[Safety and efficacy of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis]

Objective: To investigate the efficacy and safety of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis. Methods: A retrospective analysis was carried out on 46 patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis who received endovascular treatment at the Strategic Support Force Medical Center from January 2015 to August 2022. Twenty-seven patients underwent balloon angioplasty alone and 19 patients underwent acute stent implantation. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of the responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality of the two groups were evaluated. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in the acute stenting group was slightly higher than that in the balloon angioplasty group (16/19 vs. 81.5%), but the difference was not statistically significant (P>0.05). Besides, there was no significant difference in the median of mRS between the acute stenting group [3.0(0, 4.0)] and the balloon angioplasty group [4.0(1.0, 5.0)] 90 days after operation (P>0.05). In terms of safety, the incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusions: The effect of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis is not inferior to that of balloon angioplasty, and it does not increase the risk of intracranial bleeding complications.

"Triple-low" radiation dose bronchial artery CT angiography before bronchial artery embolisation: a feasibility study

AIM

To explore the feasibility of a "triple-low" dose (low tube voltage, low tube current, and low contrast agent volume) bronchial artery computed tomography (CT) angiography (CTA) to replace routine dose bronchial artery CTA before bronchial artery embolisation (BAE).

MATERIALS AND METHODS

CTA was obtained from 60 patients with body mass index (BMI) < 30 kg/m2 using a 256 multi-section iCT system, and they were divided into two groups: (1) group A: 100 kVp, 100 mAs, 50 ml contrast medium (CM); (2) group B: 120 kVp, automatic tube current modulation (ACTM), 80 ml CM. CT attenuation of the thoracic aorta, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and subjective image quality scores and traceability scores assessed. The effective radiation dose was calculated.

RESULTS

The radiation dose was reduced by 79.7% in group A compared to group B (p<0.05). The CT attenuation of the thoracic aorta was increased by approximately 13% in group A compared to group B (p<0.05). Higher image noise, lower SNR, and CNR were obtained in group A compared to group B (all p<0.05). Both subjective image quality scores and traceability scores did not differ between groups A and B (both p>0.05).

CONCLUSION

It is feasible to use the "triple-low" dose CTA protocol for patients with a body mass index (BMI) < 30 kg/m2. The radiation dose was reduced by 79.7%, and the dose of contrast medium was reduced by 37.5% to ensure the diagnostic value.

Laparoscopic posterior pelvic exenteration is safe and feasible for locally advanced primary rectal cancer in female patients: a comparative study from China PelvEx collaborative

PURPOSE

Posterior pelvic exenteration (PPE) for locally advanced rectal cancer is a technical and challenging procedure. The safety and feasibility of laparoscopic PPE remain to be determined. This study aims to compare short-term and survival outcomes of laparoscopic PPE (LPPE) with open PPE (OPPE) in female patients.

METHOD

From January 2015 to December 2020, data from 105 female patients who underwent PPE at three institutions were retrospectively analyzed. The short-term and oncological outcomes between LPPE and OPPE were compared.

RESULTS

A total of 54 cases with LPPE and 51 cases with OPPE were enrolled. The operative time (240 vs. 295 min, p = 0.009), blood loss (100 vs. 300 ml, p < 0.001), surgical site infection (SSI) rate (20.4% vs. 58.8%, p = 0.003), urinary retention rate (3.7% vs. 17.6%, p = 0.020), and postoperative hospital stay (10 vs. 13 days, p = 0.009) were significantly lower in the LPPE group. The two groups showed no significant differences in the local recurrence rate (p = 0.296), 3-year overall survival (p = 0.129), or 3-year disease-free survival (p = 0.082). A higher CEA level (HR 1.02, p = 0.002), poor tumor differentiation (HR 3.05, p = 0.004), and (y)pT4b stage (HR 2.35, p = 0.035) were independent risk factors for disease-free survival.

CONCLUSION

LPPE is safe and feasible for locally advanced rectal cancers and shows lower operative time and blood loss, fewer SSI complications, and better preservation of bladder function without compromising oncological outcomes.

Short- and long-term outcomes of laparoscopic versus open pelvic exenteration for locally advanced rectal cancer: a single-center propensity score matching analysis

BACKGROUND

Research on short-term outcomes and long-term oncological results of laparoscopic pelvic exenteration (LPE) for locally advanced rectal cancer (LARC) is still limited. The purpose of this study was to compare the outcomes of LPE and open pelvic exenteration (OPE).

METHODS

Between January 2010 and December 2019, consecutive LARC patients who underwent radical pelvic exenteration at Peking University First Hospital were enrolled. Groups were matched at a 1:1 ratio using propensity score matching. The primary endpoints were 3 year overall survival (OS) and disease-free survival (DFS). The secondary endpoints were postoperative short-term outcomes.

