[Clinical characteristics and outcome of pregnant patients with myasthenia gravis]

Objective: To study the clinical characteristics of pregnant patients with myasthenia gravis (MG) and the influence of MG to pregnancy. Methods: A retrospective study was conducted including 28 MG patients with 38 pregnancies admitted to the 8th Medical Center of PLA General Hospital between January 2013 and October 2018. Data were collected including clinical scores of MG, serum level of acetylcholine receptor (AChR) antibodies, abnormal repetitive nerve stimulation (RNS) and history of thymectomy before pregnancy. The course of pregnancy, delivery and neonatal outcome were also analyzed. According the outcome of MG, patients were divided into three groups, i.e. improvement group, stable group and deterioration group. Results: (1) The age of MG patients ranged from 21 to 36 (27±4) years. The previous course of MG was 0.5-17.2 (7.4±5.8)years. Based on Osserman clinical type, type ⅡA was the most common one [44.1% (15/34)], followed with type Ⅰ [29.4% (10/34)], type ⅡB [23.5% (8/34)] and type Ⅳ (2.9%).(2)There were 38 pregnancies in 28 women whose pregnancy outcomes resulted in one spontaneous abortion, three embryonic arrest and 34 live births. All abortions developed in the first trimester. Among the 34 pregnancies with live births, the symptoms of MG improved in 16 pregnancies (47.1%), whereas those deteriorated in 10 pregnancies (29.4%) during the first or third trimester and remained stable in 8 pregnancies (23.5%). (3) Compared with improvement group and stable group, the deterioration group had shorter duration of MG [(1.1±0.5) years vs. (7.1±5.1) years, (9.0±5.4) years respectively], higher clinical scores (20.9±6.0 vs. 14.8±6.6,13.3±5.0) and more frequent abnormal RNS(9/10 vs. 8/16, 4/8) and type ⅡB(6/10 vs. 1/16, 1/8) before pregnancy. Positive rate of serum AChR antibody and percentage of thymectomy before pregnancy were comparable between three groups. (4) Spinal anesthesia was performed in 23 pregnancies and 11 cases were vaginal delivery. No transient neonatal MG were found in live-born infants. Conclusions: Pregnancy in patients with under-controlled myasthenia gravis should not be discouraged. The outcome of MG is affected by the duration of MG, MG score and RNS before pregnancy. The first and third trimesters of pregnancy are considered high-risk periods for MG exacerbations. Neonatal transient myasthenia is uncommon, but the newborn should be carefully monitored by obstetricians and neurologists.

[Epidemiological characteristics of human rabies in China, 2016-2018]

Objective: To analyze epidemiological characteristics and explore control and prevention measures based on the rabies surveillance data in China from 2016 to 2018. Methods: The surveillance data of rabies in China from 2016-2018 were collected from the "Infectious Disease Surveillance Information Reporting Management System", eleven national surveillance sites in Hunan, Anhui, Guizhou, Jiangsu and Shandong provinces and National Bureau of Statistics. Descriptive epidemiological method was used to analyze the distributions of rabies outbreaks in China during this period, and univariate and multivariate analyses were conducted on the data using SPSS 25.0. Results: Rabies epidemics were mainly found in southern and central areas in China. Rabies mainly occurred in summer and autumn, and the majority of patients were farmers, students and children outside child care settings. The male to female ratio of the cases was 2.38∶1(1 114∶468). The cases were reported in all age groups and the incidence curve was bimodal, and more cases occurred in middle aged and old adults than in youths. In the case analysis of rabies from 2016 to 2018, the majority of the animals biting human were dogs, accounting for 91.46%(439/480). And about 71.88% (345/480) of the exposures were degree Ⅲ. The vaccination rate after exposure was only 8.13%(39/480). Age, degree of exposure, site of exposure, wound management, vaccination and injection of passive immunization product might influence the incubation period. Conclusions: The human rabies incidence in China declined consecutively from 2016 to 2018, and the affected areas decreased. No cases were reported in northwestern area. The rate of post exposure prophylaxis, vaccination and passive immunization product injection were all improved, but the level of standard wound management after exposure needs to be improved. Attention should be paid to epidemic surveillance in high-incidence provinces and neighboring provinces. It is necessary to strengthen professional treatment training in relevant medical institutions, strengthen immunization and management of dog to achieve the goal of "zero human rabies death by 2030".

