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The emergence of antibiotics residues in pharmaceutical industrial wastewater has been a significant environment problem. However, current methods of treating antibiotic-polluted wastewater are inefficient, of high cost and time-consuming. In this study, highly effective enzymatic Fe3O4 magnetic nanoparticles were developed, which is extremely simple and can degrade antibiotics in a fast manner at a low cost. β-Lactamase, a representative enzyme for β-lactam antibiotic degradation, was covalently immobilized on the surface of magnetic nanoparticles modified with amino groups by a simple cross-linking process. The immobilized β-lactamase displayed a wider pH and temperature range for penicillin G degradation than the free enzyme. Meanwhile, the thermostability and storage stability of the immobilized β-lactamase were improved. Fifty milligrams magnetic nanoparticles immobilized with β-lactamase can thoroughly degrade 100 mL penicillin G (5–50 mg L−1) within 5 min. Even if the β-lactamase immobilized on the nanoparticles was reused 35 times in the 5 mg L−1 penicillin G solution, it still kept more than 95% degradation efficiency. These suggest that magnetic nanoparticles immobilized with β-lactamase have a sufficient capacity for degrading antibiotics in wastewater and will serve as a practical and economical solution to antibiotic pollution in pharmaceutical industrial wastewater treatment.

Background Contrast-induced acute kidney injury (CI-AKI) is one of the most serious complications in patients who undergo percutaneous coronary intervention (PCI), especially in those with acute coronary syndrome. It has been shown that inflammation may play an important role in the pathophysiology of CI-AKI. Hypothesis Inflammatory factors may play a predominant role in the prediction of CI-AKI in patients who undergo emergency PCI. Methods Patients who underwent emergency PCI from 2013 to 2015 were consecutively enrolled and were divided into CI-AKI and non–CI-AKI groups. Logistic analysis was used to identify the risk factors of CI-AKI. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve (AUC) and to establish the optimal cutoff. Results A total of 1061 patients were included, and the CI-AKI rate was 5.47% (58/1061). Logistic analysis showed that the white blood cell (WBC) count (odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.018-1.195, P = 0.016), neutrophil (N) count (OR: 1.134, 95% CI: 1.045-1.232, P = 0.003), neutrophil to lymphocyte ratio (NLR) (OR: 1.105, 95% CI: 1.044-1.169, P = 0.001), C-reactive protein (CRP) level (OR: 1.006, 95% CI: 1.001-1.011, P = 0.020), high-sensitivity C-reactive protein (hs-CRP) level (OR: 1.099, 95% CI: 1.020-1.184, P = 0.013), and big endothelin-1 (ET-1) level (OR: 4.030, 95% CI: 1.989-8.165, P < 0.001) were all significant predictors for CI-AKI, as was the left ventricular ejection fraction and diuretic administration. The AUC of the big ET-1 level was the highest (0.793, 95% CI: 0.733-0.853), followed by the NLR (0.708, 95% CI: 0.641-0.774), hs-CRP level (0.705, 95% CI: 0.627-0.782), CRP level (0.684, 95% CI: 0.607-0.761), N count (0.655, 95% CI: 0.584-0.726), WBC count (0.620, 95% CI: 0.544-0.695), and erythrocyte sedimentation rate (0.611, 95% CI: 0.527-0.695). Conclusions The WBC count, N count, NLR, CRP level, hs-CRP level, and big ET-1 level are all associated with an increased risk of CI-AKI, and among which, the big ET-1 level, NLR, and the hs-CRP level might have high predictive value for CI-AKI after an emergency PCI.

Background Although primary percutaneous coronary intervention (pPCI) is the optimal reperfusion method for ST-segment elevation myocardial infarction (STEMI), it remains difficult to implement in many areas. Some STEMI patients have to accept fibrinolytic therapy and no reperfusion therapy instead. Purpose The aim of this study was to describe the impact of reperfusion therapy on the long-term outcomes of STEMI patients in China. Methods Using data from the China Acute Myocardial Infarction (CAMI) registry, we analyzed the 2-year outcomes of 18,075 STEMI patients symptom onset within 7 days from January 2013 to September 2014 according to the type of reperfusion therapy. The primary endpoint was a composite of major adverse cardiovascular event (MACE), defined as all-cause mortality, myocardial infarction or stroke. Results 7798 (43%) were treated with pPCI and 1798 (10%) underwent fibrinolysis; 8479 (47%) did not receive any reperfusion. The 2-year MACE was 9.6% following pPCI, 15.7% following fibrinolysis, and 21.5% for patients without reperfusion therapy (P6 hours (HR 0.86, 95% CI 0.76–0.97, P=0.01) of symptom onset. Adjusted cumulative MACE rate Conclusions In a real-world setting, early reperfusion is the optimal strategy for STEMI. Fibrinolysis was not associated with better outcome in STEMI patients admitted >3 hours of symptom onset in Chinese real world setting. Acknowledgement/Funding Ministry of Science and Technology of China (Grant No. 2011BAI11B02)

