[Evaluation of anticoagulant effect and predicted dose of low molecular weight heparin in hemodialysis by anti-â ©a factor activity].

The purpose of this study was to explore the reasonable dose of low molecular weight heparin (LMWH) in hemodialysis (HD) and the strategy of preventing extracorporeal circuit coagulation (ECC). A retrospective case-control study included patients who used LMWH for anticoagulation during maintenance hemodialysis (MHD) in the Hemodialysis Center of Beijing Hospital from December 2020 to January 2021. Basic data such as weight, height, basic kidney disease, dialysis age and anti-Ⅹa factor activity before, during and after dialysis were collected. A total of 46 patients were enrolled in this study, including 5 patients in coagulation group (10.9%) and 41 patients in non-coagulation group (89.1%). The anti-Ⅹa factor activity reached its peak at 0.5 h after the start of HD. The level of anti-Ⅹa factor was incorporated into the receiver operating characteristic curve (ROC curve). The results showed that the area under the ROC curve (AUC) was 0.802 (95% confidence interval: 0.651-0.54, P=0.029), and the cutoff was 0.31 IU/ml (sensitivity 1, specificity 0.683). It is suggested that the body surface area should be used as the basis to estimate the anticoagulant dose of LMWH in HD, and the activity of HD 4 h anti-Ⅹa factor ≤0.31 IU/ml, which is of diagnostic value for ECC. In addition, the results of binary logistic regression analysis showed that dialysis age was an independent risk factor for ECC (OR value 1.319, 95%CI 1.052-1.654, P=0.017). In summary, this study reveals that dialysis age may be a risk factor for ECC and that the activity of HD 4 h anti-Ⅹa factor ≤0.31 IU/ml can be used as a potential diagnostic cut-off point for ECC in HD patients, which provides a scientific basis for monitoring strategies to prevent blood coagulation in HD filters.

[Application of 21-gene recurrence risk score in patients with breast cancer].

Objective: To investigate the relationship between 21-gene recurrence risk score (21-Gene RS) and the prognosis and clinicopathological features of hormone receptor (HR) positive, HER2-negative early breast cancer patients who did not receive neoadjuvant therapy. Methods: A total of 469 patients with HR positive and HER2-negative early breast cancer who received surgical treatment in the First Affiliated Hospital, Zhejiang University School of Medicine from January 2014 to October 2017 were selected. Their clinicopathological data were retrospectively analyzed. Tumor tissue samples were collected from patients, and the expression of 21-gene was detected by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). The 21-Gene RS was calculated according to the Trial Assigning Individualized Options for Treatment (TAILORx) RS grouping and National Surgical Adjuvant Breast and Bowel Project B-20 (NSABP B-20) RS grouping principles. Patients were divided into low (21-Gene RS<11 or 21-Gene RS<18), intermediate (11≤21-Gene RS<26 or 18≤21-Gene RS<31) and high (21-Gene RS≥26 or 21-Gene RS≥31) risk groups, and the clinicopathological features and prognostic differences of patients in different risk groups were compared. Statistical data were compared by chi-square test. Survival analysis was performed using Kaplan-Meier curve analysis and the differences between groups were compared using Log-rank test. Multivariate analysis was conducted by COX regression analysis. Results: Based on TAILORx RS grouping, the proportions of low-risk, intermediate-risk and high-risk groups among the 469 patients were 18.8% (88/469), 48.2% (226/469) and 33.0% (155/469), respectively. Based on NSABP B-20 RS grouping, the proportion of low-risk, intermediate-risk and high-risk groups were 43.1% (202/469), 37.5% (176/469) and 19.4% (91/469), respectively. The association of 21-Gene RS with histological grading, luminal typing, Ki-67 expression, and chemotherapy and treatment modalities were statistically significant (P<0.05) regardless of TAILORx RS grouping or NSABP B-20 RS grouping. Kaplan-Meier survival curve suggested poor prognosis in high-risk group (P<0.05, Log-rank test). Multivariate COX regression analysis showed that surgical method and 21-Gene RS were risk factors affecting the prognosis of patients. Conclusions: 21-Gene RS is significantly associated with the prognosis of patients with HR-positive, HER2-negative, early-stage breast cancer not receiving neoadjuvant therapy, as well as with their clinicopathological characteristics such as patients' histologic grade, luminal typing, Ki-67 expression, and whether or not they are treated with chemotherapy or other treatment modalities.The 21-Gene RS threshold of 11 and 26 or 18 and 31 can be used to grade the prognosis in Chinese patients with early-stage breast cancer. More researches are needed to guide the selection of postoperative adjuvant therapy for patients with HR-positive and HER2-negative early-stage breast cancer.

