Objective:To investigate the genetic and evolutionary characteristics of hemagglutinin (HA) and neuraminidase (NA) genes of influenza B/Victoria (BV) virus in Xi′an city from 2019 to 2023.Methods:Twenty-five BV strains isolated from the Xi′an influenza surveillance network laboratory between 2019 and 2023 were collected. The HA and NA genes were sequenced using MiniSeq high-throughput sequencing platform. An evolutionary tree was constructed using bioinformatics software to analyze homology and mutation sites, and to predict N-glycosylation sites online. The antigenicity of the strains was analyzed through hemagglutination inhibition tests.Results:The BV influenza in Xi′an exhibited a distinct seasonal transmission pattern from 2019 to 2023, with peak prevalence occurring during the winter and spring seasons. The evolutionary analysis of the HA genes shows that the strains from Xi′an in 2019 belong to the V1A.3 branch, and the strains from 2021 to 2023 belong to the V1A.3a.2 branch. Analysis of antigenic sites showed that there were variations in 6 sites of 3 antigenic determinants in the HA proteins of the BV strains from 2021-2022 compared to 2019, and 2 sites of 1 antigenic determinant changed in the HA proteins in 2023 compared to 2021-2022. The evolutionary analysis of the NA genes indicates that the BV strains from Xi′an in 2019 belong to the A. 1.1 branch. By 2021 and 2022, it had evolved into the A. 1.2 clade, and by 2023, it had further evolved into the B clade and its derivatives, with no strains showing mutations associated with resistance to NA inhibitors. Antigenic analysis indicated that the majority of BV strains in Xi′an were similar to the strains included in the vaccine composition. Furthermore, glycosylation analysis showed that the potential N-glycosylation sites in the HA proteins of BV strains from 2021-2023 were reduced by one compared to those from 2019, and only a few strains from 2023 displayed alterations in the potential N-glycosylation sites of the NA proteins.Conclusions:The HA and NA genes of the BV strains from 2019 to 2023 are continuously mutating and evolving into new branches. Since 2021, V1A.3a.2 has become the dominant evolutionary branch of the HA genes, while the evolutionary branches of the NA genes from 2019 to 2023 have been continuously changing.

Objective:To analyze the etiological and epidemiological characteristics of hand, foot and mouth disease (HFMD) in Xi′an from 2019 to 2021, so as to provide evidence for the prevention and control of HFMD.Methods:Stool specimens and anal swabs were collected from patients with HFMD. Enteroviruses (EVs) including enterovirus 71 (EV71), coxsackievirus A16 (CVA16), CVA6 and CVA10 were detected by RT-PCR. Excel 2007 and SPSS18.0 software were used for data collection and statistical analysis, respectively. The epidemiological data of HFMD cases were analyzed by descriptive epidemiology method. The VP1 gene sequence of the representative strain of each CVA6 genotype was downloaded. Phylogenetic trees were constructed using MEGA X software and the genetic characteristics were analyzed.Results:A total of 1 531 HFMD cases were involved and 1 365 were positive for EVs with a positive rate of 89.16%. The detection rates of EV71, CVA16, CVA6, CVA10 and other EVs were 1.31% (20/1 531), 32.46% (497/1 531), 38.47% (589/1 531), 5.09% (78/1 531) and 11.23% (172/1 531), respectively. There were significant differences in the pathogen composition in HFMD cases of different clinical types (χ 2=46.14, P<0.01) and occupations (χ 2=34.65, P<0.01) as well as in different years (χ 2=462.86, P<0.01). The average age was greater in patients with CVA16 infection than in those with CVA6 or CVA10 infection ( F=6.00, P<0.01). In 2019, the HFMD cases were mainly caused by CVA16, while in 2020 and 2021, the main pathogen was CVA6. Enterovirus-positive cases showed a bimodal distribution with the main peak from May to July and the secondary peak from September to November. CVA16 was the predominant pathogen in spring and summer, and CVA6 was the predominant pathogen in autumn. CVA6 was the dominant pathogen in eight districts and counties of Xi′an; CVA16 was the dominant pathogen in six districts and counties; CVA6 and CVA16 co-circulated in one district. The CVA6 isolates belonged to two evolutionary branches of D3a subtype. Conclusions:CVA6 and CVA16 were the prevalent pathogens of HFMD and CVA6 subtype D3a circulated in Xi′an from 2019 to 2021. The pathogen composition of HFMD cases showed obvious differences in population, time and regional distribution.

