Objective:To investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.Methods:This retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group, one mediastinal drainage tube was placed intraoperatively, while in the study group, two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively, inflammatory indexes in patients with AL, grading of AL, rate of nasal fistula placement, incision infection, anastomotic stenosis, and incidence of hoarseness.Additionally, it compared ICU occupancy, ventilator use, and ICU length of stay between the two groups.Results:The analysis included clinical data from 455 elderly patients.Among the patients who developed AL, the study group had significantly lower peak body temperature[(39.58±1.03)℃ vs.(38.05±0.56)℃, t=4.298, P<0.05], white blood cell count[(18.63±3.35)×10 9/L vs.(14.28±2.78)×10 9/L, t=3.450, P<0.05], and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L, t=2.131, P<0.05]. The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4% vs.30.0%, P<0.05). In terms of ICU indicators, the study group had a significantly lower ICU admission rate(64.7% vs.10.0%, P<0.05), shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days, t=2.62, P<0.05], and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days, t=2.184, P<0.05]. Conclusions:Double mediastinal drainage tubes, have been found to significantly alleviate inflammation, decrease the rate of nasal fistula placement and ICU admission, and shorten the length of ICU stay in elderly patients.Therefore, they are considered safe and deserving of clinical promotion.

Vaccination is an effective public health measure to prevent and control vaccine-preventable diseases for individual and society. However, China currently confronts significant challenges, including a dearth of skilled professionals in the field of vaccination and disparities in the capacity for immunization services. This review introduced the experiences of four prime international vaccinology education models, including London School of Hygiene & Tropical Medicine, Johns Hopkins University, Leading International Vaccinology Education, and the Bill & Melinda Gates Foundation, in the aspect of personnel development, academic research and communication platforms establishment. It is supposed to give some insights and feasible suggestions on the establishment and advancement of vaccinology as a sub-discipline within high-level public health school in China, with the aim of development of a robust vaccinology education framework in China, which is essential for nurturing the next generation of public health leaders and practitioners for our country.

Vaccination is an effective public health measure to prevent and control vaccine-preventable diseases for individual and society. However, China currently confronts significant challenges, including a dearth of skilled professionals in the field of vaccination and disparities in the capacity for immunization services. This review introduced the experiences of four prime international vaccinology education models, including London School of Hygiene & Tropical Medicine, Johns Hopkins University, Leading International Vaccinology Education, and the Bill & Melinda Gates Foundation, in the aspect of personnel development, academic research and communication platforms establishment. It is supposed to give some insights and feasible suggestions on the establishment and advancement of vaccinology as a sub-discipline within high-level public health school in China, with the aim of development of a robust vaccinology education framework in China, which is essential for nurturing the next generation of public health leaders and practitioners for our country.

The peroxisome proliferator-activated receptor gamma(peroxisome proliferator-activated receptor gamma,coactivator 1 beta,PPARGC1B)gene is an intranuclear receptor transcription fac-tor responsible for regulating the expression of target genes.To comprehend the characteristics and mutations of the PPARGC1B gene within the Sichuan yak population,the SNP loci of the PPARGC1B gene were identified through direct sequencing of PCR products.Additionally,the cod-ing region of the PPARGC1B gene was obtained via PCR amplification and sequencing.Bioinforma-tics analyses were conducted to predict protein-coding and mRNA secondary structure.This study identified four exon SNP mutation sites(E9-189A→C,E9-387G→A,E9-542C→T,and E9-554T→C)based on the single nucleotide polymorphism analysis of the PPARGC1B gene in Sichuan yaks.Notably,the E9-387G→A and E9-554T→C loci exhibited significant correlations with shear force and backfat thickness in Sichuan yaks.Subsequently,bioinformatics analysis of the four mutation sites revealed that the PPARGC1B protein is an acidic,unstable,non-transmembrane,and non-secretory hydrophilic protein with a coiled helix structure.It lacks a signal peptide and transmembrane region,predominantly functions in the nucleus,and features 106 phosphorylation sites,one glycosylation site,and one conserved RRM structure.The secondary structure comprises mainly α-helix and random coils.Although the protein structure of the PPARGC1B gene remained unchanged post-mutation,there were significant differences in mRNA secondary structure.These findings suggest that the polymorphic loci of the PPARGC1B gene in Sichuan yaks could serve as a theoretical basis for enhancing meat quality traits through molecular biological methods,presen-ting practical applications in breeding.

