Search

OBJECTIVES To develop a predictive model for the oncological outcomes of clear cell renal cell carcinoma in a Chinese population. METHODS A retrospective study of 1108 patients with clear cell renal cell carcinoma who underwent nephrectomy or partial nephrectomy between January 2006 and December 2013 was carried out. Recurrence-free survival was calculated using Kaplan-Meier analysis. Differences between the groups were compared using the log-rank test. Cox proportional hazard regression was used to test associations between features and outcomes. The discriminative ability of the models was validated using Harrell's concordance index and bootstrapping. RESULTS Overall, 942 patients who met the inclusion criteria had been followed. The median follow-up period was 72 months (range 1-143 months). Multivariate analysis showed that age, Eastern Cooperative Oncology Group performance status, preoperative platelet count, neutrophil-to-lymphocyte ratio, tumor size, 2010 tumor stage (pT3 and pT4) and Fuhrman nuclear grade were independent risk factors affecting recurrence-free survival in clear cell renal cell carcinoma patients (P

Objective: To examined whether prehypertension prior to pregnancy increased the risk of hypertensive disorders of pregnancy (HDP) and postpartum metabolic syndrome.Methods:1060 singleton pregnancy ...

ObjectiveTo determine dynamic changes in clinical characteristics by examining an outbreak of adenovirus infection that occurred from December 20, 2012, to February 25, 2013, in Tianjin, China.MethodsActive surveillance for febrile respiratory illnesses was conducted, and medical records of patients were collected. Real-time quantitative polymerase chain reaction and sequencing were used for pathogen identification and viral genome study, respectively. Student’s t-test was used to compare the mean values of normally distributed continuous variables. Mann-Whitney U or Kruskal-Wallis tests were used if continuous variables were not normally distributed. Pearson’s chi-square test or Fisher’s exact test was used to compare categorical variables.ResultsThe outbreak was sourced from the index case diagnosed as the common cold on December 20, 2012; a total of 856 cases were reported in the following 66 days. The pathogen was identified as human adenovirus (HAdV) 55. The symptoms manifested differently in severe and mild cases. Routine blood examinations, liver function indexes, and heart function indexes showed different dynamic patterns over time in hospitalized patients.ConclusionsClinical characteristics and laboratory examinations may reveal unique patterns over the course of HAdV-55 infection. (Disaster Med Public Health Preparedness. 2018;12:464–469)

Background Stroke is the prime cause of morbidity and mortality in the general population, and hypertension will increase the recurrence and mortality of stroke. We report a protocol of a pragmatic randomized controlled trial (RCT) using blood pressure (BP)-lowering acupuncture add-on treatment to treat patients with hypertension and stroke. Methods This is a large-scale, multicenter, subject-, assessor- and analyst-blinded, pragmatic RCT. A total of 480 patients with hypertension and ischemic stroke will be randomly assigned to two groups: an experimental group and a control group. The experimental group will receive “HuoXueSanFeng” acupuncture combined with one antihypertensive medication in addition to routine ischemic stroke treatment. The control group will only receive one antihypertensive medication and basic treatments for ischemic stroke. HuoXueSanFeng acupuncture will be given for six sessions weekly for the first 6 weeks and three times weekly for the next 6 weeks. A 9-month follow-up will, thereafter, be conducted. Antihypertensive medication will be adjusted based on BP levels. The primary outcome will be the recurrence of stroke. The secondary outcomes including 24-h ambulatory BP, the TCM syndrome score, the Short Form 36-item Health Survey (SF-36), the National Institute of Health Stroke Scale (NIHSS), as well as the Barthel Index (BI) scale will be assessed at baseline, 6 weeks and 12 weeks post initiating treatments; cardiac ultrasound, carotid artery ultrasound, transcranial Doppler, and lower extremity ultrasound will be evaluated at baseline and 12 weeks after treatment. The safety of acupuncture will also be assessed. Discussion We aim to determine the clinical effects of controlling BP for secondary prevention of stroke with acupuncture add-on treatment. Trial registration ClinicalTrials.gov, ID: NCT02967484. Registered on 13 February 2017; last updated on 27 June 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2171-5) contains supplementary material, which is available to authorized users.

