[Survey on situation and cognition of influenza vaccination among population in six provinces of China]

Objective: To understand the cognition on and status quo of influenza vaccination among all age groups in the survey areas from 6 provinces so as to explore the main factors related to influenza vaccination. Methods: A cross-sectional survey method was conducted to study the knowledge on influenza prevention and control, as well as on the status of influenza vaccination in Beijing, Inner Mongolia, Shanghai, Guangdong, Yunnan, and Gansu provinces through 12320 health hotline telephone with method of random number table in Mar-May 2018. The survey sample size was 9 438 respondents. Results: The survey response rate was 46.4%(10 045/21 658). A total of 10 045 respondents were surveyed. The awareness on flu-related knowledge "influenza is different from the common cold" was 75.3% (7 564/10 045), rate on "influenza virus will cause serious consequences" was 82.0% (8 241/10 045). The rate of health behavior such as frequent hand, washing hand, wearing masks and isolating themselves were 80.41% (7 936/9 873), 75.8% (7 506/9 899) and 73.6%(7 228/9 822) respectively when the influenza-like symptoms already started. The influenza vaccination rate in the past year was only 5.7% (570/10 037). Multivariate logistic analysis of influenza vaccination rate in the past year showed that respondents who were from Gansu province or Beijing, respondents occupations were as medical staff or full-time students, respondents who were living with more than 2 people at the same house, respondents who had had influenza symptoms without wearing masks, the influenza vaccination rates were higher in the past year. Conclusions: Rates regarding the awareness of influenza-related knowledge, health behavior when the influenza-related symptoms already started and having received the influenza vaccine vaccination in the past year should be further improved in the six provinces. Health education on influenza-related knowledge and vaccine vaccination should be strengthened, strategies including free vaccination are bound to be explored.

[Association of dietary patterns and diabetes risk level among adult residents in Datong city of Shanxi Province]

Objective: To explore the association of dietary pattern and type 2 diabetes mellitus (T2DM) risk. Methods: In 2013, 3 747 participants from 87 coalmine branches of a large coal mine group in Datong City, Shanxi Province were selected by using a two-stage cluster stratified sampling method. Data on demographic characteristics, smoking, drinking, and family history of diabetes were collected by using a self-made questionnaire, and the International Physical Activity Questionnaire was used to assess the level of physical activity. Physical, glucose and lipid metabolism indicators were measured and subjects were divided into high-risk groups and low-risk groups of T2DM according to the T2DM risk score. Dietary data were collected by using Semi-quantitative Food Frequency Questionnaire, and dietary patterns were derived by using the exploratory factor analysis and cluster analysis. The unconditional logistic regression model was used to assess the association of dietary patterns and T2DM risk. Results: The age of the subjects was(41.48±8.62) years old, and 2 843 of them were males (84.31%). A total of 1 819 subjects were in the high-risk group and 1 553 in the low-risk group. Four dietary patterns, healthy diet, high-salt diet, meats diet, and carbohydrate-rich diet, were identified in this study. The unconditional logistic regression analysis showed that compared with the healthy diet pattern, after the adjustment of demographic characteristics, smoking, and drinking, the OR (95%CI) of T2DM risk in high-salt diet, carbohydrate-rich diet and meats diet patterns was 1.54 (1.26-1.88), 1.80 (1.43-2.28) and 1.20 (0.99-1.46), respectively. Conclusion: High-salt diet and carbohydrate-rich diet were positively associated with T2DM risk, whereas there was no association of meats diet and T2DM risk.

A26 PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE INCREASES THE RISK OF VENOUS THROMBOEMBOLISM: A CANGIEC POPULATION-BASED STUDY

Background

Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism (VTE) in patients of all ages but the risk of VTE among Canadian children with IBD has not previously been investigated.

Aims

Report the incidence of VTE and subtypes pulmonary embolism (PE) and deep vein thrombosis (DVT) in children with and without IBD.

Methods

Children diagnosed with IBD <16y were identified from health administrative data in Ontario (2002–2014), Alberta (2007–2015), and Nova Scotia (2002–2012) using validated algorithms and matched by age and sex to children without IBD (1:5 ratio). Validated ICD-10 codes identified hospitalizations for incident VTE (DVT, PE, and sinovenous thrombosis). Province-specific 5-year cumulative incidence per 1000 person-years (PY) of VTEs were pooled using fixed-effects generalized linear mixed models with a Freeman-Tukey double arcsine transformation. Incidence rate ratios (IRR) within 5 years of diagnosis were pooled using fixed-effects generalized linear mixed models to compare children with and without IBD, and children with Crohn’s disease (CD) and ulcerative colitis (UC).

