Detection of blaKPC and blaNDM genes by duplex PCR with lateral flow dipsticks from sterile body fluid samples

Duplex polymerase chain reaction with lateral flow dipsticks (duplex PCR-LFD) was developed for the simultaneous detection of beta-lactamase Klebsiella pneumoniae carbapenemase (bla_KPC ) and beta-lactamase New Dehli metallo-beta-lactamase (bla_NDM ) genes in body fluid samples. This method was validated using well-characterized isolates. The assessment of the specificity of duplex PCR-LFD showed that there was no cross-reactivity with other targets. The detection limit of the duplex PCR-LFD assay was 20 CFU per ml for bla_KPC and bla_NDM . Among 177 sterile body fluid samples tested by the duplex PCR-LFD assay, 40 were bla_KPC -positive and five were bla_NDM -positive. The results obtained from 122 corresponding Gram-negative bacteria which were isolated from these clinical samples and tested by duplex PCR-LFD assay showed that there were 37 strains carrying bla_KPC genes in 40 bla_KPC -positive samples and three strains carrying bla_NDM genes in five bla_NDM -positive samples. Statistical analysis indicated that there was no significant difference between the direct detection of bla_KPC and bla_NDM genes in clinical sterile body fluid samples and their corresponding clinical isolates. Therefore, duplex PCR-LFD can be effective for the simultaneous detection of bla_KPC and bla_NDM in clinical isolates and directly from clinical samples, which may be helpful for the administration of appropriate antimicrobial treatment.

Development of a Screening Tool for Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: Pediatric PainSCAN

OBJECTIVE

Neuropathic pain (NP) and complex regional pain syndrome (CRPS) in children can result in significant disability and emotional distress. Early assessment and treatment could potentially improve pain, function, quality of life, and reduce costs to the health care system. Currently, there are no screening tools for pediatric NP and CRPS. This research aimed to develop and establish the content validity of a screening tool for pediatric NP and CRPS using a phased approach.

MATERIALS AND METHODS

Phase I surveyed clinical experts using a modified Delphi procedure to elicit disease concepts for inclusion. In phase II, a consensus conference including clinicians, researchers, and people with lived experience, informed the initial item pool. Consensus for item inclusion was achieved using a nominal group technique for voting. Phase III used iterative rounds of cognitive interviews with children aged 8 to 18 years with CRPS or NP to evaluate the tool's comprehensiveness and individual item relevance and comprehensibility. Descriptive statistics were used to describe participant characteristics. Content analysis was used to analyze patient interviews.

RESULTS

Phase I (n=50) generated an initial item pool (22 items). Phase II generated a comprehensive item pool (50 items), after which an initial version of the screening tool was drafted. Following phase III (n=26) after item revision and elimination, 37 items remained.

DISCUSSION

The Pediatric PainSCAN is a novel screening tool that has undergone rigorous development and content validity testing. Further research is needed to conduct item reduction, determine scoring, and test additional measurement properties.

[Genomic investigation of human Streptococcus suis infection in Shandong Province]

To investigate Streptococcus suis (S.suis) isolated from patients in Shandong province using genomic epidemiology and pathogenologic analysis. To provide the foundation to establish reasonable and accurate prevention and control measures of human S. suis infection. Molecular typing, whole genome phylogenetic tree, virulence gene typing, antibiotic resistance profile and mobile genetic elements carrying antibiotic resistance genes of isolated S. suis strains were investigated. The pathogenicity of isolated strains was also evaluated by comparing their capacity to induce pro-inflammatory cytokine production in vitro. S. suis infections in Shandong province were predominantly due to serotype 2 and sequence type 1 strains. The major symptoms were meningitis. The studied strains could be divided into five lineages. All strains belong to highly pathogenic type in Shandong province,Strains from lineage 2 possessed higher capacity to stimulate pro-inflammatory cytokine production than other strains did, even though other strains belong to highly pathogenic strains. In addition, multiple antibiotic resistance genes and corresponding mobile genetic elements werewidespread in S. suis strains from Shandong province, except strains from lineage 3. High diversities in genome, evolutionary path and pathogenicity of S. suis strains from Shandong province were revealed. It was necessary to surveillant the S. suis strain in genomic level.

