[Clinical features of patients with metastatic pheochromocytoma/paraganglioma]

Objective: To analyze the clinical features of patients with metastatic pheochromocytoma/paraganglioma (PPGL). Methods: A follow-up study. The clinical data of 250 patients with metastatic PPGL treated at Peking Union Medical College Hospital from January 2018 to August 2023 were retrospectively analyzed, including 124 males and 126 females. The clinical features and treatment status of patients with metastatic PPGL were summarized and analyzed. Kaplan-Meier survival curve was used to evaluate patients' prognosis. Results: The age of onset, age of diagnosis, and age of tumor metastasis in patients with metastatic PPGL were (33.1±14.2) years, (35.4±15.2) years, and (40.7±15.3) years, respectively. Metastasis occurred in 26.4%(66/250) of patients at the time of initial diagnosis. Among patients without metastases at the time of initial diagnosis, the time from primary tumor resection to metastasis[M(Q1, Q3)] was 5.0 (3.0, 9.0) years, among which 20.1%(37/184) of patients had metastases more than 10 years after surgery. Most patients showed increased 24-hour urinary norepinephrine and plasma normetanephrine, accounting for 78.2%(176/225) and 78.7%(85/108), respectively. 42.3%(69/163) of patients had increased neuron specific enolase (NSE)levels. Germline mutations were screened in 201 patients, of which 55.2%(111/201) had germline pathogenic mutations. In patients with gene mutations, 76.5%(85/111) had SDHB mutations. 52.0%(130/250) of metastatic PPGL patients had primary sites outside the adrenal gland, with the Ki-67 index of 5% (3%, 8%). There were 85.6%(214/250) patients had multisystem metastasis, with bone metastasis being the most common site of metastasis, accounting for 60.8%(152/250). In terms of treatment, 32.8%(75/229) of patients underwent two treatment regimens and 8.7%(20/229) of patients underwent three treatment regimens. Most patients had a good prognosis, with a 5-year and 10-year survival rate of 88.0% and 84.0%, respectively. However, some patients had rapid disease progression, and as of August 2023, 30 patients died, and the time from diagnosis to death in deceased patients was 2.0 (1.0, 4.0) years. Conclusions: Patients with metastatic PPGL have a high rate of germline mutations, especially those with SDHB mutations. The metastatic PPGL is usually multisystem metastasis with the characteristics of mostly paraganglioma, large lesion diameter and high Ki-67 index.

[A survey on the current situation of serum vitamin A and vitamin D levels among children aged 2-<7 years of 20 cities in China]

Objective: To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China. Methods: A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors. Results: The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A (χ2=7.91 and 8.06, both P=0.005) and vitamin D (χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively (OR=0.68 and 0.22, 95%CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB (χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively (χ2=93.22 and 202.54, both P<0.001). Conclusions: Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.

Role and Modality of Combining Radiotherapy with Immunotherapy in Stage III-IV Unresectable Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

The combination of radiotherapy and immunotherapy was rarely reported in the management of small cell lung cancer (SCLC). We retrospectively assessed the role and modality of this combination in Stage III-IV unresectable SCLC.

MATERIALS/METHODS

Patients with stage III and IV SCLC were enrolled according to AJCC 8th edition. Both efficacy and safety of immunotherapy combined with radiotherapy were evaluated. Thereinto, patients received first-line chemo-immunotherapy and sequential thoracic consolidation radiotherapy (TCRT) were further evaluated. Survival and descriptive analyses were performed.

RESULTS

Between January 1, 2019 and December 31, 2021, 51 patients were included in our analysis. Median follow-up was 28.0 months (95% CI 22.8-33.2). Patients received radiotherapy in treatment course had a prolonged 2-year overall survival (OS). And in the first-line immunotherapy cohort of 27 patients, the addition of TCRT significantly improved 2y-OS (72.22% vs. 13.89%, p = 0.0048), 2y-locoregional recurrence free survival (LRRFS) (90.00% vs 48.00%, p = 0.011), and 2y-distance progression free survival (DPFS) (66.67% vs. 16.67%, p = 0.039). Subgroup analyses showed that TCRT rendered superior outcomes regardless of brain metastases. Dose-escalation (45 Gy/15f) and earlier radiotherapy seemed to improve the benefit. Of 70.37% (19/27) patients experienced disease progression in the TCRT evaluation cohort, 63.16% (12/19) patients failed in brain. A tendency toward better OS and superior brain metastases free survival (BMFS) were observed after receiving prophylactic cranial irradiation (PCI). Finally, the most common grade 2 or higher toxic effects were pneumonitis in all patients (11.76% of immune-related vs. 7.84% of radiation related).

CONCLUSION

Earlier addition of TCRT to immunotherapy could significantly improve survival and extracranial control for stage IIIA-IVB unresectable SCLC patients, with no increased risk of adverse events. In the era of immunotherapy, PCI may still be a recommended strategy. Further investigation is warranted.

[Research progress on the comorbidity between hepatitis B virus infection and noncommunicable diseases]

With the decline in hepatitis B virus (HBV) incidence and the increase in the life expectancy of infected individuals, the population infected with HBV is experiencing rapid aging, leading to an escalating risk of co-morbid chronic noncommunicable diseases (NCDs). This study summarizes research related to the comorbidity between HBV and NCDs, discussing the aging of the HBV-infected population, the mechanisms, prevalence, and management of this comorbidity. This study provides insights into potential directions for future research on the comorbidity between HBV and NCDs and aims to provide a basis for further research and the development of prevention and treatment strategies for the comorbidity of NCDs among HBV-infected individuals in China.

[Preliminary study on the ability of 68Ga-Pentixafor PET/CT to differentiate between adrenal aldosterone-producing adenoma and nonfunctional adenoma]

Objective: To evaluate the ability of ⁶⁸Ga-Pentixafor (nuclide ligand imaging agents for chemokine receptor 4) PET/CT to differentiate between aldosterone-producing adenoma (APA) and adrenal nonfunctional adenoma (NFA), and to assess how well this imaging method correlates with clinical features and postoperative outcomes. Methods: This was a cross-sectional study involving 73 APA and 12 NFA patients who received ⁶⁸Ga-Pentixafor PET/CT imaging at Peking Union Medical College Hospital from August 2018 to October 2021. The receiver operating characteristic (ROC) curve was used to evaluate the differential value of visual analysis and the maximum standard uptake value (SUV_max) of the focus on APA and NFA. The related factors of SUV_max, and its predictive effect on postoperative outcomes were analyzed using Pearson or Spearman analysis and χ² text. Results: ⁶⁸Ga-Pentixafor PET/CT imaging was positive in 64 APA patients (sensitivity=87.7%) and negative in all 12 NFA patients (specificity=100%). The area under the ROC curve with SUV_max differentiating APA and NFA was 0.932 (P<0.001). When the SUV_max cut-off point was 6.23, the sensitivity was 80.8% and the specificity was 100%. The SUV_max correlated positively with lesion size (r=0.598) and aldosterone/renin activity ratio (r=0.313) and correlated negatively with potassium level (r=-0.286), renin activity (r=-0.240) and age of diagnosis (r=-0.273) (all P<0.05). Of the patients who underwent adrenalectomy and received more than 6 months of post-surgical follow-up, the clinical complete remission rate was higher for ⁶⁸Ga-Pentixafor PET/CT imaging-positive patients than imaging-negative patients (24/39 vs. 0/4, P=0.031). Conclusions: ⁶⁸Ga-Pentixafor PET/CT is effective at differentiating between APA and NFA. The SUV_max of ⁶⁸Ga-Pentixafor PET/CT correlates with age at onset, lesion size, and the severity of clinical manifestations, and is able to predict postoperative outcomes.

