurrence. Four patients required repeat ERC interventions and eventually all had cholecystectomy subsequently. The most common reason for declining cholecystectomy was 'not keen' and already asymptomatic (46.9%, n=15/32). Among patients who were not offerred cholecystectomy (n=53/130), symptoms recurrence occurred in 15.2% (n=7/53). Four patients required repeat ERC interventions and three subsequently underwent cholecystectomy. Conclusions: The cholecystectomy rate remains low after ERC interventions. Recurrence of symptoms necessating re-interventions occurred in patients offerred and not offerred cholecystectomy. The uptake rate should be improved and delay to cholecystectomy should be reduced to avoid symptoms recurrence. Patients not undergoing interventions should be advised regarding symptoms recurrence and should be monitored.
Choledocholithiasis ; Cholecystectomy ; Cholangiopancreatography, Endoscopic Retrograde ; CHOLELITHIASIS

Objective To study the clinical application of laparoscopy in the treatment of closed abdominal trauma. Methods Emergent laparoscopic exploration and treatment was conducted in 21 patients with closed abdominal trauma, who had stable hemodynamic parameters,from July 2000 to December 2003. Results Diagnosis was clarified laparoscopically in all the 21 patients. There were 4 cases of open liver repair, 2 cases of laparoscopic liver repair, 5 cases of open splenectomy, 3 cases of hand-assisted laparoscopic splenectomy, 2 cases of video-assisted small incisional intestinal repair, 4 cases of partial intestinal resection and 1 case of laparoscopic greater omentum hemostasis. Conclusions Laparoscopy in the diagnosis and treatment of closed abdominal trauma is accurate, safe and effective.

Abstract: To report the diagnosis and treatment of Mucor infection in two cases of renal transplantation, and to provide reference for diagnosis and treatment of Mucor infection. Case 1, a male patient, who underwent allogeneic kidney transplantation due to increased creatinine for more than 8 years. The renal function had partially recovered 25 days after the operation, but then the patient suddenly got worse epigastric pain. Pathogen culture, smear microscopy, mass spectrometry identification and next-generation metagenomic sequencing (mNGS) were performed on the peritoneal drainage, with the result pointing to Rhizopus microsporus. The patient's condition improved after antifungal treatment using amphotericin B lipid complex (ABLC) and was discharged. Case 2, a male patient with hypertension and increased creatinine for more than 7 years was admitted to the hospital. After allograft kidney transplantation, tissue culture smear and histopathological examination suggested Mucor infection. The patient then underwent a "hand muscle debridement surgery + closed negative pressure drainage (VSD)" procedure, and amphotericin B was given postoperative treatment against Mucor infection and debridement. Subsequent retesting with mNGS showed no signs of Mucor infection. In the course of treatment, two patients developed abdominal pain after treatment with tegacycline, which was immediately diagnosed as pancreatitis and recovered after withdrawal. Both patients being male, with one case associated with hypertension. After initially guiding the diagnosis with traditional smear tests, final confirmation was done using histopathological examination, mNGS and mass spectrometry. One case was infected by Rhizopus microspora, and the other was infected by Rhizopus oryzae and Cunninghamia microbicans. The causes leading to Mucor infection in patients post renal transplantation varied greatly. Early diagnosis is the key to treatment of patients with Mucor infection after renal transplantation. Treatment with amphoteric B and its liposome is an effective means to improve mucormycosis patients after renal transplantation. The use of amphotericin B lipid complex treatment proved to be an effective treatment method for patients with Mucor infection after renal transplantation.

0.05).The death rate of cases with pneumonia combined with ascites was higher than that of cases with ascites only(?2=4.894,P=0.027) and cases without ascites and infections(?2=9.260,P=0.002).Unfavorable prognosis was found in cases with Enterococcus faecium isolated before OLT.CONCLUSIONS Severe lung infection before OLT is one of the main reasons of death.It is important to grasp characteristics of infection,evaluate risk fully,control infections and screen cases strictly before OLT to improve survival rate.

Objective To assess the Chinese System for Cardiac Operative Risk Evaluation (SinoSCORE) model in patients undergoing heart valve surgery at our center.Methods From January 2009 to December 2011,2098 consecutive adult patients who underwent heart valve surgery at our center were collected and scored according to the SinoSCORE model.All patients were divided into three risk subgroups.The entire cohort and each risk subgroup were analysed.Calibration of the SinoSCORE model was assessed by the Hosmer-Lemeshow(H-L) test.Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.Results Observed mortality of all 2098 patients was 3.00％.Despite there were significant differences between the SinoSCORE population and our own population sample,the SinoSCORE model showed good calibration(Hosmer-Lemeshow:P =0.783) and discriminative power (area under the ROC curve of 0.752)in predicting in-hospital mortality at the entire cohort.Conclusion The SinoSCORE model give an accurate prediction for individual operative risk in heart valve surgery patients at our center.

