ObjectiveTo monitor and analyze the epidemiological characteristics of viral pathogens among elderly patients with acute upper respiratory tract infections in Shaoxing City from 2020 to 2023, to guide prevention and treatment. MethodsNasopharyngeal swab samples were collected from elderly patients at the Infectious Disease Outpatient Department of Shaoxing infectious disease surveillance sentinel hospital for acute upper respiratory tract infections between January 2020 and December 2023. The multiple nucleic acid detection method was used to detect the influenza A virus (Flu A), influenza B virus (Flu B), respiratory syncytial virus (RSV), human rhinovirus (HRV), adenoviruses (ADV), and Mycoplasma pneumoniae (MP). Epidemiological analysis was conducted on the six pathogens mentioned above. χ2 test was used for statistical analysis. ResultsOf the 3 670 nasopharyngeal swab samples collected from the elderly patients with acute upper respiratory tract infections aged 60-89,2 330 were positive, with a detection rate of 63.49%. Among these, 2 293 were single pathogen infections, including 1 255 Flu A, 356 Flu B, 63 ADV, 76 RSV, 363 HRV, and 180 MP cases, with positive rates of 34.20%, 9.70%, 1.72%, 2.07%, 9.89%, and 4.90%, respectively. A total of 37 cases were mixed infections with two or more pathogens, with a positive detection rate of 1.01%. The rate of severe cases was significantly higher in patients with mixed infections compared to single pathogen infections (χ2=24.468, P<0.001). Among the single pathogen infections, ADV had the highest rate of severe cases at 4.76%, followed by Flu A at 3.19% and RSV at 2.63%. The lowest rate of severe cases was caused by MP infection at 0.56%. The distribution of severe cases of the six respiratory pathogen infections corresponded to their epidemic peaks. ConclusionAcute upper respiratory tract infections in the elderly are closely related to different respiratory pathogens, and mixed respiratory pathogen infections may increase the severity of respiratory cases in elderly patients.

Clinical pathway is an important quality management tool for regulating medical behavior both at home and abroad, and an important means of controlling medical costs in the reform of medical insurance payment methods.The author reviewed the current development status of clinical pathways both at home and abroad, focusing on summarizing the development experience of foreign countries, and analyzing the shortcomings in the development of clinical pathways in China from the perspectives of formulation, implementation, and evaluation. It is proposed that China should establish and improve the regulatory and incentive mechanisms for clinical pathways, accelerate the construction of supporting medical security systems, explore new incentive transmission models, attach importance to the role of patient participation in the formulation and implementation of clinical pathways, and so on, in order to provide reference for promoting the efficient development of clinical pathways in China.

Objectives Comparative analysis on epidemiological characteristics of measles in Minhang District before and after Large scale supplementary immunization activities of measles containing vaccine(MCV) in 2010. Methods Measles incidence data of MCV-SIA in 2010 and the first five years before 2010 (from January 1, 2005 to December 31, 2009), the next five years (from January 1, 2011 to December 31, 2015) and the second five years (from January 1, 2016 to December 31, 2020) after were collected. Descriptive epidemiological method was used for comparative analysis. Results The incidence rate of measles in Minhang District, Shanghai after MCV-SIA in 2010 showed a significant downward trend, The average annual incidence (per 100 0000) in the first 5 years before 2010 was 155.96, SIA was 30.08,The next five years was 29.52, The second five years was 2.84,There was statistical difference in the annual incidence rate between the four groups.（χ²=3165.821，P<0.01）. The annual incidence rate between registered residence and non registered residence population were not statistically different after second SIA years after the SIA（χ²=1.646，P=0.223）The proportion of 8-month-old children under the age of MCV decreased from 15.46% in the first five years of MCV-sia to 5.88%,In the second five years after MCV-sia, the proportion of 10-14 age group increased from 7.81% to 13.83%, The susceptible population of measles before MCV-SIA was less than 8 month old and under the age of MCV initial immunization, no migrant workers with no history of immunization and adults with registered residence. Once there is a source of infection, it is easy to cause the spread of the epidemic. After MCV-SIA, foreign students in international schools and nonworking population became the focus of measles. Of the 95 cases in which measles virus genotypes were available in the next five years, 2 (2.11%) were A genotype, and 93 (97.89%)were the indigenous H1 genotype ; Of the 7 cases in which measles virus genotypes were available in the second five years,7 (100%)were the indigenous H1 genotype . Conclusions After MCV-SIA, the comprehensive measles prevention and control measures can effectively control the incidence and prevalence of measles in Minhang District. But circulation of the indigenous H1 genotype was not interrupted, the work of normalization measures to eliminate measles also needs to cooperate with many departments to strengthen the prevention and control measures of measles in foreign schools and the nonworking population.

