[Whether extracorporeal membrane oxygenation can be used in adult patients with sepsis and septic shock?]

Sepsis is a critical medical problem that needs to be solved urgently worldwide. Some patients with sepsis have refractory shock or/and severe respiratory failure, which may require supporting with extracorporeal membrane oxygenation (ECMO). Particularly, it is important to choose the optimal mode and grasp the optimal timing of the initiation in the experienced ECMO center. The choice of mode is mainly based on the patient's condition of oxygenation and hemodynamics. During the management of ECMO support, some issues like blood flow, anticoagulation and therapy of antibiotics should be noted. Thus far, the research of ECMO in adult patients with sepsis and septic shock are mainly retrospective, observational and with small sample size. Further exploration is needed in the future.

Stability profiling and degradation products of dihydromyricetin in Dulbecco's modified eagle's medium

Dihydromyricetin has shown many bioactivities in cell level. However, dihydromyricetin was found to be highly instable in cell culture medium DMEM. Here, the underlying degradation mechanism was investigated via UPLC-MS/MS analysis. Dihydromyricetin was mainly converted into its dimers and oxidized products. At lower temperature, dihydromyricetin in DMEM showed higher stability. Vitamin C increased the stability of dihydromyricetin in DMEM probably due to its high antioxidant potential.

[Classification and reconstruction of complex defects after lateral facial tumor surgery]

Objective: To explore the classification and reconstruction strategy of defects in lateral face region after operation of malignant tumors. Methods: Eighteen cases with the reconstruction of complicated defects after resection of tumors in the region of lateral face from January 2015 to January 2018 in Hunan Cancer Hospital were retrospectively reviewed. There were 14 males and 4 females, aged from 32 to 68 years. According to the presence or absence of bony scaffold, complicated defects were divided into two main categories: soft tissue perforating defects and soft tissue defects combined with bony scaffold defects. All soft tissue perforating defects in 5 cases were repaired with free anterolateral femoral flaps. Among 13 cases with soft tissue plus bony scaffold defects, 3 were repaired with free fibular flaps, 6 with free fibular flaps combined with free anterolateral femoral flaps, and 4 with chimeric deep circumflex iliac artery perforator flaps combined with anterolateral femoral flaps. Results: All flaps survived well. Two patients complicated with fistula in floor of mouth, but the wound healed after dressing change. Transoral feeding was resumed within 2 weeks after surgery in all patients. One year follow-up evaluation showed that 14 cases had symmetrical face and 10 cases had mouth opening more than 3 transverse fingers. After 36-50 months of follow-up, 6 patients died, with an overall 3-year survival rate of 66.7%. Conclusion: The classification of defects with or without bony stent loss is conducive to the overall repair design, the recovery of facial contour stent, the effective fill of dead space and the maintain of residual occlusal relationship. Good reconstruction results require a multi flap combination of osteocutaneous and soft tissue flaps.

[Outcome of radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma, nasal-type]

Objective: To evaluate the prognosis and determine the failure patterns after radiotherapy for low-risk early-stage patients with extranodal NK/T-cell lymphoma, nasal-type (ENKTCL). Methods: A total of 557 patients from 2000-2015 with low-risk early-stage ENKTCL who received radiotherapy (RT) with or without chemotherapy (CT) from China Lymphoma Collaborative Group were retrospectively reviewed. Among them, 427 patients received combined modality therapy, whereas 130 patients received RT alone. Survivals were calculated by Kaplan-Meier method and compared with Log-rank test. Overall survival (OS) was compared with age and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Cox stepwise regression model was used for multivariate analysis. Results: The 5-year OS and progression-free survival (PFS) were 87.2% and 77.2%. The SMR was 3.59 (P<0.001) at 1 year after treatment, whereas it was 1.50 at 4 years after treatment, without significant difference between ENKTCL group and country-matched general population (P=0.146). Compared with RT alone, CMT did not result in significantly superior 5-year OS (87.0% vs 87.4%, P=0.961) or PFS (76.1% vs 80.7%, P=0.129). Local failure (11.5%, 64/557) and distant failure (10.8%, 60/557) were the main failure modes, while regional failure was rare (2.9%, 16/557). The 5-year locoregional control rate (LRC) was 87.2% for the whole group, with 89.5% for ≥50 Gy versus 73.7% for <50 Gy (P<0.001). Radiotherapy dose was an independent factor affecting LRC(P<0.05). Conclusions: Radiotherapy achieves a favorable prognosis in patients with low-risk early-stage ENKTCL. The incidence of either locoregional or distant failure is low. Radiation dose still is an important prognostic factor for LRC.

