[Multiple pulmonary nodules with cavity formation]

A 64-year-old female patient was admitted to Beijing Chao-Yang Hospital on February 21, 2023 because of right-sided chest pain for more than 4 years and left-sided chest pain for more than 9 months. She had a past medical history of previous tuberculosis and rheumatoid arthritis. A chest CT in October 2018 revealed multiple pulmonary nodules. A CT-guided biopsy showed no tumors, and adenosine deaminase levels in the pleural effusion were elevated, suggesting a high likelihood of tuberculosis. As a result, anti-tuberculosis treatment was initiated in March 2019. In December 2019, she underwent a right lower lobe resection due to localized hydropneumothorax on the right side. Postoperative pathology unveiled granulomatous inflammation with necrosis. A chest CT in May 2020 showed a significant increase in nodules and cavities. In January 2023, a diagnosis of cryptococcal pneumonia was considered, and she was prescribed oral fluconazole. Finally, the diagnosis of pulmonary rheumatoid nodules was confirmed after a pathological consultation of the postoperative specimen. After one month of treatment with oral prednisone and mycophenolate mofetil, a follow-up chest CT showed improvement. It was recommended that she continue with her current treatment and undergo regular chest CT scans.

Development and validation of a prediction model for early screening of people at high risk for colorectal cancer

BACKGROUND

Colorectal cancer (CRC) is a serious threat worldwide. Although early screening is suggested to be the most effective method to prevent and control CRC, the current situation of early screening for CRC is still not optimistic. In China, the incidence of CRC in the Yangtze River Delta region is increasing dramatically, but few studies have been conducted. Therefore, it is necessary to develop a simple and efficient early screening model for CRC.

AIM

To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.

METHODS

Data of 64448 participants obtained from Ningbo Hospital, China between 2014 and 2017 were retrospectively analyzed. The cohort comprised 64448 individuals, of which, 530 were excluded due to missing or incorrect data. Of 63918, 7607 (11.9%) individuals were considered to be high risk for CRC, and 56311 (88.1%) were not. The participants were randomly allocated to a training set (44743) or validation set (19175). The discriminatory ability, predictive accuracy, and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic (ROC) curves and calibration curves and by decision curve analysis. Finally, the model was validated internally using a bootstrap resampling technique.

RESULTS

Seven variables, including demographic, lifestyle, and family history information, were examined. Multifactorial logistic regression analysis revealed that age [odds ratio (OR): 1.03, 95% confidence interval (CI): 1.02-1.03, P < 0.001], body mass index (BMI) (OR: 1.07, 95%CI: 1.06-1.08, P < 0.001), waist circumference (WC) (OR: 1.03, 95%CI: 1.02-1.03 P < 0.001), lifestyle (OR: 0.45, 95%CI: 0.42-0.48, P < 0.001), and family history (OR: 4.28, 95%CI: 4.04-4.54, P < 0.001) were the most significant predictors of high-risk CRC. Healthy lifestyle was a protective factor, whereas family history was the most significant risk factor. The area under the curve was 0.734 (95%CI: 0.723-0.745) for the final validation set ROC curve and 0.735 (95%CI: 0.728-0.742) for the training set ROC curve. The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.

CONCLUSION

The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age, BMI, WC, lifestyle, and family history exhibited high accuracy.

A Comparative Study of Measuring Bladder Volume in Patients with Pelvic Tumor Receiving Radiotherapy Using a Portable Bladder Scanner Made in China and CT Analog Positioning Machine

PURPOSE/OBJECTIVE(S)

The purpose of this study was to investigate whether the bladder volume of patients with pelvic tumor treated with radiotherapy (RT) can be accurately measured using the Meike Palm Bladder Scanner PBSV3.2 manufactured in China and the accuracy of its measurement under different influencing factors.

MATERIALS/METHODS

One hundred and sixty-five patients with pelvic tumor radiotherapy who were positioned in our department from January 12, 2022, to July 7, 2022, were selected. All patients voided their bowels and urine one hour before positioning, had a gynecological examination, were instructed to drink 500-800 ml of water, urine volume was measured using PBSV3.2 when they felt the urge to urinate, and urine volume reached 150-350 ml given for positioning (20 minutes expected from making the film appliance to the end of positioning), and the data were measured and recorded using a cystometric device immediately after positioning. The CT bladder volume outlined by the treating physician is viewed in the planning system. The accuracy of PBSV3.2 was evaluated by comparing the bladder volume measured by the bladder scanner and CT. To investigate the accuracy of PBSV3.2 in different sex, ages, treatment purpose, and bladder volume.

RESULTS

There was a significant positive correlation with bladder volume on CT and PBSV (r = 0.874; p<0.001). The mean difference between CT measured values and PBSV was (-0.14±50.17) ml. The results of the different variables showed that the overall mean of PBSV and CT measurements were statistically different in the age ≥65 years, bladder volumes >400ml and ≤400ml groups (p = 0.028, 0.002, 0.001). There was no statistical significance between the remaining variables. The volume difference between PBSV measurement and CT was 12.87ml in male patients, which was larger than that in female patients 3.27ml. Pearson correlation analysis showed that the correlation coefficient was 0.473 for bladder volume greater than 400ml and 0.868 for bladder volume less than 400ml; the correlation coefficient of the other variables ranged from 0.802 to 0.893.

CONCLUSION

This is the first large-sample study to evaluate the accuracy of PBSV in a pelvic tumor RT population using the convenient bladder scanner PBSV3.2 made in China. PBSV provides an acceptable indicator for monitoring bladder volume in patients with pelvic RT. It is recommended to monitor bladder volume with PBSV when the planned bladder volume is 200-400ml. For male and patients ≥65 years old, at least two repeat measurements are required when using a bladder scanner and the volume should be corrected by using a modified feature to improve bladder volume consistency.

Optimizing the Imaging Scheme of Small-Dose Contrast Agent in 4D-CT Localization Enhancement Scan for Radiotherapy of Liver Cancer

PURPOSE/OBJECTIVE(S)

The primary liver cancer radiation therapy 4D-CT-enhanced (CE-4DCT) scan can accurately reflect the state of the liver as it moves with respiration, and enables clear visualization of the tumor, providing a precise range for target area outlining. However, the CE-4DCT scan localization time of primary liver cancer is long, and the fixed delay time of diagnostic CT cannot obtain high-quality 4DCT images. To this end, we designed a randomized controlled study to investigate the ideal localization scan delay time parameters for primary liver cancer CE-4DCT.

MATERIALS/METHODS

Patients with primary hepatocellular carcinoma who presented to our department for radiotherapy CT localization from January to December 2022 participated in this study. All subjects were randomly divided into two groups in a 1:1 ratio. CE-4DCT scans were performed using a high concentration of iodomepril (400 mg/ml) contrast agent with a contrast volume equal to the patient's body weight. The scanning parameters were set according to scheme A (flow rate 2.0 ml/s, delay time 30s) and B (2.0 ml/s, 35s) respectively. Before the CE-4D CT scan, CT plain scan was routinely performed, physicians measured the CT value (HU) of abdominal aorta, portal vein, left hepatic vein, middle hepatic vein, right hepatic vein, liver parenchyma and tumor lesion on CT40 time item and plain scan images respectively. The image quality was subjectively and qualitatively assessed. The image enhancement effect is divided into excellent, good, relatively poor and poor.

RESULTS

A total of 18 patients were included in this study. Patient characteristics were well-balanced in both groups. There were statistical differences between the two groups (A vs B) in the abdominal aorta (226.66 ± 45.59 vs. 176.66 ± 32.84, p = 0.017), left hepatic vein (142.77 ± 24.41 vs. 164.88 ± 19.02, p = 0.048); in the portal vein, middle hepatic vein, right hepatic vein, liver parenchyma, and tumor lesions CT values were not statistically different. The comparison of all flat-scan images between the two groups was statistically significant. The comparison of all flat-scan images in both groups was statistically significant. The subjective qualitative assessment of the developing effect was excellent in 44.4% (33.3% vs. 11.1%), good in 16.7% (5.6% vs. 11.1%), and poor in 38.9% (16.7% vs. 22.2%) in both groups. image quality was slightly higher in group A than in group B, but did not reach statistical significance (χ2 = 1.088, p = 0.698). In patients with primary hepatocellular carcinoma with portal vein carcinoma thrombosis 83.33% subjectively evaluated poor results.

