[Analysis of the clinical features and the risk factors of severe adenovirus pneumonia in children]

Objective: To analyze the clinical characteristics, risk factors for critical illness and death of severe adenovirus pneumonia in children, so as to provide clinical evidences for early diagnosis and reliable treatment. Methods: A total of 75 pediatric cases with severe adenovirus pneumonia admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to October 2019 were studied. The clinical features, laboratory and imaging data, therapeutic approaches, efficacy of the treatments and prognosis were investigated retrospectively. Patients were divided into severe group and critical group. Chi square test and Mann-Whitney U rank sum test were used to analyze the data of the two groups. The risk factors for critical illness and death were analyzed by univariate and multivariate Logistic regression. Results: Among the 75 children, there were 52 males and 23 females, aged from 3 months to 8 years, including 30 of severe cases and 45 of critical case. The positive rate of adenovirus antigen in nasopharyngeal swab was 21% (15/72), and the positive rate of serum adenovirus IgM antibody was only 13% (10/75). However, the positive rate of adenovirus nucleic acid in nasopharyngeal swab was 75% (21/28). What is more, the positive rates of metagenomics next generation sequencing (mNGS) in plasma and bronchoalveolar lavage fluid were 92% (33/36) and 96% (54/56), respectively, of which 95% (63/66) were confirmed as adenovirus type 7. Relatively high dose of ribavirin and integrated therapeutic approaches (respiratory support, glucocorticoids, immunoglobulin and organ supportive therapies) were used. The recovery rate was 77% (58/75), the improvement rate was 8% (6/75) and the mortality rate was 15% (11/75). The proportion of children with the duration of fever longer than 3 days after ribavirin treatment in the critical group was significantly higher than that in the severe group(51% (18/35) vs. 8% (2/26), χ²=12.949, P<0.05). The risk factors for critical illness were younger than 4 years, longer duration of fever before and after admission to PICU, oxygenation index<300 mmHg (1 mm Hg=0.133 kPa), ferritin>1 000 μg/L, lactate dehydrogenase (LDH)>1 500 U/L, 5 lung lobes involvement, pleural effusion and (or) air leakage (all P<0.05). Among them, 5 lung lobes involvement was the independent risk factor for critical illness (adjusted OR=49.641, 95%CI 4.186-588.618, P=0.002). Risk factors for death included longer duration of fever after being admitted to PICU, oxygenation index<100 mmHg, ferritin>2 000 μg/L, interleukin (IL)-6>100 ng/L, LDH>1 500 U/L, pleural effusion and (or) air leakage (all P<0.05). Among them, IL-6>100 ng/L was the independent risk factor for the mortalities of critically ill children (adjusted OR=16.094, 95%CI 2.059-25.787, P=0.008). Conclusions: The mortality rate of severe pediatric adenovirus pneumonia caused by adenovirus type 7 is high. High positive rates of adenovirus nucleic acid in nasopharyngeal swabs and mNGS in plasma or bronchoalveolar lavage fluid contribute to early diagnosis, and mNGS can also be used for serotyping. Younger children under 4 years of age, persistent fever, extensive pulmonary lesions and significantly increased inflammatory cytokines such as IL-6 are warning indicators for critical illness and poor prognosis. Relatively high dose of ribavirin combined with integrated therapeutic approaches are beneficial for prognosis.

Association of C-Reactive Protein and Motoric Cognitive Risk Syndrome in Community-Dwelling Older Adults: The China Health and Retirement Longitudinal Study

OBJECTIVES

Motoric cognitive risk syndrome (MCR) is a newly described pre-dementia syndrome characterized by cognitive complaints and slow gait and is associated with numerous adverse outcomes. Previous studies have indicated an association between C-reactive protein (CRP) and cognitive decline, but no clear relationship between CRP and MCR has been reported. The purpose of the study is to examine the associations between CRP with MCR and MCR subtypes.

METHODS

Participants were 5,642 adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). MCR was defined as cognitive complaints and slow gait speed without dementia or impaired mobility. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, such as MCR-MI and MCR-non-MI. MI was evaluated through the immediate recall and delayed recall in a word recall test during the CHARLS and was defined as 1.0 standard deviation or more below the mean values of the test scores in this cohort.

RESULTS

Of the participants, 421 (7.46%) met the criteria for MCR. After multivariate adjustment, participants with higher CRP levels had an increased likelihood of MCR (fourth quartile: adjusted odds ratio [OR]=1.44; 95% confidence interval [CI]: 1.06-1.95) compared with those in the first quartile group. The OR for MCR-MI was 2.04 (95% CI: 1.35-3.09) for the highest quartile of CRP compared to the lowest quartile. No significant associations between CRP levels and odds of MCR-non-MI were observed.

