[Analysis of airborne allergens in chronic urticaria with airway allergic diseases]

To analyze the sensitization characteristics and significance of airborne allergens in chronic urticaria (CU) with airway allergic diseases (allergic rhinitis and/or asthma). From May to August 2015, the Department of allergy, Beijing Shijitan Hospital Affiliated to Capital Medical University conducted an epidemiological survey of allergic diseases in grassland area of Inner Mongolia by multistage stratified cluster sampling. The results of skin prick test (SPT) for airborne allergens in 191 patients with CU and 1 132 patients with airway allergic diseases were analyzed. The statistical data were tested by chi-square segmentation method, and the stratified trend of rate was tested by Linear-by-Linear. Among the 191 patients with CU, 92 (48.17%) had CU without airway allergic diseases (CU alone), and 99 (51.83%) had CU with airway allergic diseases. The top three air allergens were house dust mite, chenopodium pollen and salix pollen in CU alone (only one is the major local allergen), and artemisia, humulus scandens and chenopodium pollen in CU with airway allergic diseases (All are the main local allergens) and airway allergic diseases. Compared between CU alone and CU with airway allergic disease, the positive rate of allergen SPT and multiple strong positive rate were statistically significant (59.60% vs 38.04%, χ²=13.336;27.12% vs 2.86%, χ²=8.729;P<0.016 7).There was no significant difference in positive rate of skin prick, multiple positive rate, strong positive rate and multiple strong positive rate between CU with airway allergic disease and airway allergic diseases (59.60% vs 57.69%, χ²=0.136, P>0.016 7; 71.19% vs 75.20%, χ²=0.461, P>0.016 7; 54.24% vs 69.68%, χ²=5.969, P>0.016 7; 27.12% vs 37.83%, χ²=2.663, P>0.016 7), but there was significant difference in these between CU without airway allergic disease and airway allergic diseases (38.04% vs 57.69%, χ²=13.336, P<0.01; 51.43% vs 75.20%, χ²=9.745, P<0.01; 28.57% vs 69.68%, χ²=25.624, P<0.01; 2.86% vs 37.83%, χ²=17.620, P<0.01).The strong positive rate and the multiple strong positive rate of allergen increased with the increase of CU with allergic diseases, and the trend difference was statistically significant (38.04%,56.98% and 76.92%, χ²=10.601, P<0.01; 28.57%,46.94% and 90.00%, χ²=12.085, P<0.01; 2.86%,24.49% and 40.00%, χ²=10.077, P<0.01). The allergen sensitization characteristics of CU with airway allergic diseases are similar to airway allergic diseases,and the detection of airborne allergens may have certain clinical value in the screening of risk factors for patients with CU associated with airway allergic diseases.

[Plasm trimethylamine-N-oxide level and association with lesion severity in coronary heart disease patients with type 2 diabetes mellitus]

Objective: To investigate the association between trimethylamine-N-oxide (TMAO) and the degree of coronary atherosclerosis in coronary heart diseases (CHD) patients with type 2 diabetes mellitus. Methods: Consecutive patients, who underwent coronary angiography due to suspected CHD in Beijing Hospital from November 2016 to January 2018, were screened in this cross-sectional study. According to blood glucose level, previous medical history and coronary angiography results, they were divided into CHD without type2 diabetes mellitus(CHD-nDM) group and CHD with type2 diabetes mellitus(CHD-DM) group. Plasma TMAO levels in each group were measured by LC-MS/MS. Spearman correlation analysis was used to evaluate the correlation between TMAO and the number of diseased vessels and Gensini scores. Multivariate logistic regression was used to analyze the correlation between TMAO and high Gensini scores. Results: A total of 590 patients were enrolled in the study, including 238 patients in CHD-DM group and 352 patients in CHD-nDM group. Patients were older, body mass index, blood pressure level, prevalence of history of hypertension and statins use were higher in CHD-DM group than in CHD-nDM group (all P<0.05). The proportion of patients with multivessel disease (2 or more vessels) was also higher in CHD-DM group than in CHD-nDM group (P<0.001). Gensini score was higher in CHD-DM group than in CHD-nDM group (P<0.05). Fasting blood glucose, glycosylated hemoglobin and urea were significantly higher, while low-density lipoprotein cholesterol and hemoglobin were significantly lower in CHD-DM group than in CHD-nDM group (all P<0.05). The levels of TMAO was significantly higher in CHD-DM group than in CHD-nDM group (P<0.001). Spearman correlation analysis showed that TMAO was positively correlated with the number of diseased vessels, Gensini score, age and blood glucose level (r=0.178, 0.189, 0.260, 0.111, respectively, all P<0.01). Multivariate logistic regression analysis showed that, TMAO level was still positively correlated with high Gensini score in CHD-DM group (OR=2.25, 95%CI 1.16-4.38, P=0.017), but not in CHD-nDM group (OR=1.29, 95%CI 0.72-2.31, P=0.386) after adjusting for age, sex, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglyceride, history of hypertension, hyperlipidemia, smoking and statin use. Conclusions: In CHD patients with tupe 2 diabetes mellitus, the plasma TMAO level is significantly increased and is independent and positively correlated with the degree of coronary artery disease.

[Follow - up prognostic study on two imported patients with human African trypanosomiasis]

OBJECTIVE

To investigate the prognosis of two rare imported patients with human African trypanosomias (HAT) after treatment in a follow-up study, and to evaluate the therapeutic efficacy, so as to provide insights into the treatment of imported HAT patients.

METHODS

The white blood cells in cerebrospinal fluid samples and the trypomastigotes in cerebrospinal fluid and blood samples were monitored in an imported case with Trypanosoma brucei rhodesiense infection 1, 3, 11 and 25 months post-treatment and in an imported case with T. brucei gambiense infection 1, 3, 8 and 12 months post-treatment to evaluate the therapeutic efficacy and prognosis.

RESULTS

There were 1, 1, 4 and 2 white blood cells in per μL of cerebrospinal fluid in the case with T. brucei rhodesiense infection 1, 3, 11 and 25 months post-treatment, and there were 3, 6, 4 and 3 white blood cells in per μL of cerebrospinal fluid in the case with T. brucei gambiense infection 1, 3, 8 and 12 months post-treatment. In addition, no trypomastigotes were identified in the cerebrospinal fluid or blood samples of either case with T. brucei rhodesiense or T. brucei gambiense infection.

CONCLUSIONS

Following standardized treatment, two imported cases with human African trypanosomiasis cases recover satisfactorily, without any signs of relapse.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

[Characteristics of consonant among children with speech sound disorder]

Objective: To investigate the characteristics of consonant among children with speech sound disorder (SSD) and to provide an empirical basis for the subsequent clinical evaluation and evidence-based intervention. Methods: In this retrospective research a total of 1 395 children diagnosed with SSD from the Language-Speech Clinic of the Department of Children Health Care, Children's Hospital, Capital Institute of Pediatrics from January 2007 to December 2018 were enrolled and underwent the phonological examination on the lexical level with picture naming, according to phoneme development in Chinese mandarin. The Chi-square trend test was applied to analyze the differences and trends of the proportion of consonant error subtypes in children of different age groups. The Chi-square test was conducted to compare the proportion of consonant error subtypes in different gender. Results: The 1 395 children diagnosed with SSD included 1 044 boys and 351 girls, with an age of (5.1±0.8) years. The occurrence of consonant errors in different locations of articulation was the highest for blade-alveolar /l/ (71.8%, 1 002/1 395) and the lowest for labial/b/(9.3%, 130/1 395). The occurrence of consonant errors of labial/p/f/, supra-dental/z/c/s/, blade-alveolar/t/l/, blade-palatal/ch/r/, velar/k/h/, and lingua-palatal/q/decreased with age (all P<0.05). The occurrence of consonant errors of labial/b/m/, supra-dental/z/c/, blade-alveolar/n/l/, blade-palatal/sh/, velar/h/, and lingua-palatal/x/were higher in boys than those in girls (10.3% (108/1 044) vs. 6.3% (22/351), 11.4% (119/1 044) vs. 6.0% (21/351), 64.8% (676/1 044) vs. 51.9% (182/351), 67.8% (708/1 044) vs. 59.8% (210/351), 16.7% (174/1 044) vs. 8.8% (31/351), 73.7% (769/1 044) vs. 66.1% (232/351), 58.0% (606/1 044) vs. 47.6% (167/351), 24.0% (251/1 044) vs. 14.2% (50/351), and 39.9% (417/1 044) vs. 27.6% (97/351); χ²=5.167, 8.533, 16.889, 7.447, 12.863, 7.412, 11.650, 14.900, and 17.099, all P<0.05). The error types of consonant were substitution, omission, and distortion. Omission was the main error type of blade-alveolar/l/(53.3%, 743/1 395), distortion was the main error type of velar/h/(11.8%, 165/1 395), and substitution was the main error type of all other consonants. Substitution with blade-palatal/ch/having the highest occurrence of error (60.2%, 840/1 395). Conclusions: The occurrence of the blade-alveolar/l/error is the highest in children with SSD, with boys demonstrating more serious articulation problems. The main error type of consonant is substitution, with blade-palatal/ch/having the highest occurrence of error. These results suggest the necessity of attending to preschoolers' articulation development. Phonological training targeting blade-alveolar/l/and blade-palatal/ch/should be carried out as early as possible.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

[Performance of a recombinase - aided amplification assay for detection of Schistosoma japonicum infections in Oncomelania hupensis]

OBJECTIVE

To evaluate the efficiency of a recombinase-aided amplification (RAA) assay for the detection of Schistosoma japonicum infections in Oncomelania hupensis snails.

