[Proactively embracing the challenges of multimorbidity]

With rapid socio-economic development and the acceleration of population aging, the average life span of human beings has increased significantly. Individuals suffering from the co-existence of multiple diseases (multimorbidity) have become a new normal in public health and posed severe challenge to human health. Multimorbidity significantly reduces the quality of life, increases disability and mortality risks, complicates disease treatment and care and increases burden of the healthcare system with higher costs. This commentary discusses the definition of multimorbidity and common public misconceptions, then assesses its profound impact on overall public health, socio-economic development and healthcare system. We also proposes the potential strategies to meet the challenges posed by multimorbidity. The main aim is to raise awareness of multimorbidity, advocate proactive responses to improve public health and build a healthy society through the development of prevention and treatment systems and promote precision prevention and treatment for multimorbidity.

Safety and efficacy of biliary stenting combined with iodine-125 seed strand followed by hepatic artery infusion chemotherapy plus lenvatinib with PD-1 inhibitor for the treatment of extrahepatic cholangiocarcinoma with malignant obstructive jaundice

Objectives

To evaluate the efficacy and safety of biliary stenting implantation with iodine-125 seed strand (SI) followed by hepatic artery infusion chemotherapy (HAIC) plus lenvatinib (Len) with programmed death-1 (PD-1) inhibitor for patients diagnosed with extrahepatic cholangiocarcinoma (ECC) and malignant obstructive jaundice (MOJ).

Methods

In this single-center retrospective study, the data of ECC patients with MOJ from March 2015 to January 2023 was assessed. Using probability score matching (PSM), the selection bias of patients was reduced. Primary study outcomes included overall survival (OS) and progression-free survival (PFS). The OS and PFS were performed using the Kaplan-Meier method and evaluated with the log-rank test.

Results

A total of 104 patients were enrolled finally, including 52 patients treated with interventional therapy (SI+HAIC) plus Len with PD-1 inhibitor (SI+HAIC+Len+P group) and 52 patients treated with interventional therapy (SI+HAIC) plus lenvatinib (SI+HAIC+Len group). 26 pairs of patients were matched after PSM analysis. After PSM analysis, the median OS and PFS in the SI+HAIC+Len+P group were significantly longer compared to those in the SI+HAIC+Len group (OS:16.6 vs. 12.3 months, P = 0.001; PFS:12.6 vs 8.5 months, P = 0.004). The DCR was significantly different between groups (P = 0.039), while ORR not (P = 0.548). The addition of PD-1 inhibitor was generally well tolerated without treatment-associated mortality.

Conclusion

Interventional therapy (SI+HAIC) plus Len with PD-1 inhibitor was effective for ECC patients accompanied by MOJ with a manageable safety profile.

Real-world efficacy and safety of TACE plus camrelizumab and apatinib in patients with HCC (CHANCE2211): a propensity score matching study

OBJECTIVES

This study aimed to investigate the efficacy and safety of transarterial chemoembolization (TACE) plus camrelizumab, a monoclonal antibody targeting programmed death-1, and apatinib for patients with intermediate and advanced hepatocellular carcinoma (HCC) in a real-world setting.

METHODS

A total of 586 HCC patients treated with either TACE plus camrelizumab and apatinib (combination group, n = 107) or TACE monotherapy (monotherapy group, n = 479) were included retrospectively. Propensity score matching analysis was used to match patients. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and safety in the combination group were described in comparison to monotherapy.

RESULTS

After propensity score matching (1:2), 84 patients in the combination group were matched to 147 patients in the monotherapy group. The median age was 57 years and 71/84 (84.5%) patients were male in the combination group, while the median age was 57 years with 127/147 (86.4%) male in the monotherapy group. The median OS, PFS, and ORR in the combination group were significantly higher than those in the monotherapy group (median OS, 24.1 vs. 15.7 months, p = 0.008; median PFS, 13.5 vs. 7.7 months, p = 0.003; ORR, 59.5% [50/84] vs. 37.4% [55/147], p = 0.002). On multivariable Cox regression, combination therapy was associated with significantly better OS (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.26-0.64; p < 0.001) and PFS (adjusted HR, 0.52; 95% CI, 0.37-0.74; p < 0.001). Grade 3 or 4 adverse events occurred in 14/84 (16.7%) and 12/147 (8.2%) in the combination and monotherapy groups, respectively.

CONCLUSIONS

TACE plus camrelizumab and apatinib showed significantly better OS, PFS, and ORR versus TACE monotherapy for predominantly advanced HCC.

CLINICAL RELEVANCE STATEMENT

Compared with TACE monotherapy, TACE plus immunotherapy and molecular targeted therapy showed better clinical efficacy for predominantly advanced HCC patients, with a higher incidence of adverse events.

KEY POINTS

• This propensity score-matched study demonstrates that TACE plus immunotherapy and molecular targeted therapy have a longer OS, PFS, and ORR compared with TACE monotherapy in HCC. • Grade 3 or 4 adverse events occurred in 14/84 (16.7%) patients treated with TACE plus immunotherapy and molecular targeted therapy compared with 12/147 (8.2%) patients in the monotherapy group, while no grade 5 adverse events were observed in all cohorts.

Efficacy and safety of transarterial chemoembolization combined with lenvatinib, programmed death-1 inhibitor, and iodine-125 seed brachytherapy for hepatocellular carcinoma with portal vein tumor thrombosis

BACKGROUND

Therapy for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) is still controversial. This study was performed to evaluate the efficacy and safety of the combination therapy comprising transarterial chemoembolization (TACE), lenvatinib (L), programmed death-1 inhibitor (P), and iodine-125 seed (I125) brachytherapy relative to TACE in combination with lenvatinib plus programmed death-1 inhibitor therapy and TACE plus lenvatinib therapy.

METHODS

The data of HCC patients with PVTT from July 2017 to August 2022 were assessed in this single-center retrospective study. Primary study outcomes were progression-free survival (PFS) and overall survival (OS), while the secondary outcomes were disease control rate (DCR), objective response rate (ORR), and treatment-related adverse events.

RESULTS

We enrolled 150 patients totally, including 50 patients treated with TACE plus lenvatinib therapy (TACE+L group), 45 patients treated with TACE in combination with lenvatinib plus programmed death-1 inhibitor therapy (TACE+L+P group), and 55 patients treated with the combination therapy of TACE along with I125 brachytherapy, lenvatinib, and programmed death-1 inhibitor therapy (TACE+L+P+I125 group). The median OS in the TACE+L+P+I125 group (21.0; 95% confidence interval [CI]: 18.4∼23.5 months) was significantly longer than that in the TACE+L group (10; 95% CI: 7.8∼12.1months) (p = 0.006), while it was insignificantly longer than that in the TACE+L+P group (14.0; 95% CI: 10.7∼17.2months) (p = 0.058). The median PFS in the TACE+L+P+I125 group (13.0; 95% CI: 10.2∼15.7 months) was significantly longer than that in the TACE+L group (5.0; 95% CI: 4.2∼5.7 months) (p = 0.014) and the TACE+L+P group (9.0; 95% CI: 6.7∼11.2 months) (p = 0.048). Statistically significant differences between groups were found in DCR (p = 0.015). There were no significant between-group differences in treatment-related adverse events (p > 0.05).

CONCLUSIONS

A combination therapy of TACE, lenvatinib, programmed death-1 inhibitor, and I125 seed brachytherapy significantly improve OS, PFS, and DCR and show better survival prognosis for HCC patients accompanied by PVTT.

[Research and reflection on the diversified method system of multi-stages and multi-scenarios surveillance and early warning of infectious diseases]

With the outbreak of infectious diseases, more and more attention has been paid to surveillance and early warning work. Timely and accurate monitoring data is the basis of infectious diseases prevention and control. Effective early warning methods for infectious diseases can improve the timeliness and sensitivity of early warning work. This paper briefly introduces the intelligent early warning model of infectious diseases, summarizes the emerging surveillance and early warning methods of infectious diseases, and seeks the possibility of diversified surveillance and early warning in different epidemic stages and different outbreak scenarios of infectious diseases. This paper puts forward the idea of constructing a diversified method system of infectious diseases surveillance and early warning based on multi-stages and multi-scenarios and discusses the future development trend of infectious diseases surveillance and early warning, in order to provide reference for improving the construction level of infectious diseases surveillance and early warning system in China.

[Progress and challenge in intelligent syndromic surveillance for infectious diseases]

Intelligent syndromic surveillance is an important part of multi-point triggering and multi-channel surveillance system of intelligent early warning of infectious diseases in China, and an inevitable development process of traditional syndromic surveillance as the constant emergence of new technologies. Intelligent syndromic surveillance collects not only the medical data of patients seeking medical care in hospitals but also massive non-medical information. However, along with its rapid development, challenges in intelligent syndromic surveillance have emerged, such as information explosion, cost-effective balance, information sharing, data security and privacy. This paper summarizes the concept and development of intelligent syndromic surveillance to provide references for the method and technique development of intelligent early warning of infectious diseases and new thought for the prevention and control of infectious diseases in China and in the world.

