The safety and efficacy of endoscopic submucosal dissection for treating early oesophageal carcinoma: a meta-analysis

INTRODUCTION

Oesophageal carcinoma is the sixth most lethal cancer in the world. At present, the choice of specific surgical methods is controversial. This study compares the safety and efficacy of endoscopic submucosal dissection and endoscopic mucosal resection in treating early oesophageal carcinoma.

METHODS

We carried out a search of online databases including the Web of Science, PubMed, Embase and the Cochrane Library with no language restrictions. The inclusion criteria were patients with early oesophageal carcinoma who accepted the treatment of endoscopic submucosal dissection compared with endoscopic mucosal resection.

FINDINGS

A total of 1,462 patients with 1,650 lesions from nine studies were included in the meta-analysis. When compared with the endoscopic mucosal resection group, the en bloc resection (endoscopic submucosal dissection 67.94% vs endoscopic mucosal resection 52.78%; odds ratio 19.79, p = 0.000) and complete resection (endoscopic submucosal dissection 75.57% vs endoscopic mucosal resection 59.47%; odds ratio 16.10, p = 0.000) rates were significantly higher in the endoscopic submucosal dissection group, while the local recurrence rate was significantly lower in the endoscopic submucosal dissection group (endoscopic submucosal dissection 0.08% vs endoscopic mucosal resection 2.66%; odds ratio 0.08, p = 0.000). The incidence of complications and procedural time were also tested.

[Long-term effect of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula and risk factors associated with anal function]

Objective: To evaluate the long-term effects of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula, and identify risk factors associated with anal function. Methods: A case-control study was conducted. Clinical and follow-up data of 123 patients with trans-sphincteric perianal fistula receiving anal fistula plug treatment in Beijing Chaoyang Hospital from August 2008 to September 2012 were retrospectively analyzed. The follow-up deadline was April 30, 2020. The Wexner score for incontinence was used to evaluate pre-and postoperative anal function (range from 0 to 20, with higher score representing worse function). The potential risk factors affecting postoperative anal function, including gender, age, fasting blood glucose, diabetes, smoking, alcoholism, location of external opening of anal fistula, surgeon expertise and operation time, were statistically analyzed. Results: Among the 123 patients, 114 were male and 9 were female, the median age was 39 (15-69) years, body mass index (BMI) was (26.2±3.9) kg/m(2), and the median distance between the external opening of anal fistula and the anal verge was 2.6 (1.0-5.0) cm. The median operation time was 30.4 (15.0-60.0) minutes. The median follow-up time was 120 (93-141) months. Sixty-nine patients (56.5%) were healed. The assessment of anal function by Wexner incontinence score showed that 33 (26.8%) patients had anal functional decline after surgery, and the postoperative median Wexner score was 1.34 (0-8), which was significantly higher than preoperative score of 0.17 (0-4) (Z=-5.057, P<0.001). Compared with preoperative levers, postoperative subscores of flatus incontinence, liquid incontinence, solid incontinence and alteration in lifestyle were increased significantly (all P<0.05). Subgroup analysis showed that both in the healed and unhealed groups, the postoperative Wexner scores were higher than those before surgery [healed group: 1.22 (0-8) vs. 0.17 (0-1), Z=-3.796, P<0.001; unhealed group: 1.5 (0-8) vs.0.17 (0-3), Z=-3.422, P=0.001]. Univariate analysis revealed that 33 patients with postoperative anal functional decline had higher BMI, higher fasting blood glucose, higher proportion of alcoholism, longer distance between external opening of anal fistula and the anal verge, and longer operation time (all P<0.05). Multivariate logistic regression analysis testified that higher BMI (OR=1.485, 95% CI: 1.220-1.807, P<0.001) and longer distance between external opening and anal verge (OR=2.207, 95% CI: 1.276-3.220, P=0.003) were independent risk factors for postoperative anal functional decline. Conclusions: The treatment for trans-sphincteric anal fistula with anal fistula plug leads to long-term postoperative anal function decline. For patients with obesity and longer distance between external opening of anal fistula and the anal verge, this procedure should be performed with particular caution, and the anal sphincter should be preserved as much as possible during the operation.

Value of contrast-enhanced ultrasound in the diagnosis of breast US-BI-RADS 3 and 4 lesions with calcifications

AIM

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for Breast Imaging-Reporting and Data System for Ultrasound (US-BI-RADS) 3 and 4 lesions with calcifications.

MATERIALS AND METHODS

A retrospective study of 168 breast lesions with calcifications detected on both mammography and conventional ultrasonography (US) in 152 patients were categorised as US-BI-RADS 3-4 at US between June 2009 and June 2018. CEUS scores were obtained based on a CEUS five-point scoring system. The combination of US-BI-RADS and CEUS scores created the Rerated BI-RADS (referred to as CEUS-BI-RADS). All results were compared with the histological findings. The diagnostic performances of US and CEUS-BI-RADS were compared.

RESULTS

The diagnostic sensitivity, specificity, and accuracy of US were 81.8% (95% confidence interval [CI]: 71.6%, 92%), 85% (95% CI: 78.4%, 91.5%), and 83.9% (95% CI: 78.4%, 89.5%), respectively, while those for CEUS-BI-RADS were 98.2% (95% CI: 94.7%, 100%), 90.3% (95% CI: 84.8%, 95.7%), and 92.9% (95% CI: 89%, 96.8%), respectively. The diagnostic sensitivity and accuracy values of CEUS-BI-RADS greatly improved compared with those of US (p=0.003 and p=0.004, respectively). The areas under the receiver operating characteristic (ROC) curves for US and CEUS-BI-RADS were 0.888 (95% CI: 0.840, 0.936) and 0.963 (95% CI: 0.936, 0.989), respectively. The diagnostic efficacy of CEUS-BI-RADS was significantly higher than that of US alone (p=0.004).

CONCLUSION

CEUS-BI-RADS significantly improves the diagnostic accuracy for breast US-BI-RADS 3 and 4 lesions with calcifications compared with US.

