Urinary albumin used as an important indicator in diagnosis of renal disease , but there are still many problems in the clinical application .The urine specimen type , threshold value , reference measurement procedures and some more aspect were summarized in this article .

Objective To investigate the urinary albumin excretion of the diabetes patients and application value in the monitoring of early impairment in kidney. Methods The random urine samples from diabetes patients and controls within three days were collectod. The changes of urinary albumin excretion within day and between days were analyzed. 24-hour urine albumin was used as a standard to evaluate early kidney damage. The correlations between results of random urine albumin at the different time points and different periods were comparod. The sensitivity and specificity of random urine albumin at the different time points and different periods was evaluated and compared to deduce the best diagnostic porformance of the random urine albumin. Results There are greater variations of the levels of urinary albumin of patients with diabetes and control. After the correction with urine creatinine and urine volume the variations can be reduced (CV:49%±23% and 64%±30%). Urinary albumin excretion rate change rhythmically within the 24 h in healthy and diabetes patients. We found the best correlation between overnight ratio of urinary concentrations of albumin and creatinine (ACR) and 24-hour urinary albumin (R2 = 0.976). It was superior to urina sanguinis (R~2 = 0.900), postprandial urine (R~2 = 0.584) and random urine (R~2 =0.791). When 24 h urinary albumin was taken as the standard, receiver operating characteristic (ROC) curve analysis showed there was significant difference between male and female(male 12.8 μg/mg urine creatinine vs female 27.0 μg/mg urine creatinine),and the the cut-off value of ACR was 27.7μg/mg urine creatinine. When the smallest available negative likelihood ratio (0.011) and the greatest positive likelihood ratio (481.000) were obtained,the concentration of 13.0 μg/mg creatinine and 87.4 μg/mg creatinine were set as the cut-off value of ACR. Conclusions The correction with urinary creatinine can reduce the variation between-days compared with urine volume, but still can not completely eliminate the variability. The ACR of overnight urine has the best correlation with the 24 h urinary albumin and can replace 24 h urinary albumin. Random urine as the most convenient collecting urine samples can also replace 24-hour urinary albumin, but the gender discrepancy need to be considered. When the concentration of 13.0 μg/mg and 87.4 μg/mg was set as a random ACR exclusion value and the confirmative value, it can basically rule out and confirm the existence of microalbuminuria.

Two non-destructive instrumental methods, infrared spectroscopy (IR) and X-ray diffraction (XRD), were studied for quality evaluation of Lobelia chinensis Lour. (L. chinensis). We obtained the IR spectra and XRD patterns of L. chinensis collected from different sources. The similarity of samples was analyzed by cal-culating the cosine coefficient. The cosine values were in the range of 0.83–0.90, indicating that the main components of L. chinensis samples are similar. Sample L1 and L6 showed a slightly lower similarity than that of L2, L3, L4, L5 detected by the two methods, which revealed that IR and XRD methods exhibited analogous detection ability for quality evaluation of L. chinensis. The two methods could be highly re-commended as simple and rapid detection means for quality evaluation of L. chinensis.

Objective: To investigate the epidemiologic characteristics of Norovirus among adult patients suffering from infectious diarrhea in Shanghai, so as to provide evidence for developing related strategies on prevention and control of the disease. Methods: Diarrheal outpatients were monitored at the 'Intestinal clinic’ from 22 hospitals involved in the sentinel surveillance program in Shanghai. Information on demographic and epidemiologic features of the patients was collected while data and clinical, fecal specimens were collected and sent to the district CDC for Norovirus detection. Positive rates of Norovirus were also compared in various populations and seasons during 2013-2018. Multivariate logistic regression model was adopted to fit into the comparisons between non-Norovirus and Norovirus groups. Results: 19.28% of the 12 083 diarrheal cases were found to have carried the Norovirus, with GⅡgroup the most commonly identified genotype. Rates of detection was seen higher in males (20.78%) than in females (17.73%). 30-44 year-old were found having the highest positive rate (21.51%). The positive rates were found the highest (23.60%) in the year of 2015. All the above shown differences were statistically significant (P<0.05). Diarrheal patients affected with Norovirus would present watery stool (75.94%) and vomiting (35.84%). Data from the multivariate logistic analysis showed that factors as: being males, 30-44 years old, officials/clerks, in winter season and with histories of travelling etc., were related to higher risks on Norovirus infection. Conclusions Infectious diarrhea caused by Norovirus occurred all year round, with seasonal peaks seen in winter and spring, in Shanghai. Specific prevention and control measures should be taken on Norovirus- caused infectious diarrhea, according to the difference on age, gender and season.

We report a case of a 44-year-old female patient with acute liver failure and hepatic encephalopathy. The patient received artificial liver treatment and underwent allogeneic orthotopic liver transplantation at 14 days after admission. Laboratory examination reported a small number of green cytoplasmic inclusions in neutrophils on the peripheral blood smear at 68 days after admission. The patient eventually died of liver failure at 71 days after admission. Green inclusions are bright green or blue-green inclusions presented in the cytoplasm of neutrophils in Wright-Giemsa stained peripheral blood smears, and is associated with liver failure and high short-term mortality.