[Thinking about development of multi-channel surveillance and multi-dimensional early warning system of emerging respiratory communicable diseases]

The world has paid a heavy price for the pandemic of the emerging respiratory communicable disease, so more concern about communicable disease surveillance and early warning has been aroused. This paper briefly reviews the establishment of the surveillance and early warning system of respiratory communicable diseases in China, discusses its future development and introduces the novel surveillance methods and early warning models for the purpose of establishment of a multi-channel surveillance and multi-dimensional early warning system of communicable diseases in the future and the improvement of the prevention and control of emerging respiratory communicable diseases in China.

[Research progress on the effectiveness of smallpox vaccination against mpox virus infection]

With the expansion of mpox virus infection from endemic to a global epidemic in 2022, the WHO declared that the mpox event constituted a Public Health Emergency of International Concern. Due to the high degree of gene sequence similarity among orthopox viruses and cross-reactive antibodies induced by orthoviruses, smallpox vaccination may affect the immune response induced by mpox virus infection. The analysis of the protective effects of smallpox vaccination against mpox virus infection will help define the focus of prevention and control. In this review, we clarify the protection of the smallpox vaccine against mpox virus infection by analyzing the correlation between smallpox vaccination, immune response status, and clinical data and providing evidence for the prevention, control, and strategies of mpox epidemics.

[The value of vaccines from the perspective of population medicine]

Vaccination is one of the most effective, broad-reach, and cost-effective public health initiatives to fight against infectious diseases. From the perspective of population medicine, this article systematically elaborates on the value of vaccines in preventing infections, reducing disease incidence, decreasing disability and severe cases, lowering mortality rates, improving population health and life expectancy, reducing antibiotic use and resistance, as well as promoting fairness in public health services. Based on the current situation, the following recommendations are proposed: first, strengthen scientific research to provide a solid foundation for related policy-making; second, increase the coverage rate of non-national immunization program vaccines; third, promote the inclusion of more appropriate vaccines in the national immunization program; fourth, strengthen the research and development of new vaccines; and fifth, increase talent training in the field of vaccinology.

Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma (CHANCE001)

There is considerable potential for integrating transarterial chemoembolization (TACE), programmed death-(ligand)1 (PD-[L]1) inhibitors, and molecular targeted treatments (MTT) in hepatocellular carcinoma (HCC). It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations. In this nationwide, retrospective, cohort study, 826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT (combination group, n = 376) or TACE monotherapy (monotherapy group, n = 450) were included from January 2018 to May 2021. The primary endpoint was progression-free survival (PFS) according to modified RECIST. The secondary outcomes included overall survival (OS), objective response rate (ORR), and safety. We performed propensity score matching approaches to reduce bias between two groups. After matching, 228 pairs were included with a predominantly advanced disease population. Median PFS in combination group was 9.5 months (95% confidence interval [CI], 8.4-11.0) versus 8.0 months (95% CI, 6.6-9.5) (adjusted hazard ratio [HR], 0.70, P = 0.002). OS and ORR were also significantly higher in combination group (median OS, 19.2 [16.1-27.3] vs. 15.7 months [13.0-20.2]; adjusted HR, 0.63, P = 0.001; ORR, 60.1% vs. 32.0%; P < 0.001). Grade 3/4 adverse events were observed at a rate of 15.8% and 7.5% in combination and monotherapy groups, respectively. Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS, OS, and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice, with an acceptable safety profile.

[Research progress on the burden of respiratory syncytial virus infection in the elderly]

Human Respiratory Syncytial Virus (HRSV) is a serious threat to the population health. The elderly are one of the susceptible populations. The prevalence of HRSV in the elderly is generally higher than that in other age groups except children, which has gradually attracted attention in recent years. This paper reviewed the prevalence, common complications and major complications of HRSV in the elderly, briefly expounded the economic burden of HRSV infection, and proposed that attention should be paid to the disease burden of the elderly after HRSV infection, timely treat common complications, so as to reduce the occurrence of adverse survival outcomes and provide scientific evidence for the prevention and control of HRSV infection in the elderly.

Effect and mechanism of pirfenidone combined with 2-methoxy-estradiol perfusion through portal vein on hepatic artery hypoxia-induced hepatic fibrosis

PURPOSE

The aim of this study was to explore the effect and mechanism of pirfenidone (PFD) combined with 2-methoxyestradiol (2-ME2) perfusion through portal vein on hepatic artery hypoxia-induced hepatic fibrosis.

MATERIALS AND METHODS

Sprague-Dawley rats were divided into 5 groups (n ​= ​3/group): control group, hepatic artery ligation (HAL) group, HAL ​+ ​PFD (portal vein perfusion of PFD) group, HAL+2-ME2 (portal vein perfusion of 2-ME2) group and HAL ​+ ​PFD+2-ME2 group depending on whether they received HAL and/or portal vein perfusion (PFD and/or 2-ME2). Livers were harvested for pathology, western blotting (WB), and quantitative real-time PCR (qRT-PCR).

RESULTS

Sirius red staining showed that portal vein perfusion of drugs resulted in degradation of liver fibrosis. Immunohistochemistry showed decreased hypoxia-inducible factor-1 α (HIF-1α) and α-smooth muscle actin (α-SMA) after portal intravenous drugs infusion compared with HAL group (P ​< ​0.05). WB analysis showed increased Smad7 in HAL ​+ ​PFD group compared with HAL group (P ​< ​0.05). qRT-PCR analysis showed decreased matrix metallo-proteinase 2 (MMP2), transforming growth factor β1 (TGF-β1), monocyte chemoattractant protein-1 (MCP-1), and Collagen I mRNA in HAL ​+ ​PFD group except for tissue inhibitor of metalloproteinase-1 (TIMP-1) compared with HAL group (P ​< ​0.05). Compared with HAL ​+ ​PFD group, the addition of 2-ME2 did not lead to better results in qRT-PCR analysis.

CONCLUSIONS

The portal vein perfusion of PFD significantly reduced the hepatic artery hypoxia-induced fibrosis degree in treated rats by down-regulating the expression of HIF-1α, α-SMA, MMP2, TGF-β1, MCP-1, and Collagen I, as well as up-regulating the TIMP-1 expression and Smad7 protein level. Combined 2-ME2 infusion was not better than PFD alone.

[Research progress on early warning model of influenza]

Influenza is an acute respiratory infectious disease caused by influenza virus. It usually exhibits seasonal transmission, but the novel influenza strain can lead to a pandemic with severe human health and socioeconomic consequences. Early warning of influenza epidemic is an important strategy and means for influenza prevention and control. On the basis of reviewing the main influenza surveillance and early warning systems, this study summarizes the principles, applications, advantages and disadvantages, and development prospects of common influenza early warning models, in order to provide reference for research and application of early warning technology for influenza and other acute respiratory infectious diseases.

[Application of pretrained model based on electronic medical record in recognition of acute respiratory infection]

Objective: To evaluate the recognition of acute respiratory infection (ARI) by a pretrained model based on electronic medical records (EMRs). Methods: 38 581 EMRs were obtained from Chongqing University Three Gorges Hospital in December 2021. Bidirectional encoder representation from transformers (BERT) pretrained model was used to identify ARI in EMRs. The results of medical professionals were considered as the gold standard to calculate the sensitivity, specificity, Kappa value, and area under the curve of the receiver operating characteristic (AUC). Results: There were 3 817 EMRs in the test set, with 1 200 ARIs. A total of 1 205 cases were determined as ARI by the model, with a sensitivity of 92.67% (1 112/1 200) and a specificity of 96.45% (2 524/2 617). The model identified ARI with similar accuracy in males and females (AUCs 0.95 and 0.94, respectively), and was more accurate in identifying ARI cases in those aged less than 18 than in adults 18-59 and adults 60 and older (AUCs 0.94, 0.89 and 0.94, respectively). The current model had a better identification of ARIs in outpatient patients than that in hospitalized patients, with AUCs of 0.74 and 0.95, respectively. Conclusion: The use of the BERT pretrained model based on EMRs has a good performance in the recognition of ARI cases, especially for the outpatients and juveniles. It shows a great potential to be applied to the monitoring of ARI cases in medical institutions.

