[Diagnosis status and genetic characteristics analysis of Fanconi anemia in China]

Objective: To analyze the clinical and molecular diagnostic status of Fanconi anemia (FA) in China. Methods: The General situation, clinical manifestations and chromosome breakage test and genetic test results of 107 pediatric FA cases registered in the Chinese Blood and Marrow Transplantation Registry Group (CBMTRG) and the Chinese Children Blood and Marrow Transplantation Registry Group (CCBMTRG) from August 2009 to January 2022 were analyzed retrospectively. Children with FANCA gene variants were divided into mild and severe groups based on the type of variant, and Wilcoxon-test was used to compare the phenotypic differences between groups. Results: Of the 176 registered FA patients, 69 (39.2%) cases were excluded due to lack of definitive genetic diagnosis results, and the remaining 107 children from 15 hospitals were included in the study, including 70 males and 37 females. The age at transplantation treatment were 6 (4, 9) years. The enrolled children were involved in 10 pathogenic genes, including 89 cases of FANCA gene, 7 cases of FANCG gene, 3 cases of FANCB gene, 2 cases of FANCE gene and 1 case each of FANCC, FANCD1, FANCD2, FANCF, FANCJ, and FANCN gene. Compound heterozygous or homozygous of loss-of-function variants account for 69.2% (72/104). Loss-of-function variants account for 79.2% (141/178) in FANCA gene variants, and 20.8% (37/178) were large exon deletions. Fifty-five children (51.4%) had chromosome breakage test records, with a positive rate of 81.8% (45/55). There were 172 congenital malformations in 80 children.Café-au-Lait spots (16.3%, 28/172), thumb deformities (16.3%,28/172), polydactyly (13.9%, 24/172), and short stature (12.2%, 21/172) were the most common congenital malformations in Chinese children with FA. No significant difference was found in the number of congenital malformations between children with severe (50 cases) and mild FANCA variants (26 cases) (Z=-1.33, P=0.185). Conclusions: FANCA gene is the main pathogenic gene in children with FA, where the detection of its exon deletion should be strengthened clinically. There were no phenotypic differences among children with different types of FANCA variants. Chromosome break test is helpful to determine the pathogenicity of variants, but its accuracy needs to be improved.

[Independent and combined effects of pre-pregnancy BMI and gestational diabetes on early adiposity rebound timing in children]

Objective: To examine the independent and combined effects of pre-pregnancy BMI and gestational diabetes (GDM) on early adiposity rebound (AR) timing in children. Methods: Based on the "Ma'anshan Birth Cohort Study", 2 896 eligible maternal and infant pairs were recruited. In the cohort, we collected pre-pregnancy height, weight, 24 to 28 weeks GDM diagnosis, follow-up at 42 days, three months, six months, nine months of age, and every six months after one year of age, and continuously followed up to 6 years old, and obtained the child's length/height, weight, and other data. The intensity of the association between pre-pregnancy BMI, GDM, and early AR timing was analyzed by the multivariate logistic regression model. Multiplication and additive models were used to analyze how pre-pregnancy BMI and GDM influenced early AR timing in children. Results: The prevalence of underweight, average weight, overweight, and obesity before pregnancy were 23.2% (672), 66.4% (1 923), 8.7% (251), and 1.7% (50). The prevalence of GDM was 12.4%. We found that 39.3% of children had AR, and the average age at AR was (4.38±1.08). The results of multifactorial logistic regression analysis showed that pre-pregnancy overweight (OR=1.67,95%CI:1.27-2.19), pre-pregnancy obesity (OR=3.05,95%CI:1.66-5.56), and maternal GDM (OR=1.40,95%CI:1.11-1.76) were risk factors for early AR timing in children. In contrast, pre-pregnancy underweight (OR=0.60,95%CI:0.49-0.73) was a protective factor for early AR timing in children. Compared with the different effects of pre-pregnancy overweight/obesity and maternal GDM alone, the combined effect caused a higher risk of early AR timing in children, with OR values (95%CI) were 2.03 (1.20-3.44), 3.43 (1.06-11.12), respectively. The multiplication and additive models showed no interaction between pre-pregnancy BMI and GDM-influenced early AR timing in children. Conclusion: Higher pre-pregnancy BMI and maternal GDM are the independent risk factors for the early AR timing in children, and the co-occurrence of the two is higher risks, but there was no statistical interaction.

[Endovascular stenting for idiopathic intracranial hypertension with different types of venous sinus stenosis]

Objective: To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension (IIH). Method: Clinical, radiological, and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019. The follow-up period was between 2.3 months to 11 years. Results: Our study enrolled 21 men (21.2%)and 78 women (78.8%) with average body mass index (BMI) 19.2-40.6(27.0±4.4) kg/m2 and median age 37 years. Before stent placement, the mean transverse sinus stenosis gradient was 1-59(26±8) mmHg. Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis. In all cases, stenting was effective for papilledema. Fifty patients complained of headaches. Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting. In one patient, replacement of stent did not improve symptoms, and a subsequent CSF diversion procedure was performed and effective. Conclusion: Irrespective of the type of stenosis, stenting of venous sinus stenosis is an effective treatment for IIH. Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.