SPIRIT 2013 Checklist. (DOC 139Â kb)

Sample size calculation process. (DOC 31Â kb)

Summary Objective To quantify the transmissibility of severe acute respiratory syndrome (SARS) in hospitals in mainland China and to assess the effectiveness of control measures. Methods We report key epidemiological details of three major hospital outbreaks of SARS in mainland China, and estimate the evolution of the effective reproduction number in each of the three hospitals during the course of the outbreaks. Results The three successive hospital outbreaks infected 41, 99 and 91 people of whom 37%, 60% and 70% were hospital staff. These cases resulted in 33 deaths, five of which occurred in hospital staff. In a multivariate logistic regression, age and whether or not the case was a healthcare worker (HCW) were found to be significant predictors of mortality. The estimated effective reproduction numbers (95% CI) for the three epidemics peaked at 8 (5, 11), 9 (4, 14) and 12 (7, 17). In all three hospitals the epidemics were rapidly controlled, bringing the reproduction number below one within 25, 10 and 5 days respectively. Conclusions This work shows that in three major hospital epidemics in Beijing and Tianjin substantially higher rates of transmission were initially observed than those seen in the community. In all three cases the hospital epidemics were rapidly brought under control, with the time to successful control becoming shorter in each successive outbreak.

Background. We followed a cohort of 773 individuals who received a monovalent vaccine against 2009 pandemic influenza A (H1N1). Approximately 6 weeks after vaccination, 12 persons developed the disease. Methods. Three groups of subjects were studied (12 patients who had or had not received previous monovalent vaccine and 1 group of 49 control subjects who had previously been immunized with the same vaccine ). For all patients, clinical features were characterized and the causative viruses sequenced for possible mutations. Nasopharyngeal swabs, serum specimens, and peripheral blood monocyte cells (PBMCs) were collected at different time points up to 11 weeks after symptom onset to measure the virus load and humoral and cellular immune responses. Serum samples and PBMCs were also collected from 49 and 16 vaccinated control subjects, respectively. Results. Both patient groups had similar clinical manifestations. No substantial viral mutations were detected. Compared with unvaccinated patients, viral loads in vaccinated patients were initially higher, but the levels decreased faster to undetectable levels. However, the virus became detectable again for 6 of them. Two weeks after infection, vaccinated and unvaccinated patients had similar neutralizing antibody levels as the vaccinated control subjects. Thereafter, the neutralizing antibody levels decreased markedly in vaccinated patients. During the acute phase, memory T cell counts and tumor necrosis factor‐a levels were significantly higher in vaccinated than in unvaccinated patients. Conclusions. Although the clinical consequences of infection are comparable between vaccinated and unvaccinated patients, humoral and cellular immune responses in vaccinated patients are boosted for some weeks, indicating an additional benefit of vaccination against 2009 pandemic influenza A (H1N1) virus. Early 2009, human infections caused by a novel influenza virus, later designated as 2009 pandemic influenza A (H1N1) virus, were identified in Mexico and spread rapidly to other regions of the world [1, 2]. The first imported case was reported in China on 9 May, fol

