[Thoughts on High-Quality Innovation and Development of in Vitro Diagnostic Reagents Industry in Shanghai].

As an important part of the Big Health Industry, in vitro diagnostic(IVD) reagents play a vital role in the prevention, diagnosis and treatment of diseases. In recent years, especially after the novel coronavirus infection, IVD industry has developed rapidly in China, but it still cannot meet the needs of clinical use. By conducting desk research, expert interview, manufacturer survey and hospital survey, this study analyzed the development status of IVD industry in Shanghai, summarized the problems encountered in the high-quality development from the aspects of raw materials, innovation ability, and clinical trials, etc., and proposed recommendations for promoting the high-quality innovation and development of IVD industry in Shanghai.

Transmission of multidrug-resistant tuberculosis in Shimen community in Shanghai, China: a molecular epidemiology study.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) has become a major public health problem in China, with mounting evidence suggesting that recent transmission accounts for the majority of MDR-TB. Here we aimed to reveal the transmission pattern of an MDR-TB outbreak in the Jing'an District of Shanghai between 2010 and 2015. METHODS: We used whole-genome sequencing (WGS) to conduct genomic clustering analysis along with field epidemiological investigation to determine the transmission pattern and drug resistance profile of a cluster with ten MDR-TB patients in combining field epidemiological investigation. RESULTS: The ten MDR-TB patients with genotypically clustered Beijing lineage strains lived in a densely populated, old alley with direct or indirect contact history. The analysis of genomic data showed that the genetic distances of the ten strains (excluding drug-resistant mutations) were 0-20 single nucleotide polymorphisms (SNPs), with an average distance of 9 SNPs, suggesting that the ten MDR-TB patients were infected and developed the onset of illness by the recent transmission of M. tuberculosis. The genetic analysis confirmed definite epidemiological links between the clustered cases. CONCLUSIONS: The integration of the genotyping tool in routine tuberculosis surveillance can play a substantial role in the detection of MDR-TB transmission events. The leverage of genomic analysis in combination with the epidemiological investigation could further elucidate transmission patterns. Whole-genome sequencing could be integrated into intensive case-finding strategies to identify missed cases of MDR-TB and strengthen efforts to interrupt transmission.

[Summary of Statistical Methods Commonly Used in Clinical Evaluation of in Vitro Diagnostic Reagents].

Referring to relevant normative documents, we summarized the commonly used statistical methods in clinical evaluation of in vitro diagnostic reagents. For qualitative and semi-quantitative products, we introduced the clinical interpretation and application conditions of commonly used statistical indicators such as sensitivity, specificity, likelihood ratio and predictive value, etc., as well as the evaluation criteria of Kappa test to evaluate the consistency of the two detection systems. For quantitative products, the criteria of outlier analysis, the application conditions and evaluation criteria of correlation analysis, Bland-Altman method, regression analysis and ROC analysis were introduced. We mainly introduced the principles, interpretation, application conditions and evaluation criteria of the commonly used statistical methods, which can be referred by reviewers of in vitro diagnostic reagents when evaluating registration application materials.

[Exploration on Knowledge Management Construction of Medical Device Evaluation].

Knowledge management is an important method for the organization to manage information and knowledge systematically and make knowledge innovate continuously. Knowledge management includes the stages of knowledge acquisition, sharing and use, and finally achieves the goal of taking knowledge as the production factor and improving work efficiency in an organization. The core work of technical evaluation of medical devices is typical knowledge work, and the knowledge management system is of great significance to the review agency in improving work efficiency, promoting talent training, improving management level and service quality. This study briefly introduces the framework of the knowledge management system of medical device technical evaluation in the Center for Certification and Evaluation, SHFDA, and provides reference for relevant organizations to carry out knowledge management of medical device technical evaluation.

Nitrate Protects Cucumber Plants Against Fusarium oxysporum by Regulating Citrate Exudation.

