Early adenocarcinoma mixed with a neuroendocrine carcinoma component arising in the gastroesophageal junction: A case report

BACKGROUND

Early adenocarcinoma mixed with a neuroendocrine carcinoma (NEC) component arising in the gastroesophageal junctional (GEJ) region is rare and even rarer in young patients. Here, we report such a case in a 29-year-old Chinese man.

CASE SUMMARY

This patient presented to our hospital with a 3-mo history of dysphagia and regurgitation. Upper endoscopy revealed an elevated nodule in the distal esophagus 1.6 cm above the GEJ line, without Barrett's esophagus or involvement of the gastric cardia. The nodule was completely resected by endoscopic submucosal dissection (ESD). Pathological examination confirmed diagnosis of intramucosal adenocarcinoma mixed with an NEC component, measuring 1.5 cm. Immunohistochemically, both adenocarcinoma and NEC components were positive for P53 with a Ki67 index of 90%; NEC was positive for synaptophysin and chromogranin. Next-generation sequencing of 196 genes demonstrated a novel germline mutation of the ERCC3 gene in the DNA repair pathway and a germline mutation of the RNF43 gene, a common gastric cancer driver gene, in addition to pathogenic somatic mutations in P53 and CHEK2 genes. The patient was alive without evidence of the disease 36 mo after ESD.

CONCLUSION

Early adenocarcinoma with an NEC component arising in the distal esophageal side of the GEJ region showed evidence of gastric origin.

[Clinical analysis of 11 cases multisystem inflammatory syndrome associated with SARS-CoV-2 Omicron variant infection in children]

Objective: To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection. Methods: A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study. Results: The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months. Conclusions: MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.

[Effects of rapid drug sensitivity testing for multidrug-resistant bacteria on the prognosis of patients with severe intra-abdominal infection]

Objective: To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection. Methods: This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results: The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group (Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant (Z=-1.686, P=0.093). Conclusions: GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

[Treatment of open abdomen combined with entero-atmospheric fistula: A retrospective study]

Objective: The purpose of this study was to analyze the course and outcome of patients with combined entero-atmospheric fistulas in open abdomen treatment. Methods: In this retrospective observational study, we collected data on 214 patients with open abdomen complicated by entero-atmospheric fistulas admitted to Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School from January 2012 to January 2021. We collected their basic characteristics, aetiology, treatment plan, and prognosis, including the durations of hospitalization and open treatment, time to resumption of enteral nutrition, duration and prognosis of definitive surgery, and overall prognosis. Results: Of the 214 patients with open abdomen complicated with entero-enteral fistulas, 23 (10.7%) died (11 of multiple organ failure caused by abdominal infection, five of abdominal cavity bleeding, four of pulmonary infection, one of airway bleeding, one of necrotizing fasciitis, and one of traumatic brain injury). The remaining 191 underwent definitive surgery at our hospital. The patients who underwent definitive surgery were predominantly male (156 patients, 81.7%); their age was (46.5±2.5) years. Trauma and gastrointestinal tumors (120 cases, 62.8%) predominated among the primary causes. The reasons for abdominal opening were, in order, severe abdominal infection (137 cases, 71.7%, damage control surgery (29 cases, 15.2%), and abdominal hypertension (25 cases, 13.1%). Temporary abdominal closure measures were used to classify the participants into a skin-only suture group (104 cases) and a skin-implant group (87 cases). Compared with the skin-implant group, in the skin-suture-only group the proportion of male patients was lower (74.7% [65/87] vs. 87.5% [91/104], χ2=5.176, P=0.023), the mean age was older ([48.3±2.0] years vs. [45.0±1.9] years, t=-11.671, P<0.001), there were fewer patients with trauma (32.2% [28 /87] vs. 58.7% [61/104), χ2=13.337, P<0.001), intensive care stays were shorter ([8.9±1.0] days vs. [12.7±1.6] days, t=19.281, P<0.001), total length of stay was shorter ([29.3±2.0] days vs. [31.9±2.0] days, t=9.021,P<0.001), there was a higher percentage of colonic fistulas (18.4% [16/87] vs. 8.7% [9/104], χ2=3.948, P=0.047), but fewer multiple fistulas (11.5% [10/87] vs. 34.6% [36/104], χ2=14.440, P<0.001). As to fistula management, a higher percentage of fistula sealing methods using 3D-printed intestinal stents were implemented in the skin-only suture group (60.9% [53/87] versus 43.3% [45/104], χ2=5.907, P=0.015). Compared with the implant group, the skin-only suture group had a shorter mean time to performing provisional closure ( [9.5±0.8] days vs. [16.0±0.6] days, t=66.023, P<0.001), shorter intervals to definitive surgery ( [165.0±10.7] days vs. [198.9±8.3] days, t=26.644, P<0.001), and less use of biopatches (56.3% [49/87) vs. 71.2% [74/104], χ2=4.545, P=0.033). Conclusions: Open abdomen complicated with entero-enteral fistulas is more common in male, and is often caused by trauma and gastrointestinal tumor. Severe intra-abdominal infection is the major cause of open abdomen, and most fistulae involves the small intestine. Collection and retraction of intestinal fluid and 3D-printed entero-enteral fistula stent sealing followed by implantation and skin-only suturing is an effective means of managing entero-enteral fistulas complicating open abdominal cavity. Earlier closure of the abdominal cavity with skin-only sutures can shorten the time to definitive surgery and reduce the rate of utilization of biopatches.

[Aspirin-exacerbated respiratory disease treated with omalizumab: 3 cases report and literature review]

Objective: To summarize the clinical data of aspirin-exacerbated respiratory disease (AERD) treated with omalizumab in Peking University First Hospital and reviewed the relative literatures. Methods: We analyzed retrospectively the clinical data of three cases of AERD treated with omalizumab in Peking University First Hospital from March 1, 2018 to December 31, 2021. The clinical researches on the treatment of AERD with omalizumab up to January 31, 2022 were retrieved in PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang Data. Results: Our three patients of AERD treated with omalizumab for 32 to 68 weeks obtained relief of symptoms of upper and lower respiratory tract, improvement in lung function, and reduction in percentage of blood eosinophils. There were 14 clinical studies on treatment of AERD with omalizumab, including 3 randomized, double-blind and placebo-controlled studies and 11 self-controlled case series studies. The majority of studies showed that omalizumab contributed to improve the symptoms of AERD, decrease the frequency of asthma attacks and reduce systemic glucocorticoid use. Conclusion: Omalizumab can improve the disease control of AERD, but further studies are needed.

Constraints on Sub-GeV Dark Matter-Electron Scattering from the CDEX-10 Experiment

We present improved germanium-based constraints on sub-GeV dark matter via dark matter-electron (χ-e) scattering using the 205.4  kg·day dataset from the CDEX-10 experiment. Using a novel calculation technique, we attain predicted χ-e scattering spectra observable in high-purity germanium detectors. In the heavy mediator scenario, our results achieve 3 orders of magnitude of improvement for m_{χ} larger than 80  MeV/c^{2} compared to previous germanium-based χ-e results. We also present the most stringent χ-e cross-section limit to date among experiments using solid-state detectors for m_{χ} larger than 90  MeV/c^{2} with heavy mediators and m_{χ} larger than 100  MeV/c^{2} with electric dipole coupling. The result proves the feasibility and demonstrates the vast potential of a new χ-e detection method with high-purity germanium detectors in ultralow radioactive background.

