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Background Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. Methods A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients’ Experience with Anticoagulation in the Post-discharge Period) for quality improvement. Results The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2–4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. Conclusions These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.

Aims Haemophilic pseudotumor (HPT) is a rare but challenging complication of haemophilia. This study was intended to provide our experience about clinical characteristics and surgical treatment of HPT. Methods Clinical medical records were retrieved from the Hemophilia Center, Nanfang Hospital, to identify the patients who had been surgically treated from 1 January 2006 to 31 December 2017 with a definite diagnosis of HPT. Their clinical features, surgical management, outcomes and complications after surgery were analysed. Results We identified 34 patients with HPT who had surgical treatment over a 12-year period and five of them had multiple HPTs. The incidence of HPT at this centre was 2.3% over the dozen years. A previous trauma leading to the development of HPT was reported in 18 cases (52.9%). The HPT affected only soft tissue in 7 patients, bone and soft tissue in 25 ones and joint in 2 ones. Preoperative infection and fistula formation happened in ten patients, two of whom were related to abdominal HPTs. Enterococcus faecalis was cultured in five cases with fistula formation. HPT associated with pathological fracture was observed in five cases, two of whom were treated by external fixation and 3 by HPT resection and metallic internal fixation. Amputation was performed for nine patients, 6 of whom had preoperative infection and fistula formation. Their follow-up duration averaged 4.2 ± 2.9 years (range, from 1 to 13.5 years) after surgery. Of all our cases, three suffered from postoperative infection, five from recurrence of HPT and two with external fixation from fracture non-union. Conclusions HPT patients with preoperative infection had worse prognosis than those without. Surgical treatment plus intensive replacement therapy was effective for HPT but with a high rate of complications. HPT resection and metallic internal fixation rather than external fixation should be recommended for HPT patients with pathological fracture.

C/C-SiC-ZrC composites with different ZrC distributions were fabricated using precursor infiltration pyrolysis combined with different drying processes. The microstructural and ablation resistance properties of the composites with different ZrC distributions were investigated. For the C/C-SiC-ZrC composites fabricated using conventional heating-drying, where ZrC particles were largely agglomerated into islands with a dimension range of 10–20 μm, the mass and linear ablation rates under a plasma flame for 60 s were 0.558 mg/s and 16.33 μm/s, respectively. By contrast, for the composites fabricated using freeze-drying, where isolated ZrC particles with a size range of 200–300 nm were uniformly dispersed in the matrix, the mass and linear ablation rates were only 0.078 mg/s and 14.20 μm/s, respectively. This difference in the distribution of ZrC particles led to the difference in ablation resistances, as the uniformly distributed fine ZrC particles were easily oxidized and well dispersed in SiO2 molten glass, which increased the viscosity of the molten glass layer. The high-viscosity SiO2-ZrO2 molten layer covering the surface of the composites effectively prevented the penetration of oxygen and resisted the scour of airflow.

Although intra-articular vancomycin powder (VP) is sometimes applied before the closure of the incision to prevent periprosthetic joint infection (PJI) after joint replacement, the dosage, efficacy, and safety remain controversial. This study aimed to explore the dosage, efficacy, and safety of intra-articular VP in the prophylaxis of infection after total knee arthroplasty (TKA) in a rat model. Sixty male rats were randomly divided into five groups after receiving TKA: control (no antibiotics); systemic vancomycin (SV) (intraperitoneal injection, 88 mg/kg of body weight, equal to 1 g in a patient weighing 70 kg); and VP0.5, VP1.0, and VP2.0 (44 mg/kg, 88 mg/kg and 176 mg/kg, respectively; intra-articular). All animals were inoculated in the knee with methicillin-resistant S. aureus (MRSA). General status, serum biomarkers, radiology, microbiological assay, and histopathological tests were assessed within 14 days postoperation. Compared with the control and SV groups, bacterial counts, knee width, tissue inflammation, and osteolysis were reduced in the VP0.5, VP1.0, and VP2.0 groups, without notable body weight loss and incision complications. Among all the VP groups, VP1.0 and VP2.0 groups presented superior outcomes with regard to knee width and tissue inflammation than the VP0.5 group. Microbial culture indicated that no MRSA survived in the knee of VP1.0 and VP2.0 groups, while bacteria growth was observed in the VP0.5 group. No obvious changes in the structure and functional biomarkers of liver and kidney were observed in either the SV or VP groups. Therefore, intra-articular vancomycin powder at a dosage from 88 mg/kg to 176 mg/kg may be effective and safe in preventing PJI induced by methicillin-resistant S. aureus in the rat TKA model.

