Objective To study the incidence of complications of visceral and vascular injury in laparoscopic surgery for gynecologic diseases,and to discuss the ways to decrease the incidence. Methods The data of 2684 patients who received laparoscopic surgery from Januray 2003 to December 2005 in the Department of Obstetrics and Gynecology were reviewed retrospectively.The incidence and treatment of complications of visceral and vascular injury were observed. Results The total incidence rate of complications was 2.53%(n=68),and that of the visceral and vascular injury was 0.37%(n=10).Four cases of injury were related with trocar punctures(injury of omental blood vessel,n=2;postperitoneal vessel,n=2),three took place during the operation (severe bleeding,n=1;bladder injury,n=2),and the other three were observed in the postoperative stage(ureter injury,n=2;intestinal fistula,n=1). Conclusion The complications in laparoscopic surgery for gynecologic diseases are increased with the extension and difficulty of operation,and are closely related with the experience of the surgeons.Proper candidates for the surgery and established operative technique are the key factors in decreasing the incidence.

Objective:To express and purify hemoglobin receptor(HgbA) and its partial fragment(HgbAF) from Haemophilus ducreyi and to develop a sandwich ELISA for the detection of H.ducreyi infection.Methods:The HgbA,a hemoglobin-binding outer membrane protein of H.ducreyi and its partial fragment(HgbAF) were expressed by cloning the genes of hgbA and its 705bp fragment into pET30a and pET28a respectively,and the expressing products were purified from E.coli BL21 with Ni-NTA-His affinity chromatography.The polyclonal antibodies were developed by immunizing rabbits with the rHgbA and rHgbAF.The anti-rHgbA IgG and anti-rHgbAF IgG were purified respectively by saturated amine sulphate precipitation,and their immunoactivity with rHgbA and rHgbAF was tested by Westen blot and ELISA analysis.A Sandwich ELISA was developed for the detection of chinical infection of H.ducreyi using the specific polyclonal antibodies.Results:The HgbA and its partial fragment,HgbAF of H.ducreyi,were expressed and purified successfully by cloning their genes respectively.The results obtained by Western blot analysis showed that each of the antibodies could react with both antigens,rHgbA and rHgbAF.The results of the ELISA analysis showed that H.ducreyi strain was strongly positive,and all other bacteria,including H.influenzae and the bacteria known to relate to genital ulcers were negative.The results of the ELISA analysis showed that the minimum amount of rHgbA detected was 1.56 ng/ml and the minimum number of CFU of H.ducreyi detected was 2?105 cfu/ml in buffer and 1?106 cfu/ml in pus.Conclusion:HgbA and its partial fragment,HgbAF of H.ducreyi are expressed and purified successfully.The polyclonal antibodies developed by immunizing rabbits using rHgbA and rHgbAF could react not only with rHgbA and rHgbAF,but also with H.ducreyi specifically.They do not react with other bacteria,including H.influenzae and the bacteria known to relate to genital ulcers.So the ELISA based on the polyclonal antibodies was specific for the detection of H.ducreyi.Although the level of sensitivity of the ELISA may not be sufficient to detect H.ducreyi in all clinical specimens,further work to increase the sensitivity could potentially make this assay a valuable tool in areas where chancroid is endemic.

Objective To establish a high performance liquid chroma-tography-tandem mass spectrometry ( UPLC-MS/MS) method to deter-mination the plasma concentration of cefdinir and to study the pharmaco-kinctics and bioequivalence of three kinds of cefdinir formulations in healthy volunteers.Methods In a randomized, 3 way-crossover and self-control study, 24 healthy male volunteers were orally administrated with three kinds of cefdinir formulations ( test sample and reference sam-ple) 100 mg.The concentrations of cefdinir in plasma were determined by LC-MS/MS.The main pharmacokinetic parameters were calculated.Results The method was validated by investigating the accuracy and precision for intra and inter -day runs in a linear concentration from 11.50-2300.00 ng· mL-1.The main pharmacokinetic parameters of test (cefdinir tables A drug, cefdinir dispersible tables B drug ) and reference (cefdinir capsules, C drug ) formulations in plasma were shown as follows:tmax were (3.00 ±0.80),(3.20 ±0.90) and (3.50 ±0.70) h ; Cmax were (548.96 ±184.58 ), ( 607.09 ±236.38 ) and ( 570.18 ±172.37 ) ng· mL-1;t1/2 were ( 2.00 ±0.30),(1.90 ±0.40)and (1.90 ±0.30) h; AUC0-t were ( 2755.35 ±956.10 ) , ( 3037.49 ±1014.42 ) and (2756.43 ±804.06 ) ng · mL-1 · h, respectively.The relative bioavailability F were ( 104.20 ±37.50 )% and (111.50 ±29.70)%.Conclusion The method was proved to be accurate, rapid and sensitive.The three kinds of cefdinir formulations are bioequivalent in healthy volunteers.