[Schwannoma originating from the branch of the inferior oblique muscle innervated by the oculomotor nerve: a report of two cases]

Patient 1 was a 44-year-old female with a progressively enlarging orbital mass on the right side for 2 years, while patient 2 was a 25-year-old female who complained of protrusion of the right eye for 2 months. Both patients presented with exophthalmos and a palpable infraorbital mass without vision loss. Magnetic resonance imaging examination showed a well circumscribed circular orbital lesion, with hypointensity on T1 weighted image and heterogeneous hyperintensity on T2 weighted image, which could be significantly enhanced, in either eye. Both eyes were diagnosed as begin orbital tumor and received resection under general anesthesia. Intraoperatively, the distal end of the tumors was found to transmigrate to normal nerves and insert into the inferior oblique muscle. Combined with the pathological diagnosis of schwannoma and postoperative occurrence of mydriasis and inferior oblique muscle paralysis in both patients, it was confirmed that the two lesions were schwannomas originating from the branch of the inferior oblique muscle innervated by the oculomotor nerve.

[The treatment effect of maximal orbital decompression surgery and intravenous glucocorticoids pulse therapy for dysthyroid optic neuropathy]

Objective: To evaluate the efficacy and safety of maximal orbital decompression surgery and intravenous glucocorticoid (ivGC) pulse therapy as the initial treatment for dysthyroid optic neuropathy (DON). Methods: Retrospective cohort study. Forty-three patients (66 eyes) with DON who were treated during April 2019 and November 2021 in Peking University People's Hospital were included. According to the treatment methods, they were divided into the glucocorticoid group (21 cases, 33eyes) and the surgery group (22 cases, 33eyes). The glucocorticoid group received a total dose of 7.5 g ivGC therapy, while the surgery group received maximal orbital decompression surgery. Clinical outcomes were recorded and assessed including pre-and post-treatment logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA), clinical activity score (CAS), visual evoked potential (VEP)-P₁₀₀ wave amplitude and peak time, muscle index (MI), and clinical proptosis. Adverse effects were also recorded. Follow-up data at 6 months after surgery or ivGC therapy were used as the post-treatment data. Wilcoxon signed rank analysis, independent or paired sample t test, Mann-Whitney U test, Chi-square test were used for statistical analysis. Non-normal distribution data were expressed in M(IQR). Results: There was no significant difference (all P>0.05) between the two groups in terms of gender, age, course of disease or laterality, as well as baseline data such as pre-treatment BCVA, CAS, VEP-P₁₀₀ wave amplitude and peak time, and MI. After treatment, logMAR BCVA of the glucocorticoid group increased significantly from 1.00 (0.65) to 0.70 (0.60), (Z=-4.55), while BCVA of the surgery group increased significantly from 1.00 (0.95) to 0.60 (0.55), (Z=-4.87). The post-treatment CAS of the glucocorticoid group decreased significantly from 5 (2) to 2 (2) (Z=-4.91), while that of the surgery group also decreased significantly from 5 (2) to 2 (2) (Z=-4.94). After treatment, the VEP-P₁₀₀ wave amplitude of the glucocorticoid group increased significantly from (3.49±1.34) μV to (5.26±2.00) μV (t=-9.08), while that of the surgery group increased significantly from (3.21±1.74) μV to (4.78±2.36) μV (t=-9.24). After treatment, the P₁₀₀ wave peak time of the glucocorticoid group was significantly shortened from (110.52±12.11) ms to (103.53±6.67) ms (t=4.67), while that of the surgery group was significantly shortened from (118.48±20.16) ms to (106.45±10.57) ms (t=2.84). There were significant differences between inner-group before and after treatment data (all P<0.001), whereas the inter-group after treatment data have no significant difference (all P>0.05). The orbital apex crowding relief (MI≤0.52) rate was 64% (21/33) in the glucocorticoid group and was 91% (30/33) in the surgery group, while the proportion of proptosis reduction (more than 2 mm) in the glucocorticoid group and the surgery group was 64% (21/33) and 94% (31/33), respectively. Surgery was better than ivGC therapy both in terms of orbital apex crowding relief and proptosis reduction (χ²=5.52, 7.34; both P<0.05). Serious adverse effects or complications occurred in none of the two groups. Mild adverse effects occurred in 38% (8/12) of the patients receiving glucocorticoids and in 59%(13/22) of the patients receiving surgical treatment, with no significant difference (P>0.05). Conclusions: Both maximal orbital decompression surgery and ivGC therapy can effectively improve the visual function and reduce the CAS of DON with high safety. Meanwhile, surgery has more advantages in relieving orbital apex crowding and reducing proptosis.

[Epidemic status of imported malaria before and after malaria elimination in Jiaozuo City of Henan Province]

OBJECTIVE

To analyze and compare the epidemiological characteristics of imported malaria in Jiaozuo City before and after malaria elimination, so as to provide insights into the malaria surveillance during the post-elimination stage and prevention of re-establishment of imported malaria.

METHODS

Data pertaining to the epidemic situation and individual investigation of malaria in Jiaozuo City before (from 2010 to 2016) and after malaria elimination (from 2017 to November, 2020) were captured from the National Notifiable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention of Chinese Center for Disease Control and Prevention and were analyzed statistically.

RESULTS

A total of 74 imported malaria cases were reported in Jiaozuo City from 2010 to 2021. Imported cases were predominantly Plasmodium falciparum malaria cases in Jiaozuo City before and after malaria elimination, and there was no significant difference in the proportion of malaria parasite species (χ² = 0.234, P > 0.05). The imported malaria cases was predominantly reported in Wuzhi County, and was identified in overseas male farmers and businessmen at ages of 20 to 59 years, while the greatest number of imported malaria cases was reported in June and December before and after malaria elimination. The imported malaria cases predominantly acquired malaria parasite infections in sub-Saharan African countries; however, the proportion of imported malaria cases returning from Southeast Asian counties increased after malaria elimination than before malaria elimination (χ² = 5.989, P < 0.05). The longest duration from onset to definitive diagnosis of malaria reduced from 27 days before malaria elimination to 18 days after malaria elimination, and the median duration reduced from 3 days to 2 days, while the proportion of definitive diagnosis of malaria increased from 60.47% before malaria elimination to 83.87% after malaria elimination (χ² = 4.724, P < 0.05). In addition, the proportion of malaria cases definitively diagnosed and reported by medical institutions increased after malaria elimination than before malaria elimination (χ² = 5.406, P < 0.05).

CONCLUSIONS

The imported malaria patients were predominantly P. falciparum malaria cases in Jiaozuo City during 2010 to 2021, and the patient's medical care-seeking awareness and medical staff's diagnosis and treatment ability have improved after malaria elimination. It is necessary to strengthen and improve malaria surveillance and response system and prevent the re-establishment of overseas imported malaria.