Σ^{+} and Σ[over ¯]^{-} Polarization in the J/ψ and ψ(3686) Decays

From 1310.6×10^{6}  J/ψ and 448.1×10^{6}  ψ(3686) events collected with the BESIII experiment, we report the first observation of Σ^{+} and Σ[over ¯]^{-} spin polarization in e^{+}e^{-}→J/ψ[ψ(3686)]→Σ^{+}Σ[over ¯]^{-} decays. The relative phases of the form factors ΔΦ have been measured to be (-15.5±0.7±0.5)° and (21.7±4.0±0.8)° with J/ψ and ψ(3686) data, respectively. The nonzero value of ΔΦ allows for a direct and simultaneous measurement of the decay asymmetry parameters of Σ^{+}→pπ^{0}(α_{0}=-0.998±0.037±0.009) and Σ[over ¯]^{-}→p[over ¯]π^{0}(α[over ¯]_{0}=0.990±0.037±0.011), the latter value being determined for the first time. The average decay asymmetry, (α_{0}-α[over ¯]_{0})/2, is calculated to be -0.994±0.004±0.002. The CP asymmetry A_{CP,Σ}=(α_{0}+α[over ¯]_{0})/(α_{0}-α[over ¯]_{0})=-0.004±0.037±0.010 is extracted for the first time, and is found to be consistent with CP conservation.

MiR-202-3p functions as a tumor suppressor and reduces cell migration and invasion in papillary thyroid carcinoma

OBJECTIVE

MicroRNAs (miRNAs) are recently identified as key regulators of tumor development and progression. MiR-202-3p functions as tumor suppressor in some cancer types. The aim of the study is to determine its expression pattern and explore the functions underlying the mechanism of miR-202-3p in papillary thyroid carcinoma (PTC).

PATIENTS AND METHODS

By using quantitative RT-PCR (QRT-PCR) analyses, we detected miR-202-3p expression in PTC tissues and cell lines. Transwell migration and invasion assays were performed to measure the migration and invasion ability of tumor cells transfected with miR-202-3p mimic. Western blot analysis was used to detect the protein expression.

RESULTS

Our results showed that miR-202-3p expression was frequently downregulated in 96 cases PTC tissues compared to adjacent normal tissues. Lower expression of miR-202-3p associated with lymph node metastasis of patients with PTC. Overexpression of miR-202-3p inhibited cell migration and invasion in TPC-1 and BCPAP cells. Furthermore, enforced expression of miR-202-3p inhibited WNT signaling by downregulating β-catenin expression in TPC-1 and BCPAP cells.

CONCLUSIONS

Our findings indicated that miR-202-3p may represent a novel therapeutic target of in PTC.

Measurement of CP-Averaged Observables in the B^{0}→K^{*0}μ^{+}μ^{-} Decay

An angular analysis of the B^{0}→K^{*0}(→K^{+}π^{-})μ^{+}μ^{-} decay is presented using a dataset corresponding to an integrated luminosity of 4.7  fb^{-1} of pp collision data collected with the LHCb experiment. The full set of CP-averaged observables are determined in bins of the invariant mass squared of the dimuon system. Contamination from decays with the K^{+}π^{-} system in an S-wave configuration is taken into account. The tension seen between the previous LHCb results and the standard model predictions persists with the new data. The precise value of the significance of this tension depends on the choice of theory nuisance parameters.

Study of Open-Charm Decays and Radiative Transitions of the X(3872)

The processes X(3872)→D^{*0}D[over ¯]^{0}+c.c.,γJ/ψ,γψ(2S), and γD^{+}D^{-} are searched for in a 9.0  fb^{-1} data sample collected at center-of-mass energies between 4.178 and 4.278 GeV with the BESIII detector. We observe X(3872)→D^{*0}D^{0}[over ¯]+c.c. and find evidence for X(3872)→γJ/ψ with statistical significances of 7.4σ and 3.5σ, respectively. No evident signals for X(3872)→γψ(2S) and γD^{+}D^{-} are found, and the upper limit on the relative branching ratio R_{γψ}≡{B[X(3872)→γψ(2S)]}/{B[X(3872)→γJ/ψ]}<0.59 is set at 90% confidence level. Measurements of branching ratios relative to decay X(3872)→π^{+}π^{-}J/ψ are also reported for decays X(3872)→D^{*0}D^{0}[over ¯]+c.c.,γψ(2S),γJ/ψ, and γD^{+}D^{-}, as well as the non-D^{*0}D^{0}[over ¯] three-body decays π^{0}D^{0}D^{0}[over ¯] and γD^{0}D^{0}[over ¯].

Measurements of Absolute Branching Fractions of Fourteen Exclusive Hadronic D Decays to η

Using 2.93  fb^{-1} of e^{+}e^{-} collision data taken at a center-of-mass energy of 3.773 GeV with the BESIII detector, we report the first measurements of the absolute branching fractions of 14 hadronic D^{0(+)} decays to exclusive final states with an η, e.g., D^{0}→K^{-}π^{+}η, K_{S}^{0}π^{0}η, K^{+}K^{-}η, K_{S}^{0}K_{S}^{0}η, K^{-}π^{+}π^{0}η, K_{S}^{0}π^{+}π^{-}η, K_{S}^{0}π^{0}π^{0}η, and π^{+}π^{-}π^{0}η; D^{+}→K_{S}^{0}π^{+}η, K_{S}^{0}K^{+}η, K^{-}π^{+}π^{+}η, K_{S}^{0}π^{+}π^{0}η, π^{+}π^{+}π^{-}η, and π^{+}π^{0}π^{0}η. Among these decays, the D^{0}→K^{-}π^{+}η and D^{+}→K_{S}^{0}π^{+}η decays have the largest branching fractions, which are B(D^{0}→K^{-}π^{+}η)=(1.853±0.025_{stat}±0.031_{syst})% and B(D^{+}→K_{S}^{0}π^{+}η)=(1.309±0.037_{stat}±0.031_{syst})%, respectively. The charge-parity asymmetries for the six decays with highest event yields are determined, and no statistically significant charge-parity violation is found.

