Treatment outcomes amongst older people with HIV infection receiving antiretroviral therapy

OBJECTIVES

There is conflicting data regarding the response of older people with HIV (PWH) to antiretroviral therapy (ART). The objective of this study was to evaluate the long-term immunological and virological responses, changes in regimen, and adverse drug reactions (ADRs) in older participants (50+ years) compared with younger (18-34 years) and middle-aged (35-49 years) PWH.

METHODS

A retrospective review of medical records was conducted on 1622 participants who received ART in Yunnan Province, China, from 2010 to 2019. The study compared CD4+ T-cell counts, CD4+/CD8+ ratio, and relative numbers between different groups using the Kruskal-Wallis test. Cox proportional hazards regression models were used to identify variables associated with the occurrence of immune reconstitution insufficiency. The rates of immune reconstitution, incidence of ADRs, and rates of treatment change were analyzed using the chi-squared test or Fisher's exact test.

RESULTS

Over 95% achieved viral load 200 copies/ml or less, with no age-related difference. However, older participants exhibited significantly lower CD4+ T-cell counts and CD4+/CD8+ recovery post-ART (P < 0.001), with only 32.21% achieving immune reconstitution (compared with young: 52.16%, middle-aged: 39.29%, P < 0.001) at the end of follow-up. Middle-aged and elderly participants changed ART regimens more because of ADRs, especially bone marrow suppression and renal dysfunction.

CONCLUSION

Although the virological response was consistent across age groups, older individuals showed poorer immune responses and higher susceptibility to side effects. This underscores the need for tailored interventions and comprehensive management for older patients with HIV.

Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

SARS-CoV-2 breakthrough infections following inactivated vaccine vaccination induce few neutralizing antibodies against the currently emerging Omicron XBB variants

•Inactivated vaccine breakthrough infection with ancestral variants induced nearly undetectable nAbs against XBB variants. •Inactivated vaccine breakthrough infection with Omicron BA.1 or BA.5 evoked very weak nAbs against XBB variants. •BA.5 infection induced higher nAbs against XBB variants than BA.1 infection.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

Using the Molecular Transmission Networks to Analyze the Epidemic Characteristics of HIV-1 CRF08_BC in Kunming, Yunnan

HIV-1CRF08_BC is the most prevalent epidemic subtype among heterosexual (HET) and intravenous drug users (IDUs) in Kunming, Yunnan. Using the pol region of gene sequences derived from molecular epidemiological surveys, we developed a molecular transmission network for the purpose of analyzing its epidemiological characteristics, assessing its epidemiological trends, identifying its potential transmission relationships, and developing targeted interventions. HyPhy 2.2.4 was used to calculate pairwise genetic distances between sequences; GraphPad-Prism 8.0 was employed to determine the standard genetic distance; and Cytoscope 3.7.2 was applied to visualize the network. We used the network analysis tools to investigate network characteristics and the Molecular Complex Detection (MCODE) tool to observe the growth of the network. We utilized a logistic regression model to examine the factors influencing clustering and a zero-inflated Poisson model to investigate the factors influencing potential transmission links. At the standard genetic distance threshold of 0.008, 406 out of 858 study participants were clustered in 132 dissemination networks with a total network linkage of 868, and the number of links per sequence ranged from 1 to 19. The MCODE analysis identified three significant modular clusters in the networks, with network scores ranging from 4.9 to 7. In models of logistic regression, HET, middle-aged and elderly individuals, and residents of northern and southeastern Kunming were more likely to enter the transmission network. According to the zero-inflated Poisson model, age, transmission category, sampling year, marital status, and CD4+ T level had a significant effect on the size of links. The molecular clusters in Kunming's molecular transmission network are specific and aggregate to a certain extent. HIV-1 molecular network analysis provided information on local transmission characteristics, and these findings helped to determine the priority of transmission-reduction interventions.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.

Significant neutralizing escapes of Omicron and its sublineages in SARS-CoV-2-infected individuals vaccinated with inactivated vaccines

In China, most SARS-CoV-2-infected individuals had been vaccinated with inactivated vaccines. However, little is known about their immune resistances to the previous variants of concerns (VOCs) and the current Omicron sublineages. Here, we collected convalescent serum samples from SARS-CoV-2-infected individuals during the ancestral, Delta, and Omicron BA.1 waves, and evaluated their cross-neutralizing antibodies (nAbs) against the previous VOCs and the current Omicron sublineages using VSV-based pseudoviruses. In the convalescents who had been unvaccinated and vaccinated with two doses of inactivated vaccines, we found infections from either the ancestral or the Delta strain elicited moderate cross-nAbs to previous VOCs, but very few cross-nAbs to the Omicron sublineages, including BA.1, BA.2, BA.3, and BA.4/5. The individuals who had been vaccinated with two doses of inactivated vaccines before Omicron BA.1 infection had moderate nAbs to Omicron BA.1, but weak cross-nAbs to the other Omicron sublineages. While three doses of inactivated vaccines followed Omicron BA.1 infection induced elevated and still weak cross-nAbs to other Omicron sublineages. Our results indicate that the Omicron sublineages show significant immune escape in the previously SARS-CoV-2-infected individuals and thus highlights the importance of vaccine boosters in this population.

