Objective To examine the clinical features of sporadic patients with H7N9 avian influenzain Taizhou city of Zhejiang province and to characterize its viral genes.Methods Fifteen patients with H7N9 influenza infection confirmed by Zhejiang Provincial Centre for Disease Control and Prevention during January 201 4 and January 201 5 were included in the study.The basic diseases,poultry exposure history,clinical manifestation,laboratory examination,imaging features,treatment and outcome and viral gene sequencing were analyzed retrospectively.Results The first clinical symptoms were fever and cough in all patients,acuterespiratory distress syndrome(ARDS)occurred in 1 3 patients,the average time from onset to antiviral therapy was (7 ±2)d.Among 1 5 patients,9 survived and 6 died,including 2 died of multiple organ failure (MOF).The phylogenetic tree showed that there was highly homologous in hemagglutinin (HA)and neuraminidase(NA)genes between human H7N9 virus strains and poultry reference strains.The result of genetic sequencing indicated that human H7N9 virus strains had mutations at 226 (Q226L)sites in HA protein.Conclusions ARDS is likely to occur in patients with H7N9 viral infection,and early antiviral treatment usually leads to a good prognosis.With the occurrence of adaptive mutation in avian influenza virus H7N9,spread from poultry to the human beings may take place.

Objective To understand the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Methods Taking a survey among the pre-hospital emergency physicians(80 people)and nurses(248 people)by Questionnaire of ethics conflicts during pre-hospital emergeney service,to investigate the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Resulls (8.046±6.990)%of the patients who needed treatments refused to be treated completely,and(14.544±10.558)%of them refused partially.(14.451±14.747)% of the patients who needed ambulance transport refused to be delivered.In the patients who refused treatments and transportation.payment problem accounted for(23.52±19.79)%,(22.22±20.84)%of them did not believe they needed.(5.77±4.47)%of them wished to die,(19.44.4±18.65)%of them were hard to be idenfified.Other reasons accounted for(30.08±25.78)%.(20.31.4±16.66)% of the patients refused the ambulance crews' judge for some state.(29.66.4±24.02)%of the patients who got the pre-hospital emergency service were not necessary to call an ambulance.(22.1 l±19.52)%of the patients' demand conflicted with pre-hospital emergency services network management system.Conclusions There exists some conflicts between the pre-hospital patients and ambulance crews' determinations.

Objective To design and synthesize a series of new type four hydrogen quinoline-benzyl/benzimidazole amine derivatives as a potential new inhibitor targeting auxiliary receptor CXCR 4, and determine their inhibitory activities to HIV-1.Methods Based on HIV-1 receptor CXCR4 inhibitors containing three nitrogen structure-activity motif and CCR5 partial hydrophobic pharmacophore , a series of new compounds were designed , synthesized and characterized by 1 HNMR and MS.The inhibitory activities of these compounds were determined using HIV-1 IIIB virus.Results and Conclusion Ten target compounds are synthesized .Four hydrogen quinoline-benzimidazole amine derivatives exhibit good anti-HIV activity(IC50 <1 μmol/L), but four hydrogen quinoline-benzyl amine compounds are less active ((IC50 >8 μmol/L).

Objective To investigate the first human brucellosis outbreak in Fujian Province,aiming to identify the source,risk factors of infection,and recommend control measures.Methods Epidemiological investigation was conducted by combining with agricultural sector on human and animal in the incident area of Zhangzhou City of Fujian Province.Respondents included 17 professionals from the outbreak sheep farm,as well as 9 ones from four nearest farms (including 2 pig farms,1 sheep farm and 1 cow farm) in directions of eastern,southern,western and northern.Then information of cognitive level and daily protection on brucellosis among pasture breeding staffs through case studies were got,serum of pasture breeding staffs and animals was collected (including 262 from the outbreak sheep farm and 50 from another sheep farm which nearly 5 kilometres away) to detect brucellosis antibody,and sheep sources were investigated simultaneously.Results A total of 26 people were detected,the infection rate was 26.9％ (17 people,in the epidemic area),the other four farming units without brucellosis infection.In epidemic focus,seven human infections (5 confirmed cases,2 asymptomatic infected) were identified,with an infection rate 41.2％ (7/17) and the brucellosis antibody positive rate among sheep was 46.2％ (121/262),while no positive sheep in the nearest sheep farm (0/50).Both unprotected lamb handling and stillbirth treatment got a 100.0％ infection rate.Among the investigated professional staffs,92.3％ (24/26) had no awareness of clinical symptoms and signs of brucellosis,while 11.5％ (3/26) took protective measures when working.Conclusions Unquarantined sheep is the infection source of this brucellosis outbreak,unprotected lamb handling and stillbirth treatment are the main route of transmission.High sheep infection rate,lack of brucellosis awareness,precaution missing among pasture breeding staffs and animal quarantine are all contributing to this outbreak.

