Does the Two-Tier System Accurately Predict Progression of Endometrial Hyperplasia to Endometrial Carcinoma in High-Risk Populations? A Retrospective Study in a Safety-Net Hospital

Introduction/Objective

In 2014, the WHO simplified the classification of endometrial hyperplasia (EH) into a two-tier system: endometrial hyperplasia without atypia/benign endometrial hyperplasia (BEH) and atypical endometrial hyperplasia (AEH)/endometrioid intraepithelial neoplasia (EIN), as opposed to the 1994 WHO 4-tier scheme. We conducted this study to assess the diagnostic validity of the two-tier scheme in predicting upgrade to endometrioid adenocarcinoma (EA) in our high-risk patient population.

Methods

Retrospective review from Aug 2009 to August 2019 revealed 144 cases of EH diagnosed on biopsy. The cases were reclassified using the 2014 two-tier scheme to 81 BEH and 63 AEH. The excisional diagnoses, if available, were compared with the initial biopsy results.

Results

At hysterectomy, 22 AEH (50%) were diagnosed as benign, with no residual AEH, 15 cases were upgraded to EA (34.1%), and 7 had residual AEH (15.9%). Endometrial polyp was identified in 29 cases out of 63 AEH, 24 of which had a follow-up excision. Among those, 6 were upgrade to EA (25%), significantly lower than the upgrade rate of AEH without polyp (45%) (p=0.0344).

Conclusion

In our high-risk patient population, the likelihood of upgrade to EA at excision of a biopsy-diagnosed AEH is significantly higher than BEH and is in line with what was reported in the literature for other populations. Patients with endometrial polyps were less likely to progress to EA. Our study demonstrated the diagnostic validity of the two- tiered classification in high-risk population and supports the emphasis on cytological atypia.

Progress and current status of molecule-targeted therapy and drug resistance in gastric cancer

Gastric cancer is one of the most common malignant tumors in the world. In China, its morbidity and mortality are second only to lung cancer. Chemotherapy combined with targeted therapy brings survival benefits to patients with advanced gastric cancer. Targets for targeted therapy of gastric cancer include human epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR) and Claudin 18.2 (CLDN 18.2). The main challenge of tumor molecule-targeted drugs is resistance. The main mechanisms of drug resistance include tumor establishment of compensatory signaling pathways, target protein changes, tumor microenvironment changes, tumor heterogeneity and tumor adaptation to targeted drugs. The combined action of multiple drug resistance mechanisms promotes the development of targeted drug resistance. In order to attract the attention of researchers, this paper reviews the mechanisms of drug resistance in gastric cancer-targeted therapy. In addition, the research status of drug resistance in molecule-targeted therapy of gastric cancer is summarized. It is of great clinical significance to explore the drug resistance mechanisms of targeted drugs and reverse drug resistance in gastric cancer. Last, the future development of molecule-targeted therapy is prospected.

Sevoflurane improves circulatory function and pulmonary fibrosis in rats with pulmonary arterial hypertension through inhibiting NF-κB signaling pathway

OBJECTIVE

The aim of this study was to explore the influences of sevoflurane inhalation therapy on circulation function and pulmonary fibrosis in rats with pulmonary arterial hypertension (PAH) and the nuclear factor-κB (NF-κB) signaling pathway.

MATERIALS AND METHODS

A total of 30 adult male Sprague-Dawley rats were randomly divided into three groups, including control group (CTL group, n=10), PAH group (n=10), and PAH + sevoflurane group (n=10) using a random number table. Subsequently, the pulmonary artery right ventricular systolic pressure (RVSP) and right ventricular hypertrophy index (RVHI) were measured. Rats in PAH group were subcutaneously injected with 60 mg/kg monocrotaline once to establish the model of PAH. 28 d later, the differences in the morphology of pulmonary tissues and the protein expression levels of phosphorylated inhibitory κB (p-IκB), p-P65, P65, cyclin D1, proliferating cell nuclear antigen (PCNA) and tubulin among the three groups were analyzed via hematoxylin-eosin (HE) staining and Western blotting, respectively. Meanwhile, the messenger ribonucleic acid (mRNA) expression level of P65 was determined via Reverse Transcription-quantitative Polymerase Chain Reaction (RT-qPCR). Additionally, changes in the expression levels of Ki-67 and α-smooth muscle actin (α-SMA) in rat pulmonary tissues of the three groups were evaluated through immunohistochemistry.

RESULTS

According to HE staining results, compared with CTL group, rats in PAH group exhibited significant thickening of the pulmonary artery wall, reduction of the vascular lumen, inflammatory cell infiltration, and thrombosis in some small arteries. This indicated that the PAH model was successfully established in rats. Compared with PAH group, PAH + sevoflurane group showed a significantly improved morphology of rat pulmonary tissues. Western blotting demonstrated that the protein expression levels of p-IκB, p-P65, and P65 in rat pulmonary tissues of PAH group were remarkably higher than CTL group (p<0.01). However, they were notably down-regulated in PAH + sevoflurane group when compared with those in PAH group (p<0.05). The above experimental results suggested that the NF-κB signaling pathway in pulmonary tissues of rats in PAH group was activated and was inhibited by sevoflurane. Subsequent RT-qPCR results indicated that no significant (N.S.) differences were observed in the mRNA level of P65 among the three groups. Compared with CTL group, PAH group showed significantly up-regulated levels of Ki-67 and α-SMA in rat pulmonary tissues (p<0.01). However, their expression levels were markedly reduced in PAH + sevoflurane group when compared with PAH group (p<0.05). Finally, the detection of pulmonary circulatory function-related indicators illustrated that RVSP and RVHI increased significantly in PAH group in comparison with CTL group. However, they declined remarkably in PAH + sevoflurane group when compared with those in PAH group (p<0.05).

CONCLUSIONS

Sevoflurane down-regulates the levels of p-IκB, p-P65, and P65 to repress the activation of the NF-κB signaling pathway. This may reduce pulmonary fibrosis and ultimately prevent PAH.

Abnormal expression and mechanism of miR-330-3p/BTG1 axis in hepatocellular carcinoma

OBJECTIVE

Increasing evidence has suggested that microRNAs (miRNAs) played critical roles in cancer development by acting as a tumor suppressor or tumor-promoting genes. However, the role of microRNA-330-3p (miR-330-3p) in hepatocellular carcinoma (HCC) is still unknown. This study aimed to investigate the expression and role of miR-330-3p in hepatocarcinogenesis.

