[The clinical characteristics of 497 children with congenital pseudarthrosis of the tibia].

Objective: To investigate the clinical and radiologic characteristics of children with congenital pseudarthrosis of the tibia (CPT) in a single center. Methods: This is a retrospective case series study. According to inclusion and exclusion criteria, clinical data of 497 children with CPT who were treated at Department of Orthopedics, the Children's Hospital Affiliated to Xiangya School of Medicine, Central South University from January 2011 to December 2020 were collected. Baseline data included gender, age at initial visit, age at onset of symptoms, accompanying symptoms, domicile, whether first treated at our hospital, and treatment-related information such as surgical or conservative treatment, surgical complications, etc., were extracted and analyzed using the health information system. Imaging data of the children, including Crawford classification, bilateral leg lengths, presence of fibular pseudarthrosis, and location of pseudarthrosis along the tibia segment, were analyzed using the Picture Archiving and Communication System. Data were compared using independent sample t-test or χ2 tests. Results: Among 497 children with CPT, there were 305 males (61.4 %) and 192 females (38.6%). The age at initial visit was (3.6±3.2) years (range: 0.1 to 16.2 years). Neurofibromatosis type 1 (NF1) symptoms were positive in 340 children (68.4%), and negative in 157 children (31.6 %). Among NF1-positive children, those with symptoms onset before 1 year of age were significantly more than NF1-negative children (74.1%(252/340) vs. 66.2%(104/157);χ2=9.24, P=0.001), and the proportion of fractures (92.9%,316/340) was significantly higher than that in the NF1-negative group (84.7%,133/157) (χ2=8.33, P=0.004). According to imaging data, Crawford type Ⅳ was the most common type, with 321 cases (63.3%), followed by type Ⅱ in 100 cases (19.7%), type Ⅲ in 54 cases (10.7 %) and type Ⅰ in 32 cases (6.3%). Pseudarthrosis occurred in the proximal third of the tibia in 14 cases (2.8 %), in the middle third in 185 cases (36.5 %), and in the distal third in 308 cases (60.8 %). Seventy-four children (14.9 %) had associated fibular pseudarthrosis. The lateral proximal tibial angle was 86.91°±5.21°(range: 72.17° to 102.08°), and the lateral distal tibial angle was 87.27°±10.73°(range: 51.07° to 128.17°). A total of 421 children (84.7%) underwent surgical treatment with (3.1±2.4) surgeries performed per child (range: 0 to 12 surgeries); 76 children (15.3 %) received conservative treatment. Postoperative complications mainly included ankle valgus (77 cases), leg length discrepancy (71 cases), refracture (48 cases), osteomyelitis (11 cases), and hardware failure (10 cases). NF1-positive children underwent more surgeries than NF1-negative children ((5.1±2.2)times vs.(2.1±1.8)times;t=14.93,P<0.01). Conclusions: Crawford type Ⅳ is the most common type of CPT in children. CPT predominantly occurs in the middle or distal third of the tibia. The majority of children with CPT experienced symptoms and were seen at outpatient clinics before the age of 3 years. The main surgical complications currently associated with CPT treatment are ankle valgus and leg length discrepancy. Compared with CPT without NF1, children with NF1-positive CPT tend to have earlier symptom onset and may require more frequent treatments.

Harmonisation of in-silico next-generation sequencing based methods for diagnostics and surveillance.

Improvements in cost and speed of next generation sequencing (NGS) have provided a new pathway for delivering disease diagnosis, molecular typing, and detection of antimicrobial resistance (AMR). Numerous published methods and protocols exist, but a lack of harmonisation has hampered meaningful comparisons between results produced by different methods/protocols vital for global genomic diagnostics and surveillance. As an exemplar, this study evaluated the sensitivity and specificity of five well-established in-silico AMR detection software where the genotype results produced from running a panel of 436 Escherichia coli were compared to their AMR phenotypes, with the latter used as gold-standard. The pipelines exploited previously known genotype-phenotype associations. No significant differences in software performance were observed. As a consequence, efforts to harmonise AMR predictions from sequence data should focus on: (1) establishing universal minimum to assess performance thresholds (e.g. a control isolate panel, minimum sensitivity/specificity thresholds); (2) standardising AMR gene identifiers in reference databases and gene nomenclature; (3) producing consistent genotype/phenotype correlations. The study also revealed limitations of in-silico technology on detecting resistance to certain antimicrobials due to lack of specific fine-tuning options in bioinformatics tool or a lack of representation of resistance mechanisms in reference databases. Lastly, we noted user friendliness of tools was also an important consideration. Therefore, our recommendations are timely for widespread standardisation of bioinformatics for genomic diagnostics and surveillance globally.

