[Metagenomic next-generation sequencing-based retrospective investigation of the drug resistance sites of Mycoplasma pneumoniae in children]

Objective: To analyze the drug-resistant gene loci of Mycoplasma pneumoniae (MP) using metagenomic next-generation sequencing (mNGS). Methods: From November 2022 to October 2023, 697 clinical samples (including sputum, alveolar lavage fluid and blood) of 686 children with Mycoplasma pneumoniae positive detected by mNGS were retrospectively analyzed. Samples were divided into intensive care unit (ICU) group and non-ICU group, Chi-square test was used to compare groups, and Mann-Kendall trend test was used to analyze the change trend of the detection rate of drug resistance gene loci over time. Results: Of the 697 samples, 164 were from the ICU group and 533 were from the non-ICU group. The detection rate of Mycoplasma pneumoniae resistance gene was 44.3% (309/697), and all detected drug-resistant gene loci of MP were A2063G. The detection rate of Mycoplasma pneumoniae in ICU group was 50.0% (82/164), and the detection rates of Mycoplasma pneumoniae resistance gene loci in sputum, alveolus lavage fluid and blood samples were 75.0% (18/24) and 48.4% (62/128), respectively. The detection rate in sputum was higher than alveolus lavage fluid samples (χ2=5.72,P=0.017). The detection rate of Mycoplasma pneumoniae in non-ICU group was 42.6% (227/533), the detection rate of Mycoplasma pneumoniae resistance gene loci in sputum and alveolar lavage fluid was 40.0% (16/40), 44.3% (201/454), and no detection rate in blood samples (0/12). There was no significant difference in the detection rate of alveolar lavage fluid and sputum (χ2=0.27, P=0.602). From November 2022 to October 2023, the detection rate of submitted samples showed an increasing trend month by month (overall: Z=3.99, ICU inspection group: Z=2.93, non-ICU group: Z=3.01, all P<0.01). Among the bacteria commonly detected with Mycoplasma pneumoniae, Streptococcus pneumoniae accounted for the highest proportion, the detection rate was 15.5% (108/697), and Epstein-Barr virus accounted for the highest proportion of 17.6% (123/697). Conclusions: From November 2022 to October 2023, the detection rate of Mycoplasma pneumoniae drug resistance gene loci showed an increasing trend. The detection rate of drug resistance gene loci in sputum samples of ICU group was higher than alveolus lavage fluid. No new drug resistance site were detected.

[Survey of Helicobacter pylori levofloxacin and clarithromycin resistance rates and drug resistance genes in Ningxia, 2020-2022]

Objective: To explore the rate of Helicobacter pylori (Hp) resistance to levofloxacin and clarithromycin and the common mutation patterns of resistance genes in Ningxia, and to assess the concordance between phenotypic resistance and genotypic resistance. Methods: Cross-sectional study. Patients diagnosed with Hp infection in 14 hospitals in Ningxia region from February 2020 to May 2022 were retrospectively selected. Hp strains were isolated from gastric biopsy specimens of Hp-infected patients and subjected to phenotypic drug sensitivity testing and detection of resistance genes to analyze the rate of Hp resistance to levofloxacin and clarithromycin and the common mutation patterns of resistance genes in Ningxia region; and the concordance rate and Kappa concordance test were used to assess the concordance between phenotypic resistance and genotypic resistance. Results: A total of 1 942 Hp strains were isolated and cultured, and among the infections, 1 069 cases (55.0%) were male and 873 cases (45.0%) were female, aged (50.0±12.5) years (15-86 years). The rates of Hp resistance to levofloxacin and clarithromycin in Ningxia were 42.1% (818/1 942) and 40.1% (779/1 942), respectively, and the rate of dual resistance to both was 22.8% (443/1 942). The rate of resistance to levofloxacin and clarithromycin of Hp strains from female patients was higher than in male patients (levofloxacin: 50.4%(440/873) vs 35.4%(378/1 069); clarithromycin: 44.4%(388/873) vs 36.6%(391/1 069), both P<0.001). Among the GyrA gene mutations associated with levofloxacin resistance, the differences in mutation rate of amino acid at positions 87 and 91 were statistically significant in both drug-resistant and sensitive strains(both P<0.001), except for Asn87Thr. Hp strains were statistically significant for levofloxacin (Kappa=0.834, P<0.001) and clarithromycin (Kappa=0.829, P<0.001) had good concordance in resistance at the phenotypic and genotypic levels. Conclusion: The resistance of Hp to levofloxacin and clarithromycin in Ningxia region is severe, and there is good consistency between genotypic and phenotypic resistance.

[Preliminary analysis of pulse-step-sine test results in healthy population]

Objective: To analyze the characteristics of pulse-step-sine (PSS) test in healthy people of different ages and to discuss its clinical value. Methods: From July 10, 2018 to December 9, 2020, a total of 78 healthy volunteers, including 40 males and 38 females, were enrolled and divided into youth group, middle age group and old age group. The I Portal NOTC rotational-chair system (NKI) was applied for PSS detection to analyze the clinical characteristics of gain, phase, asymmetry, and slope of step and sinusoidal components. Statistical analysis was performed using SPSS17.0 software. Results: In the same age group, there were no statistically significant differences in left and right step gain, slope gain and sine gain (All P values were greater than 0.05). Pairwise comparison between different age groups showed that there was no significant difference in the corresponding parameters between the youth group and the middle age group. Compared with young group, the old age group had a significantly lower step gain value in their left side (P<0.01) but not in the right side (P>0.05).The left and right slopes of the old age group were significantly lower than those of the young group and the middle group, and the differences were statistically significant (All P values<0.05). Conclusion: The PSS test can detect bilateral and unilateral horizontal semicircular canal function with good tolerance in different age groups, better than the traditional rotational chair examination to determine the well-compensated unilateral vestibular function. PSS test is a new vestibular detection method.

[Etiology and epidemiology of hand, foot and mouth disease in China]

Hand, foot and mouth disease (HFMD) has been widespread in the world, and caused fever, rashes and other clinical symptoms of children, and sometimes inducing respiratory failure, brainstem encephalitis, and other complications, even death. The disease is mainly caused by enterovirus 71 (EV-A71) and coxsackievirus 16 (CV-A16). Since 2013, the proportion of HFMD cases caused by other enteroriruses has gradually increased, causing severe and even fatal cases. This paper summarizes the research progress in the epidemiological and etiological characteristics of HFMD in China since 2008.

[Correlation analysis of 3D-FLAIR MRI characteristics of the inner ear and vestibular function in the patients with vestibular neuritis]

Objective: The characteristics of 3D-FLAIR MRI images of the inner ear of patients with vestibular neuritis were preliminarily studied to explore the possible pathogenesis of vestibular neuritis, and the correlation analysis was conducted in combination with vestibular function to provide a basis for accurate diagnosis of vestibular neuritis. Methods: A total of 36 patients with vestibular neuritis (VN) from December 2019 to October 2020 were collected from the Vertigo Department of Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University. There were 36 cases (18 females, 18 males) with unilateral acute vestibular neuritis, 17 cases of left ear and 19 cases of right ear. According to the results of 3D-FLAIR MRI in the inner ears, the patients were divided into the enhanced group and the non-enhanced group (the health side served as the normal control group). The results of vestibular function examination in the two groups were compared. SPSS19.0 software was used for statistical processing to analyze the relationship between the vestibular function and the characteristics of 3D-FLAIR imaging in the inner ears. Results: Abnormal enhancement of 3D-FLAIR was found in 31 cases (86.1%) of the 36 cases, including 14 cases of both vestibular nerve and vestibular terminal organ enhancement, eight cases of superior vestibular nerve enhancement alone, seven cases of vestibular terminal organ enhancement alone, and two cases of cochlear enhancement alone. Observation of abnormal reinforcement of vestibular nerve showed: twenty-one cases of superior vestibular nerve reinforcement, one case of superior and inferior vestibular nerve reinforcement. No abnormalities were found in 3D-FLAIR of inner ear in 5 cases. According to the analysis of vestibular function results, there were 19 cases (52.8%) with total vestibular involvement, sixteen cases (44.4%) with superior vestibular involvement alone, and one case (2.8%) with inferior vestibular involvement alone. Comparison of vestibular function between the five cases (non-enhancement group) and the 31 cases (enhanced group) in the 3D-FLAIR group of the inner ears showed that the CP values of caloric tests in the enhanced group were higher (60.81±3.49 vs 34.12±7.37), with statistically significant difference (t=-2.898, P<0.01). Conclusion: In patients with vestibular neuritis, 3D-FLAIR MRI scan of the inner ear provides visual imaging evidence for clinical practice, considering that the lesion site of vestibular neuritis is not only in the vestibular nerve, but also in the vestibular end organ. Patients with 3D-FLAIR enhanced in the inner ear may have more significant vestibular function damage.

