Brain Perfusion Alterations on 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in Patients with Autoimmune Encephalitis: A Case Series and Literature Review

Autoimmune encephalitis is a heterogeneous group of newly identified disorders that are being diagnosed with increasing frequency. Early recognition and treatment of autoimmune encephalitis are crucial for patients, but diagnosis remains challenging and time-consuming. In this retrospective case series, we describe the findings of conventional MR imaging and 3D pseudocontinuous arterial spin-labeling in patients with autoimmune encephalitis confirmed by antibody testing. All patients with autoimmune encephalitis showed increased CBF in the affected area, even when some of them presented with normal or slightly abnormal findings on conventional MR imaging. Additionally, serial 3D pseudocontinuous arterial spin-labeling showed perfusion reduction in 1 patient after therapy. For patients with highly suspected autoimmune encephalitis, 3D pseudocontinuous arterial spin-labeling may be added to the clinical work-up. Further studies and longitudinal data are needed to corroborate whether and to what extent 3D pseudocontinuous arterial spin-labeling improves the diagnostic work-up in patients with autoimmune encephalitis compared with conventional MR imaging.

Observation of Two New Excited Ξ_{b}^{0} States Decaying to Λ_{b}^{0}K^{-}π^{+}

Two narrow resonant states are observed in the Λ_{b}^{0}K^{-}π^{+} mass spectrum using a data sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the LHCb experiment and corresponding to an integrated luminosity of 6  fb^{-1}. The minimal quark content of the Λ_{b}^{0}K^{-}π^{+} system indicates that these are excited Ξ_{b}^{0} baryons. The masses of the Ξ_{b}(6327)^{0} and Ξ_{b}(6333)^{0} states are m[Ξ_{b}(6327)^{0}]=6327.28_{-0.21}^{+0.23}±0.12±0.24 and m[Ξ_{b}(6333)^{0}]=6332.69_{-0.18}^{+0.17}±0.03±0.22  MeV, respectively, with a mass splitting of Δm=5.41_{-0.27}^{+0.26}±0.12  MeV, where the uncertainties are statistical, systematic, and due to the Λ_{b}^{0} mass measurement. The measured natural widths of these states are consistent with zero, with upper limits of Γ[Ξ_{b}(6327)^{0}]<2.20(2.56) and Γ[Ξ_{b}(6333)^{0}]<1.60(1.92)  MeV at a 90% (95%) credibility level. The significance of the two-peak hypothesis is larger than nine (five) Gaussian standard deviations compared to the no-peak (one-peak) hypothesis. The masses, widths, and resonant structure of the new states are in good agreement with the expectations for a doublet of 1D Ξ_{b}^{0} resonances.

Measurement of the Nuclear Modification Factor and Prompt Charged Particle Production in p-Pb and pp Collisions at sqrt[s_{NN}]=5 TeV

The production of prompt charged particles in proton-lead collisions and in proton-proton collisions at the nucleon-nucleon center-of-mass energy sqrt[s_{NN}]=5  TeV is studied at LHCb as a function of pseudorapidity (η) and transverse momentum (p_{T}) with respect to the proton beam direction. The nuclear modification factor for charged particles is determined as a function of η between -4.8<η<-2.5 (backward region) and 2.0<η<4.8 (forward region), and p_{T} between 0.2<p_{T}<8.0  GeV/c. The results show a suppression of charged particle production in proton-lead collisions relative to proton-proton collisions in the forward region and an enhancement in the backward region for p_{T} larger than 1.5  GeV/c. This measurement constrains nuclear PDFs and saturation models at previously unexplored values of the parton momentum fraction down to 10^{-6}.

Probing the Gluonic Structure of the Deuteron with J/ψ Photoproduction in d+Au Ultraperipheral Collisions

Understanding gluon density distributions and how they are modified in nuclei are among the most important goals in nuclear physics. In recent years, diffractive vector meson production measured in ultraperipheral collisions (UPCs) at heavy-ion colliders has provided a new tool for probing the gluon density. In this Letter, we report the first measurement of J/ψ photoproduction off the deuteron in UPCs at the center-of-mass energy sqrt[s_{NN}]=200  GeV in d+Au collisions. The differential cross section as a function of momentum transfer -t is measured. In addition, data with a neutron tagged in the deuteron-going zero-degree calorimeter is investigated for the first time, which is found to be consistent with the expectation of incoherent diffractive scattering at low momentum transfer. Theoretical predictions based on the color glass condensate saturation model and the leading twist approximation nuclear shadowing model are compared with the data quantitatively. A better agreement with the saturation model has been observed. With the current measurement, the results are found to be directly sensitive to the gluon density distribution of the deuteron and the deuteron breakup process, which provides insights into the nuclear gluonic structure.

