Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019) / 北京大学学报(医学版)

OBJECTIVE@#To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019).@*METHODS@#A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval.@*RESULTS@#From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing.@*CONCLUSION@#The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.

Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty / 亚洲男科学杂志(英文版)

This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs -0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions - improving erection and increasing penile length - thus increasing patient satisfaction and confidence in penile rehabilitation.

Expression of Neuroligin1 after Spinal Cord Injury in Rats / 中国康复理论与实践

Objective To observe the change of expression of neuroligin1 (NL1) in injured spinal cord in rats. Methods A total of 60 adult female Sprague-Dawley rats were randomly divided into control group (n=30) and experi-ment group (n=30), and both groups were further arranged into three days, seven days, 14 days, 21 days, and 28 days subgroups. The control group accepted T9-11 laminectomy, while the experiment group was injured at T10 spi-nal cord hit by Allen's technique (10 g×25 mm). They were assessed with Basso, Beattie & Bresnahan locomotor rating scale (BBB scale), in their time-points, while Golgi-Cox staining was used to observe the variation of den-drites and density of dendritic spine in the white matter located at upper end of spinal cord injured center, and im-munofluorescence staining was used to detect the expression of NL1. Results The score of BBB scale reduced in the experiment group compared with that in the control group in every sub-group (P<0.001). Compared to the control group, both dendrites and density of dendritic spine in the white mat-ter decreased with time after injury (P<0.001), while the level of NL1 increased three days after injury, peaked on the 14th day after injury (P<0.05). Conclusion NL1 increases spontaneously after spinal cord injury, but it is not enough to promote synaptic regeneration.

Effect of posterior condylar offset on clinical results after posterior-stabilized total knee arthroplasty / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To determine the effect of the posterior condylar offset (PCO) on clinical results after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis.</p><p><b>METHODS</b>We prospectively studied the clinical and radiographic materials of 89 consecutive female patients (89 knees), who had undergone primary TKAs for end-stage osteoarthritis. All operations were performed by a single senior surgeon or under his supervision using the same operative technique. Based on the corrected PCO change, we divided all cases into two groups: group A (corrected PCO change ≥0 mm, 58 knees) and group B (corrected PCO change<0 mm, 31 knees). One-year postoperatively, clinical and radiographic variables from the two groups were compared by independent t-test. The associations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation.</p><p><b>RESULTS</b>One-year postoperatively, the Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, non-weight-bearing active and passive range of knee flexion, flexion contracture, extensor lag, and their improvements had no statistical differences between the two groups (all p>0.05). The corrected PCO change was not significantly correlated with the improvement of any clinical variable (all p>0.05). Group A demonstrated greater flexion than group B during active weight bearing (p<0.05).</p><p><b>CONCLUSIONS</b>Restoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA, while it has no benefit to non-weight-bearing knee flexion or any other clinical result.</p>

The Stent-Assisted Coil-Jailing Technique Facilitates Efficient Embolization of Tiny Cerebral Aneurysms

OBJECTIVE: Tiny cerebral aneurysms are difficult to embolize because the aneurysm's sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms. MATERIALS AND METHODS: Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up. RESULTS: All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela. CONCLUSION: The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data.

Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the increase in hemodialysis (HD) patients, the blood dialysis patient's quality of life (QoL) and long-term survival are still a challenge for clinicians. Recent studies have found that most of the HD patients have sleep disorders, which have a certain correlation with long-term survival and QoL. But there are few studies of Chinese in this field. This study aimed to investigate whether increasing the dialysis dose can improve sleep quality, so we treated HD patients on long intermittent hemodialysis (LIHD).</p><p><b>METHODS</b>Forty patients who were treated by conventional HD at the Beijing Friendship Hospital Blood Purification Center were offered the option of LIHD. The patients' laboratory data, medication use, and questionnaire answers were analyzed. Conventional HD was delivered thrice weekly with 4 hours per treatment, and LIHD was delivered thrice weekly with 8 hours per treatment. The study lasted 6 months. Questionnaires included sleep quality survey and QoL SF-36; the former includes the Athens Insomnia Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS).</p><p><b>RESULTS</b>After conversion to LIHD the dialysis efficiency (Kt/V) significantly increased than before (P < 0.05) and clearance rate of urea nitrogen also increased from 67 to 78% (P < 0.01). After conversion, median values for Hb increased from 108.95 to 126.55 g/L (P < 0.01); albumin increased from 38.85 to 40.05 g/L (P < 0.01). Phosphorus decreased from 2.69 to 1.54 mmol/L (P < 0.01), but there was no alteration in blood calcium; phosphorus and calcium-phosphate product levels were under more control, but parathyroid hormone (iPTH) level did not change after conversion to LIHD. After conversion, blood pressure (BP) was better controlled than before and the mean number of antihypertensive drugs prescribed declined from 2.9 to 0.5 (P < 0.01). There was a significant reduction in the use of erythropoietin-stimulating agent of 5250 U/w (P < 0.01). Sleep quality significantly improved in the 2 months after conversion to LIHD, and the PSQI score decreased from 10.80 to 5.45 and the ESS score decreased from 12.05 to 5.30 (P < 0.01). However, sleep quality started to decline after 2 months on LIHD. QoL SF-36 score increased from 410.92 to 592.53 (P < 0.01).</p><p><b>CONCLUSION</b>LIHD offers an effective improvement in dialysis adequacy for Chinese maintenance HD patients, but it improves sleep quality only briefly which may be related to loss of serum calcium and parathyroid dysfunction.</p>