Objective To evaluate the diagnostic value of intra-arterial thrombi under went susceptibility weighted imaging(SWI) in patients with acute ischemic stroke(AIS).Methods The MRI images of 133 patients with AIS was analyzed,included time of flight MR angiography(TOF-MRA )and SWI.The patients were divided into two groups according to the time between onset of symptoms and MR imaging (group A,interval time<24 h;group B,interval time 24-72 h).Two neuroradiologists who were blin-ded to the patients clinical information,documented the number and location of susceptibility vessel sign (SVS)in SWI and embolic occlusion or stenosis on TOF-MRA in AIS patients.Results The thrombus detection rate in group A was higher than that in group B.There was no significant difference in the overall detection rate of thrombi between SWI and TOF-MRA in all AIS patients,but the thrombi detection rate in M3 segement of middle cerebral artery(MCA)with SWI was higher than that with TOF-MRA in group A(P <0.05).Conclusion SWI performs a high diagnostic value for thrombus detection in AIS patients,especially for the thrombus detection of M3 segement in early period of AIS.

Objective To observe the effects and safety of oxycodone hydrochloride combined with parecoxib sodium in preventing postoperative hyperalgesia induced by remifentanil. Methods Eighty-eight ASA Ⅰ or Ⅱ patients undergoing elective laparoscopic myomectomy surgery were randomly divided into four groups (C,O,P,PO) with 22 cases in each group. Patients in group C,O,P,PO were given with 10 mL saline, 0.1 mg?kg-1 oxycodone hydrochloride, 40 mg parecoxib sodium, 0.1 mg?kg-1 oxycodone hydrochloride and 40 mg parecoxib sodium 30 min before the end of the surgery, respectively. The VAS scores were recorded at the end of surgery 30 min, 1 h, 2 h, 4 h, 8 h, and the cases of agitation, rigor, vomiting and increasing of analgesics were recorded. Results Compared with group C, the VAS scores in group O, P,PO were significantly lower(P<0.05). The VAS scores in group PO were lower than those in group O,P(P<0.05). The cases of agitation and rigor in group PO (0.0%, 5.0%) were less than those in group C (45.0%,23.0%) (P<0.05). The increased doses of analgesics in group PO(0) were less than those in groups C (12), group P (5), and group O (5)(P<0.05). Conclusion Oxycodone hydrochloride combined with parecoxib sodium can effectively prevent postoperative hyperalgesia induced by remifentanil, and reduce the incidence of postoperative agitation.

Objective To evaluate the diagnostic ability of fusion images of SWI and DWI in ischemic penumbra(IP)of patients with acute ischemic stroke(AIS).Methods 47 AIS patients were retrospective analyzed.Two neuroradiologists analyzed the fusion images of SWI and DWI respectively.SDM was defined as that the hypo-intensity signals of intramedullary or sulcal veins were dilated or increased on fusion images compared with contralateral areas.The results compared with the PDM,which was considered as the“gold standard”.Areas under the receiver operating characteristic curve(AUC)were used to assess the efficacy of SDM which determined by fusion images and compared to PDM.Chi-square test was used to analyze the consistency between the two neuroradiologists and also the consistency between SDM and PDM in IP assessment Results The fusion images of SWI and DWI had a high diagnostic efficacy compared to PDM, AUC of the two radiologists were 0.885,0.877,the diagnostic sensitivity were 84.2%,78.9% and specificity were 92.9%,96.4%respectively.There was also a high consistency in SDM assessment through fusion images between the two neuroradiologists (Kappa=0.908,P >0.05). Conclusion Fusion images of SWI and DWI have a high diagnostic efficacy in IP assessment,which may be considered as a simple approach for IP assessment in patients with AIS.

