[A multicenter retrospective study on the etiology of necrotizing pneumonia in children]

Objective: To investigate the etiology of necrotizing pneumonia (NP) in children and the clinical characteristics of NP caused by different pathogens in China. Methods: A retrospective, case-control study was performed in children with NP who were admitted to 13 hospitals in China from January 2008 to December 2019. The demographic and clinical information, laboratory data, etiological and radiological findings were analyzed. The data were divided into three groups based on the following years: 2008-2011, 2012-2015 and 2016-2019, and the distribution characteristics of the pathogens in different period were compared. Meanwhile, the pathogens of pediatric NP in the southern and northern China were compared. And the clinical characteristics of the Mycoplasma pneumoniae (MP) NP and the bacterial NP were also compared. T-test or Mann-Whitney nonparametric test was used for comparison of numerical variables, and χ² test was used for categorical variables. Results: A total of 494 children with NP were enrolled, the median ages were 4.7 (0.1-15.3) years, including 272 boys and 222 girls. Among these patients, pathogens were identified in 347 cases and the pathogen was unclear in the remaining 147 cases. The main pathogens were MP (238 cases), Streptococcus pneumoniae (SP) (61 cases), Staphylococcus aureus (SA) (51 cases), Pseudomonas aeruginosa (13 cases), Haemophilus influenzae (10 cases), adenovirus (10 cases), and influenza virus A (7 cases), respectively. MP was the most common pathogen in all three periods and the proportion increased yearly. The proportion of MP in 2016-2019 was significantly higher than that in 2012-2015 (52.1% (197/378) vs. 36.8% (32/87), χ²=6.654, P=0.010), while there was no significant difference in the proportion of MP in 2012-2015 and that in 2008-2011 (36.8% (32/87) vs. 31.0% (9/29), χ²=0.314, P=0.575).Regarding the regional distribution, 342 cases were in the southern China and 152 in the northern China. Also, MP was the most common pathogen in both regions, but the proportion of MP was higher and the proportion of SP was lower in the north than those in the south (60.5% (92/152) vs. 42.7% (146/342), χ²=13.409, P<0.010; 7.9% (12/152) vs. 14.3% (49/342), χ²=4.023, P=0.045). Comparing the clinical characteristics of different pathogens, we found that fever and cough were the common symptoms in both single MP and single bacterial groups, but chest pain was more common (17.0% (34/200) vs. 6.1% (6/98), χ²=6.697, P=0.010) while shortness of breath and wheezing were less common in MP group (16.0% (32/200) vs. 60.2% (59/98), χ²=60.688, P<0.01; 4.5% (9/200) vs. 21.4% (21/98), χ²=20.819, P<0.01, respectively). The white blood cell count, C-reactive protein and procalcitonin in the bacterial group were significantly higher than those in the MP group (14.7 (1.0-67.1)×10⁹/L vs. 10.5 (2.5-32.2)×10⁹/L, 122.5 (0.5-277.3) mg/L vs. 51.4 (0.5-200.0) g/L, 2.13 (0.05-100.00) μg/L vs. 0.24 (0.01-18.85) μg/L, Z=-3.719, -5.901 and -7.765, all P<0.01). Conclusions: The prevalence of pediatric NP in China shows an increasing trend during the past years. MP, SP and SA are the main pathogens of NP, and the most common clinical symptoms are fever and cough. The WBC count, C-reactive protein and procalcitonin in bacterial NP are significantly higher than those caused by MP.

[Disease burden of breast cancer in women in China, 1990-2017]

Objective: To analyze the trend of the incidence, mortality and disease burden of breast cancer in women in China during 1990-2017. Methods: Based on the estimation of data in China from the Global Burden of Disease 2017 (GBD2017), the incidence,mortality, disability- adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) on breast cancer for women in China during 1990-2017 were standardized by the world standard population used for GBD2017. The GBD study applied the attributable burden formula to estimate the attributable deaths by five risk factors of breast cancer, including alcohol use, high body mass index (BMI), high fasting plasma glucose, low physical activity and tobacco smoking. The incidence, mortality, attributable deaths and the disease burden due to breast cancer in women in China were analyzed. Results: In 2017, a total of 357.6 thousand female breast cancer cases, including 84.8 thousand deaths, were reported in China, with the age-standardized incidence rate of 35.62/100 000, which increased by 286.18%, 114.14% and 88.77% respectively compared with 1990. The age-standardized mortality rate decreased from 8.57/100 000 in 1990 to 7.84 /100 000 in 2007, then increased to 8.71 /100 000 in 2015, and then decreased to 8.47/100 000 in 2017. The mortality of breast cancer increased with age in 1990 and 2017. From 1990 to 2017, the trend of standardized DALY rate and standardized YLL rate were the same as that of standardized mortality, while the standardized YLD rate and the proportion of YLD in DALY increased year by year. In 2017, the standardized DALY rate, standardized YLL rate and standardized YLD rate of breast cancer were 253.00/100 000, 228.96/100 000, and 24.05/100 000, respectively. Compared with 1990, the change rates were -6.88% and -11.73% and 95.85% respectively. The proportion of breast cancer deaths attributable to high BMI increased significantly by 165.76%, from 5.49% in 1990 to 14.59% in 2017. The proportion of breast cancer deaths attributable to alcohol use and high fasting blood glucose increased; and the proportion of breast cancer deaths attributed to low physical activity and smoking remained stable. In 2017, the three provinces with the highest age-standardized mortality rate of female breast cancer were Hongkong (9.93/100 000), Guangxi (9.52/100 000) and Liaoning (9.49/100 000). Compared with 1990, the age-standardized mortality of 19 provinces decreased, and Beijing (-27.17%), Macao (-26.06%) and Jilin (-23.89%) had the fastest decrease. The two provinces with the highest growth rates were Hebei (28.85%) and Henan (24.34%). Conclusions: The disease burden of female breast cancer in China increased during 1990-2017. Therefore it is necessary to strengthen the prevention and treatment of breast cancer.

[Analysis of 39 children with acute necrotizing encephalopathy]

Objective: To investigate the risk factors for death in children with acute necrotizing encephalopathy (ANE) in pediatric intensive care unit (PICU). Methods: This was a multicenter retrospective study. Thirty-nine children with ANE were from PICUs in 4 centers from December 1, 2014 to December 1, 2020. The 4 participating centers were Beijing Children's Hospital, Shengjing Hospital of China Medical University, Hebei Children's Hospital, and Bao'an Maternity & Child Health Hospital. Patients were divided into survival and non-survival groups by the outcome at discharge, and the differences in clinical data between the two groups were compared. Risk factors for death in children with ANE and the odds ratios (OR) were analyzed by univariable Logistic regression. Results: Thirty-nine children with ANE were included. There were 18 males and 21 females. The median onset age was 30 months. The mortality at discharge was 41% (16/39). The onset age of most patients (74%, 29/39) was younger than 4 years old. Influenza virus was the most common precursor infection (80%, 20/25). Patients with shock at PICU admission were more common in the non-survival group (12/16 vs. 17% (4/23), P=0.001). Glasgow coma score (GCS) at PICU admission was significantly lower in the non-survival group than survival group (3 (3, 6) vs. 6 (5, 7), Z=-2.598, P=0.009). The optimal cut-off value was 4. The proportion of patients with GCS ≤ 4 at PICU admission was higher in the non-survival group (10/16 vs. 22% (5/23), P=0.018). ANE severity score (ANE-SS) at PICU admission was significantly higher in the non-survival group (5 (2, 6) vs. 2 (1, 4), Z=-2.436, P=0.015). The proportion of patients with high risk ANE-SS was higher in non-survival group than the survival group (9/16 vs. 22% (5/23), P=0.043). The proportion of application of high-dose methylprednisolone (20 mg/(kg·d)) was significantly higher in survival group than non-survival group (43% (10/23) vs. 1/13, P=0.031). Univariable Logistic regression indicated that risk factors for death in children with ANE were shock (OR=14.250, 95%CI 2.985-68.018, P=0.001), GCS≤4 (OR=6.000, 95%CI 1.456-24.733, P=0.013) and high risk ANE-SS (OR=4.629, 95%CI 1.142-18.752, P=0.032) at PICU admission. Conclusions: ANE usually occurs in children under 4 years old after influenza infection. Shock, GCS≤4 and high risk ANE-SS at PICU admission were risk factors for death in children with ANE. High-dose methylprednisolone may improve the prognosis of children with ANE.

[Preliminary analysis of intestinal microflora in patients with different severity of OSAHS]

Objective: To analyze the diversity, abundance and structural composition of intestinal microflora in patients with different severity of OSAHS, and to explore their potential role in the occurrence and development of OSAHS. Methods: A total of 27 healthy volunteers(N) [male 19, female 8, age 22-78(44.4±2.7)years old] of Health Examination Center of the Second Hospital of Shanxi Medical University and 100 patients with OSAHS [male 86, female 14, age 19-78(49.1±1.3) years old] of Sleep Medicine Center of the Second Hospital of Shanxi Medical University were enrolled from December 2018 to September 2019, and patient-related sleep monitoring data and medical history data were collected.According to the AHI classification and whether there were complications, OSAHS patients were divided into mild group (L), moderate group (M), severe group (S) and severe complication group (SC).Using 16S rRNA high-throughput sequencing technology to analyze the intestinal flora of all people, bioinformatics related statistics were analyzed by QIIME2 software, and clinical data were analyzed by SPSS 25.0 software. Results: There was no significant difference in intestinal flora Alpha and Beta diversity among all groups (P>0.05). At phylum level, the relative abundance of Bacteroides in OSAHS group was lower than that in normal group (N group: 24.96%, L group: 18.31%, M group: 12.95%, S group: 15.78%, Sc group: 16.48%). At genus level, the relative abundance of Bacteroides (N group:16.03%, L group: 10.82%, M group: 9.79%, S group: 9.29%, Sc group: 8.25%) and Faecalibacterium (N group: 11.21%, L group: 10.42%, M group: 10.21%, S group: 8.54%, Sc group: 6.27%) were negatively correlated with the severity of OSAHS (the values of r respectively were -0.887, -0.945) while the relative abundance of Bifidobacterium (N group: 3.20%, L group: 2.47%, M group: 4.10%, S group: 4.93%, Sc group: 6.27%) and Blautia (N group: 2.52%, L group: 3.59%, M group: 3.81%, S group: 4.11%, Sc group: 5.86%) were positively correlated with the severity of OSAHS (the values of r respectively were 0.916, 0.940) Compared with the S group, the relative abundance of Roseburia (S group: 10.22%, Sc group: 6.65%) in the Sc is lower and the relative abundance of Shigella(S group: 4.64%, Sc group: 10.01%) is higher. Redundancy analysis (RDA) showed that Apnea hypopnea index (AHI), The lowest oxygen saturation (SpO₂min), The average saturation of blood oxygen (SpO₂mean) and The longest time of apnea (Tmax) were not significantly correlated with the overall abundance of intestinal flora (P>0.05), However, there was a significant correlation between the abundance of different flora and sleep monitoring indicators. Conclusion: There is an intestinal microecological imbalance in patients with OSAHS, mainly due to the reduction of the relative abundance of probiotics producing short-chain fatty acids and the increase of pathogenic bacteria, suggesting that the disturbance of intestinal flora may be related to the occurrence and development of OSAHS.