[Survival analysis of silicosis patients in Wuxi City]

Objective: To analyze the living condition and influencing factors of silicosis patients in Wuxi City form 1975 to 2019. Methods: Through the monitoring of death causes of residents, the paper-based materials and online report system of diagnosis over the years, and the combination of public security and human social system to obtain 3721 cases of silicosis patients as subjects form August to December 2019. And the combination of Kaplan Meier method and life table method were used to carry out single factor survival analysis. Through Cox regression model to analyze the factors affecting the survival time of patients. Results: From 1975 to 2019, 3721 cases of silicosis and 1274 deaths have been reported in Wuxi City, with a mortality rate of 34.24% and a median survival time of 30.9 years. With the development of diagnosis time, the mortality decreased significantly (χ(2)=747.75, P<0.05) . Compared with the first stage silicosis patients, the risk of decreased survival time of the third stage silicosis patients increased (HR=1.486, P<0.05) . Compared with the non-smoking patients, the risk of decreased survival time of the smoking patients increased (HR=1.136, P<0.05) . Compared with the patients who were less than 30 years old, the risk of decreased survival time of patients with 40-49 years old, 50-59 years old and more than 60 years old were increased (HR=9.641, 13.650, 26.794, P<0.05) . Compared with the patients who received industrial and commercial insurance, the risk of decreased survival time of patients who received compensation from employers, basic medical insurance for urban and rural residents, other social compensation and no compensation were increased (HR=3.137, 3.119, 5.129, 8.442, P<0.05) . Conclusion: The survival time of silicosis patients is related to the stage of silicosis, smoking condition, age of onset and social compensation. We should focus on controlling the above risk factors so as to improve the quality of life of patients and prolong their lives.

Inactivation of lncRNA HOTAIRM1 caused by histone methyltransferase RIZ1 accelerated the proliferation and invasion of liver cancer

OBJECTIVE

Liver cancer is the second most common cause of cancer death, causing more than 700,000 deaths every year. It has been demonstrated that Long non-coding RNA (LncRNA) plays an important regulatory role in a series of diseases. However, the regulatory mechanism of LncRNAs in liver cancer has not been fully elucidated. The purpose of this study was to explore the interaction of lncRNA HOTAIRM1 and aberrant histone modification in liver cancer.

MATERIALS AND METHODS

qRT-PCR was used to detect the expression levels of RIZ1 and miR-125b in liver cancer cells. Cell proliferation was measured using the CCK8 assay. ChIP-Real-time PCR confirmed the binding site of the promoter of HOTAIRM1 by H3K9me1. The direct target of HOTAIRM1 and miR-125b in liver cancer cells was measured by a luciferase reporter assay. Cell proliferation was detected by Cell Counting Kit-8 (CCK8). Cell invasion was measured by transwell assays and cell migration was detected by wound healing assay.

RESULTS

The expression level of RIZ1 and miR-125b was upregulated, and HOTAIRM1 was downregulated in liver cancer cells. Transwell and CCK-8 assay showed that RIZ1 expression is associated with the proliferation, invasion and migration of liver cancer cells, silencing of RIZ1 inhibited cell proliferation, migration, and invasion in HEPG2 and HCC-LM3 cells. RIZ1 interference could significantly inhibit H3K9me1 expression. H3K9me1 protein can bind to HOTAIRM1 promoter directly. Furthermore, the bioinformatics prediction and luciferase assay demonstrated that miR-125b can interact with HOTAIRM1 by direct binding. HOTAIRM1 down-expression promoted HEPG2 cell growth and metastasis, which was further strengthened following the co-transfection of miR-125b. Furthermore, overexpressed HOTAIRM1 inhibited HCC-LM3 cell growth and metastasis and a complete reversal of the results seen when transfected with miR-125b.

