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Objective:To investigate the effect of teriparatide on residual back pain (RBP) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was used to analyze the clinical data of 90 OVCF patients sustaining RBP after PKP admitted to Second Affiliated Hospital of Kunming Medical University from September 2015 to March 2019, including 18 males and 72 females, at age of 57-85 years［(68.0±5.9) years］. Teriparatide treatment was applied regularly in 32 patients (teriparatide group) and antiosteoporosis drug was administered routinely in 58 patients (routine treatment group). Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups before operation, at 24 hours, 1 month, 3 months, 6 months and 12 months after operation. Anterior vertebral body height (ABH), middle vertebral body height (MBH), kyphosis angle (KA), maintenance rate of anterior vertebral body height (MRABH), maintenance rate of middle vertebral body height (MRMBH) and difference of kyphosis angle (DKA) were measured at 24 hours and 12 months after operation to evaluate the maintenance of vertebral height and incidence of vertebral refracture. Levels of type I collagen carboxy-terminal peptide (β-CTX) and serum N-terminal osteocalcin (N-MID) were measured before operation and at 12 months after operation to evaluate the improvement of bone metabolism. The adverse reactions of teriparatide group were observed.Results:All patients were followed up for 12-36 months［(14.3±0.6)months］. VAS and ODI were decreased gradually with time in both groups (all P<0.01). There were no significant differences in VAS between the two groups before operation and at 24 hours after operation (all P>0.05). Teriparatide group showed VAS of (4.4±0.6)points, (3.2±0.5)points, (2.0±0.5)points, (1.1±0.1)points at 1, 3, 6 and 12 months after operation, significantly lower than those in routine treatment group［(4.9±0.6)points, (4.0±0.6)points, (3.2±0.7)points, (2.7±0.1)points, respectively］(all P<0.01). Teriparatide group showed ODI of 26.5±1.3 and 20.6±1.2 at 6 months and 12 months after operation, significantly lower than those in routine treatment group (28.2±1.6, 23.6±1.6) (all P<0.01). There were no significant differences in ODI between the two groups at other time points (all P>0.05). Both groups presented significantly lowered levels of ABH and MBH at 12 months after operation as compared with those at 24 hours after operation (all P<0.01). There were no significant differences in ABH or MBH between the two groups at 24 hours after operation (all P>0.05). ABH, MBH, MRABH and MRMBH in teriparatide group were (1.9±0.2)cm, (1.7±0.2)cm, 0.91±0.02 and 0.92±0.02 at 12 months after operation, significantly higher than those in routine treatment group［(1.7±0.2)cm, (1.6±0.2)cm, 0.86±0.02 and 0.87±0.02］(all P<0.01). KA in both groups showed significant increase at 12 months after operation as compared with that at 24 hours after operation (all P<0.01). There was no significant difference in KA between the two groups at 24 hours after operation ( P>0.05). KA in teriparatide group was (7.3±0.7)° at 12 months after operation, significantly lower than (9.5±0.5)° in routine treatment group ( P<0.01). DKA in teriparatide group was (5.3±1.3)° at 12 months after operation, significantly lower than (6.6±1.4)° in routine treatment group ( P<0.01). Incidence of vertebral refracture in teriparatide group was 7% (2/32), significantly lower than 35% (15/58) in routine treatment group ( P<0.05). Level of β-CTX was not significantly different between and within the two groups before operation and at 12 months after operation (all P>0.05). There was no significant difference in N-MID between the two groups before operation ( P>0.05). After treatment for 12 months, level of N-MID in teriparatide group was significantly increased［19.5 (17.6, 20.9)pg/ml］as compared with that before operation［18.2 (14.6, 21.0)pg/ml］( P<0.01), and was significantly higher than that in routine treatment group［17.6 (15.3, 19.9)pg/ml］( P<0.01). Routine treatment group showed no significant difference in level of N-MID before operation and at 12 months after operation ( P>0.05). Two patients in teriparatide group had orthostatic hypotension after treatment. Conclusion:For OVCF patients with RBP after PKP, teriparatide can effectively alleviate pain, improve motor dysfunction, maintain the height of bone cement vertebral body, reduce incidence of vertebral refracture and enhance the activity of osteoblasts, with less adverse reactions.
