[Objective]To explore a new type of internal fixation system for the fixation of femoral intertrochanteric fracture.[Method]According to femoral tuberosity anatomical shape,anatomical locked hook-plate internal fixation system(ALHP) was designed,its biomechanical properties was examined and ALHP was applied for the clinical treatment of intertrochanteric fracture of the aged patients.[Result]Twenty-seven cases of intertrochanteric fracture were fixed with ALHP and followed up from 1.5 to 2 years,with an average time was 1.8 years.According to Sanders functional sores:the good and excellent rate was 100%.[Conclusion]Anatomy type locked hook-plate internal fixation system possesses reasonable design and produces firm fixation for intertrochanteric fracture.It can offer the elderly patients early exercises and reduce the incidence of complication.

Objective To explore the effect of apolipoprotein E (ApoE) gene polymorphism on brain volume in healthy young adults.Methods One hundred and ninety-three healthy young volunteers (age:20-40 years) were recruited in Shengjing Hospital of China Medical University between August 2013 and May 2014.Two milliliters of peripheral blood were collected for the determination of ApoE genotype using direct sequencing of polymerase chain reaction (PCR) products.Brain MRI scans were performed using three-dimensional T1-weighted turbo field echo imaging sequence.The diffcrences of brain morphometry between the ε4 carriers group (ε3/ε4 and ε4/ε4 genotype) and the ε4 non-carriers group (ε3/ε3 genotype) were analyzed using voxel based morphometry (VBM).Results The ε4 carriers accounted for 14.51％ (28/193) of the total population.Twenty of ε4 carriers and 45 of ε4 non-carriers were included in the final images analysis.VBM analysis showed that the ApoE ε4 carriers had 10 atrophic brain areas compared with the ε4 non-carriers (P ＜ 0.005,uncorrected,10 continuous voxels),which mainly located in the right anterior cingulate,the bilateral caudates,parietal lobes and lateral temporal lobes.Conclusions The influence of ApoE gene polymorphisms on brain volume has appeared in the youth.The ε4 gene is related to the reductions of the gray matter volume in multiple brain areas.

Objective To review the basic clinical characteristics and the pathogens and their antimicrobial susceptibilities to neonatal sepsis in very low birth weight infants (VLBWI) and extremely low birth weight infants ( ELBWI) for selection of appropriate antibiotics. Methods A retrospective chart review of 56 cases with neonatal sepsis(early onset neonatal sepsis 3 cases, late onset 53 cases) in VLBWI and ELBWI admitted to the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 1, 1999 to December 31, 2008 was conducted. The basic clinical characteristics and the results of blood culture and antimicrobial susceptibilities were analyzed. Results Among the 56 cases, the clinical presentations were non-specific. A total of 43 strains of bacteria were isolated, and the most important pathogens responsible for neonatal sepsis in VLBWI and ELBWI were opportunistic pathogenic bacteria. In early onset neonatal sepsis, there was only one culture-proven sepsis that was Chryseobacterium meningosepticum. In the late onset neonatal sepsis cases, the main pathogens of Gram-negative organisms were Klebsiella pneumoniae (33. 3%, 14/42), and the most common Gram-positive organisms were coagulase-negative Staphylococci (26. 2%, 11/42), followed by Enterococcus species (11. 9%,5/42). Furthermore, there were 2 fungal sepsis(4. 8%, 2/42), which were infected by Candida albicans. All of the coagulase-negative Staphylococci were methicillin-resistant coagulase-negative Staphylococci, and they were resistant to common antibiotics and sensitive to vancotnycin and rifampicin. And all of the Klebsiella pneumoniae produced extended-spectrum (Hactamases, which were sensitive only to a few antibiotics such as carbopenems, aminoglycosides and quinolones. Among those 56 cases, 43 patients were cured, 13 died, including six patients who refused any treatments, the mortality rate of neonatal sepsis in VLBWI and ELBWI was 23. 2%. Conclusions The clinical presentations of neonatal sepsis in VLBWI and ELBWI were non-specific, and the most important pathogens were opportunistic pathogenic bacteria, which were multi-drug resistant. Routine blood culture should be taken from infants who are suspected of neonatal sepsis and empirical use of appropriate antibiotics should be initiated as soon as the blood specimen for culture has been drawn. To reduce the occurrence of multi-drug resistant bacteria, we should restrict the use of antibiotics especially the third generation of cephalosporins in neonates as much as possible.

