SFTSV infection is associated with transient overproliferation of monoclonal lambda-type plasma cells

The impairment of antibody-mediated immunity is a major factor associated with fatal cases of severe fever with thrombocytopenia syndrome (SFTS). By collating the clinical diagnosis reports of 30 SFTS cases, we discovered the overproliferation of monoclonal plasma cells (MCP cells, CD38⁺cLambda⁺cKappa^-) in bone marrow, which has only been reported previously in multiple myeloma. The ratio of CD38⁺cLambda⁺ versus CD38⁺cKappa⁺ in SFTS cases with MCP cells was significantly higher than that in normal cases. MCP cells presented transient expression in the bone marrow, which was distinctly different from multiple myeloma. Moreover, the SFTS patients with MCP cells had higher clinical severity. Further, the overproliferation of MCP cells was also observed in SFTS virus (SFTSV)-infected mice with lethal infectious doses. Together, SFTSV infection induces transient overproliferation of monoclonal lambda-type plasma cells, which have important implications for the study of SFTSV pathogenesis, prognosis, and the rational development of therapeutics.

Host inflammatory response is the major factor in the progression of Chlamydia psittaci pneumonia

Purpose

Chlamydia psittaci (C. psittaci) has caused sporadic, but recurring, fatal community-acquired pneumonia outbreaks worldwide, posing a serious threat to public health. Our understanding of host inflammatory responses to C. psittaci is limited, and many bronchitis cases of psittaci have rapidly progressed to pneumonia with deterioration.

Methods

To clarify the host inflammatory response in psittacosis, we analyzed clinical parameters, and compared transcriptomic data, concentrations of plasma cytokines/chemokines, and changes of immune cell populations in 17 laboratory-confirmed psittacosis cases, namely, 8 pneumonia and 9 bronchitis individuals, in order to assess transcriptomic profiles and pro-inflammatory responses.

Results

Psittacosis cases with pneumonia were found to have abnormal routine blood indices, liver damage, and unilateral pulmonary high-attenuation consolidation. Transcriptome sequencing revealed markedly elevated expression of several pro-inflammatory genes, especially interleukins and chemokines. A multiplex-biometric immunoassay showed that pneumonia cases had higher levels of serum cytokines (G-CSF, IL-2, IL-6, IL-10, IL-18, IP-10, MCP-3, and TNF-α) than bronchitis cases. Increases in activated neutrophils and decreases in the number of lymphocytes were also observed in pneumonia cases.

Conclusion

We identified a number of plasma biomarkers distinct to C. psittaci pneumonia and a variety of cytokines elevated with immunopathogenic potential likely inducing an inflammatory milieu and acceleration of the disease progression of psittaci pneumonia. This enhances our understanding of inflammatory responses and changes in vascular endothelial markers in psittacosis with heterogeneous symptoms and should prove helpful for developing both preventative and therapeutic strategies.

Pneumonia Severity and Phase Linked to Virus-Specific T Cell Responses with Distinct Immune Checkpoints during pH1N1 Infection

The detailed features and the longitudinal variation of influenza-specific T cell responses within naturally infected patients and the relationship with disease severity remain uncertain. In this study, we characterized the longitudinal influenza-specific CD4⁺ and CD8⁺ T cell responses, T cell activation, and migration-related cytokine/chemokine secretion in pH1N1-infected patients with or without viral pneumonia with human PBMCs. Both the influenza-specific CD4⁺ and CD8⁺ T cells presented higher responses in patients with severe infection than in mild ones, but with distinct longitudinal variations, phenotypes of memory markers, and immune checkpoints. At 7 ± 3 d after onset of illness, effector CD8⁺ T cells (CD45RA⁺CCR7^-) with high expression of inhibitory immune receptor CD200R dominated the specific T cell responses. However, at 21 ± 3 d after onset of illness, effector memory CD4⁺ T cells (CD45RA^-CCR7^-) with high expression of PD1, CTLA4, and LAG3 were higher among the patients with severe disease. The specific T cell magnitude, T cell activation, and migration-related cytokines/chemokines possessed a strong connection with disease severity. Our findings illuminate the distinct characteristics of immune system activation during dynamic disease phases and its correlation with lung injury of pH1N1 patients.

Seroprevalence of influenza viruses in Shandong, Northern China during the COVID-19 pandemic

Nonpharmaceutical interventions (NPIs) have been commonly deployed to prevent and control the spread of the coronavirus disease 2019 (COVID-19), resulting in a worldwide decline in influenza prevalence. However, the influenza risk in China warrants cautious assessment. We conducted a cross-sectional, seroepidemiological study in Shandong Province, Northern China in mid-2021. Hemagglutination inhibition was performed to test antibodies against four influenza vaccine strains. A combination of descriptive and meta-analyses was adopted to compare the seroprevalence of influenza antibodies before and during the COVID-19 pandemic. The overall seroprevalence values against A/H1N1pdm09, A/H3N2, B/Victoria, and B/Yamagata were 17.8% (95% CI 16.2%-19.5%), 23.5% (95% CI 21.7%-25.4%), 7.6% (95% CI 6.6%-8.7%), and 15.0 (95% CI 13.5%-16.5%), respectively, in the study period. The overall vaccination rate was extremely low (2.6%). Our results revealed that antibody titers in vaccinated participants were significantly higher than those in unvaccinated individuals (P < 0.001). Notably, the meta-analysis showed that antibodies against A/H1N1pdm09 and A/H3N2 were significantly low in adults after the COVID-19 pandemic (P < 0.01). Increasing vaccination rates and maintaining NPIs are recommended to prevent an elevated influenza risk in China.

One-Year Sustained Cellular and Humoral Immunities in Coronavirus Disease 2019 (COVID-19) Convalescents

BACKGROUND

The longitudinal antigen-specific immunity in COVID-19 convalescents is crucial for long-term protection upon individual re-exposure to SARS-CoV-2, and even more pivotal for ultimately achieving population-level immunity. We conducted this cohort study to better understand the features of immune memory in individuals with different disease severities at 1 year post-disease onset.

