[Clinical analysis of 6 critically ill children with acute chlorine poisoning].

Objective: To analyze the clinical characteristics and treatment of critically ill children with acute chlorine poisoning and explore the risk factors and effective strategies. Methods: This retrospective study collected the clinical data, including general state, clinical characteristics, treatment and follow-up(till 1 year and 6 months after discharge), of 6 critically ill children who were hospitalized in the Pediatric Intensive Care Unit of Beijing Children's Hospital due to acute chlorine poisoning in August 2019. Results: There were 6 children characterized by severe dyspnea in this accident, among whom 4 were boys and two girls, aged 4-12 years. When the accident occurred, they were within 5 m of the chlorine source. These patients underwent tracheal intubation and mechanical ventilation in 3.5-7.0 h after poisoning. The child who was the closest to the chlorine source (1.5 m) and took the longest time (5 min) to evacuate was the most severe one. He suffered hypoxia which could not be corrected by conventional mechanical ventilation and severe shock, then had veno-arterial extracorporeal membrane oxygenation(ECMO) treatment started 10 h after the accident. All the 6 children in this study survived. Following-up found no growth and developmental abnormality. The pulmonary function tests were normal except for one case with increased small airway resistance due to previous suspected asthma, and the lung CT, electhoencephalogram, and brain magnetic resonance imaging were all normal. Conclusions: Severe chlorine poisoning is mainly characterized by respiratory failure. Mechanical ventilation is often required within a few hours after poisoning. When conventional mechanical ventilation is ineffective, ECMO could save live. Timely treatment could improve prognosis.

[Reevaluation of equivocal HER2 status detected by immunohistochemistry according to the 2019 guidelines for HER2 detection].

Objective To understand the effects and clinical significance of the 2019 guidelines for the human epidermal growth factor receptor 2 (HER2) detection. Methods: According to the 2014 guidelines, 548 cases of invasive breast cancer with equivocal HER2 (2+) detected by immunohistochemistry (IHC) in Taizhou Enze Medical Center, Zhejiang Province, China from 2013 to 2019 were selected. The results of IHC and HER2/CEPl7 double-probe were reevaluated and divided into groups according to the 2019 guidelines for the comparative analysis. Results: Among the 548 IHC HER2 (2+) invasive breast cancers, the number of positive, equivocal and negative cases for HER2 were 96 (17.52%), 81 (14.78%) and 371 (67.70%), respectively, according to the 2014 guidelines. However, according to the 2019 guidelines, 10 cases (1.82%) were reclassified as IHC 1+, 2 cases in the group 2 were reclassified as negative, and all the originally equivocal cases in group 4 were reclassified as negative. Finally, the total number of positive and negative cases for HER2 were 94 (17.15%) and 454 (82.85%), respectively. Conclusions: After applying the 2019 guidelines, the number of IHC 2+ cases decreases, and the positive rate for HER2 also decreases slightly due to the reevaluation change in groups 2 and 4, leading to reclassification of the cases that were deemed equivocal according to the 2014 guidelines. In general, the new 2019 guidelines are more reasonable and easier to use.

[Intraobserver reproducibility of Ki-67 assessment of breast cancers based on digital slide].

Objective: To investigate the intra-observer reproducibility of Ki-67　　　assessment in breast cancers using three methods based on digital slide. Methods: Thirty cases of invasive breast cancer tissues were immunostained for Ki-67 by automatic stainer, and then scanned into digital pathological slides. Ki-67 positive index was measured individually by three pathologists using size-set visual assessment of hot spot (SSVAHS), size-set semi-automatic counting of hot spot(SSSACHS), and size-set automatic counting of hot spot (SSACHS), respectively, and repeated for 10 times. Intraclass correlation coefficient (ICC) of each assessment method was calculated, and the intraobserver reliability was classified as excellent, good, fair and poor according to ICC. Results: The ICC by 3 pathologists using SSVAHS was 0.832, 0.843 and 0.826, respectively, The ICC using SSSACHS was 0.926,0.938,0.929, and the ICC using SSACHS was 0.964, 0.971 and 0.968.The intraobserver reliability level of all three methods was excellent. Conclusion: The three methods of Ki-67 assessment achieve satisfactory intraobserver reproducibility, and the order of reproducibility from high to low is SSACHS, SSSACHS, and SSVAHS.

Process optimization and the relationship between the reaction degree and the antioxidant activity of Maillard reaction products of chicken liver protein hydrolysates.

