[Typical case analysis of COVID-19 cluster epidemic in Shaanxi, 2020]

Objective: By analyzed the transmission patterns of 4 out of the 51 COVID-19 cluster cases in Shaanxi province to provide evidences for the COVID-19 control and prevention. Methods: The epidemiological data of RT-PCR test-confirmed COVID-19 cases were collected. Transmission chain was drawn and the transmission process was analyzed. Results: Cluster case 1 contained 13 cases and was caused by a family of 5 who traveled by car to Wuhan and returned to Shaanxi. Cluster case 2 had 5cases and caused by initial patient who participated family get-together right after back from Wuhan while under incubation period. Cluster case 3 contained 10 cases and could be defined as nosocomial infection. Cluster case 4 contained 4 cases and occurred in work place. Conclusion: Higher contact frequency and smaller places were more likely to cause a small-scale COVID-19 cluster outbreak, with potential longer incubation period. COVID-19 control strategies should turn the attention to infection prevention and control in crowded places, management of enterprise resumption and prevention of nosocomial infection.

[Analysis of transmission characteristics of COVID-19 in Shaanxi Province]

A total of 245 cases of COVID-19 in Shaanxi Province reported in the China information system for disease control and prevention as of February 24, 2020 were selected as the research objects, the cases are divided into imported cases (116 cases, 47.3%) and local cases (129 cases, 52.7%), their basic characteristics, time distribution, transmission mode, intergenerational interval and latent period transmission are analyzed. The age of local cases [(51.74±15.67) years old], female patients (69 cases, 53.5%), housework and retired staff (40 cases, 31.0%), and patients isolated at the time of onset (50 cases, 38.8%) were higher than imported cases, respectively[(40.66±15.41) years old, (45 cases, 38.8%), (21 cases, 18.1%), (17 cases, 14.6%)] (P values were < 0.05); The infection rate was 0.8% (31/3 666) in close contacts with local cases, which was lower than imported cases 2.0% (69/3 435) (P<0.001); The main source of infection in local cases was relatives (70 cases, 54.3%), and the main way of infection was living together and party (90 cases, 69.8%); the proportion of latent period transmission in our province was 15.5% (20 cases), and the interval between the second-generation case and the source of infection was about 4 days, and the interval between generations was about 6 days. In summary, the main way of infection of local cases in Shaanxi Province was living together and party, there were a certain proportion of latent period transmission cases at present, it's suggested that the investigation of close contacts should be started 4 days or earlier before the onset of the case.

[Epidemiological characteristics of COVID-19 in Shaanxi province]

Objective: To understand the incidence trend and epidemiological characteristics of COVID-19 in Shaanxi province. Methods: The incidence data of COVID-19 reported in Shaanxi as of 22 February, 2020 were collected for an epidemiological descriptive analysis. Results: A total of 245 confirmed cases of COVID-19 were reported in Shaanxi. Most cases were mild (87.76%). As time passed, the areas where confirmed cases were reported continued to increase. The case number in Xi'an was highest, accounting for nearly half of the total reported cases in the province. The epidemic pattern in Shaanxi had gradually shifted from imported case pattern to local case pattern, and the transmission of local cases was mainly based on family cluster transmission. The confirmed cases from different sources had caused the secondary transmission in Shaanxi. After February 7, the number of reported cases began to fluctuate and decrease stably, indicating a decrease-to-zero period. Conclusions: At present, the overall epidemic of COVID-19 in Shaanxi has gradually been mitigated. However, considering the approaching of return to work and study and the increasing of imported cases from other countries, the prevention and control of COVIS-19 in Shaanxi will face new challenges.

High-resolution imaging of the human incudostapedial joint using synchrotron-radiation phase-contrast imaging

