Objective:Toinvestigate the etiological agents of the outbreak ofhand-foot-mouth disease(HFMD)in ChongQing area from April to September in 2009.Methods:100 specimens(including cerebral spinal fluid,vesicle fluid,stool,throat swabs,anal swab) were collected from 47 patients with HFMD during the epidemic season.The specimens were inoculated into RD cells for isolation of enteroviruses(EV),The supernatant of cytopathic effect(CPE)were detected by RT-PCR with universal primers of enterovirus, genus-specific primers of EV71 and genus-specific primers of Coxsackie A16,and the amplified products were sequenced to determine the outbreak of the pathogen enteroviruses(EV),The sequencing results will be compared with international representatives BrCr strain to identify the enteroviruses(EV)by Bioedit biological software.Results:In the 100 cell cultures of clinical specimens of children HFMD, apparent Cytopathic were observed in 7.The results of RT-PCR showed that seven specimens were positive with intestinal universal primers,and three were positive results with EV71-specific primers,which were from two cases of out-patient children and one with clinical diagnosis of suspected case,while the negative results were obtained with CA16-specific primers for all the samples.The recovery of the PCR products were cloned and the sequencing identification confirmed as EV71 virus,while sequencing analysis of homology-related in the results.Conclusion:EV71 were the major etiological agents of the HFMD outbreak in Chongqing from February to April in 2009.

Objective To explore the relationship between vertebrobasilar insufficiencies caused by subclavian steal syndrome and degree or type of steal phenomena.Methods 80 patients who were diagnosed subclavian steal syndrome by transcranial doppler ultrasound were analyzed retrospectively,24 cases in them were received digital subtraction angiography.The degree of steal phenomena were determined by direction of blood flow in the ipsilateral vertebral artery,and the type of steal phenomena were determined by whether basilar artery involved in steal phenomena.Finally,we made the correlation analysis between vertebrobasilar insufficiency caused by subclavian steal syndrome and degree or type of steal phenomena.Results There was a significant relationship between the severity of subclavian artery stenosis and degree of VA steal in 24 patients performed with both TCD and DSA(t =15.59,P ＜0.05).There was no significant relationship between the vertebrobasilar insufficiency and severity of steal phenomena (P ＞0.05).There were 21cases(77.8％) exist vertebrobasilar insufficiency in the patients whose basilar artery were involved in steal phenomena,and there were 18 cases(33.9％) exist ertebrobasilar insufficiency in the patients whose basilar artery were not involved in steal phenomena.There was a significant differences between the two type of steal phenomena(P ＜ 0.05).Conclusion The vertebrobasilar insufficiency caused by subclavian steal syndrome doesn't associate with the degree of steal phenomena,and associates with the type of steal phenomena.Paying close attention to whether basilar arteries are involved in steal phenomena is useful for analyzing the patient 's condition and guide clinical treatment.

OBJECTIVE: Autologous bone transplantation has been extensively used clinically, but the scant bone source eligible for transplantation cannot meet the demand in large bone defect repair. Tissue engineering seems to provide a way out, by inducing bone regeneration for repairing bone defect. In this article, the authors review the development in bone tissue engineering achieved in recent years.DATA SOURCES: A literature review was conducted with Google and Medline-based search for reports published in Chinese on bone tissue engineering in the last 3 years, as well as for worldwide literature published from January 1964 to December 2002, using the key words for retrieval of bone tissue engineering, scaffold, hydroxyapatite composites.STUDY SELECTION: Fifty-six articles were selected, which documented in vtiro bone culture, non-crystal medical biomaterials, development of bone tissue engineering, experimental and clinical trials of bone tissue engineering and clinical application of the results of bone tissue engineering.DATA EXTRACTION:From the 56 articles, 14 were excluded for repetition of contents. The remaining 42 were classified for reviewing and 21 of these were enrolled as references here.DATA SYSTHESIS: Autologous bone grafting is the usual choice for bone defect repair. The grafts include allografts and xenograft of spongy bone and compact bone, joints, decalcified bone matrix, marrow, ceramics and ceramics composites. But the effect of repair or reconstruction of large bone defect as left by excision of large bone tumors is not satisfactory. Tissue-engineering studies on composites for repair of the damaged nerve, tendon and skin are still in their infancy, while studies of bone scaffold materials has made great progress.CONCLUSION: Great breakthroughs have been made in tissue engineering and relevant studies of tissue defect and function impairment is fast developing. As the structure of motor system and skeletal system are relatively simple,and the bone or cartilage defects clinically common, bone tissue engineering might first enter clinical use in the field of orthopedics.