Urinary concentrations of phthalate metabolites during gestation and intrahepatic cholestasis of pregnancy: a population-based birth cohort study

Phthalates, a class of widely used endocrine-disrupting chemicals (EDCs), are toxic to various organ systems in animals and humans. Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver dysfunction causing cholestasis in late pregnancy. Evidence on the associations between exposure to phthalates and ICP is still lacking. In the present study, we investigated the relationships between urinary concentrations of phthalate metabolites and the risk of ICP in a Chinese population-based birth cohort. Pregnant women participated in the Ma'anshan Birth Cohort (MABC) study in China. Seven phthalate metabolites were detected in a urine sample in early pregnancy. Chemical concentrations were grouped by quartiles, and associations with outcomes were examined using logistic regression with adjustment for urine creatinine, race, education, poverty status, smoking status, alcohol consumption, maternal age, prepregnancy body mass index (BMI), parity, twin pregnancy, and pregnancy-related liver complications. Of 3474 women recruited into the Ma'anshan Birth Cohort, 2760 met the inclusion criteria and contributed to further analysis and biomonitoring data. Elevated odds ratios (ORs) of ICP were observed in the highest quartiles of monomethyl phthalate (MMP) exposure (OR = 1.59, 95% confidence intervals (CI) = 1.01-2.51) and monobutyl phthalate (MBP) exposure (OR = 1.82, 95% CI = 1.16-2.85) in the adjusted analyses. Our findings add to the evidence that supports the role of maternal phthalate exposure in the first trimester of gestation as a risk factor for ICP.

[Investigation of temporal and spatial characteristics of allergic rhinitis epidemics by Baidu Index in China]

Objective: To explore the temporal and spatial characteristics of search volume (SV) of allergic rhinitis (AR) and related search terms on Baidu Index, as well as the correlation between SV from Baidu Index and epidemiology of AR. Methods: SV of AR and related search terms in mainland area of China from January 2012 to December 2016 were extracted from Baidu Index. Firstly, we investigated the temporal and spatial characteristics of SV of AR and related search terms ("pollen allergy" and" dust mite allergy", etc.), and explored the correlation between SV of AR and SV of related search terms. Secondly, the SV of specific search terms in Beijing and Guangzhou were compared with the actual pollen count in Beijing from April to September in 2016 and the monthly outpatient volume of AR patients in the Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University from 2014 to 2016 respectively to analyze the consistency between SV from Baidu Index and the real-world data. Spearman correlation analysis was used to explore the correlation between different search terms according to the normality and homogeneity of variance of the data. P<0.05 was considered statistically significant. Results: SV of AR showed repetitively seasonal pattern, with the first peak in May and the second peak from August to September. SV of AR in northeast China, north China and northwest China were correlated with both SV of "pollen allergy" and "dust mite allergy" (r value was 0.533, 0.638, 0.609, 0.791, 0.517, 0.682, respectively, all P<0.05). In east China, central China, south China and southwest China, SV of AR showed significant correlation only with SV of "dust mite allergy" (r value was 0.897, 0.884, 0.799, 0.937, respectively, all P<0.05), but not with SV of "pollen allergy" (r value was 0.110, 0.171, 0.020, 0.265, respectively, all P>0.05). The correlation between pollen count and the SV of AR on the day and SV of "pollen allergy" on the next day was the highest (r value was 0.692 and 0.713, respectively, all P<0.05). The SV of AR was correlated with the monthly outpatient volume of AR patients one month and two months later (r value was 0.523 and 0.503, respectively, all P<0.05). Conclusion: The SV of AR and related search terms show different trends in different times and regions which are consistent with the AR epidemiological survey, and significantly correlate with pollen count and AR outpatient volume.

Weight changes since age 20 and cardiovascular risk factors in a middle-aged Chinese population

Background

Little is known about the association between weight changes and adverse health outcomes among Chinese adults.

