Application of PDCA cycle in quality improvement of neonatal resuscitation / 中国新生儿科杂志

Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.

Clinical observation on osimertinib combined with bevacizumab in treatment of advanced non-small cell lung cancer with epidermal growth factor receptor T790M positive / 肿瘤研究与临床

Objective:To explore the clinical effect of osimertinib combined with bevacizumab in treatment of advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) T790M positive.Methods:A prospective study was conducted on 83 EGFR T790M-positive advanced NSCLC patients who were admitted to Anhui Chest Hospital from April 2018 to December 2020. The patients were randomly divided into the observation group and the control group using random number table method. Among them, 41 cases in the control group were treated with osimertinib, while 42 cases in the observation group were treated with osimertinib combined with bevacizumab. The clinical efficacy, tumor markers [carcinoembryonic antigen (CEA), serum neuron specific enolase (NSE)] levels, tumor vascular associated protein factor (S100β protein) level and adverse reactions between the two groups after 3 months of treatment were compared. Kaplan-Meier method was used to draw survival curves, and the 1-year survival status of patients in the two groups was compared.Results:The disease control rate in the observation group was 69.05% (29/42), which was higher than that in the control group [43.90% (18/41)] ( χ2 = 5.34, P = 0.021), but there was no statistical difference in the objective response rate between the two groups [33.33% (14/42) vs. 21.95% (9/41)] ( χ2 = 1.34, P = 0.247). After treatment, the serum levels of CEA [(19.9±3.6) μg/ml vs. (79.3±7.9) μg/ml, (27.8±4.8) μg/ml vs. (78.6±8.1) μg/ml] and NSE [(18.9±3.2) ng/ml vs. (27.2±5.0) ng/ml, (22.0±3.3) ng/ml vs. (26.1±4.8) ng/ml] in the observation group and control group were lower than those before treatment (all P < 0.05). There was no statistical difference in CEA and NSE levels between the two groups before treatment (both P > 0.05), and after treatment, the observation group was lower than the control group (both P < 0.001). The serum S100β levels of patients in the observation and control groups after treatment were all higher than those before treatment [(50±5) μg/ml vs.(44±5) μg/ml, (55±4) μg/ml vs. (45±6) μg/ml, both P = 0.001), and the difference in S100β level between the two groups before treatment was not statistically significant ( P > 0.05), and after treatment, the observation group was lower than the control group ( P < 0.001). Both groups of patients did not experience acute severe adverse reactions during the medication period. There were no statistical differences between the observation group and the control group in the incidence rates of nausea and vomiting [9.52% (4/42) vs. 7.32% (3/41)], constipation and diarrhea [4.76% (2/42) vs. 4.88% (2/41)], thrombocytopenia [9.52% (4/42) vs. 4.88% (2/41)], and liver function damage [7.14% (3/42) vs. 2.44% (1/41)] (all P > 0.05). The 1-year overall survival rate of the observation group was higher than that of the control group [68.3% (95% CI 47.9%-86.1%) vs. 41.0% (95% CI 22.4%-65.3%)], and the overall survival of the observation group was better than that of the control group ( χ2 = 2.60, P = 0.037). Conclusions:The combination of osimertinib and bevacizumab in treatment of EGFR T790M-positive advanced NSCLC can effectively regulate the levels of tumor related factors, with good efficacy and safety.

Whole-genome characterization and traceability analysis of the first COVID-19 outbreak caused by Omicron variant in Henan Province / 中华微生物学和免疫学杂志

