[Epidemiological and clinical characteristics of respiratory syncytial virus infection among people aged 60 and above in Beijing City]

Objective: To investigate the epidemiological and clinical characteristics of RSV among patients aged ≥60 years in Beijing from 2015 to 2023. Methods: Based on the respiratory pathogen surveillance system, samples of upper respiratory tract infections (URTI), non-severe community-acquired pneumonia (nsCAP) and severe community-acquired pneumonia (sCAP) among people aged ≥60 years were collected from 28 sentinel hospitals in 16 districts of Beijing from January 2015 to December 2023. Swab samples were collected from URTI within one week, and lower respiratory tract samples from nsCAP and sCAP were collected. Demographic and epidemiological data were also collected. Various respiratory pathogens including RSV were detected. Results: From January 2015 to December 2023, a total of 20 349 cases of acute respiratory infections aged ≥60 years were included, with the RSV-positive rate of 1.54% (313/20 349, 95%CI: 1.39%-1.68%). Among them, the total RSV-positive rates of older people during the pre-pandemic, pandemic, and post-pandemic periods of COVID-19 were 1.59% (207/13 006, 95%CI: 1.38%-1.81%), 0.82% (38/4 650, 95%CI: 0.56%-1.08%) and 2.53% (68/2 693, 95%CI: 1.93%-3.12%), respectively. The difference in RSV-positive rate was statistically significant (P<0.001). Based on the sampling time of cases, the RSV epidemic season for older people in Beijing was from October to March of the following year, with a peak period in December or January of the following year. In the post COVID-19 pandemic, there were very few RSV-positive cases detected in the elderly from April to June 2023, with only one positive case detected in May and one in June. The RSV-positive rate of older people increased significantly from October to December, reaching 11.75% (51/383) in December. Among 263 RSV-positive cases in the elderly, RSV-A, RSV-B and unclassified type accounted for 43.35% (114/263), 29.28% (77/263) and 27.38% (72/263), respectively. Since 2020, there has been a subtype conversion, with RSV-B being the main focus. Among 197 elderly cases that have complete clinical data, the main symptoms were cough (86.8%, 171/197), sputum (80.2%, 158/197) and fever (73.60%, 145/197). About 24.87% (49/197) of elderly cases experienced complications. The hospitalization mortality rate was 4.57% (9/197), and the hospitalization rate was 78.68% (155/197). The ICU occupancy rate was 1.99% (36/197). The mechanical ventilation usage rate was 13.32% (33/197), and the length of hospital stay [M (Q1, Q3)] was 12 (9, 16) days. Conclusion: In Beijing, the RSV infection rate is relatively low during the COVID-19 pandemic, and the prevalence of COVID-19 is relatively high. In 2023, there was no out-of-season outbreak of RSV infection among the elderly. Elderly RSV infection cases have multiple complications, severe diseases, and poor prognosis.

Learned Helplessness and Associated Factors Among Patients with Lung Cancer

Purpose

Learned helplessness (LH) is the psychological state in which an individual experiences multiple failures and setbacks and experiences a sense of loss when facing the current situation. It is a significant burden for lung cancer patients that can impair quality of life and lead to physical, social, and psychological difficulties. Thus, this study aimed to determine the level of LH among patients with lung cancer and identify factors associated with LH.

Patients and Methods

From August 2022 to March 2023, 237 patients with lung cancer from Chongqing University Cancer Hospital were selected for this study. A general information questionnaire, the LH scale, the Brief Illness Perception questionnaire, the Strategies Used by People to Promote Health questionnaire, the Medical Coping Modes questionnaire, and the Self-esteem scale were used for the investigation. Multiple linear regression was employed to identify influencing factors for LH in patients with lung cancer.

Results

The total LH score of patients with lung cancer was 52.19±11.20. Multiple linear regression analysis showed that illness perception (β=0.249, P=0.001), self-efficacy (β=-0.194, P=0.017), and resignation coping mode (β=0.267, P<0.001) were the main influencing factors of LH (P<0.05), which explained 42.0% of the total variance.

Conclusion

The score of LH in patients with lung cancer was at a moderate level in this study. Illness perception, self-efficacy, and resignation coping mode have been found to impact LH among patients with lung cancer. Healthcare professionals should implement effective interventions, such as promoting self-efficacy, encouraging positive coping, and reducing illness perception, to alleviate LH.