Results

3127 children with IBD (1826 CD; 1045 UC) were matched to 15,635 children without IBD. The cumulative incidence of VTE within 5 years of IBD diagnosis was 2.8 (95% CI 2.1–3.8) per 1000 PYs compared to 0.13 (95% CI 0.07–0.24) per 1000 PYs in children without IBD (Table). The 5-year cumulative incidences of VTE, DVT, and PE were significantly higher in children with IBD than in children without IBD (VTE: IRR 21.44, 95% CI 10.73–42.82; DVT: IRR 25.15, 95% CI 11.12–56.89; PE: IRR 4.01, 95% CI 1.22–13.18). Compared to UC patients, children with CD were at lower risk of VTE (IRR 0.53, 95% CI 0.29–0.96) and numerically, but not statistically, lower risk of DVT (IRR 0.59, 95% CI 0.30–1.14).

Conclusions

Although VTEs are relatively rare among children with IBD, these children are at much greater risk than children without IBD. Gastroenterologists caring for these patients should be cognizant of VTE risk and provide appropriate prophylaxis to those at high risk of VTE.

Funding Agencies

CCC

[Correlation analysis on meteorological factors regarding the incidence of hand, foot and mouth disease in Xinjiang Uygur Autonomous Region, 2011-2018]

Objective: To study the correlation between meteorological factors and the incidence of hand, foot and mouth disease (HFMD) in Xinjiang Uygur Autonomous Region (Xinjiang) so as to provide scientific evidence for the early warning, prediction, prevention and control of HFMD. Methods: Data on HFMD surveillance and related population was collected from the China Information System for Disease Control and Prevention from 2011 to 2018. Meteorological data was obtained from http://www.tianqihoubao.com. Correlation analysis on meteorological factors and the incidence of HFMD in Xinjiang was conducted, using the Excel 2007, SPSS 17.0, and Spatial Distribution Map by ArcGIS 10.2 software. Results: HFMD usually occurred between April and July. Numbers of patients reached the top in May and June. Temperature was positively correlated with the incidence of HFMD (r=0.370, P<0.01) while precipitation was positively correlated with the incidence of HFMD (r=0.747, P<0.01). The temperature threshold appeared as 5 ℃-35 ℃ for the incidence of HFMD. Interval period was one month between the peak of both the incidence of HFMD and the precipitation. A power function relationship (y=0.009 4x(2.332 9), R(2)=0.898 9) was noticed between the precipitation and the incidence of HFMD. Conclusions: The incidence of HFMD was closely related to the meteorological factors including temperature and precipitation in Xinjiang during 2011-2018. Our findings have provided evidence for the development of early warning system on HFMD in Xinjiang.

Imaging characteristics of the mandible and upper airway in children with Robin sequence and relationship to the treatment strategy

Some patients with Robin sequence (RS) may respond to conservative therapy, while others require surgery; however, there are currently no objective anatomical criteria to gauge surgical indication. The purpose of this study was to explore the imaging characteristics of the mandible and upper respiratory tract in children with RS and examine how individual morphometric parameters influence the treatment strategy. Cone beam computed tomography (CBCT) images were obtained from 57 children with RS. Twenty parameters were measured as potential surgical indicators. The children were divided into two groups according to surgical requirement: a non-surgical group (26 children) and a surgical group (31 children who underwent mandibular osteodistraction). Differences in the imaging parameters were compared between the groups. The mandibular ramus was shorter bilaterally (left, P = 0.047; right, P = 0.027) and the mandibular body was longer bilaterally (left, P = 0.030; right, P = 0.025) in the surgical group when compared to the non-surgical group. In addition, the mandibular angle bilaterally (left, P = 0.023; right, P = 0.003) and the cross-sectional area at the epiglottis tip (P = 0.010) were smaller in the surgical group. Compared to RS patients receiving conservative treatment, children requiring surgery have specific anatomical features of the mandible and upper airway that can be used as surgical indications.