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Objective:To study the genotyping and regional distribution characteristics of Yersinia pestis by single nucleotide polymorphism (SNP) in Gansu Province. Methods:A total of 52 strains of Yersinia pestis isolated from Himalaya Marmot plague foci and Spermophilus alaschanicus plague foci in Gansu Province from 1962 to 2017 were selected for culture and extraction of DNA. The genomic DNA of Yersinia pestis was sequenced by the second generation of Illumina PE150 to identify the SNP sites. The species characteristics of Yersinia pestis in Gansu Province was determined by the Kimura-2-parameter model of neighbor joining of Mega 10.0 software based on the SNP sites. The molecular evolutionary tree of the groups was determined by Hasegawa-Kishino-Yano model of maximum likelihood method according to the SNP sites. Results:A total of 103 SNP sites were identified in 52 strains of Yersinia pestis in Gansu Province, including 28 intergenic loci, 43 non-synonymous mutations, 31 synonymous mutations and 1 nonsense mutation. The 52 strains of Yersinia pestis were divided into 2 biotypes and 3 groups, which were ancient type (1.IN2, 3.ANT) and medieval type (2.MED). Among them, 35 strains belonged to 1.IN2 group, 13 strains belonged to 3.ANT group, and 4 strains belonged to 2.MED group. The 1.IN2 group was further divided into 5 subgroups: the groups of Yuerhong Town and Dangchengwan Town in Subei County, the groups of Mati Town and Dahe Town in Sunan County, and the group of Xiahe County. The 3.ANT group was further divided into 2 subgroups: the groups of Hongliuwan Town in Aksay County and Machang in Dangchengwan Town of Subei County. Conclusion:The SNP method can be used to genotype Yersinia pestis from different plague foci in Gansu Province, which has certain regional characteristics.
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Objective:To explore the risk factors of adjacent segment diseases (ASDis) after lumbar fusion, summarize the prevention strategies and provide reference for clinical treatment.Methods:All of 258 patients who underwent lumbar interbody fusion from March 2014 to March 2019 were retrospectively analyzed, including 95 males and 163 females, the age of whom was 61.8±8.4 years (range, 39-77 years). The patients were divided into ASDis group and non-ASDis group according to whether ASDis occurred at the follow-up of 24 months after operation. The patient's individual factors [gender, age, body mass index (BMI), main diagnosis, preoperative paraspinal muscle fatty degree, etc.] and surgical factors (operation type, fixed segment, fusion segment, etc.), sagittal parameters [lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI-LL] were recorded. After univariate analysis of potential risk factors, the factors with P<0.05 were substituted into logistic regression model for multivariate analysis to determine the risk factors of ASDis after lumbar fusion. Results:ASDis occurred in 24 patients after lumbar fusion, with an incidence of 9.3% (24/258); univariate analysis showed that age ≥ 60 years old, complicated with osteoporosis, preoperative fatty degree of paraspinal muscle (GCS grade≥3), PLIF operation, suspension fixation, total laminectomy and multi-segment fusion (≥ 3 segments) were the potential risk factors for ASDis after operation (P<0.05); Gender, education level, partner status, type of work, BMI, obesity (BMI≥24 kg/m 2) , smoking, use of bisphosphonates, concomitant lumbar spinal stenosis, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle, sacral slope angle, and PI-LL had no significant correlation with ASDis. Logistic regression analysis showed that age ≥ 60 years ( OR=5.63, 95% CI: 1.56, 20.29, P=0.008), preoperative paravertebral muscle fatty GCS ≥ 3 ( OR=4.82, 95% CI: 1.36, 17.13, P=0.015), combined with osteoporosis ( OR=14.04, 95% CI: 2.53, 77.79, P=0.002), PLIF ( OR=9.69, 95% CI: 1.91, 49.03, P=0.001), and multi-segment fixation ( OR=9.36, 95% CI: 1.77, 49.41, P=0.008) were the risk factors for ASDis after lumbar fusion; Incomplete laminectomy ( OR=0.09, 95% CI: 0.02, 0.37, P=0.001) and suspension fixation ( OR=0.16, 95% CI: 0.02, 0.94, P=0.042) were the protective factors of ASDis after lumbar fusion. Conclusion:The patients with age ≥ 60 years old, osteoporosis and preoperative paraspinal muscle fatty degree ≥ 3 grade GCS should be more careful in choosing the surgical methods, and try to choose transforaminal interbody fusion, posterolateral fusion, short segment fusion, decompression with preservation of vertebral lamina, suspension fixation and other surgical methods to reduce the incidence of postoperative ASDis.
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Objective:To investigate the efficacy of azithromycin combined with different-dose methylprednisolone therapy for refractory mycoplasma pneumoniae pneumonia(RMPP)in children.Methods:Two hundred and twenty cases of RMPP admitted to Chengdu Women′s and Children′s Central Hospital between January 2014 and December 2019 were selected.They were treated with azithromycin combined with 1~2 mg/(kg·d)(low-dose)of methylprednisolone for 3 days, then they were divided into 2 groups, 152 cases with effective treatment in the control group A(effective group), 68 cases with ineffective treatment in observation group B(ineffective group). Among group B, according to the IgG, IgM and IgA as defined in Zhu Futang Practice of Pediatrics, 45 cases with normal immunity named normal-immune group B, change methylprednisolone dose to 10~30 mg/(kg·d)(high-dose)for 3 days, and 23 cases with low immunity named weakened-immune group B, change methylprednisolone dose to 10~30 mg/(kg·d)for 3 days and give immunomodulator therapy, that is human immunoglobulin for intravenous injection(IVIG)200 mg/(kg·d)for 3 days.After treatment, duration of fever, lung inflammation, extrapulmonary complications, hospitalization days and other indicators were compared.Results:Comparison between group A and group B, the lung rale absorption time[(11.32±3.62)d vs(10.00±2.32)d], lung consolidation absorption rate(64.10% vs 83.33%), pulmonary atelectasis retentive rate(52.38% vs 82.60%), effusion absorption rate(66.67% vs 100.00% ), the incidence rate of extrapulmonary complications(38.82% vs 25.00%), the disappearance time of complications[(10.96±2.98)d vs(8.94±2.86)d], the average hospitalization stay[(12.30±3.56)d vs(11.25±3.84)d]were significantly different( P<0.05). Comparison between normal-immune group B and weakened-immune group B after giving high doses of methylprednisolone, the fever dropped time[(10.51±3.26)h vs(8.60±3.31)h], the lung rale absorption time[(10.51±2.24)d vs(9.00±2.19)d], lung consolidation absorption rate(72.00% vs 100.00%), the average hospitalization stay[(12.00±3.96)d vs(9.78±3.19)d]were significantly different( P<0.05). Conclusion:Compared to low-dose of methylprednisolone, azithromycin combined with high-dose methylprednisolone therapy is better for RMPP.For the children with weakened immunity, better curative effect was obtained by IVIG.
