GENERATION OF TOLEROGENIC DENDRITIC CELLS UNDER THE PERSISTENT INFLAMMATION STIMULATION

ABSTRACT

Immunosuppression, commonly accompanied by persistent inflammation, is a key feature in the later phase of sepsis. However, the pathophysiological mechanisms underlying this phenomenon remain unclear. Dendritic cells (DCs), specifically tolerogenic DCs (tolDCs), play a crucial role in this process by regulating immune responses through inducing T cell anergy and releasing anti-inflammatory cytokines. Nevertheless, the existing cell models are inadequate for investigating tolDCs during the immunosuppressive phase of sepsis. Therefore, this study aimed to develop a novel in vitro model to generate tolDCs under chronic inflammatory conditions. We have successfully generated tolDCs by exposing them to sublethal lipopolysaccharide (LPS) for 72 h while preserving cell viability. Considering that IL-10-induced tolDCs (IL-10-tolDCs) are well-established models, we compared the immunological tolerance between LPS-tolDCs and IL-10-tolDCs. Our findings indicated that both LPS-tolDCs and IL-10-tolDCs exhibited reduced expression of maturation markers, whereas their levels of inhibitory markers were elevated. Furthermore, the immunoregulatory activities of LPS-tolDCs and IL-10-tolDCs were found to be comparable. These dysfunctions include impaired antigen presenting capacity and suppression of T cell activation, proliferation, and differentiation. Notably, compared with IL-10-tolDCs, LPS-tolDCs showed a reduced response in maturation and cytokine production upon stimulation, indicating their potential as a better model for research. Overall, in comparison with IL-10-tolDCs, our data suggest that the immunological dysfunctions shown in LPS-tolDCs could more effectively elucidate the increased susceptibility to secondary infections during sepsis. Consequently, LPS-tolDCs have emerged as promising therapeutic targets for ameliorating the immunosuppressed state in septic patients.

Dynamic increase in myoglobin level is associated with poor prognosis in critically ill patients: a retrospective cohort study

Background

Myoglobin is an important biomarker for monitoring critically ill patients. However, the relationship between its dynamic changes and prognosis remains unclear.

Methods

We retrospectively enrolled 11,218 critically ill patients from a general and surgical intensive care unit (ICU) of a tertiary hospital between June 2016 and May 2020. Patients with acute cardiovascular events, cardiac and major vascular surgeries, and rhabdomyolysis were excluded. To investigate the early myoglobin distribution, the critically ill patients were stratified according to the highest myoglobin level within 48 h after ICU admission. Based on this, the critically ill patients with more than three measurements within 1 week after ICU admission were included, and latent class trajectory modeling was used to classify the patients. The characteristics and outcomes were compared among groups. Sensitivity analysis was performed to exclude patients who had died within 72 h after ICU admission. Restricted mean survival time regression model based on pseudo values was used to determine the 28-day relative changes in survival time among latent classes. The primary outcome was evaluated with comparison of in-hospital mortality among each Trajectory group, and the secondary outcome was 28-day mortality.

Results

Of 6,872 critically ill patients, 3,886 (56.5%) had an elevated myoglobin level (≥150 ng/mL) at admission to ICU, and the in-hospital mortality significantly increased when myoglobin level exceeded 1,000 μg/mL. In LCTM, 2,448 patients were unsupervisedly divided into four groups, including the steady group (n = 1,606, 65.6%), the gradually decreasing group (n = 523, 21.4%), the slowly rising group (n = 272, 11.1%), and the rapidly rising group (n = 47, 1.9%). The rapidly rising group had the largest proportion of sepsis (59.6%), the highest median Sequential Organ Failure Assessment (SOFA) score (10), and the highest in-hospital mortality (74.5%). Sensitivity analysis confirmed that 98.2% of the patients were classified into the same group as in the original model. Compared with the steady group, the rapidly rising group and the slowly rising group were significantly related to the reduction in 28-day survival time (β = -12.08; 95% CI -15.30 to -8.86; β = -4.25, 95% CI -5.54 to -2.97, respectively).

Conclusion

Elevated myoglobin level is common in critically ill patients admitted to the ICU. Dynamic monitoring of myoglobin levels offers benefit for the prognosis assessment of critically ill patients.

Recombinant erythropoietin protective and related effects on brain injury in premature infants

OBJECTIVE

The aim of this study was to investigate the protective effect of recombinant erythropoietin at different doses on brain injury in premature infants and the related effects on blood routine, liver function, intellectual development, mental development index (MDI), psychomotor development index (PDI), etc. PATIENTS AND METHODS: A total of 120 premature infants were divided into four groups, including experimental group A (n=30), experimental group B (n=30), experimental group C (n=30) and control group (n=30). The experimental group was treated with different doses of recombinant erythropoietin for brain injury protection of premature infants, while the control group with conventional methods.

RESULTS

There was no statistical significance in all test indicators of the four groups of patients before the intervention. After the intervention experiment, the S-100B index was p<0.05, and the erythropoietin (EPO) index was p<0.05. In the comparison of IL-6 indicators, the indicators of the experimental group were reduced after the comparison experiment, and there were significant differences, p<0.05. In neonatal behavior evaluation, there was a statistical difference between groups A and B and the control group (p<0.05), and no statistical significance was shown between group C and the control group (p>0.05). In the intelligence test comparison, the F value of the experimental group was 3.113 three months after treatment. After six months, the F value was 3.654. After nine months, the F value was 3.392 with p<0.05. In the comparison of blood routine indicators, the p-values of four indicators between groups were more than 0.05. In the comparison of liver function indexes, the indexes of groups A, B, and C were significantly changed before and after treatment, and the data after treatment were significantly different from those before treatment, p<0.05. In the comparison of development, there were no significant differences observed in the p-values of the two indicators of vigorous exercise and language in the experimental group.

CONCLUSIONS

Recombinant erythropoietin has a protective effect on infants with brain injury and can improve the intellectual development of premature infants, but has no significant effect on blood routine indicators. It can effectively improve the MDI, PDI, and related cytokines of premature infants, and has certain significance for the treatment of brain injury.

Study Protocol of a Multicenter, Randomized, Single-Blind Trial: Efficacy and Safety of Remimazolam Tosylate for Sedation in ICU Patients

INTRODUCTION

Pharmacodynamic and pharmacokinetic studies in animal experiments and a phase 1 study suggested remimazolam tosylate as an effective and safe sedation/anesthetic agent. However, the effects and safety dose of remimazolam for light sedation in intensive care unit (ICU) patients are not clear and should be confirmed in a phase 2 study.

METHODS

Sixty ICU patients requiring sedation treatment and undergoing mechanical ventilation will be enrolled and randomly assigned to a high dose group (HD group, 30 cases) and a low dose group (LD group, 30 cases) in a 1:1 ratio. Patients in both groups will be sedated using remimazolam tosylate in a primary dose of 0.08 mg/kg and a range of 0-2.0 mg/kg/h after randomization. Dose adjustment will be made at the range of every 0.1 mg/kg/h in the LD group and 0.2 mg/kg/h in the HD group to maintain the target Richmond Agitation and Sedation Score (RASS) at - 2 to + 1. The primary outcome will be the proportion of subjects that meet the following conditions: the time within the range of RASS (- 2 to + 1) accounts for 70% of the study drug administration time; without other rescue treatments. Secondary outcomes including the percentage time to reach the sedation goal; the proportion of subjects receiving rescue sedation and/or analgesic, and the mean dose of rescue drug throughout the study period; duration of mechanical ventilation; recovery time to full consciousness and nursing scores. Evaluations of safety including adverse events (AEs), serious AEs, physical examination, laboratory examination, etc. OUTCOME: The results of this study will provide crucial information for the use of remimazolam tosylate for ICU sedation.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT05152303.

