[The gender disparity and relevant factors of frailty in the elderly of communities in Beijing based on Fairlie decomposition analysis]

Objective: To analyze the gender disparity and relevant factors of frailty in the elderly of communities in Beijing. Methods: From November 2015 to January 2016, 1 557 participants aged 60 and older in four communities of Dongcheng district in Beijing were recruited by cluster sampling. The information of demographic characteristics, social support, economic status, health status, prevalence situation, cognitive function, emotion and comprehensive assessment of the elderly were collected by a self-made questionnaire. The frailty index (FI) model was used to evaluate the frailty of the elderly. Multivariate nonconditional logistic regression model and Fairlie decomposition method were applied to analyze the relevant factors and their contribution rate to the difference between males and females. Results: The age of subjects was (74.5±8.5) years old, ranging from 60-102 years old, among which 641 were males, accounting for 41.2%. The M (Q₁, Q₃) of FI was 0.09 (0.06, 0.14), among which the value in males was 0.08 (0.05, 0.13), lower than females [0.10 (0.06, 0.15)] (P<0.001).The frail proportion in female was 14.9% (137/916), higher than that of male [8.4% (54/641)] (P<0.001). Multivariate nonconditional logistic regression model analysis demonstrated that common relevant factors associated with frailty in older women and men include: age ≥80 years old, marital status as not married (unmarried, separated, divorced, or widowed), living alone increased the risk of frailty; participating in group activities ≥3 times/week and exercising regularly decreased the risk of frailty (all P<0.05). Fairlie decomposition method showed that the contribution rate of life style, family support, marital status and social support were 32.21%, 15.26%, 8.23% and 4.34%, respectively (all P<0.05). Conclusions: The frailty degree and frailty proportion of elderly women in communities in Beijing were higher than those of men of the same age. The frailty gender difference was related to lifestyle, family support, marital status and social support.

LncRNA LINC00467 contributes to osteosarcoma growth and metastasis through regulating HMGA1 by directly targeting miR-217

OBJECTIVE

Osteosarcoma (OS) is a common primary bone tumor. Despite multiple treatment strategies have made great progress, the overall clinical outcome of OS patients is frustrating. Long non-coding RNA (lncRNA) LINC00467 has been reported in several cancers, while the research of the role of LINC00467 in OS is limited. The aim of this study was to figure out the potential mechanism of LINC00467 in OS.

PATIENTS AND METHODS

The expression levels of LINC00467, microRNA-217 (miR-217) and high mobility group A1 (HMGA1) were quantified by reverse transcription quantitative polymerase chain reaction (qRT-PCR). Cell counting kit-8 (CCK-8), flow cytometry and transwell assay were performed to detect cell proliferation, apoptosis, migration and invasion, respectively. The protein levels of HMGA1, B-cell lymphoma-2 (Bcl-2), Bax, Cleaved Caspase-3 (C-Caspase 3), E-cadherin, N-cadherin and vimentin were measured by Western blot assay. Online software starbase was used to predict the binding sites of miR-217. Luciferase report assay and RNA Binding Protein Immunoprecipitation (RIP) assay were carried out for detecting the interaction between miR-217 and LINC00467 or HMGA1.

RESULTS

The expression of LINC00467 and HMGA1 was increased in OS tissues and cells, while miR-217 expression was reduced. High expression of HMGA1 led to the poor overall survival. Down-regulation of LINC00467 or up-regulation of miR-217 could accelerate cell apoptosis, and slump cell proliferation, migration, invasion and EMT. However, miR-217 under-expression or HMGA1 over-expression could rescue these effects. Moreover, it was indicated that LINC00467 directly targeted miR-217 and HMGA1 was a target of miR-217.

CONCLUSIONS

LINC00467 promoted cell proliferation, migration, invasion and EMT, and suppressed cell apoptosis by up-regulating HMGA1 via targeting miR-217.

[Analysis for the breast cancer screening among urban population in Hebei province, 2018-2019]

From 2018 to 2019, 3 453 cases of high-risk population were screened by the Cancer Screening Program in Urban China (CanSPUC) in Hebei Province, with the age of (53.94±8.00). 147 and 686 cases of breast cancer positive and suspicious positive patients were found, with the positive rate and suspicious positive rate of 4.26% and 19.87% respectively. The suspicious positive rate of 45-49 years old age group was the highest (28.32%), and the positive rate of over 70 years old age group was the highest (7.32%). The positive detection rate of mammography combined with ultrasound was 5.16%, which was higher than that of ultrasound alone (2.46%) (χ²=30.28,P<0.001) or mammography alone (3.06%) (χ²=14.56,P<0.001).

Retraction notice to "30MO ORIENT-3: A randomized, open-label, phase III study of sintilimab versus docetaxel in previously treated advanced/metastatic squamous non-small cell lung cancer (sqNSCLC)": [Annals of Oncology Volume 31, Supplement 7, December 2020, Page S1428]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article was retracted at the request of the authors. The authors of this abstract have advised that full agreement between authors and sponsors on publication of the abstract has not been reached and they are therefore unable to publish this data at present.

MicroRNA-29c-3p inhibits osteosarcoma cell proliferation through targeting PIK3R3

OBJECTIVE

MicroRNAs (miRNAs) are endogenous, non-coding small RNAs involving in pathological regulation. Previous studies have shown that microRNA-29c-3p is a tumor-suppressor gene. However, the role of microRNA-29c-3p in osteosarcoma (OS) has not been reported. This study aims to investigate the potential influence of microRNA-29c-3p on the progression of OS.

PATIENTS AND METHODS

Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) was applied to examine microRNA-29c-3p levels in 40 matched pairs of OS tumor tissues and adjacent ones. The correlation between microRNA-29c-3p expression and clinical indicators in OS patient was analyzed. At the same time, qRT-PCR was used to detect microRNA-29c-3p level in OS cell lines. In addition, microRNA-29c-3p knockdown and the overexpression models were constructed in OS cell lines. The effects of microRNA-29c-3p on the biological functions of OS cells were analyzed via cell counting kit-8 (CCK-8) and transwell assays. Finally, the potential mechanism underlying microRNA-29c-3p in OS was explored by Western Blot and cell recovery experiment.