PATIENTS AND METHODS

A total of 30 human hepatocellular carcinoma tissues and adjacent normal tissues were obtained from 30 hepatocellular carcinoma patients. Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) assay was carried out to measure the expression of miR-330-3p in HCC tissues and cell lines. The relation between B-cell translocation gene 1 (BTG1) and miR-330-3p was predicted by TargetScan and confirmed by dual-luciferase reporter assay. Cell Counting Kit-8 (CCK-8), flow cytometry analysis, and transwell assay were used to determine cell viability, apoptosis, cell migration, and invasion, respectively. In addition, the mRNA and protein expression of Cyclin D1, Bcl-2, Bax, and matrix metalloproteinase (MMP)9 were detected using qRT-PCR and Western blotting.

RESULTS

We found that miR-330-3p expression was up-regulated in HCC tissues and cell lines. BTG1 was a direct target of miR-330-3p and it was down-regulated in HCC tissues and cell lines. Moreover, down-regulation of miR-330-3p suppressed HCCLM3 cell viability, migration, invasion, and enhanced cell apoptosis, while the tumor-suppressive effects were reversed by BTG1-siRNA. In addition, miR-330-3p inhibitor decreased the expression of Cyclin D1, Bcl-2, and MMP9 while enhanced the expression of Bax. Meanwhile, BTG1-siRNA led to the opposite effects.

CONCLUSIONS

The data suggested that miR-330-3p acted as a tumor gene in HCC by targeting BTG1 and it might be a potential therapeutic target for the HCC treatment.

The prokaryotic expression, polyclonal antibody preparation, and subcellular localization of the transmembrane protein NS2A of the duck Tembusu virus

Duck Tembusu virus (DTMUV) is a single-stranded, positive-sense RNA arbovirus, belonging to the genus Flavivirus, the family Flaviviridae. As a transmembrane protein, non-structural protein 2A (NS2A) plays an important role in virion assembly, replication complex and antagonizing host immune response. Since NS2A protein contains many hydrophobic amino acids, it is hard to gain the full-length protein of NS2A for prokaryotic expression. Therefore, to make a deep study, prokaryotic expression and polyclonal antibody preparation of truncated DTMUV NS2A was performed. The truncated NS2A gene (178-450 bp) was obtained, and sub-cloned into the prokaryotic vector pGEX-4T-1 (pGEX-4T-1-NS2A178-450bp). Subsequently, the recombinant GST-NS2A60-150aa protein was successfully expressed in E. coli BL21 (DE3) with the induction by 0.3 mmol/l isopropyl β-D-thiogalactoside (IPTG) for 6 h at 37°C. The GST-NS2A60-150aa protein was extracted from the gel. The BALB/c mice were immunized with the purified recombinant NS2A protein to prepare polyclonal antibodies against the truncated NS2A protein. The titer of the polyclonal antibodies, determined by ELISA analysis, was 1:128,000. The specificity of the polyclonal antibodies (mPAb-DTMUV-NS2A60-150aa) were verified by Western blot analysis. Furthermore, the indirect immunofluorescence (IFA) was performed to explore the subcellular localization of NS2A. NS2A protein was, in the transfected cells, located mainly around nucleus in the endoplasmatic reticulum. Taken together, our study provided a useful tool for the further exploration of the biological functions and molecular mechanism of DTMUV NS2A. Keywords: duck Tembusu virus; non-structural protein 2A; prokaryotic expression; polyclonal antibodies; subcellular location.

Weighted gene co-expression network analysis reveals potential candidate genes affecting drip loss in pork

Drip loss is an essential evaluation indicator for pork quality. It is closely related to other meat quality indicators, including water-holding capacity, water loss rate and pH value at 45 min (pH₁ ) and 24 h post-mortem (pH₂ ), and is influenced by environmental and genetic factors and their interactions. We previously conducted differentially expressed gene analysis to identify candidate genes affecting drip loss using eight individuals with extremely high- and low-drip loss selected from 28 purebred Duroc pigs. Using 28 identical samples, in the present study, we performed weighted gene co-expression network analysis with drip loss and drip loss-related traits, including water-holding capacity, water loss rate, pH₁ and pH₂ . A total of 25 modules were identified, and five of them correlated with at least two drip loss or drip loss-related traits. After functional enrichment analysis of genes in the five modules, three modules were found to be critical, as their genes were significantly involved in amino acid metabolism, immune response and apoptosis, which have potential relationships with drip loss. Furthermore, we identified five candidate genes affecting drip loss in one critical module, AASS, BCKDHB, ALDH6A1, MUT and MCCC1, as they overlapped with differentially expressed genes detected in our previous study, exhibited protein-protein interactions and had potential biological functions in affecting drip loss according to the literature. The outcomes of the present study enhance our understanding of the molecular mechanisms underlying drip loss and will aid in improving the pork quality.

[Assessment of mortality burden and economic loss attributed to long-term PM(2.5) exposure in the Beijing-Tianjin-Hebei area]

Objective: To accurately estimate the health burden and corresponding economic loss attributed to PM(2.5) pollution in the Beijing-Tianjin-Hebei (BTH) area in China in 2015. Method: By using satellite-retrieved PM(2.5) concentration data and population data provided by NASA (the spatial resolution was 1 km×1 km), this study estimated excess mortality attributed to long-term PM(2).5 exposure in BTH area in 2015 based on Global Exposure Mortality Model (GEMM). Besides, Value of Statistic Life (VSL) method was used to evaluate the corresponding health economic loss. Result: In BTH area, the population-weighted average PM(2.5) concentration during 2012-2014 was 46.25 μg/m(3), and 56.6% of total population lived in the area where annual average PM(2.5) concentration exceeded Grade Ⅱ of National Ambient Air Quality Standard in China (35 μg/m(3)); The PM(2.5)-related premature deaths amounted to 193.8 thousand (95%CI: 140.9 thousand-233.3 thousand), Beijing, Tianjin, Baoding, Shijiazhuang, and Handan were the top five cities with high incidences of PM(2.5)-related premature deaths; The corresponding health economic loss was about 35.934 billion (95%CI: 26.099 billion - 43.255 billion) RMB, accounting for 0.70% (95%CI: 0.51%-0.85%) of the area's GDP in 2015, Beijing, Tianjin, Baoding, Shijiazhuang, and Cangzhou were the top five cities with high health economic loss. Conclusions: PM(2.5) pollution has caused severe disease and economic burden in BTH area. Its spatial distribution suggested that it is particularly necessary to develop the air pollution prevention and control policies for key cities.

