[Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial].

Objective: To investigate the effect of esmolol in septic shock patients with tachycardia. Methods: A prospective randomized controlled trial was conducted. Screening septic shock patients that admitted to Department of General Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from June 2016 to August 2017. After 24 h resuscitation therapy, 100 cases of septic shock patients with tachycardia (heart rate>100 bpm) were divided into esmolol group (n=50) and control group (n=50) with random number table. Patients in esmolol group accepted standard treatment plus esmolol injection with an initial dose of 25 mg/h. Heart rate target is 80 to 100 bpm. Patients in esmolol group continued to use esmolol for 7 days or to the day the patient left the ICU when the heart rate didn't achieve the target. Patients in control group were given standard treatment. Primary outcome was 28 d mortality. Secondary outcomes included heart rate, norepinephrine dosages, lactate level, inflammatory markers in per day during the trial; acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on day 1, 3, 5, 7; length of hospital stay, length of mechanical ventilation, medication time of vasoactive agent. The data were compared with t test or rank sum test between the two groups. Results: The 28 d mortality of esmolol group and control group was 62%, 68%, respectively(χ(2)=0.529, P=0.529). Logistic regression analysis showed that primary heart rate (increase of 10 bpm, OR=1.568, 95%CI: 1.039-1.238, P=0.027), primary APACHEⅡ (OR=1.134, 95%CI: 1.026-1.239, P=0.005), integral heart rate (per 10 bpm, OR=2.207, 95%CI: 1.400-3.479, P=0.001) were independent risk factors for 28 d mortality. Compared with control group, the esmolol group had a lower heart rate on day 1-7; but over all, there was no statistically significant difference in heart rate between the two groups (P>0.05). There was no significant difference in total does of norepinephrine, lactate level, inflammatory markers, APACHE Ⅱ, SOFA, length of hospital stay between the two groups (all P>0.05). Conclusion: Tachycardia significantly increases the risk of death in patients with septic shock, esmolol may decrease the mortality by controlling heart rate.

First Report of Fusarium avenaceum Causing Postharvest Decay of 'Gala' Apple Fruit in the United States.

Apples are kept in controlled atmosphere cold storage for 9 to 12 months and are highly susceptible to postharvest decay caused by various fungi. Fusarium avenaceum is a wound pathogen that has been shown to account for the majority of Fusarium rot on apple fruit in Croatia (1). F. avenaceum produces an array of mycotoxins including moniliformin, acuminatopyrone, and chrysogine, which are of primary concern for the apple processing industry (2). In February 2013, 'Gala' apple fruits with soft, circular, brown, watery lesions with characteristic abundant whitish mycelium covering the surface of the colonized fruit were obtained from bins from a commercial storage facility located in Pennsylvania. Several samples were collected and prepared for pathogen isolation. Apples were rinsed with sterile water, and the lesions were sprayed with 70% ethanol until runoff. The apple skin was aseptically removed with a scalpel, and asymptomatic tissue was placed onto full strength potato dextrose agar (PDA) petri plates without antibiotics and incubated at 25°C under natural light. Two single-spore isolates were propagated on PDA and permanent cultures were maintained as slants and stored in a cold room at 4°C in the dark. Fungal colonies initially formed abundant fluffy white mycelium and produced a golden orange pigment on PDA at 25°C. Isolates were identified as Fusarium based on cultural and conidial morphology as macroconidia were slightly falcate, thin-walled, usually 3 to 5 septate, with a tapering apical cell that was on average 23.6 µm long × 5.0 µm wide (n = 50). Microconidia were produced on PDA plates while chlamydospores were not evident. Identity of the isolates was confirmed through DNA extraction followed by amplification and sequencing of the translation elongation factor (EF-1α, 350 bp) gene region. The amplicons were sequenced using the forward and reverse primers and assembled into a consensus representing 2X coverage. MegaBLAST analysis revealed that both isolates were 100% identical with many other culture collection F. avenaceum sequences in Genbank (Accessions JQ949291.1, JQ949305.1, and JQ949283.1), which confirms their identification in conjunction with the morphological observations. Koch's postulates were conducted to determine pathogenicity using organic 'Gala' apple fruit that were surface sanitized with soap and water, sprayed with 70% ethanol, and wiped dry. The fruit were wounded with a finishing nail to 3 mm depth, inoculated with 50 µl of a conidial suspension (1 × 104 conidia/ml) using a hemocytometer, and stored at 25°C in 80-count boxes on paper trays for 21 days. Water-only controls were symptomless. Ten fruit composed a replicate for each isolate, and the experiment was repeated. Symptoms observed on artificially inoculated 'Gala' apple fruit were identical to the decay observed on 'Gala' apples that were obtained from cold storage. Decay caused by F. avenaceum may represent an emerging problem for the apple storage and processing industry. Therefore, it is important to monitor for this pathogen to prevent future losses and mycotoxin contamination of processed fruit products caused by this fungus. To the best of our knowledge, this is the first report of Fusarium rot caused by F. avenaceum on apple fruit from cold storage in the United States. References: (1) Z. Sever et al. Arch. Ind. Hygiene Toxicol. 63:463, 2012. (2) J. L. Sorenson. J. Agric. Food Chem. 57:1632, 2009.

