Objective:To classify the etiology of secondary hemophagocytic syndrome (sHLH) and explore its clinical, laboratory and therapeutic characteristics in order to deepen the understanding of the disease.Method:A retrospective observational study was conducted on sHLH patients who were treated at Peking University People's Hospital from January 2016 to December 2021. Patients under the age of 18 and those with missing clinical data were excluded. The distribution of departments visited and etiologies of sHLH were analyzed. Baseline data, clinical characteristics, complications, laboratory data, treatment, and in-hospital outcomes of sHLH were collected. The sHLH patients were then divided into 3 groups including malignancy group, macrophage activation syndrome (MAS) group and other etiologies (mainly infection) group. Intergroup comparisons were performed using chi-square tests, analysis of variance, Mann-Whitney tests, and other statistical methods.Results:A total 169 patients were enrolled, among these patients, 27.8% were malignancy-related HLH, 47.9% were MAS, and 24.3% were other etiologies related HLH. Statistical analysis revealed that the clinical characteristics of other etiological group was highly consistent with the malignancy group, including more and severer peripheral blood cell reduction, higher sCD25 levels, more Epstein-Barr virus infection, and the prognosis was similar, both were with more than 50% in-hospital mortality. And the incidence of hemophagocytosis was highest in other etiological groups (65.9%). In contrast, MAS group was with an obviously lower mortality of 17.3% ( P<0.05). Meanwhile, treatments including methylprednisolone pulse, cyclosporine A and interleukin-2 were used frequently in MAS group. Conclusion:Malignancy related HLH and other etiologies related HLH exhibit more similar clinical characteristics and prognosis, while the MAS group, has a milder overall condition and better prognosis.

Objective To investigate genetic characteristics of Coxsackie virus B5 (CVBS) in acute flaccid paralysis(AFP) cases in Sichuan Province.Methods 10 CVB5 strains isolated from stool samples of AFP cases in Sichuan Province over 2007-2014 were subjected to entire VP1 coding region amplification by reverse transcription-polymerase chain reaction (RT-PCR) and nucleotide sequencing,and phylogenetic tree was constructed for genetic characterization.Results All of the 10 strains were identified as genogroup D.The nucleotide and the amino acid homologies were 80.4％-81.9％ and 95％-97.1％,which compared with the Faulkner prototype strain.The amino acid homologies between Ziyang strain and Chengdu strain obtained in 2014 were 100％,respectively.The nucleotide and the amino acid homologies between Nanchong isolate and Yibin isolate obtained in 2014 were both 100％,respectively.Conclusions The isolates from AFP cases in Sichuan Province over 2007-2014 were belong to genogroup D.The genetic characteristics of 10 strains were stable.

Objective To analyze the genetic characteristics of measles virus in Sichuan province in 2015.Methods Measles virus was isolated from throat swab specimens collected from suspected measles cases.Nucleotide sequences coding for C terminus of nucleoprotein were amplified by RT-PCR and sequenced for phylogenetic analysis.Results 398 measles virus isolates were obtained from 971 throat swab specimens.Phylogenetic analysis showed that 397 belonged to H1 genotype,the sequences homologies were 96.2％-98.0％ compared with H1 genotype reference strain;and all those isolates separated into 2 clusters in phylogenetic tree with the average nucleotide divergence of 2.0％.1 isolate belonged to A genotype,and shared 98.0％ nucleotide homology compared with A genotype reference strain.Conclusions H1 genotype virus remained predominant circulating in Sichuan Province.There was no much genetic variation in N gene.But a minor nucleotide divergence existed between different clusters,leading to 2 transmission chains.

Objective To understand the genetic characteristics of rubella virus in Sichuan province in 2015.Methods Veto/SLAM cells were used for rubella virus isolation and culture.The 739 nucleotides of E1 gene was amplified by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and subjected to sequence and homological analysis.Results 19 strains of rubella virus were isolated and identified as genotype 2B.The homology of nucleotides and amino acids were 99％-100％ and 97.9％-100％,respectively.There were no changes in the important antigenic epitopes.Conclusions The rubella virus genotype circulated in Sichuan province in 2015 was genotype 2B.

