Objective To analyze the etiological and epidemiological characteristics of hand-foot-mouth disease(HFMD) in Liuzhou city from 2013 to 2016,and to provide scientific evidence for preventive policy making.Methods Specimens of HFMD cases were collected from the hospitals and county CDC from 2013 to 2016.The nucleic acids which are enterovirus viruses71(EV71),coxasckie virus A16(CoxA16) and other enterovirus(EV) was detected by Real time PCR technique.Results A total of 3 503 suspected HFMD cases were found,and 2 720 cases were identified.The main pathogen of HFMD in Liuzhou city was change every year from 2013 to 2016,in addition to EV71 and CoxA16,there was a higher proportion of EV.HFMD was a seasonal disease,most cases occurred from March to September.The children under 5 years old,especially 1-3 years old were the main patients,and male patients was higher than female.Severe and death HFMD was EV71,but death HFMD had no CoxA16.Conclusion EV was the main pathogen of mild HFMD in Liuzhou city from 2013 to 2016,but the pathogenic spectrum was changing every yeas.EV71 was the main pathogen of severe and death HFMD.

Doxycycline is a broad-spectrum antimicrobial agent used in clinical for a long time. In recent years, many studies showed that its pharmacological activities of anti-tumor, heart function improvement, nerve protection and antiasthma depended on its inhibition of matrix metalloproteinase ( MMPs) . In the present paper,the new pharmacological actions of doxycycline were reviewed to promote the applications in clinics.

Objective:To investigate the clinical effect of combination of aluminum magnesium carbonate and lansoprazole sodium in the treatment of gastric ulcer.Methods:From October 2017 to October 2018, 100 patients with gastric ulcer in Hangzhou Dajiangdong Hospital were randomly divided into control group and observation group by random number table method, with 50 cases in each group.The control group was treated with routine triple therapy, and the observation group was treated with aluminum magnesium carbonate combined with lansoprazole sodium capsule.The course of treatment in both two groups was eight weeks.The curative effect of the two groups was observed.Results:The total effective rate of the observation group was 96.0%(48/50), which was higher than that of the control group [70.0%(35/50)], the difference was statistically significant(χ 2=12.428, P<0.01). After treatment, the motilin, gastrin, percentages of collagen fiber area and neutral mucus area in the observation group were (255.22±36.29)ng/L, (142.19±9.86)μg/L, (46.29±5.27)%, (55.29±6.82)%, respectively, which were better than those in the control group [(281.73±30.84)ng/L, (114.58±8.35)μg/L, (35.69±4.38)%, (36.75±5.23)%], the differences were statistically significant( t=36.582, 31.125, 12.785, 21.745, all P<0.05). The scores of abdominal pain, belching, acid regurgitation and abdominal distension in the observation group were (1.46±0.52)points, (0.35±0.05)points, (0.49±0.13)points and (1.38±0.23)points, respectively, which were lower than those in the control group [(2.58±0.41)points, (1.46±0.71)points, (1.28±0.54)points and (2.65±0.48)points] ( t=1.836, 1.485, 1.023, 1.258, all P<0.05). The incidence of adverse reactions in the observation group[4.0%(2/50)] was lower than that in the control group [30.0%(15/50)](χ 2=14.258, P<0.01). Conclusion:The combination of magnesium aluminum carbonate and lansoprazole sodium has good clinical effect on gastric ulcer, which is superior to the conventional triple therapy.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.

Objective To be investigated the morphology of colorectal small flat adenoma and the expressions of p53 , p21, ER and PR. Methods Colonoscopy ( Olympus CF 240) and microscopy ( Olympus BV 41) were used to observe 50 cases of colorectal small flat adenomas. The expressions of p53 , p21 , ER, and PR were detected by the two steps of immunohistochemistry in 50 cases of small flat adenomas and the surrounding mucosa, 26 cases of colorectal carcinomas, while 15 cases of the normal colorectal mucosa as control group. Results These lesions were distributed throughout the large bowel, the prevalence in order was transverse colon, sigmoid and rectum. The small flat adenoma was round, flat, or sessile in shape, and sized