CONCLUSIONS

Higher CRP levels were associated with increased odds of prevalent MCR-MI but not MCR-non-MI among community-dwelling older adults.

From end-of-life tires to storable energy carriers

End-of-life tires are an increasingly important environmental burden. Since retreading is only partly possible, safe and economic methods of disposal need to be developed. Pyrolysis of ELTs, and subsequent upgrading/application of the produced energy carriers, is considered a valuable treatment method. In order to design the process, numerous operation units have to be taken into account. Char, vapour and gas are formed in the reactor. The char is purified from ZnO with a leaching process. The pyrolysis vapour is separated into a condensable fraction (oil) and a non-condensable fraction (gas) thanks to a cross-flow condenser with air as indirect cooling medium. The remaining gas is compressed to 6 bar: a part of it is continuously converted in electricity for process use, while another part is stored for power generation at peak demand time. A flowsheet of the process is established and environmental and assessment of investments and production are discussed. For the pyrolytic treatment of 3 ton/hr of ELTs, the required heat for the reactor is 271 kW at 380 °C, provided by electrical heating elements. A reactor volume is determined for a residence time of about 6 h. For the cross-flow condenser, indirectly air-cooled, a heat-transfer area of about 13.2 m² is required. The compression of the gas the pressurized pyrolytic gas storage tank depends upon the excess pyrolytic gas produced during operation. The char cooler requires a heat-transfer area of 10.2 m², when indirectly cooled by water. Operating parameters of the leaching and subsequent recovery of Zn²⁺ complete the design. The product added-value and the large-scale capacity make the process economically viable, although the ROI is between 2 and 3 years.

[Epidemiological characteristics of malaria in Henan Province from 1950 to 2019]

OBJECTIVE

To analyze the epidemiological characteristics of malaria in Henan Province from 1950 to 2019, so as to provide the scientific evidence for consolidating malaria elimination achievements in the province.

METHODS

The epidemiological situation of malaria and demographic data in Henan Province from 1950 to 2019 were collected, and the statistical analyses were performed using a descriptive epidemiological method. The spatial temporal distribution of malaria cases was identified using the software ArcGIS version 10.3.

RESULTS

During the period from 1950 through 2019, the progress of malaria elimination was divided into 4 stages in Henan Province, including the baseline-survey and key-control stage, morbidity-control and incidence-reduction stage, basic-eradication and achievement-consolidation stage and elimination stage. The spatial distribution of malaria cases shifted from south of the Huai River and the plain regions between the Yellow River and Taihang Mountain to the Huang-Huai-Hai Plain and Nanyang Basin, then was concentrated in eastern part of southern Huai River where Anopheles anthropophagus was distributed, and finally was gradually under control following malaria outbreak in Eastern Henan Plain. In addition, the species of Plasmodium changed from P. vivax, P. falciparum and P. malariae co-endemics to a single P. vivax infection, and the current co-endemics of 5 invasive malaria parasites, and the malaria vectors shifted from co-existence of Anopheles sinensis and An. anthropophagus to An. sinensis alone.

CONCLUSIONS

There has been a large change in the epidemiological characteristics of malaria in Henan Province from 1950 to 2019. Although malaria has been eliminated in Henan Province, the consolidation of the malaria elimination achievements remain a great challenge due to overseas imported malaria.

Development and usability test of an intelligent cardiovascular risk elimination application for patients with coronary heart disease

Background

The mortality of coronary heart disease (CHD) can be largely reduced by improving CHD risk factors through facilitating adherence to unhealthy lifestyle modification (UhLM) and secondary preventive medications (SPMs). Current interventions, however, have been unsatisfactory worldwide.

Purpose

To develop an Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination system (iCARE) for facilitating adherence to UhLM and SPMs, and test its usability and feasibility for implementation.

Methods

Based on a set of individualized interventions formulated in our preliminary work, we developed iCARE using mHealth techniques and a user-centred approach, which included 3 phases: (1) identifying patient preferences regarding formats for providing interventions; (2) designing the functions, architecture, and user interface (UI); (3) developing the iCARE using prototyping techniques. Usability test was conducted in patients with acute coronary syndromes and/or underwent percutaneous coronary intervention from January to March 2019 in two University affiliated hospitals in our city. The iCARE was implemented in 4 cardiac units of the same hospitals thereafter.