RESULTS

There were 144 patients (68 males and 76 females, median age 58.5 [range 27.0-86.0] years). After matching, patients were stratified into LPE (n = 48) and OPE (n = 48) groups (LPE: 24 males and 24 females, median age 57.0 [range 27.0-81.0] years; OPE: 26 males and 22 females, median age 58.0[range 36.0-80.0] years). There were no significant differences on baseline data between the two groups. Compared with the OPE group, the LPE group had a significantly lower estimated blood loss (200 vs 500 ml, p = 0.003), less overall postoperative complications (12/48 vs 25/48, p = 0.006), less surgical site infection (8/48 vs 20/48, p = 0.007), shorter length of stay (12 vs. 15 days, p = 0.005), but similar operative time (344 vs. 360 min, p = 0.493). The pathological R0 resection rate (98.0% vs. 93.7%, p = 0.610), 3 year local recurrence (18.4% vs. 23.5, p = 0.140), 3 year OS (74.6% vs. 65.5%, p = 0.290) and 3-year DFS (60.0% vs. 50.3%, p = 0.208) were similar between the two groups. Shorter distance from anal verge (HR = 0.92, p = 0.042), (y) pT4b (HR = 2.45, p = 0.023), (y)pN1-2 (HR = 2.42, p = 0.004) and positive CRM (HR = 6.23, p = 0.004) were independent prognostic risks for 3 year DFS.

CONCLUSIONS

LPE can be performed safely and has certain short-term advantages over OPE, most notably less blood loss and surgical site infection. However, LPE does not improve long-term oncological outcomes.

Transcription factor MdLSD1 negatively regulates α-farnesene biosynthesis in apple-fruit skin tissue

α-Farnesene is a sesquiterpene present in plants. It was first discovered in apples. It plays an important role in the plant defence response and is considered a key factor in the occurrence of superficial scald. The gene encoding α-farnesene synthase, which is the last key enzyme in the biosynthetic pathway of α-farnesene in apple fruit, has become the primary target enzyme for controlling the genetic manipulation of α-farnesene biosynthesis. In this study, the yeast one-hybrid assay and the dual luciferase assay were used to ascertain the relationship between MdLSD1 and MdAFS. Real-time PCR was used to analyse the molecular mechanism underlying the regulation of MdAFS by MdLSD1. Our results revealed that transcription factor MdLSD1, which is closely related to programmed cell death in apple fruit tissues, binds to MdAFS. Transient transformation of apple skin with vectors overexpressing MdLSD1 showed that the gene negatively regulates MdAFS. Overall, we suggest that MdLSD1 negatively regulates MdAFS. Our results are of great significance for future research on the transcriptional regulation of the α-farnesene synthase gene and provide a new direction for exploring the specific mechanism of programmed cell death involved in superficial-scald incidence.

POS1368 DIVERSITY OF HEMODYNAMIC TYPES IN CONNECTIVE TISSUE DISEASE ASSOCIATED PULMONARY HYPERTENSION: MORE THAN A SUBGROUP OF PULMONARY ARTERIAL HYPERTENSION

Background

Connective tissue disease (CTD) associated pulmonary hypertension (PH) is classified as a subgroup of WHO group 1 PH, also called pulmonary arterial hypertension (PAH). However, not all CTD-PH fit the hemodynamic definition of PAH. This study investigates the diversity of hemodynamical types of CTD-PH, their different clinical characteristics and outcomes.

Objectives

This study investigates the diversity of hemodynamical types of CTD-PH, their different clinical characteristics and outcomes.

Methods

We performed a retrospective cohort study. CTD-PH patients underwent right heart catheterization (RHC) were enrolled and divided into WHO group1 PH, WHO group 2 PH and high output PH (PVR<3WU and PAWP<15mmHg) according to hemodynamic features. Patients with obvious lung diseases, left heart disease and pulmonary embolism were excluded. Baseline characteristics, inflammatory markers, autoantibodies, cardiac function status, echocardiogram parameters, hemodynamics and survival rates were compared.

Results

207 CTD-PH patients were included, including 139 in WHO group 1 PH, 36 in WHO group 2 PH and 32 in high output PH. Incidence of anti-ribonucleoprotein antibody was lower in WHO Group 2 PH. High output PH is less severe, presenting lower NT-proBNP level, better WHO functional class, lower mPAP and PVR, higher cardiac output, and less cardiac remodeling. Among patients with elevated PAWP, combine pre& post-capillary PH had higher mPAP and larger right ventricle diameter. Association of mild to moderate interstitial lung disease didn’t show significant difference in disease characteristics. Short-term survival was significantly worse in WHO group 2 PH, yet 5-year survival rates didn’t differ between groups.

Conclusion

Pre-capillary PH is not the only hemodynamic type of CTD-PH. Different types of CTD-PH present different clinical phenotypes and outcome. Carefully phenotyping PH in CTD-PH patients is important.

Disclosure of Interests

None declared

[Safety and efficacy of intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism undergoing endovascular reperfusion therapy]

Objective: To evaluate the safety and efficacy of intra-arterial tirofiban infusion during endovascular reperfusion therapy in patients with acute cardiogenic cerebral embolism. Methods: Clinical data of 72 patients with acute cardiogenic cerebral embolism caused by large artery occlusion were retrospectively analyzed in Department of Neurology, Strategic Support Force Medical Center from August 2015 to August 2020.Among those, 52 patients were treated with intra-arterial tirofiban, the other 20 patients were treated with control medication. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality were evaluated and compared in two groups. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in tirofiban group was higher than that in control group (92.3% vs. 75.0%), but the difference was not statistically significant (P=0.104). At 90 days after operation, the rate of patients with good prognosis (mRS≤2) in tirofiban group (61.5%) was significantly higher than that in control group (35.0%) (P<0.05). The incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusion: Intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism is effective and feasible, which improves the prognosis without increasing the risk of intracranial bleeding complications.

