Objective To analyze the epidemiologic characteristics and tendency of hemorrhagic fever with renal syndrome (HFRS) in Xi'an from 2005 to 2014,and to grasp the epidemic regularity and predict the trend of HFRS for establishing effective prevention and control measures.Methods The descriptive epidemiological method was used to analyze the epidemic situation of HFRS in Xi'an from 2005 to 2014.The autoregressive integrated moving average (ARIMA) model was applied to analyze,fit and predict the epidemic data of 2015.Results There were 8 500 HFRS patients in Xi'an from 2005 to 2014,the incidence rate was 10.60/100 000.The morbidity increased at first and then decreased from 2005 to 2014;the incidence rate was 9.06/100 000 in 2005 and up to 19.46/100 000 in 2010,then down to 3.43/100 000 in 2014.More cases were reported in spring (15.85％,1 347/8 500) and autumn-winter seasons (72.91％,6 197/8 500).The high-risk age group of HFRS was between 15 to 59 years,accounting for 77.71％ (6 605/8 500) of the overall incidence rate;there were no significant differences in ＜ 15 years,15 to 59 years and ＞ 59 years groups (x2 =15.63,P ＞ 0.05).The male to female ratio was 3.01 ∶ 1.00,male incidence was 15.57/100 000 and female incidence rate was 5.41/100 000,and the difference was statistically significant between gender (x2 =1 948.84,P ＜ 0.05).The main occupation was farmers,accounting for 66.04％ (5 613/8 500) of the overall incidence rate.The top 4 districts were Chang'an,Zhouzhi,Huxian and Lintong;the incidence rate was 31.07/100 000,22.74/100 000,21.09/100 000 and 11.06/100 000,respectively,and the 10 years cumulative incidence rate was higher than the total incidence.The monthly incidence was predicted with ARIMA (1,1,0) × (0,1,1)12 models in Xi'an from 2005 to 2014,and the predicted number of cases was 235 in 2015 (lower than 2014).Conclusions The overall trend of the epidemic has continued to fall but slowly.Positive and effective comprehensive measures should be taken to maintain the incidence of hemorrhagic fever at a lower level.

Objective To describe the vaccine inoculation rate of hemorrhagic fever with renal syndrome (HFRS) and the movement characteristics of rural population in the Xi'an epidemic area.Methods This was a cross-sectional study.The study covered all the four HFRS traditional high incidence areas (counties):Zhouzhi,Huxian,Chang'an and Lintong.Three villages were selected in each county and 20 households were selected in each village in 2013.Participants included all the persons of these families.People 16-60 years old were interviewed face to face about their sociodemographic and environmental information,and at the same time related HFRS vaccine history and characters of migrant workers were collected.Results Nine hundred and ninety-six persons were investigated,69.3 percent (690/996) were vaccinate-age population.Of all,49.0 percent (338/690) had HFRS vaccine history and 53.9 percent (372/690) had worked away from home most of the year.The inoculation proportion of workers which worked in their own counties (56.8％,67/118) were higher than that of workers worked outside (37.0％,60/162;39.1％,36/92,x2 =10.74,6.44,all P ＜ 0.017).In the workers that went back home every week,60.3 percent (76/126) had vaccinated.Workers that went back home once a year had the lowest proportion of inoculation (16.7％,7/42).The morbidity of HFRS decreased significantly accompany with ascend of inoculation rate (Y =-0.524X + 38.319,t =-4.581,P ＜ 0.05).Conclusions After the free vaccinations,there is still a gap between the vaccine inoculation rate and prevention benefit.The current vaccination strategies need to be adjusted.

Objective To describe the clinical features of patients with hemorrhagic fever with renal syndrome (HFRS) in popular period and other period.Methods All the HFRS patients from epidemic areas in Xi' an were surveyed retrospectively.The sociodemographic data,symptom characteristics and laboratory test results were collected.Chi-square test,rank test were used to analyze the data.Results Totally 429 HFRS cases were recruited including 280 male (65.3％) and the male/female ratio was 1.9 ∶ 1.Adults with 16-60 years of age were the main group,which accounted for 74.8％ of the total cases.The constituent ratios of cases with 16-60 years of age in popular period and other period were 76.1％ (245/322) and 71.0％ (76/107),respectively; the sex ratios were 1.93∶1 and 1.74∶1,respectively; the time from fever onset to hospitalization was 3 d and 4 d,respectively; the time of hospitalization was both 10 d; the proportions of emergency cases were 59.8％ (189/316) and 67.6％ (71/105),respectively; the proportions of cured cases were 56.4％ (181/321) and 43.4％ (46/106),respectively.The clinical features were not significantly different between popular period and other period (all P＞0.05).The immunoglobulin M (IgM) antibody positive rate was 85.4％ (315/369) and those in popular period and other period were 88.4％ (251/ 284) and 75.3％ (64/85),respectively (x2 =8.968,P＜0.01).There was a positive correlation between symptom severity and outcome of discharge (x2=18.558,P＜ 0.01),the more slight symptoms were related with the better outcome.Conclusion The clinical features are similar in cases from popular period and other period from Jan 2008 to Jun 2011.