METHODS

A group test was employed. Fifty Oncomelania snails were collected as a detection sample. The detection samples without infected snails were designated as negative specimens, while the detection samples that contained different numbers of infected snails were designated as positive specimens. A total of 10 negative specimens, 10 positive specimens containing 1 infected snail, 20 positive specimens containing 2 infected snails and 10 positive specimens containing 3 infected snails were assigned. Following random grouping, 40 specimens were subject to the florescent RAA assay using a blind method. The miradium shedding method served as a gold standard, and the sensitivity, specificity, Youden's index and coincidence rate of the florescent RAA assay were estimated. In addition, 20 samples consisted of 5 negative specimens and 15 positive specimens with 1, 2 and 3 infected snails respectively were grouped randomly. The same specimens were detected using the crushing method and fluorescent RAA assay with the blind method in a paired-design manner. Then, the test results were compared and analyzed.

RESULTS

Florescent RAA assay detected 29 positives in the 30 specimens containing different numbers of infected snails, with a sensitivity of 96.67%, and 8 negatives in the 10 detection specimens without infected snails, with a specificity of 80.00%, showing a Youden's index of 0.77. The coincidence rate was 100% among 10 repeated assays for a detection specimen. In addition, there was no significant difference in the detection of infected snails between the florescent RAA assay and the crushing method (χ² = 0, P > 0.05), and the actual coincidence rates of the florescent RAA assay and crushing method were 95.00% (19/20) and 90.00% (18/20) with the real results, respectively.

CONCLUSION

Fluorescent RAA assay has a favorable efficiency for the detection of S. japonicum infections in Oncomelania snails, which shows a potential in screening of S. japonicum-infected Oncomelania snails.

Identification of genes associated with litter size combining genomic approaches in Luzhong mutton sheep

Litter size is one of the most important reproductive traits of sheep, which has pronounced effects on the profit of husbandry enterprises and enthusiasm of breeders. Despite the importance of litter size, the underlying genetic mechanisms have not been entirely elucidated. Therefore, based on a high-density SNP chip, genome-wide comparative analysis was performed between two groups with different fecundity to reveal candidate genes linked to litter size via detection of homozygosity and selection signatures in Luzhong mutton sheep. Consequently, nine promising genes were identified from six runs of homozygosity islands, and functionally linked to reproduction (ACTL7A, ACTL7B, and ELP1), embryonic development (KLF5 and PIBF1), and cell cycle (DACH1, BORA, DIS3, and MZT1). A total of 128 genes were observed under selection, of which HECW1 and HTR1E were related to total lambs born, GABRG3, LRP1B, and MACROD2 to teat number, and AGBL1 to reproductive seasonality. Additionally, the presence of inbreeding depression implies the urgency of reasonable mating system to increase litter size in the present herd. These findings provide a comprehensive insight to the genetic makeup of litter size, and also contribute to implementation of marker-assisted selection in sheep.

[Effect of digital virtual simulation system for preclinical teaching of access and coronal cavity preparation]

Objective: To investigate the effectiveness of a digital virtual simulation training system applied in the preclinical teaching of access and coronal cavity preparation. Methods: Twenty dental undergraduate students from Peking University School and Hospital of Stomatology were recruited and divided randomly and equally into two groups according to the random number method after being unified with theory training, including access and coronal cavity preparation skills assessment form and Simodont system operation manual. Tests for access and coronal cavity preparation skills by using standard simulation plastic teeth were performed and the scores were recorded as baseline for each student. Students in group of virtual simulation priority were trained using Simodont virtual simulation system, while those in group of phantom-simulator priority were trained using conventional phantom-simulator system. Access and coronal cavity preparation skills of standard simulation plastic teeth were assessed once again and recorded as the second scores for the two groups. Furthermore, the two groups of students exchanged training systems and were assessed and graded once more as the third scores. Finally, all students were asked to fill up a Teaching Questionnaire after the training. The data were then collected and analyzed. Results: For the group of virtual simulation priority, after the training by using Simodont virtual simulation system and conventional phantom-simulator system, the mean score of access and coronal cavity preparation (16.00±1.49) was significantly higher than the baseline score (13.30±1.41) (P<0.05). For the group of phantom-simulator priority, after the training by using conventional phantom-simulator system and Simodont virtual simulation system, the mean score of access and coronal cavity preparation (15.60±1.26) was also significantly higher than the baseline score (13.00±1.89) (P<0.05). Furthermore, in the group of virtual simulation priority, of which the students were trained by using Simodont virtual simulation system first and then conventional phantom-simulator system, the score of access and coronal cavity preparation was significantly higher than the score of training by using conventional phantom-simulator system only (14.30±1.77) (P<0.05). In the group of phantom-simulator priority, of which the students were trained by using conventional phantom-simulator system first and then Simodont virtual simulation system, the score of access and coronal cavity preparation was significantly higher than the score of training by using Simodont virtual simulation system only (14.10±1.45) (P<0.05). Moreover, in the group of virtual simulation priority, the score of training by using conventional phantom-simulator system after using Simodont virtual simulation system was significantly higher than that of training by using Simodont virtual simulation system only (P<0.05). The results of the questionnaire showed that the students fully agreed that "the Simodont virtual simulation system has the characteristics of repeatability, multi-dimension and multiple practice, and provides me with more attention to details" [80% (16/20)], however "it needs to be improved and upgraded to be close to the conventiaonl phantom-simulator system" [90% (18/20)]. Conclusions: Compared with using the conventional phantom-simulator system only, the preclinical teaching effectiveness of access and coronal cavity preparation could be effectively improved by using Simodont virtual simulation system combined with the phantom-simulator training system and might influenced by the training sequence.

[Effect of body mass index on the assisted reproductive outcome of frozen-thawed embryo transfer in patients with polycystic ovary syndrome]

Objective: To investigate the effect of body mass index (BMI) on clinical pregnancy and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) during frozen-thawed embryo transfer. Methods: A total of 650 patients with PCOS who received routine in vitro fertilization or intracytoplasmic sperm injection treatment for frozen-thawed embryo transfer from June 2014 to June 2019 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed. According to BMI, PCOS patients were divided into group A (18.5≤BMI<23 kg/m², n=253), group B (23≤BMI<25 kg/m², n=167), and group C (BMI≥25 kg/m², n=230). The general information, clinical pregnancy outcomes, pregnancy complications, the incidence of macrosomia and low-birth-weight infants were compared in the three groups, and the influencing factors of neonatal birth weight were analyzed. Results: The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate all showed downward trend with the increase of BMI, but the differences were not statistically significant (all P>0.05). The live birth rate in group C [47.0% (108/230)] was significantly lower than those in groups A and B, with statistical significance (χ²=7.43, P=0.024). The late miscarriage rate was higher in group C [9.4% (13/139)] than in groups A and B (χ²=7.66, P=0.022). The birth rates of macrosomia in groups B [22.2% (16/72)] and group C [21.1% (16/76)] were significantly higher than that in group A, and the difference was statistically significant (χ²=14.15, P=0.001). There was no statistically significant difference in the incidence of gestational diabetes between the three groups (χ²=3.81, P=0.149). The incidence of hypertension disorders complicating pregnancy increased with the increase of BMI, and the difference was not statistically significant (P>0.05). Regression analysis showed that macrosomia was significantly associated with maternal pre-pregnancy BMI and gestational weeks, and the risk of macrosomia increased by 15% (95%CI: 3%-28%) for every increase in maternal BMI. Conclusions: The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate of PCOS patients in frozen-thawed embryo transfer cycles show downward trend with the increase of BMI. Obese patients with PCOS have a significant increase in late miscarriage rate and a significant decrease in live birth rate. The incidence of hypertension disorders complicating pregnancy in PCOS patients in the obese group has an increasing trend, and the birth rate of macrosomia has increased significantly. Therefore, it is recommended that obese women with PCOS lose weight scientifically before pregnancy to improve pregnancy and neonatal outcomes.

