[Study on the overall implementation status of the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases]

Objective: To understand the current overall status of implementation on the National Demonstration Areas of Comprehensive Prevention and Control of Non-communicable Diseases. Methods: According to the scheme design of the questionnaires, all the National Demonstration Areas were involved in this study. For each National Demonstration Areas, eight departments were selected to complete a total of 12 questionnaires. Results: Scores related to the implementation of the National Demonstration Areas accounted for 71.8% of the total 170 points. Based on the scores gathered from this study, the 23-items-index-system that represented the status of project implementation was classified into seven categories. Categories with higher percentile scores would include: monitoring (88.0%), safeguard measures (75.0%), health education and health promotion (75.0%). Categories with lower percentile scores would include: the national health lifestyle actions (67.7%), community diagnosis (66.7%), discovery and intervention of high-risk groups (64.7%), and patient management (60.9%). There were significant differences noticed among the eastern, central and western areas on items as safeguard measures, health education/promotion, discovery and intervention of high-risk groups. In all, the implementation programs in the eastern Demonstration Areas seemed better than in the central or western regions. As for the 23 items, five of the highest scores appeared on policy support, mortality surveillance, tumor registration, reporting system on cardiovascular/cerebrovascular events, and on tobacco control, respectively. However, the lowest five scores fell on healthy diet, patient self-management program, oral hygiene, setting up the demonstration units and promotion on basic public health services, respectively. The overall scores in the eastern region was higher than that in the central or the western regions. The scores in the central and western regions showed basically the same. Conclusions: The overall status of implementation on the National Demonstration Areas was satisfactory. Future attention should be focusing on patient management as well as discovery and intervention of high-risk groups, which also presented the lowest scores, in this survey.

Sialoblastoma in chin and management of treatment

OBJECTIVE

Sialoblastoma is a rare salivary gland tumor mainly located in parotid. In this article, we aimed to review the clinical manifestations and treatments of sialoblastoma, especially to provide effective chemotherapy regimens to instruct internal medicine therapy for unresectable or recurrent tumors.

METHOD

We reported a 1-year old girl who presented a left-sided firm facial mass and subsequently diagnosed as sialoblastoma. Afterwards, we reviewed and analyzed relevant literatures.

RESULTS

Sixty-four cases of pediatric sialoblastoma were reviewed. Of them, surgical excision was the basic treatment, 17 cases received chemotherapy, and 15 cases got good response. Lung metastasis was reported in six patients, all of whom had good response to chemotherapy.

CONCLUSION

Chemotherapy may play an important role in residual, extensive, metastatic and relapsed cases. In addition, lung metastasis was unlikely to exert a significant effect on prognosis.

Laser Q-switching with PtS2 microflakes saturable absorber

Numerous studies have been conducted to explore the performance of two-dimensional (2D) layered nano-materials based saturable absorber (SA) for pulsed laser applications. However, fabricating materials in nanoscale requires complicated preparation processes, high energy consumption, and high expertise. Hence, the study of pulsed laser performance based on the saturable absorber prepared by layered materials with bulk-micro size have gained a great attention. Platinum disulfide (PtS₂), which is newly developed group 10 2D layered materials, offers great potential for the laser photonic applications owing to its high carrier mobility, broadly tunable natural bandgap energy, and stability. In this work, the first passively Q-switched Erbium (Er) doped fiber laser is demonstrated with an operational wavelength of 1568.8 nm by using PtS₂ microflakes saturable absorber, fabricated by a simple liquid exfoliation in N-Methyl-2-pyrrolidone (NMP) and then incorporated into polyvinyl alcohol (PVA) polymer thin film. A stable Q-switched laser operation is achieved by using this PtS₂-SA within a fiber laser ring cavity. The maximum average output power is obtained as 1.1 mW, corresponding to the repetition rate of 24.6 kHz, the pulse duration of 4.2 μs, and single pulse energy of 45.6 nJ. These results open up new applications of this novel PtS₂ layered material.

