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.

[Evolution, controversies, and exploration of the nature of the definition of acute respiratory distress syndrome]

Acute respiratory distress syndrome (ARDS) is a collection of clinical syndromes characterized by a variety of heterogeneous causes. It includes diffuse lung diseases of various etiologies that ultimately lead to refractory hypoxia and severe acute respiratory failure. Despite advances in research and treatment of ARDS, its incidence and mortality continue to pose significant challenges in clinical practice. Since its inception in 1967, the definition of ARDS has undergone several revisions that have generated controversy and influenced the implementation of diagnostic and treatment strategies. At present, ARDS remains a formidable obstacle to both diagnosis and treatment. This article undertakes a comprehensive review of the evolution of ARDS definitions, examines the current diagnostic paradigm, and explores its far-reaching consequences. Our aim is to identify research directions, both in the realm of basic science and clinical practice, that are consistent with the nature of this complex disorder.

[Role of glucocorticoids in pneumocystis pneumonia in patients with non-HIV infection/AIDS (HIV/AIDS) and related mechanisms]

Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis carinii and is the most common fungal infection in HIV/AIDS patients. With the routine use of antiretroviral therapy (ART), the incidence of PCP infection in HIV/AIDS patients has decreased and the prognosis has improved significantly. On the other hand, the use of chemoradiotherapy and immunotherapy in patients with cancer, post-transplantation and autoimmune diseases are increasing dramatically, which has led to a similar increase in the incidence of PCP in these non-HIV/AIDS patients. There is a global shift in research on PCP from HIV-infected co-infected PCP (HIV-PCP) to non-HIV-infected co-infected PCP. The clinical course of non-HIV-PCP is rapid and severe, and the morbidity and mortality rates are higher than those of HIV-PCP. Studies have shown that 90% of non-HIV-PCP patients have a history of glucocorticoid use prior to infection, such as in patients with hematologic malignancies, solid organ transplants, and rheumatic diseases, and that long-term high-dose glucocorticoid use is an important risk for PCP susceptibility. Clinical practice has shown that PCP often occurs during the tapering of glucocorticoids, and a higher proportion of patients develop diffuse pulmonary lesions and, in more severe cases suffer from life-threatening acute respiratory failure. The pathogenesis of non-HIV infections associated with PCP is not yet clarified, and there is a lack of effective therapeutic practices that require further investigation.

[Pathogenesis and assessment of exertional dyspnea in chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a common respiratory system disease that seriously affects the quality of life and has a high mortality rate. Exertional dyspnea is the most common symptom in COPD patients with complexed pathogenesis and limited therapeutic drug effects. In this paper, we reviewed the relevant mechanisms and assessment, in order to improve understanding of the pathogenesis of exertional dyspnea in COPD, to emphasize the importance of accurate assessment, and to explore effective interventions that can effectively improve the degree of dyspnea and even delay or reverse the decline in lung function.

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.

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.

[Identification of study populations in the clinical study of chronic obstructive pulmonary disease: Surface-based or essence-based]

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder characterized by chronic bronchitis, emphysema, or both. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has had a tremendous impact on the diagnosis and treatment of COPD. This article reviewed the evolution of the definition of COPD in GOLD and the change of its treatment strategy. In addition, in light of relevant clinical studies, the paper attempted to illustrate the importance of understanding the heterogeneous nature of COPD, and analyzed the possible consequences of ignoring this nature, including confusion with bronchial asthma caused by lung function as the "gold standard" and excessive use of inhaled glucocorticoids (ICS). It is suggested that in clinical practice, the essential characteristics of COPD patients should be clarified by collecting a variety of information in order to provide personalized treatment for patients' assessment, therapy and rehabilitation. At the same time, more basic and clinical research on COPD should be conducted, based on the nature of the disease, to explore new treatment methods.

Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy followed by minimally invasive esophagectomy for locally advanced esophageal squamous cell carcinoma: a prospective multicenter randomized clinical trial

BACKGROUND

Neoadjuvant therapy is recommended for locally advanced esophageal cancer, but the optimal strategy remains unclear. We aimed to evaluate the safety and efficacy of neoadjuvant chemoradiotherapy (nCRT) versus neoadjuvant chemotherapy (nCT) followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal squamous cell carcinoma (ESCC).

PATIENTS AND METHODS

Eligible patients staged as cT3-4aN0-1M0 ESCC were randomly assigned (1 : 1) to the nCRT or nCT group stratified by age, cN stage, and centers. The chemotherapy, based on paclitaxel and cisplatin, was administered to both groups, while concurrent radiotherapy was added for the nCRT group; then MIE was carried out. The primary endpoint was 3-year overall survival. This study is registered with ClinicalTrials.gov (NCT03001596).

RESULTS

A total of 264 patients were eligible for the intention-to-treat analysis. By 30 November 2021, 121 deaths had occurred. The median follow-up was 43.9 months (interquartile range 36.6-49.3 months). The overall survival in the intention-to-treat population was comparable between the nCRT and nCT strategies [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.58-1.18; P = 0.28], with a 3-year survival rate of 64.1% (95% CI 56.4% to 72.9%) versus 54.9% (95% CI 47.0% to 64.2%), respectively. There were also no differences in progression-free survival (HR 0.83, 95% CI 0.59-1.16; P = 0.27) and recurrence-free survival (HR 1.07, 95% CI 0.71-1.60; P = 0.75), although the pathological complete response in the nCRT group (31/112, 27.7%) was significantly higher than that in the nCT group (3/104, 2.9%; P < 0.001). Besides, a trend of lower risk of recurrence was observed in the nCRT group (P = 0.063), while the recurrence pattern was similar (P = 0.802).

CONCLUSIONS

NCRT followed by MIE was not associated with significantly better overall survival than nCT among patients with cT3-4aN0-1M0 ESCC. The results underscore the pending issue of the best strategy of neoadjuvant therapy for locally advanced bulky ESCC.

Constraints on Heavy Decaying Dark Matter from 570 Days of LHAASO Observations

The kilometer square array (KM2A) of the large high altitude air shower observatory (LHAASO) aims at surveying the northern γ-ray sky at energies above 10 TeV with unprecedented sensitivity. γ-ray observations have long been one of the most powerful tools for dark matter searches, as, e.g., high-energy γ rays could be produced by the decays of heavy dark matter particles. In this Letter, we present the first dark matter analysis with LHAASO-KM2A, using the first 340 days of data from 1/2-KM2A and 230 days of data from 3/4-KM2A. Several regions of interest are used to search for a signal and account for the residual cosmic-ray background after γ/hadron separation. We find no excess of dark matter signals, and thus place some of the strongest γ-ray constraints on the lifetime of heavy dark matter particles with mass between 10^{5} and 10^{9}  GeV. Our results with LHAASO are robust, and have important implications for dark matter interpretations of the diffuse astrophysical high-energy neutrino emission.

