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Spatial scan statistic methods are commonly used for geographical disease surveillance and cluster detection. The standard spatial scan statistic does not model any variability in the underlying risks of subregions belonging to a detected cluster. For a multilevel risk cluster, the isotonic spatial scan statistic could model a centralized high-risk kernel in the cluster. Because variations in disease risks are anisotropic owing to different social, economical, or transport factors, the real high-risk kernel will not necessarily take the central place in a whole cluster area. We propose a spatial scan statistic for a nonisotropic two-level risk cluster, which could be used to detect a whole cluster and a noncentralized high-risk kernel within the cluster simultaneously. The performance of the three methods was evaluated through an intensive simulation study. Our proposed nonisotropic two-level method showed better power and geographical precision with two-level risk cluster scenarios, especially for a noncentralized high-risk kernel. Our proposed method is illustrated using the hand-foot-mouth disease data in Pingdu City, Shandong, China in May 2009, compared with two other methods. In this practical study, the nonisotropic two-level method is the only way to precisely detect a high-risk area in a detected whole cluster. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) infection in infants is a global health priority. We aimed to investigate the common manifestations of RSV infection by age group and human development index (HDI) level and to assess its association with the development of wheezing and recurrent wheezing illness., Methods: We searched the literature published between January 1, 2010 and June 2, 2022 in seven databases. Outcomes included common manifestations and long-term respiratory outcomes of RSV infection in children. Random- and fixed-effect models were used to estimate the effect size and their 95% confidence intervals. Subgroup analysis was conducted by age and HDI levels. This review was registered in PROSPERO (CRD42022379401)., Results: The meta-analysis included 47 studies. The top five manifestations were cough (92%), nasal congestion (58%), rhinorrhea (53%), shortness of breath (50%), and dyspnea (47%). The clinical symptoms were most severe in infants. In our analysis, compared to very high and high HDI countries, fewer studies in medium HDI countries reported related manifestations, and no study in low HDI countries reported that. The RSV-infected infants were more likely to develop wheezing than the non-infected infants [odds ratio (OR), 3.12; 95% CI, 2.59-3.76] and had a higher risk of developing wheezing illnesses after recovery (OR, 2.60; 95% CI, 2.51-2.70)., Conclusions: Cough and shortness of breath are common manifestations of RSV infection. More attention should be given to infants and areas with low HDI levels. The current findings confirm an association between RSV infection and wheezing or recurrent wheezing illness., (© 2023. The Author(s).)

Background: Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group., Methods: A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. Seventeen diarrhea-related pathogens, including seven viruses and ten bacteria, were investigated and their association with occurrence of fever symptoms was assessed using multivariate logistic analysis., Results: A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. Th diarrheal children below 5 years had the highest frequency of fever (24.2%), and related to significantly higher prevalence of viral enteropathogens (40.2%) as compared with other age groups (P < 0.001). Within each age group, the febrile-diarrheal patients were associated with a significantly higher prevalence of bacterial pathogens than afebrile-diarrheal patients (all P < 0.01). There was discrepancy when each pathogen was compared, i.e., nontyphoidal Salmonella (NTS) was overrepresented in febrile vs non-febrile patients of all age groups, while the febrile vs non-febrile difference for diarrheagenic Escherichia coli (DEC) was only significant for adult groups. The multivariate analysis revealed significant association between fever and infection with rotavirus A among children [odds ratio (OR) = 1.60], for DEC in adult groups (OR = 1.64), for NTS in both children (OR = 2.95) and adults (OR = 3.59)., Conclusions: There are significant discrepancy of the infected enteric pathogens in patients with acute diarrhea with fever between age groups, and it is valuable for priority detection of NTS and rotavirus A in patients with children < 5 years old and NTS and DEC in adult patients. The results may be useful in identifying dominant pathogen candidates for the application of diagnostic assays and prevention control., (© 2023. The Author(s).)