Correlation of Four Single Nucleotide Polymorphisms of the RELN Gene With Schizophrenia

OBJECTIVE

This study aims to determine the association between single-nucleotide polymorphisms (SNPs) of the RELN gene and schizophrenia.

METHODS

134 patients aged 16 to 58 (mean, 38.0) years who were diagnosed with acute or chronic schizophrenia at the Zhongshan Third People's Hospital between January 2018 and April 2020 were recruited, as were 64 healthy controls aged 22 to 59 (mean, 45.6) years who matched with the age and sex of the patients. MassARRAY mass spectrometry genotyping technology was used to determine the genotypes of four SNPs of RELN (rs2073559, rs2229864, rs362691, and rs736707).

RESULTS

There were no significant between-group or between-sex differences in terms of genotype, allele frequency, or haplotype frequency of the SNPs (all p > 0.05). In the association analysis between genotypes and quantitative traits in the Positive and Negative Syndrome Scale, rs2229864 and rs736707 were associated with the scores for items P3 (hallucinatory behaviour) and G11 (attention disorder), and rs362691 was associated with G10 (disorientation). However, the associations did not remain significant after Bonferroni correction.

CONCLUSION

Multiple pathogenic polymorphisms of RELN might be associated with hallucinatory behaviour and attention disorder in Chinese patients with schizophrenia.

[Study on protective effect of dust mask for workers exposed to super absorbent polymer dust]

Objective: To analyze the protective effect of dust masks worn by super absorbent polymer (SAP) dust-exposed workers and the influence of each test exercise on the protective effect of mask. Methods: In March 2017, forty nine SAP dust-exposed workers in a large chemical enterprise were selected as subjects. The respirator fitness tester was used to test the protective effect of dust mask before and after training, and the influence of each test exercise on the protective effect of dust mask was analyzed. Results: After training, the qualified rate of dust mask protective effect of SAP dust-exposed workers was 95.92% (47/49) , which was significantly higher than that before training [63.31% (32/49) ], and the difference was statistically significant (χ²=14.69, P<0.01) . When the total protective effect was qualified, the fit factor (FF) decreased significantly when speaking aloud and bending down (Z=-2.59, -4.20, P<0.01) . The qualified rates of protective effect of each exercise were significantly different (χ²=42.70, P<0.01) , among which the qualified rates of deep breath was the highest (100.00%) , and the qualified rate of bending down was the lowest (70.21%) . Conclusion: Strengthening the training of workers to wear masks correctly is helpful to improve their respiratory protection efficiency. Under the condition that the total protective effect of dust masks is qualified, workers should try to avoid unnecessary actions, especially speaking aloud and bending down frequently.

[Clinical and molecular pathological features of uterine inflammatory myofibroblastic tumor]

Objective: To evaluate the clinical and molecular pathologic features of uterine inflammatory myofibroblastic tumor (UIMT). Methods: Six UIMT cases collected at Department of Pathology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University from 2019 to 2020. They were analyzed for their general characteristics and clinicopathologic features. ALK rearrangements were detected by fluorescence in situ hybridization. Results: The age of the six patients ranged from 14 to 65 years, the tumors ranged in size from 2.5 to 6.0 cm. The masses were intramural or submucosal in location. Most of them (4/6) were white with yellow foci, and two (2/6) were white with tan foci. Other features noted included a soft or firm appearance. The fasciitis-like pattern of UIMT had myxoid stroma around the spindle cells and inflammatory cells. The ganglion-like pattern showed either fascicular or storiform architecture with diffuse growth. Nuclear atypia was mild or moderate. Mitoses ranged from 2 to 4 per 10 high-power fields. Five tumors were ALK-positive with granular cytoplasmic staining by immunohistochemistry. ALK rearrangements were detected in five cases but was absent in one case. Conclusions: UIMT is an intermediate grade soft tissue tumor, a minority may present with extrauterine spread and/or recurrence. The tumors are composed of spindled cells. The main differentials include smooth muscle tumors and endometrial stromal tumors and their morphology may overlap with that of UIMT. Immunohistochemical positivity for ALK or FISH testing for ALK rearrangements can help in the diagnosis.

Transfemoral-venous transcatheter access to left ventricle through the created communication of inter-ventricular septum with the assistance of arterio-venous circuit

Background

During transcatheter aortic/mitral valve replacement (TA/MVR), current available routes are limited due to unfavorable entry-angle, vessel-anatomy or mini-thoracotomy. Through created communication of inter-ventricular septum (C-IVS), transfemoral venous transcatheter access to left ventricle becomes feasible with the assistance of arterio-venous circuit.

Purpose

The study was conducted to investigate the feasibility and safety of transfemoral-venous transcatheter access to left ventricle through the created C-IVS in a swine model.

