Development of the social burnout scale for college students

Although fruitful achievements have been explored about job burnout, little is known about burnout in the field of social interaction among college students. To address this limitation, this study defined the concept of Social Burnout and developed a measurement tool for it. The study adopted the method of combining qualitative research with quantitative research. After the qualitative study, we gathered examples of social burnout and finished item writing. Using convenient sampling and theoretical sampling methods, six different samples were recruited for reliability and validity testing. Confirmatory factor analysis (CFA) revealed the scale's two-factor structure: emotional exhaustion and depersonalization. Cronbach's alpha measured the internal consistency of the social burnout scale (SBS), which was excellent (Cronbach's alpha of emotional exhaustion = 0.94; depersonalization = 0.82; the overall = 0.92). Susequently, the method of calculating AVE and CR evaluated the scale's convergent and discriminant validity, which were relatively good (AVE of emotional exhaustion = 0.60, depersonalization = 0.59; CR of emotional exhaustion = 0.93, depersonalization = 0.81). Then, regression analysis verified the nomological network and criterion-related validity (r = -0.30, p < 0.01; r = -0.39, p < 0.01; β = -0.25, p < 0.01). The SBS was shown to be a reliable and appropriate measure for assessing students' social burnout. Furthermore, the SBS is recommended for use in academic research and by healthcare professionals to measure students' social distress. Further validation studies of this scale are needed in other cultural contexts.

The Dominant Mechanism of Cyclophosphamide-Induced Damage to Ovarian Reserve: Premature Activation or Apoptosis of Primordial Follicles?

Cyclophosphamide (CPM), a part of most cancer treatment regimens, has demonstrated high gonadal toxicity in females. Initially, CPM is believed to damage the ovarian reserve by premature activation of primordial follicles, for the fact that facing CPM damage, primordial oocytes show the activation of PTEN/PI3K/AKT pathways, accompanied by accelerated activation of follicle developmental waves. Meanwhile, primordial follicles are dormant and not considered the target of CPM. However, many researchers have found DNA DSBs and apoptosis within primordial oocytes under CPM-induced ovarian damage instead of premature accelerated activation. A stricter surveillance system of DNA damage is also thought to be in primordial oocytes. So far, the apoptotic death mechanism is considered well-proved, but the premature activation theory is controversial and unacceptable. The connection between the upregulation of PTEN/PI3K/AKT pathways and DNA DSBs and apoptosis within primordial oocytes is also unclear. This review aims to highlight the flaw and/or support of the disputed premature activation theory and the apoptosis mechanism to identify the underlying mechanism of CPM's injury on ovarian reserve, which is crucial to facilitate the discovery and development of effective ovarian protectants. Ultimately, this review finds no good evidence for follicle activation and strong consistent evidence for apoptosis.

Reversal of the immunosuppressive tumor microenvironment via platinum-based neoadjuvant chemotherapy in cervical cancer

Background

Immunotherapy favors patients with tumors; however, only 3-26.3% of patients with cervical cancer benefit from single-agent immune checkpoint inhibitors. Combined immunotherapy and chemotherapy has been explored against tumor; however, the combination remains controversial. This study aimed to investigate the tumor immune microenvironment (TIME) and the effects of platinum-based neoadjuvant chemotherapy (NACT) in cervical cancer to identify the clinical value of combining chemotherapy with immunotherapy.

Methods

Multiplex immunohistochemistry (IHC) with 11 markers (cluster of differentiation [CD]3, CD8, CD4, CD11c, CD68, forkhead box P3 [Foxp3], programmed cell death 1 [PD-1], programmed cell death 1 ligand 1 [PD-L1], indoleamine 2,3-dioxygenase [IDO], cyclin-dependent kinase inhibitor 2A [p16], and cytokeratin [CK]) was performed to evaluate TIME from 108 matched pre- and post-NACT cervical cancer samples. The mechanism of antitumor immunity triggered by NACT was explored using RNA sequencing (RNA-seq) from four paired samples and subsequently verified in 41 samples using IHC.

Results

The infiltration rate of the CD8+ T cells in treatment-naive cervical cancer was 0.73%, and those of Foxp3+ regulatory T cells (Tregs) and IDO+ cells were 0.87% and 17.15%, respectively. Moreover, immunoreactive T cells, dendritic cells, and macrophages were more in the stromal than the intratumor region. NACT increased dendritic, CD3+ T, CD8+ T, and CD4+ T cells and decreased Tregs. The aforementioned alterations occurred predominantly in the stromal region and were primarily in responders. Non-responders primarily showed decreased Tregs and no increase in CD8+ T or dendritic cell infiltration. Furthermore, dendritic cells interacted more closely with CD3+ T cells after NACT, an effect primarily observed in responders. RNA-seq data revealed activation of the antigen receptor-mediated signaling pathway and upregulation of major histocompatibility complex (MHC) I and MHC II after chemotherapy, validated using IHC.

Conclusions

NACT can reduce Tregs, and when tumor cells are effectively killed, antigen presentation is enhanced, subsequently activating antitumor immunity finitely. Our study provides the molecular characteristics and theoretical basis for the simultaneous or sequential combination of platinum-based NACT and immunotherapy for cervical cancer.

Intergenerational effects of parental [Cnmim]BF4 (n = 4, 6, 8) ionic liquids exposure on zebrafish development based on transcriptomic analysis

Ionic liquids (ILs) have been developed as alternatives to traditional solvents, and their toxicity may be affected by alkyl chain length. Currently, there is limited evidence for whether parental exposure to different alkyl chain length ILs will induce intergenerational toxicity in zebrafish offspring. To address this knowledge gap, the parental zebrafish (F0) were exposed to 25 mg/L [C_nmim]BF₄ (n = 4, 6, 8) for 7 days. Following this, fertilized F1 embryos from the exposed parents were reared in clean water for 120 h. Increased mortality, higher deformity rate, increased pericardial edema rate, and a shorter swimming distance and average speed were detected in the unexposed F1 embryonic larvae from the exposed F0 compared to the F1 generation from the unexposed F0. Parental exposure to [C_nmim]BF₄ (n = 4, 6, 8) resulted in cardiac malformations and dysfunction in F1 larvae, including increased pericardial areas, increased yolk sac areas and decreased heart rate. Moreover, the intergenerational toxicity of [C_nmim]BF₄ (n = 4, 6, 8) in F1 offspring appeared to be alkyl chain length-dependent. Parental [C_nmim]BF₄ (n = 4, 6, 8) exposure led to global transcriptomic changes involved in developmental processes, nervous system process, cardiomyopathy, cardiac muscle contraction, and metabolic signalling pathways such as PI3K-Akt, PPAR and cAMP pathways in unexposed F1 offspring. Overall, the present study provides evidence that the neurotoxicity and cardiotoxicity of ILs in zebrafish can be markedly transmitted to offspring, and the intergenerational developmental toxicity is probably linked to transcriptomic alterations, highlighting the necessity of assessing ILs' environmental safety and human health risks.

[Evaluation of severity and prognosis of acute pancreatitis by CT severity index and modified CT severity index]

Objectives: To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis. Methods: Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN). Results: A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively. Conclusions: AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.