Objective:To investigate the safety and feasibility of the CHESS endoscpic ruler (CHESS ruler), and the consistency between the measured values and the interpretation values by endoscopic physician experience.Methods:From January 2021 to January 2022, a total of 105 liver cirrhosis patients with portal hypertension were prospectively enrolled from General Hospital, Xixia Branch Hospital, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region (29 cases), and the First People′s Hospital of Yinchuan (25 cases), General Hospital of Ningxia Medical University (18 cases), Wuzhong People′s Hospital (10 cases), the Fifth People′s Hospital of Ningxia Hui Autonomous Region (10 cases), Shizuishan Second People′s Hospital (6 cases), Yinchuan Second People′s Hospital (5 cases), and Zhongwei People′s Hospital (2 cases) 8 hospitals. The clinical characteristics of all the patients, including gender, age, nationality, etiolog of liver cirrhosis, and Child-Pugh classification of liver function were recorded. A big gastroesophageal varices was defined as diameter of varices ≥5 mm. Endoscopist (associated chief physician) performed gastroscopy according to the routine gastroscopy procedures, and the diameter of the biggest esophageal varices was measured by experience and images were collected, and then objective measurement was with the CHESS ruler and images were collected. The diameter of esophageal varices of 10 randomly selected patients (random number table method) was determined by 6 endoscopists (attending physician or associated chief physician) with experience or measured by CHESS ruler. Kappa test was used to test the consistency in the diameter of esophageal varices between measured values by CHESS ruler and the interpretation values by endoscopic physician experience.Results:Among 105 liver cirrhosis patients with portal hypertension, male 65 cases and female 40 cases, aged (54.8±12.2) years old, Han nationality 82 cases, Hui nationality 21 cases and Mongolian nationality 2 cases. The etiology of liver cirrhosis included chronic hepatitis B (79 cases), alcoholic liver disease (7 cases), autoimmune hepatitis (7 cases), chronic hepatitis C (2 cases), and other etiology (10 cases). Liver function of 32 cases was Child-Pugh A, Child-Pugh B 57 cases, and Child-Pugh C 16 cases. All 105 liver cirrhosis patients with cirrhotic portal hypertension were successfully measured the diameter of gastroesophageal varices by CHESS ruler, and the success rate of application of CHESS ruler was 100.0% (105/105). The procedure time from the CHESS ruler into the body to the exit of the body after measurement was (3.50±2.55) min. No complications happened in all the patients during measurement. Among 105 liver cirrhosis patients with cirrhotic portal hypertension, 96 cases (91.4%) were recognized as big gastroesophageal varices by the endoscopists. Totally 93 cases (88.6%) were considered as big gastroesophageal varices by CHESS ruler. Eight cases were recognized as big gastroesophageal varices by the endoscopist, however not by the CHESS ruler; 5 cases were recognized as big gastroesophageal varices by the CHESS ruler, but not by the endoscopists; 4 cases were not recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler; 88 cases were recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler. The missed diagnostic rate of big gastroesophageal varices by the endoscopists experience was 5.4% (5/93), and the Kappa value of consistency coefficient between the measurement by the CHESS ruler and the interpretation by endoscopists experience was 0.31 (95% confidence interval 0.03 to 0.60). The overall Kappa value of consistency coefficient by 6 endoscopists measured by CHESS ruler in big gastroesophageal varices diagnosis was 0.77 (95% confidence interval 0.61 to 0.93).Conclusion:As an objective measurement tool, CHESS ruler can make up for the deficiency of subjective judgment by endoscopists, accurately measure the diameter of gastroesophageal varices, and is highly feasible and safe.