Purpose: Caspase recruitment domain containing protein 9 (CARD9) has been demonstrated to be a pro-tumor factor in various cancers. However, our previous study found a significant decrease of CARD9 in malignant pleural effusion compared with benign pleural effusion. So we investigated the role of CARD9 in non-small cell lung cancer (NSCLC) and its working mechanism. Materials and Methods: Immunohistochemistry, western blot, and quantitative real-time polymerase chain reaction were used to detect the expression of CARD9 in specimens of NSCLC patients. The Cancer Genome Atlas (TCGA) databasewas also used to analyze the expression of CARD9 in NSCLC and its predicting value for prognosis. Immunofluorescence was used for CARD9 cellular location. Cell growth assay, clonal formation assay, wound healing assay, matrigel invasion assay, and flow cytometry were used to test cell proliferation, migration, invasion, apoptosis, and cycle progression of NSCLC cells with CARD9 knockdown or CARD9 overexpression. Co-immunoprecipitation was used to identify the interaction between CARD9 and B-cell lymphoma 10 (BCL10). SB203580 was used to inhibit p38 activation. Results: CARD9 was decreased in NSCLC tissues compared with normal tissues; low CARD9 expression was associated with poor survival. CARD9 was expressed both in tumor cells and macrophages. Downregulation of CARD9 in NSCLC cells enhanced the abilities of proliferation, invasion and migration via activated MAPK/p38 signaling, while overexpression of CARD9 presented antitumor effects. BCL10 was identified to interact with CARD9. Conclusion We demonstrate that CARD9 is an independent prognostic factor in NSCLC patients and inhibits proliferation, migration, and invasion by suppressing MAPK/p38 pathway in NSCLC cells.

Objective To introduce the establishment of Shanghai Diarrhea Comprehensive Surveillance System ,and to analyze the epidemiological and etiological characteristics of infectious diarrhea outpatients in Shanghai based on data of Shanghai Diarrhea Comprehensive Surveillance System .Methods Diarrhea patients were surveyed according to a unified designed questionnaire ,who visited one of 22 adult sentinel hospitals and 4 children sentinel hospitals of Shanghai Diarrhea Comprehensive Surveillance during September 2013 to August 2016 .Stool specimens were collected according to different sampling intervals and detected for 12 bacteria and 5 viruses .Characteristics of diarrhea patients were compared and analyzed .Chi-square test was used for statistical analysis .Results Of 4497 infectious diarrhea patients ,the detection rate of viral infection was 29 .77％ ,of which norovirus infection (16 .33％ ) , rotavirus infection (7 .90％ ) and sapovirus infection (1 .90％ ) were dominated . The detection rate of bacterial infection was 15 .38％ ,diarrheagenic E .coli (DEC) infection (5 .25％ ) ,V . parahaemolyticus infection (4 .27％ ) and Salmonella spp .infection (3 .13％ ) .Mixed infection accounted for 11 .07％ .The detection rate ,the infection types and the predominant pathogens in different age groups were statistically different (χ= 18 .11 ,61 .86 and 449 .52 ,respectively ,all P< 0 .01) .DEC ranked first in 3 - 14 years age group , and norovirus ranked first in all other age groups .The pathogen spectrum of infectious diarrhea patients≥ 15 years old showed obvious seasonal changes ,with mainly bacterial infection in summer (peaked in August ,accounting for 81 .56％ ) and mainly viral infection in winter (peaked in January ,accounting for 95 .27％ ) .Norovirus ranked first through the year ,except January ,June ,July and August .Among patients ≥ 15 years old , abdominal pain , fever and loose stools were main symptoms in bacterial infections .Vomiting and watery stool were main symptoms in viral infections . Loose stools appeared frequently in patients ≤ 14 years old .Conclusions Diarrhea Comprehensive Surveillance System based on scientific design and rational distribution is beneficial for understanding the epidemic trends and pathogen characteristics of diarrhea .Viral infections are predominant in infectious diarrhea patients in Shanghai . Norovirus and rotavirus are the most common diarrheal pathogens .The pathogen spectrum of infectious diarrhea patients shows obvious seasonal changes .DEC is common in diarrhea patients ≤ 14 years old . The clinical symptoms of infectious diarrhea caused by different pathogens are different . Targeted preventive measures should be taken for infectious diarrhea of different ages ,different pathogens ,and in different seasons .