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China, 2002-2019, and Predictions to 2030

OBJECTIVE

This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.

METHODS

Data were obtained from the China national vital registration system. Significant changes in mortality were assessed by Joinpoint regression. Age-period-cohort analysis was used to explain the reasons for the changes. Future mortality and counts were predicted by the Bayesian age-period-cohort model.

RESULTS

Between 2002 and 2019, a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded. The age-adjusted mortality rates (AAMRs) of women showed a downward trend. The annual percent changes (APC) were -3.5% (-5.2%, -1.7%) for urban women and -2.8% (-3.7%, -1.9%) for rural women. By contrast, the AAMRs per 100,000 for rural men aged 25-44 years continued to rise from 9.40 to 15.46. The AAMRS for urban men aged 25-44 years and urban and rural men aged 45-64 years did not change significantly. Between 2020 and 2030, the projected stroke deaths are 1,423,584 in men and 401,712 in women.

CONCLUSION

Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China. Targeted health policy measures are needed to address the burden of stroke in the young generation, especially for rural men, with a focus on the prevention and management of high risk factors.

[Energy and nutrients intake from complementary foods of children aged 6-23 months in China in 2019-2021]

OBJECTIVE

To describe the energy and nutrients intake from complementary foods of children aged 6-23 months in different areas of China.

METHODS

The data was from the National Special Program for Science &amp; Technology Basic Resources Investigation-China Children&apos;s Nutrition and Health System Survey and Application of 0-18 Years Old Children. Children aged 6-23 months(n=546) were included in the current study. Demographic characteristics, socioeconomic status and birth status were collected through questionnaire survey. We used 24-hour weighted dietary record method to collect the intake of complementary foods. Energy, protein, fat, carbohydrate, calcium, iron, zinc, selenium, potassium, vitamin A, vitamin B_1, vitamin B_2 and vitamin C intakes were calculated by using Chinese Food Composition Database.

RESULTS

For children aged 6-8 months, 9-11 months, 12-17 months and 18-23 months, the energy intake from complementary foods was 156.1, 258.0, 388.7 and 581.1 kcal, respectively. The protein intake was 5.1, 10.1, 15.0 and 21.7 g, respectively. The fat intake was 3.3, 6.7, 9.5 and 15.9 g, respectively. The calcium intake was 38.7, 54.8, 78.6 and 106.9 mg, respectively. The iron intake was 1.3, 2.2, 3.5 and 5.3 mg, respectively. The zinc intake was 0.7, 1.4, 2.0 and 2.9 mg, respectively. The vitamin A intake was 83.7, 100.3, 157.4 and 180.4 μgRAE, respectively. The vitamin B_1 intake was 0.1, 0.2, 0.2 and 0.3 mg, respectively. The vitamin B_2 intake was 0.1, 0.1, 0.2 and 0.3 mg, respectively. The vitamin C intake was 1.8, 6.3, 9.5 and 19.2 mg, respectively. Compared with the World Health Organization recommended value of nutrients density, the density of protein from complementary foods for children aged 6-23 months was higher(2.6-3.8 mg/100 kcal vs.0.9-1.0 mg/100 kcal). The density of iron(1.0, 0.9 mg/100 kcal vs.4.5, 3.0 mg/100 kcal) and zinc(0.5, 0.5 mg/100 kcal vs.1.6, 1.1 mg/100 kcal) was lower for children aged 6-8 months and 9-11 months, respectively.

CONCLUSION

The main issues of complementary food for children in China were high protein for children aged 6-23 months and low iron and zinc for infants aged 6-11 months.

N,S-Chelating triazole-thioether palladium for the one-pot synthesis of biaryls

In this work, for the one-pot two-step coupling reaction of aryl halides with bis(pinacol)diboron, we first applied a phosphorus-free N,S-chelated triazole sulfide palladium-catalyzed system. At the same time, we also carried out careful ligand design to explore the effect of the environment around the coordinating sulfur atom on the reaction. Experiments have shown that the N2-thioether substituted 1,2,3-triazlole palladium is an optimal catalyst The reaction could also reach up to quantitative yield in 4 h with only 1 mol% catalyst. Moreover, some low-activity aryl chlorides can also be coupled with bis(pinacolato)diboron under this catalytic system. We were able to obtain biaryls containing various functional groups in good to excellent yields.

[Association of beverages intake with myopia among 11-14-year-old Chinese children in 2019-2021]

OBJECTIVE

To describe beverages intake and its association with myopia among 11-14-year-old children in China.

METHODS

Multi-stage stratified cluster random sampling was used and children aged 11 to 14 years were selected from 28 cities and rural areas in 14 provinces in China, and a total of 12 397 children were included in this study. Information including demographic characteristics, myopia status, dietary intake, physical activity, screen time, sleep duration were collected from questionnaire survey.

RESULTS

During 2019-2021, the prevalence of myopia among children aged 11 to 14 in China was 45.0%. The median beverages intake was 42.7 g/d. Children who did not drink beverages and whose beverages intake was &lt;150 g/d and ≥150 g/d accounted for 42.8%, 44.8% and 48.4%, respectively. Multivariate Logistic regression analysis showed that girls&apos; beverages intake ≥150 g/d was still a risk factor for the prevalence of myopia after controlling for confounding factors such as age, area, physical activity, screen time, sleep duration and intake of sugary food(OR=1.24, 95%CI 1.08-1.42, P&lt;0.05). Among children with myopia, mild myopia, moderate and above myopia accounted for 71.6% and 28.4% among boys and 73.8% and 26.3% among girls, respectively. There was no statistically significant regression between beverages intake and myopia in boys and girls regardless of whether confounding factors were adjusted(P &gt;0.05).

CONCLUSION

Children&apos;s beverages intake was generally common in China in 2019-2021. Children who consumed higher beverages were more likely to have myopia than that did not consume beverages.

[Relationship between sugary food intake and myopia in 11-14 years old Chinese children in 2019-2021]

OBJECTIVE

To investigate the relationship between the intake of sugary foods and the occurrence and development of myopia in children aged 11-14 in China.

METHODS

In the 28 urban and rural survey sites in 14 provinces that implemented the "China Children&apos;s Nutrition and Health System Survey and Application for 0-18 Years Old" project, a multi-stage stratified random cluster sampling method was adopted, and finally 12 397 adolescent children aged 11 to 14 were selected in the analysis. Demographic characteristics, myopia information and the intake of sugary food(cakes, preserved fruits, candies, chocolates and ice cream) were collected through questionnaires. Multifactor Logistic regression was used to analyze the relationship between sugary food intake and myopia in children.

RESULTS

The median daily intake of sugary foods(cakes, preserved fruits, candies, chocolates and ice cream)of 11-14 year old boys and girls in China was 11.4 g and 11.2 g respectively, 33.9% of boys and 34.2% of girls consumed ≥22 g of sugary food every day. The myopia rates of boys with intakes of &lt;2 g, 2-21 g and ≥22 g were 36.0%, 39.2% and 41.6%, and girls&apos; myopia rates were 45.9%, 51.8% and 55.1%. The result of Logistic regression analysis showed that after controlling for confounding factors such as age, gender, region, weekly high-intensity physical activity time, daily screen time, daily sleep time and daily intake of sugary beverages, compared with boys whose daily intake of sugary food was less than 2 g, the risk of myopia for boys whose daily intake of sugary food reached 2-21 g and ≥22 g was 1.18 and 1.23 times, for girls whose daily intake was less than 2 g, the risk of myopia was 1.27 times and 1.38 times for girls whose intake reached 2-21 g and ≥22 g(P&lt;0.05). No matter whether confounding factors were controlled or not, there was no correlation between the intake of sugary foods and the degree of myopia(P&gt;0.05).