First Report of Alternaria tenuissima Causing Postharvest Decay on Apple Fruit from Cold Storage in the United States.

Apples are grown and stored for 9 to 12 months under controlled atmosphere conditions in the United States. During storage, apples are susceptible to various fungal pathogens, including several Alternaria species (2). Alternaria tenuissima (Nees) Wiltshire causes dry core rot (DCR) on apples during storage and has recently occurred in South Africa (1). Losses range widely, but typically occur at 6 to 8% annually due to this disease (2). In February 2013, 'Nittany' apples with round, dark-colored, dry, spongy lesions were obtained from wooden bins in a commercial cold storage facility located in Pennsylvania. Symptomatic fruits were transported to the lab, rinsed with sterile water, and the lesions were sprayed with 70% ethanol until runoff and wiped dry. The skin was aseptically removed with a scalpel, and asymptomatic tissue was placed onto potato dextrose agar (PDA) and incubated at 25°C. Two single-spore isolates were propagated on PDA and permanent cultures were maintained as slants and stored at 4°C. The fungus produced a cottony white mycelium that turned olive-green to brown with abundant aerial hyphae and had a dark brown to black reverse on PDA. Isolates were identified as Alternaria based on conidial morphology as the spores were slightly melanized and obclavate to obpyriform catentulate with longitudinal and transverse septa attached in unbranched chains on simple short conidiophores. Conidia ranged from 10 to 70 µm long (mean 27.7 µm) and 5 to 15 µm wide (mean 5.25 µm) (n = 50) with 1 to 6 transverse and 0 to 2 longitudinal septa. Conidial beaks, when present, were short (5 µm or less) and tapered. Mycelial genomic DNA was extracted, and a portion of the histone gene (357 bp) was amplified via gene specific primers (Alt-His3-F/R) using conventional PCR (Jurick II, unpublished). The forward and reverse sequences were assembled into a consensus representing 2× coverage and MegaBLAST analysis showed that both isolates were 100% identical to Alternaria tenuissima isolates including CR27 (GenBank Accession No. AF404622.1) that caused DCR on apple fruit during storage in South Africa. Koch's postulates were conducted using 10 organic 'Gala' apple fruit that were surface sterilized with soap and water, sprayed with 70% ethanol, and wiped dry. The fruit were aseptically wounded with a nail to a 3 mm depth, inoculated with 50 µl of a conidial suspension (1 × 104 conidia/ml), and stored at 25°C in 80 count boxes on paper trays for 21 days. Mean lesion diameters on inoculated 'Gala' apple fruit were 19.1 mm (±7.4), water only controls (n = 10 fruit) were symptomless, and the experiment was repeated. Symptoms observed on artificially inoculated 'Gala' apple fruit were similar to the decay observed on 'Nittany' apples from cold storage. Based on our findings, it is possible that A. tenuissima can cause decay that originates from wounded tissue in addition to dry core rot, which has been reported (1). Since A. tenuissima produces potent mycotoxins, even low levels of the pathogen could pose a health problem for contaminated fruit destined for processing and may impact export to other countries. To the best of our knowledge, this is the first report of alternaria rot caused by A. tenuissima on apple fruit from cold storage in the United States. References: (1) J. C. Combrink et al. Decid. Fruit Grow. 34:88, 1984. (2) M. Serdani et al. Mycol. Res. 106:562, 2002. (3) E. E. Stinson et al. J. Agric. Food Chem. 28:960, 1980.

First Report of Alternaria alternata Causing Postharvest Decay on Apple Fruit During Cold Storage in Pennsylvania.

