Objective To explore the application value of the lower leg perforator flaps in repairing soft tissue defect on ankle.Methods From January 2007 to December 2012,62 cases of soft tissue defect on ankles have been repaired.The defects were combined with tendon and/or bone exposure for all the cases,among them 7 cases were exposure or sinus tract after achilles tendon rupture surgery,8 cases with ankle or intertarsal joint defect and exposure,24 cases with distal tibia fracture,or medial malleolus fracture,or lateral malleolus fracture,or calcaneus fracture,11 cases with different level of infection.Fifteen cases were primarily repair,and 47 cases were secondly repair or extended phase.The cases were repaired by applying different types retrograde transferred perforator pedicle flaps of lower legs,with 10 cases of posterior tibial artery perforator flaps on the medial malleolus,12 cases of front top flaps of com peroneal artery on external ankle,40 cases of back top flaps of peroneal artery on external ankle.The sizes of the flap ranged from 4.0 cm ×5.5 cm to 9.0 cm × 15.0 cm.Ten cases were applied direct suturing in donor site,and other cases were applied skin grafts to repair the defect.Results Flaps in 56 cases completely survived.Partial necrosis appeared in 3 cases of front top flaps of peroneal artery on external ankle,one perforator flap of posterior tibial artery on the medial malleolus and 2 cases of back top flaps of peroneal artery on external ankle.All these cases recovered after careful dressing changes.Sixty two cases were followed up for 3-12 months.Texture of flaps was soft with good elasticity.All of the donor skin grafts in patients survived.Conclusion Perforator flaps have the advantage of easy operation,little damage to the main blood vessels,high reliability in flap survival,less destroy to donor site.It is important that individualized flap is selected given different position of defect.

Adult ; Aged ; Disease Outbreaks ; Female ; Humans ; Leptospirosis ; epidemiology ; Male ; Middle Aged

Objective To explore parental confidence on immunization and its influential factors and provide scientific basis for immunization management and confidence enhancement strategy in Jinhua. Methods A questionnaire survey was conducted among 1 865 parents in the district, and the cumulative Logit regression model was used to analyze the influential factors of parental confidence on immunization. Results It was found that 96.41% of the children′s parents believed immunization was necessary, 70.03% believed immunization was safe, 93.51% was willing to be vaccinated, and parental confidence on immunization was 90.89%.The sequence of influential factors of confidence was satisfaction of immunization services, cognitive level of immunization knowledge, immunization about route and age obtained through medical staff. Conclusion By strengthening health education and health promotion, improving the cognitive level of parents′ immunization knowledge and elevating the quality of daily immunization service, the parental confidence can be improved effectively in immunization.

OBJECTIVETo investigate the secondary operation methods and the effects on the prognosis of unexpected gallbladder cancer (UGC).

METHODSA retrospective analysis on the clinical data was made for 41 patients who underwent extended radical excision from June 1995 to December 2002. Among the patients, 12 were male, 29 were female. The average age was 51 years old. The 41 patients had undergone gallbladder excision because of cholecystitis complicated lithiasis of gallbladder (32 cases), polypi of gallbladder or adenoma (9 cases). Postoperative pathology showed that 32 cases were adenocarcinoma of gallbladder, 6 cases were squamous carcinoma, 3 cases were squamous adenocarcinoma. Six cases were on the stage of Nevin I, 16 on Nevin II, 17 on Nevin III, 2 on Nevin IV. The second operation was performed after 6-30 d of the first operation. The second operation chose the improved method of Glenn excision of carcinoma of gallbladder.

RESULTSOn the second operation, 14 cases were with lymphatic metastasis, 14 with gallbladder metastasis, 6 with bile duct metastasis, 2 with pancreas metastasis. Fourteen cases were on the stage of Nevin IV, 9 on Nevin V, none on Nevin I, II and III. After the second operation, 1 year survival rate was 100% (41 cases); The three-year survival rate was 53.8% (22 cases); The five-year survival rate was 17.5% (7 cases).

CONCLUSIONExtended radical excision is one of the most important methods for the treatment of UGC.

