Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective To investigate relative translations of the glenohumeral joint during abduction, scaption and forward flexion in normal Chinese, so as to provide references for diagnosis, treatment and follow-up of glenohumeral joint instability and subacromial impingement syndrome.Methods The biplanar fluoroscopy system combined with model-image registration technique were used to measure the humeral translation relative to the scapular in 13 healthy volunteers during abduction, scaption and forward flexion.Results The anterior-inferior glenohumeral translation during abduction, scaption and forward flexion was (4.0±1.3), (4.1±1.5),(4.8±1.9) mm, respectively. The superior-inferior glenohumeral translation was (3.0±1.0), (3.1±1.1), (3.3±1.5) mm, respectively. During the whole motion, there was a significant difference in superior-inferior translation at different arm elevation angles, while other significant differences were not found.Conclusions For normal Chinese, the humeral head was positioned posteriorly and superiorly on the glenoid. During forward flexion, the anterior-inferior and superior-inferior glenohumeral translation was the maxium. Therefore, in the process of clinical diagnosis, treatment and follow-up, patients performing the forward flexion may obtain a better evaluation effect.

Objective:To evaluate the accuracy of an ultrasound-guided robot-assisted system for percutaneous facet joint puncture in an animal experiment by registration of ultrasound images and two-dimensional X-ray fluorescence images.Methods:Six specimens of fresh adult sheep lumbar spine were prepared and soaked in gelatin solution. The specimens contained a total of 48 facet joints with 24 ones respectively on the left and right sides. Half of the joints were assigned by the random number table method into a robot-assisted group which were subjected to percutaneous facet joint puncture assisted by the ultrasound-guided robot-assisted system while the contralateral ones into a freehand group which were subjected to percutaneous facet joint puncture by freehand. In the robot-assisted group, the left facet joints were 3 L 1, 3 L 2, 3 L 3 and 3 L 4 ones while the right facet joints were 2 L 1, 3 L 2, 5 L 3 and 2 L 4 ones. In this self-control animal experiment, both the robot-assisted punctures and the freehand punctures were carried out in the same specimen. The puncture success rate, puncture needle adjustment, positioning deviation, orientation deviation and operation time were recorded. Results:The positioning deviation and orientation deviation in the robot-assisted group [(2.21 ± 1.12) mm and 1.51° ± 0.47°] were significantly lower than those in the freehand group [(3.26 ± 1.44) mm and 2.24° ± 0.89°] ( P < 0.05). All the articular facet joint punctures were successfully accomplished for the first time in the robot-assisted group while those required multiple adjustments in the freehand group. In the robot-assisted group, the total operation time [(463.84 ± 34.93) s] was significantly longer than that in the freehand group [(298.40 ± 27.48) s], but the puncture time [(37.97 ± 6.87) s] was significantly shorter than that in the freehand group [(261.61 ± 33.15) s] ( P < 0.05). Conclusion:The ultrasound-guided robot-assisted system for percutaneous facet joint puncture can lead to accurate puncture with limited needle adjustments.

Objective To analyze plantar pressure features of patients in injured and healthy sides of the lower limbs under different walking conditions after the trimalleolar fracture surgery, and compare these characteristics with healthy subjects. Methods Twelve Trimalleolar fracture patients and twenty-three healthy subjects were recruited and their plantar pressure characteristics under different walking conditions were tested, including peak pressure, contact area and contact time percentage. Results Comparison between injured and healthy sides: during level walking, peak pressure of the 3rd-5th toe in the injured feet were smaller than those in the healthy sides; in inversion position, peak pressure and contact area of the 3rd-5th toe area in the injured feet were smaller than those in the healthy side; in eversion position, peak pressure, contact area and contact time of the 3rd-5th toe in the injured feet were smaller than those in the healthy sides, and peak pressures of the hindfoot area were larger than those in the healthy sides. Comparison between patients and healthy subjects: under three kinds of walking conditions, peak pressures of the 2nd and 3rd metatarsus bones, the 2nd toe, the 3rd-5th toe, contact area of the 1st-5th toe and contact time percentage of the 2nd toe, the 3rd-5th toe area were all smaller than those of healthy subjects, while contact time of the hindfoot and mid-foot area were all smaller than those of healthy subjects. Conclusions The plantar pressure characteristics of Trimalleolar fracture patients were asymmetrical. Compared with healthy subjects, the plantar pressure features of patients were abnormal during stance phase. Compared with healthy subjects, the motor control ability and stability of patients in eversion positions were decreased. The plantar pressure characteristics at ankle eversion can be used to evaluate ankle joint function.

