Introduction:Coxsackievirus A12 (CVA12) is a serotype of Enterovirus A. Its evolutionary and molecular characteristics remain poorly understood. Methods:The metagenomic Next-Generation Sequencing (mNGS) strategy were used to investigate the viral diversity. The viral isolation, proliferation assays, phylogenetic relationships and recombination events were analyzed. Results:In this study, nine clinical specimens collected in Beijing, China, during March 2010 to October 2019 were identified as CVA12 positive, among which five were confirmed by mNGS. Then five CVA12 strains were isolated, and the proliferation assays demonstrated the preferential replication of CVA12 in rhabdomyosarcoma (RD) cells, with rapid intracellular replication before being released extracellularly, over Hep-2 cells. Transcriptomic profiling of infected RD cells revealed that the significant up-regulated genes were involved in inflammatory responses and transcriptional regulation (e.g., JUN, FOS), suggesting robust host immune activation. Phylogenetic analysis identified that four strains were clustered into genogroup E, indicating a lineage undergoing active transmission in Beijing, China, the other one into genogroups B. Recombination analysis revealed that strain s7275 exhibited recombination with CVA5 (strain 3,490, GenBank access number OK334538) at the breakpoint position 3,373-6,634, while the others showed recombination with EV-A71 (strain EV71/P1034/2013/China, GenBank access number KP289419) at breakpoint position 3,370-6,645. Discussion:These findings underscored the genetic diversity and recombination dynamics which provided insights into the evolutionary implications of CVA12, and its proliferation features in RD cells of CVA12. Further research is needed to elucidate the functional mechanisms of CVA12 infection and its role for disease.

ABSTRACT Human bocavirus (HBoVs) is an emerging virus globally, and its prevalence, diversity, and evolution in children with acute gastroenteritis require further study. Fecal specimens collected from outpatients with acute gastroenteritis in Beijing, China, from April 2014 to December 2023, were tested for HBoVs by PCR targeting the NS1 gene. Genotyping was based on the NP1/VP1 boundary region, and nearly full-length HBoV2 sequences were analyzed phylogenetically. A total of 79 HBoVs-positive specimens (2.5%, 79/3,116, 95% CI: 2.0%–3.1%) were detected, with HBoV2 (65.8%, 52/79, 95% CI: 55.4%–76.3%) as the dominant genotype, followed by HBoV1 (25.3%, 20/79, 95% CI: 15.7%–34.9%) and HBoV3 (8.9%, 7/79, 95% CI: 2.6%–15.1%). HBoVs were distributed throughout the year, with higher positive rates observed from August to December 2018–2021. They predominantly infected children younger than 5 years, especially those aged 6–24 months (3.3%, 52/1,591, 95% CI: 2.4%–4.1%). HBoV2C was the prevalent sub-genotype in Beijing. Novel recombination events were detected between HBoV2 sub-genotypes, with breakpoints in the NS1 and VP3 gene regions. Evolutionary analysis estimated the time to the most recent common ancestor (tMRCA) for HBoV2 dating back to 1845, with a mean nucleotide substitution rate of 1.4 × 10−4 substitutions/site/year, and that HBoV2A evolved faster than HBoV2C. The evolutionary rates decreased in the following order: NP1, VP3, VP1, and NS1. A purifying selection was observed on HBoV2 genes, with one positively selected site in the NS1 gene. In conclusion, HBoV2 was the dominant genotype in children with acute gastroenteritis in Beijing, China, with higher susceptibility in those under 2 years old. Novel recombination events between HBoV2 sub-genotypes occurred frequently.IMPORTANCEAcute gastroenteritis remains a leading cause of morbidity and mortality in children, with viral infections being the primary causative agents. In this study, we investigated the prevalence of human bocavirus (HBoVs) in children with acute gastroenteritis in Beijing from 2014 to 2023, identifying HBoV2C as the predominant sub-genotype. Additionally, this study reported the first estimate of the evolutionary rate for global HBoV2 (1.4 × 10−4 substitutions/site/year) and identified novel intra-genotype recombination events in HBoV2. The results not only filled a gap in the evolutionary studies of global HBoV2 but also offered valuable data for the development of effective surveillance and prevention strategies for controlling acute gastroenteritis in children.

