Metabolic habitat imaging with hemodynamic heterogeneity predicts individual progression-free survival in high-grade glioma

AIM

We design a feasibility study to obtain a set of metabolic-hemodynamic habitats for tackling tumor spatial metabolic patterns with hemodynamic information.

MATERIALS AND METHODS

Preoperative data from 69 high-grade gliomas (HGG) patients with subsequent histologic confirmation of HGG were prospectively collected (January 2016 to March 2020) after concurrent chemoradiotherapy (CCRT). Four vascular habitats were automatically segmented by multiparametric magnetic resonance imaging (MRI). The metabolic information, either at enhancing or edema tumor regions, was obtained by two neuroradiologists. The relative habitat volumes were used for weight estimation procedures for computing the coefficients of a linear regression model using weighted least squares (WLS) for metabolite semiquantifications (i.e. the Cho/NAA ratio and the Cho/Cr ratio) at vascular habitats. Multivariate Cox proportional hazard regression analyses are used to obtain the odds ratio (OR) and develop a nomogram using weighted estimators corresponding to each covariate derived from Cox regression coefficients.

RESULTS

There was a strongly correlation between perfusion indexes and the Cho/Cr ratio (rCBV, r=0.71) or Cho/NAA ratio (rCBV, r=0.66) at high-angiogenic enhancing tumor habitats (HAT) habitat. Compared isocitrate dehydrogenase (IDH) mutation to their wild type, the IDH wild type had significantly decreased Cho/Cr ratio (IDH mutation: Cho/Cr ratio = 2.44 ± 0.33, IDH wildtype: Cho/Cr ratio = 2.66 ± 0.36, p=0.02) and Cho/NAA ratio (IDH mutation: Cho/Cr ratio = 4.59 ± 0.61, IDH wildtype: Cho/Cr ratio = 4.99 ± 0.66, p=0.022) at the HAT. The C-index for the median progression-free survival (PFS) prediction was 0.769 for the Cho/NAA nomogram and 0.747 for the Cho/Cr nomogram through 1000 bootstrapping validation.

CONCLUSIONS

Our findings suggest that spatial metabolism combined with hemodynamic heterogeneity is associated with individual PFS to HGG patients post-CCRT.

Prevalence of Fundus Tessellation and Its Screening Based on Artificial Intelligence in Chinese Children: the Nanjing Eye Study

INTRODUCTION

To investigate the prevalence of fundus tessellation (FT), and the threshold for screening FT using an artificial intelligence (AI) technology in Chinese children.

METHODS

The Nanjing Eye Study was a population-based cohort study conducted in children born between September 2011 and August 2012 in Yuhuatai District of Nanjing. The data presented in this paper were obtained in 2019, when these children were 7 years old and underwent 45° non-mydriatic fundus photography. FT in whole fundus, macular area, and peripapillary area was manually recognized from fundus photographs and classified into three grades. Fundus tessellation density (FTD) in these areas was obtained by calculating the average exposed choroid area per unit area using artificial intelligence (AI) technology based on fundus photographs. The threshold for screening FT using FTD was determined using receiver operating characteristic (ROC) curve analysis.

RESULTS

Among 1062 enrolled children (mean [± standard deviation] spherical equivalent: - 0.28 ± 0.70 D), the prevalence of FT was 42.18% in the whole fundus (grade 1: 36.53%; grade 2: 5.08%; grade 3: 0.56%), 45.57% in macular area (grade 1: 43.5%; grade 2: 1.60%; grade 3: 0.50%), and 49.72% in peripapillary area (grade 1: 44.44%; grade 2: 4.43%; grade 3: 0.85%), respectively. The threshold value of FTD for screening severe FT (grade ≥ 2) was 0.049 (area under curve [AUC] 0.985; sensitivity 98.3%; specificity 92.3%) in the whole fundus, 0.069 (AUC 0.987; sensitivity 95.5%; specificity 96.2%) in the macular area, and 0.094 (AUC 0.980; sensitivity 94.6%; specificity 94.2%) in the peripapillary area, respectively.

CONCLUSION

Fundus tessellation affected approximately 40 in 100 children aged 7 years in China, indicating the importance and necessity of early FT screening. The threshold values of FTD provided by this study had high accuracy for detecting severe FT and might be applied for rapid screening.

Fundus Tessellated Density Assessed by Deep Learning in Primary School Children

Purpose

To explore associations of fundus tessellated density (FTD) and compare characteristics of different fundus tessellation (FT) distribution patterns, based on artificial intelligence technology using deep learning.

Methods

Comprehensive ocular examinations were conducted in 577 children aged 7 years old from a population-based cross-sectional study, including biometric measurement, refraction, optical coherence tomography angiography, and 45° nonmydriatic fundus photography. FTD was defined as the average exposed choroid area per unit area of the fundus, and obtained by artificial intelligence technology. The distribution of FT was classified into the macular pattern and the peripapillary pattern according to FTD.

Results

The mean FTD was 0.024 ± 0.026 in whole fundus. Multivariate regression analysis showed that greater FTD was significantly correlated with thinner subfoveal choroidal thickness, larger parapapillary atrophy, greater vessel density inside the optic disc, larger vertical diameter of optic disc, thinner retinal nerve fiber layer, and longer distance from optic disc center to macular fovea (all P < 0.05). The peripapillary distributed group had larger parapapillary atrophy (0.052 ± 0.119 vs 0.031 ± 0.072), greater FTD (0.029 ± 0.028 vs 0.015 ± 0.018), thinner subfoveal choroidal thickness (297.66 ± 60.61 vs 315.33 ± 66.46), and thinner retinal thickness (285.55 ± 10.89 vs 288.03 ± 10.31) than the macular distributed group (all P < 0.05).

