[Expression of SIL-2R in Patients with Multiple Myeloma and Its Clinical Significance].

OBJECTIVE: To investigate the expression and clinical significance of soluble interleukin-2 receptor(sIL-2R) in patients with multiple myeloma(MM). METHODS: 54 newly diagnosed MM patients in the Second Affiliated Hospital of Fujian Medical University from February 2020 to December 2021 were selected as the observation group, and 60 healthy people in our hospital in the same period were selected as the control group. The expression levels of sIL-2R in the serum of the two groups were detected by enzyme-linked immunosorbent assay. The differences of sIL-2R expression level among different clinical parameter groups in MM patients were compared. The clinical parameters include:gender, age, ISS stage, hemoglobin, albumin, serum creatinine, lactate dehydrogenase and ß2-microglobulin, blood calcium, bone marrow plasma cell ratio and treatment response. The relationship between sIL-2R expression level and progression-free survival(PFS) and overall survival(OS) in MM patients were analyzed. RESULTS: The expression of serum SIL-2R in MM patients was significantly higher than that in healthy control group (P<0.05). The expression of sIL-2R in MM patients who did not achieve complete remission(CR) was significantly higher than those of CR patients (P=0.037). There was no significant difference in the expression of serum sIL-2R between the groups of different sex, age, ISS stage, hemoglobin concentration, albumin content, serum creatinine level, lactate dehydrogenase level, the content of ß2-microglobulin, the concentration of blood calcium, and the proportion of bone marrow plasma cells(P>0.05). The PFS of sIL-2R high expression group(15 months) was shorter than that of sIL-2R low expression group (22 months), which was significant difference (P=0.041). But there was no significant difference in OS between sIL-2R high expression group and sIL-2R low expression group (P=0.124). Univariate analysis results showed that the high expression of serum sIL-2R was associated with poor PFS in MM patients. Multivariate analysis results showed that the high expression of serum sIL-2R was still an independent adverse prognostic factor for PFS in MM patients, However, the expression of serum sIL-2R was not statistically significant in evaluating OS in MM patients by univariate and multivariate analysis. CONCLUSION: The expression of serum sIL-2R in MM patients was significantly higher than that in healthy people. Serum sIL-2R is an independent prognostic factor of PFS in MM patients.

Secondhand smoking exposure and quality of life among pregnant and postnatal women: a network approach.

OBJECTIVE: This study examined the prevalence of exposure to secondhand smoke, its correlates and its association with quality of life (QOL) among pregnant and postnatal Chinese women. DESIGN: This was a multicentre, cross-sectional study. SETTING: Participants were consecutively recruited from eight tertiary hospitals located in eight municipalities or provinces in China. PARTICIPANTS: A total of 1140 women were invited to join this study and 992 (87.02%) completed all measures. PRIMARY AND SECONDARY OUTCOME: Measures women's secondhand smoking behaviour (frequency and location of exposure to secondhand smoking), and their QOL measured by the WHO Quality of Life Questionnaire. RESULTS: A total of 211 women (21.3%, 95% CI 18.7% to 23.8%) had been exposed to secondhand smoking. Exposure to secondhand smoking was most common in public areas (56.4%), and residential homes (20.5%), while workplaces had the lowest rate of exposure (13.7%). Women with physical comorbidities were more likely to report secondhand smoking exposure, while older women, women living in urban areas, those with college or higher education level, and women in their second trimester were less likely to report exposure to secondhand smoking. Network analysis revealed that there were six significant links between secondhand smoke and QOL items. The strongest negative edge was the connection between secondhand smoke and QOL9 ('physical environment health', edge weight=-0.060), while the strongest positive edge was the connection between secondhand smoke and QOL3 ('pain and discomfort', edge weight=0.037). CONCLUSION: The prevalence of exposure to secondhand smoking is becoming lower among pregnant and postnatal women in China compared with findings reported in previous studies. Legal legislation should be maintained and promptly enforced to establish smoke-free environments in both public and private urban/rural areas for protection of pregnant and postnatal women, especially those who are physically vulnerable and less educated.

Prevalence, correlates, and network analysis of Internet addiction symptoms among Chinese pregnant and postpartum women.