[Comparison of prognostic significance between multiparameter flow cytometry and real-time quantitative polymerase chain reaction in the detection of minimal residual disease of Philadelphia chromosome-positive acute B lymphocytic leukemia before allogeneic hematopoietic stem cell transplantation]

目的

探讨多参数流式细胞术（MFC）与实时定量聚合酶链反应技术（RQ-PCR）两种方法检测费城染色体阳性（Ph⁺）急性B淋巴细胞白血病（B-ALL）患者异基因造血干细胞移植（allo-HSCT）前微小残留病（MRD）的预后意义。

方法

回顾性分析2014年7月至2018年2月在北京大学血液病研究所接受allo-HSCT的280例Ph⁺ B-ALL患者，同时用MFC和RQ-PCR法（检测BCR-ABL融合基因表达）检测移植前MRD。

结果

RQ-PCR与MFC检测MRD具有相关性（rs＝0.435，P<0.001）。MFC、RQ-PCR法检测移植前MRD的阳性率分别为25.7％（72/280）、60.7％（170/280）。移植前MFC-MRD阳性组患者移植后白血病3年累积复发率（CIR）明显高于MFC-MRD阴性组（23.6％对8.6％，P<0.001）。RQ-PCR检测BCR/ABL融合基因阳性组（RQ-PCR MRD阳性组）的3年CIR、非复发死亡（NRM）、无白血病生存（LFS）、总生存（OS）与BCR/ABL融合基因阴性组（RQ-PCR MRD阴性组）相比差异均无统计学意义（P>0.05）。移植前RQ-PCR MRD≥1％组比<1％组具有更高的3年CIR（23.1％对11.4％，P＝0.032）、更低的LFS率（53.8％对74.4％，P＝0.015）与OS率（57.7％对79.1％，P＝0.009）。多因素分析显示，移植前MFC-MRD阳性是影响移植后CIR的危险因素（HR＝2.488，95％CI1.216～5.088，P＝0.013），移植前RQ-PCR MRD≥1％是影响LFS（HR＝2.272，95％CI 1.225～4.215，P<0.001）、OS（HR＝2.472，95％ CI 1.289～4.739，P＝0.006）的危险因素。MFC检测MRD预测复发的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）分别为48.50％、77.56％、23.62％、87.16％。以RQ-PCR MRD≥1％预测复发的敏感性、特异性、PPV、NPV分别为23.00％、88.59％、17.15％、91.84％。移植前MFC-MRD阳性或RQ-PCR MRD≥1％二者任一成立为指标预测移植后复发的敏感性、特异性、PPV、NPV分别为54.29％、73.88％、45.70％、91.87％。

结论

MFC和RQ-PCR法检测移植前MRD水平均可预测Ph⁺ B-ALL患者移植预后。移植前MFC-MRD阳性是移植后复发的危险因素。联合使用两种方法（移植前MFC-MRD阳性状态或RQ-PCR MRD≥1％成立）可提高预测移植后复发的敏感性、阳性预测值与阴性预测值，有助于更好筛选出高危患者。

[A sub-cohort study design of the maternal and infant microbes in China National Birth Cohort]

The importance of gut microbes to human health has gradually attracted attention. With the use of animal models, it has been revealed that maternal microbes during pregnancy could influence their children's health outcomes through shaping their microbial composition and regulating the development of their metabolic and immune system. However, the physiological mechanism of the human body is more complex and is affected by the interaction of multiple factors. The research results obtained from animal models are often inconsistent with human studies. At present, the influence of maternal intestinal microbes during pregnancy on the microbial colonization in their offspring and on a series of children's health outcomes is still unclear. Establishing a sub-cohort to detect the microbiome of the women across pregnancy and of their offspring, and further to integrate with variety of environmental and behavioral exposures can better provide reliable support for the research on the mechanism of children's health and diseases. This paper briefly introduces the research objectives, content, progress, strength and limitations of the sub-cohort study.

[Relationship between health literacy and health-related behaviors of enterprise employees]

Objective: To explore the relationship between the health literacy of employees and smoking, drinking, diet and exercise, and provide scientific basis for health education and targeted intervention. Methods: From February to July 2019, a cluster random sampling method was adopted to select enterprise employees in Shihezi City to conduct a questionnaire survey. Self-made questionnaires and "National Resident Health Literacy Monitoring Questionnaire" were used to assess the social demographics, health literacy, and Health-related behaviors were investigated, and 1053 valid questionnaires were collected. Logistic regression model was used to analyze the relationship between health literacy and the three dimensions with smoking, drinking, diet and exercise. Results: Total score of health literacy of enterprise employees is (42.06±11.03) points and the employee health literacy rate of Shihezi City in 2019 is 19.47%. Univariate analysis showed that non-smokers had higher health literacy and three-dimensional health literacy availability than smokers (P<0.01) ; fewer drinkers had higher health literacy availability than overdrinkers (P<0.05) ; balanced diet health literacy availability The health literacy availability rates in the three dimensions were higher than those in the unbalanced diet (P<0.01) . In the logistic regression analysis, healthy lifestyle and behavioral literacy were independently related to smoking behavior (OR=1.571, P<0.05) ; the presence of health literacy and the three dimensions of health literacy were not statistically related to alcohol consumption (P>0.05) ; there is a statistical correlation between health literacy, healthy lifestyles, behaviors, and health skills and regular exercise among employees (OR=1.829、2.503、1.395, P<0.05) ; employees with health literacy and three dimensions of health literacy are more likely to have a balanced diet (P<0.01) . Conclusion: There is a correlation between the health literacy of enterprise employees and diet and exercise. The improvement of health literacy level is an important way to interfere with unhealthy behaviors.

[Investigation and analysis of noise hazards in three key industries in Shenzhen City]

Objective: To understand the basic situation of noise hazards in wood furniture manufacturing, stone processing and special equipment manufacturing industries in Shenzhen City, and to provide basis for preventing and controlling noise hazards. Methods: In August 2019, stratified random sampling ws used to select 21 wood funiture manafacturing, 15 stone processing and 24 special equipment manufactruing as survey object. Through the methods of occupational health field investigation, noise intensity measurement and occupational health examination data collection, the noise hazards of 60 enterprises in three industries were statistically analyzed. Results: There were 154, 44 and 113 noise detection points in wood furniture manufacturing, stone processing and special equipment manufacturing enterprises, and 101, 27 and 78 out of standard points respectively, and the exceeding standard rates were 65.6% (101/154) , 61.4% (27/44) and 69.0% (78/113) , respectively. There were 1670, 172 and 856 workers exposed to noise in the three industries. Among them, 1198, 134 and 703 people had taken occupational health examination. The physical examination rates were 71.7% (1198/1670) , 77.9% (134/172) and 82.1% (703/856) , respectively. The abnormal rates were 19.1% (229/1198) , 51.5% (69/134) and 37.8% (266/703) , respectively. Conclusion: High intensity noise working environment, too long noise exposure time, incorrect wearing of personal protective equipment and neglect of occupational health examination are important reasons for hearing loss of noise exposed personnel.

[Use of sofosbuvir-based regimens in the treatment of adolescents and children with chronic hepatitis C]

Sofosbuvir has ushered in a new era of hepatitis C treatment with its strong inhibition on the replication of hepatitis C virus, favorable safety profile and less interactions with other drugs. Sofosbuvir-based regimens have been included as the first-line therapies for the treatment of adults with chronic hepatitis C (CHC) in international guidelines. Available clinical trial data show that sofosbuvir with ribavirin and ledipasvir/sofosbuvir are highly efficacious and safe in CHC patients aged 3-17 years old; therefore, they can meet the unmet medical needs of adolescents and children with CHC in China. Furthermore, the pan-genotypic sofosbuvir/velpatasvir is being investigated in adolescents and children with CHC, which is expected to make the treatment in such patients more convenient upon approval.

[Analysis of the catastrophic health expenditure of HIV-positive maternal households in high AIDS endemic areas in Liangshan prefecture]

Objective: To analysis the income and expenditure of HIV-positive pregnant women and the catastrophic health expenditure of their households in high AIDS endemic areas in Liangshan prefecture. Methods: From December 2018 to January 2019, a total of 250 pregnant women were recruited from 2 of 17 counties in Liangshan Prefecture, including 133 HIV-positive pregnant women and 117 HIV-negative pregnant women. The data, including basic information of pregnant women, basic information of the family, annual family income in 2017, annual family health expenditure in 2017, and maternal and child-related expenditure in 2017, were collected for analyzing the incidence of catastrophic health expenditure in the family. Results: The average annual income and average annual health expenditure of HIV-positive pregnant women households were 7 000 CNY and 2 000 CNY, while those of HIV-negative pregnant women households were 10 000 CNY and 3 000 CNY, respectively. Based on the criteria of 15%, 25% and 40%, the incidence of catastrophic health expenditure of HIV-positive pregnant households was 39.10%, 33.83% and 27.82%, with average differences of 34.84%, 31.17% and 26.65%, respectively, while that of HIV-negative pregnant women households was 38.46%, 33.33% and 23.93%, with average differences of 31.68%, 28.35% and 24.22%, respectively. Conclusion: The incidence of catastrophic health expenditure of pregnant households in high AIDS endemic areas in Liangshan prefecture is high. The incidence of HIV-positive families is slightly higher than that of HIV-negative families. We suggest that medical insurance compensation in Liangshan prefecture should be improved to reduce the impact of catastrophic health expenditure.

