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.

In March 2020, the outflow of age limited videos from ICU in Spain inspired us to rethink whether there is age discrimination in the allocation of scarce medical resources. This paper frist reflected on the problem of age discrimination caused by this phenomenon from four moral intuitions: the sacred view of life, the quality of life and values, public health ethics and Chinese culture, and then examined whether it is illegal from the legal level, finally pointed out the negative impact on the society, and put forward that taking age as the standard for the allocation of scarce medical resources is not suitable for China’s national conditions.

Objective:To investigate the predictive value of XRCC1 Arg399Gln gene polymorphism in the adverse events and prognosis of SOX chemotherapy for advanced gastric cancer after D2 resection.Methods:A total of 62 patients with advanced gastric cancer receiving Sox chemotherapy after D2 resection from January 2015 to April 2018 in Quzhou People′s Hospital were included and the baseline characteristics were collected retrospectively. Postoperative pathological specimens were used for genotyping of XRCC1 Arg399Gln gene variation. To analyze the relationship between the polymorphism of XRCC1 Arg399Gln in patients and the clinicopathological features and the occurrence of adverse chemotherapy reactions. Also, to evaluate the disease-free survival (DFS) and overall survival(OS) of patients in the different genotypes. Cox regression analysis was used to screen for prognostic risk factors.Results:The genotype distribution of XRCC1 Arg399Gln locus in 62 patients with gastric cancer was G/G in 35 cases (56.45%), G/A in 21 cases (33.87%) and A/A in 6 cases (9.68%). And the distribution frequencies of the three genotypes were in accordance with the hardy-weinberg equilibrium( P = 0.295). G/A and A/A genotypes were merged in the subsequent analysis. Comparison of baseline characteristics between the G/G genotype and G/A+A/A genotype showed no statistically significant differences (all P>0.05). Different genotypes had no significant differences in the adverse reactions of Sox chemotherapy after advanced gastric cancer surgery (all P>0.05). The median DFS of the G/G genotype was 45 months (95% CI 41.73 - 48.28), which was higher than G/A+A/A genotype 38 months (95% CI 35.71 - 40.29)( P = 0.047). Univariate Cox regression analysis showed that the polymorphism of XRCC1 Arg399Gln was risk factor for tumor recurrence in patients with advanced gastric cancer who received SOX chemotherapy after surgery ( RR = 2.178, 95% CI 1.078 - 4.402, P = 0.030). Multivariate Cox regression analysis showed that the polymorphism of XRCC1 Arg399Gln was independent risk factor for tumor recurrence in patients with advanced gastric cancer who received SOX chemotherapy after surgery ( RR = 2.581, 95% CI 1.242 - 5.363, P = 0.011). The median OS of G/G genotype and G/A+A/A genotype were 60 months (95% CI 57.81 - 62.19) and 55 months (95% CI 49.62 - 60.38). There was no significant difference in OS between G/G genotype and G/A+A/A genotype ( P = 0.202). Univariate regression analysis showed that the polymorphism of XRCC1 Arg399Gln wasn′t risk factor for death in patients with advanced gastric cancer who received SOX chemotherapy after surgery ( RR = 1.702, 95% CI 0.744 - 3.896, P = 0.208). Conclusions:The XRCC1 Arg399Gln gene polymorphism has no correlation with the adverse reactions of SOX chemotherapy after D 2 resection for advanced gastric cancer. But, the XRCC1 Arg399Gln G/G type is closely associated with the prognosis of patients, it has predictive value for better DFS.

In March 2020, the outflow of age limited videos from ICU in Spain inspired us to rethink whether there is age discrimination in the allocation of scarce medical resources. This paper frist reflected on the problem of age discrimination caused by this phenomenon from four moral intuitions: the sacred view of life, the quality of life and values, public health ethics and Chinese culture, and then examined whether it is illegal from the legal level, finally pointed out the negative impact on the society, and put forward that taking age as the standard for the allocation of scarce medical resources is not suitable for China’s national conditions.

Lymphedema is a chronic disease in plastic surgery. Accurate diagnosis is the key to treatment. At present, the diagnosis of lymphedema is primarily based on medical history, symptoms and signs, with few objective diagnostic criteria. Therefore, the imaging diagnosis of lymphedema has become a research emphasis in recent years. This paper systematically reviews the imaging diagnosis of lymphedema, including X-ray lymphography, magnetic resonance imaging and contrast imaging, computed tomography and contrast imaging, fluorescence contrast imaging and Doppler ultrasound. The purpose of this study is to clarify their guiding significance in clinical practice by analyzing the characteristics of lymphedema in various imaging modalities.