OBJECTIVE: To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity. METHODS: Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups ( P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation ( P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient's satisfaction were recorded. RESULTS: The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group ( P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points ( P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation ( P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points ( P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group ( P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence ( P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups ( P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant ( P>0.05). CONCLUSION For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.
Humans ; Arthroplasty, Replacement, Hip ; Enhanced Recovery After Surgery ; Comorbidity ; Pain ; Postoperative Period

Objective:To evaluate the long-term outcomes of posterior release, reduction, fixation, and fusion for irreducible atlantoaxial dislocation (AAD).Methods:Between January 2005 and June 2016, a total of 31 patients with irreducible AAD who had received posterior approach surgery were included. Among them, there were 13 males and 18 females, the average age was 39.1±13.5 years (range 9-72 years). The clinical data of the eligible individuals were collected and analyzed. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) scores were recorded to evaluate the recovery of neck and neurological functions. The atlantodental interval (ADI), clivus-canal angle (CCA), and cervico-medullary angle (CMA) were measured to evaluate the reduction of AAD. C 0-C 2 angle and C 2-C 7 angle were measured to evaluate the recovery of cervical alignment. For individuals with basilar invagination, the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction. The duration of bony fusion and complications were also analyzed. Results:The mean follow-up period was 82.7±26.4 months (range 61-170 months). In terms of functional scores, the NDI dropped from 43.41%±11.60% before surgery to 12.19%±6.97% at the six months follow-up, and 9.45%±7.51% at the last follow-up ( F=89.56, P<0.001). The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up, and 14.97±1.47 points at the last follow-up ( F=52.89, P<0.001). Regarding the horizontal and vertical dislocations, the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up, and 1.29±1.08 mm at the last follow-up ( F=189.61, P<0.001). The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up, and 2.15±3.02 mm at the last follow-up ( F=37.58, P<0.001). The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to -2.23±1.58 mm at the six months follow-up, and -2.27±1.58 mm at the last follow-up ( F=122.16, P<0.001). For the amelioration of the compression on medulla and spinal cord, the CCA increased from 113.68°±12.67° before surgery to 143.39°±7.38° at the six months follow-up, and 142.39°±7.13° at the last follow-up ( F=67.13, P<0.001). The CMA increased from 115.71°±13.69° before operation to 145.58°±10.78° at the last follow-up ( F=41.44, P<0.001). Regarding the curvature of the cervical spine, the C 0-C 2 angle recovered from 1.94°±15.82° before surgery to 14.84°±6.45° at the last follow-up ( F=11.97, P<0.001), and the C 2-C 7 angle ameliorated from 27.26°±8.49° before operation to 19.26°±5.44° at the last follow-up ( F=11.13, P<0.001). Bony fusion was achieved in all cases, the fusion time was 9.71±2.55 months (range 5-15 months). A total of five complications occurred in the cases (two cerebrospinal fluid leakages, one deep infection, one transient neurologic deficit, and one dysphagia). They were all cured with corresponding treatments. In the last follow-up, none of the cases developed failure of internal fixation or re-dislocation. Conclusion:Posterior approach release, reduction, fixation and fusion technique is a safe and efficient surgical strategy with favorable long-term follow-up outcomes for irreducible AAD.

