Epidemiological and clinical characteristics of human brucellosis in Sichuan Province from 2018 to 2020 / 中华地方病学杂志

Objective:To analyze the epidemiological and clinical characteristics of human brucellosis in Sichuan Province, and to provide a scientific basis for prevention and control of brucellosis.Methods:Retrospective analysis methods were used to collect the data of reported cases of brucellosis in Sichuan Province from 2018 to 2020 from the "Infectious Disease Reporting Information Management System" in the "China Disease Prevention and Control Information System". The distribution (population, time and region) and case investigation data (epidemiological contact history and clinical manifestations) were analyzed by descriptive epidemiological.Results:A total of 309 cases of brucellosis were reported in Sichuan Province in 2018 - 2020, and no deaths occurred. The annual incidence rate was 0.123/100 000. Among the 309 reported cases of brucellosis, the sex ratio of men to women was 2.4 ∶ 1.0 (218 ∶ 91); the age of onset was mainly 20 - 60 years old, accounting for 79.9% (247/309); the occupation was mainly farmers, accounting for 51.8% (160/309). Brucellosis cases were reported in every month of the year, mainly from March to August, accounting for 72.5% (224/309) of the total number of cases. Cases were reported in 21 cities (autonomous prefectures) in Sichuan Province from 2018 to 2020. The top 5 cities (autonomous prefectures) in terms of cumulative number of cases were Chengdu, Liangshan, Zigong, Neijiang and Luzhou in order, accounting for 60.5% (187/309) of the total number of cases. Among the 309 reported cases of brucellosis, 279 case investigations were completed. Among them, 258 cases had a history of contact with livestock and their products, accounting for 92.5%; all contacted livestock were sheep; the main mode of transmission was direct contact, accounting for 88.5% (247/279); the main routes of transmission were sheep farming (50.2%, 140/279), sheep slaughtering (18.6%, 52/279), selling mutton or cutting sheep products in mutton restaurants (11.1%, 31/279); the main clinical manifestations were fever, fatigue, hyperhidrosis, and muscle and joint pain, accounting for 91.4% (255/279), 89.2% (249/279), 80.3% (224/279) and 65.2% (182/279), respectively.Conclusions:The spread of brucellosis in Sichuan Province is increasing, and spring and summer are the epidemic seasons. Brucellosis cases are most common in sheep farms, and the infection method is mainly direct contact infection; the clinical manifestations are diverse and non-specific. Relevant departments should strengthen the prevention and control of the disease in key populations and regions to control the outbreak of brucellosis.

Approach to creating early diabetic peripheral neuropathy rat model / 北京大学学报(医学版)

OBJECTIVE@#To create the early diabetic peripheral neuropathy (DPN) rat model.@*METHODS@#After one-week adaption, 26 male Sprague-Dawley (SD) rats were divided into two groups, the control group (n=6) and the model group (n=20). High-sucrose/high-fat diet (D12451, 35% of energy from carbohydrate, 45% of energy from fat) was given to the model group for six weeks to induce insulin resistance, meanwhile normal diet was given to the control group. Afterwards, streptozocin (STZ) buffer solution (35 mg/kg bodyweight) was injected into abdomen of the model group to induce specific pancreatic injury, meanwhile an equal amount of buffer solution was given to the control group. Then 48 h later, type 2 diabetes mellitus (T2DM) was supposed to be successfully induced according to the random blood glucose more than 16.7 mmol/L in the model group. Then the basic features of the T2DM rats were evaluated, including body weight, fasting blood glucose (FBG), glucose tolerance (oral glucose tolerance test, OGTT), and insulin tolerance (intraperitoneal insulin tolerance test, IPITT). Subsequently, withdrawal thermal latency (WTL) was measured regularly to determine when the early DPN occurred. Once confirmed, sciatic nerve conduction velocity (NCV) of all the rats was conducted.@*RESULTS@#The T2DM rats were successfully induced in the model group through high-sucrose/high-fat diet for six weeks along with STZ intraperitoneal injection (35 mg/kg bodyweight). When compared to the control group, the T2DM rats had higher FBG (P<0.001), and the glucose tolerance and insulin tolerance were both damaged (P<0.001 in OGTT, P=0.002 in IPITT). It was on the 17th day when the T2DM rats became much more sensitive to heat stimulus compared to the control group (P=0.004). Meanwhile, the sciatic NCV was conducted. There was no significant difference between the early DPN group and the control group (P=0.196).@*CONCLUSION@#High-sucrose/high-fat diet for six weeks along with STZ intraperitoneal injection (35 mg/kg bodyweight) could successfully induce T2DM rat model, manifested by a certain extent of insulin resistance and deficiency of insulin secretion. It was about 17 days later when the early DPN emerged. In the early DPN, small fiber neuropathy came out earlier than large fiber neuropathy.

