Hepatitis B virus infection in patients with Wilson disease: A large retrospective study

BACKGROUND

Wilson disease (WD) is the most common genetic metabolic liver disease. Some studies have shown that comorbidities may have important effects on WD. Data on hepatitis B virus (HBV) infection in patients with WD are limited.

AIM

To investigate the prevalence and clinical impact of HBV infection in patients with WD.

METHODS

The clinical data of patients with WD were analyzed retrospectively, and the data of patients with concurrent WD and HBV infection were compared with those of patients with isolated WD.

RESULTS

Among a total of 915 WD patients recruited, the total prevalence of current and previous HBV infection was 2.1% [95% confidence interval (CI): 1.2%-3.0%] and 9.2% (95%CI: 7.3%-11.1%), respectively. The main finding of this study was the identification of 19 patients with concurrent WD and chronic hepatitis B (CHB) infection. The diagnosis of WD was missed in all but two patients with CHB infection. The mean delay in the diagnosis of WD in patients with concurrent WD and CHB infection was 32.5 mo, which was significantly longer than that in patients with isolated WD (10.5 mo). The rates of severe liver disease and mortality in patients with concurrent WD and CHB infection were significantly higher than those in patients with isolated WD (63.1% vs 19.3%, P = 0.000 and 36.8% vs 4.1%, P < 0.001, respectively). Binary logistic regression analysis revealed a significantly higher risk of severe liver disease at the diagnosis of WD in patients with current HBV infection [odds ratio (OR) = 7.748; 95%CI: 2.890-20.774; P = 0.000)] or previous HBV infection (OR = 5.525; 95%CI: 3.159-8.739; P = 0.000) than in patients with isolated WD.

CONCLUSION

The total prevalence of current HBV infection in patients with WD was 2.1%. The diagnosis of WD in CHB patients is usually missed. HBV infection is an independent risk factor for severe liver disease in WD patients. The diagnosis of WD should be ruled out in some patients with CHB infection.

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

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

Dual-channel compressed ultrafast photography for Z-pinch dynamic imaging

The compressed ultrafast photography (CUP) can capture non-repetitive time-evolving events at 7 × 10¹³ fps, which is anticipated to find a diverse range of applications in physics, biomedical imaging, and materials science. The feasibility of diagnosing ultrafast phenomenon of Z-pinch by using the CUP has been analyzed in this article. Specifically, a dual-channel CUP design has been adopted for acquiring high quality reconstructed images and the strategies of identical masks, uncorrelated masks, and complementary masks have been compared. Furthermore, the image of the first channel was rotated by 90° to balance the spatial resolution between the sweep direction and the non-sweep direction. Both five synthetic videos and two simulated Z-pinch videos were chosen as the ground truth to validate this approach. The average peak signal to noise ratio of the reconstruction results is 50.55 dB for the self-emission visible light video and 32.53 dB for the laser shadowgraph video with unrelated masks (rotated channel 1). The simulation results show that the time-space-evolving process of plasma distribution can be well retold, and the phenomenon of plasma instability can be accurately diagnosed by the dual-channel CUP with unrelated masks (rotated channel 1). This study may promote the practical applications of the CUP in the field of accelerator physics.

A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment

BACKGROUND

The arrival of the Delta variant of SARS-CoV-2 was associated with increased transmissibility and illness of greater severity. Reports of nosocomial outbreaks of Delta variant COVID-19 in acute care hospitals have been described but control measures varied widely.

AIM

Epidemiological investigation of a linked two-ward COVID-19 Delta variant outbreak was conducted to elucidate its source, risk factors, and control measures.

METHODS

Investigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS).

FINDINGS

This linked two-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting, suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection. Sudden onset of symptoms, within 72 h, was observed in 79% of all Ward 2 patients, and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point-source outbreak. RT-PCR assays showed low cycle threshold (C_T) values, indicating high viral load from environmental swabs including the vital signs cart. WGS results with ≤3 SNP differences between specimens were observed.

CONCLUSION

Outbreaks on both wards settled rapidly, within 3 weeks, using a `back-to-basics' approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, co-operation from HCWs, including testing and interviews, and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.

[Evaluation of the effectiveness of malaria control health education among overseas enterprise employees]

OBJECTIVE

To evaluate the effectiveness of health education on knowledge, attitude and practice (KAP) relating to malaria control among overseas enterprise employees.

METHODS

In September 2019, on-site malaria control health education was conducted among all Chinese employees of a China-funded mining enterprise in the Democratic Republic of Congo. The KAP questionnaire for malaria control was generated on the Questionstar website, and the participants were subjected to two questionnaire surveys prior to and 14 months after health education. After the questionnaires were recovered, all valid questionnaires were divided into 4 groups, including the baseline group (the questionnaires filled out by respondents who received health education and participated in two questionnaire surveys before health education), the loss-to-follow-up group (the questionnaires filled out by respondents who received health education but only participated in the questionnaire survey after health education), the retest group (the questionnaires filled out by respondents who received health education and participated in two questionnaire surveys after health education) and the new group (questionnaires filled out by respondents who did not receive health education and only participated in the questionnaire survey after health education) according to subjects' receiving health education and participation in two questionnaire surveys. The correct rate of malaria control knowledge, the proportion to good attitudes towards malaria control and the proportion of good practices towards malaria control were compared between the baseline group and the loss-to-follow-up group, between the baseline group and the retest group, and between the retest group and the new group.

RESULTS

A total of 110 and 142 valid questionnaires were recovered during the two surveys, and the recovery rates were 90.9% and 70.3%, respectively. There were 77, 77, 33, and 65 valid questionnaires recovered from the baseline group, the loss-to-follow-up group, the retest group, and the new group, respectively. There were no significant differences in respondents' gender, age and educational levels between the baseline group and the loss-to-follow-up group (all P values > 0.05), and there were no significant differences between the two groups in terms of the mean score of malaria control knowledge (Z = 2.011, P > 0.05), the mean score of attitudes towards malaria control (t = -0.787, P > 0.05) and the mean score of practices towards malaria control (t = -0.787, P > 0.05). There were significant differences between the retest group and the baseline group in terms of the mean score of malaria control knowledge (10.83 vs. 9.79; Z = -4.017, P < 0.05), the mean score of attitudes towards malaria control (29.48 vs. 28.61; Z = -1.981, P < 0.05) and the mean score of practices towards malaria control (6.43 vs. 5.91; Z = -2.499, P < 0.05). There were no significant differences between the retest group and the new group in terms of gender, age or education levels (all P values > 0.05), and a higher mean score of malaria control knowledge was found in the retest group than in the new group (10.83 vs. 9.81; Z = -2.962, P < 0.05), while no significant differences were seen in the mean score of attitudes towards malaria control (29.48 vs. 30.17; Z = -1.158, P > 0.05) and the mean score of practices towards malaria control (6.43 vs. 6.37; Z = -0.048, P > 0.05) between the two groups.

CONCLUSIONS

Malaria control health education may significantly improve the understanding of malaria control knowledge, positive attitudes towards malaria control and the compliance of practices towards malaria control among overseas enterprise employees.

[Efficacy of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy with Roux-en-Y reconstruction for early upper gastric cancer]

Objective: To compare clinical efficacy between laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) in patients with early upper gastric cancer, and to provide a reference for the selection of surgical methods in early upper gastric cancer. Methods: A retrospective cohort study method was carried out. Clinical data of 80 patients with early upper gastric cancer who underwent LPG-DTR or LTG-RY by the same surgical team at the Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2021 were retrospectively analyzed. Patients were divided into the DTR group (32 cases) and R-Y group (48 cases) according to surgical procedures and digestive tract reconstruction methods. Surgical and pathological characteristics, postoperative complications (short-term complications within 30 days after surgery and long-term complications after postoperative 30 days), survival time and nutritinal status were compared between the two groups. For nutritional status, reduction rate was used to represent the changes in total protein, albumin, total cholesterol, body mass, hemoglobin and vitamin B12 levels at postoperative 1-year and 2-year. Non-normally distributed continuous data were presented as median (interquartile range), and the Mann-Whitney U test was used for comparison between groups. The χ(2) test or Fisher's exact test was used for comparison of data between groups. The Mann-Whitney U test was used to compare the ranked data between groups. The survival rate was calculated by Kaplan-Meier method categorical, and compared by using the log-rank test. Results: There were no statistically significant differences in baseline data betweeen the two groups, except that patients in the R-Y group were oldere and had larger tumor. Patients of both groups successfully completed the operation without conversion to laparotomy, combined organ resection, or perioperative death. There were no significant differences in the distance from proximal resection margin to superior margin of tumor, postoperative hospital stay, time to flatus and food-taking, hospitalization cost, short- and long-term complications between the two groups (all P>0.05). Compared with the R-Y group, the DTR group had shorter distal margins [(3.2±0.5) cm vs. (11.7±2.0) cm, t=-23.033, P<0.001], longer surgery time [232.5 (63.7) minutes vs. 185.0 (63.0) minutes, Z=-3.238, P=0.001], longer anastomosis time [62.5 (17.5) minutes vs. 40.0 (10.0) minutes, Z=-6.321, P<0.001], less intraoperative blood loss [(138.1±51.6) ml vs. (184.3±62.1) ml, t=-3.477, P=0.001], with significant differences (all P<0.05). The median follow-up of the whole group was 18 months, and the 2-year cancer-specific survival rate was 97.5%, with 100% in the DTR group and 95.8% in the R-Y group (P=0.373). Compared with R-Y group at postoperative 1 year, the reduction rate of weight, hemoglobin and vitamin B12 were lower in DTR group with significant differences (all P<0.05); at postoperative 2-year, the reduction rate of vitamin B12 was still lower with significant differences (P<0.001), but the reduction rates of total protein, albumin, total cholesterol, body weight and hemoglobin were similar between the two groups (all P>0.05). Conclusions: LPG-DTR is safe and feasible in the treatment of early upper gastric cancer. The short-term postoperative nutritional status and long-term vitamin B12 levels of patients undergoing LPG-DTR are superior to those undergoing LTG-RY.