Determination of Strong-Phase Parameters in D→K_{S,L}^{0}π^{+}π^{-}

We report the most precise measurements to date of the strong-phase parameters between D^{0} and D[over ¯]^{0} decays to K_{S,L}^{0}π^{+}π^{-} using a sample of 2.93  fb^{-1} of e^{+}e^{-} annihilation data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector at the BEPCII collider. Our results provide the key inputs for a binned model-independent determination of the Cabibbo-Kobayashi-Maskawa angle γ/ϕ_{3} with B decays. Using our results, the decay model sensitivity to the γ/ϕ_{3} measurement is expected to be between 0.7° and 1.2°, approximately a factor of three smaller than that achievable with previous measurements, based on the studies of the simulated data. The improved precision of this work ensures that measurements of γ/ϕ_{3} will not be limited by knowledge of strong phases for the next decade. Furthermore, our results provide critical input for other flavor-physics investigations, including charm mixing, other measurements of CP violation, and the measurement of strong-phase parameters for other D-decay modes.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

Observation of New Ξ_{c}^{0} Baryons Decaying to Λ_{c}^{+}K^{-}

The Λ_{c}^{+}K^{-} mass spectrum is studied with a data sample of pp collisions at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 5.6  fb^{-1} collected by the LHCb experiment. Three Ξ_{c}^{0} states are observed with a large significance and their masses and natural widths are measured to be m[Ξ_{c}(2923)^{0}]=2923.04±0.25±0.20±0.14  MeV, Γ[Ξ_{c}(2923)^{0}]=7.1±0.8±1.8  MeV, m[Ξ_{c}(2939)^{0}]=2938.55±0.21±0.17±0.14  MeV, Γ[Ξ_{c}(2939)^{0}]=10.2±0.8±1.1  MeV, m[Ξ_{c}(2965)^{0}]=2964.88±0.26±0.14±0.14  MeV, Γ[Ξ_{c}(2965)^{0}]=14.1±0.9±1.3  MeV, where the uncertainties are statistical, systematic, and due to the limited knowledge of the Λ_{c}^{+} mass. The Ξ_{c}(2923)^{0} and Ξ_{c}(2939)^{0} baryons are new states. The Ξ_{c}(2965)^{0} state is in the vicinity of the known Ξ_{c}(2970)^{0} baryon; however, their masses and natural widths differ significantly.

SAT0242 REGIONAL VARIATION IN CARDIOVASCULAR DISEASE AMONG SLE PATIENTS

Objectives:

To evaluate whether the risk of cardiovascular disease (CVD) including myocardial infarction (MI) and cerebrovascular (CVA) differs across geographic regions among SLE patients.

Methods:

We identified SLE patients using two ICD codes 60 days apart within two years recorded in Medical Services Plan (MSP) or hospital discharge database (DAD). We defined the second of two diagnosis dates as the index date. We included incident SLE patients (7-year continuous registries in MSP before the first diagnosis date) with an index date between 1997 and 2012 and excluded patients with previous MI or CVA before the index date. We followed each patient from the index date up to 10 years and censored at the date of death date, leaving the province, or March 31, 2015.

We assessed the incident CVD that was defined as the first ever diagnosis of MI or CVA recorded in DAD or as the primary cause of death in Vital Statistics. We also evaluated MI and CVA separately.

The Province’s publicly administered and funded health care system is organized into five regional health authorities (HA): Interior (IHA), Fraser (FHA), Vancouver Coastal (VCHA), Vancouver Island (VIHA), and Northern (NHA) [Figure 1(a)].We assigned each patient the HA she/he was registered at the index date. We extracted baseline covariates using the information during a period of 365 days prior to the index date, including socio-demographic characteristics, health care resource use, comorbidities, and prescription medication use. We calculated the incident rate (IR) of MI, CVA, and CVD (first ever MI or CVA) by HA. Using Cox Proportional Hazard model adjusting for potential confounders at baseline, we estimated the adjusted hazard ratios (aHR) of CVD for each HA compared to FHA or VCHA which have the large proportion of provincial population and SLE patients. We evaluated the regional disparities in MI and CVA separately using the same methods.

Figure 1.

HA and CVD Incident Rate

Results:

We included 3,960 incident SLE patients free of CVD at baseline with a mean (SD) age of 48.5 (15.8), including 726 (18.3%) from IHA, 1634 (42.3%) from FHA, 854 (21.6%) from VCHA, 504 (12.7%) from VIHA, and 242 (6.1%) from NHA. During 26378 person-year (PY) follow-up, 133 patients developed incident CVD including 91 MI and 43 CVA. [Table 1]

Table 1.

Incident Rates and HR

HAIncidenceaHR (95%CI)NPYIR (95%CI)10,000 PYReference: FHAReference: VCHACVDIHA35457976(54,105)1.93(1.17,3.2)2.05(1.17,3.58)FHA391119735(25,47)ref1.06(0.64,1.76)VCHA27584446(31,66)0.94(0.57,1.57)refVIHA22316570(44,103)1.65(0.96,2.83)1.74(0.98,3.11)NHA10159263(31,110)1.81(0.86,3.8)1.92(0.88,4.17)MIIHA24457952(34,76)2.09(1.14,3.83)1.81(0.95,3.47)FHA271119724(16,34)ref0.87(0.48,1.56)VCHA21584436(23,54)1.15(0.64,2.07)refVIHA12316538(20,64)1.29(0.64,2.58)1.12(0.54,2.31)NHA7159244(19,85)2.11(0.88,5.11)1.84(0.74,4.56)CVAIHA11457924(12,41)1.79(0.71,4.55)2.35(0.8,6.88)FHA121119711(6,18)ref1.31(0.49,3.48)VCHA7584412(5,23)0.76(0.29,2.03)refVIHA10316532(16,55)2.79(1.14,6.85)3.66(1.34,10.01)NHA<5159219(5,49)1.45(0.36,5.72)1.89(0.44,8.22)

The IR of CVD varied from 35 in FHA to 76 per 10,000 PY in IHA [Figure 1(b)]. IHA had significantly higher risk of CVD than FHA (aHR=1.93, 95%CI=1.17~3.2) and VCHA (aHR=2.05, 95%CI=1.17~3.58).

The IR of MI varied from 24 in FHA to 52 per 10,000 PY in IHA [Figure 2(a)]. IHA had significantly higher risk of MI than FHA (aHR=2.09, 95%CI=1.14~3.83).

Figure 2.

MI and CVA incident Rate by HA

The IR of CVA varied from 11 in FHA to 32 per 10,000 PY in VIHA [Figure 2(b)]. VIHA had significantly higher risk of CVA than FHA (aHR=2.79, 95%CI=1.14~6.85) and VCHA (aHR=3.66, 95%CI=1.34~10.01).

Conclusion:

Compared with FHA and VCHA, IHA had higher risk of CVD and VIHA had higher risk of CVA. IHA also had higher risk of MI than FHA.