[Research progress of FAPI PET/CT in the diagnosis of malignant liver tumors].

Malignant liver tumors have a high incidence and mortality rate. Therefore, it is of great significance to promptly learn about tumor advancement status through relevant examinations for patients' follow-up, diagnosis, and therapy as well as the improvement of the five-year survival rate. The primary lesions and intrahepatic metastases of malignant liver tumors have been better demonstrated in the clinical study with the use of various isotope-labeled fibroblast activating protein inhibitors because of their low uptake in liver tissues and high tumor/background ratio, which provides a new method for early diagnosis, precise staging, and radionuclide therapy. In light of this context, a review of the research progress of fibroblast-activating protein inhibitors for the diagnosis of liver malignant tumors is presented.

[Chinese expert consensus on management of dyslipidemia in the elderly].

Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.

The effect of a consortium of Penicillium sp. and Bacillus spp. in suppressing banana fungal diseases caused by Fusarium sp. and Alternaria sp.

AIMS: This study sought to utilize indigenous soil micro-organisms to suppress wilt-causing fungal pathogens of the banana. METHODS AND RESULTS: Fungal pathogens were isolated from wilt-affected rhizospheric soil, and potential antagonistic bacterial strains were isolated from healthy rhizospheric soil in the same area from which fungal pathogens were isolated. The antifungal activity of isolated micro-organisms against fungal pathogens was studied both in vitro and in vivo against fungal pathogens. It was found that Fusarium oxysporum and Alternaria sp. were pathogenic, while Penicillium sp., Bacillus velezensis and Bacillus subtilis were antagonistic. Moreover, it was seen that B. velezensis, B. subtilis and Penicillium sp. inhibited the growth of the two fungal pathogens in both in vitro and in vivo experiments. Further investigation indicated that B. velezensis, B. subtilis and Penicillium sp. were able to produce enzymatic antifungal compounds (chitinase and ß-1,3-glucanase). The spray application around rhizome revealed that a combination of Bacillus spp. and Penicillium sp. in greenhouse conditions gave the highest reduction in disease severity by up to 60% to both fungal pathogens among the treatments. CONCLUSIONS: Banana disease is seen to be induced not only by F. oxysporum but also by Alternaria sp. The isolated indigenous micro-organisms can effectively control both the pathogens. The combination of isolated antagonistic micro-organisms has thus demonstrated substantial potential for suppressing banana disease. SIGNIFICANCE AND IMPACT OF THE STUDY: An antagonistic consortium isolated in this study has demonstrated remarkable potential for controlling fungal diseases caused by Fusarium sp. and Alternaria sp. Therefore, the use of indigenous microflora to improve disease suppression of banana plants against soil-borne pathogens is a preferable approach.

[Analysis of the clinical efficacy and safety of bronchial thermoplasty in the treatment of patients with severe asthma and asthma-chronic obstructive pulmonary disease overlap].