[Progress of researches on the involvement of indoleamine 2, 3-dioxygenase in regulation of parasite-host immune interactions]

Indoleamine 2, 3-dioxygenase (IDO) is an important immunoregulatory enzyme, which mediates immune effects by depleting tryptophan and producing multiple metabolites. Recently, the studies on the immune function of IDO have been mostly restricted in tumors and autoimmune diseases. Nevertheless, there are few studies pertaining to the role of IDO in parasitic diseases, notably in parasite-host immune interactions. This review mainly describes IDO-mediated immunoregulatory effects and its regulation of parasite-host interactions, so as to provide insights into the development of immune intervention schemes against parasitic diseases.

[Comparative study on prognosis of neoadjuvant chemotherapy followed by hepatic surgery versus upfront surgery in patients with synchronous colorectal liver metastasis]

Objective: To compare the survival outcome in patients with synchronous colorectal cancer liver metastasis receiving neoadjuvant chemotherapy followed by hepatic surgery versus upfront surgery strategies. Methods: A retrospective cohort study was carried out. Data of patients undergoing surgery at the Department of Hepatopancreatobiliary Surgery Unit I of Peking University Cancer Hospital from January 2008 to December 2018 for initially resectable synchronous colorectal liver metastasis were retrospectively collected. A total of 282 cases were enrolled, including 244 in the neoadjuvant chemotherapy group, 38 in the upfront surgery first group. The overall survival (OS) and progression-free survival (PFS) of the two groups were compared. A propensity score risk adjustment was used to eliminate potential bias between groups, and the covariates including sex, age, location of primary tumor, T stage, clinical risk score (CRS), RAS gene status, adjuvant chemotherapy, and resection margin status were included for adjustment. Results: In the neoadjuvant chemotherapy group, 244 cases received 4 (1-15) cycles of chemotherapy before hepatic resection, among whom 207 cases received oxaliplatin-based regimens, 37 cases received irinotecan-based regimens, and 90 cases received combined targeted agents in the first line treatment. The median follow-up time was 30 (5-134) months, and loss of follow-up was 1%. Before adjustment, Kaplan-Meier survival analysis showed that the 1-year and 3-year OS rates in the neoadjuvant chemotherapy group (95.1% and 66.4%) were better than those in the upfront surgery first group (94.7% and 51.5%, P=0.026); 1-year and 3-year PFS rates in neoadjuvant chemotherapy group (51.0% and 23.4%) were also better than those in surgery first group (39.5% and 11.5%, P=0.039). After propensity score risk adjustment, Cox multivariate analysis indicated that neoadjuvant chemotherapy was an independent protective factor of PFS (HR=0.664, 95% CI: 0.449-0.982, P=0.040), however, neoadjuvant chemotherapy was not an independent protective factor of OS (HR=0.651, 95% CI: 0.393-1.079, P=0.096). Subgroup analysis showed that the 1-year and 3-year OS rates in the patients with response to the first line treatment (194, including complete remission, partial remission and reduction but not partial remission) (96.9% and 67.1%) were better than those in the upfront surgery group (94.7% and 51.5%, P=0.026) after adjustment. However, the 1-year and 3-year OS rates in the patients without response to the first line treatment (50, including tumor progression or enlargement) were 90.0% and 63.3%, respectively, which were not significantly different with 94.7% and 51.5% in the upfront surgery group (P=0.310) after adjustment. Conclusions: For patients with resectable synchronous colorectal cancer liver metastasis, liver resection after neoadjuvant chemotherapy can provide longer PFS than upfront surgery. Although the whole OS benefit is not significant, patients with effective neoadjuvant first-line chemotherapy have better OS than those undergoing upfront surgery.

[A preliminary study on the mixed teaching of human parasitology based on MOOC resources and the experimental teaching digital platform]

The mixed teaching model combines the advantages of traditional teaching and network teaching in the "Internet +" era, which has become one of the important trends in the higher education teaching development. In order to follow this development trend, the human parasitology teaching team makes a reasonable use of modern information techniques, actively promotes the construction and application of online resources, and conducts mixed online and offline teaching based on MOOC resources and the experimental teaching digital platform. This mixed teaching model has shown a positive impact on both teaching and learning among teachers and students; however, students' personalized independent and deep learning remains unsatisfactory. It is suggested that the online course resources construction, teaching design and digital literacy remain to be increased, so as to create a high-level, innovative and challenging online-offline mixed "golden course".

[Epidemiological characteristics of imported malaria in Shandong province, 2017-2018]

Objective: To understand epidemiological characteristics of imported cases of malaria in Shandong province and provide scientific basis for timely adjustment of prevention and control measures. Methods: The incidence data of malaria, case investigation data and case review data by Shandong Provincial Reference Laboratory for Malaria Diagnosis from 2017 to 2018 were collected. Software SPSS 18.0 was used for statistical analysis and software QGIS 2.18 was used for mapping. Results: A total of 442 imported cases of malaria were reported in Shandong from 2017 to 2018, and the main infection source was in Africa (97.96%, 433/442). All the 17 prefectures in Shandong reported imported malaria cases, mainly in Jining (88 cases), Yantai (65 cases), Weihai (46 cases), Qingdao (44 cases) and Dezhou (42 cases), accounting for 64.48% (285/442). The cases were distributed in 77.37%(106/137) of counties of the province. The cases were reported in every month without seasonal characteristics. The median (M) of time interval between onset and the first medical care seeking was 2 days, and the interquartile range (IQR) was 3 days. The M of time interval between the first medical care seeking and final diagnosis was 0 day, and the IQR was 3 days. The proportion of medical care seeking on onset day was only 27.83% (123/442). Only 69.68% (308/442) of cases were diagnosed with malaria in the first medical care seeking, and the diagnostic accuracy of medical institutions below the county level was lower than other medical institutions (all P<0.01). Only 51.13% (226/442) of cases were diagnosed with malaria in the first medical care seeking, the differences in the rates among medical institutions at different levels were not significant (P>0.05). Conclusions: The imported malaria in Shandong was characterized by a large number of cases, multiple infection sources and wide area distribution during 2017-2018. The awareness of timely medical care seeking in the cases was low, meanwhile the awareness and ability of malaria diagnosis and treatment in primary medical institutions were still inadequate. It is necessary to adjust the prevention and control measures accordingly.

[The role of macrophage polarization in parasitic infections: a review]

Macrophages are important members of innate immunity and play an extremely important role in the host defense against pathogenic infections, tumors, and allergic diseases. Macrophages have a high degree of plasticity, and may be polarized into classical activated macrophages (M1 macrophages) and alternative activated macrophages (M2 macrophages) under the stimulation of different environments. M1 macrophages are found to promote inflammatory responses, which facilitates the clearance of pathogens, while M2 macrophages may inhibit inflammatory responses, which facilitates the survival and reproduction of pathogens. This review summarizes the role of macrophage polarization in parasitic infections, so as to provide insights into the prevention and treatment of parasitic diseases.

Removal of heavy metals in medical waste incineration fly ash by Na2EDTA combined with zero-valent iron and recycle of Na2EDTA: Acolumnar experiment study

In this study, an effective circulating system was developed to remove heavy metals in medical waste incineration (MWI) fly ash. MWI fly ash (MWIFA)-column experiments were performed to remove Cu, Pb, Zn, Cd, and Ni from MWIFA using EDTA disodium (Na₂EDTA). Iron-column experiments were conducted to study the removal effect of zero-valent iron on the five heavy metals from washing wastewater. Toxicity Characteristic Leaching Procedure (TCLP) test method was employed to evaluate heavy metals toxicity of MWIFA residues generated after 0-0.2 mol/L Na₂EDTA solution treated. After being washed by 0.2 mol/L Na₂EDTA solution, TCLP leaching values of Cu, Pb, Zn, Cd, and Ni were the lowest and satisfied the standard (GB 5085.3-2007), and the leaching values were 58.4 ± 2.0 mg/L, 2.81 ± 0.14 mg/L, 64.3 ± 4.0 mg/L, 0.156 ± 0.005 mg/L, 0.381 ± 0.006 mg/L. Concentrations of Cu, Pb, Zn, Cd, and Ni in iron-column effluent were reduced by 99.7%, 91.6%, 91.6%, 75.4%, and 75.7%, respectively. Na₂EDTA was recovered and recycled to the removal of heavy metals from MWIFA. Comparing new Na₂EDTA solution with recycled Na₂EDTA solution, recycled Na₂EDTA and water could be reutilized to dispose MWIFA. The removal efficiencies of Cu, Pb, Zn, Cd, and Ni by recycled 0.2 mol/L Na₂EDTA solution were 67.1%, 68.8%, 63.2%, 73.9%, 50.7%, respectively, the removal efficiencies using recovered Na₂EDTA decreased by 2.6%, 3.9%, 3.3%, 4.2%, and 1.6%, respectively. Successive batch experiments were also conducted to evaluate industrialization potential and reusable times for recycled Na₂EDTA. After four recirculation cycles, extraction efficiencies of Pb and Cd (removal efficiency at different cycles divided by removal efficiency of new Na₂EDTA) declined toward 80%. Results from this research indicated that this circulating system possessed industrialization potential. Implications: An effective circulating system was developed to remove heavy metals in MWI fly ash (MWIFA). Integration of Na₂EDTA with Fe⁰ promoted the removal of heavy metals from MWIFA. Na₂EDTA, NaCl and water were stepwise extracted from iron-column effluent, respectively. Recovered Na₂EDTA can still effectively remove heavy metals from MWIFA. Results from this research indicated that this circulating system possessed industrialization potential.