CONCLUSIONS

For the first time, we found that RIZ1 was upregulated in liver cancer cells and RIZ1-mediated H3K9me1 enrichment on the HOTAIRM1 promoter regulated the growth and metastasis of liver cancer cells by targeting miR-125b, which could further accelerate tumor proliferation, migration and invasion. It may serve as a therapeutic marker for liver cancer treatment.

[Comparison of different reconstruction procedures after distal gastrectomy in patients with gastric cancer]

Objective: To systematically compare the effect of Roux-en-Y with Billroth Ⅰ or Billroth Ⅱ in gastric cancer patients after distal gastrectomy by meta-analysis. Methods: Systematic search was conducted on the relevant electronic databases of Pubmed, Embase, Wanfang Database, CNKI and VIP from the established time to August 18, 2019. The randomized controlled trials about comparison of Roux-en-Y with Billroth Ⅰ or Billroth Ⅱ were strictly screened and analyzed by the software of Revman 5.3. Procedure and postoperative outcomes were analyzed, respectively. Results: A total of 783 relevant literatures were systematically retrieved, and 6 randomized controlled trials, including 954 patients, finally met the inclusion criteria after strict screening. The results of meta-analysis showed that operative time of Billroth Ⅰ was significantly shorter than that of Roux-en-Y (MD=-37.60, 95%CI:-50.79--24.40, P<0.001), intraoperative bleeding (MD=-21.64, 95%CI:-32.20--11.07, P<0.001) and the number of delayed gastric emptying (RR=0.52, 95%CI: 0.31-0.86, P=0.01) of Billroth Ⅰ were both significantly less than those of Roux-en-Y, while bile reflux (RR=8.17, 95%CI: 2.21-31.53, P=0.002) and residual gastritis (RR=1.75, 95%CI:1.43-2.14, P<0.000 01) of Billroth Ⅰ were both significantly higher than those of Roux-en-Y, other outcomes showed no significant difference. Compared with Roux-en-Y, operative time of Billroth Ⅱ was significantly shorter (MD=-19.73, 95%CI:-32.82--6.64, P=0.003), while bile reflux (RR=17.63, 95%CI: 4.50-69.02, P<0.001), residual gastritis (RR=1.94, 95%CI:1.15-3.26, P=0.01) and reflux esophagitis (RR=3.13, 95%CI: 1.31-7.45, P=0.01) of Billroth Ⅱ were all significantly higher, and there was no significant difference in other outcomes. Conclusion: Compared with Billroth Ⅰ and Billroth Ⅱ, the operation time of Roux-en-Y in gastric cancer patients undergoing distal gastrectomy is longer, but the incidences of bile reflux and residual gastritis are both lower, and the postoperative quality of life seems better.

Predicting non-elective hospital readmission or death using a composite assessment of cognitive impairment and frailty in elderly inpatients with cardiovascular diseases

Background

Cardiovascular disease (CVD) and related complications are significant healthcare problems in the growing elderly population. Metabolic factors are the predominant risk factors for CVD, sedentary behaviour and physical inactivity are major modifiable risk factors for CVD. Age-associated cognitive decline and impairment are associated with an increased mortality. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for CVD. There is a clinical need to identify more practical screens that can assist us to definite cognitive impairment and physical frailty, then to determine which patients with CVD are at high risk of adverse outcomes, early management of these high-risk patients can reduce readmission rates, healthcare spending, and improve quality of care.

Purpose

We aimed to assess the utility of a combination developed using the mini-mental state examination + clock drawing test and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD.

Methods

A single center prospective cohort was conducted between September 2018 and February 2019. Inpatients aged 65 years or older were recruited. All enrolled patients received a comprehensive geriatric assessment during hospitalization. The Kaplan-Meier curves were used to estimate the cumulative incidence of events. The multivariate Cox regression model was used to analyze the association between frailty and cognitive status and the non-elective hospital readmission or death.