Objective To observe the efficacy of pregabalin in the treatment of painful diabeticperipheral neuropathy.Methods In a 8-week study,50 patients were randomly assigned into two groups:the therapy group and the control group.The patients in the therapy group were treated with pregabalin 150 mg/d,and the patients in the control group were treated with carbamazepine 200 mg/d.The dose of pregabalin was increased to 300 mg/d till pain was alleviated in the therapy group,and the dose of carbamazepine was increased to 600 mg/d till pain was alleviated in the control group.The therapeutic effect and VAS score in the two groups were observed and evaluated.Results After 1 and 8 weeks' treatment,the therapeutic effect of therapy group were significantly superior to the control group ( At 1 week:U =2.028,P =0.046 ; At 8 week:U =3.540,P ＜0.001 ).After 1 and 8 weeks' treatment,the VAS scores of therapy group were significantly lower than the control group ( At 1 week:5.13 ± 1.76 vs.6.74 ± 1.52,P ＜ 0.05 ; At 8 week:1.13 ± 0.45 vs 3.27 ± 1.04,P ＜ 0.05).There were 5 patients (20％) and 10 patients (40％) had adverse reaction in the therapy and the control groups respectively.Conclusion Pregabalin is effective and safe for the treatment of painful diabetic peripheral neuropathy.

· AlM:To analyze the association between the macular thickness and emmetropic, low myopic, moderate myopic and highly myopic eyes.
·METHODS:The 276 teenagers (276 eyes) between 18~28 years treated in our hospital from January, 2013 to May, 2014 were selected, whose corrective visual acuity was≥1.0 and intraocular preasure was ≤21mmHg and who were willing to participate in this research.Forty-nine emmetropic, 72 low myopic, 104 moderate myopic and 51 highly myopic eyes were measured by optical coherence tomography ( OCT ) to detect the central subfield thickness, bitamporal, superior, lateral and inferior region thickness of inner and outer region, average thickness of retinal macula, foveal thickness and retinal volume.The thickness of different parts of macula lutea was measured and statistically compared among emmetropic, low myopic, moderate myopic and highly myopic eyes.
· RESULTS: The central subfield thickness of emmetropic, low myopic, moderate myopic and highly myopic eyes were (225.38±20.97), (230.97±19.15), (227.01±16.92), (231.91 ±18.97 )μm. The average thickness of retinal macula, of emmetropic, low myopic, moderate myopic and highly myopic eyes were (280.92±12.71), (278.15± 11.90), (270.05±12.07), (267.93±11.08) μm.There were no significant differences of center thickness (F=1.253, P=0.291) and central subfield thickness ( F=1.034, P=0.378) between emmetropic, low myopic, moderate myopic and highly myopic eyes.The macular thickness of inner and outer region in moderate myopic eyes was significantly less than that in emmetropic eyes, and there was significant difference (P<0.05).Comparison between low myopic, moderate myopic and highly myopic eyes was carried out and macular thickness of all regions of inner and outer region in moderate myopic group was significantly increased, and there was significant difference (P<0.05).There was no significant difference when compared with the macular thickness of inner and outer region of the highly myopic group (P>0.05).
· CONCLUSlON: ln low myopic eyes of teenagers, the center macular thickness do not become thinner. However, the macular thickness of inner and outer region is thinner than that of emmetropic eyes.Furthermore, with the increase of the degree of the myopia, the amount of macular thinner gradually decreases from outer region to inner region.

Objective To investigate the health condition of swimmers who swim in a river in Guangzhou city and to know the influencing factors in order to provide the scientific data for making the diseases control guide for swimmers swimming in the river.Methods The swimmers who swam in a river in Guangzhou city were selected and the cluster sampling survey was conducted by telephone interview and questionnaires in 2006.The statistic analysis of the data was done with the chi-square and Logistic regression.Results 17.9% of the investigated swimmers felt disconffortable in the first time to swim in the river,the main symptoms were eye and skin symptoms,12.2% had the same symptoms in second time to swim in the river,there was a significant difference between the prevalence rates of the eye symptoms.The Logistic regression analysis showed that the following factors were associated with the prevalence of discomfortable symptoms:age,gender,swimming with any kinds of tampon in unclean river water,in the first time to swim in the river and in the second time to swim in the river,the related OR values were 0.95 and 0.97,3.55 and 2.32,14.83 and 6.7.Other factors associated with the prevalence of discomfortable symptoms were as follows:swimming period in unclean fiver water,swimming stroke,chokes the water,times of choking water,using earplugs,head position in water,the related OR values were 1.06,0.50,2.1,1.22,0.44,1.65.Concousion To swim in the natural unclean river may cause the discomfort,the main problems are eye and skin symptoms.