[CART therapy followed by allo-HSCT for patients with B-cell acute lymphoblastic leukemia relapsing after the first hematopoietic stem cell transplantation]

目的

观察嵌合抗原受体T细胞（CART）序贯二次异基因造血干细胞移植（allo-HSCT）治疗移植后复发急性B淋巴细胞白血病（B-ALL）的疗效。

方法

回顾性分析2015年10月至2020年6月在河北燕达陆道培医院接受二次allo-HSCT的41例B-ALL患者的临床资料，入选患者均为移植后骨髓形态学或髓外复发且二次移植前接受CART治疗。

结果

全部41例患者中男21例、女20例，二次移植时中位年龄为16（3～46）岁。移植后骨髓复发31例（75.6％）、髓外复发5例（12.2％）、骨髓和髓外复发5例（12.2％）。复发后接受CD19-CART治疗35例（85.4％）、CD22-CART治疗2例（4.9％）、CD19-CART联合CD22-CART治疗4例（9.8％）。二次移植后预期3年总生存（OS）率为48.9％（95％ CI 23.0％～70.6％）、无白血病生存（LFS）率为41.8％（95％ CI 17.3％～64.9％），累积复发率（RI）为8.8％（95％ CI 2.9％～26.4％），非复发相关死亡率（NRM）为51.1％（95％ CI 31.2％～83.6％）。首次移植后复发时间≤6个月组（10例）二次移植后1年OS率低于复发时间>6个月组（31例）［45.0％（95％ CI 12.7％～73.5％）对75.0％（95％ CI 51.4％～88.8％），P＝0.017］。

结论

CART序贯二次allo-HSCT可使部分造血干细胞移植后复发B-ALL患者获得长生存，但NRM较高，移植方案有待进一步改进。

[Comparison of the clinical outcomes of haploidentical and matched-sibling donor stem cell transplantation for T cell acute lymphoblastic leukemia in complete remission]

目的

比较亲缘单倍型造血干细胞移植（HIDT）和同胞相合造血干细胞移植（MSDT）治疗完全缓解期（CR）急性T淋巴细胞白血病（T-ALL）的疗效。

方法

回顾性分析2012年5月至2017年5月间在河北燕达陆道培医院接受HIDT（81例）和MSDT（17例）的CR期T-ALL患者的临床特点和预后。

结果

HIDT组、MSDT组移植后100 d Ⅱ～Ⅳ度急性GVHD发生率分别为51.9％（95％CI42.0％～64.0％）、29.4％（95％CI 14.1％～61.4％）（P＝0.072），Ⅲ/Ⅳ度急性GVHD发生率分别为9.8％（95％CI 5.1％～19.1％）、11.8％（95％CI 3.2％～43.3％）（P＝1.000），巨细胞病毒（CMV）血症发生率分别为53.1％（95％CI 43.3％～65.2％）、29.4％（95％CI 14.1％～61.4％）（P＝0.115），EB病毒（EBV）血症发生率分别为35.8％（95％CI 26.8％～47.9％）、11.8％（95％CI 3.2％～43.3％）（P＝0.048）。HIDT、MSDT两组移植后5年总生存（OS）率分别为60.5％（95％CI 5.4％～49.0％）、68.8％（95％CI 11.8％～40.0％）（P＝0.315），无白血病生存（LFS）率分别为58.0％（95％CI 5.5％～46.5％）、68.8％（95％CI11.8％～40.0％）（P＝0.258），累积复发率分别为16.1％（95％ CI 9.8％～26.4％）、11.8％（95％ CI3.2％～43.3％）（P＝0.643），非复发死亡率（NRM）分别为25.9％（95％CI 17.9％～37.5％）、19.4％（95％CI6.9％～54.4％）（P＝0.386）。

结论

对于CR期T-ALL患者，当缺乏合适供者时，HIDT可作为替代选择。

[Prognostic analysis of allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia in complete remission in the era of tyrosine kinase inhibitors]

目的

探讨在酪氨酸激酶抑制剂（TKI）时代Ph染色体阳性急性淋巴细胞白血病（Ph⁺ALL）在完全缓解（CR）状态下行异基因造血干细胞移植（allo-HSCT）的预后和影响因素。

方法

回顾性分析2012年5月至2017年5月河北燕达陆道培医院收治的116例在CR状态下行allo-HSCT的Ph⁺ALL患者的预后及其影响因素。

结果

116例患者中男72例，女44例。中位年龄20（4～64）岁。同胞全相合移植21例，亲缘单倍型移植77例，非血缘移植18例。5年总生存（OS）率为73.2％（95％CI 63.8％～80.5％），其中诊断至移植间隔时间<180 d的亚组5年OS率为87.5％。5年无病生存（DFS）率为61.4％（95％CI 51.8％～69.7％）。5年细胞形态及分子学水平复发累积发生率为18.5％（95％CI 12.6％～27.3％）。5年移植相关死亡率（TRM）为19.9％（95％CI 13.8％～28.7％）。多因素分析显示，15～39岁（HR＝2.730，P＝0.044）、诊断至移植间隔时间≥180 d（HR＝4.534，P＝0.010）、发生Ⅲ～Ⅳ度急性移植物抗宿主病（aGVHD）（HR＝7.558，P＝0.000）是影响患者OS的不利因素；发生局限型慢性移植物抗宿主病（cGVHD）是影响患者OS的有利因素（HR＝0.300，P＝0.034）。而性别、起病时WBC（<30×10⁹/L，≥30×10⁹/L）、BCR-ABL融合基因类型、体细胞突变类型、移植前状态（CR₁，>CR₁）、移植前微小残留病（MRD）水平（MRD阴性，MRD阳性）、预处理方案（全身照射方案，白消安为基础方案）、预处理方案强度、移植类型、GVHD预防方案（环孢素A，他克莫司）、抗胸腺细胞免疫球蛋白的种类、巨细胞病毒和EB病毒血症的有无对OS的影响无统计学意义。

结论

TKI时代Ph⁺ALL在CR状态下行allo-HSCT时，影响生存的因素有年龄、诊断至移植间隔时间和发生重度aGVHD。

[The analysis of clinical characteristics of 34 novel coronavirus pneumonia cases in Ningxia Hui autonomous region]