OBJECTIVEBacterial meningitis is a kind of central nervous system infection with a high incidence, disability and fatality in children. Prompt diagnosis and treatment are associated with an improved prognosis. Low positive rate of bacterial cultures of the cerebrospinal fluid (CSF) makes it difficult to make a definite diagnosis. This experiment aimed to investigate a proteome profile of normal CSF of Chinese children by two-dimensional polyacrydamide gel electrophoresis (2-DE), and to sieve the disease-specific proteins of Staphylococcus epidermidis meningitis (SeM) to provide basis for early diagnosis and treatment of SeM.

METHODSFour mL CSF samples were obtained respectively from SeM and normal children. The separated proteins with immobile pH gradient (IPG) 2-DE technology and protein spots were visualized by Coomassie Brilliant Blue staining. The stained 2-DE gels were scanned on the Imagescanner and pictures were obtained through Labscan software. The images were analyzed with PDQuest software and the differences of protein spots were compared between the SeM and normal children.

RESULTSMean protein spots of the 2-DE gels were 438 and 425 in the SeM and normal groups respectively. Twenty-five protein spots only occurred in normal CSF and 12 spots only occurred in the SeM group. The expression of 6 protein spots showed up-regulation and that of 19 showed down-regulation in the SeM group compared with that in the normal group.

CONCLUSIONSA 2-DE profile of CSF proteome was successfully established in SeM and normal children through proteomic technique. By the differentiated analysis of these CSF 2-DE gels, the differences of CSF proteome profiles were found between SeM and normal children. Future analysis and identification of these spots will contribute to find out the disease specific proteins of SeM and to provide basis for early diagnosis and therapy of this disorder.

Cerebrospinal Fluid Proteins ; analysis ; Child ; Humans ; Meningitis, Bacterial ; cerebrospinal fluid ; Pilot Projects ; Proteomics ; Reagent Kits, Diagnostic ; Staphylococcal Infections ; cerebrospinal fluid ; Staphylococcus epidermidis

OBJECTIVETo compare the predictive values of eight staging systems for primary liver cancer in the prognosis of combined hepatocellular-cholangiocellular carcinoma (cHCC-CC) patients after surgery.

METHODSThe clinical data of 54 cHCC-CC patients who underwent hepatectomy or liver transplantation from May 2005 to Augest 2013 in Chinese PLA General Hospital were collected. We evaluated the prognostic value of the Okuda staging system, Cancer of the Liver Italian Program (CLIP) score, French staging system, Barcelona Clinic Liver Cancer (BCLC) staging system, 7th edition of tumour-node-metastasis (TNM) staging system for hepatocellular carcinoma and intrahepatic cholangiocarcinoma (ICC), Japan Integrated Staging (JIS) score, and Chinese University Prognostic Index. The distribution, Kaplan-Meier method, Log-rank test, and area under a receiver operating characteristic curve were used to compare the prognosis-predicting ability of these different staging systems in 54 cHCC-CC patients after surgery.

RESULTSThe TNM staging system for ICC and JIS score had a better distribution of cases. The 12-and 24-month survivals of the entire cohort were 65.5% and 56.3%, respectively. A Log-rank test showed that there was a significant difference existing in the cumulative survival rates of different stage patients when using TNM staging system for ICC (stage 1 vs. stage 2, P=0.012; stage 2 vs. stage 3-4, P=0.002), Okuda staging system (stage 1 vs. stage 2, P=0.025), and French staging system (stage A and stage B, P=0.045). The 12-and 24-month area under curve of TNM staging system for ICC, BCLC staging system, JIS score, and CLIP score were 0.836 and 0.847, 0.744 and 0.780, 0.723 and 0.764, and 0.710 and 0.786, respectively.

CONCLUSIONThe 7th edition of TNM staging system for ICC has superior prognostic value to other seven staging systems in cHCC-CC patients undergoing surgical treatment.

Bile Duct Neoplasms ; diagnosis ; surgery ; Carcinoma, Hepatocellular ; diagnosis ; surgery ; Cholangiocarcinoma ; diagnosis ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnosis ; surgery ; Neoplasm Staging ; methods ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Survival Rate

OBJECTIVETo determine the detection rate of Helicobacter pylori (Hp) in children with Meckel's diverticulum (MD) and its clinical significance among children with MD.