Objective:To analyze the whole genome of Omicron variants causing the first local Omicron outbreak in Henan Province and to investigate the mutations in the SARS-CoV-2 genome for source tracing.Methods:Respiratory tract samples from COVID-19 cases in the Omicron outbreak in Henan Province from January 7 to 29, 2022 were subjected to whole-genome sequencing and sequence alignment analysis. Whole-genome identity, variations and evolution of the Omicron variants were analyzed.Results:Through high-throughput sequencing, the whole-genome sequences of SARS-CoV-2 were obtained from 120 cases, which accounted for 25.64% (120/468) of all COVID-19 cases in Anyang during the same period. Compared with the genome of Wuhan reference strain (NC_045512.2), there were 57-59 nucleotide mutation sites in the 120 whole genome sequences, and one or two nucleotide mutation sites were added to the shared 57 nucleotide sites. All of the 120 strains were VOC/Omicron (BA.1.1) variants and shared high homology. The whole-genome sequence obtained from the first case A contained 57 nucleotide mutation sites, while apart from the 57 identical nucleotide mutation sites, one specific mutation site (C1594T) was found in the whole-genome sequence obtained from the first case B, suggesting that the two cases were in the same transmission chain. After comparing with the database of domestic and imported cases by the Chinese Center for Disease Control and Prevention and the Henan Provincial Center for Disease Control and Prevention, it was found that the current outbreak was linked with the same transmission chain as the existing local epidemics in other provinces. Moreover, epidemiological investigation showed that on January 2, case A had come into contact with her cousin and his family who returned from an affected area outside the province.Conclusions:Based on the gene sequencing results and epidemiological investigation, the COVID-19 outbreak in Anyang city, Henan Province was a local epidemic and the source of it was a college student who returned to Anyang city from other province on December 28, 2021. These infections were linked to the same transmission chain as the existing local infection in other provinces.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants / 浙江大学学报·医学版

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Phenotype analysis of 11 fetuses with 22q11.2 microduplication diagnosed prenatally / 中华全科医师杂志

Objective:To analyze the clinical phynotypes of fetuses with 22q11.2 microduplications.Method:Eleven fetuses were diagnosed with 22q11.2 microduplications among 2 969 cases who underwent prenatal chromosomal microarray analysis from January 2016 to February 2020. The phenotypes, indications for invasive prenatal diagnosis, genetic results, pregnancy outcomes and postnatal clinical presentation were analyzed.Results:There were 6 cases diagnosed with classic 3.0 Mb microduplication (DiGeorge and velocardiofacial syndromes, DGS/VCFS) in the 22q11.2, 1 case with 1.5 Mb proximal microduplication and 4 cases with distal small segment microduplication (E-H). Out of 11 fetuses with 22q11.2 microduplications,7 cases were inherited, 2 cases was de novo and data were not available for 2 cases. Vicular septal defect and anencephalu were diagnosed by ultrasonography in 2 cases,fetal growth restriction was diagnosed in 2 cases,no any abnormalities were found in remaining 7 cases. Seven cases(3 cases of classic 3.0 Mb microduplication, 1 case of proximal microduplication and 3 cases of distal small segment microduplication) were delivered at full-term;and pregnancy was terminated in 4 cases. Seven infants were followed up after birth, 4 infants were normal, 3 showed abnormal phenotypes.Conclusion:The clinical phenotypes after birth of fetuses with 22q11.2 microduplication are diverse. Prenatal genetic counseling is necessary,so that pregnant women and their families can fully understand the possible clinical phenotypes and make informed choices.

Application of ESA flipped classroom combined with SPOC teaching mode in practice teaching of rehabilitation medicine / 中华医学教育探索杂志

Objective:To explore the application of engage-study-activate (ESA) flipped classroom combined with small private online course (SPOC) teaching in the practice teaching of rehabilitation medicine.Methods:A total of 87 students who practiced in the department of rehabilitation medicine from January 2018 to October 2020 were divided into control group ( n=43) and observation group ( n=44). The control group used routine teaching, and the observation group used ESA flipped classroom combined with SPOC teaching. The individual assessment results and team assessment results of the two groups of interns were compared, and the evaluation of teaching effect and the recognition of interns were analyzed. SPSS 22 0 was performed for chi-square test and t test. Results:The scores of medical history collection, specialized physical examination, treatment methods, individual assessment, humanistic communication, participation and team assessment in the observation group were better than those in the control group ( P<0.05). There was no significant difference in auxiliary examination score, diagnosis score and teamwork score between the two groups ( P>0.05). The scores of learning efficiency, classroom interaction ability, autonomous learning ability, combination of theory and practice, mastery of basic knowledge, clinical innovative thinking ability and teamwork ability in the observation group were higher than those in the control group ( P<0.05). The recognition of teaching in the observation group was 97.73% (43/44), which was higher than 81.40% (35/43) in the control group. Conclusion:ESA flipped classroom combined with SPOC teaching can improve the individual assessment results and group assessment results of interns, improve the educational environment, and its teaching effect is better than conventional teaching methods, which can improve the recognition of interns, so it has important application value in medical teaching.