[Time to initial diagnosis of imported malaria and its influencing factors in Jiangsu Province]

OBJECTIVE

To investigate the health-seeking behaviors of imported malaria cases after returning to China, and to investigate the factors affecting the time to initial diagnosis, so as to provide the scientific evidence for early identification of imported malaria cases and prevention of severe cases development and secondary transmission.

METHODS

The individual demographic features, and the disease onset and the time to initial diagnosis of imported malaria cases in Jiangsu Province in 2019 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China. The characteristics of health-seeking behaviors and epidemiological features of imported malaria cases were descriptively analyzed, and the factors affecting the time to initial diagnosis of imported malaria cases after returning to China were identified using multivariate logistic regression analysis.

RESULTS

A total of 244 imported malaria cases were reported in Jiangsu Province in 2019, and the time to initial diagnosis of the cases were 1-12 days, with mean time of (1.53 ± 1.65) days, with median time of one day. The highest number of malaria cases seeking healthcare services were found on the day of developing primary symptoms (76 cases, 31.1%), followed by on the second day (68 cases, 27.9%), on the third day (46 cases, 18.9%), and 54 cases (22.1%) received initial diagnosis 3 days following presence of primary symptoms, including 3 cases with initial diagnosis at more than one week. High proportions of imported malaria cases with a delay in the time to initial diagnosis were seen in migrant workers who returned to China in January (14 cases, 5.7%) and December (13 cases, 5.3%) and those aged between 41 and 50 years (32 cases, 13.1%). Multivariate logistic regression analysis showed relative short time to initial diagnosis among imported malaria cases returning to China on March [odds ratio (OR) = 0.16, P = 0.03, 95% confidence interval (CI): (0.03, 0.85)] and those with a history of overseas malaria parasite infections [OR = 0.36, P = 0.001, 95% CI: (0.19, 0.67)].

CONCLUSIONS

Timely health-seeking behaviors should be improved among imported malaria cases in Jiangsu Province, patients with a history of overseas malaria infections require faster health-seeking activities.

[Epidemiological characteristics of imported Plasmodium ovale malaria in Jiangsu Province from 2012 to 2020]

OBJECTIVE

To analyze the epidemiological characteristics of imported cases with Plasmodium ovale infections in Jiangsu Province from 2012 to 2020, so as to provide insights into the development of the imported malaria control strategy in the province.

METHODS

All data pertaining to cases with definitive diagnosis of P. ovale malaria in Jiangsu Province from 2012 to 2020 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China, including the date of going abroad and returning to China, time of malaria infections overseas, date of malaria onset, initial diagnosis and definitive diagnosis. All data pertaining to epidemic status were descriptively analyzed.

RESULTS

A total of 347 cases of P. ovale malaria were reported in Jiangsu Province from 2012 to 2020, with the highest number seen in 2015 (71 cases). All cases were laboratory-confirmed overseas imported malaria cases, accounting for 14.32% of all reported malaria cases in Jiangsu Province during the period from 2012 to 2020. The 5 cities with the highest number of imported P. ovale malaria cases included Lianyungang City (53 cases, 15.27%), Nantong City (44 cases, 12.68%), Huai'an (44 cases, 12.68%), Taizhou City (44 cases, 12.68%) and Yangzhou City (36 cases, 10.37%). The highest number of imported P. ovale malaria cases was reported in October (39 cases, 11.24%), and the lowest number was seen in December (21 cases, 6.05%). P. ovale infections mainly occurred in were Equatorial Guinea (97 cases, 37.95%), Angola (60 cases, 17.29%) and Nigeria (40 cases, 11.53%). The median duration between returning to China and malaria onset was 64 (144) days, and 7.49% (26/347) of all cases developed malaria one year after returning to China. The initial diagnosis of P. ovale malaria was mainly made at county-level medical institutions (117 cases, 33.72%), and the definitive diagnosis was mainly made at city-level medical institutions (122 cases, 35.16%). The correct rate of initial diagnosis of P. ovale malaria increased from 0 in 2012 to 78.26% in 2020, appearing a tendency towards a rise year by year (χ² = 50.90, P < 0.01).

CONCLUSIONS

Imported P. ovale malaria cases were reported in Jiangsu Province each year from 2012 to 2020, and P. ovale infections predominantly occurred in Africa. Initial and definitive diagnoses of P. ovale malaria were mainly made at city- and county-level medical institutions. Training on the detection ability of malaria parasites is recommended among grassroots microscopists to improve the diagnostic ability of P. ovale malaria, and consolidate the achievements of malaria elimination in Jiangsu Province.

[Research progress of ocular manifestations and treatments of human immunodeficiency virus and syphilis co-infection]

Acquired immune deficiency syndrome caused by human immunodeficiency virus (HIV) infection is a fatal disease involving multiple systems. Syphilis is a systemic chronic infection disease caused by treponema pallidum infection. In recent years, the incidence of the two infectious diseases in China has been on the rise. Both of them have the same high-risk population and similar transmission routes, and co-infection is increasing day by day. They can influence each other. Syphilis significantly increases the risk of HIV infection, and HIV is able to change the natural course of syphilis. HIV and syphilis co-infection leads to diverse ocular manifestations which are not typical or specific. This condition results in not only a high rate of missed diagnosis and misdiagnosis, but also a high rate of treatment failure and recurrence. There is a high correlation between ocular syphilis and neurosyphilis in HIV-positive patients. Many patients with HIV/syphilis co-infection visit eye clinics for the initial symptom. In order to provide reference for clinical diagnosis, treatment and research, this article reviews the recent advances on the studies of the co-infection of HIV and syphilis, including epidemiological characteristics, ocular manifestations and treatments. (Chin J Ophthalmol, 2021, 57: 865-870).

[Surveillance of Culex mosquitoes in Jiangsu Province from 2018 to 2019]

OBJECTIVE

To investigate the distribution and density of Culex mosquito populations and the resistance of Culex pipiens pallens to insecticides in Jiangsu Province in 2018 and 2019.

METHODS

During the period from June to October in 2018 and 2019, six counties (districts, cities) were sampled in southern, northern and central Jiangsu Province as surveillance sites. The density of Culex mosquitoes was measured overnight using the light trapping technique. In addition, Culex pipiens pallens mosquitoes were collected from Hai'an of Nantong City and Yandu District of Yancheng City, central Jiangsu Province, and the sensitivity of female first filial generations to dichlorodiphenyltrichloroethane (DDT), malation, proposur, beta cypermethrin and deltamethrin was tested using the standard WHO insecticide susceptibility test assay.

RESULTS

A total of 104 423 Culex mosquitoes were captured in six surveillance sites of Jiangsu Province in 2018 and 2019, and Culex quinquefasciatus (49.11%), Culex pipiens pallens (28.38%), and Culex tritaeniorhynchus (21.04%) were predominant species. The density of Culex mosquitoes started to increase since early June, peaked in July and tended to be low in late October. Culex pipiens pallens mosquitoes captured from Hai'an was susceptible to malation, while those from Yandu District were moderately resistant to malation. Culex pipiens pallens mosquitoes from both Yandu and Hai'an were moderately resistant to proposur, and were resistant to DDT, beta cypermethrin and deltamethrin.

CONCLUSIONS

Culex quinquefasciatus, Culex pipiens pallens and Culex tritaeniorhynchus are predominant Culex species in Jiangsu Province. Culex pipiens pallens is resistant to DT, beta cypermethrin and deltamethrin in central Jiangsu Province.