BACKGROUND Long non-coding RNAs (lncRNAs) participate in all cancer biology processes of cells. Although functions and associated mechanisms of lncRNAs have been proven in colorectal cancer (CRC), the roles of lncRNA X-inactive specific transcript (XIST) have not been clearly investigated in CRC. MATERIAL AND METHODS Expression of XIST was detected by quantitative real-time PCR (qRT-PCR) assay in CRC cell lines and 196 clinical samples. Correlations between XIST expression and CRC clinicopathological features were analyzed. Log-rank test and Kaplan-Meier test were performed to assess and compare the prognoses of patients with higher and lower expression of XIST. The multivariate Cox regression and univariate Cox regression were conducted to evaluate the risk factors for prognosis of CRC. RESULTS lncRNA XIST was upregulated in CRC cells lines and tissues (p

The rate of eradication of periprosthetic joint infection (PJI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is still not satisfactory with systemic vancomycin administration after one-stage revision arthroplasty. This study aimed to explore the effectiveness and safety of intraarticular (IA) injection of vancomycin in the control of MRSA PJI after one-stage revision surgery in a rat model. Two weeks of intraperitoneal (IP) and/or IA injection of vancomycin was used to control the infection after one-stage revision surgery. The MRSA PJI rats treated with IA injection of vancomycin showed better outcomes in skin temperature, bacterial counts, biofilm on the prosthesis, serum α(1)-acid glycoprotein levels, residual bone volume, and inflammatory reaction in the joint tissue, compared with those treated with IP vancomycin, while the rats treated with IP and IA administration showed the best outcomes. However, only the IP and IA administration of vancomycin could eradicate MRSA. Minimal changes in renal pathology were observed in the IP and IP plus IA groups but not in the IA group, while no obvious changes were observed in the liver or in levels of serum markers, including creatinine, alanine aminotransferase, and aspartate aminotransferase. Therefore, IA use of vancomycin is effective and safe in the MRSA PJI rat model and is better than systemic administration, while IA and systemic vancomycin treatment could eradicate the infection with a 2-week treatment course.

BACKGROUND With the modernization of society and transportation in the last decades in China, the incidence of high-energy trauma increased sharply in China, including that of acetabular fractures. AIM To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum. METHODS The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer. After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity, the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones. RESULTS In the standing position, the maximum stress was 46.21 MPa. In the sitting position, the sacrum bore the simulated gravity load at the upper end. When comparing the five fixations, there were no significant differences in the stress mean values among groups (sitting: P = 0.9794; standing: P = 0.9741). In terms of displacement, the average displacement of the internal iliac plate group was smaller than that of the spring plate group (P = 0.002), and no differences were observed between the other pairs of groups (all P > 0.05). In the standing position, there were no significant differences in the mean value of displacement among the groups (P = 0.2985). It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment. CONCLUSION There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.

