[Effect evaluation of the primary screening strategy for liver cancer in rural areas of China].

Objective: To estimate the effectiveness of the primary screening strategy for liver cancer in rural areas to provide basic information for the optimization and perfection of the technical program for the early detection and treatment of liver cancer. Methods: Residents including males aged 35-64 and females aged 45-64 from 9 counties in rural China between 2013 and 2015 were selected as the target population. The participant was classified into a high-risk and non-high-risk group based on the standardized questionnaire or HBsAg, and the Chi-squared test was applied to compare differences between the two groups. The Cox proportional hazard regression models were applied to assess hazard ratio (HR) and its 95% confidence interval (CI). Results: 358 348 participants were recruited from 2013 to 2015. 1 196 individuals were identified with liver cancer until December 31, 2021, with an incidence density of 52.0/10(5) person-years. Of the participants, 54 650 were assessed as high risk (15.3%) based on the questionnaire and the status of HBsAg. The high-risk population had a higher incidence density (168.3/10(5) person-years vs 31.5/10(5) person-years) and higher risk of developing liver cancer (HR=2.98, 95% CI=2.64-3.35), compared to the non-high-risk group. Based on the questionnaire-based high-risk assessment system, 47 884 (13.4%) individuals were identified as high risk, who showed statistical differences in terms of incidence density and incidence risk, in comparison to the low-risk population (all P<0.05). HBsAg can screen out a higher proportion of high-risk individuals who are women, non-smokers, non-drinkers, and individuals without a family history of liver cancer (all P<0.05). The sensitivity analysis of the effectiveness of the whole primary screening method is stable, and high-risk individuals still had a higher risk of liver cancer. Conclusions: The primary screening method of the questionnaire-based risk assessment system and HBsAg can achieve satisfactory effectiveness. The questionnaire-based risk assessment system could identify high-risk individuals to some extent, however, it still needs to be improved to meet the actual requirements.

[Evaluation of root resorption after surgical orthodontic treatment of skeletal Class â ¢ malocclusion by three-dimensional volumetric measurement with cone-beam CT].

OBJECTIVE: To explore the method of measuring root volume with cone-beam computed tomography (CBCT) three-dimensional reconstruction technology, and to study root length and root volume of upper and lower central incisors in patients with skeletal Class Ⅲ malocclusion treated by surgical orthodontic treatment. METHODS: Twenty patients with skeletal Class Ⅲ malocclusion undergoing surgical orthodontic treatment were selected. CBCT data at three time points, before decompensation treatment (T0), after decompensation treatment (before orthognathic surgery, T1), and the end of post-operative orthodontic treatment (T2) were collected. Three-dimensional reconstruction technology was used to measure the root length and root volume of the upper and lower central incisors (including total root volume, cervical root and apical root), calculate the percentage of reduction volume, and measure the distance of tooth movement after orthodontic treatment. Data were statistically analyzed by SPSS 20.0 software. Least significant difference (LSD) method was used for pair comparison between the groups subject to normal distribution, and non-parametric test was used for comparison between the groups not subject to normal distribution. The differences of root length and root volume of upper and lower incisors were compared, and the characteristics of root absorption were analyzed. RESULTS: Root length and root volume of the upper and lower central incisors were reduced during the surgical orthodontic treatment (P < 0.05) in cases. Both the root volume of cervical root and apical root were significantly reduced (P < 0.05), the reduction of apical root was more significant. The percentage of root volume reduction of the upper central incisor was (30.51±23.23)%, and lower central incisor (23.24±11.96)%. Compared with the upper central incisor, the root volume reduction amount and percentage of the lower central incisor were smaller, and apical root volume reduction of the upper central incisor was greater than that of the lower central incisor, which was statistically significant (P < 0.05). During pre-surgical orthodontic treatment, maxillary central incisor palatal moving was in a controlled tipping manner, and the mandibular central incisor tipped labially. CONCLUSION: In patients with skeletal Class Ⅲ malocclusion, root length and total root volume of upper and lower central incisors decreased during surgical orthodontic treatment. Root volume measurement indicated that the cervical root also had root resorption. The difference in root resorption of the upper and lower central incisors might be related to the distance and direction of teeth movement. CBCT three-dimensional reconstruction will compensate for the limitation of root length measurement in evaluating root resorption.