[Current status and prospect of virtual reality technique's application in wound repair]

As a new technology of drug-free treatment, virtual reality technique has been used in various medical fields, and is being increasingly applied in the field of wound repair. Virtual reality technology can alleviate the pain caused by acute and chronic wounds, relieve the psychological anxiety of patients with wounds, and then facilitate the recovery of patients. This paper reviews the research progress of virtual reality technique's application as a clinical adjuvant therapy in wound repair in three aspects: pain treatment, psychological treatment, and functional rehabilitation, analyzes the advantages and disadvantages of this technique, and discusses the prospects of its further application in the field of wound repair.

Exploring Lorentz Invariance Violation from Ultrahigh-Energy γ Rays Observed by LHAASO

Recently, the LHAASO Collaboration published the detection of 12 ultrahigh-energy γ-ray sources above 100 TeV, with the highest energy photon reaching 1.4 PeV. The first detection of PeV γ rays from astrophysical sources may provide a very sensitive probe of the effect of the Lorentz invariance violation (LIV), which results in decay of high-energy γ rays in the superluminal scenario and hence a sharp cutoff of the energy spectrum. Two highest energy sources are studied in this work. No signature of the existence of the LIV is found in their energy spectra, and the lower limits on the LIV energy scale are derived. Our results show that the first-order LIV energy scale should be higher than about 10^{5} times the Planck scale M_{Pl} and that the second-order LIV scale is >10^{-3}M_{Pl}. Both limits improve by at least one order of magnitude the previous results.

[The enlightenment of foreign MD-MPH double degree program to the cultivation of high-level applied public health talents in China]

Objective: To understand the current status of foreign dual-degree programs of Medical Doctor (MD) and Master of Public Health (MPH) and provide evidence-based decision-making reference for promoting the education of high-level applied public health talents in China. Methods: The list of involved institutions and information of foreign MD-MPH dual-degree programs was collected through literature retrieval, online information searching, and additional survey of key figures. We extracted the details of each project regarding professional fields, core competence, length of schooling, teaching and learning arrangement, internship eligibility, and graduation assessment. Python 3.8.0 was used for data cleaning, and the occurrence frequency of related items in each dimension was calculated. Results: A total of 99 MD-MPH programs from 104 foreign institutions were included, among which 97.1% of them were implemented in universities from the United States. The School of Public Health provided 42.4% (42/99) of the programs. Epidemiology was the major discipline set up among most programs, accounting for 12.0% (29/241) of all the specialties involved. Epidemiological research methods, health policy management and practice, and public health practice were the top 3 core competencies to be mastered. Of the 99 programs, 87 gave information on the length of the program, of which 74.7% (65/87) were five years, 6.9% (6/87) were four years, and 18.4% (16/87) included both 4-year and 5-year programs. Conclusions: The international MD-MPH programs were sophisticated and mainly organized by the School of Public Health alone or in conjunction with the School of Medicine. Epidemiology is the core course and competence objective, with a length of 4-5 years. Through learning experience from international MD-MPH programs and the Chinese unique medical development background, China should optimize its medical education system to develop a suitable talent training strategy for MD-MPH dual-degree programs in the new era.

[Hot issues in robotic-assisted thoracic day surgery]

The application of day surgery on thoracic surgery is just started, and the innovation of surgical robots and their application on thoracic surgery bring new opportunities to the development of thoracic day surgery. However, the clinical practice of robot-assisted thoracic day surgery (RTDS) in China still has challenges and disagreements. Based on the experience of domestic experts in the field of RTDS clinical practice, this review discussed several key points of RTDS, including the future direction of RTDS, adjusting the indications according to their own conditions for the institutions carrying out RTDS, the robot-assisted advantage of RTDS being brought into play during the operation, and the perfect post-discharge follow-up mechanism being an important guarantee for the safe development of RTDS, to promote the application progress of RTDS in China.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

Effect of Na2O and ZnO on the microstructure and properties of laser cladding derived CaO-SiO2 ceramic coatings on titanium alloys

To improve the bioactivity of titanium alloy (Ti-6Al-4V), CaO-SiO₂ coatings on titanium alloys were fabricated using laser cladding method. The effect of Na₂O and ZnO on the microstructure and properties of the prepared coatings was discussed. The microstructure of the CaO-SiO₂ coatings consists of cellular grains and cellular dendrites. The mutual diffusion of elements occurs between the coating and substrate. The base CaO-SiO₂ coating is composed of different phases including CaTiO₃, α-Ca₂(SiO₄), SiO₂, TiO₂ and CaO. The formation of CaTiO₃ in the ceramic layer was analyzed through thermodynamics. Na₂O has little influence on the microstructure, average hardness and wear resistance. When ZnO is added to the precursor, the microstructure turns to cell dendrite, and ZnO and Zn₂SiO₄ appear in the corresponding coating. The addition of ZnO reduces the average hardness and wear resistance of the ceramic layer. The in vitro soaking in SBF shows that the laser cladding coating has the ability to form an apatite layer.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

Understanding and perception of direct-to-consumer genetic testing in Hong Kong

Direct-to-consumer genetic testing (DTCGT) is gaining popularity in Hong Kong (HK). As DTCGT forgoes specialist medical involvement, healthcare professionals have raised concerns regarding its validity, utility, and the public's ability to interpret DTCGT results. Thus, genetic counseling (GC) is recommended to facilitate understanding of DTCGT. This study aimed to investigate HK public's perception toward DTCGT and the importance of GC in DTCGT. A total of 304 HK adults were invited to complete a 37-item survey online. Participants' genomic literacy, understanding and attitude toward DTCGT and GC, and responses to a mock DTCGT scenario were assessed. 48% of participants were aware of DTCGT while 82% indicated an interest. 30% of participants were aware of GC services in HK; 49% were interested in GC services for understanding DTCGT results. Participants scored on average 7.6/11 in the genomic sequencing knowledge scale and were weak in limitations of genomic testing. In the mock DTCGT scenario, 73% of participants expressed concern with the positive results initially. After being explained limitations of DTCGT, 40% of participants reported decreased concern. Reduced perceived helpfulness in medical management and lifestyle modification were also reported by 35% and 27%, respectively. This HK population demonstrated a high level of awareness and interest in DTCGT. As potential DTCGT users, they might experience excess concern and overestimate the usefulness of positive DTCGT results, particularly in medical management. The importance of GC to educate and guide interpretation of DTCGT results is supported; yet the awareness and access of GC services is inadequate in HK.

