Objective To analyze the epidemiologic characteristics and tendency of hemorrhagic fever with renal syndrome (HFRS) in Xi'an from 2005 to 2014,and to grasp the epidemic regularity and predict the trend of HFRS for establishing effective prevention and control measures.Methods The descriptive epidemiological method was used to analyze the epidemic situation of HFRS in Xi'an from 2005 to 2014.The autoregressive integrated moving average (ARIMA) model was applied to analyze,fit and predict the epidemic data of 2015.Results There were 8 500 HFRS patients in Xi'an from 2005 to 2014,the incidence rate was 10.60/100 000.The morbidity increased at first and then decreased from 2005 to 2014;the incidence rate was 9.06/100 000 in 2005 and up to 19.46/100 000 in 2010,then down to 3.43/100 000 in 2014.More cases were reported in spring (15.85％,1 347/8 500) and autumn-winter seasons (72.91％,6 197/8 500).The high-risk age group of HFRS was between 15 to 59 years,accounting for 77.71％ (6 605/8 500) of the overall incidence rate;there were no significant differences in ＜ 15 years,15 to 59 years and ＞ 59 years groups (x2 =15.63,P ＞ 0.05).The male to female ratio was 3.01 ∶ 1.00,male incidence was 15.57/100 000 and female incidence rate was 5.41/100 000,and the difference was statistically significant between gender (x2 =1 948.84,P ＜ 0.05).The main occupation was farmers,accounting for 66.04％ (5 613/8 500) of the overall incidence rate.The top 4 districts were Chang'an,Zhouzhi,Huxian and Lintong;the incidence rate was 31.07/100 000,22.74/100 000,21.09/100 000 and 11.06/100 000,respectively,and the 10 years cumulative incidence rate was higher than the total incidence.The monthly incidence was predicted with ARIMA (1,1,0) × (0,1,1)12 models in Xi'an from 2005 to 2014,and the predicted number of cases was 235 in 2015 (lower than 2014).Conclusions The overall trend of the epidemic has continued to fall but slowly.Positive and effective comprehensive measures should be taken to maintain the incidence of hemorrhagic fever at a lower level.

Objective To describe the clinical features of patients with hemorrhagic fever with renal syndrome (HFRS) in popular period and other period.Methods All the HFRS patients from epidemic areas in Xi' an were surveyed retrospectively.The sociodemographic data,symptom characteristics and laboratory test results were collected.Chi-square test,rank test were used to analyze the data.Results Totally 429 HFRS cases were recruited including 280 male (65.3％) and the male/female ratio was 1.9 ∶ 1.Adults with 16-60 years of age were the main group,which accounted for 74.8％ of the total cases.The constituent ratios of cases with 16-60 years of age in popular period and other period were 76.1％ (245/322) and 71.0％ (76/107),respectively; the sex ratios were 1.93∶1 and 1.74∶1,respectively; the time from fever onset to hospitalization was 3 d and 4 d,respectively; the time of hospitalization was both 10 d; the proportions of emergency cases were 59.8％ (189/316) and 67.6％ (71/105),respectively; the proportions of cured cases were 56.4％ (181/321) and 43.4％ (46/106),respectively.The clinical features were not significantly different between popular period and other period (all P＞0.05).The immunoglobulin M (IgM) antibody positive rate was 85.4％ (315/369) and those in popular period and other period were 88.4％ (251/ 284) and 75.3％ (64/85),respectively (x2 =8.968,P＜0.01).There was a positive correlation between symptom severity and outcome of discharge (x2=18.558,P＜ 0.01),the more slight symptoms were related with the better outcome.Conclusion The clinical features are similar in cases from popular period and other period from Jan 2008 to Jun 2011.