Methods

Via femoral artery, transcatheter puncture of mid-IVS was performed with the custom-made nickel-titanium needle (0.038-inch, needle-tip bent 60 degrees automatically associated with increased hardness when temperature was above 30°C) and 6F-sheath in 20 healthy Chinese mini-swine. Then femoral arterio-venous circuit was established through created C-IVS with hydrophilic guidewire in all swine, and femoral veno-venous circuit was further created through C-IVS and atrial septum in 4 swine. After pre-dilation of C-IVS, a 20F-sheath was introduced into left ventricle transvenously over the guidewire. Furthermore, transfemoral-venous TAVR was attempted with this approach in one swine. C-IVS was evaluated postoperatively and was further confirmed pathologically 2 months later.

Results

All transcatheter puncture of IVS was performed successfully in left ventricle and the thickness of mid-IVS was 7.67±0.98 mm. During the puncture, ventricular fibrillation occurred in one swine (successfully defibrillation) and only isolated ventricular premature beats/non-sustained ventricular tachycardia were observed in other swine. In all swine, femoral arterio-venous/veno-venous circuit was established via C-IVS, and the 20F-sheath was introduced into left ventricle safely through femoral vein and C-IVS. With the aid of vessel circuit, the 20F-sheath was further advanced into aorta in 16 swine (the entry-angle was 145.3±12.2 degrees) and into left atrium in 4 swine. After the procedure, there was one swine with moderate tricuspid regurgitation and 5 swine with mild residual shunt (2.6±0.7 mm). In addition, epicardial coronary arteries were normal in all swine. Two months later, residual shunt was still detected in 3 swine and the communication was confirmed pathologically. In other swine, there was no defect of IVS and mild replacement-scar was identified along C-IVS. In the swine underwent transfemoral-venous TAVR, prosthetic valve was deployed successfully with good function.

Conclusions

With the aid of vessel circuit, transfemoral-venous transcatheter access to left ventricle is feasible and safe via C-IVS, and transfemoral-venous TAVR was achieved successfully using this novel approach with favorable entry-angle.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): National Natural Science Foundation of China

[The keypoints in treatment of the critical coronavirus disease 2019 patient(1)]

COVID-19 has been prevalent in Wuhan and spread rapidly to all of our country. Some cases can develop into ARDS, or even death. We will share the treatment experience of severe COVID-19 with the first-line treatment experience. The best respiratory support mode should be selected, but the timing of intubation and protection during intubation are two difficulties; patients with high level peep and poor effect in prone position can be given ECMO support. For COVID-19 patients with mechanical ventilation, reasonable sedation and analgesia strategies should be formulated; delirium should not be ignored. In addition, there is up regulation of inflammatory factors in patients with severe COVID-19, but the effect of renal replacement therapy needs to be further confirmed by clinical research.

[The keypoints in treatment of the critical coronavirus disease 2019 patient(2)]

The treatment of critically ill patients with coronavirus disease 2019(COVID-19) faces compelling challenges. In this issue, we'd like to share our first-line treatment experience in treating COVID-19. Hemodynamics need be closely monitored and different types of shock should be distinguished. Vasoconstrictor drugs should be used rationally and alerting of complications is of the same importance. The risk of venous thromboembolism (VTE) needs to be assessed, and effective prevention should be carried out for high-risk patients. It is necessary to consider the possibility of pulmonary thromboembolism (PTE) in patients with sudden onset of oxygenation deterioration, respiratory distress, reduced blood pressure. However, comprehensive analysis of disease state should be taken into the interpretation of abnormally elevated D-Dimer. Nutritional support is the basis of treatment. It's important to establish individual therapy regimens and to evaluate, monitor and adjust dynamically. Under the current epidemic situation, convalescent plasma can only be used empirically, indications need to be strictly screened, the blood transfusion process should be closely monitored and the curative effect should be dynamically evaluated.

Integrated sensing layer of bacterial cellulose and polyethyleneimine to achieve high sensitivity of ST-cut quartz surface acoustic wave formaldehyde gas sensor

Surface acoustic wave (SAW)-based formaldehyde gas sensor using bi-layer nanofilms of bacterial cellulose (BC) and polyethyleneimine (PEI) was developed on an ST-cut quartz substrate using sol-gel and spin coating processes. BC nanofilms significantly improve the sensitivity of PEI films to formaldehyde gas, and reduces response and recovery times. The BC films have superfine filamentary and fibrous network structures, which provide a large number of attachment sites for the PEI particles. Measurement results obtained using in situ diffuse reflectance Fourier transform infrared spectroscopy showed that the primary amino groups of PEI strongly adsorb formaldehyde molecules through nucleophilic reactions, thus resulting in a negative frequency shift of the SAW sensor due to the mass loading effect. In addition, experimental results showed that the frequency shifts of the SAW devices are determined by thickness of PEI film, concentration of formaldehyde and relative humidity. The PEI/BC sensor coated with three layers of PEI as the sensing layer showed the optimal sensing performance, which had a frequency shift of 35.6 kHz for 10 ppm formaldehyde gas, measured at room temperature and 30 % RH. The sensor also showed good selectivity and stability, with a low limit of detection down to 100 ppb.

Rapid and visual detection of 2019 novel coronavirus (SARS-CoV-2) by a reverse transcription loop-mediated isothermal amplification assay

OBJECTIVE

To evaluate a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and compare it with RT-PCR.