CONCLUSION

Qualitatively acceptable enhanced images were obtained for primary hepatocellular carcinoma (CE-4DCT) localization scans with a delay time controlled at 30s when using the least amount of contrast agent and the same flow rate.

Prognostic value of nutritional status in patients with human immunodeficiency virus infection-related lymphoma

Objective

To investigate the predictive value of nutritional status on the prognosis of patients with human immunodeficiency virus (HIV) infection-related lymphoma.

Materials and methods

A total of 149 patients with HIV infection-related lymphoma who were admitted to our hospital from August 2012 to May 2022 were selected as research subjects. Based on the patient prognosis, they were divided into a poor prognosis group (n = 30) and a good prognosis group (n = 119). General data from patients in both groups were collected, and the nutritional status of the patients was evaluated using the Controlling Nutritional Status (CONUT) score. Factors affecting the prognosis of HIV infection-related lymphoma were analyzed using univariate and multivariate analyses, and a prediction model was developed based on the analyzed factors. The receiver operating characteristic (ROC) curve was used to analyze the prediction model of the CONUT score alone and included the CONUT score in the prognosis of patients with HIV infection-related lymphoma. The predictive value of the data was assessed, and a survival curve was drawn to compare the survival of patients with different nutritional statuses.

Results

There were significant differences in age, B symptoms, treatment conditions, International Prognostic Index (IPI), pathological stage, Eastern Collaborative Tumor Group physical status score (ECOG PS), CD4+ cell count, β2 microglobulin, and lactate dehydrogenase (LDH) between the poor prognosis group and the good prognosis group (p &lt; 0.05). The CONUT score of the poor prognosis group was higher than that of the good prognosis group, and the difference was statistically significant (p &lt; 0.05). A univariate analysis demonstrated that the age, B symptoms, treatment status, IPI, pathological stage, ECOG PS, CD4+ cell count, β2 microglobulin, LDH, and CONUT score were prognostic factors for patients with HIV infection-related lymphoma (p &lt; 0.05). The results of a multivariate regression analysis demonstrated that the age, B symptoms, treatment status, IPI, pathological stage, ECOG PS, and CONUT score were independent risk factors for the prognosis of patients with HIV infection-related lymphoma (p &lt; 0.05). The prediction model was constructed according to the multivariate Cox regression analysis results. The model formula was as follows: Logit(p) = −10.687 + 1.728 × age + 1.713 × B symptoms + 1.682 × treatment status + 1.810 × IPI + 1.643 × pathological stage + 1.584 × ECOG PS + 1.779 × CONUT score. The ROC curve was used to analyze the predictive value of the CONUT score alone and the predictive model including the CONUT score on the prognosis of patients with HIV infection-related lymphoma. The predictive value of the prognosis of patients with tumors was higher (p &lt; 0.05). According to the results of the ROC curve analysis, the patients were divided into a high CONUT group (CONUT &gt; 6.00 points, n = 31) and a low CONUT group (CONUT ≤ 6.00 points, n = 118) based on the Optimum threshold of the CONUT score. The survival curve showed that the survival rate of the high CONUT group was lower than that of the low CONUT group (p &lt; 0.05).

Conclusion

The poor prognosis of HIV infection-related lymphoma is related to nutritional status, which is an independent risk factor affecting the prognosis of patients and can be used as a practical indicator to predict the prognosis of patients.

[Efficacy of CT-guided percutaneous stylomastoid foramen puncture through the mandibular angle approach and radiofrequency ablation of facial nerve for the treatment of hemifacial spasm]

Objective: To investigate the efficacy of CT-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through stylomastoid foramen for the treatment of hemifacial spasm. Methods: A total of 82 patients with primary facial spasm who underwent CT-guided RFT in the Department of Pain Medicine of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and Department of Pain Medicine of the First Hospital of Jiaxing from January 2019 to June 2021 were retrospectively analyzed, including 27 males and 55 females, aged 24-85 (59±11) years. All patients were divided into three groups according to the different puncture approaches: anterior mastoid approach group (Group A, n=35), posterior mastoid approach group (Group P, n=25) and mandibular angle approach group (Group M, n=22). The puncture time, the minimum stimulating current inducing the twitch of facial muscles on the affected side, the temperature at the end of RFT and the duration of RFT at this temperature, the total treatment time, as well as the degree of facial paralysis and complications 1 day after operation were compared among the three groups. Results: The puncture time of the Group A, Group P and Group M was (31.0±4.9) min, (31.9±6.5) min and (35.3±5.9) min, respectively, and the difference was statistically significant (P=0.020). The puncture time of the Group M was longer than that of the Group A and P (both P<0.05). The minimum stimulation current inducing the twitch of the affected facial muscle in the three groups was (0.5±0.2) mA, (0.4±0.1) mA and (0.3±0.1) mA, respectively, with a statistically significant difference (P=0.000). The minimum stimulation current in the Group M was less than that in the Group A and P (both P<0.05). The temperature at the end of RFT of the three groups was (78.6±8.1) ℃, (76.6±8.3) ℃ and (67.0±8.4) ℃, respectively, and the difference was statistically significant (P<0.001). The temperature of the Group M was lower than that of the Group A and P (both P<0.05). There were no significant differences among the three groups in the duration of RFT at the final temperature, the total treatment time, and the degree of facial paralysis 1 day after operation (all P>0.05). No hematoma, infection, hearing impairment and other complications occurred in all patients. Conclusion: CT-guided percutaneous RFT through stylomastoid foramen is efficacious in the treatment of hemifacial spasm, and the mandibular angle approach provides better performance.

[The 497th case: fever, anterior hypopituitarism, lymphadenopathy]

A 57-year-old woman was admitted to hospital with fever. She still had fever treated with multiple antibiotics, and no definite evidence for infection was found. Hypothermia and hypotension developed, and magnetic resonance imaging (MRI) examination showed enlarged anterior pituitary and multiple small nodular lesions with mild enhancement on the left side. Hormone replacement and anti-infection treatment were administrated, but fever did not improve. Remarkable lymphadenopathy was found in left supraclavicular area. The pathology of lymph node biopsy indicated peripheral T-cell lymphoma (not otherwise specified, NOS). Positron emission tomography-computed tomography (PET-CT) revealed hypermetabolism in multiple lymph nodes, infiltration of the liver and spleen. The final diagnosis were peripheral T-cell lymphoma with involvement of liver and spleen (stage Ⅳ) and anterior hypopituitarism. After chemotherapy, fever alleviated and the function of anterior pituitary recovered gradually.

[Identification of rare variants in exons of NLRC4 gene in patients with type 1 diabetes and their impact on gene function]

Objective: To identify rare variants in exon and exon-intron boundary of containing NLR family CARD domain protein 4 (NLRC4) in type 1 diabetes (T1DM) patients, and to explore their effects on gene function. Methods: A total of 508 T1DM patients and 527 healthy controls in the Department of Metabolic Endocrinology, Second Xiangya Hospital of Central South University from August 2017 to September 2020 were selected. The case group included 264 males and 244 females, and the age [M (Q₁, Q₃)] was [27 (11, 43)] years. The control group included 290 males and 237 females, and their age［M（Q₁，Q₃）］was [47 (36, 60)] years old. Identification of rare variants in exons of NLRC4 gene in T1DM patients and healthy controls was performed and verified by next-generation sequencing and sanger sequencing. The NLRC4 gene wild-type and mutant plasmids were constructed and transfected into 293T cells. Western blot (WB) was used to detect the expression of NLRC4 protein and cleavage products of pro-cysteinyl aspartate specific proteinase(procaspase-1). Cycloheximide (CHX) was added to 293T cells transfected with wild-type or mutant NLRC4 plasmid to detect the degradation of NLRC4 protein. The localization of NLRC4 protein was detected by immunofluorescence, and the concentration of IL-1β in the cell supernatant was detected by enzyme-linked immunosorbent assay (ELISA). Results: The sequencing results showed that 4 patients and 2 healthy controls had a heterozygous variant c.208C>T in exon 3 of the NLRC4 gene. Two patient had a heterozygous variant c.1564T>C in exon 4, and 1 patients had c.1219G>C in exon 4. These three variants might be pathogenic variants in T1DM. In 293T cells transfected with NLRC4 wild-type and c.208C>T、c.1564T>Cc.1219G>C mutant plasmids, the expression level, degradation rate, localization of NLRC4 protein and the content of cleavage products of procaspase-1 did not change significantly. However, the concentration of IL-1β secreted by 293T cells transfected with c.1219G>C and c.208C>T plasmid [M(Q₁, Q₃)] was 15.25 (12.98, 17.52) and 15.44 (13.81, 17.07) ng/L, respectively, which was lower than 18.70 (16.59, 20.81) ng/L of 293T cells transfected wild-type plasmid (P=0.020, 0.010). Conclusions: NLRC4 gene rare variants c.208C>T, c.1564T>C and c.1219G>C may not change the protein expression, degradation and localization, but c.208C>T and c.1219G>C may inhibit the secretion of IL-1β. This result suggests that NLRC4 rare variants may have an impact on gene function.