[Psychological and behavioral functioning of children and adolescents during long-term home-schooling]

Objective: To study the characteristics and risk factors of psychological and behavioral problems of children and adolescents of different ages and genders in long-term home-schooling during the coronavirus disease-2019 pandemic. Further, to provide scientific basis for more targeted psychological intervention and coping strategies in the future. Methods: A cross-sectional survey using an online questionnaire was conducted on students aged 6-16 years old in five representative cities of North (Beijing), East (Shanghai), West (Chongqing), South (Guangzhou) and Middle (Wuhan) in China. In this study, the social behavior and psychological abnormalities which was defined as the positive of any dimension were investigated in multiple dimensions during long-term home-schooling. The influencing factors of psycho-behavioral problems were analyzed by Logistic regression, and the confounding factors were corrected with graded multivariable adjustment. Results: A total of 6 906 valid questionnaires were collected including 3 592 boys and 3 314 girls, of whom 3 626 were children (6-11 years old) and 3 280 were adolescents (12-16 years old). The positive detection rate of psychosocial-behavioral problems were 13.0% (900/6 906) totally, 9.6% (344/3 592) in boys and 16.8% (556/3 314) in girls respectively, and 7.3%(142/1 946) in boys aged 6-11, 14.0%(235/1 680) in girls aged 6-11, 12.3%(202/1 646) in boys aged 12-16, 19.6%(321/1 634) in girls aged 12-16 respectively. There were significant differences between the psychological problems group and the non-psychological problems group in gender, parent-offspring conflict, number of close friends, family income change, sedentary time, homework time, screen exposure time, physical activity, dietary problems (χ²=78.851, 285.264, 52.839, 26.284, 22.778, 11.024, 10.688, 36.814, 70.982, all P<0.01). The most common symptoms in boys aged 6-11 years were compulsive activity, schizoid and depression, in girls aged 6-11 years were schizoid/compulsive activity, hyperactivity and social withdrawal, in boys aged 12-16 years were hyperactivity, compulsive activity and aggressive behavior, and in girls aged 12-16 years were schizoid, anxiety/compulsive activity and depression/withdrawal, respectively. After graded multivariable adjustment, besides the common risk factors, homework time and online study time were the risk factors of 6-11 years old groups [boys OR(95%CI): 1.750 (1.32-2.32), 1.214(1.00-1.47), girls: 1.579(1.25-1.99), 1.222(1.05-1.42), all P<0.05], videogames time were the risk factors of 12-16 years old groups [ boys: 2.237 (1.60-3.13), girls: 1.272 (1.00-1.61), all P<0.05]. Conclusions: Some children and adolescents may have psychological and behavioral problems during long-term home-schooling. The psychological and behavioral manifestations differed in age and gender subgroups, which deserve special attention in each subgroups. Schools, families and specialists should actively provide precise psychological support and comprehensive intervention strategies according to special features and risk factors.

[The study of the association between lung cancer screening and smoking behavior change]

The smoking cessation rate of 1 314 people at high risk of lung cancer in the area of lung cancer screening and early diagnosis and early treatment in Sichuan Province increased from 22.37% at baseline to 41.78% after screening (χ²=227.97, P<0.001), and the smoking amount of persistent smokers decreased from 20 cigarettes per day to 15 cigarettes per day (t=11.76, P<0.001). Those with positive results in lung cancer screening were more likely to quit smoking or continue to quit smoking. Male, younger age or lower education level would increase the risk of continuous smoking or relapse (P<0.05).

[Related factors and the long-term outcome after percutaneous coronary intervention of premature acute myocardial infarction]

Objective: To explore the related factors of premature acute myocardial infarction(AMI), and to compare the the long-term outcomes in patients with and without premature AMI after percutaneous coronary intervention (PCI). Methods: This study was a prospective cohort study.From January 2013 to December 2013, 10 724 consecutive patients with coronary heart disease undergoing PCI in Fuwai Hospital were enrolled. Among them 1 920 patients with the diagnosis of AMI were divided into two groups: premature AMI (man≤50 years old, woman≤60 years old) and non-premature AMI. The baseline characteristics were collected, and multivariate logistic regression was uesed to analysis the related factors of premature AMI. The clinical outcomes, including the major adverse cardiovascular and cerebrovascular events(MACCE) which was the composite of cardiac death, myocardial infarction, revascularization, stroke and stent thrombosis, as well as bleeding events, during hospitalization, at 2 years and 5 years follow-up were analyzed. Results: A total of 1 920 AMI patiens were included(age was (56.5±11.3) years old)，with 1 612(84.0%) males. There were statistically significant differences between the two groups in gender, body mass index, blood lipid, complications, inflammatory markers, etc (all P<0.05). Multivariate logistic regression analysis showed body mass index(OR=1.06, 95%CI 1.01-1.10, P<0.01), triglyceride(OR=1.47, 95%CI 1.14-1.90, P<0.01), serum uric acid level(OR=1.02, 95%CI 1.01-1.04, P<0.01), high density lipoprotein cholesterol level(OR=0.33, 95%CI 0.14-0.78, P=0.01) and history of hypertension(OR=0.72, 95%CI 0.56-0.93, P=0.01) were independent related factors of premature AMI. The incidence of all-cause death and cardiac death were lower during hospitalization, at 2 years and 5 years follow-up in the premature AMI group than in non-premature AMI group(all P<0.05). In the premature AMI group, the incidence of MACCE and stroke was lower, with more bleeding events in 5 years follow-up(all P<0.05). Conclusions: Metabolic abnormalities, including high BMI, high triglyceride level and high serum uric acid, low high-density lipoprotein cholesterol level are the related factor of premature AMI. The incidence of ischemic events in patients with premature AMI is lower, while the incidence of bleeding events is higher than non-premature AMI patients.

Characterization of Wheat Monogenic Lines with Known Sr Genes and Wheat Lines with Resistance to the Ug99 Race Group for Resistance to Prevalent Races of Puccinia graminis f. sp. tritici in China

Wheat stem rust, caused by Puccinia graminis f. sp. tritici, is one of the most serious fungal diseases in wheat production, seriously threatening the global supply of wheat and endangering food security. The present study was conducted to evaluate wheat monogenic lines with known Sr genes to the most prevalent P. graminis f. sp. tritici races in China. In addition, wheat lines introduced from the International Maize and Wheat improvement Center (CIMMYT) with resistance to the Ug99 race group were also evaluated with the prevalent Chinese P. graminis f. sp. tritici races. The monogenic lines containing Sr9e, Sr21, Sr26, Sr31, Sr33, Sr35, Sr37, Sr38, Sr47, and SrTt3 were effective against races 21C3CTTTM, 34C0MRGSM, and 34C3MTGQM at both seedling and adult-plant stages. In contrast, monogenic lines containing Sr6, Sr7b, Sr8a, Sr9a, Sr9b, Sr9d, Sr9f, Sr9g, Sr13, Sr16, Sr18, Sr19, Sr20, Sr24, Sr28, Sr29, and Sr34 were highly susceptible to these races at both seedling and adult-plant stages. Lines with Sr5, Sr10, Sr13, Sr14, Sr15, Sr17, Sr21, Sr22, Sr23, Sr25, Sr27, Sr29, Sr30, Sr32, Sr36, and Sr39 were resistant to one or more of the tested races. Among the 123 CIMMYT lines, 38 (30.9%) showed varying levels of susceptibility to Chinese P. graminis f. sp. tritici races. The results should be useful for breeding wheat cultivars with resistance to stem rust.

