Driving mechanism of different nutrient conditions on microbial mediated nitrate reduction in magnetite-present river infiltration zone

Significant research is focused on the ability of riparian zones to reduce groundwater nitrate contamination. Owing to the extremely high redox activity of nitrate, naturally existing electron donors, such as organic matter and iron minerals, are crucial in facilitating nitrate reduction in the riparian zone. Here, we examined the coexistence of magnetite, an iron mineral, and nitrate, a frequently observed coexisting system in sediments, to investigate nitrate reduction features at various C/N ratios and evaluate the response of microbial communities to these settings. Additionally, we aimed to use this information as a foundation for examining the effect of nutritional conditions on the nitrate reduction process in magnetite-present environments. These results emphasise the significance of organic matter in enabling dissimilatory nitrate reduction to ammonium (DNRA) and enhancing the connection between nitrate reduction and iron in sedimentary environments. In the later phases of nitrate reduction, nitrogen fixation was the prevailing process in low-carbon environments, whereas high-carbon environments tended to facilitate the breakdown of organic nitrogen. High-throughput sequencing analysis revealed a robust association between C/N ratios and alterations in microbial community composition, providing insights into notable modifications in essential functioning microorganisms. The nitrogen-fixing bacterium Ralstonia is more abundant in ecosystems with scarce organic matter. In contrast, in settings rich in organic matter, microorganisms, such as Acinetobacter and Clostridia, which may produce ammonia, play crucial roles. Moreover, the population of iron bacteria grows in such an environment. Hence, this study proposes that C/N ratios can influence Fe(II)/Fe(III) conversions and simultaneously affect the process of nitrate reduction by shaping the composition of specific microbial communities.

Cardiac MRI feature-tracking-derived torsion mechanics in systolic and diastolic dysfunction in systemic light-chain cardiac amyloidosis

AIM

To describe the myocardial torsion mechanics in cardiac amyloidosis (CA), and evaluate the correlations between left ventricle (LV) torsion mechanics and conventional parameters using cardiac magnetic resonance imaging feature tracking (CMR-FT).

MATERIALS AND METHODS

One hundred and thirty-nine patients with light-chain CA (AL-CA) were divided into three groups: group 1 with preserved systolic function (LV ejection fraction [LVEF] ≥50%, n=55), group 2 with mildly reduced systolic function (40% ≤ LVEF <50%, n=51), and group 3 with reduced systolic function (LVEF <40%, n=33), and compared with age- and gender-matched healthy controls (n=26). All patients underwent cine imaging and late gadolinium-enhancement (LGE). Cine images were analysed offline using CMR-FT to estimate torsion parameters.

RESULTS

Global torsion, base-mid torsion, and peak diastolic torsion rate (diasTR) were significantly impaired in patients with preserved systolic function (p<0.05 for all), whereas mid-apex torsion and peak systolic torsion rate (sysTR) were preserved (p>0.05 for both) compared with healthy controls. In patients with mildly reduced systolic function, global torsion and base-mid torsion were lower compared to those with preserved systolic function (p<0.05 for both), while mid-apex torsion, sysTR, and diasTR were preserved (p>0.05 for all). In patients with reduced systolic function, only sysTR was significantly worse compared with mildly reduced systolic function (p<0.05). At multivariable analysis, right ventricle (RV) end-systolic volume RVESV index and NYHA class were independently related to global torsion, whereas LVEF was independently related to sysTR. RV ejection fraction (RVEF) was independently related to diasTR. LV global torsion performed well (AUC 0.71; 95% confidence interval [CI]: 0.61, 0.77) in discriminating transmural from non-transmural LGE in AL-CA patients.

CONCLUSION

LV torsion mechanics derived by CMR-FT could help to monitor LV systolic and diastolic function in AL-CA patients and function as a new imaging marker for LV dysfunction and LGE transmurality.

Nitrate denitrification rate response to temperature gradient change during river bank infiltration

Nitrate attenuation during river bank infiltration is the key process for reducing nitrogen pollution. Temperature is considered to be an important factor affecting nitrate attenuation. However, the magnitude and mechanism of its impact have not been clear for a long time. In this study, the effects of temperature and temperature gradient on the nitrate denitrification rate were investigated via static batch and dynamic soil column simulation experiments. The results showed that temperature had a significant effect on the denitrification rate. Temperature effects were first observed in denitrifying bacteria. At low temperatures, the microorganism diversity was low, resulting in a lower denitrification rate constant. The static experimental results showed that the denitrification rate at 19 °C was approximately 2.4 times that at 10 °C. The dynamic soil column experiment established an exponential positive correlation between the nitrate denitrification decay kinetic constant and temperature. The affinity of denitrifying enzymes for nitrate in the reaction substrate was ordered as follows: decreasing temperature gradient (30 °C → 10 °C) > zero temperature gradient (10 °C) > increasing temperature gradient condition (0 °C → 10 °C). This study provides a theoretical basis for the biogeochemical processes underlying river bank infiltration, which will help aid in the development and utilization of groundwater resources.

Predictive effect of net water uptake on futile recanalisation in patients with acute large-vessel occlusion stroke

AIM

To determine whether net water uptake (NWU) based on automated software evaluation could predict futile recanalisation in patients with acute anterior circulation large-vessel occlusion (LVO).

MATERIALS AND METHODS

Patients with acute anterior circulation LVO undergoing mechanical thrombectomy in Jinling Hospital were evaluated retrospectively. NWU and other baseline data were evaluated by performing univariate and multivariate analyses. The primary endpoint was 90-day modified Rankin scale score ≥3. A nomogram to predict poor clinical outcomes was developed based on multivariate logistic regression analysis.

RESULTS

Overall, 135 patients who underwent thrombectomy with a TICI grade ≥2b were enrolled. In multivariate logistic regression analysis, the following factors were identified as independent predictors of futile recanalisation: age (odds ratio [OR]: 1.055, 95 % confidence interval [CI]: 1.004-1.110, p=0.035), female (OR: 0.289, 95 % CI: 0.098-0.850, p=0.024), hypertension (OR: 3.182, 95 % CI: 1.160-8.728, p=0.025), high blood glucose level (OR: 1.36, 95 % CI: 1.087-1.701, p=0.007), admission National Institutes of Health Stroke Scale score (OR: 1.082, 95 % CI: 1.003-1.168, p=0.043), and NWU (OR: 1.312, 95 % CI: 1.038-1.659, p=0.023).

CONCLUSIONS

NWU based on Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) could be used to predict the occurrence of futile recanalisation in patients with acute anterior circulation LVO ischaemic stroke.

Causal relationship between cigarette smoking behaviors and the risk of hernias: a Mendelian randomization study

PURPOSE

As the global population continues to age, there is a noticeable yearly rise in the incidence of hernias. Simultaneously, smoking, a widespread addictive behavior and a significant contributor to mortality, has evolved into a pervasive public health concern. Existing literature has already established a connection between smoking and an increased risk of postoperative recurrence and postoperative infections following hernia surgery. However, there remains a dearth of research exploring the association between smoking and hernia morbidity. In this study, our objective is to systematically evaluate the causal relationship between cigarette smoking behaviors and hernia morbidity using a Mendelian randomization (MR) approach.