Disclosure of Interests:

None declared

OP0010 EFFECTIVENESS OF THE MAKING IT WORK™ PROGRAM AT IMPROVING PRESENTEEISM AND WORK CESSATION IN WORKERS WITH INFLAMMATORY ARTHRITIS – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background:

Arthritis often leads to presenteeism (decreased at-work productivity), missed days from work and permanent work disability, leading to reduced quality of life and high costs to individuals and society. Yet, health services addressing the employment needs of people with arthritis are lacking.

Objectives:

We evaluated the effectiveness of the Making-it-WorkTM(MiW) program, an online self-management program developed to help people with inflammatory arthritis (IA) deal with employment issues.

Methods:

A multi-center RCT evaluated the effectiveness of MiW at improving presenteeism and preventing work cessation (WC) over two years. Participants were recruited from rheumatologist practices, consumer organizations and arthritis programs, in three Canadian provinces. Eligibility criteria: diagnosis of IA, employed, age 18-59, and concerned about ability to work. Participants were randomized 1:1 to MiW or usual care plus printed material on workplace tips. MiW consists of five online self-learning modules and group meetings, and individual vocational counselling and ergonomic consultations. Questionnaires were administered every 6 months. Outcomes were presenteeism [Rheumatoid Arthritis Work Instability Scale (RA-WIS)], time to WC ≥ 6 months, and time to WC ≥ 2 months (secondary outcome). Baseline characteristics (age, gender, ethnicity, occupation, education, disease duration and self-employment) were collected. Intention-to-treat (ITT) longitudinal analysis of RA-WIS using linear mixed effect regression models with 2-year comparison as primary endpoint and survival analysis for time to WC using Kaplan-Meier and Cox Proportional Hazard models were performed. Robustness analyses were conducted by using various missing values imputation methods like last observation carried forward, imputation using worse possible outcomes and model-based multiple imputations; using square root transformation of RA-WIS outcome; and adjusting for baseline covariates. SAS version 9.4 was used.

Results:

A total of 564 participants were recruited, with 478 (84.75%) completing 2-year follow-up. Baseline characteristics were similar between groups. Mean RA-WIS scores were significantly lower in the intervention group from 6 months onwards, with the greatest difference observed at 2 years (-1.78, 95%CI: -2.7, -0.9, p < .0001), yielding a standardized effect size of 32%. Satisfactory robustness was observed. Work cessation occurred less often in intervention than control groups, but only reached statistical significance for WC ≥ 2 months (WC ≥ 6 months: 31 versus 44 events, aHR 0.70, 95%CI: 0.44, 1.11, p = 0.13; WC ≥ 2 months: 39 versus 61 events, aHR: 0.65, 95%CI: 0.43, 0.98, p = 0.04).

Conclusion:

Results of the RCT reveal the program was effective at improving presenteeism and preventing short-term WC. Effectiveness at preventing long-term work disability will be assessed at 5 years. This program fills one of the most important and costly unmet needs for people with inflammatory arthritis.

References:

[1]Carruthers EC, Rogers P, Backman CL, et al. “Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).BMC Med Inform Decis Mak. 2014;14:59. Published 2014 Jul 21. doi:10.1186/1472-6947-14-59

Disclosure of Interests:

Andre Luquini: None declared, Yufei Zheng: None declared, Hui Xie: None declared, Catherine Backman: None declared, Pamela Rogers: None declared, Alex Kwok: None declared, Astrid Knight: None declared, Monique Gignac: None declared, Dianne Mosher: None declared, Linda Li: None declared, John Esdaile: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Lacaille: None declared

Search for the Rare Decays B_{s}^{0}→e^{+}e^{-} and B^{0}→e^{+}e^{-}

A search for the decays B_{s}^{0}→e^{+}e^{-} and B^{0}→e^{+}e^{-} is performed using data collected with the LHCb experiment in proton-proton collisions at center-of-mass energies of 7, 8, and 13 TeV, corresponding to integrated luminosities of 1, 2, and 2  fb^{-1}, respectively. No signal is observed. Assuming no contribution from B^{0}→e^{+}e^{-} decays, an upper limit on the branching fraction B(B_{s}^{0}→e^{+}e^{-})<9.4(11.2)×10^{-9} is obtained at 90(95)% confidence level. If no B_{s}^{0}→e^{+}e^{-} contribution is assumed, a limit of B(B^{0}→e^{+}e^{-})<2.5(3.0)×10^{-9} is determined at 90(95)% confidence level. These upper limits are more than one order of magnitude lower than the previous values.

Population pharmacokinetics of cefazolin in critically ill children infected with methicillin-sensitive Staphylococcus aureus

OBJECTIVES

Cefazolin is one of curative treatments for infections due to methicillin-sensitive Staphylococcus aureus (MSSA). Both growth and critical illness may impact the pharmacokinetic (PK) parameters. We aimed to build a population PK model for cefazolin in critically ill children in order to optimize individual dosing regimens.

METHODS

We included all children (age < 18 years, body weight (BW) > 2.5 kg) receiving cefazolin for MSSA infection. Cefazolin total plasma concentrations were quantified by high-performance liquid chromatography. A data modelling process was performed with the software MONOLIX. Monte Carlo simulations were used in order to attain the PK target of 100% fT _> 4 ×MIC.

RESULTS

Thirty-nine patients with a median (range) age of 7 (0.1-17) years and a BW of 21 (2.8-79) kg were included. The PK was ascribed to a one-compartment model, where typical clearance and volume of distribution estimations were 1.4 L/h and 3.3 L respectively. BW, according to the allometric rules, and estimated glomerular filtration rate (eGFR) on clearance were the two influential covariates. Continuous infusion with a dosing of 100 mg/kg/day to increase to 150 mg/kg/day for children with a BW < 10 kg or eGFR >200 mL/min/1.73m² were the best schemes to reach the PK target of 100% fT_> 4 ×MIC.

CONCLUSIONS

In critically ill children infected with MSSA, continuous infusion seems to be the most appropriate scheme to reach the PK target of 100 % fT _> 4 ×MIC in children with normal and augmented renal function.

