Objective To study the epidemiological characteristics and influencing factors of hand-foot-mouth dis-ease(HFMD)outbreaks in kindergartens,so as to provide reference for control and prevention of HFMD. Methods Papers published between 2009 and 2015 about HFMD outbreaks in kindergartens were retrieved from Wanfang database and China National Knowledge Infrastructure (CNKI),then collected papers were analyzed. Results Data about 39 cases of HFMD outbreaks were obtained,35 cases occurred in 2008-2012,1 case occurred respectively in 2007,2013,2014,and 2015. 33.34% and 23.08% of outbreaks occurred in May and April. Out-breaks lasted 5-52 days,with a median of 11 days,30.77% of outbreaks lasted more than 2 weeks. The attack rates of the whole kindergartens were 1.90% -39.74% ,attack rates of whole kindergartens were 5% -15% a-mong 65.79% of outbreaks,attack rate of whole kindergartens was >20% among 13.16% of outbreaks. 85.71%of outbreaks involved more than 20% of classes,25.71% of which involved all classes. Both EV71 and CoxA16 caused HFMD outbreaks in kindergartens,two kinds of viruses were both detected in some outbreaks;there were no significant difference in attack rate of whole kindergartens,attack rate of classes with highest incidence,class in-volving rate,and duration of epidemic between EV71 and CoxA16 epidemic groups(all P>0.05).Conclusion Once an HFMD outbreak occurred in a kindergarten,epidemic intensity would be high,both EV71 and CoxA16 can cause HFMD outbreak. There is no obvious correlation between class size and attack rate.

The enrollment of international medical students has been expanding.How to improve the quality of medical education is a key point.To explore a better way and method to improve the quality of the medical teaching for foreign students in China,the preliminary experi-ences of teaching of Clinical Diagnostics for foreign students are reviewed.

Objective To screen a sensitive method for detecting respiratory viruses from three different methods of singleplex conventional PCR , multiplex conventional PCR and multiplex real-time RT-PCR.Methods Parallel examination of 17 respiratory viruses was performed on 73 throat swab specimens collected from patients with upper respiratory tract infection by the three methods .The detection rates of dif-ferent respiratory viruses were used as evaluating indicator for the three methods .Results The numbers of respiratory viruses detected by singleplex conventional PCR , multiplex conventional PCR and multiplex real-time PCR were 56, 41 and 87, respectively.Conclusion The multiplex real-time RT-PCR might be used for the detection of respiratory viruses in laboratory as its high detection rate in comparison with the other two methods .

BACKGROUND: Present therapeutic tool cannot supplement infarct myocardium. Studies have shown that stem cell transplantation can promote regeneration of myocardium and vessels and improve heart function and prognosis.OBJECTIVE: To observe changes in morphology and hemodynamics in myocardium following embryonic stem cell transplantation in and surrounding the acute myocardial infarct site.DESIGN, TIME AND SETTING: The randomized, controlled, animal study was performed at the Laboratory of Neurobiology,Department of Human Anatomy and Neurobiology, Xiangya Medical College, Central South University from March 2007 to October 2008.MATERIALS: A total of 40 SPF grade Wistar rats were equally randomized into 4 groups, normal control, infarct model,central transplantation and peripheral transplantation groups. Embryonic stem cells-D3 (ES-D3) and Buffalo rat hepatocytas were supplied by Shanghai Cell Institute, Chinese Academy of Sciences.METHODS: Following resuscitation, ES-D3 cells at (2.0-5.0)×107/L were incubated in a flask, and induced to in vitro differentiate in conditioned medium containing Buffalo rat hepatocytes. Except normal control group, rat models of acute myocardial infarction were established by ligating left anterior descending coronary artery in the infarct model, central transplantation and peripheral transplantation groups. At 1 week following model induction, ES-D3 cells were labeled by BrdU for 1 day, and implanted at 1×109/L. Three sites were selected in the infarct site in the central transplantation group. 10 μ L cell suspension (104 cells) was implanted in the ventricular wall through each site. In the peripheral transplantation group, an equal volume of cell suspension was separately implanted in three peripheral infarct sites by the same method.MAIN OUTCOME MEASURES: Results of immunohistochemistry and hemodynamics were measured.RESULTS: ES-D3 cells in buffalo rat hepatocyte conditioned medium presented regular colony-shaped. At 8 days following differentiation, some embryo proper had spontaneous rhythmic contraction, showed positive reaction of cardiac troponin T after immunostaining. Under the electron microscope, myotube and muscle fiber appeared, which verified the differentiation of cardiomyocytes. Cells were positive for BrdU in the peripheral transplantation group, but negative in the central transplantation group. Cells were also positive for cardiac troponin T. 4 weeks following transplantation, left ventricular systolic pressure,minimum/maximum rate of ventricular pressure (±dp/dtmax) were significantly reduced (P ＜ 0.01), but left ventricular end diastolic pressure was significantly increased (P ＜ 0.01), left ventricular mass and left ventricular mass index were significantly increased (P ＜ 0.01 ) in the infarct model group compared with the normal control group. Compared with the infarct model group, no significant changes in hemodynamics indices were found in the central transplantation group (P ＞ 0.05); left ventricular systolic pressure, ±dp/dtmax were significantly increased (P ＜ 0.01), left ventricular end diastolic pressure was significantly decreased (P ＜ 0.01 ), left ventricular mass, left ventricular mass index and infarct area were significantly reduced(P ＜ 0.01) in the peripheral transplantation group.

