ABSTRACT
Objective@#To understand the epidemiologic features of the rabies in Xishuang banna prefecture of Yunnan province, China in 2008-2017 and the viral molecular-evolution characteristics.@*Methods@#The data of rabies case questionnaire were collected. The brain tissue samples from mad dogs, suspicious sick dogs and human brain tissue, saliva and cerebrospinal fluid samples from rabies patients were collected in Xishuangbanna. Coding region of nucleoprotein and glycoprotein genes were amplified by RT-PCR and sequenced. Homology and phylogenetic analysis were performed using the relevant bioinformatics software.@*Results@#A total of 62 cases of human rabies were occurred in 28 districts of the 3 counties, Xishuangbanna prefecture in 2008-2017. Of them, 37 cases in Jinghong county, 15 in Menghai county and 10 in Mengla county. In which 48 cases were bitten by domestic dogs (77.42%), 11 cases were bitten by wild dogs (17.74%). Rabies case was occurred every year in the past decade. The seasonal incidence was not obvious. The majority of patients were aged from 30 to 59 years-old, with the youngest 1 year-old and the eldest 91 year-old. The male to female ratio was 1.70∶1, most cases were farmers. The nucleotide sequences of nucleoprotein gene of 9 virus strains (7 from Jinghong, 1 from Menghai and 1 from Mengla) were obtained from the samples of dogs and patients. Homology and phylogenetic analyses indicated that the 5 strains belonged to clade China-Ⅰ, 3 clade China-Ⅱ and 1 clade China-Ⅵ. The nucleotide sequences of glycoprotein gene of 5 virus strains (3 from Jinghong, 1 from Menghai and 1 from Mengla) were obtained from these positive samples, and all were clade China-Ⅰ, it is same with nucleoprotein genes analysis result from these 5 virus strains. These China-Ⅰ and China-Ⅱ strains from Xishuangbanna have a closer genetic relationship with same clade strains isolated from Pu’er and other prefectures of Yunnan province as well as Sichuan, Guizhou and Guangxi. The China-Ⅵ strain from Xishuangbanna share high homology and genetic relationship with China-Ⅵ strains isolated from southwestern Yunnan and neighbouring countries such as Myanmar, Laos and Vietnam in recent years.@*Conclusions@#In Xishuangbanna, rabies mainly occurred in rural area and domestic dog was the main source of transmission. These RABV clades China-Ⅰ, China-Ⅱ and China-Ⅵ were found in this region and the China-Ⅰ was principal clade. The transmission source of China-Ⅰ and China-Ⅱ were from adjacent areas in the province and China-Ⅵ was from Myanmar and Laos.
ABSTRACT
Objective To explore the value of transthoracic echocardiography(TTE) combined with partial pressure of end-tidal CO2 (PETCO2) monitoring in preventing venous air embolism (VAE) during hysteroscopy operation.Methods From August 2010 to August 2012,300 cases undergoing hysteroscopic surgery under general anaesthesia were enrolled in this study.With the echocardiography combined with PETCO2 monitoring during hysteroscopic surgery,the time of VAE appearing in the right atrium,the extent of air embolism(grade 0-4),the changes of PET CO2,peripheral oxygen saturation (SpO2),blood pressure (Bp),the amount of fluid intravasation and the blood loss were recorded in detail.Take the 24 cases that the grades of VAE in grade 3 or above and a decrease in PETCO2 ≥5 mm Hg (1 mm Hg =0.133 kPa) as intervention group.Stop operation immediately,the left side and raise your right shoulder,oxygen inhalation and dexamethasone 10 mg intravenous drip were given to the intervention group; the control group (5 cases in grade 3 or above and a decrease in PETCO2 ＜ 5 mm Hg) only stop operation immediately,observation patient's condition closely.Results (1) The occurrence of VAE:air embolism occurred in 34 patients among all 300 patients,all of 34 patients had evidence of gas embolism in the inferior vena cava,right atrium(RA) and right ventricle chamber,and 29 patients had evidence of continuous groups of gas emboli.There were 32 cases with the decrease in PETCO2 ＞ 2 mm Hg,14 cases with SpO2 less than 95％,and 4 cases with a drop in Bp ≥ 20％.(2) The change of the decrease of PET CO2 and the grades of VAE:the decrease of PETCO2 and the grades of VAE were positively correlated (r =0.601,P ＜ 0.01),continuous groups of gas emboli signal in RA,when the drop of PETCO2 ≥5 mm Hg,8 of the 34 cases whose drop of PETCO2 ≥ 10 mm Hg,7 cases in grades 4.The decrease of PET CO2 [(7.5 ± 2.4) mm Hg versus (11.1 ±4.1)mm Hg],the amount of fluid intravasation[(688 ± 150) ml versus (925 ±268) ml] and the blood loss [(71 ± 36) ml versus (127 ± 56) ml] all had statistical difference in grade 3 and 4 (P ＜ 0.05).The sensitivity of PETCO2 was better than SpO2 and Bp in detecting of VAE.(3)The cases of PETCO2 continue to decline and recovery time between the two groups:2 cases' PETCO2 continued to decline in the intervention group,but 4 cases in the control group.The recovery time of the two groups was(4.8 ± 1.6) and (8.3 ±1.9) min,respectively,which reached statistical difference between (P ＜ 0.05).Conclusions TTE combined with PET CO2 monitoring can effectivelv predict the occurrence of air embolism in hysteroscopic surgery; Continuous groups of gas emboli signal in RA accompanied by a decrease in PETCO2 ≥5 mm Hgindicates that the occuTence of air embolism ; the more the amount of intravasation of distension fluid and the blood loss,the more the air into the body.Timely intewention can effectively prevent the development of air embolism when the VAE in grade 3 or above accompanied by a decrease in PETC02 ≥5 mm Hg.