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Objective:To understand the plague epidemic characteristics in the natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province, and to provide scientific basis for innovative prevention and control of the plague in combination with local conditions. Methods:A retrospective study was used to collect the monitoring data of the natural foci of plague in Gansu Province from 2011 to 2018 (from the epidemic surveillance files of the Center for Disease Control and Prevention of Gansu Province and direct network reporting information). Descriptive epidemiological method was used to analyze the plague epidemic characteristics of natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province from 2011 to 2018, including the distribution of host animals, pathogenic and serological testing of the plague bacteria, and the epidemic characteristics of human plague. Results:From 2011 to 2018, the total average marmot density in the natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province was 0.21/hm 2, of which Tianzhu County had the highest average marmot density of 0.58/hm 2, and Jiayuguan City had the lowest average marmot density of 0.01/hm 2. A total of 381 strains of Yersinia pestis were isolated in the foci, of which 4 were isolated from human corpses, 298 were host animals, and 79 were infectious vectors. Among them, the top 3 counties (cities) of isolated strains were Aksai County (38.85%, 148 strains), Subei County (31.50%, 120 strains) and Yumen City (16.27%, 62 strains). A total of 6 860 marmot serum, 1 769 dog serum were tested, the F1 antibody positive rates were 2.70% (185/6 860), 8.42% (149/1 769); and the F1 antigen positive rate of 814 animal materials was 4.30% (35/814), respectively. There were 4 times of human plague, 4 cases occurred and 4 cases died; 3 times occurred in Subei County and 1 time in Yumen City. The onset months were July, September, November and December. Active contact with infected animals such as shepherd dogs was the main route of infection, and migrant herders were the key occupation population. Conclusions:The animal epidemic situation in the natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province is active, and the plague presents different epidemic states in different regions. The prevention and control measures should be taken according to local conditions and guided by classification to strictly prevent the occurrence and transmission of the plague.
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Objective To analyze the correlation between the direct measurement of pulmonary artery pressure and the related echocardiographic parameters in rats with pulmonary arterial hypertension ( PA H ) , and establish a predictable equation for pulmonary artery pressure using non‐invasive ultrasonic parameters . Methods Fifteen male Wistar rats were randomly divided into normal control ( NC ) group with five rats and PA H model group with 10 rats .PA H model was established by intraperitoneal injection of 1% MCT solution in the dose of 60 mg/kg . All the rats were examined by ultrasonic apparatus to record cardiac parameters including right ventricle anterior wall thickness ( RVAWT ) ,pulmonary artery diameter ( PAD) , aorta diameter ( AOD ) , pulmonary artery acceleration time ( PAAT ) , pulmonary artery ejection time ( PAET ) ,right ventricle end‐diastolic diameter ( RVEDD ) ,right ventricle end‐diastolic length ( RVEDL ) , tricuspid annular plane systolic excursion ( T APSE) and left ventricular ejection fraction ( LVEF ) before experiments as well as 2 and 4 weeks after modeling . At the fifth week of modeling ,all the rats were administrated with thoracotomy and right ventricular catheter to obtain pulmonary artery systolic ,diastolic and mean pressures ( PASP ,PADP and PAM P) . Results As time went on ,measures of RVAWT ,PAD , PAD/AOD ,RVEDD ,RVEDL ,RVEDD/RVEDL increased ,while measurements of PAA T ,PAA T/PAET , T APSE decreased in the model group .T he changes of RVAWT ,PAD ,PAA T/PAET ,RVEDD in the model group appeared early in the second week in contrast to data before molding ( P ＜0 .05) . When comparing model group with NC group ,there were statistic differences of RVAWT ,PAAT/PAET as early as 2 weeks after modeling measuring (all P ＜0 .05) and the dramatic variance in the parameters of PAD/AOD ,PAAT , RVEDD ,RVEDD/RVEDL ,T APSE appeared in 4‐week observation . Correlation analysis suggested there were high‐degree correlations between PAA T ,PAA T/PAET and PASP ,PAM P ( for PASP : r ＝ －0 .829 ,－0 .865 ,P＜ 0 .05 ; for PAM P : r ＝ －0 .831 , －0 .842 , P ＜ 0 .05 ) ,and moderate‐degree correlations between RVAWT ,PAD/AOD ,RVEDD ,RVEDD/RVEDL ,T APSE and PASP ,PAM P ( for PASP :|r|＝0 .615－0 .786 , P ＜0 .05 ; for PAM P : r ＝0 .683－0 .799 , P ＜0 .05) .T he linear dependent equations were established as PASP ＝ －169 .392 PAAT/PAET + 105 .092 ( r2 ＝ 0 .748 , P ＝ 0 .000 ) ,PASP ＝ 49 .576 RVAWT+67 .314RVEDD/RVEDL －45 .198 ( r2 ＝0 .731 , P ＝0 .003) ,PAM P＝ －150 .664PAAT/PAET+88 .156 ( r2 ＝0 .709 , P ＝ 0 .001 ) ,PAM P＝37 .988RVAWT +82 .072RVEDD/RVEDL －50 .517 ( r2 ＝0 .794 , P ＝ 0 .001 ) to represent the relationships between PASP or PAM P and PAAT/PAET or RVAWTcombined RVEDD/RVEDL . Conclusions Echocardiography can monitor changes in heart structure and hemodynamics .Ultrasonic parameters especially PAAT/PAET or RVAWT ,RVEDD/RVEDL could be used to estimate PASP or PAM P measured by catheterization .