[Transcranial sonographic characteristics of Parkinson's disease with symptoms of restless legs syndrome]

Objective: To evaluate the transcranial sonographic characteristics in patients with Parkinson's disease (PD) with symptoms of restless legs syndrome (RLS). Methods: Patients with diagnosis of definite PD from the Second Affiliated Hospital of Soochow University and 3 other participating hospitals between September 2018 and December 2019 were consecutively enrolled. Concurrent RLS symptoms were determined using Non-motor Symptoms Questionnaire. Transcranial sonography (TCS) and clinical assessments were performed during the same time and the related variables were compared between the two groups using t-test, non-parametric test, Chi-square test and Spearman correlation analysis, respectively. Results: Among 349 patients with PD, the prevalence of RLS symptoms was 22.6%. Compared to patients without RLS symptoms, those with RLS had longer disease duration (43.0 (24.0, 91.0) months vs 37.0 (20.0, 60.0) months, P<0.05) and higher Hoehn-Yahr stage (2.5 (2.0, 3.0) vs 2.0 (1.5, 2.5), P<0.01).TCS revealed that patients with RLS symptoms were more likely to have abnormality in the raphe nucleus (21.50% vs 7.78%, χ²=15.9, P<0.001) and increased third ventricle width ((6.22±1.97) mm vs (5.16±1.90) mm, P<0.001). No significant differences were found regarding parameters of substantia nigra. Conclusions: Concurrent RLS symptoms are common in PD patients. Abnormal echogenicity of raphe nucleus and increased third ventricle width could be characteristics of TCS in PD patients with RLS symptoms.

[Strategies and studies of malaria vector control in Jiangsu Province]

Malaria was one of the major infectious diseases in Jiangsu Province, where Anopheles sinensis and An. anthropophagus are main vectors for malaria transmission. Following the concerted efforts for decades, the goal of malaria elimination was achieved in Jiangsu Province in 2019, and the vector control strategy has played a vital role during the progress towards malaria elimination in Jiangsu Province. Hereby, we review the historical distribution and ecological features of An. sinensis and An. anthropophagus and describe vector control strategies at different stages of malaria control in Jiangsu Province. In addition, the advances in the research of vector biology and control in Jiangsu Province are discussed, including vector identification, strain colonization, susceptibility to malaria parasites and insecticide resistance.

[Epidemic situation of malaria in Jiangsu Province in 2019]

OBJECTIVE

To analyze the epidemic situation of malaria in Jiangsu Province in 2019, so as to provide the scientific basis for the development of the strategy for the prevention of re-introduction of imported malaria.

METHODS

The malaria case report information, epidemiological case investigation information, epidemic foci investigation and management report in Jiangsu Province in 2019 were collected, and all epidemiological data were descriptively analyzed.

RESULTS

A total of 244 malaria cases were reported in Jiangsu Province in 2019, and all cases were laboratory-confirmed overseas imported cases, including 4 cases with vivax malaria, 206 cases with falciparum malaria, 12 cases with malariae malaria and 22 cases with ovale malaria. In 2019, there were 12 malaria cases progressing into severe cases in Jiangsu Province, with one death. Nanjing, Nantong, Lianyungang, Taizhou and Changzhou cities contributed the largest number of malaria cases in 2019, with the number of malaria cases accounting for 59.84% of total cases in Jiangsu Province. The infections occurred in Papua New Guinea (2 cases), Pakistan (1 case) and 27 African countries (241 cases), including Angola, the Democratic Republic of the Congo, Nigeria, Equatorial Guinea, Cote d'Ivoire and so on. There were 77 cases (31.55%) with a visit to doctor on the day of onset, and 146 cases (59.84%) within 1 to 3 days after onset. In addition, there were 149 cases (61.06%) with definitive diagnosis at the first visit and 77 cases (31.55%) diagnosed within 1 to 3 days after the visit, and the mean duration from the visit to definitive diagnosis was (0.80 ± 1.59) d, which significantly shortened as compared to that (1.34 d ± 2.59 d) in 2018 (U = 2.53, P < 0.05).

CONCLUSIONS

Intensifying the surveillance and management of imported malaria and improving the diagnostic capability of imported malaria and the treatment of severe malaria cases are required to consolidate the achievements of malaria elimination in Jiangsu Province.

Clinical characteristics of very late-onset neuromyelitis optica spectrum disorder

BACKGROUND

The typical age at onset of neuromyelitis optica spectrum disorder (NMOSD) is between 30 and 40 years. A growing awareness about the disease and advances in diagnostic techniques have led to an increase in the number of patients being diagnosed with very late-onset (VLO) NMOSD. This study compared the clinical characteristics, treatments, and prognoses between patients with VLO-NMOSD or late-onset (LO) NMOSD.

METHODS

Patients in our study were assigned to two groups based on age at onset of the disease: LO-NMOSD (50-70 years old at onset) and VLO-NMOSD (> 70 years old at onset). We compared clinical characteristics, magnetic resonance imaging of lesions, prognosis, and treatments between the two groups.

RESULTS

We collected data from 12 VLO-NMOSD patients with a median age at onset of 74.0 years (interquartile range, 72.6-75.9 years) and 104 LO-NMOSD patients with a median age at onset of 56.0 years (55.8-57.9 years). There were a high proportion of female patients in both the VLO-NMOSD group (9, 75.0%) and the LO-NMOSD group (91, 87.5%). Our study indicated that VLO-NMOSD patients had significantly higher expanded disability status scale (EDSS) scores (8.5 vs 4.0, p = 0.01), higher motor disability rates (41.7% vs 9.6%, p = 0.002), and higher mortality rates (25.0 vs 4.8%, p = 0.044) at last follow-up. However, patients with VLO-NMOSD had lower rates of immunosuppressant usage (50.0% vs 76.9%, p = 0.044). Age at onset was positively correlated with EDSS score at remission (r = 0.49, p < 0.001).

CONCLUSION

VLO-NMOSD was associated with higher EDSS score at remission, higher rates of mortality and motor disability, but lower rates of immunosuppressive treatment usage than LO-NMOSD. Future studies are needed to understand the effects of NMOSD on older patients, and to seek suitable treatment to improve their prognosis.

Development of an x-ray detector by polycrystalline diamond and its application in Z-pinch x-ray detection

Large-grain-sized polycrystalline diamond films are fabricated by electron assisted chemical vapor deposition. A pure SP3 carbon bond in the cubic lattice structure is confirmed by Raman spectrum analysis. The grain size is on the order of several hundreds of μm or larger. Interlaced-finger electrodes are imprinted onto a 6 × 6 mm² × 500 µm film to fabricate the x-ray detector. The width of every finger is 25 µm, and the distance between nearby fingers is 25 μm. Strong x ray irradiates when a pulsed current flows through a double-layer nested tungsten wire array in the Z-pinch. This diamond detector now works as one of the main x-ray detectors for the Z-pinch device. The diamond detector is calibrated using a plastic scintillator. The comparison between the signal measured by these two methods confirms that the large-grain-sized polycrystalline diamond is a good candidate for the detection of nanosecond pulsed x ray.

[Epidemic situation of malaria in Jiangsu Province in 2018]

OBJECTIVE

To analyze the epidemic situation of malaria in Jiangsu Province in 2018, so as to provide scientific evidence for formulating post-elimination malaria surveillance schemes and technical measures in Jiangsu Province.

METHODS

The malaria case report cards, epidemiological individual investigation forms of malaria cases and foci data were collected from Jiangsu Province in 2018, and the epidemic situation of malaria was descriptively analyzed.

RESULTS

A total of 243 malaria cases were reported in Jiangsu Province in 2018, which increased by 1.67% in relative to in 2017 (239 cases), and these cases included 171 cases with falciparum malaria, 14 cases with vivax malaria, 15 cases with quartan malaria, 42 cases with ovale malaria and a case with mixed infection of P. vivax and P. ovale. All cases were overseas imported, and no local secondary cases were found. The malaria cases were predominantly workers (76.54%). Nantong City (48 cases), Yangzhou City (33 cases) and Taizhou City (22 cases) were the most 3 cities with the largest number of malaria cases across Jiangsu Province. The malaria infections predominantly occurred in African areas (96.30%), and the other 9 cases had infections in Asia (8 cases) and Central America (1 case). There were 125 cases (51.44%) and 91 cases (37.45%) with definitive diagnosis at the day of admission and within 1 to 3 days post-admission, respectively. The percentages of definitive diagnosis at initial diagnosis were 48.27%, 88.76% and 97.30% at township-, county- and city-level medical institutions, respectively, and the percentage of definitive diagnosis at initial diagnosis was significantly lower in township-level medical institutions than in county- (χ² = 21.47, P < 0.01) and city-level medical institutions (χ² = 32.86, P < 0.01).

CONCLUSIONS

There are no local malaria cases in Jiangsu Province; however, the number of overseas imported malaria cases remains high in China. In the future, improving the post-elimination malaria surveillance system, enhancing the awareness of malaria prevention and control knowledge among high-risk populations, increasing the diagnostic capability of malaria in medical institutions, and improving the management of imported malaria cases should be performed to consolidate the achievements of malaria elimination.