The incudostapedial joint (ISJ) of the middle ear is important for proper transmission of sound energy to the cochlea. Recently, the biomechanics of the ISJ have been investigated using finite-element (FE) modelling, using simplified geometry. The objective of the present study was to investigate the feasibility of synchrotron-radiation phase-contrast imaging (SR-PCI) in visualising the ISJ ultrastructure. Three human cadaveric ISJs were dissected and scanned using SR-PCI at 0.9 µm isotropic voxel size. One of the samples was previously scanned at 9 µm voxel size. The images were visually compared and contrast-to-noise ratios (CNRs) were calculated (of both bone and soft tissues) for quantitative comparisons. The ISJ ultrastructure as well as adjacent bone and soft tissues were clearly visible in images with a 0.9 µm voxel size. The CNRs of the 0.9 µm images were relatively lower than those of the 9 µm scans, while the ratio of bone to soft tissue CNRs were higher, indicating better discernibility of bone from soft tissue in the 0.9 µm scans. This study was the first known attempt to image the ISJ ultrastructure using an SR-PCI scanner at submicron voxel size and results suggest that this method was successful. Future studies are needed to optimise the contrast and test the feasibility of imaging the ISJ in situ. LAY DESCRIPTION: The human middle ear consists of the eardrum, three small bones (the malleus, incus and stapes) and two joints connecting the bones (the incudostapedial joint and the incudomallear joint). The role of the middle ear is to amplify and transfer sound energy to the cochlea, the end organ of hearing. The incudostapedial joint (ISJ) of the middle ear is a synovial joint which is important for proper transmission of sound energy to the cochlea. Similar to other synovial joints it consists of meniscus, fluid and articulating surfaces. Recently, the biomechanics of the ISJ have been investigated using computational models, using grossly simplified geometry. Synchrotron radiation phase contrast imaging (SR-PCI) is a high-resolution imaging technique used to visualise small structures in three dimensions. The objective of the present study was to investigate the feasibility of using SR-PCI in visualising the ISJ ultrastructure. Three human cadaveric ISJs were dissected and scanned using SR-PCI at 0.9 µm isotropic voxel size. One of the samples was previously scanned at 9 µm voxel size. The images were both qualitatively and quantitatively compared. This study was the first known attempt to image the ISJ ultrastructure using an SR-PCI scanner at submicron voxel size and results suggest that this method was successful. Future studies are needed to optimise the contrast and feasibility of imaging the ISJ in situ.

Modulative effects of lncRNA TCONS_00202959 on autonomic neural function and myocardial functions in atrial fibrillation rat model

OBJECTIVE

Atrial fibrillation (AF) is a typical cardiac arrhythmia. The autonomic nervous system can modulate the myocardial system with complicated mechanisms. Long non-coding RNA (lncRNA) is involved in myocardial diseases, and lncRNA TCONS_00202959 is down-regulated in AF. However, the detailed effects of AF on automatic functions or cardiomyocytes are not well known yet.

MATERIALS AND METHODS

Sprague-Dawley (SD) rats were randomly divided into control group, AF group (which was prepared by injecting the acetylcholine-CaCl2 solution) and treatment group (receiving lentiviral transfection of lncRNA TCONS_00202959 on AF rats). Real Time-quantitative PCR (RT-PCR) was used to measure the expression of lncRNA TCONS_00202959. Atrial effective refractory period (AERP) and AF induction rate were measured, along with heart rate variability (HRV) analysis to reveal autonomic nervous function. The expression of tyrosine hydroxylase (TH) and choline acetyltransferase (CHAT) was analyzed in atrial tissues.

RESULTS

The expression of lncRNA TCONS_00202959 was decreased in the AF group compared to the control group (p < 0.05), which also had shortened AERP and elevated AF induction rate. The analysis of the autonomic nervous function revealed lower standard deviation of NN intervals (SDNN), SDNN of atrial (SDANN), root mean square of successive differences (RMSSD) and SDNN intervals in all 5-min segments (SDNNindx), plus elevated power ratio of low frequency (LF)/high frequency (HF). TH expression was increased whilst CHAT expression was decreased (p < 0.05). The treatment group showed enhanced expression of lncRNA TCONS_00202959, elongated AERP plus decreased AF induction rate. The treatment rats also had higher SDNN, SDANN, RMSSD and SDNNindx, lower LF/HF ratio, decreased TH expression and increased CHAT expression (p < 0.05 compared to the AF group).

CONCLUSIONS

AF rats had decreased expression of lncRNA TCONS_00202959, which can help to prevent AF pathogenesis by suppressing cardiac autonomic nervous function.

An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring

The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.

Patient-reported quality of life after endoscopic surgery for pituitary lesions: a meta-analysis

Patient-reported outcomes are now considered as an important part of overall outcome assessment of a surgical intervention. The objective of the current study was to evaluate the patient-reported quality of life (QoL) of the subjects of endoscopic pituitary surgery. A literature search was carried out in several electronic databases and study selection was based on pre-determined eligibility criteria. Meta-analyses of standardized mean difference (SMD) were conducted to observe significance of difference between preoperative and postoperative scores of important tools. Sixteen studies were included [931 patients; 51.16 years (95% CI 49.13, 53.19) age; 48.41 % (43.74, 53.08) males]. Generally, there was no significant differences between postoperative and preoperative health-related QoL after postoperative month 1 or after fourth postoperative month. QoL after endoscopic pituitary surgery remains unchanged predominantly but may deteriorate in regard to physical role and sinonasal outcome transiently.