[Analysis of chronic obstructive pulmonary disease screening questionnaire and pulmonary function test among migrant workers exposed to dust]

Objective: To analyze the application of Chronic Obstructive Pulmonary Disease (COPD) Screening Questionnaire and pulmonary function test in dust-exposed migrant workers. Methods: In May 2019, 149 cases of dust exposed migrant workers were selected as the research subjects through the free clinic in the countryside. COPD Screening Questionnaire and lung function test were carried out to analyze the high-risk groups and the influencing factors of positive pulmonary function test results. Results: Among 149 cases of dust-exposed migrant workers, 107 (71.8%) were positive for questionnaire screening, 73 (49.0%) were positive for pulmonary function test, 75 (50.3%) were diagnosed with coal worker's pneumoconiosis, and 101 (67.8%) were diagnosed with lung function injury. The positive rate of pulmonary function of migrant workers with positive questionnaire screening results was significantly higher than that of those with negative results (P<0.05) . The results of multivariate analysis showed that compared with non-pneumoconiosis, the risk of positive pulmonary function test results was higher in dust-exposed migrant workers with stage Ⅲ pneumoconiosis (OR=16.462, 95%CI: 3.390-79.946; P<0.01) . Compared with non-smoking, the risks of positive pulmonary function test results of dust-exposed migrant workers with smoking index of 11-20 package years and >20 package years were higher (OR=19.814, 95%CI: 3.854-101.883; OR=9.733, 95%CI: 2.310-41.008; P<0.01) . Conclusion: The risk of COPD in dust-exposed migrant workers is high, so we should strengthen the early examination of the high pneumoconiosis stage and smoking population. The screening questionnaire can better screen out the high-risk groups of COPD, and it can be used as a basic screening tool.

[Research of prognostic immunophenotypes in 163 patients of diffuse large B-cell lymphoma]

目的

筛选并分析与弥漫大B细胞淋巴瘤（DLBCL）预后相关的免疫表型，探究其预后价值。

方法

选取天津医科大学肿瘤医院2011年1月至2016年12月收治的163例DLBCL患者，免疫组织化学染色检测DLBCL常见免疫表型，COX模型探索独立于国际预后指数（IPI）影响总生存（OS）与无进展生存（PFS）的免疫表型，并分析其两两联合表达对预后的影响。

结果

多因素分析显示BCL6阴性（PFS：HR＝1.652，95％ CI 1.030～2.649，P＝0.037）、P53阳性（OS：HR＝1.842，95％ CI 1.008～3.367，P＝0.047）、BCL2强阳性（OS：HR＝2.102，95％CI 1.249～3.537，P＝0.005；PFS：HR＝2.126，95％ CI 1.312～3.443，P＝0.002）是DLBCL中独立于IPI的预后不良因素。亚组分析显示，在年龄≤60岁组患者中BCL6阴性（PFS：HR＝2.042，95％CI 1.021～4.081，P＝0.043）、P53阳性（OS：HR＝3.069，95％ CI 1.244～7.569，P＝0.015）和BCL2强阳性（OS：HR＝2.433，95％ CI 1.165～5.082，P＝0.018；PFS：HR＝3.209，95％CI 1.606～6.410，P＝0.001）对预后影响显著；在IPI 0～2分亚组患者中，BCL6阴性（OS：HR＝2.467，95％CI 1.322～4.604，P＝0.005；PFS：HR＝2.248，95％CI 1.275～3.965，P＝0.005）和BCL2强阳性（PFS：HR＝2.045，95％CI 1.119～3.735，P＝0.020）对预后影响显著。BCL6和BCL2强阳性的联合表达与DLBCL的预后相关（P＝0.005和P<0.001），BCL6阳性/BCL2非强阳性（86例）预后最好［3年OS率（71.6±4.9）％，3年PFS率（67.0±5.1）％］，BCL6阴性/BCL2强阳性（10例）预后最差［3年OS率（20.0±12.6）％，3年PFS率（10.0±9.5）％］；BCL6、P53的联合表达与DLBCL的预后差异无统计学意义（P＝0.061和P＝0.089），但生存曲线显示BCL6阳性/P53阴性的病例（98例）预后较好［3年OS率（70.6±4.7）％，3年PFS率（64.6±4.9）％］；BCL2强阳性、P53的联合表达与DLBCL的预后显著相关（P<0.001和P<0.001），BCL2强阳性/P53阳性的病例（5例）预后最差（3年OS率和PFS率均为0）；无论BCL6与P53表达如何，BCL2强阳性的病例预后均比非强阳性病例差。

结论

BCL6阴性、P53阳性、BCL2强阳性三种免疫表型单独及联合表达对DLBCL尤其是年龄≤60岁和IPI 0～2分患者的预后预测具有一定价值。

Transcriptome Sequencing Analysis of Chrysomyia Megacephala Pupae in Different Growing Periods

