We investigated the genetic diversity and evolution of the M gene of human influenza A viruses in Hangzhou (Zhejiang province, China) from 2009 to 2013, including subtypes of A(H1N1) pdm09 strains and seasonal A(H3N2) strains. Subtypes of analyzed viruses were identified by cell culture and real-time reverse transcription-polymerase chain reaction, followed by cloning, sequencing and phylogenetic analyses of the M gene. Assessment of 5675 throat swabs revealed a positive rate for the influenza virus of 20.46%, and 827 cases were diagnosed as. infections due to influenza A viruses. Seventy-six influenza-A strains were selected randomly from nine stages during six phases of a virus epidemic. Sequences of the M gene showed high homology among six epidemics with identities of amino-acid sequences of 98.98-100%. All strains contained the adamantine-resistant mutation S31N in its M2 protein. Two of the A(H1N1)pdm09 strains had double mutants of V27A/S31N or V271/S31N. One of the seasonal A(H3N2) viruses had another form of double-mutant R45H/S31N. Evolutionary rate of the M gene was much lower than that of the HA gene and NA gene. Compared with A(H3N2) strains, higher positive pressure on the M1 and M2 proteins of A(H1N1) pdm09 viruses was observed. Separate analyses of M1 and M2 proteins revealed very different selection pressures. Knowledge of the genetic diversity and evolution of the M gene of human influenza-A viruses will be valuable for the control and prevention of diseases.
Amino Acid Substitution ; China ; epidemiology ; Evolution, Molecular ; Genetic Variation ; Humans ; Influenza A Virus, H1N1 Subtype ; classification ; genetics ; isolation & purification ; Influenza A Virus, H3N2 Subtype ; classification ; genetics ; isolation & purification ; Influenza, Human ; epidemiology ; virology ; Phylogeny ; Selection, Genetic ; Viral Matrix Proteins ; genetics ; Viral Proteins ; chemistry ; genetics

Safety-based culture is a new practice of safety assurance in the area of safety-based science,playing a key role in safety managemenL By means of innovating a safety-based culture and nurturing a safe service atmosphere,the hospital regulates medical behavior with regulations to guarantee patient safety,builds a scientific appraisal-feedback-improvement system,and launch people-oriented skills training to build a harmonic doctor-patient relationship.All these aim to better the service flow and service,upgrading both quality of care and patient safety.

OBJECTIVETo determine the frequency of RHD1227A allele in Chinese Hans.

METHODSFor a total of 890403 ethnic Han blood donors, the D antigen was determined with a saline method and indirect antiglobulin test. The RHD1227A allele and number and type of zygosity of RHD gene were determined with PCR sequence specific primer (PCR-SSP). Allelic frequency was calculated through statistics.

RESULTSIn total 2385 donors were found to be Rh-negative, 108 individuals were found to be weakly positive for D antigen (including weak D and partial D phenotypes). The remaining 887 910 individuals were Rh-positive. Among the Rh-negative individuals, 516 were found with RHD1227A. Among these, 467 were RHD1227A/d and 49 were RHD1227A/RHD1227A. Two of 108 D antigen weak-positive individuals were found as RHD1227A/RHD+. In addition, 8 of 1073 random Rh-positive samples were found to be RHD1227A/RHD+. The allele frequency of RHD1227A in the population was calculated as 0.004 036. The figure should be 0.006 682 if calculated based on the detected rate of the allele in Rh-negative individuals, and 0.007 884 if calculated based on the reported average phenotype rate of DEL in Rh-negative individuals.

CONCLUSIONBy taking main influencing factors such as the RHD zygosity, the rate of RHD1227A and DEL phenotype may be determined. The allele frequency of RHD1227A in Chinese Hans is between 0.004 036 and 0.007 884.