Analysis of the local dengue fever outbreak in the north of Henan Province in 2019 / 中华微生物学和免疫学杂志

Objective:To provide data support for the prevention and control of dengue fever in Henan Province by analyzing the molecular epidemiological and etiological characteristics of dengue fever outbreaks in Puyang in 2019.Methods:Blood samples were collected from all suspected cases of dengue fever. The antigen, antibody and nucleic acid of dengue virus (DENV) were detected. The E gene was amplified by viral nucleic acid extraction and sequenced. Phylogenetic tree was constructed to trace the source of infection. Results:A total of 61 local cases of dengue fever were reported, and no deaths were reported. Among them, 4 cases (72.13%) were positive for DENV NS1 antigen; 16(26.23%) cases were positive for specific IgM; 38(62.30%) cases were positive for specific IgG; 34 cases (54.10%) were positive for dengue nucleic acid testing. Ten dengue virus strains were isolated, all of which were dengue virus type 1(DENV-1). Sequence analysis of E gene suggested it belonged to the same clade as Henan201903 strain imported from Cambodia to Zhumadian, Henan in 2019, with the highest homology. Conclusions:The dengue fever epidemic in Henan Province was caused by DENV-1, which might be improted from Cambodia, Singapore, Myanmar and other Southeast Asian countries. Therefore, the surveillance of DENV in people returning from Southeast Asia should be strengthened.

Real-time RT-PCR for the detection of SARS-CoV-2 nucleic acid / 中华微生物学和免疫学杂志

Objective:To investigate the performance of real-time RT-PCR for the detection of SARS-CoV-2 nucleic acid in clinical diagnosis of COVID-19.Methods:Laboratory test data and basic case information of Henan COVID-19 cases were collected from the China′s Infectious Disease Information System as of March 5, 2020. All information was entered by local hospitals and Center for Disease Control and Prevention (CDC). Local hospitals or country CDC were responsible for sampling and municipal CDC was responsible for nucleic acid testing.Results:A total of 6 714 specimens were detected and the positive rate of SARS-CoV-2 nucleic acid was 23.82%. The specimens were collected from 1 200 confirmed cases, 2 178 suspected cases and 77 asymptomatic cases. The nucleic acid diagnosis rate of COVID-19 was 36.96% (1 277/3 455). In all cases, the positive rates of SARS-CoV-2 nucleic acid in nasal swabs, sputum samples and throat swabs were 19.38%, 28.59% and 23.53%, respectively (χ 2=15.896, P<0.01). The positive rate of SARS-CoV-2 nucleic acid in confirmed COVID-19 cases was 63.10%. The positive rates in nasal swabs, sputum samples and throat swabs were 50.80%, 58.71% and 65.21 (χ 2=18.612, P<0.01). The positive rates of SARS-CoV-2 nucleic acid were 43.51%, 23.98%, 22.82%, 12.17%, 14.46% and 13.21% in samples collected on the day of symptom onset and one week, two weeks, three weeks, four weeks, five weeks and above five weeks after the onset, respectively. The positive rates in confirmed cases were respectively 89.03%, 86.57%, 52.30%, 17.53%, 17.69% and 24.14% at those time points. Conclusions:Real-time RT-PCR is the most effective method for early pathogenic diagnosis of COVID-19. The highest detection rate of nucleic acid is achieved within one week after the onset of COVID-19, and the latest time for nucleic acid detection is 38 d after the onset.

