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To observe therapeutic effect of L‐carnitine combined cyclic adenosine monophosphate and its influence on serum levels of IFN‐γ and IL‐4 in patients with viral myocarditis .Methods : A total of 132 VMC pa‐tients treated in our hospital from 2017 to 2018 were randomly and equally divided into L‐carnitine group and com‐bined treatment group (received cAMP based on L‐carnitine group ) , both groups were treated for two weeks .Pe‐ripheral serum levels of IFN‐γ , IL‐4 , cardiac troponin T (cTnT) and creatine kinase isoenzyme MB (CK‐MB) be‐fore and two weeks after treatment , therapeutic effect and incidence of adverse drug reactions were observed and compared between two groups .Results : Compared with before treatment , there was significant rise in serum IL‐4 level , and significant reductions in serum levels of IFN‐γ , cTnT and CK‐MB in two groups after two‐week treat‐ment , P＝0. 001 all ;compared with L‐carnitine group , there was significant rise in serum IL‐4 level [ (47. 43 ± 9.17) ng／ml vs.(55. 38 ± 10.23 ) ng／ml] , and significant reductions in serum levels of IFN‐γ [ (65.22 ± 11.82 ) ng／ml vs .(52.18 ± 10.06) ng／ml] , cTnT [ (0. 37 ± 0.09) ng／ml vs.(0.18 ± 0.03) ng／ml] and CK‐MB [ (28.56 ± 5. 34) U／L vs.(16. 22 ± 3. 47) U／L] in combined treatment group , P＝0.001 all.Total effective rate of com‐bined treatment group was significantly higher than that of L‐carnitine group (92.4% vs.80.3%) , P＝ 0.042. There was no significant difference in incidence rate of adverse drug reactions between two groups , P＝0. 784. Con‐clusion : L‐carnitine combined cAMP can significantly reduce peripheral serum IFN‐γ level and increase IL‐4 level , regulate Th1／Th2 imbalance with significant therapeutic effect in VMC patients .And its safety is good .
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Objective To evaluate the economic effect of new strategy for preventing poliomyelitis in Zhejiang Province. Methods Based on the population of Zhejiang Province in 2016, cost-effectiveness ratio (CER) , benefit-cost ratio (BCR), and net benefit (NB) were applied to calculate the health economic difference for the new strategy and the original strategy as compared to no vaccination strategy. Univariate sensitivity analysis was used to assess the robustness of results with main parameters; including burdens of poliomyelitis, cost of vaccines, and the vaccination program itself, and the discount rate. Results CERdisease, CERdeath, BCR and NB for the new strategy were 1:52700 RMB Yuan per case, 1:1813700 RMB Yuan per case, 12.26 and 796.6622 million and CERdisease, CERdeath, BCR and NB for the original strategy were 1 :32900 RMB Yuan per case, 1 :1133900 RMB Yuan per case, 19.58 and 823.1753 million, respectively. The results of the univariate sensitivity analysis with main parameters were robust. Conclusion The new strategy for preventing poliomyelitis is necessary for this period of the global polio eradication. Though the new strategy appears not as good as the original strategy on economic evaluation, its health economic benefit is significant.
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Objective To evaluate the quality of the hepatitis B report data on a pilot surveillance in Zhejiang Province from 2013 to 2015.Methods Hepatitis B report data of 6 pilots in Zhejiang Province from 2013 to 2015 were extracted from national notifiable infectious disease reporting system,including reported cases of hepatitis B,classification of hepatitis B cases and supplementary card information etc. To evaluate the accuracy of hepatitis B classification,information of supplementary cards was used to make classification diagnose for hepatitis B.Results A total of 3214 hepatitis B cases were reported in 6 pilot surveillance counties in Zhejiang Province between 2013 and 2015. Excluded 32 duplicated cases within the year and between years,3182 hepatitis B cases were actually reported,hepatitis B cases repeated reporting rate was 1%. A total of 2717 hepatitis B cases were correctly classified,and the accuracy rate of classification was 85.39%,showing an increasing trend (P<0.05). The proportion of accurate classification of reported hepatitis B by referring to the results of positive time of HBsAg and ALT from the supplementary card were 80.86% and 97.29% respectively. Among those reported acute hepatitis B cases,90.43% of them filled with anti-HBc IgM positive in supplementary card. The proportion of accurate classification of reported hepatitis B by referring to the information for liver puncture and the HBsAg and anti-HBs transform during the recovery period in supplementary cards were 0.19% and 5.13% respectively. Among those reported acute hepatitis B cases,0.69% of them were chronic or undetermined. Among those reported chronic hepatitis B cases,13.92% of them were acute,undetermined or HPV carrier. Five out of 3182 cases were unclassified,accounting for 0.16%.Conclusion The quality of classification diagnosis for hepatitis B should be improved in Zhejiang Province. Filling in the supplementary card is very beneficial for the classification of hepatitis B.
