Objective To understand the molecular epidemiology of penicillin resistance Streptococcus pneumonia (PNSP) isolated from children in Guangzhou area to provide the experimental basis for clinical prevention and control of Streptococcus pneumonia infectious diseases.Methods Specific primers were designed according to Genebank,penicillin binding protein(PBP) genes PBP1A,PBP1B,PBP2A,PBP2B,PBP2X,PBP3 were amplified by PCR.The sequencing analysis was performed.The PCR products were digested by Hinf I,and the restriction fragment length polymorphism (RFLP) was analyzed.Results DNA of PNSP was successfully extracted,the PCR results showed that in 50 strains of PNSP,the positive rates of bacterial strains containing PBP1A,PBP1B,PBP2A,PBP2B,PBP2X and PBP3 were 48.9%,64.4%,71.1%,31.1%,40.0% and 31.1% respectively.The sequencing showed that their homologies with known sequences in GenBank were 99%,98%,100%,97%,95% and 100% respectively.Using RFLP in Hinf I showed that PBP1A,PBP1B,PBP2A and PBP3 only had one kind of genotype,PBP2B and PBP2X had two kinds of genotypes,the positive rates were 71.4%,28.6%,66.7% and 33.3% respectively.Conclusion The gene distribution of PNSP strains among children in Guangzhou is dominated by PBP2A,PBP1B and PBP1A,there are two subtypes in PBP2B,PBP2X when digested by Hinf I,in which the predominant subtype >65%.

The clinical application of arthroscopic minimally invasive treatment of shoulder joint disease technology has become a routine,and it has been widely carried out around the world.Compared with the traditional open surgery,it only needs to establish a few channels in the shoulder and then the diagnosis and treatment of the structure under the acromion and glenoid joint internal lesions can be completed through the arthroscopic technique under direct vision,of course,including local collection of pathological specimens.Shoulder arthroscopic surgery has the advantages of simple operation technique,small economic burden of patients,small tissue trauma,quick recovery and high accuracy of disease diagnosis.At present,there are two main options for shoulder arthroscopy:the beach chair position (BCP) and the lateral decubitus position (LDP).The choice of surgical position for surgeons is closely related to the intraoperative operation,the risk of complications,the efficacy of surgery,and the cost of setting the posture.Shoulder arthroscopy of these two positions have their own advantages and disadvantages:in the BCP,the surgeon gets a better anatomical operation experience,if necessary,can be converted into open surgery at any time.Without continuous traction,upper limb nerve and vascular damage caused by traction can be avoid.But the incidence of cerebral ischemic events in patients may increase in the BCP.There is also possibility of the nerve damage of the pillow small nerve,great auricular nerve,lateral femoral cutaneous nerve and other nerves.In theory the risk of air embolism in the patients will increase in the BCP,and the cost of setting the position is also higher than the LDP.While in the LDP due to the patient's forearm continuous traction,the surgeon can get a more extensive operating space,and the occurrence of cerebral ischemic events is very rare.In the treatment of anterior shoulder instability after shoulder arthroscopic surgery,there is a lower recurrence rate in the LDP.The cost of setting the position is also significantly lower than the BCP.Of course,the disadvantages of the LDP is also obvious.In the LDP,the brachial plexus and other nerves or vascular injury may increase due to the continuous traction of the forearm.Meanwhile sustained traction in the LDP is also a risk factor for thrombosis,and so on.Therefore,there is still a debate about the optimal location of the shoulder arthroscopy.Many clinicians choose shoulder arthroscopic position based on their own experience and habits.

