Objective To study the epidemiological characters of an influenza A/H1N1 outbreak in a middle school in Huaian city,and to provide scientific measures for prevention and control of influenza A/ H1N1.Method The outbreak of influenza A/H1N1 was investigated through the field epidemiology.The samples were used for virus isolation.Nucleotide sequences of H1N1 HA1 region were determined by RT-nested-PCR and sequencing.H1N1 genotypes were analyzed using bioinformatic programs by MEGA 5.0 software,and phylogenetic tree was constructed.Result 51 cases were reported during 11 days,the attack rate was 2.49％ (51/2051).The sequence analysis showed that the sequence homologous rates of H1N1 virus HA gene nucleotide were 99.6％-99.9％ with H1N1 genotype in 2014,98.5％-98.8％ in 2013,and lower than 98.4％ in 2011.Conclusion The popularity of this outbreak was low.Timely isolation of H1 N1 patients and close contacts played an important role in control the epidemics.Implementation of health propaganda and immunization of influenza A/H1N1 should be strengthened.

Objective:To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods:From February 2015 to June 2019, 8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh. Right foot in 4 cases, left foot in 3 cases and bilateral in 1 case. There were 5 males and 3 females. Ages ranged from 16 to 56, with an average age of 31. Clinical features: scar ulcer in 4 cases, bone-sticking scar in 4 cases, bone exposure in 1 case. After debridement, the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm, the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm. All flaps were fixed by cross-leg with pedicle. The pedicle division were performed one month after the skin flap transmission.Results:Of the 9 flaps transferred, 8 survived, 1 died in the distal part of the flap and was repaired by secondary expanded flap, and the donor site healed in linear scar stage. After 6-24 months follow-up, the plantar flap was in good shape and could walk with weight-bearing, without ulceration, and the protective tactile sensation was gradually restored in 12 months.Conclusions:The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh, which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole. It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.

Objective:To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods:From February 2015 to June 2019, 8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh. Right foot in 4 cases, left foot in 3 cases and bilateral in 1 case. There were 5 males and 3 females. Ages ranged from 16 to 56, with an average age of 31. Clinical features: scar ulcer in 4 cases, bone-sticking scar in 4 cases, bone exposure in 1 case. After debridement, the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm, the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm. All flaps were fixed by cross-leg with pedicle. The pedicle division were performed one month after the skin flap transmission.Results:Of the 9 flaps transferred, 8 survived, 1 died in the distal part of the flap and was repaired by secondary expanded flap, and the donor site healed in linear scar stage. After 6-24 months follow-up, the plantar flap was in good shape and could walk with weight-bearing, without ulceration, and the protective tactile sensation was gradually restored in 12 months.Conclusions:The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh, which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole. It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.

Objective:To explore the effects of painting psychology training assisted with antipsychotics on recovery effects of patients with schizophrenia during convalescence.Methods:A total of 160 patients with schizophrenia in Kailuan Mental Health Center from September 2018 to August 2019 during convalescence were randomly divided into painting group and control group, with 80 cases in each group. The control group was treated with antipsychotics, and painting group was given painting psychology training assisted with antipsychotics. At 12 weeks of treatment, the changes of mental symptoms, cognitive function, and intelligence and behaviors were compared between the two groups.Results:After treatment, the positive and negative syndrome scale (PANSS) negative symptom score, general psychopathological symptom score and PANSS total score in painting group were significantly lower than those in control group ( P<0.05), and there was no significant difference in PANSS positive symptom score between the two groups ( P>0.05). The scores of number of persistent responses, number of persistent errors, number of completed classifications, number of correct responses, percentage of conceptual level responses of Wsiconsin card sorting test (WCST) scale were significantly better than those in control group ( P<0.05). The mini-mental state examination (MMSE) score in painting group was significantly higher than that in control group ( P<0.05), and the scores of positive factors of personal cleanliness, social interest and social ability and negative factors of depression, delay, irritability and psychiatric performance of nurse observation scale for inpatient evaluation (NOISE-30) scale were significantly better than those in control group ( P<0.05). Conclusions:Painting psychology training assisted with antipsychotics can significantly improve the negative symptoms of patients with schizophrenia during convalescence, enhance cognitive function, and promote the recovery of intelligence and behaviors of patients.

