Association between serum trace elements and dyslipidemia： a community-based cross-sectional study / 上海预防医学

Objective:To investigate the association between serum trace elements and dyslipidemia in Pudong New Area. Methods:A community-based cross-sectional study was carried out. A stratified， cluster sampling approach was used for sampling. In total 1 814 community residents aged above 35 years old were recruited in Pudong New Area， Shanghai. A face-to-face investigation was conducted and blood samples were collected. Serum levels of 16 trace elements， including boron， vanadium， chromium， manganese， iron， cobalt， nickel， copper， zinc， arsenic， selenium， strontium， molybdenum， tin， antimony， and barium were measured by inductively coupled plasma mass spectrometry （ICP-MS）. The relationship between serum trace elements and dyslipidemia was analyzed with single and multiple Logistic regression models. Results:Prevalence of dyslipidemia is higher among participants of more than 45 years old with high BMI， hypertension or diabetes．Serum iron leveled the highest， followed by copper， zinc， selenium， strontium， boron and other trace elements. After adjusting for potential confounders， the odds ratios of dyslipidemia associated with the highest quartile of trace elements concentrations were 1.41 （95%CI： 1.12-1.78）， 0.77 （95%CI： 0.61-0.96）， 1.65 （95%CI： 1.31-2.09）， 1.27 （95%CI： 1.02-1.58）， and 1.32 （95%CI： 1.06-1.66） for chromium， cobalt， zinc， arsenic， and tin， respectively， compared with that associated with the other three quartiles. Conclusion:Some serum trace elements are potentially associated with dyslipidemia in community residents.

Association between sleep quality and risk of acute exacerbation of mild and moderate chronic obstructive pulmonary disease： a community-based prospective study / 上海预防医学

Objective:To investigate the association between sleep quality and the risk of acute exacerbation in mild and moderate chronic obstructive pulmonary disease （COPD） patients in Pudong New Area of Shanghai. Methods:This was a prospective study involving eligible mild and moderate COPD patients from 10 communities randomly selected in Pudong New District of Shanghai. A structured questionnaire was used to collect demographic characteristics， clinical information and information on acute exacerbation. Sleep quality was assessed using the Pittsburgh Sleep Quality Index （PSQI） in Chinese. Multiple negative binomial regression was used to estimate the association between sleep quality and risk of exacerbation. Results:Altogether 212 mild/moderate COPD patients participated and completed the entire survey， of whom the majority （95.8%） were mild COPD patients， 110 persons female and over half （54.2%） over 65 years old. 32.9% of the patients had poorer sleep quality at baseline. 18.9% of the patients reported exacerbation over the past year during follow-ups. Multiple negative binomial regression suggested that increased PSQI was related to higher risk of exacerbation （RRad=1.12， 95%CI：1.02-1.24）， and patients with poorer sleep efficiency had a higher risk of exacerbation （RRad=1.66， 95%CI：1.17-5.43）. Conclusion:Poorer sleep quality is associated with a higher risk of exacerbation in community mild/moderate COPD patients， especially in those with problem of sleep efficiency. More attention to sleep disorders is warranted in community management or self-management of patients with COPD.

Etiology and epidemiological characteristics of gastroenteritis virus in food-borne diarrhea from three cities in Shandong Province, 2017 / 中华预防医学杂志

