Objective: To assess the risk of public health emergencies in Zhejiang Province, March 2021. Methods: An expert counsel was conducted to assess the risk of coronavirus disease 2019 ( COVID-19 ) , enteritis due to norovirus, chicken pox and influenza by professionals in Zhejiang CDC, based on the information from infectious disease and public health emergency surveillance in Zhejiang Province, domestic health administrative departments, World Health Organization, and European CDC. Results: In March 2021, the risk of imported COVID-19 epidemic will be high in Zhejiang Province, and the possibility of local spread could not be ruled out. The possibility of a large-scale outbreak of enteritis due to norovirus and a small-scale outbreak of chickenpox in schools and kindergartens could not be ruled out after the new term begins. An increased risk of influenza epidemic is predicted in collective units such as schools and kindergartens, yet the risk of a large-scale one will be low. Conclusion High attention should be paid to COVID-19 and enteritis due to norovirus, and general attention should be paid to chicken pox and influenza outbreak.

OBJECTIVEWernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. The disorder is still greatly underdiagnosed in children because of either a relatively non-specific clinical presentation in some cases or unrecognized clinical setting. The aim of this literature review was to provide knowledge of pediatric WE in an effort to assist in early diagnosis, thereby reducing the morbidity and mortality.

METHODSThe clinical manifestations, characteristic magnetic resonance imaging (MRI), diagnosis and treatment of one case and the other 35 cases reported in the last decade in children were summarized.

RESULTSThirty-six cases (22 boys and 14 girls, 2-month to 16-year-old) were analyzed. All the other 35 cases except for our case had underlying diseases: improper feeding in 25/35 cases, long-time vomiting in 5/35 cases, immunosuppressive therapy in 4/35 cases, long-time total parenteral nutrition without multivitamin preparations supplementation in 3/35 cases and anorexia nervosa in 1/35 case. The classic triad (mental-status changes, nystagmus and ophthalmoplegia, and ataxia) was seen in 6/36 cases. The other clinical manifestations included consciousness disturbance in 24/36 cases, infection in 22/36 cases, pathological reflex and muscular tension changes in 18/36 cases, convulsion in 17/36 cases, developmental delay in 4/36 cases and failure to thrive in 2/36 cases. Cerebrospinal fluid examination was performed in 31/36 cases, and a slightly raised protein concentration was seen in 7/31 cases. The cerebrospinal fluid lactate levels were detected in 4/36 cases (all increased), serum lactic acid levels in 7/36 cases (6/7 cases increased), serum pyruvate in 4/36 cases (all increased), thiamine pyrophosphate effect (TPPE) in 9/36 cases (all increased), and serum thiamine in 2/36 cases (increased in 1/2 cases). The brain computed tomography (CT) scan was conducted in 20/36 cases and 16/20 cases showed abnormal hypodensity in bilateral basal ganglia, one case revealed diffuse cortical atrophy. The brain MR scan was conducted in 13/36 cases and all the 13 cases revealed symmetrical abnormal signal in bilateral mamillary body and basal ganglia, and 7/13 cases showed abnormal signals in the tegmentum of midbrain, cerebral aqueduct and white matter around the third and fourth ventricles. The diagnosis of WE was confirmed by MR in 12 cases, triad combined with MR in 3 cases, autopsy in 1 case among the 13 cases who underwent MR scan. The diagnosis of WE was confirmed by the TPPE and/or lactate levels in 9/11 cases. The initial thiamine was given by intravenous or intramuscular infusion in 33/36 cases, unknown method in 1 case, orally in 1 case and no thiamine was used in 1 case. The dosage of thiamine was 100 mg daily in 29/35 cases, unknown in 3/35 cases, 50 mg daily in 2/35 cases, 600 mg daily in 1/35 case. 34/35 patients' clinical symptoms improved during 24 hours to 1 week after initial treatment, and 1 case died due to no response to thiamine. Nineteen patients were followed up for 2-2.5 months and 17 cases recovered completely.

CONCLUSIONWernicke's encephalopathy can be difficult to diagnose because of a relatively non-specific clinical presentation. The characteristic MRI findings and the dramatic response of neurological signs to parenteral thiamine will assist early clinical diagnosis. Early and timely thiamine supplementation could reverse the clinical features and improve the prognosis in most cases.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Sepsis ; complications ; Wernicke Encephalopathy ; complications ; diagnosis

OBJECTIVETo elucidate clinical and pathological features of primary sclerosing cholangitis (PSC) in order to improve clinician's awareness of this rare disease.