[Lung cancer screening in urban Beijing from 2014 to 2019]

Objective: To analyze the current status of lung cancer screening among residents in Urban Beijing Cancer Screening Program, 2014-2019. Methods: Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program, residents aged 40 to 69 were recruited from 80 streets in six districts of Beijing (Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai, and Shijingshan District) by using a cluster sampling method. Subjects who were evaluated as high-risk individuals by using the questionnaire received Low-Dose spiral Computed Tomography (LDCT) screening in designated hospitals. All participants were followed up annually using active and passive follow-up methods to obtain their health outcomes (diagnosed with lung cancer or not). The proportion of high-risk cases evaluated by using the questionnaire, clinical recall rate for receiving LDCT screening, the proportion of cases with positive pulmonary node, incidence rate, cumulative incidence rate, and the proportion of patients with stage 0 or Ⅰ were calculated. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) among individuals who experienced different screening scenarios. Results: A total of 88 044 residents with the age of (57.4±7.4) with completed high-risk assessment were included in the analysis. 23.14% of participants were evaluated as high-risk individuals by using the questionnaire. The clinical recall rate was 52.26% among the high-risk individuals. The positive rate of pulmonary node detected by LDCT was 10.99%. The incidence rate of lung cancer among males and females aged 40-69 years were 172.82/100 000 person-years and 133.52/100 000 person-years, respectively after 3 years follow-up. The incidence rates increased with age (P_trend<0.001). The incidence rate of lung cancer among high-risk individuals was 259.22/100 000 person-years, with the HR (95%CI) about 2.27 (1.83-2.81) when compared with that among low-risk individuals. The incidence rate and cumulative incidence rate of lung cancer among individuals with positive pulmonary node detected by LDCT were 1 825.03/100 000 person-years and 4 615.38/100 000, respectively, with the HR (95%CI) about 13.80 (8.91-21.36) when compared with that among individuals with no or negative pulmonary node. The early diagnosis rate among individuals who received LDCT screening was 70.21%, which was higher than that among individuals with no LDCT screening (45.45%). Conclusion: Individuals with a high risk of lung cancer in Beijing have a better recall rate of receiving LDCT screening. Using LDCT screening among high-risk individuals is an effective strategy to detect lung cancer cases and improve the early detection rates of lung cancer in Beijing, China.

Do distribution and expansion of exotic invasive Asteraceae plants relate to leaf construction cost in a man-made wetland?

Exotic species especially Asteraceae plants severely invade wetlands in Shenzhen Bay, an important part of the coast wetland in Guangdong-Hong Kong-Macau Bay Area, China. However, the reasons causing their expansion are unclear. The leaf traits and expansion indices of six invasive Asteraceae plants from the Overseas Chinese Town (OCT) wetland were studied and the results showed that nearly 45% of the total plant species (31 out of 69 species) in the OCT wetland, belonging to 15 families and 27 genera, were exotic invasive species. The expansion indices of six Asteraceae species negatively correlated with their leaf construction cost based on mass (CCM), caloric values and carbon concentration, but their relations with ash content were positive. Multiple linear regression analysis revealed that CCM was the most important factor affecting the expansion of an exotic species, indicating CCM may be an important reason causing the expansion of exotic species in coastal wetlands.

[Comparison of severity classification of Chinese protocol, pneumonia severity index and CURB-65 in risk stratification and prognostic assessment of coronavirus disease 2019]

Objective: To investigate the application of severity classification according to the protocol on the Diagnosis and Treatment of coronavirus disease 2019(COVID-19)by the National Health Commission of China, pneumonia severity index(PSI) and CURB-65　in risk stratification and prognostic assessment of COVID-19. Methods: Clinical data of 234 in-hospital patients with COVID-19 were collected and retrospectively reviewed in Wuhan Tongji Hospital. Patients were divided into 3 groups (common, severe, and critical type) at admission according to the sixth version of the protocol issued by the National Health Commission of China on Diagnosis and Treatment of COVID-19. At the same time, the severity of pneumonia was calculated by PSI and CURB-65, and the patients were stratified into 3 risk groups, namely mild, moderate, and severe groups. The hospital mortality rate was evaluated in each group. Sensitivity, specificity, positive predictive values, negative predictive values, and the area under the receiver operating characteristic(ROC) curve(AUC) for predicting hospital mortality in each rule were assessed. Results: According to the severity classification of Chinese protocol, the proportion of patients with common type, severe type, and the critical type was 15.8%, 75.6%, and 8.5%, respectively. No in-hospital death occurred in the common type. As for PSI and CURB-65, greater proportions of patients were classified as low risk(79.1% and 75.6%, respectively), while smaller proportions of patients were classified as moderate and high risk(16.2%, 15.0%; 4.7%, 9.4%, respectively). In-hospital death occurred in low and moderate risk patients identified by these 2 scoring systems. The mortality of the critical group of the Chinese protocol was 65%, and the sensitivity and specificity of predicting in-hospital mortality were 36.4% and 97.0%, respectively. The mortality in the high risk group of PSI and CURB-65 was 100% and 77.3%. The risk class V of PSI and CURB-65 score 3-5 had high specificity(100% and 97.4%, respectively)but low sensitivity(33.3% and 51.5%, respectively)in predicting in-hospital mortality. The AUC of the Chinese protocol severity classification, PSI, and CURB-65 was 0.735, 0.951, and 0.912. The optimal cut-off point of PSI was risk class Ⅳ, and the sensitivity and specificity for predicting mortality were 90.9% and 90.5%. The optimal cut-off point of CURB-65 was score 2, and the corresponding sensitivity and specificity were 84.8% and 85.6%. Conclusions: PSI and CURB-65 can be used for risk stratification and prognostic assessment in patients with COVID-19.

[Breast cancer screening in urban Beijing, 2014-2019]

Objective: To analyze the current status of breast cancer screening among females in Urban Beijing Cancer Screening Program, 2014-2019. Methods: Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program, women residences aged 40 to 69 were recruited from 80 streets in six districts of Beijing (Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan District) using cluster sampling method. General demographic information and potential risk factors, results of clinical examination and follow-up outcomes of the target population (diagnosed breast cancer or not) were collected using epidemiological questionnaire, risk evaluation, clinical examination using ultrasound and (or) joint screening with mammography and follow-up, respectively. Proportion of high-risk cases evaluated by the questionnaire, recall rate, proportion of cases with BI-RADS grade 3 and BI-RADS grade 4/5, proportion of the cases with stage 0 or I, incidence rate and cumulative incidence rate were calculated. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) among females who experienced different screening scenario. Results: A total of 53 916 women with the age of (57.2±7.3) completed high-risk assessment were included into analysis. The proportion of overweigh and obesity were 40.90% (22 053 cases) and 15.34% (8 270 cases), respectively. A total of 17 535 cases (32.52%) were evaluated as positive case detected by the questionnaire. The clinical recall rate was 47.64% (8 353 cases) among the high-risk females. The positive rate detected by ultrasound or mammography alone was 1.84% and 4.00%, while the suspicious positive detection rates were 14.50% and 17.83%, respectively. The positive rate and suspicious positive rate detected by joint screening using ultrasound and mammography were 5.44% and 27.74% respectively. In total, 252 cases were diagnosed with breast cancer after an average of 2.68 years follow-up. The incidence rate and cumulative incidence rate of breast cancer were 174.34/100 000 person years and 470/100 000, respectively. The early detection rate was 68.6% among the residences who received clinical examination. Compared with the negative residence evaluated by the questionnaire, the positive cases has a 55% higher risk of diagnosed with breast cancer (HR=1.55, 95%CI:1.20-2.00); Cases that recognized by baseline ultrasound and mammography joint screening as BI-RADS 4/5 and BI-RADS 3 have higher risk of diagnosed with breast cancer than that of with the results of BI-RADS 1-2, with the HR of 12.60 (95%CI:6.49-24.47) and 1.89 (0.93-3.83), respectively. Conclusion: Females with high risk of breast cancer in Beijing have a better recall rate of receiving the clinical screening examination. Joint using ultrasonography and mammography in breast cancer screening can improve the positive detection rate among high risk females.

