[A retrospective study of postoperative adjuvant therapy following immunotherapy combined with targeted therapy and sequential curative surgical procedures for initially unresectable hepatocellular carcinoma]

Objective: To report the clinical efficacy of adjuvant therapy based on pathological results following immunotherapy combined with targeted therapy and sequential curative surgical procedures in patients with initially unresectable hepatocellular carcinoma. Methods: This is a retrospective case series study. Data from 100 patients who underwent adjuvant therapy based on pathological results following immunotherapy combined with targeted therapy and sequential curative surgical procedures with long-term survival were collected from December 2018 to December 2022 at the Faculty of Hepato-Pancreato-Biliary Surgery, First Medical Center, Chinese People's Liberation Army General Hospital. According to inclusion and exclusion criteria, 47 cases were included, among which patients who met the discontinuation criteria and maintained a drug-free tumor-free status. Thirty-nine male and eight female patients were included, with an age of (54.2±18.8)years(range:38 to 73 years) at initial diagnosis. At the time of initial diagnosis, 43 cases (91.5%) were classified as Barcelona Clinic Liver Cancer(BCLC) stage C. Survival curves were made using Kaplan Meier method. Results: Forty-seven patients underwent R0 resection, all achieved a drug-free tumor-free state through postoperative adjuvant therapy based on pathological examination results. Thirty-six patients(76.6%) maintained a drug-free tumor-free survival status for more than 6 months,28 patients(59.6%) for more than 12 months,and 8 patients(17.0%) for more than 24 months. The longest drug-free tumor-free survival in this cohort reached 48 months. The median follow-up time in this study was 32 months. After diagnosis, the overall survival rates at 1- and 3- years were 97.7%(95%CI:93.4% to 100%) and 90.7%(95%CI:82.5% to 99.8%). The postoperative recurrence-free survival rates at 1- and 3- years were 91.0%(95%CI:83.0% to 99.8%) and 71.3%(95%CI:58.7% to 86.5%). Conclusions: The adjuvant therapy based on pathological results following immunotherapy combined with targeted therapy and sequential curative surgical approach provides long-term survival benefits for patients with initially unresectable hepatocellular carcinoma. Standardized adjuvant therapy maybe sustain long-term tumor-free status,and achieve drug-free tumor-free survival.

Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.

Constraints on Heavy Decaying Dark Matter from 570 Days of LHAASO Observations

The kilometer square array (KM2A) of the large high altitude air shower observatory (LHAASO) aims at surveying the northern γ-ray sky at energies above 10 TeV with unprecedented sensitivity. γ-ray observations have long been one of the most powerful tools for dark matter searches, as, e.g., high-energy γ rays could be produced by the decays of heavy dark matter particles. In this Letter, we present the first dark matter analysis with LHAASO-KM2A, using the first 340 days of data from 1/2-KM2A and 230 days of data from 3/4-KM2A. Several regions of interest are used to search for a signal and account for the residual cosmic-ray background after γ/hadron separation. We find no excess of dark matter signals, and thus place some of the strongest γ-ray constraints on the lifetime of heavy dark matter particles with mass between 10^{5} and 10^{9}  GeV. Our results with LHAASO are robust, and have important implications for dark matter interpretations of the diffuse astrophysical high-energy neutrino emission.

[Pars plana vitrectomy techniques guiding by the pathological anatomy in rhegmatogenous retinal detachment]

Rhegmatogenous retinal detachment (RRD) is a retinal vitreous disease, with increasing incidence in recent years. Pars plana vitrectomy is one of the most common treatments for RRD. To prevent re-detachment after the primary surgery and guarantee the visual outcome of the patients, we highlight the techniques for RRD during the PPV, including the surgical skills to manipulate the breaks, peripheral retina and vitreous base, meanwhile, empathized on the posterior vitreous detachment and posterior vitreous cortex. The aim is to increase the rate of anatomical re-attachment and to improve visual function.

[A case of diabetic retinopathy with coagulation factor Ⅷ and Ⅻ deficiency]

The patient was a 48-year-old male with a previous history of diabetes mellitus and hypertension. The patient had persistent bleeding after vitrectomy of the left eye, and the patient was examined for abnormal coagulation factor Ⅷ combined with Ⅻ. This case suggests that we need effective control of blood glucose and blood pressure in patients undergoing vitrectomy in clinical work, and adequate examination of coagulation function. Patients with coagulation factor deficiency should be treated with plasma transfusion to supplement coagulation factors before performing the necessary surgical treatment to prevent severe bleeding.

[Knobloch syndrome: a case report]

A 5-year-old girl came to the Tianjin Medical University Eye Hospital in May 2021 because of her poor eyesight after birth. The physical examination showed that she had high myopia, esotropia, horizontal tremor, and high myopia retinopathy of both eyes. After inquiring about her medical history, we found that the baby's occipital cystic mass swelled after birth, and CT examination showed that the occipital skull plate defect with meningocele, but without treatment, at present, the occipital mass had subsided by itself. Considering the eye manifestations and skull changes of the child, it may be conformed to Knobloch syndrome, after the detection of V4 by full exon gene, it was found that the child had the compound heterozygous variation of pathogenic gene COL18A1, and Knobloch syndrome was definite, Knobloch syndrome is a rare autosomal recessive hereditary disease with typical features of high myopia, retinal detachment and occipital encephalocele. At present, there is no clear treatment plan, and gene therapy may be an effective treatment for Knobloch syndrome in the future.

[Relationship and coordination between water pollution control and mosquito breeding]

Change of water environment is strongly associated with mosquito breeding. Because of long-term effectiveness, low cost and high environmental compatibility, ecological pollution control systems have been widely used in water pollution control projects. However, the potential effects of mosquito breeding are likely to cause expansion of mosquito populations and an increase in the risk of transmission of vector-borne diseases, which may become an urgent problem to be solved during the water environment "post-remediation" period. This review summarizes the physical, chemical and biological factors affecting mosquito breeding caused by water environment changes and analyzes the effects of water pollution control approaches on mosquito breeding and the underlying mechanisms, so as to promote the interdisciplinary connections between water pollution control and vector control, and avoid secondary disasters caused by ecological environment restoration, such as mosquito infestation. This review may provide insights into the use of technology combinations and water pollution control approaches in vector control.

Exploring Lorentz Invariance Violation from Ultrahigh-Energy γ Rays Observed by LHAASO

Recently, the LHAASO Collaboration published the detection of 12 ultrahigh-energy γ-ray sources above 100 TeV, with the highest energy photon reaching 1.4 PeV. The first detection of PeV γ rays from astrophysical sources may provide a very sensitive probe of the effect of the Lorentz invariance violation (LIV), which results in decay of high-energy γ rays in the superluminal scenario and hence a sharp cutoff of the energy spectrum. Two highest energy sources are studied in this work. No signature of the existence of the LIV is found in their energy spectra, and the lower limits on the LIV energy scale are derived. Our results show that the first-order LIV energy scale should be higher than about 10^{5} times the Planck scale M_{Pl} and that the second-order LIV scale is >10^{-3}M_{Pl}. Both limits improve by at least one order of magnitude the previous results.

17β-Estradiol promotes angiogenesis of stria vascular in cochlea of C57BL/6J mice

It is widely accepted that the stria vascularis (SV) in cochlea plays a critical role in the generation of endocochlear potential (EP) and the secretion of the endolymph. 17β-estradiol (E2) is the most potent and abundant endogenous estrogen during the premenopausal period, thus, considered as the reference estrogen. This study aimd to investigate the protective effect of E2 by promoting the expression of vascular endothelial growth factor (VEGF) and thus promoting the vascular regeneration of the SV in elderly mice. After being treated with E2 either in vivo or in vitro, the hearing threshold changes of C57BL/6J elder mice continuously reduced, endothelial cell morphology improved, the number of endothelial cells (ECs) tubular nodes increased significantly, the ability of tubular formation enhanced significantly and the expression of VEGF increased. In vitro, cell model in conjunction with in vivo ovariectomized model was established to demonstrate for the first time that E2 promotes angiogenesis by promoting the secretion of VEGF through the phosphatidylinositol 3-kinase (PI3K)/AKT pathway (PI3K/AKT). In conclusion, E2 demonstrated potent angiogenesis properties with significant protection against Age-Related Hearing Loss (ARHL), which provides a new idea for the improvement of ARHL.