Background: Traditional bismuth-containing quadruple therapy, as a first-line eradication treatment for Helicobacter pylori (H. pylori), has several disadvantages, including drug side effects, low medication adherence, and high costs. Trials of high-dose dual treatment have demonstrated its advantages, which include good safety and adherence profiles. In this study, we investigated the efficacy, safety, and compliance of a high-dose dual therapy when compared with bismuth-based quadruple treatment for the initial eradication of H. pylori infection on Hainan Island, China., Methods: We randomized 846 H. pylori-infected patients into two groups. A bismuth-containing quadruple therapy group was administered the following: esomeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily, and colloidal bismuth pectin in suspension 150 mg three times/day for 2 weeks. A high-dose dual therapy group was administered the following: esomeprazole 20 mg four times/day and amoxicillin 1000 mg three times/day for 2 weeks. Patients were given a 13C urea breath test at 4 weeks at treatment end. Adverse effects and compliance were evaluated at follow-up visits., Results: Eradication rates in the high-dose dual therapy group were: 90.3% (381/422, 95% confidence interval [CI]: 87.1%-92.9%) in intention-to-treat (ITT) and 93.6% (381/407, 95% CI: 90.8%-95.8%) in per-protocol (PP) analyses. Eradication rates were 87.3% in ITT (370/424, 95% CI: 83.7%-90.3%) and 91.8% in PP analyses (370/403, 95% CI: 88.7%-94.3%) for quadruple therapy, with no statistical differences (P = 0.164 in ITT and P = 0.324 in PP analyses). Adverse effects were 13.5% (55/407) in the dual group and 17.4% (70/403) in the quadruple group (P = 0.129). Compliance was 92.4% (376/407) in the dual group and 86.6% (349/403) in the quadruple group (P = 0.007)., Conclusions: High-dose dual therapy had high eradication rates comparable with bismuth-based quadruple treatment, with no differences in adverse effects, however higher adherence rates were recorded., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Severe community-acquired pneumonia (SCAP) is associated with a substantial number of hospitalisations and deaths worldwide. Infection or co-infection patterns, along with their age dependence and clinical effects are poorly understood. We aimed to explore the causal and epidemiological characteristics by age, to better describe patterns of community-acquired pneumonia (CAP) and their association with severe disease., Methods: National surveillance of CAP was conducted through a network of hospitals in 30 provinces in China from 2009-20 inclusive. Patients with CAP were included if they had evidence of acute respiratory tract, had evidence of pneumonia by chest radiography, diagnosis of pneumonia within 24 h of hospital admission, and resided in the study catchment area. For the enrolled patients with CAP, nasopharyngeal and oral swabs were taken and tested for eight viral pathogens; and blood, urine, or expectorated sputum was tested for six bacterial pathogens. Clinical outcomes, including SCAP, were investigated with respect to age and patterns of infections or co-infections by performing binary logistic regression and multivariate analysis., Findings: Between January, 2009, and December, 2020, 18 807 patients with CAP (3771 [20·05%] with SCAP) were enrolled. For both children (aged ≤5 years) and older adults (aged >60 years), a higher overall rate of viral and bacterial infections, as well as viral-bacterial co-infections were seen in patients with SCAP than in patients with non-SCAP. For adults (aged 18-60 years), however, only a higher rate of bacterial-bacterial co-infection was observed. The most frequent pathogens associated with SCAP were respiratory syncytial virus (RSV; 21·30%) and Streptococcus pneumoniae (12·61%) among children, and influenza virus (10·94%) and Pseudomonas aeruginosa (15·37%) among older adults. Positive rates of detection of most of the tested pathogens decreased during 2020 compared with the 2009-19 period, except for RSV, P aeruginosa, and Klebsiella pneumoniae. Multivariate analyses showed SCAP was significantly associated with infection with human adenovirus, human rhinovirus, K pneumoniae, or co-infection of RSV and Haemophilus influenzae or RSV and Staphylococcus aureus in children and adolescents (aged <18 years), and significantly associated with infection with P aeruginosa, K pneumoniae, or S pneumoniae, or co-infection with P aeruginosa and K pneumoniae in adults (aged ≥18 years)., Interpretation: Both prevalence and infection pattern of respiratory pathogens differed between patients with SCAP and patients with non-SCAP in an age-dependent manner. These findings suggest potential advantages to age-related strategies for vaccine schedules, as well as clinical diagnosis, treatment, and therapy., Funding: China Mega-Project on Infectious Disease Prevention and The National Natural Science Funds of China., Translation: For the Chinese translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Acute meningitis or encephalitis (AME) results from a neurological infection causing high case fatality and severe sequelae. AME lacked comprehensive surveillance in China., Methods: Nation-wide surveillance of all-age patients with AME syndromes was conducted in 144 sentinel hospitals of 29 provinces in China. Eleven AME-causative viral and bacterial pathogens were tested with multiple diagnostic methods., Findings: Between 2009 and 2018, 20,454 AME patients were recruited for tests. Based on 9,079 patients with all-four-virus tested, 28.43% (95% CI: 27.50%‒29.36%) of them had at least one virus-positive detection. Enterovirus was the most frequently determined virus in children <18 years, herpes simplex virus and Japanese encephalitis virus were the most frequently determined in 18-59 and ≥60 years age groups, respectively. Based on 6,802 patients with all-seven-bacteria tested, 4.43% (95% CI: 3.94%‒4.91%) had at least one bacteria-positive detection, Streptococcus pneumoniae and Neisseria meningitidis were the leading bacterium in children aged <5 years and 5-17 years, respectively. Staphylococcus aureus was the most frequently detected in adults aged 18-59 and ≥60 years. The pathogen spectrum also differed statistically significantly between northern and southern China. Joinpoint analysis revealed age-specific positive rates, with enterovirus, herpes simplex virus and mumps virus peaking at 3-6 years old, while Japanese encephalitis virus peaked in the ≥60 years old. As age increased, the positive rate for Streptococcus pneumoniae and Escherichia coli statistically significantly decreased, while for Staphylococcus aureus and Streptococcus suis it increased., Interpretation: The current findings allow enhanced identification of the predominant AME-related pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures in China, and a possible reassessment of vaccination strategy., Funding: China Mega-Project on Infectious Disease Prevention and the National Natural Science Funds., Competing Interests: We declare no competing interests., (© 2021 The Author(s).)

Background: Non pharmaceutical interventions (NPI) including hand washing directives were implemented in China and worldwide to combat the COVID-19 pandemic, which are likely to have had impacted a broad spectrum of enteric pathogen infections., Methods: Etiologically diagnostic data from 45 937 and 67 395 patients with acute diarrhea between 2012 and 2020, who were tested for seven viral pathogens and 13 bacteria respectively, were analyzed to assess the changes of enteric pathogen infections in China during the first COVID-19 pandemic year compared to pre-pandemic years., Findings: Test positive rates of all enteric viruses decreased during 2020, compared to the average levels during 2012-2019, with a relative decrease of 71•75% for adenovirus, 58•76% for norovirus, 53•50% for rotavirus A, and 72•07% for the combination of other four uncommon viruses. In general, a larger reduction of positive rate in viruses was seen among adults than pediatric patients. A rebound of rotavirus A was seen after September 2020 in North China rather than South China. Test positive rates of bacteria decreased during 2020, compared to the average levels during 2012-2019, excepting for nontyphoidal Salmonella and Campylobacter coli with 66•53% and 90•48% increase respectively. This increase was larger for pediatric patients than for adult patients., Interpretation: The activity of enteric pathogens changed profoundly alongside the NPIs implemented during the COVID-19 pandemic in China. Greater reductions of the test positive rates were found for almost all enteric viruses than for bacteria among acute diarrhea patients, with further large differences by age and geography. Lifting of NPIs will lead to resurgence of enteric pathogen infections, particularly in children whose immunity may not have been developed and/or waned., Funding: China Mega-Project on Infectious Disease Prevention; National Natural Science Funds., Competing Interests: The authors declare no competing interests., (© 2021 The Author(s). Published by Elsevier Ltd.)

