ObjectiveTo evaluate the efficacy,safety and clinical value of anterior urethral fusion to treat diphallia.MethodsA 17-year-old male patient with complete penile diphallia was treated in March 2011.The physical examination showed two completely separated mature penis; urethrography,and urethroscope showed the two urethras were completely separated and entered the bladder respectively.Two anterior urethras were incised respectively at ventral sides ( from the meatus to bulbar urethra) and then two incised anterior urethras were splintered by a continuous suture with 4-0 polyglactin sutures in side and side.Two penises were splintered into one.The nocturnal penile tumescence test and the penis vibration thresholds were assessed before,and after surgery..ResultsThe patient was followed up for 12 months.There was no hematoma,urinary fistula,urinary incontinence and other complications postoperatively.The penis was recovered with normal appearance; urination and morning erection of penile were normal.6 months after surgery,there was no significant difference in the nocturnal penile tumescence and penis vibration thresholds detection ( P ＞ 0.05).ConclusionThe operation of anterior urethral fusion is a safe and efficient surgical treatment to treat partial complete penile diphallia with less complication and no worse effect on urination and erection of penile.

Objecgive To investigate the HB awareness,the infection rate of HBV and the immunity status among adults at the communities of Wuxi,and to provide some evidences for vaccination strategy.Methods Two communities were enrolled in the study through cluster sampling method.A household survey was conducted to collect subjects' information through a face-to-face interview and blood samples were collected to detect HBsAg,anti-HBs,HBeAg,anti-HBe and anti-HBc.Results 3744 subjects were enrolled in this study.The general knowledge coverage rate of hepatitis B was high and 87.30%respondents claimed that hepatitis B was an infectious disease.The percentage of subjects who got more than 5 scores in persons had got hepatitis B vaccination was 60.18%(239/393),and this was significantly higher than in those without vaccine inoculation(x2=17.07,P＜0.01),with the proportion being 49.49%(1071/2164).rnIe percentage of subjects who got more than 5 scores in persons had family history of HBV infection was 60.00%(318/530),and this wag significantly higher than in those without family history (x2=53.05,P＜0.01),with the proportion of 43.00%(1382/3214).The standardized HBV infection rate was 49.88%.There were 1109(29.62%)subjects whose HBsAg,anti-HBs,HBeAg,anti-HBe and HBcAg were negative.There were 8 subjects(0.21%) whose HBsAg,HBeAg and anti-HBc were positive simultaneously,and there were 133 subjects(3.55%)whose HBsAg,anti-HBe and anti-HBc were positive simultaneously.The positive rate of anti-HBc was significantly higher in males than in females( 59.37%and 53.08%,P=0.00).The positive rates of HBsAg,anti-HBs,HBeAg,anti-HBe and HBcAg were 2.84%,44.05%,0.64%,1.93%,33.44%respectively in 20 year age group,while they were 5.69%,65.85%,0.81%,4.07%,69.44%respectively in 80 year age group.The positive rates of anti-HBs,HBeAg,anti-HBe and HBcAg increased with age(x2trend=256.16,P＜0.001).Among 3744 objects,530 subjects (accounted for 14.16%)had the family history of hepatitis B.HB immunization coverage rate was 11.77% (393/3339),with the standardized rate being 20.20%.The positive conversion rate of anti-HBs among those had HB vaccine inoculation was 21.12%(83/393).Conclusion The infection rate of HBV was high,whereas the immunization rate of hepatitis B vaccine and the level of anti-HBs were low in adults,Thus,to improve the immunization rate of hepatitis B vaccine is a key step to decrease the infection rate.

Objective To investigate the presence of pepsin and trypsin in the middle ear effusion of children with acute suppurative otitis media(ASOM).Methods Middle ear effusion samples were collected from 71 children with ASOM at Children's Hospital of Xuzhou.According to the characteristics of the middle ear effusions,the effu-sion was divided into serous and mucous types.The pH testing,Western Blotting(WB),and enzyme-linked immu-nosorbent assay(ELISA)were performed.Results ① There were 49.29％(35/71)of ASOM patients had a posi-tive RSI score(＞13).② The positive rate of pepsin in ASOM children was 49.29％(35/71),and the positive rate of trypsin was 42.25％(30/71).In addition,the positive rate of pepsin in RSI-positive children was 100％(35/35),and the positive rate of trypsin was 60％(21/35).There was no significant difference in the positive rate of pepsin and trypsin between serous and mucous middle ear effusion(P＞0.05).③ The pepsin concentration was 47.80(39.80,69.30)ng/ml and the trypsin concentration was 291.87±20.45 ng/ml in middle ear effusion of chil-dren with ASOM who had a positive WB test,and the trypsin concentration was significantly higher than pepsin(P＜0.05).There was no significant difference between the pepsin and the trypsin concentrations in serous and mu-cous middle ear effusion(P＞0.05).④ The pH value of mucous middle ear effusion was 7.39±0.28,and the pH value of serous middle ear effusion was 7.36±0.26.There was no significant difference between the pH value in se-rous and mucous middle ear effusion(P＞0.05).Conclusion The detection rates of pepsin and trypsin in middle ear effusion of children with ASOM were high which has important diagnostic value for children with ASOM combined with LPRD.

Objecgive To investigate the HB awareness,the infection rate of HBV and the immunity status among adults at the communities of Wuxi,and to provide some evidences for vaccination strategy.Methods Two communities were enrolled in the study through cluster sampling method.A household survey was conducted to collect subjects' information through a face-to-face interview and blood samples were collected to detect HBsAg,anti-HBs,HBeAg,anti-HBe and anti-HBc.Results 3744 subjects were enrolled in this study.The general knowledge coverage rate of hepatitis B was high and 87.30%respondents claimed that hepatitis B was an infectious disease.The percentage of subjects who got more than 5 scores in persons had got hepatitis B vaccination was 60.18%(239/393),and this was significantly higher than in those without vaccine inoculation(x2=17.07,P＜0.01),with the proportion being 49.49%(1071/2164).rnIe percentage of subjects who got more than 5 scores in persons had family history of HBV infection was 60.00%(318/530),and this wag significantly higher than in those without family history (x2=53.05,P＜0.01),with the proportion of 43.00%(1382/3214).The standardized HBV infection rate was 49.88%.There were 1109(29.62%)subjects whose HBsAg,anti-HBs,HBeAg,anti-HBe and HBcAg were negative.There were 8 subjects(0.21%) whose HBsAg,HBeAg and anti-HBc were positive simultaneously,and there were 133 subjects(3.55%)whose HBsAg,anti-HBe and anti-HBc were positive simultaneously.The positive rate of anti-HBc was significantly higher in males than in females( 59.37%and 53.08%,P=0.00).The positive rates of HBsAg,anti-HBs,HBeAg,anti-HBe and HBcAg were 2.84%,44.05%,0.64%,1.93%,33.44%respectively in 20 year age group,while they were 5.69%,65.85%,0.81%,4.07%,69.44%respectively in 80 year age group.The positive rates of anti-HBs,HBeAg,anti-HBe and HBcAg increased with age(x2trend=256.16,P＜0.001).Among 3744 objects,530 subjects (accounted for 14.16%)had the family history of hepatitis B.HB immunization coverage rate was 11.77% (393/3339),with the standardized rate being 20.20%.The positive conversion rate of anti-HBs among those had HB vaccine inoculation was 21.12%(83/393).Conclusion The infection rate of HBV was high,whereas the immunization rate of hepatitis B vaccine and the level of anti-HBs were low in adults,Thus,to improve the immunization rate of hepatitis B vaccine is a key step to decrease the infection rate.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.