Prognostic values of STAT3 and HIF-1α in esophageal squamous cell carcinoma

OBJECTIVE

To investigate the expressions of signal transduction and activator of transcription 3 (STAT3) and hypoxia-inducible factor 1-alpha (HIF-1α) in esophageal squamous cell carcinoma (ESCC), and their potential roles in the pathology of ESCC.

PATIENTS AND METHODS

Tumor tissues and clinical data of 202 ESCC patients treated in our hospital from January 2011 to June 2013 were collected. Expressions of STAT3 and HIF-1α in tumor tissues and normal esophageal tissues were detected by immunohistochemical S-P method. Correlation of STAT3 and HIF-1α with clinicopathological parameters and prognosis of ESCC were analyzed.

RESULTS

STAT3 was positively expressed in 82/202 ESCC tissues, with a positive expression rate of 40.59%, and HIF-1α was positively expressed in 142/202 ESCC tissues, with a positive expression rate of 70.30%. Both STAT3 and HIF-1α were highly expressed in ESCC tissues than those normal esophageal tissues, showing statistically significant differences (p<0.05). The expression of STAT3 was positively correlated with that of HIF-1α in ESCC tissues (r=0.401, p<0.05). Overall survival (OS) and disease-free survival (DFS) of ESCC patients with positive STAT3 and HIF-1α expression were markedly worse than those with negative expression (p<0.05). STAT3 and HIF-1α were related to the infiltration depth (T stage) of ESCC (p<0.05). Univariate and multivariate analyses revealed that the expression of STAT3 was associated with OS and DFS (p<0.05) and was an independent prognostic factor for ESCC.

CONCLUSIONS

High expressions of STAT3 and HIF-1α are closely related to ESCC. STAT3 is an independent prognostic risk factor for ESCC, and HIF-1α may be a poor prognostic survival factor for ESCC, both of which can be used as indicators to predict the prognosis of ESCC patients.

[Safety and efficacy of bivalirudin versus unfractionated heparin during perioperative period of percutaneous coronary intervention]

Objective: To compare the safety and efficacy of bivalirudin versus unfractionated heparin during perioperative period of percutaneous coronary intervention(PCI) in real-world. Methods: A total of 13 097 serial patients who underwent PCI from January 2016 to November 2018 in the Northern Theater Command were enrolled in the present study. Patients were stratified as the bivalirudin group or the heparin group according to antithrombotic therapy during PCI. The primary efficiency endpoint was 30-day net adverse clinical event(NACE), defined as all-cause death, re-infarction, urgent target lesion revascularization (uTLR), stroke or any bleeding. The second efficiency endpoint was 30-day major cardiac and cerebral events (MACCE), defined as all-cause death, re-infarction, uTLR and stroke. Additional end points included the rates of stent thrombosis at 30 days. Propensity scores included clinical and demographic variables, with 1∶2 matching. Compared the incidence of events above between the two groups before and after matching. Results: Among the 13 097 included patients(age was (61±10) years old), 3 421 (26.1%) were female. And 2 734 patients were divided into the bivalirudin group, and 10 363 patients to the heparin group(5 468 after matching). Before propensity score matching, patients in bivalirudin group were older and received higher levels of CRUSADE score than heparin group. These patients were more likely to have hypertension and more with ST-segment elevation acute coronary syndromes（all P＜0.05）. After propensity score matching, the incidence of 30-day NACE(3.8%(103/2 734) vs.5.0%(271/5 468), P=0.015) and any bleeding (2.0%(54/2 734) vs. 2.8%(151/5 468), P=0.032) in the bivalirudin group were lower than that in the heparin group, but the incidence of MACCE (1.9%(51/2 734) vs. 2.3%(127/5 468), P=0.180) and stent thrombosis (0.1%(2/2 734) vs. 0.1%(3/5 468), P=1.000) were comparable between the two groups. Conclusion: The risk of bleeding and the incidence of NACE are significantly lower for patients using bivalirudin during perioperative period of PCI compared to heparin, without significant differences in ischemic events.

Efficacy of laparoscopic gastric bypass vs laparoscopic sleeve gastrectomy in treating obesity combined with type-2 diabetes

OBJECTIVE

This prospective study compared the efficacy and safety of laparoscopic gastric bypass and laparoscopic sleeve gastrectomy in treating overweight and obese patients with BMI>28 kg/m² and type-2 diabetes.

METHODS

Patients were randomized into a gastric bypass group (n = 77) or a gastrectomy group (n = 80). The surgery time, intraoperative blood loss, recovery time, and hospitalization time were collected. BMI, waistline, hipline, C-peptide level, insulin resistance index (HOMA-IR), and their blood and lipid profile were also measured.

RESULTS

Surgery time and blood loss were significantly higher in the gastrectomy group, when compared to the gastric bypass group (P < 0.05). In both groups, the levels of BMI, waist circumference and hip circumference (but not their ratio) gradually and significantly decreased after surgery compared with baseline (P < 0.05), and no significant difference was found between these two groups. The C-peptide level, HOMA-IR, fasting blood glucose, 2-hour postprandial blood glucose and glycosylated haemoglobin gradually and significantly decreased after surgery compared with the values before treatment (P < 0.05). The levels of total cholesterol, triglyceride, LDL, and monocyte chemoattractant protein-1 were also lower after surgery in both groups, while HDL and glucagon-like peptide-1 were significantly higher after surgery compared with the values before treatment (P < 0.05). However, no significant difference was found between these two groups of patients.

CONCLUSION

Both laparoscopic gastric bypass and laparoscopic sleeve gastrectomy improved the BMI and diabetic conditions of overweight/obese diabetics, while laparoscopic sleeve gastrectomy had a shorter surgical time and less blood loss.