OBJECTIVE: Excessive Internet use is a common health problem globally. This study aimed to assess the prevalence, correlates, and network structure of Internet addiction symptoms (Internet addiction hereafter) among Chinese pregnant and postpartum women. METHODS: This was a multicenter cross-sectional study using Internet Addiction Test (IAT) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate Internet addiction and quality of life (QOL), respectively. Univariate analyses, multivariate logistic regression analyses, and network analyses were performed. RESULTS: Of a total of 1,060 women who completed the study, 320 (30.19%, 95% CI=27.42%-32.96%) women reported Internet addiction during or after pregnancy. Women with previous adverse pregnancy experiences (OR=1.831, P=0.001) and physical comorbidities (OR=1.724, P=0.004) had a higher likelihood of developing Internet addiction. Internet addiction was significantly associated with poor QOL in all domains. Network analyses revealed that IAT item 16 (request an extension for longer time spent online) was the most central symptom in the analyses, and also one of the strongest bridging symptoms linking the Internet addiction and QOL communities. LIMITATIONS: This was a cross-sectional study, all study findings were based on self-reported data, and possible recall bias and selection bias may exist. CONCLUSION: Internet addiction is common among Chinese pregnant and postpartum women, and is significantly associated with lower QOL. Effective strategies, especially focusing on central symptoms, are needed to reduce the impact of Internet addiction and improve QOL in pregnant and postpartum women.

[The Types and Laboratory Characteristics of Non-Hodgkin Lymphoma with Bone Marrow Invasion as the First Manifestation].

OBJECTIVE: To investigate the types and laboratory characteristics of non-Hodgkin lymphoma(NHL) with bone marrow invasion as the first manifestation. METHODS: 81 non-Hodgkin lymphoma patients with bone marrow invasion as the first manifestation treated in our hospital from January 2010 to July 2019 were selected. The clinical features, blood routine, lactate dehydrogenase (LDH), EB virus results, bone marrow features, immunophenotyping, gene and genetic characteristics of all patients were analyzed retrospectivel. RESULTS: Among 81 patients, 73 cases(90%) were B-cell lymphoma, 5 cases(6%) were T-cell lymphoma and 3 cases(4%) were NK/T-cell lymphoma, while the mantle cell lymphoma and diffuse large B-cell lymphoma were the highest, which accounted for 21%(17 cases) and 19.7%(16 cases), and lymphoma accounted for 8.6%(7 cases). There were 44 cases(54.3%) showed B symptoms, 65 cases (80.2%) showed abnormal blood routine. The MYD88 gene was detected in 5 of 17 cases. 25 cases of patients underwent chromosome examination, the result showed that 5 cases were t(8; 14) (q24; q32), 3 cases were complex karyotype and 17 cases were normal karyotype. 23 cases(23.4%) were EB virus positive, 42 cases(51.9%) were LDH increased. The proportion of bone marrow lymphoma cells was 1%-92%. Among them, 32 cases were diagnosed as lymphoma leukemia, and 6 cases of bone marrow lymphoma cells showed mass distribution similar to extramedullary tumor cells with bone marrow metastasis. CONCLUSION: B-cell lymphoma is the predominant NHL with bone marrow invasion as the first manifestation, while mantle cell lymphoma and diffuse large B-cell lymphoma are the most common pathological types with blood routine abnormalities. Bone marrow lymphoma cells can also present clusters of bone marrow metastasis, different types of lymphoma cells can make directional diagnosis.

The Prevalence of Depression and Its Association With Quality of Life Among Pregnant and Postnatal Women in China: A Multicenter Study.

Background: This study examined the prevalence of depressive symptoms (depression hereafter) and its association with quality of life (QOL) among pregnant and postnatal women in China. Methods: In this multi-center, cross-sectional study, 1,060 pregnant and postnatal women from eight hospitals were assessed. Depression and QOL were measured using the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Questionnaire - brief version, respectively. Results: The prevalence of depression was 7.45% (95% CI: 5.87-9.04%) in the sample. Women with depression had lower QOL in physical, psychological, social and environmental domains compared to those without. Women with physical comorbidities were more likely to suffer from depression (OR = 2.391, 95% CI = 1.384-4.130, P = 0.002). Conclusion: Due to its negative association with QOL, increased attention should be paid to depression in pregnant and postnatal women. Regular screening assessment and preventive measures should be adopted to reduce risk of depression in this population.