A preterm infant born to a mother with severe influenza A / 中华围产医学杂志

We report a case of a 2 200 g premature male baby born through cesarean section under maternal endotracheal intubation mechanical ventilation combined with extracorporeal membrane oxygenation at 34 +1 gestational weeks, while his mother was infected with influenza A in late pregnancy. Due to neonatal pneumonia, neonatal respiratory distress syndrome, prematurity, and low birth weight, the neonate was transferred to the neonatal intensive care unit for body temperature maintenance, respiratory support, maintenance of perfusion and internal environment, and nutritional management. The infant was discharged 17 days after birth and was well at six-month-old follow-up. His mother was discharged at 20 days post-delivery.

Analysis of Monitoring Focus Drugs in an Obstetrics and Gynecology Hospital Based on ABC-VEN Matrix Analysis / 中国药房

OBJECTIVE：To investigate drug use in an obstetrics and gynecology hospital and confirm the types of drugs that need to be monitored so as to provide reference for rational drug use in clinic. METHODS： Activity based classification （ABC） analysis， Vital-Essential-Nonessential Medicine （VEN） analysis and ABC-VEN matrix analysis were used to statistically analyze the types of drugs in the inpatients and outpatients of this hosptial during Jan. 2016-Dec. 2017， and consumption sum in the hospital so as to determine the types of monitoring focus drugs. RESULTS： The drugs were divided into class A， B， and C by using ABC analysis， and the constitute ratio of them were 6.08％， 7.71％ and 86.21％； the constitute ratio of consumption sum were 70.97％， 19.07％ and 9.96％， respectively. The drugs were divided into class V， E and N， and the constitute ratio of them were 36.51％， 43.61％ and 19.88％； constituent ratios of their consumption sum were 31.89％， 33.89％ and 34.22％， respectively. The drugs were divided into group Ⅰ （class AV， AE， AN， BV， CV）， group Ⅱ （class BE， CE， BN） and group Ⅲ （class CN） by using ABC-VEN matrix analysis； the constitute ratios of accumulative number of drug type were 40.56％， 44.43％ and 15.01％，while those of accumulative consumption sum were 77.29％， 20.52％ and 2.19％， respectively. Among class N， the constituent ratio of consumption sum of class AN as Chinese patent medicine， blood substitutes and perfusion solutions were higher， being 12.48％ and 7.92％； that of class BN as Chinese patent medicine was higher， being 3.21％； those of class CN as Chinese patent medicine， sex hormones and modulators of the genital system were higher， being 1.14％， 0.50％. CONCLUSIONS： In the Obstetrics and Gynecology Hospital， consumption sum of class A is the main part of the total consumption sum of drugs， and they should be seleted according to therapeutic efficacy. Active regulatory policies should be adopted for class V and E so that more drug types that possess cost- effectiveness advantages； for class N， management control and reasonable utilization should be monitored closely to reduce irrational drug use. Some Chinese patent medicines， blood substitutes and perfusion solutions among class AN should be monitored and controlled emphatically.

Effect of urokinase thrombolytic therapy for optic artery and retinal artery occlusion caused by facial microinjection with hyaluronic acid and spontaneous retinal artery occlusion / 中华眼底病杂志

Objective@#To compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.@*Methods@#From January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using ttest.@*Results@#At 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients.@*Conclusions@#Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.

Review on the etiology and complications of hand, foot and mouth disease, using data from the national sentinel surveillance program, in China, 2015-2016 / 中华流行病学杂志

