Objective:To analyze the influenza surveillance results and epidemiological characteristics of the disease in Gansu province in 2010-2018, and provide scientific basis for the formulation and adjustment of influenza prevention and control strategies.Methods:Real-time PCR was used to detect the specimens of ILI illness (ILI) cases reported by 19 national influenza surveillance sentinel hospitals in Gansu province. Influenza virus isolation and culture were carried out using canine kidney cells (MDCK).Results:Total of 93 334 specimens from ILI cases were collected from Jan. 2010 to Dec. 2018, and 13 439 samples were positive for influenza virus nucleic acid. The positive rate of viral nucleic acid detection was 14.40%, and the proportion of influenza B virus in positive samples was the highest (37.02%), and seasonal H3N2 influenza virus (35.25%), H1N1 influenza virus (26.78%). The advantages are different in various periods. The peak period of influenza is from Dec. to Mar., and the highest incidence rate is in the age group of 5-15 years (20.34%). The incidence rates of the other age groups are similar. The difference of influenza positive rate in different age groups is statistically significant ( χ2=775.153, P<0.001), but in male and female was not significant. Total of 16 101 ILI specimens positive for influenza virus nucleic acid were subjected to virus isolation and cultured, and 3 892 strains of influenza virus were isolated, of which influenza B virus accounted for the highest proportion (37.82%), followed by seasonal H3N2 influenza virus (33.04%), H1N1 influenza virus (28.96%). Conclusions:The epidemic of influenza in Gansu province had an obvious regularity, and it was undulating and prevalent. It is necessary to strengthen prevention and control measures among school-age children and adolescents.

Objective:To analyze the genomic characteristics of human infection with H9N2 avian influenza virus in Gansu province.Methods:The etiological analysis was conducted for human infection with H9N2 avian influenza virus detected in influenza like illness cases in northwestern China in 2016. Molecular bioinformatics Mega 7.0 software was used to analyze the full genomic sequences of the viral isolate.Results:The gene fragments of HA, NA, MP, NP, NS, PA, PB1 and PB2 of the isolate were highly similar (>90%) to those of H9N2 avian influenza virus strain isolated in external environment in Gansu from 2014 to 2019. The HA gene belonged to BJ/94-like branch, PB2 and MP belonged to G1/97-like branch, and the PB1, PA, NS, and NP genes belonged to F/98-like branch. MP and PB2 were closely related to H7N9, H10N8 and H5N6 viruses. Amino acid sequence alignment showed that the HA cleavage site was arranged in PSRSSR ↓ GLF, H183N and Q226L mutated which included 7 HA glycosylated sites; 62-64 sites of NA absented 3 amino acids (ITE); and M2-31N, NS1-42S, PA-356R, and PA-409N mutated.Conclusions:Apparently, this case of human infection with human infection with H9N2 avian influenza virus was an incidental. However, the isolates of H9N2 influenza virus in external environment of Gansu had a series of mammalian adaptive molecular markers, suggesting that the risk of human infection is higher. It is necessary to strengthen the surveillance by multi departments to deal with influenza pandemic.

Objective:To understand the characteristics and differences of diarrhea-related symptoms caused by different pathogens, and the clinical features of various pathogens causing diarrhea.Methods:Etiology surveillance program was conducted among 20 provinces of China from 2010 to 2016. The acute diarrhea outpatients were collected from clinics or hospitals. A questionnaire was used to survey demographics and clinical features. VFeces samples were taken for laboratory detection of 22 common diarrhea pathogens, to detect and analyze the clinical symptom pattern characteristics of the patient’s.Results:A total of 38 950 outpatients were enrolled from 20 provinces of China. The positive rates of Rotavirus and Norovirus were the highest among the five diarrhea-causing viruses (Rotavirus: 18.29%, Norovirus: 13.06%). In the isolation and culture of 17 diarrhea-causing bacterial, Escherichia coli showed the highest positive rates (6.25%). The clinical features of bacterial diarrhea and viral diarrhea were mainly reflected in the results of fecal traits and routine examination, but pathogenic Vibrio infection was similar to viral diarrhea. Conclusion:Infectious diarrhea presents different characteristics due to various symptoms which can provide a basis for clinical diagnosis.