[Comparison of etiology and incidence of pulmonary infection in patients with esophageal carcinoma accompanied by esophagotracheal fistula before and after the airway stent implantation].

Objective: To compare the etiology and incidence of pulmonary infection in patients with esophageal carcinoma accompanied by esophagotracheal fistula before and after the airway stent implantation. Methods: The clinical records of patients with esophageal carcinoma accompanied by esophagotracheal fistula in Respiratory Department and Oncology Department of Meitan General Hospital were retrospectively analyzed from March 2008 to January 2018. The demographic data, comorbidities, pathological results and etiology were collected before and after tracheal stents were implanted in all patients. The incidence of pulmonary infection was analyzed, and the classification of etiology was compared before and after tracheal stents implantation. Results: A total of 100 patients were included in the study. The incidence rate of pulmonary infection before stents implantation was 83.0%. A total of 105 bacterial strains were cultured, including 73 strains of gram-negative bacteria (69.5%) and mainly pseudomonas aeruginosa, 5 strains of gram-positive bacteria [all methicillin-resistant staphylococcus aureus (MRSA)] (4.8%), and 27 strains of fungi (25.7%) and mainly candida albicans. The incidence rate of pulmonary infection was lowered to 53.0% after tracheal stents implantation (χ(2)=29.102, P<0.001). A total of 79 bacterial strains were cultured, and the main bacteria were still gram-negative bacteria and fungi, in which pseudomonas aeruginosa and candida albicans accounted for the majority. However, 13 strains of MRSA were cultured (16.5%), significantly higher than those before stents implantation (χ(2)=7.451, P=0.005). Conclusions: The incidence rate of pulmonary infection in patients with esophageal carcinoma accompanied by esophagotracheal fistula is very high. Gram-negative bacteria and fungi are the main etiologies. Tracheal stents implantation can effectively reduce the incidence of pulmonary infection. However, the incidence rate of MRSA is significantly increased after stents implantation.

[Study on the related factors of esophageal cancer and precancerous lesions in rural residents aged 40-69 years in Shandong Province].

Objective: To analyze the related factors of esophageal squamous cell carcinoma and precancerous lesions among residents aged 40-69 years old in rural areas of Shandong Province. Methods: In October 2018, 300 villages in 13 counties of the Shandong upper gastrointestinal cancerearly diagnosis and treatment projectin 2017 were selected as research areas, and 30 400 residents aged 40-69 were recruited in this study. The demographic characteristics, health status and lifestyle information were collected through the questionnaire survey, and endoscope iodine staining and indicative biopsy methods were used for cancer screening among eligible people.The multivariate logistic regression model was used to analyze the risk factors for esophageal cancer and precancerous lesions. Results: The subjects in this study were (56.42±7.24) years old, including 13 193 males (43.40%).There were 936 cases of esophageal cancer and precancerous lesions (3.08%), including 521 males and 415 females.Compared with women, 40-49 years old, high level education, drinking tap water, regular intake of meat, eggs and milk, and family average annual income more than 30 000 RMB, men (OR=1.90, 95%CI: 1.65-2.19), 60-69 years old (OR=5.28, 95%CI: 4.11-7.30), primary school education or below (OR=1.50, 95%CI: 1.20-1.89), drinking groundwater (OR=1.71, 95%CI: 1.38-2.13), never eating meat, eggs and milk (OR=1.48, 95%CI: 1.22-1.80), and family average annual income less than 30 000 RMB (OR=1.41, 95%CI: 1.16-1.70) would increase the risk of esophageal cancer and precancerous lesions. Conclusion: The gender, age, educational level, annual household income, drinking water source, the frequency of eating meat, egg and milk were related to the occurrence of esophageal cancer and precancerous lesions among 40-69 years old residents in rural areas of Shandong Province.

[Natural history of breast cancer: a systematic review of worldwide randomized controlled trials of mammography screening].

