A family cluster of three confirmed cases infected with avian influenza A (H7N9) virus in Zhejiang Province of China.

BACKGROUND: A total of 453 laboratory-confirmed cases infected with avian influenza A (H7N9) virus (including 175 deaths) have been reported till October 2,2014, of which 30.68% (139/453) of the cases were identified from Zhejiang Province. We describe the largest reported cluster of virologically confirmed H7N9 cases, comprised by a fatal Index case and two mild secondary cases. METHODS: A retrospective investigation was conducted in January of 2014. Three confirmed cases, their close contacts, and relevant environments samples were tested by real-time reverse transcriptase-polymerase chain reaction (RT-PCR), viral culture, and sequencing. Serum samples were tested by haemagglutination inhibition (HI) assay. RESULTS: The Index case, a 49-year-old farmer with type II diabetes, who lived with his daughter (Case 2, aged 24) and wife (Case 3, aged 43) and his son-in-law (H7N9 negative). The Index case and Case 3 worked daily in a live bird market. Onset of illness in Index case occurred in January 13, 2014 and subsequently, he died of multi-organ failure on January 20. Case 2 presented with mild symptoms on January 20 following frequent unprotected bed-side care of the Index case between January 14 to 19, and exposed to live bird market on January 17. Case 3 became unwell on January 23 after providing bedside care to the Index case on January 17 to 18, and following the contact with Case 2 during January 21 to 22 at the funeral of the Index case. The two secondary cases were discharged on February 2 and 5 separately after early treatment with antiviral medication. Four virus strains were isolated and genome analyses showed 99.6 ~100% genetic homology, with two amino mutations (V192I in NS and V280A in NP). 42% (11/26) of environmental samples collected in January were H7N9 positive. Twenty-five close contacts remained well and were negative for H7N9 infection by RT-PCR and HI assay. CONCLUSIONS: In the present study, the Index case was infected from a live bird market while the two secondary cases were infected by the Index case during unprotected exposure. This family cluster is, therefore, compatible with non-sustained person-to-person transmission of avian influenza A/H7N9.

Radon natural radioactivity measurements for evaluation of primary pollutants.

Radon is naturally released from the soil into the surface layer of the atmosphere, and by monitoring the natural radioactivity data of radon and its shot-live decay products we can get valuable information about the dilution properties of the lower boundary layer. This paper explores the dispersion characteristics of the lower layer of the atmosphere in Lanzhou, China, and the close relationship with the patterns of primary pollutants' concentrations. Measurements were conducted from July 2007 to May 2008 at one station and a fifty-day campaign was carried out at two stations in Lanzhou. The interpretation of radon radioactivity measurement showed that the measured atmospheric stability index (ASI) data at two stations in Lanzhou had statistically significant correlation, and well described the lower atmospheric layer mixing property in the area. The temporal trend of PM10 data was consistent with the temporal trend of ASI, with almost twice as high values in December than it in August. The results show that the ASI allows to highlight the dilution factor playing an important role in determining primary pollution events, and the mixing properties of the lower boundary layer is the key factor determining PM10 concentration in urban areas.

Prevalence and associated factors of diabetes mellitus among individuals aged 18 years and above in Xiaoshan District, China, 2018: a community-based cross-sectional study.

OBJECTIVE: With the rapid development of the Chinese economy, Xiaoshan District, Zhejiang Province has experienced urbanisation, population ageing and significant lifestyle changes, so diabetes mellitus (DM) has attracted more attention. This study aimed to evaluate the prevalence of DM and its risk factors among individuals aged 18 years and above in the district. STUDY DESIGN AND METHODS: A community-based cross-sectional study was carried out in Xiaoshan, China from 1 March to 31 August 2018. A multistage sampling method was used. Sociodemographic and behavioural characteristics were collected using a combination of centralised surveys and household surveys. Anthropometric parameters were measured with standardised techniques and calibrated equipment. Venous blood samples were obtained after at least 8 hours of fasting to determine the level of fasting blood glucose (FBG) and blood lipids. A standard 2-hour 75 g oral glucose tolerance test was also given if 6.1 mmol/L≤FBG<7.0 mmol/L. Univariate and multivariate logistic regression analyses were used to assess the associated factors of DM. RESULTS: The overall prevalence of DM was 12.47%, and the proportion of previously undiagnosed DM (UDM) was 48.66%. The prevalence of pre-diabetes was 10.92%. Age, family history of DM (FHDM), obesity, abdominal obesity, systolic blood pressure (SBP), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were significantly associated with DM. CONCLUSIONS: This study found a high prevalence of DM and pre-diabetes, especially a high prevalence of UDM among adults. The associated risk factors identified for DM were age, FHDM, obesity, abdominal obesity, SBP, TG and HDL-C.