BackgroundWe initiated the Fujian Tulou Pedigree-based Cohort (FTPC) as the integration of extended pedigrees and prospective cohort to clarify the genetic and environmental risk factors of cardiometabolic diseases. MethodsFTPC was carried out in Nanjing County, Fujian Province, China from August 2015 to December 2017 to recruit probands with the same surnames and then enroll their first-degree and more distant relatives. The participants were asked to complete questionnaire interview, physical examination, and blood collection. According to the local genealogical booklets and family registry, we reconstructed extended pedigrees to estimate the heritability of cardiometabolic traits. The follow-up of FTPC is scheduled every 5 years in the future. ResultsThe baseline survey interviewed 2,727 individuals in two clans. A total of 1,563 adult subjects who completed all baseline examinations were used to reconstruct pedigrees and 452 extended pedigrees were finally identified, including one seven-generation pedigree, two five-generation pedigrees, 23 four-generation pedigrees, 186 three-generation pedigrees, and 240 two-generation pedigrees. The average age of the participants was 57.4 years, with 43.6% being males. The prevalence of hypertension, diabetes and dyslipidemia in FTPC were 49.2, 10.0, and 45.2%, respectively. Based on the pedigree structure, the heritability of systolic blood pressure, diastolic blood pressure, fast blood glucose, total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein was estimated at 0.379, 0.306, 0.386, 0.452, 0.568, 0.852, and 0.387, respectively. ConclusionAs an extended pedigree cohort in China, FTPC will provide an important source to study both genetic and environmental risk factors prospectively.

Objective:To summarize the suspected cases of pertussis, to explore the pathogen, and to analyze the clinical features of pertussis.Methods:A retrospective study was conducted to analyze the clinical data of suspected pertussis cases who visited the Department of Infectious Diseases in the Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2015 to May 2019.Results:(1) The PCR test for respiratory secretions of Bacillus pertussis was completed in 400 cases, with 198 cases positive (49.5%). (2) Among the 198 cases, 158 cases with pertussis were less than 1 year old (79.8%), 113 cases had a clear history of close contact with cough patients (57.1%), and 162 cases were not vaccinated or did not complete full diphtheria and tetanus toxoids and pertussis(DTP) vaccination (81.8%). The incidence of spasmodic cough was 73.7%(146/198 cases); the duration from onset to diagnosis was (17.2±12.3) d; the incidence of cyanosis after cough was 31.3%(62/198 cases), cough with vomiting 17.7% (35/198 cases), inspiratory croup 12.1%(24/198 cases); other concomitant symptoms included wheezing, runny nose, fever, diarrhea, etc.(3) All the patients were divided into the pertussis group (198 cases), other pathogen group (104 cases), and unknown pathogen group (98 cases). Comparison of the clinical symptoms of the three groups showed the highest incidence of cyanosis after cough in pertussis group ( χ2=15.334, P<0.001), and the highest incidence of wheezing, dyspnea, fever, pulmonary rales and stridor in other pathogen group ( χ2=79.208, 38.214, 16.709, 44.794, 42.480, all P<0.001). The percentages of white blood cells, lymphocytes and platelets in the pertussis group were higher than those in the other two groups ( F=15.812, 18.198, 10.819, all P<0.001). Conclusions:Suspected cases of pertussis are infected with various pathogens.Improving the pertussis nucleic acid detection and respiratory virus detection can help to make a clear diagnosis.Pertussis is more common in infants under 1 year of age and in those who have not completed vaccination.The most prominent clinical symptom is spasmodic cough, and the incidence of cyanosis after cough is higher than that of patients infected with other pathogens.