Objective: To parameterize the 1-year transition probabilities between different health status of the natural history of breast cancer based on the data of randomized controlled trial of X-ray mammography screening worldwide. Methods: Based on the breast cancer screening randomized controlled trials defined by a mammography screening review from the Cochrane 2013 and the International Agency for Research on Cancer, a systematic review was initiated in PubMed by searching names of the key investigators of the trials, combined with the diseases, screening intervention and outcome indicators. If applicable, all the original cumulative incidence rates were converted into one-year transition rate, using the life-table approach considering time length of follow-up. Results: A total of 23 reports from 9 RCTs were included. The data on transition rate between the healthy status to precancerous lesions was absent. The 1-year transition rate from health to carcinoma in situ was 17.78 to 50.21 per 100 000 persons in the intervention group and 9.16 to 26.84 per 100 000 persons in the control group. Correspondingly, the 1-year transition rate from health to breast cancer (including carcinoma in situ and invasive cancer) were estimated as 143.75 to 316.97 per 100 000 persons in the intervention group, and 141.45 to 288.84 per 100 000 persons in the control group. Furthermore, the transition rate from the healthy status to invasive breast cancer was 159.79 to 264.60 per 100 000 persons in intervention group and 170.12 to 255.33 per 100 000 persons in control group. The transition rate from carcinoma in situ to invasive breast cancer varied among different pathological types. Conclusions: The most common natural history states of reported by the included trials involved the full healthy status, carcinoma in situ and invasive breast cancer. The findings of transition rates between different health statuses will be informative for future model development of natural history studies of breast cancer. Information in relation to breast precancerous lesions still limited and needs to be further addressed.

Molecular characterization and tissue expression profile of porcine Ephrin-B2.

Ephrin-B2 (EFNB2) is a signaling molecule that plays an important role in cell adhesion, proliferation, and migration in humans. However, little is known about this molecule in pigs. In order to investigate whether EFNB2 is associated with the skeletal muscle in pigs, we cloned the full-length cDNA of EFNB2 (GenBank accession No. KF500033) from the longissimus dorsi muscle of Yorkshire pigs by rapid amplification of cDNA ends. The results indicated that its full-length cDNA comprises 1991 bp, with an open reading frame of 1002 bp, a 5' end of 88 bp, and a 3' end of 901 bp. We analyzed the homology of porcine EFNB2 with sequences from other species, and the phylogenetic tree showed that pig EFNB2 was most closely related to that from sheep, followed by domestic cats and wolf, with mackerel being the most distantly related. Porcine EFNB2 is a water-soluble protein with a theoretical molecular weight of 36,928.1 Da, an isoelectric point of 8.98, and a hydrophilic transmembrane-spanning region. It contains 19 glycosylation sites and eight phosphorylation sites. The tertiary structure of the EFNB2 protein showed a forniciform helix structure. The porcine EFNB2 gene was expressed in ten different tissues from 25-day-old Shaziling and Yorkshire piglets, with the highest expression observed in the longissimus dorsi. These results lay the foundation for further study on the EFNB2 gene in pigs.

Molecular characterization, tissue expression profile, and single nucleotide polymorphism analysis of the periostin gene in swine.

Periostin, also called osteoblast-specific factor 2, is an important regulator of bone, cardiac development, and wound healing. A recent study revealed that periostin plays an important role in tumor development and is upregulated in a wide variety of cancers. However, little is known about periostin in swine. Therefore, the cDNA sequence of the porcine periostin gene was obtained by rapid amplification of cDNA ends (RACE). One C/T single nucleotide polymorphism anchored in intron 9 was identified and genotyped by PCR-RFLP-HaeIII. In Daweizi, Shaziling, Ningxiang, Taoyuan, Wuzhishan, Landrace, and Yorkshire pigs, the C allele was dominant, while the T allele was dominant in the Duroc pig. Quantitative PCR analysis showed that the periostin gene was expressed in all examined tissues from 25-day-old Shaziling and Yorkshire piglets, with mRNA expression in the longissimus dorsi muscle being the highest in these two breeds, and that in the kidney and lungs being the lowest. There was a significant difference in periostin gene expression in the intestines, heart, and spleen (P < 0.05). These findings might contribute to our understanding of the function of periostin in swine.