[Application of autoregressive integrated moving average model in predicting the reported notifiable communicable diseases in China]

Objective: To develop the models for predicting the reported legally notifiable diseases in China. Autoregressive integrated moving average (ARIMA) model was applied to forecast the trend of diseases. Methods: Cases used for building the model were from of the records of Notifiable Infectious Diseases in China from May 2009 to July 2016 with R software and the model's predictive ability was tested by the data from August 2016 to January 2017. Results: A strong seasonal nature was seen in the reported cases of notifiable communicable diseases, with the lowest point in February and highest peak in June. ARIMA (4, 1, 0) (1, 1, 1)(12) model was established by the team to forecast the notifiable communicable diseases. Data showed that the biggest and lowest relative errors appeared as 9.78% and 2.21%, respectively, with the mean of the relative error as 5.39%. Conclusion: Based on the results of this study, the ARIMA (4, 1, 0) (1, 1, 1)(12) model seemed to have had the sound prediction of notifiable communicable diseases in China.

Discussion of “The Evolution of Boosting Algorithms” and “Extending Statistical Boosting”

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the papers “The Evolution of Boosting Algorithms – From Machine Learning to Statistical Modelling” [1] and “Extending Statistical Boosting – An Overview of Recent Methodological Developments” [2], written by Andreas Mayr and co-authors. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Mayr et al. papers. In sub-sequent issues the discussion can continue through letters to the editor.

Clinical features and outcomes in secondary adult hemophagocytic lymphohistiocytosis

BACKGROUND

Hemophagocytic lymphohistiocytosis (HLH) is a rare clinical syndrome characterized by an infrequent but immune-mediated life-threatening disease, with confusing clinical manifestations, rapidly deteriorating health, high morbidity and mortality and challenging diagnosis.

AIM

The purpose of this study was to improve the recognition and understanding of HLH.

DESIGN

Retrospective observational cross-sectional study.

METHODS

Data were collected for all cases of adult patients diagnosed with HLH in a large cohort managed at a single medical center from January 2011 to December 2015.

RESULTS

The median age was 52 years (range 18-90 years) and 123 (60.0%) were male. Over 95% patients manifested fever, hyperferritinemia and elevated lactate dehydrogenase. Underlying triggers of HLH were as follows: 119 (58.0%) malignancies, 83 (40.5%) infections, 14 (6.8%) unknown triggers and 14 (6.8%) autoimmune disorders. The median overall survival was 55 days. And elderly patients (age ≥60 years) had a markedly worse survival compared with young patients (age <60 years) (median overall survival 24 days vs. 159 days, respectively; P <0.001). In a multivariable analysis, platelet <40 × 109/l (HR = 2.534; 95% CI 1.152-5.573; P = 0.021), PT prolonged >3 s (HR = 1.909; 95% CI 1.127-3.234; P = 0.016) and malignancy (HR = 1.614; 95% CI 1.008-2.582; P = 0.046) were correlated with poor survival.

CONCLUSION

HLH adult patients had very complex clinical manifestations as well as underlying diseases. Patients with PLT <40 ×109/l, PT prolonged >3 s and malignancy had inferior survival. It is of great importance to improve our understanding of this syndrome.

Aberrant Thalamocortical Connectivity in Juvenile Myoclonic Epilepsy

The purpose of this study was to investigate the functional connectivity (FC) of thalamic subdivisions in patients with juvenile myoclonic epilepsy (JME). Resting state functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) data were acquired from 22 JME and 25 healthy controls. We first divided the thalamus into eight subdivisions by performing independent component analysis on tracking fibers and clustering thalamus-related FC maps. We then analyzed abnormal FC in each subdivision in JME compared with healthy controls, and we investigated their associations with clinical features. Eight thalamic sub-regions identified in the current study showed unbalanced thalamic FC in JME: decreased FC with the superior frontal gyrus and enhanced FC with the supplementary motor area in the posterior thalamus increased thalamic FC with the salience network (SN) and reduced FC with the default mode network (DMN). Abnormalities in thalamo-prefrontocortical networks might be related to the propagation of generalized spikes with frontocentral predominance in JME, and the network connectivity differences with the SN and DMN might be implicated in emotional and cognitive defects in JME. JME was also associated with enhanced FC among thalamic sub-regions and with the basal ganglia and cerebellum, suggesting the regulatory role of subcortical nuclei and the cerebellum on the thalamo-cortical circuit. Additionally, increased FC with the pallidum was positive related with the duration of disease. The present study provides emerging evidence of FC to understand that specific thalamic subdivisions contribute to the abnormalities of thalamic-cortical networks in JME. Moreover, the posterior thalamus could play a crucial role in generalized epileptic activity in JME.