The aim of this study was to optimize the protein hydrolysates from chicken liver with xylose under Maillard reaction (MR) conditions using response surface methodology. The correlation between the browning degree, grafting degree, and the antioxidant activities of the Maillard reaction products (MRPs) was investigated. The optimal reaction conditions were achieved with a reaction temperature of 138.78°C, an initial pH of 7.99, and a reaction time of 93.14 min. The grafting degree (41.98%) and browning degree (2.582) of chicken liver protein hydrolysate MRPs (CLPHM) were notably higher (P < 0.05) than those of protein MRPs (CLPM) and were significantly lower (P < 0.05) than those of sonicated hydrolysate MRPs (SCLPHM). The reducing power, 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging and hydroxyl radical scavenging of CLPM, CLPHM, and SCLPHM were significantly higher (P < 0.01) than those of the protein or hydrolysate substrates. The grafting degree and browning degree of CLPM, CLPHM, and SCLPHM had positive correlations with DPPH and hydroxyl radical scavenging activity. Hence, this study could enhance the added value of chicken liver by exhibiting the enhancements from ultrasound pretreatment and the MR. MRPs could have an effective and potential application in the food industry.

Effect of different time of ultrasound treatment on physicochemical, thermal, and antioxidant properties of chicken plasma protein.

The aim of present study was to investigate the effect of different times (5 min (UCPP-5), 10 min (UCPP-10), 20 min (UCPP-20), and 30 min (UCPP-30)) of ultrasound treatment on physicochemical, thermal, and antioxidant properties of chicken plasma protein (CPP). UCPP-20 had the highest fluorescence intensity and the lowest particle size. However, no major changes in the subunit compositions and the secondary structure of UCPPs were presented in SDS-PAGE and circular dichroism. The surface hydrophobicity and sulfhydryl content of UCPPs increased significantly (P < 0.05) as compared to those of CPP. With the increasing time of ultrasound treatment, there were more and deeper holes on the protein surfaces. Furthermore, protein modification by ultrasound could improve the thermal properties of UCPPs. Additionally, UCPPs showed a significant increase in antioxidant properties over CPP, especially UCPP-20. These observations indicated that ultrasound treatment was necessary for modification of CPP to meet the requirements for food processing.

[Nasal continuous positive airway pressure ventilation in children with community-acquired pneumonia under five years of age: a prospective, multi-center clinical study].

Objective: To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population. Method: This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis. Result: Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO(2)), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO(2) ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO(2)/fraction of inspiration O(2) (FiO(2) ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO(2) of NCPAP effective group decreased significantly, while the PaO(2) and PaO(2)/FiO(2) increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO(2) in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation. Conclusion: NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO(2) or low PaO(2)/FiO(2), and they may need early intubation.

Effects of ultrasound-assisted alkaline extraction on the physiochemical and functional characteristics of chicken liver protein isolate.

This research investigated the physiochemical and functional characteristics of chicken liver protein isolate, which was extracted by alkali (CLPI) and ultrasound-assisted alkali (UCLPI), respectively. Protein yield of UCLPI was increased by 55.4% over that of CLPI (P < 0.05). Several amino acids were significantly higher and methionine was lower in UCLPI (P < 0.05). Ultrasound treatment reduced the particle size and prolonged the stability of the protein isolate during 7 d storage. Lower pH and a higher amount of total solubilized proteins (68.5%) were found in UCLPI by comparison with CLPI (61.8%). Surface hydrophobicity increased greatly by 63.0% compared with CLPI, but the total/reactive sulfhydryl groups and the primary structure molecular weight profile between them were not significantly different (P > 0.05). However, the enthalpy of denaturation in UCLPI decreased by 41.7%, which was related to the changes in its second structure. This resulted in better water/oil holding capacity and emulsifying properties for UCLPI. The changed physiochemical characteristics and improved functional properties of UCLPI demonstrated the potential utilization of ultrasound-assisted alkaline extraction in the food industries.

[Clinical analysis of chronic rhinosinusitis in the different age group patients].

Objective:To investigate the clinical materials of chronic rhinosinusitis (CRS) in the different age group patients and explore its clinical characteristics and prognosis.Method:A retrospective analysis was carried out in 395 CRS patients with surgical treatment in our hospital in the past three years. They were divided into the young group (18 to 39 years old ), the middle-aged group (40 to 59 years old ), and the old group (over 60 years old). The clinical symptoms, accompanying diseases and prognosis in CRS patients were analyzed.Result:Among the presenting symptoms,facial pain and rhinorrhea were most common in the young group (P< 0.05), while dysosmia was most common in the old group (P< 0.05). Allergy was more prevalent in the young group and the middle-aged group than the old group (P< 0.05). CRS without polyposis was the most common diagnosis in the young group and CRS with polyposis was the more common diagnosis in the middle-aged group and the old group (P< 0.05). Patients in the young group got higher rate of improvement in olfactory function while patients in the old group got higher rate of improvement in rhinorrhea following FESS (P< 0.05).Conclusion:CRS in different age groups had different clinical features and prognosis. We can improve the personalized treatment program to this disease through the classification and grading treatment.