METHODS

We conducted a systematic antigen-specific immune evaluation in 101 COVID-19 convalescents, who had asymptomatic, mild, moderate, or severe disease, through 2 visits at months 6 and 12 after disease onset. The SARS-CoV-2-specific antibodies, comprising neutralizing antibody (NAb), immunoglobulin (Ig) G, and IgM, were assessed by mutually corroborated assays (ie, neutralization, enzyme-linked immunosorbent assay [ELISA], and microparticle chemiluminescence immunoassay [MCLIA]). Meanwhile, T-cell memory against SARS-CoV-2 spike, membrane, and nucleocapsid proteins was tested through enzyme-linked immunospot assay (ELISpot), intracellular cytokine staining, and tetramer staining-based flow cytometry, respectively.

RESULTS

SARS-CoV-2-specific IgG antibodies, and NAb, can persist among >95% of COVID-19 convalescents from 6 to 12 months after disease onset. At least 19/71 (26%) of COVID-19 convalescents (double positive in ELISA and MCLIA) had detectable circulating IgM antibody against SARS-CoV-2 at 12 months post-disease onset. Notably, numbers of convalescents with positive SARS-CoV-2-specific T-cell responses (≥1 of the SARS-CoV-2 antigen S1, S2, M, and N proteins) were 71/76 (93%) and 67/73 (92%) at 6 and 12 months, respectively. Furthermore, both antibody and T-cell memory levels in the convalescents were positively associated with disease severity.

CONCLUSIONS

SARS-CoV-2-specific cellular and humoral immunities are durable at least until 1 year after disease onset.

Rapid humoral immune responses are required for recovery from haemorrhagic fever with renal syndrome patients

Haemorrhagic fever with renal syndrome (HFRS) following Hantaan virus (HTNV) infection displays variable clinical signs. Humoral responses elicited during HTNV infections are considered important, however, this process remains poorly understood. Herein, we have investigated the phenotype, temporal dynamics, and characteristics of B-cell receptor (BCR) repertoire in an HFRS cohort. The serological profiles were characterized by a lowered expression level of nucleoprotein (NP)-specific antibody in severe cases. Importantly, B-cell subsets were activated and proliferated within the first two weeks of symptom onset and moderate cases reacted more rapidly. BCR analysis in the recovery phase revealed a dramatic increase in the immunoglobulin gene diversity which was more significantly progressed in moderate infections. In severe cases, B-cell-related transcription was lower with inflammatory sets overactivated. Taken together, these data suggest the clinical signs and disease recovery in HFRS patients were positively impacted by rapid and efficacious humoral responses.

Local is “lekker”

Local anaesthetics agents (LAA) are used ubiquitously in the medical field and in a wide variety of ways: tissue infiltration, perineural, intra-articular and intravenous. The purpose of this review is to explore the pharmacology of LAAs and to examine the clinical applications for LAAs.

Two passions, one goal, and a pandemic: the future of medical education in South Africa

Medical education in South Africa is experiencing two major disruptions: the Fourth Industrial Revolution and the COVID-19 pandemic. I will explore the effects these events have had on our education and possible solutions in the context of our country.

Clinical and Immunological Characteristics of Human Infections With H5N6 Avian Influenza Virus

BACKGROUND

H5N6 avian influenza virus (AIV) has caused sporadic, recurring outbreaks in China and Southeast Asia since 2013, with 19 human infections and 13 deaths. Seventeen of these infections occurred since December 2015, indicating a recent rise in the frequency of H5N6 cases.

METHODS

To assess the relative threat of H5N6 virus to humans, we summarized and compared clinical data from patients infected with H5N6 (n = 19) against data from 2 subtypes of major public health concern, H5N1 (n = 53) and H7N9 (n = 160). To assess immune responses indicative of prognosis, we compared concentrations of serum cytokines/chemokines in patients infected with H5N6, H5N1, H7N9, and 2009 pandemic H1N1 and characterized specific immune responses from 1 surviving and 2 nonsurviving H5N6 patients.

RESULTS

H5N6 patients were found to have higher incidences of lymphopenia and elevated alanine aminotransferase and lactate dehydrogenase levels compared with H5N1 and H7N9 patients. Hypercytokinemia was detected at substantially higher frequencies from H5N6 patients compared to those infected with other AIV subtypes. Evaluation of adaptive immunity showed that both humoral and cellular responses could be detected in the H5N6-infected survivor, but cellular responses were absent in the nonsurvivors. In addition, the surviving patient had lower concentrations of both pro- and anti-inflammatory cytokines/chemokines compared to the nonsurvivors.

CONCLUSIONS

Our results support that H5N6 virus could potentially be a major public health threat, and suggest it is possible that the earlier acquisition of cellular immunity and lower concentrations of cytokines/chemokines contributed to survival in our patient. Analysis of more patient samples will be needed to draw concrete conclusions.

Avian Influenza A Viruses among Occupationally Exposed Populations, China, 2014-2016

To determine the seroprevalence and seroconversion of avian influenza virus (AIV) antibodies in poultry workers, we conducted a seroepidemiologic study in 7 areas of China during December 2014–April 2016. We used viral isolation and reverse transcription PCR to detect AIVs in specimens from live poultry markets. We analyzed 2,124 serum samples obtained from 1,407 poultry workers by using hemagglutination inhibition and microneutralization assays. We noted seroprevalence of AIV antibodies for subtypes H9N2, H7N9, H6N1, H5N1-SC29, H5N6, H5N1-SH199, and H6N6. In serum from participants with longitudinal samples, we noted seroconversion, with >4-fold rise in titers, for H9N2, H7N9, H6N1, H5N1-SC29, H6N6, H5N6, and H5N1-SH199 subtypes. We found no evidence of H10N8 subtype. The distribution of AIV antibodies provided evidence of asymptomatic infection. We found that AIV antibody prevalence in live poultry markets correlated with increased risk for H7N9 and H9N2 infection among poultry workers.

