[Current status of pubertal sexual characteristics development of 2 704 girls aged 6-18 years in Tongzhou District of Beijing]

Objective: To understand the current status of pubertal sexual characteristics development of girls aged 6-18 years in Tongzhou District of Beijing and to compare the differences in sexual characteristics development among girls characterized as thin, normal, overweight, and obese. Methods: A cross-sectional survey was conducted among 2 844 girls aged 6-18 years in Tongzhou District of Beijing from September 2022 to July 2023. The developmental stages of breast and pubic hair were assessed on site, and menarche status was inquired. Weight and height were measured. The girls were subsequently characterized into thin, normal, overweight and obese groups. Basic information (including family and personal history) was obtained through questionnaires. Probit probability unit regression was applied to calculate the age of each Tanner stage of sexual characteristics development and the age of menarche. The χ2 test was applied to compare the counting data between two or multiple groups. Results: A total of 2 844 girls were surveyed and 2 704 girls met the inclusion criteria, resulting in a valid response rate of 95.1%. Among these girls, 1 105 (40.9%) were aged 6-9 years, 1 053 (38.9%) were aged 10-13 years, and 546 (20.2%) were aged 14-18 years. The of height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and body mass index-for-age Z-score (BAZ) were 0.46(-0.23,1.16), 0.69(-0.16,1.67), and 0.67(-0.27,1.73) respectively. The prevalences of thin, overweight, and obesity were respectively 1.7% (45/2 704), 17.3% (467/2 704), and 19.9% (538/2 704), respectively. There were 45 girls in the thin group, 1 654 girls in the normal weight group, 1 005 girls in the overweight and obesity group. The age of Tanner stage breast 2 (B2), Tanner stage pubic hair 2 (P2), and menarche was 9.0 (95%CI 8.9-9.1), 10.5 (95%CI 10.4-10.6), and 11.4 (95%CI 11.3-1.5) years, respectively. The current status of breast and pubic hair maturity in girls with pubertal development shows that 64.6% (1 211/1 874) of these girls had breast development preceding pubic hair development, 32.4% (607/1 874) had concurrent breast and pubic hair development, and 3.0% (56/1 874) had pubic hairs development preceding breast development. The interval age between B2 and B5 was 4.7 (95%CI 4.6-4.8) years, between P2 and P5 was 4.5 (95%CI 4.4-4.6) years, and between B2 and menarche was 2.4 (95%CI 2.3-2.5) years. The ages of sexual characteristics development in overweight and obese groups were earlier than that in normal and thin groups. The ages of B2 in thin, normal, overweight, and obese groups were 10.0 (95%CI 9.5-10.6), 9.3 (95%CI 9.2-9.4), and 8.6 (95%CI 8.4-8.7) years, respectively. The age of menarche in thin, normal, overweight, and obese groups were 13.1 (95%CI 12.4-13.7), 11.6 (95%CI 11.4-11.7), and 11.1 (95%CI 11.0-11.2) years, respectively. The interval ages between B2 and B5 and between P2 and P5 was 4.5 and 4.1 years, respectively in the overweight and obese groups, and those in normal group and thin group was 4.7 and 4.5 years, 4.6 and 4.7 years, respectively. Conclusions: The ages of sexual characteristics development and menarche tend in Tongzhou District of Beijing to be earlier than that being reported of Beijing's survey 20 years ago. Girls characterized as overweight and obese not only start puberty at an earlier age than girls of normal weight, but also have a shorter developmental process.

[Updated growth standards for Chinese children under 7 years of age]

Objective: To construct growth standards for Chinese children under 7 years of age. Methods: Cross-sectional study design based on national representative data on children's growth and development in 2015 was used. Stratified cluster sampling method was used. A total of 83 628 healthy children aged 0-<7 years from 9 cities, including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, and Kunming, were investigated from June to November 2015, excluding those with adverse conditions that may impact the establishment of the growth standards. Weight, length (height) and head circumference were measured using unified measurement tools and measurement methods. The Lambda-Mu-Sigma method was employed to establish percentile and standard deviation score reference values of weight-for-age, length (height)-for-age, head circumference-for-age, weight-for-length (height) and body mass index (BMI)-for-age of the study population. The standard deviation score curves of the new-established growth standards were compared with the 2009 reference standards. Results: Reference values of percentile (P3, P10, P25, P50, P75, P90, P97) and standard deviation score (-3, -2, -1, 0,+1,+2,+3) of weight-for-age, length (height)-for-age, head circumference-for-age, weight-for-length (height) and BMI-for-age were obtained. Compared with the 2009 growth standards, the difference of weight at P50 was -0.1-0.4 kg, the difference of length (height) at P50 was 0.1-1.3 cm, the difference of head circumference at P50 was -0.2-0.2 cm, the difference of weight for length (height) at P50 was -0.2-0.5 kg, and the difference of BMI at P50 was -0.2-0.2 kg/m2. The main differences were as follows: weight for girls aged 5.0-<7.0 years was 0.4-0.6 kg higher at +2 s, height for boys and girls aged 2.0-<7.0 years was 0.4-1.4 cm higher at -2 s, and BMI for boys and girls aged 5.0-<7.0 years was 0.1-0.3 kg/m2 higher at +2 s than the 2009 reference standards. Conclusion: The newly established growth standards for Chinese children under 7 years of age that have achieved a minor revision to the 2009 reference standards, are recommended for nationwide use in growth monitoring and nutritional assessment.

[Clinical characteristics of COVID-19 Omicron variant infection in children with allergic diseases]

Objective: To analyze the clinical characteristics of infection of COVID-19 Omicron variants in children with allergic diseases. Methods: This was a cross-sectional retrospective study. A total of 657 pediatric patients with allergic diseases aged between 0-17 years confirmed with COVID-19 infection were enrolled from the Children's Hospital affiliated to Capital Institute of Pediatrics from January to March 2023. The median age was 6.6(4.7,9.9) years, with 443 males (67.4%) and 214 females (32.6%). Demographic data, vaccination status, clinical manifestations, therapeutic drugs, and other data were collected. The patients were then divided into different groups according to the age, type of allergic diseases and vaccination status, and their clinical characteristics were compared. Results: A total of 657 children with allergic diseases were included in this study, among them 568 with asthma. Fever is the most common symptoms after COVID-19 infection (627/657, 95.4%), and 509 children (77.5%) with high fever. Cough was observed in 446 (67.9%) and fatigue in 167 (25.4%) cases.10 cases (1.5%) were diagnosed as pneumonia. The proportion of pharyngalgia(22%,84/382, χ2=19.847, P<0.01), fatigue (31.7%, 121/382,χ2=23.831, P<0.01), headache(34.6%, 132/382,χ2=57.598, P<0.01), muscle joint pain(16.0%, 61/382,χ2=22.289, P<0.01) and vomiting(11.0%, 42/382,χ2=12.756, P<0.01) were highest in the>6 years group. Children younger than 3 years had the lowest proportion of runny nose(8.8%, 5/57,χ2=8.411, P<0.01), cough(45.6%, 26/57,χ2=6.287, P<0.05) and expectoration(7.0%, 4/57,χ2=5.950, P<0.05). 62.8%(137/218) of the patients in 3-6 year group had the highest rate of cough(χ2=6.287, P<0.05), with a higher proportion of wheezing (10.1%, 22/218). Cough and/or wheezing symptoms were most quickly relieved in the 6 year old group, who had a highest proportion of 68.8%(260/382) in duration of respiratory symptoms within 1 week compared with 52.2% (114/218)of 3-6 years group and 41.2% (22/57)of<3 year group, respectively(χ2=23.166, P<0.01). The asthma group had a significant higher proportion of cough(59.7% vs 41.6%, χ2=10.310, P<0.01), wheezing (8.5% vs 0.0%, χ2=8.114, P<0.01) and expectoration (19.2% vs 7.9%, χ2=10.310, P<0.01) than that of non-asthma group. Besides, patients with cough and/or wheezing in the asthma group had more impact on exercise and sleep (16.1% vs 0, χ2=5.436, P<0.05) and a longer duration over 4 weeks (25.1% vs 3.7%, χ2=6.244, P<0.05). Conclusions: The most common symptoms in children with allergy infected with COVID-19 Omicron variant were fever and cough. Children under 3 years of age had relatively fewer respiratory symptoms while those with asthma or aged 3-6 years were more likely to have cough and wheezing and longer duration of symptoms. The data suggested that the prevention and management of COVID-19 should be strengthened in children with allergy.