Summary objectives To describe clinical characteristics of severe acute respiratory syndrome (SARS) patients ina hospital in Tianjin, China, thereby comparing probable and suspected cases; to study risk factorsassociated with the death of cases; to describe the implementation of preventive interventions during thehospital outbreak.methods Physical and haematological information was obtained from clinical records. White bloodcell counts, and percentages of neutrophilic granulocytes and neutrophilic lymphocytes were measured.The service department of the hospital provided information about daily use of protective materials.Differences in clinical symptoms between probable and suspected SARS cases were tested by Fisher’sexact test. Non-linear mixed modelling was used to test for differences between the haematologicalpatterns for probable and suspected cases. Risk factors for dying among probable SARS cases weretested by logistic regression.results TheSARSoutbreakstartedwithapatientfromBeijingon15April2003,andspreadquicklyamongthehealthcareworkersandin-patientsinthehospital.Intotal90probableand21suspectedcaseswerereported,with17deathsamongthem(casefatalityrate15%).Haematologicalpatternsweresignifi-cantlydifferentbetweenprobableandsuspectedcases,whereasthepercentageswithcertainclinicalsymptomsshowednoapparentdifference.DeathofprobableSARScaseswasonlysignificantlyassociatedwithhighageanduseofarespiratorymachine(mainlyforthemostseverecases),wherease.g.co-morbidityandsteroidtreatmentshowednoimpactinmultivariateanalysis.Stringentcontrolmeasures,includingdistributionofhugenumbersofprotectivematerials,startedon20April,whichsoonleadtoastrongdecreaseintheincidenceofnewcases.AfterthelastSARScaseleftthehospitalon6June,protectivematerialsweredispensedatsubstantiallylowerrates,butnottozero,aswasthecaseduringthefirstdaysoftheoutbreak.conclusion The working definition of probable SARS used during the epidemic appeared to havebeen fairly accurate. Many valuable lessons were learned regarding prevention of hospital spread ofinfection, especially the need to have sufficient protective supplies available and to implement theserigidly and at an early stage of an (threatening) epidemic.keywords severe acute respiratory syndrome, hospital outbreak, haematology, protective materials,ChinaIntroductionOn 12 March 2003, the World Health Organization(WHO) issued a global alert on atypical pneumonia, calledsevere acute respiratory syndrome (SARS), after reportsfrom the Department of Health of Hong Kong of anoutbreak of pneumonia in one of its public hospitals(WHO 2003). At about the same time, WHO receivedreports of these cases from China, Singapore, Vietnam,Thailand, Indonesia, Taiwan and Philippines, as well asfrom countries in other continents including Canada, theUnited States and Germany (WHO 2003). After the diseasespread from Guangdong province to Beijing, Shanxiprovince and other places, Tianjin city was also hit by the

Objective: To study roles of Clara cell protein 16 (CC16) and surfactant protein-D (SP-D) as serum biomarkers in the early diagnosis and the pathogenesis of silicosis. Methods: Thirty healthy volunteers, 30 silica-exposed workers, and 30 workers with suspected silicosis and phase I silicosis were included. Serum CC16 and SP-D concentrations were determined using enzyme-linked immunosorbent assay. Results: Serum CC16 concentrations decreased in silica-exposed workers when compared with in controls, but serum SP-D levels increased, and this trend was obvious in phase 0+ and I groups. Discriminant analysis showed that the accuracies of classifying group membership into control, phase 0, phase 0 + , and phase I were 86.7%, 46.7%, 66.7%, and 70%, respectively, and the total classification accuracy rate was 67.5%. Conclusion: Serum CC16 and SP-D may be useful biomarkers for early diagnosis, and serum SP-D concentration may associate with the pathogenesis of silicosis.

Summary Objectives To assess associations between the functional polymorphisms G-2518A at the chemokine (C–C motif) ligand 2 gene (CCL2) and mannose binding lectin (MBL) codon 54 variant (A/B) and susceptibility to SARS. Methods We genotyped the CCL2 G-2518A and MBL codon 54 variant (A/B) in 4 case–control populations of Chinese descent, totally consisting of 932 patients with SARS and 982 control subjects. Results Both the high-CCL2-producing GG genotype and the low-MBL-producing B allele were consistently associated with increased risks of SARS-CoV infection in all 4 case–control populations (joint P = 1.6 × 10−4 and 4.9 × 10−8, for CCL2 and MBL respectively), with no interaction between polymorphisms could be detected. Furthermore, all the 4 case–control studies demonstrated a cumulative effect on risk of SARS-CoV infection for the combination of polymorphisms (joint P = 1.3 × 10−10). However, tests using the area under the curve (AUC) indicated that at this stage, the polymorphisms were unlikely to be appropriate for risk prediction testing because of low AUC values (all, Highlights • This study includes the largest cohort in genetic association studies of SARS. • The GG genotype at CCL2 G-2518A was associated with an increased risk of SARS-CoV infection. • The MBL B allele was associated with an increased risk of SARS-CoV infection. • SNPs of CCL2 and MBL cumulatively increase susceptibility to SARS-CoV infection. • The joint population attributable fraction (PAF) for these two SNPs is 28.5%.