RESULTS

QRT-PCR results revealed that microRNA-29c-3p level in OS tumor tissues was conspicuously lower than that in adjacent tissues. Compared with OS patients with the high expression of microRNA-29c-3p, those with low expression of microRNA-29c-3p had a higher incidence of distant metastasis and worse overall survival. Cell proliferative capacity and invasiveness in OS were enhanced after knockdown of microRNA-29c-3p; while the opposite results were observed after the overexpression of microRNA-29c-3p. QRT-PCR results revealed that microRNA-29c-3p negatively regulated PIK3R3 expression in OS cells. Moreover, microRNA-29c-3p and PIK3R3 levels were confirmed to be negatively correlated in OS tissues. In addition, cell reverse experiment demonstrated that PIK3R3 was responsible for the malignant progression of OS regulated by microRNA-29c-3p.

CONCLUSIONS

MicroRNA-29c-3p expression was reduced in OS, and conspicuously associated with distant metastasis and poor prognosis. MicroRNA-29c-3p might inhibit the malignant progression of OS by modulating PIK3R3 expression.

[A real-world study of 176 cases with aplastic anemia treated in outpatient]

目的

探索真实世界门诊治疗再生障碍性贫血（AA）患者的诊断流程、治疗及疗效。

方法

评估2018年1月至2019年12月门诊治疗176例AA患者的诊断流程、治疗方案及疗效。

结果

患者出现症状至首次就诊中位时间7（5～120）个月，就诊原因包括出血（52.3%）、贫血（51.7%）、感染（6.8%）。诊断流程中168例（95.5%）患者完成髂骨骨髓穿刺（骨穿），仅22例（17.1%）完善了多部位骨穿（胸骨分类）；骨髓活检完成率85.1%（143/168）；只有59.5%（100/168）和58.9%（99/168）完成了骨髓流式免疫分型及染色体核型分析；86例（48.5%）完成阵发性睡眠性血红蛋白尿（PNH）克隆筛查；造血祖细胞培养检查完成率最低，仅45例（26.8%）。环孢素A（CsA）联合雄激素及左旋咪唑为最常见治疗方案，总计77例（43.8%），其次为CsA联合雄激素45例（25.6%），单用CsA者24例（13.6%），单用雄激素者16例（9.1%），14例（7.9%）患者确诊后选择中药或未治疗。根据门诊复诊频率将176例患者分为复诊规律组（每年≥4次）130例（73.9%）和复诊欠规律组（每年<4次）46例（26.1%）。复诊规律组6个月有效率较高（52.5%对28.0%，P＝0.005），12个月高质量缓解率更好（40.7%对16.7%，P＝0.027），24个月复发率更低（4.4%对36.4%，P＝0.001）。

结论

真实世界治疗的AA患者诊断流程需重视多部位骨穿检查并完成PNH克隆筛查、流式免疫分型、染色体核型分析及造血祖细胞培养检查；门诊规律复诊患者可获得高质量缓解，复发率低，推荐每年至少复诊4次。

[Fuxinfang improves hypoxia-induced injury of human aortic endothelial cells by regulating c-Fos-NR4A1-p38 pathway]

OBJECTIVE

To explore the molecular mechanism of Fuxinfang for improving injury of human aortic endothelial progenitor cells (HAECs).

OBJECTIVE

Serum samples were collected from male SD rats treated with Fuxinfang (n=8) or saline (n= 5). HAECs cultured in normoxia or hypoxic condition (2% O₂) were treated with serum from normal rats or with diluted serum (1% and 10%) from rats treated with Fuxinfang. The differentially expressed genes (DEGs) between Fuxinfang-treated and control cells were detected using high-throughput sequencing to screen the target DEGs that participated in arterial endothelial cell injury and underwent changes in response to both hypoxia and Fuxinfang treatment. AmiGo and String databases were used to infer the interactions among the target genes, and the expressions of the genes were analyzed in HAECs with different treatments using enzyme-linked immunosorbent assay (ELISA) and Western blotting.

OBJECTIVE

HAECs cultured in hypoxia did not show obvious changes in cell morphology or expressions of hypoxia-related factors in response to treatment with 1% or 10% serum from Fuxinfang-treated rats. The results of high-throughput sequencing showed a total of 7134 DEGs (4205 up-regulated and 2929 down-regulated genes) in HAECs in hypoxia model group and 762 DEGs (305 upregulated and 457 down-regulated genes) in Fuxinfang-treated HAECs. Analysis of AmiGo and String databases and the constructed protein-protein interaction network identified c-Fos, NR4A1, and p38MAPK as the target genes. The results of ELISA and Western blotting showed that the expressions of c-Fos, NR4A1, p38MAPK and pp38MAPK increased significantly in cells with hypoxic exposure (P < 0.05); treatment with the serum containing Fuxinfang significantly reduced the expression levels of c-Fos, NR4A1 and p-p38MAPK in hypoxic HAECs in a concentration-dependent manner (P < 0.05).

OBJECTIVE

The serum from Fuxinfang-treated rats can concentration-dependently inhibit the expressions of the DEGs occurring in hypoxia. Fuxinfang improves hypoxic injuries of HAECs possibly by down-regulating the expression of c-Fos to inhibit NR4A1 expression and suppressing hypoxia-induced p38 phosphorylation.

Influence of miR-155 on behaviors of depression mice through regulating Wnt/β-catenin signaling pathway

OBJECTIVE

To study the influence of micro ribonucleic acid (miR)-155 on depression-like behaviors of depression mice, and to explore the role of Wnt/b-catenin signaling pathway in behavioral regulation of depression mice.

MATERIALS AND METHODS

The mouse model of depression was established via chronic unpredictable mild stress (CUMS). All mice were randomly divided into control group (n=12), model group (n=12), and fluoxetine group (n=12). The expression level of miR-155 in the hippocampus of mice in each group was detected via quantitative Polymerase Chain Reaction (qPCR). The changes in the behaviors of mice in each group were evaluated via behavioral experiments. The apoptosis level in the hippocampus of mice in each group was detected via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. Moreover, the content of inflammatory factors in the hippocampus of mice in each group was detected using the enzyme-linked immunosorbent assay (ELISA) kits. The expression levels of Wnt/b-catenin signaling pathway-related proteins in each group were detected via Western blotting.

