Objective: To understand current status of drinking water and toilet sanitation in rural schools of Anhui Province, and to provide basic knowledge for environmental sanitation improvement among rural schools in Anhui. Methods: One primary school and one secondary school from each of the 5 villages from 24 counties in Anhui were selected during 2014-2018. Data was collected through information review, on-site inspections and interviews. Results: School water supply methods were mainly based on local water supply from villages and towns, the rate was 58.16%, 58.95%, 65.07%, 62.78%, 67.69% from 2014 to 2018, respectively. Self-supplied water in some schools was initially untreated. The proportion of schools with sanitary toilets was 66.39%, 74.88%，76.26%，82.30%，94.20% during 2014 to 2018, respectively. The proportion of schools with toilets in the teaching building is lower than 30%. Proportions of schools with squatting toilets for girls was highest in 2017 (62.78%). The number of schools with no water faucets and no soap decreased by year, the lowest of 4.02% and 56.70% in 2018. Conclusion During the past five years, improvement has been observed in drinking water supply in rural schools in Anhui Province, however, the construction of toilets and surrounding environmental facilities still needs to be strengthened. The number of female toilet squats and the number of toilets in the teaching building and in the dormitory are relatively insufficient. While increasing the scale of toilet construction, it is also necessary to strengthen the quality of toilet management, and should pay attention to the relevant health education to teachers and students.

Objective:To retrospectively analyze the risk factors for the development of liver cancer in patients with hepatitis B-related liver cirrhosis (LC) treated and fully managed with long-term nucleos(t)ide analogues (NAs).Methods:The study subjects were derived from the follow-up cohort of chronic hepatitis B and liver cirrhosis who received antiviral therapy in the Department of Infectious Diseases of the First Affiliated Hospital of Guangxi Medical University from February 2004 to September 2019. LC patients who met the inclusion criteria were enrolled. The life-table method was used to calculate the incidence of liver cancer. Multivariable Cox regression model was used to analyze the risk factors that may affect the development of liver cancer in patients with LC. A subgroup analysis was conducted in liver cirrhotic patients who developed liver cancer to evaluate the effectiveness of antiviral treatment compliance. The 2 test was used for rate comparison. Results:The median follow-up time of 198 LC cases treated with NAs was 6.0 years (1.0-15.3 years). By the end of the visit: (1) 16.2% (32/198) of LC patients had developed liver cancer, and the cumulative incidence of liver cancer in 1, 3, 5, 7, and 9 years were 0, 8.9%, 14.3%, 18.6%, and 23.4%, respectively, with an average annual incidence of 3.1%. Among the 32 cases with liver cancer, 68.7% had developed small liver cancer (22/32). (2) Univariate Cox model analysis showed that the development of liver cancer was related to four factors, i.e., the presence or absence of LC nodules, whether the baseline was first-line medication, the family history of liver cancer, and patient compliance. The results of multivariate Cox model analysis showed that poor patient compliance and baseline non-first-line medication were risk factors for liver cancer. (3) The results of log-rank test subgroup analysis showed that the 5-year cumulative incidence of liver cancer in patients with hardened nodules was significantly higher than that of patients without hardened nodules (21.7% vs. 11.5%, P = 0.029). The 5-year cumulative incidence of liver cancer in patients with non-first-line drugs was significantly higher than that of patients with first-line drugs (22.0% vs.8.2%, P = 0.003). The 5-year cumulative incidence of liver cancer in patients with poor compliance was significantly higher than that of patients with good compliance (21.3% vs. 12.7%, P = 0.014). The 5-year cumulative incidence of liver cancer in patients with a family history of liver cancer was significantly higher than that of patients without a family history of liver cancer (22.3% vs. 8.1%, P = 0.006). (4) Compared with patients with poor compliance, patients with good compliance had higher HBV DNA negative serconversion rate (98.7% vs. 87.8%, P = 0.005), and a lower virological breakthrough rate (12.1% vs. 29.3%, P = 0.007). Conclusion:The long-term NAs antiviral therapy can reduce the risk of liver cancer, but it cannot completely prevent the development of liver cancer, especially in patients with a family history of liver cancer and baseline hardened nodules (high risk of liver cancer). Furthermore, the complete management can improve patient compliance, ensure the efficacy of antiviral therapy, and reduce the risk of liver cancer development, so to achieve secondary prevention of liver cancer, i.e., early detection, diagnosis and treatment.