[Diagnosis and treatment value of bedside pulmonary ultrasound for atelectasis in patients after cardiac surgery]

Objective: To investigate the value of bedside pulmonary ultrasound in the diagnosis and treatment of atelectasis in patients after cardiac surgery. Methods: A total of 45 patients developed respiratory failure within 1 week after cardiovascular surgery from April 2017 to April 2018 were enrolled in this study. Among them, 27 were male and 18 were female, mean age was (47±5) years. The postoperative pulmonary ultrasound and chest CT findings were collected, and the consistency, efficacy evaluation, timeliness and safety value of pulmonary ultrasound and chest CT diagnosis were compared. The consistency of the two diagnostic methods was checked based on the Kappa consistency test. Results: A total of 87 foci of atelectasis were diagnosed in 45 patients, including 29 foci of complete atelectasis and 58 foci of incomplete atelectasis. Thoracic CT examination confirmed 44 cases of atelectasis (positive rate 97.8%), and 42 cases (93.3%) were found with atelectasis with ultrasound test. The two methods were consistent in the diagnosis of atelectasis (Kappa value was 0.741, P<0.05). In the evaluation of the atelectasis, the results of the two examination methods were completely consistent, and the pulmonary ultrasound couldcheck the lung recruitment in real time. Ultrasound examination after lung recruitment showed that the total ventilation score of 42 patients decreased significantly when compared with that before treatment ((18.3±3.6) vs (26.6±3.8), t=10.229, P<0.05). There was no significant difference in the safety between the two examination methods. The time the bedside pulmonary ultrasound used was significantly shorter than that in the chest CT. Conclusions: The accuracy of bedside pulmonary ultrasound in assessing atelectasis after cardiovascular surgery is consistent with chest CT, it brings dynamic monitoring of lung status and assessment of lung recruitment by changes in lung ventilation scores. The inspection takes a short time and is worth promoting.

[Application of double skin island free forearm flap in the repair of large perforating defect of palate]

Objective:To explore the value of free forearm flap with double skin island in repairing large perforating defect of palate. Method:The free forearm flap with double skin island was used to repair 6 cases of large perforating palatal defect due to oral malignant tumor. Preoperative Allen test and ultrasound doppler examination were used to judge the forearm vessels. Result:All the free forearm flap with double skin island survived in 6 cases, followed up for 3 months to 24 months, the patients ate normally, swallowing without nasal regurgitation. The patients had mild to moderate nasal sounds, and the patients were satisfied with the effect of operation and the quality of life. Conclusion:The double skin island free forearm flap is a reliable method for repairing large perforating defect of palate, with satisfactory morphological function and good effect.

[Research on the surgery treatment and etiology of fungal endophthalmitis]

Objective: To evaluate the efficacy of vitrectomy and etiological diagnosis in the treatment of fungal endophthalmitis. Methods: A retrospective survey was done on the clinical manifestation, etiological diagnosis and treatment efficacy of 15 patients (15 eyes) who had been diagnosed with fungal endophthalmitis at the inpatient department of Peking Union Medical College Hospital during 2002-2015. A total of 15 eyes of 15 patients, 3 male and 12 female patients, were included in this study. The mean age of the patients was (45.8±15.3) years. Among the 15 eyes, 12 (12 patients) were diagnosed with endogenous fungal endophthalmitis and 3 (3 patients) were diagnosed with exogenous fungal endophthalmitis. Fourteen eyes have been misdiagnosed with uveitis, systematic or local application of glucocorticoid and/or immunosuppressor have been conducted on the patients which resulted in exacerbation. Baseline visual acuity: light perception in 2 eyes, hand movement for 12 eyes, and 1 eye of 0.1. Six eyes showed slight inflammatory reaction in anterior chamber, four eyes showed moderate inflammatory reaction in anterior chamber, while five eyes showed severe inflammatory reaction with hypopyon in anterior chamber. B-Scan ultrasound examination showed inflammatory vitreous opacity in all 15 eyes, combined proliferative vitreoretinopathy (PVR) were found in 11 eyes, retinal detachment were found in 10 eyes, which include 6 cases of tractional retinal detachment, 1 case of exudative retinal detachment, and 3 cases of retinal and choroid detachment. Forty eyes underwent vitrectomy, 1 eye underwent intravitreal injection. Nine eyes were processed with silicone oil tamponade, one eye was processed with C(3)F(8) tamponade. At the beginning of the operation, vitreous fluids were collected for preparing smears which were later used for fungus culture and drug susceptibility testing. Results: According to the smear results of vitreous fluid, fungal hyphae and spores were found in 10 eyes. The fungus culture indicated positive results in 12 eyes, including candida albicans in 6 eyes, fusarium, candida parapsilosis, paecilomyces lilacinus, asoergullus terreus, mulan candida and aspergillus in 1 eye respectively. Based on etiological diagnosis, 14 eyes received amphotericin B intraocular injection during operation, and 9 patients received fluconazole (venous transfusion or oral administration), 2 patients received voriconazole through venous transfusion or oral administration, one patient received itraconazole through oral administration. All 15 eyes received local application of amphotericin B eyedrop or fluconazole eyedrop. The intraocular inflammations in all 15 eyes were mitigated. The visual acuity improved in 6 eyes, remained unchanged in 4 eyes, and reduced in 5 eyes. Postoperative visual acuity achieved 0.1 to 0.15 in 2 eyes, 0.01 to 0.04 in 2 eyes, CF in 2 eyes, HM in 4 eyes, LP in 2 eyes, and NLP in 3 eyes. The retina of 5 eyes remained in position, the retina of 2 eyes reattached, the retina of 2 eyes failed to reattach. Recurrent retinal detachment happened in the other 6 eyes, 5 of which received reoperation. Eventually, the retina of 10 eyes reattached, and the retina of the 5 eyes failed to reattach. Conclusions: Vitrectomy is an effective method for treatment of fungal endophthalmitis. The positive rates of vitreous smear and fungus culture were really high. Application of sensitive anti-fungal drugs based on etiological diagnose can improve therapeutic level. (Chin J Ophthalmol, 2018, 54: 270-276).

[The ocular manifestations of human immunodeficiency virus and syphilis coinfection]

Objective: To investigate the ocular manifestations of human immunodeficiency virus (HIV) and syphilis coinfection. Methods: A retrospective analysis of the ocular manifestations was carried out in 27 patients (54 eyes) diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017. The research included 26 males and 1 female, aging from 24 to 76 years old, with a mean age of 40.40±12.94 years old. Ocular anterior segments were examined with slit-lamp microscope. Fundus examinations were conducted with papillary dilation, fundus photography. Results: At the first visit, there were 2 eyes without light perception, 4 eyes with light perception, 1 eye with hand movement, 1 eye with finger counting, 2 eyes with 0.01-0.09 eyesight, 8 eyes with 0.1-0.2 eyesight, 12 eyes with 0.25-0.4 eyesight, 15 eyes with 0.5-0.9 eyesight, 9 eyes with 1.0-1.5 eyesight. Among the 27 patients (54 eyes) coinfected with HIV and syphilis, keratic precipitates were identified in 20 eyes, aqueous flare positive in 20 eyes, float positive in 15 eyes, and iris posterior synechias in 7 eyes. Nineteen eyes were diagnosed as syphilis uveitis, including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis, among which, vitreous inflammatory opacity was observed in all 19 eyes, disk atrophy in 2 eyes, optic edema in 1 eye, vitreous hemorrhage in 1 eye, retinal detachment in 2 eyes, retinal hemorrhage and white vein in 1 eye. In addition, 8 eyes were diagnosed as HIV retinopathy, all manifested as cotton-wool spot. Among the 8 eyes, 4 were diagnosed as cytomegalovirus retinitis, 3 showed retinal yellow-white lesions, and 1 was in late phase which showed retinal pigmentation. The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased. The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis. Six patients first visited the Department of Ophthalmology, and were then diagnosed as HIV and syphilis coinfection. Conclusions: The ocular manifestations of HIV and syphilis coinfection are diversified, which can be manifested as fundus necrotic lesions as well as anterior and posterior inflammatory. For HIV positive patients, syphilis serologic test should be routinely performed. The same, syphilis positive patients should be tested for HIV serum antibodies, in order to improve the diagnosis level of HIV/syphilis coinfection and give timely etiological treatment, which is of vital importance for saving visual acuity. (Chin J Ophthalmol, 2019, 55:267-272).

Identifying factors affecting the pharmacokinetics of voriconazole in patients with liver dysfunction: A population pharmacokinetic approach

Voriconazole is a broad-spectrum antifungal agent commonly used to treat invasive fungal infections. Voriconazole has significant intraindividual and interindividual pharmacokinetics variability in different patient populations. Pharmacokinetic data of voriconazole in patients with liver dysfunction were limited. The aims of this study were to evaluate the population pharmacokinetics of voriconazole in patients with liver dysfunction and to identify the factors that affect voriconazole pharmacokinetics. A total of 166 samples taken from 57 patients with liver dysfunction were included in the study. A one-compartment pharmacokinetic model with first-order absorption and elimination was used to describe the data. Voriconazole clearance (CL) was 0.58 L/h, the volume of distribution (V_d ) was 134 L, and oral bioavailability (F) was 80.8%. This study showed that platelet count was significantly associated with voriconazole pharmacokinetic parameters. CYP2C19 polymorphisms had no effect on voriconazole pharmacokinetic parameters. Voriconazole CL was significantly decreased in patients with liver dysfunction. This study provides useful pharmacokinetics information for patients with liver dysfunction while highlighting the value of therapeutic drug monitoring in adjusting doses.

Analysis of Genetic Polymorphism and Genetic Distance of 19 Autosomal STR Loci in Jiangsu Han Population

OBJECTIVES

To investigate the distribution of alleles in 19 autosomal short tandem repeat （STR） loci in Jiangsu Han population.

