Search

Objective: To analyze and summarize the clinical characteristics, diagnosis, treatment and prognosis of benign upper airway space occupancy in infants. Methods: The clinical data of 141 cases with begin upper airway space from January 2012 to January 2022 were analyzed. Among them, 101 were male and 68 were female, the age is 0-3 years old. In which there were 24 newborns. The clinical characteristics, auxiliary examination and treatment results were summarized and analyzed. Results: The main clinical manifestations of 141 infants were dyspnea and/or laryngeal wheezing, including 116 cases of congenital cyst of tongue, 15 cases of hair polyps, 4 cases of nasopharyngeal second pharyngeal fissure cysts, 2 cases of congenital laryngeal cysts, 2 cases of pharyngeal bronchial cyst, 1 case of nasopharyngeal teratoma and 1 case of myofibroma. All the infants had completed the corresponding examination and treatment. The diagnosis was clear, and there was no missed diagnosis or misdiagnosis. Among them, 19 infants with congenital cyst of tongue were given cyst puncture to relieve dyspnea. 2 cases of congenital cyst of tongue recurred half a year after operaion, and then they underwent reoperation. The prognosis of the remaining infants were good. Conclusion: The most common occupying of benign upper airway space occupancy is cyst, and low-temperature plasma resection under endoscope is the main treatment method. Timely puncture therapy is also a safe and effective treatment for infants who are dyspnea and life threatening., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To develop a multi-modal deep learning method for automatic classification of immune-mediated glomerular diseases based on images of optical microscopy (OM), immunofluorescence microscopy (IM), and transmission electron microscopy (TEM)., Methods: We retrospectively collected the pathological images from 273 patients and constructed a multi-modal multi- instance model for classification of 3 immune-mediated glomerular diseases, namely immunoglobulin A nephropathy (IgAN), membranous nephropathy (MN), and lupus nephritis (LN). This model adopts an instance-level multi-instance learning (I-MIL) method to select the TEM images for multi-modal feature fusion with the OM images and IM images of the same patient. By comparing this model with unimodal and bimodal models, we explored different combinations of the 3 modalities and the optimal methods for modal feature fusion., Results: The multi-modal multi-instance model combining OM, IM, and TEM images had a disease classification accuracy of (88.34±2.12)%, superior to that of the optimal unimodal model [(87.08±4.25)%] and that of the optimal bimodal model [(87.92±3.06)%]., Conclusion: This multi- modal multi- instance model based on OM, IM, and TEM images can achieve automatic classification of immune-mediated glomerular diseases with a good classification accuracy.

Objective: To understand the infection status and epidemiological characteristics of hepatitis C in people aged 1-69 years in Henan Province in 2020. Methods: The estimated sample size was 5 827. From August to December 2020, multistage sampling was used to select 8 counties (districts) in Henan, and two survey sites were selected in each county (district), and a questionnaire survey was conducted in local people aged 1-69 years, blood samples were collected from them for anti-HCV, HCV RNA and genotype detections. Results: A total of 5 165 people aged 1-69 years completed the questionnaire survey. Men accounted for 44.76% (2 312/5 165), women accounted for 55.24% (2 853/5 165). In the people aged 1-69 years, the overall prevalence rates of anti-HCV and HCV RNA were 0.69% (95% CI: 0.68%-0.70%) and 0.20% (95% CI: 0.19%-0.21%) respectively. The prevalence rates of anti-HCV and HCV RNA were 0.48% (95% CI: 0.46%-0.50%), 0.09% (95% CI: 0.08%-0.10%) in men and 0.86% (95% CI: 0.85%-0.87%), 0.30% (95% CI: 0.28%-0.32%) in women. The prevalence rates of anti-HCV and HCV RNA increased with age. The prevalence rates of anti-HCV and HCV RNA were 0.87% (95% CI: 0.86%-0.88%), 0.28% (95% CI: 0.26%-0.30%) in urban residents and 0.53% (95% CI: 0.51%-0.55%), 0.14% (95% CI: 0.13%-0.15%) in rural residents. The genotyping results of 10 HCV RNA positive samples ware genotype 1b (4/10), genotype 2 (3/10), genotype 1b/3 (1/10), genotype 1b/3/6 (1/10) and genotype 2/6 (1/10). Conclusions: The prevalence of hepatitis C was low in Henan in 2020. It is necessary to strengthen hepatitis C surveillance in people aged 40 years and above. The major HCV genotypes were 1b and 2, and mixed genotype infection existed.

Objective: We propose a novel region- level self-supervised contrastive learning method USRegCon (ultrastructural region contrast) based on the semantic similarity of ultrastructures to improve the performance of the model for glomerular ultrastructure segmentation on electron microscope images., Methods: USRegCon used a large amount of unlabeled data for pre- training of the model in 3 steps: (1) The model encoded and decoded the ultrastructural information in the image and adaptively divided the image into multiple regions based on the semantic similarity of the ultrastructures; (2) Based on the divided regions, the first-order grayscale region representations and deep semantic region representations of each region were extracted by region pooling operation; (3) For the first-order grayscale region representations, a grayscale loss function was proposed to minimize the grayscale difference within regions and maximize the difference between regions. For deep semantic region representations, a semantic loss function was introduced to maximize the similarity of positive region pairs and the difference of negative region pairs in the representation space. These two loss functions were jointly used for pre-training of the model., Results: In the segmentation task for 3 ultrastructures of the glomerular filtration barrier based on the private dataset GlomEM, USRegCon achieved promising segmentation results for basement membrane, endothelial cells, and podocytes, with Dice coefficients of (85.69 ± 0.13)%, (74.59 ± 0.13)%, and (78.57 ± 0.16)%, respectively, demonstrating a good performance of the model superior to many existing image-level, pixel-level, and region-level self-supervised contrastive learning methods and close to the fully- supervised pre-training method based on the large- scale labeled dataset ImageNet., Conclusion: USRegCon facilitates the model to learn beneficial region representations from large amounts of unlabeled data to overcome the scarcity of labeled data and improves the deep model performance for glomerular ultrastructure recognition and boundary segmentation.

The fatality rate of liver failure caused by fatal amanita poisoning is high, and there are no effective antidote drugs in China. On July 30, 2020, the department of infectious diseases and liver diseases of the First People's Hospital of Yunnan Province admitted a 67-year-old female patient with liver failure caused by fatal amanita poisoning. The patient went to the emergency department for treatment due to abdominal pain, vomiting and diarrhea after eating 350-400 g of amanita mushroom for 2 days, accompanied by fatigue for 1 day. There was no abnormality in physical examination. Laboratory indexes: alanine aminotransferase (ALT) 4 798 U/L, aspartate aminotransferase (AST) 10 030 U/L, activated partial thromboplastin time (APTT) 57.5 s, prothrombin time (PT) 72.1 s, international normalized ratio (INR) 8.66, prothrombinactivity (PA) 10%. Based on the patient's medical history, clinical manifestations and laboratory data, the diagnosis was amanita peptide mushroom poisoning and acute liver failure. According to the mechanism of amanita toxin poisoning as enterohepatic circulation, endoscopic retrograde cholangiopancreatography and ultrasound-guided gallbladder puncture and drainage for drainage of bile to discharge toxins were performed to interrupt the enterohepatic circulation of toxins. However, both methods failed, so open cholecystostomy was performed. Because the patient's coagulation function was very poor, artificial hepatic plasma exchange was given to improve coagulation function before open cholecystostomy, and eventually bile was drained successfully. After a total of 19 days of comprehensive medical treatment, the patient was cured and discharged from the hospital, and no sequelae was found after 1 year of follow-up. For such patients, early identification of the disease is required, and blocking the enterohepatic circulation of toxins as soon as possible according to the characteristics and toxicological mechanism of toxins may be the key treatment for rescuing patients with liver failure poisoned by amanita toxin, and it is necessary to combine comprehensive treatments such as active fluid replacement and blood purification to further improve the survival rate.

Objective To investigate the therapeutic effect of bone marrow cell adoptive therapy on metabolic-dysfunction-associated fatty liver disease (MAFLD) in mice and its possible cell population. Methods The staining was used to detect the liver lesions of MAFLD in C57BL/6 mice induced by methionine and choline deficiency diet (MCD) and the adoptive therapeutic effect of bone marrow cells on MAFLD was evaluated by detecting the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The mRNA expressions of low density lipoprotein receptor (LDLR) and interleukin-4 (IL-4) in liver immune cells (including T, NKT, Kupffer cells and other cell populations) were detected by real-time quantitative PCR. The bone marrow cells labeled with 5, 6- carboxyfluorescein diacetate succinimidyl ester (CFSE) were injected into the tail vein of mice. The proportion of CFSE positive cells in liver tissue was observed by the frozen section, and the proportion of labeled cells in the liver and spleen was tracked by flow cytometry. The expression of CD3, CD4, CD8, NK1.1, CD11b and Gr-1 in CFSE labeled adoptive cells was detected by flow cytometry. The intracellular lipid content of NKT cells in liver tissue was evaluated by Nile Red lipid staining. Results The injury of liver tissue and the levels of serum ALT and AST in MAFLD mice were significantly reduced. At the same time, liver immune cells up-regulated the expression of IL-4 and LDLR. LDLR knockout mice induced more severe MAFLD after giving MCD diet. Bone marrow adoptive cells had a significant therapeutic effect and differentiated more NKT cells to colonize the liver. At the same time, the intracellular lipids of these NKT cells increased significantly. Conclusion Bone marrow cell adoptive therapy can reduce liver injury in MAFLD mice by differentiating more NKT cells and increasing the intracellular lipid content of these cells.

