Advances in the study of postpancreatectomy acute pancreatitis / 中华外科杂志

Postpancreatectomy acute pancreatitis (PPAP) is an acute inflammation of the remnant pancreas in the early postoperative period caused by a variety of factors. With the progress of related research,PPAP has been confirmed as an independent risk factor for many severe complications such as postoperative pancreatic fistula. In some cases, it progresses to necrotizing PPAP, increasing the risk of mortality. Currently, the International Study Group for Pancreatic Surgery has standardized and graded PPAP as an independent complication, taking into account factors including serum amylase, radiological features, and clinical impact. This review summarizes how the concept of PPAP was proposed, as well as the latest progress in the research related to its etiology, prognosis, prevention, and treatment. However, given the large heterogeneity of relevant studies and the fact that they were mostly retrospective, in the future, it is necessary to place more emphasis on PPAP and elucidate the problems through more standardized studies to optimize strategies for the prevention and management of complications after pancreatic surgery.

Outbreak of dengue Fever in central China, 2013 / 生物医学与环境科学（英文）

In 2013, the first dengue fever (DF) outbreak in central China was reported in the central of Henan province, northern temperate regions, although they have been sequentially recorded in Southern China. 106 suspected DF cases were reported and 73 patients were confirmed dengue virus type 3 (DEN-3) infections. 62/392 (15.8%) local health persons showed DEN antibodies positive. To this day Henan is the northernmost province in China which has been reported about outbreak of DF and what is important is that it warns us the endemic range of DF has been expanded geographically in China.

Genome sequences of coxsackievirus B5 isolated from viral encephalitis patients in Henan province, 2011 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the complete genome sequences of two coxsackievirus B5 (CVB5) isolated in Henan province, 2011.</p><p><b>METHODS</b>Specimens were collected from viral encephalitis patients and followed by viral isolation on them. RNA were extracted from positive isolates and the amplified products were sequenced. The full-length genomes of them were acquired by assembling the fragments, using DNAStar 5.01 software while phylogenetic analysis were performed with Mega 5.05 and other software.</p><p><b>RESULTS</b>The genomes RNA of 03001N and 17Y showed 7408 bp and 7404 bp long, and the 5'- and 3'-untranslated regions were 747 bp, 743 bp and 103 bp, 103 bp, respectively. BLAST analysis of these two isolates, based on the complete genome, showed 97% identity, with both of them having the highest similarity(98%, 99%)to the CVB5 strain isolated from Henan in 2010 rather than other CVB5 strains. Coding regions of both isolates were 6558 bp, code for a polyprotein of 2185 amino acids (aa) and both of them showed 99% amino acid identity. Phylogenetic tree in VP1 region showed that the two isolates belonged to the same clade with other strains isolated from all over the country in the past years, except for some CVB5 strains isolated from Henan and Shandong province in 2009 that formed the other cluster.</p><p><b>CONCLUSION</b>It seemed that more than one group of CVB5 were circulating in Henan province and these two isolates appeared the main epidemic strains circulating in the past years.</p>

Comparison of different molecular assays for the rapid detection of enterovirus 71 (EV71) / 病毒学报

Molecular detection of enterovirus (EV)71 RNA based on PCR methods is a quick and sensitive approach. At present, different PCR-based methods for EV71 RNA detection are available, but comparisons of results obtained using different approaches are limited. This study is to compare the analytical sensitivity and specificity of different real-time reverse transcription-polymerase chain reaction (rRT-PCR) and conventional reverse transcription-polymerase chain reaction (cRT-PCR) assays for enterovirus and EV71 detection, Altogether, three rRT-PCR assays and one cRT-PCR assay targeting the 5'UTR gene for universal detection of enterovirus; two rRT-PCR assays andone cRT-PCR assay targeting the VP1 gene for specific detection of EV 71 were examined. All assays showed good specificity. The detection sensitivity ranged from 8.19 x 10 to 8.19 x 10(5) copy equivalents. In general, rRT-PCR assays were more sensitive than cRT-PCR assays. All rRT-PCR assays showed 100% sensitivity for clinical specimens.