Conclusions

FTD can be applied as a quantitative biomarker to estimate subfoveal choroidal thickness in children. The role of blood flow inside optic disc in FT progression needs further investigation. The distribution of FT and the peripapillary pattern correlated more with myopia-related fundus changes than the macular pattern.

Translational Relevance

Artificial intelligence can evaluate FT quantitatively in children, and has potential value for assisting in myopia prevention and control.

[Performance of pulmonary function test in people aged 40 years and above in China, 2019-2020]

Objective: To understand the performance of pulmonary function tests in people aged ≥40 years and its changes in China, and provide evidence for the evaluation of the effect of chronic obstructive pulmonary disease (COPD) prevention and control in China. Methods: The subjects of the survey were from COPD surveillance during 2014-2015 and during 2019-2020, which covered 31 provinces (autonomous regions and municipalities) in China. The survey used multi-stage stratified cluster random sampling method, the trained investigators conducted face-to-face interview to know whether subjects had previous pulmonary function testing or not. Complex sampling weighting was used to estimate the rate of pulmonary function testing in people aged ≥40 years, and the pulmonary function testing rates of the two COPD surveillance periods were compared. Results: A total of 148 427 persons were included in the analysis, including 74 591 persons during 2014-2015 and 73 836 persons during 2019-2020. In 2019-2020, the pulmonary function testing rate in Chinese residents aged ≥40 years was 6.7% (95%CI: 5.2%-8.2%), the rate in men (8.1%, 95%CI: 6.7%-9.6%) was higher than that in women (5.4%, 95%CI: 3.7%- 7.0%), and the rate in urban residents (8.3%, 95%CI: 6.1%-10.5%) was higher than that in rural residents (4.4%, 95%CI: 3.8%-5.1%). The rate of pulmonary function testing increased with the increase of education level. During 2019-2020, the residents with history of chronic respiratory diseases had the highest rate of pulmonary function testing (21.2%, 95%CI: 16.8%-25.7%), followed by the residents with respiratory symptoms (15.1%, 95%CI: 11.8%-18.4%) , the pulmonary function testing rate in those who knew the name of chronic respiratory disease was higher than that in those who did not knew the name of respiratory disease, and the pulmonary function testing rate in former smokers was higher than that in current smokers and non-smokers. Those exposed to occupational dust and/or harmful gases had a higher rate of pulmonary function testing compared with those who were not exposed, and those who used polluted fuels indoors had a lower rate of pulmonary function testing than those who did not use polluted fuels indoors (all P<0.05). Compared with 2014-2015, the pulmonary function testing rate in residents aged ≥40 years in China increased by 1.9 percentage points during 2019-2020, and the rate of pulmonary function testing in groups with different characteristics all increased, and the rates of pulmonary function testing increased by 7.4 percentage points and 7.1 percentage points in residents with respiratory symptoms and in those with history of chronic respiratory diseases (all P<0.05). Conclusions: Compared with 2014-2015, the rate of pulmonary function testing increased in China during 2019-2020 and the increase in residents with history of chronic respiratory diseases and respiratory symptoms was relatively obvious, but the overall pulmonary function testing rate was still at a low level. Effective measures should be taken to further increase the rate of pulmonary function testing.

[The perforator flap of ipsilateral nasolabial sulcus used to repair the defect after the eradication of nasal vestibular squamous cell carcinoma]

Objective: To investigate the feasibility of only surgical resection for nasal vestibular squamous cell carcinoma and the efficacy of perforator flap of ipsilateral nasolabial sulcus in repairing postoperative defects. Methods: The clinical data of 8 cases with squamous cell carcinoma of the nasal vestibule who admitted to Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University were analyzed, including 6 males and 2 females, aged from 38 to 75 years. The tumor of the nasal vestibule was eradicated in time after making definite diagnosis of lesions, then the perforators flap of the ipsilateral nasolabial sulcus was used for repairment, without performing further chemotherapy or radiotherapy after surgery. The tumor recurrence, facial appearance, nostril form, donor area scar, nasal ventilation function, and cutaneous sensation were evaluated after surgery. Descriptive analysis was used in this research. Results: There were 2 cases of stage T1 and 6 cases of stage T2 in 8 cases. After 32 to 45 months of following-up, no recurrence accurred and all the flaps survived well. However, there was about 2 mm necrosis of the transplanted flap in the lateral foot of the alar in one case, which was healed well by carrying out wound care after 10 d. And the dark color flap was occurred in another case, showing the flap's backflow trouble, yet it was improved with addressing timely during 5 d postoperation. Pincusion-like deformity of the transplanted flap occurred in 4 cases (50%), which subsided gradually after 6 months. The morphology of the anterior nostril was altered in 4 cases (50%), but there was no ventilation trouble and no need for addressment in any case. The postoperative facial appearance was rated as excellentor good with hidden scar in the donor site, and the sensation of the transplanted flaps was indistinct from the surrounding tissue after 3 months. Conclusions: Surgical resection of nasal vestibular squamous cell carcinoma with tumor stage T1-2 is a feasible treatment. And it is the one of the best reconstructive methods of the perforator flap of the ipsilateral nasolabial sulcus to repair the deformities after the surgery.

Instrument referral criteria for PlusoptiX and SureSight based on 2021 AAPOS guidelines: A population-based study

Objective

The study aims to assess two refractive instrument-based methods of vision screening (SureSight and PlusoptiX) to detect refractive amblyopia risk factors (ARFs) and significant refractive errors in Chinese preschool children and to develop referral criteria according to the 2021 AAPOS guidelines.