Rapamycin Alleviates the Symptoms of Multiple Sclerosis in Experimental Autoimmune Encephalomyelitis (EAE) Through Mediating the TAM-TLRs-SOCS Pathway.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). Our research aimed to find an immunomodulatory therapy for MS. An experimental autoimmune encephalomyelitis (EAE) mouse model of MS was established induced with the syntheticmyelin oligodendrocyte glycoprotein peptide 35-55 (MOG35-55). Fifty C57BL/6 mice were randomly divided into the Normal group, EAE group, and Rapamycin group (EAE mice treated with three different doses of rapamycin). Hematoxylin and eosin staining and Weil myelin staining were performed on the brain tissues of mice after 21 days post-immunization. The protein expression of Gas6, Tyro3, Axl, Mer in paraventricular tissues were analyzed by immunohistochemistry. The mRNA and protein expression of Gas6, Tyro3, Axl, Mer, SOCS1, SOCS3, Toll-like receptor (TLR) 3, and TLR4 were detected by quantitative real-time PCR (qRT-PCR) and Western blot, respectively. An enzyme-linked immunosorbent assay (ELISA) was used to detect the secretion of the inflammatory factors IFN-γ and IL-17. Rapamycin treatment could ameliorate the behavior impairment in EAE mice induced by MOG35-55. The expression of Gas6, Tyro3, Axl, Mer, SOCS1, and SOCS3 were decreased in EAE mice at 21 days post-immunization, while the expression of Gas6, Tyro3, Axl, and Mer in rapamycin group was higher than that in EAE group. It was accompanied by an increase in anti-inflammatory proteins SOCS1 and SOCS3, a decrease in the inflammatory proteins TLR-3, TLR-4 and in the amount of IFN-γ, and IL-17. Rapamycin injection relieved the nerve function of and the loss of myelin sheath in the EAE mice, mainly through mediating the TAM-TLRs-SOCS signaling pathway to regulate natural immunity.

[Analysis of Essential Thrombocythemia to Acute Myeloid Leukemia].

OBJECTIVE: To improve the understanding of the transformation of essential thrombocythemia (ET) into acute myeloid leukemia (AML), and to explore the relationship between JAK2 V617F gene mutation and disease transformation. METHODS: The detection of bone marrow morphology,cytogenetics, JAK2 V617F gene were performed before and after transformation, as well as the immunological tests after transformation was performed in 3 patients with ET into AML. The characteristics, clinical features, diagnosis and treatment of the patients before and after transformation were compared. RESULTS: Case 1 transformed into AML-M2a 5 years after diagnosis of ET. The patient abandoned treatment and was discharged from hospital. Case 2 transformed into AML 6 years after diagnosis of ET. After one course of chemotherapy, bone marrow was partially relieved, and platelets continued to rise up to 702×109/L, presenting as ET bone marrow image. One year later, AML relapsed and no remission was observed after chemotherapy. Case 3 transformed into AML-M6a 7 years after diagnosis of ET. The patient abandoned treatment and was discharged from hospital. The morphological heteromorphism of 3 cases of AML transformed from ET was more obvious than that of patients with newly diagnosed acute leukemia. The AML could not be classified accurately based on morphology simply, but could be classified accurately based on immunological detection. JAK2 V617F gene was positive before and after transformation in case 1 and case 2 of ET, the case 3 showed that JAK2 V617F gene was positive at ET stage and negative after AML transformation. Complex chromosome karyotypes were detected by routine karyotype analysis after ET transformation into AML in case 1, while normal karyotypes were found in case 2 and case 3. CONCLUSION: The morphological abnormality of AML transformed from ET is more significant than that of newly diagnosed acute leukemia, and it needs immunological detection to classify it accurately. The transformation of ET into AML may not involve JAK2 V617F gene mutation, but may be related with the occurrence of abnormal chromosome karyotypes. The condition of AML transformed from ET is dangerous and the effect of chemotherapy is poor.