Analysis of the epidemic characteristics of fever and thrombocytopenia syndrome in Henan province, 2007 - 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the epidemiological characteristics of fever thrombocytopenia and leukopenia syndrome (FTLS) in Henan province, China in 2007 - 2011.</p><p><b>METHODS</b>Data from specific surveillance system for FTLS in Henan and Information Management System of Chinese Center for Disease Control and Prevention were used to collect the information of the cases.Descriptive epidemiological methods were used to analyze the surveillance data during 2007 - 2011. Patients' sera were collected to detect new bunyavirus using fluorescent RT-PCR and virus isolation.</p><p><b>RESULTS</b>During 2007 - 2011, 1021 FTLS cases were reported in Henan province. The fatality rate was 2.25%with 23 deaths. The cases reported in Xinyang city were 1007, accounting for 98.75%.Cases were mainly occurred between April and October, accounting for 96.47% (985/1021). Epidemic peak was May to July, accounting for 59.16% (604/1021). The second peak occurred in September, accounting for 12.05% (123/1021). The age of the cases ranged from 1 to 88 years old with the median age of 59. Sex ratio (male:female) was 1:1.50 (408:613). In all cases, 93.73% (957/1021) were farmers. In 465 patients' sera, the positive rate of new bunyavirus was 69.25% (322/465) using fluorescent RT-PCR. In 164 patients' sera, 67 strains of new bunyavirus were isolated with isolation rate of 40.85% (67/164).</p><p><b>CONCLUSION</b>FTLS in Henan province is caused mainly by the new bunyavirus and has certain regional and seasonal characteristics. Most cases are female older farmers.</p>

Analysis on the diagnosis and treatment of a cluster of cases infected by new bunyavirus / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze and summarize the clinical characteristics, experience of diagnosis and treatment of cases infected by new bunyavirus, which occurred in Henan province in 2010.</p><p><b>METHODS</b>The clinical characteristics and effect of diagnosis and treatment of 5 cases were analyzed using descriptive epidemiological method. Blood specimens were detected by RT-PCR and pathogen separation.</p><p><b>RESULTS</b>PCR testing was positive for all 5 cases. New bunyavirus were isolated from 2 cases. In 5 cases, fever (5/5), the whole body aches (5/5), fatigue (5/5), anorexia (5/5), nausea (5/5), the chills (4/5), cough (4/5), expectoration (4/5), vomiting (3/5), conjunctival hyperemia (3/5); Leukocyte reduction (5/5), thrombocytopenia (5/5), elevated alanine aminotransferase (4/5), elevated aspartate aminotransferase (4/5), elevated lactate dehydrogenase (5/5), creatine kinase elevations (4/5), urinary protein (3/5). By symptomatic and supportive treatment and prophylactic antibiotics, the first case died and the other 4 cases were cured. The average course of disease was 15.4 days.</p><p><b>CONCLUSION</b>Cases infected by new bunyavirus have complicated clinical feature and multiple organ damage. If symptomatic treatment is in time, prognosis will be good.</p>

Establishment of indirect immunofluorescence assay (IFA) for detection of IgG antibody against new bunyavirus / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop an indirect immunofluorescence assay (IFA) for detection of IgG antibodies against new bunyavirus.</p><p><b>METHODS</b>The antigen slides were prepared with 5 new bunyavirus strains isolated using Africa green monkey kidney (Vero) cells. Specificity and sensitivity evaluation of IFA were carried out by optimizing working conditions of IFA. Using established IFA, serum samples from both acute and recovery phases were tested for 126 cases with fever thrombocytopenia and leukopenia syndrome in Xinyang, Henan province in 2007 - 2011. The results were compared with detections by RT-PCR.</p><p><b>RESULTS</b>The new bunyavirus stable immunofluorescence specific WZ69 strain was selected to prepare antigen slides of IFA. The optimum conditions of IFA were: optimum dilution for primary antibody (serum) and secondary antibody (isosulfocyanic acid fluorescence marked goat anti-human IgG antibody) was 1:40 and 1:150 respectively. The optimum dilution for Evans blue in secondary antibody was 1:20 000. Among the 126 patients, 96 paired serum specimens were tested positive to the new bunyavirus and 30 patients were tested negative to the virus. The positive rate of antibodies was 76.19%. There was no significant difference in results between IFA and RT-PCR (72.22% (91/126)) (P > 0.05).</p><p><b>CONCLUSION</b>The IFA has high sensitivity and specificity with easy operation. It can be used in detecting the new bunyavirus infection in patients with fever, thrombocytopenia and leukopenia syndrome.</p>

