Objective: To establish the indexes and weights of risk assessment of shellfish poisoning outbreak caused by red tide. Methods: The risk assessment indexes were developed with the methods of literature review, brainstorm and expert consultation, and the weights of indexes were calculated by the method of analytic hierarchy process. The established indexes contained the risk possibility, impacts of public health, population vulnerability and resilience. The relative risk indexes(integrated risk indexes) of different shellfish poisoning were computed by combining hierarchy process and TOPSIS methods. Moreover, the weights of indexes were further used to generate absolute risk values by multiplying indexes. Results: Four primary indexes and 17 secondary indexes were identified for risk assessment of shellfish poisoning outbreak. Of 17 secondary indexes, the knowing rate of shellfish poisoning, medical accessibility, the number of people being affected, laboratory testing capacity and the habits of eating seafood of local residents had relatively large weights (0.0876, 0.0840, 0.0716, 0.0703 and 0.0644, respectively), which accounted for nearly 38% of the total weight. All consistency ratio (CR) were less than 0.1. The index system was applied in Cangnan county of Zhejiang province. The results showed the relative risk indexes of paralytic shellfish poisoning (PSP), diarrhetic shellfish poisoning (DSP), neurotoxic shellfish poisoning (NSP) and amnesic shellfish poisoning (ASP) were 0.4526, 0.7116, 0.1657 and 0.2884, and the absolute risk values were 0.2542, 0.2668, 0.1907 and 0.2184, respectively. The risk orders of the 4 kinds of shellfish poisoning sorted by relative risk indexes and absolute risk values were consistent. Conclusion: The indexes and weights of risk assessment of shellfish poisoning outbreak caused by red tide are established, which can provide scientific advice for prevention and control of shellfish poisoning outbreak.

Objective: To establish a public health risk assessment indexes for flood disaster. Methods: Delphi method and expert consultation were used to establish the public health risk assessment index system and scoring criteria, and the analytic hierarchy process (AHP) method was used to obtain the weight of the indexes. Then, the established index system was applied to evaluate the public health risk of the flood disaster in Anhui province, 2016. Results: A public health risk assessment system consisting of 5 categories and 17 indexes was constructed. The assessment result of the flood disaster in Anhui province of 2016 showed that the public health risk score was 0.26, suggesting that "the health emergency measures were effective, and the public health risks were effectively controlled". Conclusion: The established indexes can effectively assess the health risk of flood disaster and also can provide the reference for other disaster assessment.

Objective: To identify and assess the potential public health risks of emergency events of infectious disease in the surrounding areas of Hangzhou during the 11th G20 summit, and to assess their impacts on the G20 summit. Methods: The surrounding cities of Hangzhou included Ningbo, Wenzhou, Jiaxing, Huzhou, Shaoxing, Jinhua, Quzhou, Zhoushan, Taizhou and Lishui. Background information on infectious diseases in Zhejiang province was collected, and the brainstorming and expert consultation methods were used to identify the risks. The local risks and the impact of local risks on the G20 summit were assessed. Results: The criteria for public health risk was first established. Through the assessments, a total of 27 kinds of infectious diseases in 4 types of public health risks were identified. The impact of these risks on Hangzhou G20 summit was divided into 1 item of high-risk, 12 items of medium risk and 14 items of low risk.According to the results of risk assessment, the recommendations for risk management of respiratory infectious diseases, intestinal infectious diseases, imported infectious diseases like Middle East respiratory syndrome and other infectious diseases were made. With risk management, Middle East respiratory syndrome was not occurred during the G20 summit, and the epidemic situation of other infectious diseases with middle or low risks was almost the same with that of past years. Conclusions: The public health risks of Hangzhou G20 summit from sudden infectious diseases in outlying areas are mainly medium and low risks. The recommendations on risk management provide a basis for reducing the adverse consequences of public health risks in the event of an outbreak of infectious diseases, avoiding the impact of various risk factors in the outlying areas on G20 summit.