Objectives To investigate the epidemiological features of diarrheagenic Escherichia coli (DEC) in patients with acute diarrhea in China. Methods An active sentinel surveillance was performed in all-age patients with acute diarrhea in China, 2009‒2018. DEC was isolated and identified by serological assay and PCR from stool samples. Results DEC was determined in 6.68% (6,119/91,651) of the patients, with higher positive rates among females than among males (6.97% vs. 6.46%) and among 18‒59 years patients (7.88%) than among other age groups. Five pathotypes were identified, the most prevalent was enteroaggregative E. coli (EAEC), followed by enteropathogenic E. coli (EPEC), and enterotoxigenic E. coli (ETEC). Pediatric patients <5 years had higher positive rate of EAEC (2.07%), followed by EPEC (1.81%), and enterohemorrhagic E. coli (EHEC) (0.31%), while the 18‒59 years patients had higher infection of ETEC (2.36%). ETEC and EPEC were more frequently identified in urban than rural areas, with age and gender adjusted positive rate of 1.68% vs. 1.14% respectively, and 1.77% vs. 1.55%, while EIEC and EHEC were more frequently identified in rural areas. Conclusions These findings highlight the epidemiology features of DEC and underscores the need for conducting DEC surveillance., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Nationwide prospective surveillance of all-age patients with acute respiratory infections was conducted in China between 2009‒2019. Here we report the etiological and epidemiological features of the 231,107 eligible patients enrolled in this analysis. Children <5 years old and school-age children have the highest viral positivity rate (46.9%) and bacterial positivity rate (30.9%). Influenza virus, respiratory syncytial virus and human rhinovirus are the three leading viral pathogens with proportions of 28.5%, 16.8% and 16.7%, and Streptococcus pneumoniae, Mycoplasma pneumoniae and Klebsiella pneumoniae are the three leading bacterial pathogens (29.9%, 18.6% and 15.8%). Negative interactions between viruses and positive interactions between viral and bacterial pathogens are common. A Join-Point analysis reveals the age-specific positivity rate and how this varied for individual pathogens. These data indicate that differential priorities for diagnosis, prevention and control should be highlighted in terms of acute respiratory tract infection patients' demography, geographic locations and season of illness in China., (© 2021. The Author(s).)

Biomedical engineering (BME) (biomedical materials track) is a typical field of interdisciplinary integration. Its specialty education simultaneously undertakes the duo reformation responsibilities for the new engineering education and the new medical education due to its unique strengths in interdisciplinary nature, comprehensive scope of knowledge, and status of being on the cutting edge of technology. We made an analysis, in this paper, of the opportunities and challenges faced by BME (biomedical materials track) specialty education on the basis of the trends and frontiers of development in biomedical materials in the world. From the perspective of new requirements raised by major national strategies and industrial development for the qualifications and competence of professionals specializing in biomedical materials, thorough reflections were made on the specialized education of BME (biomedical materials track) under the background of the new engineering education and the new medical education. Furthermore, we proposed herein to reconstruct the specialized core knowledge system according to the main line of the reactions and the responses between the biomedical materials and human bodies at different levels and set up a series of courses of biomedical materials science centered on Materiobiology as the core. We also proposed to establish a diversified integrated reform model of the training system incorporating production, learning, research and application for highly competent BME (biomedical materials track) professionals. This paper attempts to contribute to the solution of the major issue of how to train the innovative talents and leaders who will pioneer a new round of diagnosis and treatment technology revolution and the development of the medical device industry., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018. Here we report the etiological, epidemiological, and clinical features of the 152,792 eligible patients enrolled in this analysis. Rotavirus A and norovirus are the two leading viral pathogens detected in the patients, followed by adenovirus and astrovirus. Diarrheagenic Escherichia coli and nontyphoidal Salmonella are the two leading bacterial pathogens, followed by Shigella and Vibrio parahaemolyticus. Patients aged <5 years had higher overall positive rate of viral pathogens, while bacterial pathogens were more common in patients aged 18‒45 years. A joinpoint analysis revealed the age-specific positivity rate and how this varied for individual pathogens. Our findings fill crucial gaps of how the distributions of enteropathogens change across China in patients with diarrhea. This allows enhanced identification of the predominant diarrheal pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures.

Aim: To investigate the role of oxidative stress in regulating the functional expression of P-glycoprotein (P-gp) in mitochondria of D407 cells., Methods: D407 cells were exposed to different ranges of concentrations of H 2 O 2 . The mitochondrial location of P-gp in the cells subjected to oxidative stress was detected by confocal analysis. Expression of P-gp in isolated mitochondria was assessed by Western blot. The pump activity of P-gp was evaluated by performing the efflux study on isolated mitochondria with Rhodamine 123 (Rho-123) alone and in the presence of P-gp inhibitor (Tariquidar) using flow cytometry analysis. The cells were pretreated with 10 mmol/L N-acetylcysteine (NAC) for 30min before exposing to H 2 O 2 , and analyzed the mitochondrial extracts by Western blot and flow cytometry., Results: P-gp was co-localized in the mitochondria by confocal laser scanning microscopy, and it was also detected in the mitochondria of D407 cells using Western blot. Exposure to increasing concentrations of H 2 O 2 led to gradually increased expression and location of P-gp in the mitochondria of cells. Rho-123 efflux assay showed higher uptake of Rho-123 on isolated mitochondria in the presence of Tariquidar both in normal and oxidative stress state. H 2 O 2 up-regulated P-gp in D407 cells, which could be reversed by NAC treatment., Conclusion: H 2 O 2 could up-regulate the functional expression of P-gp in mitochondria of D407 cells, while antioxidants might suppress oxidative-stress-induced over-expression of functional P-gp. It is indicative that limiting the mitochondrial P-gp transport in retinal pigment epithelium cells would be to improve the effect of mitochondria-targeted antioxidant therapy in age-related macular degeneration-like retinopathy.