Methods

A total of 1715 Chinese adults, 45-60 years of age, have been recruited to participate in the Hefei Nutrition and Health Study started in 2012. Multivariate logistic regression analysis was performed to determine the association of weight changes since age 20 (loss ≥5.0 kg; maintain [±4.9 kg]; gain 5.0-9.9 kg; gain ≥10.0 kg) with cardiovascular risk factors.

Results

Men who gained 10.0 kg or more had increased risks of hypertension (odds ratios (OR) = 3.07; 95% CI: 1.98-4.76), impaired fasting glucose (OR = 1.74; 95% CI: 1.02-2.97), reduced high-density lipoprotein (HDL) cholesterol levels (OR = 2.77; 95% CI: 1.42-5.40) and elevated triglyceride levels (OR = 5.72; 95% CI: 2.94-11.12). Women who gained 10.0 kg or more had increased risks of hypertension, elevated low-density lipoprotein (LDL) cholesterol levels and elevated triglycerides levels of 2.01(95% CI: 1.18-3.42), 3.40 (95% CI: 1.18-9.82) and 5.60 (95% CI: 1.59-19.61), respectively.

Conclusion

Weight gain during adulthood was associated with increased risks of high triglycerides, hypertension, impaired fasting glucose and risk of reduced HDL cholesterol in men. Furthermore, weight gain was a predictor of high-risk triglycerides, hypertension and elevated LDL cholesterol in women.

[Expert consensus on rabies exposure prophylaxis]

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post-exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization's position paper on rabies vaccine in 2018 and related research progress in recent.

[Association between elective cesarean delivery and duration of breastfeeding in Ma'anshan City from 2013 to 2014]

Objective: To analyze the correlation between elective cesarean delivery and duration of breastfeeding in Ma'anshan city from 2013 to 2014. Methods: From May 2013 to September 2014, a total of 3 474 pregnant women with the first prenatal checkup were recruited from Ma'anshan maternal and child health care hospital. Finally, 3 109 pregnant women were included after exclusion of those with terminated pregnancies, adverse birth outcomes, twin or multiple pregnancies, breech traction, breech midwifery and loss of delivery information. Demographic data of pregnant women, mode of delivery and breast feeding of children were collected through questionnaires and hospital records. Logistic regression model was used to analyze the relationship between elective cesarean delivery and duration of breastfeeding in children, with the mode of delivery as independent variable and the duration of breastfeeding as dependent variable. Results: The age of 3 109 subjects was (26.6±3.6) years old, the rate of vaginal delivery was 51.1% (1 589), and the rate of elective cesarean delivery was 46.4% (1 443), among which the rate of non-indicative elective cesarean delivery was 26.4% (820), the rate of indicative elective cesarean delivery was 20.0% (623), and the rate of emergency cesarean delivery was 2.5% (77). The proportion of breastfeeding lasting until 4, 12 and 18 months was 45.0% (1 348/2 998), 23.7% (702/2 962) and 5.2% (154/2 944), respectively. After adjusting the confounding factors, compared with vaginal delivery, the OR (95%CI) values of breastfeeding for 4 months in indicative elective cesarean delivery and non-indicative elective cesarean delivery women were 0.870(0.714-1.059), 0.795(0.665-0.949), and the OR (95%CI) values of breastfeeding for 12 months were 0.772(0.611-0.975), 0.755(0.610-0.934), respectively. Conclusion: Elective cesarean delivery may result in shorter duration of breastfeeding in children.

[Expert consensus on rabies exposure prophylaxis]

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post-exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization's position paper on rabies vaccine in 2018 and related research progress in recent.

[Effect of breastfeeding on the behavioral development of infants and children: a birth cohort study in Ma'anshan]