RESULTS

The expression level of miR-155 in the hippocampus was significantly higher in model group than that in control group (p<0.01). Meanwhile, the expression level of miR-155 was significantly lower in fluoxetine group than that in model group (p<0.01). There were no statistically significant differences in the crossing score and rearing score in the open field test among groups (p>0.05). Compared with those in control group, the immobility time in tail suspension test and forced swimming test were significantly increased (p<0.01), while the sucrose preference degree significantly declined (p<0.01) in model group. Fluoxetine could significantly reduce the immobility time in tail suspension test and forced swimming test (p<0.01) and increase the sucrose preference degree (p<0.01) in model group. The number of TUNEL-positive cells in the hippocampus of mice in model group was significantly larger than that in control group (p<0.01). Fluoxetine could effectively reduce the number of TUNEL-positive cells in the hippocampus (p<0.01). Compared with those in control group, the content of tumor necrosis factor-α (TNF-a), interleukin-1b (IL-1b), and IL-6 in the hippocampus was significantly increased (p<0.01), while the content of IL-10 was significantly decreased (p<0.01) in model group. Fluoxetine could effectively reduce the content of TNF-a, IL-1b, and IL-6 (p<0.01) and increase the content of IL-10 (p<0.01). Besides, in model group, the expression levels of dishevelled-1 (DVL-1) and b-catenin in hippocampus remarkably declined (p<0.01), while the expression levels of glycogen synthase kinase-3b (GSK-3b) and adenomatous polyposis coli (APC) were remarkably increased (p<0.01) compared with those in control group. Fluoxetine could effectively lower the expressions of GSK-3b and APC in the hippocampus (p<0.01) and increase the expressions of DVL-1 and b-catenin (p<0.01) in model group.

CONCLUSIONS

MiR-155 is involved in regulating the depression-like behaviors of depression mice through promoting the release of inflammatory factors and the apoptosis of hippocampal neurons. Its mechanism may be related to the inhibition of the Wnt/b-catenin signaling pathway.

Bypassing the Structural Bottleneck in the Ultrafast Melting of Electronic Order

Impulsive optical excitation generally results in a complex nonequilibrium electron and lattice dynamics that involves multiple processes on distinct timescales, and a common conception is that for times shorter than about 100 fs the gap in the electronic spectrum is not seriously affected by lattice vibrations. Here, however, by directly monitoring the photoinduced collapse of the spectral gap in a canonical charge-density-wave material, the blue bronze Rb_{0.3}MoO_{3}, we find that ultrafast (∼60  fs) vibrational disordering due to efficient hot-electron energy dissipation quenches the gap significantly faster than the typical structural bottleneck time corresponding to one half-cycle oscillation (∼315  fs) of the coherent charge-density-wave amplitude mode. This result not only demonstrates the importance of incoherent lattice motion in the photoinduced quenching of electronic order, but also resolves the perennial debate about the nature of the spectral gap in a coupled electron-lattice system.

Recurrent Extra-gastrointestinal Stromal Tumor of the Vagina: A Case Report and Review of the Literature

Gastrointestinal tumors are uncommonly found outside the gastrointestinal tract, and extremely rare in the vaginal wall. In this case report, a 39-year-old female, she was finally diagnosed with an extra gastrointestinal stromal tumor (EGIST) when she presented with a recurrent vaginal tumor, while misdiagnosed after the first surgery. She had definitive surgical clearance and was taking targeted drug therapy with no sign of recurrence after follow-up for 13 months. Immunohistochemistry and cytogenetic's remain the most definitive method to diagnose EGISTs. Surgical resection and postoperative adjuvant targeted therapy are the optimum treatment options.

Glycation sites and bioactivity of lactose-glycated caseinate hydrolysate in lipopolysaccharide-injured IEC-6 cells

During the thermal processing of milk, Maillard reactions occur between proteins and lactose to generate glycated proteins. In this study, a lactose-glycated caseinate was hydrolyzed by trypsin. The obtained glycated caseinate (GCN) hydrolysate had a lactose content of 10.8 g/kg of protein. We identified its glycation sites and then assessed it for its protective effect against lipopolysaccharide-induced barrier injury using a rat intestinal epithelial cell line (IEC-6 cells) as a cell model and unglycated caseinate (CN) hydrolysate as a reference. Results from our liquid chromatography-mass spectrometry analysis of the GCN hydrolysate verified that lactose glycation occurred at the Lys residues in 3 casein components (α_S1-casein, β-casein, and κ-casein), and this resulted in the formation of 5 peptides with the following amino acid sequences: EMPFPKYPKYPVEPF, HIQKEDVPSE, GSENSEKTTMPL, NQDKTEIPT, and EGIHAQQKEPM. The results from cell experiments showed that the 2 hydrolysates could promote cell growth and decrease lactate dehydrogenase release in the lipopolysaccharide-injured cells; more importantly, they could partially protect the damaged barrier function of the cells by increasing trans-epithelial electrical resistance, decreasing epithelial permeability, and upregulating the expression of the 3 tight junction proteins zonula occludens-1, occludin, and claudin-1. However, compared with CN hydrolysate, GCN hydrolysate showed lower efficacy in protecting against cellular barrier dysfunction. We propose that the different chemical characteristics of the CN hydrolysate and the GCN hydrolysate (i.e., amino acid loss and lactose conjugation) contributed to the lower barrier-protective efficacy of the GCN hydrolysate. During dairy processing, protein glycation of the Maillard type might have a non-negligible, unfavorable effect on dairy proteins, in view of the resulting protein glycation we found and the critical function of proteins for maintaining the integrity of the intestinal barrier.

RETRACTED: ORIENT-3: A randomized, open-label, phase III study of sintilimab versus docetaxel in previously treated advanced/metastatic squamous non-small cell lung cancer (sqNSCLC)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article was retracted at the request of the authors. The authors of this abstract have advised that full agreement between authors and sponsors on publication of the abstract has not been reached and they are therefore unable to publish this data at present.

Early and late pregnancy loss in women with polycystic ovary syndrome undergoing IVF/ICSI treatment: a retrospective cohort analysis of 21 820 pregnancies

OBJECTIVE

To examine early and late pregnancy loss in women with and without polycystic ovary syndrome (PCOS) undergoing IVF/ICSI transfers.

