Arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement in the treatment of chronic lateral ankle instability concomitant with fibular tendinitis / 中华创伤杂志

Objective:To compare the efficacies of arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement in the treatment of chronic lateral ankle instability (CLAI) concomitant with fibular tendinitis.Methods:A retrospective cohort analysis was conducted on the clinical data of 31 patients with CLAI concomitant with fibular tendinitis, who were treated in Beijing Tongren Hospital, Capital Medical University between March 2019 and December 2021. The patients included 17 males and 14 females, aged 16-57 years [(32.8±9.6)years]. The anterior drawer test and talar tilt test were positive in all patients preoperatively. Diagnosis was confirmed by physical examination and MRI, and calcaneofibular ligament rupture was excluded. Eleven patients received arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement (modified Brostr?m procedure+tendon debridement group), and 20 underwent pure arthroscopic modified Brostr?m procedure (modified Brostr?m procedure group). The operation time, intraoperative blood loss and length of hospital stay were documented. The visual analogue score (VAS) in peroneal tendon area was assessed before operation and at postoperative 2, 6 and 12 weeks. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle outcome score (FAOS) were assessed before operation and at postoperative 6 and 12 weeks. The anterior drawer test was performed at the last follow-up. The foot and ankle ability measure (FAAM) score was assessed before operation and at the last follow-up. Postoperative wound healing and complications were also observed.Results:All the patients were followed up for 4-19 months [(11.3±3.5)months]. The operation time was (66.0±4.2)minutes in the modified Brostr?m procedure+tendon debridement group, which was significantly longer than (61.5±3.4)minutes in the modified Brostr?m procedure group ( P<0.05). There was no significant difference in intraoperative blood loss or length of hospital stay between the two groups (all P>0.05). Compared with the preoperation, the value of VAS was significantly lowered, and the values of AOFAS ankle-hindfoot score, FAOS and FAAM score were significantly increased at different postoperative timepoints (all P<0.01). No significant differences in the values of VAS, AOFAS ankle-hindfoot score, FAOS or FAAM score were seen between the two groups before operation (all P>0.05). The value of VAS was 3.0(3.0, 4.0) points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 4.0(4.0, 4.0)points in the modified Brostr?m procedure group at 2 weeks postoperatively ( P<0.05). The value of VAS was 2.0(1.0, 3.0)points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 3.0(2.3, 3.0)points in the modified Brostr?m procedure group at 6 weeks postoperatively ( P<0.05). At 12 weeks postoperatively, there was no significant difference in the value of VAS between the two groups ( P>0.05). There were no significant differences in the values of AOFAS ankle-hindfoot score and FAOS between the two groups at 6 or 12 weeks postoperatively (all P>0.05). The anterior drawer test was negative in all patients at the last follow-up. No significant difference was seen in the value of FAAM score between the two groups at the last follow-up ( P>0.05). All incisions were healed well in the first stage after operation, without the occurrence of joint infection, impaired joint motion, nerve injury or deep vein thrombosis. Conclusions:Arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement can both improve the foot function in CLAI patients concomitant with fibular tendinitis. However, the combined treatment allows for early pain relief, without increasing the risk of complications, and can therefore contribute to a faster postoperative recovery.

Clinical efficacy of different anesthesia methods in patients with endovascular treatment for acute anterior circulation ischemic stroke: a meta-analysis / 中华神经科杂志

