Objective: To investigate the environmental contamination of norovirus in nurseries and primary/secondary schools, so as to provide a scientific basis for effective prevention and control measures. Methods: A total of 483 external environmental samples were collected from 34 cluster outbreaks of norovirus gastroenteritis in kindergartens and primary/secondary schools in Linhai City from 2021 to 2024. Pathogen detection was conducted using a rapid nucleic acid extraction kit and realtime fluorescence RT-PCR, and the results were analyzed using the χ2 test or Fishers exact test. Results: Among the collected external environmental samples, the total positive rate of surface contamination was 13.66%. The positive rates in kindergartens and primary/secondary schools were 12.20% and 15.82%, respectively. In kindergartens, the five surfaces with the highest detection rates were desks/chairs (23.33%), toilet stool troughs (20.69%), urinal troughs (12.00%), washbasins/sinks (11.11%), and toilet mops (9.38%). In primary/secondary schools, the top five were toilet stool troughs (38.30%), urinal troughs (23.53%), toilet door handles (13.04%), toilet mops (12.50%), and drinking cups (11.11%). The difference in positive detection rates among different external environments in primary/secondary schools was statistically significant (Fishers exact probability test, P<0.01). The positive detection rate in sanitary toilets was higher than that in classroom environments (χ2=17.38), while the positive detection rate in classroom environments of kindergartens was higher than that in primary/secondary schools (χ2=5.42)(P<0.05). Conclusions Norovirus exhibits a high contamination rate in nurseries and schools, particularly in restroom areas. Strengthening sanitation and disinfection in highrisk environments, and improving hygiene awareness among children and staff, are essential for the effective prevent and control of norovirus.

OBJECTIVE: To compare the effectiveness of dynamic fixation and plate augmentation combined with bone grafting for femoral nonunion after interlocking intramedullary nails. METHODS: Between January 2008 and December 2022, a total of 128 patients who developed femoral nonunion following static fixation with interlocking intramedullary nailing were retrospectively analyzed. All patients underwent either dynamic intramedullary nail fixation or plate fixation with bone grafting while retaining the original intramedullary nail. There were 104 males and 24 females;the age ranged from 19 to 59 years old with an average of(32.70±9.21) years old. Patients were categorized into dynamization group and plate group based on the distinct treatment modalities. There were 67 patients in the dynamization group, comprising 54 males and 13 females. The age range was from 19 to 58 years old, with a mean age of (32.68±9.33) years old. All patients underwent open reduction and anterograde interlocking intramedullary nail fixation. Dynamic fixation was implemented between 10 and 28 months postoperatively.The plate group comprised 61 patients, of whom 50 were male and 11 were female. The age distribution ranged from 20 to 59 years old, with a mean age of (32.84±9.07) years old. All patients underwent open reduction and anterograde interlocking intramedullary nailing. Plate reinforcement fixation was performed between 10 and 30 months postoperatively. The incision length, duration of surgery, intraoperative blood loss, hospitalization period, fracture healing status, and incidence of complications were compared between the two groups of patients. RESULTS: All patients were followed up for a minimum duration of 1 year. The mean follow-up period for the dynamization group was(26.12±11.82) months, compared to (26.57±12.48) months for the plate group. No statistically significant difference was observed between the two groups (P>0.05). The incision size (2.73±1.21) cm, operation time (22.73±3.20) min and blood loss (19.06±6.22) ml in the dynamization group were significantly less than those in the plate group(22.53±2.24) cm, (126.40±13.91) min and(237.36±81.56) ml, respectively(P<0.05). All nonunion in the plate group were successfully healed, and the healing time duration ranged from 4 to 7 months with an average of(6.16±0.99) months. In the dynamization group, a total of 42 patients achieved fracture healing, with a healing duration ranging from 4 to 8 months with an average of (6.26±1.23) months. There was significant difference in healing rate between 2 groups (P<0.05), but there was no significant difference in healing time between 2 groups (P>0.05). The average treatment cost was(17 700.18±4 846.27) yuan in the plate group and (334.24±18.16) yuan in the dynamization group, and there was significant difference in costs between 2 groups (P<0.05). CONCLUSION Either dynamic fixation or plate augmentation combined with bone grafting is an effective method, but dynamic fixation is superior to plate augmentation combined with bone grafting for the treatment of femoral hyperplastic nonunion after interlocking intramedullary nails. Dynamic fixation offers several advantages, including simplified procedures, reduced trauma, and cost-effectiveness in medical expenses, making it superior to additional plate fixation combined with bone grafting. However, dynamic fixation is not suitable for the treatment of femoral atrophic nonunion.
Humans ; Male ; Female ; Adult ; Middle Aged ; Fracture Fixation, Intramedullary/adverse effects* ; Femoral Fractures/surgery* ; Fractures, Ununited/surgery* ; Bone Nails ; Retrospective Studies ; Bone Plates ; Young Adult