Methods

Eye examinations were conducted in children aged 61 to 72 months (n = 1,173) using a PlusoptiX photoscreener, SureSight autorefractor, and cycloplegic retinoscopy (CR). The Vision Screening Committee of AAPOS's preschool vision screening guidelines from 2021 were adopted for comparison. Paired t-test analysis and Bland-Altman plots were used to assess the differences and agreement between the PlusoptiX photoscreener, SureSight autorefractor, and CR. In addition, the validity of the cut-off values of the several ARFs measured with the SureSight and PlusoptiX was estimated using receiver operating characteristic (ROC) curves and compared to the age-based 2021 AAPOS examination failure levels.

Results

A total of 1,173 children were tested with comprehensive eye examinations. When the referral numbers based on the 2013 (43/3.67%) and 2021 (42/3.58%) AAPOS guidelines were compared, significant differences between the values of astigmatism (72.09 vs. 52.38%) and anisometropia (11.63 vs. 38.10%) were found. The 95% limits of agreement (LOA) of the spherical value and the cylindrical value between PlusoptiX and CR were 95.08 and 96.29%. It was 93.87 and 98.10% between SureSight and CR. Considering refractive failure levels, the ROC curves obtained the optimal cut-off points. However, the PlusoptiX and the SureSight showed lower efficiency in hyperopia (Youden index, 0.60 vs. 0.83) and myopia (Youden index, 078 vs. 0.93), respectively. After adjusting the above cut-off points, the optimized NES (Nanjing Eye Study) referral criteria for myopia, hyperopia, astigmatism, and anisometropia were -0.75, 1.25, -1.0, and 0.5 with PlusoptiX and -1.25, 2.75, -1.5, and 0.75 with SureSight.

Conclusions

SureSight and PlusoptiX showed a good correlation with CR and could effectively detect refractive ARFs and visually significant refractive errors. There were obvious advantages in detecting hyperopia using SureSight and myopia using PlusoptiX. We proposed instrumental referral criteria for age-based preschool children based on AAPOS 2021 guidelines.

Corneal endothelial cell density and its correlation with birth weight, anthropometric parameters, and ocular biometric parameters in Chinese school children

Background

To describe the distribution of corneal endothelial cell density (ECD), and to explore its correlation with birth weight (BW), anthropometric parameters, and ocular biometric parameters in Chinese school children.

Methods

In the population-based cross-sectional Nanjing Eye Study, children were measured for anthropometric information, for ECD by the noncontact specular microscope and for ocular biometric parameters by the optic low-coherent reflectometer. Data from right eyes were analyzed to illustrate the distribution of ECD and for determining correlated factors with ECD using univariate and multiple linear regression analysis. Comparisons among three different BW groups were performed using a one-way ANOVA analysis followed by the Bonferroni correction for pairwise comparisons.

Results

Of 1171 children, the mean (± standard deviation) ECD was 2875.34 ± 195.00 cells/mm². In the Multiple Linear Regression analysis, BW, gender and central corneal thickness were significantly associated with ECD. The ECD increased by 36.16 cells/mm² with BW increasing by 1 kg (P = 0.001) and increased by 0.44 cells/mm² for every additional 1 mm in central corneal thickness (P = 0.01). The ECD of girls was 54.41 cells/mm² higher than boys (P < 0.001). Children born with low BW presented significantly lower ECD than those born with normal BW (P < 0.05) and high BW (P < 0.05). Age and axial length were not significantly associated with ECD (P = 0.06 and P = 0.21, respectively).

Conclusions

In Chinese school children aged 82 to 94 months, the ECD is positively correlated with BW and central corneal thickness, in which BW is a newly identified associated factor. It is like that gender plays an important role in ECD distribution while girls have relatively greater ECD than boys.

Altered retinal nerve fiber layer thickness in children with allergic conjunctivitis: the Nanjing eye study

Background

So far, few data are available on the relationship between allergic conjunctivitis (AC) and ocular fundus. Whether retinal parameters change in patients with AC remains unknown. In this study, we investigated the influence of AC on retinal thickness and vessel density among 7-years-old school-age children.

Methods

This large population-based study is part of the Nanjing Eye Study (NES). Comprehensive examinations including anthropometric parameters, refraction, ocular biometric parameters, intraocular pressure and retinal parameters were conducted on each child. Retinal thickness and vessel density were assessed using the optical coherence tomography angiography. Information on AC was obtained from a comprehensive questionnaire.

Results

A total of 739 children (mean age ± SD: 7.40 ± 0.29 years) had complete eye examination and questionnaire data we needed. Ninety-four children (12.7%) had AC, among which, 5 children had the history of corticosteroid use and were excluded from the final analysis. Spherical equivalent, axial length, body mass index and birth weight were correlated with retinal parameters. After adjusting for sex, age, spherical equivalent, axial length, body mass index, birth weight and premature history, children with AC had thinner retinal nerve fiber layer thickness for average (117.39 versus 120.97 μm, p = 0.007), temporal (80.73 versus 84.34 μm, p = 0.001), nasal (98.82 versus 102.18 μm, p = 0.049) and inferior (152.68 versus 157.06 μm, p = 0.034) quadrants than the control group.

Conclusions

Children with AC tended to have thinner retinal nerve fiber layer thickness. More attention is needed to fundus condition of children with AC.

Supplementary information

The online version contains supplementary material available at 10.1186/s12886-022-02399-7.

Association of sleep disorders with subfoveal choroidal thickness in preschool children

OBJECTIVE

To explore the association between sleep disorders and subfoveal choroidal thickness (SFCT) in preschool children.

METHODS

In this population-based cross-sectional study, children aged 60-72 months were measured for SFCT using spectral-domain optical coherence tomography (SD-OCT) and for sleep disorders using the Chinese version of Children's Sleep Habits Questionnaire (CSHQ). Multiple linear regression analyses were performed to assess the association between sleep disorders and SFCT.

