Functional connectome hierarchy of thalamus impacts fatigue in acute stroke patients.

This study aimed to explore the topographic features of thalamic subregions, functional connectomes and hierarchical organizations between thalamus and cortex in poststroke fatigue patients. We consecutively recruited 121 acute ischemic stroke patients (mean age: 59 years) and 46 healthy controls matched for age, sex, and educational level. The mean age was 59 years (range 19-80) and 38% of acute stroke patients were females. Resting-state functional and structural magnetic resonance imaging were conducted on all participants. The fatigue symptoms were measured using the Fatigue Severity Scale. The thalamic functional subdivisions corresponding to the canonical functional network were defined using the winner-take-all parcellation method. Thalamic functional gradients were derived using the diffusion embedding analysis. The results suggested abnormal functional connectivity of thalamic subregions primarily located in the temporal lobe, posterior cingulate gyrus, parietal lobe, and precuneus. The thalamus showed a gradual increase from the medial to the lateral in all groups, but the right thalamus shifted more laterally in poststroke fatigue patients than in non- poststroke fatigue patients. Poststroke fatigue patients also had higher gradient scores in the somatomotor network and the right medial prefrontal and premotor thalamic regions, but lower values in the right lateral prefrontal thalamus. The findings suggested that poststroke fatigue patients had altered functional connectivity and thalamocortical hierarchical organizations, providing new insights into the neural mechanisms of the thalamus.

Neuroimaging of neuropsychological disturbances following ischaemic stroke (CONNECT): a prospective cohort study protocol.

INTRODUCTION: Neuropsychiatric distubance is a common clinical manifestation in acute ischemic stroke. However, it is frequently overlooked by clinicians. This study aimed to explore the possible aetiology and pathogenesis of neuropsychiatric disturbances following ischaemic stroke (NDIS) from an anatomical and functional perspective with the help of neuroimaging methods. METHOD AND ANALYSIS: CONNECT is a prospective cohort study of neuroimaging and its functional outcome in NDIS. We aim to enrol a minimum of 300 individuals with first-ever stroke. The neuropsychological disturbances involved in this study include depression, anxiety disorder, headache, apathy, insomnia, fatigue and cognitive impairment. Using scales that have been shown to be effective in assessing the above symptoms, the NDIS evaluation battery requires at least 2 hours at baseline. Moreover, all patients will be required to complete 2 years of follow-up, during which the NDIS will be re-evaluated at 3 months, 12 months and 24 months by telephone and 6 months by outpatient interview after the index stroke. The primary outcome of our study is the incidence of NDIS at the 6-month mark. Secondary outcomes are related to the severity of NDIS as well as functional rehabilitation of patients. Functional imaging evaluation will be performed at baseline and 6-month follow-up using specific sequences including resting-state functional MRI, diffusion tensor imaging, T1-weighted imaging, T2-weighted imaging, diffusion-weighted imaging, arterial spin labelling, quantitative susceptibility mapping and fluid-attenuated inversion recovery imaging. In addition, we collect haematological information from patients to explore potential biological and genetic markers of NDIS through histological analysis. ETHICS AND DISSEMINATION: The CONNECT Study was approved by the Ethics Review Committee of the First Hospital of the University of Science and Technology of China (2021-ky012) and written informed consent will be obtained from all participants. Results will be disseminated via a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ChiCTR2100043886.

Altered Resting-State Brain Activity and Functional Connectivity in Post-Stroke Apathy: An fMRI Study.