[Update on the medical management of parathyroid carcinoma]

Parathyroid carcinoma is a rare endocrine malignancy with an increasing rate of incidence. Most parathyroid carcinoma patients will develop local recurrence or metastases leading to poor prognosis. Medical management is the mainstay of treatment for patients with unresectable parathyroid carcinoma. However, the therapeutic outcome of medical management remains unsatisfactory restricted by limited options and efficacy. With the deepening of research, several novel drugs have been reported to be applied in the treatment of parathyroid carcinoma. Calcimimetics and receptor activator for nuclear factor-κB ligand inhibitors aiming to control hypercalcemia have been applied in the endocrine therapy of parathyroid carcinoma. Besides, preliminary studies have shown the therapeutic effects of targeted therapy and immunotherapy on parathyroid carcinoma. These new drugs have shed light on this clinical dilemma; however, their clinical efficacy remains to be determined. In this article, the recent progress in the medical management of parathyroid carcinoma is updated.

Oncologic outcomes of fertility-sparing surgery in early stage epithelial ovarian cancer: a population-based propensity score-matched analysis

OBJECTIVE

To evaluate the safety of fertility-sparing surgery (FSS) in reproductive women (younger than 50 years) with early epithelial ovarian cancer (EOC).

METHODS

Reproductive women diagnosed with stage I EOC in the Surveillance, Epidemiology and End Results (SEER) database were identified. Surgeries that did not undergo hysterectomy and/or bilateral salpingo-oophorectomy were categorized as FSS, whereas non-FSS included bilateral salpingo-oophorectomy and hysterectomy. Propensity-score matching (PSM) was conducted to balance the covariates. Risk factor was identified by COX analysis. Kaplan-Meier curves were performed to evaluate the overall survival (OS) and cancer-specific survival (CSS).

RESULTS

3556 patients with stage I EOC were identified and divided into non-FSS group and FSS group. After PSM, 625 pairs of patients with stage I EOC were included. FSS was not inferior to non-FSS in the OS curve [HR 0.9127, 95% CI (0.6971 ~ 0.1.195), P = 0.5174; HR: 0.9378, 95% CI (0.6358 ~ 0.1.383), P = 0.7460] and the CSS curve [HR 0.8284, 95% CI (0.5932 ~ 1.157), P = 0.2949; HR 0.9003, 95% CI (0.5470 ~ 1.482), P = 0.6803] both in overall cohort and in matched cohort. Univariate COX analysis identified older age (45-49), moderate-differentiated to un-differentiation grade, IC stage, bigger tumor size (> 10 cm) and chemotherapy as risk factors of prognostic outcome (P < 0.1). Not only in univariate subgroup analyses but also in bivariate factors subgroup analysis, the evidence was not enough to regard FSS as a harmful factor compared with non-FSS.

CONCLUSIONS

Fertility-sparing surgery was comparable to non-FSS in terms of survival in reproductive women with stage I EOC. Patients with high-risk factors could also consider FSS as an effective alternative compared with non-FSS.

[Relationship between nutritional factors and clinical outcome in children with tuberculous meningitis]

Objective: To investigate the relationship between nutritional risk status and clinical outcome in children with tuberculous meningitis (TBM). Methods: The clinical data (basic information, clinical symptoms and laboratory test results) of 112 patients with TBM, who were admitted to Department of Pediatric Infectious Diseases of West China Second Hospital of Sichuan University,from January 2013 to December 2020 were retrospectively analyzed. The patients were divided into the nutritional risk group and the non-nutritional risk group according to the assessment of the nutritional risk by the STRONGkids Scale. The variables of basic information, clinical symptoms and laboratory test measurements etc. were compared between the two groups by using Student t test, Rank sum test or Chi-square test. Multivariate Logistic regression analysis were used to analyze nutritional risk factors. Results: Among 112 patient with TBM, 55 were males and 57 females. There were 62 cases in the nutritional risk group and 50 cases in the non-nutritional risk group. The proportion of cases with nutritional risk was 55.4% (62/112). Patients in the nutritional risk who lived in rural areas, had symptoms of brain nerve damage, convulsions, emaciation and anorexia, with a diagnosis time of ≥21 days, and the level of cerebrospinal fluid (CSF) protein were all higher than those in the non-nutritional risk group ((50 cases (80.6%) vs. 32 cases (64.0%), 20 cases (32.3%) vs.8 cases (16.0%), 33 cases (53.2%) vs. 15 cases (30.0%), 30 cases (48.4%) vs. 2 cases (4.0%), 59 cases (95.2%) vs. 1 case (2.0%),41 cases (66.1%) vs.18 cases (36.0%), 1 406 (1 079, 2 068) vs. 929 (683, 1 208) mg/L, χ²=3.91, 3.90, 6.10, 26.72, 98.58, 10.08, Z=4.35, all P<0.05). The levels of serum albumin,hemoglobin,lymphocyte count, white blood cell count, and CSF glucose were significantly lower in patients with nutritional risk ((36±5) vs. (41±4) g/L, (110±17) vs. (122±14) g/L, 1.4 (1.0, 2.0)vs. 2.3 (1.6, 3.8)×10⁹/L, 7.8 (6.3, 10.0)×10⁹ vs. 10.0 (8.3, 12.8)×10⁹/L, 1.0 (0.8, 1.6) vs. 2.1 (1.3, 2.5) mmol/L, t=-6.15, -4.22, Z=-4.86, -3.92, -4.16, all P<0.05).Increased levels of serum albumin (OR=0.812, 95%CI:0.705-0.935, P=0.004) and lymphocyte count (OR=0.609, 95%CI:0.383-0.970, P=0.037) may reduce the nutritional risk of children with TBM; while convulsions (OR=3.853, 95%CI:1.116-13.308, P=0.033) and increased level of CSF protein (OR=1.001,95%CI:1.000-1.002, P=0.015) may increase the nutritional risk of children with TBM. Similarly, the rate of complications and drug-induced liver injury was higher in the nutritional risk group (47 cases (75.8%) vs. 15 cases(30.0%), 31 cases (50.0%) vs.8 cases (16.0%), χ²=23.50, 14.10, all P<0.05). Moreover, the length of hospital stay was also longer in the nutritional risk group ((27±13) vs. (18±7) d, t=4.38, P<0.05). Conclusions: Children with TBM have a high incidence of nutritional risk. Convulsive, the level of serum albumin, the level of lymphocyte count and CSF protein may affect the nutritional risk of children with TBM. The nutritional risk group has a high incidence of complications and heavy economic burden.It is necessary to carry out nutritional screening and nutritional support for children with TBM as early as possible.

396 Rotator Cuff Assessment Following Traumatic Anterior Shoulder Dislocation

Aim

Glenohumeral joint dislocation is the most common traumatic joint dislocation with a high recurrence rate correlating with age at first dislocation. There is an associated increased incidence in concurrent rotator cuff tears with increasing age affecting 40% aged 40–60. Patient care was assessed against BESS/BOA standard: These patients should have rotator cuff assessment and those aged 40–60 should undergo routine MRI/Ultrasound imaging.