Objective: To discuss the relationship between breastfeeding and the behavioral development of infants and children. Methods: Based on the Ma'anshan Birth Cohort Study, there were 3 474 pregnant women recruited from Ma'anshan Maternal and Child Care Center between May 2013 and September 2014, including 3 273 singleton live births. Follow up the infants to the age of 18 months old. Excluded the infants with incomplete information of breastfeeding and who did not finish the ASQ-3 evaluation in 6 months old and 18 months old, 2 404 valid subjects were included in the study. The information of demographic characteristics, deliver, infants and breastfeeding was collected. The behavioral development were evaluated by the third edition of Ages and Stages Questionnaire (ASQ-3) at 6 months old and 18 months old, and the effect of breastfeeding on behavioral development among infants and children were analyzed by multivariable logistic regression model. Results: The intensity of breastfeeding of infants within 6 months old was (26.56±10.56). The rate of breastfeeding as pure or major intake for infants between 0-5 months old were separately 54.2% (1 303), 54.0% (1 298). 54.0% (1 297), 50.5% (1 213), 34.4% (827) and 9.9% (237). After age, pre-pregnant BMI, intelligence, delivery mode, gender, gestational age, birth weight and family economic status adjusted, compared to never-breastfeeding, continuous breastfeeding for 1-3 months could protect children from severe developmental delay in fine motor domain aged 6 months old (RR=0.36, 95%CI: 0.17-0.79), communication domain aged 18 months old (RR=0.27, 95%CI: 0.08-0.88), and social domain aged 18 months old (RR=0.36, 95%CI: 0.21-0.63). Compared to never-breastfeeding, continuous breastfeeding for more than 4 months could protect children from severe developmental delay in fine motor domain aged 6 months old (RR=0.58, 95%CI: 0.34-0.97), communication domain (RR=0.57, 95%CI: 0.39-0.83) and mild developmental delay (RR=0.65, 95%CI: 0.48-0.87) aged 18 months old and fine motor domain (RR=0.57, 95%CI: 0.39-0.83) aged 18 months old and social domain aged 18 months old (RR=0.57, 95%CI: 0.39-0.83). With the breastfeeding intensity rising, there were less children evaluated as severe development delay in communication domain aged 6 months old, communication, fine motor and problem-solving domains aged 18 months old, with RR (95%CI) at 0.98 (0.96-1.00), 0.96 (0.93-0.99), 0.98 (0.97-1.00) and 0.98 (0.96-1.00); and less children evaluated as mild development delay in communication domain aged 18 months old with RR (95%CI) at 0.99 (0.98-1.00). Conclusion: Breastfeeding with longer duration and increased intensity could promote better development in children.

Temporal Variability of Cumulative Risk Assessment on Phthalates in Chinese Pregnant Women: Repeated Measurement Analysis

The assessment of the combined effects of multiple phthalate exposures at low levels is a newly developed concept to avoid underestimating their actual cumulative health risk. A previous study included 3455 Chinese pregnant women. Each woman provided up to three urine samples (in total 9529). This previous study characterized the concentrations of phthalate metabolites. In the present study, the data from 9529 samples was reanalyzed to examine the cumulative risk assessment (CRA) with two models: (1) the creatinine-based and (2) the volume-based. Hazard index (HI) values for three phthalates, dibutyl phthalate, butyl benzyl phthalate, and di(2-ethylhexyl) phthalate, in the first, second, and third trimesters of pregnancy, were calculated, respectively. In creatinine-based model, 3.43%, 14.63%, and 17.28% of women showed HI based on the European Food Safety Authority tolerable daily intake exceeding 1 in the first, second, and third trimester of pregnancy, respectively. The intraclass correlation coefficient of HI was 0.49 (95% confidence interval: 0.46-0.53). Spearman correlations between HI of the creatinine model and ∑androgen disruptor (a developed potency weighted approach) ranged from 0.824 to 0.984. In summary, this study suggested a considerable risk of cumulative exposure to phthalates during the whole gestation in Chinese pregnant women. In addition, moderate temporal reproducibility indicated that single HI, estimated by the phthalate concentration in single spot of urine, seemed representative to describe the throughout pregnancy CRA. Finally, strong correlation between HI of the creatinine model and ∑androgen disruptor revealed that the creatinine-based model was more appropriate to evaluate the CRA.

