Risk prediction of low birth weight infants in Shanghai / 上海预防医学

ObjectiveTo investigate the risk factors of fertility behaviors with preterm birth and low birth weight， and to develop a nomogram model to predict the occurrence of low birth weight. MethodsBirth registration information in Shanghai from 2010 to 2020 was collected， and ANOVA and Chi-square tests were used to compare the differences in reproductive behavior factors and newborn health status across time. The odds ratio （OR） value and 95%CI were calculated by a multi-classification logistic regression model to determine the association between reproductive behavior factors and preterm birth or low birth weight infants. A nomogram model was established based on logistic model and the area under the ROC curve was used to assess the effect of the model. ResultsThis analysis included 2 089 384 live newborns. The incidence of full-term low birth weight， preterm normal weight and preterm low birth weight in Shanghai was 0.94%， 2.48% and 2.01%， respectively. From 2010 to 2020， 40.00% women had a history of abortion， the proportion of women who gave birth at age ≥40 years old increased from 1.05% to 2.24%， the proportion of fathers aged ≥40 years increased from 4.79% to 7.48%， and the proportion of women with postgraduate or above increased from 4.81% to 11.74%. The incidence of preterm low birth weight in Shanghai showed an increasing trend over time. Logistic regression analysis showed that the risk of preterm low birth weight was lower in female than in male infants （OR=0.97， 95%CI： 0.95‒0.98）， and the risk of full-term low birth weight was higher than in male infants （OR=1.85， 95%CI： 1.80‒1.90）. The risk of preterm birth and low birth weight was lower for couples of childbearing age with higher education. The risk of preterm low birth weight in newborns tended to increase with maternal age at childbirth >30 years， paternal age ≥40 years， and the number of abortions >2 times. Mother <25 or >35 years， father aged 30‒34 years， and the number of abortions >3 times were the risk factors of full-term low birth weight infants. ConclusionCouples of childbearing age who choose to have children at too high or too low age may increase the risk of preterm birth or low birth weight， so it is necessary to strengthen population awareness and promote age-appropriate childbirth. Multiple abortions are also associated with preterm birth and low birth weight， and it is advisable to popularize the scientific knowledge of contraception and birth control to reduce unnecessary abortions. The nomogram in the study can visualize the risk of full-term and low birth weight infant at different levels of factors， which can assist couples preparing for pregnancy in making decisions about the timing of childbirth and understanding the level of risk.

Effectiveness of inactivated and Ad5-nCoV COVID-19 vaccines against SARS-CoV-2 Omicron BA. 2 variant infection, severe illness, and death

BackgroundLimited data are available on effectiveness of inactivated and Ad5-nCoV COVID-19 vaccines in real-world use - especially against Omicron variants in SARS-CoV-2 infection-naive population. During an outbreak in Shanghais SARS-CoV-2 infection-naive population, we evaluated vaccine effectiveness (VE) against Omicron infection, severe or critical COVID-19, and COVID-19-related death. MethodsA matched case-control study was conducted among people aged [≥]3 years between 2 December 2021 through 13 May 2022. Cases were SARS-CoV-2 infected individuals, individuals with severe/critical COVID-19, or COVID-19-related deaths. Controls were selected from consecutively test negative individuals at the same time as cases were diagnosed and were exact-matched on year-of-age, gender, birthplace, illness onset date, and residency district in ratios of 1:1 with infected individuals and 4:1 with severe/critical COVID-19 and COVID-19-related deaths. ResultsOur study included 612597 documented SARS-CoV-2 infections, among which 1485 progressed to severe or critical illness and 568 died. Inactivated vaccine was 16.3% (95% CI: 15.4%-17.2%) effective against infection, 88.6% (95% CI: 85.8%-90.9%) effective against severe/critical COVIID-19 and 91.7% (95% CI: 86.9%-94.7%) against COVID-19 death. Ad5-vectored vaccine was 13.2% (95% CI: 10.9%-15.5%) effective against infection and 77.9% (95% CI: 15.6%-94.2%) effective against severe/critical COVIID-19. Booster vaccination with inactivated vaccines enhanced protection against severe COVID-19 (92.7%, 95% CI: 90.1%-94.6%) and COVID-19 death (95.9%, 95% CI: 91.4%-98.1%). Inactivated VE against infection began to wane 12 weeks after the last dose but two- and three-dose sustained high protection levels (>80%) against severe/critical illness and death. ConclusionsOur real-world study found high and durable two- and three-dose inactivated VE against Omicron-associated severe/critical illness and death across all age groups, but lower effectiveness against Omicron infection. High direct protection from severe/fatal Omicron COVID-19 provided by inactivated vaccines, and a consequent potential reduction in health-care utilization, reinforces the critical importance of full-series vaccination and timely booster dose administration for all eligible individuals.