Method

All patients admitted to the emergency departments of the 3 Lanarkshire hospitals undergoing first time traumatic anterior dislocation of the shoulder in February 2021 were included. This was the third cycle of this audit. Previous interventions were presentation at a CPD meeting after cycle one and an NHS Lanarkshire regional meeting after cycle two.

Results

Cycle one (2018)-14 patients. 3/14 underwent rotator cuff assessment. 5/14 aged 40–60. 1/5 underwent rotator cuff imaging.

Cycle two (2020)-11 patients. 0/9 underwent rotator cuff assessment (Two excluded as managed operatively). 4/11 aged 40–60. 0/4 underwent rotator cuff imaging.

Cycle three (2021)-13 patients. 3/11 underwent rotator cuff assessment (Two excluded as managed operatively). 3/13 aged 40–60. 0/3 underwent rotator cuff imaging.

Conclusions

Although a slight improvement has been made over the 3 cycles with rotator cuff assessment the BOA standard is not being met. There has been no improvement in the additional imaging required in traumatic anterior shoulder dislocations in those aged 40–60 over the 3 cycles. These patients may develop pain, reduced function, and rotator cuff arthropathy. There is now an aim to introduce a pathway for these patients across the health board.

Clinical characteristics, pregnancy outcomes and ovarian function of pregnancy-associated breast cancer patients: a retrospective age-matched study

Background

Pregnancy-associated breast cancer (PABC) is a rare disease with increasing incidence. The prognosis, pregnancy outcomes and subsequent ovarian function of PABC patients are attracting attention.

Methods

Sixty-three PABC patients and 126 age-matched non-PABC patients were obtained in Tongji Hospital from January 2011 to September 2019. The clinical characteristics and ovarian function of PABC patients were compared with those of non-PABC patients. The pregnancy outcomes and neonatal outcomes of patients with breast cancer diagnosed during pregnancy (BCP) were described. Nonparametric tests, the χ2-test Kaplan–Meier, Cox regression and binomial logistic regression were used for analysis.

Results

PABC patients were diagnosed with a more advanced tumour stage (II: 47.6% vs. 45.2%, III: 33.3% vs. 19.8%, IV 3.2% vs. 0%, p = 0.003), which caused worse progression-free survival (PFS) (log-rank p = 0.0138) and breast cancer-specific survival (CSS) (log-rank p = 0.0076) than non-PABC patients. Tumour stage (III/IV vs. 0/I/II) (HR 16.017, 95% CI 5.830 ~ 44.006, p < 0.001) and endocrine therapy (HR 0.254, 95% CI 0.099 ~ 0.653, p = 0.004) were predictors of PFS. Tumour stage (III/IV vs. 0/I/II) (HR 30.875, 95% CI 7.232 ~ 131.820, p < 0.001), endocrine therapy (HR 0.200, 95% CI 0.049 ~ 0.818, p = 0.025) and targeted therapy (HR 0.143, 95% CI 0.028 ~ 0.743, p = 0.021) were predictors for breast CSS. Among the 15 BCP patients, 11 patients voluntarily continued their pregnancy, and the newborns had no obvious birth defects, either in 5 patients who received chemotherapy or in 6 patients who did not receive chemotherapy during pregnancy. Among the patients who received chemotherapy and did not receive endocrine therapy, 24 PABC patients and 48 non-PABC patients experienced chemotherapy-induced amenorrhea. There was no significant difference in resumption of menstruation between the two groups at 6 months and 12 months after the end of chemotherapy. No potential factors affecting resumption of menstruation were found.

Conclusion

Pregnancy at diagnosis or within 1 year after delivery was not a risk factor for a worse prognosis in PABC patients. Compared with non-PABC patients, patients with PABC presented more aggressive tumour characteristics, which could mostly explain the worse prognosis observed in PABC patients. Receiving the appropriate regimen of chemotherapy in the second and third trimesters did not affect the maternal outcomes or neonatal outcomes of BCP patients. The special physiological state during pregnancy and lactation did not interfere with the damage of chemotherapy to ovarian function.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09260-6.

Repurposing Ivermectin to augment chemotherapy's efficacy in osteosarcoma

BACKGROUND

Osteosarcoma is the most frequent malignant bone malignancy and the current treatments are ineffective. Ivermectin, an anti-protozoal drug, has been shown to have anti-cancer activity. This work investigated the potential of repurposing ivermectin to augment chemotherapy's efficacy in osteosarcoma.

METHODS

Proliferation, migration and apoptosis assays were performed in ivermectin-treated osteosarcoma cells. Combination studies were performed. Osteosarcoma xenograft mouse model was established to investigate the in vivo efficacy of ivermectin. Intracellular reactive oxygen species (ROS) and mitochondrial superoxide, membrane potential, ATP, 8-OHdG level, protein carbonylation and lipid peroxidation were determined after ivermectin treatment.

RESULTS

Ivermectin was effective and acted synergistically with doxorubicin in osteosarcoma cells regardless of cellular origin and genetic profiling. This was achieved through suppressing inhibiting growth and migration, and inducing caspase-dependent apoptosis. Ivermectin also significantly inhibited osteosarcoma growth in vivo and its combination with doxorubicin resulted in much greater efficacy than doxorubicin alone. Importantly, the effective dose of ivermectin was clinically feasible and did not cause significant toxicity in mice. Mechanistical analysis showed that ivermectin induced oxidative stress and damage, and mitochondrial dysfunction.

CONCLUSIONS

Our findings indicate that ivermectin has utility in treating patients with osteosarcoma, especially those resistant to chemotherapy.

A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China

BACKGROUND

Vulvovaginal candidiasis (VVC) is frequent in women of reproductive age, but very limited data are available on the epidemiology in cases of VVC in China.

OBJECTIVES

The current study has been conducted to reveal the prevalence, species distribution of yeast causing VVC and molecular genetics of Candida albicans in China.

METHODS

Vaginal swabs were collected from 543 VVC outpatients recruited in 12 hospitals in China between September 2017 and March 2018. They were preliminarily incubated on Sabouraud dextrose agar and then positive subjects of which were then transmitted to our institute for further identification. CHROMagar™ was used to isolate Candida species, and all isolates were finally identified by DNA sequencing. Multilocus sequence typing (MLST) was used to analyse phylogenetic relationships of the various C. albicans isolates.

RESULTS

Eleven different yeast species were identified in 543 isolates, among which C. albicans (84.7%) was the most frequent, followed by C. glabrata (8.7%). We obtained 117 unique diploid sequence types from 451 clinical C. albicans isolates and 92 isolates (20.4%) belonged to a New Clade. All the strains appearing in the New Clade were from northern China and they were isolated from non-recurrent VVC.

CONCLUSIONS

Our findings suggest that C. albicans are still the main cause of VVC in China and the majority of C. albicans isolates belongs to Clade 1 with DST 79 and DST 45 being two most common. Moreover, the New Clade revealed in our study seems to be specific to northern China.

349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma

Introduction

Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016.

Method

Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis.

Results

Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%).

Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients.

Conclusions

Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P &lt; 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.

