[Clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer]

Objective: To investigate the clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer (DFU) wounds. Methods: A retrospective observational study was conducted. From August 2018 to August 2021, 15 patients with DFU who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University, including 12 males and 3 females, aged 42-65 years, with a history of type 2 diabetes for 5-19 years. All the wounds of patients were complicated with local bone, muscle, or tendon defects or exposure. The wounds were covered with antibiotic bone cement after debridement in stage Ⅰ+free anterolateral thigh chimeric perforator flap (perforator flap+muscle flap) or simple free anterolateral thigh flap grafting in stage Ⅱ. The defect area of the wound after bone cement removal and debridement was 9.0 cm×5.0 cm-20.0 cm×7.0 cm, the incision area of the flap was 10.0 cm×5.0 cm-22.0 cm×7.0 cm, and the incision area of the muscle flap was 5.0 cm×3.0 cm-8.0 cm×4.0 cm. The donor sites of flaps were sutured directly. During follow-up, the situations of donor site healing and flap survival were observed. At the last follow-up, the texture and shape of the flap, the presence of new ulcers on both limbs, and the walking ability of the patient were observed. Results: During the follow-up of 8 to 21 months after operation in stage Ⅱ, the donor sites healed well with only residual linear scar; flaps in 14 patients survived completely, and the flap in 1 patient developed partial necrosis at 3 weeks after stage Ⅱ surgery, which was healed after debridement and skin grafting. At the last follow-up, the flaps were good in texture and appearance, there were no new ulcers in the affected limb or opposite limb, and the patients had no obvious impairment in daily walking function. Conclusions: To repair DFU wounds with antibiotic bone cement combined with free anterolateral thigh flap can rapidly control the infection, achieving a high survival rate of flap after operation with no obvious impairment in daily walking function of patients.

[Research advances on the application of free flaps in repairing diabetic foot ulcers]

Free flaps have been successfully used in the repair of diabetic foot ulcers (DFUs), which can reduce amputation rate, maintain normal gait of patients, and improve life quality of patients. However, there are still many challenges in the repair of DFUs with free flaps, and many problems need to be solved. This paper summarizes the selection of patients, preoperative cautions, types of flaps, methods of vascular anastomosis, clinical effects, and existing problems in using free skin flaps for repairing DFUs.

[A multicenter clinical trial of collar-button type keratoprosthesis implantation for the treatment of corneal blindness in high-risk transplantation]

Objective: To evaluate the efficiency and safety of collar-button type keratoprosthesis (c-bKPro) implantation for corneal blindness in high-risk transplantation in China. Methods: It was a case series study. High-risk corneal blind patients who planned to undergo c-bKPro implantation were prospectively and continuously enrolled in the Eye Hospital of Shandong First Medical University, Ophthalmology Division of Chinese PLA General Hospital, Zhongshan Ophthalmic Center, Department of Ophthalmology in Eye & ENT Hospital of Fudan University, and Eye Hospital of Wenzhou Medical University from July 2019 to January 2020. The cure for blindness and surgical success were assessed based on visual acuity (VA)≥0.05. The complications and keratoprosthesis retention rate were recorded to determine the safety of the surgery. Results: Thirty-seven subjects (eyes) were included, of which 32 were male and 5 were female, aged 27 to 72 years old. The indications of c-bKPro implantation were corneal graft failure (21 eyes, 56.8%), chemical injury (8 eyes, 21.6%), thermal burn (5 eyes, 13.5%), unexplained corneal opacity (2 eyes, 5.4%), and corneal perforation (1 eye, 2.7%). Two patients withdrew from the clinical trial at 3 months postoperatively. Thirty-five patients were followed up for 6 months, and 31 were followed up for 12 months. The VA was ≥0.05 in 83.8% of eyes at 6 months and in 81.8% of eyes at 12 months. Among the 11 eyes diagnosed with concurrent glaucoma, 6 eyes achieved a VA of ≥0.05. At 12 months, the c-bKPro retention rate was 100%. The surgical complications included retroprosthetic membrane formation (5 eyes, 16.1%), persistent corneal epithelial defects (5 eyes, 16.1%), macular edema (4 eyes, 12.9%), new-onset glaucoma (4 eyes, 12.5%; including one eye withdrawn from the study at 3 months), sterile corneal melting (2 eyes, 6.5%), sterile vitritis (1 eye, 3.2%), and infectious keratitis (1 eye, 3.2%). Conclusions: C-bKPro implantation is an effective and safe option for treating corneal blindness in high-risk transplantation in China. Improved visual outcomes could be achieved in most cases, with a relatively low incidence of postoperative complications.

Evaluation of nail psoriasis with ultrasound enhanced blood flow imaging (eflow) and Power Doppler (PD)

OBJECTIVE

The aim of this study was to assess the discriminative utility of nail features detected by B-mode (BM), enhanced flow (eflow) and power Doppler (PD) in patients with psoriasis or nail psoriasis (NP) and healthy controls.

PATIENTS AND METHODS

Ultrasound appearance of nails was investigated in 5 patients with NP, 8 patients with psoriasis and 7 healthy controls. In total, 195 nails were examined.

RESULTS

The thickness of the nail bed (TNB), the thickness of the nail plate (TNP) and the thickness of the nail matrix (TNM) did not differentiate between NP and psoriasis in longitudinal and cross-section of nails. Resistance index (RI) in nails was higher in patients with NP than in patients with psoriasis, and significantly higher in patients with psoriasis than in healthy controls. TNP between patients with psoriasis and healthy controls was statistically insignificant in longitudinal section of nails, but higher than that in the cross-section of nails. TNM was higher in patients with psoriasis than in healthy controls. The ultrasound features of NP in longitudinal and cross-section of nails, nail bed (NB) eflow and PD signal were statistically significant among patients with NP or psoriasis and healthy controls. In patients with NP, there was a correlation between the ultrasound features of NP in longitudinal and cross-section of nails and nail psoriasis severity index (NAPSI).

CONCLUSIONS

Our study displayed the usefulness of ultrasound nail examinations in psoriatic nails, not only assessing ultrasonic features of nails and proving correlation between ultrasonic features of nails and NAPSI, but also comparing the accuracy of new technology of blood flow signal in nails.

