[Clinical features and reasons for missed diagnosis of allergic bronchopulmonary aspergillosis]

Objective: To summarize the clinical features of allergic bronchopulmonary aspergillosis (ABPA) and analyze the common causes of missed diagnosis. Methods: The clinical data of patients with ABPA who were admitted into Qilu Hospital of Shandong University from October 2014 to November 2017 were retrospectively analyzed, including baseline data, eosinophil count in peripheral blood, serum total IgE, A. fumigates-specific antibody (sIgE, sIgG and sIgM), pulmonary function tests and chest CT, etc. Then the correlations between serum total IgE, sIgE and forced expiratory volume in one second (FEV₁) as percentage of predicted value (FEV₁%pred) was conducted, as well as that between serum total IgE, sIgE and FEV₁/forced vital capacity (FEV₁/FVC). The clinical features of the patients were summarized and the causes of missed diagnosis were analyzed. Results: There were 46 patients with ABPA (21 males and 25 females, 48.3±13.2 years old) in total. Only 2 cases (4.3%) were diagnosed after the first symptom onset, and 44 cases (95.7%) were treated repeatedly for many years before being diagnosed. The misdiagnoses were asthma (26 cases, 56.5%), bronchiectasis (13 cases, 28.3%), pneumonia (4 cases, 8.7%), pulmonary tuberculosis (3 cases, 6.5%), and lung cancer (4 cases, 8.7%). Common symptoms of ABPA included cough, expectoration, wheezing, chest tightness, fever, weight loss, chest pain, etc. Peripheral blood eosinophil count increased in 37 patients (80.4%). Serum total IgE in 37 patients (80.4%) were higher than 1 000 U/ml, and 9 cases (19.6%) were less than 1 000 U/ml. The positive rate of sIgE, sIgG and sIgM was 100.0%, 89.1% and 54.3%, respectively. All patients underwent pulmonary function tests and 35 cases (76.1%) had obstructive ventilation dysfunction, 5 cases (10.9%) with mixed ventilation dysfunction, 5 cases (10.9%) were normal and 1 case (2.2%) with restrictive ventilation dysfunction. All patients underwent Chest CT examination, 28 cases (60.9%) showed bronchiectasis, 8 cases (17.4%) manifested mucus plugs (among them, 4 cases with high-attenuation mucus) and 10 cases (21.7%) had other atypical imaging. Serum total IgE and sIgE had no correlations with FEV₁%pred and FEV₁/FVC. Conclusions: ABPA is characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. The main reasons of misdiagnosis in ABPA patients were: atypical symptoms, variety of predisposing diseases, early atypical imaging changes, limitations and misunderstandings of screening indicators, interference with tumor markers, and the presence of pulmonary aspergillus overlap syndrome. The severity of asthma attacks is not related to the degree of fungal sensitization.

Methylation and expression analysis of mismatch repair genes in extramammary Paget's disease

BACKGROUND

Extramammary Paget's disease (EMPD) is a rare skin cancer with relative high frequencies of germline and somatic mismatch repair (MMR) genes mutations. However, the methylation and expression of these genes have not been validated in EMPD.

OBJECTIVE

This study aims to confirm the methylation and expression of MMR genes in EMPD.

METHODS

Immunohistochemical (IHC) staining detection and Methylation-specific PCR (MSP) were used to analyse MLH1, MSH2, MSH6 and PMS2 proteins' expression and promoters' methylation in 57 EMMD samples, and pyro-sequence was used to find highly methylated CpG sites in MSH2 promoter.

RESULTS

Immunohistochemical detection displayed reduced expression of MSH2 in 38.6% EMPD cases but normal expression of MLH1, MSH6 and PMS2 in all tumour tissues. Hypermethylation also was found in the promoter of MSH2 but not in other MMR genes. Pyrosequencing of MSH2 promoter showed CpG6 (-87) and CpG3 (-98) were the most common two methylated CpG dinucleotides. There is a significant correlation between reduced MSH2 expression and MSH2 methylation.

CONCLUSION

Reduced MSH2 expression and hypermethylation in this gene promoter were common genetic changes in EMPD, which expands our understanding of the role of MMR function in this skin cancer.

Regulatory T-cell levels in systemic lupus erythematosus patients: a meta-analysis

Background

The contribution of regulatory T-cells (Tregs) to systemic lupus erythematosus (SLE) pathogenesis remains a matter of debate. The objective of this study was to quantify the association between peripheral blood Tregs and disease status in SLE patients.