Objective: To investigate the changes in serum levels of endothelin-1 (ET-1) and connective tissue growth factor (CTGF) in patients with atrial fibrillation (AF) and their value for predicting recurrence of AF after radiofrequency ablation (RFCA)., Methods: Sixty-six patients with paroxysmal AF (PaAF) and 72 with persistent AF (PaAF) admitted in our hospital were recruited as AF group and 80 patients with sinus rhythm as the control group, and in all the participants, serum levels of ET-1 and CTGF were measured using ELISA and Western blotting. From 6 patients with AF and 6 with sinus rhythm undergoing cardiac surgery in our hospital, tissue samples of the right atrial appendage were taken intraoperatively for observation of structural changes of the cardiomyocytes, myocardial fibrosis and expression of ET-1 and CTGF protein. In AF group, the patients receiving RFCA were followed up for 6 months following the procedure for assessment of the outcomes., Results: Compared with the control patients, the patients with AF showed obvious damages of the cardiomyocyte structure and myocardial fibrosis. Serum levels of ET-1 and CTGF levels were significantly higher in PaAF and PeAF groups than in the control group, and were higher in PeAF group than in PaAF group. In the patients with AF, serum ET-1 and CTGF levels were positively correlated with left atrial diameter (LAD) ( P < 0.05), and ET-1 was positively correlated with CTGF levels ( P < 0.05). In patients with postoperative AF recurrence, the serum levels of ET-1 and CTGF were significantly higher than those in patients without recurrence; serum ET-1 and CTGF levels before and after the operation were positively correlated with the recurrence of PeAF, and elevated serum levels of ET- 1 and CTGF were identified by logistic regression analysis as independent risk factors for postoperative recurrence of PeAF., Conclusion: Serum levels of ET-1 and CTGF are significantly elevated in AF patients in positive correlation with AF duration. ET-1 and CTGF levels are higher in AF patients with postoperative recurrence, and they both have predictive value for recurrence of PeAF following RFCA.

Objective: To investigate the related factors associated with the structure of the gut microbial community in HIV infection/AIDS cases (HIV/AIDS) in Henan province. Methods: The convenience sampling method was used to select 122 cases who were receiving Antiviral Treatment (ART) or ART-naive in Henan. Whole blood and stool specimens were collected. Genomic DNA of stool samples was extracted, and the V3-V4 hypervariable regions of the 16S rRNA gene were sequenced using Illumina NovaSeq 6000 high-throughput sequencing system. The analysis was performed mainly at the genus level, and the 30 genera with the highest abundance were selected as a measure of the gut microbial community structure. The correlation between community structure and related factors was analyzed using redundancy analysis and Envfit function. Results: 122 cases were finally completed sequencing and analysis, the average BMI was (23.62±2.78) kg/m 2 and the average age was (47±13) years. Among them, male accounted for 66.39% (81/122), and heterosexual transmission route constituted the largest ratio, accounting for 51.64% (63/122). 36 cases were treatment naive (29.51%, 36/122). The top five dominant genera of the total population (122 cases) were Prevotella, Roseburia, Megamonas, Bacteroides and Faecalibacterium and the top five dominant genera of the ART population (86 cases) were Prevotella, Megamonas, Bacteroides, Roseburia and Faecalibacterium. The top five dominant genera of the ART-naive population (36 cases) appeared as Prevotella, Faecalibacterium, Roseburia, Bacteroides and Megamonas . In the total population, ART ( P <0.001) was the most significant factors of community structure. Other significant factors were: duration of diagnosis ( P =0.009), viral load ( P =0.022) and anti-HCV ( P =0.018). ART was positively correlated with Megamonas and negatively correlated with Prevotella , Roseburia and Faecalibacterium , while the other three factors of duration of diagnosis, viral load and anti-HCV were positively correlated with Prevotella , Roseburia and Faecalibacterium and negatively correlated with Megamonas . In the ART-naive population, duration of diagnosis ( P =0.003) were the factors significantly associated with community structure. Duration of diagnosis was positively correlated with Roseburia , Faecalibacterium , Megamonas and Prevotella and negatively correlated with Bacteroides . Conclusion: ART and duration of diagnosis were factors significantly associated with gut microbial community structure and had a significant impact on multiple high-abundance genera.

Objective: To explore the genetic basis for a Chinese patient with amyotrophic lateral sclerosis (ALS)., Methods: Peripheral blood samples were collected from the patient and his parents for the extraction of genomic DNA. Genetic variant was identified by whole exome sequencing. Candidate variant was verified by Sanger sequencing of his parents and healthy controls., Results: The patient was found to harbor a heterozygous c.420C>G (p.Asn140Lys) variant of the SOD1 gene. The same variant was not detected in his parents and 100 healthy controls. The variant has not been included in HGMD, dbSNP and other databases., Conclusion: The c.420C>G variant of the SOD1 gene may underlie the ALS in this patient. Above finding has enriched the spectrum of SOD1 gene variants.

Objective: To analyze the pathogenic variant of preaxial polydactyly in a Chinese Han pedigree and identify the cause of polydactyly., Methods: The peripheral blood DNA of the proband and her parents was extracted. The polydactyly-related genes were detected by trio whole exome sequencing, and the suspected pathogenic gene was screened out. Sanger sequencing was applied to other members of the pedigree., Results: The results of gene sequencing showed that the LMBR1 gene had a heterozygous variant of c.423+4909(IVS5)C>T in 6 patients of the pedigree. The same variant was not detected in family members with normal phenotype. Based on the ACMG guidelines, c.423+4909(IVS5)C>T of the LMBR1 gene was predicted to be pathogenic (PM1+PM2+PP1-S(PS)+PP4+PP5)., Conclusion: The heterozygous C>T variant at position 4909 of intron 5 of the LMBR1 gene probably underlies the disease in this pedigree.

Objective To investigate the effect of insulin-like growth factor 1 (IGF-1) on the migration of alveolar epithelial cells (AECs) and its related mechanisms. Methods The MLE-12 cells (mouse AEC line) were stimulated by IGF-1 and sphingosine 1 phosphate (S1P) in the presence or absence of the PI3K inhibitor Wortmannin. Then, the cell migration was detected by the scratch test and the expression of p-Akt was detected by Western blot. With AECs stimulated by IGF-1, the secretion and expression of S1P were tested by ELISA and Western blot respectively. In the blocking experiment, the effect of IGF-1 on cell migration or p-Akt expression was detected by scratch test or Western blot after the interference of AEC S1P receptor 1 (S1PR1) or the action of S1PR1 blocking antibody. Results After 12 hours of IGF-1 stimulation, the expression of p-Akt in AECs increased and the migration of AECs accelerated. When blocking PI3K signal, the effect of IGF-1 on promoting AEC migration was partially eliminated. IGF-1 induced AECs to produce S1P, which accelerated AEC migration through S1PR1. The expression of p-Akt in AECs increased after S1P stimulation. When blocking the PI3K pathway, the ability of S1P to accelerate the migration of AECs was reduced. When S1PR1 in AECs was blocked or interfered, the effect of IGF-1 on accelerating AEC migration and promoting AEC p-Akt expression was partially reduced. Conclusion IGF-1 activates the PI3K pathway through S1P-S1PR1 signal to promote the migration of AECs.

To understand surface soil heavy metal pollution characteristics, and the spatial distribution and sources of pollution in the main sedimentary features of the Qaidam Basin, a total of 129 topsoil samples(0-10 cm) were collected within a 25 km radius. The concentrations of As, Ba, Cr, Mn, Nb, Ni, Pb, Ti, Zn, Zr, and ten kinds of heavy metals were determined, the degree of contamination and potential sources quantitatively analyzed based on enrichment factors(EFs), the ground accumulation index( I geo ), and the absolute principal component-multiple linear regression(APCS-MLR) receptor model. The results showed that the surface soils of the Qaidam Basin have experienced pollution from ten kinds of heavy metals since the 1960s, with varying degrees of enrichment. As and Pb represent probable point source pollutants, and the basin as a whole shows negligible to low levels of pollution. The APCS-MLR analysis showed that heavy metal pollution derives from two sources, natural factors and anthropogenic(transportation) sources. Specifically, As, Cr, Mn, Nb, Ni, Ti, Zn, and Zr are associated with natural sources, while Ba and Pb are associated with both natural and anthropogenic sources.

