Peritoneal Metastasis After Treated With Abemaciclib Plus Fulvestrant for Metastatic Invasive Lobular Breast Cancer: A Case Report and Review of the Literature.

Peritoneal metastases from invasive lobular carcinoma (ILC) of breast are uncommon and usually related to poor prognosis due to difficulty of detection in clinical practice and drug resistance. Therefore, recognizing the entities of peritoneal metastases of ILC and the potential mechanism of drug resistance is of great significance for early detection and providing accurate management. We herein report a case of a 60-year-old female who presented with nausea and vomiting as the first manifestation after treated with abemaciclib (a CDK4/6 inhibitor) plus fulvestrant for 23 months due to bone metastasis of ILC. Exploratory laparotomy found multiple nodules in the peritoneum and omentum, and immunohistochemistry confirmed that the peritoneal metastatic lesions were consistent with ILC. Palliative therapy was initiated, but the patient died two months later due to disease progression with malignant ascites. Whole exome sequencing (WES) was used to detect the tumor samples and showed the peritoneal metastatic lesions had acquired ESR1 and PI3KCA mutations, potentially explaining the mechanism of endocrine therapy resistance. We argue that early diagnosis of peritoneal metastasis from breast cancer is crucial for prompt and adequate treatment and WES might be an effective supplementary technique for detection of potential gene mutations and providing accurate treatment for metastatic breast cancer patients.

A breast one-patient panel of heterogeneous genomes reveals genetic alterations driving DCIS into invasive lesions.

Aim: Utilize breast cancer samples in the same patient to indicate breast cancer development. Patients & methods: We performed whole-exome analysis of spatially independent ductal carcinoma in situ (DCIS) and invasive ductal carcinoma samples from the same breast. Results: In VEGF pathway, we observed two genes disrupted in DCIS, while another four (including ACTN2) mutated in invasive ductal carcinoma. When looked up TCGA database, we identified seven breast cancer patients with ACTN2 somatic mutations and observed a dramatic decrease in the overall survival time in ACTN2 mutant patients (p = 0.0182). A further finding in the TCGA database shows that breast cancer patients with ≥2 mutated genes in VEGF pathways showed worse prognosis (p = 0.0013). Conclusion: TCGA database and special case could inform each other to reveal DCIS developmental rules.

Exploration of the association between meteorological factors and incidence of hand, foot, and mouth disease based on the distributed lag non-linear model in Jiangyin / 中华疾病控制杂志

Objective To explore the effect of meteorological factors on the incidence of hand foot and mouth disease (HFMD) in Jiangyin City. Methods The distributed lag non-linear model (DLNM) was used to estimate the delayed and cumulative effects of meteorological factors on incidence of HFMD in Jiangyin from 2012 to 2017. Results A total of 21 791 HFMD cases were reported in Jiangyin City during 2012-2017. We observed significant correlations between the daily incidence of HFMD and daily mean temperature (rs=0.402, P<0.001), daily mean pressure (rs=-0.453, P<0.001), and daily mean relative humidity (rs=0.075, P<0.001), respectively. It was indicated that the maximum cumulative effect of daily mean temperature on the incidence of HFMD was 11 ℃ (RR=1.473, 95% CI: 1.99-1.974), and the impact on the onset of HFMD was acute and hightest at the first day (RR=1.090, 95% CI: 1.045-1.136). The cumulative effect on incidence of HFMD was highest at 85% daily relative humidity (RR=1.346, 95% CI: 1.154-1.571), and the impact on HFMD peaked on the 6th day (RR=1.023，95% CI: 1.015-1.031); The maximum cumulative effect of daily mean pressure with the incidence of HFMD was 1010.0 hpa (RR=1.221, 95% CI: 1.020-1.463), but no lag effect was observed at this level. Conclusions Meteorological factors have significant impact on the incidence of HFMD in Jiangyin City, and the effects of temperature and humidity are lagged.

