Genetic and clinical assessment of 2009 pandemic influenza in southern China

Introduction: South China has a proven role in the global epidemiology of previous influenza outbreaks due to its dual seasonal pattern. We present the virologic, genetic and clinical characterization of pandemic H1N1 influenza infection (pH1N1) in Shantou and Nanchang, cities in southern China, during the second wave of the 2009-2010 pandemic. Methodology: Nasopharyngeal swabs were collected from 165 individuals with influenza-like illness (ILI) who presented to the hospitals in Shantou and Nanchang. Laboratory diagnosis and characterization was performed by real-time PCR, virus isolation in embryonated chicken eggs, and sequencing. Results: pH1N1 activity was sustained in three different temporal patterns throughout the study period. The overall positivity rate of pH1N1 was 50% with major distribution among young adults between the ages of 13 and 30 years. High fever, cough, expectoration, chest pain, myalgia, nasal discharge and efficient viral replication were observed as major clinical markers whereas a substantial number of afebrile cases (17%) was also observed. Rate of hospitalization and disease severity (39%) and recovery (100%) were also high within the region. Furthermore, severe complications were likely to develop in young adults upon pH1N1 infection. Genetic characterization of the HA and NA genes of pH1N1 strains exhibited homogenous spread of pH1N1 strains with 99% identity with prototypic strains; however, minor unique mutations were also observed in the HA gene. Conclusion: The study illustrates the detailed characteristics of 2009 influenza pandemic in southern parts of China that might help to strategize preparedness for future pandemics and subsequent influenza seasons.</br

Heterogeneous virulence of pandemic 2009 influenza H1N1 virus in mice

Background Understanding the pathogenesis of influenza infection is a key factor leading to the prevention and control of future outbreaks. Pandemic 2009 Influenza H1N1 infection, although frequently mild, led to a severe and fatal form of disease in certain cases that make its virulence nature debatable. Much effort has been made toward explaining the determinants of disease severity; however, no absolute reason has been established. Results This study presents the heterogeneous virulence of clinically similar strains of pandemic 2009 influenza virus in human alveolar adenocarcinoma cells and mice. The viruses were obtained from patients who were admitted in a local hospital in China with a similar course of infection and recovered. The A/Nanchang/8002/2009 and /Nanchang/8011/2009 viruses showed efficient replication and high lethality in mice while infection with A/Nanchang/8008/2009 was not lethal with impaired viral replication, minimal pathology and modest proinflammatory activity in lungs. Sequence analysis displayed prominent differences between polymerase subunits (PB2 and PA) of viral genomes that might correlate with their different phenotypic behavior. Conclusions The study confirms that biological heterogeneity, linked with the extent of viral replication, exists among pandemic H1N1 strains that may serve as a benchmark for future investigations on influenza pathogenesis.</br

Cost-effectiveness analysis of renal replacement therapy strategies in Guangzhou city, southern China

Objectives This study aims to assess the cost-effectiveness of three renal replacement therapy (RRT) modalities as well as proposed changes of scheduled policies in RRT composition in Guangzhou city.Methods From a payer perspective, we designed Markov model-based cost-effectiveness analyses to compare the cost-effectiveness of three RRT modalities and four different scheduled policies to RRT modalities in Guangzhou over three time horizons (5, 10 and 15 years). The current situation (scenario 1: haemodialysis (HD), 73%; peritoneal dialysis (PD), 14%; kidney transplantation (TX), 13%) was compared with three different scenarios: an increased proportion of incident RRT patients on PD (scenario 2: HD, 47%; PD, 40%; TX, 13%); on TX (scenario 3: HD, 52%; PD, 14%; TX, 34%); on both PD and TX (Scenario 4: HD, 26%; PD, 40%; TX, 34%).Results Over 5-year time horizon, HD was dominated by PD. At a willingness-to-pay (WTP) threshold of US$44 300, TX was cost-effective compared with PD with an incremental cost-effectiveness ratio of US$35 518 per quality-adjusted life year (QALY) gained. The scenario 2 held a dominant position over the scenario 1, with a net saving of US$5.92 million and an additional gain of 6.24 QALYs. The scenarios 3 and 4 were cost-effective compared with scenario 1 at a WTP threshold of US$44 300. The above results were consistent across the three time horizons.Conclusions TX is the most cost-effective RRT modality, followed in order by PD and HD. The strategy with an increased proportion of incident patients on PD and TX is cost-effective compared with the current practice pattern at the given WTP threshold. The planning for RRT service delivery should incorporate efforts to increase the utilisation of PD and TX in China

Development and validation of an instrument in job evaluation factors of physicians in public hospitals in Beijing, China.

