[Suggestions for thoracic surgery clinical practice in non-epidemic area of 2019 coronavirus disease]

In this paper, the mechanism of destroying human alveolar epithelial cells and pulmonary tissue by 2019 novel coronavirus (2019-nCoV) was discussed firstly. There may be multiple mechanisms including killing directly the target cells and hyperinflammatory responses. Secondly, the clinical features, CT imaging, short-term and long-term pulmonary function damage of the 2019 coronavirus disease (COVID-19) was analyzed. Finally, some suggestions for thoracic surgery clinical practice in non-epidemic area during and after the epidemic of COVID-19 were provided, to help all the thoracic surgery patients receive active and effective treatment.

[Effect of lncRNA-AC013472.3 on LPS-stimulated secretion of tumor necrosis factor-α in NR8383 rat alveolar macrophages]

Objective: To investigate the effect of long non-coding RNA-AC013472.3 on lipopolysaccharide (LPS)-stimulated secretion of tumor necrosis factor (TNF)-α in NR8383 rat alveolar macrophages. Methods: Silencing and overexpression models of lncRNA-AC013472.3 were established with NR8383 rat alveolar macrophages as the experimental subjects. The silencing models were divided into three groups: random nonsense negative small interfering RNA sequence (si-con) group (si-con group, si-con transfected NR8383 cells), LPS+si-con group (10 μg/L LPS was used to treat si-con transfected NR8383 cells for 24 h), and siRNA group (siRNA transfected NR8383 cells), and LPS+siRNA group (10 μg/L LPS was used to treat siRNA transfected NR8383 cells for 24 h). The overexpression models were divided into the empty plasmid (p-con) group (p-con transfected NR8383 cells), LPS+p-con group (10 μg/L LPS was used to treat p-con transfected NR8383 cells for 24 h), lncRNA overexpression plasmid (plncRNA) group (plncRNA transfected NR8383 cells), and the LPS+plncRNA group (10 μg/L LPS was used to treat plncRNA transfected NR8383 cells for 24 h). The mRNA levels of TNF-α in each group were examined by quantitative real-time PCR (qPCR). The protein levels of tumor necrosis factor receptor-related factor-6 (TRAF-6) and phosphorylated nuclear factor-κB (NF-κB) p65 were examined by Western blot. Results: In the silencing model, the mRNA levels of TNF-α, the protein levels of TRAF-6 and NF-κB p65 in the LPS+si-con group were significantly higher than those in the si-con group (2.040±0.195 vs 1.048±0.207, 0.473±0.022 vs 0.293±0.076 and 0.469±0.062 vs 0.252±0.038)(all P<0.05). The mRNA levels of TNF-α, the protein levels of TRAF-6 and NF-κB p65 in the LPS+siRNA group were significantly higher than those in the siRNA group (4.158±0.119 vs 1.028±0.019, 0.700±0.104 vs 0.231±0.023 and 0.771±0.095 vs 0.258±0.050)(all P<0.05). The relative expression levels of all indexes in the LPS+siRNA group were significantly higher than those in the LPS+si-con group (all P<0.05). In the overexpression model, the mRNA levels of TNF-α, the protein levels of TRAF-6 and NF-κB p65 in the LPS+p-con group were significantly higher than those in the p-con group (1.961±0.169 vs 0.999±0.143, 0.533±0.047 vs 0.247±0.020 and 0.565±0.108 vs 0.276±0.048) (all P<0.05). The mRNA levels of TNF-α, the protein levels of TRAF-6 and NF-κB p65 in the LPS+plncRNA group were significantly higher than those in the plncRNA group (1.322±0.110 vs 1.043±0.093, 0.347±0.035 vs 0.232±0.023 and 0.405±0.072 vs 0.268±0.031) (all P<0.05). The relative expression of all indexes in the LPS+plncRNA group were significantly lower than that in the LPS+p-con group (all P<0.05). Conclusion: LncRNA-AC013472.3 may inhibit the activation of NF-κB signaling pathway, thereby inhibiting the LPS-stimulated secretion of TNF-α in NR8383 rat alveolar macrophages.

[Evaluation of medium to long term efficacy of balloon dilation in the treatment of aural fullness as chief complaint]

Objective: To discuss the characteristics of symptoms improvement based on the follow-up evaluation of Eustachian tube balloon dilation medium to long-term efficacy in patients with symptomatic Eustachian tube dysfunction (SETD). Methods: Patients from 2015 to 2017 were followed up after Eustachian tube balloon dilation (with the sense of aural fullness, or tinnitus and hearing ambiguity). All participants had been done ETDQ-7 before surgery and were re-evaluated with ETDQ-7 in follow-up. The improvement of overall and individual symptoms scores in ETDQ-7, the effects of gender and the difference of scores at different stages (12-18 months, 18-24 months and 24-30 months) after the operation were analyzed. Results: There were 29 patients, including 16 males and 13 females, whose age ranged from 20 to 62 years old. The medium to long-term score of ETDQ-7 significantly declined after surgery (27.0±7.9 vs. 14.1±7.5, P<0.05). Among all symptoms, symptoms like "blockage feeling in ear or being like under the water, constriction feeling" , "sound of blisters or explosions in the ear" decreased obviously (P<0.05). Comparing different stages after surgery, the scores of ETDQ-7 existed no difference (P>0.05). And the difference of gender showed no significant influence on surgery effects. Conclusion: The subjective symptoms of patients with Eustachian tube dysfunction diagnosed with SETD can be significantly improved in the medium to long-term follow-up after Eustachian tube balloon dilation, and the degree of improvement is not linearly related to the postoperative time.

