[Characteristics of the white matter involvement sites on MRI in patients with multiple gliomas]

The retrospective study included 122 cases of multiple glioma and 183 cases of single glioma. Of these, there were 74 males and 48 female with multiple gliomas, aged 18 to 83 (53±13) years, and 104 males and 79 females with single gliomas, aged 10 to 84 (51±14) years. A standard spatial-based lesion analysis method was used for constructing a spatially distributed frequency heatmap of multiple gliomas, to observe the characteristics of their white matter invasion sites. The spatial distribution was more frequent in the subventricular zone, corpus callosum and cingulate gyrus in the multiple glioma group compared to the single glioma group (P<0.001).The white matter areas of multiple gliomas were more extensively involved, with more frequent involvement of the conjoined fibers (corpus callosum, P<0.05) and contact fibers (cingulate, dome, 0.05<P<0.10) areas.The spatial distribution of the brain and the white matter invasion of multiple gliomas have certain site specificity.

Microeukaryotic Community Shifting Along a Lentic-Lotic Continuum

As an important regulator of ecosystem functions in river systems, microeukaryotes play an important role in energy and material conversion, yet little is known about the shift along a lentic-lotic continuum. In this study, the 18S rRNA genes sequencing was used to identify the microeukaryotic communities at 82 sites along a lentic-lotic continuum with the aim of understanding the impact of upstream inlet river on microeukaryotic communities in Baiyang Lake (BYD) and its downstream. Our results showed that the upstream inlet river affected the diversity and community composition of microeukaryotes in BYD and downstream rivers, and environmental variables greatly affected the composition of microeukaryotic community. The community composition in BYD had lower variabilities. Co-occurrence network analysis revealed that the network was non-random and clearly parsed into three modules, and different modules were relatively more abundant to a particular area. As keystone taxa, some nodes of the upstream microeukaryotic network played an important role in structuring network and maintaining the stability of the ecosystem. In BYD and downstream, the microeukaryotic network was highly fragmented, and the loss of keystone taxa would have an adverse impact on the integrity and function of the microeukaryotic community. Microeukaryotes had strong tendencies to co-occur, which may contribute to the stability and resilience of microeukaryotic communities. Overall, these findings extend the current understanding of the diversity and community composition of microeukaryotic along a lentic-lotic continuum.

Small Run-of-River Dams Affect Taxonomic and Functional β-Diversity, Community Assembly Process of Benthic Diatoms

Being increasingly constructed worldwide, dams are a main driver of flow regime change and biodiversity decline. Although small run-of-river dams have exceeded the number of large dams, their impacts on taxonomic and functional β-diversity as well as community assembly process of aquatic organisms have been largely neglected. Ninety sites within twenty three small run-of-river dams in the Xiangxi River were selected, and the hydrological and physicochemical variables for each site were measured. We analyzed the traits and β-diversity of benthic diatoms, and explored the key driving mechanism of benthic diatom community assembly. Our results indicated that the construction of small run-of-river dams could affect the β-diversity of benthic diatoms and the mechanism of community assembly. Specifically, we found that small run-of-river dams could change the relative contribution of nestedness components to the trait-based β-diversity of benthic diatoms, but generally the taxonomy-based β-diversity was relatively higher than the trait-based β-diversity. Furthermore, the community assembly process of benthic diatoms was also affected. In areas affected directly by small run-of-river dams, dispersal assembly was the key mechanism for community assembly. Compared to unregulated habitats, the dispersal assembly process between the impacted and the unregulated habitats has been enhanced. We advocate that this study can be expanded to other organisms (such as macroinvertebrates, phytoplankton, fish) in future to fully understand impacts of small run-of-river dams on biodiversity from a multi-trophic level aspect. Based on our results, we suggest that maintaining genetic and ecological connectivity based on an effective impact assessment in dry seasons is a potential solution to mitigate the impacts of such dams, as key to adaptive management and sustainability.