Results

A total of 542 patients were included; and a total of 113 patients (20.9%) died or were readmitted at 6-month. Overall 20% screened positive for cognitive impairment, including 8% were cognitive impairment combined with physical frailty, which were more older, more common in women and non-married group, had a lower education and a higher risk of malnutrition. Frail participants with normal (hazard ratio [HR]: 1.73, 95% confidence intervals [CI]: 1.06–2.82, P=0.028) and impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients, after adjustment for age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and previous stroke.

Conclusions

The presence of physical frailty and cognitive frailty were powerful predictors of non-elective hospital readmission or death in elderly inpatients with CVD, and taking cognitive impairment into account in the frailty model may allow better prediction of adverse outcomes of frailty in the short time.

Kaplan-Meier survival curves

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Beijing Municipal Science & Technology Commission, Chinese Academy of Medical Sciences

Correlation between COX-2 gene polymorphism and susceptibility to nasopharyngeal carcinoma

OBJECTIVE

The aim of this study was to investigate cyclooxygenase-2 (COX-2) gene polymorphism in peripheral blood cells of patients with nasopharyngeal carcinoma (NPC) and normal people, and to explore the correlation between polymorphism and the occurrence of NPC.

PATIENTS AND METHODS

The genotype and allele distributions of gene loci COX-2-899 (G/C) and COX-2-1195 (G/A) in peripheral blood of 56 normal people and 114 NPC patients were analyzed via reverse transcription-polymerase chain reaction (RT-PCR). The genetic equilibrium was detected by TaqMan genotyping technique. Meanwhile, the risk factors for NPC were analyzed via multivariate logistic regression analysis. Subsequently, the effects of risk factors, clinical features, and gene polymorphism of NPC on the prognosis and survival of patients were analyzed using univariate and multivariate COX regression analysis. Finally, the correlation of smoking, Epstein-Barr (EB) virus infection and COX-2-1195 gene polymorphism with NPC was explored via χ2-test.

RESULTS

There was a significant difference in the genotype and allele distributions at COX-2-1195 (G/A) between the two groups (p<0.05). However, no significant differences were observed at COX-2-899 (G/C) between the two groups (p>0.05). According to the results of univariate and multivariate COX regression analysis, smoking and EB virus infection were risk factors for NPC (p<0.05). The χ2-test indicated that there was an evident gene polymorphism at COX-2-1195 in smokers and EB virus-infected people compared to non-smokers and non-infected people (p<0.05).

CONCLUSIONS

COX-2-1195 gene polymorphism is associated with susceptibility to NPC. Smoking and EB virus infection are major risk factors for NPC, both of which can affect COX-2-1195 gene polymorphism.

Volcanic origin for Younger Dryas geochemical anomalies ca. 12,900 cal B.P

The Younger Dryas (YD) abrupt cooling event ca. 12.9 ± 0.1 ka is associated with substantial meltwater input into the North Atlantic Ocean, reversing deglacial warming. One controversial and prevailing hypothesis is that a bolide impact or airburst is responsible for these environmental changes. Here, highly siderophile element (HSE; Os, Ir, Ru, Pt, Pd, and Re) abundances and 187Os/188Os ratios were obtained in a well-dated sediment section at Hall's Cave, TX, USA to test this hypothesis. In Hall's Cave, layers below, above, and in the YD have 187Os/188Os ratios consistent with incorporation of extraterrestrial or mantle-derived material. The HSE abundances indicate that these layers contain volcanic gas aerosols and not extraterrestrial materials. The most likely explanation is that episodic, distant volcanic emissions were deposited in Hall's Cave sediments. Coupled 187Os/188Os ratios and HSE concentration data at close stratigraphic intervals are required to effectively differentiate between bolide and volcanic origins.