[Whole transcriptome analysis and critical gene regulatory network analysis during Schistosoma japonicum infection and praziquantel treatment in mice]

OBJECTIVE

To investigate long non-coding RNA (lncRNA)-microRNA (miRNA)-messenger RNA (mRNA) interactions and identify the critical gene regulatory network during Schistosoma japonicum infections and praziquantel treatment using whole transcriptome sequencing.

METHODS

A total of 110 male C57BL/6 mice were randomly divided into the control group, the infection group and the treatment group. Mice in the infection treatment and the control group were infected with S. japonicum cercariae via the abdomen, and liver specimens were sampled from 10 mice 3, 6, 8 weeks post-infection. Praziquantel treatment was given to mice in the treatment group 8 weeks post-infection, and liver specimens were sampled from 10 mice 2, 4, 6, 8, 10 weeks post-treatment. Total RNA was isolated from mouse liver specimens, and the transcriptome library was constructed for highthroughput whole transcriptome sequencing. The significant differentially expressed genes were subjected to functional annotations, Gene Ontology (GO) terms enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Correlation analysis of liver specimens was performed using R Corrplot and Himsc functions, and the lncRNAmiRNA-mRNA interaction network analysis was performed using R MixOmics and Himsc functions.

RESULTS

There were 1 176 differentially expressed miRNAs, 5 270 differentially expressed mRNAs, and 2 682 differentially expressed lncRNAs between the infection group and the control group, 1 289 differentially expressed miRNAs, 7 differentially expressed mRNAs, and 69 differentially expressed lncRNAs between the treatment group and the infection group, and 1 210 differentially expressed miRNAs, 4 456 differentially expressed mRNAs, and 2 016 differentially expressed lncRNAs between the treatment group and the control group. Correlation analysis showed a higher correlation of gene expression between the treatment group and the control group. Principal component analysis showed obvious separate clustering between the infection group and the treatment group. The differentially expressed genes with significant relevance were significantly enriched in 24 GO terms, including arachidonic acid metabolic process, xenobiotic catabolic process, unsaturated fatty acid metabolic process, xenobiotic metabolic process, long-chain fatty acid metabolic process, and 8 KEGG metabolic pathways, including cholesterol metabolism, tyrosine metabolism, linoleic acid metabolism, retinol metabolism, and steroid hormone biometabolism.

CONCLUSIONS

There were 23 mRNAs including Cyp2b9 and 14 lncRNAs including Rmrpr in the core position of the gene regulatory network, which may play a critical role in S. japonicum infections and praziquantel treatment, and 9 miRNAs including miR-8105 may serve as potential molecular markers for diagnosis of S. japonicum infections.

[Prenatal pyrethroid pesticides exposure and neurodevelopment of 2-year-old children: a birth cohort study]

Objective: To investigate the influence and critical windows of prenatal exposure to pyrethroid pesticides (PYRs) on neurodevelopment of 2-year-old children. Methods: The subjects of this study were derived from the Xuanwei Birth Cohort. A total of 482 pregnant women who participated in the rural district of Xuanwei birth cohort from January 2016 to December 2018 were included. Maternal urinary concentrations of PYRs metabolites during 8-12 gestational weeks, 20-23 gestational weeks and 32-35 gestational weeks were measured with ultra high performance liquid chromatography system coupled with a tandem mass spectrometry detector. Child neurodevelopment was evaluated with the Bayley Scales of Infant and Toddler Development-Third Edition at 2 years of age. Multivariate linear regression models and binary logistic regression models were used to assess the association between PYRs exposure during pregnancy and children's neurodevelopment. Results: A total of 360 mother-child pairs had complete data on maternal urinary PYRs metabolites detection and children's neurodevelopment assessment. The detection rate of any one PYRs metabolites during the first, second and third trimester were 93.6% (337/360), 90.8% (327/360) and 94.2% (339/360), respectively. The neurodevelopmental scores of Cognitive, Language, Motor, Social-Emotional, and Adaptive Behavior of 2-year-old children were (102.3±18.9), (100.2±16.3), (102.0±20.3), (107.8±23.3) and (85.8±18.6) points, respectively. After controlling for confounding factors, 4-fluoro-3-phenoxybenzoic acid (4F3PBA, one of PYRs metabolites) exposure in the first trimester reduced Motor (β=-5.02, 95%CI: -9.08, -0.97) and Adaptive Behavior (β=-4.12, 95%CI:-7.92, -0.32) scores of 2-year-old children, and increased risk of developmental delay of adaptive behavior (OR=2.07, 95%CI:1.13-3.82). Conclusion: PYRs exposure during the first trimester of pregnancy may affect neurodevelopment of 2-year-old children, and the first trimester may be the critical window.

[Perifosine inhibits biofilm formation of Pseudomonas aeruginosa by interacting with PqsE protein]

To explore the biofilm inhibitory efficacy of perifosine against Pseudomonas aeruginosa (P. aeruginos) and its mechanisms. Twenty-fourwell plate was used to form biofilms at the bottom and crystal violet staining was used to determine the biofilm inhibitory effects of perifosine against P. aeruginosa, the wells without perifosine was set as control group. Glass tubes combined with crystal violet staining was used to detect the gas-liqud interface related bioiflm inhibitory effects of perifosine, the wells without perifosine was set as control group. Time-growth curved was used to detect the effects of perifosine on the bacteial planktonic cells growth of P. aeruginosa, the wells without perifosine was set as control group. The interaction model between perifosine and PqsE was assessed by molecular docking assay. The inhibitory effects of perifosine on the catalytic activity of PqsE was determined by detection the production of thiols, the wells without perifosine was set as control group. Binding affinity between perifosine and PqsE was detected by plasma surface resonance. The biofims at the bottom of the microplates and air-liquid interface were effectively inhibited by perifosine at the concentration of 4-8 μg/ml. There was no influence of perifosine on the cells growth of P. aeruginosa. The resuts of molecular docking assay indicates that perifosine could interacted with PqsE with the docking score of -10.67 kcal/mol. Perifosine could inhibit the catalytic activity of PqsE in a dose-dependent manner. The binding affinity between perifosine and PqsE was comfirmed by plasma surface resonance with KD of 6.65×10^-5mol/L. Perifosine could inhibited the biofilm formation of P. aeruginosa by interacting with PqsE.