[Efficacy of rituximab therapy for 10 patients suffering from systemic lupus erythematosus with intestinal involvement]

We retrospectively analyzed therapy efficacy and the adverse reactions of 10 patients suffering from systemic lupus erythematosus (SLE) with intestinal involvement treated with rituximab (RTX). Patients were hospitalized in the Department of Rheumatology and Immunology of the First Medical Center of PLA General Hospital from January 2015 to January 2023. Among the 10 patients, two were men and eight were women. The age of the cohort was (41.9±8.8) years. The age at disease onset was (28.8±9.2) years. The total course of the SLE diagnosis was(109.6±59.9) months. The course of the diagnosis of SLE with intestinal involvement was (89.3±50.2) months. The time from the appearance of intestinal symptoms to the diagnosis of SLE with intestinal involvement was 1.5 (1.0,8.0) months. The time from the diagnosis of SLE with intestinal involvement to RTX use was 13.0 (1.0,46.3) months. Follow-up duration after application of RTX treatment was (55.3±28.4) months. There were five cases of abdominal pain, four cases of abdominal distension, nine cases of diarrhea, three cases of nervous-system involvement, nine cases of lupus nephritis, and seven cases of serositis. All 10 patients underwent computed tomography and radiology of the abdomen. Eight patients had intestinal-wall edema, seven suffered intestinal dilation, four had target signs, three suffered congestion of mesenteric blood vessels, eight had increased mesenteric-fat density, and six had false intestinal obstruction. All 10 patients showed a low level of complement C3 (250-750 mg/L). Nine cases showed a low level of complement C4 (10-90 mg/L). The SLE disease activity index 2000 (SLEDAI-2K) at baseline in 10 patients was 20.5 (17.8, 30.0). After receiving RTX (0.5 g: day 1, day 14, or 375 mg/m2: day 1, day 14) induction treatment, the intestinal symptoms of 10 cases were relieved completely. Four patients had adverse reactions, of which three received a high-dose glucocorticoid combined with RTX treatment simultaneously. Adverse reactions manifested mainly as a reduced level of IgG and infection with herpes simplex virus in one case, reduced level of IgG and lung infection in one patient, lung infection in one case, and reduced IgG level in one patient. RTX may an efficacious treatment strategy for patients suffering from refractory SLE with intestinal involvement.

[Metagenomic next-generation sequencing for the diagnosis of Pneumocystis jirovecii pneumonia after allogeneic hematopoietic stem cell transplantation]

Objectives: To investigate the value of metagenomic next-generation sequencing (mNGS) in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The data of 98 patients with suspected pulmonary infection after allo-HSCT who underwent pathogen detection from bronchoalveolar lavage fluid between June 2016 and August 2023 at Nanfang Hospital were analyzed. The diagnostic performance of mNGS, conventional methods, and real-time quantitative polymerase chain reaction (qPCR) for PJP were compared. Results: A total of 12 patients were diagnosed with PJP, including 11 with a proven diagnosis and 1 with a probable diagnosis. Among the patients with a proven diagnosis, 1 was positive by both conventional methods and qPCR, and 10 were positive by qPCR only. Pneumocystis jirovecii was detected by mNGS in all 12 patients. The diagnostic sensitivity of mNGS for PJP was 100%, which was greater than that of conventional methods (8.3%, P=0.001) and similar to that of qPCR (91.6%, P=1.000) . A total of 75% of the patients developed mixed pulmonary infections, and cytomegalovirus and Epstein-Barr virus were the most common pathogens. Mixed infection was detected in eight patients by mNGS and in five patients by qPCR, but not by conventional methods (P=0.008) . Conclusions: mNGS had good sensitivity for diagnosing PJP after allo-HSCT and was advantageous for detecting mixed infectious pathogens; therefore, mNGS might be an effective supplement to regular detection methods and qPCR.

[Analysis of the current status and related factors of human papillomavirus infection among community-dwelling women aged 18-24 years without a history of vaccination in Shanghai City]

Objective: To understand the status of human papillomavirus (HPV) infection among young women without a history of vaccination in Shanghai, and analyze the related factors of HPV infection in this population. Methods: A total of 2 660 women aged 18-24 years old who had made an appointment for HPV vaccine at 36 community health service centers in Shanghai from July 2022 to February 2023 were selected as the study subjects. Basic information (including demographic characteristics, previous disease history, female menstrual and reproductive history, sexual life history, etc.) was collected by a self-filling electronic questionnaire. Cervical secretions were detected by HPV nucleic acid typing. The multivariate logistic regression model was used to analyze the factors related to high-risk HPV (HR-HPV) infection in the target population. Results: The age of the subjects was (23±1) years old, and the infection rate of HPV was 14.51% (386 cases), among which the infection rates of HR-HPV and low-risk HPV were 13.53% (360 cases) and 1.84% (49 cases), respectively. The main subtypes of HR-HPV infection were HPV52, 16, 58, 39 and 66. The multivariate logistic regression model analysis showed that compared with the control group, the OR (95%CI) values for HR-HPV infection in the group of married, earned less than 2 000 yuan/month, drank alcohol occasionally, gynecological disease history, had two or more sexual partners in the past year, and did not know whether the partners had other sexual partners were 0.41 (0.25-0.66), 0.39 (0.21-0.70), 1.45 (1.13-1.86), 1.29 (1.00-1.66), 2.18-5.18 (1.02-16.05), and 1.82 (1.31-2.54), respectively. Conclusion: The infection rate of HPV among women aged 18-24 years old in Shanghai remains at a high level. The main subtypes of HR-HPV infection are HPV52, 16, 58, 39 and 66. The marital status, economic income level, drinking status, gynecological disease history and sexual life history are related to HR-HPV infection.