Objective: To analyze the clinical characteristics of 34 COVID-19 cases and to provide the basis for the prevention and control of the epidemic disease. Methods: Thirty-four COVID-19 patients diagnosed with RT-PCR in the isolation ward of the Fourth People's Hospital of Ningxia Hui autonomous region (infectious diseases hospital) from the January 22 to February 4, 2020 were selected as the research subjects. The clinical data were collected. Excel was used to describe the relationship between clinical classification and age distribution, contact history and date of onset. SPSS 25.0 statistical software was used for analysis. The general information, clinical symptoms, blood test, virus nucleic acid test results, epidemiology, CT imaging, treatment and prognosis were analyzed. Results: There were 5 mild cases (5/34), 24 ordinary cases (24/34), 5 severe cases (5/34). The elderly was more common in severe patients. The main clinical symptoms were fever (27/34)and dry cough(26/34). The peripheral blood showed normal or decreased leukocyte count (33/34), decreased lymphocyte count (12/34). The increase of C-reactive protein (CRP) and D-dimer was related to the severity of the disease. Some patients had mild liver and kidney damage. Six patients were diagnosed through 3 or more times of nucleic acid tests. Sixteen cases had Wuhan related history,13 cases were close contacts, 5 cases had no confirmed route. The clustered infections were found in 6 families. In typical cases, CT showed single or multiple patchy ground glass shadow with thickening of interlobular septum. In severe cases, diffuse lesions of both lungs were found, with ground glass shadow, consolidation shadow and strip shadow coexisting. Thirty-four patients were treated with interferon-α and Lopinavir/Ritonavir with good prognosis. Conclusions: The clinical characteristics of COVID-19 were similar to that of general viral pneumonia but with strong infectivity. Close contact and family aggregation caused disease outbreaks. COVID-19 could not be excluded if two nucleic acid tests were negative and high-resolution CT was helpful for differential diagnosis. Early detection, early isolation, early diagnosis and early treatment are important for good prognosis. The effectiveness of antiviral drugs needs to be further verified.

[The 476th case: skin rash, edema, thrombocytopenia and anemia]

The 21-year-old male patient was admitted to the Department of Rheumatology and Immunology at Peking Union Medical College Hospital with chief complaints of "skin rash for 1 year and edema for 2 months". He was diagnosed with systemic lupus erythematosus (SLE) with renal, cardiac and hematological involvement. Remission was not achieved after glucocorticoid pulse treatment. The patient experienced oliguria, malignant hypertension, accompanied by thrombocytopenia and low serum complements, and elevated lactate dehydrogenase and serum creatinine. Schistocytes were seen in the peripheral blood smear. Thrombotic microangiopathy (TMA) secondary to SLE was diagnosed. Though plasma exchange was partially effective, TMA could not be controlled yet. The activity of serum von Willebrand factor -cleaving protease (ADAMTS 13) was 100%, and ADAMTS 13 inhibitor was negative. Finally, remission of the disease was achieved after second glucocorticoid pulse therapy and rituximab treatment. At the 3-month follow-up, the patient's condition was stable with mild anemia and normal platelet count. Patients with TMA secondary to SLE are heterogenous, while normal ADAMT 13 activity indicates poor prognosis. Early and aggressive treatment is important for disease control, and plasma exchange is helpful as a supportive care.

[The 469th case: multiple cutaneous abscesses, pelvic mass, and lung cavities]

A 28-year-old woman with multiple abscesses for 2 month and fever for 1 month was admitted in Peking Union Medical College Hospital. The skin abscesses gradually developed at skull, face, abdominal wall and pelvis. Laboratory examinations related to inflammatory reactions were strongly high including erythrocyte sedimentation rate 99 mm/1 h,C-reactive protein160.28 mg/L and ferritin 1 584 μg/L. Multiple nodules and cavities were detected in lungs. And vesico-cervical fistula was found during exploratory laparotomy. The pathological tests of abdominal tissues demonstrated necrosis and granuloma. Evidence of infectious diseases was not definite. Positive anti-proteinase 3 (PR3) antibody confirmed the diagnosis of granulomatosis with polyangiitis. After treated with glucocorticoid and immunosuppressants, the patient's symptoms improved remarkably. This case suggested that systemic vasculitis should be considered as a differential diagnosis of multiple abscesses which are not explained by infections.

[Clinical characteristics and prognosis of 34 cases of acute myeloid leukemia with FLT3 internal tandem duplication and MLL gene rearrangement]

目的

探讨同时伴FLT3-ITD突变及MLL基因异常的急性髓系白血病（AML）患者的临床特征及转归。

方法

回顾性分析34例同时伴FLT3-ITD突变及MLL基因异常的AML患者的临床资料，比较化疗、化疗加靶向药物治疗及allo-HSCT的疗效及影响因素。

结果

34例同时伴FLT3-ITD突变及MLL基因异常的AML患者占同期住院AML患者的2.02%。入院时WBC>30×10⁹/L的患者占63.6%，其中WBC>50×10⁹/L者占39.4%。FAB亚型中以M₅比例最高，占35.3%，染色体核型异常者达63.6%，其中复杂异常占12.1%。34例患者中仅有FLT3-ITD及MLL基因异常（双基因异常）者11例（32.4%），具FLT3及MLL以外的1种及1种以上的基因异常（多基因异常）者23例（67.6%）。34例患者2个疗程完全缓解（CR）率为29.4%，7例（20.6%）化疗≥3个疗程后CR，CR患者的早期复发率为52.9%。WBC>50×10⁹/L以及多基因异常的患者2个疗程CR率较低（7.7%、5.4%），其中具有3种以上基因异常的患者无一例CR。34例患者2年总生存（OS）率为28.8%（95%CI 13.5%~46.0%），2年无病生存（DFS）率为27.1%（95% CI 12.5%~44.0%）。18例仅使用化疗或化疗加靶向药物治疗的患者，17例在2年内死亡，1例放弃治疗后失访。接受allo-HSCT治疗的患者3年OS率为43.4%（95%CI 13.7%~70.4%），3年DFS率为42.7%（95% CI 13.4%~69.7%）。