Objective: To assess the risk of local outbreaks of H7N9 avian influenza infection in Zhejiang province and to explore the semi-quantitative assessment method for public health risks in emergency. Methods: Risk index system of human infection with H7N9 avian influenza caused by local transmission were reviewed. The weights of indexes were calculated by analytic hierarchy process, which was combined with the TOPSIS method to calculate the risk comprehensive index. Results: Four primary indexes and 23 secondary indexes were identified for risk assessment in local outbreaks of H7N9 avian influenza infection. The weights ranked on the top five were:morbidity (0.0972), closure measures (0.0718), sterilization measures (0.0673), fatality rate (0.0651), and epidemic spread (0.0616). The comprehensive index of the risk of local outbreaks of H7N9 avian influenza ranged from high to low were Hangzhou (0.5910), Shaoxing (0.5711), Jiaxing (0.5199), Taizhou (0.5198), Huzhou (0.4662), Ningbo (0.3828), Wenzhou (0.3719), Jinhua (0.3392), Lishui (0.2727), Quzhou (0.2001) and Zhoushan (0.0508). Conclusion: A semi-quantitative method has been established in this study, which provides scientific basis for prevention and control of H7N9 avian influenza epidemic in Zhejiang province.

Objective: To establish an emergency response capability assessment indexes for disease control and prevention institutions. Methods: Health emergency response capability assessment indexes of Shanghai Centers for Disease Control and Prevention(CDCs) was drafted based upon documentary analysis, expert consultation and focus group discussion according to duties and features of emergency work of CDCs. The assessment indexes were determined by applying Delphi method (18 experts), and the weights of indexes were determined using analytic hierarchy process and proportional distribution method. And then the established index system was used to assess the emergency response capability of CDCs in Shanghai. Results: Two rounds of expert consultations were conducted. Kendall's coefficient of concordance was 0.420 and 0.495 at the first and second round of expert consultations respectively. After two rounds of consultations, the expert authority score was above 0.7. There were 7 primary indexes, 24 secondary indexes and 84 third-level indexes. The seven primary indexes included emergency management system, emergency response team, surveillance and early-warning ability, emergency response capacity, emergent supply capability, communication and cooperation, scientific research and exchange, with systematic weights of 0.2123, 0.1754, 0.1334, 0.1916, 0.1281, 0.0962 and 0.0630, respectively. According to the investigation, Shanghai Municipal Center for Disease Control and Prevention ranked first in the total score of emergency response capability evaluation. Conclusion: The indexes identified in this study have good reliability and feasibility, and can be used in assessment of emergency response capability in disease prevention and control institutions.

Objective: To explore the association between UCP2 rs659366 polymorphisms and the outcomes of patients after surgery for colorectal cancer. Methods: The study was conducted among a cohort of 501 patients with primary colorectal cancer who had surgery in Sichuan Cancer Hospital during March 2010 and July 2013. The outcomes of the patients were followed up. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was applied to detect UPC2 rs659366 genotypes. The log-rank test was performed to analyze the effects of clinical features on patients' outcomes. The correlation between UCP2 rs659366 polymorphisms and the outcomes of patients was analyzed using the Cox proportional hazard model. Results: In this study, the median of follow-up time was 44.23(0.13-78.53)months, and 101 out of 501 (20.2%) patients failed to follow-up. The log-rank test showed the tumor site, TNM stage, vascular invasion, perineural invasion and the preoperative carcino-embryonic antigen(CEA) level were significantly associated with the outcome of colorectal cancer (P < 0.05 or P < 0.01). The overall survival rate of patients with AA, GA and GG genotypes were 62.7%, 69.9% and 75.5%, respectively. Multivariate analysis according to Cox proportional hazard model taking the GG genotype as the reference indicated that the AA genotype increased risks for survival of patients (HR=1.823); under the dominant genetic model taking GG genotype as reference, GA+AA genotypes increased risks for the poorer outcomes of patients (HR=1.498); the addictive genetic model showed that allele A increased the hazard for the poorer outcomes (HR=1.787). Conclusion: The UCP2 rs659366 polymorphisms are significantly associated with the outcome of patients with colorectal cancer.