To analyze the etiology and epidemiological characteristics of gastroenteritis virus in foodborne diseases from three cities in Shandong. From January to December 2017, six sentinel hospitals in Jinan, Yantai and Linyi city of Shandong Province were selected as the research sites. Stool samples of 1 397 diarrhea patients were collected, as well as basic information and clinical symptoms. Duplex quantitative RT-PCR was used to detect Norovirus genogroupⅠ (Nov GⅠ) and genogroupⅡ (Nov GⅡ), Sapovirus (SAV) and Human astrovirus (HAstV), respectively, quantitative RT-PCR was used to detect group A Rotavirus (RVA), and quantitative PCR was used to detect Enteric adenovirus (EAdV). The specific gene of the virus were sequenced and typed. It was compared that the gastroenteritis virus rate in cases with different characteristics and the clinical symptoms difference between the virus positive and negative cases. The median age ((25), (75)) was 23 (1, 42) , mainly male, 57.48% with 803 cased and children under 5 years old, 36.36% with 508 cases. The positive rate of gastroenteritis virus was 33.93% (474 cases), and that of Jinan, Linyi and Yantai City were 32.03% (147/459), 41.54% (189/455) and 28.57% (138/483), respectively (0.001). Nov GⅡ had the highest positive rate, 16.54% (231 cases), which, mainly GⅡ.P16/GⅡ.2 (48.28%, 56/116), peaked in May (24.75%, 50/202) and June (19.59%, 38/194). In patients of gastroenteritis virus positive, 44.51% (211/474) had vomiting symptoms, higher than that of patients of gastroenteritis virus negative (34.13%, 315/923). The difference was statistically significant (0.001). In Shandong Province, the majority of gastroenteritis patients were male and children under 5 years old. Nov GⅡ possessed highest epidemic intensity, and peaked in spring and summer. Viral gastroenteritis had atypical clinical symptoms.

Superficial siderosis of the central nervous system caused by myxopapillary ependymoma of conus medullaris and cauda equine: a case report and literature review / 北京大学学报(医学版)

Superficial siderosis of the central nervous system (SSCNS) is a rare disorder caused by hemosiderin deposits in the subpial layers of the brain and spinal cord due to prolonged or recurrent low-grade bleeding into the cerebrospinal fluid (CSF). Central nervous system tumor could be one of the sources of bleeding. Some problems exist at present regarding the diagnosis and treatment of SSCNS in China. On account of fewer cases, the insufficient awareness of the condition, and the lack of long-term follow-up data, enough attention has not been paid to etiological diagnosis. The speculative high rate of missed diagnoses of SSCNS indicates a great disparity in the treatment from the world's advanced level. Related data of clinical and basic research need to accumulate as soon as possible to promote the clinical diagnosis and treatment of the disease. The progressive neurological deficits are involved in the typical clinical manifestations of SSCNS with a triad of bilateral symmetrical sensorineural hearing loss, cerebellar ataxia and signs of corticospinal tract dysfunction. Nevertheless, there are few patients with the triad signs at the same time, which lead to a delayed diagnosis or misdiagnosis. Detection of this disease was commonly post-mortem until the advent of MRI with signal and location characteristics, which made diagnosis easier. Siderosis appears as a hypointense rim covering the surface of the cerebellum, the brain stem, the spinal cord, similar to a black pencil line, thin on SE-T2-weighted images, thick and conspicuous on GE-T2-weighted images or on susceptibility-weighted imaging (SWI). The only effective way of treating the disorder is to identify the source of bleeding and remove it. MR examination is useful for seeking a source of bleeding too. Therefore, once superficial siderosis is considered, lesions of the central nervous system must be searched using MRI of the brain and spine. We report here a 37-year-old male diagnosed of SSCNS with the classical clinical symptoms of cerebellar ataxia, sensorineural hearing loss and myelopathy. T2-weighed MRI showed characteristic marginal hypo-intensity around the central nervous system. Etiological explorations revealed a large conus medullaris / cauda equina ependymoma filling the lumbosacral spinal canal, a myxopapillary ependymoma (MPE) confirmed by surgical resection and histopathological examination. The related literature was reviewed to ascertain the mechanism of SSCNS secondary to MPE, and to discuss the pathogenesis, clinical features, diagnosis and treatment of SSCNS. This paper aims to improve the awareness of SSCNS and diagnostic level, and to lay stress on the etiological explorations that is beneficial to the development of exact treatment plan.

Efficacy and safety of Wanfeile in the treatment of erectile dysfunction: Report of 100 cases and review of the literature / 中华男科学杂志

Objective@#To investigate the clinical effect and safety of Wanfeile in the treatment of erectile dysfunction (ED).@*METHODS@#Totally 100 ED patients received oral Wanfeile at 100 mg, once every 3 days, for a course of 3 months. We compared the IIEF-5 scores of the patients before and after medication and among the patients with different degrees of ED. We evaluated the total clinical effectiveness of Wanfeile and analyzed adverse reactions.@*RESULTS@#The total effectiveness rate of Wanfeile was 95.6%. All the patients showed significant improvement in the IIEF-5 scores after treatment as compared with the baseline (P <0.05). Adverse reactions were observed in 5 cases (5.50%), all mild and transient.@*CONCLUSIONS@#Wanfeile is safe and efficacious for the treatment of ED.