CONCLUSION

The consumption of sugary food such as cakes, preserved fruits, candies, chocolates and ice cream among children aged 11 to 14 in China is common, and there is a certain degree of positive correlation with the prevalence of myopia, but no correlation is observed with the degree of myopia.

[Current status and challenges of anticoagulation management in extracorporeal membrane oxygenation]

The anticoagulant management of extracorporeal membrane oxygenation(ECMO) is facing great challenges. Complications related to the coagulation system such as bleeding or embolism are one of the main factors affecting the mortality of patients. How to control the dynamic balance between thrombosis and bleeding complications has become the top priority of ECMO management. This article reviews the coagulation changes during ECMO support, how to choose appropriate anticoagulant drugs and anticoagulation monitoring methods, aiming to explore the best anticoagulation strategy for ECMO patients.

Unilateral cerebral ischemia induces morphological changes in the layer V projection neurons of the contralateral hemisphere

Decreased blood flow to the brain causes stroke and damage to neuronal networks. Neuronal damage occurs not only in the infarct core but also in areas away from the infarcts. This study was aimed to assess alterations of the cortical projection neurons that were distantly connected with the infarcts. Unilateral cortical ischemia was generated by middle cerebral artery occlusion in the right somatosensory cortex. Pre-labeled thalamocortical neurons disappeared, whereas contralateral callosal projection neurons survived 48 h post-ischemia. The unilateral ischemia increased the total length, segment length and the spine volume of dendrites from layer V callosal neurons in the homotopic cortex of the contralateral hemisphere. The morphological remolding of the contralateral cortical neurons cannot be reproduced by the spinal cord hemisection that cuts axons of corticospinal projection neurons of layer V. The data suggest that the retrograde degeneration of axons may not account for the early morphological changes in the contralateral cortex. We hypothesize that the loss of innervations from the ischemic cortex may bring in adaptive changes to the connected neurons, and adult cortical neurons can adjust their morphology to meet the reduction of synaptic inputs. This study may improve our understanding of the re-organization of cortical circuits following focal cerebral ischemia and help the development of new treatments designed to minimize the disability associated with stroke.

POS1558-HPR INFLUENCING FACTORS ON WORK BURNOUT OF PRE-EXAMINATION AND TRIAGE NURSES UNDER THE NORMAL EPIDEMIC PREVENTION AND CONTROL

Background

Nurse is a high-risk groups work fatigue feeling, which seriously affects the quality of conventional work efficiency and bureden pressures for contradiction between nurses and patients especially during the COVID-19 pandemic.Normalized epidemic prevention and control during the preview triage nurse need to all patients to the hospital and the accompanying personnel carries on the preliminary screening.COVID-19 fixed point hospital preview triage nurse with an infected person contact, more prone to anxiety,depression, results in the decrease of efficiency, to treat the service object formulation work sense of fatigue performance, etc.

Objectives

To explore the influencing factors of work burnout of pre-test and triage nurses under normal epidemic prevention and control.

Methods

A total of 110 pre-test and triage nurses from 4 Grade-A hospitals in Shanxi Province were enrolled in this study. The general data questionnaire, Nurse Job Burnout Scale, Pittsburgh Sleep Quality Index Scale, Self-Rating Anxiety Scale and Self-Rating Depression Scale were investigated towork burnout of pre-examination and triage nurses. Comparison between groups using two Independent sample t-test and single factor variance analysis. Multiple regression were applied to analysis factors affecting nurse fatigue feeling dimensions by SPSS22.0. P values<0.05 were considered significant.

Results

As shown in Table 1, different professional title, department, and the sleep quality of preview triage nurses emotional exhaustion dimension comparison(P<0.001), different department nurses to personalized level dimension comparison(P<0.05), nurse personal accomplishment dimension comparison of different cultural levels(P<0.05). Professional title, working department, sleep quality and educational level were the influencing factors of job burnout of pre-test and triage nurses.

Table 1.

Univariate analysis of job burnout of pre-examination triage nurses from different dimensions.

ItemNumberJob BurnoutEmotional exhaustionDepersonalizationPersonal accomplishmentscoreF(t)PscoreF(t)PscoreF(t)Pgender0.0200.8880.1620.6890.3190.575 female10020.10±13.676.98±6.1528.40±13.41 male1021.00±12.088.20±9.5225.98±8.70age(year)5.5110.0074.1430.0210.7500.477 18~253020.33±12.408.40±7.3328.07±6.97 26~304013.60±11.624.00±3.5526.65±10.70 31~404027.00±13.489.20±6.9924.35±8.79marriage-0.9390.352-1.1550.2530.6150.541 unmarried5218.38±13.306.04±6.4027.00±9.99 married5821.79±13.578.03±6.4025.48±8.29job title5.7390.0062.3200.1080.6110.547 junior nurse5216.12±12.945.96±5.9827.26±8.33 senior nurse3819.68±12.536.63±6.1426.50±10.62 supervisor nurse2031.70±10.3810.90±7.2223.40±5.60work experience(year)1.2770.2920.9380.4290.6590.581 ＜12024.80±15.877.60±6.9827.90±5.67 1 ~32418.42±12.056.33±6.5124.25±13.00 4 ~93416.00±10.535.47±6.0324.69±9.16 10 ~203223.06±15.109.06±6.4328.00±7.46department-3.8750.000-2.3370.0230.4010.690 out-patient5413.81±10.505.11±4.3826.70±10.65 emergency5626.32±13.239.00±7.5025.71±7.42average working time per day(hour)0.7910.4591.1250.3322.1730.124 6~6.91815.33±7.925.11±5.2830.56±8.35 7~7.94420.26±13.616.43±7.2827.09±9.33 ≥84822.00±14.888.52±5.8123.61±8.62education degree-0.6430.523-1.0000.3222.4650.017 junior college1816.00±14.764.00±5.4836.50±8.43 college9220.51±13.427.33±6.4725.39±8.70SAS(score)2.0800.0421.6370.1080.4980.621 ≤503417.74±12.716.16±5.3327.12±8.74 >507625.65±13.759.18±8.1625.79±9.31SDS(score)0.2400.8110.8250.4130.4280.671 ≤507219.58±12.946.11±3.9626.58±9.66 >503820.50±13.857.61±7.4025.47±8.05PSQI(score)2.3790.0212.0290.047-0.5210.604 ≤74017.06±12.175.80±4.9826.69±9.33 >77025.65±14.089.35±8.0225.35±8.79

Conclusion

In the COVID-19 epidemic, managers should pay more attention to the main factors that affect the sense of exhaustion of pre-test and triage nurses, and take targeted intervention measures to alleviate the sense of exhaustion of nurses, so as to ensure the safety of nursing.

Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 82001740).

Disclosure of Interests

None declared

The crystal structure of dichlorido-(2-((4-phenyl-2H-1,2,3-triazol-2-yl)methyl)pyridine-κ2 N,N′)palladium(II), C14H12Cl2N4Pd

C14H12Cl2N4Pd, monoclinic, P21/c (no. 14), a = 11.990(3) Å, b = 13.027(3) Å, c = 9.730(2) Å, β = 92.163(4)°, V = 1518.7(6) Å3, Z = 4, R gt (F) = 0.0290, wR ref (F 2) = 0.0856, T = 296(2) K.

