Holocene climate change in southern Oman deciphered by speleothem records and climate model simulations

Qunf Cave oxygen isotope (δ18Oc) record from southern Oman is one of the most significant of few Holocene Indian summer monsoon cave records. However, the interpretation of the Qunf δ18Oc remains in dispute. Here we provide a multi-proxy record from Qunf Cave and climate model simulations to reconstruct the Holocene local and regional hydroclimate changes. The results indicate that besides the Indian summer monsoon, the North African summer monsoon also contributes water vapor to southern Oman during the early to middle Holocene. In principle, Qunf δ18Oc values reflect integrated oxygen-isotope fractionations over a broad moisture transport swath from moisture sources to the cave site, rather than local precipitation amount alone, and thus the Qunf δ18Oc record characterizes primary changes in the Afro-Asian monsoon regime across the Holocene. In contrast, local climate proxies appear to suggest an overall slightly increased or unchanged wetness over the Holocene at the cave site.

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

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

[Study of incubation period of infection with 2019-nCoV Omicron variant BA.5.1.3]

Objective: To study the incubation period of the infection with 2019-nCoV Omicron variant BA.5.1.3. Methods: Based on the epidemiological survey data of 315 COVID-19 cases and the characteristics of interval censored data structure, log-normal distribution and Gamma distribution were used to estimate the incubation. Bayes estimation was performed for the parameters of each distribution function using discrete time Markov chain Monte Carlo algorithm. Results: The mean age of the 315 COVID-19 cases was (42.01±16.54) years, and men accounted for 30.16%. A total of 156 cases with mean age of (41.65±16.32) years reported the times when symptoms occurred. The log-normal distribution and Gamma distribution indicated that the M (Q₁, Q₃) of the incubation period from exposure to symptom onset was 2.53 (1.86, 3.44) days and 2.64 (1.91, 3.52) days, respectively, and the M (Q₁, Q₃) of the incubation period from exposure to the first positive nucleic acid detection was 2.45 (1.76, 3.40) days and 2.57 (1.81, 3.52) days, respectively. Conclusions: The incubation period by Bayes estimation based on log-normal distribution and Gamma distribution, respectively, was similar to each other, and the best distribution of incubation period was Gamma distribution, the difference between the incubation period from exposure to the first positive nucleic acid detection and the incubation period from exposure to symptom onset was small. The median of incubation period of infection caused by Omicron variant BA.5.1.3 was shorter than those of previous Omicron variants.

Coupled atmosphere-ice-ocean dynamics during Heinrich Stadial 2

Our understanding of climate dynamics during millennial-scale events is incomplete, partially due to the lack of their precise phase analyses under various boundary conditions. Here we present nine speleothem oxygen-isotope records from mid-to-low-latitude monsoon regimes with sub-centennial age precision and multi-annual resolution, spanning the Heinrich Stadial 2 (HS2) - a millennial-scale event that occurred at the Last Glacial Maximum. Our data suggests that the Greenland and Antarctic ice-core chronologies require +320- and +400-year adjustments, respectively, supported by extant volcanic evidence and radiocarbon ages. Our chronological framework shows a synchronous HS2 onset globally. Our records precisely characterize a centennial-scale abrupt "tropical atmospheric seesaw" superimposed on the conventional "bipolar seesaw" at the beginning of HS2, implying a unique response/feedback from low-latitude hydroclimate. Together with our observation of an early South American monsoon shift at the HS2 termination, we suggest a more active role of low-latitude hydroclimate dynamics underlying millennial events than previously thought.

Spatial origin of the extracellular ATP-induced cytosolic calcium signature in Arabidopsis thaliana roots: wave formation and variation with phosphate nutrition