Human adenovirus serotype 41 (HAdV-F41) is an important pathogen that causes diarrhea in children. However, the data on its molecular genetic characteristics and evolutionary history are still neither comprehensive nor sufficient. Four capsid protein genes from 58 HAdV-F41-positive specimens taken from diarrheal children in Beijing during 2010-2019 were amplified and analyzed. Variant amino acids in the hexon gene (18 sites) and short fiber gene (4 sites) clustered these strains into two clades and four subclades. The deletion of 15 amino acids found in the gene seemed to have little effect on the genomic strain cluster same as to penton gene. The HAdV-F41 strains had high diversity, as assessed from the intraspecific recombination of hexon, short fiber and long fiber. The molecular evolutionary rate of HAdV-F41's concatenated genes was 4.07 x 10(-5) substitutions/ site/year, and it diverged from the most recent common ancestor in 1720. Apart from in the penton gene, positive selection codons were predicted in the other three genes, which may play a synergistic role in the evolution of HAdV-F41. These results provide new insights for understanding the characteristics of infectivity and developing vectors and vaccine vehicles for HAdV-F41.

目的 建立一个儿童手足口病(H FM D)的临床诊断评分系统,并评价其准确度.方法 回顾性分析2012年1月至2017年12月在首都儿科研究所附属儿童医院感染科就诊的1435例年龄≤3岁的急性出疹性疾病患儿的临床资料,根据肠道病毒核酸检测结果,分为H FM D组1094例和非H FM D组341例.随机选取70％ 作为训练集(1004例),其余30％ 作为测试集(431例),采用多元Logistic回归筛选临床变量并建立手足口病临床诊断评分系统,同时在测试集中进行评分系统的验证及评价.结果 H FM D组病程、年龄、暴露史阳性占比均显著大于非H FM D组(χ2/t值分别为3.36、4.44、97.88,P<0.01),两组性别构成比差异无统计学意义(P>0.05);HFMD组在硬腭、软腭、舌、颊粘膜、牙龈、前胸、后背、臀部和足趾的皮疹分布数量较非H FM D组更多(χ2值分别为61.77、48.25、20.79、41.32、7.73、27.53、30.34、44.23、29.27,P<0.05);H FM D组发热的比例以及白细胞计数和中性粒细胞占比均高于非H FM D组(χ2/t值分别为13.49、5.21、10.17,P<0.05);利用训练集数据共筛选出7项纳入多因素评分预测模型,包括年龄、暴露史、3个口腔溃疡部位(硬腭、软腭、颊粘膜)和2个躯体皮疹部位(背部、臀部),该评分系统受试者工作特征(ROC)曲线下面积为0.80(95％CI:0.77～0.84,P<0.01),敏感度为0.76,特异度为0.68;评分系统在测试集中ROC曲线下面积为0.76(95％CI:0.71～0.81,P<0.01),敏感度为0.76,特异度为0.62.结论 该评分系统敏感度、特异度及准确性较好,可作为一种儿童手足口病快速、低成本的辅助诊断方法.

Coxsackievirus A16 (CVA16) is one of the major etiological agents of hand, foot and mouth disease (HFMD). This study aimed to investigate the molecular epidemiology and evolutionary characteristics of CVA16. Throat swabs were collected from children with HFMD and suspected HFMD during 2010–2019. Enteroviruses (EVs) were detected and typed by real-time reverse transcription-polymerase chain reaction (RT-PCR) and RT-PCR. The genotype, evolutionary rate, the most recent common ancestor, population dynamics and selection pressure of CVA16 were analyzed based on viral protein gene (VP1) by bioinformatics software. A total of 4709 throat swabs were screened. EVs were detected in 3180 samples and 814 were CVA16 positive. More than 81% of CVA16-positive children were under 5 years old. The prevalence of CVA16 showed obvious periodic fluctuations with a high level during 2010–2012 followed by an apparent decline during 2013–2017. However, the activities of CVA16 increased gradually during 2018–2019. All the Beijing CVA16 strains belonged to sub-genotype B1, and B1b was the dominant strain. One B1c strain was detected in Beijing for the first time in 2016. The estimated mean evolutionary rate of VP1 gene was 4.49 × 10–3 substitution/site/year. Methionine gradually fixed at site-23 of VP1 since 2012. Two sites were detected under episodic positive selection, one of which (site-223) located in neutralizing linear epitope PEP71. The dominant strains of CVA16 belonged to clade B1b and evolved in a fast evolutionary rate during 2010–2019 in Beijing. To provide more favorable data for HFMD prevention and control, it is necessary to keep attention on molecular epidemiological and evolutionary characteristics of CVA16.