[A pathological report of three COVID-19 cases by minimal invasive autopsies]

Objective: To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19). Methods: Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV. Results: Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs. Conclusions: The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

[Efficacy comparison between robot-assisted and laparoscopic surgery for mid-low rectal cancer: a prospective randomized controlled trial]

Objective: To compare the short- and long-term outcomes of robot-assisted and laparoscopic radical resection for mid-low rectal cancer. Methods: A prospective randomized controlled trial was conducted. A total of 130 patients with mid-low rectal cancer (inclusion criteria: age > 18 or ≤80 years old; pathological diagnosis of rectal adenocarcinoma by colonoscopy; distance from tumor to the anal verge ≤12 cm; no distant metastasis; cT1-3N0-1 or ycT1-3 after neoadjuvant radiotherapy and chemotherapy; suitable for laparoscopic and robotic surgery) at the Department of Colorectal Surgery of the First Affiliated Hospital of Nanchang University from October 2016 to September 2018 were prospectively enrolled. According to computer-generated random number method, patients were randomly divided into the robot group (n=66) and laparoscopy group (n=64), and underwent robot-assisted surgery or laparoscopic surgery respectively. Clinicopathological data of all the patients were collected and analyzed. The demographic parameters, short- and long-term outcomes were compared between two groups. Results: One patient in robot group whose postoperative sample was diagnosed as rectal adenoma by pathology was excluded. There were no statistically significant differences in age, sex, BMI, ASA classification, distance from tumor to the anal verge, serum CEA level, CA199 level between two groups (all P>0.05). Operations were successfully performed in all the patients without conversion to open operation. Robotic surgery was found to be associated with less intraoperative blood loss than laparoscopic surgery [(73.4±49.7) ml vs. (119.1±65.7) ml, t=-4.461, P<0.001], while there were no statistically significant differences in surgical procedures, operation time, time to first flatus, time to first liquid intake, time to removal of catheter or postoperative hospital stay between two groups (all P>0.05). Besides, there was no significant difference in the morbidity of postoperative complication between two groups [10.8% (7/65) vs. 12.5 (8/64), χ(2)=4.342, P=0.720]. The median number of harvested lymph node in the robot group and the laparoscopy group was 15.7±6.2 and 13.8±6.1 (t=1.724, P=0.087). There were no significant differences between two groups in tumor sample length, distance between proximal and distal resection margin, integrity grade of TME specimen, number of positive lymph nodes, postoperative pathological stage and tumor differentiation (all P>0.05). The distal resection margin of samples in two groups was all negative. One case in the robot group was found to have positive circumferential resection margin. The median follow up was 24 (9 to 31) months. In the robot group and the laparoscopy group, the 2-year overall survival rate was 95.4% and 90.6% respectively; the 2-year disease-free survival rate was 90.8% and 85.9% respectively, whose differences were not significant (both P>0.05). Conclusion: Robot-assisted radical resection for mid-low rectal cancer can achieve similar short-term and long-term outcomes of laparoscopic resection, while robot-assisted surgery can decrease blood loss during operation, leading to more precise practice in minimally invasive surgery.

[Key points and skills of assistant in robotic radical gastrectomy for gastric cancer]

An excellent assistant for robotic radical gastrectomy can play an important role in the operation, especially in a initial team. In robotic gastric cancer surgery, an excellent assistant should actively participate in the operation process, choose the appropriate trocar position according to patient's body habitus. Moreover, he should master various surgical instruments skillfully and switch instruments fluently to assist the surgeon to expose key parts during operation, and provide effective help in the operative details, so that the whole operation process can run more smoothly and the operation efficiency and quality will be greatly improved. The growth of the assistants needs constant practice and summary of experience. Meanwhile, the encouragement of the chief surgeon also plays a positive role in promoting the development of the assistants.

[Short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction]

Objective: To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction. Methods: A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m(2); (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018. Results: There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups. Conclusion: Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.

[Analysis of the level of the core knowledge and related factors of cancer prevention and treatment in the upper gastrointestinal cancer screening area of Sichuan Province in 2018]

Objective: To investigate the level of the core knowledge and related factors of cancer prevention and treatment among residents in the upper gastrointestinal cancer screening areas of Sichuan Province in 2018. Methods: From April to May 2018, a total of 1 386 residents from Chaotian District of Guangyuan, Enyang District of Bazhong, Nanjiang County of Bazhong, Cangxi County of Guangyuan, Shehong County of Suining, Yilong County of Nanchong, Xichong County of Nanchong and Xuanhan County of Dazhou were recruited in this study. A questionnaire survey was conducted to collect basic demographic characteristics and the knowledge of cancer prevention and treatment. The level of the core knowledge of cancer prevention and treatment of different population was analyzed. A multivariate linear regression model was performed to analyze the related factors. Results: In total, 80.9% (1 120) of all subjects was 25-64 years old and 48.0% (665) were male. The total number of questions answered by the subjects was 18 018, of which 12 147 were known, and the overall awareness rate among the respondents was 67.42%. The female respondents, respondentsaged 65 years old and over, with junior college education or above, and worked in government institutions had a good performance of the core knowledge (P<0.05), about 70.11% (6 571/9 373), 69.23% (387/559), 76.05% (6 327/8 320), and 77.09% (5 602/7 267) respectively. The results of multivariate linear regression showed that the older the age [β=0.871 (95%CI: 0.623-1.119)], the higher the educational level [β=0.741 (95%CI: 0.540-0.943)], the more questions respondents could know; compared with the workers in government organization and institution, workers in enterprise [β=-2.913 (95%CI:-3.499--2.327)], farming workers [β=-0.635 (95%CI:-1.175--0.095)] and other occupation people [β=-1.126 (95%CI:-1.663--0.589)] could know fewer questions. Conclusion: In 2018, the level of the core knowledge of cancer prevention and treatment among residents in upper gastrointestinal cancer screening areas of Sichuan Province was relatively high. Age, education level and occupation were relevant factors.

Virulence structure and its genetic diversity analyses of Blumeria graminis f. sp. tritici isolates in China

BACKGROUND

Blumeria graminis f. sp. tritici (Bgt), the causal agent of wheat powdery mildew severely affects yield security wheat production in China. Understanding the virulence structure and genetic variations of this pathogen is important for breeding wheat lines resistant to wheat powdery mildew. However, information related to genes controlling resistance remains elusive. This study analyzes the virulence structure and the genetic diversity of pathogenic Bgt populations isolated from northeastern (Liaoning, Heilongjiang) and northwestern (Gansu) China, two representative wheat producing areas, on 37 wheat cultivars each carrying a known powdery mildew resistance (Pm) gene.

RESULTS

Bgt isolates from northeastern China show higher frequencies of virulence genes than populations from Gansu Province. Many of the known Pm genes failed to provide resistance in this study. However, Pm21 provided 100% resistance to all isolates from all three provinces, obtained during two consecutive years, while Pm13 provided 100% resistance in Gansu. Pm13, Pm16, Pm18, and Pm22 also showed partial resistance in northeastern China, while Pm16, Pm18, Pm22, Pm5 + 6 and Pm2 + 6 +? maintained some resistance in Gansu. Genetic diversity among populations in different regions was detected by cluster analyses using expressed sequence tag-simple sequence repeat (EST-SSR). When the genetic similarity coefficient is relatively high, populations from the same regional origin are mostly clustered into one group while populations from different regions exhibit large genetic differences.

CONCLUSION

Pm21 remains the best choice for breeding programs to maintain resistance to Bgt. Only 58% of the isolates tested show a clear correlation between EST-SSR genetic polymorphisms and frequency of virulence gene data.