Objective To describe the vaccine inoculation rate of hemorrhagic fever with renal syndrome (HFRS) and the movement characteristics of rural population in the Xi'an epidemic area.Methods This was a cross-sectional study.The study covered all the four HFRS traditional high incidence areas (counties):Zhouzhi,Huxian,Chang'an and Lintong.Three villages were selected in each county and 20 households were selected in each village in 2013.Participants included all the persons of these families.People 16-60 years old were interviewed face to face about their sociodemographic and environmental information,and at the same time related HFRS vaccine history and characters of migrant workers were collected.Results Nine hundred and ninety-six persons were investigated,69.3 percent (690/996) were vaccinate-age population.Of all,49.0 percent (338/690) had HFRS vaccine history and 53.9 percent (372/690) had worked away from home most of the year.The inoculation proportion of workers which worked in their own counties (56.8％,67/118) were higher than that of workers worked outside (37.0％,60/162;39.1％,36/92,x2 =10.74,6.44,all P ＜ 0.017).In the workers that went back home every week,60.3 percent (76/126) had vaccinated.Workers that went back home once a year had the lowest proportion of inoculation (16.7％,7/42).The morbidity of HFRS decreased significantly accompany with ascend of inoculation rate (Y =-0.524X + 38.319,t =-4.581,P ＜ 0.05).Conclusions After the free vaccinations,there is still a gap between the vaccine inoculation rate and prevention benefit.The current vaccination strategies need to be adjusted.

Objective To study the risk factors of hemorrhagic fever with renal syndrome (HFRS) in children and adolescents in Xi'an City.Methods HFRS laboratory confirmed cases aged under 16 from January 2013-December 2015 were selected,which were reported by Information System of Disease Prevention and Control of the People's Republic of China.A 1:1 matched case-control study was adopted to retrospective investigate the risk factors.Logistic regression analysis was used to analyze relationships between various factors and HFRS in single factor analysis,the influence factors in the single factor analysis with statistical significances were further analyzed in the multiple factors analysis.Results Eighty-eight matched pairs were investigated.Single factor Logistic regression analysis found that non-nuclear family [odds ratio (OR) =20.25,95％ confidence interval (CI):2.32-76.80],less hand washing frequency before meals (OR =3.67,95％CI:1.40-9.62),the river or pond around the place (OR =1.55,95％CI:1.32-2.94),sit on the hay and play (OR =1.36,95％CI:1.17-1.80),eating in the snack bar (OR =8.33,95％CI:1.78-9.47),do not spray water when sweeping the floor (OR =2.22,95％CI:1.24-4.12),living in the edge of village (OR =1.55,95％CI:1.32-2.94),and keeping pets in the home (OR =12.00,95％CI:1.12-28.84) were associated with HFRS.In multiple factors Logistic regression analysis,risk factors according to the contribution value from high to low in the order were keeping pets in the home (OR =5.40,95％CI:1.78-16.32),less hand washing frequency before meals (OR =3.96,95％CI:1.89-7.23),living in the edge of village (OR =2.42,95％CI:1.82-5.50),and the river or pond around the place (OR =2.21,95％CI:1.86-2.49).Conclusion Risk factors as keeping pets in the home,less hand washing frequency before meals,living in the edge of village,the river or pond around the place are likely risk factors of HFRS.

Objective To establish a flow cytometric measurement of detecting minimal residual disease(MRD) according to the leukemia-associated immunophenotypes in children with acute lymphoblastic leukemia(ALL) and to explore the significance of MRD detection in ALL children for a individualized treatment. Methods A variety of four-color fluorescent antibody combinations were used to investigate the children's normal bone marrow. The normal bone marrow pattern at two-parameter plots was established to identify the residual tumor cells, seventy-five bone marrow samples from newly diagnosed ALL children were analyzed with four-color cytometry to determined the optimal combinations which can clearly distinguish the tumor cells from normal cells. The bone marrow samples were monitored with the combination panel in 60 patients at the end of induction therapy and follow-up treatment. Cytomorphology test, PCR amplification of 29 fusion genes as well as IgG and TCR gene rearrangements were performed simultaneously. Results Sixty-nine cases (92.0%) could be identified for effective antibody combinations to monitor MRD by four-color cytometry. Fusion genes or IgG and T cell receptor (TCR) gene rearrangements can be detected in 21 cases (28.0%) to monitor MRD by PCR. No MRD can be detected in 25 bone marrow samples at the end of induction therapy and follow-up treatment. Four-color cytometry could detect as low as 0.021%-4.130% residual leukemia cells. Conclusion MRD can be monitored by flow cytometry which is faster than PCR, and the sensitivity is superior to morphology method.