Objective@#To understand the characteristics relating to the etiology and complications of hand, foot and mouth disease (HFMD) based on data from the pilot National Sentinel Surveillance (NSS) program so as to explore the feasibility, advantages and disadvantages of the NSS.@*Methods@#Data were extracted from the NSS system, conducted in 11 provinces of China from November 2015 to October 2016. Characteristics regarding the etiology, complications of HFMD and factors related to the positive rates of HFMD specimens were analyzed under the logistic regression method by SPSS 20.0 software.@*Results@#A total of 4 783 specimens were collected, including 3 390 from mild, 1 390 from severe and 3 from death cases. The overall positive rate was 81.43% (3 895/4 783). Other enteroviruses (non EV71/Cox A16 enteroviruses) appeared the major serotype (52.68%, 1 482/2 813) for mild infection of the disease while EV71 was for the severe cases (65.31%, 706/1 081). The serotype spectrum revealed by the pilot NSS was almost identical with the existing surveillance system. Other enteroviruses tended to infect younger children (χ2=130.17, P<0.001) than EV71 and Cox A16, in China. The multivariate logistic regression results showed that higher positive rate was associated with specimens which were collected from males, at children’ hospitals, in peak seasons, timely and in stools. The positive rates presented downwarding trends with the extension of the onset-sampling interval (χ2=14.47, P<0.001 in stool specimen; χ2=31.99, P<0.001 in throat swab; χ2=24.26, P<0.001 in anal swab). Aseptic meningitis, non-brainstem encephalitis and brainstem encephalitis appeared the top three complications of both EV71-associated and other enteroviruses-associated severe HFMD cases.@*Conclusions@#Factors as gender, season/place/timeliness of specimen collection, and types of hospital all appeared independently influenced the positive rates. NSS seemed feasible to be used as an alternative or supplement tool to the existing surveillance program in China.

Cellular and molecular genetic analysis of sex chromosome chimerism and dicentric isochromosome structural abnormalities: a report of two cases / 中华围产医学杂志

Objective@#To investigate the value of karyotype analysis, bacterial artificial chromosomes-on-beads (BoBs), chromosome microarray analysis (CMA) and fluorescence in situ hybridization (FISH) in the diagnosis of sex chromosome numerical and structural abnormalities.@*Methods@#Conventional G-banding staining technique was used to analyze the karyotypes of amniotic fluid cells and parental peripheral blood cells in two pregnancies with prenatal diagnosis indications. Sex chromosome numerical and structural abnormalities were analyzed based on the results of G-banding, BoBs, CMA and FISH.@*Results@#The results of G-banding karyotype analysis showed that there were mosaics in amniotic fluid cells collected from both cases. Karyotype of Case A was 45,X[25]/46,X,idic(Y)(q11.2?)[6], and Case B was 45,X[39]/46,X,psu idic(X)(q21.32?)[44]. Parental peripheral blood karyotypes of both families were normal. Prenatal BoBs indicated copy number abnormalities in sex chromosomes (Y chromosome in Case A and X chromosome in Case B). CMA results suggested a 20.1 Mb duplication in Yp11.32q11.222, and a 7.7 Mb deletion in Yq11.222q11.23 in fetus A with possible karyotype of 46,X,idic(Y)(q11.222); for fetus B, a 92.0 Mb duplication in Xp22.33q21.32, and a 63.0 Mb deletion in Xq21.32q28 were detected, and the karyotype might be 46,X,psu idic(X)(q21.32). The mid-term FISH test of amniotic fluid cells showed that 90% of the amniotic cells from Case A were 45,X, and 10% were 46,X,idic(Y)(q11.2); about 38% were 45,X, and 62% were 46,X,psu dic(X)(q21.3) from Case B.@*Conclusions@#Numerical and structural abnormalities of sex chromosomes could be accurately diagnosed by combination of several methods including G-banding karyotype analysis, prenatal BoBs, CMA and FISH, which would help to effectively reduce birth defects.

Etiological characteristics and molecular typing of Yersinia enterocolitica in Henan province / 中华微生物学和免疫学杂志

Objective To investigate the distribution and etiological characteristics of Yersinia en-terocolitica in Henan province between 2011 and 2017 and to analyze the homology among pathogenic strains. Methods A total of 12728 samples, including stool specimens from patients with diarrhea and domestic animals, flies, and smear specimens from raw and cooked meat products, were collected. Cold enrichment method was used to isolate Yersinia enterocolitica. The isolated strains were analyzed by biochemical identifi-cation, biotyping, serotyping and virulence gene detection with PCR. Pulsed-field gel electrophoresis ( PFGE) was performed for molecular typing of pathogenic strains. Results There were 390 strains of Yersinia enterocolitica isolated from the 12728 specimens with a detection rate of 3. 06％, including 13 hu-man strains and 377 animal strains. Most of the strains were isolated from pig and chicken feces and both ac-counted for 25. 13％ (98/390). The predominant biotype was 1A and the serotypes of the strains were main-ly O : 5 and O : 8. Results of the virulence gene analysis showed that 21 strains of O : 3 serotype were path-ogenic, including one human strain and 20 pig strains. After NotⅠdigestion, these pathogenic strains were divided into three band types with a band similarity of 94％-100％. Conclusions Yersinia enterocolitica ex-isted in both human population and many kinds of animals in Henan province. Pig was the main host of path-ogenic strains and there was a high homology among these strains.