Objective To investigate the symptom,esophageal motility characteristics and the prevalence of gastroesophageal reflux disease(GERD)in patients with typeⅠ,Ⅱand Ⅲ gastroesophageal junction (EGJ)diagnosed by high resolution esophageal manometry(HREM).Methods From 6th January to 27th December in 2012,the clinical data of 171 patients with reflux symptoms and received HREM were retrospectively analyzed.According to the Chicago classification V.3.0,the patients were divided into EGJ type Ⅰ,Ⅱ and Ⅲ groups.The age,body mass index(BMI),GERD related symptoms,esophageal motility parameters and the incidence of GERD were compared among the three groups.Chi-square test, t test and analysis of variance were used for statistical analysis.Relationship between EGJ types and other variables were analyzed by Spearman rank correlation.Results In 171 patients,136 cases(79.5%)with type Ⅰ EGJ,22 cases(12.9%)with type Ⅱ EGJ and 13 cases(7.6%)with type Ⅲ EGJ.The age of patients with type Ⅱ EGJ was significantly older than that of patients with type Ⅰ EGJ((56.5 ± 2.3) years vs(48.6 ± 1.0)years,t=2.992,P=0.003),however the differences were not statisticant when compared with type Ⅲ EGJ patients((51.2 ± 3.8)years,P> 0.05).The BMI of patients with typeⅢ EGJ was higher than that of typeⅠand typeⅡEGJ patients((26.0 ± 1.3)kg/m2vs(21.9 ± 0.3)kg/m2and (23.5 ± 0.6)kg/m2),and the difference was statistically significant(t=4.082 and 2.108,both P<0.05). The resting pressure of lower esophageal sphincter(LES)of patients with type Ⅱ and Ⅲ EGJ were lower than that of typeⅠEGJ((10.6 ± 1.5)mmHg(1 mmHg=0.133 kPa)and(3.4 ± 0.7)mmHg vs(17.1 ± 0.7)mmHg),and the resting pressure of LES of type Ⅲ EGJ was lower than that of type Ⅱ EGJ((3.4 ± 0.7)mmHg vs(10.6 ± 1.5)mmHg),and the differences were all statistically significant(t= -3.882,-6.411 and -2.769,all P< 0.01).The amplitude of contraction at 11 cm above LES and distal contractile integral(DCI)of patients with type Ⅲ EGJ were both lower than those of patients with typeⅠ EGJ((32.2 ± 5.4)mmHg vs(48.5 ± 2.5)mmHg,and(392.0 ± 94.1)mmHg·s·cm vs(805.1 ± 61.4)mmHg·s·cm),and the differences were statistically significant(t= -2.580 and -2.041,both P<0.05).The incidences of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ were 68.4%(93/136), 77.3%(17/22)and 10/13,respectively,and the difference was not statistically significant(χ2 =1.021, P=0.600).EGJ types were positively correlated with age and BMI(r= 0.214 and 0.290,both P<0.01).However,EGJ types were negatively correlated with the LES resting pressure,contraction amplitudes at 7 cm and 11 cm above the LES,and DCI(r= -0.474,-0.182,-0.333 and -0.191,all P<0.05).Conclusions Aging,overweight and obesity are risk factors of the LES and crural diaphragm separation.EGJ types are not predictable based on symptoms.The esophageal motility seems to decrease in patients with type Ⅱ and Ⅲ EGJ,the incidence of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ are all high.

Objective:To explore any effect of repeated transcranial magnetic stimulation (rTMS) on the upper limb motor function and cerebral cortex activation of stroke survivors.Methods:Sixty stroke survivors were randomly divided into an intervention group and a control group, each of 30. In addition to routine rehabilitation training (including drug therapy, comprehensive hemiplegic limb training and physical factor therapy), the intervention group received 15 minutes of rTMS daily, five days a week for 4 weeks while the control group was given false rTMS. Upper limb motor function was evaluated before and after the treatment using the Fugl Meyer upper limb motor function rating scale (FMA-UE). Functional near-infrared spectroscopy was used to detect and compare the activation (β values) of the prefrontal cortex, the motor cortex and the primary somatosensory cortex in the 2 groups. The correlation between the FMA-UE scores and the β values was quantified.Results:①There was no significant difference in the average FMA-UE scores between the two groups before the treatment. Afterward, though both groups′ average scores had increased significantly, there was significantly greater improvement in the treatment group. ②There was also no significant difference in average β value between the two groups before the experiment, but afterward the average βs of channels 27 and 13 in the intervention group were significantly higher than in the control group. Moreover, in patients with lesion in the left brain, the β-values of CH27 and CH13 were also significantly higher than the control group ( P<0.05). ③The FMA-UE scores of the intervention group were moderately correlated with the CH27 and CH13 β values, but those of the control group were only weakly correlated with the β values of CH27. Conclusion:Transcranial magnetic stimulation activates a lesioned left brain region, improving upper limb motor function. The improvement is correlated with the activation of the left prefrontal cortex and the left primary somatosensory cortex.

Objective:To investigate the genotype and genetic characteristics of the pathogens associated with the epidemic outbreak of acute gastroenteritis (AGE) in Deyang city, Sichuan province, and to provide perspectives on disease prevention and vaccine development.Methods:Norovirus (NoV) nucleic acid in the sixty-three samples collected from three AGE outbreaks were detected by Real-time RT-PCR. The genes of RNA-dependent RNA polymerase (RdRp) and capsid protein (VP1) of the positive samples were amplified by conventional RT-PCR and sequenced and made phylogenetic analysis.Results:Three AGE outbreaks were all caused by NoV, and twenty-one samples were positive for NoV GII. Two of the outbreaks were caused by GII.17[P17] NoV and shared high similarities with global reference sequences from 2014. One of the outbreaks was caused by GII.2[P16] NoV and shared high similarities with global reference sequences from 2016.Conclusions:The three AGE outbreaks in Deyang city in 2018 were caused by two different NoV genotypes.

Objective: To investigate the genotype and genetic characteristics of the pathogens associated with the epidemic outbreak of acute gastroenteritis(AGE) in Guangyuan city, Sichuan province. Methods: Eighteen stool samples and 15 anal swab samples from 4 AGE outbreaks were collected from Feb 2017 to May 2017. Norovirus (NoV) nucleic acid was detected by Real-time PCR method , and the positive samples were amplified by conventional reverse transcription-polymerase chain reaction (RT-PCR) and nucleotide sequencing. Results: Four AGE outbreaks were all caused by NoV. And 20 (60.6%) samples were positive for NoV GⅡ. Gene sequence comparison and phylogenetic analysis showed that 4 AGE outbreaks were all caused by GⅡ.P16/GⅡ.2 NoV. All the strains of GⅡ.P16/GⅡ.2 NoV shared high homology in nucleotides. One of the outbreaks was caused by GⅡ.P16/GⅡ.2 and GⅡ.P7/GⅡ.14 NoV co-infection. Conclusions The 4 outbreaks of AGE in Guangyuan city, Sichuan province were major caused by GⅡ.P16/GⅡ.2 NoV, meanwhile GⅡ.P16/GⅡ.2 and GⅡ.P7/GⅡ.14 NoV co-infection existed.

Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.