Objective:To systematically evaluate the efficacy and safety of general anesthesia versus conscious sedation in patients with endovascular therapy for acute ischemic stroke.Methods:Databases, including English databases PubMed, Embase and Cochrane, as well as Chinese databases Wan Fang Data and CNKI, were screened for randomized controlled trials (RCT) of general anesthesia versus conscious sedation on the effect of endovascular treatment for acute anterior circulation ischemic stroke. The searching period was from the establishment of databases to July 14, 2022. Two researchers independently screened literatures, extracted data and evaluated the risk of bias. And meta-analysis was performed using RevMan5.3 software.Results:A total of 7 RCTs involving 923 patients were included, with 461 in the general anesthesia group and 462 in the other. As the meta-analysis showing, general anesthesia could significantly improve the good outcomes (modified Rankin Scale score≤2) at 3 months after endovascular treatment in comparison with conscious sedation ( OR=1.34, 95% CI 1.01-1.78, P=0.04), and significantly increased the rate of successful revascularization ( OR=1.87, 95% CI 1.32-2.65, P<0.001). In addition, there were no statistically significant differences between the two groups in mortality ( OR=0.93, 95% CI 0.66-1.29, P=0.65), symptomatic intracranial hemorrhage ( OR=0.88, 95% CI 0.57-1.35, P=0.55) and intervention-related complications ( OR=0.83, 95% CI 0.50-1.36, P=0.46). However, general anesthesia was associated with higher risk for both 20% reduction in mean arterial pressure ( OR=4.76, 95% CI 1.49-15.19, P=0.008) and pneumonia ( OR=2.58, 95% CI 1.51-4.39, P<0.001). Conclusions:Compared with conscious sedation, endovascular treatment under general anesthesia in patients with acute anterior circulation ischemic stroke may contribute to better outcomes and higher successful revascularization. However, this method will lead to the risk of blood pressure variability and the incidence of pneumonia.

Application of reperfusion-expanding-thrombectomy-stenting technique in carotid tandem lesions / 中华神经科杂志

Objective:To analyze the feasibility and clinical efficacy of reperfusion-expanding-thrombectomy-stenting (RETS) technique in the endovascular treatment of acute carotid artery tandem lesion.Methods:The general clinical data of 88 patients with carotid artery tandem lesion who received emergency endovascular treatment from January 2018 to December 2020 in Department of Neurology, Linyi People′s Hospital were reviewed, the Modified Rankin Scale (mRS) was used as the evaluation standard for the prognosis of patients at 90 days after endovascular treatment, and the clinical data were analyzed, including the recanalization (modified thrombolysis in cerebral infarction ≥2b), perioperative complications and 90-day prognosis, and good prognosis was defined as a mRS score of 0-2.Results:A total of 88 patients with tandem carotid artery disease were included,48 of whom were treated with RETS technique, 40 were treated with anterograde approach. Compared with antegrade recanalization, RETS technique had significant differences in the time from puncture to recanalization [(72.06±17.29) min vs (98.88±26.09) min, t=-5.56, P<0.001] and the primary recanalization rate [35/48(73.0%) vs 21/40(52.5%),χ2=3.93 ,P=0.047], with statistically significant difference. There was no significant difference in clinical prognosis and surgical complications between the two methods (all P>0.05). Conclusions:RETS technique can shorten the operation time and increase the primary recanalization rate. RETS technique is safe and feasible for the treatment of carotid tandem lesions.

Clinical prognoses of acute ischemic stroke patients with large core infarction after endovascular therapy and their influencing factors / 中华神经医学杂志

Objective:To explore the clinical prognoses of acute ischemic stroke (AIS) patients with large core infarction after endovascular therapy (EVT) and their influencing factors.Methods:Totally, 139 AIS patients with large area core infarction (volume of infarction core area≥70 mm3) admitted to our hospital from November 2019 to December 2020 were enrolled in our study; their clinical data were analyz ed retrospectively. These patients were divided into EVT group ( n=78) and non-EVT group ( n=61) according to whether endovascular treatment was performed, and the clinical prognoses of patients from the 2 groups were compared. According to the 3-month modified Rankin scale (mRS) scores, the patients in the EVT group were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2); univariate and multivariate Logistic regressions were used to analyze the independent influencing factors for prognoses of AIS patients with large area core infarction after EVT. Results:As compared with those in the non-EVT group, patients in the EVT group had significantly higher good prognosis rate (11.48% vs. 42.31%), and significantly lower proportion of patients with neurological deterioration, cerebral hernia and death ( P<0.05). As compared with the poor prognosis subgroup, the good prognosis subgroup had significantly lower percentage of patients with atrial fibrillation, significantly higher percentage of conscious patients, significantly higher Alberta stroke program early CT scale (ASPECT) scores, statistically lower volume of infarction core areas, and significantly higher percentage of patients with grading 2-4 in collateral circulation ( P<0.05). ASPECT scores ( OR=4.164, 95%CI: 2.081-8.332, P=0.000), volume of infarction core areas ( OR=0.917, 95%CI: 0.855-0.984, P=0.016), and collateral circulation grading ( OR=5.113, 95%CI: 1.104-23.683, P=0.037) were independent influencing factors for prognoses of AIS patients with large area core infarction after EVT. Conclusion:EVT can effectively improve the prognoses and reduce the complication rate of AIS patients with large area core infarction; patients with high ASPECT scores, low infarct core volume, and high collateral circulation grading get great benefits.