OBJECTIVETo observe the therapeutic effects of continuous plasma filtration absorption (CPFA) treatment on burn sepsis.

METHODSThirty burn patients with sepsis hospitalized in Beijing Fengtai You'anmen Hospital from July 2009 to October 2012 were treated by CPFA for twice besides routine treatment. The blood samples were collected at five sites (A, B, C, D, and E, respectively) of blood purification equipment before and after CPFA, before and after hemoabsorption, and before hemofiltration. The plasma levels of TNF-α, IL-1β, IL-6, IL-10, interleukin-1 receptor antagonist (IL-1RA), soluble tumor necrosis factor receptor (sTNFR) I , and sTNFR-II from sites A, C, and E were determined with ELISA before CPFA was performed for the first time, and those from sites B and D were determined with ELISA after CPFA was performed for the first time. Plasma levels of the above-mentioned cytokines from sites A and B were determined with ELISA before CPFA and after CPFA was performed for the second time. The data of plasma levels of IL-1βP3, IL-1RA, sTNFR-I, sTNFR-II, and TNF-α before CPFA and after CPFA was performed for the second time were collected for calculation of the ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α. The expression rate of human leukocyte antigen DR (HLA-DR) on the CD14 positive monocytes, acute physiology and chronic health evaluation (APACHE) II score, body temperature, pulse, respiratory rate, and leukocyte count of patients were evaluated or recorded before CPFA and after CPFA was performed for the second time. Patients'condition was observed. Data were processed with paired t test.

RESULTSThe plasma levels of TNF-α, IL-1β, IL-6 and IL-10 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the first time (with t values respectively 7.05, 5.23, 4.73, 2.37, P values below 0.01). After CPFA was performed for the first time, the plasma levels of TNF-α, IL-1β, and IL-6 from site D were significantly lower than those from site C before CPFA was performed for the first time (with t values respectively 5.48, 2. 17, 1.78, P < 0.05 or P <0.01). The plasma levels of all cytokines were close between site B after CPFA was performed for the first time and site E before CPFA was performed for the first time (with t values from 0.04 to 1.05, P values above 0.05). The plasma levels of TNF-α, IL-1β, and IL-6 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the second time (with t values from 1.87 to 5.93, P <0.05 or P <0.01). The ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α, and expression rate of HLA-DR were increased significantly after CPFA was performed for the second time as compared with those before CPFA (with t values from 3.99 to 7. 80, P values below 0.01). APACHE II score after CPFA was performed for the second time was 11 ± 6, which was lower than that before CPFA (22 ± 7, t =4.63, P <0.01). After CPFA was performed for the second time, body temperature, pulse, and respiratory rate of patients were improved (with t values from 1.95 to 3.55, P values below 0.05) , and the leukocyte count was significantly decreased (t =4.36, P <0.01) as compared with those before CPFA. All patients survived and were discharged with length of stay of (27 ± 31) d, and no adverse effects occurred during CPFA treatment.

CONCLUSIONSCPFA, which combines hemoabsorption and hemofiltration, can facilitate the treatment of burn sepsis by decreasing the level of pro-inflammatory cytokines efficiently, alleviating systemic inflammatory response, and improving the immune status.

Adsorption ; Aged ; Biomarkers ; blood ; Burns ; blood ; complications ; immunology ; Cytokines ; blood ; Fluid Therapy ; Hemofiltration ; methods ; Hospitalization ; Humans ; Inflammation Mediators ; blood ; Interleukin 1 Receptor Antagonist Protein ; blood ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Sepsis ; blood ; immunology ; therapy ; Treatment Outcome ; Tumor Necrosis Factor-alpha

Objective To investigate the effect of early intervention on general movements (GM) in preterm infants during fidgety movement. Methods 315 preterm infants during fidgety movement period were divided into intervention group (n=160) and control group (n= 155). The intervention group accepted very early intervention program consisted of hospital intervention and family intervention, and the control group accepted routine treatment and nursing. The incidences of different kinds of GMs were compared. Results There is no statistical difference (χ2=0.641, P=0.726) in writhing movement before intervention, and the fidgety movement presented more in the intervention group than in the control group (χ2=8.710, P=0.003), while the absence of fidgety movement was significantly fewer (χ2=5.685, P=0.017) after intervention. Conclusion Very early intervention can reduce the incidence of absence of fidgety movement and improve fidgety movement.