Possible itinerant excitations and quantum spin state transitions in the effective spin-1/2 triangular-lattice antiferromagnet Na2BaCo(PO4)2

The most fascinating feature of certain two-dimensional (2D) gapless quantum spin liquid (QSL) is that their spinon excitations behave like the fermionic carriers of a paramagnetic metal. The spinon Fermi surface is then expected to produce a linear increase of the thermal conductivity with temperature that should manifest via a residual value (κ₀/T) in the zero-temperature limit. However, this linear in T behavior has been reported for very few QSL candidates. Here, we studied the ultralow-temperature thermal conductivity of an effective spin-1/2 triangular QSL candidate Na₂BaCo(PO₄)₂, which has an antiferromagnetic order at very low temperature (T_N ~ 148 mK), and observed a finite κ₀/T extrapolated from the data above T_N. Moreover, while approaching zero temperature, it exhibits series of quantum spin state transitions with applied field along the c axis. These observations indicate that Na₂BaCo(PO₄)₂ possibly behaves as a gapless QSL with itinerant spin excitations above T_N and its strong quantum spin fluctuations persist below T_N.

[Evaluation of the efficacy and safety of iron therapy in patients with paroxysmal nocturnal hemoglobinuria complicated with iron deficiency anemia]

Objective: To evaluate the efficacy and safety of iron supplement in patients who have paroxysmal nocturnal hemoglobinuria (PNH) with iron deficiency. Methods: We performed analyses on the clinical data of 48 patients who accepted oral and/or intravenous iron treatment. Forty-eight consecutive PNH patients with iron deficiency who visited our hospital between November 2011 and August 2018 were enrolled in the study. Results: Total 30 patients received oral iron; 18 patients received intravenous iron supplements, including 6 who did not respond to oral iron. The median PNH clone size was 90.2% (38.5%-99.9%) in the granulocytes and 69.7% (27.6%-98.1%) in the red blood cells. The response rate was 56% (20/36) in patients who received oral iron, and the hemoglobin concentration increased 21 (10-52) g/L compared to that at baseline. Sixteen out of eighteen (89%) patients responded to intravenous iron; 6 patients who did not respond to oral iron received intravenous iron, and the hemoglobin level of 5 patients increased. Patients exhibited increased LDH levels and deepen urine after iron supplementation; however, no severe adverse events, such as thrombosis and iron-related adverse effects, were noted. Conclusion: Iron treatment is safe and effective in increasing the hemoglobin level in PNH patients with iron deficiency; those who did not respond to oral iron could benefit from intravenous iron supplement.

[Efficacy of percutaneous transluminal renal angioplasty for pediatric renovascular hypertension: a meta-analysis]

Objective: To evaluate the efficacy and the related factors of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH) by a systematic review and meta-analysis. Methods: A systematic search was performed on international and domestic databases (Pubmed, Excerpt Medical Database (EMBASE), Cochrane library, Clinical trial.gov, Medline, China Biology Medicine (CBM), China national knowledge infrastructure (CNKI), VIP database and Wanfang) which included studies on PTRA for pediatric RVH from the establishment of the databases to March 2019. Key words of "pediatric" "children" "renal artery stenosis" "renovascular hypertension" "angioplasty" and "intervention" were used. Meta-analysis was made on the rate of technical success, clinical blood pressure improvement, complication and restenosis of PTRA as well as the predictors of its efficacy. The data consolidation, analysis of heterogeneity and sensitivity, and publication bias were performed using Comprehensive meta analyst and Open meta analyst software. Results: Seventeen observational non-controlled studies comprising 384 patients with RVH who underwent PTRA were identified. The technical success rate of PTRA was 93.9% (95% confidence interval (CI) 89.3%-97.5%). The improvement rate of blood pressure was 68.4% (95%CI 57.2%-78.7%), and the cure rate was 40.0% (95%CI 25.0%-55.8%). The subsequent subgroup analysis showed that there was no significant difference in the improvement rate of blood pressure after PTRA among the patients with RVH caused by fibromuscular dysplasia, Takayasu arteritis and neurofibromatosis type 1, respectively (P>0.05). The improvement rate of blood pressure in patients with combined lesions in renal artery branches was significantly lower than that in patients with lesions only in main renal artery (RR=1.659, 95%CI 1.023-2.689, P=0.040). It was found that 25.5% (95% CI 19.3%-32.2%) of patients required repeat procedure because of restenosis of lesions. Procedural complication of PTRA occurred in 8.3% (95%CI 3.5%-14.4%) of patients. In terms of clinical blood pressure improvement rate after PTRA, there was heterogeneity among the enrolled studies, but the results of meta-analysis were robust with low risk of publication bias (t=1.690, 95%CI -0.363-3.124, P=0.110). Conclusion: The result of the Meta-analysis suggests that PTRA may provide a safe and effective treatment for pediatric RVH, and patients with stenosis of renal arterial branches are associated with relatively poor clinical outcomes.

Activated inducible co-stimulator-positive programmed cell death 1-positive follicular helper T cells indicate disease activity and severity in ulcerative colitis patients

Inducible co-stimulator-positive (ICOS) and programmed cell death 1-positive (PD-1) are important markers for follicular helper T cells (Tfh); however, their roles and clinical values in ulcerative colitis (UC) remain unknown. In this study, we recruited 68 UC patients and 34 healthy controls. Circulating ICOS⁺ , PD-1⁺ and ICOS⁺ PD-1⁺ Tfh subsets were analyzed by flow cytometry. Twelve active UC patients achieving remission after treatment with 5-aminosalicylic acid were followed-up and Tfh subset changes were analyzed. Serum immunoglobulin (Ig)G, C-reactive protein (CRP), interleukin (IL)-4 and IL-21 levels and B cell subsets were analyzed and Mayo scores were calculated. Correlation analyses were performed between Tfh subsets and the clinical indicators. Receiver operating characteristic (ROC) curves were generated to evaluate the efficiency of Tfh subsets for disease monitoring. We found that levels of ICOS⁺ , PD-1⁺ and ICOS⁺ PD-1⁺ Tfh cells were significantly increased in active UC and significantly decreased when achieving clinical remission. Activated ICOS⁺ PD-1⁺ Tfh cells were positively correlated with serum CRP and Mayo scores. Furthermore, ICOS⁺ PD-1⁺ Tfh cells were significantly correlated with circulating new memory B cells and plasmablasts, as well as serum IgG, IL-4 and IL-21. ROC analyses showed that when ICOS⁺ PD-1⁺ Tfh cells were used in combination with PD-1⁺ Tfh cells, the diagnostic efficacy in distinguishing active UC from stable remission patients was higher than that of any one used alone, with area under curve (AUC) value 0·931. Our findings suggest that increased ICOS⁺ PD-1⁺ Tfh cells are associated with the activation of B cells in the pathogenesis of UC, and may be a potential biomarker for UC disease monitoring.