OBJECTIVE: To assess the clinical value of digital PCR (dPCR) for the prenatal diagnosis of common fetal aneuploidies. METHODS: A dPCR-based assay was developed for detecting trisomies 21, 18, and 13. A retrospective analysis was carried out on 173 amniotic fluid samples collected by the Prenatal Diagnosis Center of Taizhou Hospital between January 2017 and December 2023. By using chromosomal karyotyping as the gold standard, the diagnostic performance of the multiplex dPCR system was evaluated in a double-blind manner. This study has been approved by the Ethics Committee of Taizhou Hospital (Ethics No. K20250339). RESULTS: Chromosomal karyotyping has identified 59 cases of trisomy 21, 5 cases of trisomy 18, 2 cases of trisomy 13, 6 cases with chromosomal structural abnormalities or mosaicisms, and 101 cases with a normal karyotype. The dPCR results (Z-score cutoff = 4.0, CI = 99.997%) showed full concordance with karyotyping (sensitivity = 100%, specificity = 100%, Kappa = 1). Among the 6 structurally abnormal or mosaicism samples, dPCR has accurately detected 4 cases, but mis-classified 2 cases of trisomy 21 with very low-level mosaicisms (3.3%, 6.9%, respectively) as normal. CONCLUSION The established multiplex dPCR system demonstrated high diagnostic accuracy for common chromosomal aneuploidies, with results available within 24 hours. It can serve as an efficient supplementary tool to conventional chromosomal karyotyping, providing reliable support for time-sensitive clinical decision-making in prenatal diagnosis.
Humans ; Female ; Pregnancy ; Aneuploidy ; Prenatal Diagnosis/methods* ; Karyotyping ; Retrospective Studies ; Polymerase Chain Reaction/methods* ; Chromosome Disorders/genetics* ; Adult ; Trisomy 13 Syndrome/diagnosis* ; Trisomy 18 Syndrome/genetics* ; Down Syndrome/genetics*

OBJECTIVE: To assess the clinical value of non-invasive prenatal testing (NIPT) for identifying maternal malignant tumors. METHODS: A retrospective analysis was carried out on pregnant women undergoing Non-invasive prenatal testing (NIPT) at Taizhou Hospital in Zhejiang Province from January 2018 to December 2022. The criteria included maternal copy number variations for at least two chromosomes. Clinical follow-up data were obtained for the high-risk population of maternal malignant tumors through telephone follow-up and review of electronic medical records. This study was approved by the Medical Ethics Committee of the Hospital (Ethics No.: K20250339). RESULTS: Among 45 141 NIPT samples, 6 (0.013%) were suggested to have maternal malignant tumors. Follow-up information was available for 5 patients (83.3%). Two cases were diagnosed with maternal malignant tumors, including 1 myelodysplastic syndrome and 1 pelvic malignant tumor. Two cases were found to have multiple uterine fibroids and 1 was lost during follow-up. CONCLUSION The abnormal copy number indicated by NIPT may serve as an early signal for maternal malignant tumors. To establish a systematic follow-up protocol and multidisciplinary collaboration are conducive to achieving early diagnosis of tumors and improving the prognosis of patients. Based on the results of this study, it is recommended that for pregnant women with unexplained copy number variations and suspected maternal tumors by NIPT, targeted tumor screening program should be implemented to optimize their clinical management.
Humans ; Female ; Pregnancy ; Adult ; Retrospective Studies ; DNA Copy Number Variations/genetics* ; Follow-Up Studies ; Neoplasms/diagnosis* ; Noninvasive Prenatal Testing/methods* ; Pregnancy Complications, Neoplastic/diagnosis* ; Prenatal Diagnosis/methods*

