[Epidemiological investigation of iron deficiency among preschool children in 10 provinces, autonomous regions, or municipalities in China]

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Measurement of the burdens of neonatal disorders in 204 countries, 1990-2019: a global burden of disease-based study

Background

Neonatal disorders are facing serious public health challenges. Previous studies were based on limited data sources and had a narrow geographical scope. We aim to understand the trends of alteration in the burden of neonatal disorders from 1990 to 2019 in 204 countries and territories.

Methods

Data were investigated from the Global Burden of Disease Study 2019. First, we visualized the burden of neonatal disorders using the number of cases and the age-standardized incidence rate (ASIR), death rate (ASDR), and disability-adjusted life years (ASR-DALYs) from 1990 to 2019. Second, estimated annual percentage changes (EAPCs) were used to evaluate the temporal trends of disease burden during different periods. Finally, the sociodemographic index (SDI) and human development index (HDI) were used to determine whether there exists a correlation between socioeconomic development level, human development level, and potential burden consequences.

Results

Overall, in the past 30 years, the ASIR trends have remained relatively steady, whereas the ASDR and ASR-DALYs have declined. However, the burden of neonatal disorders varied greatly in various regions and countries. Among 21 regions, the ASIR trend had the largest increase in Central Latin America (EAPC = 0.42, 95%CI = 0.33-0.50). Conversely, the ASDR and ASR-DALYs experienced the largest decrease in Central Europe (EAPC = -5.10, 95%CI = -5.28 to 4.93) and East Asia (EAPC = -4.07, 95%CI = -4.41 to 3.73), respectively. Among 204 countries, the ASIR (EAPC = 3.35, 95%CI = 3.13-3.56) trend in Greece displayed the most significant increase, while the ASDR (EAPC = 1.26, 95%CI = 1.01-1.50) and ASR-DALYs (EAPC = 1.26, 95%CI = 1.03-1.49) trends in Dominica experienced the most substantial increase. Furthermore, there was a strong correlation between the EAPCs in ASIR, ASDR, ASR-DALYs, and SDI or HDI in 2019, with some exceptions. In addition, countries with elevated levels of HDI experienced a faster increase in ASDR and ASR-DALYs for neonatal disorders.

Conclusion

Although the burden of neonatal disorders shows a downward trend from 1990 to 2019, it is still not optimistic. It is necessary to implement a multi-pronged approach to reduce the increasing burden of neonatal disorders.

Distinct forebrain regions define a dichotomous astrocytic profile in multiple system atrophy

The growing recognition of a dichotomous role of astrocytes in neurodegenerative processes has heightened the need for unraveling distinct astrocytic subtypes in neurological disorders. In multiple system atrophy (MSA), a rare, rapidly progressing atypical Parkinsonian disease characterized by increased astrocyte reactivity. However the specific contribution of astrocyte subtypes to neuropathology remains elusive. Hence, we first set out to profile glial fibrillary acidic protein levels in astrocytes across the human post mortem motor cortex, putamen, and substantia nigra of MSA patients and observed an overall profound astrocytic response. Matching the post mortem human findings, a similar astrocytic phenotype was present in a transgenic MSA mouse model. Notably, MSA mice exhibited a decreased expression of the glutamate transporter 1 and glutamate aspartate transporter in the basal ganglia, but not the motor cortex. We developed an optimized astrocyte isolation protocol based on magnetic-activated cell sorting via ATPase Na+/K+ transporting subunit beta 2 and profiled the transcriptomic landscape of striatal and cortical astrocytes in transgenic MSA mice. The gene expression profile of astrocytes in the motor cortex displayed an anti-inflammatory signature with increased oligodendroglial and pro-myelinogenic expression pattern. In contrast, striatal astrocytes were defined by elevated pro-inflammatory transcripts accompanied by dysregulated genes involved in homeostatic functions for lipid and calcium metabolism. These findings provide new insights into a region-dependent, dichotomous astrocytic response-potentially beneficial in the cortex and harmful in the striatum-in MSA suggesting a differential role of astrocytes in MSA-related neurodegenerative processes.

Short-term effects of air pollution exposure on the risk of preterm birth in Xi'an, China

INTRODUCTION

Long-term exposure to air pollution is known to be harmful to preterm birth (PTB), but little is known about the short-term effects. This study aims to quantify the short-term effect of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM_2.5), ≤10 μm (PM₁₀) and nitrogen dioxide (NO₂) on PTB.

MATERIALS AND METHODS

A total of 18,826 singleton PTBs were collected during the study period. Poisson regression model combined with the distributed lag non-linear model was applied to evaluate the short-term effects of PTBs and air pollutants.

RESULTS

Maternal exposure to NO₂ was significantly associated increased risk of PTB at Lag1 (RR: 1.025, 95%CI: 1.003-1.047). In the moving average model, maternal exposure to NO₂ significantly increased the risk of PTB at Lag01 (RR: 1.029, 95%CI: 1.004-1.054). In the cumulative model, maternal exposure to NO₂ significant increased the risk of PTB at Cum01 (RR:1.026, 95%CI: 1.002-1.051), Cum02 (RR: 1.030, 95%CI: 1.003-1.059), and Cum03 (RR: 1.033, 95%CI: 1.002-1.066). The effects of PM_2.5, PM₁₀ and NO₂ on PTB were significant and greater in the cold season than the warm season.

CONCLUSIONS

Maternal exposure to NO₂, PM_2.5 and PM₁₀ before delivery has a significant risk for PTB, particularly in the cold season.Key messagesMaternal exposure to NO₂ was significant associated with an increased risk of preterm birth at the day 1 before delivery.Particle matter (PM_2.5 and PM₁₀) showed a significant short-term effect on preterm birth in the cold season.The effects of air pollutants on preterm birth was greater in the cold season compared with the warm season.

Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis

The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.