Purpose: This study aimed to establish whether computed tomography (CT)–determined sarcopenia is a useful imaging biomarker for postoperative outcome in elderly colorectal cancer (CRC) patients, and construct sarcopenia-based nomograms to predict individual outcomes after surgery. Materials and Methods: CT imaging data of 298 elderly CRC patients who underwent surgery in 2012-2014 were retrospectively analyzed. Skeletal muscle mass was determined by CT, and sarcopenia was diagnosed based on the optimal cutoff value determined by X-tile program. The correlation between sarcopenia and risk of preoperative nutrition and postoperative complications was evaluated. A Cox proportional hazards model was used to determine survival predictors. Sarcopenia-based nomograms were developed based on multivariate analysis, and calibrated using concordance index and calibration curves. Results: A total 132 patients (44.3%) had sarcopenia based on the optimum cutoff values (29.9 cm2/m2 for women and 49.5 cm2/m2 for men). Sarcopenia was an independent risk factor for preoperative nutrition (p < 0.001; odds ratio [OR], 3.405; 95% confidence interval [CI], 1.948 to 5.954) and postoperative complications (p=0.008; OR, 2.192; 95% CI, 1.231 to 3.903). Sarcopenia was an independent predictor for poor progression-free survival (p < 0.001; hazard ratio [HR], 2.175; 95% CI, 1.489 to 3.179) and overall survival (p < 0.001; HR, 2.524; 95% CI, 1.721 to 3.703). Based on multivariate analysis, we produced four nomograms that had better predictive performance. Conclusion CT-determined sarcopenia is a useful imaging biomarker for predicting preoperative nutritional risk, postoperative complications, and long-term outcomes in elderly CRC patients. The sarcopenia-based nomograms can provide a scientific basis for guiding therapeutic schedule and follow-up strategies.

Hip arthroscopy has become a routine treatment for the localized hip lesions.With the rapid development of arthroscopy,the number of surgeries has increased greatly.Though hip arthroscopy is considered as low risk operation,its complications have been constantly reported and noted.There are two major types in hip arthroscopy surgeries:conventional operative complications and special complications.Conventional operative complications include venous thromboembolism,hemorrhage,and pain.Special complications are associated with arthroscopic techniques and local anatomical structures of the hip,such as the perineal nerve,the lateral femoral cutaneous nerve,the acetabular labium or the iatrogenic injury of the cartilage surface of the femoral head.Hip arthroscopy has obvious advantages such as small surgical wound and rapid recovery,but its complications can not be ignored.Joint surgeons must fully recognize it and keep vigilant so as to avoid complications as much as possible.This review will systematically elaborate the complications of hip arthroscopic surgery from general and special aspects so as to provide ideas for reducing the occurrence of complications in hip arthroscopic surgery.

Objective To evaluate the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification after hip arthroscopy.Methods Literature search was conducted in PubMed,Embase,Cochrane Library,CNKI and Wanfang data with time range from January 1973 to November 2017.Clinical case control articles on NSAIDs in preventing heterotopic ossification after hip arthroscopy were screened based on the inclusion and exclusion criteria.Meta analysis was done using RevMan 5.3 software to investigate the incidence of complications such as heterotopic ossification and gastrointestinal bleeding after hip arthroscopy in patients taking NSAIDs orally.Results Six articles were included in the study,with a total of 754 cases and 536 controls.NSAIDs reduced the incidence of heterotopic ossification after hip arthroscopy (RR =0.09,95％ CI 0.03-0.27,P ＜ 0.05).Selective COX-2 inhibitor celecoxib (RR =0.17,95％ CI 0.03-0.91,P ＜ 0.05) and PG synthase inhibitor of naproxen (RR =0.17,95％ CI 0.09-0.32,P ＜ 0.05) were also effective in preventing heterotopic ossification.There was no significant difference in the incidence of gastrointestinal complications between the cases and controls after NSAIDs prophylaxis (RR =2.17,95％ CI 0.92-5.12,P ＞ 0.05).Conclusion NSAIDs can effectively reduce the incidence of heterotopic ossification after hip arthroscopy and does not increase the incidence of postoperative gastrointestinal complications.Therefore,it is effective and safe to use NSAIDs to prevent the occurrence of heterotopic ossification after hip arthroscopy.

Vaccination is a main measure for protecting chickens against Marek's disease,while it is not able to suppress the infection,proliferation,transmission,and virulence enhancement on Marek's disease virus.Inhibiting the proliferation of Marek's disease virus in chicken is therefore an im-portant option for enhancing defense effectiveness.In this study,a compound,DUBs-IN-1,was found to inhibit the activity of MDV049,a protease encoded by Marek's disease virus,via screening a protease inhibitor library using MDV049 as target and ubiquitin probe.Molecular docking re-vealed that DUBs-IN-1 can interact with the residues which formed the catalytic pocket of MDV049,blocking the interaction between Ub substrate and the catalytic center of MDV049,then suppress the activity of MDV049 with competitive inhibition.Using the CPE model,it was found that DUBs-IN-1 at the concentration of 0.35 and 0.70 μmol/L significantly inhibited the CPE in-duced by Marek's disease virus in CEF cells.Quantitative analysis revealed that DUBs-IN-1 inhibi-ted the proliferation of Marek's disease virus in CEF cells(P＜0.01).Furthermore,it was found that the administration of 80 and 150 pg/(kg·d)of DUBs-IN-1 in chicken infected by Marek's disease virus significantly inhibited the proliferation of MDV in T cells(P＜0.01).In summary,this study demonstrated that the compound DUBs-IN-1 is able to inhibit the proliferation of Marek's disease virus in chicken cells,laying a theoretical and practical foundation for further de-velopment of the drugs against Marek's disease virus.