METHODS

Goldeneye^® 20A kit was used to detect 9 025 samples. Genetic analysis was performed on typing data of 19 autosomal STR loci, and genetic distance with other 17 populations was analyzed.

RESULTS

All the 19 autosomal STR loci were consistent with the Hardy-Weinberg equilibrium （P>0.05）, with the heterozygosity 0.616 1-0.916 3, probability of match 0.012 8-0.202 6, discrimination power 0.797 4-0.987 2, probability of paternity exclusion 0.310 8-0.828 8, and polymorphic information content 0.561 7-0.913 6. The cumulative discrimination power and cumulative probability of exclusion were 0.999 999 999 999 999 998 434 1 and 0.999 999 989, respectively. The Jiangsu Han population had close genetic distances with the Han population in Tianjin, Hunan and Jilin, and significant difference with Han population in Aletai region in Xinjiang （P<0.05）.

CONCLUSIONS

The STR allele polymorphism data and population genetic parameters of Jiangsu Han population can provide data support for the forensic application of these STR loci in Jiangsu Han population.

[Clinical application of folded free radial forearm flaps for reconstruction of full-tickness cheek defects after resection of buccal carcinoma]

Objective:To investigate the therapeutic effect of folded free radial forearm flaps (RFF) for reconstruction of full-tickness cheek defects after the resection of buccal carcinoma.Method:Seventeen cases of buccal carcinoma received radical neck dissection with cheekectomy and mandibulectomy, and the folded RFF to reconstruct full-tickness cheek defects simultaneously. Preoperative Allen test, ultrasonic doppler blood flow meter examination or computed tomography angiography confirmed good vascular condition of the forearm. Result: RFF were obtained from all patients, and completely survived. During the follow-up period of 6-36 months, the lateral morphology of the cheek was restored well and the mouth opening is normal. Language and swallowing function recovered well, without salivation or cheek biting. There were no obvious complications in the donor site. One case（T₃N₁M₀）died of pulmonary metastatic carcinoma a year later. Conclusion:The success rate is high and the morphology and function recovered well of the folded RFF for reconstruction of full-tickness cheek defects, so it is a reliable method to reconstruct full-tickness cheek defects after the resection of buccal carcinoma.

[Current status of malaria rapid diagnostic testing strips application in primary-level healthcare providers in Jiangsu Province]

Objective: To investigate the current status of malaria rapid diagnostic test (RDT) strips application and malaria laboratory technicians' evaluation about them at primary healthcare provider level in Jiangsu Province. Methods: From November to December 2016, 878 medical institutions and 118 CDCs of city, county and township/community level in Jiangsu Province were selected as study samples using stratified random sampling method. Self-designed questionnaire was distributed to investigate the institution's malaria work task, RDT strips application and evaluation status in 2015. We also investigated the socio-demographic information and collected the RDT strips evaluation score from the malaria laboratory technicians selected from the institutions investigated (one technician from each institution). Rank sum test was performed to compare the RDT strips evaluation scores between medical institutions and CDCs, and among different medical institutions and CDCs. Results: In 2015, 405 cases of malaria were reported, 362 200 person-time of malaria blood testing task was conducted, and 100 000 RDT strips were procured and provided for healthcare providers in Jiangsu province for free. Of the 996 healthcare institutions investigated, 628 used RDT strips in the year 2015 and the median (P(25), P(75)) of RDT strips volume used in these institutions was 10 (2, 25). The volume of RDT strips used in CDCs (15 (5, 52)) was significantly higher than that in medical institutions (10 (2, 25), (Z=3.42, P=0.001)). The investigated CDCs gave higher score on RDT strips' testing time per operation (10 (8.5, 10)) than medical institutions (9(8, 10), (Z=-2.20, P=0.028)). The employers of 614 investigated malaria laboratory technicians used RDT strips in 2015. The median of the scores given by CDC malaria laboratory technicians for RDT strips in terms of testing time per operation, testing operation and results judgement difficulties were 10 (9, 10), 10 (9, 10) and 10 (9, 10), respectively, which were significantly higher than those from technicians of medical institutions (9 (8, 10), 9 (8, 10), 9 (8, 10), (Z values were -2.55, -2.97 and -2.96, respectively; P values were all less than 0.05)). Conclusion: RDT strips had been widely performed in health institutions in Jiangsu Province. The amount of RDT strips used in CDCs was significantly higher than that in medical institutions. Primary-level institutions and malaria laboratory technicians generally recognized RDT strips' advantage for application in terms of testing time and operational procedure. CDCs and malaria laboratory technicians from them gave higher regards on RDT strips in terms of testing time per operation, testing operation and results judgement difficulties compared with that of medical institutions.

[Investigation and analysis of health-related quality of life in myasthenia gravis patients with myasthenia gravis quality of life-15 Chinese version]

OBJECTIVE

To investigate the level and influencing factors of health-related quality of life in myasthenia gravis (MG) patients with myasthenia gravis quality of life-15 (MGQOL-15) Chinese version and to provide corresponding measures in one tertiary hospital of Sichuan Province.

METHODS

We collected the general data (gender, age, body mass index BMI, marital status, educational level and employee status), clinical data [Osserman type, myasthenia gravis composite (MGC), other immunopathies, disease duration, frequency of outpatient visits per month, ratio of disease cost to income each month and frequency of symptoms during the past month] and the MGQOL-15 Chinese version from 168 myasthenia gravis patients in one tertiary hospital of Sichuan Province.

RESULTS

The mean score of MGQOL-15 was 17.67±12.78. The score of the item "My occupational skills and job status have been negatively affected." was the highest, followed by "I have trouble using my eyes." and "I am frustrated by my MG." Single factor analysis showed that MG patients' QOL were different with different disease severity MGC (F=19.353, P<0.001), ratio of disease cost to income each month (F=5.831, P<0.001) and the frequency of symptoms during the past month (F=9.128,P<0.001). Multiple regression analysis showed that disease severity MGC (β=0.743,P<0.001), ration of disease cost to income each month (β=3.347,P<0.001) and the frequency of symptoms during the past month (β=2.216,P<0.003) were the main predictors of HRQOL in the MG patients.

CONCLUSION

Our study showed that the MGQOL-15 is helpful for clinicians to evaluate MG patients' QOL regularly, investigate the influencing factors and implement corresponding interventions the so as to improve the patients' quality of life. Disease severity MGC, ratio of disease cost to income each month and the frequency of symptoms during the past month were the main predictors of MG patients' QOL. Clinicians should pay more attention to MG patients' disease severity MGC and the frequency of symptoms during the past month.

Cryptococcosis manifesting as isolated biliary infection: Case report and brief review of literature

BACKGROUND

Biliary cryptococci infection is rare, which is frequently diagnosed by exploratory laparotomy, preoperative diagnosis is difficult.

CASE PRESENTATION

A 14-year-old girl presented with intermittent jaundice for 6 years. She had no pruritus, anorexia, nausea or vomiting, fever, abdominal pain, or clay stools. Laboratory tests showed obstructive jaundice, eosinophilia, and increased IgE levels. The patient was ultimately diagnosed as Cryptococcal infection by bone marrow culture. The patient responded to antifungal therapy.

CONCLUSION

Unnecessary surgical intervention was avoided by an early and accurate diagnosis. Cryptococcosis infection of bile duct should be highly suspected, when the children with obstructive jaundice have eosinophilia and increased IgE levels.

The Role of IL-27 and its Receptor in the Pathogenesis of HIV/AIDS and Anti-viral Immune Response

BACKGROUND

Cytokines have been widely demonstrated to involve in the pathogenesis of AIDS and the mechanisms of antiretroviral therapy. Interleukin 27 (IL-27) is a new member of the IL-12 cytokine family and has been shown to interfere HIV-1 virus replication with controversial findings. This study is to investigate the dynamic changes in plasma IL-27 level and cell surface IL-27 receptor expression in HIV/AIDS patients who underwent HAART.

METHODS

Whole blood was collected from 34 HIV-positive/AIDS patients 0, 6, and 12 months after initiation of HAART and 27 healthy subjects. Plasma IL-27, IFN-γ, and IL-4 were measured by enzyme-linked immunosorbent assay, while peripheral blood CD3+CD4+ T cells count and the gp130 expressed CD3+CD4+cell were measured by flow cytometry.

RESULTS

The plasma IL-27 concentration, IFN-γ concentration, and percentage of positive gp130 CD4 cells were significantly decreased in previously treatment-naive HIV/AIDS patients compared to healthy controls, but gradually increased 6 and 12 months after initiation of HAART. Conversely, IL-4 levels were significantly increased in treatment-naive HIV/AIDS patients compared to healthy controls, but gradually decreased 6 and 12 months after HAART. The concentrations of plasma IL-27 were positively correlated with the percentage of gp130 positive CD4 cells (r=0.438, p=0.016). Both plasma IL-27 concentration and gp130 positive cell percentage were positively associated with peripheral blood CD3+CD4+ T cell count (P<0.05 or P<0.01), but negatively associated with plasma HIV viral load (P<0.05 or P<0.01).