RESULTS

A total of 1337 children (mean (SD) age: 66.88 (3.41) months) were included in the analyses. In multivariable linear analysis, a higher total CSHQ score (indicating higher likelihood of sleep disorders) was associated with a thinner subfoveal choroid (beta, -0.070; 95% CI, -0.141 to -0.001; P = 0.046). When each of eight CSHQ subscale scores was analysed by the multivariable model, only the Daytime Sleepiness subscale score was negatively associated with the SFCT (beta, -0.115; 95% CI, -0.183 to -0.046; P = 0.001). The children with clinically significant daytime sleepiness (n = 364, 27.2%) had significantly thinner subfoveal choroid than other children (295.47 vs. 308.52 μm, P = 0.007).

CONCLUSIONS

Only daytime sleepiness was significantly associated with SFCT in preschool children in this study. The potential relationship between sleep disorders during childhood and children's ocular development needs further research.

The biometric parameters of aniso-astigmatism and its risk factor in Chinese preschool children: the Nanjing eye study

Backgrounds

Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children.

Methods

In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J₀ or J₄₅ between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model.

Results

Of 1131 children (66.90 ± 3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI) = 1.14–2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR) = 6.42, 95%CI = 2.63–15.69, P < 0.001; non-vectorial aniso-TA: OR = 4.99, 95%CI = 1.41–17.68, P = 0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR = 2.43, 95%CI = 1.05–5.60, P = 0.04). Pre-term delivery (OR = 2.60, 95%CI = 1.09–6.15, P = 0.03) and post-term delivery (OR = 3.61, 95%CI = 1.31–9.96, P = 0.01) were significantly associated with higher risk of vectorial aniso-CA.

Conclusions

Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score < 7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01808-7.

Effect of birth order on stereoacuity in Chinese preschool children: a cross-sectional study

OBJECTIVE

This study aimed to investigate the relationship between birth order and stereoacuity among Chinese children aged 60-72 months.

DESIGN

Cross-sectional.

PARTICIPANTS

1342 children with complete data on the questionnaire, stereoacuity and refraction were included.

RESULTS

The mean stereoacuity was 53.2±1.7, 56.9±1.9 and 60.9±1.5 s of arc in the first-born group, second-born group and third-born group, respectively. Lower birth order was significantly correlated with better stereoacuity (p=0.036). Third-borns (OR=3.02, p=0.027) were at higher risk of having subnormal stereoacuity compared with first-borns in the multivariate analysis.

CONCLUSION

Later-borns had poorer stereoacuity than first-borns.

Decreased retinal thickness in preschool offspring of maternal gestational hypertension: the Nanjing Eye Study

PURPOSE

To evaluate the influence of maternal gestational hypertension (GH) on retinal thickness of 5-6-year-old children, including macular thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness and peripapillary retinal nerve fibre layer (RNFL) thickness.

METHODS

As part of Nanjing Eye Study, comprehensive ocular examinations were conducted in children aged 61-72 months, including noncycloplegic refraction, ocular biometric parameters and retinal parameters. Retinal thickness was measured by Spectral Domain-Optical Coherence Tomography. Data on pregnancy and birth history were obtained from a detailed questionnaire completed by parents.

RESULTS

Among 1062 children [mean age (standard deviation): 66.9 (3.4) months] with complete from eye examination and questionnaire, 30 (2.8%) children were born with maternal GH. In generalized linear models (adjusted for sex, age, spherical equivalent, axial length, body mass index, birth weight and premature history), children born with maternal GH had thinner average RNFL thickness (100.5 versus 104.4 μm, p = 0.035), superior RNFL thickness (123.7 versus 132.0 μm, p = 0.007), superior GC-IPL thickness (83.7 versus 86.4 μm, p = 0.005), superior-nasal GC-IPL thickness (86.3 versus 88.4 μm, p = 0.029) and superior outer macular thickness (278.0 versus 283.0 μm, p = 0.034) than children born with normal pregnancy.

CONCLUSION

Children exposed to maternal GH tended to have thinner macular, RNFL and GC-IPL thickness. These findings suggest that maternal GH may affect the development of retina in children thus hinders the development of the offspring's nervous system.

Prevalence, incidence and risk factors of strabismus in a Chinese population-based cohort of preschool children: the Nanjing Eye Study

AIMS

To evaluate the prevalence, incidence and their related risk factors of strabismus among preschool children in China.

METHODS

Children born between September 2011 and August 2012 in Yuhuatai District of Nanjing were invited to participate in the Nanjing Eye Study for a comprehensive eye examination annually since 2015. The data presented in this paper were obtained from 2015 to 2017, when these children grew from the age of 3 to 5 years. Eye examinations included visual acuity, anterior segment, posterior segment, refraction, and ocular alignment and motility. Risk factors were evaluated using univariable and multivariable logistic regression models for prevalent and incident strabismus.

RESULTS

In 2015, a total of 2018 children (87.7% response rate) of 2300 eligible preschoolers completed the baseline eye examination when they were 3 years old. Among the 2018 participants, 50 had strabismus (prevalence rate, 2.48%). In multivariable analysis, prevalent strabismus was independently associated with parental strabismus history (OR=11.60, p<0.001), hyperopia (OR=6.22, p<0.001), prematurity (OR=3.07, p=0.01) and astigmatism (OR=2.15, p=0.04). Among 1766 children followed up for 2 years, 63 developed strabismus (annual incidence rate, 1.78%), of whom 57 had exotropia and 6 had esotropia. In multivariable analysis, incident strabismus was significantly associated with parental strabismus history (OR=5.55, p=0.04) and prematurity (OR=3.77, p<0.001).