Venous thromboembolism (VTE) is a common complication of hip and knee arthroplasty and of many major orthopedic surgeries.VTE mainly includes two aspects,ie,deep vein thrombosis (DVT) and pulmonary embolism (PE).Symptomatic PE is likely to endanger patients' life,resulting in irreversible severe consequences.With the return of venous blood,DVT may also fall off at any time,forming a new PE.Therefore,the prevention of VTE in large orthopedic surgeries has been highly valued by scholars worldwide.However,the problem of VTE after arthroscopic surgery has not drawn much attention from clinicians.Researchers have not reached a consensus on whether routine anticoagulation therapy is required after surgery because of VTE's low incidence and discrepancy among various studies (0.42％-17.9％).With a large number of knee arthroscopy being performed per year,the postoperative VTE incidence can not be ignored.For these reasons,some scholars have suggested that patients after knee arthroscopy should be stratified and that patients with a higher risk of postoperative VTE need to be given anticoagulant therapy.Risk factors for VTE after knee arthroscopy may have effects on the clinical treatment of patients.Therefore,a review of the literature to explore the possible risk factors for postoperative VTE was conducted.

Objective: To investigate the epidemiological characteristics of norovirus outbreaks in Shenzhen during 2005 to 2017 in order to provide reference for disease control and prevention. Methods: Monitoring data of norovirus outbreaks in Shenzhen from January 1, 2005 to December 31, 2017 were collected from Shenzhen Communicable Disease Information System and China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used for data analysis. Results: From January 2005 to December 2017, 346 norovirus outbreaks (five or more cases in one community within one week) were reported in Shenzhen, of which 6.36% (22/346) were public health emergency events. Fewer outbreaks were reported during 2006 to 2013 and they were mainly caused by GⅡ.4 genotype, but the number increased sharply since 2014 with 57.80% (200/346) occurred in 2016—2017 and the epidemic genotype changed from GⅡ.4 to GⅡ.17 and GⅡ.2. The outbreaks peaked during November to March (76.88%, 266/346). There were 63.87% (221/346) reported in urban areas, 67.05% (232/346) in nurseries and 23.70% (82/346) in primary/middle schools. Among the 22 public health emergency events, 40.91% (10/22) were caused by person-to-person contacts, 40.91% (10/22) by foodborne transmission and 13.64% (3/22) by waterborne transmission. Moreover, 75.80% (238/314) of the outbreaks in nurseries and primary/middle schools were confined to one classroom and most were due to contact transmission. Conclusions Norovirus outbreaks increased obviously since 2014, which might be related to the changes of the predominant genotype from GⅡ.4 to GⅡ.17 and GⅡ.2. It is necessary to strengthen a comprehensive prevention and control in key units such as nurseries and primary/middle schools in winter and spring.

The traditional Chinese medicine （TCM） myocardial infarction （MI） unit is a standardized， regulated， and continuous integrated care unit guided by TCM theory and built upon existing chest pain centers or emergency care units. This unit emphasizes multidisciplinary collaboration and forms a restructured clinical entity without altering current departmental settings， offering comprehensive diagnostic and therapeutic services with full participation of TCM in the treatment of MI. Its core medical model is patient-centered and disease-focused， providing horizontally integrated TCM-based care across multiple specialties and vertically constructing a full-cycle treatment unit for MI， delivering prevention， treatment， and rehabilitation during the acute， stable， and recovery phases. Additionally， the unit establishes a TCM-featured education and prevention mechanism for MI to guide patients in proactive health management， reduce the incidence of myocardial infarction， and improve quality of life.