METHODS

We designed primers specific to the orf1ab and S genes of SARS-CoV-2. Total viral RNA was extracted using the QIAamp Viral RNA Mini Kit. We optimized the RT-LAMP assay, and evaluated it for its sensitivity and specificity of detection using real-time turbidity monitoring and visual observation.

RESULTS

The primer sets orf1ab-4 and S-123 amplified the genes in the shortest times, the mean (±SD) times were 18 ± 1.32 min and 20 ± 1.80 min, respectively, and 63°C was the optimum reaction temperature. The sensitivities were 2 × 10¹ copies and 2 × 10² copies per reaction with primer sets orf1ab-4 and S-123, respectively. This assay showed no cross-reactivity with 60 other respiratory pathogens. To describe the availability of this method in clinical diagnosis, we collected 130 specimens from patients with clinically suspected SARS-CoV-2 infection. Among them, 58 were confirmed to be positive and 72 were negative by RT-LAMP. The sensitivity was 100% (95% CI 92.3%-100%), specificity 100% (95% CI 93.7%-100%). This assay detected SARS-CoV-2 in a mean (±SD) time of 26.28 ± 4.48 min and the results can be identified with visual observation.

CONCLUSION

These results demonstrate that we developed a rapid, simple, specific and sensitive RT-LAMP assay for SARS-CoV-2 detection among clinical samples. It will be a powerful tool for SARS-CoV-2 identification, and for monitoring suspected patients, close contacts and high-risk groups.

[Pharmacotherapeutics for the new coronavirus pneumonia]

The new coronavirus pneumonia (NCP), also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. The number of diagnosed cases is more than 40,000 until the submission of this manuscript. Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new coronavirus is unprecedentedly fulminating. The published cohorts of 2019 new coronavirus (n-Cov) are single-center studies, or retrospective studies. We here share the therapeutic experiences of NCP treatment with literature review. Combination of Ribavirin and interferon-α is recommended by the 5(th) edition National Health Commission's Regimen (Revised Edition) because of the effect on Middle East respiratory syndrome (MERS), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. Systemic glucocorticosteroid is recommended as a short term use (1~2 mg·kg(-1)·d(-1), 3~5 d) by the 5(th) edition National Health Commission's Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.

[Pharmacotherapeutics for the New Coronavirus Pneumonia]

The New Coronavirus Pneumonia (NCP, also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. The number of diagnosed cases is more than 40,000 until the submission of this manuscript. Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new Coronavirus is unprecedentedly fulminating. The published cohorts of 2019 new Coronavirus (n-Cov) are single-center studies, or retrospective studies. We here share the therapeutic experiences of NCP treatment with literature review. Combination of Ribavirin and Interferon-α is recommended by the 5(th) edition National Health Commission's Regimen (Revised Edition) because of the effect on MERS (Middle East Respiratory Syndrome), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. Systemic glucocorticosteroid is recommended as a short term use (1~2 mg.kg(-1).d(-1), 3~5d ) by the 5(th) edition National Health Commission's Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.

Diagnostic accuracy of droplet digital PCR analysis of cerebrospinal fluid for tuberculous meningitis in adult patients

OBJECTIVES

Tuberculous meningitis (TBM) is difficult to diagnose. Digital PCR (dPCR) is a novel method which can quantify trace nucleic acids. This study sought to evaluate the diagnostic accuracy of dPCR analysis of cerebrospinal fluid (CSF) for TBM.

METHODS

We collected CSF specimens from hospitalized TBM and non-TBM patients. Total CSF DNA was purified and the concentrations of Mycobacterium tuberculosis insert sequence 6110 (IS6110) and gyrase subunit B (gyrB) were quantified using droplet dPCR. The receiver operating characteristic curves of dPCR were established and the diagnostic performances were obtained. We also compared the sensitivity of dPCR with routine diagnostic tests.

RESULTS

A total of 101 patients were recruited, 68 of whom suffered from TBM (26 definite, 34 probable and eight possible TBM) and 33 from non-TBM. The sensitivity of IS6110-dPCR assay for total TBM was higher than that of gyrB-dPCR assay (57.4% (44.8-69.3%) vs. 22.1% (12.9-33.8%)), and there was no significant difference for specificity between them (97.0% (84.2-99.9%) vs. 100% (89.4-100.0%)). The sensitivity of IS6110-dPCR in definite TBM was higher than that in probable and possible TBM (73.1% vs. 52.9% and 25.0%, respectively). IS6110-dPCR assay showed a higher sensitivity than smear microscopy (53.3% vs. 6.7%), mycobacterial culture (50.0% vs. 12.5%), IS6110-quantitative PCR (53.1% vs. 21.9%) and Xpert MTB/RIF (70.4% vs. 29.6%). Long anti-tuberculosis treatment time was found to be significantly associated with negative dPCR results.

CONCLUSION

CSF IS6110-dPCR assay is a rapid and sensitive molecular test, which has the potential to be used to enhance the diagnosis of TBM.