Gene-metabolite network analysis in different nonalcoholic fatty liver disease phenotypes

We sought to identify common key regulators and build a gene-metabolite network in different nonalcoholic fatty liver disease (NAFLD) phenotypes. We used a high-fat diet (HFD), a methionine-choline-deficient diet (MCDD) and streptozocin (STZ) to establish nonalcoholic fatty liver (NAFL), nonalcoholic steatohepatitis (NASH) and NAFL+type 2 diabetes mellitus (T2DM) in rat models, respectively. Transcriptomics and metabolomics analyses were performed in rat livers and serum. A functional network-based regulation model was constructed using Cytoscape with information derived from transcriptomics and metabolomics. The results revealed that 96 genes, 17 liver metabolites and 4 serum metabolites consistently changed in different NAFLD phenotypes (>2-fold, P<0.05). Gene-metabolite network analysis identified ccl2 and jun as hubs with the largest connections to other genes, which were mainly involved in tumor necrosis factor, P53, nuclear factor-kappa B, chemokine, peroxisome proliferator activated receptor and Toll-like receptor signaling pathways. The specifically regulated genes and metabolites in different NAFLD phenotypes constructed their own networks, which were mainly involved in the lipid and fatty acid metabolism in HFD models, the inflammatory and immune response in MCDD models, and the AMPK signaling pathway and response to insulin in HFD+STZ models. Our study identified networks showing the general and specific characteristics in different NAFLD phenotypes, complementing the genetic and metabolic features in NAFLD with hepatic and extra-hepatic manifestations.

An investigation on the situation of disability and its influencing factors among the elderly in community / 预防医学

Objective To learn the status of disabled elderly in community,and to analyze the influencing factors on activities of daily living. Methods With the method of cluster stratified random sampling, a self -designed questionnaire and Modified Barthel Index (MBI)was used in investigation of survival status and activities of daily living (ADL)of the elderly in community of Sijiqing Street,Jianggan District,Hangzhou City,and the logistic regression model was used to analyze its influencing factors.Results A total of 883 valid questionnaires were completed and analyzed,and 1 91 interviewees was found to be with disability according to the disability standards with the percentage 21 . 6%.Logistic regression analysis suggested that age(OR=4. 99,95%CI:4. 52-5. 66),chronic disease situation(OR=2. 1 9,95%CI:1. 74-2. 72),stroke(OR=3. 78,95%CI:2. 65 -5. 06),osteoarthritis(OR=1. 87,95%CI:1. 55 -2. 39),chronic bronchitis(OR=2. 1 7,95%CI:1 . 73-2. 91 ),visual(OR=1 . 73,95%CI:1 . 37 -2. 28),dementia(OR=1 . 92,95%CI:1 . 23-2. 69 ),lumbocrural pain (OR =2. 04,95%CI:1 . 47 -2. 89 )were the risk factors of disability.Educational background(OR=0. 87,95%CI:0. 82-0. 95),income(OR=0. 81 ,95%CI:0. 76 -0. 87),outdoor activity(OR=0. 69, 95%CI:0. 63-0. 81 ),physical exercise(OR=0. 67,95%CI:0. 56 -0. 79)were protective factors.Conclusion The status of disabled in community of Hangzhou affected by various factors,and it is necessary to provide them health management and comprehensive intervention.