Objective To observe the head and neck CTA application value in the diagnosis of ischemic cerebrovascular disease.Methods 430 patients with suspected diagnosis of ischemic cerebrovascular disease were adopted with head and neck CTA examination.The carotid artery stenosis degree,grade and plaque formation were observed,and the sensitivity and specificity of CTA in the diagnosis of ischemic cerebrovascular disease were calculated.Results After CTA examination,a tctal of 293 cases (68.14％) with carotid artery stenosis symptoms,among them 87 cases of mild stenosis,moderate stenosis in 169 cases,35 cases of severe stenosis and occlusion in 2 cases.430 plaques were detected in 430 patients,in extracranial arteries,81 soft plaques were identified,as well as 134 calcified plaque and 107 cases of mixed plaque,totally 322 cases;in intracranial arteries 312 cases of the soft plaque were identified,as well as 115 cases of calcified plaque and 97 cases of mixed plaque,totally 524 cases.The sensitivity of CTA in the diagnosis of ischemic cerebrovascular disease was 97.09％ and the specificity was 83.33％.Conclusion In the diagnosis of ischemic cerebrovascular disease,head and neck CTA examination for head and neck vascular stenosis and plaques has visual assessment,and high sensitivity,specificity.

Objective To compare the efficacy and safety of precise hepatic pedicle anatomic hepatectomy and the irregular hepatecto-my method, and to analyze the clinical application value of precise hepatic pedicle dissection. Methods The clinical data of 120 patients with hepatocellular carcinoma treated in our hospital from Mar. 2009 to Mar. 2013 were analyzed retrospectively, and they were divided into the experimental group and the control group according to the patients’ clinical characteristics and their needs of treatment. The experimental group were given precise hepatic pedicle dissection, while the control group were given irregular liver excision. The effect, complications and recurrence rate of the two methods were compared. Results The operation time, the volume of blood during operation, hospitalization time and the cost of hospitalization of the experimental group were were less than those of the control group with statistically significant difference between the two groups (P<0. 05). The incidence of complications in the experimental group was 10. 0%, recurrence rate was 13. 3%;whereas in the control group, the incidence rate was 33. 3%, the recurrence rate was 35%, it is of significant differences between the two groups (P<0. 05). The aspartate aminotransferase and alanine aminotransferase levels of the experimental group were significantly lower than those of the control group with a statistically significant difference (P<0. 05). Conclusion The precise hepatic pedicle dissection is of significant efficacy, low complication and relapse rate, and it is of certain clinical application value.

Objective To assess the role of the combination of Helicobacter pylori (H.polyri)antibody detection and serum pepsinogen (PG) examination (ABC method) in risk prediction of gastric cancer.Methods From July 2014 to July 2015,a total of 320 patients underwent gastroendoscopy examination because of stomach discomfort were enrolled.According to the results of serum H.polyri antibody test,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio (PGR),patients were divided into four groups:group A was both H.polyri and PG negative,group B was H.polyri positive and PG negative,group C was both H.polyri and PG positive,group D was H.polyri negative and PG positive.The incidence rates of gastric cancer were compared among the groups.PG positive was defined as PG Ⅰ ≤70 μg/L and PGR≤3.0.And according to the results of gastroendoscopy examination and histopathology,the levels of gastrin 17,PG Ⅰ,PG Ⅱ and PGR of different atrophic regions with different pathological changes and atrophic degree were compared.Chi-square test and analysis of variance were performed for statistical analysis.Receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of serum PG Ⅰ and PGR in gastric cancer diagnosis.Results Among the 320 patients,there were 159 patients in group A,124 patients in group B,23 patients in group C and 14 patients in group D,respectively.The incidence of gastric cancer in group A,group B,group C and group D were 0.63％ (1/159),4.03％ (5/124),13.04％ (3/23) and 3/14,respectively.The incidences of gastric cancer in group C and D were much higher than those in group A and B (x2 =11.700 and 21.900,both P＞0.01).Among the 320 patients,there were 179 cases in non-atrophic gastritis group,129 in atrophic gastritis group and 12 in gastric cancer group.The PG Ⅰ and PGR levels of gastric cancer group were (46.84 ± 24.07) μg/L and 3.21 ±1.45,which were lower than those of atrophic group ((100.09±48.15) μg/L and 9.78±7.32) and nonatrophic group ((103.97 ± 44.72) μg/L and 13.09 ± 9.05),and the differences were statistically significant (F=12.460 and 30.290,both P＜0.01).The PGR level of severe atrophy group was 5.62±3.00,which was significantly lower than those of moderate atrophy group (10.04 ± 6.08) and mild atrophy group (11.61±4.05).And the PGⅡ level of severe atrophy group was (18.85±10.54) μg/L,which was much higher than those of moderate atrophy group ((14.63 ± 11.19) μg/L) and mild atrophy group ((10.88 ± 7.41) μg/L),and t he differences were statistically significant (F=8.057,P＜ 0.01;F =3.374,P=0.021).The gastrin 17 level of antrum atrophy group was 2.16 pmol/L (1.12 pmol/L to 4.15 pmol/L),which was lower than those of gastric body atrophy group (4.49 pmol/L,1.88 pmol/L to 18.71 pmol/L) and whole gastric atrophy group (6.18 pmol/L,2.63 pmol/L to 17.82 pmol/L),and the differences were statistically significant (H=13.408,P＜0.01).The optimal cut-off values of PG Ⅰ and PGR for the diagnosis of gastric cancer were 66.7 μg/L and 4.45.Conclusions ABC stratification has certain value in gastric cancer screening in China,however,it still needs improvement.For patients with digestive symptoms,PG Ⅰ ≤ 66.7 μg/L and PGR ≤4.45 can be considered as high risk of gastric cancer and suggested to receive gastroendoscopy examination.

