[Epidemiological study of occupational diseases in Shenzhen City, China in 2006~2017]

Objective: To study the epidemiological characteristics of occupational diseases in Shenzhen City, China in 2006-2017, and to provide a scientific basis for prevention and control of occupational diseases. Methods: Cases of occupational diseases in 2006-2017 were collected from the Information System of Occupational Diseases and Occupational Health. A statistical analysis was performed to identify the characteristics of the disease distribution in terms of spectrum of disease, year, area, industry, type of economy and enterprise scale. Results: A total of 1673 cases of occupational disease (64 types, 8 classes) were diagnosed and reported in 2006-2017, chemical poisoning (31.50%) , ear, nose and throat diseases (28.21%) , and pneumoconiosis and other respiratory diseases (21.34%) were the most three commonest occupational diseases. The constituent of ratio of ear, nose and throat diseases and occupational diseases caused by physical factors increased in turn, the constituent of chemical poisoning, pneumoconiosis and other respiratory diseases, and skin disease reduced in turn, which all showed the difference was statistically significant (P<0.01) . Occupational diseases were often seen in districts of Baoan, Longgang, Longhua and Pingshan, as well as in private economy and small enterprise, mainly occurred in manufacturing industry. Conclusion: The incidence of occupational diseases increased steadily in 2006-2017, and we need to strengthen common occupational diseases, especially occupational noise-induced hearing loss, pay attention to districts of Baoan, Longgang, Longhua and Pingshan, as well as private economy and small enterprise.

Genetic signature of hybridization between Chinese spot-billed ducks and domesticated ducks

In this study, we analyzed 93 whole genomes from Chinese spot-billed ducks (CSB), meat-type ducks (MET), and egg and dual purpose-type ducks (EDT) to characterize the genetic material flowing between the CSB and modern ducks. Using a frequency of shared identical-by-descent method, approximately 10.9 Mb introgression segments containing 140 genes were identified showing the signatures of introgression between CSB and EDT. Meanwhile, nearly 10.6 M introgression regions containing 149 genes were identified between CSB and MET. Based on the haplotypes tree of each segment, we found that the introgression between CSB and domesticated ducks was asymmetric with a high level of gene flow from domestic to CSB and a low level of migration in the opposite direction. Moreover, we identified several genes that were introgressions from CSB and showed the signature of positive selection, which may contribute to the breeding of modern ducks. Our results provide new insight into the evolution and breeding history of domestic ducks and may be useful for the future management of wild and domestic duck populations.

[Efficacy evaluation after 5 years of inoculation of 23 valent pneumococcal polysaccharide vaccine for the elderly aged 60 years old and above in Shanghai during 2013-2018]

Objective: To evaluate the efficacy of 23 valent pneumococcal polysaccharide vaccine (PPV23) inoculation against community-acquired pneumonia (CAP) among the elderly aged 60 years old and above in Shanghai. Methods: A prospective cohort study was conducted using a stratified random sampling from October 2013, in which 1 214 and 2 387 elderly people aged 60 and above were selected as the inoculation group and control group, respectively. And a unified questionnaire was used to investigate the basic information of the subjects in the inoculation group and the control group. From October 2013 to December 2018, the subjects were followed up at home or by telephone for a total of 20 times, mainly for whether they had CAP during the observation period. Multivariate logistic regression model was used to calculate RR and 95%CI of CAP incidence between inoculation group and control group for comparing. Results: There were 556 males (45.8%) in the inoculation group and 1 012 males (42.4%) in the control group. And the incidence density of CAP in the inoculation group was lower than that of the control group (0.848/100 person-years vs. 1.452/100 person-years), and the vaccine protection rate was 41.6%, with a statistically significant difference ［RR (95%CI)= 0.584 (0.428-0.790), P<0.001］. After adjusting for age, RR (95%CI) was 0.699 (0.507-0.956), and the difference was still statistically significant (P=0.025).Further stratified analysis showed that the vaccine protective rates of PPV23 in the 60-69 year-old group, the 70-79 year-old group and the ≥80 year-old group were 36.7%, 21.6% and 26.0%, respectively, but only in the 60-69 year-old group showed statistical difference (RR=0.633, 95%CI=0.399-0.990, P=0.045). Conclusion: To a certain extent, the incidence of CAP can be reduced by inoculation of PPV23 in elderly population aged 60 and above in Shanghai, and it should be further recommended in elderly population of low age.