Exotic Dark Matter Search with the CDEX-10 Experiment at China's Jinping Underground Laboratory

A search for exotic dark matter (DM) in the sub-GeV mass range has been conducted using 205 kg day data taken from a p-type point contact germanium detector of the CDEX-10 experiment at China's Jinping underground laboratory. New low-mass dark matter searching channels, neutral current fermionic DM absorption (χ+A→ν+A) and DM-nucleus 3→2 scattering (χ+χ+A→ϕ+A), have been analyzed with an energy threshold of 160 eVee. No significant signal was found; thus new limits on the DM-nucleon interaction cross section are set for both models at the sub-GeV DM mass region. A cross section limit for the fermionic DM absorption is set to be 2.5×10^{-46}  cm^{2} (90% C.L.) at DM mass of 10  MeV/c^{2}. For the DM-nucleus 3→2 scattering scenario, limits are extended to DM mass of 5 and 14  MeV/c^{2} for the massless dark photon and bound DM final state, respectively.

[Efficacy of fenestrated atrial septal defect occulders on pulmonary hypertension dogs]

Objective: To explore the short-term efficacy of fenestrated atrial septal defect (ASD) occulders in the treatment of pulmonary arterial hypertension (PAH). Methods: Thirty-six healthy dogs were divided into the balloon atrial septostomy (BAS)+fenestrated ASD occulders group (n=12), BAS group (n=12) and non-septostomy group (n=12). PAH was induced by intra-atrial injection of dehydrogenized monocrotaline (1.5 mg/kg) in all dogs. Animals in the BAS+fenestrated ASD occulders group underwent atrial septal puncture and fenestrated ASD occulders implantation. Animals in the BAS group underwent balloon atrial septostomy. The non-septostomy group received no surgical intervention. The hemodynamic indexes and blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) of dogs were measured before modeling, 2 months after modeling, 1, 3, and 6 months after surgery, respectively. Echocardiography was performed to observe the patency of the shunt and atrial septostomy of the dogs in the BAS+fenestrated ASD occulders group and BAS group at 1, 3, and 6 months after surgery. Three dogs were sacrificed in each group at 1, 3, and 6 months after surgery, respectively. Atrial septal tissue and fenestrated ASD occulders were removed to observe the patency and endothelialization of the device. Lung tissues were obtained for hematoxylin-eosin (HE) staining to observe the inflammatory cells infiltration and the thickening and narrowing of the pulmonary arterials. Results: Among 36 dogs, 2 dogs died within 24 hours after modeling, and 34 dogs were assigned to BAS+fenestrated ASD occulders group (n=12), BAS group (n=11), and non-septostomy group (n=11). Compared with BAS group, the average right atrial pressure (mRAP) and NT-proBNP of dogs in the BAS+fenestrated ASD occulders group were significantly reduced at 3 months after surgery (P<0.05), and the cardiac output (CO) was significantly increased at 6 months after surgery, arterial oxygen saturation (SaO₂) was also significantly reduced (P<0.05). Compared with non-septostomy group, dogs in the BAS+fenestrated ASD occulders group had significantly lower mRAP and NT-proBNP at 1, 3, and 6 months after surgery (P<0.05), and higher CO and lower SaO₂ at 6 months after surgery (P<0.05). Compared with the non-septostomy group, the dogs in the BAS group had significantly lower mRAP and NT-proBNP at 1 month after surgery (P<0.05), and there was no significant difference on mRAP and NT-proBNP at 3 and 6 months after surgery (P>0.05). Echocardiography showed that there was a minimal right-to-left shunt in the atrial septum in the BAS group at 1 month after the surgery, and the ostomy was closed in all the dogs in the BAS group at 3 months after the surgery. There was still a clear right-to-left shunt in the dogs of BAS+fenestrated ASD occulders group. The shunt was well formed and satisfactory endothelialization was observed at 1, 3 and 6 months after surgery. The results of HE staining showed that the pulmonary arterials were significantly thickened, stenosis and collapse occurred in the non-septostomy group. Pulmonary microvascular stenosis and inflammatory cell infiltration in the pulmonary arterials were observed in the non-septostomy group. Pulmonary arterial histological results were comparable between BAS+fenestrated ASD occulders group and non-septostomy group at 6 months after surgery. Conclusions: The fenestrated ASD occulder has the advantage of maintaining the open fistula hole for a longer time compared with simple balloon dilation. The fenestrated ASD occulder can improve cardiac function, and it is safe and feasible to treat PAH in this animal model.

[Experience and thinking on the normalization stage of prevention and control of COVID-19 in China]

COVID-19 is an important public health issue of great concern at home and abroad, and it is still in the state of global pandemic. During the normalization stage of prevention and control of the epidemic of COVID-19, China effectively controlled the outbreak and spread of the epidemic by adopting the strategy of "import of external prevention and rebound of internal prevention", and effectively reduced the occurrence of death cases. The social economy recovered quickly, and various measures were highly recognized by the public, and the positive trend of the epidemic continued to consolidate. At present, although the spread of the local epidemic has been basically stopped, the international epidemic continues to rise rapidly, and the pressure of "imported prevention and control" in China continues to increase. Considering the characteristics of the normalization of epidemic prevention and control and the particularity of the virus, the connotation of the normalization of epidemic prevention and control should be understood scientifically. The prevention and control goal of the epidemic in the normalization stage should be to maximize early detection, early treatment and early disposal, and resolutely prevent the continuous spread of the epidemic in communities, that is, to prevent the infection as much as possible, and resolutely prevent the rebound (sustained spread in communities), rather than "zero infection". The prevention and control policy of "timely detection, rapid disposal, precise management and control, and effective treatment" has been implemented in various localities, and a series of effective and regular experience in prevention and control has been formed in the practice of prevention and control. Winter and spring are the key periods for the prevention and control of the epidemic. We should continue to work together to prevent and control the epidemic, fulfill the responsibilities of all parties, and prevent and control the epidemic in a scientific and effective way.

[Analysis of the effect of transgluteal percutaneous drainage in the treatment of deep pelvic abscess]

Objective: To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. Methods: A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. Results: All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) μg/L, 122.2 (55.8, 226.0) μg/L, 59.2 (29.0,203.5) μg/L and 64.1 (30.0,88.4) μg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (F=3.586, P=0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all P>0.05). Conclusion: Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.

[Comparison of severity classification of Chinese protocol, pneumonia severity index and CURB-65 in risk stratification and prognostic assessment of coronavirus disease 2019]

Objective: To investigate the application of severity classification according to the protocol on the Diagnosis and Treatment of coronavirus disease 2019(COVID-19)by the National Health Commission of China, pneumonia severity index(PSI) and CURB-65　in risk stratification and prognostic assessment of COVID-19. Methods: Clinical data of 234 in-hospital patients with COVID-19 were collected and retrospectively reviewed in Wuhan Tongji Hospital. Patients were divided into 3 groups (common, severe, and critical type) at admission according to the sixth version of the protocol issued by the National Health Commission of China on Diagnosis and Treatment of COVID-19. At the same time, the severity of pneumonia was calculated by PSI and CURB-65, and the patients were stratified into 3 risk groups, namely mild, moderate, and severe groups. The hospital mortality rate was evaluated in each group. Sensitivity, specificity, positive predictive values, negative predictive values, and the area under the receiver operating characteristic(ROC) curve(AUC) for predicting hospital mortality in each rule were assessed. Results: According to the severity classification of Chinese protocol, the proportion of patients with common type, severe type, and the critical type was 15.8%, 75.6%, and 8.5%, respectively. No in-hospital death occurred in the common type. As for PSI and CURB-65, greater proportions of patients were classified as low risk(79.1% and 75.6%, respectively), while smaller proportions of patients were classified as moderate and high risk(16.2%, 15.0%; 4.7%, 9.4%, respectively). In-hospital death occurred in low and moderate risk patients identified by these 2 scoring systems. The mortality of the critical group of the Chinese protocol was 65%, and the sensitivity and specificity of predicting in-hospital mortality were 36.4% and 97.0%, respectively. The mortality in the high risk group of PSI and CURB-65 was 100% and 77.3%. The risk class V of PSI and CURB-65 score 3-5 had high specificity(100% and 97.4%, respectively)but low sensitivity(33.3% and 51.5%, respectively)in predicting in-hospital mortality. The AUC of the Chinese protocol severity classification, PSI, and CURB-65 was 0.735, 0.951, and 0.912. The optimal cut-off point of PSI was risk class Ⅳ, and the sensitivity and specificity for predicting mortality were 90.9% and 90.5%. The optimal cut-off point of CURB-65 was score 2, and the corresponding sensitivity and specificity were 84.8% and 85.6%. Conclusions: PSI and CURB-65 can be used for risk stratification and prognostic assessment in patients with COVID-19.