[The role of three-dimensional speckle tracking imaging derived parameters on predicting outcome of hypertrophic cardiomyopathy patients with MYH7 mutations]

Objective: To evaluate the cardiac functional changes in hypertrophic cardiomyopathy(HCM) patients with β-myosin heavy chain gene (MYH7) mutations by three-dimensional (3D) speckle tracking imaging(3D-STI) and conventional echocardiography modalities, and then to explore the potential predictors of adverse cardiovascular events in these patients. Methods: A consecutive series of 192 HCM patients admitted in our center from October 2014 to October 2016 were genetically screened to identify MYH7 mutations in this retrospective study. A total of 43 HCM patients with MYH7 mutations were enrolled. The patients were divided into events group(n=13) and no event group(n=30) according to the presence or absence of adverse cardiovascular events(primary and secondary endpoints). All patients were followed up to January 2019 after comprehensive evaluation of 3D-STI, two-dimensional and Doppler echocardiography. The adverse cardiovascular events were recorded. Results: The median follow up time was 1 012 (812, 1 330) days. During follow-up, 13 patients (30.2%) reached endpoints: 6 cases of the primary endpoints(2 cases of sudden cardiac death(SCD), 3 cases of survival after defibrillation, and 1 case of appropriate implantable cardioverter-defibrillator(ICD) discharge); 7 cases of the second endpoints(5 cases of heart failure hospitalization, 1 case of syncope and cardioversion due to supraventricular tachycardia, and 1 case of end-stage HCM). Patients with adverse cardiovascular events had higher prevalence of syncope and risk of SCD, enlarged left atrial volume index(LAVI) and reduced 3D left ventricular global longitudinal train (3D-GLS), as compared to those without adverse events(all P<0.05). The multivariate Cox regression analysis showed that reduced 3D-GLS(HR=0.814, 95%CI 0.663-0.999, P=0.049) was an independent predictor for adverse cardiovascular events. The cutoff value of 3D-GLS≤13.67% was linked with significantly increased risk of adverse cardiovascular events in this patient cohort(AUC=0.753, 95%CI 0.558-0.948, sensitivity 86%, specificity 69%, P<0.05). The Kaplan-Meier analysis indicated that the patients with the 3D-GLS≤ 13.67% faced higher risk of death than those with 3D-GLS>13.67%. Conclusion: 3D-GLS is useful on predicting adverse cardiovascular events in HCM patients with MYH7 mutations.

Coexistence of bistable multi-pulse chaotic motions with large amplitude vibrations in buckled sandwich plate under transverse and in-plane excitations

This paper researches the dynamic snap-through phenomena and the coexistence of the multi-pulse jumping chaotic dynamics in bistable equilibrium positions and the large amplitude nonlinear vibrations for a simply supported buckled 3D-kagome truss core sandwich rectangular plate under combined transverse and in-plane excitations based on the extended high-dimensional Melnikov method. According to the two-degree-of-freedom non-autonomous nonlinear dynamical system of the buckled truss core sandwich rectangular plate and the theory of normal form, it is found that some nonlinear terms have less effects on the nonlinear dynamic responses than other nonlinear terms. The extended high-dimensional Melnikov method is employed to investigate the dynamic snap-through phenomena and the bistable multi-pulse jumping chaotic vibrations around the upper-mode and the lower-mode for two different cases of buckling in the truss core sandwich rectangular plate. A numerical method is used to detect the bistable multi-pulse jumping chaotic vibrations around two stable equilibrium positions for the non-autonomous buckled truss core sandwich rectangular plate. The obtained theoretical and numerical results indicate that there exists the coexistence of the bistable multi-pulse jumping chaotic vibrations and the large amplitude nonlinear vibrations in the buckled truss core sandwich rectangular plate under combined transverse and in-plane excitations.

Transcriptomic changes in the nasal epithelium associated with diesel engine exhaust exposure

BACKGROUND

Diesel engine exhaust (DEE) exposure causes lung cancer, but the molecular mechanisms by which this occurs are not well understood.

OBJECTIVES

To assess transcriptomic alterations in nasal epithelium of DEE-exposed factory workers to better understand the cellular and molecular effects of DEE.

METHODS

Nasal epithelial brushings were obtained from 41 diesel engine factory workers exposed to relatively high levels of DEE (17.2-105.4 μg/m3), and 38 unexposed workers from factories without DEE exposure. mRNA was profiled for gene expression using Affymetrix microarrays. Linear modeling was used to identify differentially expressed genes associated with DEE exposure and interaction effects with current smoking status. Pathway enrichment among differentially expressed genes was assessed using EnrichR. Gene Set Enrichment Analysis (GSEA) was used to compare gene expression patterns between datasets.

RESULTS

225 genes had expression associated with DEE exposure after adjusting for smoking status (FDR q < 0.25) and were enriched for genes in pathways related to oxidative stress response, cell cycle pathways such as MAPK/ERK, protein modification, and transmembrane transport. Genes up-regulated in DEE-exposed individuals were enriched among the genes most up-regulated by cigarette smoking in a previously reported bronchial airway smoking dataset. We also found that the DEE signature was enriched among the genes most altered in two previous studies of the effects of acute DEE on PBMC gene expression. An exposure-response relationship was demonstrated between air levels of elemental carbon and the first principal component of the DEE signature.

CONCLUSIONS

A gene expression signature was identified for workers occupationally exposed to DEE that was altered in an exposure-dependent manner and had some overlap with the effects of smoking and the effects of acute DEE exposure. This is the first study of gene expression in nasal epithelial cells of workers heavily exposed to DEE and provides new insights into the molecular alterations that occur with DEE exposure.

Measurement of f_{s}/f_{u} Variation with Proton-Proton Collision Energy and B-Meson Kinematics

The ratio of the B_{s}^{0} and B^{+} fragmentation fractions f_{s} and f_{u} is studied with B_{s}^{0}→J/ψϕ and B^{+}→J/ψK^{+} decays using data collected by the LHCb experiment in proton-proton collisions at 7, 8, and 13 TeV center-of-mass energies. The analysis is performed in bins of B-meson momentum, longitudinal momentum, transverse momentum, pseudorapidity, and rapidity. The fragmentation-fraction ratio f_{s}/f_{u} is observed to depend on the B-meson transverse momentum with a significance of 6.0σ. This dependency is driven by the 13 TeV sample (8.7σ), while the results for the other collision energies are not significant when considered separately. Furthermore, the results show a 4.8σ evidence for an increase of f_{s}/f_{u} as a function of collision energy.