[Iodine status of vulnerable populations in Henan Province of China three years after the implementation of new iodized salt standard]

Iodine nutrition surveillance of vulnerable population was conducted in 18 cities of Henan Province in 2015. The medians and quartiles of urinary iodine concentration in women of reproductive-age (n=3 318), pregnant women (n=36 366), lactating women (n=4 153), infants <2 years of age (n=1 017), and children aged 8-10 years (n=4 806) were 202.1(124.0, 310.0), 192.4(133.6, 262.4), 168.3(119.1, 248.3), 214.2(156.1, 272.3) and 90.0 (121.8, 285.6) μg/L, respectively. Iodine status of the vulnerable populations was generally regarded as adequate in Henan Province. But the median of urinary iodine concentration of reproductive-age women were slightly above the adequate level. The proportions above iodine adequate level were 26.7% in reproductive-age women, 29.4% in pregnant women and 22.5% in children aged 8-10 years.

Experience of pediatric urogenital tract inserted objects: 10-year single-center study

INTRODUCTION

Urogenital tract foreign bodies (FBs) have been rarely reported in children, and the management is still challenging.

OBJECTIVE

The aim of this study is to review a 10-year experience with urogenital tract FBs in a single center.

PATIENTS AND METHODS

The authors reviewed the records of children suspected with urogenital tract FBs and first admitted to the hospital, including demographic characteristics, presenting symptoms, methods of diagnosis, and management. The authors compared the surgery strategies in different locations of FBs and age, and the locations of FBs in different age groups.

RESULTS

Two hundred and thirty-nine cases were reviewed, and 188 were confirmed to retain urogenital tract FBs (150 girls and 38 boys). The number of the patients increased progressively in the last 10 years and mainly concentrated in spring and summer in the last 4 years. The peak ages were 3-5 years old and 9-13 years old. General anesthesia surgeries were performed on 20 patients (Fig. 1). Vagina FBs were more likely to require day surgery, whereas bladder FBs required surgery in hospital. Patients younger than 6 years were more likely to be girls with vagina FBs, and patients older than 11 years were more likely to be boys with bladder FBs.

DISCUSSION

Urogenital tract FBs in children is a great challenge. As the vagina is shorter and wider than the urethra, girls with vagina FBs are usually treated by day surgery and adolescent boys of urethra FBs are treated by hospital surgery. Misdiagnosis may occur when patients conceal FBs insert history, have severe urinary tract infections, or have previous surgery history. Ultrasonography helps to reduce misdiagnosis. FBs should be taken into consideration when patients have new symptoms after hypospadias repair, and postoperative changes of hypospadias repair, such as urinary calculi, have been excluded. Appropriate surgery techniques, based on the size, nature, and location of FBs, should be performed for complete removal of FBs with minimal complications to reduce secondary injury. Sharp FBs could be migrated among the digestive system, urogenital system, and deep pelvic. If the procedure is difficult, patients with a stable needle can be conservatively managed with close follow-up. Nevertheless, symptomatic patients should be treated actively.

CONCLUSION

The awareness of potential severity of pediatric urogenital tract FBs should be raised. Appropriate toys and timely sex education help prevent children from urogenital tract FBs insertion. Selecting appropriate techniques for particular situations is the best way to reduce secondary injury, especially for cases with migrated FBs (needles), magnetic FBs, and postoperative FBs.

Ewing sarcoma/primitive neuro-ectodermal tumor of the urogenital system in children: a retrospective observational case series

INTRODUCTION

Pediatric Ewing sarcoma (ES)/primitive neuro-ectodermal tumor (PNET) occurring in the genitourinary system has been rarely reported. And the result of long-term follow-up is still a matter of debate.

OBJECTIVE

The aim of the study was to identify the characteristics, therapeutic strategies, and long-term outcomes of pediatric ES/PNET in the genitourinary system.