Apathy is a common neuropsychiatric disease after stroke and is linked to a lower quality of life while undergoing rehabilitation. However, it is still unknown what are the underlying neural mechanisms of apathy. This research aimed to explore differences in the cerebral activity and functional connectivity (FC) of subjects with post-stroke apathy and those without it. A total of 59 individuals with acute ischemic stroke and 29 healthy subjects with similar age, sex, and education were recruited. The Apathy Evaluation Scale (AES) was used to evaluate apathy at 3 months after stroke. Patients were split into two groups-PSA (n = 21) and nPSA (n = 38)-based on their diagnosis. The fractional amplitude of low-frequency fluctuation (fALFF) was used to measure cerebral activity, as well as region-of-interest to region-of-interest analysis to examine functional connectivity among apathy-related regions. Pearson correlation analysis between fALFF values and apathy severity was performed in this research. The values of fALFF in the left middle temporal regions, right anterior and middle cingulate regions, middle frontal region, and cuneus region differed significantly among groups. Pearson correlation analysis showed that the fALFF values in the left middle temporal region (p < 0.001, r = 0.66) and right cuneus (p < 0.001, r = 0.48) were positively correlated with AES scores in stroke patients, while fALFF values in the right anterior cingulate (p < 0.001, r = -0.61), right middle frontal gyrus (p < 0.001, r = -0.49), and middle cingulate gyrus (p = 0.04, r = -0.27) were negatively correlated with AES scores in stroke patients. These regions formed an apathy-related subnetwork, and functional connectivity analysis unveiled that altered connectivity was linked to PSA (p < 0.05). This research found that abnormalities in brain activity and FC in the left middle temporal region, right middle frontal region, right cuneate region, and right anterior and middle cingulate regions in stroke patients were associated with PSA, revealing a possible neural mechanism and providing new clues for the diagnosis and treatment of PSA.

Sex differences in outcomes after endovascular treatment of patients with vertebrobasilar artery occlusion.

BACKGROUND: Current studies on the role of sex in the prognosis of acute vertebrobasilar artery occlusion (VBAO) are limited. We aimed to explore whether there are sex differences on outcomes in patients treated with endovascular therapy (EVT) for VBAO. METHODS: Patients from December 2015 to December 2018 with acute VBAO within 24 h of the estimated occlusion time in 21 stroke centers in China were retrospectively analyzed. Baseline data between sexes were compared in the total population cohort and propensity score (PS)-matched cohort. Multivariate logistic regression and ordinal regression were used to analyze the association of sex with outcomes. Mixed-effects regression model was performed for changes in modified Rankin Scale (mRS) scores in men and women from 90 days to 1 year after discharge. RESULTS: A total of 577 patients (28.4% women) were finally included. Multivariate logistic regression showed that women had a lower probability of favorable outcome (mRS score 0-3 at 90 days; OR 0.544; 95% CI 0.329-0.899) and functional independence (mRS score 0-2 at 90 days; OR 0.391; 95% CI 0.228-0.670) as well as a higher possibility of shifting to worse mRS (OR 1.484; 95% CI 1.020-2.158) than men. After PS matching, 391 patients (39.4% women) were analyzed, confirming the same results regarding favorable outcome (OR 0.580; 95% CI 0.344-0.977), functional independence (OR 0.394; 95% CI 0.218-0.712), and shift mRS (OR 1.504; 95% CI 1.023-2.210). However, the results of repeated ANOVA showed that men and women had a comparable functional recovery from 90 days to 1 year. CONCLUSIONS: Stroke due to VBAO treated with EVT is associated with worse outcomes in women than in men. However, men and women showed similar long-term improvement trends.

Construction of graphene quantum dot-based dissolving microneedle patches for the treatment of bacterial keratitis.

Bacterial keratitis (BK) is an ophthalmic infection caused by bacteria and poses a risk of blindness. Numerous drugs have been used to treat BK, the majority suffered from limited effect owing to their backward antimicrobial and delivery efficacy. Herein, we evaluated the antibacterial effect of a cationic carbon-based nanomaterial, i.e., imidazole-modified graphene quantum dots (IMZ-GQDs), which exhibits disinfection rates of >90% against three typical Gram-positive strains within 3 h owing to the loss of membrane integrity and decline in membrane potential. For ocular application, we further developed IMZ-GQDs-loaded dissolving microneedle patches (IMZ-GQDs MNs) via a typical two-step micromolding method. IMZ-GQDs MNs showed sufficient dissolution and penetration for intrastromal delivery in vitro and successfully overcome the rabbit corneal epithelial layer in vivo. The excellent biocompatibility of IMZ-GQDs MNs was demonstrated both in cell and animal models, and they exhibited low cytotoxicity, low invasiveness and low ocular irritation. The topical application of IMZ-GQDs MNs has the benefits of both high antibacterial activity and effective drug delivery, thereby leading to the resolution of Staphylococcus aureus-induced BK in rabbits in 7 days. Therefore, IMZ-GQDs MNs is a promising approach for BK treatment, which is safe and efficient.

Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry.

BACKGROUND: Few studies have focused on the effect of systemic inflammation in vertebrobasilar artery occlusion (VBAO). The aim of this study was to investigate the relationship between inflammatory indicators and the prognosis of VBAO patients receiving endovascular treatment (EVT). METHOD: Patients with VBAO who were treated with EVT within 24 hours of the estimated occlusion time were included in this study. Multivariate logistic regression and elastic net regularization were performed to analyze the effects of inflammatory indicators on the prognosis of patients with VBAO. The primary outcome was unfavorable outcome (a modified Rankin Scale score of 4-6) at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage, in-hospital mortality, 90 day mortality, 1 year unfavorable outcome, and mortality. RESULTS: 560 patients were included in the study. Multivariate analysis showed that white blood cells (W), neutrophils (N), neutrophil to lymphocyte ratio (NLR), platelet to neutrophil ratio, platelet to white blood cell ratio, and NLR to platelet ratio were associated with the primary outcome. Elastic net regularization indicated that W, N, and NLR were the major inflammatory predictors of unfavorable outcome at 90 days. For long term prognosis, we found that the inflammatory indicators that predicted 1 year outcomes were consistent with those that predicted 90 day outcomes. CONCLUSION: Inflammatory indicators, especially W, N, and NLR, were associated with moderate and long term prognosis of patients with VBAO treated with EVT.

Surveillance results of viral diarrhea in children under five years of age in Shaoxing City / 预防医学

Objective@#To investigate the epidemiological and etiological characteristics of viral diarrhea among children under 5 years of age in Shaoxing City, Zhejiang Province, so as to provide insights into management of viral diarrhea.@*Methods@#The surveillance data on viral diarrhea among children under 5 years of age in Shaoxing City from 2019 to 2022 were collected, including demographics and stool testing results. The epidemiological and etiological characteristics of viral diarrhea were analyzed using a descriptive epidemiological method. @*Results@#A total of 763 diarrheal children under 5 years of age were reported in Shaoxing City from 2019 to 2022, and 236 children were tested positive for virus (30.93%). The detection of virus was 49.01%, 31.61%, 20.43% and 21.89% from 2019 to 2022, which appeared an overall tendency towards a decline (P<0.05). The incidence of viral diarrhea peaked from November to March of the next year and from May to July, and the detection of virus was lower among children with diarrhea living in urban areas (Yuecheng District, Keqiao District and Shangyu District) than among those in suburb areas (Zhuji City, Shengzhou City and Xinchang County) (30.22% vs. 52.00%, P<0.05). There were 206 children tested positive for a single virus, and the detection rates of rotavirus (RV), enteric adenovirus (EAdV), norovirus (NoV), and sapovirus (SaV) were 9.57%, 8.91%, 8.39%, and 0.13%, respectively. There were 25 children with virus co-infections, and the positive rates of EAdV and NoV, RV and EAdV and RV and NoV co-infections were 1.31%, 1.18% and 0.79%, respectively. There were 5 children with triple infections of RV, EAdV and NoV (0.66%). The highest detection of EAdV was seen in April, the highest detection of RV and NoV was seen in January, while SaV was only detected in April. @*Conclusion@#The incidence of viral diarrhea among children under 5 years of age peaked in winter and spring in Shaoxing City from 2019 to 2022, and the cases predominantly occurred in urban areas. The detection of virus appeared an overall tendency towards a decline, with high detection of RV, EAdV and NoV.