Early prosthodontic intervention on two three-year-old twin girls with ectodermal dysplasia

AIM

Early prosthodontic treatment for cases of ectodermal dysplasia (ED) is usually difficult because of oligodontia, undeveloped alveolar ridges, and the young age of the patients. Although some cases of prosthetic management of ED patients have been reported in the literature, there have been few cases about prosthetic treatment in children younger than 5 years of age.

CASE REPORT

This case report presents early prosthetic oral rehabilitation of 2 twin sisters with ectodermal dysplasia and severe hypodontia in the primary dentition. Fixed partial dentures with bands retained on deciduous molars were fabricated when the girls were 3 years old. New flexible removable partial dentures were made when the girls turned 6 years to accommodate the ongoing alveolar development. After the dental treatment, the two girls' aesthetics, phonetics, and chewing functions all improved significantly, which in turn raised the girls' self-esteem and increased their overall quality of life.

CONCLUSION

These two cases demonstrated that properly timed and managed early prosthodontic intervention can improve the overall life quality of young patients with ectodermal dysplasia.

[Transmission cluster and network of HIV-1 CRF01_AE strain in China, 1996-2014]

Objective: To understand the transmission patterns and risk factors of HIV-1 strain CRF01_AE subtypes in China, and to provide guidance for the implementation of precise intervention. Methods: A total of 2 094 CRF01_AE pol sequences were collected in 19 provinces in China between 1996 and 2014. Phylogenetic tree was constructed by PhyML 3.0 software to select the transmission clusters. Transmission network was constructed by Cytoscape 3.6.0, which was further used for exploring of the major risk factors. Results: Of the 2 094 sequences, 12.18% (255/2 094) were in clusters. A total of 82 transmission clusters were identified. The numbers of clusters and contained sequences in intra-provincial transmission (61, 173) were significantly more than those in inter-provincial transmission (21, 82). The ratio of transmission clustering in MSM increased over time from 2.41% (2/83) during 1996-2008 to 23.61% (72/305) during 2013-2014, showing a significant upward trend (χ(2)=27.800, df=1, P=0.000). The proportion of MSM with inter-provincial transmission clusters were higher than those with intra-provincial transmission clusters, which increased from 0.67% (2/297) during 1996-2008 to 6.36%(30/472) during 2013-2014, showing a significant upward trend (χ(2)=20.276, df=1, P=0.000). The transmission rate in homosexuals of the inter-transmission clusters (86.59%, 71/82) was higher than that of intra-provincial transmission clusters (56.65%, 98/173), and the difference was statistically significant (χ(2)=22.792, P=0.000). The proportion of inter-provincial transmission clusters with more than 2 transmission routes (33.33%, 7/21) was higher than that of intra-provincial clusters (13.11%, 8/61), and the difference was statistically significant (χ(2)=4.273, P=0.039). Results from the transmission network analysis indicated that the proportion of high risk population (degree≥4) with inter-provincial transmission clusters (51.22%, 42/82) was significantly higher than that with intra-provincial transmission clusters (26.59%, 46/173), and the difference was statistically significant (χ(2)=14.932, P=0.000). Inter-provincial clusters were mainly detected in and and MSM. Conclusions: Complex transmission networks were found for HIV-1 CRF01_AE strains in the mainland of China. Inter-provincial transmission clusters increased rapidly, MSM played an important role in the wide spread of the strain. More researches in transmission networks are needed to guide the precision intervention.

A paradigm shift in the provision of improved critical care in the emergency department

With Hong Kong's ageing population, advancement of medical technologies and hospital congestion, it is not uncommon for emergency physicians to encounter complicated critically ill patients in daily practice. It becomes a fundamental role of emergency physicians to initiate timely diagnostic and therapeutic interventions to save a patient's life and improve their prognosis. It is the reason a critical care service has been developed in emergency departments worldwide over the last decade. This article shares how emergency department intensivists can contribute to this novel model of care with some illustrative cases. Advanced airway and peri-intubation management, difficult mechanical ventilation, treatment of shock, circulatory arrest, and metabolic disturbances can be safely and efficiently handled in the current emergency department setting. Obstacles, barriers, and the road ahead will be discussed.

Gender differences, UV exposure and risk of lentigo maligna in a nationwide healthcare population cohort study

BACKGROUND

Our understanding of the relationship between ultraviolet (UV) radiation exposure and lentigo maligna (LM) has been largely derived from epidemiologic/clinical studies based on invasive melanoma. Recent studies have shown gender differences in melanocytic tumours incidence.

OBJECTIVE

To examine the association of UV light with LM by gender remains unclear.

METHODS

Two prospective cohort study [Nurses' Health Study (1980-2012)] and [Health Professionals Follow-up Study (1986-2010)] were analysed. All participants with LM or MIS, non-LM type were included in analysis. UV index at birth, age 15, and age 30 were calculated by gender. Lifetime UV flux was calculated. Hazard ratios (HRs) were calculated.

RESULTS

A total of 110 485 women from NHS and 41 015 men from HPFS were examined. A total of 281 LM and 776 melanoma in situ (MIS), non-LM cases were reported. Risk of LM increased with increasing UV flux exposure in multivariate-adjusted models for men (P for trend = 0.04), but not for women (P for trend = 0.91).

CONCLUSIONS

UV flux may be associated with LM in men but not in women.

[Association between high risk human papillomavirus DNA load and cervical lesions in different infection status]

Objective: To explore the relationship between high risk HPV (HR-HPV) DNA load and cervical lesions in HR-HPV single/ multiple infections. Methods: Two thousand six hundred and forty-six women from Shanxi, Henan and Xinjiang were recruited into a cervical cancer screening program. Cervical exfoliated cell specimens collected from all of the participants were detected by hybrid capture Ⅱ (HC2), cytological diagnosis was performed according to the Bethesda System, and pathological diagnosis was interpreted using cervical intraepithelial neoplasia (CIN) terminology.Totally 571 cervical specimens were selected and retested to ascertain the HPV types and single/ multiple infections by liner array, a PCR-based method. Semi-quantitative result of HR-HPV DNA load (pg/ml) was estimated by HR HC2.According to the taxonomy of "International Human Papillomavirus Reference Center" , 13 HR-HPVs, including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68, which could be detected by HR HC2 were divided into 4 subgroups. Results: The positive rate of HR-HPV in normal cervix (436 cases), CIN1 (88 cases), CIN2+ (47 cases) group were 29.82%, 85.23% and 100%, respectively. The overall prevalence and median viral load increased coordinating with the pathological degree of cervical lesions (P<0.001). The positive rate and viral load of single infection with HR-HPV belongs to α9 species increased coordinating with the pathological degree of cervical lesions (P<0.05). The viral load of single infection with HR-HPV belongs to α7 species in CIN1 group was higher than those of normal group and CIN2+ group, but without statistical significance (P=0.130). The viral load of multiple infections in CIN1 group was 559.13 pg/ml, significantly higher than 37.73 pg/ml of normal histology (P=0.025), but without significant difference of 332.91 pg/ml of CIN2+ group (P=0.790). The median viral load of HPV single infection in CIN1 group was 167.93 pg/ml, significantly lower than 559.73 pg/ml of multiple infections (P=0.044). The incidence of co-infection with HR-HPVs belong to α9 species was 80.56%, dominated in all patterns of multiple infections and their median viral load increased coordinating with the pathological degree of cervical lesions, but without significant difference (P>0.05). The incidence of co-infection with HR-HPVs belong to α7 species was 66.67%, their median viral load in CIN1 group was higher than that of CIN2+ group, but without statistical significance (P>0.05). Conclusions: Viral loads of single/ multiple infections with HR-HPVs belong to different species show different tendencies coordinating with the pathological degree of cervical lesions. Women with high grade of cervical lesion were dominantly infected with high viral load of HR-HPVs belong to α9 species, and the viral load of multiple infections is higher than that of single infection in low grade of cervical lesion.