Prophylaxis and treatment with oseltamivir effectively controlled a community outbreak of pandemic influenza A (H1N1) in China. The genetic makeup of strains of different generations seemed to be stable. Travel in confined settings might accelerate the transmission of pandemic influenza in a community outbreak.

Human enterovirus 68 (HEV-68) is an enterovirus associated with respiratory illness. In China, no information about HEV-68 is available for children yet. This study aimed to investigate the presence of HEV-68 in mainland China between 2009 and 2012 and to explore the migration events of HEV-68 across the world. Among 1565 samples tested from children, 41 (2.6 %) were positive for HEV and 223 (14.3 %) for human rhinovirus (HRV). Seven (17.1 %) of 41 HEVs were HEV-68. Two HEV-68- and five HRV-positive samples were detected in 585 adult samples. HEV-68 is the predominant type of enterovirus in children with acute respiratory tract infection (ARTI), followed by HEV-71 and coxsackievirus A6. Three HEV-68-infected children presented with severe pneumonia and one presented with a severe asthma attack. The viruses were attributed to two novel distinct sublineages of HEV-68 based on phylogenetic analysis of partial VP1 gene sequences. Migration events analysis showed that the USA and the Netherlands were possible geographical sources of HEV-68, from where three strains migrated to China. In conclusion, HEV-68 may play a predominant role among the enteroviruses associated with ARTI in children. Additional surveillance is needed to clarify the reason why HEV-68 causes such a wide spectrum of disease, from asymptomatic to severe respiratory disease and even death.

To explore the correlation between the exposure levels and serum protein fingerprints in population exposed to silica.Liquid chip time-of-flight mass spectrometry technology was used to investigate the serum profiles in control group (30 cases), group exposed to silica (30 cases), silicosis group (I stage, 25 cases) and suspected silicosis group (30 cases), and screen the differential expression proteins. The correlation between the levels of the differential expression proteins and the exposure levels was performed.Five differential expression proteins were found among 4 groups, the expression of 5081 and 5066 proteins was upregulated, and the expression of 3954, 2021 and 1777 proteins was downregulated. There was no the correlation between the exposure levels and the peak with M/Z among those proteins.the results of present investigation indicated there was no correlation between the exposure levels and protein/peptide peak.

To observe the effects of complement fragment C3f on expression and secretion of collagen I, III and transforming growth factor( TGF)-beta1 in human embryonic lung fibroblast (MRC-5) cells.MRC-5 cells were cultured with C3f (the synthetic 17 peptides fragments of complement C3). The extracellular and intracellular expression levels of type I, III collagens and TGF-beta1 in MRC-5 cultures were detected by ELISA and immunohistochemistry, respectively.The expression levels of type I, III collagen and TGF-beta1 in the supernatant of MRC-5 cultures decreased significantly with the concentrations of C3f as compared with controls (P0.05). Also the expression level of TGF-beta1 in MRC-5 cytoplasm reduced significantly as compared with controls (P0.05).The results of present in vitro study showed that the complement fragment C3f could reduce the formation of TGF-beta1 and type I, III collagens in MRC-5 cells, and inhibit the lung tissue fibrosis.

To describe the epidemical characteristics of A (H1N1) influenza identified in the early stage (from May 11 to June 22, 2009) of the epidemic, in mainland China.Epidemical characteristics of 420 confirmed A (H1N1) influenza cases reported from May 11 to June 22, 2009 were analyzed descriptively, including the distribution of age, sex, source of infection, main symptoms and incubation period.A total of 77.8% early cases in mainland China were imported from other countries. Three countries including America, Canada and Australia were attributed to 90% of the imported cases. Most of the cases were from 6 months to 73 years old, with 94% of them under 50 years. Most of the symptoms would include fever (81%), cough (40%) and sore throat (35%). The mean incubation period of second-generation cases was 4.3 (4.2 +/- 1.5) days.Imported cases dominated the total cases in the early stage of the epidemic had similar gender distribution of those from exporting countries. Fever, cough and sore throat were the three main symptoms manifested in influenza cases. 2.5 +/- 1.9 (1 - 11) days was found in imported cases between the day of off-board and the onset of symptoms. The incubation period was 4.3 +/- 1.7 (1 - 8) days among the secondary cases.