The occurrence, distribution, and risk of 11 typical pharmaceutical and personal care products(PPCPs) were investigated in the major rivers and bay areas of Sanya City. The results showed that the significant seasonal variations in eleven PPCPs in major rivers of the city were affected by intense tourism alongside reduced annual runoff. In winter, all 11 PPCPs had 100% detection frequencies, of which CFI had the highest concentration at 1449.10 ng·L -1 . The highest concentration of MTP was 427.06 ng·L -1 and highest concentration of RTM was 311.59 ng·L -1 . In summer, all 11 PPCPs were again detected, with a lowest detection rate of 87.5%, of which CFI, MTP, RTM, ETM, and OFL were predominant. All 11 PPCPs were also detected in the surface seawater of the main bay areas, with detection frequencies of 85.7%, 57.1%, and 71.4% for SMX, MTP, and CFI respectively; the other eight PPCPs had 100% detection frequencies. CFI had the highest concentration at 220.78 ng·L -1 . An ecological risk assessment of the 11 PPCPs showed that the risk quotients(RQ) of STZ at Yuechuan Bridge and RTM at Fenghuang Road were higher than 1 in winter, posing a high risk to the aquatic ecology. This was mainly attributed to the discharge of water from nearby hospitals and sewage treatment plants. In summer, the RQ of STZ at Sanya Bridge and RTM at Hongsha Wharf was between 0.1 and 1, which indicates a medium level of risk to the aquatic environment in Sanya City.

Objective: To explore the efficacy and mechanism of using 3-n-butylphthalide (NBP) in combination with bone marrow mesenchymal stem cells (BMSCs) in the treatment of experimental autoimmune encephalomyelitis (EAE) in mice., Methods: Myelin oligodendrocyte glycoprotein (MOG35-55) was used for the induction and establishment of the EAE model in C57BL/6 mice. The mice were randomly assigned to the EAE group, which received intraperitoneal injection of phosphate-buffered saline (PBS), the NBP-treated EAE group, or the NBP group, which received intraperitoneal injection of NBP, the BMSCs transplantion EAE group, or the BMSCs group, which received BMSCs injected into the lateral ventricle and intraperitoneal injection of PBS, and the BMSCs and NBP combination treatment EAE group, or the BMSCs+NBP group, which received BMSCs injected into the lateral ventricle and intraperitoneal injection of NBP. Each group had 10 mice, while ten normal mice were used as the blank control group receiving intraperitoneal injection of PBS. The neurological function scores were documented daily. The mice were sacrificed 22 days after EAE induction, and the demyelination state of of the spinal cords was observed through Luxol fast blue (LFB) staining. In addition, the levels of serum interleukin-6 (IL-6), IL-10, IL-17, IL-22 and transforming growth factor-β (TGF-β) were examined with ELISA. The levels of glial fibrillary acidic protein (GFAP), microtubule associated protein-2 (MAP-2) and myelin basic protein (MBP) in the brain were examined with immunofluorescence staining. Western blot was used to check the expressions of nuclear factor (NF)-κB pathway, phosphoinositide-3 kinase (PI3K)/protein kinase B (PKB or Akt) pathway, IL-17 and forkhead box P3 (Foxp3) in the spinal cords., Results: The neurological function scores and average scores of each treatment group were significantly lower than those of the EAE group ( P <0.05). The scores of the BMSCs+NBP group decreased more significantly than those of the single treatment groups (the NBP group and the BMSCs group) ( P <0.05). LFB staining results of the spinal cords were consistent with the neurological function scores and the average scores. Compared with the EAE group, the levels of pro-inflammatory cytokines, including IL-6, IL-17 and IL-22, significantly decreased ( P <0.05), and the levels of anti-inflammatory cytokines IL-10 and TGF-β significantly increased ( P <0.05). The change in cytokine expression was more significant in the BMSCs+NBP group ( P <0.05). The expressions of GFAP, MAP-2 and MBP in the BMSCs+NBP group were significantly higher than those of the BMSCs group ( P <0.05). Compared with the EAE group, the p-NF-κB/NF-κB ratio and the IL-17/Foxp3 ratio in NBP group, BMSCs group and BMSCs+NBP group decreased, while P-IκBα/IκBα, p-pI3k/PI3K and P-Akt/Akt ratios increased, especially in the BMSCs+NBP group( P <0.05)., Conclusion: The combined treatment of NBP and BMSCs can help alleviate the symptoms of EAE model mice, showing better efficacy than treatment with NBP or BMSCs alone. The mechanism is related to the inhibition of the NF-κB pathway to regulate Th17/Foxp3 ratio and the activation of the PI3K/Akt pathway to promote the neurogenic differentiation of BMSCs., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Objective: To investigate the clinical significance of the primary tumor size in patients with endometrial carcinoma (EC). Methods: A total of 385 patients with EC admitted to Peking University People's Hospital from January 2006 to December 2016 with complete follow up data were selected, whose tumor size data before biopsy were retrospectively studied. Results: (1) The mean diameter of the primary tumor was (3.6±1.8) cm (range: 1-15 cm). And 48 cases were 0-<2 cm, 78 cases were 2-<3 cm, 92 cases were 3-<4 cm, 73 cases were 4-<5 cm, 94 cases were ≥5 cm. The diameter of the tumor was associated with age <60 years old, premenopause, CA 125 ≥35 kU/L, non-parturition, poor differentiation, stage Ⅲ-Ⅳ, depth of myometrial infiltration ≥1/2, cervical interstitial involvement, adnexal metastasis and lymph node metastasis (all P <0.05), but not associated with body mass index, hypertension, diabetes mellitus, pathology, lymph-vascular space invasion (all P >0.05). (2) Among the 334 patients underwent lymphadenectomy, 45 (13.5%, 45/334) cases with lymph node metastasis were observed. Stratified analysis showed that lymph node metastasis and recurrence rate of patients with EC gradually increased with the increase of tumor size ( P <0.05). Adopting 2, 3, 4 and 5 cm as cut-off values of tumor size, there were significant differences in the rate of lymph node metastasis and recurrence among them observed ( P <0.05), except for lymph node metastasis rate and recurrence rate when the cut-off value was 2 cm ( P >0.05). (3) An receiver operating characteristic (ROC) curve analysis showed that a tumor diameter of 4.25 cm was the cut-off prognostic value to predict lymph node metastasis and recurrence of EC. Conclusions: Tumor diameter is significantly correlated with lymph node metastasis and recurrence in patients with EC. Tumor size should be considered in determining the scope of surgery and adjuvant therapy.

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To analyze the characteristics of COVID-19 case spectrum and spread intensity in different provinces in China except Hubei province. Methods: The daily incidence data and case information of COVID-19 were collected from the official websites of provincial and municipal health commissions. The morbidity rate, severity rate, case-fatality rate, and spread ratio of COVID-19 were calculated. Results: As of 20 March, 2020, a total of 12 941 cases of COVID-19 had been conformed, including 116 deaths, and the average morbidity rate, severity rate and case-fatality rate were 0.97/100 000, 13.5 % and 0.90 % , respectively. The morbidity rates in Zhejiang (2.12/100 000), Jiangxi (2.01/100 000) and Beijing (1.93/100 000) ranked top three. The characteristics of COVID-19 case spectrum varied from province to province. The first three provinces (autonomous region, municipality) with high severity rates were Tianjin (45.6 % ), Xinjiang (35.5 % ) and Heilongjiang (29.5 % ). The case-fatality rate was highest in Xinjiang (3.95 % ), followed by Hainan (3.57 % ) and Heilongjiang (2.70 % ). The average spread ratio was 0.98 and the spread intensity varied from province to province. Tibet had the lowest spread ratio (0), followed by Qinghai (0.20) and Guangdong (0.23). Conclusion: The intervention measures were effective in preventing the spread of COVID-19 and improved treatment effect in China. However, there were significant differences among different regions in severity, case-fatality rate and spread ratio.