[Research on the interaction between COVID-19 and influenza]

Since the global pandemic of COVID-19, different countries have implemented various prevention and control measures, which has affected the epidemic characteristics of respiratory infectious diseases such as influenza. From 2020 to 2021, the level of influenza activity was relatively low, but it is necessary to be alert that with the adjustment of national prevention and control measures, influenza may have a relatively strong epidemic rebound. In order to deal with influenza epidemic, experts were organized to publish a series of influenza studies in this issue, suggesting that influenza prevention and control cannot be underestimated during the COVID-19 pandemic. It is suggested to carry out research on the interaction between COVID-19 and influenza to explore the epidemic characteristics of the disease, develop new technologies and tools to improve the efficiency of monitoring and early warning, identify obstacles to vaccination, promote the scientific implementation of intervention measures, and achieve joint prevention and control of multiple diseases.

[Strengthen evaluation of vaccine effectiveness to facilitate scientific and targeted prevention and control of the COVID-19 pandemic]

The COVID-19 continues to spread throughout the world, and local clusters and outbreaks related to overseas imports have occurred in many places in China. Vaccination against COVID-19 is one of the most effective tools to prevent disease, severe illness and death. For vaccines developed and used by China, it is particularly important for scientific and targeted prevention and control to study different outbreak scenarios, to conduct in-depth real-world research on SARS-CoV-2 variants, and to further promote vaccine development and technical reserves. This article commented the effectiveness of COVID-19 vaccine, and prospected the future research on vaccine efficacy, immunization strategy and vaccine development, which provided evidence for optimizing vaccination strategy.

[Strategy and measures in response to highly uncertain emerging infectious disease]

The incidence and spread of emerging infectious diseases are highly uncertain. This paper summarizes the uncertainty and complexity of emerging infectious disease, and suggests that for the response to the varied emerging infectious diseases in the future, it is still necessary for human to take the strategy of constantly strengthening the prevention and control capability and improving various preparedness protocols. For the better response to emerging infectious diseases and protection of people's health and life, the following measures can be taken, paying more attention to the layout of the infectious disease surveillance network, establishing and maintaining the laboratory surveillance network of infectious diseases, establishing and improving a "wartime-peacetime" transition mechanism or system of medical treatment and response, developing and improving the prevention and control plan for emerging infectious diseases, strengthening the training and rehearsal of emerging infectious disease treatment and response, establishing and improving the system for the grading, classification and stockpile of medical supplies for public health emergency response and establishing and maintaining the system of early warning of emerging infectious diseases and technical platform regulations.

[Elimination of infectious disease in China, past and future]

In the long history, infectious disease once caused huge disasters to human beings, not only resulting in serious impacts on public health, but even threatening socioeconomic development and national security. Since the founding of the People's Republic of China, China has attached great importance to the prevention and treatment of infectious disease and achieved remarkable achievements. This article mainly summarizes the historical progresses of the eradication of smallpox and the eliminations of polio, leprosy, filariasis, neonatal tetanus, blinding trachoma and malaria in China, and discusses the eliminations of the infectious diseases which can be conducted in the future.

Diets varying in ratio of sweet sorghum silage to corn silage for lactating dairy cows: Feed intake, milk production, blood biochemistry, ruminal fermentation, and ruminal microbial community

The objective of this study was to investigate the effects of partial substitution of corn silage (CS) with sweet sorghum silage (SS) in the diets of lactating dairy cows on dry matter (DM) intake, milk yield and composition, blood biochemistry, and ruminal fermentation and microbial community. Thirty mid-lactation Holstein dairy cows [mean ± standard deviation; 639 ± 42.0 kg of body weight; 112 ± 24.0 d in milk (DIM)] were assigned to 3 groups (n = 10/treatment) by considering parity, milk yield, and DIM. The cows were fed ad libitum total mixed rations containing 55% forage and 45% concentrate, with only the proportion of CS and SS varying in 3 treatments (DM basis): SS0 (0% substitution of CS), 40% CS and 0% SS; SS25 (25% substitution of CS)_, 30% CS and 10% SS; and SS50 (50% substitution of CS)_, 20% CS and 20% SS. Dry matter intake and milk protein concentration tended to linearly decrease with increasing proportion of SS in the diet. Yields of milk (mean ± standard deviation, 30.9 ± 1.12 kg/d), 4% fat-corrected milk (30.0 ± 0.81 kg/d), energy-corrected milk, milk protein, lactose, and total solids, concentrations of milk fat, lactose, somatic cell counts, and milk efficiency did not differ among diets. The concentrations in blood of urea nitrogen, phosphorus, aspartate aminotransferase, and malondialdehyde linearly increased with increasing SS proportion. Blood IgA decreased with increasing SS substitution rate, but blood IgG and IgM were not different among diets. Ruminal pH did not differ among diets, whereas ruminal NH₃-N concentration quadratically changed such that it was greater for SS50 than for SS0 and SS25. Molar proportions of propionate and acetate to propionate ratio were less for SS25 than for SS0. Although the diversity and general ruminal microbial community structure were not altered by partially replacing CS with SS, the relative abundances of predominant bacteria were affected by diets at the phylum and genus levels. Firmicutes and Bacteroidetes were dominant phyla in the ruminal bacterial community for all diets, and their relative abundance linearly decreased and increased, respectively, with increasing SS substitution rate. Prevotella_1 and Ruminococcaceae_NK4A214_group were detected as the most and the second most abundant genera, with their relative abundance linearly increased and decreased, respectively, with increasing SS substitution rate. The relative abundance of Fibrobacter linearly increased with increasing dietary SS proportion, with greater abundance observed for SS25 and SS50 than for SS0. These results suggest that substitution of CS with SS altered the relative abundances of some predominant bacteria; however, these changes had little effect on ruminal fermentation and milk yield. Under the current experimental conditions, substituting up to 50% of CS with SS had no negative effects on milk yield, indicating that SS can partially replace CS in the diets of high-producing lactating dairy cows without adding extra grain, when diets are fed for a short time. As the effects of substituting CS with SS depend upon the chemical composition and digestibility of these silages and the nutrient requirements of the cows, additional grain may be required in some cases to compensate for the lower starch content of SS.

[Summary and prospect of early warning models and systems for infectious disease outbreaks]

This paper summarizes the basic principles and models of early warning for infectious disease outbreaks, introduces the early warning systems for infectious disease based on different data sources and their applications, and discusses the application potential of big data and their analysing techniques, which have been studied and used in the prevention and control of COVID-19 pandemic, including internet inquiry, social media, mobile positioning, in the early warning of infectious diseases in order to provide reference for the establishment of an intelligent early warning mechanism and platform for infectious diseases based on multi-source big data.

[Evaluation of demand of resources for laboratory testing and prevention and control of COVID-19 in the context of global pandemic]

Objective: To rapidly evaluate the level of healthcare resource demand for laboratory testing and prevention and control of corona virus disease 2019 (COVID-19) in different epidemic situation, and prepare for the capacity planning, stockpile distribution, and funding raising for infectious disease epidemic response. Methods: An susceptible, exposed, infectious, removed infectious disease dynamics model with confirmed asymptomatic infection cases and symptomatic hospitalized patients was introduced to simulate different COVID-19 epidemic situation and predict the numbers of hospitalized or isolated patients, and based on the current COVID-19 prevention and control measures in China, the demands of resources for laboratory testing and prevention and control of COVID-19 were evaluated. Results: When community or local transmission or outbreaks occur and total population nucleic acid testing is implemented, the need for human resources is 3.3-89.1 times higher than the reserved, and the current resources of medical personal protective equipment and instruments can meet the need. The surge in asymptomatic infections can also increase the human resource demand for laboratory testing and pose challenge to the prevention and control of the disease. When vaccine protection coverage reach ≥50%, appropriate adjustment of the prevention and control measures can reduce the need for laboratory and human resources. Conclusions: There is a great need in our country to reserve the human resources for laboratory testing and disease prevention and control for the response of the possible epidemic of COVID-19. Challenges to human resources resulted from total population nucleic acid testing and its necessity need to be considered. Conducting non-pharmaceutical interventions and encouraging more people to be vaccinated can mitigate the shock on healthcare resource demand in COVID-19 prevention and control.

[Experience and thinking on the normalization stage of prevention and control of COVID-19 in China]

COVID-19 is an important public health issue of great concern at home and abroad, and it is still in the state of global pandemic. During the normalization stage of prevention and control of the epidemic of COVID-19, China effectively controlled the outbreak and spread of the epidemic by adopting the strategy of "import of external prevention and rebound of internal prevention", and effectively reduced the occurrence of death cases. The social economy recovered quickly, and various measures were highly recognized by the public, and the positive trend of the epidemic continued to consolidate. At present, although the spread of the local epidemic has been basically stopped, the international epidemic continues to rise rapidly, and the pressure of "imported prevention and control" in China continues to increase. Considering the characteristics of the normalization of epidemic prevention and control and the particularity of the virus, the connotation of the normalization of epidemic prevention and control should be understood scientifically. The prevention and control goal of the epidemic in the normalization stage should be to maximize early detection, early treatment and early disposal, and resolutely prevent the continuous spread of the epidemic in communities, that is, to prevent the infection as much as possible, and resolutely prevent the rebound (sustained spread in communities), rather than "zero infection". The prevention and control policy of "timely detection, rapid disposal, precise management and control, and effective treatment" has been implemented in various localities, and a series of effective and regular experience in prevention and control has been formed in the practice of prevention and control. Winter and spring are the key periods for the prevention and control of the epidemic. We should continue to work together to prevent and control the epidemic, fulfill the responsibilities of all parties, and prevent and control the epidemic in a scientific and effective way.