[The diagnostic value of eosinophilic and eosinophilic cationic proteins in blood and nasal secretions for allergic rhinitis]

Objective:To compare the diagnostic value of eosinophil and eosinophil cationin protein（ECP） in blood and nasal secretions for allergic rhinitis（AR）. Method:Collecting the blood samples of 33 patients with AR （AR group） and 40 healthy people（control group）, and test the concentration of ECP in serum and the percentage of eosinophil in blood. At the same time, collecting the nasal secretions samples of 33 patients with AR and 24 healthy people, and test the concentration of ECP and the percentage of eosinophils in nasal secretions. Using receiver operating characteristic curve（ROC） analysis, calculate the area under the curve（AUC） for each parameter and determine their predictive capabilities, then analyzing the correlation between each indicator and clinical symptom scores. Result:Compared with the healthy control group, the concentration of ECP and the percentage of eosinophil in blood and nasal secretion increased significantly（P<0.001） in patients with AR. The AUG of ECP concentration in nasal secretions was 0.965 9, when the cut-off value was 3.634, 100% sensitivity and 88% specificity were obtained; the AUG of eosinophil percentage in blood was 0.9087, and when its cut-off value was 4.6, 95% sensitivity and 73% specificity were obtained; the ECP concentration in serum had an AUG of 0.903, and when the cut-off value was 0.866, 90% sensitivity and 76% specificity were obtained; the AUG of nasal secretion eosinophil's percentage was 0.863 6, when its cut-off value is 0.72, 100% sensitivity and 73% specificity were obtained. Conclusion:For allergic rhinitis, ECP concentrate in nasal secretions is the ideal auxiliary diagnosis marker, and has the best predictive capability.

[Expression of autophagy-related proteins in cortical nodules of tuberous sclerosis complex]

Objective: To investigate the expression of LC3B, p-AMPKα and p27 in cortical tuberous sclerosis complex (TSC). Methods: Nineteen specimens of surgically resected TSC cortical tubers were collected at Xuanwu Hospital, Capital Medical University, from 2014 to 2017. The expression of the three proteins in the lesions and the adjacent relatively normal regions was detected by immunohistochemical staining (EnVision two-step method). Results: LC3B was mainly expressed in the dysmorphic neuron and giant cell in TSC cortical tubers and in the adjacent relatively normal neurons, and the expression was diffuse or perinuclear cytoplasmic. There was no significant difference in the average optical density between abnormal cells and neurons adjacent to the lesions (0.343±0.195 vs. 0.419±0.088, P>0.05). p-AMPKα was localized in the cytoplasm of dysmorphic neurons and giant cell in TSC cortical tubers. The average optical density of abnormal cells in the lesions was significantly higher than that of neurons adjacent to the lesions (0.306±0.123 vs. 0.233±0.654, P<0.05). P27 showed nuclear positivity, mainly expressed in the neurons and glial cells close to TSC cortical tubers, while the positive rate in the abnormal cells in TSC cortical tubers was low (15/19 vs. 7/19, P<0.05). Conclusion: There is no significant decrease in the level of autophagy in dysmorphic neurons and giant cells in TSC cortical tubers, which may be related to the compensatory mechanism of AMPK signaling pathway, but without activation of downstream p27.

[Epidemiological analysis of allergic diseases in primary and middle school students of Foshan]

Objective:To investigate the prevalence and state of allergic rhinitis, asthma, eczema, allergic conjunctivitis, and food allergy of students in primary and middle schools of Foshan, and to analyze the characteristics of each disease and correlation of the five diseases, in order to provide epidemiology evidence for management of allergic diseases. Method:Ten primary schools and 10 junior middle schools were sampled from 5 districts of Foshan, then students in grade one and grade seven from sampled schools were investigated by electronic questionnaire method formulated by the International Study of Asthma and Allergies in Childhood and the Europrevall Project Commission. Students and their parents answered and uploaded electronic questionnaires with the consent of parents, and then team members collected and analyzed uploaded data. Result:Four thousand one hundred and sixty-six effective questionnaires were collected, and the response rate was 95.77％. During the five districts, 13.97%, 2.01%, 29.29%, 5.19%, and 7.28% of the respondents in grade one had previously diagnosed with allergic rhinitis, asthma, eczema, allergic conjunctivitis, and food allergy respectively, and the correspondent rates in grade seven were 15.99%, 2.89%, 16.73%, 2.46%, and 6.97%. The prevalence rates of the five diseases in boys were higher than that in girls in both two grades. 67.27% students with asthma kept coughing and wheezing in the last 12 months, and 24.85% non-asthma students had the same respiratory symptoms. The most common allergenic food were shrimp and crabs, followed by milk and milk products, eggs, and shellfish. Cutaneous symptoms and oral allergy symptoms were predominant clinical manifestations in all students with food allergy. The prevalence of the above allergic diseases of children with atopic family history was higher than that of children without family history, and the prevalence of the 5 diseases of children living in city was higher than that of children living in rural areas. The prevalence rate of asthma of children with allergic rhinitis in both grades was higher than that of children without allergic rhinitis, and the same happened to children with eczema, allergic conjunctivitis, and food allergy. Conclusion:Prevalence rates of allergic rhinitis and asthma in primary and middle school students of Foshan increased as children grew, while the prevalence rates of eczema, allergic conjunctivitis and food allergy decreased with age. The most common allergenic food were shrimp and crabs, milk and milk products, and eggs. 67.27% students with asthma had poor respiratory control in the last 12 months. The prevalence of allergic diseases of children living in city and with atopic family history was higher than that of children living in rural areas and without family history. Students with allergic conjunctivitis, food allergy, allergic rhinitis and eczema had high risk of asthma.