A total of 3499 cases of influenza A (H1N1) were included in this study for analysis.Epidemiological and clinical data of these cases were input into EpiData software and analyzed by SPSS software. Throat swabs were collected from the cases and detected for nucleic acid of influenza A ( H1N1 )virus using real-time polymerase chain reaction (RT-PCR) with fluorescence quantitative method, and time of viral excretion and clinical features of the cases were analyzed. Results showed that 0. 37% of the cases were in-apparent and asymptomatic and the most common symptom of the cases was fever (86. 77% ).Throat swabs converted to negative on the sixth day of onset in average, and no factors related to the time of conversion was found with logistic regression analysis.

Objective To describe the epidemiological features of severe cases and deaths of pandemic influenza A (H1N1) 2009 in Beijing and to explore the main risk factors associated with the disease severity. Methods Data of pandemic influenza A (H1N1) 2009 reported in Beijing were collected and analyzed. The relative risks between disease condition and possible risk factors were determined using the multi-factor Logistic regression analysis. Results The incidence of pandemic influenza A(H1N1) 2009 was 66. 1/100 000, and the highest incidence was 86. 8/100 000 which occurred among people aged 25-60 years old. The prevalence of critical patients (12. 5/100 000 and 3.9/100 000, respectively), mortality (0. 9/100 000 and 0. 7/100 000, respectively) and fatality (2.4 % and 3.3 %, respectively) in people aged 0-5 years old and above 60 years old were higher than other age groups. There were 110 (20. 0%) preschool children among 549 critical cases, which were the largest proportion of critical cases. Among 69 death cases, 17 (24. 6%) were retirees with the highest proportion of death cases. More than 70. 0% of the critical cases and deaths visited hospital within two days of onset. The chronic heart disease and chronic lung disease were the most frequent risk factors of severe and death cases. Multi-factor Logistic regression analysis showed that the variables including aged above 60 years old (OR = 3. 586, 95 % CI = 1. 586 - 8. 117), chronic heart disease (OR=2. 126, 95%CI= 1. 178-3. 835), and chronic lung disease (OR=1. 954, 95%CI=1. 126-3. 391) were significantly associated with the disease severity. Conclusion Factors of aged above 60 years older, chronic heart disease and chronic lung disease may aggravate the severity of influenza A (H1N1).

Objective: To analyze the influencing factors of acute gastroenteritis outbreaks caused by norovirus in Beijing from 2014 to 2018. Methods: Data of acute gastroenteritis events caused by norovirus in Beijing from April 2014 to March 2018 were collected. Unconditional logistic regression model was conducted to identify the risk factors of the outbreaks. Results: A total of 765 acute gastroenteritis epidemics caused by norovirus were reported in Beijing, in which 85.88% (657/765) were cluster events and 14.12% (108/765) were outbreaks. Among the outbreaks, 70.37% (76/108) were reported in 2017; 84.26% (91/108) were reported in winter and spring; 88.89% (96/108) were reported in kindergartens, primary or secondary schools; 81.48% (88/108) were through person-to-person transmission; 93.52% (101/108) were caused by norovirus GⅡ infection. The risk of outbreaks in suburban and out suburb area were 1.84 times (95%CI: 1.13-3.02) and 3.78 times (95%CI: 1.62-8.82) as high as that in urban area, respectively. The risks of outbreaks in primary, secondary schools and other institutions were 6.26 times (95%CI: 3.53-11.10), 14.98 times (95%CI: 6.23-36.01) and 8.71 times (95%CI: 3.07-24.71) as high as that in kindergartens, respectively. The risk of outbreak in which patients having lower hospital visiting rate than the median rate of all events was 2.29 times than that in the context of having higher hospital visiting rate (95%CI:1.42-3.68). The risk of foodborne outbreak was 14.55 times as high as that transmitted through person-to-person (95%CI: 3.15-67.07). Conclusion Measures such as strengthening the prevention and control of norovirus outbreaks in suburbs, primary schools, secondary schools and other institutions, promoting patients to visit the hospital actively, improving the management of foodborne events and kitchen workers should be taken to reduce the incidence of acute gastroenteritis outbreaks caused by norovirus.