[Clinicopathological characteristics and outcomes of 122 patients with colorectal cancer metastasize to the ovary]

Objective: To explore the clinicopathological characteristics and prognosis of patients with ovarian metastases from colorectal cancer. Methods: A total of 122 female patients with ovarian metastases from colorectal cancer underwent treatment in Cancer Hospital, Chinese Academy of Medical Sciences between 2010 and 2015 were recruited. The clinicopathological features, treatment details and survival data of these patients were retrospectively analyzed. Kaplan-Maier method was used for survival analysis, log rank test and Cox proportional hazards model were used for prognostic factor analysis. Results: The median overall survival (OS) was 19.7 months. The 1-year, 3-years and 5-years OS rates were 72.1%, 24.7% and 9.9%, respectively. A total of 99 (81.1%) patients underwent oophorectomy. The median OS of patients who underwent oophorectomy was 21.9 months, significantly longer than 10.3 months of patients without oophorectomy (P<0.01). Ovary as the only site of metastasis, primary tumor resection, and oophorectomy were associated with improved survival (all P<0.01). Primary tumor resection and oophorectomy were independent prognostic factors for OS (both P<0.01). Conclusion: Patients with ovarian metastases from colorectal cancer might acquire a survival benefit from surgical resection of the primary tumor and ovaries.

[Synchronous robotic resection for colorectal liver metastasis]

Surgical resection remains the only curative therapy for colorectal adenocarcinoma and liver metastasis. Synchronous robotic resection for colorectal liver metastasis (CRLM) offers the advantage of avoiding double surgical stress, while providing the benefits of small incision, quicker recovery, shorter hospital stay and faster postoperative adjuvant therapy. Compared with the laparoscopic approach, robotic approach is mostly suitable for rectal cancer liver metastasis, which is associated with low conversion rate, good nerve protection, high success rate for major hepatectomy and resection of difficult segments. Appropriately selected patients, multidisciplinary cooperation and skillful robotic surgeons are the key to success. Current data have demonstrated the feasibility and safety of synchronous robotic resection for CRLM. With the coming randomized controlled trial data and evolution of robotic surgical system, the future of synchronous robotic resection for colorectal liver metastasis is promising.

[Management and improving the marginal adaptation of chairside computer aided design/computer aided manufacturing restorations]

The fabrication process of restorations made by chairside computer aided design/computer aided manufacturing (CAD/CAM) is different from the conventional fabrication techniques. Chairside CAD/CAM system with digital intraoral scanning and in-practice milling device allows for a quick manufacturing of restorations. However, many factors involved in the clinical and CAD/CAM workflow may affect the clinical outcomes, especially the marginal adaptation of the restorations. This commentary summarizes the factors affecting the marginal adaptation of CAD/CAM restorations and recommends the solutions to achieve improved clinical outcomes.

microRNA-23B inhibits non-small cell lung cancer proliferation, invasion and migration via downregulation of RUNX2 and inhibition of Wnt/Β-catenin signaling pathway

Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancer cases. MicroRNAs (miRNAs/miRs) have been reported to play significant roles in the progression of human tumors, however, the expression and biological role of miR-23b in NSCLC remains elusive. Underexpression of miR-23b was detected in NSCLC tissues in comparison with the matched para-carcinoma tissues. The clinical value of miR-23b was analyzed, and the findings showed that miR-23b expression was negatively correlated with poor overall survival and malignant clinicopathologic characteristics of NSCLC patients. Furthermore, functional assays demonstrated that overexpression of miR-23b inhibited NSCLC cell viability, invasion and migration. Luciferase reporter assay and qRT-PCR revealed that RUNX2 was a functional target of miR-23b. The elevated expression of RUNX2 was positively correlated with overall survival of NSCLC patients. Additionally, Western blot analysis indicated that EMT and Wnt/β-catenin pathways were blocked by the upregulation of miR-23b. Taken together, these data demonstrated that dysregulation of miR-23b/RUNX2 signal may be a novel therapeutic target for the treatment of NSCLC.

Skimmed Milk Diluent Promotes the Sperm Motility and Conception Rate of Dorper Sheep Compared to Vitamin B12 Diluent

BACKGROUND

Dorper sheep is an ideal breed for improvement, with higher meat production and increased adaptability. Artificial insemination is an efficient technique for Dorper genetic improvement and reproduction management. However, there is no uniform diluent for Dorper semen dilution.

OBJECTIVE

To compare the effects of vitamin B12 (VB12) and skimmed milk diluents on sperm motility at different ratios and time points, and the effects on conception rate.

MATERIALS AND METHODS

We detected the effect of diluents on sperm density, deformity, motility and conception rate of Dorper sheep.

RESULTS

We found the optimal dilution ratio of skimmed milk is 1:3. Compared to VB12, skimmed milk at 1:3 ratio prolonged semen storage time (48 h vs. 18 h, storage at a low temperature of 4°C) and increased the survival index of sperm (44.7 ± 2.8 vs. 18.5 ± 0.6, P<0.01).

CONCLUSION

Skimmed milk is more effective, nutritious and convenient than vitamin B12, representing a more advantageous diluent.

[Spatio-temporal patterns of Oncomelania hupensis snail habitats in Suzhou, Wuxi and Changzhou cities along the Taihu Lake region]

OBJECTIVE

To investigate the spatio-temporal distribution characteristics of Oncomelania hupensis snail habitats in three cities of Suzhou, Wuxi and Changzhou along the Taihu Lake region, so as to provide technical supports for establishing a sensitive and highly effective surveillance and forecast system for schistosomiasis.

METHODS

Snail distribution data were collected from Suzhou, Wuxi and Changzhou cities from 1950 to 2018, and the changing trend for snail habitats were described over years. In addition, the clusters of snail habitats were detected using Kernel density analysis and SaTScan space-time scan analysis.

RESULTS

The number of snail habitats appeared a single-peak distribution in Suzhou, Wuxi and Changzhou cities from 1950 to 2018, which peaked in 1970 and then declined rapidly. There were 62.68% of snail habitats eliminated within 10 years after identification, of which 38.24% were eliminated at the year of identification. Kernel density analysis and SaTScan space-time scan analysis revealed that high-density clusters of snail habitats were mainly distributed in Kunshan City, Wuzhong District and Xiangcheng District from 1970 to 1980, and in Yixing City in 1990; since then, the clusters gradually shrank, and overall appeared a move from northeast to west of Taihu Lake. A total of 4 new clusters were detected after 1970, as revealed by space-time scanning of snail habitats. In current snail habitats, emerging snail habitats are mainly identified in Huqiu District (Dongzhu Town), Wuzhong District (Guangfu Town), Taicang City (Shaxi Town) and Jintan District, and re-emerging snail habitats are scattered in 7 districts.

CONCLUSIONS

The distribution of snail habitats are spatio-temporal aggregation in Suzhou, Wuxi and Changzhou cities. The monitoring and prediction of emerging and re-emerging snail habitats are the key points in the future.

[Preliminary Study on the Secretory Performance of Mycobacterium tuberculosis Hypoxic Response Protein 1 (Rv2626c)]

OBJECTIVE

To verify the secretory ability of the hypoxic response protein 1 (HRP1) encoded by Mycobacterium tuberculosis (Mtb) Rv2626c.

METHODS

The target gene attached with His tag was amplified from the genome of Mtb standard virulence strain H37Rv. The recombinant plasmid contained the above amplified product was constructed and electroporated into Mycobacterium smegmatis (Ms) (MC ²155) to construct a recombinant strain. Protein expression was induced under heat condition, and the expression of protein from the culture filtrates and the bacterial lysates was detected afterward. The 10 kDa culture filtrate antigen (CFP-10) (Ms) and CFP-10 (Mtb) were used as positive controls, and the cytoplasmic protein heat shock protein 65 (GroEL2) (Mtb) was used as negative controls.

RESULTS

The HRP1, GroEL2 (Mtb), CFP-10 (Mtb) and CFP-10 (Ms) were successfully amplified by PCR from recombinant plasmid, and sequencing results of the recombinant plasmid is right, confirming the successful construction of the recombinant plasmid. The recombinant Ms was successfully constructed and it could express the proteins GroEL2 (Mtb), HRP1, CFP-10 (Mtb) and CFP-10 (Ms). The target protein HRP1 was detected in both of the lysate and the culture filtrate of the recombinant strain by Western blot, which was consistent with the positive control CFP-10. The negative control GroEL2 (Mtb) was only detected in the bacterial lysate, but not detected in the culture filtrate.

CONCLUSION

The protein HRP1 encoded by Mtb Rv2626c can be secreted out of Ms by the secretion system of Ms. It may be a secreted protein and play an important role in the pathogenesis of Mtb.