Objective: To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination., Methods: Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis, Malaria and Echinococcosis, published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention, the malaria incidence and intervention data were selected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interventions in the target provinces was analyzed based on the Panel Data Regression Model, and the key interventions were determined., Results: Four provinces namely Anhui, Yunnan, Hainan and Henan were targeted with 87.56% of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence, X1 as the log of the number of historical cases receiving radical treatment in the pre-transmission stage (RTPT) (F = 14.53, P < 0.01, R2 = 0.72), X2 as the log of risk population receiving RTPR (F = 15.90, P < 0.01, R2 = 0.71) and X3 as the number of technicians trained in microscopy (F = 11.53, P < 0.01, R2 = 0.61), three space-fixed effect models were established respectively, and X1, X2, as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence, X1 as the accumulated technicians trained in microscopy (F = 11.06, P < 0.01, R2 = 0.87), X2 as the log of technicians trained in entomology (F = 15.28, P < 0.01, R2 = 0.89) , two two-way (space and time) fixed effect models were established respectively, and both X1 and X2 had negative effects on Y value., Conclusion: RTPT among historical patients and at-risk populations as well as microscopy training influences the variation of vivax malaria incidence, while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

Objective: To identify the risk area in China during the malaria elimination process, and provide the evidence for promotion of the national malaria elimination programme and implementation of elimination strategy., Methods: Data collection was conducted in 24 endemic provinces in 2010, including data of transmission capacity, potential risk of malaria transmission and the capacity of health professional team at county level. Quantitative assessment of the malaria transmission risk as well as the capacity of health facilities were conducted based on the calculation of malaria transmission risk index (MTI) and health facilities capacity index (CI). ArcGIS 10.0 was used to develop the risk map based on the outcome of quantitative assessment., Results: The data of transmission capacity, potential risk of transmission and the capacity of health professional team were collected from 2147 counties in 24 provinces. Based on MTI and CI calculated for each county, statistic results showed that about 40% of the counties were under the average level of both MTI and CI. The relationship among potential risk of transmission, the capacity of health professional team and malaria incidence were analyzed in three dimensions, and four types were categorized among 2147 counties. Type I (super-high risk area) counties (20) distributed in Yunnan (9), Guangxi (5), Henan (1), Hunan (1), Hebei (1), Sichuan (1), Chongqing (1), and Tibet (1). 17 counties were classified into type II (high risk area) area, distributed in Yunnan (3), Guangxi (2), Guizhou (2), Shaanxi (2), Guangdong (1), Jiangxi (1), Hubei (1), Sichuan (1), Gansu (1), Hebei (1), Fujian (1) and Tibet (1). A total of 170 type III (moderate risk area) counties distributed in 19 provinces including Yunnan (15), Guizhou (14), Hebei (14), Sichuan (13), Shanxi (10), Guangxi (9), Hunan (9), Anhui (9), Jiangsu (9), Shaanxi (9), Shandong (9), Chongqing (8), Gansu (8), Jiangxi (7), Henan (7), Fujian (6), Guangdong (5), Hubei (5), and Zhejiang (4). 1940 type IV (low risk area) counties distributed in 24 provinces., Conclusion: The distribution of four types of risk area for malaria elimination is identified in China.

Objective: To analyze and further improvement the application of the China Infectious Diseases Automated-alert and Response System (CIDARS) in Guangxi Zhuang Autonomous Region., Methods: Results related to the amount of signal, proportion of signal responded, time to signal response, manner of signal verification and on each signal of Guangxi in CIDARS from 2009 to 2011 were described. Performance was compared between the periods of pre/ post the adjustment of parameters in CIDARS on December 10, 2010., Results: A total of 29 788 signals were generated on 16 infectious diseases in the system in Guangxi. 100% signals had been responded with the median time to response as 1.5 hours. The average amount of signal per county per week was 1.7;with 624 signals(2.09%)verified as suspected outbreaks preliminarily and 191 outbreaks of 9 diseases were finally confirmed by further field investigation. The sensitivity of CIDARS was 89.25% , and the timeliness of detection was 2.8 d. After adjusting the parameter of CIDARS, the number of signals reduced, and the sensitivity and timeliness of detection improved for most of the diseases., Conclusion: The signals of CIDARS were responded timely, and the performance of CIDARS might be improved by adjusting the parameters of early-warning model, which helped enhance the ability of outbreaks-detection for local public health departments. However the current proportion of false positive signals still seemed to be high, suggesting that both the methods and parameters should be improved, according to the characteristics of different diseases.

To explore the effect of magnitude and duration on the performance of Cumulative Sum (CUSUM), with simulation method used on the subject after the insertion of 11 outbreak events into baseline data with Poisson distribution. Sensitivity fluctuated from 9.1% to 100.0% with specificities higher than 98.6%. Sensitivity was significantly correlated with magnitude, and increased along with the increase of magnitude. However, no significant correlation was observed between sensitivity and duration. A magnitude which was at least 2.6 times higher than that of the mean daily baseline could result in the sensitivity of 100.0%. Time-lag would be improved along with the increase of magnitude. Time between onset and detection of an outbreak was no longer than one day when magnitude was more than 1.8 of the mean daily baseline. In summary, the performance of CUSUM was influenced by magnitude, but not by duration. CUSUM had the advantage of good time-lag and high sensitivity when the outbreak magnitude was more than 2.4 time over the baseline data.