Abstract

Objective To study the growth regulation, environmental adaption and epigenetic regulation of Chrysomyia Megacephala pupae, in order to obtain the transcriptome data of Chrysomyia Megacephala in different growing periods, and lay the foundation for forensic application. Methods The Chrysomyia Megacephala was cultivated and after pupation, 3 pupae were collected every 24 h from pupation to emergence, and stored at -80 ℃ for later use. High-throughput sequencing was performed by Illumina Hiseq 4000 and Unigenes were obtained. The Unigenes were compared by comparison tool BLAST from NCBI in databases such as NR, STRING, SWISS-PROT （including Pfam）, GO, COG, KEGG in order to obtain the corresponding annotation information. The expression amount of Unigenes obtained by sequencing in Chrysomyia Megacephala in six different growing periods was calculated by FPKM method, and the discrepant genes were screened according to the following standards： the log₂ multiple absolute value of FPKM expression amount between two different growing periods must be larger than 1 （log₂|FC|>1）, and the false discovery rate must be less than 0.05. Results When the mean temperature was 25.6 ℃, Chrysomyia Megacephala emerged 6 d after they pupated. A total of 43 408 pieces of Unigenes were obtained and their mean length was 905 bp, of which 32 500, 18 720, 13 542, 9 191 and 18 720 pieces were annotated by NR, SWISS-PORT, Pfam, STRING and KEGG databases. According to the discrepant gene analysis of pupae in two different growing periods, the number of genes with variants ranged from 801 to 5 307, and the total number of discrepant genes was 45 676. Conclusion The gene expressions of the transcriptome data of Chrysomyia Megacephala pupae in different growing periods are different. The results provided a good foundation for further research on the transcriptome changes in each period of the pupae of sarcosaprophagous flies and provided the basis for exploring the genes associated with the growth of Chrysomyia Megacephala pupae.

[Expression of GATA3 and bcl-11b in peripheral T-cell lymphoma and their clinical significance]

Objective: To study the expression of GATA3 and bcl-11b in peripheral T-cell lymphoma (PTCL) and their correlation with clinicopathological features. Methods: The Oncomine and GEO databases were used for analyzing the expression levels of GATA3 and bcl-11b mRNA in PTCL. Immunohistochemistry was used to detect the expression of GATA3 and bcl-11b proteins in 127 cases of PTCL diagnosed at Shanxi Provincial Cancer Hospital from January 2010 to June 2020, as well as 40 cases of lymph node with reactive hyperplasia. Results: The data in Oncomine and GEO databases showed that the expression of GATA3 and bcl-11b mRNA in PTCL was lower than that in normal tissues (P<0.05). Immunohistochemistry showed that the positive rates of GATA3 in PTCL and lymph nodes with reactive hyperplasia were 60.6% (77/127) and 85.0% (34/40, P<0.05), respectively. The expression rates of bcl-11b in PTCL and lymph nodes with reactive hyperplasia were 55.1% (70/127) and 75.0% (30/40, P<0.05), respectively. The expression of GATA3 was related to the pathological classification of the patients with PTCL, and was inversely related to the Ann Arbor stage of the patient, while the expression of bcl-11b was inversely correlated with the IPI score of the patient (P<0.05). The expression of GATA3 and bcl-11b was related to the patients' age, gender, LDH level, and B symptoms. Other clinicopathological characteristics were irrelevant. Spearman correlation analysis shows that the expression of GATA3 protein was associated with that of bcl-11b protein in PTCL. Conclusion: GATA3 and bcl-11b are closely related to the prognosis of PTCL, and may be important factors involved in the occurrence and development of PTCL.

[A multicenter retrospective study on the etiology of necrotizing pneumonia in children]