Adult ; Aged ; Cholecystectomy ; methods ; Diagnostic Errors ; Female ; Gallbladder Neoplasms ; diagnosis ; mortality ; surgery ; Humans ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Survival Rate

OBJECTIVETo observe the differences of therapeutic effects on common cold of wind-cold type at early stage treated by different cupping duration.

METHODSSixty cases of common cold of wind-cold type were randomly divided into an observation group and a control group by fifty-fifty. Flash cupping was applied at Dazhui (GV 14), Fengmen (BL 12), Feishu (BL 13), Xinshu (BL 15) and Geshu (BL 16), etc., and the cupping was retained for 25-30 min in the observation group and 15 min in the control group. The therapeutic effects were compared after twice treatments.

RESULTSThe total effect rate was 93.3% (28/30) in observation group, superior to that 66.7% (20/30) in control group (P < 0.01).

CONCLUSIONThe therapeutic effect of common cold of wind-cold type at early stage treated with cupping for 25-30 min is obvious, superior to that for 15 min.

Acupuncture Points ; Adolescent ; Adult ; Common Cold ; therapy ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Treatment Outcome ; Young Adult

Objective To investigate the epidemic characteristics of mycoplasmal pneumonia outbreak in a middle school, and to provide suggestions for outbreak prevention and control.Methods Principle and method of field epidemiology was used and,speciously,questionnaire investigation was carried out for the outbreak of mycoplasmal pneumonia.Outbreak characteristics and corresponding emergency intervention were discussed.Results There was an outbreak of mycoplasmal pneumonia in 2 classes of the middle school,and the attack rate was 42.50%.The attack rate of other classes was 6.75%.Timely identification and diagnosis of the disease,and comprehensive control to prevent the spread of the epidemic,brought the disease under control.Conclusion The outbreak of mycoplasmal pneumoniae infection is associated with the close contact in daily activities.Emergency intervention can prevent the further spread of the disease.

Objective Toevaluatetheeffectof3differentkindsofpropagandamodesofchargevaccinesonchanging knowledge,attitude and behavior of community residents,and to explore the effective propaganda mode of vaccination. Methods Sanjiang,JiangnanandSumengwereselectedaspilotstreets,respectively.And"motherclass"(A)mode, vaccination clinics "inform-booking"(B)mode and the community responsible doctor recommended mode (C)mode were used to carry out intervention.Intervention time was from March to September,2014.Awareness rate,necessity awareness rate,compliance rate and vaccination rate of the children of school age were used to evaluate effect of 3 propagandamodes.Results Therewerenosignificantdifferencesindemographiccharacteristicsamongthreemodes(P>0.05).Through intervention of A,B mode,the awareness knowledge,necessity awareness and willingness to vaccination were improved (P<0.05),while the other indicators were not improved through C mode intervention except for 4 vaccine related knowledge (P<0.05).After controlling for the time factor,the improving effect of related knowledge,attitude and behaviorofchargevaccinethroughAandBmodeswerebetterthanthosethroughCmode(P<0.05).Conclusion The effect of"mother class"mode,the vaccination clinics"inform-booking"mode to carry out the charge vaccine propaganda is significant,but the community responsible doctor recommended mode needs to be improved.