Accumulation, translocation, and transformation of two CdSe/ZnS quantum dots in rice and pumpkin plants

As a widely applied semiconductor nanomaterial, quantum dots (QDs) have drawn considerable interest. In this study, pumpkin and rice seedlings were hydroponically exposed to two core/shell CdSe/ZnS QDs coated with cysteamine (CdSe/ZnS-CA) and polyethylene glycol-carboxy (CdSe/ZnS-PEG-COOH) for 10 days to analyze their time-varying uptake, translocation, and transformation behaviors in plants. Both QDs were mainly adsorbed/absorbed by the roots in the particulate state, and more CdSe/ZnS-CA accumulated than CdSe/ZnS-PEG-COOH. For CdSe/ZnS-CA-treated plants, the Se and Cd concentrations (CSe and CCd) associated with the roots were 561 ± 75 and 580 ± 73 μg/g (dw) for rice and 474 ± 49 and 546 ± 53 μg/g (dw) for pumpkin, respectively, on day 10. For CdSe/ZnS-PEG-COOH-treated plants, the concentrations of Se and Cd associated with roots were 392 ± 56 and 453 ± 56 μg/g (dw) for rice and 363 ± 52 and 417 ± 52 μg/g (dw) for pumpkin, respectively. The surface charges and coatings significantly affected the accumulation of QDs at the beginning of exposure; however, the impaction decreased with time. The ratios between the Cd and Se concentrations (CCd/CSe) in the stems and leaves varied from those of the QD standards, indicating the transformation of the QDs in the exposure system. Se and Cd were more likely to translocate in CdSe/ZnS-PEG-COOH-treated plants than in CdSe/ZnS-CA-treated plants. The vertical translocation of Se was greater than that of Cd. Rice showed greater abilities of accumulation and translocation of Se and Cd from both QDs than pumpkin. These findings improve our understanding of the interference of QDs with plants and their environmental fate.

[Establishment and preliminary evaluation of a fluorescent recombinase-aided amplification/CRISPR-Cas12a system for rapid detection of Plasmodium falciparum]

OBJECTIVE

To establish a fluorescent assay for rapid detection of Plasmodium falciparum based on recombinaseaided amplification (RAA) and CRISPR-Cas12a system,and to preliminarily evaluate the diagnostic efficiency of this system.

METHODS

The 18S ribosomal RNA (rRNA) gene of P. falciparum was selected as the target sequence, and three pairs of RAA primers and CRISPR-derived RNA (crRNA) were designed and synthesized. The optimal combination of RAA primers and crRNA was screened and the reaction conditions of the system were optimized to create a fluorescent RAA/CRISPR-Cas12a system. The plasmid containing 18S rRNA gene of the P. falciparum strain 3D7 was generated, and diluted into concentrations of 1 000, 100, 10, 1 copy/μL for the fluorescent RAA/CRISPR-Cas12a assay, and its sensitivity was evaluated. The genomic DNA from P. vivax, P. malariae, P. ovum, hepatitis B virus, human immunodeficiency virus and Treponema pallidum was employed as templates for the fluorescent RAA/CRISPR-Cas12a assay, and its specificity was evaluated. Fifty malaria clinical samples were subjected to the fluorescent RAA/CRISPR-Cas12a assay and nested PCR assay, and the consistency between two assays was compared. In addition, P. falciparum strain 3D7 was cultured in vitro. Then, the culture was diluted into blood samples with parasite densities of 1 000, 500, 200, 50, 10 parasites/μL with healthy volunteers' O-positive red blood cells for the RAA/CRISPR-Cas12a assay, and the detection efficiency was tested.

RESULTS

The Pf-F3/Pf-R3/crRNA2 combination, 2.5 μL as the addition amount of B buffer, 40 min as the RAA reaction time, 37 °C as the reaction temperature of the CRISPR-Cas12a system were employed to establish the fluorescent RAA/CRISPR-Cas12a system. Such a system was effective to detect the plasmid containing 18S rRNA gene of the P. falciparum strain 3D7 at a concentration of 1 copy/μL, and presented fluorescent signals for detection of P. falciparum, but failed to detect P. ovum, P. malariae, P. vivax, T. pallidum, hepatitis B virus or human immunodeficiency virus. The fluorescent RAA/CRISPR-Cas12a system and nested PCR assay showed completely consistent results for detection of 50 malaria clinical samples (kappa = 1.0, P < 0.001). Following 6-day in vitro culture of the P. falciparum strain 3D7, 10 mL cultures were generated and the fluorescent RAA/CRISPR-Cas12a system showed the minimal detection limit of 50 parasites/μL.

CONCLUSIONS

The fluorescent RAA/CRISPR-Cas12a system is rapid, sensitive and specific for detection of P. falciparum, which shows promising value for rapid detection and risk monitoring of P. falciparum.

[Ultrasonographic features of retinal pigment epithelial adenoma]

Objective: To investigate the ultrasonographic features of retinal pigment epithelium (RPE) adenoma. Methods: It was a retrospective case series study. The clinical clata of 15 patients (15 eyes) with pathologically confirmed RPE adenoma after local resection of intraocular tumor was collected at Beijing Tongren Hospital, Capital Medical University from November 2013 to October 2019. The general conditions of the patients and the location, size, shape, internal echo features of the lesions in the ocular ultrasound sonogram were analyzed, and the blood flow in the lesions was checked by color Doppler flow imaging (CDFI). Results: Of all the patients included in the study, 7 were male and 8 were female. Their age ranged from 25 to 58 years, with a mean age of (45.7±10.2) years. The most common symptom was vision loss or blurred vision (11 cases). Other symptoms included dark shadows or obscuration in front of the eyes (3 cases) and no symptoms (1 case). A history of previous ocular trauma was present in one case, and the rest of the patients had no history of ocular trauma.The location of tumor growth is scattered. The ultrasonographic features were as follows: the average maximum basal diameter was (8.07±2.75) mm and the average height was (4.02±1.81) mm; the ultrasonographic features mostly demonstrated abruptly elevated dome-shaped echo (6 cases); the lesion edge was not smooth, the internal echo was medium or low, and there could be hollow features (2 cases), with no choroidal depression; and the blood flow signal could be seen in the CDFI lesion, which could lead to retinal detachment and vitreous opacification. Conclusion: The ultrasound imaging features of RPE adenomas mostly demonstrate abruptly elevated dome-shaped echo, unsmooth lesion edge, with no choroidal depression, which may provide valuable evidence for clinical diagnosis and differentiation.