CCDC no.: 2118554

National Nutrition and Health Systematic Survey for Children 0-17 Years of Age in China

The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China (CNHSC) was to collect basic data on the nutrition, development, and health status for children in different regions across China using evidence-based, reliable, and cost-effective approaches. Children and their parents or guardians from seven regions (south, southwest, north, northwest, eastern, central, and northeast China) in China were recruited. A multi-stage stratified randomized sampling method was used. Two provinces were randomly sampled from each of the seven regions, from which one urban district and one rural country were also randomly sampled, resulting in a total of 28 survey counties/districts. Dietary surveys, health examinations, laboratory testing, and questionnaires were used to collect dietary intake, nutritional status, child development, and health status information. Nutrition, health, and lifestyle assessment of children and their parents was determined using the Knowledge Attitude Practice (KAP) survey. Greater than 100,000 children (38,000 children < 6 years of age and 66,000 children 6-17 years of age) completed the survey. The survey provided comprehensive data on child nutrition and health status for future studies and will serve as the basis for an integrated nutrition and health improvement strategies proposal for children in China.

[Status of infant and young child feeding using World Health Organization 2021 indicators in China]

OBJECTIVE

To describe the feeding status of infant and young child aged 6-23 months in China.

METHODS

Data was from the China Nutrition and Health Surveillance among 0-5 Years Old Children and Lactating Women in 2013.Stratified multistage cluster sampling method was used, and 9983 children aged 6-23 months were involved. We analyzed the infant and young child feeding practices with World Health Organization(WHO) 2021 updated indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010.We used Rao-Scott Chi-square test for statistical difference.

RESULTS

The proportions of children aged 6-23 months meeting minimum dietary diversity(MDD) was 34.5%(95% CI 28.8%-40.2%); it was over 50% in large cities, and only 20.4% in poor rural areas. The proportions of children aged 6-23 months meeting minimum meal frequency(MMF) was 69.2%(95% CI 64.7%-73.7%); it was about 80% in large cities, medium and small cities, and only 45.3% in poor rural areas. The proportions of children aged 6-23 months meeting minimum acceptable diet(MAD)was 23.7%(95% CI 19.2%-28.2%), it was 44.2% in large cities, and less than 10% in poor rural areas. No consistent differences were observed between boys and girls for all 3 dietary indicators(MDD, MMF and MAD), and there was significant difference in different areas and various months of age(P&lt;0.05).

CONCLUSION

The minimum dietary diversity and minimum acceptable diet among children aged 6-23 month were not optimal in China, especially in poor rural areas.

Prevalence and Correlates of Healthy Aging Among Elderly Aged 65 Years and Over - 6 PLADs, China, 2019

Summary

What is already known on this topic?

Healthy aging among Chinese older people has low prevalence. Some sociodemographic and lifestyle factors were shown to be associated with healthy aging.

What is added by this report?

The age-adjusted prevalence of healthy aging in the 6 provincial-level administrative divisions (PLADs) of China is 15.8 % in 2019. County-level factors, such as the prevalence of healthy communities in a county, as well as some sociodemographic variables and physical exercise, are potential factors of healthy aging.

What are the implications for public health practice?

These findings showed that more targeted actions, including generalizing healthy communities and individual-level interventions, may be of great importance for healthy aging.

Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China

BACKGROUND

Systemic corticosteroids are now recommended in many treatment guidelines, although supporting evidence is limited to 1 randomized controlled clinical trial (RECOVERY).

OBJECTIVE

To identify whether corticosteroids were beneficial to COVID-19 patients.

METHODS

A total of 1514 severe and 249 critical hospitalized COVID-19 patients from 2 medical centers in Wuhan, China. Multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]) were used to estimate the association of corticosteroid use with risk of in-hospital mortality in severe and critical cases.

RESULTS

Corticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to the non-corticosteroid group, systemic corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality in either severe cases (HR = 1.77; 95% CI, 1.08-2.89; P = 0.023), or critical cases (HR = 2.07; 95% CI, 1.08-3.98; P = 0.028). Findings were similar in time-varying Cox analysis. For patients with severe COVID-19 at admission, corticosteroid use was not associated with improved or harmful outcome in either PSM or IPTW analysis. For critical COVID-19 patients at admission, results were consistent with multivariable Cox model analysis.

CONCLUSION

Corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan. Absence of the beneficial effect in our study in contrast to that observed in the RECOVERY clinical trial may be due to biases in observational data, in particular prescription by indication bias, differences in clinical characteristics of patients, choice of corticosteroid used, timing of initiation of treatment, and duration of treatment.

Survival analysis of patients with primary gallbladder cancer from 2010 to 2015: A retrospective study based on SEER data

This study aims to assess the survival status of patients with Primary gallbladder cancer (PGC) and analyze the prognosis factors to facilitate the exploration of the prevention and therapeutic strategies of PGC.Data from 2433 PGC patients collected from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER*Stat, SPSS 23.0 and GraphPad Prism 8 were used for statistical analyses. Kaplan Meier analysis was performed for the survival curve, log-rank test analyses were used to compare the survival rate difference and Cox regression analyses were performed to determine the prognosis factors.A total of 2433 PGC cases were reported from 2010 to 2015. The median age was 64.2 ± 10.4 years old and the percentages of the white patients were 73.7% (1794/2433). The percentage of patients who received surgery treatment was 82.1% (1998/2433). The overall median survival time of all patients was 19 months and the 5-year survival rate was 28.8%. The 5-year survival rate of PGC patients in pN2 stage dropped to 0% and the 5-year survival rate for PGC patients with distant metastasis was only 2.7%. Age, tumor size, grade, pT stage, pM stage were risk factors for prognosis, surgery or not and radiation or not were protective factors for prognosis.Survival analysis of PGC patients based on the SEER database have provided an opportunity for understanding PGC prognosis and the basis for the exploration of viable PGC prevention and therapeutic strategies.

[Validity and reliability of physical activity questionnaires in children and adolescents: a Meta-analysis]

Objective: This review is to systematically summarize the studies examining physical activity questionnaires in children and adolescents and assess the overall validity and reliability, providing evidence on epidemiology research of physical activity in youth. Methods: A meta-analysis was performed using Stata 14.0 software. PubMed/Medline and EMBASE databases using the following terms:'Physical Activity'AND (' Questionnaire'OR'Self-report'OR'Recall') AND'Valid*'AND (' Reliab*'OR'Reproducib*'OR'Sensitiv*'OR'Responsiv*') AND (' Child*' OR'Adolescen*'OR'Youth') were searched from January 2008 to December 2018. Articles meeting the inclusion criteria were screened and adopting 'COnsensusbased Standards for the selection of health status Measurement Instruments' to evaluate the quality of the included studies. Results: This review yielded 17 articles on 20 different physical activity questionnaires, the total number of 2 778 participants for validity study and 2 137 participants for reliability study. The combined values of correlation coefficients in validity study were 0.27 (95%CI: 0.23-0.31) for moderate-to-vigorous intensity physical activity, 0.24 (95%CI: 0.18-0.30) for moderate intensity physical activity, 0.33 (95%CI: 0.24-0.42) for vigorous intensity physical activity. The combined values of intraclass correlation coefficients in reliability study were 0.75 (95%CI: 0.68-0.83) for moderate-to-vigorous intensity physical activity, 0.56 (95%CI: 0.46-0.65) for moderate intensity physical activity, 0.68 (95%CI: 0.61-0.75) for vigorous intensity physical activity. Conclusion: Until now, no questionnaires were identified for good validity and reliability to assess the physical activity level in young population.

