3,4-diaminopyridine base effectively treats the weakness of Lambert-Eaton myasthenia.

INTRODUCTION: 3,4-diaminopyridine has been used to treat Lambert-Eaton myasthenia (LEM) for 30 years despite the lack of conclusive evidence of efficacy. METHODS: We conducted a randomized double-blind placebo-controlled withdrawal study in patients with LEM who had been on stable regimens of 3,4-diaminopyridine base (3,4-DAP) for ≥ 3 months. The primary efficacy endpoint was >30% deterioration in triple timed up-and-go (3TUG) times during tapered drug withdrawal. The secondary endpoint was self-assessment of LEM-related weakness (W-SAS). RESULTS: Thirty-two participants were randomized to continuous 3,4-DAP or placebo groups. None of the 14 participants who received continuous 3,4-DAP had > 30% deterioration in 3TUG time versus 72% of the 18 who tapered to placebo (P < 0.0001). W-SAS similarly demonstrated an advantage for continuous treatment over placebo (P < 0.0001). Requirement for rescue and adverse events were more common in the placebo group. DISCUSSION: This trial provides significant evidence of efficacy of 3,4-DAP in the maintenance of strength in LEM. Muscle Nerve 57: 561-568, 2018.

The Cymbidium genome reveals the evolution of unique morphological traits.

The marvelously diverse Orchidaceae constitutes the largest family of angiosperms. The genus Cymbidium in Orchidaceae is well known for its unique vegetation, floral morphology, and flower scent traits. Here, a chromosome-scale assembly of the genome of Cymbidium ensifolium (Jianlan) is presented. Comparative genomic analysis showed that C. ensifolium has experienced two whole-genome duplication (WGD) events, the most recent of which was shared by all orchids, while the older event was the τ event shared by most monocots. The results of MADS-box genes analysis provided support for establishing a unique gene model of orchid flower development regulation, and flower shape mutations in C. ensifolium were shown to be associated with the abnormal expression of MADS-box genes. The most abundant floral scent components identified included methyl jasmonate, acacia alcohol and linalool, and the genes involved in the floral scent component network of C. ensifolium were determined. Furthermore, the decreased expression of photosynthesis-antennae and photosynthesis metabolic pathway genes in leaves was shown to result in colorful striped leaves, while the increased expression of MADS-box genes in leaves led to perianth-like leaves. Our results provide fundamental insights into orchid evolution and diversification.

Data Monitoring for the Chinese Clinical Trials of Remdesivir in Treating Patients with COVID-19 During the Pandemic Crisis.

Two phase-III, double-blind, randomized clinical trials of remdesivir plus SOC (standard of care) versus placebo plus SOC have been conducted in Wuhan hospitals by Chinese investigators during the urgent COVID-19 epidemic [ClincalTrials.gov NCT04257656 and NCT04252664]. These trials have been highly anticipated worldwide. We expect investigators of the trials will soon report the clinical and laboratory findings from the medical perspective. This manuscript provides documentary style information on the process of monitoring key data and making recommendations to the sponsor and investigators based on analytical insights when dealing with the emergent situation from the statistical viewpoint. Having monitored data sequentially from 237 patients, we comment on the strength and weakness of the study design and suggest the treatment effect of remdesivir on severe COVID-19 cases. Our experience with using the Dynamic Data Monitoring (DDM) tool has demonstrated its efficiency and reliability in supporting DSMB's instantaneous review of essential data during the emergent situation. DDM, when used properly by disciplined statisticians, has shown its capability of exploring the trial data flexibly and, in the meantime, protecting the trial's scientific integrity.

Complete chloroplast genome of Arundina graminifolia (Orchidaceae).

Arundina graminifolia is a popular terrestrial orchid in Southeast Asia. It has high medicinal and ornamental value. In this study, the chloroplast genome of A. graminifolia was determined from BGISEQ-500 sequencing data. The total chloroplast genome was 159,482 bp in length, consisting of a large single-copy region (LSC 87,285 bp), a small single-copy region (SSC 18,581 bp), and two inverted repeat regions (IRA and IRB 26,813 bp). The complete chloroplast genome contains 135 genes, including 88 protein-coding genes, 38 transfer RNA (tRNA) genes, and 8 ribosomal RNA (rRNA) genes. In addition, the phylogenetic analysis indicates that A. graminifolia was sister to Bletilla ochracea, Bletilla striata, and Neottia fugongensis. The chloroplast genome will contribute to the research and conservation of A. graminifolia.

The complete chloroplast genome sequence of Goodyera foliosa（Orchidaceae）.