[Clinical features and prognosis of pneumocystis pneumonia in patients treated with rituximab for autoimmune diseases]

Objective: To determine the clinical features and outcomes of pneumocystic pneumonia (PCP) in patients treated with rituximab for autoimmune diseases. Methods: PCP patients with autoimmune diseases as underlying diseases from January 2009 to April 2019 in Peking University First Hospital (male 67 cases, female 35 cases, age 17-79) were retrospectively reviewed. Patients were grouped as rituximab group and non-rituximab group based on the fact if they were treated with rituximab before the onset of PCP. Demographic data, clinical features, and outcomes of the two groups were analyzed. Results: There were 102 cases altogether, and 7 patients were treated with rituximab before the onset of PCP. Patients in rituximab group were relatively younger than that in non-rituximab group [(32.0±18.7) vs (52.4±14.9) years, P=0.010]. Patients in rituximab group had more CD3(+), CD4(+), CD8(+)T lymphocytes in peripheral blood samples than that in non-rituximab group [(1 306±596) vs (546±439)/μl, (674±401) vs (243±232)/μl, (616±249) vs (282±256)/μl, respectively, all P<0.01]. However, the B lymphocyte count and plasma level of IgG and IgM were significantly lower in rituximab group than that in non-rituximab group [0 (0, 0.2) vs 72 (50.0, 124.4)/μl, 4.0 (2.6, 5.8) vs 9.4 (5.3, 12.0) g/L, 0.3 (0.2, 1.0) vs 1.1 (0.6, 1.8) g/L, respectively, all P<0.05]. The incidence of Cytomegalovirus (CMV) pneumonia was significantly lower in rituximab group (0/7 and 57/95, P=0.007). Other demographic data, the use of corticosteroids, the incidence of severe PCP, mechanical ventilation, intubation, pneumothorax and mediastinal emphysema complications, as well as hospital mortality and length of stay in hospital in the two groups were comparable. Conclusions: In patients treated with rituximab for autoimmune diseases, the number of B lymphocytes in peripheral blood and the plasma level of immunoglobulins but not CD3(+), CD4(+), and CD8(+)T lymphocyte counts may play an important role in the pathogenesis of PCP. These patients are not vulnerable to be complicated with CMV pneumonia.

Direct Detection Constraints on Dark Photons with the CDEX-10 Experiment at the China Jinping Underground Laboratory

We report constraints on the dark photon effective kinetic mixing parameter (κ) with data taken from two p-type point-contact germanium detectors of the CDEX-10 experiment at the China Jinping Underground Laboratory. The 90% confidence level upper limits on κ of solar dark photon from 205.4 kg-day exposure are derived, probing new parameter space with masses (m_{V}) from 10 to 300  eV/c^{2} in direct detection experiments. Considering dark photon as the cosmological dark matter, limits at 90% confidence level with m_{V} from 0.1 to 4.0  keV/c^{2} are set from 449.6 kg-day data, with a minimum of κ=1.3×10^{-15} at m_{V}=200  eV/c^{2}.

Endophytic Bacillus velezensis strain B-36 is a potential biocontrol agent against lotus rot caused by Fusarium oxysporum

AIM

The aim of this study was to screen potential lotus plant endophytic bacterial isolate for effective inhibition against lotus rot causing fungal pathogen Fusarium oxysporum.

METHODS AND RESULTS

In this study, endophytic bacteria were isolated from lotus tissues and tested for antagonistic activities against the pathogenic fungus F. oxysporum. Among the putative endophytic Bacillus strains identified, suspensions of the strain B-36 showed the highest inhibition rate against F. oxysporum growth. Pot assays indicated that B-36 was effective in controlling F. oxysporum-inducing lotus rot. However, the control efficiency varied with the inoculation method and concentration, where injection of 800 μl B-36 suspension per plant (2 × 10⁸  CFU per ml) into stems showed the highest control efficiencies of 77·1 and 60·0% for pre-inoculation and post-inoculation. In addition, the colonizing population levels (CPLs) of B-36 on lotus also varied with the inoculation method and concentration, with the highest CPLs, that is, 3·05 and 2·83 log(CFU per gram), being observed on lotus leaves and stems respectively for stem injection of 200 μl per plant. Moreover B-36 showed no noticeable effects on lotus seed germination rate or seedling growth. Finally, B-36 was characterized as Bacillus velezensis based on its morphology, Gram-positive characteristics, as well as its 16S rDNA and gyrB sequences.

CONCLUSION

The isolate B-36 can be applied as a biocontrol agent against F. oxysporum-inducing lotus rot.

SIGNIFICANCE OF IMPACT OF THE STUDY

The soil-borne fungus F. oxysporum causes lotus rot and severe yield loss, and currently available control methods are very limited. Here we identify a new promising biocontrol agent against lotus rot caused by F. oxysporum.

[Investigation of treatment and analysis of prognostic risk on enterocutaneous fistula in China: a multicenter prospective study]

Objective: To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF. Methods: A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration. Results: A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn's disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn's disease (χ(2)=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ(2)=5.460, P=0.019), multiple ECF (χ(2)=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ(2)=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ(2)=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ(2)=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ(2)=179.699, P<0.001), sepsis (χ(2)=211.851, P<0.001), hemorrhage (χ(2)=85.300, P<0.001), pulmonary infection (χ(2)=60.096, P<0.001), catheter-associated infection (χ(2)=10.617, P=0.001) and malnutrition (χ(2)=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015). Conclusions: The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.

Search for Light Weakly-Interacting-Massive-Particle Dark Matter by Annual Modulation Analysis with a Point-Contact Germanium Detector at the China Jinping Underground Laboratory

We present results on light weakly interacting massive particle (WIMP) searches with annual modulation (AM) analysis on data from a 1-kg mass p-type point-contact germanium detector of the CDEX-1B experiment at the China Jinping Underground Laboratory. Datasets with a total live time of 3.2 yr within a 4.2-yr span are analyzed with analysis threshold of 250 eVee. Limits on WIMP-nucleus (χ-N) spin-independent cross sections as function of WIMP mass (m_{χ}) at 90% confidence level (C.L.) are derived using the dark matter halo model. Within the context of the standard halo model, the 90% C.L. allowed regions implied by the DAMA/LIBRA and CoGeNT AM-based analysis are excluded at >99.99% and 98% C.L., respectively. These results correspond to the best sensitivity at m_{χ}<6  GeV/c^{2} among WIMP AM measurements to date.

