In order to explore the significance of enterovirus environmental surveillance of sewage,two sewage treatment plants in Fuzhou City were selected as sentinel surveillance sites.One sewage sample was collected from entrance of each plant every month,and total 48 samples were studied from 2013 to 2014 in Fuzhou City.Using the RD,L20B and Hep-2 cell lines to isolate the viruses,44 of the 48 sewage samples (91.67％) were positive,268 strains were isolated which covered at least 22 enterovirus serotypes.The peak season of virus isolation from sewage was in February and July which was two months earlier than patient surveillance.Eehovirus type 7 (Echo 7) was the predominant serotype in 2013 with 58 isolations (43.61％),and in 2014 echovirus type 6 (ECHO 6) became the predominant serotype with 85 isolates (62.96％),among the strains isolated from sewage sample.Phylogenetic analysis found that the predominant serotype Echo 6 and Echo 7 isolated from sewage were more diversified than that from clinical cases during the same period,and were high homology with isolates form patients which belong to same branch in phylogenetic tree.In conclusion,enterovirus environmental sewage surveillance is an effective approach,and could be more sensitive than patient surveillance.

The prevalence of acute flaccid paralysis (AFP) associated with EV71 and the genetic variation in Fujian , China from 2003 to 2012 was investigated in this study .Descriptive epidemiology was used to analyze the epidemiologic and clinical features of AFP cases associated with EV 71 .Phylogenetic analysis was performed to explore the genetical characteris-tics of EV71 based on the complete VP1 nucleotide and amino acid sequences .Results showed that the mean incidence of EV71-associated AFP in children under 15 years old was 2 .24/10 000 000 in Fujian Province during 2003 and 2012 ,based on the number of EV71 isolates and the reported AFP cases .And the incidence has increased since 2008 .The EV71 strains isolated from the AFP cases or from the healthy contacts were distributed in 9 prefectures of Fujian Province ,most in the months of May and June .Of 76 .0% (19/25) of AFP cases associated with EV 71 were the children under 3 years and the male-to-female ratio was 1 .5 :1 .Twenty out of twenty-two cases (90 .91% ) had fevers before the onset of paralysis .Most cases had unilater-al limb paralysis (14/22 ,63 .6% ) .Typical manifestations of hand-foot-and-mouth disease (HFMD) were observed in five cases before the onset of paralysis .Residual paralysis was observed in two cases during the follow-up visits .The strains isolated from 25 cases belonged to genotype C4 .All other strains belonged to subtype C4a except the subtype C4b strains isolated in 2003 .The homology among the strains was high in 2009-2011 ,and the homology among these strains and the representative strains in Fuyang ,Anhui Province was also in the high level .Therefore ,it was possible that the isolated strains had the same origin and might cause the epidemic .In conclusion ,an AFP surveillance system could be developed for analyzing the incidence of AFP associated with EV71 ,determining the features of the isolates ,and describing the intensity and trends of EV71 epidem-ics .

Objective To explore the predictive value of plasma cell-free DNA (cf-DNA) for prognosis in patients with sepsis. Methods 105 patients with sepsis admitted to department of emergency of the First Hospital of Quanzhou Affiliated to Fujian Medical University from June 2015 to June 2017 were enrolled. Patients were divided into sepsis group (n = 50) and severe sepsis group (n = 55). At the same time, 50 cases of physical examination center in our hospital were randomly selected as the healthy control group. The differences of cf-DNA, procalcitonin (PCT) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score among the three groups were compared. The correlation between cf-DNA and PCT or APACHEⅡ were analyzed by Bivarite method. Logistic regression was used to analyze the independent predictors of sepsis. The receiver operating characteristic curve (ROC) was made to evaluate cf-DNA, PCT, APACHEⅡ alone or combined ability to predict the prognosis of sepsis. Results The PCT, APACHE Ⅱ and cf-DNA in the sepsis group and severe sepsis group were significantly higher than those in the healthy control group [PCT (μg/L):5.80 (3.28, 8.85), 17.53 (8.40, 29.61) vs. 0.02 (0.01, 0.03); APACHEⅡ: 13.04±3.03, 23.29±8.02 vs. 2.10±1.05;cf-DNA (μg/L): 1 438.0 (1 154.0, 1 576.0), 2 595.0 (2 162.0, 5 198.0) vs. 17.0 (13.0, 20.5); all P﹤0.05], and the indicators in the severe sepsis group were further higher than the sepsis group (all P < 0.05). Correlation analysis showed that cf-DNA was significantly positive correlated with PCT [r = 0.675, 95% confidence interval (95%CI) = 0.575-0.766, P < 0.001] and APACHEⅡ (r = 0.911, 95%CI = 0.874-0.939, P < 0.001). ROC curve analysis showed that the areas under ROC curve (AUC) of PCT, APACHEⅡ, cf-DNA, PCT+APACHEⅡ, cf-DNA+PCT, cf-DNA+APACHEⅡ, cf-DNA+PCT+APACHEⅡ to predict the prognosis of sepsis patients were 0.898, 0.905, 0.961, 0.941, 0.974, 0.976 and 0.982, respectively. It was shown that when predicted alone with PCT, APACHEⅡ and cf-DNA, the AUC of cf-DNA was the largest (0.961), the sensitivity was 100%, and the specificity was 81.43%; the combined prediction of cf-DNA with PCT or APACHEⅡ could further increase AUC, and the combined prediction of cf-DNA, PCT and APACHEⅡhad the highest AUC (0.982), the sensitivity was 94.29%, the specificity was 98.57%. Conclusions cf-DNA, PCT and APACHEⅡ have certain predictive value for the prognosis of sepsis. The value of cf-DNA was the highest when predicted alone, but the predictive ability of cf-DNA combined with PCT and APACHEⅡ was the best.