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Objective To investigate the effect of Tanreqing injection on the concentrations of serum inflammatory mediators in patients with acute lung injury (ALI). Methods One hundred and thirty-six patients with ALI by clinical diagnosis admitted to Xinxiang Central Hospital from December 2013 to December 2017 were enrolled, they were randomly divided into a conventional treatment group and a Tanreqing treatment group, 68 cases in each group; in the mean time, 50 healthy subjects having undertaken physical examinations in this hospital were assigned in the healthy control group. In the conventional and Tanreqing treatment groups, the primary diseases of patients were treated, combined with corticosteroid and antiseptic drugs to combat against infection, and nutrition support, fluid supplement and symptomatic therapy were also used. The patients in the Tanreqing treatment group beside received conventional treatment, additionally they were treated with Tanreqing injection 20 mL in 0.9% Sodium Chloride solution or 5% Glucose 250 mL intravenous drip in 2 hours, once daily. And, the difference of each index was evaluated on the 7th day after the patient entering the group. The concentrations of serum interleukin (IL-1, IL-6) and tumor necrosis factor-α (TNF-α) were detected for the patients in two groups and controls by using the enzyme linked immunosorbent assay (ELISA) and radioimmunoassay (RIA), respectively. Meanwhile, the changes of arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/FiO2), pH value, systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were observed in the conventional and Tanreqing treatment groups. Results The concentrations of serum IL and TNF-α in the conventional and Tanreqing treatment groups before treatment were significantly higher than those in healthy controls [IL-1 (ng/L): 128.45±27.91, 131.12±26.26 vs. 24.55±6.12, IL-6 (ng/L): 65.77±7.21, 64.08±7.05 vs. 19.13±4.55, TNF-α (ng/L): 41.24±7.01, 40.07±6.76 vs. 10.62±2.65, all P ＜ 0.05]. Moreover, the levels of IL-1, IL-6, TNF-α, PaCO2, SVR and PVR in the conventional and Tanreqing treatment groups after treatment were significantly lower than those before treatment, and the levels of PaO2 and PaO2/FiO2were obviously increased compared with those before treatment, and the changes of the above indicators were more significant in the Tanreqing treatment group [IL-1 (ng/L): 75.67±18.58 vs. 101.22±21.13, IL-6 (ng/L):42.05±5.31 vs. 54.02±6.89, TNF-α (ng/L): 19.63±5.19 vs. 30.35±4.55, PaO2(mmHg, 1 mmHg = 0.133 kPa):93.06±7.95 vs. 72.66±8.04, PaCO2(mmHg): 42.32±2.44 vs. 50.25±3.43, PaO2/FiO2(mmHg): 316.28±16.73 vs. 256.33±14.25, SVR (kPa·s·L-1): 0.73±0.09 vs. 0.81±0.10, PVR (kPa·s·L-1): 0.08±0.02 vs. 0.10±0.02, all P ＜0.05]. The pH value was restored to normal (conventional treatment group was 7.37±0.27, Tanreqing treatment group was 7.41±0.31). Conclusion Tanreqing injection can reduce the concentrations of serum inflammatory mediators, significantly improve the blood gas and hemodynamic indexes, and reduce inflammatory reaction in the patients with ALI.
