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Objective:To construct of comprehensive quality of evaluation index system about palliative care in general hospitals, so as to provide reference for promoting the scientific and standardized development of palliative care.Methods:Based on the structure-process-outcome quality model, literature research and Delphi method were used to determine the quality of palliative care evalution index system and index weight for general hospitals.Results:A total of 12 experts were consulted for two rounds,the rates of questionnaire retrieve were 12/15 and 12/12 respectively. The authoritative coefficients were 0.909 and 0.879, the Kendall′s W values were 0.27, 0.32 and 0.26 respectively with good coordination degree ( χ2=6.50, 106.62, 494.64, all P<0.05). Finally, the quality of palliative care indicator system in general hospitals was constructed, which included 3 first-level indicators, 30 second-level indicators and 157 third-level indicators. Conclusions:The establishment process of the construction of quality of palliative care indicator system in general hospitals was scientific and reasonable, focusing on the development characteristics of palliative care and can make significant contributions to improve the quality of palliative care.
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Objective:To observe and analyze the clinical features, treatment methods and efficacy of patients with retinopathy associated with incontinentia pigmenti (IP).Methods:A retrospective case study. Twelve clinical confirmed IP patients (24 eyes) in Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2015 to December 2018 were included in this study. The best corrected visual acuity and intraocular pressure examination were performed in patients (>4 years old). All patients were examined on the anterior segment, vitreous body, and fundus under topical anesthesia or general anesthesia. Eight cases underwent genetic testing. Patients with active disease should be given anti-vascular endothelial growth factor (VEGF) drug treatment, retinal laser photocoagulation or vitrectomy, those without active disease should be observed. All patients were followed up for 1 to 3 months, with an average follow-up time of 18.7 months.Results:All patients were all female, with an average age of 6.3±9.8 years old at the first ophthalmology visit. According to the recommendations of the pediatrician, 3 cases were actively screened for ophthalmology (referrals), with an average age of 0.4±0.5 years (median age: 2 months). A total of 9 cases were not recommended for referrals (non-referrals), including 3 cases of ophthalmology who were diagnosed for the first time due to visual impairment, and 6 cases of undiagnosed IP before the ophthalmology visit, the average age of their first visit was 8.2±10.8 years (medium age: 3 years old). The age of the first visit for non-referred patients was larger than that of referrals, and the difference was statistically significant ( Z=-2.141, P=0.036). Among the 24 eyes of 12 cases, there were no obvious fundus abnormalities in 1 case or 2 eyes, 11 cases of IP-related retinopathy in 22 eyes (91.7%, 22/24), 8 cases of binocular asymmetry (66.7%, 8/12). There were active lesions on the fundus in 7 eyes (29.2%, 7/24). Patients underwent simple retinal laser photocoagulation and/or anti-VEGF drug therapy. During the follow-up, retinal neovascularization recurred in 1 eye. Among the 8 cases that underwent genetic testing, 3 cases (37.5%, 3/8) were deleted in exons 4-10 of the IKBKG gene. Conclusions:IP is more common in women. IP-associated retinopathy is noted with early-onset, asymmetrical retinopathy, which is identified with retinal neovascularization and vitreous proliferation. Early detection and timely treatment are essential.
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RationaleSeveral studies have estimated basic production number of novel coronavirus pneumonia (NCP). However, the time-varying transmission dynamics of NCP during the outbreak remain unclear. ObjectivesWe aimed to estimate the basic and time-varying transmission dynamics of NCP across China, and compared them with SARS. MethodsData on NCP cases by February 7, 2020 were collected from epidemiological investigations or official websites. Data on severe acute respiratory syndrome (SARS) cases in Guangdong Province, Beijing and Hong Kong during 2002-2003 were also obtained. We estimated the doubling time, basic reproduction number (R0) and time-varying reproduction number (Rt) of NCP and SARS. Measurements and main resultsAs of February 7, 2020, 34,598 NCP cases were identified in China, and daily confirmed cases decreased after February 4. The doubling time of NCP nationwide was 2.4 days which was shorter than that of SARS in Guangdong (14.3 days), Hong Kong (5.7 days) and Beijing (12.4 days). The R0 of NCP cases nationwide and in Wuhan were 4.5 and 4.4 respectively, which were higher than R0 of SARS in Guangdong (R0=2.3), Hongkong (R0=2.3), and Beijing (R0=2.6). The Rt for NCP continuously decreased especially after January 16 nationwide and in Wuhan. The R0 for secondary NCP cases in Guangdong was 0.6, and the Rt values were less than 1 during the epidemic. ConclusionsNCP may have a higher transmissibility than SARS, and the efforts of containing the outbreak are effective. However, the efforts are needed to persist in for reducing time-varying reproduction number below one. At a Glance CommentaryO_ST_ABSScientific Knowledge on the SubjectC_ST_ABSSince December 29, 2019, pneumonia infection with 2019-nCoV, now named as Novel Coronavirus Pneumonia (NCP), occurred in Wuhan, Hubei Province, China. The disease has rapidly spread from Wuhan to other areas. As a novel virus, the time-varying transmission dynamics of NCP remain unclear, and it is also important to compare it with SARS. What This Study Adds to the FieldWe compared the transmission dynamics of NCP with SARS, and found that NCP has a higher transmissibility than SARS. Time-varying production number indicates that rigorous control measures taken by governments are effective across China, and persistent efforts are needed to be taken for reducing instantaneous reproduction number below one.