METHODS

Hernia-related data were sourced from the FinnGen Biobank database, while cigarette smoking behavior data were gathered from the GWAS and Sequencing Consortium of Alcohol and Nicotine Use. To assess the causal relationship, we employed five methods: the weighted median, the weighted mode the inverse variance weighted (IVW), MR-Egger, and the simple mode. Sensitivity analysis was conducted, incorporating Cochran's Q test, the MR-Egger intercept test, leave-one-out analysis, and funnel plot. The presentation of the causal relationship is expressed as an odds ratio (OR) along with their corresponding 95% confidence intervals (CI).

RESULTS

Employing the IVW method as the reference standard, we found that smoking intensity is associated with an increased risk of diaphragmatic hernia (OR = 1.21, 95% CI 1.00-1.46, P = 0.047). These consistent findings were further corroborated by the weighted median and weighted mode methods (OR = 1.26, 95% CI 1.03-1.54, P = 0.026; OR = 1.25, 95% CI 1.02-1.52, P = 0.045). Conversely, when applying the IVW method, we identified no statistically significant causal relationship between smoking age, smoking initiation status, smoking cessation status, and the incidence of hernia.

CONCLUSIONS

Our MR study has uncovered genetic evidence linking smoking intensity and the occurrence of diaphragmatic hernia. The risk of developing diaphragmatic hernia rises in tandem with the intensity of smoking. This emphasizes the crucial role of regularly advising patients to cease smoking in clinical settings.

Thermodynamics, statistical mechanics and the vanishing pore width limit of confined fluids

Temperature, particle number and volume are the independent variables of the Helmholtz free energy for a bulk fluid. For a fluid confined in a slit pore between two walls, they are usually complemented by the surface area. However, an alternative choice is possible with the volume replaced by the pore width. Although the formulations with such two sets of independent variables are different, we show they are equivalent and present their relations. Corresponding general statistical-mechanics results are also presented. When the pore width becomes very small, the system behaves rather like a two-dimensional (2D) fluid and one can wonder if thermodynamics still holds. We find it remains valid even in the limit of vanishing pore width and show how to treat the divergences in the normal pressure and the chemical potential so that the corresponding 2D results can be obtained. Thus, we show that the Gibbs surface thermodynamics is perfectly capable of describing small systems.

Nanoscale thermodynamics needs the concept of a disjoining chemical potential

Disjoining pressure was discovered by Derjaguin in 1930's, which describes the difference between the pressure of a strongly confined fluid and the corresponding one in a bulk phase. It has been revealed recently that the disjoining pressure is at the origin of distinct differential and integral surface tensions for strongly confined fluids. Here we show how the twin concept, disjoining chemical potential, arises in a reminiscent way although it comes out eighty years later. This twin concept advances our understanding of nanoscale thermodynamics. Ensemble-dependence (or environment-dependence) is one hallmark of thermodynamics of small systems. We show that integral surface tension is ensemble-dependent while differential surface tension is not. Moreover, two generalized Gibbs-Duhem equations involving integral surface tensions are derived, as well as two additional adsorption equations relating surface tensions to adsorption-induced strains. All the results obtained in this work further evidence that an approach alternative of Hill's nanothermodynamics is possible, by extending Gibbs surface thermodynamics instead of resorting to Hill's replica trick. Moreover, we find a compression-expansion hysteresis without any underlying phase transition.

Effects of magnetite on microbially driven nitrate reduction processes in groundwater

Nitrate is a common pollutant in the aquatic environment. Denitrification and dissimilatory nitrate reduction to ammonium (DNRA) are the main reduction processes of nitrate. In the relatively closed sediment environment, the competitive interaction of these two nitrate reduction determines whether the ecosystem removes or retains nitrogen. In the process of NO₃^--N bioreduction, Magnetite, which is a common mineral present in soil and other sediments can play a crucial role. However, it is still not clear whether magnetite promotes or inhibits NO₃^--N bioreduction. In this paper, the effect of magnetite on NO₃^--N bioreduction was studied by batch experiments. The results show that magnetite can increase the NO₃^--N reduction rate by 1.48 %, and can inhibit the DNRA process at the beginning of the reaction and then promote the DNRA process. Magnetite changed the microbial community structure in our experiment systems. The relative abundance of Sphingomonas, which mainly exists in a high carbon and low nitrogen environment, increased under sufficient carbon source conditions. The relative abundance of Fe-oxidizing and NO₃^--N reducing bacteria, such as Flavobacterium, increased in the absence of carbon sources but in the presence of magnetite. In addition, magnetite can significantly increase activity of the microbial electron transport system (ETS). the added microbial electronic activity of magnetite increased nearly two-fold under the same experiment conditions. The acid produced by the metabolisms of Pseudomonas and Acinetobacter further promotes the dissolution of magnetite, thus increasing the concentration of Fe (II) in the system, which is beneficial to autotrophic denitrifying bacteria and promote the reduction of NO₃^--N. These findings can enhance our understanding of the interaction mechanism between iron minerals and nitrate reducing bacteria during nitrate reduction under natural conditions.

Survival after laparoscopic radical surgery for stage IA-IIB cervical cancer: 1316 consecutive cases from a national laparoscopic training center in China

BACKGROUND

To investigate the survival of cervical cancer patients undergoing laparoscopic radical hysterectomy (LRH) in a minimally invasive gynecology center.

METHODS

A consecutive series of patients undergoing first LRH for cervical cancer from May 2008 to December 2017 at a national laparoscopic training center was retrospectively analyzed. The overall survival (OS) and progression-free survival (PFS) were compared between groups.

RESULTS

In total, 1316 women with FIGO (2009) stage IA-IIB cervical cancer received LRH. Among them, 1114 (84.7%) were followed up for 3 months or longer; the median follow-up period was 48 months (range 3-144 months). In patients with stage IA, IB1 (≤ 2 cm), IB1 (> 2 cm), IB2, IIA1 and IIA2-IIB tumors, the 4-year PFS rates were 98.6, 94.5, 87.4, 65.6, 80.0 and 67.4%, respectively, and the 4-year OS rates were 98.6, 96.8, 91.1, 77.4, 85.6 and 76.2%, respectively. The 4-year PFS and OS were as high as 96.2 and 97.5%, respectively, in patients with squamous cell carcinoma of 2 cm or smaller in diameter. A stable high 4-year OS and PFS was achieved after completing 100 LRHs. In patients operated on by the same surgeon, an improvement in survival was observed after 40 LRHs.

CONCLUSION

Favorable oncologic outcomes can be achieved in patients with IA-IB1 cervical cancer after LRH in a center with a high surgery volume.