Background Prediction of in-hospital bleeding is critical for clinical decision making for acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Machine learning methods can automatically select the combination of the important features and learn their underlying relationship with the outcome. Objective We aim to evaluate the predictive value of machine learning methods to predict in-hospital bleeding for AMI patients. Methods We used data from the multicenter China Acute Myocardial Infarction (CAMI) registry. We randomly partitioned the cohort into derivation set (75%) and validation set (25%). Using data from the derivation set, we applied a state-of-art machine learning algorithm, XGBoost, to automatically select features from 106 candidate variables and train a risk prediction model to predict in-hospital bleeding (BARC 3, 5 definition). Results 16736 AMI patients who underwent PCI were consecutively included in the analysis, while 70 (0.42%) patients had in-hospital bleeding followed the BARC 3,5 definition of bleeding. Fifty-nine features were automatically selected from the candidate features and were used to construct the prediction model. The area under the curve (AUC) of the XGBoost model was 0.816 (95% CI: 0.745–0.887) on the validation set, while AUC of the CRUSADE risk score was 0.723 (95% CI: 0.619–0.828). Relative contribution of the 12 most important features Feature Relative Importance Direct bilirubin 0.078 Heart rate 0.077 CKMB 0.076 Creatinine 0.064 GPT 0.052 Age 0.048 SBP 0.036 TG 0.035 Glucose 0.035 HCT 0.031 Total bilirubin 0.030 Neutrophil 0.030 ROC of the XGBoost model and CRUSADE Conclusion The XGBoost model derived from the CAMI cohort accurately predicts in-hospital bleeding among Chinese AMI patients undergoing PCI. Acknowledgement/Funding the CAMS innovation Fund for Medical Sciences (CIFMS) (2016-12M-1-009); the Twelfth Five-year Planning Project of China (2011BAI11B02)

Aims We aim to investigate the effect of single dose of statin pretreatment prior to primary Percutaneous Coronary Intervention (PCI) on long-term clinical outcomes in patients with ST-elevation Myocardial Infarction (STEMI). Methods Using data from China Acute myocardial Infarction (CAMI) registry, we compared the outcome in STEMI patients with vs without atorvastation pretreatment prior to primary PCI. The primary endpoint was the composite outcome of all-cause mortality, non-fatal MI or stroke events during follow-up. Propensity-score (PS) matching was used to assemble a cohort of patients with similar baseline characteristics. All patients were followed till 24 months since baseline. Results Of all 3772 patients who met our inclusion criteria at 108 hospitals in China, 3288 patients (1644 patients in each arm) were included in our PS-matched cohort. In the PS-match cohort, overall 144 (8.65%) and 113 (6.79%) patients in the control group and pretreatment group had the primary endpoint respectively (p=0.048). The estimated HRs were 0.78 (95% CI: 0.606–0.997, p=0.046) in the unadjusted model and 0.76 (95% CI: 0.596–0.984, p=0.032) in the adjusted model (Figure). The HRs were broadly similar for the pretreatment dosage of 40 mg or 80 mg (0.78 vs 0.77, p=0.75). The HRs were even stronger in patients with single-vessel only than multi-vessel coronary artery disease (0.31 vs 0.75, p=0.014). Conclusion Among Chinese patients with STEMI, atorvastatin pretreatment before primary PCI may have better long-term composite outcome of all-cause mortality, non-fatal MI, or stroke events. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

Animal and imaging study evidence favors early reperfusion for acute myocardial infarction. However, in clinical trials, the effect of symptom-onset-to-balloon (S2B) time on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) has been inconsistent. Moreover, there are few data regarding the ischemic time in China. A total of 3,877 consecutive patients with STEMI with available S2B time undergoing pPCI from January 2013 to September 2014 at 108 hospitals that participated in the China Acute Myocardial Infarction registry were included and stratified into 3 S2B groups:6 hours, 6 to 12 hours,12 hours S2B time was tested in multivariate logistic regression analyses as an independent risk factor of mortality (primary outcome), major adverse cardiovascular and cerebrovascular events (MACCE), and impaired myocardial perfusion (secondary outcomes). The median S2B time was 5.5 (3.75 to 8.50) hours. Longer S2B time was associated with higher in-hospital mortality (6 hours: 2.7%; 6 to 12 hours: 3.4%;12 hours: 4.9%; p = 0.047) and ST-segment resolution50% (6 hours: 16.7%; 6 to 12 hours: 19.2%;12 hours: 24.3%; p = 0.002) but not MACCE. In multivariate-adjusted analysis, S2B12 hours remained associated with ST-segment resolution50% (odds ratio 1.53, 95% confidence interval 1.16 to 2.01, p = 0.002) but not with in-hospital mortality (odds ratio 1.673, 95% confidence interval 0.95 to 2.94, p = 0.073). In conclusion, median S2B time in patients with STEMI undergoing pPCI was longer than that in registry studies from other countries. Longer S2B time was associated with impaired myocardial perfusion but not with in-hospital mortality or MACCE.