Objective:To establish a method for determination of the butanone in urine by gas chromatography (GC) with pre-column derivation.Methods:For detecting of butanone in urine, potassium iodide and potassium dichromate were added into urine under acidic condition, sample derivatization was undertaken in 50 ℃ water bath for 60 min and the iodine butanone was extracted with n-hexane. After the sodium thiosulfate solution was used to remove excess iodine, urine samples were centrifuged at 10000 r/min for 5 min, then the supernatant was analyzed using temperature rising programming with the Agilent Hp-5 column (30 m×0.32 mm, 0.25 μm) and electron capture detector (ECD) as the detector. The detector temperature was 300 ℃, the inlet temperature was 200 ℃, and the carrier gas was nitrogen.Results:For detecting of butanone in urine, potassium iodide and potassium dichromate were added for derivatization under the acidic condition. After extraction and centrifugation, the supernatant directly put through column and detected by ECD. In present study, the sample pretreatment condition was optimized, the relative standard deviations of intra-day and inner-day, the spiked samples and its recovery were evaluated for analyzing the accuracy of the proposed method.Conclusion:This method has proved to be simple, efficient and highly sensitivity, it can be utilized for butanone detection in occupational population.

Objective:To establish a method for determination of the butanone in urine by gas chromatography (GC) with pre-column derivation.Methods:For detecting of butanone in urine, potassium iodide and potassium dichromate were added into urine under acidic condition, sample derivatization was undertaken in 50 ℃ water bath for 60 min and the iodine butanone was extracted with n-hexane. After the sodium thiosulfate solution was used to remove excess iodine, urine samples were centrifuged at 10000 r/min for 5 min, then the supernatant was analyzed using temperature rising programming with the Agilent Hp-5 column (30 m×0.32 mm, 0.25 μm) and electron capture detector (ECD) as the detector. The detector temperature was 300 ℃, the inlet temperature was 200 ℃, and the carrier gas was nitrogen.Results:For detecting of butanone in urine, potassium iodide and potassium dichromate were added for derivatization under the acidic condition. After extraction and centrifugation, the supernatant directly put through column and detected by ECD. In present study, the sample pretreatment condition was optimized, the relative standard deviations of intra-day and inner-day, the spiked samples and its recovery were evaluated for analyzing the accuracy of the proposed method.Conclusion:This method has proved to be simple, efficient and highly sensitivity, it can be utilized for butanone detection in occupational population.

Objective To analyze the genetic characteristics of breakthrough varicella-zoster virus infection during the varicella outbreaks in Minhang District of Shanghai in 2013-2014. Methods Samples of the varicella-zoster liquid were collected from patients with chickenpox in Minhang District in 2013-2014 and used for the extraction of genomic DNA. The open reading frame ( ORF) of 22 and 62 regions were se-quenced and further analyzed by using bioinformatics methods. Results A total of 24 samples were success-fully collected and sequenced, and all of them were wild strains. Among the 24 varicella-zoster virus strains, 23 strains were highly homologous to the parental strain ( P-Oka) and the vaccine strain ( V-Oka) , indica-ting that they belonged to J genotype. Only one strain, whose genotype was between M and E, was highly ho-mologous to the mosaic( M) CA123 strain ( M1 genotype) , indicating that it might belong to M1 genotype. Conclusion The epidemic strains of varicella-zoster virus in Minhang District were mainly J genotype. Lo-cal epidemic of M and other genotypes of varicella-zoster virus also existed. There were some gene variations in different strains of J genotype. These varicella-zoster virus strains of non-vaccine genotypes might be one of the reasons causing the breakthrough cases of chicken pox.