Quantifying the effect of the nitrogen biogeochemical processes on the distribution of ammonium in the riverbank filtration system

Ammonium (NH₄⁺) enrichment of riverbank filtration (RBF) systems is gaining popularity. However, most previous research has concentrated on NO₃^- removal efficiencies, while the mechanisms of NH₄⁺ enrichment remain unknown. A nitrogen biogeochemical process model was developed for the quantitative analysis of NH₄⁺ enrichment in the Kaladian well field in northwest Songyuan City, NE China. Data from laboratory experiments and in-situ monitoring were used to determine initial values and calibrate the thermodynamic/kinetic parameters representing nitrogen (N) biogeochemical reactions. (1) The NO₃^- from river was subjected to denitrification (DNF) and dissimilatory nitrate reduction to ammonium (DNRA) within 10-14 m of the shore, whereas the NH₄⁺ in groundwater was caused by DNRA, organic nitrogen mineralization (MIN), and mixing with laterally recharged high NH₄⁺ groundwater. (2) DNF and DNRA were regulated by hydrodynamic processes, with the ranges of these processes being more significant in the wet season due to a higher hydraulic gradient. MIN occurred widely throughout the water flow path, with temperature primarily controlling the rates of the three reactions. (3) DNRA activity was relatively higher in the wet season when the water temperature was higher within 10-14 m of the shore. In the wet season, DNRA contributed 25%-30% to NO₃^- reduction, which was higher than in the dry season (5%-10%). DNRA contributed at least 40% and 15% to NH₄⁺ enrichment in the wet and dry seasons, respectively. (4). Organic N in media gradually released NH₄⁺ into groundwater via MIN and desorption across the entire flow path, with contributions to NH₄⁺ enrichment reaching 75% and 85%, respectively, in the wet and dry seasons.

[A case of sclerocornea combined with open-angle glaucoma]

A patient complained of progressive visual acuity decline in the left eye for 3 years was admitted. The appearance of the patient was bilateral microcornea. After ocular ultrasonography, ultrasound biomicroscopy, etc, the patient was diagnosed as sclerocornea of the left eye with open-angle glaucoma. Trabeculectomy of the left eye was performed after drug treatment failed, and there were no surgical complications. The intraocular pressure of the left eye was normal and the anterior chamber was well formed 6 months after surgery.

Adsorption/desorption of naphthalene and phenanthrene in a binary competitive system in the riparian zone

Polycyclic aromatic hydrocarbons (PAHs) such as naphthalene (Nap) and phenanthrene (Phe) are organic pollutants that are of concern because of their environmental toxicity. Adsorption is a promising process for the removal of Nap and Phe from water and soil. The riparian zone between a river and a riparian aquifer, which is rich in adsorption medium, may be important for PAH remediation. Nap and Phe may be removed from the surface water through adsorption by the media in the riparian zone. However, there is still a lack of the removal patterns and mechanisms of media in the riparian zone to remediate water contaminated by Nap and Phe simultaneously. In this study, focusing on the typical PAHs (Nap and Phe) as target pollutants, batch static adsorption and desorption experiments of Nap and Phe were carried out to explore the competitive adsorption mechanisms of Nap and Phe in the binary system. Batch dynamic adsorption experiments were conducted to ascertain the adsorption regulation of Nap and Phe in sediments during the recharge of groundwater by river water in a riparian zone. The static adsorption experiment results showed that competitive adsorption of Nap and Phe occurred, and a mutual inhibitory effect of Nap and Phe adsorption was observed in the binary system. Phe had a stronger inhibitory effect on Nap, Phe was preferentially adsorbed on the medium in binary adsorption. The results of batch dynamic experiments showed that, in terms of adsorption, the riparian zone in the study area showed stronger performance for removal of Phe than Nap. The results of this paper could be useful for alleviating Nap and Phe pollution of groundwater and developing treatment protocols for groundwater exposed to Nap and Phe.

Effects of carbon load on nitrate reduction during riverbank filtration: Field monitoring and batch experiment

Riverbank filtration (RBF) is a well-established technique worldwide, and is critical for the maintenance of groundwater quality and production of clean drinking water. Evaluation of the decay of exogenous nitrate (NO₃^-) in river water and the enrichment of ammonium (NH₄⁺) in groundwater during RBF is important; these two processes are mainly influenced by denitrification (DNF) and dissimilatory nitrate reduction to ammonium (DNRA) controlled by the groundwater carbon load. In this study, the effects of carbon load (organic carbon [OC]: NO₃^-) on the competing nitrate reduction (DNRA and DNF) were assessed during RBF using field monitoring and a laboratory batch experiment. Results show the groundwater OC: NO₃^- ratio did not directly affect the reaction rate of DNRA and DNF, however, it could control the competitive partitioning between the two. In the near-shore zone, the groundwater OC: NO₃^- ratio shows significant seasonal variations along the filtration path owing to the changing conditions of redox, OC-rich, and NO₃^--limited. A greater proportion of NO₃^- would be available for DNRA in the wet season with higher OC: NO₃^- ratio (> 10), resulting in a significantly NH₄⁺-N enrichment rate (from 1.43 × 10^-3 to 9.54 × 10^-4 mmol L^-1 d^-1) in the near-shore zone where the zone of Mn (IV) oxide reduction. However, the activity of DNRA was suppressed with lower OC: NO₃^- ratio (< 10) in the dry season, resulting in a stable NH₄⁺-N enrichment rate (from 3.12 × 10^-4 to 1.30 × 10^-4 mmol L^-1 d^-1). Benefiting from seasonal variation of OC-rich and NO₃^--limited conditions, DNRA bacteria outcompeted denitrifiers, which eventually led to seasonal differences in NO₃^- reduction in the near-shore zone. Overall, under the effect of DNRA induced by continuous high carbon load in RBF systems, nitrogen input is not permanently removed but rather retained in groundwater during RBF.

The identification of treatment-resistant depression patients in electronic health records, a retrospective cohort study in China

Introduction

Previous Electronic Health Records (EHR) based studies adopted various definitions in identifying Treatment-Resistant Depression (TRD) patients. There is a lack of similar attempts among Chinese population which limits the understanding of TRD in China.

Objectives

Assess TRD identification using EHR from a major psychiatric hospital in China.

Methods

This study utilized a retrospective Major Depressive Disorder (MDD) cohort of patients who newly initiated pharmaceutical treatment (2010-2018); follow-up was ended upon 1-year or treatment discontinuation (≥120d without treatment). TRD was first identified based on common clinical definition of two prior regimen failures (change of regimen) with 4-week as regimen adequacy threshold (Def1). Alternative adequacy thresholds of 2-week and 6-week were applied. Based on Def1 (4-week), at least 3 distinctive regimens were additionally required in TRD identification (Def2). Further, a data-driven definition (Def3) based on drug count as having ≥3 antidepressants or ≥1 antipsychotic within 1 year was considered (Cepeda et al., 2018).

Results

From 12257 MDD patients included in the cohort, Def1 identified 633 (5.2%) TRD cases, whereas regimen adequacy thresholds of 2-week and 6-week identified 1772 (14.5%) and 61 (0.5%) cases, respectively. Further, Def2 identified 261 (2.4%) TRD cases. Finally, Def3 yielded 2449 (20.0%) TRD cases, including 1966 exclusive cases that were not identified by Def1.