Fusarium wilt causes severe yield losses in cash crops. Nitrogen plays a critical role in the management of plant disease; however, the regulating mechanism is poorly understood. Using biochemical, physiological, bioinformatic and transcriptome approaches, we analyzed how nitrogen forms regulate the interactions between cucumber plants and Fusarium oxysporum f. sp. cucumerinum (FOC). Nitrate significantly suppressed Fusarium wilt compared with ammonium in both pot and hydroponic experiments. Fewer FOC colonized the roots and stems under nitrate compared with ammonium supply. Cucumber grown with nitrate accumulated less fusaric acid (FA) after FOC infection and exhibited increased tolerance to chemical FA by decreasing FA absorption and transportation in shoots. A lower citrate concentration was observed in nitrate-grown cucumbers, which was associated with lower MATE (multidrug and toxin compound extrusion) family gene and citrate synthase (CS) gene expression, as well as lower CS activity. Citrate enhanced FOC spore germination and infection, and increased disease incidence and the FOC population in ammonium-treated plants. Our study provides evidence that nitrate protects cucumber plants against F. oxysporum by decreasing root citrate exudation and FOC infection. Citrate exudation is essential for regulating disease development of Fusarium wilt in cucumber plants.

Transmission of Mycobacterium tuberculosis in China: a population-based molecular epidemiologic study.

BACKGROUND: Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. METHODS: We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. RESULTS: Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0%) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.25-2.63) and infection with a Beijing family strain (aOR, 1.56; 95% CI, 1.23-2.96) were associated with clustering. Eighty-four of 280 (30.0%) clusters had a putative source case that was sputum smear negative, and 30.6% of their secondary cases were attributed to transmission by sputum smear-negative patients. The relative transmission rate for sputum smear negative compared with sputum smear-positive patients was 0.89 (95% CI, .68-1.10), and was 1.51 (95% CI, 1.00-2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. CONCLUSIONS: Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear-negative cases were responsible for at least 30% of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China.

Mycobacterium tuberculosis Beijing strains favor transmission but not drug resistance in China.

BACKGROUND: The Mycobacterium tuberculosis Beijing strains are widespread globally. We aimed to determine whether Beijing strains in China are more likely than other strains to spread, and whether they are more likely to become drug resistant. We also sought to determine whether different Beijing sublineages have distinct phenotypic characteristics. METHODS: We conducted a population-based molecular epidemiologic study in 6 provinces in China from 2009 to 2010. We analyzed data and specimens from culture-confirmed pulmonary tuberculosis patients. Each patient's isolate was genotyped using 16-loci variable number of tandem repeats and 6 single-nucleotide polymorphisms. RESULTS: By genotyping, 75.0% (1031/1375) of the strains of M. tuberculosis were Beijing strains. Beijing strains were more likely than non-Beijing strains to be in a genotypic cluster (odds ratio, 2.40, P < .001), and were significantly associated with younger age (P(trend) < .05). There was no significant difference in the proportion of Beijing strains and non-Beijing strains that were drug resistant, even when stratified by new vs retreatment patients. We identified 6 sublineages of Beijing strains in the study population. The modern sublineage of Beijing strains were more likely than the ancient sublineages to be clustered (odds ratio, 2.27, P < .001). CONCLUSIONS: Beijing strains of M. tuberculosis were significantly associated with genotypic clustering, reflecting recent transmission, and younger age, but were not associated with drug resistance. Future studies of Beijing family strains should avoid assuming and attributing characteristics to the entire family and should assess strains of specific sublineages and/or settings.

[Spatial distribution and risk factors of tuberculosis in Songjiang district, Shanghai during 2006 and 2009].