Specification tests for covariance structures in high-dimensional statistical models

We consider testing the covariance structure in statistical models. We focus on developing such tests when the random vectors of interest are not directly observable and have to be derived via estimated models. Additionally, the covariance specification may involve extra nuisance parameters which also need to be estimated. In a generic additive model setting, we develop and investigate test statistics based on the maximum discrepancy measure calculated from the residuals. To approximate the distributions of the test statistics under the null hypothesis, new multiplier bootstrap procedures with dedicated adjustments that incorporate the model and nuisance parameter estimation errors are proposed. Our theoretical development elucidates the impact due to the estimation errors with high-dimensional data and demonstrates the validity of our tests. Simulations and real data examples confirm our theory and demonstrate the performance of the proposed tests.

[Analysis on the project personnel's attitude and its influential factors of 23-valent pneumococcal polysaccharide vaccination program for the elderly in Shanghai]

Objective: To understand the project personnel's attitude towards the 23-valent pneumococcal polysaccharide vaccination program for the elderly in Shanghai and its conversion to routine vaccination and to explore its influential factors, so as to provide reference for the further development of the program. Methods: In 2016, a one-to-one questionnaire survey was conducted among the people involved in the project in the 9 districts of Shanghai and the data of demographic characteristics, cognition of pneumococcal pneumonia and PPV23, evaluation of the project, support rate of the project and its conversion to routine vaccination of the project personnel were collected. Results: Among the 2005 respondents, 28.6% (574 persons) of them were male, 85.5% (1 714 persons) of them supported the free vaccination for the elderly, and 69.5% of them (1 394 persons) supported the routine vaccination. For the 23-valent pneumococcal polysaccharide vaccination program, people under 55 years old, in Qingpu District, with poor cognition of pneumonia and 23-valent pneumococcal polysaccharide vaccine (PPV23) or having lower evaluation of the project's scientificity or enforceability had lower support rate than others, and the OR (95%CI) were 0.38 (0.19-0.75), 0.21 (0.10-0.43), 0.16 (0.06-0.41) and 0.26 (0.10-0.69). People believing that the elderly were susceptible to pneumococcal pneumonia and PPV23 was safe and reliable, and those who were willing to vaccinate the elderly at home had higher support rate, and the OR (95%CI) were 2.30 (1.18-4.47), 2.84 (1.62-4.69) and 5.60 (3.74-8.38). For the program's conversion to routine vaccination, people under 35 years old, in Qingpu District, in the vaccination clinic, and those believing that the project was not scientific and difficult to implement had low support rate, and the OR (95%CI) were 0.56 (0.32-0.98), 0.48 (0.26-0.89), 0.26 (0.12-0.59), 0.58 (0.42-0.79) and 0.50 (0.30-0.81); people with technical secondary school or senior school, in Jiading, Putuo or Minhang District, believing that PPV23 was effective in the prevention of pneumococcal pneumonia in the elderly, and those who were willing to vaccinate the elderly with PPV23 had higher support rate, and the OR (95%CI) were 1.63 (1.11-2.39), 2.28 (1.71-3.03), 1.69 (1.25-2.28) and 4.10 (2.86-5.88). Conclusion: The support rate of pneumococcal vaccination project for the elderly in Shanghai needs to be improved, especially its conversion to the routine vaccination.

[Safety evaluation of mass inoculation of 23 valent pneumococcal polysaccharide vaccine among elderly people aged 60 and above in Shanghai from 2013 to 2017]

Objective: To evaluate the safety of 23 Valent Pneumococcal Polysaccharide Vaccine (PPV23) among eldly people aged 60 and above in Shanghai. Methods: A total of 1 310 660 monitoring data of adverse events following immunization (AEFI) of PPV23 among people aged 60 and above were collected through the National AEFI Surveillance System from September 14, 2013 to December 31, 2017 in Shanghai. And the descriptive epidemiological methods were used for analysis. Results: 433 cases of AEFI were reported from September 14, 2013 to December 31, 2017, with the incidence rate of AEFI was 33.04/100 000 doses. The general reactions were reported as 392 cases (90.53%), with 17 cases of abnormal reactions (3.93%), 23 cases of coincidences (5.31%) and 1 case of psychogenic reactions (0.23%). The reported incidence rates of general reactions and abnormal reactions of free PPV23 inoculation among elderly people in urban areas were 41.31 per 100 000 doses and 1.91/100 000 doses, respectively, which were higher than those in suburban areas (24.18/100 000 doses, 1.32/100 000 doses) and exurban areas (27.84/100 000 doses, 0.59/100 000 doses). The reported incidence rate of general reaction in females (35.38/100 000 doses) was higher than that in males (24.06/100 000 doses), and the reported incidence rate of abnormal reaction in males (1.58/100 000 doses) was higher than that in females (1.03/100 000 doses). The reported incidence rates of general and abnormal reactions were the highest in 60-64 years old group (62.65/100 000 doses and 4.87/100 000 doses, respectively). In addition, all patients with general reactions or abnormal reactions were better or cured. Conclusion: PPV23 vaccination is safe among people aged 60 and above in Shanghai.