Assessment of COVID-19 Omicron epidemic trend in Shanghai based on time-varying reproduction number / 上海预防医学

ObjectiveTo assess the epidemic trend of COVID-19 Omicron and the effectiveness of containment measures in Shanghai by estimating the time-varying reproduction number （Rt）. MethodsBased on the daily reported confirmed cases and asymptomatic infections in Shanghai from February 20 to April 26， 2022， the R package "Epiestim"， which was built by Bayesian framework method， was used to estimate the variation curve of Rt during the epidemic period and to analyze the trend of the epidemic. ResultsIn the early stage of the epidemic， after the implementation of school closure and nuclear acid screening in some communities， Rt continued to fluctuate between 2.000 and 3.000， reaching a peak of 2.740 （95%CI： 2.640‒2.830） on March 21， but began to decline around one week after the city lock-down on April 1. As of April 18， the Rt value in Shanghai was below the threshold of 1.000 for the first time， reaching 0.955 （95%CI： 0.951‒0.961）. ConclusionAfter the implementation of public health measures with increasing strength of containment in Shanghai， the transmission rate gradually decreased， reflecting the effectiveness of the interventions. In the actual prevention and control process， the containment work should not be relaxed in order to keep the Rt below 1.000.

Analysis of cerebrovascular disease between 1996 and 2021 in Minhang District of Shanghai / 上海预防医学

ObjectiveTo analyze the changing trend of cerebrovascular disease burden in Minhang District of Shanghai from 1996 to 2021， and to provide scientific evidence for government to formulate targeted cerebrovascular disease prevention and control strategies. MethodsMortality， years of life lost（YLL）， years of lived with disability（YLD） and disability⁃adjusted life years（DALY） were used to evaluate the burden of cerebrovascular diseases in Minhang District. Joinpoint linear regression was used to analyze the trend of disease burden. ResultsFrom 1996 to 2021， the YLL rate of cerebrovascular diseases in Minhang District showed a downward trend （whole population： APC=-1.69%， t=-6.9， P<0.05）， The YLD rate of cerebrovascular diseases showed a slow upward trend （whole population： APC=1.17%， t=3.5， P<0.05）， The DALY rate of cerebrovascular diseases showed a downward trend， and fluctuated since 2003 （whole population： APC= -1.43%， t=-5.6， P<0.05）. The YLL rate of cerebrovascular diseases in men was higher than that in women， and the YLD rate of cerebrovascular diseases in women was higher than that in men. After 2014， the DALY of cerebrovascular diseases in men was higher than that in women. With the increase of age， the burden of cerebrovascular diseases increased， and the burden of disease increased significantly in the age group above 70. ConclusionThe burden of cerebrovascular diseases in Minhang District is at a high level， and there are differences in age， gender and other aspects. Measures such as screening， intervention and rehabilitation need to be improved to reduce disability and premature death caused by cerebrovascular diseases and to reduce the burden of cerebrovascular diseases on individuals， families and society.

Spatial Correlation of Particulate Matter Pollution and Death Rate of COVID-19

The Coronavirus (COVID-19) epidemic, which was first reported in December 2019 in Wuhan, China, has caused 3,314 death as of March 31, 2020 in China. This study aimed to investigate the spatial associations of daily particulate matter (PM) concentrations with death rate of COVID-19 in China. We conducted a cross-sectional analysis to examine the spatial associations of daily PM2.5 and PM10 concentrations with death rate of COVID-19 in China through multiple linear regression method. We found that COVID-19 held higher death rates with increasing concentration of PM2.5 and PM10 levels in the spatial scale, which may affect the process of patients developed from mild to severe and finally influence the prognosis of COVID-19 patients.