The application of robotic nephrectomy, work bench surgery with robotic kidney autotransplantation in nephron-sparing surgery of complex renal tumors / 中华泌尿外科杂志

Objective To investigate the safety and feasibility of robotic nephrectomy,work bench surgery with robotic kidney autotransplantation in the treatment of complex renal tumors.Methods The clinical data of 5 patients with renal tumors admitted from January 2018 to July 2018 were analyzed retrospectively.There were 4 males and 1 females.The median age was 49 years old,ranging 32-66 years.The median body mass index was 25.6 kg/m2,ranging 21.1-27.8 kg/m2.Serum creatinine level was 87.2 μmol/L,ranging 78.0-88.9μmol/L before bench surgery.5 patients had multiple bilateral renal tumors and had undergone laparoscopic or robotic partial nephrectomy on the contralateral kidney.For bench surgery kidney,4 cases were on the left side and 1 case was on the right side.Each kidney has more than 2 separate tumors,combined with complete endophytic tumors,tumors larger than 7 cm in diameter or hilar tumors.5 patients were all performed robotic nephrectomy,work bench partial nephrectomy with robotic kidney autotransplantation under general anesthesia.The patient was first in a lateral decubitus position for robotic nephrectomy,and the kidney was removed through a median 6 cm periumbilical incision.After kidney removal,kidney tumors were resected and kidney was reconstructed on a hypothermic working table.Then the kidney was packed in a plastic bag,filling with ice slush.The corresponding parts of the plastic bag were cut to expose the renal artery and vein.Finally,the patient was moved to lithotomy position with Trendelenburg tilt of 20°,and the autologous kidney wrapped in the plastic bag was placed through the previous periumbilical incision into the abdominal cavity for robotic kidney autotransplantation.The renal artery and vein were anastomosed end-to-side with the right external iliac artery and vein.The ureter and bladder were anastomosed.Autologous kidneys were placed in abdominal cavity in 4 cases,and placed in right iliac fossa with retroperitonealization in 1 case.Ice slush on the surface of the autologous kidney did not completely melt before the blood supply was restored during the operation,and the autologous kidney immediately urinated after the blood supply was restored.Results All surgeries were performed successfully without conversion to open surgeries.The total operation time was 460 min,ranging (415-645 min),the time of robotic nephrectomy was 120 min,ranging (74-300 min),the time of robotic kidney autotransphntation was 135 min,ranging(103-163 min),the warm ischemia time was 3 min,ranging (1.5-6.0 min),the cold ischemia time was 182 min,ranging(135-210 min),the rewarming time was 50 min,ranging(45-55 min),the estimated blood loss during operation was 100 ml,ranging(50-300 ml),and the hospital stay was 6 d,ranging(5-9 d).The number of resected tumors was 4,ranging(2-6).The pathology reveals clear cell carcinoma in 3 cases and chromophobe cell carcinoma in 2 cases.The surgical margins were all negative.The serum creatinine levels were 111.1 μmol/L (87-217.6 μ mol/L) and 106.1 μmol/L (87.1-172 μmol/L) on the 7th and 30th day after operation,respectively.One month after operation,CT showed that the function and morphology of the autologous kidneys were fine.No recurrence or metastasis was found in 5 patients during a median follow-up of 7 months,ranging (5.4-11.7 mon).Conclusions For patients with complex renal tumors who cannot undergo in situ partial nephrectomy,robotic nephrectomy,work bench surgery with robotic kidney autotransplantation can completely remove the tumors,maximize the preservation of renal function and minimize the trauma of patients,making the ultimate means of nephron-sparing surgery for patients with complex renal tumors more minimally invasive and safe.

Design method of constitution regulating and healthcare foods based on medicinal property combination mode / 中国中药杂志

Currently, the herbal prescription therapy for corresponding constitutional diseases is a common constitution regulating method. This method has an obvious effect in treating and regulating constitution-related diseases. However, for people who do not have disease, they prefer to regulate constitution with dietary therapy. In this paper, the researchers came up with a design method of constitution regulating and healthcare foods based on medicinal property combination mode of clinical empirical formulas. With "Yupinfeng San", a common formula for Qi-insufficiency constitution and specific endowment constitution, as the example for constitution regulating and healthcare foods, the researchers proved the effectiveness and rationality of healthcare food schemes in terms of the efficacy of single herb and the modern pharmacological study.

Application of oral micro-carrier drug delivery system in studies on traditional Chinese medicine / 中国中药杂志

Drug-loading micro-particles are a targeted, positioned and controlled-release drug delivery carrier with a wide application prospect. Various micro-carrier drug delivery systems have their own advantages in promoting absorption, improving stability, targeting and controlled release. Accordingly, it is of far-reaching significance for the studies on micro carrier drug delivery systems to build oral traditional Chinese medicine (TCM) compound micro-carrier drug delivery systems with effective TCM components and effective fractions. This article introduces several features and advantages of oral micro-carrier drug delivery systems, and summarizes their application in the field of TCMs.

Epidemiology and etiology of hand-foot-and-mouth disease seen in Jiangsu province from 2008 to 2010 / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the etiological and epidemiological characteristics of hand-foot-and-mouth disease (HFMD) seen in Jiangsu province from 2008 to 2010, and provide evidence for its prevention and control.</p><p><b>METHODS</b>Based on the requirement of supervision program of HFMD, surveillance and report were done according to National Disease Supervision Information Management System. Descriptive epidemiological method, performed between 2008 and 2010, was used to analyze the time, region and population distribution and results of etiologic analysis of HFMD. Nucleic acid of enterovirus (EV) genome was detected by real-time RT-PCR.</p><p><b>RESULTS</b>The average incidence rate of HFMD was 86.70 per million between 2008 and 2010, the peak incidence occurred in April to July. There were significant differences among the incidence in different districts (P<0.05), and the highest incidence was seen in the densely inhabited southern areas of Jiangsu province. Most of the cases were infants and children aged less than 5 years. The number of male cases (2008: 17,008, 2009: 48 768, 2010: 50,231) was much larger than that of the female cases 2008: 9662, 2009: 29 151, 2010: 30,655. The HFMD cases with mild symptoms were caused mainly by enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16) and there was difference among different years. The severe HFMD cases and deaths were mainly caused by EV71 infection.</p><p><b>CONCLUSIONS</b>The epidemiologic characteristics of HFMD in Jiangsu province from 2008 to 2010 had close relationship with season, population and region. The mild cases of HFMD were mainly infected with EV71 and Cox A16. However, EV71 illness seemed to be more severe and had significantly greater frequency of serious complications and fatality than the illness caused by Cox A16.</p>

Transurethral partial cystectomy with a 2 micron laser in diagnosis and treatment for bladder submucosal lesions in adults / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of transurethral partial cystectomy with a 2 µm laser in diagnosis and treatment for the bladder submucosal lesions in adults.</p><p><b>METHODS</b>Nine patients with suspected pathological diagnosed bladder submucosal lesions in out-patient department were diagnosed and treated transurethral with a 2 µm laser under sacral block between August 2009 and December 2010. The diameters of tumors were 1.5 - 2.5 cm. A 2 µm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with bladder wall at the base were removed together and sent for pathological examination. The surgical procedures, intraoperative hemorrhage, intraoperative and postoperative complications were observed, pathological diagnosis and postoperative follow-up were performed.</p><p><b>RESULTS</b>All operations were successful. Mean operative time was 36.4 minutes (range 25 to 47 minutes), perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage detected after surgery. Postoperative pathological diagnosis included leiomyoma in 3 cases, pheochromocytoma in 3 cases, endometriosis in 1 case and metastatic bladder cancer in 2 cases.</p><p><b>CONCLUSIONS</b>Transurethral partial cystectomy with a 2 µm laser can diagnose and treat bladder submucosal lesions. The procedures are effective and safe. Patients could get accurate pathological diagnosis without further painful and some bladder tumors can be treated by minimally invasive surgery.</p>

Retroperitoneal laparoendoscopic single-site donor nephrectomy using home-made single-port device:report of 11 cases / 中华器官移植杂志