Objective: To investigate the clinical efficacy and safety analysis of bronchial thermoplasty (BT) in the treatment of severe asthma and asthma-chronic obstructive pulmonary disease overlap. Methods: The clinical data of 49 patients with asthma-COPD overlap who received BT in the University of Chinese Academy of Sciences Shenzhen Hospital from January 2016 to December 2018 and 50 patients with severe asthma who received BT in the same period were retrospectively analyzed. Patients were divided into overlap group and asthma group, and the baseline data of two groups were recorded. The pulmonary function before and after treatment (including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1 as a percentage of predicted value (FEV1% pred)), hormone consumption, asthma control test (ACT) score, asthma quality of life questionnaire (AQLQ) score, asthma control questionnaire (ACQ) score, the overlap group before and after treatment COPD assessment test (CAT) score, modified British Medical Research Council (mMRC) score and postoperative respiratory adverse events in the next 3 weeks were comparatively analyzed. Results: The general baseline characteristics of the two groups are compared. The patients in the overlap group were older than those in the asthma group, and the course of disease and smoking history were longer than those in the asthma group. The inhaled hormone dosage in asthma group was greater than those in the overlap group ((64±11) years vs (48±11) years; 10.00 (10.00, 25.00) years vs 9.00 (1.75, 20.00) years; 20.00(2.00, 40.00) years vs 0 (0, 10.00) years; 320 (320, 640) µg/d vs 960 (320, 960) µg/d) (all P<0.05). The predicted values of lung function indexes FVC, FEV1, FEV1% pred in the overlap group before treatment were all lower than those in the asthma group (1.98 (1.43, 2.43) L vs 2.54 (2.02, 3.15) L; 0.92 (0.61, 1.26) L vs 1.69(1.17, 2.16) L; (50±16) L vs (65±14) L) (all P<0.05). There were no significant differences in ACT, ACQ, and AQLQ scores between the two groups before treatment (all P>0.05). Within 3 months after treatment, except for no significant improvement in FEV1% predicted value and inhaled hormone dosage in the overlap group (all P>0.05), other indexes in both groups were improved compared with those before treatment (all P<0.05). After 1 year of treatment, all indexes of the two groups were significantly improved than those before treatment, and all indexes of the asthma group were better than those of the overlap group (all P<0.05). In terms of respiratory adverse events occurring within 3 weeks after the operation, the incidence of cough and bloody sputum in the overlap group was higher than that in the asthma group, while the incidence of sputum and short-term wheezing was lower than that in the asthma group (all P<0.05). There were no statistically significant differences in the incidence of chest tightness, chest pain, segmental atelectasis and pneumonia between the two groups (all P>0.05), and the postoperative adverse reactions could be effectively controlled in a short period of time. Conclusion: BT treatment could not only improve the lung function, clinical symptoms and quality of life of asthmatic patients, but was also effective for asthma-COPD overlap patients. However, BT treatment had more benefits for asthmatic patients without serious adverse events occurred.

[Analysis of the safety and efficacy of bronchial thermoplasty for severe asthma with the first second forced expiratory volume (FEV(1)) as a percentage of the predicted value (FEV(1)%pred)<60].