Immune Response to COVID-19 During Pregnancy

Pregnant women are generally more susceptible to viral infection. Although the impact of SARS-CoV-2 on pregnant women remains to be determined, evidence indicates that risks of adverse clinical outcomes are similar in pregnancy to the general population. Here we analyzed clinical symptoms and outcomes of 20 pregnant and 299 reproductive-aged non-pregnant female COVID-19 patients who were hospitalized during the same period. Laboratory measurements were compared among mild cases and healthy pregnant women. Our study found that pregnant patients showed enhanced innate immune response evident by higher neutrophils and C-reactive protein. Cytokines, chemokines, and growth factors (CCGFs) profiles from 11 pregnant and 4 non-pregnant COVID-19 patients and 10 healthy pregnant female patients, and lymphocyte subsets analysis of 7 pregnant patients and 19 non-pregnant patients, indicate suppressed cytokine storm and potential enhanced CD8+ T cell and NK cell activity in pregnant patients with COVID-19, which may be essential in contributing to the unique anti-SARS-CoV-2 response in pregnancy.

Development of deep learning algorithms for predicting blastocyst formation and quality by time-lapse monitoring

Approaches to reliably predict the developmental potential of embryos and select suitable embryos for blastocyst culture are needed. The development of time-lapse monitoring (TLM) and artificial intelligence (AI) may help solve this problem. Here, we report deep learning models that can accurately predict blastocyst formation and usable blastocysts using TLM videos of the embryo’s first three days. The DenseNet201 network, focal loss, long short-term memory (LSTM) network and gradient boosting classifier were mainly employed, and video preparation algorithms, spatial stream and temporal stream models were developed into ensemble prediction models called STEM and STEM⁺. STEM exhibited 78.2% accuracy and 0.82 AUC in predicting blastocyst formation, and STEM⁺ achieved 71.9% accuracy and 0.79 AUC in predicting usable blastocysts. We believe the models are beneficial for blastocyst formation prediction and embryo selection in clinical practice, and our modeling methods will provide valuable information for analyzing medical videos with continuous appearance variation.

Liao et al. propose a deep learning model to predict blastocyst formation using TLM videos following the first three days of embryogenesis. The authors develop an ensemble prediction model, STEM and STEM⁺, which were found to exhibit 78.2% and 71.9% accuracy at predicting blastocyst formation and useable blastocysts respectively.

Distinct Clinical Characteristics and Risk Factors for Mortality in Female Inpatients With Coronavirus Disease 2019 (COVID-19): A Sex-stratified, Large-scale Cohort Study in Wuhan, China

Background

As the coronavirus disease 2019 (COVID-19) outbreak accelerates worldwide, it is highly significant to evaluate sex-specific clinical characteristics and outcomes, that may affect public health policies.

Methods

COVID-19 patients admitted to Tongji Hospital between January 18and March 27, 2020 were evaluated. Clinical features, laboratory data, complications and outcomes were compared between females and males. Risk factors for mortality in the whole population, females and males were determined respectively.

Results

There were 1667 (50.38%) females among the3309 patients included in this study. The mortality rate was only 5.9% in females but 12.7% in males. Compared with males, more females had no initial symptoms (11.1% vs 8.3%, p=0.008). Complications including acute respiratory distress syndrome, acute kidney injury, septic shock, cardiac injury and coagulation disorder were less common in females; critical illness was also significant less common in females (31.1% vs 39.4%, p<0.0001). Significantly fewer female patients received antibiotics treatment (p=0.001), antiviral therapy (p=0.025) glucocorticoids treatment (p<0.0001), mechanical ventilation (p<0.0001) and had Intensive Care Unit admission (p<0.0001). A lower risk of death was found in females (odds ratio 0.44, 95% confidence interval 0.34-0.58) after adjusting for age and coexisting diseases. Among females, age, malignancy, chronic kidney disease and days from onset to admission were significant associated with mortality, while chronic kidney disease was not risk factor in males.

Conclusions

Significantly more mild illness and fewer deaths were found in female COVID-19 inpatients and risk factors associated with mortality varied among male and female population.

Malnutrition Prolongs the Hospitalization of Patients with COVID-19 Infection: A Clinical Epidemiological Analysis

OBJECTIVES

During the 2019 coronavirus disease (COVID-19) outbreak, malnutrition may contribute to COVID-19 adverse outcomes. We conducted a clinical epidemiological analysis to investigate the association of malnutrition with hospitalized duration in patients with COVID-19.

DESIGN

Retrospective survey study.

SETTING

Taikang Tongji (Wuhan) hospital in Wuhan, China.

PARTICIPANTS

139 patients with COVID-19.

METHODS

In total, 139 patients with COVID-19 from patients in the Infection Department of Taikang Tongji (Wuhan) hospital from February 2020 to April 2020 were analyzed retrospectively. We used the "Global leadership Initiative on Malnutrition(GLIM)" assessment standard published in 2019 to assess nutritional status. Prolonged hospitalization was lasting more than the median value of the hospitalized days (17 days) in this population.

RESULTS

According to the assessment results of GLIM nutrition assessment, the patients were divided into malnutrition group and normal nutrition group. Compared with the patients in the normal nutrition group, the hospitalization time was longer(15.67±6.26 days versus 27.48±5.04 days, P = 0.001). Kaplan-Meier analysis showed patients with malnutrition were more likely to be hospitalized longer compared with those normal nutrition (mean with 95% confidence interval [CI]: 28.91[27.52-30.30] versus 22.78[21.76-23.79], P = 0.001). COX regression analysis showed that malnutrition (hazard ratio [HR] = 3.773, P for trend = 0.001) was proportional associated with being discharged from hospital delayed.

CONCLUSION AND IMPLICATIONS

Present findings suggested that malnutrition contributed to predicting a probability of prolonged hospitalization in patients with COVID-19 infection, to whom extra attentions and precautions should be paid during clinical treatments. Based on the existing results, it is recommended that inpatients with nutritional risk or malnutrition start nutritional support treatment as soon as possible.

Immunocyte density in parathyroid carcinoma is correlated with disease relapse

PURPOSE

Parathyroid carcinoma (PC) is an endocrine malignancy with a poor prognosis. The tumour immune microenvironment is a critical factor influencing the outcomes of multiple cancer types. However, knowledge of the immune microenvironment in PC remains limited.

METHODS

The intratumoural density of immunocytes and the Ki-67 index were evaluated immunohistochemically in 51 PC patient samples and were compared with clinicopathological features and parafibromin staining results. The Kaplan-Meier method and Cox proportional hazards analysis were used to estimate the effects of these variables on clinical outcomes.

RESULTS

Intratumoural immunocyte density was not correlated with age, gender, urolithiasis, or palpation of a neck mass. The Ki-67 index was correlated with the intratumoural density of CD3⁺ cells (P = 0.022) and CD8⁺ cells (P = 0.021) and serum calcium levels (P = 0.022). In the intratumoural area of primary foci, Kaplan-Meier method showed that the risk factors associated with recurrence/metastasis were a low density of CD3⁺ (P = 0.017), CD8⁺ (P = 0.019) and CD45⁺ cells (P = 0.047), a high density of CD163⁺ cells (P = 0.003) and a high Ki-67 index (P = 0.004). Cox regression multivariate analysis revealed that CD163⁺ cell density (hazard ratio (HR) 16.19, 95% confidence interval (CI) 1.99-131.66; P = 0.009) and CD8⁺ cell density (HR 0.13, 95% CI 0.02-0.76, P = 0.024) were independent factors associated with PC relapse.