Objective: To investigate the spectrum of pathogenic agents in pediatric patients with acute respiratory infections (ARI) during the outbreak of coronavirus infectious diseases 2019 (COVID-19). Methods: Three groups of children were enrolled into the prospective study during January 20 to February 20, 2020 from Capital Institute of Pediatrics, including children in the exposed group with ARI and epidemiological history associated with COVID-19 from whom both pharyngeal and nasopharyngeal swabs were collected, children in the ARI group without COVID-19 associated epidemiological history and children in the screening group for hospital admission, with neither COVID-19 associated epidemiological history nor ARI. Only nasopharyngeal swabs were collected in the ARI group and screening group. Each group is expected to include at least 30 cases. All specimens were tested for 2019-nCoV nucleic acid by two diagnostic kits from different manufacturers. All nasopharyngeal swabs were tested for multiple respiratory pathogens, whilst the results from the ARI group were compared with that in the correspondence periods of 2019 and 2018 used by t or χ(2) test. Results: A total of 244 children were enrolled into three groups, including 139 males and 105 females, the age was (5±4) years. The test of 2019-nCoV nucleic acid were negative in all children, and high positive rates of pathogens were detected in exposed (69.4%, 25/36) and ARI (55.3%, 73/132) groups, with the highest positive rate for mycoplasma pneumoniae (MP) (19.4%, 7/36 and 17.4%, 23/132, respectively), followed by human metapneumovirus (hMPV) (16.7%, 6/36 and 9.8%, 13/132, respectively). The positive rate (11.8%, 9/76) of pathogens in the screening group was low. In the same period of 2019, the positive rate of pathogens was 83.7% (77/92), with the highest rates for respiratory syncytial virus (RSV) A (29.3%, 27/92), followed by influenza virus (Flu) A (H1N1) (19.6%, 18/92) and adenovirus (ADV) (14.1%, 13/92), which showed significant difference with the positive rates of the three viruses in 2020 (RSV A: χ(2)=27.346, P<0.01; FluA (H1N1): χ(2)=28.083, P<0.01; ADV: χ(2)=7.848, P=0.005) . In 2018, the positive rate of pathogens was 61.0% (50/82), with the highest rate for human bocavirus (HBoV) (13.4%, 11/82) and followed by ADV (11.0%, 9/82), and significant difference was shown in the positive rate of HBoV with that in 2020 (χ(2)=6.776, P=0.009). Conclusions: The infection rate of 2019-nCoV is low among children in Beijing with no family clustering or no close contact, even with epidemiological history. The spectrum of pathogens of ARI in children during the research period is quite different from that in the previous years when the viral infections were dominant. MP is the highest positively detected one among the main pathogens during the outbreak of COVID-19 in Beijing where there is no main outbreak area.

OBJECTIVE:To estimate the univariate heritability of resting heart rate and common chronic disease such as hypertension, diabetes, and dyslipidemia based on extended pedigrees in Fujian Tulou area and to explore bivariate heritability to test for the genetic correlation between resting heart rate and other relative phenotypes. METHODS:The study was conducted in Tulou area of Nanjing County, Fujian Province from August 2015 to December 2017. The participants were residents with Zhang surname and their relatives from Taxia Village, Qujiang Village, and Nanou Village or residents with Chen surname and their relatives from Caoban Village, Tumei Village, and Beiling Village. The baseline survey recruited 1 563 family members from 452 extended pedigrees. The pedigree reconstruction was based on the family information registration and the genealogy booklet. Univariate and bivariate heritability was estimated using variance component models for continuous variables, and susceptibility-threshold model for binary variables. RESULTS:The pedigree reconstruction identified 1 seven-generation pedigree, 2 five-generation pedigrees, 23 four-generation pedigrees, 186 three-generation pedigrees, and 240 two-generation pedigrees. The mean age of the participants was 57.2 years and the males accounted for 39.4%. The prevalence of hypertension, diabetes, dyslipidemia in this population was 49.2%, 10.0%, and 45.2%, respectively. The univariate heritability estimation of resting heart rate, hypertension, and dyslipidemia was 0.263 (95%CI: 0.120－0.407), 0.404 (95%CI: 0.135－0.673), and 0.799 (95%CI: 0.590－1), respectively. The heritability of systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was 0.379, 0.306, 0.393, 0.452, 0.568, 0.852, and 0.387, respectively. In bivariate analysis, there were phenotypic correlations between resting heart rate with hypertension, diabetes, diastolic blood pressure, fasting glucose, and triglyceride. After taking resting heart rate into account, there were strong genetic correlations between resting heart rate with fasting glucose (genetic correlation 0.485, 95%CI: 0.120－1, P<0.05) and diabetes (genetic correlation 0.795, 95%CI: 0.181－0.788, P<0.05). CONCLUSION:Resting heart rate was a heritable trait and correlated with several common chronic diseases and related traits. There was strong genetic correlation between resting heart rate with fasting glucose and diabetes, suggesting that they may share common genetic risk factors.