Objective: To explore the expression of Blimp1, ATF4 and CHOP in bone marrow mononuclear cells from patients with multiple myeloma as well as the effect of aspirin on their expression., Methods: Sixty untreated patients with multiple myeloma and 30 patients with relatively normal bone marrow were selected. Mononuclear cells from the bone marrow fluid were separated using Ficoll separation solution. CD138 + plasma cells were sorted by immunomagnetic beads method. RT-PCR was used to detect the expression levels of Blimp1, ATF4 and CHOP mRNA in U266 cells cultured in vitro. The cells were divided into blank control group, negative control group (no-loaded virus transfection) and positive experimental group [LV-Blimp1-RNAi (40051-2) transfection] by lentivirus transfection. RT-PCR was used to detect the expression of Blimp1, ATF4 and CHOP mRNA in cells of different groups. U266 cells were stimulated in vitro with different concentrations of aspirin solution (0, 0.5 mmol/L, 2.5 mmol/L, 5.0 mmol/L) for 24, 48 h and 72 h, respectively. The ability of cell proliferation in different groups was measured by CCK-8. U266 cells were stimulated with different concentrations of aspirin for 48 hours. And the mRNA expression of Blimp1, ATF4 and CHOP was detected by RT-PCR., Results: Compared with plasma cells in normal group, the expression of Blimp1 mRNA in CD138 + plasma cells of MM patients significantly increased (8.040±1.878), and the mRNA expression levels of ATF4 and CHOP significantly decreased (0.735±0.089; 0.837±0.062) (P＜0.05). U266 cells were cultured in vitro. Compared with the blank control group and the negative control group, the mRNA expression level of Blimp in the positive experimental group was significantly down-regulated after infection with LV-Blimp1-RNAi (40051-2) lentiviral expression vector (0.637±0.021). ATF4 and CHOP mRNA expression levels were significantly increased (1.452 ± 0.027; 1.721 ± 0.038) (P＜0.05). The proliferation of U266 cells decreased after stimulation with aspirin. In the range of (0.5-5) mmol/L, aspirin could significantly inhibit the proliferation of U266 cells. The inhibition effect of aspirin was increased along with prolongation of time and increase of concentrations. After aspirin stimulation of different concentrations for 48 hours, the expression level of Blimp1 in U266 cells decreased with increasing of drug concentration, while the expression levels of ATF4 and CHOP increased with increasing of drug concentration., Conclusion: Inhibition of Blimp1 expression in multiple myeloma cells can promote the expression of ATF4 and CHOP. Aspirin can inhibit the proliferation activity of myeloma cells by down-regulating Blimp1 expression in myeloma cells and up-regulating ATF4 and CHOP expression, therefore plays an anti-tumor rote.

Objective: To identify the type and origin of ATP7B gene mutation in a family affected with Wilson disease by combined use of multiple methods., Methods: Peripheral blood samples were collected from the proband, her parents and her brother. Sanger sequencing were used to detect point mutation and small deletion/insertion of the 21 exons and flanking sequences of the ATP7B gene in all family members. Array-based comparative genomic hybridization (aCGH) was performed to identify copy number variations (CNVs) of the ATP7B gene in the proband. The result was validated by quantitative PCR (qPCR) in other 3 members., Results: Sanger sequencing indicated that the proband carried a heterozygous variation c.2668G>A (p.V890M) derived from her mother. In addition, 5 common SNPs were detected in her mother, three of which were also identified in her father and brother. The 5 SNPs in the proband were of the wide type. aCGH analysis demonstrated that the proband was heterozygous for a 4 kb deletion, which encompassed exons 2 and 3 of the ATP7B gene and 2 SNPs. qPCR showed that the copy number in her father and brother was about half of the control, indicating heterozygous loss of exons 2 and 3., Conclusion: The combined Sanger sequencing, array CGH and qPCR has identified a novel CNV involving the ATP7B gene. The strategy can improve the diagnostic rate for hereditary or rare diseases.

JCI standard is the most professional and authoritative certification standard of medical quality and safety system in the world. HRP information system is a systematic hospital resource management platform which integrates the existing hospital information resources and establishes a set of unified, efficient, interconnected and information sharing operation and management of the hospital. In order to meet the requirements of closed-loop management of implantable medical devices in the JCI standard, our hospital has established a set of standards which based on the HRP system platform, including access permission, purchase application, entering and leaving the warehouse, bookkeeping charge, cost accounting and postoperative traceability of implanted medical device management system. HRP system improves the management level of implantable medical devices, and realizes the closed-loop management of the whole process of implantable medical devices.

To investigate the effect of miR-331-3p on the proliferation of porcine renal epithelial cells (PK15) and its mechanism, the pcDNA 3.1(+) overexpression vector of miRNA-331-3p (pcDNA 3.1(+)-miR-331-3p) was constructed. PK15 cells were divided into four groups, including experimental group, experimental control group, inhibitor group and inhibitor control group. Experimental group and experimental control group were transfected with pcDNA 3.1(+)-miR-331-3p and pcDNA 3.1(+), respectively. Inhibitor group and inhibitor control group were transfected with miR-331-3p inhibitor and miR-331-3p negative control (miR-331-3p NC), respectively. Above all, CCK-8 reagent was used to plot the cell proliferation curve and Propidium (PI) staining was used to detect the proportion of cell stages. Secondly, its expression change were detected by quantitative real-time PCR that included the growth inhibitory protein family member 5 (ING5), cyclin-dependent kinase 2 (CDK2), cyclin-dependent kinase 3 (CDK3), cyclin-dependent kinase 4 (CDK4), Cyclin B and cyclin-dependent kinase inhibitor 1A (CDKN1A). The results showed that the expression of miRNA-331-3p was significantly increased in the experimental group. The cell proliferation curve showed that the number of cells in experimental group was significantly higher than that in experimental control group or inhibitor control group at 48 h and 72 h (P<0.05). Simultaneously, Inhibitor group was significantly lower than experimental control group or inhibitor control group in the number of cells at 48 h and 72 h (P<0.05), but there was no significant difference between the experimental group and the control group. Compared with the experimental control group, the proportion of cells of experimental group in G0/G1 phase decreased, the proportion of S phase and G2/M phase increased, and the inhibitor control group showed the opposite trend. Simultaneously, the expression levels of CDK2, CDK3, CDK4 and Cyclin B genes in the experimental group were significantly increased, while ING5 and CDKN1A genes inhibiting proliferation showed a significant downward trend. These results demonstrate that the miR-331-3p overexpression vector was successfully constructed, and miR-331-3p has the ability to promote the proliferation of PK15 cells. The study lays a solid foundation for further research for its role in pig growth and development.

Objective: To investigate CPC-nanoparticles of low concentrations in treatment of staphylococcus aureus and pseudomonas aeruginosa biofilms in vitro. Method: We established specific biofilms of staphylococcus aureus ATCC 25923 and pseudomonas aeruginosa ATCC 15692, and prepared CPC-nanoparticles and CPC micelle solutions of low concentrations(0.010%, 0.025% and 0.050%). AlamarBlue was used to test the viability of both planktonic staphylococcus aureus and pseudomonas aeruginosa and their biofilms after treatment for 5 minutes and 2 hours respectively in the bactericidal efficacy study.The interaction between CPC-nanoparticles and staphylococcus aureus and pseudomonas aeruginosa biofilms was observed by confocal laser scanning microscope(CLSM). Result: 0.010%, 0.025% and 0.050% CPC-nanoparticles and CPC-micelle solutions had significant bactericidal effect on planktonic staphylococcus aureus and pseudomonas aeruginosa after fiveminute exposure( P <0.05), and staphylococcus aureus and pseudomonas aeruginosa biofilms after both five-minute and two-hour treatments( P <0.05). In CLSM study, the size of staphylococcus aureus biofilms decreased, while dead bacteria of pseudomonas aeruginosa biofilms increased after two-hour treatment. Conclusion: CPC-nanoparticles had significant bactericidal effects on staphylococcus aureus and pseudomonas aeruginosa biofilms, which could be used in treatment of CRS., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the risk factors of ventricular arrhythmias in patients with Brugada syndrome. Methods: Clinical data of 60 Brugada syndrome patients admitted in the department of cardiology of the First Affiliated Hospital of Nanjing Medical University from March 2003 to December 2016 were collected and retrospectively analyzed. The age at diagnosis was (43.2±13.1) years (0.6-83.0 years), 98.3% were males ( n= 59), and the patients were followed up to (92±41) months (12-169 months). The 12-lead surface electrocardiogram (ECG) recorded at the time of diagnosis and showing the highest type 1 ST elevation, either spontaneously or after provocative drug test, was used for the analysis. Patients were divided into ventricular arrhythmia (VA, n= 12) group and non-ventricular arrhythmia (non-VA, n= 48) group depending on the presence or absence of clinical VA event. The demographic data and ECG data of the 2 groups were compared, and the independent risk factors of VA events were analyzed by stepwise logistic regression. Results: Incidence of family history of sudden death (7/12 vs. 22.9% (11/48)) and percentage of type 1 ST elevation in the peripheral ECG leads (6/12 vs. 16.67% (8/48)) were significantly higher in VA group than in non-VA group (both P< 0.05). Max Tpeak-Tend (Max-Tpe) interval ((144±53)ms vs. (110±16)ms) and dispersion of Tpe ((74±50)ms vs. (43±17)ms) were significantly higher in VA group than in non-VA group (both P< 0.05). The area under receiver operating characteristic (ROC) curves for the Max-Tpe interval was 0.693 and Max-Tpe interval ≥140 ms was determined as an optimized cutoff point with increased risk of VA event, which had a sensitivity of 50.0%, a specificity of 98.0%, a positive predictive value of 85.7%, and a negative predictive value of 88.7% for predicting VA event. The ROC curves for the dispersion of Tpe was 0.775 and dispersion of Tpe ≥45 ms was determined as an optimized cutoff point for predicting VA event, which had a sensitivity of 91.7%, a specificity of 64.6%, a positive predictive value of 39.3%, and a negative predictive value of 96.9% for predicting VA event. In multivariate analysis, Max-Tpe interval ≥140 ms ( OR= 27.53, 95 %CI 1.07-706.77, P= 0.045) and family history of sudden death ( OR= 24.63, 95 %CI 2.05-295.38, P= 0.011) were found to be the independent risk factors of arrhythmic events. Conclusions: Max-Tpe interval ≥140 ms and family history of sudden death are risk factors of VA event in included patients with Brugada syndrome.