Objective: To investigate the etiology of necrotizing pneumonia (NP) in children and the clinical characteristics of NP caused by different pathogens in China. Methods: A retrospective, case-control study was performed in children with NP who were admitted to 13 hospitals in China from January 2008 to December 2019. The demographic and clinical information, laboratory data, etiological and radiological findings were analyzed. The data were divided into three groups based on the following years: 2008-2011, 2012-2015 and 2016-2019, and the distribution characteristics of the pathogens in different period were compared. Meanwhile, the pathogens of pediatric NP in the southern and northern China were compared. And the clinical characteristics of the Mycoplasma pneumoniae (MP) NP and the bacterial NP were also compared. T-test or Mann-Whitney nonparametric test was used for comparison of numerical variables, and χ² test was used for categorical variables. Results: A total of 494 children with NP were enrolled, the median ages were 4.7 (0.1-15.3) years, including 272 boys and 222 girls. Among these patients, pathogens were identified in 347 cases and the pathogen was unclear in the remaining 147 cases. The main pathogens were MP (238 cases), Streptococcus pneumoniae (SP) (61 cases), Staphylococcus aureus (SA) (51 cases), Pseudomonas aeruginosa (13 cases), Haemophilus influenzae (10 cases), adenovirus (10 cases), and influenza virus A (7 cases), respectively. MP was the most common pathogen in all three periods and the proportion increased yearly. The proportion of MP in 2016-2019 was significantly higher than that in 2012-2015 (52.1% (197/378) vs. 36.8% (32/87), χ²=6.654, P=0.010), while there was no significant difference in the proportion of MP in 2012-2015 and that in 2008-2011 (36.8% (32/87) vs. 31.0% (9/29), χ²=0.314, P=0.575).Regarding the regional distribution, 342 cases were in the southern China and 152 in the northern China. Also, MP was the most common pathogen in both regions, but the proportion of MP was higher and the proportion of SP was lower in the north than those in the south (60.5% (92/152) vs. 42.7% (146/342), χ²=13.409, P<0.010; 7.9% (12/152) vs. 14.3% (49/342), χ²=4.023, P=0.045). Comparing the clinical characteristics of different pathogens, we found that fever and cough were the common symptoms in both single MP and single bacterial groups, but chest pain was more common (17.0% (34/200) vs. 6.1% (6/98), χ²=6.697, P=0.010) while shortness of breath and wheezing were less common in MP group (16.0% (32/200) vs. 60.2% (59/98), χ²=60.688, P<0.01; 4.5% (9/200) vs. 21.4% (21/98), χ²=20.819, P<0.01, respectively). The white blood cell count, C-reactive protein and procalcitonin in the bacterial group were significantly higher than those in the MP group (14.7 (1.0-67.1)×10⁹/L vs. 10.5 (2.5-32.2)×10⁹/L, 122.5 (0.5-277.3) mg/L vs. 51.4 (0.5-200.0) g/L, 2.13 (0.05-100.00) μg/L vs. 0.24 (0.01-18.85) μg/L, Z=-3.719, -5.901 and -7.765, all P<0.01). Conclusions: The prevalence of pediatric NP in China shows an increasing trend during the past years. MP, SP and SA are the main pathogens of NP, and the most common clinical symptoms are fever and cough. The WBC count, C-reactive protein and procalcitonin in bacterial NP are significantly higher than those caused by MP.

[Correlation between preoperative inflammatory biomarkers and postoperative pneumonia or long-term prognosis in patients with esophageal cancer after neoadjuvant therapy]

Objective: To examine the correlation between neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and neutrophil-monocyte ratio (NMR) for postoperative pneumonia or long-term overall survival in patients with esophageal cancer after neoadjuvant therapy. Methods: The clinical data of 137 patients, including 111 males and 26 females, with the age of (M(QR))61(10) years (range: 45 to 75 years), undergoing radical resection of esophageal cancer after neoadjuvant therapy admitted at Department of Thoracic Surgery, West China Hospital from January 2016 to May 2019 were analyzed retrospectively. The blood routine one or two days before surgery and the occurrence of pneumonia after surgery were collected via hospital information system. The absolute count of neutrophils, lymphocytes and monocytes was recorded, to calculate NLR, LMR and NMR. The survival of patients was recorded systematically via follow-up. In the first part, the influencing factors of postoperative inflammation were analyzed, to group the patients into two groups according to the occurrence of postoperative pneumonia. χ2 test, t-test or rank-sum test were conducted for inter-group comparison. In the second part, cutoff values of inflammatory biomarkers were obtained with the receiver operating characteristic (ROC) curve and grouped, with postoperative pneumonia as endpoint criteria. Independent factors correlated with postoperative pneumonia were determined through univariate and multivariate Logistic regression analysis. In the third part, the analysis on prognosis factors was carried on, with the survival as endpoint criteria. Cutoff values of inflammatory biomarkers were obtained with X-Tile software and grouped. The survival analysis was carried on with univariate and multivariate Cox proportional hazards regression model, and the Kaplan-Meier curve was drawn finally. The results of survival analysis were verified by Log-rank test. Results: Median follow-up time was 614 (299) days (range: 382 to 1 612 days). Cutoff values of NLR, LMR, and NMR obtained via the ROC curve were 3.0, 3.9, and 6.2, respectively. According to the multivariate Logistic regression analysis, NLR>3.0 (OR=2.740, 95% CI: 1.221 to 6.152, P=0.015) and LMR>3.9 (OR=0.140, 95% CI: 0.022 to 0.890, P=0.037) were independent prognosis factors for postoperative pneumonia in patients with esophageal cancer after neoadjuvant therapy. Cutoff values of NLR, LMR, and NMR obtained with X-Tile software were 3.3, 4.2, and 7.2, respectively. Through multivariate Cox proportional risk regression analysis, late tumor ypTNM staging (8th AJCC) (HR=2.087, 95% CI:1.079 to 4.038, P=0.029), poor pathologic response (HR=2.251, 95% CI: 1.117 to 4.538, P=0.023), and LMR>4.2 (HR=0.347, 95% CI: 0.127 to 0.946, P=0.039) could be independent prognosis factors for overall survival. Kaplan-Meier survival analysis indicated that the overall survival of patients with LMR ≤4.2 was worse (P=0.002), with the 1-year overall survival rate of 82.9%, and the 1-year overall survival rate of patients with LMR>4.2 was 94.6%. Conclusion: Preoperative LMR ≤3.9 and NLR>3.0 can be considered as independent prognosis factors for postoperative pneumonia, while LMR≤4.2 as one of independent prognosis factors for overall survival.