Complete mitochondrial genome of the Liuyang black goat and its phylogenetic relationship with other Caprinae.

In this study, the complete mitochondrial genome sequence of the Liuyang black goat was investigated, and phylogenetic relationships between the Liuyang black goat and other species of Caprinae were analyzed. The total length of the mitochondrial genome was 16,715 bp, which consisted of 33.50% A, 27.27% T, 25.98% C, and 13.25% G. The mitochondrial genome contained a major non-coding control region (D-loop region), two ribosomal RNA genes, 13 protein-coding genes, and 22 transfer RNA genes. Neighbor-joining and maximum-parsimony trees of Caprinae constructed using 13 mitochondrial protein-coding genes showed that the Liuyang black goat is phylogenetically closest to Hemitragus jemlahicus (the Himalayan tahr) and Blue sheep to form clade A. Tibetan antelopes clustered separately in clade B and so did sheep in clade C.

[Expression of PDGFRA and CMYC in extranodal NK/T-cell lymphoma and their prognostic implications].

Objective: To investigate the relationship between expression of PDGFRA/CMYC and clinicopathologic features of extranodal NK/T-cell lymphoma. Methods: Fifty-four cases of extranodal NK/T-cell lymphoma were included in the study.Immunohistochemistry was used to detect the expression of CD20, CD2, CD3, CD56, TIA1, GrB, Ki-67, PDGFRA and CMYC.In situ hybridization was performed to detect the presence of EBV encoded small RNA (EBER). Fifty cases of nasopharyngeal mucosal lymphoid tissue hyperplasia were used as normal control. Results: Among 54 cases of ENKTL, CD2, CD3, GrB, and TIA1 were expressed in all the tumors. CD56 was expressed in 47 cases (81.0%) and CD20 was not detectable in any cases. Ki-67 proliferative index expression of > 60% was found in 45 cases (83.3%). In situ hybridization for EBER was positive in all cases (100%). The positive expression rates of PDGFRA and CMYC in extranodal NK/T-cell lymphomas were 51.9%(28/54) and 53.7%(29/54), respectively, much higher than those in nasopharyngeal mucosal lymphoid tissue hyperplasia (0, P<0.05). There was a positive correlation between PDGFRA and CMYC (r=0.295, P<0.05). The expression of CMYC was correlated with clinical efficacy (P<0.05), but not with gender, age, Ann Arbor stage, B symptoms and therapeutic regimen (all P>0.05). The expression of PDGFRA was correlated with B symptoms (P<0.05), while not with gender, age, Ann Arbor stage, therapeutic regimen and clinical efficacy (all P>0.05). The co-expression of PDGFRA and CMYC was not correlated with gender, age, Ann Arbor stage, B symptoms, therapeutic regimen and clinical efficacy (P>0.05). Univariate analysis showed that the stage, clinical efficacy, CMYC protein and the co-expression of PDGFRA and CMYC were significantly correlated with the prognosis. The overall survival of the patients with CMYC positive expression was shorter than of that of the patients with negative expression (P<0.05). Multivariable Cox regression analysis further confirmed that clinical stage, CMYC protein expression, and the co-expression of PDGFRA and CMYC were independent prognostic factors in patients with extranodal NK/T-cell lymphoma. Conclusion: CMYC protein, and the co-expression of PDGFRA and CMYC can be as an independent prognostic factor in patients with extranodal NK/T-cell lymphoma and influence the prognosis of patients.

[Incidence, bacterial spectrum and predictive risk factors for stent associated respiratory tract infection].