Dusky works upstream of Four-jointed and Forked in wing morphogenesis in Tribolium castaneum

Dusky (dy) is required for cytoskeletal reorganization during wing morphogenesis in Drosophila melanogaster, but which genes participate together with dy for wing morphogenesis has remained unclear. In Tribolium castaneum, dy is highly expressed at the late embryonic stage. Tissue-specific expression analysis indicated high expression levels of dy in the epidermis, head and fat body of late-stage larvae. RNA interference (RNAi) targeting dy significantly decreased adult wing size and caused improper folding of the elytra. Meanwhile, dy knockdown reduced the transcription of four-jointed (fj) and forked (f). Our results show that fj RNAi reduces adult wing size and that silencing f results in abnormal wing folding in T. castaneum. Interestingly, knocking down fj and f simultaneously phenocopies dy RNAi, suggesting that dy probably acts upstream of fj and f to regulate wing morphogenesis in T. castaneum.

[Current status of folic acid supplementation in women at child-bearing age in suburban area of Beijing]

Objective: To access the current status of folic acid supplementation in women at childbearing age in suburban area of Beijing, 2016. Methods: In this cross-sectional study, a total of 722 women aged 17-41 years from six hospitals in suburban areas of Beijing were selected through cluster sampling. A questionnaire survey was conducted. Results: The rates of folic acid intake and regular folic acid intake among women under survey were 63.9% (456/714) and 83.3% (380/456). In women who remembered the duration of folic acid supplementation, the overall rate of preconceptional folic acid supplementation was 35.5% (159/450), in whom 27.3% (123/450) began to take folic acid 0-3 months before pregnancy; 8.0% (36/450) began to take folic acid 3 months before pregnancy. Multivariate logistic regression analysis indicated that household registering type, preparation for pregnancy or pregnancy, parity, smoking and alcohol use were the influencing factors for folic acid supplementation. Conclusions: The rate of folic acid supplementation remained low in childbearing aged women in suburban area of Beijing. It is necessary to further strengthen the health education about the importance of folic acid supplementation to improve the intake rate and the regular intake rate of folic acid in pregnant women and to promote maternal infant health and reduce the related complications.

Microindentation - a tool for measuring cortical bone stiffness? A systematic review

Objectives

Microindentation has the potential to measure the stiffness of an individual patient’s bone. Bone stiffness plays a crucial role in the press-fit stability of orthopaedic implants. Arming surgeons with accurate bone stiffness information may reduce surgical complications including periprosthetic fractures. The question addressed with this systematic review is whether microindentation can accurately measure cortical bone stiffness.

Methods

A systematic review of all English language articles using a keyword search was undertaken using Medline, Embase, PubMed, Scopus and Cochrane databases. Studies that only used nanoindentation, cancellous bone or animal tissue were excluded.

Results

A total of 1094 abstracts were retrieved and 32 papers were included in the analysis, 20 of which used reference point indentation, and 12 of which used traditional depth-sensing indentation. There are several factors that must be considered when using microindentation, such as tip size, depth and method of analysis. Only two studies validated microindentation against traditional mechanical testing techniques. Both studies used reference point indentation (RPI), with one showing that RPI parameters correlate well with mechanical testing, but the other suggested that they do not.