OBJECTIVE: To identify spatial distribution and risk factors among tuberculosis (TB) cases in Songjiang district, Shanghai, 2006 - 2009. METHODS: All active TB cases and all bacteriologically confirmed TB cases diagnosed during the period from 2006 to 2009 were recruited into the study. Spatial scan statistics were used to identify spatial clusters. Using logistic regression, we compared the demographic and clinical characteristics of TB cases in spatial clusters versus TB cases not in spatial clusters. RESULTS: A total of 1815 active TB cases and 730 bacteriologically confirmed TB cases were recruited during 2006 - 2009. Chedun township and Xinqiao township was detected to be a spatial cluste (RR = 1.38, LLR = 16.78, P < 0.01), which was the location of the municipal industrial zone. No spatial cluster was found during 2006 - 2007, while during 2008 - 2009 Chedun township was detected to be a spatial cluster (RR = 1.70, LLR = 15.06, P < 0.01). Among resident population, the spatial cluster of TB cases was located in the southwestern part of Songjiang district, which included five townships Xinbang, Shihudang, Xiaokunshan, Maogang and Yongfeng (RR = 1.49, LLR = 10.52, P < 0.01); while among migrant population, the spatial cluster of TB cases was located in Chedun township (RR = 1.55, LLR = 15.64, P < 0.01). There were higher proportions of resident TB cases who were farmers (AOR = 4.9, 95%CI: 1.9 - 12.3) or had other occupations (AOR = 2.6, 95%CI: 1.1 - 5.9) in the spatial cluster. There were higher proportions of migrant TB cases who lived here for less than 5 years (< 1 year: AOR = 5.9, 95%CI: 1.8 - 19.5; 1 - 5 years: AOR = 3.2, 95%CI: 1.0 - 9.9) or worked at other occupations (AOR = 2.8, 95%CI: 1.5 - 5.1) and lower proportions of migrant TB cases who came from Eastern region (AOR = 0.3, 95%CI: 0.1 - 0.8) or Middle region (AOR = 0.5, 95%CI: 0.3 - 0.9) in the spatial cluster. CONCLUSION: In Songjiang district there was a spatial cluster in TB cases, which was Chedun township. Local residents with TB who were farmers or had other occupations were more likely to be in the spatial cluster. Migrants with TB who lived here for less than 5 years or came from Western region were more likely to be in the spatial cluster.

Water balance altered in cucumber plants infected with Fusarium oxysporum f. sp. cucumerinum.

Fusarium wilt is caused by the infection and growth of the fungus Fusarium oxysporum in the xylem of host plants. The physiological responses of cucumbers that are infected with Fusarium oxysporum f. sp. cucumerinum (FOC) was studied in pot and hydroponic experiments in a greenhouse. The results showed that although water absorption and stem hydraulic conductance decreased markedly in infected plants, large amounts of red ink accumulated in the leaves of infected cucumber plants. The transpiration rate (E) and stomatal conductance (gs) of the infected plants were significantly reduced, but the E/gs was higher than healthy plants. We further found that there was a positive correlation between leaf membrane injury and E/gs, indicating that the leaf cell membrane injury increased the non-stomatal water loss from infected plants. The fusaric acid (FA), which was detected in the infected plant, resulted in damage to the leaf cell membranes and an increase in E/gs, suggesting that FA plays an important role in non-stomatal water loss. In conclusion, leaf cell membrane injury in the soil-borne Fusarium wilt of cucumber plants induced uncontrolled water loss from damaged cells. FA plays a critical role in accelerating the development of Fusarium wilt in cucumber plants.

[Studies of the association between angiotensinogen gene regulation and cytokines in essential hypertension].

This study is to explore the association between M235T allele polymorphism of angiotensinogen (AGT) gene and cytokines using essential hypertension probands research method. In hypertensives and controls, polymerase chain reaction combined with restriction endonuclease digestion was used to detect the target genotype variation, and enzyme-lined immunosorbant assay (ELISA) was used to detect the cytokine concentrations (IL-1, IL-6, TNF). The results showed that in hypertensives AGT gene, TT genotype was 55.88%, MT 35.29% and MM 8.82%. The ratio of T/M allele frequency was 0.735/0.265. In controls AGT gene, TT genotype was 47.46%, MT 42.37% and MM 10.17%. The ratio of T/M allele frequency was 0.686/0.314. AGT gene 235 T allele frequency in hypertensives was slightly higher than those in controls. Furthermore AGT gene 235 TT genotype and T allele frequency in middle and high grade of hypertensives were significantly higher than those in mild grade. In subjects of AGT 235 T allele group, the concentrations of IL-1, IL-6 and TNF in hypertensives were significantly higher than those in controls. In subjects of AGT gene 235 M allele frequency, the concentrations of IL-1 and IL-6 in hypertensives were no significant than those in controls. No matter in groups more than 60 years old or less than 60 years old, the concentrations of IL-1, IL-6 and TNF in hypertensives were higher than those in controls. No matter in hypertensives or controls, there were no differences in concentrations of IL-1, IL-6 and TNF when comparing groups more than 60 years old with groups less than 60 years old. The study indicated that AGT gene TT genotype and AGT gene 235 T allele frequency may be an important risk factor for hypertension. The high frequency of AGT gene 235 T allele and the high concentrations of IL-1, IL-6 and TNF in hypertensives may cause hypertension developing. It is also suggested the cytokines may effect the transcription and expression of AGT gene 235 TT genotype in hypertension. The concentrations of IL-1, IL-6 and TNF had nothing to do with age no matter hypertensives or controls.