HUWE1 plays important role in mouse preimplantation embryo development and the dysregulation is associated with poor embryo development in humans.

HUWE1 is a HECT domain containing ubiquitin ligase implicated in neurogenesis, spermatogenesis and cancer development. The purpose of the current study is to investigate the role of HUWE1 in early embryo development. Here we demonstrate that Huwe1 is expressed in both nucleus and cytoplasm of preimplantation mouse embryos as well as gametes. Hypoxia (5% O2) treatment could significantly increase Huwe1 expression during mouse embryo development process. HUWE1 knockdown inhibited normal embryonic development and reduced blastocyst formation, and increased apoptotic cell numbers were observed in the embryos of HUWE1 knockdown group. Human embryo staining result showed that reduced HUWE1 staining was observed in the poor-quality embryos. Furthermore, Western blot result showed that significantly reduced expression of HUWE1 was observed in the villi of miscarriage embryos compared with the normal control, indicating that reduced expression of HUWE1 is related to poor embryo development. Oxidative reagent, H2O2 inhibited HUWE1 expression in human sperm, indicating that HUWE1 expression in sperm is regulated by oxidative stress. In conclusion, these results suggest that HUWE1 protein could contribute to preimplantation embryo development and dysregulated expression of HUWE1 could be related to poor embryo development and miscarriage in IVF clinic.

Effects of Candidatus Liberibacter asiaticus on the fitness of the vector Diaphorina citri.

AIMS: The Asian citrus psyllid (ACP), Diaphorina citri Kuwayama transmits the bacterium 'Candidatus Liberibacter asiaticus' (Las), which causes citrus huanglongbing (HLB) disease. Although many studies have been conducted on the biology of ACP on different host plants, few have taken the plant, Las bacteria and the vector insect within one context to evaluate the effects of Las on the fitness of ACP under field conditions. Understanding the relationship between Las and ACP is critical for both ACP and HLB disease management. METHODS AND RESULTS: We estimated the development and survival of ACP immatures, the longevity and fecundity of ACP female adults in four treatments (Las-positive or -negative ACP on Las-infected and -free citrus plants). Las-positive ACP immatures developed significantly faster on Las-infected citrus than those on Las-free plants. The fecundity and longevity of Las-positive female adults were also greater, or longer on Las-infected citrus shoots, whereas the survival of Las-positive immatures was significantly lower on Las-infected citrus shoots, compared to those that developed on Las-free plants. Similarly, the intrinsic rate of population increase (rm ) was highest (0·1404) when Las-positive ACP fed on Las-infected citrus shoots and the lowest (0·1328) when the Las-negative ACP fed on Las-free citrus shoots. CONCLUSIONS: Both the Las infection in ACP and citrus plants had obvious effects on the biology of ACP. When compared to the Las infection in ACP insects, the Las infection in citrus shoots had a more significant effect on the fitness of ACP. SIGNIFICANCE AND IMPACT OF THE STUDY: To efficiently prevent the occurrence and spread of HLB disease, it is critical to understand the ecological basis of vector outbreaks and disease incidence, especially under field conditions. Thus, this study has increased our understanding of the epidemiology of HLB transmitted by psyllids in nature.

[Mutation status of epidermal growth factor receptor and KRAS gene in non-small cell lung cancers at Xuanwei regions of Yunnan Province].