OBJECTIVE: To explore the efficacy of a novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint. METHODS: Retrospective analysis of 13 cases of proximal clavicle fracture with dislocation of sternoclavicular joint treated with sternoclavicular hook-plate from June 2011 to January 2019 in our department. There were 9 males and 4 females, aged 26 to 78 years old, with an average age of (54.08±13.91) years old. All the patients had closed injuries without damage of blood vessels and nerves. The patient's operation time, intraoperative blood loss, hospital stay time, and postoperative complications were recorded. Fracture healing and reduction were evaluated according to X-ray and CT after operation. Constant-Murley score and Rockwood sternoclavicular joint score were used to evaluate limb function at 12 months after operation. RESULTS: All the patients were treated with sternoclavicular hook-plate. The operation time ranged from 50 to 76 min, with a mean of (54.08±13.91) min. The intraoperative blood loss ranged from 20 to 56 ml, with a mean of (46.08±11.15) ml. The hospital stay time ranged from 6 to 14 d, with a mean of (8.31±2.32) d. X-ray and CT examination on the second day after operation showed that all fractures and dislocations were anatomically reduced, and shoulder joint function exercise was performed early. All patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (16.77±4.63) months. The healing time ranged from 9 to 13 d, with a mean of (11.00±1.75) d;and the bone healing time ranged from 3 to 4 months, with a mean of (3.65±0.46) months. There were no complications such as infection, internal fixation failure and nerve injury. At 12 months follow-up, the constant Murley score ranged from 78 to 100, with a mean of 87.83± 11.26; and Rockwood score ranged from 9 to 15, with a mean of 13.70±1.85. Among them, 11 cases were excellent, 1 case was good, and 1 case was general. CONCLUSION The use of the novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint is an effectively internal fixation with high safety, allowing early functional exercise for patients.
Adult ; Aged ; Bone Plates ; Clavicle ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; Humans ; Joint Dislocations ; Male ; Middle Aged ; Retrospective Studies ; Sternoclavicular Joint ; Treatment Outcome

Objective: To analyze three events of severe fever with thrombocytopenia syndrome （SFTS） among family members by exposure risk matrix, so as to provide reference for SFTS prevention and control. Methods : The field investigation and clinical data of seven confirmed cases with SFTS reported in Linhai from 2014 to 2016 were collected. Exposure risk matrix was used to list the risk of exposure two weeks before the onset, such as the environment, duration of activity and protection, and evaluate the possible routes of transmission. Results: The first event involved three sisters. Two of them had plucked tea together on a hill, and the possibility of infection through tick bites were 60% and 75%, respectively. Another sister was more likely to be infected by ticks in her residence after visiting her sister （no physical contact with the sick sister）, with a possibility of 74%. The second event involved two cases （mother and son）. They were more likely to be infected by ticks in the current residential area, and the possibility were 100% and 80%, respectively. The third event involved two cases （husband and wife）. The wife had 60% possibility of being infected by the ticks on the hill she picked arbutus, and 40% by the ticks in her residence. The husband was most likely to be infected through contacting with body fluids or blood of his wife （44%）, then through the ticks on the hill he picked arbutus （33%）. Conclusion Among seven cases with SFTS reported in Linhai from 2014 to 2016, six cases have more than 50% possibility of being infected by tick bites; one case has higher possibility of being infected by contacting with body fluids or blood of a patient, but tick bites could not be ruled out.

BACKGROUND: Primary lung cancer and metastatic lung cancer are common malignant tumors of the lung and are the main cause of cancer-related death. Advanced lung cancer and lung metastatic cancer are mainly treated by systemic therapy, and local treatment is also an effective treatment for the refractory or recurrent lesions in the lungs after systemic treatment. ¹²⁵I radioactive particle implantation, as an efficient conformal radiotherapy, has a certain control effect on localized lung cancer. The purpose of this study was to investigate the clinical efficacy and safety of computed tomography (CT) guided percutaneous puncture of lung tissue with ¹²⁵I radioactive particle implantation in the treatment of advanced lung cancer and lung metastatic cancer. METHODS: Continuouslycollectedthe clinical and pathological data of 105 patients with advanced lung cancer and metastatic lung cancer treated by ¹²⁵I radioactive seed implantation in the Department of Thoracic Surgery, First Affiliated Hospital of Zhejiang University School of Medicine from January 1, 2014 to November 30, 2018. The patients were followed until March, 2019. The clinical efficacy and complications of seedimplantation were analyzed. RESULTS: A total of 105 patients were included in the study, 78 patients with advanced lung cancer and 27 patients with lung metastases. The median survival time after seed therapy was 395 days. The 1-year survival rate was about 78.1%, and the 2-year survival rate was about 56.1%. Seed implantation for advanced lung cancer is equivalent to lung metastasis. Seed combined with radiofrequency ablation, microwave ablation, and chemotherapy did not improve seed treatment. However, particle combined with external radiation therapy has a significant survival disadvantage compared with simple seed therapy. CONCLUSIONS The CT-guided ¹²⁵I radioactive seed implantation has controllable complications and can be used as a safe and effective treatment for advanced lung cancer and lung metastases.