Association of improved overall survival with decreased distant metastasis following asparaginase-based chemotherapy and radiotherapy for intermediate- and high-risk early-stage extranodal nasal-type NK/T-cell lymphoma: a CLCG study

BACKGROUND

This study evaluated the survival benefit of asparaginase (ASP)-based versus non-ASP-based chemotherapy combined with radiotherapy in a real-world cohort of patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (ENKTCL).

PATIENTS AND METHODS

We identified 376 patients who received combined radiotherapy with either ASP-based (ASP, platinum, and gemcitabine; n = 286) or non-ASP-based (platinum and gemcitabine; n = 90) regimens. The patients were stratified into low-, intermediate-, and high-risk groups using the early stage-adjusted nomogram-revised risk index. Overall survival (OS) and distant metastasis (DM)-free survival (DMFS) between the chemotherapy regimens were compared using inverse probability of treatment weighting (IPTW) and multivariable analyses.

RESULTS

ASP-based (versus non-ASP-based) regimens significantly improved 5-year OS (84.5% versus 73.2%, P = 0.021) and DMFS (84.4% versus 74.5%, P = 0.014) for intermediate- and high-risk patients, but not for low-risk patients in the setting of radiotherapy. Moreover, ASP-based regimens decreased DM, with a 5-year cumulative DM rate of 14.9% for ASP-based regimens compared with 25.1% (P = 0.014) for non-ASP-based regimens. The survival benefit of ASP-based chemotherapy and radiotherapy remained consistent after adjusting the confounding variables using IPTW and multivariate analyses; additional sensitivity analyses confirmed these results.

CONCLUSIONS

The findings provided support for ASP-based chemotherapy and radiotherapy as a first-line treatment strategy for intermediate- and high-risk early-stage ENKTCL.

[Clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography in repairing skin and soft tissue defects around the knee or in proximal lower leg]

Objective: To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg. Methods: A retrospective cohort study was conducted. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal lower leg were admitted to the Department of Orthopedics of Jizhong Energy Xingtai Mig General Hospital, including 12 males and 5 females, aged 16-65 years, with an average age of 35 years. The areas of skin and soft tissue defects after debridement ranged from 6.0 cm×3.0 cm to 15.0 cm×9.0 cm. The retrograde anterolateral thigh perforator flaps were designed according to the origin and distribution of the perforating branches in flaps and the length of the vascular pedicle examined with CTA and the condition of the wound to repair the wounds. The areas of resected flaps ranged from 6.5 cm×3.5 cm to 15.5 cm×9.5 cm. The wounds in donor sites of flaps were sutured directly or covered with medium-thickness skin grafts from healthy upper leg. The sources of the perforating branches in flaps were recorded. The lateral circumflex femoral artery, its branches, and the relative length of the vascular pedicle were compared between preoperative CTA detection and intraoperative observation. The survivals of the flaps were observed. At the last follow-up, the effects of flaps in repairing wounds were evaluated according to evaluation standard of efficacy satisfaction; the motion ranges of flexion and extension of the knee joint were measured, and the knee joint function was evaluated according to the Hohl knee joint function evaluation standard; the sensory function in the flap area was evaluated according to the sensory function evaluation standard formulated by the British Medical Research Council; the wound healing and the occurrence of complication affecting motor function of limb of flap donor sites was observed. Data were statistically analyzed with paired sample t test. Results: The perforating branches in flaps originated from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery in 7, 6, and 4 patients, respectively. The flaps with blood supply from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery were type 1, 2, and 3 retrograde anterolateral thigh perforator flaps, respectively. The preoperative CTA examination of lateral circumflex femoral artery and its branches were consistent with those observed during operation. The relative lengths of vascular pedicles of type 1, 2, and 3 retrograde anterolateral thigh perforator flaps calculated after CTA examination were 0.32±0.13, 0.56±0.07, and 0.56±0.15, which were close to 0.35±0.12, 0.52±0.10, and 0.53±0.12 measured and calculated during operation, respectively (t=0.45, 0.80, 0.31, P>0.05). All flaps survived in 17 cases without vascular crisis. At the last follow-up, 16 patients were satisfied with effects of flaps in wound repair, with 1 patient feeling average about the effect; the flexion range of knee joint was 100-120°, and the extension range of knee joint was -2-0°; knee joint function was evaluated as excellent in 9 cases, good in 7 cases, and poor in 1 case; the sensory function of the flap area reached S₄ level in 2 cases, S₃ level in 8 cases, and S₂ level in 7 cases; the wounds in flap donor sites healed well; there was no adverse effect in motor function of limbs. Conclusions: Retrograde anterolateral thigh perforator flap is an effective method for repairing skin and soft tissue defects around the knee or in proximal lower leg. Preoperative CTA examination can fully show the anatomical characteristics of the branches of the lateral circumflex femoral artery and the perforating vessels of each branch, which can guide preoperative flap design and operation, thus shortening operation time and improving flap survival rate, with good clinical effects.