ObjectiveTo investigate the morphology and dimensions of the vestibular aqueduct on axial, single-oblique and double-oblique computed tomography images.MethodsThe computed tomography temporal bone scans of 112 patients were retrospectively evaluated. Midpoint and opercular measurements were performed using axial, single-oblique and double-oblique images. Morphometric analyses were also conducted. The vestibular aqueduct sizes on axial, single-oblique and double-oblique images were compared.ResultsAt the midpoint, the mean (± standard deviation) vestibular aqueduct measured 0.61 ± 0.23 mm, 0.74 ± 0.27 mm and 0.82 ± 0.38 mm on axial, single-oblique and double-oblique images, respectively; at the operculum, the vestibular aqueduct measured 0.91 ± 0.30 mm, 1.11 ± 0.45 mm and 1.66 ± 1.07 mm on the respective images. The co-efficients of variation of the vestibular aqueduct measured at the midpoint were 37.4 per cent, 36.5 per cent and 47.5 per cent on axial, single-oblique and double-oblique images, respectively; at the operculum, the measurements were 33.0 per cent, 40.5 per cent and 64.5 per cent. Regarding morphology, the vestibular aqueduct was fissured (33.5 per cent), tubular (64.3 per cent) or invisible (2.2 per cent).ConclusionThe morphology and dimensions of the vestibular aqueduct were highly variable among axial, single-oblique and double-oblique images.

Xie KX, Wang XY, Gao XJ, Yuan CY, Li JX, Chu CH. Fracture resistance of root filled premolar teeth restored with direct composite resin with or without cusp coverage. International Endodontic Journal. Aim To evaluate the fracture resistance and fracture patterns of root filled maxillary first premolar teeth (with mesio‐occlusal cavity preparation) restored with

SUMMARYToxoplasmosis, caused by the protozoan parasiteToxoplasma gondii, is one of the most common parasitic infections in humans. Primary infection in pregnant women can be transmitted to the fetus leading to miscarriage or congenital toxoplasmosis. Carefully designed nationwide seroprevalence surveys and case-control studies of risk factors conducted primarily in Europe and America, have shaped our view of the global status of maternal and congenital infection, directing approaches to disease prevention. However, despite encompassing 1 in 5 of the world's population, information is limited on the status of toxoplasmosis in China, partly due to the linguistic inaccessibility of the Chinese literature to the global scientific community. By selection and analysis of studies and data, reported within the last 2 decades in China, this review summarizes and renders accessible a large body of Chinese and other literature and aims to estimate the seroprevalence in Chinese pregnant women. It also reviews the prevalence trends, risk factors, and clinical manifestations. The key findings are (1) the majority of studies show that the overall seroprevalence in Chinese pregnant women is less than 10%, considerably lower than a recently published global analysis; and (2) the few available appropriate studies on maternal acute infection suggested an incidence of 0·3% which is broadly comparable to studies from other countries.

Five streptococcal strains were isolated from dental plaque and saliva of caries-free humans. The cells were gram-positive, non-spore-forming, non-motile cocci that were arranged in short chains. The strains were catalase-negative, facultatively anaerobic and produced lactic acid exclusively from glucose fermentation. Biochemical analysis that used both conventional methods and the commercial API 20 Strep system showed that the five strains fermented only a few kinds of sugar. The mean DNA G + C content of the five novel strains was 39.5 +/- 0.8 mol%. Phylogenetic analysis based on 16S rDNA sequence homology indicated that the new isolates represented a novel member of the mitis group of the genus Streptococcus, related most closely to the recently described species Streptococcus sinensis. DNA-DNA relatedness between novel strain LMG 21535T and type strains of phylogenetically related species of oral streptococci was 7.1-16.4%. Therefore a novel Streptococcus species, Streptococcus oligofermentans sp. nov., is proposed. The type strain is LMG 21535T=AS 1.3089T.