TSUnet-CC: Temporal Spectrogram Unet embedding Cross Channel-wise attention mechanism for MDD identification

Automatic detection of major depressive disorder (MDD) with multiple-channel electroencephalography (EEG) signals is of great significance for treatment of the mental diseases. In a U-net network, clear EEG signals are fed to obtain temporal feature tensor through encoder and decoder networks with several convolution operations. Moreover, the clear EEG signals can be converted into multi-scale spectrogram to obtain the rich saliency information and then the spectrogram feature tensor can be extracted by another symmetrical U-net. The temporal and spectrogram feature tensors can provide more comprehensive information, but may also contain redundant information, which may affect the detection of MDD. To deal with such issue, this paper proposed a novel Temporal Spectrogram Unet (TSUnet-CC), which embeds the cross channel-wise attention mechanism for multiple-channel EEGbased MDD identification. We make three novel contributions: 1) multi-scale saliency-encoded spectrogram using Fourierbased approach to capture rich saliency information under different scales, 2) TSUnet network using a symmetrical twostream U-net architecture that learns multiple temporal and spectrogram feature tensors in time and frequency domains, and 3) cross channel-wise block enabling the larger weights of key feature channels that contain MDD information. The leaveone-subject-out experiments show that our proposed TSUnetCC gains high performance with a classification accuracy up to 98.55% and 99.22% in eyes closed and eyes open datasets, which outperformed some state-of-the-art methods and revealed its clinical potential.

[Clinicopathological analysis of primary gastric (gastrointestinal)-type mucoglandular lesion of endometrium]

Objective: To investigate the clinical and pathological features of primary gastric (gastrointestinal)-type mucoglandular lesions of the endometrium. Methods: Eight cases of primary gastric (gastrointestinal)-type mucoglandular lesions of endometrium diagnosed between 2014 to 2022 were retrieved from pathology archives of the Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai, China. The clinical history, pathological sections and follow-ups were analyzed. Results: The eight patients ranged in age from 35 to 67 years, with an average age of 55.5 years. Seven patients were examined for high-risk human papillary virus (HPV) before operation. Only one of them was positive for high-risk HPV52. No cervical mucinous lesions were found in any of the patients. Two cases were invasive gastric (gastrointestinal)-type adenocarcinoma, 2 cases were benign gastric (gastrointestinal)-type mucinous metaplasia, and the other 4 cases were atypical gastric (gastrointestinal)-type mucinous gland hyperplasia. Microscopically, tumor cells showed mucous epithelium with gastrointestinal differentiation. Immunophenotyping showed that MUC6 was diffusely or focally positive in 5 cases, CK20 and CDX2 were positive in 3 cases. And p16 was negative or focally positive in 5 cases and strongly positive in 1 case. ER was expressed in both benign and atypical lesions, and weakly positive or negative in the invasive adenocarcinoma. p53 showed mutant expression in one case and wild-type expression in the rest. HPV in situ hybridization was negative. Conclusions: Primary gastric (gastrointestinal)-type mucoglandular lesions of the endometrium show various forms of gastrointestinal differentiation, which are high-risk HPV independent. Morphology combined with immunohistochemistry is helpful for the diagnosis, which can only be made on exclusion of cervical gastrointestinal glandular lesion, gastrointestinal metastatic carcinoma and the mucinous subtype of endometrioid carcinoma.

Non-linear connections between maternal hemoglobin during the third trimester of pregnancy and birth weight outcomes in full-term newborns: Estimating the breakpoints

Objective

Anemia is still an unfinished global health problem, and adverse birth weight outcomes have everlasting influences on the health of later life. However, the non-linear connections and breakpoints of maternal hemoglobin with birth weight outcomes are still needed to be further elucidated. We aimed to reveal the non-linear connections between maternal hemoglobin during the third trimester of pregnancy and birth weight, low birth weight (LBW), macrosomia, small for gestational age (SGA), and large for gestational age (LGA) in full-term newborns and elucidate the breakpoints of the connections.

Methods

A total of 11,411 singletons, full-term, and live newborns, whose mothers conducted the examination of hemoglobin concentration before delivery, were included in this study. A generalized additive model was used to identify and visualize the non-linear connections between maternal hemoglobin and birth weight outcomes. Piecewise linear regression model was adopted to estimate the breakpoints of the connections and report the non-linear connections in detail.

Results

There were inverted "U"-shaped exposure-response connections between maternal hemoglobin concentration and birth weight and the risk of macrosomia. There was an increasing trend of the risk of LBW and a decreased trend of LGA with the increase in maternal hemoglobin concentration. The breakpoints of maternal hemoglobin for birth weight were 100 and 138 g/L, and those for SGA were 97 and 138 g/L. The breakpoints of maternal hemoglobin were 119 g/L for LBW, 105 g/L for macrosomia, and 106 g/L for LGA. When maternal hemoglobin concentration ranged from 100 to 138 g/L, maternal hemoglobin concentration increased per 1 g/L, and birth weight significantly decreased by 2.58 g (95% CI: -3.33, -1.83). When maternal hemoglobin concentration ranged from 97 to 138 g/L, maternal hemoglobin concentration increased per 1 g/L, and the risk of SGA significantly increased by 2% (95% CI: 1%, 3%). When maternal hemoglobin concentration was equal to or lower than 119 g/L, maternal hemoglobin concentration increased per 1 g/L, and the risk of LBW significantly increased by 3% (95% CI: 0%, 5%). When maternal hemoglobin concentration was higher than the breakpoints, the risks of macrosomia (OR = 0.99, 95% CI: 0.98, 0.99) and LGA (OR = 0.99, 95% CI: 0.98, 1.00) declined as the increase of maternal hemoglobin concentration.

Conclusions

There were non-linear connections between maternal hemoglobin and birth weight outcomes, and there are breakpoints in the connections. Cost-effective interventions targeting pregnant women in the prevention of abnormal maternal hemoglobin concentration should be taken to reduce the incidence of adverse birth weight outcomes.