Predicting inhabitable areas for locust based on field observation and multi-environmental factors in alpine grassland—A case study in the Qilian Mountain National Park, China

Alpine grassland is one of the most critical grassland types in the world, and it is vulnerable and sensitive to external disturbances. The development and outbreak of locust might result in the irreversible degradation. However, most locust studies have been on the tropical, temperate, and desert areas. Our knowledge of inhabitable areas in alpine grassland still needs to be explored. This study was carried out in the alpine grassland in the Qilian Mountain National Park. Environmental factors (remote sensing vegetation index, meteorology, soil, topography, and grassland types) and their impact on locust density were investigated. Finally, the inhabitable areas of locust in the study area were mapped. The results showed that: (1) six out of 26 factors [including precipitation, solar radiation (average and maximum value), normalized vegetation index (NDVI), soil, and temperature] had great influence on locust density, with a relative contribution (RC) more than 10%. (2) Among all locust density estimation models, those based on average and maximum solar radiation, maximum precipitation, maximum NDVI, average temperature, and clay content in deep soil performed better than others, with R ranging from 0.58 to 0.73 and root mean square error ranging from 21.70 to 25.82 head/m2. (3) The areas most suited for locust growth, development, and frequent outbreak were found in the south of Tianjun County, middle and northwest of Qilian County (account for 27% of the study area), while the inhabitability was weak in south of Gangcha County, northwest of Tianjun County, and most of Delingha City. Thus our study clarified the distribution region and occurrence variation of the locust and provided a scientific basis for locust prevention and control in alpine grassland in the Qilian Mountain National Park.

Design and first measurements of the fast-ion D-alpha diagnostic at the HL-2A tokamak

The fast-ion D-alpha diagnostic (FIDA) is employed to detect Dα light emitted by neutralized fast ions during neutral beam injection. A tangentially viewing FIDA has been developed for the HuanLiuqi-2A (HL-2A) tokamak and typically achieves temporal and transverse spatial resolutions of ∼30 ms and ∼5 cm, respectively. A fast-ion tail on the red shifted wing of the FIDA spectrum is obtained and analyzed with the Monte Carlo code FIDASIM. Good agreement has been presented between the measured and simulated spectra. As the FIDA diagnostic's lines of sight intersect the central axis of neutral beam injection with small angles, the beam emission spectrum is observed with a large Doppler shift. Thus, tangentially viewing FIDA could detect only a small portion of fast ions with an energy of ≈ 20 ∼ 31 keV and a pitch angle of ≈ -1 ∼ -0.8. A second FIDA installation with oblique viewing is designed to minimize spectral contaminants.

Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study

PURPOSE

Growth hormone-secreting pituitary adenomas (GH-PAs) with a low Knosp grade are typically associated with a good postoperative biochemical remission (BR) rate. However, a proportion of patients do not achieve remission. In this study, we aimed to investigate predictive factors of postoperative remission for lower Knosp GH-PAs.

METHODS

In this retrospective study, we enrolled 140 patients who were diagnosed with lower Knosp (0-2) GH-PAs and received trans-sphenoidal surgery between December 2016 and June 2021 from the largest pituitary tumor surgery center in southern China. The univariate, binary Logistic regression, and receiver operating characteristic curve (ROC) analyses were employed to determine independent predictors and cutoff values of remission. The postoperative outcome was defined as remission using the 2010 consensus criteria of acromegaly.

RESULTS

One hundred and thirty six patients (97.1%) achieved gross total resection. The postoperative long-term BR was 68.6%. Empty sella, tumor maximum diameter and postoperative GH levels were independent factors predicting remission. ROC revealed that postoperative 24 h GH ≤ 1.3 ng/mL and  ≤ 1.23 ng/mL were valuable predictors for 3-month and long-term remission respectively, and that postoperative 3-month GH ≤ 1.6 ng/mL and tumor maximum diameter  ≤ 17 mm were predictors for delayed remission.

CONCLUSION

Early postoperative GH levels can be used as predictors of remission. However, BR was not associated with preoperative somatostatin analogs therapy or Knosp grade (0-2). For patients without residual tumor or recurrence and whose GH levels are slightly elevated within 1 year after surgery, adjuvant treatments may not be necessary.

[Attention should be paid to the application of regional citrate anticoagulation in blood purification]

Compared with traditional low-molecular-weight heparin anticoagulation or non-anticoagulant hemodialysis, regional citrate anticoagulation (RCA) has emerged as a promising anticoagulant method considering its satisfactory efficacy, reduced incidence of bleeding, extended life of the dialyzer and increased removal of the toxin. RCA has received more and more attention in recent years which contributes as a first-line anticoagulant regimen for continuous renal replacement therapy, and it gradually gains wide clinical application in maintenance hemodialysis (MHD). In addition, RCA has been reported to be successfully used in plasma exchange and hemoperfusion. This article elaborates on mechanism of RCA and the problems in clinical application, in order to further expand the application of RCA and improve the effect of blood purification in the future.

Successful Eisenmenger syndrome-targeted drug therapy in pregnant women: a case series and literature review

OBJECTIVE

To clarify the real-world outcomes in pregnant women with Eisenmenger syndrome (ES) in the new therapeutic era and provide a literature review.

DESIGN

Retrospective case and literature review.

SETTING

Tertiary referral hospital (The Second Xiangya Hospital of Central South University).

SAMPLE

Thirteen women with ES delivered between 2011 and 2021.

METHODS

Respective study and literature reviews.

MAIN OUTCOMES MEASURES

Maternal and neonatal mortality and morbidity.

RESULTS

12/13 (92%) pregnant women were treated with targeted drugs. 9/13 (69%) of patients had heart failure, but no maternal deaths occurred. 12/13 (92%) of women chose caesarean delivery. One pregnant woman gave birth at 37⁺¹  weeks, and the remaining 12 (92%) patients had preterm birth. 10/13 (77%) women gave birth to live infants, of which 9/10 (90%) were low birthweight infants with a mean birthweight of 1575 g. The infant mortality rate was 1/10 (10%). Cardiac functional class improved during pregnancy, probably due to therapy; 11/13 (85%) of the pregnant women were in cardiac functional level III/IV at admission and 12 (92%) were in cardiac functional class II/III at discharge. Our literature review identified 72 cases of pregnancy with ES from 11 studies, which were characterised by a low rate of targeted drug use (28%) and a high maternal mortality rate of 24% in the perinatal period.