[Thoughts and practice on the treatment of severe and critical new coronavirus pneumonia]

Severe and critical coronavirus pneumonia 2019 (COVID-19) often occurs in elder patients with multiple comorbidities, and severe hypoxemia events constitute a key factor for the deterioration of some cases. The critical type of COVID-19 could progress into acute respiratory distress syndrome and multi-organ dysfunction, which are the major causes of death. Early non-invasive ventilation (NIV) treatment of possible pathophysiological abnormalities is helpful to improve prognosis. Close monitoring of oxygenation, reducing patients' oxygen consumption, active psychological intervention, and rapid handling of severe hypoxemia events are the key factors for successful NIV treatment. In addition, active adjuvant therapies such as correcting coagulation dysfunction, providing proper nutritional support, accurate volume control, and safe individualized blood glucose monitoring are of great significance.

[Analysis on the consciousness of the early cancer treatment and its influencing factors among urban residents in China from 2015 to 2017]

Objective: To understand the consciousness of the cancer early treatment and its demographic and socioeconomic factors. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The questionnaire collected personal information, the consciousness of the cancer early treatment and relevant factors. The Chi square test was used to compare the difference between the consciousness of the cancer early treatment and relevant factors among the four groups. The logistic regression model was used to analyze the influencing factors related to the consciousness of the cancer early treatment. Results: With the assumption of being diagnosed as precancer or cancer, 89.97% of community residents, 91.84% of cancer risk assessment/screening population, 93.00% of cancer patients and 91.52% of occupational population would accept active treatments (P<0.001). If the immediate family members were diagnosed as precancer or cancer, people who would encourage their family members to receive early treatment in the four groups accounted for 91.96%, 91.94%, 92.44% and 91.55%, respectively (P<0.001). The company employees, annual household income with 40 000 yuan and more and other three groups had a relatively better consciousness of the cancer early treatment (P<0.05). Male, widowed, unemployed and from the central and western regions had a relatively worse consciousness of the cancer early treatment (P<0.05). Conclusion: Residents in urban China participants had a good consciousness of the cancer early treatment. The marital status, occupation, annual household income and residential regions were major factors related to the consciousness of the cancer early treatment.

[Diagnosis and treatment experience of 161 cases of pancreatic serous cystic neoplasm in single center and analysis of cause of preoperation misjudgement]

Objective: To analyze the causes of preoperative miscarriage of pancreatic serous cystadenoma (SCN) and find the ways to improve it. Methods: Clinical data of 425 pancreatic cystic neoplasm patients who underwent surgical resection from January 2006 to December 2016 in Department of Pancreatic Surgery in Huashan Hospital were retrospectively analyzed.Excel database was created which covered 128 fields of 7 fields: general information of patients, preoperative blood biochemical indexes, tumor markers, surgical related data, postoperative complications, imaging findings and pathology.One hundred and sixty-one cases of SCN were analyzed in depth, mainly in three aspects: surgical benefit, preoperative imaging diagnostic value and interference factors in preoperative judgement.The classification data were analyzed by χ(2) test and the quantitative data were analyzed by t test.The Logistic regression model was used for multiple factor analysis. Results: Of the 425 PCN cases surgically removed, 161 cases (37.9%) were SCN, the incidence of operative complications was 40.4%(65/161), the hospitalization days was (20.7±12.1)days and the medical cost was (75 267±37 866) yuan.Only 3 of 161 cases of SCN were accurately diagnosed by preoperative imaging methods, 61 cases were diagnosed as "cystic lesions of pancreas" (37.9%) and 52 cases were diagnosed as "pancreatic cystadenoma" (32.3%). SCN was misdiagnosed as MCN(32.3%) and IPMN(28%) before operation.25.5% of them were diagnosed as SCN before operation, but still underwent radical operation.The rate of preoperative imaging diagnosis for identifying SCN was 62.8%.The lack of preoperative endoscopy and the lack of understanding of the image characteristics and biological behavior of SCN were the most important factors affecting the accuracy of preoperative judgment.Statistics found that gender, age, CA125 and tumor location can be used as independent factors contribute to the clinical identification(χ(2)=8.995, P=0.003; χ(2)=10.019, P=0.007; t=3.157, P=0.002; χ(2)=6.790, P=0.009). Logistic analysis showed that women, older than 60 years old, the tumors located in the pancreatic body and tail were the independent factors of SCN classification and diagnosis (OR=0.481, 0.376, 0.577, 0.666, 95% CI: 0.305-0.759, 0.199-0.710, 0.361-0.924, 0.433-1.024, P=0.002, 0.003, 0.022, 0.064). Conclusions: SCN has more benign biological behavior.Although surgical excision is acceptable for clinical safety, the corresponding benefit is very limited.It is possible to improve the rationality of SCN clinical operation decisions to some extent by performing endoscopic examination, imaging doctors to improve the SCN feature recognition and surgeons to enhance the awareness of SCN.

[Analyses on the difference and trend of lung cancer incidence in Beijing, 2000-2012]

Objective: To analyze the temporal trends of lung cancer incidence between age, gender (male and female) and areas (urban and rural) in Beijing during 2000-2012. Methods: The lung cancer cases were collected by Beijing cancer registry between 2000 and 2012. We calculated the incidence and world age-standardized incidence rates (ASR) which standardized by World Segi's population. Also, the average age and median age of lung cancer incidence were calculated. The annual percent changes (APC) for the whole period, for the gender ratio and for the area ratio were evaluated with Joinpoint analysis. Result: Totally, 81 378 new cases of lung cancer were diagnosed in 2000-2012 with the average incidence rate of 52.67/100 000. The incidence rate increased by 4.84% per year from 38.99/100 000 to 65.33/100 000, but the APC of ASR was 1.69% (P<0.001) . The ASR increased 0.54% (P=0.029) per year in urban from 29.71/100 000 to 30.55/100 000 and 3.93% (P<0.001) in rural areas from 24.02/100 000 to 35.79/100 000. The incidence ratio of urban to rural decreased from 1.24 to 0.85 (APC=-3.29%, P<0.001). The incidence ratio of male to female decreased from 1.84 to 1.69 (APC=-0.45%, P=0.019).The average age of lung cancer incidence of male and female increased from 66.27 and 66.00 to 68.97 and 69.11 (P<0.001), respectively. Conclusion: The incidence rate of lung cancer increased slightly in urban areas but increased significantly in rural areas during 2000-2012, the area ratio trend was declined. The average age of lung cancer occurrence gradually increased, but the temporal trends varied with age group. The gender ratio decreased from 2000 to 2012.