Objective: To investigate the efficacy and safety of bronchial thermoplasty (BT) in severe asthma patients with the first second forced expiratory volume (FEV(1)) as a percentage of the predicted value (FEV(1)%pred) <60%. Methods: A retrospective analysis was performed on 75 patients with asthma who were treated with BT at Shenzhen University Hospital of the Chinese Academy of Sciences from January 2016 to January 2018. The patients were divided into two groups based on the FEV(1)%pred before treatment: FEV(1)%pred <60% group (39 cases) and FEV(1)%pred ≥60% group (36 cases). Comparative analysis of glucocorticoid consumption, times of acute attack, asthma control test (ACT) score, changes in lung function, and adverse reactions at 3 weeks after treatment were performed between the two groups of patients. Results: Before BT treatment, the consumption of oral prednisone, the amount of budesonide inhaled, and the times of acute attack [M (Q(1), Q(3))] in the FEV(1)%pred <60% group were significantly greater than those in the FEV(1)%pred ≥60% group, and the ACT score was significantly lower than the FEV(1)%pred ≥60% group [10.00 (0, 20.00) vs 0(0, 3.75) mg/d, 960 (320, 960) vs 320 (320, 640) µg/d, 5(4, 8) vs 4 (4, 5) times/year, 13 (9, 15) vs 17 (13, 19) scores] (all P<0.05). Except that the oral prednisone dosage in the FEV(1)%pred<60% group was still higher 1 year after treatment [0 (0, 5.00) vs 0 (0, 0) mg/d] (P=0.009), there was no significant difference in the remaining indicators between the two groups 1 year after treatment and 2 years after treatment (all P>0.05). After 1 year and 2 years of treatment, all indicators in the two groups were better than before treatment (all P<0.05). The inhaled budesonide amount and the times of acute exacerbation in the FEV(1)%pred <60% group 2 years after treatment were less than those 1 year after treatment [320 (320, 320) vs 320 (320, 640) µg/d, 0 (0, 0) vs 0(0, 1) times/year] (all P<0.05), and there was no significant difference in the remaining indicators. In the FEV(1)%pred ≥60% group, there was no significant difference between 2 years after treatment and 1 year after treatment in the above indicators except the amount of inhaled budesonide (all P>0.05). In the FEV(1)%pred <60% group, FEV(1) and the FEV(1)%pred were significantly lower than the FEV(1)%pred ≥60% group before treatment, 1 year after treatment and 2 years after treatment [FEV(1):(1.21±0.41) vs (2.26±0.80)L, (1.84±0.73) vs (2.30±0.78)L, (1.70±0.66) vs (2.38±0.76)L; FEV(1)%pred:46.2 (38.5, 53.7)% vs 80.8(66.5, 93.6)%, 60.1 (48.2, 71.6)% vs 87.4 (68.5, 96.5)%, 58.5 (48.6, 74.8)% vs 86.6 (73.0, 97.3)%] (all P<0.05). In the FEV(1)%pred <60% group, FEV(1) and FEV(1)%pred 1 year after treatment and 2 years after treatment were all increased compared with before treatment (all P<0.05). In the FEV(1)%pred ≥60% group, there was no statistical difference in FEV(1) at each time point before and after treatment (all P>0.05), but the FEV(1)%pred at 2 years after treatment was higher than before treatment (P<0.05). There were no significant differences in adverse events between the two groups (all P>0.05). Conclusion: BT can significantly improve the lung function, reduce the times of acute attack and the dosage of glucocorticoids in severe asthma patients with FEV(1)% pred<60%, which is safe and effective.

[A clinical performance study of modified CT angiography in detecting bronchial artery-pulmonary artery fistula].

Objective: To evaluate the clinical value of modified computed tomography angiography(CTA) in detecting bronchial artery-pulmonary artery fistula(BPF). Methods: Retrospective analysis was performed on 246 patients with hemoptysis admitted to the First Affiliated Hospital of Wenzhou Medical University from July 2017 to December 2018, who underwent modified CTA and DSA examination at the same time. CT was performed with Toshiba Aquilion one 320 row 640-slice spiral CT scanner. All modified CTA images were read blindly by two radiologists above the attending doctors. The sensitivity, specificity and accuracy of the modified CTA in diagnosing BPF were calculated with the DSA results as the reference,and the consistency of the two tests was analyzed. Results: DSA detected 186 cases of positive and 60 cases of negative, modified CTA detected 160 cases of positive and 86 cases of negative. The sensitivity,specificity and accuracy of modified CTA for BPF diagnosis was 85.5%(159/186),98.3%(59/60), 88.6%(218/246) respectively, and they were with high consistency with DSA examination results (kappa=0.73,P<0.01). Conclusion: Modified CTA has high diagnostic specificity for BPF,which can be used as the preferred method for non-invasive screening of suspected BPF patients.

Characterization and phylogenomics of the complete mitochondrial genome of the polyzoic cestode Gangesia oligonchis (Platyhelminthes: Onchoproteocephalidea).

The order Onchoproteocephalidea (Eucestoda) was recently erected to accommodate the hook-bearing tetraphyllideans and the proteocephalideans, which are characterized by internal proglottization and a tetra-acetabulate scolex. The recognized subfamilies in the Proteocephalidae appeared to be non-monophyletic based on 28S recombinant DNA (rDNA) sequence data. Other molecular markers with higher phylogenetic resolution, such as large mitochondrial DNA fragments and multiple genes, are obviously needed. Thus the mitochondrial genome of Gangesia oligonchis, belonging to the putative earliest diverging group of the Proteocephalidae, was sequenced. The circular mitogenome of G. oligonchis was 13,958 bp in size, and contained the standard 36 genes: 22 transfer RNA genes, two rRNA genes and 12 protein-coding genes, as well as two major non-coding regions. A short NCR and a large NCR (lNCR) region were 216 bp and 419 bp in size, respectively. Highly repetitive regions in the lNCR region were detected with that of 11 repeat units. The mitogenome of G. oligonchis shared 71.1% nucleotide identity with Testudotaenia sp. WL-2016. Phylogenetic analyses of the complete mitochondrial genomes with Bayesian inference and maximum likelihood methods indicated that G. oligonchis formed a sister clade with Testudotaenia sp. WL-2016 with maximum support. The ordinal topology is (Caryophyllidea, (Diphyllobothriidea, (Bothriocephalidea, (Onchoproteocephalidea, Cyclophyllidea)))). The mitogenomic gene arrangement of G. oligonchis was identical to that of Testudotaenia sp. WL-2016. Both mitogenomic and nuclear sequence data for many more taxa are required to effectively explore the inter-relationships among the Onchoproteocephalidea.