Observation of a Resonant Structure in e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}

A partial-wave analysis is performed for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} at the center-of-mass energies ranging from 2.000 to 2.644 GeV. The data samples of e^{+}e^{-} collisions, collected by the BESIII detector at the BEPCII collider with a total integrated luminosity of 300  pb^{-1}, are analyzed. The total Born cross sections for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}, as well as the Born cross sections for the subprocesses e^{+}e^{-}→ϕπ^{0}π^{0}, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), are measured versus the center-of-mass energy. The corresponding results for e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} and ϕπ^{0}π^{0} are consistent with those of BABAR with better precision. By analyzing the cross sections for the four subprocesses, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), a structure with mass M=(2126.5±16.8±12.4)  MeV/c^{2} and width Γ=(106.9±32.1±28.1)  MeV is observed with an overall statistical significance of 6.3σ, although with very limited significance in the subprocesses e^{+}e^{-}→K_{1}^{+}(1270)K^{-} and K^{*+}(892)K^{*-}(892). The resonant parameters of the observed structure suggest it can be identified with the ϕ(2170), thus the results provide valuable input to the internal nature of the ϕ(2170).

Isospin Amplitudes in Λ_{b}^{0}→J/ψΛ(Σ^{0}) and Ξ_{b}^{0}→J/ψΞ^{0}(Λ) Decays

Ratios of isospin amplitudes in hadron decays are a useful probe of the interplay between weak and strong interactions and allow searches for physics beyond the standard model. We present the first results on isospin amplitudes in b-baryon decays, using data corresponding to an integrated luminosity of 8.5  fb^{-1}, collected with the LHCb detector in pp collisions at center of mass energies of 7, 8, and 13 TeV. The isospin amplitude ratio |A_{1}(Λ_{b}^{0}→J/ψΣ^{0})/A_{0}(Λ_{b}^{0}→J/ψΛ)|, where the subscript on A indicates the final-state isospin, is measured to be less than 1/21.8 at 95% confidence level. The Cabibbo suppressed Ξ_{b}^{0}→J/ψΛ decay is observed for the first time, allowing for the measurement |A_{0}(Ξ_{b}^{0}→J/ψΛ)/A_{1/2}(Ξ_{b}^{0}→J/ψΞ^{0})|=0.37±0.06±0.02, where the uncertainties are statistical and systematic, respectively.

Cost-effectiveness of bivalent versus monovalent vaccines against hand, foot and mouth disease

OBJECTIVES

Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010-2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China.

METHODS

We used a static model parameterized with the national HFMD surveillance data during 2010-2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010-2013 and caregiver survey data of costs and health quality of life during 2012-2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy.

RESULTS

In the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2-5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively.

CONCLUSIONS

Bivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.

First Observation of Excited Ω_{b}^{-} States

We report four narrow peaks in the Ξ_{b}^{0}K^{-} mass spectrum obtained using pp collisions at center-of-mass energies of 7, 8, and 13 TeV, corresponding to a total integrated luminosity of 9  fb^{-1} recorded by the LHCb experiment. Referring to these states by their mass, the mass values are m[Ω_{b}(6316)^{-}]=6315.64±0.31±0.07±0.50  MeV, m[Ω_{b}(6330)^{-}]=6330.30±0.28±0.07±0.50  MeV, m[Ω_{b}(6340)^{-}]=6339.71±0.26±0.05±0.50  MeV, m[Ω_{b}(6350)^{-}]=6349.88±0.35±0.05±0.50  MeV, where the uncertainties are statistical, systematic, and the last is due to the knowledge of the Ξ_{b}^{0} mass. The natural widths of the three lower mass states are consistent with zero, and the 90% confidence-level upper limits are determined to be Γ[Ω_{b}(6316)^{-}]<2.8  MeV, Γ[Ω_{b}(6330)^{-}]<3.1  MeV and Γ[Ω_{b}(6340)^{-}]<1.5  MeV. The natural width of the Ω_{b}(6350)^{-} peak is 1.4_{-0.8}^{+1.0}±0.1  MeV, which is 2.5σ from zero and corresponds to an upper limit of 2.8 MeV. The peaks have local significances ranging from 3.6σ to 7.2σ. After accounting for the look-elsewhere effect, the significances of the Ω_{b}(6316)^{-} and Ω_{b}(6330)^{-} peaks are reduced to 2.1σ and 2.6σ, respectively, while the two higher mass peaks exceed 5σ. The observed peaks are consistent with expectations for excited Ω_{b}^{-} resonances.

[Comparison of the visual quality at 1 year following femtosecond laser-assisted LASIK, wavefront-guided femtosecond LASIK and small incision lenticule extraction for myopia and astigmatism]