Humans ; Cross-Sectional Studies ; SARS-CoV-2 ; COVID-19 Vaccines/therapeutic use* ; Pandemics ; COVID-19/prevention & control* ; China/epidemiology* ; Attitude ; Vaccination

BACKGROUND: World Health Organization recommends that influenza vaccines should benefit as much of the population as possible, especially where resources are limited. Corona virus disease 2019 (COVID-19) has become one of the greatest threats to health systems worldwide. The present study aimed to extend the evidence of the association between influenza vaccination and COVID-19 to promote the former. METHODS: In this systematic review, four electronic databases, including the Cochrane Library, PubMed, Embase, and Web of Science, were searched for related studies published up to May 2022. All odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by meta-analysis. RESULTS: A total of 36 studies, encompassing 55,996,841 subjects, were included in this study. The meta-analysis for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection provided an OR of 0.80 (95% CI: 0.73-0.87). The statistically significant estimates for clinical outcomes were 0.83 (95% CI: 0.72-0.96) for intensive care unit admission, 0.69 (95% CI: 0.57-0.84) for ventilator support, and 0.69 (95% CI: 0.52-0.93) for fatal infection, while no effect seen in hospitalization with an OR of 0.87 (95% CI: 0.68-1.10). CONCLUSION: Influenza vaccination helps limit SARS-CoV-2 infection and severe outcomes, but further studies are needed. REGISTRATION PROSPERO, CRD42022333747.
Humans ; COVID-19/epidemiology* ; SARS-CoV-2 ; Influenza, Human ; Intensive Care Units ; Vaccination

Objective:To explore the epidemic situation and brucellosis in key occupational populations of brucellosis monitoring sites in Jiangsu Province, and provide a basis for development of prevention and control strategies against brucellosis.Methods:From 2013 to 2017, according to the requirements of the "National Brucella Surveillance Programme", two brucellosis monitoring sites in Yixing City of Wuxi and Huaiyin District of Huai'an, Jiangsu Province were established to monitor brucellosis. Brucellosis epidemic data were collected and analyzed of the two monitoring sites in Yixing City and Huaiyin District from 2013 to 2017 (data were from Jiangsu Provincial Legal Infectious Disease Reporting System). Blood samples were collected from the general occupational populations (health check-up population) and the key occupational populations (people engaged in livestock trading, livestock slaughtering, and the fur, milk and meat processing) in the monitoring sites. Tiger red plate agglutination test (RBPT) and serum tube agglutination test (SAT) were used for serological examination. Results:From 2013 to 2017, a total of 18 cases of brucellosis were reported at the two monitoring sites in Yixing City and Huaiyin District, Jiangsu Province, including 13 males and 5 females, with a male to female sex ratio of 2.6∶1.0; the age of onset was mainly 35 - 64 years, accounting for 72.22% (13/18); the time of onset was mainly from January to June, accounting for 94.44% (17/18); and the occupational distribution was mainly farmers, accounting for 77.78% (14/18); there was no epidemic and outbreaks of brucellosis. A general occupational populations survey was conducted in 17 743 cases, serological tests were negative, no infection and no signs and symptoms were found in the two monitoring sites. In 2013 - 2017, a total of 113 cases of serological tests were positive in the key occupational populations of brucellosis in Jiangsu Province, with a positive rate of 7.83% (113/1 444), and the overall trend was downward year by year ( t = 6.463, P < 0.05). Among them, the positive rates in Yixing City and Huaiyin District were 11.79% (106/899) and 1.28% (7/545), respectively. The difference between different regions was statistically significant (χ 2 = 51.926, P < 0.01). The positive rates of occupational groups engaged in livestock trading, livestock slaughtering, and the fur, milk and meat processing were 5.10% (20/392), 9.74% (49/503), and 8.01% (44/549), respectively. The differences were statistically significant between different occupations (χ 2 = 6.618, P < 0.05); and the positive rates of livestock slaughtering occupations and the fur, milk and meat processing occupations were higher than that of livestock trading occupations ( P < 0.05). Conclusions:The positive rate of brucellosis in key occupational populations has showed a general downward trend, the livestock slaughtering occupations and the fur, milk and meat processing occupations are more susceptible to Brucella infection. It is still necessary to strengthen the health education for the key occupational populations of brucellosis and inspection and quarantine work for prevention of the epidemic of brucellosis in humans.