[Alertness and task processing speed impairment status and influencing factors of young-middle aged men with obstructive sleep apnea hypopnea syndrome]

Objective: To investigate the alertness and task processing speed impairment status in young-mild aged men with obstructive sleep apnea hypopnea syndrome (OSAHS), and analyze its influencing factors. Methods: This prospective study recruited 251 snoring patients aged 18 to 59 (38.9±7.6) years in the Sleep Center of the Second Affiliated Hospital of Soochow University from July 2020 to September 2021 and all patients were diagnosed by polysomnography (PSG). Clinical information, Epworth Sleepiness Scale (ESS) and PSG date were collected. All patients were assessed with the Montreal Cognitive Assessment (MoCA) questionnaires, Mini-mental State Examination (MMSE) and Computerized Neurocognitive Assessment System which includes the reaction time of Motor Screening Task (MOT) for alertness, the reaction time of pattern recognition memory (PRM), spatial span (SSP) and spatial working memory (SWM) for task processing speed. Based on AHI tertiles, all patients were divided into Q1 group (AHI<15 times/h, n=79), Q2 group (15 times/h≤AHI<45 times/h, n=88), and Q3 group (AHI≥45 times/h, n=84). The characteristics of clinical information, ESS, PSG parameters and cognitive scores among three groups were compared. Multiple linear stepwise regression was conducted to analyze the influencing factors of cognitive impairment. Results: There were no statistically significant differences in age, years of education, history of smoking and drinking, and past disease history (except for the prevalence of hypertension) among the 3 groups (P>0.05). There were statistically significant among-group differences in the body mass index (BMI), ESS, prevalence of hypertension and complaints of daytime sleepiness (P<0.05). Compared with Q1 and Q2 group, the arousal index (ArI), oxygen desaturation index (ODI),the proportion of non-rapid eye movement phase 1 and 2 (N1+N2) and percentage of total sleep time with oxygen saturation level<90% (TS90) of Q3 group were higher (all P<0.05). In the cognitive assessment, there was no statistically significant difference in the MoCA total and individual scores and MMSE scores among the three groups (P>0.05). Compared with the Q1 group, the task processing speed and alertness were worse in Q3 group, as shown by slower PRM immediate and delayed reaction time, SSP reaction time and MOT reaction time (all P<0.05). The total time of SWM in Q2 group was slower than that in Q1 group (P<0.05). Multiple linear stepwise regression showed that years of education (β=-40.182, 95%CI:-69.847--10.517), ODI (β=3.539, 95%CI: 0.600-6.478) were the risk factors of PRM immediate reaction time. Age(β=13.303,95%CI: 2.487-24.119), years of education(β=-32.329, 95%CI:-63.162--1.497), ODI (β=4.515, 95%CI: 1.623-7.407) were the risk factors of PRM delayed reaction time. ODI was the risk factor of SSP reaction time (β=1.258, 95%CI: 0.379-2.137). TS90 was the risk factor of MOT reaction time (β=1.796, 95%CI: 0.664-2.928). Conclusions: The early cognitive impairment in young-mild aged OSAHS patients was manifested in decreased alertness and task processing speed, and intermittent nocturnal hypoxia was its influencing factor in addition to age and years of education.

[Reference values and growth curves of length for weight and head circumference for weight among Chinese newborns]

Objective: To establish the reference values and growth curves of length for weight and head circumference for weight among Chinese newborns in order to provide a reference for the assessment of body proportionality at birth. Methods: A cross-sectional design was applied. A total of 24 375 singleton live birth newborns with gestational ages at birth of 24⁺⁰ to 42⁺⁶ weeks were recruited from June 2015 to November 2018 from 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha, and Shenzhen, excluding those with maternal or newborn conditions that may impact the establishment of the reference values. The generalized additive model for location, scale, and shape was employed to establish reference values in terms of percentile and growth curves of length for weight and head circumference for weight for male and female newborns. The random forest machine learning method was employed to analyze the importance of variables between the established reference values in this study and the previous published weight/length, body mass index (BMI), ponderal index (PI), weight/head circumference, length/head circumference in the assessment of symmetrical and asymmetrical small for gestational age (SGA) newborns. Results: A total of 24 375 newborns with 13 197 male infants (preterm birth 7 042 infants and term birth 6 155 infants) and 11 178 female infants (preterm birth 5 222 infants and term birth 5 956 infants) were included in this study. The reference values in terms of percentile (P₃, P₁₀, P₂₅, P₅₀, P₇₅, P₉₀, P₉₇) and growth curves of length for weight and head circumference for weight were obtained for male and female newborns with gestational ages of 24⁺⁰ to 42⁺⁶ weeks. The median birth lengths corresponding to the birth weights of 1 500, 2 500, 3 000, and 4 000 g were 40.4, 47.0, 49.3 and 52.1 cm for males and 40.4, 47.0, 49.2, and 51.8 cm for females, respectively; the median birth head circumferences were 28.4, 32.0, 33.2 and 35.2 cm for males and 28.4, 32.0, 33.1, and 35.1 cm for females, respectively. The differences of length for weight between males and females were minimum, with the difference range of -0.3 to 0.3 cm at P₅₀; the differences of head circumference for weight between males and females were minimum, with the difference range of 0 to 0.2 cm at P₅₀. Based on the match between birth length and birth weight for classifying symmetrical and asymmetrical SGA, length for weight and PI contributed the most, accounting for 0.32 and 0.25, respectively; based on the match between birth head circumference and birth weight, head circumference for weight and weight/head circumference contributed the most, accounting for 0.55 and 0.12, respectively; based on the match between birth length or head circumference with birth weight, head circumference for weight and length for weight contributed the most, accounting for 0.26 and 0.21, respectively. Conclusion: The establishment of the new standardized growth reference values and growth curves of length for weight and head circumference for weight among Chinese newborns are useful for clinical practice and scientific research.

[Clinical characteristics of patients with obstructive sleep apnea hypopnea syndrome combined with alveolar hypoventilation]

Objective: To evaluate the clinical characteristics of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) combined with alveolar hypoventilation. Methods: This retrospective study included patients who were diagnosed as OSAHS by polysomnography (PSG) and underwent daytime awake transcutaneous carbon dioxide (PtcCO₂) monitoring from November 2019 to February 2021 at the Sleep Center of the Second Affiliated Hospital of Soochow University. A total of 177 patients were enrolled in the analysis, including 167 males and 10 females, aged (40±8) years old. Patients with daytime awake PtcCO₂>45 mmHg (1 mmHg=0.133 kPa) were diagnosed as daytime alveolar hypoventilation, with which participants were divided into the daytime alveolar hypoventilation group and non-daytime alveolar hypoventilation group. Body mass index (BMI) cut-off value predicting daytime alveolar hypoventilation was calculated and the patients were divided into the high BMI group and low BMI group. The continuous nocturnal PtcCO₂ data was available for a subset of 128 patients, and the patients were divided into two groups according the daytime alveolar hypoventilation or not. Across-group differences were compared, respectively. Results: Compared with the non-daytime alveolar hypoventilation group (n=125), the BMI [27.57 (26.55, 30.33) vs 26.60 (25.06, 28.09) kg/m²], Epworth sleepiness score(ESS) score [9.50 (6.25, 12.00) vs 7.00 (4.00, 10.75)], higher oxygen desaturation index (ODI) [38.00 (15.23, 64.93) vs 26.80 (11.30, 44.30) events/h] and percentage of total time with oxygen saturation level<90% (TS90%) [11.24% (1.88%, 32.44%) vs 4.35% (0.72%, 9.87%)] of the daytime alveolar hypoventilation group(n=52) were significantly higher (P<0.05), and lowest arterial oxygen saturation (LSaO₂) [74.50% (60.25%, 82.00%) vs 79.00% (73.00%, 84.50%)], mean arterial oxygen saturation (MSaO₂) [94.00% (91.00%, 95.00%) vs 95.00% (94.00%, 96.00%)] were significantly lower (P<0.05). The BMI cut-off value for predicting daytime alveolar hypoventilation was 27.04 kg/m². Of the 177 enrolled patients, 90 were in the high BMI group and 87 were in low group. Compared with the low BMI group, the proportion of daytime sleepiness, the ESS score, the prevalence of hypertension, AHI and daytime awake PtcCO₂ in the high BMI group were significantly higher (P<0.05). Among the subset of 128 patients with nocturnal PtcCO₂ data available, the BMI, daytime PtcCO₂ level, the nocturnal CO₂ level and the prevalence of sleep related alveolar hypoventilation in the daytime alveolar hypoventilation group (n=40) were significantly higher than those in the non-daytime alveolar hypoventilation group (n=88) (P<0.05). Conclusions: The OSAHS patients with alveolar hypoventilation have higher BMI and more severe nocturnal hypoxia. OSAHS patients with BMI>27.04 kg/m² are more likely to develop sleep related alveolar hypoventilation disorder.

[Focus on the importance of classification of hyperglycemia in pregnancy and diagnostic criteria for gestational diabetes mellitus]

Hyperglycemia in pregnancy (HIP) is the most common pathological obstetric disease. However, there is no uniform standard in the world for classification of HIP and diagnosis of gestational diabetes mellitus(GDM). This article will analyze this issue and support the International association of diabetes and pregnancy study group(IADPSG) criteria as a global standard for diagnosing GDM,also support HIP should be divided into four categories: PGDM, ODM, GDM and prediabetes, so as to refine clinical management.

Utilizing patient information to identify subtype heterogeneity of cancer driver genes

Identifying cancer driver genes is essential for understanding the mechanisms of carcinogenesis and designing therapeutic strategies. Although driver genes have been identified for many cancer types, it is still not clear whether the selection pressure of driver genes is homogeneous across cancer subtypes. We propose a statistical framework MutScot to improve the identification of driver genes and to investigate the heterogeneity of driver genes across cancer subtypes. Through simulation studies, we show that MutScot properly controls the type I error in detecting driver genes. In addition, we demonstrate that MutScot can identify subtype heterogeneity of driver genes. Applications to three studies in The Cancer Genome Atlas (TCGA) project showcase that MutScot has a desirable sensitivity for detecting driver genes and that MutScot identifies subtype heterogeneity of driver genes in breast cancer and lung cancer with regards to the status of hormone receptor and to the smoking status, respectively.

