Personalised follow-up and management schema for patients with screen-detected pulmonary nodules: A dynamic modelling study

BACKGROUND

Selecting the time target for follow-up testing in lung cancer screening is challenging. We aim to devise dynamic, personalized lung cancer screening schema for patients with pulmonary nodules detected through low-dose computed tomography.

METHODS

We developed and validated dynamic models using data of pulmonary nodule patients (aged 55-74 years) from the National Lung Screening Trial. We predicted patient-specific risk profiles at baseline (R0) and updated the risk evaluation results in repeated screening rounds (R1 and R2). We used risk cutoffs to optimize time-dependent sensitivity at an early decision point (3 months) and time-dependent specificity at a late decision point (1 year).

RESULTS

In validation, area under receiver operating characteristic curve for predicting 12-month lung cancer onset was 0.867 (95 % confidence interval: 0.827-0.894) and 0.807 (0.765-0.948) at R0 and R1-R2, respectively. The personalized schema, compared with National Comprehensive Cancer Network (NCCN) guideline and Lung-RADS, yielded lower rates of delayed diagnosis (1.7% vs. 1.7% vs. 6.9 %) and over-testing (4.9% vs. 5.6% vs. 5.6 %) at R0, and lower rates of delayed diagnosis (0.0% vs. 18.2% vs. 18.2 %) and over-testing (2.6% vs. 8.3% vs. 7.3 %) at R2. Earlier test recommendation among cancer patients was more frequent using the personalized schema (vs. NCCN: 29.8% vs. 20.9 %, p = 0.0065; vs. Lung-RADS: 33.2% vs. 22.8 %, p = 0.0025), especially for women, patients aged ≥65 years, and part-solid or non-solid nodules.

CONCLUSIONS

The personalized schema is easy-to-implement and more accurate compared with rule-based protocols. The results highlight value of personalized approaches in realizing efficient nodule management.

Treatment for Gorham-Stout syndrome with a combination of teriparatide and denosumab

Gorham-Stout syndrome is an aggressive, non-hereditary, and rare disease affecting bone metabolism. Its etiology and pathogenesis remain elusive. The syndrome manifests with diverse clinical symptoms, often leading to frequent misdiagnoses and presenting challenges in treatment. In this study, we report a case of cranial and maxillary osteolysis in a 47-year-old female patient with somatic mutations in the VEGF-A, VEGF-B, and VEGF-C genes and the EPHB4 gene. After treatment with bisphosphonates, this patient still had persistent resorption of the mandible, but switching to a teriparatide and denosumab combination yielded substantial improvement. This study is the first report to show that teriparatide combined with denosumab can be used to treat Gorham-Stout syndrome.

Biocompatibility of Antifogging SiO-doped Diamond-Like Carbon Laparoscope Coatings

Laparoscopes can suffer from fogging and contamination difficulties, resulting in a reduced field of view during surgery. A series of diamond-like carbon films, doped with SiO, were produced by pulsed laser deposition for evaluation as biocompatible, antifogging coatings. DLC films doped with SiO demonstrated hydrophilic properties with water contact angles under 40°. Samples subjected to plasma cleaning had improved contact angle results, with values under 5°. Doping the DLC films with SiO led to an average 40% decrease in modulus and 60% decrease in hardness. Hardness of the doped films, 12.0 - 13.2 GPa, was greater than that of the uncoated fused silica substrate, 9.2 GPa. The biocompatibility was assessed through CellTiter-Glo assays, with the films demonstrating statistically similar levels of cell viability when compared to the control media. The absence of ATP released by blood platelets in contact with the DLC coatings suggests in vivo hemocompatibility. The SiO doped films displayed improved transparency levels in comparison to undoped films, achieving up to an average of 80% transmission over the visible spectrum and an attenuation coefficient of 1.1 × 10⁴ cm^-1 at the 450 nm wavelength. The SiO doped DLC films show promise as a method of fog prevention for laparoscopes.

[Discussion from metabolism to fatty liver disease: rethinking the origin of disease and the endpoint of new drugs or metabolic dysfunction-associated steatotic liver disease]

The diagnosis of nonalcoholic fatty liver disease (NAFLD) is an exclusionary diagnosis, and the name does not reflect the disease's nature or mechanism. Internationally, MAFLD (metabolic dysfunction-associated fatty liver disease) and MASLD (metabolic dysfunction-associated steatotic liver disease) have recently been proposed, which are translated as metabolic dysfunction-associated fatty liver disease in Chinese. The new name reflects the initiating factors of the disease, its occurrence and development process, and the clinical significance of associated outcomes. Through interventions against metabolic disorders, liver disease (hepatic manifestations of systemic disease) reflecting MASLD (MAFLD) has the potential to improve clinical outcomes.

Identification of a linear epitope in the capsid protein of goose astrovirus with monoclonal antibody

Goose astrovirus (GoAstV) is a novel avastrovirus that typically causes gosling gout and results in 2 to 20% mortality. GoAstV capsid protein is the sole structural protein, which is responsible for viral attachment, assembly, maturation as well as eliciting host antibodies. However, the epitopes within capsid protein have not been well studied. In this study, a monoclonal antibody, named 1D7, was generated against GoAstV capsid protein by hybridoma technology. Western blot results showed that this MAb could react with recombinant capsid protein expressed in E. coli. Also, it recognized the precursor of capsid protein, VP90 and VP70, in GoAstV-infected cells. Besides, excellent specificity of MAb 1D7 was further demonstrated in indirect immunofluorescence assay and immunohistochemical analysis. Epitope mapping results revealed that MAb 1D7 recognized the epitope 33QKVY 36 within Cap protein. Sequence alignment indicated that 33QKVY 36 is a conserved epitope among the isolates of goose astrovirus type 2 (GoAstV-2), suggesting the potential for its use in GoAstV-2 specific diagnostic assay. These findings may provide some insight into a function of the GoAstV capsid protein and further contribute to the development of diagnostic methods for GoAstV infection.

Effect of lactose-free milk powder on lactose intolerance symptoms and nutritional status of pet dogs

The effects of standard cow, goat and lactose-free cow milk powder on lactose intolerance symptoms and the nutritional status of dogs was studied. Forty adult Springer Spaniels with lactose intolerance were randomly allocated into four groups with ten dogs each and fed one of the milk powders or water for 21 d. The milk powders were reconstituted daily by diluting 10 g milk powder to 60 g water and 2 g milk powder/kg body weight was provided ad libitum and refusals were monitored daily. Lactose intolerance was assessed by faecal composition and pH, water and lactose contents. Biochemical markers for nutritional status were analysed. Feeding intolerance and lactose in faecal samples were observed in dogs fed the standard cow and goat milk powder, but not for the lactose-free milk powder or control groups. The high- and low-density lipoprotein cholesterol increased in all milk powder groups, while there were no other differences in nutritional status measurement. The results suggested that feeding lactose-free milk powder to dogs with lactose intolerance reduced the occurrence of symptoms, thereby enhancing the health and wellbeing of dogs.