Search for the Chiral Magnetic Effect via Charge-Dependent Azimuthal Correlations Relative to Spectator and Participant Planes in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

The chiral magnetic effect (CME) refers to charge separation along a strong magnetic field due to imbalanced chirality of quarks in local parity and charge-parity violating domains in quantum chromodynamics. The experimental measurement of the charge separation is made difficult by the presence of a major background from elliptic azimuthal anisotropy. This background and the CME signal have different sensitivities to the spectator and participant planes, and could thus be determined by measurements with respect to these planes. We report such measurements in Au+Au collisions at a nucleon-nucleon center-of-mass energy of 200 GeV at the Relativistic Heavy-Ion Collider. It is found that the charge separation, with the flow background removed, is consistent with zero in peripheral (large impact parameter) collisions. Some indication of finite CME signals is seen in midcentral (intermediate impact parameter) collisions. Significant residual background effects may, however, still be present.

Study of Z Bosons Produced in Association with Charm in the Forward Region

Events containing a Z boson and a charm jet are studied for the first time in the forward region of proton-proton collisions. The data sample used corresponds to an integrated luminosity of 6  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. In events with a Z boson and a jet, the fraction of charm jets is determined in intervals of Z-boson rapidity in the range 2.0<y(Z)<4.5. A sizable enhancement is observed in the forwardmost y(Z) interval, which could be indicative of a valencelike intrinsic-charm component in the proton wave function.

Evidence for a New Structure in the J/ψp and J/ψp[over ¯] Systems in B_{s}^{0}→J/ψpp[over ¯] Decays

An amplitude analysis of flavor-untagged B_{s}^{0}→J/ψpp[over ¯] decays is performed using a sample of 797±31 decays reconstructed with the LHCb detector. The data, collected in proton-proton collisions between 2011 and 2018, correspond to an integrated luminosity of 9  fb^{-1}. Evidence for a new structure in the J/ψp and J/ψp[over ¯] systems with a mass of 4337_{-4}^{+7} _{-2}^{+2}  MeV and a width of 29_{-12}^{+26} _{-14}^{+14}  MeV is found, where the first uncertainty is statistical and the second systematic, with a significance in the range of 3.1 to 3.7σ, depending on the assigned J^{P} hypothesis.

[Expression and diagnostic value of NKX3.1 and NKX2.2 in mesenchymal chondrosarcoma]

Objective: To investigate the immunohistochemical expression of NKX3.1 and NKX2.2 in mesenchymal chondrosarcoma (MC), and to explore the differential diagnostic value of NKX3.1 and NKX2.2 in MC and other types of small round cell malignant tumors. Methods: A total of 12 cases of MC and 97 other small round cell malignant tumors diagnosed in Jinling Hospital, Nanjing University School of Medicine from 2001 to 2020 were collected for NKX3.1 and NKX2.2 immunohistochemical detection. Among them, two kinds of NKX3.1 antibodies [rabbit polyclonal antibody and rabbit monoclonal antibody (EP356)] were used for detection in 12 cases of MC, and one NKX3.1 antibody (rabbit polyclonal antibody) was detected in 97 cases of other small round cell malignant tumors, and the relevant literature was reviewed. Results: The 12 MC patients included 7 females and 5 males, with a mean age of 33 years (14-54 years). Nine cases were from bone and three from soft tissue. Among the 12 MC patients, 8 patients had postoperative recurrence or metastasis, and 3 of them died of tumor recurrence or metastasis. Histologically, 12 cases of MC showed typical bidirectional differentiation.The positive rate of both NKX3.1 antibodies in MC was 12/12, NKX3.1 was focal weakly positive in only one of 12 chondrosarcomas (grade 3), 5 alveolar rhabdomyosarcomas, 5 embryonal rhabdomyosarcomas, and 5 solitary fibrous tumors, respectively. The remaining 70 cases of other small round cell malignant tumors were negative. The positive rates of NKX2.2 in MC, Ewing sarcoma and olfactory neuroblastoma were 12/12, 15/15 and 4/5, respectively. In 12 cases of chondrosarcoma (grade 3), 5 cases of poorly differentiated synovial sarcoma, 5 cases of alveolar rhabdomyosarcoma, and 5 cases of solitary fibrous tumor, NKX2.2 was focally and weakly positive in only one case, respectively, and all the remaining 50 cases of other small round cell malignant tumors were negative. Conclusions: The expression of NKX3.1 and NKX2.2 proteins are significant indicators in the diagnosis of MC, and the combined detection of NKX3.1 and NKX2.2 can help distinguish MC from most other small round cell malignant tumors.