[Applicational value of 2017 ACR TI-RADS stratification in diagnosing thyroid nodules].

OBJECTIVE: To summarize and evaluate the value of applying the thyroid imaging reporting and data system (TI-RADS) released by American College of Radiology (ACR) in 2017 of the thyroid classification, and to propose an optimized classification method based on the result to facilitate more accurate and precise risk stratification of thyroid nodules. METHODS: In the study, 342 thyroid nodules assessed by 2017 ACR TI-RADS were retrospectively analyzed. Each nodule had a score, and all the scores of nodules were compared with the pathological results. The proportion of malignant nodules in different scoring ranges was obtained. The diagnostic efficacy of all nodules, nodules above 1 cm and less than or equal to 1 cm was evaluated by ROC curve, respectively. RESULTS: The AUC of all nodules, nodules above 1 cm and less than or equal to 1 cm were 0.907, 0.936 and 0.717, respectively. With the increase of the scores, the proportion of benign nodules decreased gradually, and the proportion of malignant nodules increased, especially nodules of 4-6 scores increased significantly. Based on the proportion of malignant nodules with 3 scores, the proportion of malignant nodules with 4, 5 and 6 scores increased 1.6, 3.8 and 5.3 times, respectively. The proportion of malignant nodules with 6-8 scores was 81%-84%, while the proportion of malignant nodules with 9 scores or more was 93%-94%. According to the distribution characteristics of malignant nodules, the classification of TI-RADS was adjusted. TI-RADS 4 was divided into TI-RADS 4a, TI-RADS 4b and TI-RADS 4c, corresponding to 4, 5 and 6-8 scores respectively, while the nodules with 9 scores or more were divided into TI-RADS 5. CONCLUSION: 2017 ACR TI-RADS has high diagnostic value for thyroid nodules above 1 cm, but it is not so effective for the nodules less than or equal to 1 cm. According to the proportion distribution of malignant nodules in different scoring ranges, appropriate adjustment of classification will be more accurate and precisely predict the malignant risk of nodules.

[The importance of occupational history in clinical thinking from the diagnosis and treatment of a case of Tsutsugamushi disease].

A farm worker in Baodi District of Tianjin was diagnosed with Tsutsugamushi disease due to fever and intermittent cough for more than 3 months.The patient's diagnosis and treatment process was complicated, and the diagnosis was delayed in the early stage of the disease because the clinician neglected the occupational history and lacked knowledge about the prevention and control of tsutsugamushi disease. As an important part of the epidemiological history, occupational history is crucial for the diagnosis of occupational related diseases. Clinical thinking runs through the whole process of clinical diagnosis and disease treatment, and correct clinical thinking can effectively reduce the occurrence of misdiagnosis.Clinicians should ask and record career history in detail to improve the quality of health care.

Complement regulatory proteins in kidneys of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.