A case of group infections with Paraginimus species in Henan, Central China.

In July of 2012, mass infections with Paragonimus species were detected in the Henan province sickening 11 of 51 people. In May 2011, these individuals had participated in an excursion during which freshwater crabs were caught and served after being toasted. Before the group infections with Paraginimus species was confirmed, 5 of the 11 patients had been misdiagnosed as tuberculosis (TB) and treated with an anti-TB drug regimen for six months. The most common and typical manifestations were eosinophilia (11/11, 100%) and pulmonary manifestations including, among others, stethalgia and cough (7/11 63.6%). Sero-examination revealed that all 11 patients were seropositive for Paragonimus species. Surprisingly, in our case, one patient presented with hemoptysis and eggs in respiratory secretions, and this is the first time P. skrjabini eggs are detected in the sputum of a patient from the Henan province. Paragonimus metacercariae were collected from 6 of 11 (54.5%) crabs caught at the infection site and were identified as Paraginiumus skrjabini by morphological and molecular examinations. Epidemiological and laboratory evidence confirmed that this is a case of group infection with P. skrjabini. As one of the most neglected tropical diseases (NTD), paragonimiasis should be differentiated diagnosed from TB to avoid the delay of treatment. To our knowledge, this is the second report of a case of group infections with Paraginimus species in Henan, Central China. The first case was reported in 1995. As a kind of food-borne parasitic disease, paragonimiasis should be included in the public health education agenda.

[Diagnostic Value of Cytomorphology in Acute Leukemia].

OBJECTIVE: To investigate the diagnostic value of cytomorphology (including cytochemical staining) in newly diagnosed acute leukemia, so as to improve the importance of cytomorphology. METHODS: The clinical data of 119 cases of acute leukemia diagnosed in our hospital from April 2016 to June 2018 were analyzed retrospectively. According to morphologic and immunological typing, accordance rate to final diagnosis was compared. RESULTS: The diagnostic accordance rate of simple morphological typing was 76.5%, and the diagnostic accordance rate of simple immunological typing was 79.8%, the difference of diagnostic coincidence rate was not significant between the two groups of acute leukemia. CONCLUSION: Cytomorphology is the cornerstone of the diagnosis of acute leukemia, it has similar value to immunological classification in the diagnosis of leukemia and should pay enough attention. MICM comprehensive diagnosis can improve the final diagnosis rate, showing a guidance significance for the treatment and prognosis of patients with acute leukemia.

[Analysis of Toxoplasma Gondii Infection Rate in Patients with Hematological Diseases].

OBJECTIVE: To investigate the infection rate of Toxoplasma gondii in patients with hematological diseases. METHODS: The Toxoplasma gondii IgM antibody in 200 patients with hematological diseases were tested, at the same time, IgM antibody in the persons received physical examination and other patients with common clinical diseases also were test, and their detection results were compared. RESULTS: The positive rate of Toxoplasma gondii IgM antibody in patients with hematological diseases was 7.50%, the positive rate in persons received physical examination was 0.67%, and the positive rate in patients with other common clinical diseases was 1.20%. The positive rate of IgM antibody in patients with hematological diseases was statistically significantly higher than that in the latter two kinds of persons(P<0.05). Among the patients with hematological diseases, the positive rate of Toxoplasma gondii IgM antibody in patients with bone marrow neoplastic diseases was 10.32%, which was statistically significantly higher than that in patients with bone marrow non-neoplastic diseases (2.70%). CONCLUSION: Patients with hematological diseases are susceptible to Toxoplasma gondii, and to whom enough attention should be paid.

Analysis of polymorphisms in the circumsporozoite protein gene of Plasmodium vivax isolates from Henan Province, China.