Objective To investigate the effects of the number of harvested lymph nodes in neoadjuvant chemoradiotherapy (nCRT) combined with surgery on prognosis of middle-low rectal cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 373 patients with middle-low rectal cancer who underwent nCRT combined with surgery in the Fujian Medical University Union Hospital from January 2009 to December 2013 were collected.There were 241 males and 132 females,aged from 26 to 81 years,with the age of (55 ± 11) years.Observation indicators:(1) treatment situations;(2) follow-up and survival;(3)influencing factors for the number of harvested lymph nodes;(4) prognostic analysis of the different number of harvested lymph nodes as cut-off for grouping;(5) stratified analysis.Follow-up using telephone interview and outpatient examination was performed to detect postoperative survival of patients once every three months within postoperative 2 years and once every 6 months during the postoperative third year up to March 2016.The endpoint of follow-up was tumor recurrence,retastasis or death.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was done using the independent sample t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Kruska1-Wallis H test.Count data was described as absolute numbers.Univariate and multivariate analyses were done by the multiple linear regression model.Survival rate was calculated by the Kaplan-Meier method,and Logrank test was used for survival analysis.Results (l) Treatment situations:373 patients underwent nCRT combined with surgery,including 329 combined with sphincter-sparing rectal resection and 44 combined with abdominoperineal rectal resection.The number of harvested lymph nodes was 12 ± 6 in 373 patients.There were 185 patients with the number of harvested lymph nodes ＜ 12 and 188 with the number of harvested lymph nodes ≥ 12.(2) Follow-up and survival:373 patients were followed up for 5-77 months,with a median follow-up time of 43 months.During the follow-up,the 1-,3-,5-year disease-free survival rates were respectively 90.4％,76.3％,and 67.5％ in the 373 patients.(3) Influencing factors for the number of harvested lymph nodes:univariate analysis showed that distance between the tumor and anal verge,tumor diameter,tumor pathological N staging,and regression grade of rectal cancer were associated factors for the number of harvested lymph nodes (t =3.156,2.992,x2=8.183,10.839,P＜0.05).Multivariate analysis showed that distance between the tumor and anal verge,regression grade of rectal cancer,and tumor pathological N staging were independent factors for the number of harvested lymph nodes (t=3.308,2.690,2.584,95％ confidence interval:0.808-3.180,0.446-2.873,0.332-2.448,P＜0.05).(4) Prognostic analysis of the different number of harvested lymph nodes as cut-off for grouping:with the number of harvested lymph nodes of 6,7,8,9,10,11,12,13,14,15,and 16 as cut-off for grouping,there was no significant difference in the 3-year disease-free survival rate,cumulative local recurrence rate,and cumulative distant metastasis rate between ＜6 group and ≥6 group,between ＜7 group and ≥7 group,between＜8 group and ≥8 group,between ＜9 group and ≥9 group,between ＜10 group and ≥ 10 group,between ＜11 group and ≥ll group,between ＜12 group and ≥12 group,between ＜13 group and ≥13 group,between ＜ 14 group and ≥ 14 group,between ＜ 15 group and ≥ 15 group,between ＜ 16 group and ≥ 16 group,respectively (P＞0.05).(5) Stratified analysis:with the number of harvested lymph nodes of 7,8,9,and 10 as cut-off for grouping in 45 of 373 patients with Ⅱ-Ⅲ regression grade of rectal cancer and negative lymph nodes (NO staging),there was no significant difference in the 3-year disease-free survival rate between ＜7 group and ≥ 7group,between ＜8 group and ≥8 group,between ＜9 group and ≥9 group,between＜10 group and ≥ 10 group,respetively (x2 =3.946,5.346,6.375,4.297,P＜0.05).Conclusions The number of lymph nodes as 12 is not the independent factor for prognosis of patients with middle-low rectal cancer after nCRT combined with surgery.The number of harvested lymph nodes as 7 to 10 is the important factor for evaluating the prognosis of middle-low rectal cancer patients with Ⅱ-Ⅲ regression grade of rectal cancer and negative lymph nodes after nCRT combined with surgery.