DESIGN

Retrospective cohort study.

SETTING

Reproductive medicine centre at a tertiary hospital.

POPULATION

We studied women with a positive β-human chorionic gonadotropin (β-hCG) after in vitro fertilisation/intra-cytoplasmic sperm injection (IVF/ICSI) treatment from May 2014 to April 2019.

METHODS

Odds ratios (OR) for early (≤13 weeks) and late (>13 weeks) pregnancy loss were calculated among women with and without PCOS for plurality of the pregnancy with adjustment for confounding factors.

MAIN OUTCOME MEASURES

Early pregnancy loss (EPL) and late pregnancy loss (LPL).

RESULTS

From 21 820 women identified with a positive β-hCG, 2357 (10.8%) women had PCOS, and 19 463 (89.2%) women did not. EPL occurred in 16.6% (391) of women with PCOS versus 18.3% (3565) in women with non-PCOS (OR 0.89, 95% CI 0.79-0.99, P = 0.04). After adjustment for age and other confounders, the rate of EPL was not statistically significantly associated with PCOS status (adjusted OR [aOR] 0.91, 95% CI 0.80-1.05). Women with PCOS demonstrated a higher rate of LPL (6.4% in PCOS versus 3.6% in non-PCOS, OR 1.81, 95% CI 1.48-2.21, P < 0.001). In multivariable analysis, the potential impact of PCOS was less strong (aOR 1.38, 95% CI 0.96-1.98), with BMI and maternal comorbidities also associated with LPL (aOR 1.08, 95% CI 1.04-1.1 and aOR 2.07, 95% CI 1.43-3.00, respectively).

CONCLUSIONS

Polycystic ovary syndrome was not independently associated with EPL. There was an increased risk of LPL but this difference was not statistically significant.

TWEETABLE ABSTRACT

Polycystic ovary syndrome women are at increased risk of late pregnancy loss, partly driven by elevated BMI and maternal comorbidities.

[Relationship between frailty status and risk of death in the elderly based on frailty index analysis]

Objective: To analyze the relationship between frailty status and the risk of death in the elderly based on the frailty index (FI). Methods: Data from a prospective cohort study conducted between 2005 and 2015 in elderly people of an urban community in Beijing were analyzed. The variables related to health and frailty status based on the 2005 baseline survey and death as outcome variables collected in 2015 were used. A FI model was used to evaluate the correlation between FI and mortality in the elderly people in different age groups was analyzed. Cox regression was applied to evaluate the influence of FI on the risk of death, and Kaplan-Meier curves was used to show the survival rate of different frailty levels in the elderly adults. Results: Of the 1 301 elderly people included in the analysis, 403 died during 2005-2015, with the 10-year mortality rate of 31.0%(403/1 301). The mortality rate of the elderly increased with the increase of FI, but, with the increase of FI value, the rate of mortality increased slowly. The limit value of FI causing death was around 0.70, indicating any new health problem might cause death at this value. Cox regression analysis showed that higher FI was associated with higher risk for death (HR=1.143, 95%CI: 1.034-1.248, P=0.000), and FI was more significantly associated with death than age (HR=1.143 vs. HR=1.048, t=5.827, P=0.000). With the increase of age, the effect of frailty on the risk of death decreased (HR=1.179 to HR=1.120). Kaplan-Meier curves showed that the survival rate of the elderly in all age groups decreased with the increase of frailty (Log-rank=317.812, 354.203, 247.258, all P=0.000). The survival time between different frailty levels in the elderly were significantly different, except for the elderly adults aged ≥80 years with severe frailty level (0.4≤FI<0.5, FI≥0.5, P=0.368). Conclusions: Compared with other evaluation tools of frailty, FI model can better reflect the frailty status of the elderly in communities in Beijing and has a high sensitivity in predicting adverse outcomes such as mortality. In the intervention of frailty in the elderly, focusing on relatively young elderly might be more effective in reducing the adverse outcomes caused by frailty.

[The mediating role of psychological capital between occupational stress and suicidal ideation]

Objective: To analyze the mediating effect of psychological capital (PsyCap) between occupational stress and suicidal ideation. Methods: In September 2017, stratified-cluster sampling method was adopted to select employees of an electronic manufacturing service industry as respondents for a questionnaire survey in Jiangsu province. The demographic characteristics of employees were collected. A total of 2 465 employees were investigated, and 2 216 valid questionnaires were collected. The level of occupational stress and PsyCap was assessed by the Effort-Reward Imbalance Scale(ERI)and PsyCap Questionnaire. Results: The age of 2 216 employees was (28.70±5.26) years old, including 1 230 males (55.5%). The scores of occupational stress on effort, reward and over-commitment were (3.08±0.63), (3.73±0.60) and (2.51±0.68), respectively. The average ERI index (ratio of effort to return) was (0.88±0.39). The total score of PsyCap was (86.62±15.23). The detection rate of suicidal ideation within two weeks was 13.9% (309/2 216). The average score of effort and over-commitment and the ERI index were positively correlated with the number of suicidal ideation detected within two weeks, with correlation coefficients about 0.081, 0.141 and 0.164, respectively. The average score of reward and total score of PsyCap were negatively correlated with the number of suicidal ideation detected within two weeks, with correlation coefficients about -0.206 and -0.228, respectively. The mediating effect results showed that PsyCap had mediating effect on the effort, reward, over-commitment and suicidal ideation of occupational stress respectively, with mediating effect values of -0.087 (95%CI: -0.018,-0.019), -0.299 (95%CI: -0.428,-0.200) and 0.096 (95%CI: 0.0394, -0.170). The mediating effect percentages were 9.43%, 17.92%, and 9.54%, respectively. Conclusion: PsyCap has a mediating effect between effort, reward, over-commitment of occupational stress and suicidal ideation.