Recent advance in relation betweent intracranial artery calcification and ischemic stroke / 中华神经医学杂志

Vascular calcification is often observed in the angiographic examination of patients with cardiovascular and cerebrovascular diseases, especially in the elderly. There are many researches on the relation between intracranial artery calcification (ICA) and ischemic stroke (IS) in clinic, but the conclusions of these researches have not been unified yet. In this article, the researches on progression of relation between ICA and IS are used as a clue to review, and try to clarify the correlation between ICA and IS in the current researches, so as to provide a new strategy for the treatment of IS in clinic.

Effect of arthroscopic augmention using suture-tape for Broström-Gould repair of anterior talofibular ligament injury / 中华骨科杂志

Objective@#To evaluate the short-term efficacy of Broström-Gould repair combined with Internal Brace artifi-cial ligament reinforcement under arthroscopy for anterior talofibular ligament injury in overweight and poor ligament quality popu-lation.@*Methods@#A total of 12 patients with anterior talofibular ligament injury treated by arthroscopy were enrolled from October 2017 to May 2018, involving 7 males and 5 females aged from 16 to 57 years old (mean 32.4 years). Patients were with ankle insta-bility, and their BMI was 28.0-30.7 kg/m2 (average, 28.8±0.91 kg/m2), among which there were 2 cases of poor ligament quality (Beighton score ≥4). The anterior tibiofibular ligament injury and the quality of the ligament stump were intraoperatively evaluated under arthroscopy. A 4.75 mm diameter anchor with Internal Brace artificial ligament was inserted into the fibula insertion site, and non-absorbable suture was placed at the talus under total arthroscopy. Firstly, the non-absorbable line on the anchor was per-formed under the standard Broström-Gould procedure to repair the anterior talofibular ligament, and the other end of the ligament was fixed near the distal end of the talus. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle ability measure (FAAM) was compared before and after surgery.@*Results@#All the incisions were healed in the first stage after operation, and no operative complications such as infection occurred. All the 12 patients were followed up for 7 to 12 months (average 9.1 months). After 2 weeks, the patient began functional exercise and could walk with ankle braces. At the latest follow-up, the anterior drawer test was negative. The ankle-posterior foot score of AOFAS was increased from 61.3±7.9 (preopera-tive) to 85.0±6.0 (latest follow-up) (t=21.422, P< 0.01), and the FAAM score was increased from 57.5±10.1 (preoperative) to 86.3±4.8 (latest follow-up) (t=15.032, P< 0.01). AOFAS score was excellent in 1 case and good in 11 cases. The excellent and good rate was 100% (12/12). No complications such as infection and re-rupture occurred after operation.@*Conclusion@#For anterior talofibu-lar ligament injury patients with overweight or poor quality of ligament, the Broström-Gould procedure can be applied to strengthen under arthroscopic Internal Brace ligament without additional tendon reconstruction, which can also obtain good results.

