Sharing medical data may reduce unnecessary repetitive studies and promote the cooperation between research groups.By analyzing the mature practices of some other countries,we proposed solutions to China's current problems in sharing medical research data,such as formulating sharing policies,strengthening platform construction and enhancing international cooperation.

The acceptance assessment is an important part of research project management.By analyzing the content,methods,process and model of the current acceptance assessment of medical research projects in China,we summarized and elaborated the main problems in the medical research management.By referring to the mature practices of some other countries,we proposed the solutions to improve the quality of acceptance assessment in China,i.e.,balancing the qualitative and quantitative assessment,improving the quality of peer-review,constructing information platform,introducing independent third party assessment and construing the overall process evaluation system.Our study may provide important reference for constructing the high-quality evaluation system of medical research projects in China.

Objective To monitor the clinical epidemiology and etiology of acute diarrhea in children in the outpatient setting in Shanghai .Methods An active surveillance study in Children′s Hospital of Fudan University between August 2013 and July 2014 was conducted .Outpatient children with acute diarrhea were enrolled in this study and stool samples were collected .Pathogens including norovirus ,diarrheagenic Escherichia coli (DEC) , nontyphoidal Salmonella spp .(NTS),Campylobacter,Shigella,pathogenic vibrio and Yersinia enterocolitica were identified and typed .The χ2 test was used for statistical analysis .Results Of the 881 stool samples from enrolled children , the pathogens included into the target detection were identified in 246 (27 .92% ) cases . Norovirus ,DEC ,NTS ,Campylobacter and Shigella were detected in 98 (11 .12% ) cases ,74 (8 .40% ) cases , 61 (6 .92% ) cases ,34 (3 .86% ) cases and 2 (0 .23% ) cases ,respectively .Neither pathogenic vibrio nor Yersinia enterocolitica was identified .Children younger than 36 months old (3 .27% ,26/794) had a lower risk (χ2=7 .41 ,P=0 .006) of Campylobacter infection compared with older children (9 .20% ,8/87) .Vomiting (37 .76% ) and watery diarrhea (21 .34% ) were more commonly seen in children with norovirus infection;fever and mucous stool were commonly seen in diarrheal children with NTS infection (40 .98% and 21 .31% ,respectively) and Campylobacter infection (29 .41% and 26 .47% ,respectively) .Conclusion Enteric pathogens play a major role in childhood acute diarrhea in Shanghai .Continuous monitoring of enteric pathogens will be helpful for reasonable treatment and prevention of acute diarrhea in children .

OBJECTIVETo discuss the applied value of rescue intracytoplasmic sperm injection(ICSI) after complete fertilization failure during in vitro fertilization (IVF) cycles.

METHODSAfter 16-18 h co-culture with sperm, all the unfertilized oocytes with the first polar body were re-fertilized by ICSI.

RESULTSAfter rescue ICSI, the abnormal fertilization rate was 17.9% and the normal fertilization rate was 42.7%. Twenty-four hours later, the normal cleavage rate of the normal fertilized oocytes was 79.6%. On the day of embryo transfer, the good-quality rate of embryos was 29.7% (22/74). A mean number of 3.4 (54/16) embryos were transferred to the patient during each cycle. Clinical pregnancy was found in 3 cases out of the 16 (18.8%).

CONCLUSIONThe applied value of rescue ICSI may be correlated with the number and maturity of oocytes on the retrieval day.

OBJECTIVETo separate high-quality sperm by PureSperm centrifugation applied to intrauterine insemination (IUI) cycles.

METHODSWe compared the separate results after washing the semen with one-layer and two-layer PureSperm gradient centrifugation methods and two-layer Percoll gradient centrifugation method, and used the recovered high-quality sperm for IUI.

RESULTSThe density of the sperm washed with one-layer PureSperm centrifugation method was significantly higher than that washed with two-layer Percoll and two-layer PureSperm centrifugation methods(P < 0.01), but there were no differences in all the results between the use of two-layer Percoll and two-layer PureSperm(P > 0.05). No significant differences in the motility, teratozoospermia and IUI results were found when the three methods were used for sperm preparation(P > 0.05). The percentage of morphologically normal sperm was markedly increased, and the non-sperm components such as leucocytes, epithelial cells and cellular fragments were significantly reduced after washed by the two methods.