[Risk factors of permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma]

Objective: To investigate the risk factors of turning temporary stoma into permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma. Methods: A case-control study was carried out. Data of rectal cancer patients who underwent transabdominal anterior resection with temporary stoma and completed follow-up in Department of General Surgery of Xiangya Hospital of Central South University from June 2008 to June 2018 were collected and analyzed. In this study, temporary stoma included defunctioning stoma (ostomy was made during operation) and salvage stoma (ostomy was made within one month after operation due to anastomotic leakage or severe complications). Cases of multiple intestinal tumors were excluded. A total of 308 rectal cancer patients were enrolled in the study, including 198 males and 110 females with a median age of 56 (48-65) years. Ninety-four patients received intraperitoneal chemotherapy during operation. Among 308 patients, upper rectal cancer was observed in 64 cases, middle rectal cancer in 89 cases and low rectal cancer in 155 cases. Twenty patients underwent transverse colostomy and 288 underwent ileostomy. Phone call following-up was conducted from August to September 2019 to investigate whether stoma was reversed, causes of reversal failure, and tumor relapsed or not in detail. Permanent stoma was defined as that the stoma was still not reversed by the latest follow-up. The univariate analysis was performed with chi-square test or Fisher's exact test, and variables with P value < 0.10 were included in the non-conditional logistic regression model for multivariate analysis. Results: The median follow-up time was 54.3 (32.4-73.8) months. During follow-up, 8 cases had local recurrence and 37 cases had distant metastasis. Among the 308 patients with temporary ostomy, 247 (80.2%) patients had stomas reversed and the median interval time was 4.5 (3.5-6.1) months. The median interval time in 65 patients with salvage stoma was significantly longer that in 182 patients with defunctioning stoma [5.5 (4.3-7.5) vs. 4.2 (3.4-5.5) months; Z=-4.387, P<0.001]. The temporary ostomy was confirmed to become permanent stoma in 61 patients (19.8%), including 45 cases of defunctioning stoma and 16 cases of salvage stoma. Univariate analysis showed that preoperative anemia, intraperitoneal chemotherapy during operation, middle rectal cancer, transverse colostomy, pathological stage, postoperative local recurrence and distant metastasis were associated with permanent stoma (all P<0.10). Multivariate analysis revealed that the intraperitoneal chemotherapy during operation (OR=1.961, 95% CI: 1.029-3.738, P=0.041), middle rectal cancer (OR=2.401, 95% CI: 1.195-4.826, P=0.014), transverse colostomy (OR=3.433, 95% CI: 1.234-9.553, P=0.018), and distant metastasis (OR=8.282, 95% CI:3.820-17.954, P<0.001) were independent risk factors of permanent stoma. Conclusions: There is high risk of turning temporary stoma into permanent stoma among rectal cancer patients undergoing transabdominal anterior resection who receive intraperitoneal chemotherapy during operation, present as the middle rectal cancer, undergo transverse colostomy or develop distant metastasis. Surgeons need to evaluate and balance the risks and benefits thoroughly, and then inform the patients in order to avoid potential conflicts.

[Gender difference in efficacy of intra-aortic balloon pump in acute myocardial infarction patients complicating with cardiogenic shock]

Objective: To investigate the effect of gender on the efficacy of intra-aortic balloon pump(IABP) applied in patients with cardiogenic shock complicated by acute myocardial infarction(AMI). Methods: A total of 209 patients diagnosed as cardiogenic shock complicated by AMI admitted in Fuwai Hospital from June 2012 to May 2018 were enrolled in our study. We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support, as well as 28-day (from diagnosis of cardiogenic shock) mortality retrospectively. Kaplan-Meier survival analysis was used to compare the 28-day survival rates of patients of different genders/with or without IABP treatment. Adjustment for age, systolic blood pressure, ST segment elevation myocardial infarction, dual antiplatelet, coma, APACHEⅡ score and SAPSⅡ score, Cox regression analysis was used to detect the affect of IABP treatment on the risk of all-cause mortality in different crowd, and using Z test to evaluate the modification effect of gender on IABP treatment efficacy. Results: A total of 209 patients were included in this study, with 148 males (80 (54.05%) cases received IABP support) and 61 females (22 (36.06%) cases received IABP support). A total of 102 patients received IABP treatment. The 28-day survival rate of male patients was higher than that of females (39.2% (58/148) vs. 26.2% (16/61), Log-rank P=0.034). The 28-day survival rate of patients receiving IABP was significantly higher than that of non-IABP groups (46.1% (47/102) vs. 25.2% (27/107), Log-rank P=0.001 7). Among female patients, there was no statistically significant difference in 28-day survival rate between those who received IABP and those who did not receive IABP (P=0.889). While in male patients, the 28-day survival rate of those who received IABP was higher than that of those who did not receive IABP (51.2% (41/80) vs. 25.0% (17/68), P=0.001). The survival rate of male patients treated with IABP was higher than that of male patients who did not receive IABP, female patients who did not receive IABP and female patients who received IABP (all P<0.05). After multiple regression analysis and adjustment of confounding factors, it was found that IABP implantation can significantly reduce the 28-day mortality risk in male patients (HR=0.44, 95%CI 0.25-0.77 P=0.004). While it had no inpact on the death risk in female patients(P= 0.401). The impact of IABP implantation in patients of different genders was significantly different (Z=-2.32, P=0.020). Conclusion: In AMI patients complicating cardiogenic shock, there is a gender difference in the impact of IABP implantation on the 28-day mortality risk, and protective effects are seen only in men.

[Clinical characteristics of 83 patients with thrombotic thrombocytopenic purpura]

Objective: To analyze the clinical characteristics, treatment and prognosis of patients with thrombotic thrombocytopenic purpura (TTP) . Methods: 83 patients with TTP from May 1998 to May 2019 were analyzed retrospectively. Results: Among the 83 patients, there were 27 males and 56 females, with a median age of 39 (10-68) years. 41 cases (49.4%) showed pentalogy syndrome and 79 cases (95.2%) showed triad syndrome. 78.0% (46/59) of the patients had a PLASMIC score of 6 or higher. TTP gene mutations was detected in 5 of 10 patients. The activity of von Willebrand factor-cleaving protease (ADAMTS13) , which was detected in 10 patients before plasma exchange (PEX) , was less than 10% in 9 patients. 83 patients were treated with PEX/plasma infusion and glucocorticoid, 35 of which were treated combined with rituximab and/or immunosuppressant. The median follow-up was 34 (1-167) months, the effective rate was 81.9%, the remission rate was 63.9%, the relapse rate was (35.7 ±7.1) %, and the 3-year overall survival (OS) rate was (78.6 ±4.6) %. The effective rate (72.9%vs 94.3%, P=0.019) and OS rate[ (63.8±7.5) %vs (94.3±3.9) %, χ(2)=8.450, P=0.004] in the group treated with PEX/PI and glucocorticoid alone were lower than those in the group treated combined with rituximab and/or immunosuppressant. COX multivariate analysis showed that age (HR=1.111, 95%CI 1.044-1.184, P=0.001) and alanine transaminase (ALT) /aspartate aminotransferase (AST) (HR=1.353, 95%CI 1.072-1.708, P=0.011) were independent risk factors for OS. Conclusion: Most patients with TTP have triad syndrome, accompanied by a decrease in ADAMTS13 activity. Plasma infusion and glucocorticoid combined with rituximab, immunosuppressive therapy could improve overall survival. The prognosis of patients with older age and high ALT/AST ratio is poor.

[Etiological diagnosis and clinical evaluation of isolated fetal ascites]

Objective: To explore the correlation between prenatal clinical data with etiological diagnosis and neonatal outcome in isolated fetal ascites. Methods: Totally, 36 pregnancy cases diagnosed as isolated fetal ascites by ultrasound in Provincial Hospital Affiliated to Shandong University from June 22nd, 2016 to September 28th, 2018 were collected. Invasive prenatal diagnosis was performed by taking fetal cord blood, amniotic fluid, and fetal ascites respectively for cytogenetics, molecular genetics and biochemical examination and the impact of intrauterine therapeutic procedures on neonatal outcomes was evaluated as well. The correlation among prenatal examination, pathogeny and prognosis was analyzed by Fisher's exact test. Results: (1) The prognosis of isolated fetal ascites initially presenting ≥28 weeks was better than that before 28 weeks, survival rate of 1-year-old were 13/15 and 9/17,respectively, the difference was statistically significant (P<0.05). (2) The etiologic diagnosis rate of ascites before delivery was 31%(11/36), which increased to 53%(19/36) totally after birth. Characteristics of cases which were defined prenatally were as follows: 8 cases of digestive tract diseases showed ultrasonic abnormalities, including echogenic bowel, bowel dilatation and polyhydramnios; platelet level in umbilical cord blood of fetuses infected with cytomegalovirus were below 100 × 10(9)/L in 2 cases; 1 case of urinary system malformation showed megalocystis and hydronephrosis. Cases which were defined causes after birth included: 3 fetuses with chyloperitonium presented persistent fetal ascites; 3 cases of digestive-related causes were rectal duplication with infection, mesentery stenosis, and intestinal atresia; other causes included Pierre-Robin syndrome and Budd-Chiari syndrome. (3) The live birth rate was 72% (26/36) and survival rate of 1-year-old was 61% (22/36). And 9/10 of infants who underwent surgeries got good outcomes. Fetal ascites due to abdominal or pelvic factors turned well in 13/16 of cases. Conclusions: The pregnancy outcome of fetal isolated ascites depends mainly on primary causes. Gastrointestinal abnormality is one of the most common causes. Excluded intrauterine infection, chromosomal abnormality and abnormal systemic ultrasonic findings, fetus with reduced ascites as the pregnancy progresses will get good outcome.