Polarized proton acceleration in ultraintense laser interaction with near-critical-density plasmas

The production of polarized proton beams with multi-GeV energies in ultraintense laser interaction with targets is studied with three-dimensional particle-in-cell simulations. A near-critical density plasma target with prepolarized proton and tritium ions is considered for the proton acceleration. The prepolarized protons are initially accelerated by laser radiation pressure before injection and further acceleration in a bubblelike wakefield. The temporal dynamics of proton polarization is tracked via the Thomas-Bargmann-Michel-Telegdi equation and it is found that the proton polarization state can be altered by both the laser field and the magnetic component of the wakefield. The dependence of the proton acceleration and polarization on the ratio of the ion species is determined and it is found that the protons can be efficiently accelerated as long as their relative fraction is less than 20%, in which case the bubble size is large enough for the protons to obtain sufficient energy to overcome the bubble injection threshold.

[Immunomicroecology: concept and applications]

Microorganism exerts a profound impact on the development and function of human immunity. Vice versa, immunity also affects the constitution and function of human microbiota. Hence, a new concept, immunomicroecology, has been put forward as an inevitable consequence of the development in the fields of microecology and immunology. Here, we describe the reciprocities between immunological system and microecological system, and elaborate the concept, developing course, and prospects of immunomicroecology.

Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

Background

Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms.

Case Description

A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up.

Conclusion

Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.

A resonance suppression method in platform style inertial reference unit via particle swarm optimization notch filter

With the development of laser communication, remote sensing imaging, and other technologies, an inertial reference unit (IRU) plays an essential part in the line-of-sight (LOS) stabilization system used for acquiring, pointing, and tracking targets. The IRU provides a stable reference beam to realize accurate LOS pointing under external disturbances. Compared with the frame style IRU, the platform style IRU (PIRU) can achieve a higher bandwidth and better precision. However, mechanical resonance is introduced by a flexure hinge inevitably in the PIRU, which affects the performance of the LOS stabilization system. In this paper, an open-loop dynamic model of PIRU is established. Identification experiments are carried out with results indicating a 28.7 dB resonance peak at 27.07 Hz in the x axis and a 30.3 dB resonance peak at 26.59 Hz in the y axis. An asymmetric notch filter is used to suppress the resonance peak to achieve a higher control bandwidth. A fitness function is designed to represent the effect of resonance suppression. A particle swarm optimization algorithm is used to search for an optimal solution of the fitness function to obtain the parameters of the asymmetric notch filter. Experimental results show that the resonance peak is reduced by 97.88% and the system bandwidth reaches 159.31 Hz.

Propofol inhibited gastric cancer proliferation via the hsa-miR-328-3p/STAT3 pathway

PURPOSE

The aim of the present study was to elucidate the functional role of hsa-miR-328-3p/STAT3 pathway in the effects of propofol on gastric cancer proliferation.

METHODS

Bioinformatics was used to analyze the molecular expression differences of hsa-miR-328-3p/STAT3 axis in stomach adenocarcinoma (n = 435) and normal samples (n = 41) from TCGA database. The expression of the above molecules in gastric cancer cells SGC-7901 and normal gastric mucosal cells GES-1 was verified via qPCR. The dual-luciferase assay was carried out to confirm the interaction between hsa-miR-328-3p and STAT3. Subsequently, the cell proliferation and the expression of the above molecules in SGC-7901 and GES-1 cells were evaluated after 10 μM propofol treatment. Finally, we analyzed whether propofol still inhibited the proliferation of gastric cancer by suppressing STAT3 pathway after hsa-miR-328-3p down-regulation.

RESULTS

Compared with normal samples, the expression of hsa-miR-328-3p was significantly down-regulated in stomach adenocarcinoma samples, while the expression of STAT3 and downstream target genes (MMP2, CCND1 and COX2) was up-regulated. The results were consistent with those in GES-1 and SGC-7901 cell lines. Meanwhile, we found that hsa-miR-328-3p can bind to the 3'-UTR of the potential target gene STAT3. Furthermore, propofol significantly inhibited the proliferation of gastric cancer cell line SGC-7901, where hsa-miR-328-3p was up-regulated and the expression of STAT3 and downstream proliferation-related target genes were down-regulated. However, the growth inhibition of propofol on SGC-7901 cell was significantly reversed after the inhibition of hsa-miR-328-3p.

CONCLUSIONS

To sum up, propofol suppressed the STAT3 pathway via up-regulating hsa-miR-328-3p to inhibit gastric cancer proliferation.

[The roles of two HIV self-testing models in promoting HIV-testing among men who have sex with men]

Objective: To evaluate the roles between two different HIV self-testing models in promoting HIV-testing among men who have sex with men (MSM). Methods: This paper focuses on two HIV self-testing service models. The first; is the online self-testing model (HIV self-testing conventional model) with the sexual health promotion network platform. The other one is an innovative HIV self-testing model (secondary distribution model), based on the previous program. The two different self-testing models, including the number of indexes and alters, the positive rate, and the demographics of indexes and alters, are compared. The influence of volunteers with or without leadership on the number of HIV self-test kits distributed or self-use is analyzed through the leadership survey scale. Results: The return rates of HIV self-testing results in the two models are 94.7%(323/341) and 99.2%(1 141/1 150), respectively, within 30 days. The proportion of alters in the secondary distribution is significantly higher (45.9%,281/612) than the conventional HIV self-testing (6.3%,20/318). In the secondary distribution model, the difference between the number of indexes and alters indicators including age, marital status, residence, sex orientation, anal sex with men in the past six months, and HIV test are statistically significant (χ² test, all P<0.05). The opinion leader of MSM has significantly impacted the promotion of HIV self-testing (P<0.05). Conclusions: Both models can promote HIV self-testing, result return, and HIV positive detection among MSM. In terms of expanding the testing and detection of HIV positive, the secondary distribution mode shows more obvious advantages, which significantly promotes a large number of MSM who have never been tested for HIV to undergo HIV testing. Influential indexes have a significant effect on increasing the HIV testing rate and promoting HIV testing among MSM.

[A preliminary study on the mixed teaching of human parasitology based on MOOC resources and the experimental teaching digital platform]

The mixed teaching model combines the advantages of traditional teaching and network teaching in the "Internet +" era, which has become one of the important trends in the higher education teaching development. In order to follow this development trend, the human parasitology teaching team makes a reasonable use of modern information techniques, actively promotes the construction and application of online resources, and conducts mixed online and offline teaching based on MOOC resources and the experimental teaching digital platform. This mixed teaching model has shown a positive impact on both teaching and learning among teachers and students; however, students' personalized independent and deep learning remains unsatisfactory. It is suggested that the online course resources construction, teaching design and digital literacy remain to be increased, so as to create a high-level, innovative and challenging online-offline mixed "golden course".