Roles of the protein disulphide isomerases AccPDIA1 and AccPDIA3 in response to oxidant stress in Apis cerana cerana

Protein disulphide isomerase (PDI) plays an important role in a variety of physiological processes through its oxidoreductase activity and molecular chaperone activity. In this study, we cloned two PDI family members, AccPDIA1 and AccPDIA3, from Apis cerana cerana. AccPDIA1 and AccPDIA3 had typical sequence features of PDI family members and were constitutively expressed in A. cerana cerana. The expression levels of AccPDIA1 and AccPDIA3 were generally upregulated after treatment with a variety of environmental stress factors. Inhibition assays showed that E. coli expressing recombinant AccPDIA1 and AccPDIA3 proteins was more resistant to oxidative stress than control E. coli. In addition, silencing AccPDIA1 or AccPDIA3 in A. cerana cerana resulted in significant changes in the expression levels of several antioxidant-related genes as well as the enzymatic activities of peroxidase (POD), superoxide dismutase (SOD) and catalase (CAT) and reduced the survival rate of A. cerana cerana under oxidative stress caused by high temperature. In conclusion, our results suggest that AccPDIA1 and AccPDIA3 may play important roles in the antioxidant activities of A. cerana cerana.

Analysis of Neutral B-Meson Decays into Two Muons

Branching fraction and effective lifetime measurements of the rare decay B_{s}^{0}→μ^{+}μ^{-} and searches for the decays B^{0}→μ^{+}μ^{-} and B_{s}^{0}→μ^{+}μ^{-}γ are reported using proton-proton collision data collected with the LHCb detector at center-of-mass energies of 7, 8, and 13 TeV, corresponding to a luminosity of 9  fb^{-1}. The branching fraction B(B_{s}^{0}→μ^{+}μ^{-})=(3.09_{-0.43-0.11}^{+0.46+0.15})×10^{-9} and the effective lifetime τ(B_{s}^{0}→μ^{+}μ^{-})=2.07±0.29±0.03  ps are measured, where the first uncertainty is statistical and the second systematic. No significant signal for B^{0}→μ^{+}μ^{-} and B_{s}^{0}→μ^{+}μ^{-}γ decays is found and upper limits B(B^{0}→μ^{+}μ^{-})<2.6×10^{-10} and B(B_{s}^{0}→μ^{+}μ^{-}γ)<2.0×10^{-9} at the 95% C.L. are determined, where the latter is limited to the range m_{μμ}>4.9  GeV/c^{2}. The results are in agreement with the standard model expectations.

[Introduction of a tool to assess Risk of Bias in Non-randomized Studies-of Environmental Exposure (ROBINS-E)]

This paper summaries the Risk of Bias in Non-randomized Studies-of Environmental Exposure (ROBINS-E), a tool for evaluating risk of bias about non-randomized studies of exposures (NRSE), and introduces the application of ROBINS-E in a published NRSE. According to the characteristics of NRSE, evaluation fields and signaling questions were designed in ROBINS-E to provide essential information about risk of bias for NRSE included in systematic reviews and GRADE. ROBINS-E is the tool in assessment of risk of bias in observational studies and quasi-randomized studies. Although the tool has been used in practice to some extent, but it still needs further improvement. Attention should be paid to its update and progress.

OUP accepted manuscript

Identifying dependency in multivariate data is a common inference task that arises in numerous applications. However, existing nonparametric independence tests typically require computation that scales at least quadratically with the sample size, making it difficult to apply them in the presence of massive sample sizes. Moreover, resampling is usually necessary to evaluate the statistical significance of the resulting test statistics at finite sample sizes, further worsening the computational burden. We introduce a scalable, resampling-free approach to testing the independence between two random vectors by breaking down the task into simple univariate tests of independence on a collection of 2 × 2 contingency tables constructed through sequential coarse-to-fine discretization of the sample space, transforming the inference task into a multiple testing problem that can be completed with almost linear complexity with respect to the sample size. To address increasing dimensionality, we introduce a coarse-to-fine sequential adaptive procedure that exploits the spatial features of dependency structures. We derive a finite-sample theory that guarantees the inferential validity of our adaptive procedure at any given sample size. We show that our approach can achieve strong control of the level of the testing procedure at any sample size without resampling or asymptotic approximation and establish its large-sample consistency. We demonstrate through an extensive simulation study its substantial computational advantage in comparison to existing approaches while achieving robust statistical power under various dependency scenarios, and illustrate how its divide-and-conquer nature can be exploited to not just test independence, but to learn the nature of the underlying dependency. Finally, we demonstrate the use of our method through analysing a dataset from a flow cytometry experiment.

Measurement of the Sixth-Order Cumulant of Net-Proton Multiplicity Distributions in Au+Au Collisions at sqrt[s_{NN}]=27, 54.4, and 200 GeV at RHIC

According to first-principle lattice QCD calculations, the transition from quark-gluon plasma to hadronic matter is a smooth crossover in the region μ_{B}≤T_{c}. In this range the ratio, C_{6}/C_{2}, of net-baryon distributions are predicted to be negative. In this Letter, we report the first measurement of the midrapidity net-proton C_{6}/C_{2} from 27, 54.4, and 200 GeV Au+Au collisions at the Relativistic Heavy Ion Collider (RHIC). The dependence on collision centrality and kinematic acceptance in (p_{T}, y) are analyzed. While for 27 and 54.4 GeV collisions the C_{6}/C_{2} values are close to zero within uncertainties, it is observed that for 200 GeV collisions, the C_{6}/C_{2} ratio becomes progressively negative from peripheral to central collisions. Transport model calculations without critical dynamics predict mostly positive values except for the most central collisions within uncertainties. These observations seem to favor a smooth crossover in the high-energy nuclear collisions at top RHIC energy.