Truncated stathmin-2 is a marker of TDP-43 pathology in frontotemporal dementia

No treatment for frontotemporal dementia (FTD), the second most common type of early-onset dementia, is available, but therapeutics are being investigated to target the 2 main proteins associated with FTD pathological subtypes: TDP-43 (FTLD-TDP) and tau (FTLD-tau). Testing potential therapies in clinical trials is hampered by our inability to distinguish between patients with FTLD-TDP and FTLD-tau. Therefore, we evaluated truncated stathmin-2 (STMN2) as a proxy of TDP-43 pathology, given the reports that TDP-43 dysfunction causes truncated STMN2 accumulation. Truncated STMN2 accumulated in human induced pluripotent stem cell-derived neurons depleted of TDP-43, but not in those with pathogenic TARDBP mutations in the absence of TDP-43 aggregation or loss of nuclear protein. In RNA-Seq analyses of human brain samples from the NYGC ALS cohort, truncated STMN2 RNA was confined to tissues and disease subtypes marked by TDP-43 inclusions. Last, we validated that truncated STMN2 RNA was elevated in the frontal cortex of a cohort of patients with FTLD-TDP but not in controls or patients with progressive supranuclear palsy, a type of FTLD-tau. Further, in patients with FTLD-TDP, we observed significant associations of truncated STMN2 RNA with phosphorylated TDP-43 levels and an earlier age of disease onset. Overall, our data uncovered truncated STMN2 as a marker for TDP-43 dysfunction in FTD.

Implementation of a Walsh-Hadamard Gate in a Superconducting Qutrit

We have implemented a Walsh-Hadamard gate, which performs a quantum Fourier transform, in a superconducting qutrit. The qutrit is encoded in the lowest three energy levels of a capacitively shunted flux device, operated at the optimal flux-symmetry point. We use an efficient decomposition of the Walsh-Hadamard gate into two unitaries, generated by off-diagonal and diagonal Hamiltonians, respectively. The gate implementation utilizes simultaneous driving of all three transitions between the three pairs of energy levels of the qutrit, one of which is implemented with a two-photon process. The gate has a duration of 35 ns and an average fidelity over a representative set of states, including preparation and tomography errors, of 99.2%, characterized with quantum-state tomography. Compensation of ac-Stark and Bloch-Siegert shifts is essential for reaching high gate fidelities.

[Application of an occupational health risk assessment method in dioctyl phthalate producing enterprise]

Objective: To find the risk assessment model of [di (2-ethylhexyl) phthalate, DEHP] fitting well for producing companies. Methods: The Cluster Sampling method was used in selecting a DEHP producing company in the occupational health and workplace environment monitoring study conducted between July and August in 2017. Data was collected by site evaluating and workplace environment monitoring. According to GBZ/T 298-2017《Technical Guidelines for Occupational Health Risk Assessment of Chemical Hazards in the Workplace》, a qualitative assessment method and a semi-quantitative comprehensive index method were chosen as the models and were compared. Results: The occupational health risk of the two methods rated 4 (high risk) and 2 (negligible risk) . Conclusion: The semi-quantitative comprehensive index method is more comprehensive and accurate when used to assess the occupational health risk caused by DEHP.

[Expression of SOX-11 and TFE3 in solid-pseudopapillary tumor of pancreas and its clinical significance]

Objective: To investigate the expression status and diagnostic value of SRY related high mobility group box 11 (SOX-11) and transcription factor E-3 (TFE3) in solid pseudopapillary tumors of pancreas (SPTPs). Methods: Thirty-eight cases of SPTPs, 36 cases of well-differentiated pancreatic neuroendocrine tumors (PanNETs) and six cases of pancreatic acinar cell carcinomas (PACCs) were collected at the Affiliated Drum Tower Hospital of Nanjing University Medical School from 2012 to 2019. The expression of SOX-11, TFE3 and β-catenin was detected by immunohistochemistry, and the TFE3 gene status was detected by FISH in 18 cases of SPTPs. Results: Among the 38 SPTP patients, 29 were female and 9 were male, with a mean age of 50 years; among 36 PanNET patients, 32 were female and 4 were male, with a mean age of 39 years; for the six PACC patients, four were male and two were female, with a mean age of 60 years. β-catenin was positive in all 38 SPTPs, but was negative in all 36 PanNETs and 5/6 PACCs. SOX-11 was positive in 35/38 (92.1%) of SPTPs, but was negative in all 36 PanNETs and 6 PACCs. TFE3 was positive in 36/38 (94.7%) of SPTPs, but was negative in all 36 PanNETs and 6 PACCs. Among these three tumors, the specificity and sensitivity of β-catenin were 97.6% and 100.0%, the specificity and sensitivity of SOX-11 were 92.1% and 100.0%, the specificity and sensitivity of TFE3 were 94.7% and 100.0%, respectively. There was a significant difference of the expression status of all three markers in SPTPs compared with PanNETs and PACCs (P<0.01). The results of SOX-11 and TFE3 immunostaining showed high consistency (Kappa>0.6). No gene rearrangement (0/18) of TFE3 was found in SPTPs. Conclusion: SOX-11 and TFE3 are highly expressed in SPTPs, and their specificity in the differential diagnosis of SPTPs is better than that of β-catenin.

Parecoxib improves the cognitive function of POCD rats via attenuating COX-2

OBJECTIVE

This study aims to explore the role of parecoxib in improving postoperative cognitive dysfunction (POCD) in rats, and to investigate the possible underlying mechanism.

MATERIALS AND METHODS

60 Sprague Dawley (SD) rats were randomly divided into the control group (n=20), the model group (n=20), and the para group (n=20). The Morris water maze test was conducted to detect the postoperative cognitive ability of rats. The hematoxylin-eosin (HE) staining was applied to observe the neuronal density in the hippocampus of rats. The TdT-mediated dUTP Nick-End Labeling (TUNEL) was used to detect the hippocampal apoptosis in rats. Meanwhile, relative levels of inflammatory factors in rat hippocampus were detected by enzyme-linked immunosorbent assay (ELISA), including interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), and prostaglandin E2 (PGE2). Furthermore, Western blot was conducted to detect the protein levels of cyclooxygenase-2 (COX-2), PGE2, EP1, and p-Akt in rat hippocampus.

RESULTS

Behavioral test results showed that the escape latency of rats in the para group was significantly shorter than that of the model group (p<0.05). Compared with the model group, rats in para group showed significantly longer time in target quadrant and more times across the platform, as well as higher Tn/Tn+Tf (p<0.05). In the control group, pathological changes of hippocampal neurons were slighter with rare apoptotic cells. Rats in model group showed great pathological lesions with abundant apoptotic neurons, which were markedly alleviated in the para group (p<0.05). Meanwhile, ELISA showed that the levels of IL-1β, IL-6, TNF-α, and PGE2 in the para group were remarkably lower than those of the model group (p<0.05). Expression levels of COX-2, PGE2, and EP1 in the para group were significantly lower than those of the model group (p<0.05). However, the expression level of p-Akt was significantly higher than the model group (p<0.05).