MiR-130b/TNF-α/NF-κB/VEGFA loop inhibits prostate cancer angiogenesis

BACKGROUND

Angiogenesis is a critical biological process essential for solid cancer growth and metastasis. It has been shown that microRNAs (miRNAs) play a vital role in a variety of biological processes in cancers. However, whether miR-130b is involved in prostate cancer angiogenesis remains ill-defined.

METHODS

We performed the miRNA microarray to analyze miRNA expression in human prostate cancer specimens. In vitro gain-of-function assays and loss-of-function assays were conducted to explore the potential functions of miR-130b in human prostate cancer cells. Correlation analysis and dual-luciferase reporter assay were performed to validate whether tumor necrosis factor-α (TNF-α) was a direct target of miR-130b. The Matrigel plug and tumor vascular imaging assays were performed to confirm the anti-angiogenic activity of miR-130b in nude mice.

RESULTS

We found that miR-130b was one of the miRNAs being most significantly downregulated. Subsequently, we found that miR-130b expression was markedly downregulated in human prostate cancer cell lines. Down-regulation of miR-130b in prostate cancer cells significantly promoted the proliferation, invasion and tubule formation of human umbilical vein endothelial cells (HUVECs), while ectopic expression of miR-130b blocked prostate cancer angiogenesis in vitro and in vivo. Mechanistic analyses indicated that tumor necrosis factor-α (TNF-α) was regulated by miR-130b directly. MiR-130b attenuated nuclear factor-κB (NF-κB) signaling and its downstream gene vascular endothelial growth factor-A (VEGFA) by directly inhibiting TNF-α expression. Additionally, subsequent investigations identified that the ectopic level of VEGFA markedly abrogated the anti-angiogenic effect induced by miR-130b. Interestingly, VEGFA could in turn decrease the expression of miR-130b, thus forming a negative feedback loop that drives the angiogenesis of prostate cancer.

CONCLUSION

These findings show that miR-130b/TNF-α/NF-κB/VEGFA feedback loop is significantly correlated with angiogenesis in prostate cancer and miR-130b could be regarded as potential therapeutic target for prostate cancer anti-angiogenesis treatment.

[Application value of Revolution CT combining three-dimensional visualization technique in precision resection of hepatic alveolar echinococcosis]

OBJECTIVE

To explore the application value of Revolution CT combining three -dimensional visualization technique in the precision resection of hepatic alveolar echinococcosis.

METHODS

Totally 12 patients with surgical treatment and pathologically confirmed hepatic alveolar echinococcosis in Qinghai Provincial People's Hospital were retrospectively analyzed. All the patients underwent the Revolution CT plain and enhancement scan before surgery, and the 0.625 millimeter scan data were obtained. The DICOM format data were imported into MI-3DVS for three-dimensional reconstruction, simulated cutting, volume measurement, and surgical planning.

RESULTS

The data of 12 patients were reconstructed successfully, and the sizes and locations of the lesions as well as the hepatic vascular systems were clearly displayed. The liver volume, hydatid volume, simulated resection volume, and residual liver ratio were measured accurately. The average whole liver volume and the lesion volume of the 11 surgical treated patients were (2 429.8 ± 335.9) mL and (919.6 ± 262.8) mL respectively. The average actually removed volume was highly associated with the average simulated resection volume (r = 0.979, P < 0.01).

CONCLUSIONS

Revolution CT combining three-dimensional visualization technique can achieve accurate diagnosis as well as optimal surgical planning before operation, which is of great value for the precision resection of difficult hepatic alveolar echinococcosis.

[Three-dimensional changes in condylar position in skeletal class Ⅲ patients with mandibular deviation after bilateral sagittal split ramus osteotomy]