Objective To observe the incidence of spontaneous clearance of hepatitis B virus (HBV) DNA in chronic hepatitis B (CHB) patients ,and to investigate the related factors of the spontaneous clearance of HBV DNA and to determine the time to start antiviral therapy .Methods Patients who met the inclusion criteria were recruited from the follow-up cohort of chronic HBV infection from January 2008 to August 2017 for observation .The liver function including alanine aminotransferase (ALT) levels ,HBV DNA load and serum markers of HBV were measured at baseline ,month 1 ,month 3 and month 6 of follow-up . Evaluation index included cumulative HBV DNA negative conversion rate and cumulative HBeAg negative conversion rate .Multivariable analysis was used to analyze the factors associated with the spontaneous clearance of HBV DNA .Results A total of 116 patients were recruited in this study .All the patients showed ALT level elevation at baseline .Without antiviral treatment ,the cumulative HBV DNA negative conversion rate was 12 .9％ after 6-month observation .HBeAg negative conversion rate was 22 .5％ .Multivariable analysis showed that patients without a family history of HBV infection ,baseline ALT level >3 times the upper limit of normal (ULN) and HBV DNA level <6 lg copies/mL had higher cumulative HBV DNA spontaneous clearance rate .HBV DNA negative conversion rate in patients whomet all the above three conditions was up to 75％ .Conclusions In CHB patients and ALT level elevation for the first time , some patients could achieve spontaneous clearance of HBV DNA without antiviral therapy .Patients without a family history of HBV infection ,baseline ALT level >3 ULN and HBV DNA level <6 lg copies/mL have higher rate of cumulative HBV DNA spontaneous clearance .

AIM To speculate the hypoglycemic mechanism for rats with type 2 diabetes by exploring the therapeutic effects of leaf aqueous extract from Cyclocarya paliurus on liver insulin receptor (InsR) and insulin receptor substrate 2 (IRS-2).METHODS The diabetic rat model was established through intraperitoneal injection of streptozotocin and fed with high-fat diet.The moleled rats were equally assigned into the control group and leaf aqueous extract from Cyclocarya paliurus group (extract group).After the test extract was orally administrated for four weeks,body weight,urine output,food intake,water intake and fasting blood-glucose (FBG) were measured,and the levels of serum insulin,InsR and IRS-2 mRNA in liver tissue were investigated in rats.RESULTS Compared with the control group,the extract group showed a reduction in urine output,food intake,water intake,FBG and insulin levels.Meanwhile,the rats' body weights in extract group were presented a trend to increase.The gene expressions of InsR and IRS-2 in liver tissue were up-regulated.Moreover,the insulin sensitivity was improved.CONCLUSION The leaf aqueous extract from Cyclocarya paliurus can reduce FBS,improve insulin sensitivity,which may be associated with the increase of InsR and IRS-2 gene expression in liver tissue.

