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Objective: By conducting a retrospective analysis of the clinical data of 14 patients diagnosed with invasive fungal rhinosinusitis (IFRS) confirmed by metagenomics next generation sequencing (mNGS) technology, we aim to explore the rapid diagnosis value of mNGS in IFRS. Methods: The clinical data of 14 IFRS patients admitted to TianJin First Central Hospital were retrospectively analyzed from February 2021 to October 2023. The study cohort comprised 8 males and 6 females, with ages ranging from 14 to 77 years. All patients were diagnosed as IFRS by performing mNGS sequencing technology of nasal sinus lesion biopsy specimens. Clinical data such as laboratory examination, imaging examination, histopathological examination results, treatment plan and prognosis were summarized and analyzed. Results: All 14 patients were diagnosed as IFRS, with mNGS detecting pathogens such as Rhizopus (7 cases), Aspergillus (5 cases), Trichoderma (1 case), and Scedosporium apiospermum (1 case). Follow-up evaluations were conducted for a period ranging from 2 months to 2 years post-treatment. At the end of follow-up, 11 out of 14 IFRS patients achieved a complete cure with no signs of recurrence, while the symptoms of the remaining 3 patients significantly improved with comprehensive treatment. Conclusion: mNGS emerges as a highly effective diagnostic tool for IFRS, providing valuable microbiological evidence for clinical diagnosis and demonstrating promising clinical utility.

Objective: To understand the distribution of genotypes and sub-genotypes of HBV in different ethnic groups in China. Methods: The HBsAg positive samples were selected by stratified multi-stage cluster sampling from the sample base of national HBV sero-epidemiological survey in 2020 for the amplification of S gene of HBV by nested PCR. A phylogeny tree was constructed to determine the genotypes and sub-genotypes of HBV. The distribution of genotypes and sub-genotypes of HBV were analyzed comprehensively by using laboratory data and demographic data. Results: A total of 1 539 positive samples from 15 ethnic groups were successfully amplified and analyzed, and 5 genotypes (B, C, D, I and C/D) were detected. The proportion of genotype B was higher in ethnic group of Han (74.52%, 623/836), Zhuang (49.28%, 34/69), Yi (53.19%, 25/47), Miao (94.12%, 32/34), Buyi (81.48%, 22/27). The proportions of genotype C were higher in ethnic groups of Yao (70.91%, 39/55). Genotype D was the predominant genotype in Uygur (83.78%, 31/37). Genotype C/D were detected in Tibetan (92.35%,326/353). In this study, 11 cases of genotype I were detected, 8 of which were distributed in Zhuang nationality. Except for Tibetan, sub-genotype B2 accounted for more than 80.00% in genotype B in all ethnic groups. The proportions of sub-genotype C2 were higher in 8 ethnic groups, i.e. Han, Tibetan, Yi, Uygur, Mongolian, Manchu, Hui and Miao. The proportions of sub-genotype C5 were higher in ethnic groups of Zhuang (55.56%, 15/27) and Yao (84.62%, 33/39). For genotype D, sub-genotype D3 was detected in Yi ethnic group and sub-genotype D1 was detected in both Uygur and Kazak. The proportions of sub-genotype C/D1 and C/D2 in Tibetan were 43.06% (152/353) and 49.29% (174/353). For all the 11 cases of genotype I infection, only sub-genotype I1 was detected. Conclusions: Five genotypes and 15 sub-genotypes of HBV were found in 15 ethnic groups. There were significant differences in the distribution of genotypes and sub-genotypes of HBV among different ethnic groups.

Retinopathy of prematurity (ROP) is a retinal vascular proliferative disease occurring in premature and low birth weight infants, which is the leading cause of blindness and low vision in children. Laser photocoagulation is still recognized as the gold standard of treatment in ROP. Recently, anti-vascular endothelial growth factor (VEGF) therapy has become a novel alternative approach in clinical practice for ROP. However, there are still many improper and deviations in identifying indications and selecting therapeutic modalities, resulting in generalization and abuse of anti-VEGF drugs in treatment of ROP. The aim of this article is to summarize and objectively evaluate the treatment indications and methods of ROP based on related research at home and abroad, in order to strictly control the theraputic indications and scientifically and rigorously select appropriate therapeutic modalities for the benefit of children with ROP.

Currently, the national schistosomiasis control program of China is moving from transmission interruption to elimination, and there are multiple challenges during the stage moving towards the progression of schistosomiasis elimination, including a high difficulty in shrinking snail-infested areas, unstable achievements for infectious source control, imperfect surveillance system and a reduction in schistosomiasis control and administration. Based on the core suggestions proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, recommendations on schistosomiasis surveillance system building, development of novel diagnostics, adjustment of the schistosomiasis control strategy and maintaining and improvements of the schistosomiasis control capability are proposed for the national schistosomiasis control program of China in the new era according to the actual status of schistosomiasis control in China. Formulation of the national schistosomiasis control strategy and goal from One Health perspective, verification of transmission interruption and elimination of schistosomiasis, precision implementation of schistosomiasis control interventions with adaptations to local circumstances, development and application of highly sensitive and specific diagnostics are recommended for elimination of schistosomiasis in China. In addition, the implementation of the 2022 WHO guideline on control and elimination of human schistosomiasis may guide the elimination of schistosomiasis in China.

Objective: To investigate the epidemiological characteristics of COVID-19 caused by 2019-nCoV Delta variant in Shangyu district, Shaoxing of Zhejiang province in 2021, and provide evidence for the improvement of COVID-19 control and prevention measures. Methods: The incidence data of COVID-19 in Shangyu from December 7 to 21, 2021 was obtained from Shangyu District Center for Disease Control and Prevention. The epidemiological characteristics of the cases, i.e. the population, time and space distributions, were analyzed, and the incubation period and time-varying reproduction numbers ( R t ) were calculated. Results: From December 7 to 21, 2021, a total of 380 COVID-19 cases caused by 2019-nCoV Delta variant were detected in Shangyu, the median age of the cases was 52 years, M ( Q 1 ，Q 3 : 38, 61). The male to female ratio of the cases was 1∶1.25, and the cases were mainly workers (36.58%) and farmers (27.63%). The epidemic affected 9 townships (or community) of Shangyu, especially Caoe and Baiguan communities with the cases accounting for 57.10% and 31.53% respectively. The median incubation period of cases was 4.00 days, M ( Q 1 ，Q 3 : 3.00, 5.75). The basic reproduction number ( R 0 ) was 4.06, and the R t was 5.62 in early phase of the outbreak (the highest) and continuously decreased to less than 1.00 within 10 days after the detection of the outbreak. The number of COVID-19 cases decreased to 0 within 14 days after the outbreak (December 7-21), and the main detection methods were screening in centralized isolation (55.53%) and home isolation (40.00%). The infection rates of close contacts and secondary close contacts were 2.06% and 0.46% respectively. Conclusion: The epidemic of COVID-19 in Shangyu characterized by short incubation period, large number of infected people, and case clustering, suggesting the strong transmission of Delta variant (B.1.617.2). Comprehensive prevention and control measures, such as management of close contacts and secondary close contacts, and high-risk area, are essential for the rapid control of the epidemic.

Objective: To analyze the genotype distribution of acute hepatitis B virus in China. Methods: A total of six hundred and twenty acute Hepatitis B cases reported to China Information System for Diseases Control and Prevention from 2015 to 2017 were selected. First, the full-length HBV genome was obtained by nested PCR amplification. In addition, the HBV genotype was determined by constructing a phylogeny tree. Finally, using primarydata, HBV genotype distribution was analyzed. Results: A total of 519 (83.71%, 519/620) sequences were obtained genotype of 620 acute hepatitis B cases, including A (0.19%, 1/519), B (27.17%, 141/519), C (62.04%, 322/519), D (9.06%, 47/519), I (0.77%, 4/519) and C/D (0.77%, 4/519); B2(95.03%, 134/141) and C2 (72.67%, 234/322) were the two major subgenotypes. Genotypes were distributed differently in seven regions of China. The proportion of genotype C appeared higher in Northeast China (94.55%, 52/55), North China (93.85%, 61/65), East China (78.87%, 56/71), and South China (58.14%, 50/86). The proportion of genotype B was higher in Central China (58.07%, 36/62) and Southwest China (52.94%, 45/85), the proportion of genotype D was the highest in Northwest China (48.42%, 46/95). A total of 515 cases were classified as serotypes, including 'adr' (57.48%, 296/515), 'adw' (30.87%, 159/515), 'ayr' (0.19%, 1/515), and 'ayw' (11.46%, 59/515). Genotype B was dominated by 'adw' serotype (92.14%, 129/140), genotype C was dominated by 'adr' serotype (91.88%, 294/320),all genotype D were 'ayw' serotype. The genotype of acute hepatitis B was correlated with serotype, 'adw' was dominant in genotype B, 'adr' was dominant in genotype C and 'ayw' was dominant in genotype D.In different gender and age group, there was no statistical significance ingenotype distribution ( P >0.05). Conclusions: The genotype of acute hepatitis B in China from 2015 to 2017 was mainly B, C, and D; genotype C was dominant in the Northeast China,North China, East China and South China; B and C were common in Central and Southwest China, and genotype B was dominant. Genotype D was primarily distributed in Northwest China. The genotype of acute hepatitis B was correlated with serotype, 'adw' was dominant in genotype B, 'adr' was dominant in genotype C and 'ayw' was dominant in genotype D. There was no difference in the distribution of acute hepatitis B genotypes among different genders and age groups.

Objective: To understand the characteristics of hepatitis B cases reported through the National Notifiable Disease Reported System (NNDRS) of China in 2019, analyze the quality of hepatitis B reporting. Methods: The survey forms and reporting cards of hepatitis B cases in 200 surveillance points in China in 2019 were collected from NNDRS, the completeness rate of the reporting card was calculated, and the reported hepatitis B cases were verified based on the diagnostic criteria (WS 299-2008). The clinical types of the cases after verification were compared with the reported ones, the consistency was evaluated with Kappa test. The reasons for the inconsistent clinical types of the cases were analyzed. Results: In 2019, a total of 64 686 hepatitis B cases were reported through NNDRS. Acute, chronic and unclassified hepatitis B cases accounted for 5.8%, 92.4% and 1.8%, respectively. The average age of reported cases was 47 (47±15) years, and males accounted for 64.4%. The average level of alanine aminotransferase was 214.2 (214.2±1 253.4) U/L. The reported cases mainly worked in agriculture, forestry, animal husbandry, fishery, and water conservancy (50.6%, 32 722). The proportions of cases reported from the eastern, western and central regions were 42.5% (27 501),22.1% (14 315) and 35.4% (22 870), respectively. The consistent rate of the clinical types between the reported cases and the verified cases was 58.8%, with a Kappa value of 0.15. For the 39 271 cases confirmed as acute and chronic hepatitis B cases in the reporting cards, the consistent rate of the clinical types between the reported cases and the verified cases was 96.9%, with a Kappa value of 0.73. In 94.5% (24 267/25 681) of the cases with inconsistent clinical types, the reporting card information were incomplete. Conclusion: The diagnosis of hepatitis B has been improved in the hepatitis B surveillance in China, but it is necessary to improve the completeness of the reporting cards of hepatitis B cases to NNDRS.

Objective: To understand the epidemiological characteristics of hepatitis B in China, evaluate the performance of elimination hepatitis B in China and provide scientific evidence for the prevention and control of hepatitis B. Methods: An analysis was conducted by using the data of hepatitis B cases reported to the National Notifiable Disease Reporting System (NNDRS) from the areas with low, moderate and high hepatitis B prevalence in China from 2013 to 2020, and the information about the diagnoses of the hepatitis B cases were collected, the incidence of hepatitis B was estimated according to the reporting and diagnosis information and the characteristics of acute and chronic hepatitis B were compared. Results: A total of 27 013 hepatitis B cases were reported to NNDRS, including 4 070 acute cases, 21 971 chronic cases and 972 unclassified cases. Among the reported acute hepatitis B cases, 69.9% (2 845/4 070) were confirmed. Among the reported chronic hepatitis B cases, 89.0% (19 548/21 971) were confirmed, and 2.1% (452/21 971) were confirmed as acute cases. It was estimated that the incidence of acute hepatitis B was 4.6/100 000 and the incidence of chronic hepatitis B cases was 54.5/100 000. The case number of acute hepatitis B in age group 31-45 years was highest, accounting for 35.3% (1 164/3 297). The case number of acute hepatitis B in children under 15 years old was lowest, accounting for 0.4% (13/3 297). The case number of chronic hepatitis B in age group 46-60 years was highest, accounting for 34.4% (7 211/20 932). Conclusions: The incidence of acute hepatitis B was in decrease and the incidence of chronic of hepatitis B was in increase in China year by year. It is important to strengthen the standardized diagnosis and treatment of chronic hepatitis B to decrease the morbidity and mortality of hepatitis B. At the same time, it is necessary to standardize the management and reporting of hepatitis B cases reported to NNDRS to improve the accuracy of the reporting of hepatitis B.

Objective: To make a cost-benefit analysis of the hepatitis B vaccination (HepB) to prevent mother-to-child transmission (PMTCT) strategies in China, 1992-2019. Methods: We built a decision analytic-Markov model to estimate the birth cohorts of 1992-2019. The parameters in our model were referred from literature, published yearbooks, and data from Chinese Center for Disease Control and Prevention. We conducted a univariate sensitivity analysis to test the robustness of the model. Results: For the 28 birth cohorts, the Chinese government has invested 37.43 billion RMB Yuan in direct costs and 47.61 billion RMB Yuan in societal costs on HepB vaccination and HBV prevention of mother to child transmission (PMTCT). And we estimated that about 50 million chronic HBV infections and 12.5 million premature deaths due to HBV-related diseases would be averted. China would save 2.89 trillion RMB Yuan and 6.92 trillion RMB Yuan for the direct and societal medical burden on HBV-related conditions. The direct and societal net benefit was 2.85 trillion RMB yuan 6.87 trillion RMB yuan, respectively. The direct and societal benefit-cost ratios (BCRs) were 77.21 and 145.29, respectively. Conclusion: The strategies of HepB vaccination for HBV PMTCT prevention were cost-effective in China during 1992-2019.

Objective: To retrospective analyze the epidemiology, clinical characteristics, treatment and prognosis in patients with coronavirus disease 2019 (COVID-19). Methods: A total of 278 patients with COVID-19 admitted to Guangzhou Eighth People's Hospital from January 20 to February 10, 2020 were selected. The general demographic data, epidemiological data, clinical symptoms, laboratory examinations, lung CT imaging, treatment and prognosis were analyzed. Results: There were 130 male patients (46.8%) and 148 females (53.2%) with age (48.1±17.0) years and 88.8% patients between 20-69 years. Two hundred and thirty-six (84.9%) patients had comorbidities. Two hundred and eleven cases (75.9%) were common type. The in-hospital mortality was 0.4% (1/278). The majority (201, 72.3%) were imported cases mainly from Wuhan (89, 44.3%). The most common clinical manifestations were fever (70.9%) and dry cough (61.5%). In some patients, hemoglobin (10.4%), platelets (12.6%) and albumin (55.4%) were lower than the normal range. Other biochemical tests according to liver and function were normal, while lactic dehydrogenase (LDH) was elevated in 61 patients (21.9%), creatine kinase increased in 26 patients (9.4%). Prolonged activated partial thromboplastin time (APTT) was seen in 52 patients (18.7%), D-dimer higher than normal in 140 patients (50.4%), while 117 patients (42.1%) had elevated high-sensitivity C-reactive protein. Typical CT manifestations included single or multiple ground glass shadows especially in lung periphery in early disease which infiltrated and enlarged during progressive stage. Diffuse consolidation with multiple patchy density in severe/critical cases and even "white lung" presented in a few patients. Two hundred and forty-two patients (87.1%) received one or more antiviral agents, 242 (87.1%) combined with antibacterials, 191 (68.7%) with oxygen therapy. There were 198 patients (71.2%) treated with traditional Chinese medicine. Conclusions: COVID-19 could attack patients in all ages with majority of common type and low mortality rate. Clinical manifestations involve multiple organs or systems. Progression of the disease results in critical status which should be paid much attention.

Objective: To assess the effectiveness of influenza vaccine in children aged 6-72 months. Methods: The cohort study was conducted based on community child vaccination clinics in Yiwu and Yongkang counties of Zhejiang province. From October 2017 to December 2017, a total of 1 752 children aged 6-72 months were enrolled from 10 child vaccination clinics. The questionnaire survey was conducted after the written consents were obtained from the parents or legal guardians of the children. Then, a follow up was conducted for enrolle children until 30 April 2018, the influenza vaccination status and the number of influenza-like illness (ILI) cases, hospital visit due to ILI, self-medication due to ILI were observed and recorded every month. Vaccine effectiveness (VE) was estimated by using the generalized linear model (GLM) where dependent variables were the number of ILI cases, hospital visit and self-medication respectively. Results: Of the 1 752 children, 925 (52.80%) were boys and the median age was 30.00 months. The cumulative observation was 308 166 person days at the end of 2017-2018 season, with 5.27 ILI cases per 1 000 person days, 3.41 hospital visit due to ILI per 1 000 person days, 1.45 self-medication due to ILI per 1 000 person days. Of the 1 752 children, 643 received the influenza vaccination in 2017-2018 season. Compared with unvaccinated children, the VE was 23.5% against ILI case number (95% CI : 15.1%-31.1%), 19.3% against hospital visit due to ILI (95% CI : 8.2%-29.1%) and 25.8% against self-medication due to ILI (95% CI : 9.3%- 39.3%). Modeling splitting 643 children with 2017-2018 vaccination into those before and after vaccination, the influenza VE was 31.9% against ILI case number (95% CI : 12.7%-46.9%), 32.6% against hospital visit due to ILI (95% CI : 8.6%-50.3%) and 44.3% against self-medication due to ILI (95% CI : 11.9%-64.8%) in children aged 36-72 months. However, the children aged 6-35 months showed no significant VEs. For the VE analysis in children with different vaccination status, the VEs were significant if they received vaccination in both 2016-2017 season and 2017-2018 season or only in 2017-2018 seasons. The VE was not demonstrated among the children who were immunized only in 2016-2017 season. Conclusion: Influenza vaccination is moderate effective in preventing the incidence of ILI and hospital visit and self-medication in children in influenza season, the protection effect in children aged 36-72 months is better than that in children aged 6-35 months.

Objective: To investigate the expression of myocyte enhancer factor 2B (MEF2B) in mantle cell lymphomas (MCL), and to analyze the correlation between the expression of MEF2B and pathological subtypes, structural subtypes, SOX11 expression and its clinical significance. Methods: Paraffin-embedded tissues were stained with HE, immunohistochemistry (EnVision method) and fluorescence in situ hybridization (FISH) , in addition, the clinical and pathological data of 60 cases of MCL were collected at Sun Yat-sen University Foshan Hospital and Sun Yat-sen University Cancer Center from January,2002 to May, 2019 for analysis. Results: Of the 60 MCLs, males is predominant (M∶F = 3∶1). Histologically, the typical MCL is the majority (classical MCL: variant type MCL=48 cases:12 cases) . Fifty cases were classified into non-complete FDC meshwork type MCL, and the remaining 10 cases were classified into the complete-FDC meshwork type MCL group. Patients with classical MCL were more than 60 years old. The coexistent lesion sites both node and extranode in pathological subtype or structural subtype was the most common lesion sites. SOX11(+) MCL was common in classical MCL ( P= 0.040) and tended to be complete-FDC meshwork type MCL ( P= 0.086). The expression rate of MEF2B in MCL was 60.0%(36/60). This rate of MEF2B in classical type, complete-FDC meshwork type and SOX11(+) MCL was significantly higher than that variant type, no complete-FDC meshwork type, SOX11(-)MCL ( P< 0.05), respectively. There was no difference in clinical characteristics of MCL between MEF2B positive and negative groups. Compared with SOX11(-)MCL, the percentage of MEF2B expressed in tumor cells of SOX11(+)MCL was significantly higher ( P= 0.027). The expression of MEF2B was not related to the proliferation of tumor cells ( P= 0.341). There was no significant difference in the survival rate between different expression groups of MEF2B and SOX11 ( P= 0.304 and P= 0.819, respectively). Only the mortality of variant type (blastoid/pleomorphic) MCL within 2 years was significantly higher than that of classical type MCL ( P< 0.05). Conclusions: The expression of MEF2B in MCL is related to the pathological subtypes, structural subtypes and the expression of SOX11, but not to the proliferation and prognosis. The high mortality rate within 2 years is only found in variant MCL. However, the role of MEF2B in MCL needs to be further studied.

Objective: To analyze the epidemiological characteristics of hepatitis E Virus antibody (anti-HEV) in people aged 1-29 years in China in 2014. Methods: Based on database of the national serologic survey of hepatitis B in people aged 1-29 years in China, in 2014, the sample size was estimated. The serum samples of the people surveyed were randomly selected to detect anti-HEV IgG by using enzyme- linked immunosorbent assay (ELISA). Statistical software SAS 9.1.3 was used to calculate the positive rate of anti-HEV and 95 % confidence interval ( CI ) in different age, gender groups, urban and rural areas and geographic areas by using the Taylor series linear method with sampling weight. The difference was determined by comparing 95 %CI . Results: A total of 14 106 serum samples were detected from people aged 1-29 years, including 6 996 males (49.60 % ), 7 013 urban residents (49.72 % ). The positive rate of anti-HEV was 8.12 % (95 %CI : 7.19-9.15) in people aged 1-29 years. There was no statistical difference between the men and women, between urban area and rural area. The positive rates of anti-HEV in western area(11.36 % , 95 %CI : 9.45-13.62) was higher than those in eastern and central areas. The positive rates of anti-HEV were 2.46 % , 2.24 % , 4.50 % , 7.58 % , 11.89 % and 17.27 % in people aged 1-, 5-, 10-, 15-, 20- and 25-29 years, respectively. As the age increased, the positive rate of anti-HEV gradually increased. In different ethnic groups, the positive rate of anti-HEV was higher in Tibetan (18.32 % , 95 %CI : 12.02-26.90), Zhuang (9.54 % , 95 %CI : 4.33-19.73) ethnic groups. Conclusion: The positive rate of anti-HEV declined slightly in China in 2014. It is still necessary to pay close attention to the HEV infection, morbidity of hepatitis E and risk factors in people aged 1-29 years.

Objective: To describe the influence of post-operative anatomical structure changes on nasal airflow characteristics by 3D reconstruction and numerical simulation in real cases after nasalisation with Draf Ⅲ so as to explore the correlation between the changes of anatomical structure and subjective symptoms as well as airflow characteristics. Methods: Ten patients underwent nasalization with Draf Ⅲ in Department of Rhinology in Beijing Tongren Hospital from 2006 to 2018 were selected retrospectively. Postoperative follow-up of all patients was more than 1 year. All patients had no abnormalities in their paranasal sinus CT scans and Lund-Kennedy scores were 0 except scar. VAS scores including nasal obstruction, stimulation in frontal sinus, and headache were collected at the same period. The control model was a normal person. Numerical simulation was used for calculating airflow characteristics in deep inspiratory period of both models. Independent sample Mann-Whitney U test and Spearman correlation test were used by software SPSS 22.0. Results: The airflow pressure in frontal sinus ostium was (7.21±1.39)×10(4) Pa (Mean±SD), which was lower than that in normal subjects (8.99×10(4) Pa) under deep inspiratory simulation. But, the velocities in frontal sinus ostium and frontal sinus were (40.10±2.46) m/s and (28.19±1.73) m/s respectively, which were higher than those in normal one (2.70 m/s, 0.73 m/s). The airflow patterns of the two models were basically similar. There was no significant difference in the opening size and volume of frontal sinus between different groups after grouped by three symptoms respectively. No correlation could be found between the opening size and volume of the frontal sinus with the appearance and severity of three subjective symptoms. Conclusions: The airflow pattern and distribution after nasalisation with Draf Ⅲ are like those of normal person. There is no correlation between the changes of anatomy in frontal recess and frontal sinus and nasal airflow characteristics as well as subjective symptoms.

Objective: To assess the effectiveness of seasonal influenza vaccine among children aged 6 to 72 months. Methods: The test-negative case control study was conducted based on available surveillance data which was from China Influenza Surveillance Information system (CSIS). From October 2016 to April 2017 and from October 2017 to April 2018,1 161 cases aged 6-72 months with influenza-like illness in Yongkang and Yiwu city, were selected as the study subjects, and the cases with influenza test-positive were selected as the case group (403 cases). Test-negative subjects were selected as control group (758 cases). The etiology and immunization data of the subjects were obtained from CSIS and Immune Information and Management System (IIMS) respectively. Vaccine effectiveness was estimated using multivariate logistic regression model,and the mixed effects of non-randomized control in TNCC study were equalized by using the propensity score (PS) method in the statistical analysis. Results: The age of the subjects was (2.44±1.60) years,and there were 681 boys (58.66%). The age of case group was (2.62±1.58) years, and there were 246 boys (61.04%). The case group was including of 237 cases (58.81%) of influenza A (H3N2), 92 cases (22.83%) of influenza A (H1N1) pmd09, 62 cases (15.38%) of influenza B(Victoria) lineage, 11 cases (2.73%) of influenza B (Yamagata) lineage and one case (0.25%) co-infection of influenza [A(H(3)N(2))+B (Victoria)]. The mean age of the control group was (2.35±1.61) years,and there were 435 boys (57.39%). Overall vaccine effectiveness (VE) against all type influenza for two seasons combined was 58% (95 %CI : 31%-74%). An analysis by age groups showed 68% (95 %CI :41%-82%) of the VE estimate among children aged 36-72 months while it was 28%(95 %CI :-80%-71%)of the VE estimate among children aged 6-35 months. The VE estimate value was 54% (95 %CI :16%-75%) against all type influenza and 65% (95 %CI :24%-83%) against influenza A (H(3)N(2)) during the 2016-2017 season. During the 2017-2018 season, the VE estimate value was 69% (95 %CI :18%-88%) against all type influenza. Conclusion: Influenza vaccine is effective in preventing influenza virus infection during the flu season,especially the effect among children aged 36-72 months is higher compared to that among children aged 6-35 months.

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To analyze the changing epidemiological characteristics of hepatitis E cases in China, in order to promote in preventing and controlling hepatitis E. Methods: Data of hepatitis E and outbreaks reported through national notifiable diseases reporting system were analyzed from 2004 to 2017, but data of Hongkong, Macau and Taiwan were not included. Data of hepatitis E were divided into three phases as 2004-2007, 2008-2011 and 2012-2017, representing eight years before, four years before and years after the postmarketing of hepatitis E vaccine. Linear regression was used for analyzing the trend of hepatitis E, improved muster method was used for analyzing the seasonal intensity. Results: From 2004 to 2017, 329 519 hepatitis E cases were reported and the annual incidence were increasing from 1.27/100 000 to 2.10/100 000 ( t= 6.87, P< 0.001). The concentrations of hepatitis E during 2004-2007, 2008-2011 and 2012-2017 were 17.43, 16.06, 11.17, respectively, with low seasonal intensity. Number of cases reported by Jiangsu, Guangdong and Zhejiang accounted for 31.54% of national cases. The incidence were lower in central (1.45/100 000) and western (1.11/100 000) region than that in eastern region (2.67/100 000), but were increasing continuously. There was an increasing trend of incidence with growing ages ( t= 7.85, P< 0.001). The incidence was higher than 2/100 000 among cases aged ≥40, and was the highest (5.22/100 000) in the age group of 65-69 years old. Farmers, retired persons, houseworkers and unemployees accounted for 67.46% of total cases. A total of 7 outbreaks were reported, among which 3 were in nursing homes. Conclusion: The incidence of hepatitis E in central and western regions were increasing continuously and the surveillance should be strengthened. There was higher risk among middle-aged population, farmers and nursing homes, so strategy for immunization among those population was in great need.

Objective: Through analyzing the epidemiological characteristics of hepatitis A and E and the situation of vaccination, to promote the recommendation profile on Hepatitis E vaccination program, in China. Methods: Three phases of time span were divided as 2004-2007, 2008-2011 and 2012-2015, with age groups divided as <20, 20-29, 30-39 and ≥40. Incidence rates in both different phases and age groups were compared. Numbers of Hepatitis A and E vaccines released and used, were described. Results: Between 2004 and 2015, a declining trend in the reported incidence of hepatitis A ( t =-12.15, P <0.001), but an increasing trend in hepatitis E ( t =6.63, P <0.001) were noticed. The mean number of hepatitis A cases declined from 6 515 to 1 986 between 2004 and 2007 while the number of hepatitis E cases increased from 1 491 to 2 277 between 2012 and 2015. The peaks of hepatitis E appeared persistent annually, in March. The incidence of hepatitis A declined in three regions, with the western region (3.46/100 000) much higher than the eastern (1.13/100 000) or central regions (1.14/100 000) ( χ (2)=32 630, P <0.01). The incidence of hepatitis E increased both in the central (1.74/100 000) and western regions (1.58/100 000), but more in the eastern region (2.66/100 000) ( χ (2)=6 009, P <0.01). Incidence of hepatitis A declined in all age groups and declined by 84.36% among the 0-19 group. However, the incidence of hepatitis E showed an increasing trend among the ≥20 group. Incidence rates appeared higher in the older age groups. The coverage of hepatitis A vaccine increased from 62.05% to 93.54%, but with a negative association seen between the coverage of Hepatitis A vaccine and the incidence ( F =10.69, χ (2)<0.05). Conclusion: The incidence of Hepatitis A declined sharply in China while hepatitis E was still increasing from 2004 to 2015, calling for the expansion on the coverage of Hepatitis E vaccine in the whole population.

Objective: To review the consistency of diagnosis and reporting of hepatitis B (HB) patient in non-surveillance hospitals in three provinces and analyze the influencing factors. Methods: In 2016, using typical survey methods, we carried out a hospital-based pilot study in three provinces: Fujian, Hainan and Gansu. In each province, we chose two hospitals with grade 3 and grade 2 respectively in each province, using the following criteria: (1) in 2015, the hospital reported a greater number of hepatitis B cases compared the hospital-based provincial mean; (2) the hospital had an advanced laboratory information system (LIS) with access to HBsAg test results; (3) the hospital had an electronic hospital information system (HIS) which linked to the LIS via the inpatient medical record number; (4) general hospital; (5) non-surveillance hospitals for hepatitis B. Using national notifiable infectious disease reporting system (NNDRS), we chose all HB patients who were reported by the investigated hospitals in 2015, and we linked NNDRS HBV case-reports with patient-data from hospital information systems (HIS) to review the diagnosis, and then to compare the consistency of reviewed diagnosis and NNDRS report diagnosis, which we made a descriptive analysis. We used multivariable logistic regression to examine factors associated with misclassification of case-reports to NNDRS. Results: We found the NNDRS report accuracy was 47.11% (669) among 1 420 eligible inpatient hepatitis B inpatients. Of the 352 reported acute HBV cases, 6.53% (23) were consistent with our medical record review, the accuracy rate for level 2 hospitals and level 3 hospitals was 9.42% (21) and 1.55% (2), respectively. Of the1 068 reported chronic HBV cases, 60.49% (646) were consistent with our medical record review, the accuracy rate for level 2 hospitals and level 3 hospitals was 57.92% (106) and 60.02% (540), respectively. Compared to primary diagnosis of HB patients, the OR (95 %CI ) for mis-report was 29.36 (19.21-44.76) in non-primary diagnosis of HB patients. Compared to Fujian Province, the mis-report risk was higher in Hainan province and Gansu Province, with the values of OR (95 %CI ) being 2.33 (1.58-3.44) and 20.38 (11.29-36.78), respectively; compared to level 3 hospitals, the OR (95 %CI ) for mis-report was 2.38 (1.66-3.42) for level 2 hospitals; compared to HB related wards, the OR (95 %CI ) for mis-report was 1.45 (1.04-2.01) in non-HB-related wards. Conclusion: In some non-surveillance areas of China, the consistency between hepatitis B diagnosed in hospital and reported in NNDRS was low. Factors affecting the accuracy of HB surveillance data in NNDRS were level 2 hospitals, non-liver disease departments and nonprimary diagnosis of HB.

Objective: To investigate the clinicopathological and immunohistochemistrical features of secretory carcinoma of the breast (SCB), as well as its diagnosis and prognosis. Methods: Five cases of SCB were collected and specimens were fully drawn. Microscopic pathology examinations and immunohistochemistry(SP method)were performed. Results: Five cases were all female patients aged from 31 to 54 years old (with an average age of 38 years), and all patients initially presented with the painless breast lump, often near the areola. Macroscopically, all the tumors were relatively circumscribed, with a mean diameter of 2.1 cm(1.2-3.0 cm). Histologically, the tumors revealed different patterns (microcystic, solid, ductal, and so forth) and appeared large amounts of intracellular and extracellular eosinophilic PAS- and AB-PAS- positive secretory materials, as well as the granular eosinophilic cytoplasm. Immunohistochemistrically, the tumor cells were strongly positive for epithelial membrane antigen (EMA) and S-100. Three cases had negative expression for estrogen receptor (ER) and progesterone (PR), and two cases had weakly focal expression. Human epidermal growth factor receptor 2 (HER2) and P53 were negative, while only one case had weakly focal expression. The tumors were positive for CK7, CK5/6, CD10, but they were negative for CEA, smooth muscle actin (SMA) and P63 . The proliferation index of Ki-67 was 5%-8%. There was no patient with metastasis of the tumor in axillary lymph node. Except 1 case lost follow-up, and the rest had no recurrence or distant metastasis. Conclusions: SCB is very rare, with low malignancy, and has better prognosis, but it is usually classified as triple-negative breast cancer because of the immune phenotype. The correct diagnosis of this lesion depends on clinical characteristics, morphology and immunohistochemistry.

Objective: To evaluate the effects on Hepatitis B surveillance models at the surveillance pilot points in China. Methods: Hepatitis B related records kept at the surveillance pilot points were downloaded from NNDRS. Data concerning proportion of unclassified Hepatitis B cases, consistency of additional records and the accuracy of reported acute Hepatitis B cases were evaluated. Results: The proportion of unclassified Hepatitis B cases was decreasing year by year ( P <0.05), from 32.07% in 2012 to 4.26% in 2015, with Kappa as 0.768, 0.821 and 0.836 respectively in 2013-2015. The accuracy of reported acute Hepatitis B was improving ( P <0.05), from 55.77% in 2013 to 74.49% in 2015. Conclusions: Additional records and blood testings on acute Hepatitis B cases seemed to be effective in improving the accuracy of Hepatitis B reporting system and decreasing the proportion of unclassified Hepatitis B cases. We suggested that this model of surveillance could be applied elsewhere in the nation to improve the quality of report system on Hepatitis B.

Objective: To analyze the epidemiological characteristics of hepatitis A cases in China from 2004 to 2015. Methods: Data of hepatitis A were reported through national notifiable disease information reporting system, which covered the 31 provinces (Hong Kong, Macau and Taiwan excluded). The inclusion criteria was: date of illness onset was between January 1(st) 2004 and December 31(st) 2015, the status of reported card was confirmed, the case was classified as laboratory confirmed or clinical diagnosed, the disease was Hepatitis A. The information such as sex, date of birth, date of illness onset, place of residence was collected. The data was divided into three phases, 2004-2007, 2008-2011, 2012-2015, which represented the phase before expanded program on immunization (EPI), first 4 years after EPI, second 4 years after EPI. Results: From 2004 to 2015, there were totally 574 697 hepatitis A cases in China, the mean annual incidence was 3.62/100 000. The risk ratio of hepatitis A in 2015 was 0.23 when compared with 2004. Sichuan, Xinjiang and Yunnan contributed to 27.27% of the total cases in China. In 2012-2015, the incidence of western (3.46/100 000) region was significantly higher than that in central (1.21/100 000) and eastern (1.08/100 000) regions. From 2004-2015, number of cases in each age group declined greatly, with number of cases declining from 43 711 to 5 938 in the age group of 5-9 years, from 29 722 to 3 438 in 10-14, from 23 212 to 3 646 in 15-19. The number of cases declined from 24 079 to 10 304 in the age group of 0-4 (declined by 57.21%), but in 2012-2015, the incidence of 0-4 age group was still the highest, with 77.72% cases in Xinjiang and Sichuan. Famers, students and scattered children accounted for 69.95% of total cases, with student cases declined from 24.08% (2004-2007) to 8.67% (2012-2015). Conclusion: The incidence of hepatitis A in China is decreasing year by year, the risk has been decreasing to a relatively low level. However, in western regions and children under age five, the risk is still high. Precision intervention is needed for further prevention and control of hepatitis A.

Objective: To compare the antibody persistence 5 years after primary immunization with 5 μg and 10 μg recombinant hepatitis B vaccine (HepB) among newborns with normal and high response. Methods: Newborns who completed three doses of 5 μg HepB made by recombinant dexyribonucleic acid technique in Saccharomyces (HepB-SC) or 10 μg HepB made by recombinant dexyribonucleic acid technique in Hansenula polymorpha (HepB-HP) were recruited. Standardized questionnaire was used and blood samples were collected 1-6 months (T(0)) and five years (T(1)) after the third dose respectively. The titer of anti-HBs was detected by chemiluminescence microparticle imunoassay (CMIA). Those who achieved normal or high antibody response (anti-HBs titer ≥100 mIU/ml) were included in the study and the positive rate (≥10 mIU/ml) and titer of anti-HBs at T(1) were compared between 5 μg HepB group and 10 μg HepB group. Multivariable analysis was conducted to identify the independent factors associated with the antibody persistence. Results: The positive rate of anti-HBs at T(1) was 49.92 % (943/1 883) and 75.92 % (1 135/1 495) respectively in 5 μg HepB group and 10μg HepB group, the difference was significant ( χ(2) =237.75, P <0.001). The anti-HBs geometric mean concentrations at T(1) were 10.23 mIU/ml (95 %CI : 9.38-11.16) and 28.91 mIU/ml (95 %CI : 26.65-31.35) in the two groups respectively, the difference was also significant ( F =280.36, P <0.001). Among those whose anti-HBs titer was<10 mIU/ml at T(1), the distributions of anti-HBs titer were significantly different between 5 μg HepB group and 10 μg HepB group ( χ (2)=39.75, P <0.001). The multivariable analysis showed that dosage of HepB was independently associated with both positive rate and titer of anti-HBs at T(1) after excluding the other factors[ P <0.001, OR =1.44 (95 %CI : 1.20-1.73); P <0.001, β =0.27 (95 %CI : 0.14-0.40)]. Conclusion: Five year anti-HBs persistence after primary immunization with 10 μg HepB might be better than that after primary immunization with 5 μg HepB among infants who achieved normal or high anti-HBs response after primary HepB immunization.

Objective: To analyze the epidemiological characteristics of HBV susceptible people in 1-29 years old people in 2006 and 2014 in China. Method: Data is from the 2006 and 2014 national sero-survey, and both of them were conducted in 160 disease surveillance points of 31 provinces (excluding Hong Kong, Macao Special Administrative Region and Taiwan province) in China. We used the centralized face-to face investigation method to collect basic information including birth date, gender, ethnicity, resident place, hepatitis B vaccination (HepB) history and so on, and 5 ml venous blood was collected for all subjects to test the sero-markers of HBsAg, anti-HBs and anti-HBc. We definite the HBV susceptible people as the HBsAg, anti-HBs and anti-HBc all negative together. And we use chi-square to analyze the epidemiological characteristics of HBV susceptibility in 1-29 years old young people in 2006 and 2014, and use multiple factors logistic regression to analyze the affect factors on HBV susceptible appearing in people with HepB vaccination. Result: In 2006 and 2014 sero-surveys, the investigated 1-29 year-old people were 49 849 and 31 713, respectively. And compared with 2006, the proportion of HBV susceptible people with HepB among 1-29 in 2014 increased from 20.87% (10 401) to 28.55% (9 055) (χ(2)=630.69, P< 0.001); and the proportion of susceptible people without HepB decreasing from 15.02% (7 485) to 7.66% (2 460) (χ(2)=953.73, P< 0.001). Compared with Han nationality, the high risk of susceptible appearing in minority people after HepB vaccination ( OR= 1.38). And compared with less than 3 doses HepB vaccination, the more than 3 doses vaccination could reduce the anti-HBs disappearing rate ( OR= 0.68); Compared with one year after last dose vaccination, the 2-4 years interval ( OR= 3.33) and more than 5 years interval ( OR= 6.53) would have high risk for anti-HBs disappearing. All above were P< 0.001. In western area, the proportion of susceptible people without HepB (9.58%, 1 047/2 460) was higher than the proportion in eastern (6.30%, 657/2 460) and middle area (7.30%, 756/2 460) ( P< 0.001). Conclusion: The HepB coverage maintained in high level in 1-4 years old children. The HBV susceptible proportion mainly concentrated in 15-29 years old people, and the immunization gap was in western, rural areas and minority peoples.

Objective: To analyze the sero-epidemiological characteristics of hepatitis B virus among people born during 1994-2001, conducted by the national hepatitis B sero-epidemiological surveys in 2006 and 2014. Methods: Based on the data of the two national hepatitis B sero-epidemiological surveys in 2006 and 2014, people born during 1994-2001 were included into our analysis as this study subjects. The two surveys were conducted in 160 disease surveillance points of 31 provinces (not including Hong Kong, Macao and Taiwan) in China. Face-to-face interviews with the subject by door to door or on the investigation site were conducted by trained staff using standard questionnaires to obtain basic information including birth date, sex, ethnicity, resident place and so on. And then 5 ml venous blood was collected. Enzyme-linked immunosorbent assay (ELISA) reagents were used for HBsAg, anti-HBs and anti-HBc measurements and Abbott micro-particle enzyme immunoassay (MEIA) reagents was used to confirm test. We analyzed HBsAg, anti-HBs and anti-HBc positive rate by gender, ethnicity, urban/rural, eastern/central/western region, birth years and compared the distribution of serum epidemiological characteristics in 2006 and 2014. Results: 19 821 and 4 712 people born during 1994-2001 were involved in 2006 and 2014 national serosurveys of China, respectively. For the people born during 1994-2001, HBsAg positive rate were 2.02% (95 % CI: 1.82%-2.21%) in 2014 and 1.95% (95 % CI: 1.56%-2.35%) in 2006. Anti-HBc positive rate were 7.94% (95 %CI: 7.17%-8.71%) in 2014 and higher than that in 2006 (6.49%, 95 %CI: 6.15%-6.83%), especially for the female (8.31%, 95 % CI: 7.20%-9.43%), urban (7.45%, 95 % CI: 6.38%-8.52%), western region (11.25%, 95 %CI: 9.79%-12.71%), minority people (16.02%, 95 %CI: 13.47%-18.57%) in 2014 were higher than that of the female (6.29%, 95 % CI: 5.81%-6.78%), urban (4.82%, 95 % CI: 4.40%-5.24%), western region (7.97%, 95 % CI: 7.31%-8.63%), minority people (11.88%, 95 % CI: 10.66%-13.00%) in 2006 respectively. Anti-HBs positive rate were 57.80% (95 %CI: 57.11%-58.48%) in 2014 and 59.13% (95 %CI: 57.72%-60.53%) in 2006. Anti-HBs positive rate of rural (58.80%, 95 % CI: 56.83%-60.78%),western region (58.50%, 95 % CI: 56.23%-60.78%), minority people (57.20%, 95 % CI: 53.76%-60.63%) in 2014 was higher than of rural (52.62%, 95 % CI: 51.64%-53.61%),western region (51.73%, 95 % CI: 50.54%-52.96%),minority people (41.14%, 95 %CI: 39.28%-43.00%) in 2006. Conclusion: Anti-HBc positive rate among people born during 1994-2001 in 2014 survey showed a rising tendency than in 2006. The risk of HBV infection was existed. Hepatitis B vaccine catch-up in childhood was necessary.

Objective: To evaluate the effect of hepatitis B prevention and control by comparative analysis on the results of HBsAg, anti-HBs and anti-HBc prevalence from national hepatitis B seroepidemiological surveys in 1992 and 2014 in different epidemic regions of China. Methods: Data was from the national seroepidemiological surveys of hepatitis B conducted in 1992 and 2014. The survey in 1992 was conducted in 145 disease surveillance points of 30 provinces (excluding Hong Kong, Macao Special Administrative Region and Taiwan province) in China. The survey in 2016 was conducted in 160 disease surveillance points of 31 provinces (excluding Hong Kong, Macao Special Administrative Region and Taiwan province) in China. In the two surveys, face-to-face interviews with the subject by door to door or on the investigation site were conducted by trained staff using standard questionnaires to obtain basic information including birth date, gender, ethnicity, resident place and so on. And then 5 ml venous blood was collected to test the sero-markers of HBsAg, anti-HBs and anti-HBc. We analyzed unweighted point prevalence and 95 % CI of HBsAg, anti-HBs and anti-HBc in 1992 which had no design weighting, and analyzed weighted point prevalence and 95 %CI of HBsAg, anti-HBs and anti-HBc in 2014 which had design weighting. Results: 34 291 and 31 713 people aged 1-29 years were involved in 1992 and 2014 national serosurveys of China, respectively. For the people aged 1-29 years, HBsAg prevalence was 2.64% (95 %CI: 2.28%-3.06%) in 2014 and decreased by 73.92% as compared with the rate 10.13% (95 % CI: 9.81%-10.45%) in 1992. Anti-HBc prevalence was 13.01% (95 %CI: 12.09%-14.00%) in 2014 and decreased by 71.61% as compared with the rate 45.84% (95 % CI: 45.31%-46.37%) in 1992. Anti-HBs prevalence was 57.79% (95 %CI: 56.33%-59.25%) in 2014 and ascended by 127.41% as compared with the rate 25.41% (95 % CI: 24.95%-25.87%) in 1992. In high, medium and low epidemic region, for the people who born during 1992-2001 when hepatitis B vaccine was introduced in routine immunization management, HBsAg prevalence was 4.74% (95 %CI: 3.79%-5.69%), 1.59% (95 %CI: 1.09%-2.10%) and 2.53% (95 %CI: 1.66%-3.39%), respectively, and anti-HBs prevalence was 64.25% (95 % CI: 62.11%-66.39%), 56.34% (95 % CI: 54.50%-58.57%), 54.49% (95 %CI: 51.75%-57.23%), respectively, and anti-HBc prevalence was 15.16% (95 %CI: 13.56%-16.76%), 11.07% (95 %CI: 9.80%-12.33%), 7.61% (95 %CI: 6.15%-9.07%), respectively. In high, medium and low epidemic region, for the people who born during 2002-2013 the duration which hepatitis B vaccine was integrated in expanded immunization program born during when HBsAg prevalence was 0.88% (95 %CI: 0.66%-1.11%), 0.37% (95 %CI: 0.24%-0.49%)and 0.71% (95 %CI: 0.48%-0.94%), respectively, and anti-HBs prevalence was 60.74% (95 %CI: 59.57%-61.90%), 59.46% (95 %CI: 58.44%-60.49%), 52.56% (95 % CI: 51.20%-53.92%), respectively, and anti-HBc prevalence was 3.30% (95 % CI: 2.87%-3.72%), 1.91% (95 %CI: 1.63%-2.20%), 2.25% (95 %CI : 1.85%-2.66%), respectively. Conclusion: China had made great achievement in hepatitis B prevention and control. HBsAg prevalence among people aged 1-29 years old in 2014 decreased dramatically as compared with that in 1992. Since hepatitis B vaccine was integrated into expanded immunization program, China reduced HBsAg prevalence to less than 1% among people aged 1-12 years in 2014 in different epidemic region.

Objective: Assess the 4-year antibody against hepatitis B surface antigen (anti-HBs) persistence after revaccination with 3-dose of hepatitis B vaccine (HepB) among low-responder infants following primary vaccination. Methods: According to stratified cluster sampling, a total of 4 147 infants were enrolled and primarily vaccinated with 5 μg HepB derived in Saccharomyces Cerevisiae (HepB-SC) at 0-1-6 months schedule from 75 towns of Jinan, Weifang, Yantai, Weihai prefectures, Shandong Province, China in Aug and Sep 2009. Blood samples were collected one to six months after the third dose of primary immunization and tested for anti-HBs using chemiluminescence microparticle immunoassay (CMIA). 717 infants who appeared low response (10 mU/ml ≤ anti-HBs<100 mU/ml) were revaccinated with 3-dose of HepB. Blood samples were collected from a total of 315 infants one month (T(0)), four years (T(1)) after revaccination and anti-HBs, antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected by CMIA. Information about their birth, primary vaccination were collected. The risk factors associated with positive rate of anti-HBs and GMC of anti-HBs were identified by multiple non-conditional logistic regression analysis and multifactor linear regression model analysis, respectively. Results: Among 315 children, 165 (52.38%) were male and 150 (47.62%) were female. The positive rate was 83.81% (264/315) at T(0) and it decreased to 16.51% (149/529) at T(1). The corresponding GMC decreased from 473.15 mU/ml to 17.37 mU/ml. The average annual decreasing rate of positive rate and GMC was 33.38% and 56.23% from T(0) to T(1). Multivariable analysis showed the positive rate and GMC among those whose anti-HBs titer higher at T(0) were significantly higher at T(1). The positive rate at T(1) among those whose anti-HBs titer 400-<600, 600-<800, 800-<1 000, ≥1 000 mU/ml at T(0) were significantly higher than those whose anti-HBs titer less than 200 mU/ml. The OR (95 %CI ) of the positive rate was 4.29 (1.03-17.84), 4.53 (1.25-16.47), 4.19 (1.10-15.97) and 9.13 (2.91-28.63), respectively. The GMC at T(1) among those whose anti-HBs titer 400-<600, 600-<800, 800-<1 000 mU/ml and those whose anti-HBs titer ≥1 000 mU/ml at T(0) were higher than those whose anti-HBs titer < 200 mU/ml. The b value (95 % CI ) of GMC was 0.84 (0.06-1.62), 1.13 (0.46-1.79), 1.33 (0.65-2.01) and 1.88 (1.33-2.44), respectively. GMC among full-term infants were significantly higher than premature infants at T(1). The b value (95 % CI ) of GMC was 0.86 (0.04-1.68). Conclusion: Anti-HBs GMC decreased rapidly 4 years after revaccination among low-responder infants, but still kept good protection. The anti-HBs persistence after revaccination was associated with anti-HBs level of titer one month after revaccination.

Objective: To analyze the sero-epidemiological features of hepatitis B among children aged 1-14 years old who were born to HBsAg positive mothers. Methods: Based on the results from the hepatitis B national sero-survey in 2014, children aged 1-14 years old born to HBsAg positive mother were involved in this study. Positive rates on HBsAg, anti-HBs, anti-HBc by gender, age, nationality, birth place, residency (urban/rural), region (eastern/central/western) and related factors of HBsAg and anti-HBs for children under research, were analyzed by SPSS 18.0 statistical software. Results: A total of 645 children aged 1-14 years old that born to HBsAg positive mothers were analyzed in the study. Positive rates on HBsAg, anti-HBs, anti-HBc among these children were 3.41 % (22/645), 71.94 % (464/645) and 7.60 % (49/645), respectively. HBsAg positive rates for children aged 1-2 years, 3-4 years, 5-9 years, 10-14 years appeared 1.27 % (3/236), 3.23 % (6/186), 5.71 % (8/140) and 6.02 % (5/83), respectively. The anti-HBs positive rates were 85.17 % (201/236), 69.35 % (129/186), 56.43 % (79/140), 66.27 % (55/83) while the anti-HBc positive rates were 4.66 % (11/236), 5.38 % (10/186), 11.43 % (16/140) and 14.46 % (12/83), respectively. Results from the multifactor logistic analysis showed that birth place, time of the first dose of HepB inoculation were major influencing factors on the positive rates among children with HBsAg. HBsAg positive rate for the children born outside the hospital was higher than those born in the hospital ( OR =7.47, 95 %CI :1.50-37.25). HBsAg positive rate for children with the first dose of HepB inoculation>24 h after birth, was higher than that inoculation within 24 h after birth ( OR =6.21, 95 % CI : 2.15-17.99). Conclusions: Some achievements in preventing mother-to-child transmission of hepatitis B had been seen in China. Hospital delivery for pregnant women and timely HepB vaccination with birth-dose for the neonates, remained the key strategy on prevention of HBV vertical transmission.

Acute Stanford type A aortic dissection with important branches involved is more complex, could lead to organ malperfusion syndrome even organ failure. The understanding of pathological anatomy, classification, staging, and the pathophysiological change has increasingly mature, but not complete. In addition, the treatment strategy for complex lesions is diversified, some questions may not reach consensus. Fully understanding of the anatomical and pathophysiology is very important for surgeons to choose reasonable treatment strategy. As the rapid development of the basic research, imaging techniques and the concept of surgery procedures, the manage technique of Stanfrod type A dissection and branch vessels at the same time is getting seriously, the related issues also need further discussions.

Objective: To understand the characteristics of acute hepatitis B inpatients reported by the hepatitis B surveillance pilot points and to estimate the consistency between the diagnosed and reported types of hepatitis B by the clinicians involved. Methods: Data related to acute hepatitis B was from the NNDRS and the characteristics of acute hepatitis B were classified by querying Hospital Information System. We recorded the results based on clinical diagnosis and analyzed the consistency between the reported and diagnosed types that the clinicians made, on hepatitis B. Results: A total of 179 patients were included in this study with all of them as acute hepatitis B reported through NNDRS in 2015-2016. In terms of the durations of disease, among the 179 cases who were HBsAg positive, 32.40% (58/179) of them exceeding 6 months, 2.79% (5/179) within 6 months and 64.80% (116/179) tested the first time or never. Among the 179 cases who claimed having the history of hepatitis, 33.52% (60/179) of them identified as having hepatitis B, 1.12% (2/179) were hepatitis A, C or E, 41.34% (74/179) did not have the signs on hepatitis, while the rest 24.02% (43/179) did not know the situation. Only 79.89% (143/179) of the patients showed the symptoms or signs of hepatitis, but the rest 20.11% (36/179) did not. Among the 179 reported acute hepatitis patients, 67 of them were diagnosed as acute hepatitis B while 112 cases were as non-acute hepatitis B. The consistent rate of acute hepatitis B was 37.43% (67/179). Among the 112 cases that were diagnosed as non-acute hepatitis B, proportions of chronic hepatitis B and cirrhosis were 49.11%(55/112) and 16.07%(18/112) respectively. Conclusion: Consistency between the reported type of acute hepatitis B inpatients and the types diagnosed by clinicians was poor. Our results suggested that clinicians should make the accurate diagnosis at first place and then report to the Network in accordance with the clinical diagnosis classification criterfia, set by the government.

Objective: To evaluate the epidemiological characteristics of the children aged 1-4 years without timely birth dose of hepatitis B vaccine (HepB(1)) vaccination. Methods: Based on the data from 160 disease surveillance points in 31 provinces of China, two-stage cluster random sampling was used to select the target population aged 1-4 years. A standard questionnaire was used to collect the information about the birth date, gender, ethnic group, place of birth, HepB immunization history of the children selected. A blood sample (3 ml) was taken from each subject for HBsAg testing. SAS software (Version 9.4) was used in our study. We analyzed the age, gender, ethnic group, area specific distributions of the children aged 1-4 years without timely HepB(1) vaccination and the influencing factors, and the relationship between the HepB(1) vaccination time and HBsAg prevalence rate. Results: A total of 12 587 children aged 1-4 years were analyzed and the non-timely HepB(1) vaccination rate was 10.12 % . The place of birth, ethnic group, urban/rural area, eastern/central/western area, age were the main influencing factor of the non-timely HepB(1) vaccination. The non-timely HepB(1) vaccination rate was higher in 3-4 years old children (11.13 % ) than in 1-2 years old children (8.97 % ), in rural area (12.05 % ) than in urban area (8.19 % ), in western area (13.41 % ) than in central area (9.27 % ) and eastern area (7.72 % ), in minority ethnic group (18.06 % ) than in Han ethnic group (8.77 % ) and in children born outside hospital (57.66 % ) than in children born in hospital (9.27 % ). The HBsAg prevalence rate among 1-4 years children was 0.31 % . The HBsAg prevalence rate of the children with timely HepB(1) vaccination (0.25 % ) was lower than that of the children without timely HepB(1) vaccination (0.89 % ). Conclusions: In China, the HBsAg prevalence rate among 1-4 years children with HepB vaccination decreased to <0.5 % and the timely HepB(1) vaccination rate reached to 90 % . We should strengthen the timely HepB(1) vaccination for the children in minority ethnic groups, in western area, in rural area as well as those born outside hospitals.

Objective: To analyze the duplicated reporting of hepatitis B in the national notifiable communicable disease report system (NNDRS) in China during 2011-2013. Methods: The data of hepatitis B reported from January 1, 2011 to December 31, 2013 were collected from NNDRS, the duplicated reporting were searched with software SAS 9.1.3 according to the cases'ID number, name, gender, birth data and current address code. Results: During 2011-2013, a total of 3 389 374 hepatitis B cases were reported through NNDRS, but the duplicated reporting rate was 7.35% (249 047). According to 6 protocols, the duplicated reporting rate ranged from 0.88% to 6.38%. If using the data in 2011 as the baseline, the duplicated reporting rate in the three years was 2.91%, 8.11% and 11.72 %, respectively. In the duplicated repeating, 33.04% (71 709) occurred in the same year, and 66.96% (145 329) occurred in other year. Without the duplicated repeating, the hepatitis B incidence in Xinjiang and Qinghai provinces in 2013 could decreased by 30.80/100 000 and 26.26/100 000, respectively. Conclusions: The analysis indicated that the duplicated repeating rate of hepatitis B was 7.36% in NNDRS during 2011-2013, and the duplicated reporting mainly occurred in other years. The duplicated reporting of hepatitis B in NNDRS had greatly affected the accuracy of surveillance data in some provinces, such as Xinjiang and Qinghai.

Objective: To evaluate the hepatitis A vaccine coverage among 2-29 year olds and the reported incidence rates of hepatitis A, in China., Methods: Based on data from the national sero-survey on hepatitis B in 2014, information on hepatitis A vaccine immunization was collected and the coverage of hepatitis A vaccine was analyzed with SAS software (Version 9.4). Incidence data on hepatitis A was also collected from the National Notifiable Disease Reporting System between 2004 and 2014, and analyzed using the micro-software Excel 2007., Results: Totally, data involving 29 058 people aged 2-29 years were available for analysis and the overall hepatitis A vaccine coverage was 44.6%. The younger the age, the higher the coverage appeared. Among the 2-6 year and the 7-14 year olds, rates of hepatitis A vaccine coverage were 91.2% and 76.0% respectively. From 2004 to 2014, the incidence rates of hepatitis A in the whole population were declining, annually. The incidence rates showed continuously declining as 82.5%, 90.6%, 72.1% among children at the age groups of 2-6 years, 7-14 years and in the whole population, from 2007 to 2013., Conclusion: After the inclusion of hepatitis A vaccine into the Expanded Programe on Immunization (EPI), the coverage of hepatitis A vaccine among the 2-6 year olds increased to over 90%, with no obvious difference between the urban and rural areas. Incidence of hepatitis A in the 2-6 year olds showed a more rapid decline than that in the whole population.

Objective: To explore anti-HBs persistence four years after revaccination with hepatitis B vaccine (HepB) among adults who were non-responsive to HepB primary immunization., Methods: A total of 24 237 healthy adults who had no history of hepatitis B infection and hepatitis B vaccination, resided in the local area for more than six months and aged 18-49 years were selected from 79 villages of Zhangqiu County, Shandong Province, China in 2009. Blood samples were obtained and hepatitis B surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs) and antibody against hepatitis B core antigen (anti-HBc) were detected using ELISA method. A total of 11 590 persons who were negative for all of these indicators were divided into four groups by cluster sampling methods. Each group was vaccinated with one of the following four types of HepB at 0-1-6months schedule: 20 μg HepB derived in Saccharomyces cerevisiae (HepB-SC), 20 μg HepB derived in Chinese hamster ovary cell (HepB-CHO), 10 μg HepB-SC and 10 μg HepB derived in Hansenula polymorpha (HepB-HP). Blood samples were collected one month after the third dose of primary immunization and tested for anti-HBs using chemiluminescence microparticle immunoassay (CMIA). The non-responders were followed up and their basic information and the histories of hepatitis B infection, HepB vaccination, smoking and drinking were investigated. Then they were revaccinated with three doses of HepB with the same schedule as the primary immunization. Blood samples were collected from all of them one month (T1), two years and four years after revaccination and anti-HBs, anti-HBc and HBsAg were detected by CMIA. A total of 356 participants were followed up from 645 low-responders four years after revaccination, and the ratio was 55.2%. The risk factors associated with the positive rate and geometric mean concentration (GMC) of anti-HBs after four years of revaccination were analyzed using multivariate unconditional logistic regression model and multivariate linear regression model, respectively., Results: Among 356 participants, 172 (48.3%) were males and 184 (51.7%) were females. The anti-HBs positive rate was 90.4% (322 cases) at T1 and was 55.9% (199 cases) four years after revaccination. The GMC of anti-HBs was 240.5 (95% CI: 186.4-310.4)mU/ml at T1 and decreased to 15.0 (95%CI: 12.2-18.5) mU/ml four years after revaccination. The average annual decreasing rate of GMC was 50.63% from one month after revaccination to four years after revaccination. The corresponding rate was 64.89% in the first two years, which was 2.12 times the rate in the latter two years (30.57%). When compared with those whose anti-HBs titer was less than 99 mU/ml at T1, the significantly higher anti-HBs four years after revaccination was observed in those whose anti-HBs titer at T1 was 100-999 mU/ml and those whose anti-HBs titer at T1 was ≥1 000 mU/ml. The OR (95%CI) was 7.14 (3.90-13.05) and 28.40 (13.16-61.30) respectively. When compared with those whose anti-HBs titer was ≤99 mU/ml at T1, the GMC of anti-HBs four years after revaccination was also significantly higher among those whose anti-HBs titer at T1 was 100-999 mU/ml and those whose anti-HBs titer at T1 was ≥1 000 mU/ml. The b (95%CI) was 1.66 (1.26-2.05) and 3.16 (2.72-3.60), respectively., Conclusion: The positive rate and GMC of anti-HBs decreased four years after revaccination among non-responsive adults, but still kept anti-HBs above protective level. The immunity durability after revaccination is mainly associated with anti-HBs titer one month after revaccination.

Objective: To evaluate the 5-year antibody persistence and the risk factors associated with the persistence after primary vaccination of hepatitis B vaccine (HepB) among normal or high-response adults., Methods: A total of 24 237 healthy adults who had no histories of hepatitis B infection and hepatitis B vaccination, resided in the local area for more than six months and were aged 18-49 years were selected from 79 villages in north of Zhangqiu county, Shandong province, China in 2009. Blood samples were obtained and hepatitis B surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs) and antibody against hepatitis B core antigen (anti-HBc) were detected using ELISA method. A total of 11 590 persons who were negative for all of these indicators were divided into four groups by cluster sampling methods. Each group was vaccinated with one of the following four types of HepB at 0-1-6 months schedule: 20 μg HepB derived in Saccharomyces cerevisiae (HepB-SC), 20 μg HepB derived in Chinese hamster ovary cell (HepB-CHO), 10 μg HepB-SC and 10 μg HepB derived in Hansenula polymorpha (HepB-HP). The normal and high-responder was followed up and their demographic characteristic (including age, gender), histories of hepatitis B infection, hepatitis B vaccination, smoking, drinking and chronic diseases were investigated. Blood samples were collected one month (T1) and five years (T2) and anti-HBs, anti-HBc and HBsAg (if anti-HBs<10 mU/ml) were detected by CMIA. A total of 1 902 participants were followed up and the risk factors associated with positive rate of anti-HBs and GMC of anti-HBs were identified by multiple logistic regression analysis and multifactor linear regression model analysis, respectively., Results: Among 1 902 adults, 824 (43.32%) were male and 1 078 (56.68%) were female. The anti-HBs positive rate was 100% at T1 and it decreased to 73.29% (1 394 cases) at T2. The corresponding GMC was decreased from 1 527.15 (95%CI: 1 437.84-1 622.01) mU/ml at T1 to 35.07 (95%CI: 32.20-38.19) mU/ml at T2. When comparing with those vaccinated 20 μg HepB-SC, the significantly lower positive rate at T2 was observed in those vaccinated 10 μg HepB-SC group and 10 μg HepB-HP group. The OR (95% CI) was 0.41 (0.28-0.61) and 0.27 (0.18-0.39), respectively. The GMC of anti-HBs was also significantly lower among those vaccinated 10 μg HepB-SC and 10 μg HepB-HP. The b (95%CI) was -0.20 (-0.28- -0.12) and -0.36 (-0.44- -0.29) , respectively. When comparing with those occasionally drinking, the significantly lower positive rate at T2 was observed in those regular drinking. The OR(95%CI) was 0.51(0.30-0.87). The GMC of anti-HBs in age group of 18-29 was significantly higher than those in 40-49 age group; the b (95%CI) was -0.10(-0.18- -0.01). When comparing with those whose anti-HBs titer was less than 999 mU/ml at T1, the significantly higher positive rate of anti-HBs at T2 was observed in those whose anti-HBs titer was 1 000-1 999 mU/ml, those whose anti-HBs titer was 2 000-2 999 mU/ml and those whose anti-HBs titer was ≥10 000 mU/ml. The OR (95%CI) was 10.11 (6.90-14.82), 20.42 (13.98-29.82) and 54.58 (22.08-134.92), respectively. When comparing with those whose anti-HBs titer was ≤999 mU/ml at T1, the GMC of anti-HBs at T2 was also significantly higher among those whose anti-HBs titer at T1 was 1 000-1 999 mU/ml, those whose anti-HBs titer at T1 was 2 000-2 999 mU/ml and those whose anti-HBs titer at T1 was ≥10 000 mU/ml. The b (95%CI) was 0.55 (0.47-0.62), 0.94 (0.88-1.00) and 1.63 (1.54-1.72), respectively. Nobody was found positive to HBsAg at T2 and the conversion rate of anti-HBc was 3.89% (74/1 902) at T2., Conclusion: Anti-HBs GMC decreased rapidly at T2 among normal and high-responder adults, while the positive rate of anti-HBs still kept at a high level. The antibody persistence among normal and high-responder adults at T2 was associated with HepB type, age, history of drinking and GMC of anti-HBs at T1.

Objective: To investigate the optimal anticoagulation methods and monitoring strategy for Chinese patients undergoing heart valve replacement, which is potentially quite different from western populations., Methods: In this multicenter prospective cohort study, the anticoagulation and monitoring strategy data was acquired from 25 773 in-hospital patients in 35 medical centers and 20 519 patients in outpatient clinic in 11 medical centers from January 1st, 2011 to December 31th, 2015., Results: As for in-hospital patients, mean age of study population was (48.6±11.2) years old; main etiology of valve pathology was rheumatic (87.5%) origin among study cohort; 94.8% of study population received mechanical valve implantation; international normalized ratio (INR) monitoring (in all the study centers) and low-intensity anticoagulation strategy (31 hospitals chose target INR range of 1.5-2.5, and actual values of INR among 89.2% of 100 069 in-hospital monitoring samples were 1.5-2.5), with mean actual INR values of 1.84±0.53, and warfarin dosage of (2.82±0.93) mg/d were widely adopted among the study centers; strategies of in-hospital warfarin administration were similar in all the study centers; complication rates of low-intensity anticoagulation strategy were low in severe hemorrhage (0.02%), thrombosis (0.05%), and thromboembolism (0.05%) events, without anticoagulation-related death.As for 18 974 outpatient clinic patients, the follow-up rate was 92.47%, with a total of 30 012 patient-years (Pty). Anticoagulation-related morbidity and mortality rates were 0.67% and 0.15% Pty; major hemorrhage morbidity and mortality rates were 0.25% and 0.13% Pty; thromboembolism morbidity and mortality rates were 0.45% and 0.03% Pty.The mean dosage of warfarin daily dosage was (2.85±1.23) mg/d and INR value was 1.82±0.57.No significant regional difference in the intensity of anticoagulation therapy was noted during the study., Conclusions: INR can be used as a normalized indicator for intensity of anticoagulation therapy in China.The optimal anticoagulation intensity with INR range from 1.5 to 2.5 is safe and effective for Chinese patients with heart valve replacement, and there is no significant regional difference in the intensity of anticoagulation therapy.

Objective: To analyze the operative methods and complications for surgical resection of carotid body tumor (CBT). Method: Clinical data of 29 patients underwent CBT resection from Jan 2007 to Apr 2015 were retrospectively studied. Result: Five out of 29 patients got bilateral CBT, the others had unilateral lesions, totally 34 CBT resection were performed. Tumor completely dissected without carotid artery clamping and reconstruction in 18 procedures, tumor resection combined with external carotid artery resection in 16 procedures, 9 out of these 16 procedures combined with internal carotid artery resection. The internal carotid artery was reconstructed with autologous greater saphenous vein in 4 procedures, with artificial graft in 3 procedures, and internal carotid artery ligation without reconstruction in 2 procedures. There was no patient death during perioperative period, cerebral infarction happened in 1 patient and cranial nerve injury occurred in 12 cases. Conclusion: Carotid artery resection and reconstruction is very common during CBT resection, surgeon must be familiar with the methods of carotid artery reconstruction, and the most common complication of carotid body tumor resection is the cranial nerve injury., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

After the master cell stock(mcs) and working cell bank of more than 30 different strains of 7 animal kidney cell lines (F-81 or CRFK cell line, MDCK cell line, Vero or Vero-2 cell line, MA-104 cell line and BHK-21 cell line) were established in China, the chromosomal number variations and structural aberrations of the above lines, primary feline or canine kidney cell (FKC or CKC) and HeLa cell line were investigated and their karyotypes of routine or Giemsa chromosomal bands were analyzed. The carcinogenesis or tumorigenicity testing of these cells in about 700 nude mice and for colony formation in soft agar (SA) and for agglutination under different concentration of plant lectins was carried out. Both tumorigenicity-negative strains of F-81, CRFK, Vero or Vero-2 lines and very-low-tumorigenicity strains of MDCK line were successfully selected and evaluated for the production of canine or feline combination viral vaccines, which are free of infectious agents, and described with respect to cytogenetic characteristics and tumorigenicity. Rate of modal chromosome number represents the ratio of cell number having modal chromosome number to all the split cell number analyzed at random. Rate of difference represents the ratio of difference of the rate of modal chromosome number between mcs (master cell stock) + n and mcs passages. The chromosomal analysis results showed that the ratio of difference of the rate of modal chromosome number between mcs + n and mcs passages was not more than 5%-15% and the structure aberrations was generally 0%-3%, not more than 5%-10%, thus the hereditary character of cell lines is comparatively stable without significant difference between different passages. The genetic characteristics of chromosomal number of cell lines determines their tumorigenicity, but it is species specific. Experimental models were established for the researches on the prevention and prophylaxis of malignant tumors or cancers and their genetically biological characteristics. Tests showed that there was correlation among cell line chromosome number variations, anchorage independence in soft agar, agglutination under plant lectins and tumor-forming ability in nude mice. Since testing in vitro is more economic, simpler, faster, and is thought to be reliable, we recommend plant lectins followed by SA or analysis of karyotypes as the initial means for monitoring tumorigenicity of animal cell line in nude mice.

From 1972 to 1990 seven kinds of microsurgical operations were used for treatment of bone and joint defects of hand. Among these cases 23 survived and 1 failed. The patients were followed up for 2-20 years. The functional results were good in 77.4%. The improved surgical procedures: (1) Use dorsalis pedis artery as the single pedicle to provide double vascular supply for double joint graft from one toe. (2) Change the fixing position of metatarsal to increase the degree of motion of the joint. The operative indications and the factors related to the survival and function are discussed.