[Treatment strategy of proliferative membranes in proliferative diabetic retinopathy based on the recognition of morphology characteristics]

Diabetic retinopathy is one of the three major microvascular complications of diabetes. Proliferative diabetic retinopathy (PDR) is an important ocular complication that affects the vision and quality of life of patients. Vitrectomy is the most effective treatment option. The characteristic of fibrovascular membranes in PDR varies at different stages of the disease, which requires specific treatment strategy and techniques. In order to improve the clinical diagnosis and treatment of PDR, this article proposes that different treatment methods should be correctly adopted for different types of proliferative membranes on the basis of fully understanding the tissue morphology of these membranes, and more attention should be paid to the treatment of the vitreous body to achieve more effective therapeutic effects. (Chin J Ophthalmol, 2021, 57: 881-885).

[The effect of large-conductance calcium-activated potassium channels on the migration of pericytes in the mice of senile cochlear stria vascularis]

Objective: To investigate whether large conductance calcium-activated potassium channel (BK(Ca)) was involved in the migration of pericytes (PC) in the mice of senile cochlear stria vascularis capillaries PC. Methods: C57BL/6J mice were divided into 3-month (n=10) and 12-month groups (n=10). Auditory brainstem response (ABR) was used to test the hearing threshold of each group. The immunofluorescence was used to detect the expression changes of osteopontin (OPN) and β-BK(Ca) channels on cochlear stria vascularis PC. The morphological changes of perivascular cells in cochlea were observed by transmission electron microscope (TEM). Cell experiment: The PC, which were in the stria vascularis of the cochlea were primary cultured and identified. A cell senile model was made with D-gal. The appropriate intervention concentration of low galactose (D-gal) was determined by CCK8. β-galactosidase (SA-β-gal) staining was used to evaluate the cell decrept level. The change of BK(Ca) channels current on PC were recorded by whole cell patch clamp technique. The expression of BK(Ca) channels on PC was detected by immunofluorescence. The migration and invasion ability of two groups were detected by using Scratch test and Transwell. The levels of OPN and β-BK(Ca) channels were detected by Western blot. SPSS 22.0 software was used to analyze the data. Results: The ABR threshold in the 12-month group was higher than 3-month group (t=12.66, P<0.01). In the 12-month group, the expression of β-BK(Ca) channel was lower and the expression of OPN was increased (t=14.64, P<0.01; t=20.73, P<0.01). In TEM, cochlear stria vascularis PC were tightly connected to endothelial cells in 3-month group, while PC were loosely connected to endothelial cells or PC soma were separated from the capillary in 12-month group. Cell experiment: The positive rate of PC in the primary cultured cochlear stria vascularis is above 95%. Compared with the SA-β-gal stained cells in the control group, the positive rate of 15 mg/ml D-gal intervention PC was 85% (t=36.90, P<0.01). Whole cell patch clamp BK(Ca) channels current decreased in the D-gal group compared with the young group PC (t=12.18, P<0.05). The OPN expression in the senile group was higher than control group (t=16.30, P<0.01), while the β-BK(Ca) channels expression was decreased (t=11.98, P<0.01; t=15.72, P<0.05), and migration ability raised (t=7.91, P<0.01;t=7.59, P<0.01). After intervened of BK(Ca) channels specific blocker IBTX in the D-gal group, the expression of OPN and migration were increased (t=4.26, P<0.05; t=5.88, P<0.01; t=21.97, P<0.01). Conclusion: PC migration capacity were increased during the senile period, and the expression of β-BK(Ca) channel was decreased. The administration of IBTX, a specific blocker of BK(Ca) channel, at the cell level could increase the migration capacity, suggesting that BK(Ca) might be involved in the migration of PC in the stria vascularis of the aging cochlea.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Relationship between Wound Age and Serum Marker Metabolites of Rats Skin Incised Wound

Abstract

Objective To observe the metabolomics changes of serum after skin incision of rats and to determine the wound age of skin incision. Methods A rat skin incision model was established, 21 SD rats were divided into 1 h, 2 h, 4 h, 8 h, 16 h, 24 h after skin incision groups and the control group, then blood was taken from rats in the experimental groups at the corresponding time points after injury, and taken from the control group directly. Gas chromatography-mass spectrometry （GC-MS） technology was used to detect serum metabolites and screen marker metabolites, then orthogonal partial least square-discriminant analysis （OPLS-DA） model was used to establish a regression model for the relationship between marker metabolite content and wound age to determine wound age of skin. Results GC-MS was used to detect the serum collected, and 21 marker metabolites were obtained through initial screening, and 4 marker metabolites were further analyzed and screened using multivariate statistical analysis methods. There was no correspondence between the change rule of the serum content and wound age, therefore it cannot be used directly to determine wound age. OPLS model could be used to obtain regression models of the content and wound age of 21 marker metabolites and 4 marker metabolites, both of which can determine wound age, but the prediction accuracy of the regression model of 21 marker metabolites was significantly higher. Conclusion Using metabolomics to establish a regression model of the metabolite content and wound age has the potential to be applied to skin incision wound age determination.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

[Minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy]

Objective: To report the efficacy and safety of minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy (PDR) and the effect of preoperative retinal photocoagulation on prognosis. Methods: Case-series study and cohort study. This study included 48 severe PDR patients (53 eyes). There are 28 males and 20 females. The average age was 53.5 (range, 40.0 to 59.0) years old. Patients were divided into two groups according to whether preoperative retinal photocoagulation was performed. Under the guidance of the concept of minimally invasive vitrectomy, all patients received intravitreal injection of conbercept 3 days before standard pars plana vitrectomy with a 27G+ vitrectomy system. To relieve traction, the proliferative fibrovascular membrane was divided into islands as small as possible. It was not necessary to pursue a complete removal of the proliferative membrane. The 27G+ vitrector was flexibly applied as a multifunctional tool for membrane removal by reducing frequencies at which the device entered and left the eye. Intraocular retinal photocoagulation was performed in the main area. The primary outcome measures were best corrected visual acuity (BCVA) and retinal reattachment rate, and the secondary outcome measures were intraoperative and postoperative complications. Statistical analysis was performed using t test, rank sum test and χ² test. Results: All patients tolerated intravitreal conbercept, with no serious intraoperative or postoperative adverse events. Postoperative BCVA values were improved significantly compared with preoperative values (χ²=125.11, P<0.01). The mean logMAR BCVA improved from 1.90 (1.30, 2.30) preoperatively to 1.00 (0.70, 1.90) at 1 week postoperatively, 0.8 (0.5, 1.3) at 1 month postoperatively, 0.7 (0.40, 1.20) at 3 months postoperatively, and 0.70 (0.40, 1.20) at 6 months postoperatively. The visual function increased progressively with time. Postoperatively, the primary and final reattachment rates were 92.5% (50/53) and 96.2% (51/53), respectively. Abnormal intraocular pressure lasted for more than one week occurred in 2 eyes; Vitreous hemorrhage recurred in 5 eyes; Retinal detachment occurred in 4 eyes (7.5%); No postoperative endophthalmitis, choroidal detachment or incision related retinal hole occurred. The intraoperative and postoperative parameters in the preoperative retinal photocoagulation group were better than the preoperative non-photocoagulation group, but the difference was not significant (P>0.05). Conclusions: Minimally invasive vitrectomy is fully qualified for the management of severe PDR, with maximized benefits. (Chin J Ophthalmol, 2021, 57:440-446).