One novel alkaloid from the stems of Tinospora crispa

The 6-methoxy-cannabisin I (1), a new alkaloid, together with five known compounds oleraisoindole A (2), cannabisin F (3), apigenin (4), syringin (5) and ethyl-syringin (6) were isolated from Tinospora crispa stems. Their structures were identified by the analysis of spectroscopic data. Compound 2 was isolated from T. crispa for the first time. Anti-inflammatory activity of compound 1 was detected against NO production in LPS-activated RAW 264.7 macrophages. However, no activity was observed.

Stereotactic Ablative Radiotherapy for Oligo-Progressive Cancers: Results of the Randomized Phase II STOP Trial

PURPOSE/OBJECTIVE(S)

In the metastatic setting, there is uncertain benefit to localized eradication of one or more lesions that are progressing despite systemic therapy. This randomized phase II trial examined if patients with ≤5 sites of oligoprogression benefited from the addition of stereotactic ablative radiotherapy (SABR) to standard of care (SOC) systemic therapy.

MATERIALS/METHODS

Eligibility criteria included age ≥18 years, ECOG performance status 0-2, and oligoprogressive disease, defined as 1-5 lesions actively progressing while on systemic therapy. Patients were required to have at least 3 months of disease stability/response on systemic therapy prior to oligoprogression. After stratifying by type of systemic therapy (cytotoxic vs. non-cytotoxic), patients were randomized 2:1 to SABR to all progressing lesions plus SOC (SABR arm) vs. SOC alone (SOC arm). The trial began exclusive to non-small cell lung cancer but did not meet accrual goals and was expanded in 2019 to include all non-hematologic malignancies. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life (QOL), toxicity, and duration of current systemic agent post-SABR.

RESULTS

Between February 2017 and June 2021, 90 patients with 125 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 patients randomized to SABR and 31 to SOC. Median age was 67 years (IQR: 61-73 years) and 39 (43%) were female. The most common primary sites were lung (44% of patients), genitourinary (23%) and breast (13%), with the most common oligo-progressive locations being lung (43%), bone (19%), lymph nodes (14%), and liver (13%). In the SABR arm, the most common fractionations were 35 Gy/5 (38% of lesions) and 50 Gy/5 (18%). Protocol adherence in the SOC arm was suboptimal: 3 patients (10%) withdrew immediately after randomization, and 7 additional patients (23%) received high-dose or ablative therapies. Median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs. 4.3 months in the SOC arm; however, the curves cross and 2-year PFS was 9% vs. 24% respectively, p = 0.91). Median OS was 31.2 months vs. 27.4 months, respectively (p = 0.22). Lesional control with SABR was 71% vs. 39% with SOC (p = 0.002). Median duration of post-randomization first-line systemic therapy was 10.3 months vs. 7.6 months, respectively (p = 0.71). Treatment was well-tolerated with 2 (3.4%) grade 3 treatment-related toxicities in the SABR arm and no grade 4/5 related events in either arm. QOL did not differ between arms.

CONCLUSION

Despite being a well-tolerated treatment providing superior lesional control, SABR for oligoprogression did not improve PFS or OS. Results may have been impacted by withdrawals and desire for ablative treatments on the SOC arm, and this lack of equipoise may make accrual to phase III trials difficult, although larger studies in select sub-populations are desired. (NCT02756793).

Observation of high-energy neutrinos from the Galactic plane

The origin of high-energy cosmic rays, atomic nuclei that continuously impact Earth's atmosphere, is unknown. Because of deflection by interstellar magnetic fields, cosmic rays produced within the Milky Way arrive at Earth from random directions. However, cosmic rays interact with matter near their sources and during propagation, which produces high-energy neutrinos. We searched for neutrino emission using machine learning techniques applied to 10 years of data from the IceCube Neutrino Observatory. By comparing diffuse emission models to a background-only hypothesis, we identified neutrino emission from the Galactic plane at the 4.5σ level of significance. The signal is consistent with diffuse emission of neutrinos from the Milky Way but could also arise from a population of unresolved point sources.