Atmospheric observations suggest methane emissions in north-eastern China growing with natural gas use.

The dramatic increase of natural gas use in China, as a substitute for coal, helps to reduce CO2 emissions and air pollution, but the climate mitigation benefit can be offset by methane leakage into the atmosphere. We estimate methane emissions from 2010 to 2018 in four regions of China using the GOSAT satellite data and in-situ observations with a high-resolution (0.1° × 0.1°) inverse model and analyze interannual changes of emissions by source sectors. We find that estimated methane emission over the north-eastern China region contributes the largest part (0.77 Tg CH4 yr-1) of the methane emission growth rate of China (0.87 Tg CH4 yr-1) and is largely attributable to the growth in natural gas use. The results provide evidence of a detectable impact on atmospheric methane observations by the increasing natural gas use in China and call for methane emission reductions throughout the gas supply chain and promotion of low emission end-use facilities.

Ambient BTX measurements in Suzhou, China.

Within the Sino-Italian environmental protection cooperation framework established in 2002, a comprehensive air quality monitoring network has been developed in urban Suzhou, a medium-sized Chinese city, in compliance with European standards (Directive 96/62/EC). This paper is among the first attempts to present a systematic and scientific analysis of benzene, toluene, and xylenes (BTX) pollution in China. It presents our analysis of BTX space-related and time-related measurement results. Background BTX concentrations were investigated by passive sampler Analyst(R) in 2003. We depicted the spatial distribution of average BTX concentrations collected from three 15-day campaigns on isoconcentration maps. This is the first time such detailed BTX concentration maps have been developed in China in a city scale. Continuous measurement of BTX by automatic gas chromatography was carried out at two fixed monitoring stations, one in an urban residential zone and one in a heavy traffic zone, from April to December 2005. The results show similar seasonal trends at both sites, the similarities reaching their greatest level in December and their lowest level in August. The average daily profile of BTX shows greater fluctuation in spring and winter with clear morning and evening peaks. Daily average benzene, toluene, and m,p-xylenes concentrations for the study period were 2.64, 11.52, and 3.52 microg m(-3), respectively. The benzene/toluene ratio we found was lower in Suzhou than those published in studies of other worldwide cities, which indicates serious levels of toluene pollution from local stationary sources. The similarities in seasonal trend and spatial distribution in these manual and automatic measurement results were compared with each other, though the concentration values differed.

Classification based on the combination of molecular and pathologic predictors is superior to molecular classification on prognosis in colorectal carcinoma.

PURPOSE: Classification based on a combination of molecular and pathologic predictors had never been done using hierarchical cluster analysis. For this purpose, we identified prognostic classification based on molecular predictors, pathologic and molecular predictors, and compared their respective prognostic efficacy together with that of tumor-node-metastasis (TNM) stage. Moreover, we investigated the prognostic significance of molecular classification in different TNM stage. EXPERIMENTAL DESIGN: Six pathologic predictors (p) and 13 immunohistochemical predictors (m) were investigated in 221 colorectal carcinomas. Unsupervised hierarchical clustering analysis was done to group the data. Survival analysis was done by Kaplan-Meier method and log-rank test, and by multivariate COX proportional hazard model. RESULTS: Six pathologic predictors and four molecular predictors were of significant prognostic value (P

An outbreak of adult measles by nosocomial transmission in a high vaccination coverage community.

OBJECTIVES: The aims of this study were to determine the mechanism of an outbreak of measles in adults and to provide scientific measures for putting forward a measles elimination program. METHODS: We performed a cross-sectional investigation during the measles outbreak to identify a possible communication link. RESULTS: From November 1, 2011 to January 26, 2012, the town reported 11 cases of measles in total. The case study identified an obvious propagation chain, which showed ordered and intimate exposure between cases. CONCLUSIONS: Hospital exposure 1-2 weeks before infection with measles was the main cause of the measles outbreak. We must be fully aware of the possibility of nosocomial infection in an outbreak of measles; controlling nosocomial infections is a vital step in the prevention and control of the propagation of measles.