Background: Long noncoding RNAs (lncRNAs) have been shown to have a fundamental role in cancer initiation and development. LncRNA microvascular invasion in hepatocellular carcinoma (MVIH) has been identified as a potential prognostic marker in several cancers; however, its role in gastric cancer (GC) has not been elucidated. Materials and Methods: A total of 152 tissue samples from patients underwent GC surgical resection in Linyi People's Hospital between 2007 and 2010 were collected. Quantitative real-time polymerase chain reaction was conducted to examine the expression level of lncRNA MVIH. The selection of clinically important cut-off scores for MVIH expression was based on receiver operating characteristic curve analysis. Then, the association between MVIH and GC clinicopathological parameters was analyzed. Moreover, univariate and multivariate Cox regression analysis were performed to reveal the relationship between MVIH and GC prognosis. Results: GC tissues exhibited a higher lncRNA MVIH expression level than paired nontumoros tissues. High MVIH level was revealed to be associated with the T stage, tumor-node-metastasis (TNM) stage and lymphatic metastasis of GC. Specially, patients with high MVIH expression level showed significantly shorter overall survival rate and progression-free survival rate. Moreover, invasion depth, distant metastasis, TNM stage, and MVIH expression were identified as risk factors of GC poor prognosis on univariate Cox regression analyses. By further analyzing these factors with multivariate logistic regression, high MVIH, and distant metastasis were discovered to be independent risk factors of GC prognosis. Conclusions: High MVIH is an independent risk factor of GC prognosis. LncRNA MVIH may serve as a potential therapeutic target and a prognostic marker of GC patients.

Purpose This study was intended to characterize the epidemiological features of thumb polydactyly (TP) in South China. Methods Clinical records were retrieved from 1 central hospital in South China to identify the patients with a definite diagnosis of TP from January 2004 to January 2017. The cases were classified by their x-ray appearance. The data collected included sex, age at first operation, reoperation, family history, unilateral/bilateral polydactyly, right/left hand involvement in unilateral cases, classification of polydactyly, and the presence of associated congenital anomalies. Results A total of 428 patients with a definite diagnosis of TP were identified (278 males and 150 females) involving 483 cases, 373 unilateral and 55 bilateral. A syndrome or associated congenital anomaly was found in 26 (18 unilateral and 8 bilateral cases). A dominant thumb, larger and more developed, was observed in 448 hands (93%), and was the ulnar thumb in 433. Owing to postoperative complications, 31 thumbs (6.4%) underwent reoperation. The average interval from initial surgery to reoperation was 4.8 years. Conclusions Thumb polydactyly had a male predominance in this Chinese cohort, mostly occurring on the right hand with an ulnar dominant thumb. Bilateral cases had a higher incidence of associated anomaly and positive family history than unilateral cases. The need for additional surgery for TP might occur as late as 4.8 years after primary surgery. Type of study/level of evidence Therapeutic IV.

In modern life, emotions affect people in all aspects of their work and life. Long-term emotional problems tend to cause physical and mental problems such as depression. The photoplethysmogram(PPG) and electroencephalogram (EEG) etc are often used for emotion recognition, because the emotional state produces reactions from different biological systems of the human body. This article uses an internationally released emotional classification database called DEAP dataset that contains 32-channel standard EEG signals and 8-channel peripheral physiological signals. To achieve wearable emotion continuous recognition, this paper strives to obtain satisfactory emotion recognition through fewer EEG channels and peripheral physiological signals. Machine learning methods are used to classify arousal and valence that are often used in emotional recognition. The results show that the arousal classification accuracy can achieve 68% and the valence classification accuracy can achieve 66% with 5 channel EEG signal and one channel PPG signal, which can be monitored through a wearable headband.

Objective To compare the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) and endoscopic variceal ligations (EVL) plus propranolol in decreasing rebleeding and improving survival rates in cirrhotic patients with cavernous transformation of the portal vein (CTPV). Methods Cirrhotic patients with CTPV and a history of variceal bleeding who were treated for recurrent variceal bleeding between June 2010 and July 2016 were identified and classified based on the treatment they received (TIPS or EVL plus propranolol). Their characteristics and clinical data were recorded. The rebleeding and long-term survival rates between the two groups were analyzed. Results A total of 51 patients were included, of whom 25 were treated with TIPS and 26 with EVL plus propranolol. The mean duration of follow up was 21 months (range 1-47 months) in the former group and 27 months (range 6-73 months) in the latter group. The recurrent variceal bleeding-free rate increased remarkably in the TIPS group compared with the EVL + propranolol group (P = 0.047). Three (14.3%) patients died in the TIPS group, and one (3.8%) in the EVL plus propranolol group (P = 0.305). Hepatic encephalopathy occurred in 14.3% (3/21) of the patients in the TIPS group and in 3.8% (1/26) in the EVL + propranolol group (P = 0.202). Conclusion TIPS appeared to be more effective in preventing rebleeding in cirrhotic patients with CTPV compared with EVL plus propranolol, without improving survival.

