[Analysis on adult health life expectancy in Shanghai]

Objective: To investigate health status and calculate health life expectancy (HE) of residents in Shanghai, analyze health related factors and provided foundation of health policy. Methods: A multi-stage stratified random sampling was used to obtain self-reported health survey in Shanghai. WHO questionnaire was used to evaluate the health quality of life which was designed for the world health survey, Sullivan's method was used to calculate HE. Results: The self-assessment disability measure for adults over 18 years old in Shanghai was 0.25, higher for women (0.28) than for men (0.23). LE was 65.76 years for adults over 18 years old, higher for women (68.22) than for men (63.39). HE for adults over 18 years old was 47.99 years old, higher for men (49.05) than women (47.14). HE's proportion in LE gradually decreases with age. It accounts for 72.97% in the 18 years old and 39.00% in the 85 years old. Conclusions: The health of adult male in Shanghai is higher than that of female, and the proportion of HE loss of elderly is higher than young people. It is necessary to focus on the aging problem and strengthen the long-term care and health support system for the elderly. Improve the prevention and control of major diseases such as chronic diseases,which affect the quality of life expectancy seriously. Promotes the health level and quality of life in Shanghai.

Tailoring the triplet level of isomorphic Eu/Tb mixed MOFs for sensitive temperature sensing

Three different thermo-responsive fluorescent thermometers were constructed by regulating the triplet energy level of organic ligands in isostructural Eu/Tb mixed MOFs. Among them, a quite unusual and rarely reported temperature-dependent fluorescence behavior was observed in LnBDC-NH₂, and Eu_0.01Tb_0.99NDC is effective in the physiological range with the maximum relative sensitivity of 7.32% °C^-1.

The ratiometric detection of the biomarker Ap5A for dry eye disease and physiological temperature using a rare trinuclear lanthanide metal-organic framework

Urgent demand for the prevention and diagnosis of physiological diseases is driving the development of biomarkers and physiological temperature fluorometric sensors. In this paper, a rare trinuclear lanthanide metal-organic framework (MOF), [(CH₃)₂NH₂][Eu₃(μ₃-OH)(2,6-NDC)₃(HCOO)₃]·(solv)_x (Eu(2,6-NDC), where 2,6-H₂NDC = 2,6-naphthalenedicarboxylic acid) was synthesized using reticular chemistry via reducing the symmetry of the organic ligand from axisymmetric 1,4-naphthalenedicarboxylic acid (1,4-H₂NDC) to non-axisymmetric 2,6-H₂NDC. Eu(2,6-NDC) shows exceptional chemical and thermal stability in acid-base solutions, PBS solution, and boiling water, and even under an air atmosphere up to 300 °C. As-synthesized Eu(2,6-NDC) exhibits ratiometric detection abilities for P¹,P⁵-di(adenosine-5') pentaphosphate (Ap5A), for use as a biomarker of dry eye disease, with a limit of detection (LOD) of 0.031 μM, as well as excellent anti-interference properties. As far as is known, it is the first Ap5A sensor based on MOFs. In addition, the results show that the ratiometric parameters of co-doped Eu_0.001Gd_0.999(2,6-NDC) deliver a good linear luminescence response to physiological temperatures (20-60 °C) with high sensitivity.

Estrogen enhances the expression of a growth-associated long noncoding RNA in chicken liver via ERα

1. The long noncoding RNA lncGLM is significantly differentially expressed in the livers of peak-laying hens compared with that in the livers of pre-laying hens, but its potential biological role and expression regulation are unclear.2. To explore the potential biological function of lncGLM, single nucleotide polymorphism (SNP) detection and association analysis were carried out in the Gushi×Anka F₂ resource population.3. The tissues and spatiotemporal expression characteristics of lncGLM were analysed by real-time quantitative PCR. The effects of 17β-oestradiol on the expression of lncGLM expression were analysed through in vitro and in vivo experiments.4. The results showed that a g.19069338 T > C SNP was present in lncGLM. Association analysis revealed that lncGLM was significantly associated with body slanting length at 12 weeks, body weight at 12 weeks, shank length at four weeks, chest depth at eight weeks, pelvic width at 12 weeks, eviscerated weight, head weight, pancreas weight, pectoralis weight, leg muscle weight, muscular stomach weight rate, pancreas weight rate, carcase weight, aspartate aminotransferase, creatinine and pectoral muscle water loss rate.5. The expression of lncGLM in the liver was higher than that in other sampled tissues. In addition, the expression of lncGLM in the liver was significantly higher in the peak-laying period than at the pre-laying period. Both in vitro and in vivo experiments showed that lncGLM expression was regulated by 17β-oestradiol via oestrogen receptor alpha (ER-α). These results demonstrated that the chicken lncGLM gene is highly expressed in liver tissue and regulated by oestrogen through ER-α.