Objective To explore the influence of iterative algorithm on image quality in ultralow-dose CT scan of lung.Methods The thoracic model was scanned using different parameter combinations.The tube voltage was chose with 80,100 kV in ultra-low dose group and the mAs was selected by 10,15,20,25 and 30 mAs.The control group selected the parameters of 120 kV,30 mAs.All the images were reconstructed with filtered back projection (FBP group) and iterative algorithm (IR group).The image noise and effective dose (E) were compared.Results When tube current and voltage were constant,the image noise of IR group was lower than that of FBP group,and the difference was statistically significant (t =1.102-8.070,P＜0.05).When the tube current was constant,the image noise of the 80 kV with FBP group was higher than that of 100 kV with FBP group,and the image noise of the 80 kV with IR group was lower than the 100 kV with FBP group(t =-8.639-7.841,P＜0.05).Compared with the conventional low-dose with FBP group,the image noise of each ultra-low-dose with FBP group was significantly increased,and the image noise of (80 kV,10 mAs),(80 kV,15 mAs),(80 kV,20 mAs) with IR group was significantly increased,and the image noise of (100 kV,15 mAs),(100 kV,20 mAs),(100 kV,25 mAs),(100 kV,30 mAs) with IR group was significantly reduced (t=-8.140-23.028,P＜0.05).There was no significant difference in image noise between the groups of (80 kV,25 mAs),(80 kV,30 mAs),(100 kV,10 mAs) with IR and the group of conventional low dose with FBP (P＞0.05).Compared with the conventional low dose group,the E of the groups of (80 kV,25 mAs),(80kV,30mAs),(100kV,10 mAs),(100kV,15mAs),(100kV,20mAs),(100kV,25 mAs),(100 kV,30 mAs) was decreased by 75.9％,71.0％,79.8％,70.4％,60.3％,50.2％,40.0％,respectively.Conclusions The image quality of the ultra-low dose protocol (100 kV,10mAs) with iterative algorithm is similar to that of the conventional low dose with FBP group,and the radiation dose could be significantly reduced.

Objective: To analyze the epidemiological and spatial-temporal distribution of Brucellosis, epidemic encephalitis B and hemorrhagic fever with renal syndrome (HFRS) in Gansu province during 2014-2018 so as to provide evidence for the prevention and control of those diseases. Methods: A database was established in Gansu province from 2014 to 2018, using the geographical information system. A spatial distribution map was drawn, with trend analysis and space-time clustering used to study the 3-dimention of the diseases, by using both ArcGIS 10.5 and SaTScan 9.6 softwares. Results: Results from the trend surface analysis showed that the incidence of Brucellosis decreased gradually from north to south parts while the U type curve could reflect the distribution from the east to the west areas. Incidence of epidemic encephalitis B decreased significantly from south to north areas in the province, with incidence higher in the eastern than in the mid-west region. Difference on the incidence of HFRS was not significantly visible in the eastern and western regions, while the incidence was slightly higher in the southern than the northern parts of the province. Spatial and space-time clustering did exist among the 3 diseases in Gansu from 2014 to 2018. The areas with clusters of Brucellosis appeared in the eastern parts during 2014-2015, including 19 counties. The areas with secondary clusters of Brucellosis were seen in the Hexi district, including 4 counties, during 2017-2018. The areas with high incidence of epidemic encephalitis B were clustered in the middle and southeast areas, including 32 counties, during 2017-2018. Areas with most clusters of HFRS appeared in Min county of Dingxi city in 2018, with the areas of secondary clusters in 8 counties of the eastern areas in 2018. Conclusions The overall incidence rates of the 3 natural focus diseases were in a upward trend and showing obvious characteristics on spatial clustering. According to the distributive characteristics, effective measures should be developed accordingly.

Objective To investigate the effect of CareDose 4D combined with Care kV on CT pulmonary ground glass nodule ( GGN) with respect to quality and radiation dose. Methods The thoracic model containing 6 GGN was performed by using 7 low-dose schemes. The CareDose 4D + Care kV was adopted in scheme 1. In schemes 2, 3 and 4, the tube voltage was 120 kV, and the tube current 30, 20 and 10 mAs respectively. In schemes 5, 6 and 7, the tube voltage was 100 kV, and the tube current was 30, 20 and 10 mAs, respectively. The image quality [ CT value, contrast noise ratio ( CNR) , noise value (SD) and subjective score] and effective dose (E) were compared. Results There was no statistically significant difference in CT value of GGN among different schemes (P>0. 05). The SD of scheme 1 was higher than those of schemes 2, 3 and 5, but lower than those f scheme 7, while the CNR of scheme 1 was lower than those of schemes 2, 3 and 5, but higher than that of scheme 7 ( t=13. 020, 9. 560, 8. 120,-5. 720, -7. 849, -5. 192, -4. 130, 1. 361,P<0. 05). SD and CNR of scheme 1 were not significantly different from those of scheme 4 and 6 ( P>0. 05) . The subjective scores of each GGN of schemes 1, 2, 3, 5 and 6 was over 3 points, but and the subjective scores of one GGN of each of schemes 4 and 7 were below 3 points. The value E of the scheme 1 was reduced by 63. 0％, 44. 4％, 38. 8％, and 9. 1％, compared with the schemes 2, 3, 5 and 6, respectively. Conclusions CareDose 4D combined with Care kV in low-dose lung CT scan can ensure the image quality of GGN and reduce the radiation dose effectively.