212 FATIGUE EXPERIENCED BY ADULTS WITH LONG-COVID WAS NOT ASSOCIATED WITH AN EMG-DERIVED MUSCLE FATIGUE INDEX

Background

One of the most prominent challenges of the COVID-19 pandemic is the emergence of the post-COVID-19 syndrome or ‘long-COVID’ following the acute phase of the viral infection. With a plethora of debilitating symptoms across many physiological systems, the pathophysiology of long-COVID remains elusive and subject of intense research efforts. Adults with long COVID are often affected by prolonged fatigue, which could be linked to neuromuscular function impairment. We hypothesised that there might be a correlation between subjective fatigue and an Electromyograph(EMG)-derived muscle fatigue index in adults with long-COVID.

Methods

As part of a neuro-cardiovascular instability assessment protocol, participants were asked to squeeze the thigh muscles as hard as possible for ten seconds during both supine resting and after active and passive standing (head-up tilt) tests. Surface EMG was used to capture on each leg the physiological activity of the vastus lateralis and rectus femoris during the squeezes, from which the muscle fatigue index was computed based on both the mean and median frequencies of each 10-second maximum prompted muscle contraction. Using two-sided Spearman correlation coefficients, we examined the associations between the muscle fatigue indices and self-reported fatigue measured by the Chalder Fatigue Scale (CFQ).

Results

108 participants were included, 77 female and 31 male, with a mean age of 46 (range 25-78) years, 22% of whom were hospitalised in the acute phase of SARS-CoV-2 infection. Strong intercorrelations were found between the muscle fatigue indices derived from the mean and median frequencies of thigh muscle contractions. However, no significant correlations were detected between the muscle fatigue indices and CFQ scores.

Conclusion

Self-reported fatigue as measured by the CFQ was not associated with an EMG-derived muscle fatigue index in this long-COVID cohort.

[The epidemiology and screening of hepatitis D]

Hepatitis D virus (HDV) is a defective RNA virus with 8 genotypes, which requires hepatitis B virus (HBV) for its replication both in co-infection (HDV infection occurs when people become infected with both hepatitis B and D simultaneously) and super-infection (HDV infection after infected with hepatitis B). Due to persistency of anti-HDV in the superinfected patient, the most epidemiology data of HDV infection suggests HBV/HDV super-infection. Because of inadequate awareness and effective HBV vaccination programme, HDV infection screen was not specific recommended, except for risk population recommended by AASLD. However, the disease burden of HDV infection was not fully understood and might be underestimated. This review summarized the anti-HDV and HDV genotype epidemiology and the screening of HDV infection.

Complete remission of pulmonary alveolar proteinosis after anti-tuberculous chemotherapy: a case report

Pulmonary alveolar proteinosis (PAP) is a rare respiratory system disorder. Patients with PAP are at risk for a wide variety of secondary infections. This current case report describes a patient with PAP complicated by tuberculosis. A 48-year-old male patient with multiple follow-up chest computed tomography scans that showed predominant diffuse ground glass opacity in both lung fields, presented a few years later with new calcified lesions and pleural effusion. At this point, the associated auxiliary examination indicated the possibility of PAP combined with tuberculosis infection. The patient achieved complete remission after anti-tuberculosis treatment. PAP is an easily overlooked clinical syndrome due to its low prevalence and lack of specific clinical manifestations, especially when combined with other pulmonary lesions. Therefore, clinicians should consider this rare disease in patients presenting with pulmonary disease and plan for its co-morbidity with other secondary outcomes, such as opportunistic infections, which are a common and life-threatening complication in patients with PAP. This case indicates the possibility that anti-tuberculosis therapy can improve alveolar proteinosis in patients with PAP and secondary Mycobacterium tuberculosis infection.

123 ACUTE-PHASE BED-REST DURATION WAS ASSOCIATED WITH LOWER GRIP STRENGTH IN A POST-COVID-19 COHORT

Background

Though age-related muscle loss is traditionally associated with older cohorts, strong evidence suggests a life-spanning precipitation of decreasing muscle mass and strength beginning as early as the fourth decade of life, with established deleterious consequences for later-life morbidity and mortality. Periods of low activity and bed rest (LA/BR) can further compound this depletion of muscle strength. Our aim was to examine such associations in a post-COVID-19 cohort.

Methods

Participants reporting ongoing symptomatology and fatigue post COVID-19 underwent assessments of grip strength via hand-held dynamometry (2 measures on each hand). Demographics of COVID-19 illness, including time since diagnosis, duration of LA/BR during acute illness, and levels of fatigue were captured via self-reported questionnaires. Independent predictors of mean grip strength were investigated using a linear regression model.

Results

Forty-nine participants underwent assessments (69% female, mean age 44(12) years). At the time of assessment, days post COVID-19 diagnosis ranged from 39–522 (mean 262(140)). The mean self-reported period of LA/BR during the acute illness was 15(18) days. In general, participants reported significant levels of fatigue (median Chalder Fatigue Scale score 22(8)). Mean grip strength was 41.3(6.3) Kg for men and 22.8(6.7) Kg for women. When predictors of grip strength were investigated, an increased duration of LA/BR was found to be associated with lower grip strength, independently of age, gender, time since COVID-19 diagnosis, and self-reported fatigue (Beta = −0.158, 95% Confidence Interval − 0.242 to −0.074, p = 0.001).

Conclusion

In this cohort, every day of LA/BR during acute COVID-19 illness was independently associated with subsequent lower grip strength of approximately 150 g. These results underscore the importance of early mobilization and discouraging bed rest in the acute phase of COVID-19. Patients who are isolating should be encouraged to maintain physical activity and muscle strength as part of a modified isolation-friendly rehabilitation programme.