Transesophageal echocardiography instead or in addition to transthoracic echocardiography in evaluating haemodynamic problems in intubated critically ill patients

Background

Transesophageal echocardiography (TEE) performed by intensivists is increasingly used in critically ill patients. However, TEE is usually not the preferred monitoring tool, especially when transthoracic echocardiography (TTE) appears to have addressed the clinical problems. As a result, it remains largely unknown whether TEE is a clinically valuable replacement or supplement for TTE as a primary tool in evaluating haemodynamic problems in critically ill surgical patients. The purpose of this study was to assess the diagnostic and therapeutic value of TEE instead or in addition to TTE in critically ill surgical patients with hemodynamic instability.

Methods

A prospective observational study was conducted. A total of 68 consecutive patients were enrolled from December 2016 to February 2018. TEE was routinely performed in addition to TTE, and the imaging data from TTE and TEE were successively disclosed to two different primary physicians, who reported any resulting changes in management. The two physicians were required to reach a consensus if there was any disagreement. The results of the additional TEE examination were compared with the clinical findings and TTE information. The image quality of TTE views was classified as a good (score 2), suboptimal (score 1) or poor view (score 0). According to the scores of TTE images, the patients were divided into two groups: patients with adequate TTE views (score ≥6) and inadequate TTE views (score <6).

Results

The results of additional TEE examination were classified into four categories. TEE failed to provide additional information about the initial diagnosis and therapy (class 1) in 26 patients (38.2%). Of the remaining 42 patients (61.8%), TEE instead or in addition to TTE revealed new findings or led to significant changes in therapy, as TTE supplied inadequate information. TEE used in addition to TTE led to a new diagnosis without therapeutic implications (class 2) in 11 patients (16.2%) and made a major clinical contribution leading to a therapeutic change (class 3) in 23 patients (33.8%). TEE used instead of TTE determined the diagnosis and therapy in 8 patients (11.8%) whose haemodynamic problems could not be addressed by TTE (class 4). In total, TEE had critical therapeutic benefits (class 3 and 4) that was not provided by TTE in 31 patients (45.6%). Of particular concern was that TEE had a higher proportion of therapeutic benefits to patients with inadequate TTE views than those with adequate TTE views (54.3% vs. 27.3%, P=0.036).

Conclusions

TEE as a feasible clinical tool is useful for critically ill surgical patients with hemodynamic instability, especially for the patients with inadequate TTE views. TEE instead or in addition to TTE could provide valuable information for diagnosis, which may bring significant therapeutic benefits.

Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

INTRODUCTION

With intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.

RESEARCH DESIGN AND METHODS

We collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.

RESULTS

Elevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.

CONCLUSIONS

Elevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

Validity and Reliability of Chinese Physical Activity Questionnaire for Children Aged 10-17 Years

OBJECTIVE

This study is aimed to report the development, the reliability and validity of the Chinese Children Physical Activity Questionnaire (CCPAQ) which was designed for the assessment of physical activity pattern in young population in China.

METHODS

The CCPAQ was administered for two times in 119 children (mean age 13.1 ± 2.4 years; boys 47%) to examine reliability by using intraclass correlation coefficients. Validity was determined in 106 participants by agreement with the CCPAQ measures and the objective method, the ActiGraph accelerometer. Data on physical activity pattern including time spent on different intensities and total physical activity, sedentary behavior as well as physical activity energy expenditure were used to assess the validity with Spearman's correlation coefficient and the Bland-Altman plots.

RESULTS

The reliability coefficient of the CCPAQ ranged from 0.63-0.93 (Intra-class correlation coefficient). Spearman's correlation coefficient for validity of time spent on total physical activity and sedentary behavior were all 0.32 (P < 0.001), and for physical activity energy expenditure was 0.58 (P < 0.001). Time spent on moderate-to-vigorous physical activity and light physical activity showed a relatively low correlation with the accelerometer (rho = 0.20, P = 0.040; rho = 0.19, P = 0.054).

CONCLUSION

The CCPAQ appears to be a promising and feasible method to assess physical activity pattern in Chinese children.

[Assessment on the capacity for prevention and control programs for chronic non-communicable diseases in China, in 2014]

Objective: To assess the capacity of prevention and control on chronic non- communicable diseases (NCDs) in China. Methods: On-line questionnaire survey was adopted by 3 395 CDCs at provincial, municipal and county (district) levels and 3 000 primary health care units, and assess on capacity of policy, infrastructure, capacity of training and guidance, cooperation, surveillance, intervention and management, assessment and scientific research from September 2014 to March 2015. Results: (1) Capacity of policy: 23 (71.9%) provincial, 139 (40.6%) municipal and 919 (31.2%) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs. (2) Capacity of infrastructure: 25 (78.1%) provincial, 136 (39.8%) municipal and 529 (18.0%) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs, with 9 787 staff members, accounting for 5.0% of the total CDC personnel, working on NCDs prevention and control programs. 68.1% of the CDCs had special funding set for NCDs prevention and control. (3) Capacity of training and guidance: 2 485 CDCs (74.9%) held all kinds of training on prevention and control of NCDs. 2 571 (87.3%) CDCs at the county (district) level provided technical guidance for primary health care units. (4) Capacity of cooperation: 42.0% of the CDCs had experiences collaborating with the mass media. (5) Capacity of surveillance: 73.8% of the CDCs had set up programs for death registration while less than 50.0% of the CDCs had implemented surveillance programs on major NCDs and related risk factors. In terms of primary health care units, 32.4% of them had set up reporting system for newly developed stroke case and 29.9% of them having programs on myocardial infarction case reporting. (6) Capacity of intervention and management: 69.1% and 68.2% of the CDCs conducted individualized intervention programs on hypertension and diabetes, while less than 40.0% CDCs conducting intervention programs on other NCDs and risk factors. More than 90.0% of the primary health care units carried out follow-up surveys on hypertension and diabetes. However, only 17.4% and 13.7% of the CDCs working on hypertension and diabetes patient management programs while 83.7% and 80.4%, of them following the standardized guidelines for management, with successful rates of control as 59.2% and 55.2%, respectively. (7) Capacity of assessment: 32.4% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs. (8) Capacity of scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs. Conclusions: Compared with the results of previous two surveys, the capacity on policies set for the prevention and control programs improved continuously, at all level NCDs, but remained relatively weak, especially at both county (district) and primary health care units.

Change of Stunting, Wasting and Overweight Among Children Under 5 in China During 2000–2010 (P11-099-19)

Objectives

To describe the change of children under 5 years old that are stunted, wasted or overweight without overlapping status in China during 2000–2010.

Methods

Data from 2000, 2005, and 2010 were sourced from the National Food and Nutrition Surveillance System. About 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites. Anthropometric measurements for children under 5 were conducted. Nutritional status was determined according to WHO child growth standards (2006).Stunting, wasting and overweight is defined as HAZ < -2 SD, WHZ < -2 SD and WHZ > + 2SD respectively.

Results

The prevalence of wasting only remained less than 3%(2.05%, 2.55%, and 2.03%); the prevalence of stunting only declined from 18.70% in 2000 to 8.77% in 2010; the prevalence of overweight only increased from 2.56% in 2000 to 5.62% in 2010; the prevalence of stunting, wasting or overweight declined from 24.55% in 2000 to 17.60% in 2010; the same trends were found in urban and rural areas during 2000–2010.

Conclusions

The prevalence of stunting is decreasing, and childhood overweight has increased dramatically in China that need for effective interventions.