Anterior cruciate ligament (ACL) deficiency is a common clinical injury that seriously affects the function of the knee. Although ACL reconstruction (ACLR) can rebuild the structure of the ACL, it does not restore the normal kinematics and dynamics of the knee. In recent years, motion analysis has been widely applied in sports science and rehabilitation. In clinics, motion analysis is mainly applied to the evaluation of clinical outcomes of the ACLR knee. It is also a scientific objective tool to assess the potential risk factors of secondary injury and early onset of osteoarthritis after ACLR. In-depth understanding of the knee functional kinematics and kinetics after ACLR will significantly improve the efficacy of current ACL deficiency treatment and rehabilitation regime. This paper reviewed studies of the knee joint motion analysis after ACLR in the past decade. The current knowledge of the ACLR knee motion from studies using optical motion capture and biplanar fluoroscopic imaging system based tracking technique was synthesized. Clinical studies have reported that regardless of the type of graft and surgical technique of the ACLR, the postoperative knee still exhibits abnormal kinematics in functional tasks, but the relationship between early-onset OA and the biomechanical changes in the ACLR knee remains unknown. Restoring the rotational stability of the knee is still one of the biggest challenges in clinical ACLR surgery. Future studies should explore the impact of ACLR on the biomechanical mechanisms of the knee joint through an appropriate research design and long-term follow-up, and help clinicians and physiotherapists to develop more effective interventions.

Objective To explore the characteristics of plantar pressure of ankle joints at different limb laterality and different stress positions. Methods Twenty-three healthy subjects were recruited to perform walking trails. Each subject was tested for plantar pressure in ankle neutral position, ankle inversion and ankle eversion through simple custom-designed walkways and plantar pressure plate. The evaluation indices were peak pressure, contact area, contact time percentage, M/L (ratio of sum of medial plantar peak pressure to sum of lateral peak pressure), A/P (ratio of sum of toe peak pressure to heel peak pressure). Results The peak pressure of the first metatarsus bone in the dominant foot was significantly larger than that in the non-dominant foot, and the peak pressure of the fifth metatarsus bone was significantly smaller than that on the non-dominant foot. The M/L of dominant side was significantly larger than that of the non-dominant side. Except for the peak pressures of the mid-foot and the first toe, there were significant differences in other regions among the three ankle positions. The percentage of contact time in each area during inversion was greater than that in neutral position, and the percentage of contact time of plantar regions during eversion was longer than that in neutral position except the second toe. The M/L in inversion, neutral and eversion position were 1.24±0.46, 1.06±0.26, 0.88±0.25. The M/L of dominant foot was greater than that of the non-dominant foot, and the A/P during inversion and eversion was greater than that in neutral positions. Conclusions The stability of the dominant foot was better than that of the non-dominant foot. The standing stability decreased during inversion and eversion. During inversion, the body shifted inward and forward to maintain the stability. During eversion, the center of gravity shifted outward and forward to maintain the stability.

Objective:To analyze the biomechanical characteristics of bilateral lumbo-iliac fixation by finite element analysis after digital optimization of a safe screw pathway.Methods:Firstly, a healthy adult male volunteer was recruited for this study who underwent CT scanning of the lumbus and pelvis, with a slice thickness of 0.625 mm.The original data were imported into Mimics 16.0 software for 3D lumbar and pelvic reconstruction.At the same time, a geometric screw pathway and a free screw pathway were generated in the pedicles of L4 and L5 and ilium.Secondly, all 3D models were imported into Ansys 12 software to assemble a finite element model.The displacements and von Misses stress distribution were measured in the conditions of forward bending, backward extending, lateral bending to the left and right, and left and right rotations in the models of 2 kinds of pathway after gravity axial load of 500 N was applied.Results:The models of 2 different pathways were similar in comprehensive displacement and stress in the conditions of forward bending, lateral bending and backward extending, and in the maximum stress of the screw in the conditions of forward bending and lateral bending.However, the comprehensive displacement and stress in the condition of rotation and the stress of the screw in the conditions of backward extending and rotating in the model of geometric screw pathway were obviously smaller than those in the model of free screw pathway.The maximum pelvic stress was on the screw surface between 190 and 260 MPa, concentrated on the bending area of the 2 screws connecting the sacrum and vertebral body.The lumbar-iliac fixation model showed high com-pressive stiffness.The maximum von Misses stress appeared in the L4-L5 pedicle screw on the longitudinal rod.Under rotational loading, the upper longitudinal rod connecting the L4-L5 pedicle screw and the iliac bone screw bore the maximum stress.Conclusions:Our finite element analysis shows that double verte-bral bodies and long screw fixation are effective ways of iliolumbar fixation.The geometric screw path optimized by digital analysis exhibits better fatigue resistance, rotation resistance and overall stability.Internal lum-bo-iliac fixation can effectively share the stress of vertebral bodies.