Objective To study the risk factors of hemorrhagic fever with renal syndrome (HFRS) in children and adolescents in Xi'an City.Methods HFRS laboratory confirmed cases aged under 16 from January 2013-December 2015 were selected,which were reported by Information System of Disease Prevention and Control of the People's Republic of China.A 1:1 matched case-control study was adopted to retrospective investigate the risk factors.Logistic regression analysis was used to analyze relationships between various factors and HFRS in single factor analysis,the influence factors in the single factor analysis with statistical significances were further analyzed in the multiple factors analysis.Results Eighty-eight matched pairs were investigated.Single factor Logistic regression analysis found that non-nuclear family [odds ratio (OR) =20.25,95％ confidence interval (CI):2.32-76.80],less hand washing frequency before meals (OR =3.67,95％CI:1.40-9.62),the river or pond around the place (OR =1.55,95％CI:1.32-2.94),sit on the hay and play (OR =1.36,95％CI:1.17-1.80),eating in the snack bar (OR =8.33,95％CI:1.78-9.47),do not spray water when sweeping the floor (OR =2.22,95％CI:1.24-4.12),living in the edge of village (OR =1.55,95％CI:1.32-2.94),and keeping pets in the home (OR =12.00,95％CI:1.12-28.84) were associated with HFRS.In multiple factors Logistic regression analysis,risk factors according to the contribution value from high to low in the order were keeping pets in the home (OR =5.40,95％CI:1.78-16.32),less hand washing frequency before meals (OR =3.96,95％CI:1.89-7.23),living in the edge of village (OR =2.42,95％CI:1.82-5.50),and the river or pond around the place (OR =2.21,95％CI:1.86-2.49).Conclusion Risk factors as keeping pets in the home,less hand washing frequency before meals,living in the edge of village,the river or pond around the place are likely risk factors of HFRS.

OBJECTIVE To study the audiological and etiological characteristics of infants failed to pass hearing screening. METHODS 126 infants received audiological diagnostic tests,including auditory brainstem response(ABR),40 Hz auditory event related potential(40 Hz AERP),distortion product otoacoustic emissions(DPOAE),tympanometry and acoustic reflex. The degrees and types of the hearing loss,and etiological characteristics were analyzed. RESULTS Among 126 infants (252 ears),61 were diagnosed with sensorineural hearing loss(48.41%),48 were conductive hearing loss(38.09%),and 17 were found to have normal ABR thresholds(13.49%). The hearing loss was associated with various factors,including history of infection during pregnancy(21 cases),threatened abortion(9 cases),pregnancy with age at or over 35(6 cases),extension of pregnancy(7 cases),history of systematic diseases(10 cases),history of neonatal jaundice(13 cases),history of asphyxia and hypoxia(18 cases),premature and low birth weight neonates(8 cases),neonatal diseases (8 cases),family history of deafness(5 cases),craniofacial deformity(3 cases),central nervous system disorder(6 cases),and 9 cases were second child. CONCLUSION The infants who failed to pass hearing screening have various etiology characteristics in hearing loss. The infants associated with risk factors were mostly found to have sensorineural hearing loss.

Objective To establish a flow cytometric measurement of detecting minimal residual disease(MRD) according to the leukemia-associated immunophenotypes in children with acute lymphoblastic leukemia(ALL) and to explore the significance of MRD detection in ALL children for a individualized treatment. Methods A variety of four-color fluorescent antibody combinations were used to investigate the children's normal bone marrow. The normal bone marrow pattern at two-parameter plots was established to identify the residual tumor cells, seventy-five bone marrow samples from newly diagnosed ALL children were analyzed with four-color cytometry to determined the optimal combinations which can clearly distinguish the tumor cells from normal cells. The bone marrow samples were monitored with the combination panel in 60 patients at the end of induction therapy and follow-up treatment. Cytomorphology test, PCR amplification of 29 fusion genes as well as IgG and TCR gene rearrangements were performed simultaneously. Results Sixty-nine cases (92.0%) could be identified for effective antibody combinations to monitor MRD by four-color cytometry. Fusion genes or IgG and T cell receptor (TCR) gene rearrangements can be detected in 21 cases (28.0%) to monitor MRD by PCR. No MRD can be detected in 25 bone marrow samples at the end of induction therapy and follow-up treatment. Four-color cytometry could detect as low as 0.021%-4.130% residual leukemia cells. Conclusion MRD can be monitored by flow cytometry which is faster than PCR, and the sensitivity is superior to morphology method.