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Objective To evaluate the status and equity of resource allocation for community vaccination services in Zhejiang Province.Methods A descriptive analysis was conducted,and Gini coefficient and Theil index were used to analyze the reasonableness and the demographic equity of resource allocation for community vaccination services in Zhejiang Province in 2013.Results The Gini coefficient of vaccination clinic and clinic staff based on population distribution in Zhejiang Province were 0.403 6 and 0.355 4,respectively.The total Theil index of vaccination clinic and clinic staff were 0.204 4 and 0.207 1,respectively.Both vaccination clinic and clinic staff,Theil index within the region were far higher than inter -regional Theil index.Conclusion The demographic equity of resource allocation for community vaccination services in Zhejiang Province should be improved.The disparity within the region is the main reason of unequal in resource allocation for community vaccination service.
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<p><b>OBJECTIVE</b>To observe the relationship of Chinese medicine (CM) syndrome pattern with heart function detected by ultrasonic cardiography and brain natriuretic peptide (BNP) level in patients with heart failure (HF).</p><p><b>METHODS</b>One hundred and sixteen inpatients of HF hospitalized in Dongfang Hospital from January, 2007 to January, 2009 were assigned to three groups according to their CM syndrome pattern differentiated, the qi-yin deficiency group (QYD), the qi-deficiency and blood-stasis group (QDBS) and the yang-deficiency with water overflowing group (YDWO). Ultrasonic cardiographic (USCG) parameters, including left ventricular end-systolic diameter (LVEDs), left ventricular end-diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were detected, and blood level of BNP was measured.</p><p><b>RESULTS</b>LVEF was decreased while BNP was increased in patients with syndrome patterns in the order of QYD --> QDBS --> YDWO, and showed significant difference between groups (P < 0.01); CM syndrome patterns was related with all the USCG parameters and BNP level, especially the BNP (r = 0.71, P < 0.05) and LVEF (r = -0.34, P < 0.05).</p><p><b>CONCLUSION</b>LVEF and BNP can reflect the severity of heart failure, and they could be taken as the beneficial objective and quantitative indices for syndrome pattern differentiation.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Diagnosis, Differential , Heart Failure , Diagnostic Imaging , Metabolism , Medicine, Chinese Traditional , Natriuretic Peptide, Brain , Blood , Stroke Volume , Physiology , Ultrasonography , Ventricular Function , PhysiologyABSTRACT
<p><b>OBJECTIVE</b>To evaluate the infectivity of severe acute respiratory syndrome (SARS) during its incubation period by investigating chains of transmission and individuals isolated for medical observation with a view to providing scientific evidence for updating protocols of medical isolation.</p><p><b>METHODS</b>Individuals related with the two SARS chains of transmission in Beijing in 2003 and a group of individuals isolated for medical observation in Haidian district of Beijing during the SARS outbreak were selected as subjects of study. Contactors with SARS patients and those with symptom development following the contacts were investigated via questionnaire. Serum samples were collected from super transmitters and tested for SARS-CoV antibody by neutralization test and enzyme linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>A total of 1112 contactors were investigated in three surveys. Of them, 669 had a history of close contact with symptomatic SARS patients, 101 developed symptoms with a rate of 15.1%, 363 had a history of close contact with patients in their incubation period, none of whom developed symptoms (0%). Serum samples were collected from 32 highly-exposed individuals, of whom 13 developing SARS symptoms after contact had serum samples positive for SARS-CoV antibody. Samples collected from the asymptomatic contactors were all negative for SARS-CoV antibody.</p><p><b>CONCLUSION</b>SARS cases are infectious only during their symptomatic period and are non-infectious during the incubation period. Isolation for medical observation should be placed for individuals who are in close contact with symptomatic SARS patients. The results of our study are of decisive significance for the Ministry of Health to the definition of SARS close contactor.</p>
Subject(s)
Humans , China , Epidemiology , Disease Outbreaks , Infectious Disease Incubation Period , Severe acute respiratory syndrome-related coronavirus , Physiology , Severe Acute Respiratory Syndrome , Epidemiology , VirologyABSTRACT
Objective To study the status on economic burden of diarrhea in Zhejiang province so as to provide evidence for allocation of health resource as well as decision-making on health issues. Methods Multi-phases stratified random cluster sampling was used to select samples in the population. Data was collected on the incidence of diarrhea in the last two weeks as well as on the related cost due to medical care etc. Results The overall incidence (person per year) of diarrhea was 0.26, with 0.29 in the rural and 0.22 in the urban areas respectively. The incidence of diarrhea in children less than 5 was 0.66 (person per year), higher than in any of the age groups. The average direct cost of medical treatment was 69.23 Yuan with average direct cost of non-medical care was 8.29 Yuan for every person, while the indirect cost was 48.43 Yuan. in conclusion, the average disease burden of diarrhea in the province was 1.697 billion Yuan per year, which accounted for 1%o of the GDP, with 1.217 billion Yuan in rural area and 0.480 billion Yuan in the urban areas respectively. The direct cost of medical care was 0.886 billion Yuan (52.21%) and the direct cost due to non-medical care was 0.124 billion Yuan (7.31%). The indirect cost appeared to be 0.480 billion Yuan (40.48%). Factors that affecting the cost would relate to: severity of diarrhea, medical insurance, location of residential area, age and education background of the patients, etc. Conclusion Programs on diarrhea prevention and control should be strengthened to reduce the economic burden caused by this disease while special attention should be paid to those children who are under 5 years of age and living in the rural areas.