CONCLUSIONS

Parecoxib improves the cognitive function of POCD rats via inhibiting COX-2 overexpression in rat brain.

Applications of microbial co-cultures in polyketides production

Polyketides are a large group of natural biomolecules that are normally produced by bacteria, fungi and plants. These molecules have clinical importance due to their anti-cancer, anti-microbial, anti-oxidant and anti-inflammatory properties. Polyketides are biosynthesized from units of acyl-CoA by different polyketide synthases (PKSs), which display wide diversity of functional domains and mechanisms of action between fungi and bacteria. Co-culture of different micro-organisms can produce novel products distinctive from those produced during single cultures. This study compared the new polyketides produced in such co-culture systems and discusses aspects of the cultivation systems, product structures and identification techniques. Current results indicate that the formation of new polyketides may be the result of activation of previously silent PKSs genes induced during co-culture. This review indicated a potential way to produce pure therapeutic polyketides by microbial fermentation and a potential way to develop functional foods and agricultural products using co-co-culture of different micro-organisms. It also pointed out a new perspective for studies on the process of functional foods, especially those involving multiple micro-organisms.

[A multicentric study on clinical characteristics and antibiotic sensitivity in children with methicillin-resistant Staphylococcus aureus infection]

Objective: To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods: The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children's hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children's general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed. The t test and Wilcoxon rank sum test were used for statistical analysis of the quantitative data and Chi-square test were used for comparison of rates. Results: Among the 452 patients, 264 were males and 188 were females, aged from 2 days to 17 years. There were 233 cases (51.5%) in the ≤1 year old group, 79 cases (17.5%) in the>1-3 years old group, 29 cases (6.4%) in the >3-5 years old group, 65 cases (14.4%) in the >5-10 years old group, and 46 cases (10.2%) in the>10 years old group. The main distributions of onset seasons were 55 cases (12.2%) in December, 47 cases (10.4%) in February, 46 cases (10.2%) in November, 45 cases (10.0%) in January, 40 cases (8.8%) in March. There were 335 cases (74.1%) CA-MRSA and 117 (25.9%) cases HA-MRSA. Among all cases, 174 cases (38.5%) had basic diseases or long-term use of hormone and immunosuppressive drugs. During the period of hospitalization, 209 cases (46.2%) received medical interventions. There were 182 patients (40.3%) had used antibiotics (β-lactams, glycopeptides, macrolides, carbapenems, oxazolones, sulfonamides etc) 3 months before admission. The most common clinical disease was pneumonia (203 cases), followed by skin soft-tissue infection (133 cases), sepsis (92 cases), deep tissue abscess (42 cases), osteomyelitis (40 cases), and septic arthritis (26 cases), suppurative meningitis (10 cases). The proportion of pneumonia in the ≤1 year old group was higher than the >1-3 years old group,>3-5 years old group,>5-10 years old group,>10 years old group (57.5% (134/233) vs. 30.4% (24/79), 31.0% (9/29), 38.5% (25/65), 23.9% (11/46), χ(2)=17.374, 7.293, 7.410, 17.373, all P<0.01) The proportion of skin and soft tissue infections caused by CA-MRSA infection was higher than HA-MRSA (33.4% (112/335) vs. 17.9% (21/117), χ(2)=10.010, P=0.002), and the proportion of pneumonia caused by HA-MRSA infection was higher than CA-MRSA (53.0% (62/117) vs. 42.1% (141/335), χ(2)=4.166, P=0.041). The first white blood cell count of the ≤1 year old group was higher than that children > 1 year old ((15±8)×10(9)/L vs. (13±7)×10(9)/L, t=2.697, P=0.007), while the C-reactive protein of the ≤1 year old group was lower than the 1-3 years old group,>5-10 years old group,>10 years old group (8.00 (0.04-194.00) vs.17.00 (0.50-316.00), 15.20 (0.23-312.00), 21.79(0.13-219.00) mg/L, Z=3.207, 2.044, 2.513, all P<0.05), there were no significant differences in procalcitonin (PCT) between different age groups (all P>0.05). After the treatment, 131 cases were cured, 278 cases were improved, 21 cases were not cured, 12 cases died, and 10 cases were abandoned. The 452 MRSA isolates were all sensitive to vancomycin (100.0%), linezolid (100.0%), 100.0% resistant to penicillin, highly resistant to erythromycin (85.0%, 375/441), clindamycin (67.7%, 294/434), less resistant to sulfonamides (5.9%, 23/391), levofloxacin (4.5%, 19/423), gentamicin (3.2%, 14/438), rifampicin (1.8%, 8/440), minocycline (1.1%, 1/91). The antimicrobial resistance rates were not significantly different between the CA-MRSA and HA-MRSA groups (all P>0.05). Conclusions: The infection of MRSA is mainly found in infants under 3 years old. The prevalent seasons are winter and spring, and MRSA is mainly acquired in the community. The main clinical diseases are pneumonia, skin soft-tissue infection and sepsis. No MRSA isolate is resistant to vancomycin, linezolid. MRSA isolates are generally sensitive to sulfonamides, levofloxacin, gentamicin, rifampicin, minocycline, and were highly resistant to erythromycin and clindamycin. To achieve better prognosis. clinicians should initiate anti-infective treatment for children with MRSA infection according to the clinical characteristics of patients and drug sensitivity of the isolates timely and effectively.