[Analysis of gene mutation spectrum and pharmacokinetics of fibrinogen infusion in 146 cases of congenital fibrinogen disorders]

Objective: To investigate the clinical type and gene mutations, clinical manifestations, laboratory tests, diagnosis, and fibrinogen replacement therapy of congenital fibrinogen disorders. Methods: Clinical data of 146 patients with congenital fibrinogen disorders diagnosed from April 2000 to November 2020 were retrospectively analyzed. Results: Among the 146 patients, 61 (41.8%) men and 85 (58.2%) women had a median age of 33.5 years at the time of consultation. 34 patients (34.7%) were found to suffer from the disease due to bleeding symptoms, 33 patients (33.7%) due to preoperative examination. 55 patients (56.1%) had at least one bleeding symptom, and 42 patients (42.9%) had no bleeding symptoms. There is a negative correlation between fibrinogen activity concentration and bleeding ISTH-BAT score (rs=-0.412, P=0.001) . A total of 34 gene mutations were detected in 56 patients, of which 84.1% were missense mutations, and 16 new mutations were found. FGA Exon2 and FGG Exon8 mutations accounted for 71.4% of all mutation sites. Patients with afibrinogenemia were younger, with a median age of 2 (1-12) years, an ISTH-BAT score of 4, and patients with dysfibrinogenemia had significantly longer thrombin time (TT) , with a median of 28.5 (19.2-36.6) s. The 1 hour in vivo recovery (IVR) after fibrinogen infusion was (127.19±44.03) %, and the 24 hour IVR was (101.78±43.98) %. In addition to the obvious increase in the concentration of fibrinogen activity, the TT and the prothrombin time (PT) both decreased significantly, and the TT decreased more significantly, with an average decrease of 15.2% compared to the baseline after 24 hours of infusion. Conclusion: Most patients with congenital fibrinogen disorders have mild or no bleeding symptoms. Patients with afibrinogenemia have more severe symptoms. There is a negative correlation between the fibrinogen and the degree of bleeding. Genetic testing is helpful for the diagnosis of disease classification. FIB∶C/FIB∶Ag<0.7 can be used as a basis for clinical diagnosis. The TT can be used as the basis for the diagnosis of dysfibrinogenemia and the effectiveness of fibrinogen infusion.

Expression of syndecan-1, PKC and VEGF in rats with acute kidney injury and correlation between syndecan-1 and renal function

OBJECTIVE

This study was designed to investigate the expression of syndecan-1 (Sdc-1), protein kinase C (PKC) and vascular endothelial growth factor (VEGF) in rats with acute kidney injury, as well as the association between Sdc-1 and indicators [such as serum creatinine (Scr) and blood urea nitrogen (BUN)] related to renal function.

MATERIALS AND METHODS

A total of 120 clean grade 2-week-old SD rats were selected and randomized into experimental group and control group (n=60). At 12 h (T1), 24 h (T2), 36 h (T3), 48 h (T4) after the model was established, 3 mL blood from abdominal aorta was taken, and Sdc-1, PKC, VEGF, serum creatinine (Scr), urea nitrogen (BUN) and other indicators were detected by Enzyme-Linked Immunosorbent Assay (ELISA).

RESULTS

The expression levels of Sdc-1, PKC and VEGF in the experimental group were increasing from T1 to T4, with statistically significant difference between every two time points (p<0.05); the expression levels of Scr and BUN in the experimental group was increasing from T1 to T4, with statistically significant difference between every two time points (p<0.05). The level of Sdc-1 in the serum of rats in the experimental group was positively correlated with Scr (r=0.668, p<0.001), negatively correlated with BUN (r=0.722, p<0.001), and positively correlated with BUN (r=0.722, p<0.001); PKC level was positively correlated with Scr (r=0.589, p<0.001), BUN (r=0.788, p<0.001), and VEGF level was positively correlated with Scr (r=0.666, p<0.001), BUN (r=0.784, p<0.001).

CONCLUSIONS

As the concentration of syndecan-1 increases gradually, renal dysfunction aggravates accordingly, so syndecan-1 can be used as a marker of acute kidney injury and can be used to judge the degree of kidney injury at an early stage.

[Advances in application of tissue clearing technique in hard tissues]

Tissue clearing is a novel technique developed within recent years, which could make the tissue optical transparency using physical or chemical methods by refractive index matching. Combined with fluorescence imaging and three-dimensional reconstruction technology, it could achieve three-dimensional observing and analyze the tissue structure at the cellular resolution. The tissue clearing technique is mainly applied to soft tissues, as less to hard tissues. In recent years, many researchers have modified tissue clearing methods and made them suitable for hard tissues, such as bone and teeth. The present paper reviews the recent application of tissue clearing techniques in hard tissues.

[Clinical and genetic analyses of hereditary factor Ⅴ deficiency cases]

Objective: To analyze the clinical phenotype and molecular pathogenesis of nine patients with hereditary factor Ⅴ (FⅤ) deficiency. Methods: Nine patients with hereditary FⅤ deficiency who were admitted to the Institute of Hematology and Blood Diseases Hospital from April 1999 to September 2019 were analyzed. The activated partial thromboplastin time, prothrombin time, and FⅤ procoagulant activity (FⅤ∶C) were measured for phenotypic diagnosis. High-throughput sequencing was employed for the F5 gene mutation screening, Sanger sequencing was adopted to confirm candidate variants and parental carrying status, Swiss-model was used for three-dimensional structure analysis, and ClustalX v.2.1 was used for homologous analysis. Results: The FⅤ∶C of the nine patients ranged from 0.1 to 10.6. Among them, eight had a hemorrhage history, with kin/mucosal bleeding as the most common symptom (three cases, 37.5%) , whereas one case had no bleeding symptom. There were five homozygotes and four compound heterozygotes. A total of 12 pathogenic or likely pathogenic mutations were detected, of which c.6100C>A/p.Pro2034Thr, c.6575T>C/p.Phe2192Ser, c.1600_1601delinsTG/p. Gln534*, c.4713C>A/p.Tyr1571*, and c.952+5G>C were reported for the first time. Conclusion: The newly discovered gene mutations enriched the F5 gene mutation spectrum associated with hereditary FⅤ deficiency. High-throughput sequencing could be an effective method to detect F5 gene mutations.

Effect of different glucogenic to lipogenic nutrient ratios on rumen fermentation and bacterial community in vitro

Aims

This study was to investigate the effect of different ratios of glucogenic to lipogenic nutrients on rumen fermentation and the corresponding ruminal bacterial communities.

Methods and Results

Four diets, including glucogenic diet (G), lipogenic diet (L), two mixed diets: GL1 (G: L = 2 : 1) and GL2 (G:L = 1 : 2), served as substrates and were incubated with rumen fluid in vitro. The results revealed that the gas production, dry matter digestibility and propionate proportion were significantly increased by the G diet than others. The G diet increased the bacterial genera of Succinivibrionaceae_UCG_002, Succinivibrio, Selenomonas_1 and Ruminobacter but decreased some cellulolytic bacteria including the Eubacterium and several genera in family Ruminococcaceae than others.

Conclusions

When the glucogenic nutrient was above 1/3 of the dietary energy source among the four diets, the in vitro incubation had a higher feed digestibility and lower acetate to propionate ratio. Bacterial genera, including Selenomonas, Succinivibrio, Ruminobacter, certain genera in Ruminococcaceae, Christensenellaceae_R‐7_group and Eubacterium, were more sensitive to the glucogenic to lipogenic nutrients ratio.

Significance and Impact of the Study

The present study provides a new perspective about the effect of dietary glucogenic to lipogenic ingredient ratios on rumen metabolism by comparing end‐products, gas production and bacterial composition via an in vitro technique.