Objective: To investigage the three-dimensional changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class Ⅲpatients with mandibular deviation using cone-beam CT (CBCT). Methods: Twenty-five skeletal class Ⅲ patients with mandibular deviation were included. The patients (12 males and 13 females, aged 19-25 years, average age 22.4 years) were treated in the Department of Orthodontics, Affiliated Stomatological Hospital, Nanchang University from October 2013 to March 2017. The patients were divided into T1, T2 and T3 groups (T1 group: CBCT taken within 1 week before operation; T2 group: CBCT taken within 1 week after operation; T3 group: CBCT taken 6-8 months after surgery). Three sets of image data of condyles on both sides (deviation side and contralateral side) were obtained. After the DICOM data collection, the software of Mimics 17.0 was used to perform three-dimensional reconstruction and condylar position measurements: the distance from the condylar top (CoT) to the standard horizontal plane (SHP), the middle sagittal plane (MSP) and the sella coronal plane (SCP) (CoT-SHP, CoT-MSP, CoT-SCP); the distance from the condylar center (CoC) to SHP, MSP and SCP (CoC-SHP, CoC-MSP, CoC-SCP); the angle from the condyle cella plane (CCP) to SHP, MSP and SCP (CCP-SHP, CCP-MSP, CCP-SCP); the angle from the condyle sagittal plane (CSP) to SHP, MSP and SCP (CSP-SHP, CSP-MSP, CSP-SCP) and the distance of the anterior, superior, posterior, medial, central and lateral joint space. One-way ANOVA and LSD-t test were used to compare the changes in condylar position at different periods (T1, T2, and T3). Results: Within 1 week before operation on the deviation side, CoT-SHP [(2.5±1.3) mm], CSP-MSP (41.2°±8.4°) and the posterior joint space [(2.0±0.6) mm] were obviously increased (P<0.05), and CoT-SCP [(9.1±3.3) mm], CCP-MSP (78.2°±5.2°) were decreased significantly (P<0.05); on the contralateral side, CoT-MSP [(50.4±3.1) mm], CCP-MSP (80.6°±6.0°), the anterior joint space [(2.2±0.6) mm] and the medial joint space [(2.6±0.6) mm] were obviously increased (P<0.05), and CCP-SCP (11.4°±8.8°) were decreased significantly (P<0.05). Six to eight months after surgery, CoT-SHP [(2.2±1.0) mm] and the posterior joint space [(1.9±0.5) mm] on deviation side and CoT-SCP [(8.4±2.8) mm] on the contralateral side were increased significantly (P<0.05). No significant difference was found in other measurements (P>0.05). Conclusions: The condylar position in skeletal class Ⅲ patients with mandibular deviation was asymmetrical. Within 1 week after the operation of BSSRO, the condyle on the deviation side was moved forward, downward and inward. Meanwhile, the condyle on the contralateral side was moved backward and outward. Six to eight months after surgery, the condylar position on both sides was gradually restored to the pre-operative condylar position.

[Role and mechanism of nonreceptor tyrosine kinase Tec in endotoxin/lipopolysaccharide-induced interleukin-8 production in human alveolar epithelial cells A549]

Objective: To investigate the role and mechanism of nonreceptor tyrosine kinase Tec in the production of pro-inflammatory cytokine interleukin-8 (IL-8) induced by endotoxin/lipopolysaccharide (LPS) in human alveolar epithelial cells A549. Methods: Human alveolar epithelial cells A549 were routinely cultured and passaged in Roswell Park Memorial Institute-1640 medium containing 10% fetal bovine serum. The second or third passage of cells were collected for subsequent experiments. (1) Cells were collected and divided into 6 groups with 4 wells in each group according to the random number table. Cells in blank control group were routinely cultured for 2 h. Cells in simple LPS group were routinely cultured for 1 h and then stimulated by 1 μg/mL LPS for 1 h. Cells in simple LFM-A13 group were cultured with conventional culture medium adding 75 μmol/L LFM-A13 for 1 h and then cultured with replaced conventional culture medium for 1 h. Cells in 25 μmol/L LFM-A13+ LPS group, 75 μmol/L LFM-A13+ LPS group, and 100 μmol/L LFM-A13+ LPS group were cultured with conventional culture medium adding 25, 75, and 100 μmol/L LFM-A13 respectively for 1 h and then all stimulated by 1 μg/mL LPS added into the replaced conventional culture medium for 1 h. The protein expression of Tec in cells of each group was detected by Western blotting, and the content of IL-8 in cell culture supernatant of each group was determined by enzyme-linked immunosorbent assay. (2) Cells were collected and divided into 5 groups with 4 wells in each group according to the random number table. Cells in blank control group were routinely cultured for 2 h. Cells in small interfering RNA (siRNA) control+ LPS group were transfected with empty lentivirus for 10 h and then stimulated by 1 μg/mL LPS added into the conventional culture medium for 2 h. Cells in Tec mus-298 RNA interference (RNAi)+ LPS group, Tec mus-299 RNAi+ LPS group, and Tec mus-300 RNAi+ LPS group were transfected with lentivirus loaded with Tec mus-298 RNAi, Tec mus-299 RNAi, and Tec mus-300 RNAi respectively for 10 h and then stimulated by 1 μg/mL LPS added into the conventional culture medium for 2 h. The protein expression of Tec in cells of each group was detected by Western blotting to screen Tec-siRNA with the best silencing effect on Tec gene. (3) Cells were collected and divided into 4 groups with 4 wells in each group according to the random number table. Cells in blank control group were routinely cultured for 2 h. Cells in virus control group were transfected with empty lentivirus for 10 h and then routinely cultured for 2 h. Cells in simple LPS group were stimulated by 1 μg/mL LPS added into the conventional culture medium for 2 h. Cells in Tec-siRNA+ LPS group were transfected with lentivirus loaded with Tec-siRNA with the best silencing effect on Tec gene for 10 h and then stimulated by 1 μg/mL LPS added into the conventional culture medium for 2 h. The protein expressions of p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK) MAPK of cells in each group were detected by Western blotting. Data were processed with one-way analysis of variance and the least significant difference-t test. Results: (1) Compared with that of blank control group, the protein expression of Tec of cells in simple LPS group was obviously increased (t=9.72, P<0.05), but the protein expression of Tec of cells in simple LFM-A13 group was not obviously changed (t=4.31, P=0.05). Compared with that of simple LPS group, the protein expression of Tec of cells in 25 μmol/L LFM-A13+ LPS group, 75 μmol/L LFM-A13+ LPS group, or 100 μmol/L LFM-A13+ LPS group was obviously decreased (t=9.72, 9.07, 16.33, P<0.05 or P<0.01). Compared with (189±22) pg/mL of blank control group, the content of IL-8 in culture supernatant of cells in simple LPS group was obviously increased [(214±10) pg/mL, t=2.18, P<0.05], but the content of IL-8 in culture supernatant of cells in simple LFM-A13 group was not obviously changed [(173±43) pg/mL, t=0.64, P>0.05]. Compared with that of simple LPS group, the content of IL-8 in culture supernatant of cells in 25 μmol/L LFM-A13+ LPS group was not obviously changed [(204±38) pg/mL, t=0.54, P>0.05], but the content of IL-8 in culture supernatant of cells in 75 μmol/L LFM-A13+ LPS group and 100 μmol/L LFM-A13+ LPS group was obviously decreased [(144±44), (137±51) pg/mL, t=3.63, 2.55, P<0.05 or P<0.01]. (2) Compared with that of blank control group, the protein expression of Tec of cells in siRNA control+ LPS group was obviously increased (t=14.24, P<0.01). Compared with that of siRNA control+ LPS group, the protein expression of Tec of cells in Tec mus-298 RNAi+ LPS group or Tec mus-299 RNAi+ LPS group was obviously decreased (t=36.03, 18.23, P<0.01), but the protein expression of Tec of cells in Tec mus-300 RNAi+ LPS group was not obviously changed (t=4.08, P>0.05). The protein expression of Tec was the lowest in cells of Tec mus-298 RNAi+ LPS group, so Tec mus-298 RNAi was used in subsequent experiment. (3) Compared with 1.16±0.16 and 0.78±0.11 of blank control group, the protein expressions of p38 MAPK and ERK MAPK of cells in virus control group were not obviously changed (1.66±0.13, 0.89±0.11, t=11.09, 3.60, P>0.05), but the protein expressions of p38 MAPK and ERK MAPK of cells in simple LPS group were obviously increased (2.83±0.29, 1.86±0.37, t=9.70, 7.23, P<0.05). Compared with those of simple LPS group, the protein expression of p38 MAPK and protein expression of ERK MAPK of cells in Tec-siRNA+ LPS group were obviously decreased (0.69±0.16, 1.03±0.24, t=13.78, 4.12, P<0.05 or P<0.01). Conclusions: Tec may mediate the production and release of pro-inflammatory cytokine IL-8 from human alveolar epithelial cells A549 induced by LPS via the p38 MAPK and ERK MAPK signal pathways.

