Objective To investigate the incidence of recurrence and occurrence rate of recurrence of hand-foot-and-mouth disease (HFMD)in Jiangbei District of Ningbo City between 2012 and 2014,analyze the influencing fac-tors,and provide a scientific basis for the prevention and control of HFMD.Methods Data of HFMD in Jiangbei in 2012-2014 were collected from China Disease Surveillance Information System,immunization data were from Im-munization Programme Information System of Ningbo City,the recurrent infectious cases were selected and analyzed by descriptive epidemiological methods.Results The occurrence rate of recurrent HFMD in Jiangbei in 2012-2014 was 5.40% ,the median month of patients with single occurrence and recurrence of HFMD were 33.77(20.03, 47.83)and 38.26(22.05,54.75)months respectively,median month of patients with the initial occurrence were 23.93(15.87,36.87)months,median of time interval of recurrent HFMD was 10.27(5.23,16.06)months. The oc-currence rate of recurrence was the highest in 3- years old group(χ2= 37.51,P<0.001). Most were scattered chil-dren and children in child-care center. Female was a protective factor of recurrence of HFMD (OR,0.73[95% CI, 0.57-0.92]),while children in child-care center was a risk factor (OR,1 .46[95% CI,1 .16-1 .84]). The median attack rate of recurrence in HFMD group and control group in blocks within 7 days were 10.36(9.29,11.44)/100000 and 8.95(8.16,9.74)/100000 respectively,there was significant difference(Z= -2.68,P<0.001). In-oculation frequency between recurrent HFMD group and control group was not significantly different (Z= -1.38,P= 0.17).Conclusion The epidemic of recurrence of HFMD was serious in Jiangbei District of Ningbo City between 2012 and 2014,boys and children in child-care center should be paid attention,contacts with patients should be re-duced,and targeted prevention and control measures should be carried out.

Objective To evaluate the efficiency and toxicities of Gemcitabine combined with S -1 cap-sule in the treatment of advanced esophageal cancer .Methods Twenty-nine patients with advanced esophageal cancer were treated with S-1 capsule 80 mg/m2 ,twice daily for 14 days and Gemcitabine (1 000 mg/m2 ) was in-travenously administrated on day 1 and 8.The chemotherapy was repeated every 21 days.After two consecutive treatment circles ,the short term efficacy ,adverse effects and follow -up condition were evaluated .Results One case showed complete remission (CR),11cases showed partial remission (PR),9 cases showed stable disease (SD),8 cases showed progressive disease(PD).The responsive rate(CR+PR)was 41.4%;the illness control rate(CR+PR+SD)was 72.4%.The major adverse events were myelosuppression ranging from grade Ⅰto Ⅲ, hand-foot syndrome,disgusting and the damage of liver function .Some patients displayed the damage of liver function.The median time to progress ( mTTP) was 6.9 months.The median 1-year survival rate was 64.3%. Conclusion The combination of Gemcitabine and S -1 capsule is an effective and well -tolerated method for the patients with advanced esophageal cancer .

Objective To evaluate the quality of observational studies on pelvic organ prolapse in China.Methods The checklist of strengthening the reporting of observational studies in epidemiology (STROBE) statement was applied to evaluate the observational studies.The articles were searched in the SinoMed database using the terms:prolapse,uterine prolapse,cystocele,rectal prolapse and pelvic floor;limited to Chinese core journals in obstetrics and gynecology from January 1996 to December 2015.With two 10-year groups (1996-2005 and 2006-2015),the x2 test was used to evaluate inter-group differences.Results (1) A total of 386 observational studies were selected,including 15.5％(60/386) of case-control studies,80.6％(311/386) of cohort studies and 3.9％ (15/386) of cross-sectional studies.(2) There were totally 22 items including 34 sub-items in the checklist.There were 17 sub-items (50.0％,17/34) had a reporting ratio less than 50％ in all of aticles,including:1a (study's design) 3.9％ (15/386),6a (participants) 24.6％(95/386),6b (matched studies) 0 (0/386),9 (bias) 8.3％ (32/386),10 (study size) 3.9％,11 (quantitative variables) 41.2％ (159/386),12b-12e (statistical methods in detail) 0-2.6％ (10/386),13a (numbers of individuals at each stage of study) 18.9％ (73/386),13b (reasons for non-participation at each stage) 18.9％,13c (flow diagram) 0,16b and 16c (results of category boundaries and relative risk) 9.6％ (37/386) and 0,19 (limitations) 31.6％ (122/386),22 (funding) 20.5％ (79/386).(3) The quality of articles published in the two decades (1996-2005 and 2006-2015) were compared,and 38.2％ (13/34) of sub-items had been significantly improved in the second 10-year (all P＜0.05).The improved items were as follows:1b (integrity of abstract),2 (background/rationale),6a (participants),7 (variables),8 (data sources/measurement),9 (bias),11 (quantitative variables),12a (statistical methods),17 (other analyses),18 (key results),19 (limitations),21 (generalisability),22 (funding).Conclusions The quality of observational studies on POP in China is suboptimal in half of evaluation items.However,the quality of articles published in the second 10-year have significantly improved.