Association of placenta-derived extracellular vesicles with pre-eclampsia and associated hypercoagulability: a clinical observational study

OBJECTIVE

Pre-eclampsia (PE) is a pregnancy-associated condition initiated by placental factors. We have demonstrated that placental extracellular vesicles (pcEVs) cause hypertension and proteinuria in pregnant and non-pregnant mice.

STUDY DESIGN

An observational study with both case-control and longitudinal designs.

SETTING

A single centre at the Department of Obstetrics and Gynaecology, Tianjin Medical University.

POPULATION

We collected blood samples and clinical information from 54 PE patients, 33 normally pregnant women at 30-36 gestational weeks and on postpartum days 1 and 4 for the cross-sectional study, and at 22-31, 32-35 and 36-40 weeks for the longitudinal study. Non-pregnant women were also recruited.

METHODS

Blood samples were analysed using flow cytometry, coagulation tests and ELISA.

MAIN OUTCOME MEASURES

The primary outcome was plasma pcEV and other extracellular vesicles (EVs), and their expressions of anionic phospholipids and von Willebrand factor (VWF). Secondary variables included coagulation, ADAMTS-13 and the anionic phospholipid-binding proteins.

RESULTS

Plasma pcEVs progressively increased from pregnant women during non-menstrual period (NW) to PE patients (interquartile range [IQR] for NW: 206/microlitre [116-255], normal pregnancy [NP]: 1108/microlitre [789-1969] and PE: 8487/microlitre [4991-16 752]) and predicted PE. EVs from endothelial cells, platelets and erythrocytes accounted for <10% of pcEVs. VWF became hyper-adhesive in PE patients and contributed to the pregnancy-associated hypercoagulability.

CONCLUSION

Placental, platelet- and endothelial cell-derived EVs were significantly elevated in PE patients, but only pcEVs predicted PE. These EVs played a causal role in the pregnancy-induced hypercoagulability.

TWEETABLE ABSTRACT

Placenta-derived extracellular vesicles predict pre-eclampsia and the associated hypercoagulability.

MicroRNA-199 inhibits proliferation and promotes apoptosis in children with acute myeloid leukemia by mediating caspase-3

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "MicroRNA-199 inhibits proliferation and promotes apoptosis in children with acute myeloid leukemia by mediating caspase-3, by F. Xue, Y. Zhu, F. Xu, L.-J. Zhou, F. Han, S.-C. Wang, published in Eur Rev Med Pharmacol Sci 2019; 23 (9): 3584-3593-DOI: 10.26355/eurrev_201905_17780-PMID: 31114982" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/17780.

[Congenital factor Ⅶ deficiency: a retrospective analysis of 43 cases]

Objective: To explore the pathogenesis, clinical characteristics, laboratory findings, diagnosis, treatment, and prognosis of congenital factor Ⅶ (FⅦ) deficiency. Methods: Clinical data of 43 patients with congenital FⅦ deficiency diagnosed from April 1999 to September 2019 were retrospectively analyzed. Results: There were 27 females and 16 males. Median age was 16 (1-70) years. Family history was found in 6 cases. There were 29 (67.4%) cases with bleeding symptoms, most common of which were mucocutaneous bleeding (13 cases, 30.2%) , oral bleeding (13 cases, 30.2%) , and epistaxis (9 cases, 20.9%) . Menorrhagia occurred in 11 cases (47.6% of female patients who were in fertile age) . Laboratory findings were characterized by significantly prolonged prothrombin time (PT) , normal partial thromboplastin time (APTT) , and decreased FⅦ activity (FⅦ∶C) . Ten cases received gene mutation analysis and 3 new mutations were found. Fourteen cases (32.6%) were treated with prothrombin complex concentrates (PCC) , 12 (27.9%) with fresh frozen plasma (FFP) , and 3 (7.0%) with human recombinant activated FⅦ (rFⅦa) . Twenty cases (46.5%) with no or mild bleeding symptoms did not receive any replacement therapy. Previous bleeding symptoms recurred in 5 patients (11.6%) , 8 females still had heavy menstrual bleeding, and 9 patients (20.9%) were lost to follow-up. Conclusion: Most patients with congenital FⅦ deficiency have mild or no bleeding symptoms, but have a tendency to excessive bleeding after surgery or trauma. There is no significant correlation between FⅦ∶C and severity of bleeding symptoms. Prophylaxis should be applied in patients with severe bleeding symptoms and rFⅦa is the first choice. Gene mutation test is significant for screening, diagnosis, and prognosis prediction of the disease.

[Clinical characteristics of 83 patients with thrombotic thrombocytopenic purpura]

Objective: To analyze the clinical characteristics, treatment and prognosis of patients with thrombotic thrombocytopenic purpura (TTP) . Methods: 83 patients with TTP from May 1998 to May 2019 were analyzed retrospectively. Results: Among the 83 patients, there were 27 males and 56 females, with a median age of 39 (10-68) years. 41 cases (49.4%) showed pentalogy syndrome and 79 cases (95.2%) showed triad syndrome. 78.0% (46/59) of the patients had a PLASMIC score of 6 or higher. TTP gene mutations was detected in 5 of 10 patients. The activity of von Willebrand factor-cleaving protease (ADAMTS13) , which was detected in 10 patients before plasma exchange (PEX) , was less than 10% in 9 patients. 83 patients were treated with PEX/plasma infusion and glucocorticoid, 35 of which were treated combined with rituximab and/or immunosuppressant. The median follow-up was 34 (1-167) months, the effective rate was 81.9%, the remission rate was 63.9%, the relapse rate was (35.7 ±7.1) %, and the 3-year overall survival (OS) rate was (78.6 ±4.6) %. The effective rate (72.9%vs 94.3%, P=0.019) and OS rate[ (63.8±7.5) %vs (94.3±3.9) %, χ(2)=8.450, P=0.004] in the group treated with PEX/PI and glucocorticoid alone were lower than those in the group treated combined with rituximab and/or immunosuppressant. COX multivariate analysis showed that age (HR=1.111, 95%CI 1.044-1.184, P=0.001) and alanine transaminase (ALT) /aspartate aminotransferase (AST) (HR=1.353, 95%CI 1.072-1.708, P=0.011) were independent risk factors for OS. Conclusion: Most patients with TTP have triad syndrome, accompanied by a decrease in ADAMTS13 activity. Plasma infusion and glucocorticoid combined with rituximab, immunosuppressive therapy could improve overall survival. The prognosis of patients with older age and high ALT/AST ratio is poor.