A variant-proof SARS-CoV-2 vaccine targeting HR1 domain in S2 subunit of spike protein

The emerging SARS-CoV-2 variants, commonly with many mutations in S1 subunit of spike (S) protein are weakening the efficacy of the current vaccines and antibody therapeutics. This calls for the variant-proof SARS-CoV-2 vaccines targeting the more conserved regions in S protein. Here, we designed a recombinant subunit vaccine, HR121, targeting the conserved HR1 domain in S2 subunit of S protein. HR121 consisting of HR1-linker1-HR2-linker2-HR1, is conformationally and functionally analogous to the HR1 domain present in the fusion intermediate conformation of S2 subunit. Immunization with HR121 in rabbits and rhesus macaques elicited highly potent cross-neutralizing antibodies against SARS-CoV-2 and its variants, particularly Omicron sublineages. Vaccination with HR121 achieved near-full protections against prototype SARS-CoV-2 infection in hACE2 transgenic mice, Syrian golden hamsters and rhesus macaques, and effective protection against Omicron BA.2 infection in Syrian golden hamsters. This study demonstrates that HR121 is a promising candidate of variant-proof SARS-CoV-2 vaccine with a novel conserved target in the S2 subunit for application against current and future SARS-CoV-2 variants.

[A case report of the first and second branchial arch syndrome with torticollis]

A 54-month-old female patient presented to the department of ophthalmology with abnormal head posture and facial asymmetry for two years. The patient's facial development was asymmetrical, with the middle 1/3 of the left side shorter than the right side. The left ear is less malformed than the right. There was no obvious abnormality in corneal light reflex and eye movement. Head tilt test ( -). So, paralysis of the superior oblique muscle was excluded. In consultation with the department of maxillofacial surgery, the patient was confirmed as the first and second branchial arch syndrome and torticollis.

Characteristics of replication and pathogenicity of SARS-CoV-2 Alpha and Delta isolates

The continuously arising of SARS-CoV-2 variants has been posting a great threat to public health safety globally, from B.1.17 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.617.2 (Delta) to B.1.1.529 (Omicron). The emerging or re-emerging of the SARS-CoV-2 variants of concern is calling for the constant monitoring of their epidemics, pathogenicity and immune escape. In this study, we aimed to characterize replication and pathogenicity of the Alpha and Delta variant strains isolated from patients infected in Laos. The amino acid mutations within the spike fragment of the isolates were determined via sequencing. The more efficient replication of the Alpha and Delta isolates was documented than the prototyped SARS-CoV-2 in Calu-3 and Caco-2 ​cells, while such features were not observed in Huh-7, Vero E6 and HPA-3 ​cells. We utilized both animal models of human ACE2 (hACE2) transgenic mice and hamsters to evaluate the pathogenesis of the isolates. The Alpha and Delta can replicate well in multiple organs and cause moderate to severe lung pathology in these animals. In conclusion, the spike protein of the isolated Alpha and Delta variant strains was characterized, and the replication and pathogenicity of the strains in the cells and animal models were also evaluated.

High prevalence of sexually transmitted infections and risk factors among HIV-positive individuals in Yunnan, China

Background

Yunnan has the highest rates of HIV in China. Other treatable sexually transmitted infections (STIs) are associated with accelerated HIV transmission and poor ART outcomes, but are only diagnosed by syndromic algorithms.

Methods

We recruited 406 HIV-positive participants for a cross-sectional study (204 ART-naive and 202 receiving ART). Blood samples and first-voided urine samples were collected. Real-time polymerase chain reaction methods were used for diagnosing Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and Mycoplasma genitalium (MG). Syphilis and herpes simplex virus type 2 (HSV-2) tests were also performed.

Results

Among the 406 participants, the overall prevalence of STIs was 47.0% and 45.1% in ART-naive individuals and 49.0% in individuals receiving ART, respectively. The testing frequencies were 11.6% (11.8% vs. 11.4%), 33.2% (29.4% vs. 37.1%), 3.2% (3.4% vs. 3.0%), 2.0% (3.4% vs. 0.5%) and 4.7% (6.4% vs. 3.0%) for active syphilis, HSV-2, CT, NG and MG, respectively. The percentage of multiple infections in both groups was 10.8% (22/204) in ART-naive participants and 9.9% (20/202) in participants receiving ART. Female sex, an age between 18 and 35 years, ever injecting drugs, homosexual or bisexual status, HIV/HBV coinfection, and not receiving ART were identified as risk factors. Self-reported asymptomatic patients were not eliminated from having a laboratory-diagnosed STI.

Conclusions

The STI prevalence was 47.0% (45.1% vs. 49.0%), and HSV-2, syphilis and MG were the most common STIs in HIV-infected individuals. We found a high prevalence (6.4%) of MG in ART-naive individuals. HIV-positive individuals tend to neglect or hide their genital tract discomfort; thus, we suggest strengthening STI joint screening and treatment services among HIV-infected individuals regardless of whether they describe genital tract discomfort.

Solid-State NMR Studies of the Succinate-Acetate Permease from Citrobacter Koseri in Liposomes and Native Nanodiscs

The succinate-acetate permease (SatP) is an anion channel with six transmembrane domains. It forms different oligomers, especially hexamers in the detergent as well as in the membrane. Solid-state NMR studies of SatP were carried out successfully on SatP complexes by reconstructing the protein into liposomes or retaining the protein in the native membrane of E. coli., where it was expressed. The comparison of ¹³C-¹³C 2D correlation spectra between the two samples showed great similarity, opening the possibility to further study the acetate transport mechanism of SatP in its native membrane environment. Solid-state NMR studies also revealed small chemical shift differences of SatP in the two different membrane systems, indicating the importance of the lipid environment in determining the membrane protein structures and dynamics. Combining different 2D SSNMR spectra, chemical shift assignments were made on some sites, consistent with the helical structures in the transmembrane domains. In the end, we pointed out the limitation in the sensitivity for membrane proteins with such a size, and also indicated possible ways to overcome it.