Objective:To investigate the effect of separation exercise training of upper limb robot in improving upper limb motor function of stroke patients,and to explore the underlying mechanism by transcranial magnetic stimu-lation motor-evoked potential(MEP)evoked potentials. Method:Stroke patients were randomly divided into the experimental group(n=21)and the control group(n=23).The experimental group was trained with a fixed trajectories(the separation movement of elbow flexion-extension and shoulder adduction-abduction),while the control group underwent upper limb robot training with random movement trajectories(a compound action that can reach for objects).Both groups received robot train-ing once a day,20min/time,5 times/week for 3 weeks.The Fugl-Meyer assessment of upper extremity(FMA-UE)and modified Barthel index(modified Barthel index,MBI)were used to evaluate motor function.The la-tency period and central motor conduction time(CMCT)of MEP were detected before and after treatment. Result:After 3 weeks of treatment,the FMA-UE,MBI and MEP were improved compared with before treat-ment in the experimental group(P＜0.05),There was no significant difference between the FMA-UE,MBI and MEP of the control group and that before treatment(P＞0.05);There were no significant differences in in FMA-UE,MBI and MEP between-group comparisons after 3 weeks of treatment. Conclusion:The separation exercise training of the upper limb robot can improve the upper limb motor func-tion and enhance daily living activities in stroke patients,which may be related to enhanced remodeling of brain function in stroke patients.

ObjectiveTo investigate the clinical value of CT/MRI-CEUS image fusion in ablation of primary liver cancer (PLC).MethodsA total of 171 PLC patients undergoing radical thermal ablation in the Third Afifliated Hospital of Sun Yat-sen University between April 2010 and February 2014 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 171 patients, 151 were males and 20 were females with the average age of (53±11) years old. Patients underwent radiofrequency ablation (RFA) or microwave ablation (MWA). CT/MRI-CEUS image fusion was used to immediately evaluate and guide the supplementary ablation during the operation. The success rate of CT/MRI-CEUS image fusion operation, the rate of intraoperative immediate supplementary ablation and incidence of postoperative complication were recorded. The complete ablation rate was assessed according to the enhanced CT/MRI results 1 month after ablation. According to intraoperative ablation conditions, the patients were divided into the satisfied ablation margin group and the unsatisfied ablation margin group after the ablation. The patients of two groups were followed up for 12 months to monitor the progression of local tumors. The local tumor progression rate of two groups was compared using Kaplan-Meier method and Log-rank test.ResultsFor the total 200 lesions, the success rate of CT/MRI-CEUS image fusion operation was 86.0% (172/200) and the immediate supplementary ablation rate was 16.9% (29/172). There were 108 lesions with satisifed ablation margin and 64 lesions with unsatisifed ablation margin. No treatment-related death was observed and the incidence of complication was 1.2% (2/171). The complete ablation rate was 100.0% (172/172), which was conifrmed by the enhanced CT/MRI after operation. The 1-year cumulative local tumor progression rate in the satisifed ablation margin group and the unsatisifed ablation margin group was respectively 1.9% and 6.5%, and no signiifcant difference was observed (χ2=2.16,P>0.05).ConclusionCT/MRI-CEUS image fusion technique can evaluate and guide the ablation for PLC immediately, and thus can enhance the complete ablation rate.

Objective To investigated the etiologic characteristics of Shigella (S.) sonnei strains causing outbreaks and sporadic cases in some areas of Guangdong province and Guangxi Zhuang Autonomous Region during 2014-2016. Methods Fourteen S. sonnei strains isolated from outbreaks and 6 S. sonnei strains from sporadic cases from Guangdong and Liuzhou of Guangxi Zhuang Autonomous Region were tested for antimicrobial resistance and analyzed by pulsed-field gel electrophoresis (PFGE). Six typical strains were selected for whole genome sequencing typing and compared with 51 strains isolated both at home and abroad from NCBI genome database. Results The antibiotic resistance test indicated the isolates had high resistance rate to ampicillin, tetracycline, gentamicin, trimethoprim/sulfamethoxazole and nalidixic acid, while sensitive to azithromycin, chloromycetin and imipenem. PFGE showed high similarity (93.2%) among the strains isolated from different areas. The whole genome sequencing analysis also revealed that all the typical strains wereclustered into a same evolution branch, close to some strains from Korea. Conclusions The S. sonnei strains isolated from some areas of Guangdong and Guangxi Zhuang Autonomous Region showed high resistance to commonly used antibiotics, but they were sensitive to azithromycin, chloramphenicol and imipenem. The isolates in this study also showed similar PFGE patterns and close phylogenic evolution.