METHODSWe retrospectively analyzed clinical data and follow-up information of 27 PSC patients who were admitted to Beijing Friendship Hospital from January 1990 to November 2009. The patients were classified into classic PSC and small-duct PSC according to biochemistry and imaging results. After 3 to 6 months of therapy, those patients with serum ALT < or = 1.5, TBil < or = 2 and ALP < or = 2.5 ULN were determined as good responders. The treatment results between the two groups were compared.

RESULTS9 out of 27 cases of PSC were small duct PSC and 18 cases were large bile duct or classic PSC. Male patients (7) were less than females (20) and the average age was 47.6 years. Main clinical symptoms included jaundice (85.2%), pruritis (48.1%),fatigue (68.4 %), abdominal pain (40.7%) and fever (14.8%), main physical sign included hepatomegaly (44.4%), splenomegaly (48.1 %) and ascites (14.8%). Laboratory features included elevated IgG (81.8%), positive ANA (69.6%) and pANCA (52.9%). 22% of these PSC patients had ulcerative colitis or Sjogren's syndrome. A small percentage of patients were responsive to standard therapy, of which small duct PSC had a better response than classic PSC (66.7 % vs 33.3%, P = 0.041).

CONCLUSIONSUlcerative colitis (22.2%) is not as common as reported by western countries. Small duct PSC has a better treatment response. Searching of effective treatment regimen for large bile duct PSC is warranted in future studies.

Adolescent ; Adult ; Aged ; Cholangitis, Sclerosing ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo screen the severe acute respiratory syndromes (SARS) mimotopes with random phage peptide library and to investigate their immunogenicity.

METHODSUsing SARS sera as selective molecule, a 12 mer phage peptide library was biopanned and positive clones containing the mimic epitopes were selected. The immuno-characteriation of the epitopes were then investigated.

RESULTS2 positive clones that having specific affinity to SARS sera were obtained. The DNA sequencing data showed no homology between the sequences of the deduced amino acid of the two mimic antigen peptides and the sequence of SARS.

CONCLUSIONSARS mimotopes were obtained by phage peptide library screening. This method might provide a new approach for SARS therapy and vaccine development.

Animals ; Antigens, Viral ; Base Sequence ; Biomimetic Materials ; Cloning, Molecular ; Enzyme-Linked Immunosorbent Assay ; Epitopes ; genetics ; immunology ; Humans ; Peptide Library ; Sequence Analysis, DNA ; Severe Acute Respiratory Syndrome ; immunology

The objective was to observe the effect of G-CSF as a mobilizer of hematopoitic stem cells on the absolute counts of T-cell subsets in peripheral blood and their relevance with the mobilized CD34(+) cells. The examples of peripheral blood from 26 patients performed of autologous stem cell transplantation were taken before and after mobilization by G-CSF. Flow cytometry was used for detecting CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD3(+)CD4(+)CD8(+) and CD3(+)CD4(-)CD8(-) cells. Concurrently, their correlations with mobilized CD34(+) cells in peripheral blood were compared. The results showed that after the mobilization by G-CSF, the amounts of CD3(+), CD3(+)CD4(+), CD3(+)CD4(+)CD8(+) and CD3(+)CD4(-)CD8(-) cells in peripheral blood increased by 2.23, 2.62, 2.99 and 10.96 fold respectively, but that of CD3(+)CD4(-)CD8(+) cells was nearly no changed (P = 0.243). The correlation coefficient of CD3(+)CD4(-)CD8(-) cells and mobilized CD34(+) cells was 0.796, (P = 0.000) and no correlation with other T-cell subsets. It was concluded that when CD34(+) cells were mobilized by G-CSF from bone marrow to peripheral blood, the absolute counts of the peripheral T-cell subsets got changed. The increase of CD3(+)CD4(-)CD8(-) cells had correlated with mobilization effect of CD34(+) cells into peripheral blood.
Adolescent ; Adult ; Antigens, CD34 ; analysis ; Female ; Granulocyte Colony-Stimulating Factor ; pharmacology ; Hematopoietic Stem Cell Mobilization ; Humans ; Male ; Middle Aged ; T-Lymphocyte Subsets ; drug effects