Temporal Association Between Particulate Matter Pollution and Case Fatality Rate of COVID-19 in Wuhan, China

The Coronavirus (COVID-19) epidemic, which was first reported in December 2019 in Wuhan, China, has caused 3,314 death as of March 31, 2020 in China. This study aimed to investigate the temporal association between case fatality rate (CFR) of COVID-19 and particulate matter (PM) in Wuhan. We conducted a time series analysis to explore the temporal day-by-day associations. We found COVID-19 held higher case fatality rate with increasing concentrations of PM2.5 and PM10 in temporal scale, which may affect the process of patients developed from mild to severe and finally influence the prognosis of COVID-19 patients.

Ambient nitrogen dioxide pollution and spread ability of COVID-19 in Chinese cities

The Coronavirus (COVID-19) epidemic, which was first reported in December 2019 in Wuhan, China, has caused 219,331 confirmed cases as of 20 March 2020, with 81,301 cases being reported in China. It has been declared a pandemic by the World Health Organization in 11 March 2020 (1). Although massive intervention measures have been implemented in China (e.g. shutting down cities, extending holidays and travel ban) and many other countries, the spread of the disease are unlikely to be stopped over the world shortly. It is becoming evident that environmental factors are associated with seasonality of respiratory-borne diseases epidemics (2). Previous studies have suggested that ambient nitrogen dioxide (NO2) exposure may play a role in the phenotypes of respiratory diseases, including, but not limited to, influenza, asthma and severe acute respiratory syndrome (SARS). NO2), for example, might increase the susceptibility of adults to virus infections (3). High exposure to NO2 before the start of a respiratory viral infection is associated with the severity of asthma exacerbation (4). This study aims to assess the associations of ambient NO2 levels with spread ability of COVID-19 across 63 Chinese cities, and provides information for the further prevention and control of COVID-19.

Effectiveness of intervention strategies for Coronavirus Disease 2019 and an estimation of its peak time

BackgroundSince its first cases occurrence in Wuhan, China, the Coronavirus Disease 2019 (COVID-19) has been spreading rapidly to other provinces and neighboring countries. A series of intervention strategies have been implemented, but didnt stop its spread. MethodsTwo mathematical models have been developed to simulate the current epidemic situation in the city of Wuhan and in other parts of China. Special considerations were given to the mobility of people for the estimation and forecast the number of asymptomatic infections, symptomatic infections, and the infections of super-spreading events (Isse). FindingsThe basic reproductive number (R0) was calculated for the period between 18 January 2020 and 16 February 2020: R0 declined from 5.75 to 1.69 in Wuhan and from 6.22 to 1.67 in the entire country (not including the Wuhan area). At the same time, Wuhan is estimated to observe a peak in the number of confirmed cases around 6 February 2020. The number of infected individuals in the entire country (not including the Wuhan area) peaked around February 3. The results also show that the peak of new asymptomatic cases per day in Wuhan occurred on February 6, and the peak of new symptomatic infections have occurred on February 3. Concurrently, while the number of confirmed cases nationwide would continue to decline, the number of real-time COVID-19 inpatients in Wuhan has reached a peak of 13,030 on February 14 before it decreases. The model further shows that the COVID-19 cases will gradually wane by the end of April 2020, both in Wuhan and the other parts of China. The number of confirmed cases would reach the single digit on March 27 in Wuhan and March 19 in the entire country. The five cities with top risk index in China with the exclusion of Wuhan are: Huanggang, Xiaogan, Jingzhou, Chongqing, and Xiangyang city. InterpretationsAlthough the national peak time has been reached, a significant proportion of asymptomatic patients and the infections of super-spreading events (Isse) still exist in the population, indicating the potential difficulty for the prevention and control of the disease. As the Return-to-Work tide is approaching and upgrading, further measures (e.g., escalatory quarantine, mask wearing when going out, and sit apart when taking vehicles) will be particularly crucial to stop the COVID-19 in other cities outside of Wuhan. What was already known about the topic concernedCurrently, a Coronavirus Disease 2019 (COVID-19) is thought to have emerged into the human population in Wuhan, and cases have been identified in neighboring provinces and other countries. In existing epidemiological studies, the basic reproduction number (R0) of the virus were estimated between 1.4 and 5. Besides, it is of crucial importance to evaluate and improve different intervention strategies which have already implemented. What new knowledge the manuscript contributesIn this study, two mathematical models were established to simulate the current epidemic situation and predict the future trend of the COVID-19. We found that with the implementation of different policies, R0 continued to decline over time and the number of confirmed cases in Wuhan will peak on around February 6. Also, we estimated and forecast the number of asymptomatic infections, symptomatic infections, and infections of super-spreading events caused by the COVID-19 and the risk index of different cities. Implications of all the available evidenceOur research has important practical implications for public health policy makers. Although the current prevention and control measures have made some significant inroads into controlling the epidemic, complete control has not yet been achieved. We recommend that self-isolation at home be strictly observed for a period of time in the future. Furthermore, our estimation of the number of asymptomatic people, super spreading and real-time inpatients would provide basis guidance for the hospital to arrange beds accordingly.