Results

The iCARE architecture and UI are displayed in Fig 1. Different from most current available mHealth CHD management system, the iCARE has a set of interventions and IF-THEN algorithms triggering interventions to ensure that patients receive individualized recommendations for UhLM and SPMs adherence. To improve effectiveness of iCARE interventions, visualization was used to augment patients' perceptions of risks of non-adherence to UhLM and SPMs, and effectiveness of adopting healthy lifestyles etc. Interventions are triggered by results of initial assessment and health data from daily monitoring. The initial assessment is conducted before patients are discharged, and a health report as well as individualized goals for risk reduction are formulated automatically. Daily diet, physical activities, smoking, medication adherence, blood pressure, blood sugar, and symptoms are monitored either through wearable devices or manual entry. Instant and individualized feedbacks as well as recommended actions are sent to patients automatically. A build-in artificial intelligent Q-A function was also included in iCARE. For the usability test, 88 patients with 71.3% male and mean age of 60 (SD 9.9) were recruited, 87.5% were satisfied with iCARE; 89.5% and 81.4% reported that iCARE was useful and easy to use, respectively. Currently, a total of 201 patients with 83.1% male and mean age of 54 (SD 10.2) were recruited from June 2019 to January 2020, and 46 of them have been followed up for 3 months.

Conclusions

The iCARE has achieved its functions of serving as an individualized and intelligent CHD management tool to improve adherence to UhLM and SPMs. The usability is satisfactory and it is feasible to implement in clinical settings.

Figure 1. The iCARE system. iCARE, Individualized, Intelligent and Integrated Cardiovascular Applicaton for Risk Elimination (iCARE) system, CHD, coronary heart disease.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): National Natural Science Funding of China

Protective effects and molecular mechanisms of baicalein on thioacetamide-induced toxicity in zebrafish larvae

Baicalein is a flavonoid that is widely found in plants. Studies have shown that baicalein has anti-inflammatory, anti-cancer, and liver-protective effects. However, the effects of baicalein on TAA-induced toxicity and the underlying molecular mechanisms in zebrafish larvae are still unknown. Here, we investigated the effects of baicalein on liver development and its anti-inflammatory effects in zebrafish larvae. The results showed that baicalein has significant anti-embryonic developmental toxicity and significant antioxidant and anti-inflammatory capabilities in TAA-induced zebrafish larvae and promotes liver development and cell proliferation, reduces the expression of apoptotic proteins, and induces the expression of anti-apoptotic proteins. At the molecular level of TAA-treated zebrafish larvae, there was a decrease in the relative expression levels of mRNAs of three subfamilies, P38, ERK1, and ERK2, of the MAPK-signaling pathway and of the products of peroxisome proliferator-activated receptor (PPAR)α. Compared with TAA-treated zebrafish larvae, zebrafish larvae treated with baicalein showed an increase in the relative expression levels of P38, ERK1, and ERK2 mRNAs and the downstream products of PPARα. When MAPK signal inhibitor (SB203580) was added, it was found that liver development was inhibited and baicalin had no protective effect on TAA induced hepatotoxicity in zebrafish larvae. The results showed baicalein can protect the zebrafish larvae against toxicity induced by TAA through MAPK signal pathway. Several molecular mechanisms discovered in this study may help in the development of new drugs.

Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic-assisted mesorectal excision and intersphincteric resection respectively in different ways

AIM

Many studies have demonstrated predictors of the difficulty of laparoscopic anterior resection for rectal cancer. Few studies focus on the influence of pelvic dimensions on robotic-assisted mesorectal excision (ME) and intersphincteric resection (ISR). This study aimed to evaluate the influences of the mesorectal fat area (MFA) and mesorectal area on the difficulty of robotic sphincter-saving surgery.

METHODS

We included 156 patients with middle and low rectal cancer who underwent robotic sphincter-saving surgery. Clinical and anatomical factors, including the pelvic dimensions, were collected. Linear regression was performed for variables associated with surgical duration. We also performed subgroup analyses for robotic-assisted ME and ISR. Logistic regression was used to find variables associated with transanal dissection.

RESULTS

For patients with middle or low rectal cancer, the sacral length and tumour distance from the anal verge were independently associated with surgical duration. The pT stage, sacral length and the MFA were independent predictors for the surgical duration of robotic-assisted ME. By contrast, a small mesorectal area was independently related to a longer duration of robotic-assisted ISR. The pelvic outlet length was independently associated with the use of transanal dissection for ISR.

CONCLUSION

It is suggested that a large MFA could affect the difficulty of ME in robotic-assisted ME, while a small mesorectal area could increase the surgical difficulty of robotic-assisted ISR for low rectal cancer. Besides, the pelvic outlet length was associated with the use of transanal dissection. Further studies are needed to validate the results and draw more scientific conclusions.