PATIENTS AND METHODS

All children with genitourinary system PNET from a single center were retrospectively reviewed. The American Joint Committee on Cancer (AJCC) staging system was used to evaluate tumor grade.

RESULTS

Four patients were included. Three were boys, and 1 was a girl. The locations of the lesions were the penis in 1 patient, ureter in 1 patient, and kidney in 2 patients. Two patients were of AJCC stage IVB, and the other 2 patients were of stage IIA. In the follow-up ranging from 2.5 to 8.0 years, 3 patients had survival, and 1 patient died. The patient with penis PNET survived during the 8 years of follow-up. One patient with renal PNET had tumor thromboses in the renal vein, inferior vena cava, and right atrium, which was the first definite report in children (case 3).

DISCUSSION

Primitive neuro-ectodermal tumor as a highly malignant subgroup of blue round cell tumor is extremely rare in the genitourinary system, especially in children. The current case series represents the first report of penis PNET in children with the longest (8 years) follow-up and first definite report of pediatric renal PNET with vena cava and atrium tumor thrombus. In contrast to the previous literature, the patient with ureteral PNET in this study was much younger, who was the youngest child to be reported in the literature thus far. Although the key prognostic factor of the outcomes is detectable metastases at diagnosis, the patient with penis PNET and bone and lung metastasis in this series still survived. It was hypothesized from the data of present cases that young age was a protective factor, which was consistent with the previous literature. Aggressive therapy is not trivial for patients with multiple recurrences who can also be a long-term survivor. The survival outcomes of these high-stage patients were favorable with combination treatment. As the patient with penis PNET in this series had bone metastasis at his 7.5 years after definite diagnosis, five years of follow-up was not enough. The follow-up period should be extended, even to a lifetime follow-up.

CONCLUSIONS

Children with PNET have a better prognosis than adults. Aggressive combination treatment should be performed to improve prognosis and the survival rate. It is better to monitor the changes of the disease by extending the follow-up period.

Disposition kinetics of orbifloxacin in tissues of crucian carp (Carassius auratus) following a single intramuscular administration

BACKGROUND

Orbifloxacin is being widely used in China to treat fish infections in an extra-label manner, which may cause its potential residues in edible tissues.

AIMS

The purpose of this study was to determine the disposition kinetics of orbifloxacin in crucian carp (Carassius auratus) following intramuscular administration for its further safe application in aquaculture industry.

METHODS

Tissue samples of skin, muscle, kidney, and liver were collected from six crucian carps reared at 25°C at 5, 10, 15, 30, 45 min, 1, 2, 4, 6, 12, 24, 48, 72, and 96 h following a single intramuscular injection at 7.5 mg/kg body weight (BW). The orbifloxacin concentrations in tissues were determined using a high-performance liquid chromatography (HPLC) method with a fluorescence detector, then average concentrations versus time data were subjected to non-compartmental analysis to obtain the kinetic parameters.

RESULTS

The peak concentration of 5.68 ± 0.03 µg/g was calculated in kidney at 2 h, followed by muscle (5.51 ± 0.01 µg/g) at 4 h, liver (4.84 ± 0.20 µg/g) at 2 h, and skin (4.27 ± 0.08 µg/g) at 4 h. Area under concentration-time curve was calculated as 79.22, 94.72, 118.65, and 129.02 h·µg/g in kidney, liver, skin, and muscle, respectively. And the elimination half-lives were determined as 18.17, 18.41, 18.77, and 19.11 h in skin, kidney, muscle, and liver, respectively.

CONCLUSION

It was shown that orbifloxacin was well distributed into tissues while relatively slowly eliminated in crucian carp reared at 25°C following a single intramuscular injection.