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<p><b>OBJECTIVE</b>To study the variation of specific antibody among convalescent of severe acute respiratory syndrome (SARS) patients through a three-year program.</p><p><b>METHODS</b>Sera samples were collected from SARS cases in the 5th, 20th and 35th month after onset of the illness. The SARS-CoV specific antibody was detected for all of them by ELISA and neutralized test simultaneously. The titer of neutralizing antibodies was calculated using Reed-Muench method, and the comparison between different time groups was analyzed regarding the variance of data on repeated measures after logarithm conversion.</p><p><b>RESULTS</b>13, 17 and 13 sera samples were collected in the 5th, 20th and 35th month after onset. Results showed that despite the fact that the positive rates of ELISA antibody were 100%, 82.4% and 84.6% respectively,the neutralizing antibody was still positive for all the samples. The average neutralizing antibody titers were 1:43 (1:16-1:203), 1:36 (1:17-1:59) and 1:21 (1:10-1:39) on the 5th, 20th and 35th month after onset, and the differences were statistically significant (F = 60.419, P < 0.001). On the 35th month after the onset, 30.8% (4/13) of the patients were still having the neutralizing antibody level of above 1:36, but the neutralizing antibody level in another 30.8% (4/13) of the patients had decreased to as low as 1:10, when the cut-off level was set as 1:8.</p><p><b>CONCLUSION</b>Results of the study indicated that the neutralizing antibody of SARS cases could last for at least three years, but the sera specific antibody in SARS cases decreased gradually when time went by. However, neutralizing antibody in some of the cases decreased to a lower level on the 35th month. Further follow-up study was worthwhile to observe the long-lasting profile of antibody existence on SARS cases.</p>
Subject(s)
Humans , Antibodies, Neutralizing , Enzyme-Linked Immunosorbent Assay , Follow-Up Studies , Severe Acute Respiratory Syndrome , Allergy and ImmunologyABSTRACT
<p><b>OBJECTIVE</b>To examine vibrio cholera (V.C) in aquatic products of littoral area, Zhejiang Province and to provide scientific evidence for administration of aquatic products and cholera epidemic control.</p><p><b>METHODS</b>All 990 samples of aquatic products collected from local markets, eateries and aquafarms in three chosen areas. Samples were proliferated in alkaline liquid medium, and purified in NO: 4 medium, the isolations were identified biochemically, and phenotype of strains were defined by phagocyte and coagulation with V.C. diagnostic serum. Three virulence genes (ctx, ace, zct) of the isolated strains were detected by polymerase chain reaction (PCR).</p><p><b>RESULTS</b>There were 1.41% samples caught by V.C., having a carrying rate highest in turtles of 8.9%. 14 strains were defined as three serogroups, and the numbers of Inaba, Ogawa, and Hikojima types were 2, 2, 10 respectively. Virulence genes had detected in 9 of 12 stains. All genes were detected in 5 strains, only ZOT genes in 3 strains, and both CTX and ACE genes in 1 strain.</p><p><b>CONCLUSIONS</b>Aquatic products from inshore in Zhejiang Province caught with V.C. strains might be divided into three serogroups. Most of them should be virulence genes. Cholera epidemic outbreak might be caused by those contaminated products.</p>
Subject(s)
China , Food Microbiology , Genes, Bacterial , Seafood , Microbiology , Vibrio cholerae , Genetics , Virulence Factors , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To study the evidence of severe acute respiratory syndrome (SARS) infection among close contacts to SARS patients and the level of sera IgG antibody in SARS cases.</p><p><b>METHODS</b>Specific IgG antibody against SARS-CoV in serum samples from contacts to patients, five months before an SARS outbreak in Beijing. Neutralized test, ELISA and immunity adherence test were studied. Samples were collected after clinical onset of patients or close contacts to patients, for 22 - 24 weeks. 19 close contacts and 13 cases were included in the study.</p><p><b>RESULTS</b>In close contacts, all tests were negative on three methods. All SARS cases were positive except one by immunity adherence test. The neutralized antibody levels were from 1:16 to 1:203, with medium level of 1:43.</p><p><b>CONCLUSION</b>According to our survey, there was no latent infection among close contacts. IgG antibody in sera continued to be at higher levels among SARS cases 22 - 24 weeks after onset.</p>