Adolescent ; Adult ; Asian Continental Ancestry Group ; ethnology ; genetics ; China ; ethnology ; Exons ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Middle Aged ; Mutation, Missense ; Rh-Hr Blood-Group System ; genetics ; Young Adult

Objective To explore the metabolism and chronic complication features of type 2 diabetes mellitus patients with hyperferritemia. Methods:A total of 268 type 2 diabetic patients with a disease course of more than 5 years, who were hospitalized in our hospital between January to December 2019 were included in this retrospective study. Serum ferritin was measured by Chemiluminescence in each participant. Patients with other diseases, which might affect serum ferritin level, were excluded. According to the results of serum ferritin, the patients were divided into hyperferritemia group ( n=115) and normal ferritin group ( n=153). The metabolic indexes, including C-reactive protein, blood glucose, blood lipid, liver and kidney function, were measured. Chronic complications and comorbidities, including diabetic retinopathy, urinary microalbumin excretion, hypertension, coronary heart disease and cerebrovascular disease were evaluated. The correlation between hyperferritemia and various variables was analyzed. Results:Body mass index, the levels of serum urea nitrogen, uric acid, C-reactive protein, alanine aminotransferase and γ-glutamyltranspeptidase, as well as prevalence of diabetic retinopathy, microalbuminuria, hypertension and coronary heart disease, were significantly higher in hyperferritemia group than in normal ferritin group (all P<0.05). Hyperferrinemia was positively correlated with C-reactive protein ( r=0.262, P<0.001), coronary heart disease ( r=0.232, P<0.001), alanine transpeptidase ( r=0.216, P<0.001), urea nitrogen ( r=0.201, P=0.001), diabetic retinopathy ( r=0.169, P=0.008) and microalbuminuria ( r=0.176, P=0.004). Multivariate logistic regression analysis showed that hyperferrinemia was an independent risk factor of coronary heart disease and diabetic retinopathy ( OR=2.246, 95% CI 1.310-3.849, P=0.003; OR=2.232, 95% CI 1.287-3.870, P=0.004, respectively) in this patient cohort. Stepwise linear regression showed that there was a significant correlation between hyperferrinemia and microalbuminuria (β=0.165, P=0.009). Conclusions:Our results show that the level of serum C-reactive protein, alanine aminotransferase, γ-glutamyltranspeptidase, urea nitrogen, uric acid and microalbuminuria are significantly increased and the risk of coronary heart disease and diabetic retinopathy are higher in type 2 diabetic patients with hyperferritemia.

Objective:To observe the clinical effects of different surgical methods in the treatment of upper eyelid aging, and to explore the strategies of different surgical methods in patients with different degrees of upper eyelid relaxation and different eyebrow positions.Methods:From January 2014 to September 2020, 688 patients were selected, and different surgical procedures were performed according to their eyebrow shape and the degree of upper eyelid laxity, such as blepharoplasty skin excision, subeyebrow-incision skin excision, supraeyebrow-incision skin excision or combined procedure. The patients were followed up for 6 to 12 months and observed on the effect of the operation and evaluated on the satisfaction over the surgery.Results:In a total of 688 patients, 396 patients presented mild and moderate blepharoptosis, 292 patients presented severe and extra severe blepharoptosis without eyebrow ptosis. There were 145 cases of double eyelid peeling, 157 cases of upper blepharoptosis correction with subeyebrow incision, 94 cases with upper blepharoptosis with superior eyebrow incision, and 292 cases with combined operation. In the postoperative follow-up, the upper eyelid skin ptosis was improved in 436 cases, satisfactory in 225 cases and dissatisfied in 27 cases, the satisfaction rate was 96.1%(661/688). The postoperative satisfaction of combined operation rendered 98.6%(288/292), higher than that of single operation 94.2%(373/396).Conclusions:Different surgical methods should be applied according to the different degree of upper eyelid skin ptosis and the change of eyebrow position. Patients with severe upper eyelid skin ptosis and eyebrow position change usually need combined operation to achieve satisfactory results.