[Neuroprotective effect of ginsenoside Rb-1 on a rat model of Alzheimer's disease]

Objective: To investigate the protective mechanism of ginsenoside Rb-1 on the brain in a rat model of Alzheimer's disease. Methods: Fifty-six male Sprague-Dawley rats were randomly divided into control group, model group, low-dose Rb-1 group (Rb-1: 25 mg•kg(-1)•d(-1)) and high-dose Rb-1 group (Rb-1:50 mg•kg(-1)•d(-1)). Morris water maze was designed to observe the changes of learning and memory ability in rats. Flow cytometry was used to detect the apoptosis of hippocampal neurons. Immunohistochemistry and Western blot were employed to detect the expression levels of apoptosis-related genes (p53, Bax, cytochrome C (Cyto C), Caspase-3 and caspase-9) and anti-oxidative stress-associated genes (nuclear Factor-E2-related factor 2 (Nrf2), kelch-like ECH-associated protein 1 (keap-1), heme oxygenase 1(HO-1) and NADPH quinone dehydrogenase 1 (NQO1)).The activities of catalase (CAT), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were detected by relevant kits. ANOVA and Tukey-Kramer test were used for statistical analysis. Results: The learning and memory ability of rats in the model group was lower than that of the control group (P<0.01).The learning and memory ability of rats in the high-dose Rb-1 treatment group was significantly higher than that of the model group [(80±8) s vs (100±11) s, t=5.390, P<0.01]. The expression levels of apoptosis-related genes (p53, Bax, Cyto C, caspase-3 and caspase-9) in the model group were significantly higher than those in the control group (P<0.01), while the expression levels of these genes in low-dose and high-dose Rb-1 groups were significantly lower than those of the model group (P<0.01). The expression levels of Nrf2, HO-1 and NQO1 genes in the model group were significantly lower than those in the control group (P<0.05), while the expression of these genes in low-dose and high-dose Rb-1 groupswere significantly higher than those of the model group (P<0.01). The activities of CAT, GSH-Px and SOD in the model group were lower than those in the control group (P<0.01), however the activities of CAT, GSH-Px and SOD in low-dose and high-dose Rb-1 groups were higher than those of model group (P<0.05). Conclusions: Both low-dose and high-dose Rb-1 have protective effect on memory and cognitive function of Alzheimer's disease rats by reducing the damage and apoptosis of hippocampal neurons, down-regulating the expression levels of p53, Bax, Cyto C, caspase-3 and caspase-9, up-regulating the expression of Nrf2, HO-1 and NQO1 genes, and increasing the activities of CAT, GSH-Px and SOD. Moreover, the protective effect of Rb-1 on rat brain may be dose-dependent.

[Analysis of risk factors for lymphoma patients dying of cardiovascular disease]

Objective: To understand and explore the risk factors of the death of lymphoma patients from cardiovascular disease. Methods: The medical records and death information of 1 173 patients with lymphoma were collected, cases that died from cardiovascular disease were screened. A binary logistic regression model was used to analyze the independent risk factors of patients with lymphoma died from cardiovascular disease. Results: Among 1 173 patients with lymphoma, 75 (6.4%) died of cardiovascular disease, including 27 cases of coronary heart disease, 25 cases of stroke, 7 cases of hypertension, 5 cases of sudden cardiac death, 4 cases of pulmonary embolism, 3 cases of heart failure, 4 cases of others. Among the patients who survived for more than 5 years, 16.1% (35/217) died of cardiovascular disease. Among those who survived for more than 10 years, 11.7% (7/60) died of cardiovascular disease. Multivariate Logistic regression analysis showed that the primary site of lymphoma (OR=0.521, P=0.039), stage (stage Ⅱ: OR=2.487, P=0.016; stage Ⅲ: OR=3.233, P=0.002) and cardiovascular toxicity in the course of diagnosis and treatment (OR=3.019, P=0.001) are independent influencing factors for the death of cardiovascular disease in patients with lymphoma. Patients whose primary sites of lymphoma were lymph nodes had lower risk of dying from cardiovascular disease, while the patients with stage Ⅱ to Ⅲ stage and cardiovascular toxicity during diagnosis and treatment had higher risk of dying from cardiovascular disease. Conclusions: Cardiovascular disease is an important factor affecting the survival of patients with lymphoma. With the extension of survival time, the risk of dying from cardiovascular disease increases significantly. The primary site, tumor stage, and cardiovascular toxicity that occur during the diagnosis and treatment may be the independent influencing factors for patients with lymphoma that die from cardiovascular disease.

[Burden of disease attributed to high level serum low-density lipoprotein cholesterol in China in 2017]

Objective: To quantitatively analyze the death and disability-adjusted life years (DALY) attributed to high level serum LDL-C in Chinese population in 2017. Methods: Data were obtained from the '2017 Global Burden of Disease Study (GBD2017)'. Population attributable fraction (PAF), number and rate of deaths and DALY attributable to high LDL-C were used to describe the burden of disease by gender, age groups, diseases and provinces in China. Both rates on mortality and DALY were standardized by GBD world population. Results: In 2017, 862 759 deaths were caused by high level serum LDL-C in China, that accounting for 8.25% of the total deaths. Of the attributable deaths, 705 355 (81.76%) persons died from ischemic heart disease (IHD), while the remaining 18.24% from ischemic stroke (IS). High LDL-C accounted for 40.30% of the total deaths from ischemic heart disease and 18.49% from ischemic stroke. The highest PAF of death (13.70%) appeared in Jilin province and the lowest in Zhejiang province (4.65%). PAF of death was seen higher in females than in males, while both age-standardized rates of mortality and DALY appeared higher in males than in females. High LDL-C attributed mortality rate appeared as 61.08/100 000 after standardization in Chinese population. High LDL-C attributed DALYs were 18.16 million person years, among which 76.76% were caused by IHD (13.94 million person years), with DALY rate as 1285.83/100 000. Among provinces, Heilongjiang showed the highest standardized DALY rate, and Zhejiang the lowest. The PAF, number of deaths, rates on mortality and DALY caused by high LDL-C were high among residents above 70 years old, with the DALY number as 8.56 million person years, highest seen in the age group from 50 to 69 years old. Conclusion: The burden of disease attributed to high level LDL-C was quite high and with gender, age group and interprovincial differences, in China in 2017.

[Neonatal capillary malformation-arteriovenous malformation complicated with acute heart failure: a case report and literature review]

Objective: To study the clinical characteristics and current treatment of neonatal capillary malformation-arteriovenous malformation (CM-AVM). Methods: Clinical data of a newborn diagnosed with neonatal CM-AVM caused by RASA1 gene variation admitted to Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine was retrospectively analyzed, and related literature was reviewed. Databases of CNKI, WanFang, and Pubmed were searched for the literature from January 1, 2009 to December 31, 2018, with the keywords of "capillary malformation-arteriovenous malformation" "neonatal" and "RASA1 gene" . The clinical features of neonatal CM-AVM were summarized. Results: A one-day-old male infant was admitted to hospital due to swelling of both lower extremities with erythema with elevated skin temperature, who later presented with acute heart failure on the third day of hospitalization. A giant spinal arteriovenous fistula was identified by abdominal contrast-enhanced computed tomography and digital subtraction angiography. After surgical ligation of two feeding arteries, both heart failure and lower limb swelling improved. Genetic testing detected a novel paternal heterozygous variation of RASA1 gene. Digital subtraction angiography showed that spinal AVM still exist at the age of 6 months, but the heart function was good. A total of 4 cases of neonatal CM-AVM had been reported in 3 papers. According to these 5 cases, the clinical manifestations of neonatal CM-AVM were summarized: multiple dermal capillary malformation (5 cases), limb swelling or head circumference enlargement (5 cases), arteriovenous malformation (5 cases), congestive heart failure (4 cases) and positive family history (5 cases). Conclusions: CM-AVM is a rare disease and could present early in neonatal period. Capillary malformation and congestive heart failure of unknown origin in infants may indicate the existence of CM-AVM, and timely imaging and genetic test will help early diagnosis and treatment, and improve prognosis.