[A single-center study on the distribution and antibiotic resistance of pathogens causing bloodstream infection in patients with hematological malignancies]

Objective: To study the incidence of bloodstream infections, pathogen distribution, and antibiotic resistance profile in patients with hematological malignancies. Methods: From January 2018 to December 2021, we retrospectively analyzed the clinical characteristics, pathogen distribution, and antibiotic resistance profiles of patients with malignant hematological diseases and bloodstream infections in the Department of Hematology, Nanfang Hospital, Southern Medical University. Results: A total of 582 incidences of bloodstream infections occurred in 22,717 inpatients. From 2018 to 2021, the incidence rates of bloodstream infections were 2.79%, 2.99%, 2.79%, and 2.02%, respectively. Five hundred ninety-nine types of bacteria were recovered from blood cultures, with 487 (81.3%) gram-negative bacteria, such as Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa. Eighty-one (13.5%) were gram-positive bacteria, primarily Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecium, whereas the remaining 31 (5.2%) were fungi. Enterobacteriaceae resistance to carbapenems, piperacillin/tazobactam, cefoperazone sodium/sulbactam, and tigecycline were 11.0%, 15.3%, 15.4%, and 3.3%, with a descending trend year on year. Non-fermenters tolerated piperacillin/tazobactam, cefoperazone sodium/sulbactam, and quinolones at 29.6%, 13.3%, and 21.7%, respectively. However, only two gram-positive bacteria isolates were shown to be resistant to glycopeptide antibiotics. Conclusions: Bloodstream pathogens in hematological malignancies were broadly dispersed, most of which were gram-negative bacteria. Antibiotic resistance rates vary greatly between species. Our research serves as a valuable resource for the selection of empirical antibiotics.

Current status and future prospects of TB digital treatment adherence technology use in China

BACKGROUND: Digital treatment adherence technologies (DATs) have been recommended by the Chinese National Tuberculosis Programme since 2015. However, until now the extent to which DATs have been adopted in China remain unclear. In this study, we aimed to understand the current status and future prospects of DAT use in China.METHODS: A cross-sectional study was undertaken to collect data from all 2,884 county-level TB-designated institutions across China using a quantitative questionnaire and extraction of information from the Chinese TB information management system. Data were collected between 1 July 2020 and 30 June 2021.RESULTS: All of the 2,884 county-level TB-designated institutions responded to the questionnaire. We found that the utilisation rate of DATs in China was 21.5% (n = 620). Among those using DATs, the uptake of DATs among TB patients was 31.0%. Lack of financial, policy and technology support were the main barriers to adoption and scale up DATs at the institution level.CONCLUSIONS: The use of DATs is in an early stage in China; however, the number of institutions who offer DATs have increased significantly after July 2020. To facilitate the use of DATs, the national TB programme should provide more financial, policy and technology support, and a national guideline is required.

Trends and seasonal variation of antibiotic consumption by community residents in Hefei, China, 2012-2016

OBJECTIVES

The aim of this study was to evaluate the trends and seasonal variations of antibiotic consumption by community residents in Hefei, China, over a 5-year period.

STUDY DESIGN

This was an ecological study.

METHODS

Data on antibiotic consumption by community residents in Hefei between 2012 and 2016 were collected from the Hefei Center for Disease Control and Prevention. Statistical analysis was carried out using Microsoft Excel 2021, SPSS 26.0 and R4.1.3. An interrupted time series (ITS) analysis was modelled to assess the impact of policies on antibiotic consumption trends.

RESULTS

Amoxicillin and cephalosporins accounted for 63.64% and 30.48%, respectively, of the total defined daily dose per 1000 inhabitant-days (DID) of antibiotics in 2016. The total consumption of antibiotics decreased from 6.92 DID in 2012 to 5.61 DID in 2016 (P_trend = 0.017). Seasonal analysis showed an average of 34.24% antibiotic consumption in the winter over the 5 years. The equation constructed by the ITS analysis was Y = 5.530 + 0.323X1 - 7.574X2 - 0.323X3 + ε.

CONCLUSION

Between 2012 and 2016, overall antibiotic consumption by community residents in Hefei decreased significantly. The impact of antibiotic policies, implemented between 2011 and 2013, started to appear in 2014 when the consumption of antibiotics decreased. This study has important policy implications for the use of antibiotics at the community level. Further studies on the trends of antibiotic consumption are required, and strategies should be designed to promote appropriate use of antibiotics.

SLC7A11-associated ferroptosis in acute injury diseases: mechanisms and strategies