The value of multimodal MRI in differential diagnosis of pure fibroadenosis and mixed fibroadenosis in the breast / 中华放射学杂志

Objective To explore the value of multi-modal MRI in the differential diagnosis of pure fibroadenosis and mixed fibroadenosis in the breast. Methods Forty female patients who underwent 3.0 T MRI within 1 week before sugery and confirmed as breast fibroadenosis by pathology in the General Hospital of the PLA Rocket Force from January 2014 to May 2016 were retrospectively analyzed in this study. There were 20 cases of pure fibroadenosis which including mass type and non-tumor type, 10 cases per type. Twenty cases of mixed fibrous adenosis which including 4 cases of mass type and 16 cases of non-mass type. According to the breast imaging reporting and data system-MRI standard, conventional MRI features, time intensity curve (TIC) types and ADC values of the lesions were observed. MRI features and ages of pure fibroadenosis and mixed fibroadenosis were compared using χ2 test (qualitative data) and independent sample t test (quantitative data), P<0.05 was considered statistically significant. Statistically significant parameters were then used to perform logistic regression analysis to evaluate predictive value . The efficacy of each MRI parameter in the differential diagnosis of pure fibroadenosis and mixed fibroadenosis was analyzed by ROC. Results Statistically significant differencein the size(P<0.05) but no differences in the shape, T2WI manifestation, marginal, internal enhancement, early enhancement curve, and late enhancement (P>0.05) were observed between pure fibroadenosis and mixed fibroadenosis. There was no significant differences in distribution, internal enhancement, early enhancement curve and late enhancement curve between non-tumor type pure fibroadenosis and mixed fibroadenosis (P>0.05). There were significant differences in age, ADC value and peak signal intensity(P<0.05) while no significant differences in early enhancement rate, maximum enhancement rate and peak time (P>0.05) between patients with pure fibroadenosis and mixed fibroadenosis. Logistic regression analysis suggested that the peak signal intensity was closely related to age. It revealed a positive correlation between ADC value, peak signal intensity and the possibility of mixed fibroadenosis. The regression coefficient value, Wals value, and P value of the ADC value were 3.652, 4.363 and 0.034, respectively. The regression coefficient value, Wals value, and P value of the peak signal intensity were 0.005, 5.463 and 0.019, respectively. The area under ROC curve of ADC value, peak signal intensity, ADC value combined with peak signal intensity were 0.697, 0.701 and 0.786, respectively. Conclusions Significantly differences of peak signal intensity and ADC value were observed in mixed fibroadenosis compared with pure fibroadenosis. The combination of ADC value and peak signal intensity had the highest efficacy in predicting pure and mixed fibroadenosis.

Effect of urokinase thrombolytic therapy for optic artery and retinal artery occlusion caused by facial microinjection with hyaluronic acid and spontaneous retinal artery occlusion / 中华眼底病杂志