[LncRNA LINC-PINT regulating proliferation and apoptosis of osteosarcoma cells by targeting miR-524-5p]

Objective: To study the effect of long non-coding RNA LINC-PINT on proliferation and apoptosis of osteosarcoma cells. Methods: Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expressions of LINC-PINT and miR-524-5p in normal osteoblast hFOB and human osteosarcoma cell lines HOS, MG63 and SAOS2 cells. The pcDNA plasmid, pcDNA-LINC-PINT plasmid, negative control siRNA (si-NC), si-LINC-PINT, negative control mimics (miR-NC), miR-524-5p mimics (miR-524-5p), pcDNA-LINC-PINT combined with miR-NC, pcDNA-LINC-PINT combined with miR-524-5p were transfected into HOS cells with liposome, respectively. The protein expressions of PCNA and cleaved-caspase-3 in the cells were detected by western blot. Cell proliferation ability was detected by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide (MTT) assay. The apoptosis was detected by flow cytometry. The transcriptional activity was detected by double luciferase reporter assay. Results: Compared with normal osteoblast hFOB cell (1.00±0.08 vs 1.00±0.06), the expressions of LINC-PINT were down-regulated (0.18±0.01; 0.33±0.01; 0.42±0.01), while the expressions of miR-524-5p were up-regulated (2.65±0.23; 1.68±0.14; 1.51±0.13) in human osteosarcoma cell lines HOS, MG63 and SAOS2 cells, respectively. Overexpression of LINC-PINT significantly inhibited the proliferation (0.41±0.05 vs. 0.62±0.05 for 48 h; 0.57±0.05 vs. 1.06±0.09 for 72 h, both P<0.05) while promoted the apoptosis (25.28±2.15 vs. 9.01±0.17, P<0.01) of HOS cells. Knockdown of LINC-PINT or overexpression of miR-524-5p can significantly promote the proliferation and inhibit apoptosis of HOS cells. Moreover, miR-524-5p inhibited the fluorescence activity of wild-type LINC-PINT (0.31±0.03) in HOS cells when comparred with miR-NC (1.00±0.03) and was negatively regulated by LINC-PINT. Overexpression of miR-524-5p reversed the proliferation inhibition and apoptosis-promotion effects of LINC-PINT in HOS cells. Conclusions: Long non-coding RNA LINC-PINT can inhibit the proliferation and promote apoptosis of osteosarcoma cells through targeting miR-524-5p, which will provide a new target for the treatment of osteosarcoma.

[Association between parental socioeconomic status and preschoolers' consumption of sugar-sweetened beverages]

Objective: To explore the association between parental socioeconomic status (SES) and preschoolers' consumption of sugar-sweetened beverages (SSB). Methods: In June 2018, all preschoolers from 15 kindergartens were selected from the jurisdiction of Education Commission in Dongcheng District of Beijing by using an equal-proportion stratified cluster sampling method in the study. A self-designed questionnaire was used to investigate the parents of preschoolers to obtain the basic information of preschoolers and parents, the consumption situation of preschoolers' sugar-sweetened beverages and the perception of parents to SSB. A tatol of 3 217 preschoolers were finally included in the analysis. A generalized structural equation model was used to analyze the relationship between preschoolers' consumption of sugar-sweetened beverages and their parents' socioeconomic status and the mediating effect of their cognition of sugar-sweetened beverages. The size of mediating effect was estimated by using deviation correction non-parameter percentile Bootstrap method. Results: The age of 3 217 preschoolers was (4.23±0.67) years, of which 52.6% (n=1 692) were boys, and 77.62% (n=2 497) were SSB consumers. Among the parents of 3 217 preschoolers, fathers and mothers accounted for 24.90% (n=801) and 75.10% (n=2 416), and the M (P₂₅, P₇₅) scores of SES were 66.7 (62.5, 69.5) and 69.5 (64.6, 71.4), respectively. The proportion of parents who took the initiative to learn about their children's consumption of SSB, lacked confidence in restricting preschooler's consumption of SSB and read nutrition labels before purchasing food was 74.08% (n=2 383), 82.90% (n=2 667) and 36.24% (n=1 166), respectively. The generalized structural equation model showed that after adjusting for preschoolers' gender, age, body mass index (BMI) of preschoolers and their parents, preschoolers' consumption of SSB was negatively associated with their parents' SES score [path coefficient (95%CI):-4.69×10^-2 (-6.56×10^-2,-2.69×10^-2) ]. The mediating effect of parents' perception of SSB consumption could explain 48.71% of the total effect [path coefficient (95%CI):-2.28×10^-2 (-3.54×10^-2, -1.10×10^-2)]. Conclusion: The consumption of SSB in preschoolers is negatively associated with their parent's SES, and this relationship is partially mediated by parent's perception of SSB consumption.

[A comparative study of four cross-sectional investigations on the status of pediatric intensive care unit in China over the past 30 years]

Objective: To understand the history, current situation and trends of intensive care unit (ICU) of pediatrics in China over the past 30 years. Methods: The results of the cross-sectional investigation on the status of ICU of pediatrics in 2014 were compared with those in 1993, 2001 and 2009. The main measurements were the number of participated provinces and hospitals, the availability of equipment, staffing, and medical technologies, the major diseases and the source of the patients. Besides, the equipment allocation and technology implementation in 2014 were compared with the standards in the "recommendations on grading construction and management of children's intensive care unit in China" published in 2016. Results: The contents of the four surveys were slightly different, with only a few measurements not documented in one or more surveys. (1) The number of provinces and hospitals involved in the four surveys were 20 hospitals in 14 provinces in year 1993, 27 hospitals in 17 provinces in year 2001, 33 hospitals in 25 provinces in year 2009 and 108 hospitals in 25 provinces in year 2014. (2) In 1993, 2001, 2009 and 2014, the ratio of doctors/beds were 0.7∶1,0.8∶1, (0.4-0.5) ∶1 and 0.5∶1, and the ratio of nurses/beds were 1.1∶1,1.4∶1, (1.1-1.7) ∶1 and 1.3∶1, respectively. (3) Regarding the equipment availability, in 1993, 2001, 2009, and 2014, the numbers of monitors were 0.3/ICU, 0.3/bed, 1.1-1.4/bed and 1.0/bed; the numbers of invasive ventilators were 0.4/bed, 0.5/bed, 0.6/bed and 0.4/bed, respectively. In 2001, 2009 and 2014, there were 60.0%, 100.0% (33/33) and 88.0% (95/108) of the participating ICU equipped with blood gas analyzer, and 70.0%, 93.9% (31/33) and 90.7% (98/108) with bedside X-ray machines, respectively. In 2009 and 2014, 69.7% (23/33) and 92.6% (100/108) ICU were equipped with non-invasive ventilators respectively. In 2014, 10.2% (11/108) ICU were equipped with extracorporeal membrane oxygenation (ECMO) equipment and 45.4% (49/108) ICU with bedside continuous blood purification equipment. In 1993, 2001 and 2014, the numbers of infusion pump were 0.5/ICU, 1.1/bed and 1.7/bed, respectively. (4) Regarding the conducted medical technology, in 2014, invasive mechanical ventilation was used in 100% (108/108) ICU, and non-invasive ventilation in 89.8% (97/108) ICU. High frequency ventilation was used in 78.8% (26/33) and 38.0% (41/108) ICU in 2009 and 2014 respectively. Blood purification was used in 22.0%, 69.7% (23/33) and 47.2% (51/108) ICU, and the application of surfactant was in 48.0%, 97.0% (32/33) and 24.1% (26/108) ICU in 2001, 2009 and 2014, respectively. Nitric oxide inhalation (iNO) was used in 24.0% and 9.3% (10/108) in 2001 and 2014 respectively. ECMO was used in 6 and 7 hospitals in 2009 and 2014 respectively. (5) Compared with the criteria in the "recommendations on grading construction and management of children's intensive care units in China" in 2016, only the availability of monitors and conventional mechanical ventilation in 2014 met the standards.The original data in 2001 was not shown due to the lack of absolute values. Conclusions: The number of ICU of pediatrics and its beds in China increased significantly from 1993 to 2014, as well as the equipment availability and the conducted medical technology. But the status in 2014 was still far behind the recommendations in 2016, with a significant shortage of professional staff.

[Clinical application value of the endoscopic surveillance system in transurethral bipolar plasmakinetic resection of the prostate]

OBJECTIVE

To evaluate the clinical application of the endoscopic surveillance system (ESS) in transurethral bipolar plasmakinetic resection of the prostate (TUPKRP).

METHODS

We retrospectively analyzed 136 cases of TUPKRP performed with the assistance of ESS from September 2018 to March 2019. According to the prostate volume (PV), we divided the patients into a PV ≥ 60 ml and a PV < 60 ml group, and compared the surgery-related parameters between the two groups of patients.

RESULTS

Operations were successfully completed in all the 136 cases. Statistically significant differences were observed between the PV ≥ 60 ml and a PV < 60 ml groups in the operation time (［78.93 ± 28.63］ vs ［51.77 ± 14.85］ min, P < 0.05), intraoperative blood loss (［261.61 ± 204.25］ vs ［69.26 ± 61.13］ ml, P < 0.05) and absorption of the rinse fluid (［948.20 ± 656.00］ vs ［347.39 ± 256.53］ ml, P < 0.05), but not in the postoperative red cell count, levels of hemoglobin, hematocrit and ions, hospital stay, incidence of prostatic perforation or blood transfusion (P > 0.05). The patients also showed statistically significant differences between the baseline and postoperative parameters in red cell count (［4.62 ± 0.63］ vs ［4.31 ± 0.74］ ×1012/L, P < 0.05) and levels of hemoglobin (［141.83 ± 18.30］ vs ［135.20 ± 19.91］ g/L, P < 0.05), K+ (［4.01 ± 0.43］ vs ［3.92 ± 0.54］ mmol/L, P < 0.05) and Na+ (［141.90 ± 3.11］ vs ［139.42 ± 3.81］ mmol/L, P < 0.05), but not in the levels of Cl－ (［103.74 ± 9.32］ vs ［103.70 ± 4.50］ mmol/L, P > 0.05) and Ca2+ (［2.21 ± 0.13］ vs ［2.19 ± 0.21］ mmol/L, P > 0.05).

CONCLUSIONS

Large-volume absorption of rinse fluid may overburden the circulatory system and induce left ventricular failure, pulmonary edema or massive bleeding during PKRP for patients with PV ≥ 60 ml due to long operation time and rich blood supply in the hyperplasia gland. The endoscopic surveillance system can provide real-time data on the absorption of rinse fluid and bleeding, reduce complications, and improve surgical safety.