Viral spectrum of 36 outbreaks of influenza like-illness in Shandong province / 中华实验和临床病毒学杂志

Objective@#To understand the viral spectrum of influenza-like illness (ILI), Shandong province during 2013-2014.@*Methods@#The data of 36 ILI outbreaks were collected and analyzed. Multiple respiratory pathogens were detected with RT-PCR in pharynx swab specimens.@*Results@#Totally, 35 outbreaks occurred in winter and spring, and dispersed in 12 cities; 27 outbreaks happened in primary and secondary schools. Many of the outbreaks, 17 (47.2%), were caused by influenza virus type B (FluB), followed by FluA H1 and H3, 5 (13.8%) outbreaks, respectively. Mixed infection caused 7 outbreaks. Totally 437 samples were collected, with 235 (53.8%) positive specimens, in which FluB was mostly detected, 142 (32.5%). Except Flu, parainfluenza virus type 2 (PIV2) was the most frequently detected, followed by coronavirus (CoV). The constituent ratio of FluB under 15 years of age was the highest, such as CoV in 25-59 years old group and FluA H1 in others groups.@*Conclusions@#ILI outbreaks occurred mostly in primary and secondary schools. Virus was the main pathogen, with the dominant strains of FluB. However, the dominant strain in different age groups was different.

Expert consensus on rabies exposure prophylaxis / 中华预防医学杂志

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post-exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization′s position paper on rabies vaccine in 2018 and related research progress in recent.

Rescue stenting after failure of endovascular treatment for acute cerebral large artery occlusive infarction / 中华神经医学杂志

Objective To investigate the safety and efficacy of rescue stenting after failure of endovascular treatment for acute cerebral large artery occlusive infarction, and compare the differences of safety and efficacy between bridged treatment and direct endovascular treatment in acute cerebral large artery occlusive infarction. Methods The clinical data of 60 patients with acute cerebral large artery occlusive infarction who underwent rescue stenting after failure of endovascular treatment in our hospital form March 2015 to March 2018 were retrospectively analyzed; 26 patients underwent bridged treatment+rescue stenting (bridged treatment group), while 34 patients underwent direct endovascular treatment+rescue stenting (direct treatment group). The recanalization degree immediately after the treatment was evaluated by Modified Thrombolysis in Cerebral Infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was performed 24 h and 5-7 d after the treatment, and modified Rankin Scale (mRS) was applied 90 d after treatment to evaluate the neurological functions. In addition, incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage (SICH) and postoperative mortality within 90 d of treatment were calculated. Results (1) Among the 60 patients, 55 patients (91.7％) had revascularization (mTICI 2b-3) immediately after the rescue stenting. NIHSS scores before rescue stenting and NIHSS scores 24 h after rescue stenting (17.50 [15.00, 24.00) vs. 12.00 [8.25, 19.00]) showed statistically significant differences (P<0.05). Twenty-nine patients (48.3％) obtained satisfactory prognosis 90 d after rescue stenting (mRS scores≤2), 9 patients (15.0％) suffered SICH after rescue stenting, and 9 patients died (15.0％). (2) The immediate revascularization rate (92.3％ vs. 91.2％), NIHSS scores 24 h and 5-7 d after surgery (12.00 [7.75, 18.00] vs. 14.50 [10.00, 22.00] and 8.00 [3.00, 12.50] vs. 10.50 [6.75, 16.75]), good prognosis rate 90 d after treatment (57.7％ vs. 41.2％), postoperative SICH incidence (19.2％ vs. 11.8％), and mortality (11.5％ vs. 17.7％) in the bridged treatment group and direct treatment group were not significantly different (P>0.05). Conclusion Rescue stenting is safe and effective for patients with acute cerebral large artery occlusive infarction, no matter it is by bridged treatment or direct intravascular treatment; and the two methods show no significant differences in safety and efficacy

Effect of arthroscopic augmention using suture-tape for Brostr(o)m-Gould repair of anterior talofibular ligament injury / 中华骨科杂志