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Objective To understand the epidemiologic characteristics of outbreaks,caused by norovims-G Ⅱ.2、G Ⅱ.17 and G Ⅱ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control.Methods Incidence data of norovirus outbreaks in Guangdong from January 1st 2013 to November 30th 2017 were collected from Public Health Emergency Management Information System.RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus.Characteristics of norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney outbreaks were analyzed.Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting.Results From January 1st 2013 to November 30th 2017,a total of 167 norovirus outbreaks were reported in Guangdong,and 115 outbreaks were caused by norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney respectively.The outbreaks caused by norovirus G Ⅱ.2 accounted for 39.68％ (25/63) in primary schools,28.57％ (18/63) in child care settings,25.40％ (16/63) in middle schools and 6.35％ (4/63) in universities.Outbreaks caused by norovirus G Ⅱ.17 accounted for 41.03％ (16/39) in middle schools,20.51％ (8/39) at workplaces,15.38％ (6/39) in primary schools,12.82％ (5/39) in universities,5.13％ (2/39) in communities and child care settings respectively.The outbreaks caused by norovirus G Ⅱ.4/Sydney accounted for 53.85％ (7/13) in universities,15.38％ (2/13) in child care settings and at workplaces respectively,7.69％ (1/13) in primary schools and middle schools respectively.The outbreaks caused by norovirus G Ⅱ.2 had 77.78％ (49/63) of contact transmission,17.46％ (11/63) of food-borne transmission.The outbreaks caused by norovirus G Ⅱ.17 showed 53.85％ (21/39) of food-borne transmission,15.38％ (6/39) of contract transmission,12.82％ (5/39) of water-borne transmission.The outbreaks caused by norovirus G Ⅱ.4/Sydney had 53.85％ (7/13) of food-borne transmission,38.46％ (5/13) of the contact transmission.In terms of the clinical manifestations,the standardized proportion of vomit was 73.76％ and the proportion of diarrhea was 42.85％ in cases infected with norovirus G Ⅱ.2,the proportion of standardized of vomit was 76.37％ and the proportion of diarrhea was 51.40％ in cases infected with norovirus G Ⅱ.17,with the standardized proportion of vomit was 54.10％ and the proportion of diarrhea was 55.95％ in cases infected with norovirus G Ⅱ.4/Sydney.Conclusions The outbreaks caused by norovirus G Ⅱ.2 through contact transmission mainly occurred in primary schools,child care settings and middle schools.The outbreaks caused by norovirus G Ⅱ.17 through food-borne transmission mainly occurred in middle schools and at workplaces.The outbreaks caused by norovirus G Ⅱ.4/Sydney food-borne transmission and contact mainly occurred in universities.
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Objective To understand the epidemiologic characteristics of outbreaks,caused by norovims-G Ⅱ.2、G Ⅱ.17 and G Ⅱ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control.Methods Incidence data of norovirus outbreaks in Guangdong from January 1st 2013 to November 30th 2017 were collected from Public Health Emergency Management Information System.RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus.Characteristics of norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney outbreaks were analyzed.Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting.Results From January 1st 2013 to November 30th 2017,a total of 167 norovirus outbreaks were reported in Guangdong,and 115 outbreaks were caused by norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney respectively.The outbreaks caused by norovirus G Ⅱ.2 accounted for 39.68％ (25/63) in primary schools,28.57％ (18/63) in child care settings,25.40％ (16/63) in middle schools and 6.35％ (4/63) in universities.Outbreaks caused by norovirus G Ⅱ.17 accounted for 41.03％ (16/39) in middle schools,20.51％ (8/39) at workplaces,15.38％ (6/39) in primary schools,12.82％ (5/39) in universities,5.13％ (2/39) in communities and child care settings respectively.The outbreaks caused by norovirus G Ⅱ.4/Sydney accounted for 53.85％ (7/13) in universities,15.38％ (2/13) in child care settings and at workplaces respectively,7.69％ (1/13) in primary schools and middle schools respectively.The outbreaks caused by norovirus G Ⅱ.2 had 77.78％ (49/63) of contact transmission,17.46％ (11/63) of food-borne transmission.The outbreaks caused by norovirus G Ⅱ.17 showed 53.85％ (21/39) of food-borne transmission,15.38％ (6/39) of contract transmission,12.82％ (5/39) of water-borne transmission.The outbreaks caused by norovirus G Ⅱ.4/Sydney had 53.85％ (7/13) of food-borne transmission,38.46％ (5/13) of the contact transmission.In terms of the clinical manifestations,the standardized proportion of vomit was 73.76％ and the proportion of diarrhea was 42.85％ in cases infected with norovirus G Ⅱ.2,the proportion of standardized of vomit was 76.37％ and the proportion of diarrhea was 51.40％ in cases infected with norovirus G Ⅱ.17,with the standardized proportion of vomit was 54.10％ and the proportion of diarrhea was 55.95％ in cases infected with norovirus G Ⅱ.4/Sydney.Conclusions The outbreaks caused by norovirus G Ⅱ.2 through contact transmission mainly occurred in primary schools,child care settings and middle schools.The outbreaks caused by norovirus G Ⅱ.17 through food-borne transmission mainly occurred in middle schools and at workplaces.The outbreaks caused by norovirus G Ⅱ.4/Sydney food-borne transmission and contact mainly occurred in universities.