Goodyera foliosa is a terrestrial orchid in Asia and has been listed as an endangered species in the Red List. In this study, we assembled the complete chloroplast genome of G. foliosa using Illumina sequencing data. Its full-length of 154,008 bp including a pair of invert repeats (IR) regions of 25,045 bp, large single-copy (LSC) region of 83,248 bp, and small single-copy (SSC) region of 20,670 bp. The chloroplast genome contains 127 genes, including 80 protein-coding genes, 39 tRNA genes, and 8 rRNA genes. In addition, the phylogenetic analysis base on 12 chloroplast genomes of Orchidaceae indicates that G. schlechtendaliana is closely related to G. foliosa. Our study would be helpful for the formulation of conservation strategies and further research of G. foliosa.

The complete chloroplast genome of Cymbidium floribundum var. pumilum (Orchidaceae).

Cymbidium floribundum var. pumilum is an epiphytic orchid distributed in the southern China. It has a high ornamental value and always be used as a hybrid parent. In this study, we obtained a complete chloroplast genome of C. floribundum var. pumilum from BGISEQ-500 sequencing data. The total chloroplast genome was 155,291 bp in length, consisting of a large single copy region (LSC 84,415 bp), a small single copy region (SSC 17,484 bp), and two inverted repeat regions (IRA and IRB 26,696 bp). The complete chloroplast genome contains 139 genes, including 80 protein-coding genes, 38 transfer RNA (tRNA) genes, and 8 ribosomal RNA (rRNA) genes. In addition, the phylogenetic analysis indicates that C. floribundum var. pumilum was sister to section Geocymbidium, section Pachyrhizanthe and section Jensoa. The chloroplast genome will contribute to establish an effective conservation strategy for C. floribundum var. pumilum.

The complete chloroplast genome sequence of Ludisia discolor from Hainan of China.

Ludisia discolor is one of the most important ornamental and medicinal orchids. To improve our understanding of the evolution of chloroplast, we resequenced complete chloroplast (cp) genome of L. discolor from Hainan, China. The cp genome sequence of L. discolor of Hainan was 153,324 bp in length, with a large single-copy (LSC) region of 82,922 bp, a small single-copy (SSC) region of 17,258 bp, and a pair of inverted repeats (IR) regions of 26,572 bp. Complete chloroplast genome contain 132 genes, there were 86 protein-coding genes, 38 tRNA genes and eight rRNA genes. The phylogenetic tree showed that L. discolor of Hainan is sister to L. discolor (unknown distributed region). Their cp genomes have same gene number but different in length of genome, indicating high conserved among them.

The complete chloroplast genome sequence of Habenaria ciliolaris (Orchidaceae).

Habenaria ciliolaris is a kind of orchid with ornamental value. In this study, we reported the complete chloroplast genome of H. ciliolaris. The complete chloroplast genome is 154,544 bp in length, consists of a pair of inverted repeat (IR, 25,455 bp) regions, a large single-copy region (LSC, 84,032 bp) and a small single-copy region (SSC, 19,602 bp). It contains 179 genes, including 133 protein-coding genes, 38 tRNAs, and 8 rRNAs. A maximum-likelihood phylogenetic analysis demonstrated a close relationship between H. ciliolaris and Habenaria radiata. This work will be valuable for genetic and phylogenetic studies on H. ciliolaris.

The complete chloroplast genome of Eria corneri (Orchidaceae).

Eria corneri is a perennial epiphytic orchid distributed in southeastern China with high value of ornamental and medicinal. In this study, the complete chloroplast genome sequence of E. corneri was determined from Illumina pair-end sequencing data. The complete chloroplast genome sequence of E. corneri is 150,538 base pairs (bp) in length, including one large single-copy region (LSC, 85,941 bp), one small single-copy region (SSC, 13,099 bp), and a pair of inverted repeat regions (IRs) of 25,749 bp. Besides, the complete chloroplast genome contains 132 genes, including 77 protein-coding genes, 38 tRNA genes, and 8 rRNA genes. Phylogenetic analysis showed that E. corneri was most closely related to Calanthe triplicata and Calanthe davidii. Our study provides a foundation for the identification and genotyping of Eria species.

The complete chloroplast genome sequence of Tainia cordifolia (Orchidaceae).