Funding Sources

Unicef China Office; Ministry of Science and Technology, Special survey of basic science and technology resources 2017FY101107.

Effect of Systolic Cardiac Function on Passive Leg Raising for Predicting Fluid Responsiveness: A Prospective Observational Study

BACKGROUND

Passive leg raising (PLR) represents a "self-volume expansion (VE)" that could predict fluid responsiveness, but the influence of systolic cardiac function on PLR has seldom been reported. This study aimed to investigate whether systolic cardiac function, estimated by the global ejection fraction (GEF) from transpulmonary-thermodilution, could influence the diagnostic value of PLR.

METHODS

This prospective, observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015. Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF (<20%) and a near-normal-GEF (≥20%) group. Within each group, baseline hemodynamics, after PLR and after VE (250 ml 5% albumin over 30 min), were recorded. PLR-induced hemodynamic changes (PLR-Δ) were calculated. Fluid responders were defined by a 15% increase of stroke volume (SV) after VE.

RESULTS

Twenty-five out of 38 patients were responders in the GEF <20% group, compared to 26 out of 40 patients in the GEF ≥20% group. The thresholds of PLR-ΔSV and PLR-Δ cardiac output (PLR-ΔCO) for predicting fluid responsiveness were higher in the GEF ≥20% group than in the GEF <20% group (ΔSV: 12% vs. 8%; ΔCO: 7% vs. 6%), with increased sensitivity (ΔSV: 92% vs. 92%; ΔCO: 81% vs. 80%) and specificity (ΔSV: 86% vs. 70%; ΔCO: 86% vs. 77%), respectively. PLR-Δ heart rate could predict fluid responsiveness in the GEF ≥20% group with a threshold value of -5% (sensitivity 65%, specificity 93%) but could not in the GEF <20% group. The pressure index changes were poor predictors.

CONCLUSIONS

In the critically ill patients on mechanical ventilation, the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function. Thus, cardiac systolic function must be considered when using PLR.

TRIAL REGISTRATION

Chinese Clinical Trial Register, ChiCTR-OCH-13004027; http://www.chictr.org.cn/showproj.aspx?proj=5540.

[Technical specification for clinical application of critical ultrasonography]

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.

miR‑23a downregulation modulates the inflammatory response by targeting ATG12‑mediated autophagy

Autophagy, part of the innate immune defense mechanisms, is activated during the initial phase of septic insult. Previous studies indicated that micro (mi)RNAs are additionally involved in the host response to sepsis; however, the association between miRNAs and autophagy during this process is not fully understood. To study the role of miRNA (miR)-23a in autophagy initiated by sepsis, macrophages treated with lipopolysaccharides, in addition to blood samples from patients, were evaluated for miR-23a expression levels. Cell viability, inflammatory mediators and autophagic markers were investigated following overexpression or inhibition of miR-23a. The results suggested that miR-23a was suppressed subsequent to septic insult, promoting autophagy and suppressing a hyper inflammatory response, leading to enhanced cell viability. A luciferase assay and western blot analysis confirmed ubiquitin-like protein ATG12 to be the target of miR-23a. The present study revealed that the downregulation of miR-23a regulates an inflammatory response during septic insult via autophagy promotion.

PKR inhibition mediates endotoxin tolerance in macrophages through inactivation of PI3K/AKT signaling

Following long‑term exposure to endotoxins, macrophages enter an immunosuppressive state that renders them unable respond to subsequent exposures to endotoxin, a phenomenon that is termed 'endotoxin tolerance'. Endotoxin tolerance increases the risks of secondary infection and mortality in patients with sepsis. In endotoxin‑tolerant macrophages, the mixed variation of gene transcription is referred to as macrophage reprogramming. The mechanisms underlying macrophage reprogramming remain unclear at present. Interferon‑induced double‑stranded RNA‑dependent protein kinase (PKR) is a widely expressed serine/threonine protein kinase. In addition to antiviral effects, PKR regulates the transcription of inflammatory cytokines by affecting transcription factors. However, the role of PKR in macrophage reprogramming remains to be elucidated. In the present study, the expression of inflammatory cytokines differed in lipopolysaccharide (LPS)‑tolerant RAW264.7 macrophages compared with LPS‑activated macrophages. Specifically, reverse transcription‑quantitative polymerase chain reaction results demonstrated that the mRNA levels of tumor necrosis factor‑α, interleukin‑1β (IL‑1β), C‑X‑C motif chemokine ligand 11, C‑C motif chemokine ligand (CCL17), CCL22 and suppressor of cytokine signaling 3 were decreased, and mRNAs levels of arginase‑1 (Arg1) and nitric oxide synthase 2 (iNOS) were increased, in LPS‑tolerant macrophages compared with LPS‑activated macrophages. Furthermore, western blot analysis demonstrated that the protein levels of phosphorylated (p)‑PKR were significantly decreased in the LPS‑tolerant cells. PKR activation with rotenone (10 µM) abrogated endotoxin tolerance by increasing the levels of the IL‑1β, CCL17 and CCL22 mRNAs and decreasing the levels of the Arg1 and iNOS mRNAs. Furthermore, western blotting demonstrated that AKT was markedly inactivated in endotoxin‑tolerant cells, as indicated by reduced p‑AKT levels. However, levels of p‑AKT were markedly increased following rotenone‑induced PKR activation in endotoxin‑tolerant cells. Ly294002 (10 µM), a phosphatidylinositol‑4,5‑bisphosphate 3‑kinase (PI3K)/AKT signaling inhibitor, partially reversed the rotenone‑induced alleviation of endotoxin tolerance. These results demonstrated that PKR inhibition mediated endotoxin tolerance in macrophages, and these effects were partially mediated by PI3K/AKT signaling. PKR may be a potential target for the treatment of endotoxin tolerance in patients with sepsis.

OTX1 regulates cell cycle progression of neural progenitors in the developing cerebral cortex

The progenitor cells in the cerebral cortex coordinate proliferation and mitotic exit to generate the correct number of neurons and glial cells during development. However, mechanisms for regulating the mitotic cycle of cortical progenitors are not fully understood. Otx1 is one of the homeobox-containing transcription factors frequently implicated in the development of the central nervous system. Mice bearing a targeted deletion of Otx1 exhibit brain hypoplasia and a decrease in the number of cortical neurons. We hypothesized that Otx1 might be crucial to the proliferation and differentiation of cortical progenitors. Otx1 knockdown by in utero electroporation in the mouse brain reduced the proportion of the G₁ phase while increasing the S and M phases of progenitor cells. The knockdown diminished Tbr1+ neurons but increased GFAP+ astrocytes in the early postnatal cortex as revealed by lineage tracing study. Tbr2+ basal progenitors lacking Otx1 were held at the transit-amplifying stage. In contrast, overexpression of wildtype Otx1 but not an astrocytoma-related mutant Y320C inhibited proliferation of the progenitor cells in embryonic cortex. This study demonstrates that Otx1 is one of the key elements regulating cortical neurogenesis, and a loss-of-function in Otx1 may contribute to the overproduction of astrocytes in vivo.

[Clinical value of lung ultrasound in the late goal-directed fluid removal in critically ill patients underwent fluid resuscitation]

OBJECTIVE

To investigate the clinical value of lung ultrasound in the late goal -directed fluid removal in critically ill patients underwent fluid resuscitation.

METHODS

A prospective study was conducted. Forty patients underwent fluid resuscitation were enrolled in the Department of Surgical Intensive Care Unit of The First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to June 2015. Lung and heart ultrasound were conducted for lung B-lines and left ventricular ejection fraction (EF). Serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), central venous pressure (CVP) and serum creatinine were also measured and fluid balance was recorded in all patients enrolled.

