Objective    To compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically. Methods    A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software. Results    Thirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77,  P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI -– 79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to – 209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01). Conclusion    Compared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.

Objective: To study the effect of activated carbon on the purification of formaldehyde in the clean workshop return air purification device and its influencing factors. Methods: From May to June 2018, choosed 4 different commercial activated carbons (bamboo charcoal, 1-3 mm, 3-5 mm; coconut shell charcoal, 6-12 mesh, 8-16 mesh) to make 5 types of activated carbon purification net. In the simulated clean plant laboratory, the detection of occupational disease hazards was used to test the purification effect of different types of activated carbon purification nets on formaldehyde. Results: The purification effect of different types of activated carbon increased with the prolongation of purification time, and the difference was statistically significant (P<0.05) . Compared with other types of activated carbon, coconut shell charcoal (8-16 mesh, double layer) had the best purification effect, 15 min and 30 min purification efficiency was 58.72% and 85.20% respectively, and the difference was statistically significant (P<0.05) . The purification effect of double-layer coconut shell charcoal was better than single layer (P<0.05) . The purification effect of double-layer coconut shell charcoal (8-16 mesh) was better than double-layer coconut shell charcoal (6-12 mesh) , the difference was statistically significant (P<0.05) . Coconut shell charcoal (8-16 mesh, double layer) had better purification effect than bamboo charcoal (P<0.05) . Conclusion Different specific surface area, particle size, and thickness of activated carbon have a certain effect on the purification effect of formaldehyde, and its selection has a certain significance in improving the occupational health protection level in the clean plant, solving the safe use of return air and reducing energy consumption.

Objective To explore the molecular epidemiological characteristics of norovirus isolated from the patients with acute gastroenteritis in Zhejiang province during 2016.Methods The stool samples and clinical data of 1 308 patients with acute gastroenteritis were collected from January to December in 2016.The type Ⅰ and Ⅱ of norovirus in stool samples were detected by one-step double real-time RT-PCR.Some of the positive specimens were selected by stratified sampling and amplified by conventional RT-PCR,and the PCR products were sequenced for genotype identification and phylogenetic analysis.Results Among the samples studied the positive rate of norovirus was 10.55％ (138/1 308) in which 12 cases were GⅠ genotype,118 cases were G Ⅱ genotype and 8 cases were mixed infection of G Ⅰ/G Ⅱ genotypes.The positive rate of norovirus in different age groups decreased with the increased age of patients,and became the lowest in the patient group of more than or equal to 60 years old.There was no significant difference for the positive rates of norovirus in different genders.Norovirus infection was distributed throughout all the year with the peak value of positive rate (37.50％) in December.The sequence analysis demonstrated that G Ⅱ.4 and G Ⅱ.17 genotypes were the prevalent strains of G Ⅱ genotypes with proportions of 40.91％ (18/44) and 34.09％ (15/44),while GⅠ.6 genotype was the prevalent strain of GⅠ genotypes.Conclusion Norovirus should be the important pathogen causing acute gastroenteritis in Zhejiang province during 2016.G Ⅱ.4 and G Ⅱ.17 of norovirus may be the predominant epidemic genotypes.

Objective To analyze the risk factors and pathogen distribution of ventilator-associated pneumonia (VAP) in patients following coronary artery bypass grafting (CABG).Methods The clinical data of 1414 patients undergoing CABG in Teda International Cardiovascular Hospital from June 2014 to June 2016 were retrospectively analyzed .The VAP developed following CABG in 42 patients ( VAP group ) and not occurred in 1372 patients ( non-VAP group) .Multivariate logistic regression was used to analyze the risk factors of VAP in patients after CABG , and the microbial culture and drug sensitivity test were performed in VAP patients.Results The incidence rate of VAP after CABG was 2.97％ (42/1414).Multivariate logistic regression analysis showed that history of smoking ( OR =2.216, 95％ CI 1.018 -4.825, P <0.05), mechanical ventilation time >48 h (OR=7.457, 95％ CI 3.443-16.161, P<0.01), LVEF<40％(OR=3.524 , 95％ CI 1.203-10.325, P<0.05) and postoperative acute kidney injury (OR=16.239, 95％ CI 7.551 -34.924, P <0.01) were independent risk factors for VAP in patients after CABG.A total of 42 pathogen strains were detected in 42 patients with VAP, including 37 strains of Gram-negative bacteria, 2 strains of Gram-positive bacteria, and 3 strains of fungus.Gram-negative bacteria mainly were Klebsiella pneumoniae subspecies ( n =23, 54.76％) and Burkholderia cepacia ( n =6, 14.27％);the Gram-positive bacteria were Staphylococcus aureus ( n =2, 4.76％);the fungus was Candida albicans ( n =3, 7.14％).Klebsiella pneumoniae was sensitive to many antibiotics;and the resistance rate to amikacin , aztreonam , meropenem , and levofloxacin was <10％, the resistance rate to ceftazidime and piperacillin was <25％. Burkholderia cepacia was naturally resistant to amikacin , ampicillin, aztreonam, cefazolin, gentamicin and sulfamethoxazole .Conclusion The incidence of VAP was higher in patients after CABG , and the involved pathogens were mainly Gram-negative bacteria .Clinically , it is necessary to take necessary measures to prevent and treat VAP in order to improve the prognosis of patients undergoing CABG .