A Microfluidic Approach for Cryoprotectant Screening: Preliminary Validation with Human Red Blood Cells

BACKGROUND

The application of microfluidics has overcome a series of long-term existing bottlenecks in the field of cryobiology. However, there is still no investigation regarding the on-chip rapid screening of cryoprotectant concentration optimization for the integration of the entire freeze, thaw and cell counting process.

OBJECTIVE

To establish an on-chip approach for rapid cryoprotectant screening and concentration optimization.

MATERIALS AND METHODS

Rapid freezing of red blood cells with glycerol and dimethyl sulfoxide was used to validate the proposed on-chip method.

RESULTS

The optimal cryoprotectant and its concentration can be determined with the described method, without the need of additional samplings and assays. The optimal concentration for glycerol and dimethyl sulfoxide used in the validation experiments was 10% (w/v).

CONCLUSION

The microfluidic approach can be used for rapid cryoprotectant screening and concentration optimization.

Genome-wide identification and characterization of microRNAs responding to ABA and GA in maize embryos during seed germination

MicroRNAs (miRNAs) are an important class of non-coding small RNAs that regulate the expression of target genes through mRNA cleavage or translational inhibition. Previous studies have revealed their roles in regulating seed dormancy and germination in model plants such as Arabidopsis thaliana, rice (Oryza sativa) and maize (Zea mays). However, the miRNA response to exogenous gibberellic acid (GA) and abscisic acid (ABA) during seed germination in maize has yet to be explored. In this study, small RNA libraries were generated and sequenced from maize embryos treated with GA, ABA or double-distilled water as control. A total of 247 miRNAs (104 known and 143 novel) were identified, of which 45 known and 53 novel miRNAs were differentially expressed in embryos in the different treatment groups. In total, 74 (37 up-regulated and 37 down-regulated) and 55 (23 up-regulated and 32 down-regulated) miRNAs were expressed in response to GA and to ABA, respectively, and a total of 18 known and 38 novel miRNAs displayed differential expression between the GA- and ABA-treated groups. Using bioinformatics tools, we predicted the target genes of the differentially expressed miRNAs. Using GO enrichment and KEGG pathway analysis of these targets, we showed that miRNAs differentially expressed in our samples affect genes encoding proteins involved in the peroxisome, ribosome and plant hormonal signalling pathways. Our results indicate that miRNA-mediated gene expression influences the GA and ABA signalling pathways during seed germination.

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis

Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.

NGS-based profiling reveals a critical contributing role of somatic D-loop mtDNA mutations in HBV-related hepatocarcinogenesis

BACKGROUND

Somatic mutations of mitochondrial DNA (mtDNA) have been extensively identified mainly by traditional Sanger sequencing technology in various cancer types. However, low detection sensitivity of traditional methods greatly limits the comprehensive profiling of mtDNA somatic mutations in cancers, especially in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Moreover, the functional roles of mtDNA mutation in HBV-related hepatocarcinogenesis have not been systematically revealed.

PATIENTS AND METHODS

Next-generation sequencing (NGS) platform was applied to profile the somatic mtDNA mutations of HCC and paired paratumor (non-HCC) tissues from a large cohort of 156 HBV-HCC patients.