Association between noise exposure during pregnancy and pregnancy complications: A meta-analysis

Background

Noise exposure has a significant impact on human health. However, the effect of occupational and residential noise on the risk of pregnancy complications was controversial in the literature. This study looked at previous research and performed a meta-analysis to determine how noise exposure during pregnancy affected the risk of pregnancy complications.

Methods

Systematic searches were conducted in PubMed, Web of Science, Scopus, Embase, Ovid, and Cochrane, and all relevant studies were included. Two investigators independently evaluated the eligibility of these studies. The risk of bias in each study and the quality and strength of each outcome was evaluated by using the GRADE approach and Navigation Guide. Random effects meta-analysis model was used.

Results

The meta-analysis retrieved 1,461 study records and finally included 11 studies. Occupational noise exposure during pregnancy was associated with preeclampsia (RR = 1.07, 95%CI: 1.04, 1.10). Neither occupational nor residential noise exposure was associated with hypertensive disorders of pregnancy (HDP) (RR = 1.10, 95%CI: 0.96, 1.25 and RR = 1.05, 95%CI: 0.98, 1.11) or gestational diabetes mellitus (GDM) (RR = 0.94, 95%CI: 0.88, 1.00 and RR = 1.06, 95%CI: 0.98, 1.16). Further bias analysis showed that the results were reliable. All outcomes were rated as low in quality and inadequate evidence of harmfulness in strength.

Conclusions

Occupational noise exposure could increase the risk of preeclampsia, according to the findings. There was no clear evidence of a harmful effect of noise exposure during pregnancy on HDP or GDM.

Deacetylation of FOXO4 by Sirt1 stabilizes chondrocyte extracellular matrix upon activating SOX9

OBJECTIVE

FOXO4 has essential roles in cellular metabolism and prevents cartilage degeneration in osteoarthritis (OA). Here we aim to provide evidence that deacetylated-FOXO4 stabilizes chondrocyte (CH) extracellular matrix (ECM) related to SOX9 activation.

PATIENTS AND METHODS

We used Chromatin immunoprecipitation (ChIP) and Dual-Luciferase reporter assay to verify that the FOXO4 protein activates SOX9 by binding to its promoter. We cultured human CHs with IL-1β to cause degeneration and supplied Sirt1 protein to deacetylate FOXO4. To confirm the function of FOXO4 and SOX9 during CHs degeneration, we also used the FOXO4 and SOX9 silenced CHs by siRNA transfection as a comparison. Western blot assay was used to analyze the protein level of Sirt1, SOX9, and the acetylated condition of FOXO4. Besides, RT-PCR was used to measure the mRNA level of collagen I/II/X, aggrecan, MMP-13, and ADAMTS-5 for determining the ECM states.

RESULTS

FOXO4 protein transcriptionally activates SOX9 expression by binding to its promoter. Under the IL-1β stimulation, FOXO4 acetyl-lysine rate increased, and the SOX9 protein expression decreased, which was alleviated after the supplement of exogenic Sirt1 protein. Meanwhile, Sirt1 overexpression increased the collagen II and aggrecan and reduced the collagen I, collagen X, MMP-13, and ADAMTS-5 mRNA expression. However, the silencing of FOXO4 abolished the Sirt1 induced SOX9 expression and weakened the ECM production stability. Additionally, SOX9 silencing also alleviated the effect of the Sirt1 supplement on the degenerated CHs, though the FOXO4 was highly deacetylated.

CONCLUSIONS

FOXO4 acetylation aggravates during the degeneration of CHs, and the deacetylation of FOXO4 by Sirt1 could activate the SOX9 expression and result in maintaining the ECM stability of cartilage.

China's experience in COVID-19 prevention and control among children in its different regions

OBJECTIVE

To summarize the experience of three Chinese cities (Wuhan, Shanghai and Haikou) and provide a reference for global efforts to combat COVID-19 spread among children.

MATERIALS AND METHODS

Through collecting the measures and outcomes of preventing and controlling COVID-19 in China's three hospitals, we compared the effect of different strategies.

RESULTS

From January to March 2020, the number of suspected and confirmed COVID-19 cases in Wuhan increased exponentially, and Wuhan Children's Hospital as a whole was transformed into a designated quarantine and treatment facility, which is the "Wuhan Model". Shanghai has more children's hospitals with better capabilities to tackle public health emergency. Besides, it is far away from Wuhan and had a small caseload. Children's Hospital of Fudan University, a facility in Shanghai to treat pediatric infectious diseases, is famous for its well-equipped building for infectious disease treatment and professional medical team, and therefore no major transformation was required. That is the "Shanghai Model". Haikou is located on an island. Amid the outbreak, large numbers of tourists and travelers from Hubei had already arrived in Haikou. Hainan Women and Children's Medical Center, as the only pediatric care hospital in Hainan Province, did not have a separate building for infectious disease treatment. After a citywide survey of the medical resources and facilities available, a temporarily idle hospital 3 kilometers away from Hainan Women and Children's Medical Center was requisitioned as the quarantine and treatment facility for pediatric cases. That is the "Hainan Model". The three models enabled the treatment of all suspected and confirmed cases and no fatality was reported.

CONCLUSIONS

The COVID-19 coping strategies for children should be designed according to the existing conditions of the local children's hospitals and the risk levels of the epidemic.

Nanofibrillar networks enable universal assembly of superstructured particle constructs

Superstructured colloidal materials exploit the synergies between components to develop new or enhanced functions. Cohesion is a primary requirement for scaling up these assemblies into bulk materials, and it has only been fulfilled in case-specific bases. Here, we demonstrate that the topology of nanonetworks formed from cellulose nanofibrils (CNFs) enables robust superstructuring with virtually any particle. An intermixed network of fibrils with particles increases the toughness of the assemblies by up to three orders of magnitude compared, for instance, to sintering. Supramolecular cohesion is transferred from the fibrils to the constructs following a power law, with a constant decay factor for particle sizes from 230 nm to 40 μm. Our findings are applicable to other nanofiber dimensions via a rationalization of the morphological aspects of both particles and nanofibers. CNF-based cohesion will move developments of functional colloids from laboratory-scale toward their implementation in large-scale nanomanufacturing of bulk materials.