Method

EMBASE and PubMed databases were searched using ‘systemic lupus erythematosus’ and ‘regulatory T-cells’ as relevant key terms. A meta-analysis of studies that examined the proportion of Tregs among peripheral blood mononuclear cells (PBMCs) and CD4+T-cells was performed using Stata software. Subgroup analysis was performed based on ethnic groups and Treg definition markers.

Results

The Treg/PBMC and Treg/CD4+T-cell ratios were significantly lower in SLE patients than in healthy controls (HCs), whereas patients with active and inactive SLE showed no difference in these indicators. A subgroup analysis indicated that Asian SLE patients had a substantially lower proportion of Tregs/PBMCs than HCs, but this difference was not seen for white and Latin American SLE patients. Patients defined by CD4+CD25+Foxp3+, CD4+CD25+ and CD4+Foxp3+ had a much lower Treg/PBMC ratio compared with HCs. Ethnic groups and choice of Treg definition markers had no influence on the proportion of Tregs/CD4+T-cells.

Conclusion

The proportion of Tregs among both PBMCs and CD4+T-cells was significantly decreased in SLE patients. Ethnic group and Treg definition markers may influence the proportion of Tregs among PBMCs. Further study of the correlation between SLE disease activity and the proportion of Tregs in peripheral blood is needed to determine the physiological role of this association.

Association between IL-10 polymorphisms rs1800896 and rs1800871 and risk of acute pancreatitis in Chinese Han population: An update systemic review and meta-analysis

The association between interleukin-10 (IL-10) promoter region (1082 A/G (rs1800896), 819 C/T (rs1800871)) polymorphisms, and acute pancreatitis (AP) is inconclusive in Chinese Han population. In this study, six eligible studies extracted from the databases of PubMed, Web of Science, and Cochrane Library were evaluated. The results revealed a significant association between 1082 A/G (rs1800896) polymorphism and AP risk in all these five models (AG/AA: OR = 1.19, 95% Cl = 1.02-1.40, P = 0.03; GG/AA: OR = 1.80, 95% Cl = 1.38-2.23, P = 0.01; AG+GG/AA: OR = 1.29, 95% Cl = 1.11-1.50, P = 0.01; GG/AG+AA: OR = 1.62, 95% Cl = 1.27-2.08, P = 0.01; G/A: OR = 1.29, 95% Cl = 1.15-1.45, P = 0.01). In contrast, no statistically significant association was found in all these five models for 819 C/T (rs1800871) polymorphism. In summary, IL-10 polymorphism 1082 A/G (rs1800896) could increase the risk of AP in Chinese Han population.

[Effect of transcutaneous oximetry on prognosis of patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation]

Objective: To investigate the prognostic value of transcutaneous oximetry in patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation(ECMO). Methods: Forty-nine patients diagnosed as severe acute respiratory failure receiving Venous-Venous(V-V)ECMO were enrolled from January 2013 to December 2015 in intensive care unit(ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University.The 10-min oxygen challenge test was performed using transcutaneous oximetry 6 h after the initiation of ECMO, and the 10-min oxygen challenge test value(OCT(10)) and oxygen challenge index(OCI) were calculated.The following data were collected: patients' baseline characteristics, results of arterial blood gas analysis, ventilator settings, APACHEⅡ, SOFA and Murray lung injury score. Patients were stratified into the survival group and the death group based on their mortality status at 60 d after initiation of ECMO.Patients' characteristics and clinical data were analyzed with SPSS 22.0 software. Receiver operating characteristics (ROC) analysis for predicting 60 d mortality was carried out to find area under curve (AUC) and threshold levels of OCT(10) and OCI. Analysis of survival probability was carried out by Kaplan-Meier method and log-rank test. Multivariable logistic regression was used to identify factors associated with outcomes. Results: There were 25 patients in the survival group and 24 patients in the death group. The characteristics(i.e., age, sex, primary disease) and clinical data(i.e., results of arterial blood gas, ventilator settings) of the 2 groups were similar (P>0.05). The survival group had a significant higher OCT(10) and OCI [(77±11) mmHg(1 mmHg=0.133 kPa), 0.77±0.17] than the death group [(57±12) mmHg, 0.55±0.13, all P<0.05]. The AUC value of OCT(10) and OCI for predicting 60 d mortality were 0.87±0.07(95%CI: 0.69-0.96, P<0.05) and 0.83±0.18(95%CI: 0.64-0.94, P<0.05) respectively, and the cutoff points for OCT(10) and OCI were 72.00 mmHg and 0.80. Kaplan-Meier survival analysis showed that a OCT(10)≥72 mmHg (81.3% vs 15.4%, χ(2)=7.04, P<0.01) and a OCI≥0.8(77.8% vs 21.7%, χ(2)=13.15, P<0.01) were related to better outcome. Multivariate logistic regression analysis showed that OCT(10)(OR=0.88, 95%CI: 0.80-0.96, P<0.01) and OCI (OR=0.01, 95%CI: 0.001-0.086, P<0.01) were both risk factors associated with 60 d mortality. Conclusion: The OCT(10) and OCI are predictive of mortality for patients with severe acute respiratory failure receiving ECMO support.