[Promote multidisciplinary integration, and strengthen capacities on prevention, control and pandemic preparedness of influenza]

Series of the studies and consensus on the basic research on seasonal and animal influenza virus, clinical characteristics of patients with pneumonia caused by influenza A (H1N1) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), disease burden of influenza, and promotion of influenza vaccination for the elderly were published in this special issue, aiming to describe the feature of influenza virological and clinical characteristics, health and economic burden, and vaccination. These researches emphasized the importance of the integration between basic medicine, clinical medicine, public health and preventive medicine in the prevention and control of infectious diseases. Based on the concept of population medicine, promoting the integration of multidisciplinary and strengthening prevention, control and pandemic preparedness on influenza, corona virus disease 2019 and other infectious diseases, could consolidate the foundation of surveillance and early warning, prevention and control, diagnosis and treatment of emerging infectious diseases, as well as improve the ability of emergency preparedness for public health events.

Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

BACKGROUND

The purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs).

METHODS

Forty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19-71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5-14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2-4 years thereafter.

RESULTS

Twenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients' pre-operative and post-operative PaO₂ and SaO₂ levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group.

CONCLUSION

Percutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

Effects of grain type and conditioning temperature during pelleting on growth performance, ruminal fermentation, meat quality and blood metabolites of fattening lambs

Ruminants can tolerate moderate concentrations of dietary tannin, making it feasible to replace corn with sorghum in ruminant diets; however, conditioning temperature of pelleted total mixed ration (PTMR) greatly affects nutrient digestibility. The objective was to determine effects of grain type and conditioning temperature during pelleting on growth performance, ruminal fermentation, meat quality and blood metabolites of fattening lambs. This was a 2 × 3 factorial study, with corn and sorghum and three conditioning temperatures (65, 75 and 85 °C) in a randomized complete design, with 36 lambs (120 ± 10.2 d and 24.9 ± 3.3 kg) grouped by weight and randomly allocated. The resulting six PTMRs were referred to as 65-S, 75-S and 85-S for sorghum-based diets, and 65-C, 75-C and 85-C for corn-based diets, for low, medium and high pelleting temperatures, respectively. There was no grain type × conditioning temperature (Grain × Temp) interaction on growth performance and apparent nutrient digestibility. Furthermore, grain type did not affect DM intake (DMI), average daily gain (ADG) or feed conversion ratio (FCR) of fattening lambs. Pelleting at 75 °C improved ADG (P < 0.03) and FCR (P < 0.02) of fattening lambs compared to other temperatures. There was a Grain × Temp interaction (P < 0.01) on ruminal pH (lowest in lambs fed 75-S). There tended (P = 0.07) to be a Grain × Temp interaction for total volatile fatty acid (VFA), and there were Grain × Temp interactions for molar proportions of acetate (P < 0.04), butyrate (P < 0.03) and branch-chained VFA (P < 0.01). Lambs fed sorghum-based PTMR had greater molar proportion of propionate (P < 0.03) and lower acetate to propionate ratio (A:P, P < 0.04). Lambs fed sorghum-based PTMR had higher plasma concentrations of urea nitrogen (N) (P < 0.03), glucose (P < 0.01) and alkaline phosphatase (P < 0.05), whereas other blood metabolites were not affected by treatments. There were Grain × Temp (P < 0.03) interactions for color coordinates of longissimus and mid-gluteal muscle. Lambs fed sorghum-based PTMR had lower (P < 0.01) dressing percentage and meat quality than those fed corn-based PTMR. We concluded that sorghum can replace corn in lamb diets without compromising growth performance and feed efficiency; furthermore, feeding sorghum vs corn improved rumen fermentation, with reduced A:P ratio and enhanced N and glucose utilization. Finally, pelleting at 75 °C increased feeding value of either sorghum- or corn-based PTMR for fattening lambs.

[Establishment of multi-point trigger and multi-channel surveillance mechanism for intelligent early warning of infectious diseases in China]

This paper reviews the limitations of current infectious disease surveillance and early warning system in China, analyzes the concepts and countermeasures of the establishment of an intelligent early warning platform of infectious diseases based on multi-point trigger mechanism and multi-channel surveillance mechanism and proposes the realization routes for the purpose of facilitating capacity building and improvement of surveillance and early warning of infectious diseases in China.

[Epidemiological study design of asymptomatic infection of the 2019 novel coronavirus]

COVID-19 is caused by the 2019 novel coronavirus (2019-nCoV). COVID-19 clinical cases are considered as the principal source of infection, however, asymptomatic cases may also play a role in the transmission. Significant gap exists in terms of the proportion or prevalence and transmissibility of asymptomatic cases. This study design plans to use data from areas with different epidemiological profiles to investigate the COVID-19 epidemic in China. In each selected region, both general community residents and key populations at high risk of COVID-19 infection, including recovered COVID-19 cases, close contacts of confirmed COVID-19 cases, medical professionals, investigators at CDCs, and visitors to fever clinics, will be recruited and examined for viral RNA of 2019-nCoV and serum antibodies. Prevalence and characterization of asymptomatic cases will be determined, stratified by varied demographics and exposure risk. During the follow-up, the change in the serum antibodies will be studied prospectively in the symptomatic and asymptomatic cases to address the scientific and public health concerns of infectivity and transmissibility of 2019-nCoV.

[Thoughts on the outbreak phases of the COVID-19 changed from emergency response to the combination of emergent response and regular prevention and control activities]

Given the scope and speed of the spread, the COVID-19 pandemic is not only complex but dangerous. Complicated objective factors such as the long-term existence of source of infection, difficulty in completely blocking the transmission route and a large susceptible population suggested that the COVID-19 pandemic might stay with us for long term. Therefore, we should be ready for a tough and long-term battle against the COVID-19 epidemic. The strategy should adhere to the principle of combining emergency response with regular prevention and control measures, and all efforts should be well harnessed in a coordinated way to keep the epidemic under control.

[Scenario-based study of medical resource requirement rapid assessment under the COVID-19 pandemic]

Objective: COVID-19 outbreak is still under global pandemic. China is facing the risks of importation and local rebound of COVID-19. Under the circumstances, preparations for medical resources are in urgently needed. Methods: Based on current understanding of the disease, we set up five scenarios and use the infectious disease transmission dynamic and pandemic theoretical static models to evaluate the demand for medical resources. Results: Different epidemic strength and strategies of disease control and prevention resulted in different levels of medical resource request, and active control strategy and effective measures could significantly decrease the requirement. During the epidemic rising phase, the cost of prevention and control measures and the requirement of professional response capacities would increase with potential high risk of medical resource demand sharply increasing. Conclusion: Regions with different economic level, population scale, and different prevention and control capabilities should all initiate scientific assessment of medical resource requirement under emergency response and prepare for possible future rebound and epidemic.

[Dramatic achievements in infectious disease prevention and treatment in China during the past 70 years]

At the beginning of the founding of People's Republic of China, infectious diseases, such as smallpox, plague, cholera, dysentery, typhoid, measles, diphtheria, pertussis, meningitis, mumps, schistosomiasis, Kala Azar, hemorrhagic fever, leptospirosis, encephalitis B, typhus, malaria, Kala Azar, leprosy, scarlet fever and pinkeye, remained as epidemic in the country and endangered people's health. During the past 70 years, the Chinese government spent huge efforts in infectious disease prevention and treatment by promulgating and implementing series of relative policies, laws and strategies, and also encouraged all Chinese people to participate in. The achievements of these efforts in controlling infectious disease epidemic were extremely successful. Today, the outbreaks and epidemic of infectious diseases in China were rarely happened with the rapid decreases in incidence and mortality rates of all notifiable infectious diseases. Smallpox was eradicated, and polio, filariasis, leprosy and neonatal tetanus were nearly eradicated. In addition, the incidence rates of vaccine-preventable diseases, i.e. measles, diphtheria, pertussis, meningitis, encephalitis B, hepatitis A, mumps, rubella, tuberculosis, were dramatically decreased and remained at relatively low levels for years. The incidence and prevalence rates of hepatitis B infection in Children decreased significantly and reached the phase objectives. Moreover, incidence rates of natural iatrogenic infectious diseases, i.e. diarrhea, typhoid and other intestinal infectious diseases, leptospirosis and schistosomiasis, and vectorborne diseases, i.e. typhus, malaria, Kala Azar, reached the lowest and some even closed to be eliminated in China. In general, infectious diseases dropped to the tenth from the top one leading cause of all deaths, which means that the achievement of Chinese infectious disease prevention and treatment strategies contributed tremendously in improving Chinese people's health status and life expectancy.