Conclusions

This study showed different definitions for TRD identification had considerable impact on the number of patients identified among Chinese population, obscuring the comparability among EHR-based TRD studies. As first step, we found the criteria of regimen adequacy as major contributor to the observed variability in China.

Disclosure

No significant relationships.

Sub-micrometer focusing setup for high-pressure crystallography at the Extreme Conditions beamline at PETRA III

Scientific tasks aimed at decoding and characterizing complex systems and processes at high pressures set new challenges for modern X-ray diffraction instrumentation in terms of X-ray flux, focal spot size and sample positioning. Presented here are new developments at the Extreme Conditions beamline (P02.2, PETRA III, DESY, Germany) that enable considerable improvements in data collection at very high pressures and small scattering volumes. In particular, the focusing of the X-ray beam to the sub-micrometer level is described, and control of the aberrations of the focusing compound refractive lenses is made possible with the implementation of a correcting phase plate. This device provides a significant enhancement of the signal-to-noise ratio by conditioning the beam shape profile at the focal spot. A new sample alignment system with a small sphere of confusion enables single-crystal data collection from grains of micrometer to sub-micrometer dimensions subjected to pressures as high as 200 GPa. The combination of the technical development of the optical path and the sample alignment system contributes to research and gives benefits on various levels, including rapid and accurate diffraction mapping of samples with sub-micrometer resolution at multimegabar pressures.

[Analysis of HIV-1 genetic subtype and pretreatment drug resistance among men who have sex with men infected with HIV-1 from 19 cities of 6 provinces in China]

Objective: To investigate the distribution of HIV-1 genetic subtypes and pretreatment drug resistance (PDR) among men who have sex with men (MSM) from 19 cities of 6 provinces in China. Methods: From April to November 2019, 574 plasma samples of ART-naive HIV-1 infected MSM were collected from 19 cities in Hebei, Shandong, Jiangsu, Zhejiang, Fujian, and Guangdong provinces, total ribonucleic acid (RNA) was extracted and amplified the HIV-1 pol gene region by nested polymerase chain reaction (PCR) after reverse transcription. Then sequences were used to construct a phylogenetic tree to determine genetic subtypes and submitted to the Stanford drug resistance database for drug resistance analysis. Results: A total of 479 samples were successfully amplified by PCR. The HIV-1 genetic subtypes included CRF01_AE, CRF07_BC, B, CRF55_01B, CRF59_01B, CRF65_cpx, CRF103_01B, CRF67_01B, CRF68_01B and unrecognized subtype, which accounted for 43.4%, 36.3%, 6.3%, 5.9%, 0.8%, 0.8%, 0.4%, 0.4%, 0.2% and 5.5%, respectively. The distribution of genetic subtypes among provinces is statistically different (χ²=44.141, P<0.001). The overall PDR rate was 4.6% (22/479), the drug resistance rate of non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors were 3.5% (17/479), 0.8% (4/479) and 0.2% (1/479), respectively. The PDR rate of recent infections was significantly higher than that of long-term infections (χ²=4.634, P=0.031). Conclusions: The HIV-1 genetic subtypes among MSM infected with HIV-1 from 19 cities of 6 provinces in China are diverse, and the distribution of subtypes is different among provinces. The overall PDR rate is low, while the PDR rate of recent infections was significantly higher than that of long-term infections, suggesting the surveillance of PDR in recent infections should be strengthened.

Shifts in microbial community structure and function in polycyclic aromatic hydrocarbon contaminated soils at petrochemical landfill sites revealed by metagenomics

Investigations of the microbial community structures, potential functions and polycyclic aromatic hydrocarbon (PAH) degradation-related genes in PAH-polluted soils are useful for risk assessments, microbial monitoring, and the potential bioremediation of soils polluted by PAHs. In this study, five soil sampling sites were selected at a petrochemical landfill in Beijing, China, to analyze the contamination characteristics of PAHs and their impact on microorganisms. The concentrations of 16 PAHs were detected by gas chromatography-mass spectrometry. The total concentrations of the PAHs ranged from ND to 3166.52 μg/kg, while phenanthrene, pyrene, fluoranthene and benzo [ghi]perylene were the main components in the soil samples. According to the specific PAH ratios, the PAHs mostly originated from petrochemical wastes in the landfill. The levels of the total toxic benzo [a]pyrene equivalent (1.63-107.73 μg/kg) suggested that PAHs might result in adverse effects on soil ecosystems. The metagenomic analysis showed that the most abundant phyla in the soils were Proteobacteria and Actinobacteria, and Solirubrobacter was the most important genus. At the genus level, Bradyrhizobium, Mycobacterium and Anaeromyxobacter significantly increased under PAH stress. Based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) annotations, the most abundant category of functions that are involved in adapting to contaminant pressures was identified. Ten PAH degradation-related genes were significantly influenced by PAH pressure and showed correlations with PAH concentrations. All of the results suggested that the PAHs from the petrochemical landfill could be harmful to soil environments and impact the soil microbial community structures, while microorganisms would change their physiological functions to resist pollutant stress.

A system dynamics model to simulate the water-energy-food nexus of resource-based regions: A case study in Daqing City, China

Resource-based regions (RBRs) have made significant contributions to the social and economic development of nations. The long-term and high-intensity development of resources puts tremendous pressure on water, energy and food resources and the ecological environment. Exploring the water-energy-food nexus (WEF nexus, WEFN) of RBRs is key to making informed decisions about regional sustainable development. In this study, a feedback model for the WEFN of RBRs was developed using a system dynamics approach. The WEFN model not only describes the WEFN system from both the supply and demand sides, but also classifies WEF resources. Using Daqing, China, as a case study, five future scenarios were designed to explore the impacts of real policies designed by different government departments on the WEFN system. Comparing the predicted results of a scheme for business as usual, a scheme for developing bioenergy, a scheme for adjustment of the production structure, a scheme for strengthening the development of water and food resources and a scheme for saving WEF resources revealed that the schemes for adjustment of the production structure and for saving WEF resources will not only improve the security of WEF resources, but also reduce pollution of the water environment by human activities, which is conducive to improving the overall benefits of the WEFN system. Finally, some practical suggestions are put forward to promote the coordinated development of the WEFN system. The WEFN model is a multi-centric tool for integrated resources management, and can be expanded to other RBRs and provides scientific support for decision-makers.