Species Identification of Sarcosaprophagous Flies Based on Vein Digital Image Analysis

Objective To identify species of common sarcosaprophagous flies based on digital image analysis of veins, in order to provide new idea for fast and accurate species identification of sarcosaprophagous flies in forensic entomology. Methods Random trapping of 226 male and female sarcosaprophagous flies that comprised of 7 common species, including Sarcophaga peregrina, Parasarcophaga ruficornis, Sarcophaga dux, Seniorwhitea reciproca, Bercaea cruentata, Aldrichina grahami, and Synthesiomysia nudiseta with carrion in the field was conducted. The 17 landmarks on the right wing of each fly were digitally processed and the images were analyzed. The effects of allometry were evaluated using a permutation test. Wing shape variations among 7 sarcosaprophagous fly species and female species was analyzed using canonical variate analysis （CVA）. Additionally, cross-validation test was used to evaluate the reliability of classification. Results Among 7 sarcosaprophagous fly species and female species, the effect of allometry had statistical significance （P<0.05）. The CVA results showed that among 7 sarcosaprophagous fly species and female species, differences in the wing shape were significant, and the first two canonical variates accounted for 82.9% and 84.1% of the total variation of vein shape. Vein digital image analysis can be used to separate the 7 common sarcosaprophagous flies, with an overall species identification accuracy of 81.2%-100.0%, and with a species identification accuracy of 75.0%-100.0% to distinguish the female flies of the 7 sarcosaprophagous flies species. Conclusion Vein digital image analysis is a relatively convenient and reliable method for identification of insect species, which can be used for species identification of common sarcosaprophagous flies.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

[Gender differences in risk factors and characteristics of young patients hospitalized for first acute coronary syndrome]

Objective: To analyze the characteristics of modifiable risk factors, coronary artery lesions, reperfusion and drug treatment in young women hospitalized for first acute coronary syndrome (ACS). Methods: Clinical data of young adults of 18 to 44 years hospitalized for first ACS in Beijing Anzhen Hospital between January 2007 and December 2017 were analyzed. A total of 7 106 young adults with ACS were enrolled, 6 593(92.8%) were male and 513(7.2%) were female. There were 2 254(31.7%) patients with ST-segment elevation myocardial infarction (STEMI), 704(9.9%) patients with non-ST-segment elevation myocardial infarction (NSTEMI) and 4 148(58.4%) patients with unstable angina (UA). Clinical characteristics, laboratory examinations, coronary angiography and medical treatment were recorded. The gender differences in the characteristics of modifiable risk factors and coronary artery stenosis in young patients with ACS were also analyzed. Results: Dyslipidemia (87.5%) followed by overweight/obese(83.8%) and smoking (68.5%) were most prevalent modifiable risk factors in men. Dyslipidemia (63.4%), overweight/obese (63.4%) and hypertension (45.5%) were most prevalent modifiable risk factors in women. The prevalence rates of at least 1 risk factor in men and women patients were 99.1% and 87.9%, respectively. Between 2007 and 2017, the rates of hypertension and overweight/obese in men increased, and the rates of dyslipidemia and smoking decreased (trend P<0.01). The changes of incidence of modifiable risk factors through the years in women were not statistically significant. The rate of men receiving coronary angiography was higher than that in women (96.6% vs 93.4%, P<0.01). Women were more likely to suffer left main coronary artery disease than men (7.3% vs 4.1%, P<0.01). Multi-vessel coronary artery disease occurred more in men (43.4%), and single vessel coronary artery disease occurred more in women (47.0%). Women presented with STEMI had a lower probability of receiving clopidogrel/ticagrelor (76.8% vs 86.1%, P<0.01) and angiotensin Ⅰ-converting enzyme inhibitor/angiotonin receptor blocker (ACEI/ARB) (46.5% vs 60.2%, P<0.01) than that in men. Women presented with UA had a lower probability of receiving aspirin (86.3% vs 89.9%), clopidogrel/ticagrelor (69.7% vs 75.6%), statin (78.8% vs 85.0%) and ACEI/ARB (32.7% vs 38.6%) than men (all P<0.01). Women had a higher probability of presenting Killip II-IV than men (38.6% vs 25.6%, P<0.05). Conclusion: The majority of young patients with ACS were men. The prevalence rates of modifiable risk factors are very high in both man and woman. Compared with man, women with AMI are more likely to develop acute heart failure with lower probability of reperfusion and drug treatment.

[Progress of researches on animal models of Blastocystis hominis infections]

Blastocystis hominis is a common parasitic protozoa in human and animal intestines; however, its pathogenicity remains controversial. Construction of animal models is of great significance to investigate the pathogenicity, pathogenic mechanisms and drug screening of B. hominis. Experimental animals, mode of infections, parasite strains and host immune status are important factors affecting the successful modeling of B. hominis infections in animals. Hereby, we review the progress of researches on animal models of B. hominis infections, and summarize the influencing factors and application of animal models of B. hominis infections, in order to provides insights into the selection of animals models of B. hominis infections.

[Progress of researches on global prevalence of Blastocystis hominis human infections and its subtypes]

Blastocystis hominis is a parasite that parasitizes in the intestines of humans and animals, and is closely related to a variety of gastrointestinal diseases such as abdominal pain and diarrhea. B. hominis is distributed worldwide, and the prevalence of B. hominis infections and dominant subgenotypes vary in countries and in regions from the same country. This paper reviews the global prevalence of B. hominis human infections, its subtypes and geographical distribution, so as to provide insights into the understanding of the global epidemiology of B. hominis and the management of B. hominis infections.

[Safety and efficacy of A1-UV aspheric intraocular lens implantation over the postoperative 5 years]

Objective: To evaluate the clinical safety and efficacy of A1-UV aspheric intraocular lens (IOL) implantation over the postoperative 5 years. Methods: Prospective cohort study. The subjects came from a finished multicenter, randomized and controlled clinical trial with a follow-up period of 1 year from April to November 2012. The clinical research centers were Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Peking University Third Hospital, Tianjin Medical University Eye Hospital, and Daping Hospital of Army Medical University. Cataract patients in the experimental group were implanted with A1-UV type IOL, while cataract patients in the control group were implanted with SN60WF type IOL, and monocular patients were enrolled. From April to May 2018, patients enrolled in the previous study were recalled for follow-up and continued observation. The visual acuity, spherical equivalent, postoperative complications, non-contact intraocular pressure and subjective evaluation results were statistically analyzed preoperatively, at 1 to 2 days, 1 week, 1 month, 3 months, 6 months, 1 year and 5 years after operation. The main statistical methods included Mann Whitney U test, Wilcoxon signed rank test, independent sample t test, chi square test and Fisher exact test. Results: A total of 42 subjects (22 in the experimental group and 20 in the control group) completed 5-year continuous observation. Among the 42 subjects, 28 were female and 14 were male. The age was (70±9) years, and the time from surgery to recall was (5.77±0.19) years. The age, gender distribution, left/right eye distribution, axial length, IOL power and nucleus hardness classification data of the experimental group and the control group were balanced and comparable (all P>0.05). At different visiting time points, there was no significant difference in the best corrected distance visual acuity (BCDVA), best corrected near visual acuity (BCNVA), uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNVA) between the groups (all P>0.05). At 5 years after operation, the UCDVA, BCDVA and BCNVA of the two groups were significantly improved compared with the baseline [all P<0.01; UCDVA was improved from 0.75 (0.30 to 1.30) to 0.10 (-0.10 to 0.70) in the experimental group and from 0.75 (0.30 to 1.60) to 0.20 (-0.10 to 0.80) in the control group; BCDVA was from 0.60 (0.10 to 1.00) to 0.00 (-0.10 to 0.54) in the experimental group and from 0.60 (0.10 to 1.60) to 0.10 (-0.10 to 0.50) in the control group; BCNVA was from 0.55 (0.00 to 1.10) to 0.10 (-0.10 to 0.60) in the experimental group and from 0.55 (0.10 to 1.60) to 0.10 (-0.20 to 0.60) in the control group], but there was no significant change in the UCNVA (both P>0.05). There were no significant differences in the spherical equivalent, intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence and comprehensive evaluation of satisfaction between the groups (all P>0.05). In the experimental group, one eye (4.5%) had an abnormal pupil, one eye (4.5%) had an abnormal IOL with a few particles on the surface of the IOL but no glistening, and 3 eyes (13.6%) had posterior capsular opacification (PCO); in the control group, one eye (5.0%) had an abnormal cornea, five eyes (25.0%) had abnormal IOLs [one eye (5.0%) had IOL calcification, and four eyes (20.0%) had IOL glistening], and one eye (5.0%) had PCO with posterior capsular folds and IOL tilt. There was no significant difference in PCO and IOL abnormality between the two groups (both P>0.05), but there was significant difference in the occurrence of IOL glistening (P=0.04). Conclusion: The long-term effect of A1-UV aspheric IOL on improving the UCDVA is stable and good, with high subjective satisfaction of patients, a low incidence of PCO, no glistening and good biocompatibility, over the postoperative 5 years. (Chin J Ophthalmol, 2021, 57: 41-47).