Objective: To reveal the characteristics and stability of the system through the analyzing the surveillance data of respiratory-feverous syndrome via the syndromic surveillance system which was established during the Shanghai World Expo in Pudong New District and provide references for the development and operation optimization on this Mass Gatherings Surveillance Systems., Methods: Data used was from the surveillance data of respiratory-feverous syndrome collected from Pudong New District Syndromic Surveillance System, through May 1 to October 31, 2010. On the basis of description of data characteristics, correlation analyses were conducted, when compared to the surveillance data of respiratory-feverous syndrome and Pudong influenza-like illness (ILI) used as reference. Comparison of variances on the surveillance data and the report lag time of the earlier and later surveillance periods were also carried out to evaluate the quality and stability of data., Results: Reports on the respiratory-feverous syndrome showed a peak in late September with day-of-week effects and holiday effects. Correlation between respiratory-feverous syndrome and ILI was the strongest in the same day (r = 0.596, P < 0.05). In the earlier surveillance period from 2010-05-01 to 2010-07-31, the correlation between respiratory-feverous syndrome and ILI was not obvious (r = -0.058, P > 0.05); however, the two-time series showed consistent trend with the correlation coefficient as 0.798 (P < 0.05), in the later period from 2010-08-01 to 2010-10-31. In addition, variability of the surveillance data on respiratory-feverous syndrome was less in the later period than in the earlier one, with quality of the report on related data better in the later period. Analyses on the correlations of reference sequence, variability and quality of report indicated that the stability of the later surveillance period was better than the earlier one., Conclusion: Only with the operation of syndromic surveillance system for a certain period of time, could data in the system maintain stability. Surveillance data showed both day-of-week effects and holiday effects, suggesting that there was a need to choose early warning models with short baseline data.

Objective: To evaluate the impact on the health status of population in the area where the 'Three Gorges Reservoir Water Storage Project' had been operated and to provide references for the development of related disease control strategies., Methods: In the Three Gorges Reservoir Area, 17 towns/streets in nine counties were chosen as surveillance points. Data on surveillance program would include infectious diseases, birth, death, biological agents etc., Methods: related to time and spatial analysis and the comparison on pre- and post-water storage were used to analyze and describe the long-term changing trend of meteorological index, distribution of biological agent and diseases, and human health status. Relationships between number of infectious diseases and media biological density and meteorological parameters were also analyzed., Results: When the water storage program came into being in 2003, the indoor (2.22%) and outdoor (2.76%) densities of rats were significantly lower than pre-water storage period (indoor 4.38% vs. outdoor 4.43%) and the annual average density of mosquito (35.09 mosquitoes per room and per hour) was also lower than before (54.24 mosquitoes per room and per hour). The incidence rates of encephalitis B, malaria, leptospirosis, and hemorrhagic fever had reduces 22.88%, 84.85%, 95.03% and 81.82% than before. The incidence rates of malaria, leptospirosis, and hemorrhagic fever were all below 0.4/100 000 and the incidence of encephalitis B was below 2/100 000. The average infant mortality was 11.83‰. The annual infant mortalities, after adjusted by missing report numbers, were between 13.07‰ and 23.88‰ which were lower than the national annual average level. The thirteen year standard mortalities were 3.77‰ - 5.12‰, with the total rate lower than the national average level in the same years., Conclusion: In 2003, the incidence rates of malaria, encephalitis B, leptospirosis, epidemic hemorrhagic fever kept going down in the surveillance sites in the Three Gorges Reservoir Area, and the overall population's health status was well enough to show that there was no negative impact on the health status of population living in the area after the water storage project was inplemented.

Objective: To better understand and measure the status of hepatitis C virus (HCV) infection, we conducted a sero-epidemiological study using the remaining blood samples and data of the nationwide survey of hepatitis B in Chinese residents which was carried out in 2006., Methods: The anti-HCV reagent was screened out from the reagents by the HCV infection blood serum plate with anti-HCV positives or negatives. This plate recognized the Murex 3.0 and Ortho 3.0 reagents as gold standards. Anti-HCV in the blood samples were tested using this reagent and confirmed by Chiron HCV RIBA 3.0 reagents., Results: Among the population aged 1 year to 59 year-olds, the overall prevalence rate of anti-HCV was 0.43% (95%CI: 0.33% - 0.53%), with the rates of anti-HCV among males and females as 0.46% and 0.40%, respectively. The prevalence rate of anti-HCV in urban area was 0.43%, and in rural area it was 0.43%. The prevalence rate of anti-HCV in the Eastern, Middle and Western areas were 0.37% (95%CI: 0.21% - 0.53%), 0.67% (95%CI: 0.40% - 0.94%) and 0.31% (95%CI: 0.20% - 0.42%) respectively. The prevalence rates of anti-HCV for the three areas did not show significant differences, statistically. The prevalence rate of anti-HCV in the South and North areas were 0.29% (95%CI: 0.21% - 0.52%) and 0.53% (95%CI: 0.38% - 0.64%) respectively., Conclusion: Our data revealed that China was in the low prevalence area for hepatitis C infection and the results also suggested that the comprehensive measures for HCV control and prevention had been successfully achieved in the country.

Objective: To set up appropriate parameters and scales of analysis for monitoring infectious diseases using Rogerson spatial pattern surveillance method., Methods: Hepatitis data in Henan provinces from 2006 to 2009 were tested using Rogerson spatial patterns surveillance method., Results: When the parameters were set with n0 = 12, K= 0.5, H = 7.17, r = 25 and analyzed at city level, 26 alarms were triggered. When the parameters were set with n0 = 4, K = 0.5, H = 8.26, r = 15 and analyzed at county level, 115 alarms were triggered., Conclusion: K and a need to be set first, followed by n0 and r with adaptation to the anticipated numbers of alarm. Then, the parameters of ARL0, ARL1, and H can be calculated. For the surveillance of hepatitis A, county level analysis is more reasonable than city level.