Objective:To observe the clinical effects of different surgical methods in the treatment of upper eyelid aging, and to explore the strategies of different surgical methods in patients with different degrees of upper eyelid relaxation and different eyebrow positions.Methods:From January 2014 to September 2020, 688 patients were selected, and different surgical procedures were performed according to their eyebrow shape and the degree of upper eyelid laxity, such as blepharoplasty skin excision, subeyebrow-incision skin excision, supraeyebrow-incision skin excision or combined procedure. The patients were followed up for 6 to 12 months and observed on the effect of the operation and evaluated on the satisfaction over the surgery.Results:In a total of 688 patients, 396 patients presented mild and moderate blepharoptosis, 292 patients presented severe and extra severe blepharoptosis without eyebrow ptosis. There were 145 cases of double eyelid peeling, 157 cases of upper blepharoptosis correction with subeyebrow incision, 94 cases with upper blepharoptosis with superior eyebrow incision, and 292 cases with combined operation. In the postoperative follow-up, the upper eyelid skin ptosis was improved in 436 cases, satisfactory in 225 cases and dissatisfied in 27 cases, the satisfaction rate was 96.1%(661/688). The postoperative satisfaction of combined operation rendered 98.6%(288/292), higher than that of single operation 94.2%(373/396).Conclusions:Different surgical methods should be applied according to the different degree of upper eyelid skin ptosis and the change of eyebrow position. Patients with severe upper eyelid skin ptosis and eyebrow position change usually need combined operation to achieve satisfactory results.

Objective To explore the application of micro-lecture in the health education of patients with osteoporosis combined with spinal tuberculosis.Methods By convenient sampling method, 102 patients with spinal tuberculosis and osteoporosis of a tertiary hospital of Beijing were selected from January 2014 to January 2016. They were divided into the control group (n=52) and the observation group (n=50). Patients in the control group received routine health education, while patients in the observation group were given micro-lecture. Health education knowledge and satisfaction to health education of patients in two groups were compared.Results Before discharge, the score of health education questionnaire in the observation group was higher than that of the control group, in which cognition was (3.97±0.82), operation (4.03±0.78), emotion (4.04±0.79); there were statistically significant differences between two groups (t=4.295,4.996,4.732;P<0.01). The score of satisfaction to health education in the observation group was (96.88±2.14), and in the control group was (90.96±5.79) (t'=6.899,P<0.01).Conclusions Micro-lecture in health education for patients with spinal tuberculosis combined with osteoporosis get good effect, and it plays a positive role in the treatment and extended care of hospitalized patients.

Objective? To explore the polypharmacy and drug adverse reactions among elderly mentally illness patients so as to provide a basis for the training of individualized medication observation, nursing and safe medication. Methods? From March to April 2018, we selected 180 patients of geriatrics department at Beijing Huilongguan Hospital and Peking University Sixth Hospital by successive sampling. We collected data involving demographic data, disease data, drug types and names, drug adverse reactions by consulting medical records. Results? Among elderly mentally illness patients, schizophrenia (40.56%) and various types of dementia (40.56%) were the commonest; the number of accompanied diseases was (5.4±2.1) and the top 5 of the commonest was cerebral infarction, cardiovascular disease, hyperlipemia, osteoporosis and hypertension. The kinds of oral medicine were (6.5±2.4); the incidences of polypharmacy and drug adverse reactions were 90.56% and 73.33% respectively. The commonest drug adverse reactions included abnormal liver function (38.33%), constipation (31.67%) and extrapyramidal syndrome (11.67%). Conclusions? The incidence of polypharmacy among elderly mentally illness patients is relatively high accompanied by severe problems. It prompts that psychiatric medical staff should understand and pay more attention to polypharmacy, and provide individualized medication observation and nursing to reduce the adverse effects of polypharmacy on patients.