Constraints on Spin-Independent Nucleus Scattering with sub-GeV Weakly Interacting Massive Particle Dark Matter from the CDEX-1B Experiment at the China Jinping Underground Laboratory

We report results on the searches of weakly interacting massive particles (WIMPs) with sub-GeV masses (m_{χ}) via WIMP-nucleus spin-independent scattering with Migdal effect incorporated. Analysis on time-integrated (TI) and annual modulation (AM) effects on CDEX-1B data are performed, with 737.1 kg day exposure and 160 eVee threshold for TI analysis, and 1107.5 kg day exposure and 250 eVee threshold for AM analysis. The sensitive windows in m_{χ} are expanded by an order of magnitude to lower DM masses with Migdal effect incorporated. New limits on σ_{χN}^{SI} at 90% confidence level are derived as 2×10^{-32}∼7×10^{-35}  cm^{2} for TI analysis at m_{χ}∼50-180  MeV/c^{2}, and 3×10^{-32}∼9×10^{-38}  cm^{2} for AM analysis at m_{χ}∼75  MeV/c^{2}-3.0  GeV/c^{2}.

[Epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients]

Objective: To analyze the epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients. Methods: From January 2010 to December 2017, bronchoalveolar lavage fluid (BALF) was detected by Grocott's methenamine silver (GMS) staining and real-time fluorescence quantitative PCR (qPCR) in non-AIDS patients with bronchoscopic alveolar lavage at Peking University First Hospital. At the same time, Pneumocystis jirovecii was detected in the environment of the hospital. Results: Within 8 years, Pneumocystis jirovecii were detected in BALF of a total of 1 407 non-AIDS patients. GMS staining was performed in all these 1 407 cases, of which 114 (8.10%) cases were with Pneumocystis jirovecii infection and 3 (0.21%) cases with colonization. There were totally 946 non-AIDS immunocompromised patients, of which 113 (11.95%) cases were infected and 2 (0.21%) cases with colonization; there were 461 non-AIDS immunocompetent patients, of which only 1 (0.22%) case was infected and 1 (0.22%) case with colonization. GMS staining and qPCR were both performed in 196 cases, of which 36 (18.37%) cases were infected and 33 (16.84%) cases with colonization. There were totally 175 non-AIDS immunocompromised patients, of which 36 (20.57%) cases were infected and 30 (17.14%) cases with colonization; there were 21 non-AIDS immunocompetent patients, of which no one was infected and 3 (14.29%) cases with colonization. By means of GMS staining and qPCR, no Pneumocystis jiroveci were detected in the environment of Peking University First Hospital. Conclusions:Pneumocystis pneumonia is rare in immunocompetent patients, but not in non-AIDS immunocompromised patients. And colonization is rare in both of them. There may be no Pneumocystis jiroveci in the environment.

[Efficacy of extended-infusion of carbapenem plus sulbactam for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter baumannii]

Objective: To evaluate the efficacy of extended-infusion of carbapenem plus sulbactam for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter baumannii (XDRAB). Methods: Clinical data of patients with ventilator-associated pneumonia caused by XDRAB who were treated with extended-infusion carbapenem plus sulbactam or tigecycline-based therapy in Peking University First Hospital from January 2015 to December 2016 were collected and reviewed in this retrospective study. Twenty-one patients were treated with extended-infusion carbapenem plus sulbactam, and 20 other patients received tigecycline combined with other antibiotics. The general status of the patient, microbiological eradication rate, superinfection rate, new microorganism colonization rate, clinical resolution rate on the third day, clinical cure rate and mortality during treatment were compared between the two groups. Results: The two groups shared similar characteristics except that patients in the carbapenem group were younger. Microbiological eradication was not observed. Superinfections occurred in 1 patients (4.8%) in the carbapenem group and 0 patients in the tigecycline group (P=1.000), the occurrences of new microorganisms colonization were 14.3% and 25.0% respectively (P=0.638). Clinical cure were achieved in 57.1% of the patients in the carbapenem group and 50.0% of the patients in the tigecycline group (P=0.647), the clinical resolution rates on the third day were 52.4% and 45.0% respectively (P=0.636). The mortality during treatment was 9.5% in carbapenem group, and 20.0% in tigecycline group (P=0.612). No serious adverse drug reactions occurred. Conclusions: Ventilator-associated pneumonia caused by XDRAB treated with either extended-infusion carbapenem plus sulbactam or tigecycline-based therapy has a similar clinical outcome.

Limits on Light Weakly Interacting Massive Particles from the First 102.8 kg×day Data of the CDEX-10 Experiment

We report the first results of a light weakly interacting massive particles (WIMPs) search from the CDEX-10 experiment with a 10 kg germanium detector array immersed in liquid nitrogen at the China Jinping Underground Laboratory with a physics data size of 102.8 kg day. At an analysis threshold of 160 eVee, improved limits of 8×10^{-42} and 3×10^{-36}  cm^{2} at a 90% confidence level on spin-independent and spin-dependent WIMP-nucleon cross sections, respectively, at a WIMP mass (m_{χ}) of 5  GeV/c^{2} are achieved. The lower reach of m_{χ} is extended to 2  GeV/c^{2}.

[The regulative effects of Aspergillus fumigatus on expression of glucocorticoid receptor in asthmatic rats]

Objective: To study the regulative effects of Aspergillus fumigatus (A.fumigatus) on expression of glucocorticoid receptor (GCR) in asthmatic rats. Methods: Wistar rats were randomly divided into 4 groups: a normal control group (UC), a normal control with A. fumigatus group (UC+ AF), an OVA group (OVA), and an OVA with A. fumigatus group (OVA+ AF). OVA and OVA+ AF groups were sensitized and challenged with OVA to establish asthmatic models. UC and UC+ AF groups were given normal saline as controls. After the last challenge, OVA+ AF and UC+ AF groups were given A. fumigatus spores intranasally. Airway hyper-responsiveness, eosinophil percentage (Eos%) and serum IgE level were measured to confirm the establishment of asthmatic models. Sections of pulmonary tissue were stained with hematoxylin-eosin (HE) and the expression of GCR mRNA and protein in lung tissues were measured by qRT-PCR and Western blot. Lung tissues and blood were plated on the potato dextrose agar(PDA)medium and cultured for 24 h to measure the number of colony. Results: The Penh value, Eos% in BALF and serum IgE level in UC+ AF group were slightly higher than those in the UC group (all the P>0.05). The Penh value, Eos% in BALF and serum IgE level in OVA group were significantly higher than those in the UC group (all the P<0.05). The Penh value in OVA+ AF group was significantly increased compared with the OVA group at the concentration of 25 g/L and 50 g/L of methacholine (all the P>0.05). Pulmonary histology revealed that both OVA group and OVA+ AF group showed high levels of inflammatory cell infiltration of bronchus and lung vessels, interstitial edema and smooth muscle thickening, while the UC and UC + AF groups were normal. Compared with the UC group, the expressions of GCR mRNA and protein in UC+ AF group and OVA group were decreased significantly (GCR mRNA in UC, UC+ AF and OVA group were 0.93±0.15, 0.65±0.10, 0.72±0.22, respectively, F=10.744, P<0.01; GCR protein in UC, UC+ AF and OVA group were 100±0, 89±8, 82±15, respectively, F=18.939, P<0.01). The expressions of GCR mRNA and protein in OVA+ AF group were further decreased than those in OVA group (GCR mRNA: OVA group: 0.72±0.22 vs OVA+ AF group: 0.52±0.08, t=2.462, P<0.05; GCR protein: OVA group: 81.88±15.41 vs OVA+ AF group: 59.09±7.60, t=2.997, P<0.05). The ratio of A. fumigatus colonization in lung tissues in OVA+ AF group (4/8) was higher than the UC+ AF group (0/8). Conclusion:A. fumigatus exposure can down-regulate the expression of GCR in the lung, which maybe an important mechanism of steroid-resistant asthma.

