[Mid-term efficacy evaluation of ABO incompatible living relative kidney transplantation based on protocol biopsy]

Objective: To evaluate the mid-term efficacy of ABO incompatible living donor kidney transplantation (ABOi-KT) based on the results of routine renal biopsy for transplantation. Methods: Retrospective collection of clinical data from 23 pairs of ABOi-KT donors and recipients at the First Affiliated Hospital of Sun Yat-sen University from July 2015 to November 2021. ABOi-KT was performed on recipients after desensitization treatment, and the results of routine kidney transplant biopsy at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were analyzed. Combined with blood type antibody levels and renal function recovery, the mid-term efficacy of ABOi-KT was evaluated. Results: Among the 23 recipients, there were 19 males and 4 females; age range from 19 to 47 years old [(29.6±6.7) years old], all underwent ABOi-KT successfully after receiving desensitization treatment. The follow-up time was (44.6±22.4) months, of which 22 cases were followed up for more than 1 year. The incidence rates of rejection reactions at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were 15.0% (3/20), 11.1% (1/9), 7.7% (1/13), 25.0% (3/12), and 12.5% (1/8), respectively. For receptors with rejection reactions, targeted anti-rejection therapy was performed based on clinical symptoms and various indicators. Borderline T cell mediated rejection (TCMR) can be converted to mild tubular inflammation after anti-rejection treatment. The positive rate of complement C4d in peritubular capillaries was 95.0% (19/20) one week after surgery, and the positive rate of complement C4d was 100% at 3 and 12 months after surgery. The cumulative survival rates at 1, 3, 5, and 7 years after surgery were all 100%. The cumulative survival rates at 1, 3, 5, and 7 years after kidney transplantation were 100%, 93.3%, 84.0%, and 84.0%, respectively. Except for 2 recipients who underwent transplantation in 2017 and experienced kidney failure at 30 and 49 months after surgery, all other transplanted kidneys survived. Conclusions: The results of routine renal transplant biopsy show that ABOi-KT has a good mid-term therapeutic effect. The pathological changes of ABOi-KT can be dynamically observed through routine renal transplant biopsy and targeted treatment for rejection reactions can be provided accordingly.

The Process Model of Stigmatized Loss: Identity-Threatened Experiences of Bereaved Mothers

Despite almost one-third of women suffering from the loss of a baby through miscarriage, stillbirth, or infant loss, it is surprising how little research examines how such loss affects the identity and stigmas experienced by these individuals. Through in-depth, semi-structured interviews with bereaved mothers (in particular, mothers who lost a baby during pregnancy or within one year after birth), this research sheds light on the bereaved mother's experiences after loss. Specifically, this research applies the identity-threat model of stigma to showcase the process of stigmatized loss. Based on our findings, we also introduce the process model of stigmatized loss that can apply to all types of stigmatized loss. Key themes emerged as we explored stigmatized loss discourses. These include situational cues that trigger stigma, identity-based responses that aim to preserve both a baby's and mother's identity, as well as nonvolitional and volitional responses that help restore control and reconstruct identity. Additionally, other themes revolve around positive and negative outcomes stemming from avoiding stigmatized identity activation and identification of triggers that initiate a recursive process through stigmatized baby loss. Importantly, stigma can be perceived as both an identity threat (negative) and an identity confirmation (positive). Findings inform theory and practice alike.

[Research advances in imaging techniques related to the diagnosis of pneumoconiosis]

Occupational pneumoconiosis (hereinafter referred to as pneumoconiosis) is the most harmful occupational disease in China. According to the current standard GBZ 70-2015 Diagnosis of Occupational Pneumoconiosis, pneumoconiosis is mainly diagnosed and staged by high kilovolt or digital radiography. Chest radiography in pneumoconiosis is the most widely studied and mature imaging technique in the diagnosis of pneumoconiosis. However, this technique has some limitations in the screening of some early pneumoconiosis and occupational health examination, and there is a certain risk of missed diagnosis and misdiagnosis. With the continuous development of imaging examination technology, computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography and artificial intelligence technology as auxiliary imaging examination methods have shown different diagnostic values in the research of auxiliary diagnosis of pneumoconiosis. This paper summarizes the advantages and problems in the application of various kinds of imaging techniques, which provides a direction for the future research of imaging techniques related to the diagnosis of pneumoconiosis.

Temporal Structures in Positron Spectra and Charge-Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic positron fluxes in the rigidity range from 1.00 to 41.9 GV based on 3.4×10^{6} positrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The positron fluxes show distinctly different time variations from the electron fluxes at short and long timescales. A hysteresis between the electron fluxes and the positron fluxes is observed with a significance greater than 5σ at rigidities below 8.5 GV. On the contrary, the positron fluxes and the proton fluxes show similar time variation. Remarkably, we found that positron fluxes are modulated more than proton fluxes with a significance greater than 5σ for rigidities below 7 GV. These continuous daily positron fluxes, together with AMS daily electron, proton, and helium fluxes over an 11-year solar cycle, provide unique input to the understanding of both the charge-sign and mass dependencies of cosmic rays in the heliosphere.

[A control study of steroid withdrawal protection strategy after kidney transplantation in children]

Objective: To study the influence of steroid withdrawal protection strategy on height growth in pediatric patients after kidney transplantation. Methods: The prospective cohort study enrolled 40 stage 5 chronic kidney disease children receiving kidney transplantation from July 2017 to September 2022 at Guangzhou Women and Children's Medical Center. Based on the primary preoperative disease, patients with immune abnormality-associated glomerular diseases or unknown causes were assigned to the steroid maintenance group, in which patients received steroid tapering within 3 months after surgery to a maintenance dose of 2.5 to 5.0 mg/d. While patients with hereditary kidney disease or congenital urinary malformations were assigned to the steroid withdrawal group, in which patients had steroids tapered off within 3 months. The characteristics of height catch-up growth and clinical data were compared between the 2 groups at baseline, 6, 12, 18 and 24 months after kidney transplantation. T-test, repeated measurement of variance analysis, Mann-Whitney U test, and Fisher exact test were used for the comparison between the 2 groups. Results: Among the 40 children, 17 were males, 23 were females, 25 were in the steroid withdraw group ((7.8±2.8) years old when receiving kidney transplantation) and 15 cases were in the steroid maintenance group ((7.6±3.5) years old when receiving kidney transplantation). The study population was followed up for (26±12) months. The total dose per unit body weight of steroids in the steroid withdrawal group was lower than that in the steroid maintenance group ((0.13±0.06) vs. (0.36±0.19) mg/(kg·d), t=5.83, P<0.001). The height catch-up rate (ΔHtSDS) in the first year after kidney transplantation in the steroid withdraw and steroid maintenance groups was 1.0 (0.7, 1.4) and 0.4 (0.1, 1.0), respectively; in the second year, the ΔHtSDS in the steroid withdraw group was significantly higher than that in the steroid maintenance group (1.1 (0.2, 1.7) vs. 0.3 (0, 0.8), U=28.00, P=0.039). The HtSDS in the steroid withdrawal group at the five follow-up time points was -2.5±0.8, -2.0±0.8, -1.5±0.8, -1.3±0.9 and -0.5±0.3, respectively, while in the steroid maintenance was -2.4±1.3, -2.2±1.1, -2.0±1.0, -1.8±1.0 and -1.6±1.0, respectively. There were statistically significant differences in HtSDS at different follow-up time points in both 2 groups (F=19.81, P<0.01), but no statistical differences in overall impact between the 2 groups (F=1.13, P=0.204). The steroid treatment was interaction with the increase of follow-up time (F=3.62, P=0.009). At the 24th month after transplantation, the HtSDS in the steroid withdrawal group was significantly higher than that in the steroid maintenance group (P=0.047). Six patients in the steroid withdrawal group experienced antibody-mediated immune rejection (AMR), while 3 did in the steroid maintenance group. Moreover, there was no significant difference in AMR between the two groups (χ2=0.06, P=0.814). Conclusion: The steroid withdrawal protection strategy favors the height catch-up growth in pediatric patients after kidney transplantation and does not increase the risk of postoperative antibody-mediated immune rejection.