CONCLUSION

Our case series and literature review suggest that targeted drugs may be key to improving maternal mortality in ES.

Identification of novel characteristic biomarkers and immune infiltration profile for the anaplastic thyroid cancer via machine learning algorithms

PURPOSE

Anaplastic thyroid cancer (ATC) is a rare and lethal malignant cancer. In recent years, the application of molecular-driven targeted therapy and immunotherapy has markedly improved the prognosis of ATC. This study aimed to identify characteristic genes for ATC diagnosis and revealed the role of ATC characteristic genes in drug sensitivity and immune cell infiltration.

METHODS

We downloaded ATC RNA-sequencing data from the GEO database. Following the combination and normalization of the dataset, we first divided the combined datasets into the training cohort and the validation cohort. We identified differentially expressed genes (DEGs) in ATC by differential expression analysis in the training cohort. We used two machine learning algorithms, least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) to identify ATC characteristic genes. The CIBERSORT algorithm was performed to calculate the abundance of various immune cells in ATC. Finally, we validated the expression of ATC characteristic genes by quantitative RT-PCR (RT-qPCR) in ATC cell lines and immunohistochemistry (IHC).

RESULTS

A total of 425 DEGs were identified in the training cohort, including 240 upregulated genes and 185 downregulated genes. Four ATC characteristic genes (ADM, PXDN, MMP1, and TFF3) were identified, and their diagnostic value was validated in the validation cohort (AUC in ROC analysis > 0.75). We established a practical gene expression-based nomogram to accurately predict the probability of ATC. We also found that ATC characteristic biomarkers are associated with the tumor immune microenvironment and drug sensitivity.

CONCLUSION

ADM, PXDN, MMP1, and TFF3 might serve as potential ATC diagnostic biomarkers and may be helpful for ATC molecular targeted therapy and immunotherapy.

Genetic Diversity Analysis and Core Germplasm Collection Construction of Radish Cultivars Based on Structure Variation Markers

Radish is an economically important root vegetable worldwide. In this study, the 217 cultivated radish accessions were collected and genotyped. To detect the genotypes of these accessions, a total of 24 structure variation (SV) markers distributed on nine chromosomes were employed to analyze genetic diversity and construct a core germplasm collection of radish. The results of polymorphism information content (PIC) indicated a good polymorphism of these SV markers. Population structure analysis and principal component analysis (PCA) results showed that the 217 radish accessions fell into three main populations (P1, P2, and P3). Genetic diversity analysis showed that these populations were highly associated with geographical distribution. The values of the fixation index (F_ST) indicated a high genetic diversity between P2 and P3, and a moderate genetic diversity between P1 and P2, and P1 and P3. Furthermore, the 43 core germplasm were exploited for creating cytoplasmic male sterility (CMS) lines and cultivating new radish varieties. The high genetic diversity of 217 radish germplasms will not only provide valuable resources for future genetic mapping and functional genomic research, but also facilitate core germplasm utilization and the molecular breeding of radish.

Invasive fungal infection is associated with antibiotic exposure in preterm infants: a multi-centre prospective case-control study

BACKGROUND

Previous antibiotic exposure is an important risk factor for invasive fungal infection (IFI). Antibiotic overexposure is common in lower-income countries; however, multi-centre studies concerning IFI in relation to antibiotic exposure are scarce.

AIM

This prospective, multi-centre matched case-control study explored the correlation of IFI and antibiotic exposure in very preterm infants or very-low-birthweight infants admitted to 23 tertiary hospitals in China between 2018 and 2021.

METHODS

Using a 1:2 matched design for gestational age, birth weight and early-onset sepsis (yes/no), the risk factors between infants diagnosed with IFI and infection-free controls were compared. The antibiotic use rate (AUR) was calculated using calendar days of antibiotic therapy in the 4 weeks preceding IFI onset divided by onset day of IFI.

FINDINGS

In total, 6368 infants were included in the study, of which 90 (1.4%) were diagnosed with IFI. Median AUR, length of antibiotic therapy (LOT) and days of antibiotic therapy (DOT) within the 4 weeks preceding IFI onset were 0.90, 18 days and 30 days, respectively. Multi-variate analysis showed that a 10% increase in AUR, each additional day of DOT and LOT, and each additional day of third-generation cephalosporins and carbapenems were notably associated with IFI.

CONCLUSION

Prolonged antibiotic therapy is common before the onset of IFI, and is an important risk factor, especially the use of third-generation cephalosporins and carbapenems. Antibiotic stewardship should be urgently developed and promoted for preterm infants in order to reduce IFI in lower-income countries such as China.

[Epidemiological features of echinococcosis cases reported in the National Notifiable Disease Report System in Henan Province from 2010 to 2021]

OBJECTIVE

To analyze the epidemiological characteristics of echinococcosis cases reported in the National Notifiable Disease Report System in Henan Province from 2010 to 2011, so as to provide insights into for echinococcosis control and surveillance.

METHODS

The data pertaining to reported echinococcosis cases in Henan Province from 2010 to 2021 were retrieved from the National Notifiable Disease Report System, and a descriptive epidemiological analysis was performed using the software SPSS 22.0.

RESULTS

A total of 150 echinococcosis cases were reported in Henan Province from 2010 to 2021, including 88 confirmed cases (58.67%) and 62 clinically diagnosed cases (41.33%), 77 cases reported by Henan Province (51.33%) and 73 cases reported by other provinces (48.67%). Echinococcosis cases were reported in each month, with 8 to 21 cases reported in each month, and the number of reported echinococcosis cases appeared no remarkable temporal changes. The echinococcosis cases were reported across 18 cities of Henan Province, with the highest number of cases reported in Zhoukou (17.33%) and Nanyang cities (17.33%) and the lowest number reported in Sanmenxia City (0.67%). The reported echinococcosis cases had a male to female ratio of 1.17:1, and the cases were found at each age group, with the the highest number of cases seen at ages of 20 to 59 years (73.33%). Farmer was the predominant occupation (63.33%), followed by housekeepers and the unemployed (12.67%). Of all reported echinococcosis cases, there were 25 local cases (16.67%) and 125 imported cases (83.33%), 144 cases reported by medical institutions (96.00%) and 6 cases reported by centers for disease control and prevention (4.00%).