Feeding diets varying in forage proportion and particle length to lactating dairy cows: II. Effects on duodenal flows and intestinal digestibility of amino acids

A study was conducted to evaluate the effects of forage-to-concentrate (F:C) ratio and forage particle length (FPL) on intake, duodenal flow, and digestibility of individual AA in the intestine of lactating dairy cows. The experiment was designed as a 4 × 4 Latin square with a 2 × 2 factorial arrangement of treatments using 4 lactating dairy cows (parity 2) with ruminal and duodenal cannulas. Low (35:65) and high (60:40) F:C ratios (dry matter basis) were combined with 2 FPL of alfalfa silage (short vs. long; 7.9 vs. 19.1 mm). Few interactions between F:C and FPL for duodenal flow and intestinal digestibility of AA occurred, but interactions were detected for intakes of several AA. Intake of essential AA and nonessential AA decreased with increasing F:C, and the intake of several individual AA increased or decreased with increasing FPL. Increasing F:C decreased duodenal flows of essential AA, nonessential AA, and microbial AA due to consistent decreased flows of most individual AA (except Glu). Degradability of most individual AA in the rumen was not affected by F:C ratio or FPL except that the degradability of His was greater with high than low F:C diets, and the degradability of Ser was greater with long versus short FPL diets. However, the degradability of individual AA within diet varied considerably. Overall, F:C ratio and FPL did not affect intestinal digestibility of AA and rumen undegradable protein AA, whereas the digestibility of individual AA in the intestine varied considerably regardless of dietary treatment. These results indicate that increasing F:C ratio decreased AA supply due to decreased flow of AA to the duodenum but altering FPL did not affect AA supply. The results also revealed the necessity to consider both the flows and digestibility of individual AA when optimizing ration formulation to meet AA requirements of dairy cows.

[Current status of chronic filariasis in Huai'an City]

OBJECTIVE

To understand the current status of chronic filariasis patients in Huai'an City, so as to provide insights into the future care of chronic filariasis patients.

METHODS

According to the data pertaining to the historically registered chronic filariasis patients in Huai 'an City, each case was followed up and the baseline data of chronic filariasis patients were captured using questionnaire survey. The demographic and clinical features of the patients, and the distribution and coverage of the care sites were analyzed.

RESULTS

There were still 616 chronic filariasis patients in Huai'an City, including 229 men (37.2%) and 387 women (62.8%), and 93.2% were aged 60 years and older. The chronic filariasis patients were found across the 8 counties (districts) across the city, and the cases were predominantly detected in Lianshui (40.3%), Huaiyin (30.8%) and Yuyi (8.0%). There were 49.0% of the patients with lymphedema or elephantiasis alone, 10.2% with chyluria alone, 1.0% with hydrocele of tunica vaginalis alone, 2.4% with lymphatic inflammation or lymphadenitis alone, and 37.3% with two or more types of symptoms, respectively, and all cases with lymphedema or elephantiasis alone had the sites of edema in the lower limbs, with over 90% at stages I to III. Currently, there are 81 care sites in the city covering 567 patients. The mean number of care activities was 3.2 times in 2018, and the mean cumulative duration of caring activities was 18.4 years in the care sites.

CONCLUSIONS

Although the number of chronic filariasis patients has remarkably decreased, the number remains high in Jiangsu Province, and the cases are characterized by high age and long course of disease. Further caring activities are required to improve the quality of life in chronic filariasis patients.

[Percutaneous full-endoscopic removalof lumbar dumbbell tumors viatransforaminal approach]

Objective: To investigate the novel application and effectof Percutaneous Full-Endoscopic transforaminal approach for lumbar dumbbell tumors. Methods: A retrospective analysis of 12 cases of lumbar dumbbell tumors was conducted by Percutaneous full-endoscopic transforaminal approach in the Department of Neurosurgery, Fujian Medical University Union Hospital from Feb, 2018 to Jul, 2019. According to Eden classification, 5 cases in type Ⅲ and 7 cases in type Ⅳ. The Japanese Orthopaedic Association (JOA) score and Pain Visual analogue Scale (VAS) were used to compare the recovery of neurological function before and after surgery. Results: All the 12 tumors were completely removed in one stage. The pathological reports were all schwannomas (WHO grade Ⅰ). The VAS scores were significantly decreased compared with preoperative ones (P<0.001). The JOA scores were significantly improved without obvious complications and spinal instability. Median length of follow-up was 14 months with a range of 4 months to 20 months, there is no tumor recurrence and spinal instability. Conclusion: In the treatment of lumbar dumbbell spinal tumor, the full endoscopic transforaminal approach is a novel, safe and effective surgical procedure which removes the tumors intra-foramen and extra-foramen with less damage of spine, smaller possibility of instability and faster recovery.

[Promoting the establishment of group standards in public health areas for China]

To better practice the Deepening Standardization Reform Plan, announced by the State Council, to promote the leadership of standard in healthy development of preventive medicine and public health, the Chinese Preventive Medicine Association (CPMA) established the Standardization Committee of Chinese Preventive Medicine Association (SC-CPMA). The SC-CPMA was responsible for the work of standardization developments of CPMA, including review of project's qualification and proposal, pre-qualification and qualification review of standard, publicity and training of standard, evaluation of standard implementation, review of standard, and public response monitoring of the standard. At December 13, 2018, CPMA published two group standards, the Technical specification of data processing for large population-based cohort study (T/CPMA 001-2018) and Technical specification of data security for large population-based cohort study (T/CPMA 002-2018). This was the first time that a group standard was published by CPMA and produced for large cohort study's establishment and research. These two standards were the milestones for public health areas and the academic achievement of team, leading by Dr. Li Liming, after decade of research and practice. The two standards were developed based on the China Kadoorie Biobank Study and aimed to formulate professional standards and standardized operation procedures that met the nationals conditions, with strong operability and generality of population cohort establishments. The group standards were also aimed to guide the establishments for other population-based cohort studies to maximum support the decision making and practice for disease control and prevention. The increasing disease burden of non-communicable disease (NCD) became severe public health problem and the etiology for NCD is complex. Large cohort studies, which became more popular recently, played an important role in observation and explanation of NCD etiology and risk factors. Under the current situation with growing number of large cohort studies, it is necessary to have a standard, which could be shared and used to guide other professional as critical scientific protocols. CPMA was committed to promoting the development of group standards in the field of public health, and supporting the implementation of the Healthy China Strategy.

[Effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in adult class Ⅰ patients with bimaxillary protrusion]

Objective: To investigate the effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in class Ⅰ adult patients with bimaxillary protrusion. Methods: Thirty class Ⅰ patients with bimaxillary protrusion that received fixed orthodontic treatment in Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University from January 2011 to September 2014 were selected using random number table. All the patients were treated with extraction of four first premolars and retraction of anterior teeth using implant anchorage. Cone-beam CT (CBCT) scans were performed before and after incisor retraction for all patients. The CBCT data of the upper airway were constructed using Mimics 16.0, and the flow field characteristics inside the upper airway were simulated using Ansys 14.0. The changes of volume (V), mean cross-sectional area (mCSA), maximum lateral diameters/maximum anteroposterior diameters (LP/AP) of cross section, the maximum pressure of airflow (P(max)), the minimum pressure of airflow (P(min)) and pressure drop (△P) of nasopharynx, oropharynx and hypopharynx before and after incisor retraction were measured and compared using paired t test. The correlation between the variation of △P in the most significant pharyngeal part and the morphological variables after incisor retraction was analyzed using Pearson correlation test. Results: No statistical differences were observed in the morphology and flow field in nasopharynx before and after incisor retraction (P>0.05). Before incisor retraction, the oropharyngeal volume and mCSA were (7 580±622) mm(3) and (217±40) mm(2), respectively, and the hypopharyngeal volume and mCSA were (2 564±162) mm(3), and (239±43) mm(2), respectively. After incisor retraction, the volumes of oropharynx and hypopharynx were (6 885±601) mm(3) and (2 535±156) mm(3), respectively, and mCSA of oropharynx and hypopharynx were (197±37) mm(2) and (236±42) mm(2), respectively. The volume and mCSA of oropharynx and hypopharynx were significantly decreased after incisor retraction (P<0.05). The greatest changes in pharyngeal volume and mCSA occurred in the oropharynx. In addition, the LP/AP of oropharynx after incisor retraction was changed from 1.9±0.6 to 2.1±0.7, which was significantly increased compared with the levels before incisor retraction (P<0.05). After simulation of pharyngeal airflow, the oropharyngeal P(min), hypopharyngeal P(max) and P(min) were (-13.7±4.3), (-8.3±3.8) and (-42.8±9.5) Pa, respectively, whereas the values turned to (-16.4±6.5), (-11.9±3.6) and (-46.0±11.0) Pa, respectively after incisor retraction, which was significantly reduced (P<0.05). △P of oropharynx was significantly increased from (42.7±10.1) Pa to (45.2±13.0) Pa after incisor retraction (P<0.05) and the variation of oropharyngeal △P was negatively correlated with the variation of V and mCSA in oropharynx before and after incisor retraction (r=-0.681, P=0.001; r=-0.844, P=0.000). Conclusions: The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adult class Ⅰ patients with bimaxillary protrusion. A comprehensive and systematic evaluation of the pharyngeal morphology and ventilatory function were very important for making a scientific and rational clinical treatment plan.