[The predictive value of the CHA2DS2-VASc score for in-hospital outcomes in patients with acute myocardial infarction: China PEACE-retrospective acute myocardial infarction study]

Objectives: This study aimed to evaluate the predictive value of the CHA₂DS₂-VASc score for in-hospital outcomes of patients with acute myocardial infarction (AMI). Methods: Data of 23 728 patients from the China patient-centered Evaluative Assessment of cardiac Events (China PEACE)Retrospective Acute Myocardial Infarction Study were analyzed retrospectively. The patients were categorized into 3 groups according to the CHA₂DS₂-VASc scores: the low score group (score 1-3), the middle score group (score 4-6) and the high score group (score 7-9). The in-hospital outcomes included major adverse cardiovascular events (MACE), death, death or withdrawal from treatment, reinfarction, ischemic stroke,etc. The CHA₂DS₂-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on in-hospital outcomes. Receiver operating Characteristic (ROC) curves were constructed, and the area under the curve (AUC) was used to evaluate the predictive value of the CHA₂DS₂-VASc score for in-hospital mortality and death or withdrawal from treatment, respectively. Results: The patients had a median age of 66 (56,75) years, and 30.7% of them were females. Patients with higher CHA₂DS₂-VASc scores had a higher in-hospital mortality and more in-hospital complications (all P<0.001). After adjustment of baseline covariates, the subjects in the high score group were associated with high risks of in-hospital mortality (OR=6.13, 95%CI 4.77-7.87, P<0.001), death or treatment withdrawal (OR=6.43, 95%CI 5.16-8.00, P<0.001) and MACE (OR=4.94, 95%CI 4.06-6.01, P<0.001). The AUCs of the CHA₂DS₂-VASc score were comparable with those of the mini-global registry of acute coronary events(mini-GRACE)score in evaluation of in-hospital mortality (0.699 vs. 0.696, P=0.752) and the death or treatment withdrawal risk (0.708 vs. 0.713, P=0.489). Conclusions: The CHA₂DS₂-VASc score is an independent predictor of in-hospital outcomes for patients with AMI. Its predictive value was comparable with the mini-GRACE score, which could be used as a simple tool for early and rapid outcome evaluation for AMI patients.

[Prenatal diagnosis and clinical outcomes of 297 fetuses with conotruncal defects]

Objective: To analyze the prenatal diagnosis results and pregnancy outcomes of conotruncal defects (CTD) fetuses, and to explore the correlation between the CTD and chromosome diseases. Methods: A total of 297 cases of invasive prenatal diagnosis and chromosome analysis were collected at the Prenatal Diagnosis Center of Guangzhou Women and Children's Medical Center due to CTD from January 1st, 2011 to December 31th, 2019. According to ultrasonic diagnosis, CTD fetuses were divided into 6 subtypes: tetralogy of Fallot (109 cases), pulmonary atresia (30 cases), transposition of the great arteries (77 cases), double outlet right ventricle (53 cases), truncus arteriosus (14 cases) and interrupted aortic arch (14 cases). According to whether they were combined with intracardiac or extracardiac abnormalities, they were divided into simple group (134 cases), combined with other intracardiac abnormalities group (86 cases), combined with extracardiac abnormalities group (20 cases), combined with intracardiac and extracardiac abnormalities group (37 cases) and only combined with ultrasound soft marker group (20 cases), the last 4 groups were referred as non-simple types. The chromosome test results and pregnancy outcomes of each type and group were analyzed retrospectively. Results: Among the 297 CTD fetuses, the chromosome abnormality rate was 17.5% (52/297). There were 21 cases of abnormal chromosome number, 28 cases of pathogenetic copy number variantions and 3 cases of mosaics. All the 19 cases of micropathogenic fragments smaller than 5 Mb were detected by chromosomal microarray analysis (CMA). Among all the subtypes of CTD, the chromosomal abnormality rate of truncus arteriosus was the highest, at 7/14; while the rate of transposition of the great arteries was the lowest, at 5.2% (4/77). There were significant differences in the rate of chromosomal abnormalities between simple and non-simple types [10.4% (14/134) vs 23.3% (38/163); χ²=8.428, P=0.004]. In each group, the chromosomal abnormality rate was the highest in the combined with intracardiac and extracardiac abnormalities group, at 37.8% (14/37), and the lowest in the simple group, at 10.4% (14/134). There was no significant difference in the rate of chromosomal abnormalities in all subtypes of simple group (all P>0.05). Among 112 cases of live birth, 1 case was 22q11.2 microdeletion syndrome, 5 cases of postnatal clinical diagnosis and prenatal ultrasound diagnosis were not completely consistent, 5 cases died after birth. Conclusions: The incidence of chromosomal abnormalities is high in fetuses with CTD. CTD fetuses with concurrent extrapardiac malformations are more likely to incorporate chromosomal abnormalities. CMA technology could be used as a first-line genetic detection method for CTD. After excluding chromosomal abnormalities, most of the children with CTD have good prognosis.

[Correlation between neck pressure pain threshold and forward head posture in patients with temporomandibular joint disorders]

Objective: To investigate the association between neck muscles pressure pain thresholds (PPT) and forward head posture (FHP) in patients with temporomandibular disorders (TMD). Methods: A total of 145 TMD patients, including 23 males and 122 females with a median age of 28 years, were enrolled in the Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2019 to April 2020. Informations of FHP and neck muscles PPT were collected for all participants. FHP was characterized by the craniocervical angle (CVA) between C7, the tragus of the ear and the horizontal line. Each of the participants completed a questionaire of the neck disability index (NDI). The patients with CVA≤51 ° were asigned into FHP group, otherwise the patients with CVA>51° were asigned into non-FHP group. PPT were measured at the midpoint of the upper trapezius and 1 cm aside from C5-C6 articular pillars. Nonparametric test and Spearman correlation analysis were conducted for the data analysis. Results: There were 70 patients in the FHP group and 75 patients in the non-FHP group. The trapezius PPT of the FHP group [2.82(0.86) kg] was significantly higher than that of the non-FHP group [2.46(0.80) kg] (P<0.01). No significant differences in PPT and NDI were observed between the two groups (P>0.05). Low correlation was found between trapezius PPT and FHP negatively (r=-0.273, P<0.01) and no correlation was found between C5-C6 PPT and FHP (r=-0.124, P>0.05). PPT in trapezius and C5-C6 was negatively correlated with NDI in moderate (r=-0.301, P<0.01) and low (r=-0.206, P<0.05) levels. Conclusions: The trapezius PPT was correlated with FHP negatively. The more FHP, the more pain tolerant of trapezius muscles. There was no correlation between neck function and FHP directly. The higher threshold was followed by better neck function.

[High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma]

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

[Artificial intelligence based on images in ophthalmology]

The application of artificial intelligence (AI) in ophthalmology will greatly reduce the workload of ophthalmologists. Machine learning is an important branch of AI, and deep learning is the most important algorithm in machine learning. At present, AI is well applied in the ophthalmic field. This article summarizes the use of AI in ophthalmology and discusses its inadequacy and future to provide reference for clinical practice. (Chin J Ophthalmol, 2021, 57: 465-469).

[HIV-1 drug resistance and subtypes in newly reported HIV/AIDS patients before antiretroviral therapy in Taizhou city, 2016-2018]

Objective: To explore the HIV-1 drug resistance and subtypes in newly reported HIV/AIDS patients before antiretroviral therapy (ART) in Taizhou city. Methods: A cross-sectional study of HIV-1 drug resistance was conducted among newly reported HIV/AIDS patients before ART in Taizhou from January 2016 to December 2018. HIV-1 pol gene sequences were obtained by RT-PCR. The sequences were submitted to the Stanford University drug resistance database. The drug resistance mutation and the sensitivity of HIV-1 strains to antiretroviral drugs were determined according to WHO Guidelines on HIV drug resistance surveillance of 2014. Results: A total of 806 HIV-1 pol gene sequences were obtained successfully. The overall HIV-1 drug resistance rate was 2.9% (23/806), 1.9% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 0.6% for nucleoside reverse transcriptase inhibitors (NRTIs), and 0.0% for protease inhibitors (PIs), respectively. From 2016 to 2018, the HIV-1 drug resistance rate was 1.6%, 1.8%, and 4.8%, respectively. The resistance mutations of NNRTIs and NRTIs were mainly K103 N (0.7%) and M184I/V (0.5%). HIV-1 subtypes were mostly CRF01_AE (42.7%,344/806),CRF07_BC (28.9%,233/806) and CRF08_BC (11.2%,90/806).HIV-1 subtypes among homosexually transmitted infections were mostly CRF01_AE (53.3%, 136/255) and CRF07_BC (32.2%, 82/255), and HIV-1 subtypes among heterosexually transmitted infections were mainly CRF01_AE (37.7%, 203/539), CRF07_BC (27.5%, 148/539) and CRF08_BC (16.1%, 87/539). Conclusion: HIV-1 drug resistance rate among newly reported HIV/AIDS patients before ART remained low in Taizhou during 2016 to 2018, an increasing trend seemed to be notifiable and warrants continuous surveillance of HIV-1 drug resistance.