OBJECTIVE To better understand the relationship between leptin and the anthropometric and physiological variables associated with diabetes, we measured this protein in an isolated Canadian aboriginal population with very high rates of NIDDM. RESEARCH DESIGN AND METHODS There were 728 individuals aged 10–79 years who participated in a population-based survey to determine the prevalence of NIDDM and its associated risk factors. Fasting blood samples for glucose, insulin, triglyceride, and leptin were collected; a 75-g oral glucose tolerance test was administered and a second blood sample drawn after 120 min. Height, weight, and waist and hip circumference were determined, and percent body fat was estimated using biological impedance analysis. Fitness level was assessed in a subsample of individuals using a validated submaximal step test. The relationship between serum leptin and the other variables was assessed using Spearman's correlation coefficients and multiple linear regression. RESULTS Serum leptin concentration was strongly correlated with adiposity, and levels were substantially higher in female subjects in all age-groups. For male subjects, percent body fat, fasting insulin level, and waist circumference were significant independent predictors of log serum leptin concentration in a multiple linear regression model (R2 ; 0.582). For female subjects, these variables plus glucose tolerance status were included in the final model (R2 ; 0.633). Fitness level, when included with the main effects of the above models, was a significant predictor for male subjectsonly. CONCLUSIONS In an isolated aboriginal community with high rates of diabetes, we found significant independent relationships between leptin and percent body fat and between leptin and fasting insulin. As documented in other populations, the higher leptin concentration among female subjects may reflect differential leptin production from different adipose tissue beds, or leptin resistance. Independent relationships also existed among leptin and glucose tolerance status in female subjects and fitness level in male subjects.

Objective: To compare the survival of glass ionomer cement (GIC) restorations placed in a dental clinic setting using both the atraumatic restorative treatment (ART) approach with hand instruments, and conventional cavity preparation with rotary instruments. Method and Materials: Two encapsulated high-strength conventional GICs (Fuji IX GP, Ketac-Molar Aplicap) were placed in 82 Class I and 53 Class II preparations and one encapsulated non-gamma 2 amalgam alloy (GK-amalgam) was placed in 32 Class I preparations, in the primary molars of 60 Chinese children with a mean age of 7.40 ± 1.24 (SD) years. Thus, 9 treatment groups were formed. Results: After two years, there were no significant survival differences found among 7 of the 9 treatment groups (p = 0.99). However, two groups comprising Fuji IX GP and Ketac-Molar Aplicap placed in Class II cavities prepared using the ART approach showed significantly lower restoration survivals (p < 0.001). Only 3 of the 72 initially sealed fissures adjacent to the restorations appeared to retain any GIC material. Conclusions: In a clinic setting, both the ART hand instrument and conventional rotary instrument methods were equally suitable for high Class I restoration survival, but not for Class II restoration survival where the conventional cavity preparation method was preferable.

Exposure of non-smoking pregnant women to environmental tobacco smoke, or passive smoking, has been shown to be associated with spontaneous abortion, perinatal death, premature delivery and low birthweight. In the west, smoking by pregnant women is a major health problem. In Asia, women smoke much less commonly, but smoking among men is increasing rapidly; therefore, passive smoking by non-smoking women is an increasing problem for maternal and child health.

Intensified plaque acidogenicity in caries–prone subjects was reported many years ago, but emerging evidence has suggested that the relationship may not be as strong as once thought. We have now determined a range of acidogenicity variables in subjects having both caries prevalence and incidence data, and have included plaque mineral data in the analysis. pH measurements were made in 20 randomly selected subjects from a high–caries group (mean DMFS = 8.95) and 20 from a caries–free group of Beijing children aged 12 years participating in a caries prediction study. Subgroups with a 12–month DMFS increment ≥2 or = 0 were also formed from the two groups, respectively. Measurements were made with an iridium oxide electrode inserted between teeth 13/14, 23/24, 34/35 and 44/45, before and every 5 min for 30 min after rinsing with 10% sucrose, and the 4 resulting ‘Stephan curves’ averaged using a plaque pH analysis program. Supragingival plaque was collected from buccal and lingual smooth surfaces of posterior and upper anterior teeth and its acid extract analysed for Ca, P and F. Caries–free subjects (based on past experience) had a significantly higher maximum plaque pH and pH value after 30 min (reflecting a faster return to resting pH), a lower minimum enamel dissolution capacity of plaque and recorded less time below pH 7.0 than did high–caries subjects. No other differences were significant, including those of the principal acidogenic parameters ‘minimum pH attained after a sugar rinse’, ‘curve area below the critical pH of 5.5’ and ‘time below the critical pH’. Selection of the caries groups on the basis of both experience and incidence did not reveal significant differences in more parameters. Upper arch plaque was significantly more acidogenic than lower arch plaque, and there was a consistently strong association between upper and lower arch values in individuals. Ca, P and F in the subjects’ plaque had little or no influence on the principal acidogenic parameters. Our failure to find a relationship between caries prevalence or activity and these principal acidogenicity parameters may be related to differences between fissure and smooth surface plaque, temporal variations in acidogenicity and/or to use of F toothpaste during the 1–year observation period. These results support the view that factors such as the frequency of acidogenic episodes may be more important in caries progression than the degree of acidogenicity during any one episode.