Epidemiological characteristics of hemorrhagic fever with renal syndrome in Shaoxing City from 2006 to 2022 / 预防医学

Objective@#To investigate the epidemiological characteristics of hemorrhagic fever with renal syndrome (HFRS) in Shaoxing City from 2006 to 2022, so as provide insights into improvements of the HFRS control strategy.@*Methods@#Data pertaining to HFRS cases in Shaoxing City from 2006 to 2022 were captured from the Surveillance System of China Information System for Disease Control and Prevention. The temporal, population and regional distributions of HFRS were analyzed using the descriptive epidemiological method, and the trends in incidence of HFRS were evaluated using annual percent change (APC). @*Results@#Totally 1 022 HFRS cases were reported in Shaoxing City from 2006 to 2022, with annual average incidence of 1.22/105 and three deaths. The incidence of HFRS appeared a tendency towards a decline in Shaoxing City from 2006 to 2022 (APC=-11.101%, t=-9.930, P<0.001), and the incidence of HFRS peaked from May to June and from November to January of the next year. A higher incidence of HFRS was seen in men than in women (1.76/105 vs. 0.68/105; χ2=201.361, P<0.001). There were 714 HFRS cases at ages of 30 to 59 years (69.86%), and farmers were the predominant occupation (78.18%). The three counties with the largest number of HFRS cases included Zhuji (366 cases), Xinchang (263 cases) and Shengzhou (134 cases). The incidence of HFRS was lower in urban districts (Yuecheng, Keqiao and Shangyu) than in counties (Zhuji, Shengzhou and Xinchang) (0.58/105 vs. 1.96/105; χ2=326.880, P<0.001).@*Conclusion@#The incidence of HFRS appeared a tendency towards a decline in Shaoxing City from 2006 to 2022, and the incidence was high in late spring, early summer and winter. The HFRS cases were mainly males, young and middle-aged people, and farmers, and predominantly distributed in counties. Targeted control measures are needed.

An outbreak of pulmonary tuberculosis and a follow-up investigation of latent tuberculosis in a high school in an eastern city in China, 2016-2019.

BACKGROUND: In October 2016, a senior high school student was diagnosed with sputum-smear positive [SS(+)] pulmonary tuberculosis (TB). We conducted an investigation of an outbreak in the school, including among students and teachers diagnosed with latent TB, who we followed until July 2019. METHODS: We defined latent TB infection (LTBI) as a tuberculin skin test (TST) induration of 15mm or larger; probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks, or TST induration of 15mm or larger; and confirmed TB as two or more positive sputum smears or one positive sputum smear plus a chest radiograph indicative of TB or culture positive with M. tuberculosis. We conducted mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing based on 24 loci in the isolates. RESULTS: Between October 2016 and July 2019, we identified 52 cases, including nine probable, six confirmed, and 37 LTBI cases. The index case-student had attended school continuously despite having TB symptoms for almost three months before being diagnosed with TB. We obtained three isolates from classmates of the index case in 2016; all had identical MIRU-VNTR alleles with the index case. The LTBI rate was lower among students (7.41%, 30/405) than among teachers (26.92%, 7/26) (rate ratio [RR] = 0.28, 95% confidential interval [CI]: 0.13-0.57). Among the 17 students who had latent TB and refused prophylaxis in October 2016, 23.53% (4/17) became probable/confirmed cases by July 2019. None of the six teachers who also refused prophylaxis became probable or confirmed cases. Of the 176 students who were TST(-) in October 2016, 1.70% (3/176) became probable/confirmed cases, and among the 20 teachers who were TST(-), 1 became a probable case. CONCLUSIONS: Delayed diagnosis of TB in the index patient may have contributed to the start of this outbreak; lack of post-exposure chemoprophylaxis facilitated spread of the outbreak. Post-exposure prophylaxis is strongly recommended for all TST-positive students; TST-negative students exposed to an SS(+) case should be followed up regularly so that prophylaxis can be started if LTBI is detected.

