It must be emphasized in the maternal serum prenatal screening that the quality is not only influenced by accuracy of biomarker assay,risk calculation parameters and biomarker database,but also influenced by clinical factors such as gestational weeks,weight and ect.The result of prenatal screening is just a risk evaluation,the subsequent diagnosis and the follow-up are more important.It is expected to improve screening efficiency by localization of prenatal screening database and making the quality management of the prenatal screening-diagnosis suitable for the national conditions.On the other hand,prenatal screening in the women of advanced maternal age and twin pregnancy,improve amniotic fluid cell culture method,chromosome analysis automation,the introduction and positioning of rapid prenatal molecular diagnosis techniques become the hot issues.

Objective To analyze the features of quality management of maternal serum prenatal screening for Down syndrome in the second trimester and investigate the methods to establish and improve quality control system.Methods Prenatal screening and clinical data were collected for statistical analysis from 17 prenatal screening centers in Zhejiang Province from 2011 to 2012.The impacts of maternal age , weight, gestational age , specimen collection , the median values of serum markers selection and different analysis software on prenatal screening results for Down syndrome were analyzed respectively .Results Totally 417 347 and 463 846 prenatal screening cases were collected in 2011 and 2012 respectively.The maternal age of the entire province presented as a Gaussian distribution.The age distributions of different screening institutions were inconsistent , while maternal weight distributions were similar.The approach to determine gestational age was significantly different among screening institutions.Median MoM of the samples from the blood collection points was different from those of the main screening center.Median MoM-freeβ-hCG was positive bias , particularly the specimens from the blood collection points.After strengthening the control of temperature and time during samples transportation , Median MoM-free β-hCG of specimens from blood collection points became nearly equal to those of main screening center .Use of local median made the median MoM value closer to 1.0 in the centers with positive or negtive bias of the markers , which had little effect in detection rate and decreased the false positive rate and screening positive rate.Six more positive cases were detected by the Lifecycle software instead of 2T software in 213 followed-up positive cases, which means the Lifecycle software can improve the detection rate.Conclusions The impact of maternal age, weight, gestational age, specimen collection and other factors on screening performance should be taken into consideration when it evaluates the screening quality of different laboratory .The use of local medians is necessary in prenatal screening.Optimization of screening analysis software can reduce false negative rate.

ObjectiveTo determine the drug resistance， main virulence genes and molecular typing of Vibrio parahaemolyticus from multiple sources in Fengxian District， Shanghai. MethodsA total of 210 strains of Vibrio parahaemolyticus were isolated in Fengxian District， Shanghai， from 2018 to 2020. Then drug susceptibility tests of 17 antibiotics， virulence gene detection of thermolabilehemolysin （tlh）， thermostable direct hemolysin （tdh） and thermostable direct hemolysin-relatedhemolysin （trh）， and pulsed-field gel electrophoresis （PFGE） were conducted. ResultsA total of 147 drug-resistant strains were detected， with the drug resistance of 70.00%. Among them， 126 strains were resistant to single antibiotic， mainly resistant to CFZ； 15 strains were resistant to two antibiotics， mainly resistant to CFZ and AMP； and 6 strains of MDR， mainly resistant to AMP， SXT， CFZ， CTX， CAZ and FEP. The AMP resistance of food-borne strains was higher than that of human-derived strains （P<0.05）. All 210 strains of Vibrio parahaemolyticus carried the virulence gene tlh. Furthermore， 84 human-derived strains carried tdh （89.29%） and trh （7.14%）. In contrast， 126 food-borne strains carried trh （1.59%）， while did not carry tdh. In additionally， 173 band patterns were determined by PFGE， sharing the similarity of 48.80%‒100.00%， among which major clones were prevalent. ConclusionVibrio parahaemolyticus in Fengxian District has multi-drug resistance， especially the resistance to β-lactam antibiotics. The prevalence of virulence gene remains high in human-derived strains. Furthermore， major clones are prevalent in human-derived strains， though the PFGE banding patterns are generally diverse. Due to high risk of food-borne diseases， this study warrants strengthening the prevention and control against Vibrio parahaemolyticus.