BACKGROUND: Conventional hemodialysis mainly for cleaning uremic micro molecule substance, such as urea nitrogen or creatinine; however, few hemodialyses can clean uremic middle molecule substances (MMS). With prolonged dialysis duration, MMS accumulates in vivo and induces a series of complications. OBJECTIVE: To compare the efficiency of adsorptive dialysis (hemoperfusion unites hemodialysis) and conventional hemodialysis in cleaning uremic MMS. METHODS: Totally 60 maintenance hemodialysis patients were averagely divided into the adsorptive dialysis group and conventional hemodialysis group. First of all, hemoperfusion apparatus and dialyser were connected in series to take the adsorptive dialysis in the adsorptive dialysis group (hemoperfusion apparatus were equipped before dialyser). 120 minutes later, the hemoperfusion apparatus was toke off and continues to hemodialysis for 120 minutes. Duration of conventional hemodialysis was 240 minutes. Changes in clinical symptoms and levels of liver function, kidney function, serum electrolytes, hemocytes and uremic MMS were observed prior to and after treatment. RESULTS AND CONCLUSION: Adsorptive dialysis could remove the MMS notably. Compared with the conventional hemodialysis group, a single 120 minutes treatment could decrease MMS significantly (P < 0.05). The platelet levels were obviously decreased in the adsorptive dialysis group after treatment (P < 0.05), which were significantly different from the conventional hemodialysis group (P < 0.05). There was no significant difference in liver function, kidney function or serum electrolytes concentration. But related symptoms, such as the skin itch, sleep disorders and myalgia, were relieved more or less.

Objective:To analyze the research status and development trend of pediatrician competence in China and abroad, for reference in promoting the pediatrician competence research in the country.Methods:Literature review on pediatric resident′s competency was made using CNKI, WanFang and PubMed databases, ranging from their establishment up to December 25, 2019. A descriptive statistical analysis was made on the literatures′ publication year, publication area, research object and application area among others, using Excel 2019 and EndnoteX8.Results:A total of 199 Chinese documents and 262 English documents were finally retrieved. From 2009, the number of publications increased year by year, of which the Pediatrics has topped the rest, followed by Academic Medicine and Chinese Journal of Medical Education Research. The publishing institutions were mostly universities and affiliated hospitals, among which the Children′s Hospital of Chongqing Medical University topped the rest. The keyword of the highest frequency was education and the researches focus on the competency application and modelling. Conclusions:The pediatric healthcare system is paying greater attention on competence researches, but China has not yet established an appropriate pediatric resident competency model fitting local conditions. Meanwhile, the researches are plagued by such setbacks as excessive concentration of resources, simple methods and lack of empirical studies. It is recommended to broaden the explorations in this regard so as to identify pediatric resident competency development models fitting China′s conditions.

Enterovirus ; Enterovirus Infections ; Humans ; Pneumonia

Objective:To investigate the relationship of interleukin (IL)-37, osteoprotegerin with coronary artery disease and its stenosisdegree.Methods:The prospective research method was used. From April 2018 to June 2019, two hundred and eleven suspected or diagnosed coronary artery disease patients who had chest pain or discomfort in Dalian Friendship Hospital were selected. The patients underwent selective percutaneous coronary angiography and completed coronary stenosis score (Gensini score). According to the degree of coronary stenosis, 211 patients were divided into the control group(coronary stenosis<50%, 45 cases), single-vessel stenosis group (single-vessel stenosis ≥ 50%, 52 cases), double-vesselstenosis group (double-vesselstenosis ≥ 50%, 58 cases), and triple-vessel stenosis group (triple-vessel stenosis ≥ 50%, 56 cases). The levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein a, uric acid, creatinine were measured by the automatic biochemical analyzer. The serum levels of IL-37 and osteoprotegerin were detected by enzyme-linked immunosorbent assay.Results:There were no statistical differences in FBG, uric acid, creatinine, TC, TG, LDL-C, HDL-C, ApoA1 and ApoB among 4 groups ( P>0.05). In the control group, single-vessel stenosis group, double-vessel stenosis group and triple-vessel stenosis group, lipoprotein a was (0.266 ± 0.060), (0.283 ± 0.070), (0.289 ± 0.066) and (0.307 ± 0.084) mg/L respectively; coronary stenosis score was (8.27 ± 7.08), (437.45 ± 98.47), (493.72 ± 125.19) and (522.61 ± 149.34) scores respectively; IL-37 was (342.27 ± 122.36), (437.45 ± 98.47), (493.72 ± 125.19) and (522.61 ± 149.34) ng/L respectively; osteoprotegerin was (378.29 ± 111.95), (458.39 ± 115.37), (502.50 ± 116.88) and (533.39 ± 139.83) ng/L respectively; and there were statistical differences among 4 groups ( P<0.05 or <0.01). IL-37, osteoprotegerin and lipoproteina were positively correlated with coronary stenosis score ( r = 0.43, 0.42 and 0.23, P<0.05), the osteoprotegerin was positively correlated with IL-37( r = 0.73, P<0.05). The multivariate linear regression analysis result showed that the IL-37 and osteoprotegerin were independent protective factors of coronary stenosis degree( β = 0.07 and 0.07, t = 2.72 and 2.57, P<0.01 or <0.05),and lipoproteina was independent risk factor of coronary stenosis degree ( β = 0.97, t = 2.89, P<0.01). Conclusions:IL-37 and osteoprotegerin are positively correlated with the degree of coronary stenosis. They are anti-inflammatory and protective factors of coronary heart disease.