Glycated albumin may be a choice, but not an alternative marker of glycated hemoglobin for glycemic control assessment in diabetic patients undergoing maintenance hemodialysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been suggested that glycated hemoglobin (HbA1c) underestimate the actual glycemic control levels in maintenance hemodialysis (MHD) patients, because of anemia and the using of erythropoietin (EPO); it was recommended that glycated albumin (GA) should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbA1c in this research by referring to mean plasma glucose (MPG) in diabetes mellitus (DM) patients undergoing MHD or not.</p><p><b>METHODS</b>MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbA1c, albumin (ALB), GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbA1c was done among the groups of MHD patients with DM (n=88) and without DM (NDM; n=90), and non-MHD ones with DM (n=102) using MPG for an actual glycemic control standard.</p><p><b>RESULTS</b>In these 3 groups, only for DM patients' (whether undergoing MHD or not), GA and HbA1c correlated with MPG significantly (P < 0.01). Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts (2.418 vs. 2.329) and slopes (0.053 vs. 0.057) were very close to each other. On the contrary, regression curves of HbA1c did not coincide in the two groups, because variance of the slopes (0.036 vs. 0.052) were relatively large. Through comparing receiver operating characteristic (ROC) areas under the curve (AUC), it could be understood that the assessment performances of GA and HbA1c in MHD patients were lower than those in non-MHD ones, and assessment performance of HbA1c in MHD patients was better than GA (P < 0.05). In addition, the effects of Hb and EPO dose on HbA1c, or that of ALB on GA were unobvious in our study.</p><p><b>CONCLUSIONS</b>Actual glycemic control level in MHD patients with DM may be underestimated by HbA1c, and it could be avoided by GA; however, glycemic evaluating performance of HbA1c may be still better than that of GA. Therefore, HbA1c should not be replaced completely although GA can be used as a choice to monitor glycemic level.</p>

One hemodialysis patient with headache, blurred vision, and hypotension induced by pituitary prolactinoma / 中华医学杂志(英文版)

We reported a rare case of a dialysis patient coincident pituitary prolactinoma with calcification. A 55-year-old woman who had undergone hemodialysis for 8 years was admitted to the nephrology unit because of headache, blurred vision, and hypotension. Physical examination was normal; endocrinological examination demonstrated elevated serum levels of prolactin (> 4240 mIU/L), but other hormonal profiles, such as growth hormon, adrenocorticotropic hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, follicle-stimulating hormone and luteinizing hormone, were absolutely or relatively lower. A cranial computed tomography (CT) suggested saddle area a high-density screenage with an anteroposterior diameter of 1.0 cm. A cerebral magnetic resonance scan confirmed the pituitary adenoma accompanied with calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor, 14 mm wide round lesion with a high intensity signal. It enlarges the sella turcica, but the optic chiasma is not displaced. We suggest that in the differential diagnosis of any hemodialysis patient with severe headache, hypotension, and visual disturbances, this syndrome should be considered as prompt pituitary adenoma.