Background Alcohol dependence and related health problems have attracted greater than ever attention in recent years.Alcohol dependence not only affected personal behavior control ability,but also brought adverse effect to families and society.Objective To analyze the relationship between cognitive function and personality traits among male alcohol-dependent patients with aggressive behavior,in order to provide references for improving the cognitive function of male alcohol-dependent patients with aggressive behavior.Methods Male patients with alcohol dependence attending Hunan Brain Hospital from March 2020 to March 2022 and fulfilling the International Classification of Diseases,tenth edition(ICD-10)diagnostic criteria were enrolled.According to the score of Modified Overt Aggression Scale(MOAS),participants were classified into aggressive behavior group and non-aggressive behavior group at 1∶1 ratio,each with 80 cases.The enrolled subjects were then evaluated using Revised Eysenck Personality Questionnaire Short Scale for Chinese(EPQ-RSC)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Pearson correlation analysis was utilized to examine the correlation between EPQ-RSC and RBANS scores among alcohol-dependent patients with aggressive behavior.Results Scores on each subscale in RBANS were all lower in aggressive behavior group than those in non-aggressive behavior group(t=2.176,2.580,2.076,2.308,2.193,P<0.05),and scores on each dimension in EPQ-RSC in aggressive behavior group were higher than those in non-aggressive behavior group(t=4.497,5.242,6.459,P<0.01).Pearson correlation analysis denoted that the scores of introversion/extroversion,neuroticism and psychoticism in EPQ-RSC were positively correlated with the scores of immediate memory,visuospatial/constructional ability,language,attention and delayed memory in RBANS among alcohol-dependent patients with aggressive behavior(r=0.294～0.482,0.362～0.511,0.265～0.475,P<0.05).Conclusion The cognitive function may have a certain correlation with personality traits in alcohol-dependent patients with aggressive behavior.

Objective:To assess the applicability of fully automatic pipeline automated testing for internal quality control (automated quality control).Methods:Stability, assay efficiency and implementation costs of 18 biochemical tests, 5 immunoturbidimetric tests and 11 chemical illuminescent tests in the Department of Laboratory Medicine of Peking Union Hospital from January 2019 to July 2022 were evaluated using automated quality control implementation methods. The detailed method is as follows: quality control materials for biochemical, immunoturbidimetric and chemiluminescent tests were stored in the refrigerator in the pipeline which was controlled by the intermediate software, and were automatically retrieved and tested as pre-set followed by documenting and storing. The quality control setup for the biochemical tests included refreshing quality control materials daily and weekly,both of which were paralleled for 3 months. The on-line storage stability of quality control materials in the pipeline was evaluated by comparing the coefficients of variation ( CV) of the quality control results between the two patterns. Effect of automated quality control application was evaluated using 6 indicators, including the results′ variation of automatically performed and manually performed quality controls, the out-of-controlled rate, the consumption of quality control materials, the change of staff workload, the impact on the testing time of the first sample, and the failure rate of automated quality control. Results:(1) Storage stability of quality control materials in the pipeline: under the pattern of weekly refresh of the biochemical quality control materials, except for total carbon dioxide (TCO 2) (the CVs of low and high level quality control were respectively 20.24% and 21.82%) and sodium (the CV of low level quality control was 1.51%) that were greater than the allowable variation set by the laboratory, the CVs of the rest tests meet the lab requirements on the allowable variations. (2) The results′ variation of quality control in automatically performed and manually performed control patterns: in the patterns of daily refresh of biochemical quality control materials and weekly refresh of immunoturbidimetric and chemiluminescent quality control materials, the CVs of both low and high levels of quality control were lower in the automatically performed control pattern than that in manually performed pattern for 8 chemiluminescent items of dehydroepiandrosterone sulfate, estradiol, follicle stimulating hormone, luteinizing hormone, serum ferritin, serum folic acid, vitamin B12 and testosterone, 3 immunologic items of complement 3, C reactive protein and immunoglobulin G, and 10 biochemical items of alkaline phosphatase, glucose, calcium, chloride, potassium, lactate dehydrogenase, sodium, urea, low density lipoprotein cholesterol, and adenosine deaminase. The out-of-control rates of biochemistry, immunoturbidimetric and chemiluminescence tests in both quality control patterns conformed with the clinical routine work requirements. (3) Comparison of quality control materials′ consumption: compared with manually performed quality control, weekly consumption of automatically performed chemiluminescent quality control materials decreased 37.5% (from 8 ml to 5 ml); weekly consumption of automatically performed immunoturbidimetric quality control materials decreased 33.3% (from 3 ml to 2 ml). (4)Comparison of staff workload and first sample testing time: compared with manually performed quality control, automatical quality control reduced manual work by about 156 steps per week, and the daily initial testing time was earlier by 15 min on average. The failure rate was 54.5% (37/64) during the early-stage application of the automated quality control which dropped to 10.2% (13/128) in the late-stage. Conclusion:The results of automated quality control detected in the pipeline system meet the quality indicators′ requirements of the laboratory, and the application of automated quality control can improve the quality control, save costs, reduce workload, and improve work efficiency.