Objective: To analyze the pathogen spectrum and epidemiological characters of infectious diarrhea cases in Shanghai from July 2013 to June 2015. Methods: From July 2013 to June 2015, using multi-stage sampling to select 22 hospitals as adult diarrhea surveillance sentinels, and 3 district central hospitals together with Shanghai municipal children's hospital as children diarrhea surveillance sentinels. A total of 6 267 diarrhea cases were sampled. The demographic characters, main clinical manifestations and signs of cases were investigated, and stool specimens were collected to conduct the bacteria culture and virus nucleic acid detection. The difference of positive rate of bacteria and virus in different seasons, and age difference of relevant pathogens were compared. Results: Among 6 267 cases, 3 262 (52.05%) were male, and most of them were in 50-69 years group (1 999 cases, 31.90%) and 30-49 years group (1 691 cases, 26.98%). Totally, 2 783 positive specimens were detected out of 6 267 specimens with the positive rate being 44.41%. A total of 7 kinds of bacteria and 5 kinds of viruses were detected. The positive rate for bacterium was 12.61%(790 cases), mainly being vibrio parahaemolyticus (256 cases), diarrheagenic E.coli (239 cases) and salmonella (209 cases). The positive rate for virus was 31.80% (1 993 cases), mainly being norovirus (1 172 cases) and rotavirus (546 cases). The positive rates of viruses in winter of 2013 and 2014 were 57.89%(429 cases) and 62.14%(522 cases) respectively, higher than those of bacterium in the same periods which were 2.43% (18 cases) and 2.86% (24 cases) respectively. The positive rates of bacterium in summer of 2013, 2014 and 2015 were 14.56% (97 cases), 25.29%(258 cases) and 21.21% (49 cases), also higher than those of viruses in the same periods which were 7.51% (50 cases), 8.43%(86 cases) and 11.69% (27 cases) respectively, all of the above differences were statistically significant (P<0.05). The cases of 50-69 years group had the highest positive rate of pathogen, which was 47.57% (951/1 999). Secondly was those of 30-49 years group with 47.13% (797/1 691). Positive rate of pathogen for cases of 0-2 years group was 35.74% (213/596). Conclusion The pathogen spectrumes of infectious diarrhea in Shanghai are mainly vibrio parahaemolyticus, diarrheagenic E.coli, salmonella, norovirus and rotavirus. The summer and winter season peak was obvious. Specific etiological surveillance and control strategies should be strengthened aiming at focus groups including children and the elderly in different seasons.

Objective To understand the epidemiologic characteristics of confirmed and suspected norovirus outbreaks in Shanghai during 2010-2014.Methods The investigation reports of confirmed and suspected norovirus outbreaks in Shanghai from 2010 to 2014 were analyzed.Results A total of 80 norovirus outbreaks, involving 2 399 cases, were reported during this period, and the overall attack rate was 4.17％.The median of the outbreak duration was 4.5 days and the incidence peaked 2 days later averagety for an outbreak.The outbreaks mainly occurred in autumn and winter,53 outbreaks occurred during October-February, accounting for 66.25％.Seventy five outbreaks occurred in schools, child care settings and nursing houses, accounting for 93.75％.The attack rates in hospitalized patients and the elders in nursing houses were higher than those in pre-school and school aged children, the differences were statistically significant (x2=683.12, P＜0.01).The attack rates in medical staff and nurses in hospitals and nursing houses or staff in pre-schools and schools were lower.Vomiting, the main clinical symptom, occurred in 1 900 cases (79.20％), diarrhea and fever developed in 694 cases (28.93％) and 364 cases (15.17％) respectively.The differences were statistically significant (x2 =2 251.48, P＜0.01).The outbreaks were mainly caused by short common exposures and contact with cases.Conclusion The surveillance for norovirus infection should be strengthened in hospitals, schools and others with the crowed during autumn-winter.The protection of risk population should be enhanced.

Objective:To understand the epidemiological and pathogenic characteristics of Legionella in artificial water environment of public places in Shanghai from 2011 to 2018, and to provide scientific basis for the prevention and control of Legionellosis.Methods:A total of 4 817 samples of artificial water environment were collected from 31 public places in Huangpu, Jing′an, Xuhui and Songjiang districts of Shanghai from 2011 to 2108. Epidemiological characteristics of the collected years and months, regional and site types, and sample types were analyzed. After treatment, culture and isolation of the collected water samples, the positive samples were analyzed for Legionella typing characteristics.Results:The positive rate of Legionella pneumophila was 21.57% (1 039/4 817), of which 96.25% (1 000/1 039) was single type, 84.31% (876/1 039) was Legionella pneumophila type 1, followed by Legionella pneumophila type 7 and 6, which accounted for 4.72% (49/1 039) and 3.75% (39/1 039), respectively, and 29 (29/1 039) were multi-type positive. Further typing. From May to October, the highest positive rates were found in July and August, 27.61%(222/804)and 28.61% (230/804)respectively. There were significant differences between different months ( P<0.001); the highest positive rates were found in central air-conditioning cooling water and chilled water (32.40%) and there were significant differences among different water samples ( P<0.001). Legionella pneumophila type 1, type 7 and type 6 were the main diversity distribution characteristics in artificial water environment of different regions, different time, different places and different types of public places. Legionella pneumophila type 1 accounted for the highest proportion, and the proportion of positive samples under different epidemiological characteristics was more than 71.64%. Conclusion:There is relatively serious pollution of Legionella pneumophila type 1 in the artificial water environment of public places in Shanghai. It is necessary to strengthen the disinfection of cooling water/freezing water of central air conditioning in public places in July and August every year.