ObjectiveTo predict the incidence trend of influenza-like illness proportion （ILI%） in Shanghai using the seasonal autoregressive integrated moving average model （SARIMA）， and to provide an important reference for timely prevention and control measures. MethodsTime series analysis was performed on ILI% surveillance data of Shanghai Municipal Center for Disease Control and Prevention from the 15^th week of 2015 to the 52^nd week of 2019， and a prediction model was established. Seasonal autoregressive integrated moving average （SARIMA） model was established using data from the foregoing 212 weeks， and prediction effect of the model was evaluated using data from the latter 36 weeks. ResultsFrom the 15^th week of 2015 to the 52^nd week of 2019， the average ILI% in Shanghai was 1.494%， showing an obvious epidemic peak. SARIMA（1，0，0） （2，0，0） ₅₂ was finally modeled. The residual of the model was white noise sequence， and the true values were all within the 95% confidence interval of the predicted values. ConclusionSARIMA（1，0，0） （2，0，0） ₅₂ can be used for the medium term prediction of ILI% in Shanghai， and can play an early warning role for the epidemic and outbreak of influenza in Shanghai.

Objective:To explore whether prophylactic anti-viral therapy is needed for hepatitis B virus (HBV) infection resolvers with high titer of hepatitis B surface antibody (anti-HBs) receiving rituximab treatment.Methods:This study was a prospective cohort study. Nine patients with hepatitis B surface antigen(HBsAg) negative/hepatitis B core antibody (anti-HBc) positive/anti-HBs positive receiving rituximab treatment in Chinese Academy of Medical Science, Peking Union Medical College Hospital from June 2017 to June 2018 were enrolled. Patients were divided into two groups according to baseline anti-HBs titers. Patients with anti-HBs≥100 mIU/mL did not receive prophylactic treatment after informed consent. Patients with anti-HBs<100 mIU/mL were prescribed with entecavir before the treatment of rituximab. All patients were followed up every month after the first use of rituximab. Liver function, HBV DNA and HBV serology markers were tested. Descriptive statistical analysis was used.Results:Of the nine patients, six patients were diagnosed with diffuse large B cell lymphoma (DLBCL), one with Waldenstrom′s macroglobulinemia, one with indolent B-cell lymphoma, and one with membranous nephropathy. There were seven patients with anti-HBs≥100 mIU/mL who did not receive prophylactic anti-HBV therapy, and two patients with anti-HBs<100 mIU/mL who received entecavir (0.5 mg/d) prophylactic treatment before chemotherapy. The anti-HBs titer of the patient with indolent B cell lymphoma decreased from 21.27 mIU/mL to 6.33 mIU/mL during the third course of rituximab treatment. After the fourth course of treatment, the anti-HBs titer of one patient with DLBCL decreased from 172.25 mIU/mL to 57.76 mIU/mL. One patient with membranous nephropathy was followed up for one year and the anti-HBs titer increased from 141.47 mIU/mL to 328.98 mIU/mL.No significant changes of anti-HBs titer were observed in other patients. No HBV reactivation occurred in all patients and HBV DNA remained negative during the follow-up.Conclusions:The anti-HBs titer may drop after rituximab treatment in resolved HBV patients. High titer of anti-HBs may protect resolved HBV patients from HBV reactivation. Patients with high titer of anti-HBs may not need prophylactic anti-viral therapy.

This paper introduced the measures to construct the hierarchical medical system in Yichang city. The authors identified problems found and proposed the city to take the following countermeasures. Such steps included service capacity building at primary level, motivating primary medical workers, attracting patients to primary care, and improving policies of hierarchical medical system.

Hierarchical medical system empowers the current healthcare reform on the medical supply side in China, a key to resolving the contradictions in the healthcare sector. This study analyzed the necessity and obstacles for such a system with synergy between hospitals, insurance and pharmacy, putting forward suggestions for building a scientific and rational hierarchical system.

Objective To investigate the change expression levels of secreted frizzled related protein 5 (SFRP5) mRNA and protein in human adipose,and muscle tissues and the relationship between SFRP5 and insulin resistance in different glucose tolerance subjects.Methods Twelve type 2 diabetes mellitus(T2DM) patients and 12 aged and sex-matched healthy control subjects were enrolled.T2DM patients were diagnosed by1999 WHO criterion.Under the same conditions,the omental adipose and muscle tissues from these patients undergoing elective abdominal surgery were obtained.Expressions of sfrp5 protein and mRNA in adipose and muscle tissues were determined by semi—quantitive RT-PCR and Western blot while body height,weight,waist circumference,hipcircumference,blood pressure,lipodemia,fasting plasma glucose,fasting insulin,glycosylated hemoglobin,fasting serum insulin(FINS),HOMA-β,HOMA-insulin resistance index(HOMA-IR) etc were investigated.Results 1.SBP,TG,FPG,2 h PG,Fins,HOMA-IR,HbA1C were significantly higher in T2DM groups than in the control group.2.The expressions of SFRP5 mRNA and protein in omental adipose tissues were significantly higher inT2DM group than in the control group(P ＜ 0.01).3.The level of SFRP5 mRNA and protein expressions were higher in omental adipose tissue than in the muscle tissues.Conclusions The fact that mRNA and protein expression level of SFRP5 was higher in adipose tissue than in muscle indicates adipose tissue may be the main source of SFRP5.The expressions of SFRP5 mRNA and protein were higher inT2DM group than in the control group indicates sfrp5 may play a role in insulin resistance.

