Objective To analyze the genetic characteristics of breakthrough varicella-zoster virus infection during the varicella outbreaks in Minhang District of Shanghai in 2013-2014. Methods Samples of the varicella-zoster liquid were collected from patients with chickenpox in Minhang District in 2013-2014 and used for the extraction of genomic DNA. The open reading frame ( ORF) of 22 and 62 regions were se-quenced and further analyzed by using bioinformatics methods. Results A total of 24 samples were success-fully collected and sequenced, and all of them were wild strains. Among the 24 varicella-zoster virus strains, 23 strains were highly homologous to the parental strain ( P-Oka) and the vaccine strain ( V-Oka) , indica-ting that they belonged to J genotype. Only one strain, whose genotype was between M and E, was highly ho-mologous to the mosaic( M) CA123 strain ( M1 genotype) , indicating that it might belong to M1 genotype. Conclusion The epidemic strains of varicella-zoster virus in Minhang District were mainly J genotype. Lo-cal epidemic of M and other genotypes of varicella-zoster virus also existed. There were some gene variations in different strains of J genotype. These varicella-zoster virus strains of non-vaccine genotypes might be one of the reasons causing the breakthrough cases of chicken pox.

Objective To evaluate the epidemiological efficacy of 23-valent pneumococcal poly-saccharide vaccine on the clinical symptoms and the incidence of respiratory tract infections in the elderly over 60 years old in Minhang District, Shanghai. Methods A prospective cohort study was conduct, in which the sample size was 1 200 for both inoculated and uninoculated groups. This study followed the two groups of subjects every quarter for a year. Clinical symptoms and the incidence of respiratory tract infectious diseases as well as the acute onset of chronic respiratory diseases were compared between the subjects of the two groups. Results Compared with the uninoculated group, less people in the inoculated group developed the clinical symptoms of respiratory tract infection (RR=0. 894, 95% CI: 0. 804-0. 994). Immunization with the 23-valent pneumococcal polysaccharide vaccine protected 57. 7% of the senior citizens (≥75 years old) from respiratory tract infections(95% CI:0. 207-0. 775). Conclusion The 23-valent pneumococcal polysaccharide vaccine can effectively reduce the incidence of respiratory tract infections in the elderly aged 60 years old and over and protects the elderly aged 75 years old and over from respiratory tract infections. Further studies on the immunological efficacy of 23-valent pneumococcal polysaccharide vaccine should be carried out by measuring the antibody titers before and after vaccination.

In order to investigate the role of the PTEN expression in carcinogenesis and development of endometrial carcinoma and clarify whether and how PTEN and PI3K/Akt pathway relate to endometrial carcinoma, the expression of PTEN and phospho-Akt was detected by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) methods and Western-blot from 24 cases of endometrial carcinoma, 10 cases of endometrial atypical hyperplasia, 10 cases of endometrial hyperplasia, and 10 cases of normal endometrium. SP immunohistochemical methods were used to measure levels of PTEN protein expression in following 5 study groups: 31 cases of endometrium in proliferative phase, 30 cases of endometrium in secretory phase, 71 cases of endometrial hyperplasia, 25 cases of atypical hyperplasia and 73 cases of endometrial carcinoma. Immunostaining score of PTEN was 3.39+/-0.15 in proliferative phase, 1.90+/-0.21 in secretory phase, 3.34+/-0.29 in endometrial hyperplasia, 0.62+/-0.11 in atypical hyperplasia, and 0.74+/-0.19 in endometrial carcinoma, respectively. PTEN mRNA relative value in normal endometrium, endometrial hyperplasia, endometrial atypical hyperplasia, and endometrial carcinoma was 2.45+/-0.51, 2.32+/-0.32, 0.46+/-0.11, and 0.35+/-0.13 respectively. The expression levels of PTEN mRNA and protein in patients with endometrial carcinoma and atypical hyperplasia were significantly lower than in those of proliferative phase and with endometrial hyperplasia. The level of PTEN expression in patients with endometrial carcinoma was significantly related to tissue type (P<0.005), differentiation (P<0.05) and clinical stage (P<0.05), but not to depth of myometrium invasion (P>0.05). Western blot analysis revealed that Phospho-Akt level in PTEN negative cases was significantly higher, and there was a negative correlation between PTEN and phospho-Akt (r=-0.8973, P<0.0001). It was suggested that loss of PTEN expression was an early event in endometrial tumorigenesis. The phosphorylation of Akt induced by the loss of PTEN took part in the tumorigenesis and development of endometrial carcinoma.