The cerebellum's contribution to beat interval discrimination

From expert percussionists to individuals who cannot dance, there are widespread differences in people's abilities to perceive and synchronize with a musical beat. The aim of our study was to identify candidate brain regions that might be associated with these abilities. For this purpose, we used Voxel-Based-Morphometry to correlate inter-individual differences in performance on the Harvard Beat Assessment Tests (H-BAT) with local inter-individual variations in gray matter volumes across the entire brain space in 60 individuals. Analysis revealed significant co-variations between performances on two perceptual tasks of the Harvard Beat Assessment Tests associated with beat interval change discrimination (faster, slower) and gray matter volume variations in the cerebellum. Participant discrimination thresholds for the Beat Finding Interval Test (quarter note beat) were positively associated with gray matter volume variation in cerebellum lobule IX in the left hemisphere and crus I bilaterally. Discrimination thresholds for the Beat Interval Test (simple series of tones) revealed the tendency for a positive association with gray matter volume variations in crus I/II of the left cerebellum. Our results demonstrate the importance of the cerebellum in beat interval discrimination skills, as measured by two perceptual tasks of the Harvard Beat Assessment Tests. Current findings, in combination with evidence from patients with cerebellar degeneration and expert dancers, suggest that cerebellar gray matter and overall cerebellar integrity are important for temporal discrimination abilities.

[An analysis of incidence trends and characteristics of soft tissue sarcoma in Beijing, 1999-2013]

Objective: To analyze the incidence trends and to describe the characteristics of soft tissue sarcoma (STS) among residents in Beijing from 1999 to 2013. Methods: Medical information of the cases diagnosed as STS(ICD10: C47&C49) from 1999 to 2013 in Beijing was extracted from the population-based database of Beijing Cancer Registry.Crude incidence rate, age-standardized incidence rates to Chinese population (ASRC)and the world population(ASRW) were calculated. The characteristics of the STS cases in different gender and age groups from urban and rural areas were respectively analyzed.The incidence trends and annual percentage changes (APC) during last 15 years were analyzed by using JoinPoint 3.4.3 software. Results: A total of 2 048 cases were diagnosed as STS during the study period and the incidence rate of STS was 1.15 per 100 000 person-years. The ASRC was 0.74 per 100 000 person-years and ASRW was 0.86 per 100 000 person-years, respectively. Except for the impact of changes in the age composition, the APC of ASRW from 1999 to 2013 was 3.95%. For males, the incidence rate was increased from 0.65 per 100 000 in 1999 to 1.51 per 100 000 in 2013, and the APC was 4.27% (P<0.05); For females, the incidence rate was increased from 0.61 per 100 000 in 1999 to 0.91 per 100 000 in 2013, and the APC was 3.38% (P<0.05). In urban area, the incidence rate increased from 1.14 per 100 000 in 2000 to 1.35 per 100 000 in 2013, and the APC was 2.70% (P=0.05); In rural area, the incidence rate increased from 0.57 per 100 000 in 2000 to 0.98 per 100 000 in 2013, and the APC was 4.66% (P=0.04). 85.89%cases were pathologically diagnosed.Among them, undifferentiated pleomorphic sarcoma was the most common subtype, which accounting for 19.22%, followed by liposarcoma (19.04%), malignantnerve sheath tumor (10.18%), fibrosarcoma (10.06%)and sarcoma without definite type(7.22%). Conclusions: The incidence rate of STS is still increasing, especially in the rural area of Beijing. The most common subtypes of STS in different age-groups were different. Further study is needed to explore the high risks of STS in the population with specific characteristics.

[Molecular epidemiologic study on Mycobacterium tuberculosis from drug resistance monitoring sites of Guangdong Province, 2015]

Objective: To understand the characteristics of Mycobacterium tuberculosis (MTB) in epidemiology and distribution from Guangdong Province, and to explore the risk factors associated with drug resistance. Methods: A total of 225 clinical strains of MTB collected from 5 drug resistance monitoring sites of Guangdong Province in 2015 were tested by Regions of Difference 105 (RD105) deletion test and 15 loci mycobacterial interspersed repetitive units (MIRU) were used for genotyping. Gene clustering was analyzed using BioNumerics7.6. Drug susceptibility test was tested by proportion method. The statistical analysis used chi-square test and multivariate logistic regression. Results: There were 158 (70.2%) Beijing family strains from the 225 cases. Hunter-gaston index of MIRU loci varied from each other. The MTBs from Guangdong Province were categorized into 2 gene clusters by clustering analysis in which the rate of cluster of complexⅠwas significantly higher than complexⅡ(χ(2) values were 9.331, P values were 0.020). It was found by multivariate logistic regression that Qub11b was associated with resistance to rifampicin and isoniazid (P values were 0.013, 0.012 respectively.), ETR F with resistance to isoniazid, streptomycin, ethambutol and ofloxacin (P values were 0.039, 0.040, 0.023 and 0.003 respectively), Mtub21 with resistance to capreomycin (P values were 0.040), and QUB26 with resistance to ethionamide (P values were 0.047). Conclusions: The genes of MTB from Guangdong Province were of polymorphisms and the distribution of strains were stable. QUB11b, ETR F, Mtub21 and QUB26 could be related to biomarkers for predicting drug resistance.

[Analysis of the effect of menopausal status and molecular subtype on survivals among breast cancer patients]

Objective: To analyze the associations between molecular subtypes and overall breast cancer survival among premenopausal and postmenopausal breast cancer in Beijing, and to provide basic information for breast cancer clinical researches and control. Methods: All the resident patients diagnosed with breast cancer in four well-established hospitals were retrieved from Beijing cancer registry, related information, such as TNM stages, receptor status, histological grade, height, weight, were collected by case extraction. Cancer registration information and population-based follow-up information were used to acquire survival outcome. All the patients were followed up until 31 December 2015, 4 531 cases with invasive, primary breast were included in the final analysis. All the cases were classified into Luminal and non-Luminal according to receptor status. Five-year survival rates of the two subtypes were estimated by the life-table method. Multivariable Cox proportional hazards models were employed to evaluate the associations between molecular subtypes and breast cancer survival. Results: Of all the 4 531 patients, premenopausal patients accounted for 44.5% (2 017 cases) and postmenopausal patients accounted for 55.5% (2 514 cases). 643 cases died during the study period. Overall five-year survival was 89.5% (95%CI: 88.6%-90.4%), for premenopausal and postmenopausal patients, they were 92.1% (95%CI: 90.9%-93.3%), and 87.5% (95%CI: 86.2%-88.8%), respectively. Among all the patients, 3 730 patients had molecular subtype, 76.7% (2 861 cases) were Luminal breast cancer, and 23.3% (869 cases) were non-Luminal breast cancer. Five-year survival rates for Luminal and non-Luminal were 91.8% (95%CI: 90.8%-92.8%), and 83.2% (95%CI: 80.7%-85.7%), respectively. No matter in premenopausal or postmenopausal patients, non-Luminal breast cancer had significantly higher risk of death compared to Luminal breast cancer (premenopausal: HR=1.85, 95%CI: 1.26-2.73; premenopausal: HR=1.42, 95%CI: 1.07-1.88). Conclusion: For both premenopausal and postmenopausal breast cancer patients, non-Luminal breast cancer had lower five-year survival rates than Luminal breast cancer, which was a risk factor on breast cancer survival.