A literature review and pooled data analysis were carried out to examine the prevalence of antibodies against five influenza virus subtypes in pigs in China over a 10-year period (1999–2009). The average seropositive frequencies of subtypes H1, H3, H5, H7 and H9 were 3478/11,168 (31.1%), 2900/10,139 (28.6%), 77/5945 (1.3%), 0/1440 (0%) and 86/3619 (2.4%), respectively. There was a geographical variation in the seroprevalence of subtype H1, with the highest seroprevalence in pigs in South and East China. BLAST analysis of genetic sequences revealed that genome segments with moderate homology to the 2009 pandemic influenza A (H1N1) virus were present among swine influenza viruses isolated in China, especially in South and East China. It was concluded from both serological and genetic studies that subtypes H1, H3, H5 and H9 are currently co-circulating in pigs in China, with the H1 subtype most commonly detected, followed by H3.

To analyze the differences of lung tissue proteins in rats exposed to silica early by using comparative proteomics method and investigate the related mechanism with the occurrence and development of silicosis.Adult male Wistar rats were randomly divided into control group and silica-treated group. The animal model was established by intratracheal (IT) instillation with silica suspension. On the 14th day after establishment of animal model, rats were sacrificed and lung tissues were collected. The total proteins were separated by means of two-dimensional gel electrophoresis (2-DE) and the differentially expressed proteins were identified by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). In addition, Western blotting was performed to verify the expression of certain candidate protein.Eleven differential expression protein spots were tested by MALDI-TOF-MS, and six proteins were identified. The levels of cathepsin D precursor, peroxiredoxin-1 (Prx-1), heat shock cognate 71 000 protein (HSP7C), heterogeneous nuclear ribonucleoprotein A3 (hnRNPA3) and fatty acid-binding protein (epidermal, E-FABP) were up-regulated in silica-treated group with the optical density (A) values. These values were 116.50+/-12.56, 148.75+/-22.40; 40.00+/-1.63, 66.00+/-13.93; 51.25+/-7.37, 92.75+/-8.69; 83.00+/-6.48, 122.75+/-24.62; 50.75+/-6.50, 93.50+/-23.10 and 100.25+/-19.99, 142.50+/-21.21 respectively. The statistical difference was observed as compared with control group (t=-2.51, -3.71, -7.28, -3.12, -3.56 and -2.90, P0.05). However, SEC14-like protein 3 with the A values 153.00+/-11.28, 109.75+/-18.32 was down-regulated (t=4.02, P0.01). Western blotting showed that in the expression of Prx-1 was higher in silica-treated group (0.61+/-0.05) than that in the control (0.35+/-0.05) (t=-7.24, P0.01) when calculating the semi-quantification of this protein using ratio of optical density.2-DE pattern of lung tissue from rats exposed to silica has been established and six differentially expressed proteins have been identified. Our study is of help for further research of the mechanisms of silicosis.

To study the differential gene expression profiling of rats exposed to silica using the normal rats as control.Animal models were established using intratracheal injection of the lung and 22 107 genes were screened in the differential expression profiling of silicosis by using oligonucleotide bead array. Differential expression profiling data were analyzed by using DAVID bioinformation software.Totally 1567 differentially expressed genes were identified in lungs of silica exposed rats including 765 up-regulated genes and 802 down-regulated genes as compared to the normal controls. Among 406 annotated genes in KEGG pathways, 204 genes and 11 pathways were up-regulated as well as 202 genes and 3 pathways were down-regulated in silica exposed rats.All 1567 genes are involved in the formation of silicosis. The differential gene expression profile of silicosis describes the general changes in the gene expressions in silicosis at transcriptional level. Further analysis of the identified genes might help reveal the molecular mechanism of pulmonary fibrosis induced by silica.