[Prevalence and correlates of plasma cytomegalovirus viremia among newly reported HIV/AIDS patients in Taizhou city, 2017-2018]

Objective: To study the prevalence and correlates of plasma cytomegalovirus (CMV) viremia among newly reported antiretroviral therapy (ART)-naive HIV/AIDS patients in Taizhou during 2017-2018. Methods: CMV DNA was measured in plasma specimens of newly reported ART-naive HIV/AIDS patients by quantitative PCR. Both univariable and multivariable logistic regression analyses were carried out to evaluate CMV viremia correlations among the individuals. Results: Of 612 HIV/AIDS patients, 480 (78.4%) were male, 125 (20.4%) were over 60 years old, 177 (28.9%) were infected via homosexual transmission, and 430 (70.3%) via heterosexual transmission. The prevalence of CMV viremia among HIV/AIDS patients was 13.4% (82/612). Multivariable logistic regression analysis showed that the risk of CMV viremia in CD₄⁺ lymphocyte cells counts (CD₄⁺) ≤200 cells/μl group was higher than CD₄ counts >500 cells/μl (OR=5.10, 95%CI:1.74-14.96, P=0.003); The median CMV DNA level (log₁₀) of 82 viremic patients was 1.57 (P₂₅,P₇₅:1.04,2.13); Viremic patients with CD₄ counts ≤200 cells/μl had the highest CMV viral load (P<0.01). Conclusions: Among ART-naive HIV/AIDS patients, the prevalence of CMV viremia was significantly associated with immunodeficiency status. Further research is needed to evaluate the association between CMV viremia and the course of HIV infection.

[Clinical application of self-made drainage tubes in different layers of soft tissue for negative-pressure wound therapy in 33 patients]

From January 2014 to June 2018, 28 patients with different types of deep soft tissue injury or infection were admitted to the Affiliated Jiangyin Hospital of Medical College of Southeast University; 5 patients were admitted to the Zhengzhou First People's Hospital. There were 24 males and 9 females, aged 18-89 (40±20) years. Disposable suction tubes with holes cut on side walls were used as self-made drainage tubes. The authors placed the self-made drainage tubes on different deep soft tissue layers and wound surfaces after debridement. The effective drainage sections of the wound surface drainage tubes were wrapped with silver ion antimicrobial functional active dressings. Bio-permeable membrane was used to close the operative area. The drainage tubes in the deep layer of wound and wound surface were connected in parallel by a tee and connected to wall-hanging medical negative-pressure suction device to conduct negative-pressure wound treatment at -20.0 to -10.6 kPa. The deep drainage tubes were usually removed or changed 4 or 5 days after surgery.The drainage tubes in the wound surface were synchronously replaced when removing or replacing he drainage tubes in the deep layer of wound. On 4 to 15 days after surgery, the deep drainage tubes were removed. On 8 to 25 days after surgery, the wound surface drainage tubes were removed. Then the treatment was changed to a conventional dressing change until the wounds were completely healed or the wound bed was ready for skin grafts or tissue flaps. The indwelling time of deep drainage tubes in this group of patients was (6.2±2.8) days, and the indwelling time of wound surface drainage tubes was (12.0±3.0) days. The wound healing time was (22±5) days, the hospital stay time was (29±7) days, and wound bacteria were reduced from 6 species and 11 strains before treatment to 3 species and 4 strains after treatment. No adverse events such as wound bleeding, irritative pain, and chronic sinus occurred during treatment. Twenty-three patients were followed up for 13 to 28 months, no treatment-related complications were observed.

Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials

Background

To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas.

Objective

This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas.

Methods

We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes.

Results

We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I²=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I²=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively.

Conclusions

The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.

Oral Glutamine May Have No Clinical Benefits to Prevent Radiation-Induced Oral Mucositis in Adult Patients With Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials

Objectives: The role of oral glutamine for the management of oral mucositis (OM) has not yet been confirmed. The objective of the present study is to further investigate whether oral glutamine is effective in preventing and treating OM among patients with head and neck cancer (HNC) receiving radiotherapy alone or concurrent with chemotherapy.

Methods: A systematic search was performed in PubMed, EMBASE, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) to capture all potential citations from the inception to June 2019. Then data extraction and assessment of risk of bias were carried out after selecting the eligible citations. RevMan 5.3 software was used to perform all statistical analyses.

Results: Six randomized controlled trials (RCTs) including 441 patients were included in the final analysis. The meta-analysis showed that oral glutamine couldn't significantly decrease the incidence of OM (risk ratio [RR] = 0.98, 95% confidence interval [CI] = 0.94−1.02) and alleviate the development of moderate or severe grade of OM (Moderate-to-severe OM: RR = 0.81, 95% CI = 0.59−1.12; Severe OM: RR = 0.45, 95% CI = 0.13−1.52). But oral glutamine may have the potential to reduce the opioid use (RR = 0.84, 95% CI = 0.71−0.99). The role of oral glutamine in delaying the onset of OM remains uncertain due to conflicting results between quantitative (mean difference [MD] = 4.11 days, 95% CI = 3.49−4.73) and qualitative results.

Conclusions: Oral glutamine may have no clinical benefits to prevent or reduce the incidence and severity of radiation-induced OM in patients with HNC receiving radiotherapy alone or concurrent with chemotherapy. It is also uncertain whether oral glutamine can delay the onset of OM. But it may have the potential to relieve the degree of oral pain. Nevertheless, we must cautiously interpret the results because the observed effect size for delay in mucositis start or reduction in opioid use is marginal. Moreover, further RCTs with more rigorous methodology and large-scale are required to enhance the quality of evidence.

Progressive Changes in the Retinal Structure of Patients with Parkinson's Disease

BACKGROUND

Many optical coherence tomography (OCT) studies have reported alterations in the retinal nerve fiber layer (RNFL) in Parkinson's disease (PD) and other neurodegenerative diseases. However, whether retinal alterations are a biomarker for PD is still controversial.

OBJECTIVE

To investigate potential correlations between PD and morphological changes in retina using OCT and to determine its usefulness as a biomarker of disease progression in PD.

METHODS

We performed a cross-sectional study on patients with PD (N = 37) and age-matched controls (N = 42), followed by a longitudinal study of the PD patients (N = 22) over approximately 2.5 years.

RESULTS

The average retinal nerve fiber layer (RNFL) thickness (p < 0.001), total macular thickness (p = 0.001), and macular volume (p = 0.001) were decreased in PD patients compared to controls and had further decreased at the follow-up visit (p < 0.05 for all). The average RNFL thickness and the total thickness of macular were negatively correlated with age in PD patients at baseline. Linear regression analysis revealed that age (p = 0.002, p = 0.003, respectively) and LEDD (p = 0.011, p = 0.013, respectively) were correlated to total thickness and volume of macular in 22 PD patients in the follow-up study. However, no correlation was found between RNFL and other parameters.

CONCLUSIONS

PD progression is associated with pronounced retinal structure changes, which can be quantified by OCT. Patterns of RNFL and macular damage detected by the noninvasive technology of OCT can be a useful biomarker for evaluating the progression of PD.

[A survey on the current status and related factors of influenza vaccination among health care workers in tertiary hospitals of Xining city during the influenza epidemic season from 2017 to 2018]

Objective: To evaluate the current status and related factors of influenza vaccination among health care workers (HCWs) in tertiary hospitals of Xining city after the implementation of the free influenza vaccination policy. Methods: In August 2018, the cluster sampling method was used to select four medical institutions in Xining that had previously conducted investigations and interventions. All HCWs(excluding logistic staff) in each medical institution were included in the study. A total of 3 260 valid respondents were included. Questionnaires were used to collect the demographic characteristics, influenza and influenza vaccination awareness, implementation of free policy in the influenza epidemic season from 2017 to 2018, influenza vaccination status, awareness of influenza vaccination schedule and free policy. The multivariate logistic regression model was used to analyze related factors of influenza vaccination. Results: The age of respondents was (31.41±5.00) years. The influenza vaccination rate was 6.80% (226/3 260) in 2017-2018 influenza epidemic season. After controlling for related factors, the awareness of the influenza vaccination schedule (OR=17.05, 95%CI: 5.86-49.59), vaccination frequency (OR=8.22, 95%CI: 2.98-22.61) and the free policy (OR=3.15, 95%CI: 1.49-6.67) had higher vaccination rate. Conclusion: The influenza vaccination rate of HCWs in tertiary hospitals of Xining city was low. Increasing the awareness of the vaccination schedule, frequency and free policy may promote the influenza vaccination rate of HCWs.

