[Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates II-The personalized analysis of partial pressure of oxygen and carbon dioxide difference between umbilical artery and vein at same time in same newborn].

Objective: In order to explore the mechanism of neonatal spontaneous breathing, the difference of oxygen and carbon dioxide between umbilical cord arteries and veins before the start of spontaneous breathing after birth has been analyzed among people. In this part, the related information is analyzed individually. Methods: After all fetal parents signed the informed consent before birth, and before the newborn was born and did not breathe, the umbilical cord was exposed as quickly as possible, and the heparinized arterial indwelling needle was inserted into the umbilical artery and umbilical vein in the direction of newborn and placenta, and then blood was taken continuously. Although dozens of mothers were selected,but only 3 cases were collected from Pua and Puv blood samplers at the same time for blood gas analysis and determination, and the differences and dynamic changes of umbilical vein and umbilical artery were calculated and analyzed. Results: In all 3 none spontaneous breathing newborns,PuvO2 was significantly higher than PuaO2 at the same time (P<0.01), with an average difference of (24.17±7.09) mmHg; while PuvCO2 was significantly lower than PuaCO2 (all P<0.01), with an average difference of (-7.67±3.70) mmHg.The difference of Puv-uaO2 was significantly higher than those of Puv-uaCO2 (P<0.05). Conclusion: PuaO2 decreases gradually with time (heartbeat frequency) before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

[The effectiveness of different respiration models to the amplitude of waveform information in arterial blood gas].

Objective: The objective is to find the characteristics of arterial blood sample waveform in different respiration models. Methods: Six post-operative patients with normal heart function and negative Allen test, were 4 male and 2 female, (59.00±16.64)year, (71.67±0.37)kg, left ventricular ejection fraction(LVEF) (61.33±2.16)%, had been placed the arterial catheterization and central venous catheterization for continuous collecting arterial in 3 different kinds of respiration models: normal breathing, no breathing and deep breathing. We selected two breaths cycles of waveform from each patient for data calculations of magnitudes and time interval. Compare the adjacent highest and lowest values of patients to verify whether there are periodic wave-like signal changes in arterial and venous blood gas in the three breathing states. In addition, statistical t-test analysis was performed on the change amplitude of the periodic wave-like signal of the patient's arterial and venous blood gas to compare whether there is a difference. Results: The heart beat numbers for drawing blood into pipe were 15-16, and all covered more than 2 breathing cycles. There were significant changes of arterial PaO2 (i.e. the highest high values compare to the next lowest values, P<0.05) in three different breathing models(normal, no breathing and high breathing), the magnitudes of which were (9.96±5.18)mmHg, (5.33±1.55)mmHg and (13.13±7.55)mmHg, with (8.09±2.43)%, (5.29±2.19)% and (10.40±2.68)% from their mean respectively. PO2 in venous blood gas did not show wavy changes under normal breathing, 20 s breath holding and high tidal volume ventilation. The amplitudes were (1.63 ± 0.41) mmHg, (1.13 ± 0.41) mmHg and (1.31 ± 0.67) mmHg, which were (3.91 ± 1.22)%, (2.92 ± 1.12)%, (3.33 ± 1.81)%, respectively, which were significantly lower than that of arterial blood gas under the same state, but there was no significant difference between groups. Conclusion: With continuous beat-by-beat arterial blood sampling and ABG analyzing method in three different breathing models, We obtain a clear evidence of the biggest periodic parameters ABG waveform in high breathing models, which followed by normal breathing models, no breathing was the smallest, and the wave variation amplitude of venous oxygen partial pressure was not obvious in the three respiratory states, which implies the oscillatory information of the arterial blood with comes from the gas exchanging in the lung.

[Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates I-The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns].