CONCLUSIONS

In this population-based cohort study, we found a higher incidence of strabismus and a higher exotropia:esotropia ratio than previous studies in preschool children. Parental strabismus history and prematurity were associated with a higher risk for both prevalent and incident strabismus.

Prevalence, causes and risk factors of reduced VA and persistent reduced VA among preschool children in Eastern China

AIMS

To determine prevalence, causes, and risk factors of reduced uncorrected visual acuity (UCVA), reduced presenting visual acuity (PVA), and persistent reduced visual acuity (VA) among Chinese preschool children.

METHODS

The longitudinal, population-based Nanjing Eye Study (NES) was carried out. Children underwent baseline comprehensive ocular examinations in 2016 (at 48-60 months old) and the follow-up ocular examinations in 2017. A comprehensive questionnaire about children and their families was completed by their legal guardians. For children having reduced PVA at baseline, a follow-up questionnaire about potential factors concerning VA correction was completed. Reduced VA was defined as VA worse than 0.30 logMAR (Snellen equivalent 6/12, 20/40), and persistent reduced VA was defined as reduced PVA in both 2016 and 2017.

RESULTS

Among 1448 participants with both eye examinations and questionnaires completed, prevalence of reduced UCVA, reduced PVA, and persistent reduced VA at age of 60-72 months were 5.94%, 3.04%, and 1.59% respectively. Causes for reduced PVA were refractive error (79.5%), amblyopia (18.2%), and amblyopia combined nystagmus (2.3%). Among 23 children having persistent reduced VA, causes of reduced PVA remained unchanged in 13 children and 4 children developed amblyopia from refractive error. Younger age (OR = 1.09 for each month decrease, p = 0.01) and non-breastfeeding (OR = 2.08, p = 0.03) were risk factors for reduced UCVA. Younger children with reduced UCVA were at higher risk of having reduced PVA (OR = 1.18 for each month decrease, p = 0.04). Children with siblings (OR = 5.95, p = 0.02) were more likely to have persistent reduced VA.

CONCLUSIONS

Future vision health promotion strategies among preschool children should focus on early vision-screening and timely refractive correction. Apart from children of non-breastfeeding mothers, attention should also be paid to children with siblings.

Nutrition, Immigration and Health Determinants Are Linked to Verbal Fluency among Anglophone Adults in the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVES

Later-life cognitive impairment is an important health issue; however, little is known about the condition among diverse groups such as immigrants. This study aims to examine whether the healthy immigrant effect exists for verbal fluency, an indicator of cognitive functioning, among anglophone middle-aged and older adults in Canada.

METHODS

Using from the baseline data of the Canadian Longitudinal Study on Aging (CLSA), multiple linear regression was employed to compare associations among immigrants (recent and long-term) and Canadian-born residents without dementia for two verbal fluency tests, the Controlled Oral Word Association Test (COWAT) and the Animal Fluency (AF) task. Covariates included socioeconomic, physical health, and dietary intake.

RESULTS

Of 8,574 anglophone participants (85.7% Canada-born, 74.8% aged 45-65 years, 81.8% married, 81.9% with a post-secondary degree), long-term immigrants (settled in Canada >20 years) performed significantly better than Canadian-born residents for the COWAT (42.8 vs 40.9) but not the AF task (22.4 vs 22.4). Results of the multivariable adjusted regression analyses showed that long-term immigrants performed better than Canadian-born peers in both the COWAT (B=1.57, 95% CI: 0.80-2.34) and the AF test (B=0.57, 95% CI: 0.19-0.95), but this advantage was not observed among recent immigrants. Other factors associated with low verbal fluency performance included being single, socioeconomically disadvantaged, having hypertension, excess body fat, and consuming low amounts of pulses/nuts or fruit/vegetables.

CONCLUSIONS

Long-term immigrants had higher verbal fluency test scores than their Canadian-born counterparts. Immigration status, social, health and nutritional factors are important considerations for possible intervention and prevention strategies for cognitive impairment.

The functional difference of eight chitinase genes between male and female of the cotton mealybug, Phenacoccus solenopsis

The cotton mealybug Phenacoccus solenopsis Tinsley (Hemiptera: Pseudococcidae) is a polyphagous insect that attacks tens of plant and causes substantial economic loss. Insect chitinases are required to remove the old cuticle to allow for continued growth and development. Though insect chitinases have been well studied in tens of insects, their functions in mealybug are still not addressed. Here, we sequenced the transcriptomes of adult males and females, from which eight chitinase genes were identified. We then used the method of rapid amplification of cDNA ends to amplify their full length. Phylogenetic analysis indicated that these genes clustered into five subgroups. Among which, group II PsCht2 had the longest transcript and was highly expressed at second instar nymph. PsCht10, PsCht3-3 and PsIDGF were highly expressed in the adult females, whereas PsCht4 and PsCht4-1 were significantly expressed at the male pupa and adult male. Next, we knocked down all eight chitinase genes by feeding the double-stranded RNA. Knockdown of PsCht4 or PsCht4-1 led to the failure of moult and, silencing PsCht5 resulted in pupation defect, while silencing PsCht10 led to small body size, suggesting these genes have essential roles in development and can be used as a potential target for pest control.