Objective To evaluate the short-term efficacy of Brostr(o)m-Gould repair combined with Internal Brace artificial ligament reinforcement under arthroscopy for anterior talofibular ligament injury in overweight and poor ligament quality population.Methods A total of 12 patients with anterior talofibular ligament injury treated by arthroscopy were enrolled from October 2017 to May 2018,involving 7 males and 5 females aged from 16 to 57 years old (mean 32.4 years).Patients were with ankle instability,and their BMI was 28.0-30.7 kg/m2 (average,28.8±0.91 kg/m2),among which there were 2 cases of poor ligament quality (Beighton score ≥-4).The anterior tibiofibular ligament injury and the quality of the ligament stump were intraoperatively evaluated under arthroscopy.A 4.75 mm diameter anchor with Internal Brace artificial ligament was inserted into the fibula insertion site,and non-absorbable suture was placed at the talus under total arthroscopy.Firstly,the non-absorbable line on the anchor was performed under the standard Brostr(o)m-Gould procedure to repair the anterior talofibular ligament,and the other end of the ligament was fixed near the distal end of the talus.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle ability measure (FAAM) was compared before and after surgery.Results All the incisions were healed in the first stage after operation,and no operative complications such as infection occurred.All the 12 patients were followed up for 7 to 12 months (average 9.1 months).After 2 weeks,the patient began functional exercise and could walk with ankle braces.At the latest follow-up,the anterior drawer test was negative.The ankle-posterior foot score of AOFAS was increased from 61.3±7.9 (preoperative) to 85.0±6.0 (latest follow-up) (t=21.422,P＜ 0.01),and the FAAM score was increased from 57.5±10.1 (preoperative) to 86.3± 4.8 (latest follow-up) (t=15.032,P＜ 0.01).AOFAS score was excellent in 1 case and good in 11 cases.The excellent and good rate was 100％ (12/12).No complications such as infection and re-rupture occurred after operation.Conclusion For anterior talofibular ligament injury patients with overweight or poor quality of ligament,the Brostr(o)m-Gould procedure can be applied to strengthen under arthroscopic Internal Brace ligament without additional tendon reconstruction,which can also obtain good results.

Diarrhea pathogens in rotavirus-negative infants in Hangzhou / 中华检验医学杂志

Objective To investigate the distribution of diarrhea pathogens in infants without rotavirus-detection in Hangzhou. Methods 605 stool samples of children with rotavirus-negative diarrhea were collected from Hangzhou First People's Hospital of Zhejiang University, Children's Hospital of Zhejiang University and Hangzhou Children's Hospital from March 2017 to June 2018. The routine test results were analyzed retrospectively and Bristol score was used for the characteristics of stool samples. DNA and/or RNA were extracted from fecal samples with DNA and RNA extraction kit. The extracted DNA and RNA-reversed cDNA were used as templates. 7 common pathogens DNA and/or RNA were amplified by polymerase chain reaction (PCR). The amplified products were detected by agarose gel electrophoresis. The positive rates of pathogens were analyzed by chi-square test. Results Among 605 children, 375 were male (28±11) months and 230 were female (29±10) months. Bristol score of stool samples was mainly in type 6 (496, 82％), followed by type 7 (85, 14％) and type 5 (24, 4％). Among 605 results 97 cases were occult blood positive (positive rate 16％) and 170 cases were white blood cell positive (positive rate 28％).452 of 605 stool samples were positive for pathogen target genes. The positive rate was 74.7％. 319 cases detected single pathogen gene fragments. 127 cases detected two pathogen genes and 6 cases detected three pathogen gene fragments. The positive rate of Clostridium difficile toxin B (48.9％, 296/605)was the highest than the others, followed by Salmonella (20.0％, 121/605) and Norovirus (10.9％, 66/605). The positive rate of Clostridium difficile toxin A was 1.0％ (6/605). The positive rates of pathogens in male and female children were 86.7％(325 / 375) and 86.5％ (199 / 230) respectively, with (χ2 =0.002, P=0.959). Conclusions Salmonella and Norovirus were the main pathogens in children with diarrhea who were negative for rotavirus detection in Hangzhou. The high positive rate of Clostridium difficile toxin B may be related to the colonization of Clostridium difficile in the gastrointestinal tract of infants rather than the pathogen of diarrhea because of the low positive rate of Clostridium difficile toxin A. There was no gender difference in the detection rate of diarrhea pathogens.