[Etiology and clinical features of primary adrenal insufficiency]

Objective: To summarize the etiology of primary adrenal insufficiency (PAI) and analyze its clinical features. Methods: A retrospective analysis was performed in the Department of Endocrinology, Peking Union Medical College Hospital from October 1981 to June 2019. Patients with PAI as the first symptom were enrolled. The etiology of PAI was analyzed and the clinical characteristics was also summarized. Results: A total of 131 patients with PAI were enrolled, including 87 males and 44 females (57 adolescents, and 74 adults). The age ranged from 0 to 73 years. The primary cause of PAI in adolescents was genetic defects (52.6%, 30/57), in which congenital adrenal dysplasia caused by DAX1 gene deficiency accounted for 50.0% (15/30), followed by autoimmunity (22.8%, 13/57). The primary cause of adult PAI was infection (58.1%, 43/74), of which tuberculosis accounted for the majority (93.0%, 40/43), and autoimmune adrenalitis accounted for 19.0% (14/74). Compared with the tuberculosis group, female patients were more common, and the onset age was younger, the plasma cortisol, serum sodium, fasting blood glucose, creatinine and aldosterone were lower (all P<0.05), and serum potassium and renin levels were higher in the autoimmune adrenalitis group (both P<0.05). Conclusions: In the current study, the proportion of PAI caused by infection in the adult group was higher than that in the adolescent group. The most common cause of adult PAI was tuberculosis infection. The most common cause of childhood PAI was genetic defects. Autoimmune damage to the adrenal glands may be more severe than tuberculosis infection.

[Screening and bioinformatic analysis of trehalase in Thelazia callipaeda]

OBJECTIVE

To characterize the trehalase gene in Thelazia callipaeda through screening the annotated data of the T. callipaeda genome, and to investigate the biological characteristics of the trehalase gene-coding protein.

METHODS

The trehalase gene was screened from the T. callipaeda genome and subjected to validation by using a PCR assay. The structural features of the coding protein were analyzed with bioinformatics tools, including hydrophobicity, transmembrane region, signal peptides, conserved domains, as well as the secondary and tertiary structures and the antigen epitope. Homology analysis of the amino acid sequences was performed, and the phylogenetic tree was built by the MEGA X software. In addition, the protein-protein interaction network was deduced from the STRING database.

RESULTS

The sequence of the trehalase gene with the complete CDS region was obtained from T. callipaeda genome, which had a length of 1 638 bp and encoded 545 amino acids. The encoded protein was predicted to have a molecular weight of 63 478.48 ku and be a secretory protein. The 5' domain of the encoded protein contained a signal peptide without transmembrane regions, and was predicted to contain 7 antigen epitopes. Based on the protein-protein interaction network of nematodes in the STRING database, the protein-protein interaction network of the trehalase gene of T. callipaeda was deduced, and 27 interactions covering 10 genes were identified.

CONCLUSIONS

A trehalase gene is successfully identified in T. callipaeda genome and its coding protein receives a bioinformatics analysis, which provides insights into the research on the biological functions of the protein and the screening of vaccine candidates for thelaziasis callipaeda.

[Prevalence of deep venous thrombosis in chronic refractory wounds and its influencing factors]

Objective: To investigate the incidence and risk factors of lower extremities deep venous thrombosis (DVT) in patients with chronic refractory wounds (chronic wounds). Methods: A retrospective analysis of 722 cases of chronic wounds admitted to the First People's Hospital of Zhengzhou from January 1, 2015 to December 31, 2018 was carried out, and clinical data such as gender, age, wound involves the lower extremities, wound type, duration of wound, D-dimer level and complicated diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock were collected. The patients were divided into DVT group and non-DVT group according to the color ultrasound test. Multivariate binary logistic regression analysis was used to screen the independent risk factors of DVT in patients with chronic wounds. Results: There were 55 (7.6%) patients in DVT group, of which 44(80.0%) were diagnosed as chronic DVT by conventional lower extremities venous color ultrasound screening at admission, and the remaining 11(20.0%) were newly diagnosed during hospitalization. There were no significant differences in gender, wound involves the lower extremities, duration of wound, complicated diabetes and hypertension between DVT group and non-DVT group (all P>0.05); and the differences were statistically significant in age, wound type, D-dimer level, complicated coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock (all P<0.05). Multivariate binary logistic regression analysis showed age [OR=2.260 (95%CI: 1.584-3.224)], D-dimer level [OR=14.201 (95%CI: 6.101-33.055)], complicated coronary heart disease [OR=2.731 (95%CI: 1.210-6.162)] and sepsis/septic shock [OR=3.170 (95%CI: 1.115-9.016)] were independent risk factors for DVT (all P<0.05). Conclusion: Chronic wounds patients have a higher incidence of DVT, most of which are chronic DVT, and age, D-dimer level, complicated coronary heart disease and sepsis/septic shock are independent risk factors for DVT in chronic wounds.

[Analysis of the characteristics of second primary malignancy affecting the survival of lymphoma patients]

Objective: To analyze the characteristics of the second primary tumor affecting the survival of patients with lymphoma, and to explore the risk factors of death from the second primary tumor. Methods: The medical records and related death information of 1 173 lymphoma patients who had already died with known causes were collected. The basic causes of death and the characteristics of patients who died of the second primary tumor were analyzed. Cox regression model was used to analyze the risk factors of lymphoma patients who died of the second primary tumor. Results: Among the 1 173 patients who had died, 94 (8.0%) died of the second primary tumor, 935 (79.7%) died of the primary lymphoma and 144 (12.3%) died of other diseases. The second primary tumor accounted for 17.5% (38/217) of all causes of death in patients with the survival period of more than 5 years, and the second primary tumor accounted for 28.3% (17/60) of all causes of death in patients with the survival period of more than 10 years. Among 94 cases who died of second primary tumors, 31 died of lung cancer, 15 died of gastric cancer, 13 died of liver cancer, 9 died of pancreatic cancer, 6 died of colorectal cancer, 6 died of second primary lymphoma and 14 died of other types of tumors. Univariate Cox regression analysis showed that age, first-line treatment effect, and chest or mediastinal radiotherapy were associated with the death from second primary tumors for lymphoma patients (all P<0.05). Multivariate Cox regression analysis showed that the effect of first-line treatment (P=0.030) and the chest or mediastinal radiotherapy (P=0.039) were independent factors for the death of lymphoma patients from the second primary tumor. Conclusions: The second primary tumor is an important factor affecting the survival of lymphoma patients, and the risk of death from second primary tumors increases significantly over time. The effect of first-line treatment and radiotherapy in the chest or mediastinum are independent factors for the death of lymphoma patients from the second primary tumor.

[Occurrence of deep venous thrombosis in adult burn patients and its risk factors]

Objective: To investigate the occurrence and risk factors of deep venous thrombosis (DVT) in adult burn patients. Methods: The clinical data of 1 219 adult burn patients admitted to the Department of Burns of Zhengzhou First People's Hospital from January 1, 2015 to August 31, 2016, conforming to the study criteria, were analyzed retrospectively by the method of case-control study, including 811 males and 408 females, aged 18-102 years. According to whether DVT occurred during hospitalization or not, the patients were divided into group DVT (n=12) and non-DVT group (n=1 207). The incidence of DVT, the diagnosis time of DVT, affected limbs, and DVT classification were counted and recorded. The gender, age, total burn area, D-dimer, lower limb burn, full-thickness burn, femoral vein indwelling central venous catheter (CVC) , inhalation injury, sepsis/infection shock, surgical operation, and infusion of concentrated red blood cells of patients between the two groups were compared with chi-square test, and then the indicators with statistically significant differences between the two groups were processed by multivariate binary logistic regression analysis to screen the independent risk factors of DVT in the adult burn patients. Results: (1) The incidence of DVT of adult burn patients was 0.98% (12/1 219), and DVT was diagnosed 24-138 days after injury, with a median of 61.5 days. DVT occurred in the right lower limb of 2 patients, left lower limb of 8 patients, and bilateral lower limbs of 2 patients, and DVT classification included 6 cases of mixed type and 6 cases of peripheral type. (2) There were no statistically significant differences in gender, age, and full-thickness burn of patients between the two groups ( χ(2)=1.524, 0.021, 3.115, P>0.05). There were statistically significant differences in total burn area, lower limb burn, inhalation injury, sepsis/infection shock, D-dimer, femoral vein indwelling CVC, surgical operation, and infusion of concentrated red blood cells among patients between the two groups (χ(2)=17.975, 6.206, 3.987, 8.875, 5.447, 15.124, 10.735, 14.031, P<0.05 or P<0.01). (3) Total burn area, D-dimer, and femoral vein indwelling CVC were independent risk factors for DVT in adult burn patients (odds ratio=10.927, 4.762, 9.394, 95% confidence interval=3.078-38.789, 1.197-18.934, 2.631-33.540, P<0.05 or P<0.01). Conclusions: The incidence of DVT in adult burn patients is relatively low, and the diagnosis time of DVT is 3 weeks after burn, with DVT classification of mixed type and peripheral type. The total burn area, femoral vein indwelling CVC, and D-dimer are independent risk factors for predicting DVT in adult burn patients.

Ground-to-satellite time and frequency synchronization link with active carrier phase compensation

In this paper, a synchronization link between one ground station and one geostationary satellite is established. The ground station receives retransmitted signals from the satellite, measures phase delay along the propagation route, and actively compensates back to its sending signals, realizing real-time phase fluctuation compensation. The transmitted signal contains two frequencies to eliminate common-mode phase noise. The difference between their carrier phase delays is measured. Different modes of carrier phase variation are separated and compensated, achieving a remaining time jitter of ±200 ps. Major sources of error are analyzed, and potential methods for improvement are discussed. The proposed ground-to-satellite link and active compensation method has potential applications in frequency standard dissemination to remote receivers (including ground stations or satellites). These potential applications justify further study of this system.