Identification and sequence analysis of a novel HLA-A*33 allele, HLA-A*33:88

HLA-A*33:88 differs from HLA-A*33:03:01 by one nucleotide exchange at position 475, G>A (codon 135 GCG>ACG).

[Rapidly progressive pulmonary malignant perivascular epithelioid cell tumor: a case report and literature review]

Objective: To analyze the pathogenesis, clinical features, diagnosis and differential diagnosis of primary perivascular epithelioid cell tumor(PEComa). Methods: The clinical features, auxiliary examinations and diagnosis of a case with rapidly progressive pulmonary malignant PEComa were reported and the related literatures were reviewed.The literature review was carried out respectively in Wanfang Data, CNKI and PubMed from Jan. 1975 to Jul. 2015 with "pulmonary malignant perivascular epithelioid cell tumor" and "PEComa" being the search terms. Results: A 50 year-old female patient was admitted to the hospital on September 4, 2014 because of cough and dyspnea for 60 days, hemoptysis for 40 days and fever for 7 days.Chest CT scan showed diffuse small nodules with infiltrative border and multiple pure and mixed ground-glass opacity. Transbronchial lung biopsy (TBLB) was performed and the pathological study confirmed the diagnosis of primary pulmonary malignant PEComa. The patient declined further specific therapy, but followed by rapidly progressive respiratory failure, and died two weeks after the diagnosis. A total of 8 literatures were retrieved from Wanfang Data, CNKI and PubMed and all of them were case reports.There were 3 male and 5 female patients, aging from 50 to 79 years.Radiographically, the previously reported cases presented as round and well-circumscribed masses with or without multiple nodules in both lungs. The symptoms had no specificity. Conclusions: Pulmonary malignant PEComa is a rare disease.It is easily misdiagnosed because of non-specific clinical and imaging manifestations.The final diagnosis depends on pathological biopsy.TBLB is an effective diagnostic method.

A novel HLA-B*40 allele, B*40:01:40, identified in a Chinese individual

A new allele, officially named B*40:01:40, was detected in a Chinese individual by sequence-based typing (SBT). The new allele differs from B*40:01:01 by a single nucleotide exchange at position 99 in codon 9, which results in synonymous substitution and seems not to compromise the HLA complex and T-cell receptor interaction.

HLA-A*02:513, a novel HLA-A*02 allele

HLA-A*02:513 shows one nucleotide difference with A*02:07:01 (125G > A).

Identification of a novel HLA-DRB1*14 allele, HLA-DRB1*14:150, in a Chinese individual

HLA-DRB1*14:150 shows one nucleotide difference when compared with DRB1*14:54:01 at codon 49 (A > P).

The effect of rapamycin on TGFβ1 and MMP1 expression in a rabbit model of urethral stricture

PURPOSE

To investigate the effect of rapamycin on TGFβ1 and MMP1 expression in a rabbit model of urethral stricture.

METHODS

Twenty-four adult New Zealand male rabbits underwent an electrocoagulation of the bulbar urethra with a 13Fr pediatric resectoscope. Then rabbits were randomly divided into three groups: (1) normal control group: normal saline (NS), (2) the vehicle control group: dimethyl sulfoxide (DMSO), and (3) the treatment group: effective-dose rapamycin in DMSO (Ra), with 12, 6, and 6 rabbits in each group, respectively. Drugs were given by urethral irrigation daily for 4 weeks. Urethral tissue was harvested for histological and molecular analyses. TGFβ1 and MMP1 expression levels were evaluated by real-time quantitative PCR and immunohistochemistry.

RESULTS

Ten, six, and six rabbits were evaluated finally in Ra, DMSO, and NS group, respectively. Histological examination revealed the distribution of fibrosis and the degree of collagen deposition in the Ra group were smaller and slighter than the two control groups. Collagen content was significantly less in the Ra group than in the DMSO group (P < 0.001) and the NS group (P < 0.001). qRT-PCR analysis showed a higher expression of MMP1 mRNA in the Ra group than in the DMSO group (P < 0.001) and the NS group (P < 0.001). Immunohistochemistry showed the protein levels of MMP1 in the Ra group were significantly increased when compared with the DMSO group (P < 0.01) and the NS group (P < 0.01). On the other hand, no statistical difference could be found between every two groups in both mRNA and protein levels of TGFβ1.

CONCLUSIONS

Rapamycin enhances the expression of MMP1 in a rabbit model of urethral stricture, but has no direct effect on the expression of TGFβ1.

Selection of human single domain antibodies recognizing the CMYC protein using enhanced intracellular antibody capture

Protein functions that are mediated by interaction with other proteins (protein-protein interactions, PPI) are important for normal cell biology and also in disease. Molecules that can interfere with PPI are required as laboratory tools to dissect function, as lead drug surrogates for target validation and as templates for drug discovery. We describe enhanced developments to Intracellular Antibody Capture (IAC) technology that can select antibody fragments able to interact with targets in cells. This is illustrated by the isolation of single heavy chain variable region domains binding to the basic-helix-loop-helix and leucine zipper region of the CMYC oncogenic protein. The enhanced IAC (eIAC) methodology deploys screening in yeast cells of a single diverse library initially with randomization only of CDR3. Further sequential randomization of CDR2 and CDR1 of three independently selected anti-CMYC clones illustrates an in vivo affinity maturation process. This concise eIAC approach facilitates the rapid selection of antibody fragments to explore the proteome interaction spectrum of mammalian cells and disease targeting.

An expression profiling analysis of hybrid millet and its parents at grain filling stage

Heterosis has been widely used in crop breeding and production. However, a shortage of genes known to function in heterosis significantly limits our understanding of the molecular basis underlying heterosis. Here, we report 740 differentially expressed genes (DEGs) in the leaves of the hybrid millet Zhang No.5 and its parents at the grain filling stage determined using Solexa Illumina digital gene expression. Of the 740 DEGs, 546 were from the hybrid and its parents and most were up-regulated in the hybrid. Particularly, a large number of DEGs related to starch and carbohydrate metabolism and 2 DEGs encoding chlorophyll a/b binding proteins were up-regulated in hybrid millet. Moreover, all DEGs were enriched in the biological process and molecular function, and no DEGs were found to be enriched in the cellular component of GO terms. Pathway enrichment using KEGG showed that several DEGs were enriched in the circadian rhythm pathway. Further analysis revealed that the altered circadian rhythm, which mediates photosynthesis and carbohydrate accumulation, may play an important role in heterosis of the hybrid millet.