Background The health effects of forest therapy have been widely recognized, while the previous studies mostly focused on a single activity mode of forest walks. The effects of different types of forest therapy activities remain unclear. Objective To explore the effects of short-term forest therapy on cardiopulmonary health, psychological health, and sleep quality, and the health effects of different types of forest therapy activities, aiming to provide population empirical study data for the development of forest therapy. Methods A self-control study was conducted in a national forest park in suburb of Beijing from August to September 2018. A total of 31 healthy college students were recruited as the study subjects, with a total forest stay for 3 days and 2 nights. During the period of study, each subject practiced walking therapy, sitting therapy with five senses experience (sitting therapy thereafter), and handmade work therapy, successively. Each type of forest therapy lasted about 2 h. Changes of blood pressure, oxygen saturation (SpO₂), lung function, and fractional exhaled nitric oxide (FeNO) were estimated by measuring corresponding indicators before and after the forest therapy. Psychological health and sleep quality were assessed by Profile of Mood States and Pittsburgh Sleep Quality Index respectively at the same time. Mixed effects models were used to analyze the changes of these health indicators. The health effects of different types of forest therapy activities were further analyzed. Results The average age and body mass index of subjects in this study were (24.5±2.6) years and (20.7±1.7) kg·m⁻², respectively. After a short-term forest therapy, the selected indicators of cardiopulmonary health, psychological health, and sleep quality of subjects were all improved. In particular, the pulse pressure (PP) and FeNO decreased by 3.02 mmHg and 1.10 ppb, respectively, while the SpO₂ and peak expiratory flow (PEF) increased by 0.65% and 0.50 L·s⁻¹, respectively, and the negative emotion and global sleep quality also presented significant positive changes (all P<0.05). Furthermore, different therapy activities presented differential effects in the health indicators. Walking therapy significantly improved pulmonary function, SpO₂, and confusion (CON) emotion, in which the SpO₂, forced expiratory volume in the first second (FEV₁), and forced vital capacity (FVC) increased by 0.48%, 0.14 L, and 0.12 L, respectively, and the score of CON decreased by 0.97 (all P<0.05). Sitting therapy significantly reduced blood pressure and tension (TEN) emotion of subjects, including a decrease of the systolic blood pressure (4.45 mmHg), PP (4.19 mmHg), and the score of TEN (0.84) (all P<0.05). The diastolic blood pressure (DBP) increased slightly after handmade work therapy (ΔDBP=2.44 mmHg, P=0.016), but there were no significant changes in other indicators. Conclusion Short-term forest therapy could significantly improve cardiopulmonary health, psychological health, and sleep quality of young healthy individuals, and different types of forest therapy activities may have differential health effects.

Objective: Fufang Biejia Ruangan Tablet (FBRT) is widely used for the treatment of liver fibrosis. However, Hominis Placenta (HP), as an important adjuvant of FBRT, has been restricted for medicinal using due to the limited availability, ethical controversy and safety issues. The present study aimed to investigate the therapeutic effects of novel FBRT (N-FBRT) with sheep placenta (SP) as substitute for HP on liver fibrosis and explore its possible mechanisms. Different dosages of SP in N-FBRT were also evaluated. Methods: Rats were subcutaneously injected with CCl

Objective:To summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.

