Objectives To investigate the recurrence risk factors and the protective factors of aortic dissection (AD) DeBakey type Ⅲ. Methods 43 patients with AD DeBakey type Ⅲ who were in Guangdong General Hospital from May 2014 to September 2014, were enrolled as the case group, while 27 volunteers exclude AD as the control group. Blood chemistries and other information obtained immediately after admissions , χ2 test or T test was used for univariate analysis of independent samples. Multivariate Logistic regression analysis was used to screen patients with recurrence risk factors or protective factors. Results The prevalence of hypertension (93.02%vs. 18.52%, P = 0.000) and proportion of smokers (34.88% vs. 11.11%, P = 0.027) were significantly higher in case group than control group. Logistic regression analysis showed that hypertension (OR=5.148, 95%CI= [2.209~13.058], P=0.001) and albumin level (OR=0.709, 95%CI = [0.541~0.929], P=0.013) were significantly associated with recurrence of aortic dissection DeBakey type Ⅲ. Conclusion Hypertension is an independent risk factor for recurrence of aortic dissection DeBakey type Ⅲ, and albumin level is a protective factor.

Objective To study the clinical manifestations and influencing prognostic factors of children with acute paraquat in-toxication ,and to search for reasonable and effective treatments .Methods Retrospectively analyzed the clinical data of 68 children with acute paraquat intoxication from March 2005 to June 2012 .According to the amount of toxic dose and clinical symptoms ,all of them were divided into 3 groups ,mild type(22 cases) ,severe type(26 cases) and fulminant type(14 cases) ,retrospective analysis on clinical manifestation ,auxiliary examination and prognosis among the groups and following up the survival of these patients ,the risk factors which may affect the prognosis were explored .Results 66 cases were poisoned by taking orally and the other 2 cases were poisoned by the skin absorption .Gastrointestinal symptoms were the most common .Among 68 cases ,6 cases was lost the following up ,20 cases died(32 .26% mortality):all children from mild type survived ;8 patients from severe type and 12 patients from fulmi-nant type(30 .77% ,85 .71% ,mortality respectively ) .As the degree of the clinical classification deteriorated ,the mortality in-creased ,there was statistical signification between each other and so did the blood urea nitrogen and serum creatinine (P<0 .05) .By following up ,children who once passed the acute stage can recovery and the pulmonary fibrosis might be reversed by the chest CT follow-up .The logistic regression analysis indicated that children who had been diagnosed with acute kidney injury and multiple or-gan dysfunction syndrome showed the worse prognosis .Conclusion Acute kidney injury is a very important factor for the short term prognosis of paraquat intoxication ,while pulmonary fibrosis determine the long-term outcomes ,lung injury may be reversed in the course of the disease ,so we should take active treatments .

Objective To analyze the status of hepatitis B and BCG vaccination in children with special health status, and analyze the reasons for the delay of vaccination, so as to improve the timely vaccination rate. Methods A total of 1 129 children with special health status who were registered and vaccinated in our hospital from September 1, 2018 to January 23, 2020 were selected. All children were classified according to the major diseases based on the discharge records. The first injection time of hepatitis B and BCG vaccine was extracted, and the children were divided into different groups based on the number of people who delayed vaccination. The comparison between groups was performed by χ² test. Results A total of 87 children without hepatitis B vaccination and 85 children without BCG vaccination were immediately vaccinated in our hospital after the establishment of the archives in our hospital. None of the 1 129 children with special health status had serious adverse reactions after vaccination. The most common diseases in the delayed hepatitis B vaccination children were premature infants, cardiovascular diseases, and nervous system diseases. The most common diseases in the delayed BCG vaccination children were premature infants, cardiovascular diseases, and neonatal disease. There was a significant difference between the number of delayed hepatitis B vaccination and the number of delayed BCG vaccination, with the number of delayed BCG vaccination being more (χ²=278.24, P<0.00). Conclusion Delayed vaccinations are common in children with special health status. Normal vaccination does not increase the incidence of adverse reactions in children with special health status. Medical staff’s understanding of diseases, types of diseases, and types of vaccines are important factors affecting the vaccination of children with special health conditions. Support from social environment, the understanding and cooperation from children's parents and guardians, and the understanding of medical workers on vaccines and diseases are the keys to truly improve the vaccination rate of children..

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures