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Objective: To investigate the safety and accuracy of CT-guided intracranial puncture biopsy and the possible influencing factors of postoperative bleeding complications. Methods: A case series study. A retrospective analysis was conducted on 101 patients who underwent CT-guided intracranial puncture biopsy at the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021. The basic data of patients and the safety and accuracy of CT-guided intracranial puncture biopsy were analyzed statistically. Univariate and multivariate logistic regression analysis were used to screen the influencing factors of bleeding complications in CT-guided intracranial puncture biopsy, and the bleeding complications in glioma subgroup were analyzed. Results: Among the 101 patients, 53 were males and 48 were females , aged (53.7±17.2) years. The average diameter of intracranial lesions was (3.5±1.4) cm, while the vertical distance from the lesion to the meninges was (2.4±1.7) cm. The needle's intracranial depth reached (3.2±1.8) cm, with adjustments averaging (3±1) occurrences and an average procedural duration of (40.2±12.9) minutes. Pathological diagnoses included glioma (36 cases), gliosis (3 cases), lymphoma (32 cases), metastatic tumors (7 cases), inflammatory lesions (13 cases), and 10 indeterminate cases. The positive rate of puncture pathology was 90.1% (91/101), and the diagnostic coincidence rate was 94.0% (78/83). The incidence of bleeding complications in CT-guided intracranial puncture biopsy was 26.7% (27/101), of which 23 cases had small intratoma or needle path bleeding, 4 cases had massive bleeding, and 2 cases died. The patients were divided into bleeding group ( n =27) and no bleeding group ( n =74), according to the presence or absence of bleeding. The results of univariate logistic regression analysis showed that thrombin time≥15 s and the number of needle adjustment were the factors affecting the occurrence of bleeding complications (both P <0.05), and the results of multivariate logistic regression showed that thrombin time≥15 s was the related factor for bleeding. Patients with thrombin time≥15 s had a 3.045 times higher risk of bleeding than those with thrombin time<15 s ( OR =3.045,95% CI :1.189-7.799, P =0.020). Among the 101 patients, 36 cases of midbrain glioma were divided into low-grade glioma group ( n =11) and high-grade glioma group ( n =25) according to the pathological grade. Subgroup analysis showed that the risk of bleeding for high-grade gliomas was 9.231 times higher than that for low-grade gliomas ( OR =9.231,95% CI :1.023-83.331, P =0.031). Conclusions: CT-guided intracranial puncture biopsy is safe and feasible with high accuracy. Complication rates are associated with thrombin time≥15 s, especially high-grade glioma, which increases the risk of postoperative bleeding.

The formulation and revision of the detection methods of indoor air quality standards is an important, rigorous and delicate endeavor. This paper introduced the formulation and revision of the detection methods of the standards for indoor air quality (GB/T 18883-2022), focusing on the revision process, revision principles, main adjustments and technical points of some key indicators to facilitate users to better understand and apply the detection methods in standards for indoor air quality (GB/T 18883-2022).

Objective: To compare the efficacy of off-pump minimally invasive cardiac surgery (MICS) via a single left intercostal space incision with median sternotomy multi-vesselcoronary artery bypass grafting (CABG). Methods: Patients who were diagnosed with multi-artery coronary artery disease (CAD) in the Ward 10 of the Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University and underwent CABG from July 2019 to January 2022 were retrospectively collected. All the patients were divided into MICS group and conventional CABG group according to the surgical methods. The perioperative outcomes were compared between thetwo groups, including intraoperative blood loss, postoperative 24 h thoracic drainage volume, ventilation duration, length of stay (LOS) in intensive care unit (ICU) and total LOS in hospital. Intraoperative blood flow of graft vesselswas measured by transit-time flow measurement (TTFM) after vascular anastomosis, and mean flow (MF) and pulsatile index (PI) were compared between the two groups. Results: A total of 444 patients were in the final analysis, with 351 males and 93 females, and the mean age of (62.0±8.9) years. There were 179 patients in MICS group and 265 cases in conventional CABG group, respectively. There were no statistically significant differences in the preoperative profiles between the two groups (all P >0.05) except that younger age [(60.7±9.3) years vs (62.8±8.5) years, P =0.017] and lower proportion of female [10.1% (18/179) vs 28.3% (75/265), P <0.001] were detected in MICS group. Likewise, there was no significant difference in the number of graft vessels between MICS group (3.18±0.74) and conventional CABG group (3.28±0.86) ( P =0.234). Compared with those in conventional CABG group, patients in MICS group showed longer operation duration [ (5.10±1.09) h vs (4.33±0.86) h], fewer intraoperative blood loss [500 (200, 700) ml vs 700 (600, 900) ml], fewer postoperative 24 h thoracic drainage volume [300 (200, 400) ml vs 400 (250, 500) ml], shorter postoperative ventilation duration [15.0 (12.0, 17.0) h vs 16.5 (12.5, 19.0) h, P <0.001], LOS in ICU [18.0 (15.0, 20.0) h vs 20.0 (16.0, 23.0) h, P <0.001] and total LOS in hospital [(12.6±2.7) d vs (14.5±3.9) d, P <0.001]. MI and PI of graft vessels were similar between the two groups (both P >0.05). Moreover, there were no significant differences in major perioperative complications (i.e., repeat thoracotomy, incision infection, stroke) and mortality between the two groups (all P >0.05). Conclusion: MICS is an alternative treatment for patients with multi-vessel CAD with better perioperative outcomes compared with conventional CABG.

Ongoing global pandemic of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has promoted the unprecedented rapid development and large-scale rolling out of different platform-based COVID-19 vaccines worldwide. How to effectively respond to the expected scale increasing adverse events after vaccination campaign of COVID-19 vaccines is a common problem faced by the world. A lot of countries and regions around the world have arranged in advance at different levels, optimizing the original vaccine safety monitoring system from the perspectives of strengthening the foundation and capabilities, promoting internal and external cooperation, upgrading methods, as well as improving transparency and public communication, which has ensured the good and efficient operation of the system and can provide reference for the construction of relevant fields in China.

Objective: By investigating the correlation between quantitative parameters of contrast enhanced ultrasound (CEUS) and commonly used activity assessment indicators of Crohn's disease (CD), and comparing the predictive power of laboratory inflammatory indicators with CEUS on Crohn's disease (CD), the significance of CEUS was evaluated. Methods: A case-control study. From October 2019 to December 2021, the clinical data of 67 patients with CD who were diagnosed by endoscopy and underwent contrast-enhanced ultrasonography were retrospectively analyzed in the First Affiliated Hospital with Nanjing Medical University, and their routine ultrasound and CEUS parameters, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC), Crohn's disease activity index (CDAI) and simplified endoscopic score for Crohn's disease (SES-CD) were collected. Using SES-CD as the standard, the patients were divided into a remission group and an active group, and the correlation of laboratory inflammatory indexes and contrast-enhanced ultrasound parameters with CDAI and SES-CD were evaluated. Besides, the ROC curve was used to analyze the predictive efficacy of each index on CD endoscopic activity. Results: A total of 67 patients were included in this study. According to the SES-CD score, there were 17 patients in the remission group and 50 patients in the active group. Except for the coefficient of the enhancement wash in slope and time to peak (TTP), the peak intensity (PI), area under the angiography curve, and laboratory inflammatory indexes were significantly different between the two groups ( P <0.05), which also showed a moderate positive correlation with CDAI and SES-CD ( P <0.05). ROC analysis showed that among the non-invasive indicators, PI and area under the angiography curve had the highest AUCs for predicting CD endoscopic activity, which were 0.912 and 0.891, respectively; with SES-CD taking >3 as the cut-off value, the corresponding sensitivities were 78.0% and 72.0%, with specificities of 100.0% and 94.1%, respectively. Conclusion: CEUS can objectively and repeatedly evaluate the disease activity of CD patients, and has great clinical application value, which can be used as a reliable imaging method for diagnosis and follow-up of patients with Crohn's disease.

Objective: Reflux esophagitis (RE) may be negatively correlated with Helicobacter pylori ( H. pylori ) infection, but the conclusion and relevant mechanism is still controversial. This study proposed to explore the correlation between RE and H. pylori infection based on natural population. Methods: From July 2013 to December 2014, 3 940 residents aged 40-69 years were recruited in Linqu County of Shandong Province and Hua County of Henan Province by the whole sampling method. All the subjects underwent gastroscopy, and gastric mucosa biopsy specimens were collected for pathological diagnosis and Warthin-Starry (WS) staining to identify H. pylori infection. Venous blood samples of some subjects were collected for H. pylori immunoglobulin G ( H. pylori -IgG) detection. Also, demographic and sociological data were collected. Chi-square test and logistic regression were used to analyze the correlation between RE and H. pylori infection. Results: A total of 359 cases of RE were detected. Excluding RE and other upper gastrointestinal organic diseases, 3 382 cases were considered as controls. Chi-square test showed that WS staining positive rate in RE group was significantly lower than that in control group ( P =0.023), but there was no significant difference in the positive rate of H. pylori -IgG between the two groups ( P =0.281). There were significant differences between RE group and control group in gender composition, age, body mass index (BMI), smoking, alcohol consumption, education level and mucosal active inflammation. Multivariate regression analysis showed that RE was negatively correlated with gastric mucosa active inflammation [ OR =0.754 (95% CI 0.600-0.949), P =0.016], and positively correlated with male [ OR =4.231 (95% CI 3.263-5.486), P <0.001], age ≥60 years, BMI≥24 kg/m 2 [ OR =1.540 (95% CI 1.220-1.945), P <0.001]. Compared to those aged 40-49 years and 50-59 years, the odds ratio ( OR ) of RE in these aged ≥60 years were 1.566 (95% CI 1.144-2.143, P =0.005) and 1.405 (95% CI 1.093-1.805, P =0.008). Conclusion: RE is more closely related to H. pylori present infection. Multivariate analysis showed that RE is negatively correlated with active inflammation of gastric mucosa caused by H. pylori infection, and positively correlated with male, overweight and aged ≥60 years.

Objective: To analyze the epidemiological characteristics of anthrax in China from 2017 to 2019 and molecular typing of Bacillus anthracis isolated from some provinces (autonomous regions). Methods: Surveillance data of anthrax cases reported from 2017 to 2019 in the Infectious Disease Surveillance information System of China Disease Prevention and Control and the Public Health Emergency Reporting and Management Information System were collected, and descriptive epidemiological methods were used to analyze the epidemic characteristics, including the temporal, geographic and demographic distribution of this disease. A total of 47 strains of Bacillus anthracis isolated from 2017 to 2019 were analyzed by canSNP and MLVA15. Results: A total of 951 cases of anthrax were reported from 2017 to 2019, of which 938 were cutaneous anthrax, representing 98.63% of the total number reported. It was mainly distributed in the west and northeast of China, and the three provinces with the highest number of cases were Gansu (215), Sichuan (202) and Qinghai (191). Cases had been reported throughout the year, more cases occurred in the summer and autumn, and August was the month with the most cases,66.35% (211/318), 72.32% (243/336) and 68.01% (202/297) of cases were reported during June to September. The age distribution was mainly between 20 and 59 years old, accounting for more than 80% of all cases. The number of male cases was significantly higher than that of female cases, the ratio of male to female was about 3∶1. The occupations were mainly herdsmen and farmers, accounting for 49.70% to 58.18% and 31.45% to 36.70%, respectively. Public health events occurred every year, and 29 events had been reported from 2017 to 2019. canSNP analysis showed that 37 of the 47 strains belonged to the A.Br.001/002 subgroup and 10 belonged to the A.Br.Ames subgroup. MLVA15 analysis showed that there were 17 genotypes, of which 10 genotypes contained only one strain. Conclusion: Cutaneous anthrax was the predominant clinical type in China from 2017 to 2019.The seasonal, geographic and demographic distribution characteristics were evident.Molecular typing methods such as canSNP and MLVA15 can be used to trace the source of infectious diseases and provide technical support for anthrax prevention and control.

To analyze the correlation between lipid profile and disease activity in patients with inflammatory bowel disease (IBD).A total of 307 Crohn's disease (CD) patients, 232 ulcerative colitis (UC) patients and 165 healthy subjects from the same geographic region were included. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a)[Lp(a)] were retrieved from their medical records. Crohn disease activity index (CDAI) and Mayo scores were calculated as measurement of disease severity for CD and UC separately. Patients with CD and UC had lower TC, TG, HDL-C and LDL-C levels than those in control group ( P <0.05). Additionally, CDAI was negatively associated with TC, HDL-C and LDL-C levels ( r =-0.218, -0.210, -0.176, P< 0.05), while TG level was not associated with CDAI. Mayo scores was not significantly associated with TC, HDL-C, LDL-C and TG. Patients with CD had higher Lp(a) levels than those in UC and control group ( P <0.05). Furthermore, patients with active CD had higher Lp (a) levels than those with inactive disease ( P <0.05).The Lp(a) levels in CD patients were positively associated with CDAI ( r =0.151, P< 0.05), while Lp(a) level in UC group was nor assocriated with Mayo score. Patients with IBD have dyslipidemia and lipid profile is associated with disease activity in CD patients.

Vaccine hesitancy has spread worldwide recent years and resulting in increasing incidence of some well-controlled vaccine-preventable diseases, which is extremely unfavorable to the consolidation of the national immunization programme and the elimination of corresponding diseases. Based on the Complacency, Convenience and Confidence ("3Cs") model of vaccine hesitancy, combined with the practice experience of management of quality control through the whole vaccine life cycle in China, we introduce a framework of vaccine hesitancy monitoring and early warning in China to provide a reference for carrying out corresponding work. The indicator system of the framework derives from monitoring of vaccine life cycle quality management, population vaccine confidence, and service availability.

Objective: To investigate the related factors of myocardial fibrosis in patients with hypertrophic cardiomyopathy. Methods: Patients with hypertrophic cardiomyopathy, hospitalized in the First People's Hospital of Yunnan Province from January 2016 to May 2020, were included in this cross-sectional study. Patients were divided into delayed enhancement positive group (fibrosis group) and non-delayed enhancement group (non-fibrosis group). According to the maximum left ventricular end diastolic wall thickness (LVMWT), patients in the fibrosis group was further divided into mild hypertrophy group, moderate hypertrophy group and severe hypertrophy group. The baseline clinical data of patients were collected by medical record management system. All enrolled patients underwent cardiac magnetic resonance imaging (CMR). The presence and location of myocardial fibrosis were identified by CMR gadolinium contrast delayed enhancement (LGE). The range of LGE (LGE%) was calculated by visual analysis. The levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in peripheral blood were measured . Results: A total of 48 patients ( age (46.4±14.3) years, 42 (87.5%) males) were enrolled. There were 34 LGE positive cases (fibrosis group) and 14 LGE negative cases (non-fibrosis group). Compared with non-fibrosis group, patients in fibrosis group were younger ( P =0.038) and prevalence of NYHA grade Ⅲ/Ⅳ was higher ( P =0.00). Compared with non-fibrosis group, patients in fibrosis group had thicker LVMWT ( P = 0.008), higher left ventricular mass index(LVMI) ( P =0.001), higher left ventricular end diastolic volume (LVEDV) ( P =0.043), lower left ventricular ejection fraction (LVEF) and cardiac index (CI) (all P <0.05). The levels of NT-proBNP and cTnI were significantly higher in fibrosis group than in non-fibrosis group (2 760.5 (1 503.4, 3 783.6) ng / L vs. 861.3 (552.2, 1 092.8) ng / L, P =0.002; 0.970 (0.448, 1.684)μg / L vs. 0.147 (0.033, 0.251)μg / L, P =0.041).In fibrosis group, there were 15 cases of mild hypertrophy (mild hypertrophy group), 10 cases of moderate hypertrophy (moderate hypertrophy group), and 9 cases of severe hypertrophy (severe hypertrophy group). The LGE% and NT-proBNP and cTnI increased in proportion with increasing myocardial hypertrophy ( P <0.05). LGE% was negatively correlated with age ( r =-0.618, P =0.011), and positively correlated with NT-proBNP and cTnI levels ( r =0.271, P =0.010; r =0.111, P =0.013, respectively), and positively correlated with LVEDV, LVMWT and LVMI ( r =0.438, P =0.09; r =0.735, P =0.001; r =0.532, P =0.034, respectively). Conclusions: In patients with hypertrophic cardiomyopathy, the extent of myocardial fibrosis increases with the increase of myocardial hypertrophy. Myocardial fibrosis is negatively correlated with age, and positively correlated with NT-proBNP and cTnI, as well as LVEDV, LVMWT and LVMI in this patient cohort.

Objective: To analyze the epidemiological characteristics and the related information on the diagnosis and treatment of inpatients with skin and soft tissue injuries. Methods: The medical records of inpatients with skin and soft tissue injuries who were admitted to the Fourth Medical Center of PLA General Hospital (hereinafter referred to as the author's unit) from January 1, 2014 to December 31, 2018, conforming to the study criteria, were retrospectively analyzed. The indexes included inpatients'gender, age, wound course, underlying disease, wound type, wound site, and wound microbiological culture result, methods and outcome of treatment, type of medical payment, hospital day, and hospitalization cost. Data were statistically analyzed with Mann-Whitney U test, Kruskal-Wallis H test, and chi-square test. Results: (1) A total of 2 997 inpatients, conforming to the study criteria, were admitted to the author's unit during the 5 years. There were 1 803 (60.16%) males and 1 194 (39.84%) females. The distribution of gender of patients showed significant differences during the 5 years ( χ (2)=13.203, P <0.05). The age of female patients was significantly older than that of male patients ( Z =-6.387, P <0.01). There were 882 (29.43%) patients with acute wounds and 2 115 (70.57%) patients with chronic wounds. The distribution of acute wounds and chronic wounds of patients showed significant differences during the 5 years ( χ (2)=66.806, P <0.01). The age of patients with chronic wounds was significantly older than that of patients with acute wounds ( Z =-12.582, P <0.01). A total of 1 910 patients (3 847 cases) were complicated with underlying diseases. The common underlying diseases orderly were diabetes 1 151 (29.92%) cases, hypertension 884 (22.98%) cases, coro-nary atherosclerotic heart disease 414 (10.76%) cases, old cerebral infarction 258 (6.71%) cases, and paraplegia 258 (6.71%) cases. More patients with chronic wounds were complicated with various underlying diseases compared with patients with acute wounds ( χ (2)=130.649, P <0.01). (2) The common types of wounds were postoperative non-healing wounds, burn wounds, diabetic foot ulcers, pressure ulcers, and skin and soft tissue infection. The distribution of types of wounds showed significant differences during the 5 years ( χ (2)=342.265, P <0.01). There were 3 957 wounds. The common wound sites were feet, legs, chests, and so on. A total of 976 patients underwent microbiological examination. The results of 719 (73.67%) patients were positive and 257 (26.33%) patients were negative. The positive rate of wound microbiological culture of patients with chronic wounds was significantly higher than that of patients with acute wounds ( χ (2)=33.981, P <0.01). Among the patients with acute wounds, 111 patients (72.08%) were simply infected, 43 (27.92%) patients were mixed infected. Among the patients with chronic wounds, 364 (64.42%) patients were simply infected, and 201 (35.58%) patients were mixed infected. A total of 1 010 strains of pathogenic bacteria were detected in 719 patients, including 447 (44.26%) Gram-positive bacteria, 548 (54.26%) Gram-negative bacteria, and 15 (1.48%) fungi. There was a significant difference in the distribution of pathogenic microorganisms between patients with acute wounds and chronic wounds ( χ (2)=12.215, P <0.01). In this group of patients, the common strains of wounds were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and so on. The common strains of patients with acute wounds were Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, and so on. The common strains of patients with chronic wounds were Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia colis, and so on. (3) The patients in this group were mainly treated by surgery. Finally, 1 330 patients were cured, 1 393 patients were improved, 257 patients were not cured, and 17 patients died. There was a significant difference in the distribution of outcome in patients with acute wounds and chronic wounds ( Z =-7.622, P <0.01). (4) The main types of payment of medical expenses for patients in this group were local medical insurance, remote medical insurance, and self-paying. The total hospitalization cost of patients in this group was 169 268 523.65 yuan, which was mainly consist of the costs of materials and drugs. The hospital day of patients in this group was 21.00 (11.00, 36.00) d, and the hospitalization cost was 30 016.34 (14 439.41, 63 685.60) yuan. There were significant differences in the hospital day and hospitalization cost among patients with different medical payment types ( χ (2)=285.986, 327.436, P <0.01). There were significant differences in the hospital day and hospitalization cost among patients with different wound types ( χ (2)=125.912, 131.485, P <0.01). Conclusions: The patients with skin and soft tissue injuries are mainly middle-aged and elderly patients, with more males than females, more chronic wounds than acute wounds. Skin and soft tissue injuries are prone to occur in sites with prominent bone, thin subcutaneous fat, and poor blood supply. The result of wound microbiological culture is mainly Gram-negative bacteria, and the positive rate of wound microbiological culture of patients with chronic wounds is higher than that of patients with acute wounds. The proportion of Gram-positive bacterial infection ranks the highest in patients with acute wounds. The proportion of Gram-negative bacterial infection ranks the highest in patients with chronic wounds. Patients with chronic wounds are often complicated with various underlying diseases, and the course of disease is long, so the constituent ratio of cured patients is lower than that of patients with acute wounds. Patients with skin and soft tissue injuries have long hospital days and high proportion of material cost, which are directly related to the clinical characteristics and long treatment cycle of chronic wounds. Therefore, it is suggested that the medical insurance administration department should adjust the consumption ratio and other management indicators according to the actual clinical needs of elderly patients with chronic wounds.

Objective: Mesenteric fat hypertrophy is present in about a quarter of Crohn's disease (CD) patients and it can be easily detected by bowel ultrasound (US). The purpose of this research was to assess the correlation between mesenteric fat hypertrophy and behavior and activity of CD. Methods: A total of 89 CD patients who admitted to the First Affiliated Hospital of Nanjing Medical University from August 2018 to November 2019 were recruited in this study. The total CD patients were divided into two groups depending on with or without mesenteric fat hypertrophy by US tests. Crohn's disease activity index (CDAI), simplified endoscopic score for Crohn's disease (SES-CD), serum inflammatory indicators and fecal calprotectin were assessed. Results: Mesenteric fat hypertrophy was significantly associated with stricturing behavior (B2, P <0.01). CDAI ( P =0.002) , blood platelet ( P =0.001) , C-reactive protein ( P =0.024) , fecal calprotectin ( P =0.004) and bowel wall thickness ( P <0.01) in patients with mesenteric fat hypertrophy were significantly higher than those without, but not the erythrocyte sedimentation rate ( P= 0.110) and SES-CD ( P =0.115) . Serum albumin ( P =0.001) in patients with mesenteric fat hypertrophy was lower than that in patients without mesenteric fat hypertrophy. Conclusion: Mesenteric fat hypertrophy is correlated with intestinal stenosis and disease activity in patients with Crohn's disease.

Objective: To explore the clinical strategies for preservation of the exposed implant in chronic wounds and wound repair. Methods: From January 2016 to January 2019, totally 8 patients (4 males and 4 females, aged 10 to 73 years) sustaining postoperative chronic wounds with exposed implants were admitted to the Fourth Medical Center of PLA General Hospital. There were 2 cases of abdominal patch exposure after abdominal trauma surgery, 2 cases of titanium plate exposure post craniocerebral surgery, 3 cases of internal fixator exposure post orthopedic surgery, and 1 case of cerebrospinal fluid drainage tube exposure after craniocerebral surgery. The wound exudate was collected for bacterial culture on admission. On the basis of glycemic control and correction of anemia and hypoproteinemia, thorough wound debridement was performed as soon as possible and the wound area after debridement ranged from 2.0 cm×0.5 cm to 6.0 cm×5.0 cm. The wounds of 4 patients were immediately closed after debridement, including 1 case by primary closure, 1 case by primary closure after local filling of platelet rich plasma gel, and 2 cases by local flap transplantation, with flap size of 10.0 cm×8.0 cm and 12.0 cm×8.0 cm, respectively. The donor sites of flaps were sutured directly and all the incisions were treated with continuous vacuum sealing drainage (VSD) after surgery. The other 4 patients were treated with continuous VSD after debridement to improve the wound bed. The wound of 1 case healed gradually, 1 case received direct wound suturing, and the wounds of 2 cases were repaired with thin split-thickness skin grafts from the thigh or the head. The results of bacterial culture of wound exudate on admission, wound healing post surgery, and follow-up were observed and recorded. Results: The bacterial culture of wound exudate on admission was positive in 6 patients, and 10 strains of bacteria were isolated with Staphylococcus epidermidis as the main pathogen. All the skin grafts or flaps of patients survived post surgery, with the incisions and wounds healed and all the implants preserved. After 1 to 3 years of follow-up, no recurrence of wound was found in any patient. Conclusions: The postoperative chronic wounds with exposed implants can be closed in primary stage by direct suturing or flap transplantation if it is clean enough on the basis of thorough debridement. The wounds with large defects or serious infection can be treated with continuous VSD firstly and then closed with direct suturing or skin grafting for delayed wound closure, thereby to reach the treatment goal of preserving the implants and repairing the wounds simultaneously.

Objective: To study the effects of miR-16-5p on proliferation, migration and invasion of osteosarcoma cells and its mechanism. Methods: Quantitative polymerase chain reaction (qPCR) and Western blotting were used to detect the mRNA and protein expression of miR-16-5p and TSPAN15 in human normal osteoblasts hFOB 1.19 and osteosarcoma cells MG63, Saos2 and HOS. The miR-16-5p or si-TSPAN15 was transfected into MG63 cells to observe its role in cell proliferation, migration and invasion. Cell proliferation was measured with MTT assay, cell migration and invasion were examined by Transwell, and the protein expression of CyclinD1, matrix metalloproteinase 2 (MMP-2), MMP-9, tetraspanin 15 (TSPAN15), phospha-tidylinositol3-kinase(p-PI3K) and phospha-protein kinase B(p-AKT) were determined by using Western blotting. The starbase website prediction combined with dual luciferase gene reporter assay was performed to analyze the targeting relationship between miR-16-5p and TSPAN15. miR-16-5p and pcDNA-TSPAN1 were co-transfected to assess the effect of high expression of TSPAN15 on overexpression of miR-16-5p-induced proliferation, migration and invasion of MG63 cells. Data comparison between the two groups was performed by using t test. Results: Compared with hFOB 1.19 cells (1.00±0.12), the expression of miR-16-5p was significantly decreased in MG63, Saos2 and HOS cells (0.32±0.05, 0.40±0.04, 0.45±0.06, respectively)( F= 156.204, P< 0.05), and TSPAN15 mRNA and protein levels were greatly increased ( F= 71.718, 110.350, both P< 0.05). Overexpression of miR-16-5p obviously reduced the expression of CyclinD1, MMP-2, MMP-9 protein, cell viability, cell migration and invasion ( F= 150.136,117.228, 154.971, 89.479, 98.373, 130.880, all P< 0.05) in MG63 cells. Knockdown of TSPAN15 greatly reduced CyclinD1, MMP-2, MMP-9 protein levels, cell survival rate, cell migration, and invasion number ( F= 93.206, 107.030, 109.326, 115.625, 146.113, 139.300, all P< 0.05). Overexpression of miR-16-5p markedly decreased the expression of p-PI3K and p-AKT protein in MG63 cells ( F= 156.755, 181.419, both P< 0.05). miR-16-5p targeted to regulate the expression of TSPAN15. High expression of TSPAN15 partially reversed the inhibitory effect of miR-16-5p on TSPAN15, CyclinD1, MMP-2, MMP-9, p-PI3K, p-AKT protein expression, cell viability, cell migration number and invasion number in MG63 cells. Conclusion: miR-16-5p inhibits the proliferation, migration and invasion of osteosarcoma cells by targeting the TSPAN15 gene and regulating the PI3K/AKT signaling pathway.

Objective: To identify the value of the detection of pepsin and bile acids in saliva for the diagnosis of gastroesophageal reflux disease(GERD). Methods: From January 2018 to June 2019, 104 GERD patients and 43 healthy people in Guangdong Provincial People's Hospital were recruited. The 104 patients of GERD group were divided into four sub-groups, including esophageal symptoms GERD group, extraesophageal symptoms GERD group, anxiety or depression group, non-anxiety and non-depression group. Saliva was collected on waking in morning and 2 h after finishing lunch. The concentration of the total pepsin(TPP) and total bile acids(TBA) from saliva was detected by ELISA method. Receiver operating characteristics analysis was used to identify the sensitivity and specificity of the saliva pepsin and bile acids detection. Results: The concentration of TPP in morning waking samples and postprandial samples in the GERD group was 27.1(9.7,50.3) μg/L and 32.4(14.0,58.7) μg/L, the concentration of TBA in postprandial samples was (18.4±2.3)μmol/L, and these levels were significantly higher than that of the control group [7.0(5.1, 9.1) μg/L, 7.4(5.2, 9.4) μg/L, (12.6±5.0)μmol/L]( P< 0.01). The concentration of TBA in morning waking samples had no significant difference between these two groups( P> 0.05). The concentration of TPP and TBA had no significant difference among the four GERD sub-groups( P> 0.05).Pepsin in postprandial saliva samples had moderate diagnostic value for GERD, when the saliva pepsin concentration in postprandial samples was higher than 41.33 μg/L, it had a sensitivity of 82.8% and a specificity of 73.3%. The bile acids in saliva had no significant diagnostic value for GERD. Conclusions: Pepsin detection in saliva has a high level of sensitivity and specificity for diagnosing GERD. However, bile acids in saliva has no significant diagnostic value for GERD.

Objective: To investigate the abnormal functional connectivity between sublaterodorsal nucleus (SLD) and the brain motor areas in Parkinson's disease with or without rapid-eye-movement (REM) sleep behavior disorder by resting state functional magnetic resonance imaging (rfMRI). Methods: A total of 64 subjects recruited in the Department of Neurology, the People's Hospital of Zhengzhou University were enrolled in this study from August 2014 to December 2017 according to international diagnosis criteria, 20 cases with PD-RBD (PD-RBD group), 23 cases without PD-nRBD (PD-nRBD group) and 21 age, gender-matched healthy controls (HC group). All subjects were examined by Hoehn-Yahr, UPDRS-Ⅲ and rfMRI. Resluts: UPDRS-Ⅲ scores and Hoehn-Yahr staging were showed significantly different from that in the HC group(KW=-27.35, P< 0.001) but showed no significantly difference from that in the PD-nRBD group(KW=6.01, P= 0.807). Compared with the control group, the FC analysis showed reduced correlations from the left SLD to the right orbital middle frontal gyrus( T =-4.567 8, P< 0.001), the left cingulate gyrus( T =-3.196 0, P< 0.001), the left cerebellum( T =-4.267 0, P< 0.001) and the right midbrain( T =-4.773 7, P< 0.001), from the right SLD to the bilateral cerebellum ( T (left) = -5.040 1, T (right) = -4.210 5, P< 0.001), the left precuneus( T =-4.468 2, P< 0.001) and the left precentral gyrus ( T =-4.473 9, P< 0.001) in the PD-RBD. The correlations between the left SLD and left cerebellum, right midbrain and between the right SLD and left precuneus, left precentral gyrus were negative correlated with the motor functional tests. Conclusions: There are abnormal functional connectivity from the SLD to the motor areas in PD-RBD patients, leading to clinical PD-RBD motor symptoms and movement disorders.

Objective: To investigate the association between orexin-2 receptor (OX2R) gene polymorphisms and Alzheimer's disease (AD). Methods: A total of 350 patients with AD diagnosed at the People's Hospital of Zhengzhou University from January 2014 to January 2018 were enrolled as the case group, and 350 healthy subjects were selected as the control group, and their general demographic data were collected. The peripheral blood samples were collected for DNA extraction, and the polymorphisms of 6 loci in OX2R gene in the two groups were detected by polymerase chain reaction (PCR) and gene sequencing. The differences in genotype and gene frequency distribution between the two groups were compared. Results: The genotype distribution of OX2R gene rs2653349 and rs2292041 in the case group was significantly different from that in the control group ( P< 0.05). Multivariate Logistic regression analysis showed that rs2653349(GA+AA) genotype was an independent risk factor for AD( P= 0.009). Five haplotypes were found in the haplotype analysis, and there were differences between the case group and the control group: rs2653349+rs2292041 GA type(χ(2)=10.922, P= 0.000 1), rs2653349+rs2292041+ rs3122169 GAA type (χ(2)=8.687, P= 0.003), ATC type(χ(2)=8.329, P= 0.003 9), rs2653349+ rs2292041 AT type(χ(2)=6.504, P= 0.010 8), rs2653349+rs2292041+rs3122169 ATA type(χ(2)=17.511, P= 0.000 1). Conclusion: The OX2R gene rs2653349 and rs2292041 polymorphisms in the Han population of Henan may be associated with AD, and the A allele may be a susceptible factor for AD.

Objective: To investigate the comprehensive nutritional status and diet behavior of middle aged and elderly women with osteoporosis, and thereby to explore the relationship between diet behavior and comprehensive nutritional status. Methods: 311 middle-aged and elderly women with osteoporosis in Chengdu were included in this study. Mini Nutritional Assessment (MNA) was applied to assess their comprehensive nutritional status. Information of social-demographic characteristics and diet behavior (about meals, snacks and water drinking, etc.) of the subjects was collected by questionnaire. Chi square test was used to assess the differences in nutritional status among patients who have different eating behaviors. Logistic regression analysis was performed to evaluate the relationship between diet behaviors and comprehensive nutritional status. Results: The mean MNA score of subjects was 25.8±2.5. 20.3% (63/311) of the subjets were at risk of potential malnutrition, but there was no malnourished subjects found. 46.9% (46/311) of the subjects were in good appetite. 95.2% (296/311) of them had a fixed food intake each meal. 65.8% (198/311) of them had snacks every day, and the most common choice was fruit (86.4% (248/287)). 54.8% (165/311) of them had initiative drinking water habits, and the most common choice was plain boiled water (79.9%, 246/308). 76.5% (238/311) of them had daily portable water less than 1 500 ml. After adjusting the effects of age, occupation and education level, bad appetite ( OR= 3.50, 95% CI: 1.18-10.62), unfixed food intake ( OR= 7.27, 95% CI: 1.40-35.83), and seldom or never intake of snack ( OR= 3.71, 95% CI: 1.42-9.72) were risk factors for malnutrition risk, while tea drinking was protective factor( OR= 0.31, 95% CI: 0.11-0.93). Conclusion: Risk of potential malnutrition and unhealthy diet behavior among the middle aged and elderly women with osteoporosis should be paid more attention. Unhealtghy diet behavior has a negative effect on their comprehensive nutritional status.

Objective: To explore the clinical efficacy of the modified laparoscopic placement of peritoneal dialysis catheters by nephrologists. Methods: A total of 188 patients diagnosed as end-stage renal disease (ESRD) were enrolled, who received catheter and continuous ambulatory peritoneal dialysis (CAPD) therapy from January 2011 to May 2016 in Zhejiang Provincial People's Hospital. They were divided into group A (with modified laparoscopic placement of peritoneal dialysis catheters, n =59) and group B (with conventional placement of peritoneal dialysis catheter, n =129). The demographic and clinical characteristics, past abdominal operation history, surgery time, hospital stay after operation, expenses for surgery and hospitalization, early and late complications including bleeding, pain, leakage, peritonitis and catheter displacement were observed. Results: Patients with previous abdominal surgery accounted for 11.9% in group A and 0 in group B(χ 2 =15.897, P <0.001). The duration of the operation was (38.9±12.8)min in group A and (64.1±12.7)min in group B( t =-6.466 6, P =0.000 0). The cost of the operation was (5 488.4±156.1) yuan in group A and (1 602.7±48.92) yuan in group B ( t =257.129, P =0.000 0). Catheter displacement within one month was observed in 0 and 11.6%(χ 2 =7.455 3, P =0.003), pain in 15.3% and 41.9% (χ 2 =12.862 2, P =0.000), and catheter displacement after one month in 0 and in 16.3% (χ 2 =10.812 4, P =0.000) of the patients, respectively in group A and group B. The incidences of peritonitis within one month and beyond one month, leakage, bleeding and so on showed no difference between the two groups( P >0.05). Conclusions: Placement of PD catheter with laparoscope is suitable for renal failure patients with abdominal operation history and replacement PD catheter. It also has the advantages of shorter surgery time, less pain and lower incidences of catheter displacement, expanding the application of PD. However, bleeding, leakage, hernia and other complications are frequently seen.

Objective: To determine the clinical value of cerebrovascular hemodynamics analysis (CVA) on cerebral microcirculation., Methods: One hundred consecutive patients from neurological department of Peking University People's Hospital from April to October, 2015, with symptoms of dizziness, lightheadedness, headache etc., who were diagnosed with ischemic cerebrovascular disease with normal transcranial doppler (TCD) and abnormal CVA, were recruited in this study.Other medical conditions were excluded through clinic and imaging examinations among these patients.Patients were categorized into mild, moderate and severe subgroups based on the degrees of decreased blood flow velocity and/or volume, and received treatment accordingly.CVA parameters including the minimum flow velocity (Vmin), the minimum flow volume (Qmin), peripheral resistance (R), critical pressure (CCP) and dynamic resistance (CVR) etc.before and after treatment were compared statistically (t test)., Results: Out of the 100 patients with abnormal CVA, 52 patients had bilateral changes and 48 patients had unilateral changes.The minimum flow velocity and the minimum flow volume anomalies were found in 100 and 92 cases, respectively.A total of 47, 32 and 21 patients had mild, moderate and severe abnormal changes, respectively.Out of the 63 patients who had follow-up CVA after treatment (drop-out 37 cases), there were 63 abnormal Vmin cases, 60 abnormal Qmin cases, 17 abnormal R cases, 18 abnormal CCP cases, 41 abnormal characteristic impedance (Zc) cases, 41 abnormal elastic wave velocity (Wv) cases, 23 abnormal vascular compliance (C) cases, all before treatment.After treatment, symptoms and Vmin synchronization improved in 61 cases (96.8%), Qmin improved in 58 cases (96.6%), R improved in 13 cases (76.5%), CCP improved in 10 cases (55.6%), Zc improved in 27 cases (65.8%), Wv improved in 25 cases (61.0%), C improved in 6 cases (26.1%). All improvements were statistically significant (P<0.05), with Vmin, Qmin, R and CCP showing most significant changes (P<0.000 1). The CVR treatment showed no significant before and after treatment (P>0.05)., Conclusions: CVA is an important method in assessing cerebral microcirculation perfusion, providing information on intracranial microvascular bed that cannot be detected by TCD.It is not only helpful for diagnosis, but also evaluable for monitoring clinical treatment of cerebral microcirculation disorder.CVA is also helpful in determining the location of cerebral circulation impairment by correlation with carotid ultrasound and TCD.

Objective: To retrospectively evaluate early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft., Methods: From January 2009 to January 2013, 383 acute, 43 sub-acute and 152 chronic patients with type B aortic dissection underwent TEVAR in our aortic center. The mean follow-up period was (27 ± 14) months. All clinical data were analyzed with SPSS 17.0., Results: The 30-day mortality and morbidity were 0.35% and 1.2% respectively. The mid-term mortality and morbidity were 0.35% and 5.5%. Serious complications included retrograde type A dissection (n = 3), new tear at the distal end of stent (n = 26), endoleak (n = 3) and paraplegia (n = 0). The retreatment rate was 5.2% ( 6 patients were transformed to open operation and 24 patients underwent re-intervention)., Conclusions: The early and mid-term results of thoracic endovascular repair (TEVAR) of type B aortic dissection by the second generation of stent graft showed lower mortality, no paraplegia and significant reduced endoleaks in comparison with the first generation stent graft. The new distal tear caused by the stent graft became the major complication. The design of the stent graft still need improvement.

Objective: To explore the role of voltage dependent anion channel 2 (VDAC2) involved mitochondrial apoptosis in heart injury of rats with severe scald injury and elucidate its possible regulatory signal pathway., Methods: A total of 60 Wistar rats were divided into sham scald group (n = 30) and scald group (n = 30) according to a random digital table. Blood and heart tissue samples were harvested at Day 1, 7, 14 post scalding. Myocardial injury was assessed with cardiac troponin I (cTnI) by enzyme-linked immunosorbent assay (ELISA). Mitochondrial apoptosis activation was evaluated by the expressions of Bax/Bcl-2 ratio, cytoplasmic cytochrome C and VDAC2. And the levels of phosphatidylinositol 3-kinase, p-Glycogen Synthase Kinase-3β and hexokinase 2 protein were determined by Western blot., Results: The serum levels of cTnI were significantly higher in scald group than those in sham scald group at Day 1, 7, 14 ((1.41 ± 0.25) vs (0.53 ± 0.23) µg/L, (1.93 ± 0.53) vs (0.43 ± 0.23) µg/L, (1.62 ± 0.34) vs (0.41 ± 0.22) µg/L respectively, all P < 0.05). Compared with sham scald group, Bax/Bcl-2 ratio increased significantly in scald group at Day 1, 7 day post-scalding (3.360 ± 0.173 vs 0.623 ± 0.044, 2.736 ± 0.341 vs 0.698 ± 0.064, 1.290 ± 0.234 vs 0.718 ± 0.063 respectively, all P < 0.05), VDAC2 protein level in scald group decreased significantly at Day 1, 7, 14 (0.070 ± 0.009 vs 0.328 ± 0.026, 0.007 ± 0.002 vs 0.291 ± 0.025, 0.009 ± 0.004 vs 0.302 ± 0.037 respectively, all P < 0.05), the cytoplasmic levels of cytochrome increased significantly in scald group at Day 1, 7, 14 (0.418 ± 0.030 vs 0.022 ± 0.007, 1.685 ± 0.169 vs 0.030 ± 0.011, 0.300 ± 0.037 vs 0.098 ± 0.014 respectively, all P < 0.05), the expression of PI3K was significantly lower in scald group at Day 14 post-scalding (0.083 ± 0.015 vs 0.328 ± 0.011, P < 0.05), the expressions of p-GSK3β all reduced significantly at Day 1, 7, 14 (0.098 ± 0.014 vs 0.446 ± 0.031, 0.064 ± 0.002 vs 0.476 ± 0.054, 0.074 ± 0.010 vs 0.442 ± 0.041, respectively, all P < 0.05) and the expressions of HK2 were lower at Day 7, 14 post-scalding (0.390 ± 0.027 vs 0.611 ± 0.070, 0.267 ± 0.018 vs 0.490 ± 0.042, respectively, all P < 0.05)., Conclusions: VDAC2 involved mitochondrial apoptosis is activated in myocardium after severe scalds. And it may be regulated by the pathway of PI3K-GSK-HK2.

Objective: To explore the effects of neural respiratory drive on ventilation in patients with chronic obstructive pulmonary disease (COPD) during sleep., Methods: Diaphragm electromyogram (EMG) from a multipair esophageal electrodes and airflow derived from pneumotachography were recorded during overnight polysomnography in 13 patients with stable COPD recruited from outpatient clinic of First Affiliated Hospital of Guangzhou Medical College from May 2010 to May 2011. Changes in diaphragm EMG and ventilation during wakefulness and different sleep stages were observed., Results: Diaphragm EMG decreased by 26% in non-rapid eye movement sleep (NREM) stage and 39% in rapid eye movement (REM) as compared with wakefulness. Coinciding with change in diaphragm EMG, ventilation (VE) (ml×min(-1)×kg(-1)) significantly decreased from wakefulness (156 ± 53) ml×min(-1)×kg(-1) to steady NREM stage (112 ± 35) ml×min(-1)×kg(-1) (P < 0.05) and further decreased from NREM stage to REM stage (95 ± 27) ml×min(-1)×kg(-1) (P < 0.05). Oxygen saturation also decreased significantly from 97.1% ± 1.8% in wakefulness to REM stage (94.0% ± 3.9%) (P < 0.01)., Conclusion: Reduced neural respiratory drive contributes to nocturnal hypoventilation in COPD patients.

Objective: To analyze the incidence of tuberculosis (TB) in people who were in close contact with smear-positive TB patients., Methods: A total of 19 159 subjects, including 17 334 family members and 1825 classmates of patients, in close contact with 6653 smear-positive TB patients in Shijiazhuang city from 2007 to 2008 were observed. All the classmates were tested by purified protein derivative (PPD) test and symptom screening, and all family members were screened by symptoms. All these subjects were trained with knowledge related to TB. The ones with positive PPD test and suspected TB symptoms were further examined by chest X-ray and sputum smear microscopy, and those without any symptom were followed up monthly throughout a two year period and were examined at any time if symptoms occurred., Results: A total of 281 patients with pulmonary TB were diagnosed in 2 years, including 176 family members and 105 classmates in all close contacts. The smear-positive incidences were 1466.67/100 000. The incidences for 14 - 25 years old group and more than 75 years old group were 2907.18/100 000 (83/2855) and 2650.96/100 000 (18/679), which were higher than those for other groups. Two higher incidences were related to close contact time periods of 6 months (929.07/100 000, 178/19 159) and 13 - 18 months (369.12/100 000, 70/18 964). Three highest incidences were observed in the roommates (11 384.62/100 000, 37/325), classmates (4533.33/100 000, 68/1500) and couples (1624.17/100 000, 86/5295)., Conclusion: Closer contact with smear-positive patients with TB may result in the higher chance of TB. Close contact for 6 months or 13 to 18 months caused more patients, and the 14 - 25 years old group and more than 75 years old group had higher incidences of TB.

Objective: To explore the expression of endoplasmic reticulum stress (ERS) associated proteins in livers of severely burned rats and examine its potential significance., Methods: Sixty-four Wistar rats were randomly divided into the control and burn groups (30% total body surface area full-thickness thermal injury) (n = 32 each). Livers were harvested at Day 1, 4, 7, 14 post-burn. Western blot was used to detect the expressions of endoplasmic reticulum stress associated proteins glucose regulated protein 78 (GRP78), C/EBP-homologous protein (CHOP), active caspase-12 and active caspase-3. Hepatic apoptosis was assessed by the assay of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)., Results: Compared with the control group, the expression of GRP78 became elevated at Day 1, 4, 7, 14 post-burn (1.29 ± 0.11 vs 1.00 ± 0.00, 1.28 ± 0.12 vs 0.95 ± 0.16, 1.29 ± 0.14 vs 0.93 ± 0.06, 1.41 ± 0.17 vs 1.02 ± 0.13 respectively); the expression of CHOP was higher at Day 1, 4 (1.72 ± 0.07 vs 1.00 ± 0.00, 1.82 ± 0.18 vs 1.46 ± 0.08 respectively) while active caspase-12 and active caspase-3 increased at Day 1, 4, 7 post-burn (2.05 ± 0.65 vs 1.00 ± 0.00, 2.16 ± 0.69 vs 0.95 ± 0.21, 1.98 ± 0.56 vs 0.90 ± 0.22; 1.96 ± 0.15 vs 1.00 ± 0.00, 1.40 ± 0.14 vs 1.07 ± 0.12, 1.77 ± 0.17 vs 1.15 ± 0.21 respectively); the apoptotic index(%) of hepatocytes was higher at Day 1, 4, 7, 14 post-burn (27.20 ± 3.63 vs 5.00 ± 0.71, 16.40 ± 1.52 vs 5.40 ± 1.14, 27.60 ± 1.82 vs 7.40 ± 1.14, 10.20 ± 1.92 vs 5.20 ± 1.64 respectively). All results were statistically significant (all P < 0.05)., Conclusion: ERS activates and expressions of associated proteins GRP78, CHOP, active caspase-12 and active caspase-3 increase in livers of severely burned rats.

Objective: To investigate the gene variations of influenza B virus isolated in Hunan province from 2007 to 2010., Methods: A total of 42 strains of influenza B virus,which were isolated in the Influenza Surveillance Network Laboratories in Hunan province between year 2007 and 2010, were selected for the study. The hemagglutinin 1 (HA1) and neuraminidase (NA) genes of the selected strains were amplified by RT-PCR, and the sequence of the purified product were detected and homologically compared with the sequence of influenza vaccine strains isolated from Northern Hemisphere by WHO during the same period. In addition, the phylogenetic trees were constructed to characterize the molecular features., Results: In the Victoria branch of the HA1 gene phylogenetic tree, the strains isolated from year 2007 to 2009 were included in the V1 sub-branch, as well as the vaccine strain Malaysia/2506/2004; the strains isolated in year 2010 were involved in the V2 sub-branch, similar to the vaccine strains Brisbane/60/2008. In the Yamagata branch,the strains isolated in year 2007 were in the Y1 sub-branch,different from the strains isolated between year 2008 and 2010, which were in the Y2 sub-branch, instead. All virus in NA gene phylogenetic tree were included in the Yamagata branch, indicated their Yamagata origin. The genetic sequence analysis of the 7 strains isolated in year 2010 revealed that the viruses were classified as genotype 2 and genotype 15. The results of homological comparison between HA1 molecule and the influenza vaccine strains recommended by WHO were as below: Victoria lineage, 98.6% - 99.1% in 2007, 98.6% - 99.1% in 2008, 98.1% - 99.1% in 2009, and 97.6% - 99.1% in 2010; and Yamagata lineage, 97.9% - 98.5% in 2007, 97.9% - 98.5% in 2009 and 97.9% - 98.2% in 2010. The major mutations of the strains isolated in year 2007 were found in sites R48K, K88R, P108A, D197N and S230G. While the major mutations of the strains isolated between year 2009 and 2010 were sited in K88R, S150I, N166Y, D197N and S230G., Conclusion: The prevalent influenza B virus isolated in Hunan province from 2007 to 2010 has mutated and evolved continuously.