[Acute respiratory failure due to Pneumocystis pneumonia in connective tissue disease patients: clinical manifestation and prognostic factors related to hospital mortality]

Objective: To investigate the clinical manifestations and prognostic factors of hospital death in connective tissue disease patients with acute respiratory failure caused by pneumocystis pneumonia (PCP) admitted to two medical intensive care units(MICU). Methods: A retrospective review was conducted for all connective tissue disease (CTD) patients with acute respiratory failure from PCP in MICU of 2 academic medical centers between 2010 and 2015. The patients were divided into survivors and non-survivors. Demographic and clinical data, including laboratory, radiological and microbiological findings, as well as therapy, clinical course, mortality and prognostic factors of hospital mortality were included in the analysis. Logistic regression models were used to determine the effect of prognostic factors on hospital death after adjusting for covariates of which the p values were less than 0.1. Results: A total of 41 patients with connective tissue disease were identified. The PaO(2)/FiO(2) ratio (PFR) on ICU admission was 120 mmHg(55-180 mmHg, 1 mmHg=0.133 kPa). Common clinical features included dyspnea (90.2%, 37/41), fever (87.8%, 36/41) and dry cough(65.9%, 30/41). 58.5%(24/41) and 17.1%(7/41) patients were co-infected by CMV and aspergillus, respectively. The overall mortality rate was 75.6%(31/41). Compared with survivors, the age, APACHEⅡ score and incidence of barotrauma in non-survivors were higher (39±17 vs 58±15, t=3.018, P=0.002), (15±6 vs 19±5, t=2.528, P=0.019), (0/10 vs 12/31, χ(2)=5.473, P=0.021), while PFR on ICU admission was lower in non-survivors (172±68 vs 116±49, t=-1.893, P=0.007). Logistic analysis showed that PFR on ICU admission was the independent risk factor for hospital death (OR=1.004, 95%CI: 1.002-1.006, P=0.048). Conclusions: Mortality rate among patients with acute respiratory failure secondary to CTD related PCP is still high, and the poor prognostic factors of hospital mortality included PFR on ICU admission and barotrauma.

Problematic effects of antibiotics on anaerobic treatment of swine wastewater

Swine wastewaters with high levels of organic pollutants and antibiotics have become serious environmental concerns. Anaerobic technology is a feasible option for swine wastewater treatment due to its advantage in low costs and bioenergy production. However, antibiotics in swine wastewater have problematic effects on micro-organisms, and the stability and performance of anaerobic processes. Thus, this paper critically reviews impacts of antibiotics on pH, COD removal efficiencies, biogas and methane productions as well as the accumulation of volatile fatty acids (VFAs) in the anaerobic processes. Meanwhile, impacts on the structure of bacteria and methanogens in anaerobic processes are also discussed comprehensively. Furthermore, to better understand the effect of antibiotics on anaerobic processes, detailed information about antimicrobial mechanisms of antibiotics and microbial functions in anaerobic processes is also summarized. Future research on deeper knowledge of the effect of antibiotics on anaerobic processes are suggested to reduce their adverse environmental impacts.

SOX9, miR-495, miR-590-3p, and miR-320d were identified as chemoradiotherapy-sensitive genes and miRNAs in colorectal cancer patients based on a microarray dataset

The study aimed to identify chemoradiotherapy (CRT)-sensitive biomarkers in colorectal cancer (CRC) patients. The GSE15781 dataset used in this study contains 42 samples: 22 CRC tissues (non-CRT: n = 13; CRT: n = 9) and 20 normal colorectal tissues (non-CRT: n = 10; CRT: n = 10). Following pretreatment, differentially expressed genes were selected using the limma package. Potential CRT-sensitive genes were identified with Venn analysis and then enriched in function and pathway clusters using the DAVID online tool. Moreover, protein-protein interaction (PPI) network analysis was implemented using the STRING database. The TRRUST database was used to establish a transcription factor (TF)-target transcriptional network. A miRNA-mRNA network was constructed based on relevant databases. miRNA and mRNA expression levels were analyzed using real-time quantitative PCR. A group of 259 candidate CRT-sensitive genes were identified that were mainly enriched in cell cycle regulation, adhesion-associated processes, and the p53 signaling pathway. A PPI network was established that contained striking nodes, including ITGA2, MYC, ESR1, and dihydropyrimidine dehydrogenase (DPYD), among which ESR1 was linked to MYC, and the two nodes were also highlighted in the TF-target regulation network. SRY-box 9 (SOX9) was another key TF. Hsa-miR-590-3p, hsa-miR-495, hsa-miR-320c, and hsa-miR-320d were predominant in the miRNA-mRNA network. Expression levels of SOX9, DPYD mRNA, miR-495, and miR-590-3p were clearly reduced after X-ray treatment in irradiated HT-29 cells, whereas that of miR-320d was notably enhanced. SOX9 may be a CRT-sensitive gene in CRC patients, and hsa-miR-590-3p, hsa-miR-495, and hsa-miR-320d may be CRT-sensitive microRNAs in CRC patients. Therefore, SOX9, hsa-miR-590-3p, hsa-miR-495, and hsa-miR-320d may be used as sensitive biomarkers in CRC patients.

