Objective:To investigate the pathogenic bacteria distribution and risk factors of pulmonary infection after tracheotomy in patients with stroke coma,and to put forward preventive measures.Methods:96 patients with stroke coma from January 2016 to February 2017 in our hospital were retrospectively analyzed.The incidence of pulmonary infection and distribution of pathogenic bacteria of patients with stroke coma were analyzed.At the same time,the risk factors of pulmonary infection were analyzed by single factor and multiple factors logistic regression analysis,and corresponding preventive measures were put forward.Results:The incidence of pulmonary infection after tracheotomy in 96 patients with stroke coma was 48.96％ (47/96).A total of 104 pathogens were isolated and cultured,including gram negative bacteria 69 strains (66.35％),gram positive bacteria 20 strains (19.23％) and fungus 15 strains (14.42％).Single factor regression analysis results showed that pulmonary infection after tracheotomy in patients with stroke coma was closely related with age,basic diseases,time of tracheotomy,and bed time,use of broad-spectrum antibiotics,smoking history,artificial airway,times of sputum suction and inhalation(P＜0.05),and it was not related to the patient's gender,weight,stroke type (P＞0.05).Multivariate logistic regression analysis showed that age 45 years old,complicated with basic disease,time oftracheotomy 5 d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway were risk factors of pulmonary infection after tmcheotomy in patients with stroke coma (P＜0.05).ROC analysis results showed that the critical point (threshold C) oftmcheotomy time was 4.3 days,and the sensitivity and specificity were 0.851 and 0.918 respectively.Conclusion:The main pathogenic bacteria of pulmonary infection after tracheotomy in patients with stroke coma is gram-negative bacteria,age 45 years old,complicated with basic disease,time of tmcheotomy 5d,use of broad-spectrum antibiotics,smoking history and the establishment of artificial airway can lead to pulmonary infection after tracheotomy in patients with stroke coma,and the risk of pulmonary infection in patients with stroke coma will increase considerably after the time of tracheotomy for more than 4.3 days.Targeted measures should be taken to reduce the risk of pulmonary infection according to pathogenic features and risk factors.

Objective: To summarize the preliminary experience with transoral endoscopic thyroidectomy via vestibular approach (TOETVA). Methods: A total of 150 consecutive patients with thyroid disease underwent TOETVA from November 2014 to February 2017 at Department of Thyroid Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. The patients were comprised of 138 females and 12 males. The mean age of the patients was (31.7±7.6) years (ranging from 15 to 51 years). There were 108 patients of differential thyroid carcinoma (T1 or T2 ≤3 cm, cN0 or cN1a, M0) and 42 patients of benign thyroid disease (solid nodule ≤6 cm). The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, complications and results of follow-up. Results: Two cases were converted into open surgery due to an incredible unexpected tumor size and tracheal invasion, respectively. One hundred and three patients with papillary carcinoma underwent transoral central neck dissection (CND), with the mean operation time of (146±34) minutes for hemithyroidectomy with CND, and (187±36) minutes for total or near total thyroidectomy with CND. The mean number of lymph node yields was 8.2±4.7, and the lymph node metastasis rate was 41.7% (43/103). Regarding postoperative complications, transient hoarseness occurred in 3 patients, and permanent recurrent laryngeal nerve occurred in 2 patients. One patient had local infection or transient mental nerve palsy. Transient hypocalcemia occurred in 31.8% of 22 patients who underwent total, near-total, or subtotalthyroidectomy, and no permanent hypocalcemia was registered. Mean hospital stay after operation was (3.5±0.6) days (ranging from 2 to 5 days). Mean follow-up period was (11.5±7.8) months (ranging from 1 to 28 months), no recurrence or metastasis occurred. Conclusions TOETVA is feasible and safe for strictly selective patients. It brings perfect cosmetic effect. Long-term follow-up and further study is needed to assess its curative effect.

Objective:To investigate the long-term risk of esophageal cancer from fresh fruit consumption. Methods:In 1985, a total of 29,479 participants aged between 40 and 69 years old were recruited for this study. Demographic characteristics, lifestyle, history of diseases, and food intake frequency were surveyed at the baseline and were then followed up. Through December 31, 2015, a median of 31.79 years of observation was obtained. The primary endpoint was death from esophageal cancer. The hazard ratio and 95%confi-dence intervals for fresh fruit consumption were calculated using a Cox proportional hazard model. Results:Overall, 31.09%of partici-pants reported consuming fresh fruit more than once every week. Compared with participants who never or rarely consumed fresh fruit, those who consumed fresh fruit more than once a week had a lower long-term risk of esophageal cancer. Death rate decreased to 7%among those who ate fresh fruit more than once a week, especially among males (11%) and those with positive smoking history (13%). Conclusion:Fresh fruit consumption is associated with a lower risk of death from esophageal cancer, but the etiological mecha-nism needs to be investigated further.