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Liver failure is characterized by hepatic encephalopathy, jaundice, hypo-coagulation and high mortality.Artificial liver support aims to temporarily replace hepatic function until liver function recover or bridge to liver transplantation.Individualized artificial liver support should be balanced and cover the following aspects: removing albumin bound toxins and/or water soluble toxins, eliminating inflammatory mediators and correcting blood coagulation disorders, in order to support metabolism and modulate immune function and to promote the regeneration of hepatocyte and reverse multiple organ failure that may lead to death of patients.Traditional non-biological artificial liver support can't meet individualized treatment.Recently developed hybrid blood purification model, such as albumin dialysis, fractionated plasma separation and adsorption (Prometheus system) and plasma diafiltration (PDF) have provided more and better choices for individualized artificial liver support.Based on the characteristics of pathophysiology and organ dysfunction of liver failure, the author has designed an alignment diagram of individualized artificial liver support for clinical selection.
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Objective To type Yersinia pestis isolated from Gansu Province,and to study the trend of diffreent strains in different administrative regions and different years.Methods Totally 193 strains were enrolled in this study,including 9 strains of Ganning Dauricus type,18 strains of Aerjin type,45 strains of Qilian type and 121 strains of Qingzang type.These strains were genotyped by clustered regularly interspaced short palindromic repeats (CRISPR),and genotypes were named according to international standard.Genotyping by CRISPR in different administrative regions and different years of Gansu Province was explored.Results Two clusters (Ca7 and Cb4),including four genotypes (genotypes 7,22,24 and 26) were classified by CRISPR.From the point of view of origin,genotype 24 was the main genotype in Akesai 36.36％ (16/44),Subei 36.17％ (17/47),Yumen 50.00％ (5/10) and Su'nan 38.67％ (29/75);the main genotype of Xiahe and Huining was genotype 26 (4/7);the main genotype of Shandan was genotype 22 (1/1).From the point of view of time,the main genotype of Yersiniapestis in Gansu Province during the years of 1960-1969,1970-1979 and 1980-1989 was genotype 26 [53.33％ (8/15),60.00％ (6/10) and 48.28％ (14/29)];the main genotype was genotype 22 [40.91％ (18/44)] during the years of 1990-1999;and the main genotype was genotype 24 [43.16％ (41/95)] during the years of 2000-2009.Conclusion Four genotypes of Yersiniapestis in Gansu Province are quite different in different administrative regions and different years.
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We studied Yersinia infection and carriage in shepherd dog on the natural foci of Marmota himalayana plague and investigated the substitution or antagonism relationship among three pathogenic Yersinia in nature,providing a novel approach for prevention and control of plague.Blood sample and rectal swab specimens from shepherd dogs were collected.Rectal swab specimens were detected and isolated for Y.enterocolitican and Y.pseudotuberculosis.IHA was used to measure the positive rate of F1 antibody.Results showed that among 88,94,70 and 64 serum specimens respectively from Akesai,Subei,Sunan,and Tianzhu,IHA positive rates were 31.82％,32.98％,2.86％ and 1.56％ separately.A total of 236 anal swab specimens of shepherd dog were collected,among which one Y.kristensenii strain and 2 non-pathogenic Y.enterocolitica strain were recovered from Akesai and Subei respectively,where plague was violently prevalent in animals.All the results indicate that shepherd dogs in natural foci of M.himalayana plague where plague in animals are prevalent with non-pathogenic Y.enterocolitica,is an evidence of antagonism relationship in three pathogenic Yersinia.
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Objective To apply the DNA barcoding technology for identification of rodent animals and to establish a rodent animal DNA barcode database in Gansu Province.Methods A total of 54 rodent animals were detected.DNA barcoding technology was used to analyze the DNA mitochondrial cytochrome C oxidase subunit Ⅰ (CO Ⅰ) gene sequence in Gansu Province.Results The intra-specific genetic distance was 0-2％ while the interspecific distance ranged from 18％ to 30％.Eight major clusters were apparently showed on a Neighbor joining tree.Conclusion DNA barcoding technology could overcome the shortcomings of the morphological identification,so it could be used to identify the rodent animals and has important implications for disease control and prevention in the natural focus of Gansu Province.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers (NPC) and to identify the prognostic factors.