BACKGROUND: Plasmodium vivax malaria has historically been a major source of disease in Henan, China. In the 1970s, the morbidity of malaria was highest in the country. With support from the government and the efforts of healthcare personnel, the reported malaria cases have declined dramatically and a national elimination programme was launched in 2010. To achieve the goal, it is essential to study the diversity of autochthonous malaria and transmission of Plasmodium parasites, which will provide baseline data for disease control and management. METHODS: Thirty-two P. vivax isolates from Henan province were collected from 2008 to 2011, and circumsporozoite protein (csp) genes were analysed to estimate the genetic diversity of this parasite. RESULTS: The assessment of csp sequences indicated that all the isolates were the VK210 type, however, none of them was identical to the VK210 strain. The sequences displayed variations in the central region, and eight sub-types were observed. Among the sub-types, HN7 was the most prevalent (37.5%), followed by HN3 (34.4%). A total of 653 repeat units were discovered in 32 Henan isolates. Nucleotide sequences were grouped in 13 unique repeat nucleotide sequence allotypes that coded for 7 different repeated amino acid allotypes. B (GNGAGGQAA) and D (GDRAAGQPA) were more frequent based on the results; they represented 53.9% (352/653) of the total. In comparison to the basic repeat units of VK210, more than 75% of the central repeat units had at least one non-synonymous nucleotide change. CONCLUSIONS: Recent P. vivax populations in Henan province showed some degree of genetic diversity in csp, with 8 sub-types among 32 samples. Meantime, the results also suggested its relative conserved parasite populations. This could provide interesting baseline data that allow identifying whether potential new cases differ from the parasites already circulating in the area.

[Effects of aqueous extracts of gecko on stemness of hepatocellular carcinoma].

To explore the effects and mechanism of aqueous extracts of gecko on cancer stem cells properties of hepatocellular carcinoma. In vitro, MTT assay was used to detect the cells growth in Huh7 and Hep3B. Spheroid-forming assay and flow cytometry were performed to observe the the stemness of Huh7 and Hep3B cells. The protein expressions of ß-catenin, CD44, c-Myc, CCND1, Sox2, Oct4, Nanog and ABCG2 were detected by Western blot. Interacting proteins were detected by co-immunoprecipitation; and a subcutaneous xenograft model was used to detect the stemness of hepatoma carcinoma cells. The results indicated that aqueous extracts of gecko induced cell growth inhibition in a dose- and time-dependent manner, with the IC50 of (0.750±0.112) g•mL⁻¹ for Huh7 and (0.454±0.039) g•mL⁻¹ for Hep3B, respectively. The number and size of tumor spheres formed by hepatoma carcinoma cells were decreased after treatment by aqueous extracts of gecko(P<0.05); the proportions of cells staining with putative markers for cancer stem cells, such as CD133 and CD44, were decreased(P<0.05). After treatment with aqueous extracts of gecko, the expression levels of ß-catenin, CD44, c-Myc, CCND1, Sox2, Oct4, Nanog and ABCG2 were decreased. Co-immunoprecipitation results showed that the aqueous extracts of gecko could inhibit the interaction between LRP6 and Frizzled6, indicating that the aqueous extracts of gecko could inhibit the proliferation of hepatoma cells, the formation of tumor spheres and the proportion of tumor stem cells, and inhibit the Wnt signaling pathway by targeting LRP6 to prevent the formation of LRP6 and Frizzled6 complexes.

[Polymorphisms of tryptophan-rich antigen gene of Plasmodium ovale subspecies from imported malaria cases in Henan Province].

Objective: To analyze the genetic sequence of tryptophan-rich antigen (PoTRA) gene of Plasmodium ovale subspecies from imported malaria cases in Henan Province in 2015. Methods: Blood samples were collected from 22 imported ovale malaria cases in Henan Province in 2015. After DNA extraction, PoTRA was amplified by nested PCR, and was inserted into the pMD18-T vector. The plasmid was extracted and sequenced, and the results were blasted in GenBank to determine the subspecies of P. ovale. The sizes and species of the PoTRA gene were analyzed. The amino-acid sequence of PoTRA was also aligned to analyze the difference in amino acid sequence. The phylogenetic tree was constructed to analyze the genetic relationship among the samples by neighbor-joining. Results: Of the 22 imported cases, eight (36.4%) were infected with P. ovale wallikeri, which had two sizes, the predominant 245 and 299 bp. The other 14 cases (63.6%) were infected with P. ovale curtisi, which had three sizes, the predominant 299, 317 and 335 bp. Amino-acid sequence alignment revealed that the two types of P. ovale wallikeri differed in two amino-acid units, MANPINMANPIN and AITPIN, while the three types of P. ovale curtisi differed in amino-acid units TITPIS and TINPIN. The phylogenetic tree showed that the 22 samples belonged to two subpopulations of P. ovale curtisi and P. ovale wallikeri, wherein the P. ovale curtisi was further divided into two sub-branches, and samples with sizes of 317 and 335 bp were in the same sub-branch with a closer genetic relationship. Conclusion: Two subspecies, P. ovale curtisi and P. ovale wallikeri, are identified from the imported ovale malaria cases in Henan Province in 2015. The P. ovale curtisi has three genetic types and P. ovale wallikeri has two genetic types of PoTRA gene, revealing genetic polymorphisms of PoTRA.