Ferroptosis is a kind of iron-dependent renewal programmed death. Its main mechanism is to catalyze the unsaturated fatty acids highly expressed on the cell membrane under the effect of divalent iron, to produce lipid peroxidation, thus inducing cell death. SLC7A11 is a known iron death-related factor. It has been proved that iron death is involved in the occurrence and development of acute diseases, but the specific mechanism is unknown. The purpose of this review is to highlight the regulatory properties of SLC7A11 and gain a deeper understanding of its role in ferroptosis-related acute injury diseases. This is a narrative review. PubMed was used as the main source to randomly implement literature search strategy to index Scopus articles. No specific terms are used. Studies have shown that SLC7A11 may affect the sensitivity of cells to iron ptosis by regulating it at the transcriptional or post-transcriptional level, which is related to the pathology of many acute injury diseases, such as acute lung injury (ALI), acute kidney injury (AKI), acute liver injury, myocardial ischemia-reperfusion injury, and acute cerebral hemorrhage. In order to clarify this point, more and more researchers turn their attention to the study of the specific mechanism between SLC7A11 and ferroptosis-related acute injury diseases. In summary, this review summarized some specific mechanisms by which ferroptosis could be controlled by SLC7A11 and clarified the underlying mechanisms of a series of diseases caused by SLC7A11-associated ferroptosis. It also provided more scientific justification for the clinical application of targeting ferroptosis in preventing and treating various diseases.

Identification and fine mapping of a new bacterial blight resistance gene, Xa43(t), in Zhangpu wild rice (Oryza rufipogon)

Bacterial blight (BB) is currently considered one of the most serious rice diseases and is caused by Xanthomonas oryzae pv. oryzae (Xoo). Numerous studies have shown that breeding resistant rice varieties is one of the most effective methods to prevent BB, and it is important to identify and isolate more BB resistance (R) genes from different rice resources. Using a map-based approach, we identified a new QTL/gene, Xa43(t), from ZhangPu wild rice, which was highly resistant to the BB isolate PX099. We performed bulked segregant analysis combined with candidate gene prediction to identify the candidate gene. The Xa43(t) gene was narrowed down to a 29-kb region containing four putative genes. More importantly, the candidate gene Xa43(t) did not affect the main agronomic traits of rice. We also identified a widely applicable molecular marker, namely Inde1-18, which co-segregates with the Xa43(t) gene. The Xa43(t) gene is a new broad-spectrum BB resistance gene without identified alleles and has good application prospects for rice disease resistance breeding.

Association between diabetes complicated with comorbidities and frailty in older adults: A cross-sectional study

AIMS AND OBJECTIVES

This study investigated the relationship between frailty and diabetes complicated with comorbidities.

BACKGROUND

Frailty is a common geriatric syndrome, and older adults with diabetes are prone to frailty. Patients with diabetes and comorbidities might be at increased risk of developing frailty.

DESIGN

A multicenter cross-sectional study.

METHODS

A cross-sectional study was conducted to identify older patients with diabetes and comorbidities in the internal medicine departments of five tertiary general hospitals in Sichuan Province, China, from March 2020 to June 2021. We used the FRAIL scale to identify frailty, and multinomial logistic regression was used to compare sociodemographic characteristics and comorbidities of frail or pre-frail participants with robust participants. The STROBE checklist was used for this cross-sectional study.

RESULTS

A total of 1652 patients (883 males, 53.5%) were included, and the prevalence of frailty was 26.5%. Multinomial logistic regression analysis revealed that compared with robust patients, diabetic patients with hypertension, coronary heart disease, chronic cardiac failure, COPD, cerebrovascular diseases, osteoarticular diseases, chronic renal diseases, chronic gastrointestinal diseases and cancer were more likely to be frail. In addition, patients who engaged in less exercise, presented more comorbidities, were older and had lower education levels, were more prone to frailty.

CONCLUSION

There was a clear correlation between diabetes complicated with comorbidities and the development of frailty. Appropriate personalised care levels for patients with diabetes and comorbidities, and early screening for frailty might reduce the prevalence of frailty in these patients.

RELEVANCE TO CLINICAL PRACTICE

This study provided information for healthcare providers to identify circumstances that increase the risk of frailty and more effectively support patients with diabetes and comorbidities.

[Efficacy and safety of half-dose rituximab in the treatment of 23 cases with lupus nephritis]

The study aimed to analyze the efficacy and safety of rituximab in the treatment of 23 cases of lupus nephritis and explore the prospect of half-dose rituximab in lupus nephritis treatment. Twenty-three patients with lupus nephritis hospitalized in the Department of Rheumatology and Immunology at the First Medical Center of the PLA General Hospital from May 2013 to December 2021 were selected. Eighteen patients received rituximab 375 mg/m² on the first and 14th days, 5 patients received 500 mg of rituximab on the first and 14th days, and rituximab was used as needed 6 months later. Methylprednisolone (80-120 mg) was given together with rituximab. Afterward, 1 mg/kg prednisone was used for 4 weeks, which was progressively tapered to maintenance doses or discontinued. B lymphocyte level, renal function, 24-h urine protein level, and systemic lupus erythematosus (SLE) disease activity index 2000 (SLEDAI2K) score before and after treatment were recorded. The efficacy and adverse reactions were analyzed. The results showed that 11 patients suffered from renal insufficiency [creatinine (162.7±58.6) μmol/L ] at baseline, while the creatinine level of 9 patients returned to normal 12 months after the treatment [ (66.3±10.1)μmol/L ]. Normal renal function of the other 12 patients was maintained during treatment. After 12 months, the 24-h urine protein level decreased from 4.00 (2.00,6.80) g in the baseline period to 0.10 (0.08,0.40) g. SLEDAI2K score decreased from 22 (18,26) in the baseline period to 3 (0,6) 12 months after the treatment. The B lymphocyte level reached 0.00 (0.00,0.01)% at 3 months. Of 23 patients, 13 patients achieved complete remission, and 7 patients achieved partial remission after 6 months of rituximab treatment. Five patients experienced adverse reactions related to rituximab, including 1 case of transfusion reaction, 1 case of perioral herpes with pulmonary infection, and 3 cases of decreased IgG levels. Therefore, rituximab regimen used in this study can be an effective treatment strategy for lupus nephritis.