[Value and related factors of preoperative diagnosis of extramural vascular invasion of rectal cancer by 3.0T magnetic resonance imaging]

Objective: To evaluate the value of preoperative diagnosis of extramural vascular invasion (EMVI) of rectal cancer with 3.0T high-resolution magnetic resonance imaging (MRI) and the MRI-related factors of EMVI in rectal cancer. Methods: The clinical and imaging data of 40 patients with rectal cancer were retrospectively analyzed. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficacy of preoperative diagnosis of EMVI of rectal cancer by high-resolution MRI, and to analyze the relationship between the EMVI and clinical and MRI features. Results: Of the 40 patients, 19 cases were diagnosed as positive EMVI and 21 were negative by MRI. Pathological diagnosis of EMVI was positive in 10 cases and negative in 30 cases. The sensitivity, specificity and accuracy of MRI in the diagnosis of EMVI were 100%, 70.0% and 77.5%, respectively. Preoperative MRI and postoperative pathology were moderately consistent in the diagnosis of EMVI in rectal cancer (Kappa=0.538, P<0.001). Pathological EMVI positivity were related to tumor size under MRI examination (P=0.028), degree of differentiation (P<0.001), depth of invasion (P=0.002), lymph node metastasis (P=0.001), liver metastasis (P=0.011), tumor apparent diffusion coefficient (ADC) value (P=0.010) and exponential apparent diffusion coefficient (eADC) value (P=0.003). It also related to extramural nerve invasion by pathological examination (P=0.005). Conclusion: According to the EMVI imaging score of rectal cancer, preoperative MRI has a high value in the diagnosis of EMVI of rectal cancer.

[Expression of eosinophilic cationic protein in neutrophils and its effect on objective evaluation of nasal inflammation]

Objective:The aim of this study is to explore the expression of ECP in the neutrophils and its impact on the evaluation of nasal inflammation.Method:Neutrophils and eosinophils in nasal secretions were collected and stained with ECP immunohistochemistry to observe the staining of ECP in different cells. The concentration of ECP and MPO in nasal secretion were detected of 32 patients with allergic rhinitis (AR group), 29 patients with chronic rhinosinusitis without nasal polyps and allergic rhinitis (CRSsNP group), and 21 healthy people (control group). The percentage of neutrophils and eosinophils were calculated and analyzed as well.Result:ECP could be found in both eosinophils and neutrophils with immunohistochemical staining. The expression of ECP is much stronger in eosinophils than that in neutrophils. The ECP and MPO concentration in the nasal secretions of AR group and CRSsNP group were significantly higher than that in control group (P<0.000 1), and the ECP concentration in AR group and CRSsNP group had no difference. The expression of ECP in the AR group was not different from that in CRSsNP group, but the expression of MPO was significantly lower than that in CRSsNP group(P<0.000 1).Conclusion:ECP is expressed in neutrophils, and which is likely to have influence on the objective evaluation to nasal inflammation. Combining with the expression of ECP and MPO, we can make a more accurate judgment of local inflammation.