[Application of Ischemia Modified Albumin for Acute Ischemic Heart Disease in Forensic Science]

OBJECTIVES

To explore the application value and forensic significance of ischemia modified albumin （IMA） in pericardial fluid to diagnose sudden cardiac death.

METHODS

IMA level in pericardial fluid was detected in acute ischemic heart disease group （n=36）, acute myocardial infarction group （n=6）, cardiomyopathy group （n=4） and control group （n=15） by albumin cobalt binding method. The levels of IMA were compared among these groups. The best cut-off IMA value was estimated and the sensitivity and specificity of acute myocardial ischemia group was distinguished from control group by receiver operating characteristics （ROC） curve.

RESULTS

The IMA level in acute ischemic heart disease group was significantly higher than that of control group （P<0.05）. Compared with acute myocardial infarction group and cardiomyopathy group, the IMA level in acute ischemic heart disease group had no significant difference （P>0.05）. The cut-off value for the identification of acute myocardial ischemia which obtained by ROC analysis was 40.65 U/mL. And the sensitivity and specificity for distinguishing acute ischemia cardiac disease was 60.0% and 80.5%, respectively.

CONCLUSIONS

The IMA value in pericardial fluid can be a reference marker for the diagnosis of acute myocardial ischemia, which also can provide objective basis for the forensic identification of sudden cardiac death.

A phase 1b/2b multicenter study of oral panobinostat plus azacitidine in adults with MDS, CMML or AML with ⩽30% blasts

Treatment with azacitidine (AZA), a demethylating agent, prolonged overall survival (OS) vs conventional care in patients with higher-risk myelodysplastic syndromes (MDS). As median survival with monotherapy is <2 years, novel agents are needed to improve outcomes. This phase 1b/2b trial (n=113) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of panobinostat (PAN)+AZA (phase 1b) and evaluate the early efficacy and safety of PAN+AZA vs AZA monotherapy (phase 2b) in patients with higher-risk MDS, chronic myelomonocytic leukemia or oligoblastic acute myeloid leukemia with <30% blasts. The MTD was not reached; the RP2D was PAN 30 mg plus AZA 75 mg/m². More patients receiving PAN+AZA achieved a composite complete response ([CR)+morphologic CR with incomplete blood count+bone marrow CR (27.5% (95% CI, 14.6–43.9%)) vs AZA (14.3% (5.4–28.5%)). However, no significant difference was observed in the 1-year OS rate (PAN+AZA, 60% (50–80%); AZA, 70% (50–80%)) or time to progression (PAN+AZA, 70% (40–90%); AZA, 70% (40–80%)). More grade 3/4 adverse events (97.4 vs 81.0%) and on-treatment deaths (13.2 vs 4.8%) occurred with PAN+AZA. Further dose or schedule optimization may improve the risk/benefit profile of this regimen.

Micro-CT versus synchrotron radiation phase contrast imaging of human cochlea

High-resolution images of the cochlea are used to develop atlases to extract anatomical features from low-resolution clinical computed tomography (CT) images. We compare visualization and contrast of conventional absorption-based micro-CT to synchrotron radiation phase contrast imaging (SR-PCI) images of whole unstained, nondecalcified human cochleae. Three cadaveric cochleae were imaged using SR-PCI and micro-CT. Images were visually compared and contrast-to-noise ratios (CNRs) were computed from n = 27 regions-of-interest (enclosing soft tissue) for quantitative comparisons. Three-dimensional (3D) models of cochlear internal structures were constructed from SR-PCI images using a semiautomatic segmentation method. SR-PCI images provided superior visualization of soft tissue microstructures over conventional micro-CT images. CNR improved from 7.5 ± 2.5 in micro-CT images to 18.0 ± 4.3 in SR-PCI images (p < 0.0001). The semiautomatic segmentations yielded accurate reconstructions of 3D models of the intracochlear anatomy. The improved visualization, contrast and modelling achieved using SR-PCI images are very promising for developing atlas-based segmentation methods for postoperative evaluation of cochlear implant surgery.