Objective: To investigate mesopic contrast sensitivity (CS) and high-order aberrations after femtosecond laser-assisted LASIK (FS-LASIK), wavefront-guided femtosecond LASIK (WF-LASIK) and small incision lenticule extraction (SMILE) for myopia and astigmatism. Methods: In this case-control study, 212 eyes of 108 patients with myopia and astigmatism from September 2014 to September 2016 were treated by refractive surgery. There were 34 males (66 eyes) and 74 females (146 = eyes), aged 27 (24, 32) years. They were divided into 3 groups, with 37 patients (71 eyes), 35 patients (69 eyes) and 36 patients (72 eyes) treated by FS-LASIK, WF-LASIK and SMILE, respectively. Refraction diopters, corneal tomography, wavefront aberrations and contrast sensitivity were evaluated before and at 12 months after surgery. The results of different groups were compared by rank sum test. Results: At 12 = months of follow-up, 69 eyes (97.18%) treated by FS-LASIK, 67 eyes (97.10%) by WF-LASIK and 69 eyes (95.83%) by SMILE had the uncorrected distance visual acuity of 20/20 or better. Fifty-nine eyes (83.10%) treated by FS-LASIK, 60 eyes (86.96%) by WF-LASIK and 61 eyes (84.72%) by SMILE had better postoperative uncorrected distance visual acuity than preoperative corrected distance visual acuity. Surface regularity index of the WF-LASIK group decreased from 0.11 (0.07, 0.28) to 0.07 (0.06, 0.20) (Z=-2.662, P=0.008), which was less than that of the FS-LASIK and SMILE groups (Z=-3.236, -3.118, P=0.001, 0.000). Surface asymmetry index of the WF-LASIK group increased from 0.34 (0.25, 0.43) to 0.38 (0.30, 0.52) (Z=-2.140, P=0.032), which was less than that of the FS-LASIK and SMILE groups (Z=-2.910, -3.779, P=0.004, 0.000). The root mean square of high-order of the FS-LASIK group increased from 0.32 (0.27, 0.41) to 0.53 (0.40, 0.65) (Z=-6.228, P=0.000), which was more than that of the WF-LASIK and SMILE groups (Z=-3.595, -4.806, P=0.000, 0.000). Coma of the WF-LASIK group increased from 0.16 (0.11, 0.24) to 0.26 (0.15, 0.37) (Z=-3.816, P=0.000), which was less than that of the FS-LASIK group (Z=-3.528, P=0.000). Spherical aberration of the FS-LASIK and WF-LASIK groups increased from 0.10 (0.05, 0.21) and 0.08 (0.04, 0.12) to 0.24 (0.13, 0.34) and 0.15 (0.09, 0.26), respectively (Z=-5.141, -4.864, P=0.000, 0.000), which were more than that of the SMILE group (Z=-2.549, -4.682, P=0.011, 0.000). CS of the WF-LASIK group at 12 cycles per degree (c/d) increased from 1.34 (1.18, 1.48) to 1.48 (1.34, 1.63) (Z=-2.985, P=0.003), which was more than that of the FS-LASIK and SMILE groups (Z=-3.194, -2.977, P=0.001, 0.003). CS with glare of the WF-LASIK group at 12.0 c/d increased from 1.26 (1.18, 1.34) to 1.34 (1.34, 1.63) (Z=-3.608, P=0.000), which was more than that of the FS-LASIK and SMILE groups (Z=-4.033, -2.913, P=0.000, 0.004). Conclusions: FS-LASIK, WF-LASIK and SMILE achieved ideal visual outcomes at 12 months postoperatively. WF-LASIK treated eyes showed the best corneal symmetry, the least increase of high-order aberrations and the best visual quality among three kinds of surgeries. (Chin J Ophthalmol, 2020, 56: 118-125).

[Comparative study on the EPLAD of profoundly deaf children with hearing aid fittings or cochlear implantations at the same age]

Objective:The purpose of the current study was to provide good clinical values for rehabilitation exercises and counseling of hearing impaired children by comparing the early prelingual auditory development（EPLAD） of children with hearing aid fittings or cochlear implantations at the same age. Method:Longitudinal evaluation of EPLAD, profoundly deaf children, who received hearing aid fittings or cochlear implantations at 2 years of age, were recruited in this study, and would be tested with Infant-toddler meaningful auditory integration scale（IT-MAIS） at 3, 6 and 12 months after intervention. One hundred and four children were recruited in this study and divided into two groups based on the types of devices: Cochlear implant group（CI group） and Hearing aid group（HA group）. Each child could be permitted to miss follow-up one time. Result:The IT-MAIS scores of children in both groups improved with increasing wear time. The scores in CI group showed a statistically significant improvement between each interval after switch-on（P=0.000）. However, there was just a statistical difference between overall scores at 3 and 12 months after fitting in HA group（P=0.042）. In addition, the IT-MAIS scores of the two groups were statistically significant at 6 and 12 months after switch-on/fitting（P=0.026, P=0.005）. Simultaneously, the mean overall score of children in CI group at 12 months after switch-on approached the average level of unaided peers with mild hearing loss. However, the mean score at 12 months after fitting was close to the average level of unaided peers with moderate hearing loss. Conclusion:Both of CI and HA could improve EPLAD of profoundly deaf children. However, the EPLAD of CI children could improve faster in the first year after switch-on. And the results would also provide more comprehensive clinical values for rehabilitation and counseling of hearing impaired children by comparing to normal and unaided hearing impaired children.

Search for A^{'}→μ^{+}μ^{-} Decays

Searches are performed for both promptlike and long-lived dark photons, A^{'}, produced in proton-proton collisions at a center-of-mass energy of 13 TeV. These searches look for A^{'}→μ^{+}μ^{-} decays using a data sample corresponding to an integrated luminosity of 5.5  fb^{-1} collected with the LHCb detector. Neither search finds evidence for a signal, and 90% confidence-level exclusion limits are placed on the γ-A^{'} kinetic mixing strength. The promptlike A^{'} search explores the mass region from near the dimuon threshold up to 70 GeV and places the most stringent constraints to date on dark photons with 214<m(A^{'})≲740  MeV and 10.6<m(A^{'})≲30  GeV. The search for long-lived A^{'}→μ^{+}μ^{-} decays places world-leading constraints on low-mass dark photons with lifetimes O(1)  ps.

Measurement of Proton Electromagnetic Form Factors in e^{+}e^{-}→pp[over ¯] in the Energy Region 2.00-3.08 GeV

The process of e^{+}e^{-}→pp[over ¯] is studied at 22 center-of-mass energy points (sqrt[s]) from 2.00 to 3.08 GeV, exploiting 688.5  pb^{-1} of data collected with the BESIII detector operating at the BEPCII collider. The Born cross section (σ_{pp[over ¯]}) of e^{+}e^{-}→pp[over ¯] is measured with the energy-scan technique and it is found to be consistent with previously published data, but with much improved accuracy. In addition, the electromagnetic form-factor ratio (|G_{E}/G_{M}|) and the value of the effective (|G_{eff}|), electric (|G_{E}|), and magnetic (|G_{M}|) form factors are measured by studying the helicity angle of the proton at 16 center-of-mass energy points. |G_{E}/G_{M}| and |G_{M}| are determined with high accuracy, providing uncertainties comparable to data in the spacelike region, and |G_{E}| is measured for the first time. We reach unprecedented accuracy, and precision results in the timelike region provide information to improve our understanding of the proton inner structure and to test theoretical models which depend on nonperturbative quantum chromodynamics.

[Long-term efficacy of bioprosthetic anal fistula plug in the treatment of transsphincteric anal fistula]

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn's disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion: The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.