[Epidemiology of human rabies in China, 2016]

Objective: To understand the epidemiological characteristics of human rabies in China in 2016 and provide evidence for the control and prevention of human rabies. Methods: The incidence data of human rabies in China in 2016 were collected from national infectious disease reporting information management system. The surveillance data were collected from provinces of Shandong, Guizhou, Anhui, Hunan, Jiangsu and Guangxi Zhuang Autonomous Region. Excel 2013 software was used to process and summarize the data, the epidemiological characteristics of human rabies in China in 2016 were described by using indicators such as morbidity, mortality and constituent ratio. Results: A total of 644 human rabies cases were reported in 28 provinces in China in 2016, a decrease of 19.60% (157/801) compared with 2015. The provinces reporting high incidences of human rabies were Henan, Hunan, Guangxi and Guizhou, accounting for 39.44% (254/644) of the total cases. One case was reported in Qinghai province and Xinjiang Uygur Autonomous Region respectively. The male to female ratio of the cases was 2.14∶1 (439/205), and the majority of the patients were farmers (444/644). Surveillance points in 6 provinces reported 1 281 340 persons seeking post-exposure treatment, of whom 1 018 367 were treated for dog bite or scratch. A total of 764 234 persons completed the vaccination series, accounting for 63.90% (764 234/1 195 956) of the persons with grade Ⅱ and Ⅲ exposures, and 28.89% (165 677/573 571) of the persons with grade Ⅲ exposure were treated with passive immunization product. The average density of dogs in each surveillance area was 7.03/100 persons, the average canine immunization rate was 37.64%. Conclusion: The incidence of human rabies has remained decline in China in 2016, the number of the affected provinces has increased and that has the tendency of spreading to low-risk regions. The cases mainly occurred in men and farmers, and caused by dog bite or scratch. It is necessary to strengthen the health education about rabies prevention and control in rural areas and expand the coverage of canine immunization to prevent and control human rabies.

Effects of the phthalate exposure during three gestation periods on birth weight and their gender differences: A birth cohort study in China

Phthalate has been widely used as a type of plasticiser in various consuming products in daily life. Recent studies have suggested that prenatal phthalate exposure may have adverse effects on fetal development. We aimed to identify the effects of in utero phthalate exposure on birth weight (BW). We evaluated a birth cohort comprising 3474 pregnant women and their single infants; 3103, 2975 and 2838 urine samples were collected in the first, second and third trimesters, respectively. Phthalate metabolites included monomethyl phthalate (MMP), monoethyl phthalate (MEP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEHHP), and mono-(2-ethyl-5-hydroxylhexyl) phthalate (MEOHP), which were analysed in the urine by using high performance liquid chromatography-tandem mass spectrometry. Mixed linear model was used in the statistical analysis. Generally, MMP and MEP exposure during pregnancy was associated with decreased birth weight of infants (MMP, β=-12.192, p=0.009; MEP, β=-11.876, p=0.014). Hierarchical analysis found that MMP and MEOHP exposure was associated with decreased infants' birth weight only in low birth weight groups (MMP, β=-42.538, p=0.005; MEOHP, β=-63.224, p=0.008); MEHP and MEHHP exposure was associated with decreased infants' birth weight in both low birth weight group (MEHP, β=-42.348, p=0.035; MEHHP, β=-50.485, p=0.006) and high birth weight group (MEHP, β=-16.580, p=0.034; MEHHP, β=-18.009, p=0.040), MBP and MEHP exposure were associated with increased infants' birth weight in male NBW group (MBP, β=10.438, p=0.039; MEHP, β=13.223, p=0.017). Moreover, the effect has sex difference. The reduction of birth weight associated with MEHP and MEOHP exposure was stronger in male infants, while MMP and MEP exposure was more significant in female infants.

[Association between elective cesarean section and infants' developmental behaviors: a cohort study]