P5396CRISPR/Cas9 mediated miR-29b editing restores muscle atrophy and exercise capacity in mice

Background

Muscle atrophy is the loss of skeletal muscle mass and strength in response to diversity catabolic stimuli, such as heart failure. At present, no effective treatment except exercise is validated on reducing multiple muscle atrophy clinically. We have recently reported that microRNA-29b (miR-29b) promotes multiple types of muscle atrophy.

Purpose

The goal of this study was to assess whether genome editing using a clustered regularly interspaced short palindromic repeat/Cas9 (CRISPR/Cas9) system can efficiently introduce loss-of-function mutations into the endogenous miR-29b in vivo and as a potential therapy by treating muscle atrophy.

Methods

We used lentivirus to express CRISPR-associated 9 and a CRISPR guide RNA targeting miR-29b. Mutagenesis rate of miR-29b and off-target mutagenesis were detected by T7 Endonuclease I (T7EI) Assay. The expression level of miR-29b were measured in vitro and vivo after administration of the virus by using qRT-PCR. After intramuscular administration of the virus, the angiotensin II (AngII), immobilization and denervation-induced muscle atrophy were performed. Then muscle function was assessed in exercise capacity, the appearance and weight of muscle, the size of the muscle fibers, molecular and cellular detection.

Results

Here, we report that CRISPR/Cas9 mediated genome editing through intramuscular administration efficiently targeting the biogenesis processing sites in pre-miR-29b. No off-target mutagenesis was detected in 10 selected sites. This CRISPR-based treatment resulted in decreased miR-29b levels specifically. In vivo, this CRISPR-based treatment could ameliorate the muscle atrophy induced by angiotensin II (AngII), immobilization and denervation via activation of PI3K-AKT-mTOR signaling pathway and protect against AngII-induced apoptosis in mice. Moreover, the exercise capacity is also significantly enhanced.

Conclusion

Our work establishes CRISPR/Cas9 based gene targeting on miRNA as a potential durable therapy for treatment of muscle atrophy and expands the strategies available interrogating miRNA function in vivo.

Acknowledgement/Funding

The grants from National Natural Science Foundation of China (81722008, 91639101 and 81570362 to JJ Xiao)

Uncut Roux-en-Y Reconstruction in a Laparoscopic Distal Gastrectomy: A Single-Center Study of 228 Consecutive Cases and Short-Term Outcomes

Aims. We have established a procedure for uncut Roux-en-Y gastrojejunostomy after laparoscopic distal gastrectomy. This study aimed to evaluate the safety and technical feasibility of the procedure for patients with distal gastric cancer according to the short-term outcomes. Methods. Two hundred and twenty-eight consecutive patients who underwent a laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy from September 2014 to August 2018 were reviewed retrospectively. All the laparoscopic operations were performed successfully without conversion to open surgery. Results. The mean operative duration was 178.28 ± 32.82 minutes, the mean anastomotic process duration was 28.22 ± 7.50 minutes, the average blood loss was 48.97 ± 29.16 mL, and the overall number of lymph nodes harvested was 37.16 ± 11.47. The mean time of out-of-bed ambulation, anal exsufflation, liquid-diet intake, and duration of hospital stay were 41.99 ± 18.37 hours, 69.57 ± 23.17 hours, 5.06 ± 1.09 days, and 8.77 ± 2.42 days, respectively. Fifteen patients suffered postoperative complications, and the overall incidence rate was 6.58% (15/228). Seventeen patients experienced afferent recanalization, the mean time of which was 11 months after the operation. Conclusion. The laparoscopic uncut Roux-en-Y reconstruction is safe and technically feasible, and it has inspiring short-term outcomes for patients undergoing distal gastrectomy.

[Serum status and their changes of some vitamin substances and homocysteine in healthy subjects in Beijing]

Objective: To investigate serum status of folate, vitamin B(12), homocysteine (Hcy) and hydroxyvitamin D (25OHD) and their trends in different gender and age groups. Methods: This was a cross-sectional study. The enrolled subjects were those received medical examination in Beijing Hospital from September to November 2018 and were identified as appeared healthy persons. 1220 subjects were recruited and were divided into groups of young and middle age group (30-49 years, 50-59 years) and the elderly group (60-69 years, 70-79 years and ≥80 years). We measured folate, vitamin B(12), and 25OHD using electrochemiluminescence by chemiluminescence immunoassay. Hcy was measured by autobiochemical analyzer. Results: Total folate levels in male and female subjects were 7.16 (4.74-10.75) and 9.17 (6.49-13.55) μg/L respectively. Total vitamin B(12) levels in the male and female were 505.60 (386.80-700.90) and 582.60 (430.70-846.98) ng/L respectively. Hcy levels were 14.68 (12.25-18.58) and 11.29 (9.65-13.58) μmol/L. 25OHD levels were 21.60 (16.40-28.70) and 16.80 (12.30-24.15) μg/L respectively. Total folate and vitamin B(12) levels in female were higher than that in male subjects (Z=-7.796, -4.772, P<0.001). However, total Hcy and 25OHD levels in male were higher than that in female subjects (Z=-15.230, -8.447, P<0.001). Comparing with the substances in the above age groups, folate level in the elderly was lower than that in the younger age and middle age groups.However, vitamin B(12), 25OHD and Hcy levels were higher in the elderly groups. Furthermore, the levels of folate, vitamin B(12) and 25OHD were getting higher in the group of ≥80 years female compared with the rest of the age groups, but it turned lower in the male group of ≥80 years. Conclusions: There are some differences in the serum values of folate, vitamin B(12), Hcy and 25OHD among various age groups as well as between males and females. These should be considered in the development of national reference ranges.

[Classification of pregnancy complicating Guillain-Barré syndrome]

Objective: To explore the classification, clinical features, the short-term efficacy of intravenous immunoglobulin (IVIg) for Guillain-Barré syndrome(GBS) and look for predictors of acute motor axonal neuropathy (AMAN) during pregnancy. Methods: The clinical data of 45 hospitalized pregnant patients with GBS recruited from October 2008 to October 2017 at the Tianjin Medical University general hospital, Handan City First Hospital and Nankai University Affiliated Tianjin Fourth Central Hospital, were collected and analyzed retrospectively, and patients were divided into the acute inflammatory demyelinating polyneuropathies (AIDP) group and the AMAN group. The clinical features and efficacy of IVIg were compared between the two groups. Logistic regression analysis was used to analyze the predictors of AMAN. Results: There were 25 cases in the AIDP group and 20 cases in the AMAN group. AIDP usually started with distal limb weakness (P=0.001), and AMAN often started with limb weakness (P=0.001) and mostly accompanied by dyspnea (P=0.042). AIDP was often associated with paresthesia (P=0.001) and autonomic dysfunction (P=0.007). The response days of active treatment in the AIDP group and the AMAN group were (1.6±0.5)d and (2.3±0.8)d (P=0.022), the improvement days were (3.6±0.8)d and (5.9±1.0)d (P=0.000), the basic cure days were (7.7±1.3)d and (9.0±0.8)d (P=0.002), the cure days were (12.3±1.1)d and (12.8±0.9)d (P=0.148). Multivariate Logistic regression analysis revealed that preceding diarrhea (OR=13.750; 95% CI 1.386-136.387), limb weakness(OR=12.000;95% CI 2.359-61.048) and limb weakness with dyspnea (OR=10.000; 95% CI 1.048-95.457) were significantly associated with the AMAN-type GBS. Conclusions: AIDP and AMAN are the main types of pregnancy complicating GBS. Most patients present with a single and benign course of disease. IVIg is generally safe and effective. Preceding diarrhea, limb weakness and limb weakness with dyspnea are the predictors of AMAN-type pregnancy complicating GBS.

[A retrospective study on misdiagnosis and prognosis of acute pregnancy complicating Guillain-Barré syndrome]

Objective: To investigate the factors of first misdiagnosis, treatment and prognosis of acute pregnancy complicating with Guillain-Barré syndrome (GBS) in order to improve the first diagnosed rate. Methods: A total of 45 acute pregnancy complicating with GBS patients were retrospectively analyzed recruited from January 2009 to October 2017 at the Tianjin Fourth Central Hospital.Patients were divided into the first diagnosis group and the first misdiagnosis group, and GBS clinical types were classified into classic and variant types to analyze the misdiagnosis factors of the first diagnosis. All patients received intravenous immunoglobulin (IVIG) treatment, and the therapeutic effect and prognosis were compared and analyzed. Results: There were 20 cases in the first diagnosis group, 25 cases in the first misdiagnosis group, 35 cases in the typical GBS group, and 10 cases in the variant GBS group.There was no statistically significant difference in the baseline data of the patients(P>0.05).The misdiagnosis factors are divided into four categories: physician factors, patient factors, disease itself factors and laboratory factors. Variant GBS is more likely to lead to misdiagnosis in the first diagnosis than typical GBS. The therapeutic effect of the first diagnosis group was better than that of the first misdiagnosis group(P<0.05).Three patients died in the first misdiagnosis group, and the rest of the pregnant patients gave birth normally, and the babies were born without congenital malformation. Conclusions: Pregnancy is one of the inducing factors of GBS. Early diagnosis and correct treatment can improve maternal and infant clinical outcomes.

[Surgical strategies for large-volume benign prostatic hyperplasia: How to choose?]

Transurethral resection of the prostate (TURP) is a gold standard for the treatment of BPH. However, for large-volume BPH, TURP has its disadvantages of longer operation time, more residual glands, more intraoperative bleeding, lower efficiency, and longer hospital stay, which increase the risks of surgery and postoperative symptomatic recurrence. Therefore, minimally invasive treatment of large-volume BPH remains a clinical challenge. This paper focuses on the status quo and prospects of minimally invasive treatment of large-volume BPH, hoping to give some help with clinical practice.