OBJECTIVE: To investigate the mutation status of epidermal growth factor receptor (EGFR) and KRAS gene in patients with non-small cell lung cancer (NSCLC) in Xuanwei, Yunnan and to correlate the mutation status with clinicopathologic features. METHODS: Mutation status of exons 18, 19, 20 and 21 of EGFR, and codons 12, 13 of KRAS in 63 cases of NSCLC were analyzed by gene sequencing and ARMS-Taqman probe method. Correlation with patients' clinicopathological characteristics was performed. RESULTS: EGFR and KRAS mutations were present in 55.6% (35/63) and 6.3% (4/63), respectively. EGFR gene mutations were present, including exon 18 G719X in 14.3% (5/35), exon 19 in 14.3% (5/35), exon 20 S768I and T790M in 20.0% (7/35), exon 21 L858R in 31.4% (11/35), exon 18 G719X and exon 20 S768I double mutation in 17.1% (6/35), and exon 20 T790M and exon 21 L858R double mutation in 2.9% (1/35). KRAS mutations were seen in codon 12 in 3 of 4 cases, and codon 13 in 1 of 4 cases. EGFR mutations were mutually exclusive with KRAS mutations. According to statistic analysis, EGFR mutations were associated with the histological types of NSCLC(P<0.05), but without correlation with patient's gender, age, smoking status and lymph node metastasis(P>0.05). KRAS mutations in NSCLC had no correlation with the clinical pathologic characteristics of the patients. CONCLUSIONS: A higher frequency of EGFR exon 18 G719X and 20 exon S768I mutations are found in the patients in Xuanwei, Yunnan. EGFR mutations are associated with histologic types of NSCLC, but without correlation with patient's gender, age, smoking status and lymph node metastasis. KRAS mutation in NSCLC has no correlation with the clinicopathologic characteristics of the patients.

[Effect of tympanostomy tube insertion with adenoidectomy for children with recurrent otitis media with effusion].

Objective:To observe the clinical effect of tympanostomy tube insertion with adenoidectomy for children with recurrent otitis media with effusion. Method:One hundred and twenty-six cases of children with recurrent otitis media were randomly divided into observation group and control group(63 in each group), subsequently compared the therapeutic effect of the two groups which observation group had tympanostomy tube insertion with adenoidectomy and the other group had only tympanostomy tube insertion. Result:In terms of the total effective rate,observation group and control group were 96.82% and 76.19% respectively, the difference had statistical significant(P<0.05);compared to control group, the recurrent rate of observation group after treatment was extremely lower, the same as middle ear cavity effusion time, which both had statistical significance (P<0.05); the complete healing time of two groups had no statistical significance(P>0.05). Conclusion:Tympanostomy tube insertion with adenoidectomy has significant treatment effect for children with recurrent otitis media with effusion, it could reduce the recurrent rate after surgery and shorten the time of middle ear cavity effusion.

[Effect observation of cryotherapy in the treatment of nasal cavity adhesion].

Objective:To investigate the effect of cryotherapy in the treatment of nasal cavity adhesion.Method:Patients with nasal cavity adhesion(68 sides in total)were randomly devided into the experimental group(34 sides) and the control group(34 sides).The experimental group were treated with cryotherapy and the control group with traditional separation surgery.The subjective symptoms and recovery of nasal mucosa were observed at 1,3 and 8 weeks after treatment.Result:①The postoperative nasal obstruction symptom evaluation score in the experiment group were significantly better than in the control group(P<0.05).②The VAS score of discomfort during therapeutic process in the experiment group were significantly better than in the control group(P<0.05).③The endoscopic mucosa morphology score at 1,3 and 8 weeks postoperatively in the experiment group was significantly better than that in the control group(P<0.05).④The cure rate of experiment group was 97.1% and 76.5% of control group .The cure rate of experiment group was significantly higher than that of the control group(P<0.05).Conclusion:Cryotherapy is a simple and safe therapeutic method in the treatment of nasal cavity adhesion with less discomfort,higher therapeutic effect and better mucosa recovery.Cryotherapy is more likely to be accepted by patients.

[Evaluation of the effect of Nasopore on nasal packing in functional endoscopic sinus surgery].

Objective:To investigate the effect of Nasopore on nasal packing in functional endoscopic sinus surgery.Method:A total of 117 chronic rhinosiunsitis with or without nasal polyps patients undergone bilateral functional endoscopic sinus surgery and finished follow up visit were recruited. In accordance with various nasal packing materials in operation, patients were divided into Nasopore group, Sorbalgon group, Merocel group and Sorbalgon combined Mercel group. The VAS score was measured and differences were observed in patients of four groups in terms of subjective symptoms,post-operation adverse reaction and recovery of mucosa of operative nasal cavity in 2,4,8 and 12 weeks.Result:①The postoperative VAS symptoms score regarding nasal obstruction, nasal pain, head pressure feeling and discomfort in removal of the nasal packing in Nasopore group were significantly better than those in the other groups(P<0.05).②In Nasopore group,incidences of adverse reactions in epiphora, dysphagia, bleeding after removal nasal packing,surrounding mucosa scratches, nasal packing incarceration were significantly lower than that in the other groups(P<0.05). The incidences of fever,sneezing,bleeding in operation day and faint when removing nasal packing in four groups had no statistical differences(P> 0.05).③The postoperative Lund-Kennedy endoscopic mucosa morphology score in 2,4,8 and 12 weeks in four groups had no statistical differences(P> 0.05), and in each group the score was significantly lower as time changes(P<0.05).Conclusion:The Nasopore packing has definite hemostatic efficacy,little postoperative discomfort and nice mucosal healing outcome as well in patients after functional endoscopic sinus surgery.It indicates that Nasopore is an effective and reliable packing material in FESS.