Objective: To investigate the feasibility and diagnostic value of preoperative transthoracic echocardiography guided three dimensional printing model (TTE Guided 3DPM) on the assessment of structural heart disease (SHD). Methods: From February 2016 to October 2016, 44 patients underwent cardiac surgery in Tianjin Chest Hospital, forty-four patients were assessed preoperatively using TTE Guided 3DPM, including 25 males and 19 females, aged 3-75 years, with an average of (44±22) years. compared to conventional three dimensional transthoracic echocardiography (3D-TTE), and took direct intraoperative findings as "Golden Standard" simultaneously. There are twelve patients with SHD, including four cases with mitral prolapse, two cases with partial endocardial cushion defect, two cases with secondary atrial septal defect, two cases with rheumatic mitral stenosis, one case with tetralogy of Fallot, one case with ventricular septal defect (VSD), thirty-two patients without SHD were designed as negative control. Results: The sensitivity and specificity of TTE Guided 3DPM were greater than or equal to 3D-TTE, P value of McNemar test of 3D-TTE was greater than 0.05, the difference was not statistically significant, kappa =0.745, P <0.01, indicated that the results of 3DTTE and the gold standard were generally consistent. P value of McNemar test of TTE Guided 3DPM was greater than 0.05, the difference was not statistically significant, kappa =0.955, P <0.01, indicated that the results of TTE Guided 3DPM and gold standards were consistent. Compared with 3D-TTE and TTE Guided 3DPM, P value was greater than 0.05, the difference was not statistically significant, kappa =0.879, P <0.01, indicated that the results of 3D-TTE and TTE Guided 3DPM were consistent. TTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly, which were consistent with intraoperative findings. Conclusion: TTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.

Objective: To develop a new method based on droplet digital PCR (DD-PCR) for detection and quantification of maternal cell contamination in prenatal diagnosis. Methods: Invasive prenatal samples from 40 couples of β(IVS-Ⅱ-654)/β(N) thalassemia gene carriers who accepted prenatal diagnosis in Affiliated Women and Children's Hospital of Guangzhou Medical University from October 2015 to December 2016 were analyzed retrospectively. Specific primers and probes were designed. The concentration gradient were 50%, 25%, 12.5%, 6.25%, 3.125%, 1.562 5%. There were 40 groups of prenatal diagnostic samples. Comparing DD-PCR with quantitative fluorescent-PCR (QF-PCR) based on the short tandem repeats for assement of the sensitivity and accuracy of maternal cell contamination, respectively. Results: DD-PCR could quantify the maternal cell contamination as low as 1.562 5%. The result was proportional to the dilution titers. In the 40 prenatal samples, 6 cases (15%, 6/40) of maternal cell contamination were detected by DD-PCR, while the QF-PCR based on short tandem repeat showed 3 cases (7.5%, 3/40) with maternal cell contamination, DD-PCR was more accurate ( P= 0.002) . Conclusion: DD-PCR is a precise and sensitive method in the detection of maternal cell contamintation. It could be useful in clinical application.

Objective: To verify whether preprocedural ultrasound of the lumbar spine could improve first-attempt success rate (defined as a successful neuraxial anesthesia with only one skin puncture) of neuraxial block in elderly patients. Methods: From septemble 2015 to February 2016, 200 elderly patients undergoing lower-limb surgery with neuraxial block at the Peking Universty Third Hospital were enrolled in this study.RandA 1.0 software was used to randomize patients into two groups: conventional surface landmark-guided group (group LM) and ultrasound-assisted group (group US). Ultrasound scanning of the lumbar spine was performed to determine the suitable insertion point of US group, using a low-frequency (2-5 MHz) curved-array probe in both paramedian sagittal oblique plane and transverse median plane.Spinal anesthesia was done via the paramedian approach.The primary outcome was the rate of successful access to subarchnoid space on the first needle insertion attempt.Secondary outcomes included the following: number of needle insertion attempts, number of needle redirection times, actual epidural needle insertion depth, time taken to eastablish landmarks, time taken to perform the spinal anesthesia (the duration between local infiltration and bupivacaine injection), procedure time (the duration from sterilizing the back to converting into supine position), total time (the sum of the time to establish landmarks and the procedure time), adverse events during the procedure and anesthesia related complications. Results: A total of 191 patients successfully received combined spinal-epidural anesthesia by resident anesthesiologists, 9 patients (7 patients in group LM vs 2 patients in group US) failed.The first-attempt success rate in group LM was 37.6%, while the first-attempt success rate in group US was 68.4%, the difference between the two groups was significant (χ 2 =18.112, P <0.01). In group LM, the number of needle insertion attempts and needle redirection attempts were 2(1, 3) and 5(3, 10), respectively. In group US, the number of needle insertion attempts and needle redirection attempts were 1(1, 2) and 3(0, 5), respectively.The differences in the number of needle insertion attempts and needle redirection attempts between the two groups were significant ( Z =-4.132, -4.077, all P <0.01). In group US, the time spent on determining the insertion point, on puncture, on finishing the procedure and the total time were as the following: 2.8(2.6, 3.1), 2.5(1.8, 4.1), 7.8(6.5, 8.9), 10.6(9.5, 11.9) min.In contrast, in group LM, those indices were as the following: 0.4(0.3, 0.4), 4.1(2.2, 6.3), 8.8(7.5, 11.4), 9.2(7.8, 11.9) min.There were significant differences in the above factors between the two groups ( Z =-11.931, -4.025, -3.550, -3.290, all P <0.01). The paramedian sagittal oblique scanning image was superior to that of the transverse median plane. Conclusions: For elderly patients, ultrasound imaging before neuraxial block increases first-attempt success rate, decreases puncture time.The strengths of prepuncture ultrasound scanning outweighs its longer total time.

A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

Objective: To compare two different regimens of continuous ultrasound-guided fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA)., Methods: Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing selective single total hip replacement in Peking University Third Hospital from May.2015 to Mar.2016 were included. Before neuraxial block, continuous ultrasound-guided FICB were administered. Patients were randomly divided into the continuous infusion group(n=30) and the automated intermittent boluses group(n=30). 10 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the continuous infusion group. 10 ml of 0.2% ropivacaine was automated injected every 60 mins in the automated intermittent boluses group. Numerical Rating Pain Scale(NRPS)was used to assess pain intensity at 4, 8, 12, 24, 36, 48 h after block at rest and during functional exercise. The usage of pethidine postoperatively, the incidence of opioid related adverse effect and patient satisfaction scores at 48 h were also recorded., Results: The pain score at rest 8, 12, 24, 36 h of the automated intermittent boluses group were 2 (1-3), 2 (1-3), 2 (1-3), 2 (1-3) score, which were lower than the continuous infusion group: 4 (2-6), 3 (2-5), 4 (3-5), 2 (1-4) score, the differences were statistically significant (Z=-6.493, -6.267, -6.235, -3.244, all P<0.05). The pain score during active and passive functional exercise at 8, 12, 24, 36 h of the automated intermittent boluses group were 4 (3-5), 4 (3-5), 2 (1-3), 1(0-3) score, which were lower than the continuous infusion group: 6 (4-7), 5 (4-7), 4 (2-6), 4 (2-5) score, the differences were statistically significant (Z=-6.499, -6.499, -5.081, -6.667, all P<0.05). The usage of pethidine postoperatively and the incidence of opioid related adverse effect of the automated intermittent boluses group were 10.0% and 3.3%, which were lower than the continuous infusion group: 33.3% and 26.7% , the differences were statistically significant (χ(2)=5.057, 4.500, all P<0.05). Patient satisfaction score at 48 h of the automated intermittent boluses group was (8.3±0.7)score, which was higher than the continuous infusion group: (7.4±0.7)score, the difference was statistically significant (t=-5.632, P<0.05)., Conclusions: Both regimens can provide effective analgesia after total hip arthroplasty. Compared with the continuous infusion group, the automated intermittent boluses group for continuous fascia iliaca block can provide better analgesic effect , with less remedial analgesia.