CT phenotypes in mild-to-moderate chronic obstructive pulmonary disease: difference before and after the age of 60 years

AIM

To investigate the pulmonary phenotype of mild-to-moderate chronic obstructive pulmonary disease (COPD) using quantitative computed tomography CT analysis techniques.

MATERIALS AND METHODS

Sixty-three patients with stable-phase mild-to-moderate COPD and 78 healthy controls, categorised as those aged <60 (28 and 40 patients, respectively) and ≥60 years (35 and 38, respectively), underwent chest low-dose respiratory dual-phase CT and pulmonary function test. Automatic software was used to measure the proximal airway parameters, and the emphysema and air-trapping indices were recorded. The intergroup differences in each parameter were assessed by one-way analysis of variance.

RESULTS

At <60 years of age, the mean Pi10WA (Wall area of a hypothetical airway with an internal perimeter of 10 mm) was greater in the mild-to-moderate COPD group than in the healthy control group (17.04 ± 1.63 versus 16.03 ± 1.16 mm²; p=0.004). Mild or moderate air-trapping was observed in the mild-to-moderate COPD group aged <60 years. There was no significant difference in the proximal airway parameters and inspiratory VI_-950 (percent voxels less than -950 HU) between the two groups at age ≥60 years (all p>0.05); however, the expiratory VI_-856 (percent voxels less than -856 HU) and mean lung density expiratory/inspiratory ratio (MLD_E/I) were higher in the mild-to-moderate COPD group than those in the healthy control group (26.02 [30.23] versus 6.45 [11.16]; 0.88 ± 0.05 versus 0.84 ± 0.04; p<0.001 and p=0.024).

CONCLUSION

For patients with mild-to-moderate COPD, the CT phenotype was predominantly the "airway remodelling" type at <60 years of age, and the "air-trapping" type at ≥60 years of age. Thus, pulmonary CT phenotypes of mild-to-moderate COPD patients of different age groups are different.

[The correlation between the severity of uncovertebral joints degeneration and heterotopic ossification after single-level artificial cervical disc replacement]

Objective: To investigate the correlation between the severity of uncovertebral joints degeneration and heterotopic ossification (HO) after single-level artificial cervical disc replacement (ACDR). Methods: From January 2005 to January 2016, 70 patients who had undergone single-level ACDR in Peking University Third Hospital and had at least 5 years follow-up were included in this study. There were 35 males and 35 females with an average age of (42±8) years (range, 25-62 years). Cervical spine A-P X-rays were taken to assess the degeneration of uncovertebral joints and lateral X-rays were taken to assess the degeneration of intervertebral space. Cervical spine lateral and the flexion-extension X-rays at 5 years follow up were taken to assess HO. Degeneration of uncovertebral joints were evaluated by the classification system set-up in Peking University Third Hospital. Kellgren&Lawrence grading system was used to evaluate the degeneration of intervertebral space. HO was evaluated by the McAfee grading standards. The data were collected before surgery and at 5-years follow-up, then the correlation between degeneration of uncovertebral joints, degeneration of intervertebral space and HO was analyzed with Spearman non-parametric test. Results: The average follow-up time of 70 patients was (62.7±4.8) years (range, 52-74 months). There was a significant positive correlation between preoperative uncovertebral joints degeneration and HO after ACDR (r=0.585, P<0.01). There was a significant positive correlation between preoperative intervertebral space degeneration and HO (r=0.557, P<0.01). There was a significant positive correlation between preoperative intervertebral space degeneration and preoperative uncovertebral joints degeneration (r=0.727, P<0.01). Conclusion: There is a significant positive correlation between preoperative uncovertebral joints degeneration and HO after ACDR.