</p><p><b>METHODS</b>Between January 2006 and March 2014, 71 patients who received endoscopic nasopharyngectomy for recurrent NPC were retrospectively reviewed. The sex and the age of the patients, T stage, and tumor necrosis were recorded. Correlation between clinicopathological features and survival time was analyzed. Kaplan-Meier analysis was used to calculate the disease overall survival, disease-specific survival, and disease-free survival rates. Cox multivariate regression analysis and ROC curve analysis were used to determine the predictive value of the parameters.</p><p><b>RESULTS</b>The median age of 71 patients with recurrent nasopharyngeal carcinoma was 51.0 years old. Male to female ratio was 2.9:1 (male: 53, female: 18). The lesions were staged as follows (AJCC, 2010, seventh edition): rT1, 27; rT2, 10; rT3, 19 and rT4, 15. All patients underwent successful endoscopic nasopharyngectomy. No patient was transferred to open approach. The mean operative time was 155 minutes. The average blood loss was 450 ml. Three patients needed intraoperative blood transfusion. No serious postoperative complications occurred. Postoperative follow-up time was 5-96 months. During follow-up, 48 cases survived, including that 7 patients survived with disease, 1 patient had pulmonary metastases, and 1 case had cervical lymph node metastasis. Two-year overall survival and disease-free survival rates were 74.0% and 60.5%, respectively. Five-year overall survival and disease-free survival rates were 39.0% and 31.9%, respectively. Multivariate analysis showed that tumor necrosis was an independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients (P=0.001).</p><p><b>CONCLUSION</b>Endoscopic nasopharyngectomy is a safe and effective procedure for the treatment of recurrent nasopharyngeal carcinoma.</p>
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Female , Humans , Male , Middle Aged , Carcinoma , Disease-Free Survival , Endoscopy , Follow-Up Studies , Kaplan-Meier Estimate , Multivariate Analysis , Nasopharyngeal Neoplasms , Diagnosis , Pathology , General Surgery , Neoplasm Recurrence, Local , Diagnosis , Pathology , General Surgery , Neoplasm Staging , Otorhinolaryngologic Surgical Procedures , Prognosis , Retrospective Studies , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To analyze the non-invasive indexes for predicting esophageal varices (EV) in liver cirrhosis, and to establish a model for predicting the degree of EV.</p><p><b>METHODS</b>A total of 294 patients with liver cirrhosis and portal hypertension were divided into the following groups according to EV grade as assessed by endoscopy: non-EV and grade I EV, grade II EV and grade III EV. The non-invasive EV predictive measures of liver stiffness (LS), platelet (PLT) count, spleen thickness (ST), PLT/ST ratio, portal vein diameter, portal vein flow velocity and Child-Pugh score (CPS) were assessed by univariate analysis and multivariate logistic regression analysis, and used to generate a predictive model. The t-test, chi-square test, logistic analysis and receiver operating characteristic (ROC) curve were used in statistical analyses.</p><p><b>RESULTS</b>The area under the ROC for the new model was 0.990. The best cutoff value for the score was 0.898, as defined from the ROC. The sensitivity of the model was 96.5%, and the specificity was 99.2%.</p><p><b>CONCLUSIONS</b>The model for predicting EV was composed of LS, PLT count, ST, PLT/ST and CPS, which was accurate and sensitive, and could be used to predict EV in clinic.</p>
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Humans , Endoscopy, Digestive System , Esophageal and Gastric Varices , Hypertension, Portal , Liver Cirrhosis , Platelet Count , ROC Curve , SpleenABSTRACT
OBJECTIVE@#To determine if greater efficacy could be achieved with the intranasal antihistamine azelastine and the intranasal corticosteroid fluticasone propionate used concurrently in the treatment of nasal obstruction of persistent non-allergic rhinitis.@*METHOD@#A total of 162 persistent non-allergic rhinitis cases with moderate to severe nasal obstruction were randomized to treatment with the following: the combination therapy or nasal corticosteroids monotherapy. Efficacy was assessed by change from baseline in nasal obstruction score at week 2 and week 6 visits. The perceptions of global treatment satisfaction(convenience, side effects, cost and effectiveness) in both groups were analyzed.@*RESULT@#In both groups, the nasal obstruction score assessment descended significantly at week 2 and week 6 visits versus at baseline (all P < 0.01). At week 2 and week 6 visits, the nasal obstruction score in the combination therapy groups were significantly improved than that in nasal corticosteroids monotherapy groups (all P < 0.01). The perceptions of global treatment satisfaction in the combination therapy groups were significantly better (P < 0.05).@*CONCLUSION@#Azelastine nasal spray and intranasal corticosteroid in combination may provide a substantial therapeutic benefit for patients with persistent non-allergic rhinitis, especially nasal obstruction. The combination therapy was well tolerated and safety.