CONCLUSIONS

Although imported echinococcosis cases were the predominant source of echinococcosis cases reported in the National Notifiable Disease Report System in Henan Province from 2010 to 2021, there were still sporadic local cases, and the emergence of local sources of infection cannot be excluded. Further expanded field surveys and surveillance of echinococcosis are required.

Neutron star mass estimates from gamma-ray eclipses in spider millisecond pulsar binaries

Reliable neutron star mass measurements are key to determining the equation of state of cold nuclear matter, but such measurements are rare. Black widows and redbacks are compact binaries consisting of millisecond pulsars and semi-degenerate companion stars. Spectroscopy of the optically bright companions can determine their radial velocities, providing inclination-dependent pulsar mass estimates. Although inclinations can be inferred from subtle features in optical light curves, such estimates may be systematically biased due to incomplete heating models and poorly understood variability. Using data from the Fermi Large Area Telescope, we have searched for gamma-ray eclipses from 49 spider systems, discovering significant eclipses in 7 systems, including the prototypical black widow PSR B1957+20. Gamma-ray eclipses require direct occultation of the pulsar by the companion, and so the detection, or significant exclusion, of a gamma-ray eclipse strictly limits the binary inclination angle, providing new robust, model-independent pulsar mass constraints. For PSR B1957+20, the eclipse implies a much lighter pulsar (1.81 ± 0.07 solar masses) than inferred from optical light curve modelling.

Investigate the multipath erasure of nitrobenzene over nanoscale zero-valent-iron/N-doped biochar hybrid with extraordinary reduction performance

In this study, the facile carbothermal reduction method was enforced using urea as dopant to modify the structure and chemical composition of nanoscale zero-valent-iron/biochar hybrid thereby boosting its reduction performance. Through fine-tuning the N-doped amount, the optimal nZVI/N-doped BC was obtained, which exhibited more active sites (nZVI, persistent free radicals (PFRs), pyrrolic-N) and superior electrochemical conductivity. With these blessings, the electrons originating from galvanic cell reaction could zip along the highway within the hybrid. Taking nitrobenzene (NB) as the target pollutant, the quantitative analysis revealed that the NB reduction and adsorption removal efficiency were dramatically improved by 2.42 and 2.78 times, respectively. What's more, combining the in-situ experimental detection and theoretical calculations, unexpected NB reductive multipath with respect to PFRs and pyrrolic-N accelerating the Fe³⁺/Fe²⁺ cycle within the nZVI/N-doped BC system was decoded. The enhancement of Fe³⁺/Fe²⁺ cycle improved the electron utilization efficiency and maintained the reduction reactivity of the hybrid. This work raised awareness of the mechanisms regarding the reduction performance of nZVI/N-doped BC elevated by N-doped and the pollutant reductive pathway within the system, uncovered the dusty roles of PFRs and N-species during the reduction process.

[The treatment strategies for complications after pancreaticoduodenectomy]

The most common complications after pancreaticoduodenectomy include pancreatic fistula, biliary fistula, delayed gastric emptying, bleeding, and abdominal infection. Although advances in surgery have led to a significant decrease in perioperative mortality in recent years, the risk of complications after pancreaticoduodenectomy remains. Thus, prevention and treatment of various complications are important to improve the prognosis of patients.

A meta-analysis of effects and safety of Tripterygium wilfordii polyglycoside in the treatment of IgA nephropathy

OBJECTIVE

To evaluate the effects and safety of Tripterygium wilfordii polyglycoside (TWP) in the treatment of immunoglobulin A (IgA) nephropathy.

SUBJECTS AND METHODS

A computer-assisted study search of Chinese Biomedical Database (CBM), Chinese Journal Full-text Database (CNKI), Wanfang Database, Chinese Scientific Journal Database (VIP), PubMed, Medline, EMBASE and Cochrane Library was performed, with the time range of retrieval set between the establishment of the database to December 31, 2019. Articles of randomized controlled trials on the treatment of IgA nephropathy by Tripterygium wilfordii polyglycoside were collected, and then screened according to the inclusion and exclusion criteria. Next, the quality of the papers was assessed, effective data were extracted, and a meta-analysis of the included studies was conducted using the Review Manager 5.3 software provided by the Cochrane Collaboration.

RESULTS

Thirty randomized controlled trials (RCT) were included ultimately, and the meta-analysis showed that 1) Single (Sgl) TWP group was superior to angiotensin-converting enzyme inhibitor/angiotension receptor blocker (ACEI/ARB) group in terms of complete remission [odds ratio (OR) = 4.74, p-value < 0.00001], total remission (OR = 3.90, p-value < 0.0001), 24-hour proteinuria [mean difference (MD) = 1.18, p-value < 0.00001], and serum albumin (MD = - 8.23, p-value < 0.00001), and no significant difference in serum creatinine (MD = 2.09, p-value = 0.08) was found between Sgl TWP and control groups; TWP + ACEI/ARB group was superior in complete remission (OR = 2.57, p-value < 0.00001), total remission (OR = 4.36, p-value < 0.00001), serum albumin [standardized mean difference (SMD) = -0.68, p-value = 0.0005], 24-hour proteinuria (SMD = 1.24, p-value < 0.00001) and serum creatinine (SMD = 0.48, p-value = 0.006); 2) TWP group was superior to glucocorticoid group in complete remission (OR = 1.93, p-value < 0.0010), total remission (OR = 3.71, p-value < 0.00001), serum albumin (MD = -3.50, p-value = 0.002), 24-hour proteinuria (SMD = 0.93, p-value < 0.0001) and serum creatinine (SMD = 0.88, p-value = 0.006); 3) TWP group was better than mycophenolate mofetil (MMF) group in complete remission (OR = 2.05, p = 0.005), total remission (OR = 3.30, p-value = 0.002), 24-hour proteinuria (MD = 2.61, p-value < 0.0001), and serum albumin (MD = -6.43, p-value < 0.00001), but the differences in serum creatinine (MD = 1.28, p-value = 0.89) between TWP and control groups were not significant. Besides, TWP + ACEI/ARB group had a higher adverse reaction rate than the control group (OR = 2.21, p-value = 0.04), but there was no significant difference in the adverse reaction rate between other control and experimental groups (p-value > 0.05).