Properties of Cosmic-Ray Sulfur and Determination of the Composition of Primary Cosmic-Ray Carbon, Neon, Magnesium, and Sulfur: Ten-Year Results from the Alpha Magnetic Spectrometer

We report the properties of primary cosmic-ray sulfur (S) in the rigidity range 2.15 GV to 3.0 TV based on 0.38×10^{6} sulfur nuclei collected by the Alpha Magnetic Spectrometer experiment (AMS). We observed that above 90 GV the rigidity dependence of the S flux is identical to the rigidity dependence of Ne-Mg-Si fluxes, which is different from the rigidity dependence of the He-C-O-Fe fluxes. We found that, similar to N, Na, and Al cosmic rays, over the entire rigidity range, the traditional primary cosmic rays S, Ne, Mg, and C all have sizeable secondary components, and the S, Ne, and Mg fluxes are well described by the weighted sum of the primary silicon flux and the secondary fluorine flux, and the C flux is well described by the weighted sum of the primary oxygen flux and the secondary boron flux. The primary and secondary contributions of the traditional primary cosmic-ray fluxes of C, Ne, Mg, and S (even Z elements) are distinctly different from the primary and secondary contributions of the N, Na, and Al (odd Z elements) fluxes. The abundance ratio at the source for S/Si is 0.167±0.006, for Ne/Si is 0.833±0.025, for Mg/Si is 0.994±0.029, and for C/O is 0.836±0.025. These values are determined independent of cosmic-ray propagation.

Temporal Structures in Electron Spectra and Charge Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic electron fluxes in the rigidity interval from 1.00 to 41.9 GV based on 2.0×10^{8} electrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The electron fluxes exhibit variations on multiple timescales. Recurrent electron flux variations with periods of 27 days, 13.5 days, and 9 days are observed. We find that the electron fluxes show distinctly different time variations from the proton fluxes. Remarkably, a hysteresis between the electron flux and the proton flux is observed with a significance of greater than 6σ at rigidities below 8.5 GV. Furthermore, significant structures in the electron-proton hysteresis are observed corresponding to sharp structures in both fluxes. This continuous daily electron data provide unique input to the understanding of the charge sign dependence of cosmic rays over an 11-year solar cycle.

[A case of pulmonary aspergillus infection in underground coal mine workers]

The underground environment is dark and humid, and it is easy to breed pathogenic microorganisms. A lump in the right lung of a coal mine underground transport worker was found druing occupational health examination. CT examination showed that the lump was located in the posterior segment of the upper lobe of the right lung, with point strip calcification, liquefaction necrosis, and proximal bronchial stenosis and occlusion. MRI examination FS-T(2)WI and DWI showed "target sign", annular low signal around the central high signal, and low mixed signal around the periphery, and annular high signal in the isosignal lesions on T(1)WI. Then the pulmonary aspergillus infection was confirmed by pathology.

[Introduction and development of the Trans Woman Voice Questionnaire authorized simplified Chinese translation]

Objective: The purpose of this article is to translate and adapt the Trans Woman Voice Questionnaire (TWVQ) into the simplified Chinese version (TWVQ-SC), and to evaluate its reliability and validity. Methods: Authorized by the author of the TWVQ,the TWVQ-SC was developed through translation, back translation,and cross-cultural adaptation.The TWVQ-SC contained 30 items capturing personal perception of vocal function, psychosocial impact of voice, and degree of limitation in social participation. Subjects included 279 trans women in the experimental group, 128 cis women in the control group, and 89 trans women in the retest group. The Cronbach α and the item total correlation coefficient (ITC) were calculated to examine the internal consistency. The intraclass correlation coefficient (ICC) was chosen to examine the test-retest reliability. Regarding validity, the expert judgment method was utilized to examine the content validity. Factor analysis and Spearman's rank correlation coefficient were used to examine the construct validity, and the discriminant validity was examined by the rank sum test of the total scores of the cisgender and transgender subjects. Results: The Cronbach's α of TWVQ-SC is 0.97 and the ITC of 30 items range from 0.40 to 0.86. The ICC is 0.84. The four principal components' cumulative contribution is 65.12%. The Spearman rank correlation coefficient to VHI-10 is 0.85 (P<0.01). The total score of the TWVQ scale in the transgender female group is significantly higher than that in the cisgender female group (U=1 580,P<0.01). Conclusion: TWVQ-SC demonstrates good reliability and validity and therefore can be used clinically as a self-assessment tool for transgender women to evaluate their own voice.

Advice from Bereaved Parents on Strategies to Heal After Baby Loss

With close to one in three babies dying between conception and infancy, research examining how to assist bereaved parents after loss is critical. Prior research focuses primarily on a general understanding of the journey post-loss or on a specific strategy that can be pursued to assist in healing but does not adequately provide a holistic examination of post-loss strategies nor is it from firsthand recommendations of bereaved parents. Our research addresses this gap in the literature by identifying the post-loss healing strategies recommended by bereaved parents themselves, thereby informing coping post-loss. To do this, 30 semi-structured interviews were conducted with bereaved mothers. Four themes emerged from our findings: (1) honor the deceased baby, (2) engage in helpful practices, (3) pursue healing now, and (4) embrace the post-loss journey as unique.

Properties of Daily Helium Fluxes

We present the precision measurement of 2824 daily helium fluxes in cosmic rays from May 20, 2011 to October 29, 2019 in the rigidity interval from 1.71 to 100 GV based on 7.6×10^{8} helium nuclei collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The helium flux and the helium to proton flux ratio exhibit variations on multiple timescales. In nearly all the time intervals from 2014 to 2018, we observed recurrent helium flux variations with a period of 27 days. Shorter periods of 9 days and 13.5 days are observed in 2016. The strength of all three periodicities changes with time and rigidity. In the entire time period, we found that below ∼7  GV the helium flux exhibits larger time variations than the proton flux, and above ∼7  GV the helium to proton flux ratio is time independent. Remarkably, below 2.4 GV a hysteresis between the helium to proton flux ratio and the helium flux was observed at greater than the 7σ level. This shows that at low rigidity the modulation of the helium to proton flux ratio is different before and after the solar maximum in 2014.

[Anatomical characteristics of profunda artery perforator flap in the posteromedial femoral region and its application in the reconstruction of oral and maxillofacial defects]

Objective: To investigate the anatomical basis for the preparation of the profunda artery perforator flap (PAPF) in the posteromedial femoral region and its application in the reconstruction of oral and maxillofacial defects. Methods: Six lower limbs of Chinese adult cadavers were micro-surgically dissected. CT angiography (CTA) data of bilateral lower limbs of 6 patients was also collected retrospectively. The number, external diameter, pedicle length, and distribution of perforators in the posteromedial femoral region were recorded from the specimens and CTA data. Meanwhile, 10 patients with oral squamous cell carcinoma in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University from August 2018 to June 2021 were treated with the PAPF. At each follow-up, contour and function of recipient and donor site, as well as swallowing and speech function were evaluated. Results: A total of 19 profunda artery perforator were identified in 6 lower limb specimens. The outer diameter at the beginning of the source artery was (2.34±0.25) mm and the total length of the pedicle was (11.12±1.06) cm. CTA data analysis of 12 legs identified 15 perforators of profunda artery in the posteromedial region. Eleven perforators were septocutaneous, including 2 perforators with a common trunk, while the remaining 4 perforators were musculocutaneous. As for different patterns of perforators (septocutaneous perforators, musculocutaneous perforators and perforators with a common trunk), the longitudinal distance to the pubic tubercle was (19.95±2.43), (21.84±2.54) and (19.48±0.55) cm respectively. The horizontal distance to the posterior edge of gracilis was (3.54±1.10), (3.72±0.30) and (3.85±1.48) cm, respectively. The initial diameters of perforators was (2.4±0.4), (2.6±0.6) and 1.9 mm respectively. Ten cases of the profunda artery perforator flaps survived successfully after operation. The flap sizes ranged from 8 cm×6 cm to 12 cm×7 cm. The patients were evaluated at 1, 3 and 6 months, and with 6 months interval ever since. During the follow-up, the shape of the recipient site was ideal, and the swallowing and language functions were not significantly affected. There was only linear scar in the donor area, and the function of the thigh was basically normal. Conclusions: PAPF possessed a good anatomic stability, suitable vascular pedicle length and diameter, minor influence to the donor area, sufficient amount tissue with good quality. It is an ideal choice for head and neck reconstruction.