Atmospheric bulk deposition of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in the vicinity of MSWI in Shanghai, China

Atmospheric bulk deposition samples were gathered month by month throughout a year at two sites in vicinity of a MSWI in Shanghai, to carry out an investigation on the atmospheric bulk deposition fluxes and seasonal variations of polychlorinated dibenzo-p-dioxinsand dibenzofurans (PCDD/Fs). The atmospheric bulk deposition fluxes of PCDD/Fs ranged from 23.5 to 560 pg m^-2·d^-1 (1.01-23.9 pg WHO-TEQ·m^-2·d^-1), with an average value of 136 pg m^-2·d^-1 (5.08 pg WHO-TEQ·m^-2·d^-1) in the Vicinity of the MSWI in Shanghai. The measured concentrations were well compared with those from urban or industrial sites in other regions in China and abroad. The seasonal trend of atmospheric bulk deposition fluxes of PCDD/Fs throughout a year exhibited as high levels in summer, moderate levels in winter, and low levels in spring and autumn. The principal component analysis (PCA) indicated not only the MSWI, but also vehicle emission was the indispensable source of PCDD/Fs in the vicinity of the MSWI, especially for the urban areas. The positive matrix factorization (PMF) apportioned 5 source categories: MSWI, diesel vehicles, atmosphere background, industrial combustion and un-leaded gas vehicles, accounting for 43.3%, 38.1%, 6.89%, 6.19% and 5.50% in average, respectively of PCDD/Fs in atmospheric bulk deposition in the vicinity of the MSWI in Shanghai, China.

[Endemic situation of schistosomiasis in national surveillance sites of Hunan Province from 2015 to 2019]

OBJECTIVE

To analyze the changes in the endemic situation of schistosomiasis in national surveillance sites of Hunan Province, so as to provide scientific basis for the development of the schistosomiasis elimination programme in the province.

METHODS

According to the requirements of the National Guidelines for Schistosomiasis Surveillance in China (2014 version), a total of 41 national schistosomiasis surveillance sites were assigned in all disease-endemic counties (districts) across Hunan Province. During the period between 2015 and 2019, Schistosoma japonicum infections were monitored in local residents, mobile populations and livestock, and snail status was monitored. The morbidity due to schistosomiasis and snail status was compared between years.

RESULTS

The sero-prevalence of S. japonicum infections was 2.57% and 1.56% in local residents and mobile populations in national surveillance sites of Hunan Province from 2015 to 2019, respectively, and the sero-prevalence appeared a tendency towards a decline over years. A higher sero-prevalence rate of S. japonicum infections was seen in men than in women (P < 0.01). During the 5-year study period, the sero-prevalence rate of human S. japonicum infections appeared a tendency towards a decline in the marshland, embankment, inner embankment and hilly types of endemic areas over years. There were 44 and 19 egg -positives detected in local residents and 5 and 1 egg-positives in mobile populations in 2015 and 2016 respectively. A total of 9 346 domestic animals were monitored from 2015 to 2019, and 6 egg-positives were detected in 2015 and 2016 (all were bovine). A total of 0.155 billion m² settings were surveyed from 2015 to 2019, and the mean density of living snails appeared a tendency towards a decline over years, with a 45.79% reduction in 2019 as compared to 2015. However, no S. japonicum infections were identified in snails during the 5-year period. A total of 1 469 mixed snail samples were detected using loop-mediated isothermal amplification (LAMP), and 6 positive snail samples were identified in 2015 (one sample) and 2017 (5 samples).

CONCLUSIONS

The overall endemic situation of schistosomiasis appears a tendency towards a decline in Hunan Province, and the prevalence of S. japonicum infections is at a low level in humans and livestock; however, there is still a risk of schistosomiasis transmission. Improvements of health education, intensification of schistosomiasis examinations in mobile populations and reinforcement of the surveillance-response system is required to consolidate the achievements of schistosomiasis control in Hunan Province.

Retinopathy develops at similar glucose levels but higher HbA1c levels in people with black African ancestry compared to white European ancestry: evidence for the need to individualize HbA1c interpretation

AIMS

To examine the association of HbA_1c and glucose levels with incident diabetic retinopathy according to black African or white European ancestry.

METHODS

In this retrospective cohort study of 202 500 US Veterans with diabetes (2000-2014), measures included HbA_1c , outpatient random serum/plasma glucose, and incident retinopathy [conversion from negative to ≥2 positive evaluations (ICD-9 codes), without a subsequent negative].