Application of generalized estimation equations to establish prediction equation for tuberculosis drug resistance in Zhejiang province / 中华流行病学杂志

Objective Drug-resistant tuberculosis (TB) may be resistant to one or multiple anti-TB drugs.We used generalized estimation equations to analysis the risk factors of drug-resistant TB and provide information for the establishment of a warning model for these non-independent data.Methods The drug susceptibility test and questionnaire survey were performed in sputum positive TB patients from 30 anti TB drug-resistance surveillance sites in Zhejiang province.The generalized estimation model was established by the GENMOD module of SAS,with resistance to 13 kinds of anti-TB drugs as dependent variables and possible influencing factors,such as age,having insurance,HBV infection status,and history of anti-TB drug intake,as independent variables.Results In this study,the probability of drug resistance at baseline level was 20.26％.Age,insurance,whether being co-infected with HBV,and treatment history or treatment withdrawal were statistically significantly correlated with anti-TB drug resistance.The prediction equation was established according to the influence degree of the factors mentioned above on drug resistance.Conclusion The generalized estimation equations can effectively and robustly analyze the correlated binary outcomes,and thus provide more comprehensive information for drug resistance risk factor evaluation and warning model establishment.

Application of generalized estimation equations to establish prediction equation for tuberculosis drug resistance in Zhejiang province / 中华流行病学杂志

Objective Drug-resistant tuberculosis (TB) may be resistant to one or multiple anti-TB drugs.We used generalized estimation equations to analysis the risk factors of drug-resistant TB and provide information for the establishment of a warning model for these non-independent data.Methods The drug susceptibility test and questionnaire survey were performed in sputum positive TB patients from 30 anti TB drug-resistance surveillance sites in Zhejiang province.The generalized estimation model was established by the GENMOD module of SAS,with resistance to 13 kinds of anti-TB drugs as dependent variables and possible influencing factors,such as age,having insurance,HBV infection status,and history of anti-TB drug intake,as independent variables.Results In this study,the probability of drug resistance at baseline level was 20.26％.Age,insurance,whether being co-infected with HBV,and treatment history or treatment withdrawal were statistically significantly correlated with anti-TB drug resistance.The prediction equation was established according to the influence degree of the factors mentioned above on drug resistance.Conclusion The generalized estimation equations can effectively and robustly analyze the correlated binary outcomes,and thus provide more comprehensive information for drug resistance risk factor evaluation and warning model establishment.

Spatial scan analysis on tuberculosis notifications in Zhejiang province, 2005-2014 / 中华传染病杂志

Objective To analyze the epidemic characteristics of tuberculosis (TB) cases in Zhejiang province from 2005 to 2014, and to identify the cluster spots.Methods TB notification data in Zhejiang province from 2005 to 2014 were analyzed at county and district level by using spatial scan statistic analysis method, which was showed on the digital map.Results In zhejiang province from 2005 to 2014, a total of 377 707 cases of patients with tuberculosis were reported.The average annual registration rates of the entire province was 72.61/100 000 (range: 28.85/100 000-182.90/100 000).Spatial analysis identified 14 clusters (RR=1.05-1.62) with statistical significance.Temporal analysis revealed that there were clusters between 2005 and 2009 in terms of the notification data on TB cases (RR=1.27,P=0.001).Spatio-temporal analysis identified 6 clusters (RR=1.19-3.55) with statistical significance.Counties and districts included in the first class cluster were similar by using the two different methods-spatial analysis and spatial-temporal analysis.Conclusions There is a descending trend of TB cases notification rates from western to eastern Zhejiang during the study period.The distribution of the TB case notified is not random at spatial, temporal and spatio-temporal levels.