OBJECTIVE: To evaluate the incidence, bacterial spectrum and predictive risk factors for stent associated respiratory tract infection (SARTI). METHODS: A prospective nested case-control study was conducted to evaluate the incidence of SARTI and the predictive risk factors for SARTI. Respiratory symptoms, sputum bacterial culture, electronic bronchoscopy investigation, bacterial culture obtained from protective bronchoscopic brushing, and chest radiographs were evaluated before and after stent implantation. RESULTS: (1) Between January, 2011 and March, 2015, a total of 103 patients were included. The incidence of SARTI was 27.2% (28/103). (2) The incidence of SARTI was similar in subgroups with different stent types (metal stent or silicon stent) and different stent shapes (straight, L or Y shape). (3)Staphylococcus aureus (50.0%, 14/28) and Pseudomonas aeruginosa (35.7%, 10/28) were the dominant pathogens. The infection of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans occurred 7 (4-60) days, 53 (15-67) days and 63 (28-90) days after stent implantation, respectively. (4) Binary logistical regression model analysis showed that female gender(OR=0.178, P=0.011) and age below 50 years (OR=3.91, P=0.036) were favorable predictive risk factors for SARTI. CONCLUSIONS: SARTI occurs in a quarter of the patients. Staphylococcus aureus and Pseudomonas aeruginosa are the dominant pathogens. Female gender and younger age are favorable predictive factors for SARTI.

Effect of age and residential status on the predictive performance of CURB-65 score.

BACKGROUND: The CURB-65 score was designed to predict 30-day mortality and decide the site of care of pneumonia. It is uncertain how age and residential status affect the accuracy of CURB-65 score in older patients. AIM: This study aimed to evaluate the effect of age and residential status on the performance of CURB-65 score in predicting 30-day all-cause mortality of pneumonia in older patients. METHODS: We used combined data from two prospective observational cohorts of adult patients with pneumonia. Older patients aged ≥ 65 years were analysed. RESULTS: Of 1644 patients, 1200 were living in the community and 464 residing in nursing homes. The 30-day mortality rates of community-acquired pneumonia (CAP) and nursing home-acquired pneumonia (NHAP) were 10.7% and 14.2% respectively. In each age group of CAP and NHAP, mortality increased with pneumonia severity. Mortality decreased with advancing age in NHAP, and the reverse was true for CAP. In NHAP but not CAP, the proportion of highly severe pneumonia (CURB-65 score ≥ 3) was lower in older patients. The overall predictive performance of CURB-65 score was comparable in CAP and NHAP. The accuracy deteriorated with advancing age in NHAP but not CAP. Using the cut-off score of ≥3 (highly severe pneumonia), the CURB-65 score achieved high negative predictive values (>90%) in CAP and NHAP. CONCLUSIONS: Advancing age adversely affected the predictive performance of CURB-65 score in NHAP but not CAP. The score was not helpful in guiding the site of care at admission in older patients with pneumonia.

Molecular characterization, tissue expression profile, and SNP analysis of porcine SLC13A5.

Solute carrier family 13 (sodium-dependent citrate transporter member 5, SLC13A5) gene has been recently found to play an important role in intramuscular fat content in pigs. In this study, the full-length cDNA of porcine SLC13A5 was obtained from the longissimus dorsi muscle of Shaziling pigs, using the rapid amplification of cDNA ends technique. Full-length porcine SLC13A5 cDNA was 2118 bp, with a 1665-bp open reading frame encoding 554 amino acids. The porcine SLC13A5 protein was analyzed using bioinformatic methodology, and found to include 18 potential phosphorylation sites (including six serine, nine threonine, and three tyrosine) and eight putative transmembrane domains. One single nucleotide polymorphism (SNP) site, A251G, was identified by polymerase chain reaction (PCR)-restriction fragment length polymorphism and the associations of this SNP with age at 100 kg and corrected back fat thickness were found to be not significant. Expression of SLC13A5 was evaluated in ten tissues from 25-day-old full-sib Yorkshire and Shaziling piglets (both N = 3), using quantitative PCR analysis. Expression levels of SLC13A5 differed significantly between the breeds in cecum, liver and crureus muscle. In each breed, gene expression levels were significantly different in longissimus dorsi muscle, compared to the nine other tissues. This study has laid the foundation for further investigations of the molecular mechanisms of SLC13A5 in pigs.

Molecular characterization, tissue expression profile and SNP analysis of porcine GLP2R.