[Clinical analysis of minimal invasive surgical treatment for pancreatic neuroendocrine tumors]

Objective: To analyze the safety and effectiveness of minimal invasive surgery treating pancreatic neuroendocrine tumors (pNETs), and to summarize surgical characteristics and share experience. Methods: The clinical data of 80 pNETs treated by a single hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were divided into laparoscopic group and robot group. And surgical procedures included pancreaticoduodenectomy (PD), distal pancreatectomy (DP), central pancreatectomy (CP), and tumor enucleation. Results: Of 80 patients, 76 cases (95%) underwent minimal invasive surgery and 4 cases (5%) changed to open surgery. There were 38 females, with median age of 54.4 (20-80) years and median BMI (17.0-38.0) kg/m(2). Among them, 24 patients (31.6%) underwent PD, 36 patients (47.4%) underwent DP, 8 patients (10.5%) underwent CP and 8 patients (10.5%) received tumor enucleation. The postoperative incidence of grade B/C pancreatic fistula was 35.5%, the incidence of abdominal infection was 10.5%, the postoperative bleeding was 7.9%, and the reoperation rate was 6.6%, without perioperative deaths. There was no significant difference in postoperative complications among different surgical methods, including postoperative pancreatic fistula (P=0.396), postoperative bleeding (P=0.297), postoperative abdominal infection (P=0.339) and reoperation (P=0.396). Conclusions: Surgical resection is an effective treatment for pNETs. pNETs are suitable for minimally invasive surgery with earlier stage and smaller tumor diameter. Minimally invasive surgery for pNETs is safe and feasible, and functional preserving surgery could take into consideration.

MiR-21 promotes fracture healing by activating the PI3K/Akt signaling pathway

OBJECTIVE

This study aims to elucidate the potential mechanism of micro ribonucleic acid (miR)-21 in promoting fracture healing.

MATERIALS AND METHODS

30 male Sprague-Dawley rats were randomly divided into group A (phosphate-buffered saline, PBS, n=10), group B (AntagomiR-21, n=10) and group C (AntagomiR-NC, n=10) according to the different treatments. The femoral fracture operation was performed in every rat, which was pathologically diagnosed via X-ray. After the successful modeling, 50 μL (2 nmoL) PBS, 50 μL AntagomiR-21 or 50 μL AntagomiR-NC was intraperitoneally injected into rats in group A, B or C, respectively. The above agents were injected once a week for 6 weeks. At 6 weeks, 3 rats were executed in each group, and the tissue at the fracture end was observed via hematoxylin-eosin (HE) staining. The fracture healing of rats was evaluated via imaging at 1 and 7 weeks. At the same time, the expression of miR-21 in the three groups was detected via Reverse Transcription-Polymerase Chain Reaction (RT-PCR), and the expression of phosphatidylinositol 3-hydroxy kinase (PI3K) and phosphorylated-serine/threonine-protein kinase B (p-Akt) in the three groups was detected via Western blotting.

RESULTS

According to the histological staining, the bone repair at the fracture end of rats in group B was not significant with fracture and poor continuity compared with those in group A and group C. The imaging evaluation revealed that in group B, the callus tissues were significantly reduced, the fracture line had undesirable healing. There were no displacement and loosening of internal fixation compared with group A and group C. Besides, RT-PCR showed that the miR-21 expression declined markedly in group B compared with that in group A and group C, and the differences were statistically significant (p<0.05). Western blotting manifested that the protein levels of PI3K and p-Akt also declined in group B compared with those in group A and group C, and there were statistically significant differences (p<0.05).

CONCLUSIONS

MiR-21 promotes the fracture healing in fractured rats by activating the PI3K/Akt signaling pathway.