[Pretreatment evaluation of 18F-FDG PET-CT in extranodal NK/T-cell lymphoma]

Objective: To investigate the clinical value of pretreatment ¹⁸F-fluorodeoxy glucose positron emission tomography/computed tomography (¹⁸F-FDG PET-CT) in extranodal NK/T-cell lymphoma. Methods: Eighty-one patients with pathologically confirmed extranodal NK/T-cell lymphoma and pretreatment with PET-CT scan in Cancer Hospital, Chinese Academy of Medical Sciences from August 2006 to December 2017 were enrolled in the study. The clinical, follow-up and imaging data were analyzed retrospectively. The relationship between maximum standard uptake value (SUV_max) and prognosis were evaluated by Mann-Whitney U test and Spearman rank correlation analysis. Results: Among the 81 patients, 98.8% (80/81) were upper aerodigestive tract (UAT) involved. Lesions at extra-UAT sites were detected in 7 cases, involving parotid gland (n=1), breast (n=1), spleen (n=1), pancreas (n=1), skin and subcutaneous soft tissue (n=1), muscle (n=1), lung (n=2) and bone (n=3). Lymph node involvement were demonstrated in 33 cases. All of the lesions had increased uptake of PET, the median SUV_max was 8.6. PET-CT changed staging in 15 cases, and 12 cases were adjusted treatment methods. 21 cases were changed radiotherapy target because of PET-CT. The 1-, 2-year progression-free survival (PFS) rates were 88.7% and 80.3% while 1-, 2-year overall survival (OS) rates were 97.2% and 94.4% respectively. The median SUV_max of patients with local lymph nodes involvement was significantly higher than those without local lymph nodes involvement (P=0.007). The SUV_max was positively associated with Ann Arbor stage (r=0.366, P=0.001), lactate dehydrogenase (r=0.308, P=0.005) and Ki-67 level (r=0.270, P=0.017). The SUV_max was inversely associated with lymphocyte count (r=-0.324, P=0.003) and hemoglobin content (r=-0.225, P=0.043). Conclusions: Extranodal NK/T-cell lymphoma predominantly occurs in extra-nodal organs, mainly in the upper respiratory and gastrointestinal tracts, with marked FDG-addiction. Compared with conventional imaging, ¹⁸F-FDG PET-CT is sensitive and comprehensive in detecting extra-nodal NK/T-cell lymphoma involvement, assisting in accurate clinical staging and treatment planning. Pretreatment SUV_max is potential for prognosis evaluation since it is correlated with prognostic factors.

Succession and Driving Factors of Periphytic Community in the Middle Route Project of South-to-North Water Division (Henan, China)

The Middle Route Project of the South-to-North Water Diversion is an artificially independent system that does not connect to other surface waters. Excessive periphyton proliferation causes a series of environmental problems in the canal. In this study, the periphyton community and environmental factors on the left and right banks of the canal in the algal growing area were investigated and sampled six times (June, September, and November of 2019 and 2020). The succession pattern of the attached organism community in the artificial canal was analyzed, and the key factors affecting the algal community were analyzed using RDA and GAM. The results showed that the seasonal variability of the environmental factors was more significant than the spatial variability. A total of 114 taxa of periphytic algae were found, belonging to seven phyla and 69 genera, and mainly composed of Bacillariophyta. Species richness was ranked as Bacillariophyta (60 taxa), Chlorophyta (31 taxa) and Cyanobacteria (15 taxa), and higher in autumn than in summer. The dominant taxa were Cymbella sp., Fragilaria sp., Navicula sp. and Diatoma sp. The abundance of periphytic algal varied from 0.07 × 10⁵ to 8.99 × 10⁵ ind./cm², with trends similar to that of species richness. The redundancy analysis and generalized additive model showed that water temperature and nutrient concentration were the key factors influencing the structure of the algal community, followed by discharge rate and velocity, which were the determinants of the spatial and temporal patterns of the algal community. In view of the influence of discharge and velocity on the structure of algal communities, it is suggested that ecological scheduling could be used to regulate the structure of the algal community on the canal wall in the operation of later water division projects to ensure the safety of water division.