ObjectiveWe conducted a drug resistance and homology analysis of diarrheagenic Escherichia coli （DEC） in Fengxian District of Shanghai in order to provide a basis for clinical rational drug use， risk monitoring and early warning. MethodsDEC were isolated from diarrheal patients in Fengxian District， Shanghai from 2019 to 2022. The minimum inhibitory concentrations （MIC） of 21 drugs to the DEC were determined. Genotyping and homology analysis were conducted with pulsed-field gel electrophoresis （PFGE）. ResultsThe DEC detection rate of diarrhea cases was 18.99% （131/690）， including enteroaggregative E.coli （EAEC） 64.89% （85/131）， enterotoxigenic E.coli （ETEC） 22.14% （29/131）， enteropathogenic E.coli （EPEC） 12.21% （16/131）， and enterohemorrhagic E.coli （EHEC） 0.76%（1/131）. The DEC detection showed obvious seasonal characteristics with a high incidence in summer. The DEC multidrug resistance rate was 66.41% with a total of 65 drug resistance profiles. The five antimicrobial drugs with the highest resistance rate were ampicillin （60.31%）， nalidixic acid （51.91%）， cefazolin （50.38%）， tetracycline （44.27%）， and cotrimoxazole （35.11%）. The rate of DEC resistance to levofloxacin was significantly increased from 2019 to 2022. Cluster analysis showed that the similarity of 85 EAEC cluster was 58.4%‒100.0%， and 69 band patterns were obtained. The similarity of 29 ETEC cluster was 58.5%‒100.0%， and 13 band patterns were obtained， including 2 dominant band types. The similarity of 16 EAEC clusters was 53.9%‒100.0%， and 15 band patterns were obtained. Five groups of homologous strains were found， consistent with the resistance phenotypes. ConclusionAmong the diarrhea cases， the DEC epidemic intensity is high， the drug resistance situation is severe， and the risk of outbreak infection is high in Fengxian District， Shanghai. Therefore， health monitoring and prevention need to be strengthened.

OBJECTIVETo compare the expression patterns of cytokeratin 7 (CK7) and CK20 in the Barrett's esophagus and gastric cardia intestinal metaplasia.

METHODSEndoscopic biopsy specimens from 19 patients with long segment Barrett's esophagus, 36 with short segment Barrett's esophagus, and 20 with histological evidence of gastric cardia intestinal metaplasia were immunostained for CK7 and CK20. The immunohistochemical data were analyzed in relation with the clinicopathological data of the patients including age, hiatal hernia, and Helicobacter pylori status.

RESULTSThe Barrett's pattern of CK7/20 expressions was found in all the 19 patients with long segment Barrett's esophagus, in 31 of the 36 (82%) patients with short segment Barrett's esophagus, and in 2 of the 20 (10%) patients with gastric cardia intestinal metaplasia. Patients with short segment Barrett's esophagus who had a Barrett's CK7/20 pattern showed similar clinicopathological findings to those with long segment Barrett's esophagus, while in cases of short segment Barrett's esophagus where no Barrett's CK7/20 pattern was found, the clinicopathological features were similar to those of gastric cardia intestinal metaplasia cases.

CONCLUSIONA Barrett's CK7/20 expression pattern is an objective marker of Barrett's mucosa. CK7 and CK20 reactivity patterns in routine endoscopic biopsy samples can reliably identify the location of intestinal metaplasia in the esophagus and stomach.

Adult ; Aged ; Barrett Esophagus ; diagnosis ; metabolism ; pathology ; Biomarkers ; metabolism ; Cardia ; metabolism ; pathology ; Female ; Humans ; Keratin-20 ; metabolism ; Keratin-7 ; metabolism ; Male ; Middle Aged ; Reagent Kits, Diagnostic

Objective To explore the effects of Chinese herbal compound, Tengmei decoction, on type II collagen-induced arthritis ( CIA) in rats, and to examine the changes of arthritis index ( AI) , limb swelling, joint tissue inflammatory infiltration, and the effects on immune-inflammatory factors.Methods Sprague-Dawley rat models of arthritis were successfully established by intradermal injection of type II collagen and Freund’ s complete adjuvant.The model rats were randomly divided into model group, positive drug group, and high-and low-dose Chinese medicine groups, 6 rats in each group.The intervention and treatment period was 12 weeks.To measure weekly the anteroposterior and transverse diameters of the rear ankles and wrists, the transverse diameter of the claw foot palm pad, the thickness and the highest point width of hind limb plantar joint swelling, and to evaluate the integrated scores of joints and limbs swelling using a vernier caliper.Results ①Compared with the normal group, the total arthritis scores and hind limbs AI scores of the model group were significantly increased ( P <0.05 or P <0.01 ) .The left forelimb AI scores were significantly increased during 10 -12 weeks ( P <0.05 ) .The anteroposterior and transverse diameters of the left hind limb, the thickness of the highest point measurement of the left hind foot pad metatarsal were significantly increased ( P<0.05 or P<0.01) in different time periods between 1-12 weeks.Compared with the model group, the total scores and the left hind limb joints AI scores of the high-and low-dose drug groups were decreased after 6 weeks (P<0.05).②Compared with the normal control group, levels of mRNA transcription and protein expression of IL-6 and TNF-αwere significantly up-regulated ( P<0.01 ) in the model group.Compared with the model group, the levels of mRNA transcription and the expression of IL-6 and TNF-αproteins were significantly down-regulated in the positive group and Chinese medicine groups ( P <0.01 ) .③ Histological examination showed that the low-dose TCM significantly improved the CIA synovial hyperplasia and inflammatory cell infiltration.Conclusions The molecular mechanism of Chinese herbal compound Tengmei decotion in improving joint pathological injury of CIA rat models may be related to its inhibitory effect on the high expression of immune-inflammatory factors in the synovial tissue of CIA rats.