Objective To compare the clinical effects ofurokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.Methods From January 2014 to February 2018,22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group).Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT).Meanwhile,MRI examination was performed.There were significant differences in age and FT between the two groups (t=14.840,3.263;P=0.000,0.003).The differecens of logMAR visual acuity,onset time and A-Rct were not statistically significant between the two groups (t=0.461,0.107,1.101;P=0.647,0.915,0.277).All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy.Among the patients in the hyaluronic acid group and control group,there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery,6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery,and 10 patients of intravenous thrombolysis.FFA was reviewed 24 h after treatment,and A-Rct and FT were recorded.Visual acuity was reviewed 30 days after treatment.The occurrence of adverse reactions during and after treatment were observed.The changes of logMAR visual acuity,A-Rct and FT before and after treatment were compared between the two groups using ttest.Results At 24 h after treatment,the A-Rct and FT of the hyaluronic acid group were 21.05 ± 3.42 s and 5.05± 2.52 s,which were significantly shorter than before treatment (t=4.569,2.730;P=0.000,0.000);the A-Rct and FT in the control group were 19.55 ± 4.14 s and 2.55± 0.91 s,which were significantly shorter than before treatment (t=4.114,7.601;P=0.000,0.000).There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=l.311,P=0.197).The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382,P=0.000).There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330,0.510;P=0.743,0.613).At 30 days after treatment,the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62± 0.32 and 0.43± 0.17,which were significantly higher than those before treatment (t=2.289,5.169;P=0.029,0.000).The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872,P=0.008).The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239,P=0.025).No ocular or systemic adverse reactions occurred during or after treatment in all patients.Conclusions Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective,with shortening A-Rct,FT and improving visual acuity.However,the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronie acid is worse than that of spontaneous RAO.

Molecular epidemiological analysis of coxsackievirus A16 strains causing neurologic complications / 中华微生物学和免疫学杂志

Objective To analyze the VP1 sequences of coxsackievirus A16(CA16) causing neu-rologic complications. Methods Clinical samples and epidemiological information were collected from pa-tients with viral encephalitis. Coxsackievirus A16 in these samples were first detected with real time RT-PCR and then isolated. RT-PCR was performed to amplify VP1 sequences and the amplified products were se-quenced. DNAStar 5.0 and Mega 5 were used for sequence analysis. All data was analyzed with SPSS statis-tical software. Results Fifteen samples were collected from 12 patients with hand, foot and mouth disease (HFMD) complicated by neurologic complications. Eight patients had the symptoms of fever, skin rash, signs of meningeal irritation and neck rigidity. No typical cluster was associated with clinical features or the time of onset. Both pharyngeal/anal swab and serum samples were collected from three patients (patient′s number:01111,01169 and 01130). The two samples collected from both 01111 and 01130 patients shared 100% similarity in nucleotide and amino acid based on VP1 sequences,while those from 01169 patient dif-fered in only one base. The 15 CA16 isolates were highly similar in VP1 gene, sharing 94.5%-100% ho-mology in nucleotide sequences and 98.0%-100% homology in amino acid sequences. These 15 isolates showed 68.5%-70.5% identities in nucleotide sequences and 90.5%-91.9% identities in amino acid se-quences with the CA16 prototype strain G10. Phylogenetic analysis revealed that based upon VP1 sequences, all of the 15 CA16 isolates grouped into genotype B subtype 1b (B1b), which was further classified into three clusters. Conclusion All of the 15 CA16 isolates causing neurologic complications belonged to B1b sub-genotype. Understanding the molecular epidemiology of CA16 would be essential for controlling morbidi-ty rates of HFMD and vaccine research.

Standing at a table while training improves the upper limb function of hemiplegic stroke survivors / 中华物理医学与康复杂志

Objective To explore the effect of standing at a table while training on the upper limb function and muscle surface electromyography of hemiplegics.Methods Sixty hemiplegic persons were randomly divided into an experimental group and a control group,each of 30.The affected upper limbs of the experimental group were trained while standing at a table,while the control group was trained while sitting.Before the treatment,as well as after 2 and 4 weeks of treatment,both groups' motor functioning was evaluated using the Fugl-Mayer upper limb assessment (FMA),as well as muscle surface electromyography.Results Before the treatment there was no significant difference betweenthe two groups' average FMA scores.After 2 and 4 weeks of treatment it had increased significantly in the experimental group,but in the control group the increase was not significant until the fourth week.In terms of surface myography,significant differences were observed in the biceps femoris and gastrocnemius muscles of both groups after 2 weeks.Two weeks later there was further significant improvement in both groups except for the tibialis anterior muscles of the control group.The differences between the two groups were significant after two weeks in the electromyograms of the biceps femoris,gastrocnemius muscle and anterior tibialis.After four weeks the differences between the groups in all of the electromyograms were significant.Conclusion Compared with the traditional sitting position,standing at a table while training can effectively improve the muscle activity of the rectus abdominis and the spine so as to promote the recovery of movement in hemiplegic upper limbs.