OBJECTIVE To study the audiological and etiological characteristics of infants failed to pass hearing screening. METHODS 126 infants received audiological diagnostic tests,including auditory brainstem response(ABR),40 Hz auditory event related potential(40 Hz AERP),distortion product otoacoustic emissions(DPOAE),tympanometry and acoustic reflex. The degrees and types of the hearing loss,and etiological characteristics were analyzed. RESULTS Among 126 infants (252 ears),61 were diagnosed with sensorineural hearing loss(48.41%),48 were conductive hearing loss(38.09%),and 17 were found to have normal ABR thresholds(13.49%). The hearing loss was associated with various factors,including history of infection during pregnancy(21 cases),threatened abortion(9 cases),pregnancy with age at or over 35(6 cases),extension of pregnancy(7 cases),history of systematic diseases(10 cases),history of neonatal jaundice(13 cases),history of asphyxia and hypoxia(18 cases),premature and low birth weight neonates(8 cases),neonatal diseases (8 cases),family history of deafness(5 cases),craniofacial deformity(3 cases),central nervous system disorder(6 cases),and 9 cases were second child. CONCLUSION The infants who failed to pass hearing screening have various etiology characteristics in hearing loss. The infants associated with risk factors were mostly found to have sensorineural hearing loss.

Objective To investigate the effects of the intervention,rehabilitation and speech development of children with severe hearing loss in some rural areas.Methods 61 children,including 35 males and 26 females,were diagnosed as severe hearing loss with ABR and 40 Hz-AERP from June 2004 to July 2008.All the children failed hearing screening or visited the hospital as outpatients.The ages ranged from 2 to 72 months with the average age of 17.59 months.During telephone follow-up,the questionnaire was used to gather the data regarding the usage of hearing aids,hearing and speech rehabilitation,speech development,and communication abilities.Results 33 (54.10%) children were fitted with hearing aids,and 2 (3.28%) received cochlear implants,while 26(42.62 %) neither had hearing aids nor cochlear implants.10 cases with hearing aids also had speech training,whereas 23 children with hearing aids did not receive the training.2 cases with cochlear implants and 2 cases with hearing aids were found to have good speech development and communication ability,while 31 cases with hearing aids had delayed speech development.26 cases without any devices had to rely on sign language for their commumication.Conclusion Children in rural area with severe hearing loss experience greater speech and communication difficulties because many of them have no access to intervention and speech training.The results suggest that it would be very important to increase public awareness and educate parents to have their children wear hearing aids and receive speech training.

Objective:To investigate the influencing factors for pancreatic endocrine and exocrine insufficiency after pancreaticoduodenectomy.Methods:The retrospective case-control study was conducted. The clinicopathological data of 168 patients who underwent pancreaticoduodenectomy in the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2017 were collected. There were 96 males and 72 females, aged (64±13)years, with a range from 38 to 75 years. Of the 168 patients, 36 had pancreatic endocrine insufficiency while 8 had pancreatic exocrine insufficiency preoperatively. All patients underwent pancreaticoduodenectomy. Observation indications: (1) surgical situations and follow-up; (2) analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy; (3) analysis of influencing factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Follow-up using out-patient examination and telephone interview was performed to detect postoperative condition of blood glucose control, diet and nutrition, tumor recurrence and metastasis up to June 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Surgical situations and follow-up: all the 168 patients underwent pancreaticoduodenectomy successfully and recovered well after operation. All patients were followed up for 6 months. The level of fasting and postprandial blood glucose of the 168 patients after surgery were 7 mmol/L(range, 5-9 mmol/L) and 10 mmol/L(range, 7-14 mmol/L), respectively. The defecation frequency was (2.4±1.2)times per day. No tumor recurrence or metastasis occurred in either patient. One hundred and thirty-two of the 168 patients were included in the study excepting patients with pancreatic endocrine insufficiency before operation. At postoperative 6 months, 47 patients developed pancreatic endocrine insufficiency, with an incidence of 35.61%(47/132). One hundred and sixty of the 168 patients were included in the study excepting patients with pancreatic exocrine insufficiency before operation. At postoperative 6 months, 68 patients had pancreatic exocrine insufficiency, with an incidence rate of 42.50%(68/160). (2) Analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that gender, metabolic syndrome, chronic pancreatitis, excision point, and postoperative chemotherapy were the related factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy ( χ2=5.300, 6.270, 4.473, 4.392, 5.397, P<0.05). Results of multivariate analysis revealed that male and metabolic syndrome were independent risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy [ hazard ratio ( HR)=5.252, 5.364, 95% confidence interval ( CI): 1.362-6.382, 1.891-12.592, P<0.05)]. (3) Analysis of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that body mass index (BMI), chronic pancreatitis, total bilirubin, excision point, postoperative pancreatic fistula as grade B or C, and pancreatic fibrosis were related factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( χ2=1.691, 4.910, 7.763, 5.605, 4.663, 7.700, P<0.05). Results of multivariate analysis showed that BMI<18.5 kg/m 2, chronic pancreatitis, total bilirubin ≥171 μmol/L were independent risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( HR=3.695, 5.231, 7.623, 95% CI: 1.232-7.324, 2.161-6.893, 1.562-5.235, P<0.05). Conclusions:Male and metabolic syndrome are risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. BMI<18.5 kg/m 2, chronic pancreatitis, and total bilirubin ≥171 μmol/L are risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy.