Influence of an InGaN superlattice pre-layer on the performance of semi-polar (11-22) green LEDs grown on silicon

It is well-known that it is crucial to insert either a single InGaN underlayer or an InGaN superlattice (SLS) structure (both with low InN content) as a pre-layer prior to the growth of InGaN/GaN multiple quantum wells (MQWs) served as an active region for a light-emitting diode (LED). So far, this growth scheme has achieved a great success in the growth of III-nitride LEDs on c-plane substrates, but has not yet been applied in the growth of any other orientated III-nitride LEDs. In this paper, we have applied this growth scheme in the growth of semi-polar (11–22) green LEDs, and have investigated the impact of the SLS pre-layer on the optical performance of semi-polar (11–22) green LEDs grown on patterned (113) silicon substrates. Our results demonstrate that the semi-polar LEDs with the SLS pre-layer exhibit an improvement in both internal quantum efficiency and light output, which is similar to their c-plane counterparts. However, the performance improvement is not so significant as in the c-plane case. This is because the SLS pre-layer also introduces extra misfit dislocations for the semi-polar, but not the c-plane case, which act as non-radiative recombination centres.

Dietary supplementation with Bacillus subtilis DSM 32315 alters the intestinal microbiota and metabolites in weaned piglets

AIM

The study was conducted to investigate the effects of dietary Bacillus subtilis (BS) DSM 32315 on the intestinal microbiota composition and metabolites of weaned pigs.

METHODS AND RESULTS

Sixty-four piglets were allocated to two groups (control and BS), each group including eight replicates with four piglets. Dietary BS DSM 32315 increased (P < 0·05) the abundances of jejunal Leucobacter and Cupriavidus, ileal Thermus, Coprococcus and Bifidobacterium, as well as colonic Succiniclasticum; and increased the concentrations of ileal straight-chain fatty acids, colonic propionate, branched-chain fatty acids (BCFAs), and tyramine, but decreased (P < .05) the colonic indole concentration. The ileal and colonic microbial community structure tended to cluster into two groups. LEfSe analysis identified five microbial biomarkers in jejunum and eight biomarkers in ileum in the BS group, and three biomarkers in colon in the control group. The ileal Bifidobacterium abundance was positively correlated (P < 0·05) with isovalerate concentration, while the colonic Actinobacteria and Lactobacillus abundances were negatively correlated (P < 0·05) with indole concentration.

CONCLUSION

These findings suggest that dietary supplementation with BS DSM 32315 could alter the diversity, composition, and metabolites of intestinal microbiota in weaned piglets.

SIGNIFICANCE AND IMPACT OF THE STUDY

Weaned piglets are often accompanied with impaired gastrointestinal tract and intestinal disorder affecting their growth. This study demonstrated that dietary BS DSM 32315 presented a beneficial role in gut health via regulating intestinal microbiota composition and metabolites.

Antimalarial agent artesunate induces G0/G1 cell cycle arrest and apoptosis via increasing intracellular ROS levels in normal liver cells

Artesunate (ARS) has been shown to be highly effective against chloroquine-resistant malaria. In vitro studies reported that ARS has anticancer effects; however, its detrimental action on cancer cells may also play a role in its toxicity toward normal cells and its potential toxicity has not been sufficiently researched. In this study, we investigated the possible cytotoxic effects using normal BRL-3A and AML12 liver cells. The results showed that ARS dose-dependently inhibited cell proliferation and arrested the G0/G1 phase cell cycle in both BRL-3A and AML12 liver cells. Western blotting demonstrated that ARS induced a significant downregulation of cyclin-dependent kinase-2 (CDK2), CDK4, cyclin D1, and cyclin E1 in various levels and then caused apoptosis when the Bcl-2/Bax ratio decreased. Conversely, the levels of intracellular reactive oxygen species (ROS) were increased. The ROS scavenger N-acetylcysteine can significantly inhibit cell cycle arrest and apoptosis induced by ARS. Thus, the data confirmed that ARS exposure impairs normal liver cell proliferation by inducing G0/G1 cell cycle arrest and apoptosis, and this detrimental action may be associated with intracellular ROS accumulation. Collectively, the possible side effects of ARS on healthy normal cells cannot be neglected when developing therapies.

Oropharyngeal Secretion as Alternative for SARS-CoV-2 Detection

This study aimed to determine if sampling of oropharyngeal secretions (OSs) helps improves detection of SARS-CoV-2 RNA by nucleic acid amplification testing of potential patients with COVID-19. The first prospective study consisted of 75 patients with COVID-19 who were ready for discharge and who had 2 consecutive negative results per nucleic acid amplification testing (NAAT) of viral samples retrieved with nasopharyngeal swabs (NPSs). Because of detection of potential false negatives in that cohort, the NAAT results of paired OS and NPS samples from 50 additional recruits with COVID-19 during their recovery stage were used in a second prospective study to compare the diagnostic values of the 2 viral RNA sampling methods. For identification of the frequency of inconsistency between the sampling methods, the McNemar's test was used for difference analysis and the kappa statistic for consistency analysis. OSs obtained from 2 of the 75 participants in the first study yielded positive results for SARS-CoV-2 nucleic acid. Both were male and aged >60 y. Subsequent chemiluminescence enzyme immunoassays indicated that they were positive for the SARS-CoV-2 IgM and IgG antibodies. For parallel NAAT of OS and NPS samples in the second study, McNemar's test indicated that the difference between the frequencies of inconsistent parts of OS and NPS was statistically significant (P = 0.021). Cohen's kappa coefficient for OS and NPS was 0.244, which is indicative of fair consistency. The NPS test has a risk of sending home more patients (59%) who still have the infection, while the OS test will make such an error in fewer patients (14%). Although OS sampling improves the accuracy of SARS-CoV-2 nucleic acid testing, it has to be emphasized that this conclusion is based on a very small sample size. Detection of viral RNA from a patient's secretions is not confirmative of viral infectivity.