[Effects of daytime hypercapnia on logical memory and working memory in patients with obstructive sleep apnea hypopnea syndrome]

Objective: To investigate the effects of daytime hypercapnia on logical memory and working memory in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This prospective study recruited patients complaining of snoring and diagnosed with OSAHS at the Sleep Center of the Second Affiliated Hospital of Soochow University from January to November 2020. Patients were assessed clinically and scored for their memory function. All patients underwent daytime transcutaneous carbon dioxide (PtcCO₂) test, and overnight polysomnography (PSG). Logical memory was scored using the Logical Memory Test (LMT), while working memory was evaluated by Digit Span Test (DST) and Cambridge Neuropsychological Test Automated Battery (CANTAB) which included Pattern Recognition Memory (PRM), Spatial Span (SSP), and Spatial Working Memory (SWM). Patients were divided into the normocapnic group and the hypercapnic group using the daytime PtcCO₂ test. The clinical and PSG parameters and the memory test scores between the two groups were compared. Binary logistic stepwise regression was conducted to identify risk factors of memory impairment in OSAHS patients. Results: Among the 123 enrolled OSAHS patients, 79 were normocapnic and 44 were hypercapnic. There was no significant difference in the general clinical parameters between the two groups. The snoring history in years in the hypercapnic group was longer than that in the normocapnic group (P<0.05). Compared with the normocapnic group, the apnea-hyponea index (AHI), oxygen desaturation index (ODI) and percentage of total sleep time with oxygen saturation level<90% (TS90) of the hypercapnic group were higher (all P<0.05), while other PSG parameters exhibited no statistically significant differences. There was no statistically significant difference in the immediate logical memory and PRM immediate accuracy rate between the two groups, while the delayed logical memory, verbal and spatial working memory, and executive function were worse in the hypercapnic group, as shown by lower total LMT scores, lower DST, lower SSP scores (all P<0.05), and higher between errors and strategy scores (P<0.01) of SWM in the hypercapnic group. Binary logistic stepwise regression showed that PtcCO₂ ≥45 mmHg (1 mmHg=0.133 kPa, OR=3.055, 95%CI 1.359-6.868, P=0.007) and higher body mass index (BMI) (OR=1.132, 95%CI 1.005-1.275, P=0.041) were risk factors for poor performance in Digit Span Backwards Test. Therefore, PtcCO₂ ≥45 mmHg was an independent risk factors for poor performance in delayed LMT, SSP, and between errors and strategy scores in SWM (OR=3.109, 3.941, 3.238 and 2.785, respectively, all P<0.05). Conclusion: Hypercapnia had negative impacts on logical memory and working memory of OSAHS patients, especially on the delayed logical memory, verbal working memory and spatial working memory impairment.

[Relationship between emotional apathy and motor symptoms, sleep and cognitive function in patients with early Parkinson's disease]

Objective: To study the relationship between emotional apathy and motor symptoms, sleep, and cognitive function in patients with early Parkinson's disease (PD). Methods: One hundred and twenty-nine early PD patients who were treated in the Second Affiliated Hospital of Soochow University from June to October 2020 were included, including 82 male and 47 female patients. The emotional apathy was assessed by modified apathy rating scale (MAES). The above 129 patients were divided into 67 patients in the PD with emotional apathy group (MAES>14 points) and 62 patients in the PD without emotional apathy group (MAES≤ 14 points). Age, gender, course of disease and levodopa equivalent dose were also collected. Hoehn-Yahr stage and unified Parkinson's disease rating scale PartⅢ(UPDRS-Ⅲ), Pittsburgh Sleep Quality Index (PSQI), polysomnography, and Montreal Cognitive Assessment Scale (MoCA) were used to evaluate the motor symptoms, sleep and cognitive functions of patients with early PD, and the clinical characteristics of patients with early PD with apathywere determined. Results: Compared with PD patients without apathy, those with apathy had longer disease duration [M(Q₁,Q₃)][5.0 (3.0, 7.0) years vs 3.0 (2.0, 5.0) years, P=0.006] and severer motor symptoms [20.0 (10.0, 28.0) vs 14.0 (8.5, 23.0), P=0.047]. There was no significant difference in PSQI score between the two groups. Among the 33 patients who completed polysomnography, compared with PD patients without apathy (n=16), those with apathy (n=17) had a longer rapid eye movement (REM) sleep latency [150 (124, 184) min vs 87 (57, 133) min, P=0.035)] and more frequent periodic limb movements in the REM phase(P=0.042).The REM sleep ratio (r=0.373, P=0.042), apnea-hypopena index (AHI)(r=0.374, P=0.046) and oxygen deficit index (r=0.409, P=0.025) were positively correlated with the degree of apathy in PD patients. PD patients with apathy had relatively poorer performance in cognition assessment than those without apathy and total MoCA score was inversely correlated with the degree of apathy (r=-0.231, P=0.017). Conclusion: Early PD patients with apathy have objective sleep disorders dominated by REM sleep disorders, which can have a negative impact on cognitive function.

[Reference values and growth curves of weight/length, body mass index, and ponderal index of Chinese newborns of different gestational ages]

Objective: To establish the reference values and growth curves of weight/length, body mass index, and ponderal index for Chinese newborns with gestational ages of 24 to 42 weeks, in order to provide a reference for the assessment of body proportionality and nutritional status at birth. Methods: Cross-sectional study design was applied. From June 2015 to November 2018, a total of 24 375 singleton live birth newborns with gestational ages of 24 to 42 weeks from 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha, and Shenzhen were selected, excluding those impacting the establishment of the reference values. The generalized additive model for location, scale, and shape (GAMLSS) was employed to establish percentile (P₃, P₁₀, P₂₅, P₅₀, P₇₅, P₉₀, P₉₇) reference values and growth curves of weight/length, body mass index, and ponderal index for male and female newborns with gestational ages of 24 to 42 weeks. The established growth standards in this study were compared with the standards from the 1988 Chinese data, the INTERGROWTH project, and the USA reference values. Results: A total of 24 375 newborns with 12 264 preterm newborns (7 042 males and 5 222 females) and 12 111 full-term newborns (6 155 males and 5 956 females) were included in this study. The percentile reference values and growth curves of weight/length, body mass index, and ponderal index were obtained for male and female newborns with gestational ages of 24 to 42 weeks. Weight/length of males in all gestational ages at P₁₀, P₅₀ and P₉₀ was 0 to 0.2 kg/m higher than that of females, and body mass index of males in all gestational ages at the P₁₀, P₅₀ and P₉₀ was 0.1 to 0.3 kg/m² higher than that of females. The established growth curves of weight/length and body mass index at the upper percentile and ponderal index at both upper and lower percentiles were greatly different from those of the 1988 Chinese data, which, for example, reported the difference ranges at P₉₀ as -1.09 to 0.40 kg/m for weight/length, -1.19 to 0.92 kg/m² for body mass index, and -0.64 to 0.81 kg/m³ for ponderal index. The established weight/length curves were generally consistent with the reference values from the INTERGROWTH project with a difference of -0.17 to 0.20 kg/m at P₅₀, while being 0.02 to 0.40 kg/m lower at P₉₀ and 0.13 to 0.41 kg/m higher at P₁₀ than that of the INTERGROWTH reference values at gestational ages of ≤32 weeks. The established body mass index curves differed from that of the USA reference values with a difference of -0.47 to 0.17 kg/m² at P₅₀, while being 0.53 to 1.10 kg/m² lower at gestational ages of ≥37 weeks but 0.17 to 0.45 kg/m² higher at gestational ages of ≤28 weeks than that of the USA reference values at P₉₀. Conclusion: The establishment of the new standardized growth reference values of weight/length, body mass index, and ponderal index for Chinese newborns by different gestational ages are useful for clinical practice and scientific research.

Whole genome sequencing of skull-base chordoma reveals genomic alterations associated with recurrence and chordoma-specific survival

Chordoma is a rare bone tumor with an unknown etiology and high recurrence rate. Here we conduct whole genome sequencing of 80 skull-base chordomas and identify PBRM1, a SWI/SNF (SWItch/Sucrose Non-Fermentable) complex subunit gene, as a significantly mutated driver gene. Genomic alterations in PBRM1 (12.5%) and homozygous deletions of the CDKN2A/2B locus are the most prevalent events. The combination of PBRM1 alterations and the chromosome 22q deletion, which involves another SWI/SNF gene (SMARCB1), shows strong associations with poor chordoma-specific survival (Hazard ratio [HR] = 10.55, 95% confidence interval [CI] = 2.81-39.64, p = 0.001) and recurrence-free survival (HR = 4.30, 95% CI = 2.34-7.91, p = 2.77 × 10-6). Despite the low mutation rate, extensive somatic copy number alterations frequently occur, most of which are clonal and showed highly concordant profiles between paired primary and recurrence/metastasis samples, indicating their importance in chordoma initiation. In this work, our findings provide important biological and clinical insights into skull-base chordoma.

