Analysis of epidemiological characteristics of Japanese encephalitis in Sichuan Province from 2008 to 2018 and application of autoregressive integrated moving average model / 中华疾病控制杂志

Objective The aim is to describe the epidemiological characteristics of Japanese encephalitis(JE) in Sichuan Province from 2008 to 2018, to build time series autoregressive integrated moving average(ARIMA) model, and to discuss the model application in the prediction of JE incidence trends. Methods Descriptive epidemiological analysis was used to analyze the epidemic situation of JE in Sichuan Province from 2008 to 2018. Monthly surveillance data of JE in Sichuan Province from January 2008 to December 2017 were used to fit ARIMA model. The number of reported cases from January to December in 2018 was used to test the model. Results The epidemic situation of JE in Sichuan Province from 2008 to 2018 showed a downward trend, and eastern and southern areas were the highly prevalent areas. The incidence peak was from July to September every year. Children were the high-risk group, but the incidence of adolescent and adult was on the rise in recent years. ARIMA(1,0,0)(2,1,0)12 could appropriately fit the time series. Conclusion ARIMA model can be used for short-term prediction of the reported incidence of JE in Sichuan Province.

Successful pregnancy following intracytoplasmic sperm injection?embryo transfer in a patient with premature ovarian insufficiency: a case report / 南方医科大学学报

We report a case of ovarian function fluctuation during long-term follow-up in a patient with premature ovarian insufficiency (POI). The patient finally obtained clinical pregnancy with subsequent uneventful full-term delivery after several intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. This case demonstrates that hormone replacement therapy (HRT) and assisted reproductive therapy should be applied as soon as possible to young patients with POI who have a strong desire for pregnancy in the absence of contraindications. This strategy helps such patients obtain pregnancy and delivery before the exhaustion of ovarian function.

Pregnancy outcome in a woman with premature ovarian insufficiency complicated by systemic lupus erythematosus during pregnancy: a case report / 南方医科大学学报

We report a case of in vitro fertilization and embryo transfer (IVF?ET) with oocyte donation in a woman with premature ovarian insufficiency (POI) complicated by systemic lupus erythematosus (SLE) during pregnancy. The patient had a diagnosis of POI 4 years earlier and 11 weeks after successful pregnancy by IVF?ET with oocyte donation in 2003, she presented with facial edema, and further examinations confirmed the diagnosis of lupus nephritis. She received treatment with prednisone to control the activity of SLE and aspirin and low?molecular?weight heparin to improve placental blood flow with close monitoring of gravida and fetus throughout pregnancy. The condition of the patient remained unstable during pregnancy, and liver damage and placental circulation disorder occurred in late gestational weeks with suspected intrauterine growth retardation (IUGR) of the fetus. For maternal and fetal safety, the patient received elective caesarean section and delivered a premature boy at 31 weeks of gestation. She subsequently received further medications for SLE and showed good recovery of the immunological parameters and absence of SLE symptoms during the follow?up for 14 years, indicating a clinical cure of SLE. Her son shows normal growth and development. Based on the experience with this case and literature review, we believe that immunological factor is an important cause of POI and thus recommend full immunological examinations in cases of idiopathic POI.

Outcome analysis of monozygotic twin pregnancy conceived by assisted reproductive techniques / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the incidence, management, and outcomes of monozygotic twin (MZT) pregnancy conceived by assisted reproductive techniques (ART).</p><p><b>METHODS</b>A retrospective analysis was performed of clinical pregnancies after in vitro fertilization and embryo transfer (IVF-ET) and introcytoplasmic sperm injection and embryo transfer (ICSI-ET) from January, 2010 to June 2015 at our center. We investigated the incidence, managements and outcomes of 94 MZT pregnancies. Comparison of the pregnancy outcomes was made between the expectantly managed MZT pregnancies, dizygotic twin (DZT) pregnancies, monozygotic (MZ)-triplet pregnancies with selective embryo reduction (SER) to 2 fetuses and 1 fetus, and non-MZ triplet pregnancies with SER to 2 fetuses.</p><p><b>RESULTS</b>Ninety-four MZT pregnancies occurred in the total of 6257 clinical pregnancy cycles with an incidence of 1.5%. No significant difference was found in the incidence of MZT pregnancies between IVF and ICSI cycles or between fresh and thawed cycles (P>0.05). Of the 94 MZT pregnancies, 45 were MZT pregnancy cycles, 43 were MZ-triplet pregnancy cycles, 3 were MZ-quadruplet pregnancy cycles and 3 were ectopic pregnancies. The expectantly managed MZT was associated with a significantly greater rate of miscarriage and malformation and a lower rate of live birth and term birth (P<0.05) in comparison with DZT pregnancy cycles that did not undergo SER. Similar outcomes were found between MZ-triplet pregnancies with SER to 2 fetuses and MZ-triplet pregnancies with SER to 1 fetus (P>0.05), and between MZ-triplets with SER to 2 fetuses and non-MZ triplet pregnancies with SER to 2 fetuses (P>0.05).</p><p><b>CONCLUSION</b>ART is associated with a much higher incidence of MZT pregnancies than spontaneous conception. MZT pregnancies are at high risk of adverse outcomes, and reduction of MZT in multiple pregnancies may help to improve the outcomes.</p>