Conclusion

Microindentation has been used in various studies to assess bone stiffness, but only two studies with conflicting results compared microindentation with traditional mechanical testing techniques. Further research, including more studies comparing microindentation with other mechanical testing methods, is needed before microindentation can be used reliably to calculate cortical bone stiffness.

Cite this article: M. Arnold, S. Zhao, S. Ma, F. Giuliani, U. Hansen, J. P. Cobb, R. L. Abel, O. Boughton. Microindentation – a tool for measuring cortical bone stiffness? A systematic review. Bone Joint Res 2017;6:542–549. DOI: 10.1302/2046-3758.69.BJR-2016-0317.R2.

High-dose dexamethasone or all-trans-retinoic acid restores the balance of macrophages towards M2 in immune thrombocytopenia

Essentials M1/M2 imbalance is involved in many autoimmune diseases, and could be restored. The expressions and functions of M1 and M2 were investigated in an in vitro culture system. A preferred M1 polarization is involved in the pathogenesis of immune thrombocytopenia (ITP). High-dose dexamethasone or all-trans-retinoic acid restores M1/M2 balance in ITP patients.

SUMMARY

Background Immune thrombocytopenia (ITP) is an autoimmune disorder. Deficiency of immune tolerance in antigen-presenting cells and cross-communication between antigen-presenting cells and T cells are involved in the pathogenesis of ITP. Macrophages can polarize into proinflammatory M1 or anti-inflammatory M2 phenotypes in response to different environmental stimuli, and have diverse immunologic functions. Objectives To investigate the M1/M2 imbalance in ITP and whether high-dose dexamethasone (HD-DXM) or all-trans-retinoic acid (ATRA) could restore this imbalance. Methods The numbers of M1 and M2 macrophages in the spleens of ITP patients and patients with traumatic spleen rupture were analyzed by immunofluorescence. Monocyte-derived macrophages were cultured and induced with cytokines and drugs. The expression of M1 and M2 markers and functions of M1 and M2 macrophages before and after modulation by HD-DXM or ATRA were evaluated with flow cytometry and ELISA. Results There was preferred M1 polarization in ITP spleens as compared with healthy controls. Monocyte-derived macrophages from ITP patients had increased expression of M1 markers and impaired immunosuppressive functions. Either HD-DXM or ATRA corrected this imbalance by decreasing the expression of M1 markers and increasing the expression of M2 markers. Moreover, HD-DXM-modulated or ATRA-modulated macrophages suppressed both CD4+ and CD8+ T-cell proliferation and expanded CD4+ CD49+ LAG3+ type 1 T-regulatory cells. HD-DXM or ATRA modulated macrophages to shift the T-cell cytokine profile towards Th2. Treating patients with HD-DXM or ATRA revealed that macrophages induced from responders showed a predominant M2-like phenotype and immunosuppressive function. Conclusions Aberrant macrophage polarization is involved in the pathogenesis of ITP. Either HD-DXM or ATRA is able to correct this imbalance.

Enhanced Photocatalytic Activity of WS2 Film by Laser Drilling to Produce Porous WS2/WO3 Heterostructure

Methods and mechanisms for improvement of photocatalytic activity, are important and popular research topics for renewable energy production and waste water treatment. Here, we demonstrate a facile laser drilling method for engineering well-aligned pore arrays on magnetron-sputtered WS2 nanofilms with increased active edge sites; the proposed method promotes partial oxidation to fabricate WS2/WO3 heterojunctions that enhance the separation of photogenerated electron-hole pairs. The WS2 film after one, two, and three treatments exhibited photocurrent density of 3.9, 6.2, and 8 μA/cm2, respectively, reaching up to 31 times larger than that of pristine WS2 film along with greatly improved charge recombination kinetics. The unprecedented combinational roles of laser drilling revealed in this study in regards to geometric tailoring, chemical transformation, and heterojunction positioning for WS2-based composite nanomaterials create a foundation for further enhancing the performance of other 2D transition metal dichalcogenides in photocatalysis via laser treatment.