Objective To explore the effects of knowledge-attitude-practice (KAP) education model on standardization in using dry powder inhaler (DPI) and quality of life among patients with COPD. Methods A total of 120 COPD patients with DPI during follow-up period in Department of Respiratory for Adults at the Second Affiliated Hospital of Wenzhou Medical University were selected as study subjects by convenience sampling from March 2014 to March 2016. They were randomly divided into observation group (n=60,conventional education) and control group (n=60,conventional education + health education based on KAP model). The standardization in using DPI and scores of COPD assessment test (CAT) were compared between two groups before and after intervention. Results Compared with that before intervention,the standardization in using DPI after health education in observation group improved with a significant difference (P< 0.05). There were statistically significant differences in entries except for device handling after medication between two groups after health education (P<0.05). Scores of CAT of both group after health education were significantly lower than those before intervention (P<0.05). The score of CAT in observation group was lower than that in control group after health education with a significant difference (P<0.05). Conclusions The health education based on KAP model can significantly improve the standardization in using DPI among COPD patients. It can also make family members understand a lot of disease-related knowledge so as to establish confidence to overcome disease,improve coping capacity of disease and quality of life.

Objective To analyze the genetic characteristics of VP1-VP4 genes carried by cox-sackievirus A6 (CVA6) strains isolated from severe cases of hand, foot, and mouth disease (HFMD) in Shenzhen during 2012 to 2015. -ethods The VP1-VP4 genes of CVA6 strains isolated from severe HFMD cases in Shenzhen during 2012 to 2015 were amplified and sequenced. Phylogenetic analysis was performed to analyze the VP1-VP4 genes of CVA6 isolates and sequences downloaded from GenBank by using DNASTAR6. 0 and MEGA6. 02 software packages. Results Four cases of severe HFMD were caused by CVA6 in Shenzhen during 2012 to 2015. All of the patients had the symptom of fever, skin rash and aseptic encephalitis. The CVA6 strain causing severe HFMD in 2013 shared 98. 8％-98. 9％ homology in nucleotide sequences and 99. 3％-99. 8％ in amino acid sequences with the strains isolated in 2012. Two amino acid mutations were found in the CVA6 strain isolated in 2013, which were G73E in VP2 region and S13G in VP1 region. However, the CVA6 strain isolated in 2015 only shared 95. 0％ homology in nucleotide sequences and 99. 3％ homology in amino acid sequences with the strain isolated in 2013. Six amino acid mutations were identified including E73G in VP2 region and T5A, S27N, A30V, N137S and V242I in VP1 region. The phylogenetic analysis revealed that the four CVA6 strains belong to D3 sub-genotype. The CVA6 strains causing severe cases in 2012 had the nearest genetic relationship with the strain isolated in Changsha in 2012 (KJ156349). The CVA6 strain isolated in Shenzhen in 2013 had the nearest genetic relationship with the strain isolated in Shanghai in 2013 (KJ612513). The Shenzhen CVA6 isolate in 2015 showed high similarity to Weifang CVA6 isolate in 2014 (KX752785). Conclusions All CVA6 strains causing severe HFMD ca-ses in Shenzhen during 2012 to 2015 belongs to D3 sub-genotype. Mutations of S27N and A30V in the VP1 region of the CVA6 isolate in 2015 are located in the B cell epitopes. In addition, the VP1-V242I mutation in the CVA6 strain isolated in 2015 is located in the binding site of PSGL-1 receptor. These mutations may affect the binding of CVA6 strains to the cellular receptors and their infectivity to people.

Objective:To provide insight into the clinical characteristics, therapy and prognosis of patients with radiation-induced brainstem injury after radiotherapy.Methods:From August 2013 to September 2021, 13 patients with radiation-induced brainstem injury were included in this study at Sun Yat-sen Memorial Hospital, and the general information and strategy of radiotherapy were collected. A retrospective analysis was adopted to investigate the clinical and radiological characteristics, treatment and clinical outcomes.Results:There were 13 cases in total, including 4 females and 9 males. The onset age of enrolled patients ranged from 29 to 66 years with an average of (48.15±10.23) years. The median dose targeted at tumor area was 70 Gy with in 33 fractions. The median interval between radiotherapy and the diagnosis of radiation-induced brainstem injury was 24 months. The common clinical manifestations included dysphagia, bucking dysarthria, dizziness and problem with balance. The MRI radiological features were hypointense on T1WI, hyperintense on T2WI, and irregularly enhanced with contrast. The median follow-up was 45 months. Seven cases got improvements, while 3 had no obvious efficacy and 3 cases died. No significant differences in prognosis were observed between those received traditional glucocorticoid and those received bevacizumab treatment( P=0.079). Conclusions:The common symptoms of radiation-induced brainstem injury were symptoms of posterior cranial nerves injury and ataxia. Lesions mostly happened in pons and medulla, with hypointense on T1WI and hyperintense on T2WI. Half of the patients have improved after treatment. There was no significant difference in prognosis between glucocorticoid and bevacizumab treatment.

Globally, the incidence of pancreatic cancer is on a rise. Pancreatic cancer is characterized by difficulty in early diagnosis, frequent distant metastasis, low surgical resection rate, and high risk of postoperative recurrence. Better treatments need to be developed to prolong the prognosis. Studies have confirmed that inflammation is closely correlated with tumorigenesis, and inflammatory mediators play important roles on tumor microenvironment of pancreatic cancer and lead to poor prognosis. This article reviewed the progress on the correlation between peripheral blood inflammatory index and the prognosis of pancreatic cancer.