[Medical Costs on Malaria in Henan Province and Analysis of the Influential Factors].

Objective: To analyze the costs for the diagnosis and treatment of malaria in Henan Province and the influential factors. Methods: Malaria cases diagnosed in and reported by medical institutions in Henan Province from November 2013 to October 2014 were selected. General information and clinical information of those with further microscopic confirmation were also collected. The rank sum test for two or more independent samples and stepwise regression analysis were used to investigate the influential factors for medical costs. Results: A total of 218 malaria cases were finally included, of whom 73.4% were from rural areas. On average, the medical costs for patients from rural areas and cities/towns were 1 503 yuan and 4 833 yuan respectively. The average medical cost per patient with first-visit in rural hospitals was 2 600 yuan, and that with first-visit in provincial hospitals was 7 800 yuan. The average medical costs for patients diagnosed in county/city-level hospitals and provincial hospitals were 1 022.5 yuan and 6 170 yuan, respectively. There was null cost for patients diagnosed at the first-visit, while for those diagnosed after 3 or more visits the average cost per patient was 5 621 yuan. Factors significantly associated with medical costs were the current living locality of patients, the hospital level of first-visit, the hospital level of diagnosis and the number of visits before diagnosis（P＜0.05）. Stepwise regression analysis showed that the hospital level of first-visit was the most important influential factor for medical cost, followed by the hospital level of diagnosis and the number of visits before diagnosis. The higher hospital levels of first-visit and diagnosis, the higher cost. The same applied to the number of visits before diagnosis. Conclusion: There is an considerable correlation between medical cost and health seeking behavior in malaria patients.

[ Effect of Malaria Prevention and Control in Henan Province from 2010 to 2014].

During 2010-2014 a total of 1 779 malaria cases were reported in Henan Province, including 958 indigenous cases, and 821 imported cases, with 12 deaths. No indigenous malaria cases were reported during 2012-2014, but the number of imported cases showed a trend of increase, rising from 106 cases in 2010 to 216 in 2014. Blood examination was conducted in 5 210 428 patients with fever during 2010-2014. A total of 4 829 anophelines were captured, of which 4 741 were Anopheles sinensis and 88 were Anopheles anthropophagus. A total of 28 067 patients were given pre-transmission medications. In addition, 3 112 staff for Plasmodium microscopical examinations and 783 epidemiological researchers received training in the five years. Seventy-two counties (cities, districts) passed the evaluation for malaria elimination. Future work should focus on the enhancement of inspection and management of imported malaria to prevent its further dissemination and to achieve the final goal of malaria elimination in the province.

[The Role of Medical Institutions in the Control of Imported Malaria Since the Initiation of Malaria Elimination Program in Henan Province].