Industrial structural adjustment plays a significant role in achieving the pollution reduction goals in China. It is an optimal choice for Hainan Province to promote industrial structure upgrading and build a "national demonstration area for ecological civilization construction". The emission factor method was used to estimate co-benefits of pollution emission reduction through closure of backward production capacities as a result of industrial structural adjustment policies. The results showed that in Hainan Province the cumulative reduction emissions of NO x , dioxins and mercury were 2826.0 t·a -1 , 10462.5 mg·a -1 and 280.8 kg·a -1 respectively from 2006 to 2013, taking into consideration of cement, iron & steel, paper making and solid clay bricks sectors. The impact of eliminating backward production capacities on reductions of NO x was not remarkable, but the impacts on control over dioxins and mercury emissions were significant. The paper provided a new approach for estimating co-benefits from reducing the conventional pollutants and emerging pollutants.

Phase-out of backward production facilities can significantly reduce the emissions of unintentional persistent organic pollutants from the industrial thermal process. An estimation of reduced dioxin emissions due to closure of backward production capacities is valuable to objectively evaluate China's efforts in and contribution to performing the Stockholm Convention on Persistent Organic Pollutants. Our group previously evaluated environmental effects of the phase-out of backward production facilities on dioxin emissions from 2006 to 2009. Based on the above study, due to the phase-out of backward production capacities from 2010 to 2013, the reductions in dioxin emissions to air from power generation sector, coke sector, and iron & steel (including ferroalloy) sector were estimated to be 86.13, 133.94 and 78.78 g · a⁻¹, respectively. Because the emission factors used in this paper are a little bit conservative, the actual reduced emissions may be greater than the estimated values. Besides the industrial sectors mentioned above, reduced dioxin emissions can also be estimated in more industrial sectors such as cement, calcium carbide, metal smelting and papermaking sectors. The paper also provided methods for the future comprehensive evaluation of dioxin reduction.

A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

Objective: To investigate the clinical significance of transvaginal ultrasound, hysteroscopy and MRI in the assessment of endometrial cancer lesions size., Methods: Data from 56 patients who successively underwent transvaginal ultrasound, MRI and hysteroscopy inspection preoperative endometrial carcinoma were retrospectively analyzed to assess the accuracy of lesions size., Results: The pathologic lesions size measured mean maximum diameter of 56 cases was (3.05±0.23) cm, while the mean maximum diameter measured by vaginal ultrasound, MRI and hysteroscopy were respectivelly (2.46±0.31) cm, (3.12±0.08) cm, and (3.18±0.21) cm. Compared with the pathologic measured values, the compliance rates of transvaginal ultrasound, hysteroscopy and MRI were respectively 54% (30/56), 71% (40/56) and 75% (42/56), which vaginal ultrasound measurement value was significantly different than that by pathologic measured (P=0.031), while there were significant difference between the hysteroscopy measured lesion size and pathologic measured, or between MRI measured values and pathologic measured (all P>0.05)., Conclusion: Preoperative assess the endometrial cancer lesions size, significance of vaginal ultrasound examination is limited, and MRI and hysteroscopy examination is accurate, but easy to over-estimated lesion size.

Objective: To understand the toxic effects of manganese exposure on health by measurement of manganese concentration and occupational health inspection among workers in an enterprise exposed to manganese, and to provide a basis for occupational disease control., Methods: The air concentrations of manganese in 12 workplaces where workers often stayed were measured by typical sampling; occupational health inspection was performed among a total of 538 workers in the enterprise by cluster sampling., Results: The average concentrations of manganese in the workplace from 2011 to 2013 were 0.179 mg/m(3), 0.122 mg/m(3), and 0.082 5 mg/m(3), respectively, indicating a significant decrease in manganese level within the three years by rank-sum test (P < 0.05). The results of health inspection showed that 165 (30.7%) out of 538 workers had abnormal indices, and the incidence of autonomic nervous system abnormalities reached 32.7% (176/538). There was no correlation between manganese concentration in the workplace and the incidence of abnormal indices in health inspection, while the manganese concentration in the workplace was positively correlated with the incidence of autonomic nervous system symptoms (r = 0.718, P < 0.05)., Conclusion: The manganese concentration in the workplace is positively correlated with the incidence of autonomic nervous system symptoms. Early exposure to a low level of manganese can induce functional changes and potential damages in the nervous system.

Objective: To explore the role and underlying mechanisms of insulin-like growth factor I (IGF-I)/extracellular signal-regulated kinase (ERK) signaling pathway in lung fibrosis., Methods: Alveolar epithelial cell A549 was used. The expressions of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in A549 culture media stimulated by IGF-I were determined by enzyme-linked immunosorbent assay (ELISA). ERK inhibitor U0126 was used. And there were three groups of control, IGF-I stimulation and RK inhibitor plus IGF-I stimulation. The activity of ERK in three groups was measured by Western blot. The mRNA level and protein concentration of MMP-2 and MMP-9 in three groups were examined by quantitative real-time-polymerase chain reaction (qRT-PCR) and ELISA., Results: The protein concentrations of MMP-2 and MMP-9 in cell culture media increased in 50, 100 ng/ml IGF-I groups as compared with 0 ng/ml IGF-I group ((18.30 ± 0.11), (21.80 ± 0.09) vs (13.52 ± 0.19) ng/ml and (0.34 ± 0.01), (0.39 ± 0.01) vs (0.25 ± 0.01) ng/ml, P < 0.001). And the protein concentrations of MMP-2 and MMP-9 in 100 ng/ml IGF-I group increased versus 50 ng/ml IGF-I group (P < 0.01). IGF-I stimulation group increased the expression of p-ERK1/2 versus control group (0.40 ± 0.01 vs 0.23 ± 0.02, P < 0.05) while ERK inhibitor plus IGF-I stimulation group decreased the expression of p-ERK1/2 versus IGF-I stimulation group (0.14 ± 0.03 vs 0.40 ± 0.01, P < 0.01). ERK inhibitor plus IGF-I stimulation group inhibited the mRNA levels of MMP-2 and MMP-9 versus IGF-I stimulation group (0.88 ± 0.03 vs 1.17 ± 0.05 and 0.82 ± 0.23 vs 1.81 ± 0.27, both P < 0.05) and decreased the concentrations of MMP-2 and MMP-9 in culture media versus IGF-I stimulation group ((21.70 ± 0.32) vs (29.15 ± 0.34) ng/ml and (0.22 ± 0.01) vs (0.29 ± 0.01) ng/ml, both P < 0.01)., Conclusions: IGF-I induces the expressions of MMP-2 and MMP-9 in alveolar epithelial cell through ERK signaling pathway. And it is associated with the disruption of epithelial basement membrane and the development of lung fibrosis.

Objective: To investigate the clinical value of high-field-strength intraoperative magnetic resonance imaging (iMRI) combined with optic radiation neuro-navigation for the resection of temporal lobe low-grade gliomas., Methods: From April 2009 to September 2013, 65 patients with temporal lobe low-grade gliomas (WHO grade II) involving optic radiation were operated with iMRI and functional neuro-navigation. Diffusion tensor imaging (DTI) based fiber tracking was used to delineate optic radiation. The reconstructed optic radiations were integrated into a navigation system, in order to achieve intraoperative microscopic-based functional neuro-navigation. iMRI was used to update the images for both optic radiations and residual tumors. Volumetric analyses were performed using 3D Slicer for pre- and intra-operative tumor volumes in all cases. All patients were evaluated for visual field deficits preoperatively and postoperatively. The Student t test was used to evaluate the average rate of extent of resection between groups. Spearman rank correlation analysis was used to assess correlations between predictors and epilepsy prognosis., Results: Preoperative tumor volumes were (78±40) cm3. In 29 cases, iMRI scan detected residual tumor that could be further resected, and extent of resection were increased from 76.2% to 92.7% (t=7.314, P<0.01). In 19 cases (29.2%), gross total resection was accomplished, and iMRI contributed directly to 8 of these cases. Postsurgical follow-up period varied from 13 months to 59 months, mean (33±13) months. Tumor progression were observed in 3 patients, newly developed or deteriorated visual field defects occurred in 4 patients (6.2%). For patients with pre-operative seizures, Engel Class I were achieved for 89.7% of them. Spearman rank correlation analysis revealed that seizure outcome (Engel Class) was related to increased excision of ratio (r=-0.452, P=0.004, 95% CI: -0.636--0.261) and larger tumors (r=0.391, P=0.014, 95% CI: 0.178-0.484)., Conclusions: With iMRI and functional neuro-navigation, the optic radiation can be accurately located, while extent of resection can be evaluated intra-operatively. This technique is safe and helpful for preservation of visual field for the resection of temporal lobe low-grade gliomas involving optic radiation.