Culture, isolation and identification of new bunyavirus in African green monkey kidney(Vero) cells / 中华预防医学杂志

<p><b>OBJECTIVE</b>To culture, isolate and identify new bunyavirus in Vero cell line.</p><p><b>METHODS</b>Samples of 164 new bunyavirus positive by real time RT-PCR detection and well preserved serum specimens were selected from cases of fever, thrombocytopenia and leukopenia syndrome (FTLS) in Xinyang, Henan province in 2009 - 2011. These sera were cultured in Vero cell line and new bunyavirus were detected by observing cytopathic effect (CPE), Real-time RT-PCR, indirect immunofluorescence assay (IFA) and thin-section electron microscopy observation. A total of 10 positive PCR products were selected randomly for sequencing and the results were compared with sequence in Genbank.</p><p><b>RESULTS</b>Among 164 FTLS serum specimens cultured in Vero cell line, no special CPE were observed and 67 strains (40.85%) were positive detected by Real-time RT-PCR. Nucleic acid similarity of 10 specimens were 97.8% - 100% and there's also a high similarity (> 99%) between specimens and new bunyavirus isolates (Accession No. HQ141600.1). Among 67 positive strains, 58 of them showed specific fluorescence particles by IFA. The viral particles were observed to be spheres with a diameter of 80 - 100 nm by electron microscopy.</p><p><b>CONCLUSION</b>Vero cell line is suitable for culture, isolation and identification of new bunyavirus.</p>

Etiology surveillance of hand-foot-mouth disease in Henan province between 2008 and 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand etiological types and distribution features of hand-foot-mouth disease (HFMD) in Henan province between 2008 and 2011.</p><p><b>METHODS</b>A total of 30 486 specimens of feces, rectal swabs or throat swabs from HFMD patients were collected by each Municipal CDC in Henan from 2008 to 2011. The enterovirus 71 (EV71), coxsackie virus A16 (CA16) and other enterovirus (EV) were detected by RT-PCR or real time RT-PCR. The VP1 gene of EV71 was amplified and the sequences were analyzed by bioinformatics software. A genetic evolution tree of the sequence was constructed as well.</p><p><b>RESULTS</b>The positive rates of EV71, CA16 and other EV were 62.70% (11 209/17 876), 12.03% (2150/17 876), 25.27% (4517/17 876) in 17 876 laboratory diagnosed cases, respectively. The differences were statistically significant (χ(2) = 157.17, P < 0.05). The positive rates of EV71, CA16 and other EV were 63.40% (7370/11 624), 11.58% (1346/11 624) and 25.02% (2908/11 624) in male patients and 61.40% (3839/6252), 12.86% (804/6252) and 25.74% (1609/6252) in female patients, respectively. The differences were statistically significant (χ(2) = 4.06, P < 0.05). The children under 5 years old were high-risk population of HFMD, accounting to 97.67% (17 459/17 876) of the laboratory-diagnosed patients.86.92% (15 537/17 876) cases were children between 1 to 3 years old. Constituent ratio of EV71 changed seasonally during a year, there was a high infection ratio of EV71 between April and June, especially in May, the infection ratio reached 69.34% (2384/3438). The positive rates of EV71, CA16 and other EV were 82.48% (5715/6929), 1.76% (122/6929) and 15.76% (1092/6929) among the 6929 laboratory-diagnosed severe cases, respectively. The positive rates of EV71 was higher than CA16 and other EV (χ(2) = 9259.17, 6170.81, P < 0.05, respectively). There were 117 deaths because of severe HFMD, 55 (47.01%) of which were laboratory confirmed. 50 death cases were infected by EV71, and according to the genetic evolution analysis, the VP1 gene of EV71 strain was belonged to subtype C4 of gene C.</p><p><b>CONCLUSION</b>The EV71 and CA16 were the main pathogens which caused HFMD in Henan province, and EV71 virus was the dominant strain, belonging to C4 subtype of gene C.</p>