Objective To investigate the feasibility and safety of retroperitoneal laparoendoscopic single-site (LESS) donor nephrectomy using home-made single-port device.Methods From January 2011 to June 2012,11 consecutive LESS left donor nephrectomies using home-made single-port device with conventional laparoscopic instrument were performed through retroperitoneal access in our center.Results The procedures were completed and no complications occurred in all donors.Mean operative time was 149.5 min.Estimated blood loss was 30-350 ml.Warm ischemia time was 2-4 min.The urine output was prompt in all cases.Recipient graft function was normal within 2 weeks.Donor hospital stay was 5-6 days after operation.Conclusion LESS donor nephrectomy using home-made single-port device in our initial experience is feasible and safe.It is also cost-effective and minimally invasive with conventional laparoscopic donor nephrectomy.This technique is a good option for living donor nephrectomy.

Frequency and linkage disequilibrium of specific HLA-DR and HLA-DQ genes in Chinese Han population / 中国实验血液学杂志

This study was aimed to investigate the distribution feature of HLA-DR/DQ gene linkage disequilibrium in Chinese Han population and to improve the accuracy of HLA matching results. Genotyping of HLA-DR and HLA-DQ gene locus was performed using PCR-SSP typing in Chinese Han population receiving kidney transplantation. The results showed that there were 29 new linkage combinations in 1799 patients, in which DR13-DQ5, DR11-DQ8 and DR8-DQ8 were discovered for 11, 8 and 7 times respectively while DR9-DQ8, DR12-DQ6 and DR14-DQ4 were both discovered for 6 times. The linkage disequilibrium parameters of these haplotypes were negative, showing that these linkages were uncommon. It is concluded that this study not only enriches the classical HLA-DR/DQ linkage combinations, but also indicates the national relevance of combination distribution, and it has great importance in improving the accuracy of HLA matching experiments and reducing unnecessary repeated work.

A viral meningitis outbreak associated with Echo30 in drinking water / 中华流行病学杂志

Objective To study the source of infection,the scope of epidemic and control measures in an outbreak involving students having symptoms as fever,dizziness,headache,vomiting and nausea.Methods The suspected-case was defined as fever (armpit temperature ≥37 ℃) and with one or more of the following symptoms:dizziness,headache,vomiting and nausea,among students and teachers at school from Mar 1,2012.Confirmed-case was among suspected case accompanied by both throat and rectal swabs enterovirus positive by RT-PCR.All the cases were collected through checking the medical records from 4 hospitals as well as through the absence records of students and teachers,from Mar 1,2012.We conducted a case-control study with ratio of 1 ∶ 2 and data on the exposures to water among students and teachers was collected prior to the illness.27 cases' throat and rectal swabs were collected and analyzed by RT-PCR and PCR sequence methods.2 warm-water samples were collected for testing the counts on total bacteria and E.coli.Results 103 students' cases were identified in school L,with the attack rate as 4.6％ (103/2255).Students from Grade three had the high attack rate as 18.1％ (72/397) and 77.7％ (80/103) of the cases located in the building with ' multiple-functions'.Epidemic curve of the outbreak showed a pattern with continuous common source of infection.It seemed that the exposure to warm-water appeared to be the major risk factor (OR =18.3,95％CI:2.0-169.5) together with the intake of un-boiled water (OR =15.5,95 ％CI:1.7-141.8).Specimens from 27 students (81.5％,22/27) were identified enterovirus positive by RT-PCR,and 7 of the 9 students were confirmed carrying Echo 30.Bacteria and coli were negative from the 2 warm-water samples.Conclusion This viral meningitis-outbreak was caused by Echo 30,with drinking water as the major risk factor.