结论

同时伴FLT3-ITD突变及MLL基因异常的AML患者FAB分型以M₅多见，常伴高白细胞血症、细胞遗传学异常及多基因异常。患者化疗缓解率低，早期复发率高，长期生存率低。高白细胞血症、多基因异常可能是此类患者疗效差的重要原因，allo-HSCT可改善患者的转归。

[Comparison of three different types of donor hematopoietic stem cell transplantation for intermediate and high-risk myelodysplastic syndrome]

目的

比较半相合移植（Haplo-HSCT）、无关供者移植（MUD-HSCT）及同胞相合移植（MSD-HSCT）治疗中高危骨髓增生异常综合征（MDS）的疗效及其预后影响因素。

方法

回顾性分析2001年8月至2015年5月接受异基因造血干细胞移植（allo-HSCT）治疗的167例中高危MDS患者病例资料，比较不同移植方式下患者的预后特征及预后影响因素。

结果

存活患者中位随访60（12~177）个月。5年实际累积无病生存（DFS）率为67.8%（95% CI 60.0%~75.6%），其中MSD-HSCT组为68.0%（95% CI 54.1%~81.9%），MUD-HSCT组为77.4%（95% CI 62.1%~92.7%），Haplo-HSCT组为64.0%（95% CI 52.4%~75.6%），三组比较差异无统计学意义（P=0.632）。单因素分析结果显示移植前病程>12个月者累积DFS率明显低于≤12个月者（P=0.018）。5年累积复发死亡率和移植相关死亡率（TRM）与上面危险因素均无明显相关性。

结论

Haplo-HSCT治疗MDS疗效显著，可以作为重要的替代供者，特别是在缺乏MSD而病情紧急没有时间去等待搜索MUD的情况下，可以主动选择；移植前病程是影响DFS的重要因素。

[Effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion: Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

[Effect of minimal residual disease monitoring by multiparameter flow cytometry pre-conditioning on prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

目的

分析预处理前多参数流式细胞术（MFC）监测的骨髓微小残留病（MRD）对急性髓系白血病（AML）异基因造血干细胞移植（allo-HSCT）预后的影响，探讨MFC监测MRD在AML allo-HSCT预后评估中的价值。

方法

回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者，预处理前骨髓细胞形态学均达第1次完全缓解（CR₁）。采用8色MFC对预处理前骨髓进行MRD检测，任何水平异常均定义为MRD阳性。

结果

①186例AML患者中151例MRD阴性；35例MRD阳性，其中25例MRD<1%，10例MRD为1%~3%。②2年总体无病生存（DFS）率为80.0%（95% CI 68.5%~92.3%）。与MRD阴性组比较，MRD阳性组DFS率低[62.9%（95% CI 50.6%~75.2%）对88.9%（95%CI 76.6%~100.0%），P<0.001]、复发率高[11.4%（95%CI 4.1%~29.0%）对3.3%（95%CI 0.6%~20.9%），P=0.003]、非复发死亡率（NRM）高[25.7%（95%CI 8.1%~43.3%）对7.9%（95%CI 1.3%~26.5%），P=0.001]。继发性AML组DFS率低（P=0.004），NRM高（P=0.003）。③多因素分析结果显示预处理前MFC检测的MRD阳性是DFS[HR=4.565（95%CI 2.918~9.482），P<0.001]、复发[HR=5.854（95% CI 1.538~22.288），P=0.010]及非复发死亡[HR=3.379（95%CI 1.361~8.391），P=0.009]的独立危险因素。

结论

预处理前MFC监测的MRD阳性是影响allo-HSCT治疗CR₁-AML独立危险因素，MFC监测MRD可用于AML allo-HSCT的预后评估。

[Experts consensus on the management of the right heart function in critically ill patients]

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

UV-curable ladder-like diphenylsiloxane-bridged methacryl-phenyl-siloxane for high power LED encapsulation

A UV curable ladder-like diphenylsiloxane-bridged methacryl-phenyl-siloxane (L-MPS) was synthesized from phenyltrichlorosilane, diphenylsilanediol and methacryloxypropyldimethylmethoxysilane via dehydrochlorination precoupling, supramolecular architecture-directed hydrolysis-condensation and end-capping reactions. The L-MPS has a condensation degree of ∼100%, and can be complete crosslinked by UV curing. XRD, TEM and molecular simulation suggest that the ladder-like molecules are close packed with a periodic distance of ca. 1.2 nm. The L-MPS shows transmittance of 98% and a refractive index of ca. 1.61 at 450 nm. The cured L-MPS with a T_d5% value of 465.5 °C showed excellent anti-yellowing and anti-sulfidation properties. The cured L-MPS film and the encapsulated LED samples were compared with those of Dow Corning OE-6630 and OE-7662. It is believed that the dense nano-ladder unit also contributes to the thermal, gas barrier and even optical properties. L-MPS shows promising potential as a high power LED encapsulant and optical coating for use in harsh environments. This work provides an approach to integrate this novel ladder structure with advanced properties.

UV-curable ladder-like polysiloxane was constructed to integrate high RI (1.61/450 nm) with high thermal stability etc. for high power LED encapsulation.