[Clinical characteristics of myelin oligodendrocyte glycoprotein antibody associated myelitis]

Objective: To evaluate the clinical characteristics of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) associated myelitis in a cohort of Chinese Han adults. Methods: From January 2016 to December 2017, 70 patients with MOG-IgG associated disorders (MOGAD) and 120 patients with aquaporin 4 antibody (AQP4-IgG) positive neuromyelitis optica spectrum disorders (NMOSD) visited the NMO/MS clinic or the neurology ward of Huashan Hospital, and the neurophthalmology clinic of Eye and ENT hospital, Shanghai Medical College, Fudan University were enrolled. The clinical and paraclinical data of the patients were retrospectively reviewed. The characteristics of MOG-IgG associated myelitis were further clarified. Results: Sixteen of the 70 patients with MOGAD had ever experienced myelitis. The frequency of myelitis was 18.6% at the first attack and 22.9% throughout the disease duration. The onset age of MOG-IgG associated myelitis was 9-57(30±11) years, and the female to male ratio was 0.6∶1. Compared with AQP4-IgG positive myelitis attacks, MOG-IgG associated myelitis attacks were more common to be accompanied by feverish prodromal symptom (30.8%) while less common to exhibit painful tonic (12.5%). Longitudinally extensive myelitis (>3 vertebral segments) was less frequent (56.3%), and short-segment myelitis and multiple short-segment myelitis could also be seen. MRI showed that MOGAD patients had more lower spinal cord lesions (20%), fewer cervical cord lesions (40%) and less transverse lesions (52%). Axial H sign was a distinct feature (36%). MOG-IgG associated myelitis attack also demonstrated a lower EDSS score after treatment. Conclusion: MOG-IgG associated myelitis should be recognized as an important clinical component of MOGAD.

Diverse biological characteristics and varied virulence of H7N9 from Wave 5

There was a substantial increase with infections of H7N9 avian influenza virus (AIV) in humans during Wave 5 (2016-2017). To investigate whether H7N9 had become more infectious/transmissible and pathogenic overall, we characterized the receptor binding and experimentally infected ferrets with highly pathogenic (HP)- and low pathogenic (LP)-H7N9 isolates selected from Wave 5, and compared their pathogenicity and transmissibility with a Wave 1 isolate from 2013. Studies show that A/Anhui/1/2013 (LP) and A/Chicken/Heyuan/16876/2016 (HP) were highly virulent in ferrets, A/Guangdong/Th008/2017 (HP) and A/Chicken/Huizhou/HZ-3/2017 (HP) had moderate virulence and A/Shenzhen/Th001/2016 (LP) was of low virulence in ferrets. Transmission was observed only in ferrets infected with A/Anhui/1/2013 and A/Chicken/Heyuan/16876/2016, consistent with the idea that sicker ferrets had a higher probability to transmit virus to naive animals. Given the Varied virulence and transmissibility observed in circulating H7N9 viruses from Wave 5, we conclude that the current public health risk of H7N9 has not substantially increased compared to 2013 and the circulating viruses are quite diverse.

Morphine spinals: ICU or ward?

No abstract available.

Cryptoanalysis on optical image encryption systems based on the vector decomposition technique in the Fourier domain

In this paper, the security of optical cryptosystems based on the vector decomposition technique in the Fourier domain is analyzed. Compared to the conventional cryptosystem based on the equal modulus decomposition (EMD) technique, an additional EMD structure is introduced in the cascaded EMD-based cryptosystem; hence, the mask including the phase information of the Fourier spectrum is further encoded in the second EMD structure to enhance the security level. However, it is shown that the number of the private keys has not been increased in the cascaded EMD-based cryptosystem, which makes it possible to crack the cascaded EMD-based cryptosystem. Therefore, a chosen-plaintext attack (CPA) and a special attack with an arbitrarily given private key are proposed to retrieve information from encoded images obtained by the cascaded EMD-based cryptosystem. In addition, the security of the cryptosystem based on the random modulus decomposition (RMD) technique is also analyzed. Compared to the EMD-based cryptosystem in which the Fourier spectrum is decomposed into two vectors with equal moduli, the security level of the cryptosystem has been improved by using the RMD technique to decompose the spectrum into vectors with unequal moduli to decrease the number of the amplitude constraints. However, it is found that the arbitrarily given ciphertext provides the attackers enough information to retrieve the precise information of the plaintext without any knowledge of the private keys. A special attack is proposed to crack the RMD-based cryptosystem. This is the first time to report that these two cryptosystems based on the vector decomposition technique are attacked successfully. Numerical simulation is conducted to validate the feasibility and effectiveness of the proposed attacks.

Security analysis and enhancement of a cryptosystem based on phase truncation and a designed amplitude modulator

In this paper, the security of a cryptosystem based on phase truncation and a designed amplitude modulator (AM) is evaluated. In the cryptosystem, an undercover AM used as an additional key is added to modulate the amplitude information of the spectrum in the Fourier plane. Compared to the conventional phase-truncated Fourier transform (PTFT)-based cryptosystem, the security of the cryptosystem is improved by increasing the number of unknown keys. However, it is found that the designed AM is irrelative to the plaintext, and one of the parameters in the designed AM contributes less to the security enhancement of the cryptosystem due to low key sensitivity. Based on the analysis, a special attack containing two iterative processes is proposed to crack the cryptosystem, in which the known-plaintext-attack-based iterative process I with a specific normalization operator is used to retrieve the designed AM and the amplitude-phase-retrieval-technique-based iterative process II is used to retrieve the corresponding plaintext from the arbitrarily given ciphertext with the help of the retrieved AM. In addition, an inherent drawback widely existing in PTFT-based cryptosystems is reported for the first time: most information of the original image could be retrieved using two correct phase keys (or only the first phase key) generated in the encryption process, even without the corresponding ciphertext in PTFT-based cryptosystems. To address this issue, a security-enhanced cryptosystem is proposed in this paper. Numerical simulation is carried out to demonstrate the effectiveness and feasibility of the proposed attack and cryptosystem.

Comparison between human infections caused by highly and low pathogenic H7N9 avian influenza viruses in Wave Five: Clinical and virological findings

OBJECTIVE

The newly emerged highly pathogenic (HP) H7N9 avian influenza virus during Wave Five has caused 28 human infections, while differences in disease severity between low pathogenic (LP)- and HP-H7N9 human infections remain unclear.

METHODS

Clinical data, concentrations of serum cytokines, dynamics of virus shedding and PaO₂/FiO₂ from patients infected with LP-H7N9 (n = 7, LP group) and HP-H7N9 (n = 5, HP group) viruses during Wave Five were compared. In addition, critical mutations associated with H7N9 virulence in mammal/human were analyzed.