RESULTS

Among the 40 patients enrolled, 35 patients survived and 5 died. In patients survived, B-lines reached its peak at 12(30)h after admitted to ICU. It started to decrease instantly after the peak and reached zero at (39±34) h. A higher peak was followed with more fluids to be removed later and longer ICU stay (P<0.01). Moreover, when compared with the survivors, B-lines in death reached a higher peak[7(8) vs 3(4), P<0.01]and without the tendency to drop down. EF was lower in death than in survivor (44.5%±3.5% vs 69.2%±11.0%, P<0.05). A lower EF was found to be followed with a higher peak of B-lines. The peak time of NT-proBNP and clinical dehydration treatment were later than the peak time of B-lines in survivors.

CONCLUSIONS

Fluid overloading occurs in late stage after resuscitation in critically ill patients. Lung ultrasound B-lines, which is more sensitive than the NT-proBNP and CVP, could help to monitor the patient's fluid status and guide the late goal-directed fluid removal.

Abstract P3-03-14: ERα propelled drug-resistance-facilitating global DNA hypermethylation by promoting the DNMT1 gene expression

This abstract was not presented at the symposium.

A simple bioscore improves diagnostic accuracy of sepsis after surgery

BACKGROUND

Rapid and accurate prediction for sepsis remains a challenge in surgical intensive care units. Detection of individual biomarkers is often of marginal usefulness, and several biomarkers are difficult to measure in the clinical setting. The aim of this study was to evaluate the diagnostic and prognostic performance of three routine biomarkers, procalcitonin (PCT), B-type natriuretic peptide (BNP), and lymphocyte percentage, as individual or in combination for sepsis in surgical critically ill patients.

MATERIALS AND METHODS

Circulating PCT, BNP, and lymphocyte percentage were measured in surgical patients on admission to the intensive care unit. A bioscore system combining these biomarkers was constructed. All studied variables were analyzed according to the diagnosis and clinical outcomes of sepsis.

RESULTS

A total of 320 consecutive patients were included in the analysis. One hundred fifty-six patients presented with sepsis. In the patients with sepsis, levels of PCT and BNP increased and lymphocyte percentage decreased. For individual biomarkers, PCT achieved the best area under the curve for the diagnosis of sepsis, whereas the diagnostic performance of the bioscore was better than that of each individual biomarker (area under the curve, 0.914 [95% confidence interval, 0.862-0.951]). Levels of BNP and bioscore increased in nonsurvivors in the entire cohort, but the accuracy of these two variables for mortality prediction was lower than that shown by Acute Physiology and Chronic Health Evaluation II score. Furthermore, bioscore failed to predict outcomes in septic patients.

CONCLUSIONS

A simple bioscore combining PCT together with BNP and lymphocyte percentage improves the diagnostic accuracy for sepsis in surgical critically ill patients but fails to predict outcomes in surgical patients with sepsis.

[Assessment on the capacity for programs regarding chronic non-communicable diseases prevention and control, in China]

OBJECTIVE

To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention (CDCs) at all levels and grass roots health care institutions, in China.

METHODS

On-line questionnaire survey was adopted by 3 352 CDCs at provincial, city and county levels and 1 200 grass roots health care institutions.

RESULTS

1) On policies: 75.0% of the provincial governments provided special funding for chronic disease prevention and control, whereas 19.7% city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control, accounting for 4.2% of all the CDCs' personnel. 40.2% CDCs had special funding used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs, 96.9% at provincial level, 50.3% at city level and 42.1% at county level had organized training on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation: 20.2% of the CDCs had experience in collaborating with mass media. 5) Surveillance capacity: 64.6% of the CDCs at county level implemented death registration, compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions, 18.6% implemented new stroke case reporting system but only 3.0% implemented program on myocardial infarction case reporting. 6) Intervention and management capacity: 36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes, while less than another 20% intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9% , with rates on standard management as 73.8% and 80.1% and on control as 48.7% and 50.0%, respectively. 7) Capacity on Assessment: 13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8) On scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs.

CONCLUSION

Policies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions, both prevention and control programs on chronic diseases did not seem to be effective.

Association of children's eating behaviors with parental education, and teachers' health awareness, attitudes and behaviors: a national school-based survey in China

BACKGROUND

In China, childhood obesity is a growing health issue. Eating behaviors among children can be influenced by both the family and school environment. We examine the association between these environments and eating habits among children.

METHODS

A total of 11 270 fourth to sixth grade school children, 11 270 of their fathers or mothers, and 1348 teachers from 48 schools were sampled using a multistage cluster random sampling method. Questionnaires collected information on eating behaviors among children, non-communicable chronic disease (NCD)-related health knowledge and behaviors among teachers, and education levels among parents. Mixed effect logistic regression models were used to describe the key associations between eating behaviors among children and teacher and parental characteristics.

RESULTS

Health awareness, positive health attitudes, never-smoking and regular-exercise among teachers was positively associated with healthy eating behaviors among their students (having breakfast, vegetables and dairy products every day; P < 0.05), and negatively associated with the unhealthy behaviors (daily intake of fried foods and desserts and sugary beverages; P < 0.05). More than one parent having a high school level or above was positively related to healthy eating behaviors among their children (P < 0.05), but its associations with high-calorie eating habits were negative in urban and positive in rural areas (P < 0.05).

CONCLUSIONS

School-based interventions which target health-related awareness, attitude and behaviors among school teachers may help improve school-aged children's eating behaviors. Parental education levels may help guide efforts to target children at higher risk of unhealthy eating habits.

[Assessment of capacity for chronic noncommunicable diseases prevention and control of the Center for Disease Control and Prevention Organizations in China]

OBJECTIVE

To evaluate the capacity for noncommunicable diseases (NCDs) prevention and control in the Centers for Disease Control and Prevention (CDCs) in China.

METHODS

All CDCs in China, including provincial, city and county CDCs were surveyed by questionnaires designed by China CDC including resource provided, capacity and efforts for NCDs.

RESULTS

(1) RESOURCE: 7483 staff members worked on NCDs prevention and control, only accounting for 4.0% of all the CDCs' personnel; 23.6% of the staff members devoted their time to NCDs control less than 6 months in 2008. Fundings for NCDs prevention and control only accounted for 2.29%, 1.70% and 2.69% of the total funds of provincial, city and county CDCs, respectively. (2) Capacity: The proportions of CDCs that had professional institutes of NCD at provincial, city and county level were 100.0%, 62.8% and 43.7% respectively. CDCs mainly cooperated with health agencies regarding NCDs prevention and control programs. 34.7% of the staff members had educational background of college undergraduate or higher, 12.1% had senior professional titles, 61.7% of them worked for NCDs less than 5 years. The average person-times of continuing education in NCDs were 21.90, 4.60 and 1.68 at the provincial, city and county CDCs respectively. 8.7% of the CDCs sent their staff members for advanced studies on NCDs. All provincial CDCs carried out surveillance but only 4.2% of them published reports of NCDs in all the CDCs during the past three years. (3) Efforts: 43.5% and 30.8% of the county CDCs carried out surveillance and intervention of NCDs respectively in 2008.

CONCLUSION

RESOURCEs for NCDs prevention and control were quite limited in CDCs. Fundings and staff members for NCDs were not enough, compared to the heavy disease burden of NCDs. Capacity for NCDs prevention and control need to be improved.