Objective: To investigate whether trajectory model can be used to explore the trend of anal human papillomavirus (HPV) infection status among HIV-negative men who have sex with men (MSM). Methods: HIV-negative MSM were recruited by using the "snowball" method from 1st September 2016 to 30th September 2017 in Urumqi. The subjects were followed-up every six months since enrollment. The cell samples in anal canal were collected and the 37-type HPV test kits were used for identification and classification of HPV infection at both baseline and follow-up visits. Taking the cumulative number of different types of HPV as the dependent variable and follow-up visits as the independent variable, the trajectory model was established for the study subjects who completed baseline, 6 months and 12 months follow-up. The model was used to simulate the trend of HPV infection status when the subjects were divided into 1, 2, 3 and 4 subgroups. Bayesian information criterion (BIC), log Bayes factor and average posterior probability (AvePP) were used to evaluate the fitting effect. Results: A total of 400 HIV-negative MSM were recruited at baseline and 187 subjects completed baseline and two follow-ups. The fitting effect attained best when the variation trend was divided into two subgroups. The first subgroup accounted for 54.5%(102/187) of the total, and the curve of change in HPV infection was decreasing; the second subgroup accounted for 45.5%(85/187) of the total, and the curve of change in HPV infection was increasing. Conclusion: Trajectory model can effectively distinguish the trend of HPV infection status in HIV-negative MSM to identify the high-risk group of HPV infection.

Objective: To survey the knowledge and behaviors of antibiotic use for children among parents in Ningbo and to explore the influencing factors. Methods: One kindergarten and one primary school were randomly selected in Yinzhou and Beilun District of Ningbo using stratified random cluster sampling method, respectively. A survey on the knowledge and behaviors of antibiotics use for children was conducted with a self-designed questionnaire among parents of children aged 2 to 14 years in the sampled kindergarten and school. Results: The scores of antibiotic use knowledge were 0-4 in 36.6%(1028/2806) of parents. In the past month, 56.6%(556/983) of parents self-medicated their children, including 20.3%(113/556) medicated with antibiotics. In the past year, 48.5%(1361/2806) of parents stored antibiotics for children at home. Multivariate logistic regression analysis showed that mother, and parents with city residence, higher education level, higher household income, medical background, male children and younger children had higher antibiotic use knowledge scores(P < 0.05 or P < 0.01); parents with city residence, higher education level and medical background were more likely to store antibiotics at home (all P < 0.01); parents with city residence and those store antibiotics at home were more likely to self-medicate their children with antibiotics (P < 0.05 or P < 0.01). Conclusions: Poor knowledge and massive antibiotic missuse for children among parents are of great concern in Ningbo. Tailored health education programs are needed to improve the knowledge and behaviors of rational antibiotic use among parents and reduce storage of antibiotics at home.

Objective: To investigate the prevalence and risk factors of diabetic nephropathy in Ningbo Yinzhou district. Methods: Nephropathy screening was conducted among patients with type 2 diabetes mellitus (T2DM) registered in Ningbo Yinzhou district. Demographic information, clinical examination information, diabetes complications and behavioral risk factors of enrolled patients were collected. Logistic regression model was used to identify possible risk factors for the occurrence of diabetic nephropathy. Results: Among 10 604 T2DM patients included in this study, there were 3744 cases of diabetic nephropathy(35.31%). Univariate analysis showed that gender, age, education level, diabetes duration, glycemic control, hypertension, stroke, smoking and waist circumference were associated with diabetic nephropathy (P < 0.05 or P < 0.01). Multivariate logistic regression analysis showed that male, elders, long diabetes duration, hypertension and smoking were independent risk factors of diabetic nephropathy (P < 0.05 or P < 0.01). Conclusions: Diabetic nephropathy is of high prevalence in T2DM patients. Male patients, elders, and those with long diabetes duration, hypertension and smoking habits are more likely to have diabetic nephropathy.