Resonance/non-resonance doublet-based self-absorption-free LIBS for quantitative analysis with a wide measurement range

A resonance/non-resonance, doublet-based, self-absorption-free, laser-induced breakdown spectroscopy (SAF-LIBS) technique is proposed for greatly expanding the measurement range of quantitative elemental analysis by using a quasi-optically thin line. The quasi-optically thin spectral line is obtained by matching the measured doublet atomic lines' intensity ratios with the theoretical one, and the applicable measurement range is expanded by utilizing the resonance and non-resonance lines. The specific calibration process consists of two parts: the nonlinear LIBS calibration and the linear SAF-LIBS calibration. For quantitative measurements, the approximate content of the unknown sample is determined first by using the LIBS calibration curve, and then the SAF-LIBS spectra and the resonance or non-resonance calibration curve that corresponds to the predetermined content are used for further implementing the quantitative analysis. Univariate quantitative analysis results of Cu show that this resonance/non-resonance doublet-based SAF-LIBS technique not only captures the quasi-optically thin spectral line in a wide range of elemental content, but also possesses high correlation coefficients of calibration curves, small relative errors of measurement and low limits of detection. The applicability and limitations of this technique are also discussed, and the evolution as well as the related major determinants of self-absorption are analyzed by taking advantage of the spatial-temporal evolution images of plasma emissivity.

Effect of bamboo vinegar powder on the expression of the immune-related genes MyD88 and CD14 in weaning piglets

The aim was to explore the feasibility of using bamboo vinegar powder as an antibiotics substitute in weaning piglets. Forty-five healthy Duroc × Landrance × Yorshire piglets (weight 6.74 ± 0.17 kg; age 31 days) were randomly divided into the control group (basic diet), ANT group (basic diet + 0.12% compound antibiotics), BV1 group (basic diet + 0.1% bamboo vinegar powder), BV5 group (basic diet + 0.5% bamboo vinegar powder) and BV10 group (basic diet + 1% bamboo vinegar powder). MyD88 and CD14 expression in immune tissues was examined using real-time PCR. MyD88 expression in the control group were significantly lower than that in other groups in all tissues (p⟨0.05), while CD14 expression showed the opposite trend. MyD88 expression was significantly higher in the BV10 group than in other groups in lung tissue (P⟨0.05), significantly higher in the ANT group than in the BV1 group in the kidneys (P⟨0.05), significantly higher in the BV10 group than in the BV1 group in the thymus (P⟨0.05), and signifi- cantly higher in the BV1 group than in the BV10 group in the lymphatic tissue (P⟨0.05). These differences between experimental groups were not observed for the CD14 gene (P>0.05). Thus, adding bamboo vinegar powder to the basic diet of weaning piglets had immune effects similar to antibiotics and the effect was dose-dependent. Moreover, the MyD88 and CD14 genes appear to play a role in these immune effects.

ERCC polymorphisms and risk of osteosarcoma: a meta-analysis

OBJECTIVE

The association between excision repair cross-complementation (ERCC) gene family (ERCC1 and ERCC2) and osteosarcoma risk was controversial. The aim of this study was to evaluate the association between ERCC1 or ERCC2 and osteosarcoma risk by systematic meta-analysis.

MATERIALS AND METHODS

Relative studies were retrieved from electronic databases without language restriction. The last search was updated on March 2017. Quality assessment was analyzed by the Newcastle-Ottawa Scale (NOS) score, which was recommended by the Agency for Healthcare Research and Quality (AHRQ). Meta-analysis was conducted by R language package (R 3.12).