Small run-of-river hydropower dams and associated water regulation filter benthic diatom traits and affect functional diversity

Knowledge of benthic diatom traits can help understand ecosystem function and guide biodiversity conservation. This is particularly important in rivers on which there are small run-of-river dams, which currently receive less attention. These dams generate power by drawing water from upstream and discharging it downstream after a large drop in penstock. We examine 15 functional diatom traits in habitats upstream, surrounding, and downstream of 23 small run-of-river dams in Xiangxi River, China. We compare the effects of these small dams on benthic diatom species traits, and taxonomic and functional diversity, from 90 sites. Dams change local environmental (e.g., channel width, flow velocity, depth) and physicochemical (e.g., dissolved oxygen, water temperature) variables, and a shift in diatom life forms and guilds is apparent, from taxa with strong attachment and low profile in high velocity waters (i.e., H1, H2 and H4) to those with weak attachment or that are planktonic below dams and outlets (i.e., H3 and H5), and towards high profile taxa below dams. Significant differences in biodiversity, particularly in functional richness, redundancy, and evenness, are apparent. Species and functional diversity indices are influenced by physical and chemical environmental factors (especially flow velocity and water depth). We found that diatom functional traits reflect longitudinal changes in flow and ecological condition, and suggest that monitoring such traits could be useful in adjusting flows to minimize ecosystem impacts. To maintain ecological flow and reasonable water depth within rivers we advocate for improved connectivity, carrying capacity and resilience of water ecosystems via a long-term, trait-based understanding of the impacts of small run-of-river dams.

Evolving framework of studies on global gulf ecosystems with Sustainable Development Goals

Gulf ecosystems provide many beneficial services to humanity and play a key role in achieving the Sustainable Development Goals (SDGs). However, the sustainability of gulf ecosystems has been severely threatened by climatic and anthropogenic stresses. Using network analysis of article records downloaded from Web of Science, we summarize the current research framework of gulf ecosystems via the perspectives of research themes, interdisciplinarity, and international collaborations. Research themes involve nutrient and eutrophication, biodiversity, mangrove and sediment pollution, and ecosystem service and climate change. Nevertheless, these themes usually focus on gulf ecosystems themselves with little consideration of their connectivity with other ecosystems. Interdisciplinarity has remained mostly within natural sciences while international collaborations exist mainly between developed and developing countries and among developed countries. Combined with the SDGs, we propose the future research framework where research themes should consider the impacts of terrestrial and freshwater ecosystems on gulf ecosystems at the watershed scale. Interdisciplinarity between natural and social and management sciences needs to be promoted by utilizing the advantages of data sciences. Collaborations with developing countries led by China, Mexico, Brazil, and India need to be strengthened. The evolved research framework could offer decision support for stakeholders to manage gulf ecosystems and achieve the SDGs.

[The clinical efficacy of the stratification medical treatment based on the risk estimation of motor complications in Parkinson's disease]