Objective To analyze the voluntary blood donors of Shaoguan city in recent 10 years HIV infection status and distri‐bution characteristics ,and to take effective prevention and control measures ,in order to reduce the risk of HIV infection through blood transfusion .Methods HIV screening test in the early by the reagent of two different manufacturers ,from 2005 to 2014 vol‐untary blood donors specimens of 265 771 doses of blood donation in Shaoguan ,and early screening positive specimens confirmed by Center for Disease Control of Shaoguan .Results The voluntary blood donors of Shaoguan in the 10 years that initial screening test anti‐HIV positive were 310 cases ,and 35 cases confirmed positive;The confirmed positive rate was 1 .317/10 000;The HIV infec‐tion rate in 2012 was highest (2 .867/10 000) and there were 9 cases ,which was significant difference (P<0 .05) .The district of the maximum rate was New Fengxian ,which was 5 .369/10 000 ,and different districts had significant difference (P<0 .05) .The epidemiology survey about HIV infections found that male were 30 cases(85 .71% ) ,which was significantly more than women;By age distribution ,most HIV infections were 18 to 35 years old young adults ,which accounted 26 cases(74 .29% ) .Married and un‐married people infected respectively accounted 28 .57% and 71 .43% .The occupations of HIV infections were scattered with farm‐ers ,staffers ,the service industry ,cadres in the majority .The HIV infection rate with low education was relative higher ,which had some relationship to educational level .The residents and the non‐residents infected respectively accouted 71 .43% and 28 .57% ;Blood donors for the first time of HIV infections were 24 cases (68 .57% ) .Blood donors for the second time of HIV infections were 11 cases (31 .43% );Other virus co‐infection respectively were 2 HBV infections ,1 HCV infection and 3 syphilis infections .The route of transmission was mainly through sexual transmission that was mainly heterosexual transmission ,which was 33 cases (94 .58% ) .Conclusion The voluntary blood donors of Shaoguan with HIV is on the rise ,and give priority to with male youths spread through heterosexual sex .It should be pay high attention to by the government ,society and blood stations ,and strengthen the propaganda work of AIDS prevention and control checks ,and minimize the risk of HIV transmission by blood transfusion in or‐der to guarantee the safety of clinical blood transfusion .

Objective To evaluate the effect of multiple intervention measures on perioperative antimicrobial use in pa-tients undergoing typeⅠincision operation in a hospital,and provide basis for rational use of antimicrobial agents. Methods 9 823 patients with type I incision operation in April and October of 2005-2012 were surveyed retrospectively, data of 2005 was as baseline,from 2006 to 2012,multiple measures,including training,examination,supervision,feed-back,and cooperation of relevant departments were conducted,antimicrobial use before and after intervention was com-pared.Results The qualified rate of perioperative antimicrobial use in patients undergoing typeⅠ incision operation in-creased from 14.20% in 2006 to 92.30% in 2012;the rate of combined use of antimicrobial agents was relatively higher (7.00%-9.00%)in 2006-2009,had a downward trend in 2010- 2012,and decreased to 3.20% in 2012.Types of an-timicrobial agents for prophylactic use in typeⅠincision operation in 2006 and 2007 were similar to that of 2005,the main used antimicrobial agents were cephalosporins,penicillin and it’s compounds,and aminoglycosides;the major antimicrobial prophylaxis in 2008-2012 were the first and second generation cephalosporins,penicillin and it’s compounds.Multivariate non-conditional logistic regression analysis showed that age (40 - 59 years old),departments (orthopedics,general surgery,and ophthalmology),and years (2011 and 2012)were the main influencing factors for the qualified use of antimicrobial agents(all P<0.05).Conclusion Implementation of multiple intervention measures can improve the qualified rate of perioperative antimicrobial use in typeⅠ incision operation,reduce types of antimicrobial use and rate of combined antimicrobial use.

OBJECTIVETo observe the clinical efficacy on senile female bladder neck obstruction treated with acupoint application, therapy and western medication.

METHODSFifty cases of senile female bladder neck observation were randomized into an obstrvation group and a control group, 25 cases in each one. Tamsulosin hydrochloride capsules were taken orally in the two groups, 0.2 mg every night, continuously for 100 days. In the observation group, with radix aconiti lateralis preparata, semen brassicae and fructus ligustri lucidi contained, bushentongyu plaster was used at Shenque (CV 8), Sanyinjiao (SP 6), Pangguangshu (BL 28), Zhongji (CV 3) and Sanjiaoshu (BL 22), once every two days. Eight treatments made one session and 6 sessions were required totally. The international prostate symptom score (IPSS), the bother score (BS), the residual volume (RV) and the maximal urinary flow rate (MFR) were observed before and after treatment in the two groups. The clinical efficacy was compared between the two groups.

RESULTSEvery score in IPSS after treatment was reduced apparently as compared with that before treatment in the two groups (all P < 0.01). The improvements in feeling of incomplete, bladder emptying, intermittency < 2 h, urgency, interupted urination and nocturia in the observation group were more advantageous than those in the control group (all P < 0.05). The total effective rate was 95.65% (22/23) in the observation group, higher than 85.71% (18/21) in the control group (P < 0.05). After treatment, RV, MFR and BS were significantly different as compared with those before treatment (all P < 0.05).