RESULTS

Our data revealed the common existence of mtDNA mutation in both inflammatory and cancer tissues with significantly different mutation pattern. The mutation density (mutation number/region length) of D-loop region was much higher than that of other regions in both HCC and non-HCC tissues. Unexpectedly, the average mutation number in D-loop region of HCC tissues was significantly less than that of non-HCC tissues. In contrast, the heteroplasmy level of D-loop region mutations was significantly increased in HCC tissues, implying that the D-loop mutations might be positively selected in HCC tissues. Furthermore, our results indicated that the patients with D-loop mutations had a significantly lower mtDNA copy number and were more likely to relapse. In vitro experiments demonstrated that proliferation, invasion and metastasis ability of HCC cells with D-loop region mutations were significantly higher than those without D-loop region mutations.

CONCLUSION

These results emphasize the critical contributing role of somatic mtDNA D-loop mutations in HBV-related hepatocarcinogenesis.

[Clinical features of intracranial vessel involvement in Takayasu's arteritis]

Objective: To analyze clinical characteristics of intracranial vessel involvement in Takayasu's arteritis (TA). Methods: Retrospectively analyzed 135 hospitalized TA patients' clinical data in Beijing Anzhen Hospital from November 2012 to November 2018. Based on intracranial artery (IA) complicated or not, TA patients were divided into two groups:32 patients within involvement and 103 patients without involvement. The difference in comparison of imaging types, basic data and laboratory test were analyzed. Results: The proportion of TA patients with intracranial vascular involvement was 23.7% (32/135) and the most common site was internal carotid artery (intracranial segment) (59.4%, 19/32). The incidences of hypertension and coronary heart disease were significantly higher in TA patients with intracranial vascular involvement compared with the patients without intracranial involvement (46.9% vs 26.2%, 21.9% vs 6.8%, χ(2)=4.863, 4.460, all P<0.05). The rate of tocilizumab treatment in the intracranial vascular involved group was higher than that in the group without intracranial vascular involvement (40.6% vs 19.4%, χ(2)=5.945, P<0.05). The platelet count in patients with intracranial involvement group was significantly lower than that in patients without intracranial involvement group [(218±55)×10(9)/L vs (272±71)×10(9)/L, t=-3.570, P<0.01], while the hemoglobin [(130±17) vs (121±18) g/L, t=2.363, P<0.05] and triglyceride [1.22(0.75, 1.64) vs 0.92(0.63, 1.21) mmol/L, U=1 017.000, P<0.01] were significantly higher than those without intracranial vascular involvement. Moreover, coronary artery involvement presented more frequently in the intracranial vascular involved group than the group without intracranial vascular involvement (43.8% vs 14.6%, χ(2)=12.331, P<0.01). Logistic regression analysis showed that the incidence of intracranial vascular disease in TA patients with coronary artery involvement was 4 times higher than that in patients without coronary artery lesions (OR=3.965, 95%CI:1.584-9.926, P=0.003). Conclusion: The proportion of intracranial vascular involvement in TA is not rare, TA patients with cardiovascular risk factors should be considered to strengthen imaging examination of intracranial vessels.

Short- and mid-term outcomes of robotic versus thoraco-laparoscopic McKeown esophagectomy for squamous cell esophageal cancer: a propensity score-matched study

Controversy exists on the advantages of robotic McKeown esophagectomy (RME) versus thoraco-laparoscopic McKeown esophagectomy (TLME). The aim was to evaluate the short- and mid-term outcomes of RME and TLME in the treatment of patients with esophageal squamous cell carcinoma (ESCC). A consecutive series of 652 patients, 280 in RME and 372 in TLME, who underwent minimally invasive McKeown esophagectomy for ESCC at our department from November 2015 to June 2018 was analyzed. A propensity score-matched comparison with clinicopathological covariates was performed between the two groups. Complications were categorized based on the Esophagectomy Complications Consensus Group (ECCG) recommendation. To identify the recurrence, all patients with R0 resection were followed with a median follow-up period of 20.2 months (range 1-33 months). After propensity score matching, 271 patients were identified for each cohort. In the matched cohorts, two patients died within 90 days in TLME, whereas no patients died in RME. RME was associated with similar intraoperative blood loss (P = 0.895), but with shorter surgical duration (244.5 vs. 276.0 min, P < 0.001), shorter thoracic duration (85.0 vs. 102.9 min, P < 0.001) and lower thoracic conversions (0.7% vs. 5.9%, P = 0.001). In spite of the similar results on total and thoracic lymph nodes dissection, RME yielded more lymph nodes along recurrent laryngeal nerve (4.8 vs. 4.1, P = 0.012), as well as the higher incidence of recurrent nerve injury (29.2% vs. 15.1%, P < 0.001) when compared to TLME. Tumor recurrence occurred in 30 patients and was locoregional only in 9 (3.5%) patients, systemic only in 17 (6.7%) patients, and combined in 4 (1.6%) patients in RME, while in 26 patients and was locoregional only in 10 (10.6%) patients, systemic only in 7 (2.8%) patients, and combined in 9 (3.6%) patients in TLME. RME was associated with a lower rate of mediastinal lymph nodes recurrence (2.0% vs. 5.3%, P = 0.044). Overall and disease-free survival was not different between the two cohorts (P = 0.097 and P = 0.248, respectively). RME was shown to be a safe and oncologically effective approach with favorable short- and mid-term outcomes in the treatment of patients with ESCC.