[Comparison of curative effect and prognosis analysis of patients with spinal metastases treated by percutaneous vertebroplasty combined with postoperative radiotherapy and radiotherapy alone]

Objective: To evaluate the efficacy of percutaneous vertebroplasty(PVP) combined with postoperative radiotherapy and radiotherapy alone in the treatment of spinal metastatic tumors and to evaluate the prognostic factors for survival. Methods: From December 2011 to December 2015, according to the choice of treatment, patients in group A(60 cases) were treated with PVP combined with postoperative radiotherapy and those in group B(50 cases) underwent radiotherapy alone, age, sex, primary tumor type , and other basic characteristics were analyzed in both groups in department of orthopedics and radiotherapy department, 307 Hospital of the People's Liberation Army. The pain visual analogue scale(visual analogue scale, VAS), tumors of the spine instability score(the spinal instability neoplastic score and sins), physical status score(Karnofsky performance score and KPS) were used to evaluate pain, spinal stability improvement and physical condition. Kaplan-Meier was used to analyze the survival rates of two groups of patients and the influence of primary tumor types on the survival of patients; Cox proportional hazard model was used to calculate the correlations between survival and visceral metastases, system medical treatment, vertebral number before treatment and physical condition. Results: There was no significant difference in baseline data between the two groups(P>0.05). The VAS in the group A was significantly lower than the scores in the group B at 1 month, 3 months, 6 months, and 12 months after surgery. The SINS score dropped from(7.8±1.2) to(6.3±0.9)(1 month), (6.1±0.8)(3 months) in patients with PVP combined with postoperative radiotherapy(P<0.05), the SINS score of radiotherapy patients simply dropped from(7.6±0.9) to(7.4±0.7)(1 month), (7.3±0.6)(3 months), and there was no statistically significant difference(P=0.12). The survival rates of 6 months, 1 years, and 3 years were similar between two groups(P>0.05). The influence of different types of primary tumors on the survival time of the patients was statistically significant(P<0.05). Multiple analysis showed that the internal organs metastasis, systemic medical treatment, the number of vertebral bodies and the physical condition were the important prognostic factors of the survival in patients with spinal metastases. Conclusion: PVP combined with postoperative radiotherapy for spinal metastases is better than radiotherapy alone in the treatment of relieving pain, maintaining the stability of vertebral body and improving the quality of life of patients. Survival prognosis was similar in two groups. The types of primary tumors, visceral metastasis, systemic medical treatment, the number of vertebral bodies and the physical condition are important prognostic factors in the survival of patients with spinal metastases.

Molecular cloning and characterization of a C-type lectin in yellow catfish Tachysurus fulvidraco

This study represents the first report of a C-type lectin (ctl) in yellow catfish Tachysurus fulvidraco. The complete sequence of ctl complementary (c)DNA consisted of 685 nucleotides. The open reading frame potentially encoded a protein of 177 amino acids with a calculated molecular mass of c.y 20.204 kDa. The deduced amino-acid sequence contained a signal peptide and a single carbohydrate recognition domain with four cysteine residues and GlnProAsp (QPD) and TrpAsnAsp (WND) motifs. Ctl showed the highest identity (56.0%) to the predicted lactose binding lectin from channel catfish Ictalurus punctatus. Quantitative real-time (qrt)-PCR analysis showed that ctl messenger (m)RNA was constitutively expressed in all examined tissues in normal fish, with high expression in trunk kidney and head kidney, which was increased following Aeromonas hydrophila challenge in a duration-dependent manner. Purified recombinant Ctl (rCtl) from Escherichia coli BL21 was able to bind and agglutinate Gram-positive and Gram-negative bacteria in a calcium-dependent manner. These results suggested that Ctl might be a C-type lectin of T. fulvidraco involved in innate immune responses as receptors (PRR).

Genetic characterization of cysteine-rich type-b avenin-like protein coding genes in common wheat

The wheat avenin-like proteins (ALP) are considered atypical gluten constituents and have shown positive effects on dough properties revealed using a transgenic approach. However, to date the genetic architecture of ALP genes is unclear, making it impossible to be utilized in wheat breeding. In the current study, three genes of type-b ALPs were identified and mapped to chromosomes 7AS, 4AL and 7DS. The coding gene sequence of both TaALP-7A and TaALP-7D was 855 bp long, encoding two identical homologous 284 amino acid long proteins. TaALP-4A was 858 bp long, encoding a 285 amino acid protein variant. Three alleles were identified for TaALP-7A and four for TaALP-4A. TaALP-7A alleles were of two types: type-1, which includes TaALP-7A1 andTaALP-7A2, encodes mature proteins, while type-2, represented byTaALP-7A3, contains a stop codon in the coding region and thus does not encode a mature protein. Dough quality testing of 102 wheat cultivars established a highly significant association of the type-1 TaALP-7A allele with better wheat processing quality. This allelic effects were confirmed among a range of commercial wheat cultivars. Our research makes the ALP be the first of such genetic variation source that can be readily utilized in wheat breeding.

Identification of Ca(2+)-binding residues of a protein from its primary sequence

Calcium is one of the most abundant minerals in the human body, playing a critical role in many cellular activities by interacting with different calcium ion (Ca(2+))-binding proteins. Therefore, the correct identification of Ca(2+)-binding residues is essential for protein functional research. In this study, a new method was developed to predict Ca2+-binding residues from the primary sequence without using three-dimensional information. Through statistical analysis, four kinds of feature parameters were extracted from amino acid sequences: the increment of diversity values of amino acid composition, the matrix scoring values of position conservation, the autocross covariance of physicochemical properties, and the center motif. These features served as input for a support vector machine to predict Ca(2+)-binding residues. This method was tested on four well-established datasets using a five-fold cross-validation. The accuracies and Matthews correlation coefficients were 75.9% and 0.53 (dataset 1), 79.2% and 0.58 (dataset 2), 77.4% and 0.55 (dataset 3), and 79.1% and 0.58 (dataset 4). Comparative results show that the developed method outperforms previous methods. Based on this study, a web server was developed for predicting Ca(2+)-binding residues from any protein sequence, being publically available at http://202.207.29.245/.