Seroprevalence of the newer enterovirus types A71, A90 and B87 in healthy individuals in Shandong Province, China / 病毒学报

This study aimed to investigate antibody levels of the newer human enteroviruses (EV) A71, A90, and B87 in the population of Shandong Province, and provide a scientific basis for the development of prevention and control measures. In this study, serum specimens were collected from 400 individuals living in Yantai city, Shandong Province in 2010. EV-A71, A90, and B87 antibodies were detected using neutralization tests, and the results were analyzed by statistical methods. It was found that the positive neutralizing antibody rates of EV-A71, A90 and B87 in the population were 46.0%, 8.8%, and 47.0%, respectively. Their geometric mean titers (GMT) were 1 : 5.20, 1 : 1.49, and 1 : 4.02, respectively. Positive antibody rates for EV-A71 and EV-B87 were lowest in the 1-yr and 7-mo age groups, respectively. Positive rates increased gradually with age, and become consistent in the population aged >5 years. Positive antibody rates of EV-A90 were consistent across all age groups. Maternal antibody levels of EV-A71 declined rapidly after birth, and the increase in seroprevalence among 3-7 years old children implied that most EV-A71 infections occurred in preschool and early elementary school children. High positive antibody rates of EV-B87 in healthy individuals, especially children, implied that there may be an immune barrier within the general population. The population monitoring of EV-A90 should be strengthened, as its positive antibody rate is low.

Research on UPLC-PDA fingerprint of andrographis paniculata and quantitative determination of 4 major constituents / 中国中药杂志

Andrographis paniculata from different parts and origins were analyzed by UPLC-PDA fingerprint to provide refererice for related preparation technology. Using the peak of andrographolide as reference, 27 common peaks were identified, and digitized UPLC-PDA fingerprints for 23 batches of andrographis paniculata were established in this research. Principal component analysis (PCA) was carried out after feature extraction. The contents of andrographolide, neoandrographolide, deoxyandrographolide, dehydroandrographolide were determined by external standard method. The Plackett-Burman design combined with pareto chart was used to analyze the factors influencing the robustness of the method. It was found that the medicinal part has a more remarkable influence on the quality of andrographis paniculata than the origin. The contents of the 4 lactones the differ greatly in the different parts of andrographis paniculata, and the pH of the mobile phase is an important factor that influenced the robustness of the method.

Analysis of characteristics of whole-genome of influenza A H1N1 virus in Qingdao between year 2009 and 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate characteristics of the whole-genome of influenza A H1N1 virus circulated in Qingdao from year 2009 to 2011.</p><p><b>METHODS</b>RNA of 35 influenza A H1N1 virus isolates circulated in Qingdao between year 2009 and 2011 was extracted and all segments were amplified by RT-PCR. The sequence was then detected and assembled by software Sequencher.25 HA full-length sequences published on GenBank were selected as reference. While MEGA 5.0 software package was explored for phylogenetic analysis to characterize the molecular feature with reference to the whole-genome sequence and the hemagglutinin (HA).1068 HA sequences of influenza A H1N1 virus isolated worldwide from August 2010 to March 2011 were downloaded for amino acid mutation analysis.</p><p><b>RESULTS</b>On the HA genes phylogenetic tree, the virus were separately divided into 4 clades in 2009-2010 and 2010-2011 surveillance season, each with a preponderant epidemic clade. The homogeneity of nucleotide and amino acids of HA isolates were 99.6%-99.9% and 99.1%-99.8% respectively in 2009-2010 surveillance season; 99.1%-99.6% and 98.2%-99.1% respectively in 2010-2011 surveillance season. The homogeneity of nucleotide and amino acids of the preponderant isolates were separately 98.8%-99.8% and 98.0%-99.6%. Compared with the vaccine strain, there were separately 14 and 12 variant amino acids of virus HA in the two surveillance season, involving 10 antigen sites and 5 positive selected sites. The sequence analysis of neuraminidase protein showed that the positions 247, 274 presented serine and histidine(S247, H274) respectively. The sequence analysis of M2 protein showed that the isolated A H1N1 viruses presented asparagine in amino acid site 31 (N31).</p><p><b>CONCLUSION</b>All the A H1N1 influenza virus circulated in Qingdao from year 2009 to 2011 presented continual variation and therefore caused antigenic drift. All the isolations were adamantane-resistance, but susceptible to inhibitors of neuraminidase.</p>

Isolation and characterization of a human enterovirus 74 isolated in Shandong Province, China / 病毒学报