Objective: To apply Wavelet Neural Networks (WNN) model to forecast incidence of Syphilis., Methods: Back Propagation Neural Network (BPNN) and WNN were developed based on the monthly incidence of Syphilis in Sichuan province from 2004 to 2008. The accuracy of forecast was compared between the two models., Results: In the training approximation, the mean absolute error (MAE), rooted mean square error (RMSE) and mean absolute percentage error (MAPE) were 0.0719, 0.0862 and 11.52% respectively for WNN, and 0.0892, 0.1183 and 14.87% respectively for BPNN. The three indexes for generalization of models were 0.0497, 0.0513 and 4.60% for WNN, and 0.0816, 0.1119 and 7.25% for BPNN., Conclusion: WNN is a better model for short-term forecasting of Syphilis.

Objective: To compare the performance of aberration detection algorithm for infectious disease outbreaks, based on two different types of baseline data., Methods: Cases and outbreaks of hand-foot-and-mouth disease (HFMD) reported by six provinces of China in 2009 were used as the source of data. Two types of baseline data on algorithms of C1, C2 and C3 were tested, by distinguishing the baseline data of weekdays and weekends. Time to detection (TTD) and false alarm rate (FAR) were adopted as two evaluation indices to compare the performance of 3 algorithms based on these two types of baseline data., Results: A total of 405 460 cases of HFMD were reported by 6 provinces in 2009. On average, each county reported 1.78 cases per day during the weekdays and 1.29 cases per day during weekends, with significant difference (P < 0.01) between them. When using the baseline data without distinguish weekdays and weekends, the optimal thresholds for C1, C2 and C3 was 0.2, 0.4 and 0.6 respectively while the TTD of C1, C2 and C3 was all 1 day and the FARs were 5.33%, 4.88% and 4.50% respectively. On the contrast, when using the baseline data to distinguish the weekdays and weekends, the optimal thresholds for C1, C2 and C3 became 0.4, 0.6 and 1.0 while the TTD of C1, C2 and C3 also appeared equally as 1 day. However, the FARs became 4.81%, 4.75% and 4.16% respectively, which were lower than the baseline data from the first type., Conclusion: The number of HFMD cases reported in weekdays and weekends were significantly different, suggesting that when using the baseline data to distinguish weekdays and weekends, the FAR of C1, C2 and C3 algorithm could effectively reduce so as to improve the accuracy of outbreak detection.

Objective: To understand the effectiveness of China Infectious Disease Automated-alert and Response System (CIDARS) for outbreak detection at the regional level., Methods: Two counties in Hunan province (Yuelu and Shuangfeng county) and two counties in Yunnan province (Xishan and Gejiu county) were chosen as the study areas. Data from CIDARS were analyzed on the following items: reported cases, warning signals, the time interval of signal response feedback, way of signal verification, outcome of signal verification and field investigation, from July 1, 2008 to June 30, 2010., Results: In total, 12 346 cases from 28 kinds of diseases were reported, and 2096 signals of 19 diseases were generated by the system, with an average of 4.94 signals per county per week. The median of time interval on signal verification feedback was 0.70 hours (P(25)-P(75): 0.06 - 1.29 h) and the main way of signal preliminary verification was through the review of surveillance data (account for 63.07%). Among all the signals, 34 of them (1.62%) were considered to be related to suspected events via the preliminary verification at the local level. Big differences were found to have existed on the proportion of signals related to the suspected events of the total signals among the four counties, with Shuangfeng county as 4.71%, Yuelu county as 1.88%, Gejiu county as 0.95% and Xishan county as 0.58%. After an indepth study on the fields of suspected events, 12 outbreaks were finally confirmed, including 5 on rubella, 4 on mumps, 2 on influenza and 1 on typhoid fever., Conclusion: CIDARS could be used to assist the local public health institutions on early detection of possible outbreaks at the early stage. However, the effectiveness was different depending on the regions and diseases.

Objective: To analyze the results of application on China Infectious Diseases Automated-alert and Response System (CIDARS) and for further improving the system., Methods: Amount of signal, proportion of signal responded, time to signal response, manner of signal verification and the outcome of each signal in CIDARS were descriptively analyzed from July 1, 2008 to June 30, 2010., Results: A total of 533 829 signals were generated nationwide on 28 kinds of infectious diseases in the system. 97.13% of the signals had been responded and the median time to response was 1.1 hours. Among them, 2472 signals were generated by the fixed-value detection method which involved 9 kinds of diseases after the preliminary verification, field investigation and laboratory tests. 2202 signals were excluded, and finally 246 cholera cases, 15 plague cases and 9 H5N1 cases as well as 39 outbreaks of cholera were confirmed. 531 357 signals were generated by the other method - the 'moving percentile method' which involved 19 kinds of diseases. The average amount of signal per county per week was 1.65, with 6603 signals (1.24%) preliminarily verified as suspected outbreaks and 1594 outbreaks were finally confirmed by further field investigation. For diseases in CIDARS, the proportion of signals related to suspected outbreaks to all triggered signals showed a positive correlation with the proportion of cases related to outbreaks of all the reported cases (r = 0.963, P < 0.01)., Conclusion: The signals of CIDARS were responded timely, and the signal could act as a clue for potential outbreaks, which helped enhancing the ability on outbreaks detection for local public health departments.