[Clinical analysis of children with group B streptococcal meningitis in 2013-2017 in a single center]

Objective: To explore the clinical features, the risk factors of mortality and drug resistance of the isolates in patients with group B streptococcus (GBS) meningitis. Methods: A retrospective analysis was performed in 96 children with GBS meningitis (46 males and 50 females) at Beijing Children's Hospital Affiliated to Capital Medical University from January 2013 to October 2017. The clinical characteristics, prognosis and drug resistance were reviewed and analyzed. According to the onset time, the patients were divided into early onset disease (EOD, 0-6 days), late onset disease (LOD, 7-89 days) and very late onset disease (VLOD, 90 days-16 years), the clinical features were compared. According to the results of cranial imaging examination, the patients were divided into two groups: those with neurological complications and those without neurological complications. The influencing factors of neurological complications were analyzed. According to the outcome of 28 days after discharge, patients were divided into death group and survival group. The risk factors of mortality were analyzed by multivariate Logistic regression analysis. Non-numeric variables were analyzed with χ(2) test or Fisher's exact test. Numeric variable between groups were compared with nonparametric test. Results: A total of 96 patients were enrolled, including 18 (19%) EOD, 71 (74%) LOD and 7 (7%) VLOD cases. The median age of EOD cases was 2 days, with a range from 0 to 6 days. The median age of LOD cases was 31 days, with a range from 7 to 81 days. The median age of VLOD cases was 153 days, with a range from 95 to 214 days. Before the onset of the disease, the mother had mastitis in 6 cases and premature rupture of membranes in 6 cases. The common clinical manifestations of patients were fever (95%, 91/96), anorexia (65%, 62/96), seizure (56%, 54/96), and consciousness changes (36%, 35/96). The differences were statistically significant in gender (13/18 vs. 28/71 vs. 5/7, χ(2)=7.705, P=0.024), the number of cases who was admitted to intensive care unit (ICU) (5/18 vs. 31/71 vs. 0, χ(2)=6.065, P=0.042) and peripheral blood leukocyte (12(4, 18)×10(9)/L vs. 6(3, 11)×10(9)/L vs. 13(6, 17)×10(9)/L, H=9.885, P=0.007) in EOD group, LOD group and VLOD group. Cranial imaging was performed in 94 patients, 60 patients (64%) developed neurological complications, including subdural effusion (31/94, 33%), followed by intracranial hemorrhage (26/94, 28%), cerebral softening (19/94, 20%), cerebral atrophy (15/94, 16%), ependinitis (8/94, 9%) and hydrocephalus (4/94, 4%). By univariate χ(2) test analysis, seizure (63% (38/60) vs.41% (14/34), χ(2)=4.310, P=0.038) was a risk factor of neurological complications. Within 28 days after discharge, 88 patients survived and 8 patients died, with a fatality rate of 8%. The independent risk factors for the death were septic shock (OR: 9.548, 95% CI 1.439-63.356, P=0.019) and respiratory failure (OR: 7.053, 95% CI 1.160-42.888, P=0.034). All of isolates were susceptible to penicillin (68/68), ceftriaxone (47/47), cefepime (50/50), vancomycin (60/60) and linezolid (54/54), while the rates of resistance to tetracycline, levofloxacin, clindamycin and erythromycin were 5/12, 17/45, 38/46 and 32/37, respectively. Conclusions: The main type of GBS meningitis is late onset cases. The incidence of neurological complications was high. The independent risk factors for death were septic shock and respiratory failure. The strains were severely resistant to clindamycin and erythromycin.

[The effective mutation of epidermal growth factor receptor in synchronous multiple primary lung cancers: study of clinical, radiographic and pathological factors]

Objective: To investigate the clinical, pathological and CT features associated with the effective mutation of epidermal growth factor receptor (EGFR) in multiple primary lung cancers (MPLCs) , and to determine the target population of EGFR mutations tests. Methods: A total of 558 nodules from 232 patients with MPLCs who underwent surgery in the Cancer Hospital of Chinese Academy of Medical Sciences from August 2017 to December 2017 were selected. Two hundreds and sixteen nodules were detected by DNA direct sequencing. Chi-square test and Mann-Whitney U test were used to compare the clinical, pathological and CT features of 216 nodules in the EGFR effective mutation group and the non-effective mutation group. Logistic regression analysis was used to explore the independent risk factors of EGFR mutation. The cut off value was determined using the receiver operating characteristic(ROC) curve. Of 232 cases 558 nodules of surgically resected MPLCs, EGFR mutation of 216 nodules was determined by direct DNA sequencing. Results: There were 58 males and 174 females with MPLCs(male︰female=1︰3). There were 117 cases of age ≥59 years old and 115 cases of age <59 years old. There were 192 non-smokers, accounting for 82.8% of all patients. There were 2-7 nodules in the patient's lungs, of which 170 patients had two nodules in the lungs, 44 patients had 3 nodules, and another patient had 7 nodules. Among them, 216 nodules were detected by EGFR gene, 136 were effective mutations, and 80 were non-effective mutations (including wild type and null mutation). EGFR effective mutation group and non-effective mutation group were statistically significant in lung adenocarcinoma patients with different gender, age, smoking history, histological type, and differentiation degree (P=0.006, 0.002, 0.002, 0.015, 0.025).Among them, the effective mutation group were 107 females, 85 cases≥ 59 years old, 117 cases with no smoking history, 68 acinar-based, 89 moderate differentiation. In the count data, 127 nodule edges were lobed, and only 9 nodule edges were smooth. Among the measurement data, the GGO CT value was approximately (-459±147) HU in the EGFR mutation group, with statistical difference (P=0.037). The GGO diameter was approximately (11±9)mm,P=0.279.Multivariate Logistic regression analysis showed that GGO diameter (OR=0.873, 95%CI: 0.780-0.997; P=0.018) and smooth margins (OR=0.183,95%CI: 0.041-0.824; P=0.027) were independent protective factors of effective mutations of EGFR. Conclusions: In MPLCs, effective EGFR mutation is more common, and associated with elder female, age≥59 years, non-smoking, GGO attenuation <-548 HU, moderately differentiated, predominant invasive papillary adenocarcinoma. Patients with MPLCs and these risk factors may be encouraged to have postoperative EGFR molecular test.