Correlation between the hemoporfin-mediated photodynamic treatment response and the dermoscopy vascular pattern in patients with a port-wine stain: a prospective study

BACKGROUND

Vascular targeted photodynamic therapy (PDT) is a novel and promising therapy for the treatment of port-wine stains (PWS). There has been little prior exploration to our knowledge of how the dermatological vascular pattern may predict the response to PDT.

OBJECTIVES

To analyse whether the vascular pattern classifications of PWS by dermoscopy can predict the efficacy of PDT.

METHODS

This prospective cohort study included 163 patients with a clinical diagnosis of PWS who were treated twice with hemoporfin-mediated photodynamic therapy (HMME-PDT) at two-month intervals and followed up for 6 months. The vascular manifestations of dermoscopy with PWS were independently classified into 8 categories by 3 dermatologists. Images of the lesions were taken using VISIA, and the vascular patterns were imaged by dermoscopy by the same investigator. Images were captured before and after each treatment. The efficacy was evaluated with pre- and post-treatment VISIA images, and correlations between efficacy and vascular patterns were analysed by four dermatologists in a blinded and independent manner, between 10 January 2019 and 11 December 2019.

RESULTS

In the dermoscopy images for the whole cohort, dotted and globular vessels (15.3%), short clubbed vessels (18.4%) and curved vessels (12.9%) were highly associated with cure and beneficial treatment effects. Pale halos surrounding brown dots (8.0%) and arborizing vessels (9.8%) were mainly correlated with skin lesion alleviation. Mixed vessels (12.9%), a grey-whitish veil (11.7%) and reticular patterns (11.0%) were mainly associated with no effect. The differences between each subgroup were statistically significant (P = 0.000).

CONCLUSIONS

There is a clear correlation between the efficacy of PDT and the dermoscopy pattern in patients with PWS. Dermoscopy may therefore provide very useful clinical information prior to treatment in these cases. In addition, the vascular manifestations of PWS determined by dermoscopy help to predict response to PDT and manage patient expectations.

Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis

BACKGROUND

Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI).

OBJECTIVES

To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women.

SEARCH STRATEGY

Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included.

DATA COLLECTION AND ANALYSIS

Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

MAIN RESULTS

Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I²  = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I²  = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92).

CONCLUSIONS

Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture.

TWEETABLE ABSTRACT

This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.

Pro-inflammatory immunological effects of adipose tissue and risk of food allergy in obesity: Focus on immunological mechanisms

Over the past three decades, the number of obese people has risen steadily. The chronic low-grade inflammatory state and the non-specific activation of the immune system have contributed greatly to the development of obesity-related immunology. Food allergy as a kind of inflammatory disease with abnormal immune response may be associated with obesity. This review begins with the pro-inflammatory immunological effects of adipose tissue in obesity, and explains the possible effects of obesity on food allergy. In short, obesity not only directly causes imbalance of allergic-related immune cells in adipose tissue, but also indirectly causes this consequence through affecting expression of adipocytokines and peroxisome proliferator-activated receptor gamma (PPARγ) in adipose tissue. As a result, circulating levels of pro-inflammatory factors which are partly derived from adipose tissue increase, which might cause intestinal barrier injury. Therefore, obesity may increase the risk of food allergy.

Economic growth and suicide rate changes: A case in China from 1982 to 2005

Objectives

It is to estimate the trend of suicide rate changes during the past three decades in China and try to identify its social and economic correlates.

Methods

Official data of suicide rates and economic indexes during 1982–2005 from Shandong Province of China were analyzed. The suicide data were categorized for the rural / urban location and gender, and the economic indexes include GDP, GDP per capita, rural income, and urban income, all adjusted for inflation.

