Objective To investigate the effects of autologous blood transfusion and allogeneic blood transfusion on postoperative complications and outcome of patients underwent craniotomy with traumatic brain injury.Methods All transfusional cases underwent emergency craniotomy with trau-matic brain injury from January,2012 to June,201 6,1 61 males and 38 females,ASA physical statusⅠ-Ⅳ,were respectively analyzed and divided into autologous blood group (n = 108)and allogeneic blood group (n =91)based on whether or not using cell salvage.The restrictive transfusion strategy was applied in the two groups and the red blood cells were infused to maintain the hemoglobin concen-tration at 70-100 g/L.The incidence of postoperative complications and adverse transfusion reaction were analyzed and the clinical outcome was judged by Glasgow outcome score (GOS).Results The incidence of postoperative complications (33% vs.56%,P <0.01 )and adverse transfusion reaction (5% vs.14%,P <0.05)of the autologous blood group were lower than that in the allogeneic blood group,and the clinical outcome was better (P <0.01).Logistic regression analysis showed that allo-genetic transfusion (OR =1.953,95%CI 1.381-2.529)was an independent risk factor of postopera-tive complications.Conclusion The use of autologous blood transfusion in patients with traumatic brain injury can reduce the incidence of postoperative complications and the risk of blood transfusion and improve clinical outcome.

Objective: To identify the avian influenza virus subtype from the avian and environmental samples using the Ion Torrent new-generation semiconductor sequencing technology and to establish a high-throughput sequencing method to identify unclassified influenza A virus. Methods: Virus RNA was extracted from the nine avian swab and environmental samples and real-time RT-PCR was carried out to detect universal fluA, H5N1, H7N9 and H9N2. The whole genome of influenza A virus was amplified by PathAmpFluA kit. Sequencing library was prepared using Next Fast DNA Fragmentation & Library Prep Set for Ion Torrent kit and high-throughput sequencing was done by Ion Torrent Personal Genome Machine(PGM). Data from the PGM was processed and quality evaluated using Ion TorrentSuite v3.0 software. Sequence assembly and influenza database blast were carried out by FluAtyping v4.0 and PathogenAnalyzer bioinformatics software to identify the influenza A virus subtype of these nine samples. Results: The results of real-time RT-PCR for universal fluA of these nine samples were positive but the results for H5N1, H7N9 and H9N2 were negative. Seven subtypes of influenza A virus were identified by high-throughput sequencing and bioinformatics analysis: six samples were H2N3, H5N6, H5N8, H7N1, H7N7, H11N3 subtype respectively and three samples were H6N6 subtype. Conclusions Avian influenza virus has many subtypes in the environment of Zhejiang province. Ion Torrent semiconductor sequencing technology is suitable for fast identification of unclassified influenza virus for avian influenza environment monitoring.

The genus Enterovirus (EV) of the family Picornaviridae containing more than 100 serotypes. These viruses cause a variety of diseases, among which viral encephalitis (VE), aseptic meningitis (AM) and acute flaccid paralysis (AFP) much threaten human health. Infections with these viruses will cause severe neurological complications and death. EV is a frequent cause of infection in children, especially in neonates and young infants. EV infections form a seasonal pattern and the incidence is the highest in the summer and autumn. In this review, we discuss our current understanding of EV structure, host-receptor interactions, epidemiological characteristics, related central nervous system diseases and laboratory diagnostics. Moreover, we briefly explain the mechanism of viral genome replication and assembly for most relevant pathogens and describe diseases prevention and control method. We reflect on how these recent discoveries may help the development of strategies to decrease viral spread.

