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??Abstract??The fifth edition of Diagnostic and Statistical Manual of Mental Disorders ??DSM-???? is released in May 2013.The new term of autism spectrum disorder ??ASD?? replaced the term of pervasive developmental disorder ??PDD??.In this paper??the background for the current definition of ASD??the major changes of DSM-?? in ASD??the possible effects on the clinical practice of diagnosis and treatment of autism??and the continuous debate on this topic will be reviewed.     

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??Prevalence and temporal trend of gallbladder cancer in Shanghai ZHANG Ming-di*,GONG Wei, ZHENG Ying, et al.*Department of General Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092,China
Corresponding author: QUAN Zhi-wei, E-mail:zhiwquan@yahoo.com.cn; GONG Wei, E-mail: gongweius@hotmail.com
Abstract Objective To analyze the epidemiological pattern of gallbladder cancer in Shanghai. Methods The data of gallbladder cancer incidence in Shanghai were collected by the Shanghai cancer registry center and the trend of the incidence in urban Shanghai population from 1973 to 2006 was assessed by using the annual percent change (APC) analysis, which were compared with epidemiological data from other countries. Results A total of 5 253 new cases of gallbladder cancer were diagnosed from 2002 to 2006 with a crude incidence of 7.81 per 100,000 and an age-adjusted incidence of 3.80 per 100,000. Gallbladder cancer ranked the fifteenth among the common cancer in the male and ranked the eleventh in the female. The male/female incidence ratio was 1:1.77. In the age group of below 70 years, incidence is higher in the rural area than that in the urban area. But in the group of over 70 years, that is on the contrary. Of all the patients, 75.1% was over 65 years old and the highest incidence was observed in the age group of 80-84 years. The age-adjusted incidence rates have increased by 141.1% and 137.6% in the male and the female from 1973 to 2006 in urban Shanghai respectively. Conclusions The incidence of gallbladder cancer in the Shanghai area is obviously beyond the middle level of the world. Comprehensive screening of high-risk groups might be the only effective population-based preventive measure of the gallbladder cancer.     

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??Surgical site infection and hand-hygiene compliance LIU Song*, WANG Meng, DING Jie, et al. *Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
Corresponding author??REN Jian-an??E-mail??Jiananr@gmail.com??GUAN Wen-xian??E-mail??guan_wenxian@sina.com
Abstract Objective To investigate the incidence of surgical site infection??summarize the microbial profiles and corresponding antimicrobial resistance, and analyze the correlation between the incidence of surgical site infection and the consumption of hand-hygiene products. Methods The clinical data of all patients that received surgical procedures in 2015 in Nanjing Drum Tower Hospital and the General Hospital of Nanjing Military Command were collected retrospectively. The characteristics of surgical site infection were analyzed. Spearman correlation and multiple linear regression models were performed for correlation analysis. Results A total of 30 678 surgical procedures were performed in 2015. Among them??307 cases of surgical site infection were identified with an overall incidence of 1.00%. General Surgery and Neurosurgery exhibited the highest and lowest incidence of surgical site infection?? with 2.14% and 0.14% respectively. E. coli ??35.8%????S. aureus ??13.2%????E. faecalis ??7.84%????P. aeruginosa ??5.89%?? and K. pneumoniae ??4.90%?? were the most common pathogens of surgical site infection. Antimicrobial resistance profiles varied between different types of pathogens. A significant negative correlation was identified between consumption of hand-hygiene products and incidence of surgical site infection ??r=-0.83~-0.88??P=0.0031~0.0083??. Furthermore?? the consumption of hand sanitizer could significantly impact the incidence of surgical site infection among surgical patients ??P=0.023??. Conclusion Hand hygiene is involved in the occurrence of surgical site infection. Promoting hand-hygiene compliance could probably decrease the incidence of surgical site infection. The characteristics of surgical site infection in current study could assist to tailor regional antimicrobial strategy in China.     