Objective: To determine measles antibody levels and influencing factors among children aged 6 to 15 years in Zhejiang province. Methods: Blood samples were collected from 2069 children aged 6 to 15 years in Changxing county (Huzhou) and Liandu district (Lishui) of Zhejiang province. Serum level of measles IgG antibody was measured using ELISA, and 800 mIU/mL was applied as the cut-off point of high antibody level. Chi-square or trend Chi-square test was used to analyze difference in positive rates of high antibody level among children with different characters, and the factors related to high antibody level in the vaccinated children were analyzed using multivariate logistic regression. Results: Among 2069 subjects, positive rate of high measles antibody level was 36.06% (746/2069). Multivariate logistic regression showed that the high measles antibody level was significantly associated with age of children and the age of first measles vaccine inoculation. The positive rate of high measles antibody level decreased with age(OR=0.866, 95%CI:0.830-0.904, P < 0.01), and the positive rate in children whose first vaccination at ≥ 12 months of age was higher than those whose first vaccination at 8 months of age(OR=0.633, 95%CI:0.498-0.805, P < 0.01). Conclusion: In order to obtain high measles antibody level and to maintain high levels of population immune barrier, it is suggested that first dose of vaccination can be appropriately delayed in low epidemic areas, and elder children should have timely catch-up vaccination.

Objective: To evaluate the application of various obstructive sleep apnea (OSA) screening scales in patients with acute ischemic stroke. Methods: One hundred and two patients with acute ischemic stroke were enrolled continuously during July 2016 and March 2017 from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. All patients were assessed by the same physician with various OSA screening scales, including Epworth scale, Berlin questionnaire, STOP-Bang questionnaire, SOS scale, four-variable scale and its modified version. Polysomnography was performed in Sleeping Disorder Center on each patient. According to the apnea-hypopnea index (AHI) acquired from polysomnography, patients were divided into moderate-severe OSA group (AHI ≥ 15, n=58) and normal-mild OSA group (AHI < 15, n=44). The efficiencies of the scales in identification of patients with moderate or severe OSA were analyzed and compared. Results: The ROC curves showed that the four-variable scale and its modified version had higher area under curve (0.806 and 0.807, both P < 0.01) for diagnosis of moderate-severe OSA, and the cut-off values for Epworth scale, Berlin questionnaire, STOP-Bang questionnaire, SOS scale, four-variable scale and its modified version were 9, 2, 4, 15, 11, 10, respectively. The sensitivities, specificities, positive and negative predictive values of four-variable scale and its modified version in diagnosis of moderate-severe OSA were higher than those of other scales. Conclusion: Compared with Epworth scale, Berlin questionnaire, STOP-Bang questionnaire and SOS scale, the four-variable scale and its modified version are more effective in screening of OSA for patients with acute ischemic stroke.

Objective: To investigate the effects of isoliquiritigenin on the migration and invasion of human glioma stem cells and the underlying mechanism. Methods: The stem cell markers CD133 and Nestin in SHG44 human glioma stem cells were examined with immunofluorescence microscopy. The migration and invasion ability of glioma stem cells was determined by transwell method. The mRNA and protein expression of matrix metalloproteinase (MMP)-2 and MMP-9 were detected by real-time RT-PCR and Western blot, respectively. Results: CD133 and Nestin were positive in SHG44 cells. The number of migrated cells in SHG44 cells treated with 20 and 80 μmol/L isoliquiritigenin for 48 h were significantly lower than that in control group (76±5 and 42±4 vs. 85±6, all P < 0.01), and the number of migrated cells in 80 μmol/L isoliquiritigenin group was lower than that in 20 μmol/L isoliquiritigenin group (P < 0.01). The numbers of cells crossing through membrane in 20 and 80 μmol/L isoliquiritigenin groups were 190±13 and 130±9, respectively, which were significantly lower than that in control group (230±14, all P < 0.01), and the number of crossed cells in the 80 μmol/L isoliquiritigenin group was lower than that in 20 μmol/L isoliquiritigenin group (P < 0.01). The mRNA and protein expression levels of MMP-2 and MMP-9 were decreased compared with control group (P < 0.05 or P < 0.01), and the expression levels in 80 μmol/L isoliquiritigenin group were lower than those in 20 μmol/L isoliquiritigenin group (P < 0.05 or P < 0.01). Conclusion: Isoliquiritigenin exhibits antitumor effects on glioma stem cells by inhibiting cell migration and invasion, which may be related to the down-regulation of MMP-2 and MMP-9.