RESULTS

Lymphopenia, elevated aspartate aminotransferase, alanine aminotransferase, C-reactive protein and lactate dehydrogenase were common features, with higher incidences of leukopenia and thrombocytopenia in the LP group. The acute phase of both groups was accompanied with elevated cytokines associated with disease severity, including MIF, MCP-1 and IP-10. Diffuse exudation of the lungs and consolidation were observed from all patients. The dynamics of virus shedding and PaO₂/FiO₂ were similar between both groups. Notably, a higher prevalence of neuraminidase inhibitors (NAIs) resistance in the HP-H7N9 virus was found.

CONCLUSIONS

Our results indicate that this newly emerged HP-H7N9 virus caused similar disease severity in humans compared with LP-H7N9 virus, while higher case fatality rate and prevalence of NAI-resistance in human HP-H7N9 infections were of great concern.

Continued reassortment of avian H6 influenza viruses from Southern China, 2014-2016

H6 subtype avian influenza virus (AIV) was prevalent in poultry and could sporadically infect humans. Here, a total of 196 novel H6 AIVs isolated from poultry in eight provinces of China from 2014 to 2016 were phylogenetically characterized. Our analysis revealed that they could be divided into two clades in the Asian H6 HA lineage, A/wild duck/Shantou/2853/2003(H6N2) (ST2853-like) (85.7%) and A/duck/Shantou/339/2000(H6N2) (ST339-like) (14.3%), in which ST2853-like strains predominate. These novel strains belonged to the H6N6 (n = 165, 84.2%), H6N2 (n = 30, 15.3%), and H6N3 (n = 1, 0.51%) subtypes, which could be classified into 36 genotypes including 12 novel genotypes described in this study. In particular, several strains possessed the V190 and S228 mutations in HA (H3 numbering), which is critical for human receptor binding and identical to the human-derived strain A/Taiwan/2/2013(H6N1). Furthermore, 10.3% of the H6N6 isolates possessed the N6-∆11b (59-69) deletion. In summary, we describe phylogenetic and molecular characterizations of H6 AIVs in southern China and highlight the constant prevalence of H6 AIVs in poultry as well as adaptation to mammalian hosts.

Recurrent fungal infections in a Chinese patient with CARD9 deficiency and a review of 48 cases

Deficiency of CARD9 (caspase recruitment domain-containing protein 9) has been reported in individuals with recurrent and invasive fungal infections. We report on a patient who first had Trichosporon asahii affecting the skin then Candida albicans infections involving the digestive tract and knee joint, along with elevated serum IgE. After stimulation with C. albicans, peripheral blood mononuclear cells of this patient produced less tumour necrosis factor-α, interferon-γ and interleukin-17 than those of healthy controls. Furthermore, the serum IgE levels of this patient were positively correlated with the severity of fungal infection during the course of treatment. Sanger sequencing identified one homozygous frameshift mutation (p.D274fsX60) in CARD9. We further performed a review including 48 cases with CARD9 deficiency. According to the data published previously, CARD9-deficient patients demonstrated obviously elevated IgE in serum (median 1300 IU mL^-1 ), which could distinguish them from otherwise healthy people with fungal infections (area under the curve 0·94, P < 0·001). Patients carrying the mutations Q289X and Q295X had a higher mortality rate (24% vs. 0%, P < 0·05). Patients with the mutations R18W, R35Q, R70W, G72S or Y91H in the CARD domain, and the nonsense mutation Q295X in the coiled-coil domain, seemed to be more prone to Candida infections (90% vs. 20%, P < 0·005) and central nervous system infections (60% vs. 12%, P < 0·005).

Prolonged Evolution of Virus-Specific Memory T Cell Immunity after Severe Avian Influenza A (H7N9) Virus Infection

Since 2013, influenza A H7N9 virus has emerged as the most common avian influenza virus subtype causing human infection, and it is associated with a high fatality risk. However, the characteristics of immune memory in patients who have recovered from H7N9 infection are not well understood. We assembled a cohort of 45 H7N9 survivors followed for up to 15 months after infection. Humoral and cellular immune responses were analyzed in sequential samples obtained at 1.5 to 4 months, 6 to 8 months, and 12 to 15 months postinfection. H7N9-specific antibody concentrations declined over time, and protective antibodies persisted longer in severely ill patients admitted to the intensive care unit (ICU) and patients presenting with acute respiratory distress syndrome (ARDS) than in patients with mild disease. Frequencies of virus-specific gamma interferon (IFN-γ)-secreting T cells were lower in critically ill patients requiring ventilation than in patients without ventilation within 4 months after infection. The percentages of H7N9-specific IFN-γ-secreting T cells tended to increase over time in patients ≥60 years or in critically ill patients requiring ventilation. Elevated levels of antigen-specific CD8+ T cells expressing the lung-homing marker CD49a were observed at 6 to 8 months after H7N9 infection compared to those in samples obtained at 1.5 to 4 months. Our findings indicate the prolonged reconstruction and evolution of virus-specific T cell immunity in older or critically ill patients and have implications for T cell-directed immunization strategies.IMPORTANCE Avian influenza A H7N9 virus remains a major threat to public health. However, no previous studies have determined the characteristics and dynamics of virus-specific T cell immune memory in patients who have recovered from H7N9 infection. Our findings showed that establishment of H7N9-specific T cell memory after H7N9 infection was prolonged in older and severely affected patients. Severely ill patients mounted lower T cell responses in the first 4 months after infection, while T cell responses tended to increase over time in older and severely ill patients. Higher levels of antigen-specific CD8+ T cells expressing the lung-homing marker CD49a were detected at 6 to 8 months after infection. Our results indicated a long-term impact of H7N9 infection on virus-specific memory T cells. These findings advance our understanding of the dynamics of virus-specific memory T cell immunity after H7N9 infection, which is relevant to the development of T cell-based universal influenza vaccines.

Hybrid attack on an optical cryptosystem based on phase-truncated Fourier transforms and a random amplitude mask

In this paper, the security of a cryptosystem based on phase-truncated Fourier transforms (PTFTs) and a random amplitude mask (RAM) is evaluated. In the cryptosystem, fake keys used as encryption keys in the second PTFT-based structure are generated by the first PTFT-based structure in which the RAM is encoded by random phase masks (RPMs) used as public keys. Compared to the classical PTFT-based encryption scheme, the security level of the cryptosystem is improved by using cascaded PTFTs to encode the encryption keys and the plaintext simultaneously. However, it is found that a known plaintext-ciphertext pair can provide enough constraints in the iterative process to retrieve the fake keys, which then can be used to retrieve unknown arbitrary plaintext from the corresponding ciphertext. Based on the analysis, we propose a specific attack based on hybrid iterative processes to break the cryptosystem. Two iterative processes with different constraints are involved in the proposed attack. The first known-plaintext-attack (KPA)-based iterative process is used to retrieve two fake keys with the help of two public keys and a known plaintext-ciphertext pair, while the second amplitude-phase retrieval algorithm-based iterative process with a median filter is employed to retrieve the plaintext from the corresponding ciphertext using two retrieval fake keys. To the best of our knowledge, it is the first time that the cryptosystem is attacked by the KPA-based iterative algorithm successfully. Numerical simulation results validate the feasibility and effectiveness of the proposed attack.