CONCLUSION

IL-27 signaling (IL-27 and its receptor) may be involved in the pathogenesis of HIV infection and immune reconstitution in HIV/AIDS patients who underwent HAART. IL-27 may exert effects through regulating Th1 / Th2 ratio.

[Cases diagnosis of imported malaria in Jiangsu province, 2014-2016]

Objective: To understand the situation related to health seeking and diagnosis of imported malaria and to provide practical measures for malaria elimination in Jiangsu province. Methods: Data on imported malaria cases in Jiangsu province was retrieved in CISDCP from 2014 to 2016. Relevant information on health seeking behavior, diagnosis and treatment of the disease was gathered. Results: A total of 1 068 imported cases were reported in Jiangsu province from 2014 to 2016. Except for one malaria case that was caused by blood transfusion, the rest patients were all recognized as 'imported'. Majority of the cases were migrant laborers working in African countries. The accurate rates on the diagnosis of ovale, vivax and quartan malaria and mixed infection were relatively low, as 79.3% (107/135), 29.5% (18/61), 52.9% (18/34) and 0.0% (0/2) at the primary health care settings, respectively. Rate of seeking health care on the same day of onset was more in 2015 than in 2014 and 2016 (χ(2)=18.6, P=0.001). While only 65.4% (699/1 068) of the patients were diagnosed correctly at the primary health care settings. There appeared no statistical difference in the 3-year-study period (χ(2)=5.4, P=0.246). Capacity on 'correct diagnosis' seemed stronger at the CDC than at the hospital levels (χ(2)=13.2, P=0.000; χ(2)=5.4, P=0.020). Totally, 72.7% (32/44) of the severe falciparum malaria cases did not immediately seek for health care when the symptoms started. Conclusions: Migrant workers returning from the high endemic malaria areas seemed to have poor awareness in seeking health care services. Capability on correct diagnosis for malaria at the primary health care settings remained unsatisfactory and staff from these settings needs to receive adequate training.

[Genetic Polymorphism of 30 InDel Loci in Han Population from Jiangsu Province]

OBJECTIVES

To investigate the genetic information of 30 insertion/deletion （InDel） loci in Han population from Jiangsu Province, and to explore the application values of Investigator® DIPplex kit for guiding the forensic analysis in Han population from Jiangsu Province.

METHODS

The autosomal InDel loci of 305 unrelated healthy Han individuals from Jiangsu Province were genotyped and analysed by Investigator® DIPplex kit, and the allelic frequencies and forensic parameters of 30 InDel loci were statistically analysed.

RESULTS

The distribution of 30 InDel loci in Han population from Jiangsu Province conformed to Hardy-Weinberg equilibrium. The minor allele frequencies of 21 InDel loci were above 0.3. The polymorphism information content ranged from 0.089 to 0.375, while the discrimination power distributed from 0.093 to 0.500. The paternity exclusion in duo cases and trio cases were 0.047-0.250 and 0.046-0.219, respectively. The linkage disequilibrium analysis of 30 InDel loci showed that all loci were independent from each other. The combined discrimination power was 1-7.369×10⁻⁸, whereas the combined mean exclusion chance in duo cases was 0.998 933 978, in trio cases was 0.997 806 392. The F_st values were all less than 0.06 except HLD118 and other four loci, which showed small differences between groups.

CONCLUSIONS

The InDel loci of Investigator® DIPplex kit can be used as complementary genetic markers for the cases associated with forensic genetics.

[Loop-mediated isothermal amplification technique in the diagnosis of hepatitis B virus infection: a Meta-analysis]

Objective: To evaluate the diagnostic performance of Loop-mediated isothermal amplification (LAMP) in the diagnosis of Hepatitis B Virus (HBV) infection using Meta-analysis. Methods: Literatures about LAMP in the diagnosis of HBV throughPubMed database of the National Library of Medicine, the EMBASE database of the Dutch Medical Digest, the Cochrane Clinical Trials Database, China Science Periodical Database, CSPD and the China National Knowledge Infrastructure (CNKI) were searched from 2000 to 2016, and the Language limited to Chinese and English. English search terms include: LAMP, Loop-mediated isothermal amplification, HBV, hepatitis B virus; Chinese search terms include: loop-mediated isothermal amplification technology, HBV, hepatitis B virus. The keywords and free words are combined to search the literature, and the references mentioned in the retrieval literature are searched twice. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), Q index as well as area under summary receiver operating characteristic curve (SROC) were calculated with Stata 12.0 software. Results: A total of 12 literatures with 1 494 cases were included. The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 0.922 (95%CI: 0.905-0.937), 0.860 (95%CI: 0.818-0.896), 0.093 (95%CI: 0.048-0.182), and 15.400 (95%CI: 2.003-118.380), respectively. The DOR, area under SROC and Q index were 311.090 (95%CI: 95.841-1 009.800), 0.986 (95%CI: 0.974-0.998) and 0.949 (95%CI: 0.922-0.976), respectively. Deek's test indicates that no publication bias were found (P=0.140). Conclusion: LAMP is worth to be popularized in field tests and primary-level hospitals tests.

[Application of voice acoustic analysis of surgical effect in children with benign hyperplastic vocal cord disease]

Objective:To evaluate the use of voice acoustic analysis in children with hyperplasia diseases of vocal cords. Method:The software developed by Dr.Speech was used to do acoustic analysis for 93 children patients with vocal cords hyperplasia diseases before the operation, 15 and 30 days after the operation, and 76 normal subjects were also analyzed as the controls. Result:The Jitter, Shimmer and NNE parameters were higher, and HNR, SNR parameters were significant lower in vocal cords hyperplasia diseases group than in normal controls (P<0.01). The Jitter, Shimmer and NNE decreased, HNR, SNR increased 15 days and 30 days after the operation in vocal cords hyperplasia diseases group. Compared with preoperative group, there was a highly statistically significant at 15 and 30 days after the operation (P<0.01). All the data returned to normal levels 30 days after surgery. Conclusion:Voice acoustic analysis can evaluate the quality of children voice and the surgical effect objectively and quantitatively.

[Value of DCE-MRI and DWI in the differential diagnosis of inflammatory pseudotumor and lymphoma in the lacrimal gland]

Objective: To evaluate the value of dynamic contrast-enhanced MR (DCE-MRI) and diffusion weighted MR (DWI) in differential diagnosis of inflammatory pseudotumor and lymphoma in the lacrimal gland. Methods: In this retrospective study, a total of 24 cases of inflammatory pseudotumor and 22 cases of lymphoma in the lacrimal gland at Beijing Tongren Hospital confirmed by histological results were enrolled from January 2010 to January 2015.DCE-MRI and DWI were performed in these cases, and the type of time-signal intensity curve (time-intensity curve, TIC), the peak contrast index (CIpeak), maximum enhancement ratio (ERmax), washout ratio (WR) and ADC value were analyzed.Differences of these parameters between inflammatory pseudotumor and lymphoma in the lacrimal gland was evaluated by independent samples t test or Mann-Whitney U test.The receiver operating characteristic analysis was used to evaluate the utility of these parameters in discriminating the two diseases. Results: Type of TIC, CIpeak, WR, ERmax and ADC values were statistically different (all P<0.05) between the inflammatory pseudotumor and lymphoma in the lacrimal gland.ERmax, CIpeak and ADC values of inflammatory pseudotumor were greater than those of lymphoma, but the WR values of inflammatory pseudotumor was less than those of lymphoma.The area under the ROC of the CIpeak, WR, ERmax and ADC values was 0.68±0.08, 0.70±0.08, 0.70±0.08, 0.84±0.81 respectively.Using an ADC(b=0, 1000) value of 1.005×10(-3) mm(2)/s as the diagnostic threshold, the sensitivity, specificity and accuracy to differentiate benign lesions from malignant lesions were 84.2%, 65.0% and 75.0% respectively.The diagnostic ability of DWI combined with DCE-MRI was superior to that of DCE-MRI(P=0.000) or DWI alone(P=0.008) with overall sensitivity, specificity and accuracy of 86.3%, 87.5% and 86.9%. Conclusion: DCE-MRI and DWI may improve the diagnostic accuracy in differentiation of the inflammatory pseudotumors and lymphomas in the lacrimal gland, and play an important role in differentiation among them.

Terahertz generation from laser-driven ultrafast current propagation along a wire target

Generation of intense coherent THz radiation by obliquely incidenting an intense laser pulse on a wire target is studied using particle-in-cell simulation. The laser-accelerated fast electrons are confined and guided along the surface of the wire, which then acts like a current-carrying line antenna and under appropriate conditions can emit electromagnetic radiation in the THz regime. For a driving laser intensity ∼3×10^{18}W/cm^{2} and pulse duration ∼10 fs, a transient current above 10 KA is produced on the wire surface. The emission-cone angle of the resulting ∼0.15 mJ (∼58 GV/m peak electric field) THz radiation is ∼30^{∘}. The conversion efficiency of laser-to-THz energy is ∼0.75%. A simple analytical model that well reproduces the simulated result is presented.