Antibiotic-loaded articulating cement spacers in two-stage revision for infected total knee arthroplasty: individual antibiotic treatment and early results of 21 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To detail our early experience and technique of a modified two-stage reimplantation protocol using antibiotic-loaded articulating cement spacers (ALACSs) for treatment of late periprosthetic infection after total knee arthroplasty (TKA).</p><p><b>METHODS</b>From January 2006 to February 2009, a series of 21 patients (21 knees) with late infected TKAs were treated by radical debridement and removal of all components and cement, and then articulating spacers were implanted using antibiotic-impregnated bone cement. For this purpose, 4 g vancomycin powder was mixed with per 40 g cement. Graduated knee motion and partial weight bearing activity were encouraged in the interval period. Each patient received an individual systemic organism-sensitive antimicrobial therapy for 4.9 (range, 2-8) weeks followed by a second-stage TKA revision. All the patients were regularly followed up using the American Knee Society Scoring System.</p><p><b>RESULTS</b>Each case underwent a successful two-stage exchange and had infection eradicated, none had recurrent infection after an average of 32.2 (range, 17-54) months of follow-up. Preoperatively, the mean knee score was 53.5 points, function score was 27.3 points, pain score was 25.7 points, range of motion (ROM) was 82.0 degree extensor lag was 2 degree Between stages, the mean knee score was increased to 61.3 points, function score to 45 points, pain score to 35 points, ROM to 88.2 degree and extensor lag to 3.4 degree At final follow-up, the mean knee score was further increased to 82.1 points, function score to 74.5 points, pain score to 42.1 points, ROM to 94.3 degree and knee extension lag to 1.9 degree The interval period was 11.5 (range, 6-32) weeks. The amount of bone loss was unchanged between stages. No patient developed noticeable dysfunction of the liver or kidney or other complications such as impaired wound healing, deep venous thrombosis, pulmonary embolism, cerebrovascular accidents, etc.</p><p><b>CONCLUSIONS</b>Treating infected TKA with ALACS avoids spacer-related bone loss, preserves knee function between stages, and eradicates infection effectively without significant complications. The early clinical results are inspiring. The authors believe that radical and repeated (if needed) debridement, individual application of systemic antibiotics, and reasonable timing judgement upon the secondary revision are all key factors related to a successful outcome with two-stage reimplantation procedure for infected TKA.</p>

Detection of human parechovirus in children hospitalized for acute gastroenteritis / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To detect human parechovirus (HPeV) from stool samples of hospitalized children for acute gastroenteritis of undetectable etiology.</p><p><b>METHODS</b>We conducted a real-time PCR to detect HPeV.</p><p><b>RESULT</b>The results showed that 24 of 99 (24%) children with gastroenteritis of undetectable etiology were detected with HPeV. Four known HPeV types (HPeV1, 3, 4, 6) were detected in the present study. HPeV1 (50%) was frequently identified as the predominant strain and follow by HPeV3 (25%), HPeV4 (8.3%) and HPeV6 (4.2%). We were unable to type 3 samples.</p><p><b>CONCLUSION</b>HPeV was prevalent in hospitalized children for acute gastroenteritis of undetectable etiology in China. Further study is needed for clarifying the role of HPeV in gastroenteritis.</p>

Influence of peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients on continuous ambulatory peritoneal dialysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Extra glucose load in peritoneal dialysis is an important cause of newly-occurred diabetic mellitus, which initiates insulin treatment in some of the dialytic patients. The purpose of this study was to discuss the influence of the peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients who are on continuous ambulatory peritoneal dialysis (CAPD).</p><p><b>METHODS</b>One hundred and forty-five patients with total KT/V per week over 2.0 were recruited, including 60 males and 85 females. Fasting blood glucose (FBG), creatinine, blood urea nitrogen (BUN), blood albumin, blood lipid profile and blood C-reactive protein (CRP) were analyzed at the beginning of the peritoneal dialysis and after 12 months. A peritoneal equilibration test (PET) was carried out at the 3rd month of CAPD, and meantime residual renal function, peritoneal solute clearance rate, ultrafiltration volume and urine volume were also evaluated.</p><p><b>RESULTS</b>Twenty-one cases were identified as a low transfer group (L), 32 cases as a low average transfer group (LA), 58 cases as a high average transfer group (HA) and 34 cases as a high transfer group (H). At the end of the 12th month, 83 cases had elevated FBG. Through stepwise multiple regression analysis we found the FBG level in these patients was positively related to glucose load and CRP, and negatively related to glucose absorption in the peritoneum (D/D(0)) and blood albumin (P < 0.05). Kaplan-Meier analysis during a 48-month follow-up found the morbidity of hyperglycemia to be 17/34 cases (50.1%) in the high transfer group, 20/58 cases (34.5%) in the high average transfer group, 11/32 cases (34.3%) in the low average transfer group, and 1/21 cases (5.4%) in the low transfer group.</p><p><b>CONCLUSIONS</b>Patients with high peritoneal transfer capacity might have the highest morbidity from hyperglycemia among patients with these four different peritoneal transfer status. Glucose load, baseline CRP and FBG level before peritoneal dialysis, and D/D0 can efficiently predict hyperglycemia in CAPD patients.</p>