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Objective:To observe the clinical characteristics of adult patients with ocular toxoplasmosis (OT).Methods:This study was a retrospective clinical trial. Among the 83 consecutive OT patients diagnosed in the Zhongshan Eye Center of Sun Yat-Sen University, 14 patients (16.9%, adult group) aged ≥18 years were included in the study from January 2017 to December 2019. A total of 14 OT patients (children group) aged less than 18 years who had consecutive visits from July to December 2019 were selected as controls. All patients underwent BCVA, slit lamp microscope, fundus color photography, and B-mode ultrasound examination. Eighteen cases underwent UBM examination, including 6 and 12 cases in the adult group and child group respectively; 23 cases underwent FFA examination, including 12 and 11 cases in the adult group and child group respectively. Snellen visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. We compared the two groups of patients' residence (urban or rural), history of contact with dogs and cats, main symptoms, reasons for treatment, course of disease, and clinical and imaging characteristics and so on. For measurement data conforming to normal distribution, t-test was performed for comparison between groups; for Skewness distribution measurement data, rank sum test was performed for comparison between groups. Results:Compared with the adult group and the child group, there was no significant difference in the canine-cat contact history ( Z=2.661, P=0.257) and the time from first diagnosis to diagnosis ( t=-0.186, P=0.351); compared with the children group and the adult group, the patient's living environment was mainly urban, and the course of disease was significantly shorter ( Z=-2.005), and the difference was statistically significant ( P=0.047). The logMAR BCVA of the adult group and the child group were 0.81±1.08 and 2.08±1.30, respectively, and the difference was statistically significant ( Z=-2.811, P=0.004); compared with the child group, the adult group had lighter vitreous opacities, but the difference was statistical significance ( Z=7.847, P=0.048). FFA examination revealed 20 cases of "fern-like" leakage of retinal capillaries. Among them, the adult group and child group were 10 (83.3%, 10/12) and 10 (90.9%, 10/11) cases respectively. Conclusions:Adult patients account for 16.9% of OT patients. Compared with children, adult patients mostly live in towns or cities, have a short course of disease, good vision at first diagnosis, and mild inflammation or hyperplasia of the vitreous cavity. FFA is helpful for the diagnosis of adult OT.
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Objective To assess the imported risk of COVID-19 in Guangdong province and its cities, and conduct early warning. Methods Data of reported COVID-19 cases and Baidu Migration Index of 21 cities in Guangdong province and other provinces of China as of February 25, 2020 were collected. The imported risk index of each city in Guangdong province were calculated, and then correlation analysis was performed between reported cases and the imported risk index to identify lag time. Finally, we classified the early warming levels of epidemic by imported risk index. Results A total of 1 347 confirmed cases were reported in Guangdong province, and 90.0% of the cases were clustered in the Pearl River Delta region. The average daily imported risk index of Guangdong was 44.03. Among the imported risk sources of each city, the highest risk of almost all cities came from Hubei province, except for Zhanjiang from Hainan province. In addition, the neighboring provinces of Guangdong province also had a greater impact. The correlation between the imported risk index with a lag of 4 days and the daily reported cases was the strongest (correlation coefficient: 0.73). The early warning base on cumulative 4-day risk of each city showed that Dongguan, Shenzhen, Zhongshan, Guangzhou, Foshan and Huizhou have high imported risks in the next 4 days, with imported risk indexes of 38.85, 21.59, 11.67, 11.25, 6.19 and 5.92, and the highest risk still comes from Hubei province. Conclusions Cities with a large number of migrants in Guangdong province have a higher risk of import. Hubei province and neighboring provinces in Guangdong province are the main source of the imported risk. Each city must strengthen the health management of migrants in high-risk provinces and reduce the imported risk of Guangdong province.