Extracellular ATP (eATP) increases cytosolic free calcium ([Ca²⁺ ]_cyt ) as a specific second messenger 'signature' through the plasma membrane DORN1/P2K1 receptor. Previous studies revealed a biphasic signature in Arabidopsis thaliana roots that is altered by inorganic phosphate (Pi) deprivation. The relationship between the two phases of the signature and possible wave formation have been tested as a function of Pi nutrition. The bioluminescent aequorin and intensiometric GCaMP3 reporters were used to resolve the spatial origin of the eATP [Ca²⁺ ]_cyt signature in Arabidopsis root tips. Application of eATP only to the root apex allowed [Ca²⁺ ]_cyt wave resolution without the confounding effects of eATP delivery by superfusion. The first apical millimetre of the root generates the first [Ca²⁺ ]_cyt increase by eATP, regardless of nutritional status. The second increase occurs sub-apically in the root hair zone, has some autonomy and is significantly reduced in Pi-starved roots. A significant component of the Pi-replete signature does not require DORN1/P2K1, but Pi-starved roots appear to have an absolute requirement for that receptor. Application of eATP specifically to the root apex provides evidence for cell-to-cell propagation of a [Ca²⁺ ]_cyt wave that diminishes sub-apically. The apex maintains a robust [Ca²⁺ ]_cyt increase (even under Pi starvation) that is the basis of a propagative wave, with implications for the ability of the root's eATP signalling systems to signal systemically. Partial autonomy of the sub-apical region may be relevant to the perception of eATP from microbes. eATP-induced [Ca²⁺ ]_cyt increase may not have always have an obligate requirement for DORN1/P2K1.

[Study of development of public health safety literacy scale in China]

Objective: To develop a suitable scale for assessing the public health safety literacy in residents in China. Methods: The initial scale of Chinese public health safety literacy was developed through theoretical conceptualization, item pooling, field verifying and item inclusion and exclusion. Then the initial scale was converted into an electronic questionnaire. A total of 2 809 residents from 4 provinces were randomly selected for field testing. Classical test theory (CTT) and item response theory (IRT) were used for item reduction. SPSS 23.0 was used for exploratory factor analysis (EFA) and unidimensional testing. Package R 4.1.1 ltm and mirt were used for the analysis of the psychometric properties of items and generate the ICC, IIC and TIF. Results: The initial scale had 30 items (B1-B30), and the test took 9.8 s to complete one item averagely. According to the CTT, B2 was deleted due to coefficient of total correlation (CITC) <0.3 and the item-dimension correlation coefficient (IDCC) <0.4. B23 was deleted due to CITC<0.3, IDCC<0.4 and difficulty index (W) <0.2. B30 was deleted due to CITC<0.3 and W<0.2. The total Cronbach's α of the scale was 0.923 after deletion. EFA indicated that 14 items should be deleted due to lower factor loadings <0.7. EFA was conducted for remaining 13 items and 2 common factors were extracted, the factor loadings of all items were >0.7, the accumulated variance contribution of the 2 common factors was 63.361%, and the total Cronbach's α was 0.891, showing unidimensionality, IRT was used to test the remaining items. B14 and B20 were deleted due to discrimination coefficient (a) <0.3, difficulty threshold coefficient (b) ∉[-3,3], the small amount of information and the flat, crowded, non-monotonic ICC, and IIC. Finally, the Cronbach's α of the 11-itemed scale was 0.936 with TLI=0.97, CFI=0.99, and RMSEA=0.03. Conclusion: The final scale has good reliability, validity, discrimination, difficulty level and feasibility, and can be applied for the rapid assessment of public health safety literacy in China.

[Study on the development of public health and safety literacy assessment scale for university freshmen]

Objective: To develop a measurement scale for the public health and safety literacy of university freshmen. Methods: Item pooling was conducted through literature review and in-depth interview with public health experts, and a nominal group was organized to develop the initial items to form the questionnaire. A total of 250 freshmen were randomly selected to complete the questionnaire, and the assessment of psychometric properties were performed to carry out item reduction by using classical test theory and item response theory. Exploratory factor analysis method (EFA) was employed to calculate the item-factor loadings. The data collected from another 318 freshmen were analyzed using confirmatory factor analysis method (CFA). Results: The scale contained 3 dimensions and 9 items with all content validity index ≥0.8. The difficulty coefficient of 9 items was 1.18-2.43. The discriminative validity analysis showed that the difficulty index was 0.41-0.78, and the discrimination index was 0.38-0.64. Each of the remaining items had a statistically significant difference in the score value between the top 27% and lowest 27% of respondents (t>3, P<0.05). The item's Cronbach's α was 0.72-0.77, corrected item-total correlation was 0.33-0.60 and the overall α of the scale was 0.77. EFA indicated all item-factor loading were higher than 0.680, and the accumulated variance contribution of the 3 factors was 62.484%. Results of CFA showed that the overall fitness index of the model reached the fitness standard except for the χ² value. There was no statistical significance in the total score of the scale and the scores of each item among groups with different demographic characteristics (P>0.05). Conclusions: The newly developed public health safety literacy scale had a good reliability,validity,stability and item constancy.It can be used in measurement of the public health and safety literacy of university freshmen.