Lymphedema is a chronic disease in plastic surgery. Accurate diagnosis is the key to treatment. At present, the diagnosis of lymphedema is primarily based on medical history, symptoms and signs, with few objective diagnostic criteria. Therefore, the imaging diagnosis of lymphedema has become a research emphasis in recent years. This paper systematically reviews the imaging diagnosis of lymphedema, including X-ray lymphography, magnetic resonance imaging and contrast imaging, computed tomography and contrast imaging, fluorescence contrast imaging and Doppler ultrasound. The purpose of this study is to clarify their guiding significance in clinical practice by analyzing the characteristics of lymphedema in various imaging modalities.

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.

Objective: To explore the clinical effect of reduction and reconstruction of the removed bony structure after one-stage posterior resection of high cervical tumors. Methods: From October 2009 to March 2018, 17 patients including 10 males and 7 females of high cervical tumors who underwent one-stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posterior arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Orthopaedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X-ray before the operation and at the last follow-up. Results: There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow-up period was 29.1±28.2 months. No recurrence was found during the follow-up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow-up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow-up in X-ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred. Conclusion Resection of high cervical dumbbell-shape tumors is a demanding surgery with high incidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.

OBJECTIVE: To analyze the clinical and molecular biological characteristics of a neonate with myeloid proliferation related to Down syndrome (DS). METHODS: The neonate, who was suspected for Down syndrome, was analyzed in terms of clinical feature, peripheral blood cell morphology, fluorescence in situ hybridization (FISH), immunological classification and other laboratory tests. On hundred and fourteen leukemia-related genes were subjected to next-generation sequencing (NGS). RESULTS: Laboratory test revealed obvious abnormal liver function and coagulation function, anemia, and extreme leukocytosis. Cell smear indicated significantly increased progenitor cells, which conformed to proliferation of megakaryocytes. FISH showed trisomy 21. By NGS, c.220+dupT, a novel mutation, was identified in exon 2 of the GATA1 gene, which encodes a N-terminal activation domain and has a frequency of 95.8%. No mutation was identified among the remaining 113 genes. CONCLUSION The neonate had DS and GATA1 gene mutation. High percentage of circulating blasts should be considered as transient myelodysplasia but not congenital leukemia.
Down Syndrome ; genetics ; GATA1 Transcription Factor ; genetics ; Humans ; In Situ Hybridization, Fluorescence ; Infant, Newborn ; Mutation ; Trisomy

Objective To investigate the role of bone marrow mesenchymal stem cells (BM-MSCs) in the invasion and metastasis of gastric cancer cells and to explore its mechanism.Methods SGC7901 and KATO-Ⅲ gastric cancer cells were co-cultured with BM-MSCs respectively,and the invasion ability of SGC7901 and KATO-Ⅲ gastric cancer cells were detected by Transwell assay.Secondly,CD133 + and CD133-cells were sorted from KATO-Ⅲ gastric cancers and co-cultured with BM-MSCs respectively to compare their changes in invasiveness.Meanwhile,the expressions of p-AKT and epithelial-mesenchymal transition (EMT) relative factors in gastric cancer cells were detected by Western-blot.The role of CD133 in BM-MSCs affecting the ability of invasion of gastric cancer cells was further vertified by the overexpression of CD133 in SGC7901 cells.SPSS17.0 software was used for statistical processing,and the stand deviation of the measurement data were expressed as the standard deviation,independent sample t test was conducted.Results The invasiveness of co-cultured SGC7901 and KATO-Ⅲ cells was significantly enhanced.The invasive ability of KATO-Ⅲ CD133+ cells co-cultured with BM-MSCs tended to increase more significantly than that of co-cultured CD133 cells[(259.0 ± 24.0)vs (58.0 ±5.6),P ＜ 0.001].The expressions of p-AKT,Snail and N-cadherin were significantly increased in co-cultured CD133+ cells (P =0.003,P =0.003,P =0.002),while the expression of E-cadherin was reduced (P =0.021).After co-cultured with BM-MSCs,the expression of E-cadherin was also reduced in CD133-cells (P =0.005),but the expressions of p-AKT,Snail and N-cadherin were no significantly changes (P =0.744,P =0.277,P =0.295).SGC7901 co-cultured with BM-MSC after overexpression of CD133 showed higher i nvasiveness than blank control group[(239.3 ± 24.0) vs (103.3 ± 15.5),P ＜ 0.001].The expressions of p-AKT,Snail and N-cadherin were significantly increased when co-cultured with BM-MSCs in the group of CD133 overexpression (P =0.001,P =0.001,P =0.001),while the expression of E-cadherin was significantly decreased(P =0.003).The expressions of Snail and N-cadherin were also significantly increased after co-cultured with BM-MSCs in the blank control group (P =0.001,P =0.004),and the expression of E-cadherin was significantly decreased (P =0.018),while the expression of p-AKT was not significantly changed (P =0.193).Conclusions BM-MSCs can enhance the invasion and metastasis of gastric cancer cells by promoting the EMT of gastric cancer cells.CD133 may be involved in the regulation of EMT in gastric cancer cells through the PI3K/AKT signaling pathway.