RESULTS

This meta-analysis was performed based on 4 case-control studies that included 1208 cases and 2448 controls. The ERCC2-rs1799793 AA+AC > CC (OR=1.3428, 95% CI=1.0201; 1.7674) had an effect on the risk of osteosarcoma development, whereas, there were no significant associations among the other ERCC SNPs (ERCC1 rs3212986, ERCC1 rs11615, and ERCC2 rs13181) and osteosarcoma.

CONCLUSIONS

The ERCC2 rs1799793 polymorphism is related to the high risk of osteosarcoma development.

[Research progression on triage of human papillomavirus positive women]

Persistently high risk human papillomavirus (HPV) infection is one of the indispensable factors of cervical cancer, which is the secondly most common cancer of women in developing countries. Nowadays HPV DNA detection has been more frequently used in cervical cancer initial screening. However, the specificity and sensitivity of HPV DNA detection are low and the triage of HPV positive women is necessary to identify the authentically high-risk population, and avoid the waste of health care resource and excessive treatment. There are different advantages and disadvantages in triage methods including the cytology, HPV DNA genotype, HPV mRNA detection and biological markers such as p16/Ki-67, respectively. Here we briefly describe and evaluate each triage method.

Genomewide association study for economic traits in the large yellow croaker with different numbers of extreme phenotypes

A traditional genomewide association study (GWAS) detects genotype-phenotype associations by the vast number of genotyped individuals. This method requires large-scale samples and considerable sequencing costs. Extreme phenotypic sampling proposes make GWAS more cost-efficient and are applied more widely. With extreme phenotypic sampling, we performed a GWAS for n-3 highly unsaturated fatty acids (HUFA) and eviscerated weight (EW) traits in the large yellowcroaker population. Of the 32,249 and 29,748 detected SNPs for the two traits, three candidate regions were found in each trait. Three candidate regions associated with HUFA were known near genes on chromosomes 4 and 11, and three candidate regions were on chromosome 6, and 15 for the EW trait. By combing through our GWAS results and the biological functional analysis of the genes, we suggest that the FABP, DGAT, ATP8B1, FAF2 and CERS2 genes, as well as the IGF2, BORA, CYP1A1, GRTP1 and HOX genes are promising candidate genes for n-3 HUFA and EW, respectively, in the large yellow croaker.Moreover, compared with the different numbers of the extreme phenotypic sampling, we conclude that 60% of the extreme phenotypic subsample can obtain a similar result as GWAS with whole phenotypes. Thus, extreme phenotypic sampling could save 40% of the cost for genotyping and DNA extraction without loss of the candidate regions and functional genes. Our study may provide a basis for further genomic breeding and a reference for others who want to perform GWAS with extreme phenotypes.

[Correlation between severity of gastroesophageal reflux cough and degree of gastroesophageal reflux disease]

Objective: To explore the correlation between the severity of gastroesophageal reflux cough and degree of gastroesophageal reflux. Methods: A cross-sectional investigation was carried out. Data of 174 cases of chronic cough were collected in Children's Hospital of Fuzhou from March 2009 to December 2016. The esophageal 24 hours pH value dynamic monitoring was used to detect gastric acid reflux index. Cases with abnomal results were divided into mild, moderate and severe groups according to severity of reflux and that of day and night cough symptoms, respectively. They were also divided into infant (1-3 years old), preschool (4-6 years old), and school age (>7 years old) groups according to age. Comparative analysis between groups by chi-square test and rank sum test were performed. Correlation analysis was used to analyze the correlation between cough severity and gastroesophageal reflux index. Results: A total of 174 patients with chronic cough, including 115 males and 59 females, aged from 1 to 15 years with an average age of (8.5±2.3) years, and (1.6±0.8) years of disease duration were enrolled. Among them, 129 cases (74.1%) were positive for esophageal reflux test and 45 cases (25.9%) with no obvious pathological gastroesophageal reflux. Patients with positive esophageal reflux test were divided into severe (n=37, 28.7%), moderate (n=23, 17.8%), and mild (n=69, 53.5%). There was no significant difference in the distribution of gastroesophageal reflux in each age group. (The proportions of mild, moderate and severe reflux in infants were 45.0% (9/20), 25.0% (5/20), and 30.0% (6/20), respectively. The proportions of mild, moderate and severe reflux in preschool children were 53.3% (32/60), 16.7% (10/60), 30.0% (18/60), respectively. The proportions of mild, moderate and severe reflux in school age children were 57.1% (28/49), 16.3% (8/49), 26.5% (13/49), respectively χ(2)=1.204, P=0.877). There was no correlation between age group and gastroesophageal reflux (r=-0.065, P=0.489).The severity of nighttime cough was positively correlated with percentages of distal esophagus pH≤4 in time, recumbent pH≤4 in time, and DeMeester score<14.72 (r=0.689, 0.621, and 0.707 respectively, all P<0.05). There was no statistically significant correlation between the severity of nighttime cough symptoms and percentage of standing pH≤4 in time (r=0.113, P>0.05). There were no statistically significant correlation between the severity of daytime cough and all gastroesophageal reflux markers (all P>0.05). Conclusion: The severity of nocturnal symptoms of gastroesophageal reflux cough is related to the degree of gastroesophageal reflux, to which clinical pediatricians should pay attention.