[The definition of heat-wave based on mortality risk assessment in different regions of China]

Objective: To identify the definition of heat wave based on mortality risk assessment in different regions of China. Methods: Daily mortality (from China Information System for Disease Control and Prevention) and meteorological data (from National Meteorological Information Center in China) from 66 counties with a population of over 200 000 were collected from 2006-2011. With the consideration of climate type and administrative division, China was classified as seven regions. Firstly, distributed lag non-linear model (DLNM) was used to estimate community-specific effects of temperature on non-accidental mortality. Secondly, a multivariate meta-analysis was applied to pool the estimates of community-specific effects to explore the region-specific temperature threshold and the duration for definition of heat wave. Results: We defined regional heat wave of Northeast, North, Northwest, East, Central and Southwest China as being two or more consecutive days with daily mean temperature higher than or equal to the P(64), P(71), P(85), P(67), P(75) and P(77) of warm season (May to October) temperature, respectively, while the thresholds of temperature were 21.6, 23.7, 24.3, 25.7, 28.0 and 25.3 ℃. The heat wave in South China was defined as five or more consecutive days with daily mean temperature higher than or equal to the P(93) (30.4 ℃) of warm season (May to October) temperature. Conclusion: The region-specific definition of heat wave developed in our study may provide local government with the guidance of establishment and implementation of early heat-health response systems to address the negative health outcomes due to heat wave.

[Mortality attributable to inadequate intake of fruits among population aged 25 and above in China, 2013]

Objective: To assess the mortality attributable to low fruit intake among people over 25 years old in China, 2013, and its effect on life expectancy. Methods: Based on data collected from China Chronic Disease and Risk Factor Surveillance in 2013, the average fruit intake in different genders and areas were calculated. Potential impact fraction (PIF) was used to examine the impact on deaths, mortality and life expectancy. Results: The average daily fruit intake was (113.3±168.9) g among people over 25 years old, with (103.6±160.1) g for men and (122.7±176.6) g for women, in China in 2013. Fruit intake for urban residents was significantly higher than that in rural residents and higher in eastern regions than that in central or western regions. Scores that attributable to low fruit intake accounted for 15.21% of the total deaths and the population attributable fraction of inadequate intake of fruits to associated diseases was 35.00%. PIF for all the deaths in rural residents (16.50%) appeared higher than that of the urban residents (13.88%), and higher in the residents living in the eastern region (15.48%) than that in the central (16.27%) or western (13.75%) regions. Number of deaths that attributable to low fruit intake was 1.348 4 million. Deaths caused by related diseases appeared as: ischemic heart disease (472.5 thousands), hemorrhagic stroke (338.8 thousands), ischemic stroke (259.0 thousands), lung cancer (208.4 thousands), esophageal cancer (60.7 thousands), laryngeal cancer (5.4 thousands) and oral cancer (3.6 thousands). Numbers of all deaths and related diseases for urban residents were lower than that of the rural residents, with central regions (452.7 thousands) higher than that in the eastern (531.1 thousands) or western (364.6 thousands) regions. The average life expectancy loss caused by low fruit intake was 1.73 years, 1.80 years for men and 1.58 years for women, in this country. Loss of life expectancy in the rural residents was higher than that of the urban residents, and higher in central regions than that in the eastern or western regions. Conclusions: The intake of fruit was far lower than the recommended standard set for the Chinese people. Population attributable fraction was related to the associated diseases caused by inadequate intake of fruits which also made serious impact on life expectancy.

[Effects of insufficient physical activity on motality and life expectancy in adult aged 25 and above among Chinese population]

Objective: To analyze the attribution of mortality and impact on life expectancy caused by insufficient physical activity in different gender and areas in adults aged ≥25 years among Chinese people. Methods: Data from the programs related to Chinese death surveillence, risk factors of chronic survey, health outcomes of physical activity as well as relative risk (RR) on Global Burden of Disease (GBD) study were used. Population attributable fraction (PAF) of different health outcomes attributable to deaths that caused physical activity and the influence of life expectancy in adults aged ≥25 years in Chinese people were calculated. Results: The overall PAF for all cause of death due to physical activity in adults aged ≥25 years was 4.24%, with 4.86% in females and 3.82% in males. The health outcomes of inadequate physical activity would include breast cancer, colorectal cancer, ischemic heart disease, ischemic stroke and diabetes with relative PAFs as 9.04%, 13.96%, 14.96%, 17.80% and 16.92%, respectively. The attribution of death on Physical activity was 388 954. The most attributed death was ischemic heart disease, followed by ischemic stroke. With the elimination of physical inactivity, the total life expectancy was expected to lose by 0.43 years, with 0.47 years in women, and 0.39 years in men. Conclusion: The increase of physical activity may benefit on health condition so to reduce the burden of chronic diseases and increase the life expectancy.

[Death and impact of life expectancy attributable to smoking in China, 2013]

Objective: To analyze the death attributable to smoking and impact of life expectancy in China in 2013. Methods: According to the characteristics of different diseases, we calculated the population attributable fractions of different diseases, death and impact of life expectancy which caused by smoking, using direct method (current smoking rate as exposure levels) and indirect method (smoking impact ratio as exposure levels), based on data from both programs of death surveillance and Chinese chronic disease risk factor surveillance of 2013. Results: In 2013, smoking caused around 1.59 million deaths which accounted for 17.38% of all deaths in China. Constituent ratio of death caused by smoking in males (23.66%) was much higher than that in females (8.30%). However, in urban areas (17.24%), it was slightly lower than that in rural areas (17.51%). Constituent ratio of death caused by smoking in the eastern regions appeared the lowest (16.81%), with western regions the highest (17.91%). In 2013, lung cancer, COPD and ischemia heart disease were the top three diseases causing deaths that related to smoking, but the top three population attributable fractions were lung cancer, COPD and nasopharyngeal carcinoma in China. In 2013, smoking caused a reduction of 2.04 years of life expectancy loss in China, with males in the western regions the highest (3.05 years). Conclusion: Smoking is still an important public health problem in China. Tobacco-control-targeted programs in the heavily involved areas could reduce the number of deaths from related diseases that caused by smoking.

[Occupational characteristics and clinical manifestations of 245 cases of occupational brucellosis]

Objective: To analyse epidemiological, clinical characteristics and laboratory examination results of 245 occupational brucellosis form 2008 to 2018, which providing theoretical basis for prevention and control of occupational brucellosis. Methods: Based on the China Center for Disease Control and Prevention Information System, a database of occupational brucellosis cases in HunlunBuir from January 2008 to July 2018 was established. The Epidemiological characteristics, Clinical manifestation, laboratory examination of 245 occupational brucellosis and 359 without occupational brucellosis were comparatively analyzed about the same period. Results: Among the 245 patients, 219 were males, 254 in 359, malese were significantly higher than control group (χ(2)=21.331, P<0.05) . Fever, fatigue, hyperhidrosis and splenomegaly are common in patients with occupational brucellosis and non occupational brucellosis. Arthralgia (54.3%/44.8%) and CRP (81.2%/71.3%) were significantly also higher than control group (χ(2)=5.193, P<0.05; χ(2)=7.704, P<0.05) Fever, hyperhidrosis, fatigue and splenomegaly were common clinical manifestation and signs in the two groups. Brucellosis can cause a variety of complications, including osteoarticular hematological system and hepatic involvement, some patients with multiple system damage. Conclusion: The incidence of occupational brucellosis in HulunBuir is concentrated in agriculture and animal husbandry. Veterinarians are the main occupational groups, Occupational health interventions should be strengthened for key occupational hazards, regular occupational health examination, avoid chronic brucellosis and protect the health of key occupational groups.

[Association between high air temperature and mortality in summer: A multi-city analysis in China]

Objective: To understand the associations between changes of high air temperature and mortality in summer in 31 cities in China. Methods: Daily mortality and meteorological data in 31 cities in China from January 1, 2008 to December 31, 2013 were collected. Distributed lag nonlinear model was used to evaluate the association between high air temperature change and mortality in early summer and late summer after controlling for the long-term trend and the effect of "day of week" . Results: The relative risk of high air temperature on mortality was higher in early summer, with relative risk in the range of 1.08-2.14 in early summer and 1.03-1.67 in late summer. In early summer, the influence of high temperature on mortality was mainly below 5(th) of percentile and above 50(th) of percentile, while in late summer it was mainly above 95(th) of percentile. The lag effect of high air temperature on mortality in early summer was 6 days, while the lag effect in late summer was only about 2 days. Conclusions: Association existed between high air temperature and mortality. The influence of high air temperature on mortality in early summer was stronger than that in late summer. It is necessary to take targeted protection measures.

[Disease burden on uterine fibroids in China, 1990 and 2016]

Objective: To assess the disease burden on uterine fibroids in China in 1990 and 2016. Methods: Data were extracted from the Global Burden of Disease Study 2016. Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016, with key indicators including number of cases, prevalence rates, disability-adjusted life year (DALY) and the rates of DALY. The WHO world standard population, 2010-2035 was used to calculate the age- standardized rates. Results: In 1990 and 2016, there were 13 695 567 and 27 169 312 women aged 15 years and older, suffered from uterine fibrosis respectively, with prevalence rate as 2.48% and 4.10%, DALY as 146 045.05 life years and 281 976.67 life years, and the DALY rate as 26.40/100 000 and 42.50/100 000, in 1990 and 2016 respectively. Both the prevalence rate and the DALY rate increased with age, reaching the peak on the 45-49 years-old, in both 1990 and 2016. Women aged 40-54 years accounted for 55.60% (1990) and 66.74% (2016) of the total cases while 48.37% (1990) and 60.65% (2016) of the total DALY. The first three provinces with highest DALYs were Shandong (1990: 12 574.67 life year; 2016: 22 728.12 life year), Henan (1990: 10 849.29 life year; 2016: 18 454.32 life year) and Jiangsu (1990: 10 501.55 life year; 2016: 18 274.10 life year), while the three provinces with leading standardized DALY rates were Heilongjiang (1990: 48.20/100 000; 2016: 47.00/100 000), Shanxi (1990: 44.50/100 000; 2016: 47.70/100 000) and Tianjin (1990: 43.80/100 000; 2016: 46.40/100 000) in both 1990 and 2016. Compared with 1990, the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as: 98.38%), standardized prevalence rate increased by 1.88%, DALY value increased by 135 931.62 life years (with the rate of change as 93.08%) and standardized DALY rate increased by 5.92% among Chinese women, in 2016. Conclusion: Menopausal women were the ones hard hit by uterine fibrosis. Compared with data from 1990, the disease burden of uterine fibrosis increased rapidly in China, in 2016.