BACKGROUND: The application of coronary stents, especially drug-eluting stents (DESs), has made percutaneous coronary intervention (PCI) one of important therapeutic methods for CHD. DES has reduced the in-stent restenosis to 5％–9％ and signifi cantly improved the long-term prognosis of patients with CHD. The study aimed to investigate the long-term efficacy and safety of domestic drug-eluting stents (DESs) in patients with acute coronary syndrome (ACS). METHODS: All patients with ACS who had undergone successful percutaneous coronary intervention (PCI) in the First Affiliated Hospital of Zhengzhou University from July 2009 to December 2010 were included in this study. Patients were excluded from the study if they were implanted with bare metal stents or different stents (domestic and imported DESs) simultaneously. The included patients were divided into two groups according to different stents implanted: domestic DESs and imported DESs. RESULTS: In the 1683 patients of this study, 1558 (92.6％) patients were folowed up successfuly for an average of (29.1±5.9) months. 130 (8.3％) patients had major adverse cardiovascular events (MACEs), including cardiac death in 32 (2.1％) patients, recurrent myocardial infarction in 16 (1％), and revascularization in 94 (6％). The rates of cardiac death, recurrent myocardial infarction, revascularization, in-stent restenosis, stent thrombosis and other MACEs were not significantly different between the two groups (allP>0.05). Multivarite logistic regression revealed that diabetes mellitus (OR=1.75, 95％CI: 1.09–2.82,P=0.021), vascular numbers of PCI (OR=2.16, 95％CI: 1.22–3.83, P=0.09) and PCI with left main lesion (OR=9.47, 95％CI: 2.96–30.26,P=0.01) were independent prognostic factors of MACEs. The Kaplan-Meier method revealed that there was no significant difference in cumulative survival rates and survival rates free from clinical events between the two groups (allP>0.05). CONCLUSIONS: The incidences of clinical events and cumulative survival rates are not statistically different between domestic DESs and imported DESs. Domestic DES is effective and safe in the treatment of patients with ACS.

Purpose To investigate the expression of sphingosine-1 phosphate receptor 1 (S1PR1) and sphingosine-1 phosphate receptor 4 (SIPR4) in triple negative breast carcinoma (TNBC) and to evaluate its correlation with the clinicopathologic features of TNBC. Methods 72 cases of tissue slides of TNBC were stained immunohistochemically and analyzed with image processing to calculate the S1PR1 and S1PR4 expression. Correlations of the S1PR1 and S1PR4 expression with the clinicopathologic features of TNBC were studied. Results Ki-67 index of high, moderate and low expression of the S1PR1 in TNBC were 48.89％, 36.11％ and 26.48％, respectively. The difference among them was significance (P＜0.001). Ki-67 index of high, moderate and low expression of the S1PR4 in TNBC were42.83％, 31.43％ and 28.93％, respectively. The difference among them was significance (P = 0.007 ). The positive rate of lymph node of high, moderate and low expression of the SI PR1 in TNBC were 31.4％, 48.6％ and 20.0％, respectively. The difference among them was significance (P = 0.012). The positive rate of lymph node of high, moderate and low expression of the S1PR4 in TNBC were 54.3％, 40.0％ and 5.7％, respectively. The difference among them was significance (P=0.010). The CD68 positive rate of high, moderate and low expression of the S1PR1 in TNBC were 47.22％, 42.59％ and31.48％, respectively. The difference among them was significance (P = 0.036). Both the difference of survive rate among high, moderate and low expression of the S1PR1 and S1PR4 were not significance (P = 0.209 and P =0.593 ). Conclusion High expression of S1PR1 and S1PR4 may contribute to the cellular proliferation and lymph node metastases in TNBC. The survive rate of TNBC maybe not related with both the S1PR1 and S1PR4 expression.