Cholinesterase inhibitors and non-steroidal anti-inflammatory drugs as Alzheimer's disease therapies: an updated umbrella review of systematic reviews and meta-analyses

OBJECTIVE

Alzheimer's Disease (AD) is a major neurological disorder marked by an amyloid-beta plaque and neurofibrillary tau-tangle depositions in the brain. Cognitive dysfunction is the key manifestation of AD. In this study, we conducted an umbrella review of meta-analyses on the risk factors and therapeutics targeting cognitive impairment and AD.

MATERIALS AND METHODS

We searched PubMed from January 2000-August, 2016, and screened systematic reviews and meta-analyses of studies that examined the effects of cholinesterase inhibitors in AD patients. We also included studies on non-steroidal anti-inflammatory drugs and AD. The studies comprised meta-analyses of randomized controlled trials and prospective cohorts, with 95% confidence interval. We considered the heterogeneity between different studies, denoted by I2.

RESULTS

We scanned a total of 750 novel meta-analyses on the topics, "risk factors for AD" and "cholinesterase inhibitors and NSAIDs" that target the disease. The search yielded three relevant studies on risk factors, and seven and three studies for ChEIs and NSAIDs respectively. A thorough examination of the studies reinforced the therapeutic role of ChEIs in AD. A combination of the glutamatergic inhibitor, memantine, with ChEIs also proved effective in ameliorating AD progression and occurrence. Contradicting the observational studies, therapeutic role of NSAIDs in AD seemed uncertain. Nonetheless, the studies showed variability in the severity of dementia and number of patient trials. Hence, we claim the need for detailed meta-analyses and superior-quality cohort studies on a larger patient population of AD.

CONCLUSIONS

Overall, our umbrella systematic review offers a unique and immensely helpful resource for researchers and clinicians in the field of AD, and identifies vital research gaps as well.

[Application of R-based multiple seasonal ARIMA model, in predicting the incidence of hand, foot and mouth disease in Shaanxi province]

OBJECTIVE

To apply the ' auto-regressive integrated moving average product seasonal model' in predicting the number of hand, foot and mouth disease in Shaanxi province.

METHODS

In Shaanxi province, the trend of hand, foot and mouth disease was analyzed and tested, under the use of R software, between January 2009 and June 2015. Multiple seasonal ARIMA model was then fitted under time series to predict the number of hand, foot and mouth disease in 2016 and 2017.

RESULTS

Seasonal effect was seen in hand, foot and mouth disease in Shaanxi province. A multiple seasonal ARIMA (2,1,0)×(1,1,0)12 was established, with the equation as (1 -B)(1 -B12)Ln (Xt) =((1-1.000B)/(1-0.532B-0.363B(2))*(1-0.644B12-0.454B12(2)))*Epsilont. The mean of absolute error and the relative error were 531.535 and 0.114, respectively when compared to the simulated number of patients from Jun to Dec in 2015. RESULTS under the prediction of multiple seasonal ARIMA model showed that the numbers of patients in both 2016 and 2017 were similar to that of 2015 in Shaanxi province.

CONCLUSION

Multiple seasonal ARIMA (2,1,0)×(1,1,0)12 model could be used to successfully predict the incidence of hand, foot and mouth disease in Shaanxi province.

BMIT facility at the Canadian Light Source: Advances in X-ray phase-sensitive imaging

The BioMedical Imaging and Therapy (BMIT) facility [1,2] located at the Canadian Light Source, provides synchrotron-specific imaging and radiation therapy capabilities. There are two separate beamlines used for experiments: the bending magnet (05B1-1) and the insertion device (05ID-2) beamline. The bending magnet beamline provides access to monochromatic beam spanning a spectral range of 15-40keV, and the beam is 240mm wide in the POE-2 experimental hutch. Users can also perform experiments with polychromatic (pink) beam. The insertion device beamline was officially opened for general user program in 2015. The source for the ID beamline is a multi-pole, superconducting 4.3T wiggler. The high field gives a critical energy over 20keV. The optics hutches prepare a beam that is 220mm wide in the last experimental hutch SOE-1. The monochromatic spectral range spans 25-150+keV. Several different X-ray detectors are available for both beamlines, with resolutions ranging from 2μm to 200μm. BMIT provides a number of imaging techniques including standard absorption X-ray imaging, K-edge subtraction imaging (KES), in-line phase contrast imaging (also known as propagation based imaging, PBI) and Diffraction Enhanced Imaging/Analyzer Based Imaging (DEI/ABI), all in either projection or CT mode. PBI and DEI/ABI are particularly important tools for BMIT users since these techniques enable visualization of soft tissue and allow for low dose imaging.