Lower respiratory tract samples are reliable for severe acute respiratory syndrome coronavirus 2 nucleic acid diagnosis and animal model study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) continue to impact countries worldwide. At present, inadequate diagnosis and unreliable evaluation systems hinder the implementation and development of effective prevention and treatment strategies. Here, we conducted a horizontal and longitudinal study comparing the detection rates of SARS-CoV-2 nucleic acid in different types of samples collected from COVID-19 patients and SARS-CoV-2-infected monkeys. We also detected anti-SARS-CoV-2 antibodies in the above clinical and animal model samples to identify a reliable approach for the accurate diagnosis of SARS-CoV-2 infection. Results showed that, regardless of clinical symptoms, the highest detection levels of viral nucleic acid were found in sputum and tracheal brush samples, resulting in a high and stable diagnosis rate. Anti-SARS-CoV-2 immunoglobulin M (IgM) and G (IgG) antibodies were not detected in 6.90% of COVID-19 patients. Furthermore, integration of nucleic acid detection results from the various sample types did not improve the diagnosis rate. Moreover, dynamic changes in SARS-CoV-2 viral load were more obvious in sputum and tracheal brushes than in nasal and throat swabs. Thus, SARS-CoV-2 nucleic acid detection in sputum and tracheal brushes was the least affected by infection route, disease progression, and individual differences. Therefore, SARS-CoV-2 nucleic acid detection using lower respiratory tract samples alone is reliable for COVID-19 diagnosis and study.

The amyloid structure of mouse RIPK3 (receptor interacting protein kinase 3) in cell necroptosis

RIPK3 amyloid complex plays crucial roles during TNF-induced necroptosis and in response to immune defense in both human and mouse. Here, we have structurally characterized mouse RIPK3 homogeneous self-assembly using solid-state NMR, revealing a well-ordered N-shaped amyloid core structure featured with 3 parallel in-register β-sheets. This structure differs from previously published human RIPK1/RIPK3 hetero-amyloid complex structure, which adopted a serpentine fold. Functional studies indicate both RIPK1-RIPK3 binding and RIPK3 amyloid formation are essential but not sufficient for TNF-induced necroptosis. The structural integrity of RIPK3 fibril with three β-strands is necessary for signaling. Molecular dynamics simulations with a mouse RIPK1/RIPK3 model indicate that the hetero-amyloid is less stable when adopting the RIPK3 fibril conformation, suggesting a structural transformation of RIPK3 from RIPK1-RIPK3 binding to RIPK3 amyloid formation. This structural transformation would provide the missing link connecting RIPK1-RIPK3 binding to RIPK3 homo-oligomer formation in the signal transduction.

Receptor Interacting Protein Kinase 3 (RIPK3) has a key role in TNF-induced necroptosis. Here, the authors combine solid state NMR measurements, MD simulations and cell based assays to characterize mouse RIPK3 and they present the structure of the RIPK3 amyloid core.

Longitudinal transcriptome analyses show robust T cell immunity during recovery from COVID-19

Understanding the processes of immune regulation in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for improving treatment. Here, we performed longitudinal whole-transcriptome RNA sequencing on peripheral blood mononuclear cell (PBMC) samples from 18 patients with coronavirus disease 2019 (COVID-19) during their treatment, convalescence, and rehabilitation. After analyzing the regulatory networks of differentially expressed messenger RNAs (mRNAs), microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) between the different clinical stages, we found that humoral immunity and type I interferon response were significantly downregulated, while robust T-cell activation and differentiation at the whole transcriptome level constituted the main events that occurred during recovery from COVID-19. The formation of this T cell immune response might be driven by the activation of activating protein-1 (AP-1) related signaling pathway and was weakly affected by other clinical features. These findings uncovered the dynamic pattern of immune responses and indicated the key role of T cell immunity in the creation of immune protection against this disease.

[Combined anluohuaxianwan and entecavir treatment significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection]

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman's rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion: Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

Amyloid structure of high-order assembly of Leucine-rich amelogenin revealed by solid-state NMR

High-order assemblies of amelogenin, the major protein in enamel protein matrix, are believed to act as the template for enamel mineral formation. The Leucine-rich amelogenin (LRAP) is a natural splice-variant of amelogenin, a functional protein in vivo, containing conserved domains of amelogenin. In this work, we showed LRAP aggregates hierarchically into assemblies with various sizes including scattered beads, beads-on-a-string and gel-like precipitations in the presence of both calcium and phosphate ions. Solid-state NMR combined with X-ray diffraction and microscopic techniques, was applied to give a picture of LRAP self-assemblies at the atomic level. Our results, for the first time, confirmed LRAP assemblies with different sizes all contained a consistent rigid segment with β-sheet secondary structure (residues 12-27) and the β-sheet segment would further assemble into amyloid-like structures.

[Determination of biomarkers in exhaled breath condensation of acute exacerbation of chronic obstructive pulmonary disease and its clinical implications]

Objective: To analyse the changes and clinical implication of biomarkers in exhaled breath condensates (EBC) of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before and after treatment. Methods: 20 patients with AECOPD were enrolled, including 15 males and 5 females. The average age was 71±10, ranging from 50-85. The concentrations of Leukotriene B4 (LTB4) and Interleukin 6 (IL-6) from EBC were assayed by ELISA kit before and after treatment. Serum inflammatory indexes, pulmonary function test and quality of life (CAT) were observed at the same time, the relationship between EBC biomarkers and clinical markers were investigated. Results: The concentration of LTB4 and IL-6 of AECOPD patients with treated [(20.79±2.27)ng/L, (0.39±0.18)ng/L, respectively], were significantly lower compared with that before treatment [(22.64±3.01)ng/L, (0.60±0.36)ng/L, P<0.05, respectively]. The percentage of neutrophils, CRP were decreased after treatment. But no correlation was found between LTB4, IL-6 and serum inflammatory indexes, pulmonary function or CAT(P>0.05). Conclusion: The concentration of biomarkers (LTB4, IL-6) in EBC of AECOPD patients can dynamically monitor the inflammation in respiratory tract and evaluate the therapeutic effect.