Epidemic characteristics and viral antibody level among healthy people of Japanese B encephalitis in Henan province in 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the epidemic characteristics and viral antibody level among healthy people of Japanese B encephalitis (JE) in Henan province in 2010.</p><p><b>METHODS</b>A total of 433 selected JE cases in Henan province in 2010 were analyzed by descriptive epidemiological method. Xinyang and Luoyang were selected as survey sites in 2010.12 administrative villages were randomly selected from both cities. As the investigation objects, 519 healthy people from the two cities were randomly selected by eight age groups:less than one year old, 1 - 2 years old, 3 - 4 years old, 5 - 6 years old, 7 - 14 years old, 15 - 19 years old, 20 - 59 years old, and above 60 years old. A total of 1008 samples of blood specimens were collected both in May and November, and JE viral antibody was detected by micro-cytopathic effect neutralization test.</p><p><b>RESULTS</b>The incidence rate of JE was 0.46/100 000 (433/94 130 434) in Henan province in 2010.97.69% (423/433) of the patients were found between July and September, and 81.06% (351/433) were distributed in Nanyang, Xinyang, Luoyang, Zhumadian and Zhoukou city. Children aged 0 to 14 years were the primarily affected group (82.22%, 356/433), the people above 15 years old accounted for 17.78% (77/433) of whole cases in Henan province, but the same group accounted for 65.79% (50/76) of whole cases in Luoyang city, which obviously higher than the percentage in Henan province (χ(2) = 79.57, P < 0.05). Most patients were scattered children in Henan province, accounting for 58.89% (255/433). In Luoyang city, most patients were peasants, accounting for 44.74% (34/76). The antibody positive rate of JE among health people above 15 years old in Luoyang city was 48.94% (46/94), which was lower than it in Xinyang city at 97.78% (88/90). The difference showed statistical significance (χ(2) = 55.42, P < 0.05). The antibody positive rate among healthy people under vaccination was 50.41% (61/121), which was obviously higher than that among people without vaccination, at 16.67% (6/36) in Luoyang city. The difference showed statistical significance (χ(2) = 12.92, P < 0.05). The antibody positive rate among healthy people under vaccination was 67.11% (51/76) in Xinyang city, which was obviously higher than that among people without vaccination, at 46.39% (45/97). The difference showed statistical significance (χ(2) = 7.40, P < 0.05).</p><p><b>CONCLUSION</b>The incidence of JE showed seasonal and regional characteristics, there were differences among ages and occupations. The difference was consistent with the difference in viral antibody level among health people in Henan province and Luoyang city.</p>

Molecular epidemiological analysis of species B enteroviruses isolated from Henan Province of China during the six months in 2010 / 病毒学报

This report presents an overview of human enterovirus B species in Henan Province. A total of 14 isolates of HEV-B species isolated under HFMD surveillance network during the six months in 2010 were examined. Based on molecular typing results targeting VP1 region, 14 isolates were classified into 6 serotypes of HEV-B. Furthermore, comparison of these 14 isolates with reference strains and strains in mainland China was conducted. The phylogenetic analysis revealed that E25, E11 and E6 showed homology with those from Shandong Province which adjoins Henan Province. E1 and E13 showed homology with those from Yunnan Province, and E30 showed homology with Henan strain isolated in 2008. Cocirculation of two lineages of echovirus 6 was observed.