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Objective To analyze the clinical courses and outcomes of COVID-19 cases and the influencing factors in Guangdong province and provide basis for the formulation or adjustment of medical care and epidemic control strategy for COVID-19. Methods We collected demographic data, medical histories, clinical courses and outcomes of 1 350 COVID-19 patients reported in Guangdong as of 4 March 2020 via epidemiological investigation and process tracking. Disease severity and clinical course characteristics of the patients and influencing factors of severe illness were analyzed in our study. Results Among 1 350 cases of COVID-19 cases in Guangdong, 72 (5.3%) and 1049 (77.7%) were mild and ordinary cases, 164 (12.1%) were severe cases, 58 (4.3%) were critical cases and 7 (0.5%) were fatal. The median duration of illness were 23 days ( P 25 - P 75 : 18-31 days) and the median length of hospitalization were 20 days ( P 25 - P 75 : 15-27 days). For severe cases, the median time of showing severe manifestations was on the 12th day after onset ( P 25 - P 75 : 9th to 15th days), and the median time of severe manifestation lasted for 8 days P 25 - P 75 : 4-14 days). Among 1 066 discharged/fetal cases, 36.4% (36/99) and 1.0% (1/99) of the mild cases developed to ordinary cases and severe cases respectively after admission; and 5.2% (50/968) and 0.6% (6/968) of the ordinary cases developed to severe cases, and critical cases respectively after admission. In severe cases, 11.4% developed to critical cases (10/88). The influencing factors for severe illness or worse included male (a HR =1.87, 95% CI : 1.43-2.46), older age (a HR =1.67, 95% CI : 1.51-1.85), seeking medical care on day 2-3 after onset (a HR =1.73, 95% CI : 1.20-2.50) pre-existing diabetes (a HR =1.75, 95% CI : 1.12-2.73) and hypertension (a HR =1.49, 95% CI : 1.06-2.09). Conclusions The course of illness and length of hospitalization of COVID-19 cases were generally long and associated with severity of disease clinical outcomes. The severe cases were mainly occurred in populations at high risk. In the epidemic period, classified management of COVID-19 cases should be promoted according to needs for control and prevention of isolation and treatment for the purpose of rational allocation of medical resources.
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Wet age-related macular degeneration (AMD),which is the leading cause of visual impairment in elderly people,significantly affects quality of life of millions worldwide.Currently,anti-VEGF is the first-line therapy for wAMD,bringing encouraging results in improving the vision.However,not all of the patients will response to this therapy,moreover,anti-VEGF may be associated with several issues,such as multiple injections,systemic adverse effects,delay or lack of response.With a deep understanding of the mechanism of wAMD,there are rapid developments of new approaches to more effective therapy.Ophthalmologists should pay attention to the advantages and disadvantages of these anti-VEGF drugs as well as the current advances of anti-VEGF drugs in order to provide better treating strategies for wAMD patients better.
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Objective@#To analyze the serological characteristics of anti-mitochondrial antibody M2 subtype (AMA-M2) in patients with drug-induced liver injury (DILI) and primary biliary cholangitis (PBC), in order to provide reference for clinical differential diagnosis.@*Methods@#Laboratory data of 2802 DILI cases who visited the hospital between January 2011 and December 2017 were retrospectively collected. AMA-M2 positive patients were analyzed with respect to laboratorical findings, and serum data of 120 patients with primary biliary cholangitis (PBC) at the same period was taken as a control. A chi-square test was used for group comparisons. One-way ANOVA and rank sum tests was used for ALT, AST, ALP, GGT and three groups of immunoglobulin M.@*Results@#Among 2802 DILI patients, AMA-M2 positive rate was 5.1% (144/2 802), 77.1% (111/144) was DILI alone, 22.2% (32/144) was DILI with PBC, and 0.7% (1/144) was DILI with Sjogren's syndrome. An AMA-M2 level in DILI alone group was mostly mild and moderate than the PBC group and the DILI combined with the PBC group. There was significant difference between the two groups (P < 0.05).There was no significant difference in AMA-M2 levels between DILI group combined with PBC group and PBC group (P > 0.05). ALT and AST levels of DILI alone group and DILI combined with PBC were (585.92 ± 653.04) U/L, (501.45 ± 512.67) U/L and (373.47 ± 502.60) U/L, (335.97 ± 513.96) U/L, respectively, which were significantly higher than PBC group [(106.33 + 134.08) U/L, (112.59 + 152.20) U/L]. There were statistically significant differences between the two groups (P < 0.05).The ALP level of DILI alone group was (152.58 + 81.46) U/L, which was lower than PBC group (237.86 + 215.09). The difference was statistically significant (P < 0.05). The level of immunoglobulin M in the DILI alone group was (1.76 ± 1.16) g/L, which was lower than PBC group (4.74 ± 5.74) g/L and the DILI combined with the PBC group (3.31 ± 1.68) g/L. There was significant difference between the two groups. During follow-up, 2.7% of patients with DILI had cirrhosis, 42.3% had lower AMA-M2 titer, 14.4% had lower AMA-M2 titer, 13.5% had higher AMA-M2 titer and five cases developed PBC.@*Conclusion@#AMA-M2 is not only positive in patients with PBC, but also low-to-medium or even high-level AMA-M2 may be detected in DILI patients. For AMA-M2-positive DILI patients, it is necessary to identify whether they are associated with PBC. Secondly, the levels of ALT, AST and ALP should be analyzed, and the patients should be on regular follow up for early and timely detection of drug-induced PBC.