The application of time series analysis in predicting the influenza incidence and early warning / 中华预防医学杂志

<p><b>OBJECTIVE</b>This research aimed to explore the application of ARIMA model of time series analysis in predicting influenza incidence and early warning in Jiangsu province and to provide scientific evidence for the prevention and control of influenza epidemic.</p><p><b>METHODS</b>The database was created based on the data collected from monitoring sites in Jiangsu province from October 2005 to February 2010. The ARIMA model was constructed based on the number of weekly influenza-like illness (ILI) cases. Then the achieved ARIMA model was used to predict the number of influenza-like illness cases of March and April in 2010.</p><p><b>RESULTS</b>The ARIMA model of the influenza-like illness cases was (1 + 0.785B(2))(1-B) ln X(t) = (1 + 0.622B(2))ε(t). Here B stands for back shift operator, t stands for time, X(t) stands for the number of weekly ILI cases and ε(t) stands for random error. The residual error with 16 lags was white noise and the Ljung-Box test statistic for the model was 5.087, giving a P-value of 0.995. The model fitted the data well. True values of influenza-like illness cases from March 2010 to April 2010 were within 95%CI of predicted values obtained from present model.</p><p><b>CONCLUSION</b>The ARIMA model fits the trend of influenza-like illness in Jiangsu province.</p>

Retroperitoneal laparoscopic live donor nephrectomy: Report of 105 cases / 华中科技大学学报（医学）（英德文版）

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications. Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors. All donor nephrectomy was successful. There were no donor deaths and no conversion to open surgery. Mean operation time was 112 min (range, 70-200 min). Intraoperative blood loss was 10-150 mL with an average of 30 mL. Warm ischemia time was 1.3 to 6 min with an average of 3.1 min. Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications. Donors were discharged from the hospital 5 to 10 days postoperation. Average postoperative hospital stay was 6.4 days. One graft was removed due to acute rejection. Delayed graft function occurred in two recipients but renal function returned to normal within four weeks. The other recipients had normal renal function in two weeks except three recipients in four weeks. We believe that retroperitoneal laparoscopic live donor nephrectomy is safe, reliable, and less invasive.

Retroperitoneal laparoscopic living donor nephrectomy: report of 58 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To review a single-institution experience with retroperitoneal laparoscopic living donor nephrectomy (RLDN).</p><p><b>METHODS</b>Fifty-eight donors underwent RLDN at our institution (including 32 male and 26 female donors aged 20-61 years, mean 42 years). Left nephrectomy was performed in 56 cases. The first 35 patients underwent total RLDN, and the latter 23 received modified RLDN.</p><p><b>RESULTS</b>RLDN was performed successfully in all the patients without conversion to open surgery. The mean surgical time was 93 min (range 70-130 min), and the mean blood loss was 20 ml (range 10-50 ml), with a mean warm ischemia time of 2.8 min (1.3-6 min). Retroperitoneal hematoma occurred postoperatively in one case. The mean hospital stay of the donors was 6.4 days (5-10 days). Two recipients showed delayed graft function, and one graft was lost because of acute rejection. The other recipients had normal renal function in two weeks except for 3 having normal renal function in 4 weeks.</p><p><b>CONCLUSION</b>RLDN is a safe procedure with minimal invasiveness, and the modified RLDN lowers the learning curve of the surgery.</p>

Serologic survey on pandemic influenza A (H1N1) virus among aged ≥3 years population from Jiangsu province in 2009, China / 中华流行病学杂志

Objective To understand the antibody levels against pandemic influenza A (H1N1) virus (2009 H1N1 ) among aged ≥3 years population in 2009, from Jiangsu province, and to describe the distribution of 2009 H1N1. Methods Serum specimens were collected from natural populations at four different periods in Jiangsu, and tested with hernagglutination-inhibition (HI)assays. Rates of protective antibody against 2009 H1N1 and Geometric mean titers (GMTs)were estimated. Results The rates of protective antibody against 2009 H1N1 rose with the and November, 2009. There were no significant differences on the rates of protective antibody between males and females at four different cross-sectional periods (P＞0.05), and no significant differences on GMTs were observed at different periods except for November 2009. Significant differences on rates of protective antibody and GMTs among various age groups were observed at four different periods (P＜0.05), and similar results were observed among different periods in various age groups (P＜0.05). There were significant differences on rates of protective antibody and GMTs among different areas (P＜0.05). Conclusion The 2009 H1N1 strain had been widely spread out in Jiangsu province since July 2009. People aged 12-17 years became the major victims after August. As of November 2009, the rate of protective antibody against 2009 H1N1 was still low, predicting that the epidemic might continue to exist for a certain period of time.