[Clinical characteristics and prognosis of mediastinal fibrosis]

Objective: To investigate the clinical characteristics and prognosis of mediastinal fibrosis. Methods: Twelve patients with mediastinal fibrosis diagnosed between 2008 and 2015 in our hospital were studied retrospectively. Clinical manifestations, radiological characteristics, endoscopic features, treatment and prognosis were analyzed. Results: There were 3 males and 9 females, with a mean age of 68.8 years.Six patients had previous tuberculosis infection. The most common clinical symptoms were dyspnea on exertion (11 cases), cough (7 cases), and wheezing (6 cases). Chest CT scans revealed an infiltrative mediastinal process, with a discrete mass, enlargement of mediastinal lymph nodes, mediastinal lymph node calcification (9 case). Twelve patients had bronchial and pulmonary artery compression at lobar or segmental levels, 7 cases had localized pulmonary edema, and 6 cases had pulmonary atelectasis. The principal findings of bronchoscopy were distortion of bronchus with stenosis, multiple pigmentation of bronchial mucosa, and bronchial mucosal edema. Pulmonary hypertension (PH) was the main severe complication. One patients suffered from sudden death after bronchoscopy. Eleven patients were followed for 3 month to 7 years, and 5 patients got progression. Anti-tuberculosis therapy with or without corticosteroid was not beneficial. Conclusion: Tuberculosis was the leading cause of mediastinal fibrosis in our study, which was characterized with diffuse bronchial and pulmonary artery compression at lobar or segmental levels, and multiple pigmentation of bronchial mucosa.Anti-tuberculosis therapy with or without corticosteroids was not beneficial.

[Holmium: yttrium-aluminum-garnet (Ho: YAG) laser lithotripsy in the treatment of broncholithiasis]

Objective: To assess the effectiveness of Ho: YAG Laser in the treatment of broncholithiasis. Methods: We retrospectively reviewed the clinical data of 6 patients who underwent Ho: YAG Laser lithotripsy in Peking University First Hospital during May 2012 to October 2015. 4 females and 2 males, with a median age of 60 years, were enrolled. Among 6 patients, persistent cough(n=2), hemoptysis(n=2), recurrent pneumonia(n=2) were the main clinical symptoms. Broncholiths were found in the left side in 1 patient and right side in 5 patients. 2 broncholiths were located in main bronchus and 4 in segmental bronchus. There were 2 patients with intraluminal broncholiths and 4 with transbranchial broncholiths. All 6 patients received Ho: YAG Laser(0.8-1.2 J pulse energies, 5-10 Hz frequencies, 365 μm laser fibers) under rigid bronchoscopy in general anesthesia and experienced relief of symptoms. Results: Complete removal of broncholith was accomplished in intraluminal broncholith group and 1 patient in transbracnhial broncholith group, the other 3 transbracnhial broncholiths were partly removed. Complications included perioperative massive hemolysis(n=1), bronchoesophageal fistula(n=1) and postoperative pneumonia (n=2), no long term complications were encounted. Conclusion: The Ho: YAG were associated with acute complications including fistula, perioperative massive hemolysis, infections and no long-term side effects. It represents a safe and effective therapy option for broncholithiasis.

[Patient-related independent clinical risk factors for early complications following interventional pulmonology procedures]

OBJECTIVE

To investigate the early complication rate and identify patient-related independent clinical risk factors for early complications in patients following interventional pulmonology procedures.

METHODS

In the period from December 2014 to December 2015, sufficient data of Peking University First Hospital Respiratory and Critical Care Medicine Department for analysis were identified in 218 subjects. Interventional pulmonology procedures were performed in all the patients. Early complications after the procedures were defined as newly respiratory failure, arrhythmia requiring treatment, severe hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, bronchopleural fistulae, acute coronary syndrome, acute cerebrovascular accident, and death. Patient-related clinical risk factors were defined as coronary atherosclerotic heart disease, cerebral infarction, diabetes mellitus, cirrhosis, chronic kidney disease, arrhythmia, asthma, chronic obstructive pulmonary disease, hypertension, and previous interventional pulmonology treatment. The patient-related independent clinical risk factors which had close relations to the occurrence of early complications were analyzed by multivariate statistical analysis with Logistic regression.

RESULTS

There were 56.4% male and 43.6% female subjects in this study. There were 10.6% current smokers, 26.6% former smokers, and 62.8% non-smokers. The overall early complication rate was 8.3%. In all the subjects groups, the patient-related independent clinical risk factors for the early complication rate were coronary atherosclerotic heart disease (B=1.545, P=0.006, OR=4.686, 95% CI 1.568-14.006), chronic obstructive pulmonary disease (B=1.037, P=0.049, OR=2.820, 95% CI 1.675-11.790), and current smoking status (B=1.412, P=0.032, OR=4.139, 95% CI 1.134-15.109); for the newly respiratory failure rates were coronary atherosclerotic heart disease (B=2.207, P=0.004, OR=9.087, 95% CI 2.028-40.714), chronic obstructive pulmonary disease (B=1.646, P=0.048, OR=5.188, 95% CI 1.783-34.375), and lesions involving three central airways (B=1.899, P=0.032, OR=6.680, 95% CI 1.182-37.740). In the malignant group, the patient-related independent clinical risk factor for the early complication rate was current smoking status (B=2.953, P=0.006, OR=19.161, 95% CI 2.360-155.572). In the benign group, the patient-related independent clinical risk factor for the early complication rate was only coronary atherosclerotic heart disease (B=1.976, P=0.022, OR=7.214, 95% CI 1.324-39.298).

CONCLUSION

Closer monitoring of patients with identified clinical risk factors is advisable prior and immediately after interventional pulmonology procedures. In order to avoid or minimize early complications, special attention should be directed toward patients who are current smokers, or patients with lesions involving three central airways, or with coronary atherosclerotic heart disease or chronic obstructive pulmonary disease.

Serum levels of S-100β correlate with the clinical status and severity of hypoxic-ischemic encephalopathy in neonates

The clinical significance of serum S-100β levels in neonates with hypoxic-ischemic encephalopathy (HIE), as a reference index to assess HIE severity, was evaluated in this study. On the basis of our strict inclusion and exclusion criteria, relevant high-quality case-control studies reporting the association between HIE and S-100β protein were selected from electronic database searches. The STATA version 12.0 software was used for the statistical analyses. The database search initially retrieved 93 studies (37 in English and 56 in Chinese), and following a multistep screening process, 13 high-quality studies were eventually included in our meta-analysis. The 13 case-control studies included a total of 646 HIE neonates and 381 healthy controls. The results of this meta-analysis revealed that serum S-100β levels in mild, moderate, and severe HIE neonates were significantly higher than those in healthy controls, and the differences were statistically significant. Importantly, the serum S-100β levels increased incrementally with HIE severity. Our results support the hypothesis that S-100β is an important biological indicator of HIE and serum S-100β levels can be used as a reference index to assess HIE severity.