[Risk factors for mortality in pediatric acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support]

Objective: To explore the risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) requiring extracorporeal membrane oxygenation (ECMO) support. Methods: Clinical data of 109 patients with severe PARDS supported by ECMO, who were hospitalized in 6 ECMO centers in China from September 2012 to February 2020, were retrospectively analyzed. They were divided into survival group and death group according to the prognosis. Chi-square test and rank sum test were used to compare the variables between the two groups, including the demographic data, laboratory examination results, clinical data before and after ECMO, and other supportive treatment. Univariate and multivariate Logistic regression models were used to analyze the prognostic risk factors. Results: In these 109 cases, 54 died and 55 survived. Compared with the survival group, the death group had higher incidences of acute kidney injury (AKI) (48.1% (26/54) vs. 21.8% (12/55), χ²=8.318, P=0.004) and coagulation dysfunction (22.2% (12/54) vs. 7.3% (4/55), χ²=4.862, P=0.027), and higher rate of renal replacement therapy (48.1% (26/54) vs. 21.8% (12/55), χ²=9.694, P=0.008) during ECMO support. Logistic regression analysis showed that continuous renal replacement therapy (CRRT) and AKI were independent risk factors for death in patients with severe PARDS requiring ECMO support (HR=3.88,95%CI 1.04-14.52, HR=4.84,95%CI 1.21-19.46, both P<0.05). Conclusion: AKI and CRRT are independent risk factors for predicting mortality in patients with severe PARDS requiring ECMO support.

[Integrated management and prognosis analysis of fetus with complete transposition of the great arteries during pregnancy and perinatal period]

Objective: To investigate the prenatal diagnosis, integrated management and prognosis of fetal complete transposition of the great arteries (D-TGA) detected by ultrasonography. Methods: The prenatal diagnosis, integrated management and prognosis of 19 D-TGA fetuses found by ultrasound during pregnancy in Peking University People's Hospital from January 2014 to June 2019 were analyzed retrospectively. Results: The incidence of D-TGA was 0.12% (19/16 028) among fetuses diagnosed by ultrasound during 5 years. Among the 19 cases, there were 7 cases (7/19) of D-TGA alone, 7 cases (7/19) of D-TGA combined with ventricular septal defect (VSD), 5 cases (5/19) of D-TGA combined with other cardiac malformations; 2 cases (2/19) of D-TGA combined with extra cardiac malformations, and 1 case (1/19) of fetal growth restriction. Nuchal translucency (NT) thickening was found in 3 cases (3/19) at the first trimester of pregnancy. Among the 19 D-TGA fetuses found by ultrasound examination, 18 (18/19) had chromosome karyotype analysis of fetuses or newborns, and chromosomal abnormalities were found in 2 cases, all of which were terminated in the second trimester of pregnancy. The integrated management and multidisciplinary diagnosis and treatment of D-TGA fetuses during pregnancy and perinatal period were carried out. Nine cases (9/19) had induction in the second trimester of pregnancy, 10 cases (10/19) were delivered at term, and the gestational week of delivery was (38.3±0.7) weeks, among which 6 cases (6/10) were delivered by caesarean section due to obstetric factors, and 4 cases (4/10) were delivered by vaginal birth. The oxygen saturation was (69.2±11.3)% at birth and (77.8±6.7)% when transferred to the department of pediatrics. Except for one case lost to follow-up, the other 9 newborns received operation. The average operation time was (21.8±22.1) days after birth, 8 cases (8/9) completed one operation and 1 case (1/9) performed two operations. All of the 9 cases treated by surgery were followed up well. Conclusions: Prenatal diagnosis, individualized evaluation and integrated management during pregnancy and perinatal period should be carried out for the patients with fetal D-TGA detected by ultrasound. Fetal D-TGA is not an indication of cesarean section. The open of ductus arteriosus can be maintained with drugs when necessary after birth, and a good prognosis could be obtained through surgery.