Tea consumption and risk of fractures: an updated meta-analysis

This meta-analysis included 16 studies, involving seven cohort studies and nine case-control studies, and the results indicated that tea consumption may be associated with a reduced the risk of fractures.

INTRODUCTION

Regarding relationship of tea consumption with the risk of fractures remains controversial. We performed a meta-analysis to elucidate the association between tea consumption and the risk of fractures.

METHODS

Relevant articles were identified up to March 2019 by searching PubMed, Web of Science, and Embase databases. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were computed utilizing fixed or random effects model based on heterogeneity.

RESULTS

Altogether 16 studies (seven cohort and nine case-control studies) were included in this meta-analysis, involving 772,707 participants with 37,166 fracture cases. The RRs (95% CIs) of fracture for the highest versus lowest category of tea consumption were 0.86 (0.78-0.94). Subgroup analysis indicated significant associations in cohort studies (0.90 (0.86-0.94)) and case-control studies (0.77 (0.69-0.85)).

CONCLUSIONS

The current meta-analysis indicates that tea consumption may be associated with a reduced the risk of fractures.

Trends in the Incidence, Prevalence, and Survival Outcomes of Appendiceal Adenocarcinoma

Background: Appendiceal carcinoma is a rare malignant tumor with aggressive potentials. Appendiceal adenocarcinoma (AA) accounts for approximately two thirds of it. Aim: This study aimed to explore the epidemiologic changes of AA and reveal the possible influences of therapeutic advances on survival of patients with AA. Methods: We retrospectively identified 6066 patients with AA treated between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) program. Pertinent data were analyzed for incidence and prevalence. Survival analysis was made by the actuarial or Kaplan-Meier and compared by log-rank test. Cox proportional hazards model was adopted for prognostic variable evaluation. Results: We identified 6066 cases with AA. Its annual age-adjusted incidence was 0.47 per 100,000 in 2000 and increased to 1.11 per 100,000 by 2014. The incidence increased the steepest in patients under 50 years old, with a threefold escalation to 0.60 per 100,000 in 2014. The elevation of the incidence was noted in all the histologic types, stages and grades. The 20-year limited-duration prevalence of AA was 6 per 100,000 on January 1, 2014. The multivariable analysis showed the median survival time was statistically different in gender, year of diagnosis, grade, stage, type of surgery performed and histologic subtype. The median survival time was prolonged from 2000-2006 to 2007-2014 (hazard ratio (HR) 0.87; 95% CI, 0.80-0.94). Conclusion: These results showed an elevation in the incidence, prevalence of AA, which may be interpreted by the advancement of examining techniques. The improvement in survival may result from the development of therapies. Furthermore, these results suggested clinicians pay more attention to AA and indicated some potential research directions.

A Nomogram for the Prediction of Kras Mutation in Colorectal Cancer

Background: KRAS mutation status is crucial in treatment decisions regarding the use of EGFR tyrosine kinase inhibitors in colorectal cancer (CRC). However, genetic testing is not available for some patients, either because tissue is limited and/or tests are not routinely offered. Aim: We aimed to build a nomogram based on clinical factors for the prediction of KRAS mutations in CRC. Methods: Colorectal cancer patients who had their tumors genotyped for KRAS mutation at Fudan University Shanghai Cancer Center (FUSCC) were retrospectively analyzed. Variables of interest were integrated in a multivariate logistic regression model. Results: A total of 759 hospitalized patients were extracted from FUSCC database. KRAS mutation presented in 40.1% (309/759) cases. Multivariate logistic regression suggested that female (OR 1.47, 95% CI 1.06-2.04), mucinous histology (OR 2.04, 95% CI 1.28-3.25), right-sided tumor (OR 1.65, 95% CI 1.13-2.39) and high levels of preoperative CEA (OR 1.45, 95% CI 1.03-2.03), CA19-9 (OR 3.87, 95% CI 2.70-5.53) and albumin/globular protein (OR 2.02, 95% CI 1.33-3.06) were significantly correlated with KRAS mutation status. A nomogram was established and showed considerable discriminating accuracy (AUC 0.744, 95% CI 0.709-0.779) in this cohort. Patients with the highest score had 88.6% chance to bear a KRAS-mutant tumor. Subgroup analysis based on metastasis status revealed a sound applicability of the established nomogram both in metastatic (AUC 0.723, 95% CI 0.666-0.781) and nonmetastatic (AUC 0.753, 95% CI 0.707-0.798) CRC. Conclusion: Six simple and easy-to-collect characteristics defined a useful nomogram to predict KRAS status both in metastatic and nonmetastatic CRC with great predictive accuracy.

Quantifying connectivity in a physiology based model using adaptive dynamic causal modelling

This paper proposes an Adaptive Dynamic Causal Modelling based approach to detect and quantify effective connectivity in human brain structures injured by epileptic activities. The identification of the parameters in the physiology based model subtended the Electroencephalographic observations is performed by improving the optimization step in the Expectation Maximization algorithm. Considering unidirectional flow propagation, we show the efficiency of our proposed approach compared to the conventional technique.

Serum uric acid level and left ventricular hypertrophy in elderly male patients with nonvalvular atrial fibrillation

BACKGROUND AND AIMS

Recent studies have suggested that serum uric acid (SUA) induces oxidative stress and inflammation, which are involved in the mechanism of cardiac hypertrophy. In patients with atrial fibrillation (AF), comorbidity of left ventricular hypertrophy (LVH) exacerbates cardiac function. In this study, we investigated the association between SUA and cardiac hypertrophy in AF patients.