[Therapy-related myeloid neoplasms after successful treatment for acute promyelocytic leukemia: a report of four cases and literature review]

目的

探讨急性早幼粒细胞白血病（APL）患者继发治疗相关性髓系肿瘤（t-MN）的临床特点、诊断、治疗及预后。

方法

回顾性分析中国医学科学院血液病医院2012年10月至2019年1月收治的4例APL继发t-MN患者的临床资料，并进行相关文献复习。

结果

4例APL继发t-MN患者均为女性，中位年龄42（40~53）岁，3例接受了以维甲酸（ATRA）+亚砷酸（ATO）为基础联合蒽环/蒽醌类药物±阿糖胞苷的前期诱导缓解及巩固治疗方案，1例采用了ATRA联合蒽环/蒽醌类药物±阿糖胞苷的治疗方案，均没有使用烷化剂。在APL获得完全缓解（CR）后40~43个月出现t-MN，其中治疗相关性骨髓增生异常综合征（t-MDS）1例，治疗相关性急性髓系白血病（t-AML）3例，出现t-MN时PML-RARα融合基因均为阴性。3例t-AML患者接受了2~4个疗程再诱导治疗，其中有1例t-AML患者在获得CR后行异基因造血干细胞移植（allo-HSCT），1例t-MDS患者接受了去甲基化治疗。中位随访54.5（48~62）个月，2例t-AML患者死亡，出现t-MN后中位生存期为12（5~18）个月。1989至2018年文献共报道63例APL继发t-MN病例，与本次报道的4例汇总分析，67例患者中男27例，女40例；中位年龄为52.5（15~76）岁；中位潜伏期39（12~168）个月，确诊t-MN后中位生存时间为10（1~39）个月。

结论

APL继发t-MN较为少见，目前缺乏有效的防治措施，预后不佳，在随访过程中（尤其是获得CR后39个月左右）若出现病情变化，应警惕t-MN的发生，对此类患者应尽快明确疾病的变化，给予合理的治疗。

[Eltrombopag for the treatment of primary immune thrombocytopenia in 23 pediatric patients]

目的

评估艾曲泊帕治疗儿童原发免疫性血小板减少症（ITP）的疗效和不良反应。

方法

回顾性分析2015年5月至2019年3月接受艾曲泊帕治疗的23例儿童ITP患者临床资料。

结果

23例患者中，男11例，女12例，中位年龄11（2~17）岁。新诊断ITP 4例（17.39%），持续性ITP 8例（34.78%），慢性ITP 11例（47.83%）。艾曲泊帕中位起始剂量为25.0（12.5~50.0）mg/d。基线中位血小板计数为14（2~82）×10⁹/L，治疗后第2周（23例）、第4周（23例）、第3个月（16例）、第6个月（11例）的中位血小板计数分别为40（4~170）×10⁹/L、20（4~130）×10⁹/L、60（4~110）×10⁹/L、70（18~160）×10⁹/L，均高于基线水平（z=-3.440，P=0.001；z=-1.964，P=0.049；z=-4.339，P<0.001；z=-5.794，P<0.001）。7例（30.43%）患者的起效时间≤7 d，10例（43.48%）患者的起效时间≤2周，总有效率为60.87%（14/23）。<6岁（6例）、6~12岁（10例）、13~17岁（7例）组的总有效率分别为33.33%（2/6）、60.00%（6/10）、85.71%（6/7），组间比较差异均无统计学意义（P>0.05）。23例患者基线WHO出血评分0、1、2级分别有4、12、7例，治疗后分别为13、7、3例，出血症状得到明显改善（χ²=7.558，P=0.006）。治疗过程中发生转氨酶、胆红素增高各4例，轻度恶心、呕吐及头晕各1例，对治疗均未造成影响。

结论

艾曲泊帕作为二线用药治疗儿童ITP疗效及耐受性均较好。

Prevalence and cardiovascular risk factors of asymptomatic intracranial arterial stenosis: the Kongcun Town Study in Shandong, China

BACKGROUND AND PURPOSE

This study was to investigate the prevalence and cardiovascular risk factors (CRFs) of asymptomatic intracranial atherosclerotic stenosis (aICAS) amongst middle-aged and older adults living in rural communities in China.

METHODS

This population-based study included 2019 subjects (aged ≥40 years, 52.3% women) who were free of stroke and living in rural communities in China. From October 2017 to May 2018, data on demographics, CRFs and health conditions were collected through face-to-face interviews, physical examination and laboratory tests. Asymptomatic ICAS was detected through a two-phase procedure: a screening phase with transcranial Doppler ultrasound, followed by a diagnostic phase with magnetic resonance angiography examination. Multivariable logistic regression models were used to analyse CRFs associated with aICAS.

RESULTS

Of the 2019 participants, aICAS was detected in 153 persons. The overall prevalence of aICAS was 7.6%, and the prevalence of moderate-to-severe aICAS was 5.0%. The multi-adjusted odds ratio (95% confidence interval) of aICAS associated with CRFs was 2.40 (1.56-3.69) for hypertension, 1.91 (1.32-2.76) for high hypersensitive C-reactive protein, 1.68 (1.14-2.49) for diabetes and 1.61 (1.08-2.41) for overweight or obesity. When these four CRFs were aggregated, compared with participants without any of these factors, the multi-adjusted odds ratios (95% confidence interval) of aICAS for persons concurrently having one, two and three or more of these factors were 1.14 (0.52-2.48), 2.91 (1.42-5.99) and 5.51 (2.64-11.50), respectively (P for linear trend <0.001).

CONCLUSIONS

Asymptomatic ICAS is common amongst rural-dwelling middle-aged and older Chinese people. Hypertension, diabetes, overweight or obesity and high hypersensitive C-reactive protein, especially when coexisting, are strongly associated with aICAS.

[Gene mutation spectrum and clinical characteristics analysis of 178 patients with essential thrombocytosis]

目的

分析原发性血小板增多症（ET）患者基因突变谱及临床特征。

方法

对2009年2月1日至2018年11月1日收治的178例初诊ET患者进行回顾性分析。

结果

全部178例患者中，男89例，女89例，中位初诊年龄为49.5（3~86）岁。JAK2V617F基因突变频率为16.45%（1.67%~43.90%），CALR基因突变频率为40.00%（10.00%~49.15%），MPL基因突变频率为25.10%（25.00%~40.00%）。与CALR基因突变的患者相比，JAK2V617F基因突变患者具有较高的发病年龄（P=0.035）、初诊白细胞计数（P=0.040）、初诊血红蛋白浓度（P=0.001）和较低的初诊血小板计数（P=0.002）。47例（27.01%）患者诊断ET前发生血栓事件，3例（1.72%）诊断ET后发生血栓事件。多因素分析结果显示，年龄>60岁（P=0.013，OR=4.595，95%CI1.382~15.282）、心血管危险因素（P<0.001，OR=8.873，95%CI2.921~26.955）为血栓事件的危险因素，CALR基因突变（P=0.032，OR=0.126，95%CI0.019~0.838）为血栓事件的保护性因素。年龄>60岁（P=0.042，OR=4.045，95%CI1.053~15.534）是影响ET患者总生存时间的危险因素。年龄≤60岁、年龄>60岁患者的OS时间分别为（115.231±1.899）、（83.291±4.991）个月（χ²=6.406，P=0.011）。

结论

心血管危险因素、年龄>60岁为ET患者血栓事件的危险因素，CALR基因突变为血栓事件的保护性因素。年龄>60岁是影响ET患者总生存的危险因素。

MiR-205 enhances cisplatin sensitivity of glioma cells by targeting E2F1

OBJECTIVE

miR-205 has been previously identified as a diagnostic and prognostic factor in glioma. However, its exact functions in glioma remain unclear. The current research aimed to decipher the role of miR-205 in the development of cisplatin resistance in glioma cells.