[Efficiency Analysis of EX16+10Y Kit on Detection of the Uygur Population in Xinjiang Province]

OBJECTIVES

To analyse the efficiency of EX16+10Y kit on the forensic detection of the Uygur in Xinjiang province.

METHODS

The blood samples were extracted from 4 620 male individuals of Uygur in Xinjiang province, and amplified by EX16+10Y kit. The typing of amplification products was performed by 3130xl genetic analyzer.

RESULTS

The genotyping graphs of 15 autosomal STR loci and 10 Y-chromosomal STR loci from 4 620 male individuals of Uygur in Xinjiang province were acquired completely. The genotype distribution of 15 autosomal STR loci was consistent with Hardy-Weinberg equilibrium. The heterozygosity, polymorphism information content and discrimination power of STR loci were 0.637-0.838, 0.580-0.860 and 0.811-0.978, respectively. There were 766 haplotypes in 10 Y -chromosomal STR loci.

CONCLUSIONS

The test results of EX16+10Y kit is accurate and trustworthy, which can simultaneously be used for the individual identification and the screening of paternal pedigree in practical work.

[Status on sexual partners among men who have sex with men among college students in Qingdao, 2016]

Objective: To investigate the situation of sexual partners and related factors among men who have sex with men (MSM) in college students. Methods: Snowball sampling and Convenience sampling were both used to recruit MSM from colleges in Tsingtao in 2016. Questionnaire-based interviews were conducted to collect data of socio-demographic and situation of sexual partners. Sample Size was estimated based on cross-sectional study, and theoretical 267. SPSS 17.0 software was used for statistical analysis. Results: A total of 300 MSM, average aged 20.7, were analyzed. Both first sex partner and the last same-sex sexual partner were met instantly, with proportions as 58.7% (176/300) and 62.3% (187/300) respectively. Among all the MSM, 88.3% (265/300) preferred selecting men as sex partners and 42.7% (128/300) enjoyed finding sex partners in college, while 86.0% (258/300) preferred finding their sex partners through internet. Conclusions: Internet had been the major way of looking for sex partner among MSM in college students, the male sexual partner were met instantly. We should focus on men who have sex with men and their sexual health among college students to prevent and control HIV/AIDS.

Clinical and radiographic outcomes of upper thoracic versus lower thoracic upper instrumented vertebrae for adult scoliosis: a meta-analysis

The aim of this study was to evaluate the clinical and radiographic outcomes of upper thoracic (UT) versus lower thoracic (LT) upper instrumented vertebrae (UIV) for adult scoliosis by meta-analysis. We conducted a literature search in three databases to retrieve related studies up to March 15, 2017. The preliminary screened studies were assessed by two reviewers according to the selection criteria. All analyses were carried out using the statistical software package R version 2.31. Odds ratios (OR) with 95% confidence intervals (CI) were used to describe the results. The I² statistic and Q statistic test were used for heterogeneity assessment. Egger's test was performed to detect publication bias. To assess the effect of each study on the overall pooled OR or standardized mean difference (SMD), sensitive analysis was conducted. Ten trials published between 2007 and 2015 were eligible and included in our study. Meta-analysis revealed that the UT group was associated with more blood loss (SMD=0.4779, 95%CI=0.3349-0.6209, Z=6.55, P<0.0001) and longer operating time (SMD=0.5780, 95%CI=0.1971-0.958, Z=2.97, P=0.0029) than the LT group. However, there was no significant difference in Oswestry Disability Index, Scoliosis Research Society (SRS) function subscores, radiographic outcomes including sagittal vertical axis, lumbar lordosis, and thoracic kyphosis, length of hospital stay, and revision rates between the two groups. No evidence of publication bias was found between the two groups. Fusion from the lower thoracic spine (below T10) has as advantages a shorter operation time and less blood loss than upper thoracic spine (above T10) in posterior long-segment fixation for degenerative lumbar scoliosis.