Objective: To investigate the trends in incidence and mortality of stroke in Ningbo City, Zhejiang Province from 2012 to 2021, so as to provide the evidence for improving the stroke control strategy in Ningbo City. Methods: Data pertaining to the stroke incidence and mortality in Ningbo City from 2012 to 2021 were captured from Ningbo Municipal Chronic Disease Collaborative Management System, and the incidence and mortality of stroke was estimated and standardized by the Sixth National Population Census in 2010. The trends in incidence and mortality of stroke were evaluated using annual percent change (APC) in Ningbo City from 2012 to 2021. Results: A total of 185 747 residents with stroke were reported in Ningbo City from 2012 to 2021. The crude incidence of stroke was 312.78/105 in Ningbo City from 2012 to 2021, which appeared a tendency towards a rise (APC=2.429%, t=5.507, P<0.001), and the standardized incidence of stroke was 188.86/105, with no remarkable changes seen (APC=-0.399%, t=-1.544, P=0.161). There were 47 355 deaths due to stroke in Ningbo City from 2012 to 2021, and the crude and standardized mortality rates were 79.74/105 and 42.79/105, which both appeared a tendency towards a decline (APC=-4.778%, t=-6.867, P<0.001; APC=-8.269%, t=-13.729, P<0.001). Higher standardized incidence and mortality were seen among men (226.05/105 and 50.14/105) than among women (153.37/105 and 35.89/105), and the crude incidence and mortality of stroke appeared a tendency towards a rise with age (χ2trend=3 671.325, 1 419.107, both P<0.001). The standardized incidence and mortality of hemorrhagic stroke were 40.38/105 and 18.56/105, both showing a tendency towards a decline (APC=-5.042%, t=-12.958, P<0.001; APC=-11.570%, t=-14.979, P<0.001), and the standardized incidence of ischemic stroke was 143.91/105, appearing a tendency towards a rise (APC=1.254%, t=3.223, P=0.012), while the standardized mortality of ischemic stroke was 19.65/105, with no obvious changes seen (APC=-2.110%, t=-2.150, P=0.064). Conclusions The incidence of stroke appeared a tendency towards a rise and the mortality appeared a tendency towards a decline in Ningbo City from 2012 to 2021. Men and the elderly are at high risk of stroke.

Abstract Ischemic stroke is characterized by high morbidity, disability and mortality. At present, there is a lack of effective treatment for ischemic stroke, so it is of great significance to reduce the incidence risk of ischemic stroke. Studies show that vitamin C can prevent atherosclerosis, thus reduce the incidence risk of ischemic stroke. However, this point is controversial due to the differences of study population, inconsistent evaluation methods of vitamin C content and the influence of various confounding factors. This paper reviews the related animal experiments, clinical trials and cohort studies, in order to provide reference for subsequent studies on reducing the incidence risk of ischemic stroke.

Objective To explore 64 row volumetric CT 3D reconstruction in the clinical application of severe craniocerebral injury.Methods 60 patients with craniocerebral injury in our hospital were retrospectively analyzed who accept craniocerebral 64 row volumetric CT 6 to 24 hours after injury. Results All cases got timely diagnosis and treatment, especially for the special parts of brain lesions, ventricle base of skull fractures and pool, and various angles show. Conclusion 64 row volumetric CT reconstruction for the diagnosis of craniocerebral injury shows important significance and may estimate the prognosis in diagnosis, guiding treatment and surgery, reducing misdiagnosis.

Objective: To analyze the features of Norovirus outbreaks in schools and kindergartens and the associated factors in Chengdu, 2017, and to provide the scientific basis for Norovious outbreaks prevention and control. Methods: A total of 75 schools and kindergartens in Chengdu of 2017 participated in the study about Norovirus outbreaks. ANOVA and binary Logistic regression models were used to analyze the influencing factors and duration of Norovirus outbreaks. Results: Overall 710 cases were included. There was an average of 9.47 cases and 27.52 hours for each outbreak,decreasing by 1.06 cases and 10.56 hours compared with those of 2016. Most outbreaks happened in kindergartens and in the firstlevel economy regions from January to March, with GII type as the main outbreak. Compared with the first case of vomiting at home, vomiting in public area (OR=11.76, 95%CI=1.63-84.69) was much more serious, and compared with the active report of school/ community, being informed of the outbreak passively (OR=4.09，95%CI=1.04-16.03) was positively associated with outbreak severity. Conclusion To prevent Norovirus infection, specific development and training of dealing with vomiting and feces should be introduced, and measures to increase the ability to surveil and report Norovirus outbreaks should be enhanced.