METHODS AND RESULTS

Initially, 1296 consecutive elderly patients (age >60) with nonvalvular AF were retrospectively selected from the inpatient clinic between January 2012 and April 2015. Demographic, clinical, and echocardiographic characteristics were carefully recorded. The final study population was 577 patients. The mean SUA level was significantly higher in patients with LVH than those without LVH. Compared with the non-LVH group, the LVH group was older, had a higher percentage of female patients, and had lower hemoglobin levels and estimated glomerular filtration rates. Patients in the LVH group also had a higher rate of coronary heart disease and fewer had history of radiofrequency ablation compared with the non-LVH group. In the hyperuricemia group, B-type natriuretic peptide levels, left atrial diameter, left ventricular mass index, and percentage of NYHA (New York Heart Association) class III/IV were significantly higher than the SUA normal group. Multivariate logistic regression analysis indicated the independent risk factors for LVH in elderly AF patients included SUA, age, male sex, the presence of coronary heart disease, and diuretic therapy. Subgroup analysis identified SUA as a significant risk factor associated with LVH in men.

CONCLUSIONS

SUA was independently associated with LVH in elderly male patients with nonvalvular AF.

Effects of non-surgical factors on digital replantation survival rate: a meta-analysis

This study aimed to evaluate the risk factors affecting survival rate of digital replantation by a meta-analysis. A computer retrieval of MEDLINE, OVID, EMBASE, and CNKI databases was conducted to identify citations for digital replantation with digit or finger or thumb or digital or fingertip and replantation as keywords. RevMan 5.2 software was used to calculate the pooled odds ratios. In total, there were 4678 amputated digits in 2641 patients. Gender and ischemia time had no significant influence on the survival rate of amputation replantation (P > 0.05). Age, injured hand, injury type, zone, and the method of preservation the amputated digit significantly influence the survival rate of digital replantation (P < 0.05). Children, right hand, crush, or avulsion and little finger are the risk factors that adversely affect the outcome.

THE LEVEL OF EVIDENCE

Level 5*.

The effects of an overnight holding of whole blood at room temperature on haemoglobin modification and in vitro markers of red blood cell aging

BACKGROUND

Some effects of the red blood cell (RBC) storage lesion are well documented whereas others are not. Whether a period of room temperature hold (RTH) during RBC production enhances the RBC storage lesion has remained controversial. In this study, we compared whole blood (WB)-derived RBCs produced after 24-h RTH with rapidly cooled (RC) RBCs and tested them for classical metabolic markers and signs of oxidative damage.

STUDY DESIGN AND METHODS

SAGM-RBCs were prepared from mixed and split pairs (n = 12) of WB units. RBCs prepared after a 24-h period of RTH on day+1 after collection (RTH-RBCs) were compared with RC-RBCs. All RBCs were stored at 4°C for 42 days with assay of in vitro variables on days+1, +15, +22, +29 and +42. The study examined standard quality parameters, glutathione, catalase and superoxide dismutase (SOD) activities, and indicative markers of oxidative cell damage including post-translational haemoglobin modification, malondialdehyde (MDA), and phosphatidylserine expression.

RESULTS

RTH-RBCs exhibited decreased levels of potassium (1·98 ± 0·26 vs. 5·23 ± 0·65 mmol/l) and of 2,3-diphosphoglycerate (2,3-DPG) on day+1 compared with RC-RBCs. Haemolysis rate on day+42 was higher in RTH-RBCs than in RC-RBCs (0·52 ± 0·13 vs. 0·37 ± 0·12%). The phosphatidylserine expression amounted to 0·25 ± 0·20% in RTH-RBCs and 0·07 ± 0·12% in RC-RBCs. Haemoglobin modification was not different between both RBC groups. RTH-RBCs showed slightly higher MDA concentration on days +29 and +42.

CONCLUSIONS

RC-RBCs and RTH-RBCs show only small differences of classical in vitro parameters and no relevant differences in antioxidative metabolism and oxidative haemoglobin modification. These findings do not explain the loss observed in in vivo survival studies with RBCs.

Paenibacillus selenii sp. nov., isolated from selenium mineral soil

Strain W126(T), a Gram-reaction-positive, spore-forming, rod-shaped, facultatively anaerobic bacterium, motile by means of peritrichous flagella, was isolated from selenium mineral soil in Hubei province of China. 16S rRNA gene sequence analysis demonstrated that this isolate belonged to the genus Paenibacillus, with 97.9 % sequence similarity to Paenibacillus anaericanus MH21(T), while compared with the other species of the genus Paenibacillus, the 16S rRNA gene sequence similarities were less than 96.0%. DNA-DNA hybridization between strain W126(T) and Paenibacillus anaericanus DSM 15890(T) was 24%. The major isoprenoid menaquinone was menaquinone-7. Anteiso-C(15 : 0) was the major fatty acid. The DNA G+C content was 42.3 mol%. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, three unknown aminophospholipids and an unknown lipid. Strain W126(T) contained A1γ-meso-diaminopimelic acid in the cell-wall peptidoglycan. The phenotypic, chemotaxonomic and genotypic data indicate that strain W126(T) represents a novel species of the genus Paenibacillus, for which the name Paenibacillus selenii sp. nov. is proposed. The type strain is W126(T) ( = KCTC 33420(T) = CCTCC AB 2014003(T)).

Low expression of Mfn2 is associated with mitochondrial damage and apoptosis in the placental villi of early unexplained miscarriage

INTRODUCTION

Early miscarriage is the most common complication of pregnancy and in many cases the etiology is not clearly understood. We aim to profile the expression of Mfn2 and mitochondrial damage in villous tissues, in order to determine the underlying mechanism of unexplained miscarriage.

METHODS

We investigated placental villous samples of 30 women with early unexplained miscarriage (miscarriage group) and 30 women with normal pregnancy (control group). Immunohistochemistry and western blotting were used to detect the Mfn2 expression. We observed trophoblastic cell apoptosis with TUNEL and analyzed Bcl-2 and Bax levels by western blotting. Transmission electron microscopy was used to analyze mitochondrial morphology and phosphomolybdic acid colorimetric method was used to measure the ATP content of all villous samples.