Ckip-1 Mediates P. gingivalis-Suppressed Cementoblast Mineralization

Porphyromonas gingivalis is responsible for the destruction of cementum in patients with periodontitis and periapical periodontitis. However, research about the effects of P. gingivalis on cementoblast mineralization and the underlying mechanism is still lacking. Casein kinase 2 interacting protein 1 (Ckip-1) is a scaffold protein that interacts with various proteins and signals to regulate different cell functions, such as cell morphology, apoptosis, and differentiation. In this study, we verified the suppressive effects of P. gingivalis and lipopolysaccharide (Pg-LPS) on OCCM-30 mineralization. We also showed that Ckip-1 gradually decreased during OCCM-30 mineralization but increased with the aggravation of Pg-induced inflammation. However, it remained unchanged when cells were stimulated with Pg-LPS, regardless of the concentration and incubation time. Then, more cellular cementum and enhanced Osterix expression were observed in Ckip-1 knockout mice when compared with the wild-type mice. Meanwhile, Ckip-1 silencing significantly enhanced cementoblast mineralization with or without P. gingivalis-associated inflammation. The trend was opposite when Ckip-1 was overexpressed. Finally, we found that the p38, Akt, and Wnt pathways were activated, while the Erk1/2 pathway was inhibited when Ckip-1 was silenced. The opposite results were also observed in the Ckip-1 overexpression group. Furthermore, we proved that cell mineralization was weakened when p38, Akt inhibitors were applied and strengthened when the Erk1/2 pathway was inhibited. In summary, Ckip-1 is upregulated underP. gingivalis-induced inflammation and negatively regulates cementoblast mineralization partially through mitogen-activated protein kinases and Akt signaling pathways, which may contribute to the restoration of cementum destroyed by P. gingivalis.

Decreased CSF Dynamics in Treatment-Naive Patients with Essential Hypertension: A Study with Phase-Contrast Cine MR Imaging

BACKGROUND AND PURPOSE

Arterial sclerosis resulting from hypertension slows CSF transportation in the perivascular spaces, showing the intrinsic relationship between the CSF and the blood vasculature. However, the exact effect of hypertension on human CSF flow dynamics remains unclear. The present study aimed to evaluate CSF flow dynamics in treatment-naive patients with essential hypertension using phase-contrast cine MR imaging.

MATERIALS AND METHODS

The study included 60 never-treated patients with essential hypertension and 60 subjects without symptomatic atherosclerosis. CSF flow parameters, such as forward flow volume, forward peak velocity, reverse flow volume, reverse peak velocity, average flow, and net flow volume, were measured with phase-contrast cine MR imaging. Differences between the 2 groups were assessed to determine the independent determinants of these CSF flow parameters.

RESULTS

Forward flow volume, forward peak velocity, reverse flow volume, reverse peak velocity, and average flow in the patients with hypertension significantly decreased (all, P < .05). Increasing systolic blood pressure was significantly associated with lower forward flow volume (β = -0.44 mL/mL/mm Hg; 95% CI, -0.83 to -0.06 mL/mL/mm Hg), forward peak velocity (β = -0.50 cm/s/mm Hg; 95% CI, -0.88 to -0.12 cm/s/mm Hg), reverse flow volume (β = -0.61 mL/mL/mm Hg; 95% CI, -0.97 to -0.26 mL/mL/mm Hg), reverse peak velocity (β = -0.55 cm/s/mm Hg; 95% CI, -0.91-0.18 cm/s/mm Hg), and average flow (β = -0.50 mL/min/mm Hg; 95% CI, -0.93 to -0.08 mL/min/mm Hg).

CONCLUSIONS

The CSF flow dynamics in patients with hypertension are decreased, and increasing systolic blood pressure is strongly associated with lower CSF flow dynamics.

Aetiology of tinea capitis in China: A multicentre prospective study

BACKGROUND

Tinea capitis is still common in developing countries, such as China. Its pathogen spectrum varies across regions and changes over time.

OBJECTIVES

This study aimed to clarify the current epidemiological characteristics and pathogen spectrum of tinea capitis in China.

METHODS

A multicentre, prospective descriptive study involving 29 tertiary hospitals in China was conducted. From August 2019 to July 2020, 611 patients with tinea capitis were enrolled. Data concerning demography, risk factors and fungal tests were collected. The pathogens were further identified by morphology or molecular sequencing when necessary in the central laboratory.