RESULTS

At baseline, the study population had a mean age of 59.3 years, their mean BMI was 31.9 kg/m² , HbA_1c level was 57 mmol/mol (7.4%) and glucose level was 8.8 mmol/l, and 77% were of white European ancestry (white individuals) and 21% of black African ancestry (black individuals). HbA_1c was 0.3% higher in black vs white individuals (P < 0.001), adjusting for baseline age, sex, BMI, estimated glomerular filtration rate (eGFR), haemoglobin, and average systolic blood pressure and glucose. Over 11 years, incident retinopathy occurred in 9% of black and 7% of white individuals, but black individuals had higher HbA_1c , glucose, and systolic blood pressure (all P < 0.001); adjusted for these factors, incident retinopathy was reduced in black vs white individuals (P < 0.001). The population incidence of retinopathy (7%) was associated with higher mean baseline HbA_1c in individuals with black vs white ancestry [63 mmol/mol (7.9%) vs 58 mmol/mol (7.5%); P < 0.001)], but with similar baseline glucose levels (9.0 vs 9.0 mmol/l; P = 0.660, all adjusted for baseline age, sex and BMI).

CONCLUSIONS

Since retinopathy occurs at higher HbA_1c levels in black people for a given level of average plasma glucose, strategies may be needed to individualize the interpretation of HbA_1c measurements.

0973 Maternal Depression And Infant Sleep Duration Trajectory In The First 3 Years: A Prospective Cohort Study

Introduction

The study was to investigate trajectories of infant sleep duration and associations with trajectories of maternal depression status during 3 years post-partum.

Methods

Data were from the Child Health Promotion Project in Shanghai (CHPPS). Mothers were recruited at the third trimester of pregnancy and followed up together with the infants until 36 months postpartum. Between 2012 and 2013, 262 women (Mage=29.5, SDage=3.2, range: 22-39 years old) were recruited and were followed from June 2012 to August 2015. Sleep duration of the children was assessed using Brief Infant Sleep Questionnaire (BISQ) at 42 days, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, and 36 months postpartum. Center for Epidemiological Survey-Depression Scale (CESD), Edinburgh Postnatal Depression Scale (EPDS), and the Profile of Mood States (POMS) were used to measure the mother’s depression status at late pregnancy, 42 days postpartum, and 12-36 months postpartum, respectively. The group-based trajectory models (GBTM) were used to estimate patterns of infant sleep duration development and maternal depression status.

Results

Two trajectories of infant day sleep duration were identified, defined as “initial short sleepers” (54.8%) and “initial long sleepers” (45.2%). Three trajectories of infant night sleep duration were identified, labeled as “increasing” (8.5%), “stable” (61.7%), and “mild declining” (29.8%). Two trajectories infant total sleep duration were identified, defined as “initial short sleepers” (51.5%) and “initial long sleepers” (48.5%). Two trajectories of maternal depression status were identified, labeled as “low” (74.2%) and “high” (25.8%). After controlling for covariates, women who have higher depression status had infants of shorter day sleep duration. There was no significant association with infant night sleep duration.

Conclusion

Our study suggests that maternal postpartum depression is associated with short infant day sleep duration, but not with infant night sleep duration.

Support

Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81602870, 81601162, 81602868)

0972 Persistence, Remission, Acquisition Of Sleep Disturbances Contributes To The Transition Of Emotional/behavioral Problems In Preschool Children

Introduction

Cross-sectional and longitudinal studies have consistently reported associations between sleep disturbances and emotional/behavioral problems in children. However, few studies have examined whether the remission, acquisition of sleep disturbances contribute to the transition of emotional and behavioral problems during preschool years.

Methods

This study used data from the Shanghai Children’s Health, Education and Lifestyle Evaluation-Preschool (SCHEDULEA-P), a prospective, population-based cohort study of newly enrolled preschoolers in Shanghai kindergartens in Nov. 2016. In total, 17182 children with complete data on parent-reported Strength and Difficulties Questionnaire (SDQ) both at school enrollment(wave 1) and the third year(wave 2) were included in the study. Children’s sleep disturbances were measured using Children Sleep Habit Questionnaire (CSHQ) at both waves.