Comparison and evaluation of laboratory test techniques for severe fever with thrombocytopenia syndrome / 中华实验和临床病毒学杂志

Objective@#Compare the detection result of blood samples of severe fever with thrombocytopenia syndrome (SFTS) patients using different detection techniques, and observe the dynamic characteristics of the virus specific RNA, IgM antibody and IgG antibody, to provide theoretical basis for selection of diagnostic methods of disease.@*Methods@#Acute phase serum of suspected SFTS cases and convalescent serum samples of lab-confirmed cases were collected. Real-time fluorescence quantitative PCR and enzyme-linked immunosorbent assay (ELISA) were used to detect the virus specific RNA, IgM antibody and IgG antibody. The detection results of different methods, the relationship between positive results and the acquisition time, and the dynamic characteristics of viral nucleic acid and antibodies were analyzed.@*Results@#A total of 87 serum samples of the suspected SFTS patients were collected, the positive rate of virus specific RNA, IgM antibody and IgG antibody were 53.41%, 31.03% and 3.41%, respectively. Among 55 confirmed cases of SFTS, the consistent rate of virus specific RNA and IgM antibody detection methods was 36.36%, and the difference between the two methods was significant (χ2=6.82, P=0.009), kappa=-0.257. The sampling intervals of RNA positive samples were all within 12 days, of which the positive detection rate was highest after 7-9 days, and the difference was statistically significant (χ2=10.35, P=0.016). In 34 SFTS convalescent serum samples, all the nucleic acid tests were negative, the positive rate of IgM antibody was 41.18%, which was not significantly different from the acute phase serum samples (P=1.00). The positive rate of IgG antibody was 94.12%, which was significantly higher than that of acute IgG antibody (0%). The dynamic characteristics of IgM and IgG antibody showed that IgM antibody could be detected on the second day after onset, the latest detection time was 74 days after onset, and the highest absorbance value and antibody detection rate occurred in 30-60 days. The earliest detection time of IgG antibody was 12 days after onset, and the last detection time was 100 days.The detection rate of IgG antibody and absorbance value increased rapidly after 30 days, and maintained in a high level. The detection rate of IgG antibody was 100% in 30-60 days.@*Conclusions@#Blood samples taken from SFTS suspected patients within two weeks of onset may be prioritized for detection of viral nucleic acids using Real-time fluorescence PCR or for detection of IgM antibodies by ELISA. Although IgM antibody can be detected 2 days after the onset, the peak appeared much later, so the negative result can’t rule out the diagnosis. IgG antibody has a high seroconversion rate in convalescent samples, and can be used as an auxiliary tool for disease diagnosis.

Establishment and application of whole genome high-throughput sequencing of hepatitis B virus with different concentrations / 中华实验和临床病毒学杂志

Objective@#To establish a high-throughput sequencing method for a whole genome in different hepatitis B virus (HBV) concentrations.@*Methods@#Two method of amplicon-sequencing and direct sequencing without PCR amplification were used for library construction in the three plasmids, including the low HBV load sample, the moderate HBV load sample and the high HBV load sample. Whole genome sequencing was performed on Illumina MiSeq platform.@*Results@#There are significant differences in data yield between the two different library construction method. Only a few reads could be mapped to the HBV genome for direct sequencing. However, three samples were successfully amplified by the nested PCR amplification and amplicon-sequencing showed that all HBV samples had a good coverage and depth, which was not affected by HBV concentration. The alignment rate of HBV genome approached 80%. A total of 27 intra-host single nucleotide variations (iSNVs) were identified and 13 iSNVs were low-frequency mutation in three samples. Compared with the high HBV load sample, mutations in the reverse transcription (RT) region was more easily appeared in the low HBV sample and the moderate HBV load sample.@*Conclusions@#Integrating nested PCR with high-throughput sequencing to the HBV whole genome sequencing is not only a practical method to detect the infection of HBV with a high-sensitivity and accuracy, but also enables to detect the mutation in the infected patient with low HBV copy number.