Objectives: To evaluate the clinical efficacy of the stratification medical treatment based on the motor complications risk estimation in improving the quality of life, motor symptoms and delaying the motor complications in Parkinson's patients. Methods: Outpatients and inpatients from Xinhua Hospital, Shanghai Jiao Tong University, were recruited between November 2019 and June 2020. The participants were all clinically diagnosed with PD and treated with anti-PD medications, but had no history of motor complications, with the 8-item Parkinson's disease questionnaire summary index (PDQ-8 SI)>18.59. At baseline, the demographic characteristics, PD medical history, levodopa dosage (LD) and levodopa equivalent dosage (LED) were collected, and the evaluation of PDQ-8, Unified Parkinson's disease rating scale (UPDRS)-Ⅱ and Ⅲ, Hoehn and Yahr (H&Y) grade, Hamilton anxiety scale-14 (HAMA-14), Hamilton depression scale-24 (HAMD-24), mini-mental state examination (MMSE), Pittsburgh sleep quality index (PSQI), and Epworth sleepiness scale (ESS) tools was accomplished in all participants. Meanwhile, a Parkinson's disease risk estimation scale for motor complications was used to assess patients' risk of motor complications, and thus the medication was stratified in PD patients accordingly. During the 6-month and 12-month follow-ups, the evaluation of the above-mentioned parameters was repeated in all participants. At the 3-month and 9-month follow-ups, the information of anti-PD medications, the occurrence of motor complications (motor fluctuations and dyskinesia) and adverse drug reactions were recorded, and PDQ-8 was also evaluated. Results: Two hundred and fifty-one patients completed the 1-year follow-up, with 135 males and 116 females. At baseline, the median age of the patients was 66 (60, 71) years and the median PDQ-8 SI was 31.2 (21.9, 40.6). Additionally, 15.9% (40/251) of the patients were at high risk of motor fluctuation, and 7.2% (18/251) were at high risk of dyskinesia. There were significant differences in the age of onset, disease duration, PD treatment duration, the scores of UPDRS-Ⅱ and Ⅲ, H&Y Grade, and PDQ-8 SI among PD patients of different risk groups (all P<0.05). In the 12th month, the median of PDQ-8 SI, Δ PDQ-8 SI and Δ UPDRS-Ⅲ was 12.5 (9.4, 18.8), -15.6 (-21.9, -9.4) and -9(-16, -4), respectively, which was statistically different from that of baseline (all P<0.05). The change of UPDRS-Ⅱ scores in the group with high risk of motor fluctuation was statistically different from that in the groups with low and moderate risk (P<0.05). The changes of PSQI score, LD and LED in the group with high risk of dyskinesia was statistically different from those in the groups with low and moderate risk (all P<0.05). During the follow-up, the incidence of motor fluctuation and dyskinesia was 9.56% (24/251) and 5.97% (15/251), respectively. Conclusion: The stratification medical treatment might have a positive intervention effect on promoting a better quality of life, improving motor symptoms and delaying motor complications in PD patients.

Using integrated models to analyze and predict the variance of diatom community composition in an agricultural area

With the growing demand of assessing the ecological status, there is the need to fully understand the relationship between the planktic diversity and the environmental factors. Species richness and Shannon index have been widely used to describe the biodiversity of a community. Besides, we introduced the first ordination value from non-metric multidimensional scaling (NMDS) as a new index to represent the community similarity variance. In this study, we hypothesized that the variation of diatom community in rivers in an agricultural area was influenced by hydro-chemical variables. We collected daily mixed water samples using ISCO auto water samplers for diatoms and for water-chemistry analysis at the outlet of a lowland river for a consecutive year. An integrated modeling was adopted including random forest (RF) to decide the importance of the environmental factors influencing diatoms, generalized linear models (GLMs) combined with 10-folder cross validation to analyze and predict the diatom variation. The hierarchical analysis highlighted antecedent precipitation index (API) as the controlling hydrological variable while water temperature, Si²⁺ and PO₄-P as the main chemical controlling factors in our study area. The generalized linear models performed better prediction for Shannon index (R² = 0.44) and NMDS (R² = 0.51) than diatom abundance (R² = 0.25) and species richness (R² = 0.25). Our findings confirmed that Shannon index and the NMDS as an index showed good performance in explaining the relationship between stream biota and its environmental factors and in predicting the diatom community development based on the hydro-chemical predictors. Our study showed and highlighted the important hydro-chemical factors in the agricultural rivers, which could contribute to the further understanding of predicting diatom community development and could be implemented in the future water management protocol.

The effect of habitat restoration on macroinvertebrate communities in Shaoxi rivers, China