[Antibiotic analysis and whole genome sequencing of two nocardia farcinica strains causing joint infection]

Objective: To analyze the molecular characteristics and antibiotic susceptibility of two strains of Nocardia farcinica isolated from patients with joint infection using whole genome sequencing. Methods: Two strains of Nocardia farcinica causing knee-joint infections in two elderly patients were collected in January 2020. Whole genome sequencing was used to determine the nocardia species. Drug sensitivity test was performed using the micro-broth dilution and E-test method according to CLSI M24 guideline. ABRicate was used to analyze drug resistance and virulence genes. Snippy and other bioinformatic tools were used for genomic comparison, and to construct SNP homologous tree. Results: The clinical isolates in this study were both Nocardia farcinica. Antimicrobial susceptibility test showed the isolates were resistant to ceftriaxone, cefepime, cefotaxime and trimethoprim/sulfamethoxazole (TMP/SMX). Imipenem, linezolid and amoxicillin-clavulanic acid showed good activity. Four antibiotic resistance genes including class A β-lactamase gene far-1, RNA polymerase binding protein gene RbpA, multi-drug resistance efflux pump transcription activator gene MtrA and regulatory transcription factor gene vanR-O were identified in the Nocardia farcinica genomes, which conferred resistance to beta-lactams, rifampicin, macrolides and vancomycin respectively. No acquired TMP/SMX resistance genes were identified. There are multiple missense mutations in the dihydrofolate reductase family genes. Four virulence genes of icl, mbtH, phoP, and relA that are homologous to Mycobacterium tuberculosis were found. SNP homologous tree analysis showed the two Nocardia strains were closely related, and there were only ten SNP sites, six compound substitutions and one deletion mutation between them. Conclusions: Whole genome sequencing technology is helpful to explore the molecular characteristics and resistance mechanisms of Nocardia species. Nocardia farcinica has a trend of spreading in China. Resistance to TMP/SMX is worthy of attention. The mutation of genes involved in the metabolic pathway of dihydrofolate might be one of multiple TMP/SMX resistance mechanisms.

[Clinical analysis of 12 cases of spontaneous uterine rupture caused by placenta percreta]

Objective: To investigate the clinical characteristics and early identification of spontaneous rupture of uterus caused by placenta percreta. Methods: The clinical data of 12 patients with spontaneous uterine rupture caused by placenta percreta and admitted to the First Affiliated Hospital of Zhengzhou University from June 2014 to December 2019 were collected. The age, gestational age, gestational history, clinical manifestations, diagnostic methods, uterine operation history, rupture location, surgical method, treatment and outcome were analyzed. Results: (1) General condition: the median age of pregnant women was 37 years (range: 30-43 years), and the median gestational week of uterine rupture was 29⁺⁶ weeks (range: 18⁺³-36⁺³ weeks). (2) Clinical manifestation: among the 12 pregnant women, 9 showed different degrees of abdominal pain; chest distress accompanied by waist soreness, abdominal distension in 2 cases; one asymptomatic pregnant women was found with uterine rupture during elective cesarean section. Preoperative color Doppler ultrasonography indicated that 9 of the 12 pregnant women had peritoneal effusion, and 6 of them underwent diagnostic peritoneal puncture or posterior vault puncture for non-clotting blood extraction. (3) Uterine operation history and rupture location: among the 12 cases of spontaneous rupture of uterus caused by placenta percreta pregnant women, 10 had placenta previa after cesarean section, including 4 cases of rupture at the incision of the original cesarean section, 3 cases of rupture at the penetrating placental implantation of the lower segment of the anterior wall of the uterus, and 1 case of placenta percreta occurred at the myomectomy site of the right angle of the uterus. Among the 2 pregnant women with spontaneous uterine rupture caused by penetrating placental implantation without a history of cesarean section, 1 case with history of multiple abortions, and uterine rupture occurred at the bottom of the palace, 1 had rupture of placental penetrating implantation after hysteroscopic electroresection of endometrial polyps, and the uterine rupture occurred at the anterior wall of the lower segment of the uterus. (4) Maternal and fetal outcomes: 11 pregnant women were injected with suspension RBC and 1 pregnant woman was not injected with blood products. Nine cases underwent hysteroplasty and 3 cases underwent subtotal hysterectomy. There were 11 maternal survivors and 1 maternal death; 7 neonates survived and 6 stillbirths. Conclusions: Uterine rupture caused by placenta percreta is of great harm to mother and infant, due to its heterogeneity in clinical manifestations, which increases the possibility of misdiagnosis. For pregnant women with risk factors of placenta percreta, early diagnosis should be made during pregnancy. For those who have been diagnosed with placenta percreta, when there is typical or atypical uterine rupture, doctors should be alert to the occurrence of uterine rupture.

Large Isospin Asymmetry in ^{22}Si/^{22}O Mirror Gamow-Teller Transitions Reveals the Halo Structure of ^{22}Al

β-delayed one-proton emissions of ^{22}Si, the lightest nucleus with an isospin projection T_{z}=-3, are studied with a silicon array surrounded by high-purity germanium detectors. Properties of β-decay branches and the reduced transition probabilities for the transitions to the low-lying states of ^{22}Al are determined. Compared to the mirror β decay of ^{22}O, the largest value of mirror asymmetry in low-lying states by far, with δ=209(96), is found in the transition to the first 1^{+} excited state. Shell-model calculation with isospin-nonconserving forces, including the T=1, J=2, 3 interaction related to the s_{1/2} orbit that introduces explicitly the isospin-symmetry breaking force and describes the loosely bound nature of the wave functions of the s_{1/2} orbit, can reproduce the observed data well and consistently explain the observation that a large δ value occurs for the first but not for the second 1^{+} excited state of ^{22}Al. Our results, while supporting the proton-halo structure in ^{22}Al, might provide another means to identify halo nuclei.

[The evaluation value of transient elastography for liver characteristics in obese children]

Objective: To evaluate the feasibility of transient elastography (FibroTouch) in obese children and to investigate the liver characteristics of obese children based on FibroTouch. Methods: Children (5-18 years of age) from the Guangzhou Women and Children's Medical Center were examined by FibroTouch. The fat attenuation parameter (FAP) was used to assess liver fat deposition, and liver stiffness measurement (LSM) was used to assess liver fibrosis. The children were divided into obesity group (n=67) and non-obesity group (n=139). The FAP, LSM, and their influencing factors were analysed in the obese group. Results: The total effective rate of FibroTouch in non-sedated children aged 5-18 years (n=229) was 97.8%. The FAP value 259.4 (235.9-275.5) dB/m in obese children was significantly higher than that in the control group 178.1 (168.7-195.6) dB/m, (Z=-10.586, P<0.001). The LSM value in obese children 5.9 (4.5-7.5) kPa was significantly higher than that in non-obese children 3.2 (2.3-4.1) kPa, (Z=-8.832, P<0.001). The proportion of liver fibrosis in obese group was 30%, and that of nonalcoholic fatty liver was 65.7%. Logistic regression analysis showed that BMI percentile (≥ 95%) was an independent factor for significant liver fibrosis (OR=1.267, 95%CI: 1.056-1.519, P=0.011) and nonalcoholic fatty liver disease (OR=1.248, 95%CI: 1.007-1.546, P=0.043). Conclusions: FibroTouch can be successfully applied to obese children. Fibrotouch can accurately evaluate the liver fibrosis and fat attenuation parameters in obese children. Obese children have higher FAP and LSM, which increase the risk of non-alcoholic fatty liver and liver fibrosis.