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??Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysms??A systematic review HU Ming??YANG Han??QIN Xiao. Department of Vascular Surgery??the First Affiliated Hospital of Guangxi Medical University??Nanning 530021??China
Corresponding author??QIN Xiao??E-mail??dr_qinxiao@163.com
Abstract Objective To evaluate therapeutic effectiveness of OR and EVAR of AAA and the difference of the cost effectiveness. Methods The Cochrane Central Register of Controlled Trials ??the Cochrane Library??,Ovid MEDLINE?? EMBASE?? ACP ??American College of Physicians?? Journal Club?? CNKI?? CBMdisc?? Chinese Science and Technology Periodical Full Text Database ??VIP??were retrieved. According to the inclusion and exclusion criteria?? randomized controlled clinical trials and non randomized controlled experiment about endovascular treatment and traditional open surgical treatment of AAA which have been completed??ongoing or published before 2016 April were studied. Results A total of 251 papers were found; 4 published randomized controlled trials and 12 non randomized controlled trials about the effectiveness and cost of AAA repair were pooled in the end. Conclusion The costs of the implant ??stent or graft???? direct costs?? medical / surgical supplies of endovascular treatment group are significantly higher than those of the conventional surgery group??the difference of the costs of following-up?? consultation fees?? operating room cost?? preoperative cost and operation cost between two groups are not obvious?? and in ICU and Ward costs?? staff costs??costs of drugs and blood?? endovascular treatment group was significantly lower than those of the conventional surgery group.     

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??Characteristics of hemodynamics in abdominal aortic aneurysm and its treatment SHU Chang??WANG Tun. Department of Vascular Surgery, the Second Xiangya Hospital of Central South University??Changsha410011??China
Corresponding author: SHU Chang, E-mail??changshu01@yahoo.com
Abstract The research of hemodynamic characteristics in abdominal aortic aneurysm focuses on blood pressure, blood flow, aortic wall stress, shear stress, as well as the physio-pathologic changes caused by the specific hemodynamic situations. The hemodynamic characteristics lead to aortic aneurysm progressing, asymmetry and mural thrombosis. Meanwhile, the spatial structure of abdominal aortic aneurysm results in the particular hemodynamic characteristics. Researching of the hemodynamic status is an important method of analyzing the development and rupture risk of abdominal aortic aneurysm, and make prevention and treatment strategies.     

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??Hepatic Kasabach-Merritt syndrome: A case report and literature review LIN Han, MA Yong, JIANG Hong-chi, et al. Department of Hepatic Surgery, the First Affiliated Hospital of Harbin Medical University; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
Corresponding author: LIU Lian-xin, E-mail: liulianxin@medmail.com.cn
Abstract Objective To investigate the clinical features, diagnosis and treatments of hepatic Kasabach-Merritt Syndrome (KMS). Methods One case of hepatic KMS admitted in October 2009 in the First Affiliated Hospital of Harbin Medical University and the literature (50 cases) reported from 1984 to 2010 were collected. The incidence, clinical manifestations, laboratory tests, treatments and prognosis were analyzed retrospectively. Results The pathophysiological basis of KMS is thrombocytopenia which is closely related to the giant hemangioma and disseminated intravascular coagulation (DIC). The clinical manifestations of the tumor are diversified and pathological manifestations are mainly cavernous hemangioma and hemangioendothelioma. Treatment procedure includes the correction of DIC and thrombocytopenia, surgical treatment ??hepatectomy, liver transplantation, etc.??or pharmacotherapy (glucocorticoids, interferon, etc.). Conclusion Hemangioma, especially giant hemangioma with thrombocytopenia, should be alert to hepatic KMS. Once the diagnosis is confirmed, the hepatic KMS should be given combined modality therapy according to the size and location of the tumor, the core of which is surgery and interventional therapy, and assisted by a variety of treatment modalities, such as pharmacotherapy, blood transfusions, etc.