Transport paths and vertical exchange characteristics of haze pollution in Southern China

Transport paths and vertical exchange characteristics are important factors for understanding the long-term transport, dispersion capability for haze prediction. Many previous studies revealed that the Pearl River Delta (PRD) region, one of the major polluted areas in China, is largely affected by the long-range pollution transport. However, mostly of these studies focused on the source apportionment or horizontal transport path of pollutants by using short-term data, and the vertical exchange characteristics had been rarely analyzed. In this study, using HYSPLIT model, the transport paths and the vertical exchange characteristics of haze episodes over four sub-region of Guangdong (GD) Province in southern China of dry season and wet season were analyzed by using 10years data from 2005 to 2014. Three major transport paths can be statistically summarized based on the long-term data. The haze episodes in PRD and North-GD were distinguished by the characteristics of high frequency and long duration, while the West-GD and East-GD are relatively clean. The haze over North-GD and PRD were mainly influenced by the airflows from northern path, which could bring the pollution from Jiangxi, Anhui, and also influenced by the airflows from coastal path, which could bring the pollution of eastern coastal from Zhejiang and Fujian to Guangdong, while regional transport contributions from Guangdong province and adjacent areas can also be clearly observed. The haze pollution from the identified two major transport paths were mainly transported within the mixing layer (>80% trajectories, <500m), whereas the probability of haze trajectories across mixing layer was relatively low and generally associated with much longer transport distance and higher terrain height over Western China. Combing the vertical exchange analysis, results also show that Wuyi Mountains and Nanling Mountains played a role as barrier to obstruct the haze airflows from other regions of China to the Guangdong province.

Race and virulence characterization of Puccinia graminis f. sp. tritici in China

Wheat stem rust was once the most destructive plant disease, but it has been largely controlled. However, to prevent future problems, the ongoing development of resistant wheat varieties requires knowledge of the changing virulence patterns for Pgt virulence of the fungus that causes wheat stem rust and the detection of new races. Surveys were conducted from 2013-2014 to determine the races of the Pgt present in China. Low levels of stem rust infections were found in China during this investigation and 11 Puccinia graminis f. sp. tritici (Pgt) samples were obtained. In addition, 22 Pgt samples collected from the alternate host (Berberis) were obtained and have been reported for the first time. Fifty-three isolates were obtained from all samples. Four race groups, including 13 physiological races, were identified. They included the most prevalent races, 34C3MTGQM and 34C6MRGQM, with 13.2% predominance, followed by 34C0MRGQM at 11.3%. Six new races that were virulent against the resistance genes, Sr5 + Sr11, were found for the first time in China, namely 34C0MRGQM, 34C3MTGQM, 34C3MKGQM, 34C3MKGSM, 34C6MTGSM, and 34C6MRGQM, with a predominance of 11.3, 13.2, 9.4, 9.4, 1.9, and 13.2%, respectively. Most of the genes studied were ineffective against one or more of the tested isolates, except Sr9e, Sr21, Sr26, Sr31, Sr33, Sr38, Sr47, and SrTt3. Genes Sr35, SrTmp, Sr30, Sr37, Sr17, and Sr36 were effective in 92.5, 86.8, 84.9, 84.9, 79.3, and 77.4% of the tested isolates, respectively. In contrast, all of the isolates were virulent against Sr6, Sr7b, Sr9a, Sr9b, Sr9d, Sr9g, and SrMcN. Our results indicate that remarkable differences exist among the categories of the races in this study (i.e., their known virulence gene spectra) and the Pgt races reported previously. In addition, the sexual cycle of Pgt may contribute to its diversity in China.

Evaluation and identification of stem rust resistance genes Sr2, Sr24, Sr25, Sr26, Sr31 and Sr38 in wheat lines from Gansu Province in China

Wheat stem rust, caused by Puccinia granimis f. sp. tritici, severely affects wheat production, but it has been effectively controlled in China since the 1970s. However, the appearance and spread of wheat stem rust races Ug99 (TTKSK, virulence to Sr31), TKTTF (virulence to SrTmp) and TTTTF (virulence to the cultivars carrying Sr9e and Sr13) have received attention. It is important to clarify the effectiveness of resistance genes in a timely manner, especially for the purpose of using new resistance genes in wheat cultivars for durable-resistance. However, little is known about the stem rust resistance genes present in widely used wheat cultivars from Gansu. This study aimed to determine the resistance level at the seedling stage of the main wheat cultivars in Gansu Province. A secondary objective was to assess the prevalence of Sr2, Sr24, Sr25, Sr26, Sr31, and Sr38 using molecular markers. The results of the present study indicated that 38 (50.7%) wheat varieties displayed resistance to all the tested races of Puccinia graminis f. sp. tritici. The molecular marker analysis showed that 13 out of 75 major wheat cultivars likely carried Sr2; 25 wheat cultivars likely carried Sr31; and nine wheat cultivars likely carried Sr38. No cultivar was found to have Sr25 and Sr26, as expected. Surprisingly, no wheat cultivars carried Sr24. The wheat lines with known stem rust resistance genes could be used as donor parent for further breeding programs.

[Association between behavioral problems and gastrointestinal disorders among children with autism spectrum disorder]

Objective: To investigate the relationship between gastrointestinal disorders (GID) and core symptoms or behavioral problems among the children with autism spectrum disorder (ASD) . Method: Totally 328 children with ASD and 202 normal controls were enrolled in this cross-sectional study from August 2013 to October 2016. The information about the gastrointestinal disorders, behavioral and emotional problems was collected by using questionnaires. Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC) were used to assess the core symptoms of the children with ASD. Neurodevelopmental status was evaluated with Gesell Developmental Scale (GDS). These variables were analyzed by using student's t-test and chi-square test. Result: The prevalence of GID was significantly higher in the children with ASD than in the normally developing children (49.4% (162/328) vs.25.7% (52/202), χ(2)=29.039, P=0.000), especially the symptoms of constipation (33.2% (109/328) vs. 13.9% (28/202)), diarrhea (9.5%(31/328) vs. 1.5% (3/202)), nausea and vomiting (9.5% (31/328) vs. 3.5% (7/202)), and foul defecation (16.5% (54/328) vs. 5.0% (10/202)) (all P<0.05). Among the ASD children, the prevalence of GID was similar between male and female (46.7% (133/285) vs. 46.5%(20/43), χ(2)=0.006, P=0.938), as well as among all age groups (χ(2)=1.907, P=0.862). There was no significant difference in scores of GDS in the ASD children with or without GID (all P>0.05). Compared with ASD children without GID (n=166), the ASD children with GID (n=162) got higher scores in the "Body and Object Use" of ABC scale ( (16.4±9.3) vs. (12.3±6.7) scores, t=2.258, P=0.028), and had more emotional problems (63.6% (103/162) vs. 49.4% (82/166), χ(2)=6.707, P=0.010). Moreover, the score of behavior problems questionnaire was higher in the ASD children with GID ( (35.3±16.8) vs. (16.1±13.6) scores, t=5.748, P=0.000). Conclusion: Children with ASD have higher risk of GID than the normal developing children. While the stereotyped behaviors, problem behaviors and emotional problems are severer in the ASD children with GID. Hence, it is important to provide comprehensive treatment and management for these groups of children.