RESULTS

Mfn2 staining showed extra-nuclear localization in the trophoblastic cells. Compared with the control group, the levels of Mfn2 and Bcl-2 were markedly decreased (P < 0.01), while both the levels of Bax protein and apoptosis index (AI) were increased in the miscarriage group (P < 0.01). Mfn2 levels positively correlated with Bcl-2, but negatively correlated with Bax. Moreover, compared to the control group (33.8 ± 6.5 μmol/g), ATP levels in the miscarriage group were significantly decreased (15.8 ± 4.8 μmol/g). In addition, obvious impairment of mitochondrial function was observed in trophoblastic cells from the unexplained miscarriage group.

CONCLUSION

Mitochondrial morphologic and functional changes were observed in trophoblastic cells, and in relation with apoptosis, may be correlated with low levels of Mfn2. Deficient expression of Mfn2 in trophoblastic cells could be an important cause of early miscarriage.

Attributable causes of cancer in China

BACKGROUND

Most cancers are due to modifiable lifestyle and environmental risk factors, and are potentially preventable. No studies have provided a systematic quantitative assessment of the burden of cancer mortality and incidence attributable to known risk factors in China.

METHODS

We calculated the proportions of cancer deaths and new cases attributable to known risk factors in China, based on the prevalence of exposure around 1990 and national data on cancer mortality and incidence for the year 2005.

RESULTS

Chronic infection is the main risk factor for cancer in China, accounting for 29.4% of cancer deaths (31.7% in men and 25.3% in women), followed by tobacco smoking (22.6% with 32.7% in men and 5.0% in women), low fruit intake (13.0%), alcohol drinking (4.4%), low vegetable intake (3.6%) and occupational exposures (2.7%). The remaining factors, including environmental agents, physical inactivity, the use of exogenous hormones and reproductive factors are each responsible for <1.0%.

CONCLUSIONS

Modifiable risk factors explain nearly 60% of cancer deaths in China, with a predominant role of chronic infection and tobacco smoking. Our findings could provide a basis for cancer prevention and control programs aimed at reducing cancer risk in other developing countries.

Dynamical changes of ion current distribution for a Penning discharge source using a Langmuir probe array

A paralleled plate electrode and a 9-tip Langmuir probe array located 1 mm behind the extraction exit of a cold cathode Penning ion source are employed to measure the total current and the dynamical changes of the ion current in the 2D profile, respectively. Operation of the ion source by 500 V DC power supply, the paralleled plate electrode and the Langmuir probe array are driven by a bias voltage ranging from -200 V to 200 V. The dependence of the total current and the dynamical changes of the ion current in the 2D profile are presented at the different bias voltage. The experimental results show that the distribution of ion current is axial symmetry and approximate a unimodal distribution.

Characteristic of a triple-cathode vacuum arc plasma source

In order to generate a better ion beam, a triple-cathode vacuum arc plasma source has been developed. Three plasma generators in the vacuum arc plasma source are equally located on a circle. Each generator initiated by means of a high-voltage breakdown between the cathode and the anode could be operated separately or simultaneously. The arc plasma expands from the cathode spot region in vacuum. In order to study the behaviors of expanding plasma plume generated in the vacuum arc plasma source, a Langmuir probe array is employed to measure the saturated ion current of the vacuum arc plasma source. The time-dependence profiles of the saturated current density of the triple vacuum arc plasma source operated separately and simultaneously are given. Furthermore, the plasma characteristic of this vacuum arc plasma source is also presented in the paper.

Sequence and phylogenetic analysis of the S-class genome segments of a duck orthoreovirus

In spite of common properties duck orthoreoviruses (DRVs) are antigenically different from other avian orthoreoviruses (ARVs). We analyzed the S-class genome segments of the DRV S12 and compared them with S-class genome segments of other orthoreoviruses compared to those of ARV S1133. The full-length S-class sigmaA, sigmaB, sigmaNS, and sigmaC genes were determined and compared with other ARVs to study the degree of genetic divergence and evolution of DRVs. The alignment of the DRV S12 sigmaA, sigmaB, sigmaNS, and sigmaC genes with DRV 89026 showed 90.0%, 93.6%, 88.0%, and 93.1% nucleotide identity and 97.1%, 94.3%, 95.8%, and 93.7% amino acid identity, respectively. The alignment of the DRV S12 sigmaA, sigmaB, sigmaNS, and sigmaC genes with other ARVs revealed 76.0-77.1%, 52.5-55.1%, 78.4-79.6%, and 2.7-9.9% nucleotide identity and 89.5-91.2%, 61.4-62.0%, 91.6-92.7% and 22.6-26.7% amino acid identity, respectively. Phylogenetic analyses demonstrated that DRVs were quite different from other ARVs and provided the evidence for the diversity among avian orthoreoviruses.

Significant association of a M129V independent polymorphism in the 5' UTR of the PRNP gene with sporadic Creutzfeldt-Jakob disease in a large German case-control study

BACKGROUND

A single nucleotide polymorphism (SNP) in the coding region of the prion protein gene (PRNP) at codon 129 has been repeatedly shown to be an associated factor to sporadic Creutzfeldt-Jakob disease (sCJD), but additional major predisposing DNA variants for sCJD are still unknown. Several previous studies focused on the characterisation of polymorphisms in PRNP and the prion-like doppel gene (PRND), generating contradictory results on relatively small sample sets. Thus, extensive studies are required for validation of the polymorphisms in PRNP and PRND.

METHODS

We evaluated a set of nine SNPs of PRNP and one SNP of PRND in 593 German sCJD patients and 748 German healthy controls. Genotyping was performed using MALDI-TOF mass spectrometry.