[Early experience of minimal invasive surgery for adolescent with pancreatic head tumor: a report of 15 cases]

Objective: To summarize the characteristics and difficulties of minimal invasive surgery for adolescent with pancreatic head tumor. Methods: The data of adolescent younger than 28 years old with pancreatic head tumor treated at Department of Gastroenterology and Pancreatic Surgery, Zhejiang Province People's Hospital from January 2014 to December 2019 were analyzed retrospectively. Fifteen cases were enrolled, included 5 males and 10 females. The median age was 20 years(range: 11 to 27 years) and the body mass index was (19.8±2.3)kg/m(2)(range: 17.3 to 21.6 kg/m(2)). Results: Standard pancreaticoduodenectomy was performed in 12 cases, including 9 cases of laparoscopic surgery and 3 cases of robotic-assisted surgery, and laparoscopic pancreaticoduodenectomy with resection of hepatic flexure of colon was performed on 1 case, and robotic-assisted duodenum-preserving pancreatic head resection with pancreatogastrostomy was performed on other 2 cases. The operative time was (269.0±65.1)minutes(range: 150 to 410 minutes), and the blood loss was (135.6±52.7)ml(range: 50 to 400 ml). Six patients got postoperative complications with gastrointestinal bleeding biochemical leakage and intestinal obstruction(n=1), pancreatic biochemical leakage(n=1), bile leakage(n=1), chylous leakage(n=1), wound infection(n=1), hepatic injury(n=1). The median postoperative hospital stay was 13 days(range: 9 to 22 days).The pathologic findings were solid pseudopapillary neoplasms(n=8), neuroendocrine neoplasms(n=3), introductal papillary mucinous neoplasm(n=1), cystic fibroma(n=1), serous cystadenoma(n=1), Ewing sarcoma(n=1).The median follow-up was 37 months(range: 2 to 75 months).The patient with Ewing sarcoma was diagnosed as liver metastasis at 41 months after surgery and died at 63 months after surgery.All the other patients survived without tumor.Three patients got the long-term complication of bile duct. Conclusions: Most of pancreatic head tumors for adolescent are benign or low malignant. Minimally invasive surgery be the first choice, and function-preserving surgery should be taken into account as much as possible.Perioperative management and communication is essential as the parents pay much attention to the quality of life after surgery.

Inactivation of airborne porcine reproductive and respiratory syndrome virus (PRRSv) by a packed bed dielectric barrier discharge non-thermal plasma

Porcine reproductive and respiratory syndrome virus (PRRSv) is one of the most significant airborne viruses impacting the pork industry in the US. Non-thermal plasmas (NTPs) are electrical discharges comprised of reactive radicals and excited species that inactivate viruses and bacteria. Our previous experiments using a packed bed NTP reactor demonstrated effective inactivation of bacteriophage MS2 as a function of applied voltage and power. The present study examined the effectiveness of the same reactor in inactivating aerosolized PRRSv. A PRRSv solution containing ∼10⁵ TCID₅₀/ml of PRRSv VR2332 strain was aerosolized at 3 ml/min by an air-jet nebulizer and introduced into 5 or 12 cfm air flow followed by NTP exposure in the reactor. Twin impingers upstream and downstream of the reactor collected samples of the virus-laden air flow for subsequent TCID₅₀ assay and qPCR analyses. An optical particle sizer measured upstream and downstream aerosol size distributions, giving estimates of aerosol filtration by the reactor. The results showed that PRRSv was inactivated to a similar degree as MS2 at the same conditions, with the maximum 1.3-log inactivation of PRRSv achieved at 20 kV and 12 cfm air flow rate. The results demonstrate the potential of properly optimized NTPs in controlling PRRSv transmission.

Highly Stable Lanthanide Metal-Organic Framework as an Internal Calibrated Luminescent Sensor for Glutamic Acid, a Neuropathy Biomarker