CONCLUSION

The immune microenvironment is an important factor influencing the relapse of PC. The intratumoural density of CD3⁺, CD8⁺, CD45⁺, and CD163⁺ immunocytes was correlated with disease-free survival (DFS) in patients with PC. Immunotherapy based on T lymphocytes or tumour-associated macrophages may be a promising treatment strategy.

Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age

RESEARCH QUESTION

Does SARS-CoV-2 infection have an effect on ovarian reserve, sex hormones and menstruation of women of child-bearing age?

DESIGN

This is a retrospective, cross-sectional study in which clinical and laboratory data from 237 women of child-bearing age diagnosed with COVID-19 were retrospectively reviewed. Menstrual data from 177 patients were analysed. Blood samples from the early follicular phase were tested for sex hormones and anti-Müllerian hormone (AMH).

RESULTS

Among 237 patients with confirmed COVID-19, severely ill patients had more comorbidities than mildly ill patients (34% versus 8%), particularly for patients with diabetes, hepatic disease and malignant tumours. Of 177 patients with menstrual records, 45 (25%) patients presented with menstrual volume changes, and 50 (28%) patients had menstrual cycle changes, mainly a decreased volume (20%) and a prolonged cycle (19%). The average sex hormone and AMH concentrations of women of child-bearing age with COVID-19 were not different from those of age-matched controls.

CONCLUSIONS

Average sex hormone concentrations and ovarian reserve did not change significantly in COVID-19 women of child-bearing age. Nearly one-fifth of patients exhibited a menstrual volume decrease or cycle prolongation. The menstruation changes of these patients might be the consequence of transient sex hormone changes caused by suppression of ovarian function that quickly resume after recovery.

Transient impact of paclitaxel on mouse fertility and protective effect of gonadotropin‑releasing hormone agonist

Paclitaxel (PXL) is a chemotherapeutic agent widely used in solid tumors. However, whether PXL causes premature ovarian insufficiency in women of reproductive age remains controversial. The aim of the present study was to answer how and for how long PXL affects fertility, and to identify the protective effect of gonadotropin-releasing hormone agonist (GnRHa) in mice. A single dose of PXL was administered to 7-week-old female ICR mice. Mice were treated with GnRHa for 1 estrous cycle prior to chemotherapy, and for another following chemotherapy. On the days 1, 6, 11 and 16 following the administration of PXL, mice were assessed by ovarian histology, ovarian stimulation and mating experiment. Multiple doses of PXL were also administered to verify the duration of the gonadotoxicity of PXL. It was determined that PXL only destroyed antral follicles on day 1 following chemotherapy without reducing primordial follicles. In vitro experiments revealed that PXL impaired oocytes in metaphase, excluding those at the germinal vesicle stage. The number and quality of retrieved metaphaseII(MII) oocytes in PXL-exposed mice were reduced on day 1 following chemotherapy, which was recovered on day 11. MII oocytes from mice pretreated with GnRHa recovered on day 6 following chemotherapy. Following 3 estrous cycles in mice after the last dose of the 3-dose paclitaxel administration, follicles in all stages and retrieved MII oocytes were recovered. It was concluded that the impairment caused by PXL on follicles and oocytes in mice lasted for <3 estrous cycles, which was shortened by pretreatment of GnRHa.

Lapatinib‑induced inhibition of ovarian function is counteracted by the STAT3 pathway both in vivo and in vitro

The present study was designed to ascertain whether lapatinib, a tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR), affects ovarian reserve and fertility potential in a mouse model. Female C57BL/6 mice were treated with either vehicle or lapatinib (100 or 200 mg/kg/day orally) for 4 weeks, after which body weight, vaginal smears, follicle numbers, serum anti‑Müllerian hormone (AMH) levels and mating outcomes were analyzed to assess the ovarian reserve and reproductive function. Slices from the ovaries of 4‑week‑old mice were cultured with lapatinib (0, 5 or 10 µM) for 24 and 48 h, and protein expression levels were assessed to validate the changes in signaling pathways. The results indicated that mice treated with 200 mg/kg lapatinib showed a slight decrease in body weight compared to those treated with vehicle or 100 mg/kg lapatinib. There was no statistical difference in estrous cyclicity among the three groups. No significant difference was observed in follicle numbers, AMH levels, histological morphologies of the ovaries or mating outcomes in the three groups of mice. Western blotting and immunohistochemical staining of the EGF receptor and its main downstream signaling pathways showed decreased phosphorylation of EGFR and mitogen‑activated protein kinase (MAPK)3/1 and increased phosphorylation of signal transducers and activators of transcription (STAT)3 in the lapatinib‑treated groups compared to the control group. Our study suggests that lapatinib has little effect on ovarian reserve and reproductive function in a mouse model. This lack of effect of lapatinib on ovarian function may be due to the activation of the STAT3 signaling pathway that counteracts the inhibitory effects of lapatinib on EGF receptors.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

[Epidemiological analysis of the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015]

Objective: To analyze the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015, in order to understand the epidemiological characteristics and to further reduce the mortality rate in Liangshan Prefecture. Methods: The relevant information was collected through the Management Database of Antiretroviral Treatment from the National AIDS Comprehensive Prevention Information System. Results: From 2005 to 2015, a total of 14 219 adult HIV/AIDS patients received antiretroviral treatment and 1 425 death cases were reported during the treatment. The cause of death was mainly AIDS-related diseases (58.9%), and the cumulative mortality rate was 10.02%. Gender, age, the way of infection, duration of antiretroviral therapy, clinical stage when received antiretroviral therapy, and CD(4)(+) T lymphocyte levels were factors for the mortality rate (P<0.001). The mortality increased with older age, higher initiation clinical stage and lower level of CD(4)(+) T lymphocyte. Among the death cases, 82.6% were male, 1 182 (82.9%) were married or cohabited, most aged between 30-39 years old (48.6%). At the initial point of receiving antiretroviral therapy, 49.7% of the cases with CD(4)(+)T lymphocytes levels< 200/μl, 61.2% of the deaths cases were>1 000 copies/ml during the last viral load test, and 16.2% of deaths were ≥500/μl in the last CD(4)(+)T lymphocyte test; 44.5% of deaths were received antiretroviral treatment within one year. Conclusion: Early and timely antiretroviral therapy should be carried out. It is necessary to strengthen the propaganda of antiretroviral therapy and to improve the management quality of follow-up information of antiretroviral therapy case files, and to improve the medication compliance of patients.