Background and Objective: With the rapid development of technology, stereotactic radiotherapy has been widely used. In a cohort of medically operable non-small cell lung cancer patients receiving stereotactic body radiation therapy (SBRT) survival rates "potentially equivalent to those of surgery" have been reported. Removing the field flattening filter, Clinac is capable of delivering dose rates much higher than conventional linac as well as reducing the treatment time. The goals of this work were to report safety and efficacy of SBRT treatment using a flattening filter-free model for non-small cell lung cancer (NSCLC) with small lesions., Methods: From December 2011 to December 2013, 31 NSCLC patients who were T1-2N0M0, solitary pulmonary recurrence after surgery, and stage IV with oligo metastasis were enrolled, receiving SBRT treatment (60 Gy/8 f or 48 Gy/4 f) applying a flattening filter-free model., Results: Compared with conventional technique, flattening filter-free model shortened the treating time with equivalent target dose and normal tissue dose. The median follow-up time is 19.4 mo. The 1-yr local control, regional control, distant control, progression free survival and overall survival rates were 96.8%, 96.8%, 83.9%, 77.4% and 96.8%. The most common side effects were radiation pneumonitis (29% grade 1, 3.2% grade 2) and chest pain (12.9% grade 1, 6.5% grade 2)., Conclusions: The use of flattening filter-free model in SBRT for small lesions of NSCLC patients is safe and effective. Long time follow-up and additional studies are still needed to validate our conclusions.

Objective: To investigate the prevalence of respiratory syncytial virus (RSV) infection in hospitalized children and the relationship between the prevalence and the climate change in Suzhou, China., Methods: A total of 42 664 nasopharyngeal secretions from hospitalized children with acute respiratory infection at the Suzhou Children's Hospital were screened for RSV antigens using direct immunofluorescence. Monthly meteorological data (mean monthly air temperature, monthly relative humidity, monthly rainfall, total monthly sunshine duration, and mean monthly wind velocity) in Suzhou between 2001 and 2011 were collected. The correlations between RSV detection rate and climatic factors were evaluated using correlation and stepwise regression analysis., Results: The annual RSV infection rate in hospitalized children with respiratory infection in the Suzhou Children's Hospital varied between 11.85% and 27.30% from 2001 to 2011. In the 9 epidemic seasons, each spanning from November to April of the next year, from 2001 to 2010, the RSV detection rates were 40.75%, 22.72%, 39.93%, 27.37%, 42.71%, 21.28%, 38.57%, 19.86%, and 29.73%, respectively; there were significant differences in the detection rate between the epidemic seasons. The monthly RSV detection rate was negatively correlated with mean monthly air temperature, total monthly sunshine duration, monthly rainfall, monthly relative humidity, and mean monthly wind velocity (P<0.05). Stepwise regression analysis showed that mean monthly air temperature fitted into a linear model (R(2)=0.64, P<0.01)., Conclusions: From 2001 to 2011, RSV infection in Suzhou was predominantly prevalent between November and April of the next year. As a whole, the infection rate of RSV reached a peak every other year. Air temperature played an important role in the epidemics of RSV infection in Suzhou.

Objective: To investigate the feasibility and application value of AR-Vol measured by GI3DQ method directly., Methods: One hundred and two patients with aortic regurgitation who underwent echocardiographic examination in Tianjin Chest Hospital from February 2014 to October 2014 were selected randomly and divided into two groups: the eccentric group included forty cases with eccentric aortic regurgitation; the central group included sixty and two cases with central aortic regurgitation. AR-Vol were directly measured by GI3DQ method, and then it was calculated by PISA method as the reference standard., Results: (1) In the eccentric group, the AR-Vol measured by GI3DQ method and PISA method were respectively (44±11) ml and (48±10) ml. In the central group, the AR-Vol measured by GI3DQ method and PISA method were respectively (34±13) ml and (33±13) ml. (2) Paired t test analysis showed significant difference in two methods of the eccentric group (P<0.01); no significant difference was found in two methods of the central group (P=0.202). (3) The correlation coefficients of the AR-Vol measurement by GI3DQ method and PISA method are relatively in two groups: r=0.835, r=0.913; consistency analysis showed differences between the two methods of the eccentric group had statistical significance, and differences between the two methods of the central group had no statistical significance., Conclusion: In the central aortic regurgitation, AR-Vol measured by GI3DQ method is feasible and accurate compared with the PISA method, which can be used for routine application.

Objective: To investigate the safety and efficacy of trans-T tube duodenal papilla balloon dilatation for the removal of residual common bile duct stone after choledocholithotomy and T tube drainage., Methods: Thirteen cases with residual common bile duct stone treated with trans-T tube duodenal papilla balloon dilatation in our department from June 2010 to April 2012 were analyzed retrospectively. Record CA19-9, bilirubin and albumin before the procedure, 1 week and 1 month later. Check if immediate complications occurs, including hemorrhage, perforation, pancreatitis and cholangitis. During the following up for 2 years, stone recurrence, reflux cholangitis and other long-term complications were observed. Analyze the changes of indicators between preoperative and postoperative and the correlation., Results: All of the 13 patients were treated successfully. 11 patients underwent one procedure, and 2 patients received twice or more times of procedures. CA19-9 decreased significantly 1 week later and 1 month later compared with those before the procedure, while ALB was opposite. Incidences of biliary tract infection and hemorrhage were 1 and 1 respectively. No severe complications occurred, including perforation of gastrointestinal or biliary tract. Incidences of recurrent stone and reflux cholangeitis were 2 and 1 in two years after the procedure., Conclusions: Trans-T tube duodenal papilla balloon dilatation is a safe and effective procedure for patients with recurrent common bile duct stone after choledocholithotomy and T-tube drainage. For the cases which could not be handled with endoscopic procedures, it provides a new therapeutic approach.

The apparatus for intrinsic dissolution test recorded in United States Pharmacopeia (USP) integrating with fiber-optic drug dissolution test system (FODT) were used to real-time monitor intrinsic dissolution processes of alliin in four media which were water, solution of HCl with pH 1.2, buffer solution of acetate with pH 4.5, and buffer solution of phosphate with pH 6.8. The intrinsic dissolution rate (IDR) and the similarity factor (f2) of two intrinsic dissolution curves with two apparatuses were calculated. The IDR values of alliin with rotating disk system were 28.1.3, 33.55, 28.38 and 30.95 mg x cm(-2) x min(-1) in four media, respectively. And the IDR values of alliin with stationary disk system were 44.16, 47.07, 45.11 and 51.34 mg x cm(-2) x min(-1), respectively. The similarity factors were 56.42, 50.75, 40.30 and 40.64, respectively. The results showed that the intrinsic alliin dissolution rates were much greater than 1 mg x cm(-2) x min(-1). It inferred that alliin dissolution would not be the rate limiting step to absorption.

Objective: To investigate the pregnancy outcome of frozen-thawed embryos transfer in different endometrial progesterone preparation time., Methods: From January to December 2012, pregnant outcome of 1 103 frozen-thawed embryo transfer cycles using artificial periodic endometrial preparation were studied retrospectively in Reproductive Medical Center of Henan Provincial People's Hospital. It was divided into 4 groups: group 3-3 (n = 543, 3 days after endometrial progesterone preparation and transfer D3 embryo), group 4-3(n = 330, 4 days after endometrial progesterone preparation and transfer D3 embryo), group 5-5 (n = 150, 5 days after endometrial progesterone preparation and transfer D5 blastula), group 6-5 (n = 80, 6 days after endometrial progesterone preparation and transfer D5 blastula). The rate of implantation, pregnancy, ectopic pregnancy, multiple pregnancy, and first trimester abortion were compared among those groups., Results: (1) With the different endometrial progesterone preparation methods and transfer D3 embryos, implantation rate [group 3-3:39.9% (429/1 074); group 4-3:44.1% (286/648)], pregnancy rate [group 3-3:56.0% (304/543); group 4-3:59.4% (196/330)], ectopic pregnancy rate [group 3-3:3.3% (10/304); group 4-3:2.6% (5/196)], multiple pregnancy rate[group 3-3: 38.5% (117/304) ; group 4-3: 43.4% (85/196)]and early abortion rate [group 3-3: 13.5% (41/304); group 4-3:13.3% (26/196)] had no significant differences between group 3-3 and group 4-3 (all P > 0.05). (2) With the different endometrial progesterone preparation methods and transfer D5 blastocysts, implantation rate [group 5-5:64.7% (191/295) ; group 6-5:69.4% (100/144)], pregnancy rate [group 5-5:80.7% (121/150) ; group 6-5:78.8% (63/80)], ectopic pregnancy rate [group 5-5:2.5% (3/121); group 6-5:0], multiple pregnancy rate[group 5-5:55.4% (67/121); group 6-5: 46.3% (37/80)] and early abortion rate [group 5-5: 5.8% (7/121); group 6-5:7.9% (5/63)]. However, there were no significantly differences between group 5-5 and group 6-5(all P > 0.05)., Conclusions: The two different progesterone transformed endometrial methods can obtain satisfactory clinical outcome with D3 embryo or D5 blastocysts transfor. It is convenient to clinical and laboratory work arrangements.