Diagnosis of two Wilson's disease patients in one pedigree and analysis of related factors of its different clinical phenotypes / 基础医学与临床

Objective To study the clinical features of Wilson's disease patients with different clinical phenotypes in one pedigree. To make the diagnosis and summarize the factors influencing the clinical manifestations of patients with Wilson's disease. Methods The clinical data of siblings in this pedigree were collected.The literature about the fac-tors influencing the clinical phenotype of Wilson's disease were found. Results There were two siblings in one pedi-gree with Wilson's disease.The younger brother whose phenotype is liver-type,was 6 years old. His brother was 16 years old and showed mixed type(nerve+kidney).Their genotype are exon5.c.1714delG(maternal),exon8.c.2333G>T,p.R778L(paternal). They have the same genotype but different phenotypes and different age of onset. After re-viewing the literature,we found some factors outside the ATP7B gene may also affect the clinical phenotype. Conclu-sions Genetic testing is of great importance in children with Wilson's disease.Screening for hepatolenticular degener-ation should be performed in children with liver disease or neurological manifestations.In addition to the ATP7B gene, the clinical phenotype of hepatolenticular degeneration may also be affected by many other factors.

Monocrotaline increases expression of IL-1βand IL-18 in lung tissue of pulmonary hypertension rats / 基础医学与临床

Objective Explore the change of IL-1β and IL-18 expression in pulmonary hypertension induced by monocrotaline.Methods Divide the mouses into two groups, control group and experimental group (n=10).Establish rats pulmonary hypertension model induced by monocrotaline.Detect the model by ultrasound, myocardial cells HE dyeing and tunnel test;ELISA was used to detect the serum biological markers NF-κB, COX2, IL-6, IL-1β, TNF-α and NO;Immunohistochemical was used to detect the expression level of IL-1β and IL-18 in the lung tissue;the protein change of NLRP3 in the lung tissue was detected by Western blot.Results Serum biological markers of NF-κB, COX2, IL-6, IL-1β, TNF-α and NO are significantly increased in PAH rats(P<0.05);The expression of IL-1β, IL-18 in the lung tissue increased obviously(P<0.05);The NLRP3 protein expression was significantly higher in experimental group.Conclusions Changes of NLRP3 effect increase expression of IL-1β and IL-18and which may play an important role in pulmonary hypertension induced by monocrotaline.

Ethanol extract of Phellinus merrillii protects against diethylnitrosamine- and 2-acetylaminofluorene-induced hepatocarcinogenesis in rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study whether the ethanol extract of Phellinus merrillii (EPM) has chemopreventive potential against liver carcinogenesis.</p><p><b>METHODS</b>Thirty male Spraque-Dawley rats were randomly divided into control group, EPM control group, hepatocarcinoma control group, low-dose EPM group and high-dose EPM group, 6 in each group. Using the Solt and Farber protocol in a rat model of hepatocarcinogenesis, the chemopreventive effect of EPM on diethylnitrosamine (DEN)-initiated, 2-acetylaminofluorene (2-AAF) and partial hepatectomy (PH)-promoted liver carcinogenesis in rats was evaluated. Basic pathophysiological and histological examinations, together with the serum levels of glutamic oxaloacetic transaminase (sGOT), glutamic pyruvic transaminase (sGPT) and gamma-glutamyl transpeptidase (γ-GT) were measured.</p><p><b>RESULTS</b>Treatment of EPM at the concentration of 2 g/kg body weight in the diet for 8 weeks clearly prevented the development of carcinogenesis and reduced the levels of sGOT, sGPT, and serum γ-GT of rats as compared with the hepatocarcinoma control group (P<0.05 or P<0.01). These phenotypes were accompanied by a significant increase in natural killer cell activity.</p><p><b>CONCLUSION</b>EPM showed a strong liver preventive effect against DEN+2-AAF+PH-induced hepatocarcinogenesis in a rat model.</p>

Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The aim of this study was to evaluate the efficacy of ultrasonic features in predicting the malignancy of thyroid nodules in a group of Chinese patients.</p><p><b>METHODS</b>In all, 762 patients with thyroid nodules (424 malignant and 338 benign) underwent ultrasound (US) check and surgery between March 2011 and July 2014 at Peking University First Hospital were identified. Univariate and receiver operating characteristic (ROC) analyses were performed to calculate the sensitivity, specificity, negative and positive predictive values of each US feature, and the accuracy of their combinations for prediction of malignancy.</p><p><b>RESULTS</b>Patients with malignant nodules were younger and without obvious risk history than those in the benign group (P < 0.001, P = 0.93). No individual US sign was fully predictive of a malignant lesion. The Youden indexes of irregular margins and hypoechogenicity were the first and second highest in all US features, which were 51.9% and 45.2%, respectively. The sensitivity of solid components (89.7%) and hypoechogenicity (89.2%) and the specificity of taller-than-wide shape (98.5%) and microcalcifications (90.6%) were the first and second highest in all US features. Intranodular flow on a color Doppler examination was a weak predictor of malignancy. Under ROC analysis excepting intranodular flow, the 95% confidence interval (CI) of areas under the curves of hypoechogenicity and irregular margins with any one of the US features were overlapped that of five-feature combinations (95% CI: 0.850-0.901).</p><p><b>CONCLUSIONS</b>We should be alert with taller-than-wide shape and microcalcifications. Intranodular flow was a weak predictor of malignancy. According to Youden indexes and ROC analysis, irregular margins and hypoechogenicity combined with solid component or taller-than-wide shapes or microcalcifications have a high predicative value for malignant thyroid nodules in Chinese patients.</p>

Efficacy and tolerability of exenatide monotherapy in obese patients with newly diagnosed type 2 diabetes: a randomized, 26 weeks metformin-controlled, parallel-group study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Incretin-based therapies provide additional options for treating type 2 diabetes. We aimed to evaluate the efficacy and tolerability of exenatide monotherapy in obese patients with type 2 diabetes.</p><p><b>METHODS</b>A 26-week, metformin controlled, parallel-group study was conducted among antidiabetic drug-naive obese patients aged > 18 years, and with type 2 diabetes. Participating patients were randomly assigned to receive exenatide or metformin treatments.</p><p><b>RESULTS</b>Fifty-nine patients (age (50.5 ± 8.6) years, body mass index (BMI) (30.2 ± 1.6) kg/m(2), and hemoglobin A1C (HbA(1C) (8.2 ± 1.2)%) were enrolled in the study. Glucose control and weight reduction improved in both groups receiving treatment. HbA(1C) and oral glucose tolerance test (OGTT) 2 hour glycemia reduction with exenatide was superior to that obtained with metformin ((-2.10 ± 1.79)% vs. (-1.66 ± 1.38)%, (-5.11 ± 2.68) mmol/L vs. (-2.80 ± 2.70) mmol/L, P < 0.05). Fast plasma glucose (FPG) reduction was not significantly different between the two groups ((-1.8 ± 2.0) mmol/L vs. (-1.6 ± 1.7) mmol/L, P > 0.05). Patients treated with exenatide achieved HbA(1C) of < 7% (97% of patients) and < 6.5% (79%) at end-point, vs. 93% and 73% with metformin (P > 0.05). Greater weight reduction was also achieved with exenatide ((-5.80 ± 3.66) kg) than with metformin ((-3.81 ± 1.38) kg, P < 0.01). Homeostasis model assessment of beta-cell function (HOMA-B) was not significantly increased, but the insulinogenic index and HOMA for insulin sensitivity (HOMA-S) were greatly improved in the exenatide group (P < 0.05). Nausea was the most common adverse effect in exenatide treatment (30% vs. 8%; P < 0.05), but most cases were of mild to moderate intensity. One case in the exenatide group was withdrawn early because of severe nausea. Hypoglycemia events were often observed during the first 4 weeks, with 12% of patients in the exenatide and 3.2% in metformin groups, respectively (P < 0.05). No incidents of severe hypoglycemia were reported.</p><p><b>CONCLUSIONS</b>Exenatide demonstrated more beneficial effects on HbA(1C), weight reduction and insulin resistance during 26 weeks of treatment, but there were more hypoglycemic events and mild-to-moderate nausea compared with metformin. These results suggested that exenatide monotherapy may provide a viable treatment option in newly developed type 2 diabetes.</p>