[Analysis on funds application of community based organizations involved in HIV/AIDS response and government financial investment in China, 2014]

Objective: To understand the government financial investments to community based organizations (CBO) involved in HIV/AIDS Control and Prevention of China and its influencing factors. Methods: Questionnaire of the situation of CBO involved in HIV/AIDS control and prevention were designed, and filled by the staff of Provincial Health Administrative Departments of 31 provinces (autonomous regions and municipalities). The research focused on the fields of CBO involved in HIV/AIDS response in 31 provinces (autonomous regions and municipalities), including intervention on HIV/AIDS high risk population (female sex worker (FSW), man who sex with man (MSM), drug user (DU) and case management and care for people living with HIV/AIDS (PLWH)). 29 valid questionnaires were collecting, with Shanxi Province and Inner Mongolia Autonomous Regions not filled. Questionnaire included financial supports from local governments, transfer payment from central government for CBO involved in HIV/AIDS response in 2014, and unit cost for CBO involved in HIV/AIDS control and prevention. Multivariate analysis was conducted on the project application and financial investment of community based organizations involved in HIV/AIDS control and prevention in 2014. Results: The total amount of CBO to apply for participation in AIDS prevention and control was 64 482 828 Yuan in 2014. The actual total amount of investment was 50 616 367 Yuan, The investment came from the central government funding, the provincial level government funding, the prefecture and county level government funding investment and other sources of funding. 22 of 28 provinces (autonomous regions and municipalities) received the funds from the central government finance, and median of investment funds 500 000 Yuan. 15 provinces (autonomous regions and municipalities) gained the funds from the provincial government finance, and median of investment funds 350 000 Yuan. 12 provinces (autonomous regions and municipalities) got the funds from the prefecture and county level government finance, and median of investment funds 408 750 Yuan. 12 provinces (autonomous regions and municipalities) acquired the funds from other sources, and median of investment funds 228 400 Yuan. The median (P(25), P(75)) unit costs of intervention for FSW from 16 provinces (autonomous regions and municipalities) was 70 (23, 280) Yuan per year; DU from 14 provinces (autonomous regions and municipalities) was 83 (44, 200 ) Yuan per year; MSM from 16 provinces (autonomous regions and municipalities) was 100 (35, 280) Yuan per year; the follow-up and care for PLWH from 17 provinces (autonomous regions and municipalities) was 200 (45, 500) Yuan per year. Multivariate linear regression analysis results showed that the amount of PLWH in 2014 influenced on the total number of application funds of CBO involved in HIV/AIDS response (b=178.11, 95% CI: 51.86-305.36) and the amount of PLWH (b=77.72, 95% CI: 16.28-139.16), and Gross Domestic Product (GDP) per capita of the province (b=36.20, 95% CI: 4.60-67.80) impacted financial investment to CBO involved in HIV/AIDS response, respectively. Conclusion: Funds application and financial investment of CBO involved in HIV/AIDS control and prevention were huge. Financial investment from government was main resources for CBO in 2014. The amount of financial investment funds from governments was influenced by the HIV/AIDS epidemic situation and the development level of local economic.

[Epidemiological characteristics of diarrheagenic Escherichia coli among diarrhea outpatients in China, 2012-2015]

Objective: To understand the epidemiological characteristics of diarrheagenic Escherichia (E.) coli (DEC) among diarrhea outpatients in China. Methods: Diarrhea surveillance program was conducted in outpatient and emergency departments from 170 hospitals that under the sentinel programs in 27 provinces, from 2012-2015. Clinical and epidemiological data regarding diarrhea patients were collected, with fecal specimens sampled and tested for DEC in 92 network-connected laboratories. Results: Among all the 46 721 diarrhea cases, 7.7% of them appeared DEC positive in those with geographic heterogeneity. In 2 982 cases (6.4%) with available data on PCR subtypes of DEC, enteroaggregative E. coli (EAEC, 1 205 cases, 40.4%) appeared the most commonly seen pathogens, followed by enteropathogenic E. coli (EPEC, 815 cases, 27.3%), and enterotoxigenic E.coli (ETEC, 653 cases, 21.9%). The highest positive rate of DEC was observed in outpatients of 25-34 years old (10.1%), living in the warm temperate zones (11.1%), and with mucous-like stool (9.4%). The positive rate of DEC showed a strong seasonal pattern, with peaks in summer, for all the subtypes. Conclusions: DEC seemed easy to be detected among diarrhea outpatients in China, with EAEC, EPEC and ETEC the most commonly identified subtypes. Epidemiological characteristics regarding the heterogeneities of DEC appeared different, in regions, age groups and seasons. Long-term surveillance programs should be strengthened to better understand the epidemiology of DEC, in China.

Response of lactating dairy cows to degree of steam-flaked barley grain in low-forage diets

This study was conducted to investigate the effects of processing method (grinding vs. steam flaking) and increasing densities of steam-flaked barley grain on dry matter intake (DMI), rumen pH and fermentation characteristics, digestibility of dry matter in the total digestive tract (DDTT), and milk production of dairy cows. Eight multiparous mid-lactation Holstein cows averaging 103 ± 24 DIM, 44.5 ± 4.7 kg milk/day and weighing 611 ± 43 kg at the start of the experiment were used in a replicated 4 × 4 Latin square design with 21-day periods. Cows were fed diets consisting of (DM basis) 23.8% corn silage, 13.5% chopped alfalfa hay and 62.7% concentrate. The dietary treatments were either ground barley (GB) using a hammer mill or steam-flaked barley (SFB) - varying density at 390, 340 or 290 g/l. Processing method (GB vs. SFB) did not affect DMI (23.6 kg/day on average), DDTT (71.0% on average), milk yield (43.4 kg/day on average), milk components, rumen pH and molar proportions of acetate, propionate, butyrate and sorting activity. Ruminal isovalerate concentration tended (p = 0.06) to be higher for cows fed GB than those fed SFB-based diets. Decreasing the density of SFB from 390, 340 to 290 g/l tended to linearly increase DMI (p = 0.09), decrease total solids percentage of milk (p = 0.10) and linearly decreased milk urea nitrogen (12.8, 12.4 and 12.1 mg/dl; p = 0.04); also, the sorting index (SI) of the particles retained on the 19.0-mm sieve without affecting the SI of the particles retained on 8.0-mm, 1.18-mm or passed through 1.18-mm sieve (p = 0.05). These results indicated the limited effects of processing method (grinding vs. steam flaking) and densities of SFB (390, 290 or 290 g/l) on cows' performance and feed utilization for dairy cows fed low-forage diets. Therefore, both processing methods could be recommended under current feeding conditions of dairy cows.

Evaluation of in vitro models for predicting acidosis risk of barley grain in finishing beef cattle

Our objective was to develop a model to predict the acidosis potential of barley based on the in vitro batch culture incubation of 50 samples varying in bulk density, starch content, processing method, growing location, and agronomic practices. The model was an adaptation of the acidosis index (calculated from a combination of in situ and in vitro analyses and from several components of grain chemical composition) developed in Australia for use in the feed industry to estimate the potential for grains to increase the risk of ruminal acidosis. Of the independent variables considered, DM disappearance at 6 h of incubation (DMD6) using reduced-strength (20%) buffer in the batch culture accounted for 90.5% of the variation in the acidosis index with a root mean square error (RMSE) of 4.46%. To evaluate our model using independent datasets (derived from previous batch culture studies using full-strength [100%] buffer), we performed another batch culture study using full-strength buffer. The full-strength buffer model using in vitro DMD6 (DMD6-FS) accounted for 66.5% of the variation in the acidosis index with an RMSE of 8.30%. When the new full-strength buffer model was applied to 3 independent datasets to predict acidosis, it accounted for 20.1, 28.5, and 30.2% of the variation in the calculated acidosis index. Significant ( < 0.001) mean bias was evident in 2 of the datasets, for which the DMD6 model underpredicted the acidosis index by 46.9 and 5.73%. Ranking of samples from the most diverse independent dataset using the DMD6-FS model and the Black (2008) model (calculated using in situ starch degradation) indicated the relationship between the rankings using Spearman's rank correlation was negative (ρ = -0.30; = 0.059). When the reduced-strength buffer model was used, however, there were similarities in the acidosis index ranking of barley samples by the models as shown by the result of a correlation analysis between calculated (using the Australian model) and predicted (using the reduced-strength buffer DMD6 model) acidosis index (ρ = 0.67; < 0.001). Results suggest that our model, which is based on a reduced-strength buffer in vitro DMD6, has the potential to predict acidosis risk and can rank barley samples based on their acidotic risk. Nonetheless, the model would benefit from further refinement by expanding the database.