A novel SiC–ZrB 2 coating was prepared using a two-step technique by slurry-sintering and chemical vapor reaction on carbon/carbon (C/C) composites. The SiC–ZrB 2 coating was composed of the scattered ZrB 2 phase and the continuous SiC phase. It was observed that a good adhesion was built between the coating and the C/C composites. The SiC–ZrB 2 coating samples exhibited a better ablation resistance in comparison with the uncoated C/C composites. The SiO 2 –ZrO 2 barrier layer, the heat dissipation of the gaseous products and the pinning effect of ZrO 2 all contributed to the good ablation resistance of the SiC–ZrB 2 coated composites.

This paper presents the design, implementation and test of a watch with the capability to measure multiple physiological signals, such as photoplethysmography (PPG), electrocardiography (ECG), and some physiological parameters extracted from PPG and ECG. Based on the PPG and ECG signals, the pulse rate and heart rate could be extracted respectively. Moreover, the pulse transmit time (PTT) could be extracted combining PPG and ECG, which was the key to calculate blood pressure (BP). The circumstance conditions (temperature, humidity and barometric pressure) were detected and displayed on the screen. A motion state was used to toggle the watch screen. Meanwhile all data measured could be sent to an android smart phone, using a Texas Instruments' (TI's) Bluetooth low energy chip CC2540. The PPG wave, ECG wave, heart rate, as well as the systolic blood pressure (SBP) and diastolic blood pressure (DBP) can be displayed on the android client in real time. Compared with the sport band and other smart watches, this multi-parameter health monitoring watch had the advantage of monitoring more parameters. We had made a test to compare this watch with standard equipment, Benavidez T5 and SUNTECH OSAR2, and the result showed that the relative error of heart rate, pulse rate, SBP and DBP against reference were 1.76 ±1.64bpm, 1.76 ±1.64bpm, 4.01 ± 2.75 mmHg, 4.64 ± 3.31 mmHg. These results demonstrated that this watch has a broad prospect in the field of mobile health care.

Background Herbal quality is strongly influenced by harvest time. It is therefore one of crucial factors that should be well respected by herbal producers when optimizing cultivation techniques, so that to obtain herbal products of high quality. In this work, we paid attention on one of common used Chinese herbals, Cyathula officinalis Kuan. According to previous studies, its quality may be related with growth years because of the variation of several main bioactive components in different growth years. However, information about the whole chemical composition is still scarce, which may jointly determine the herbal quality. Methods Cyathula officinalis samples were collected in 1–4 growth years after sowing. To obtain a global insight on chemical profile of herbs, we applied a metabolomics approach based on gas chromatography–mass spectrum. Analysis of variance, principal component analysis, partial least squares discriminant analysis and hierarchical cluster analysis were combined to explore the significant difference in different growth years. Results 166 metabolites were identified by using gas chromatography–mass spectrum method. 63 metabolites showed significant change in different growth years in terms of analysis of variance. Those metabolites then were grouped into 4 classes by hierarchical cluster analysis, characterizing the samples of different growth ages. Samples harvested in the earliest years (1–2) were obviously differ with the latest years (3–4) as reported by principal component analysis. Further, partial least squares discriminant analysis revealed the detail difference in each growth year. Gluconic acid, xylitol, glutaric acid, pipecolinic acid, ribonic acid, mannose, oxalic acid, digalacturonic acid, lactic acid, 2-deoxyerythritol, acetol, 3-hydroxybutyric acid, citramalic acid, N-carbamylglutamate, and cellobiose are the main 15 discrimination metabolites between different growth years. Conclusion Harvest time should be well considered when producing C. officinalis. In order to boost the consistency of herbal quality, C. officinalis is recommended to harvest in 4th growth year. The method of GC–MS combined with multivariate analysis was a powerful tool to evaluate the herbal quality. Electronic supplementary material The online version of this article (doi:10.1186/s13020-017-0133-1) contains supplementary material, which is available to authorized users.