Genome-wide identification of the SWEET gene family in wheat

The SWEET (sugars will eventually be exported transporter) family is a newly characterized group of sugar transporters. In plants, the key roles of SWEETs in phloem transport, nectar secretion, pollen nutrition, stress tolerance, and plant-pathogen interactions have been identified. SWEET family genes have been characterized in many plant species, but a comprehensive analysis of SWEET members has not yet been performed in wheat. Here, 59 wheat SWEETs (hereafter TaSWEETs) were identified through homology searches. Analyses of phylogenetic relationships, numbers of transmembrane helices (TMHs), gene structures, and motifs showed that TaSWEETs carrying 3-7 TMHs could be classified into four clades with 10 different types of motifs. Examination of the expression patterns of 18 SWEET genes revealed that a few are tissue-specific while most are ubiquitously expressed. In addition, the stem rust-mediated expression patterns of SWEET genes were monitored using a stem rust-susceptible cultivar, 'Little Club' (LC). The resulting data showed that the expression of five out of the 18 SWEETs tested was induced following inoculation. In conclusion, we provide the first comprehensive analysis of the wheat SWEET gene family. Information regarding the phylogenetic relationships, gene structures, and expression profiles of SWEET genes in different tissues and following stem rust disease inoculation will be useful in identifying the potential roles of SWEETs in specific developmental and pathogenic processes.

Related to ABI3/VP1-Like 1 (RAVL1) regulates brassinosteroid-mediated activation of AMT1;2 in rice (Oryza sativa)

The promotive effects of brassinosteroids (BRs) on plant growth and development have been widely investigated; however, it is not known whether BRs directly affect nutrient uptake. Here, we explored the possibility of a direct relationship between BRs and ammonium uptake via AMT1-type genes in rice (Oryza sativa). BR treatment increased the expression of AMT1;1 and AMT1;2, whereas in the mutant d61-1, which is defective in the BR-receptor gene BRI1, BR-dependent expression of these genes was suppressed. We then employed Related to ABI3/VP1-Like 1 (RAVL1), which is involved in BR homeostasis, to investigate BR-mediated AMT1 expression and its effect on NH4+ uptake in rice roots. AMT1;2 expression was lower in the ravl1 mutant, but higher in the RAVL1-overexpressing lines. EMSA and ChIP analyses showed that RAVL1 activates the expression of AMT1;2 by directly binding to E-box motifs in its promoter. Moreover, 15NH4+ uptake, cellular ammonium contents, and root responses to methyl-ammonium strongly depended on RAVL1 levels. Analysing AMT1;2 expression levels in different crosses between BRI1 and RAVL1 mutant and overexpression lines indicated that RAVL1 acts downstream of BRI1 in the regulation of AMT1;2. Thus, the present study shows how BRs may be involved in the transcriptional regulation of nutrient transporters to modulate their uptake capacity.

Seedling Resistance to Stem Rust and Molecular Marker Analysis of Resistance Genes in Wheat Cultivars of Yunnan, China

Stem rust is one of the most potentially harmful wheat diseases, but has been effectively controlled in China since 1970s. However, the interest in breeding wheat with durable resistance to stem rust has been renewed with the emergence of Ug99 (TTKSK) virulent to the widely used resistance gene Sr31, and by which the wheat stem rust was controlled for 40 years in wheat production area worldwide. Yunnan Province, located on the Southwest border of China, is one of the main wheat growing regions, playing a pivotal role in the wheat stem rust epidemic in China. This study investigated the levels of resistance in key wheat cultivars (lines) of Yunnan Province. In addition, the existence of Sr25, Sr26, Sr28, Sr31, Sr32, and Sr38 genes in 119 wheat cultivars was assessed using specific DNA markers. The results indicated that 77 (64.7%) tested wheat varieties showed different levels of resistance to all the tested races of Puccinia graminis f. sp. tritici. Using molecular markers, we identified the resistance gene Sr31 in 43 samples; Sr38 in 10 samples; Sr28 in 12 samples, and one sample which was resistant against Ug99 (avirulent to Sr32). No Sr25 or Sr26 (effective against Ug99) was identified in any cultivars tested. Furthermore, 5 out of 119 cultivars tested carried both Sr31 and Sr38 and eight contained both Sr31 and Sr28. The results enable the development of appropriate strategies to breed varieties resistant to stem rust.

Transposon Ds-Mediated Insertional Mutagenesis in Rice (Oryza sativa)

Rice (Oryza sativa) is the most important consumed staple food for a large and diverse population worldwide. Since databases of genomic sequences became available, functional genomics and genetic manipulations have been widely practiced in rice research communities. Insertional mutants are the most common genetic materials utilized to analyze gene function. To mutagenize rice genomes, we exploited the transpositional activity of an Activator/Dissociation (Ac/Ds) system in rice. To mobilize Ds in rice genomes, a maize Ac cDNA was expressed under the CaMV35S promoter, and a gene trap Ds was utilized to detect expression of host genes via the reporter gene GUS. Conventional transposon-mediated gene-tagging systems rely on genetic crossing and selection markers. Furthermore, the activities of transposases have to be monitored. By taking advantage of the fact that Ds becomes highly active during tissue culture, a plant regeneration system employing tissue culture was employed to generate a large Ds transposant population in rice. This system overcomes the requirement for markers and the monitoring of Ac activity. In the regenerated populations, more than 70% of the plant lines contained independent Ds insertions and 12% expressed GUS at seedling stages. This protocol describes the method for producing a Ds-mediated insertional population via tissue culture regeneration systems. © 2016 by John Wiley & Sons, Inc.

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

Bone metastasis is a common complication in prostate cancer patients that can cause bone pain and pathological fracture. This study tested serum levels of prostate specific antigen (PSA), alkaline phosphatase (ALP), bone sialoprotein (BSP), collagen type I pyridine crosslinking peptide (ICTP) in prostate cancer patients and the significance of the receiver operator characteristic (ROC) curve in the diagnosis of prostate cancer bone metastases. Eighty-three prostate cancer patients were enrolled including 42 in the bone metastases group and 41 in the non-bone metastases group. Serum levels of BSP, ALP, ICTP, and PSA were highest in the bone metastases group followed by the non-bone metastases group, hyperplasia group, and then the control group (P < 0.05). Based on Gleason score, serum levels were highest in the poorly differentiated group followed by moderately differentiated and well-differentiated groups (P < 0.05). ROC curve analysis revealed that the diagnostic efficiency of the biomarkers in turn was BSP, PSA, ICTP, and ALP. The sensitivity of BSP, ALP, ICTP, and PSA in the diagnosis of prostate cancer bone metastases were 80.95, 57.14, 69.05, 71.43%, respectively, and the specificity of the same markers were 72.80, 64.80, 76.80, and 88.80%, respectively. Combined detection of the four markers improved sensitivity to 97.62% and the negative-predictive value increased to 97.60%. PSA + BSP showed the best efficiency when combining two markers. In conclusion, serum levels of BSP, ALP, ICTP, and PSA increased in patients with bone metastases, and combined detection of all markers could improve the positive-predictive value.