Collapse of the Liangzhu and other Neolithic cultures in the lower Yangtze region in response to climate change

The Liangzhu culture in the Yangtze River Delta (YRD) was among the world’s most advanced Neolithic cultures. Archeological evidence suggests that the Liangzhu ancient city was abandoned, and the culture collapsed at ~4300 years ago. Here, we present speleothem records from southeastern China in conjunction with other paleoclimatic and archeological data to show that the Liangzhu culture collapsed within a short and anomalously wet period between 4345 ± 32 and 4324 ± 30 years ago, supporting the hypothesis that the city was abandoned after large-scale flooding and inundation. We further show that the demise of Neolithic cultures in the YRD occurred within an extended period of aridity that started at ~4000 ± 45 years ago. We suggest that the major hydroclimatic changes between 4300 and 3000 years ago may have resulted from an increasing frequency of the El Niño–Southern Oscillation in the context of weakened Northern Hemisphere summer insolation.

Preparation of high-precision CO2 with known triple oxygen isotope for oxygen isotope analysis

The objective of this work is to propose a more effective way to prepare an in-house CO₂ with known triple oxygen isotope compositions. The major experimental steps include: (1) the O₂ is combusted to CO₂ on a graphite rod at 750 °C with Pt-catalyst for 3-4 min; and (2) converted CO₂ is subsequently purified by two cryogenic traps. The results show high reproducibility of δ¹³C and δ¹⁸O values of the converted CO₂ within 0.010-0.020 ‰ and 0.006-0.010 ‰ (1σ, SD), and the identical δ¹⁸O value within error with that of the original O₂. Additionally, we have measured the triple oxygen isotope compositions of converted CO₂ using an O₂-CO₂ Pt-catalyzed oxygen-isotope equilibration method. The measured δ¹⁷O values of CO₂ show high reproducibility within 0.006 ‰ (1σ, SD), and are identical within error with the original O₂ as well. Notably, our experiments also found that the O₂ with heavier oxygen isotope ratios (δ¹⁸O > 40 ‰, VSMOW) might have a lesser conversion efficiency, and this effect, combined with the lighter isotope preferential fractionations during the reaction processes of O₂ to CO and CO to CO₂, may explain the observed lower ¹⁷O/¹⁶O and ¹⁸O/¹⁶O ratios of the converted CO₂ relative to the original O₂.

[Transitions on frailty status and related risk factors for its status worsening: finding from the Beijing MJ Health Screening Center]

Objective: To evaluate the transitions of frailty status and related factors influencing its worsening in middle-aged and elderly adults. Methods: Data was obtained from the Beijing MJ Health Screening Center. A total of 13 689 participants who attended health checkups at least twice during 2008-2019 and had more than three years' intervals during these two health checkups were included in the study. The frailty index comprising 28 variables was used to measure frailty status. Frailty was defined as frailty index ≥0.25, and prefrailty was defined as frailty index >0.10 and <0.25. Logistic regression analysis was performed to investigate the association of socio-demographic factors and lifestyle characteristics with the worsening of frailty status, stratified by frailty status at the first health checkup. Results: The mean age at the first and last health checkups were (42.3±9.2) and (47.9±9.3) years, respectively. The mean interval during these two health checkups was (5.7±1.9) years. At the first health checkup, the prevalence of frailty and prefrailty were 2.5% and 50.3%, respectively. While at the last health checkup, the prevalence of frailty and prefrailty rose to 3.9% and 55.4%. Of all participants, 67.3% remained in the same frailty state, 21.2% worsening, and 12.5% improving. In robust participants at the first health checkup, older age, female, low education level, smoking cessation, daily smoking, being general obesity measured by BMI or central obesity measured by WHR showed an increased the risk of worsening frailty status. However, in prefrail participants at the first health checkup, older age, female, general, or central obesity presented as risk factors for worsening frailty status. Conclusion: Modifiable factors such as low education level, smoking, and obesity may increase the risk of worsening frailty status.