In recent decades, the biodiversity of freshwater environments has decreased sharply due to anthropogenic disturbances that damaged ecosystem structures and functions. Habitat restoration has emerged as an important method to mitigate the degradation of river ecosystems. Although in many cases a post-project monitoring has been promoted to access the restoration progress, it is still unclear how aquatic community changes following river habitat restoration in China. Macroinvertebrate communities intermediately positioned within ecosystem food webs play a key role in ecosystem processes within river ecosystem, driving energy flow and nutrient cycling. Here, benthic macroinvertebrates are used as bio-indicators to assess the ecosystem health of degraded urban rivers, restored urban rivers, and undisturbed rivers. This study aims to determine (i) how habitat restoration influences macroinvertebrates diversity and how this compared to degraded and reference conditions; (ii) how did macroinvertebrate community compositions differ in restored, degraded, and reference sites; and (iii) the environmental factors shaping macroinvertebrate communities. Habitat restoration significantly increased the diversity and richness of macroinvertebrate community and intolerant species and shifted the community composition towards reference status. Habitat characteristics and water chemistry, including substrate diversity, water velocity, and both nutrients (TN) and organic pollutants (TOC), appeared to shape the turnover of these communities. Habitat characteristics contributed to most of the variation of the entire macroinvertebrate community. Our research indicates that habitat restoration is an efficient approach to restore the aquatic community and hence improve river ecosystem health for freshwater conservation and sustainable management in Zhejiang province. This study strengthens our understanding of the changes of macroinvertebrate community after habitat restoration and important controlling variables that attribute to these changes, which provides an important guidance for future freshwater management.

Validation of F3ALLS Assessment in Older Adults

OBJECTIVES

The study aimed to evaluate the brief F3ALLS assessment's validity in screening fall risk.

DESIGN

This is a cross sectional and longitudinal study.

SETTING

Participants were recruited from outpatient primary care clinics.

PARTICIPANTS

Older ambulatory adults ages 65-90 volunteered for this study.

MEASUREMENTS

Falls risk was measured with TGBA and F3ALLS questionnaires. A 6-month follow-up period assessed for falls using falls diaries and chart review.

RESULTS

Participants (n=97) were older adults ages 73.91±6.4, 68% (n=66) female. 31% of participants reported at least one fall at 6-months. F3ALLS scores were higher in participants who reported 1 or more falls at 6-months follow-up (3.23±1.5). Higher F3ALLS scores were associated with 6-month fall risk (OR=1.463, 95% CI=1.098-1.949). A score > 3 stratified patients as at risk of falling (AUC=0.77, P<.001; Sensitivity=0.65, Specificity=0.71).

CONCLUSION

The F3ALLS questionnaire adequately classifies person at risk versus not at risk for falls, and higher (worse) F3ALLS scores are associated with falls over 6 months.

Nitrous acid emission from soil bacteria and related environmental effect over the North China Plain

Soil bacteria could be one of the important sources for ambient HONO. However, the HONO emission from soil bacteria over North China Plain (NCP) with vast croplands has not yet been evaluated. In this study, high-resolution simulations are created to explore the HONO emission from soil bacteria over NCP and related influences on atmospheric chemistry. Ground measurements of critical air pollutants including O₃, HONO, and PM_2.5 compositions are incorporated to constrain the model simulations. Results show that abundant HONO is emitted from soil bacteria over NCP during summertime and the emission rate varies dramatically for different areas (about 0.2 kg km^-2 d^-1 - 2.0 kg km^-2 d^-1). The HONO emission rate presents clear diurnal cycles with peaks of 1.5 kg km^-2 d^-1 in the afternoon and valleys of 0.4 kg km^-2 d^-1 during the early morning hours. The resulting HONO concentration ranges from 0.2 μg m^-3 to 1.4 μg m^-3, which predominates the total HONO concentration in ambient air, particularly in western NCP. The soil bacteria source can significantly alter the diurnal cycles of ambient HONO and OH concentrations over NCP, but only slightly change O₃ and PM_2.5 concentrations via participating photochemistry and secondary aerosol formations. These results highlight the pressing need for the involvement of HONO emission from soil bacteria in modeling studies regarding atmospheric chemistry, particularly in rural areas.