[Status analysis of patients with hypertension in 22 community health centers of Shenzhen Futian District].

OBJECTIVE: To investigate current situation of blood pressure control in patients with hypertension in 22 community health centers of Shenzhen Futian District, and to find out related factors which affect blood pressure control. METHODS: In the study, 10 020 cases with essential hypertension that had been registered in 22 Community Health Centers were selected as cases for the survey. The questionnaires, physical examinations, and laboratory tests were used to obtain the patients' baseline data. RESULTS: The mean blood pressure (median) levels were 142/86 mmHg (1 mmHg=0.133 kPa). Those of the males were higher than those of the females (142/86 mmHg vs. 140/85 mmHg, ZSBP=-6.14,ZDBP=-9.93,P<0.001), the systolic blood pressure increased with age. The overall blood pressure control rate was 40.2%. The blood control rates were different with different gender, body mass index (BMI) and waist circumference. The majority of the patients took single antihypertensive drug, and the proportion accounted to 54.4%. Regression analysis showed that gender, age, hyperlipidemia, smoking, and waist circumference were the main factors that affected blood pressure control. CONCLUSION: The blood control rate was low in these communities. Patients with high blood pressure often merge a variety of factors that affect blood pressure control, and at the same time of antihypertensive therapy for the patients, we should pay attention to the control of these factors.

Proteolysis and cathepsin activities in the processing of dry-cured duck.

Changes in sarcoplasmic and myofibrillar proteins, free amino acids, and cathepsin activities were measured to evaluate the contribution of cathepsins to the proteolysis of muscle proteins in dry-cured duck processing. Thirty-six dry-cured ducks were processed with the traditional method, and samples were collected at different stages. Sarcoplasmic and myofibrillar proteins were found to be degraded to some degree at different stages, whereas content of free amino acids increased from 43.9 to 133.97 mg/100 g during the whole process. Cathepsin B, D, and L activities decreased significantly, and the activities in the end product were 22.4, 26.2, and 40.5% of those in the raw material, respectively. Statistical analysis showed there were significant correlations among changes in proteins, free amino acids, and cathepsin activities. The results indicated that cathepsins are involved in the proteolysis of muscle proteins in dry-cured duck processing.

Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study.

This randomized, double-blind, placebo-controlled study evaluated whether lamivudine given during late pregnancy can reduce hepatitis B virus (HBV) perinatal transmission in highly viraemic mothers. Mothers were randomized to either lamivudine 100 mg or placebo from week 32 of gestation to week 4 postpartum. At birth, infants received recombinant HBV vaccine with or without HBIg and were followed until week 52. One hundred and fifty mothers, with a gestational age of 26-30 weeks and serum HBV DNA >1000 MEq/mL (bDNA assay), were treated. A total of 141 infants received immunoprophylaxis at birth. In lamivudine-treated mothers, 56 infants received vaccine + HBIg (lamivudine + vaccine + HBIg) and 26 infants received vaccine (lamivudine + vaccine). In placebo-treated mothers, 59 infants received vaccine + HBIg (placebo + vaccine + HBIg). At week 52, in the primary analyses where missing data was counted as failures, infants in the lamivudine + vaccine + HBIg group had a significant decrease in incidence of HBsAg seropositivity (10/56, 18%vs 23/59, 39%; P = 0.014) and in detectable HBV DNA (11/56, 20%vs 27/59, 46%; P = 0.003) compared to infants in the placebo + vaccine + HBIg group. Sensitivity analyses to evaluate the impact of missing data at week 52 resulting from a high dropout rate (13% in the lamivudine + vaccine + HBIg group and 31% in the placebo + vaccine + HBIg group) remained consistent with the primary analysis in that lower transmission rates were still observed in the infants of lamivudine-treated mothers, but the differences were not statistically significant. No safety concerns were noted in the lamivudine-treated mothers or their infants. Results of this study suggest that lamivudine reduced HBV transmission from highly viraemic mothers to their infants who received passive/active immunization.