Treatment with 1,25(OH)2D3 induced HDAC2 expression and reduced NF-κB p65 expression in a rat model of OVA-induced asthma

Recent evidence indicates that a deficiency of 1,25-dihydroxyvitamin D₃ (1,25[OH]₂D₃) may influence asthma pathogenesis; however, its roles in regulating specific molecular transcription mechanisms remain unclear. We aimed to investigate the effect of 1,25(OH)₂D₃ on the expression and enzyme activity of histone deacetylase 2 (HDAC2) and its synergistic effects with dexamethasone (Dx) in the inhibition of inflammatory cytokine secretion in a rat asthma model. Healthy Wistar rats were randomly divided into 6 groups: control, asthma, 1,25(OH)₂D₃ pretreatment, 1,25(OH)₂D₃ treatment, Dx treatment, and Dx and 1,25(OH)₂D₃ treatment. Pulmonary inflammation was induced by ovalbumin (OVA) sensitization and challenge (OVA/OVA). Inflammatory cells and cytokines in the bronchoalveolar lavage (BAL) fluid and histological changes in lung tissue were examined. Nuclear factor kappa B (NF-κB) p65 and HDAC2 expression levels were assessed with Western blot analyses and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR). Enzyme activity measurements and immunohistochemical detection of HDAC2 were also performed. Our data demonstrated that 1,25(OH)₂D₃ reduced the airway inflammatory response and the level of inflammatory cytokines in BAL. Although NF-κB p65 expression was attenuated in the pretreatment and treatment groups, the expression and enzyme activity of HDAC2 were increased. In addition, 1,25(OH)₂D₃ and Dx had synergistic effects on the suppression of total cell infusion, cytokine release, and NF-κB p65 expression, and they also increased HDAC2 expression and activity in OVA/OVA rats. Collectively, our results indicated that 1,25(OH)₂D₃might be useful as a novel HDAC2 activator in the treatment of asthma.

Clinical effects and safety review of self-expanding stent surgery for extracranial carotid artery stenosis treatment

This study aimed to investigate the clinical effects and safety review of self-expanding stent surgery in the treatment of extracranial carotid artery stenosis. Seventy-eight patients with carotid artery stenosis were applied with the self-expanding stent for endovascular interventional therapy. Eighty-one stents were implanted into 80 blood vessels of the 78 patients, in which protective umbrellas were used in 56 cases, and the success rate of stent implantation was 100%. The stenosis degree decreased from the preoperative (86.72 ± 9.5%) to the postoperative (13.43 ± 5.62%) stage, and the blood peak velocity of the stenosed vessels decreased from 189.58 ± 13.5 to 83.73 ± 5.61 cm/s. Transient blood pressure and heart rate decreases occurred in 21 cases, continuously low blood pressure and heart rate decreasing occurred in 29 cases, and acute occlusion of the ipsilateral middle cerebral artery occurred in 1 case, which was resolved through thrombolysis and thrombus breaking in time. Over-perfusion symptoms were observed in 13 cases, although without serious complications such as cerebral hemorrhage. The follow-up period continued for 6-32 months, and ultrasonography revealed that 77 cases had no stent-restenosis, while 1 case had restenosis. The application of self-expanding stents had good clinical effects, with fewer complications and higher safety for the treatment of extracranial carotid artery stenosis.

Urethane suppresses renal sympathetic nerve activity in Wistar rats

AIM

To investigate the effects of urethane on renal sympathetic nerve activity (RSNA) in Wistar rats.

MATERIALSAND METHODS

46 rats were randomly allocated in two groups: group A in which rats were injected with urethane; group B in which barbital sodium was used as a control. The changes of RSNA, blood pressure (BP) and heart rate (HR) of each group were evaluated and analyzed.

RESULTS

Compared to the control group, the value of RSNA, BP and HR were all significant decreased in rats of group A after urethane injection (p < 0.05).

CONCLUSIONS

These results suggest that urethane could affect RSNA through somatosensory system.

Spectrophotometric determination of nitrate and nitrite in water and some fruit samples using column preconcentration

A sensitive analytical method for the simultaneous assay of nitrate and nitrite in water and some fruit samples is presented. The method is based on nitrite determination using the diazotization-coupling reaction by column preconcentration and on the reduction of nitrate to nitrite using the Cd-Cu reductor column. Nitrite is diazotized with sulfanilamide (SAM) in the pH range 2.0-5.0, sulfamethizole (SM) in pH 1.8-5.6 and sulfadimidine (SD) in pH 1.8-4.0 in a hydrochloric acid medium to form water-soluble colourless diazonium cations. These cations were coupled with sodium 1-naphthol-4-sulfonate (NS) in the pH range 9.0-12.0 for the SAM-NS system, pH 8.6-12.0 for the SM-NS system and pH 9.4-12.0 for the SD-NS system to be retained on naphthalene-tetradecyldimethylbenzylammonium (TDBA)-iodide (I) adsorbent packed in a column. The solid mass is dissolved out from the column with 5 ml of dimethylformamide (DMF) and the absorbance is measured by a spectrophotometer at 543 nm for SAM-NS, 537 nm for SM-NS and 530 nm for SD-NS. The calibration graph was linear over 30-600 ng NO(2)-N and 22-450 ng NO(3)-N in 15 ml of final aqueous solution (i.e. 2-40 ng NO(2)-N ml(-1) and 1.5-30 ng NO(3)-N ml(-1) in aqueous sample) for three systems. The detection limits were 1.4 ng NO(2)-N ml(-1) and 1.1 ng NO(3)-N ml(-1) for SAM-NS, 1.2 ng NO(2)-N ml(-1) and 0.89 ng NO(3)-N ml(-1) for SM-NS, 1.0 ng NO(2)-N ml(-1) and 0.75 ng NO(3)-N ml(-1) for SD-NS, respectively. The concentration factor is eight for SAM-NS and SM-NS, and 12 for SD-NS. Interferences from various foreign ions have been examined and the method was successfully applied to the determination of low levels of nitrate and nitrite in water and some fruit samples.

Overexpression of the cytochrome P450 monooxygenase (cyp71av1) and cytochrome P450 reductase (cpr) genes increased artemisinin content in Artemisia annua (Asteraceae)

Finding an efficient and affordable treatment against malaria is still a challenge for medicine. Artemisinin is an effective anti-malarial drug isolated from Artemisia annua. However, the artemisinin content of A. annua is very low. We used transgenic technology to increase the artemisinin content of A. annua by overexpressing cytochrome P450 monooxygenase (cyp71av1) and cytochrome P450 reductase (cpr) genes. CYP71AV1 is a key enzyme in the artemisinin biosynthesis pathway, while CPR is a redox partner for CYP71AV1. Eight independent transgenic A. annua plants were obtained through Agrobacterium tumefaciens-mediated transformation, which was confirmed by PCR and Southern blot analyses. The real-time qPCR results showed that the gene cyp71av1 was highly expressed at the transcriptional level in the transgenic A. annua plants. HPLC analysis showed that the artemisinin content was increased in a number of the transgenic plants, in which both cyp71av1 and cpr were overexpressed. In one of the transgenic A. annua plants, the artemisinin content was 38% higher than in the non-transgenic plants. We conclude that overexpressing key enzymes of the biosynthesis pathway is an effective means for increasing artemisinin content in plants.

Magnetic structure of Gd5Si2Ge2 and Gd5Si2Ge1.9M0.1 (M = Ga, Cu)

Powder x-ray diffraction patterns of the doped compounds Gd(5)Si(2)Ge(1.9)M(0.1) (M = Ga, Cu) show the same crystal structure, orthorhombic Gd(5)Si(4)-type, in the ferromagnetic and paramagnetic phases. This is different from Gd(5)Si(2)Ge(2), whose paramagnetic phase is monoclinic. The magnetic structure at low temperature, solved from diffraction experiments with hot neutrons, is the same in all the three compounds, collinear ferromagnetic with moments along the crystal b-axis, or F(y)F(By) according to Bertaut's notation. These results, combined with those of heat capacity and magnetocaloric effect, indicate, similarly to Gd(5)Si(4), a second-order, purely magnetic, transition in the doped compounds explaining the absence of hysteresis.