Subject(s)
Female , Humans , Male , Antibodies, Viral , Blood , China , Epidemiology , Disease Outbreaks , Immunoglobulin G , Blood , Severe acute respiratory syndrome-related coronavirus , Allergy and Immunology , Seroepidemiologic Studies , Severe Acute Respiratory Syndrome , Epidemiology , Allergy and ImmunologyABSTRACT
<p><b>OBJECTIVES</b>To investigate the transmission process of severe acute respiratory syndrome (SARS) and to evaluate the infectiveness of SARS patients in different periods of disease epidemics.</p><p><b>METHODS</b>Standardized questionnaire was used to conduct case investigation and contact tracing by combining the field investigation and telephone interview. Transmission process, infectivity, transmission chain and contact history of SARS were studied through data analyses.</p><p><b>RESULTS</b>On 25th March 2003, a 91 year old man was admitted to Hospital J in Beijing with stroke and fever. He died on 30th March. From 31st March, there was an outbreak of SARS among his contacts in the family and in the hospital he was admitted to. Contacts would include his relatives, other co-patients and health care workers in the Hospital J. Chinese Field Epidemiology Training Program trainees conducted an investigation of the outbreak. Among the 207 contacts of the index cases through different generations, there were 36 cases of SARS (attack rate 17%) patients with one death. There were 12 cases having directly contact with the index case and 13 cases with one secondary case. The transmission chains of this outbreak could clearly be depicted. All the cases had close contacts during the symptomatic period of their index patients. Among the relatives, 85% of the cases had 3 - 5-day contact with their index patients after the onset of the illnesses. There was no significant difference between the two attack rates-70% for whose who had contact with the patient before and after illness onset) and 67% for those who only had contact after the onset of the illness. Out of the 44 social acquaintances and 38 of the family members who had contacts with the index patients during the incubation period, no one was found ill. Among the close contacts at the hospital who had no protection when providing care to the patient, the attack rate was found over 80%.</p><p><b>CONCLUSIONS</b>All the secondary cases of this outbreak had a history of direct and close contacts to the index patients after the onset of the illness. There was no evidence indicating that SARS cases were infectious during their incubation period.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , China , Epidemiology , Infectious Disease Transmission, Patient-to-Professional , Severe Acute Respiratory Syndrome , EpidemiologyABSTRACT
<p><b>OBJECTIVE</b>To estimate the frequency of injections and proportion of unsafe injections and to analyses the critical determinants of poor injection practices in general population in China. Also, to study knowledge, attitudes, practice research in providers and general population.</p><p><b>METHODS</b>A random sample consisting residents and health care providers in a rural county was elected and interview about the frequency of received injection, as well as knowledge, attitudes and practices regarding injections were studied.</p><p><b>RESULTS</b>Overall, 1 004 village residents, and 94 providers were interviewed. Among residents, 145 persons (14.4%), with 457 times (0.46 times per person) had received at least one injection during the previous 3 months. The frequency of injection was 1.84 per year. The proportion of received injections on treatment and immunizations was significantly different among > 12 years age group and < or = 12 years age group. Ninety-four point four percent of disposable syringes/needles were used for injections. Knowledge among the population and providers regarding injection safety was limited.</p><p><b>CONCLUSION</b>Injections were moderately frequent in this rural area and the proportions of disposable syringes/needles used for injections was very high. Knowledge of safe injection and reasonable injection as well as consciousness of self-protection in the providers and residents need to be improved.</p>