Effectiveness of olfactory ensheathing cell transplantation for treatment of spinal cord injury

The aim of this study was to determine the effectiveness and safety of transplantation of olfactory ensheathing cells for functional repair of the spinal cord. An olfactory bulb was obtained from a 4- to 5-month-old aborted fetus, and it was digested into single olfactory ensheathing cells and then cultured and purified for 1 to 2 weeks. Under general anesthesia, these single-cell suspensions of olfactory ensheathing cells were injected into the corresponding spinal injury site with 0.45-mm-diameter injections. The American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate spinal function. A total of 15 patients (12 men, 3 women; age range, 18-56 years; mean age, 40) were admitted for obsolete spinal injuries. Spinal functions of the 15 patients were observed and followed postoperatively for a period ranging from 2 weeks to 1 month. All the 15 patients exhibited improvements in spinal function, and the improvement tendencies continued. Twelve patients had obvious spinal function improvement, and three had slight improvement according to the ASIA scale, with an obvious difference between preoperation and postoperation measures (P < 0.05). No fevers, infections, functional deteriorations, or deaths were seen. Thus, transplantation of olfactory ensheathing cells promoted spinal and neurofunctional recovery in patients with malignant spinal injuries, and this therapeutic method was safe.

Solitary intracranial Rosai-Dorfman disease: case report and literature review

Rosai-Dorfman disease is a well-established autoimmune histioproliferative disorder, and solitary central nervous system involvement is rare. A 35-year-old man presented with headache and transient blurred vision of 4 months' duration and weakness of the left extremities for 1 month. He had left temporal hemianopsia, a right nasal visual field defect of the upper medial quadrant and decreased muscle strength of the left extremities. Magnetic resonance imaging (MRI) showed a contrastenhancing tentorium-based lesion in the right trigone, intruding into the right lateral ventricle. The lesion was totally resected. Rosai-Dorfman disease was confirmed pathologically by an inflammatory infiltrate in the absence of an infectious agent, emperipolesis and positive S100 staining. From a review of the literature on Rosai-Dorfman disease in the central nervous system it is concluded that follow-up MRI should be performed in order to detect possible recurrence and that this rare entity should be considered in the differential diagnosis of intracranial lesions.

Contribution of working memory components to the performance of the tower of hanoi in schizophrenia

OBJECTIVES

To examine the underlying structure of neuropsychological tests involving working memory components and those not involving working memory components that contribute to the performance of the Tower of Hanoi task in schizophrenic patients.

PARTICIPANTS AND METHODS

A total of 90 patients with residual schizophrenia received a comprehensive cognitive assessment. Working memory was assessed with Letter-Number Span and Visual Patterns tests. Executive function was assessed by the Tower of Hanoi task. Stepwise multiple linear regressions were performed including age, education, duration of illness, and all cognitive functions.

RESULTS

Principal component analysis was conducted and yielded a 4-factor solution: auditory working memory, visual working memory, verbal working memory, and verbal fluency. Subsequent stepwise regression indicated that only visual working memory components and auditory working memory components were retained in the final model accounting, which explained 23.5% of the variance.

CONCLUSIONS

These findings emphasise the importance of memory components, particularly those involving visual- and auditory-based working memory, when conceptualising the performance of the Tower of Hanoi task in residual schizophrenia.

Decolorization of C.I. Reactive Yellow 84 in aqueous solution by electrocoagulation enhanced with ozone: influence of operating conditions

We studied the use of a combination of electrocoagulation (EC) and ozonation for the decolorization of the azo dye, C.I. Reactive Yellow 84 (RY84). The effects of initial dye concentration, initial pH, current density, salt concentration, ozone flow rate, temperature and interelectrode distance on the decolorization of RY84 were investigated. The results showed that a synergistic effect was achieved by combining EC with ozone for the decolorization of RY84. Under the experimental conditions, the decolorization rate increased with an increase in current density. However, the decolorization rate decreased with an increase in initial dye concentration and salt concentration. The interelectrode distance did not substantially affect the decolorization rate. Other operating parameters such as initial pH, ozone flow rate and temperature had both positive and negative effects. Over 97% of the color decay was achieved within 10 min reaction time under reasonable experimental conditions. When the decolorization of RY84 was complete, the efficiency of removal of total organic carbon (TOC) was more than 85%.

The performance and application of fly ash modified by PDMDAAC

Fly ash modification by polydimethydiallylammonium chloride (PDMDAAC) in laboratory scale was explored in this work and the adsorption performance of modified fly ash and its application in dyeing wastewater treatment were also studied. The key factors (concentration and temperature) for PDMDAAC to affect the adsorption properties of fly ash (FA) were revealed using the orthogonal test with four factors. The results indicated that the adsorption magnitude of fly ash to PDMDAAC increased due to its favorable specific surface causing the change of the surface charge nature. Hence, adsorption performance of modified fly ash on organic molecules and its ion exchange capacity are strengthened. The maximum color removal efficiency was obtained as 88.2% by modified fly ash with 2.0 g/100 mL dosage in dyeing wastewater, which is much higher than 12.5% color removal efficiency by raw fly ash with the same dosage. And, the used modified fly ash could be used for cement production as additive agent. The intensity of cement produced with 15% the modified fly ash in weight reached the Chinese Cement Standard (GB/T17671-1999), blazing a promising novel way in fly ash utilization.