CONCLUSIONPureSperm centrifugation is a safe, efficient and easy method for separating high-quality sperm on intrauterine insemination cycles.

Objective To investigate the relationship between serum progesterone level at the day with human chorionic gonadotrophin (hCG) administration and pregnant outcome from in in-vitro fertilization-embryo transfer(IVF-ET). Methods From Mar. 2002 to Apr. 2007, 786 cycles with serum progesterone measurement on the day of hCG administration for final oocyte maturation in IVF were analyzed retrospectively in Reproductive Medicine Center in First Affiliated Hospital of Nanjing Medical University.All stimulations were down-regulated with gronadotrophin release hormone agonist (GnRH-a) in both long protocols and short protocols before gonadotrophin stimulation. When the thresholds of serum progesterone were set at 5.5, 6.0,6.5,7.0,7.5,8.0,8.5 and 9.0 nmol/L, respectively. If the level of progesterone was less than the thresholds, those patients were in lower progesterone group, on the contrary, more than the threshold value, those patients were in higher progesterone group. The laboratory results and the clinical outcomes between all patients at lower and higher progesterone group at different thresholds value were analyzed. Results The rate of normal fertilization, quality embryos, successful implantation, chemical pregnancy, clinical pregnancy and live birth did not exhibit remarkable difference between patients with higher and lower serum progesterone level at multiple thresholds on the day of hCG administration in the 786 cycles (P >0.05). However, when the thresholds of serum progesterone were at 8.5 and 9.0 nmol/L, early abortion rates of 27.3% (3/11) and 3/7 in higher progesterone group were significantly higher than 8.8% (26/297) and 8.6% (26/301) in lower progesterone group (P<0.05). And the total abortion rates of 3/7 in higher progesterone group were significantly higher than 11.0% (34/301) in lower progesterone group when the thresholds of serum progesterone were 9.0 nmol/L (P<0.05). Conclusions This study did not prove the correlationship between progesterone level at the clay with hCG administration and the probability of clinical pregnancy or live birth. However, early abortion rates or the total abortion rates were associated with higher progesterone level when the thresholds of serum progesterone were at 8.5 nmol/L or 9.0 nmoL/L.

Objective we assessed our institutional outcomes of hybrid treatment for aortic arch disease with supra-aortic debranching and endovascular stent graft repair.Methods From March 2016 to November 2016,6 patients underwent Hybrid total aortic arch repair:1 had aortic arch pseudoaneurysm;1 had type Ⅲ aortic dissection;4 had aortic arch aneurysm because of hypotension,of whom 1 with aneurysm prerupture and 1 with Aortic intramural hematoma.Supra-aortic vessels were involved and high-risk for traditional operations in all patients.Bifurcated artificial vessels were used,main vessel was end-to-side anastomosed with ascending aorta.Branching vessel were end-to-end anastomosed with right innominate artery and left subclavian artery,end-to-side anastomosed with left common carotid artery.Then,stent graft was implanted into ascending aorta and aortic arch.All patients were followed postoperatively,with regularly contrast computed tomography angiogram (CTA) and echocardiography(discharge,three months,six months,and yearly).Results Hybrid procedure with supra-aortic debranching and endovascular stent graft repair were completed in all patients,technical success rate was 100％.There were no perioperative obvious morbidity and mortality,follow-up period were 2-9 months.1 patients had stroke during follow-up period,condition improved after treatment.Supra-aortic vessels were patency and there were no endoleak in all patients.There were no recurrent aortic disease during follow-up period.Conclusion Hybrid aortic arch replacement can be performed with good postoperative and early results in high-risk patients for traditional open repair.