A highly sensitive method using ultra-fast liquid chromatography coupled with quadrupole/linear ion trap mass spectrometry (UFLC-Q/Trap MS) was developed to simultaneously screen and confirm nine beta-blockers (BBs) in porcine tissues (porcine muscle, liver and kidney). The method was used for trace determination of atenolol, pindolol, acebutolol, metoprolol, carazolol, labetalol, bisoprolol, propranolol and penbutolol. The homogenized tissues were hydrolyzed by beta-glucuronidase/aryl sulfatase and extracted with acetonitrile, followed by continuous purification procedures of disperse solid phase extraction (d-SPE) with diatomaceous earth and BondElut cartridge. The ultra-fast chromatographic separation was conducted on a Kinetex C18-XB column (150 mm x 2.1 mm, 2.6 microm) using 0.1% (v/v) formic acid aqueous solution and methanol as mobile phases in gradient elution. The optimized ion transitions were mployed in the mixed-mode of scheduled multiple reaction monitoring (sMRM) -information dependent acquisition (IDA)-enhanced product ion (EPI) scan. Qualification analysis was performed through spectra-matching with on-line lab-built MS/MS library. For quantification stable isotope-labelled analogues of the analytes were used as internal standards. As a result, in porcine liver, kidney and muscle, the nine BBs showed good linearity with all the correlation coefficients (r) more than 0.995 in the range of 0.1-20 microg/L. The limits of quantification (LOQ, S/N > or = 10) were 0.5 kg/kg for all the analytes. The developed method gave average recoveries of 87.5%-111.8% spiked at 0.5, 1.0 and 5.0 microg/kg with the relative standard deviations of 4.0%-12. 5%. The proposed method can be used to screen and confirm the nine BBs in a single run, which makes it effective in surveillance and detection of the BBs residues in porcine tissues.

Objective: To identify the enterovirus from stool samples of patients with hand, foot and mouth disease(HFMD) in Guangzhou from 2010 to 2012 and to perform phylogenetic analysis of the VP1 gene sequences of coxsackievirus A4 and coxsackievirus A10., Methods: A total of 5 484 samples of suspected cases of HFMD which Guangzhou Center for Disease Control received from 2010 to 2012 were collected.Virus RNA was tested by nested RT-PCR method as human enterovirus 71, coxsackievirus A16, coxsackievirus A4, coxsackievirus A10 and other enteroviruses positive, and 4 111 samples were positive. Phylogenetic tree was constructed by partial VP1 gene sequences of coxsackievirus A4 and coxsackievirus A10 to perform phylogenetic analysis., Results: In 4 111 enterovirus-positive samples, the positive rate of EV71, CoxA16, CoxA10 and CoxA4 was 35.1% (1 443/4 111) , 30.7% (1 261/4 111) , 2.0% (82/4 111),0.8% (31/4 111) respectively. Different enterovirus-positive rate was statistically significant (χ(2) = 148.34, P < 0.05) .Incidences of coxsackievirus A4 positive was highest in 3-year old children as 1.3% (7/534) , and that of coxsackievirus A10 positive was highest in 0-year old children as 3.7% (34/914) . The highest positive rate of diagnosed coxsackievirus A4 positive cases was admitted in April(2.6%, 12/460) , and the highest positive rate of diagnosed coxsackievirus A10 positive cases was admitted in August 4.3% (12/278). Phylogenetic analysis indicated that all the CoxA4 stains were divided into subtype A and subtype B, and the CoxA10 stains were divided into subtypes A, subtype B and subtype C. The VP1 gene nucleotide sequences of CoxA4 and CoxA10 this study measured both belonged to subtype A., Conclusions: The VP1 gene nucleotide sequences of CoxA4 and CoxA10 in Guangzhou from 2010 to 2012 both belonged to subtype A.

Objective: To study the methylation changes in promoter CpG islands induced by low-dose X-ray radiation (LDR)., Methods: Twenty male BALB/c mice were randomly divided into control and fractionated radiation group exposed to 6 MV X-ray for 10 days (0.05 Gy/day). All the mice were sacrificed 2 h after the last radiation on day 10, and blood samples were collected for detecting DNA methylation changes using Roche-NimbleGen mouse DNA methylation 3×720K Promoter Plus CpG Island Array. MeDIP-qPCR was used to further validate the methylation status of specific genes., Results: A total of 811 genes were found to show specific hypermethylation in fractional radiation group as compared with the control group, involving almost all the main biological processes by GO analysis. Eight candidate genes (Rad23b, Tdg, Ccnd1, Ddit3, Llgl1, Rasl11a, Tbx2, and Slc6a15) were confirmed to be hypermethylated in LDR samples by MeDIP-qPCR, consistent with the results of the methylation chip study., Conclusion: LDR induces promoter hypermethylation on specific genes, which may contribute to radiation-induced pathogenesis.

Mitochondrial tRNA genes are the hot spots for mutations associated with essential hypertension. We report here the clinical and molecular genetic characterization of two Han Chinese pedigrees with materially inherited essential hypertension. Clinical evaluation revealed the variable severity and age-at-onset of hypertension among matrilineal relatives. In particular, the age-at-onset of hypertension in the maternal kindred ranged from 36 years to 79 years. The sequence analysis of entire mitochondrial genome in two probands showed that two probands carried the identical homoplasmic tRNAMet/tRNAGlnA4401G and tRNACysG5821A mutations and distinct sets of polymorphisms belonging to East Asian haplogroup C. The A4401G mutation may affect the processing of the precursors of tRNAMet and tRNAGln , thereby altering the tRNA metabolism. The tRNACys G5821A mutation is located in the acceptor stem of tRNACys. This mutation may abol-ish the predicted G6-C67 pairing and consequently affect the structure and stability of mitochondrial tRNACys, thereby leading to mitochondrial dysfunction. Therefore, these data suggested that the tRNAMet/tRNAGlnA4401G and tRNACys G5821A mutations are likely associated with essential hypertension in these two Chinese pedigrees.

Objective: To identify the pathogen and characteristics on a case of hand-foot-mouth disease (HFMD) caused by coxsackie-virus A6 (CA6) associated with vaccine-derived poliovirus (VDPV) co-infection., Methods: Field epidemiological study at the epidemic area was conducted and 16 stool samples including from the patient and close contacts were collected for isolation and identification of the enterovirus (EV). 21 stool samples from patients diagnosed as HFMD were collected in the same hospital at the same month to detect CA16,EV71, CA6 and PV by real-time RT-PCR or RT-PCR. The VP1 gene of the CA6 was amplified by RT-PCR and PCR products were sequenced and analyzed., Results: The patient showed only HFMD symptoms, but no symptoms related to acute flaccid paralysis (AFP). No EVs were isolated from 16 samples collected from the patient and close contacts. And no AFP cases were found by an active search. A total of 21 samples from patients diagnosed as HFMD were collected in the same hospital at the same month and 4 were found to be EV71, 2 were CA16 and 15 (include the patient)were CA6. Only this patient was found to have had VDPV II infection. The CA6 VP1 gene was amplified from the HFMD patient and 9 other cases from the same hospital at the same month. Nucleotide sequences of the VP1 gene among the 9 strains shared 98.9%-100.0% in homology and 96.0%-100.0% in the deduced amino acid sequences. Phylogenetic analysis of the VP1 sequences categorized the 9 strains into the same branch. There were 6 nucleotides changes including U2909A between the VP1 region of the VDPV strain of the case and Sabin II. Results from phylogenetic analysis on the VP1 sequences indicated that the VDPV strain of the case was different from other VDPVs strains isolated in the world., Conclusion: This case was a HFMD which caused by CA6 co-infection with VDPV II and the VDPV was newly discovered. HFMD symptoms of the case were caused by CA6. The reason why this case did not have AFP symptoms was probably due the protective effect of IPV vaccine. No AFP cases were found by the active search for AFP cases conducted in the area, which indicated that VDPV did not cause virus circulation in this area.

Objective: To study the feasibility of endometrial sampling device as a sampling tool during the follow-up visit for endometrial cancer patients undergone conservative treatment., Methods: Before the hysteroscopy examination, endometrial sampling device was used to take the endometrium specimens 43 times in 19 patients who had been diagnosed as endometrial cancer or atypical hyperplasia, and were undergone conservative treatment during May 2012 to Mar. 2013. All cases accepted vaginal ultrasound screening before every sampling by endometrial sampling device. The histological results were compared with those done by hysteroscopy., Results: The average age of those patients was (30 ± 6) years old. The mean thickness of the endometrium during the treatment was (0.81 ± 0.65) cm. The qualified rate for the sampling was 95% (41/43). Compared with the specimens undergone by hysteroscopy direct sampling, 32 samples got by the endometrial sampling device with thicker endometrium (0.93 ± 0.70) cm had the same histological results, while the other 9 patients with thinner endometrium (0.40 ± 0.14) cm were not (P = 0.031)., Conclusion: The endometrial sampling device could be used during the follow-up visit for the conservative treatment patients with endometrial cancer or atypical hyperplasia, the vaginal ultrasound screening should be used together to figure out those with thinner endometrium.