[Clinical features and outcomes of pediatric acute fulminant myocarditis requiring extracorporeal membrane oxygenation]

Objective: To observe the clinical features and effects of extracorporeal membrane oxygenation (ECMO) in critically ill children with acute fulminant myocarditis (AFM). Methods: A retrospective analysis was performed in pediatric patients with AFM requiring ECMO, from December 2015 to December 2018, who were admitted to the Pediatric Intensive Care Unit (PICU) in Shanghai Children's Hospital. According to whether patient was alive at least 48 hours after weaning, the children were divided into successful weaning group (9 cases) and unsucessful weaning group (3 cases). The factors related to successful ECMO weaning were explored. The changes of clinical and biochemical parameters before and after ECMO treatment in successful weaning group were analyzed. Continuous variables were presented as median (inter quartile range) for abnormal distribution data, and Mann-Whitney U test was used to compare the data. Results: A total of 12 pediatric patients including 4 males and 8 females were enrolled in this study. The median body weight was 20 (17, 36) kg, and the median age was 66 (48, 103) months. Nine cases were successfully weaned from ECMO, and 8 cases survived to discharge, and 4 cases died in the hospital. The median interval between symptoms onset and ECMO establishment was 3.0 (2.2, 4.0) days, the median duration of ECMO support was 120 (68, 152) hours. In the unsuccessful weaning group, patients displayed higher levels of initiallactic acid (LA), higher vasoactive-inotropic score (VIS), and longer QRS duration before ECMO establishment when compared with those in the successful weaning group (all P<0.05). After ECMO establishment, mean arterial pressure (MAP), systemic central venous oxygen saturation, LA, myocardial injury markers and left ventricular ejection fraction were all significantly improved in the successful weaning group (all P<0.05). Conclusion: In pediatric AFM patients, serum LA level, VIS and QRS duration before ECMO establishment are associated with successful ECMO weaning.

[Clinical features and surgical management of orbitotemporal neurofibromatosis]

Objective: To report the clinical features and surgical treatment of orbitotemporal neurofibromatosis. Methods: It was a retrospective case series study. The clinical records of 24 patients who were treated for orbitotemporal neurofibromatosis between April 2007 and July 2017 at Beijing Tongren Hospital, Capital Medical University were analyzed. Data collected included sex, age, laterality, periorbital deformities, surgical treatment, follow-up time, complication and recurrence. Results: Sixteen males and 8 females were included. Age at surgery was (15±7) years (4-30 years). All patients were unilaterally involved. Twenty-three patients (96%) had upper lid involvement and ptosis. Nine patients (38%) had lower lid involvement. Fourteen patients (58%) had lateral canthal disinsertion. Three patients (13%) had brow involvement, 10 patients (42%) had conjunctival involvement and 2 patients (8%) had lacrimal gland infiltration. All patients had tumor debulking procedure. Twenty-two patients (92%) had correction of ptosis. Fourteen patients (58%) required lid reconstruction and lateral canthus reattachment surgery. Three patients (13%) had correction of brow ptosis.One patient (4%) had skull and orbit reconstruction. The median follow-up time was 3.5 (1.0-10.0) years. All patients had improved appearance. Ptosis recurred in 6 patients, but were corrected with surgery. On the last follow-up, 7 patients were free of ptosis. In 14 patients, mild ptosis was noted, but the upper lid did not cover the pupil. In 2 patients the pupil was half covered. Only in 1 patient who had not received ptosis correction surgery the pupil was covered completely. Conclusions: The periorbital deformities of orbitotemporal neurofibromatosis include upper eyelid infiltration with ptosis, lateral canthal disinsertion and infiltration of lower eyelid, brow, conjunctiva and lacrimal gland. The appearance of patients with orbitotemporal neurofibromatosis can be significantly improved through oculoplastic surgery. (Chin J Ophthalmol, 2019, 55: 828-833).

A population-based study of postfracture care in Manitoba, Canada 2000/2001-2014/2015

We previously found that population-based postfracture notification, which informed primary care physicians of their patient's recent fracture and suggested assessment for osteoporosis, led to an improvement in postfracture care in the context of a randomized controlled trial ( ClinicalTrials.gov identifier NCT00594789, fractures from late 2007 to mid-2010). Since June 2010, a province-wide postfracture notification program was implemented. This study was to (1) determine whether this program has resulted in sustained improvement in postfracture care and (2) test factors associated with receiving osteoporosis care.

METHODS

A retrospective matched cohort study was performed using population-based health administrative data in Manitoba, Canada. We selected individuals aged 50+ years with an incident major osteoporosis fracture (MOF; N = 18,541) in fiscal years 2000/2001 to 2013/2014 and controls without a MOF (N = 92,705) matched (5:1) on age, sex, and residential area. The Cochran-Armitage test tested for a linear trend in osteoporosis care outcomes for cases and controls. Logistic regressions were used to test characteristics associated with the likelihood of receiving osteoporosis care.