Bi2Fe4O9 submicron-rods were synthesized by a low-heating temperature solid state precursor method. This process, featured by low cost and simplicity, does not involve the use of metal catalyst or protective gas. The effects of different calcine temperatures on the structure, morphology, magnetic and optical properties of the Bi2Fe4O9 were characterized by X-ray diffraction, scanning electron microscope, energy dispersive X-ray spectroscopy, transmission electron microscopy techniques, vibrating sample magnetometer and ultraviolet visible absorption spectra. The Bi2Fe4O9 submicron-rods attained at 700 degrees C possess a perfect submicron-rod shape with a smaller bandgap (1.76 eV).

Based on the rigorous coupled wave theory, the narrowband reflect spectral imaging characteristics on two-dimensional photonic crystal are analyzed, and two-dimensional photonic crystal sensor probe biological structure and photonic crystal biosensor system are constructed. The simulation proved that, when the adsorption medium at the surface of two-dimensional photonic crystal are different, the white light narrowband reflection resonance mode peak wavelength would drift, and the drift quantity of the peak wavelength and the refractive index of the adsorptive medium is in a linear relationship. Colored the space imaging spectra of photonic crystal, the changes of the adsorbate refractive index in different area of the photonic crystal surface can be observed , the adsorbate concentration changes can also be got. This conclusion can be applied to biochemical substances, pharmaceutical, biological molecules and environmental pollution detection.

Objective This study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis. Patients and methods We retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12–63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76 cm (range, 2.7–15.7 cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity). Results The mean follow-up after removal of the apparatus was 25.26 months (range, 14–51 months). The mean finite fixator time was 10.15 months (range, 8–14 months) in group A versus 17.21 months (range, 11–24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)]. Conclusions In the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.

The chemokine receptor 4 (CXCR4) has been widely used in diagnosis and prognosis of colorectal cancer (CRC). However, there is no current consensus on the impact of CXCR4 on CRC patients. The purpose of this study was to evaluate the prognostic and clinicopathological importance of CXCR4 in CRC patients. Databases, such as PubMed, Cochrane library, CBM and EMBASE updated to 2014 were searched to include eligible articles. We analysed correlations between CXCR4 expression and clinicopathological features and overall survival (OS). A total of 1, 055 CRC patients from twelve studies were included in the study. The pooled odds ratios (ORs) which indicated CXCR4 expression was likely to be associated with TNM stage (OR=0.43, CI=0.34-0.55, P

The expiration of patents on many biological medicinal products has prompted the development of these products as similar biological (biosimilar) products. The standard approach of demonstration of bioequivalence for chemical generic products is scientifically not applicable for biosimilar products. The biosimilar product approach, based on comparability (demonstration of similarity), should be adopted. In view of the impending submissions and to facilitate access of such products at a more affordable price in Singapore, the Health Sciences Authority (HSA) formalised the procedures and requirements for registration of biosimilar products in 2009. HSA has published the “Guideline on Registration of Similar Biological Products in Singapore” which describes the basic principles, submission procedure, and requirements pertaining to documentation, pharmacovigilance, and post-approval batch release for the registration of biosimilar products. This article provides a brief overview as well as key points on the registration of medicinal products and biosimilar products in Singapore.

To evaluate the recurrence of common bile duct stones and risk factors for recurrence following routine endoscopic sphincterotomy (EST) versus small-incision endoscopic sphincterotomy plus endoscopic papillary balloon dilation (EST-EPBD). Three hundred patients who were hospitalized between June 2007 and June 2008 with common bile duct stones >10 mm in diameter were randomly assigned to the EST or EST-EPBD group. We compared the short-term (≤3 years) and long-term (>3 years) recurrence of ductal stones in the two groups over a 72-month follow-up period. Potential risk factors were evaluated using a logistic regression analysis. A total of 291 patients completed the study. The short-term recurrence rate in the EST group was not significantly higher than that in the EST-EPBD group (P > 0.05). The long-term recurrence rate for the EST group was significantly higher than that for the EST-EPBD group (P