RESULTS

Among all enrolled patients, 74.1% of the cases were 2- to 8-year-olds. The children with tinea capitis were mainly boys (56.2%) and more likely to have an animal contact history (57.4% vs. 35.3%, P = 0.012) and zoophilic dermatophyte infection (73.5%). The adults were mainly females (83.3%) and more likely to have anthropophilic agent infection (53.5%). The most common pathogen was zoophilic Microsporum canis (354, 65.2%), followed by anthropophilic Trichophyton violaceum (74, 13.6%). In contrast to the eastern, western and northeastern regions where zoophilic M. canis predominated, anthropophilic T. violaceum predominated in central China (69.2%, P < 0.0001), where the patients had the most tinea at other sites (20.3%) and dermatophytosis contact (25.9%) with the least animal contact (38.8%). Microsporum ferrugineum was the most common anthropophilic agent in the western area, especially in Xinjiang Province.

CONCLUSIONS

Boys aged approximately 5 years were mainly affected. Dermatologists are advised to pay more attention to the different transmission routes and pathogen spectra in different age groups from different regions.

Repeat hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a retrospective multicentre study

BACKGROUND

The therapeutic value of repeat hepatic resection (rHR) or radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC) is unknown. This study aimed to investigate the safety and efficacy of rHR or RFA.

METHODS

This was a retrospective multicentre study of patients with recurrent HCC within the Milan criteria who underwent rHR or RFA at nine university hospitals in China and Italy between January 2003 and January 2018. Survival after rHR or RFA was examined in unadjusted analyses and after propensity score matching (1 : 1).

RESULTS

Of 847 patients included, 307 and 540 underwent rHR and RFA respectively. Median overall survival was 73.5 and 67.0 months after rHR and RFA respectively (hazard ratio 1.01 (95 per cent c.i. 0.81 to 1.26)). Median recurrence-free survival was longer after rHR versus RFA (23.6 versus 15.2 months; hazard ratio 0.76 (95 per cent c.i. 0.65 to 0.89)). These results were confirmed after propensity score matching. RFA was associated with lower morbidity of grade 3 and above (0.6 versus 6.2 per cent; P < 0.001) and shorter hospital stay (8.0 versus 3.0 days, P < 0.001) than rHR.

CONCLUSION

rHR was associated with longer recurrence-free survival but not overall survival compared with RFA.

Branching Fraction Measurements of the Rare B_{s}^{0}→ϕμ^{+}μ^{-} and B_{s}^{0}→f_{2}^{'}(1525)μ^{+}μ^{-} Decays

The branching fraction of the rare B_{s}^{0}→ϕμ^{+}μ^{-} decay is measured using data collected by the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV, corresponding to integrated luminosities of 1, 2, and 6  fb^{-1}, respectively. The branching fraction is reported in intervals of q^{2}, the square of the dimuon invariant mass. In the q^{2} region between 1.1 and 6.0  GeV^{2}/c^{4}, the measurement is found to lie 3.6 standard deviations below a standard model prediction based on a combination of light cone sum rule and lattice QCD calculations. In addition, the first observation of the rare B_{s}^{0}→f_{2}^{'}(1525)μ^{+}μ^{-} decay is reported with a statistical significance of 9 standard deviations and its branching fraction is determined.

Prospective evaluation of first-trimester screening strategy for preterm pre-eclampsia and its clinical applicability in China

OBJECTIVES

To evaluate, in a Chinese population, the performance of a screening strategy for preterm pre-eclampsia (PE) using The Fetal Medicine Foundation (FMF)'s competing-risks model and to explore its clinical applicability in mainland China.

METHODS

This was a prospective, multicenter, observational cohort study including 10 899 women with singleton pregnancy who sought prenatal care at one of 13 hospitals, located in seven cities in mainland China, between 1 December 2017 and 30 December 2019. Mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and maternal serum levels of placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks' gestation were measured and converted into multiples of the median using Chinese reference ranges. Individualized risk for preterm PE was calculated using the FMF algorithm. Prior risk was calculated based on maternal demographic characteristics and obstetric history. We evaluated the efficiency of the screening strategy using various combinations of biomarkers and analyzed its predictive performance for a composite of placenta-associated adverse pregnancy outcomes, including PE, placental abruption, small-for-gestational age (SGA) and preterm birth, at fixed false-positive rates for preterm PE.

RESULTS

We identified 312 pregnancies that developed PE, of which 117 cases were diagnosed as preterm PE (< 37 weeks' gestation). There were 386 pregnancies complicated by severe composite placenta-associated adverse outcome, including preterm PE, 146 cases of severe SGA (birth weight < 3^rd percentile) neonate, 61 cases with placental abruption and 109 cases of early preterm birth < 34 gestational weeks. The triple-marker model containing biomarkers MAP, UtA-PI and PAPP-A achieved, at fixed false-positive rates of 10%, 15% and 20%, detection rates for preterm PE of 65.0%, 72.7% and 76.1%, respectively, and detection rates for severe composite placenta-associated adverse outcome of 34.7%, 41.7% and 46.4%, respectively. Replacing PAPP-A with PlGF or adding PlGF to the model did not improve the performance. Of women screening positive for preterm PE at a fixed 5% false-positive rate, an estimated 30% developed at least one placenta-associated adverse pregnancy outcome, including PE, placental abruption, SGA (birth weight < 10^th percentile) and preterm birth < 37 weeks.