Association of Dietary Quality with Cognitive Function in Chinese Adults Aged 55 Years and Above: A Longitudinal Study

OBJECTIVES

Diet is an important modifiable factor for brain health and aging. Present study aimed to explore association of dietary quality with cognitive function and poor cognition in middle-aged and older adults participating in the China Health and Nutrition Survey (CHNS).

DESIGN

A longitudinal study with a twenty-year follow-up.

SETTING AND PARTICIPANTS

Data were drawn from the CHNS 1997, 2000, 2004, 2006, 2015 and 2018. Subjects aged 55 years and more who participated in at least two waves and had completed data on socio-demographics, lifestyle, disease history, anthropometrics, dietary measure and cognitive assessment were eligible in present study.

METHODS

Baseline diet were assessed by 3-day 24-hour dietary recalls and used to evaluate diet quality via China Elderly Dietary Guidelines Index 2022 (CDGI 2022-E). Cognitive function was examined using part items of the Telephone Interview for Cognitive Status-modified. Three-level linear mixed effects models and three-level mixed effects logistic regression models were performed to estimate the association between diet quality and cognitive function and odds of poor cognition, respectively.

RESULTS

At baseline, 4173 subjects with median age of 63.7 years were recruited. Median of CDGI 2022-E total score was 44.7. Median score of global cognition was 16.0, and the proportion of people with poor cognitive function was 13.9%. Difference in global cognitive score was observed by tertiles of CDGI 2022-E (p<0.05). Significant associations of high diet quality with increment in global cognitive score [β (95%CI): 0.704 (0.394~1.015)], composite cognitive z score [0.086 (0.045~0.128)] and standardized verbal memory score [0.221 (0.122~0.320)] were observed in total subjects. Consistent associations were also found in those below 65 years at baseline. The likelihood of poor cognition in the highest tertile of CDGI 2022-E decreased by 18% (95%CI: 0.698~0.965) relative to the lowest tertile group in total population.

CONCLUSIONS

High diet quality may be beneficial for improving cognitive function and delaying cognitive decline in Chinese middle-aged and older population.

Adjuvant Radiotherapy in Stage II Endometrial Cancer: Selective De-intensification of Adjuvant Treatment

AIMS

Risk stratification, including nodal assessment, allows for selective de-intensification of adjuvant radiotherapy in stage II endometrial cancer. Patterns of treatment and clinical outcomes, including the use of reduced volume 'mini-pelvis' radiotherapy fields, were evaluated in a population-based study.

MATERIALS AND METHODS

All patients diagnosed with pathological stage II endometrial cancer between 2000 and 2014, and received adjuvant radiotherapy in a regional healthcare jurisdiction were reviewed. Registry data were supplemented by a comprehensive review of patient demographics, disease characteristics and treatment details. The Charlson Comorbidity Score was calculated. Survival and recurrence data were analysed.

RESULTS

In total, 264 patients met the inclusion criteria. Most patients had endometrioid histology (83%); 41% of patients had International Federation of Gynecologists and Obstetricians grade 1 disease. Half (49%) had surgical nodal evaluation; 11% received chemotherapy. Most patients (59%) were treated with full pelvic radiotherapy fields ± brachytherapy. Seventeen per cent of patients received mini-pelvis radiotherapy ± brachytherapy, whereas 24% received brachytherapy alone. Five-year recurrence-free survival was 87% for the entire cohort, with no significant difference by adjuvant radiotherapy approach. Only one patient receiving mini-pelvis radiotherapy ± brachytherapy recurred in the pelvis but outside of the mini-pelvis field. Recorded late toxicity rates were highest for full pelvis radiotherapy + brachytherapy.

CONCLUSION

Risk stratification in a real-world setting allowed for selective de-intensification of adjuvant radiation with equivalent outcomes for stage II endometrial cancer. Mini-pelvis radiotherapy combined with brachytherapy is effective in highly selected patients, with the potential to decrease toxicity without compromising local control. Brachytherapy should be considered in low-risk stage II patients.