Objective: To retrospectively overview the diagnosis and treatment of malaria during 2010-2014 in Henan Province and understand the role of medical institutions in imported malaria control. Methods: Information on malaria epidemic situation as well as its diagnosis and treatment during 2010-2014 in Henan Province was collected from the infectious disease surveillance system and information management system for the prevention and treatment of parasitic disease. Descriptive analysis was performed to determine the role of medical institutions in the reporting, diagnosis and treatment of malaria. Results: A total of 821 imported malaria cases were reported during 2010-2014 in Henan Province, among whom 12 died, with a case fatality rate of 1.7%. The 12 deaths were all due to falciparum malaria and from Africa. The number of cases reported by medical institutions and disease control agencies were 432（52.6%） and 389（47.4%）, respectively. Among the 569 imported malaria cases with diagnosis records, 380 were determined to be malaria at first-diagnosis, with a diagnostic accuracy of 66.8%（380/569）. The accuracy of first diagnosis by medical institutions（49.2%, 178/362） was significantly lower than that by disease control agencies（97.6%, 202/207）（χ2=139.147, P<0.01）. The accuracy of first diagnosis by medical institutions at the town-ship level or below, the county level, the city/prefecture level and the provincial level was 14.2%（18/127）, 43.4% （23/53）, 73.6%（67/97） and 76.9%（70/91）, respectively（χ2=112.764, P<0.01）. However, there was no significant difference in the accuracy among disease control agencies of the above levels（χ2=0.380, P＞0.05）. The cases diagnosed by medical institutions and disease control agencies constituted 48.9%（278/569） and 51.1%（291/569）, respectively, with no significant difference（χ2=0.594, P＞0.05）. In addition, the cases diagnosed by medical institutions at the town-ship level or below, the county level, the city/prefecture level and the provincial level constituted 1.2%（7/569）, 3.7%（21/569）, 12.5%（71/569） and 31.5%（179/569）, respectively（χ2=299.143, P<0.01）. Similar results were also obtained for disease control agencies of the above levels（χ2=91.569, P<0.01）. Conclusion: There are considerable differneces of the first diagnosis accuracy and the diagnosis rate among medical institutions of different levels. Medical institutions of lower levels, which establish a diagnosis mainly based on microscopic examination, have lower diagnosis rate than the disease control agencies at same levels.

[Results of Soil-transmitted Nematode Monitoring in Henan Province in 2011-2015].

To understand the endemic situation of soil-transmitted nematodiasis (Ascaris lumbricoides, Trichuris trichiura and Ancylostoma sp.) in Huaiyang County, Henan Province. Over 1 000 fecal samples from inhabitants in Huaiyang County of Henan Province were collected each year during 2011-2015, in which the soil-transmitted nematodes eggs and other intestinal helminth eggs were examined by Kato-Katz technique. The helminth-positive samples were examined by filter paper culture method to identify the species of hookworm. The cellophane swab method was used to detect Enterobius vermicularis eggs in children aged 3～12 years. Soil samples were collected from vegetable field, lavatory, courtyard and kitchen of 10 families randomly selected in each year to examine Ascaris eggs by a modified saturated sodium nitrate floatation method. In 2011-2015, 5 229 people were examined and 54 person infected with intestinal helminths were found. Five intestinal helminthes, A. lumbricoides, T. trichiura, Ancylostoma duodenale, Enterobius vermicularis and Trichostrongylus orientalis were found with 13, 2, 9, 29 and 1 infection person respectively. All showed mild infection and no multiple infections were found. There was no significant difference between the year 2015 which had the highest soil-transmitted nematode infection rate 0.6%（7/1 134） and the year 2013 which had the lowest infection rate 0.3%（3/1 037）（P>0.05）. The infection rate of intestinal helminths was highest in group of <10 years（2.8%, 25/905）, followed by the groups of >70 years（1.6%, 4/256） and 30～40 years（1.2%, 8/671）（P>0.05）. The average infection rate of E. vermicularis was 1.8%（18/993） The infection rate of E. vermicularis was relatively higher in kindergarten kids（1.6%, 6/366） and students（1.3%, 13/1 005） than that in farmers（0.3%, 10/3 782）（P<0.01）. No Ascaris eggs were found in the 200 randomly collected soil samples. The intestinal helminth infection status maintaines at low level in Henan Province during 2011-2015.

[The Impact of the Malaria National Strategy Application Program of the Global Fund on Malaria Elimination in Henan Province].