Objective To analyze the bacterial etiology and drug resistance of pathogens from the outpatients with acute infectious diarrhea in the Children's Hospital Capital Institute of Pediatrics.Methods The children with acute infectious diarrhea in the outpatient department of our hospital were randomly enrolled in the period of August 2017 to July 2018.Enteric pathogenic bacteria were cultured and isolated from the fresh stool specimens.The serum of Salmonella spp were identified while five types of diarrheagenic Escherichia coli were detected by PCR method.Antibiotic susceptibility of Salmonella spp and diarrheagenic Escherichia coli were tested by Kirby-Bauer disk diffusion method.Chi-square or Fisher exact test was done for statistical analysis.Results Of the 356 stool specimens,103 strains of 6 pathogenic bacterial species were detected.The positive rate was 27.8％ (99/356),and 2 strains were detected in four stool samples.The isolation rate of Salmonella spp,which was the highest in this study,was 10.7％ (38/356).The isolation rate of Staphylococcus aureus,diarrheagenic Escherichia coli and Pseudomonas aeruginosa were 8.4％ (30/356),5.6％ (20/356) and 3.7％ (13/356),respectively.No Shigella spp strain was isolated.Salmonella enteritidis and Salmonella typhimurium were the dominant serotype for 38 Salmonella spp stains with the isolation rate of 63.2％ (24 / 38).Each 10 Enteropathogenic Escherichia coli and 10 Enteroaggregative Escherichia coli isolates were detected among the diarrheagenic Escherichia coli.Enterohemorrhagic Escherichia coli,Enteroinvasive Escherichia coli and Enterotoxigenic Escherichia colistrain was not found in this study.The resistant rates of Salmonella spp to ampicillin and ceftriaxone were 52.6％ (20/38) and 13.2％ (5/38),while the diarrheagenic Escherichia coli were 11/20 and 1/20,respectively.Three diarrheagenic Escherichia coli isolates produced extended spectrum beta-lactamase.Conclusions Salmonella spp was the major bacterial pathogen among the outpatients with infectious diarrhea in the hospital.The study indicated that the infection ratios of Staphylococcus aureus,diarrheagenic Escherichia coli and Pseudomonas aeruginosa increased.Shigella spp was no long the main pathogenic agent.The resistant rates of Salmonella spp and diarrheagenic Escherichia coli to ampicillin were high,but low resistant rates to ceftriaxone were found among these two kinds of bacteria.The third-generation cephalosporins should be the first choice for the treatment of childhood bacterial diarrhea.