The feasibility of outpatient data used for respiratory syndromic surveillance in general hospital / 中华流行病学杂志

Objective To find out the data sources of respiratory syndromes and their components from the outpatients of general hospitals and to describe the time distribution and mutual relations of different respiratory syndromes. Feasibility of respiratory syndromes used for early warning surveillance on respiratory infectious disease was also under research. Methods Retrospective investigation on Hospital Information System (HIS) was implemented in a general hospital in Guangzhou, 2005, and data of outpatients was collected and classified into different syndromes. The respiratory syndromes with its time distribution similar to influenza like illness (ILI),were selected, and cross-correlation analyses were conducted to inveshgate the feasibility of respiratory syndromes for early warning surveillance on respiratory infection diseases (influenza as an example). Results Primary sub-classification of respiratory syndromes in outpatient department would include upper respiratory infection(URI)(51.20%), trachitis/bronchitis (18.80%), asthma ( 17.52% ), etc. Pulmonary infection accounted for only 2.26%. Time distributions of URI, trachitis/bronchitis, pulmonary infection, cough and asthma in outpatient department, X-ray tests and pneumonia/acute respiratory distress syndromes (ARDSs) in outpatient X-ray room were similar, with two peaks observed. Cross-correlation functions were calculated with the data sets of 1st-28th week.The most significant correlation was detected between the time series of outpatient pulmonary infections and ILIs moved 4 weeks backward (r＝0.739, P＜0.01 ), and that was detected between URIs and ILIs moved 5 weeks backward (r=0.714, P＜0.01 ). Correlation between X-ray tests,pneumonia/ARDSs in outpatient X-ray room and ILIs was the strongest when ILIs time series moved 1 week backward (r=0.858, P＜0.001; r=0.821, P＜0.001 ). Conclusion Outpatient data from HIS system in general hospital could be applied to syndromic surveillance on respiratory diseases. For early warning epidemics or outbreaks of influenza or other respiratory infectious diseases, data of outpatient pulmonary infection appeared to be the most feasible for its specificity and timeliness, followed by URI and cough. X-ray tests and pneumonia/ARDSs in outpatient X-ray findings were important supplementary to verify the respiratory disease epidemics or outbreaks for its good specificity, but with no advantage for early warning.

An outbreak of human Streptococcus suis serotype 2 infections presenting with toxic shock syndrome in Sichuan, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>In mid-July 2005, five patients presented with septic shock to a hospital in Ziyang city in Sichuan, China, to identify the etiology of the unknown reason disease, an epidemiological, clinical, and laboratory study were conducted.</p><p><b>METHODS</b>An enhanced surveillance program were established in Sichuan, the following activities were introduced: active case finding in Sichuan of (a) laboratory diagnosed Streptococcus suis infection and (b) clinically diagnosed probable cases with exposure history; supplemented by (c) monitoring reports on meningococcal meningitis. Streptococcus suis serotype 2 infection was confirmed by culture and biochemical reactions, followed by sequencing for specific genes for serotype and virulence factors.</p><p><b>RESULTS</b>From June 10 to August 21, 2005, 68 laboratory confirmed cases of human Streptococcus suis infections were reported. All were villagers who gave a history of direct exposure to deceased or sick pigs in their backyards where slaughtering was performed. Twenty six (38%) presented with toxic shock syndrome of which 15 (58%) died. Other presentations were septicaemia or meningitis. All isolates were tested positive for genes for tuf, species-specific 16S rRNA, cps2J, mrp, ef and sly. There were 136 clinically diagnosed probable cases with similar exposure history but incomplete laboratory investigations.</p><p><b>CONCLUSION</b>An outbreak of human Streptococcus suis serotype 2 infections occurred in villagers after direct exposure to deceased or sick pigs in Sichuan. Prohibition of slaughtering in backyards brought the outbreak to a halt. A virulent strain of the bacteria is speculated to be in circulation, and is responsible for the unusual presentation of toxic shock syndrome with high case fatality.</p>