Objective To clarify the source of infection of a student brucellosis case in Ningde City, make clear its influencing range as well as risk factors of transmission, then take measures to effectively control the epidemic.Methods Clue sampling was carried out, then the survey site village was chosen where the student case came from.①Fundamental state survey: resident population as well as the situation of livestock were collected.②Human outbreak investigation: detailed interview was carried out on the first case.Base on the principle of informed consent, serum samples were collected from breeders and those who had once contacted with sheep in order to detect brucellosis antibodies, then investigation was conducted on farmers to collect cognitive information;case searching was conducted by reviewing outpatient and inpatient records as well as government broadcasting.③Livestock epidemic: serum samples from some of the sheep were collected by agricultural sector.Results There were 200 households with 500 inhabitants in the survey site of Ningde City, among which there were 5 sheep feeding families and totally 154 sheep on hand.Patient was male, 12 years old, student.Sick on June 2nd, 2014,confirmed on July 5th.The patient's neighbor was a sheep farmer, he had once contacted with the sheep.Totally we collected 8 serum samples from livestock personnel, positive Brucella antibody was 4, with a positive rate 50％ (4/8);collected 15 serum samples from those contacted with sheep, positive Brucella antibody was 2, with a positive rate 13％ (2/15).Meanwhile, agricultural sector collected 17 sheep serum samples from these two sheep farms, among which there were 7 serum samples showing a positive Brucella antibodies, with a positive rate 41％ (7/17).After surveyed of 8 livestock breeding personnel and 15 livestock non-breeding personnel, we found that no one was familiar with the clinical characteristics and transmission of brucellosis.Conclusions The direct source of brucellosis infection is local infected sheep, general population has been involved in this epidemic.Brucellosis surveillance should be seriously carried out on both human and animal.Furthermore, improving the awareness of brucellosis among professionals as well as general population is eagerly needed and health education must be carried out immediately.

Objective To investigate the value of early?phase enhancement ratio combined with peripheral vascular diameter in the differential diagnosis of benign and malignant breast lesions using 3.0 T dynamic contrast?enhanced magnetic resonance imaging (DCE?MRI). Methods Sixty seven cases of patients (35 with malignant lesions and 32 with benign lesions in the breasts) were retrospectively analyzed. Their diagnoses were confirmed by surgery and pathology and all the patients underwent breast MRI plain scan and DCE?MRI in the two weeks before surgery. Lesion ROIs were drawn and time?signal intensity curves in the DCE?MRI were generated. Early?phase enhancement rate, time to peak, early?phase enhancement ratio, numbers of tumor vessel within 3 cm of the lesion and diameter of the largest vessel were recorded. Mann?Whitney U test was used to compare the difference of DCE?MRI between benign and malignant lesions, and the ROC curve was used to evaluate the efficiency of early?phase enhancement rate, early?phase enhancement ratio and vascular diameter in differentiating benign and malignant lesions. Results With breast malignant lesions, the medians of time to peak, early?phase enhancement rate, early?phase enhancement ratio, numbers of tumor vessel and vascular diameter were 2.2 s, 176.0%, 100.0%, 4 and 2.96 mm respectively, while with benign lesions of these parameters were 4.7 s, 113.3%, 81.9%, 0 and 0.00 mm respectively, and the differences were statistically significant (all P<0.05).When early?phase enhancement rate was used for differential diagnosis of breast benign and malignant lesions, the area under the ROC curve was 0.702 and the sensitivity and specificity were 82.86%and 56.25%with a threshold of 120.0%. When early?phase enhancement ratio was used, the area under the ROC curve was 0.854 and the sensitivity and specificity were 94.29% and 68.75% with a threshold of 86.0%. When peripheral vascular diameter was used, the area under the ROC curve was 0.896 and the sensitivity and specificity were 74.29%and 84.38% with a threshold of 2.78 mm. When early?phase enhancement ratio was combined with peripheral vascular diameter, the area was 0.925 and the sensitivity and specificity were 97.14% and 62.50%. Conclusion In the differential diagnosis of benign and malignant breast lesions under DCE?MRI, early?phase enhancement ratio combining with peripheral vascular diameter has improved sensitivity.

AIM: To investigate the relationships between I?1 hs1,2 VNTR polymorphism and IgA nephropathy. METHODS: Four hundred and ninteen patients with IgA nephropathy and their first-degree relatives were recruited. Two hundred and one sex and age-matched normal Chinese Han volunteers were also recruited as controls. After extracting genomic DNA, the VNTR genotypes of I?1 hs1,2 region were determined by PCR and electrophoresis, and the results were analyzed by transmission disequilibrium test (TDT) and haplotype relative risk (HRR) in the families, and Chi-Square test in the case-control analysis. RESULTS: ① TDT analyses showed that B allele of the I?1 hs1,2 VNTR region was significantly more transmitted from heterozygous parents to patients than expected (101 Trios, ?2=6.818, P