Norwegian patients and retail chicken meat share cephalosporin-resistant Escherichia coli and IncK/blaCMY-2 resistance plasmids.

OBJECTIVES: In 2012 and 2014 the Norwegian monitoring programme for antimicrobial resistance in the veterinary and food production sectors (NORM-VET) showed that 124 of a total of 406 samples (31%) of Norwegian retail chicken meat were contaminated with extended-spectrum cephalosporin-resistant Escherichia coli. The aim of this study was to compare selected cephalosporin-resistant E. coli from humans and poultry to determine their genetic relatedness based on whole genome sequencing (WGS). METHODS: Escherichia coli representing three prevalent cephalosporin-resistant multi-locus sequence types (STs) isolated from poultry (n=17) were selected from the NORM-VET strain collections. All strains carried an IncK plasmid with a blaCMY-2 gene. Clinical E. coli isolates (n=284) with AmpC-mediated resistance were collected at Norwegian microbiology laboratories from 2010 to 2014. PCR screening showed that 29 of the clinical isolates harboured both IncK and blaCMY-2. All IncK/blaCMY-2-positive isolates were analysed with WGS-based bioinformatics tools. RESULTS: Analysis of single nucleotide polymorphisms (SNP) in 2.5 Mbp of shared genome sequences showed close relationship, with fewer than 15 SNP differences between five clinical isolates from urinary tract infections (UTIs) and the ST38 isolates from poultry. Furthermore, all of the 29 clinical isolates harboured IncK/blaCMY-2 plasmid variants highly similar to the IncK/blaCMY-2 plasmid present in the poultry isolates. CONCLUSIONS: Our results provide support for the hypothesis that clonal transfer of cephalosporin-resistant E. coli from chicken meat to humans may occur, and may cause difficult-to-treat infections. Furthermore, these E. coli can be a source of AmpC-resistance plasmids for opportunistic pathogens in the human microbiota.

In vitro assessment of chloramphenicol and florfenicol as second-line antimicrobial agents in dogs.

The aim of this study was to evaluate the potential of chloramphenicol and florfenicol as second-line antimicrobial agents for treatment of infections caused by methicillin-resistant Staphylococcus pseudintermedius (MRSP) and extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli in dogs, through a systematic in vitro assessment of the pharmacodynamic properties of the two drugs. Minimum inhibitory concentrations (MIC) and phenicol resistance genes were determined for 169 S. pseudintermedius and 167 E. coli isolates. Minimum bactericidal concentrations (MBC), time-killing kinetics, and postantibiotic effect (PAE) of both agents against wild-type isolates of each species were assessed. For S. pseudintermedius, the chloramphenicol MIC90 was 32 µg/mL. No florfenicol resistance was detected in this species (MIC90 = 4 µg/mL). The MIC90 of both agents against E. coli was 8 µg/mL. Resistance genes found were catpC221 in S. pseudintermedius and catA1 and/or floR in E. coli. The phenicols displayed a time-dependent, mainly, bacteriostatic effect on both species. Prolonged PAEs were observed for S. pseudintermedius, and no PAEs were detected for E. coli. More research into determination of PK/PD targets of efficacy is needed to further assess the clinical use of chloramphenicol and florfenicol as second-line agents in dogs, optimize dosage regimens, and set up species-specific clinical break points.

An evaluation of preferred lip positions according to different age groups.

The purpose of this study was to compare preferred facial profiles rated by different age groups. An average profile of each gender was constructed from subjects with normal occlusions. Each average profile was located in the centre, and then the lips were protruded or retruded in six 1mm increments in each direction. 70 lay people were divided into 3 groups: young adult (20-39 years); middle-aged (40-54 years); and senior (55-70 years). They were asked to rank their 3 most preferred profiles for each gender. The distribution of the most pleasing profile was compared according to age groups by the Kruskal-Wallis test and according to the rater's gender by the Mann-Whitney U-test. There was a significant difference between the three age groups regarding the preferred male and female profiles (P<0.001). Both the middle-aged and the senior groups tended to select a slightly more retruded lip/flat profile than the young adult group. There was no gender dimorphism in the selection of the preferred profile. The young adult group preferred the straight profile while the middle-aged and senior groups favoured the slightly retruded profile. This may provide useful information for treatment planning in orthodontics and orthognathic surgery.