Objective:To analyze the clinical features of type 2 diabetic patients with insulin autoimmune syndrome after treatment with exogenous insulin.Methods:A total of 106 patients with type 2 diabetes diagnosed with exogenous insulin-related insulin autoimmune syndrome (EIAS) were included from September 2017 to March 2019 in the Department of Endocrinology, Zhongshan Hospital, Fudan University. The clinical data, physical examination, and laboratory examination results of patients were collected.Results:Of the 106 patients, 84 (79.24%) used premixed human insulin or premixed insulin analogs, and 18 patients (16.98%) presented recurrent hypoglycemia. The arginine stimulation test showed that the median value of the baseline insulin was 73.40 (23.07-146.75) μU/ml, and the median ratio of 4 minute insulin to 0 minute insulin was 1.27 (1.03-1.85), with the mean of the ratio 1.72±1.47. The ratio of baseline insulin (μU/ml) to C-peptide (ng/ml) was 44.60 (14.92-87.93), with an average of 81.92±130.93. Taking the two-fold upper limit of fasting insulin reference value (49.8 μU/ml) as the cut-off point, the subjects were divided into insulin accumulation group (baseline insulin≥49.8 μU/ml) and insulin non-accumulation group (baseline insulin <49.8 μU/ml). Among the 66 patients in the insulin accumulation group, 14 patients had hypoglycemia (21.21%) and 4 patients in the insulin non-accumulation group presented hypoglycemia (10%). The ratio of 4 minute insulin to baseline insulin, ratio of baseline insulin to C-peptide, blood glucose level standard deviation (SDBG) and maximum blood glucose fluctuation amplitude (LAGE) in the insulin accumulation group were significantly higher than those in the insulin non-accumulation group (all P<0.05). Among 66 patients in the insulin accumulation group, 36 patients changed the type of insulin preparafion (insulin treatment group), 30 patients were changed from insulin to oral hypoglycemic agents (oral medication group). After treatment, both SDBG and LAGE in the two groups were significantly lower than before treatment ( P<0.05). Conclusions:With the aggravation of exogenous insulin accumulation, the fluctuation of blood glucose and the proportion of hypoglycemia were significantly increased. There was a characteristic change in islet function in patients with insulin autoimmune syndrome. After arginine stimulation, there was no significant peak of insulin secretion, showing a " high-level" curve. The baseline insulin/C-peptide ratio was significantly increased. The prognosis of EIAS patients is good after timely diagnosis and adjustment of treatment.

Objective:To understand the attitudes and cognition of disease control and prevention professionals at provincial level on public health physician standardized training and provide evidence for the improvement of the standardized training and exploration of more effective training mode in China.Methods:By cluster sampling, 2 193 professionals at provincial centers for disease control and prevention (CDC) in 6 provinces, including Jiangsu and Guangdong, Shanxi and Hubei,Sichuan and Xinjiang were selected as the study subjects, the sample size was estimated to be 1 933 persons.Results:A total of 1 716 provincial-level CDC professionals were surveyed, the support rate to the standardized training was 70.7%(1 213/1 716). The level of support was negatively associated with the educational level of professionals and their specialty of public health and preventive medicine. Of 875 public health and preventive medicine professionals, 61.6%(318/516) of those with master's degree or above supported the standard training for public health physicians, which was lower than 73.1%(225/308) of those with bachelor's degree and 86.3%(44/51) of those with college degree or below. There were 14.9%(232/1 555) of the respondents suggested a two year training, and 60.4%(933/1 544) suggesting a field training mode. In terms of training content, 86.6%(1 355/1 564) suggesting "epidemiological survey and public health practice", and 76.7%(1 199/1 564) suggesting "basic theories and methodology".Conclusions:In general, the professionals of provincial CDC showed a relatively low interest in the standardized training for public health physicians and failed to reach a consensus. Besides, they were ill-informed about current training duration, method and content. Thas, the professionals at provincial CDC are suggested to be the key target-population whom should be mobilized during the training pilot period, especially the highly educated ones with relevant specialties of public health. It is suggested that public health physician standardized training should to be implemented in whole CDC system to reach full consensus based on its practical achievements and effects. It is also suggested to establish public health graduate medical education system in China.