[Clinicopathologic features of secretory breast carcinoma]

Objective: Investigate the clinicopathological features for secretory carcinoma of breast (SCB). Methods: The clinical data of 3 SCB cases were collected, immunohistochemical staining was performed by the streptavidin-peroxidase (SP) method to test the expression of the antibodies: ER, PR, HER-2, Ki-67, S100, CK5/6, p63, SMA, calponin, GCDFP-15, and EGFR. Fluorescence in situ hybridization (FISH) was used to detect the ETV6-NTRK3 gene fusion. Results: ER was focal weakly positive in case 1 and case 2 (about 5%) , and negative in case 3. PR was focal weakly positive in case 1 (about 5%) and completely negative in case 2 and case 3. Three cases showed that HER-2, SMA, calponin, GCDFP-15 were negative, while S100, CK5/6, EGFR were diffuse strongly positive. The proliferation index was nearly 15% in case 1 and case 2, and 10% in case 3. p63 was negative in mostly tumor cells of case 1, and focal positive expression in the nucleus and cytoplasm. In case 2, p63 was completely negative. However, p63 was observed positive in the cytoplasm as well as some secretory material in case 3. ETV6-NTRK3 gene fusion detection by FISH was positive in all cases. Conclusions: SCB is a rare low grade triple-negative breast cancer with the unique pathomorphologic features, while its recurrent t (12; 15) (p13; q25) translocation resulting in ETV6 -NTRK3 gene fusion. It has the indolent clinical behavior and good prognosis.

[Data analysis on HIV/AIDS sentinel surveillance programs targeting community population in Liangshan Yi Autonomous Prefecture, 2010-2015]

Objective: To investigate the epidemiologic and behavioral characteristics of HIV among community population in Liangshan prefecture. Methods: We collected social demographic, behavioral and serological information by means of the monitoring questionnaire and serological tests. Data was analyzed by using the chi-square test and logistic regression. Results: From April to June of 2010 to 2015, 14 092 cases of community population were selected as the study objects, with 267 cases diagnosed as HIV positive patients. The HIV positive rates were 3.24%, 3.07%, 1.17%, 1.38%,1.42% and 1.25%, respectively. We observed that when community population having the following characteristics as: living in Butuo country (OR=3.83), being males (OR=1.77), being Yi nationality (OR=4.40) being widowed (OR=28.57), with history of drug abuse (OR=3.71) or injecting drug use (PWID) (OR=4.92), or history of needle sharing among PWID (OR=8.53), were under higher risks for HIV infection. With histories as: having had secondary or above levels of schooling (OR=0.59), having protected sex with regular partners (OR=0.21) and with non-regular partners (OR=0.46), they seemed to be somehow protected for getting HIV infection. Conclusion: The positive HIV rates of HIV among community population in Dechang, Ningnan and Butuo varied from 0.10% to 8.77% while the HIV transmission among general population remained challenging.

Detection and analysis of laser driven proton beams by calibrated Gafchromic HD-V2 and MD-V3 radiochromic films

The radiochromic film (RCF) is a high-dose, high-dynamic range dosimetry detection medium. A stack of RCFs can be used to detect both spatial and energetic distribution of laser driven ion beams with a large divergence angle and continuous energy spectrum. Two types of RCFs (HD-V2 and MD-V3, from Radiation Products Design, Inc.) have been calibrated using MeV energy protons and carbon ions produced by using a 2 × 6 MV tandem electrostatic accelerator. The proportional relationship is obtained between the optical density and the irradiation dose. For protons, the responses are consistent at all energies with a variation of about 15%. For carbon ions, the responses are energy related, which should be noted for heavy ion detection. Based on the calibration, the broad energy spectrum and charge distribution of laser accelerated proton beam with energy from 3 to 8 MeV and pC charge were detected and reconstructed at the Compact LAser Plasma Accelerator at Peking University.

Laser Acceleration of Highly Energetic Carbon Ions Using a Double-Layer Target Composed of Slightly Underdense Plasma and Ultrathin Foil

We report the experimental generation of highly energetic carbon ions up to 48 MeV per nucleon by shooting double-layer targets composed of well-controlled slightly underdense plasma and ultrathin foils with ultraintense femtosecond laser pulses. Particle-in-cell simulations reveal that carbon ions are ejected from the ultrathin foils due to radiation pressure and then accelerated in an enhanced sheath field established by the superponderomotive electron flow. Such a cascaded acceleration is especially suited for heavy ion acceleration with femtosecond laser pulses. The breakthrough of heavy ion energy up to many tens of MeV/u at a high repetition rate would be able to trigger significant advances in nuclear physics, high energy density physics, and medical physics.

Incidence of hepatitis B virus infection in young Chinese blood donors born after mandatory implementation of neonatal hepatitis B vaccination nationwide

This study was carried out to determine the incidence of hepatitis B virus (HBV) infection in the young generation born after mandatory implementation of hepatitis B vaccination since 1992. Repeat blood donors born between 1992 and 1997 were enrolled, who gave blood at least twice during the past 3 years. Donors were tested for HBV infection markers of HBsAg, anti-HBc, anti-HBs and viral DNA by immunoassays (EIAs) and nucleic acid tests (NAT). A total of 14 937 pre-donation screening qualified young repeat donors aged 18-23 years were tested with 9 (0.06%) being HBsAg by EIA and 10 (1:1494) HBV DNA positive by Ultrio NAT (10.4 IU/mL), respectively. HBV DNA was further detected in 1:192 (9/1732) anti-HBc+ repeat donors with Ultrio Plus NAT (3.4 IU/mL). Most cases were identified as occult HBV infection (OBI). Of 14 937 repeat donors, 20.9% were anti-HBc+ positive, while approximately 50% of 12 024 repeat donors were anti-HBs negative or had levels <100 IU/L. HBsAg+ or OBI strains were classified as wild type of genotype B or genotype C. Incident HBV infection in repeat donors was approximately 1:18.5 person-years (1.1%/year) but significantly less frequent in donors with confirmed HBV vaccination (2.4%-3.3%) than those unsure of vaccination status (10.5%; P = .0023). Hepatitis B virus vaccination appears largely protective of HBV infection, but incidence of infections increases in young adults with mostly undetectable or low anti-HBs or occasionally high anti-HBs. A boost of hepatitis B vaccine for adolescents prior to age 18 years may reduce HBV infection, and implementation of more sensitive NAT in blood donation screening may improve HBV safety in blood transfusion.

Regulatory network analysis of LINC00472, a long noncoding RNA downregulated by DNA hypermethylation in colorectal cancer

Colorectal cancer (CRC), one of the common malignant cancers in the world, is caused by accumulated alterations of genetic and epigenetic factors over a long period of time. Along with that protein-coding genes being identified as oncogenes or tumor suppressors in CRC, a number of lncRNAs have also been found to be associated with CRC. Considering the important regulatory role of lncRNAs, the first goal of this study was to identify CRC-associated lncRNAs from a public database. One such lncRNA, LINC00472, was verified to be downregulated in CRC cell lines and cancer tissues compared with adjacent tissues. In addition, the down-regulation of LINC00472 seemed to be caused by DNA hypermethylation at its promoter region. Furthermore, the expression of LINC00472 and DNA methylation of promoter were significantly correlated with clinicopathological features. And DNA hypermethylation of LINC00472 may serve as a better diagnostic biomarker than its expression for CRC. Finally, we predicted the functions of LINC00472 and constructed a regulatory network and found LINC00472 may be involved in cell cycle and cell proliferation processes. Our results may provide a clue to further research into the function and regulatory mechanism of LINC00472 in CRC.