Glutamic acid (Glu) is the most abundant excitatory neurotransmitter in the central nervous system, and an elevated level of Glu may indicate some neuropathological diseases. Herein, three isomorphic microporous lanthanide metal-organic frameworks (MOFs) [(CH₃)₂NH₂]₂[Ln₆(μ₃-OH)₈(BDC-OH)₆(H₂O)₆]·(solv)_x (ZJU-168; ZJU = Zhejiang University, H₂BDC-OH = 2-hydroxyterephthalic acid, Ln = Eu, Tb, Gd) were designed for the detection of Glu. ZJU-168(Eu) and ZJU-168(Tb) suspensions simultaneously produce the characteristic emission bands of both lanthanide ions and ligands. When ZJU-168(Eu) and ZJU-168(Tb) suspensions exposed to Glu, the fluorescence intensity of ligands increases while the emission of lanthanide ions is almost unchanged. By utilizing the emission of ligands as the detected signal and the emission of lanthanide ions as the internal reference, an internal calibrated fluorescence sensor for Glu was obtained. There is a good linear relationship between fluorescence intensity ratio and Glu concentration in a wide range with the detection limit of 3.6 μM for ZJU-168(Tb) and 4.3 μM for ZJU-168(Eu). Major compounds present in blood plasma have no interference for the detection of Glu. Furthermore, a convenient analytical device based on a one-to-two logic gate was constructed for monitoring Glu. These establish ZJU-168(Tb) as a potential turn-on, ratiometric, and colorimetric fluorescent sensor for practical detection of Glu.

[Laparoscopic gastroduodenostomy with manual suture for Billroth Ⅰ anastomosis: a report of 36 cases]

Objective: To examine the clinical efficiency of laparoscopic gastroduodenostomy with BillrothⅠanastomosis with manual suture. Methods: The clinic data of 36 patients with gastric cancer who underwent laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis from November 2017 to September 2019 in Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital were analyzed retrospectively.There were 22 males and 14 females, aged (64.3±9.3) years(range: 43 to 80 years), underwent complete laparoscopic gastroduodenostomy. The laparoscopic manual suture was used for Billroth Ⅰ anastomosis. Results: All the laparoscopic radical gastrectomy and manual suturing gastroduodenostomy were successfully performed. The operation time was (226.7±40.4) minutes (range: 180 to 320 minutes), including (24.8±7.1) minutes (range: 15 to 48 minutes) for gastroduodenostomy.There was (3.8±0.9) days (range: 2 to 6 days) for anal exhaust, (5.7±2.0) days (range: 3 to 13 days) for extubation of gastric tube, and (10.3±3.1) days (range: 7 to 19 days) for hospitalization. There was no death in perioperative period. Postoperative pathological report showed 3 cases of highly differentiated adenocarcinoma, 5 cases of moderately differentiated adenocarcinoma, 22 cases of poorly differentiated adenocarcinoma and 6 cases of signet ring cell carcinoma, including 27 cases in T1 stage and 9 cases in T2 stage. The number of lymph nodes harvested was 36.4±8.9 (range: 23 to 60). Lymph node metastasis was positive in 7 cases and negative in 29 cases. TNM stage included 24 cases in ⅠA stage, 8 cases in ⅠB stage and 4 cases in Ⅱ stage. After the operation, the upper digestive tract radiography showed that the anastomosis opening was unobstructed without complications such as anastomotic stenosis. Conclusion: Laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis with manual suture is safe and feasible, has a good short-term effect.

Lanthanide metal–organic frameworks with nitrogen functional sites for the highly selective and sensitive detection of NADPH

A series of isostructural fluorescent Ln-MOF [Ln(BPDC-xN)] (Ln = Eu/Tb, x = 0, 1, 2] probes was prepared using a nitrogen modification strategy to achieve the improved selective detection of NADPH.

[The role of abnormal mitochondrial fusion and fission in PBDE-47-induced change in mitochondrial mass in PC12 cells]