[Current situation and related policies on the implementation and promotion of influenza vaccination among health care workers]

Health care workers have higher risk of influenza infection because of their occupational exposure to infected patients. Infection of the health care workers may not only result in the increasing risk of the nosocomial infection and family transmission, but also disrupt the health services due to absence from work. Health care workers were recommended as a priority group of influenza vaccinationin more than 40 countries and regions in the world. In recent years, domestic surveys show that the influenza vaccine coverage among health care workers was low. This paper outlines the current status and related policies of influenza vaccination among health care workers in China and global. Additionally, we analyzed and discussed the proper immunization strategy of influenza vaccine for medical staff in China.

[Application of self-made vacuum sealing drainage device in postoperative fixation and drainage of abdominal pedicled flaps in 8 patients with deep burns of upper limbs]

From January 2013 to December 2017, 8 patients with deep burns of upper limbs were admitted to our hospital, including 6 males and 2 females, aged 23-48 years. The wound area of full-thickness burns to burns with tendon and bone injury was 4.5 cm×2.0 cm-20.0 cm×10.5 cm. After debridement, thin abdominal flaps with subdermal vascular network in the size of 5.0 cm×2.5 cm-22.0 cm×12.0 cm were applied to cover the wounds, and the donor sites were sutured directly by relaxation. The disposable suction tubes with holes cut on side walls were used as drainage tubes. The part of drainage tubes with holes were wrapped with nano-silver antimicrobial dressings and then placed at the lowest position of pedicle and donor site of abdominal flap and the space between the injured limb and the abdominal wall. The loose nano-silver antibacterial dressing was used to fill the webs of fingers and the gap between the injured limb and the abdominal wall. The transparent film dressing was used to close the surgical area and then connected with a low negative voltage electric suction device to continuously suck at a negative pressure of -15 to -10 kPa. The self-made vacuum sealing drainage device was replaced at intervals of 4 to 5 days until pedicle breakage was performed 2 to 3 weeks after operation. The pedicled abdominal flaps of 8 patients had no torsion or avulsion, no pedicle blood supply disorder, and no infection or skin erosion in the operation area, and all the flaps survived after pedicle breakage.

[BRAF gene mutations in ameloblastic fibromas]

OBJECTIVE

To investigate the BRAF gene mutations in ameloblastic fibroma (AF), and to further analyze the relationship between the BRAF mutation and clinical characteristics so as to provide new reference to the study of AF's molecular pathology.

METHODS

Sixteen cases diagnosed as AF at the Department of Oral Pathology, Peking University School of Stomatology between January 1990 and December 2017 were collected. Genomic DNA was extracted from formalin-fixed, paraffin embedded tissues using the QIAamp DNA Mini Kit (Qiagen, Germany) according to the manufacturer's instructions. Polymerase chain reaction (PCR) and direct sequencings were used to detect the BRAF gene mutations. The clinicopathological data, such as the age, location of the lesion, symptoms and treatments were retrospectively analyzed.

RESULTS

The sixteen cases of AF involved nine women and seven men aged 2-67 years. Three lesions occurred in the maxilla and thirteen in the mandible. The most common presenting symptom of AF was a painless slowly enlarging mass with swelling. Ten patients received conservative treatment and the other six patients received radical surgery. Three cases relapsed during the study period. BRAF gene mutation was found in sixteen of all the sixteen samples analyzed (100%). The BRAF mutation was a point mutation with a thymine-adenine transversion at nucleotide 1 799 of 15 exons, resulting in a change at residue 600 that substituted glutamine for valine. This mutation was the strongest activator of the downstream RAS/RAF/MEK/ERK-MAPK signaling pathway. This helped to bring about a gain-of-function mutation due to a V600E substitution. Many studies identified that BRAF regulated survival, apoptosis, and proliferation of cells by inducing MAPK pathways activation. For the existing cases, none of the age, sex, location, recurrence and treatments had a statistically significant correlation with BRAF mutation.

CONCLUSION

Our findings demonstrated high prevalence of BRAF V600E mutation in AF. The pathogenic role remains to be clarified．.

[Technical guidelines for seasonal influenza vaccination in China, 2018-2019]

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and its complications. Currently, China has licensed trivalent (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. In most parts of China, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients need to pay for it. To strengthen the technical guidance for prevention and control of influenza and the operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC), Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" , based on most recent existing scientific evidences. The main updates include: epidemiology and disease burden of influenza, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, and, IIV3 and IIV4 vaccines'major immune responses, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The recommendations include: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for any influenza vaccine product for persons who can accept ≥1 licensed, recommended, and appropriate products. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-60 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to pregnant during the influenza season. Children aged 6 months to 8 years old require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in previous influenza season, 1 dose is recommended. People ≥ 9 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. Influenza vaccination should continue to be available for those unable to be vaccinated before the end of October during the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for CDC members who are working on influenza control and prevention, PoVs members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and members of maternity and child care institutions at all levels.

[A clinical study of diaphragmatic dysfunction in subjects with mechanical ventilation in sepsis]

Objective: To investigate the prevalence of diaphragmatic dysfunction in mechanical ventilated subjects with sepsis and the relationship between diaphragmatic dysfunction and clinical outcomes. Methods: Newly intubated patients with sepsis diagnosed according to "Sepsis-3" were enrolled from January 2017 to October 2017 in Intensive Care Unit (ICU) of Sir Run Run Shaw Hospital. Diaphragm thickness was recorded ultrasonographically at end-inspiration and end-expiration when the patients' spontaneous breathing recovered. The diaphragmatic thickening fraction (DTF) was calculated as the percentage from the following formula: (Thickness at end-inspiration-Thickness at end-expiration) / Thickness at end-expiration. The subjects were stratified into a diaphragmatic dysfunction group and a non-diaphragmatic dysfunction group based on whether DTF was < 20%. Results: Fifty-three subjects were included, and the prevalence of diaphragmatic dysfunction was 41.5%(22/53). The diaphragm thickness at end-expiration of the 2 groups were similar(t=1.328, P>0.05). A significant difference of diaphragm thickness at end-inpiration was observed between the 2 groups[(2.2±0.4)mm vs. (2.8±0.8)mm, t=3.677, P<0.05]. Ventilation time after inclusion [(10±8)d vs. (6±5)d, t=2.340, P<0.05], mechanical ventilation durations [(15±8)d vs. (11±6)d, t=2.201, P<0.05] and ICU length of stay [(18±8)d vs. (14±7)d, t=2.039, P<0.05]were all significantly longer in the diaphragmatic dysfunction group than in the non-diaphragmatic dysfunction group. There was no significant difference in the mortality between these 2 groups(χ(2)=0.366, P>0.05). Conclusions: Diaphragmatic dysfunction was common in patients with sepsis treated by mechanical ventilation and was the consequence of contractile force damages. Subjects with such diaphragmatic dysfunction showed longer mechanical ventilation durations and ICU stays.

[Technical guidelines for seasonal influenza vaccination in China (2018-2019)]

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" . The main updates in this version include: epidemiology, disease burden, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, IIV3 and IIV4 immune response, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The influenza vaccine TWG provided the recommendations for influenza vaccination for the 2018-2019 influenza season based on existing scientific evidence. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2017-2018 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels.

[Influenza vaccination and its influencing factors among clinical staff of the hospitals in 2016-2017 season, Xining, Qinghai province, China]

Objective: To investigate the influenza vaccination and its influencing factors among the clinical staff in Xining, Qinghai province, in the 2016-2017 influenza season, and to explore the promoting strategies to encourage the target population for influenza vaccination. Methods: Four sample hospitals were randomly selected from the total 11 tertiary hospitals in Xining city. Clinical staff that worked in the four hospitals and agreed to participate were recruited for investigation via a self-administered questionnaire. Results: During the 2016-2017 influenza season, the coverage rate of influenza vaccines among the clinical staff was 5.14% (95%CI: 4.80%-5.49%). Multivariate logistic regression showed that knowing the priority of vaccination, the frequency of vaccination, effect of vaccination, and possessing higher professional qualifications were major influencing factors for influenza vaccination. The intention on recommendation of seasonal influenza vaccine was higher in vaccinated group than that in the unvaccinated group (χ(2)=99.57, P<0.001). Conclusion: The lower coverage rate was primarily associated with the lack of knowledge about influenza vaccine among the clinical staff of the hospital. Tailored information should be provided to the clinical staff through effective methods to improve vaccination and the recommendation of influenza vaccine.