·AIM: To investigate the efficacy of intravitreal injection of Conbercept in the treatment of diabetic macular edema (DME). ·METHODS: Totally 95 patients(95 eyes) with diabetic macular edema treated in our hospital from January 2014 to December 2016 were retrospectively analyzed, and 42 cases received Ranibizumab intravitreal injection were included into control group, 53 cases treated with conbercept intravitreal injection were included into observation group. The changes of preoperative and postoperative follow up visual acuity and macular foveal thickness in the two groups were observed. The repeated medication, complications and medical expenses were also compared. ·RESULTS:The preoperative best corrected visual acuity between groups showed no difference (P>0. 01). The postoperative best corrected visual acuity between groups showed distinct difference (F = 105. 326, P<0. 01; F =86.365,P<0.01). At 3mo after the operation,visual acuity of two groups sharply improved, a significant difference was shown within the groups (P<0. 05), but held no obvious difference between groups (P>0. 05). At 6mo after operation,the observation group's visual acuity was evidently higher than that at 3mo (P<0.05). The visual acuity at postoperatively 6mo of the observation group was significantly higher than that of the control group,the difference between groups was statistically marked (P<0.01). The control group's visual acuity at postoperative 3 and 6mo showed no marked difference (P>0.05). The overall changes of foveal thickness between two groups showed a significant difference (F=86.365, P<0.01; F=84.235,P<0.01). The foveal thickness reduced obviously during the postoperative 1, 3 and 6mo of followed up, which showed remarkable difference within groups (P<0.05) but no difference between groups (P>0.05). The repeated medication of observation group during the postoperative 1,3 and 6mo of followed up was evidently less than that of the control group,the difference between groups was significant (P<0.05). There was no statistical difference between groups in complications after operation (P>0. 05). The average medical cost of the observation group was obviously less than that of the control group,and the difference between the two groups was evident (P<0.01). ·CONCLUSION:Intravitreal injection of conbercept in the treatment of diabetic macular edema can effectively enhance vision and relieve macular edema, as well as shows lasting efficacy,low cost and high safety.

Objective To understand pathogenic distribution and epidemiological characteristics of diarrhea syndrome in Gansu Province． Methods Fecal specimens from diarrhea syndrome surveillance cases at sentinel hospitals in Gansu Province from 2009 to 2018 were collected，and virus nucleic acids were detected by real－time fluorescent chain reaction，and bacteria were detected by isolation culture． Ｒesults 1 547 positive cases were detected from 4 406 stool specimens with the positive rate of 35. 11%． Among the positive samples，1 281 cases were positive for virus with the positive rate of 47. 20%; 287 ca- ses were positive for bacteria with the positive rate of 8. 57%． Top five of pathogenic spectrum were rota- virus ( 46. 04%) ，astrovirus ( 13. 37%) ，norovirus ( 13. 15%) ，Shigella ( 9. 90%) and adenovirus ( 7. 81%) ． In different age groups，statistically significant differences were found in the positive rates of rotavirus，norovirus，astrovirus，Shigella and non typhoid Salmonella ( all P＜0. 05) ． The positive rate of virus was higher from November to March of next year，and the positive rate of bacteria was higher from June to August． The epidemic seasons of pathogens were different，of which rotavirus was dominating in four seasons． Conclusions The pathogenic spectrum of diarrhea is wide relatively in Gansu Province， and viral diarrhea is more common，with obvious seasonal peak． Continuous monitoring should be strengthened to grasp characteristics and epidemic trends of pathogens，and it is helpful to take targeted and seasonal preventive measures in population at high risk．

INTRODUCTIONIntravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset is a licensed proven therapy for ischaemic stroke, with recent trial data showing benefit up to 4.5 hours. We previously published in this journal data of a survey conducted in 2004 showing only 9% of ischaemic stroke patients presenting to the Singapore General Hospital (SGH) arrived within 2 hours of onset. We aimed to determine whether the problem of delayed hospital arrival persists in 2009 and to establish the impact of widening the time window for intravenous tPA to 4.5 hours.

MATERIALS AND METHODSWe prospectively surveyed consecutive ischaemic stroke patients admitted to the SGH from 9th March to 30th April 2009. Patients and/or relatives were interviewed with a standardised form similar to the 2004 survey.

RESULTSAmong the 146 ischaemic stroke patients surveyed (median age 67 years, 59% male, median NIHSS score 2), 6% presented to SGH within 2 hours and 15% within 3.5 hours of onset. Median time from stroke onset to hospital arrival was 1245 minutes (20.75 hours). Pre-hospital consultation was significantly associated with hospital arrival after 2 hours from onset. Main reasons cited for delay were not realising the gravity of symptoms (31%) and not recognising them as stroke (27%).

CONCLUSIONDelayed arrival to SGH following acute ischaemic stroke remains a problem in 2009. This confirms the lack of stroke awareness in Singapore and highlights the need for public stroke education. Furthermore, these data confirm that widening the time window for intravenous tPA treatment to 4.5 hours at SGH will increase its utilisation.

Acute Disease ; therapy ; Aged ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitalization ; trends ; Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care ; statistics & numerical data ; Prospective Studies ; Stroke ; therapy ; Time Factors