Objective:To investigate the antibiotics resistance of patients with Helicobacter pylori ( H. pylori) infection of different age in Ningxia. Methods:From July to December 2021, a total of 1 040 patients with H. pylori infection confirmed by 14C-urea breath test who had no history of H. pylori treatment and underwent gastroscopy were selected from the H. pylori special outpatient clinics from Ningxia Hui Autonomous Region People′s Hospital, Ningxia Hospital of Integrated Traditional Chinese and Western Medicine, Yuanzhou District People′s Hospital of Guyuan, Wuzhong People′s Hospital, the Second People′s Hospital of Shizuishan, People′s Hospital of Zhongwei, Yinchuan First People′s Hospital. Gastric mucosa specimens were obtained under gastroscopy and cultured for H. pylori in vitro. Harvested H. pylori were detected for H. pylori drug resistance phenotype. Kirby-Bauer disk diffusion method was used to detect antibiotic sensitivity. Previous use of antibiotics of patients were recorded. The characteristics of primary drug resistance of people≤44, 45 to 59, and ≥60 years old were analyzed. Chi-square test was used for statistical analysis. Results:A total of 538 H. pylori strains were obtained from 1 040 gastric mucosa specimens cultured in vitro, with a positive rate of 51.7%. A total of 187 patients could provide information on history of antibiotics usage. The primary drug resistance rates of metronidazole, clarithromycin and levofloxacin were high, which were 95.5% (514/538), 44.6% (240/538) and 45.4% (244/538), respectively; however drug resistance of amoxicillin, furazolidone and tetracycline were not found. The double drug resistance rate was 36.4% (196/538), mainly resistant to metronidazole and clarithromycin or metronidazole and levofloxacin, the drug resistance rates were 17.8% (96/538), 18.2% (98/538), respecitively. The triple drug resistance rate was 25.5% (137/538), all of the strains were metronidazole, clarithromycin and levofloxacin resistant strains. The primary drug resistance rates to levofloxacin and clarithromycin in patients with H. pylori infection who had previous history of quinolones and macrolides were 60.9% (28/46) and 63.4% (83/131), respectively; which were higher than those of patients who had not used corresponding drugs (41.8%, 59/141 and 39.3%, 22/56), and the differences were statistically significant ( χ2=5.05 and 9.23, P=0.023, 0.002). The drug resistance rates of metronidazole of ≤44, 45 to 59, and ≥60 years old group were 94.2% (163/173), 95.5% (231/242) and 97.6% (120/123), respectively, and the differences were not significant ( P>0.05). The single drug resistance rates of levofloxacin of ≤44, 45 to 59, and ≥60 years old group were 34.7% (60/173), 48.3% (117/242) and 54.5% (67/123), respectively, and the differences were statistically significant ( χ2=12.95, P=0.002). The levofloxacin resistance rate of ≤44 years old group was lower than that of 45 to 59, and ≥60 years old group, and the differences were statistically significant ( χ2=7.70 and 11.49, P=0.006, 0.001). The single drug resistance rates of clarithromycin of ≤44, 45 to 59, and ≥60 years old group were 36.4% (63/173), 50.4% (122/242) and 44.7% (55/123), respectively, and the differences were statistically significant ( χ2=8.00, P=0.018). The clarithromycin resistance rate of ≤44 years old group was lower than 45 to 59 years old group, and the difference was statistically significant ( χ2=8.00, P=0.005). Dual drug resistance rates of levofloxacin and clarithromycin of ≤44, 45 to 59 and ≥60 years old group were 49.7%(86/173), 70.2%(170/242), 45.5%(56/123), and the difference was statistically significant( χ2=27.63, P<0.001). The resistance rate of clarithromycin and levofloxacin in 45 to 59 years old group was higher than that in ≤44 and ≥60 years old group, and the difference was statistically significant ( χ2=18.00 and 21.13, both P<0.001). Conclusions:Primary drug resistance rates to metronidazole, levofloxacin and clarithromycin are high in patients with H. pylori infection of different ages in Ningxia. Individualized eradication therapy guided by drug resistance test is recommended.

Objective:To characterize the epidemiology of hand, foot and mouth disease (HFMD) cases caused by coxsackievirus group A type 6 (CV-A6) in Xi’an from 2016 to 2020 and provide evidence for the prevention and control of HFMD.Methods:The enterovirus (EV) types were identified using real-time RT-PCR. The data of HFMD cases were collected from the National Notifiable Infectious Diseases Reporting System of China Center for Disease Control and Prevention. Descriptive epidemiological method were used to analyze the distributions and the data were statistically analyzed with Excel 2007 and SPSS 18.0.Results:In the 4 034 HFMD cases, 17.85% had enterovirus group A type 71 (EV-A71) infections, 23.92% had coxsackievirus group A type 16 (CV-A16) infections, and 47.79% had other EV infections. 2 571 HFMD cases were randomly selected, including 1 268 other EV positive cases. The detection rate of CV-A6 in HFMD cases was 34.73% (893/2 571), and the constituent ratio of CV-A6 in other EV positive cases was 70.43% (893/1 268). The cases mainly occurred in children aged≤5 years (95.18%), more boys were affected than girls (1.47∶1). HFMD caused by CV-A6 was concentrated in April to June. Compared with EV-A71 and CV-A16, the clinical classification had significant difference in CV-A6 group ( χ2=139.55, P<0.001), but the ratio of sex and age-group had no significant difference ( F=2.74, P=0.065; χ2=2.43, P=0.297). Conclusions:The predominant pathogen of HFMD in Xi’an from 2016 to 2020 were other EV, among which CV-A6 accounted for the highest proportion in other EV positive cases. It is necessary to strengthen the prevention and control of HFMD caused by CV-A6 and carry out the surveillance for various pathogens of HFMD.