BACKGROUND: Microwave ablation and radioactive seed implantation are therapeutic options for patients with advanced lung cancer and lung metastases lesion who are not surgical candidates. However, reports on therapeutic effectiveness and safety of the two combination treatments methods have been limited to small case series. This research was to assess the clinical outcome and safety of radioactive seed implantation combined with computed tomography (CT)-guided microwave ablation for the treatment of advanced lung cancer and lung metastases lesion. METHODS: The clinical data of 21 advanced lung cancer and lung metastases patients who received treatment at author hospital during the period from May 2018 to December 2018 were retrospectively analyzed. The patients were divided into two groups by whether received extra percutaneous microwave thermal ablation therapy. The short-term effectiveness and safety were analyzed. RESULTS: The efficacy of control group was 28.75%, and the efficacy of experiment group was 14.28%. The rate of adverse reaction between two groups has no significantly difference (P>0.05). CONCLUSIONS Seed implantation combined with CT-guided microwave ablation for advanced lung cancer and lung metastases is safety and effective.

Objective: To explore the positive expressions of P16 and Ki-67 proteins in cervical biopsy lesions of patients with high-risk HPV infection and abnormal detection of liquid-based thin-layer cytology test(TCT), and the clinical value in predicting occurrence of early cervical cancer. Methods: A total of 120 patients with high-risk HPV infection(16 and 18 subtypes positive) and abnormal TCT in the Traditional Chinese Medicine Hospital of Linhai from January 2016 to July 2017 were enrolled in the study.The colposcopy was used to get cervical biopsy lesions for pathological diagnosis, immunohistochemical staining was used to detect P16 and Ki-67 proteins. Results: There were up to 66 patients with HPV-16 positive, 34 cases with HPV-18 positive, other 20 cases with 16 and 18 positive; 6 cases of atypical squamous epithelial cells(ASC), 46 cases of low-grade squamous intraepithelial lesions (LSIL), 60 cases of high-grade SIL(HSIL), other 8 cases of cervical squamous cell carcinoma(SCC) were diagnosed by TCT; 5 cases of inflammation, 105 cases of CIN and 10 cases of SCC by pathologically diagnosis.The positive rates of P16 and Ki-67 proteins were gradually increased in patients with inflammation, CIN and SCC[0(0/5), 36.2%(38/105), 70.0%(7/10), χ²=4.382, P=0.036; 0(0/5), 40.0%(42/105), 80.0%(8/10), χ²=5.945, P=0.015]. The patients with CIN were followed up for 21~36 months, median time 29.5 months.Twenty-six patients progressed to SCC, at the end of follow-up, the positive rates of P16 and Ki-67 proteins in patients with SCC were significantly higher than those in the CIN patients without progress[61.5%(16/26) vs.39.2%(31/79), χ²=3.934, P=0.047; 69.2%(18/26) vs.41.8%(33/79), χ²=5.905, P=0.015]. Conclusion The positive expression rates of P16 and Ki-67 proteins in cervical biopsy tissues are significantly higher in patients with high-risk HPV infection and abnormal TCT, which in patients with pathologically diagnosis of SCC are higher than CIN patients, the same results in CIN patients with SCC progression than non-progressing patients, suggesting that P16 and Ki-67 proteins are of great value in predicting occurrence of early cervical cancer.

Objective: To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods: The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children′s hospitals from 2014 to 2018 were analyzed retrospectively. Results: Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced β-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively. Conclusions Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.