Objective To compare the difference in recurrence rates between the endovenous laser therapy(EVLT) combined with percutaneous continuous circumsature (PCCS) and simplex EVLT following the treatment of great saphanous vein incompetence through the introduction of propensity score matching (PSM).Methods T the baseline data of 170 patients diagnosed with great saphanous vein incompetence who were treated in Punan Hospital in Pudong New District of Shanghai from 2009 to 2014 were retrospectively analyzed,of which underwent EVLT were 87 cases as EVLT group and EVLT combined with PCCS were 83 cases as EVLT +PCCS group.The groups covariate were balanced based on the PSM function of SPSS software using 1 ∶ 1 nearest neighbor matching method.The recurrence rates of the two groups were estimated by Kaplan-Meier method and the differences between the two groups were evaluated by Log-rank test.Results Sixty-seven pairs of patients were successfully matched.No significant difference between the two matched groups in the basic clinical features.Before PSM,the 1,2,and 3 year cummulative recurrence rates were 3.5％,5.4％ and 7.3％ in the EVLT group,and 0.9％,4.7％ and 4.7％ in the EVLT+PCCS group,respectively,there were no statistically significant differences between the two groups by Log-rank test (P =0.491).After PSM,the 1,2,and 3 year cummulative recurrence rates were 5.2％,5.2％ and 7.1％ in the EVLT group,and 0％,1.0％ and 1.0％ in the EVLT+PCCS group,there were statistically significant differences between the two groups (P =0.031).Conclusion The PSM methods can effectively balanced the covariates of groups in non-randomised study.EVLT combined with PCCS can effectively reduce the recurrence rate after the treatment of great saphanous vein incompetence.

Purpose Unilateral absence of pulmonary artery is a rare congenital pulmonary arterydysplasia whose untypical symptom often leads to missed diagnosis or misdiagnosis.Diagnostic and follow-up values of ultrasound cardiogram to pediatric congenital unilateral absence of pulmonary artery (UAPA) are explored in this paper.Materials and Methods Ultrasound cardiogram images of 35 UAPA patients confirmed by surgery or CT angiography in Guangzhou Women and Children's Medical Center from May 2009 to July 2016 were analyzed retrospectively,and images characteristics of the correctly diagnosed and missed diagnosis or misdiagnosed ultrasound cardiogram were analyzed.Results Among these 35 UAPA patients,21 cases were on the right side,14 cases on the left side,16 cases single UAPA and 19 cases combined with other intracardiac malformations.27 cases were initially diagnosed by ultrasound cardiogram,7 cases were missed diagnosed and 1 case misdiagnosed,with 77.1％ diagnosis accuracy.UAPA ultrasound cardiogram showed that normal bifurcation structure of pulmonary artery disappears.Main pulmonary artery continued to be one-side pulmonary artery,running to left or right and forming left branch or right branch of pulmonary artery.Pulmonary artery of the one-side absence of pulmonary segment supplied blood through aorta or other branches or vessels on the other side.After receiving unilateral pulmonary artery reconstruction surgery,ultrasound cardiogram of 8 patients of one month indicated that average flow rate of close-end anastomosis was (1.22± 0.17) m/s and far-end (2.17± 0.56) m/s.Conclusion Ultrasound cardiogram is efficient for UAPA preoperative diagnosis.Meanwhile,it is convenient,noninvasive and efficient in assessing anastomosis and pressure of pulmonary artery after surgery.

OBJECTIVETo evaluate the prognosis and clinical features of patients with giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD).

METHODKD complicated with GCAA was diagnosed in 55 patients between January 2003 and December 2012 in Guangzhou Women and Children's Medical Center.Of the 55 patients, 48 were studied(43 boys, 5 girls). According to the follow-up time, these patients were divided into four groups: ≤ 1 year follow-up group, > 1-3 years follow-up group, > 3-5 years follow-up group, and > 5-10 years follow-up group. These patients were investigated at the acute stage, and were followed up respectively at two weeks, one month, three months, six months, and one year after hospitalization and every 3 to 6 months after a year. All patients regularly accepted echocardiography and electrocardiographic examination, while some cases accepted CT coronary angiography (CTA) examination and coronary angiography (CAG) examination to confirm the condition of GCAA.