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Objective To understand the epidemiologic characteristics of outbreaks,caused by norovims-G Ⅱ.2、G Ⅱ.17 and G Ⅱ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control.Methods Incidence data of norovirus outbreaks in Guangdong from January 1st 2013 to November 30th 2017 were collected from Public Health Emergency Management Information System.RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus.Characteristics of norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney outbreaks were analyzed.Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting.Results From January 1st 2013 to November 30th 2017,a total of 167 norovirus outbreaks were reported in Guangdong,and 115 outbreaks were caused by norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney respectively.The outbreaks caused by norovirus G Ⅱ.2 accounted for 39.68％ (25/63) in primary schools,28.57％ (18/63) in child care settings,25.40％ (16/63) in middle schools and 6.35％ (4/63) in universities.Outbreaks caused by norovirus G Ⅱ.17 accounted for 41.03％ (16/39) in middle schools,20.51％ (8/39) at workplaces,15.38％ (6/39) in primary schools,12.82％ (5/39) in universities,5.13％ (2/39) in communities and child care settings respectively.The outbreaks caused by norovirus G Ⅱ.4/Sydney accounted for 53.85％ (7/13) in universities,15.38％ (2/13) in child care settings and at workplaces respectively,7.69％ (1/13) in primary schools and middle schools respectively.The outbreaks caused by norovirus G Ⅱ.2 had 77.78％ (49/63) of contact transmission,17.46％ (11/63) of food-borne transmission.The outbreaks caused by norovirus G Ⅱ.17 showed 53.85％ (21/39) of food-borne transmission,15.38％ (6/39) of contract transmission,12.82％ (5/39) of water-borne transmission.The outbreaks caused by norovirus G Ⅱ.4/Sydney had 53.85％ (7/13) of food-borne transmission,38.46％ (5/13) of the contact transmission.In terms of the clinical manifestations,the standardized proportion of vomit was 73.76％ and the proportion of diarrhea was 42.85％ in cases infected with norovirus G Ⅱ.2,the proportion of standardized of vomit was 76.37％ and the proportion of diarrhea was 51.40％ in cases infected with norovirus G Ⅱ.17,with the standardized proportion of vomit was 54.10％ and the proportion of diarrhea was 55.95％ in cases infected with norovirus G Ⅱ.4/Sydney.Conclusions The outbreaks caused by norovirus G Ⅱ.2 through contact transmission mainly occurred in primary schools,child care settings and middle schools.The outbreaks caused by norovirus G Ⅱ.17 through food-borne transmission mainly occurred in middle schools and at workplaces.The outbreaks caused by norovirus G Ⅱ.4/Sydney food-borne transmission and contact mainly occurred in universities.