[Clinical effect of negative pressure wound therapy in emergency limb-salvage operation of destructive injury of limb]

Objective: To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. Methods: From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent sample t test or chi-square test. Results: Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group (χ(2)=0.043, P>0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group (χ(2)=5.847, P<0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (t=2.813, P<0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group (χ(2)=1.293, P>0.05). Conclusions: NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.

[Post-marketing multi-center safety surveillance of inactivated enterovirus A71 vaccine (Vero cell)]

Objective: To evaluate the post-marketing safety profiles of the inactivated enterovirus type 71 (EV-A71) vaccine (Vero cell) after routine inoculation. Methods: Eleven cities of Zhejiang Province, Fengtai district of Beijing, Qinnan district, two counties as Pingle and Pingguo of Guangxi Zhuang Autonomous Region, and Dongtai city of Jiangsu Province were selected as the field sites. A total of 45 239 subjects were enrolled in this study from children who seeked the vaccination of EV-A71 vaccine during the period from July, 2016 to June, 2018. Different sampling method were adopted in different sites. All vaccinated children were invited to participate in the study in Fengtai and Dongtai, however, systematic sampling method were adopted in other sites. Active surveillance was conducted and information about adverse reactions (ARs) occurred in 30 min, 3 d and 30 d following each dose of EV-A71 immunization was collected by field observation, phone-call or face-to-face interview. The incidence of ARs in different types, symptoms and grades were described. Results: In total, there were 45 239 children who received 71 243 doses EV-A71 vaccine. The overall incidence of ARs was 1.079% (769 doses), with the highest incidence of 1.182% (177/14 973) in 5-11 month group and the lowest incidence of 0.849% (18/2 119) in ≥ 36 month group among different age groups. There was a higher incidence in solicited ARs, which was 1.047% (746 doses). The incidences of grade 1 and grade 2 ARs were also higher, which were 0.404% (288 doses) and 0.554% (395 doses), respectively. No grade 4 ARs occurred. The doses of the first and the second vaccination was 40 736 and 30 507, respectively, and the incidences of ARs were 1.281% (522 doses) and 0.810% (247 doses). Also, the incidences of ARs were 0.091% (37 doses) and 0.043% (13 doses) in local, and 1.168% (476 doses) and 0.760% (232 doses) in system. The symptoms of ARs after the two doses of vaccination were basically the same. Redness at the injection site was the most common local ARs after each dose vaccination, with doses of 24 and 11, while fever was the most common systemic ARs, with doses of 362 and 190. Moreover, ARs mainly occurred in 30 min to 3 d after each dose vaccination, with incidence of 1.016% (414 doses) and 0.698% (213 doses) in the first and second dose, respectively. Conclusion: The ARs had a low incidence after vaccination in children and most were mild or moderate. EV-A71 vaccine with good safety is suitable for inoculation in a large scale.

[Association between interleukin-17A and 17F single nucleotide polymorphisms and knee osteoarthritis]

Objective: To investigate the association between single nucleotide polymorphisms (SNP) of IL-17A (rs2275913) and IL-17F (rs763780) genes and susceptibility to knee osteoarthritis (KOA) in Chinese Han and Tibetan populations. Methods: A case-control study was conducted. Total of 122 Han KOA patients and 124 Han healthy controls and 76 Tibetan KOA patients and 68 Tibetan healthy controls in Qinghai Province were selected between 2015 and 2017. SNP typing was performed on four groups of rs2275913 and rs763780 polymorphisms by polymerease chain reaction (PCR)-sequencing to detect IL-17A and IL-17 F genotype frequencies and allele frequencies. The t test was used to compare data between groups. Results: The genotype AA frequency of IL-17A (rs2275913) was significantly different between the Han KOA and the control group (OR=2.625, P=0.016). Compared with the frequency of allele A in healthy control group, the allele A frequency in Han KOA group was significantly higher(OR=1.445, P=0.047); the genotype frequency of IL-17A,however,was comparable between the KOA and the healthy control in Tibetan population (OR=1.696, 1.355, both P>0.05); there were also not difference in the IL-17F (rs763780) genotype frequency and allele frequency between the Han KOA and Tibetan KOA groups and two control groups,respectively (OR=1.346, 1.126, both P>0.05). Conclusion: It is highly likely that the pathogenesis of KOA in Chinese Han population is positively related to the genotype AA and allele A of IL-17A (rs2275913).