Objective:To provide evidence for clinical diagnosis, prevention and control of group A rotavirus (RVA) diarrhea, the clinical characteristics of RVA diarrhea in children in Beijing from 2011 to 2018 were analyzed.Methods:From January 2011 to December 2018, 4 819 stool samples from children under 5 years old with diarrhea were collected monthly from 3 hospitals in Beijing. General information, clinical characteristics and other information of children were collected. RVA was detected by enzyme-linked immunosorbent assay (ELISA), genotype was identified by multiple semi-nested RT-PCR. The Vesikari clinical severity score was used to define the severity of diarrhea in children. Dichotomous unconditional logistic regression was used to analyze clinical symptoms and other differences between RVA positive and negative cases. Chi-square and Fisher direct probability tests were used to compare the composition among different groups.Results:A total of 4 819 fecal samples were collected, 953 were positive for RVA, the positive detection rate was 19.78%. The positive rate of RVA was high in the younger age group, and the incidence was high in winter and spring. RVA-positive children had more risk on diarrhea ≥5 times a day, vomiting symptoms, fever, mild dehydration, and Vesikari score ≥11. The positive rate of RVA in watery stool samples (26.13%, 214/819) and infectious diarrhea cases (42.20%, 265/628) was the highest respectively. There were no significant differences in clinical symptoms, clinical diagnoses and fecal traits among children with different RVA genotypes.Conclusions:The clinical symptoms of RVA diarrhea were severe in children. RVA genotype did not affect the clinical symptoms. Stool traits (watery stools) and Vesikari score can assist physicians in diagnosing RVA diarrhea.

Objective: To analyze the infection characteristics of patients in acute gastroenteritis outbreaks caused by noroviruses. Methods: Between April 2014 and March 2016, the clinical data and samples were collected from the patients in acute gastroenteritis outbreaks caused by noroviruses in Beijing. Noroviruses were detected and genotyped using real time RT-PCR, and the infection characteristics of norovirus gastroenteritis were analyzed using the descriptive epidemiological method. Results: A total of 1743 clinical diagnosed cases of norovirus gastroenteritis were collected, and children under 12 years old accounted for 77.68% (1354/1743). The detection rate of noroviruses was 73.98% (509/688). The detection rates of noroviruses in fecal, swab and vomitus samples were gradually decreased (χ²=67.798, P<0.001). Among these clinical diagnosed cases, vomiting was the most common symptom (93.98%), followed by abdominal pain (40.34%), diarrhea (30.35%) and fever (27.94%). The most common symptom of patients under 6 years old was vomiting(98.14%), whereas diarrhea was most common among over 18 years old patients (68.12%). With the increase of age of the patients, the incidence of vomiting was gradually decreased (χ²=100.913, P<0.001), whereas the incidence of diarrhea was gradually increased (χ²=261.164, P<0.001). There was no statistical difference in vomiting, diarrhea and abdominal pain symptoms between patients infected with genogroup Ⅰ and Ⅱ noroviruses, and patients infected with genogroup Ⅱ (34.49%, 149/432) had the higher incidence rate of fever than that of genogroup Ⅰ (18.18%, 14/77) (χ²=7.985, P<0.01). Conclusions Noroviruses mainly infected children under 12 years old in acute gastroentertis outbreaks. The most common symptom of patients with acute gastroenteritis caused by noroviruses was vomiting, and the incidences of vomiting and diarrhea were significantly correlated with age of the patients. Patients infected with genogroup Ⅱ had the higher incidence rate of fever than genogroup Ⅰ infection.