InP-based pseudomorphic InAs/InGaAs triangular quantum well lasers with bismuth surfactant

An InP-based 2.1 μm InAs/In_0.53Ga_0.47As triangular quantum well laser grown with Bi surfactant has shown improved performance in comparison to the device with the same structure but grown without Bi surfactant. Under continuous-wave driving operation, the output light power is increased from 32.6 to 37.5 mW at the same injecting current of 850 mA at 200 K. The external differential and internal quantum efficiencies for the laser with Bi surfactant are 18.4% and 41%, respectively, which are correspondingly higher than 13.1% and 31% for the reference device. Furthermore, a decreased internal loss from 20.9 to 17.6  cm^-1 for the Bi surfactant laser is also observed. These results suggest that Bi surfactant is promising for further enhancing performances of strained quantum well laser diodes.

[Prevalence of hearing disorders in China: a population-based survey in four provinces of China]

Objective: To investigate the prevalence, severity of hearing disorders and demographics of people with hearing disorders based on the whole population in Jilin, Guangdong, Shannxi and Gansu provinces in China. Methods: According to " WHO Ear and Hearing Disorders Survey Protocol" , 144 clusters were chosen with probability proportional sampling(PPS) method from the four provinces covering 194, 688, 061 residents. Audiological test, otological examination and questionnaire surveying were conducted for all samples from August, 2014 to September, 2015. The hearing disorders were classified according to WHO criteria and classification. Results: Among 47 511 targeted residents, 45, 052 individuals (94.82% response rate) participated in the survey. The standardized prevalence rates of hearing disorders and disabling hearing disorders were 15.84 % and 5.17 % respectively. Almost 50% of people with hearing disorders had no awareness of it or its starting time. There was significant difference in the prevalence among people of different ages, genders, occupations, provinces, marital status and education levels. The prevalence of hearing disorders increased significantly as age grew. People above 60 years old occupied 55.31% of the total hearing disorders. The prevalence of hearing disorders among male, people of low education and those who lost husband or wife, as well as workers and farmers was relatively higher. Conclusions: The prevalence of hearing disorders is high, and hearing disorders are " invisible" . Demographics and socioeconomic factors significantly influence the prevalence of hearing disorders.

A novel HLA-B allele, HLA-B*13:91, was identified by sequencing-based typing in the CMDP

The new allele HLA-B*13:91 was initially identified in a Chinese individual by sequence-based typing.

[A long-term follow-up results of Enterprise stent in treatment of severe symptomatic basilar artery atherosclerotic stenosis]

OBJECTIVE

To evaluate the safety and efficacy of Enterprise stent in the treatment of severe symptomatic basilar artery atherosclerosis stenosis.

METHODS

All patients who underwent Enterprise stent for the treatment of symptomatic basilar artery atherosclerotic stenosis in our center from Nov. 2011 to Nov. 2014 were enrolled in the study. Preoperative and postoperative dual antiplatelet drugs and intensive lipid-lowering therapy were given to all the patients. Multi-modality imaging guiding for stent angioplasty was performed in all the patients, including head MRI or CT, CT or MRI perfusion, high resolution MRI for plaque analysis and angiography. Angiography after 6 months was recommended. The main outcome parameters were any stroke or death within 30 days, stroke recurrence in the basilar artery blood supply area during the follow-up period and in-stent restenosis.

RESULTS

A total of 35 cases were enrolled in the study with operation technical success rate of 100%. The average preoperative and postoperative stenosis rate was (83.0±10.1)% and (28.1±8.9)%. The main perioperative complication and mortality rate was 0. The average follow-up period was (10.6±7.9) months. During follow-up period, only 2 cases (5.7%) of TIA related to the stented artery were observed. In patients with follow-up period more than 6 months, 17 cases (56.7%) underwent cerebral angiography. Restenosis rate was 17.6%. One patient with in-stent restenosis suffered from transient cerebral ischemia and received another Enterprise stenting successfully.

CONCLUSION

Long term follow-up results show that Enterprise stent for the treatment of symptomatic basilar artery severe stenosis is safe and recurrence of stroke can be prevented effectively.

Diagnosis of latent tuberculosis by ELISPOT assay and tuberculin skin test

OBJECTIVE

To determine the prevalence of latent tuberculosis infection (LTBI) in college students.

PATIENTS AND METHODS

Four hundred and twenty newly admitted college students were enrolled. The Enzyme-Linked ImmunoSpot assay (ELISPOT) was used. Overall, 171 students with ELISPOT assay+/TST+ were monitored for three years to detect active TB disease.

RESULTS

The overall positive rate of ELISPOT assay was 40.7% among TST+ students. The ELISPOT positive rates were 36.9%, 45.4%, and 64.3% in groups of TST induration of 10-14mm, 15-20mm, and ≥20mm, respectively, with a significant difference (χ(2)=10.136, P<0.01) but no significant difference between BCG scar and no scar (41.2% vs. 38.8%; P>0.05). None of the 171 untreated students contracted active TB within the three-year monitoring period.

CONCLUSION

The LTBI rate might be overestimated by TST compared with interferon-γ release assays. On the basis of a close monitoring, few students developed active TB despite a positive result to the TST and ELISPOT assay.