Objective: To analyze the pilot results of both temporal and temporal-spatial models in outbreaks detection in China Infectious Diseases Automated-alert and Response System (CIDARS) to further improve the system., Methods: The amount of signal, sensitivity, false alarm rate and time to detection regarding these two models of CIDARS, were analyzed from December 6, 2009 to December 5, 2010 in 221 pilot counties of 20 provinces., Results: The sensitivity of these two models was equal (both 98.15%). However, when comparing to the temporal model, the temporal-spatial model had a 59.86% reduction on the signals (15 702) while the false alarm rate of the temporal-spatial model (0.73%) was lower than the temporal model (1.79%), and the time to detection of the temporal-spatial model (0 day) was also 1 day shorter than the temporal model., Conclusion: Comparing to the temporal model, the temporal-spatial model of CIDARS seemed to be better performed on outbreak detection.

Objective: To compare the different thresholds of 'moving percentile method' for outbreak detection in the China Infectious Diseases Automated-alert and Response System (CIDARS)., Methods: The thresholds of P(50), P(60), P(70), P(80) and P(90) were respectively adopted as the candidates of early warning thresholds on the moving percentile method. Aberration was detected through the reported cases of 19 notifiable infectious diseases nationwide from July 1, 2008 to June 30, 2010. Number of outbreaks and time to detection were recorded and the amount of signals acted as the indicators for determining the optimal threshold of moving percentile method in CIDARS., Results: The optimal threshold for bacillary and amebic dysentery was P(50). For non-cholera infectious diarrhea, dysentery, typhoid and paratyphoid, and epidemic mumps, it was P(60). As for hepatitis A, influenza and rubella, the threshold was P(70), but for epidemic encephalitis B it was P(80). For the following diseases as scarlet fever, typhoid and paratyphoid, hepatitis E, acute hemorrhagic conjunctivitis, malaria, epidemic hemorrhagic fever, meningococcal meningitis, leptospirosis, dengue fever, epidemic endemic typhus, hepatitis C and measles, it was P(90). When adopting the adjusted optimal threshold for 19 infectious diseases respectively, 64 840 (12.20%) signals had a decrease, comparing to the adoption of the former defaulted threshold (P(50)) during the 2 years. However, it did not reduce the number of outbreaks being detected as well as the time to detection, in the two year period., Conclusion: The optimal thresholds of moving percentile method for different kinds of diseases were different. Adoption of the right optimal threshold for a specific disease could further optimize the performance of outbreak detection for CIDARS.

Objective: To explore an effective method for further improving the surgical results of treatment of olfactory groove meningiomas., Methods: Sixty seven cases of olfactory groove meningiomas were treated by microneurosurgery, among which fifty seven were de novo cases, eight were recurrent tumors and the other two re-recurrent cases. Modified Derome approach was used in 12 cases, bilateral subfrontal approach in 28 cases, modified pterional approach in 21 cases and unilateral subfrontal approach in six cases. Tumors were resected microsurgically with radical removal of invaded dura, bone, and paranasal sinus mucosa. Reconstruction was performed in patients with skull base defect., Results: Simpson grade I removal was accomplished in 59 cases, grade II in seven cases and grade IV in one case. Among 57 patients with de novo tumor, Simpson I resection was accomplished in 54 cases. Postoperative rhinorrhea and intracranial infection occurred in one case and was cured after temporal lumbar CSF drainage and antibiotic therapy. Two patients (2.9%) died within one month after operation, i.e.one aged patient of heart failure and the other of severe hypothalamus complication. Forty seven patients (72.3%) were followed up from one to ten years with an average of five years and four months. With the exception of two cases died, among the alive 45 patients, there were only three patients with tumor recurrence, which had undergone Simpson II or IV tumor resection. No recurrence was found in cases with Simpson I tumor removal. Previous blurred vision was not improved in three patients, hemiparalysis in two patients, and the other patients recovered well, resuming previous jobs or being able to take care themselves., Conclusions: Total tumor removal (Simpson I) should be the surgical goal for treatment of olfactory groove meningiomas, especially for de novo cases. An appropriate approach is fundamental in the effort to remove an OGM totally. Appropriate anterior skull base reconstruction with vascularized material is important and mandatory.

In recent years, for improving the ability of early detection on infectious disease outbreak, many researchers study the disease outbreak detection algorithms, based on many disease surveillance data, expecting to detect the abnormal increasing and cluster of disease and symptom at an early stage by adopting appropriate algorithm. This paper introduces a cumulative sum control chart method, one of statistical process control algorithms widely used in foreign countries and describes its basic principle and characteristic, key points of design, typical examples in application of disease outbreak detection of cumulative sum method, with expect to provide reference for its application in studies of disease outbreak early warning in China.

Objective: To compare the effect of extensive duraplasty and subsequent early cranioplasty on the recovery of neurological function in management of patients with severe traumatic brain injuries received decompressive craniectomy., Methods: The computer-aided designation of titanium armor plate was used as a substitute for the repair of skull defect in all the patients. The patients were divided into three groups. Twenty-three patients were in early cranioplasty group who received extensive duraplasty in craniectomy and subsequent cranioplasty within 3 months after previous operation (Group I). Twenty-one patients whose cranioplasty was performed more than 3 months after the first operation were in the group without duraplasty (Group II); while the other 26 patients in the group with duraplasty in previous craniotomy (Group III). Both the Barthel index of activity of daily living (ADL) 3 months after craniotomy for brain injuries and 1 month after cranioplasty and Karnofsky Performance Score (KPS) at least 6 months after cranioplasty were assessed respectively., Results: The occurrence of adverse events commonly seen in cranioplasty, such as incision healing disturbance, fluid collection below skin flap, infection and onset of postoperative epilepsy was not significantly higher than other 2 groups. The ADL scores at 3 months after craniotomy in Groups I-III were 58.9 ± 26.7, 40.8 ± 20.2 and 49.2 ± 18.6. The ADL scores at 1 month after cranioplasty were 70.2 ± 25.2, 50.8 ± 24.8 and 61.2 ± 21.5. The forward KPS scores were 75.4 ± 19.0, 66.5 ± 24.7 and 57.6 ± 24.7 respectively. The ADL and KPS socres were significantly higher in group I than other 2 groups., Conclusion: The early cranioplasty in those with extensive duraplasty in previous craniotomy is feasible and helpful to improving ADL and long-term quality of life in patients with severe traumatic brain injuries.