[Characteristics of human papillomavirus infection and abnormal cervical cytology in health check-up females in Shenzhen]

Objective: To describe the characteristics of human papillomavirus infection and thinprep cytologic test (TCT) outcome in health check-up females in Shenzhen. Methods: Use cross-sectional design, collect information from data from health check-up females in Shenzhen and describe characteristics of HPV infections screening and TCT outcomes. Results: We collected the data of 75 754 females, 103 508 females and 69 964 females received HPV detection, TCT and combined detection respectively. HPV standardized infection rate was 19.89% (95%CI: 19.45%-20.33%) and showed a "U-shaped" pattern in age distribution. The most prevalent HPV genotypes were 52, 51, 16, 58 and 53. Infection rate was higher for high-risk HPV than low-risk HPV genotype. Single infection was more common than its multiple infection. In addition, 7.48% (95%CI: 7.22%-7.75%) women were TCT positive, of whom 4.58% (95%CI: 4.40%-4.76%), 2.54% (2.40%-2.69%), 0.27% (95%CI: 0.23%-0.31%) had atypical squamous cells, low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions, respectively. Overall and subtype HPV infection rates increased with severity of abnormal cervical cytology. The most prevalent HPV genotypes were 52, 58 and 16 in women with abnormal cervical cytology. Conclusions: HPV prevalence remains at a high level in Shenzhen. This study suggests that attention should be paid to HPV screening, especially in young, perimenopausal women and in high risk HPV genotype infection. Timely follow-up and cervical cytology screening are required for women with high-risk HPV infection or persistent infection. Future vaccination strategies should take account of prevalent HPV genotype.

A multimillennial climatic context for the megafaunal extinctions in Madagascar and Mascarene Islands

Madagascar and the Mascarene Islands of Mauritius and Rodrigues underwent catastrophic ecological and landscape transformations, which virtually eliminated their entire endemic vertebrate megafauna during the past millennium. These ecosystem changes have been alternately attributed to either human activities, climate change, or both, but parsing their relative importance, particularly in the case of Madagascar, has proven difficult. Here, we present a multimillennial (approximately the past 8000 years) reconstruction of the southwest Indian Ocean hydroclimate variability using speleothems from the island of Rodrigues, located ∼1600 km east of Madagascar. The record shows a recurring pattern of hydroclimate variability characterized by submillennial-scale drying trends, which were punctuated by decadal-to-multidecadal megadroughts, including during the late Holocene. Our data imply that the megafauna of the Mascarenes and Madagascar were resilient, enduring repeated past episodes of severe climate stress, but collapsed when a major increase in human activity occurred in the context of a prominent drying trend.

[Experience and challenge on interoperability of big data in health care]

Problems in interoperability is the biggest barrier limiting the use of big data in health care worldwide. Interoperability contains five dimensions: business, security, ethics, semantics and technology. Based on the comparison of the three common interoperability models led by government, enterprise or research institution, and the current status of big data development in China, this paper proposes a new operation model which can be led by university, aided by enterprise and supported by government, and summarizes the three major challenges in the development of big data interoperability in China: professional standard and specification, data security and ethics, incentive mechanism and assessment. Only when a feasible model is adopted, technical difficulties are overcome and data are truly shared, we can achieve maximized integration of multi-source data, expanding its application fields and establish a multi-business mode to comprehensively improve the population based health decision-making and management.

Association between depression subtypes and response to repeated-dose intravenous ketamine

OBJECTIVE

About half or more of treatment-resistant depressed patients do not respond to ketamine, and few clinical predictors to gauge the most likely antidepressant response have been proposed. We explored whether depression subtypes are associated with response to ketamine.

METHOD

Ninety-seven participants with depression were administered six repeated-dose intravenous ketamine and assessed for depression (Montgomery-Åsberg Depression Rating Scale, MADRS), anxiety (Hamilton Anxiety Rating Scale, HAMA), and suicidal ideation (Beck Scale for Suicidal Ideation, SSI) at baseline, 24 h after each infusion, and 2 weeks after the whole treatment. Participants were classified by melancholic/anxious subtype. Individuals who met criteria for neither or both subtypes were classified separately, resulting in four mutually exclusive groups.

RESULTS

Patients with melancholic or melancholic-anxious features were less likely to respond (e.g., day 13, melancholic-anxious vs. anxious, OR 0.138, 95% CI 0.032-0.584, P = 0.007) or remit (e.g., day 26, melancholic vs. no subtype, OR 0.182, 95% CI 0.035-0.960, P = 0.045) and took longer to achieve response/remission than those with anxious or no subtype features. Faster HAMA score reductions were observed in patients with anxious or melancholic-anxious features, and faster SSI score reductions were observed among those with melancholic-anxious features.