Alternaria rot, caused by Alternaria alternata (Fr.) Keissl., occurs on apple fruit (Malus × domestica Borkh) worldwide and is not controlled with postharvest fungicides currently registered for apple in the United States (1). Initial infections can occur in the orchard prior to harvest, or during cold storage, and appear as small red dots located around lenticels (1). The symptoms appear on fruits within a 2 month period after placement into cold storage (3). In February 2013, 'Nittany' apple fruit with round, dark, dry, spongy lesions were collected from bins at commercial storage facility located in Pennsylvania. Symptomatic apples (n = 2 fruits) were placed on paper trays in an 80 count apple box and immediately transported to the laboratory. Fruit were rinsed with sterile water, and the lesions were superficially disinfected with 70% ethanol. The skin was removed with a sterile scalpel, and tissues underneath the lesion were cultured on potato dextrose agar (PDA) and incubated at 25°C with constant light. Two single-spore isolates were propagated on PDA, and permanent cultures were maintained on PDA slants and stored at 4°C in darkness. Colonies varied from light gray to olive green in color, produced abundant aerial hyphae, and had fluffy mycelial growth on PDA after 14 days. Both isolates were tentatively identified as Alternaria based on multicelled conidial morphology resembling "fragmentation grenades" that were medium brown in color, and obclavate to obpyriform catentulate with longitudinal and transverse septa attached in chains on simple conidiophores (2). Conidia ranged from 15 to 60 µm (mean 25.5 µm) long and 10 to 25 µm (mean 13.6 µm) wide (n = 50) with 1 to 6 transverse and 0 to 1 longitudinal septa per spore. To identify both isolates to the species level, genomic DNA was extracted from mycelial plugs and gene specific primers (ALT-HIS3F/R) were used via conventional PCR to amplify a portion of the histone gene (357 bp) (Jurick II, unpublished). Amplicons were sequenced using the Sanger method, and the forward and reverse sequences of each amplicon were assembled into a consensus representing 2× coverage. A megaBLAST analysis revealed that the isolates were 99% identical to Alternaria alternata sequences in GenBank (Accession No. AF404617), which was previously identified to cause decay on stored apple fruit in South Africa. To prove pathogenicity, Koch's postulates were conducted using organic 'Gala' apples. The fruit were surface disinfested with soap and water and sprayed with 70% ethanol to runoff. Wounds, 3 mm deep, were done using a sterile nail and 50 µl of a conidial suspension (1 × 104 conidia/ml) was introduced into each wound per fruit. Fruit were then stored at 25°C in 80 count boxes on paper trays for 21 days. Water only was used as a control. Ten fruit were inoculated with each isolate or water only (control) and the experiment was repeated once. Symptoms of decay observed on inoculated were 'Gala' apple fruit were identical to the symptoms initially observed on 'Nittany' apples obtained from cold storage after 21 days. No symptoms developed on fruit in the controls. A. alternata was re-isolated 100% from apple inoculated with the fungus, completing Koch's postulates. A. alternata has been documented as a pre- and postharvest pathogen on Malus spp. (3). To our knowledge, this is the first report of postharvest decay caused by A. alternata on apple fruit during cold storage in Pennsylvania. References: (1) A. L. Biggs et al. Plant Dis. 77:976, 1993. (2) E. G. Simmons. Alternaria: An Identification Manual. CBS Fungal Biodiversity Center, Utrecht, the Netherlands, 2007. (3) R. S. Spotts. Pages 56-57 in: Compendium of Apple and Pear Diseases, A. L. Jones and H. S. Aldwinkle, eds. American Phytopathological Society, St. Paul, MN, 1990.

First Report of Mucor Rot on Stored 'Gala' Apple Fruit Caused by Mucor piriformis in Pennsylvania.