Results

The 17182 participants included 8935(52.0%) males, with a mean (SD) age of 3.73(0.29) years at wave 1. 66.9%, 7.2%, 17.4% and 8.5% of these children were divided into persistent sleep disturbance, acquired, remitted group and persistent normal sleep group, respectively. The proportion of persistent, acquired, remitted emotional/behavioral problems and normal group was 13.7%, 9.4%, 21.1%, 55.8%. SDQ scores of acquired sleep disturbances group stayed high at wave 3, while SDQ scores of remitted sleep disturbances group decreased sharply during the preschool years. After adjusted for confounding factors, the odds of remission from emotional/behavioral problems among children who experienced remission of sleep disturbances, who had persistent normal sleep were both much higher compared to those who had persistent sleep disturbances (OR=2.53(2.12-3.01), p&lt;0.001; OR=2.74(2.01-3.75), p&lt;0.001). Meanwhile, the odds of acquisition of emotional/behavioral problems at wave 2 among subjects who newly acquired sleep disturbances at wave 2 and who had persistent sleep disturbances was similarly higher than those who never have sleep disturbances(OR= 2.75, P&lt;0.001 VS OR=2.77, P&lt;0.001). Besides, those who experience remission of sleep disturbances still have 1.48 times the odds of acquisition of emotional / behavioral problems(P=0.006).

Conclusion

The remission of sleep disturbances contributed to the remission of emotional/behavioral problems, while the emergence of sleep disturbances throughout preschool years increased the risk of the acquisition of emotional/behavioral problems.

Support

Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81602870, 81601162, 81602868)

NF-κB inhibitor QNZ protects human chondrocyte degeneration by promoting glucose uptake through Glut4 activation

OBJECTIVE

Glucose is not only an energy source but also raw material for proteoglycan biosynthesis of chondrocyte. The aim of the present study is to explore the role of QNZ in the progress of chondrocytes glucose uptake and investigate whether it will improve the chondrocytes degeneration through Glut4 activation.

PATIENTS AND METHODS

We isolated human chondrocytes from the cartilage by the patients who underwent total knee arthroplasty operations. Chondrocytes were pretreated with insulin or QNZ for 24 h. The uptake of glucose with stimulation, as well as the expression of Glut4, collagen II, aggrecan, MMP13, TNF-α, PCNA, and the p16 levels were determined by Western blot, quantitative reverse-transcription polymerase chain reaction (qPCR), or immunofluorescence.

RESULTS

Both insulin and QNZ stimuli to chondrocytes contributed to the expression of Glut4 and glucose uptake compared to the normal cells. Additionally, collagen II and aggrecan expression was detected to a significant increase, along with the reduced levels of MMP13 and TNF-α after exposed to QNZ. Moreover, QNZ protected chondrocytes degeneration via promoting proliferation and delaying aging. After blocking Glut4, the glucose uptake significantly reduced in QNZ treatment, as well as the expression of collagen II and aggrecan. However, no significant changes were noticed in the MMP13 and TNF-α levels.

CONCLUSIONS

The present study demonstrates that inhibition of NF-κB activation by QNZ would improve the glucose uptake through Glut4 activation, which plays an important role in the protection of chondrocytes degeneration.

[Survey of the capacity building of the county-level schistosomiasis diagnosis network laboratory in Hunan Province]

OBJECTIVE

To examine the construction and operation of the schistosomiasis diagnostic network platform in Hunan Province, so as to provide insights into the improvements of the schistosomiasis diagnostic network laboratory system in the province.

METHODS

According to the criteria and requirements for the construction of the county-level schistosomiasis diagnostic network laboratory in China, the establishment and operation of the laboratory were assessed using self-assessment and field review in national schistosomiasis surveillance sites of Hunan Province.

RESULTS

A total of 41 county-level schistosomiasis diagnostic network laboratories were built in national schistosomiasis surveillance sites of Hunan Province, and 36 met the requirements for the construction of the national schistosomiasis diagnostic network laboratory in China, which were approved for inclusion in the province-level schistosomiasis diagnostic network laboratory. During the six inter-laboratory comparisons performed by the national schistosomiasis diagnostic reference center of China, full consistency was achieved by 3 county-level schistosomiasis diagnostic network laboratories in Hunan Province, and the coincidence rates for re-review of serological and pathogenic detection samples were 98.40% and 100%, respectively.

CONCLUSIONS

The county-level schistosomiasis diagnostic network laboratory system has been preliminarily built and under effective operation in Hunan Province; however, the building capability remains to be improved.

Impact of mismatches in HbA1c vs glucose values on the diagnostic classification of diabetes and prediabetes

AIMS

To determine whether HbA_1c mismatches (HbA_1c levels that are higher or lower than expected for the average glucose levels in different individuals) could lead to errors if diagnostic classification is based only on HbA_1c levels.