[Epidemiological investigation and analysis of allergic rhinitis among 6-12 years old children in Zaoyang City of Hubei Province]

Objective:The aim of this study is to investigate the epidemiological characteristics of allergic rhinitis(AR) among 6-12 years old children in Zaoyang.Method:All the children aged from 6 to 12 years old from 2 primary schools in Zaoyang in June 2018 were randomly selected as the research objects.The AR questionnaire was designed, and the epidemiological investigation was carried out. The results were analyzed by SPSS 20.0 software.Result:The prevalence rate of children aged 6-12 in Zaoyang was 13.7%,the prevalence rate of girls was 11.9%,and the prevalence rate of boys was 15.3%. The prevalence rate of boys was higher than that of girls,but the difference was not statistically significant(χ²=3.033,P>0.05).Univariate analysis showed that the factors related to AR were age(t=2.729,P<0.01), family history of allergic diseases (χ²=172.067,P<0.01),exposure to smoking or dust environment (χ²=43.091,P<0.01),exposure to smoking environment during pregnancy (χ²=6.09,P<0.05) and pet feeding history (χ²=9.473,P<0.01).Conclusion:The incidence of allergic rhinitis among 6-12 years old children in Zaoyang is high,age,family history of allergic diseasese,exposure to smoking or dust environment,exposure to smoking environment during pregnancy,and pet feeding history are risk factors for the incidence of allergic rhinitis in children.

[An analysis of relative factors, bacteriological profile and antibiogram of neonatal sepsis]

Objective: This study was designed to identify the relative factors, bacteriological profile and their antibiotic susceptibility pattern of neonatal sepsis. Methods: A retrospective survey was conducted on the clinical information, pathogen identification and antibiotic sensitivity results of 425 newborns with neonatal sepsis admitted to Nanjing Maternity and Child Health Care Hospital from 2010 to 2017. Of the 425 positive blood-cultures, 148 (34.82%) were early-onset neonatal sepsis (EOS) and 277 (65.18%) were late-onset neonatal sepsis (LOS). Clinical information and pathogen identification were compared between EOS and LOS. Antibiotic sensitivity of gram negative organisms (G(-)) and gram positive organisms (G(+)) were also detected. Results: The rates of premature delivery (78.70%, n=218), low birth weights (67.15%, n=186) and cesarean delivery (59.57%, n=165) were significantly increased in LOS (P<0.05) compared with those rates in EOS, which were 41.89% (n=62), 37.84% (n=56) and 46.62% (n=69). Parturients fever (18.24%, n=27) and meconium like amniotic fluid (25.68%, n=38) were significantly increased in EOS (P<0.05) compared with those rates in LOS, which were 7.94% (n=22) and 5.42% (n=15). Among the identified pathogen, the incidence of G(-) and G(+) bacteria were 216 (50.83%) and 201 (47.29%) respectively, and the rest was Candida glabrata (1.88%, n=8). Escherichia coli 68 (16.00%) was the predominant isolate followed by Klebsiella pneumoniae (13.18%, n=56). The detection rate of Hemolytic staphylococcus (10.81%, n=16) was significantly increased in EOS (P<0.001) compared with LOS (1.44%, n=4). However, the incidence of Klebsiella pneumonia (5.88%, n=44) was higher in LOS (P=0.024) compared with EOS (8.11%, n=12). Most of the gram positive isolates exhibited high resistance to penicillin (90.32%-100.00%) and cephalosporin group antibiotics (25.00%-100.00%). Similarly, the majority of the gram negative isolates showed higher resistance to ampicillin (83.33%-100.00%), but susceptible to aminoglycosides (0-11.76%), quinolones (0-17.65%) and β-lactams (0-5.88%). Conclusion: Among the study population, the percent of preterm, low birth weight and cesarean section were higher in LOS while parturients fever and meconium-like amniotic fluid were higher in EOS. The pathogens with the highest detection rate were Escherichia coli and Klebsiella pneumoniae. The results of antibiotic susceptibility test showed that common pathogens had high resistance to commonly used antibacterial drugs.

[Value of base excess in predicting the prognosis of patients with paraquat poisoning]

Objective: To explore prognostic factors of acute paraquat poisoning (APP) , analyze the correlation between base excess (BE) and plasma concentration of paraquat (C-PQ) and discuss BE level in evalua-tion of prognosis of acute paraquat poisoning patients. Methods: We retrospectively selected 84 APP patients who admitted to Emergency Intensive Care Unit (EICU) of our hospital from 2009.9.1 to 2015.8.31.Clinical data from 84 APP patients were analyzed. BE、C-PQ、time of gastric lavagesince ingestion、time of hemoperfusion since ingestion、severity index of paraquat poisoning (SIPP) 、white blood cell (WBC) 、percentage of neutrophils (N%) 、hemoglobin (HB) 、creatinine (Cr) 、alanine aminotransferase (ALT) 、aspartate aminotransferase (AST) 、partial pressure of oxygen (PaO(2)) 、partial pressure of carbon dioxide (PaCO(2)) and other laboratory parameters were measured. A total of 41 patients in non-survivors died during the 30 days after admission and 43 patients in survivors survived during the 30 days. The factors of prognosis in paraquat poisoining and the role of BE in evalu-ating prognosis was analyzed, as well as the correlation between BE and C-PQ. Results: 1.Logistic regression analyses showed BE、C-PQ、ALT、AST、Cr was of prognostic significance[odds ratio (OR) of BE: 0.511, 95%CI 0.267, 0.978; C-PQ:-=0.999, 95%CI 0.999, 1.000; both P<0.05] ; 2.The area under the receiver operating characteristic curve (ROC curve) of BE、C-PQ and prognosis were 0.775、0.927 respectively, BE≤-1.7 mmol/L was the best cut-off value, the sensitivity、specificity for predicting were 82.9%、62.8%, the evaluation value was lower to C-PQ>3 273.935 ng/ml (AUC 0.927, 78.0%、95.3%) ; 3.BE negative correlated with C-PQ[-1.100 (-4.100, -0.200) , -5.900(-8.650, -2.500) , both P<0.05]. (r=-0.4, P<0.01). Conclusion: These results suggest that BE may be useful for the prediction of prognosis in PQ poisoning and BE negative correlated with C-PQ.