Objective To explore the clinical,neuroimage,and neuropsychological profiles of semantic dementia (SD).Methods Detailed medical history were collected on 18 SD patients.Brain MRI scans were administered.Neuropsychological evaluation taping semantic memory (things naming),overall cognitive function ( Mini-mental State Examination,MMSE),visuoconstructive skill ( Clock Drawing Test,CDT), daily functional ability (Activities of Daily Living, ADL), neuropsychiatric symptoms (Neuropsychiatric Inventory,NPI),and disease severity (Frontotemporal Lobar Degeneration Modified Clinical Dementia Rating Scale,FTLD-CDR) were performed on all patients.Results The mean age at onset was (60.6 ± 8.5 ) years,with 5 cases over 65. All patients developed progressive word-finding difficulty and anomic speech.Ten patients complained significant memory impairment and 14 experienced behavioral disturbance.Five patients were previously diagnosed as Alzheimer' s disease (AD) and 1 as schizophrenia.All patients developed marked semantic memory impairment both for living things and nonliving things.The mean score on MMSE was 10.94 ± 8.86,with 16 cases performed incorrectly on naming.Mean score on CDT copy was 4.61 ±0.85,with 14 cases scored normally.Mean score on ADL was 29.72 ± 8.75.Cases with a 5-year course showed a significant overall decline.Fourteen cases presented behavior symptoms and scored 8.00 ± 7.22 on NPI.All patients scored worst on language domain among all the domains evaluated in FTLD-CDR.Atrophy,typically involving the left anterior temporal was shown on MRI scans.However,predominantly right temporal atrophy was observed in one patient.Atrophy confined to the temporal lobe in patients with early stage and extended to the contralateral temporal,frontal lobe,and parietal lobe as disease progression. Conclusions Current study suggested that SD tend to develop in presenile age.However,about 1/3 cases develop the disease after 65 years. Deficit in language is the earliest and most prominent symptom. Behavior change is prevalent as well. Patients are commonly misdiagnosed as AD or lack a definite diagnosis.Visuoconstructive skill and other abilities are relatively preserved in the early stage.With progression into the 5th years,overall decline comes inevitably.Brain scans can reflect the disease characteristics and progression. Of note,there exists individual with right dominant atrophy.

Objective To compare the short-term results of rectal cancer treated either by laparoscopic or open total mesorectal excision(TME). Methods A series of 165 unselected consecutive patients with rectal cancer from August 2002 to December 2005, who decided to accept the laparoscopic or open TME, were included in this study. The following parameters were compared between the two groups: length of the surgical specimen, distance between the distal incisal edge of the rectum and the inferior margin of the tumor, the number of the lymph nodes resected, local recurrence rate, incidence of distant metastases, and 2 year survival rate. The mean follow-up period for both groups was 26.9 months (range, 6-46 months). Results Demographic data and Dukes stage were matched in two groups. The mean length of the resected specimens was 24.4 cm in the laparoscopic TEM group and 25.2 cm in the open TEM group. The distance from the distal incisal edge of the rectum to the inferior margin of the tumor was 2.9 cm in the laparoscopic TEM group and 2.7 cm in the open TEM group, and the mean number of lymph nodes scavenged was 11.5 in the laparoscopic TEM group and 10.6 in the open TEM group. The local recurrence rate after laparoscopic resection was 9.6%, as compared with 11% after open resection. Distant metastases occurred in 11.5% of the patients in the laparoscopic group, whereas it was 14.6% in the open group. Two year survival rate was 85.7% and disease free survival was 76.2% after laparoscopic resection and compared to 78.8% and 69.7% after open resection. All above parameters did not show statistically different between the two groups. Conclusion The oncologic resection and the early outcomes are comparable between the two surgical approaches.

Objective:To explore the time course of memory recovery during post-traumatic amnesia after brain injury.Methods: A patient (WGS, aged 34) with lesions in the left temporal lobe was compared with four matched control subjects on various cognitive tests. These tests included Galveston Orientation and Amnesia test, Wechsler Memory Scale-Revised Test, Semantic Memory, and Remote Memory Test. WGS was tested at 20th days and 33rd days after the brain injury. Results: During the period of post-traumatic amnesia, marked recovery was observed for orientation, semantic memory and remote memory (especially the recent and the earlier items). While the recovery of learning for new knowledge was slow, learning curve of association of unrelated items was flat.Conclusion: The differential time courses for recovery of cognitive functions should be well considered in rehabilitative training after traumatic brain injury.