RESULT(1) The age of 48 patients ranged from 2 months to 10 years. Twenty cases were less than 1 age (42%), 30 cases were under 3 years of age (62%) and follow-up time was (4.0 ± 3.1) years. Age at endpoint was 1.5 to 19 years, mean (6.8 ± 4.2) years respectively. (2) In ≤ 1 year follow-up group, the proportions of no significant changes, retraction, and stenosis were 48%, 48% and 4% respectively. In > 1-3 years follow-up group, the proportions of no significant changes, retraction, and stenosis were 39%, 39% and 22% respectively. In > 3-5 years follow-up group, the proportions of no significant changes, retraction, and stenosis were 30%, 35% and 35% respectively. In > 5-10 years follow-up group, the proportions of no significant changes, retraction, stenosis were 30%, 20% and 50% respectively. Compared with the ≤ 1 year group, a significant increase in the proportion of coronary artery stenosis occurred at the other three groups.Significant difference in the stenosis rate could be found between the ≤ 1 year group and the other three groups respectively (χ(2)=6.026, 11.121, 15.652; P=0.019, 0.002, 0.001). (3) The rate of retraction in bilateral GCAA group (20 cases) was lower than unilateral GCAA group (28 cases ); bilateral GCAA group had lower rate than the unilateral group(15% (3/20) vs. 36% (10/28)). There was no significant difference in coronary artery outcome between two groups (P > 0.05) . (4) There were six severe ischemic heart disease in 48 cases including 2 deaths. (5) CTA showed coronary artery wall thickening, mural thrombus and calcification, the CAG could display coronary artery occlusion and recanalization and collateral vessels formation.

CONCLUSIONKD complicated with GCAA may occur in infants under one year of age, especially infants under 6 months of age. A significant increase in the proportion of coronary artery stenosis occurred with the follow-up time extended. The proportion of bilateral GCAA patients who had ischemic heart disease and died was higher than the unilateral cases. The combined application of echocardiography, CTA and CAG may greatly help to discover coronary thrombosis, stenosis and occlusion.

Child ; Child, Preschool ; Coronary Aneurysm ; complications ; Coronary Angiography ; Coronary Thrombosis ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; Prognosis

Objective To discuss the value of color Doppler echocardiography in diagnosis of scimitar syndrome .Methods The echocardiographic results of 6 patients with a diagnosis of scimitar syndrome were reviewed retrospectively .Their sonographic and hemodynamic characteristics were also analyzed connected with the reports in the literature .Results Three cases had dextrocardia and the others had mesocardia .All cases got right ventricular dimension enlargement .Total or partial of right pulmonary venous connection to the inferior vena cava were 3 cases respectively .All cases had right pulmonary artery hypoplasia .All of 6 cases echocardiographic results were in accordance with the findings by CT angiography and 4 cases were confirmed by operation .Conclusions The sonographic features of scimitar syndrome were obvious ,and echocardiography was contribute to early diagnosis of scimitar syndrome .

The main complications of Kawasaki diseases(KD) is relative to cardiovascular,especially coronary artery.Coronary artery lesions can be showed as arteritis,artery dilatation,aneurysm,arterial stenosis and so on.As a noninvasive,convenient,fast and well reproducible inspection method,echocardiography can offer dynamically observa tion of the evolution process of coronary artery lesions in each stage,accurately measure the coronary artery diameter,evaluate heart function in children,find other cardiac complications and which has become a standard diagnosis technics.With upgrades and new technology,the echocardiography plays a more and more important role in the diagnosis of acute period of KD and observation of curative effect,prognosis and long-term follow-up of recovery period of KD.

As an important member of the adisintegrin and metalloproteinase (ADAM) superfamily,ADAM17 can mediate a variety of membrane molecular hydrolysis off,such as adhesion molecules,cytokines,growth factors,etc,and play an important role in regulating tumor cell adhesion,apoptosis,metastasis and proliferation through the EGFR-PI3K-Akt pathway,Notch signaling pathway and other signaling pathways.The research of ADAM17 targeted drugs provides a new direction for cancer therapy.