Association of cardiovascular diseases with milk intake among general Chinese adults

BACKGROUND

The association of milk intake with cardiovascular disease (CVD) and cause-specific mortality remained controversial and evidence among the Chinese population was limited. We aimed to study the relationship between milk intake and CVDs among general Chinese adults.

METHODS

A total of 104,957 participants received questionnaire survey. Results of physical examination such as anthropometric measurements and biochemical tests during 2007 to 2008, demographic data and their information on milk intake were collected through standardized questionnaires. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of CVD incidence, cause-specific mortality and all-cause mortality related to milk intake. Restricted cubic splines (RCSs) were applied to examine dose-response associations.

RESULTS

Among the 91,757 participants with a median follow-up period of 5.8 years, we documented 3877 CVD cases and 4091 all-cause deaths. Compared with participants who never consumed milk, the multivariate-adjusted HRs (95% CIs) of CVD incidence for 1 to 150 g/day, 151 to 299 g/day, and ≥300 g/day were 0.94 (0.86-1.03) (P > 0.05), 0.77 (0.66-0.89) (P < 0.05), and 0.59 (0.40-0.89) (P < 0.05), respectively; each 100 g increase of daily milk intake was associated with 11% lower risk of CVD incidence (HR, 0.89; 95% CI: 0.85-0.94; P < 0.001), and 11% lower risk of CVD mortality (HR, 0.89; 95% CI: 0.82-0.97; P = 0.008) after adjustment for age, sex, residential area, geographic region, education level, family history of CVD, smoking, alcohol drinking, physical activity level, body mass index, and healthy diet status (ideal or not). RCS analyses also showed a linear dose-response relationship with CVD (P for overall significance of the curve <0.001; P for non-linearity = 0.979; P for linearity <0.001) and stroke (P for overall significance of the curve = 0.010; P for non-linearity = 0.998; P for linearity = 0.002) incidence, and CVD mortality (P for overall significance of the curve = 0.045; P for non-linearity = 0.768; P for linearity = 0.014) within the current range of daily milk intake.

CONCLUSIONS

Daily milk intake was associated with lower risk of CVD incidence and mortality in a linear inverse relationship. The findings provide new evidence for dietary recommendations in CVD prevention among Chinese adults and people with similar dietary pattern in other countries.

MiR-20a promotes lung tumorigenesis by targeting RUNX3 via TGF-β signaling pathway

MiR-20a shows a significant role in the development of various human tumors. However, its specific biological function in non-small-cell lung cancer (NSCLC) is still not clear. qRT-PCR was applied for detecting miR-20a expression. The analysis of cell growth and apoptosis were performed by MTT, xenograft models, Western blot assays. Dual luciferase reporter, Western blotting and qRT-PCR were carried out to verify the potential target of miR-20a. In NSCLC tissues and cells, miR-20a was highly expressed and RUNX3 was lowly expressed. Moreover, up-regulation of miR-20a expression promoted NSCLC cell proliferation, invasion and migration, while low-expression of miR-20a showed the converse case on cell proliferation, invasion and migration. RUNX3 was verified as the direct target of miR-20a and it could overturn its biological function in NSCLC cells. Moreover, miR-20a negatively regulated RUNX3 expression. Mechanistically, increasing miR-20a expression inhibited RUNX3 expression and then activated the TGF-β signaling pathway. Taken together, our results demonstrated that re-expression of miR-20a promoted lung tumorigenesis by down-regulation of RUNX3 and facilitating the activation of TGF-β signaling pathway.

Biological background of the genomic variations of cf-DNA in healthy individuals

BACKGROUND

Cell-free DNA (cf-DNA)-based liquid biopsy is emerging as a revolutionary new method in individualized cancer treatment and prognosis monitoring, although detecting early-stage cancers using cf-DNA remains challenging, partially because of the undefined biological background of cf-DNA.

MATERIALS AND METHODS

We investigated somatic mutations in the cf-DNA of 259 cancer-free individuals with a median age of 47 years using an endogenous barcoding duplex method with an ultralow base error rate (2 × 10-7) and compared the variant allele frequencies (VAFs) of these mutations between the cf-DNA and the corresponding blood cell DNA.

RESULTS

Sixty percent (155/259) of the samples showed at least one nonsynonymous mutation on either of two similar target panels covering 508 and 559 cancer-related genes. For individuals older than 50 years of age, the positive rate increased to 76%. Most cf-DNA mutations were also present at similar VAFs in the paired blood cell DNA. The most frequently mutated genes were driver genes of hematologic malignancies, including DNMT3A, TET2, AXSL1, and JAK2. However, the other 58.4% (192/329) of the mutations were likely 'passenger mutations' of clonal hematopoiesis, including mutations in NOTCH2, FAT3, EXT2, ERBB4, and ARID2, which are driver genes of solid tumors.

CONCLUSION

Hematopoietic clone-derived mutations, including 'driver mutations' and 'passenger mutations', are prevalent in the cf-DNA of both healthy individuals and cancer patients and may be a potential source of false positives in the liquid biopsy. Our results also suggest the ineffectiveness for distinguishing clonal hematopoietic mutations of low VAF (≤0.1%) from tumor-derived mutations using conventional next-generation sequencing of blood cell DNA. However, an error correction model with an ultralow error rate and high coverage depth is required for blood cell DNA sequencing, which is difficult and costly to achieve with current technologies.

[Spatio-temporal distribution of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal]

OBJECTIVE

To explore the spatio-temporal characteristics of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, so as to provide scientific evidence for the dynamic assessment of the risk of snail spread in this region.

METHODS

O. hupensis snail status was collected in the plain regions with waterway networks in the study area from 2012 to 2017. The spatio-temporal variations of snail distribution were investigated along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal using buffer zone analysis, spatial autocorrelation, hotspot analysis and standard deviational ellipse with the geographical information system (GIS) tools.

RESULTS

The number of snail habitats showed a tendency towards a rise in the study area from 2012 to 2017, and snail habitats were predominantly distributed in the 1 000 m long buffer zone of the Danyang-Jintan-Liyang Canal, notably along the Jiuqu River at the junction between the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal. The distribution of snail habitats appeared spatial autocorrelations in 2014, 2016 and 2017, and the hotspot areas were mainly identified at the junction between the Danyang-Jintan-Liyang Canal and the Beijing-Hangzhou Grand Canal. In addition, the overall distribution of snail habitats was located in the northeastern-southwestern part of the study aera, and gradually shifted to the southern and northern parts with the time.

CONCLUSIONS

The spatial distribution of O. hupensis snails is complex along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, and there is a risk of snail spread from the upper reaches to the lower reaches, where snail control needs to be intensified.

[Status of grass-roots schistosomiasis control professionals in Jiangsu Province: a cross-sectional study]

OBJECTIVE

To understand the status of grass-roots schistosomiasis control professionals in Jiangsu Province, so as to provide scientific evidence for the rational resource allocation and the improvement of capability building.

METHODS

A cross-sectional survey was conducted by telephone interview and e-mail among city- and county-level disease prevention and control institutions that undertook schistosomiasis control activities in Jiangsu Province, and the age, educational background, major, duration of working, professional title and professional capability were descriptively analyzed.

RESULTS

There were totally 274 fulltime schistosomiasis control professionals working at grass-roots institutions in Jiangsu Province, with a mean age of (43.19 ± 9.47) years. The least professionals were below 30 years of age (12.77%, 35/274), and the most professionals were aged from 41 to 50 years (36.86%, 101/274). Among the 274 professionals, 43.07% (118/274) had duration of working of less than 10 years, 62.04% (170/274) had a bachelor degree, and 40.88% (112/274) had the medium-level professional title.

CONCLUSIONS

A schistosomiasis control team with a relatively high academic degree and professional title has been built at the grassroot level in Jiangsu Province. However, capability building remains to be improved through the participation of more young professionals and professional training with adaptation to local conditions.

MRI combined with PSA density in detecting clinically significant prostate cancer in patients with PSA serum levels of 4∼10ng/mL: Biparametric versus multiparametric MRI

PURPOSE

To compare the performance of biparametric magnetic resonance imaging (bpMRI) to that of multiparametric MRI (mpMRI) in combination with prostate-specific antigen density (PSAD) in detecting clinically significant prostate cancer (csPCa) in patients with PSA serum levels of 4∼10ng/mL.

MATERIALS AND METHODS

A total of 123 men (mean age, 66.3±8.9 [SD]; range: 42-83 years) with PSA serum levels of 4∼10ng/mL with suspected csPCa were included. All patients underwent mpMRI at 3 Tesla and transrectal ultrasound-guided prostate biopsy in their clinical workup and were followed-up for >1 year when no csPCa was found at initial biopsy. The mpMRI images were reinterpreted according to the Prostate Imaging Reporting and Data System (PI-RADS, v2.1) twice in two different sessions using either mpMRI sequences or bpMRI sequences. The patients were divided into 2 groups according to whether csPCa was detected. The PI-RADS (mpMRI or bpMRI) categories and PSAD were used in combination to detect csPCa. Receiver operating characteristic (ROC) curve and decision curve analyses were performed to compare the efficacy of the different models (mpMRI, bpMRI, PSAD, mpMRI+PSAD and bpMRI+PSAD).