Solid-State Structure of Abeta (Aβ) in Alzheimer's Disease

Alzheimer's disease (AD) has become the most common neurodegenerative disease. The deposition of amyloid fibrils in the brain is one of the characteristics of AD. The fibrils are composed of amyloid-β peptide (Aβ). Aβ is produced through a series event of protease cleavage of a transmembrane protein called β-amyloid precursor protein (APP) which is commonly expressed in the brain. The production of Aβ and its propensity to aggregation to form oligomers and fibrils are believed to initiate a sequence of events that lead to AD dementia. The production of Aβ is influenced by the transmembrane domain (TM) structure of APP. The structure variety of different Aβ assemblies including oligomers and fibrils may result in different neurotoxicity to the brain. Therefore, enormous work has been carried out to study the structure of APP TM and various Aβ assemblies. Solid-state NMR has advantages in studying immobile protein structures with large molecular weight. In this review, solid-state NMR structure of APP TM and different Aβ assemblies will be discussed, especially various Aβ amyloid fibril structures. This structural information greatly enhanced our understanding in AD, providing fundamental knowledge that will help in finding a treatment for AD.

Molecular cloning and expression vector construction of bovine TRIM28

The bovine TRIM28 gene was amplified from ovary tissue by using RT-PCR. The TRIM28 gene was inserted into the eukaryotic expression vector pIRES2-EGFP and transfected into bovine fetal fibroblasts by using Lipofectamine 3000. TRIM28 mRNA and protein were detected by fluorescence microscope and western blotting. The results showed that the full length of TRIM28 was cloned and pIRES2-EGFP-TRIM28 was constructed successfully. EGFP expression was observed, and the pIRES2-EGFP-TRIM28 transfected group expressed more TRIM28 protein than that by the pIRES2-EGFP group. The TIMR28 gene has been successfully transferred into bovine fetal fibroblasts.

[Investigation on infection sources of schistosomiasis in mountainous regions, Nanjian County, Yunnan Province]

OBJECTIVE

To understand the types of schisotsome infection sources and their roles in schistosomiasis transmission in mountainous endemic regions in Yunnan Province, so as to provide the evidence for implementing the comprehensive control measures based on infection source control.

METHODS

Two villages of typical mountainous regions in Nanjian County were chosen for field investigation. The Oncomelania hupensis snail status was surveyed by the methods of systematic and environmental sampling. The infections of schistosomiasis were surveyed in residents with the indirect haemagglutination and the hatching method, in livestock with the hatching method and in wild animals with the anatomical method and the hatching method. The distribution and pollution status of wild faeces were investigated in the snail environments nearby villages or with livestock frequent activities. The positives of schistosomiasis in wild faeces were tested with the hatching method. The pollution index of wild feces was calculated.

RESULTS

A total of 533.56 hm2 were investigated in two villages, and the area with snails was 16.52 hm2. The rate of frame with snails was 1.03%, the average density of snails was 0.07 snails/0.1 m2, and no positive snails were found. The positive rate of blood examinations of population was 1.61%, but no persons were positive with the hatching method. The infection rates were 0.90%, and 0.62% in cattle and equus, respectively, and there were no positives in other livestock. Totally 472 piles of wild feces of 6 species (human, cattle, equus, goat, pig and dog) distributed in the investigation areas, and among them, the densities of wild feces of cattle, equus, and dog were 7.2, 4.3 piles/hm2, and 2.1 piles/hm2 respectively, being relatively higher than others. The hatching positive rates of wild faeces of cattle, equus, and dog were 2.27% (3/132), 2.63% (2/76), and 3.70% (1/27), respectively. The relative pollution indexes of wild faeces of cattle, equus, and dog were 80.68%, 15.89%, and 3.43%, respectively.

CONCLUSIONS

After schistosomiasis transmission is controlled, the potential epidemic factors still remain in the mountainous endemic regions of schistosomiasis in Yunnan Province. The cattle are still the most infection source of schistosomiasis, but equus and dog as infection sources should be not neglected. We should extend the investigation and monitor scope of the infection sources, and carry out scientific and feasible control technique and management measures.

[Effects of three kinds of molluscicides in fields of mountainous areas of Yunnan Province]

The molluscicidal effects of 10% salt of quinoid- 2' ,5-dichloro-4'-nitrosalicylanilide (LDS) with dusting method, 26% amine molluscicide (MNSC) and 50% niclosamide (WPN) with insufflation method were tested in the fields of mountainous areas of Yunnan Province. After 7, 15 and 30 days of the tests, the death rates of snails, decline rates of living snail densities, and occurrence rates of frames with living snails of the 10% LDS group were 72.69%-87.16%, 74.10%-88.84%, and 20.00%-30.00%, respectively; those of the 26% MNSC group were 66.21%-91.06%, 69.55%-91.36%, and 19.44%-27.78% respectively; those of the 50% WPN group were 78.10%-90.18%, 82.44%-91.60%, 17.50%-20.00%, respectively. The results showed that the molluscicidal effects of 10% LDS, 26% MNSC and 50% WPN were basically equal.

[Molluscicidal effect of suspension concentrate of metaldehyde and niclosamide in fields of mountainous areas in Yunnan Province]

OBJECTIVE

To evaluate the molluscicidal effect of 26% suspension concentrate of metaldehyde and niclosamide (MNSC) in the fields of mountainous areas in Yunnan Province.

METHODS

Some representative Oncomelania snail environments of schistosomiasis endemic regions were selected as study areas in Heqing County, Yunnan Province and 26% MNSC and 50% wettable powder of niclosamide ethanolamine salt (WPN) were used to kill the snails with the mechanical spraying and sprinkler spraying methods respectively.