[Clinical characteristics of patients with indication of cardiac implantable electronic devices implantation complicating with acute pulmonary thromboembolism]

Objective: To investigate the clinical characteristics of inpatients with the indication of cardiac implantable electronic devices (CIED) therapy and combined acute pulmonary thromboembolism (APTE). Methods: We retrospectively screened 8 641 inpatients who admitted with the indication of CIED implantation in Fuwai Hospital from January 2014 to May 2019. The clinical characteristics, management strategies and clinical outcome were analyzed for patients diagnosed as APTE. Results: APTE were identified in 45 (5‰) patients in this cohort, there were 18(40%) male patients, the average age was (73±8) years old and body mass index was (27±10) kg/m².Thirty-two (70%) patients were at intermediate-risk and 13 (30%) at low-risk. Anti-coagulation therapy was initiated in 38(84%) patients, and 30 patients underwent CIED implantation (27 pacemaker, 2 CRT and 1 ICD). No postoperative bleeding or pocket hematoma were detected in the 23 patients taking anticoagulation medication before implantation. During an average of (30±7) months' follow up, thrombus was dissolved in 20 patients, hemorrhage complications were observed in 2 patients (1 cerebral hemorrhage and 1 hematuria), anticoagulation therapy was discontinued in these 2 patients. Among 15 patients without immediate CIED implantation and treated with anticoagulation therapy during hospitalization, 2 patients developed complete paroxysmal Ⅲ° atrioventricular block, and recovered after therapy during hospitalization. Seven patients were re-hospitalized for CIED implantation due to bradycardia. Five patients died during follow-up (3 sudden cardiac death, 1 APTE combined with cerebral infarction, and 1 pulmonary infection). Conclusion: APTE is not rare in patients with the indication of CIED implantation, CIED implantation and anti-coagulation therapy are safe for these patients, and transient atrioventricular block could be detected in APTE patients.

Analysis of a registry database for esophageal cancer from high-volume centers in China

Esophageal cancer has a high incidence among malignancies in China, but a comprehensive picture of the status of its surgical management in China has hitherto not been available. A nationwide database has recently been established to address this issue.

METHOD

A National Database was setup through a network platform, and data was collected from 70 high-volume centers (>100 esophagectomies/per year) across China. Data was entered between January 2009 and December 2014, and was analyzed in June 2015 after a minimal follow-up of 6 months for all patients. 8181 patients with complete data who received surgery for primary esophageal cancer on the Database were included in the analysis.

RESULT

In this series, there were 6052 males and 2129 females, with a mean age of 60.5 years (range: 22-90 years). The pathology in 95.5% of patients was squamous cell carcinoma. The pathological stage distribution was 1.2% in stage 0, 2.5% in Ia, 11.5% in Ib, 14.8% in IIa, 36.1% in IIb, 19.3% in IIIa, 8.3% in IIIb, 6.2% in IIIc. 1800 patients (22.0%) with locally advanced disease received preoperative neoadjuvant therapy and 3592 patients (43.9%) underwent postoperative adjuvant chemotherapy and/or radiotherapy. The esophagectomies were performed through left thoracotomy approach in 5870 cases (72.6%), through right chest approach in 2215 cases (27.4%) including right thoracotomy (21.3%) and VATS (6.1%). The 30-day postoperative mortality rate was 0.6% (43 patients), and the overall postoperative complication rate was 11.6% (951 patients). The 1-, 3-, and 5-year overall survival rates were 82.6%, 61.6%, and 52.9%, respectively.

CONCLUSION

This National Registry Database from high-volume centers provides a comprehensive picture of surgical management for esophageal cancer in China for the first time. Squamous cell carcinoma predominates, but there is heterogeneity with respect to the surgical approach and perioperative oncologic management. Overall, surgical mortality and morbidity rates are low, and good survival rates have been achieved due to improvement of surgical treatment technology in recent years.

[Effect of pedicled thoracodorsal artery perforator flap on the repair of moderate to severe axillary scar contracture deformity]

Objective: To investigate the effect of pedicled thoracodorsal artery perforator (TDAP) flap on the repair of axillary moderate to severe scar contracture deformity. Methods: From January 2012 to January 2017, 29 patients with axillary moderate to severe scar contracture deformity were admitted to the the Second Xiangya Hospital of Central South University, including 18 females and 11 males, aged 14-42 years. There were 3 patients with cicatricial contracture deformity of bilateral axillas and 26 patients with cicatricial contracture deformity of unilateral axilla. After relevant preoperative examinations were completed and basic diseases were controlled, axillary scar was removed or released under the anesthesia of endotracheal intubation. The areas of wounds ranged from 7.5 cm×5.0 cm to 21.0 cm×8.5 cm after the operation. The pedicled TDAP flaps were used to repair the defects, which were thinned based on demand of the recipient sites before being transferred. The areas of flaps ranged from 9.0 cm×6.0 cm to 22.0 cm×10.0 cm. The donor sites were sutured directly. The status of thinned flaps, the survival of flaps after the operation and during follow-up, and the shoulder joint function during follow-up were observed. Results: Thirty-two pedicled TDAP flaps were harvested for repairing the defects. Among them, 14 flaps were transferred directly without thinning and the thickness of the flaps ranged from 9.0 mm to 15.0 mm, with average thickness of 13.6 mm.While the other 18 flaps were thinned, and the thickness of the thinned flaps ranged from 5.0 mm to 8.0 mm, with average thickness of 7.5 mm. The distal parts of 3 flaps in 3 patients showed small size of blackening or necrosis within 72 hours after the operation, and 2 of them were thinned and the other one was not. Finally, the 3 flaps were healed after hyperbaric oxygen therapy, dressing change, or other treatments. One flap occurred vein congestion 8 hours after the operation caused by pressure on the pedicle, and the color of the flap turned back to normal after the pressure was relieved. The rest of the flaps survived well. All the patients were followed up for 9 to 36 months, with an average of 18 months. All the flaps survived well, the color of the flaps was nearly the same as the recipient sites, and none of the flaps developed obvious contraction. The shoulder joint function of all patients was significantly improved compared with that before operation, with abduction angles of shoulder joints ranged from 90.0-145.0°, with an average of 130.0°. Conclusions: Pedicled TDAP flap is an relatively ideal choice for the repair of moderate to severe axillary scar contracture deformity, and better results will be achieved if the flaps are thinned to a appropriate thickness according to the condition of axillary defects.

[Cost-effectiveness of HIV self-testing strategy in men who have sex with men]

Objective: To analyze the cost-effectiveness and willingness-to-pay of HIV self-testing (HIVST) strategy and facility-based HIV rapid testing (HIV-RDT) strategy in men who have sex with men (MSM) in Zhuhai, and provide scientific evidence for making health policy. Methods: From the perspective of health service providers, the data of the costs and effectiveness of two HIV testing strategies in MSM in Zhuhai during January-September 2019 were collected, and a decision-tree model of cohort of 10 000 MSM was constructed by using software TreeAge Pro 2019 to measure the cost-effectiveness ratio (CER) and the incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analysis was performed for the uncertainty of the parameters in the model, and the cost-effectiveness and affordability curve was introduced to estimate the affordability of two strategies. Results: After the mobilization of MSM community-based organization through Internet and social media, 2 303 MSM had HIVST, in whom 33 were HIV positive (1.7%), and 816 MSM received HIV-RDT, in whom 35 were HIV positive (4.3%). The cost for per screening was 60.45 yuan and 240.43 yuan (RMB) respectively, and the cost for per positive screening was 4 218 yuan and 5 606 yuan (RMB) rerspectively. The results of the decision-tree model showed that the mean cost for a MSM using HIVST and using HIV-RDT was 44.67 yuan and 148.42 yuan (RMB) respectively, and the ICER was negative. HIVST strategy was a more cost-effective option when the willing-to-pay was below 6 528 yuan (RMB) for per positive screening, and HIV-RDT strategy was a more cost-effective option when the investment was higher than 6 528 yuan (RMB). Conclusion: HIVST strategy in Zhuhai is a public health project with economic value, and policy makers should strengthen the support to MSM community-based organization to promote the application of HIVST among MSM.