Epidemiological characteristics of COVID-19 in Shaoxing / 预防医学

Objective@#To analyze the epidemiological characteristics of coronavirus disease 2019 ( COVID-19 ) in Shaoxing from January 23 to March 31, 2020, so as to provide basis for the prevention and control of COVID-19.@*Methods@#The information of the COVID-19 cases in Shaoxing were collected from the National Diseases Prevention and Control Information System and the field investigation by CDCs. A descriptive analysis was used for the epidemiological characteristics, including time, spatial and population distribution, clinical features and exposure history. @*Results@# Totally 42 confirmed cases of COVID-19 were reported by March 31, without deaths. The first case was reported on January 23 and the last one was on February 13. The onset of cases peaked in mid-to-late January. All the counties ( cities or districts ) had confirmed cases, 14 cases were reported in Yuecheng District. Twenty-five ( 59.52% ) cases were 45 years old or over. Thirteen ( 30.95% ) cases were engaged in business and eight ( 19.05% ) cases were unemployed. No cases were found among medical staff. The main clinical symptoms were fever, dry cough, fatigue and imaging features of pneumonia, with nine ( 21.43% ) severe cases and three ( 7.14% ) critical cases. There were 34 ( 80.95% ) imported cases, who mainly came from Hubei Province. Totally 1 955 close contacts were tracked down, among whom 4 cases were confirmed, with the infection rate of 0.20%.@*Conclusions@#The COVID-19 cases reported in Shaoxing were mainly aged 45 years or over, severe and imported from Hubei Province. There was no continuous transmission in the community, and no infection in medical staff or deaths.

Epidemic trend of viral hepatitis B in Shaoxing from 2008 to 2018 / 预防医学

Objective@#To understand the epidemiological characteristics of viral hepatitis B in Shaoxing from 2008 to 2018,so as to provide basis for formulating the viral hepatitis B prevention and control strategy. @*Methods@#The data of viral hepatitis B cases in Shaoxing from 2008 to 2018 were collected from infectious diseases reporting and management system. Descriptive epidemiological method was employed to analyze the time,place and population characteristics of viral hepatitis B cases in Shaoxing. Annual percentage change（APC）was calculated to analyze the development trend of viral hepatitis B.@*Results @#From 2008 to 2018,a total of 22 764 cases of viral hepatitis B were reported in Shaoxing,with an average annual incidence rate of 42.24/100 000 and a standardized incidence rate of 39.19/100 000. The incidence rate of viral hepatitis B decreased from 2008 to 2018,among which the APC from 2012 to 2018 was -18.00% with a significantly downward trend（P<0.05）. Six counties,cities or districts in Shaoxing reported cases of viral hepatitis B,of which Zhuji（49.40/100 000）,Yuecheng（44.17/100 000）and Xinchang（43.28/100 000）ranked top three in average annual incidence rate. The incidence rate of viral hepatitis B in men was 57.07/100 000,which was higher than 27.33/100 000 in women（P<0.05）.The age of onset was mainly 25-59 years old,with 16 941 cases（74.42%）reported. The top three occupations were farmers,workers and migrant workers,with 15 013（65.95%）,2 730（11.99%）and 1 121（4.92%）cases reported,respectively. @*Conclusions@#The incidence of viral hepatitis B in Shaoxing from 2008 to 2018 showed a downward trend. Farmers,workers and migrant workers aged 25-59 years were at high risk of hepatitis B infection.

Analysis of differential expression profile of miRNA in peripheral blood of patients with lung cancer.

PURPOSE: To identify potential molecular targets for lung cancer intervention and diagnosis, we analyzed the differential miRNA expression of peripheral blood between lung cancer patients and healthy controls. METHODS: Three pairs of cases' and controls' peripheral blood samples were evaluated for miRNA expression by microarray. 12 miRNAs were selected for RT-PCR validation and target genes prediction. In addition, 4 miRNAs were selected for future validation by RT-PCR in a large sample of 145 cases and 55 frequency-matched healthy controls. RESULTS: A total of 338 differentially expressed miRNAs were screened and identified by microarray. According to the fold changes, the top ten upregulated miRNAs were hsa-miR-124-3p, hsa-miR-379-5p, hsa-miR-3655, hsa-miR-450b-5p, hsa-miR-29a-5p, hsa-miR-200a-3p, hsa-miR-542-3p, hsa-miR-138-5p, hsa-miR-219a-2-3p, and hsa-miR-4701-3p, and the top ten downregulated miRNAs were hsa-miR-34c-5p, hsa-miR-135a-5p, hsa-miR-132-3p, hsa-miR-3178, hsa-miR-4449, hsa-miR-4999-3p, hsa-miR-1246, hsa-miR-4424, hsa-miR-1252-5p, and hsa-miR-24-2-5p. RT-PCR verification of the 12 miRNAs revealed that 5 of 8 upregulated miRNAs, 2 of 4 downregulated miRNAs showed a significant difference between the cases and controls (P < .05). A large number of target genes and their functional set showed overlapping among the 453 predicted target genes of the 12 miRNAs (P < .01). RT-PCR in the large sample confirmed the significant differential expression level of hsa-miR-29a-5p, hsa-miR-135a-5p, hsa-miR-542-3p, and hsa-miR-4491 between cases and controls (P < .05), and three of these microRNA, except hsa-miR-29a-5p, were significant after Bonferroni correction for adjustment of multiple comparisons. CONCLUSION: There was a significant difference in miRNAs expression in the peripheral blood between lung cancer patients and healthy controls, and 4 miRNAs were validated by a large-size sample.