[The observation of secretogranin Ⅲ in the peripheral blood and vitreous of patients with diabetic retinopathy]

Objective: To study the expression levels of secretogranin Ⅲ (SCG3) in the peripheral blood and vitreous of patients with diabetic retinopathy (DR). Methods: Cross-sectional research. A total of 77 patients (41 men and 36 women, 77 eyes) received vitrectomy in Tianjin Medical University Eye Hospital from May to December 2018, with an average age of (60.75±11.34) years. According to the blood glucose level, diabetes history and fundus status, all the patients were divided into the DR group and the non-diabetic group. According to the patients' blood lipids and body mass index (BMI), patients were further divided into subgroups of high blood lipids, normal blood lipids, high BMI and normal BMI. All patients were tested with eye examinations, height and weight to calculate the BMI, and blood lipid levels in the peripheral blood. The vitreous was collected during the vitrectomy surgery, and the levels of SCG3 in the vitreous and peripheral blood were analyzed by ELISA. All the data were analyzed statistically with Wilcoxon rank sum test. Results: There were 43 patients in the DR group, among whom 25 had hyperlipidemia, 18 had normal blood lipids, 22 had a high BMI, and 21 had a normal BMI. There were 34 patients in the non-diabetic group, among whom 13 had hyperlipidemia, 21 had normal blood lipids, 17 had a high BMI, and 17 had a normal BMI. The level of SCG3 in the DR group [6.02 (4.34, 11.76) ng/ml] was higher than that in the non-diabetic group [4.30 (3.20, 10.78) ng/ml] (Z=-2.339, P =0.019). The level of SCG3 in the hyperlipidemia subgroup of the DR patients [7.94 (5.33, 13.51) ng/ml] was higher than that in the normal blood lipid subgroup of the non-diabetic patients [4.04 (3.12, 7.77) ng/ml] (Z=-3.473, P=0.001), and higher than that in the DR patients without hyperlipidemia [4.45 (3.71, 9.14) ng/ml] (Z=-2.511, P=0.012). The level of SCG3 in the DR patients with a high BMI [7.12 (4.56, 13.12) ng/ml] was higher than that in the non-diabetic patients with a normal BMI [3.53 (3.16, 4.38) ng/ml] (Z=-3.767, P =0.000). The level of SCG3 in the DR patients with a normal BMI [5.72 (4.10, 11.60) ng/ml] was higher than that in the non-diabetic patients with a normal BMI (Z=-2.862, P = 0.004). SCG3 in the plasma was rare or can not be detected. Conclusions: The concentration of SCG3 in the vitreous increase in DR patients. However, SCG3 can not be detected in the healthy vascular system. (Chin J Ophthalmol, 2020, 56: 933-937).

Clone, expression and plasminogen binding property of three fructose-1,6-bisphosphate aldolases from Clonorchis sinensis

Fructose-1,6-bisphosphate aldolase (FbA), a well characterized glycometabolism enzyme, has been found to participate in other important processes besides the classic catalysis. To understand the important functions of three fructose-1,6-bisphosphate aldolases from Clonorchis sinensis (CsFbAs, CsFbA-1/2/3) in host-parasite interplay, the open reading frames of CsFbAs were cloned into pET30a (+) vector and the resulting recombinant plasmids were transformed into Escherichia coli BL21 (DE3) for expression of the proteins. Purified recombinant CsFbAs proteins (rCsFbAs) were approximately 45.0 kDa on 12% SDS-PAGE and could be probed with each rat anti-rCsFbAs sera by western blotting analysis. ELISA and ligand blot overlay indicated that rCsFbAs of 45.0 kDa as well as native CsFbAs of 39.5 kDa from total worm extracts and excretory-secretory products of Clonorchis sinensis (CsESPs) could bind to human plasminogen, and the binding could be efficiently inhibited by lysine analog ε-aminocaproic acid. Our results suggested that as both the components of CsESPs and the plasminogen binding proteins, three CsFbAs might be involved in preventing the formation of the blood clot so that Clonorchis sinensis could acquire enough nutrients from host tissue for their successful survival and colonization in the host. Our work will provide us with new information about the biological function of three CsFbAs and their roles in hostparasite interplay.

[The status and related factors of myopia for children and adolescents aged 5-18 years old in Shaanxi Province in 2018]

In 2018, the myopia detection rate of children and adolescents aged 5-18 years old in Shaanxi Province was 54.9% (11 060/20 144). The myopia detection rate of girls ［58.6%(5 830/9 949)］ was higher than that of boys ［58.6% (3 416/5 830)］ (P<0.001). In children and adolescents, the myopia detection rate increased with the age before their 16 years old, and saw a stable or downward trend after the age of 16. After adjusting the confounding factors, the myopia detection rate of children and adolescents from regions with per capita GDP>100 000 yuan was higherthan that of children and adolescents from regions with per capita GDP<50 000 yuan［OR (95%CI):1.58(1.34-1.87)］.

Distinct genomic profiles of 589 Chinese early-stage breast cancer

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Background: Extensive efforts by The Cancer Genome Atlas (TCGA) Network had provided much of our current understanding of the molecular profile of various solid tumors including breast tumors; however, Asian patients were underrepresented in this cohort. In this study, we aimed to elucidate the comprehensive genetic alteration profile of early-stage breast tumors among Chinese patients. Methods: Surgical tissue samples from 589 Chinese women with stage I-III breast cancer with various histology and molecular subtype consecutively diagnosed at Guangdong Provincial People’s Hospital were sequenced using a panel targeting 520 cancer-related genes spanning 1.64Mb of the human genome. Clinical and genomic data from our cohort was compared with publicly-available data from 1,046 stage I-III breast cancer patients from the TCGA dataset. Results: Based on the analysis of the genetic alteration profile from our cohort, at least one genetic alteration was observed from 98% of the tumor samples, with TP53 (47%), PIK3CA (45%), ERBB2 (30%), and CDK12 (18%) as the most commonly altered genes. The most common genetic alteration types were copy number amplification (43.6%) and missense mutations (36.8%). As compared with the TCGA dataset, our cohort is mostly composed of women 50 years and younger (59.1% vs. 30.4%, P< 0.001), with significantly fewer patients with lobular carcinoma histology (2.4% vs. 19.0%, P< 0.001), and significantly more patients with pathologic stage I tumors (23.3% vs. 17.3%, P= 0.012). Consistently, genetic alterations detected from our cohort affected genes involved in PI3K (63% vs. 56%, P= 0.009) and cell cycle (23% vs. 35%, P< 0.001) pathways, with statistically different genetic alteration rates as compared with the TCGA dataset. Comparison of genetic alteration profile between the two cohorts revealed that our cohort had more frequent genetic alterations in genes including PIK3CA ( P< 0.001), TP53, particularly in hotspot mutations Q192* ( P< 0.001) and A307V/del ( P= 0.02), and ERBB2 amplification ( P< 0.001). Conclusions: Our study contributes to the understanding of the key pathways and specific genetic alterations harbored by Chinese patients with early-stage breast cancer that could potentially be developed as markers of treatment response to targeted therapeutics.