RESULTS

Seven, 15, 30 days after the spraying with the mechanical spraying method, in corn fields, the snail mortality rates were from 88.68% to 92.88% in the MNSC group, and from 89.86% to 90.32% in the WPN group respectively, and in the ditch, the snail mortality rates were from 89.97% to 94.46% in the MNSC group and from 90.08% to 96.74% in the WPN group respectively, and there was no significant difference between the 2 groups (P > 0.05); 7, 15, 30 days after the spraying with the sprinkler spraying method, in corn fields, the snail mortality rates were from 66.14% to 89.11% in the MNSC group, and from 78.40% to 91.22% in the WPN group, respectively, in the ditch, the snail mortality rates were from 84.13% to 94.27% in the MNSC group, and from 85.81% to 95.26% in the WPN group respectively, and there was no significant difference between the 2 groups (P > 0.05).

CONCLUSION

26% MNSC has good molluscicidal effect in the fields of mountainous areas in Yunnan Province

[Killing effect of garlic extract on Schistosoma japonicum cercariae and Oncomelania snails]

The killing effect of different concentrations of garlic extract solution on Schistosoma japonicum cercariae and Oncomelania snails was observed under dissecting microscope. Mice were infected by cercariae through the abdominal skin daubed by garlic solution or by deionized water as control. The results showed that the cercariae were killed in (77.33 +/- 25.01) s in average, it needed (73.00 +/- 1.73)- (299.67 +/- 18.96) s under the garlic solution concentrations of 50.00%-0.79% respectively, while the cercariae kept alive in 600 s in the control. The snails were killed in 1 d by 100% garlic solution but no death in the control in 2 d. No mouse daubed with different concentrations of garlic solution was found infected by schistosomes while 100% of the control mice got infected. It is concluded that the garlic shows satisfactory effect in killing cercariae and Oncomelania snails, and may prevent schistosome infection by daubing the skin.

Maximum thickness of subarachnoid blood is associated with mortality in patients with traumatic subarachnoid haemorrhage

This study was designed to evaluate whether the maximum thickness of subarachnoid blood is an independent prognostic marker of mortality after traumatic subarachnoid haemorrhage. Multivariate analysis showed the maximum thickness of subarachnoid blood was an independent predictor of death versus survival 1 month after injury and was inversely associated with Glasgow Coma Scale (GCS) score. Receiver operating characteristic curve analysis showed that maximum thickness of subarachnoid blood > 6.7 mm immediately after non-surgical resuscitation predicted 1-month mortality with 83.9% sensitivity and 67.1% specificity; its predictive value was similar to that of the GCS score. Addition of maximum thickness of subarachnoid blood to the GCS score did not significantly improve predictive performance. Hence, the maximum thickness of subarachnoid blood is a new independent prognostic marker of mortality and might become an additional, valuable tool for risk stratification and decision making in the acute phase of traumatic subarachnoid haemorrhage.

Toward sustainable and comprehensive control of schistosomiasis in China: lessons from Sichuan

Triggered by a fascinating publication in the New England Journal of Medicine detailing China's new multi-pronged strategy to control and eventually interrupt the transmission of Schistosoma japonicum, this PLoS Neglected Tropical Diseases Debate critically examines the generalizability and financial costs of the studies presented from the marshlands of the lake region. Edmund Seto from the University of California and colleagues emphasize that the epidemiology and control of schistosomiasis varies according to the social-ecological context. They conjecture that the successful intervention packages piloted in the lake region is not fully fit for the hilly and mountainous environments in Sichuan and Yunnan provinces, and hence call for more flexible, setting-specific, and less expensive control strategies. In response, Xiao-Nong Zhou from the National Institute of Parasitic Diseases at the Chinese Center of Disease Control and Prevention and colleagues explain the steps from designing pilot studies to the articulation and implementation of a new national control strategy through a careful process of scaling-up and adaptations. Finally, the two opponents converge. The need for integrated, intersectoral, and setting-specific control measures is stressed, supported by rigorous surveillance and continuous research. Experiences and lessons from China are important for shaping the schistosomiasis elimination agenda.

Association of Interleukin-11 with Mortality in Patients with Spontaneous Basal Ganglia Haemorrhage

This study evaluated interleukin (IL)-11 as an independent prognostic marker of mortality following intracerebral haemorrhage (ICH). Plasma IL-11 levels in patients with ICH were significantly higher than in healthy controls. Multivariate analysis indicated that plasma IL-11 level was an independent predictor for mortality within 1 week of ICH onset and was positively associated with haematoma volume. Receiver operating characteristic curve analysis identified that a baseline plasma IL-11 level > 20.9 pg/ml predicted mortality within 1 week of ICH onset with 81.2% sensitivity and 74.1% specificity. The area under the curve for IL-11 level was significantly smaller than that for the Glasgow Coma Scale score, but similar to that for haematoma volume. IL-11 did not, however, significantly improve the predictive value of the Glasgow Coma Scale or haematoma volume. Thus, IL-11 may be considered as a new independent prognostic marker of mortality and an additional valuable tool for risk stratification and decision-making in the acute phase of ICH.

[Molluscicidal effect of LDS in mountainous areas of Yunnan Province]

OBJECTIVE

To observe the molluscicidal effect of a novel molluscicide, salt of quinoid-2', 5-dichloro-4'-nitrosalicylanilide (LDS) on Oncomelania hupensis in laboratory and field of mountainous areas of Yunnan Province.

METHODS

With the immersion method, 10% LDS with concentrations of 0.1, 0.2, 0.4, 0.6, 0.8 mg/L was tested, and 50% niclosamide (WPN) with the concentration of 2 mg/L as well as fresh water were tested as the controls. The molluscicidal effects of 24, 48, 72 h were observed in lab and the field. With the insufflation method and powdering method, 10% LDS with doses of 0.2, 0.4, 0.6, 0.8, 1.0 g/m2 was tested and 50% WPN with the dose of 2 g/m2 as well as fresh water were tested as the controls. The molluscicidal effects of 1, 3, 7 d were observed in lab and the field.