Interactions of physical activity and body mass index with age at menarche: A school-based sample of Chinese female adolescents.

BACKGROUND: To test the independent and interactive associations of physical activity (PA) and body mass index (BMI) with age at menarche among Chinese adolescence. METHODS: We conducted a cross-sectional survey in two elementary schools in September 2015 in Shaoxing city, Zhejiang province, China. We used self-administered questionnaires to collect the information of the participators. Analyses were performed with logistic regression models, and the relative excess risk due to interaction (RERI), the attributable proportion because of the interaction (AP), and the synergy index (S) were used to evaluate the biological interaction. RESULTS: A total of 1530 middle school students from grade 1-3 were selected for this study, and we collected 1505 (98.366%) valid questionnaires for the last analyses. The mean age of menarche is 11.603 (SD=0.447)years. Students with overweight/obesity and without SMPA had the highest risks of early age of menarche (OR=3.507, 95%CI: 1.929-6.376) compared with women both with a normal BMI and with SMPA, and the RERI was 1.846 (95% CI: 0.415-4.107), meaning that there was positive interaction on the additive scale. CONCLUSION: Insufficient PA can significantly modify the association between obesity and early menarche risk. Therefore, the government and society should pay more attention to the promotion of PA throughout childhood and adolescence.

Application of the analytic hierarchy process to a risk assessment of emerging infectious diseases in Shaoxing city in southern China.

This study aimed to assess the likelihood of an outbreak or epidemic of emerging infectious diseases (EIDs) in Shaoxing city, China, and its resulting impact to provide decision makers with quantitative, directive results. Factors related to the risk of EIDs were selected through meeting with experts and were arranged in a hierarchical structure. These evaluation factors were also weighted to allow the use of a point system for evaluation. As a result, 14 evaluation factors comprising a 3-layer hierarchy were generated. The riskiest top 10 EIDs were HIV/AIDS (consistency index [CI] = 3.206), cholera (CI = 3.103), SARS (CI = 2.804), acute schistosomiasis (CI = 2.784), malaria (CI = 2.777), legionellosis (CI = 2.743), avian influenza A/H5N1 (CI = 2.734), dengue fever (CI = 2.702), Escherichia coli O157:H7 enteritis (CI = 2.593), and plague (CI = 2.553). The risk assessment was specifically intended to support local and national government agencies in the management of high risk EIDs in their efforts to (i) make resource allocation decisions, (ii) make high-level planning decisions, and (iii) raise public awareness of the EID risk. The results showed that the EID risk in Shaoxing could be effectively assessed through an analytic hierarchy process.

Risk factors of severe hand, foot and mouth disease: a meta-analysis.