Association of IL1R2 rs34043159 with sporadic Alzheimer's disease in southern Han Chinese

BACKGROUND AND PURPOSE

The objective of the study was to investigate the relationship between IL1R2 rs34043159 and Alzheimer's disease (AD) in the Chinese population.

METHODS

A total of 500 AD patients and 500 healthy controls were recruited. The SNaPshot technique was used to detect IL1R2 rs34043159.

RESULTS

The dominant and recessive models of IL1R2 rs34043159 were associated with AD with or without adjustment of age, gender and education [dominant model, P = 0.019, odds ratio (OR) 1.42, 95% confidence interval (CI) 1.06-1.89, adjusted; recessive model, P = 0.011, OR 0.69, 95% CI 0.51-0.92, adjusted]. The recessive model of IL1R2 rs34043159 was associated with early-onset AD (EOAD) with or without adjustment of age, gender and education (recessive model, P = 0.038, OR 0.60, 95% CI 0.37-0.97, adjusted). The additive model was associated with late-onset AD (LOAD) (P = 0.041). The dominant model of IL1R2 rs34043159 was associated with LOAD with or without adjustment of age, gender and education (dominant model, P = 0.005, OR 1.68, 95% CI 1.17-2.44, adjusted).

CONCLUSION

An association between the dominant and recessive model of IL1R2 rs34043159 and AD was found. The recessive model of IL1R2 rs34043159 was associated with EOAD. The additive and dominant models of IL1R2 rs34043159 were associated with LOAD.

Expression level of lncRNA PVT1 in serum of patients with coronary atherosclerosis disease and its clinical significance

OBJECTIVE

The purpose of this study was to detect the expression level of PVT1 in the serum of coronary artery disease (CAD) patients, and to explore the clinical significance of PVT1 in CAD.

PATIENTS AND METHODS

A total of 200 CAD patients and 200 healthy controls in the same period were included. The serum level of PVT1 in every subject was detected. Then, the correlation between PVT1 level and Gensini score in CAD patients was analyzed by Spearman correlation test. Finally, multivariable Logistic regression test was conducted to assess risk factors influencing coronary atherosclerosis disease.

RESULTS

It was found that PVT1 was highly expressed in the serum of CAD patients and its level was correlated with Gensini score (r=0.761, p=0.023). Besides, multivariable Logistic regression test obtained that PVT1 was the risk factor influencing coronary atherosclerosis disease (crude OR = 2.074, 95% CI: 1.642-3.529; adjusted OR = 1.762, 95% CI: 1.382-2.096).

CONCLUSIONS

Serum level of PVT1 helps to distinguish mild and severe CAD. Meanwhile, PVT1 is an independent risk factor influencing the development of coronary atherosclerosis disease.

[Prognostic factors of cyclosporine A combined with androgen in the treatment of transfusion dependent non-severe aplastic anemia]

目的

调查影响环孢素A（CsA）联合雄激素方案治疗输血依赖非重型再生障碍性贫血(TD-NSAA)获得血液学反应的因素。

方法

回顾性分析2010–2013年连续收治的77例TD-NSAA患者临床资料，单因素和多因素分析影响CsA联合雄激素治疗方案获得血液学反应患者的基线临床和血液学特征。

结果

77例TD-NSAA患者治疗后6个月和12个月获得血液学反应分别为43例（55.8％）和53例（68.8％），单因素分析基线血小板计数［19（6～61）×10⁹/L对13.5（5～45）×10⁹/L，P＝0.001］是影响6个月获得血液学反应的唯一因素；基线血小板计数［18（6～61）×10⁹/L对10.5（5～45）×10⁹/L，P<0.001］、网织红细胞绝对值［0.03（0.01～0.06）×10¹²/L对0.03（0.02～0.06）×10¹²/L，P＝0.043］、血小板输注依赖（P＝0.007）和红细胞及血小板输注依赖（P＝0.012）为治疗后12个月能否获得血液学反应相关因素。多因素分析显示基线血小板水平为获得血液学反应独立影响因素（P值分别为0.010和0.009）。受试者工作特征曲线（ROC曲线）方法显示基线PLT界值为15.5×10⁹/L。

结论

TD-NSAA患者初诊时较高的血小板基线水平、网织红细胞基线水平和不伴血小板输注依赖均提示预后较好，血小板水平≥15.5×10⁹/L时可以考虑采用CsA联合雄激素治疗。

Retrospective analysis of defect reconstruction after abdominal wall tumor resection in 30 patients

PURPOSE

It is difficult to manage the full-thickness defect that is created by radical resection of an abdominal wall tumor. This report aimed to review our institutional experience with immediate reconstruction using mesh reinforcement after abdominal wall tumor resection.

METHODS

We retrospectively examined patients who underwent abdominal wall tumor resection with immediate mesh-reinforced reconstruction between April 2014 and November 2018. The patients' records were reviewed to collect data regarding their demographic characteristics, surgical procedures, and complications.

RESULTS

We identified 30 eligible patients, including 5 who underwent simultaneous resection of affected intra-abdominal organs or tissues. The median size of the resulting abdominal wall defect was 60 cm² (interquartile range: 32-127.5 cm²) and the median mesh size was 150 cm² (interquartile range: 150-225 cm²). The median operative time was 85 min (interquartile range: 60-133.8 min), the mean hospital stay was 19.4 ± 9.0 days, and the mean follow-up period was 28.6 ± 16.0 months. The complications included seroma (n = 4), infection (n = 2), massive hematoma (n = 1), and abnormal sensation (n = 3). Tumor recurrence was observed in two patients, and three patients died because of cancer progression. No patient developed a ventral hernia or abdominal bulging.

CONCLUSION

Immediate mesh-reinforced reconstruction is feasible and effective for patients who require abdominal wall tumor resection.

CCL3/CCR1 mediates CD14+CD16- circulating monocyte recruitment in knee osteoarthritis progression

OBJECTIVES

Monocyte-derived macrophages, as the predominant immune cell type that is increased in inflamed synovium, play a vital role during knee osteoarthritis (KOA) progression. However, the mechanisms underlying the recruitment of circulating monocytes to osteoarthritic knees remain uncertain. Based on previous data obtained from plasma, we investigated the contributions of CCL2, CCL3, CCL4 and their cognate receptors in circulating monocyte chemotaxis and KOA development.