目的 总结儿童麻疹发病特征.方法 回顾性分析2008年1月至2017年12月于首都儿科研究所附属儿童医院隔离门诊就诊和病房住院的麻疹病例的临床资料,对每年确诊病例总数、年龄、性别、疫苗接种情况、临床发病特点及并发症进行统计,根据是否接种麻疹疫苗进行分组比较.结果 10年间共确诊麻疹病例274例,其中男156例,女118例,发病年龄0～16岁,以3岁以下儿童为主(236/274,86.1％).每年3～5月是麻疹高发月份.未接种麻疹疫苗228例(83.2％),其中未达麻疹疫苗初免年龄(＜8个月)的患儿105例(46.1％),接种麻疹疫苗46例.全部病例均有不同程度的发热及皮疹,未接种疫苗组符合典型麻疹出疹顺序的患儿比例高于接种疫苗组(68.0％ vs.52.2％,x2=4.223,P＜0.05);未接种疫苗组口腔麻疹黏膜斑发生率高于接种疫苗组(71.5％ vs.47.8％,x2=9.775,P＜0.01);咳嗽为最常见的呼吸道症状,未接种疫苗组咳嗽发生率高于接种疫苗组(92.1％ vs.69.6,x2=18.853,P＜0.01),腹泻发生率也高于接种疫苗组(37.7％ vs.21.7％,x2=4.295,P＜0.05).呼吸道并发症以支气管炎及肺炎常见,支气管炎发生率未接种疫苗组高于接种疫苗组(25.9％ vs.4.3％,x2=10.252,P＜0.01),肺炎发生率也高于接种疫苗组(30.7％ vs.10.9％,x2=7.573,P＜ 0.01).结论 儿童麻疹发病以未接种麻疹疫苗的儿童为主,接种疫苗的患儿临床症状趋于不典型,未接种麻疹疫苗患儿更常发生呼吸道并发症,及时接种麻疹疫苗可降低麻疹发病率,利于麻疹防控.

In recent years, accumulating evidence has supported the hypothesis that lower vitamin D status is associated with several known risk factors of stroke. However, the relationship between vitamin D and stroke is still uncertain. To explore if there was an association between vitamin D status and the risk of stroke, a systematic review and a meta-analysis were conducted by searching three databases: Pubmed, Embase, and the Cochrane Library. Following the application of inclusion and exclusion criteria, the relative risk estimates of all the included studies were pooled together to compare the risk of stroke between the lowest and the highest category of vitamin D. The Newcastle–Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool were used to assess the risk of bias, and the publication bias was detected by using a funnel plot and Egger’s test. Nineteen studies were included and the pooled relative risk was 1.62 (95% CI: 1.34–1.96). Further analysis found that vitamin D status was associated with ischemic stroke (relative risk = 2.45, 95% CI: 1.56–3.86), but not with hemorrhagic stroke (relative risk = 2.50, 95% CI: 0.87–7.15). In conclusion, our meta-analysis supported the hypothesis that lower vitamin D status was associated with an increased risk of ischemic stroke. Further studies are required to confirm this association and to explore the association among different subtypes.

大规模开放在线课程(massive open online courses, MOOCs),又称为慕课,自2012年开创以来,在全球范围内引发了慕课建设热潮,中国大学慕课、Coursera、Udacity以及edX等国内外平台上已开设了大量慕课课程.北京大学公共卫生学院在2014年率先加入我国预防医学的慕课建设,目前多门预防医学慕课课程在各大平台上线,为开展预防医学教育教学改革、丰富我国的预防医学教育模式进行了有益的尝试.

Objective: To describe the study design, the characteristics of participants as well as the pedigrees included in the baseline survey of Fujian Tulou Family Cohort Study. Methods: Fujian Tulou Family Cohort Study was a prospective open cohort study with a biological sample bank. A baseline survey was conducted in Tulou areas of Nanjing county in Fujian province from 2015 to 2018, including questionnaire survey, physical and biochemical indicators examinations, and blood sample collection in adults aged ≥18 years. In addition, family relationship of the participants was also recorded. The pedigree information of the juveniles under 18 years old were also collected. Results: The baseline survey included 2 727 individuals in two clans, of whom 2 373 (87.0%) were adults, and 2 126 participants completed questionnaires, physical examinations and biochemical tests. The average age of the 2 126 participants was (57.9±13.3) years, with 39.4% being males. The current smoking rates in male and female participants were 41.2% and 2.1%, respectively. The corresponding rates of current alcohol consumption were 19.0% and 2.6%. For common chronic diseases, the prevalence rates were 51.3% for hypertension, 9.7% for diabetes and 26.7% for hyperlipemia according to the self-reported disease diagnoses, health examination results and biochemical examination results in class Ⅱ or Ⅲ hospitals. Based on the family relationship information and genealogical data, 710 pedigrees were finally identified, consisting of 5 087 family members. The numbers of five, four, three, and two generations pedigrees were 3, 88, 238 and 381, respectively. The pairs of the first to the fifth degree relatives were 12 039, 2 662, 1 511, 202 and 31, respectively. Conclusion: The establishment of Fujian Tulou Family Cohort provides valuable resources for exploring the genetic risk factors, environmental risk factors and gene-environment interactions contributing to the risk of common chronic diseases.