The role of autophagy in THP-1 macrophages resistance to HIV- vpr-induced apoptosis

Macrophages are resistant to cell death and are one of HIV reservoirs. HIV viral protein Vpr has the potential to promote infection of and survival of macrophages, which could be a highly significant factor in the development and/or maintenance of macrophage viral reservoirs. However, the impact of vpr on macrophages resistance to apoptosis is yet to be comprehended. Autophagy is a cell survival mechanism under stress state. In this study, we investigated whether autophagy is involved in macrophages resistant to vpr-induced apoptosis. Using the THP1 macrophages, we studied the interconnection between macrophages resistance to apoptosis and autophagy. We found that vpr is able to trigger autophagy in transfected THP-1 macrophages confirmed by electron microscopy (EM) and western blot analysis, and inhibition of autophagy with 3MA increased vpr-induced apoptosis. The results indicate that autophagy may be responsible for maintenance of macrophage HIV reservoirs.

Structural and antigenic analysis and cloning of surface antigen protein 5 in Toxoplasma gondii

Toxoplasma gondii is identified as an obligate intracellular apicomplexan parasite that infects warm blooded animals and humans worldwide. SAG5 protein includes SAG5A, -5B, -5C, -5D, and -5E five subtypes. SAG5A, -5B, -5C, and -5D are expressed on the surface of Toxoplasma gondii. In this study, we used online T-Coffee tool to analyze SAG5 proteins sequence alignment. SMART software was used to predict secondary structures of SAG5A, -5B, -5C, and -5D. The 3D models of SAG5 proteins were constructed and analyzed with SWISS-MODEL server and VMD software. Results indicated that SAG5A, -5B, -5C, and -5D are highly homologous proteins. Furthermore, liner-B cell epitopes and Th-cell epitopes of the four proteins were predicted using DNAMAN software and Epitope Database online service. The bioinformatics analysis of SAG5A, -5B, -5C, and -5D proteins could provide valuable information on prevention and treatment of toxoplasmosis. In addition, the four genes were obtained by PCR and inserted into an eukaryotic expression vector pEGFP-C1 respectively. Identified by restriction enzyme digestion, the four recombinant plasmids were transfected into HEK 293-T cells and tested by RT-PCR. Results showed that the constructed plasmids were all transfected to HEK 293-T cells successfully.

Clinical value of detection of immune index and inflammatory reaction changes in patients with autoimmune disease

Previous studies have shown a close correlation between the generation of B cell autoantibodies and imbalances in T lymphocyte subpopulations and the occurrence of disease. In this study, we have analyzed the effects of abnormal expression of CD4+CD25+-regulatory T cells, T lymphocyte subpopulations, immunoglobulins, complement factors, inflammatory factors, and adhesion molecules in the peripheral blood on the occurrence and development of autoimmune disease. Eighty patients with autoimmune disease were randomly (equally) divided into active-stage and stable-stage disease groups (according to pre-defined criteria). Fifty healthy people were recruited to the control group. The above-mentioned indices were detected by flow cytometry, immunity transmission turbidity, and enzyme-linked immunosorbent assay. We observed an obvious decrease in the CD4+CD25+- regulatory T cell, CD4+ cell, CD4+/CD8+ cell, NK cell, C₃, and C₄ expression in all three groups; however, this decrease was statistically significant in the active-stage group (P < 0.05). Alternately, we observed a significant increase in the expression of CD8+ cells, immunoglobulin (Ig) A, IgG, IgM, tumor necrosis factor-α, interleukin (IL)-10, IL-17, interferon-g, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and E-selectin expression in the active-stage group (P < 0.05). Therefore, inflammatory reactions and immune dysfunction occurs during the active-stage of autoimmune disease, and detection of the immune indices and inflammatory and adhesion factors could help evaluate the immune stage in these patients, providing an experimental basis for the determination of disease progression and clinical treatment.

[Major depressive disorder in relation with coronary heart disease and stroke in Chinese adults aged 30-79 years]

OBJECTIVE

To investigate the associations of major depressive disorder with coronary heart disease (CHD) and stroke in Chinese adults aged 30-79 years.

METHODS

In 2004-2008, China Kadoorie Biobank was conducted in 10 geographically defined regions (5 urban and 5 rural) of China. A total number of 512 891 participants aged 30-79 years were recruited in the baseline survey. A laptop-based electronic questionnaire was administrated face-to-face by trained health workers, collecting the general demographic and socio-economic status, dietary and other lifestyle behaviours (e.g. smoking, alcohol drinking, physical activity), medical history and family history of common chronic diseases. Major depressive episodes (MDE) in the past 12 months were assessed with the World Health Organization composite international diagnostic interview-short form (CIDI-SF). The physical measurements included the heights and weights, which were used to calculate the body mass indexes (BMI).Chi squared and t test were used to compare the differences in participants characteristics according to their major depressive disorder. Logistic models were employed to estimate the odds ratios (OR) and 95% CI of their major depressive disorder with prevalent coronary heart disease and stroke.

RESULTS

Among the 512 891 participants, 3 281 (0.6%) showed an MDE in the preceding 12 months, 15 472 (3.0%) reported prevalent CHD, and 8 884 (1.7%) reported prevalent stroke. Major depressive disorder was significantly associated with an increased risk of CHD and risk of stroke. Age- and gender-adjusted ORs (95% CI) were 1.80 (1.53-2.12) for CHD and 2.53 (2.09-3.05) for stroke. The associations were significant after further adjustment for potential confounders, such as other socio-demographic status, smoking, alcohol drinking, physical activity, and BMI, prevalent hypertension, diabetes as well as family history of cardiovascular diseases (OR=1.83, 95% CI=1.54-2.18 for CHD; OR=2.19, 95% CI=1.79-2.69 for stroke). Moreover, gender significantly interacted with MDE on prevalent stroke (P for multiplicative interaction=0.013). The men with an MDE in the past 12 months had the highest risk of stroke in the joint analyses of gender and depression disorder (OR=5.02, 95% CI=3.70-6.82).

CONCLUSION

The findings from this large cross-sectional study suggest that the presence of MDE is a risk factor for both CHD and stroke in Chinese adults aged 30-79 years, but further prospective studies are warranted to validate the results.

[Application of CT angiography for detecting perforator vessels in the anterolateral thigh flap surgery]

Objective:To investigate the effectiveness of CT angiography for detecting perforator vessels in the anterolateral thigh flap surgery.Method:Eight patients with oral and maxillofacial soft tissue defects were repaired with the anterolateral thigh flap. Preoperative CT angiography was conducted to detect perforator vessels. The perforator vessel with large diameter, abundant blood flow, and long pedicle was selected to design the flap.Result:The position of perforator vessels during operation were completely consistent with those detected by CT angiography. The anterolateral thigh flap for 8 cases tally survived.One case had the vascular crisis，which was survived after surgical exploration. The flap ranged from 10 cm×5 cm to 6 cm×4 cm in size. Donor recipient site was not severe complications.Conclusion: CT angiography can be used to locate the perforator vessels preoperatively and accurately，which is beneficial for surgeons to design the flap and reduce surgical complications. The anterolateral thigh flap is an effective method of repairing oral and maxillofacial soft tissue defects.

Model of high-order harmonic generation from laser interaction with a plasma grating

Harmonic generation from linearly polarized high-intensity short-pulse laser normally impacting a solid plasma grating is investigated using analytical modeling and particle-in-cell simulation. It is found that when the radiation excited by the relativistic electron quiver motion in the laser fields suitably matches a harmonic of the grating periodicity, it will be significantly enhanced and peak with narrow angular spread in specific directions. The corresponding theory shows that the phenomenon can be attributed to an interference effect of the periodic grating on the excitation.

Correlation between IL-6 and invasiveness of ectoderm cells of embryo in early pregnancy

This study aimed to explore the correlation between Interleukin-6 (IL-6) and invasiveness of ectoderm cells of embryo in early pregnancy, in order to further discuss whether IL-6 can enhance invasiveness of ectoderm cells. The study lays the foundation for determination of pathogenesis of some gestation period-related diseases. Differences in mRNA and protein expression of trophoblastic cell line JEG-3 cells in IL-6, matrix metalloproteinase-2 (MMP-2) and MMP-9 were analyzed; the regulating effect of different concentrations of IL-6 on invasive ability of trophoblast cells was studied by Transwell assay; the effect of IL-6 on proliferation of ectodermal cell line JEG-3 of embryo was analyzed by methyl thiazolyl tetrazolium (MTT) assay. The invasive number of JEG-3 cells incubated by IL-6 (10 ng/ml) was higher than that of the control group, and the difference had statistical significance (p < 0.05). Results of using MMT assay to detect the effect of IL-6 on proliferation of trophoblastic cell line JEG-3 showed that JEG-3 cells before and after processing had no significant difference from the control group (p >0.05). Therefore, IL-6 can enhance invasiveness of ectoderm cells of embryo through activation of MMP-2.