To seek differentially expressed serum proteins in recovered SARS patients complicating avascular necrosis of femoral head (AVNFH).2-DE and MALDI-TOF MS were used to study the comparative serum proteomics among female SARS AVNFH group, female SARS non-AVNFH group and female healthy group. ELISA method was used to detect serum amyloid P component in individual serum; specificity and sensitivity of serum amyloid P component were analyzed.Average protein points on 2-DE of 3 groups were 632 +/- 28, 671 +/- 55, 688 +/- 42 respectively, and the matching rate of protein points was ranged from 85% to 95%; eighteen differentially expressed proteins were discovered including transthyretin, serpin peptidase inhibitor, alpha-1-antitrypsin precursor, serum amyloid P components, etc. Compared to healthy group and SARS non-AVNFH group, transthyretin, C4B3, fibrinogen gamma, apolipoprotein L, apolipoprotein A-IV precursor, albumin and prealbumin showed lower expression, inversely serpin peptidase inhibitor, alpha-1-antitrypsin precursor and serum amyloid P components showed higher expression in serum in the SARS AVNFH necrosis group. The serum amyloid P component in 3 groups were 0.54 +/- 0.30 ng/ml, 0.83 +/- 0.39 ng/ml, 1.21 +/- 0.29 ng/ml respectively. The areas under the ROC curve on serum amyloid P component was 0.854, the specificity was 77.8% and the sensitivity was 85.2%.There were differentially expressed serum proteins in three groups. Serum amyloid P components might be one of the potential biomarkers in serum of recovered SARS patients complicating avascular necrosis of femoral head.

BACKGROUND: Cytokines play important roles in antiviral action. We examined whether polymorphisms of interleukin (IL)-12 receptor B1 (IL-12RB1) affect the susceptibility to and outcome of severe acute respiratory syndrome (SARS). METHODS: A case-control study was carried out in Chinese SARS patients and healthy controls. The genotypes of 4SNPs on IL-12 RB1 gene, +705A/G,+1158T/C, +1196G/C and +1664 C/T, were determined by PCR-RFLP. Haplotypes were estimated from the genotype data using the expectation-maximisation algorithm. RESULTS: Comparison between patients and close contacts showed that individuals with the +1664 C/T (CT and TT) genotype had a 2.09-fold (95% confidence interval [CI], 1.90-7.16) and 2.34-fold (95% CI, 1.79-13.37) increased risk of developing SARS, respectively. For any of the other three polymorphisms, however, no significant difference can be detected in allele or genotype frequencies between patients and controls. Additionally, estimation of the frequencies of multiple-locus haplotypes revealed potential risk haplotypes (GCCT) for SARS infection. CONCLUSIONS: Our data indicate that genetic variants of IL12RB1confer genetic susceptibility to SARS infection, but not necessary associated with the progression of the disease in Chinese population.

Objective: To screen for serum biomarkers of silicosis and to study their roles using surface-enhanced laser desorption ionization time-of-fly mass spectrometry (SELDI-TOF-MS) techniques. Methods: The serum protein/ peptide profile on the CM10 proteinchip was acquired using SELDI-TOF-MS from workers classified by the Chinese national diagnostic standard for pneumoconiosis. Discriminant analysis was performed to establish a decision tree using protein/peptide peaks. Results: Protein/ peptide peaks changed much more in silica-exposed populations than they did in the control. Discriminant analysis using Wilks' lambda method could give high sensitivity and specificity in distinguishing the silica-exposed population from the control; the decision tree could give 100% sensitivity and 95 % specificity in distinguishing the silicosis phase among the control group. Conclusions: Special proteins/peptides may change in silica-exposed workers and these changes may be used to distinguish silica-exposed populations from the control with the proper discriminant analytical method.