Objective:The epidemiological and host animal pathogen data of leptospirosis in the population of Zhejiang Province in 2023 were analyzed, providing scientific basis for formulating prevention and control strategies of leptospirosis.Methods:The data of human leptospirosis in the population were collected from the China Information System for Disease Control and Prevention, and analyzed using descriptive epidemiological methods. The data on isolation, culture, and nucleic acid testing of Leptospira pathogens from mouse kidneys, frog kidneys, pig kidneys, and duck kidneys as well as duck serum antibody data were collected from Zhejiang Provincial Center for Disease Control and Prevention "Leptospirosis Surveillance Project of Zhejiang Province". The carrying and changing status of Leptospira epidemic microbiota in populations and host animals were analyzed. Results:In 2023, a total of 83 cases of leptospirosis were reported in Zhejiang Province, with a incidence rate of 0.126 2/ 100 000, aged (62.66 ± 11.31) years, including 68 males and 15 females. Leptospirosis cases were reported in 11 cities, mainly concentrated in the southern cities of Wenzhou City, Lishui City and Taizhou City(a total of 68 cases), accounting for 81.93% of the total number of cases. August to October were high incidence months for leptospirosis (a total of 70 cases), accounting for 84.34% of the total number cases. The male to female ratio of patients was 4.53 ∶ 1.00, and all were adults ≥20 years old, the middle and old people aged 45 - 79 years were the high-risk population (a total of 77 cases), accounting for 92.77% of the total number of cases. The patient's occupation was mainly farmers, with a total of 54 cases, accounting for 65.06% of the total number cases. The shortest time from onset to initial diagnosis for patients with leptospirosis was 0 day, and the longest was 13 days. The shortest time from initial diagnosis to confirmed diagnosis was 0 day, and the longest was 16 days. The 72.29% of the leptospirosis cases (60 cases) had a history of field labor or suspected contact with contaminated water within one month before the onset of the disease, and 18.07% of the leptospirosis cases (15 cases) had a history of contact with animals such as mice, frogs, pigs, cows, dogs, fish or ducks, or their excreta within one month before the onset of the disease. The average nucleic acid positive rate of host animals with leptospirosis was 5.92% (31/524) in mouse kidney, 6.74% (36/534) in frog kidney, and 0.66% (1/151) in pig kidney. The isolation and culture of leptospirosis from duck kidney, nucleic acid detection, and antibody detection in duck blood were all negative. The leptospirosis bacteria detected in human population were serogroup Icterohaemorrhagiae (3 samples) and Hebdomadis (4 samples), and the bacteria group detected in host animals was serogroup Icterohaemorrhagiae (3 samples). Conclusions:The outbreak of leptospirosis in Zhejiang Province mainly occurs in the summer and autumn, with the affected areas mainly concentrated in the southern region of Zhejiang Province. The affected population is mainly middle-aged and elderly males, and the population carrying Leptospira is still mainly composed of the serogroup Icterohaemorrhagiae and the Hebdomadis, with the host animal being the serogroup Icterohaemorrhagiae.

Objective:To identify the phosphodiesterase (PDE) activity of the gene product encoded by LA_RS06960 of Leptospira interrogans ( L. interrogans), and analyze whether dinucleotides that can be degraded by PDE can activate macrophages to express innate immune factors. Methods:The LA_RS06960 gene in L. interrogans strain 56601 was amplified by PCR, and the prokaryotic expression system was constructed for the protein expression. The expressed rPDE was purified by Ni-NTA affinity chromatography. High performance liquid chromatography (HPLC) was used to measure the degration of c-di-AMP or 5′-pApA to AMP by rPDE. Real-time fluorescent quantitative RT-PCR (qRT-PCR) was used to detect the changes in the expression of target genes in Leptospira or THP-1 cells associated with innate immune factors during infection. qRT-PCR and ELISA were used to detect the changes in the expression and secretion level of the innate immune factors in macrophages treated with bacterial dinucleotide. Results:The prokaryotic expression system for LA_RS06960 gene of L. interrogans was constracted successfully, and the purified rPDE could degrate 5′-pApA and c-di-AMP into AMP in vitro. The mRNA level of leptospiral LA_RS06960 gene was significantly down-regulated, while IFN-β, TNF-α, IL-6 and IL-1β encoding genes of macrophages were significantly up-regulated during infection. The mRNA level or the secretion level of IFN-β and IL-6 of macrophages were increased after treated with the bacterial dinucleotide substrate of PDE. Conclusions:PDE encoded by LA_RS06960 gene has phosphodiesterase activity, and the bacterial dinucleotide substrate of the PDE could activate the innate immune response of macrophages.

Objective:To understand the in vitro antimicrobial resistance and resistance phenotypes profile of Streptococcus suis strains isolated from human in Zhejiang Province. Methods:The strains of sporadic Streptococcus suis infections were isolated during 2005 to 2021 in Zhejiang Province, and were subjected to antimicrobial resistance analysis using agar dilution method. Polymerase chain reaction (PCR) technology was also used to detect 70 resistance genes including tetracyclines, macrolides and aminoglycosides. Results:The results of antimicrobial resistance analysis showed that these strains were sensitive to eleven kinds of antimicrobial agents with a sensitivity rate ≥96.8%, including cefepime, cefotaxime, ceftriaxone, chloramphenicol, daptomycin, ertapenem, levofloxacin, linezolid, meropenem, penicillin and vancomycin. These strains were mainly resistant to tetracycline, clindamycin, azithromycin and erythromycin, especially resistant to tetracycline with a rate of 93.5%(29/31). Fourteen strains (45.2%) exhibited multidrug resistant patterns. The PCR analysis of 70 drug resistance genes showed that 14(20.0%) different resistance genes were detected. The highest detection rate of resistant genes came from tetracycline, including tet ( O) gene (58.1%, 18/31), tet ( M) gene (48.4%, 15/31), tet ( 40) gene (35.5%, 11/31), followed by ermB gene (41.9%, 13/31) in the class of macrolide. Fourteen strains (45.2%) with more than three drug resistance genes were detected, of which eight strains (25.8%) detected 10 drug resistance genes. The analysis of antibiotic resistance and resistance phenotypes profile showed that tet ( M)+ ST7 accounted for 35.5%(11/31), tet( O)+ tet( 40)+ ermB+ mef( A)+ mef( A/ E)+ msrD+ Ant( 6)- Ⅰb+ aph( 3′)- Ⅲa+ aadB+ sat4+ ST7 accounted for 25.8%(8/31). Conclusions:The antimicrobial resistance and resistance phenotypes profile of sporadic Streptococcus suis strains isolated from human in Zhejiang Province are endemic, with mainly two types of characteristic genetic cloning of drug resistance genes.