METHODSEighty-one children with MD were divided into two groups according to the presence (n=45) or absence (n=36) of digestive hemorrhage. The detection rates of Hp in MD tissues and stomach tissues were determined by immunohistochemistry. The detection rates of Hp were compared between the two groups and between the MD tissues with different clinical features in the hemorrhage group.

RESULTSThe detection rate of Hp in MD tissues for the hemorrhage group was 76% (34/45), which was significantly higher than that for the non-hemorrhage group (47%, 17/36) (P<0.05). The detection rate of Hp in stomach tissues for the hemorrhage group (87%, 39/45) was insignificantly higher than that for the non-hemorrhage group (67%, 24/36) (P>0.05). Among patients in the bleeding group, the detection rate of Hp in MD tissues showed no relationship with age, sex, preoperative hemorrhage frequency, amount of hemorrhage, length of MD, basal diameter of MD, and pathological type (P>0.05), but was related to location of MD, presence or absence of ulcer, and depth of ulcer (P<0.05). For the hemorrhage group, a significant positive correlation was found between the detection rates of Hp in MD tissues and stomach tissues (P<0.05), as shown by the Spearman correlation analysis.

CONCLUSIONSThe detection rate of Hp in MD tissues is increased in children with MD complicated by digestive hemorrhage. Hp infection may play some role in the hemorrhage process among children with MD.

Adolescent ; Child ; Child, Preschool ; Female ; Gastric Mucosa ; microbiology ; Gastrointestinal Hemorrhage ; etiology ; microbiology ; Helicobacter pylori ; isolation & purification ; Humans ; Immunohistochemistry ; Infant ; Male ; Meckel Diverticulum ; complications ; microbiology

OBJECTIVETo evaluate the clinical application of transumbilical double-hole laparoscopic operation for incarcerated inguinal hernia in the infants.

METHODSForty-eight cases with incarcerated inguinal hernia (male 39, female 9) aging from 4 months to 3 years (mean 1.2 +/- 0.8 years) received the laparoscopic transumbilical double-hole operation (LTO group) during April.2003 to April.2004. Thirty cases were left side incarcerated inguinal hernia, 12 cases were right side and 6 cases were bilateral. Fifty infants of incarcerated inguinal hernias treated with traditional operation served as controls (TO group). The mean operation time, length of stay, return of bowel function and postoperative complication were compared between the two groups.

RESULTSAll cases of both groups recovered without any complication. The operation time, average hospitalization and return of bowel function in LTO were (30 +/- 5) min, (7.8 +/- 0.3) h and (4.4 +/- 0.3) d, respectively, and in TO were (43 +/- 6) min, (23.3 +/- 2.4) h and (6.7 +/- 0.4) d, respectively. There was a significant difference in the two groups (P < 0.05). The patients in both groups were followed up for 3 months to one year. LTO group had no recurrence or atrophy of testis and TO group had one relapse of hernia.

CONCLUSIONSTransumbilical double-hole laparoscopic operation is safe and microinvasive. It is a useful microinvasive procedure in the treatment of incarcerated inguinal hernia for infant.

Child, Preschool ; Female ; Follow-Up Studies ; Hernia, Inguinal ; surgery ; Humans ; Infant ; Laparoscopy ; methods ; Male ; Treatment Outcome

OBJECTIVETo summarize the major pathological findings, causes of deaths and reasons for misdiagnosis of 141 autopsy cases and thereby to improve the diagnosis level and reduce misdiagnosis.

METHODA retrospective analysis of pathological reports and clinical materials of 141 pediatric autopsy cases from June, 1986 to June, 2006 of our department was performed. Classification was based on (1) international classification of diseases of the World Health Organization; (2) age: cases 28 d-3 years old were defined as infants and young children group, -7 yeas olds were defined as preschool age group, -14 years olds were school age group; (3) when statistics was conducted, the first 3 items of the clinical diagnoses were counted. If one of them was consistent with the pathological diagnosis, it was regarded as basically in accordance with the pathology, if none of the first 3 was consistent with pathological diagnosis, the case was regarded as misdiagnosed.