Glucagon-like peptide-2 receptor (GLP2R), a member of the G-protein-coupled receptor family, plays an important role in intramuscular fat formation. Little is known, however, about porcine GLP2R. In the present study, GLP2R was cloned, and its expression in pig muscle characterized. By rapid amplification of cDNA ends, gene sequence was obtained from Shaziling pigs. Full-length cDNA was 1868 bp, including an open reading frame 1665 bp in length, encoding 554 amino acids, and 203 bp at the 3' end. The GLP2R homology between porcine and other species was performed using bioinformatics techniques to construct a phylogenetic tree. Porcine GLP2R was most closely related to those from Orcinus orca and Ovis aries, and most distantly related to those from Chrysemys picta, Taeniopygia guttata, and Falco peregrinus. Real-time PCR analysis showed expression of porcine GLP2R in 10 different tissues from 25-day-old Yorkshire and Shaziling piglets, with expression levels being highest in the longissimus dorsi muscle and lowest in kidney. For each pig breed, expression level in longissimus dorsi muscle was highest among ten tissues (P < 0.05). Between the two breeds, GLP2R expression levels were significant in pancreas, the crureus and longissimus dorsi muscles (P < 0.05). A single SNP of porcine GLP2R, A343G, was identified, and genotypes were determined by PCR-RFLP. This study provides an insight into the function of GLP2R in swine.

Characterization of porcine GAS6 cDNA gene and its expression analysis in weaned piglets.

The growth arrest-specific 6 gene (GAS6) is a member of the family of plasma vitamin K-dependent proteins, which are able to bind to phospholipids using an N-terminal gamma-carboxyglutamic acid domain. A recent report has demonstrated that the GAS6 gene can promote fat deposition and is associated with an increased number of fat cells in mice. In order to investigate whether GAS6 expression is associated with meat quality in pigs, a 2382-bp cDNA sequence of the porcine GAS6 gene (GenBank accession No. KC526197) was first obtained using rapid amplification of cDNA ends from porcine longissimus dorsi tissue. One A/G single nucleotide polymorphism anchored in exon 12 was genotyped using the marker PCR-RFLP-BglI, and the G allele was dominant in the pig breeds tested. Quantitative real-time polymerase chain reaction showed that the porcine GAS6 gene was expressed in all tissues examined in weaned male Shaziling (SZL) and Yorkshire (YS) weanling piglets, and mRNA expression of GAS6 in the longissimus dorsi tissue of SZL piglets was significantly higher than that in YS piglets (P < 0.05). The GAS6 protein was likely to be a membrane protein and was detected in longissimus dorsi tissue from SZL and YS piglets using immunohistochemistry, with an abundant protein expression index (P > 0.05). The results imply that the GAS6 gene can be considered a potential candidate for meat quality trait selection and fat deposition in pigs.

Molecular characterization and tissue expression profile analysis of the porcine JAZF1 gene.

A recent study indicated that the JAZF1 gene was related to lipid metabolism by regulating the level of gene expression in humans and mice. In order to investigate whether JAZF1 gene expression was associated with fat deposition in pig, we cloned the full-coding region of the JAZF1 gene (GenBank accession No. KF307636) from porcine longissimus dorsi. Results showed that the open reading frame of JAZF1 covered 732 bp and encoded 243 amino acids. Multiple alignment of isoform sequences revealed that the deduced amino acid sequence of JAZF1 had a high degree of sequence similarity to other vertebrates, indicating that it was highly conserved during evolution. Bioinformatic analysis indicated that pig JAZF1 contained 23 phosphorylation sites and 19 glycosyl sites. JAZF1 was predicted to have 3 ZnF-C2H2 and 2 low-complexity domains. The JAZF1 mRNA expression pattern indicated that JAZF1 mRNA expression level in the liver was significantly different in 2 divergent breeds (P < 0.05). This article perhaps provided an important experimental basis for further research on the mechanisms of lipid metabolism and fat deposition in pigs.

Recurrent hospitalisation with pneumonia is associated with higher 1-year mortality in frail older people.