[Ibrutinib treatment for 2 cases of relapsed/refractory autoimmune hemolytic anemia: a pilot study]

目的

探索伊布替尼治疗复发/难治原发性自身免疫性溶血性贫血（AIHA）的疗效及安全性。

方法

2例原发性AIHA患者多次复发，1例有脾切除史，经糖皮质激素、利妥昔单抗及多种免疫抑制药物治疗无效，诊断为复发/难治原发性AIHA。给予伊布替尼起始剂量280 mg/d（例1第3～8周加量到420 mg/d）治疗，观察疗效及安全性。

结果

例1治疗2周后脱离输血，HGB增长>20 g/L，获得部分疗效；10周后HGB 113 g/L伴有代偿性溶血实验室改变，获得完全缓解伴代偿性溶血状态（CRi）。例2治疗2周后脱离输血，HGB增长>20 g/L，获得部分疗效；6周后HGB 118 g/L伴有代偿性溶血实验室改变，获得CRi。2例患者分别随访16周和12周，已维持疗效14周和10周，未复发。伊布替尼治疗期间2例患者血液学不良反应轻，非血液学不良反应轻微。

结论

伊布替尼单药治疗复发/难治原发性AIHA有初步疗效，尚需规范的临床研究试验进一步验证其疗效及安全性。

Genomic Alterations of NTRK, POLE, ERBB2, and Microsatellite Instability Status in Chinese Patients with Colorectal Cancer

Background

The increasing molecular characterization of colorectal cancers (CRCs) has spurred the need to look beyond RAS, BRAF, and microsatellite instability (MSI). Genomic alterations, including ERBB2 amplifications and mutations, POLE mutations, MSI, and NTRK1–3 fusions, have emerged as targets for matched therapies. We sought to study a clinically annotated Chinese cohort of CRC subjected to genomic profiling to explore relative target frequencies.

Methods

Tumor and matched whole blood were collected from 609 Chinese patients with CRC. Extracted DNA was analyzed for all classes of genomic alterations across 450 cancer‐related genes, including single‐nucleotide variations (SNVs), short and long insertions and deletions (indels), copy number variations, and gene rearrangements. Next‐generation sequencing–based computational algorithms also determined tumor mutational burden and MSI status.

Results

Alterations in TP53 (76%), APC (72%), and KRAS (46%) were common in Chinese patients with CRC. For the first time, the prevalence of NTRK gene fusion was observed to be around 7% in the MSI‐high CRC cohort. Across the cohort, MSI was found in 9%, ERBB2 amplification in 3%, and POLE pathogenic mutation in 1.5% of patients. Such results mostly parallel frequencies observed in Western patients. However, POLE existed at a higher frequency and was associated with large tumor T‐cell infiltration.

Conclusion

Comparing to the Western counterparts, POLE mutations were increased in our cohort. The prevalence of NTRK gene fusion was around 7% in the MSI‐high CRC cohort. Increased adoption of molecular profiling in Asian patients is essential for the improvement of therapeutic outcomes.

Implications for Practice

The increasing use of genomic profiling assays in colorectal cancer (CRC) has allowed for the identification of a higher number of patient subsets benefiting from matched therapies. With an increase in the number of therapies, assays simultaneously evaluating all candidate biomarkers are critical. The results of this study provide an early support for the feasibility and utility of genomic profiling in Chinese patients with CRC.

The emergence of precision medicine has identified genomic variants, such as NTRK gene fusion, microsatellite instability (MSI), HER2 amplification, and POLE pathogenic mutation, as potential agonistic biomarkers for immune or targeted therapies. This article examines NTRK, HER2, and POLE in a cohort of Chinese patients with colorectal cancer.

The role of hsa_circ_0000285 in metastasis of hepatocellular carcinoma

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "The role of hsa_circ_0000285 in metastasis of hepatocellular carcinoma, by X.-J. Zhang, G. Cao, J. Fu, H.-J. Zhuang, J. Shi, published in Eur Rev Med Pharmacol Sci 2020; 24 (7): 3579-3585-DOI: 10.26355/eurrev_202004_20819-PMID: 32329832" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/20819.

Aspirin protects human coronary artery endothelial cells by inducing autophagy

Although the use of aspirin has substantially reduced the risks of cardiovascular events and death, its potential mechanisms have not been fully elucidated. In a previous study, we found that aspirin triggers cellular autophagy. In the present study, we aimed to determine the protective effects of aspirin on human coronary artery endothelial cells (HCAECs) and explore its underlying mechanisms. HCAECs were treated with oxidized low-density lipoprotein (ox-LDL), angiotensin II (Ang-II), or high glucose (HG) with or without aspirin stimulation. The expression levels of endothelial nitric oxide (NO) synthase (eNOS), p-eNOS, LC3, p62, phosphor-nuclear factor kappa B (p-NF-κB), p-p38 mitogen-activated protein kinase (p-p38 MAPK), and Beclin-1 were detected via immunoblotting analysis. Concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured via ELISA. NO levels were determined using the Griess reagent. Autophagic flux was tracked by tandem mRFP-GFP-tagged LC3. Results showed that aspirin increased eNOS level and reduced injury to the endothelial cells (ECs) caused by ox-LDL, Ang-II, and HG treatment in a dose-dependent manner. Aspirin also increased the LC3II/LC3I ratio, decreased p62 expression, and enhanced autophagic flux (autophagosome and autolysosome puncta) in the HCAECs. p-NF-κB and p-p38 mitogen-activated protein kinase inhibition, sVCAM-1 and sICAM-1 secretion, and eNOS activity promotion by aspirin treatment were found to be dependent on Beclin-1. These results suggested that aspirin can protect ECs from ox-LDL-, Ang-II-, and HG-induced injury by activating autophagy in a Beclin-1-dependent manner.

Status analysis and evaluation of the blood scrap rate from 2015-2017 for a blood center in China

OBJECTIVES

The objective of this study was to ascertain the current conditions and development in the past three years of clinical transfusion practice in Nanjing, Jiangsu province, China.

MATERIALS AND METHODS

Blood quality control practices and the blood production scrap rate from 2015-2017 were monitored and measured using different quality statistics and management tools.

RESULTS

The causes of unqualified and scrapped blood during blood collection and supply were analyzed and evaluated. The analysis of the key indices for blood component quality control showed that the qualified rate of FVIII activity (from fresh frozen plasma) was 54.55%, which failed to meet the threshold of 75%. Retrospective analysis of conventional blood scrapping factors showed that laboratory scraps accounted for the majority. The composition ratio of TTI screening results included ALT (31.91%), HBV (21.92%), TP (12.15%), NAT (10.78%), HCV (8.45%), and HIV (7.43%). Retrospective analysis of unconventional blood scrapping factors showed that the total unconventional blood depletion rate was 0.565%. Insufficient or small quantities of collected blood was the most important factor related to unconventional scrapping. The blood donor and blood hospital service satisfaction rates were over 95% and 90%, respectively, which achieved the quality target.