Objective: To explore the associations of Hand-Foot-Mouth disease (HFM) among children of different age groups in kindergartens, and to provide scientific evidence for HFM prevention and control. Methods: Cluster sampling was used to select 9 912 children from 40 kindergartens. The major caregivers of children were invited to participate into the study and fulfill a self-administered questionnaire that consisted of general background, hand washing and the history of HFM among children in the recent 1 year. Chi-square and binary logistic regression were applied,to analyze the influencing factors of HFM among children of different age groups. Results: In the 2 year-old-group, children who were male (OR=1.76, 95%CI=1.24-2.50), had the major caregiver with high school educational background or below (OR=1.54, 95%CI=1.06-2.24), had family income more than 100 000 yuan or more per year(OR=1.49, 95%CI=1.01-2.20), children whose major caregiver seldom wash hands immediately after coming home(OR=2.10, 95%CI=1.05-4.19)，and 3-5 times per week(OR=2.07, 95%CI=1.26-3.41) were more likely to have HFM. In the 3 year-old-group, the more time children spent in the outdoors, the less likely they got HFM(3-5 times per week: OR=0.58, 95%CI=0.43-0.81; ≥6 times per week: OR=0.45, 95%CI=0.29-0.70). Children whose major caregiver did not use soap were more likely to have HFM(OR=1.67, 95%CI=1.11-2.49). In the 4 year-old-group, children who occasionally took toys when going out were less likely to get HFM (vs always, OR=0.57, 95%CI=0.38-0.88). No significant factors were found in the 5 year-old-group. Conclusion The behaviors and activities of major caregivers and children could influence the HFM incidence.To prevent HFM, it was advised that the major caregivers should wash hands immediately after coming home, and develop the habit of using soap for handwashing together with children at the earlier age, and encourage children to take more outside-door activities according to the age characteristics. Attention should be paid to avoid contaminating takeout snacks, and to clean the takeout toys timely.

Objective To investigate the influence of earlier renal fibrosis on ischemia and reperfusion induced acute kidney injury. Methods Male C57BL/6 mice at eight to twelve weeks old age were divided into 4 groups randomly: (1)Sham (n=3); (2)Unilateral ureter obstruction (UUO, n=6):UUO for 3 days (UUO3d, n=3) and UUO for 5 days (UUO5d, n=3);(3)Ischemia and reperfusion (IR, n=7): bilateral kidney ischemia for 40 minutes followed by 24 hours of reperfusion; (4)UUO for 3 days plus IR (UUO3d+IR, n=6): bilateral kidney ischemia after UUO 2 days for 40 minutes followed by 24 hours of reperfusion, and the real time for UUO was 3 days. Pathologic analysis for acute or chronic injury was performed on paraffin embedded kidney sections with hematoxylin and eosin (HE) or Masson staining. Apoptosis was detected by immunohistochemistry(IHC) and Western blotting with anti-caspase-3 antibody, and proliferation was observed by IHC with anti-ki67 antibody. Results On kidney sections with HE or Masson staining, it showed that the chronic kidney lesions and fibrosis got more severe as time of UUO prolonged from 3 days to 5 days; the area of matrix deposition increased in UUO5d and UUO3d mice significantly compared to Sham mice (P<0.05) and was smaller in UUO3d mice compared with UUO5d mice obviously (P<0.05). Acute kidney injury could be observed in UUO3d+IR mice, such as massive inflammatory cells infiltration, tubules dilation, brush border disappearance, tubular epithelial cells vacuolar degeneration, necrosis, casting formation, coexisting with chronic lesions: thinner cortex, broadened interstitial space, and increased blue stained matrix. Acute kidney injury score in UUO3d+IR mice was higher than that in IR mice significantly (P<0.05), and serum creatinine level increased significantly in UUO3d+IR mice compared to Sham mice (P<0.05). Caspase-3 expression increased and ki67 positive tubular cells decreased in UUO3d+IR mice than those in IR mice obviously (P<0.05). Conclusion Earlier renal fibrosis aggravates acute kidney injury induced by ischemia reperfusion in mice through increasing apoptosis and decreasing proliferation of tubular epithelial cells.

Objective: To investigate the clinicopathologic features of cardiac myxofibrosarcomas. Methods: The clinical data, pathomorphologic and immunohistochemical features were evaluated in five cases of cardiac myxofibrosarcoma collected from January 2009 to December 2014, with relevant literature review. Results: Five patients with cardiac myxofibrosarcoma, including four women and one man [age range 39-61 years; mean (50.4±9.0) years] were included. All tumors were broadbased and located mainly in the left atrium, with one case extending through the atrial wall and pericardium to the left lower lung lobe. The morphological grade was low in one case, intermediate in one, and high in three. Using Fédération Nationale des Centres de Lutte Contre le Cancer (FNLCC) grading system, one case was grade 1 and four cases were grade 2. Immunohistochemical analysis revealed diffuse and strong expression for vimentin in all cases. Smooth muscle actin and muscle specific actin were variably expressed. Complete tumor excision was performed in one case, and tumor debulking was performed in the other four cases. Clinical follow-up was available in three cases. One patient with en bloc excision of the tumor mass survived 13 months and the other two with tumor debulking died one month after surgery. Conclusions The most common location for cardiac myxofibrosarcoma is the left atrium. Some myxofibrosarcoma may be histologically bland and misdiagnosed as myxoma due to histological similarities. Thus caution should be exercised in their microscopic differentiation. Precise imaging, multidisciplinary approach and adequate initial surgery may contribute to improving the clinical outcomes of myxofibrosarcoma.