RESULTS

In addition to PRNP 129, we detected a significant association between sCJD and allele frequencies of six further PRNP SNPs. No significant association of PRND T174M with sCJD was shown. We observed strong linkage disequilibrium within eight adjacent PRNP SNPs, including PRNP 129. However, the association of sCJD with PRNP 1368 and PRNP 34296 appeared to be independent on the genotype of PRNP 129. We additionally identified the most common haplotypes of PRNP to be over-represented or under-represented in our cohort of patients with sCJD.

CONCLUSION

Our study evaluated previous findings of the association of SNPs in the PRNP and PRND genes in the largest cohorts for association study in sCJD to date, and extends previous findings by defining for the first time the haplotypes associated with sCJD in a large population of the German CJD surveillance study.

Expression of endothelial nitric oxide synthase traffic inducer in the placentas of women with pre-eclampsia

OBJECTIVE

To investigate the expression of endothelial nitric oxide synthase traffic inducer (NOSTRIN) in the placenta of women with pre-eclampsia (PE) and discuss its role in the pathogenesis of PE.

METHODS

Western blot analysis was used to detect the expression of NOSTRIN and endothelial nitric oxide synthase (eNOS). The activity of eNOS in placental tissue was assayed by spectrophotometry. Serum and placental NO(2)/NO(3), the stable metabolic end product of NO, was measured using nitrate reductase.

RESULTS

Western blot analysis showed that the protein level of NOSTRIN was significantly higher in women with PE than in the control group (P<0.01). However, no significant difference between groups was observed in the expression of placental eNOS (P>0.05). The activity of eNOS was significantly decreased in women with PE (13.727+/-3.58 U/mg) compared with the control group (21.69+/-3.84 U/mg) (P<0.01). The placental levels of NO(2)/NO(3) were significantly lower in women with PE (27.53+/-8.51 micromol/mg) than in the control group (44.38+/-9.59 micromol/mg) (P<0.01). The levels of serum NO(2)/NO(3) were significantly lower in women with PE (48.56+/-8.49 micromol/L) than in the control group (65.37+/-9.61 micromol/L) (P<0.01). A significant negative correlation existed between the expression of NOSTRIN protein and the activity of eNOS in the placental tissues of women with PE (r=-0.57, P<0.01).

CONCLUSION

The level of NOSTRIN expression in the placental tissues of women with PE is increased and is negatively correlated with the activity of eNOS-which may play an important role in the pathogenesis of PE.

Prion protein codon 129 polymorphism and risk of Alzheimer disease

The authors investigated the PRNP Met129Val polymorphism in 1,393 subjects including 482 patients with Alzheimer disease (AD) and two independent control groups. In patients, PRNP Met homozygosity conferred increasing risk with decreasing age at onset (onset: 61 to 70 years, n = 151, p = 0.02, odds ratio [OR] = 1.72, 95% CI = 1.2 to 2.53; onset: < or =60 years, n = 138, p = 0.013, OR = 1.92, 95% CI = 1.31 to 2.87), whereas no association was obtained in patients with onset at older than 70 years. The results suggest involvement of the prion protein in the pathogenesis of early-onset AD.

Photodynamic effects induced by aminolevulinic acid esters on human cervical carcinoma cells in culture

Fluorescence diagnosis and photodynamic therapy using 5-aminolevulinic acid (ALA) provide new methods for the detection and treatment of cervical cancer and especially its precursors. However, these techniques are restricted by the rate of uptake of the hydrophilic ALA, its poor diffusion through the bilayer of biological membranes or both. In this study we evaluated the effect of some esterified ALA derivatives on the induction of the endogenous photosensitizer, protoporphyrin IX (PpIX), and the photodamage in cultured human cervical cells (C33-A and CaSki). The kinetics of PpIX accumulation showed that ALA esters, especially the ALA-hexylester (h-ALA), induced significantly faster PpIX formation than ALA at the same concentration (0.5 mM). The PpIX induction showed a dose-dependent characteristic. The highest PpIX values could be achieved by an up to 1.3-13-fold lower concentration of ALA esters than with ALA. Using the Annexin V assay, apoptosis was found to be induced rapidly after irradiation in both ALA- and ALA esters-treated cells. On measuring mitochondrial activity, the incubation with h-ALA induced a more pronounced photodamage. The results indicate that improved or at least comparable photodynamic effects can be achieved by using remarkably lower doses of ALA esters.

Photodynamic effects induced by aminolevulinic acid esters on human cervical carcinoma cells in culture

Fluorescence diagnosis and photodynamic therapy using 5-aminolevulinic acid (ALA) provide new methods for the detection and treatment of cervical cancer and especially its precursors. However, these techniques are restricted by the rate of uptake of the hydrophilic ALA, its poor diffusion through the bilayer of biological membranes or both. In this study we evaluated the effect of some esterified ALA derivatives on the induction of the endogenous photosensitizer, protoporphyrin IX (PpIX), and the photodamage in cultured human cervical cells (C33-A and CaSki). The kinetics of PpIX accumulation showed that ALA esters, especially the ALA-hexylester (h-ALA), induced significantly faster PpIX formation than ALA at the same concentration (0.5 mM). The PpIX induction showed a dose-dependent characteristic. The highest PpIX values could be achieved by an up to 1.3-13-fold lower concentration of ALA esters than with ALA. Using the Annexin V assay, apoptosis was found to be induced rapidly after irradiation in both ALA- and ALA esters-treated cells. On measuring mitochondrial activity, the incubation with h-ALA induced a more pronounced photodamage. The results indicate that improved or at least comparable photodynamic effects can be achieved by using remarkably lower doses of ALA esters.