Genomic characteristics of coxsakievirus A16 isolated in Henan Province / 病毒学报

To reveal the genomic sequence characteristics of coxsackievirus A16 (CoxA16) strain isolated from patients with hand-foot-mouth disease (HFMD) in Henan province. A total of 406 samples were detected by reverse-transcription polymerase chain reaction (RT-PCR) and cell-culture-based isolation of coxsackievirus A16. The whole genome of CoxA16 isolate was amplified using 10 pairs of primers, the sequences were analyzed and phylogenetic tree was generated by bioinformatics software. The full length of HN1162/HN/CHN/2010 genome was 7411bp. Compared with the other CoxA16 strains released in GenBank, the nucleotide similarities were 87.0-97.9%, 77.0%-95.4%, 80.3%-96.9%, 77.9% 96.2%, 80.5-100% in 5'UTR, P1, P2, P3, 3'UTR region, respectively; The similarities of nucleotide and amino acid sequences in VP1 region were 91.4%-96.4% and 99.3%-99.7%, respectively. Phylogenetic tree analysis showed that CoxA16 strains isolated from Henan, Shenzhen, Guangzhou and Fujian belonged to the same cluster. The newly isolated CoxA16 from Henan province belonged to subgenotype C2/B-2. These results will have great significance in monitoring CoxA16 and for prevention and control of hand-foot-mouth disease.

The spatial distribution and dynamics of human rabies cases at the county level in Henan province / 中华流行病学杂志

Objective To study the spatial distribution and dynamics of human rabies cases at the county level, in Henan province to provide scientific evidence for the development of control program on rabies. Methods Data of human rabies cases at the county level from 2004 to 2010 in Henan province were analyzed by Poisson distribution and negative binomial distribution. Data calculation was conducted manually. Results According to the level of α =0.05 being set, there were three different results appeared: the first was fitted negative binomial distribution in 2004, 2005,2007 and 2009; the second was prioritized negative binomial distribution, but the poisson distribution could not be excluded in 2008 and 2010; the last one was fitted neither negative binomial distribution nor poisson distribution in 2006. By the clustering parameter k, the clustering degree at county level decreased from 2004 to 2008, then ascending in 2009 but descending again in 2010. The degree of clustering showed a positive correlation with the county mean cases in the prevalent counties (r=0.807,P=0.028). Conclusion As a whole,the distribution of human rabies at county level in Henan from 2004 to 2010 showed negative binomial distribution and presented the spatial clustering.However, the degree of clustering decreased in recent years and showed that the infection resource was possibly scattered more evenly at the county level.

Discussion on five methods used for the determination of temporal clustering on infectious diseases / 中华流行病学杂志

To demonstrate and evaluate five different methods in the determination of temporal clustering on infectious diseases. The incidence rates of bacillary dysentery in Jinshui district, Zhengzhou city, Henan province from 2008 to 2010 were analyzed by 5 different methods-Cluster Analysis, Runs Test, Negative Binomial Distribution, Circular Distribution and Concentration Ratio. Through Cluster Analysis, data showed that the epidemic period was from May to Sept. with August as the peak. Runs Test confirmed a cluster of month-incidence in 2008 and 2009 (P < 0.05) and a random distribution in 2010. The Concentration Ratio showed a weakened seasonal incidence cluster to a certain extent by M from 2008 to 2010. The Circular Distribution demonstrated an inclining cluster of time (P < 0.01) and it was on July 11(th) and 29(th), as well on August 24(th) in 2008, 2009 and 2010. In terms of day-incidence, the Negative Binomial Distribution presented a cluster in 2008 and 2010, but with no significant difference in 2009. The five above said methods could flexibly be used in determining the temporal clustering of infectious disease at different occasions.