[Timing of permanent tooth emergence and its association with physical growth among children aged from four to seven years in nine cities of China]

Objective: To investigate the timing of permanent tooth emergence and its association with physical growth among children aged 4-7 years in 9 cities of China, and to analyze the trend of permanent teeth development. Methods: According to a stratified cluster sampling design, a cross-sectional survey on the timing of permanent tooth emergence children aged 4-7 years was carried out in 9 cities (Beijing, Harbin and Xi'an in northern China; Shanghai, Nanjing and Wuhan in central China; Guangzhou, Fuzhou and Kunming in southern China) from June to October in 2015. A total of 37 973 children (19 035 boys and 18 938 girls) were recruited and were divided into different age groups (4.0-<4.5, 4.5-5.0, 5.0-5.5 and 6.0-<7.0 years of age). The situation of the exfoliation of primary teeth and the eruption of permanent teeth were investigated. Height and weight were measured using the standardized methods. Z-scores of physical growth indicators were calculated using the growth standards for Chinese children in 2009. Probit regression analysis was used to determine the median and percentile age of transition from deciduous to permanent teeth. Chi-square test was used for comparison of categorical data and t test was used for comparison of measurement data between boys and girls, urban and suburban as well as among different ages and regions. Meanwhile, the data from the national survey on physical growth and development of children under 7 years of age in 9 cities of China in 1995 were used to analyze the trends of the permanent teeth development. Results: The rate of transition from deciduous to permanent teeth in 37 973 children aged 4-7 years was higher with age, which was 0.6% (42/7 568) in 4.0-<4.5 years of age group, 30.3% (2 295/7 583) in 5.5-<6.0 years of age group, and 74.5% (5 680/7 627) in 6.0-<7.0 years of age group. The rates of transition from deciduous to permanent teeth in boys were all lower than those of girls except for children aged 4.0-<4.5 years (all P<0.01). The rate of transition from deciduous to permanent teeth in urban children was higher than that in suburban children for older than 5.5-6.0 years of age group in boys and older than 4.5-5.0 years of age group in girls, which was 74.2% (1 427/1 924) in urban boys aged 6.0-<7.0 years and 69.2% (1 305/1 885) in suburban boys aged 6.0-<7.0 years (χ(2)=11.446, P<0.01). The age of transition from deciduous to permanent teeth was 6.00 (95%CI: 5.98-6.01) years and the range of the 3-97 percentile was 4.88-7.11 years of age. The median permanent tooth emergence age of girls was lower than that of boys (5.94 vs. 6.06 years) and the median age of urban children was lower than that of suburban children (5.94 vs. 6.05 years). The median permanent tooth emergence age of southern Chinese children (6.05 years) was higher than that of northern (5.97 years) and central Chinese children (5.97 years). The weight for age Z-scores (WAZ), height for age Z-scores (HAZ) and body mass index for age Z-scores (BMIZ) of children with transition from deciduous to permanent teeth (0.35±1.17, 0.32±1.00, 0.23±1.16) were significantly higher than those of children without transition from deciduous to permanent teeth (0.03±1.13, 0.03±1.02, 0.04±1.13, t=20.81,21.67,12.09, all P<0.05). In comparison with the data in 1995, data in 2015 showed that the rate of transition from deciduous to permanent teeth was higher, for example, the rate of urban boys aged 6.0-<7.0 years group was 63.8% (1 146/1 796) in 1995, and increased to 74.2% (1 427/1 924) in 2015 (χ(2)=46.748, P<0.01). The median permanent tooth emergence age decreased by 0.24 years in 2015 as compared with that in 1995. Conclusions: The development of permanent teeth is earlier in girls than in boys, earlier in urban children than in suburban children and slightly delay in southern children than in central and northern Chinese children. In addition, the development of permanent teeth, which is related to the physical growth, slightly accelerate in China during the past 20 years.

[Survey on the stunting of children under seven years of age in nine cities of China]

Objective: To survey the children under 7 years of age in nine cities of China for a better understanding of the current situation of childhood stunting. Methods: According to a stratified cluster sampling design, a cross-sectional survey on children under 7 years of age was carried out in 9 cities (Beijing, Harbin and Xi'an in northern China; Shanghai, Nanjing and Wuhan in central China; and Guangzhou, Fuzhou and Kunming in southern China) from June to November in 2016. A total of 110 499 children were recruited. Height of children was evaluated using the growth standards for Chinese children (2009 edition) .Children with height less than the 3rd percentile of the growth standards were considered as stunting, and children with height between the 3rd and 10th percentiles of the growth standards were considered as relatively short stature. Chi-square test was used for comparison between data of boys and girls, urban and suburban, as well as among different ages and regions. Results: Totally 113 084 children under 7 years of age should be investigated and actually 110 499 children were investigated, with a rate of 97.7%. The prevalence of stunting was 1.9% (2 141/110 499) among all the children. The prevalence of stunting in urban children (1.6%, 904/55 524) was lower than that in suburban children (2.3%, 1 237/54 975, χ(2)=56.246, P<0.01). The gender difference in stunting prevalence was not statistically significant (1.9% (1 121/57 921) in boys and 1.9% (1 020/52 578) in girls, χ(2)=0.003, P=0.965). The prevalence of stunting decreased with age for children younger than 3 years, from 1.8% (312/17 080) in 0-<1 year of age group to 1.2% (168/13 740) in 2-<3 years of age group, but increased to 2.2% (240/11 073) at 6-<7 years group. Comparison among different regions showed that the stunting prevalence in southern region was higher than those in the central and northern regions (0.9% (193/20 374) in northern urban, 0.8% (154/18 486) in central urban, and 3.3% (557/16 664) in southern urban children), showing a statistical significance (χ(2)=437.736, P<0.01); 1.1% (241/21 924) in northern suburban, 1.4% (227/16 775) in central suburban and 4.7% (769/16 276) in southern suburban children, showing a statistical significance (χ(2)=646.533, P<0.01). In urban areas, the difference between the central and northern regions showed no statistical significance (χ(2)=1.429, P=0.232) and the stunting prevalence of central Chinese children was slightly higher than that of northern Chinese children in suburban areas (χ(2)=5.130, P=0.024). Among the nine cities, the stunting prevalence of Guangzhou (6.1%, 613/10 019) was higher than those of other cities (χ(2)=1 559.64, P<0.01). Among the stunting children, 78.4% (1 679/2 141) were classified as borderline or mild and only 7.2% (154/2 141) were classified as severe. The prevalence of relatively short stature was 5.2% (5 721/110 499). Conclusions: The prevalence of stunting among children under 7 years of age in nine cities of China is low and most of the stunting children were classified as mild; the prevalence of stunting in suburban children is higher than that in urban children; the gender difference show no statistical significance; and the prevalence of stunting in southern Chinese children is higher than those in central and northern Chinese children.

[Progress of interruption of schistosomiasis transmission in Jiangsu Province]

Schistosomiasis was once heavily endemic in Jiangsu Province. Following the control efforts for several decades, schistosomiasis was almost eradicated in all endemic counties in Jiangsu Province in 1980, and transmission control was achieved in the province in 2011. According to the principle of "implementing the control measures with adaptation to local circumstances and guiding the control programs with classified interventions", an integrated strategy with emphasis on the management of both infectious sources and snails has been recently employed for schitsosomiasis control in Jiangsu Province. In addition, a sensitive and highly effective surveillance system has been built and the application of novel techniques and information construction has been intensified to effectively interrupt the transmission of schistosomiasis in the Province. Transmission interruption of schistosomiasis was achieved in all endemic counties in Jiangsu Province. The paper summarizes the endemic situation of schistosomiasis, progress of schistosomiasis control, and major schistosomiasis control measures implemented during the stage of transmission interruption in Jiangsu Province.

A magneto-microfluidic platform for fluorescence immunosensing using quantum dot nanoparticles

This study reports the online fluorescent detection of carcinoembryonic antigen (CEA) and α-fetoprotein (AFP) biomarker proteins in microfluidic channels using functional nanoparticles. Functional magnetic nanoparticles labeled with two antibodies were predeposited on separated microfluidic channels. Antigens were passed through each microfluidic channel to react with the respective antibodies. Two types of fluorescent nanoparticles labeled with antibodies were then used to detect and confirm antigens in the immunocomplex. Results indicate that online fluorescent detection of proteins can provide advantages for real-time monitoring and diagnostic applications. The running time was less than 20 min for each trial. The detection limits of CEA and AFP were found to be 0.6 and 0.2 pg ml^-1. These detection limits are lower than those of ELISA. The linear ranges of CEA and AFP detection were from 1.8 pg ml^-1 to 1.8 ng ml^-1 and from 0.68 pg ml^-1 to 0.68 ng ml^-1 for two deposition zones in a magnetic sandwich immunoassay. The linear ranges of this method are wider than those of ELISA and those of most other methods. The measurements of CEA and AFP in serum samples from this method differed from ELISA results by 11% and 9.4%, respectively. The detection limit of online detection has achieved the same range as those of previous offline detection. This method has a good potential for automation and multichannel analysis to increase the throughput with some modifications in the future. The proposed method can provide simple, fast, and sensitive online detection for biomarkers.