[Spatial distribution characteristics of tuberculosis and its visualization in Qinghai province, 2014-2016]

Objective: To analyze the spatial distribution of tuberculosis (TB) and identify the clustering areas in Qinghai province from 2014 to 2016, and provide evidence for the prevention and control of TB. Methods: The data of pulmonary TB cases confirmed by clinical and laboratory diagnosis in Qinghai during this period were collected from National Disease Reporting Information System. The visualization of annual reported incidence, three-dimensional trend analysis and local Getis-Ord G(i)(*) spatial autocorrelation analysis of TB were performed by using software ArcGIS 10.2.2, and global Moran's I spatial autocorrelation analysis were analyzed by using software OpenGeoDa 1.2.0 to describe and analyze the spatial distribution characteristics and high incidence areas of TB in Qinghai from 2014 to 2016. Results: A total of 20 609 pulmonary TB cases were reported in Qinghai during this period. The reported incidences were 101.16/100 000, 123.26/100 000 and 128.70/100 000 respectively, an increasing trend with year was observed (trend χ(2)=187.21, P<0.001). The three-dimensional trend analysis showed that the TB incidence increased from northern area to southern area, and up-arch trend from the east to the west. Global Moran's I spatial autocorrelation analysis showed that annual reported TB incidence in different areas had moderate spatial clustering (Moran's I values were 0.631 3, 0.605 4, and 0.587 3, P<0.001). And local G(i)(*) analysis showed that there were some areas with high TB incidences, such as 10 counties of Yushu and Guoluo prefectures (Gande, Banma and Dari counties, etc., located in the southwest of Qinghai), and some areas with low TB incidences, such as Huangzhong county, Chengdong district and Chengbei district of Xining city and Dachaidan county of Haixi prefecture, and the reported TB incidences in the remaining areas were moderate. Conclusion: The annual reported TB incidence increased year by year in Qinghai from 2014 to 2016. The distribution of TB cases showed obvious spatial clustering, and Yushu and Guoluo prefectures were the key areas in TB prevention and control. In addition, the spatial clustering analysis could provide the important evidence for the development of TB prevention and control measures in Qinghai.

Serum sodium and chloride are inversely associated with dyskinesia in Parkinson's disease patients

OBJECTIVE

We aim to report and evaluate the associations between serum sodium and chloride and dyskinesia in patients with Parkinson's disease. One hundred and two patients with Parkinson's disease were enrolled in this study.

METHODS

Patients' serum electrolytes including sodium, calcium, potassium, magnesium, and chloride were measured. Other demographic information was collected, and Unified Parkinson's disease rating scale and Hoehn and Yahr stage scale were also performed.

RESULTS

Patients with dyskinesia tended to have longer duration of disease, higher daily levodopa-equivalent dose, and Hoehn-Yahr stage, with lower serum sodium than those without dyskinesia. Spearman correlation analyses showed that serum sodium inversely correlated with duration of disease (r = -.218, p = .028), and positively correlated with serum chloride levels (r = .565, p < .001). Univariate logistic regression analysis found that duration of disease, daily levodopa-equivalent dose, serum sodium, and serum chloride were associated with dyskinesia in Parkinson's disease patients (p < .05 for all). After adjusting for age, sex, age at onset of Parkinson's disease, medical history, and other covariates, serum sodium and chloride were still associated with dyskinesia, with corresponding Odd ratios 0.783 (95% confidence intervals, 0.642-0.955) and 0.796 (95% confidence intervals, 0.652-0.972), respectively.

CONCLUSION

Our findings indicated that serum sodium and chloride levels were inversely associated with dyskinesia in patients with Parkinson's disease. Further studies with large samples and range of serum sodium and chloride are needed.

[Myeloid-derived suppressor cells promoted autologous B cell proliferation in rheumatoid arthritis]

OBJECTIVE

To investigate the effect of myeloid-derived suppressor cells (MDSC) on pro-liferation of B lymphocytes in rheumatoid arthritis (RA) patients.

METHODS

The peripheral blood specimens were collected from 15 healthy adults and 38 RA patients who were divided into high disease activity group, medium activity group and low activity group according to their 28-joint disease activity score (DAS28). And the frequencies of MDSC were determined by flow cytometry. Then, B cells and MDSC were isolated by flow cytometry, respectively. B cells were labeled with carboxyfluorescein diacetate succinimidyl ester (CFSE) and then were co-cultured with MDSC in the presence of 3 mg/L anti-CD40 antibody and 10 mg/L CpG, for 3 days. Flow cytometry was performed to investigate the proliferation of B cells.

RESULTS

MDSC expanded markedly in high disease activity patients (7.13% ±2.17%) compared with medium (5.35%±1.36%) and low disease activity patients (4.72%±1.08%) or healthy controls (4.79%±1.02%) (P<0.05), and there were no statistical differences between healthy controls, medium and low disease activity RA (P>0.05). Moreover, the frequencies of MDSC were positively correlated with the DAS28 (P<0.05). After co-culture, MDSC significantly promoted B cell proliferation (P<0.01).

CONCLUSION

Our studies showed that MDSC expanded obviously in high disease activity RA patients, and their frequencies were positively correlated with the disease activities. Furthermore, MDSC could promote autologous B cell proliferation remarkably in vitro. These findings suggest that MDSC might be involved in RA pathogenesis through regulating B cell functions.

[Diagnostic values of BRAF(V600E) mutation analysis and Bethesda system for reporting thyroid cytopathology in thyroid nodules with TIRADS 4 and 5]

Objective: To evaluate the diagnostic efficacies of BRAF(V600E) testing and Bethesda system for reporting thyroid cytopathology (BSRTC) in thyroid nodules with thyroid imaging reporting and data system (TIRADS) category 4 and 5. Methods: A total of 187 thyroid nodules in 187 patients underwent the examinations of ultrasound-guided fine needle aspiration cytology (FNAC) and BRAF(V600E) mutation were analyzed retrospectively. Receive operating characteristic (ROC) curve was used to investigate the diagnostic values of both methods and the clinical application of BRAF(V600E) combined with BSRTC was evaluated. SPSS17.0 software was used to analyze the data. Results: Among 187 thyroid nodules, 123 were malignant nodules confirmed with histopathological examination and 64 benign nodules determined by FNAC, histopathological examination, or long-term follow-up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BRAF(V600E) test were better than those of BSRTC [69.1%, 98.4%, 98.8%, 62.4%(χ(2)=77.3, P=0.000) vs 62.6%, 93.8%, 95.1%, 56.6%(χ(2)=54.4, P=0.000)]. While the sensitivity, specificity, PPV and NPV of the combined test of BRAF(V600E) and BSRTC for diagnosis of malignant thyroid nodules were 87.8%, 92.2%, 95.6%, 79.7%(χ(2)=112.6, P=0.000), respectively. The area under the ROC curve for the combined test was higher than that for each of tests (0.900 vs 0.858 or 0.838). Conclusions: The combined test of BRAF(V600E) mutation and BSRTC has a higher diagnostic efficacy for malignant thyroid nodules compared with BRAF(V600E) mutation or BSRTC alone.