Human Enterovirus HEV 74 is a new member of species Human enterovirus B (HEV-B). To understand its evolution and restructuring characteristics, we report the complete genome sequence of a HEV74 strain 05293/SD/CHN/2005(abbreviated as 05293) isolated from an acute flaccid paralysis (AFP) case in Shangdong Province, China, 2005. Analysis of the complete genomic sequence of 05293 showed that its genome was collinear with that of previously described 2 HEV74 strains, except for insertions and deletions at the 5'NTR and the 3 NTR regions. The complete genome sequence of strain 05293 displayed 80. 8% nucleotide and 96% amino acid identity to the prototype strain USA/CA75-10213, and 80. 6% and 95. 9% to another isolated strain Rikaze-136. The P1, P2 and P3 coding regions of strain 05293 displayed 81. 5%, 80. 0%, 79. 7% nucleotide and 95. 9%, 96. 0%, 96.2% amino acid identity to the prototype strain USA/CA75-10213, and 81. 9%, 78. 8%, 79. 5% and 95. 9%, 96. 1%, 95. 7% to strain Rikaze-136, respectively. The phylogenetic tree and Simplot analysis on 05293 and HEV-B genome sequences were performed, and the result indicated frequent recombination within HEV-B.

Analysis of evolution features of whole genome of influenza virus H3N2 in Qingdao between year 2007 and 2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the evolution features of whole-genome of influenza virus H3N2 prevalent in Qingdao from year 2007 to 2011.</p><p><b>METHODS</b>The RNA of 58 strains of influenza virus H3N2 prevalent in Qingdao between 2007 and 2011 was extracted and all segments amplified by RT-PCR. The sequence was then detected and assembled by software Sequencer. A total of 589 strains of influenza virus H3N2 with more than 300 amino acid recorded by GenBank were selected. The phylogeny and molecular features of all gene segments were analyzed by software Mega 5.0, referred by the heavy chain of hemagglutinin (HA1).</p><p><b>RESULTS</b>Hemagglutinin (HA) genes of influenza virus H3N2 prevalent in Qingdao between year 2007 and 2011 formed a single trunk of phylogenetic tree. Every prevalent strain originated in last season. The analysis of the evolution of whole genome found that reassortment virus strains were prevalent between year 2009 and 2010, but between 2010 and 2011 there were two series of prevalent strains, which showed complicated reassortment. Compared with the vaccine strains, the variant amino acids of protein of virus HA1 between year 2007 and 2011 were 8, 6, 6, 8 and 11, involving 13 antigenic sites. The sequence analysis of M2 protein showed that the isolated influenza virus H3N2 mutated in amino acid site 31, from serine to asparagine (S31N). HA1 gene of influenza virus H3N2 isolated in Qingdao between 2007 and 2011 shared the similar phylogenetic tree with the globally prevalent strain. The comparison of the sequence and the analysis of the antigenicity found co-infection between H3N2 and A/H1N1 in the strain A/Qingdao/F521/2011.</p><p><b>CONCLUSION</b>The evolution features of all segments of influenza virus H3N2 prevalent in Qingdao between year 2007 and 2011 were complicated.</p>