[Development of primary teeth among infants and toddlers in nine cities of China in 2015]

Objective: To investigate the status of the development of primary teeth and to identify the development patterns among infants and toddlers in nine cities of China in 2015. Methods: Healthy children aged 1-<36 months were investigated by across-sectional survey and retrospective studies, which was carried out in 9 cities (Beijing, Harbin and Xi'an in northern China; Shanghai, Nanjing and Wuhan in central China; and Guangzhou, Fuzhou and Kunming in southern China) from June to October in 2015. Subjects (n=103 995) were divided into 14 age groups (1-<2, 2-<3, 3-<4, 4-<5, 5-<6, 6-<8, 8-<10, 10-<12, 12-<15, 15-<18, 18-<21, 21-<24, 24-<30, 30-<36 months). There were 150-200 boys and girls respectively in each group of urban and suburb areas in each city. The eruption status and the number of primary teeth were examined by the trained child health care physician or pediatrician on the spot. The timing of primary teeth eruption of children was retrospectively surveyed using a questionnaire. The prevalence of primary teeth was calculated and χ(2) test was used for comparison of categorical data. Probit regression analysis was used to determine the median and percentile age of eruption of primary teeth. Results: Totally 103 995 children aged 1-<36 months were investigated. There were 52 346 children in urban areas (boys 26 228, girls 26 118) and 51 649 children in suburb areas (boys 25 912, girls 25 737). The eruption rate of primary teeth in children under 2 years became higher with age and the difference among each age group was statistically significant (χ(2)=85 913.868, P<0.01), which was 0.3% (22/7 450) in 3-<4 months group, 43.0% (3 227/7 503) in 6-<8 months group and 99.9% (7 441/7 446) in 15-<18 months group. The eruption age of primary teeth was 6.6 months (95%CI: 6.5-6.7 months), and the range of the 3rd to 97th percentile was 4.1-10.6 months. The eruption ages of primary teeth in urban and suburb areas children were 6.6 months (95%CI: 6.5-6.7 months) and 6.6 months (95%CI: 6.5-6.7 months) respectively. The eruption age of primary teeth was earlier in boys (6.4 months, 95%CI: 6.3-6.5 months) than that in girls (6.7 months, 95%CI: 6.6-6.8 months). The median eruption age of primary teeth was earlier in northern China (6.2 months) than that in central (6.7 months) and southern China (6.9 months). The eruption rate of primary teeth became higher with age, showing that the median number of primary teeth was 2 in 8-<10 months group, 8 in 12-<15 months group and 20 in 30-<36 months group. Conclusions: The timing of eruption of primary teeth was similar between urban and suburb areas children and that of the boys was slightly earlier than that of the girls. There were slight differences among different regions in the eruption timing of primary teeth. The range of the 3rd to 97th percentile in the eruption age of primary teeth was 4.1-10.6 months and the number of primary teeth followed the regular development pattern with age.

Associations of CDH1 germline variant location and cancer phenotype in families with hereditary diffuse gastric cancer (HDGC)

INTRODUCTION

Hereditary diffuse gastric cancer (HDGC) is a cancer syndrome associated with variants in E-cadherin (CDH1), diffuse gastric cancer and lobular breast cancer. There is considerable heterogeneity in its clinical manifestations. This study aimed to determine associations between CDH1 germline variant status and clinical phenotypes of HDGC.

METHODS

One hundred and fifty-two HDGC families, including six previously unreported families, were identified. CDH1 gene-specific guidelines released by the Clinical Genome Resource (ClinGen) CDH1 Variant Curation Expert Panel were applied for pathogenicity classification of truncating, missense and splice site CDH1 germline variants. We evaluated ORs between location of truncating variants of CDH1 and incidence of colorectal cancer, breast cancer and cancer at young age (gastric cancer at <40 or breast cancer <50 years of age).

RESULTS

Frequency of truncating germline CDH1 variants varied across functional domains of the E-cadherin receptor gene and was highest in linker (0.05785 counts/base pair; p=0.0111) and PRE regions (0.10000; p=0.0059). Families with truncating CDH1 germline variants located in the PRE-PRO region were six times more likely to have family members affected by colorectal cancer (OR 6.20, 95% CI 1.79 to 21.48; p=0.004) compared with germline variants in other regions. Variants in the intracellular E-cadherin region were protective for cancer at young age (OR 0.2, 95% CI 0.06 to 0.64; p=0.0071) and in the linker regions for breast cancer (OR 0.35, 95% CI 0.12 to 0.99; p=0.0493). Different CDH1 genotypes were associated with different intracellular signalling activation levels including different p-ERK, p-mTOR and β-catenin levels in early submucosal T1a lesions of HDGC families with different CDH1 variants.

CONCLUSION

Type and location of CDH1 germline variants may help to identify families at increased risk for concomitant cancers that might benefit from individualised surveillance and intervention strategies.

Performance of Arma chinensis reared on an artificial diet formulated using transcriptomic methods

An artificial diet formulated for continuous rearing of the predator Arma chinensis was inferior to natural prey when evaluated using life history parameters. A transcriptome analysis identified differentially expressed genes in diet-fed and prey-fed A. chinensis that were suggestive of molecular mechanisms underlying the nutritive impact of the artificial diet. Changes in the diet formulation were made based on the transcriptome analysis and tested using life history parameters. The quantity of pig liver, chicken egg, tuna fish, biotin, nicotinamide, vitamin B6, thiamine, riboflavin, vitamin C, L-glutamine, and sucrose was reduced, and wheat germ oil, calcium pantothenate and folic acid were increased. Ecuadorian shrimp was added as a partial substitute for tuna fish. Several parameters improved over six generations, including increased egg viability, and decreased egg and adult cannibalism. Additionally, several parameters declined, including longer developmental times for 2nd-5th instars, and decreased nymphal weights. The improvements in life history parameters support the use of transcriptome analyses to help direct formulation improvements. However, the decline in some parameters suggests that additional information, e.g., proteomic data, may be useful as well to maximize diet formulations.

Preventing arteriovenous shunt failure in hemodialysis patients: a population-based cohort study

Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients. 95 971 people under hemodialysis were followed in a claims database in Taiwan. Aspirin reduced vascular access failure rate and did not increase major bleeding rate. Clopidogrel, Aggrenox, and warfarin might increase major bleeding rate. SUMMARY: Background Dialysis adequacy is a major determinant of survival for patients with end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives This study evaluated the impacts of different drugs on the vascular access failure rate of an arteriovenous fistula or an arteriovenous graft and the rate of major bleeding in hemodialysis patients. Patients and methods We studied patients with end-stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for thrombectomy or percutaneous angioplasty. Major bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. The adjusted odds ratios between person-quarters with or without antiplatelet or oral anticoagulant use were calculated using a generalized estimating equation. Results The odds ratio of vascular access failure was 0.21 (0.11-0.39) for aspirin, 0.76 (0.74-0.79) for clopidogrel, 0.67 (0.59-0.77) for dipyridamole, 0.67 (0.53-0.86) for Aggrenox and 0.96 (0.90-1.03) for warfarin. The highest odds ratio for intracerebral hemorrhage was 5.33 (1.25-22.72) in younger patients using Aggrenox. The highest odds ratio for gastrointestinal bleeding was 1.34 (1.10-1.64) for clopidogrel. Conclusion Antiplatelet agents, but not warfarin, might reduce the vascular access thrombosis rate. The gastrointestinal bleeding rate was increased in the group using clopidogrel. Aggrenox should be used with caution in young individuals because it might increase the rate of intracerebral hemorrhage.

[Clinical characteristics of silent pheochromocytoma]

Objective: To summarize the clinical characteristics of silent paraganglioma. Methods: A total of 247 pheochromocytoma cases in Peking University First Hospital between January 1993 and December 2015 were analyzed retrospectively.The cases were divided into two groups according to whether they had hypertension: non-silent group (193 cases) and silent group (53 cases), then the clinical characteristics between the groups were compared, and the clinical features of silent pheochromocytoma were reviewed. Results: There were 53 silent pheochromocytoma cases in this study, which accounted for 21.5% (53/247), and imaging was the main way to find the tumor. Forty-one in 53 cases (77.4%) located in adrenal gland, in which 31 cases (75.6%) were benign and 2.3-8.0 cm in diameter, while 10 cases (24.4%) were malignant and 3.5-12.0 cm in diameter. Twelve in 53 cases (22.6%) located in extra-adrenal tissue, in which 4 cases were benign and 2.0-5.5 cm in diameter, while 8 cases were malignant and 5.0-10.5 cm in diameter. With the tumor diameter increased, the malignant rate increased: 1 in 8 cases in diameter<3 cm, 2 in 12 cases in diameter 3-5 cm, 15 in 33 cases in diameter>5 cm were malignant. There was no significant difference in age, sex, tumor location, benign or malignant rate between the two groups (all P>0.05). Compared with the non-silent group, the proportion of tumor size≥5 cm in silent group was significantly higher (62.3% vs 45.9%, P=0.034), and the incidence of hyperglycemia and the concentrations of norepinephrine and epinephrine were lower (all P<0.05) in silent group.Misdiagnosis was common in silent group, and up to 35.8% (19/53) had not been diagnosed correctly before operation. Twenty-one in 53 (39.6%) silent pheochromocytoma cases occured severe intra-operative blood pressure fluctuation. Conclusions: Silent pheochromocytoma was not uncommon and imaging was the main way to find it. The tumor size was always big and misdiagnosis was common, especially extra-adrenal tumors. Therefore, regardless of the adrenal or extra-adrenal tumors, especially in diameter>3.0 cm but with normal blood pressure, the possibility of silent pheochromocytoma should be considered. In order to reduce misdiagnosis and intra-operative blood pressure fluctuations, preoperative diagnosis and preparation, as well as intra-operative monitoring should be fully made.

Polarization rotation and the electrocaloric effect in barium titanate

We study the electrocaloric effect in the classic ferroelectric BaTiO₃ through a series of phase transitions driven by applied electric field and temperature. We find both negative and positive electrocaloric effects, with the negative electrocaloric effect, where temperature decreases with applied field, in monoclinic phases. Macroscopic polarization rotation is evident through the monoclinic and orthorhombic phases under applied field, and is responsible for the negative electrocaloric effect.