Diadenylate cyclase evaluation of ssDacA (SSU98_1483) in Streptococcus suis serotype 2

Cyclic diadenosine monophosphate is a recently identified signaling molecule. It has been shown to play important roles in bacterial pathogenesis. SSU98_1483 (ssDacA), which is an ortholog of Listeria monocytogenes DacA, is a putative diadenylate cyclase in Streptococcus suis serotype 2. In this study, we determined the enzymatic activity of ssDacA in vitro using high-performance liquid chromatography and mass spectrometry. Our results showed that ssDacA was a diadenylate cyclase that converts ATP into cyclic diadenosine monophosphate in vitro. The diadenylate cyclase activity of ssDacA was dependent on divalent metal ions such as Mg(2+), Mn(2+), or Co(2+), and it is more active under basic pH than under acidic pH. The conserved RHR motif in ssDacA was essential for its enzymatic activity, and mutation in this motif abolished the diadenylate cyclase activity of ssDacA. These results indicate that ssDacA is a diadenylate cyclase, which synthesizes cyclic diadenosine monophosphate in Streptococcus suis serotype 2.

Effect of argon protection on the biological activity of acid etched titanium surface

OBJECTIVE

As the contamination of implant surface seriously affects the early osseointegration of implants and reduces the survival rate of implants, it has attracted wide attention of researchers. The most oral titanium implants used in current clinical applications are stored in sealed packages. During the process of packaging, storage and usage, the implants inevitably contact air, which results in the surface contamination. As an inert gas, the argon has very inactive chemical properties and is routinely used as a protective gas to cut air pollution. In this study, we investigated whether argon protection can cut air pollution and maintain lasting surface biological activity of titanium implants.

MATERIALS AND METHODS

We prepared sandblasting etched titanium samples under air protection or under argon protection. The samples prepared under air protection were used as the control. With the scanning electron microscopy, the contact angle measurements and the X-ray photoelectron spectroscopy, we examined surface morphology, hydrophilicity, chemical structures and components of the implants prepared under two gas protections. By using beagles as the animal model, we assessed the bone guide of the implants prepared under argon protection and morphological changes of surrounding tissues.

RESULTS

While compared with those implants prepared under air protection, the surface morphology of implants prepared under argon protection did not change, which had preferable hydrophilicity, and there were differences in percentage of surface chemical elements and chemical structure. After 4 weeks, the bone-implant contact (BIC) in argon protection group was twice of the control group and the difference was statistically significant (p < 0.01). The Implant Niuchu experiments also proved that under argon protection, the implants would have good integration with the surrounding bone tissues.

CONCLUSIONS

This study revealed the implants prepared under argon can cut air pollution and have high bone guide property and biological activity.

Subtypes of major depression: latent class analysis in depressed Han Chinese women

BACKGROUND

Despite substantial research, uncertainty remains about the clinical and etiological heterogeneity of major depression (MD). Can meaningful and valid subtypes be identified and would they be stable cross-culturally?

METHOD

Symptoms at their lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾ 30 years, with recurrent DSM-IV MD. Latent class analysis (LCA) was performed in Mplus. RESULTS; Using the nine DSM-IV MD symptomatic A criteria, the 14 disaggregated DSM-IV criteria and all independently assessed depressive symptoms (n = 27), the best LCA model identified respectively three, four and six classes. A severe and non-suicidal class was seen in all solutions, as was a mild/moderate subtype. An atypical class emerged once bidirectional neurovegetative symptoms were included. The non-suicidal class demonstrated low levels of worthlessness/guilt and hopelessness. Patterns of co-morbidity, family history, personality, environmental precipitants, recurrence and body mass index (BMI) differed meaningfully across subtypes, with the atypical class standing out as particularly distinct.

CONCLUSIONS

MD is a clinically complex syndrome with several detectable subtypes with distinct clinical and demographic correlates. Three subtypes were most consistently identified in our analyses: severe, atypical and non-suicidal. Severe and atypical MD have been identified in multiple prior studies in samples of European ethnicity. Our non-suicidal subtype, with low levels of guilt and hopelessness, may represent a pathoplastic variant reflecting Chinese cultural influences.

IL-6 gene promoter polymorphisms and risk of coronary artery disease in a Chinese population

We investigated the relationships between single nucleotide polymorphisms (SNPs) of the interleukin (IL)-6 gene 174 G>C (rs1800795), 572 G>C (rs1800796), and 597 G/A (rs1800797) and coronary artery disease (CAD) risk in a Chinese population. This case-control study recruited 296 CAD patients and 327 controls between January 2009 and May 2012. Genotyping of IL-6 174 G>C (rs1800795), 572 G>C (rs1800796), and 597 G/A (rs1800797) was performed on a 384-well plate format using the Sequenom MassARRAY platform. CAD patients were more likely to be older and male, with a higher body mass index, diabetes, and hypertension, and presented higher triglycerides, and lower total cholesterol, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol. We found that the IL-6 174CC genotype was associated with a significantly increased risk of CAD compared to the wild-type GG genotype in a codominant model [odds ratio (95% confidence interval) = 1.94 (1.13-3.37)], whereas IL-6 174 G>C polymorphisms presented an increased risk of CAD in dominant and recessive models. However, we did not find that the IL-6 572 CC and 597 AA genotypes were correlated with an increased risk of CAD. IL-6 174 G>C rs1800795 was associated with CAD risk in a Chinese population. Further large-scale studies are required to determine whether IL-6 SNPs interact with environmental factors in the development of CAD.