Investigation on the levels of carbon-, nitrogen-, iodine-containing disinfection by-products in a water plant in Jiangsu province, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>This work aimed to investigate the carbon-, nitrogen-, iodine-containing disinfection by-products (DBPs) formation and pollution situation in different treatment processes and pipe water of a water plant in Jiangsu province China.</p><p><b>METHODS</b>12 water samples were collected from raw water, different time points after the addition of chlorine, finished water and pipe water in July, 2011. Trihalomethanes (THM(4)), haloacetic acids (HAA(6)), haloacetonitriles (HAN(s)), chloropicrin (CPs), haloketones (HK(s)), iodoform (IF) and iodoacetic acid (IAA) were detected by gas chromatography with electron capture detector (GC-ECD) after liquid-liquid extraction. Nitrosamines (NAms) were detected by gas chromatography with mass spectrometer (GC-MS) after solid-phase extraction. The concentration of DBPs was represented as the mean of duplicate samples.</p><p><b>RESULTS</b>Most DBPs were found in water treatment processes except dibromochloromethane (0.61 µg/L), chloroform (1.64 µg/L) and N-nitrosodimethylamine (3.06 ng/L), which were detected in raw water. Pre-chlorination formed HAA(6) (5.01 µg/L), HKs (0.66 µg/L), HANs (0.57 µg/L) and NAms (98.09 ng/L). Chlorination and post-chlorination led to a dramatic increase in the levels of THM(4), HAA(6) (70.31 and 43.71 µg/L, respectively), while Nams didn't increase. In finished water, bromodichloromethane (34.12 µg/L) had the highest concentration among THM(4) (70.31 µg/L), and so was trichloroacetic acid (13.45 µg/L) among HAA(6) (43.71 µg/L). Levels of HANs, HKs, and CPs were 14.96, 2.32, 0.96 µg/L, respectively. Levels of N-nitrosodimethylamine and N-nitrosodipropylamine were 21.22, 69.43 ng/L, respectively. IAA, IF and other six NAms including N-nitrosomethylethylamine, N-nitrosodiethylamine, N-nitrosopyrrolidine, N-nitrosomorpholine, N-nitrosopiperidine and N-nitrosodibutylamine were not detected in all water samples.</p><p><b>CONCLUSION</b>Levels of DBPs in this water plant are relative high.and measures should be taken to control DBPs.</p>

The significance of contribution degree of hurting factors in mental injury and the research progress / 法医学杂志

In forensic psychiatric evaluation, experts frequently need to assess the contribution degree of hurting factors to the victims. The contribution degree reflects the extent of hurt caused by the injurer and is the quantitative index of the responsibility which should be undertaken by the injurer. It is also important evidence for the judgement. Presently, there is no accepted and practicable quantitative tool to reflect the objective contribution degree. This article reviews domestic and international researches on the contribution degree of hurting factors in mental injury, including the concept, connotation, related assessment methods, problems in assessment and its future study trend.

The clinical analysis of high resolution MR image diagnosing brachial plexus root avuision injury / 中华显微外科杂志

Objective To discuss the characteristic of brachial plexus root avulsion injury of high resolution MR imaging and the value in diagnosing of brachial plexus root avulsion injury early.Methods Fourty-five cases of brachial plexus root avulsion injury patients had being used for investigation to find the characteristic and diagnostic value of MR image of brachial plexus root avulsion injury,which all have pre-operative MR imaging and were diagnosed brachial plexus root avulsion injury by intra-operative exploration and electrophysiology form February 2006 to February 2011.Results Post-traumatic spinalmeningolceles were seen in 42 cases,the frequency was 93.3％; Displacement of spinal cord was seen in 25 cases,the frequency was 55.6％; Absence of anterior and posterior root of spinal nerve was seen in 8 eases,the frequency was 17.8％;Black line sign was seen in 18 cases,the frequency was 40.0％.The sensitivity,specificity,and accuracy of MRI in diagnosing brachial plexus root injury were 95.7％,77.8％ and 94.6％ respectively.Conclusion Posttraumatic spinalmeningolceles are most often seen in MR of brachial plexus root avulsion injury,this sign can play an important role in diagnosing and treatment of brachial plexus root avulsion injury.

Etiology of hand, foot and mouth disease in Qingdao during 2008-2009 / 病毒学报

An etiology study on HFMD in Qingdao region during 2008-2009 was conducted. The virus RNA were isolated from throat swabs of HFMD,the EV, EV71 and CVA16 were detected by multiplex realtime RT-PCR. For those specimens with EV positive and both EV71 and CVA16 negative,a reverese transcription-seminested polymerase chain reaction (RT-snPCR) was perfomed to amplify part sequence of the VP1 gene for sabsequent analysis to identify the serotype. The results indicated that EV71 and CVA16 were the major pathogens of HFMD in Qingdao during 2008-2009. The proportion of EV71 was greater than CVA16 in either mild or serious HFMD cases. Sequence analysis showed that 5 non-EV71 and non-CVA16 serotypes (8 specimens) were obtained in 2008 including Coxsackievirus A5, A6, A10, A12 and Echovirus 9, which were well distributed. Three serotypes(13 specimens) were obtained in 2009 including Coxsackievirus A9, A12 and B2, of which CVA12 was of a big proportion (11/13). CVA12 became a new relatively major pathogen of HFMD in Qingdao during 2009.