Clinical outcome of in vitro fertilization or intracytoplasmic sperm injection-embryo transfer in women aged 40 years and above / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical outcomes in vitro fertilization or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in women aged over 40 years.</p><p><b>METHODS</b>We retrospectively analyzed 1050 non-donor IVF/ICSI-ET cycles performed from January, 2007 to December, 2015 in women at the age 40 years or above, including 393 women at 40 years of age, 266 at 41 years, 158 at 42 years, 107 at 43 years, 64 at 44 years, and 65 at 45-51 years. The clinical characteristics and outcomes of the women in different age groups were compared and analyzed. The pregnancy outcome of different ovarian stimulation protocols and different numbers of embryo transferred were also compared.</p><p><b>RESULTS</b>Oocyte retrieval was achieved in 1032 treatment cycles. Of the 750 embryo transfer cycles, the clinical pregnancy rate was 17.7% (113/750), and the live birth rate was 8.5% (64/750). The clinical pregnancy rate in the 5 age groups was 23.4%, 21.0%, 13.1%, 9.2%, 5.6% and 0%, and the implantation rate was 11.2%, 10.2%, 6.3%, 5.1%, 2.3% and 0%, respectively; the early spontaneous abortion rate was 31.0%, 35.9%, 42.9%, 42.9% and 100%, and the live birth rate was 11.9%, 11.8%, 2.8% and 3.9%. The clinical pregnancy rates of long protocol, short prorocol, GnRHa antagonist protocol, and ovulation induction protocol were 23.6%, 10.2%, 13.3%, and 2.3%, respectively. In the 750 transfer cycles, the clinical pregnancy rate was 3.8% with single embryo transfer, 12.6% with double embryos transfer, and 23.0% with 3 embryos transfer.</p><p><b>CONCLUSION</b>In women aged 40 years or above, the clinical pregnancy rate decreased significantly with age, and the live birth rate was extremely low in women aged beyond 44 years. Assisted reproductive technique is recommended for women aged 40 years and above even when no identifiable causes of sterility are present. For women aged above 44 years of age, oocyte donation may be a better option.</p>

Japanese encephalitis virus with genotype I is predominant in Sichuan Province / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To understand molecular characteristics of Japanese encephalitis virus (JEV) isolated from the major Japanese encephalitis epidemic areas in Sichuan Province, and to provide the foundation for JEV prevention.</p><p><b>METHODS</b>13 JEV strains were isolated from mosquitoes in Sichuan during 2007-2010, E genes and preM genes were sequenced and phylogenetic analyses were performed using MEGA5 molecular software.</p><p><b>RESULTS</b>Phylogenetic analysis indicated that all 13 JEV strains from Sichuan belonged to genotype I, homologies at nucleotide level and deduced amino acid level in PreM gene were 97%-100% and 98.7%-100%, and 97.8%-99.9% and 99.6%-100% in E gene, respectively. Homologies at nucleotide level and deduced amino acid level in PreM gene between 13 JEV strains and JEV isolated in 2004 in Sichuan were 96.2%-99.1% and 97.5%-98.7%, and were 97.7%-99.6% and 98. 6%-100% in E gene, respectively. By comparison with vaacine strains P3 and SA14-14-2, homologies at nucleotide level and deduced amino acid level were 84.1%-85.8% and 93.7%-96.2% in PreM gene, and were 87.6%-88.3% and 97%-97.8% in E gene, respectively. The neurovirulence-related 8 amino acid sites encode by E gene remained unchanged in 13 JEV strains.</p><p><b>CONCLUSION</b>JEV with genotype I predominated in Sichuan, nucleotide sequences and deduced amino acid sequences in PreM gene and E gene were highly conserved, key neurovirulence-rerlated sites remained unchanged. It suggested currently used vaccine is still capable of preventing JEV infection.</p>

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>