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Humans , Administration, Intranasal , Adrenal Cortex Hormones , Therapeutic Uses , Drug Therapy, Combination , Histamine H1 Antagonists , Therapeutic Uses , Nasal Obstruction , Phthalazines , Therapeutic Uses , Rhinitis , Drug TherapyABSTRACT
Objective To evaluate the relative efficacy of different dosages of Calf Pulmonary Surfactant (Calsurf) administration in premature infants with established respiratory distress syndrome (NRDS).Methods Four neonatal intensive care units in Jiangsu province were enrolled.Premature infants,birth weight ＜ 2 500 g,with NRDS,received 70 mg/kg (61 cases)or 100 mg/kg (69 cases)Calsurf.Clinical and respiratory parameters were recorded.The primary outcome measures were blood gas analysis of 1 h,12 h and 36 h after administration,the need for oxygenation and ventilatory requirements and the adverse events of NRDS.Results Arterial oxygen tension[pa (O2)] results in a significant improvement(80.27-±36.81) mmHg,(73.03 ±24.94) mmHg and (72.35 ± 24.72) mmHg at 1 h,12 h and 24 h in higher dose group(P ＜ 0.05),(67.95 ± 23.79) mmHg,(72.35 ± 24.72) mmHg in 24 h,as compared with the lower dose group at the same time [(67.07 ± 19.94) mmHg,(62.93 ± 21.71) mmHg,(67.95 ±-23.79) mmHg] (P ＞ 0.05).Inspired oxygen (FiO2) and pa (O2) decreased after administration in two groups and the duration of FiO2 decline lasted to 48 h (all P ＜ 0.05).The oxygen index (OI) was improved after Calsurf administration,especially in the infants who received 100 mg/kg of Calsurf with 6.1 ± 2.8,5.6 ± 3.3,5.5 ± 3.5,5.8 ± 4.5,5.3 ± 3.1 in 1 h,12 h,24 h,36 h,48 h,respectively(P ＜ 0.01).The arterial-to-alveolar oxygen tension ratio (a/APO2) of 100 mg/kg group was reduced significantly in 1 h,12 h,24 h,36 h,48 h with 0.39 ±0.22,0.42 ±0.20,0.45 ± 0.22,0.44 ± 0.22,0.46 ± 0.21 as compared with 0.27 ± 0.18 which was at the time point before administration (P ＜ 0.01).Although not statistically significant,the mean time of duration of mechanical ventilation and oxygen inhalation of higher dose group were decreased as compared to the lower dose group [(94.54 ± 113.44) h vs (109.27 ± 124.87) h (P＞0.05) and (259.10 ±280.45) vs (372.31 ±398.08) h(P ＞0.05)].There were no significant differences in the rates of other adverse events such as pneumonia,pneumothorax,intracranial hemorrhage,patent ductus arteriosus (PDA),pneumorrhagia,necrotizing enterocolitis,septicemia between two groups (P ＞ 0.05).Conclusions Calsurf given to preterm infants with NRDS at a dose of 100 mg/kg resulted in a higher Pa (O2),a/APO2,better OI and lower FiO2 as compared with those receiving 70 mg/kg.The need for mechanical ventilation and oxygen supplement were reduced with higher-dose administration.Large dose of Calsurf did not increase the risk of complications as mentioned above.
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Objective To evaluate the imaging features of pneumonia caused by A (H1N1) influenza virus. Methods Imaging data of 51 patients with pneumonia caused by A H1N1 influenza were retrospectively reviewed. All patients underwent mobile chest radiographs and 44 patients underwent CT as well. On the basis of the lesion degree in the lung, the patients were classified into mild, moderate and serious types. Results Mild type showed patchy consolidation at chest imaging in 4 patients. Moderate type demonstrated consolidation and(or) ground -glass opacities more than 2 lung fields in 33 patients, including 30 bilateral and 3 unilateral. Serious type displayed diffuse consolidation and ground-glass opacities, probably accompanying with interstitial lesions in the lungs in 14 patients, including 6 patients with ARDS, 2 with infection and 1 with cutaneous emphysema. Conclusion The imaging features of pneumonia caused by A H1N1 influenza mainly manifest as consolidation and ground-glass opacities, probably accompanying with interstitial changes. The imaging findings show various in patients with infection. Some serious patients even develope to ARDS.
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Objective To review the clinical characteristics of H1N1 influenza A, and suggest the clinical practices for the diagnosis and treatment of H1N1 influenza A in the future. Methods Thirty-three cases of H1N1 influenza A hospitalized in Beijing Ditan Hospital from May 15 to June 22, 2009 were studied and the clinical data were statistically analyzed with SPSS 11.0 for Windows. Results Twenty-five of the 33 patients had a history of travelling in America, Canada, Japan etc within a week; the latent period was between 1 and 6 days in 12 close contact patients. The main symptoms of H1N1 influenza A are fever (66.7%), dry cough (60.6%), cough with sputum (42.4%) and sore throat (36.4%). The laboratory tests in 24 cases(72.7%) were normal, while mild abnormal results were found in the remaining patients.All of the 33 cases were discharged according to the Standard of Diagnosis and Treatment of H1N1 Influenza A published by The Minister of Health, China. The period between 2-consecutive negative results in viral nucleic acid RT-PCR detection and the presenting symptom was 2 to 16 days and the period of hospitalization was 3 to 16 days. Conclusion The new type of H1N1 influenza A is characterised by mild symptoms, short period of hospitalization and good prognosis. All the patients can be cured, if they do not suffer from other severe chronic disease.
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To explore the expressional information of PIWIL4 in human ovarian cancer, semi-quantitative reverse transcription polymerase chain reaction(semi-qRT-PCR) was used to detect the mRNA expression level of PIWIL1, PIWIL2, PIWIL3 and PIWIL4 in human ovarian clear cell carcinoma ES-2 cells.Meanwhile, in human ovarian cancer and adjacent normal tissues, the mRNA expression of PIWIL4 was determined.Then, PIWIL4-siRNA, which was designed to target PIWIL4 and chemical synthesized, was transfected into ES-2 cells with lipofectamine.MTT assay and clone formation assay were used to investigate the effects of PIWIL4-siRNA on the cell growth activity and proliferation capacity of ES-2 cells.Experimental results showed that the mRNA expression level of PIWIL4 was the highest compared to PIWIL1, PIWIL2 and PIWIL3 in ES-2 cells(P