Electrical properties and fatigue resistance of polyamide 6,6 fabrics with nanocrystal silver coating

Nanocrystalline silver was coated on plain woven fabrics made from continuous polyamide multifilament yarns by sputtering technique. Electrical conductivity and abrasion resistances of the coating fabric were measured. There was a minimum value of resistance when the coating thickness varies. The critical coating thickness at the minimum resistance was found to be much greater than that necessary to form a continuous layer of coating on a single fabric. X-ray diffraction (XRD) and transmission electron microscope (TEM), and field emission scanning electronic microscopy (FESEM) were employed to identify the contributing factors of dips between two adjacent parallel fibres and cross-over junction of the warp and weft yarns.

Membrane water permeability related to antigen-presenting function of dendritic cells

Aquaporin 5 (AQP5) is one of the water channel proteins which participate in a wide array of physiological processes and are primary determinants of membrane osmotic water permeability. The AQP5 gene is located in human chromosome 12q, the same region as the location of the major asthma susceptibility loci. In this study we try to determine whether the AQP5 knock-out has some effect on allergen-induced asthma. With a mouse asthma model induced by ovalbumin (OVA), we found that deletion of AQP5 reduced some major characteristic features of asthma, such as less inflammation cell infiltration in lung tissues, lower cytokine expression and fewer inflammation cells in bronchoalveolar lavage fluids compared with those from wild-type (WT) mice. Because it was found that mice injected intratracheally with OVA-pulsed dendritic cells (DCs), the AQP5 gene knock-out (AQP5(-/-)) ones presented fewer inflammation cells. Because DCs are major antigen-presenting cells that play an important role in antigen-induced asthma, we also probed into the possible effect of gene knock-out on DCs. Surprisingly, reverse transcription-polymerase chain reaction and fluorescence activated cell sorter analysis showed high levels of AQP5 on the surface of DCs from in vivo or bone marrow monocyte-derived DCs (mDC) in vitro. Immature mDC from AQP5 knock-out mice (AQP5(-/-)) showed decreased expression of CD80 and CD86 and endocytosis ability compared with that from WT, but the difference disappeared after mDCs matured with lipopolysaccharide. AQP5-mediated water transmembrane may play some role in the function of DCs. However, the mechanism of the effect of AQP5 on the DCs' function needs to be investigated further.

Bacterial Wilt of Mulberry (Morus alba) Caused by Enterobacter cloacae in China

In August of 2006, a new bacterial disease was noted in Hangzhou mulberry orchards of Zhejiang Province, China where bacterial wilt of mulberry caused by Ralstonia solanacearum was previously reported (3). In the summer, the disease caused severe wilt, especially on 1- or 2-year-old mulberry plants, that resulted in premature plant death. Leaf wilt symptoms generally started on older leaves at the bottom of the plant and spread to the younger leaves. The leaves of infected plants became withered and dry, turned dark brown, and eventually the plants became defoliated. The root xylem of infected plants was moist and discolored with brown stripes. The phloem was asymptomatic, however, in severe infections, the phloem was decayed. The observation of wilting proceeding from the bottom of the plant to the top distinguishes this disease from bacterial wilt caused by R. solanacearum. Five bacterial strains isolated from infected mulberry plants showed characteristics similar to those of the standard reference strain of Enterobacter cloacae subsp. cloacae IBJ0611from China, but differed from R. solanacearum IBJ35, E. cancerogenus LMG2693^T, and E. cloacae subsp. dissolvens LMG2683^T from the University of Gent, Belgium in phenotypic tests, including the Biolog Identification System version 4.2 (Biolog Inc., Hayward CA), pathogenicity tests, transmission electron microscopy (TEM,KYKY-1000B, Japan) observation, and gas chromatographic analysis of fatty acid methyl esters (FAMEs) using the Microbial Identification System (MIDI Company, Newark, DE) with the aerobic bacterial library (TABA50). Isolates were gram negative, facultative anaerobic, rod shaped, 0.3 to 1.0 × 1.0 to 3.0 μm with peritrichous flagella. Colonies on nutrient agar were light yellow, smooth, circular, entire, and convex with no green fluorescent diffusible pigment on King's medium B (3). Weak hypersensitive reaction was observed on tobacco 3 days after inoculation. All five strains were identified as E. cloacae with Biolog similarity of 0.662 to 0.863 and FAMEs similarity of 0.632 to 0.701. Inoculation of 10 6-month-old intact mulberry plants of cv Husang with cell suspensions containing 10⁹ CFU/ml by pinprick at the base of the stem reproduced symptoms observed in natural infections. No symptoms were noted on the two control plants inoculated by the same method but with sterilized distilled water. The bacterium was reisolated from the symptomatic mulberry plants. E. cloacae has been reported from the United States as the cause of internal yellowing of papaya fruits (1) and rhizome rot of edible ginger (2). To our knowledge, this is the first report of mulberry wilt caused by E. cloacae in China. References: (1) K. Nishijima et al. Plant Dis. 71:1029, 1987. (2) K. Nishijima et al. Plant Dis. 88:1318, 2004. (3) L. Xu et al. Acta Phytophylacica. Sin. 34:141, 2007.

Domains of phase separation in a charged colloidal dispersion driven by electrolytes

We put forth the idea of treating coexisting phases as a composite system and express its free energy as the average of its constitutent free energies weighted by their respective volume proportions. As a result, the theoretical study of charged colloidal phase separation in the presence of electrolytes reduces to optimizing solely the entities pertaining to colloids and small ions. As concrete illustrations, we demarcated the boundaries of coexisting phases for the simplest colloidal dispersion driven by salts at moderate to high concentrations and compared the results with those obtained in the usual manner to numerically show the robust efficiency of the present theory. Also, for a charged colloidal dispersion at very low ionic strength, we crosshatched both the homogeneous one phase and coexisting phases, and used the domains of coexisting phases to interpret an anomalous "transition" of phase diagrams exhibited in dilute colloidal dispersions induced by salts on dilution.

Irx4 forms an inhibitory complex with the vitamin D and retinoic X receptors to regulate cardiac chamber-specific slow MyHC3 expression

The slow myosin heavy chain 3 gene (slow MyHC3) is restricted in its expression to the atrial chambers of the heart. Understanding its regulation provides a basis for determination of the mechanisms controlling chamber-specific gene expression in heart development. The observed chamber distribution results from repression of slow MyHC3 gene expression in the ventricles. A binding site, the vitamin D response element (VDRE), for a heterodimer of vitamin D receptor (VDR) and retinoic X receptor alpha (RXR alpha) within the slow MyHC3 promoter mediates chamber-specific expression of the gene. Irx4, an Iroquois family homeobox gene whose expression is restricted to the ventricular chambers at all stages of development, inhibits AMHC1, the chick homolog of quail slow MyHC3, gene expression within developing ventricles. Repression of the slow MyHC3 gene in ventricular cardiomyocytes by Irx4 requires the VDRE. Unlike VDR and RXR alpha, Irx4 does not bind directly to the VDRE. Instead two-hybrid and co-immunoprecipitation assays show that Irx4 interacts with the RXR alpha component of the VDR/RXR alpha heterodimer and that the amino terminus of the Irx4 protein is required for its inhibitory action. These observations indicate that the mechanism of atrial chamber-specific expression requires the formation of an inhibitory protein complex composed of VDR, RXR alpha, and Irx4 that binds at the VDRE inhibiting slow MyHC3 expression in the ventricles.

Chlamydial nucleic acids in synovium in osteoarthritis: what are the implications?

OBJECTIVE

To study whether there is evidence of bacterial DNA in some osteoarthritic (OA) joint tissues, and the clinical implications of finding bacterial DNA in this relatively noninflammatory disease.