Maternal Hyperleptinemia Is Associated with Male Offspring's Altered Vascular Function and Structure in Mice

Children of mothers with gestational diabetes have greater risk of developing hypertension but little is known about the mechanisms by which this occurs. The objective of this study was to test the hypothesis that high maternal concentrations of leptin during pregnancy, which are present in mothers with gestational diabetes and/or obesity, alter blood pressure, vascular structure and vascular function in offspring. Wildtype (WT) offspring of hyperleptinemic, normoglycemic, Leprdb/+ dams were compared to genotype matched offspring of WT-control dams. Vascular function was assessed in male offspring at 6, and at 31 weeks of age after half the offspring had been fed a high fat, high sucrose diet (HFD) for 6 weeks. Blood pressure was increased by HFD but not affected by maternal hyperleptinemia. On a standard diet, offspring of hyperleptinemic dams had outwardly remodeled mesenteric arteries and an enhanced vasodilatory response to insulin. In offspring of WT but not Leprdb/+ dams, HFD induced vessel hypertrophy and enhanced vasodilatory responses to acetylcholine, while HFD reduced insulin responsiveness in offspring of hyperleptinemic dams. Offspring of hyperleptinemic dams had stiffer arteries regardless of diet. Therefore, while maternal hyperleptinemia was largely beneficial to offspring vascular health under a standard diet, it had detrimental effects in offspring fed HFD. These results suggest that circulating maternal leptin concentrations may interact with other factors in the pre- and post -natal environments to contribute to altered vascular function in offspring of diabetic pregnancies.

Molecular Characterization of Six Small Heat Shock Proteins and Their Responses Under Cadmium Stress in Oxya chinensis (Orthoptera: Acridoidea)

Small heat shock proteins (sHSPs) have been implicated in many physiological processes and play important roles in the response to various stresses. In this study, the full-length sequences of six sHSPs: OcHSP19.1, 19.8, 20.4, 20.7, 21.1, and 23.8 were obtained from the rice grasshopper Oxya chinensis transcriptome database. The deduced amino acid sequences of the six OcsHSPs contain a typical α-crystallin domain, which consists of approximately 100 amino acid residues and five β-strands. The phylogenetic analysis suggested that OcHSP23.8 was orthologous to the sHSPs of other species and that OcHSP19.1, 20.4, 20.7, and 21.1 were species specific, whereas OcHSP19.8 did not cluster closely to Orthoptera but was placed on the basal end of the cluster. Developmental stage-dependent and tissue-specific expression patterns were evaluated using quantitative real-time polymerase chain reaction. The six genes were expressed in all developmental stages and showed clear tissue specificity. The cadmium acute experiment indicates that Cd(2+) can induce the six genes. However, various response patterns were observed among these genes under Cd(2+) stress conditions. OcHSP19.1, 19.8, 20.4, and 20.7 were highly induced by 2.61 mM Cd(2+) at 24 h. OcHSP23.8 was significantly upregulated by 2.61 mM Cd(2+) at 6 h. For OcHSP21.1, the highest expression levels were found after treatment with 0.87 mM Cd(2+) for 24 h, 1.74 mM Cd(2+) for 36 h, and 2.61 mM Cd(2+) for 12 h. These differential characteristics will facilitate future investigations into the physiological functions of sHSPs.

[Management of pelvic injury associated with complete anterior sacroiliac joint dislocation]

OBJECTIVE

To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation.

METHODS

In the study, 6 cases of pelvic injury associated with complete anterior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed. We described the history and severity of injury, emergency treatment, and fracture radiology. In all the cases, the surgical treatment and postoperative functional exercise were performed. We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience.

RESULTS

All the 6 patients with fractures recovered without infection and nerve symptoms after surgery. Their X-rays showed good reduction of sacroiliac joints. All the cases were followed up on an average of 1.6 years. Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1. The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick. The 2 patients with low scores could not resume the original work.

CONCLUSION

Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.

Performance and Cost Comparisons for Continuous Rearing of Arma chinensis (Hemiptera: Pentatomidae: Asopinae) on a Zoophytogenous Artificial Diet and a Secondary Prey

The impact of a zoophytogenous, insect-free artificial diet and a secondary prey, pupae of Chinese oak silk moth Antheraea pernyi (Guérin-Méneville) (Lepidoptera: Saturniidae), on the developmental rate, life history parameters, and fertility was examined for F6, F9, and F12 consecutive generations for domesticated Arma chinensis (Fallou) (Heteroptera: Pentatomidae). This study showed that when fed an insect-free artificial diet during both the nymphal and adult stages, developmental times were prolonged, and fecundity, egg viability, net reproductive rates (R0), and intrinsic rates of increase (rm) declined. As a result, the cost to rear A. chinensis on the artificial diet approached 1.7 times the cost of rearing A. chinensis on pupae of A. pernyi. Future diet improvements should attempt to reduce developmental time, increase fecundity, and egg viability and use less costly nutrient sources.

EUS-guided FNA cytology of pancreatic neuroendocrine tumour (PanNET): a retrospective study of 132 cases over an 18-year period in a single institution

OBJECTIVE

To determine the diagnostic accuracy and pitfalls of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) cytology of pancreatic neuroendocrine tumour (PanNET).

METHODS

A search of our laboratory information system was performed from July 1992 to June 2010 to identify all FNA cytology and corresponding surgical specimens in which the diagnosis of PanNET was rendered or considered.

RESULTS

One hundred and thirty-two cases diagnosed by EUS-guided FNA were collected. Histological correlation was available for 77 (58%) of FNAs; 55 patients may have been treated elsewhere or had no surgery because of advanced disease or co-morbidity. Among 56 cases diagnosed as PanNET on FNA, 54 (96%) were confirmed histologically; the remaining two were poorly differentiated adenocarcinoma with focal neuroendocrine features in one case and no tumour was found in the other. Follow-up histology of nine patients diagnosed as suspicious for PanNET on FNA showed four PanNETs, two pancreatic ductal adenocarcinomas (PDA), one solid pseudopapillary tumour (SPT) and two cases of chronic pancreatitis. Nine cases rendered by FNA as atypical (n = 3), no atypical cells identified (n = 4) or unsatisfactory (n = 2) were PanNETs on histology. Lastly, three cases of oncocytic variant of PanNET were misdiagnosed on FNA as either adenocarcinoma (n = 2) or as suspicious for carcinoma (n = 1).

CONCLUSIONS

Overall, 54 of the 70 histologically confirmed PanNET cases (77%) were correctly diagnosed by preoperative FNA as PanNET. FNA cases designated as no atypical cells identified and unsatisfactory (7/132, 5%) were attributable to sampling error. Diagnostic pitfalls in our study mainly included PDA, SPT and chronic pancreatitis.

Effect of dietary cadmium on the activity of glutathione S-transferase and carboxylesterase in different developmental stages of the Oxya chinensis (Orthoptera: Acridoidea)

Glutathione S-transferases (GSTs) and carboxylesterases (CarEs) play important roles in the detoxification of endogenous and exogenous compounds. In this study, the biochemical effects of dietary cadmium (Cd) on the activities of GST and CarE in different developmental stages of the rice grasshopper Oxya chinensis Thunberg were studied. The results showed that the effects of the Cd concentration and developmental stage on GST activity were statistically significant. GST activity in O. chinensis increased at the highest Cd concentration in most nymphs, suggesting that GST is typically inducible by Cd. However, GST activity was inhibited in adults under Cd stress owing to life-stage-specific physiological characteristics. The results showed that the substrates, developmental stage, and Cd concentration had statistically significant effects on CarE activity. In most studies of CarE activity, the interaction between any two studied factors was statistically significant, although the interaction effects of the substrates, developmental stages, and Cd concentrations were not significant, which implied that the insect physiological condition and the external environmental may affect CarE activity. The results suggest that the insect's life stage and enzyme substrates should be considered when enzyme activity under Cd stress is studied.

Cyclophilin A and nuclear factor of activated T cells are essential in cyclosporine-mediated suppression of polyomavirus BK replication

Immunosuppressants have impacts on the development of polyomavirus-associated nephropathy. We previously demonstrated that cyclosporin A (CsA) suppressed polyomavirus BK (BKV) replication. The role of cyclophilin A (CypA) and nuclear factor of activated T cells (NFAT) in CsA-imposed suppression of BKV replication was determined in this study. Results demonstrated that knockdown of CypA but not CypB significantly reduced BKV large T antigen (TAg) expression and BKV titer. Overexpression of CypA reversed CypA siRNA-induced inhibition in BKV TAg expression. In addition, CypA overexpression attenuated the suppressive effect of CsA on TAg expression, suggesting CypA implicated in CsA-mediated anti-BKV effect. Knockdown of NFATc3 abrogated TAg expression, while overexpression of NFATc3 promoted TAg expression and augmented BKV promoter activity. NFATc3 binding to the BKV promoter was verified by chromatin immunoprecipitation assay and electrophoretic mobility shift assay. Renal histology also displayed an increase in NFATc3 expression in tubulointerstitium of BKV-associated nephropathy. Furthermore, overexpression of NFATc3 rescued CsA-mediated inhibition of BKV load and TAg expression. A CsA analog, NIM811, which cannot block NFAT functionality, failed to suppress TAg expression. In conclusion, CypA and NFAT are indispensable in BKV replication. CsA inhibits BKV replication through CypA and NFAT, which may be potential targets of anti-BKV treatment.