Next-generation sequencing (NGS) identifies a new breast cancer subtype with HER2 low-amplification status as a candidate for targeted therapy

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Background: HER2 expression or amplification qualify patients to receive targeted therapeutics against HER2; however, traditional methods of quantifying HER2 amplification using fluorescence in situ hybridization (FISH) do not include a reliable definition for low level amplification. With the promising response rate of patients with low HER2 amplified-metastatic breast cancer to subsequent-line trastuzumab deruxtecan (DS-8201a) therapy, there is a need to improve the existing criteria to accurately identify patients with low HER2. In our study, we investigate whether HER2 amplification quantified by NGS could provide a method to stratify patients into subgroups. Methods: A total of 774 patients diagnosed with breast cancer from Guangdong Provincial People's Hospital (GDPH) who underwent targeted NGS using 520 or 33 cancer-related genes and had their HER2 status evaluated with either FISH or IHC were included in this study. HER2 status were defined as per 2018 ASCO/ACP guidelines. Results: Our results demonstrate that NGS could quantify HER2 amplification with high sensitivity and specificity, with area under the curve of 0.990 [95%CI: 0.982-0.999]. The receiver operating curve indicated an optimal cut-off of 2.62 copy number (CN) for identifying IHC/FISH HER2-negative status with 97.8% specificity. Meanwhile, the cut-off of ≥ 3.62 CN identified patients with IHC/FISH HER2-positive status with 99.8% specificity. Among the 774 patients, 65.8% (n = 509) had HER2 CN of ≤ 2.62 and were classified as HER2 non-amplified, while 25.8% (n = 199) had HER2 CN of ≥ 3.62, classified as HER2-amplified. The remaining 66 patients (8.5%) had HER2 CN between 2.62 and 3.62, and were the patients with heterogeneous IHC/FISH results, classified using NGS as HER2 low-amplified. Patients with low-amplified (49.0% vs. 38.8%, P < 0.001) and amplified (50.3% vs. 38.8%, P < 0.001) HER2 had significantly more number of copy number amplifications in other gene, including CDK12, RARA, and SPOP (P < 0.001, P < 0.001) than patients with HER2 non-amplified, indicating distinct mutation profile. Conclusions: Our results demonstrate that NGS could provide a more accurate stratification of patients based on their HER2 amplification levels. Patients with low levels of HER2 amplification has a distinct mutation profile, suggesting that NGS could serve as a robust tool to identify patients with HER2 amplification, whether high or low, who could benefit treatment with targeted agents designed against heterogeneous HER2 expression.

Somatic and germline mutation profiles of Chinese breast cancer patients younger than 35

554

Background: Limited studies have investigated the molecular underpinnings driving breast cancer development in Chinese younger women. Based from our previous data, more Chinese women are diagnosed with early-onset breast cancer than in the West. In our study, we aim to investigate the comprehensive mutational profile of Chinese women 35 years old and younger (≤35y) diagnosed with breast cancer. Methods: Targeted sequencing was performed on surgically-removed tumor tissues and blood samples collected from 589 women diagnosed with stage I-III breast cancer of various molecular subtypes at the Guangdong Provincial People’s Hospital (GPDH) using a gene panel interrogating 520 cancer-related genes. We compared the data of 53 women aged ≤35y from our cohort to the data from 33 breast cancer patients aged ≤35y included in The Cancer Genome Atlas (TCGA) dataset. Results: Among the women aged ≤35y with early-stage breast cancer from both cohorts, our cohort had more number of hormone receptor-positive (HR+) patients (GPDH, 72% vs. TCGA, 61%, P< 0.001). Analysis revealed an overall mutation detection rate of 98% in our cohort, with mutations affecting genes involved in the PI3K pathway (47%) and cell cycle pathway (23%). TP53 and PIK3CA were the most commonly mutated genes, with mutation rates of 51% and 25% from our cohort. No statistical difference in mutation profile was found between GPDH and TCGA cohorts. Moreover, germline mutations considered as pathogenic and likely pathogenic (P/LP) in breast cancer susceptibility genes including BRCA1 (n = 4), BRCA2 (n = 2), PALB2 (n = 1), PMS2 (n = 1), PTEN (n = 1), and ATM (n = 1) were detected from 18.9% (10/53) of the patients from our cohort. Women aged ≤35y had significantly more germline BRCA1 mutations than patients > 35y from our cohort (7.5%, 4/53 vs. 2.1%, 11/536 P= 0.049). Conclusions: Our study has identified the involvement of PI3K and cell cycle as the two key pathways in the early development of breast tumors in younger women. In addition, our results also support the role of P/LP germline mutations in breast oncogenesis in Chinese patients with early-onset breast cancer, indicating the need to include a more comprehensive germline mutation screening in our population.

[Clinical analysis of 382 immediately breast reconstruction after mastectomy in Beijing City, Tianjin City and Hebei Province from 2012 to 2016]

Objective: To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. Methods: A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. Results: There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, P=0.000). Conclusions: There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.

[Proteomic analysis of aqueous humor in acute primary angle-closure glaucoma]

Objective: To analyze the difference among expression of aqueous humor proteins in acute primary angle-closure glaucoma (APACG). Methods: Case-control study. The patients with APACG combined cataract (APACG with cataract group) and patients with cataract (cataract group), who had undertaken surgical treatment at the Tianjin Medical University Eye Hospital from October 2016 to June2017 were collected. Upon receipt of patient's consent, 50 μl of aqueous humor were collected with 1 ml syringe and No.1 needle through the surgical access during the surgery, and then injected into a sterile collection tube to be stored at -80 ℃. Those proteins extracted from aqueous humor were analyzed by quantitative proteomic mass spectrometry. The differential significance test was performed by Maxquant significances A approach. The differential proteins of the two groups were screened and determined with the conditions of P<0.05 and difference multiple>2. The functions and signal pathway of differential proteins in aqueous humor were annotated in biological big data, on the basis gene ontology (GO) and the Kyoto gene and genomic encyclopedia (KEGG) analyses. Results: There were 3 males and 7 females with an average age of (68±6) years in the APACG group. The cataract group included 2 males and 8 females with an average age of (71±8) years. There were no statistical differences in gender ratio and age between the two groups (both P>0.05). A total of 91 differential proteins were detected in this experiment, including 50 up-regulated proteins (annexinA1, vimentin, S100 calcium binding protein A8, interleukin 6, C reactive protein, laminin β2, etc.) and 41 down-regulated (keratin 85, γ-crystallin D, syntaxin-binding protein 5, semaphoring 4B, matrilin 2, cathepsin O, cadherin 4, semaphoring 3B, platelet-derived growth factor D, transforming growth factor β, etc.). On one hand, the functions of differential proteins involved in many aspects. AnnexinA1, CD163, S100 calcium-binding protein A8, C reactive protein, interleukin 6 are involved in the inflammatory reaction, cadherin 4 and laminin β2 regulate cell adhesion, matrilin 2, vimentin and laminin β2 participate in tissue fibrosis; on the other hand, KEGG analysis showed that the differential proteins participate diverse signaling pathways such as phosphatidylinositol-3-kinase-protein kinase B signaling pathway, transformation growth factor β signaling pathway, mitogen activated protein kinase signaling pathway, Toll-like receptor signaling pathway, the nuclear factor κ-light chain enhancer of the activated B cells signaling pathway, focal adhension and extracellular matrix receptor interaction pathway and so on. Conclusions: The expression of annexin A1 is significantly up-regulated in the aqueous humor in APACG, while some other factors such as transformation growth factor β, cadherin-4, and matrilin 2 are down-regulated. The change of proteins in aqueous humor is related with the outbreak of APACG. (Chin J Ophthalmol, 2019, 55: 687-694).

Population dynamics of Echinops gmelinii Turcz. at different successional stages of biological soil crusts in a temperate desert in China

The effects of biological soil crusts (BSC) on vascular plant growth can be positive, neutral or negative, and little information is available on the impacts of different BSC successional stages on vascular plant population dynamics. We analysed seedling emergence, survival, plant growth and reproduction in response to different BSC successional stages (i.e. habitats: bare soil, cyanobacteria, lichen and moss crusts) in natural populations of Echinops gmelinii Turcz. in the Tengger Desert of northwest China. The winter annual E. gmelinii is a dominant pioneer herb after sand stabilisation. During the early stages of BSC succession, the studied populations of E. gmelinii were characterised by high density, plant growth and fecundity. As the BSC succession proceeded beyond moss crusts, the fecundity decreased sharply, which limited seedling recruitment. Differences in seedling survival among the successional stages were not evident, indicating that BSC have little effect on survival in arid desert regions. Moreover, E. gmelinii biomass allocation exhibited low plasticity, and only reproductive allocation was sensitive to the various habitats. Our results further suggest that the negative effects of BSC succession on population dynamics are primarily driven by increasing topsoil water-holding capacity and decreasing rain water infiltration into deeper soil. We conclude that BSC succession drives population dynamics of E. gmelinii, primarily via its effect on soil moisture. The primary cause for E. gmelinii population decline during the moss-dominated stage of BSC succession is decreased fecundity of individual plants, with declining seed mass possibly reducing the success of seedling establishment.