CONCLUSIONS

The FMF competing-risks model for preterm PE was found to be effective in screening a mainland Chinese population. Women who screened positive for preterm PE had increased risk for other placenta-associated pregnancy complications. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

What is an appropriate caesarean delivery rate for China: a multicentre survey

Objective

To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction.

Design

A multicentre cross‐sectional study.

Setting

A total of 94 hospitals across 23 provinces in China.

Population

A total of 73 977 randomly selected deliveries.

Methods

We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates.

Main outcome measures

CD rates in China.

Results

In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs.

Conclusions

Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD.

Tweetable abstract

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.

Establishment and verification of a nomogram for predicting severe acute pancreatitis

OBJECTIVE

The purpose of this study was to establish a nomogram for predicting the severity of acute pancreatitis (AP) and verify its predictive value.

PATIENTS AND METHODS

A total of 571 AP patients received by Ordos Central Hospital from January 2015 to December 2018 were included in this study. According to the 2012 Revised Atlanta classification, the included subjects were classified into severe AP (SAP) group and non-severe AP (NSAP) group [including patient with mild AP (MAP) and moderately SAP (MSAP)]. The baseline characteristics, imageological data and pathological data within 24 h after the disease onset between the two groups were analyzed using One-way analysis of variance (one-way ANOVA). R language was used for establishing a predictive nomogram, whose performance was verified by clinical data of 150 AP cases collected from December 2018 to December 2019.

RESULTS

One-way ANOVA shows that SAP and NSAP patients show significant differences in sex, calcium ions, creatinine, neutrophils ratio, lymphocytes ratio and eosinophils ratio (p<0.05). A predictive nomogram was accordingly established using the six indicators. Validation on this predictive nomogram showed high internal validation concordance index (C-index) of 0.69 (95% CI, 0.64-0.74), and high external validation C-index of 0.71 (95% CI, 0.67-0.76).

CONCLUSIONS

This nomogram can be used as a clinical tool to predict the severity of SAP.

Observation of the Mass Difference between Neutral Charm-Meson Eigenstates

A measurement of mixing and CP violation in neutral charm mesons is performed using data reconstructed in proton-proton collisions collected by the LHCb experiment from 2016 to 2018, corresponding to an integrated luminosity of 5.4  fb^{-1}. A total of 30.6 million D^{0}→K_{S}^{0}π^{+}π^{-} decays are analyzed using a method optimized for the measurement of the mass difference between neutral charm-meson eigenstates. Allowing for CP violation in mixing and in the interference between mixing and decay, the mass and decay-width differences are measured to be x_{CP}=[3.97±0.46(stat)±0.29(syst)]×10^{-3} and y_{CP}=[4.59±1.20(stat)±0.85(syst)]×10^{-3}, respectively. The CP-violating parameters are measured as Δx=[-0.27±0.18(stat)±0.01(syst)]×10^{-3} and Δy=[0.20±0.36(stat)±0.13(syst)]×10^{-3}. This is the first observation of a nonzero mass difference in the D^{0} meson system, with a significance exceeding seven standard deviations. The data are consistent with CP symmetry and improve existing constraints on the associated parameters.

[Prevalence and influencing factors of deciduous dental caries among preschool children in Qingdao city in 2019]

In 2019, the rate of primary tooth caries rate among 1 598 preschool children in Shinan District and Shibei District of Qingdao was 59.4%. The multivariate logistic regression model showed that compared with children ≤ 2 years old with history of iron deficiency anemia (IDA), suffering IDA, breastfeeding to 2 years old and no tooth melanin, children ≤ 2 years old without history of IDA, not suffering IDA, breastfeeding to less than 2 years old and heavy tooth melanin had a lower risk of primary tooth caries, with OR (95%CI) values about 0.328 (0.197-0.549), 0.354 (0.208-0.603), 0.636 (0.437-0.926) and 0.301 (0.143-0.635), respectively.

Observation of D_{s}^{±}/D^{0} Enhancement in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the first measurement of charm-strange meson D_{s}^{±} production at midrapidity in Au+Au collisions at sqrt[s_{NN}]=200  GeV from the STAR experiment. The yield ratio between strange (D_{s}^{±}) and nonstrange (D^{0}) open-charm mesons is presented and compared to model calculations. A significant enhancement, relative to a pythia simulation of p+p collisions, is observed in the D_{s}^{±}/D^{0} yield ratio in Au+Au collisions over a large range of collision centralities. Model calculations incorporating abundant strange-quark production in the quark-gluon plasma and coalescence hadronization qualitatively reproduce the data. The transverse-momentum integrated yield ratio of D_{s}^{±}/D^{0} at midrapidity is consistent with a prediction from a statistical hadronization model with the parameters constrained by the yields of light and strange hadrons measured at the same collision energy. These results suggest that the coalescence of charm quarks with strange quarks in the quark-gluon plasma plays an important role in D_{s}^{±}-meson production in heavy-ion collisions.