[Factors correlated with height gain after posterior spinal correction surgery in lenke 1 adolescent idiopathic scoliosis]

Objective: To investigate the correlated factors of height gain (ΔSH) after posterior spinal correction surgery in Lenke 1 adolescent idiopathic scoliosis (AIS), and to propose the predictive model of ΔSH. Methods: From 2013 to 2015, a total of 150 Lenke 1 AIS patients undergoing posterior spinal correction surgery were included in the study, with the age of (14.3±2.9) years. The Cobb angle of major curve, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured on both pre-op and post-op standing whole spine x-rays. The change in Cobb angle, TK and LL were calculated. The difference between pre-operation and post-operation was compared and the linear regression analysis was used for the predictive model of ΔSH. Results: The pre-op and post-op values were (41.6±3.0)cm and (43.9±2.7)cm for spinal height (SH)[ΔSH=(2.4±0.8)cm, P=0.000]; (50.5±10.4)° and (14.6±6.4)° for Cobb angle (P=0.000). The Pearson correlation analysis showed that ΔSH was significantly correlated with pre-op SH (P=0.000), pre-op Cobb angle (P=0.000), pre-op TK (P=0.000), post-op SH (P=0.020), post-op Cobb angle (P=0.000), change in Cobb angle (P=0.000) and change in TK (P=0.000). The linear regression model 1 revealed that ΔSH was linearly correlated with change in Cobb angle (P=0.000) as well as change in TK (P=0.000); the linear regression model 2 showed that the pre-op Cobb angle (P=0.000) and pre-op TK (P=0.020) could be used for the pre-op prediction of ΔSH. Conclusions: The positively correlated factors of ΔSH include pre-op and post-op Cobb angle, TK, change in Cobb angle and change in TK. High pre-op Cobb angle and TK indicates high height gain in Lenke 1 AIS patients.

[Prediction of occult carcinoma in contralateral nodules based on the ultrasonic features of unilateral papillary thyroid carcinoma]

Objective: To investigate the occurrence of occult carcinoma in contralateral lobes based on the ultrasonic features of unilateral papillary thyroid carcinoma. Methods: The study included 202 consecutives cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from June 2014 to December 2015. All patients received total thyroidectomies, and with postoperative pathological examination they were divided into two groups, one including 60 cases with positive occult cancer and another one consisting of 142 cases with negative occult cancer. Univariate and multivariate analyses were performed to analyze the sonographic features of unilateral papillary thyroid carcinoma relevant to the occurrence of occult carcinoma in the contralateral nodules. Results: Univariate analysis indicated occult carcinoma in the contralateral lobes was associated with Hashimoto's thyroiditis(χ(2)=3.955, P=0.047), unclear border (χ(2)=4.375, P=0.036)and multifocality in the ipsilateral(χ(2)=7.375, P=0.007), but not with tumors maximum size, location, A/T, shape, internal structure, internal echo, acoustic halo, calcification, capsular invasion and blood flow signal in the lobe with carcinoma on another side. Multivariate analysis showed unclear border (OR=2.727, P=0.010) and multifocality in the ipsilateral(OR=2.807, P=0.005)of carcinoma were independent predictive factor for contralateral occult PTC. Conclusions: Unclear border and multifocality of PTC in the ipsilateral were closely relevant to the occurrence of occult carcinoma in the contralateral nodules.

[A cross-sectional study on application of glucocorticoid in systemic lupus erythematosus patients]

Objective: To explore the status of glucocorticoid application in patients with systemic lupus erythematosus (SLE) in China. Methods: Epidemiological survey was used. The SLE patients who met the 1997 classification criteria of American College of Rheumatology were enrolled. The usage of glucocorticoid and related adverse reactions were recorded and analyzed. Results: A total of 400 SLE patients were enrolled, including 35 men and 365 women. The average age was (37.4±14.0) years old, and the average duration of disease was (6.7±5.8) years. There were 310 patients using glucocorticoid as maintenance. Sixty-one percent (n=244) patients started using medium dose (prednisone 30-<60 mg/d) as the initial treatment of glucocorticoid, which lasted for(37±11)days.The time of drug duration in patients with low dose prednisone (7.5-<30 mg/d)and high dose (60-100 mg/d) was(92±20)and(17±3)days respectively (P<0.05 between 3 groups). However, patients receiving different initial dosage were of no discrepancy in the maintenance therapy. During maintenance, even though 51.0% (n=158) patients were on prednisone 2.5-5 mg/d, the duration of drug use in >5-10 mg/d groupwas longer[(29.9±3.3) months]. Patients with involvement of internal organs had a higher tendency to use 60-100 mg/d prednisone or pulse-dose therapy in the initial treatment, nevertheless these two groups had no difference of maintenance dosage. Among all 400 patients, 62 patients withdrew glucocorticoid, including 17 patients with disease remission (4.3%), 44 by self-withdrawal and one with adverse reaction. Conclusion: In China, the medium dosage of glucocorticoid is the most common initial treatment in patients with SLE.Prednisone 2.5-5 mg/d was the most common choicefor maintenance therapy. Currently, the proportion of glucocorticoid withdrawal remains low in SLE patients achieving remission.

[Clinical observation on human alpha glucosidase in treatment of five patients with glycogen storage disease Ⅱ]

Objective: To evaluate the effect of enzyme replacement therapy (ERT) on glycogen storage disease typeⅡ(GSDⅡ). Method: The clinical data of three juvenile onset and two infant onset GSDⅡpatients were collected from First Affiliated Hospital of Sun Yat-sen University in October 2015 to July 2016.Patient 1 was female, the age of onset was 15 months. Patient 2 was male, the age of onset was 20 months. Patient 3 was female, the sister of patient 2, the age of onset was 47 months. Patient 4 was male, the age of onset was 5 months. Patient 5 was male, the age of onset was 1 month.The age at the start of ERT of the 5 patients was 32, 31, 56, 34, and 3 months respectively and the duration of ERT was 19, 9, 4, 5, 5 doses respectively.ERT was administered at 20 mg/kg every 2 weeks.Dexamethasone was regularly given before each infusion. Result: ERT was well tolerated, only one time, Patient 1 developed tachycardia and hypertension without using dexamethasone.Patient 2 underwent successfully ventilator weaning.Patient 1 underwent a tracheotomy, also needed mechanical ventilation treatment.Patient 4 noninvasive ventilation was tried. Conclusion: Recombinant human alpha-glucosidase treatment was effective and well tolerated in patients with GSDⅡ.

Involvement of oxidative stress in tri-ortho-cresyl phosphate-induced liver injury in male mice

Tri-ortho-cresyl phosphate (TOCP) has been widely used as plasticizers, plastic softeners, and flame retardants in industry and reported to have delayed neurotoxicity and reproductive toxicology in animals. However, it remains to be elusive whether TOCP induces liver injury. In this study, male mice were orally administered different concentrations of TOCP (100, 200, or 400 mg/kg/day) for 28 days. Histological examination showed that TOCP led to serious hepatocellular injury. In addition, administration of TOCP induced a marked elevation in the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in mice. The content of malondialdehyde (MDA) was increased significantly in the liver after the mice were treated with TOCP; while there was a dramatic decrease in the content of glutathione (GSH) and the activities of antioxidative enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX). TOCP inhibited viability of mouse liver cancer Hepa 1-6 cells in a dose-dependent manner. Meanwhile, TOCP significantly increased MDA content and inhibited GSH content and the activities of SOD and GSH-PX in the cells, respectively. Oxidative stress dramatically inhibited viability of Hepa 1-6 cells; while inhibition of oxidative stress by N-acetyl-l-cysteine could rescue the cell viability inhibited by TOCP to a certain extent. In summary, oxidative stress might be involved in TOCP-induced hepatocellular injury in male mice.

Assessment of genetic diversity of cucumber cultivars in China based on simple sequence repeats and fruit traits

The cucumber (Cucumis sativus L.) is an important crop grown worldwide. In this study, the genetic diversity of 42 cucumber cultivars in China was analyzed using 51 pairs of simple sequence repeat (SSR) primers. These primers identified 129 polymorphic loci, 95.6% of which were polymorphic. The mean effective number of alleles, mean Nei's gene diversity, and mean Shannon's information index were 0.36, 0.16, and 0.21, respectively. A cluster analysis demonstrated that the 42 cultivars could be divided into three groups, a result that was largely consistent with those of a principal component analysis (PCA). The PCA indicated that the three groups displayed significant variation in fruit traits. The cultivars of group 1 tended to have longer fruits (>30 cm), longer fruit ends (>4 cm), larger fruit diameters (>5 cm), a sharp strigose fruit spine, and the same fruit end shape. The basal color of the fruit in group 2 was dark green. Group 3 cultivars have no wax or mottling on the fruit surface. Our study demonstrates the value of our SSR primers for assessing genetic diversity in cucumber.