[Prognostic evaluation value of (18)F-FDG PET-CT in Hodgkin's lymphoma after treatment]

Objective: To investigate the prognostic value of (18)F-fluorodeoxygen-D-glucose-positron emission tomography /computerized tomography ((18)F-FDG-PET-CT) in Hodgkin's lymphoma (HL) at the end of first-line treatment (PET-end), by comparing the ratio of maximum standardized uptake value (SUV(max)) of lesion and liver SUV (rLL), SUV(max) reduction between baseline PET (PET-0) and PET-end (ΔSUV(max)), and Deauville 5-point scale (5-PS). Methods: Patients with HL newly treated in our hospital from August 2006 to December 2015 were retrospectively analyzed. All the patients enrolled in the study underwent post-treatment FDG PET-CT. The rLL and ΔSUV(max) were calculated, and all the cases were scored using Deauville 5-PS. The receiver operating characteristic (ROC) approach was applied to identify the optimal cut-point value, and survival curves according to different PET-CT assessment methods were estimated using the Kaplan-Meier analysis. The prognostic efficacy of different PET-CT assessment methods was compared, and DeLong test was used to verify it. Kaplan-Meier method and multivariate analysis using the Cox proportional hazards model were performed to analyze the potential independent risk factors. Results: There were 5 patients progressed within a 3-year follow-up. In the three PET-CT assessment methods, the predictive value of rLL and Deauville 5-PS were significant effective. ROC analysis for rLL as a progression predictor showed an optimal cut-point of 1.29. Deauville 5-PS=4 and rLL=1.29 showed the best prognostic accuracy. The sensitivity of rLL and Deauville 5-PS were both 80.0%, and the specificity of each was 98.0% and 93.7%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of rLL were 66.7% and 98.7%, while the PPV and NPV of 5-PS were 44.4% and 98.7%. The 3-years progression-free survival (PFS) rates of rLL≥1.29 group and rLL<1.29 group were 33.3% and 98.7%, with significant difference (P<0.001). The 3-years PFS rates of post-treatment Deauville 5-PS<4 group and Deauville 5-PS≥4 group were 98.7% and 55.6%, with significant difference (P<0.001). The prognostic evaluation efficacy of rLL was positively correlated with that of Deauville 5-PS (r=0.75, P<0.05). Area under curves (AUC) of rLL and Deauville 5-PS were 0.93 (95%CI: 0.825-1.000) and 0.91 (95%CI: 0.757-1.000), respectively. DeLong test showed the significant difference between the two methods (P<0.05). The univariate analysis results showed that clinical baseline stage, post-treatment rLL and Deauville 5-PS were associated with the prognoses of HL patients (P<0.05). The multivariate analysis results showed that post-treatment rLL and Deauville 5-PS were independent prognostic factors of HL (P<0.05). Conclusions: The rLL and Deauville 5-PS are potential prognostic factors for HL response assessment. The new semi-quantitative method rLL has methodological advantages over visual analysis, and it is a good supplement for Deauville 5-PS. rLL can improve prognostic evaluation accuracy of PET-CT and is useful to early identify patients with HL at a high risk of relapsing after first-line treatment.

Microbial biofilm community dynamics in five lowland streams

Stream biofilms are complex aggregates of diverse organism groups that play a vital role in global carbon and nitrogen cycles. Most of the current studies on stream biofilm focus on a limited number of organism groups (e.g., bacteria and algae), and few have included both prokaryote and eukaryote communities simultaneously. In this study, we incubated artificial substrates in five Danish lowland streams exhibiting different hydrological and physico-chemical conditions and explored the dynamics of community composition and diversity of the benthic biofilm, including both prokaryotes and eukaryotes. We found that few phyla in the prokaryote (Gammaproteobacteria and Bacteroidetes) and eukaryote (Cercozoa) communities accounted for over two-thirds of the total abundance at most of the sites. Both prokaryotic and eukaryotic diversity displayed the same temporal patterns, i.e., diversity peaked in July and January. We also found that hydrological and physico-chemical variables significantly explained the variation in the community composition at phylum level for both prokaryotes and eukaryotes. However, a large proportion of variation remained unexplained, which can be ascribed to important but unmeasured variables like light intensity and biological factors such as trophic and non-trophic interactions as revealed by network analysis. Therefore, we suggest that use of a multitrophic level perspective is needed to study biofilm i.e., the "microbial jungles", where high occurrences of trophic and non-trophic interactions are expected.