Vasopressin induces depolarization and state-dependent firing patterns in rat thalamic paraventricular nucleus neurons in vitro

The thalamic midline paraventricular nucleus (PVT) is prominently innervated by vasopressin-immunoreactive neurons from the suprachiasmatic nucleus (SCN), site of the brain's biological clock. Using patch-clamp recordings in slice preparations taken from Wistar rats during the subjective day, we examined 90 PVT neurons for responses to bath-applied AVP (0.5–2 μM; 1–3 min). In current clamp at resting membrane potentials (−65 ± 1 mV), PVT neurons displayed low-threshold spikes (LTSs) and burst firing patterns. In 50% of cells tested, AVP induced a slowly rising, prolonged membrane depolarization and tonic firing, returning to burst firing upon recovery. AVP modulated hyperpolarization-activated LTSs by decreasing the time to the initial sodium spike at the onset of LTS, also increasing the duration of the afterdepolarization. Responses were blockable with a V1a receptor antagonist (Manning compound). Under voltage clamp, AVP induced a TTX-resistant, slowly rising, and prolonged (∼15 min) inward current (<40 pA). Current-voltage relationship ( I-V) analyses of the AVP responses revealed a decrease in membrane conductance to 73.1 ± 6.2% of control, with net AVP current reversing at −106 ± 4 mV, and decreased inward rectification at negative potentials. These observations are consistent with an AVP-induced closure of an inwardly rectifying potassium conductance. On the basis of these in vitro observations, we suggest that the SCN vasopressinergic innervation of PVT is excitatory in nature, possibly releasing AVP with circadian rhythmicity and contributing to state-dependent firing patterns in PVT neurons over the sleep-wake cycle.

[Determination of impurity elements in high purity gold using ICP-AES method after matrix extraction and separation]

A system for separation of trace impurity elements (Cd, Cr, Cu, Fe, Mn, Ni, Pb, Pt) from large amounts of matrix element gold is proposed in this paper. It is based on the MIBK extraction. The effect of pH to the extraction is studied, the final measuring solution is effectively 10% hydrochloric acid. The recovery of elements is between 93.3%-100% under this acidity after the first extraction. Content of trace elements of 99.99% gold is in the range 0.1-20 micrograms.g-1.

The exogenous wild-type p14ARF gene induces growth arrest and promotes radiosensitivity in human lung cancer cell lines

The cyclin-dependent kinase inhibitor p16INK4a encoded by the INK4A/CDKN2A/MTS1 gene is a frequent target of 9p21 inactivation in human lung cancers. The p14ARF transcript, which is an alternative spliced form of this locus, is also altered or deleted in a proportion of human lung cancers and has been shown to inhibit cell cycle progression as an endogenous cellular regulator of the p53 protein, raising the possibility that it might constitute an additional lung tumor suppressor gene at the 9p21 locus. To test the candidacy of p14ARF as a lung cancer suppressor and assess the role it plays in radiosensitivity, we transfected the wild-type p14ARF gene into four cell lines which had various endogenous gene backgrounds of INK4A-/p53+/RB+ (A549 and H460), INK4A+/p53+/RB- (H446) as well as p14ARF+/p53-/RB+ (Calu-1). We found that transfection of p14ARF is related to an obvious growth inhibition in all wtp53 cell lines, regardless of INK4A/ARF and RB status. Although it has been shown that p53-induced G1 checkpoint in response to DNA damage by ionizing radiation is p14ARF-independent, we found the radiosensitivity of two p14ARF-deficient cell lines was increased after p14ARF gene transfer. The results indicated that cell cycle redistribution after acquiring the exogenous gene might be the main explanation for the enhanced sensitization. An increased radiation-induced apoptotic proportion in one cell line also suggested a fortified p53 function that might be triggered by the restored p14ARF protein.

Dynamics of environmental supplementation of iodine: four years' experience of iodination of irrigation water in Hotien, Xinjiang, China

Hotien prefecture, Xinjiang Province, China, in the Taklamakan Desert, is an area of severe iodine deficiency. Because usual methods of iodine supplementation failed here, we began supplementation in 1992 with potassium iodate, which was added to irrigation water (Lancet 1994; 334:107-110). We report 4 y experience with this method in 3 townships that contained a total treated population of 37,000. Potassium iodate was dripped into irrigation water (to a concentration 10-80 microg/l) during a 2- to 4-wk period. During the 3 y that followed, no further supplementation was made, and iodine concentrations increased several fold in crops and plants, sheep and chicken thyroid glands, and meat and in urine of children 2-6 y of age and of women who were of childbearing age. Infant mortality decreased 50%, and sheep production increased 43%. Iodine repletion of soil through irrigation water is an effective and cost-efficient way of providing iodine in appropriate situations.

Effect on infant mortality of iodination of irrigation water in a severely iodine-deficient area of China

BACKGROUND

Hotien county in Xinjiang province, China, is an area of severe iodine deficiency and has a high infantmortality rate. We investigated whether iodine replacement through iodination of the irrigation water would decrease infant mortality.

METHODS

We added potassium iodate to irrigation water over a 2 to 4 week period beginning in 1992 in certain areas of three townships (Tusala, Long Ru, and Bakechi). Logistic regression analysis was used to compare the odds ratios for infant and neonatal mortality in treated and intreated areas.

FINDINGS

The median urinary iodine concentration significantly increased in women of child-bearing age from < 10 micrograms/L to 55 micrograms/L. Infant-mortality rates decreased in the treated areas of Long Ru (mean [SD] 58.2 [4.4] per 1000 births to 28.7 [7.1] per 1000 births), Tusala (47.4 [12.4] per 1000 births to 19.1 [1.5] per 1000 births), and Bakechi (106.2 [9.5] per 1000 births to 57.3 [7.3] per 1000 births). Similar results were also seen for neonatal mortality. On regression analysis iodine treatment and time were significant independent predictors of infant mortality.