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Objective To analyze the epidemiological characteristics of hand foot and mouth disease (HFMD) cases caused by Coxsackie virus A16 (Cox A16) in Guangdong province from 2012 to 2016.Methods The data of mild HFMD cases caused by Cox A 16 were collected from 8 sentinel hospitals in 8 prefecture-level cities in Guangdong to estimate Cox A16 infection status and its population and time distribution characteristics.Results (1) The highest estimated incidence of Cox A16 infection was in 2014 (113.0/100 000),followed by 2016 (86.4/100 000) and 2012 (79.1/100 000),while the estimated incidence was lower in 2015 (29.0/100 000) and 2013 (28.8/100 000).(2) Cox A16 was confirmed to be the predominant pathogen causing HFMD outbreaks (54.6％,89/163).The number of outbreaks in the year with high incidence (28 outbreaks) was 11.2 times higher than that in the year with low incidence (2.5 outbreaks).(3) Across all age groups,the annual estimated incidence of Cox A16 infection decreased with age (trend x2=853 905.63,P＜0.01).The incidence was highest in age group 1 year (1 449.2/100 000),followed by that in age group 3 years (1 097.0/100 000),in age group 2 years (1 083.5/100 000),in age group 4 years (687.8/100 000) and in age group 0 year (604.9/100 000).Among the age groups ＜12 months,the estimated incidence increased with age (trend g2=5 541.77,P ＜ 0.01),which was highest in age group 11-months (2 105.1/100 000),followed by that in age groups 10-months (1 448.6/100 000),9-months (938.3/100 000),8-months (703.3/100 000) and 6-months (664.6/100 000).(4) The annual incidence peak was during May (143.9/100 000)-June (131.5/100 000).Conclusion The prevalence of Cox A16 infection differed with year in Guangdong during 2012-2016.When the incidence of Cox A16 infection was high,more outbreaks occurred.The prevalence occurred mainly in nurseries and kindergartens from May to June each year.Children aged 0-4 years were the high risk group for Cox A16 infection,children aged 6-11 months were at high risk for Cox A16 infection.
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Objective To understand the epidemiologic characteristics of outbreaks,caused by norovims-G Ⅱ.2、G Ⅱ.17 and G Ⅱ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control.Methods Incidence data of norovirus outbreaks in Guangdong from January 1st 2013 to November 30th 2017 were collected from Public Health Emergency Management Information System.RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus.Characteristics of norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney outbreaks were analyzed.Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting.Results From January 1st 2013 to November 30th 2017,a total of 167 norovirus outbreaks were reported in Guangdong,and 115 outbreaks were caused by norovirus G Ⅱ.2,G Ⅱ.17 and G Ⅱ.4/Sydney respectively.The outbreaks caused by norovirus G Ⅱ.2 accounted for 39.68％ (25/63) in primary schools,28.57％ (18/63) in child care settings,25.40％ (16/63) in middle schools and 6.35％ (4/63) in universities.Outbreaks caused by norovirus G Ⅱ.17 accounted for 41.03％ (16/39) in middle schools,20.51％ (8/39) at workplaces,15.38％ (6/39) in primary schools,12.82％ (5/39) in universities,5.13％ (2/39) in communities and child care settings respectively.The outbreaks caused by norovirus G Ⅱ.4/Sydney accounted for 53.85％ (7/13) in universities,15.38％ (2/13) in child care settings and at workplaces respectively,7.69％ (1/13) in primary schools and middle schools respectively.The outbreaks caused by norovirus G Ⅱ.2 had 77.78％ (49/63) of contact transmission,17.46％ (11/63) of food-borne transmission.The outbreaks caused by norovirus G Ⅱ.17 showed 53.85％ (21/39) of food-borne transmission,15.38％ (6/39) of contract transmission,12.82％ (5/39) of water-borne transmission.The outbreaks caused by norovirus G Ⅱ.4/Sydney had 53.85％ (7/13) of food-borne transmission,38.46％ (5/13) of the contact transmission.In terms of the clinical manifestations,the standardized proportion of vomit was 73.76％ and the proportion of diarrhea was 42.85％ in cases infected with norovirus G Ⅱ.2,the proportion of standardized of vomit was 76.37％ and the proportion of diarrhea was 51.40％ in cases infected with norovirus G Ⅱ.17,with the standardized proportion of vomit was 54.10％ and the proportion of diarrhea was 55.95％ in cases infected with norovirus G Ⅱ.4/Sydney.Conclusions The outbreaks caused by norovirus G Ⅱ.2 through contact transmission mainly occurred in primary schools,child care settings and middle schools.The outbreaks caused by norovirus G Ⅱ.17 through food-borne transmission mainly occurred in middle schools and at workplaces.The outbreaks caused by norovirus G Ⅱ.4/Sydney food-borne transmission and contact mainly occurred in universities.