AIM: To study the characterization of thyrotropin receptor (TSHR) and its active fragment TSHR aa352-366 as immunogens in BALB/c mice. METHODS: BALB/c mice were injected peritoneally with TSHR aa352-366-KLH (hemocyanin from keyhole limpets) and the mixture of TSHR aa352-366-KLH and guinea pig TSHR every 15 days, respectively. The levels of thyroid hormones and TSHR antibodies and TSHR mRNA were measured, and the pathological changes of thyroid tissue were observed. RESULTS: In the group injected with TSHR aa352-366-KLH, the serum levels of TT_3 and TT_4 decreased (P

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.

Objective: To understand the occupational hazard and distribution of silica dust (free SiO₂≥10%) in the workplace environment of the enterprises in Fengxian District, and to provide scientific basis for improving the working environment and protecting the physical and mental health of the workers. Methods: Individual sampling monitoring and on-site labor hygiene investigation were conducted on 421 workers involved in 87 silicon dust enterprises in the jurisdiction from 2014 to 2018, and measured concentration-time weighted average (C_TWA) . Results: The results showed that the range of the C_TWA was (0.021~17.000) mg/m³, the median was 1.600 mg/m³, and the qualified rate of 30.88%. The difference of total dust concentration was statistically significant in different years (Z=38.831, P<0.05) . The qualified rate of small-scale enterprises is higher than that of medium-scale enterprises (χ²=9.472, P<0.05) . The qualified rate of other domestic enterprises is higher than that of private enterprises and foreign enterprises (χ²=10.089, P<0.05) . The acceptance rate of metal products manufacturing is lower than that of general equipment manufacturing and other manufacturing enterprises (χ²=64.626, P<0.05) . The qualification rate of natural ventilation is higher than that of mechanical ventilation (χ²=6.278, P<0.05) . Conclusion The enterprises involved in silicon production in Fengxian District need to further strengthen the production process reform and improve the ventilation and dust removal protection measures. Widely carry out the publicity of occupational disease prevention and control law, conduct targeted pre-job training, improve workers' awareness of self-protection, and protect the occupational health of workers in many ways.

Objective: To analyze the epidemiological characteristics of varicella epidemic situation at schools and kindergartens in Fengxian district of Shanghai during 2012-2018, and to provide evidence for developing control and prevention strategies. Methods: Data of varicella epidemic situation at schools and kindergartens and varicella cases were analyzed by descriptive methods. The rates were compared with chi-square test. Results: A total of 6 727 varicella cases were reported in Fengxian during 2012-2018, for an incidence of 85.34 per 100 000 population. Totally 66 varicella epidemic outbreaks and public health emergencies caused by varicella were reported, which involved 741 varicella cases. Among them, 426 were breakthrough cases (57.49%). The average interval time of breakthrough cases were (6.78±2.79)years, and the incidence was more concentrated in the 3-9 years after vaccination with varicella vaccine. Most breakthrough cases appeared 5 years past vaccination. The peak time of varicella was from April to June and from October to December. Most of cases were in the 5-11 year-old group and 15-17 year-old group. The cases in males was higher than in females. Kindergarten childcare and primary school children were at high risk of varicella. Timeliness of reporting was positively correlated with the duration of the varicella epidemic situation( r =0.52， P <0.05). Conclusion Most varicella epidemic situation in Fengxian district of Shanghai occued in primary schools during autumn and winter, and most of the varicella cases were breakthrough cases. Emergency vaccination of varicella vaccine can effectively control the spread of the epidemic. It is suggested to increase the publicity of the immunization program of 2 doses of varicella vaccine and raise the awareness of varicella vaccination of children’s parents.