[An observational study of high air temperature on diabetes mortality in six cities in China]

Objective: To evaluate the effect of high air temperature on diabetes mortality in six cities in China. Methods: Daily diabetes mortality and meteorological data were collected from January 1, 2008 to December 31, 2013 in Beijing, Tianjin, Shanghai, Chongqing, Guangzhou, and Shenyang. Distributed lag nonlinear model was used to evaluate the association between high air temperature and diabetes mortality after controlling for the long-term trend and the effect of "day of week" . Results: The effect of high air temperature on diabetes mortality varied in different cities, the maximum cumulative relative risk of Beijing, Tianjin, Shanghai, Chongqing, Guangzhou and Shenyang were 1.37 (lag 2 days), 1.32 (lag 0 days), 1.40 (lag 0 days), 1.26 (lag 2 days), 1.48 (lag 2 days) and 1.67 (lag 3 days). The daily diabetes death numbers were similar in men and women, but the death number in women were slightly higher than that in men, no gender specific characteristics were found. The death number was highest in age group 65-84 years, accounting for >60% of the total deaths, the difference was significant. Conclusion: The mortality of diabetes increased obviously in the context of high air temperature environment.

[Analysis of body composition and resting metabolic rate of 858 middle-aged and elderly people in urban area of Beijing]

Objective: To understand the overweight rate and obesity rate in middle-aged and elderly people in urban area of Beijing, and analyze the changes of body composition and resting metabolic rate with age. Methods: From November 2014 to December 2015, body composition measurement and resting metabolic rate detection were conducted among 858 people aged 51 to 99 years, including 760 men, 98 women, who received physical examination at Beijing Hospital. Results: The overweight rate was 51.4%, and the obesity rate was 16.9%. The overweight rate was 26.5% and the obesity rate was 14.3% in women, significantly lower than those in men (54.6% and 17.2%) (P<0.001). The distribution of skeletal muscle volume, muscle index, body fat percentage, visceral fat area and resting metabolic rate in different age groups were different (P<0.001). In the normal weight group, the skeletal muscle volume, muscle index and resting metabolic rate in age group ≥80 years decreased obviously (P<0.05). At the same time, the body fat percentage and visceral fat area increased obviously (P<0.05). However, the skeletal muscle volume, muscle index and resting metabolic rate of the overweight and obese groups began to decrease obviously in age group 70- years (P<0.05), and the decrease in age group ≥80 years was more obvious. At the same time, body fat percentage and visceral fat area increased significantly in age group 70- years (P<0.05). Conclusion: The overweight and obesity rates were high in the middle-aged and elderly people in the urban area of Beijing, and the rates were higher in men than in women. With the increase of age, the skeletal muscle volume, muscle index and resting metabolic rate gradually decreased, while the percentage of body fat and visceral fat area increased; Overweight and obese people had earlier changes in body composition and resting metabolic rate.

Fast creation and transfer of coherence in triple quantum dots by using shortcuts to adiabaticity

Motivated by the progress on shortcuts to adiabaticity, we propose three schemes for speeding up (fractional) stimulated Raman adiabatic passage, and achieving rapid and non-adiabatic creation and transfer of maximal coherence in a triple-quantum-dot system. These different but relevant protocols, designed from counter-diabatic driving, dress-state method, and resonant technique, require their own pumping fields, applied gate voltages and varying tunneling couplings between two spatially separated dots. Such fast and reliable shortcuts not only allow for feasibly experimental realization in solid-state architectures but also may have potential applications in quantum information processing and quantum control.

[Etiological study of diarrhea in children under 5 years old in Dongcheng district of Beijing]

Objective: To analyze the etiological characteristics of infectious diarrhea among people under 5 years old in Dongcheng District, Beijing. Methods: The age, time of infection, clinical symptoms and laboratory test results of the cases who didn't used antibiotics within 3 days in the second maternal and child health care hospital were collected from 2012 to 2015, through the information management system of infectious disease monitoring technology platform. To compare the detection rate of virus and bacteria in children with different sex, time and age,and the difference of clinical characteristics between virus detection group and bacteria detection group by chi square test. Results: 1 977 cases of infectious diarrhea were collected, the median of the month age (P(25), P(75)) was 14.19 (8.31, 23.15) months. The virus detection rate was 34.3% (679 cases); the bacterial detection rate was 14.6% (288 cases). The difference of virus detection rate in children with different months was statistically significant (χ(2)=72.38, P<0.001), the virus detection rate of 24-60 months (40.9% (188/460)) was the hightest, and the detection rate of 0-5 months (15.3% (48/314)) was the lowest. The difference of bacteria detection rate was also statistically significant (χ(2)=32.67, P<0.001), and the detection rate of 12-17 months (19.0% (81/426)) was the highest, the detection rate of 0-5 months (6.7% (21/314)) was the lowest. The proportion of vomit and water sample in the virus detection group was 22.2% (136 cases) and 73.3% (449 cases), respectively, which were higher than those in bacteria detection group (8.1% (18 cases) and 57.2% (127 cases)), the difference was statistically significant (χ(2) values were 125.92 and 19.60; P values were both<0.001); the proportion of mucus stool and fever was 0.8% (5 cases) and 14.0% (86 cases), respectively, which were lower than those in bacterial detection group (4.1% (9 cases) and 18.5% (41 cases)), and the difference was statistically significant (χ(2) values were 8.50 and 23.01; P values were 0.004 and <0.001). Conclusion: The virus detection rate of infantile infective diarrhea is higher than that of bacteria in Dongcheng district of Beijing, and the clinical characteristics are significantly different.

[The influence of statutory holidays on the proportion of the outpatient and emergency visits for influenza-like illness]

Objective: To analyze the reasons for the fluctuations in the percentage of outpatient or emergency visits for influenza-like illness (ILI) during the Spring Festival and National Day in 2014-2018 surveillance season. Methods: ILI surveillance data was collected during the period of Spring Festival and National Day in mainland China, and downloaded from Chinese Influenza Surveillance Information System, during the 2014-2018 surveillance season. Results: There was no significant difference noticed in the number of ILI reports in the festival week with weeks before or after in both the southern and northern provinces. The number of outpatient visits was much less than that of the week before and after, but the number of emergency visits was statistically significantly increased. Conclusion: In the holiday peak of ILI%, the major causes was the impact of holiday-off at sentinel hospitals, resulting in a large reduction in the number of outpatient visits in the consulting room during the festivals.

Accurate self-calibrated fiber transfer delay measurement

An accurate self-calibrated fiber transfer delay measurement method is demonstrated. Using the simplified self-calibration configuration, the measurement uncertainty of fiber transfer delay is improved. To demonstrate the accuracy of the method, the measurement results of two systems are compared. It shows that this method achieves a sub-picosecond accuracy. Besides, the chromatic dispersion of fiber under test is also obtained, which is in agreement with the nominal value.

[Pigmented extramammary Paget's disease accompanied with condyloma acuminatum: a case report]

Pigmented extramammary Paget's disease (PEMPD) is an uncommon intraepithelial adenocarcinoma and a rare variant of Paget's disease, characterized as a superficial pigmented scaly macule clinically and an increased number of melanocytes scattered between the Paget's cells histologically. So it may be confused clinically and histologically with melanocytic tumors, dermatitis and other dermatoses. Different therapeutic attitudes are required in this case of adenocarcinoma in situ as opposed to melanoma and dermatitis. Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection, which is also called as genital warts. In this article, we first reported a case of a 65-year-old Chinese man who had pigmented extramammary Paget's disease complicated with CA. This patient presented with verrucous papules on the scrotum for 3.5 years, infiltrative erythema with itch on the mons pubis for 3 years, and scrotum and penis involved gradually for 4 months. Physical examination showed a 8 cm×10 cm dark red patch on the upper part of the scrotum, penis and mons pubis, as well as few maculopapules and nodules. Histopathologic examination of the lesion on the scrotum revealed a focus of Paget's disease, characterized by the presence of large round cells with abundant pale or granular/dusty cytoplasm, pleomorphic vesicular nuclei and prominent nucleoli (Paget's cells), while the histology of the verrucous lesion was consistent with CA. Immunohistochemistry was performed, which showed diffuse positive staining with CK, CEA, PAS, CK20, EMA, CK7, and Ki-67 (40%), HER2 in Paget's cells and negative with P53, P16, CK5/6, S100, MelanA, HMB45, estrogen receptor, progesterone receptor, and gross cystic disease flid protein 15 (GCDFP15). Human papillomavirus-11 (HPV-11) was positive by genotyping using gene amplification in the lesion of scrotum. According to clinical features and laboratory findings, a diagnosis of PEMPD complicated with CA was made. Local excision of the lesion was performed and sent for histological examination, with all margins clear of tumor. Both aforementioned diseases often occur in the vulva. Even so, it has been rarely reported coexisting of the above two diseases, of which the clinical significance and association are also unclear. In this article, we also reviewed the literature relating to PEMPD, and on this basis, the profile of this disease is discussed including its pathogenesis, clinical manifestation, diagnosis, treatment and advances. Due to PEMPD occasionally accompanied with an underlying carcinoma, it's essential to make an accurate diagnosis. Besides, review of the literature reveals that pigmented variant of Paget's disease could be initially misdiagnosed as melanocytic tumors and other dermatoses unless the entity is considered in the differential diagnosis and additional confirmatory studies are performed.