CONCLUSIONS

The present evidence shows that Tripterygium wilfordii polyglycoside can effectively improve the remission rate, reduce proteinuria, and protect kidney function of IgA nephropathy patients, and also has good safety. However, limited by the quality of the included studies, the effects and safety of Tripterygium wilfordii polyglycoside in the treatment of IgA nephropathy need to be verified by more high-quality, large-scale, multi-center RCTs.

[Analysis on characteristic of pulmonary tuberculosis cases reported in children from four provinces in China, 2019-2021]

Objective: To analyze the reported characteristics of pulmonary tuberculosis (TB) in children aged 0-14 years in four provinces (municipalities), Beijing, Hubei, Chongqing and Sichuan, in China, and provide evidence for the prevention and control of pulmonary TB in children. Methods: The incidence data of childhood pulmonary TB were collected from notifiable disease and tuberculosis management information system of Chinese information system for disease control and prevention,and descriptive epidemiological methods were used to analyze the medical care seeking flow, characteristics and management inclusion of pulmonary TB cases in children. Statistical analysis and data visualization were conducted with softwares Excel 2015, R 4.1.2 and Echart 4.7.0. Results: A total of 6 811 pulmonary TB cases in children were reported in the four provinces during 2019-2021, in which 4 741 (69.6%) were clinically diagnosed and 2 070 (30.4%) were laboratory confirmed. A total of 526 medical institutions reported TB cases in children, including 356 general hospitals (67.7%, 356/526) reporting 4 706 cases, 11 infectious disease hospitals (2.1%, 11/526) reporting 836 cases and 5 children's hospitals (1.0%, 5/526) reporting 542 cases. A total of 6 249 (91.7%) local cases and 562 (8.3%) non-local cases were reported. The reported local incidence rates of TB from 2019-2021 were 6.20/100 000, 7.10/100 000 and 7.20/100 000, respectively, showing an increase trend year by year. The sex ratio of the cases were 0.98∶1(3 373∶3 438). The cases were mainly distributed in age group 10-14 years (4 887 cases, 71.8%). The cases were mainly students (5 167 cases, 75.9%). The management inclusion rates of the local cases and non-local cases were 20.60% and 2.67%, respectively. Conclusions: The main medical institutions reporting pulmonary TB cases in children were children's hospitals, infectious disease hospitals and TB special hospitals, the incidence of pulmonary TB in children in Sichuan was higher. In 2020, the inter-provincial medical seeking behavior of the pulmonary TB cases decreased significantly. The incidence rate in boys was lower than that in girls, and children aged 10-14 years were the population with high incidence of pulmonary TB. The management inclusion rate in non-local cases was lower than that in local cases.

Accurate Determination of Colorectal Polyp Counts Is Not Mission Impossible for Pathologists and Is Essential for Surveillance Interval Decision-Making: A Review of 1294 Specimens

Introduction/Objective

The US Multi-Society Task Force on colorectal cancer updated recommendations in 2020 for follow-up after colonoscopy. This emphasized differential surveillance intervals based on the number of polyps removed. We determined how often we accurately counted the number of polyps and what submission practices allowed accurate quantification.

Methods/Case Report

We reviewed consecutive colorectal polyp cases from 10/1 to 12/31, 2019, excluding inflammatory polyps in inflammatory bowel disease. Pathology reports were reviewed to determine if the polyp number could be determined from history, gross description, and histologic findings. When numbers did not match or were unclear, endoscopy reports and glass slides were reviewed.

Results (if a Case Study enter NA)

601 cases with 1294 specimens were identified. We accurately determined polyp number in 1235 (95.4%) specimens. 1072 (82.8%) specimens were submitted as single polyp per container (SP), while 222 (17.2%) were submitted with &gt; 1 polyp per container (MP). Polyp number was not quantifiable in 58 (26.1%) MP due to 11 labeled as “multiple polyps” in requisition/endoscopy reports and 47 submitted with polyp number different from number of tissue portions seen grossly and microscopically. In 1 (0.1%) SP, polyp number was unclear because separate portions of tissue contained two different diagnoses. Rate of accurate polyp count is significantly different between SP and MP (p&lt;0.01) by Fisher exact test.

Conclusion

We accurately determined number of polyps in most specimens (95.4%) because our gastroenterologists usually submit SP. In MP, polyp count in 26.1% of specimens was unquantifiable. This could lead to uncertainty in surveillance follow-up intervals. Therefore, we recommend submitting one polyp per container.

Development and signals simulation of a diamond detector neutral particle analyzer on Huanliu-2A (HL-2A) tokamak

A new neutral particle analyzer (NPA) diagnostic based on single crystal chemical vapor deposition (sCVD) diamond detector that provides measurements of fast ions has been designed and installed on HL-2A tokamak. Diamond detectors have been applied in some magnetic confinement fusion devices due to their outstanding properties of compact size and radiation hardness. This DNPA can measure energies above 13.4 keV. The line of sight (LOS) of the DNPA intersects with the NBI No. 2 with a tangency radius of 154.8 cm. Due to the pitch angle defined by the LOS and geometry of the diagnostic, the DNPA is mainly sensitive to trapped ions. To interpret the energy spectrum and verify the feasibility of the design of the DNPA, a Monte Carlo code called FIDASIM, which is a synthetic diagnostic code that simulates fast ion D-alpha and NPA signals, is applied to model the neutral flux reaching the detector. The results show that the flux is mainly contributed by the low energy fast ions (E < 10 keV) and it is mainly coming from the active components, the passive signal is dominant in the high energy region (E > 15 keV). The modeling features the ability to distinguish between active and passive signals, and the simulated strong passive signals are suggested to come from charge exchange between cold neutrals and fast ions around the plasma edge. In addition, despite the large ratio of halo neutrals, essentially it has a limited contribution to the energy spectrum.