Associations between hsa-miR-603 polymorphism, lifestyle-related factors and colorectal cancer risk.

BACKGROUND: Accumulated studies have suggested that single nucleotide polymorphisms (SNPs) in microRNAs are associated with risk of colorectal cancer (CRC). OBJECTIVE: We tested our hypothesis that rs11014002 in hsa-miR-603 may be associated with CRC risk with a crosstalk of life-related factors. METHODS: We conducted a case-control study which included 102 CRC patients and 204 matched cancer-free controls in Xiaoshan County. RESULTS: We observed that subjects with rs11014002 CT/TT genotype had an increased susceptibility for CRC (CT vs. CC: odds ratio (OR)=2.352, 95% confidence interval (CI): 1.142-4.840, P=0.020; CT+TT vs. CC: OR=2.031, 95% CI: 1.063-3.883, P=0.032). After stratification by lifestyle-related factors, similar results were found among nonsmokers (CT vs. CC: OR=2.753, 95% CI: 1.085-6.983, P=0.033; CT+TT vs. CC: OR=2.971, 95% CI: 1.188-7.435, P=0.020) and non-alcohol drinkers (CT+TT vs. CC: OR=3.279, 95% CI: 1.071-10.033, P=0.037). CONCLUSIONS: Our data suggest that hsa-miR-603 may be involved in colorectal tumorigenesis, and the genetic polymorphism in hsa-miR-603 is associated with CRC susceptibility.

Particle formation events measured at a semirural background site in Denmark.

The particle formation and growth events observed at a semirural background site in Denmark were analyzed based on particle number size distribution data collected during the period from February 2005 to December 2010. The new particle formation (NPF) events have been classified visually in detail according to 3D daily plots in combination with an automatic routine. A clear seasonal variation was found in the way that events occurred more frequently during the warm season from May to September and especially in June. The mean values of the apparent 6 nm particle formation rates, the growth rate and the condensation sink were about 0.36 cm(-3) s(-1), 2.6 nm h(-1), 4.3 × 10(-3) s(-1), respectively. A positive relationship of oxidation capacity (OX = O3 + NO2) of the atmosphere and the appearance of NPF events was found indicating that the oxidation of the atmosphere was linked to the formation of new particles. An analysis of a 3-day backward trajectories revealed that NW air masses from the North Sea were giving the highest probability of NPF events, namely between 20 and 40 %.

Environmental connections of novel avian-origin H7N9 influenza virus infection and virus adaptation to the human.

A novel H7N9 influenza A virus has been discovered as the causative identity of the emerging acute respiratory infection cases in Shanghai, China. This virus has also been identified in cases of infection in the neighboring area Hangzhou City in Zhejiang Province. In this study, epidemiologic, clinical, and virological data from three patients in Hangzhou who were confirmed to be infected by the novel H7N9 influenza A virus were collected and analyzed. Human respiratory specimens and chicken feces from a contacted free market were tested for influenza virus by real-time reverse transcription PCR (RT-PCR) and sequencing. The clinical features of the three cases were similar featured with high fever and severe respiratory symptoms; however, only one of the patients died. A certain degree of diversity was observed among the three Hangzhou viruses sequenced from human samples compared with other reported H7N9 influenza A viruses. The sequences of the novel avian-origin H7N9 influenza viruses from Hangzhou City contained important amino acid substitutions related to human adaptation. One of the Hangzhou viruses had gained a novel amino acid substitution (Q226I) in the receptor binding region of hemagglutinin. More importantly, the virus sequenced from the chicken feces had a 627E substitution in the PB2 protein instead of the mammalian-adapted 627K substitution that was found in the PB2 proteins from the Hangzhou viruses from the three patients. Therefore, the newly-emerging H7N9 virus might be under adaptation pressure that will help it "jump" from avian to human hosts. The significance of these substitutions needs further exploration, with both laboratory experiments and extensive field surveillance.

rs12904 polymorphism in the 3'UTR of EFNA1 is associated with colorectal cancer susceptibility in a Chinese population.