Cloning and sequence analysis of sucrose phosphate synthase gene from varieties of Pennisetum species

Sucrose phosphate synthase (SPS) is an enzyme used by higher plants for sucrose synthesis. In this study, three primer sets were designed on the basis of known SPS sequences from maize (GenBank: NM_001112224.1) and sugarcane (GenBank: JN584485.1), and five novel SPS genes were identified by RT-PCR from the genomes of Pennisetum spp (the hybrid P. americanum x P. purpureum, P. purpureum Schum., P. purpureum Schum. cv. Red, P. purpureum Schum. cv. Taiwan, and P. purpureum Schum. cv. Mott). The cloned sequences showed 99.9% identity and 80-88% similarity to the SPS sequences of other plants. The SPS gene of hybrid Pennisetum had one nucleotide and four amino acid polymorphisms compared to the other four germplasms, and cluster analysis was performed to assess genetic diversity in this species. Additional characterization of the SPS gene product can potentially allow Pennisetum to be exploited as a biofuel source.

Overregulation of microRNA-212 in the poor prognosis of esophageal cancer patients

There have been few reports evaluating the expression and function of the microRNA miR-212 in esophageal cancer. The aim of this study was to investigate the relationship between miR-212 expression and clinicopathological factors and prognoses of esophageal cancer. MicroRNA was extracted from 46 esophageal cancer patients using the Taqman MicroRNA assay. All patients were at the same tumor node metastasis stage, but with different prognoses, and had all undergone surgery. The correlation between miR-212 expression and clinicopathological features was analyzed and the significance of miR-212 as a prognostic factor as well as its relationship with survival was determined. miR-212 expression was higher in patients with poor prognoses than in those with good prognoses (P < 0.0001). Kaplan-Meier analysis results showed that the miR-212 expression level was significantly correlated with survival time (P = 0.024). Patients with higher expression of miR-212 showed longer survival times. Cox multi-factor model analysis showed that miR-212 expression was significantly correlated with survival time (P = 0.026). mir-212 is related with prognostic factors and survival time and may be a biomarker for esophageal cancer.

Characteristics of unrecognised bipolar disorder in patients treated for major depressive disorder in China: general versus psychiatric hospitals

OBJECTIVES

Bipolar disorder is often misdiagnosed as major depressive disorder. Such misdiagnosis partly depends on the type of treatment setting. This study compared general hospital psychiatric units with psychiatric hospitals in China with respect to basic demographic and clinical characteristics of patients with unrecognised bipolar disorder who are treated for major depressive disorder.

METHODS

Patients treated for major depressive disorder were consecutively examined in 13 health centres (6 general hospital psychiatric units and 7 psychiatric hospitals) in China. Their socio-demographic and clinical features were recorded using a standardised protocol and data collection procedure. The DSM-IV diagnoses were established using the Mini-International Neuropsychiatric Interview.

RESULTS

Of the 1487 patients included in the study, 309 (20.8%) were diagnosed with bipolar disorder. There was no significant difference between general hospital psychiatric units and psychiatric hospitals in the ratio of all types of unrecognised bipolar disorders (χ2 = 0.008, degrees of freedom = 1, p = 0.9) and bipolar II disorders (χ2 = 3.1, degrees of freedom = 1, p = 0.08). The proportions of unrecognised bipolar I disorders (χ2 = 4.1, degrees of freedom = 1, p = 0.04) differed significantly between the 2 types of study site. Multivariate analyses showed that patients with bipolar I disorders with more seasonal depressive episodes were more likely to receive treatment in general hospital psychiatric units (odds ratio = 3.3, 95% confidence interval = 1.1-9.8).

CONCLUSION

Patients with bipolar I disorders receiving treatment in general hospital psychiatric units had different clinical characteristics compared to their counterparts treated in psychiatric hospitals in China.

Influence of fluoride additions on biological and mechanical properties of Na2O-CaO-SiO2-P2O5 glass-ceramics

Two series of Na2O-CaO-SiO2-P2O5 glass-ceramics doped with NH4HF2 (G-NH4HF2) or CaF2 (G-CaF2) have been prepared by sol-gel method. The glass-ceramic phase composition and morphology were characterized by X-ray diffraction (XRD) and scanning electron microscopy coupled with energy dispersive spectroscopy (SEM-EDS). The mechanical properties and thermal expansion coefficient were measured by a microhardness tester, an electronic tensile machine and a thermal expansion coefficient tester. The structure difference between these two glass-ceramics was investigated by Fourier transform infrared spectroscopy (FTIR), and the in vitro bioactivity of the glass-ceramics was determined by in vitro simulated body fluid (SBF) immersion test. The hemolysis test, in vitro cytotoxicity test, systemic toxicity test and the implanted experiment in animals were used to evaluate the biocompatibility of the glass-ceramics. The mechanical properties of sample G-NH4HF2 are lower than that of sample G-CaF2, and the bioactivity of sample G-NH4HF2 is better than that of sample G-CaF2. The thermal expansion coefficients of these two glass-ceramics are all closer to that of Ti6Al4V. After 7 days of SBF immersion, apatites were induced on glass-ceramic surface, indicating that the glass-ceramics have bioactivity. The hemolysis test, in vitro cytotoxicity test and systemic toxicity test demonstrate that the glass-ceramics do not cause hemolysis reaction, and have no toxicity to cell and living animal. The implanted experiment in animals shows that bone tissue can form a good osseointegration with the implant after implantation for two months, indicating that the glass-ceramics are safe to serve as implants.

Abstract P4-11-08: A Pilot Safety and Feasibility Study of Concurrent Capecitabine and External Beam Irradiation in the Adjuvant Treatment of High Risk Early Stage Breast Cancer

Background: Capecitabine (Xeloda ®) is an oral 5-FU pro-drug that is preferentially converted to the active form 5-FU within tumor tissue, offering many of the same benefits of continuous 5-FU infusion with the convenience of oral delivery. In studies of patients receiving chemotherapy with or without radiation therapy, combination therapy has proved more efficacious than either modality alone. If radiation therapy can more effectively eliminate local microscopic residual disease, this will resultin improved local control and may potentially increase overall survival. This phase II study was performed to ascertain the safety and feasibility of capecitabine concurrent with radiation therapy in high risk non-metastatic breast cancer.