Objective: To investigate the effect of elective cesarean section (ECS) on infants' developmental behaviors. Methods: A total of 3 474 pregnant women living in Ma'anshan more than 6 months and accepting obstetric examination in Ma'anshan Maternal and Child Care Center were recruited from May 2013 to September 2014. Excluding participants with pregnancy termination (162), twin pregnancy (39), assisted delivery (14), emergency cesarean section (76) and unclear delivery mode (141), 3 042 pair of mother and infant entered the final analysis. Information of maternal basic demographic characteristics, pregnancy histories, pregnancy life style and pregnancy-related diseases were collected by using self-complied Maternal and Child Health Questionnaire. Information of infants' general condition and delivery modes were acquired from obstetric record. The Ages and Stages Questionnaires-third edition was used to assess infants' communication, gross motor, fine motor, problem solving and person-social function, which was completed at age of 6 months old and 18 months old, respectively. And multi-factor non-conditional logistic regression model was used to analyze the association between ECS and infants' developmental behaviors. Results: The prevalence of ECS was 47.5% (1 443/3 042), among which ECS without medical indication and ECS with medical indication were 27.2% (826/3 042) and 20.3% (617/3 042), respectively. After maternal demographic characteristics, pregnant exposure and infants' basic information adjusted, compared to women with vaginal delivery, both ECS with medical indication and without medical indication increased the risk of a delay in gross motor on infants at 6 months old (RR (95%CI: 1.72 (1.08-2.77) and 1.87 (1.11-3.15), respectively.) ECS without indication decreased the risk of a delay in fine motor on infants at 6 months old (RR (95%CI):0.48 (0.28-0.82)), both ECS without medical indication and with medical indication had no statistically significant effect on 18 months infants' communication, gross motor, fine motor, problem solving and person-social function, the RR (95%CI) for ECS without medical indication were 0.86 (0.43-1.74), 1.55 (0.86-2.78), 0.74 (0.49-1.15), 1.10 (0.68-1.78) and 1.17 (0.66-2.08), respectively; and the RR (95%CI) for ECS with medical indication were 0.33 (0.12-1.02), 1.10 (0.55-2.21), 0.79 (0.48-1.29), 0.58 (0.29-1.13) and 1.48 (0.78-2.81), respectively. Conclusion: ECS affected motor development in infants at the age of 6 months old, and no influence was found in infants at the age of 18 months old.

[Effects of pretreatment with dimethyloxalylglycine on the survival of multi-territory perforator flap in rat and related mechanism]

OBJECTIVE

To observe the effects of pretreatment with dimethyloxalylglycine (DMOG) on the survival of multi-territory perforator flap and the vessels of choke zone (CZ) 2 in rat, and to explore related mechanism.

METHODS

Sixty adult SD rats were divided into group DMOG and normal saline group (NS) according to the random number table, with 30 rats in each group. Perforator flap with three angiosomes was made on the right dorsal side of rat, including deep iliac circumflex artery perforator, intercostal artery perforator, thoracodorsal artery perforator, as well as CZ 1 and CZ 2. Rats in group DMOG were intraperitoneally injected with 2 mL NS containing DMOG (40 mg/kg) 2 days before operation, 2 hours before operation, and 2 days after operation. Rats in group NS were intraperitoneally injected with equivalent volume of NS at the same time point. On post operation day (POD) 7, gross observation was conducted, and the survival rate of flap was calculated. On POD 7, the vascularity in CZ 2 and potential zone of flap was observed using angiography. On POD 7, new vessel in CZ 2 of flap was observed with HE staining, and the microvessel density (MVD) was calculated. On POD 7, the expression of vascular endothelial growth factor (VEGF) in CZ 2 of flap was detected by immunohistochemistry and Western blotting (respectively denoted as integral absorbance values and ratio of gray value), and blood flow volume of vessel in CZ 2 of flap was examined by laser Doppler perfusion imager. The sample number of each index was 6 in each group. Data were processed with t test.

RESULTS

(1) On POD 7, rats in two groups all survived, and the flaps were not infected. In group DMOG, the necrotic area of flaps of rats with dark yellow crust and soft texture was observed approximately at the distal end of skin entry point of thoracodorsal artery perforator. In group NS, the necrotic area of flaps of rats with brownish black crust and hard texture was observed approximately at the distal end of CZ 2. The survival rate of flap of rats in group DMOG was (88±3) %, which was significantly higher than that in group NS [(82±3) %, t=3.38, P<0.01]. (2) On POD 7, there were clear vascular structure and many new vessels in CZ 2 of flaps of rats in group DMOG, with intact vascular structure in potential zone. On POD 7, there were unclear vascular structure and few new vessels in CZ 2 of flaps of rats in group NS, with disorder vascular structure in potential zone. (3) On POD 7, MVD in CZ 2 of flaps in rats of group DMOG was (29.2±2.2)/mm(2,) which was significantly higher than that of group NS [(20.3±3.6)/mm(2,) t=5.10, P<0.01]. (4) On POD 7, the expressions of VEGF in CZ 2 of flaps in rats of group DMOG detected by immunohistochemistry and Western blotting were 5 060±432 and 0.48±0.04 respectively, which were significantly higher than those of group NS (2 811±382 and 0.26±0.06, with t values respectively 9.54 and 5.67, P values below 0.01). (5) On POD 7, blood flow volume of vessel in CZ 2 of flaps in rats of group DMOG was (58±4) perfusion units (PU), which was significantly more than that of group NS [(46±4) PU, t=5.20, P<0.01].