Surveillance on Japanese encephalitis in Henan province, 2006-2010 / 中华流行病学杂志

Objective To analyze the epidemiological characteristics and risk factors of Japanese encephalitis (JE) in Henan province.Methods Epidemiological characteristics and related factors of JE cases in Henan province from 2006 to 2010 were analyzed with descriptive epidemiological method and JE IgM antibodies of the serum or cerebrospinal fluid of the cases were detected by ELISA.Results 3099 cases were reported in Henan province from 2006 to 2010.The incidence fluctuated from 0.39/100 000 to 1.08/100 000,and the incidence rate was decreasing.Patients were concentrated mainly in Xinyang,Nanyang and Luoyang cities,which accounted for 60.12％ of the total.The peak season was in July-September,accounted for 93.26％ of all the cases.Most cases were in 0-14 year old (83.61％) in the whole province.However,in Luoyang city,number of cases in the ≥ 15 year old group,had an obvious increase (57.63％).Compared with the provincial data,significant difference was found between the two ≥ 15 year old groups (x2=330.0341,P＜0.05)statistically.20.23％ of the JE cases were vaccinated but 75.54％ of them did not complete the whole course.79.77％ of the cases were not sure if they had received the vaccination.42.98％ of the JE cases were confirmed through laboratory tests but other 45.95％ of them were clinically diagnosed,with the rest 11.07％ were suspected cases.Conclusion The distribution of JE cases showed seasonal,regional characteristics and crowd differences in Henan province.Basic immunization and the program on strengthening immunization of JE should be further standardized.The laboratory diagnosis rate of JE cases should be further improved.

Genomic characteristics and recombination of enterovirus 71 strains isolated in Henan Province between 2008 and 2010 / 病毒学报

To reveal the genetic features and recombination of enterovirus 71 isolates between 2008 and 2010. A total of 5 enterovirus 71 isolates were sequenced completely and phylogenetic analysis and recombination were performed. Phylogenetic analysis based on VP1 regions revealed that the Henan enterovirus 71 between 2008 and 2010 belonged to C4a in subgenotype C4. Bootscan analyses and phylogenetic analysis based on the 5'UTR, P1, P2, P3 genomic regions revealed the recombinations between EV71 genotypes B and C at the 2A-2B junction, and between EV71 genotype B and CA16 strain G-10 at the 3B-3C junction. Henan enterovirus 71 isolates between 2008 and 2010 belonged to C4a in subgenotype C4 which was the predominant virus genotype circulating in mainland China since 2004, a combination of intratypic and intertypic recombination were found in EV71 subgenotype C4.

Etiology survey on an outbreak of viral encephalitis / 中华预防医学杂志

<p><b>OBJECTIVE</b>To isolate and identify the pathogen that caused an outbreak of viral encephalitis in Henan province in 2010; and to analyze the genetic characteristic of gene viral protein1(VP1) on the viral strains isolated.</p><p><b>METHODS</b>During the period of the outbreak of viral encephalitis in Lushan county, Pingdingshan city, Henan province, eight hospitalized patients were recruited in the study. All the patients' feces samples were collected. Three patients' cerebrospinal fluids samples and another four patients' serum samples were collected separately. The virus in the samples were isolated and identified by enterovirus (EV) combined serum. The VP1 gene of the positive isolate was amplified by reverse transcriptase PCR method, and its nucleotide sequence was detected and the genetic evolution was analyzed.</p><p><b>RESULTS</b>Fifteen samples were collected in total, including 8 feces samples, 3 cerebrospinal fluids samples and 4 serum samples. The results of Fluorescence Quota PCR detection showed that 11 out of 15 samples were positive; 2 strains of virus were isolated from 2 feces samples and the serotype were all Coxsackie-positive identified by the EV combined serum. The full-length VP1 genetic sequences were all 849 bp, and showed 77.1% - 96.9% similar to the nucleotide and 95.8% - 100% similar to the amino acid of CoxB5. The analysis showed that the genetic evolution tree was just the same with Genotype-D.</p><p><b>CONCLUSION</b>CoxB5 whose genotype was Genotype-D, was the pathogen that caused the outbreak of viral encephalitis in Lushan county, Pingdingshan city, Henan province.</p>