[Effects of guan-mai-shu on tissue-type plasminogen activator and plasminogen activator inhibitor in the plasma of patients with coronary heart disease].

Effects of Guan-Mai-Shu (GMS), a traditional Chinese medicine preparation, on tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) in the plasma of patients with coronary heart disease were studied. It was found that those patients had a significant decrease in t-PA activity (P < 0.05) and a significant increase in PAI activity (P < 0.01) compared to healthy subjects. After treatment of GMS, t-PA activity significantly increased (P < 0.001), while PAI activity decreased (P < 0.001). These results indicated that GMS could raise t-PA activity and reduce PAI activity in the plasma of patients with coronary heart disease.

Perceptual aberration and brain hemisphere reversal of foreperiod effect on time estimation.

An auditory warning signal of 3 seconds' duration was followed by tachistoscopic presentation of a single dark dot to either the left or the right visual field (N = 18). The warning signal was presented monaurally to the left or to the right ear. The duration of the warning signal constituted foreperiod. The task was verbal estimation of the duration of the dot. For those who showed little or no sign of aberration of personal body image, as detected by Chapman's Perceptual Aberration Scale, time estimation of dot duration tended to be longer when the warning signal was presented to the left ear than to the right ear. For those who showed substantial sign of such aberration, the laterality of foreperiod effect was reversed, so that time estimation of dot duration was longer for the right ear than for the left ear. There was no such hemispheric reversal in terms of visual field.

Binocular locus of brain hemisphere reversal of time information effect in schizophrenia.

Investigated brain hemisphere laterality of time information among 60 schizophrenics and 60 nonschizophrenics. Duration estimation of a single dark dot presented to the left, center and right visual fields was studied with respect to an auditory warning signal of variable duration. Three conclusions were drawn: First, the relation between posterior and prior time information was shown to be that of inverse variation, and this relation was intact among schizophrenics. Second, time information was lateralized toward the left hemisphere among nonschizophrenics and toward the right hemisphere among schizophrenics, which indicates hemispheric reversal of time information as a characteristic of schizophrenia. Third, such hemispheric reversal of time information was confined to binocular, therefore, bilateral, stimulus input.

On ego regression and prior time information effect in schizophrenia.

Process schizophrenics, reactive schizophrenics, neurotics, and alcoholics (N = 80) estimated the duration of a dark dot that followed an auditory warning signal of variable duration. The duration of the warning signal constituted foreperiod (FP). The effect of FP duration on time estimation (TE) was an increasing one for all Ss, and schizophrenics were indistinguishable from nonschizophrenics. Similarly, there was no group difference with respect to the effect of preceding foreperiod (PFP). Prior time information (TI) in terms of the correlation between the pitch of the warning signal and FP duration eliminated the effects of FP and FP change for schizophrenics. As for neurotics, such prior TI accentuated the effect of decrease of FP duration and attenuated the effect of increase of FP duration. The multi-level conceptualization of time is proposed in order to establish the distinction between regression in time and regression of time. Neurosis is regarded as involving regression in time; schizophrenia is regarded as involving regression on time.

Extensionality of information accompanying effect of numerosity on estimation of time duration.

60 subjects estimated the duration of the stimulus consisting of 1, 3, or 5 dark dots, following the auditory warning signal. The duration of the warning signal constituted duration of foreperiod which was either 1 or 5 sec. For the correlated groups, pitch of the warning signal weas perfectly correlated with numerosity of dots. For the uncorrelated group, there was no such correlation. For the constant group, pitch of the warning signal was constant. The increasing effect of numerosity of stimulus elements was reduced for the 5-sec foreperiod but not for the 1-sec. foreperiod in the correlated group. Such effect was present for both durations for foreperiod in the uncorrelated group and was absent for both durations of foreperiod in the constant group.

Binocular locus of prior time information effect in schizophrenia.

Schizophrenics and alcoholic controls estimated the duration of a single dark dot, which followed an auditory warning signal of variable duration that functioned as foreperiod duration. The effect of foreperiod duration on time estimation was an increasing one for both schizophrenics and alcoholics alike. Elimination of such foreperiod effect by prior time information in terms of correlation between pitch of the warning signal and foreperiod duration, was shown to be unique to schizophrenics. However, this prior time information effect was demonstrated only when the dot was viewed binocularly, not when viewed monocularly. This binocular locus of time expectancy in schizophrenia reflects the tendency toward spatialization of prior time information.