Objective: To identify hub genes and key pathways associated with anaplastic thyroid carcinoma (ATC), and to explore possible intervention strategy. Methods: The differentially expressed genes (DEGs) in ATC were identified by Gene Expression Omnibus (GEO) combined with using R language; the pathway enrichment of DEGs were performed by using Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO). The protein-protein interaction (PPI) network of DEGs was constructed by STRING database and visualized by Cytoscape. Furthermore, the hub genes and key nodes were calculated by MCODE. Finally, the drug repurposing was performed by L1000CDS². Results: A total of 2087 DEGs were identified. The DEGs were clustered based on functions and pathways with significant enrichment analysis, among which PI3K-Akt signaling pathway, p53 signaling pathway, inflammatory response, extracellular matrix organization were significantly upregulated. The PPI network was constructed and the most significant three modules and nine genes were filtered. Twenty-two potential compounds were repurposed for ATC treatment. Conclusion: Using integrated bioinformatics analysis, we have identified hub genes and key pathways in ATC, and provide novel strategy for the treatment of ATC.

Colorectal cancer is caused by the interaction of genetic and environment factors. Domestic and foreign scholars have attempted to develop several colorectal cancer risk prediction models, in order to identity risk factors, to screen for high risk population and evaluate the risk of developing colorectal cancer, so as to provide personalized screening protocols for individuals with different risk, and eventually reduce the incidence and mortality rate of colorectal cancer. Currently, the common colorectal cancer risk prediction models were mainly developed based on case-control study and cohort study. Models developed in European and American regions and Asia (excluding China) only include common risk factors, while Chinese models also include hereditary factors on the bases of common risk factors. However, the development and verification of each model are mainly based on local population, whether it can be applied for other population need to be determined. This article reviews the development, validation and evaluation of the risk prediction models, in order to provide a basis for developing more precise risk prediction models for colorectal cancer.

Fatal arrhythmias, heart failure, and sudden cardiac death after myocardial ischemia/infarction are serious threats to human health. In recent years, studies have shown that spinal cord stimulation (SCS) can balance autonomic activity, inhibit myocardial structural remodeling, improve blood flow to ischemic myocardium, effectively reduce the incidence of arrhythmia, heart failure and sudden cardiac death after myocardial ischemia/infarction, but its specific mechanism has not yet been fully elucidated. The effect of SCS on cardiac function may be achieved by inhibiting neural remodeling, or by ameliorating structural remodeling and electrical remodeling. This article reviews the progress on the role and mechanism of SCS in myocardial ischemia/infarction.

Pulmonary arterial hypertension (PAH) is a multi-etiological chronic disease characterized by a progressive elevation in pulmonary resistance and vascular remodeling. Its pathogenesis is complicated. Recently, emerging researches suggest that autophagy, as a self-protection mechanism maintaining the intracellular environment homeostasis in eukaryotes, participate in the occurrence and development of various types of PAH. Autophagy can regulate the survival, apoptosis of pulmonary vascular wall cells and secretion of vasoactive substances and inflammatory cytokines, thus influencing pulmonary vascular homeostasis. Some drugs based on regulating autophagy activity can effectively improve the prognosis of PAH. In this article, the regulatory role of autophagy on the development of pulmonary hypertension is reviewed to provide insight into PAH and its treatment.