MATERIALS AND METHODS

miR-205 expressions in both cisplatin sensitive and resistant cell lines were compared by the Real-time PCR method. The dose-response to cisplatin of U87/DDP cells was determined by MTT assay. Cell cycle and apoptosis were determined by flow cytometry, caspase 3/7 activity assay and Western blot assay. The direct repression of E2F1 by miR-205 was confirmed by luciferase assay and Western blot assay.

RESULTS

miR-205 expression was decreased in cisplatin resistant glioma cell lines, and cisplatin treatment led to a decrease of miR-205 in glioma cells. Overexpression of miR-205 in U87/DDP restored its cisplatin sensitivity by enhancing apoptosis and G1/S cell cycle arrest; notably, all these effects were then partially abrogated by E2F1 overexpression. Luciferase assay and Western blot assay confirmed E2F1 as the direct target of miR-205 in U87/DDP cells.

CONCLUSIONS

These findings suggest that down-regulation of miR-205 confers the cisplatin resistance in glioma cells via upregulation of E2F1. It might serve as a candidate for glioma therapy.

Geographical variation in life-history traits suggests an environmental-dependent trade-off between juvenile growth rate and adult lifespan in a moth

Life-history theory predicts a trade-off between the juvenile growth rate and adult traits related to survival. However, this hypothesized negative correlation is difficult to test robustly because many trade-offs are mild, and environmental variables, such as changes in nutrient availability, can ameliorate the trade-off or make it more pronounced. Thus, it is reasonable to expect that the expression of the trade-off can be condition-dependent. In the present study, we first examined the pre-adult life-history traits of the cotton bollworm, Helicoverpa armigera, collected from northern, central, and southern China at different temperatures. We found that the northern China population has a significantly shorter pre-adult developmental time and higher growth rate than the southern China population as a result of adaptation to the decreased seasonal length. Then, we tested for a trade-off between the juvenile growth rate and adult lifespan in different temperature and nutrient conditions. We found a negative relationship between juvenile growth rate and adult lifespan under starvation or desiccation conditions; however, a continuous supply of sugar can diminish or obviate the apparent negative relationship, in which the adult lifespan did not show a significant difference in most of the comparisons. These results suggested a resource-mediated trade-off may exist between juvenile growth rate and adult lifespan. However, the adult size may have some positive effect on the lifespan under starvation and desiccation conditions, which may affect the expression of trade-off.

MicroRNA-199 inhibits proliferation and promotes apoptosis in children with acute myeloid leukemia by mediating caspase-3

OBJECTIVE

The aim of this study was to detect the expression level of microRNA-199 in acute myeloid leukemia (AML). Meanwhile, we also investigated whether microRNA-199 could inhibit the proliferation and promote apoptosis of AML cells by regulating caspase-3.

PATIENTS AND METHODS

The expression level of microRNA-199 in peripheral blood samples of AML patients and healthy controls was determined using Real Time-quantitative Polymerase Chain Reaction (RT-qPCR). Similarly, microRNA-199 expression was also detected in AML cells and human medullary cells. The overexpression plasmid of microRNA-199 was constructed and transfected into cells. Subsequently, the regulatory effects of microRNA-199 on the proliferation, cell cycle, apoptosis, invasion and migration were accessed. The relationship between microRNA-199 and caspase-3 expression was further elucidated by Western blot and RT-qPCR.

RESULTS

MicroRNA-199 was lowly expressed in peripheral blood of AML patients and AML cell lines than normal controls. The overexpression of microRNA-199 significantly decreased proliferative, invasive and migratory capacities of AML cells, whereas markedly increased apoptotic rate. Western blot results showed that microRNA-199 increased caspase-3 expression in AML cells. Rescue experiments demonstrated that microRNA-199 inhibited malignant progression of AML by targeting caspase-3.

CONCLUSIONS

MicroRNA-199 is lowly expressed in AML patients. Furthermore, it inhibits the malignant progression of AML by targeting caspase-3.

[The incidence and risk factors for thrombosis in primary immune thrombocytopenia]

目的

探讨原发免疫性血小板减少症（ITP）患者血栓发生情况及相关危险因素。

方法

对2005年12月至2017年12月在中国医学科学院血液病医院血栓止血中心住院治疗的3 225例ITP患者进行回顾性分析。

结果

共46例患者（1.43%）发生血栓事件，中位发病年龄为54（26~83）岁，成人患者中>40岁人群血栓发生率明显高于40岁以下人群[3.37%（40/1 187）对0.58%（6/1 030），P=0.000]。男、女性患者血栓发生率差异无统计学意义[1.53%（20/1309）对1.36%（26/1 916），P=0.187]。动脉血栓的发生率高于静脉血栓[1.12%（36/3 225）对0.22%（7/3 225），P=0.000]。82.61%（38/46例）患者发生血栓时PLT<100×10⁹/L。吸烟、高血压病、糖尿病及脾切除是ITP患者发生血栓的危险因素（P值分别为0.232、0.531）；糖皮质激素、TPO治疗患者治疗在有无血栓事件的两组间比较差异无统计学意义（P值分别为0.064、0.075、0.531）。

结论

对于中国人群，ITP疾病本身可能也是一种可伴发血栓的免疫性疾病，即使血小板水平低下仍可发生血栓事件；且具有明显的年龄分布特点；吸烟史、高血压病、糖尿病史及脾切除是发生血栓的危险因素。

[Immune tolerance induction in a case of hemophilia B with inhibitor with prothrombin complex concentrate and rituximab]

目的

探讨血友病B伴抑制物的免疫耐受诱导（ITI）治疗，提高血友病B伴抑制物的诊疗水平。

方法

应用基于APTT标准曲线的一期法测定重型血友病B患者凝血因子Ⅸ（FⅨ）活性，应用Bethesda法进行FⅨ抑制物定量测定；利用凝血酶原复合物（PCC）进行ITI并联合利妥昔单抗清除患者抑制物。

结果

患儿既往PCC暴露日为20 d，抑制物滴度峰值为56 BU/ml。在2015年11月患儿抑制物滴度降至10.4 BU/ml时开始ITI治疗，单用PCC一段时间无效，给予PCC联合利妥昔单抗治疗，17个月后成功清除患者体内FⅨ抑制物，未发生过敏反应及肾病综合征等并发症。ITI过程中患者年化出血率有所改善。