Mucor piriformis E. Fischer causes Mucor rot of pome and stone fruits during storage and has been reported in Australia, Canada, Germany, Northern Ireland, South Africa, and portions of the United States (1,2). Currently, there is no fungicide in the United States labeled to control this wound pathogen on apple. Cultural practices of orchard sanitation, placing dry fruit in storage, and chlorine treatment of dump tanks and flumes are critical for decay management (3,4). Cultivars like 'Gala' that are prone to cracking are particularly vulnerable as the openings provide ingress for the fungus. Mucor rot was observed in February 2013 at a commercial packing facility in Pennsylvania. Decay incidence was ~15% on 'Gala' apples from bins removed directly from controlled atmosphere storage. Rot was evident mainly at the stem end and was light brown, watery, soft, and covered with fuzzy mycelia. Salt-and-pepper colored sporangiophores bearing terminal sporangiospores protruded through the skin. Five infected apple fruit were collected, placed in an 80-count apple box on trays, and temporarily stored at 4°C. Isolates were obtained aseptically from decayed tissue, placed on potato dextrose agar (PDA) petri plates, and incubated at 25°C with natural light. Five single sporangiospore isolates were identified as Mucor piriformis based on cultural characteristics according to Michailides and Spotts (1). The isolates produced columellate sporangia attached terminally on short and tall, branched and unbranched sporangiophores. Sporangiospores were ellipsoidal, subspherical, and smooth. Chlamydospore-like resting structures (gemmae), isogametangia, and zygospores were not evident in culture. Mycelial growth was examined on PDA, apple agar (AA), and V8 agar (V8) at 25°C with natural light. Isolates grew best on PDA at rates that ranged from 38.4 ± 5.3 to 34.5 ± 2.41 mm/day, followed by AA from 30.5 ± 1.22 to 28.5 ± 2.51 mm/day, and V8 from 29.2 ± 3.0 to 26.7 ± 2.17 mm/day. Species-level identification was conducted by isolating genomic DNA, amplifying a portion of the 28S rDNA gene, and directly sequencing the products. MegaBLAST analysis of the 2X consensus sequences revealed that all five isolates were 99% identical to M. piriformis (GenBank Accession No. JN2064761) with E values of 0.0, which confirms the morphological identification. Koch's postulates were conducted using organic 'Gala' apples that were surface sanitized with soap and water, then sprayed with 70% ethanol and allowed to air dry. Wounds 3 mm deep were created using the point of a finishing nail and then inoculated with 50 µl of a sporangiospore suspension (1 × 105 sporangiospores/ml) for each isolate. Ten fruit were inoculated with each isolate, and the experiment was repeated. The fruit were stored at 25°C in 80-count boxes on paper trays for 14 days. Decay observed on inoculated 'Gala' fruit was similar to symptoms originally observed on 'Gala' apples from storage and the pathogen was re-isolated from inoculated fruit. This is the first report of M. piriformis causing postharvest decay on stored apples in Pennsylvania and reinforces the need for the development of additional tools to manage this economically important pathogen. References: (1) T. J. Michailides, and R. A. Spotts. Plant Dis. 74:537, 1990. (2) P. L. Sholberg and T. J. Michailides. Plant Dis. 81:550, 1997. (3) W. L. Smith et al. Phytopathology 69:865, 1979. (4) R. A. Spotts. Compendium of Apple and Pear Diseases and Pests: Second Edition. APS Press, St. Paul, MN, 2014.

First Report of Colletotrichum fioriniae Causing Postharvest Decay on 'Nittany' Apple Fruit in the United States.

Bitter rot of apple is caused by Colletotrichum acutatum and C. gleosporioides and is an economically important disease in the mid-Atlantic and southern regions of the United States (1). However, other Colletotrichum spp. have been found to infect apple and pear fruit in Croatia that include C. fioriniae and C. clavatum (3). The disease is favorable under wet, humid conditions and can occur in the field or during storage causing postharvest decay (2). In February 2013, 'Nittany' apples with round, brown, dry, firm lesions having acervuli in concentric rings were observed at a commercial cold storage facility in Pennsylvania. Samples were placed on a paper tray in an 80-count apple box and immediately transported to the lab. Fruit were rinsed with sterile water, and lesions were sprayed with 70% ethanol until runoff. The skin was aseptically removed with a scalpel, and tissue under the lesion was placed onto potato dextrose agar (PDA) petri dishes. Dishes were incubated at 25°C with constant light, and a single-spore isolate was propagated on PDA. Permanent cultures were maintained as PDA slants stored at 4°C in darkness. The isolate was identified as a Colletotrichum sp. based on culture morphology, having light gray mycelium with a pinkish reverse and abundant pin-shaped melanized acervuli oozing pink conidia on PDA. Conidia were fusiform, pointed at one or both ends, one-celled, thin-walled, aseptate, hyaline, and averaged 10.5 µm (7.5 to 20 µm) long and 5.1 µm (5 to 10 µm) wide (n = 50). Genomic DNA was extracted from mycelia and amplified using conventional PCR and gene specific primers for 313 bp of the Histone 3 gene and with ITS4/5 primers for the internal transcribed spacer (ITS) rDNA region. MegaBLAST analysis of both gene sequences showed that our isolate was identical to other Colletotrichum fioriniae sequences in GenBank and was 100% identical to culture-collection C. fioriniae isolate CBS:128517, thus confirming the morphological identification. To prove pathogenicity, Koch's postulates were conducted using organic 'Gala' apple fruit that were washed with soap and water, sprayed with 70% ethanol, and wiped dry. The fruit were wounded with a sterile nail to a 3-mm depth, inoculated with 50 µl of a conidial suspension (1 × 104 conidia/ml), and stored at 25°C in 80-count boxes on paper trays for 14 days. Lesion diameter was measured from 10 replicate fruit with a digital micrometer and averaged 31.2 mm (±2.5 mm) over two experiments (n = 20). Water-only controls were symptomless. Artificially inoculated 'Gala' apples had identical external and internal symptoms (v-shaped decay pattern when the fruit were cut in half) to those observed on 'Nittany' apples that were originally obtained from cold storage. Bitter rot caused by C. fioriniae may become an emerging problem for the pome fruit growing industry in the near future, and may require investigation of new disease management practices to control this fungus. This is the first report of postharvest decay caused by C. fioriniae on apple fruit from cold storage in the United States. References: (1) H. W. Anderson. Diseases of Fruit Crops. McGraw-Hill, New York, 1956. (2) A. R. Biggs et al. Plant Dis. 85:657, 2001. (3) D. Ivic et al. J. Phytopathol. 161:284, 2013.