Correlation analysis of hormone receptors and the expressions of HER-2 and Ki-67 in breast cancer

OBJECTIVE

This study aims to investigate the correlation and clinical significance of hormone receptors and the expressions of HER-2 and Ki-67 in breast cancer primary lesions and lymph node metastatic tissues.

METHODS

83 cases were studied, who were performed breast cancer surgeries and confirmed the ipsilateral axillary lymph node metastasis by the postoperative pathological diagnosis. Immunohistochemical method was used to simultaneously detect the expressions of ER, PR, HER-2 and Ki-67 in the primary lesions and lymph node metastases.

RESULTS

ER exhibited the expression concordance rate as 85.5% in primary lesions and metastases, with significant difference (P = 0.039); the expression concordance rates of PR and HER-2 in primary lesions and metastases were 90.4% and 89.2%, respectively, without significant difference (P = 0.289, 0.180); between the Ki-67-highly-expressed primary lesions and Ki-67-lowly-expressed metastases, the expressions of ER in primary lesions and metastases exhibited statistical significance, with P as 0.031.

CONCLUSIONS

The primary lesions and lymph node metastases had higher consistency, while there was still about 10% patients showed differentiated expression. The simultaneous detection of breast cancer primary lesions and lymph node metastases was still very necessary.

Far-field sound radiation of a submerged cylindrical shell at finite depth from the free surface

The far-field sound radiation behavior of a circular cylindrical shell submerged at finite depth from the free surface is studied. Based on the Flügge shell theory and the Helmholtz equation, the structure-acoustic coupling equation is established. An image method is applied so that the sound boundary condition of the free surface can be satisfied. Analytical expression of the far-field sound pressure is obtained using the stationary phase method and the Graf's addition theorem. In order to evaluate the effect of the submerged depth on sound radiation, the results of the submerged cylindrical shell at finite depth from the free surface are compared with those of the submerged cylindrical shell in the infinite fluid. The characteristics of the far-field sound pressure with the change of the depth are investigated. It is found that the submerged depth has a significant influence on the far-field sound pressure radiated from the submerged cylindrical shell due to the free surface effects. The work provides more understanding on the sound radiation properties of the submerged circular cylindrical shell without assuming infinite fluid field, which was commonly used in previous studies.

Clinical features of diabetes mellitus cases complicated by Burkholderia pseudomallei septicemia

The aim of this study was to analyze the clinical characteristics of diabetes mellitus patients with Burkholderia pseudomallei septicemia and evaluate strategies of diagnosis and treatment. The clinical characteristics, diagnosis, treatment, and prognosis of 39 diabetes mellitus patients with B. pseudomallei septicemia were retrospectively analyzed. Farmers, fishermen and workers were found to be high-risk groups. The clinical manifestations of patients were diverse without specific features, but mainly presented manifestations of acute fulminant septicemia, diabetic ketoacidosis, and abscesses in tissues or/and organs. Patients showed high mortality and misdiagnosis rates and were prone to relapses and long treatment duration as there are currently few effective and sensitive antibiotics for the disease. Consequently, the cost of treatment for the disease was high. Early diagnosis, a prolonged course of heavy doses of sensitive intravenous antibiotics, drainage of abscesses, intensive insulin therapy, and supportive treatment are the keys for successful management of the disease. Regular follow-ups combined with long-term blood glucose control can help reduce the disease recurrence.

Organo-erbium systems for optical amplification at telecommunications wavelengths

Modern telecommunications rely on the transmission and manipulation of optical signals. Optical amplification plays a vital part in this technology, as all components in a real telecommunications system produce some loss. The two main issues with present amplifiers, which rely on erbium ions in a glass matrix, are the difficulty in integration onto a single substrate and the need of high pump power densities to produce gain. Here we show a potential organic optical amplifier material that demonstrates population inversion when pumped from above using low-power visible light. This system is integrated into an organic light-emitting diode demonstrating that electrical pumping can be achieved. This opens the possibility of direct electrically driven optical amplifiers and optical circuits. Our results provide an alternative approach to producing low-cost integrated optics that is compatible with existing silicon photonics and a different route to an effective integrated optics technology.

Who are Prone to Develop Adverse Effects with Oral Tramadol? a Retrospective Cohort Study

Objective

Oral tramadol is a commonly prescribed analgesic in Hong Kong. Significant adverse effects are frequently observed in our locality. Our study aims to describe the rate of significant adverse effect that warrant discontinuation of oral tramadol and identify the risk factors for development of adverse effect.

Design

Retrospective cohort study.

Methods

Adult patients aged greater than 18 years old admitted to the emergency medicine ward of a large-scale local hospital in Hong Kong being prescribed with oral tramadol during in-hospital stay were recruited. Significant adverse effects during the hospital stay were observed as the outcome of interest.

Results

A total of 575 subjects were recruited. 29.9% experienced significant adverse effects likely related to tramadol. Age (p=0.006; odds ratio [OR] = 1.017, 95% confidence interval [CI] = 1.005-1.029) and sex (p=0.006; OR=1.696, 95% CI= 1.166-2.465) were statistically significant predictors of adverse effects after oral tramadol.

Conclusion

Our study suggests that female and increasing age patients are significant predictors for the development of adverse effect after taking oral tramadol. Possible adverse effects should be explained to the patients careful especially the higher risk groups. (Hong Kong j. emerg.med. 2014;21:3-9)

Effects of prenatal polycyclic aromatic hydrocarbon exposure and environmental tobacco smoke on child IQ in a Chinese cohort

OBJECTIVE

This study of a birth cohort in the city of Tongliang in Chongqing, China, evaluated the relationship between two prenatal exposures (polycyclic aromatic hydrocarbons(PAH) and environmental tobacco smoke(ETS)) and child intelligence quotient (IQ) as measured by the Wechsler Preschool and Primary Scale of Intelligence at age 5 years. A coal-fired power plant was the major source of ambient PAH in this city. We tested the hypothesis that, after adjusting for potential confounders, prenatal exposure to these pollutants would be associated with lower IQ scores at 5 years of age.

METHODS

Nonsmoking mothers and children were enrolled before delivery. PAH exposure was measured by DNA adducts in umbilical cord white blood cells using High-Performance Liquid Chromatography-Fluorescence. Estimated exposure to environmental tobacco smoke was based on personal interview. At age 5 years, scores for verbal, performance, and full scale IQ were obtained. Multiple regression was used to test the main effects of adducts and environmental tobacco smoke on IQ and to explore the interactions between these exposures on IQ.

RESULTS

after adjusting for potential confounders, neither DNA adducts nor exposure to environmental tobacco smoke had significant main effects on IQ. However, significant interactions between adducts and environmental tobacco smoke were observed on full scale (p=0.025) and verbal (p=0.029) IQ scores, indicating that the adverse effects of prenatal PAH exposure became greater as exposure to environmental tobacco smoke increased. The interaction on performance IQ score was not significant (p=0.135).

CONCLUSION

These results suggest that exposure of pregnant women to emissions of PAHs from the coal-burning plant, in combination with prenatal exposure to envrionmental tobacco smoke, may have adversely affected cognitive function of children at age 5. The polluting coal-fired plant has since been closed by the government, with likely important benefits to child health and development.