Tainia cordifolia is a subtropical plant with significant ornamental value. Herein, we determined the complete chloroplast (cp) genome sequence of T. cordifolia using Illumina sequencing data. The whole cp genome is 158,089 bp in size, consisting of a pair of inverted repeats (IR 25,260 bp), a large single-copy region (LSC 86,876 bp), and a small single-copy region (SSC 20,693 bp). Plastid genome contains 136 genes, 88 protein-coding genes, 38 tRNA genes, and 8 rRNA genes. What is more, a maximum-likelihood phylogenetic analysis demonstrated that T. cordifolia was most closely related to Oberonia japonica and Dendrobium salaccense. The cp genome will provide reference for the further investigation and research of T. cordifolia.

The complete chloroplast genome of Tainia dunnii (Orchidaceae): genome structure and evolution.

Tainia dunnii is a terrestrial orchid with high ornamental value. Herein, we assembled the complete chloroplast genome of Tainia dunnii by next-generation sequencing technologies. The complete chloroplast genome sequence of Tainia dunnii is 158,305 base pairs (bp) in length, including a pair of inverted repeat regions (IRs, 25,244 bp), one large single-copy region (LSC, 86,819 bp), one small single-copy region (SSC, 20,998 bp). Besides, the complete chloroplast genome contains 136 genes in total, including 88 protein-coding genes, 38 tRNA genes, and 8 rRNA genes. Phylogenetic analysis showed that Tainia dunnii has the closest relationship with Calanthe davidii and Calanthe triplicata. Our study lay a foundation for further research of Tainia dunnii.

Conversion between 2 military combat-related injury coding systems.

Deployable medical systems(DEPMEDS) patient conditions (PCs) and Military Combat Injury Scale (MCIS) are 2 important military medical coding systems. However, both of them have defects when applied in military medical planning. Although each PC code contains information about treatment, intensity of care, treatment time, length of stay, and probability of disposition that is relevant to simulation, its description is too comprehensive and ambiguous to code historical military medical records. Therefore, conversion between PC and other medical coding systems applied in standard medical data is required when validity is required following simulation. The information linked to each PC code is based on subject matter expert opinion instead of standard medical data from the theater that need to be continuously updated depending on the results of medical data analysis. MCIS, a combat-related injury coding system, shows significant promise in coding real medical data, but it does not seek detailed information important for prediction and simulation unlike PCs. Therefore, MCIS cannot be used in planning tools directly. Thus, the effort to map MCIS to PCs is significant for medical logistic planning. We aim to identify whether conversion between PCs and MCIS is possible and to evaluate inter-coder reliability.Three senior coders assigned all possible MCIS codes to 187 combat-related PC codes. The data records were structured based on an earlier study. Inter-rater reliability was measured by using Cohen's k statistic and percent agreement.Low inter-rater reliability indicated the difficulty in conversion between PCs and MCIS.The injury descriptors of PCs should be expanded by referring to new standard medical data. The existing MCIS codes need to be modified to include more information on treatment brief, treatment time, length of stay, and other key information, and historical data statistics need to be developed.

A system dynamics approach to understanding the One Health concept.

There have been many terms used to describe the One Health concept, including movement, strategy, framework, agenda, approach, among others. However, the inter-relationships of the disciplines engaged in the One Health concept have not been well described. To identify and better elucidate the internal feedback mechanisms of One Health, we employed a system dynamics approach. First, a systematic literature review was conducted via searches in PubMed, Web of Knowledge, and ProQuest with the search terms: 'One Health' and (concept* or approach*). In addition, we used the HistCite® tool to add significant articles on One Health to the library. Then, of the 2368 articles identified, 19 were selected for evaluating the inter-relationships of disciplines engaged in One Health. Herein, we report a visually rich, theoretical model regarding interactions of various disciplines and complex problem descriptors engaged in One Health problem solving. This report provides a conceptual framework for future descriptions of the interdisciplinary engagements involved in One Health.

A Review of Evidence that Equine Influenza Viruses Are Zoonotic.

Among scientists, there exist mixed opinions whether equine influenza viruses infect man. In this report, we summarize a 2016 systematic and comprehensive review of the English, Chinese, and Mongolian scientific literature regarding evidence for equine influenza virus infections in man. Searches of PubMed, Web of Knowledge, ProQuest, CNKI, Chongqing VIP Database, Wanfang Data and MongolMed yielded 2831 articles, of which 16 met the inclusion criteria for this review. Considering these 16 publications, there was considerable experimental and observational evidence that at least H3N8 equine influenza viruses have occasionally infected man. In this review we summarize the most salient scientific reports.

Development and application of triage and medical evacuation system for casualties at sea.

Traditional triage could not meet the needs of battlefield casualties' care in modern warfare. This paper designs of triage and medical evacuation system for casualties at sea that can quickly address mass-casualty triage, and store and transmit medical information during battlefield treatment and medical evacuation. This system consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.