A multiple-threshold AR(1) model

We consider the model Zt = φ (0, k)+ φ(1, k)Zt–1 + at (k) whenever rk−1<Zt−1≦rk, 1≦k≦l, with r0 = –∞ and rl =∞. Here {φ (i, k); i = 0, 1; 1≦k≦l} is a sequence of real constants, not necessarily equal, and, for 1≦k≦l, {at(k), t≧1} is a sequence of i.i.d. random variables with mean 0 and with {at(k), t≧1} independent of {at(j), t≧1} for j ≠ k. Necessary and sufficient conditions on the constants {φ (i, k)} are given for the stationarity of the process. Least squares estimators of the model parameters are derived and, under mild regularity conditions, are shown to be strongly consistent and asymptotically normal.

Some comments on spectral representations of non-stationary stochastic processes

The first part of the paper gives a multitude of essentially different representations of a stationary stochastic process. The second part gives a sufficient condition for the sum of two oscillatory processes to be again oscillatory.

Determination of the order of a Markov chain by Akaike's information criterion

Using Akaike's information criterion, we have presented an objective procedure for the determination of the order of an ergodic Markov chain with a finite number of states. The procedure exploits the asymptotic properties of the maximum likelihood ratio statistics and Kullback and Leibler's mean information for the discrimination between two distributions. Numerical illustrations are given, using data from Bartlett (1966), Good and Gover (1967) and some weather records.

MUC13 protects colorectal cancer cells from death by activating the NF-κB pathway and is a potential therapeutic target

MUC13 is a transmembrane mucin glycoprotein that is over produced by many cancers, although its functions are not fully understood. Nuclear factor-κB (NF-κB) is a key transcription factor promoting cancer cell survival, but therapeutically targeting this pathway has proved difficult because NF-κB has pleiotropic functions. Here, we report that MUC13 prevents colorectal cancer cell death by promoting two distinct pathways of NF-kB activation, consequently upregulating BCL-X_L. MUC13 promoted tumor necrosis factor (TNF)-induced NF-κB activation by interacting with TNFR1 and the E3 ligase, cIAP1, to increase ubiquitination of RIPK1. MUC13 also promoted genotoxin-induced NF-κB activation by increasing phosphorylation of ATM and SUMOylation of NF-κB essential modulator. Moreover, elevated expression of cytoplasmic MUC13 and NF-κB correlated with colorectal cancer progression and metastases. Our demonstration that MUC13 enhances NF-κB signaling in response to both TNF and DNA-damaging agents provides a new molecular target for specific inhibition of NF-κB activation. As proof of principle, silencing MUC13 sensitized colorectal cancer cells to killing by cytotoxic drugs and inflammatory signals and abolished chemotherapy-induced enrichment of CD133⁺ CD44⁺ cancer stem cells, slowed xenograft growth in mice, and synergized with 5-fluourouracil to induce tumor regression. Therefore, these data indicate that combining chemotherapy and MUC13 antagonism could improve the treatment of metastatic cancers.

A note on one-dimensional chaotic maps under time reversal

We have furnished further examples on the connection between some standard one-dimensional chaotic deterministic models and stochastic time series models via time reversal.

On the use of the deterministic Lyapunov function for the ergodicity of stochastic difference equations

We have shown that within the setting of a difference equation it is possible to link ergodicity with stability via the physical notion of energy in the form of a Lyapunov function.

Prenatal diagnosis of trisomy 21, 18 and 13 by quantitative pyrosequencing of segmental duplications

Chromosomal aberration mostly occurs in chromosomes 21, 18 and 13, with an incidence approximately 1 out of 160 live births in humans, therefore making prenatal diagnosis necessary in clinics. Current methods have drawbacks such as time consuming, high cost, complicated operations and low sensitivity. In this paper, a novel method for rapid and accurate prenatal diagnosis of aneuploidy is proposed based on pyrosequencing, which quantitatively detects the peak height ratio (PHR) of different bases of segmental duplication. A direct polymerase chain reaction (PCR) approach was undertaken, where a small volume of amniotic fluid was used as the starting material without DNA extraction. Single-stranded DNA was prepared from PCR products and subsequently analyzed using pyrosequencing. The PHR between target and reference chromosome of 2.2 for euploid and 3:2 for a trisomy fetus were used as reference. The reference intervals and z scores were calculated for discrimination of aneuploidy. A total of 132 samples were collected, within trisomy 21 (n = 11), trisomy 18 (n = 3), trisomy 13 (n = 2), and unaffected controls (n = 116). A set of six segmental duplications were chosen for analysis. This method had consistent results with karyotyping analysis, a correct diagnosis with 100% sensitivity and 99.9% specificity.

Fluorescence lifetime imaging of optically levitated aerosol: a technique to quantitatively map the viscosity of suspended aerosol particles

A technique to measure the viscosity of stably levitated single micron-sized aerosol particles.

Association of serum homocysteine levels with the severity and calcification of coronary atherosclerotic plaques detected by coronary CT angiography

AIM

In this study, we aim to evaluate the association of risk factors including homocysteine (Hcy) with the severity and burden of coronary atherosclerotic plaques detected by computed tomography angiography (CTA).

METHODS

Six hundred fifty-nine subjects who underwent CTA for the assessment of coronary artery disease (CAD) were studied. All the subjects enrolled had no clinical cardiovascular disease symptoms. Logistic regression showed apart from age, hypertension, smoking, triglyceride, low-density lipoprotein (LDL) cholesterol, and total bilirubin, Hcy was an independently risk factor of the severity of coronary disease. And Hcy was also found an independent predictor for the presence of calcified plaque. When the participants were divided into 4 groups according to serum Hcy quartiles (Q1-Q4 groups), both the percentage of patients with >50% stenosis and the percentage of patients with calcified plaque were higher in Q4 compared to other groups. The OR of Hcy (>15 µmol/L) for >50% stenosis was 2.212 (95% CI=1.119 to 4.375, P=0.022) and the OR for Hcy (>15 µmol/L) for calcification was 1.668 (95% CI=1.030 to 2.699, P=0.037) respectively.