Molecular epidemiology of human enterovirus 71 strains in Qingdao region,Shandong province,2007-2009 / 中华流行病学杂志

Objective To study the molecular epidemiology of human enterovirus 71(EV71)isolated from patients with hand-foot-mouth disease(HFMD) in Qingdao region between 2007 and 2009.Methods Throat swabs of HFMD were detected for total enterovirus(EV),EV71and CA16 by fluorescence reverse transcription-polymerase chain reaction(RT-PCR).The VP1 region was amplified from positive EV71 specimens and 51 nucleotide sequences of VP1 gene were successfully sequenced.EV71 genotypes were characterized by phylogenetic analysis.Results 51Qingdao EV71 strains identified between 2007 and 2009 belonged to C4a cluster of subgenotype C4and 5.3%nucleotide divergence and 1.7%amino acid divergence were found among them.The strains in 2008 and 2009 were respectively divided into several lineages on phylogenetic flees but there was a main lineage(namely prominent strain)every year.The Qingdao prominent strains identified in 2008had high identities with the Linyi prominent strains in 2007.The Qingdao prominent strains in 2009and the secondary prominent strains in 2008 had high identities with the Fuyang prominent strains in 2008.Two Qingdao strains in 2007 had high identities with the Linyi popular strains in 2007.Conclusion Data showed that several EV71 transmission chains were co-circulating in Qingdao between 2008 and 2009.The main transmission chain in 2008 became the minor one but the minor transmission chain in 2008 was transferred into the main transmission chain in 2009.

Effective evaluation of brucellosis related risk behaviors of occupation groups and the effect of health education / 中国地方病学杂志

Objective To find out demography characteristic and risk behaviors of occupation groups and to evaluate the effect of health education. Methods A baseline survey was conducted among occupation groups in the western part of Liaoning province by stratified random cluster sampling. Health education started to intervene in occupation groups in Linghai city of Liaoning province. An investigation of brucellosis related behaviors was carried out before and after a health education among occupation groups. Other occupational groups were as the control group. The research on high-risk behaviors of occupation groups was in the following eight aspects: protection taken when contact with abortion livestock, timely slaughter and burying deeply of sick animals, not selling sick animals do not eat dead meat, nor drink raw milk, do not eat raw meat, and immunity of livestock. Results Before the intervention, a total of 916 objects, of which intervention group 499 and control group 417 were investigated. The high-risk behaviors of brucellosis were not significantly different between the two groups[70.9% (354/499), 64.3%(321/499 ), 53.8% (268/499), 92.2% (460/499), 82.2% (410/499 ), 87.5% (437/499), 93.6% (467/499), 56.2%(280/499) in intervention group, 68.8% (287/417), 59.2% (247/417 ), 54.7% (228/417), 89.2% (372/417 ), 85.6%(360/417) ,885%(369/417),94.0%(392/417),55.9%(233/417) in control group, all P ＞ 0.05]. After the intervention,a total of 908 survey objects, of which intervention group 499 and control group 409, were investigated. The above eight aspects of high-risk behaviors in the intervention group were 85.4% (426/499),79.0% (394/499),69.9%(349/499),96.4%(481/499),943%(471/499),94.9%(474/499),94.0%(469/499), 99.4%(496/499), respectively; in the control 66.8% (273/409),57.3% (234/409),50.1% (205/409),85.3% (349/409),88.8% (363/409),89.5%(366/409) ,90.1% (369/409), and 57.2% (234/409), respectively. Between the two groups, the difference was statistically significant (x2 = 43.991,49.833,37.111,35.032,9.537,9.826,4.485,253.808, all P ＜ 0.05 ). The above seven aspects of high-risk behaviors except do not eat raw dairy at the beginning of intervention were compared with those of after the intervention, the differences were statistically significant (x2 = 30.426,26.284,27.854,7.364,36.027,17.238,9270.286, all P ＜ 0.05). Conclusions Health education intervention can significantly improve the behavior change rate of occupational groups at high risk of brucellosis, and the education intervention is worthwhile to communicate and promote.