CONCLUSIONS

DMOG can increase the survival rate of multi-territory perforator flap through promoting angiogenesis in CZ 2 of flap on the back of rat and improving blood supply of flap.

[Technical guideline for human rabies prevention and control (2016)]

In order to promote the prevention and control programs on rabies in our country, to regulate the prevention and disposition of rabies and to reduce the deaths caused by rabies, the Chinese Center for Disease Control and Prevention has organized a panel of experts, in the reference with Guidelines issued by WHO, American Advisory Committee on Immunization Practices, and the latest research progress from home and abroad, and compiled this document-"Technical Guidelines for Human Rabies Prevention and Control (2016)". The Guidelines conducted a systematic review on the etiology, clinical characteristics, laboratory diagnosis, epidemiology of rabies and provided evidence on varieties, mechanisms, effects, side-effects and security of rabies vaccine, as well as on other preparations on passive immunity of its kind, on methods related to prevention and disposition of exposure etc, finally to have come up with the recommendation on the above mentioned various techniques. The guidelines will be used by staff working on prevention and control of rabies from the Center for Disease Control and Prevention at all levels, from the departments of outpatient and divisions of infection and emergency control in all the medical institutions. The guideline will be updated and revised, following the research progress from home and abroad.

Expression and purification of soluble B lymphocyte stimulator from recombinant Escherichia coli

In this work, the expression conditions of fusion protein thioredoxin (Trx)-soluble B lymphocyte stimulator (sBLyS) in shake flask and bioreactor from the recombinant Escherichia coli BL21 (DE3) with a pET system encoding the fusion protein gene of Trx-sBLyS and the purification method of the sBLyS were optimized to effectively obtain the bioactive protein sBLyS with a high purity. A yield of about 250 mg Trx-sBLyS/g DWC (1686 mg Trx-sBLyS/L) and expression level of about 38.5% in soluble Trx-sBLyS were obtained in a 30 1 bioreactor after optimization of the fermentation conditions. After the completion of the optimized purification procedure in order of affinity chromatography, enzymatic cleavage with enterokinase and DEAE ion exchange chromatography, about 200 mg sBLyS per liter fermentation broth was obtained with a purity of about 95% and a yield of near 30%, respectively. Furthermore, the molecular weight (MW) and the isoelectric point (pI) of the purified sBLyS were determined by 2-D gel electrophoresis and SDS-PAGE analysis and estimated to be over 16 kDa and about pH 4.15, respectively. In addition, the bioactivities of the soluble Trx-sBLyS in fermentation broth and the purified sBLyS were tested by two kinds of analytical methods of bioactivity. The good fermentation yield and the satisfied, purified sBLyS product with high purity, yield and bioactivity demonstrated the sBLyS production procedure was promising in industry.

Fine-tuning the synthesis of ZnO nanostructures by an alcohol thermal process

A simple and efficient alcohol thermal technique was applied to control the growth of the dimensions and morphology of ZnO nanostructures under mild conditions, where surfactant was not necessary. The size of ZnO nanocrystals increased with growth temperature and they transformed into nanorods with different aspect ratios through tuning the reaction time. The length of nanorods increased significantly with the reaction time, but their thickness only slightly increased. The as-prepared ZnO nanocrystals were monocrystalline and the growth orientation of ZnO nanorods was [001]. Photoluminescence measurements showed a blue shift in violet emission with a reduction in crystal size and revealed the quantum confinement effect. Electron irradiation induced structural damage was observed in the ZnO nanorods synthesized at 120 degrees C. Experimental results proved that the possible growth mechanism of ZnO nanostructures was oriented attachment.