METHODS

Using flow cytometry staining, we characterized the expression patterns of the chemokine receptors in CD14⁺CD16^- circulating monocytes from KOA patients and healthy volunteers. The expression of chemokines in synovial fluids, synovium and cartilage was investigated in KOA patients and in patients without KOA. The role of chemokines and their cognate receptors in the chemotaxis of CD14⁺CD16^- circulating monocytes was assessed using chemokine neutralizing antibodies (NA) and receptor antagonists in vitro and in vivo.

RESULTS

The majority of CD14⁺CD16^- circulating monocytes were CCR1-and CCR2-positive. CCL2, CCL3 and CCL4 were elevated in synovial fluid of KOA patients compared with that of controls. The most likely source of these chemokines is inflamed synovium and cartilage in the osteoarthritic knee. The CCL3/CCR1 and CCL2/CCR2 axes showed substantial ability to recruit CD14⁺CD16^- monocytes in transwell assays. Similar results were confirmed in a mouse model of collagenase-induced KOA (CIA) in which blocking either the CCL3/CCR1 axis or the CCL2/CCR2 axis reduced synovial hyperplasia and F4/80⁺ macrophage infiltration.

CONCLUSIONS

Our findings suggested that, analogous to the CCL2/CCR2 axis, CCL3 produced in osteoarthritic knees can chemoattract circulating monocytes to the inflamed synovium through CCR1.

The role of Sigma-1 receptor agonist in hepatic ischemiareperfusion injury

Sigma-1 receptor (Sig-1R) is a ligand-operated protein that modulates activity of various proteins. It is expressed within the endoplasmic reticulum membranes of multiple organs. We examined the role of Sig-1R in hepatic ischemia-reperfusion injury (IRI). We studied IRI indicators in Sig-1R-/- mice and compared them with wild-type controls. In addition, we assessed the influence of Sig-1R agonist, fluvoxamine, on IRI in both types of animals. We found that Sig-1R-/- mice exhibited significantly decreased liver damage after hepatic IRI as compared to wild-type mice. This effect was manifested by decreased serum levels of alanine aminotransferase (AST), aspartate aminotransferase (ALT), myeloperoxidase (MPO), and supernatant level of lactate dehydrogenase (LDH), decreased endothelial glycocalyx shedding indexed by decreased serum levels of heparan sulfate and syndecan-1, slightly improved liver histology and reduced metalloproteinase-9 expression. Furthermore, in comparison to Sig-1R-/- mice, fluvoxamine significantly increased serum levels of AST, ALT, MPO, and LDH in wildtype animals in a dose-dependent manner at 6 h after IRI. Our findings demonstrate that the absence of Sig-1R provides a protective effect during hepatic IRI. Sig-1R-mediated signaling pathways may play distinct roles in IRI in different organs. The dynamic interaction between Sig-1R and other signaling molecules in different organs needs to be examined further.

Molecular genetic analysis in 21 Chinese families with congenital insensitivity to pain with or without anhidrosis

BACKGROUND AND PURPOSE

Hereditary sensory and autonomic neuropathies (HSANs) are a group of clinically and genetically heterogeneous neurological disorders characterized by sensory dysfunctions. Here, 21 affected Chinese families are reported, including 19 with congenital insensitivity to pain with anhidrosis (CIPA; namely HSAN IV) and two with congenital insensitivity to pain (CIP; namely HSAN IID) caused by biallelic variations in NTRK1 and SCN9A, respectively, aiming to identify causative variants in these families and compare how different variants in NTRK1 affect the function of tropomyosin receptor kinase A (TrkA).

METHODS

Recombinant plasmids harboring the wild-type and six mutant alleles (p.Gln216*, p.Glu584Lys, p.Leu595Arg, p.Pro684Leu, p.Val709Leu and p.Arg765Cys) of NTRK1 cDNA were constructed and transfected into HEK293 cells.

RESULTS

The results suggested that the five missense variants only presented a subtle influence on the expression level and glycosylation of TrkA but compromised the receptor phosphorylation. Our findings also suggested that a synonymous variant c.219C>T in NTRK1 may cause aberrant splicing, indicating a potential novel pathogenic mechanism of CIPA. Furthermore, gross deletion of SCN9A was first associated with CIP.

CONCLUSIONS

This study identified multiple forms of variants responsible for CIPA/CIP in the Chinese population and might provide new insights into the pathogenesis of CIPA.

Effects of Diutina rugosa SD-17 on growth performance, intestine morphology, and immune status of chickens

Probiotics are considered the preferred alternatives to antibiotics for growth promotion and disease prevention. Previous studies have confirmed that Diutina rugosa SD-17 has the potential as a probiotic. We evaluated the probiotic effect of D. rugosa SD-17 on 360 one-day-old Hy-line brown chickens that were divided into 2 groups, and each group contained 6 replicate pens with 30 birds per pen. The chickens were fed with basal diet supplemented with or without D. rugosa SD-17, and the effects of D. rugosa SD-17 on growth performance, intestine morphology, and immune status were assessed. Body weight was significantly improved from week 3 to 6 (P < 0.05), and the feed conversion ratio was significantly improved in weeks 1 and 2 (P < 0.001). The length of the duodenum was lengthened significantly in week 3 (P < 0.05), and supplementation of D. rugosa SD-17 significantly increased villus height and villus height to crypt depth ratio in the ileum in week 3 (P < 0.05). Expressions of tight-junction-related genes of zonula occludens-2 and occludin in the ileum were significantly increased (P < 0.05). The proliferation capacity of blood lymphocytes stimulated by concanavalin A was significantly enhanced (P < 0.05), and the proportion of helper T (Th) cells increased significantly (P < 0.05). Expressions of Th1 cell markers IL-2 and interferon (IFN)-γ and immune-related genes of IL-1β, transforming growth factor-β, and IFN-γ in ileum were significantly increased (P < 0.05). These results indicated that D. rugosa SD-17 improved the growth and regulated immunity of chickens, and could be optimized for use as a feed additive for livestock and poultry.