Introduction From 2011 to 2012, we received an unexpectedly high number of reports of suppurative lymphadenitis following administration of a BCG vaccine used in our childhood vaccination programme in Singapore. We sought to determine the local incidence rates of BCG-associated suppurative lymphadenitis across the 2009 to 2012 vaccinated cohorts, and to analyse the potential factors contributing to this outbreak. Methods Reports of lymphadenitis following BCG vaccination from an AEFI active surveillance system at the KK Women's and Children's Hospital (KKH) and passive surveillance data from other healthcare institutions were reviewed. All valid reports received from January 2009 to December 2013 involving neonates vaccinated with the BCG vaccine in 2009 to 2012 that met case definitions were included in our analysis. Details of the demographics and vaccination history of the child, and statistics from the local vaccination programme were also obtained. Potential contributory factors were selected for further investigation based on a literature review of similar outbreaks overseas. Results We identified 283 cases of lymphadenitis, of which 76% were suppurative. A spike in suppurative lymphadenitis cases was seen in the 2011 vaccinated cohort, with an incidence rate of 3.16 per 1000 vaccinees, as compared to 0.71 to 0.85 per 1000 in the 2009, 2010 and 2012 cohorts. Our investigations identified the likely cause of the outbreak to be batch-related, arising from manufacturing issues encountered by the manufacturer, after ruling out vaccine administration-related and host-related factors. Conclusions The three-fold spike in BCG-associated suppurative lymphadenitis cases observed in the 2011 vaccinated cohort, possibly due to batch-to-batch variation of the vaccine, highlights that manufacturing controls can continue to be a challenge. Development of a more sensitive assay to test the reactogenicity of the BCG vaccine may help reduce the occurrence of such outbreaks and improve public confidence in the nation's vaccination programme.

Background A retrospective study was performed to assess the causes, diagnostic methods for, and clinical features of, jejunoileal hemorrhage in Shandong province, China and to derive recommendations for management of this condition from these data. Methods We performed a retrospective systematic collection of data from between January 1999 and December 2008 in seven cities in Shandong province, China, identified 72 patients with jejunoileal hemorrhage and analyzed the relevant clinical data. Results Overall, tumors were the most common cause of jejunoileal hemorrhage (42 patients, 58.3%). The causes of this condition were significantly different (P Conclusion Tumor, enteritis and angiopathy and diverticular disease are the most common causes of jejunoileal hemorrhage in Shandong province, China. The main clinical manifestations are bloody stools, most commonly in the form of melena, with or without abdominal pain. We recommend that female patients over the age of 40 with jejunoileal hemorrhage accompanied by abdominal pain should undergo urgent further assessment because of the strong probability of jejunoileal tumor.

The mutational profiles of hypopharyngeal squamous cell carcinoma (HSCC), an anatomical and clinical subtype of head and neck squamous cell carcinoma (HNSCC) was characterized in this study. Whole exome sequencing of HSCC tumors (n=15) and normal pairs (n=15) reveals distinct somatic gene mutations to HSCC (KDR, ABL-1, ATM, and HNF1A), while some others are common to HNSCC significantly mutated genes (e.g. TP53, HRAS, NOTCH1 and PIK3CA). Copy number analysis shows distinct signatures of HSCC gene amplifications(e.g. CCND1) or deletions(e.g. GSTT1). Furthermore, pathway analysis identified several statistically significant enriched pathways (e.g. VEGFR signaling) for genomic alterations specific to HSCC. We then performed targeted therapies to individual patients corresponding to their mutation profiles, and monitored their responses to the personalized treatment by enumerating the circulating tumor cells. These findings offer new insights into understanding fundamental tumorigenic mechanisms of HSCC and exploring precise therapies. Citation Format: Zhiye Liu, Lai Wei, Dewei Zhao, Ruoyu Wang, Kai Tong, Yuewei Zhang, Bin Yang, Hong Cao, Nina Li, Shanshan Liang, Jiahuan Gu, Zhiqiang Wang, Yan Ding. Mutation profiling reveals distinct signatures in hypopharyngeal squamous cell carcinoma. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr 20.