METHODS

In a cross-sectional study, 3106 participants without known diabetes underwent a 75-g oral glucose tolerance test (fasting glucose and 2-h glucose) and a 50-g glucose challenge test (1-h glucose) on separate days. They were classified by oral glucose tolerance test results as having: normal glucose metabolism; prediabetes; or diabetes. Predicted HbA_1c was determined from the linear regression modelling the relationship between observed HbA_1c and average glucose (mean of fasting glucose and 2-h glucose from the oral glucose tolerance test, and 1-h glucose from the glucose challenge test) within oral glucose tolerance test groups. The haemoglobin glycation index was calculated as [observed - predicted HbA_1c ], and divided into low, intermediate and high haemoglobin glycation index mismatch tertiles.

RESULTS

Those participants with higher mismatches were more likely to be black, to be men, to be older, and to have higher BMI (all P<0.001). Using oral glucose tolerance test criteria, the distribution of normal glucose metabolism, prediabetes and diabetes was similar across mismatch tertiles; however, using HbA_1c criteria, the participants with low mismatches were classified as 97% normal glucose metabolism, 3% prediabetes and 0% diabetes, i.e. mostly normal, while those with high mismatches were classified as 13% normal glucose metabolism, 77% prediabetes and 10% diabetes, i.e. mostly abnormal (P<0.001).

CONCLUSIONS

Measuring only HbA_1c could lead to under-diagnosis in people with low mismatches and over-diagnosis in those with high mismatches. Additional oral glucose tolerance tests and/or fasting glucose testing to complement HbA_1c in diagnostic classification should be performed in most individuals.

[Rectum-preserving surgery after consolidation neoadjuvant therapy or totally neoadjuvant therapy for low rectal cancer: a preliminary report]

Objective: To investigate the feasibility and safety of sphincter-preserving surgery after neoadjuvant chemoradiotherapy (nCRT) with consolidation chemotherapy in the interval period or total neoadjuvant therapy (TNT) for low rectal cancer. Methods: A descriptive case series study was carried out. Clinical data of patients with locally advanced low rectal cancer (LALRC) who achieved complete clinical response (cCR) or nearly cCR (near-cCR) after nCRT at the Department of Colorectal Surgery of Fujian Medical University Union Hospital from May 2015 to February 2019 were retrospectively analyzed. Case inclusion criteria: (1) Low rectal adenocarcinoma within 6 cm from the anal verge. (2) After nCRT, tumor presented markedly regression as mucosal nodule or abnormalities, superficial ulcer, scar or a mucosal erythema (< 2 cm); no regional lymph node metastasis or distant metastasis was found in rectal ultrasonography, pelvic MRI and PET-CT; MRI showed obvious fibrosis in the original tumor site; and post-treatment CEA was normal. (3) The patient and the family members adhered to receive the transanal full-thickness local excision with informed consent. (4) When the residual lesions were difficult to detect after nCRT, patients received the watch and wait (W&W) strategy. Exclusion criteria: (1) Before nCRT, pathological results showed poorly differentiated or signet-ring cell carcinoma; lateral lymph node metastasis was suspected. (2) When the residual lesion size was more than 3 cm after nCRT, it was difficult to perform local excision. The consolidation nCRT group received 3-4 cycles of CAPOX regimen (oxaliplatin and capecitabine) or six cycles of mFOLFOX6 (oxaliplatin, leucovorin, and 5-fluorouracil) combined with the long-course radiotherapy (intensity-modulated radiation therapy with a total dose of 50.4Gy). Patients with concurrent chemotherapy more than or equal to five cycles of CAPOX or eight cycles of mFOLFOX6 were defined as total neoadjuvant therapy (TNT) group. Local resection was recommended for patients who were near-cCR according to modified MSKCC criteria 8-33 weeks after the end of radiotherapy. Patients with a near-cCR, who were judged as ycN0 according to PET-CT and MRI and were ypT0 after local excision, could enter the W&W strategy. Patients with pathologic stage more advanced than ypT1, and those with positive resection margin, or lymphovascular invasion were recommended for salvage radical surgery after local excision. The ypT1 patients with a negative resection margin and without lymphovascular invasion might receive the W&W management carefully if they refused radicalsurgery to sacrifice the sphincter for low rectal cancer. Results: Of 32 patients, 14 were males and 18 were females with the average age of 59 years old. Twenty-three patients underwent consolidation nCRT, and 9 received TNT. The first evaluation after treatments showed 19 cases with cCR and 13 with near-cCR. Twenty-nine patients received local excision while 3 patients with undetectable lesions received W&W policy. Four cases (12.5%) underwent salvage radical surgery with abdominoperineal resection. After local excision, 3 cases underwent salvage radical surgery immediately, and the final pathologic result was ypT3N0, ypT2N0, and ypT2N0 respectively, of whom 2 cases were in the group of consolidation CRT and 1 was in the TNT group. Of these 3 cases, 1 case with an initial cT3 stage showed a pathologic stage of ypT1 and a negative circumferential resection margin after consolidation nCRT and local excision, however, the final pathologic stage was ypT3 with fragmented tumor deposits in the mesorectum after the salvage radical surgery. Meanwhile 1 patient in the TNT group receiving W&W suffered from intraluminal regrowth after 7.4 months follow-up and underwent salvage abdominoperineal resection. One patient in the consolidation nCRT group died of stroke 42.5 months after local resection. Another patient in the TNT group had cerebral metastasis 10 months after the W&W policy, but no local recurrence was found in the pelvic cavity, then received resection of the metastatic tumors. The average follow-up for all the patients was 23 (5-51) months. The cumulative local regrowth rate was 5.0%. The overall survival rate was 85.7%, and the sphincter-preservation rate was increased from 25.0% (28/32) in the original plan to 87.5% (28/32) actually. The 3-year disease-free survival rate was 89.7%. The 3-year organ-preserving survival rate was 85.7%, and the 3-year stoma-free survival rate was 82.5%. At present, 31 patients still survived. Conclusions: After nCRT with consolidation chemotherapy or TNT for low rectal cancer, patients with cCR, ycN0 according to PET-CT and MRI, and ypT0 after local excision, can consider the W&W strategy. Strict patient selection with a near-cCR for local resection and sphincter-preserving strategy can reduce the local regrowth of cancer, and the short-term outcomes are satisfactory.