RESULTS

At the room temperature of 25-26 degrees C and water temperature of 21-22 degrees C, when exposed for 72 h by the immersion method, the snail death rates of above-mentioned five concentrations of LDS and WPN as well as fresh water were 93.33%, 100%, 100%, 100%, 100%, 100% and 6.67%, respectively in lab. At the field temperature of 18-28 degrees C and water temperature of 18-23 degrees C, when exposed for 72 h by the immersion method, the snail death rates of above-mentioned five concentrations of LDS and WPN as well as fresh water were 91.11%,100%,100%, 100%, 100%, 100% and 3.33%, respectively in the field. When exposed for 7 d by the insufflation method, the snail death rates of five above-mentioned dosages of LDS and WPN as well as fresh water were 90.00%, 94.00%, 96.00% 99.00%, 99.00%, 94.00% and 6.00%, respectively in lab and 80.00%, 82.14%, 88.35%, 90.83%, 96.55%, 92.56% and 4.55%, respectively in the field. When exposed for 7 d by the powdering method, the snail death rates were 74.77%, 88.89%, 94.50%, 90.38%, 92.17%, 90.38% and 4.55%, respectively in the field.

CONCLUSION

LDS has a good molluscicidal effect on Oncomelania hupensis in mountainous areas.

[Relationship between environmental remote sensing alternate indexes and Oncomelania snail distribution in hilly and mountainous areas]

OBJECTIVE

To analyze the relationship between Oncomelania snail distribution and environmental remote sensing indexes in hilly and mountainous areas.

METHOD

The normalized different vegetation index (NDVI), land surface temperature (LST), humidity index (Wetness) of 85 snail spots in Dali City were extracted for statistical analysis by TM image, and the land-use types were classified. LST, NDVI, Wetness, snail density and land-use types were overlaid and analyzed by using a weight of suitability model of ArcGIS 9.2, and snail appropriate distribution range in Dali City was calculated.

RESULTS

The distribution of LST, NDVI, Wetness values of the investigated snail points were approximately normal, and most of the snail points distributed nearby the average values of the remote sensing alternate indexes, then gradually reduced to the ends. More than 90% of the snail spots were distributed in the land type with crops and grassland. The environments in Dali City were divided into unsuitable snail environment (0-14 points), suitable snail environment (15-21 points), and optimum snail environment (22-26 points) by the weight suitability mode.

CONCLUSIONS

Environmental remote sensing indicators can reflect the environmental factors affecting snail distribution directly. Combining remote sensing with GIS and field survey can describe, judge and forecast the distribution of snails.

[Control strategy of schistosomiasis and key points in the 12th Five-Year Plan in China]

Based on the objective of long- and mid-term development program for schistosomiasis control in China, the paper presents an analysis of strategy for schistosomiasis control and its function in the 12th Five-Year Plan. Meanwhile, the strategy and key elements of schistosomiasis control for recent years are put forward for different endemic areas.

[Strengthening the achievements of schistosomiasis control in hilly regions of China]

In this paper we summarize the epidemiological characteristics, trends, and control achievements of schistosomiasis in hilly regions of China, as well as analyze the challenges of schistosomiasis control in these areas after transmission control, and further explore the control measures and strategies in the post-transmission control period to strengthen the control achievements and sustainable development with the ultimate goal of achieving transmission interruption.

Elder abuse and mortality: the role of psychological and social wellbeing

BACKGROUND

Elder abuse is a pervasive human right and public health issue.

OBJECTIVES

We aimed to examine the mortality associated with elder abuse across levels of psychological and social factors.

METHODS

The Chicago Health and Aging Project (CHAP) is a prospective population-based cohort study that began in 1993. A subset of these participants enrolled between 1993 and 2005 had elder abuse reported to social services agencies (n = 113). Mortality was ascertained during follow-up and with the National Death Index. Psychosocial factors (depression, social network and social engagement) were assessed during the CHAP interview. Cox proportional hazard models were used to assess the mortality of elder abuse across levels of psychosocial factors using time-varying covariate analyses.

RESULTS

The median follow-up time for the cohort (n = 7,841) was 7.6 years (interquartile range 3.8-12.4 years). In multivariate analyses, those with highest (hazard ratio (HR) 2.60, 95% CI 1.58-4.28) and middle levels (HR 2.18, 95% CI 1.19-3.99) of depressive symptoms had an increased mortality risk associated with elder abuse. For social network, those with lowest (HR 2.50, 95% CI 1.62-3.87) and middle levels (HR 2.65, 95% CI 1.52-4.60) of social network had increased mortality risk associated with elder abuse. For social engagement, those with lowest (HR 2.32, 95% CI 1.47-3.68) and middle levels (HR 2.59, 95% CI 1.65-5.45) of social engagement had increased mortality risk associated with elder abuse. Among those with lowest levels of depressive symptoms, highest levels of social network and social engagement, there was no significant effect of reported or confirmed elder abuse on mortality risk.

CONCLUSION

Mortality risk associated with elder abuse was most prominent among those with higher levels of depressive symptoms and lower levels of social network and social engagement.

Safety and radiation-enhancing effect of sodium glycididazole in locoregionally advanced laryngeal cancers previously treated with platinum-containing chemotherapy regimens: A preliminary report

PURPOSE

To determine the safety and radiation-enhancing effect of sodium glycididazole in laryngeal squamous cell carcinoma (stage T3-4,N0-3,M0) with conventional radiotherapy.