Reference-plane-based fast pixel-by-pixel absolute phase retrieval for height measurement

Absolute phase retrieval is essential for height measurement in digital fringe projection. However, projections of additional structured patterns that are normally required for phase unwrapping increase the measurement complexity. In this paper, we propose two reference-plane-based pixel-by-pixel absolute phase retrieval techniques with as few projections as possible, suitable for different object depth ranges. The wrapped phase on the object is absolutely unwrapped by referring just to the absolute phase map on the reference plane. Single-frequency absolute phase retrieval with one-reference-plane-based calibration is first proposed for objects within a height limit that equals a calibrated system constant. To extend the measurement depth range, dual-frequency absolute phase retrieval with two parallel reference planes is further proposed. The additional low frequency is used to choose the unwrapping reference from the two reference plane phases for unwrapping the high-frequency phase. Moreover, the proposed techniques are capable of high-frequency absolute phase unwrapping for objects with step-height surface discontinuities. Experiments have been conducted to demonstrate the efficiency of the proposed two techniques.

Abstract P3-01-06: Can axillary evaluation be omitted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy?

Background

Patients diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) have a great chance of upgrading invasive cancer on the final pathology. Positive axillary lymph nodes can be found in these patients. The present study sought to identify clinicopathological factors associated with upgrading and axillary lymph nodes metastasis in patients preoperatively diagnosed with DCIS by CNB.

Materials and Methods

This study identified 604 patients (cT1-3N0M0) with preoperative diagnosis of pure DCIS by CNB who had undergone axillary evaluation from August 2006 to December 2015 at Fudan University Shanghai Cancer Center (FUSCC). Predictors of upgrading and axillary lymph nodes metastasis were analyzed, respectively.

Results

Of all 604 patients, 513 (84.93%) and 91 (15.07%) patients had undergone sentinel lymph nodes biopsy (SLNB) and axillary lymph nodes dissection (ALND), respectively. Overall, 121 (20.03%) and 193 (31.95%) patients were upgraded to DCIS with microinvasion (DCISM) and IDC on final pathology, respectively. Positive axillary lymph nodes were identified in 41 (6.79%) patients, of which 35 (5.80%) patients had 1-2 positive axillary lymph nodes, 6 (0.99%) patients had 3 or more positive axillary lymph nodes. Among patients with axillary lymph nodes metastasis, 4 (9.76%), 4 (9.76%) and 33 (80.48%) patients were in DCIS, DCISM and IDC group, respectively. Predictors of upgrading included tumor size on ultrasonography (P=0.001), Ki-67 (P=0.046) and molecular subtype (P=0.007) in univariate analysis. In multivariate analysis, patients with larger tumor size on ultrasonography (&gt;2cm) (OR 1.767, P=0.001) were more likely to be upgraded on final pathology. Also, ER+ HER2+ patients were more likely to be upgraded than ER+ HER2- patients (OR 1.659, P=0.047). Factors associated with axillary lymph nodes metastasis included nipple discharge (P&lt;0.001), tumor size on pathology (P=0.037), number of lesions (P=0.039), axillary evaluation methods (P=0.029) and molecular subtype (P=0.049) in univariate analysis. Whereas, only nipple discharge and larger tumor size on pathology (&gt;2cm) reached statistical significance in multivariate analysis (OR 5.959, P&lt;0.001; OR 2.361, P=0.042). In addition, further analysis showed upgrading on final pathology had a significant influence on axillary lymph nodes status (P&lt;0.001). However, this correlation was not shown between patients with DCIS and DCISM in pairwise comparison.

Conclusion

The data of upgrading and axillary lymph nodes metastasis in patients with an initial diagnosis of DCIS by CNB was comparable in this cohort with published data. Despite of a 51.98% upgrading rate, the rate of axillary lymph nodes metastasis in these patients is low, which supports the omission of axillary evaluation in selected patients.

Citation Format: Si J, Yang B, Guo R, Huang N, Quan C, Chen J, Wu J. Can axillary evaluation be omitted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-06.

Security analysis of a double-image encryption technique based on an asymmetric algorithm

In this paper, we evaluate the security of a double-image encryption technique based on an asymmetric algorithm. Compared with traditional cryptosystems based on a phase-truncated Fourier transform, the technique is able to improve the security of the encryption by combining a joint transform correlator; consequently, the encryption scheme is immune to some common attacks. We propose a special attack based on a phase retrieval algorithm with median filtering and normalization operation to break the cryptosystem. Low key sensitivity of a position parameter set has been found and an additional constraint is utilized to improve the attack to simplify the process and further decrease the computational time. Numerical simulation results show that the cryptosystem is vulnerable to the proposed special attack.

Simplified paraboloid phase model-based phase tracker for demodulation of a single complex fringe

A regularized phase tracker (RPT) is an effective method for demodulation of single closed-fringe patterns. However, lengthy calculation time, specially designed scanning strategy, and sign-ambiguity problems caused by noise and saddle points reduce its effectiveness, especially for demodulating large and complex fringe patterns. In this paper, a simplified paraboloid phase model-based regularized phase tracker (SPRPT) is proposed. In SPRPT, first and second phase derivatives are pre-determined by the density-direction-combined method and discrete higher-order demodulation algorithm, respectively. Hence, cost function is effectively simplified to reduce the computation time significantly. Moreover, pre-determined phase derivatives improve the robustness of the demodulation of closed, complex fringe patterns. Thus, no specifically designed scanning strategy is needed; nevertheless, it is robust against the sign-ambiguity problem. The paraboloid phase model also assures better accuracy and robustness against noise. Both the simulated and experimental fringe patterns (obtained using electronic speckle pattern interferometry) are used to validate the proposed method, and a comparison of the proposed method with existing RPT methods is carried out. The simulation results show that the proposed method has achieved the highest accuracy with less computational time. The experimental result proves the robustness and the accuracy of the proposed method for demodulation of noisy fringe patterns and its feasibility for static and dynamic applications.