The complement system activation is involved in the development of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). The study aimed to investigate the expression of complement regulatory proteins (CRPs) CD46, CD55 and CD59 in kidneys of 51 AVV patients. The expression of CD46, CD55 and CD59 in kidneys was detected by immunohistochemistry and double immunofluorescence staining. The immunohistochemical examination revealed that expression of the three CRPs could be detected in the glomeruli and tubules of both AAV patients and normal controls. The expression levels of the three CRPs in glomeruli of patients with AAV were significantly lower than those of normal controls. The scores of CD46 and CD55 expression in the tubules of AAV patients were significantly lower than those of normal controls, while there was no significant difference between the scores of CD59 expression in tubules of AAV patients and those of normal controls. Among AAV patients, the expression level of CD46 in glomeruli correlated inversely with the proportion of normal glomeruli, while it correlated with tubular atrophy in renal interstitium (r = -0·305, P = 0·026; r = 0·330, P = 0·023, respectively). The expression levels of CD55 and CD59 in glomeruli correlated with the proportion of total crescents (r = 0·384, P = 0·006; r = 0·351, P = 0·011, respectively). Double immunofluorescence staining indicated that all three CRPs were expressed on endothelial cells, podocytes and mesangial cells in glomeruli. The expression levels of the three CRPs were dysregulated in kidneys of patients with AAV. The expression levels of CD46, CD55 and CD59 were associated with the severity of renal injury of AAV patients.

Fluoroscopy-guided removal of individualised airway-covered stents for airway fistulas.

AIM: To report the techniques and complications associated with fluoroscopy-guided removal of individual covered stents for airway fistula disease over a 6-year period. MATERIALS AND METHODS: A retrospective analysis was conducted of 85 patients, 72 male and 13 female, who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Patients ranged in age from 15 to 81 years (mean, 54.9±12.3 years). Before removal, 90 stents had been placed for airway fistula disease. All patients underwent diagnostic flexible bronchoscopy and airway computed tomography (CT) prior to stent removal. The indications for stent removal and post-interventional complications were analysed. RESULTS: Eighty-nine of 90 airway stents were successfully removed from 85 consecutive patients, for a technique success rate of 98.9%. Of these, 14 stents showed strut fracture, one stent showed retained stent pieces, and the remaining 75 stents were removed in one piece. Indications for stent removal included regular removal (n=46), stent migration (n=11), excessive granulation tissue (n=10), strut fracture (n=4), intolerance of stenting (n=6). Complications of stent removal were as follows: retained stent pieces (n=1), mucosal tear with massive bleeding (n=2), re-obstruction requiring stenting (n=1), dyspnoea with mechanical ventilation needed (n=1), and dyspnoea with oxygen inhalation needed (n=1). CONCLUSIONS: Airway stents can be safely removed under fluoroscopy guidance. Removal after 31-90 days is recommended for removal to avoid excessive granulation tissue.

[Surveillance of contamination level and antimicrobial resistance analysis of Salmonella on broiler carcasses after chilling in 4 poultry slaughterhouses of Henan Province].

Objective: Tests were carried out for obtaining contamination level and antimicrobial resistance of Salmonella on broiler carcasses after chilling in four poultry slaughterhouses in Henan. Methods: Totally, two hundred sixty nine broiler carcasses after chilling were collected in four slaughterhouses with the daily slaughter amount around 15 000 to 50 000. For qualitative analysis of Salmonella EFSA method was used and for quantitative analysis of Salmonella modified Rappaport-Vassiliadis most probable number (MSRV-MPN) method was used. All of the isolates were subjected to antimicrobial susceptibility testing of 8 antibiotics by minimum inhibitory concentration (MIC). Results: Overall, 48.7% (131/269) of the broiler carcasses after chilling were contaminated by Salmonella, and the average of contamination level is 1.32 most probable number MPN/g. Eight serotypes were detected. The dominant serotype is Salmonella enteritidis (93, 71.0%) followed by Salmonella Indiana (21, 16.0%). Only 2 (1.5%) Salmonella enteritidis strains were sensitive to all the tested antibiotics and the remaining 129 isolates were resistant to at least one kind of eight class antibiotics. Among them, resistant to NAL was the common (104, 79.4%) and 51 (38.9%) Salmonella isolates were multidrug-resistant. Conclusion: The contamination rate and multiple antimicrobial resistant of Salmonella on broiler carcasses after chilling from slaughterhouses was very serious, while the isolates contained various serotypes.

Differential expression of duplicated binary toxin genes binA/binB in Lysinibacillus sphaericus C3-41.