Objective: To investigate the effect of 2, 2', 4, 4'-tetrabromodiphenyl ether (PBDE-47) on the mitochondrial mass in rat adrenal pheochromocytoma (PC12) cells and the potential mechanisms. Methods: Highly differentiated PC12 cells were divided into control, 1, 10 or 20 μmol/L PBDE-47-treated groups and cultured for 24 h. Transmission electron microscopy was employed to observe the changes in mitochondrial morphology and quantity in PC12 cells. Flow cytometry was used to measure the fluorescence intensity of Nonyl Acridine Orange (NAO) , a fluorescent indicator of mitochondrial membrane cardiolipin, to reflect mitochondria mass. Western blotting was used to determine the expression levels of Mitofusion 1 (Mfn1) and Fission 1 (Fis1) proteins. To further explore the role of abnormal mitochondrial fusion and fission in PBDE-47-induced mitochondrial mass changes, PC12 cells were divided into control group, 5 μmol/L M1 treatment group, 20 μmol/L PBDE-47 treatment group and 5 μmol/L M1+20 μmol/L PBDE-47 combined treatment group and cultured for 24 h, then the fluorescence intensity of NAO and expression levels of Mfn1 and Fis1 proteins were detected. Results: The control group showed numerous mitochondria with normal morphology, while the number of mitochondria decreased after PBDE-47 treatment. Especially, the disappeared cristae, swelling and vacuoles of mitochondria and decreased fluorescence intensity of NAO (P<0.05) were observed in 10 and 20 μmol/L PBDE-47-treated groups. Meanwhile, the expression levels of Mfn1 and Fis1 proteins in the 10 and 20 μmol/L PBDE-47-treated groups were significantly decreased compared with control group (P<0.05) . However, 5 μmol/L M1 co-treatment with 20 μmol/L PBDE-47 significantly increased the levels of Mfn1 and Fis1 proteins and fluorescence intensity of NAO compared with the 20 μmol/L PBDE-47 group (P<0.05) . Conclusion: PBDE-47 can inhibit the mitochondrial fusion and fission process, thus leading to damage of mitochondria mass in PC12 cells.

Inactivation of airborne viruses using a packed bed non-thermal plasma reactor

Outbreaks of airborne infectious diseases such as measles or severe acute respiratory syndrome can cause significant public alarm. Where ventilation systems facilitate disease transmission to humans or animals, there exists a need for control measures that provide effective protection while imposing minimal pressure differential. In the present study, viral aerosols in an airstream were subjected to non-thermal plasma (NTP) exposure within a packed-bed dielectric barrier discharge reactor. Comparisons of plaque assays before and after NTP treatment found exponentially increasing inactivation of aerosolized MS2 phage with increasing applied voltage. At 30 kV and an air flow rate of 170 standard liters per minute, a greater than 2.3 log reduction of infective virus was achieved across the reactor. This reduction represented ~2 log of the MS2 inactivated and ~0.35 log physically removed in the packed bed. Increasing the air flow rate from 170 to 330 liters per minute did not significantly impact virus inactivation effectiveness. Activated carbon-based ozone filters greatly reduced residual ozone, in some cases down to background levels, while adding less than 20 Pa pressure differential to the 45 Pa differential pressure across the packed bed at the flow rate of 170 standard liters per minute.

Characterization of fungal microbiota on normal ocular surface of humans

OBJECTIVES

Our objective was to characterize the fungal microbiota on normal ocular surface of humans with the culture-based method and high-throughput sequencing approach.

METHODS

A total of 45 adults were recruited from an urban community, and 90 conjunctival swabs were obtained, one from each eye of each participant. One of the two swabs from each participant was randomly chosen and allocated to internal transcribed spacer (ITS) sequencing, and the other was subjected to conventional fungal cultivation.

RESULTS

Four filamentous fungi were isolated from the 45 samples using the culture-based method, Penicillium citrinum, Aspergillus niger, Phialophora and Trichoderma. In the other 45 samples, 18 samples were positive for PCR amplification and sent for subsequent ITS sequencing. A total of 518 703 valid reads were generated and assigned into 467 operational taxonomic units. Overall, 4 phyla and 94 genera were identified. Two phyla, Basidiomycota (78.67%) and Ascomycota (19.54%), and five genera, Malassezia (74.65%), Rhodotorula (1.93%), Davidiella (1.89%), Aspergillus (1.25%) and Alternaria (0.61%), which accounted for >80% of the fungal microbiome and presented in >80% of the individuals tested, constituted the possible 'core fungal taxa' on normal ocular surface.

CONCLUSIONS

The fungal microbiome on normal ocular surface of humans was identified using the high-throughput sequencing method, providing a basis for further investigations on the potential role of the fungal microbiota in ocular health and disease.