Influencing mechanisms of siderite and magnetite, on naphthalene biodegradation: Insights from degradability and mineral surface structure

Biodegradation is the most economical and efficient process for remediating polycyclic aromatic hydrocarbons (PAHs) such as naphthalene (Nap). Soil composition is pivotal in controlling PAH migration and transformation. Iron minerals such as siderite and magnetite are the primary components of soil and sediment and play key roles in organic pollutant biodegradation. However, it is unclear whether siderite and magnetite promote or inhibit Nap biodegradation. The effects of siderite and magnetite on Nap biodegradation were investigated through batch experiments in this study. The results indicated that siderite increased Nap biodegradation efficiency by 7.87%, whereas magnetite inhibited Nap biodegradation efficiency by 3.54%. In the presence of siderite, Nap-degrading bacteria with acid-producing effects promoted siderite dissolution via metabolic activity, resulting in an increased Fe (II) concentration in solution which accelerated the iron reduction process and promoted Nap biodegradation. In addition, the presence of iron minerals altered the genus-level community structure. Anaerobic sulfate-reducing bacteria such as Desulfosporosinus occurred in the presence of siderite, indicating that sulfate reduction occurred in advance under the influence of siderite. In the presence of magnetite, Fe (III) in iron minerals were converted to Fe (II), and under the mediation of microorganisms, Fe (II) combined with carbonate to form secondary minerals (e.g., siderite). Secondary minerals were attached to the surface of magnetite, which inhibited magnetite dissolution and reduced the efficiency of Fe (III) utilization by microorganisms. Furthermore, as the reaction proceeds, acid-producing microorganisms promoted magnetite further dissolution, resulting in a longer duration of the Fe (III) reduction process. Bacteria utilizing sulfuric acid as the terminal electron acceptor consumed organic matter more rapidly than those using iron as the terminal electron acceptor. Therefore, magnetite inhibited Nap degradation. These observations enhance our understanding of the interaction mechanisms of iron minerals, organic pollutants, and degrading bacteria during the biodegradation process.

[G-protein coupled receptor Smo positively regulates proliferation and migration of adult neural stem cells in vitro]

OBJECTIVE

To investigate the role of G-protein coupled receptor Smoothened (Smo) in regulating proliferation and migration of adult neural stem cells (ANSCs) and explore the underlying mechanism.

METHODS

Cultured ANSCs were treated with purmorphamine (PM, an agonist of Smo) or cyclopamine (CPM, an inhibitor of Smo), and the changes in cell proliferation migration abilities were assessed using cell counting kit-8 (CCK8) assay and wound healing assay, respectively. The mRNA expressions of membrane receptor Patched 1 (Ptch1), Smo, glioma-associated oncogene homolog 1 (Gli1), axon guidance cue slit1 (Slit1) and brain-derived neurotrophic factor (BDNF) in the treated cells were detected using real-time quantitative PCR (RT-PCR).

RESULTS

PM significantly promoted the proliferation (P < 0.01) and migration of ANSCs (P < 0.01), and up-regulated the mRNA expressions of Ptch1, Smo, Gli1, Slit1 and BDNF. Treatment with CPM significantly inhibited the proliferation and migration of ANSCs.

CONCLUSION

Modulating Smo activity can positively regulate the proliferation and migration of ANSCs possibly by regulating the expressions of BDNF and Slit1.

Experimental study on the biodegradation of naphthalene and phenanthrene by functional bacterial strains in the riparian soil of a binary system

Polycyclic aromatic hydrocarbons (PAHs) such as naphthalene (Nap) and phenanthrene (Phe) are organic pollutants of concern owing to their toxicity, carcinogenicity, and teratogenicity. Biodegradation is considered the most economical and efficient process to remediate Nap and Phe. The riparian zone between a river and a riparian aquifer, which is rich in indigenous microorganisms, may be important for PAH remediation. However, few studies have evaluated the ability of indigenous microorganisms to remove Nap and Phe. In this study, focusing on the typical PAHs (Nap and Phe) as target pollutants, the genus-level community structure of Nap- and Phe-degrading bacteria was identified. Batch static and dynamic biodegradation experiments were conducted to explore the biodegradation mechanisms of Nap and Phe in the riparian zone and identify the factors influencing Nap and Phe biodegradation in the binary system (i.e., where Nap and Phe are simultaneously present). According to the genus-level community structure test results, the dominant bacterial genus in the binary system was mainly the Phe-degrading bacteria. The Nap and Phe-biodegradation percentages were 19.20% lower and 19.49% higher, respectively, in the binary system than in the unitary system. The results indicated that functional bacteria can degrade Nap and Phe, and that Nap weakly promoted Phe biodegradation. Additionally, the initial Nap and Phe concentration ratio, hydraulic gradient, and temperature affected Nap and Phe biodegradation. Dynamic biodegradation experiments showed that the biodegradation percentage decreased as the hydraulic gradient increased, and biodegradation percentage of Phe was always higher than that of Nap. According to the results of the dynamic laboratory experiments, the removal percentages of Nap and Phe by indigenous riparian-zone microorganisms were 6.21-16.73% and 13.95-24.45%, respectively. The findings in this study will be useful for alleviation of Nap and Phe pollution in groundwater and will facilitate determination of appropriate treatment measures for groundwater exposed to this type of pollution.

[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.

Resumption of the treatment of non-COVID-19 gynecologic patients after lifting lockdown: Triage and infection prevention experiences from Wuhan

Aim

To share our experiences of resuming the treatments for gynecologic patients after lifting the lockdown in a hotspot area for the Coronavirus Disease 2019 (COVID‐19) pandemic.

Methods

The triage process used to resume medical activities for gynecologic patients at the Wuhan Union Hospital after a 76‐day lockdown of the city is described, and its effectiveness in preventing COVID‐19 nosocomial transmission is shown.

Results

Nonemergency patients were pretriaged based on their contact history and body temperature at an outpatient clinic, and negative COVID‐19 screening test results were required for admission to the buffering rooms at the gynecologic department. The buffering lasted at least 3 days for symptom monitoring, and a second round of COVID‐19 testing was required before patients could be transferred to the regular gynecologic wards. For patients who needed emergency surgery, the first screening was completed at the isolation wards after surgery, followed by buffering at the gynecologic department. We received 19 298 outpatient visits, admitted 326 patients, and performed 223 operations in the first 2 months after the lockdown was lifted. No COVID‐19 cases occurred in the hospitalized patients, while the proportion of potentially high‐risk patients with cancer and severe anemia was increased in comparison to that observed during the same period in 2019 and the first 2 months of 2020 before the lockdown.

Conclusions

We provide an effective triage system with buffering at two levels to guarantee safe and timely treatment for non‐COVID‐19 gynecologic patients in the postlockdown phase.

Drug utilization of paliperidone in adolescent schizophrenia patients: A retrospective cohort study in China

Introduction

In China, the indications of paliperidone extended in schizophrenia adolescents (12-17 years) was approved by National Medical Products Administration (NMPA) in 2017. But, the utilization of paliperidone in this group needs to be further investigated.

Objectives

To assess paliperidone utilization in schizophrenia adolescents.

Methods

The study employed the electronic medical records (EMRs) database from a psychiatry specialized hospital (PH) and a general hospital (GH), respectively. General information, including birth date, gender, visit date, diagnosis (inpatient and outpatient) with ICD-10 coding, drug characterize, prescription date and dosage, was de-identified and standardized for analysis. Schizophrenia adolescents (ICD-10: F20.x) received at least one prescription of paliperidone between 2018 and 2019 were included in this study. Index date was defined as the date of first identified paliperidone prescription. The patients were followed up until the end of 2019 with the last record, or upon reaching 18 years. The database was analyzed based on days of supply, administration frequency, and daily dose.