PATIENTS AND METHODS

Patients with locoregional advanced laryngeal cancer (stage T3-4,N0-3,M0) were included: group 1(control, n=30)were not administered of sodium glycididazole; group 2 (test, n=30) received sodium glycididazole at a dose of 700 mg/m(2) intravenous infusion 30 minutes before radiotherapy three times a week. Surrogate end-points of efficacy were tumor and nodal size. Safety parameters were vomiting, nausea, mucositis, laryngeal edema, esophagus and skin reaction, dysphagia, dyspnea, neurological deficit. Patients were evaluated weekly during treatment for 7 weeks and thereafter monthly for 3 months.

RESULTS

In the test, the overall response rate was 88.89% (95%CI, 71.00-97.00%) at 7 weeks and 92.59% (95%CI, 76.00 to 99.00%) at 1 month of follow-up. In the control, the overall response rate was 62.5% (95%CI, 41.00 to 81.00%) at 7 weeks and 58.33% (95%CI, 37.00 to 78.00%) at 1 month of follow-up. The short-term locoregional response rate was better in the test group at 7 weeks (p=0.027) and at 1 month (p=0.005) of follow-up. The test group had significantly more nausea and vomiting in weeks 1 (p=0.047), 2 (p=0.007), and 3 (p=0.01) of treatment.

CONCLUSIONS

The study indicates sodium glycididazole is an effective radiation-enhancing agent that improves short-term locoregional control and is well tolerated in patients with locoregionally advanced laryngeal cancer.

Predictors for presence and abundance of small mammals in households of villages endemic for commensal rodent plague in Yunnan Province, China

Background

Ninety-one rodent plague epidemics have occurred in Lianghe county, Yunnan Province, China, between 1990 and 2006. This study aimed to identify predictors for the presence and abundance of small mammals in households of villages endemic for rodent plague in Lianghe county.

Results

Rattus flavipectus and Suncus murinus were the two species captured in 110 households. Keeping cats decreased the number of captures of R. flavipectus by one to two thirds and the chance of reported small mammal sightings in houses by 60 to 80%. Food availability was associated with fewer captures. Keeping food in sacks decreased the small mammal captures, especially of S. murinus 4- to 8-fold. Vegetables grown around house and maize grown in the village reduced the captures of S. murinus and R. flavipectus by 73 and 45%, respectively. An outside toilet and garbage piles near the house each reduced R. flavipectus captures by 39 and 37%, respectively, while raising dogs and the presence of communal latrines in the village increased R. flavipectus captures by 76 and 110% but were without detectable effect on small mammal sightings. Location adjacent to other houses increased captures 2-fold but reduced the chance of sightings to about half. In addition, raising ducks increased the chance of sighting small mammals 2.7-fold. Even after adjusting for these variables, households of the Dai had higher captures than those of the Han and other ethnic groups.

Conclusion

Both species captures were reduced by availability of species-specific foods in the environment, whereas other predictors for capture of the two species differed. Other than the beneficial effect of cats, there were also discrepancies between the effects on small mammal captures and those on sightings. These differences should be considered during the implementation and interpretation of small mammal surveys.

[Study on the epidemiological significance related to community-structural difference of the rat plague host and vectors in Western Yunnan, China]

OBJECTIVE

To study the epidemiological significance of community-structural difference regarding both small mammal and flea communities on Rattus flavipectus in Dehong and Baoshan areas, Yunnan province, during 1982 to 1996.

METHODS

Methodologies as cluster analysis, communities dominated constitution and species diversity were used for data analysis.

RESULTS

75 490 small mammals of 27 species could be divided into three types: I. Ruili habitat-communities dominated by R. flavipectus (54.41%) and Suncus murinus (33.37%); II. Longchuan and Yingjiang habitat-communities dominated by R. flavipectus (62.99%), S. murinus (23.25%) and Mus musculus (10.06%); III. Baoshan habitat-community dominated by R. flavipectus (48.07%), S. murinus (19.56%) and Crocidura attenuats (14.37%). The captured 61 122 fleas of 11 species on R. flavipectus could be divided into three types: i. Ruili habitat-communities dominated by Xenopsylla cheopis (83.51%) and Lentistivslius ferinus (13.86%); ii. Longchuan and Yingjiang habitats X. cheopis (74.42%) and L. segnis (22.94%); iii. Baoshan habitat-communities dominated by L. segnis (70.62%) and X. cheopis (22.70%). There had been 1471 strains of Y. pestis isolated from the hosts of 7 species and vectors of 5 species in Dehong areas for the ten year period. 36 strains of Y. pestis were isolated from host of one species and vectors of 2 species in Baoshan area for ten years. The constitution ratio of R. flavipectus and X. cheopis was higher in Dehong area with average as 58.70% and 78.97% respectively. However, the diversities of species among host and vector communities were low, with average as 1.010 and 0.625. On the contrary, the constitution ratios of R. flavipectus and X. cheopis were lower in Baoshan area, with an average as 48.07% and 22.70% respectively but the diversities of species among host and vector community were higher with the averages as 1.471 and 0.829 respectively. The main dominative flea species from 'group ii' to 'group iii' in the flea community had changed from X. cheopis to L. segnis.

CONCLUSION

The species diversity index of host and vector community was higher in Baoshan area, while the constitution ratio of main host and vector community was lower. This findings seemed to be the important factor of the decrease of plague prevalence in Baoshan area.