[Risk factors of intracranial hemorrhage with 125I seeds for the treatment of brain tumors]

Objective: To analyze the risk factors of intracranial hemorrhage after implanting 125-iodine seeds for brain tumors. Methods: A total of 234 patients with intracranial tumors receiving treatment of 125-iodine seeds from March, 2013 to November, 2020 were retrospectively analyzed. Patients were divided into bleeding group and non-bleeding group according to whether postoperative intracranial hemorrhage was reported. Univariate and multivariate analysis was performed by logistic regression to determine the independent risk factors of intracranial hemorrhage. Result: A total of 22 cases (9.4%) reported postoperative intracranial hemorrhage in 234 patients treated with 125-iodine seeds. Univariate analysis showed that the type of tumor and the history of anti-angiogenic drug within one month were possible risk factors (P<0.1). Multivariate logistic regression analysis showed that anti-angiogenic drug within one month was the independent risk factor for intracranial hemorrhage (P<0.05). Conclusions: The application of anti-angiogenic drugs within one month is the independent risk factor of intracranial hemorrhage with 125-iodine seeds for the treatment of brain tumors.

Periodicities in the Daily Proton Fluxes from 2011 to 2019 Measured by the Alpha Magnetic Spectrometer on the International Space Station from 1 to 100 GV

We present the precision measurement of the daily proton fluxes in cosmic rays from May 20, 2011 to October 29, 2019 (a total of 2824 days or 114 Bartels rotations) in the rigidity interval from 1 to 100 GV based on 5.5×10^{9} protons collected with the Alpha Magnetic Spectrometer aboard the International Space Station. The proton fluxes exhibit variations on multiple timescales. From 2014 to 2018, we observed recurrent flux variations with a period of 27 days. Shorter periods of 9 days and 13.5 days are observed in 2016. The strength of all three periodicities changes with time and rigidity. The rigidity dependence of the 27-day periodicity is different from the rigidity dependences of 9-day and 13.5-day periods. Unexpectedly, the strength of 9-day and 13.5-day periodicities increases with increasing rigidities up to ∼10  GV and ∼20  GV, respectively. Then the strength of the periodicities decreases with increasing rigidity up to 100 GV.

Erratum: Properties of a New Group of Cosmic Nuclei: Results from the Alpha Magnetic Spectrometer on Sodium, Aluminum, and Nitrogen [Phys. Rev. Lett. 127, 021101 (2021)]

This corrects the article DOI: 10.1103/PhysRevLett.127.021101.

[Control study of chest CT imaging features of aluminosis and silicosis patients]

Objective: To understand the chest CT features of aluminosis caused by alumina and to improve the understanding of the imaging findings of alumina pneumoconiosis. Methods: The chest CT findings of 17 cases of alumina-induced pneumoconiosis and 30 cases of silicosis (the control group) diagnosed in Zibo Occupational Disease Prevention Hospital from April 2015 to July 2020 were analyzed retrospectively. The characteristics of fibrosis of the two kinds of pneumoconiosis and the incidence of size, density, distribution, tractive bronchiectasis, pleural thickening and interlobular septal thickening of pneumoconiosis nodules were compared. Results: Alumina pneumoconiosis showed nodules with thickened interlobular septal of 66.67% (12/18) , honeycomb lung of 22.22% (4/18) , ground glass shadow of 61.11% (11/18) , simple nodules of 11.11% (2/18) , and no fusion mass. In the control group, the long-line fibrosis of nodules with thickened interlobular septal were 16.67% (5/30) , 6.67% (2/30) with honeycomb lung and ground glass density shadow, 23.33% (7/30) with fusion mass and 53.33% (16/30) with simple nodule. There were significant differences in CT findings of nodules with thickened interlobular septal, ground glass density shadow, fused mass and simple nodules between the two groups (P<0.05) . The interstitial beaded nodules were seen in 18 cases of alumina pneumoconiosis, 50.00% (9/18) of them were beaded nodules, 61.33% (46/75) of low density nodules and 38.89% (7/18) of central lobular nodules were seen in alumina pneumoconiosis. The average width of nodules was (1.29±0.38) mm. Central lobular nodules were seen in all 30 cases of silicosis, 10.00% (3/30) were mainly beaded nodules, low density nodules were 36.29% (90/248) , and the average width diameter of nodules was (1.85±0.58) mm. There were significant differences between the two groups (P<0.05) . Alumina pneumoconiosis was often accompanied by traction bronchiectasis, pleural thickening and interlobular septal thickening (11, 18, 17 cases, 61.11%, 100.00%, 94.44%) , compared with the control group (9, 18, 18 cases, 30.00%, 60.00%, 60.00%) . The differences were statistically significant (P<0.05) . The maximum CT value of noncalcified mediastinal lymphnodes in alumina pneumoconiosis was (103.43±26.33) HU, which was higher than that of the control group[ (75.22±16.70) HU], and the difference was statistically significant (P<0.05) . Conclusion: Alumina pneumoconiosis chest CT shows slightly low-density beaded nodules, thickened interlobular septal, and pulmonary interstitial fibrosis of ground-glass shadows, mostly combines with stretched bronchiectasis, thickened pleura, and mediastinum increased lymph node density.

Properties of a New Group of Cosmic Nuclei: Results from the Alpha Magnetic Spectrometer on Sodium, Aluminum, and Nitrogen

We report the properties of sodium (Na) and aluminum (Al) cosmic rays in the rigidity range 2.15 GV to 3.0 TV based on 0.46 million sodium and 0.51 million aluminum nuclei collected by the Alpha Magnetic Spectrometer experiment on the International Space Station. We found that Na and Al, together with nitrogen (N), belong to a distinct cosmic ray group. In this group, we observe that, similar to the N flux, both the Na flux and Al flux are well described by the sums of a primary cosmic ray component (proportional to the silicon flux) and a secondary cosmic ray component (proportional to the fluorine flux). The fraction of the primary component increases with rigidity for the N, Na, and Al fluxes and becomes dominant at the highest rigidities. The Na/Si and Al/Si abundance ratios at the source, 0.036±0.003 for Na/Si and 0.103±0.004 for Al/Si, are determined independent of cosmic ray propagation.

Accuracy of Nolla Method for Age Estimation of Northern Chinese Han Children

Abstract

Objective To study the accuracy of Nolla method for age estimation of Northern Chinese Han children aged between 5.00 and 14.99 years based on original transformation tables and multiple regression model. Methods A total of 2 000 orthopantomographs （OPGs） were collected from the Hospital of Stomatology, Xi'an Jiaotong University, including 1 000 males and 1 000 females. Development stage of 7 left mandibular permanent teeth （except third molars） was assessed based on Nolla method, then age estimation was conducted through transformation tables and multiple regression model, respectively. Firstly, the development stage results of 7 permanent teeth were added up and the estimated age was obtained through the original transformation tables. Secondly, 80% of the samples （80 males and 80 females in each age group） were randomly selected from 2 000 OPGs as the train set. The chronological age of the selected patients was taken as the dependent variable, while gender and the development stage results of 7 permanent teeth were taken as the independent variable to establish multiple regression model. The remaining 20% of the samples were substituted into the model as the test set, to verify the accuracy of age estimation by multiple regression model. Results Mean chronological ages of males and females were 10.03±0.09 years and 10.01±0.09 years, respectively. The age estimated by original transformation tables showed an overestimation for males （0.18 years on average） and an underestimation for females （0.02 years on average）, with mean absolute error （MAE） of 0.94 years and 0.97 years, respectively. While the results by multiple regression model showed that males were overestimated by 0.06 years on average and females were underestimated by 0.02 years on average. The MAE was 0.66 years and 0.77 years, respectively. Conclusion The Nolla method is suitable for age estimation of Northern Chinese Han children. Compared with the original transformation tables method, the multiple regression model is more accurate for age estimation.