First Report of Penicillium expansum Isolates Resistant to Pyrimethanil from Stored Apple Fruit in Pennsylvania.

Apples in the United States are stored in low-temperature controlled atmospheres for 9 to 12 months and are highly susceptible to blue mold decay. Penicillium spp. cause significant economic losses worldwide and produce mycotoxins that contaminate processed apple products. Blue mold is managed by a combination of cultural practices and the application of fungicides. In 2004, a new postharvest fungicide, pyrimethanil (Penbotec 400 SC, Janseen PMP, Beerse, Belgium) was registered for use in the United States to control blue mold on pome fruits (1). In this study, 10 blue mold symptomatic 'Red Delicious' apples were collected in May 2011 from wooden bins at a commercial facility located in Pennsylvania. These fruit had been treated with Penbotec prior to controlled atmosphere storage. Ten single-spore Penicillium spp. isolates were analyzed for growth using 96-well microtiter plates containing Richards minimal medium amended with a range of technical grade pyrimethanil from 0 to 500 µg/ml. Conidial suspensions adjusted to 1 × 105 conidia/ml were added to three 96-well plates for each experiment; all experiments were repeated three times. Nine resistant isolates had prolific mycelial growth at 500 µg/ml, which is 1,000 times the discriminatory dose that inhibited baseline sensitive P. expansum isolates from Washington State (1). However, one isolate (R13) had limited conidial germination and no mycelial proliferation at 0.5 µg/ml and was categorized as sensitive. One resistant (R22) and one sensitive (R13) isolate were selected on the basis of their different sensitivities to pyrimethanil. Both isolates were identified as P. expansum via conventional PCR using ß-tubulin gene-specific primers according to Sholberg et al. (2). Analysis of the 2X consensus amplicon sequences from R13 and R22 matched perfectly (100% identity and 0.0 E value) with other P. expansum accessions in GenBank including JN872743.1, which was isolated from decayed apple fruit from Washington State. To determine if pyrimethanil applied at the labeled rate of 500 µg/ml would control R13 or R22 in vivo, organic 'Gala' apple fruit were wounded, inoculated with 50 µl of a conidial suspension (1 × 104 conidia/ml) of either isolate, dipped in Penbotec fungicide or sterile water, and stored at 25°C for 7 days. Twenty fruit composed a replicate within a treatment and the experiment was performed twice. Non-inoculated water-only controls were symptomless, while water-dipped inoculated fruit had 100% decay with mean lesion diameters of 36.8 ± 2.68 mm for R22 and 38.5 ± 2.61 mm for R13. The R22 isolate caused 30% decay with 21.6 ± 5.44 mm lesions when inoculated onto Penbotec-treated apples, while the R13 isolate had 7.5% decay incidence with mean lesion diameters of 23.1 ± 3.41 mm. The results from this study demonstrate that P. expansum pyrimethanil-resistant strains are virulent on Penbotec-treated apple fruit and have the potential to manifest in decay during storage. To the best of our knowledge, this is the first report of pyrimethanil resistance in P. expansum from Pennsylvania, a major apple growing region for the United States. Moreover, these results illuminate the need to develop additional chemical, cultural, and biological methods to control this fungus. References: (1) H. X. Li and C. L. Xiao. Phytopathology 98:427, 2008. (2) P. L. Sholberg et al. Postharvest Biol. Technol. 36:41, 2005.