[Epidemiological characteristic and current status of surgical treatment for esophageal cancer by analysis of national registry database]

Objective: To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China. Methods: A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014. Results: Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively. Conclusions: The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

[Correlation research between imaging performance and pulmonary function of pneumoconiosis patients at stage three]

Objective: To study the imaging performance and pulmonary function of pneumoconiosis patients at stage three. Methods: 89 cases of pneumoconiosis patients at stage three for high thousand volt back chest, chest CT, pulmonary function, analysis the relationship of high thousand volt back chest, chest CT manifestations and pulmonary function. Results: In patients with chest X-ray progressive massive fibrosis range of 2.31-102.95 cm(2), divide patients according to the X-ray performance into three groups, the difference of each group pulmonary function index FVC、FEV(1)、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV is statistically significant (P<0.01) , the difference of FEV(1)/FVC%、RV/TLC、DLCO is no statistical significance (P>0.05) . Checked by related, in pneumoconiosis patients at stage three, the X-ray manifestations and pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、DLCO showed a negative correlation (r=-0.326, -0.438, -0.251, -0.344, -0.317, -0.337, -0.425, -0.347, -0.230) . With the deterioration of the X-ray imaging findings, pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、DLCO is a trend of decrease (P<0.05) . The X-ray changes is not associated with RV/TLC. By linear regression analysis, FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、DLCO regression equation are meaningful. The RV/TLC regression equations is meaningless. The volume of the patients with chest CT progressive massive fibrosis range of 4.86~179.74 cm(3), divide patients according to the chest CT performance into three groups, the difference of each group pulmonary function index FVC、FEV(1)、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、RV/TLC is statistically (P<0.05) , the difference of FEV(1)/FVC%、DLCO is no statistical significance (P>0.05) . Checked by related, in pneumoconiosis patients at stage three, chest CT manifestations and pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV showed a negative correlation (r=-0.360, -0.419, -0.256, -0.432, -0.366, -0.326, -0.254, -0.405, ) , It is not associated with the RV/TLC、DLCO. With the deterioration of the chest CT imaging findings, pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV is a trend of decrease (P<0.05) . By linear regression analysis, FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV regression equations are meaningful. The RV/TLC、DLCO regression equations are meaningless. Conclusion: It is correlated with chest X-ray, chest CT manifestations and pulmonary function in pneumoconiosis patients at stage three, that could help guide clinicians comprehensive evaluation in patients with pulmonary function status.

[Iodine status of vulnerable populations in Henan Province of China three years after the implementation of new iodized salt standard]

Iodine nutrition surveillance of vulnerable population was conducted in 18 cities of Henan Province in 2015. The medians and quartiles of urinary iodine concentration in women of reproductive-age (n=3 318), pregnant women (n=36 366), lactating women (n=4 153), infants <2 years of age (n=1 017), and children aged 8-10 years (n=4 806) were 202.1(124.0, 310.0), 192.4(133.6, 262.4), 168.3(119.1, 248.3), 214.2(156.1, 272.3) and 90.0 (121.8, 285.6) μg/L, respectively. Iodine status of the vulnerable populations was generally regarded as adequate in Henan Province. But the median of urinary iodine concentration of reproductive-age women were slightly above the adequate level. The proportions above iodine adequate level were 26.7% in reproductive-age women, 29.4% in pregnant women and 22.5% in children aged 8-10 years.

P6017Permanent left bundle branch area pacing for atrioventricular block: feasibility, safety and acute effect

Background

Left bundle branch area pacing (LBBAP), lacks adequate evaluation for AVB.

Purpose

We aimed to assess the feasibility, safety, and acute clinical outcomes of permanent LBBAP in patients with AVB.

Methods

We retrospectively recruited AVB patients with indication for ventricular pacing who had underwent LBBAP from May to Sep. 2018. ECG characteristics, pacing parameters, echocardiographic parameters and adverse events were evaluated during follow-up. Successful LBBAP was defined as the paced QRS morphology of RBBB pattern and QRSd less than 130ms.

Results

A total of 33 patients were involved in this study (mean age: 55.1±18.5 years; 66.7% male, 48.4% with bundle branch block,BBB). LBBAP was successfully performed in 90.9% (30/33) of all patients. The mean capture threshold of LBBAP was 0.76±0.26 V/0.4 ms during the procedure and 0.64±0.20 V/0.4ms at 3-month follow-up. The paced QRSd was 112.8±10.9 ms during the procedure and 116.8±10.4ms at 3-month follow-up. Baseline left or right BBB was corrected by LBBAP (153.3±27.8 ms vs. 122.2±9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure and LBBAP was successfully repeated by lead revision. Cardiac function and left ventricular synchronization at three-month follow-up presented slightly improvement as compared with baseline.

Table 1. Complications and changes in pacing parameters within 3 months after LBBAP Pacing parameters LBBAP (N=30) During the procedure Before discharge 3-month follow up Sensing amplitude, mV 14.4±5.1 15.8±11.7 14.6±4.6 Pacing threshold@0.4ms, V 0.76±0.26 0.59±0.16 0.64±0.20 Pacing impedance, Ω 691.7±133.8 588.0±79.3 554.7±93.7 Paced QRSd at 3.0V@0.4 ms output, ms 112.8±10.9 114.4±14.2 116.8±10.4 VP, % NA NA 79.4±24.6 Complications, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Infection, n (%) 0 (0.0) 0 (0.0) 0 (0.0) Septal perforation, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Dislodgement, n (%) 0 (0.0) 0 (0.0) 0 (0.0) QRSd, QRS duration; VP, ventricular pacing percentage.

Figure 1. Characteristics of LBBAP

Conclusion

Permanent LBBAP yielded stable threshold, narrow QRSd and preserved left ventricle synchrony with few complications. Our preliminary results indicate that LBBAP holds promise as an attractive physiological pacing strategy for AVB.

[Clinical analysis of scimitar syndrome in 6 pediatric patients]

Objective: To characterize the clinical features and outcomes of scimitar syndrome (SS) to aid the understanding of this syndrome. Methods: This retrospective study included 6 children who were diagnosed with SS at the pediatric cardiovascular center of Beijing Anzhen Hospital from January 2012 to September 2018. SS was diagnosed by echocardiography and confirmed by cardiac computed tomography angiography(CTA) or surgery. All data were collected to analyze the clinical and imaging characteristics and prognosis. Results: Among the 6 SS children (aged 2 months to 15 years; 5 males) weighed 5.6-17.1 kg. Three cases were infant type, the clinical manifestations were recurrent respiratory tract infection with growth retardation, including 2 cases with severe pulmonary hypertension, while 3 cases with adult type, were asymptomatic. Cardiac CTA imaging showed that the right single or all pulmonary veins descended through the diaphragm and converged into the inferior vena cava. One case was isolated infracardiac partial anomalous pulmonary venous connection (PAPVC) without other malformations. The remaining 5 cases complicated with atrial septal defect, different vascular and trachea malformations as well as spinal malformations. Vascular malformations included pulmonary veins stenosis, abnormal origin of pulmonary artery branches, collateral branches of systemic artery supplying local lung tissue, and persistent left superior vena cava. The treatment varied according to the specific location of anomalous pulmonary venous connection, the degree of pulmonary hypertension and the severity of clinical symptoms. Four cases underwent one-stage radical surgery, one case accepted intervention to occlude the collateral artery which was supplying the right lower lung and received stage Ⅱ radical surgery half a year later, and the remaining one case died from pulmonary hypertension crisis preoperation. Conclusions: Isolated SS can easily miss diagnosis due to mild clinical symptoms. Patients with complicated malformations can benefit from combination therapy. SS associated with severe pulmonary hypertension can lead to early death. Therefore, early diagnosis and appropriate treatment can improve the prognosis of patients.