Objective: The objective of this study was to establish a next generation sequencing (NGS) method for severe fever with thrombocytopenia syndrome virus(SFTS). Methods: SFTS virus RNA was extracted from the patient serum inoculated and isolated by Vero cells. Two methods of random primer sequencing and oligo(dT) beads selection sequencing were used for library construction. The libraries were built based on the best amplification and purification conditions. Whole genome sequencing was performed on NGS platform. Results: There were significant differences in data of 3 virus between the two methods.The sample was sequenced by random primer sequencing showed low coverage and depth. However, three samples were sequenced by oligo(dT) beads selection showed coverage was over 99% and depth was over 900.The alignment rate of database from NCBI was more than 90%. The initial detection quality of this method was 300ng RNA. Conclusions In this study, we used the method of oligo(dT) beads selection to build libraries, and established a SFTS virus genome detection based on next generation sequencing.

Objective To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) (TACE-MWA) versus repeat resection (RR) in the treatment of recurrent hepatocellular carcinoma (RHCC). Methods A total of 178 patients with RHCC who were admitted to The Second People's Hospital of Neijiang from June 2015 to September 2020 were enrolled, and according to the treatment modality, they were divided into RR group with 64 patients and TACE-MWA group with 114 patients. Baseline demographic data, liver function, and tumor conditions before treatment were recorded, and the patients were followed up to October 2021 to compare postoperative overall survival (OS) time and recurrence-free survival (RFS) time between the two groups. Subgroup analysis based on recurrence pattern (recurrence time and tumor size) was performed, and the influencing factors for prognosis were analyzed. The independent samples t -test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data; the Kaplan-Meier method was used for postoperative survival rate, the Log-rank test was used for survival difference analysis, and a multivariate Cox regression analysis was used to investigate independent risk factors for survival. Results The multivariate analysis showed that tumor diameter, alpha-fetoprotein (AFP) level, alanine aminotransferase, albumin, and time to recurrence were independent prognostic factors for OS (all P < 0.05), and AFP level and time to recurrence were independent prognostic factors for RFS (both P < 0.05). For RHCC with late recurrence (> 2 years), there were significant differences between the two groups in median OS (54.0 months vs 36.0 months, χ 2 =6.171, P =0.013) and median RFS (28.0 months vs 21.0 months, χ 2 = 5.211, P =0.022). For RHCC with a tumor diameter of ≤5 cm, there was a significant difference in median OS between the two groups (33.0 months vs 27.0 months, χ 2 =6.447, P =0.011). Conclusion RR has a similar clinical effect to TACE-MWA in RHCC with early recurrence or a tumor diameter of > 5 cm, but RR should be the first choice for RHCC with late recurrence or a tumor diameter of ≤5 cm.

Objective:To analyze the epidemiological characteristics of rabies in China from 2007 to 2023, and to provide reference evidence for tailoring strategies to facilitate the elimination of rabies in the country.Methods:Case data from 2007 to 2023 were obtained from China′s National Notifiable Infectious Disease Reporting Information System, and the spatial, temporal, and demographic features of cases were analyzed.Results:From 2007 to 2023, a total of 18 751 human rabies cases were reported in China, with an average annual incidence rate of 0.08 per 100 000. The average annual percentage change (AAPC) in incidence rate was -18.58% (95% CI: -21.32% to -15.75%, P<0.05), with three significant turning points in 2011, 2018, and 2021. Based on the trend of the epidemic, Chinese provinces can be roughly divided into five categories. The geographical range affected by rabies has decreased from 23 provinces and 984 counties (districts) in 2007 to 17 provinces and 101 counties (districts) in 2023. Since 2019, the high-incidence counties (districts) have been mainly concentrated in the southwestern part of Hunan, the southern part of Henan, and the western part of Anhui. Fourteen provinces have reported no cases for at least two consecutive years. Males (70.24%) and farmers (72.18%) were the main affected groups, and the proportion of cases aged 65 and above increased from 17.43% in 2007 to 36.07% in 2023. Conclusions:The incidence of rabies in China has changed from endemic in many areas to sporadic, with the remaining endemic regions mainly located in parts of the middle and lower reaches of the Yangtze River. The main vulnerable groups are middle-aged and elderly farmers. The current prevention and control measures can effectively curb the transmission of rabies, but the decline of cases has slowed down recently.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.