Background: Oral clefts (OCs) are common human birth defects. Children with OCs in underdeveloped regions are more likely to suffer from poverty and hardship in their future lives. Here, we attempted to estimate the prevalence of OCs among live births in Gansu Province in 2008 to understand the epidemiologic pattern of the disease. Methods: A cross-sectional study was conducted from January 2008 to December 2008 in Gansu Province. The live births delivered between January and December 2008 with OCs were investigated through face-to-face questionnaire survey. Results: A total of 468 infants with OCs were identified among 347,137 live births in 2008 in Gansu Province, which yielded a prevalence of 1.35 per 1000 live births. The majority of these cases were CL (cleft lip) (prevalence = 0.85 per 1000 live births), and the prevalence of CLP (cleft lip and palate) and CP (cleft palate) was 0.34 and 0.11 per 1000 live births, respectively. We also found that the prevalence of OCs in Jiayuguan (3.39 per 1000 live births) and Dingxi (2.71 per 1000 live births) was higher than those of other cities in Gansu Province. Additionally, we failed to detect significant correlation between economic conditions of the cities and the prevalence of OCs in our study. Conclusions: The prevalence of OCs among live births in Gansu Province in 2008 was higher than the prevalence of OCs in other provinces in China. The high prevalence may reflect the need for further etiological studies to explore the potential risk factors in this region. In addition, more subtype information needs to be collected in future prevalence studies for better understanding of the epidemiologic pattern of the disease.

Objective To compare the clinical efficacy of conventional dose and large dose of Kaihoujian Spray ( for children ) in the the treatment of hand-foot-mouth disease ( HFMD ) . Methods 150 cases of HFMD patients were randomly divided into the control group, conventional dose group and high dose group, 50 cases in each group. The control group was only given oral treatment of Qingrejiedu traditional Chinese medicine;on this basis, the conventional dose group and high dose group used different doses of Kaihoujian Spray ( for children ) orally. The temperature, oral herpes reduction, clinical signs and the changes such as oral pain and dysphagia remission were observed and analyzed. Results The clinical efficacy of the conventional group and the high dose group was significantly higher than that of the control group ( P < 0. 05 ) . The clinical cure rate and oral herpes reduction rate in the high dose group were significantly higher than those in the control group and the conventional dose group ( P < 0. 05 ) . Conclusion Kaihoujian Spray has clear clinical efficacy, and is safe and reliable. The use of large dose can shorten the course of disease, which is worthy of clinical promotion.