Clinical characteristics and treatment of severe encephalitis associated with neurogenic pulmonary edema caused by enterovirus 71 in China / 世界急诊医学杂志（英文）

BACKGROUND:Hand-foot-mouth disease has become a major public health issue in children in China. In the present prospective study we investigated the clinical characteristics and emergency management of children with severe encephalitis associated with NPE caused by enterovirus 71. METHODS:The study was conducted in 2 pediatric intensive care units (PICUs) over a 2-month period. Clinical records were reviewed of critically ill children with severe encephalitis associated with NPE caused by EV71 who were admitted to PICUs during the period of May to June 2008 in Fuyang. RESULTS:We reviewed the complete records of 36 children, of whom 23 (63.9％) were male and 13 (36.1％) female. Their age ranged from 4 to 48 months, with an average of 15.8 months. Al children except one were under 3 years of age. The overal mortality in these children was 19.4％. The average duration of critical life threatening signs and symptoms was 2.1 days (12 hours-5 days). Nervous system diseases included brainstem encephalitis in 27 children (75％), brainstem encephalitis associated with myelitis in 6 children (16.7％), and general encephalitis in 3 chidren (8.3％), respectively. In 12 patients of NPE (33.3％) pink or bloody bubble sputum and asymmetric pulmonary edema or hemorrhage was the primary manifestation but no typical exanthema was observed. Five children died of acute onset of NPE and / or pulmonary hemorrhage with rapid progression of cardiopulmonary failure within hours after admission. Therapeutic management consisted of mechanical ventilation and administration of mannitol, methylprednisolone, intravenous immunoglobulin (IVIG) and vasoactive drugs, associated with the need of fluid volume resuscitation in 9 (25％) of the 36 children. CONCLUSIONS:In children less than 3 years of age found to be affected by severe EV71 encephalitis associated with NPE, one fifth may die. The major organ systems infected by severe EV71 include the central nervous system, the respiratory system, and the cardiovascular system. Early diagnosis and evaluation, respiratory support, treatment of intracranial hypertension, and mainttenance of function of the cardiovascular system are the most important therapeutic measures.

Anatomical and Biomechanical Study of Sacral Pedicle and Lateral Mass / 医用生物力学

Objective To study the anatomical and biomechanical features of sacral pedicle and lateral mass to provide evidence for clinical sacral pedicle and lateral mass screw fixation technology. Method 60 adult patient's spiral CT images of sacrum and coccyx were selected randomly. The sacral pedicle and lateral mass screw entry point was determined, and the crew trajectory were measured using the three dimensional reconstruction. Meanwhile, the gross anatomy was done for 15 adult cadavers to determine the sacral pedicle and lateral mass screw entry point. The length, width and angle of sacral pedicle and lateral mass screw trajectory was measured. 8 of 15 cadaver specimens were selected to test for the maximal extraction force for sacral pedicle and lateral mass screws. ResultsThe diameter and length of S1～S5 sacral pedicle and lateral mass screw trajectory are significantly regular, with inclination angle is about 20°. The S1 pedicle screw entry point is located at intersection point of basal lateral part of articular process and median line of transverse process, no significant difference is found between the maximal extraction force of pedicle and lateral mass screws (P>0.05）. The entry points of S2～5 pedicle screws are located at the intersection point of the line connecting adjacent posterior sacral foramina and median line of transverse process. The lateral mass screw entry point of S2～5 is on the median side of intersection point between median line of transverse process and lateral sacral crest. The maximal extraction force of pedicle screws are significantly different from the lateral mass screws（P<0.05）. Conclusions Both the sacral pedicle and the lateral mass screw fixation technology can offer effective fixation and reconstruction for the fracture of sacrum and coccyx, but the pedicle screw fixation may be more convenient, safe and reliable than the lateral mass screw fixation technology.