CONCLUSIONS

Nonconforming product control was proposed and determined as the urgent theme of the first QCC. It is necessary for blood stations to effectively control blood scrapping, which can reduce the cost of blood collection, protect the blood donation of unpaid blood donors, increase the rate of repeated blood donation, and improve blood safety.

[Orthodontic treatment in patients with periodontitis]

Patients with malocclusions and periodontitis need to conduct the orthodontic treatment based on good periodontal treatment. Combined orthodontic-periodontal treatment can improve occlusal relationship, effectively promote inflammation control and long-term stability.

[A prospective cohort study on blood pressure control and risk of ischemic stroke in patients with hypertension]

Objective: To explore the association between blood pressure control and risk of ischemic stroke (IS) in patients with hypertension. Methods: A total of 5 488 patients with hypertension from 60 communities were randomly selected from 101 communities in 8 streets of Nanshan District in Shenzhen City by using two-stage sampling method. The social demographic characteristics, behavior and life style, coronary heart disease and diabetes were collected and the physical condition, blood pressure and blood biochemical indexes were measured. From April 1, 2010 to August 31, 2017 as the follow-up period, the incidence of IS was annually collected by using telephone survey. Cox proportional hazard regression model was used to analyze the relationship between blood pressure control, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the risk of IS. Results: The age of all patients was (58.50±12.14) years old, including 2 712 males (49.42%) and 3 112 patients with well-controlled blood pressure (56.71%). During the follow-up period, 358 new cases of IS were confirmed, and the incidence density was 1 346.27/100 000 person-years. Cox proportional hazard regression model analysis showed after adjusting for confounding factors, unstable blood pressure control, SBP≥150 mmHg (1 mmHg=0.133 kPa; compared with SBP<120 mmHg), and DBP≥95 mmHg (compared with DBP<80 mmHg) were associated with risk of IS. The HR (95%CI) was 1.29 (1.04, 1.59), 2.00 (1.26, 3.17) and 1.52 (1.01, 2.64), respectively. Subgroup analyses showed these associations only existed in female patients with hypertension. The HR (95%CI) was 1.39 (1.05, 1.85), 2.53 (1.41, 4.56) and 1.73 (1.00, 3.36), respectively. Conclusion: Unstable blood pressure control increases the risk of IS in female patients with hypertension.

[Characteristics of methadone maintenance treatment clinic patients and influencing factors for HBsAg positivity based on Bayesian network model]

Objective: To understand the characteristics and explore the influencing factors of HBsAg positivity in methadone maintenance treatment (MMT) clinic patients. Methods: A face to face interview and medical record review were conducted in 1 040 patients at three MMT clinics in Guangxi from September to November in 2014. The questionnaire information included general demographic characteristics, drug use history, MMT status, sexual behaviors, and health status, etc. Blood samples were collected from the patients at the same time for the detections of the level of HBsAg, anti-HBs and anti-HCV. By using χ(2) test, unconditional logistic regression model and Bayesian network model the influencing factors for HBsAg positivity in MMT clinic patients and the complex network relationship among these factors were explored. Results: A total of 1 031 MMT clinic patients were surveyed, the HBsAg positive rate was 11.35% (117/1 031). The anti-HCV positive rate was 71.77% (740/1 031), among the anti-HCV positive patients, the HBsAg positive rate was 10.27% (76/740). After adjusting for the confounding factors, anti-HBs positive persons might not be HBsAg positive (OR=0.05, 95%CI: 0.03-0.09), and anti-HCV positive persons might not be HBsAg positive too (OR=0.30, 95%CI: 0.17-0.52) compared with anti-HBs negative and anti-HCV negative persons, respectively. The persons with family history of hepatitis B virus infection were more likely to be HBsAg positive compared those with no such family history (OR=5.30, 95%CI: 2.68-10.52). Bayesian network model analysis results showed that family history of hepatitis B virus infection and anti-HBs were directly related with HBsAg positivity. Anti-HCV, intravenous drug use in the past three months and other drug using during treatment were indirectly related with HBsAg positivity. Conclusions: Anti-HBs, family history of hepatitis B virus infection, anti-HCV, intravenous drug use in past three months and other drug use during treatment were related with the HBsAg positivity in MMT clinic patients. So, it is necessary to enhance health education, improve health awareness and decrease high risk behaviors to reduce the rate of HBV infection.

Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York City hospital through screening of virulence genes

OBJECTIVES

The 'hypervirulent' variant of Klebsiella pneumoniae (hvKp) is a predominant cause of community-acquired pyogenic liver abscess in Asia, and is an emerging pathogen in Western countries. hvKp infections have demonstrated 'metastatic' dissemination in immunocompetent hosts, an unusual mode of infection associated with severe complications. Two cases alerted us to the possible presence of hvKp at our hospital, both involving elderly Hispanic males who presented with recurrent fever, bacteraemia, epigastric pain and liver abscesses/phlegmon, thus prompting an assessment of hvKp prevalence.

METHODS

A surveillance of K. pneumoniae blood, body fluid and wound isolates was conducted using real-time PCR to detect virulence-associated genes (uni-rmpA, iucA and peg344). Positive isolates were further characterized by wzi gene sequencing to determine capsular types (K-type) and by multilocus sequence typing and pulsed-field gel electrophoresis to determine strain relatedness.

RESULTS

Four-hundred and sixty-three K. pneumoniae isolates, derived from 412 blood, 21 body fluids and 30 abdominal wound specimens, were screened over a 3-year period. Isolates included 98 multidrug-resistant strains. Eighteen isolates from 17 patients, including two from the index patient, screened positive for all three virulence genes. Sixteen of 18 positive isolates had K-types associated with hvKp, and isolates from different patients were unrelated strains, indicating likely community acquisition. Of 13 patients with significant morbidity, five died; eight patients had co-existing hepatobiliary disease, and six had diabetes mellitus.

CONCLUSIONS

Multiple strains of hvKp are emerging in New York City and are associated with high mortality relative to multidrug-resistant and classical Klebsiella infections. Co-existing hepatobiliary disease appears to be a potential risk factor for these infections.