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Objective To analyze the epidemiological characteristics of hand foot and mouth disease (HFMD) cases caused by Coxsackie virus A16 (Cox A16) in Guangdong province from 2012 to 2016.Methods The data of mild HFMD cases caused by Cox A 16 were collected from 8 sentinel hospitals in 8 prefecture-level cities in Guangdong to estimate Cox A16 infection status and its population and time distribution characteristics.Results (1) The highest estimated incidence of Cox A16 infection was in 2014 (113.0/100 000),followed by 2016 (86.4/100 000) and 2012 (79.1/100 000),while the estimated incidence was lower in 2015 (29.0/100 000) and 2013 (28.8/100 000).(2) Cox A16 was confirmed to be the predominant pathogen causing HFMD outbreaks (54.6％,89/163).The number of outbreaks in the year with high incidence (28 outbreaks) was 11.2 times higher than that in the year with low incidence (2.5 outbreaks).(3) Across all age groups,the annual estimated incidence of Cox A16 infection decreased with age (trend x2=853 905.63,P＜0.01).The incidence was highest in age group 1 year (1 449.2/100 000),followed by that in age group 3 years (1 097.0/100 000),in age group 2 years (1 083.5/100 000),in age group 4 years (687.8/100 000) and in age group 0 year (604.9/100 000).Among the age groups ＜12 months,the estimated incidence increased with age (trend g2=5 541.77,P ＜ 0.01),which was highest in age group 11-months (2 105.1/100 000),followed by that in age groups 10-months (1 448.6/100 000),9-months (938.3/100 000),8-months (703.3/100 000) and 6-months (664.6/100 000).(4) The annual incidence peak was during May (143.9/100 000)-June (131.5/100 000).Conclusion The prevalence of Cox A16 infection differed with year in Guangdong during 2012-2016.When the incidence of Cox A16 infection was high,more outbreaks occurred.The prevalence occurred mainly in nurseries and kindergartens from May to June each year.Children aged 0-4 years were the high risk group for Cox A16 infection,children aged 6-11 months were at high risk for Cox A16 infection.
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Objective@#To analyze the hand-foot-mouth disease (HFMD) enterovirus 71 (EV-A71) infection epidemic characteristics of Guangdong Province from 2011 to 2015.@*Methods@#We colleted data on common cases of hand-foot-mouth disease infected with EV-A71 reported from eight sentinel hospitals in Guangdong Province from January 2011 to December 2015, through the "Guangdong Province Acute Infectious Disease Surveillance Information Platform System" , including the age and incidence of cases. Time and etiological data, etc.We also collected data on the number of reported cases of HFMD disease and the number of laboratory-confirmed cases, through the "China Disease Prevention and Control Information System" , including data on common cases of HFMD disease, data on epidemics of severe cases and deaths, and the age, onset time, and pathogens of cases. Learning data, etc.The data from two sources were used to estimate the incidence of HFMD in EV-A71 and describe its distribution characteristics.Chi-square test was used to compare the positive rate of HF-A71 infection in hand-foot-mouth disease and the difference in estimated incidence among different age groups and months.@*Results@#Eight sentinel hospitals from 2011 to 2015 reported a total of 1 855 common cases of EV-A71 infection, of which the highest was in 2014 (31.6%, 605/1 916) and the lowest was in 2015 (6.8%, 134/1 971) (χ2=521.85, P<0.001).According to the Disease Surveillance Reporting Information System, 1 772 516 cases of HFMD disease were reported from 2011 to 2015 in Guangdong Province, and 1 902 cases of severe and fatal cases of EV-A71 infection.The composition ratio of EV-A71 infected was 72.6% (1 775/2 444) and 97.0% (127/131) of severe HFMD disease in Guangdong province during 2011-2015.The average annual incidence of HF-A71 infection in all age groups showed a decreasing trend with age (χ2trend=990 273.20, P<0.001), and it was the highest in the 1-year-old group, which was 1 697.67/100 000, and the lowest in the 4-year-old group, which was 705.46/100 000. The difference of monthly average incidence of EV-A71 infection in HF-A71 in each month was statistically significant (χ2=401.23, P<0.001), the highest in May at 15.51 per 100 000, and the lowest in July at 9.42 per 100 000.@*Conclusion@#EV-A71 infection rate of ordinary HFMD varies in different years. The most severe and death cases of HFMD were EV-A71 infected. 1 year old children were the high-risk group of infected with EV-A71 HFMD. April was the epidemic months of EV-A71 HFMD infection.
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Objective To analyze transmission factors of norovirus outbreaks in Guangdong province during 2008-2015 and provide evidence for the prevention and control of norovirus infection.Methods Epidemiological analysis was performed on the data of norovirus outbreaks reported in Guangdong from January 1,2008 to December 31,2015,which were obtained from the Public Health Emergency Management Information System of Guangdong province.The samples collected from the norovirus outbreaks were detected for norovirus by RT-PCR and the gene sequencing of the positive PCR products were performed.Results A total of 96 norovirus outbreaks were reported in Guangdong during 2008-2015.Sixteen outbreaks were reported during 2008-2012and 80 outbreaks were reported during 2013-2015 (83.3％).Eighty-two outbreaks (85.4％) occurred in schools.The infection routes included foodborne transmission in 39 outbreaks (40.6％),person to person transmission in 23 outbreaks (24.0％) and waterborne transmission in 8 outbreaks (7.3％).The gene sequencing results showed that variant G Ⅱ.4/Sydney2012 was the predominant pathogen for 6 of the 20 outbreaks (30.0％) during 2012-2013.Variant G lⅡ.17 was the predominant pathogens for 33 of the 53 outbreaks (62.3％) during 2014-2015.Conclusion The norovirus outbreaks in Guangdong during 2008-2015 were caused by foodborne and person to person transmissions of two emerging variant:G Ⅱ.4/Sydney2012 and G Ⅱ.17.