[Clinical analysis of seven cases of H1N1 influenza-associated encephalopathy in children]

Objective: To investigate the clinical manifestations, diagnosis, and treatment of H1N1 influenza A-associated encephalopathy (IAE) in children. Methods: The clinical manifestations, laboratory tests, cranial magnetic resonance imaging (MRI), electroencephalography (EEG) examinations and treatments of seven children with H1N1 IAE hospitalized in Guangzhou Women and Children's Medical Center from December 2018 to January 2019 were retrospectively analyzed. Results: Five of the seven children with H1N1 IAE were female. The age at admission was 4 years and 5 months (range 7 months-9 years). Neurological symptoms occurred simultaneously or early (0-3 days) after the flu-like symptom appeared. The main clinical manifestations of neurological symptoms were seizures (repeated seizures in five cases and status convulsion in two cases, including one case of unexpected fever and repeated seizures in a nine-year old girl) accompanied with altered consciousness (drowsiness in five cases and coma in two cases). Cranial MRI in three cases displayed multifocal lesions, mainly in the bilateral thalamus, brainstem and cerebellar hemisphere. MRI also showed reversible splenial lesion in the corpus callusumin in three cases. EEG tracings were characterized by diffuse slow wave activity in four cases, and status epilepticus was monitored in one case. All the 7 cases were treated with oral oseltamivir. Three cases were treated with pulsed methylprednisolone and intravenous immunoglobulin. One case was treated with intravenous immunoglobulin alone and all the patients received oral oseltamivir. All the patients survived, with three patients had minor neurological sequelae at discharge. Conclusions: The main clinical manifestations of H1N1 IAE are seizures and altered consciousness. Cranial MRI combined with EEG is helpful for early diagnosis. Intravenous immunoglobulin and (or) methylprednisolone should be considered for severe cases.

Acute Toxicity and Hazardous Concentrations of Zinc to Native Freshwater Organisms Under Different pH Values in China

Zinc bioavailability to aquatic organisms varies greatly under different pH values. In the present study, five native species in China and four common international test species were selected to investigate the influence of changing pH on acute zinc toxicity. The results showed that the higher trophic levels exhibited increasing sensitivity to zinc as pH decreased. However, when the pH value was between 8 and 11, the acute toxicity of zinc was relatively constant. In addition, by using a species-sensitivity distribution (SSD) method, the short-term hazardous concentrations of zinc at different pH values (based on the 5th percentiles of the pH-specific SSDs) were determined to be 17.26 µg/L (pH 4), 48.31 µg/L (pH 5), 80.34 µg/L (pH 6) and 230.6 µg/L (pH 7), respectively. The present study provides useful information for deriving water quality criteria and assessing the risks of metals in the near future.

[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．.

[The relationship between autoimmune thyroiditis and pregnancy outcomes of patients with PCOS following in vitro fertilization and embryo transfer IVF-ET]

Objective: To investigate the impact of autoimmune thyroiditis (AIT) on pregnancy outcomes in patients with polycystic ovary syndrome (PCOS) following the in vitro fertilization and embryo transfer (IVF-ET) by analyzing their pregnancy outcomes. Methods: The patients undergoing IVF-ET treatment diagnosed with PCOS in Peking University Third Hospital from May 2010 to December 2014 were investigated. According to the anti-thyroid antibodies (TPOAb or TGAb), patients were divided into AIT group and non-AIT group. The pregnancy outcomes of two groups were analysed for investigate the effect of AIT on pregnancy outcomes. Results: Four hundred and ninety patients with PCOS were enrolled, 119 (24.3%) of AIT group and 371 (75.7%) of non-AIT group. Patients with PCOS had a higher incidence (24.3%) of AIT. There was no correlation between AIT and the different pregnancy outcomes.TSH was negatively correlated with pregnancy as a risk factor. Hyperandrogenemia was negatively correlated with clinical pregnancy as a risk factor. Hyperprolactinemia was negatively correlated with delivery as a risk factor, while TSH was positively correlated with delivery. Conclusions: The incidence of AIT was higher in patients with PCOS. AIT was not the risk factor of adverse pregnancy outcomes for PCOS women undergoing IVF. The metabolic disorders (including hyperinsulinemia, hyperandrogenemia and hyperprolactinemia) were the risk factors of adverse pregnancy outcomes. Patients in AIT group had the high TSH level. They should be received more care and monitoring to make it conducive to delivery.

[Three-level logistic analysis related to influencing factors on condom use among female sex workers aged 35 years and above in Qingdao]

Objective: To analyze the influencing factors on condom use among 35-years-or-older female sex workers (OFSWs) in Qingdao by using the three-level logistic model. Methods: From March to June 2014, OFSWs were recruited in Qingdao, using respondent-driven sampling. Related information on OFSWs and their recent five sexual partners (not including husband) were obtained by conducting a questionnaire survey on OFSWs. A Three-level logistic regression model was conducted to analyze the influencing factors of condom use between OFSWs and their sexual partners. Results: A total of 420 OFSWs participated the survey as well as information on 2 100 sexual partners. Results from the empty model showed that the use of condoms among OFSWs having an aggregation that related to the levels of working sites and their own behaviors. Results from the three-levels of logistic model analysis showed that, OFSWs that having had junior middle school education (OR=1.450, 95%CI: 1.054-1.994)/high school education or above (OR=2.264, 95%CI: 1.215-4.222), knowing the function of condom use (OR=2.004, 95%CI: 1.273-3.154) would have higher rates of condom use. OFSWs with higher score of attitude on condom use (OR=0.796, 95%CI: 0.745-0.849), having had syphilis infections in the past (OR=0.657, 95%CI: 0.478-0.902) would have lower rate of condom use. For the sexual partners, the rate of condom use among OFSWs' regular partners were higher than that of OFSWs' boyfriends (OR=15.291, 95%CI: 8.441-27.700; OR=29.032, 95%CI: 15.413-54.682). Conclusion: Condom use of OFSWs was affected by behaviors of both OFSWs themselves and their sexual partners. Prevention and control programs should focus on OFSWs and their sexual partners at the same time. The key intervention contents should include target populations as: OFSWs with low level of education, having had infections of syphilis, those who do not use condoms with their trusted partners.

[Effects of Luteolin on Proliferation and Programmed Cell Death of Human Multiple Myeloma Cell RPMI-8226]

OBJECTIVE

To investigate the effect of Luteolin on proliferation and cell death of human multiple myeloma cell line RPMI-8226 and its mechanisms.

METHODS

The effect of Luteolin on the growth of human multiple myeloma cell line RPMI-8226 was detected by CCK-8, and then the minimal effective concentration was determined and was used to treat RPMI-8226 cells. The effects of luteolin and chloroquine on expression of cleaved-caspase 3 and LC3 in RPMI8826 cells was detected by Western blot.

RESULTS

The luteolin significant inhibited RPMI-8226 cell proliferation in a dose-dependent manner. Treatment with lutedin 40-80µmol/L for 24 hours and luteolin 20-80µmol/L for 48 hours inhibited RPMI-8226 cell proliferation in a dose-dependent manner (24 h, r= -0.983; 48 h, r= -0.985). After treatment with lutelin 20µmol/L for 48 h, the expression of cleaved caspase3 and LC3 Ⅱ/Ⅰ in RPMI 8826 cells significantly increased; after treatment with chloroquine at the same time, the expression of cleaved-caspase 3 and LC3 Ⅱ/Ⅰ significantly decreased.

CONCLUSION

Luteolin inhibits the proliferation of RPMI-8226 cells by inducing the pathways of both apoptosis and autophagy, moreover the actions of apoptosis and autophagy are interactive or/and promotive each other.