Objective: To analyze the clinical data of children with pertussis and explore the necessity of respiratory virus detection in the combined diagnosis so as to improve the clinician's understanding and standardize the diagnosis and treatment of pertussis in children. Method: Clinical data and laboratory examination of 195 suspected pertussis children between Jan. 2015 and Dec. 2016 in Children's Hospital Affiliated to Capital Institute of Pediatric were analyzed retrospectively. Result: The nasopharyngeal secretions were collected from 195 suspected pertussis children, PCR was employed to detect the nucleic acid of Bordetella pertussis. Meanwhile, 172 of 195 cases were screened for antigens of 7 common respiratory viruses by direct immunofluorescence (DIF) (respiratory syncytial virus(RSV), adenovirus(ADV), influenza virus A and B, parainfluenza viruses type Ⅰ-Ⅲ). (1) Eighty cases were positive in pertussis nucleic acid detection (positive rate was 41.0%), 47 males and 33 females, age ranged from one month to ten years, all of them had paroxysmal cough (100.0%), 50 cases with spasmodic cough (62.5%), 9 cases with vomiting after cough(11.2%), 22 cases with cyanosis after cough(27.5%), 13 cases with roaring after cough(16.2%), 4 cases with dyspnea(5.0%), 18 cases were diagnosed as pneumonia by chest radiography(22.5%) and 1 case was diagnosed as pertussis encephalopathy(1.2%); (2) 172 cases of respiratory virus DIF detection were completed and 69 of them were positive(positive rate was 40.1%), including 32 cases positive for RSV(18.6%), 29 cases for PIVⅢ(16.8%); (3) In 80 confirmed pertussis children, 66 cases of respiratory virus DIF detection were completed and 9 were positive(9/66, 13.6%), including 7 cases positive for PIVⅢ. The clinical manifestations were cyanosis after cough(6 cases), dyspnea(2 cases) and pneumonia were diagnosed by chest radiography in 3 cases, the clinical symptoms of these children were more prominent than children with general pertussis; (4) Patients were divided into three groups according to the pathogens: 57 cases in single pertussis group, 32 cases in RSV infection group, 22 cases in single PIVⅢ infection group.The cases of spasmodic cough in Pertussis group was 35 (61.4%), RSV infection group was 7(21.9%), single PIVⅢ infection group was 8(36.4%), compared with the other two groups, the incidence of spasmodic cough were higher in Pertussis group (χ(2) =12.850, 4.013, P<0.05). The cases of roaring in Pertussis group was 11 (19.3%), RSV infection group was 1(3.1%), single PIVⅢ infection group was 0, and the incidence were higher in Pertussis group (χ(2)=4.596, 4.932, P<0.05). The cases of dyspnea in Pertussis group was 2 (3.5%), RSV infection group was 11(34.4%), single PIVⅢ infection group was 0, and the incidence was higher in RSV infection group (χ(2)=15.654, 9.487, P<0.01). Conclusion: Pertussis is common in children, especially in unvaccinated or incompletely vaccinated infants. The typical clinical manifestation is paroxysmal spasmodic cough; complicated with PIVⅢ infection is a risk factor for sever pertussis. Early detecting of Bordetella by PCR is helpful for the diagnosis of pertussis, RSV and PIVⅢ are the main pathogen for Pertussis-like syndrome. The detection of respiratory virus is helpful for differential diagnosis and medication guidance.

Chronic obstructive pulmonary disease (COPD) refers to a common complex disease characterized by progressive and incomplete reversible airflow limitation. COPD is one of the leading causes on morbidity and mortality in China. Genetic risk factors play important roles on the occurrence of COPD. However, the genetic risk factors of COPD remain unknown, to some extent. The aim of this review is to provide a comprehensive overview on literature concerning the most promising findings related to genetic risk factors of COPD.

目的 对实验室确诊的手足口病病例的皮疹特点进行分析,总结不同病原所致手足口病皮疹特点,有助于提高临床诊断准确性.方法 对2013年4月-2014年12月疑似或临床诊断手足口病的患儿留取咽拭子标本,采用实时荧光定量聚合酶链反应(Real-Time PCR)方法检测标本中肠道病毒核酸,根据VP1核苷酸序列同源性进行型别鉴定,据病原学诊断结果分为3组(EV71组、CA16组和CA6组)进行皮疹特点分析.结果 ①经病原学确诊并且临床资料完整的病例共809例,EV71组244例,CA16组367例,CA6组198例,年龄3月～12岁.②EV71组咽峡部疱疹发生率最低,CA16组上腭、颊黏膜疱疹发生率最高,CA6组颊黏膜、齿龈、舌部疱疹发生率低,各组间比较差异有统计学意义(PEV71/CA16、PEW1/CA6、PCA16/CA均＜0.05).③CA6组手背、肘关节、膝关节、前胸、后背皮疹较其他两组多,手心、手指、足趾皮疹较其他两组少,组间差异有统计学意义(PEV71/CA6、PCA16/CA均＜0.01);CA16组足心、足背皮疹较CA6组较少,组间差异有统计学意义(PCA16/CA6均＜0.05).④52.9％的患儿(428/809)存在两种形态以上皮疹,CA6组皮疹更具多形性,两种及以上皮疹形态共存病例数与其他两组比较差异有统计学意义(PEV71/CA6、PCA16/CA6均＜0.01).结论 不同型别肠道病毒感染所致手足口病皮疹特点有所不同,CA6感染所致皮疹更具特征性,尤其在不具备病原检测的条件时,可帮助医生区分肠道病毒型别,判断预后.