Properties of Heavy Secondary Fluorine Cosmic Rays: Results from the Alpha Magnetic Spectrometer

Precise knowledge of the charge and rigidity dependence of the secondary cosmic ray fluxes and the secondary-to-primary flux ratios is essential in the understanding of cosmic ray propagation. We report the properties of heavy secondary cosmic ray fluorine F in the rigidity R range 2.15 GV to 2.9 TV based on 0.29 million events collected by the Alpha Magnetic Spectrometer experiment on the International Space Station. The fluorine spectrum deviates from a single power law above 200 GV. The heavier secondary-to-primary F/Si flux ratio rigidity dependence is distinctly different from the lighter B/O (or B/C) rigidity dependence. In particular, above 10 GV, the F/Si/B/O ratio can be described by a power law R^{δ} with δ=0.052±0.007. This shows that the propagation properties of heavy cosmic rays, from F to Si, are different from those of light cosmic rays, from He to O, and that the secondary cosmic rays have two classes.

[The correlations between C-reactive protein to albumin ratio and postoperative complications in patients with colorectal surgery]

Objective: To examine the correlations of C-reactive protein (CRP)/albumin ratio (CAR) with the postoperative complications of patients with colorectal cancer. Methods: The clinic data of 312 patients undergoing elective surgery for colorectal cancer in Hainan Hospital of People's Liberation Army General Hospital between January 2013 and July 2018 was analyzed retrospectively. There were 188 males and 124 females, aged (61.0±12.9) years (range: 21 to 86 years). Logistic analysis was used to identify relative factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and compare diagnostic accuracy of the CAR and CRP levels. Results: Postoperative complications occured in 28.5% (89/312) cases. Hemoglobin on postoperative day(POD) 3 (OR=0.977, 95% CI: 0.957 to 0.998, P=0.034), preoperative CRP (OR=1.209, 95% CI: 1.055 to 1.386, P=0.006) and CAR on POD 3 (OR=0.033, 95% CI: 0.016 to 0.067, P<0.01) were found to be significant independent relative factors for postoperative complications. The cutoff point of CAR on POD 3 was 0.325, patients with CAR≥0.325 were found to have more postoperative complications than those with CAR<0.325. The area under the curve of CAR on POD 3 and preoperative CRP were 0.872, 0.626, respectively. The positive predictive value of CAR on POD 3 was higher than that of preoperative CRP (79.9% vs. 55.1%). Conclusions: CAR is closely related to the occurrence of postoperative complications in colorectal surgery. Patients with CAR≥0.325 on POD 3 has higher incidence of postoperative complications.

[Efficacy of high flow nasal oxygen therapy in children with acute respiratory failure]

Objective: To investigate the efficacy of high flow nasal cannula (HFNC) in children with acute respiratory failure. Methods: A prospective study was conducted. A total of 153 patients aged from 1 to 14 years with acute respiratory failure were enrolled, who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from January 2018 to December 2019. HFNC success was defined as no need for invasive mechanical ventilation and successfully withdrawn from HFNC, while HFNC failure was defined as need for invasive mechanical ventilation. HFNC at a flow rate of 2 L/(kg·min) (maximum ≤ 60 L/min) with inhaled oxygen concentration (FiO₂) between 0.30 and 1.00 was applied to maintain percutaneous oxygen saturation (SpO₂) of 0.94-0.97. Parameters including arterial partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide in artery (PaCO₂), SpO₂ and PaO₂/FiO₂ were collected before and during the application of HFNC at 1 h, 6 h, 12 h, 24 h and 48 h, as well as over 48 h after HFNC withdrawn. Comparison between the groups was performed by student t test, Mann-Whitney U test or chi-square test. The sensitivity and specificity of the above parameters in predicting HFNC success were evaluated by receiver operating characteristic (ROC) curve. Results: A total of 153 children (70 males and 83 females) were enrolled. Among them, 131 (85.6%) cases were successfully weaned off from HFNC and 22 (14.4%) failed. The duration of HFNC was 57 (38, 95) hours in the successful group, and the PaO₂/FiO₂ before HFNC application and after HFNC was withdrawn were 187 (170, 212) mmHg (1 mmHg=0.133 kPa) and 280 (262, 292) mmHg, respectively. The duration of HFNC in the failure group was 19 (9, 49) hours, and the PaO₂/FiO₂ before HFNC application and after HFNC withdrawn were 176 (171, 189) mmHg and 159 (156, 161) mmHg, respectively. The values of PaO₂/FiO₂ were significantly higher in the successful group than those in the failed group at using HFNC initially 1 h (196 (182, 211) vs. 174 (160, 178) mmHg, Z =-5.105, P<0.01), 6 h (213 (203, 220) vs. 168 (157, 170) mmHg, Z =-6.772, P<0.01), 12 h (226 (180, 261) vs. 165 (161, 170) mmHg, Z =-4.308, P<0.01), 24 h (229 (195, 259) vs. 165 (161, 170) mmHg, Z=-4.609, P<0.01) and 48 h (249 (216, 273) vs. 163 (158, 169) mmHg, Z =-4.628, P<0.01) after the HFNC application, and over 48 h after HFNC was withdrawn (277 (268, 283) vs. 157 (154, 158) mmHg, Z=-3.512, P<0.01). Moreover, the PaO₂ levels were significantly higher in the successful group than those in the failed group using HFNC initially at 1 h (73.7 (71.0, 76.7) vs. 70.0 (66.2, 71.2) mmHg, Z=-4.587, P<0.01) and 6 h (79.0 (75.0, 82.0) vs. 71.0 (62.0, 72.0) mmHg, Z=-5.954, P<0.01) after HFNC application. Also, the SpO₂ levels showed the same differences at 1 h (0.96 (0.95, 0.96) vs. 0.94 (0.92, 0.94), Z =-4.812, P<0.01) and 6 h (0.96 (0.95, 0.97) vs. 0.94(0.91, 0.95), Z=-5.024, P<0.01) after HFNC application. Forty eight hours after HFNC was withdrawn, the PaO₂ (88.0 (81.7, 95.0) vs. 63.7 (63.3, 66.0) mmHg, Z =-3.032, P<0.01) and SpO₂ (0.96 (0.94, 0.98) vs. 0.91 (0.90, 0.92), Z=-3.957, P<0.01) were also significantly higher in the successful group. Regarding the HFNC complications, there was one case with atelectasis and one with pneumothorax in the failure group. HFNC was used as sequential oxygen therapy after extubation in 79 children, successful in all. ROC curve showed that the area under curve of PaO₂/FiO₂ in predicting HFNC success was 0.990, and the optimal cut-off value was 232 mmHg with the 95%CI of 0.970-1.000 (P<0.01). Conclusions: HFNC could be used as a respiratory support strategy for children with mild to moderate respiratory failure and as a sequential oxygen therapy after extubation. The PaO₂/FiO₂ when HFNC withdrow is the optimal index to evaluate the success of HFNC application.

Properties of Iron Primary Cosmic Rays: Results from the Alpha Magnetic Spectrometer

We report the observation of new properties of primary iron (Fe) cosmic rays in the rigidity range 2.65 GV to 3.0 TV with 0.62×10^{6} iron nuclei collected by the Alpha Magnetic Spectrometer experiment on the International Space Station. Above 80.5 GV the rigidity dependence of the cosmic ray Fe flux is identical to the rigidity dependence of the primary cosmic ray He, C, and O fluxes, with the Fe/O flux ratio being constant at 0.155±0.006. This shows that unexpectedly Fe and He, C, and O belong to the same class of primary cosmic rays which is different from the primary cosmic rays Ne, Mg, and Si class.

Ethnic Disparities in Dental Caries among Adolescents in China

Comprehensive research on ethnic disparities in dental caries in China is limited. The aims of this cross-sectional study were to compare the levels of dental caries in adolescents between the Han ethnic group and ethnic minority groups in China and to explore the risk indicators for dental caries within ethnic subgroups. Data from the Fourth National Oral Health Survey in 2015, which covered all 31 province-level administrative divisions in mainland China, were used. The dental caries status in the permanent dentition of adolescents aged 12, 13, 14, and 15 y was measured using the decayed, missing, and filled teeth (DFMT) score, and sociodemographic characteristics and oral health-related behaviors were also collected. A total of 118,601 adolescents were included, with ethnic minority groups accounting for 13.15%. Of the Han and minority groups, the standardized prevalence of dental caries experience was 40.58% and 47.67%, and the mean DMFT scores were 0.97 and 1.28, respectively. According to the multivariate zero-inflated negative binomial regression analysis, the caries status of minorities was more severe than Han adolescents (adjusted prevalence rate ratio [PRR], 1.14; 95% confidence interval [CI], 1.10-1.18). This disparity was greater among adolescents who lived in rural areas, had mid-level economic status, and frequently consumed sugary beverages. After propensity score matchings, Uygur (PRR, 1.44; 95% CI, 1.25-1.67), Tibetan (PRR, 1.39; 95% CI, 1.3-1.48), and Yi (PRR, 1.24; 95% CI, 1.04-1.48) adolescents were significantly more likely to have caries than Han adolescents. Subgroup analyses revealed that gender, age, location of residence, economic status, region, consumption of sweet snacks and sugary beverages, and dental visit pattern were significantly associated with dental caries within ethnic minorities.