Identification of the novel HLA-C*07:530 allele by polymerase chain reaction sequence-based typing

HLA-C*07:530 differs from HLA-C*07:02:01 by a single nucleotide at position 363G>C.

Aberrant Thalamocortical Connectivity in Juvenile Myoclonic Epilepsy

The purpose of this study was to investigate the functional connectivity (FC) of thalamic subdivisions in patients with juvenile myoclonic epilepsy (JME). Resting state functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) data were acquired from 22 JME and 25 healthy controls. We first divided the thalamus into eight subdivisions by performing independent component analysis on tracking fibers and clustering thalamus-related FC maps. We then analyzed abnormal FC in each subdivision in JME compared with healthy controls, and we investigated their associations with clinical features. Eight thalamic sub-regions identified in the current study showed unbalanced thalamic FC in JME: decreased FC with the superior frontal gyrus and enhanced FC with the supplementary motor area in the posterior thalamus increased thalamic FC with the salience network (SN) and reduced FC with the default mode network (DMN). Abnormalities in thalamo-prefrontocortical networks might be related to the propagation of generalized spikes with frontocentral predominance in JME, and the network connectivity differences with the SN and DMN might be implicated in emotional and cognitive defects in JME. JME was also associated with enhanced FC among thalamic sub-regions and with the basal ganglia and cerebellum, suggesting the regulatory role of subcortical nuclei and the cerebellum on the thalamo-cortical circuit. Additionally, increased FC with the pallidum was positive related with the duration of disease. The present study provides emerging evidence of FC to understand that specific thalamic subdivisions contribute to the abnormalities of thalamic-cortical networks in JME. Moreover, the posterior thalamus could play a crucial role in generalized epileptic activity in JME.

[Advances in the research of treatment of angiogenesis inhibitor on pathological scars]

Angiogenesis inhibitors are a class of agents that prevent the angiogenesis by inhibiting the activation, migration, and proliferation of endothelial cells. In recent years, studies have found that there was a close relationship between the occurrence of pathological scars and angiogenesis. The vascular density in pathological scars is significantly higher than that in normal skin and scars. Neovascularization supports the fibroblasts growth and collagen production, which contribute to the development of pathological scars. Therefore, the angiogenesis inhibitor may become a possible agent for prevention and treatment of pathological scars. This review explores the relationship between pathological scars and angiogenesis inhibitor.

[Characteristics of epidemiology and antimicrobial resistance of gram-negative bacterial bloodstream infections in children]