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Objective To analyze transmission factors of norovirus outbreaks in Guangdong province during 2008-2015 and provide evidence for the prevention and control of norovirus infection.Methods Epidemiological analysis was performed on the data of norovirus outbreaks reported in Guangdong from January 1,2008 to December 31,2015,which were obtained from the Public Health Emergency Management Information System of Guangdong province.The samples collected from the norovirus outbreaks were detected for norovirus by RT-PCR and the gene sequencing of the positive PCR products were performed.Results A total of 96 norovirus outbreaks were reported in Guangdong during 2008-2015.Sixteen outbreaks were reported during 2008-2012and 80 outbreaks were reported during 2013-2015 (83.3％).Eighty-two outbreaks (85.4％) occurred in schools.The infection routes included foodborne transmission in 39 outbreaks (40.6％),person to person transmission in 23 outbreaks (24.0％) and waterborne transmission in 8 outbreaks (7.3％).The gene sequencing results showed that variant G Ⅱ.4/Sydney2012 was the predominant pathogen for 6 of the 20 outbreaks (30.0％) during 2012-2013.Variant G lⅡ.17 was the predominant pathogens for 33 of the 53 outbreaks (62.3％) during 2014-2015.Conclusion The norovirus outbreaks in Guangdong during 2008-2015 were caused by foodborne and person to person transmissions of two emerging variant:G Ⅱ.4/Sydney2012 and G Ⅱ.17.
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Objective@#To investigate the clinical and laboratory features of patients with liver disease and positive anti-liver/kidney microsomal-1 (anti-LKM-1) antibody, and to provide a reference for clinical diagnosis and differential diagnosis.@*Methods@#The clinical data of patients with positive anti-LKM-1 antibody who were treated in our hospital from 2006 to 2016 were collected, and clinical and laboratory features were analyzed and compared. An analysis was also performed for special cases.@*Results@#The measurement of related autoantibodies was performed for about 100 thousand case-times, and 15 patients were found to have positive anti-LKM-1 antibody. Among the 15 patients, 7 were diagnosed with type 2 autoimmune hepatitis (AIH) with an age of 11.0 ± 9.0 years and were all adolescents with acute onset; 8 were diagnosed with hepatitis C with an age of 51.5 ± 9.0 years, among whom 7 were middle-aged patients and 1 was a child aged 12 years, and all of them had an insidious onset. Compared with the patients with hepatitis C, the AIH patients had significantly higher levels of alanine aminotransferase (1 003.9 ± 904.3 U/L vs 57.0 ± 84.1 U/L, P < 0.05), aspartate aminotransferase (410.7 ± 660.3 U/L vs 34.9 ± 42.9 U/L, P < 0.05), and total bilirubin (98.0 ± 191.0 μmol/L vs 15.4 ± 6.0 μmol/L, P < 0.05). There was a reduction in immunoglobulin G after the treatment with immunosuppressant, compared with the baseline. Of all 8 patients with hepatitis C, 6 received antiviral therapy with interferon and ribavirin, and 5 out of them achieved complete response, among whom 4 had a reduction in the level of anti-LKM-1 antibody after treatment; however, a 12-year-old child developed liver failure after interferon treatment and died eventually.@*Conclusion@#Positive anti-LKM-1 antibody is commonly seen in patients with type 2 AIH or hepatitis C, but there are differences between these two groups of patients in terms of age, disease onset, liver function, and the level of anti-LKM-1 antibody. The hepatitis C patients with a confirmed diagnosis and exclusion of autoimmune hepatitis can achieve good response to interferon under close monitoring, even if anti-LKM-1 antibody is positive. As for adolescent patients with hepatitis C and positive anti-LKM-1 antibody, the possibility of AIH should be excluded.