Effects of the herbicides metazachlor and flufenacet on phytoplankton communities - A microcosm assay

Agrochemicals are the main pollutants in freshwater ecosystems. Metazachlor and flufenacet are two common herbicides applied in fall (i.e., August-October) to agricultural fields in Northern Germany. High concentrations of these herbicides are often found in adjacent aquatic ecosystems. Phytoplankton are one of the highly susceptible non-targeted aquatic organismal groups for herbicides and effects on phytoplankton may initiate a chain of consequences in meta communities through trophic interactions. Few studies have focused on responses of the phytoplankton community for metazachlor and, no studies have focused on flufenacet. We studied the effects of metazachlor and flufenacet on the phytoplankton community by conducting a microcosm experiment exposing natural fall phytoplankton communities to environmentally realistic concentrations as 0 (control), 0.5, 5 and 50 µg L-1 of metazachlor and flufenacet treatments over a 4-week period. We measured changes in density, composition (i.e., in phyla and species level), taxonomic diversity indices, and functional features of phytoplankton communities as a response to herbicides. A reduction in the density of Chlorophyta species (e.g., Koliella longiseta, Selenastrum bibraianum) and Cyanobacteria species (e.g., Merismopedia tenuissima and Aphanocapsa elegans) was observed in herbicide treatments compared to controls. The phytoplankton community shifted towards a high density of species from Bacillariophyta (e.g., Nitzschia fonticola and Cyclotella meneghiniana), Miozoa (i.e., Peridinium willei), and Euglenozoa (i.e., Trachelomonas volvocina) in herbicide treatments compared to controls. Metazachlor and flufenacet showed significant negative effects on taxonomic diversity indices (e.g., species richness, the Shannon-Wiener index) and functional features (e.g., functional dispersion and redundancy) of the phytoplankton communities, with increasing herbicide concentrations. Our study provides insights into direct, selective, and irrecoverable effects of metazachlor and flufenacet on phytoplankton communities in the short-term. The comprehensive understanding of these effects of environmentally realistic herbicide concentrations on aquatic biota is essential for a sustainable management of aquatic ecosystems in agricultural areas.

Carbapenem-resistant Enterobacterales colonization and subsequent infection in a neonatal intensive care unit in Shanghai, China

Background

Colonization has been reported to play an important role in carbapenem-resistant Enterobacterales (CRE) infection; however, the extent to which carriers develop clinical CRE infection and related risk factors in neonatal intensive care unit (NICU) patients is unclear.

Aim

To investigate the frequency of CRE colonization and its contribution to infections in NICU patients.

Methods

CRE colonization screening and CRE infection surveillance were performed in the NICU in 2017 and 2018.

Findings

Among 1230 unique NICU patients who were screened for CRE colonization, 144 patients tested positive (11.7%, 144/1230), with 9.2% (110/1197) in the intestinal tract, which was higher than that in the upper respiratory tract (6.6%, 62/945) (P=0.026). Gestational age, low birth weight and prolonged hospitalization were risk factors for CRE colonization (all P<0.001). Diversilab homology monitoring found an overall 17.4% (25/144) risk of infection among patients colonized with CRE. For carbapenem-resistant Klebsiella pneumoniae (CR-KP) and carbapenem-resistant Escherichia coli (CR-ECO), the risks were 19.1% (21/110) and 13.8% (4/29), respectively. The independent risk factors for CR-KP clinical infection among CR-KP carriers were receiving mechanical ventilation (odds ratio (OR), 10.177; 95% confidence interval (CI), 2.667–38.830; P=0.013), a high level of neonatal nutritional risk assessment (OR, 0.251; 95% CI, 0.072–0.881; P=0.031) and a high neonatal acute physiology II (SNAP-II) score (OR, 0.256; 95% CI, 0.882–1.034; P=0.025).

Conclusions

The colonization of CRE may increase the incidence of corresponding CRE infection in NICU patients. Receiving mechanical ventilation, malnutrition and critical conditions with high SNAP-II scores were independent risk factors for subsequent CR-KP clinical infection.