Release of soluble ions and heavy metal during fly ash washing by deionized water and sodium carbonate solution

Two municipal solid waste incineration fly ashes were selected for washing by deionized water and Na₂CO₃ solution for comparison. Results showed that the benefits of washing were two folds: (1) Washing was able to reduce the contents of Cl^- and SO₄^2- while increased the contents of CaO, SiO₂, Al₂O₃ etc.; (2) Washing by Na₂CO₃ solution showed increased stability of heavy metals (Cr, Ni, Cd, Cu, Zn and Pb) and fly ash was safe for later reuse. Release of Cl^- was high at more than 90% regardless of washing solution. SO₄^2- and Ca²⁺ removal was highly dependent on the dissolution and precipitation equilibriums. Na₂CO₃ washing promoted the formation of CaCO₃. Thus SO₄^2- was washed off instead of precipitating as CaSO₄ and retained in fly ash solid. SO₄^2- removal was raised to more than 80% by Na₂CO₃ washing as compared with about 30% by deionized water. At the same time, Ca removal by Na₂CO₃ dropped to 1-2%. In addition, the basicity of fly ash was important as high basicity helped SO₄^2- removal. Overall, washing by Na₂CO₃ appears to be a promising option for fly ash treatment.

[High expression of CCBE1 in adjacent tissues of tongue squamous cell carcinoma is correlated with pericancerous lymphatic vessel proliferation and poor 5-year survival outcomes]

OBJECTIVE

To examine the correlation of CCBE1 expression in adjacent tissues of tongue squamous cell carcinoma (TSCC) with pericancerous lymphatic vessel proliferation, cervical lymph node metastasis and survival outcomes of the patients.

METHODS

Lymphatic vessel density was quantified in pericancerous tissue sections of 44 cases of cT_1-2N₀ TSCC using D2-40 as the lymphatic vessel endothelial marker for calibration and counting of the lymphatic vessels. Of these 44 cases, 22 showed a relatively low lymphatic vessel density (group A) and the other 22 had a high lymphatic vessel density (group B), and the expression levels of CCBE1 in the adjacent tissues determined using immunohistochemistry, immunofluorescence assay and Western blotting were compared between the two groups. The expression level of CCBE1 was also measured in another 90 patients with TSCC using immunohistochemistry, and all the patients were followed up for their survival outcomes.

RESULTS

Immunohistochemistry and Western blotting showed a significantly lower rate of high CCBE1 expression in group A than in group B (P < 0.05). Immunofluorescence assay showed co-localization of CCBE1 and D2-40 in the adjacent tissues of TSCC. In the 90 TSCC patients with complete follow-up data, a high expression of CCBE1 was found to correlate with lymph node metastasis and a poor 5-year survival outcomes of the patients (P < 0.05).

CONCLUSION

A high expression of CCBE1 in the adjacent tissues of TSCC is closely related with pericancerous lymphatic vessel proliferation, cervical lymph node metastasis and a poor 5-year survival of the patients, suggesting the value of CCBE1 as a potential prognostic predictor for TSCC.

Proteome Analysis of Temporomandibular Joint with Disc Displacement

Disc displacement without reduction is a common disorder of the temporomandibular joint, causing clinical symptoms and sometimes condylar degeneration. In some cases, bone regeneration is detected following disc-repositioning procedures. Until now, however, systems-wide knowledge of the protein levels for condylar outcome with disc position is still lacking. Here, we performed comprehensive expression profiling of synovial fluid from 109 patients with disc displacement without reduction using high-resolution data-independent acquisition mass spectrometry and characterized differences in 1,714 proteins. Based on magnetic resonance imaging, samples were divided into groups with versus without condylar absorption and subgroups with versus without new bone. For the proteomic analysis, 32 proteins in groups presented with statistical significance (>2-fold, P < 0.05). Pathways such as response to inorganic substances, blood coagulation, and estrogen signaling were significantly expressed in the group with bone absorption as compared with pathways such as regulation of body fluid levels, vesicle-mediated transport, and focal adhesion, which were enriched in the group without bone absorption. In subgroup analysis, 45 proteins of significant importance (>2-fold, P < 0.05) were associated with pathways including would healing, glycolysis and gluconeogenesis, and amino acid metabolism. Combined with clinical examination, molecules such as acetyl-CoA carboxylase beta (ACACB) and transforming growth factor beta 1 (TGFB1) were related to features such as visual analog scale and maximum interincisal opening (P < 0.05). In addition, 7 proteins were examined by Western blotting, including progesterone immunomodulatory binding factor 1 (PIBF1), histidine-rich glycoprotein (HRG), and protein kinase C and casein kinase substrate in neurons 2 (PACSIN2). In conclusion, this study provides the first proteome analysis of condylar absorption at disc displacement without reduction and postoperative new bone formation after disc reposition. Integrated with clinical data, this analysis provides an important insight into the proteomics of condylar modification at disc position.

[Chronic active Epstein-Barr virus infection in the gastrointestinal tract: a clinicopathological study of three cases]

Objective: To study the clinicopathological features of chronic active Epstein-Barr virus infection (CAEBV) in the digestive tract and to discuss its differential diagnosis. Methods: The clinical data of 3 cases of CAEBV in the digestive tract diagnosed in Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing, China from December 2018 to August 2020 were collected. Three cases of CAEBV were evaluated using histology, immunohistochemistry and in situ hybridization. The related literature was reviewed. Results: Three patients were all males, aged 33, 32 and 31 years, respectively. All patients had a history of intermittent fever and repeated diarrhea for the past years with persistent increase in EB viral load (DNA copies) in peripheral blood. Endoscopically, intestinal tract was involved in all cases with ulcers, and esophagus was involved concurrently in 1 case showing nodular lesions. Microscopically, there were moderate polymorphic inflammatory infiltrate with lymphoid component displaying no or mild atypia in all cases and deep fissuring ulcers in one case (case 3). All tumor cells were positive for CD3 and TIA-1, and negative for CD56 and CD5. Cases 1 and 2 showed CD4^-/CD8^-, whereas case 3 displayed CD4⁺/CD8^-. In situ hybridization for Epstein-Barr virus-encoded RNA was positive in all 3 cases. Follow-up data showed that cases 1 and 2 were free of disease progression at the end of follow-up (16 months and 17 months, respectively). However, case 3 progressed to extranodal NK/T-cell lymphoma 22 months after the initial diagnosis. Conclusions: CAEBV of the digestive tract is a rare lymphoid proliferative disorder with potential transformation to extranodal NK/T-cell lymphoma. It is a great mimicker of inflammatory bowel disease, especially in small biopsy specimens. It is important to integrate clinicopathological, radiological and laboratory data to avoid misdiagnosis.