Materials and methods: Eligible patients had undergone surgery and chemotherapy for high risk breast cancer, defined for this study as either a T3 or T4 primary tumor, or N2 (≥4 nodes involved) or greater nodal status. Capecitabine was administered at 825 mg/m2 twice daily on days of radiotherapy. The primary endpoint of this study was toxicity, scored using CTCAE v 3.0, evaluated during therapy and in follow-up at intervals up to 12 months. Clinically significant toxicities were defined as skin toxicity or hematological toxicity of grade 3 or greater, or other toxicity felt related to capecitabine of grade 2 or greater. Feasibility was defined as percent of patients completing the course of drug, and the percent of patients completing radiation therapy to a dose of at least 50.4 Gy. Cosmesis was rated by the physician and the patient separately.

Results: 50 women were enrolled in this study; the mean age was 52 (range 33-77). T stage distribution was as follows: T0 4%, T1 16%, T2 50%, T3 18%, and T4 12%. N stage N0 6%, N1 18%, N2 44%, and N3 32%. Mean number of pathologically involved nodes was 8 (range 0-36); 56 % of patients were treated with neoadjuvant chemotherapy prior to definitive surgery, which for 84% was mastectomy. Four patients withdrew prior to starting or within the first week; of the remaining 46 patients, 10 had capecitabine discontinued or dose-reduced, and one patient died during treatment. Those patients who did not receive the full drug dose had on average 3.8 weeks of capecitabine therapy; of the overall 46 patients, 76 % received the intended dose of drug throughout the radiation treatments; 98% of patients received at least 50.4 Gy. Toxicities observed included 7 pts with grade 3 radiation dermatitis, 3 with grade 3 hand-foot syndrome, 1 with grade 4 diarrhea, and 1 with grade 5 cardiac arrest felt possibly related to capecitabine; 2 other grade 3 toxicities (range of motion limitation and bone pain) were felt not related to the study. Mean cosmesis scores at baseline were assessed to be “good” by both patients and physicians; these were stable at 12 months of follow-up. 90 % of patients were alive at 12 months, and 2 (4 %) were observed to suffer local, in-field failure. Discussion: Radiation therapy in combination with capecitabine is a well tolerated adjuvant therapy for patients with high risk breast cancer, with most patients completing all therapy. Controlled studies examining efficacy are warranted.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-08.

Effects of dissolved oxygen on dye removal by zero-valent iron

Effects of dissolved oxygen concentrations on dye removal by zero-valent iron (Fe(0)) were investigated. The Vibrio fischeri light inhibition test was employed to evaluate toxicity of decolorized solution. Three dyes, Acid Orange 7 (AO7, monoazo), Reactive Red 120 (RR120, diazo), and Acid Blue 9 (AB9, triphenylmethane), were selected as model dyes. The dye concentration and Fe(0) dose used were 100 mg L(-1) and 30 g L(-1), respectively. Under anoxic condition, the order for dye decolorization was AO7>RR120>AB9. An increase in the dissolved oxygen concentrations enhanced decolorization and chemical oxygen demand (COD) removal of the three dyes. An increase in gas flow rates also improved dye and COD removals by Fe(0). At dissolved oxygen of 6 mg L(-1), more than 99% of each dye was decolorized within 12 min and high COD removals were obtained (97% for AO7, 87% for RR120, and 93% for AB9). The toxicity of decolorized dye solutions was low (I(5)<40%). An increase in DO concentrations obviously reduced the toxicity. When DO above 2 mg L(-1) was applied, low iron ion concentration (13.6 mg L(-1)) was obtained in the decolorized AO7 solution.

Treatment and toxicity evaluation of methylene blue using electrochemical oxidation, fly ash adsorption and combined electrochemical oxidation-fly ash adsorption

Treatment of a basic dye, methylene blue, by electrochemical oxidation, fly ash adsorption, and combined electrochemical oxidation-fly ash adsorption was compared. Methylene blue at 100 mgL(-1) was used in this study. The toxicity was also monitored by the Vibrio fischeri light inhibition test. When electrochemical oxidation was used, 99% color and 84% COD were removed from the methylene blue solution in 20 min at a current density of 428 Am(-2), NaCl of 1000 mgL(-1), and pH(0) of 7. However, the decolorized solution showed high toxicity (100% light inhibition). For fly ash adsorption, a high dose of fly ash (>20,000 mgL(-1)) was needed to remove methylene blue, and the Freundlich isotherm described the adsorption behavior well. In the combined electrochemical oxidation-fly ash adsorption treatment, the addition of 4000 mgL(-1) fly ash effectively reduced intermediate toxicity and decreased the COD of the electrochemical oxidation-treated methylene blue solution. The results indicated that the combined process effectively removed color, COD, and intermediate toxicity of the methylene blue solution.

Phytoremediation of Cr(III) by Ipomonea aquatica (water spinach) from water in the presence of EDTA and chloride: effects of Cr speciation

Wastewater is often co-contaminated with chromium, chelating agents, and chloride. Influences of Cr(3+) speciation on Cr phytoremediation by Ipomonea aquatica were investigated. MINEQL+ was employed to estimate Cr speciation. Statistic regression was used to investigate the relationships between Cr speciation and accumulation. I. aquatica accumulated high Cr concentration (13,217 mg kg(-1)) in the root at Cr(3+) of 10 mg l(-1) and EDTA of 10(-4) M after 14 d growth. Pearson correlation analysis indicates that root Cr concentration significantly correlated with Cr-EDTA speciation (r = 0.67, p < 0.05) and Cr-Cl speciation (r = 0.91, p < 0.01). Shoot Cr concentration also significantly correlated with Cr-Cl speciation (r = 0.97, p < 0.01). An increase in Cl(-) concentration to 1.72 x 10(-4) M enhanced root Cr concentration; however, the accumulation of root Cr was inhibited at high Cl(-) concentration (5.76 x 10(-5) M). Microscopic image showed that a high portion of Cr(3+) accumulated on the root surface.

Treatment of Reactive Black 5 by combined electrocoagulation-granular activated carbon adsorption-microwave regeneration process

Treatment of an azo dye, Reactive Black 5 (RB5) by combined electrocoagulation-activated carbon adsorption-microwave regeneration process was evaluated. The toxicity was also monitored by the Vibrio fischeri light inhibition test. GAC of 100 g L(-1) sorbed 82% of RB5 (100 mg L(-1)) within 4h. RB5-loaded GAC was not effectively regenerated by microwave irradiation (800 W, 30s). Electrocoagulation showed high decolorization of RB5 within 8 min at pH(0) of 7, current density of 277 A m(-2), and NaCl of 1 g L(-1). However, 61% COD residue remained after treatment and toxicity was high (100% light inhibition). GAC of 20 g L(-1) effectively removed COD and toxicity of electrocoagulation-treated solution within 4h. Microwave irradiation effectively regenerated intermediate-loaded GAC within 30s at power of 800 W, GAC/water ratio of 20 g L(-1), and pH of 7.8. The adsorption capacity of GAC for COD removal from the electrocoagulation-treated solution did not significantly decrease at the first 7 cycles of adsorption/regeneration. The adsorption capacity of GAC for removal of both A(265) (benzene-related groups) and toxicity slightly decreased after the 6th cycle.