Objective To investigate the effects of the intervention,rehabilitation and speech development of children with severe hearing loss in some rural areas.Methods 61 children,including 35 males and 26 females,were diagnosed as severe hearing loss with ABR and 40 Hz-AERP from June 2004 to July 2008.All the children failed hearing screening or visited the hospital as outpatients.The ages ranged from 2 to 72 months with the average age of 17.59 months.During telephone follow-up,the questionnaire was used to gather the data regarding the usage of hearing aids,hearing and speech rehabilitation,speech development,and communication abilities.Results 33 (54.10%) children were fitted with hearing aids,and 2 (3.28%) received cochlear implants,while 26(42.62 %) neither had hearing aids nor cochlear implants.10 cases with hearing aids also had speech training,whereas 23 children with hearing aids did not receive the training.2 cases with cochlear implants and 2 cases with hearing aids were found to have good speech development and communication ability,while 31 cases with hearing aids had delayed speech development.26 cases without any devices had to rely on sign language for their commumication.Conclusion Children in rural area with severe hearing loss experience greater speech and communication difficulties because many of them have no access to intervention and speech training.The results suggest that it would be very important to increase public awareness and educate parents to have their children wear hearing aids and receive speech training.

Objectives To investigate the epidemiological and clinical characteristics of dyslipidemia as well as its treatment and influence on accompanying diseases in impaired glucose status among inpatients. Methods A cross-sectional survey was conducted among the inpatients registered in ten university hospitals of Guangdong, China during the week before the Diabetes Day in 2004. The fasting blood glucose (FBG), lipid profiles, BMI, waist to hip ratio (WHR) and concomitant disorders of the first screen during the hospitalization period were recorded. Those who had FBG level from 5.6 to 6. 9 mmol/L and not been previously diagnosed diabetes (PDM) underwent oral glucose tolerance test (OGTF). Results Of the 8753 inpatients investigated, 1067 eases had complete medical records(CMR case) including PDM cases and previously non-diagnosed diabetes ones with FBG ≥ 5. 6 mmol/L. Of the previously non-diagnosed diabetes cases with FBG levels from 5.6 to 6.9 mmmol/L, 65.8% accepted OGTT. Of the CMR cases, 41.9% had PDM, 21.7% was newly diagnosed diabetes mellitus (NDM), 29. 1% had impaired glucose regulation (IGR) and only 7.3% had normal glucose tolerance (NGT). The TG levels in NDM and PDM group were higher than those in IGR and NGT group (P < 0.05, respectively). The HDL-C levels in IGR, NDM and PDM group were lower than those in NGT group (P < 0.05, respectively). Sixty-nine point six percent of the diabetes mellitus (DM) inpatients was accompanied with dyslipidemia and the rate was higher than those in NGT (56.4%) and IGR inpatients (52.5%, P <0.05, respectively). Only 22. 8% of the PDM inpatients underwent treatment of dyslipidaemia and just 3.4% achieved the target suggested by the guideline of ATP-Ⅲ. BMI was higher and waistline longer in the PDM and NDM inpatients than those in the NGT cases (P <0.05, respectively). Seventy-two point eight percent of the PDM inpatients was complicated with more than one type of vascular diseases. Nine point seven percent and 0. 2% of the NDM inpatients were tormented by diabetic nephropathy and diabetic retinopathy respectively. Conclusions More inpatients with accompany DM or IGR had concomitant dyslipidemia than those with NGT, which included hypertriglyccridemia, hypo-high-density lipoproteinemia and metabolic syndrome. Concomitant vascular diseases were more frequently found in PDM inpatients than in the others. Some of the NDM and IGT inpatients were complicated with microvascular diseases.