Accumulated evidence has indicated that Ephrin A1 (EFNA1) is associated with angiogenesis and tumorigenesis in various types of malignancies, including colorectal cancer (CRC). In the current study, we performed an online search using the public microarray database to investigate whether EFNA1 expression might be altered in CRC tissues. We then conducted a case-control study including 306 subjects (102 cases and 204 well-matched controls) in Xiaoshan County to assess any association between genetic polymorphisms in EFNA1 and CRC susceptibility. Searches in the Oncomine expression profiling database revealed EFNA1 to be overexpressed in CRC tissue compared with adjacent normal tissue. The rs12904 G-A variant located in the 3' untranslated region (UTR) of EFNA1 was observed to be associated with CRC susceptibility. Compared with the AA homozygous genotype, those carrying GA genotype had a decreased risk of developing CRC (odds ratio (OR) =0.469, 95% confidence interval (CI): 0.225-0.977, and P =0.043). The association was stronger among smokers and tea drinkers, however, no statistical evidence of interaction between rs12904 polymorphism and smoking or tea drinking on CRC risk was found. Our results suggest that EFNA1 is involved in colorectal tumorigenesis, and rs12904 A>G polymorphism in the 3' UTR of EFNA1 is associated with CRC susceptibility. Larger studies and further mechanistic investigations are warranted to confirm our findings.

The first avian influenza A (H7N9) viral infection in humans in Zhejiang Province, China: a death report.

This study reports the first death caused by a novel avian influenza A (H7N9) virus in Zhejiang Province, China. The patient had chronic hepatitis B and history of exposure to poultry. The patient initially complained of diarrhea and influenza-like symptoms on March 7 and 14 respectively. The disease progressed to severe pneumonia, sustained hypoxia, and coagulation abnormalities. The patient died on March 27 because of respiratory failure, multiple organ failure, and disseminated intravascular coagulation without oseltamivir treatment. This H7N9 virus from Zhejiang is highly similar to isolates obtained from Shanghai, Jiangsu, Anhui, etc. Analysis of hemagglutinin, neuramidinase, and matrix genes indicated that the isolates share the same avian origin, have low virulence, and are sensitive to oseltamivir, but are resistant to adamantine. Only the isolate that caused the fatality exhibited substitution of Q226I in the HA gene, which indicates a potentially enhanced human affinity. The secondary transmission rate was 1.6% (2/125). Only two health workers presented with influenza-like symptoms, and they subsequently tested negative for H7N9 RNA. In conclusion, underlying disease, late diagnosis, and untimely antiviral treatment are possible high-risk factors for infections and death caused by the lowpathogenicity avian influenza A (H7N9). Person-to-person transmission of the H7N9 virus was not detected among close contacts, but such transmission should be investigated in the future. Expanding and enhancing surveillance will help in the early discovery and diagnosis of suspected cases, which will reduce the number of severe cases and deaths.

[Clinical and epidemiological characteristics of the 6 confirmed human cases with novel influenza A (H7N9) virus infection in Zhejiang].

OBJECTIVE: To explore the clinical spectrum, geographic location of human H7N9 avian influenza as well as the characteristics of population at high risk of infection, in order to develop strategies for the prevention and control of the infection. Clinical and epidemiological characteristics on the 6 confirmed human cases in Zhejiang were also analyzed. METHODS: Real-time fluorescent quantitative PCR was used to test the nucleic acid of human H7N9 avian influenza infection, from pharyngeal swabs of the patients and their close contacts. Face to face interview and descriptive method were used to collect related clinical and epidemiological data. Statistical analysis was performed by SPSS 17.0. RESULTS: Six confirmed cases were distributed in Hangzhou and Huzhou cities. The 6 confirmed human cases, including 5 males and 1 female were all confirmed with novel influenza A (H7N9) virus infection, with an average age as 60.83 years (with median as 64.50 years). Cough was the most common initial symptom to be noticed. The clinical manifestations would include fever, dizziness, pain of muscles, coughing, expectoration and short of breath. All the X-ray chest films showed severe pneumonia, and 5 of them having had other chronic diseases. None of the cases admitted to have had a history of exposure to ill/death avians. However, all of the cases had been frequently exposed to the agricultural-byproduct-trading-markets where the positive rate of novel influenza A (H7N9) virus in environmental specimens was up to 43.21%. 32 of the 375 close contacts (8.53%) to the 6 cases appeared abnormal symptoms, but no positive result related to novel influenza A (H7N9) virus nucleic acid was detected from their throat swabs. CONCLUSION: Acute infection on the respiratory system seemed the main clinical manifestation. Elderly men, especially those with chronic diseases were under high risk of human infection with H7N9 avian influenza. The source of infection might be associated with the exposure to poultry. There was still lack of evidence to confirm the route of person to person transmission on H7N9 avian influenza.