A new Kondo antiferromagnet Ce(Ni(0.25)In(1.75))

We find that Ce(Ni(0.25)In(1.75)) crystallizes in the hexagonal AlB(2)-type structure with lattice parameters a = 0.4850(5) nm and c = 0.3908(5) nm. Magnetic susceptibility, electrical resistivity and low-temperature specific heat data reveal that the bulk phase transition at 3.7 ± 0.2 K in Ce(Ni(0.25)In(1.75)) is to an antiferromagnetic state. The magnetic contribution to the resistivity ρ(mag) of Ce(Ni(0.25)In(1.75)) increases as ln(T) when temperature is lowered from room temperature and reaches a plateau at 9 K, followed by a rapid decrease around 4 K. These results associated with a reduction of the Ce magnetic moment and of the magnetic entropy at T(N) suggest that Ce(Ni(0.25)In(1.75)) could be a Kondo antiferromagnet. The Kondo temperature is estimated to be of order 6 K.

Apoptosis in primary cardiac tumours

Apoptosis, or programmed cell death, is now recognised as an important cellular event during both normal development and specific disease progression. Apoptosis has been suggested to play a critical role in several cardiovascular diseases, but has not yet been identified as a major influence in primary cardiac tumours. A retrospective review of the achieved material at Chang Gung Memorial Hospital revealed seven patients with cardiac myxoma and one with a tumour originating from the crista terminalis, from January 2002 to December 2002. The medical chart, surgical pathology reports and microscopic slides were available in all cases. All patients, including eight cardiac myxomas and one tumour from crista terminalis, were assessed for apoptosis by terminal deoxynucleotidyl transferase nick-end labelling assay. In this study, apoptosis is well documented in all seven myxoma and has even been reported in tumour from the crista terminalis. Interestingly, apoptosis appears related to the nature of the cell properties rather than the incidence of embolism. In conclusion, apoptosis is important in the progression of the primary cardiac tumours, but the mechanism of cardiac tumour regression still remains uncertain.

The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis

OBJECTIVE

To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment.

PATIENTS AND METHODS

Between 1980 and 1994, 96 patients with prostate cancer and bony metastasis were included for an evaluation by a retrospective review of their charts. All 96 had received hormonal treatment after a diagnosis of metastatic prostatic carcinoma. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were assessed before treatment. The patients were divided into two groups according to their response during the follow-up. Group 1 (good response) had no change or resolution of metastatic lesion(s) on the bone scan and a declining prostate-specific antigen (PSA) level. Group 2 had increased PSA or progression of metastatic lesion(s) on the bone scan. Tumours were graded as low (2-4), intermediate (5-7) and high (8-10) using the Gleason score.

RESULTS

There were 43 patients in group 1 and 53 in group 2; the overall mean (sd) age was 72.5 (6.8) years and the follow-up 29.5 (0.5) months. The respective mean (sd) levels of testosterone, LH, FSH and prolactin before treatment were 4.6 (1.6) ng/mL, 20.2 (13.3) mIU/mL, 19.6 (18.6) mIU/mL and 20.7 (12.1) ng/mL in group 1, and 2.6 (1.0) ng/mL, 27.3 (11.0) mIU/mL, 27.1 (9.8) mIU/mL and 41.3 (28.4) ng/mL in group 2. The level of testosterone was significantly higher in group 1 than in group 2, while LH, FSH and prolactin were significantly lower in group 1 than in group 2. When stratified by tumour grade, patients in group 1 still had significantly higher pretreatment testosterone and lower LH, FSH and prolactin than those in group 2.

CONCLUSION

Higher testosterone and lower LH, FSH and prolactin levels were good prognostic factors for patients with metastatic prostatic cancer under hormonal treatment, irrespective of tumour grading.

Kuntz's fiber: the scapegoat of surgical failure in sympathetic surgery

Resection of Kuntz's fiber is considered a guarantee to treat Hyperhidrosis in sympathetic surgery. The incidence of Kuntz's fiber is about 60.0% in clinical studies while the surgical failure rate is about 1.5% when Kuntz's fiber is preserved on Endoscopic Thoracic Sympathetic Block by clamping, which is performed by clamping the upper and lower end of ganglion. We found that supererogatory resection of Kuntz's fiber is inessential; clamping of upper and lower ends of the ganglia should be a complete procedure in sympathetic surgery. Kuntz's fiber plays only anatomic, and no clinical role in surgical failure of sympathetic surgery.

Endoscopic t4-sympathetic block by clamping (ESB4) in treatment of hyperhidrosis palmaris et axillaris--experiences of 165 cases

Prevention of postoperative complications becomes relatively important when surgical procedures are easy to learn and perform. Endoscopic Thoracic Sympathetic Surgery (ETS), which is now more accessible to surgeons after the 2nd International Symposium of Thoracic Sympathicotomy, would be the typical examples in surgery. Reflex sweating is one of the famous and annoying complications that surgeons endeavor to avoid but in vain in ETS. Incidentally, we found that preservation of sympathetic tone to the head is the main influential factor in avoiding reflex sweating in ETS; and with the lower sympathetic ganglion blocked, the more sympathetic tone to the head is preserved. T4-sympathetic block is an ideal procedure that can treat palmar and/or axillary hyperhidrosis and preserve most of sympathetic tone to head. We used T4-sympathetic block by clamping (ESB4) in treatment of 165 cases of Hyperhidrosis et axillaris and attained excellent operative results without reflex sweating from August 1, 2000 to February 28, 2001. We concluded, ESB4 is the method that can treat hand and axillary hyperhidrosis without inducing reflex sweating.

Species distribution of polymeric aluminium-ferrum--timed complexation colorimetric analysis method of Al-Fe-ferron

The effects of the colorimetric buffer solutions were investigated while the two colorimetric reactions of Al-ferron complex and Fe-ferron complex occurred individually, and the effects of the testing wavelength and the pH of the solutions were also investigated. A timed complexation colorimetric analysis method of Al-Fe-ferron in view of the total concentration of (Al + Fe) was then established to determine the species distribution of polymeric Al-Fe. The testing wavelength was recommended at 362 nm and the testing pH value was 5. With a comparison of the ratios of nAl/nFe, the standard adsorption curves of the polymeric Al-Fe solutions were derived from the experimental results. Furthermore, the solutions' composition were various in both the molar nAl/nFe ratios, i.e. 0/0, 5/5, 9/1 and 0/10, and the concentrations associated with the total [Al + Fe] which ranged from 10(-5) to 10(-4) mol/L.

Significance of benign endometrial cells in Pap smears from postmenopausal women

OBJECTIVE

To assess the significance of benign exfoliated endometrial epithelial or stromal cells on cervicovaginal Pap smears obtained from postmenopausal women not receiving exogenous hormones.

STUDY DESIGN

A computerized search of the cytology database at two institutions was performed for a five-year period, and all cervical cytology cases from postmenopausal patients diagnosed with benign endometrial cells were identified. Those cases with histologic follow-up within 12 months of the original cytologic evaluation were selected for analysis, and their cytology and surgical pathology slides were reviewed.

RESULTS

A total of 227 postmenopausal women with benign endometrial cells were identified. Of the 61 patients with histologic follow-up, 25 (41%) had significant endometrial diseases, including hyperplasia without atypia (11), atypical endometrial hyperplasia (5), well-differentiated adenocarcinoma (8) and high grade serous carcinoma (1). Benign diagnoses, including atrophy (15), weakly proliferative endometrium (9) and proliferative endometrium (6), were noted in 30 patients (49%). Endometrial polyp was identified in three patients (5%). There were three cases of nondiagnostic histologic specimens that lacked endometrial tissue (5%). Two of nine women (22%) with proven carcinoma were asymptomatic.

CONCLUSION

The diagnosis of endometrial cells, cytologically benign, in a postmenopausal woman not receiving hormone on Pap smears is associated with a significant number of cases of endometrial hyperplasia, atypical hyperplasia and carcinoma.

The role of nitric oxide in development of topographic precision in the retinotectal projection of chick

The axonal projection from the retina to the tectum exhibits a precise topographic order in the mature chick such that neighboring ganglion cells send axons to neighboring termination zones in the contralateral tectum. The initial pattern formed during development is much less organized and is refined to the adult pattern during a discrete period of development. Refinement includes elimination of radically aberrant projections, such as those from the temporal side of the retina to posterior regions of the tectum, as well as a more subtle improvement in the topographic precision of the projection. The enzyme that synthesizes nitric oxide is expressed at high levels in the tectum during the developmental period in which the topography improves. Pharmacological blockade of nitric oxide synthesis during this period prevented elimination of topographically inappropriate retinotectal projections in a dose-dependent manner. This effect could not be duplicated by treatment of embryos with a vasoconstrictor, indicating that vascular changes were not a factor. These results show that nitric oxide is involved in refinement of the topography of the retinotectal projection as well as in other aspects of refinement of this projection in developing chick.