Correlation between mutation landscape and clinical outcomes of neoadjuvant therapy in HER2-positive breast cancer patients

579

Background: The standard management of early stage human epidermal growth factor receptor 2 (HER2) positive (+) breast cancer (BC) involves neoadjuvant therapy with combination of chemotherapy and HER2-targeted therapy followed by surgery. However, diverse pathologic responses were observed. We interrogated whether baseline genomic heterogeneity contributes to the varied therapeutic responses. Methods: Capture-based targeted sequencing using a panel consisting of 520 cancer-related genes, spanning 1.6MB of human genome, was performed on tissue biopsy samples, obtained prior to neoadjuvant therapy, of 33 HER2+ women with stage I-III BC. The median age of the cohort was 53. The correlation between genomic alterations and pathologic response were analyzed by multivariate analysis. Results: A majority of them was diagnosed with stage II (67%, 22/33), while 30% (10/33) had stage III and 3% (1/33) had stage I disease. 58% (19/33) were HR+ and 42% (14/33) were HR-. Mutation profiling of baseline samples revealed 349 mutations spanning 145 genes, with TP53, CDK12 and PIK3CA being the top 3 most frequently mutated genes. Neoadjuvant regimen was comprised of trastuzumab and HER2 inhibitor (i.e. pertuzumab or lapatinib). 15 patients used single HER2 inhibitor;18 used dual HER2 inhibitors. Endocrine therapy was also administered to HR+ patients (19/33) in combination with trastuzumab and HER2 inhibitor. Complete pathologic response (pCR) was observed in 45.5% (15/33) of patients. Interestingly, ROS1 copy number amplifications (CANs) were only identified in patients achieved pCR (p = 0.033). In contrast, missense mutations in PIK3CA and CNAs in CCND1, FGF19, FGF3, FGF4, SPOP, HNF1B and BRIP1 showed a trend of being less likely to mutate in pCR patients (p values between 0.05-0.1). Previous reports have suggested that pCR rates in HER2+ patients are associated with HR status. However, our data revealed comparable pathologic response of patients based on either HR status or neoadjuvant regimen. Conclusions: Our data revealed a distinct mutational profile between patients achieved pCR vs patients did not. Further studies with a larger cohort are required to confirm these findings.

G protein-coupled estrogen receptor activation improves contractile and diastolic functions in rat renal interlobular artery to protect against renal ischemia reperfusion injury

OBJECTIVE

This work aimed to investigate whether G protein-coupled estrogen receptor (GPER) can improve the renal interlobular artery vascular function by increasing the NO content, thereby protecting against renal ischemia-reperfusion (IR) injury.

METHODS

This study classified ovariectomised (OVX) female Sprague-Dawley rats into OVX, OVX + IR, OVX + IR + G1 (the GPER agonist G1), OVX + IR + G1+G15 (GPER blocker) and OVX + IR + G1+L-NAME (eNOS blocker) groups. Enzyme-linked immunosorbent assay was performed to detect the estrogen levels in the body and eliminate interference from endogenous estrogens. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling (TUNEL) and HE staining, renal function test and Paller scoring were performed to identify the successful model and detect the degree of renal and renal interlobular arteries injury. The in vitro microvascular pressure diameter measurement technique was used to detect the contraction and diastolic activities of the renal interlobular arteries in each group. Immunofluorescence technique was used to observe the localisation and expression levels of GPER and eNOS in renal interlobular arteries. The GPER and eNOS protein expression levels in each group were detected by Western blot. The NO content in the serum of each group was detected by the nitrate reductase method.

RESULT

After OVX, the estrogen level in the body decreased significantly (P < 0.01), and TUNEL staining showed a significant increase in the degree of renal tubular epithelial cell apoptosis in the IR group. Serum creatinine (SCr) and blood urea nitrogen (BUN) levels were significantly increased in the IR group (P < 0.01), and the Paller score showed significantly increased kidney damage. When performing drug treatment, the G1 intervention group significantly decreased serum BUN and SCr levels after IR injury (P < 0.01). The Paller score showed significantly decreased the degree of renal injury (P < 0.01). After IR, the renal interlobular artery contraction rate and systolic velocity of blood vessels were significantly decreased (P < 0.01). The G1 intervention group significantly restored contraction rate and systolic velocity of blood vessels (P < 0.01), and G15 and L-NAME partially reversed this effect (P < 0.01). Immunofluorescence technique showed that GPER was expressed in renal interlobular artery smooth muscle and endothelial cells. After IR injury, the GPER protein expression increased, and the eNOS protein expression decreased significantly (P < 0.01). Western blot showed that after IR injury, the GPER protein expression increased, and the eNOS protein expression decreased significantly. After G1 intervention, the GPER content did not change, and the eNOS content increased significantly (P < 0.01). After ischemia and reperfusion, the serum NO content decreased significantly, but it increased after G1 intervention. G15 and L-NAME reversed the effects of G1 to varying degrees (both at P < 0.01).

CONCLUSION

GPER may improve the renal interlobular artery vascular function by increasing the NO content, thereby protecting against renal IR injury.

[Outcomes of 27G(+) transconjunctival sutureless vitrectomy for posterior segment disease]

Objective: To report the clinical outcomes and safety profile of 27G(+) transconjunctival sutureless vitrectomy (TSV) in eyes with posterior segment disease. Methods: Prospective, interventional case series. Eyes undergoing 27G(+) TSV for a vitreoretinal surgery indication were included from Dec 2015 to Mar 2016. Change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 6 weeks were recorded. Results: Eighty-three eyes met the inclusion criteria. Surgical indications included epiretinal membrane (n=27), proliferative diabetic retinopathy (n=17), full-thickness macular hole (n=11), rhegmatogenous retinal detachment with or without proliferative vitreoretinopathy (PVR) (n=8), vitreous hemorrhage(n=7), vitreous opacities (n=7), diabetic macular edema non-response to anti-VEGF agents(n=4), intraocular lens or cataract nucleus dropped into vitreous cavity (n=2). Mean follow-up was 19 weeks (range 6-34 weeks). Visual acuity improved in all cases. The cutter incarcerated with trocar in a vitreous hemorrhage case. There were no other intraoperative complications and no case required sutured at the conclusion of surgery. Postoperative complications included transient ocular hypertension in 2 eyes (2.4%) and transient hypotony in 1 eye (1.2%). No cases of postoperative endophthalmitis, sclerotomy related retinal tears, or choroidal detachments were encountered in the follow-up period. Conclusion: The 27G(+) TSV was effective and safe for varied surgical indications with low rates of intraoperative and postoperative complications. (Chin J Ophthalmol, 2018, 54:918-922).

[Pleural amoebic empyema: a case report]

In this paper, a case of pleural amoebic empyema and its diagnosis and treatment were reported.

[The sensitization feature of Cypress pollen in urban area of Beijing]

Objective: To explore the sensitization features of Cypress pollen in urban area of Beijing and analyze the seasonal changes. Methods: Four thousand two hundred and one patients in Department of Allergy of Beijing Shijitan Hospital during January to December 2017 were enrolled in this study and received skin prick test (SPT) of Cypress extract. Cypress sensitization was divided into two types: mono-sensitization and multiple-sensitization. Difference of sensitization rate between age, gender and visiting month was analyzed by chi-square test. Difference of visiting rate and sensitization rate among each month was analyzed by K-W test. Pearson test was carried out for correlation analysis. Results: Positive rate of Cypress pollen was 32.3% (1 358/4 201) in overall patients in which male had a higher positive rate than female (35.6% vs 30.1%, χ(2)=13.465, P<0.001). The positive rate was highest in age 11-20 years and 31-40 years and then decreased with age (P<0.001). Multi-sensitization was observed in this study with a rate of 27.5% (1 154/4 201) while mono-sensitization of Cypress was only 4.7% (199/4 201). The consultation rate during January to December was positively correlated with SPT positive rate of Cypress pollen (r(2)=0.715 9, P=0.001). The positive rate varied with season with the highest rate in March (53.0%, 316/596), followed by April (36.6%, 208/568). The season peak of positive rate was observed in adults but not children. Mono-sensitization rate varied with one season peak (spring) while multi-sensitization showed two season peaks (spring and autumn). Conclusion: Cypress sensitization is prevalent in urban area of Beijing and is prone to multi-sensitization, which changes with season with the peak in March.