METHODS

Polymerase chain reaction (PCR) was used to detect DNA of Chlamydia trachomatis, Chlamydia pneumoniae, and other bacteria using panbacterial primers in synovial membranes and other articular tissues of 32 consecutive patients undergoing surgery for hip and knee OA. Patients were interviewed and examined postoperatively. Operative reports were reviewed and followup examinations were accomplished on all patients.

RESULTS

Nine of 32 patients with OA (28.1%) had evidence for bacterial DNA in joint tissues with at least one set of primers for Chlamydia: 7 for C. trachomatis (21.9%), 2 for C. pneumoniae (6.2%). Five of 32 (15.6%) patients had postoperative complications; 3 of these were in patients who showed amplified DNA of C. trachomatis in joints and one in a patient in whom we detected Escherichia coli.

CONCLUSION

C. trachomatis and C. pneumoniae nucleic acids can be present in joints in some cases of apparently classical OA. Whether chlamydial or other difficult to culture bacterial presence is associated with complications is suggested, but remains to be determined. Simple presence of C. trachomatis by PCR does not define a clinical syndrome or disease course.

[Expression of the gE gene of pseudorabies virus in insect cells]

In order to develop a simple and safe test for the detection of vaccinated as well as wild type Pseudorabies virus (PRV) infected pigs, the modified gE gene of PRV Ea strain, obtained by cutting the 5' UTR using PCR and DNA recombinant technique, was inserted into baculovirus expression vector pFastBac 1, resulting the trans-position plamid pFE1.75. After homologous recombination, recombinant baculovirus rvBacE1.75 was gained and high level expression of glycoprotein E (gE) was observed after the infection of rvBacE1.75 to Tn-5B1-4 cells. The expression product was 80-88 kD and was specific to antisera against PRV Ea strain by Western-blotting. Purified recombinant proteins were used as an antigen in Latex Agglutination Test(gE-LAT) and the test was specific, sensitive, safe and simple.

Chromosomal DNA from a variety of bacterial species is present in synovial tissue from patients with various forms of arthritis

OBJECTIVE

We and others have reported the presence of Chlamydia and other bacterial species in joint specimens from patients with reactive arthritis (ReA). The present study was conducted to investigate whether bacteria other than those specified by diagnostic criteria for ReA could be identified in synovial fluid (SF) or tissue from patients with various arthritides, and whether the presence of such organisms corresponds to particular clinical characteristics in any patient set or subset.

METHODS

DNA in synovial biopsy samples and SF obtained from 237 patients with various arthritides, including ReA, rheumatoid arthritis, and undifferentiated oligoarthritis, was assayed by polymerase chain reaction (PCR) using "panbacterial" primers; we chose only samples known to be PCR negative for Chlamydia, Borrelia, and Mycoplasma species. PCR products were cloned, and cloned amplicons from each sample were sequenced; DNA sequences were compared against all others in GenBank for identification of bacterial species involved.

RESULTS

Ten percent of patient samples were PCR positive in panbacterial screening assays. Bacterial species identified belonged to the genera Neisseria, Acinetobacter, Moraxella, Salmonella, Pseudomonas, and others. Thirty-five percent of PCR-positive patients showed the presence of DNA from more than a single bacterial species in synovium; overall, however, we could identify no clear relationship between specific single or multiple bacterial species in the synovium and any general clinical characteristics of any individual or group of patients.

CONCLUSION

This analysis provides the first systematic attempt to relate bacterial nucleic acids in the synovium to clinical characteristics, joint findings, and outcomes. Many patients with arthritis have bacterial DNA in the joint, and, in some cases, DNA from more than a single species is present. However, except for 1 case of a control patient with staphylococcal septic arthritis, it is not clear from the present study whether the synovial presence of such organisms is related to disease pathogenesis or evolution in any or all cases.

Realistic calculation of the low- and high-density liquid phase separation in a charged colloidal dispersion

A realistic statistical-mechanics model is applied to describe the repulsive interaction between charged colloids. The latter, in combination with the long-range van der Waals attraction simulated under excess salt environment, gives rise to a total intercolloidal particle potential showing a clear second potential minimum. Differing from the usual Derjaguin-Landau-Verwey-Overbeek (DLVO) model, the present model is valid at any finite concentration of colloids and is thus an appropriate model for investigating the low- and high-density liquid phase transition. Employing this two-body colloid-colloid potential and in conjunction with the Weeks-Chandler-Andersen [J. D. Weeks, D. Chandler, and H. C. Andersen, J. Chem. Phys. 54, 5237 (1971)] thermodynamic perturbation theory, we derive analytical expressions for the pressure, chemical potential, and related thermodynamic functions. These thermodynamic quantities were used to calculate the phase diagrams of charged colloidal dispersions in terms of the critical parameters: temperature, volume fraction, and electrolyte concentration parameter k(D). Compared with the DLVO model, we find the areas enclosed within the spinodal decomposition and also the liquid-liquid coexistence curves broader in the present model for an excess salt condition kappa=k(D)sigma(0)< or similar to 200, sigma(0) being the macroion diameter, in addition to exhibiting a shift in the critical point kappa(c) to lower values; for kappa>300, the disparities between the two models reduce. The same thermodynamic perturbation theory has been employed to study also the weak reversible coagulation whose physical origin is attributed to the presence of the second potential minimum. We examine various colloidal parameters that affect the structure of the latter and deduce from our analysis the conditions of colloidal stability. In comparison with the measured flocculation data for a binary mixture of polystyrene lattices and water, we find that our calculated results are generally reasonable, thus lending great credence to the presently used model.

Comparison of inactivation and unfolding of methanol dehydrogenase during denaturation in guanidine hydrochloride and urea

The activity and the conformational changes of methanol dehydrogenase (MDH), a quinoprotein containing pyrrolo-quinoline quinone as its prosthetic group, have been studied during denaturation in guanidine hydrochloride (GdnHCl) and urea. The unfolding of MDH was followed using the steady-state and time resolved fluorescence methods. Increasing the denaturant concentration in the denatured system significantly enhanced the inactivation and unfolding of MDH. The enzyme was completely inactivated at 1 M GdnHCl or 6 M urea. The fluorescence emission maximum of the native enzyme was at 332 nm. With increasing denaturant concentrations, the fluorescence emission maximum red-shifted in magnitude to a maximum value (355 nm) at 5 M GdnHCl or 8 M urea. Comparison of inactivation and conformational changes during denaturation showed that in general accord with the suggestion made previously by Tsou, the active sites of MDH are situated in a region more flexible than the molecule as a whole.

[Interleukin-2 stimulates the proliferation of cultured RC-4B/C pituitary adenoma cell line]

The aim of the present study was to investigate whether interleukin-2 (IL-2) is involved in the proliferation control of the cultured RC-4B/C cell, which is a derived pituitary adenoma cell line of the rat. The level of cell proliferation was estimated by assessing (3)H-thymidine ((3)H-TdR) incorporation rate. IL-2 (10 1000 U/ml) significantly stimulated (3)H-TdR incorporation into the cell line in a dose-dependent manner. Specific PTK inhibitor tyrphostin (1 micromol/L) suppressed RC-4B/C cell proliferation and blocked the effect of IL-2 on RC-4B/C cells. After the PKA signaling pathway was inhibited by specific PKA inhibitor H-9 (1 micromol/L), the proliferation rate of RC-4B/C cells increased significantly. H-9 also enhanced the stimulation of IL-2 on RC-4B/C cell growth. Anti-estrogen tamoxifen (1 micromol/L) had no significant effect on the action of IL-2 on the proliferation of RC-4B/C cells. In conclusion, it is suggested that IL-2 modulates the proliferation of the cultured RC-4B/C pituitary adenoma cell line, and the action is closely related with the PTK and PKA signaling pathway.