Objective:To investigate the influencing factors for pancreatic endocrine and exocrine insufficiency after pancreaticoduodenectomy.Methods:The retrospective case-control study was conducted. The clinicopathological data of 168 patients who underwent pancreaticoduodenectomy in the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2017 were collected. There were 96 males and 72 females, aged (64±13)years, with a range from 38 to 75 years. Of the 168 patients, 36 had pancreatic endocrine insufficiency while 8 had pancreatic exocrine insufficiency preoperatively. All patients underwent pancreaticoduodenectomy. Observation indications: (1) surgical situations and follow-up; (2) analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy; (3) analysis of influencing factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Follow-up using out-patient examination and telephone interview was performed to detect postoperative condition of blood glucose control, diet and nutrition, tumor recurrence and metastasis up to June 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Surgical situations and follow-up: all the 168 patients underwent pancreaticoduodenectomy successfully and recovered well after operation. All patients were followed up for 6 months. The level of fasting and postprandial blood glucose of the 168 patients after surgery were 7 mmol/L(range, 5-9 mmol/L) and 10 mmol/L(range, 7-14 mmol/L), respectively. The defecation frequency was (2.4±1.2)times per day. No tumor recurrence or metastasis occurred in either patient. One hundred and thirty-two of the 168 patients were included in the study excepting patients with pancreatic endocrine insufficiency before operation. At postoperative 6 months, 47 patients developed pancreatic endocrine insufficiency, with an incidence of 35.61%(47/132). One hundred and sixty of the 168 patients were included in the study excepting patients with pancreatic exocrine insufficiency before operation. At postoperative 6 months, 68 patients had pancreatic exocrine insufficiency, with an incidence rate of 42.50%(68/160). (2) Analysis of influencing factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that gender, metabolic syndrome, chronic pancreatitis, excision point, and postoperative chemotherapy were the related factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy ( χ2=5.300, 6.270, 4.473, 4.392, 5.397, P<0.05). Results of multivariate analysis revealed that male and metabolic syndrome were independent risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy [ hazard ratio ( HR)=5.252, 5.364, 95% confidence interval ( CI): 1.362-6.382, 1.891-12.592, P<0.05)]. (3) Analysis of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy. Results of univariate analysis showed that body mass index (BMI), chronic pancreatitis, total bilirubin, excision point, postoperative pancreatic fistula as grade B or C, and pancreatic fibrosis were related factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( χ2=1.691, 4.910, 7.763, 5.605, 4.663, 7.700, P<0.05). Results of multivariate analysis showed that BMI<18.5 kg/m 2, chronic pancreatitis, total bilirubin ≥171 μmol/L were independent risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy ( HR=3.695, 5.231, 7.623, 95% CI: 1.232-7.324, 2.161-6.893, 1.562-5.235, P<0.05). Conclusions:Male and metabolic syndrome are risk factors for pancreatic endocrine insufficiency after pancreaticoduodenectomy. BMI<18.5 kg/m 2, chronic pancreatitis, and total bilirubin ≥171 μmol/L are risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy.

Objective:To investigate the feasibility of universal newborn hearing screening in countryside in order to provide reliable evidence in launching this program all over the countryside of China. Method:Subjects were 12 638 infants who were born in 9 counties from Jan 2004 to Dec 2005. TEOAE was used for the fast hearing screening. Infants were screened on the 2-7 days after the birth. The re-screening was conducted in 4-6 weeks if failed in the initial screening,and follow-up were provided continually if they also failed in the re-screening. Result; Ten thouand eight hundred and forty-five of 12 638(85. 8%) were screened including 9 963(91. 9%) normal newborns and 882(8. 1%) newborns with high-risk. Seven thouand four hundred and fifty (68. 7%) newborns passed the initial screening, and 3 395 (31. 3%) people failed. One thouand seven hundred and ninty-three (14. 2%) infants were refused to be screened.Only 2 536 (74. 7%) were re-screened on time, and 859(25. 3%) did not receive re-screening. One hundred and twenty were failed in the re-screening or first screening, and 79 (65. 8%)of them received diagnostic assessment. Among the infants received diagnostic assessment, 6(7.6%)ca-ses were found to have profound hearing loss in both ears, 9(11. 4%)cases were found to be severe hearing loss(7 in both ears and 2 in single ear) , 11(13. 9%)cases were found to be moderate hearing loss (5 in both ear and 6 in single ear), 26 (32. 9%) were found to have slight hearing loss (11 in both ear and 15 in single ears), and 27 (34.2%) were normal. Fifty-two infants were diagnosed as hearing loss with a prevalence of congenital hearing loss(in binaural and monaural) of 0. 5%(52/10845)and a prevalence of bilateral hearing loss of 0. 3%(29/10845). A prevalence of congenital hearing loss was 0. 2% (22/9 963) in well infants and 3. 4% (30/882) in high risk infants. Among the 13 cases of children with severe and profound hearing loss in both ears children, 8(61. 5%)cases were fitted with hearing aids and 1 (7. 7%) case was implanted with cochlear implants. Conclusion:It is necessary and feasible to conduct hearing screening program in the rural area. However, the suitable model to perform the program in the countryside needs to be set up as soon as possible in order to get more poor infants to participate into the hearing screening program for free and increase the screening rate.