The structural basis for the functional comparability of factor VIII and the long-acting variant recombinant factor VIII Fc fusion protein

Essentials Recombinant factor VIII (rFVIII) Fc fusion protein has a 1.5-fold longer half-life than rFVIII. Five orthogonal methods were used to characterize the structure of rFVIIIFc compared to rFVIII. The C-terminal Fc fusion does not perturb the structure of FVIII in rFVIIIFc. The FVIII and Fc components of rFVIIIFc are flexibly tethered and functionally independent.

SUMMARY

Background Fusion of the human IgG1 Fc domain to the C-terminal C2 domain of B-domain-deleted (BDD) factor VIII (FVIII) results in the recombinant FVIII Fc (rFVIIIFc) fusion protein, which has a 1.5-fold longer half-life in humans. Objective To assess the structural properties of rFVIIIFc by comparing its constituent FVIII and Fc elements with their respective isolated components, and evaluating their structural independence within rFVIIIFc. Methods rFVIIIFc and its isolated FVIII and Fc components were compared by the use of hydrogen-deuterium exchange mass spectrometry (HDX-MS). The structure of rFVIIIFc was also evaluated by the use of X-ray crystallography, small-angle X-ray scattering (SAXS), and electron microscopy (EM). The degree of steric interference by the appended Fc domain was assessed by EM and surface plasmon resonance (SPR). Results HDX-MS analysis of rFVIIIFc revealed that fusion caused no structural perturbations in FVIII or Fc. The rFVIIIFc crystal structure showed that the FVIII component is indistinguishable from published BDD FVIII structures. The Fc domain was not observed, indicating high mobility. SAXS analysis was consistent with an ensemble of rigid-body models in which the Fc domain exists in a largely extended orientation relative to FVIII. Binding of Fab fragments of anti-C2 domain antibodies to BDD FVIII was visualized by EM, and the affinities of the corresponding intact antibodies for BDD FVIII and rFVIIIFc were comparable by SPR analysis. Conclusions The FVIII and Fc components of rFVIIIFc are structurally indistinguishable from their isolated constituents, and show a high degree of structural independence, consistent with the functional comparability of rFVIIIFc and unmodified FVIII.

[Effects of bisphenol A on the expression of N-cadherin, Vimentin and FSHR in rat Sertoli cells]

Objective: To explore the effects of BPA on the expression of N-cadherin, Vimentin and FSHR in rat Sertoli cells. Methods: Primary Sertoli cells collected from prepuberty rats (18-21 d) were cultured for 48 h, and then they were treated with 0, 30, 50, 70 μmol/L BPA respectively for 24 h. The methods of MTT, real-time quantitative PCR and Western blotting were utilized to measure the cell ability of Sertoli cells, the mRNA and protein expression levels of N-cadherin, Vimentin and FSHR respectively. Results: Compared with control, the cell abilities of Sertoli cells in 50 μmol/L BPA group and 70 μmol/L BPA group increased significantly (P<0.05) . The cell abilities of Sertoli cells decreased with the increases of exposure doses of BPA. Compared with control, the expression of N-cadherin mRNA only increased in 30 μmol/L BPA group (P<0.05) , the expression of Vimentin mRNA decreased significantly in all doses group of BPA (P<0.05) , the expression of FSHR mRNA increased in all doses group of BPA (P<0.05) . Compared with the control, the protein levels of N-cadherin increased significantly in 50 μmol/L BPA group (P<0.05) , the protein levels of Vimentin decreased significantly in all doses group of BPA (P<0.05) , the protein levels of FSHR decreased significantly in 50 μmol/L BPA group and 70 μmol/L BPA group (P<0.05) . Conclusion: The mechanism of testicular toxicity from BPA might be the alterations of N-cadherin, Vimentin and FSHR by disturbing normal spermatogenesis.

Abstract P3-14-06: A single-center report of 125 cases of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction

Objective

The aim of the current study is to determine the clinical value of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction using internal mammary as recipient vessels and to investigate the risk factors of internal mammary lymph nodes metastasis.

Methods

The clinical data of all free abdominal flap breast reconstructions using internal mammary as recipient vessels performed from November 2006 to April 2016 in Department of Breast Surgery, Fudan University Shanghai Cancer Center were included into the study. The incidence of internal mammary lymph node biopsy and the rate of metastasis were described. The differences between groups were compared using χ2 test. Univariate and multivariate Logistic regression analysis was conducted to evaluate risk factors of internal mammary lymph node metastasis.

Results

A total of 125 patients met the inclusion criteria, 89 (71.2%) of whom adopted unilateral immediate breast reconstructions. 64.8% of them were diagnosed with primary invasive breast cancer, while 27.2% were carcinoma in situ. According to AJCC TNM staging system, the percentages of patients with stage 0, I, II, III were 27.2%, 26.4%, 27.2% and 8.0%.

62 (49.6%) patients had internal mammary lymph nodes harvested. 6.4% (4/62) of those who adopted internal mammary lymph nodes biopsies were diagnosed with internal mammary lymph nodes metastasis, all in immediate breast reconstructions. 72 (57.6%) patients cut off costicartilage (the second or third costicartilage) during the exposure of internal mammary vessels. The excision of costicartilage is not associated with the harvest rate of internal mammary lymph node (P&gt;0.05). All of the 4 patients upstaged their TMN stage of tumor after internal mammary lymph node metastasis and adopted adjuvant chemotherapy and radiotherapy. Up to May 2016, no recurrence or distant metastasis was reported.

In Logistic regression analysis, larger invasive tumor size and axillary lymph node metastasis were found to have correlations with internal mammary lymph node metastasis (larger invasive tumor size: P=0.029; axillary lymph node metastasis: P=0.004), while tumor location or immunohistochemical subtype had no correlations. In addition, axillary lymph node metastasis was proved to be a independent risk factor of internal mammary lymph node metastasis (P=0.036) while tumor size was not.