Analyses of nucleotide, synonymous codon and amino acid usages at gene levels of Brucella melitensis strain QY1

Brucella melitensis is the causative pathogen of the zoonotic disease brucellosis in China. This work focused on analyses of genetic features represented by nucleotide, synonymous codon and amino acid usages at gene levels of B. melitensis strain QY1 isolated from China. Although nucleotide usage biases at different codon positions all work on synonymous codon usage bias, nucleotide usage biases at the 1st and 3rd positions play more important roles in codon usages. Mutation pressure caused by nucleotide composition constraint influences the formation of over-representative synonymous codons, but neighboring nucleotides surrounding a codon strongly influence synonymous codon usage bias for B. melitensis strain QY1. There is significant correlation between amino acid usage bias and hydropathicity of proteins for B. melitensis strain QY1. Compared with different Brucella species about synonymous codon usage patterns, synonymous codon usages are not obviously influenced by hosts. Due to nucleotide usage bias at the 1st codon position influencing synonymous codon and amino acid usages, good interactions among nucleotide, synonymous codon and amino acid usages exist in the evolutionary process of B. melitensis.

Correction to: Characterization of bactericidal efficiency, cell selectivity, and mechanism of short interspecific hybrid peptides

Facing rising global antibiotics resistance, physical membrane-damaging antimicrobial peptides (AMPs) represent promising antimicrobial agents. Various strategies to design effective hybrid peptides offer many advantages in overcoming the adverse effects of natural AMPs.

[Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane]

Objective: To evaluate the relationship between the structure of macular region and prognosis after vitrectomy in idiopathic macular epiretinal membrane patients. Methods: Retrospective case series study. The cases of 74 idiopathic macular epiretinal membrane patients (31 female patients, 43 male patients, aged 68.1±6.9) who received surgery treatment in our hospital during January 2013 and December were collected and analyzed. Ophthalmic routine examination and optical coherence tomography (OCT) have been conducted for all patients prior to operation. All eyes underwent vitecrtomy and macular epiretinal membrane peeling. During the 12 months follow up, the preoperative and postoperative data including best corrected visual acuity (BCVA), foveal thickness, changes of morphology in ellipsoid zone were observed and analyzed. All the patients were divided into two groups, continuous group (52 patients) and discontinuous group (22 patients), based on the preoperative continuity status of ellipsoid zone. The data of preoperative macular retinal thickness, the relationship between age and course of the disease, preoperative BCVA and postoperative BCVA were analyzed statistically with repeated ANOVA method. The postoperative BCVA were analyzed statistically with t test mtehod, based on the different grouping of continuity status of ellipsoid zone. Results: The preoperative LogMar BCVA, and the postoperative LogMAR BCVA of 1 month, 3 month, 6 month and 12 month after operation were 0.59±0.26, 0.63±0.34, 0.46±0.22, 0.45±0.23, 0.41±0.23 (F=25.122, P<0.05) respectively. The preoperative foveal thickness, and the postoperative foveal thickness of 1 month, 3 month, 6 month and 12 month after operation were (468.12±73.07), (371.57±57.09), (320.57±65.88), (294.85±69.36), (283.5±66.56)μm (F=8.802, P<0.05), the difference between the figures are of statistical significance. The postoperative BCVA of continuous group (0.34±0.27) improved significantly, as compared to the BCVA of discontinuous group (0.62±0.24) (t=-4.209, P<0.05). There is no obvious relationship between the degree of preoperative macular edema and postoperative visual function (r=0.015, P> 0.015). Seven patients still have macular edema one year after surgery. Conclusion: The postoperative visual function in patients with idiopathic macular epiretinal membrane has negative correlation with preoperative thickness of fovea, and has positive correlation with continuity of ellipsoid zone. (Chin J Ophthalmol, 2018, 54: 258-262).

Characterization of bactericidal efficiency, cell selectivity, and mechanism of short interspecific hybrid peptides

Facing rising global antibiotics resistance, physical membrane-damaging antimicrobial peptides (AMPs) represent promising antimicrobial agents. Various strategies to design effective hybrid peptides offer many advantages in overcoming the adverse effects of natural AMPs. In this study, hybrid peptides from different species were investigated, and three hybrid antimicrobial peptides, LI, LN, and LC, were designed by combining the typical fragment of human cathelicidin-derived LL37 with either indolicidin, pig nematode cecropin P1 (CP-1) or rat neutrophil peptide-1 (NP-1). In an aqueous solution, all hybrid peptides had an unordered conformation. In simulated membrane conditions, the hybrid peptide LI displayed more β-turn and β-hairpin structures, whereas LN and LC folded into α-helix structures. The three interspecific hybrid peptides LI, LN, and LC exhibited different levels of antimicrobial activity against Gram-positive and Gram-negative bacteria. LI demonstrated the highest antimicrobial activity and cell selectivity. The results of the swimming motility indicated that LI repressed bacterial motility in a concentration-dependent method. Endotoxin binding assay demonstrated that hybrid peptide LI conserved the binding ability to LPS (polyanionic lipopolysaccharides) of its parental peptides. Fluorescence assays, flow cytometry, and SEM further revealed that hybrid peptide LI acted through different bacteriostatic mechanisms than LL37 and indolicidin and that LI killed bacterial cells via membrane damage. In summary, this study demonstrated that hybrid peptide LI produced by interspecific hybrid synthesis possessed strong cell selectivity and is a promising therapeutic candidate for drug-resistant bacteria infection.

Unique features of nucleotide and codon usage patterns in mycoplasmas revealed by information entropy

Currently, the comparison between GC usage pattern at the 3rd codon position and codon usage index is commonly used to estimate the roles of evolutionary forces in shaping synonymous codon usages, however, this kind of analysis often losses the information about the role of A/T usage bias in shaping synonymous codon usage bias. To overcome this limitation and better understand the interplay between nucleotide and codon usages for the evolution of bacteria at gene levels, in this study, we employed the information entropy method with some modification to estimate roles of nucleotide compositions in the overall codon usage bias for 18 mycoplasma species in combination with Davies-Bouldin index. At gene levels, the overall nucleotide usage bias represents A content as the highest, followed by T, G and C for mycoplasmas, resulting in a low GC content. This feature is universal across these species derived from different hosts, suggesting that the hosts have the limited impact on nucleotide usage bias of mycoplasmas. Information entropy and Davies-Bouldin index can better reveal that the nucleotide usage bias at the 3rd codon position is essential in shaping the overall nucleotide bias for all given mycoplasmas except M. pneumoniae M129. Davies-Bouldin index revealed that the 1st and 2nd codon position play more important role in synonymous codon usage bias than that of the 3rd position at gene levels. To our knowledge, this is the first comprehensive investigation into cooperation between nucleotide and codon usages for mycoplasma and extends our knowledge of the mechanisms that contribute to codon usage and evolution of this microorganism.

[Clinicopathological characteristics of papillary thyroid microcarcinoma and risk factors for central lymph node metastasis]

Objective: To analyze the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) and risk factors for central lymph node metastasis(CLNM) in PTMC. Methods: The data of 900 patients with PTMC initially treated in our hospital from January 2004 to December 2015 were retrospectively analyzed. Chi-square test and Logistic regression analysis were performed to determine the risk factors for CLNM. Results: CLNM affected 162 (22.9%) of 707 patients treated with central lymph node dissection. Age, maximum tumor size, multifocality, bilaterality, and extracapsular spread (ECS) were significantly correlated with CLNM (all P<0.01). Age<45 years, maximum tumor size>5 mm, multifocality, bilaterality, and extracapsular spread were independently correlated with CLNM. Conclusion: A prophylactic central lymph node dissection should be considered in PTMC patients with age<45 years, maximum tumor size>5 mm, multifocality, bilaterality, and extracapsular spread.