Antimite activity of essential oils and their constituents from Taiwania cryptomerioides

Antimite activity of essential oils and their components obtained from Taiwania cryptomerioides Hayata heartwood against Dermatophagoides pteronyssinus (Trouessart) and Dermatophagoides farinae Hughes was investigated in this study. Results from antimite tests demonstrated that the essential oil extracted from T. cryptomerioides heartwood had miticidal activity against D. pteronyssinus and D. farinae with a mortality of 67.0 and 36.7% at the dosage of 12.6 microg/cm2 after 48 h. Alpha-cadinol possessed the strongest antimite activity compared with other components of the T. cryptomeioides heartwood essential oil. The rectified mortalities of D. pteronyssinus and D. farinae were 100% for alpha-cadinol at the dosage of 6.3 microg/cm2. The order of antimite activity of four dominant constituents was alpha-cadinol > T-muurolol > ferruginol > T-cadinol. Paired Student's t-tests showed that there were significant differences between the rectified mortality of alpha-cadinol, T-muurolol, ferruginol and that of T-cadinol at the dosage of 6.3 microg/cm2 after 48 h.

Antinociceptive effect of a genomic herpes simplex virus-based vector expressing human proenkephalin in rat dorsal root ganglion

Endogenous opiate peptides acting pre- and post-synaptically in the dorsal horn of spinal cord inhibit transmission of nociceptive stimuli. We transfected neurons of the dorsal root ganglion in vivo by footpad inoculation with 30 microl (3 x 10(7) p.f.u.) of a replication-incompetent (ICP4-deleted) herpes simplex virus (HSV) vector with a cassette containing a portion of the human proenkephalin gene coding for 5 met- and 1 leu-enkephalin molecules under the control of the human cytomegalovirus immediate-early promoter (HCMV IEp) inserted in the HSV thymidine kinase (tk) locus. Vector-directed expression of enkephalin produced a significant antinociceptive effect measured by the formalin footpad test, that was most prominent in the delayed ("tonic") phase 20-70 min after the administration of formalin. The magnitude of the antinociceptive effect diminished over 4 weeks after transduction, but reinoculation of the vector reestablished the analgesic effect, without evidence for the development of tolerance. The antinociceptive effect was blocked completely by intrathecal naltrexone. These results suggest that gene therapy with an enkephalin-producing herpes-based vector may prove useful in the treatment of pain.

Video-assisted thoracoscopic sympathetic ramicotomy for hyperhidrosis--a way to reduce the complications

Endoscopic resectional surgery of sympathetic nerves is now the most acceptable method to treat palmar hyperhidrosis, though the resection of the sympathetic trunk and ganglia can result in the irreversible compensatory hyperhidrosis. The ideal way to treat the palmar hyperhidrosis, without the undesirable complication of the compensatory hyperhidrosis, is still pending. We adapt endoscopic cutting of the second and third sympathetic rami without injury to the sympathetic ganglia and trunk, and find that it is a good way to reduce the complications. Most importantly, it has a cure rate comparable with the conventional technique. The longer operation time and the higher operation risk are the drawbacks.

Video-assisted thoracoscopic management of mediastinal tumors

BACKGROUND

Many successful attempts at removing benign mediastinal tumors with the video-assisted thoracoscopic technique have been reported, but no formal report has been published regarding malignant mediastinal tumors treated with this technique. We report our preliminary experience with video-assisted thoracoscopic removal of mediastinal tumors, benign or malignant.

METHODS

Seven patients with mediastinal tumors treated with video-assisted thoracoscopic surgery were reviewed from January 1999 to April 2000. Their tumor pathologies included benign or malignant thymoma, neurilemmoma, and teratoma.

RESULTS

The mean operation time was 240 minutes. The mean blood loss was 173 mL. The mean insertion time of chest tubes was 3 days. The mean admission time was 6 days. No deaths occurred during the study. Morbidity occurred in 2 patients. No tumor recurrence has been seen during the mean follow-up of 7 months.

CONCLUSIONS

The short-term results support the feasibility of VATS in managing technically resectable mediastinal tumors. Yet the long-term prognosis for the malignant lesions is deferred and needs further study.

Normal development of the ipsilateral retinocollicular pathway and its disruption in double endothelial and neuronal nitric oxide synthase gene knockout mice

The development of the ipsilateral retinocollicular pathway involves activity-dependent refinement in which misdirected axons retract to form a precise retinotopic map in adults. This refinement is altered by disruption of genes for the endothelial and neuronal isoforms of nitric oxide synthase (e,nNOS), but the extent of disruption during early development is not known. Therefore, we studied the refinement of this pathway in normal C57/BL6 and e,nNOS double knockouts from P4 to P21 and in adults. Anterograde tracers were injected into one eye to localize the ipsilateral retinal projection (IRP) within the superior colliculus (SC). At P4, the IRP in normal mice was distributed throughout the dorsoventral extent of the superficial gray layer (SGL) across most of the rostrocaudal axis of SC. Between P4 and P9, the pathway retracted to the rostromedial SC, and retracted further between P15 and P21, such that multiple patches of label were seen only in the rostral 200-300 microm. Refinement also began to occur between P4 and P9 in e,nNOS double knockout mice, but labeling was more extensive in P9, P15, and P21 knockout animals. This delay in refinement was confirmed quantitatively at P15 where differences in the area occupied by the pathway were statistically significant. The refinement process is therefore in progress in both normal and e,nNOS knockout mice before eye opening but is significantly delayed in the double knockouts. The IRP in normal mice is also more exuberant at early ages, and the process of refinement more protracted than has been previously reported, suggesting that there is a prolonged critical period of synaptic plasticity.

p53 protein oxidation in cultured cells in response to pyrrolidine dithiocarbamate: a novel method for relating the amount of p53 oxidation in vivo to the regulation of p53-responsive genes

A novel method was developed to determine the oxidation status of proteins in cultured cells. Methoxy-polyethylene glycol-maleimide MW 2000 (MAL-PEG) was used to covalently tag p53 protein that was oxidized at cysteine residues in cultured cells. Treatment of MCF7 breast cancer cells with pyrrolidine dithiocarbamate (PDTC), a metal chelator, resulted in a minimum of 25% oxidation of p53. The oxidized p53 had an average of one cysteine residue oxidized per p53 protein molecule. The effect of PDTC treatment on downstream components of the p53 signal-transduction pathway was tested. PDTC treatment prevented actinomycin D-mediated up-regulation of two p53 effector gene products, murine double minute clone 2 oncoprotein and p21(WAF1/CIP1) (where WAF1 corresponds to wild-type p53-activated fragment 1 and CIP1 corresponds to cyclin-dependent kinase-interacting protein 1). Actinomycin D treatment led to accumulation of p53 protein in the nucleus. However, when cells were simultaneously treated with PDTC and actinomycin D, p53 accumulated in both the nucleus and the cytoplasm. The data indicate that an average of one cysteine residue per p53 protein molecule is highly sensitive to oxidation and that p53 can be efficiently oxidized by PDTC in cultured cells. PDTC-mediated oxidation of p53 correlates with altered p53 subcellular localization and reduced activation of p53 downstream effector genes. The novel method for detecting protein oxidation detailed in the present study may be used to determine the oxidation status of specific proteins in cells.

Endometrial brush biopsy (Tao brush). Histologic diagnosis of 200 cases with complementary cytology: an accurate sampling technique for the detection of endometrial abnormalities

We examined 200 cases of endometrial brush biopsy (EBB) using the Tao brush and correlated findings with histologic findings from subsequent dilatation and curettage (D&C) or hysterectomy specimens. Diagnosis by EBB relied mainly on histologic evaluation of H&E-stained tissue sections and was complemented by additional cytologic smear examination. EBB correctly detected the following cases: endometrioid adenocarcinoma, 3; complex hyperplasia with atypia, 1; simple hyperplasia without atypia (SH), 2; and benign endometrium, 177. In 3 cases the diagnosis of atrophic endometrium was made by EBB; corresponding D&C specimens were nondiagnostic. Five cases of SH were interpreted by EBB as proliferative endometrium, and 13 endometrial polyps were not identified by EBB. Nine samples were nondiagnostic. Sensitivity and specificity were 100% for detecting atypical hyperplasia and carcinoma. However, it was difficult for EBB to distinguish SH from disordered proliferative endometrium or to diagnose endometrial polyps. We found that diagnosis by EBB is reproducible; a second pathologist blinded to histologic follow-up correctly identified all adenocarcinoma/atypical hyperplasia cases. EBB is an accurate, safe, and easy procedure that is well tolerated by patients and should be considered in the initial evaluation of high-risk outpatients.

Integrated control of the dengue vector Aedes aegypti in Liu-Chiu village, Ping-Tung County, Taiwan

Because of an inadequate supply of potable water, villagers of Small Liu-Chiu Isle, Ping-Tung County, Taiwan, store water in containers supporting a large population of Aedes aegypti. In 1989-96, integrated control measures against Ae. aegypti were implemented on the basis of community participation. These measures included release of mosquito larvivorous fish in the drinking water storage facilities, application of larvicides to the water storage facilities in vegetable gardens, removal of discarded and unused containers and tires, improvement of household water storage facilities, and increase of potable water supply. Before implementation of the integrated control measures in 1988, 74% of the water-containing vessels were water storage facilities, and 24% of those were infested by Ae. aegypti. In 1989, the Breteau index for the entire island, indicating the average distribution density for larval Ae. aegypti, was 53.9, as compared to an index of 1.2 in 1996. In 4 villages located at the southwest and middle of the island, Ae. aegypti nearly became extinct because of the enthusiastic participation of the community. Before the implementation of integrated control, Ae. aegypti was the dominant species in containers both inside and outside the household, but after the integrated control, Aedes albopictus became predominant outside.