[Analysis on the characteristics of postural blood pressure changes recorded with continuous non-invasive arterial pressure monitoring system and the correlative factors in elderly hospitalized patients]

Objective: To explore the characteristics of postural blood pressure changes in elderly inpatients and the related factors of orthostatic hypotension (OH). Methods: This study was a clinical case control study. Two hundred and sixty-six elderly patients (≥60 years old), who were hospitalized between April 2016 and November 2017 in Geriatric Department of Peking University First Hospital, were included. They were divided into direct standing group and indirect standing group. Direct standing group involved 102 patients, they changed posture from supine directly to standing position, and the blood pressures at the moments of supine, immediately after standing and the first, second, and third minute after standing were recorded by continuous noninvasive arterial pressure (CNAP) system. Indirect standing group involved 164 patients, and they changed posture from supine to sitting for 3 minutes, and then changed to standing position. Blood pressures at the moments of supine, immediately after sitting, the third minute after sitting, immediately after standing and the third minute after standing was recorded by CNAP. Blood pressure changes after different postural changes mode and the rates of OH were compared. The related factors of OH was analyzed by binary logistic regression analysis. Results: The lowest systolic blood pressures (SBP) mostly occurred immediately after postural change: immediately after standing for direct standing group (86.3%(88/102)), and immediately after sitting for indirect standing group (59.1%(97/164)). The lowest diastolic blood pressures (DBP) mostly occurred immediately after standing in the two groups: 87.3%(89/102) for direct standing group and 43.3% (71/164) for indirect standing group. The maximum SBP drop (SBP of supine minus the lowest SBP during postural changes) of direct standing group was significantly higher than indirect standing group (median 20.5(14.0, 29.3) vs. 18.0(11.0, 26.0) mmHg (1 mmHg=0.133 kPa, P<0.05). The rates of OH occurred immediately and within 3 minutes from supine to standing position were significantly higher in direct standing group than in indirect standing group (65.7% (67/102) vs. 43.9% (72/164), and 70.6% (72/102) vs. 49.4% (81/164), both P<0.05). Binary logistic regression analysis showed that brachial-ankle pulse wave velocity was positively associated with OH after a transition from supine to standing position (immediately and within 3 minutes, OR=1.002 (95%CI 1.000-1.004), 1.003 (95%CI 1.001-1.006), P=0.014, 0.006) in direct standing group. Conclusions: OH is common in elderly hospitalized patients. The most obvious blood pressure changes are likely to occur immediately after position changes. Adding a sitting position during the transition of supine to standing position may decrease the amplitude of SBP drop. Brachial-ankle pulse wave velocity is associated with OH after the transition from the supine to standing position in the elderly inpatients.

[Clinical analysis of seven cases of rare hemolytic disease of the newborn]

Objective: To summarize the clinical features of 7 rare cases of hemolytic disease of newborn (HDN), and to improve the understanding of rare HDN. Methods: Data of clinical information, laboratory findings, treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M, two cases due to anti-Kidd, and one case due to anti-Duffy. All of them were admitted to the Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medial University from July 2007 to June 2017. Results: Among the four MN hemolytic babies, two were males and two were females. Jaundice was found in three cases. Two cases had hyperbilirubinemia, one of them had severe hyperbilirubinemia. All the four cases developed anemia, including severe anemia in three cases. Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia, but did not reach the level of severe hyperbilirubinemia and severe anemia. MN hemolytic disease babies got negative results in direct antiglobulin test, whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test. None of the babies had blood transfusion, and they were discharged from the hospital. Conclusions: Without maternal and fetal blood group incompatibility (ABO or Rh blood-group system), for early onset of jaundice, severe jaundice or anemia, antiglobulin test to mother and child earlier should be administered, and MN, Kidd, Duffy and other rare hemolytic disease of the newborn should be pay attention to.

Effects of antibiotic residues in milk on growth, ruminal fermentation, and microbial community of preweaning dairy calves

The aim of this study was to evaluate the effects of antibiotic residues in milk on growth, ruminal fermentation, and microbial community of dairy calves in their first 35 d of age. Twenty newborn Holstein bull calves were assigned to 1 of 2 treatments equally: milk replacer without antibiotics (control) and milk replacer plus 4 antibiotics: 0.024 mg/L of penicillin, 0.025 mg/L of streptomycin, 0.1 mg/L of tetracycline, and 0.33 mg/L of ceftiofur (ANT). Starter intake and fecal consistency scores of each calf were recorded on a daily basis. Body weight, withers height, body length, and heart girth were measured on d 1, 7, 14, 21, 28, and 35 before feeding in the morning. Rumen fluid was collected on d 15, 25, and 35 to determine ruminal pH, volatile fatty acids (VFA), and NH₃-N concentrations. A total of 10 (5 per treatment) samples of rumen fluid taken on d 35 were analyzed for microbial community. Rumen tissues from the cranial ventral sac and cranial dorsal sac were collected from 8 calves of each group for morphology analysis on d 35 after being harvested. The results showed that calves in 2 treatments had similar starter intake, body weight, withers height, body length, heart girth, and average daily gain. The ANT group showed a lower diarrhea frequency in wk 4, and no differences were found for other weeks. Calves in the ANT group exhibited a greater concentration of acetic acid in the rumen and no differences for other VFA, total VFA, rumen pH, or NH₃-N. As for rumen morphology, the length of papillae from cranial ventral sac of the ANT group was longer than that of the control group. The results of ruminal microbial community showed that antibiotic residues had minor effects on bacteria phyla and bacteria diversity. At the genus level, calves in the ANT group showed lower richness of Prevotella and higher richness of Acetitomaculum. In conclusion, antibiotic residues stimulated the development of ruminal papillae and increased the production of acetic acid in rumen, which might be caused by the influence of antibiotics on the ruminal microbial community.