CONCLUSIONThe combined therapy of acupoint application of bushentongyu plaster and oral administration of tamsulosin hydrochloride capsules achieves the significant efficacy on senile female bladder neck obstruction as compared with the simple administration of tamsulosin hydrochloride capsules.

Acupuncture Points ; Aged ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Middle Aged ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; drug therapy ; physiopathology ; Urination

Objective In China primary hyperparathyroidism is not a kind of common disease as in the wesyrn countries.This article reports the current status in the diagnosis and treatment of primary hyperparathyroidism in the mainland of China. Methods We collected 730 cages of primary hyperparathyroidism diagnosed and treated in 7 top hospitals for endocrine surgery from 1965 to 2005.Results In this study.652(89.3%)cases were clinically symptomatic while 78(10.7%)cases were asymptomatic:442 cases were positive on 99mTc-MIBI scanning.Bilateral explorations were undertaken in 377 patients and unilateral or uni-gland exploration through the conventional incision in 204 cases.Minimally invasive parathyroidectomy in 143 cases.Endoscopically assisted 2 cm incision was taken in 6 cases for unilateral gland exploration.Pathologically 632(86.6%)cases were identified as adenoma,58(8.3%)cases were of hyperplasia and 40(5.5%)cases were of carcinoma.There were no major postoperative complications.While 20 patients suffering from recurrence or persistent postoperative hyperparathyroidism,the others are of normal or depressed serum level of calcium. Conclusions Preoperative localization is very helpful: Unilateral exploration for parathyroid adenoma is feasible; minimally invasive parathyroidectomy throush minimal incision is a kind of improving procedure for the localized parathyroid adenoma.

Objective To study the mutation characteristics in phenylalanine hydroxylase gene of Xinjiang minority nationality phenylketonuria (PKU) patients and provide a scientific basis for PKU prevention and cure strategy.Methods Mutations in phenylalanine hydroxylase gene were detected by Dolymerase chain reaction-single strand comformation polymorphism (PCR/SSCP) and gene sequencing in 12 minoritv nationality patients.Results Thirteen different mutations,including 8 missense mutations,1 nonsense mutation and 3 splice mutations were found in 24 alleles.The moat common mutations were EX696A＞G and P281 L.which were respectively prevalent in Asia and Europe populations.The common mutations were R243Q,R111X,R176X and F161S.The mutation frequency of R243Q was the highest and R111X was the third highest in Northern China.R176X and F161S were two rare mutations world wide.Especially.F161S was a Chinese-specific mutation because it was for the second time that it was found in China.The mutations detected in this study were first reported in these 3 minority nationality populations,which showed a distinct ethical characteristic.Condusions There is not only a consanguineous relation but also a distinct difference in PAH gene distribution between Xinjiang minority nationality population and yellow race and Latin-American.The results suggest that Xinjiang could probably be a special PAH gene distribution region.

Objective: To investigate the relationship between prognosis and alteration of oxygen(utilization) coefficient(O_2UC) in patients with sepsis.Methods: Sixty critically ill patients were divided into(sepsis)(n=30) and nonsepsis(n=30) groups,and 30 healthy controls were selected as normal control group.Gas analysis of arterial blood and central venous blood and calculation of O_2UC(O_2UC=arterial oxygen(saturation-venous) oxygen saturation/arterial oxygen saturation) were carried out at 8 o′clock in sepsis and(non-sepsis) groups on admission and 1,2,3,5,7 and 10 days after admission,and gas analysis of arterial blood and central venous blood was carried out only once in the controls.Results: On admission and 1 day(after) admission,O_2UCs in sepsis and non-sepsis groups were significantly higher than that of control group(both P0.05)).When O_2UC in critically ill patients persisted higher than 55% for 12-24 hours,the prognosis of the patients was poor and had a tendency to die in a short time.From the 2 nd day after admission,O_2UCs in sepsis and non-sepsis groups were lower than that in control group,and O_2UC in sepsis group was obviously lower than that in non-sepsis group(all P0.05),but from the 2 nd day after admission,O_2UC in sepsis group remained at a lower level compared with that in control group(all P

Objective To explore the diagnosis and treatment of thyroid malignant tumor (TMT) arising on basis of Hashimoto′s disease (HD).Methods 150 pathology proved HD patients admitted between 1976 and 1999 were retrospectively analyzed for the incidence of TMT.Results 15 HD patients were found suffering from thyroid carcinoma with a concurrent rate of 10%, and 3 with thyroid malignant lymphoma (TML) (2%). All postoperative TMT patients were followed up for an average period of 6 years, 15 TC patients were all alive without recurrence, and all TML patients died within 2 years.[WT5”HZ] Conclusion Surgical treatment of HD patient associated with TMT is indicated. The key to diagnosis and rational treatment are a detailed understanding its clinical feature, routine examination of serum antibodies and FNAC or frozen section in operation.