Observation of Several Sources of CP Violation in B^{+}→π^{+}π^{+}π^{-} Decays

Observations are reported of different sources of CP violation from an amplitude analysis of B^{+}→π^{+}π^{+}π^{-} decays, based on a data sample corresponding to an integrated luminosity of 3  fb^{-1} of pp collisions recorded with the LHCb detector. A large CP asymmetry is observed in the decay amplitude involving the tensor f_{2}(1270) resonance, and in addition significant CP violation is found in the π^{+}π^{-}S wave at low invariant mass. The presence of CP violation related to interference between the π^{+}π^{-}S wave and the P wave B^{+}→ρ(770)^{0}π^{+} amplitude is also established; this causes large local asymmetries but cancels when integrated over the phase space of the decay. The results provide both qualitative and quantitative new insights into CP -violation effects in hadronic B decays.

Measurement of the Cross Section for e^{+}e^{-}→Ξ^{-}Ξ[over ¯]^{+} and Observation of an Excited Ξ Baryon

Using a total of 11.0  fb^{-1} of e^{+}e^{-} collision data with center-of-mass energies between 4.009 and 4.6 GeV and collected with the BESIII detector at BEPCII, we measure fifteen exclusive cross sections and effective form factors for the process e^{+}e^{-}→Ξ^{-}Ξ[over ¯]^{+} by means of a single baryon-tag method. After performing a fit to the dressed cross section of e^{+}e^{-}→Ξ^{-}Ξ[over ¯]^{+}, no significant ψ(4230) or ψ(4260) resonance is observed in the Ξ^{-}Ξ[over ¯]^{+} final states, and upper limits at the 90% confidence level on Γ_{ee}B for the processes ψ(4230)/ψ(4260)→Ξ^{-}Ξ[over ¯]^{+} are determined. In addition, an excited Ξ baryon at 1820  MeV/c^{2} is observed with a statistical significance of 6.2-6.5σ by including the systematic uncertainty, and the mass and width are measured to be M=(1825.5±4.7±4.7)  MeV/c^{2} and Γ=(17.0±15.0±7.9)  MeV, which confirms the existence of the J^{P}=3/2^{-} state Ξ(1820).

Identification of factors associated with minimal erythema dose variations in a large-scale population study of 22 146 subjects

Background

Minimal erythema dose (MED) has substantial inter‐ and intraindividual variations, reflecting the influence of very diverse factors. However, related studies showed little consistency probably because of their limited sample size.

Objective

To identify the factors associated with MED variations in a large‐scale population study.

Methods

The MED test was performed by following the international standard procedure on 22 146 subjects. The results were analysed in adjusted multivariable linear and logistic regression models.

Results

This large‐scale study revealed that lower MED was consistently associated with lighter skin [β‐coefficient = −0.33, 95% confidence interval (CI) −0.36 to 0.30, P = 6.41 × 10⁻⁸⁴]. Females had significantly higher MED than male (β = 0.91, 0.32–1.50, P = 2.93 × 10⁻³). Stratified analyses showed that MED was not associated with age [female: odds ratio (OR) = 0.99, 0.98–1.01; male: OR = 0.99, 0.97–1.00]. MED was lower in summer than in other seasons (spring: OR = 1.08, 1.06–1.11; autumn: OR = 1.11, 1.08–1.13; winter: OR = 1.20, 1.18–1.22). Furthermore, MED was associated with air temperature (β = −0.36, −0.49 to 0.23, P = 4.81 × 10⁻⁸) and air pressure (β = −0.64, −0.82 to 0.46, P = 8.01 × 10⁻¹²) in summer only while not in other seasons.

Conclusions

This study provides unprecedented evidence that MED is associated with skin colour, sex, season and meteorological factors, but not with age.

[Research progress of vertigo and sleep disorder]

Summary Sleep disorders are commonly encountered in patients with vertigo. Comorbid of them is a major clinical challenge as the outcomes of both conditions are worsened by each other. The sleep and vertigo issues that are covered in this review are epidemiology, possible mechanisms and pathogenesis, and most recent clinical studies. In addition, treatment recommendations on vertigo patients with sleep disorders are discussed briefly. The multiple interactions between vertigo and sleep disorders underscore the need for improving the ability to deal with comorbidity.

[The prevalence and causes of hyponatremia in hospitalized patients]

Objective: The study was aimed to investigate the prevalence and causes of hyponatremia in hospitalized patients, and to analyze the relationship between hyponatremia and mortality. Methods: A retrospective analysis was carried out in 525 patients with hyponatremia, who were older than 14 years old and hospitalized in the Zhoushan Hospital from Jan. 2014 to Apr. 2014. Based on the severity of the hyponatremia the patients were divided into three groups: the mild, moderate and severe hyponatremia groups. The underlying causes of hyponatremia were analyzed, and the association between hyponatremia and mortality was explored using logistic regression analyses. Results: (1) The prevalence of hyponatremia was 5.26% in whole hospitalized patients (n=9 989) during the study period. It was 6.1% in the elderly population (≥60 years old). (2) Malignant tumors and infectious diseases were the main primary diseases of hyponatremia in all three groups. Among them, lung cancer was the most common malignant tumor, and pneumonia was the most common infectious disease associated with hyponatremia. Cerebral hemorrhage was common in patients with moderate and severe hyponatremia, in which subarachnoid hemorrhage was the major primary disease associated with moderate to severe hyponatremia. In the subgroup of elderly patients, malignant tumor and infectious diseases were the major basic diseases. (3) Among the 525 cases, 13.7% and 3.8% of them were diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS), respectively. The proportions of SIADH and CSWS increased to 17.4% and 4.2%, respectively, in the elderly hyponatremic patients (n=264). (4) More patients were prescribed with sodium-excretion drugs in the moderate and severe hyponatremia groups than those in the mild one(42.2% vs.21.4%, 43.2% vs.21.4%, all P<0.05). (5) Patients with moderate or severe hyponatremia had a higher mortality compared to those with mild hyponatremia (moderate vs. mild group: OR 6.92, 95%CI 2.53-18.92, P<0.001; severe vs. mild group: OR 4.54, 95%CI 1.05-19.58, P=0.043). Conclusions: Hyponatremia was common in hospitalized patients. The major primary diseases were malignant tumor (lung cancer), infectious diseases (pneumonia) and cerebral hemorrhage complicated with SIADH and CSWS. Use of sodium-excretion drugs increased the risk of moderate to severe hyponatremia. Patients with moderate to severe hyponatremia had a higher risk of death in hospitals.