CONCLUSION

Our study shows promising results for ketamine as a novel antidepressant preferentially for the treatment of non-melancholic or anxious depression.

P4621Incidence, management, and in-hospital mortality of cardiogenic shock complicating ST-elevated myocardial infarction in China: insights from the China Acute Myocardial Infarction Registry

Background and purpose

Limited data is available on the situation of cardiogenic shock (CS) complicating ST-elevated myocardial infarction (STEMI) in China. This study aims to disclose the incidence, management and in-hospital mortality (IHM) of patients with STEMI complicated by CS (STEMICS) in China and at different levels of hospitals.

Methods

We queried the 2013–2016 China Acute Myocardial Infarction (CAMI) registry databases to identify patients with STEMI and/or CS (developing before or during hospitalization). The overall and different hospital-level incidence of STEMICS and IHM were analyzed.

Results

Of 28230 STEMI patients, 2273 patients (8.05%) had CS. The incidence of STEMICS in provincial, prefectural and county-level hospitals were 5.23%, 8.46% and 13.76% (p<0.001), respectively. Primary PCI (PPCI) was performed on 675 patients (29.7%) with STEMICS. The proportion of STEMICS patients undertaking PPCI in provincial, prefectural and county-level hospitals were 46.53%, 31.48% and 8.00% (p<0.001). The overall IHM rate of patients with STEMICS was 49.8% with no difference among the different hospital levels. However, the IHM rate of prehospital STEMICS in county-level hospitals were significantly higher than that in prefectural and provincial hospitals (42.3% versus 33.3% and 28.3%, respectively; p<0.01), while that of in-hospital STEMICS were similar among the different hospital levels (66.5%, 66.9% and 62.2%; provincial, prefectural and county-level hospitals, respectively). After adjustment, the difference of IHM in prehospital STEMICS between county-level hospitals and the other two levels no longer existed. However, once PPCI was excluded from the multivariable adjustment model, the IHM of prehospital STEMICS remained higher in county-level hospitals.

Table 1. Differences in IHM of prehospital STEMICS between county-level hospitals and other two levels of hospitals before or after adjustment Provincial hospitals/ County-level hospitals Prefectural hospitals/ County-level hospitals Unadjusted OR (95% CI) 0.54 (0.36, 0.80); P=0.0019 0.68 (0.49, 0.94); P=0.0193 Adjusted OR* (95% CI) 0.63 (0.34, 1.17); P=0.1455 0.64 (0.38, 1.08); P=0.0962 Adjusted OR† (95% CI) 0.49 (0.27, 0.90); P=0.0214 0.54 (0.32, 0.91); P=0.0198 IHM: in-hospital mortality; OR: odd ratio; CI: confidence interval. *Adjusted for baseline characteristics, in-hospital medications and primary PCI; †adjusted for baseline characteristics and in-hospital medications.

Figure 1. Flowchart

Conclusion

The overall incidence and IHM rate of STEMICS in China are still high. Especially, higher IHM rate of prehospital STEMICS is observed in county-level hospitals, which may be attributed to the lower implementation rate of PPCI.

Acknowledgement/Funding

CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

[Combining relative alpha variability and electroencephalogram reactivity to predict the prognosis of hypoxic-ischemic encephalopathy in adult patients]

Objective: To evaluate the role of combining relative alpha variability and electroencephalogram (EEG) reactivity to predict the prognosis of hypoxic-ischemic encephalopathy(HIE) in adult patients. Methods: A total of 28 adult patients with HIE admitted to general intensive care unit at Xiangya Hospital in Central South University were enrolled in this observational study from January2016 to April 2017. These patients with body temperature over 35℃ after 72-hour admission could be continuously monitored at least 12 hours byEEG.At the same time,each patient was assessed for EEG reactivity.Then we analyzed the correlation between EEG reactivity, relative alpha variability and clinical prognosis. Results: EEG reactivity was elicited in 15/28 patients, among whom 12 patients had a good outcome. While in the other 13 patients, EEG reactivity was not elicited, among whom only 3 patients had a good outcome. As to the results ofrelative alpha variability,11/13 patients with degree 3-4were of good prognosis; while only 3/15 patients with degree 1-2 were of good prognosis. Glasgow coma scale(GCS), EEG reactivity, and relative alpha variability were correlated with clinical outcome(χ(2)=5.073,9.073,-3.626, respectively,all P<0.05). The sensitivity of GCS, EEG reactivity, and relative alpha variability to predict the poor prognosis were 69.2%, 76.9%, 84.6%, respectively. The specificity were 73.3%, 80.0%, 73.3%, respectively. The consistency rates were 71.4%, 78.6%, 78.6%, respectively. The positive predictive values were 69.2%, 76.9%, 73.3%, respectively. The negative predictive values were 73.3%, 80.0%, 84.6%, respectively. More importantly, the accuracy of the relative alpha variability combined with EEG reactivity for the prediction of poor prognosis was much higher with the positive predictive value of 90.0%,the specificity of 93.3%, the sensitivity of 69.2%, the consistency rate of 82.1%,and the negative predictive values of 77.8%. Conclusions: The combination of relative alpha variability and EEG reactivityis reliable to predict clinical outcome of patients with HIE.