Objective: To investigate the etiology composition of enterovirus (EV) in patients with severe hand, foot, and mouth disease (HFMD) in children. To assess the diagnostic value of cerebrospinal fluid (CSF) tests in severe HFMD, and to find the key laboratory tests for severe HFMD. Methods: A total of 288 hospitalized cases of children clinically diagnosed with severe HFMD in Hangzhou Children′s Hospital were included from March to July 2016. Throat swabs were collected and enterovirus nucleic acids were detected by fluorescence quantitative reverse transcription (RT)-PCR. Synchronous CSF and serum samples were collected for EV-A71 and CV-sackievirus A16 (CV-A16)-IgM antibody detection. CSF samples underwent routine and biochemical tests. Normally distributed continuous variables were compared using t test. Non-normal distribution continuous variables were compared using Mann-Whitney U test. Differences between categorical variables were compared with χ² test. Results: The total positive rate of enterovirus nucleic acid EV-A71/CV-A16/EV by fluorescence quantitative RT-PCR in the 288 cases of children clinically diagnosed with HFMD was 83.7% (241/288), including EV-A71 55.2% (159/288), CV-A16 4.9% (14/288) and the other enterovirus 23.6% (68/288). Among the other enterovirus group, there were 29.4% CV-A6 (20/68) , 16.2% CV-A4 (11/68) and CV-A10 10.3% (7/68). The total positive rate of combined serum and CSF detection of EV nucleic acid and EV-A71 and CV-A16 IgM antibody was 98.3% (283/288). EV nucleic acid positive rate was 83.7% (24/288). The positive rates were statistically different (χ² =37.289, P=0.000). The CSF nucleated cells count in EV-A71 positive subgroup was higher than those in CV-A16 positive subgroup and other enteroviruses subgroup (Z=-4.472 and -9.991, respectively, both P<0.05). The CSF nucleated cells positive rate in EV-A71 positive subgroup was higher than those in CV-A16 positive subgroup and other enteroviruses subgroup (χ²=43.857 and 133.078, respectively, both P<0.05). The CSF protein level in EV-A71 positive subgroup was higher than those in CV-A16 positive subgroup and other enteroviruses subgroup (Z=-3.151 and -5.255, respectively, both P<0.05). The CSF protein positive (>400 mg/L) rate in EV-A71 positive subgroup was higher than those in CV-A16 positive subgroup and other enteroviruses subgroup (χ²=4.956 and 11.795, respectively, both P<0.05). The CSF nucleated cell counts and positive rates in EV-A71 IgM antibody-positive subgroup were both higher than those in antibody-negative subgroup (both P<0.05). The CSF protein level and elevated proportion in antibody-positive subgroup were both higher than those in antibody-negative subgroup (both P<0.05). The lactate dehydrogenase concentration in antibody-positive subgroup was significantly higher than those in antibody-negative subgroup (P<0.05). The EV-A71 IgM antibody in serum was significantly correlated with the antibody in CSF (r=0.600, P<0.05). Conclusions EV-A71 is still the most important pathogen of severe HFMD in Hangzhou in 2016. Other enterovirus such as CV-A6, CV-A4 increases compared to those in 2014 and 2015. The CSF routine and biochemical tests and the IgM antibody levels can serve as an important indicator for the diagnosis of children with severe HFMD.

Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24％ (2 034/164 215).Smokers were 23.8％ (39 137/164 215) in the whole population.Smokers were 34.5％ (702/2 034) in asthmatic patients,compared with 23.7％ (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79％ and 1.06％ in smokers and nonsmokers respectively (P ＜0.001),suggesting that OR of smoking was 1.70 (95％ CI 1.55-1.86,P ＜ 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2％ vs 35.3％).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 ％ vs 20.12％),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77％ vs 24.47％) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.

Objective:To analyze the levels of arachidonic acid (AA)and docosahexaenoic acid (DHA)in the breast milk of lactating mothers in Changchun City of Jilin Province, and to explore their influence factors. Methods:The lactating mother’s basic information was collected with questionnaire, and the breast milk of lactating mothers on postpartum 22-25 d was obtained and the 3-day 24-hour dietary recall method was used to investigate the dietary intake information of 514 healthy lactating mothers.The Food Composition Table of China 2009 was used to calculate the intakes of five kinds of polyunsaturated fatty acids (PUFAs) in diet of lactating mothers and the gold key nutrition expert system software for corresponding nutrient analysis was used to calculate the amount of various kinds of foods in the lactating mothers’daily diet.The levels of AA and DHA in breast milk were determined with gas chromatography and the linear regression was used to analyze the related factors of AA and DHA levels in breast milk.Results:①The average concentration of AA in breast milk of 514 lactating mothers was (0.08±0.04)g·100 g-1,and the average concentration of DHA was (0.05±0.04)g·100 g-1. ②The single factor correlation analysis results showed that the oil intake was both positively correlated with AA and DHA levels in milk of lactating mothers (r= 0.360,r=0.354,P<0.001),while the intakes of linoleic acid (LA), alpha linolenic acid (ALA),eicosapentaenoic acid (EPA),DHA,dairy and meats and seafood in diet were both negatively correlated with AA (r= -0.321,r=-0.280,r=-0.255,r=-0.299,r=-0.196 ,r=-0.306,P<0.05)and DHA (r=-0.315,r=-0.279,r=-0.175,r=-0.189,r=-0.248,r=-0.142,P<0.05).③The linear regression analysis results showed regression equation that dairy intake (β=-0.265)and EPA intake (β=-0.144)were both negatively correlated with the level of AA (P=0.009),and dairy intake was also negatively correlated with the level of DHA (β=-0.233,P<0.001).Conclusion:The AA and DHA levels in breast milk of lactating mothers didn’t increase with the increasing of intake of milk or dairy products in the study.Moreover there is a competitive relationship between n-6 and n-3 series polyunsaturated fatty acids in the process of metabolism.

Objective To evaluate ultrasound-guided methylene blue dyeing for radical liver segmental resection.Methods Liver segmental resection with uhrasound-guide methylene blue dyeing (UMD-SR) was performed in 16 cases, results were compared with 16 conventional liver segmental resection (CSR) retrospectively.Results All the operations under uhrasound-guided methylene blue dyeing were successfully carried out, among them, reverse dyeing was used in cases with segment Ⅳ, Ⅴ, Ⅷ resection.The blood loss in UMD-SR group was much less than CSR group(t =3.011 ,P =0.009) , at the cost of a longer operation time (t =5.423,P =0.000 07).There was no difference in the mortality and morbidity rates between two groups.Tumor recurrence rate was 6.25％ in UMD-SR group and 18.75％ in CSR group (x2 =0.133,P =0.285).Conclusions Ultrasound-guided methylene blue dyeing liver segmental resection can reduce the blood loss during operation, improve the safety of hepatectomy in case of hepatic carcinoma.

Objective To summarize the minimally invasive transthoracic ventricular septal defect (VSD) occlusion operation experience in the clinical application. Methods 142 VSD patients (admitted from August, 2013 to October, 2014) were chosen. All patients were treated with minimally invasive transthoracic device closure under the monitoring of transoesophageal echocardiogram. Results 136 cases received successful closure, and 6 cases still need CPB conventional extracorporeal circulation operation. After follow-up for 3 ~ 12 months for 102 patients, 16 cases remain residual shunt. Conclusion The short-term therapeutic effect of minimally invasive transthoracic device closure of VSD is satisfying. However , the long-term follow-up remains to be studied.