ObjectiveTo investigate the feasibility of Legacy pedicle screw system plus minimally invasive technique in treatment of Tile type C pelvic fracture and evaluate its therapeutic effects.MethodsFrom January 2008 to March 2010, 12 patients with closed Tile type C pelvic fractures were treated with Legacy pedicle screw system plus minimally invasive technique.There were seven males and five females, at age range of 21-60 years (average 39.6 years).All patients had sacrum fractures of the posterior pelvic rings.The anterior pelvic ring fractures included unilateral ischiadic ramus fractures in four patients and bilateral ischiadic ramus fractures in eight.Three patients were combined with shock.The anterior pelvic rings were fixed with minimally invasive reconstruction plates and the posterior pelvic rings fixed with minimally invasive technique plus Legacy pedicle screw system.ResultsThe operation lasted for average 90 minutes (range, 80-110 minutes) , with average intraoperative blood loss of 105 ml (range, 80-150 ml).All patients were followed up for average 18 months (range, 6-32 months), which showed that all patients got satisfactory reductions and that the fractures were healed at one stage, with average period of 11.5 weeks (range, 9-13 weeks).There occurred no infections, failures of internal fixations or nerve injuries.According to improved Lindahl standard of pelvic injury function assessment, the result was excellent in 10 patients and good in two, with average score of 78.6 points.Conclusions Under master of the surgical indications, Legacy pedicle screw system plus minimally invasive technique takes advantages of minor trauma, less intraoperative fluoroscopy, short operation time, good curative resuhs and few complications in treatment of Tile type C pelvic fractures by fixation of the posterior pelvic rings and reconstruction of the anterior pelvic rings.

H7N9 avian influenza is the latest subtype of influenza virus to emerge in the world. By April 17, 2013 in Shanghai, a total of 31 confirmed cases were reported, and 11 of these patients died. The epidemiological characteristics and the clinical progress of this new human flu infection are still not clear. Thirteen confirmed patients have now been treated in Shanghai Public Health Clinical Center. Among the first batch of patients, hospitalised at the beginning of April 2013, two who were admitted with the same estimated date of onset of disease had very different outcomes. After active treatment at the Centre, one recovered by April 18, 2013, but one patient entered critical condition and died on April 11, 2013. The clinical and laboratory characteristics in hospital are here analysed and compared to learn more about H7N9 avian influenza. Confirmation that the observed differences are valuable for prognosis and treatment decisions for H7N9 patients awaits authentication by analysis of more patients.
Influenza in Birds ; Influenza A Virus, H7N9 Subtype ; Communicable Diseases ; Laboratories

Objective: To assess the relationship between the characteristic of drug resistance in Pseudomonas aeruginosa and the syndrome of traditional Chinese medicine(TCM)in ICU.Methods: The 73 strains of Pseudomonas aeruginosa were isolated from sputum specimenpatients of in-patients in our ICU from March 2005 to February 2006.The data of the drug sensitivity test in vitro was analysised.The relation between the syndrome of TCM and drug resistance in Pseudomonas aeruginosa was probed.Results: The 73 strains of Pseudomonas aeruginosa were drug resistant to majority kinds of anti-infective except Piperacillin-Tazobactam,Piperacillin,Cefoperazone-Sulbactam,and Amikacin.The mains syndromes of TCM of all patients infected Pseudomonas aeruginosa were deficiency-excess complex(虚实夹杂证) and excess pattern(实证)(97.26%).The mains of deficiency-excess complex(虚实夹杂证) were Qi vacuity and phlegm obstruction(气虚痰阻证)and Yin vacuity internal heat(阴虚热郁证).The mains of excess pattern(实证) were phlegm-heat(痰热郁阻证)and phlegm-stasis(痰瘀互阻证).Conclusions: Combined ?-lactam antibiotics and aminoglycoside antibiotics is the first selection to treat the multidrugresistant Pseudomonas aeruginosa.Indentifing patterns and determining treatment in TCM could be tried in the treatment of patients infected Pseudomonas aeruginosa.

Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.

[Summary] Four patients with hyperthyroid-associated exophthalmos, myxedema, acropachy ( EMA ) syndrome, including three male patients and one female patient were diagnosed with Graves′diseases and treated by 131 I therapy. Complaints of thyrotoxicosis were presented at the onset. Tibia myxedema and acropathy appeared, and eye symptoms aggravated in two patients after anti-thyroid drug therapy and 131 I therapy. Four cases were all given clobetasol propionate, miconazole nitrate, neomycin sulfate and urea cream alone or in combination with compound betamethasone local injection treatment, and three cases were given low-dose oral prednisone treatment. Complaints of tibia myxedema and eye symptoms were significantly improved after the treatment. Therefore, we should be wary of the occurrence of hyperthyroid-associated EMA syndrome after 131 I therapy. Corticosteroid might be the effective therapy for myxedema and eye symptoms of EMA syndrome.

Objective To measure the titers of varicella live attenuated vaccines ( VarV) during the process of transportation and storage in different seasons and communities of Minhang Distract, Shang-hai, to evaluate the operation of cold chain system and the thermal stability of vaccines and to provide refer-ences for the management, introduction, research and development of vaccine in future.Methods Four communities with high outbreak rates of varicella during 2012 to 2013 and four communities with low out-break rates were randomly selected from 13 communities in Minhang District, Shanghai.The titers of VarVs were detected by using the quantitative plaque assay before and after 30 days of storage in November 2013 and February, May, August 2014.Results The overall rate of qualified VarVs was 90.63% with a geo-metric mean titer (GMT) of 3.67 (LgPFU/0.5 ml).96.88%of the VarVs produced by company C met the quality standard with a GMT of 3.89 ( LgPFU/0.5 ml) followed by those produced by company B with a rate of 91.67%and a GMT of 3.75 ( LgPFU/0.5 ml) .The rate of qualified VarVs produced by company A was the lowest, which was 80.00%, with GMT of 3.29 (LgPFU/0.5 ml).There were significant differences in the rates of qualified VarV among the three companies (χ2=8.288, P=0.016).The rate of qualified vac-cines in communities close to the Shanghai Minhang Center for Disease Control and Prevention ( Minhang CDC) was 91.67%, while 100%of the vaccine samples collected form the communities at a middling dis-tance from or far from the Minhang CDC met the quality standard.No significant difference in the rate of qualified vaccine was found among the three types of communities (χ2=3.441, P=0.179).The quarterly rates of qualified vaccines produced by B and C companies were 100%except for the third quarter.The rates of qualified vaccines produced by A, B and C companies in the third quarter were respectively 70.00%, 66.67%and 87.50%.No statistical differences in the quarterly rates of qualified vaccines were found among the three companies (χ2=1.25, P=0.7412;χ2=6.545, P=0.088; χ2=6.194, P=0.103).No statistical differences in the rates of qualified vaccines before and after 30 days of storage were found among the three companies (χ2=0.625, P=0.347;χ2=0.000, P=1.000;χ2=2.065, P=0.492).Conclusion A well-managed and-operated cold chain system was implemented in Minhang District in the storage and transport of vaccines as well as other related links.The thermal stability of vaccines produced by company C was better than those of the other two companies.A surveillance for the titers of vaccines produced by com-pany A should be strengthened.

Stereotactic body radiotherapy (SBRT ) and stereotactic ablative radiotherapy (SABR) ,methods of high local precision ,have been widely used in early stage inoperable non‐small‐cell lung cancer (NSCLC) patients .In some clinical trials ,the 3‐year local control rate and 3‐year survival rate were close to the effect of surgery ,and had little effect on the pulmonary function of patients .This paper briefly reviews the clinical practice and research progress of SBRT /SABR in early stage NSCLC .