Results

We found a significant increase of economic development and decrease of suicide rates over the past decades under study. The suicide rate decrease is correlated with the tremendous growth of economy.

Conclusion

The unusual decrease of Chinese suicide rates in the past decades is accounted for within the Chinese cultural contexts and maybe by the Strain Theory of Suicide.

[The surgical effect of secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy]

Objective: To evaluate the effect of extraocular muscle surgery in treating secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy (TAO). Methods: Retrospective case series study. Eleven secondary esotropic patients with diplopia after orbital decompression for TAO who underwent extraocular muscle surgery during March 2016 and October 2018 in Tianjin Eye Hospital were included. All patients had new onset esotropia after decompression surgery and underwent strabismus surgery. Deviation angle, diplopia, and ocular movement were observed preoperatively and postoperatively. Surgeries were carried out under the monitored anesthesia care combined with local anesthesia, and the eye alignment was adjusted to orthotropia with no diplopia in the operation with the technique of intraoperative adjustable suture and forced duction test results. All the patients were followed up. Results: The ages of the patients were from 26 to 42 years (1 male and 10 females). The deviation angles were 10-98 prism diopter. Orbital CT scan showed that the horizontal rectus thickness was increased at different levels, and the thickness of the medial rectus was increased more than that of the lateral rectus. Two patients had monocular medial rectus recession only, 2 had bilateral medial rectus recession only, 2 had monocular medial rectus recession combined with lateral rectus resection, and the other 5 had bilateral medial rectus recession with monocular lateral rectus resection. The recession of medial rectus muscle was 3.5 to 7.5 mm in 11 patients and 2.0 to 6.0 mm in 7 patients with the resection of lateral rectus muscle. Diplopia of the 11 patients disappeared with orthotropia at primary gaze position after the extraocular muscle surgery. The limitation of abduction changed from preoperative (-1.91±1.04) to postoperative (-0.64±0.81). All the patients were satisfied with the surgical results. At the end of the follow-up (6 to 24 months), the results of the patients were stable, and no over-correction was found. Conclusion: Extraocular muscle surgery with intraoperative adjustable suture technique can effectively treat TAO patients with secondary esotropia with diplopia after orbital decompression. (Chin J Ophthalmol, 2020, 56: 183-188).

[Prognostic value of Montreal Cognitive Assessment in heart failure patients]

Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions: Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

[Surgical selection and metastatic warning of splenic lymph node dissection in advanced gastric cancer radical surgery: a prospective, single-center, randomized controlled trial]

Objective: To investigate the surgical options for splenic lymph node dissection in patients with advanced gastric cancer undergoing radical total gastrectomy, and to evaluate the sentinel effect of No. 4s lymph node on splenic lymph node metastasis. Methods: A prospective, single-center, randomized and controlled study was carried out (Trial registration, No.NCT02980861). Enrollment criteria: (1) >18 years old and <65 years old; (2) gastric adenocarcinoma locating in the proximal or corpus; (3) preoperative clinical staging as cT2-4aN0-3M0; (4) D2 radical total gastrectomy feasible judged before operation; (5) physical ability score 0 to 1; (6) I to III of ASA classification. Pregnant or lactating women, patients with severe mental illness or previous history of upper abdominal surgery, those suffered from other malignant tumors in the past 5 years, or heart and lung system diseases judged to affect surgery before operation, those receiving preoperative chemotherapy, radiotherapy or targeted therapies, and distant metastases being found during surgery were excluded. According to above criteria, 222 patients at The First Medical Center of Chinese PLA General Hospital from December 2016 to December 2017 were enrolled prospectively and were randomly divided into the laparoscopic splenic hilar lymph node dissection group (laparoscopic group, n=114) and the open splenic hilar lymph node dissection group (open group, n=108). The result of rapid frozen immunohistochemistry of harvested No.4s lymph nodes was used to evaluate the sensitivity and specificity of sentinel effect on splenic hilar lymph node metastasis. The surgical parameters, postoperative recovery parameters, and complication rates were compared between the two groups. Results: There were 80 males and 34 females in the lapascopic group with a mean age of (56.1±10.2) years, and 69 males and 39 females in the open group with a mean age of (58.4±10.9) years. There were no significant differences in baseline data between the two groups (all P>0.05). Total blood loss was less in the laparoscopic group [(96.3±82.4) ml vs. (116.6±101.9) ml, t=1.124, P<0.001], and the amount of bleeding from the splenic hilar lymph nodes dissected was also less than that in the open group [(25.3±17.8) ml vs. (59.5±36.4) ml, t=1.172, P<0.001]. However, the operation time, the time of splenic hilar lymph node, the number of lymph node dissected and number of splenic hilar lymph node dissected were not significantly different between the two groups (all P>0.05). As compared to the open group, the laparoscopic group had shorter time to the first flatus [(1.3±1.2) days vs. (1.6±1.5) days, t=1.665, P=0.021], shorter time to fluid diet [(4.6±1.4) days vs. (4.9 ± 1.6) days, t=1.436, P=0.007], shorter time to remove nasogastric tube [(3.9±2.6) days vs. (4.3±2.4) days, t=0.687, P<0.001] and shorter hospital stay [(10.3±6.6) days vs. (12.1±7.2) days, t=0.697, P<0.001]. Complication rate was 14.0% (16/114) and (12.0%) ((1)3/108) in the laparoscopic group and the open group, respectively, without significant difference (χ(2)=6.723, P=0.331). The sensitivity of the No. 4s lymph node for the prediction of splenic hilar lymph node metastasis reached 89.5%, and the specificity reached 99.6%. Conclusions: Laparoscopic technique is safe and feasible in the treatment of splenic hilar lymph node dissection in advanced gastric cancer. The No.4s lymph node examination has good sentinel effect on predicting the metastasis of splenic hilar lymph nodes.