Results

Overall, 112 and 117 eligible patients were included in the present study from PH and GH, respectively. The median drug supply was 179.0 days and 44.0 days, respectively, during which median number of prescriptions patients received was 6.0 and 3.0. Paliperidone was mostly initiated alone (57.1% and 88.9%) with frequency of once daily (97.3% and 88.9%), and the median of average daily dose during follow-up was 5.7 mg/day and 6.0 mg/day, respectively.

Conclusions

The duration of paliperidone usage was very different in two hospitals, but the dosages in both hospitals were generally agreed with prescribing information.

Dosage of antipsychotics in China routine practice

Introduction

The antipsychotic dosage of Chinese schizophrenia patients has rarely been studied, although nonstandard dosage has impact on prognosis.

Objectives

To describe the dosage of antipsychotics in China routine practice.

Methods

This was a retrospective cohort study using de-identified data from a Chinese mental health hospital. The included patients were adults (≥18 years) with at least one diagnosis of schizophrenia (ICD-10: F20) and one prescription of any antipsychotic between 2014 and 2019. Date of first identified antipsychotic prescription was defined as index date, patients were followed up until last prescription of antipsychotics, end of 2019, or discontinuation (>60 days without antipsychotic prescription), whichever was earliest. Dosage was summarized using defined daily dose (DDD), calculated by cumulative average daily dose (CAD) with a unit of DDDs/day, i.e., total DDDs of all antipsychotics in follow-up period divided by total days of follow-up. CAD was categorized into low (<0.5 DDDs/day), moderate (0.5-1.5 DDDs/day), and high (>1.5 DDDs/day) groups.

Results

13554 patients were included with an average follow-up of 269.9 days. Median CAD was 0.8 DDDs/day (IQR=0.5-1.3), patients with hospitalization during follow-up and used multiple antipsychotics at the same time had larger median CAD, 1.0 DDDs/day and 1.2 DDDs/days, respectively. There were 3245 (23.9%), 7627 (56.3%), and 2682 (19.8%) patients in low, moderate, and high groups, respectively. The median CAD of high dosage group was 2.5 DDDs/day (IQR=1.9-10.5).

Conclusions

CAD of most Chinese schizophrenia patients was low or moderate. Association between CAD and hospitalization and multiple concurrent antipsychotics merit further research.

Topographic distribution of lymph node metastasis in patients with stage IB1 cervical cancer: an analysis of 8314 lymph nodes

Background

Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment.

Methods

A total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification.

Results

Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases.

Conclusions

The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.

Region-specific Risk Factors for Pelvic Lymph Node Metastasis in Patients with Stage IB1 Cervical Cancer

Objectives: We aimed to identify the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location in patients with stage IB1 cervical cancer.

Methods: A primary cohort of 728 patients with stage IB1 cervical cancer who underwent radical hysterectomy and systematic pelvic lymphadenectomy were retrospectively studied. All removed pelvic nodes (N=20,134) were pathologically examined. The risk factors for LNM in different anatomic regions (obturator, internal iliac, external iliac, and common iliac) were evaluated by multivariate logistic regression analyses. Nomograms were generated from the primary cohort and validated in another external cohort (N=242). The performance of the nomogram was assessed by its calibration and discrimination. Overall survival and progression-free survival in patients with different LNM patterns were compared.

Results: LNM was found in 266 (1.3%) removed nodes and 106 (14.6%) patients. The incidences of LNM at the obturator, internal iliac, external iliac, common iliac, and parametrial regions were 8.5%, 5.4%, 4.7%, 1.9% and 1.8%, respectively. Among others, tumour size and lymph-vascular space invasion (LVSI), which are preoperatively assessable, were identified as independent risk factors of LNM in the common iliac region and the lower pelvis, respectively, and age was an additional independent risk factor of obturator LNM. The negative predictive values of tumour size <2 cm for common iliac LNM and negative LVSI combined with older age (> 50 years) for obturator LNM were 100% and 98.7%, respectively. A nomogram of these two factors showed good calibration and discrimination (concordance index, 0.761 in the primary cohort and 0.830 in validation cohort). The patients with common iliac LNM had poorer survival than those with LNM confined to the lower pelvis, while the differences in survival between patients with LNM confined to one node, one region or single side and those with more widely spreading LNM were not statistically significant.

Conclusions: Tumour size, LVSI and age are region-specific risk factors for pelvic LNM in IB1 cervical cancer, which could be used to allocate the appropriate extent of pelvic lymphadenectomy.

Improved node culture methods for rapid vegetative propagation of switchgrass (Panicum virgatum L.)

BACKGROUND

Switchgrass (Panicum virgatum L.) is an important bioenergy and forage crop. The outcrossing nature of switchgrass makes it infeasible to maintain a genotype through sexual propagation. Current asexual propagation protocols in switchgrass have various limitations. An easy and highly-efficient vegetative propagation method is needed to propagate large natural collections of switchgrass genotypes for genome-wide association studies (GWAS).

RESULTS

Micropropagation by node culture was found to be a rapid method for vegetative propagation of switchgrass. Bacterial and fungal contamination during node culture is a major cause for cultural failure. Adding the biocide, Plant Preservative Mixture (PPM, 0.2%), and the fungicide, Benomyl (5 mg/l), in the incubation solution after surface sterilization and in the culture medium significantly decreased bacterial and fungal contamination. In addition, "shoot trimming" before subculture had a positive effect on shoot multiplication for most genotypes tested. Using the optimized node culture procedure, we successfully propagated 330 genotypes from a switchgrass GWAS panel in three separate experiments. Large variations in shoot induction efficiency and shoot growth were observed among genotypes. Separately, we developed an in planta node culture method by stimulating the growth of aerial axillary buds into shoots directly on the parent plants, through which rooted plants can be generated within 6 weeks. By circumventing the tissue culture step and avoiding application of exterior hormones, the in planta node culture method is labor- and cost-efficient, easy to master, and has a high success rate. Plants generated by the in planta node culture method are similar to seedlings and can be used directly for various experiments.

CONCLUSIONS

In this study, we optimized a switchgrass node culture protocol by minimizing bacterial and fungal contamination and increasing shoot multiplication. With this improved protocol, we successfully propagated three quarters of the genotypes in a diverse switchgrass GWAS panel. Furthermore, we established a novel and high-throughput in planta node culture method. Together, these methods provide better options for researchers to accelerate vegetative propagation of switchgrass.

MicroRNA miR-927 targets the juvenile hormone primary response gene Krüppel homolog1 to control Drosophila developmental growth

Krüppel homolog1 (Kr-h1) is a juvenile hormone (JH) response transcriptional factor that transduces JH signalling to repress insect metamorphosis in both hemimetabolous and holometabolous insects. While few studies about microRNAs (miRNAs) downregulating Kr-h1 expression to mediate insect metamorphosis have been demonstrated in hemimetabolous insects, the miRNAs that target the Kr-h1 of holometabolous insects have not been reported. Here, we identified two miR-927 binding sites within the 3'UTR region of Kr-h1 in Drosophila melanogaster, and miR-927 was found to downregulate the expression of Kr-h1. The expression profiles of miR-927 and Kr-h1 displayed relatively opposite pattern during most of the larval development stages. Overexpression of miR-927 in the fat body significantly decreased the expression of Kr-h1 and resulted in reduced oviposition, increased mortality, delayed pupation, and reduced pupal size. Notably, the co-overexpression of Kr-h1 rescued the developmental and growth defects associated with miR-927 overexpression, indicating that Kr-h1 is a biologically relevant target of miR-927. Moreover, the expression of miR-927 was found to be repressed by JH and its receptor Met/gce, forming a positive regulatory loop of JH signalling. Overall, our studies support a conserved role for the JH/miRNA/Kr-h1 regulatory axis in growth control during insect development.