Weakness and instability of time expectancy in schizophrenia.

Duration of a tachistoscopically presented dark dot was estimated by schizophrenics and alcoholics. The dot was preceded by the auditory warning signal of viariable duration of up to 9 seconds. The duration of the warning signal constituted foreperiod duration. Estimation was a monotonically increasing function of foreperiod duration for both schizophrenics and alcoholics when the probability distribution of foreperiods was constant. However, this monotonicity was eliminated when changes in foreperiod duration became infrequent. When intrusion of extraneous stimulus accompanied such infrequent changes, the effect of foreperiod duration on estimation of stimulus duration became curvilinear, with the maximum estimation at the mid-range. For alcoholics, the monotonically increasing effect of foreperiod duration was independent of relative frequency of foreperiod changes and intrusion of extraneous stimulus. Weakness and instability of time expectancy as characteristics unique to schizophrenia were demonstrated.

Prior event uncertainty reduction under two different levels of time uncertainty of foreperiod duration in schizophrenia.

Schizophrenic and alcoholic Ss judged stimulus durations of .50 and .55 seconds. Stimulus was 1, 3 or 5 dark dots and was preceded by variable foreperiod duration of 1, 3 or 5 seconds. Judgment of stimulus duration was found to be a monotonically increasing function of both foreperiod duration and numerosity of dots. When pitch of sound, which functioned as a warning signal, was correlated with numerosity of dots, the monotonic relation between numerosity of dots and estimation of stimulus duration was eliminated for alcoholics, but not for schizophrenics, only when foreperiod duration was constant from trial to trial. The effect of prior information as to numerosity of dots was negligible for both schizophrenics and alcoholics when foreperiod duration was variable from trial to trial.

Prior time uncertainty reduction of foreperiod duration under two different levels of event uncertainty in process and reactive schizophrenia.

Process and reactive schizophrenic Ss judged stimulus durations of .50 and .55 seconds. Stimulus was 1, 3 or 5 dark dots and was preceded by variable foreperiod duration of 1, 3 or 5 seconds. Judgment of stimulus duration was found to be a monotonically increasing function of foreperiod duration. When pitch of the auditory warning signal was correlated with foreperiod duration so that it functioned as prior time information, such monotonic function was eliminated for process schizophrenics only when the numerosity of dots was constant from trial to trial. The effect of prior time information that concerned foreperiod duration was negligible for both process and reactive schizophrenics when the numerosity of dots was variable from trial to trial. Uniqueness of process schizophrenia was shown to be associated with prior time uncertainty reduction of foreperiod duration in the context of minimal event uncertainty of stimulus.

Prior time uncertainty reduction of foreperiod duration in schizophrenia and old age.

Four groups of college students, alcoholics, schizophrenics, and old age Ss judged stimulus durations of .50 and .55 seconds. The stimulus was preceded by a sound that functioned as the warning signal. The foreperiod duration, that is, the interval between the onsets of the warning signal and the stimulus, was variable and was either 1,3, or 5 seconds. There was no group difference with respect to the effect of foreperiod variability. Estimation of stimulus duration was a monotonically increasing function of foreperiod duration. However, when pitch of the sound was correlated with the corresponding foreperiod duration, this monotonic relation between foreperiod duration and estimation of stimulus duration was eliminated for schizophrenics, but not for nonschizophrenics. Although schizophrenics were not distinguishable from nonschizophrenics in terms of the effect of foreperiod variability, receptivity to prior information associated with time uncertainty reduction was shown to be unique for schizophrenia.

Prior time uncertainty reduction of foreperiod duration under two different levels of event uncertainty in schizophrenia.

Schizophrenic and alcoholic Ss judged stimulus durations of .50 and .55 seconds. Stimulus was 1, 3 or 5 dark dots and was preceded by variable foreperiod duration of 1, 3 or 5 seconds. Judgment of stimulus duration was found to be a monotonically increasing function of foreperiod duration. When pitch of sound was correlated with foreperiod duration so that it functioned as prior information, such monotonic function was eliminated for schizophrenics only when the numerosity of dots was constant from trial to trial. The effect of prior information as to foreperiod duration was negligible for both schizophrenics and alcoholics when the numerosity of dots was variable from trial to trial. Uniqueness of schizophrenia was shown to be associated with prior time uncertainty reduction of foreperiod duration in the context of minimal event uncertainty of stimulus.