Analysis of HTLV infection among voluntary blood donors in Wenzhou / 中国输血杂志

Objective To analysis the human T lymphotropic virus (HTLV) infection status in Wenzhou among voluntaty blood donors.Methods Selected 72 417 voluntary blood donors of Wenzhou from from March,1,2016,to November,30,2016,to screen HTLV-Ⅰ / Ⅱ antibody by ELISA method.The positive samples were reexamined two times,two test results of samples were determined positive by ELISA.HTLV positive samples was confiemed by Western Blotting (WB).Results Screened 23 cases of anti-HTLV positive by ELISA method,then confirmed 9 cases of HTLV positive by Western Blotting (WB).HTLV infection rate of Wenzhou blood donors was 0.01％ (9/72 417).Conclusions HTLV infection was found among volunteer blood donors in Wenzhou,but the HTLV infection rate of volunteer blood donors in Wenzhou is still at a relatively low level.

Human enterovirus infection status and clinical characteristics of 274 patients with viral encephalitis in Henan Province, 2011-2012 / 中华预防医学杂志

Objective@#To investigate human enterovirus (HEV) infection and clinical characteristics of viral encephalitis patients in Pingdingshan, Henan Province.@*Methods@#Cerebrospinal fluid specimens and epidemiological information were collected from 274 viral encephalitis patients in the departments of pediatrics and neurology in hospitals in Pingdingshan, Henan Province, from April 2011 to August 2012. Patients with bacterial infections were excluded from the study. Demographic information was collected by questionnaires and clinical information was mainly obtained from hospital examinations. Viral RNA was extracted using magnetic bead extraction. Real-time RT-PCR was then performed for HEV, CV-A16, and EV-A71 testing. SPSS statistical software was statistical analyses. Significant differences were determined using the chi-squared test (P<0.05).@*Results@#Among 274 cases of viral encephalitis, 180 cases (65.7%) were male and 94 cases were female (34.3%). The median age was 2.17 years. Approximately 61.3% (168) of patients were younger than 3 years of age. A total of 107 (39.1%), 2 (0.7%), and 42 (15.3%) cases were positive for HEV, CV-A16, and EV-A71, respectively. Eleven patients were younger than 6 months of age and one patient was co-infected with HEV and EV-A71. In the<3, 3-5, 6-15, and>15 years old age groups, HEV infections comprised 31.5% (53/168), 52.9% (18/34), 53.0% (35/66), and 16.7% (1/6) (χ2=13.10, P=0.003), respectively. The EV-A71 infection rates were 17.9% (30/168), 23.5% (8/34), 6.1% (4/66), and 0 (χ2=8.04, P=0.045), respectively. The other enterovirus (OEV) infection rates were 12.5% (21/168), 29.4% (10/34), 48.5% (32/66), and 16.7% (1/6) (χ2=35.19, P<0.001), respectively. The rate of vomiting in OEV and EV-A71 infected patients was 73% (44/60) and 26% (11/42), respectively, while the frequency of skin rash in OEV and EV-A71 infected patients was 32% (19/60) and 79% (33/42), respectively. Approximately 95% (99/104) of patients infected with HEV had a fever, and the breathing rhythm change rate was 19% (20/104), which was lower than that of patients without HEV infection (36.8% (60/163)) (χ2=9.35, P=0.002).@*Conclusion@#In Pingdingshan, HEV was a major causative agent of viral encephalitis and the rate of OEV infection was high, especially in children aged 3-15 years old. Fever was a common clinical symptom of patients infected with HEV. Patients infected with OEV primarily exhibited vomiting symptoms and EV-A71 infected patients showed skin rash.