An outbreak of human orf disease caused by introduced black goats / 中华流行病学杂志

Objective To identify risk factors for a human orf disease outbreak in a village in Chongqing city. Methods Standardized case-definition was set and a case-finding program was conducted among all the residents of the village. All the patients were interviewed using a standardized questionnaire and collected fluids in the skin rash for laboratory testing. A retrospective cohort investigation was conducted among all the village residents who introduced the black goats to analyze the risk of orf infection, in relation to the mode and frequency of contacts to the infected goats. Results We found 18 cases (including 16 suspected cases and 2 confirmed cases) among the members of 10 families that introduced the black goats. Village residents who had ever used their legs to grip the goats were nearly five times as likely to develop orf disease as those who did not (RR=4.98, 95％CI: 1.34-75.27). Village residents who had ever washed and wiped the goats were three times as likely to develop orf disease as those who had not (RR = 3.09,95％CI: 0.98-45.38). The frequency of contacts with the infected goats was associated with the risk of developing orf disease in a dose-response fashion (x2 test for trends: P= 0.006).Frequently wearing long trousers when dealing with the goats appeared as a protective factor (RR=0.30,95％CI: 0.15-0.78). Conclusion This outbreak was caused by the introduced black goats which carried and infected by the orf virus. Direct physical contact with infected goats but without wearing protective clothing were risk factors for the development of human orf disease.

An outbreak of human Streptococcus suis serotype 2 infections presenting with toxic shock syndrome in Sichuan, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>In mid-July 2005, five patients presented with septic shock to a hospital in Ziyang city in Sichuan, China, to identify the etiology of the unknown reason disease, an epidemiological, clinical, and laboratory study were conducted.</p><p><b>METHODS</b>An enhanced surveillance program were established in Sichuan, the following activities were introduced: active case finding in Sichuan of (a) laboratory diagnosed Streptococcus suis infection and (b) clinically diagnosed probable cases with exposure history; supplemented by (c) monitoring reports on meningococcal meningitis. Streptococcus suis serotype 2 infection was confirmed by culture and biochemical reactions, followed by sequencing for specific genes for serotype and virulence factors.</p><p><b>RESULTS</b>From June 10 to August 21, 2005, 68 laboratory confirmed cases of human Streptococcus suis infections were reported. All were villagers who gave a history of direct exposure to deceased or sick pigs in their backyards where slaughtering was performed. Twenty six (38%) presented with toxic shock syndrome of which 15 (58%) died. Other presentations were septicaemia or meningitis. All isolates were tested positive for genes for tuf, species-specific 16S rRNA, cps2J, mrp, ef and sly. There were 136 clinically diagnosed probable cases with similar exposure history but incomplete laboratory investigations.</p><p><b>CONCLUSION</b>An outbreak of human Streptococcus suis serotype 2 infections occurred in villagers after direct exposure to deceased or sick pigs in Sichuan. Prohibition of slaughtering in backyards brought the outbreak to a halt. A virulent strain of the bacteria is speculated to be in circulation, and is responsible for the unusual presentation of toxic shock syndrome with high case fatality.</p>