Cooling ameliorates decreased milk protein metrics in heat-stressed lactating Holstein cows

Cooling can alleviate the negative consequences of heat stress on multiple milk production metrics in dairy cows. However, it is still controversial whether cooling can increase milk protein content compared with heat-stressed cows. The objective of the present study was to evaluate the relief effect of cooling on the decrease in milk protein concentration during heat stress and elucidate the potential metabolic mechanisms. Thirty lactating multiparous Holstein cows (days in milk = 175 ± 25 d, milk yield = 27.5 ± 2.5 kg/d; mean ± SD) were assigned to 1 of 3 treatments: heat stress (HS; n = 10), cooling (CL; n = 10), and cooling with pair-feeding (PFCL; n = 10). The barns for PFCL and CL cows were equipped with sprinklers and fans, whereas the barn for HS cows were not. The average temperature-humidity index during the experiment ranged from 74 to 83. The spraying was activated automatically 2 times per day (1130-1330 h and 1500-1600 h) with 3 min on and 6 min off during the first 2 wk, and 1.5 min on and 3 min off during the last 2 wk, whereas the fans operated 24 h/d. The experiment lasted for 4 wk in total. Milk, urine, feces, total mixed ration, blood, and rumen fluid samples were collected weekly. Compared with HS, feed efficiency (1.24 and 1.49), milk protein yield (0.82 and 0.94 kg/d), and milk fat yield (0.98 and 1.26 kg/d) were increased in PFCL, whereas the differences between CL and HS were not significant. Compared with HS cows, PFCL and CL cows had a lower respiratory rate (70.6, 59.1, and 60.3 breaths per minute, respectively), rectal temperature (38.95, 38.61, and 38.51°C), and shoulder skin temperature (33.95, 33.25, 33.40°C), and had greater milk protein content (3.41, 3.72, and 3.69%) and milk fat percent (4.08, 4.97, 4.65%). Both the blood activity of catalase (increased by 12.8 and 41.0%) and glutathione peroxidase (12.6 and 40.4%) of PFCL and CL cows were greater than the HS cows. Compared with HS, cooling increased the blood content of glucose, methionine, threonine, and cystathionine by 10.7% and 10.3%, 19.0% and 9.5%, 15.8% and 12.0%, and 9.5% and 23.8% in PFCL and CL, respectively. In conclusion, the results indicated that cooling partially rescued milk protein synthesis induced by heat stress, and the potential mechanism may have been due to increased antioxidant ability, blood glucose, and key AA. Consequently, in addition to modifying the environment, nutritional and physiological strategies designed to influence carbohydrate, AA, and oxidative homeostasis may be an opportunity to maintain or correct low milk protein content during the warm summer months.

[Mental health status and its influencing factors of nurses in geriatric department after workplace violence]

Objective: To investigate the mental health status and influencing factors of geriatric nurses after workplace violence. Methods: From February 2019 to January 2020, 102 geriatric nurses who suffered workplace violence in three hospitals in Shaoxing were collected as the observation group and 100 geriatric nurses who did not suffer workplace violence in the same period as the control group. The general data of nurses in the two groups were investigated, the workplace violence was investigated with the hospital workplace violence questionnaire, the mental disorders and mental diseases were investigated with the symptom checklist 90 (SCL-90) , the symptoms of post-traumatic stress disorder were investigated with the symptom checklist of post-traumatic stress disorder (pcl-c) , and the psychological elasticity was investigated with the psychological elasticity scale, Social support was investigated with social support scale (SSRs) . Results: The total average score of symptom checklist 90 (SCL-90) of nurses with workplace violence was (1.49 ± 0.48) . Compared with the control group, the total average score of SCL-90, somatization, obsessive-compulsive symptoms, depression, anxiety and fear factors in the observation group were significantly increased (P<0.05) . The total score of post-traumatic stress disorder symptom list (pcl-c) in the observation group was (34.51±9.87) . Compared with the control group, the total average score of pcl-c, re experience, avoidance and vigilance factors in the observation group were significantly increased (P<0.05) . The total average score of SCL-90 of nurses with workplace violence was positively correlated with psychological elasticity and social support (P<0.05) . Multivariate linear analysis showed that psychological elasticity, tenacity and control, optimism, social support and subjective support were the main factors affecting nurses＇mental health. Conclusion: Geriatric nurses suffering from workplace violence are prone to mental health problems and post-traumatic stress disorder, which should be improved by improving their psychological elasticity and social support.