Multifunctional phototheranostic nanomedicine for cancer imaging and treatment

Cancer, as one of the most life-threatening diseases, shows a high fatality rate around the world. When improving the therapeutic efficacy of conventional cancer treatments, researchers also conduct extensive studies into alternative therapeutic approaches, which are safe, valid, and economical. Phototherapies, including photodynamic therapy (PDT) and photothermal therapy (PTT), are tumor-ablative and function-reserving oncologic interventions, showing strong potential in clinical cancer treatment. During phototherapies, the non-toxic phototherapeutic agents can be activated upon light irradiation to induce cell death without causing much damage to normal tissues. Besides, with the rapid development of nanotechnology in the past decades, phototheranostic nanomedicine also has attracted tremendous interests aiming to continuously refine their performance. Herein, we reviewed the recent progress of phototheranostic nanomedicine for improved cancer therapy. After a brief introduction of the therapeutic principles and related phototherapeutic agents for PDT and PTT, the existing works on developing of phototheranostic nanomedicine by mainly focusing on their categories and applications, particularly on phototherapy-synergized cancer immunotherapy, are comprehensively reviewed. More importantly, a brief conclusion and future challenges of phototheranostic nanomedicine from our point of view are delivered in the last part of this article.

CKB1 regulates expression of ribosomal protein L10 family gene and plays a role in UV-B response

Plastid casein kinase 2 (CK2), which is a major Ser/Thr-specific enzyme in higher organisms, plays an essential role in plant development and diverse abiotic stresses. CKB1 is a regulatory subunit beta of CK2. To expand our understand of functions of the CKB1 gene in Arabidopsis thaliana, protein changes among wild-type (WT) and CKB1 gain- and loss-of-function mutants were compared. Proteins extracted from the CKB1 knockout mutant and overexpressing mutant were compared with Col-0 plants using 2D-PAGE. Proteins regulated by CKB1 were identified with matrix-assisted laser desorption ionisation time-of-flight/time-of-flight mass spectrometry (MALDI-TOF/TOF), and its transcript was verified by qRT-PCR. Bioinformatics analysis, including gene ontology and protein-protein interaction analysis, were employed. The results of mass spectra and bioinformatics analysis suggest that CKB1 may have functions in regulation of the ribosomal protein L10 (RPL10) family and is involved in ultraviolet-B (UV-B) response. Furthermore, qRT-PCR verification showed CKB1 expression was up-regulated by UV-B stress. The expression levels of five genes in the RPL10 family were reduced in the ckb1 T-DNA insertion mutants, whereas they increased in the CKB1 overexpressing mutants under both normal conditions and UV-B treatment. In conclusion, CKB1 has important functions in UV-B radiation stress. Our study implies that CKB1 positively regulates UV-B radiation stress signalling, possibly through modulating expression of the RPL10 family.