Whole genome analysis of human H3N2 influenza virus outbreak in a poultry farm / 中华实验和临床病毒学杂志

Objective@#To understand the epidemiological characteristics of outbreaks and analyze the genetic characteristics of the whole genome of influenza H3N2 virus among avian-human-swine, and to elaborate the source of influenza virus.@*Methods@#The epidemic information was collected using the case investigation, the pharyngeal swab samples from influenza-like-illness cases were detected by real-time PCR and virus isolation. The phylogeny and molecular features of whole-genome were analyzed with EditSeq and MEGA 5.05 software.@*Results@#The prevalence rate of this outbreak was 34.88%, 15 samples of throat swabs were collected, the positive rate of nucleic acid detection was 73.33%, 5 strains of seasonal influenza A (H3N2) influenza viruses were isolated. The phylogenetic analysis showed the eight gene segments of the isolated influenza viruses belonged to the same cluster with 2015-2016 influenza vaccine strain A/Switzerland/9715293/2013(H3N2), and no recombination was found. Compared with vaccine strain, 14 variant amino acids of protein of HA were identified, and 8 of them were located in antigenic sites. All strains were sensitive to neuraminidase inhibitors while they showed resistance to blockers of M2 ion channel. The glycosylation sites analysis showed that two new glycosylation sites NRT151-153 and NAT245-247were added.@*Conclusions@#The outbreak was caused by seasonal influenza A (H3N2) virus which had an antigenic drift and no genetic avian-human-swine recombination was found.

Evaluation of clinical application of two molecular assays for detection of toxigenic Clostridium difficile / 中华检验医学杂志

Objective In comparison with Xpert C.difficile/Epi through detection of Clostridium difficile toxin genes from clinical stool , the performance of a laboratory-developed ( LD) assay was evaluated in detail.Methods A total of 176 stool specimens collected from patients with diarrhea in the First People′s Hospital of Yuhang District and the People′s Hospital of Yingzhou , Ningbo from August 1 to December 30 were detected by the two assays in parallel , and meanwhile the C.difficile strains will be isolated and identified for C.difficile toxin genes by a conventional PCR assay .The Cross-tabs Analysis was used for the results by using SPSS20.0 software.Results In comparison with the results of Xpert C.difficile/Epi as the standard, the LD assay had a sensitivity of 91.7％(22/24), a specificity of 100％(152/152), a positive predictive value (PPV) of 100％(22/22), and negative predictive value (NPV) 98.7％(152/154).The results of two assays were statistically coherent (Kappa=0.950, P<0.001).In comparison with culture and detection of toxin genes results , the LD assay had a sensitivity of 90.0％ ( 18/20 ) , a specificity of 97.0％(152/156), a PPV of 81.8％ (18/22), and NPV of 98.7％ (152/154)(Kappa=0.838, P<0.001), and the Xpert C.difficile/Epi assay had a sensitivity of 90.0％ (18/20), a specificity of 96.0％(150/156), a PPV of 75.0％(18/24), and NPV of 98.7％ (150/152)(Kappa=0.792, P<0.001). Conclusions The performance of the LD assay was similar to that of the Xpert C .difficile/Epi kit in detection of toxigenic C.difficile.The LD assay could be directly applied to detection of toxigenic C.difficile from clinical stool samples .The clinical application of this LD assay will also provide a domestic and promising diagnostic assay for diagnosis of C.difficile infection in China.

Simultaneous detection and characterization of toxigenic Clostridium difficile directly from clinical stool specimens / 医学前沿

We employed a multiplex polymerase chain reaction (PCR) coupled with capillary electrophoresis (mPCR-CE) targeting six Clostridium difficile genes, including tpi, tcdA, tcdB, cdtA, cdtB, and a deletion in tcdC for simultaneous detection and characterization of toxigenic C. difficile directly from fecal specimens. The mPCR-CE had a limit of detection of 10 colony-forming units per reaction with no cross-reactions with other related bacterial genes. Clinical validation was performed on 354 consecutively collected stool specimens from patients with suspected C. difficile infection and 45 isolates. The results were compared with a reference standard combined with BD MAX Cdiff, real-time cell analysis assay (RTCA), and mPCR-CE. The toxigenic C. difficile species were detected in 36 isolates and 45 stool specimens by the mPCR-CE, which provided a positive rate of 20.3% (81/399). The mPCR-CE had a specificity of 97.2% and a sensitivity of 96.0%, which was higher than RTCA (x = 5.67, P = 0.017) but lower than BD MAX Cdiff (P = 0.245). Among the 45 strains, 44 (97.8%) were determined as nonribotype 027 by the mPCR-CE, which was fully agreed with PCR ribotyping. Even though ribotypes 017 (n = 8, 17.8%), 001 (n = 6, 13.3%), and 012 (n = 7, 15.6%) were predominant in this region, ribotype 027 was an important genotype monitored routinely. The mPCR-CE provided an alternative diagnosis tool for the simultaneous detection of toxigenic C. difficile in stool and potentially differentiated between RT027 and non-RT027.