Gemcitabine in combination with intraperitoneal cisplatin in advanced hepatobiliary cancers

e15666

Background: Standard chemotherapy for advanced hepatobiliary cancers remains undefined. This study was to observe the therapeutic effect of gemcitabine combined with intraperitoneal cisplatin for the treatment of advanced hepatobiliary cancers and analyze their toxicities. Methods: Patients with measurable hepatobiliary cancers were unrandomized into gemcitabine (GEM) + cisplatin (DDP) (GEM group) and epirubicin (EPI) + DDP (EPI group). GEM was used intravenously by infusion for 30 min with the dose to 1,000 mg/m2 on day 1 and 8; cisplatin was infused intraperitoneal with a dose of 25mg/m2 on day1, 3 and 5. Twenty-one days counted as one cycle. After 2 cycles, treatment efficacy and adverse events were evaluated according to WHO criteria. Results: A total of 76 patients were enrolled from May 2004 to May 2006, with 30 patients for EPI group and 46 patients for GEM group, and all the patients were eligible for effectiveness analysis. Among GEM group patients, there was no complete response. The partial response rate was 32.61% and clinical benefit response (CR+ PR +SD) was 67.39%. All those data mentioned above were significantly higher than that of EPI group. The main adverse re-ction was hematologic toxicity, while nonhematologic toxicity was mild. Conclusions: This study demonstrated that combination gemcitabine with intraperitoneal infusion of cisplatin was an effective and safety treatment for the patients with advanced hepatobiliary cancers.

No significant financial relationships to disclose.

The impact of CVB3 infection on host cell biology

CVB3 myocarditis can lead to dilated cardiomyopath (DCM). DCM is one of the leading causes of the need for heart transplantation, so it is important to understand the life cycle of CVB3 and its interactions with the host cell. Infection causes rapid death of host cardiomyocytes by altering normal cellular homeostasis for the efficient release of progeny virion. In this chapter, we will examine the impact that CVB3 replication has on host cell biology, from events that take place at receptor ligation to progeny virus release. The primary focus will be on the myriad of signalling pathways that are activated at all stages of virus replication and their downstream effects. We will also discuss some of the extracellular effects of infection as well as immune and matrixmetalloprotease activation. Interactions of host cell proteins with the 5' untranslated region (UTR) are required for translation and replication of CVB3. These interactions do not always benefit the virus since the interactions of a 28-kDa host protein with the 5' UTR are thought to be responsible for inhibitory activity against CVB3. Finally, we will discuss how the elucidation of the different stages of replication has provided the opportunity to develop novel strategies for combating CVB3 infection.

Inhibition of glycogen synthase kinase 3beta suppresses coxsackievirus-induced cytopathic effect and apoptosis via stabilization of beta-catenin

Coxsackievirus B3 (CVB3), a common human pathogen for viral myocarditis, induces a direct cytopathic effect (CPE) and apoptosis on infected cells. To elucidate the mechanisms that contribute to these processes, we studied the role of glycogen synthase kinase 3beta (GSK3beta). GSK3beta activity was significantly increased after CVB3 infection and addition of tyrosine kinase inhibitors blocked CVB3-triggered GSK3beta activation. Inhibition of caspase activity had no inhibitory effect on CVB3-induced CPE; however, blockage of GSK3beta activation attenuated both CVB3-induced CPE and apoptosis. We further showed that CVB3 infection resulted in reduced beta-catenin protein expression, and GSK3beta inhibition led to the accumulation and nuclear translocation of beta-catenin. Finally, we found that CVB3-induced CPE and apoptosis were significantly reduced in cells stably overexpressing beta-catenin. Taken together, our results demonstrate that CVB3 infection stimulates GSK3beta activity via a tyrosine kinase-dependent mechanism, which contributes to CVB3-induced CPE and apoptosis through dysregulation of beta-catenin.

Interaction of farnesylated PRL-2, a protein-tyrosine phosphatase, with the beta-subunit of geranylgeranyltransferase II

Protein of regenerating liver (PRL)-1, -2, and -3 comprise a subgroup of closely related protein-tyrosine phosphatases featuring a C-terminal prenylation motif conforming to either the consensus sequence for farnesylation, CAAX, or geranylgeranylation, CCXX. Yeast two-hybrid screening for PRL-2-interacting proteins identified the beta-subunit of Rab geranylgeranyltransferase II (betaGGT II). The specific interaction of betaGGT II with PRL-2 but not with PRL-1 or -3 occurred in yeast and HeLa cells. Chimeric PRL-1/-2 molecules were tested for their interaction with betaGGT II, and revealed that the C-terminal region of PRL-2 is required for interaction, possibly the PRL variable region immediately preceeding the CAAX box. Additionally, PRL-2 prenylation is prequisite for betaGGT II binding. As prenylated PRL-2 is localized to the early endosome, we propose that this is where the interaction occurs. PRL-2 is not a substrate for betaGGT II, as isoprenoid analysis showed that PRL-2 was solely farnesylated in vivo. Co-expression of the alpha-subunit (alpha) of GGT II, betaGGT II, and PRL-2 resulted in alpha/betaGGT II heterodimer formation and prevented PRL-2 binding. Expression of PRL-2 alone inhibited the endogenous alpha/betaGGT II activity in HeLa cells. Together, these results indicate that the binding of alphaGGT II and PRL-2 to betaGGT II is mutually exclusive, and suggest that PRL-2 may function as a regulator of GGT II activity.

Expression and significance of cell cycle-related proteins Cyclin Dl, CDK4, p27, E2F-l and Ets-1 in chondrosarcoma of the jaws

To elucidate the expression and significance of cell cycle-associated proteins in chondrosarcoma of the jaws, Cyclin Dl, CDK4, p27, E2F-l and Ets-l expressions were examined in chondrosarcoma and osteochondroma of the jaws by immunohistochemical ABC method. The results demonstrated that Cyclin Dl, CDK4, p27, E2F-1 and Ets-1 were positive 75% (15 of 20), 60% (12 of 20), 25% (5 of 20), 65% (13 of 20) and 60% (12 of 20) in chondrosarcoma of the jaws, respectively. There was no remarkable difference in the expression of these proteins among histological grades of the chondrosarcoma (P>0.05). In osteochondroma of the jaws, CDK4 and E2F with an equal positivity of 12.5% (1 of 8), whereas p27 was positive 75% (6 of 8). None of the osteochondroma cases was immunohistochemically positive for Cycin Dl and Ets-1. In addition, the positive rate of Cyclin Dl, CDK4, E2F-l and Ets-1 proteins was significantly higher, whereas p27 was lower in chondrosarcoma than in osteochondroma of the jaws (P<0.05). These data show that the expression of cell cycle regulatory proteins is altered in chondrosarcoma of the jaws: cyclin Dl, CDK4, E2F-1 and Ets-1 are over-expressed and p27 is low-expressed.

[The ultrastructure of bone morphogenetic protein 2 gene transfected human periodontal ligament fibroblasts]

OBJECTIVE

To observe the ultrastructure of bone morphogenetic protein 2 (BMP-2) gene transfected human periodontal ligament fibroblasts (HPDLFs).

METHODS

An expression vector for BMP-2 was transfected into HPDLFs by using Lipofect AMINE. The stable expression of BMP-2 was determined by in situ hybridization and immunohistochemistry. The ultrastructure of the transfected cells was examined by transmission electron microscope.

RESULTS

The results showed that the BMP-2 gene transfected cells showed expansive endoplasmic reticulum, incremental myelin sheath-like figures and matrix vesicles. The collagenous fibrillae was distributed widely intercellular.

CONCLUSIONS

The results suggests that BMP-2 gene transfection tends to accelerate HPDLFs into osteoblast-like cells.