[The predictive value of parathyroid hormone levels and decreases for postoperative hypocalcemia after total thyroidectomy]

Objective:To investigate the predictive value of parathyroid hormone levels and decreases for postoperative hypocalcemia after total thyroidectomy. Method:We reviewed 71 consecutive patients who underwent total thyroidectomy, measured postoperative hypocalcemia, parathyroid hormone (PTH) values within 24 hours after surgery, divided them into subgroups accroding to hypocalcemia symptom. Combining with postoperative serum calcium，postoperative PTH values and decreases (△PTH), we used the receiver operating characteristic curve (ROC) analysis to assessment of predictive value. Result:The mean value of postoperative serum calcium, postoperative PTH and △PTH between subgroups have a significant difference (P<0.01). ROC area under the curve (AUC) of △PTH is 0.9706, with cutoff value 0.7366. AUC of postoperative PTH is 0.9580, with cutoff value 14.82 ng/L. Conclusion:The postoperative PTH and △PTH is a reliable indicator to judging postoperative hypocalcemia after total thyroidectomy.

[Analysis of clinicopathological characteristics of papillary thyroid carcinoma and BRAF V600E gene mutation]

Objective: To study the correlation between the BRAF V600E mutation and the clinicopathological features of papillary thyroid carcinoma(PTC), and to explore the application value of BRAF V600E mutation in PTC. Method: The BRAF V600E gene mutation was detected in 108 PTC cases and 30 control cases by qPCR. The results were statistically analyzed by using SPSS 21.0 software. Result: The BRAF V600E mutation was absent in the control group. The BRAF V600E mutation rate was 72.20% in 108 PTC cases. Compared with patients with wild type,the mean age of patients with the mutant BRAF V600E was significantly older(P<0.05). BRAF V600E mutations were associated with PTC tissue subtypes and central area lymph node metastasis(P<0.05). BRAF V600E mutations were not correlated with tumor diameter, patient gender, multifocality, tumor site, concomitant disease, lymph node metastasis in side region of neck, capsule invasion, and TNM staging(P>0.05). Conclusion: The value of BRAF V600E mutation in the prognosis of PTC remains to be studied. BRAF V600E mutation is of value for pathological diagnosis of PTC.

[Analysis on the factors related to the immediate success rate of radiofrequency catheter ablation on patients with idiopathic right ventricular outflow tract ventricular arrhythmia]

Objective: To analyze the clinical characteristics of patients with idiopathic right ventricular outflow tract (RVOT) ventricular arrhythmias (VA) and factors related to the immediate success rate of radiofrequency ablation. Methods: Patients diagnosed as idiopathic RVOT arrhythmia in Fuwai Hospital from February 2009 to January 2013 were retrospectively screened. Patients with structural heart disease or inherited arrhythmia were excluded. All patients underwent endocardial electrophysiological study and radiofrequency catheter ablation. Baseline clinical and operation records were collected and analyzed. Immediate success rate was defined as no inducible ventricular arrhythmia by isoprinosine and electrophysiological induction at the end of ablation. The origins of idiopathic RVOT were classified as septal, anterior, posterior, free wall site, epicardial and RVOT-aorta root site. Results: A total of 468 patients were finally included, and the age was (40.4±13.3) years old and 60.5%(283/468) patients were female. Immediate radiofrequency success rate was 89.3%(418/468). Patients were divided into ablation success group (n=418) and ablation failure group (n=50). Percent of female patients and patients with interventricular septal origin was significantly higher in the ablation success group than in ablation failure group (261(62.4%) vs. 22 (44.0%) , P=0.01, and 233(55.7%) vs. 18(36.0%), P=0.005), while percent of patients with epicardial origin was significantly lower in the ablation success group than in ablation failure group (17(4.1%) vs. 11(22.0%), P<0.001). Immediate success rate was the highest for patients with the septal origin and the lowest for patients with epicardial origin (92.8%(233/251) vs. 60.7%(17/28), P<0.05). Multivariate analysis showed that the origin site of VAs was the most important independent factor related to the success rate of ablation. Compared with the septal origin patients, patients with RVOT-aorta root and epicardial origin VAs faced with 1.82-fold and 8.26-fold increased risk of failed ablation, respectively (OR=2.82, 95%CI 1.05-7.57, and OR=9.26, 95%CI 3.60-23.86). Sex category was not the independent risk factor for failed ablation(OR=1.76, 95%CI 0.93-3.33, P=0.08) . Conclusions: The immediate success rate of radiofrequency catheter ablation for idiopathic RVOT ventricular arrhythmia is relative high, however, immediate success rate of radiofrequency catheter ablation is relatively low for patients with epicardial and RVOT-aorta root origin arrhythmia and VAs origin is an independent risk factor of immediate ablation success rate.

[Association between small dense low-density lipoprotein cholesterol and carotid atherosclerosis]

Objective: To explore the association between small dense low-density lipoprotein cholesterol (sdLDL-C) and carotid atherosclerosis. Methods: 1 578 subjects were enrolled in an annual health check-up program in aerospace center hospital from 2016 to 2017, and these patients were divided into 471 cases (men 343 and women 128) with carotid atherosclerosis (subjects with increased carotid artery intima-media thickness or carotid atherosclerosis plaque) and 1 107 cases (men 567 and women 540) with non- carotid atherosclerosis according to ultrasonography. Serum sdLDL-C levels were measured by peroxidase assay. Results: Serum sdLDL-C was significantly higher in carotid atherosclerosis group (1.11±0.44) mmol/L than that in non-carotid group (0.88±0.40) mmol/L, with significant difference (t=9.856, P<0.001). Stratified by quartiles of sdLDL-C (Q1-Q4), the prevalence of carotid atherosclerosis was significantly increased trend along with increased sdLDL-C levels (P<0.001). In multivariate Logistic regression analysis, after adjustment for age, sex and other traditional atherosclerosis risk factors, comparing Q4 with Q1, the odd ratio of prevalence of carotid atherosclerosis was 5.164, and 95% confidence interval(CI) was 2.833-9.413. While the sdLDL-C threshold was 0.727 mmol/L as the optimal cut-off point, the clinical sensitivity and specificity of sdLDL-C for screening carotid atherosclerosis were 80.5% and 41.4%, respectively. Conclusion: Serum sdLDL-C was an independent risk factor of carotid atherosclerosis. sdLDL-C may be a potentially useful risk marker in early screening for carotid atherosclerosis.

[Association between serum adipocyte fatty acid binding protein level and insulin resistance in patients with OSAS]

Objective: To investigate the association between serum adipocyte fatty acid binding protein (A-FABP) level and insulin resistance in patients with obstructive sleep apnea syndromes (OSAS). Methods: Eighty patients with snoring were monitored by overnight polysomnography (PSG) from September 2015 to July 2017, and there were 59 males and 21 females, aged from 22 to 77 years old (mean age 47±14 years old). Based on the apnea-hypopnea index (AHI), these patients were divided into three groups: primary snoring group (AHI<5/h, n=19), mild-moderate OSAS groups (5/h≤AHI≤30/h, n=23) and severe OSAS groups (AHI>30/h, n=38). The levels of A-FABP, the fasting plasma glucose (FPG), fasting insulin (FINS) and insulin resistance index (IRI) were compared between the primary snoring group and OSAS patients with different severities, and the correlations between serum A-FABP and IRI as well as PSG parameters were further evaluated using partial correlation analysis. Results: Compared with the primary snoring group [(15.6±3.5) μg/L] and mild-moderate group [(17.4±4.3) μg/L], there was a significant increase of the serum A-FABP level in the severe OSAS group [(21.4±4.6) μg/L](P=0.001, P=0.025). Additionally, after adjustment for BMI and age, serum A-FABP level showed significant positive correlations with FINS and IRI (r=0.478, P<0.001; r=0.356, P=0.035); serum A-FABP level was positively correlated with AHI and the arterial oxygen saturation (SaO(2)) < 90% time ratio in night (TS90%) (r=0.251, P=0.041 and r=0.271, P=0.035). Nevertheless, serum A-FABP level showed significant negative correlation with the lowest SaO(2) and the mean SaO(2) (r=-0.244, P=0.038 and r=-0.280, P=0.018). Conclusion: Insulin resistance and the increased level of serum A-FABP are common in OSAS patients, the level of serum A-FABP is significantly correlated with insulin resistance and nocturnal intermittent hypoxia, both of which suggest that A-FABP plays a potential role in insulin resistance in patients with OSAS.