A total of 245 cases of COVID-19 in Shaanxi Province reported in the China information system for disease control and prevention as of February 24, 2020 were selected as the research objects, the cases are divided into imported cases (116 cases, 47.3%) and local cases (129 cases, 52.7%), their basic characteristics, time distribution, transmission mode, intergenerational interval and latent period transmission are analyzed. The age of local cases [(51.74±15.67) years old], female patients (69 cases, 53.5%), housework and retired staff (40 cases, 31.0%), and patients isolated at the time of onset (50 cases, 38.8%) were higher than imported cases, respectively[(40.66±15.41) years old, (45 cases, 38.8%), (21 cases, 18.1%), (17 cases, 14.6%)] ( P values were < 0.05); The infection rate was 0.8% (31/3 666) in close contacts with local cases, which was lower than imported cases 2.0% (69/3 435) ( P<0.001); The main source of infection in local cases was relatives (70 cases, 54.3%), and the main way of infection was living together and party (90 cases, 69.8%); the proportion of latent period transmission in our province was 15.5% (20 cases), and the interval between the second-generation case and the source of infection was about 4 days, and the interval between generations was about 6 days. In summary, the main way of infection of local cases in Shaanxi Province was living together and party, there were a certain proportion of latent period transmission cases at present, it's suggested that the investigation of close contacts should be started 4 days or earlier before the onset of the case.

A total of 245 cases of COVID-19 in Shaanxi Province reported in the China information system for disease control and prevention as of February 24, 2020 were selected as the research objects, the cases are divided into imported cases (116 cases, 47.3%) and local cases (129 cases, 52.7%), their basic characteristics, time distribution, transmission mode, intergenerational interval and latent period transmission are analyzed. The age of local cases [(51.74±15.67) years old], female patients (69 cases, 53.5%), housework and retired staff (40 cases, 31.0%), and patients isolated at the time of onset (50 cases, 38.8%) were higher than imported cases, respectively[(40.66±15.41) years old, (45 cases, 38.8%), (21 cases, 18.1%), (17 cases, 14.6%)] ( P values were < 0.05); The infection rate was 0.8% (31/3 666) in close contacts with local cases, which was lower than imported cases 2.0% (69/3 435) ( P<0.001); The main source of infection in local cases was relatives (70 cases, 54.3%), and the main way of infection was living together and party (90 cases, 69.8%); the proportion of latent period transmission in our province was 15.5% (20 cases), and the interval between the second-generation case and the source of infection was about 4 days, and the interval between generations was about 6 days. In summary, the main way of infection of local cases in Shaanxi Province was living together and party, there were a certain proportion of latent period transmission cases at present, it's suggested that the investigation of close contacts should be started 4 days or earlier before the onset of the case.

We think that all the methods of puncturing into the skin to prevent and treat diseases are belong to acupuncture science. In spite of its basic theory of meridian and acupoint, anatomy and physiology have been important parts of modern acupuncture science. "Dry needling", however, is limited to trigger point theory. As for the positions, acupuncture is applied mainly at acupoints, involving in skin, muscles, tendons, vessels and nerves; while "dry needling" is used mostly at muscles. The needles of acupuncture are in various lengths and diameters and its manipulations are abundant, including the traditional skills and the achievements of modern science and technology research, such as electroacupuncture. It is different from the "dry needling" with the single tool and manipulation. Thus, acupuncture is suitable for a large range of syndromes, but "dry needling" is mainly for fascia muscularis pain and other related disorders. The acupuncturists need to embrace Chinese and western medicine, which is more rigorous than the training for "dry needling" practitioners. Based on the above reasons, we consider "dry needling" as part of acupuncture science, and it is a method during the modern development of traditional acupuncture.