Objective To evaluate the epidemiological efficacy of 23-valent pneumococcal poly-saccharide vaccine on the clinical symptoms and the incidence of respiratory tract infections in the elderly over 60 years old in Minhang District, Shanghai. Methods A prospective cohort study was conduct, in which the sample size was 1 200 for both inoculated and uninoculated groups. This study followed the two groups of subjects every quarter for a year. Clinical symptoms and the incidence of respiratory tract infectious diseases as well as the acute onset of chronic respiratory diseases were compared between the subjects of the two groups. Results Compared with the uninoculated group, less people in the inoculated group developed the clinical symptoms of respiratory tract infection (RR=0. 894, 95% CI: 0. 804-0. 994). Immunization with the 23-valent pneumococcal polysaccharide vaccine protected 57. 7% of the senior citizens (≥75 years old) from respiratory tract infections(95% CI:0. 207-0. 775). Conclusion The 23-valent pneumococcal polysaccharide vaccine can effectively reduce the incidence of respiratory tract infections in the elderly aged 60 years old and over and protects the elderly aged 75 years old and over from respiratory tract infections. Further studies on the immunological efficacy of 23-valent pneumococcal polysaccharide vaccine should be carried out by measuring the antibody titers before and after vaccination.

Objective To measure the titers of varicella live attenuated vaccines ( VarV) during the process of transportation and storage in different seasons and communities of Minhang Distract, Shang-hai, to evaluate the operation of cold chain system and the thermal stability of vaccines and to provide refer-ences for the management, introduction, research and development of vaccine in future.Methods Four communities with high outbreak rates of varicella during 2012 to 2013 and four communities with low out-break rates were randomly selected from 13 communities in Minhang District, Shanghai.The titers of VarVs were detected by using the quantitative plaque assay before and after 30 days of storage in November 2013 and February, May, August 2014.Results The overall rate of qualified VarVs was 90.63% with a geo-metric mean titer (GMT) of 3.67 (LgPFU/0.5 ml).96.88%of the VarVs produced by company C met the quality standard with a GMT of 3.89 ( LgPFU/0.5 ml) followed by those produced by company B with a rate of 91.67%and a GMT of 3.75 ( LgPFU/0.5 ml) .The rate of qualified VarVs produced by company A was the lowest, which was 80.00%, with GMT of 3.29 (LgPFU/0.5 ml).There were significant differences in the rates of qualified VarV among the three companies (χ2=8.288, P=0.016).The rate of qualified vac-cines in communities close to the Shanghai Minhang Center for Disease Control and Prevention ( Minhang CDC) was 91.67%, while 100%of the vaccine samples collected form the communities at a middling dis-tance from or far from the Minhang CDC met the quality standard.No significant difference in the rate of qualified vaccine was found among the three types of communities (χ2=3.441, P=0.179).The quarterly rates of qualified vaccines produced by B and C companies were 100%except for the third quarter.The rates of qualified vaccines produced by A, B and C companies in the third quarter were respectively 70.00%, 66.67%and 87.50%.No statistical differences in the quarterly rates of qualified vaccines were found among the three companies (χ2=1.25, P=0.7412;χ2=6.545, P=0.088; χ2=6.194, P=0.103).No statistical differences in the rates of qualified vaccines before and after 30 days of storage were found among the three companies (χ2=0.625, P=0.347;χ2=0.000, P=1.000;χ2=2.065, P=0.492).Conclusion A well-managed and-operated cold chain system was implemented in Minhang District in the storage and transport of vaccines as well as other related links.The thermal stability of vaccines produced by company C was better than those of the other two companies.A surveillance for the titers of vaccines produced by com-pany A should be strengthened.

OBJECTIVESTo survey on the vaccination of varicella live attenuated vaccine among 4-17 children in Minhang District, and analyze the protective effect against varicella.

METHODSWe collected outbreak chickenpox cases reported from infectious disease report system and surveillance units in Minhang district from 1st May in 2012 to 30th Apr in 2013. The 1: 3 matched case-control study was conducted to questionnaire the legal guardian of the cases and control group, and calculate the protective effect and effective term of protection. The survey included vaccination, chickenpox exposure history, previous history of varicella illness, suffering from the symptoms of chickenpox, the vaccinations brand, etc. The criteria of accepted case were those healthy students who were in the same class with those chickenpox cases. The accepted matched controlling data were those children who were from the same class with outbreak chickenpox cases without varicelliform eruption, similar live condition, the closest house, the same gender, the closest age. This study investigated 390 cases of patients and the control group included 1 170 cases. Chi-square test was used to compare the vaccination of cases and controls, as well as the incidence of chickenpox vaccination different brands VarV, Mantel-Haenzel chi-square test was applied to compare the protective effect of the two groups.