Objective: The fetus has no actual respiration, and the newborn begins to breathe after birth. We assume that the first breath dominantly generated by hypoxia. In this study, the changes and lowest limit of blood oxygen partial pressureof umbilical artery (PuaO2) after chemoreceptor were analyzed to explore the mechanism of neonatal spontaneous breathing. Methods: With signed consent form by all fetal parents before birth, 14 newborns successfully completed the umbilical artery or vein catheterization and drawn blood according to the heartbeat. All blood samples analyzed by blood gas analyzer,calculated and analyzed the similarities and differences between umbilical vein(Puv) and umbilical artery(Pua). Results: Although we completed 14 newborns, there were only 9 cases of umbilical artery samples and 8 cases of umbilical vein samples were collected. Only 3 cases collected both Pua and Puv blood samples at the same time (see serial paper II). PuaO2 in gradually decreased with time (heartbeat frequency), until Pua contracted after spontaneous breathing produced about 8~10 heartbeats, and then could not get enough blood samples. Only 3 newborns were able to take blood samples after spontaneous breathing for 8~10 heartbeats, and their PuaO2 were jumped to 186.0, 137.0 and 93.8 mmHg respectively. The mean value of PuaO2 was (25.94±6.79, 18.04~37.51)mmHg, the highest value was (29.11±6.46, 23.00~45.90)mmHg, and the lowest value was (21.34±5.54, 14.00~33.60)mmHg. Although PuvO2 decreased gradually with time (heartbeat) too, most of them also showed the tendency of alternately rising and falling with the regularity of mother's respiration. The mean value of PuvO2 was (53.35±21.35, 32.56~100.73)mmHg, the highest value was (90.38±48.44, 43.40~153.00)mmHg, and the lowest value was (36.96±14.90, 24.80~73.80)mmHg. Although there were large individual differences, the mean, highest and lowest values of PuvO2 were significantly higher than those of PuaO2 (P<0.05); although PuvCO2 slightly lower than PuaCO2, it was no significant difference (P>0.05). Conclusion: PuaO2 decreases gradually with time before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

[The experimental evidence of waveform information in arterial blood gas by beat-by-beat sampling method in human body-the differences of waveform information between arterial and venous blood samples].

Objective: The arterial blood with the oscillatory information comes from the right heart system after gas exchanging in the lung. However, the evidence of the waveform of venous ABG is lack. The objectives of this article are to compare the different information between arterial and venous beat-by-beat blood sample at the same time. Methods: Six post-operative patients with normal heart function and negative Allen test, had been placed the arterial catheterization and central venous catheterization directly connected to pre-heparin plasticpipes for continuous collecting arterial and venous blood. We twisted the 2 pipes into helix formation. After drawing arterial and venous blood with syringes in one heart beat with one helix at the same time, totally 15 heart beats, clipping the pipes with forceps, we put the helix pipe into icedwater at once and analyses PaO2, PaCO2, pH and SaO2 as soon as possible. We selected two breathscycles of waveform from each patient for data calculations of magnitudes and time interval. Results: The heart beat numbers for drawing blood into pipe were 15~16, and all covered more than 2 breathing cycles. There were significant changes of arterial PaO2(i.e. the highest high values compare to the next lowestvalues, P<0.05), but no significant changes in venous blood(P>0.05). The magnitudes of changing PaO2 in arterial and venous blood sample were (9.96±5.18)mmHg and (1.63±0.41)mmHg with significant variance(P=0.010), and they were (8.09±2.43)% and (3.91±1.22)%from their mean with significant variance(P=0.009) respectively. Conclusion: With continuous beat-by-beat arterial and venous blood sampling and ABG analyzing method at the same time, we obtain a clear evidence of periodic parameters ABG waveform, which following breathing cycle, but no clear ABG waveform of the periodic parameters in the venous blood samples, which implies the oscillatory information of the arterial blood with comes from the gas exchanging in the lung.

Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation.

STUDY QUESTION: Can avian influenza A (H7N9) virus be transmitted between unrelated individuals in a hospital setting? METHODS: An epidemiological investigation looked at two patients who shared a hospital ward in February 2015, in Quzhou, Zhejiang Province, China. Samples from the patients, close contacts, and local environments were examined by real time reverse transcriptase (rRT) polymerase chain reaction (PCR) and viral culture. Haemagglutination inhibition and microneutralisation assays were used to detect specific antibodies to the viruses. Primary outcomes were clinical data, infection source tracing, phylogenetic tree analysis, and serological results. STUDY ANSWER AND LIMITATIONS: A 49 year old man (index patient) became ill seven days after visiting a live poultry market. A 57 year old man (second patient), with a history of chronic obstructive pulmonary disease, developed influenza-like symptoms after sharing the same hospital ward as the index patient for five days. The second patient had not visited any poultry markets nor had any contact with poultry or birds within 15 days before the onset of illness. H7N9 virus was identified in the two patients, who both later died. Genome sequences of the virus isolated from both patients were nearly identical, and genetically similar to the virus isolated from the live poultry market. No specific antibodies were detected among 38 close contacts. Transmission between the patients remains unclear, owing to the lack of samples collected from their shared hospital ward. Although several environmental swabs were positive for H7N9 by rRT-PCR, no virus was cultured. Owing to delayed diagnosis and frequent hospital transfers, no serum samples were collected from the patients, and antibodies to H7N9 viruses could not be tested. WHAT THIS STUDY ADDS: Nosocomial H7N9 transmission might be possible between two unrelated individuals. Surveillance on patients with influenza-like illness in hospitals as well as chickens in live poultry markets should be enhanced to monitor transmissibility and pathogenicity of the virus. FUNDING, COMPETING INTERESTS, DATA SHARING: Funding support from the Program of International Science and Technology Cooperation of China (2013DFA30800), Basic Work on Special Program for Science and Technology Research (2013FY114600), National Natural Science Foundation of China (81402730), Special Program for Prevention and Control of Infectious Diseases in China (2013ZX10004218), US National Institutes of Health (1R01-AI108993), Zhejiang Province Major Science and Technology Program (2014C03039), and Quzhou Science and Technology Program (20111084). The authors declare no other interests and have no additional data.