To establish 2-dimensional gel electrophoresis (2-DE) images and seek differentially expressed serum proteins for understanding the pathogenesis of silicosis.2-DE and matrix-assisted laser desorption/ionization time of flight tandem mass spectrometry (MALDI-TOF-MS/MS) were used to screen differentially expressed serum proteins among silica-exposed population, suspect of silicosis (0+), phase one (I) group with silicosis and control group(non silica exposure).Complement C4, leucine-rich alpha-2-glycoprotein and alpha-1-antitrypsin were significantly highly expressed in suspect of silicosis (0+) group(P0.01), but lowly in other groups. Inversely, serotransferrin was significantly down-regulated only in suspect of silicosis (0+) group(P0.01). Plasma glutathione peroxidase, tetranectin, apolipoprotein A-I and transthyretin were equally expressed in the serum of control group and silica-exposed population group, but decreased in the suspect of silicosis (0+) and phase (I) group.Complement C4, leucine-rich alpha-2-glycoprotein, alpha-1-antitrypsin, serotransferrin, plasma glutathione peroxidase, tetranectin, apolipoprotein A-I and transthyretin are differentially expressed in the silica-exposed group and phase (I) group with silicosis, and the result should be validated by other biochemical technologies.

To explore changes of Clara cell protein (CC16) and surfactant protein-D (SP-D) in the serum of patients with silicosis.The concentrations of CC16 and SP-D were measured in the serum by sandwich enzyme-linked immunosorbent assays. The subjects consisted of 30 healthy volunteers and 90 silica-exposed workers including silica-exposed group, the silicosis of suspects group (0(+)) and the silicosis phase I group, 30 subjects each groups.The concentrations of CC16 in the serum was significantly decreased in silica-exposed workers compared to controls (P0.01); The concentrations of CC16 in the serum were higher in lifelong nonsmokers than the current smokers in control subjects (P0.05), but they were no differences between lifelong nonsmokers and current smokers of 90 silica-exposed workers. Compared with control subjects, the levels of SP-D in the serum of silicosis suspects (0(+)) and silicosis phase I groups were significantly elevated (P0.01, respectively), which were also higher than silica-exposed group (P0.05 and P0.01, respectively), Discriminant equations set by CC16 and SP-D were used in diagnosis of silicosis, and the rate of accuracy in healthy volunteers, the silica-exposed group and the silicosis phase I group were 86.7%, 86.7% and 76.7%, respectively, The total rate of correct classification hit 84.2%.The serum CC16 of long-term silica-exposed workers is decreased, and SP-D is increased gradually.

To study the factors in relation to severe acute respiratory syndromes (SARS) among health care workers and to develop related protective measures.Case-control study was applied. A standardized questionnaire was used to collect SARS related information for health care workers who had contacted or treated SARS patients. Univariate analysis was conducted using SPSS 10.0 software package and multivariate logistic regression analysis was conducted using SAS 6.12.Twenty-seven of the 49 factors under study were significantly associated with SARS infection, in which 22 factors were protective, and the other 5 were risk factors. 27 factors were included for multivariate logistic regression analysis. Results showed that six factors as wearing eye glasses, wearing protection gowns, exposure to secrets/mode of contact with SARS patients, types of mask and the working years atc, remained significant association with hospital infection of SARS.SARS infection in heath care workers was related to many factors during the process of diagnoses and/or treatment. It is recommended that adequate masks, eye-protection and protective gowns should be adopted for heath care workers during the process of clinical diagnoses and treatment of SARS patients.

To study the correlation between positive rates of RNA in clinical confirmed severe acute respiratory syndrome (SARS) patients and its appearance in relation to the development of the disease in order to provide scientific basis for early diagnosis, effective prevention and treatment of the disease.One-step reverse transcription-polymerase chain reaction (RT-PCR) was used to amplify the SARS RNA in the clinical specimens from different courses of the disease. The representative amplicons were then sequenced. Chi-square for trend test was performed to study the correlation between positive rates of RT-PCR and at different periods after the onset of the disease.The fragments amplified from the sputum specimens of SARS patients were shown to share 100% homology with the published SARS-associated coronavirus. Of the different clinical specimens, positive rate in the stools appeared to be the highest (21.55%). Chi-square for trend test revealed that the positive rates of stools and sputa of SARS patients decreased with the development of the disease (chi(2) for trend = 12.55 and 16.408, P = 0.0004 and P = 0.000 05 respectively).One-step RT-PCR proved to be an effective method for the detection of SARS-associated coronavirus from clinical specimens. Data as indicated that the positive rates of SARS coronavirus were decreasing in SARS patients along with the disease progression.