Objective:To identify the risk factors of clinically relevant pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) for Vater′s ampullary carcinoma.Methods:The clinical data of 93 Vater's ampullary carcinoma patients who had undergone PD in Nanjing Drum Tower Hospital from January 2018 to December 2020 was retrospectively analyzed. According to the occurrence of CR-POPF, all patients were divided into the CR-POPF group and no CR-POPF group. Univariate analysis and multivariate analysis by logistic regression model were performed for perioperative risk factors of CR-POPF to identify the independent risk factors for CR-POPF after PD for Vater's ampullary carcinoma.Results:44 patients developed CR-POPF and the rate of CR-POPF was 47.3%(44/93). The most frequently detected microorganisms from abdominal drain fluid after operation were Klebsiella pneumoniae (25.8%), Enterococcus faecalis (19.4%), Enterobacter cloacae (11.8%) and Enterococcus faecium (10.7%). The results of univariate analysis showed that operation time, C-reactive protein (CRP) on postoperative day (POD)1, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium in the abdominal drainage were statistically different between the two groups (all P value <0.05). Multivariate analysis revealed that CRP on POD1 ( OR 1.029, 95% CI 1.003-1.055, P=0.026), Klebsiella pneumoniae( OR 8.671, 95% CI 2.366-31.772, P=0.001), Enterococcus faecalis( OR 10.497, 95% CI 2.306-41.776, P=0.002) and Enterococcus faecium ( OR 22.580, 95% CI 2.303-221.403, P=0.007) in the abdominal drainage were independent risk factors for the development of CR-POPF after PD for Vater′s ampullary carcinoma. Conclusions:CRP on POD1, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium in the drain samples were independent risk factors for the development of CR-POPF after PD for Vater′s ampullary carcinoma.

Objective:To analyze the epidemiological characteristics and tendency of hemorrhagic fever with renal syndrome (HFRS) in Xi'an, master its popular and development laws, and provide scientific basis for formulating targeted prevention and control measures.Methods:The retrospective method was used to collect HFRS epidemic data and demographic data from 2009 to 2018 in Xi'an. The descriptive epidemiological method was used to analyze the three distributions (time, region, population distributions) of HFRS.Results:There were 8 710 HFRS cases in Xi'an from 2009 to 2018, with an average annual incidence of 10.13/100 000 and an average annual mortality rate of 0.08/100 000; the incidence of HFRS had decreased year by year since the peak incidence in 2010 (19.46/100 000), and had rebounded in 2017 (9.14/100 000), 2018 (9.04/100 000). The time distribution of the onset of HFRS was bimonthly, with peak in autumn and winter (October to January of following year) each year, accounting for 74.08% (6 452/8 710) of the total number of cases; the peak in spring and summer (May to July) accounted for 14.33% (1 248/8 710). HFRS cases were mainly concentrated in Chang'an District (2 446 cases), Zhouzhi County (1 494 cases), Hu County (1 170 cases), and Lintong District (940 cases), accounting for 69.46% (6 050/8 710). The age of onset of HFRS cases was mainly concentrated in 15-59 years old, accounting for 74.06% (6 451/8 710); the incidence rate in males was 14.77/100 000, in females was 5.25/100 000, the difference was statistically significant between gender (χ 2=1 921.42, P < 0.05); the occupational distribution was mainly farmers, accounting for 68.38% (5 956/8 710). Conclusions:From 2009 to 2016, the HFRS epidemic situation in Xi'an has showed a downward trend, and the incidence of HFRS has rebounded in 2017-2018. Xi'an should continue to take active and effective comprehensive measures to intervene to further realize effective control of HFRS.