BACKGROUND: In recent years, outbreaks of hand, foot and mouth disease (HFMD) have increased, and more and more severe cases have appeared. We conducted a meta-analysis to generate large-scale evidence on the risk factors of severe HFMD. METHODS: PubMed, Elsevier Science Direct, China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 11.0. RESULTS: We conducted a meta-analysis of 19 separate studies. Duration of fever ≥ 3 days (odds ratio (OR) 10.09, 95% confidence interval (CI) 6.22-16.35), body temperature ≥ 37.5°C (OR 4.91, 95% CI 1.26-19.18), lethargy (OR 7.75, 95% CI 3.78-15.89), hyperglycemia (OR 2.77, 95% CI 2.06-3.71), vomiting (OR 8.83, 95% CI 1.05-74.57), increased neutrophil count (weighted mean difference (WMD) 0.61, 95% CI 0.52-0.70), enterovirus 71 (EV71) infection (OR 5.13, 95% CI 3.11- 8.46), young age (WMD - 0.44, 95% CI - 0.69 to -0.19), and home care (OR 1.65, 95% CI 1.26-2.17) were significantly related to the risk of severe HFMD. We also found that a confirmed diagnosis at first visit to hospital significantly decreased the risk of severe HFMD (OR 0.30, 95% CI 0.09-0.99). We did not find an association between oral rash (OR 1.07, 95% CI 0.82-1.39), increased leukocyte count (WMD 0.51, 95% CI - 0.05-1.06), male sex (OR 1.06, 95% CI 0.91-1.24), or living in a rural area (OR 1.39, 95% CI 0.95-2.02) and the risk of severe HFMD. CONCLUSIONS: Duration of fever ≥ 3 days, body temperature ≥ 37.5°C, lethargy, hyperglycemia, vomiting, increased neutrophil count, EV71 infection, and young age are risk factors for severe HFMD. A confirmed diagnosis at first visit to hospital can significantly decrease the risk of severe HFMD.

Outbreak of pulmonary tuberculosis in a Chinese high school, 2009-2010.

BACKGROUND: In February 2009, a high school student was diagnosed with sputum-smear positive pulmonary tuberculosis (TB). One year later, 2 other students in the same grade developed sputum-smear positive TB. METHODS: We used tuberculin skin testing (TST), chest radiography, sputum smear, and symptomatology for case identification. We defined latent TB infection (LTBI) as a TST induration of 15 mm or larger, probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks or TST induration of 15 mm or larger, and confirmed TB as 2 or more positive sputum smears or 1 positive sputum smear plus a chest radiograph indicative of TB. RESULTS: Of students in the same grade as the primary case-student, 26% (122/476) had LTBI and 4.8% (23/476) had probable/confirmed TB. Of teachers, 43% (18/42) had LTBI and none had probable/confirmed TB. Sharing a classroom with the primary case-student increased risk for LTBI (rate ratio = 2.5; 95% CI: 1.9-3.4) and probable/confirmed TB (rate ratio = 17, 95% CI: 7.8-39). Of students with LTBI in February 2009 who refused prophylaxis, 50% (11/22) had probable/confirmed TB in April 2010. CONCLUSIONS: This TB outbreak was likely started by delayed diagnosis of TB in the case-student and was facilitated by lack of post-exposure chemoprophylaxis. Post-exposure prophylaxis is strongly recommended for all TST-positive students.

Intervention to increase condom use and HIV testing among men who have sex with men in China: a meta-analysis.

Behavioral interventions have been shown to both promote and change many health-related behaviors and issues. This meta-analysis was performed to assess whether behavioral interventions have the potential to increase condom use and HIV testing uptake among men who have sex with men (MSM) in China. PubMed, Elsevier Science Direct, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to June 2011 to identify relevant articles. Data of eligible citations were extracted by two reviewers. Sixteen studies were identified. Aggregated findings indicated that interventions were associated with a significant increase in condom use between MSM and male sex partners in the last anal sex act (RR=1.17, 95% CI=1.05-1.29) and consistent condom use between MSM and male sex partners in the past 6 months (RR=1.36, 95% CI=1.15-1.60) and HIV testing (RR=2.22, 95% CI=1.72-2.88). However, no significant increase was detected in condom use over the course of the intervention among MSM engaging in sex with women. In the subgroup analyses, the positive effects were not detected in some subgroups such as anal sex with casual partners and intervention interval less than or equal to 6 months. The sensitivity analysis showed that these estimates were unchanged after removal of the study that had the biggest sample or the studies that had the most rigorous study design. This meta-analysis can inform future intervention design and implementation in terms of sample size, target populations, settings, goals for process measures, and intervention interval.