BackgroundJob evaluation has been widely used to establish a foundation for internal equity and other human resource functions. The United Kingdom adopts the National Health Service (NHS) Job Evaluation scheme to determine the pay bands for most NHS staff and ensure equal pay for work of equal value. The challenges of recruiting and retaining physicians in Chinese public hospitals have heightened the need for a reliable job evaluation system to ensure the equality of physician compensation. The aim of this study was to construct job evaluation factors of physicians in Chinese public hospitals based on the NHS Job Evaluation scheme and to examine the reliability and validity of the established system.MethodsQuestionnaire surveys and statistical analyses were used to determine the job evaluation factors for physicians. The preliminary screening of the evaluation factors was based on a literature review, focused interviews with physicians and the Delphi method. Based on the results of preliminary screening, a questionnaire with 25 factors was designed to survey physicians regarding the importance of each factor in physician job evaluation. After the pretest, final questionnaire data were collected from 900 physicians by adopting a stratified sampling from 6 tertiary public hospitals in Beijing. A principal component analysis was used for factor extraction and structural validity analysis. The reliability was determined using Cronbach's alpha.ResultsThe results of the principal component analysis showed that the 25 physician job evaluation factors were grouped into the 5 dimensions of Task Characteristics, Knowledge, Responsibility, Effort/Environment, and Skills. The Cronbach's alpha coefficients of the five dimensions ranged from 0.841 to 0.909, which indicated a high level of reliability. The result of the factor analysis indicated fair structural validity. The content validity was established by building onto the NHS Job Evaluation scheme and other well-established job evaluation systems.ConclusionsOur study indicates that the Chinese version of physician job evaluation is an instrument with fair reliability and validity, which fully reflects the characteristics of physicians in Chinese public hospitals. This system can provide an important basis for developing a physician compensation plan and ensuring internal equity in healthcare organizations

Three-dimensional visual technique based on CT lymphography data combined with methylene blue in endoscopic sentinel lymph node biopsy for breast cancer

Abstract Background The combined application of blue dye and radioisotopes is currently the primary mapping technique used for sentinel lymph node biopsy (SLNB) in breast cancer patients. However, radiocolloid techniques have not been widely adopted, especially in developing countries, given the strict restrictions on radioactive materials. Consequently, we carried out a retrospective study to evaluate the feasibility and accuracy of three-dimensional visualization technique (3DVT) based on computed tomography-lymphography (CT-LG) in endoscopic sentinel lymph node biopsy (ESLNB) for breast cancer. Methods From September 2018 to June 2020, 389 patients who underwent surgical treatment of breast cancer in our department were included in this study. The CT-LG data of these patients were reconstructed into digital 3D models and imported into Smart Vision Works V1.0 to locate the sentinel lymph node (SLN) and for visual simulation surgery. ESLNB and endoscopic axillary lymph node dissection were carried out based on this new technique; the accuracy and clinical value of 3DVT in ESLNB were analyzed. Results The reconstructed 3D models clearly displayed all the structures of breast and axilla, which favors the intraoperative detection of SLNs. The identification rate of biopsied SLNs was 100% (389/389). The accuracy, sensitivity, and false-negative rate were 93.83% (365/389), 93.43% (128/137), and 6.57% (9/137), respectively. Upper limb lymphedema occurred in one patient 3 months after surgery during the 12-month follow-up period. Conclusions Our 3DVT based on CT-LG data combined with methylene blue in ESLNB ensures a high identification rate of SLNs with low false-negative rates. It, therefore, has the potential to serve as a new method for SLN biopsy in breast cancer cases

Organic-Free Synthesis of Zeolite Y with High Si/Al Ratios: Combined Strategy of In Situ Hydroxyl Radical Assistance and Post-Synthesis Treatment

[EN] Zeolite Y, with a high SiO2/Al(2)O(3)ratio (SAR), plays an important role in fluidized catalytic cracking processes. However, in situ synthesis of zeolite Y with high SARs remains a challenge because of kinetic limitations. Here, zeolite Y with an SAR of 6.35 is synthesized by a hydroxyl radical assisted route. Density-functional theory (DFT) calculations suggest that hydroxyl radicals preferentially enhanced the formation of Si-O-Si bonds, thus leading to an increased SAR. To further increase the SAR, a dealumination process was carried out using citric acid, with a subsequent second-step hydrothermal crystallization, giving an SAR of up to 7.5 while maintaining good crystallinity and high product yield. The resultant zeolite Y shows good performance in cumene cracking. Introduced here is a new strategy for synthesizing high SAR zeolite Y, which is widely used in commercial applications.We thank the National Natural Science Foundation of China (Grant 21920102005, 21621001 and 21835002), the National Key Research and Development Program of China (Grant 2016YFB0701100), the 111 Project (B17020), and the Spanish Government-MINECO (SEV-2016-0683 and MAT2017-82288-C2-1-P (AEI/FEDER, UE)) for supporting this work. P. F. thanks ITQ for his contract.Wang, J.; Liu, P.; Boronat Zaragoza, M.; Ferri-Vicedo, P.; Xu, Z.; Liu, P.; Shen, B.... (2020). Organic-Free Synthesis of Zeolite Y with High Si/Al Ratios: Combined Strategy of In Situ Hydroxyl Radical Assistance and Post-Synthesis Treatment. Angewandte Chemie International Edition. 59(39):17225-17228. https://doi.org/10.1002/anie.202005715S17225172285939Martínez, C., & Corma, A. (2011). Inorganic molecular sieves: Preparation, modification and industrial application in catalytic processes. 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