Fyn stimulates the progression of pancreatic cancer via Fyn-GluN2b-AKT axis

OBJECTIVE

To assess the expression levels of Fyn in human tissue samples and pancreatic cancer cells and explore the potential mechanisms of Fyn in pancreatic cancer progression.

MATERIALS AND METHODS

Quantitative PCR and immunohistochemical (IHC) assays were performed to detect the expression of Fyn in 30 cancer tissue samples from pancreatic cancer patients and corresponding adjacent normal tissues. In addition, the potential correlations between Fyn expression levels and clinical pathological features were assessed. We further detected the effects of Fyn on the proliferation, apoptosis, migration, and invasion of the pancreatic cancer cells through colony formation assay, flow cytometry (FCM) assay, wound healing assay, and transwell assay, respectively. The potential effects of Fyn on tumor growth were assessed using an animal model.

RESULTS

We demonstrated the possible involvement of Fyn in the progression of pancreatic cancer. We found that Fyn was upregulated in human pancreatic cancer tissues and cells, and we analyzed the correlations between Fyn expression and the clinicopathological features, including metastasis staging (p=0.010*) and tumor size (p=0.025*) of patients with pancreatic cancer. Our data further confirmed that Fyn affects cell proliferation, apoptosis, migration, and invasion of pancreatic cancer cells via the phosphorylation of GluN2b and regulation of AKT signaling pathway. We also demonstrated that Fyn promoted tumor growth of pancreatic cancer cells in vivo.

CONCLUSIONS

We investigated the potential involvement of Fyn in the progression of pancreatic cancer, and therefore indicated Fyn as a possible therapeutic target for pancreatic cancer.

Prevalence of myocardial viability and ischemic burden in chronic total occluded coronary artery disease

Aims

We assessed the viable myocardium status and investigated the relationship between collaterals with the ischemia burden and myocardial viability utilizing cardiac magnetic resonance imaging (CMR) and adenosine stress single-photon emission computed tomography (SPECT).

Methods and results

150 consecutive patients with at least one native CTO artery, as confirmed by coronary arteriography or coronary CT angiography, were prospectively recruited. SPECT examination was accepted by only 50 patients while declined by the other 100 patients for reasons such as financial problems. Of all segments in the 173 CTO artery territories, only 10.4% exhibited transmural myocardial infarction and 60.2% showed no late gadolinium enhancement. Among 50 patients who completed SPECT examination, 36 patients showed inducible perfusion defect in CTO territory, and the proportion of the ischemic area of 42% patients was over 10%.

Conclusion

Most patients with CTO had different degrees of myocardial infarction detected by CMR, but only a minority of them showed transmural infarction and cardiac function in patients with transmural infarction declined compared to those without transmural infarction. Approximately half of CTO patients exhibited inducible ischemia in CTO territory. Based on this, a large proportion of patients potentially benefit from CTO-PCI.

Figure 1. Relationship between WMSI, LVE

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Beijing Municipal Education Commission Science and Technology Plan for 2020, Capital Health Development Research Project (no. 2018-2-2063)

Identification of the most appropriate existing anthropometric index for home-based obesity screening in children and adolescents

OBJECTIVES

Home-based self-screening and monitoring for obesity is particularly valuable for the prevention and control of chronic diseases. This study aimed to identify an anthropometric index suitable for home-based obesity screening in children and adolescents.

STUDY DESIGN

The design of this study is a cross-sectional study.

METHODS

A total of 14,042 students (6-17 years) from the Qibao Community, Minhang District, Shanghai, were studied in 2018. The percentage body fat (PBF), height, weight, waist circumference (WC) and hip circumference were measured. Body mass index (BMI), triponderal mass index (TMI), body adiposity index (BAI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Partial correlation analysis was used to evaluate the relationships between these indices and PBF, and receiver operating characteristic (ROC) curves were used to evaluate their performance for obesity screening.

RESULTS

BMI, TMI, WC and WHtR were found to strongly correlate with PBF (r ≥ 0.830, all P < 0.001). The optimal index for obesity screening in children (6-11 years) was BMI (area under the ROC curve [AUC] = 0.980 for boys and 0.981 for girls) and in adolescents (12-17 years) was TIM (AUC = 0.976 for boys and 0.945 for girls); however, the optimal cut-off values for BMI and TMI differed among the subgroups. The ROC curve analysis showed that WHtR had similar cut-off values in each subgroup (0.45 for boys of 6-11 years and 0.43 for the other subgroups), excellent performance in children (AUC>0.90) and good performance in adolescents (AUC = 0.960 for girls and 0.878 for boys).

CONCLUSIONS

Owing to its accuracy and stable cut-off value for defining obesity, WHtR should be recommended for home-based obesity screening in children and adolescents.

Role of carbon nanoparticle suspension in sentinel lymph node biopsy for early-stage cervical cancer: a prospective study

OBJECTIVE

To evaluate the clinical diagnostic validity of carbon nanoparticle suspension (CNS) in sentinel lymph node biopsy (SLNB) for assessing lymphatic spread of early-stage cervical cancer.

DESIGN

A prospective study.

SETTING AND POPULATION

356 cases.

METHODS

We enrolled 356 stage Ia2-IIa2 cervical cancer patients to undergo SLNB using CNS, followed by systematic pelvic lymphadenectomy. All lymph node specimens were assessed using conventional histopathologic ± pathologic ultrastaging analyses.

MAIN OUTCOME MEASURES

Sentinel lymph node detection rate (DR), clinical diagnostic validity and various related factors were analysed.

RESULTS

CNS identified 1456 SLNs in 325 patients. The overall SLN DR was 91.29%. A significantly higher DR was found for patients with tumours <20 mm (97.75% versus 71.91%; P < 0.001). Two patients had false-negative results. SLNB with CNS had sensitivity of 96.65%, false-negative rate (FNR) of 4.35% and negative predictive value (NPV) of 99.29%. Importantly, sensitivity (100%), NPV (100%) and FNR (0%) were improved when testing the subgroup of patients with tumours <20 mm (267 cases). There were no observed differences in DR based on pathological type or grade, stage, depth of stromal invasion, surgical approach, menopausal status or prior treatment with chemotherapy (P > 0.05).

CONCLUSIONS

Sentinel lymph node biopsy with CNS results in favourable DR, sensitivity and NPV for women with early-stage cervical cancer with small tumour sizes. SLNB with CNS is safe, feasible and relatively effective for guiding precise surgical treatment of early-stage cervical cancer.