To the editor: Influenza is a complex and continually changing disease that infects individuals of all ages. 1 In April 2009, the 2009 pandemic influenza A (pH1N1) virus was identified in the United States in California and in Mexico, which was followed by a worldwide spread of the infection. 2 The first imported case in China was reported on 10 May 2009, followed by the wide spread of pH1N1 virus in the country, leading to an unexpected earlier influenza season in the northern China, which usually takes place on the beginning of November. In a 2‐year influenza‐like illness (ILI) surveillance from 1 April (week 14) 2009 to 31 March (week 13) 2011, we performed surveillance at eight hospitals in five cities of China (the Hospital 301 in Beijing, the Children’s Hospital of Chongqing Medical University in Chongqing, four sentinel hospitals of Chinese People’s Armed Police Forces(CPAPF) CDC including the General Hospital of CPAPF, the General Hospital of Henan People’s Armed Police Corps, the General Hospital of Shanxi People’s Armed Police Corps, the affiliated hospital of Logistic University of CPAFP and two hospitals of Jinan CDC including the Fourth People’s Hospital of Jinan City and the Sixth People’s Hospital of Jinan City) (Appendix S1). All the hospitals were members of the Chinese national influenza sentinel hospitals, and the inclusion of ILI cases was performed according to the standard criteria defined by China CDC. 3 Altogether 6143 ILI cases (person‐time) with monthly average of 255 cases were included. An estimated 26.78% (1645/6143) cases were detected positive for influenza, in which seasonal H3N2 (sH3N2), pH1N1, and influenza B accounted for (41.76%, 687/1645), (31.98%, 526/1645), and (21.15%, 348/1645) of the total ILI cases, followed by untyped influenza (3.22%, 53/1645) and sH1N1 (1.88%, 31/1645), respectively. Temporally, the influenza were predominantly detected from August to March next year during the 2009–2010 influenza season, while from November to January next year in the 2010–2011 season (Figure 1). Geographically, the detection rates of influenza virus as a whole and the predominant influenza subtypes were similar among observed areas. Influenza attacks the population of all ages; however, the highest age‐specific attack rates of pH1N1 observed in 10–14 years (16.04%,47/293), sH3N2 in 30–39 years (14.93%, 63/422), sH1N1 in more than 70 years (2.63%, 2/76), and B in 5–9 years (12.30%, 61/496). Different epidemic patterns were observed for the 2009–2010 and the 2010–2011 influenza season. In the 2009–2010 influenza season, the peaking monthly detection rate was 52.84% (251/475), significantly higher than that of the 2010–2011 season (24.12%, 123/510). According to influenza subtyping analysis, the predominant (sub)types were sequenced as sH1N1, sH3N2, pH1N1, and influenza B in 2009–2010 influenza season, which was switched to sH3N2, pH1N1, and influenza B in the 2010–2011 season. Another interesting finding is that the epidemic of sH3N2 was kept at stable level during the 2‐year surveillance, while the epidemic of pH1N1 and sH1N1 decreased remarkably in the 2010–2011 season, compared with that in the 2009–2010 season. Although published data showed that exposure to pH1N1 had no impact on typical influenza seasonal peaks according to surveillance, 4 the data in this paper implied that typical epidemiology of influenza may be altered because of the introduction of pH1N1 in China. 3 In summary, the predominant (sub)types of influenza were seasonal H3N2, pH1N1, and influenza B during April 2009 to March 2011. As a novel introduced virus, the pH1N1 influenza in 2009 may affect the epidemic of seasonal influenza, in which the intensity and the duration of influenza epidemic, as well as each influenza (sub)types could all be influenced. Figure 1 ILI and Influenza cases in eight hospitals in China. April 2009–March 2011.