Objective: To analyze the expressions of TrkB and TRIM29 in biopsy tissues from preoperative gastroscopy in patients with gastric cancer and investigate the relationship between their expression and rate of lymph node metastasis., Methods: Through immunohistochemistry, the authors analyzed the expression status of TRIM29 and TrkB in biopsy tissues from preoperative gastroscopy in 67 patients with a diagnosis of gastric cancer undergoing radical operations during 2005 - 2009 at Peking University Third Hospital. There were 39 males and 28 females. Then the relationship was explored between the expression of both proteins and lymph node metastasis and other clinical pathological factors. Image pro Plus 6.0 software was used for image analysis. The data underwent a logarithmic process and were analyzed through SPSS 17.0 statistical software., Results: The expression of TrkB in lymph node metastasis (n = 42) was higher than that in without lymph node metastasis (n = 25) (lgA 4.79 ± 0.42 vs 3.98 ± 0.71, t = -5.873, P = 0.003), while the expression of TRIM29 with lymph node metastasis (n = 36) was also higher than that in without lymph node metastasis (n = 24) (5.21 ± 0.27 vs 5.02 ± 0.37, t = -2.257, P = 0.040). Logistic regression analysis showed that the TrkB expression was an independent predictor for lymph node metastasis. A discriminant was set based on the result (discriminant value = 1.705 × TrkB lgA+ 1.803 × TRIM29 lgA-16.880, cutoff value = 0). This discriminant achieved a prediction accuracy of 80.0% (48/60), a positive likelihood ratio 3.332 and a negative likelihood ratio 0.223. Patients with a high expression of TrkB showed a worse survival rate than those with a low TrkB expression [36.0% (9/25) vs 66.7% (16/24), P = 0.047). Patients with a high TRIM 29 expression showed a worse survival rate than those with a low TRIM29 expression [38.1% (8/21) vs 66.7% (14/21), P = 0.044]., Conclusion: The expressions of TrkB and TRIM29 are correlated with lymph node metastasis in gastric cancer, and discriminant based on the expressions of TrkB and TRIM29 had important values for preoperative prediction of lymph node metastasis in gastric cancer.

Objective: To explore the clinical and genetic characteristics of two patients with 11 β-hydroxylase deficiency (11 β-OHD)., Methods: The clinical features and laboratory data were collected from the patients and their families. All exons of CYP11B1 gene were amplified by PCR. And the PCR product sequences were identified by a DNA analyzer., Results: Two patients presented with juvenile hypertension with bilateral adrenal hyperplasia and congenital hypospadias, hypertension for 17 years and periodic hematuria for 3 months after dexamethasone therapy respectively. Steroid analysis showed the typical pattern of 11 β-OHD: elevated plasma levels of adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone (17OHP), 11-deoxycortisol, androstenedione and testosterone and lowered levels of potassium, aldosterone and plasma renin activity (PRA). CT scan revealed the presence of bilateral nodular hyperplasia of adrenal glands. Sequencing analysis showed compound heterozygous mutations of [R453Q]+[R454C] at exon 8 in patient 1 and homozygous mutation of [R454C] at exon 8 in patient 2., Conclusion: 11 β-OHD is the second major cause of congenital adrenal hyperplasia. The classic characteristics are hypertension with low a level of PRA, hypokalemia, female pseudohermaphroditism and male sexual precocity. 11 β-OHD should be screened in the patients with juvenile onset hypertension accompanied by bilateral adrenal hyperplasia.

Objective: To investigate the possible association of interleukin-23 receptor (IL-23R) polymorphisms with the susceptibility and phenotype of inflammatory bowel diseases (IBD) in Jiangsu Han population., Methods: We genotyped 178 IBD patients including 135 patients with ulcerative colitis (UC), 43 patients with Crohn's disease (CD), and 134 healthy controls for rs11805303, rs1343151, rs11465804, rs11209032, rs17375018, rs11465788., Results: Comparing with the controls (50.4%), there was a significant increase in the carriage of the T allele of rs11805303 in UC (60.4%)(P = 0.020). In genotype-phenotype correlation of rs17375018 in UC, clinical severity (UCDAI) was associated with the prevalence of the G allele showed a trend to mild activity. Genotype polymorphisms of rs17375018A was observed more in younger than 25 in the genotype-phenotype correlation in CD (41.7% vs 22.0%, P = 0.050, OR = 2.532, 95%CI 0.988 - 6.494), while rs11805303 was associated with age at diagnose and disease lesion (P = 0.039 and 0.044). The risk of extra intestinal manifestation in rs17375018A allele carriers was lower (23.1% vs 46.7%, P = 0.040, OR = 2.917, 95%CI 1.027 - 8.283)., Conclusions: We confirmed the susceptibility of rs11805303 polymorphisms with UC and first demonstrated the genotype-phenotype correlation of rs11805303, rs17375018 with UC, CD in Jiangsu Han population.

Objective: Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagen band with an inflammatory infiltrate in the mucosa. This report describes the first case of collagenous gastritis occurring in a young Chinese woman and reviews the literatures., Methods: The patient underwent the gastroscopy screening, and the biopsy specimens were treated with HE staining, Masson staining, Congo red staining and Warthin-Starry staining.Patients' clinical data was discussed and followed up., Results: A twenty-year-old girl had intermittent epigastric pain for 4 years, abdominal distention, hiccup and weight loss for two months. The gastric endoscopy revealed diffuse white nodular appearance of the mucosa in angular incisura and antrum. Pathologic examination of the gastric biopsies from the antrum and angular showed a subepithelial collagen deposition with moderate infiltrates of lymph plasma cells and eosinophils of the lamina propria. The collagen band measured up to 120.3 µm (mean 43.8 µm). Prednisone 20 mg/d for 4 weeks led to clinical remission and weight gain., Conclusion: There are about 40 cases in literatures to date, and the cause and pathogenesis of collagenous gastritis remain unknown. According to the clinical and pathological characteristics, the patient in this article is the subtype of collagenous gastritis that occurring in children and young adults. Specific therapy has not been established, the gluten-free diet and glucocorticosteroid may be helpful to relieve symptoms in collagenous gastritis patients.

Objective: To explore the distribution of Toll-like receptors gene polymorphisms in inflammatory bowel disease (IBD) in Chinese Han patients and Caucasians., Methods: The toll-like receptor 2 (TLR2) genes Arg677Trp and Arg753Glu, TLR4 genes Asp299Gly and Thr399Ile, and TLR9 gene 1237T/C polymorphisms were genotypes in 113 patients with IBD and 120 age and gender-matched healthy controls by the analyses of polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). A meta-analysis was performed to test whether TLR4 Asp299Gly and Thr399Ile polymorphisms were associated with ulcerative colitis (UC) or Crohn's disease (CD) susceptibility and whether 299Gly carriage was associated with phenotypes of CD patients in the Caucasian population., Results: We found two carriers of TLR9 1237C in UC patients, one carrier in CD patients and one in healthy controls respectively (CD: P = 0.361; UC: P = 0.569). There was no statistically significant difference in both allelic and genotypic frequencies. The mutant genotypes of TLR2 gene Arg677Trp and Arg753Glu, TLR4 gene Asp299Gly and Thr399Ile were not found in either the IBD patients or the healthy controls. The TLR4 299G allele showed a significant association with CD and UC in Caucasian population (OR = 1.29, 95%CI: 1.08 - 1.54, P = 0.004 and OR = 1.28, 95%CI: 1.08 - 1.51, P = 0.004 respectively). Similar association was detected between T399I polymorphism and susceptibility to IBD (OR = 1.37, 95%CI: 1.12 - 1.68, P = 0.002 and OR = 1.46, 95%CI: 1.13 - 1.88, P = 0.003 respectively). However, no significant association was identified between CD phenotypes and 299Gly carriage., Conclusion: TLR2 genes Arg677Trp and Arg753Glu, TLR4 genes Asp299Gly and Thr399Ile and TLR9 gene 1237T/C polymorphisms are not associated with IBD in Chinese Han patients. In Caucasians, both TLR4 299G and 399I confer a significant risk for developing CD and UC. The contribution of genetic determinants may differ significantly between ethnicities.