[Clinicopathological characteristics of pulmonary artery intimal sarcoma]

Objective: To describe the clinicopathological features of pulmonary artery intimal sarcoma (PAIS), and to understand its molecular alterations. Methods: Sixty cases of pulmonary artery endarterectomy performed at the China-Japan Friendship Hospital, Beijing, China from January 2017 to January 2020 were reviewed. Clinical data of 5 patients with pulmonary artery intimal sarcoma were collected. Hematoxylin-eosin staining, immunohistochemistry staining and fluorescence in situ hybridization (FISH) were performed to evaluate the pathological features. RNA sequencing was conducted to assess the fusion gene changes in PAIS. Results: The detection rate of PAIS was 8.3% (5/60), with the median age of 49 years and a female predominance. Their clinical manifestations were non-specific. Histopathological examination showed that the tumors were composed of malignant spindle or epithelioid cells, with various degrees of atypia. Focal heterologous osteosarcomatous or leiomyosarcomatous differentiation was noted. The tumor cells could express PDGFRA, CDK4 and MDM2 with co-amplification of MDM2, CDK4 and EGFR genes. RNA sequencing detected multiple in-frame fusions in the tumors. Conclusions: PAIS is a rare, highly heterogeneous, and poorly-or un-differentiated sarcoma accompanied by complex changes of multiple genes.It has no known effective treatments, and thus has a poor prognosis.

[Analysis on the effect of sound insulation reconstruction in operation room of steel rolling production line in a steel plant]

Objective: To investigate the effect of sound insulation improvement on the noise exposure of workers in the operation room of hot rolling line for wide and heavy plate. Methods: From September 2019 to September 2017, based on the occupational health Survey, the data of 25 fixed operation rooms and workers in operation rooms of a steel rolling production line were collected retrospectively, the noise exposure levels before and after the improvement of sound insulation were statistically analyzed. Results: The noise exposure value of the workers, the qualified rate of 0 Grade 8 hours equivalent noise (L(EX, 8 h)) ≤85 dB (A) and the qualified rate of the design limit value of the operation room were all higher than those before the modification, the difference was statistically significant (P<0.01) , after the renovation, the Class II and above noise hazards were eliminated, the equivalent continuous a sound level (L(Aeq, 8 h)) >75 dB (A) of the workers in the operation room was 8h, and the noise level in the operation room still did not meet the Ergonomics limit standard. Conclusion: The improvement of sound insulation can effectively improve the working environment of noise workplace operating room and reduce the workers'noise exposure level.

[A cohort study on the correlation between body mass index trajectories and new-onset non-alcoholic fatty liver disease]

Objective: To explore the correlation between the body mass index (BMI) trajectories and new-onset non-alcoholic fatty liver disease (NAFLD) so as to provide a scientific basis for the prevention and treatment of NAFLD. Methods: A total of 16388 observation subjects that met the inclusion criteria in the Kailuan study were used to form a cohort study. According to the BMI values of the observed subjects during annual physical examinations from 2006 to 2007, 2008 to 2009 and 2010 to 2011, SAS Proc Traj was used to determine four different BMI trajectories groups, namely, the low-stable medium-stable, medium-high and high-stable group. NAFLD incidence in each group was followed up during annual physical examinations from 2012 to 2013, 2014-2015 and 2016-2017. A total of 14998 observation subjects were finally included in the statistical analysis. The cumulative incidences of NAFLD differences in the four groups were compared. The Cox's proportional hazards regression model was used to analyze the correlation between different BMI trajectories and new-onset NAFLD. One-way analysis of variance was used to compare the intergroup difference of measurement data, and pairwise comparisons were conducted. LSD test was used for the homogeneity of variance. Dunnett's T3 test was used for heterogeneity of variances. χ (2) test was used to compare the count data, and the difference of NAFLD cumulative incidence rate between the different BMI trajectories groups was compared by log-rank test. Results: (1) the cumulative incidence of NAFLD was increased with the increase of BMI trajectories, which were 31%, 47%, 63%, 77%, respectively, and the difference was statistically significant (P < 0.01). (2) after adjusting for multiple confounding factors such as age and gender with the Cox's proportional hazards regression model, the risk of NAFLD in the BMI medium stable, medium-high, and high stable group was still 1.757 times [95% confidence interval (CI): 1.589 ~ 1.942], 2.612 (95%CI: 2.353 ~ 2.900), 3.566 (95%CI: 3.129 ~ 4.064) of the low-stable group (P < 0.01). Conclusion: The risk of NAFLD increases with increase of BMI trajectories, and long-term high levels of BMI are independent risk factors for the onset of NAFLD.