BACKGROUND: Previous studies persistently showed that functional dependence was associated with higher long-term (≥1 year) mortality of older patients hospitalised with community-acquired pneumonia (CAP). The importance of other factors was, however, not well reported. AIM: This study aimed to investigate the relative contributions of comorbidity, nutritional status and frailty to 1-year mortality. METHODS: We prospectively recruited older patients, aged ≥65 years, hospitalised with CAP from October 2009 to September 2010 at the Prince of Wales Hospital, Hong Kong. Demographics, Charlson's Comorbidity Index, mid-arm circumference (MAC) and Clinical Frailty Scale (CFS) were recorded as baseline characteristics. The severity of pneumonia was evaluated by the CURB score (confusion, blood urea nitrogen, respiratory rate and low blood pressure). The surviving patients were followed for 1 year since discharge to monitor readmission for CAP and all-cause mortality. We entered the following variables into the multivariate Cox regression model to identify independent predictors of 1-year all-cause mortality: age, sex, residential status, MAC, Charlson's Comorbidity Index, CFS and readmission for CAP. RESULTS: The final cohort consisted of 428 patients who were discharged from hospital. Within 1 year after hospital discharge, all-cause mortality and readmission for CAP were 22.4% and 32.0% respectively. Independent predictors of 1-year mortality were male sex (hazard ratio (HR) = 1.57, 95% confidence interval (CI) = 1.02-2.48), severe under-nutrition (MAC ≤21 cm) (HR = 3.75, 95% CI = 1.66-8.46), frailty (CFS ≥5) (HR = 2.36, 95% CI = 1.29-4.27) and readmission for CAP (HR = 4.50, 95% CI = 2.82-7.17). CONCLUSIONS: Recurrent pneumonia may be a terminal life event of frail older people so that advance care planning should be considered in those with recurrent admission for pneumonia.

[Human chorionic gonadotropin-secreting gonadoblastomas in a girl of 45, X Turner syndrome: a case report and literature review].

Objective: To summarize the experience in diagnosis and treatment of 45, X Turner syndrome (TS) with gonadal Y chromosome mosaicism and bilateral gonadoblastoma (Gb) secreting human chorionic gonadotrophin(HCG). Methods: A female patient aged 5 years and 3 months was admitted to the hospital with a complaint of "enlarged breasts for 27 months, and elevated blood ß-HCG for 8 months". The clinical data were summarized, and related literature up to March 2022 with the key words"Turner syndrome" "Gonadoblastoma" "Y chromosome" "human chorionic gonadotropin" "precocious" in PubMed, CNKI and Wanfang databases were reviewed. Results: The girl went to the local hospital for 2-month breast development at age of 3 years, and was found with a heart murmur diagnosed with "pulmonary venous malformation and atrial septal defect (secondary foramen type)". Surgical correction was performed. She experienced the progressive breast development, rapid linear growth and markedly advanced skeletal age, which cannot be explained by partial activation in the hypothalamic-pituitary-gonadal axis determined at the age of 3 years and 7 months in local hospital. Then whole-exome sequencing revealed chromosome number abnormality 45, X, which was confirmed by Karyotyping. At the age of 4 years and 6 months, serum ß-HCG was found to be elevated (24.9 U/L) with no lesion found at the local hospital. On physical examination, she was found with breast development, pubic hair development and clitoromegaly with elevated serum testosterone (1.96 µg/L) and ß-HCG (32.3 U/L). Sex determining region Y(SRY) gene was negative in peripheral blood sample. Thoracic and abdominal CT, head and pelvic magnetic resonance imaging were normal. Exploratory laparotomy confirmed the presence of a left adnexal tumor and a right fibrous streak gonad. During surgery, simultaneous samples of bilateral gonadal and peripheral venous blood were obtained and serum ß-HCG, estradiol and testosteron concentrations was higher to lower from left gonadal venous blood, right gonadal venous blood, to peripheral venous blood. Bilateral gonadectomy was performed. Histopathology revealed bilateral gonadoblastomas. SRY was positive in bilateral gonadal tissues. After surgery, serum E2, testerone and ß-HCG returned to normal. So far 4 cases of HCG-secreting gonadoblastoma had been reported worldwide. The phenotypes of the 4 cases were all female, with virilization or amenorrhea, and the preoperative peripheral blood ß-HCG concentrations were 74.4, 5.0, 40 456.0, and 42.4 U/L, respectively. Conclusions: There is a high risk of Gb in TS with Y chromosome components. Gb is infrequently presented with breast development, and Gb associated with HCG secretion is rare. Karyotyping should be performed in a phenotypic female with masculinization, and virilization in TS indicates the presence of Y chromosome material with concurrent androgen secreting tumors.