[Characteristics and diversity of infectious diarrheal caused by various pathogens]

Objective: To understand the characteristics and differences of diarrhea-related symptoms caused by different pathogens, and the clinical features of various pathogens causing diarrhea. Methods: Etiology surveillance program was conducted among 20 provinces of China from 2010 to 2016. The acute diarrhea outpatients were collected from clinics or hospitals. A questionnaire was used to survey demographics and clinical features. VFeces samples were taken for laboratory detection of 22 common diarrhea pathogens, to detect and analyze the clinical symptom pattern characteristics of the patient's. Results: A total of 38 950 outpatients were enrolled from 20 provinces of China. The positive rates of Rotavirus and Norovirus were the highest among the five diarrhea-causing viruses (Rotavirus: 18.29%, Norovirus: 13.06%). In the isolation and culture of 17 diarrhea-causing bacterial, Escherichia coli showed the highest positive rates (6.25%). The clinical features of bacterial diarrhea and viral diarrhea were mainly reflected in the results of fecal traits and routine examination, but pathogenic Vibrio infection was similar to viral diarrhea. Conclusion: Infectious diarrhea presents different characteristics due to various symptoms which can provide a basis for clinical diagnosis.

[Therapeutic effect of tonsillectomy on IgA nephropathy after kidney transplantation]

Objective: To observe the clinical effect of tonsillectomy on IgA nephropathy (IgAN) after renal transplantation. Methods: From March 2011 to July 2018, 201 kidney transplantation recipients who were diagnosed of IgAN by transplant renal biopsy in the Department of Organ Transplantation of the First Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed, of which 18 patients underwent tonsillectomy after renal biopsy. The clinical data of the 18 patients were collected, patient and kidney survival time and function of the transplanted kidney were analyzed. Results: Of the 18 recipients, 13 were male and 5 were female, with an average age of (36.0±10.9) years. All 18 patients survived during follow-up. Two patients returned to dialysis treatment 10 months and 14 months after tonsillectomy, respectively. The creatinine was 94 (78, 133) μmol/L, 95 (74, 139) μmol/L, 106 (87, 158) μmol/L and 95(81, 147) μmol/L before tonsillectomy, 3 months, 1 year and 2 years after tonsillectomy, respectively (P=0.206). Urinary protein quantification was 0.31 (0.16, 1.38) g/24 h, 0.34 (0.10, 1.42) g/24 h, 0.33 (0.11, 0.56) g/24 h and 0.25 (0.10, 0.50) g/24 h at the same time points, respectively (P=0.104). The two patients who returned to dialysis were diagnosed of IgAN by transplant renal biopsy because of elevated creatinine, proteinuria and hematuria, 9 years and 4 years after kidney transplant respectively. Renal biopsy suggested that glomerular and segmental sclerosis were 7/24, 5/24 and 1/6, 2/6, respectively. Additionally, interstitial fibrosis and tubular atrophy (IF/TA) were both occupied 30% in the biopsies, and tonsillectomy was performed 461 days and 1 077 days after diagnosis of IgAN, respectively. Conclusions: Tonsillectomy can maintain the stability of renal function and prevent the aggravation of proteinuria in IgAN patients after renal transplantation. However, if pathology suggests obvious glomerulosclerosis or IF/TA, tonsillectomy may not be effective.

[Efficacy and safety of non-vitamin K antagonist versus vitamin K antagonist oral anticoagulants in the prevention and treatment of thrombotic disease in active cancer patients: a systematic review and meta-analysis of randomized controlled trials]

Object We aimed to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonist (VKA) in the prevention and treatment of thrombotic diseases in patients with active cancer. Methods: To find randomized controlled trials (RCT) in which NOACs were compared VKAs in active cancer, we searched the electronic databases (PubMed, Web of Science and Clinical Trials) up to May 2019 and and languages restricted to Chinese and English. According to the screening strategy, two researchers independently screened and extracted literature, evaluated the quality of literature, the suitability of collected cross study data for analysis, and tested the heterogeneity. The relative risk (RR) and 95% confidence interval (95%CI) of major bleeding, clinically related non-major bleeding, VTE, stroke and all-cause mortality in active cancer patients with VTE, active cancer patients with non-valvular atrial fibrillation (NVAF) was calculated and the results were compared between NOAC with VKA. Results: A total of 9 RCTs were included, including 5 cancers with VTE (5/9) and 4 cancers with NVAF (4/9). A total of 5 867 patients were included. After excluding 1 818 (30.99%) patients with cancer history, 4 049 (68.86%) patients with active cancer were statistically analyzed. Among them, 2 278 (56.26%) received NOAC treatment, 1 771 patients (43.74%) received VKA treatment. The quality of the included documents was high (all scores were>5 points), and the data of each included document could be summarized and analyzed (P>0.05). The heterogeneity of main outcome events was very low (I2 = 0). In VTE patients with active cancer, NOACs were more effective in reducing recurrence of VTE （RR=0.55, 95%CI 0.36 -0.84; P = 0.005) and clinically related non-major bleeding (RR=0.77, 95%CI 0.60 -0.98; P = 0.03) than VKAs. In NVAF patients with active cancer, efficacy of NOACs and VKAs was similar in terms of reducing VTE, stroke, clinically related non-major bleeding, major bleeding and all-cause mortality events (P>0.05). Conclusions: For patients with active cancer accompanied by VTE, NOAC may has more advantages in efficacy and safety compared to VKA in the prevention and treatment of thrombotic diseases.

[Clinical features and outcomes of cancer-related versus non-cancer-related sepsis in pediatric intensive care unit]