结论

该患者是国内首例报道的采用ITI联合利妥昔单抗成功治疗血友病B伴抑制物的病例。PCC联合利妥昔单抗ITI治疗是目前有希望清除血友病B抑制物的方法。

Isostructural metal-insulator transition in VO2

The metal-insulator transition in correlated materials is usually coupled to a symmetry-lowering structural phase transition. This coupling not only complicates the understanding of the basic mechanism of this phenomenon but also limits the speed and endurance of prospective electronic devices. We demonstrate an isostructural, purely electronically driven metal-insulator transition in epitaxial heterostructures of an archetypal correlated material, vanadium dioxide. A combination of thin-film synthesis, structural and electrical characterizations, and theoretical modeling reveals that an interface interaction suppresses the electronic correlations without changing the crystal structure in this otherwise correlated insulator. This interaction stabilizes a nonequilibrium metallic phase and leads to an isostructural metal-insulator transition. This discovery will provide insights into phase transitions of correlated materials and may aid the design of device functionalities.

CCR6 defines a subset of activated memory T cells of Th17 potential in immune thrombocytopenia

Current researches have determined the significance of C-C chemokine receptor (CCR)6 expression as either a marker of T helper cells (Th) or an effector and regulator of T cell function. However, the roles of CCR6 in the pathogenesis of immune thrombocytopenia (ITP) are unclear. In this study, we aimed to investigate the phenotype and functional characteristics of circulating CCR6⁺ T cells in blood from chronic ITP patients and healthy controls. We found that the frequency of CCR6⁺ CD4⁺ cells was higher in ITP patients than in healthy controls. Anti-CD3/anti-CD28 stimulation induced rapid expansion of CCR6⁺ CD4⁺ cells in ITP patients. CCR6⁺ CD4⁺ cells had a phenotype of activated cells and predominantly expressed CD45RO. Forkhead box protein P3 (FoxP3) and CD25-positive cells were exclusively detected within the CCR6⁺ CD4⁺ cells. In ITP patients, CCR6⁺ regulatory T cells (T_reg ) were decreased and positively correlated with platelet counts and transforming growth factor (TGF)-β plasma levels. In contrast to CCR6^- counterparts, CCR6⁺ CD4⁺ cells produced higher levels of interleukin (IL)-17A. The frequency of CCR6⁺ Th17 was higher in ITP patients and positively correlated with IL-17A levels in supernatant. Most importantly, CCR6⁺ CD4⁺ cell subpopulations, but not CCR6^- CD4⁺ , were closely correlated to treatment response of ITP patients. These findings suggest that circulating CCR6⁺ CD4⁺ cells in ITP patients have characteristics of activated memory Th17 phenotype and could be used to monitor disease activity and treatment response.

[Analysis of clinical efficacy of recombinant activated factor Ⅶ on bleeding in patients with hematologic disorders]

目的

研究重组人凝血因子Ⅶa（rFⅦa）治疗血液病患者出血的疗效。

方法

回顾性分析rFⅦa治疗31例血液病患者共38次出血的临床资料。

结果

rFⅦa治疗获得性血友病A（AHA）/血友病伴抑制物、急性早幼粒细胞白血病（APL）、急性非APL白血病患者出血的总体有效率分别为90%（9/10）、71.4%（5/7）、60.0%（3/5），高于造血干细胞移植后患者（30.8%）；rFⅦa治疗评分为2分出血的有效率（100.0%）高于3分（66.7%）及4分（51.6%）出血；5例次颅内出血中2例次（25.0%）有效；9例次血尿中6例次（66.7%）有效；12例次消化道出血中5例次（41.7%）有效。3例次关节及肌肉出血的疗效均为极好，5例次出血部位为皮肤、鼻黏膜、咽部及齿龈，疗效均为极好；移植后患者在出血评分为4分时，高剂量以及多次使用rFⅦa并不一定能取得好的疗效。AHA/血友病伴抑制物及急性白血病患者合并的出血，在评分为4分时，使用低剂量rFⅦa能取得好的疗效，但最低用药剂量（22.5 µg/kg）的疗效差。

结论

rFⅦa的止血疗效受疾病类型、出血部位以及严重程度等多个因素的影响。rFⅦa对AHA/血友病伴抑制物以及急性白血病患者的出血具有较好的疗效，但对移植后患者的出血疗效欠佳。出血早期使用rFⅦa对于疗效至关重要。在止血治疗的同时，应积极治疗基础疾病。

Influence of serum HMGB1 level on the incidence of respiratory Distress syndrome in neonates

The aim of this study was to analyse the correlation between high mobility group protein B1 (HMGB1) and neonatal respiratory distress syndrome (NDS), and to provide a theoretical basis for its diagnosis and prognosis. Sixty cases of neonates with respiratory distress syndrome were selected and designated as a survival group (36 cases) and a death group (24 cases) according to their prognosis. Sixty healthy neonates were also selected and designated as the control group. Peripheral venous blood and related clinical data of the neonates were collected 12-24 h after birth. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of HMGB1 in the sera of the two groups. SPSS 17 software was used for statistical analysis of the experimental data. The test results showed that the serum HMGB1 levels of those in the study group were significantly higher than those of the control group, and the difference was statistically significant (P less than 0.05); the serum HMGB1 levels of those in the death group was significantly higher than those in the survival group, and the difference was statistically significant (P less than 0.05). Serum HMGB1 level predicts the area under curve (AUC) value of NRDS as 0.872. A serum HMGB1 level of 625.2198pg/mL represents the best boundary value for predicting NRDS. The serum HMGB1 level predicts the AUC of death from NRDS children as 0.912, and a level of 786.7643pg/mL represents the best boundary value for predicting patient death. In conclusion, the level of HMGB1 in the sera of newborns can better predict the occurrence and death of NRDS, and can therefore be considered as a marker for its diagnosis, evaluation and prognosis.

Genome-wide detection of CNVs associated with beak deformity in chickens using high-density 600K SNP arrays

Beak deformity (crossed beaks) is found in several indigenous chicken breeds including Beijing-You studied here. Birds with deformed beaks have reduced feed intake and poor production performance. Recently, copy number variation (CNV) has been examined in many species and is recognized as a source of genetic variation, especially for disease phenotypes. In this study, to unravel the genetic mechanisms underlying beak deformity, we performed genome-wide CNV detection using Affymetrix chicken high-density 600K data on 48 deformed-beak and 48 normal birds using penncnv. As a result, two and eight CNV regions (CNVRs) covering 0.32 and 2.45 Mb respectively on autosomes were identified in deformed-beak and normal birds respectively. Further RT-qPCR studies validated nine of the 10 CNVRs. The ratios of six CNVRs were significantly different between deformed-beak and normal birds (P < 0.01). Within these six regions, three and 21 known genes were identified in deformed-beak and normal birds respectively. Bioinformatics analysis showed that these genes were enriched in six GO terms and one KEGG pathway. Five candidate genes in the CNVRs were further validated using RT-qPCR. The expression of LRIG2 (leucine rich repeats and immunoglobulin like domains 2) was lower in birds with deformed beaks (P < 0.01). Therefore, the LRIG2 gene could be considered a key factor in view of its known functions and its potential roles in beak deformity. Overall, our results will be helpful for future investigations of the genomic structural variations underlying beak deformity in chickens.