RESULTS

Thirty-seven patients (30.1%, 37/123) had csPCa. ROC analysis showed that bpMRI (AUC=0.884 [95% confidence interval (CI): 0.814-0.935]) outperformed mpMRI (AUC=0.867 [95% CI: 0.794-0.921]) (P=0.035) and that bpMRI and mpMRI performed better than PSAD (0.682 [95% CI: 0.592-0.763]) in detecting csPCa; bpMRI+PSAD (AUC=0.907 [95% CI: 0.841-0.952]) performed similarly to mpMRI+PSAD (AUC=0.896 [95% CI: 0.828-0.944]) (P=0.151) and bpMRI (P=0.224). The sensitivity and specificity were 81.1% (95% CI: 64.8-92.0%) and 88.4% (95% CI: 79.7-94.3%), respectively for bpMRI, and 83.8% (95% CI: 68.0-93.8%) and 80.2% (95% CI: 70.2-88.0%), respectively for mpMRI (P>0.999 for sensitivity and P=0.016 for specificity). Among the 5 decision models, the decision curve analysis showed that all models (except for PSAD) achieved a high net benefit.

CONCLUSION

In patients with PSA serum levels of 4∼10ng/mL, bpMRI and bpMRI combined with PSAD achieve better performance than mpMRI in detecting csPCa; bpMRI has a higher specificity than mpMRI, which could decrease unnecessary biopsy, and may serve as a potential alternative to mpMRI to optimize clinical workup.

Beneficial effects of moderate to vigorous physical activity on cardiovascular disease among Chinese adults

BACKGROUND

In China, lack of evidence remains a significant challenge for the national initiative to promote physical activity (PA). We aimed to quantify the beneficial effects of meeting or maintaining the recommended PA level [150 minutes per week (min/wk) of moderate PA or 75 min/wk of vigorous PA or an equivalent combination] on incident cardiovascular disease (CVD) among Chinese population.

METHODS

We included 100,560 participants without history of CVD from three cohorts in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events and its subtypes, including stroke, coronary heart disease, heart failure, and CVD death.

RESULTS

During a median follow-up of 7.3 years (range: 6-15 years), 777,163 person-years and 4693 incident CVD events were observed. Compared with participants who were inactive at baseline, the multivariable adjusted HR (95% CI) of developing CVD was 0.74 (0.69-0.79) for those who met recommended moderate to vigorous physical activity (MVPA) level at baseline. Furthermore, the risk of CVD incidence was reduced with increment of MVPA (P trend < 0.001), and the HR (95% CI) of highly-active versus inactive category was 0.62 (0.56-0.68). Compared with individuals who were inactive both at the baseline and follow-up, those keeping active over the period of follow-up had a substantial lower risk of incident CVD with the HR (95% CI) of 0.57 (0.43-0.77).

CONCLUSIONS

The findings demonstrated that meeting and maintaining the recommended MVPA level could reduce the cardiovascular risk. Wider adoption of the PA recommendations would have considerable health impacts to the Chinese population.

[High-intensity focused ultrasound in the treatment of glaucoma]

In recent years, with the improvement of high-intensity focused ultrasound technology, ultrasound cycloplasty has once again gained clinical recognition, becoming one of the non-invasive procedures for glaucoma treatment. Although high-level evidence is still lacking so far, the existing literature has shown that ultrasound cycloplasty can effectively and safely decreases the intraocular pressure in glaucoma by reducing the formation of aqueous humor and increasing the drainage of aqueous humor through the uveoscleral pathway. This article focuses on the efficacy and safety of ultrasound cycloplasty in the treatment of glaucoma, reviews the existing literature, and summarizes the information on the development of equipment, treatment mechanisms, surgical procedures, effectiveness of intraocular pressure reduction, and post-operative complications, with the purpose to provide reference for clinical research and application. (Chin J Ophthalmol, 2020, 56: 66-70).

[Feasibility of echocardiography-guided repeated intraventricular blood sampling in mice]

Objective: To investigate the feasibility of echocardiography-guided closed-chest repeated intraventricular blood sampling in mice, and to clarify the maximum blood volume that can be collected by this method, and whether the method can be used for long-term repeated blood collection in mice. Methods: Twenty-four male C57BL/6J mice (10-14 weeks old) were divided into the terminal experiment group (n=4, for investigating the maximum blood amount that could be sampled at one time), the repeated 0.5 ml blood collection group (n=10, sampling 0.5 ml whole blood each time, once every two days for consecutive 4 weeks), and the repeated 0.75 ml blood collection group (n=10, sampling 0.75 ml whole blood each time, once every two days for consecutive 4 weeks). High-frequency echocardiography was used to display the largest section of the left ventricle, guiding the insulin syringe needle through the thorax into the left ventricle for blood collection. In the repeated 0.5 ml blood collection group, echocardiography was used to detect the cardiac structure and function before blood collection, three minutes after blood collection, and one week after the last (the 14th) blood collection. Results: We successfully performed echocardiography-guided closed-chest intraventricular blood sampling, with an average operating time (88±19)s per mouse, and a maximum blood volume (1.43±0.11)ml per mouse. In the repeated 0.5 ml blood collection group, heart rate, left ventricular ejection fraction, left ventricular fractional shortening, left ventricular end-diastolic dimension and left ventricular posterior wall end-diastolic thickness remained uncganged before the first blood collection and after 4 weeks of repeated blood collection (all P>0.05). No death in the repeated 0.5 ml blood collection group. However, in the 0.75 ml blood collection group, two mice died before the end point. Conclusions: The echocardiography-guided closed-chest intraventricular blood sampling is a safe, minimally invasive, convenient and efficient method, and can be used repeatedly for long-term blood collection in mice.

Association between Depressive Symptoms and Supplemental intake of Calcium and Vitamin D in Older Adults

OBJECTIVES

We explored the associations between depressive symptoms and supplemental calcium and vitamin D intake in older adults.

DESIGN

This was a prospective cohort study.

PARTICIPANTS

8,527 older adults aged ≥60 years from Zhejiang Major Public Health Surveillance Program (ZPHS) without depressive symptoms at baseline survey.

MEASUREMENTS

Participants were divided into non-supplementation, calcium (Ca), vitamin D, and calcium plus vitamin D (CaD) groups based on their supplemental intake during the past year. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Binary logistic regression analyses were performed to examine the association between depressive symptoms and supplemental intake.

RESULTS

When compared to the non-supplementation group, the Ca group exhibited a significant odds ratio (OR) of 0.731 (95% CI: 0.552-0.967, P=0.028). After adjusting for age, sex, and Ca food sources, the OR was even smaller for the CaD group (OR: 0.326; 95% CI: 0.119-0.889, P=0.029). Additionally, our results indicated that taking Ca supplements ≥4 days/week yielded a significant OR of 0.690 (95% CI: 0.492-0.968) after full adjustment. Taking CaD supplements ≥4 days/week yielded a significant OR of 0.282 (95% CI: 0.089-0.898) after adjusting for age, sex, and Ca food sources.

CONCLUSIONS

Supplemental intake of Ca or CaD ≥4 days/week can decrease the risk of depressive symptoms in older adults, although CaD supplements may be more effective.

[The association of pre-pregnancy body mass and weight gain during pregnancy with macrosomia: a cohort study]

Objective: To examine the association of pre-pregnancy body mass and weight gain during pregnancy with macrosomia. Methods: From January 2015 to December 2015, a total of 20 477 pregnant women were recruited by probabilistic proportional scale sampling with simple randomization in Sichuan, Yunnan and Guizhou Provinces. Basic information of pregnant women, weight gain during pregnancy and weight of newborn were collected. A multiple logistic regression model was used to assess the association between the pre-pregnancy body mass and gestational weight gain indicators with macrosomia. Results: 20 321 mother-infant were included in the final analysis. 20 321 pregnant women were (30.09±4.10) years old and delivered at (39.20±1.29) weeks, among which 12 341 (60.73%) cases were cesarean delivery. The birth weight of 20 321 infants were (3 292.26±431.67) grams, and 970 (4.77%) were macrosomia. The multiple logistic regression model showed that after adjusting for the age of women, compared to the normal weight group in the pre-pregnancy, the overweight and obesity group elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.69-2.35) and 4.05 (95%CI: 3.05-5.39), respectively. After adjusting for the age, the pre-pregnancy BMI, delivery weeks, delivery mode and infant's gender, compared to the weight-gain appropriate group, higher weight gain rate in the mid-pregnancy and excessive total gestational weight gain elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.66-2.39) and 1.80 (95%CI: 1.55-2.08), respectively. Conclusion: The overweight before pregnancy, obesity before pregnancy, the rate of weight gain in the second trimester and the high total weight gain during pregnancy could increase the risk of macrosomia.

[Endemic situation of schistosomiasis in national surveillance sites of Jiangsu Province from 2011 to 2018]

OBJECTIVE

To analyze and investigate the changing trend of the endemic situation of schistosomiasis in national surveillance sites of Jiangsu Province from 2011 to 2018, so as to provide scientific evidence for formulating strategies for schistosomiasis control.