Effect of wheat dried distillers grains with solubles and fibrolytic enzymes on ruminal fermentation, digestibility, growth performance, and feeding behavior of beef cattle

Two experiments were conducted to evaluate the effect of wheat dried distillers grains with solubles (DDGS) and fibrolytic enzymes (FE) on ruminal fermentation, in situ ruminal and in vivo total tract digestibility, growth performance, and feeding behavior of growing beef cattle. In Exp. 1, 6 ruminally cannulated Angus heifers (average BW of 794 ± 44.2 kg) were used in a 6 × 6 Latin square design with 2 × 3 factorial arrangement of treatments. Treatments were a control diet consisting of 50% barley silage, 10% grass hay, and 40% barley grain-based concentrate (CON) and the CON with 15% DDGS substituted for barley grain (WDG) combined with either 0, 1, or 2 mL FE/kg diet DM, respectively. Inclusion of DDGS increased total tract digestibility of CP ( < 0.01), NDF ( = 0.04), and ADF ( = 0.03). Increasing FE linearly ( = 0.03) increased CP digestibility without affecting the digestibility of other nutrients. There were no effects of DDGS inclusion or FE on ruminal pH or VFA concentration except that propionate was greater ( = 0.04) with the WDG. In situ ruminal DM and NDF disappearance of barley silage was greater ( < 0.04) in heifers fed the WDG than in heifers fed the CON after 24 h of incubation. Increasing FE linearly ( = 0.03) increased in situ NDF disappearance of barley silage after 24 h of incubation. In Exp. 2, 120 weaned steers (initial BW of 289 ± 11.0 kg) were fed diets similar to those in Exp. 1. The steers fed the WDG had greater ( < 0.01) final BW, ADG, DMI, and G:F compared with steers fed the CON. Increasing FE did not alter ADG or G:F but tended ( < 0.07) to linearly decrease DMI. There were interactions ( < 0.02) between DDGS and FE on eating rate and the time spent at the feed bunk. Supplementing FE decreased ( < 0.01) time at the bunk and increased ( < 0.01) eating rate for steers fed the WDG but not for steers fed the CON. Eating rate ( < 0.01) and meal frequency ( = 0.02) were greater but eating duration was shorter ( < 0.01) for steers fed the WDG than for those fed the CON. These results indicate that inclusion of wheat DDGS in a growing diet increased total tract digestibility of NDF and CP and improved the feed efficiency of steers. Moreover, supplementation of FE in barley silage-based growing diets may also have the potential to increase profits, with the evidence of the trend for a decline on DMI without decreasing ADG when adding FE.

[Epidemic features and impact factors on hospitalization of Plasmodium vivax in China 2011-2014]

OBJECTIVE

To investigate the epidemiological characteristics and impact factors on hospitalization of Plasmodium vivax (P.vivax) since initiation of national malaria elimination program, so as to facilitate the adjustment of technical guideline in response to the epidemic changing of malaria in China.

METHODS

The data of individual P. vivax case (probable and confirmed) and population during 2011-2014 were collated from China National Notifiable Infectious Disease Reporting Information System, and the data of epidemiological investigation for individual P. vivax case (imported and indigenous) during 2011-2014 were collected from China Parasite Disease Prevention and Control Information System. All of the data didn't include China's Hongkong, Macao, Taiwan and foreign cases. The risk factors on hospitalization were explored by multiple factors variable binary classification unconditioned logistic regression model.

RESULTS

During study period of four years, a total of 5 656 Plasmodium vivax cases were detected. Among them, 69.9% (3 951 cases) were imported cases and 30.1% (1 705 cases) were autochthonous cases. The male cases accounted for 82.7% of all cases. Among the autochthonous cases, 535 cases (31.4%) occurred in the cross-bordering areas, and 577 cases (33.8%) were reported in the junction of difference provinces. The amount of autochthonous cases decreased from 1 363 cases in 2011 to 53 cases in 2014, and the county affected by autochthonous cases was shrunk from 185 counties to 10 counties. The proportion of autochthonous cases introduced by domestic migrants increased constantly, which reached 41.5% in 2014. The imported cases were detected from 614 counties of 30 provinces, who were originated from 57 overseas countries of 4 continents, with Southeast Asia being the leading origins (2 772 cases, 70.2%). There were 1 494 cases hospitalized for treatment, with the male (OR=1.41, 95%CI: 1.16-1.71), 14 years old and younger (OR=2.26, 95%CI: 1.44-3.56), and oversea imported cases (OR=2.73, 95%CI: 2.30-3.25) were the high risk group for hospitalization.

CONCLUSION

The scale and scope of P. vivax occurrence decreased dramatically since initiation of malaria elimination grogram in 2010. However, the risk of P. vivax introduction by the overseas imported cases and domestic migrants should be highlighted.

The effects of increasing garlic powder and monensin supplementation on feed intake, nutrient digestibility, growth performance and blood parameters of growing calves

The objective of this study was to evaluate the effects of increasing garlic powder and monensin supplementation on feed intake, nutrient digestibility, growth performance and blood metabolites of growing calves. Forty Holstein calves (BW = 100 ± 11 kg) were randomly assigned to four dietary treatments (n = 10) in a complete randomized design. Experimental treatments consisted of the following: (i) basal diet (control), (ii) basal diet supplemented with 0.0003% of dietary dry matter (DM) sodium monensin, (iii) low level of garlic powder (Low-GAR; 0.5% of dietary DM) and (iv) high level of garlic powder (High-GAR; 1% of dietary DM). DM intake (DMI) and DM digestibility were (p < 0.05) decreased by High-GAR. However, calves supplemented with Low-GAR had a similar DMI to the control calves and similar DM digestibility to the control and monensin groups. The digestibility of other nutrients were not affected by the treatments. Although supplementing monensin relative to Low-GAR increased the DMI (p < 0.05), average daily gain was similar between Low-GAR and monensin supplemented calves, which were higher than the control and High-GAR groups (p < 0.05). As a result, feed conversion ratio was improved in the Low-GAR group versus other treatment groups (p < 0.05). Administrating garlic powder decreased the blood low-density lipoprotein (LDL) and non-esterified fatty acids (p < 0.05) without affecting the blood triglyceride, high-density lipoprotein and beta-hydroxybutyric acid concentrations. In conclusion, the calves fed the Low-GAR showed an improved FCR and blood metabolites without changing the DMI and nutrient digestibility. It suggests that garlic powder could be used as an alternative to monensin for growing calves under the current feeding conditions.

Randomized Controlled Trial of the Prophylactic Effect of Urea-Based Cream on Sorafenib-Associated Hand-Foot Skin Reactions in Patients With Advanced Hepatocellular Carcinoma

Purpose

To assess whether urea-based cream (UBC) has prophylactic benefits on sorafenib-induced hand-foot skin reaction (HFSR) in patients with advanced hepatocellular carcinoma (HCC).

Patients and Methods

In this randomized, open-label trial, 871 patients with advanced HCC throughout China were treated with 10% UBC three times per day plus best supportive care (BSC; n = 439) or BSC alone excluding all creams (n = 432), starting on day 1 of sorafenib treatment, for up to 12 weeks. HFSR was assessed every 2 weeks and at 14 weeks for patients completing the study. Once HFSR occurred, patients were allowed any cream, including a UBC.

Results

The 12-week incidence of any grade HFSR was significantly lower in the UBC group versus the BSC-alone group (56.0% v 73.6%, respectively; odds ratio [OR], 0.457; 95% CI, 0.344 to 0.608; P < .001), as was the incidence of grade ≥ 2 HFSR (20.7% v 29.2%, respectively; OR, 0.635; 95% CI, 0.466 to 0.866; P = .004). Median time to first occurrence of HFSR was significantly longer in the UBC group than the BSC-alone group (84 v 34 days, respectively; hazard ratio, 0.658; 95% CI, 0.541 to 0.799; P < .001). Elevated AST was associated with increased risk of HFSR but did not alter the treatment effect of UBC. UBC plus BSC, compared with BSC alone, did not affect the sorafenib dose reduction or interruption rate (9.1% v 11.8%, respectively; P = .1937), response rate (11.1% v 10.1%, respectively; P = .6674), or disease control rate (98.8% v 98.2%, respectively; P = .5350) at week 12.