[The research advances and applications of genome editing in hereditary eye diseases]

Genome editing is a cutting-edge technology that generates DNA double strand breaks at the specific genomic DNA sequence through nuclease recognition and cleavage, and then achieves insertion, replacement, or deletion of the target gene via endogenous DNA repair mechanisms, such as non-homologous end joining, homology directed repair, and homologous recombination. So far, more than 600 human hereditary eye diseases and systemic hereditary diseases with ocular phenotypes have been found. However, most of these diseases are of incompletely elucidated pathogenesis and without effective therapies. Genome editing technology can precisely target and alter the genomes of animals, establish animal models of the hereditary diseases, and elucidate the relationship between the target gene and the disease phenotype, thereby providing a powerful approach to studying the pathogenic mechanisms underlying the hereditary eye diseases. In addition, correction of gene mutations by the genome editing brings a new hope to gene therapy for the hereditary eye diseases. This review introduces the molecular characteristics of 4 major enzymes used in the genome editing, including homing endonucleases, zinc finger nucleases, transcription activator-like effector nucleases, and clustered regularly interspaced short palindromic repeats (CRISPR)/ CRISPR-associated protein 9 (Cas9), and summarizes the current applications of this technology in investigating the pathogenic mechanisms underlying the hereditary eye diseases. (Chin J Ophthalmol, 2017, 53: 386-371).

Outcomes of the six-strand M-Tang repair for zone 2 primary flexor tendon repair in 54 fingers

We repaired complete divisions of flexor tendons in zone 2 in 54 fingers using a six-strand core M-Tang repair method. Partial active digital motion started with early passive digital motion carried out first in the first 3-4 weeks after surgery and full range of active motion in later weeks. The patients were followed for 4-27 months. According to Strickland criteria or Tang criteria, 24 (83%) had excellent or good, four fair and one poor results in 28 fingers with follow-up of more than one year. In the other 25 fingers which were followed for less than 12 months, 19 (76%) had excellent and good, four fair and two poor results. There were no repair ruptures. We analysed outcomes against ages, gender, pulley integrity, accompanied injuries and follow-up times. The patients younger than 37 years old, male patients and with their A2 pulley(s) vented there were significantly better outcomes. The patients with longer than one year follow-up had significantly smaller extension deficits than those with less than one year follow-up.

LEVEL OF EVIDENCE

IV.

Characterization and development of 56 EST-SSR markers derived from the transcriptome of Odontobutis potamophila

Expressed sequence tags (ETSs) are the sources of microsatellite development. In this study, we isolated and characterized microsatellite markers for Odontobutis potamophila by using Illumina RNA-sequencing. We sequenced a large number of ESTs and screened 200 potential microsatellites. Consequently, a total of 56 novel polymorphic microsatellite repeat markers were identified in thirty-two individuals from a wild population area (Jiande, Zhejiang Province, China). The number of alleles per locus varied from two to eight, the observed heterozygosity (H_O) ranged from 0.03571 to 0.9375, and the expected heterozygosity (H_E) ranged from 0.14326 to 0.81549. The average number of alleles, H_O, and H_E were 5.0, 0.4467, and 0.5518, respectively. By the calculation, the range of polymorphism information content (PIC) was 0.1177-0.8492. Most of the loci showed moderate or high polymorphism. These newly developed EST-simple sequence repeat (EST-SSR) markers would serve as an efficient tool for analyzing population connectivity and provide sufficient information for genetic diversity research, parentage, and molecular breeding of O. potamophila and other fishes with similar genetic relationship.

Suppressing stathmin-l can inhibit chkl protein expression and reduce the invasion and tumorigenicity of cervical cancer cells

The purpose of this study was to evaluate the effects of stathmin-l on chkl protein expression in cervical cancer cells and the influ- ences on the cells' invasion and tumorigenicity. Suppressed stathmin-l expression in Hela cells and C33A cells by lentiviral vector were utilized. Real time PCR and Western blot were used to examine the expression of chkl. Cell proliferation and invasion were stud- ied using MTT assays and transwell migration assays.The differences of tumorigenicity in vivo were explored using xenograft experi- ments. In addition, stathmin-l expressions in 24 cervical cancer patients were studied without regional lymph nodes metastasis and 16 metastatic patients by immunohistochemistry assays and real time PCR. This study found downregulating stathmin-l reduced chkl ex- pressions and the proliferation and invasion in cervical cancer cells and reduced the tumorigenicity of tumor cells.

[Evaluation of the safety and visual quality after implantation of the domestic made aspheric intraocular lens]

OBJECTIVE

To evaluate the safety and efficacy of the domestic foldable one-piece aspheric intraocular lens (IOL, Model: A1-UV) for the treatment of cataract.

METHODS

A prospective randomized controlled clinical research were conducted. One hundred and nineteen cases (119 eyes) of cataract patients were randomly assigned to the study group (58 cases) and the control group (61 cases). The study group were implanted with the domestic made aspheric intraocular lens (Model: A1-UV) and the control group were implanted with imported aspheric intraocular lens (Model: SN60WF, Alcon Laboratories, Inc.). The visual acuity and the slit lamp examination were evaluated 1-2 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. In addition, the contrast sensitivity tests were carried out 3 months, 6 months and 1 year postoperatively. Data were analyzed by chi-square test and independent t-test.

RESULTS

100 patients had completed 1 year of follow-up, among which 49 cases were from the study group and 51 cases were from the control group. No severe inflammation or complications associated with intraocular lens were noted in either group within 1 year follow-up. The mean BCDVA, BCNVA, UCDVA, UCNVA(Log MAR) of the study group and the control group were 0.04±0.11, 0.11±0.17, 0.13±0.20, 0.35± 0.19 and 0.07±0.15, 0.15±0.20, 0.18±0.23, 0.41±0.21 at 1 year postoperatively. No statistically significant differences were noted between groups in mean BCDVA, BCNVA, UCDVA, UCNVA (t=-1.39, P=0.166; t=- 1.25, P=0.216; t=-1.06, P=0.292; t=-1.59, P=0.116) at 1 year postoperatively. And there was no significant difference in visual acuity between the two groups (P>0.05) 1-2 day, 1 week, 1 month, 3 months and 6 months postoperatively. The difference of the contrast sensitivity between the two groups was not statistically significant (P>0.05), besides the contrast sensitivity of the study group was significantly better than the control group at 12c/d, 18 c/d under bright light(t=2.18, P=0.031; t=2.67, P=0.009) at 3 months postoperatively. And the mean contrast sensitivity of the study group and the control group at 12c/d, 18 c/d under bright light were 1.31 ± 0.36, 0.86 ± 0.41 and 1.15 ± 0.40, 0.65 ± 0.44 at 3 months postoperatively.

CONCLUSION

The safety and efficacy of the domestic made foldable one-piece aspheric intraocular lens (Model: A1-UV) for the treatment of cataract is equivalent to the imported aspheric intraocular lens (Model: SN60WF).

PI3K, AKT, and P-AKT levels in thin endometrium

The aim of this study was to explore the expression of PI3K, AKT, and P-AKT, and to investigate the role of PI3K/AKT signaling pathway in thin endometrium. We included 40 women treated in affiliated Shenzhen Nanshan People's Hospital of Guangdong Medical University for endometrial conditions between August 2013 and January 2015, 20 with a normal endometrium, and 20 with thin endometrium. The expression of PI3K, AKT, and P-AKT was evaluated by the immunohistochemical S-P method. The expression of PI3K, AKT, and P-AKT proteins was significantly lower in the thin endometrium group than in the normal endometrium group (P < 0.05). The expression of PI3K and AKT was positively correlated with the expression of P-AKT. The expression of PI3K, AKT, and P-AKT proteins in the thin endometrium decreases during the proliferative phase, and this process could be associated with PI3K/AKT signaling.