A, Barbano A, Barwick SW, Bastian B, Basu V, Baur S, Bay R, Beatty JJ, Becker KH, Becker Tjus J, Bellenghi C, BenZvi S, Berley D, Bernardini E, Besson DZ, Binder G, Bindig D, Blaufuss E, Blot S, Boddenberg M, Bontempo F, Borowka J, Böser S, Botner O, Böttcher J, Bourbeau E, Bradascio F, Braun J, Brinson B, Bron S, Brostean-Kaiser J, Browne S, Burgman A, Burley RT, Busse RS, Campana MA, Carnie-Bronca EG, Chen C, Chen Z, Chirkin D, Choi K, Clark BA, Clark K, Classen L, Coleman A, Collin GH, Conrad JM, Coppin P, Correa P, Cowen DF, Cross R, Dappen C, Dave P, De Clercq C, DeLaunay JJ, Delgado López D, Dembinski H, Deoskar K, Desai A, Desiati P, de Vries KD, de Wasseige G, de With M, DeYoung T, Diaz A, Díaz-Vélez JC, Dittmer M, Dujmovic H, Dunkman M, DuVernois MA, Dvorak E, Ehrhardt T, Eller P, Engel R, Erpenbeck H, Evans J, Evenson PA, Fan KL, Fazely AR, Fedynitch A, Feigl N, Fiedlschuster S, Fienberg AT, Filimonov K, Finley C, Fischer L, Fox D, Franckowiak A, Friedman E, Fritz A, Fürst P, Gaisser TK, Gallagher J, Ganster E, Garcia A, Garrappa S, Gerhardt L, Ghadimi A, Glaser C, Glauch T, Glüsenkamp T, Goldschmidt A, Gonzalez JG, Goswami S, Grant D, Grégoire T, Griswold S, Günther C, Gutjahr P, Haack C, Hallgren A, Halliday R, Halve L, Halzen F, Ha Minh M, Hanson K, Hardin J, Harnisch AA, Haungs A, Hebecker D, Helbing K, Henningsen F, Hettinger EC, Hickford S, Hignight J, Hill C, Hill GC, Hoffman KD, Hoffmann R, Hokanson-Fasig B, Hoshina K, Huang F, Huber M, Huber T, Hultqvist K, Hünnefeld M, Hussain R, Hymon K, In S, Iovine N, Ishihara A, Jansson M, Japaridze GS, Jeong M, Jin M, Jones BJP, Kang D, Kang W, Kang X, Kappes A, Kappesser D, Kardum L, Karg T, Karl M, Karle A, Katz U, Kauer M, Kellermann M, Kelley JL, Kheirandish A, Kin K, Kintscher T, Kiryluk J, Klein SR, Koirala R, Kolanoski H, Kontrimas T, Köpke L, Kopper C, Kopper S, Koskinen DJ, Koundal P, Kovacevich M, Kowalski M, Kozynets T, Kun E, Kurahashi N, Lad N, Lagunas Gualda C, Lanfranchi JL, Larson MJ, Lauber F, Lazar JP, Lee JW, Leonard K, Leszczyńska A, Li Y, Lincetto M, Liu QR, Liubarska M, Lohfink E, Lozano Mariscal CJ, Lu L, Lucarelli F, Ludwig A, Luszczak W, Lyu Y, Ma WY, Madsen J, Mahn KBM, Makino Y, Mancina S, Mariş IC, Martinez-Soler I, Maruyama R, Mase K, McElroy T, McNally F, Mead JV, Meagher K, Mechbal S, Medina A, Meier M, Meighen-Berger S, Micallef J, Mockler D, Montaruli T, Moore RW, Morse R, Moulai M, Naab R, Nagai R, Nahnhauer R, Naumann U, Necker J, Nguyen LV, Niederhausen H, Nisa MU, Nowicki SC, Nygren D, Obertacke Pollmann A, Oehler M, Oeyen B, Olivas A, O’Sullivan E, Pandya H, Pankova DV, Park N, Parker GK, Paudel EN, Paul L, Pérez de los Heros C, Peters L, Peterson J, Philippen S, Pieper S, Pittermann M, Pizzuto A, Plum M, Popovych Y, Porcelli A, Prado Rodriguez M, Price PB, Pries B, Przybylski GT, Raab C, Rack-Helleis J, Raissi A, Rameez M, Rawlins K, Rea IC, Rehman A, Reichherzer P, Reimann R, Renzi G, Resconi E, Reusch S, Rhode W, Richman M, Riedel B, Roberts EJ, Robertson S, Roellinghoff G, Rongen M, Rott C, Ruhe T, Ryckbosch D, Rysewyk Cantu D, Safa I, Saffer J, Sanchez Herrera SE, Sandrock A, Sandroos J, Santander M, Sarkar S, Sarkar S, Satalecka K, Schaufel M, Schieler H, Schindler S, Schmidt T, Schneider A, Schneider J, Schröder FG, Schumacher L, Schwefer G, Sclafani S, Seckel D, Seunarine S, Sharma A, Shefali S, Silva M, Skrzypek B, Smithers B, Snihur R, Soedingrekso J, Soldin D, Spannfellner C, Spiczak GM, Spiering C, Stachurska J, Stamatikos M, Stanev T, Stein R, Stettner J, Steuer A, Stezelberger T, Stokstad R, Stürwald T, Stuttard T, Sullivan GW, Taboada I, Ter-Antonyan S, Tilav S, Tischbein F, Tollefson K, Tönnis C, Toscano S, Tosi D, Trettin A, Tselengidou M, Tung CF, Turcati A, Turcotte R, Turley CF, Twagirayezu JP, Ty B, Unland Elorrieta MA, Valtonen-Mattila N, Vandenbroucke J, van Eijndhoven N, Vannerom D, van Santen J, Verpoest S, Walck C, Watson TB, Weaver C, Weigel P, Weindl A, Weiss MJ, Weldert J, Wendt C, Werthebach J, Weyrauch M, Whitehorn N, Wiebusch CH, Williams DR, Wolf M, Woschnagg K, Wrede G, Wulff J, Xu XW, Yanez JP, Yoshida S, Yu S, Yuan T, Zhang Z, Zhelnin P. Evidence for neutrino emission from the nearby active galaxy NGC 1068