METHODS

From 2011 to 2014, the national schistosomiasis surveillance sites were set in seven schistosomiasis endemic counties (cities, districts) across Jiangsu Province as according to the National Schistosomiasis Surveillance Scheme (2011 version), and from 2015 to 2018, the national surveillance sites were assigned in all 64 counties (cities, districts) endemic for schistosomiasis in Jiangsu Province according to the National Schistosomiasis Surveillance Scheme (2014 version). Schistosoma japonicum infections in local populations, mobile populations and livestock, and snail status were monitored in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and the monitoring data were statistically analyzed.

RESULTS

The sero-prevalence of S. japonicum infections was 1.50% to 4.61% among local populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and a higher sero-prevalence was seen in men than in women, with the sero-positives predominantly detected in local populations at ages of over 50 years. The positive rate of stool examinations was 0 to 0.14% among sero-positive local populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no acute case was found in local populations during the study period. The sero-prevalence of S. japonicum infections was 0.46% to 15.97% among mobile populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no egg-positives were identified. A total of 1 453 livestock were tested in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no S. japonicum infections were detected. During the period from 2011 through 2018, snail survey was conducted in an area of 216 million m² in the national schistosomiasis surveillance sites of Jiangsu Province, and 1 291.01 hm² snail habitats were identified, with snail densities ranging from 0.01 to 0.47 snails/0.1 m²; however, no S. japonicum infections were identified in snails.

CONCLUSIONS

The overall endemic situation of schistosomiasis appears a tendency towards a decline in Jiangsu Province, and S. japonicum infection remains at a low level in both humans and livestock. No S. japonicum infection has been identified in local populations in Jiangsu Province since 2012. In the future, monitoring and management of imported sources of S. japonicum infections should be intensified in Jiangsu Province, and the capability building of passive surveillance of schistosomiasis should be improved in sentinel hospitals in national schistosomiasis surveillance sites of Jiangsu Province. In addition, the examination of schistosomiasis should be strengthened in mobile populations in Jiangsu Province, a sensitive and effective surveillance-response system for schistosomiasis is urgently needed.

[Influence of five-in-one management mode on disease prevention and control of school children with asthma]

Objective: To investigate the influence of five-in-one management mode(standardized asthma treatment, asthma diary, peak expiratory flow (PEF) monitoring, reasonable diet and physical exercise) on disease prevention and control of school children with asthma. Methods: From April to October 2018, 70 children with asthma in clinical remission were selected from Affiliated Hospital of Qingdao University using randomized controlled study design. These children were randomly divided into study group and control group, with 35 cases in each group. In the study group, 5 cases were lost to follow-up, and 30 cases were actually enrolled. In the control group, 6 cases were lost to follow-up, and 29 cases were actually enrolled. Children in the control group received routine medication and regular outpatient consultation, and children in the study group received the five-in-one asthma management model. In the first time of seeing a doctor, after 3 months and 6 months of follow-up, asthma control test score, medication compliance index score and lung function index (forced expiratory volume in 1 second (FEV1), PEF were evaluated respectively.Parental satisfaction, asthma acute episodes, weight, height and biochemical index were recorded during the 6 months of follow-up. Pulmonary function index, asthma control score and body mass index of overweight children with asthma were compared with t-test, medication compliance was compared with chi-square test, and the rank sum test was used for the comparison of the number of emergency visits of asthma attacks and parents' satisfaction. Results: A total of 59 children with asthma were included, among them 30 were in the study group (8.1±1.5) years old and 29 in the control group (9.2±1.1) years old. After 3 months of follow-up, FEV1, PEF, asthma control score in the study group were (86.3±1.5)%, (83.3±2.4)%, (24.7±2.6) points respectively; and in the control group, FEV1, PEF, asthma control score were (84.4±2.5)%, (82.2±1.9)%, (21.1±1.3) points respectively. The indicators in the study group were higher than those in the control group (t=3.62, 1.97, 6.64, P<0.05). After 6 months of follow-up, FEV1, PEF, asthma control score in the study group were (88.4±2.3)%, (85.4±2.2)%, (26.8±1.8) points respectively; and in the control group, FEV1, PEF, asthma control score were (85.5±1.9)%, (83.2±1.7)%, (22.5±1.4) points respectively. The indicators in the study group were significantly higher than those in the control group (t=5.34, 4.24, 10.41, P<0.05). During the 6-month follow up, the number of emergency visits of asthma attacks in the study group and in the control group were 0.42(0.36, 0.51) and 0.92(0.72, 1.27) respectively. The indicator in the study group was significantly lower than that in the control group (Z=3.21, P<0.05). After 3 months of follow-up, the proportions of children with good compliance in the study group and control group were 67% (20/30) and 62% (18/29), the proportions of poor compliance were 27% (8/30) and 34% (10/29), the proportions of non-compliance were 7% (2/30) and 7% (2/29). There were no statistically significant differences (χ(2)=0.14, 0.43, 0.00, P=0.71, 0.51, 0.97). After 6 months of follow-up, the proportions of children with good compliance in the study group and control group were 87% (26/30) and 69% (20/29), the proportion of poor compliance were 10% (3/30) and 28% (8/29), the proportion of non-compliance were 3% (1/30) and 7% (2/29), There were no statistically significant differences (χ(2)=2.70, 3.00, 0.39, P=0.10, 0.08, 0.53). After 6 months of follow-up, the number of great satisfaction, satisfaction and dissatisfaction in the study group were 20, 10 and 0 respectively, the satisfaction rate was 100%, meanwhile those indicators in the control group were 4, 15 and 10 respectively, the satisfaction rate was 66%, The indicator in the study group was significantly higher than that in the control group (Z=4.60, P<0.05). Conclusions: The application of "five-in-one" asthma management model (standardized asthma treatment, asthma diary, PEF monitoring, reasonable diet and physical exercise) for school-age children with asthma can significantly improve lung function, as well as reduce the number of acute asthma attacks. It has a high parent satisfaction, therefore it should be recommended for clinical implementation.

[Relative factors of transmural intestinal necrosis in acute superior mesenteric vein thrombosis]

Objective: To examine the relative factors of transmural intestinal necrosis (TIN) during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis (ASMVT). Methods: Clinical data of patients with ASMVT admitted to Department of General Surgery, Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively. There were 52 males and 37 females, aging (45.9 ± 12.6) years (range: 20 to 69 years). According to the postoperative pathological results and follow-up, the patients were divided into TIN group (n=31) and non-TIN group (n=58, including 18 cases of intestinal stricture). The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test, U test and χ(2) test accordingly, and factors with statistically significance were subsequently submitted to binary Logistic regression analysis. The predictive value and cut-off point of factors were evaluated by receiver operator characteristic (ROC) curve and area under the curve. Results: In univariate analysis, smoking, hypertension, peritonitis, white blood cell count,haemoglobin, international normalized ratio, blood albumin, thrombosis of superior mesenteric branches vein, free intraperitoneal fluid, decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors (all P<0.05). According to the binary Logistic regression analysis, white blood cell count (OR=1.093, 95%CI: 1.010 to 1.182, P=0.027), thrombosis of the superior mesenteric branches vein (OR=11.519, 95%CI: 1.906 to 69.615, P=0.008), pneumatosis intestinalis (OR=11.140, 95%CI: 2.360 to 52.585, P=0.002) were independent relative factors of TIN in patients with AMI, and the area under the ROC curve of the above factors and predictive model was 0.759 (95%CI: 0.647 to 0.871), 0.745 (95%CI: 0.641 to 0.848), 0.737 (95%CI: 0.621 to 0.854), 0.909 (95%CI: 0.847 to 0.971), respectively. The cutoff value of white blood cell count was 18.1 × 10(9)/L. Conclusion: White blood cell levels, superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.

[HIV early infant diagnosis test in HIV-exposed children in China, 2015-2017]

Objective: To understand the early infant diagnosis (EID) test rate and associated factors in HIV-exposed children in China during 2015-2017. Methods: The follow-up information cards of 12 096 HIV-exposed children for 18 months after birth during 2015-2017 were collected from the Management Information System of China's Prevention of Mother-to-Child Transmission of HIV for a retrospective analysis. The EID test characteristics of HIV exposed children and associated factors were analyzed. Results: From 2015 to 2017, the EID test rate in HIV exposed children increased from 65.6% to 83.4% in China (trend χ(2) P<0.001). The EID test rate within 8 weeks after birth increased from 61.1% to 76.8% (trend χ(2) P<0.001), but the EID positive rate decreased from 8.7% to 3.4% (trend χ(2) P<0.001). The EID positive rate in fatal HIV-exposed children was 47.7%, 36.9% and 36.3% during 2015-2017, respectively, the differences were not significant. EID test rate was associated with ethnic group, living area, survival status and the year reaching 18-month-old of the children. Conclusions: The performance of EID test has been standardized step by step in China. The positive rate of EID test decreased gradually with year. However, the EID test rates in children who were from minority ethnic groups, lived in areas with lower prevalence of HIV infection and died within 18 months after birth were relatively low.