Plasma cell-free DNA integrity plus circulating tumor cells: a potential biomarker of no distant metastasis breast cancer

Cell-free DNA integrity (cfDI) is a promising diagnostic and prognostic biomarker in breast cancer. However, no specific study has evaluated the diagnostic ability of cfDI in patients with no distant metastasis breast cancer (no-MBC) and benign breast tumor (BBT) to date. We assessed the plasma cfDI of 84 patients with no-MBC and 30 patients with BBT using quantitative PCR and compared it with circulating tumor cells (CTCs) and carbohydrate antigen 153 (CA153). The no-MBC group had significantly lower mean cfDI (0.58) than the BBT group (0.74, p = 0.004). Subgroup analysis showed that decreased cfDI seem to be associated with risk factors such as age 14% (mean cfDI = 0.57), tumor size > 2 cm (mean cfDI = 0.58), and positive lymph node status (mean cfDI = 0.56), but had no statistical significance. McNemar's test suggested that cfDI had stronger diagnostic power than CTCs, cfDNA concentration, or CA153 (p < 0.001). Spearman's rho showed that the correlation coefficient between cfDI and CTCs was 0.278 (p = 0.04) in the no-MBC group. Receiver operating characteristic curve analysis also suggested that cfDI was superior to CTCs or CA153. Combined with CTCs, cfDI reduced the false positive rate from 50% to 10.71% and increased the area under the curve value from 0.66 to 0.68. Our results suggest that cfDI is a potential diagnostic biomarker of no-MBC. Using cfDI and CTCs as a combined diagnostic tool for no-MBC could improve diagnostic sensitivity and specificity but more samples will be needed.

[Predictive value of cytokines and procalcitonin on infection in children with hematological malignancies]

Objective: To explore the value of cytokines and procalcitonin (PCT) in predicting the potential pathogen and the severity of infection in children with hematological malignancies. Methods: This was a prospective cohort study. A total of 1 543 children (3 912 episodes) with hematological malignancies admitted to the Department of Hematology/Oncology in Children's Hospital of Zhejiang University School of Medicine from November 2010 to June 2018 were prospectively enrolled in this study. According to the pathogen, the patients were divided into sepsis group with positive blood culture (380 patients/608 episodes), sepsis group with negative blood culture (539/1 484), non-septic infection group (549/1 709), viral infection group (18/21) and fungal infection group (57/90). The patients were also divided into two groups in either shock group (171/187) or non-shock group (1 372/3 725). Meanwhile, 89 children (112 episodes) with matched hematological malignancies without fever were enrolled as the control group. The levels of PCT and cytokines were measured for detecting the potential relationship between these markers and infection severity. Mann-Whitney U test or Kruskal-Wallis H test was used to compare the differences between groups. The Receiver Operator Characteristic curve analysis was used to explore the predictive value. Results: (1) There were significantly higher levels of interleukin (IL) 6 (H=210.002, P<0.01), IL-10 (H=223.045, P<0.01), and PCT (H=76.799, P<0.01) in the infection group, with area under curre (AUC) of 0.67 (95%CI 0.64-0.69), 0.69 (95%CI 0.66-0.71) and 0.59 (95%CI 0.56-0.61), respectively. (2) Among the patients in the shock group, IL-6 (Z=11.460, P<0.01), IL-10 (Z=14.242, P<0.01) and PCT (Z=10.813, P<0.01) were significantly higher than those in the non-shock group, with the AUC of 0.75 (95%CI 0.70-0.79), 0.81 (95%CI 0.77-0.84) and 0.73 (95%CI 0.69-0.77), respectively. (3) In patients with septic shock, the incidence of Gram negative bacteria (GNB) infection (60 episodes) was significantly higher than Gram positive bacteria (GPB) infection (22 episodes) (χ(2)=29.665, P<0.01). The AUC of IL-6, IL-10 and PCT for predicting GNB infection were 0.75 (95%CI 0.72-0.78), 0.82 (95%CI 0.79-0.85) and 0.67 (95%CI 0.63-0.70), respectively. (4) The predictive power of IL-6, IL-10 and PCT combination (AUC=0.994) was superior to IL-10 alone (AUC=0.810) in predicting septic shock (Z=10.211, P<0.01). Conclusions: IL-6 and IL-10 are better predictors of GNB infection than PCT in hematology-oncology children. Furthermore, the combination of these two cytokines and PCT is more valuable in predicting the severity of infection.