[Clinical study on effect of recombinant roasted licorice decoction combined with low-dose glucocorticoids in treating idiopathic thrombocytopenic purpura].

OBJECTIVE: To explore the clinical effect of recombinant roasted licorice decoction (RRLD) combined with low-dose glucocorticoids (GC) in treating idiopathic thrombocytopenic purpura (ITP). METHODS: Forty-three patients were divided semi-randomly into the treated group (n = 21) and the control group (n = 22), the former was treated with RRLD plus low-dose GC, and the latter was treated mainly with normal dosage of GC. RESULTS: The total effective rate of the treated group was better than that of the control group, the difference between these two groups was significant (P < 0.05). After treatment the platelet count in the treated group arose from (36.29 +/- 9.70) x 10(9)/L to (95.14 +/- 18.26) x 10(9)/L, while in the control group from (37.31 +/- 9.29) x 10(9)/L to (77.73 +/- 21.96) x 10(9)/L, the RRLD was superior to nat of GC in raising platelet count, the difference between them was also significant (P < 0.01). The treated group was lower obviously than the control group in adverse reaction (P < 0.01). CONCLUSION: The efficacy of RRLD plus low-dose GC is reliable in treating ITP, with less adverse reaction.

[Topography of intraabdominal supra and infra-hepatic IVC and its application in hepatectomy].

Topographic study of infra-diaphragmatic and supra-hepatic IVC (ISIVC) was made in 16 fresh adult cadavers. The diameter and length of ISIVC averaged 35.94 +/- 5.68 mm and 16.87 +/- 5.14 mm respectively, hence making band-blockade of the ISIVC is practical. In clinical application, 21 cases of liver cancer involving the second or third hepatic hilus underwent lobectomy or segmentectomy with temporary band-blocking of the ISIVC, the infrahepatic IVC and the first hepatic hilus to prevent or to treat massive bleeding. In 3 of the 21 cases, the middle hepatic vein was inadvertently torn and was successfully suture repaired with this way.

Safety and immunogenicity of live attenuated hepatitis A virus vaccine (H2 strain) in humans.

A study was made in Neijiang City, Sichuan Province to observe the safety and immunogenicity of a live attenuated hepatitis A virus (HAV) vaccine (H2 strain). 3,031 children, aged 6 to 9 years, were injected subcutaneously with 10(6.0) TCID50, 10(5.5) TCID50, and 10(5.0) TCID50 of HAV vaccine; the seroconversion rate and antibody GMT were 97.52%-90.68%, GMT = 1:5.19 +/- 1.90-1:3.36 +/- 1.94; 84.75%-76.27%, GMT = 1:4.29 +/- 1.96-1:2.0 +/- 2.67; 53.23%-51.61%, GMT = 1:2.57 +/- 1.89-1:1.68 +/- 1.41 respectively after 4 weeks to 12 months of inoculation. Forty-eight children in the control group were anti-HAV negative at 4, 8, and 12 weeks; 21 children in the oral group were not antibody positive 4 and 8 weeks after oral administration of the vaccine. The stool specimens of 3 of the 14 vaccinated children were HAA positive. The results suggest that the live attenuated HAV vaccine (H2 strain) is of good immunogenicity and safety.

Omental autotransplantation in treatment of thromboangiitis obliterans.

From 1981 to 1985, omental autotransplantation was performed for 28 patients with thromboangiitis obliterans on the left lower extremities in 16 patients, the right ones 11, and the right upper limb 1. The early results in all patients were satisfactory. In 19 patients followed up from 1 to 4 years, the results were encouraging, with the improvement of symptoms after operation. In 18 patients, digital ulcers healed within 2-4 weeks. Doppler and electrical impedance plethysmography examinations showed the blood circulation of affected extremities was markedly improved in the 18 patients except one who had the recurrence of digital ulcer 2 years later. In one of the 19 patients the disease recurred one month after the operation, and a lumbar sympathectomy was performed. The indications, the operative technique, and the mechanism of this operation are discussed.