Delivery of AIB1 siRNA by Ca2+/PEI/heparin composite nanoparticles effectively inhibits the growth of human breast cancer

Here, a novel carrier fabricated by the interaction of negatively charged heparin and positively charged PEI and Ca²⁺ was investigated to deliver AIB1 siRNA into breast cancer cells both in vitro and in vivo. Ca²⁺/PEI/heparin nanoparticles were prepared by simply mixing heparin, PEI and CaCl₂ aqueous solution. Heparin in the Ca²⁺/PEI/heparin nanoparticles (40.9% heparin, w/w) decreased the cytotoxicity of PEI. According to the MTT assay, Ca²⁺/PEI/heparin NPs are superior to commercial Lipofectamine 2000 considering the safety. The Ca²⁺/PEI/heparin NPs are able to deliver siAIB1 into breast cancer cells as effectively as Lipofectamine 2000 both in vitro and in vivo. The in vivo experiment also indicated that the NF-κB/BCL-2 signal pathway might be the downstream signal pathway of AIB1 in regulating breast cancer proliferation and progression.

First Report of Race Composition and Distribution of Sunflower Broomrape, Orobanche cumana, in China

Sunflower broomrape (Orobanche cumana Wallr.) is a holoparasitic plant that penetrates the vascular system of sunflower roots, absorbs plant nutrients and water, and thus causes stunting, reduced growth, and severe yield losses (3). To date, seven races of sunflower broomrape (O. cumana) have been identified by using international standard race differential hosts in Bulgaria, Serbia, Romania, Turkey, and Russia (4). However, the race types present in China are unknown. To identify the race composition of sunflower broomrape in China, race differential hosts of sunflower broomrape were received from Dr. Dragan Skoric (Serbian Academy of Sciences and Arts, Novi Sad, Serbia): Line AD66 has no resistant genes; Kruglik-41 contains resistant gene Or1; B-RO-02A has Or2; Record has Or3; LC1002B has Or4; LC1003B has Or5; LC-1093 has Or6, and Race-G-2 has Or7 (1). Eighteen sunflower broomrape samples were collected in August of 2011, 2012, and 2013 from different provinces/locations in China, including Xinjiang (Xinyuan, Shihezi, Tekesi, Beitun, Urumqi, and Yining), Inner Mongolia (Linhe, Xixiaozhao, Wuqianqi, Tuzuoqi, Keyouqianqi, and Aohanqi), Shanxi (Hunyuan, Shilou, Mizhi, and Dingbian), Jilin (Tongyu), and Hebei (Xuanhua). The differential hosts were each inoculated with the seeds of each broomrape isolate that was recovered, as described by Pancenko with minor modification (2). Briefly, two parts of field soil and one part of vermiculite were mixed together and used as potting mix. The mix was inoculated with broomrape seeds at 10 mg of seeds per 100 g of potting mix. The inoculated mix was placed in a 7-cm (diameter) × 11-cm (height) plastic pot to fill two-thirds of the pot volume. Three sunflower seeds were placed on the surface of the mix at an even distance from each other and covered with additional mix. The pots were kept in a greenhouse under a 16-h photoperiod at 10,000 lux of illumination intensity, temperature of 20-25°C, and 40% relative humidity. Forty days after incubation, sunflower seedlings were taken out from the pot and the roots washed with tap water. The number of tubercles was recorded on the root of each differential host. Race types were determined based on the reaction (tubercule formation on roots) of all the standard differential hosts to the test isolate. The results showed that races A, D, E, and G of O. cumana were present among the isolates. Race G was found in Wuqianqi, Xixiaozhao, and Linhe in the western part of Inner Mongolia. Race E was found only in Shihezi of Xinjiang. Race D was found in Aohanqi and Keyouqianqi (eastern part of Inner Mongolia); Xinyuan, Tekesi, Beitun, and Urumqi (northern part of Xinjiang); and Tongyu (northern part of Jilin). Race A was found in Mizhi, Shilou, and Hunyuan of Shanxi province and Xuanhua in Hebei province. Additionally, race A was also found in Tuzuoqi, the middle region of Inner Mongolia. Thus, races A, D, E, and G were the main race types of O. cumana in China. Race D was the predominant race type and had the widest distribution. Race G was the highest level race type in this study but was mainly limited to the western part of Inner Mongolia. This is the first report of race composition and distribution of sunflower broomrape (O. cumana) in China. References: (1) Y. Kaya et al. Helia 40:211, 2004. (2) A. N. Pancenko, Zbirnik VNIIMK. Page 107, 1973. (3) C. Parker. Page 17 in: Proc. 3rd Int. Workshop on Orobanche and Related Striga Research, 1994. (4) P. Shindrova et al. Helia 35:87, 2012.

Diagnostics for energetic particle studies on the HL-2A tokamak

About 13 kinds of diagnostics for energetic particle physics studied on the HuanLiuqi-2A (commonly referred to as HL-2A) tokamak are described in this paper. Their measurement ranges, resolutions, and arrangement are presented. Three under-construction diagnostics including imaging fast ion D-alpha, scintillator matrix (for hard X-ray detection), and bundle fission chamber are described in detail.

First Report of Fusarium oxysporum and F. solani Causing Fusarium Dry Rot of Carrot in China

Carrot (Daucus carota L.) is an economically important vegetable crop in China. In August 2008, a disease was observed on carrot in Inner Mongolia. The symptoms appeared as dry rot lesions on root surface, expressing light brown cankers with defined rounded or irregular shapes (1,3). The average disease incidence was up to 80% in Tuo Ke Tuo County. The disease has been a serious problem in these two counties since then, especially where consecutive carrot cropping was practiced. Carrot roots with typical dry rot symptoms were washed with tap water. Root tissues near the margin of necrotic lesions were excised, surface sterilized with 1% NaOCl for 3 min, and rinsed with sterile distilled water three times. The disinfected tissue was placed on potato dextrose agar (PDA) in a petri dish. Plates were incubated at 25 ± 1°C in the dark for 4 days. Fusarium single spore isolates were obtained from characteristic colonies (1). Three isolates (CF1, CF2, and CF3) were used for further study. The isolates were identified as Fusarium spp. on the basis of microscopic morphology on PDA. CF1 produced pink pigment, abundant falciform macroconidia of 14.7 to 38.2 × 4.5 to 5.7 μm with 2 to 3 septates, and elliptic microconidia of 7.5 to 15.1 × 3.3 to 5.4 μm with none or one septate. CF2 and CF3 produced light blue pigment, abundant falciform macroconidia of 16.4 to 34.4 × 4.0 to 6.1 μm with 2 to 3 septates, and elliptic microconidia of 6.7 to 10.7 × 3.0 to 4.9 μm with none or one septate. They were further identified and confirmed by PCR. The PCR involved amplifying the internal transcribed spacer (ITS) region of ribosomal DNA using genomic DNA as the template with universal primers ITS1 and ITS4 (2). The PCR products were sequenced. BLAST analysis of these sequences against the GenBank database determined the taxonomy of the isolates. The sequence of CF1 was 99% identical to F. oxysporum (Accession No. KC594035); sequences of CF2 and CF3 were 99% identical to F. solani (KC215123). To confirm the pathogenicity of the isolates, mature carrot roots (cv. Hong Ying 2) were inoculated with mycelial plugs (5 mm in diameter) cut from the margin of actively growing colonies on PDA plates. One mycelial plug was placed on each carrot root, with the mycelial side facing the root. PDA plugs were used for controls. Each treatment had five replicates. The inoculated roots were incubated in a humid chamber (90% RH) at 25°C. Four days after incubation, mycelia of the isolates developed and covered most of the surface of carrot roots, and brown rot lesions were observed on all inoculated roots, while the controls remained symptomless. This experiment was repeated. In another trial, carrot seeds (cv. Hong Ying 2) were sown in sterilized soil in pots (30 × 25 cm opening) with 15 seeds per pot. The soil was infested with either CF1, CF2, or CF3 by adding spore suspension to make the final concentration of 1 × 10⁴ CFU/g soil. Plants grown in non-infested soil served as controls. There were three replicates per treatment. All the treated pots were placed in a field. After 13 weeks, the same symptoms of dry rot were observed as previously described. No symptoms were observed on the control plants. The trial was repeated. Symptomatic tissues from the inoculated roots were sampled and the pathogen was re-isolated, and identified using PCR. To our knowledge, this is the first report of F. oxysporum and F. solani causing dry rot of carrot in China. References: (1) H. Abe et al. Annual Report of the Society of Plant Protection of North Japan, 48:106-108, 1997. (2) X. Lu. Plant Dis. 97:991, 2013. (3) A. F. Sherf and A. MacNab. Pages 138-139 in: Vegetable Diseases and Their Control. John Wiley & Sons, Inc., 1986.

Design of broadband omnidirectional antireflection coatings using ant colony algorithm

Optimization method which is based on the ant colony algorithm (ACA) is described to optimize antireflection (AR) coating system with broadband omnidirectional characteristics for silicon solar cells incorporated with the solar spectrum (AM1.5 radiation). It's the first time to use ACA method for optimizing the AR coating system. In this paper, for the wavelength range from 400 nm to 1100 nm, the optimized three-layer AR coating system could provide an average reflectance of 2.98% for incident angles from Raveθ+ to 80° and 6.56% for incident angles from 0° to 90°.