Objective: To compare the clinical features and outcomes of cancer-related and non-cancer-related sepsis in children who were admitted pediatric intensive care unit (PICU). Methods: The clinical history of patients with sepsis, who were admitted to PICU in Shanghai Children's Hospital, Shanghai Jiao Tong University from August 2016 to July 2019, were retrospectively reviewed. A total of 768 patients were divided into the cancer-related sepsis group (135 cases) and the non-cancer-related sepsis group (633 cases). The patients in the cancer-related group were further categorized into three subgroups including hematological malignancy (80 cases), solid tumor (43 cases) and hemophagocytic lymphohistiocytosis (HLH) (12 cases). The variables of clinical features, laboratory tests, pathogens, management strategies and in-hospital mortality were compared between the two groups by student t test, Mann-Whitney U test or Chi-square test. Results: The patients with cancer-related sepsis accounted for 17.6% of all patients (135/768). Regarding the site of initial infection, the incidence of gastrointestinal infection (43.0% (58/135) vs. 28.6% (181/633), χ(2)=10.718, P=0.001), blood stream infection (29.6% (40/135) vs. 17.1% (108/633), χ(2)=11.297, P=0.001) and skin and soft tissue infection (22.2% (30/135) vs. 4.1% (26/633), χ(2)=54.013, P<0.01) were higher in the patients with cancer-related sepsis than in those with non-cancer-related sepsis. On first PICU admission, the levels of hemoglobin (71 (61, 83) vs. 106 (92, 116) g/L, Z=13.594, P<0.01), white blood cell (1.4 (0.3, 5.2) vs. 9.8 (5.8, 15.1)×10(9)/L, Z=11.213, P<0.01), platelet count (51 (15, 121) vs. 286 (192, 384)×10(9)/L, Z=13.336, P<0.01), CD19(+)cells (0.106 (0.008, 0.274) vs. 0.325 (0.224, 0.454), Z=6.555, P<0.01), and neutrophil (0.449 (0.170, 0.730) vs. 0.683 (0.537, 0.800), Z=5.974, P<0.01) were significantly lower in patients with cancer-related sepsis; however, the levels of C-reactive protein (82 (25, 155) vs. 36 (11, 86) mg/L, Z=-5.257, P<0.01), procalcitonin (1.5 (0.3, 12.0) vs. 0.8 (0.2, 4.0) μg/L, Z=-2.767, P=0.006), CD8(+)cells (0.329 (0.253, 0.514) vs. 0.209 (0.156, 0.275), Z=-5.699, P<0.01), interleukin (IL) -6 (0.1 (0.1, 522.4) vs. 0.1 (0.1, 0.1) ng/L, Z=-2.747, P=0.006), IL-8 (0.1 (0.1, 177.0) vs. 0.1 (0.1, 4.5) ng/L, Z=-2.087, P=0.037), and IL-10 (0.1 (0.1, 42.7) vs. 0.1 (0.1, 6.6) ng/L, Z=-2.148, P=0.032) were significantly higher in patients with cancer-related sepsis. Similarly, the rate of continuous renal replacement therapy (CRRT) (34.8% (47/135) vs. 16.9% (107/633), χ(2)=26.267, P<0.01) and the use of intravenous immunoglobulin (IVIG) (83.0% (112/135) vs. 66.2% (419/633), χ(2)=14.667, P<0.01) were significantly higher in cancer-related sepsis group. Moreover, the incidence of co-infection with fungi was also higher in cancer-related sepsis group (14.1% (19/135) vs. 0.5%(3/633), χ(2)=73.965, P<0.01), and so was the number of multiple organ dysfunction (3 (2, 5) vs. 2 (1, 3), Z=-6.988, P<0.01). Finally, the in-hospital mortality rate of cancer-related sepsis and non-cancer-related sepsis were 36.3% (49/135) and 9.3% (59/633), respectively, also significantly different (χ(2)=67.000, P<0.01). There was no difference in the in-hospital mortality among children with hematologic tumors, solid tumors and HLH (35.0% (28/80) vs. 32.6% (14/43) vs. 7/12, χ(2)=2.838, P=0.242). Conclusions: The site of initial infection, inflammatory markers on PICU admission, and co-infection pathogen during hospitalization are different between patients with cancer-related sepsis and non-cancer-related sepsis. Besides, the in-hospital mortality of cancer-related sepsis is about 4-fold that of non-cancer-related sepsis. The monitoring of clinical features and organ dysfunction, and timely treatment are crucial for cancer-related sepsis.

[Continuous renal replacement therapy combined with extracorporeal membrane oxygenation for pediatric cardiopulmonary failure]

Objective: To explore the effectiveness and safety of continuous renal replacement therapy (CRRT) combined with extracorporeal membrane oxygenation (ECMO) on rescuing pediatric patients with cardiopulmonary failure. Methods: The medical records of patients treated with ECMO admitted to pediatric intensive care unit (PICU) in Shanghai Children's Hospital from December 2015 to November 2017 were retrospectively extracted. There were 14 patients treated with ECMO combined with CRRT (ECMO+ CRRT group) due to acute kidney injury (AKI) or fluid overload, while 11 cases treated with ECMO only. The demographics and clinical characteristics of patients, the indications, details and complications of ECMO and CRRT support, and the survival rates were analyzed. Results: A total of 25 cases including 15 boys and 10 girls with cardiopulmonary failure treated with ECMO were enrolled in this study, whose median age and body weight were 9 (1-117) months and 10 (2-42) kg. The median duration of ECMO support was 199.2 h, and the median duration of CRRT was 78.6 h. Among the 14 cases in ECMO + CRRT group, 12 cases were treated with CRRT connected to ECMO pipeline, and 2 other cases were treated with independently operated CRRT. The serum level of creatinine was significantly higher in ECMO+ CRRT group than that in ECMO group (53 (22- 126) vs. 29 (12- 92) μmol/L, Z=-2.208, P=0.043). There was no significant difference in running time between ECMO+CRRT group and ECMO group ((257±203) vs. (122± 83) h, t=-2.062, P=0.051). And the incidence of thrombocytopenia was higher in ECMO+CRRT group than that in ECMO group (10/14 vs. 3/11 , χ(2)=4.812, P=0.028). There were no differences in the successful weaning rate and discharge survival rate between ECMO + CRRT and ECMO group (9 vs. 8, χ(2)= 0.203, P= 0.652 and 8 vs. 8, χ(2)= 0.659, P= 0.417, respectively). Conclusion: The combination of CRRT and ECMO is an effective and safe treatment to alleviate fluid overload and improve kidney function in pediatric patients with cardiopulmonary failure.

[Effects of continuous veno-venous hemodiafiltration in patients with severe Kawasaki disease complicated with multiple organ dysfunction syndrome]

Objective: To explore the effects of continuous veno-venous hemodiafiltration (CVVHDF) as a rescue therapy in children with Kawasaki disease (KD) complicated with multiple organ dysfunction syndrome (MODS). Methods: The medical records of 5 patients diagnosed as KD with MODS treated with CVVHDF, who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from November 2015 to October 2017 were retrospectively collected. The inflammatory factors and parameters of organ function before and after CVVHDF treatment were analyzed. Wilcoxon test was used to compare the changes of parameters before and after CVVHDF treatment. Results: The pediatric critical illness score (PCIS) and the pediatric risk of score mortality score Ⅲ (PRISMⅢ) were 74.0 (70.0, 81.0) and 14.5 (12.5, 17.0), respectively. The duration of CVVHDF treatment was 46.0 (24.5, 48.0) h. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), blood lactic acid were significantly decreased after the CVVHDF treatment (0.4 (0.1, 28.8) vs. 142.0 (123.1, 1 454.6) ng/L, Z=-2.023, P=0.043; 0.1 (0.1, 9.3) vs. 1.7(1.1, 30.0) ng/L, Z=-2.023, P=0.043; 1.2(1.1,1.4) vs. 2.5(2.4, 2.7) mmol/L, Z=-2.041, P=0.041 respectively). Moreover, the lung, liver and kidney function were significantly improved as indicated by the ratio of PaO(2) to FiO(2) (380.0 (182.5, 397.5) vs. 160.0 (52.5, 185.0)mmHg (1 mmHg=0.133 kPa), Z=2.041, P=0.041), the level of total bilirubin ((14.9±1.3) vs. (86.4±9.9) μmol/L), and the levels of creatinine (2 cases: 24.0vs. 103.0 μmol/L, 38.0 vs. 142.0 μmol/L). Conclusion: CVVHDF as an adjuvant therapy can rapidly reduce the levels of IL-6 and TNF-α,and improve the organ functions in children with KD complicated with MODS.

The expression of prostaglandins-related genes in erythrocytes of broiler chicken responds to thiram-induced tibial dyschondroplasia and recombinant glutathione-S-transferase A3 protein

Tibial dyschondroplasia (TD) is a type of bone deformity found in fast-growing chickens, which induce inflammatory responses. Prostaglandins (PGs) implicate in bone formation and bone resorption, associated with inflammation in an autocrine/paracrine manner. This study used qRT-PCR and immunohistochemistry analysis to identify the expression patterns of PG-related genes in the erythrocytes of broiler chickens and explore the effects of thiram-induced TD and the recombinant glutathione-S-transferase A3 (rGSTA3) protein on the expression of PG-related genes: GSTA3, cyclooxygenase 2 (COX-2), prostaglandin D2 synthase (PTGDS), prostaglandin E synthase (PTGES), prostaglandin E2 receptor (PTGER) 3, PTGER4 and prostaglandin reductase 1 (PTGR1). Interestingly, the results showed that these seven PG-related genes expression was identified in the erythrocytes of broiler chicken, and thiram-induced TD suppressed the expression of these PG-related genes in the initial stage of TD and promoted their expression in TD recovery. These findings demonstrated that the immunoregulatory function of erythrocytes can be inhibited in the early stage of TD and promoted in the recovery stage by modulating the expression of PG-related genes. Further, the rGSTA3 protein can modulate the expression of PG-related genes in erythrocytes and participate in the recovery of TD.