TWEETABLE ABSTRACT

Sentinel lymph node biopsy with carbon nanoparticle suspension is safe and feasible for early-stage cervical cancer.

Prediction models for the risk of cardiovascular diseases in Chinese patients with type 2 diabetes mellitus: a systematic review

OBJECTIVES

Diabetes mellitus (DM) is a serious public health issue worldwide, and DM patients have higher risk of cardiovascular diseases (CVDs), which is the leading cause of DM-related deaths. China has the largest DM population, yet a robust model to predict CVDs in Chinese DM patients is still lacking. This systematic review is carried out to summarize existing models and identify potentially important predictors for CVDs in Chinese DM patients.

STUDY DESIGN

Systematic review.

METHODS

Medline and Embase were searched for data from April 1st, 2011 to May 31st, 2018. A study was eligible if it developed CVD (defined as total CVD or any major cardiovascular component) risk prediction models or explored potential predictors of CVD specifically for Chinese people with type 2 DM. Standardized forms were utilized to extract information, appraise applicability, risk of bias, and availabilities.

RESULTS

Five models and 29 studies focusing on potential predictors were identified. Models for a primary care setting, or to predict total CVD, are rare. A number of common predictors (e.g. age, sex, diabetes duration, smoking status, glycated hemoglobin (HbA1c), blood pressure, lipid profile, and treatment modalities) were observed in existing models, in which urine albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are highly recommended for the Chinese population. Variability of blood pressure (BP) and HbA1c should be included in prediction model development as novel factors. Meanwhile, interactions between age, sex, and risk factors should also be considered.

CONCLUSIONS

A 10-year prediction model for CVD risk in Chinese type 2 DM patients is lacking and urgently needed. There is insufficient evidence to support the inclusion of other novel predictors in CVDs risk prediction functions for routine clinical use.

[Pay attention to the exposure risk of patients with chronic wounds on the way to hospital during coronavirus disease 2019 epidemic prevention and control]

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%. Among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of coronavirus disease 2019 released by National Health Commission of China. It is an unavoidable fact that the patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that quite a few patients preferred going far afield in choosing hospital for treatment due to various reasons. During the prevention and control of coronavirus epidemic, this " go far afield" style of seeking medical treatment may increase the exposure risk during travelling. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the " Five Measures" encouraging the patients with chronic wounds to seek medical treatment nearby. The principle of this operation is that when seeking medical treatment, patients with chronic wounds should try their best to reduce the travel distance as much as possible to minimize the exposure risk during the epidemic period, which will in turn support the campaign of epidemic prevention and control.

Identification of risk factors associated with pelvic lymph node metastasis in patients with stage IB1 cervical cancer

e18005

Background: Evaluation the distribution of nodal metastases in the stage IB1 cervical cancer and the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location. Methods: 728 patients with stage IB1 cervical cancer who underwent radical hysterectomies and systemic pelvic lymphadenectomies from January 2008 to December 2017 were retrospectively studied. All removed pelvic lymph nodes were pathologically examined, and the risk factors for LNM at the obturator, internal iliac, external iliac, and common iliac regions were evaluated by univariate and multivariate logistic regression analyses. Results: 20,134 lymph nodes were analysed with the average number of 27.80 (± SD 9.43) lymph nodes per patient. Nodal metastases were present in 266 (14.6%) patients. The obturator was the most common site for nodal metastasis (42.5%) followed by the internal iliac nodes (20.3%) and the external iliac nodes (19.9%), while the common iliac (9.8%) and parametrial (7.5%) nodes were the least likely to be involved. Tumor size more than 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion correlated independently significantly with the higher risk of the lymphatic metastasis. Obesity (BMI≥25) was independently significantly negatively correlated with the risk of lymphatic metastases. All the positive common iliac nodes were found in patients with tumors greater than 2 cm. The multivariate analysis showed that tumor size greater than 3 cm was associated with a 16.6-fold increase in the risk for common iliac LNM. Interestingly, tumor size was not an independent risk factor for pelvic LNM in the lower regions, i.e., the obturator, internal iliac and external iliac areas, where LVSI was the most significant predictor for LNM. In addition, parametrial invasion was related to external and internal iliac LNM; deep stromal invasion and age less than 50 years were associated with obturator LNM. Conclusions: The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. The data offer the opportunity for tailored individual treatment in selected patients with small tumors and obesity.

Current practice and potential strategy in diagnosing COVID-19

OBJECTIVE

To summarize the current practice and potential strategy in diagnosing coronavirus disease 2019 (COVID-19).

MATERIALS AND METHODS

PubMed, Web of Science were systematically searched using terms including "COVID-19", "SARS-CoV-2" and "2019-nCoV". After removing duplicates, we then identified articles, letters and commentaries regarding diagnosing COVID-19.

RESULTS

Here we summarized relatively mature diagnostic methods like nuclear acid test and computed tomography. Besides, new aspects regarding these detection methods like suitable specimens for nuclear acid test, possible use of 18F-FDG PET/CT were also reported. Especially, we also presented several novel techniques for diagnosing COVID-19 like lung ultrasound.

CONCLUSIONS

Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th edition) by National Health Commission is recommended to follow as it provides detailed diagnostic procedures using currently available tools. We suggest clinicians further explore the saliva's utility as a specimen for nuclear acid test and the use of lung ultrasound.

Oncolytic adenovirus ORCA-010 increases the type 1 T cell stimulatory capacity of melanoma-conditioned dendritic cells

Immune checkpoint blockade has resulted in durable responses in patients with metastatic melanoma, but only in a fraction of treated patients. For immune checkpoint inhibitors (ICI) to be effective, sufficient infiltration with tumor‐reactive T cells is essential. Oncolytic viruses (OV) selectively replicate in and lyse tumor cells and so induce an immunogenic form of cell death, providing at once a source of tumor‐associated (neo)antigens and of danger signals that together induce effective T cell immunity and tumor infiltration. Melanoma‐associated suppression of dendritic cell (DC) differentiation effectively hampers OV‐ or immune checkpoint inhibitor (ICI)‐induced anti‐tumor immunity, due to a consequent inability to prime and attract anti‐tumor effector T cells. Here, we set out to study the effect of ORCA‐010, a clinical stage oncolytic adenovirus, on DC differentiation and functionality in the context of human melanoma. In melanoma and monocyte co‐cultures, employing a panel of five melanoma cell lines with varying origins and oncogenic mutation status, we observed clear suppression of DC development with apparent skewing of monocyte differentiation to a more M2‐macrophage‐like state. We established the ability of ORCA‐010 to productively infect and lyse the melanoma cells. Moreover, although ORCA‐010 was unable to restore DC differentiation, it induced activation and an increased co‐stimulatory capacity of monocyte‐derived antigen‐presenting cells. Their subsequent ability to prime effector T cells with a type I cytokine profile was significantly increased in an allogeneic mixed leukocyte reaction. Our findings suggest that ORCA‐010 is a valuable immunotherapeutic agent for melanoma.