Objective: To study the epidemiology and antimicrobial resistance of Gram-negative bacterial bloodstream infections in children, and to guide the choice of antimicrobials and the control of nosocomial infection. Method: Clinical data, bacteriology and antimicrobial susceptibility test results were collected retrospectively in hospitalized children who were diagnosed with gram-negative bacterial bloodstream infections in Yuying Children's Hospital of Wenzhou Medical University from January, 2010 to December, 2015. Result: A total of 399 cases (253 male and 146 female) were identified. The age ranged from 16 hours to 16 years (median age 10.1 months). The majority of cases were collected from division of neonatology (n=261, 65.4%), followed by 31 cases (7.8%) from pediatric intensive care unit and 29 cases (7.3%) from Gastroenterology Department; 275 cases (68.9%) had underlying diseases, mainly including preterm birth(n=172), neonatal respiratory distress syndrome(n=67) and newborn asphyxia(n=53). Eighty cases had received invasive procedures and 20 had surgical operation; 149 cases (37.3%) were community-acquired and 250 cases (62.7%) were hospital acquired. Fifty cases had complications, among those, 40 cases had septic shock, 32 cases had multiple organ dysfunction syndrome and 7 cases had disseminated intravascular coagulation; 288 cases were cured, 48 improved, 17 gave up treatment and discharged, and 46 died; totally 408 strains were isolated from 399 children, including Enterobacteriaceae (346, 84.8%), non-fermentative Gram-negative bacteria (49, 12.0%) and other gram-negative bacteria (13, 3.2%). The resistance rates of Escherichia coli (n=175) and Klebsiella pneumoniae (n=106) to carbapenems, β-lactams enzyme and its inhibitors, amikacin and cefoxitin were all lower than 10%. Totally 245 multi-drug resistant strains (60.1%) were isolated, including 225 strains of Enterobacteriaceae and 18 strains of non-fermentative Gram-negative bacteria (P<0.01) . Nine strains of Carbapenem-resistant Enterobacteriaceae were isolated, which were all sensitive to amikacin and the sensitive rates to fluoroquinolone reached 88.9%. Five strains which were detected sensitive to tigecycline were all sensitive. The proportion of Klebsiella sp in Gram-negative bacteria between 2013-2015 and 2010-2012 were 32.9% and 21.2%, respectively. The resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams and its enzyme inhibitors and carbapenems had no significant change. Conclusion: Gram-negative bacterial bloodstream infections occur more frequently in newborns. Most children had combined underlying diseases. Escherichia coli and Klebsiella pneumoniae are the most common pathogens. β-Lactams and its enzyme inhibitors and carbapenems are the empirical choice of antimicrobial therapy for severe Enterobacteriaceae bloodstream bacterial infections.

Extracellular diffusion quantified by magnetic resonance imaging during rat C6 glioma cell progression

Solution reflux and edema hamper the convection-enhanced delivery of the standard treatment for glioma. Therefore, a real-time magnetic resonance imaging (MRI) method was developed to monitor the dosing process, but a quantitative analysis of local diffusion and clearance parameters has not been assessed. The objective of this study was to compare diffusion into the extracellular space (ECS) at different stages of rat C6 gliomas, and analyze the effects of the extracellular matrix (ECM) on the diffusion process. At 10 and 20 days, after successful glioma modeling, gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) was introduced into the ECS of rat C6 gliomas. Diffusion parameters and half-life of the reagent were then detected using MRI, and quantified according to the mathematical model of diffusion. The main ECM components [chondroitin sulfate proteoglycans (CSPGs), collagen IV, and tenascin C] were detected by immunohistochemical and immunoblot analyses. In 20-day gliomas, Gd-DTPA diffused more slowly and derived higher tortuosity, with lower clearance rate and longer half-life compared to 10-day gliomas. The increased glioma ECM was associated with different diffusion and clearance parameters in 20-day rat gliomas compared to 10-day gliomas. ECS parameters were altered with C6 glioma progression from increased ECM content. Our study might help better understand the glioma microenvironment and provide benefits for interstitial drug delivery to treat brain gliomas.

[Changes in genotype prevalence of human papillomavirus over 10-year follow-up of a cervical cancer screening cohort]

Objective: To evaluate the dynamic variation of genotypes distribution of human papillomavirus (HPV) over 10-year follow-up in a cervical cancer screening cohort. Methods: Based on the Shanxi Province Cervical Cancer Screening Study Ⅰ cohort, we detected HPV genotypes on the well-preserved exfoliated cervical cells from women who were tested HPV positive from year 2005 to year 2014 using reverse linear probe hybridization assay. The changes of prevalence of type-specific HPV over time among the overall population were estimated using linear mixed models. The association between the type-specific HPV and cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) was calculated by linear Chi-square test. Finally, the trends of multiple infections of HPV with the increase of the age were analyzed. Results: During the cervical cancer screening of the overall population from 2005 to 2014, the most common genotypes among the population were HPV16 and 52. The prevalence of HPV16 decreased over time from 4.6% in 2005 to 2.2% in 2010 and 2014 (F=8.125, P<0.001). The prevalence of HPV52 remained pretty stable and HPV33, 51 and 58 slightly decreased then apparently increased. Further stratification analysis by pathological lesions showed the same trend of the HPV prevalence for the histology normal women with the overall population. Of note, for those women with the cervical intraepithelial neoplasia (CIN2 +), the detection rate of HPV16 decreased from 65.22% in 2005 to 41.03% in 2010 and finally to 31.58% in 2014 (χ(2)=4.420, P=0.036) and that of HPV33 substantially increased. No significant variation was found for other types of HPV. Multiple infection rate varied with the growing age of the women. Conclusions: The genotypes prevalence of HPV tended to vary over time during cervical cancer screening in the context of regular screening combining with immediate treatment for those CIN2 + women. HPV16 prevalence significantly decreased over time, which indicated that the variation of type-specific HPV prevalence should be considered when regular cervical cancer screening was organized using HPV technique.