Molecular cloning of the goose GnRH gene and identification of GnRH polymorphisms associated with laying traits

1. Egg-laying traits are important economic characteristics in goose production (Anser cygnoides). The gene GnRH, which encodes gonadotropin-releasing hormone, is a strong candidate gene for egg-laying traits in avian species. 2. In this study, a 3520 bp genomic sequence and a 279 bp mRNA sequence for GnRH, which encoded 92 amino acids, were determined. The GnRH DNA sequence contains four exons and three introns, and the DNA and deduced amino acid sequences were highly conserved across mammals (human, macaque, cow, and sheep) and avians (chicken, fulmar and quail). 3. Using a direct sequencing method, 46 single nucleotide polymorphisms (SNPs) were identified in the GnRH genomic sequence that were shared between two Sichuan White goose populations (217 and 208 individuals). Furthermore, 44 haplotypes were constructed using a sliding window approach. Association analysis between the SNPs and haplotypes and egg-laying traits showed that 10 SNPs affected the first egg weight, average egg weight, egg number at 48 weeks and egg number at 64 weeks. 4. These results lay the foundation for further studies of the function of GnRH in geese and provide a theoretical basis for marker-assisted selection of egg-laying traits in the Sichuan white goose population.

Ultrafast Control of Excitonic Rashba Fine Structure by Phonon Coherence in the Metal Halide Perovskite CH_{3}NH_{3}PbI_{3}

We discover hidden Rashba fine structure in CH_{3}NH_{3}PbI_{3} and demonstrate its quantum control by vibrational coherence through symmetry-selective vibronic (electron-phonon) coupling. Above a critical threshold of a single-cycle terahertz pump field, a Raman phonon mode distinctly modulates the middle excitonic states with persistent coherence for more than ten times longer than the ones on two sides that predominately couple to infrared phonons. These vibronic quantum beats, together with first-principles modeling of phonon periodically modulated Rashba parameters, identify a threefold excitonic fine structure splitting, i.e., optically forbidden, degenerate dark states in between two bright ones with a narrow, ∼3  nm splitting. Harnessing of vibronic quantum coherence and symmetry inspires light-perovskite quantum control and sub-THz-cycle "Rashba engineering" of spin-split bands for ultimate multifunction device.

Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

BACKGROUND AND PURPOSE

Identifying the mere presence of carotid intraplaque hemorrhage would be insufficient to accurately discriminate the presence of acute cerebral infarct. We aimed to investigate the association between signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted MR imaging and acute cerebral infarct in patients with hemorrhagic carotid plaques using MR vessel wall imaging.

MATERIALS AND METHODS

Symptomatic patients with carotid intraplaque hemorrhage were included. The signal intensity ratios of carotid intraplaque hemorrhage against muscle on T1-weighted, TOF, and MPRAGE images were measured. The acute cerebral infarct was determined on the hemisphere ipsilateral to the carotid intraplaque hemorrhage. The association between signal intensity ratios of carotid intraplaque hemorrhage and acute cerebral infarct was analyzed.

RESULTS

Of 109 included patients (mean, 66.8 ± 9.9 years of age; 96 men), 40 (36.7%) had acute cerebral infarct. Patients with acute cerebral infarct had significantly higher signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted images than those without (Median, 1.44; 25-75 Percentiles, 1.14-1.82 versus Median, 1.27; 25-75 Percentiles, 1.06-1.55, P = .022). Logistic regression analysis revealed that the signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images was significantly associated with acute cerebral infarct before (OR, 4.08; 95% CI, 1.34-12.40; P = .013) and after (OR, 3.34; 95% CI, 1.08-10.31; P = .036) adjustment for clinical confounding factors. However, this association was not significant when further adjusted for occlusion of the carotid artery (P = .058) and volumes of intraplaque hemorrhage and lipid-rich necrotic core (P = .458).

CONCLUSIONS

The signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images is associated with acute cerebral infarct in symptomatic patients with carotid hemorrhagic plaques. This association is independent of traditional risk factors but not of the size of plaque composition. The possibility of applying T1 signals of carotid intraplaque hemorrhage to predict subsequent cerebrovascular ischemic events needs to be prospectively verified.

Staged horizontal bone augmentation for dental implants in aesthetic zones: A prospective randomized controlled clinical trial comparing a half-columnar bone block harvested from the ramus versus a rectangular bone block from the symphysis

In this study, the clinical outcomes of horizontal ridge augmentation using half-columnar bone grafts from the ramus (group I: 27 patients, 32 implants) versus rectangular bone grafts from the symphysis (group II: 19 patients, 27 implants) were compared; grafts were combined with organic bovine bone and collagen membrane. Cone beam computed tomography images were obtained preoperatively, immediately after restoration (baseline), and 1 year after loading. Four months after grafting, horizontal bone resorption at the alveolar crest did not differ significantly between the two groups (P=0.291). At 4mm apical to the alveolar crest, horizontal bone resorption in group I was significantly less than that in group II (P=0.041). One year after loading, horizontal bone resorption in group I was lower than that in group II, with no significant difference. The residual thickness of the labial bone at the implant site in group I was significantly higher than that in group II. Horizontal ridge augmentation with either a half-columnar autogenous graft from the ramus or a rectangular autogenous graft from the symphysis can provide acceptable results in aesthetic regions. The half-columnar group demonstrated better graft stability both at 4 months after augmentation and 1 year after loading.

The characteristics and clinical value of chest CT images of novel coronavirus pneumonia

AIM

To investigate the characteristics and clinical value of chest computed tomography (CT) images of novel coronavirus pneumonia (NCP).

MATERIALS AND METHODS

Clinical data and CT images of 80 cases of NCP were collected. The clinical manifestations and laboratory test results of the patients were analysed. The lesions in each lung segment of the patient's chest CT images were characterised. Lesions were scored according to length and diffusivity.

RESULTS

The main clinical manifestations were fever, dry cough, fatigue, a little white sputum, or diarrhoea. A total of 1,702 scored lesions were found in the first chest CT images of 80 patients. The lesions were located mainly in the subpleural area of the lungs (92.4%). Most of the lesions were ground-glass opacity, and subsequent fusions could increase in range and spread mainly in the subpleural area. Pulmonary consolidation accounted for 44.1% of all of the lesions. Of the 80 cases, 76 patients (95%) had bilateral lung disease, four (5%) patients had unilateral lung disease, and eight (10%) patients had cord shadow.

CONCLUSION

The chest CT of NCP patients is characterised by the onset of bilateral ground-glass lesions located in the subpleural area of the lung, and progressive lesions that result in consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have inflammatory changes in the lungs alongside a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.