Objective: To analyze the impact of the national strategy application （NSA） program of the global fund on malaria elimination in Henan Province. Methods: The internal control system on project, fund and supplies was developed to ensure the normalized implementation of NSA program in Henan Province. The multi-channel communication platform including telephone, e-mail and so on was established for data's progressively reporting, review and summary. The training, supervision and assessment were implemented to ensure that the data was real and correct. The data derived from the NSA program and other project involved with malaria control in the Province from 2009 to 2012 was collected and compared. Changes on human resources, financial input, supplies purchasing and the main malaria control measures before and after the implementation of the program were analyzed. Results: A total of 29.72 million yuan financial support which accounted for more than half of the total financial input on malaria control at the same time in the Province was provided by the NSA program. A total of 3 966 microscopists and 61 415 health workers from primary health care received skill training on malaria dectection and control. After implementation of the program, there was an increase in the diagnosis rate by blood test from 2009 （45.67%, 738/1 616） to 2012 （99.36%, 155/156） （χ2=161.91. P＜0.01）. The malaria incidence showing a step-wise decline from 2009 to 2012 which were 1.71/100 000, 0.94/100 000, 0.34/100 000 and 0.17/100 000 respectively, with an increase in imported cases（χ2=1 310.70, P＜0.01） and no report of indigenous malaria cases in 2012, for the first time. The reported cases in counties of the NSA program during 2009-2012 constituted 98.08%（1 585/1 616）, 92.75% （831/896）, 80.25% （252/314） and 67.31% （105/156） of all malaria cases reported in that year in the Province （χ2=300.38, P＜0.01）. The awareness rates on malaria prevention and treatment among residents and students were 94.65% （25 246/26 673） and 93.73% （16 328/17 421） in 2012, both significantly higher than the baseline in 2009 （63.88%, 5 755/9 009; 53.39%, 3 170/5 937） （χ2=5 594.01, P＜0.01; χ2=5 221.53, P＜0.01）. Conclusion: The implementation of the NSA program has motivated the elimination of malaria in Henan Province.

[The associations between idiosyncratic adverse drug reactions and HLA alleles and their underlying mechanism].

With the advent of Twenty-First century, more and more genome-wide association studies (GWAS) showed that idiosyncratic adverse drug reactions (ADRs) were closely related with human leukocyte antigen (HLA) alleles, such as the associations of abacavir-HLA-B*5701, allopurinol-HLA-B*5801, and carbamazepine-HLA-B*1502, etc. To explore the mechanisms of these idiosyncratic drug reactions, hapten hypothesis, danger signal hypothesis, pharmacological interaction (P-I) concept and autoimmune mechanism are proposed. In this paper, recent GWAS studies on the HLA-mediated adverse drug reactions and underlying mechanism are reviewed in detail.

[Treatment of diabetic foot by clearing heat, detoxification, activating blood, and dredging collaterals method].

OBJECTIVE: To study the mechanism of treating diabetic foot by clearing heat, detoxification, activating blood, and dredging collaterals method. METHODS: Sixty diabetic foot patients were randomly assigned to the treatment group and the control group, 30 cases in each group. On the basis of the same routine treatment, patients in the treatment group were treated by Qingjie Tongluo Recipe (QTR) plus external washing of Chinese herbs plus external dressing by herbs with removing necrosis and promoting granulation actions, while those in the control group were treated with routine aseptic external dressing. Three months was taken as one therapeutic course. The wound area and basic fibroblast growth factor (bFGF) were detected before and after treatment. The content of vascular endothelial growth factor (VEGF), the peripheral vascular and nerve functions were also measured. The therapeutic effects were also observed. RESULTS: After treatment, in the treatment group,15 patients were cured, 12 markedly effective, 2 effective, 1 ineffective, the cure rate was 50.0% and the total effective rate was 96.7%, while in the control group, 9 cases were cured, 6 markedly effective, 8 effective, 7 ineffective, the cure rate was 30.0% and the total effective rate was 76.7%. The total effective rate was better in the treatment group than in the control group (P <0. 01). The contents of bFGF and VEGF were significantly higher in the two groups after treatment (P <0.01). Besides, better results were obtained in the treatment group (P < 0.01). The blood flow speed of the dorsalis pedis artery, the inner diameter of the dorsalis pedis artery, and the common peroneal nerve conduction velocity were somewhat improved (P <0.05, P <0.01). Besides, better results were obtained in the treatment group (P <0.01). CONCLUSIONS: QTR combined external washing plus external dressing by herbs with removing necrosis and promoting granulation actions could promote the healing of diabetic foot induced ulcers, improve the vascular and nerve functions. Its efficacy was superior to that of the control group.