[Risk factors for recurrence of benign paroxysmal positional vertigo: a Meta analysis]

Objective:To investigate the risk factors for recurrence after otolith reduction of benign paroxysmal positional vertigo by Meta analysis.Method:The relevant literatures of risk factors for recurrence of BPPV were searched by the database of PubMed, Embase, OVID, Springer, Proquest. Revman 5.3 software was used to perform Meta analysis of the included literature. Result:A total of 15 articles were included in the final analysis and a total of 4 477 cases were included. Meta analysis results showed: the recurrent after otolith reduction of BPPV in patients with the hyperlipidemia and Meniere's disease increased significantly, compared to the patients without the hyperlipidemia and Meniere's disease, difference was statistically significant［OR=1.74, 95%CI(1.14-2.65),P=0.01;OR=4.57,95%CI(2.78-7.52),P<0.01］. There was no significant difference in the recurrence after otolith reduction of BPPV in patients with diabetes and migraine compared without diabetes and migraine［OR=1.14,95%CI(0.84-1.54),P>0.05; OR=0.99, 95%CI(0.66-1.47),P>0.05］.Conclusion:Hyperlipidemia and Meniere's disease are risk factors for the recurrence after otolith reduction of BPPV.

[Clinical study of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis]

Objective: To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis(IPN). Methods: From February 2014 to August 2017, there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery, Xuanwu Hospital, Capital Medical University. There were 57 male and 32 female patients aging of (49.5±14.4)years (ranging from 23 to 84 years). The body mass index of 89 patients was (25.4±3.8)kg/m(2) (ranging from 17.6 to 36.7 kg/m(2)). Among the 89 patients, 37 cases(41.6%) of biliary pancreatitis, 10 cases (11.2%) of alcoholic pancreatitis, 16 cases(18.0%) of hyperlipidemic pancreatitis, and 26 cases(29.2%) of other reasons. Results: Of 89 patients, IPN in 6 patients(6.7%) resolved using only percutaneous catheter drainage; another 83 patients underwent laparoscopic debridement(n=3, 3.4%) or video-assisted debridement(n=80, 89.9%). No patient was conversed to laparotomy. The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately. The complication rate(Clavien-Dindo grade≥Ⅲ) was 9.0%(8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8). The overall mortality rate was 6.7%(6/89). Among them, 3 cases died of abdominal infection, bacteremia and multiple organ failure, 2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection. Conclusion: No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.

[Difference of one year death and stroke recurrence in ischemic stroke patients with anterior and posterior circulation intracranial atherosclerosis]

Objective: To explore the differences of one year death and stroke recurrence between ischemic stroke patients with intracranial atherosclerotic stenosis or occlusion of anterior circulation and those of posterior circulation. Methods: All the patients were from the Chinese Intracranial Atherosclerosis Study (CICAS), between October 2007 and June 2009; patients with extracranial stenosis or occlusion, patients without acute infarction by diffusion weighted image, and patients with intracranial atherosclerosis of both anterior and posterior circulation were excluded.All the enrolled patients were divided into three groups: no significant intracranial atherosclerosis group (n=964), anterior circulation intracranial atherosclerosis group (n=440), posterior circulation intracranial atherosclerosis group (n=233). One year outcome was evaluated by any cause of death and stroke recurrence. Results: Of the 1 637 patients, 30 cases were died and 58 cases had stroke recurrence within one year.Compared with : no significant intracranial atherosclerosis group, adjusted hazard ratio (95% confidence interval) of one-year death for anterior and posterior circulation intracranial atherosclerosis group were 1.349 (0.311-5.851), 4.542 (1.227-16.813), respectively.Adjusted hazard ratio (95% confidence interval) of one year stroke recurrence were 1.663 (0.620-4.460) and 2.464 (0.935-6.493), respectively. Conclusions: Ischemic stroke patients with intracranial atherosclerosis of posterior circulation has higher risk of one year death. One year stroke recurrence risk for patients with intracranial atherosclerosis of anterior and posterior circulation needs to be further evaluated.

[Construction and assessment of a three-dimensional finite element model of mandibualr second molar mesialization using customized lingual appliance and mini-implant]

Objective: To construct a three-dimensional (3D) finite element model and analyze the biomechanical characteristics during mandibular second molar mesialization using customized lingual appliances and mini-implant. Methods: One adult student volunteer from The First Affiliated Hospital of Zhengzhou University with lower left first molar extraction was selected. After CT scanning, Mimics, Geomagic, ANSYS were employed to develop a 3D finite element model including customized lingual brackets, stainless steel lingual arch wire, buccal buckles, lower dentition, periodontal ligaments and alveolar bone. Four different loading methods (1. the force of 1.470 N loaded at the lingual side only; 2, 3, 4. the forces of 0.490, 0.735 and 0.980 N loaded at both buccal and lingual sides, respectively.) were included. The initial displacements of the lower second molar and stress distribution in the periodontal ligaments were analyzed. Results: More uniform stress distributions in the periodontal membrane of mandibular left second molar were found when the mesial force were loaded at both buccal and lingual sides than the force loaded at lingual side only. More inclination of the second molar was observed when force loaded at both sides than at lingual side only. With the values of the force increased, the mesial inclination potential of the second molar, the initial movement of the second molar and the stress distribution in the periodontal membrane increased. Under the force of 0.735 N at both buccal and lingual sides, mesially inclined initial displacements of the mandibuar second molar were observed and the stress values of von Mises was in the suitable area. Conclusions: Less second molar rotation was found when the force loaded at both buccal and lingual sides than loaded at lingual side only. However, force loaded at both sides would increase the measial inclination potential of the second molar.

[Correlation between self-reported gingival bleeding and type 2 diabetes mellitus in aged ≥18 years adults in China]

Objective: To understand the correlation between self-reported gingival bleeding and type 2 diabetes mellitus (T2DM) in adults in China. Methods: The database of China' s 2010 Chronic Disease and Risk Factor Surveillance (CCDRFS) survey among people aged ≥18 years was used to analyze the demographic characteristics of subjects with self-reporting gingival bleeding and the prevalence of major chronic diseases among adults. Correlation and interaction analyses were conducted on the relationships between frequent gingival bleeding and T2DM, hypertension and dyslipidemia, and interaction of age and gingival bleeding, age and hypertension, age and dyslipidemia, age and gender on the prevalence of T2DM. Results: Among 93 647 adults surveyed, 87.4% were in Han ethnic group. The incidence of frequent gingival bleeding was higher in females (63.6%) than in males (36.4%). The incidence of frequent gingival bleeding was highest (30.1%) in adults with middle school education level. Among the adults aged 45-60 years, 12.8%(2 839/22 179) had T2MD but no gingival bleeding, 15.6% (163/1 044) had both frequent gingival bleeding and T2DM, frequent gingival bleeding was correlated with T2DM (OR=1.29, 95%CI: 1.08-1.54) and the interaction with age had influence on T2DM (P<0.005). In males, frequent gingival bleeding was correlated with T2DM (OR=1.30, 95% CI: 1.08-1.56, P=0.005). In hypertension group, frequent gingival bleeding was correlated with T2DM (OR=1.25, 95% CI: 1.07-1.46), and interaction of hypertension and gingival bleeding had influence on T2DM (P<0.05). Conclusions: The positive correlation between frequent gingival bleeding and T2DM was observed in adults surveyed, and the interaction of age and hypertension had influence on prevalence of T2DM. Frequent gingival bleeding was correlated with T2DM in males either.

Effects of protein and phosphate buffer concentrations on thermal denaturation of lysozyme analyzed by isoconversional method

Thermal denaturation of lysozymes was studied as a function of protein concentration, phosphate buffer concentration, and scan rate using differential scanning calorimetry (DSC), which was then analyzed by the isoconversional method. The results showed that lysozyme thermal denaturation was only slightly affected by the protein concentration and scan rate. When the protein concentration and scan rate increased, the denaturation temperature (Tm) also increased accordingly. On the contrary, the Tm decreased with the increase of phosphate buffer concentration. The denaturation process of lysozymes was accelatated and the thermal stability was reduced with the increase of phosphate concentration. One part of degeneration process was not reversible where the aggregation occurred. The other part was reversible. The apparent activation energy (Ea) was computed by the isoconversional method. It decreased with the increase of the conversion ratio (α). The observed denaturation process could not be described by a simple reaction mechanism. It was not a process involving 2 standard reversible states, but a multi-step process. The new opportunities for investigating the kinetics process of protein denaturation can be supplied by this novel isoconversional method.