Observation of New Resonances Decaying to J/ψK^{+} and J/ψϕ

The first observation of exotic states with a new quark content cc[over ¯]us[over ¯] decaying to the J/ψK^{+} final state is reported with high significance from an amplitude analysis of the B^{+}→J/ψϕK^{+} decay. The analysis is carried out using proton-proton collision data corresponding to a total integrated luminosity of 9  fb^{-1} collected by the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV. The most significant state, Z_{cs}(4000)^{+}, has a mass of 4003±6_{-14}^{+4}  MeV, a width of 131±15±26  MeV, and spin parity J^{P}=1^{+}, where the quoted uncertainties are statistical and systematic, respectively. A new 1^{+}  X(4685) state decaying to the J/ψϕ final state is also observed with high significance. In addition, the four previously reported J/ψϕ states are confirmed and two more exotic states, Z_{cs}(4220)^{+} and X(4630), are observed with significance exceeding 5 standard deviations.

Two atypical gram-negative bacteria-binding proteins are involved in the antibacterial response in the pea aphid (Acyrthosiphon pisum)

The activation of immune pathways is triggered by the recognition of pathogens by pattern recognition receptors (PRRs). Gram-negative bacteria-binding proteins (GNBPs)/β-1,3-glucan recognition proteins (βGRPs) are a conserved family of PRRs in insects. Two GNBPs are predicted in the genome database of pea aphids; however, little is known about their functions in the aphid immune system. Here, we show that pea aphid GNBPs possess domain architectures and sequence features distinct from those of typical GNBPs/βGRPs and that their expression is induced by bacterial infection. Knockdown of their expression by dsRNA resulted in lower phenoloxidase activity, higher bacterial loads and higher mortality in aphids after infection. Our data suggest that these two atypical GNBPs are involved in the antibacterial response in the pea aphid, likely acting as PRRs in the prophenoloxidase pathway.

Measurement of e^{+}e^{-} Momentum and Angular Distributions from Linearly Polarized Photon Collisions

The Breit-Wheeler process which produces matter and antimatter from photon collisions is experimentally investigated through the observation of 6085 exclusive electron-positron pairs in ultraperipheral Au+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements reveal a large fourth-order angular modulation of cos4Δϕ=(16.8±2.5)% and smooth invariant mass distribution absent of vector mesons (ϕ, ω, and ρ) at the experimental limit of ≤0.2% of the observed yields. The differential cross section as a function of e^{+}e^{-} pair transverse momentum P_{⊥} peaks at low value with sqrt[⟨P_{⊥}^{2}⟩]=38.1±0.9  MeV and displays a significant centrality dependence. These features are consistent with QED calculations for the collision of linearly polarized photons quantized from the extremely strong electromagnetic fields generated by the highly charged Au nuclei at ultrarelativistic speed. The experimental results have implications for vacuum birefringence and for mapping the magnetic field which is important for emergent QCD phenomena.

[Prediction of the vaulting after posterior chamber intraocular lens implantation]

Objective: To investigate the influencing factors on the vaulting one month after implantable collamer lens (ICL) implantation, and to develop and verify a prediction formula. Methods: The first half of this study was retrospective case series study, and the second half was cross-sectional stydy. A total of 83 eyes of 83 patients who underwent ICL implantation in the Lixiang Eye Hospital of Soochow University were included in the first half of the study, with an average age of (27±5) years, from August 1, 2019 to December 30, 2019. All patients underwent a complete preoperative examination, including axis length, anterior chamber depth, comprehensive optometry, intraocular pressure, central corneal thickness, white-to-white diameter, horizontal and vertical sulcus-to-sulcus diameter (STS), crystalline lens thickness (LT), corneal curvature, and bright and dark pupil diameter. Multiple linear regression (stepwise) was used to develop a prediction formula. In the validation part, a total of 65 people (65 eyes) were included, with an average age of (26±5) years, from March 1, 2020 to June 1, 2020. The accuracy and reliability of the formula were verified by the intergroup correlation coefficient and Bland-Altman consistency test. Results: At 1 month after surgery, ICL size had the greatest impact on the vaulting (β=0.942, P<0.001), followed by horizontal STS (β=-0.517, P<0.001), LT (β=-0.376, P<0.001), and vertical STS (β=-0.257, P=0.017). The influence of other factors was not statistically significant (all P>0.05). The regression equation was as follows: the vaulting (μm)=-1 369.05+657.12×ICL size-287.41×horizontal STS-432.50×LT-137.33×vertical STS (the fitting degree R=0.813, R²=0.660, and corrected R²=0.643). In the verification part, the predicted average vaulting was (497.31±102.75) μm, while the actual vaulting was (514.62±152.99) μm. About 96.92% (63/65) of the patients were fitted in the moderate vault, and 3.08% (2/65) were in the high vault. The intergroup correlation coefficient was 0.581. According to the Bland-Altman test, the actual vaulting was 17.31 μm, higher than the predicted value, and the 95% confidence interval of the difference was -260.28 to 294.90 μm. Conclusion: The ICL size, horizontal and vertical STS and LT are the factors that affect and predict the vaulting one month after ICL implantation, and our prediction formula has good accuracy and reliability. (Chin J Ophthalmol, 2021, 57: 519-525).