A supermassive black hole, obscured by cosmic dust, powers the nearby active galaxy NGC 1068. Neutrinos, which rarely interact with matter, could provide information on the galaxy’s active core. We searched for neutrino emission from astrophysical objects using data recorded with the IceCube neutrino detector between 2011 and 2020. The positions of 110 known gamma-ray sources were individually searched for neutrino detections above atmospheric and cosmic backgrounds. We found that NGC 1068 has an excess of 79 − 20 + 22 neutrinos at tera–electron volt energies, with a global significance of 4.2σ, which we interpret as associated with the active galaxy. The flux of high-energy neutrinos that we measured from NGC 1068 is more than an order of magnitude higher than the upper limit on emissions of tera–electron volt gamma rays from this source.

Search for Unstable Sterile Neutrinos with the IceCube Neutrino Observatory

We present a search for an unstable sterile neutrino by looking for a resonant signal in eight years of atmospheric ν_{μ} data collected from 2011 to 2019 at the IceCube Neutrino Observatory. Both the (stable) three-neutrino and the 3+1 sterile neutrino models are disfavored relative to the unstable sterile neutrino model, though with p values of 2.8% and 0.81%, respectively, we do not observe evidence for 3+1 neutrinos with neutrino decay. The best-fit parameters for the sterile neutrino with decay model from this study are Δm_{41}^{2}=6.7_{-2.5}^{+3.9}  eV^{2}, sin^{2}2θ_{24}=0.33_{-0.17}^{+0.20}, and g^{2}=2.5π±1.5π, where g is the decay-mediating coupling. The preferred regions of the 3+1+decay model from short-baseline oscillation searches are excluded at 90% C.L.

Isolated hand weakness due to brain lesion

When hand weakness is linked to a brain lesion, there is risk of misdiagnosis. A case of hand weakness related to stroke is presented. The electromyography report indicated a segmental lesion of the median nerve at the wrist. Thus, the patient was initially diagnosed with carpal tunnel syndrome, and was referred to the orthopedic department for release surgery. Because the symptom was immediate and did not include hand numbness, the orthopedic surgeon ruled out the previous diagnosis and ordered a head CT scan, which revealed stroke. Aspirin and other medications were given. Percutaneous carotid balloon angioplasty with stent implantation and percutaneous vertebral artery balloon angioplasty were performed. The weakness of the left hand was greatly improved. So far, only a few cases suggest that hand weakness may be linked to stroke. Therefore, physicians should pay attention to physical examination.

[Hepatitis C elimination among drug users in China: challenges, strategies and experiences]

The prevalence of hepatitis C among drug users in China is high, and thus it is one of the populations that needs attention to achieve hepatitis C elimination. However, due to the complexities of this population's situation, hepatitis C elimination still faces many challenges, such as difficult screening, low cure rate, poor compliance, and high reinfection rates. Therefore, the existing diagnostic and therapeutic system cannot meet the needs of this population. China has pledged to establish a unified system for drug users that will integrate drug treatment programs, education, medical care, and rehabilitation, creating favorable conditions for integrating hepatitis C diagnosis and treatment and improving the accessibility of drug users. Starting with the current situation and challenges of eliminating hepatitis C among drug users in China, in combination with cases from other countries, this paper discusses the strategy for eliminating hepatitis C and introduces what Hainan Province did to eliminate hepatitis C among drug users.