Whole-genome sequencing to detect recent transmission of Mycobacterium tuberculosis in settings with a high burden of tuberculosis.

Whole genome sequencing (WGS) of Mycobacterium tuberculosis has been used to trace the transmission of M. tuberculosis, the causative agent of tuberculosis (TB). Previously published studies using WGS were conducted in developed countries with a low TB burden. We sought to evaluate the relative usefulness of traditional VNTR and SNP typing methods, WGS and epidemiological investigations to study the recent transmission of M. tuberculosis in a high TB burden country. We conducted epidemiological investigations of 42 TB patients whose M. tuberculosis isolates were classified into three clusters based on variable-number tandem repeat (VNTR) typing. We applied WGS to 32 (76.2%) of the 42 strains and calculated the pairwise genomic distances between strains within each cluster. Eighteen (56.3%) of the 32 strains had genomic differences ≥100 SNPs with every other strain, suggesting that direct transmission did not likely occurred. Ten strains were grouped into four WGS-based clusters with genomic distances ≤5 SNPs within each cluster, and confirmed epidemiological links were identified in two of these clusters. Our results indicate that WGS provides reliable resolution for tracing the transmission of M. tuberculosis in high TB burden settings. The high resolution of WGS is particularly useful to confirm or exclude the possibility of direct transmission events defined by traditional typing methods.

Tuberculosis in an urban area in China: differences between urban migrants and local residents.

BACKGROUND: The increase in urban migrants is one of major challenges for tuberculosis control in China. The different characteristics of tuberculosis cases between urban migrants and local residents in China have not been investigated before. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective study of all pulmonary tuberculosis patients reported in Songjiang district, Shanghai, to determine the demographic, clinical and microbiological characteristics of tuberculosis cases between urban migrants and local residents. We calculated the odds ratios (OR) and performed multivariate logistic regression to identify the characteristics that were independently associated with tuberculosis among urban migrants. A total of 1,348 pulmonary tuberculosis cases were reported during 2006-2008, among whom 440 (32.6%) were local residents and 908 (67.4%) were urban migrants. Urban migrant (38.9/100,000 population) had higher tuberculosis rates than local residents (27.8/100,000 population), and the rates among persons younger than age 35 years were 3 times higher among urban migrants than among local residents. Younger age (adjusted OR per additional year at risk = 0.92, 95% CI: 0.91-0.94, p<0.001), poor treatment outcome (adjusted OR = 4.12, 95% CI: 2.65-5.72, p<0.001), and lower frequency of any comorbidity at diagnosis (adjusted OR = 0.20, 95% CI: 0.13-0.26, p = 0.013) were significantly associated with tuberculosis patients among urban migrants. There were poor treatment outcomes among urban migrants, mainly from transfers to another jurisdiction (19.3% of all tuberculosis patients among urban migrants). CONCLUSIONS/SIGNIFICANCE: A considerable proportion of tuberculosis cases in Songjiang district, China, during 2006-2008 occurred among urban migrants. Our findings highlight the need to develop and implement specific tuberculosis control strategies for urban migrants, such as more exhaustive case finding, improved case management and follow-up, and use of directly observed therapy (DOT).