To treat residual or recurrent stones after operation on hepatolithiasis conveniently and effectively, a subcutaneous permanent tunnel to bile duct (SPTBD) was established in 564 cases of hepatolithiasis by using an afferent jejunum or a well-functioned gallbladder in order to provide a postoperative way to remove residual or recurrent stones through cholangioscopy. We found that by cutting SPTBD open to remove residual or recurrent stones through cholangioscopy in 96 out of 238 followed-up cases, all the patients got good clinical effects without death or complications. The results suggest that it is a good method to establish a SPTBD during operation in patient with hepatolithiasis. It is a simple and effective way to cut SPTBD open to remove residual or recurrent stones after operation.

With the constant development and perfection of hospital information systems, health information legislation has become a problem needing prompt solution. The authors explained the urgency and significance of health information legislation in the current practice of hospital information systems and pointed out specific manifestations of the involvement of legal basis. Their recommendations include: ①establishing and perfecting regulations on the management of local networks; ②establishing and perfecting a system of regulations on health information; ③expanding the development, accreditation and spread of techniques for guaranteeing network safety; ④doing a good job of the standard application and management of electronic medical records in the transition period.

[Objective]To evaluate long term curative effect on treatment of developmental dislocation of hip(DDH) in children between 18~36 months old by combined close-reduction method of adductor-cut,close-reduction and frog type plaster fixation.[Method]One hundred and fifty-six children(232 hips) treated by combined close-reduction method in 1993 to 2001 were followed-up with mean follow-up time of 9.2(5.5~14.5) years.There were 77 hips of grade Ⅰ dislocation,95 hips of grade Ⅱ,and 60 hips of grade Ⅲ according to Zhou Yongde grading criteria.Periodical imaginological and hip joint function examinations were evaluated and analyzed.[Result]One hundred and ninety-five hips obtained satisfactory concentric reduction with excellent and good rate of 84.05% according to Zhou Yongde criteria.There were 9 hips with femoral head necrosis at follow-up.Mean preoperative acetabular index(AI) of successful reduction hips was(35.34?5.96)%,and that of failure reduction hips was(44.51?5.32)%.The excellent and good rate were 84.41% in cases of grade Ⅰ hips,85.21% in grade Ⅱ hips,and 81.67% in grade Ⅲ hips.[Conclusion]Combined method of adductor-cut,close-reduction and frog type plaster fixation is an effective way for treatment of DDH of children between 18~36 months old.Preoperative AI but not degree of dislocation is the criteria to determine whether close-reduction is necessary or not.

Objective To explore the anesthesia effect and influence of combined spinal epidural anesthesia (CSEA)with head -up of 10°on maternal hemodynamics during cesarean section.Methods 120 pregnant women undergoing cesarean section were selected,and were randomly divided into group A,B and C,40 cases in each group. Three groups were all given CSEA,yet pregnant women in group A were taken supine position,group B was taken head-up of 10°,and group C was taken head -up of 20°.Hemodynamic parameters of three groups of the following time points were compared,including before anesthesia(T0 ),5min after anesthesia(T1 ),skin incision(T2 ),fetal disen-gagement immediately(T3 ),and operation at the end(T4 ),also anesthesia effect was recorded,and usage of ephedrine and local anesthetic was noted,and adverse reactions were compared.Results Compared with T0 ,group A's hemody-namics in T1 decreased,including systolic blood pressure (SBP),diastolic blood pressure (DBP),and increased in T2 and T3 ,yet there were no statistical differences on hemodynamics in three groups in T4 .Compared with group B and C,there were statistical differences on hemodynamics in T1 ,T2 and T3 in group A(t =3.63 -7.25,P <0.05 or P <0.01),yet there were no statistical differences on hemodynamics in group B and C(t =0.00 -0.93,all P >0.05). Anesthesia block scores in group A,B and C were (2.0 ±0.3)points,(2.5 ±0.2)points,(2.6 ±0.2)points,and scores of B and C were higher than that in group A(t =3.92,4.01,all P <0.05).Cases and total usage of ephedrine in group A were higher than those of group B and C(χ2 =31.43,50.61,t =16.27,20.17,all P <0.01).Cases of adjusting surgical position,and addition of local anesthetic in group C were significantly higher than those of group B (χ2 =23.85,28.47,all P <0.01).Conclusion It has better anesthetic effect of taking CSEA by head -up of 10°, and maternal hemodynamics are more stable,can better meet operation's requirements,also with easier operation,so it is superior to supine position and head -up of 20°.