Human plague outbreak in two villages, Yunnan Province, China, 2005

Plague is still a serious public health problem in Asia. On July 5, 2005, a suspected outbreak of human plague in two Chinese villages was reported to Yunnan Institute of Endemic Disease Control and Prevention (YIEDC). Active case finding, laboratory investigation, environmental inspection, and control measures were conducted by provincial and local health authorities. A suspected case was an individual who resided in one of the two villages and developed fever and painful swollen lymph nodes in the groin, axilla, and neck between June 26 and July 11, 2005. Confirmation was by indirect hemagglutination test (IHA) for plague F1 antibody. A confirmed animal plague case was an animal that tested positive for one of the following tests: IIA, reverse indirect hemagglutination, or bacterial culture. There were three confirmed and one suspected case of human plague. Of nine retrieved rats, three were confirmed cases. Most surveyed houses had poor sanitation, and there was a history of dead rats observed in the villages. After control measures were implemented, the rat density and flea index decreased to acceptable levels and no new cases occurred. The cause of this outbreak was likely due to rat die off in the villages, such that rat flea populations migrated to humans under environmentally favorable conditions. The outbreak was controlled after implementing environmental and educational control measures.

Epidemiology of schistosomiasis in the People's Republic of China, 2004

Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People's Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6-65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.

Expression of endothelial nitric oxide synthase in the postnatal developing porcine kidney

The postnatal pattern of renal endothelial nitric oxide synthase (eNOS) is unknown. The purpose of this study was to characterize eNOS expression during maturation and compare this to neuronal NOS (nNOS). The experiments measured whole kidney eNOS mRNA expression by RT-PCR and protein content by Western blot, as well as cortical and medullary protein content in piglets at selected postnatal ages and in adult pigs. Whole kidney eNOS mRNA was compared with nNOS. Whole kidney eNOS expression decreased from the newborn to its lowest at 7 days, returning by 14 days to adult levels. This eNOS mRNA pattern contrasted with nNOS, which was highest at birth, and progressively decreased to its lowest level in the adult. At birth, cortical eNOS protein was greater than medullary, contrasting with the adult pattern of equivalent levels. In conclusion eNOS is developmentally regulated during early renal maturation and may critically participate in renal function during this period. The eNOS developmental pattern differs from nNOS, suggesting that these isoforms may have different regulatory factors and functional contributions in the postnatal kidney.

Ontogeny of neuronal nitric oxide synthase, NOS I, in the developing porcine kidney

To determine if the developing kidney differs from the adult in the expression of the neuronal nitric oxide synthase, NOS I, these experiments measured mRNA gene expression by RNase protection assay and protein content by Western blot of NOS I in piglets at ages newborn and 3, 7, 10, 14, and 21 days and adult pigs. Whole kidney NOS I mRNA was greatest at birth and decreased progressively during renal maturation to adult levels. NOS I protein content paralleled this developmental pattern. Cortical NOS I protein was equivalent in newborn and 14-day-old piglets and was greater at both ages than the adult. Medullary NOS I protein was relatively greater than cortical in both immature ages and decreased from a peak at birth to adult levels. We conclude the following. 1) During postnatal maturation, renal NOS I mRNA and protein content show a pattern that is developmentally regulated. 2) This developmental pattern of NOS I after birth may, in part, contribute to the enhanced functional role of NO during renal maturation.

Complete DNA sequence and analysis of an emerging cryptic plasmid isolated from Yersinia pestis

A 6-kb cryptic plasmid (pYC; 5919 bp) has been recovered from Yersinia pestis isolates originating from regions of Yunnan province in China. The sequence of pYC was determined, and analysis of the sequence has revealed that two of the plasmid DNA regions (ORFs 10 and 11) are similar to the DinJ1 and DinJ2 gene products encoded by Escherichia coli chromosomal DNA. This plasmid is increasingly harbored by Y. pestis isolates recovered from a domestic rodent cycle in the southern regions of the province. Further studies will determine the origin and function of pYC.

A cryptic 19-kilobase plasmid associated with U.S. isolates of Yersinia pestis: a dimer of the 9.5-kilobase plasmid

Yersinia pestis, the etiologic agent of plague, carries three prototypic plasmids with sizes of 110 kb (pFra, pTox), 70 kb (pLcr, pVW, pCad), and 9.5 kb (pPla, pPst). Studies suggest that geographic isolates of Y. pestis may be differentiated by plasmid profiles. Yersinia pestis isolated from the western United States harbor an additional plasmid, estimated to be approximately 19 kb in size. This cryptic plasmid was characterized by restriction endonuclease digestion, amplification and sequencing of the plasminogen activator gene segment, Southern blotting, and visualized by electron microscopy. Results revealed that this cryptic plasmid is a supercoiled DNA plasmid, 18.85+/-0.59 (mean+/-SD) kb in length, and is a dimer of the 9.5-kb plasmid. The genetic reason for the appearance of this form of the 9.5-kb plasmid in Y. pestis from Arizona, California, Colorado, New Mexico, and Texas is under study.

[A new morphological classification of urinary erythrocytes for evaluating the source of hematuria]

For differentiation of glomerular from urological hematuria more accurately, a new morphological classification of urinary erythrocytes was studied in 74 cases of glomerular and 58 cases of urological hematuria. For each urine sample, 100 urinary erythrocytes were observed with phase-contrast microscopy and classified into 5 "glomerular" shapes (G1-G5), 5 "urological" shapes (N1-N5) and an unclassified shape. The result was that occurrence of G1, G2, G3, G4, G5 or unclassified shape group appeared significantly (P < 0.01) higher in glomerular diseases than in urological diseases, and among them G1 was the most specific shape for glomerular hematuria. Using percentage of sigma G (G1 + G2 + G3 + G4 + G5) and setting the cut-off at 20%, the sensitivity and specificity for the diagnosis of glomerular diseases were 95.9%. When percentage of G1 (doughnut-like cell with one or more blebs) was used at a cut-off of 1%, sensitivity and specificity were 75.7% and 96.5% respectively. These results were more satisfactory as compared with those in most of the previous reports. Moreover, this new classification is more objective, accurate and clear.