[Soil and water loss from cultivated slope land derived from granite under different cropping systems in Three-Gorges reservoir areas]

The water and soil loss caused by cultivation on slope land derived from granite under different cropping systems in the Three-Gorges reservoir area was analyzed based on the data from localized observation. The results showed that in this area, proximately 60% of total annual rainfall, distributed in May to August, and 60% of soil erosion occurred in these four months, with 50% in June and July. The coverage rates under different cropping systems differed significantly, e.g., triple-cropping systems and inter-croping system with perennial plants (grass and day lily) had a bigger covering than double-cropping systems. The soil loss under cropping system with peanut was much lower than that with sweet potato, because the covering rate of the former was higher than that of the latter in summer raining season. The sequence of soil and nutrient loss for different cropping systems was rape (wheat) sweet potato > rape(wheat)/corn/sweet potato > rape(wheat)/corn/peanut/rape(wheat)/grass/peanut/rape(wheat)/day lily/peanut. It was concluded that soil loss from cultivated slope land could be controlled below a permissible value, if rational cropping and management systems were adopted.

The primate lentiviral receptor Bonzo/STRL33 is coordinately regulated with CCR5 and its expression pattern is conserved between human and mouse

Chemokines play necessary and important roles in regulating the trafficking of lymphocytes to intra- or interlymphoid tissues as well as to sites of inflammation. The complex migratory patterns of lymphoid lineage cells is governed by subset-specific expression of chemokine receptors and their access to specific ligands. Several chemokine receptors and chemokine receptor-like orphan receptors also serve, in conjunction with CD4, as coreceptors for infection by human and simian immunodeficiency viruses (HIV and SIV). Here we show that the expression pattern of Bonzo/STRL33, an orphan SIV/HIV coreceptor, is highly restricted to the memory subset of T cells and is up-regulated upon stimulation of these cells with IL-2 or IL-15. Both the pattern and the regulation of Bonzo expression closely paralleled that of CC family chemokine receptors CCR5 or CCR6 and inversely correlated with CXCR4 expression. However, in striking contrast to CCR5, Bonzo expression was not down-modulated by PMA or mitogen stimulation of T cells. Targeted replacement of the Bonzo gene with a gene encoding green fluorescent protein in mice revealed that the expression and cytokine regulation of mouse Bonzo are comparable to those of its human counterpart. The similar expression and regulation patterns of Bonzo and the HIV coreceptor CCR5 may have implications for understanding the role of HIV/SIV receptors in viral evolution and pathogenesis.

Assessment of 5-aminolevulinic acid-induced porphyrin fluorescence in patients with peritoneal endometriosis

OBJECTIVE

The purpose of this study was to examine the diagnostic potential for patients with endometriosis of porphyrin fluorescence after oral administration of 5-aminolevulinic acid.

STUDY DESIGN

Fifteen women referred for laparoscopy because of suspected endometriosis received 1 or 10 mg/kg 5-aminolevulinic acid orally. After 1.5 to 6 hours endoscopic fluorescence spectral analysis and video inspection were performed.

RESULTS

With 10 mg/kg 5-aminolevulinic acid and application intervals of >3 hours we observed a significantly higher porphyrin fluorescence in active peritoneal endometriosis than in adjacent normal peritoneum. Pigmented and nodular endometriosis showed weak to negative fluorescence. A strong fluorescence of the fimbrial mucosa was seen. A 1-mg/kg dose of 5-aminolevulinic acid was insufficient for fluorescence diagnosis. No side effects were recorded.

CONCLUSION

Porphyrin fluorescence after oral administration of 5-aminolevulinic acid may be beneficial in diagnosis of peritoneal endometriosis. The strong fluorescence of fimbrial mucosa may limit the applicability of this technique in young women, however, because phototoxic damage cannot be excluded at present.

Photodetection of cervical intraepithelial neoplasia using 5-aminolevulinic acid-induced porphyrin fluorescence

BACKGROUND

Screening for cervical carcinoma and its precursors is based on cervical cytology and diagnostic colposcopy. Despite the decrease in the incidence of cervical carcinoma in countries with a good screening program, this rate of decline is leveling off. Known problems are false-negative rates of cytology and low specificity of colposcopy. This clinical study examined the diagnostic potential of porphyrin fluorescence in patients with cervical intraepithelial neoplasia Grade 1-3 (CIN 1-3).

METHODS

Sixty-eight women attending our colposcopy clinic underwent a gynecologic examination, including cytology, human papillomavirus (HPV) testing, and colposcopy. They received 10 mL 0.5% or 1.0% 5-aminolevulinic acid (5-ALA) topically. After 30-360 minutes, real-time image analysis was performed, and spectra were obtained from 685 sites.

RESULTS

Due to rapid photobleaching, 0.5% 5-ALA proved ineffective for fluorescence assessment. Using 1% 5-ALA, the authors found that fluorescence intensities correlated with incubation time; however, fluorescence contrast showed a maximum at 60-90 minutes (ratio 11:1). HPV DNA positive lesions showed significantly higher fluorescence. Fluorescence imaging after 60-90 minutes achieved similar sensitivity and specificity compared with colposcopy in detecting CIN with 94% and 51% versus 95% and 50%, respectively. However, the specificity was markedly improved by fluorescence spectroscopy, achieving 75%. The evaluation of spectral measurements revealed significantly higher values for CIN compared with normal tissue and for CIN 2/3 compared with CIN 1 (P < 0.001).

CONCLUSIONS

Using a time interval of 60-90 minutes after topical application of 1% 5-ALA, the authors observed specific porphyrin fluorescence of CIN. Fluorescence spectroscopy promises to become a valuable tool for the diagnosis of CIN.

Identification of seven serotypes of bluetongue virus from the People's Republic of China

Seven serotypes (1, 2, 3, 4, 12, 15 and 16) of bluetongue virus were isolated from the blood of sheep and cattle in the People's Republic of China between 1986 and 1996. Six of these viruses were isolated in Yunnan province. The sheep from which serotypes 1 and 16 were isolated showed obvious signs of bluetongue disease, whereas the cattle from which serotypes 2, 3, 4, 12 and 15 were isolated were clinically normal. Phylogenetic analyses of these viruses indicate that they are more closely related to one another, and to an Australian strain of serotype 1, than they are to prototype strains of bluetongue virus serotypes 2, 10, 11, 13 and 17 from the USA.