Due to the self-produced binary toxins BinA/BinB, some Lysinibacillus sphaericus isolates exhibit high toxicity against mosquito larvae and are utilized in mosquito control programmes. Previous whole-genome sequencing revealed the presence of a large plasmid pBsph in L. sphaericus C3-41, which contains a 30·5-kb duplication of the genome including the binary toxin genes binA/binB. This was confirmed by Southern blot and qPCR experiments in this study. Mutants of L. sphaericus C3-41, bearing disruptions of the chromosomal-bin (C3-41ΔCab ) or the plasmid-bin (C3-41ΔPab ) and a plasmid-cured strain G725, were generated. It was observed that the three mutants, especially that of C3-41ΔPab and G725, had lower mRNA level from the early to middle sporulation phase and expressed less binary toxin during the whole sporulation phase. The mosquitocidal activity of the wild strain against 4th instar Culex quinquefasciatus larvae determined by LC50 displayed about 4, 15 and 35 times higher than that of C3-41ΔCab , C3-41ΔPab and G725 respectively. These results suggest that both chromosomal- and plasmid-borne bin genes, especially the latter, contribute to the full toxicity of the wild strain. The study provides an important clue for the evolution and application of mosquitocidal L. sphaericus. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides the first empirical evidence that Lysinibacillus sphaericus C3-41 has chromosomal- and plasmid-borne bin operon and both are necessary for full toxicity against mosquito larvae, of which the plasmid-borne one contributes more to the production and activity of the binary toxin than the chromosomal-born one. The study provides an important clue for the evolution and application of mosquitocidal L. sphaericus.

[Mean blood pressure among the adults in China 2010-2012: based on the results of mercury sphygmomanometer and converted electronic sphygmomanometer].

Objective: To analyze the average systolic blood pressure (SBP) and diastolic blood pressure (DBP) among adults aged 18 years old and above in China between 2010 and 2012; and to compare the difference in the results measured by mercury sphygmomanometer and converted electronic sphygmomanometer. Methods: The data was collected from Chinese Nutrition and Health Surveillance in 2010-2012. 120 428 adults aged 18 years old and above were selected from 150 survey counties (districts) of 31 provinces in China Mainland, by multi-stage stratified and probability proportion to size (PPS) cluster randomization sampling method. The average blood pressure value was calculated from three systolic and diastolic blood pressure readings measured by mercury sphygmomanometer. The value of Electronic Sphygmomanometer was converted by regression formula. Age-standardized results were calculated incorporating a complex sample weighting using the population data from the National Bureau of Statistics in 2009. Results: The overall adjusted mean of SBP based on the value of mercury sphygmomanometer among Chinese adults aged 18 years old and above was 122 mmHg (1 mmHg=0.133 kPa), 124 mmHg in men and 120 mmHg in women. The average SBP value was separately 115, 127, and 137 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average SBP was 122 mmHg in urban and 122 mmHg in rural areas. Mean DBP was 78 mmHg, 79 mmHg in men and 76 mmHg in women. The average DBP was separately 75, 81, and 81 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was 78 mmHg in urban and 77 mmHg in rural areas. The overall adjusted mean of SBP based on converted electronic device was 129 mmHg,130 mmHg in men and 127 mmHg in women, respectively. The mean of SBP was separately122, 134, and 143 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. Mean SBP was both 129 mmHg in urban and in rural areas. Mean DBP was 76 mmHg, 78 mmHg in men and 75 mmHg in women, respectively. The average DBP was separately 74, 79, and 79 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was both 76 mmHg in urban and rural areas. Conclusion: The average SBP and DBP was different between the mercury sphygmomanometer and converted electronic device. However, the results from both measures showed that the blood pressure was higher in men than in women, the blood pressure increased with the increase of age, and there was no difference between urban and rural areas.

[Characteristics of Schizophrenia Patients' Homicide Behaviors and Their Correlations with Criminal Capacity].