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Objective@#To analyze the etiological of herpangina(HA) in Guangzhou City in 2015, and to provide laboratory data for the epidemic control.@*Methods@#Two hundred and eleven herpangina samples (stool and throat swab) were collected.Real-time (RT)-PCR and semi-nested (Sn)-PCR assays were performed to detect human enteroviruses (HEVs)-positive samples. The human rhabdomyosarcoma (RDa) cell lines were used to inoculate virus from HEVs-positive samples. The entire sequences of viral genes encoding VP1 of CVA6 positive samples or strains were amplified and sequenced. The phylogenetic analysis was performed to analyze the full-length gene sequences encoding VP1 of CVA6 by using DNAStar6.0 and MEGA5.2 software packages.@*Results@#According to the laboratory test results, 115 cases were HEVs-positive and positive rate was 93.50%, eight serotypes of EV including CVA6, CVA10, CVA2, EV71, CVA16, CVB2, Echo14 and Echo30 were detected.The CVA6 positive rate was the highest with a percentage of 60.98%, followed by CVA10 with a percentage of 13.01%. The enterovirus positive rate of stool samples (χ2=29.88, P<0.01) and viruses isolated positive rate (χ2=8.67, P<0.01) were higher than that in throat swab samples. Phylogenetic analysis showed that all CVA6 strains detected in this study belonged to D3 subgenotype, and shared 96.9%-99.9% homologies in nucleotide and 99.0%-100.0% in amino acid.@*Conclusions@#CVA6 of the enterovirus A group accounted for the main pathogen of herpangina in Guangzhou City in Guangdong province in 2015, which belonged to D3 subgenotype.
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Objective To investigate the differences in the expression of PHF20 and Bax and their correlations in non-small cell lung cancer before chemotherapy.Methods An immunohistochemical method was used to detect the expression of PHF20 and Bax in non-small cell lung cancer,and to analyze the clinical significance of PHF20 and the possible correlation between PHF20 and Bax proteins.Results PHF20 protein is expressed in the cytoplasm of non-small cell lung cancer cells.Moreover,it is highly expressed in squamous cell carcinoma,less expressed in adenocarcinoma,and closely related with cell differentiation,TNM staging,and lymph node metastasis.The expression of PHF20 and Bax was positively correlated with squamous cell lung carcinoma.Conclusion The expression of PHF20 in non-small cell lung cancer is closely associated with tumor progression and the expression of Bax.PHF20 may be a new target for the treatment of non-small cell lung cancer.
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OBJECTIVE: Microstructural changes in dentin carious lesions were investigated using a 3D laser scanning microscope, which has a morphological theoretical foundation in the further study of clinical caries disease prevention and treatments. METHODS: Six fresh extracted caries molars were prepared into cross-section specimens. The sections were examined by 3D and laser measuring morphology. RESULTS: Zones were identified in the lesions on the basis of their optical appearance. Two zones were identified in the lesions on the basis of their laser appearance. The microstructure showed that the tubular was partly closed in transparent dentin; peritubular and intertubular dentin were reduced in the zone of demineralization; peritubular and intertubular dentin were damaged and fused; a beaded sample and oval lesions formed in the zone of bacterial invasion; and abnormal dentin structure was present in the zone of destruction on the basis of their laser appearance. Four zones were iden-tified in the lesions according to their colors, as determined from their 3D appearance. CONCLUSIONS: 3D laser scanning micros-cope may be a powerful, accessible, and non-destructive technique, as it identified the lesion and tubular zones, as well as peritubular and intertubular dentin in the four zones' lesions. The microstructure of dentin caries lesions may have significant merit in the evaluation of clinical prevention and treatment.
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Cárie Dentária , Dentina , Humanos , Microscopia ConfocalRESUMO
Objective To examine the reliability and validity of the Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) in Chinese women with breast cancer.Methods The Chinese version of the FACT-Cog was obtained by FACT.A total of 202 patients with breast cancer were investigated by convenient sampling survey.The reliability and validity of the scale were analyzed by the principal component analysis and Pearson correlation analysis.Results The Cronbach α of the Chinese version of the FACT-Cog was 0.96, and those of four dimensions were 0.87-0.96.The test-retest correlation coefficients for the Chinese version of the FACT-Cog were 0.45-0.73, P＜0.01.The four-factor structure of the Chinese version of the FACT-Cog was confirmed and accounted for 66.63％ of the total variance.The criterion-related validity of the Chinese version of the FACT-Cog were significantly related with those of anxiety, depression and fatigue,-(0.36～0.48),-(0.42～0.52), 0.48-0.59,P＜0.01.Conclusion The Chinese version of the FACT-Cog is valid, reliable, and appropriate for clinical and research use in Chinese women with breast cancer.