Anlysis on features of dead cases with human Streptococcus suis infections / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the clinical and epidemiological features of dead cases with human Streptococcus suis infections, and to find the target population for preventing death and the related indicators.</p><p><b>METHODS</b>Epidemiological investigation on human Streptococcus suis infections was implemented used unified questionnaires. Analysis on dead cases and survival cases (as contrast) was done.</p><p><b>RESULTS</b>The population with highest fatality rate was in 40-49 age group. 97.37% of dead cases had toxic shock syndrome. The mean interval from onset to admission was 0.76 days, and the mean course was 2.11 days. The progression among dead cases was faster than that among survival cases. Chief clinical manifestations of dead cases that are more frequent than survival cases are purpura (73.68%), diarrhea (50.0%), dyspnea (21.05%), conjunctival congestion (34.21%), etc. Renal impairment and liver involvement in dead cases were more significant than that in survival cases. No significant difference between mean incubation period, exposure rates of main risk factors in dead cases and in survival cases was found.</p><p><b>CONCLUSION</b>Preventing toxic shock syndrome might reduce the fatality rate. The target population for preventing death is aged > or = 40. Liver function and renal function testing might be indicators for monitoring the progression of human Streptococcus suis infections.</p>

Matched case-control study for risk factors of human Streptococcus suis infection in Sichuan Province, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the potential risk factors of human infecting with Streptococcus suis.</p><p><b>METHODS</b>1: M matched case-control study was conducted. 29 human cases of Streptococcus suis infection in the early phase were included in the case group, Patients' family members, neighbors and peoples who had worked together with patients to handle deceased or sick pigs in the last week were recruited as matched controls. There were 147 controls in total. Both cases and controls received questionnaire investigation including the ways to contact sick/dead pigs. Conditional logistic regression was employed to analyze matching data.</p><p><b>RESULTS</b>According to the results of multivariate analysis, slaughtering (OR = 11.978, 95% CI: 3.355-42.756), carcasses cutting and processing (OR = 3.008, 95% CI: 1.022-8.849) sick/dead pigs were associated with cases related to human Streptococcus suis infection. The attributable risk proportion were 91.65% and 66.76% respectively. The other types of exposures to sick/ dead pigs, including feeding, selling, burying and eating, were not associated with the human Streptococcus suis infection in our study population.</p><p><b>CONCLUSION</b>Slaughtering, carcasses cutting and processing sick/dead pigs were important risky behavior for humans to be infected by Streptococcus suis.</p>

Severe acute respiratory syndrome epidemiology in Sichuan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the epidemiological characters of severe acute respiratory syndrome (SARS) in Sichuan province in order to provide evidence for prevention and control.</p><p><b>METHODS</b>To generate data on SARS in Sichuan province through descriptive and analytical studies on time, geographic distribution, population, source of infection, the way of case finding, symptom, diagnosis and treatment of the cases.</p><p><b>RESULTS</b>The peak of the epidemic last from April 16 to May 7. The number of cases in Luzhou and Guangyuan cities took up 60% of the total. Mobile population occupied 68% of the cases. Most of the patients were above the age of 20 with a sex ratio of 1.5:1 (m/f). 80% of the cases had a history of working in Guangdong province and recently returned to their hometowns. The main symptoms and signs of the SARS patients would include fever, cough and chest X-ray changes.</p><p><b>CONCLUSION</b>All cases were imported. Fluctuation of the epidemics was mainly affected by the mobility of working population who recently returned to their hometowns. Measures concerning the prevention and control of the epidemics would mainly target on the isolation of confirmed and suspected patients who might serve as the sources of infection through setting up quarantine station, assigned hospitals and special 'fever-clinics'.</p>