Interpretation of ground-level ozone episodes with atmospheric stability index measurement.

PURPOSE: This paper presents a novel approach to interpret ground-level O(3) with the measured atmospheric stability index (ASI). METHODS: O(3) concentrations were monitored by automatic analysers at three types of stations: traffic site, residential site and regional background site in 2005, and the ASI was simultaneously measured by observing radon and its short-lived decay products. RESULTS: The observed results showed a clear annual variation of O(3) concentrations with a maximum in spring, relatively high at the regional background site over 120 ppb, and lower at the residential and traffic sites at about 70 ppb. ASI gives information about the dilution properties of the lower boundary layer and allows to highlight the relevant role of the dilution factor in determining atmospheric pollution events. We demonstrated the analysis of O(3) night peak episodes with vertical wind and ASI. CONCLUSIONS: With the advantage of ASI and vertical wind profiles, it was possible to isolate particular photochemical pollution phenomena of O(3) peaks from the free troposphere reservoir or formed by local reactions. This shows that the index constitutes a powerful and valuable tool for describing O(3) night-peak episodes at background station.

Micropapillary component in colorectal carcinoma is associated with lymph node metastasis in T1 and T2 Stages and decreased survival time in TNM stages I and II.

Colorectal carcinoma with a micropapillary component (MP) is an exceptionally aggressive variant, but has never been investigated in terms of survival analysis. Thirty colorectal carcinomas with a MP were identified from a series of 221 colorectal carcinomas. Carcinomas with and without a MP were compared in terms of histologic and immunohistochemical markers. Colorectal carcinoma with a MP seemed to have a lower differentiation status, increased tumor budding, more frequent lymphovascular and perineural invasion, more frequent lymph node metastasis, higher tumor node metastasis (TNM) stage, and less nuclear beta-catenin staining (P<0.05). Further analysis revealed that the presence of a MP predicted more frequent lymph node metastasis in T1 and T2 stages but not in T3 and T4 stages. Five-year survival rates for patients with a MP and those without were 50% and 73%, respectively. Furthermore, in TNM stages I and II, but not in TNM stages III and IV, a MP was an unfavorable prognostic variable. A MP was demonstrated to be an independent unfavorable prognostic indicator in TNM stages I and II by the multivariate Cox proportional hazard model. Colorectal carcinoma with a MP should be distinguished from colorectal carcinoma of conventional histologic type.

[Study on independent factors on the prognosis of colorectal carcinoma: TNM stage, tumor budding, perineural invasion, peritumoral-lymphocytic infiltration and urine glucose].

OBJECTIVE: To study the influence of clinical and pathological-morphological parameters on the prognosis of colorectal carcinoma. METHODS: Univariate and multivariate Cox proportional hazard model were used to study the influence of clinical and pathological-morphological factors on the prognosis in 226 colorectal carcinoma cases. RESULTS: Using univariate analysis, data showed that the factors significantly related to disease prognosis would include: the depth of direct spread, vessel invasion, perineural invasion, tumor budding, peritumoral-lymphocytic infiltration, Crohn-like reaction, number of positive lymph nodes, distant metastasis, TNM stage and urine glucose. Multivariate Cox proportional hazard model showed that six factors were identified to be associated with higher relative-risk (RR), including: older age, advanced TNM stage, more severe budding, perineural invasion, less peritumoral-lymphocytic infiltration and urine glucose. CONCLUSION: Age, TNM stage, tumor budding, perineural invasive, peritumoral-lymphocytic infiltration and urine glucose were independent predictors to the prognosis of colorectal carcinoma.