Objective To explore risk factors of the progression to castration-resistant prostate cancer(CRPC)after hormone therapy (HT).Methods A total of 178 patients with prostate cancer from February 2009 to February 2018 were enrolled to analyze the risk factors of the progression to castrationresistant prostate cancer after androgen deprivation therapy in Fujian Medical University Union Hospital.The mean age was72 years (range,49-91 years);the middle Gleason score was 7 (range,4-10);the middle PSA at the initiation of HT was 24.45 ng/ml (range,0.16-100.0 ng/ml);the middle time to PSA nadir was 9 months (range,0.5-69.0 months);the middle PSA nadir after HT was 0.030 ng/ml (range,0.003-78.670 ng/ml);the mean hemoglobin level was 131 g/L (range,64-184 g/L);the mean alkaline phosphatase level was 98 U/L (range,35-734 U/L);39 patients were diabetes mellitus (21.9％);82 patients were bone metastasis/visceral metastasis (46.1％);85 patients (47.8 ％) were in clinical T1 + T2;93 patients(52.2％)were in clinical T3 + T4.We studied the relationship between CRPC and these risk factors including age,Gleason score,PSA at the initiation of HT,PSA nadir after HT,the time to PSA nadir,hemoglobin level,alkaline phosphatase,bone metastasis/visceral metastasis,clinical T stage,diabetes mellitus by x2 test,univariate and multivariate Cox regression analysis methods.Results The middle follow-up time was 30 months (range,6-92 months).There were 74 of 178 patients progressed to CRPC after HT.The median time of progression to CRPC in this cohort was 15 months (range,4-47 months).On x2 test analysis,there were statistically significant differences between the progression to CRPC group after HT and the rest group in Gleason score (P ＜0.001),PSA nadir after HT (P ＜0.001),PSA at the initiation of HT (P =0.042),alkaline phosphatase (P =0.002),bone metastasis/visceral metastasis (P＜0.001) and clinical T stage (P ＜0.001).Additionally,on multivariate Cox regression analysis,Gleason score (OR =6.152,P ＜ 0.001),PSA nadir after HT (OR =3.022,P ＜ 0.004) and the time to PSA nadir (OR =0.375,P ＜0.001) were found to be significantly associated with the rapid progression to CRPC.Conelusions Gleason score,PSA nadir after HT and the time to PSA nadir were significantly associated with the progression to CRPC.Patients with higher PSA nadir or the shorter time to PSA nadir were more likely to progress to CRPC.

OBJECTIVETo investigate the surgical endpoint of separation of mesorectum during total mesorectal excision (TME), suggesting the concept of "terminal line", in order to perform above separation better for middle-low rectal cancer.

METHODSGross anatomy of mesorectum endpoint from 81 surgical specimens of low anterior resection (LAR, 5 to 6 cm of distance from low margin of cancer to anal edge) and 71 surgical specimens of abdominal perineal resection(APR, <5 cm of distance from low margin of cancer to anal edge) was observed. Clinicopathological, magnetic resonance imaging(MRI) morphological and operative video data of 108 low rectal cancer patients undergoing TME at Department of Colorectal Surgery of Affiliated Union Hospital of Fujian Medical University between March 2016 and March 2017 were retrospectively analyzed. Rates of the "terminal line" exposure of TME between different surgical procedures(robot or laparoscope) and different anatomical instruments (ultrasonic knife or electric hook) were compared for evaluating the site of separation endpoint.

RESULTSThe gross anatomical findings of specimens from LAR showed that the rectal wall below the levator hiatus level had no mesorectum attachment, and gross anatomical finding of specimens from APR showed that the levator hiatus was the most terminal attachment margin of the mesorectum whose thickness was only 2 millimeters in levator hiatus level. MRI morphological findings of 108 low rectal cancer patients showed that high signal intensity of mesorectal tissue on T2 MRI gradually thinned to the level of levator hiatus. High quality laparoscopic and robotic operation revealed a white linear structure formed by pelvic fascia, which covered and surrounded levator hiatus, so the "terminal line" of TME was defined. The operation video of 108 revealed that the overall exposure rate of the "terminal line" was 45.4%, the exposure rate of "terminal line" in robotic surgery was similar to that in laparoscopic surgery [(60.0%(18/30) vs. 39.7%(31/78), P=0.058], while such rate in ultrasonic knife was superior to electric hook [55.4%(41/74) vs. 23.5%(8/34), P=0.002]. Laparoscopy combined with ultrasonic knife can also obtained a high exposure rate of 52.3%(23/44).

CONCLUSIONSThe white linear structure referring to pelvic fascia which covers and surrounds levator hiatus is the "terminal line" of TME. The use of an ultrasonic knife is easier to expose this structure and to guarantee the quality of TME.