Investigation of significant microRNA-mRNA pairs associated with nonspecific digestive disorder in rabbits

Nonspecific digestive disorders (NSDD) are one of the major intestinal problems in rabbit, with considerable economic losses in industrial rabbit farms. MicroRNAs (miRNAs), as small non-coding RNAs, have significant biological involvement in intestinal disorders. In this study, we investigated the expression levels of 25 genes and 25 miRNAs in ileum, rabbit sacculus rotundus (RSR) and colon tissues from 9 rabbits with different severity of NSDD. These molecules have been found to be related to NSDD or inflammatory bowel disease, which will help recognise the miRNA-mRNA pairs. Finally, 108 possible pairs of miRNA-mRNA pairs with an anti-correlation were identified by Pearson’s correlation analysis between differentially expressed 25 miRNAs and 23 mRNAs. Ninety-five of these miRNA-mRNA pairs were hitherto unexplored, and their roles in NSDD biology require further elucidation. Our results give a clue to the potential miRNA-mRNA pairs for the NSDD that can further improve the understanding of the pathogenesis of NSDD in rabbit.

p16 gene expression in pancreatic cancer tissue and its importance in diagnosis

The aim of this study was to assess the importance of p16 gene expressions in pancreatic cancer tissue for early diagnosis and treatment. Two groups were included in the study: an experimental group of 35 pancreatic cancer tissue specimens and a control group of 35 pancreatic cancer adjacent tissues collected during surgery. The expression of p16 gene in the two groups was observed using the immunohistochemical streptavidin peroxidase conjugated (S-P) method. The results were statistically interpreted using SPSS22.0 software. The positive expression rate of p16 in the experimental group was lower than that of the control group (p less than 0.05). Comparing the intensity of p16 gene expression, differentiation degree, clinical stage and metastases of nearby lymph nodes the differences had statistical significance (p less than 0.05). The intensity of p16 gene expression in high and medium differentiated pancreatic cancer group was higher than that of the low differentiated group. p16 gene expression in stages III and IV groups was lower than that in stages I and II groups. Differentiation degree, clinical stage, metastases of nearby lymph nodes and distant metastasss were negatively related with p16 gene expression (p less than 0.05). There was no correlation between age or gender and p16 gene expression. The decreased expression of p16 gene in pancreatic cancer tissue was negatively correlated with differentiation degree and clinical stage. Our results indicated that p16 can be used as a cue signal for diagnosing advanced pancreatic cancer.

HBV/HCV co-infection is associated with a high level of HCV spontaneous clearance among drug users and blood donors in China

Understanding the biology of spontaneous clearance of hepatitis C virus (HCV) infection could lead to improved strategies to prevent the sequelae associated with chronic HCV infection. Chronic infections with hepatitis virus are very common in China, but the factors associated with spontaneous clearance of HCV have not been adequately studied. We evaluated the spontaneous clearance of HCV among 1918 drug users and 1526 HCV-seropositive blood donors in Guangzhou, China. Among participants who were co-infected with hepatitis B virus (HBV), 41.38% of drug users and 39.47% of blood donors had cleared their HCV infection without antiviral therapy compared to 9.41% of drug users and 16.73% of blood donors who were mono-infected with a single virus (P<.01). The proportion of subjects who had cleared their HCV infection was significantly greater in the co-infected subjects whose serum HBV DNA was greater than 2000IU/mL than those with lower levels. A multiple logistic regression analysis found female gender, IL28B rs8099917 TT genotype, HBV co-infection and blood donors (vs drug users) associated with increased spontaneous clearance of HCV infection. Although acute HCV infections are common in China, the incidence of chronic HCV may be reduced among the high prevalence of chronic HBV and IL28B genotypes associated with spontaneous clearance of HCV in Chinese populations.

[Clinical characteristics and therapeutic effect of drug-resistant tuberculosis in children]

Objective: To explore the clinical characteristics of drug-resistant tuberculosis (TB) in children and to study the effectiveness of second-line anti-TB therapy for children and to examine the incidence of adverse drug reactions. Method: Retrospective research was conducted. The clinical records of children in West China Second Hospital diagnosed as drug-resistant TB from January 2010 to June 2014 were investigated.The clinical characteristics and risk factors were analyzed retrospectively. Treatment effect at discharge was examined as a short-term outcome indicator to evaluate the effectiveness of second-line anti-TB therapy and the incidence of adverse drug reactions. χ(2) test was used. Result: Forty-six patients were diagnosed as drug-resistant TB in 443 children infected with TB, with a 10.4% resistance rate. The 46 children included 26 male and 20 female patients, aged from one month and 28 days to 17 years and 5 months, with the average age (8.4±4.5) years, >7 to 14 years old patients as the biggest part(25 patients, 54.3%). Among the 46 children, 20 patients(43.5%)had close contact with TB patients, of whom 12 patients (60.0%) contacted with family members (including parents, brothers and sisters and grandparents living together) and 8 patients(40.0%) contacted with patients from outside family (such as relatives or neighbors). Moreover, 11 cases (23.9%) were under initial treatment and 35 cases (76.1%) were retreated.From 2010 to 2014, the number of cases of initial and retreated patients had no significant difference(0 and 1, 1 and 13, 4 and 7, 4 and 11, 2 and 3 cases, χ(2)=3.255, P=0.196). Among retreated patients, 31.4% (11/35) had irregular treatment before.Until discharge, the effective rate was 87.0% (40/46), while the incidence rate of adverse drug reaction was 10.9%(5/46). Conclusion: The therapy for drug-resistant TB is effective and the incidence of adverse drug reaction is relatively low.

[Estimation on the HIV-1 incidence in Liangshan Yi Autonomous Prefecture, under BED-capture enzyme immunoassay, from 2011 to 2013]

OBJECTIVE

This paper aimed to analyze the situation of HIV infection in Liangshan Yi Autonomous, including HIV recent rate of infection and the ongoing strategies on prevention of the disease in this prefecture.

METHODS

Surveillance data on population size, medical institutions, from 2011 to 2013 in Liangshan prefecture was collected. The total numbers of people living in the areas appeared as 412 608, 393 699 and 443 025 from the above mentioned three years. The overall numbers of people living with HIV/AIDS were 4 480, 3 999 and 4 719 respectively in the three years of observation, using the ELISA and WB blot. We also used the ELISA, and Western blotting methods to find out the HIV-positive individuals. We then applied the ' BED HIV-1 incidence capture enzyme immunoassay (BED-CEIA)' on these HIV-positive individuals to locate those who were recently infected, to estimate the annual recent infection rates.

RESULTS

The HIV-positive rates in Liangshan Prefecture appeared as 1.09%, 1.02% and 1.07% respectively, from 2011 to 2013, with the recent infection rates as 0.34% (95%CI: 0.32-0.37), 0.62% (95%CI: 0.58-0.66) and 0.61% (95%CI: 0.57-0.65) respectively. The newly infections mainly involved with males, with Yi ethnicity, married, being illiterate or received primary school education. In males, the rates of infection appeared as 64.24% (433/674), 59.22% (504/851) and 58.37% (495/848) respectively, in the three years of observation among people with Yi ethnicity, the recent infection rates were 84.72% (571/674) in 2011, 94.59% (805/851) in 2012 and 84.20% (714/848) in 2013. The rates seen in married people were 61.57% (415/674), 61.45% (523/851) and 60.50% (513/848) respectively. Among the illiterates or people only received primary school education, the rates appeared as 60.24% (406/674) in 2011, 61.57% (524/851) in 2012, and 60.03% (509/848) in 2013.