Conclusions

Internal mammary lymph nodes found incidentally during internal mammary recipient vessel exposure for free flap breast reconstruction could provide surgeons with important information for further treatment. This approach for internal mammary lymph node biopsy revealed an appreciable success rate and should be promoted in clinical practice. The size of invasive tumor and the axillary lymph node metastasis were associated with internal mammary lymph node metastasis.Objective

The aim of the current study is to determine the clinical value of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction using internal mammary as recipient vessels and to investigate the risk factors of internal mammary lymph nodes metastasis.

Methods

The clinical data of all free abdominal flap breast reconstructions using internal mammary as recipient vessels performed from November 2006 to April 2016 in Department of Breast Surgery, Fudan University Shanghai Cancer Center were included into the study. The incidence of internal mammary lymph node biopsy and the rate of metastasis were described. The differences between groups were compared using χ2 test. Univariate and multivariate Logistic regression analysis was conducted to evaluate risk factors of internal mammary lymph node metastasis.

Results

A total of 125 patients met the inclusion criteria, 89 (71.2%) of whom adopted unilateral immediate breast reconstructions. 64.8% of them were diagnosed with primary invasive breast cancer, while 27.2% were carcinoma in situ. According to AJCC TNM staging system, the percentages of patients with stage 0, I, II, III were 27.2%, 26.4%, 27.2% and 8.0%.

62 (49.6%) patients had internal mammary lymph nodes harvested. 6.4% (4/62) of those who adopted internal mammary lymph nodes biopsies were diagnosed with internal mammary lymph nodes metastasis, all in immediate breast reconstructions. 72 (57.6%) patients cut off costicartilage (the second or third costicartilage) during the exposure of internal mammary vessels. The excision of costicartilage is not associated with the harvest rate of internal mammary lymph node (P&gt;0.05). All of the 4 patients upstaged their TMN stage of tumor after internal mammary lymph node metastasis and adopted adjuvant chemotherapy and radiotherapy. Up to May 2016, no recurrence or distant metastasis was reported.

In Logistic regression analysis, larger invasive tumor size and axillary lymph node metastasis were found to have correlations with internal mammary lymph node metastasis (larger invasive tumor size: P=0.029; axillary lymph node metastasis: P=0.004), while tumor location or immunohistochemical subtype had no correlations. In addition, axillary lymph node metastasis was proved to be a independent risk factor of internal mammary lymph node metastasis (P=0.036) while tumor size was not.

Conclusions

Internal mammary lymph nodes found incidentally during internal mammary recipient vessel exposure for free flap breast reconstruction could provide surgeons with important information for further treatment. This approach for internal mammary lymph node biopsy revealed an appreciable success rate and should be promoted in clinical practice. The size of invasive tumor and the axillary lymph node metastasis were associated with internal mammary lymph node metastasis.

Citation Format: Quan C, Huang N, Yang B, Zhang Y, Huang X, Chen J, Wu J. A single-center report of 125 cases of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-06.

Multi-subzone algorithm for absolute phase retrieval in digital fringe projection profilometry

Codewords are important in encoded absolute phase retrieval techniques such as two-frequency, gray-code, and phase-coding. Each sinusoidal fringe is marked by a unique codeword so that an absolute fringe order can be determined by decoding the codeword. However, due to the limited number of unique codewords, sinusoidal fringe patterns do not contain high-frequency fringes without the use of additional patterns. A multi-subzone coding and decoding algorithm is thus proposed to overcome this limitation. Three multi-subzone coding methods based on two-frequency, gray-code, and phase-coding techniques are presented. The coding creates multiple subzones of unique codewords and the decoding enables it to use non-unique codewords to identify absolute fringe order. Specifically, the range of fringe order is estimated by the use of a wrapped phase map and the absolute fringe order is identified by a codeword. Experimental studies demonstrate the advantages of the proposed algorithm over existing coding methods. The proposed algorithm is suitable to measure objects with large step-height surface discontinuities.

Cross-immunity Against Avian Influenza A(H7N9) Virus in the Healthy Population Is Affected by Antigenicity-Dependent Substitutions

BACKGROUND

 The emergence of infections by the novel avian influenza A(H7N9) virus has posed a threat to human health. Cross-immunity between A(H7N9) and other heterosubtypic influenza viruses affected by antigenicity-dependent substitutions needs to be investigated.

METHODS

 We investigated the cellular and humoral immune responses against A(H7N9) and 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09), by serological and T-cell-specific assays, in a healthy population. The molecular bases of the cellular and humoral antigenic variability of A(H7N9) were illuminated by structural determination.

RESULTS

 We not only found that antibodies against A(H7N9) were lacking in the studied population, but also revealed that both CD4⁺ and CD8⁺ T cells that cross-reacted with A(H7N9) were at significantly lower levels than those against the A(H1N1)pdm09 peptides with substitutions. Moreover, individual peptides for A(H7N9) with low cross-reactivity were identified. Structural determination indicated that substitutions within these peptides influence the antigenic variability of A(H7N9) through both major histocompatibility complex (MHC) binding and T-cell receptor docking.

CONCLUSIONS

 The impact of antigenicity-dependent substitutions on cross-reactivity of T-cell immunity against the novel influenza virus A(H7N9) in the healthy population benefits the understanding of immune evasion of influenza viruses and provides a useful reference for universal vaccine development.

Quantitative vibration analysis using a single fringe pattern in time-average speckle interferometry

In this paper, a novel technique for quantitative vibration analysis using time-average electronic speckle pattern interferometry is proposed. An amplitude-varied time-average refreshing reference frame method is used to capture a fringe pattern with a better fringe contrast than the conventional reference frame technique. The recorded fringe patterns with improved contrast provide better mode shape visibility and are easier to process. A derivative-based regularized phase tracker model is used to retrieve vibration amplitudes from a single fringe pattern. The method does not require a phase shifter to obtain the mode shape or amplitude. The method provides unwrapped amplitude and amplitude derivatives maps directly, so a separate phase unwrapping process is not required. Experimental work is carried out using a circular aluminum plate test specimen and the results are compared with a finite element method modal analysis. Both experimental and numerical results show that the proposed method is robust and accurate.