Epidemiological features and risk factors associated with the spatial and temporal distribution of human brucellosis in China.

BACKGROUND: Human brucellosis incidence in China has been increasing dramatically since 1999. However, epidemiological features and potential factors underlying the re-emergence of the disease remain less understood. METHODS: Data on human and animal brucellosis cases at the county scale were collected for the year 2004 to 2010. Also collected were environmental and socioeconomic variables. Epidemiological features including spatial and temporal patterns of the disease were characterized, and the potential factors related to the spatial heterogeneity and the temporal trend of were analysed using Poisson regression analysis, Granger causality analysis, and autoregressive distributed lag (ADL) models, respectively. RESULTS: The epidemic showed a significantly higher spatial correlation with the number of sheep and goats than swine and cattle. The disease was most prevalent in grassland areas with elevation between 800-1,600 meters. The ADL models revealed that local epidemics were correlated with comparatively lower temperatures and less sunshine in winter and spring, with a 1-7 month lag before the epidemic peak in May. CONCLUSIONS: Our findings indicate that human brucellosis tended to occur most commonly in grasslands at moderate elevation where sheep and goats were the predominant livestock, and in years with cooler winter and spring or less sunshine.

Mapping spread and risk of avian influenza A (H7N9) in China.

The outbreak of human infections with an emerging avian influenza A (H7N9) virus occurred in China in early 2013. It remains unknown what and how the underlying risk factors were involved in the bird-to-human cross-species transmission. To illustrate the dynamics of viral spread, we created a thematic map displaying the distribution of affected counties and plotted epidemic curves for the three most affected provinces and the whole country. We then collected data of agro-ecological, environmental and meteorological factors at the county level, and used boosted regression tree (BRT) models to examine the relative contribution of each factor and map the probability of occurrence of human H7N9 infection. We found that live poultry markets, human population density, irrigated croplands, built-up land, relative humidity and temperature significantly contributed to the occurrence of human infection with H7N9 virus. The discriminatory ability of the model was up to 97.4%. A map showing the areas with high risk for human H7N9 infection was created based on the model. These findings could be used to inform targeted surveillance and control efforts in both human and animal populations to reduce the risk of future human infections.

Decision support system for the response to infectious disease emergencies based on WebGIS and mobile services in China.

BACKGROUND: For years, emerging infectious diseases have appeared worldwide and threatened the health of people. The emergence and spread of an infectious-disease outbreak are usually unforeseen, and have the features of suddenness and uncertainty. Timely understanding of basic information in the field, and the collection and analysis of epidemiological information, is helpful in making rapid decisions and responding to an infectious-disease emergency. Therefore, it is necessary to have an unobstructed channel and convenient tool for the collection and analysis of epidemiologic information in the field. METHODOLOGY/PRINCIPAL FINDINGS: Baseline information for each county in mainland China was collected and a database was established by geo-coding information on a digital map of county boundaries throughout the country. Google Maps was used to display geographic information and to conduct calculations related to maps, and the 3G wireless network was used to transmit information collected in the field to the server. This study established a decision support system for the response to infectious-disease emergencies based on WebGIS and mobile services (DSSRIDE). The DSSRIDE provides functions including data collection, communication and analyses in real time, epidemiological detection, the provision of customized epidemiological questionnaires and guides for handling infectious disease emergencies, and the querying of professional knowledge in the field. These functions of the DSSRIDE could be helpful for epidemiological investigations in the field and the handling of infectious-disease emergencies. CONCLUSIONS/SIGNIFICANCE: The DSSRIDE provides a geographic information platform based on the Google Maps application programming interface to display information of infectious disease emergencies, and transfers information between workers in the field and decision makers through wireless transmission based on personal computers, mobile phones and personal digital assistants. After a 2-year practice and application in infectious disease emergencies, the DSSRIDE is becoming a useful platform and is a useful tool for investigations in the field carried out by response sections and individuals. The system is suitable for use in developing countries and low-income districts.