Anlysis on features of dead cases with human Streptococcus suis infections / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the clinical and epidemiological features of dead cases with human Streptococcus suis infections, and to find the target population for preventing death and the related indicators.</p><p><b>METHODS</b>Epidemiological investigation on human Streptococcus suis infections was implemented used unified questionnaires. Analysis on dead cases and survival cases (as contrast) was done.</p><p><b>RESULTS</b>The population with highest fatality rate was in 40-49 age group. 97.37% of dead cases had toxic shock syndrome. The mean interval from onset to admission was 0.76 days, and the mean course was 2.11 days. The progression among dead cases was faster than that among survival cases. Chief clinical manifestations of dead cases that are more frequent than survival cases are purpura (73.68%), diarrhea (50.0%), dyspnea (21.05%), conjunctival congestion (34.21%), etc. Renal impairment and liver involvement in dead cases were more significant than that in survival cases. No significant difference between mean incubation period, exposure rates of main risk factors in dead cases and in survival cases was found.</p><p><b>CONCLUSION</b>Preventing toxic shock syndrome might reduce the fatality rate. The target population for preventing death is aged > or = 40. Liver function and renal function testing might be indicators for monitoring the progression of human Streptococcus suis infections.</p>

Matched case-control study for risk factors of human Streptococcus suis infection in Sichuan Province, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the potential risk factors of human infecting with Streptococcus suis.</p><p><b>METHODS</b>1: M matched case-control study was conducted. 29 human cases of Streptococcus suis infection in the early phase were included in the case group, Patients' family members, neighbors and peoples who had worked together with patients to handle deceased or sick pigs in the last week were recruited as matched controls. There were 147 controls in total. Both cases and controls received questionnaire investigation including the ways to contact sick/dead pigs. Conditional logistic regression was employed to analyze matching data.</p><p><b>RESULTS</b>According to the results of multivariate analysis, slaughtering (OR = 11.978, 95% CI: 3.355-42.756), carcasses cutting and processing (OR = 3.008, 95% CI: 1.022-8.849) sick/dead pigs were associated with cases related to human Streptococcus suis infection. The attributable risk proportion were 91.65% and 66.76% respectively. The other types of exposures to sick/ dead pigs, including feeding, selling, burying and eating, were not associated with the human Streptococcus suis infection in our study population.</p><p><b>CONCLUSION</b>Slaughtering, carcasses cutting and processing sick/dead pigs were important risky behavior for humans to be infected by Streptococcus suis.</p>

Surveillance on hemorrhagic fever with renal syndrome in Jiangsu province from 1996 to 2000 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the incidence rate, animal hosts, and human inapparent infection rate from surveillance data collected in Jiangsu province from 1996 to 2000 and the risk factors of hemorrhagic fever with renal syndrome (HFRS).</p><p><b>METHODS</b>Data on the incidence rate was collected from the whole province to describe the epidemiologic characteristics of HFRS. Data on the density of rats, proportion of rats with virus, index of rats with virus and the human inapparent infection rate were collected in special areas according to the standardised protocol in the project.</p><p><b>RESULTS</b>The incidence rate of HFRS reduced continuously in Jiangsu province, with a 42.17% reduction from 1996 to 2000. The ratio between the incidence rate of autumn-winter peak and spring peak had also reduced. The main host in spring was Rattus norvegicus (with a density of 3.07%), while that in autumn was Apodemus agrarius (with a density of 4.64%). The density of main hosts and mixed species of rats had all reduced during the five years of observation. The proportions of Rattus norvegicus, Apodemus agrarius, Mus musculus with virus were relatively high in spring and autumn. The index of Rattus norvegicus and Mus musculus with virus in spring were 0.025 5 and 0.028 4 respectively, while that of Apodemus agrarius with virus in autumn was 0.030 2. The average human inapparent infection rate was 4.73% in the five years.</p><p><b>CONCLUSION</b>The incidence rate of HFRS in Jiangsu reduced significantly from 1996 to 2000, but the risk factors still widely existed. Suggesting that the surveillance program needs to be carried out steadily in Jiangsu.</p>