Objective:To understand the gene characteristics of Sapovirus from diarrhea cases in diarrhoeal disease clinics in Beijing.Methods:In 2019, stool samples were collected from diarrhea cases in diarrhoeal disease clinics in Beijing. The samples were used for the detection of nucleic acid of Sapovirus with real-time RT-PCR. Different RT-PCR methods were used for the partial gene segment amplification in the capsid protein VP1 region and the polymerase RdRp region, and sequencing was conducted for amplified positive products. The sequences were aligned with software BioEdit 7.0.9.0 and analyzed with software Mega 6.06.Results:The overall detection rate of Sapovirus was 2.89% (44/1 522), the detection rate in children under 5 years old was 3.34% (18/539) and 2.64% (26/983) in children aged ≥5 years. The capsid protein VP1 region was sequenced in 23 strains belonging to 8 genotypes (GⅠ.2 had 6 strains, GⅠ.1 and GⅡ.3 had 5 strains, respectively, GⅠ.3 and GⅡ.5 had 2 strains, respectively, GⅠ.5, GⅡ.1 and GⅣ.1 had 1 strain, respectively). A total of 16 strains were detected in the cases aged ≥5 years, and the proportion of GⅠ.2 was highest (37.50%, 6/16), and 7 strains were detected in the cases under 5 years old, the proportions of GⅠ.1 and GⅡ.3 were highest (both 42.86%, 3/7); The internal similarity of each genotype was 95.5%-100.0%, and the similarity with the 51 reference strains of human or sewage sources in different years and different countries was 92.2%-100.0%. The polymerase RdRp region was sequenced in 25 strains belonging to 8 genotypes (GⅡ.P3 had 9 strains, GⅠ.P3 had 4 strains, GⅠ.P1, GⅠ.P2 and GⅡ.P1 had 3 strains, respectively, GⅠ.P5, GⅡ.P5 and GⅣ.P1 had 1 strain, respectively). Fifteen strains were detected in the cases aged ≥5 years, and GⅡ.P3 had the highest proportion (40.00%, 6/15). Ten strains were detected in the cases under 5 years old, and the proportions of GⅠ. P1, GⅡ.P1 and GⅡ.P3 were highest (all 30.00%, 3/10); The internal similarity of each genotype was 94.0%-100.0%, and the similarity with the 39 reference strains of human or sewage sources in different years and different countries was 90.2%-99.1%.Conclusions:Sapovirus is one of the pathogens among diarrhea cases in Beijing. The main genome is GⅠ and GⅡ, and the genotypes are diverse and dispersed. The main genotypes of diarrhea cases in people aged ≥5 years and less than 5 years are different.

Objective:To understand the epidemiological characteristics and clinical features of rotavirus-, norovirus-, adenovirus-and astrovirus-associ ated acute gastroenteritis in children under 5 years old in Beijing from Octorber, 2015 to March, 2017.Methods:In the intestinal clinic of 6 hospitals in 6 districts of Beijing, information and stool samples of the first 30 patients with acute gastroenteritis who are under the age of 5 years are collected monthly.Rotavirus, norovirus, adenovirus and astrovirus are identified by PCR.Descriptive epidemiological method was used to describe the epidemiological characteristics of diarrhea caused by rotavirus, norovirus, adenovirus and astrovirus in Beijing. One-way analysis of variance was used to analyze the Vesikari clinical severity score of of acute gastroenteritis caused by each virus. Unconditional logistic regression analysis was used to analysis the associated factors of clinical features.Results:Of the 2 052 samples, 709 (34.6%) were non-mixed infections: the positive rate of rotavirus, norovirus, adenovirus and astrovirus were 20.0%, 7.5%, 4.2% and 2.9%, respectively. A total of 135 cases (6.6%) were mixed infection. The mean and standard deviation of Vesikari clinical severity score was 8.0±3.1 for rotavirus associated acute gastroenteritis, which was significantly higher than norovirus (6.4±2.4, P<0.001), adenovirus (6.2±2.1, P<0.001) and astrovirus (6.1±2.0, P<0.001). The comparison of clinical features showed that compared with astrovirus, the children under 5 years old infected with rotavirus were more likely to have a diarrhea ≥5 days ( OR=3.334), have vomiting ≥3 times within one day ( OR=8.788), have vomiting≥1 day ( OR=3.963), have a Vesikari clinical severity score ≥11 severe cases ( OR=13.194). Norovirus infected cases were prone to have vomiting≥3 times in 1 day ( OR=5.710).Adenovirus infected cases were prone to have a diarrhea≥5 days ( OR=2.616). When using rotavirus as a reference, children under 5 years of age were less likely to develop fever≥38.4 ℃ after infection with norovirus ( OR=0.397) or adenovirus ( OR=0.280). Conclusions:The results of this study showed that the characteristics of acute gastroenteritis caused by different viruses are different. The clinical symptoms caused by rotavirus are more serious. Children under 24 months of age are at high risk of rotavirus infection. Effective preventive measures such as vaccination should be taken as soon as possible.