Resistance to Fusarium head blight and mycotoxin accumulation among 129 wheat cultivars from different ecological regions in China

A total of 129 wheat cultivars collected from local breeders in four ecological regions in China was evaluated for Fusarium head blight resistance after natural infection under epidemic conditions. The disease index was scored and seven toxins concentrations were determined by UPLC-MS/MS. The disease index ranged from 6.3 to 80.9% and a strong correlation was found between the regions from which the cultivars originate and disease index. The middle and lower reaches of Yangtze River Region showed the highest disease resistance, followed by the upper reaches of the Yangtze River Region. FHB resistance of cultivars from northern and southern Huanghuai Region was lowest and all cultivars in these regions are highly or moderately susceptible. Disease index was significantly correlated with toxin accumulation on nation scale, but no clear correlation was found within most ecological regions. The toxin accumulation was also not well correlated with resistant levels. As the incidence of FHB has increased dramatically over the last decade, improved FHB resistance in cultivars is urgently needed. We recommend that besides scoring for disease index also mycotoxin accumulation in cultivars is incorporated in breeding procedures and the evaluation of cultivars.

Three-field versus two-field lymphadenectomy in transthoracic oesophagectomy for oesophageal squamous cell carcinoma: short-term outcomes of a randomized clinical trial

BACKGROUND

The benefit and harm of three-field lymphadenectomy for oesophageal cancer are still unknown. The aim of this study was to compare overall survival and morbidity and mortality between three- and two-field lymphadenectomy in patients with oesophageal squamous cell carcinoma.

METHODS

Between March 2013 and November 2016, patients with squamous cell carcinoma of the middle or distal oesophagus were assigned randomly to open oesophagectomy with three-field (cervical-thoracic-abdominal) or two-field (thoracic-abdominal) lymphadenectomy. No chemo(radio) therapy was given before surgery. This paper reports on the secondary outcomes of the study: pathology and surgical complications.

RESULTS

Some 400 patients were randomized, 200 in each group. A median of 37 (i.q.r. 30-49) lymph nodes were dissected in the three-field group, compared with 24 (18-30) in the two-field group (P < 0·001). Some 43 of 200 patients (21·5 per cent) in the three-field group had cervical lymph node metastasis. More patients in the three-field group had pN3 disease: 21 of 200 (10·5 per cent) versus 10 of 200 (5·0 per cent) (P = 0·040). The rate and severity of postoperative complications were comparable between the two groups, except that six patients in the three-field arm needed reintubation compared with none in the two-field group (3·0 versus 0 per cent; P = 0·030). The 90-day mortality rate was 0 per cent in the three-field group and 0·5 per cent (1 patient) in the two-field group (P = 1·000).

CONCLUSION

Oesophagectomy with three-field lymphadenectomy increased the number of lymph nodes dissected and led to stage migration owing to a 21·5 per cent rate of cervical lymph node metastasis. Postoperative complications were largely comparable between two- and three-field lymphadenectomy. Registration number: NCT01807936 ( https://www.clinicaltrials.gov).