Pubertal development timing in urban Chinese boys.

We describe current pubertal development in healthy urban Chinese boys. A cross-sectional study of the pubertal development of 18,807 urban Chinese boys aged from 3.50 to 18.49years was conducted between 2003 and 2005. Testicular volume was evaluated with a Prader orchidometer. Pubic hair development was assessed according to the Tanner method. Data on spermarche were collected using the status quo method. Probit analysis was used to calculate the median age and 95% CI at different stages of testicular development, pubic hair development and spermarche. By age 9, 12.99% of the boys had a testicular volume of 4mL or greater. The median age of onset of puberty defined as the age at attainment of testicular volume of 4mL or greater was 10.55 (95% CI 10.27-10.79) years. The median age for onset of pubic hair development (PH(2) ) and spermarche was 12.78 (95%CI 12.67-12.89) years and 14.05 (95%CI 13.80-14.32) years, respectively. Pubertal onset in urban Chinese boys is earlier than currently used clinical norms but their pubic hair development occurs relatively late in comparison with the reported data from numerous other countries. There is also evidence of a secular trend towards an earlier age of spermarche since 1979 in Chinese urban boys.

[Experimental study on the effect of olfactory training on olfactory function in mice with olfactory dysfunction].

Objective: To observe the effect of olfactory training on mice with olfactory dysfunction induced by 3-methylindole (3-MI). Methods: Thirty-one male BALB/c mice were randomly divided into 3 groups by random digits table: control group (group A, n=10), olfactory dysfunction group (group B, n=10) and olfactory dysfunction+olfactory training group (group C, n=11). Mice in group B and group C were intraperitoneally injected with 150 mg/kg 3-MI to induce olfactory dysfunction model, while mice in group A were intraperitoneally injected with corn oil of the same volume. From the first day after injection, mice in group C were treated with 4 kinds of odors by inhalation, while mice in group B were treated with distilled water by inhalation, with 2 times/d, 30 min/time/kind of odor, and continuous training for 28 d. Group A was not treated. Buried food pellet tests were conducted before injection and at 7, 14, 21 and 28 days after injection, respectively. The olfactory epithelium was harvested for observation of the number of olfactory marker protein (OMP) and the thickness of olfactory epithelium on the 28th day after injection. SPSS 23.0 software was used for statistical analysis. Results: Before injection, all mice in each group had no olfactory dysfunction. At the 7th, 14th, 21st and 28th days after injection, the food finding time of mice in group C was shorter than that in group B, and the difference was statistically significant ((175.88±100.50) s vs (266.73±46.83) s, (132.00±84.62) s vs (264.10±48.50) s, (103.57±77.43) s vs (197.43±69.78) s, (67.79±32.54) s vs (176.63±61.06) s, all P<0.05), but food finding time of mice in group B and C was longer than that in group A (the food finding time of group A at the 7th, 14th, 21st and 28th days after injection was (27.13±5.36) s, (25.83±7.28) s, (23.13±2.72) s, (26.63±7.60) s, respectively, all P<0.05). At the 28th day after olfactory training, the number of OMP positive cells in group B and C were fewer than that in group A, and the difference was statistically significant ((108.00±28.19)/HP vs (288.22±84.06)/HP, (199.33±58.55)/HP vs (288.22±84.06)/HP, all P<0.05). The number of OMP positive cells in group C were higher than that in group B (P<0.05). The number of OMP positive cells had negative correlation with food finding time (r=-0.886, P<0.01). As for the thickness of the olfactory epithelium, the thickness of group B was thinner than that in group A and C, and the difference was statistically significant ((59.57±31.27) µm vs (114.55±40.70)µm vs (90.54±37.72) µm, all P<0.05). Conclusion: Olfactory training can accelerate the recovery of olfactory function in 3-MI-induced olfactory impaired mice.