Conclusion

UBC prophylaxis in patients with advanced HCC starting sorafenib reduced HFSR rates, extended the time to first occurrence of HFSR, and improved patient quality of life compared with BSC. Blinded, randomized, placebo-controlled trials to determine the role of UBC on the incidence and severity of HFSR are warranted.

Impact of hard vs. soft wheat and monensin level on rumen acidosis in feedlot heifers

Many feedlot finishing diets include wheat when the relative wheat prices are low. This study was conducted to examine the responses in ruminal pH and fermentation as well as site and extent of digestion from substituting soft or hard wheat for barley grain and to determine whether an elevated monensin concentration might decrease indicators of ruminal acidosis in feedlot heifers. Five ruminally cannulated beef heifers were used in a 5 × 5 Latin square with 2 × 2 + 1 factorial arrangement. Treatments included barley (10% barley silage, 86% barley, 4% supplement, with 28 mg monensin/kg DM) and diets where barley was substituted by either soft or hard wheat with either 28 or 44 mg monensin/kg diet DM. Intake of DM was not affected by grain source, whereas increasing monensin with wheat diets reduced (P < 0.02) DMI. Mean ruminal pH was lower (P < 0.04) and durations of pH < 5.8 and pH < 5.5 greater (P < 0.03) for wheat than for barley diets. However, ruminal pH was not affected by wheat type or monensin level. Total VFA concentrations were greater (P < 0.03) for wheat than barley diets with no effect of wheat type. The molar proportion of propionate was greater (P < 0.04), whereas butyrate (P < 0.01) and ratio of acetate to propionate tended to be lower (P < 0.09), with the high as compared to low level of monensin. Replacing barley with wheat in finishing diets did not affect the duodenal flow or the digestibility of OM, likely as a result of greater (P < 0.01) NDF digestion from barley offsetting the increased (P < 0.03) supply of digested starch from wheat. Feeding soft vs. hard wheat delivered a greater (P < 0.03) duodenal supply of OM and nonammonia N with no differences in total tract nutrient digestion. The increased monensin concentration decreased the flow of OM (P < 0.01), total N (P < 0.05), and microbial protein (P < 0.05) to the small intestine due to decreased DMI. These results indicated that hard and soft wheat exhibited digestive characteristics similar to barley, but ruminal pH measurements indicate that compared with barley, wheat increased the risk of ruminal acidosis. Although an increased level of monensin had limited impact on ruminal indicators of acidosis, an increase in propionate would be expected to improve efficiency of feed use by heifers fed wheat-based finishing diets.

Effects of maternal protein or energy restriction during late gestation on immune status and responses to lipopolysaccharide challenge in postnatal young goats

Knowledge of maternal malnutrition of ruminants and effects on development of the immune system of their offspring is lacking. A study was conducted to investigate the effects of maternal protein or energy restriction during late gestation on immune status of their offspring at different ages. Sixty-three pregnant goats (local breed, Liuyang black goat, 22.2 ± 1.5 kg at d 90 of gestation) were fed control (CON, ME = 9.34 MJ/kg and CP = 12.5%, DM basis), 40% protein restricted (PR), or 40% energy restricted (ER) diets from d 91 of gestation to parturition, after which all animals received an adequate diet for nutritional recovery. Plasma concentrations of complement components (C3, C4), C-reactive protein (CRP) and immunoglobulins (IgG and IgM), jejunum cytokines (IL-2, IL-6, and IL-10) expression levels and morphology in the offspring were measured. Additionally, plasma concentration of complement and IL-6, and cytokines expression levels in gastrointestinal tract obtained at 6 wk from young goats were assessed under saline or lipopolysaccharide (LPS) challenging conditions. Maternal PR or ER decreased (P < 0.05) plasma C3, C4, IgG, and IgM concentrations, and IL-2 and IL-6 mRNA expression in the jejunum from neonatal kids, but did not alter (P > 0.05) plasma CRP concentration. The IL-10 mRNA expression of jejunum from PR kids was also less (P < 0.01) than that from CON kids. Moreover, jejunum villous height (P < 0.10 in PR, P < 0.05 in ER) and crypt depth (P < 0.05 both in PR and ER) were reduced in neonatal kids from malnourished mothers. At 6 wk of age, there were no differences (P > 0.05) in any plasma or tissue immune parameters among the 3 treatments. However, when given a LPS challenge, ER and PR kids had greater (P = 0.02) IL-6 concentration compared with CON kids. Our results suggest that both PR and ER during late gestation induced short-term as well as long-lasting alterations on immune responses in their offspring, which may make the animals more susceptible to a bacterial pathogen challenge. The present findings expand the existing knowledge in immunological mechanisms responsible for the development of disease in later life.

Using a fibrolytic enzyme in barley-based diets containing wheat dried distillers grains with solubles: ruminal fermentation, digestibility, and growth performance of feedlot steers

Two experiments were conducted to evaluate the effects of adding an exogenous fibrolytic enzyme (FE) on ruminal pH and fermentation, digestibility, and growth performance of feedlot beef cattle fed a finishing diet containing wheat dried distillers grains with solubles (DDGS). In Exp. 1, 4 ruminally cannulated Angus heifers (average BW of 807 ± 93.9 kg) were used in a replicated 4 × 4 Latin square design. Treatments were 1) control (CON; 10% barley silage and 90% barley grain-based concentrate), 2) CON diet substituting 30% wheat DDGS for barley grain (WDG), 3) WDG diet supplemented with low FE (WDGL), and 4) WDG diet supplemented with high FE (WDGH). Heifers fed WDG had less (P = 0.01) total tract DM digestibility than heifers fed CON. Increasing FE linearly (P < 0.05) increased starch digestibility without affecting digestibility of other nutrients. Addition of FE also reduced (P = 0.03) ruminal ammonia-N (NH3-N) concentration but did not affect VFA concentration. Moreover, application of FE to wheat DDGS linearly increased in situ ruminal DM (P < 0.01) and NDF (P = 0.02) disappearance after 48 h of incubation. In Exp. 2, 160 yearling steers (initial BW = 495 ± 37.9 kg) were fed the same diets as in Exp. 1. No differences in DMI, final BW, ADG, dietary NEg, or carcass characteristics were observed among diets. However, the steers fed WDG had less (P < 0.05) G:F and greater number of (P < 0.01) abscessed livers than steers fed CON. Increasing FE application in wheat DDGS diets did not affect DMI, final BW, or ADG but tended (P < 0.09) to linearly improve feed efficiency and decreased (P = 0.03) the incidence of abscessed livers. These results demonstrated adverse effects of including wheat DDGS in finishing diets on feed digestion, feed efficiency, and animal health. Application of FE in wheat DDGS-based diets potentially improved starch digestion, protein metabolism in the rumen, feed efficiency, and animal health.

Effects of isobutyrate supplementation on ruminal microflora, rumen enzyme activities and methane emissions in Simmental steers

The objective of this study was to evaluate the effects of isobutyrate supplementation on rumen microflora, enzyme activities and methane emissions in Simmental steers consuming a corn stover-based diet. Eight ruminally cannulated Simmental steers were used in a replicated 4 × 4 Latin square experiment. The treatments were control (without isobutyrate), low isobutyrate (LIB), moderate isobutyrate (MIB) and high isobutyrate (HIB) with 8.4, 16.8 and 25.2 g isobutyrate per steer per day respectively. Isobutyrate was hand-mixed into the concentrate portion. Diet consisted of 60% corn stover and 40% concentrate [dry matter (DM) basis]. Dry matter intake (averaged 9 kg/day) was restricted to a maximum of 90% of ad libitum intake. Population of total bacteria, cellulolytic bacteria and anaerobic fungi were linearly increased, whereas that of protozoa and total methanogens was linearly reduced with increasing isobutyrate supplementation. Real-time PCR quantification of population of Ruminococcus albus, Ruminococcus flavefaciens, Butyrivibrio fibrisolvens and Fibrobacter succinogenes was linearly increased with increasing isobutyrate supplementation. Activities of carboxymethyl cellulase, xylanase and β-glucosidase were linearly increased, whereas that of protease was linearly reduced. Methane production was linearly decreased with increasing isobutyrate supplementation. Effective degradabilities of cellulose and hemicellulose of corn stover were linearly increased, whereas that of crude protein in diet was linearly decreased with increasing isobutyrate supplementation. The present results indicate that isobutyrate supplemented improved microflora, rumen enzyme activities and methane emissions in steers. It was suggested that the isobutyrate stimulated the digestive micro-organisms or enzymes in a dose-dependent manner. In the experimental conditions of this trial, the optimum isobutyrate dose was approximately 16.8 g isobutyrate per steer per day.