Objective To investigate the effect of early adequate enteral nutrition (EN) on diaphragmatic thickness and prognosis of mechanical ventilation (MV) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by ultrasound. Methods Sixty-two MV patients with AECOPD and feasible to receive early EN were admitted to the Department of Intensive Care Unit (ICU) of Wenling Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from April 2017 to March 2018, and they were divided into an observation group and a control group according to random number table, 31 cases in each group. Besides conventional treatment, both groups started EN (EN) within 2 days, in the observation group, the EN was adequately treated, and the target calories were gradually reached within 3 days; in the control group, nourishing feeding was given, and the target calories were gradually reached after 7 days. Ultrasound was used to measure the diaphragmatic end-expiratory muscle thickness (DTee) and end-inspiratory muscle thickness (DTei) before and after treatment for 3 days, 7 days, and the diaphragmatic thickening fraction (DTF) were calculated; in addition, the MV time, ICU time of stay, 14-day success rate of off-line and incidence of ventilator associated pneumonia (VAP) were compared between the two groups. Results There were no statistical significant differences in the comparisons of age, arterial blood gas analysis and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score etc general status, and the parameters of DTee, DTei and DTF between the two groups before treatment (all P > 0.05). No statistical significant differences in DTee were found after treatment for 3 days, 7 days and after off-line in the comparisons between the two groups (mm: 3 days was 2.69±0.12 vs. 2.68±0.15, 7 days was 2.70±0.14 vs. 2.70±0.13, off-line was 2.71±0.15 vs. 2.70±0.10, all P > 0.05); while the DTei of the two groups were decreased after treatment for 3 days of treatment, the difference between the two groups being not statistically significant (mm: 3.27±0.13 vs. 3.26±0.12, P > 0.05), but the levels of DTei in the two groups were significantly increased after treatment for 7 days and after off-line, the differences between the two groups being statistically significant (7 days: 27.26±5.25 vs. 28.74±6.39, off-line: 34.19±4.78 vs. 30.10±2.90, both P < 0.01). There was no significant difference in MV time and ICU time of stay between the two groups [MV time (days): 7.8±1.0 vs. 8.5±1.2, ICU time of stay (days): 11.4±2.6 vs. 12.1±2.8, both P > 0.05], the 14-day success rate of off-line and incidence of VAP were similar in the two groups, and the difference were not statistically significant [14-day success rate off-line: 77.42% (24/31) vs. 70.98% (22/31), incidence of VAP: 6.45% (2/31) vs. 9.68% (3/31), both P > 0.05]. Conclusion The early adequate EN therapy can improve diaphragmatic function and prognosis in MV patients with AECOPD.

Objective To identify the risk factors of the incidence rate of initial poor graft function (IPGF)in recipients after living donor liver transplantation. Methods Clinical data of 309 patients undergoing living donor liver transplantation were retrospectively analyzed. Candidate risk factors:(1 )donor factors included age,gender and body mass index (BMI);(2)recipient factors included age,gender,BMI and preoperative Child-Pugh classification,model for end-stage liver disease (MELD)grading,preoperative renal insufficiency,serum total bilirubin elevation,hyponatremia and hypopotassaemia;(3)graft factors included graft cold ischemia time,graft recipient weight ratio (GRWR);(4)recipient surgery factors included total operation time,blood loss volume,blood transfusion volume,platelet transfusion and anhepatic phase≥1 00 min. Single factor analysis was performed to identify the potential risk factors of IPGF. Logistic regression analysis was conducted to explore independent risk factors. Results and Conclusions Child-Pugh C of preoperative recipient liver function,MELD score≥20,serum total bilirubin elevation(>68. 4μmol/L),hyponatremia(<1 35 mmol/L), hypopotassaemia (<3. 5 mmol/L)and anhepatic phase≥1 00 min were potential risk factors of IPGF (all P<0. 05 ). Child-Pugh C of preoperative recipient liver function was an independent risk factor of the incidence rate of IPGF following living donor liver transplantation (P=0. 01 9).

Objective To explore the relationship between the serum gamma glutamyl transpeptidase (GGT) level and the prognosis of liver cancer patients undergoing living dornor liver transplantation.Methods A retrospective analysis was made on 139 liver cancer cases receiving living donor liver Tx from Apri 2005 to Oct 2015 in Sichuan University Huaxi Hospital.GGT cut-off value of 71 U/L was calculated from the ROC curve method (sensitivity was 72.2％,specificity was 59.0％).According to the values of the cut-off patients were divided into high GGT group (73 cases) and low GGT group (66 cases),chi-square test was used to judge its correlation with capillary tumor emboli and Kaplan Meier method to determine the overall survival rate difference.Results The tumor vascular invasion,AFP level,tumor size were in disfavour for higher GGT group (P ＜0.05).The 1,3,5 year's survival rates were 59.0％,44.5％,39.7％,for high GGT group,and in low GGT group it was 78.6％,63.6％,63.6％,P =0.010).Conclusions The liver cancer patients with high preoperative serum GGT values have poor long-term prognosis after receiving living donor liver transplantation.