CONCLUSION

Our study shows Hcy is independently associated with both the severity and calcified plaque detected by CTA. Hcy may provide additional information about CAD in the subjects without clinical symptoms.

Proton pump inhibitors are associated with hypersensitivity reactions to drugs in hospitalized patients: a nested case-control in a retrospective cohort study

BACKGROUND

Previous research has shown that gastric acid suppression by antacid drugs can promote allergic reactions to acid-labile food proteins. No data are available about whether antacid drugs can promote drug hypersensitivity reactions. The most potent and longer lasting inhibition of gastric secretion is provided by proton pump inhibitors (PPIs). We hypothesized that gastric acid suppression by proton pump inhibitors could be causative of drug hypersensitivity reactions during hospitalization.

OBJECTIVE

To estimate the risk of developing drug hypersensitivity reactions during the hospitalization of patients treated with proton pump inhibitors, and other associated factors.

METHODS

A nested case-control in a retrospective cohort study of hospitalized patients from September 2008 to December 2010 (70 771 admissions) was conducted using the registry of cases of interconsultations to the Allergy Department (161 confirmed cases of drug hypersensitivity reactions). A total of 318 controls were matched by first drug suspected in the hypersensitivity reaction, time of admission, age, gender and hospitalization wards.

RESULTS

The relative risk of drug hypersensitivity reaction occurrence during hospitalization of patients treated with PPIs compared with those not treated in the period of study was significant (RR: 3.97; 95% CI: 1.97-8.29). After controlling for confounders in the nested case-control cohort, the use of PPIs persists as a predisposing factor (OR: 4.35; 95% CI: 2-9.45). Personal history of drug allergy and a long hospitalization time were other predisposing factors of drug hypersensitivity reactions (DHRs). The hazard that a DHR has occurred during PPI treatment was 3.7% per day. The hazard for immediate or accelerated reactions was 1.706 (P = 0.003) times that of delayed reactions.

CONCLUSION AND CLINICAL RELEVANCE

In hospitalized patients, the use of proton pump inhibitors was associated with a significant increase risk of drug hypersensitivity reactions along with a personal history of drug allergies and long hospitalization time.

Construction of a recombinant plasmid harbouring the glyceraldenyde-3-phosphate dehydrogenase gene of periodic Brugia malayi and observation on DNA immunity

PURPOSE

Controlling and eliminating lymphatic filariasis will require further research of preventative measures and implementation. Parasite is dependent on glycolysis for ATP production. The glycolytic enzyme glyceraldenyde-3-phosphate dehydrogenase (GAPDH) plays an important role in glycolysis and therefore is either a potential target for anti-parasite drug development or a vaccine candidate. Therefore, we tried to investigate the DNA vaccine-elicited immune responses in BALB/c mice.

MATERIALS AND METHODS

We cloned a gene encoding the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) from periodic Brugia malayi into vector pcDNA3.1. Mice were injected at a dosage of 100 μg recombinant plasmid DNA with CpG intramuscular injection and immunized three times at 2-week intervals. pcDNA3.1 and normal saline were used as control. The tissue of muscles at the 4 weeks after the third injection was collected and target genes were detected using RT-PCR. The humoral responses elicited in mice by inoculation with the recombinant plasmid pcDNA3.1-BmGAPDH were detected using a standard ELISA. Two weeks after the third immunization, stimulation index (SI) was measured using the MTT method and the level of secreted IL-4 and INF-g were detected using ELISA.

RESULTS

Specific gene fragment coding GAPDH was amplified and the recombinant plasmid pcDNA3.1-BmGAPDH was constructed. Post-challenge sera from the mice immunized with the DNA vaccine had specific antibody titres of 1:1600 to 1:6400, and the highest titre was observed in the mice that were inoculated by pcDNA3.1-BmGAPDH/CpG at 6 weeks. At 4 weeks after immunization, the spleens of the mice were obviously enlarged. The proliferation of spleen T lymphocytes seen on the MTT assay was higher in the pcDNA3.1-BmGAPDH group than in the control group (P value <0.05). The levels of IL-4 and INF-γ in serums from the immunized mice were significantly higher than that of the control (P value <0.05).

CONCLUSIONS

We conclude that the recombinant eukaryotic plasmid pcDNA3.1-BmGAPDH could elicit humoral and cellular immune responses in mice.

Effects of hydrogen peroxide on human dentin structure

It has been hypothesized that hydrogen peroxide (H(2)O(2)) bleaching may cause destruction of dentin by a mechanism of protein oxidation. However, to our knowledge, there has been no direct chemical evidence to validate this viewpoint. To investigate the effects of H(2)O(2) on the structure of human dentin, we used Fourier transform infrared spectroscopy (FTIR) and attenuated total reflection (ATR) spectroscopy. Human intact dentin specimens were treated either with 30% H(2)O(2) or Hanks' balanced salt solution (HBSS). Significant differences were observed in ATR spectra parameters. Additionally, demineralized dentin specimens were also tested. They were completely dissolved in the H(2)O(2), but remained intact in the 0.1 N HCl and HBSS. The results suggested that H(2)O(2) attacked both the organic and mineral components of dentin. Destruction of the organic components was mainly because of the oxidizing ability of H(2)O(2), while changes in the mineral components were probably due to its acidity.