Integration of spatial epidemiology and molecular epidemiology used for study on tuberculosis / 中华流行病学杂志

Spatial epidemiology and molecular epidemiology have been widely used in the studies of tuberculosis (TB),but each with limitations.Integration of the two methods provides new ideas and methods in TB research.All referenced articles are from CNKI,Wan Fang database,PubMed database and Web of Science database.Method of combining spatial epidemiology and molecular epidemiology has been widely used in determining the local epidemic strains of TB genotype,the transmission mechanism,risk factors of TB,drug-resistant TB,as well as evaluating the effectiveness of TB prevention and control measures.Application of the combined methods is of important significance in the studies of TB,thus worthy to be further introduced to researchers and disease prevention and control workers in this country.

Spatial distribution characteristics analysis on multidrug-resistant tuberculosis cases in Zhejiang province, 2010-2012 / 中华流行病学杂志

Objective To analyze the spatial distribution characteristics ofmultidrug-resistant (MDR) tuberculosis (TB) cases in Zhejiang province in 2010-2012.Methods Data on MDR-TB cases in Zhejiang province were collected and linked to the digital map at the county and district levels.ArcGIS 10.0 software was used for spatial analysis.Results Results from the spatial autocorrelation analysis showed that spatial aggregation appeared in MDR-TB distribution during 2010-2012 while local Moran's I spatial autocorrelation analysis identified several "high incidence regions" (Wuxing,Deqing,Yuhang,Gongshu,Jianggan,Xiaoshan,Yuecheng,Shaoxing Shengzhou,Changshan,Kecheng),and "low incidence region" (Haishu).Through Getis-Ord General G spatial autocorrelation analysis,18 "positive hotspots" (Wuxing,Nanxun,Deqing,Yuhang,Shangcheng,Xiacheng,Gongshu,Jianggan,Binjiang Xiaoshan Xihu,Haining,Yuecheng,Shaoxing,Zhuji,Shengzhou,Kecheng and Suichang) and 11 "negative hotspots" (Nanhu,Haiyan,Cixi,Dinghai,Zhenhai,Jiangbei,Jiangdong,Beilun,Yinzhou,Fenghua,and Yueqing) were identified.Conclusions Spatial analysis on MDR-TB incidence implied the spatial aggregation in Zhejiang province.Data showed that the hotspots with high population density and human movement were under progressive expansion.

Integration of spatial epidemiology and molecular epidemiology used for study on tuberculosis / 中华流行病学杂志

Spatial epidemiology and molecular epidemiology have been widely used in the studies of tuberculosis (TB),but each with limitations.Integration of the two methods provides new ideas and methods in TB research.All referenced articles are from CNKI,Wan Fang database,PubMed database and Web of Science database.Method of combining spatial epidemiology and molecular epidemiology has been widely used in determining the local epidemic strains of TB genotype,the transmission mechanism,risk factors of TB,drug-resistant TB,as well as evaluating the effectiveness of TB prevention and control measures.Application of the combined methods is of important significance in the studies of TB,thus worthy to be further introduced to researchers and disease prevention and control workers in this country.