A simplified system for generating recombinant E3-deleted canine adenovirus-2

Canine adenovirus type 2 (CAV-2) has been used extensively as a vector for studying gene therapy and vaccine applications. We describe a simple strategy for generating a replication-competent recombinant CAV-2 using a backbone vector and a shuttle vector. The backbone plasmid containing the full-length CAV-2 genome was constructed by homologous recombination in Escherichia coli strain BJ5183. The shuttle plasmid, which has a deletion of 1478 bp in the nonessential E3 viral genome region, was generated by subcloning a fusion fragment containing the flanking sequences of the CAV-2 E3 region and expression cassette sequences from pcDNA3.1(+) into modified pUC18. To determine system effectiveness, a gene for enhanced green fluorescent protein (EGFP) was inserted into the shuttle plasmid and cloned into the backbone plasmid using two unique NruI and SalI sites. Transfection of Madin-Darby canine kidney (MDCK) cells with the recombinant adenovirus genome containing the EGFP expression cassette resulted in infectious viral particles. This strategy provides a solid foundation for developing candidate vaccines using CAV-2 as a delivery vector.

Multiple-image encryption by space multiplexing based on compressive sensing and the double-random phase-encoding technique

In this paper, a new multiple-image encryption and decryption technique that utilizes the compressive sensing (CS) concept along with a double-random phase encryption (DRPE) has been proposed. The space multiplexing method is employed for integrating multiple-image data. The method, which results in a nonlinear encryption system, is able to overcome the vulnerability of classical DRPE. The CS technique and space multiplexing are able to provide additional key space in the proposed method. A numerical experiment of the proposed method is implemented and the results show that the proposed method has good accuracy and is more robust than classical DRPE. The proposed system is also employed against chosen-plaintext attacks and it is found that the inclusion of compressive sensing enhances robustness against the attacks.

PCB153 disrupts thyroid hormone homeostasis by affecting its biosynthesis, biotransformation, feedback regulation, and metabolism

PCB153, one of the 3 dominant congeners in the food chain, causes the disruption of the endocrine system in humans and animals. In order to elucidate the effects of PCB153 on the biosynthesis, biotransformation, regulation, metabolism, and transport of thyroid hormones (THs), Sprague-Dawley (SD) rats were dosed with PCB153 intraperitoneally (i.p.) at 0, 4, 16 and 32 mg/kg/day for 5 consecutive days and sacrificed 24 h after the last dose. Results showed that after treatment with PCB153, serum total thyroxine (TT4), total triiodothyronine (TT3), and thyrotropin releasing hormone (TRH) decreased, whereas serum thyroid stimulating hormone (TSH) concentration did not alter. The serum sodium iodide symporter (NIS), thyroid peroxidase (TPO), and thyroglobulin (Tg) levels decreased. The mRNA expressions of type 2 and 3 deiodinases (D2 and D3) reduced, but the type 1 deiodinase (D1) showed no significant change. The TSH receptor (TSHr) and TRH receptor (TRHr) levels declined. PCB153 induced hepatic enzymes, and the UDPGTs, CYP2B1, and CYP3A1 mRNA levels were significantly elevated. Taken together, the observed results from the present study indicated that PCB153 disrupted thyroid hormone homeostasis through influencing synthesis-associated proteins (NIS, TPO and Tg), deiodinases, receptors (TSHr and TRHr), and hepatic enzymes, and the decrease of D3 expression might be the compensatory response of body.

TNIP1, SLC15A4, ETS1, RasGRP3 and IKZF1 are associated with clinical features of systemic lupus erythematosus in a Chinese Han population

Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous clinical manifestations influenced by genetic and environmental factors. Five novel susceptibility genes (TNIP1, SLC15A4, ETS1, RasGRP3 and IKZF1) for SLE have been identified in a recent genome-wide association study of a Chinese Han population. This study investigated their relationships with disease subphenotypes, including renal nephritis, photosensitivity, antinuclear antibody (ANA), age at diagnosis, malar rash, discoid rash, immunological disorder, oral ulcer, hematological disorder, neurological disorder, serositis, arthritis and vasculitis. Significant associations were found for the single nucleotide polymorphism rs10036748 of TNIP1 with photosensitivity (odds ratio (OR) = 0.87, p = 0.01) and vasculitis (OR = 1.18, p = 0.04); rs10847697 of SLC15A4 with discoid rash (OR = 1.18, p = 0.02); rs6590330 of ETS1 with SLE of age at diagnosis <20 years (OR = 1.24, p = 8.91 x 10(-5)); rs13385731 of RasGRP3 with malar rash (OR = 1.20, p = 0.01), discoid rash (OR = 0.78, p = 0.02) and ANA (OR = 0.72, p = 0.004); rs4917014 of IKZF1 with renal nephritis (OR = 1.13, p = 0.02) and malar rash (OR = 0.83, p = 0.00038), respectively. The study suggested that these susceptibility genes might not only play important roles in the development of SLE, but also contribute to the complex phenotypes of SLE.

Motion detection using extended fractional Fourier transform and digital speckle photography

Digital speckle photography is a useful tool for measuring the motion of optically rough surfaces from the speckle shift that takes place at the recording plane. A simple correlation based digital speckle photographic system has been proposed that implements two simultaneous optical extended fractional Fourier transforms (EFRTs) of different orders using only a single lens and detector to simultaneously detect both the magnitude and direction of translation and tilt by capturing only two frames: one before and another after the object motion. The dynamic range and sensitivity of the measurement can be varied readily by altering the position of the mirror/s used in the optical setup. Theoretical analysis and experiment results are presented.

One novel and two recurrent mutations in the keratin 5 gene identified in Chinese patients with epidermolysis bullosa simplex

Epidermolysis bullosa simplex (EBS) is a group of inherited skin diseases, characterized by the formation of intraepidermal blisters. We performed genetic analysis of the keratin 5 (KRT5) gene in two Chinese pedigrees. One novel missense mutation was identified in a patient with sporadic EBS (general, non-Dowling-Meara). Sequence analysis showed a heterozygous T > A transition at nucleotide 1730 of KRT5, changing phenylalanine (Phe) to tyrosine (Tyr) at position 577 of the keratin 5 (K5). In addition, two recurrent mutations c.1649delG (p.Gly550AlafsX77) and c.508G > (p.Glu170Lys) in KRT5 were identified in Chinese patients with mottled pigmentation EBS and localized EBS, respectively. None of the mutations were found in any unaffected family members or in an additional 100 unrelated control samples. These results suggest that these mutations are pathogenic and might be one of the potential causes of EBS in these Chinese patients.