OBJECTIVES: To explore the characteristics of schizophrenia patients' homicide behaviors and the influences of the assessments of criminal capacity. METHODS: Indicators such as demographic and clinical data, characteristics of criminal behaviors and criminal capacity from the suspects whom were diagnosed by forensic psychiatry as schizophrenia （n=110） and normal mental （n=70） with homicide behavior, were collected by self-made investigation form and compared. The influences of the assessments of criminal capacity on the suspects diagnosed as schizophrenia were also analyzed using logistic regression analysis. RESULTS: There were no significant statistical differences between the schizophrenic group and the normal mental group concerning age, gender, education and marital status （P>0.05）. There were significant statistical differences between the two groups concerning thought disorder, emotion state and social function before crime （P<0.05） and there were significant statistical differences in some characteristics of the case such as aggressive history （P<0.05）, cue, trigger, plan, criminal incentives, object of crime, circumstance cognition and self-protection （P<0.05）. Multivariate logistic regression analysis suggested that thought disorder, emotion state, social function, criminal incentives, plan and self-protection before crime of the schizophrenic group were positively correlated with the criminal capacity （P<0.05）. CONCLUSIONS: The relevant influences of psychopathology and crime characteristics should be considered comprehensively for improving the accuracy of the criminal capacity evaluation on the suspects diagnosed as schizophrenia with homicide behavior.

[Comparison of Criminal Characteristics in Depression Patients and Schizophrenics with Homicide Behavior].

OBJECTIVES: To explore the criminal characteristics of forensic psychiatry expertise in depression patients and schizophrenics with homicide behavior. METHODS: A total of 40 depression （depressive episode） patients and 50 schizophrenics with homicide behavior were randomly assigned into the study group and control group, respectively. Data of demographic and criminal characteristic of the two groups were collected by a self-designed questionnaire, and then were compared. RESULTS: There were no statistical differences in age, education level and career between study and control groups （P>0.05）. Compared with the control group, the victims in the study group were mainly the patient's children and parents, and most offenders had suicidal behavior after homicide （70%）. In study group, the motives of crime were mainly extended suicide and indirect suicide, and most offenders had attempted suicide （85%） and diminished capacity of criminal responsibility （70%）, which in control group had no capacity of criminal responsibility （56%）. Except for criminal site, there were statistical differences in other criminal characteristics between two groups （P<0.05）. CONCLUSIONS: There are different criminal characteristics between depression patients and schizophrenics with homicide behavior in forensic psychiatry, and these characteristics should be considered when these two diagnoses are distinguished in forensic psychiatry expertise.

Clinical correlation of extensive-stage small-cell lung cancer genomics.

BACKGROUND: Genomic studies in small-cell lung cancer (SCLC) lag far behind those carried out in nonsmall-cell lung cancer (NSCLC). To date, most SCLC studies have evaluated patients with surgically resectable disease. Here we sought to evaluate the genomic mutation spectrum of 'every-day' SCLC patient tumors with extensive stage disease (ES-SCLC) and to correlate mutations with the main clinical outcomes of response to chemotherapy, progression-free (PFS) and overall (OS) survival. PATIENTS AND METHODS: A total of 50 SCLC patient tumors were examined in this study; targeted exome sequencing was obtained on 42 patients and whole-exome sequencing on 8 patients. Mutated genes were correlated with clinical outcomes using Kaplan-Meier methods (PFS, OS) and logistic regression (chemo-response). RB1 protein expression was detected by either western blotting of cultured cell lysates or immunohistochemistry of tumor specimens. RESULTS: In all, 39 patients had ES-SCLC; 15 patients had either primary refractory/resistant disease and 21 patients had sensitive disease. The two most frequently mutated genes were TP53 (86%) and RB1 (58%); other frequently mutated genes (>10% patients) were involved in epigenetic regulation as well as the mTOR pathway. We identified a number of low-frequency, targetable mutations, including RICTOR, FGFR1, KIT, PTCH1 and RET. Using multivariate analysis, RB1 was the only significant factor (P = 0.038) in predicting response to first-line chemotherapy, with an odds ratio of 5.58 comparing mutant RB1 with wild-type. Patients with mutant RB1 had both better OS (11.7 versus 9.1 months P = 0.04) and PFS (11.2 versus 8.6 months, P = 0.06) compared with patients with wild-type RB1. Interestingly, ∼25% of SCLC cell lines and tumor specimens expressed RB1 protein, possibly representing the subgroup with wild-type RB1. CONCLUSIONS: We found that SCLC tumors harboring no mutation in RB1 had a poor response to chemotherapy.