Clinical benefits of TNF-α inhibitors in Chinese adult patients with NLRP3-associated autoinflammatory disease

BACKGROUND

Nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3)-associated autoinflammatory disease (NLRP3-AID) is a rare, heterogeneous disease entity associated with mutations in NLRP3. Biologic therapy for NLRP3-AID yields diverse results.

OBJECTIVES

We aimed to evaluate the clinical features and outcomes of Chinese adult patients with NLRP3-AID who were treated with tumour necrosis factor (TNF)-α inhibitors.

METHODS

Five patients with NLRP3-AID were diagnosed and treated with TNF-α inhibitors at Peking Union Medical College Hospital between 2017 and 2020 and were followed up for 6 to 12 months. All patients were systematically studied for treatment outcomes, including clinical manifestations and inflammatory markers.

RESULTS

All five adult NLRP3-AID patients were Chinese Han, and four patients were males. The mean age at disease onset was 4.2 ± 4.1 years, and the mean time of diagnosis delay was 19.8 ± 6 years. All patients received TNF-α inhibitors with or without methotrexate/prednisone. During follow-up, all patients achieved remarkable clinical remission of skin lesions and polyarthritis and showed improvements in acute-phase reactants, inflammatory cytokines, patient visual analogue scale, physician global assessment and 36-item Short Form (SF-36).

CONCLUSIONS

Early diagnosis and effective therapy for NLRP3-AID are essential for avoiding irreversible organ damage. TNF-α inhibitors might serve as a therapeutic alternative for patients with NLRP3-AID who have unsatisfactory responses or no access to interleukin-1 inhibitors.

[Analysis of the relationship between the anatomical location of intrapulmonary metastatic lymph nodes and relapse risk and survival in patients with N1 non-small cell lung cancer]

Objective: To evaluate the relationship between the anatomical location of intrapulmonary metastatic lymph nodes and relapse risk and survival in patients with N1 non-small cell lung cancer(NSCLC). Methods: A retrospective analysis of the clinical and pathological data of 138 patients with completely resected N1 NSCLC was conducted. There were 79 males and 59 females, aged from 26 to 81 years with an average of (59±10) years. All of them were treated in the Department of Thoracic Surgery Ⅱ of Peking University Cancer Hospital between January 2007 and December 2015. Patients were stratified based on the 8th edition of the American Joint Committee on Cancer (AJCC) N1 classification and the modified pathological N1 classification strategy, respectively. According to modified pathological N1 classification strategy, which was defined based on the anatomical location of intrapulmonary metastatic lymph nodes, N1 nodes were subcategorized into the hilar (stations 10-11, mN1b) (n=36) and peripheral (stations 12-14, mN1a) (n=102) zones. The Kaplan-Meier curves were plotted to compare the relapse risk and survival analysis, disease-free survival (DFS), and overall survival (OS) were compared between the two staging methods through univariate and multivariate analysis to evaluate the effectiveness of the two classifications in stratifying patients with distinct risks of disease relapse and survival. Results: According to the modified N1 classification, the differences in 5-year DFS and OS between the subgroups (mN1a vs mN1b) were statistically significant(59.5% vs 35.7%; 81.2% vs 56.0%; both P<0.05). However, following the 8th edition of the AJCC N1 classification, no significant differences were found in DFS and OS between the subgroups (both P>0.05). Multivariate analysis showed that the modified N1 classification was an independent prognostic factor to DFS (HR=1.814, 95%CI: 1.005-3.275) and OS (HR=3.919, 95%CI: 1.918-8.009) (all P<0.05). However, the 8th edition of the AJCC N1 classification was not an independent prognostic factor to DFS (HR=1.360, 95%CI:0.767-2.412) or OS (HR=1.620, 95%CI:0.839-3.131) (both P>0.05) as revealed by multivariate analysis. Conclusions: The relapse risk and survival could be assessed effectively using the modified pathological N1 classification, which was defined and subcategorized based on the anatomical location of intrapulmonary metastatic lymph nodes for N1 NSCLC patients. The modified pathological N1 classification is superior to the 8th edition of the AJCC classification.