INTERPRETATION

Iodine supplementation of irrigation water in areas of severe iodine deficiency decreases neonatal and infant mortality. Iodine replacement has probably been an important factor in the national decrease in infant mortality in China.

Timing of vulnerability of the brain to iodine deficiency in endemic cretinism

BACKGROUND

Endemic cretinism, caused by severe iodine deficiency during pregnancy, is the world's most common preventable cause of mental retardation. It can be prevented by iodine treatment before conception, but whether it can be prevented or ameliorated by treatment during pregnancy or after delivery is not known.

METHODS

In a severely iodine-deficient area of the Xinjiang region of China, we systematically administered iodine to groups of children from birth to three years of age (n = 689) and women at each trimester of pregnancy (n = 295); we then followed the treated children and the babies born to the treated women for two years. We used three independent measures of neural development: the results of the neurologic examination, the head circumference (which correlates with brain weight in the first postnatal year), and indexes of cognitive and motor development. Untreated children one to three years of age, who were studied when first seen, served as control subjects.

RESULTS

The prevalence of moderate or severe neurologic abnormalities among the 120 infants whose mothers received iodine in the first or second trimester was 2 percent, as compared with 9 percent among the 752 infants who received iodine during the third trimester (through the treatment of their mothers) or after birth (P = 0.008). The prevalence of microcephaly (defined as a head circumference more than 3 SD below U.S. norms) decreased from 27 percent in the untreated children to 11 percent in the treated children (P = 0.006), and the mean (+/- SD) developmental quotient at two years of age increased (90 +/- 14, vs. 75 +/- 18 in the untreated children; P < 0.001). Treatment in the third trimester of pregnancy or after delivery did not improve neurologic status, but head growth and developmental quotients improved slightly. Treatment during the first trimester, which was technically problematic, improved the neurologic outcome.

CONCLUSIONS

Up to the end of the second trimester, iodine treatment protects the fetal brain from the effects of iodine deficiency. Treatment later in pregnancy or after delivery may improve brain growth and developmental achievement slightly, but it does not improve neurologic status.

Iodination of irrigation water as a method of supplying iodine to a severely iodine-deficient population in Xinjiang, China

Severe iodine deficiency still occurs in many countries, and causes cretinism and mental impairment. In southern Xinjiang province, China, after usual methods of iodine supplementation had failed, we iodinated irrigation water to increase iodine in soil, crops, animals, and human beings. 5% potassium iodate solution, dripped into an irrigation canal for 12 or 24 days, increased soil iodine 3-fold, and crop and animal iodine 2-fold. Median urinary iodine excretion in children increased from 18 to 49 micrograms/L (two groups of similar age). The cost for iodine was US $0.05 per person per year. Soil iodine remained stable over one winter, and dripping of iodine during the second year (US $0.12 per person per year) resulted in a further 4-fold increase in soil iodine and a 1.8-fold increase in iodine in crops. We conclude that iodination of irrigation water is an advantageous and cost-effective method of supplying iodine in southern Xinjiang, and may be useful in other areas dependent on irrigation.

Immunohistochemical study of hepatitis E virus antigen in liver tissues from patients with hepatitis E

Hepatitis E virus antigen (HEVAg) has been identified in liver tissue of 6 out of 14 patients with hepatitis E using anti-HEV-IgG-horseradish peroxidase (HRP) and direct immunoperoxidase staining methods. HEVAg was found only in the cytoplasm of hepatocytes, but nor in the nuclei. The HEVAg positive hepatocytes were scattered singly, but in a few parts, where the liver damage was severe, the HEVAg positive cells were quite concentrated. We also observed the invasion of lymphocytes into the HEVAg positive hepatocytes. These phenomena suggest that the liver damage may be related to the immune reaction. No HEVAg was found in the liver tissues of stillborn fetus and neonate from woman patients with hepatitis E.

Epidemiology of hepatitis E in China

A total of 9 hepatitis E epidemics have been documented in China since 1982. Five of them were waterborne and four foodborne, and they occurred in 6 of 30 provinces or autonomous regions in the country. The disease most frequently affects young adults, with fewer cases in children and the elderly. A relative male excess of cases has been observed. However, the fatality rate in female patients with hepatitis E is significantly higher than in males. The disease has a distinctive autumn seasonality in endemic areas. A peak of fecal excretion of hepatitis E virus is found at the late incubation period and early acute phase. The incubation period of the disease ranges from 15 to 75 days, with a mean of 36 days. A randomized double-blind and controlled study showed that human immune serum globulin had no prophylactic effects on hepatitis E.

Points that merit consideration in the diagnosis of retinoblastoma

According to the clinical appearances and the characteristics of the onset of 86 Rb cases, some points in the diagnosis merit consideration: 1) Since the average symptomatic age was 21.75 months and the mean diagnostic age was 24.32 months, children under 3 years with leukocoria should be carefully examined, while adult Rb should not be neglected. 2) The primary symptom of Rb is mostly leukocoria, but Rb eyes without any symptoms or leukocoria (26 out of 105 eyes in our groups) might also be encountered. 3) 4 out of the 86 cases were retinocytoma which is supposed to be a type of Rb degeneration or benign Rb. 4) Attention should be paid to abnormalities and second primary tumors in Rb patients. 5) The pedigree investigations, twin method and laboratory studies in Rb such as chromosome analysis, EsD, LDH measurement and RFLP technique are useful in the prenatal diagnosis, early diagnosis and the diagnosis of the carriers.