A research on rotaviral diarrhea outbreak in Guangxi Province / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analyze epidemiological characters of an outbreak of rotavirus diarrhea in Daxing County, Guangxi Province.</p><p><b>METHODS</b>Rotavirus-positive specimens were identified by ELISA kit. G/P typing assays were confirmed with multiplex seminested RT-PCR. Full-length VP7 genes of 4 positive specimens were amplified and analyzed.</p><p><b>RESULTS</b>30 cases of Rotavirus-positive were identified from 64 specimens. The attack rate was 46.9%, and G/P typing was G1P[8]. A change of VP7 amino acid residue is at positions 68.</p><p><b>CONCLUSION</b>G1P[8] rotavirus is the etiologic agents of this diarrhea outbreak. In addition, adults were included in this outbreak.</p>

Characteristics analysis on major genes and the encoded proteins of human G9P8 rotaviruses LL52696 and LL52727 / 病毒学报

Two Rotavirus G9P[8] strains (LL52696 and LL52727) were recognized during a sentinel-based survey in Lulong, China. Phylogenetic analysis of the VP7 gene showed that both strains isolated constituted a divergent genetic cluster distinct from the other G9 strains isolated in China. Analysis of VP4, VP6, and NSP4 genes revealed that these strains were closely related to Lulong strains. We hold that two strains were reassortant between G9 and Lulong predominant strains.

Study on the mortality-related factors in patients undergoing maintenance hemodialysis / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identify the mortality-related factors in patients undergoing maintenance hemodialysis.</p><p><b>METHODS</b>One hundred and seven long-term hemodialysis patients having suffered from chronic glomerulonephritis and received hemodialysis treatment in the hemodialysis center of the Friendship Hospital during February 1990 to February 2002 were selected to take part in a retrospective study. Survival analysis was done using Life Tables study. Cox regression analysis was used to find factors related to risk. Patients were divided into two groups according to the clinical value of the factors which showed statistical significance in Cox regression analysis. Survive rates were compared between two groups on Gehan test.</p><p><b>RESULTS</b>Among the 107 patients, 22 died (15.3%) and 85 survived (84.7%) during the follow-up period. Cumulative survival rates of 5 years and 10 years were 79.91% and 64.36% respectively. Prognostic factors would include age (P < 0.001), blood urea nitrogen (BUN, P = 0.004), serum creatinine (SCr, P = 0.001), value of plasma calcium multiplied by plasma phosphate (P = 0.019), and KT/V (P = 0.001), which were all tested during the third dialysis month. The Hazard Ratios (HR) were 1.107 (95% Confidence Interval, 95% CI: 1.049 - 1.168), 0.951 (95% CI: 0.918 - 0.984), 0.727 (95% CI: 0.599 - 0.883), 1.025 (95% CI: 1.004 - 1.046), and 0.013 (95% CI: 0.001 - 0.161), respectively. The survival rates between two groups were significant different (age >or= 60 years group vs < 60 years group P = 0.0006, BUN >or= 28.6 mmol/L vs < 28.6 mmol/L group P = 0.0415, SCr >or= 884 micro mol/L vs < 884 micro mol/L group P = 0.0146, value of plasma calcium multiplied by plasma phosphate >or= 40 vs < 40 group P = 0.0464, KT/V >or= 1.30 vs < 1.30 group P = 0.0215).</p><p><b>CONCLUSIONS</b>The mortality related prognostic factors of maintained hemodialysis patients seemed to include age, BUN, SCr, value of plasma calcium multiplied by plasma phosphate, and KT/V, which were all tested during the third dialysis month. Among them, age and the value of plasma calcium multiplied by plasma phosphate were risk factors of death, while the others were protective factors.</p>