Objective To observe the application effect of transcutaneous acupoint electrical stimulation in the psychological craving and protracted abstinence symptoms of alcohol-dependent pa-tients.Methods A total of 120 male alcohol-dependent patients who completed the acute alcohol withdrawal phase and were hospitalized in the Department of Alcoholism in Hunan Brain Hospital were selected as the study subjects.They were divided into conventional drug group,transcutaneous acu-point electrical stimulation group and placebo group according to different treatment methods,with 40 patients in each group.The conventional drug group was treated with benzodiazepine drugs for re-placement and reduction and supportive symptomatic treatment.The transcutaneous acupoint electri-cal stimulation group was treated with conventional treatment combined with transcutaneous acupoint electrical stimulation.The placebo group was treated with conventional treatment combined with simu-lated transcutaneous acupoint electrical stimulation.The Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Alcohol Urge Questionnaire(AUQ),Visual Analogue Scale(VAS),Pittsburgh Sleep Quality Index(PSQI)score and recurrence conditions were compared before and af-ter treatment among the three groups.Results After treatment,the SAS,SDS,AUQ and VAS scores of the three groups were lower than those before treatment,and the above scores of the transcu-taneous acupoint electrical stimulation group were lower than those of the conventional drug group and placebo group(P＜0.05).After treatment,the scores of sleep quality,the time to fall asleep,sleep duration,sleep efficiency,sleep disturbance,hypnotic drugs,daytime dysfunction and total PSQI score of the three groups were lower than those before treatment,and the above scores of the transcutaneous acupoint electrical stimulation group were lower than those of the conventional drug group and placebo group(P＜0.05).The recurrence rate of the transcutaneous acupoint electrical stimulation group was lower than that of the conventional drug group and placebo group(P＜0.05).Conclusion Compared with conventional treatment and simulated transcutaneous electrical stimulation,transcutaneous acu-point electrical stimulation is more effective in reducing the severity of protracted abstinence symp-toms such as anxiety,depression and insomnia,and is also beneficial in reducing patients'psycho-logical craving,thereby reducing the recurrence rate.

Objective To observe the application effect of transcutaneous acupoint electrical stimulation in the psychological craving and protracted abstinence symptoms of alcohol-dependent pa-tients.Methods A total of 120 male alcohol-dependent patients who completed the acute alcohol withdrawal phase and were hospitalized in the Department of Alcoholism in Hunan Brain Hospital were selected as the study subjects.They were divided into conventional drug group,transcutaneous acu-point electrical stimulation group and placebo group according to different treatment methods,with 40 patients in each group.The conventional drug group was treated with benzodiazepine drugs for re-placement and reduction and supportive symptomatic treatment.The transcutaneous acupoint electri-cal stimulation group was treated with conventional treatment combined with transcutaneous acupoint electrical stimulation.The placebo group was treated with conventional treatment combined with simu-lated transcutaneous acupoint electrical stimulation.The Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Alcohol Urge Questionnaire(AUQ),Visual Analogue Scale(VAS),Pittsburgh Sleep Quality Index(PSQI)score and recurrence conditions were compared before and af-ter treatment among the three groups.Results After treatment,the SAS,SDS,AUQ and VAS scores of the three groups were lower than those before treatment,and the above scores of the transcu-taneous acupoint electrical stimulation group were lower than those of the conventional drug group and placebo group(P＜0.05).After treatment,the scores of sleep quality,the time to fall asleep,sleep duration,sleep efficiency,sleep disturbance,hypnotic drugs,daytime dysfunction and total PSQI score of the three groups were lower than those before treatment,and the above scores of the transcutaneous acupoint electrical stimulation group were lower than those of the conventional drug group and placebo group(P＜0.05).The recurrence rate of the transcutaneous acupoint electrical stimulation group was lower than that of the conventional drug group and placebo group(P＜0.05).Conclusion Compared with conventional treatment and simulated transcutaneous electrical stimulation,transcutaneous acu-point electrical stimulation is more effective in reducing the severity of protracted abstinence symp-toms such as anxiety,depression and insomnia,and is also beneficial in reducing patients'psycho-logical craving,thereby reducing the recurrence rate.

Objective To investigate the clinicopathological characteristics and the prognosis of bladder neuroendocrine carcinoma ( NEC) .Methods Clinicopathological data from 17 NEC of the bladder cases were collected , and immunohistochemical staining was performed with follow-up analysis and literature review.Results The recruited included 13 male and 4 female patients, aged from 48 to 86 years old ( average 61 years;14 patients >60 years ) .Gross hematuria of the whole urination course or intermittent was the initial symptom .Macroscopically , the outer surface of the tumor presented with polypoid , lobulated , fungating or ulcerous structures . Histologically, according to the criteria of WHO classification of neuroendocrine tumor of the lung , our NEC cases were divided into three histological types: 13 cases of small cell carcinoma , 3 cases of large cell neuroendocrine carcinoma and 1 case of atypical carcinoid .The urothelial carcinoma was concurrent with NEC in 6 cases, and adenocarcinoma was concurrent with NEC in 2 cases.Most tumor tissue infiltrated to the muscular layer , some infiltrated to the outer membrane . Immunohistochemically , the positive expression rates of CD 56, Syn and CgA were 16/17, 16/17 and 12/17, respectively.The epithelial markers, including CK7 and CKpan, were also expressed with positive rates of 12/17 and 15/17, respectively.TTF-1 was positively expressed in 11 cases.The follow-up data were available in 14 cases, of which 9 patients died of the tumor 1-34 months after surgery ( average, 11 months).Five patients lived uneventfully for 1-12 months after surgery.Conclusions NEC is a rare malignant tumor of the bladder .Immunohistochemical markers such as CD 56, Syn, CgA and CKpan could be helpful in determining the diagnosis and differential diagnosis of the tumor .NEC is a highly invasive malignant tumor with poor prognosis .Based on its biological behavior , radical cystectomy is the preferred method of treatment for the tumor .