RESULTS(1) The top three major pathological diagnosis and causes of death were: 1) Classified according to system: 41 cases had tumor (29.1%), 25 cases had respiratory diseases (17.7%), 18 cases had infectious diseases (12.7%); 2) Classified according to disease: 18 cases had malignant histiocytosis, 12 cases had sepsis, 11 cases had lobular pneumonia. (2) The causes of deaths changed gradually. The top cause of death was respiratory diseases during the former 10 years and was tumor during the latter 10 years; the materials showed that 95 cases were 28 d-3 years old (67.4%), and some rare diseases, such as mediastinal and lung chorionic epithelioma (choriocarcinoma), and pulmonary alveolar proteinosis were found. (3) In 90 cases the clinical diagnosis was basically in accordance with the pathological diagnosis (63.8%) and misdiagnosis was found in 51 cases (36.2%).

CONCLUSIONFor clinical diagnosis of critically ill patients, both common and rare diseases should be considered. Analysis of autopsy materials could confirm and/or correct clinical diagnosis and is helpful to summarize clinical diagnosis experience.

Adolescent ; Autopsy ; statistics & numerical data ; Cause of Death ; Child ; Child, Preschool ; Diagnostic Errors ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pathology, Clinical ; Retrospective Studies

Objective To investigate the spatial-temporal distribution characteristics of varicella outbreak in Jiading District in Shanghai from 2015 to 2018. Methods Varicella epidemic report data was collected from the national system of disease control and prevention and analyzed by spatial-temporal scanning statistic methods. Results There were 5 889 varicella cases reported from the year 2015 to 2018, and the annual average incidence rate was 91.68 per 100 000.The incidence rate for children below 3 years old was found to be the highest, reaching 621.45 per 100 000, which was significantly higher than that for the group of 18 years old and above (χ²=16 616.788, P < 0.001).There were 5.41% and 5.31% of the cases in September and February, respectively, which were lower than other months, and the peak incidence occurred in December and November, accounting for 13.41% and 11.95%, respectively.The highest and lowest incidence rates were 151.80 per 100 000 occurring in central urban area and 59.89 per 100 000 in rural area, respectively.The spatial-temporal scanning showed that the low population density area had a wide cluster range and a low effect value.The high population density area has small cluster range and high effect value. Conclusion The incidence of vanicella presents a trend of population, seasonal and regional clustering.Therefore, targeted measure should be taken to prevent varicella in focus population.

Objective To identify the effect of six components of salviae miltiorrhizae on the metabolism of fluvastatin in the human liver microsomes (HLMs) and to further explore the effect of cryptotanshinone and dihydrotanshinone Ⅰ on the metabolism of fluvastatin based on the polymorphism (* 1,* 2,* 3) of cytochrome P450 2C9 (CYP2C9).Methods Establishing the incubation system of HLMs and recombinase and determining the concentration of fluvastatin by HPLC.To calculate the enzyme kinetic parameters,half maximal inhibitory concentration (IC50) and inhibition constant (Ki) so as to compare the impact of different CYP2C9 mutation site on the metabolism of fluvastatin and the influence of components of salviae miltiorrhizae on the metabolism process.Results It was shown that cryptotanshinone and dihydrotanshinone Ⅰ exerted significant inhibition on the metabolism of fluvastatin and the residual activity were 30.24％,14.52％ respectively when the concentrations were 10 μmol · L-1 in the HLMs.However,other exhibited no inhibitory effect.The michaelis constant (Km),maximum velocity (Vmax) and intrinsic clearance (CLint) of CYP2C9 * 1,* 2,* 3 recombinase-catalyzed fluvastatin was (1.56±0.21),(1.79±0.25),(2.32±0.43)μmol· L-1,(41.75±1.67),(26.55±1.08),(12.85±0.79) pmol · min-1 · mg-1 and 26.71,14.86,5.53 μL · min-1 · mg-1 respectively.It was indicated that the metabolic activity of CYP2C9 * 1 was stronger than * 2,* 3.The IC50 value of CYP2C9 * 1,* 2,* 3 recombinase-catalyzed fluvastatin by cryptotanshinone and dihydrotanshinone Ⅰ was (1.74 ± 0.41),(2.64 ± 0.81),(3.17 ± 0.32) μmol · L-1 and (0.19 ±0.09),(0.56 ±0.16),(1.52 ±0.34) μmol · L-1.The IC50 and Ki value of CYP2C9 * 1 was less than * 2 and * 3 but there was statistical significance between the * 1 and * 3 with respect to the difference of IC50 and Ki.Conclusion The mutation site of 430(C ＞ T) and 1075 (A ＞ C) could influence the metabolic activity of CYP2C9.The cryptotanshinone and dihydrotanshinone Ⅰ exerted strong inhibitory effect against CYP2C9 recombinase-catalyzed fluvastatin and their inhibitions on CYP2C9 * 1,* 2,* 3 recombinase-catalyzed fluvastatin were different.