Spatial distribution characteristics analysis on multidrug-resistant tuberculosis cases in Zhejiang province, 2010-2012 / 中华流行病学杂志

Objective To analyze the spatial distribution characteristics ofmultidrug-resistant (MDR) tuberculosis (TB) cases in Zhejiang province in 2010-2012.Methods Data on MDR-TB cases in Zhejiang province were collected and linked to the digital map at the county and district levels.ArcGIS 10.0 software was used for spatial analysis.Results Results from the spatial autocorrelation analysis showed that spatial aggregation appeared in MDR-TB distribution during 2010-2012 while local Moran's I spatial autocorrelation analysis identified several "high incidence regions" (Wuxing,Deqing,Yuhang,Gongshu,Jianggan,Xiaoshan,Yuecheng,Shaoxing Shengzhou,Changshan,Kecheng),and "low incidence region" (Haishu).Through Getis-Ord General G spatial autocorrelation analysis,18 "positive hotspots" (Wuxing,Nanxun,Deqing,Yuhang,Shangcheng,Xiacheng,Gongshu,Jianggan,Binjiang Xiaoshan Xihu,Haining,Yuecheng,Shaoxing,Zhuji,Shengzhou,Kecheng and Suichang) and 11 "negative hotspots" (Nanhu,Haiyan,Cixi,Dinghai,Zhenhai,Jiangbei,Jiangdong,Beilun,Yinzhou,Fenghua,and Yueqing) were identified.Conclusions Spatial analysis on MDR-TB incidence implied the spatial aggregation in Zhejiang province.Data showed that the hotspots with high population density and human movement were under progressive expansion.

Effects of daily mean temperature on respiratory hospital admissions in Shanghai: time-series analysis / 中华预防医学杂志

<p><b>OBJECTIVE</b>To quantitatively evaluate the effects of daily mean temperature on respiratory diseases.</p><p><b>METHODS</b>Based on the data of daily hospital admissions for respiratory diseases, meteorological parameters and air pollution in Shanghai between January 2006 and December 2011, we used a generalized additive model (GAM) to explore the effects of daily mean temperature on hospital admissions on respiratory diseases adjusted for the secular trend, seasonal trend, day of week and other confounders.</p><p><b>RESULTS</b>A J-shaped relationship was found between daily mean temperature and respiratory disease and the optimum temperature (OT) corresponding to low risk of respiratory hospital admissions was about 25 °C. For cold effects over lag 0-30 days, the overall excess risk (ER) of hospital admission associated with 1 °C below the OT was 3.00% (95% CI: 2.54%-3.45%), 3.00% (95% CI: 2.55%-3.45%) and 3.02% (95% CI:2.51%-3.49%) for overall, males and females, respectively. For hot effects over lag 0-30 days, the overall excess risk (ER) was 2.15% (95% CI: 0.67%-3.66%), 1.86% (95% CI: 0.39%-3.34%) and 2.57% (95% CI: 0.82%-4.36%) for overall, males and females, respectively. The optimum temperature between daily mean temperature and respiratory disease were 14 °C, 20 °C, 25 °C and 28 °C in different age groups. The effect of low temperature increased with age for the people above 45 years old; however the effect of high temperature was significant for the people under 65 years old.</p><p><b>CONCLUSIONS</b>Both of higher temperature and lower temperature resulted in ER of respiratory hospital admissions increase with lag effects. The effects of lower temperature lagged longer and stronger than higher temperature. Different age group and gender shows different effects.</p>

Ethical Roles of Dispute Processing Personnel in Medical Dispute / 中国医学伦理学

This paper focused on the role conflicts owing to the multiple identity of roles and professional limi -tations in the dispute processing personnel , analyzed the probability in the medical processes and results , appeal of the patients and pattern of medical dispute processing , and made the conclusion that the medical dispute processing personnel is volunteers promoting social harmony and a practitioner of new medical model from the social perspec -tive and should carry forward the dedication , fraternity, mutual assistance and progressive spirit , the concept of the biological -psychology -social medical model to analyze the loss of patients in dispute and appeal , truly safe-guard the health rights and interests of patients , and give some advices to perfect the role ethics dispute processing .

Postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension / 中国医师进修杂志

Objective To study the effect of postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension.Methods One hundred and forty patients with cirrhosis and portal hypertension receiving splenectomy and periesophagastric devascularization were divided into anticoagulant group (76 cases) and control group (64 cases) by random number table,patients in anticoagulant group received postoperative anticoagulant therapy,principally according to the platelet count,gave ligustrazine,aspirin,low molecular heparin after operation; patients in control group without postoperative anticoagulant therapy.Postoperative monitoring platelet count and D-dimer,ultrasound or CT check the presence of portal vein thrombosis.Results Platelet count,D-dimer levels in anticoagulant group and control group in 2 days after operation were significantly increased,the difference was significant compared with preoperative [anticoagulant group:(95.73 ± 28.06) × 109/L vs.(38.41 ± 11.96) × 109/L,(3.61 ± 0.18) mg/L vs.(0.42 ± 0.09) mg/L;control group:(92.56 ± 27.75) × 109/L vs.(35.13 ± 11.38) × 109/L,(3.26 ± 0.16) mg/L vs.(0.37 ± 0.09) mg/L,P ＜ 0.05].Platelet count and D-dimer levels between two groups at preoperative and postoperative in 2 days had no statistical significance (P ＞ 0.05).Ten cases of control group occurred postoperative portal vein thrombosis,anticoagulant group were 3 cases,portal vein thrombosis incidence of anticoagulant group [3.95％ (3/76)] compared with control group [15.62％(10/64)] was statistically significant (P ＜ 0.05).Conclusion Postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension is an effective method to prevent portal vein thrombosis.

A molecular and spatial clustering analysis of active pulmonary tuberculosis patients in Funing county of Jiangsu Province, China / 中华传染病杂志

Objective To describe the distribution and spatial clustering of active pulmonary tuberculosis patients in Funing county of Jiangsu Province,China,and to determine the rules of recent transmission in TB patients and help establish the strategy of TB control with the results of genetic typing of Mycobacterium tuberculosis (M.TB).Methods Newly reported and retreated tuberculosis patients registered in Funing county,Jiangsu Province between Jun 1,2009 and Nov 30,2010 were recruited as research subjects.Geographic information system was applied to analysis the spatial clustering of tuberculosis patients.The M.TB isolates were genotyped by mycobacterial interspersed repetitive units (MIRU).Cluster was defined as two or more patients' M.TB isolates harboring identical MIRU genotype.Results During the study period,there were a total of 681 active pulmonary tuberculosis patients reported.Global Moran's I value and local Moran's I value indicated a random and sporadical manner instead of global spatial clustering of tuberculosis patients in Funing county.Spatial scan statistics (SaTScan) showed that the patients in Guoshu town was statistically significant in spatial clustering (RR=1.85,P=0.036).Among 169 strains of M.TB,27 strains distributed in 12 clusters,which indicated recent transmission among patients within the cluster.Conclusions In rural areas with high tuberculosis incidence,it is less likely to have massive tuberculosis outbreak.Sporadic transmission of tuberculosis may have played an important role in the transmission of tuberculosis in high prevalence area.

Trends and impact factors of drug-resistant tuberculosis in Ningbo from 2007 to 2010 / 中华传染病杂志

Objective To determine the prevalence,trends and risk factors of drug-resistant tuberculosis (TB) in Ningbo during 2007-2010,and to explore the efficient control strategy of drugresistant TB.Methods A cross-sectional study of regional anti-TB drug resistance was conducted in Ningbo.The registered and culture-positive TB patients were enrolled and drug sensitivity test was performed.The demographic and clinical information were collected from the national TB report system.Logistic regression model was used to determine the risk factors of drug resistance.Results Of 1613 enrolled TB patients,39.3％-48.3％ were resistant to any first-line anti-TB drug and 14.0％-19.9％ were multidrug resistant (MDR)-TB.The proportion of new cases resistant to any first-line anti-TB drug was 35.4 ％-42.1％ and MDR TB was 9.8％- 12.2 ％,which were both significantly lower than those of retreated patients (69.5％-72.7％ and 33.9％ - 54.5％,respectively).The multivariate Logistic regression model showed that anti-TB treatment history and migration were significantly associated with any drug resistance (OR=3.298,95 ％ CI 2.391 4.550and OR=0.771,95 ％CI 0.608 - 0.978,respectively) ; while age,treatment history and migration were also significantly associated with MDR-TB.Conclusions Drug-resistant TB prevalence showed a decrease trend in Ningbo,while the resistant rates in both new cases and retreated cases still remain at high levels. Improved case management,including directly observed treatment short-course and appropriate treatment regimens specifically for drug-resistant TB,should be developed to prevent further transmission and development of drug-resistant TB in this setting.