[Research advances on influencing factors and intervention strategies of pediatric burns]

Burns not only affect children's physiology and psychology, but also bring a burden to their families and society, which can be prevented to a large extent. By introducing the epidemiological characteristics and current disease burden of pediatric burns, and combining them with the Haddon matrix, this paper reviews the progresses on the influencing factors and interventional measures of pediatric burns from three aspects: host, injury factors, and environment. It aims to provide a theoretical basis for the developments of burn risk assessment tools suitable for Chinese pediatric burns and to provide a reference for the formulation of related comprehensive and multi-level intervention measures.

An Analysis of the Effects of the English Language and Literature on Students' Language Ability from a Multidimensional Environment

One of the most crucial components of a student's language proficiency is basic language proficiency, which is also its fundamental component. The development of students' language skills is greatly aided by ELL (English Language and Literature). It can not only foster the growth of students' language thinking but also widen their perspectives and enhance their capacity for language comprehension. In this essay, the rules of English are examined from the multifaceted ELL viewpoint. This study extracts personality characteristic data from practical texts and incorporates it into a modelling process of students' knowledge changes based on DM- (data mining-) related technology and multidisciplinary expertise. According to the t-test results, ELL, which incorporates communicative competence, has started to take on a role in education and is helping students' language skills. The performance gains are 3.95, 4.21, and 3.66, when the number of computing nodes is increased to 10, 20, and 30 times that of the original nodes, and the linear expansion indices are 0.914, 0.928, and 0.93. This proves that the Hadoop+Hive-based data cleaning tool has excellent linear scalability.

[The nutritional management in the early rehabilitation for critically ill patients]

The early rehabilitation is one of the important measures for the prevention or management of the post-intensive care syndrome. The nutritional intervention, as another essential supportive treatment for critically ill patients, is closely linked to rehabilitation management. However, the nutritional management in relation to early rehabilitation for critically ill patients has been rarely studied up to now. This paper sorts out the link between nutrition support and early rehabilitation for patients with critical illness, and looks forward to providing evidence for the combination of critical care rehabilitation management and nutritional intervention.

[Analysis of epidemiological characteristics of pulmonary tuberculosis patients in Fengtai District, Beijing City from 2011 to 2021]

Objective: To analyze the epidemiological characteristics of pulmonary tuberculosis (PTB) in Fengtai District from 2011 to 2021. Methods: A retrospective study was conducted, the data of PTB patients in Fengtai District from 2011 to 2021 were collected in Chinese disease prevention and Control Information System, which included etiological classification, gender, age, occupation, onset time, demographic information etc. the epidemiological characteristics of reported PTB patients was analysis. Results: A total of 10 342 cases of PTB were reported from 2011 to 2021 in Fengtai District, with an average annual reported incidence rate of 42.87/ 100 000. The incidence rate was the highest in 2012(75.89/100 000), and significantly declined from 2013, which declined to 29.70/100 000 in 2017. It showed a slow rise from 2018 to 2021. The difference was statistically significant (χ²=1 471.77,P<0.001).There were 2 975 cases of etiologic positive PTB from 2011 to 2021, and 76 cases of Rifampicin-resistant PTB from 2017 to 2021. The ratio of male cases to female was 1.75, the average annual incidence rate of male (53.94/100 000) was higher, than female(31.57/100 000).(χ²=704.01,P<0.001). Among all age groups, 25-29 years group, 20-24 years group and 30-34 years group had the highest proportion, which were 1 506 cases (14.56%) , 1 292 cases (12.49%) and 1 024 cases (9.90%) respectively. The average annual incidence rate was the lowest in the group less than 10 years old (1.43/100 000), and the highest in the group 85 years old and over (195.20/100 000), the difference was statistically significant(χ²=3164.24, P<0.001). The top occupations from high to low were housework and unemployment (2 917 cases, 28.21%), retirees (2 308 cases, 22.32%), workers (1 047 cases, 10.12%), cadres and staff (950 cases, 9.19%), farmers (860 cases, 8.32%), business services (698 cases, 6.75%), teachers and students (455 cases, 4.40%). Conclusion: From 2011 to 2021, the incidence rate of PTB was decreased from 2012 to 2017, and slowly increased lately in Fengtai District. The epidemiological characteristics of PTB vary in different age and gender.

Effects of weight loss on bone turnover, inflammatory cytokines, and adipokines in Chinese overweight and obese adults

PURPOSE

Plenty of studies have examined the long term effect of weight loss on bone mineral density. This study aimed to explore the effects of 10% weight loss on early changes in bone metabolism as well as the possible influencing factors.

METHODS

Overweight and obese outpatients (BMI > 24.0 kg/m²) were recruited from the nutrition clinic and followed a calorie-restricted, high-protein, low-carbohydrate diet program. Dietary intake, body composition, serum procollagen type I N-propeptide (PINP), β-Crosslaps, PTH, 25(OH) VitD, a series of inflammatory cytokines and adipokines were measured for the participants before starting to lose weight and after 10% weight loss (NCT04207879).

RESULTS

A total of 75 participants were enrolled and 37 participants achieved a weight loss of at least 10%. It was found that PINP decreased (p = 0.000) and the β-Crosslaps increased (p = 0.035) in female participants. Decreases in PTH (p = 0.001), serum IL-2 (p = 0.013), leptin (p = 0.001) and increases in 25(OH) VitD (p = 0.001), serum ghrelin (p = 0.033) were found in 37 participants after 10% of their weight had been lost. Change in PINP was detected to be significantly associated with change in lean body mass (r = 0.418, p = 0.012) and change in serum ghrelin(r = - 0.374, p = 0.023).

CONCLUSIONS

Bone formation was suppressed and bone absorption was increased in female subjects after a 10% weight loss. Bone turnover was found to be associated with lean body mass and affected by the circulating ghrelin level.