RESULTSVarV overall vaccination rate was 68.3% (1 065/1 560), among them, the case group coverage was 45.1% (176/390), significantly lower than the control group (76.0% (889/1 170)) (χ² = 128.55, P < 0.01). The coverage in children of 4-10 years old group was 88.4% (375/424), significantly higher than the 11-17 years old group (60.7% (690/1 136)) (χ² = 109.40, P < 0.01). The overall protective effect of VarV was 78.10% (71.82%-82.98%).Vaccinated group incidence ratio was 16.5% (176/1 065), significantly lower than the unvaccinated group (43.2% (214/495)) (χ² = 128.55, P < 0.01). The chickenpox risk of the children who were vaccinated was lower than those who were not, and the OR (95%CI) was 0.22(0.17-0.28) . Proportion of the fever and the typical symptoms of varicella zoster were 26.1% (46/176), 8.0% (14/176) in the children vaccinated VarV, significantly lower than children without VarV vaccination history (54.7% (117/214) , 18.2% (39/214) ) (χ² values were 32.33 and 8.67, respectively. P values both <0.01). The varicella incidence was 17.4% (139/797) in children vaccinated domestic VarV, and it was 13.8% (37/268) in the group of imported VarV (χ² = 1.92, P = 0.184) . The average duration of effective protection period for domestic and imported VarV was (6.2 ± 2.7), (6.3 ± 3.4) years (F = 2.24, P = 0.136).

CONCLUSIONSThe risk of varicella incidence and the proportion of fever or typical varicella zoster were lower in the one dose of VarV vaccinated; Effective protective effect was consistent in the children with domestic or imported VarV vaccination.

Adolescent ; Case-Control Studies ; Chickenpox ; Chickenpox Vaccine ; Child ; Child, Preschool ; China ; Disease Outbreaks ; Fever ; Humans ; Immunity, Active ; Incidence ; Risk ; Surveys and Questionnaires ; Treatment Outcome ; Vaccination ; Vaccines, Attenuated

Objective To discuss of the therapeutic effects of treating three TCM types of Chronic superficial gastritis (CSG)disharmony of liver and stomach, weakness of the spleen and the stomach, and damp heat in the spleen and the stomach with chinese medicine, and to discuss its impact on the changes of three gastrointestinal hormones-- motilin (MTL), gastrin (GAS), and somatostatin (SS). Methods The data of 150 CSG patients in Shenzhen Bao’an Hospital from Feb, 2011 to Mar, 2013 were selected. These patients belonged to three kinds of syndrome, which was disharmony of liver and stomach, weakness of the spleen and the stomach, and damp heat in the spleen and the stomach, each syndrome had 50 cases. Different Chinese medicines were applied to different syndrome of patients. After one month treatment, the therapeutic effects and the changes of MTL, GAS, SS in these patients were detected by radioimmunoassay. Results After treatment, the total effective rate of the damp heat in the spleen and the stomach syndrome was 94%, the weakness of the spleen and the stomach type was 88%, disharmony of liver and stomach type was 90%, the difference was not statistically significant among the three types(χ2=3.84, P>0.05);after treatment, the serum MTL, SS level of disharmony of liver and stomach, weakness of the spleen and the stomach, and damp heat in the spleen and the stomach type were [damp heat in the spleen and the stomach type were (240.25±7.29)pg/ml, (68.23± 5.97)pg/ml;the weakness of the spleen and the stomach type were (260.16±8.84)pg/ml, (75.35±4.65)pg/ml;disharmony of liver and stomach type were(258.32±15.23)pg/ml, (80.12±7.88)pg/ml] higher than before treatment [damp heat in the spleen and the stomach type were (87.26±7.58)pg/ml, (49.34±4.93)pg/ml;the weakness of the spleen and the stomach type were (67.11±7.81)pg/ml, (57.15±5.11)pg/ml; disharmony of liver and stomach type were (89.26±7.60)pg/ml, (40.63±7.26)pg/ml], and the levels of serum GAS [(156.38±17.36)pg/ml, (146.15±15.56)pg/ml, (140.26±13.37)pg/ml] was lower than before treatment [(274.59 ± 17.82)pg/ml, (320.83 ± 15.02)pg/ml, (216.15 ± 13.77)pg/ml], the difference was statistically significant (P<0.05 or 0.01). Conclusions The changes of three hormones-MTL, GAS, SS can be used as an objective basis for the diagnosis and the judgment of healing efficacy of CSG treated by traditional Chinese medicine.