Quantitative analysis of efficacy and associated factors of calcium intake on bone mineral density in postmenopausal women

A model-based meta-analysis method was performed to quantitatively analyze the efficacy characteristics of calcium intake in BMD increase among postmenopausal women. We found that age and calcium intake dose were key factors affecting the efficiency and onset of BMD change, and daily 1200 mg calcium was suggested to be a beneficial dosage.

INTRODUCTION

This paper aims to quantify the efficacy of calcium intake in preventing bone mineral density (BMD) decrease among postmenopausal women and to investigate the factors that may affect the efficacy.

METHODS

Comprehensive literature search was conducted in PubMed and EMBASE from January 2016. Placebo-controlled or no-treatment controlled randomized trials focused on calcium intake for the management of osteoporosis in postmenopausal women were included. The clinical and demographic characteristics of participants and efficacy data, defined as the mean percentage change of spine BMD (L2-L4) at each observation time point compared with that of baseline, were extracted from the studies. Model-based meta-analysis (MBMA) was used to describe the time course of BMD change by calcium intake and identify the related factors.

RESULTS

This study includes 17 trials involving 2537 subjects. The results showed that a classic pharmacodynamic maximal effect (E _max) model could describe the time course of BMD change by calcium intake. Using this model, we found that age and calcium intake dose were key factors affecting the efficiency and onset of BMD change. A 60-year-old woman administered with 800 mg/day calcium can achieve a maximum BMD increasing rate of 2.38%, and the time to reach 50% of this maximum (known as onset time) was 9.44 months. An increase of 0.0817% per year was noted in the maximal effect value for women aged between 50 and 83 years. For calcium dose interval from 250 to 2000 mg/day, the onset time was expressed as 9.44 × (dose/800)^-1.33 months. Two-year calcium intake of 700, 1200, and 2000 mg/day resulted in a maximum efficacy of BMD of 68.0, 81.3, and 89.6%, respectively. This indicates that the final efficacy had already reached the plateau (>80% E _max) under the 1200-mg/day dose.

CONCLUSION

Calcium intake can effectively postpone the tendency of BMD decrease in postmenopausal women. An increased calcium dose contributes to the shortening of the onset time. Considering the drug-acting rate and safety into account, menopausal women can be administered with a rational dose of 1200 mg/day to reduce bone loss.

[Current situation and thinking of diagnosis and treatment in some types of thyroid cancer]

As arising incidence of thyroid cancer, the treatment for thyroid carcinoma is becoming increasingly standardized. But there are different opinions on the treatment for some types of thyroid cancers, including the determination of operative opportunity, surgical method, and follow-up observation plan. There are mainly two categories of patients, namely the patients diagnosed as familial thyroid cancer mutation carriers through family screening, including medullary thyroid carcinoma and familial nonmedullary thyroid carcinoma, and the patients with thyroid microcarcinoma that can be observed after diagnosed by fine needle biopsy cytology. We will discuss current situation for the diagnosis and treatment of these patients.

Piccolo mediates EGFR signaling and acts as a prognostic biomarker in esophageal squamous cell carcinoma

The presynaptic cytomatrix protein Piccolo, encoded by PCLO, is frequently mutated and amplified in esophageal squamous cell carcinoma (ESCC), but its exact roles in ESCC remain unclear. Here we report that Piccolo expression correlates significantly with clinical stage, patient survival and tumor embolus. Functional studies demonstrate that PCLO knockdown remarkably attenuates ESCC malignancy in vitro and in vivo, and ectopic EGFR expression partially compensates for Piccolo loss. PCLO knockdown promotes ubiquitination and degradation of EGFR, which is associated with the negative regulatory effect of Piccolo on E3 ligase Siah1. An anti-Piccolo monoclonal antibody inhibited tumor proliferation in a mouse model of ESCC. These results demonstrate that Piccolo contributes to tumor aggressiveness in ESCC, likely by stabilizing EGFR and promoting EGFR-dependent signaling. Our results further suggest that Piccolo may represent a novel prognostic biomarker and therapeutic target for patients with ESCC.