CONCLUSION

Using the HIV recent infection rate to describe the situation of AIDS in Liangshan prefecture, figures seemed to be more reliable than under the regular HIV-positive rate.

Splenic preservation in laparoscopic distal pancreatectomy

Background

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is designed principally for the removal of benign and low-grade malignant lesions in the left pancreas. The aims of this study were to compare LSPDP with laparoscopic distal pancreatectomy with splenectomy (LDPS), compare two splenic preservation techniques (splenic vessel preservation and Warshaw technique) and investigate factors that influence splenic preservation.

Methods

Information from patients who underwent laparoscopic distal pancreatectomy between December 2004 and January 2016 at a single institution was reviewed. Data were extracted from a prospectively developed database. Intention-to-treat and propensity score matching analyses were employed. Univariable and multivariable analyses were used to investigate factors affecting splenic preservation.

Results

There were 206 patients in total (126 planned LSPDP and 80 planned LDPS procedures), of whom 108 underwent LSPDP and 98 LDPS. In intention-to-treat analysis, the duration of surgery was significantly shorter in the LSPDP group than in the LDPS group (mean 191·0 versus 220·5 min respectively; P &lt; 0·001). Tumour size was an independent risk factor for splenic vessel resection in planned splenic vessel preservation operations, and a cut-off value of 3 cm provided optimal diagnostic accuracy. After a median follow-up of 35·9 months, there were no clinically significant splenic infarctions and no patient developed gastrointestinal bleeding after LSPDP.

Conclusion

Planned LSPDP had a high splenic preservation rate and was associated with significantly shorter operating time than LDPS. Splenic vessel preservation could be predicted using a tumour cut-off size of 3 cm.

Middle East respiratory syndrome in South Korea during 2015: Risk-related perceptions and quarantine attitudes

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Korean public had low trust in the government for controlling the MERS outbreak.

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Korean public perceived low risk from contracting MERS during the MERS outbreak.

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Most Korean public believed that quarantine was ineffective to control MERS.

A telephone survey involving 200 household members in and around Seoul, South Korea, was completed during the maturity stage of the outbreak of Middle East respiratory syndrome (MERS) in Korea during June 2015. The study found that respondents perceived low risk from contracting MERS, had low trust in government in controlling MERS, and generally held unfavorable attitudes toward quarantine.

Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours

BACKGROUND

Enucleation of pancreatic neuroendocrine tumours (pNETs) via robotic surgery has rarely been described. This study sought to assess the safety and efficiency of robotic surgery for the enucleation of small pNETs.

METHODS

A comparison was conducted of enucleation of pNETs smaller than 2 cm by robotic or open surgery between January 2000 and May 2015. Propensity score matching was used to balance sex, age, BMI, tumour location and tumour diameter. Pathological results, safety-related outcomes (postoperative pancreatic fistula (POPF) rate, estimated blood loss, and short-term mortality and morbidity) and efficiency-related outcomes (duration of surgery and postoperative length of hospital stay) were compared between the groups.

RESULTS

A cohort of 120 patients with pNET were enrolled in the study (1 : 1 matched for open or robotic surgery, 60 per group). Ninety-three patients (77·5 per cent) had a grade 1 tumour and 114 (95·0 per cent) had an insulinoma. Robotic surgery had a conversion rate of 5 per cent (3 of 60), and was not associated with an increased POPF rate (10 per cent versus 17 per cent after open surgery; P = 0·283) or grade III-V surgical complications according to the Dindo-Clavien classification (3 versus 10 per cent respectively; P = 0·272). Estimated blood loss was reduced with the robotic approach (32·5 versus 80·0 ml in the open group; P = 0·008), as was duration of surgery (117 versus 150 min; P < 0·001). Length of hospital stay after surgery was similar in the two groups (12·0 versus 13·5 days respectively; P = 0·071).

CONCLUSION

Robotic surgery for enucleation of pNETs smaller than 2 cm did not increase POPF or major complication rates, and reduced the duration of surgery and estimated blood loss, compared with open surgery.

REGISTRATION NUMBER

NCT02125929 ( https://www.clinicaltrials.gov/).

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Passenger leukocyte transfer from the donor lung to the recipient is intrinsically involved in acute rejection. Direct presentation of alloantigen expressed on donor leukocytes is recognized by recipient T cells, promoting acute cellular rejection. We utilized ex vivo lung perfusion (EVLP) to study passenger leukocyte migration from donor lungs into the recipient and to evaluate the effects of donor leukocyte depletion prior to transplantation. For this purpose, female pigs received male left lungs either following 3 h of EVLP or retrieved using standard protocols. Recipients were monitored for 24 h and sequential samples were collected. EVLP-reduced donor leukocyte transfer into the recipient and migration to recipient lymph nodes was markedly reduced. Recipient T cell infiltration of the donor lung was significantly diminished via EVLP. Donor leukocyte removal during EVLP reduces direct allorecognition and T cell priming, diminishing recipient T cell infiltration, the hallmark of acute rejection.

Circulation stabilizing therapy and pulmonary high-resolution computed tomography in a porcine brain-dead model

BACKGROUND

Currently 80% of donor lungs are not accepted for transplantation, often due to fluid overload. Our aim was to investigate if forced fluid infusion may be replaced by a new pharmacological therapy to stabilize circulation after brain death in an animal model, and to assess therapy effects on lung function and morphology trough blood gas parameters and state-of-the-art High-resolution CT (HRCT).

METHODS

Brain death was caused by surgical decapitation. To maintain mean aortic pressure > 60 mmHg, pigs were treated with forced electrolyte solution infusion (GI; n = 6) or the pharmacological therapy (GII; n = 11). GIII (n = 11) were non-decapitated controls. Lung function was investigated with blood gases and lung morphology with HRCT.

RESULTS

GI pigs became circulatory instable 4-6 h after brain death in spite of forced fluid infusion, five pigs showed moderate to severe pulmonary edema on HRCT and median final PaO2 /FiO2 was 29 kPa (Q1; Q3; range 26; 40; 17-76). GII and GIII were circulatory stable (mean aortic pressure > 80 mmHg) and median final PaO2 /FiO2 after 24 h was 72 kPa (Q1; Q3; range 64; 76; 53-91) (GII) and 66 kPa (55; 78; 43-90) (GIII). On HRCT, only two pigs in GII had mild pulmonary edema and none in GIII. More than 50% of HRCT exams revealed unexpected lung disease even in spite of PaO2 /FiO2 > 40 kPa.

CONCLUSION

Pharmacological therapy but not forced fluid infusion prevented circulatory collapse and extensive HRCT verified pulmonary edema after acute brain death. HRCT was useful to evaluate lung morphology and revealed substantial occult parenchymal changes justifying efforts toward a more intense use of HRCT in the pre-transplant evaluation.