Objective To analyze the causes of revision surgery after percutaneous transforaminal endoscopic discectomy (PTED) for lumbar spinal stenosis,and to provide references for indications and operative methods.Methods From January 2015 to October 2017,206,491 and 60 patients of lumbar spinal stenosis were treated with PTED in Tianjin Hospital,Shanxi People's Hospital,Ningbo Sixth Hospital,respectively;among them,4,10 and 4 cases received revision surgery.Another 13 patients of lumbar spinal stenosis were treated with revision surgery due to poor results after PTED in other hospitals.Among 31 cases of reoperation,there were 16 males and 15 females,aged 27-82 years (average,66.2±12.7 years).The lesion segments included 1 case of L3,4,23 cases of L4,5,5 cases of L5S1,1 cases of L3-L5,and 1 cases of L4-S1.Patients were followed up after reoperation from 3 to 24 months (average,12.1 months).The causes of poor result and revision surgery were analyzed according to preoperative,intraoperative and postoperative data.Results All of 757 cases of lumbar spinal stenosis were treated with PTED in three hospitals,of which 18 cases (2.4％) were re-operated.The causes of reoperation included:bone slice displacement in 1 case;nerve injury in 4 cases;lumbar instability in 4 cases;disc protrusion in 10 cases (residual or recurrence);insufficient decompression in 21 cases;planed staging operation in 4 cases with bilateral or two-level stenosis.32 revision surgeries were performed for 31 patients,including PTED in 15 cases,microendoscopic discectomy (MED) in 1 case,mobile MED (MMED) in 5 cases,MMED assisted fusion in 2 cases,transforaminal lumbar interbody fusion (TLIF) in 4 cases,Minimally invasive TLIF (Mis-TLIF) in 2 cases,and open decompression and fusion in 3 cases.All patients experienced relieve of symptoms after revision surgery.At final follow-up,VAS leg pain deceased form 7.1±3.9 before revision surgeries to 1.9±1.2,VAS low back pain decreased form 6.3±3.2 to 1.8±1.3,ODI score decreased from 35％± 14％ to 7.6％±5％.According to the MacNab score,the result was excellent in 11 cases,good in 16 cases,and fair in 4 cases.Conclusion The treatment of lumbar stenosis with PTED has high technical requirements,the indications of PTED for lumbar stenosis should be strictly controlled according to technical conditions,and appropriate operative methods should be chosen according to the specific conditions of the lesions.Insufficient decompression,disc protrusion,lumbar instability and nerve injury are the common causes of reoperation.Suitable indications and proper operation should be selected.

Objective Retrospective study and report on cases of "symptomatic facet of residual bone mass" caused by percutaneous transforaminal endoscopic discectomy (PTED),to analysis of its causes and revision strategies.Methods Seven cases of "symptomatic facet of residual bone mass" after PTED were found in six medical centers from July 2015 to November 2017.Weintroduced the course of diagnosis and treatment,to analysis of the causes,clinical features and revision strategies of the rare complication.Results Seven patients came from different medical centers (2 cases in Ningbo No.6 Hospital and 1 case in each of the other medical centers).The average age of the subject is 67.29±9.64 years (range from 57-83 years).Among them there were 1 male and 6 female.PTED was performed for all cases with lumbar disc herniation or stenosis.The operative segments were 1 of L2,3,2 of L3,4,3 of L4,5,1 of L5S1.Symptoms occurred immediately after surgery in all cases except one after a week of operation and another one month later.Two cases were appeared symptom of contralateral irritation,and the rest were aggravated by the original symptoms.Two cerebrospinal fluid leakage caused by bone mass piercing the dural sac.The bone mass compressed the nerve root and caused 1 case of lower limb muscle weakness.Foraminoplasty was performed during PTED in all patients.After CT scan,5 cases of bone mass were found on the same side of operation,and 2 cases were in the contralateral side.The shortest time for revision was 2 days and the longest 3 months.After conservative treatment,the symptoms were relieved in only one case.Revision surgeries were performed for all the other 6 cases,2 with microendoscopic discectomy (MED),1 mobile microendoscopic discectomy (MMED),1 small incision operation,1 PTED and 1 with minimal invasive surgery of transforaminal lumbar intervertebral fusion (MIS-TLIF).The VAS scores of low back pain and leg pain was significantly relieved from 8.67±0.52 to 1.50±0.55.Conclusion FTED may lead to residual bone mass in lumbar foraminoplasty.The penetration of the bone mass block into the spinal canal can cause the compression symptoms of the corresponding segment.The patients showed the corresponding spinal canal stenosis and nerve root irritation symptoms.A revision operation is required to remove the oppressed bone mass to relieve the symptoms as soon as possible if the conservative treatment not effective.