Effect of iron source on iron absorption and gene expression of iron transporters in the ligated duodenal loops of broilers

This experiment was conducted to investigate the effect of iron source on Fe absorption and the gene expression of divalent metal transporter 1 (DMT1) and ferroportin 1 (FPN1) in the ligated duodenal loops of broilers. The in situ ligated duodenal loops from Fe-deficient broiler chicks (28-d-old) were perfused with Fe solutions containing 0 to 14.33 mmol Fe/L from 1 of the following: Fe sulfate (FeSO∙7HO), Fe methionine with weak chelation strength (Fe-Met W; chelation strength is expressed as quotient of formation [Q] value, Q = 1.37), Fe proteinate with moderate chelation strength (Fe-Prot M; Q = 43.6), and Fe proteinate with extremely strong chelation strength (Fe-Prot ES; Q = 8,590) for up to 30 min. The gene expression of DMT1 and FPN1 in the duodenal loops from the control group and the groups treated with 3.58 mmol Fe/L from 1 of 4 Fe sources was analyzed. The absorption kinetics of Fe from different Fe sources in the duodenum followed a saturated carrier-dependent transport process. The maximum transport rate (J) values in the duodenum were greater ( < 0.03) for Fe-Prot ES and Fe-Prot M than for Fe-Met W and FeSO∙7HO. The Fe perfusion inhibited ( < 0.05) the mRNA expression of but enhanced ( < 0.0008) the mRNA expression of in the duodenum and had no effect ( > 0.14) on the protein expression levels of the 2 transporters. These results indicated that organic Fe sources with greater Q values showed higher Fe absorption; however, all Fe sources followed the same saturated carrier-dependent transport process in the duodenum, and DMT1 and FPN1 might participate in Fe absorption in the duodenum of broilers regardless of Fe source.

Relationship Between Femur and Femoral Arteries for Identifying Risk Factors for Vascular Injury

Background

This study aimed to identify risk factors for vascular injury in proximal femoral fracture through identifying frequency and distances between femur and femoral arteries with computed tomography angiography and 3-dimensional reconstruction.

Material/Methods

In a series of 400 participants, based on measurement results regarding the distribution of femoral arteries in the medial femur, the femoral portion covering that part was divided into levels A–E. The center region, margin region, and risky area in the medial femur were defined. The frequency of femoral arteries and interested shortest distance between the outer femur and superficial, deep, and perforating femoral arteries (SFAs, DFAs, and PFAs) in the center region, margin region, and risky area at each level were recorded.

Results

There were 173 males and 227 females (average age: 63.61±19.18 years) in this study. The starting point and end point for femoral arteries in the medial femur were from 22.55±4.23% to 54.56±8.39% of the whole femur. The femoral arteries in the medial femur mainly were distributed at levels B (88.2%), C (65.9%), and D (40.6%). The femoral arteries in center regions in the risky area, most of which were DFAs and PFAs, were mainly concentrated at levels B (26.93%) and C (11.81%).

Conclusions

The mid-shaft level was the most risky level, and the DFAs and PFAs were easier to injure than the SFAs when performing internal fixation of proximal femoral fracture. We recommended that great attention be paid to drill and screw insertion around the mid-shaft level for prevention of iatrogenic vascular injury.

[Mechanism of the Piezo1 protein-induced apoptosis of the chondrocytes through the MAPK/ERK1/2 signal pathway]

OBJECTIVE

To invstigate the mechanism of new mechanically-activated cation channel protein (Piezo1) can cause the apoptosis of the human chondrocytes under compressive loading, using a Flexercell unit by activating classical Mitogen-activated protein kinase (MAPK) signal pathyway(ERK1/2).

METHODS

Primary human chondrocytes were isolated, cultured, and then subjected to the static compressive loading for 0, 2, 12, 24, 48 h, respectively.The expressions of Piezo1 and the ERK1/2 were assessed by reverse transcription-polymerase chain reaction(PT-PCR), as well as the apoptosis gene B cell lymphoma/leukemia-2(Bcl-2) Bel-associated X protein(Bax). In addition, Piezo1inhibitor, Grammostola spatulata mechanotoxin 4(GsMTx4), was used to block Piezo1, served as a positive control.The immunofluorescence was used to locate the expression of Piezo1 protein and ERK1/2.AnnexinV-PI was used to detect the apoptosis of chondrocytes.

RESULTS

The expression of the Piezo1 in chondrocytesis was weak, the 12 h group was significant increased(0.198 1 vs 0.021 4, P<0.05), the 24 h group was the highest expression while the expression of the 48 h group was lower than the 24 h group, as well as the ERK1/2, Bcl-2 and caspase3.The result of AV-PI had shown that the 2 h group had increased early stage of apoptosis.The 12 h group had increased late stage of apoptosis, and the 24 h group's apoptotic rate was the highest, while the apoptotic rate of the 48 h group was lower than the 24 h group(0.497 1 vs 0.743 1, q=0.035 9). The GsMTx4 could inhibit the late stage of apoptosis, and the location of the Piezo1 was expressed in the nucleus and cytoplasm of the chondrocytes.

CONCLUSIONS

Piezo1 plays an important role in the apoptosis of the human chondrocyte through the classic MAPK/ERK1/2 signal pathway.

[Effect of allogenic mesenchymal stem cells transplantation on the expression of interleukin-22 and matrix metalloproteinase-3 in rats with collagen induced arthritis]

Objective: To study the effect of allogeneic bone marrow mesenchymal stem cells transplantation on the expression of interleukin -22 (IL-22), matrix metalloproteinase -3 (MMP-3) in serum and synovial of rats with collagen induced arthritis. Methods: Type Ⅱ collagen were injected twice to establish the collagen induced arthritis (CIA) rat model. Forty-eight rats were randomly divided into 3 groups: control group, CIA control group, CIA experiment group. Rat bone marrow mesenchymal stem cells were cultured by bone marrow method combined with adherent culture method. After identify, the remaining cells were injected in the CIA experimental group. Enzyme linked immunosorbent assay (ELISA) and immunohistochemistry were used to detect the expression of IL-22 and MMP-3 in serum and anklebone joint's synovium of rats, respectively. Synovial cells were isolated and cultured, and were treated with different concentrations of IL-22. MMP-3 protein and mRNA were detected before and after stimulation by Western blot and real-time quantitative polymerase chain reaction (RT-qPCR). Results: After MSC transplantation, arthritis index, X-ray, HE staining of CIA rat showed that joint damage significantly reduced compared with the control group. The ELISA results showed that the expression of MMP-3 and IL-22 in CIA control group was higher than those in the control group (125.79±9.12 vs 102.00±7.63 ng/ml, P<0.05), (292.35±31.23 vs 257.27±13.99 ng/ml, P<0.05) and CIA experiment group (125.79±9.12 vs 97.94±9.50 ng/ml, P<0.05), (292.35±31.23 vs 262.16±22.02 ng/ml, P<0.05) with statistically significant difference (P<0.05). There was no significant difference between the control group and CIA experimental group. Immunohistochemical showed similar results with ELISA. Western blotting and RT-qPCR showed that MMP-3 protein and mRNA expression was increased after IL-22 stimulation in a dose-dependent manner. Conclusion: IL-22 and MMP-3 play an important role in the pathogenesis of rheumatoid arthritis. IL-22 could regulate the expression of MMP-3, and bone marrow mesenchymal stem cells could reduce the expression of MMP-3 in the treatment of rheumatoid arthritis by reducing the expression of IL-22.