[Relationship between screening and colorectal cancer incidence: a systematic review and meta-analysis]

Objective: To explore a relationship between screening and incidence for colorectal cancer (CRC). Methods: Medline, Scopus, BIOSIS Previews, and the Cochrane Library were searched for studies, which included any randomized controlled trial (RCT) about CRC screening with a report on using endoscopy in screening arms and a usual care in control arms. Results: Nine qualified trials, four one-time and five two-or-more-time screening programs, were included in this review with 997 131 persons randomized and a median follow-up of 10-28 years. In an intention-to-screen analysis, screening was associated with a reduced incidence of advanced CRCs by 10%-60%. Compared with control groups, incidence of CRC firstly increased and then decreased following a screening procedure. Five RCT with six screening arms reported incidences at different follow-up time points, and the incidence ratios at the last time of follow-up were 0.96 (95%CI: 0.86-1.06), 0.80 (95%CI: 0.70-0.92), 1.02 (95%CI: 0.91-1.14), 0.80 (95%CI: 0.70-0.90), 0.83 (95%CI: 0.73-0.94) and 0.94 (95%CI: 0.85-1.05) at the 9.0th, 10.9th, 13.0th, 18.0th, 18.0th, and 19.5th year after baseline, respectively. Compared with population-based screening, people in the hospital/clinic-based screenings had more benefits from CRC incidence reduction, particularly for those with high endoscopy rates, more lesions detected and resected by screening. Conclusions: This study indicates that screening is likely associated with reduction of CRC incidence after 10 years since baseline screening, and this reduction seems to be highly affected by CRC risk of population screened, screening procedure program, and compliance to screening program including accepting endoscopy.

Marginal structural model to evaluate the association between cumulative osteoporosis medication and infection using claims data

Due to the suboptimal persistence to osteoporosis (OP) treatment, factors triggering treatment discontinuation/switching may be causing time-varying confounding. BP treatment was associated with the risk of overall infection in opposite directions in the unweighted Cox model versus the weighted MSM. The discrepancy of effect estimates for overall infection in the MSM suggested there may be time-varying confounding.

INTRODUCTION

Due to the suboptimal persistence to osteoporosis (OP) treatment, factors triggering treatment discontinuation/switching may be affected by prior treatment and confound the subsequent treatment effect, causing time-varying confounding.

METHODS

In a US insurance database, the association between joint treatment of bisphosphonates (BP) and other OP medication and the incidence of infections among postmenopausal women was assessed using a marginal structural model (MSM). Stabilized weights were estimated by modeling treatment and censoring processes conditioning on past treatment, and baseline and time-varying covariates.

RESULTS

BP treatment was associated with the risk of overall infection in opposite directions in the unweighted Cox model {incidence rate ratio [IRR] [95% confidence interval (CI)] = 1.15 [1.14-1.17]} versus the weighted MSM [IRR (95% CI) = 0.79 (0.77-0.81)], but was consistently associated with a lower risk of serious infection in both the unweighted Cox model [IRR (95% CI] = 0.79 (0.78-0.81)) and the weighted MSM [IRR (95% CI) = 0.71 (0.68-0.75)]. Similar results were found when current and past treatments were simultaneously assessed.

CONCLUSIONS

The discrepancy of effect estimates for overall but not serious infection comparing unweighted models and MSM suggested analyses of composite outcomes with a wide range of disease severity may be more susceptible to time-varying confounding.

[Lower airway abnormalities in patients with allergic rhinitis]

Objective: To investigate the characteristics of lower airway abnormalities in allergic rhinitis(AR) patients without asthma. Methods: Between June 2008 and December 2012, 377 consecutive AR patients and 264 healthy subjects were recruited. All subjects underwent meticulous history taking, nasal examination, allergen skin prick test, blood routine test, serum total immunoglobin E assay, induced sputum cell count and differentials, measurement of fractional exhaled nitric oxide (FeNO) and bronchial challenge test. Results: The positive rates in AR patients was 12.2%(46/377) for bronchial provocation test, 49.2%(185/377) for FeNO, 39.0%(147/377) for sputum eosinophilia, 15.6%(40/377) for peripheral blood eosinophilia and 55.4%(209/377) for increased serum total IgE levels, which were consistently and statistically higher than those of healthy controls(P<0.01). The levels of FeNO [35.0 (21.8, 65.9)ppb], induced sputum eosinophil percentage [2.0 (0.0, 7.5)%], peripheral blood eosinophil percentage [2.9 (1.8, 4.5)%] and serum total IgE [178.4 (63.1, 384.0)kU/L] in AR patients were also higher(P<0.01). Compared with healthy controls, patients with AR demonstrated lower levels of FEV₁/FVC%, MMEFpred%, MEF₇₅ pred%, MEF₂₅pred% (all P<0.05). Statistical analysis showed that FeNO, ratio of induced sputum eosinophil percentage and peripheral blood eosinophil percentage had significant correlations with each other(P<0.01), the r value being 0.247, 0.235, 0.355 respectively. Conclusion: AR without asthma is characterized by lower airway inflammation, small airway impairment and bronchial hyperreactivity, features similar to those of asthma.

Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome

OBJECTIVES

The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures.

METHODS

Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared.

RESULTS

The relative displacement of the EFLIF was less than that of the plate (0.1363 mm to 0.1808 mm). The highest von Mises stress value on the plate was 33% higher than that on the EFLIF. A normal restoration of the Böhler angle was achieved in both groups. No significant difference was found in the clinical outcome on the American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale, or on the Visual Analogue Scale between the two groups (p > 0.05). Wound complications were more common in those who were treated with ORIF (p = 0.028).

CONCLUSIONS

Both EFLIF and ORIF systems were tested to 160 N without failure, showing the new construct to be mechanically safe to use. Both EFLIF and ORIF could be effective in treating Sanders type 2 calcaneal fractures. The EFLIF may be superior to ORIF in achieving biomechanical stability and less blood loss, shorter surgical time and hospital stay, and fewer wound complications.Cite this article: M. Pan, L. Chai, F. Xue, L. Ding, G. Tang, B. Lv. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome. Bone Joint Res 2017;6:433-438. DOI: 10.1302/2046-3758.67.2000640.