[Synchronous mucinous metaplasia and neoplasia of the female genital tract]

Objective: To describe the clinicopathological features of synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT). Methods: The sample consisted of 7 cases of SMMN-FGT recorded from November 2014 to September 2017 at Obstetrics and Gynecology Hospital, Fudan University.PAP method was used in immunohistochemistry.Clinical histories were retrieved and pathological slides were reviewed. Results: The patients were 37 to 70 years old(mean 54 years old). All patients showed endometrial mucinous lesions associated with cervical lesions. Three cases were an admixture of minimal deviation adenocarcinoma(MDA) and gastrictype adenocarcinoma(GAS). Three cases were an admixture of lobular endocervical glandular hyperplasia (LEGH), atypical LEGH and focal gastrictype adenocarcinoma in situ, one of which had early invasive gastrictype adenocarcinoma.Endometrium showed a structure of LEGH in one patient with focal simple gastric mucinous metaplasia in her cervix. Gastric mucinous differentiation was found in unilateral fallopian tube in 6 patients. Ovarian mucinous lesions were found in 3 patients. p16 was negative staining in 6 cases and positive in 1 case. CK7 was diffusely positive in all lesions. CK20 and CDX2 were negative or only focally positive.The expression of MUC6 was strongly positive staining or focal staining. p53 in GAS and GAS in situ had mutant expression, but wild expression in MDA region. Patients were followed up for 2 to 34 months and no recurrence was found. Conclusions: SMMN-FGT is a series of rare mucinous lesions involving multiple areas of the female genital tract, including benign or malignant lesions with gastric differentiation. It is not related to infection with high-risk human papilloma virus. When cervical gastrictype lesions are found, SMMN-FGT should be considered and should be differentiated from metastatic mucinous adenocarcinoma.

East Asian hydroclimate modulated by the position of the westerlies during Termination I

Speleothem oxygen isotope records have revolutionized our understanding of the paleo East Asian monsoon, yet there is fundamental disagreement on what they represent in terms of the hydroclimate changes. We report a multiproxy speleothem record of monsoon evolution during the last deglaciation from the middle Yangtze region, which indicates a wetter central eastern China during North Atlantic cooling episodes, despite the oxygen isotopic record suggesting a weaker monsoon. We show that this apparent contradiction can be resolved if the changes are interpreted as a lengthening of the Meiyu rains and shortened post-Meiyu stage, in accordance with a recent hypothesis. Model simulations support this interpretation and further reveal the role of the westerlies in communicating the North Atlantic influence to the East Asian climate.

[Ovarian clear cell borderline tumour: a clinicopathologic analysis]

Objective: To investigate the clinical and pathological characteristics and prognosis of ovarian clear cell borderline tumor. Methods: A total of 12 cases of ovarian clear cell borderline tumors recorded were collected from May 2011 to December 2017 at Obstetrics and Gynecology Hospital, Fudan University.Clinical histories were retrieved and pathological slides were reviewed. Results: The age of the patients ranged from 35 to 65 years with a mean age of 52 years. Seven cases were associated with cystic endometriosis of the ovary. All tumors consisted of irregular and crowded glands or cysts embedded in a fibromatous stroma. The cysts and glands were lined by mild to moderate atypical cells.CK7 and HNF-1β were expressed in all cases, and Naspin A was expressed in 11 cases. ARID1A expression was absent in 5 cases and p53 showed wild-type expression. None of the cases developed recurrence during follow-up ranging from 7 to 79 months. Conclusions: Ovarian clear cell borderline tumor may be associated with endometriosis and tumor suppressor gene ARIDA. The tumor has a good prognosis without recurrence and progression to carcinoma.