[Association between hyponatremia and hemodynamic and prognosis in patients with intermediate-risk acute pulmonary embolism]

Objective: To investigate the association between hyponatremia and hemodynamic and prognosis in patients with intermediate-risk acute pulmonary embolism. Methods: We retrospectively recruited 110 intermediate-risk acute pulmonary embolism patients (right ventricular dysfunction was confirmed by echocardiography and CT scan with or without the elevated levels of cardiac injury biomarkers) in the first and the second affiliated hospital of Harbin medical university from January 1,2011 to December 31, 2014. The patients were aged (58.4±14.9) years old.There were 49 males and 61 females.Patients were divided into 2 groups as non-hyponatremia group (plasma sodium>135 mmol/L, 93 cases) and hyponatremia group (plasma sodium≤135 mmol/L, 17 cases). Baseline clinical and hemodynamic parameters were obtained from these patients. All enrolled patients were followed up after discharge. Results: Heart rate ((106.7±21.9) beats per minute vs. (93.4±19.4) beats per minute, P=0.043),N-terminal pro B type natriuretic peptide (NT-proBNP, (5 561±1 593) ng/L vs. (1 738±589) ng/L, P=0.005), mean pulmonary arterial pressure((42.6±12.6)mmHg(1 mmHg=0.133 kPa) vs. (33.9±13.3)mmHg, P=0.046), mean right atria pressure ((20.6±8.1)mmHg vs. (10.2±5.4)mmHg, P=0.014), systolic right atria pressure ((27.3±9.0)mmHg vs. (15.6±6.1)mmHg,P=0.013) and diastolic right atria pressure(6.5(4.3,15.5)mmHg vs. 5.0(2.0,8.0)mmHg,P=0.016) were significantly higher in hyponatremia group than in non-hyponatremia group,and systolic blood pressure was significantly lower in hyponatremia group than in non-hyponatremia group ((113.5±21.9)mmHg vs.(129.5±28.9)mmHg, P=0.048). Pearson correlation analysis showed that hyponatremia was negatively correlated with heart rate (r=-0.262, P=0.043), NT-proBNP (r=-0.227, P=0.048), mean pulmonary arterial hypertension (r=-0.259, P=0.046), mean right ventricular pressure (r=-0.296, P=0.047), mean right atria pressure (r=-0.550, P=0.001), systolic right atria pressure (r=-0.552, P=0.001), and diastolic right atria pressure (r=-0.542, P=0.001). Kaplan-Meier survival analysis showed that the 1-year, 2-year and 3-year cumulative survival rates were 76.5%,70.6%,and 64.7% in the hyponatremia group, and 90.3%,86.0%,and 83.9% in the non-hyponatremia group(log-rank test, P=0.036).Multivariate Cox regression analysis showed that hyponatremia was an independent risk factor of death of intermediate-risk pulmonary embolism patient(HR=4.126, 95%CI 1.982-11.343, P=0.036). Conclusion: Hyponatremia is associated with adverse hemodynamic and reduced survival in patients with intermediate-risk pulmonary embolism.

[Clinical relevance of common inhibitory immune checkpoint genes in esophageal squamous cell carcinoma]

Objective: To analyze the potential clinical relevance of inhibitory immune checkpoint genes, including PD1, PD-L1, CTLA4, LAG3 and TIM3 in esophageal squamous cell carcinoma (ESCC). Methods: Expression were extracted from mRNA microarray data from 119 paired ESCC and adjacent normal tissues, which were collected from National Cancer Center/Chinese Academy of Medical Sciences between December 2005 and December 2007.Differential expression analyses and survival analyses were then performed to identify potential clinical relevance using R software. Results: Expression of PD-L1, CTLA4, LAG3 and TIM3 were significantly upregulated in ESCC tissues compared with adjacent normal tissues (P<0.05). CTLA4 was significantly correlated with tumor location and age (P<0.05). PD1 and LAG3 were significantly associated with overall survival and were favorable prognostic factors in ESCC. Conclusions: Inhibitory immune checkpoint genes are commonly overexpressed in ESCC and are significantly associated with patients overall survival.These results provide important references in the application of immune checkpoints therapy in ESCC.