Influence of Treg cells and HBV genotype on sustained response and drug resistance in the treatment with nucleoside drugs

We aimed to investigate the influence of regulatory T cells including CD4+CD25+, CD8+CD28- and hepatitis B virus (HBV) genotype on sustained virological response and tolerance of nucleoside drugs. One hundred and thirty-seven patients were enrolled. Lamivudine was administered to 84 patients. Entecavir was administered to the other 53 patients. Before treatment, biochemical tests, HBV DNA load, HBV serum level, HBV genotype, PB CD3+, CD4+, CD8+, CD4+CD25+/CD3+, and CD8+CD28-/CD3+ frequencies were measured. Based on HBV DNA loads after 4 weeks of therapy, patients were divided into response group and suboptimal response group. The lamivudine group received treatment continuously, and then patients were categorized into non-resistance group and resistance group. Compared with the suboptimal response and resistance groups for lamivudine, CD4+CD25+/CD3+ levels were higher in the response and non-resistance groups (t=4.372, P=0.046; t=7.262, P=0.017). In the non-resistance group, CD8+CD28-/CD3+ frequency was lower than in the resistance group (t=5.527, P=0.037). Virus load and hepatitis B E antigen (HBeAg)-positive rate were significantly lower than in the response and resistance group (t=2.164, P=0.038; X2=4.239, P=0.040; t=2.015, P=0.044; X2=16.2, P=0.000). Incidence of drug resistance was high in patients with virogene type C. For the virological response to entecavir, CD8+CD28-/CD3+ level was significantly lower than that of the suboptimal response group (t=6.283, P=0.036). Response and suboptimal response groups were compared in CD3+, CD4+, CD8+, CD4+CD25+/CD3+ and virus genotype, and differences were not statistically significant (P>0.05). Baseline regulatory T cells including CD4+CD25+/CD3+ and CD8+CD28-/CD3+ frequencies have a relationship with the incidence of rapid virological response and the resistance to nucleoside drugs. Patients with HBV genotype C receiving lamivudine more often underwent drug resistance. Antiviral efficacy and the resistance to lamivudine were closely correlated with baseline factors; the same cannot be found for entecavir.

[Risk factors for acute rejection in living-donor kidney transplant recipients in China: a subgroup analysis of a multi-center, registry study]

Objective: To evaluate pre-and early post-transplantation risk factors for acute rejection(AR) in kidney recipients. Methods: This subgroup analysis of a multi-center registry study was conducted on living-donor kidney transplant recipients in China with 10 years of follow-up. This study analyzed 1 255 recipients including 921 males(73.4%) and with a mean age of (33±10)years. Data from patients were first analyzed with univariate analysis and then multivariate analysis was used for finding out the potential risk factors of AR. Results: A total of 106(8.4%) patients were suspected with AR after kidney transplantation, while 1 149 patients were considered as non-AR. Multivariable analysis demonstrated a significant influence of recipient age and cold ischemia time(CIT) on the occurrence of AR(OR: 0.956, 95% CI: 0.923-0.990; OR: 1.006, 95% CI: 1.002-1.011, respectively). The frequency of severe infection was significantly higher in the AR group than non-AR group(38.7% vs 10.8%; P<0.000 1). The occurrence of new-onset diabetes mellitus and tumors was similar in the two groups. Conclusions: Recipient age and CIT are risk factors for AR after living-donor kidney transplantation. Reducing CIT and intensive management of younger recipient could benefit kidney transplant patients.

[Preliminary influence of 2015 cigarette excise tax up-regulation on cigarette retail price]

Objective: To evaluate the impact of cigarette excise tax up-regulation on the retail price of cigarettes in 2015. Methods: Nominal and real price of selected cigarette varieties were calculated with data from Tobacco Retail Price Monitoring Project, which was conducted in 10 cities of China from 2013 to 2015. The trend of the cigarette prices changing was analyzed with annual data. Results: A total of 352 varieties of cigarettes were surveyed during the three years. The nominal price of these cigarettes did not change significantly from 2013 to 2014. Compared with nominal price of 2014, the price of 286 varieties increased and the price of 10 most popular varieties increased from 0.6% to 7.4% after cigarette excise tax increased, but the actual prices had both rise and fall compared with 2013. Conclusions: Cigarette excise tax raise in 2015 had influence on the retail price of cigarettes. But the increase in retail price was very limited, if factors including inflation and purchasing power are taken into consideration. Therefore, the influence of 2015 cigarette excise tax raise on tobacco control needs further evaluation.

[The new therapy progress of recurrent nasal polyps]

The worldwide incidence of nasal polyps is on the rise. Because of the etiology and pathogenesis of nasal polyps is indistinct, operative treatment is one of methods in the process of treating nasal polyps，it makes the treatment of nasal polyps become a difficult problem to recurrent easily after operation. Nasal polyps cause enormous inconvenience to patients，so it is very important to research effective treatment of nasal polyps.This paper expounds the concept of nasal polyps, recurrent nasal polyps, and the research progress on nasal endoscopic surgery,drugs,radioactive therapy and immunotherapy in order to explore better ways to treat nasal polyps and to promote the development of clinical research.

Catechol-based layer-by-layer assembly of composite coatings: a versatile platform to hierarchical nano-materials

Inspired by the marine mussel's ability to adhere to surfaces underwater, an aqueous catechol-based dip coating platform was developed. Using a catechol-functionalized polyacrylamide binder in combination with inorganic nanoparticles enables the facile fabrication of robust composite coatings via a layer-by-layer process. This modular assembly of well-defined building blocks provides a versatile alternative to electrostatic driven approaches with layer thickness and refractive indices being readily tunable. The platform nature of this approach enables the fabrication of hierarchically ordered nano-materials such as Bragg stacks.

ZnxGe1-xO 3D micronano structures with excellent performance as anode material in lithium ion battery

As anode material used in power storage device, lithium ion battery (LIB) for example, ZnO has not been recognized as a promising candidate, although which shows advantages like environmental benign, low cost, and large reservation. Several problems, such as volume expansion, pulverization, and active substance detachment because of the particular lithiation kinetics, which result in very high irreversible capacity and following fading, can account for the present situation. Here in this work, we report the self-assembly of ZnxGe1-xO three-dimensional (3D) micronano structures and achieve enormous improvement on both recyclability and rate performance. After the 100th cycle, the capacity remains ∼690 mAh/g at the rate of 100 and ∼510 mA/g at the rate of 500 mAh/g. The capacity recovered rapidly even the rates alternating repeatedly between 50 mA/g and 3.5A/g. Ex situ observation reveals that substance detachment and nanoparticle agglomeration were avoided, benefiting from the firm 3D space configuration. As the Li(+) insertion, the 3D architectures fracture hierarchically with releasing the volume-expansion produced strain. Stable and smooth Li(+)/electrons path would form in these nanoparticles integrated microfragments, which act as the working unit free of further detachment. These facts demonstrate that ZnO based anode materials are anticipant to be good candidate in LIB device through rational design of advanced mirco-nano structures without introduction of carbon coating.

Step-flow kinetics model for the vapor-solid-solid Si nanowires growth

Vapor-solid-solid (VSS) process has recently received continued attention as an alternative to grow Si nanowire. In comparison with common vapor-liquid-solid (VLS) growth with liquid catalyst, VSS growth can prevent the catalyst species from incorporating into nanowires with deep-level impurity, and achieve the compositionally abrupt interfaces by restraining the so-called "reservoir effect". However, despite the huge advances in experimental observations with in situ electron microscopy, VSS growth still remains much less understood in theory. Here, we developed a general mass-transport-limited kinetic model to describe the VSS growth process of Si nanowires by considering three surface diffusion processes and a slow interface diffusion process, where the former determines the atoms supplies way, while the latter dominates the growth of nanowires. The present model is not only well consistent with the available experimental data of Si nanowire, but also gives a clear physical image for the successive side-to-side ledge flow VSS growth.