Evaluation of a real-time PCR assay for the qualitative detection of Clostridium difficile toxin gene and its clinical application / 中华检验医学杂志

Objective In comparison of the performances for the detection of Clostridium difficile toxin B genes from stool between BD MAX Cdiff assay and a laboratory-developed (LD) assay.The LD assay was evaluated in clinical application.Methods This study was a clinical application research.A total of 147 stool specimens from patients with diarrhea in Hangzhou First Hospital affiliated with Zhejiang Chinese Medical University were detected by the two assays from 1 July to 30 September 2014.DNA extraction and amplification of the tcdB gene were performed automatically on the BD MAX platform.Meanwhile, the tcdA and tcdB gene were detected by the LD real-time PCR assay after DNA extraction.Then, the results were analyzed by use of SPSS 10.0.Results A total of 147 stool samples were collected.There were 33 C.difficile positive cases and 114 negative cases detected by both of two assays.However, there were four stool samples had incongruent results.In comparison with BD MAX, the LD assay had a sensitivity of 93.94% (31/33), a specificity of 98.25% (112/114), a positive predictive value of 93.94% (31/33), and negative predictive value 98.25% (112/114).Furthermore, the results of the LD assay were statistically coherent with that of the BD assay (Kappa=0.922, P<0.01).Conclusions The LD assay was highly sensitive and accurate as BD MAX Cdiff assay in the detection of toxigenic Clostridium difficile.Furthermore, this LD assay could be also applied to detection of clinical stool samples directly with low cost.The assay will be more promising in diagnosis of toxigenic C.difficile in clinical application in China due to no additional instrument needed.

Clinical stages and outcomes of severe cases on hand, foot and mouth disease / 中华流行病学杂志

Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.

Clinical stages and outcomes of severe cases on hand, foot and mouth disease / 中华流行病学杂志

Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.

Epidemiological characteristics of natural focus and vector borne infectious diseases in Zibo City Shandong Province between 2004 and 2015 / 中华地方病学杂志

Objective To analyze the incidence trends and epidemiological characteristics of natural focus and vector borne infectious diseases in Zibo City between 2004 and 2015,and to provide evidence for control and prevention of the diseases.Method Surveillance data of natural focus and vector borne infectious diseases in Zibo City between 2004 and 2015 from the National Disease Reporting Information System were analyzed via descriptive epidemiological methods.Results A total of 10 natural foci and vector borne infectious diseases and 3 287 cases including 55 death cases were reported in Zibo City from 2004 to 2015.The average annual incidence was 6.24/100 000 and the case fatality rate was 1.67％ (55/3 287).The incidence rate increased in recent years after the lowest rate in 2009 (2.83/100 000),and the rate in 2015 was 8.83/100 000.The top three diseases with higher incidence were hemorrhagic fever with renal syndrome (3.44/100 000),brucellosis (1.48/100 000) and tsutsugamushi fever (0.53/100 000).The top three high-prevalence areas with higher incidence were Yiyuan County (13.22/100 000),Zichuan District (9.73/100 000) and Boshan District (6.13/100 000).The cases mainly occurred from March to May and September,October,which accounting for 27.47％ (903/3 287) and 24.64％ (810/3 287),respectively of the total.The 40-59 year-oldage group was the highest,accounting for 48.13％ (1 582/3 287)of the total.And 75.48％ (2 481/3 287) of reported cases were farmers.Conclusions The overall incidence of the natural focus and vector borne infectious diseases in Zibo City has a annual increasing trend in recent years,while the incidence of brucellosis and tsutsugamushi fever have continued to rise since 2004.These diseases have showed a significant seasonal distribution and population distribution.It is necessary to conduct targeted prevention and control strategies.