RESULTS

The percentage of individuals receiving DXA testing and/or osteoporosis medication increased in fracture cases (p < 0.001), but decreased in controls (p < 0.001). Odds ratios for osteoporosis care in years following the postfracture notification program were approximately double of those prior to the clinical trial. In addition to prior MOF (OR 9.03, 95% CI 8.60-9.48), factors associated with osteoporosis care included lower income (OR   0.72, 95% CI 0.67-0.78), glucocorticoid use (OR   4.37, 95% CI 3.72-5.14), diabetes diagnosis (OR =  0.74, 95% CI 0.68-0.80), and Charlson Comorbidity Index (indexes 1-2: OR 1.27, 95% CI 1.20-1.34; indexes 3-5: OR 1.26, 95% CI 1.13-1.40).

CONCLUSIONS

Adopting a population-based postfracture notification program led to sustained improvements in postfracture care.

Expression of three proteins in endometrioid adenocarcinoma and their significance in clinical nursing, diagnosis and treatment

OBJECTIVE

This study aimed to investigate the role of NEDD9 (neural precursor cell expressed developmentally down-regulated 9), BCAR1/P130CAS (BCAR1/P130 Crk-associated substrate) and paxillin in predicting the prognosis of endometrioid adenocarcinoma (EA), so as to guild the nursing of EA.

PATIENTS AND METHODS

A total of 65 patients who visited Affiliated Hongqi Hospital of Mudanjiang Medical University between June 2015 and June 2017 were enrolled. They underwent gynecological surgery and had their EA confirmed by pathology, and they were assigned to the EA group. All EA tissues were sampled and archived in paraffin blocks. In addition, 40 specimens of atypical endometrial hyperplasia (EAH) (the EAH group) and 40 specimens of normal proliferative endometria with benign uterine fibroids (the EN group) were selected as controls. The protein levels of NEDD9, BCAR1/P130CAS, and paxillin in each group were then detected by immunohistochemical staining.

RESULTS

The expression of the three proteins in the EA group and EAH group was significantly higher than that in the EN group, and their expression was significantly correlated with the clinical stage, histological grade and lymph node metastasis of EA. In addition, the expression of NEDD9, BCAR1/P130CAS, and paxillin in the EA group was positively correlated with each other.

CONCLUSIONS

BCAR1/P130CAS and paxillin interact with NEDD9 to participate in the growth and migration of EA cells. Therefore, their proteins can be used as biomarkers for the diagnosis, treatment, and prognosis of EA.

Mesenchymal Sufu Regulates Development of Mandibular Molars via Shh Signaling

Sonic hedgehog (Shh) in dental epithelium regulates tooth morphogenesis by epithelial-mesenchymal signaling transduction. However, the action of Shh signaling regulation in this process is not well understood. Here we find that mesenchymal Suppressor of Fused (Sufu), a major negative regulator of Shh signaling, plays an important role in modulating the tooth germ morphogenesis during the bud-to-cap stage transition. Deletion of Sufu in dental mesenchyme by Dermo1-Cre mice leads to delayed development of mandibular molar into cap stage with defect of primary enamel knot (EK) formation. We show the disruption of cell proliferation and programmed cell death in dental epithelium and mesenchyme in Sufu mutants. Epithelial-specific adhesion molecule E-cadherin is evidently reduced in the bilateral basal cells of tooth germ at E14.5. The cells in the presumptive EK, predominantly expressing P-cadherin, appear stratified but fail to condense. Moreover, the transcripts of primary EK marker genes, including Shh, Fgf4, and p21, are significantly decreased compared to controls. In contrast, we find that deficiency of Sufu results in elevation of Shh signaling in mesenchyme, indicated by the significant upregulation of Gli1 and Ptch1. Meanwhile, the expression of Bmp4 and Fgf3, the critical factors of mesenchymal-epithelial induction, is significantly inhibited in dental mesenchyme. Furthermore, the expression of Runx2 experiences a transient decrease at the bud stage. Taken together, these data suggest that mesenchymal Sufu is necessary for tuning the Shh signaling, which may act as an upstream modulator of Bmp4 and Fgf3 to coordinate the interplay between the dental mesenchyme and epithelium of tooth germ.