BACKGROUND: Caspofungin, a novel echinocandins systemic antifungal agent, has been shown to exert broad-spectrum antibacterial effect on deep fungal infections, which is superior to or equivalent with the role of amphotericin B, but there is no report on its application for preventing fungal infection after renal transplantation.OBJECTIVE: To analyze the difference in high risk factors of fungal infection after kidney transplantation using donation after cardiac death donors and living-related donor kidney transplantations, and to explore the feasibility and safety of caspofungin to prevent fungal infection after kidney transplantation using donation after cardiac death donors.METHODS: This was a prospective, single-center, controlled trial finished at the Department of Kidney Transplantation,the First Affiliated Hospital of Zhengzhou University, Henan Province, China. Totally 188 patients undergoing primary kidney transplantation without history of fungal infection and use of antifungal drugs between January 2012 and August 2013 were enrolled, including kidney transplantation with donation after cardiac death donors (n=102, trail group), and kidney transplantation with living-related donors (n=86, control group). The CYP3A5 genotype was determined preoperatively. All patients received tacrolimus+mycophenolate mofetil+prednisone triple immunosuppression after transplantation. The trial group was subjected to caspofungin therapy for 2 weeks. The risk factors for fungal infection in the two groups were compared, and the effects of caspofungin on the tacrolimus concentration, tacrolimus concentration/dose were detected in the recipients with same CYP3A5 genotype recipients at 1 and 2 weeks, and 1, 3 and 6 months postoperatively. The liver and kidney function, adverse events and fungal infections were recorded at different time points. This trial was registered with the Chinese Clinial Trial Registry (Regitration number:ChiCTR-OON-17013342).RESULTS AND CONCLUSION: The survival rate of patient/kidney was 98.4% and 97.3% respectively, 97 cases in the trial group and 86 controls competed 6-month follow-up. Preoperative hemodialysis time, hemoglobin value, cold ischemia time, warm ischemia time, intraoperative blood transfusion volume, time of central venous catheter kept in situ,methylprednisolone usage, ATG usage, serum creatinine reduced level at 1 week, thrombocytopenia and duration of postoperative body temperature > 38 ℃ were the risk factors for fungal infection in the trail group relative to the control group. The fungal infection rate in the trial and control groups was 0% and 2.3%, respectively, at 6 months of follow-up.The serum creatinine level in the trail group was significantly higher than that in the control group at 1 month postoperatively (P < 0.05), and the level showed no significant difference between two groups at other time points (P >0.05). After 2 weeks of caspofungin treatment, the concentrations of tacrolimus and tacrolimus concentration/dosage did not differ significantly in different CYP3A5 genotype recipients (P > 0.05). Caspofungin might induce some adverse reactions, especially electrolyte disturbance with an incidence of 21.6%, but there was no significant difference between two groups (P > 0.05). These findings imply that kidney transplantation using donation after cardiac death donors presents with various risk factors for fungal infection compared with living-related donor kidney transplantation.Furthermore, caspofungin is effective and safe for preventing fungal infection and has no effect on tacrolimus concentration; therefore, it can be used as a new anti-fungal agent after kidney transplantation.

BACKGROUND: The tumor necrosis factor recepter associated factor (TRAF) 6 is an important intracellular adapter protein that plays a pivotal role in activating multiple inflammatory and immune related processes induced by cytokines. TRAF6 represents a strong candidate susceptibility factor for sepsis. We investigated whether polymorphisms at the TRAF6 gene are associated with the susceptibility to and severity of sepsis. METHODS: A hospital-based case-control study was conducted with 255 patients with sepsis and 260 controls who were recruited from Zhengzhou, China. Haplotype tagging single nucleotide polymorphisms (htSNPs) were selected from the HapMap database and genotyped using the SNPstream genotyping platform. The associations with the susceptibility and disease severity of sepsis were estimated by logistic regression, and adjusted for age, sex, smoking, drinking, chronic diseases status, APACHEII score and critical illness status. RESULTS: A total of 13 TRAF6 SNPs were tagged by 7 htSNPs. Five htSNPs (rs5030490, rs5030411, rs5030416, rs5030445 and rs3740961) were genotyped in the case control study. Genotype frequencies of the htSNPs were conformed to the Hardy-Weinberg equilibrium in both patients and controls. No significant association was found between the 5 htSNPs and the susceptibility to and severity of sepsis. Compared with the main haplotype -11120A/-10688T/-9423A/805G/12967G, no certain haplotype was associated with the significantly susceptibility to or severity of sepsis. CONCLUSION: TRAF6 gene polymorphisms might not play a major role in mediating the susceptibility to and severity of sepsis in the Chinese population. A larger population-based case-control study is warranted.

Abnormalities, Multiple ; diagnosis ; surgery ; Anus, Imperforate ; surgery ; Colon ; abnormalities ; Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; Ischium ; abnormalities ; Treatment Outcome ; Twins, Conjoined ; surgery