Objective To explore application of automatic tube current modulation combined with iterative reconstruction in CT scanning ( non-enhanced and enhanced) of neck. Methods A total of 80 patients with CT scanning of neck were randomly divided into test group(n=40, automatic tube current modulation, iterative reconstruction ) and control group ( n = 40, 200 mAs, filtered-back-projection reconstruction ) . Subjective scores and objective evaluation of two groups were evaluated. Evaluation included image noise ( SD ) of thyroid gland, trapezius muscle, sternocleidomastoid muscle, submandibular gland, lateral pterygoid muscle and brain tissue. Effective dose ( E ) was compared. Results The E of non-enhanced and enhanced scanning in test group was lower than that of control group with the statistically significant difference(t = -2. 451, -2. 451, P <0. 05). The subjective scores of non-enhanced and enhanced scanning in test group were higher than those of control group with the statistically significant difference (Z = - 1.969, - 2.056, P < 0.05), while SD of thyroid gland, trapezius muscle, sternocleidomastoid muscle, submandibular gland in test group were lower than that of control group with the statistically significant difference ( t =2. 400,2. 516,2. 120,2. 411,4. 134,4. 674, 2. 711,2. 892, P<0. 05). There were no significant differences in SD of lateral pterygoid muscle, brain tissue of non-enhanced and enhanced scanning between two groups (P>0. 05). Conclusions Automatic tube current modulation combined with iterative reconstruction in CT scanning of neck could improve image quality, and reduce effectively radiation dose.

Objective To study the epidemiologic characteristics of influenza in Gansu province of China and to optimize the related vaccination program.Methods Weekly influenza surveillance data from the first week of 2010 to the fortieth week of 2016 were collected,in Gansu province.x2 test was used to compare the differences of nucleic acid positive rate and the virus types in the four seasons.Time series seasonal decomposition (TSSD) was used to explore seasonal patterns and characteristics of influenza epidemics in Gansu.Results 59 791 specimens were tested,with 8 501 positive for influenza virus and positive rates as 14.22％.Types A(H1N1)pdm09,A(H3N2) and type B were accounted for 98.76％ of all the positive specimens.Proportions of the positive rate of influenza virus appeared in spring,summer,autumn and winter were 15.12％,0.98％,4.02％ and 24.26％ respectively.The predominant type of virus in autumn and winter was A(H3N2),with B mainly in spring.Influenza in Gansu province showed typical single-peak type distribution,with epidemic peak appeared from December to next January.The type A(H3N2) related peak appeared the earliest,followed by A(H1N1)pdm09,with type B the latest.Conclusions Peaks and the duration of influenza seasonal epidemics were related to the types of dominant strains.Annual influenza vaccination campaigns should start in October,to provide effective protection during the epidemic period.

Objective: To understand the contamination status of avian influenza virus H5, H7, and H9 in environmental samples in Gansu province during 2015, and provide scientific guidance for the prevention and control of human infection with AIV in the province. Methods: We detected the AIV nucleic acid of 2015 environmental samples with real-time PCR; the samples were collected from all of the monitoring points in the whole province, then we analyzed the result of environmental monitoring of pathogens in the province. Results: The detection rates of FluA, H5, H7 and H9 were 19.90%, 0.05%, 0 and 19.65% respectively. The sample specific detection rate of FluA was the highest in wipe specimen of the board surface of slaughtering or placing poultry (31.09%) and the lowest in stool specimens (13.85%). FluA detection rate was the highest in December and the lowest in June and July(8.59% and 8.66%). The detection rate of Dingxi city and Longnan city of nucleic acid of avian influenza virus FluA and H9 were significantly higher than those in other cities in the province(χ²=4.523~88.059, P<0.05). Conclusions The main AIV pollution of the external environment in Gansu province in 2015 were the H9 subtype, and there was no H7N9 positive, we should strengthen the monitoring and early warning for avian influenza.

Objective:To investigate the open method(OC) and laparoscopic cholecystectomy (LC) after bile duct dilation incidence of contrast.Methods:collected from 2006 December to 2014 December in the department of hepatobiliary surgery requires 412 patients underwent cholecystectomypatients hospitalized with cholecystolithiasis,chronic cholecystitis,gallbladderpolyps,were randomly divided into LC group and OC group,LC group of 207 cases,205 cases in OC group,and were respectively treated with LC and OC.Start regular follow-up after a month,the comparison of 2 surgical operation time,blood loss and postoperative application of antibiotics time,anus exhaust time,eating time and hospitalization time.And to observe the two groups the incidence of patients after bile duct dilatation in follow-up after operation.Results:207 cases of LC patients were 89 patients had bile duct dilation,205 cases of OC patients were 41 patients had bile ductdilation,statistically significant differences between the two groups (P＜0.05).In group LC,the diameter of common bile duct in operation half months began to increase,the increase continued until 3 months after operation.After 3 months of little change in the diameter of common bile duct.The averagepreoperative bile duct diameter is 5.3 mm,after 6.1 mm,there was significant difference(P＜0.01).Conclusion:LC is a safe and reliable operation method,Identifying cause dilatation of common bile duct after LC operation and attention as soon as possible to give the corresponding prevention and treatment,further can reduce complications occur.