Objective: To sequence and analyze the complete genome of two new Japanese encephalitis virus (JEV) strains isolated from mosquitoes collected in Hubei province in 2008, and to understand the molecular biological characteristics of JEV in this area., Methods: RT-PCR was used to amplify the fragments of HBZG08-09 strain and HBZG08-55 strain with 16 pairs overlapping primers after they had been recovered and identified, then the full-length genome was obtained by sequencing and splicing. Biological sequence alignment, nucleotide and amino acid sequence analysis, phylogenetic analysis and analysis of amino acid differences were performed by the software of Clustal X (1.83), MegAlign, Mega (4.0) and Genedoc (3.2)., Results: The genome of two new strains were both 10 965 nucleotides in length with a single open reading frame from 96 to 10 392 coding for a 3432 amino acid poly-protein, the homology of nucleotide and amino acid sequence between two isolates were 98.2% and 99.7% respectively. Further study showed that the new strains were both belonging to genotype I. Two new strains were most closely related to isolates obtained from Henan and Zhejiang province in recent years. Compared with the live attenuated vaccine strain SA-14-14-2 in China, HBZG08-09 strain had 82 amino acid divergence; HBZG08-55 had 84 amino acid divergences. But the amino acid difference occurred in sites were not the key ones affecting the toxicity or antigenic of JEV., Conclusion: Two new JEV isolates were both belonging to genotype I, and the key sites of amino acid were not changed.

Objective: Characteristics and tendency of mosquito and major mosquito-borne diseases (including epidemic encephalitis B and malaria) were analyzed in the Three Gorges Reservoir Area from 1997 to 2008., Methods: Information on surveillance data related to mosquito-borne infectious diseases and on mosquito density and category, from 1997 to 2008 was collected from Health Surveillance System in Three Gorges Reservoir Area. Data regarding meteorological factors and construction of Three Gorges Reservoir was also collected. Pearson and Poisson models were used., Results: From 1997 to 2008, in the Three Gorges Reservoir Area, the incidence rates of epidemic encephalitis B and malaria were decreasing. Positive correlations were shown between indoor and outdoor mosquito density as well with temperature with coefficient as 0.281 and 0.355 respectively. Correlations of mosquito-borne diseases with indoor and outdoor mosquito density were positive, with correlation coefficient as 0.340 and 0.328 respectively., Conclusion: There seemed lack of evidence to prove that negative influences had occurred on the incidence of mosquito-borne infectious diseases or the mosquito density after the Three Gorges Reservoir water storage came into being in 2003, however, long-time surveillance program needs to be carried out to gather information on this issue.

Objective: To understand the health status and potential impact resulted in the second stage of Three Gorges Reservoir Areas sluicing., Methods: Data were collected on deaths, prevalence rates of infectious and endemic diseases, as well as on vector surveillance through the project entitled 'Three Gorges Population Health Survey System'., Results: The main causes of death in the population living in the Three Gorges Reservoir Areas would include: circulatory system diseases, tumors, respiratory system diseases, injuries/poison and digestive system diseases. The number of deaths caused by the above said five kind of diseases accounted for 90.94% of the total number of deaths. The prevalence rates on Water-born diseases related to the sluicing of reservoir and zoonosis-borne diseases related to the changes of vectors were still low. The indoor and outdoor densities of rodents were 3.11% and 3.16%, both were higher than that in 2006 but lower than the average numbers in the five years prior to the sluicing. The constituent ratio of Apodemus agrarius had constantly risen since 2006. The density of mosquitoes found in livestock barns and human households was higher than that in 2006 but lower than the average number of the five-year studies prior to the sluicing., Conclusion: Environment change after the sluicing of the Three Gorges Reservoir Areas did not seem to have obvious impact on the health status of the people living in the areas. However, to strengthen the surveillance on the biological features of the vectors which might have related to the transmission of diseases would be highly recommended.

Objective: To evaluate quality of surveillance and emendate rates of birth and death of population of the Three Gorges area., Methods: Data on the two samples collected were designed based on principle of capture-recapture method. An investigation of missing report of birth and death was conducted in 7061 families selected through stratified random sampling method. We collected and registered the data of birth and death in every family investigated and checked with correlative records reported in disease surveillance system of the Three Gorges area. The missing report rates and the 95% confidence intervals of birth rate and death rate were calculated., Results: The underreporting rates of birth and death were 13.91% and 15.60% and death of infant was 33.33%. The emended birth rate was 8.92 per thousandth and the 95% confidence interval of birth rate was 8.38 per thousandth-9.45 per thousandth. The emended report rate of death was 6.88 per thousandth and the collectivity 95% confidence interval was 6.37%-7.38 per thousandth., Conclusion: Results showed that the quality of birth and death in the disease surveillance reporting system of Three Gorges area was competent to the quality level of the standard set for national disease surveillance system. The birth and death rates of population in the Three Gorges area were under 10.00 per thousandth.

Background: To determine the etiologic agent of an atypical pneumonia human case admitted to Xiangtan City hospital, Hunan Province in Oct. 2005., Methods: The patient's respiratory tract samples and serum were collected. Throat swabs were tested by microneutralization and hemagglutination-inhibition assays., Results: The results of nucleic acid detection of all respiratory samples were negative and virus isolation was also negative. The H5-specific antibodies of convalescence showed a 4-fold greater rise than acute phase., Conclusion: The atypical pneumonias case was confirmed as the first human case of avian influenza A (H5N1) infection in the mainland of China.