Objective: To summarize the experience of internet-based online database of orthopedic failure surgery., Methods: Based on the OrthoChina project, a sub-database for orthopedic failure surgery was established, open to the orthopedic surgeons for viewing, uploading, and sharing the experience. All cases were uploaded by the orthopedic surgeon users registering in the OrthoChina project from 25 August 2006 to 31 December 2007 were summarized., Results: 102 failure surgery cases had been uploaded in the database, in which 87 were caused by internal instrumentation, 5 by external fixation, 7 by conservative treatment, and 3 by hip arthroplasty. Sixty-seven cases involved the poor performance of the orthopedic surgeons, 4 involved the patients related, and the causes of the other 31 cases remained unknown. Six failure cases occurred in class 1 hospitals, 76 cases in class 2 hospitals, and 20 in class 3 hospitals., Conclusion: Internet based online database for orthopedic failure surgery helps collect the failed orthopedic treatment from different surgeons and different hospitals. Sharing such experience helps the orthopedic surgeons avoid such therapeutic errors and improve their work. Qualified training and certification are necessary for the application of new techniques and implants.

Objective: To investigate the effects of tumor necrosis factor-alpha-inducing protein-alpha (Tipalpha) released from Helicobacter pylori (Hp) on human gastric epithelial cells., Methods: Human gastric epithelial cells of the line GES-1 were cultured. Tipalpha gene located in Hp 0596 was extracted from the genome sequence of the Hp strain 26695 and its open reading frame were cloned into the eukaryotic expressing vector pcDNA3.1. The recombinant plasmid pcDNA3.1-Tipalpha thus obtained and the blank plasmid pcDNA3. 1 were transfected into the GES-1 cells, and the G418-resistent clones were screened. The GES-1 cells transfected with blank vector pcDNA3.1 and normal GES-1 cells were used as controls. RT-PCR and Western blotting were used to detect the expression of Tipalpha. The influences of Tipalpha protein on the cells proliferation, apoptosis and cell cycles, concentration of related cytokines such as TNF-alpha, IL-1beta, and IL-8, and the expression of Bcl-2 and P53 genes were respectively observed by MTT assay, flow cytometry, ELISA, and Western blotting., Results: 1. A eukaryotic expression vector of Hp Tipalpha was successfully constructed. Steadily transfected strains were screened by G418. 2. MTT method showed that the growth curve of the GES-1 cells transfected with GpcDNA3.1-Tipalpha was higher, showing a faster growth. 3. Flow cytometry showed an increase in the proportion of the S-phase and a decrease in the G1-phase in the GpcDNA3.1-Tipalpha-transfected cells [(45.33 +/- 1.03)% vs (38.24 +/- 1.5)%, (33.94 +/- 1.67)%, (41.39 +/- 0.08)% vs (49.74 +/- 0.12)%, (49.27 +/- 0.15)%], and the apoptotic rate of the GpcDNA3.1-Tipalpha-transfected cells was 0.76 +/- 0.04, significantly lower than those of the GpcDNA3.1-transfected cells and non-transfected cells (16.84 +/- 2.16 and 8.36 +/- 1.07 respectively, both P < 0.05). 4. ELISA showed that there was no significant difference in intracellular TNF-alpha concentration among the 3 GES-1 cell groups (all P > 0.05), however, the extra-cellular TNF-alpha level of the GpcDNA3.1-Tipalpha-transfected cells was significantly higher than those of the 2 control groups (both P < 0.05), and that the intra- and extra-cellular IL-1beta and IL-8 concentrations of the GpcDNA3.1-Tipalpha-transfected cells were both significantly higher than those of the 2 control groups (all P < 0.05). 5. The expression level of Bcl-2 gene of the GpcDNA3.1-Tipalphac-transfected cells was obviously higher than those of the 2 control groups, and the expression of P53 gene of the GpcDNA3.1-Tipalphac-transfected cells was lower than those of the 2 control cells., Conclusion: The GpcDNA3.1-Tipalpha-transfected cells steadily and highly express Tipalpha protein, that induces the high expression of TNF-alpha, IL-1beta, and IL-8, proinflammatory cytokines, enhances cell proliferation, and upregulates Bcl-2 gene and down-regulates P53 gene. Tipalpha may play an important carcinogenic role in gastric cancer progression.

Objective: To investigate the changes in natural ecology and social environment after the construction of the dam in the Three Gorges Reservoir area, and to understand the social behavior status and education backgrounds of the local residents, and to analyze the potential impact of these factors on schistosomiasis spreading., Methods: Data of nature and social economy after the construction of the dam in the Three Gorge area were collected, and a cross-sectional study with questionnaire survey on information including social demographic characteristics, people's production and life style, knowledge about schistosomiasis was conducted among natives, emigrations., Results: After the construction of the dam, as the stream became slower, the water-level fluctuating zone on the bank of the reservoir was formed. The main source of drinking water and daily life activity are mainly depends on the river supplying (accounting about 68.7% and 75.8%, respectively); due to the needs of farming, washing cloths and vegetables, 45.6% of resident had a close contact with river water. People with away-from-home employment among emigrations were increased from 5.7% to 18.7%. The proportion of using hygienic lavatory was 88.6%. The main source of water for drinking and daily life among emigrations was tap water (85.4% and 87.0%). The residents had no awareness about the health hazard for schistosomiasis, with less health information, Conclusion: The natural environment of reservoir areas and the life style are risk factors for the spread of schistosomiasis. The improved sanitation condition and the economy construction after the construction of the dam is propitious to keeping away from the introduction of schistosomiasis. However, people with away-from-home employment among emigrations are still at risk of schistosomiasis.

Objective: To use the snail survey data of Yugan, Jiangxi Province as an example to evaluate the effects and advantages of global positioning system integrated with digital maps and remote sensing data in order to manage and analyze the whole country's surveillance data of schistosomiasis by using geographic information system., Methods: The data of geographic information and snail information of 20 marshlands in Yugan, Jiangxi Province were collected, and by the correction of remote sensing images based on the digital maps and index extraction, the snail current situation and trend were analyzed and expressed., Results: A series of specific procedure images of these 20 marshlands was established and the effects of Yugan surveillance platform based on geographic information system were validated., Conclusion: The whole country's surveillance data of schistosomiasis might be successfully integrated with geographic information system by global positioning system and be managed and expressed, which supplies a successful platform in using the surveillance data effectively.

Objective: To investigate the relationship between intrathyroidal dendritic cells and humoral immune disorder in Graves' disease., Methods: With the use of S-100 protein antibodies and the help of SP immunohistochemical method, the number and distribution of S-100 protein positive dendritic cells were observed in thyroid glands from 34 patients with Graves' disease and 5 controls. Serum thyroid stimulating antibodies (TSAb) before operation were measured with human embryo-kidney cells expressing the recombinant thyrotrophin receptor. The correlation between the infiltrating degree of intrathyroidal dendritic cells and the values of serum TSAb was analyzed in patients with Graves' disease., Results: In normal thyroid glands, no S-100 protein positive dendritic cells were found. Dendritic cells were seen in all observed thyroid glands from patients with Graves' disease. Most of the dendritic cells were seen in close contact with the adjacent thyroid epithelial cells or infiltrating lymphocytes. The infiltrating degree of intrathyroidal dendritic cells in Graves' disease correlated closely with the values of serum TSAb (r = 0.4461, P < 0.01)., Conclusion: It is suggested that the intrathyroidal dendritic cells have a close relation with humoral immune disorder and play an important role in the initiation and/or maintenance of thyroid autoimmune reaction in Graves' disease.

Objective: To detect the telomerase activity and c-Myc expression in gastric diseases and to examine the relation between these values and Helicobacter pylori (Hp) as a risk factor for gastric cancer., Methods: 171 gastric samples were studied to detect telomerase activity with telomerase polymerase chain reaction enzyme linked immunosorbent assay and c-Myc expression using immunohistochemistry., Results: Telomerase activity and c-Myc expression were higher in cancers (87.7% and 61.5%) than in noncancerous tissues. Telomerase activity and c-Myc expression were higher in chronic atrophic gastritis with moderate or severe intestinal metaplasia (52.4% and 47.6%) than in chronic atrophic gastritis with mild intestinal metaplasia (13.3% and 16.7%). In chronic atrophic gastritis with moderate or severe intestinal metaplasia, telomerase activity and c-Myc expression were higher in cases with Hp infection (67.9% and 67.9%) than in these without infection (21.4% and 7.1%). c-Myc expression was higher in gastric cancer with Hp infection (77.3%) than that without infection (28.6%). Telomerase activity and c-Myc expression were coordinately up-regulated in Hp infected gastric cancer and chronic atrophic gastritis with moderate or severe intestinal metaplasia., Conclusions: Hp infection may influence both c-Myc expression and telomerase activity in gastric diseases, especially in chronic atrophic gastritis. c-Myc and telomerase co-expressed in gastric cancer and chronic atrophic gastritis with moderate or severe intestinal metaplasia.