[Preliminary clinical observations of retina injury in alkaline ocular trauma patients]

Objective: To investigate the features of the full-field electroretinogram (FERG) in patients with ocular surface alkaline injury, and to clarify the clinical significance of FERG examination in alkaline ocular trauma. Methods: Retrospective series of case study. A total of 22 patients with chemical ocular surface injury who were treated in the Department of Ophthalmology of Peking University Third Hospital from May 2018 to January 2020 were selected, including 20 males (25 eyes) and 2 females (2 eyes). The age ranged from 19 to 60 years old (average, 41). There were 17 eyes with alkaline ocular trauma, 7 eyes with thermal burn, and 3 eyes with acid ocular trauma. Seventeen contralateral healthy eyes in patients with unilateral mechanical trauma were used as controls. Fourteen alkaline trauma eyes with visual acuity records were further observed according to the degree of visual impairment. All patients were subjected to different flash intensity stimuli in accordance with a standard of the International Society for Clinical Electrophysiology of Vision for dark-adapted and light-adapted full-field FERG. One-way ANOVA and SNK-q was used for the comparison between groups. The unpaired t test was used for the comparison of patients with different vision. Results: Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG b-wave under the dark stimulation of 0.01 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (135±85), (169±55), and (112±43) versus (341±53) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=31.38; q=8.94, 5.70， 5.45；all P<0.01). Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG a-wave under the dark stimulation of 3.00 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (178±78), (172±35), and (99±53) versus (334±60) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=24.33; q=7.04， 5.60， 5.80；all P<0.01). Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG b-wave under the dark stimulation of 3.00 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (354±79), (342±77), and (352±201) versus (600±78) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=27.68; q=8.11， 6.51， 4.48； all P<0.01). Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG OPs under the dark stimulation of 3.00 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (97±54), (107±41), and (45±22) versus (206±32) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=25.03; q=7.36， 5.13， 5.96； all P<0.01).There was no significant difference in FERG between patients with visual acuity≥0.2 and those with visual acuity<0.2 (P>0.05) after alkaline ocular trauma. Conclusions: By detecting the amplitude change of FERG wave form of chemical ocular trauma, in this study, the amplitude of FERG wave form in alkaline ocular trauma was generally decreased. It's suggested that alkaline ocular trauma can cause damage to the rod and cone systems of retinal. (Chin J Ophthalmol, 2020, 56: 514-518).

[Prediction of KCNQ4gene polymorphism varies with CNE or noise exposure duration on the Risk of NIHL-Cox model analysis based on cohort study]

Objective: The purpose of this study was to explore the association between gene in the potassium recycling pathway 4 (KCNQ4) polymorphisms and the susceptibility to noise-induced hearing loss (NIHL) , and analysis the effect of cumulative noise exposure (CNE) and noise exposure duration on this association. Methods: A nested case-control study with 1∶1 matched was used based on the cohort of noise exposure in a steel factory. A total of 286 cases were selected as the group of hearing loss and 286 controls were chosen according to the matching standards of same gender, same type of work, age difference ≤ 5 years, noise exposure duration ≤ 2 years. The single nucleotide polymorphisms (SNPs) of rs4660468, rs4660470, rs34287852 in KCNQ4 were genotyped by SNPscan(TM) method. The codominant, dominant and recessive models were established to study KCNQ4 polymorphisms and the susceptibility to NIHL by single-factor conditional logistic regression analysis. The COX regression analysis was used to analyze the risk of developing NIHL in individuals with different genotypes along with the extending of noise exposure duration or CNE. Results: In the case of CNE≤96 dB (A) ·year, the risk of developing NIHL in individuals with TA genotype of rs4660470 was 2.197 times than individuals with TT genotypes (95%CI: 1.032~4.677) , and those with TA+AA and TT genotypes (HR=2.467, 95%CI: 1.025~5.934) With the increase of noise exposure duration, in rs4660470, individuals with TA genotype had a higher risk of suffering NIHL than those with TT genotype (HR=1.461, 95%CI: 1.061~2.011) , individuals with TA and/or AA genotype had a earlier risk of suffering NIHL than those with TT genotype. Conclusion: The mutant allele A of rs4660470 in KCNQ4 may be a risk factor for developing NIHL, CNE≤100 dB (A) ·year or the increase of noise exposure duration may further increase the risk of NIHL.