Quantum Criticality of the Ising-like Screw Chain Antiferromagnet SrCo_{2}V_{2}O_{8} in a Transverse Magnetic Field

The quantum criticality of an Ising-like screw chain antiferromagnet SrCo_{2}V_{2}O_{8}, with a transverse magnetic field applied along the crystalline a axis, is investigated by ultralow temperature NMR measurements. The Néel temperature is rapidly and continuously suppressed by the field, giving rise to a quantum critical point (QCP) at H_{C_{1}}≈7.03  T. Surprisingly, a second QCP at H_{C_{2}}≈7.7  T featured with gapless excitations is resolved from both the double-peak structure of the field-dependent spin-lattice relaxation rate 1/^{51}T_{1} at low temperatures and the weakly temperature-dependent 1/^{51}T_{1} at this field. Our data, combined with numerical calculations, suggest that the induced effective staggered transverse field significantly lowers the critical fields, and leads to an exposed QCP at H_{C_{2}}, which belongs to the one-dimensional transverse-field Ising universality.

Effects of AIF-1 inflammatory factors on the regulation of proliferation of breast cancer cells

The purpose of this study was to explore the effect of Allograft Inflammatory Factor 1 (AIF-1) on the regulation of proliferation of breast cancer cells. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), cell culture and counting, and mass spectrometry were performed. The biologically active high-purity recombinant protein rhAIF-1 was obtained by optimizing the rhAIF-1 protein purification system, and MDA-MB-231 and MDA-MB-361 breast cancer cell lines were used. After adding to the culture medium, rhAIF-1 was found to promote cell proliferation in dose-dependent and time-dependent manners. The purified protein rhAIF-1 was marked with rhodamine and incubated with the cells. Confocal imaging analysis revealed that the foreign protein was localized in the cytoplasm, and rhAIF-1 was unevenly distributed in the cytoplasm. Although AIF-1 accumulates around the nucleus, it can not enter the nucleus, suggesting that other factors might be involved in the regulation of cell proliferation. In order to find the possible interacting protein of rhAIF-1, protein immunoprecipitation technique and mass spectrometry were employed, and it was indicated that ADAM28m was the possible interacting protein of rhAIF-1. The interaction between rhAIF-1 and ADAM28m was validated by immunoprecipitation along with Western blotting. It was found that rhAIF-1 could precipitate ADAM28m protein by immunoprecipitation. The results indicated that IF-1 participates in the development of breast cancer by interacting with ADAM28m and activating downstream signaling pathways. It was concluded that AIF-1 provides a new idea for the molecular mechanism of breast cancer cell proliferation and acts as a new target for the prevention and treatment of breast cancer in the future.

LASP1 in Tumor and Tumor Microenvironment

The growing evidence shows that LIM and SH3 Domain Protein 1 (LASP1) is a multi-functional protein that plays important role in forming cytoskeleton and prognostic marker in different cancers. LASP1 expression is correlated with the grade, size, and the metastasis of tumor in clinical samples. And the upregulation of LASP1 facilitates tumor cells proliferation, migration, and invasion perhaps through the interaction with cytoskeleton and increased nuclear translocation. The underlying mechanism of LASP1 on tumor is still in the initial stage; therefore, the signaling pathways in various tumors are specifically summarized to deepen the biological understanding of LASP1. This article systematically summarizes the current status of knowledge regarding the contribution of LASP1 in physiological and pathological processes, especially the progress in tumor. This article also gives an emphasized overview of LASP1 on the correlation with tumor microenvironment.

Nonparametric generalized fiducial inference for survival functions under censoring

Since the introduction of fiducial inference by Fisher in the 1930s, its application has been largely confined to relatively simple, parametric problems. In this paper, we present what might be the first time fiducial inference is systematically applied to estimation of a nonparametric survival function under right censoring. We find that the resulting fiducial distribution gives rise to surprisingly good statistical procedures applicable to both one-sample and two-sample problems. In particular, we use the fiducial distribution of a survival function to construct pointwise and curvewise confidence intervals for the survival function, and propose tests based on the curvewise confidence interval. We establish a functional Bernstein–von Mises theorem, and perform thorough simulation studies in scenarios with different levels of censoring. The proposed fiducial-based confidence intervals maintain coverage in situations where asymptotic methods often have substantial coverage problems. Furthermore, the average length of the proposed confidence intervals is often shorter than the length of confidence intervals for competing methods that maintain coverage. Finally, the proposed fiducial test is more powerful than various types of log-rank tests and sup log-rank tests in some scenarios. We illustrate the proposed fiducial test by comparing chemotherapy against chemotherapy combined with radiotherapy, using data from the treatment of locally unresectable gastric cancer.