Results of a Pilot External Quality Assessment Scheme for Genetic Testing of Newborns with Spinal Muscular Atrophy.

BACKGROUND: This study aims to evaluate the ability of laboratories to perform spinal muscular atrophy (SMA) genetic testing in newborns based on dried blood spot (DBS) samples, and to provide reference data and advance preparation for establishing the pilot external quality assessment (EQA) scheme for SMA genetic testing of newborns in China. METHODS: The pilot EQA scheme contents and evaluation principles of this project were designed by National Center for Clinical Laboratories (NCCL), National Health Commission. Two surveys were carried out in 2022, and 5 batches of blood spots were submitted to the participating laboratory each time. All participating laboratories conducted testing upon receiving samples, and test results were submitted to NCCL within the specified date. RESULTS: The return rates were 75.0% (21/28) and 95.2% (20/21) in the first and second surveys, respectively. The total return rate of the two examinations was 83.7% (41/49). Nineteen laboratories (19/21, 90.5%) had a full score passing on the first survey, while in the second survey twenty laboratories (20/20, 100%) scored full. CONCLUSIONS: This pilot EQA survey provides a preliminary understanding of the capability of SMA genetic testing for newborns across laboratories in China. A few laboratories had technical or operational problems in testing. It is, therefore, of importance to strengthen laboratory management and to improve testing capacity for the establishment of a national EQA scheme for newborn SMA genetic testing.

Dynamic risk assessment of a coal slurry preparation system based on the structure-variable Dynamic Bayesian Network.

In order to strengthen the safety management of coal slurry preparation systems, a dynamic risk assessment method was established by using the bow-tie (BT) model and the Structure-variable Dynamic Bayesian Network (SVDBN). First, the BT model was transformed into a static Bayesian network (BN) model of the failure of a coal slurry preparation system by using the bow-tie model and the structural similarity of the Bayesian cognitive science, based on the SVDBN recursive reasoning algorithm. The risk factors of the coal slurry preparation system were deduced using the Python language in two ways, and at the same time, preventive measures were put forward according to the weak links. In order to verify the accuracy and feasibility of this method, the simulation results were compared with those obtained using GeNIe software. The reasoning results of the two methods were very similar. Without considering maintenance factors, the failure rate of the coal slurry preparation system gradually increases with increasing time. When considering maintenance factors, the reliability of the coal slurry preparation system will gradually be maintained at a certain threshold, and the maintenance factors will increase the reliability of the system. The proposed method can provide a theoretical basis for the risk assessment and safety management of coal slurry preparation systems.

Result of a Pilot External Quality Assessment Scheme for Clinical Diagnosis of Inherited Metabolic Disorders in China.

BACKGROUND: We aimed to evaluate the diagnostic capabilities of Chinese laboratories for inherited metabolic disorders (IMDs) using gas chromatography-mass spectrometry (GC-MS) on urine samples. Meanwhile, based on the result of the pilot external quality assessment (EQA) scheme, we hope to establish a standardized and reliable procedure for future EQA practice. METHODS: We recruited laboratories that participated in the EQA of quantitative analysis of urinary organic acids with GC-MS before joining the surveys. In each survey, a set of five real urine samples was distributed to each participant. The participants should analyze the sample by GC-MS and report the "analytical result", "the most likely diagnosis", and "recommendation for further tests" to the NCCL before the deadline. RESULTS: A total of 21 laboratories participated in the scheme. The pass rates were 94.4% in 2020 and 89.5% in 2021. For all eight IMDs tested, the analytical proficiency rates ranged from 84.7% - 100%, and the interpretational performance rate ranged from 88.2% - 97.0%. The performance on hyperphenylalaninemia (HPA), 3-methylcrotonyl-CoA carboxylase deficiency (MCCD), and ethylmalonic encephalopathy (EE) samples were not satisfactory. CONCLUSIONS: In general, the participants of this pilot EQA scheme are equipped with the basic capability for qualitative organic acid analysis and interpretation of the results. Limited by the small size of laboratories and samples involved, this activity could not fully reflect the state of clinical practice of Chinese laboratories. NCCL will improve the EQA scheme and implement more EQA activities in the future.

Nutritional screening and assessment tools for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition criteria.

BACKGROUND: Malnutrition is highly prevalent and associated with complications and mortality in patients with cirrhosis. METHODS: This was a prospective observational study. Patients with cirrhosis were screened using the Nutritional Risk Screening 2002, the Royal Free Hospital-Nutritional Prioritizing Tool and the Skeletal Muscle Index. Then, the sensitivity, specificity, positive and negative predictive values, and consistency with the Global Leadership Initiative on Malnutrition criteria results were calculated. We also analysed the association between nutritional status and short-term prognosis. RESULTS: We enrolled 125 patients with cirrhosis, of whom 59.20% and 60.00% were malnourished based on the Global Leadership Initiative on Malnutrition criteria and Skeletal Muscle Index. Some 53.60% and 65.60%, respectively, were classified medium-to-high nutritional risk by Nutritional Risk Screening 2002 and the Royal Free Hospital-Nutritional Prioritizing Tool. The Royal Free Hospital-Nutritional Prioritizing Tool had the best predictive value, and it was more sensitive and had a better negative predictive value than the Nutritional Risk Screening 2002 Tool. The Skeletal Muscle Index also had good sensitivity and predictive value. The Royal Free Hospital-Nutritional Prioritizing Tool, Skeletal Muscle Index and Global Leadership Initiative on Malnutrition criteria showed high concordance. The 3- and 6-month mortality rates were significantly higher for patients with moderate-to-high nutritional risk or malnutrition, regardless of the tool. CONCLUSIONS: When assessing cirrhosis with the Global Leadership Initiative on Malnutrition criteria, the Royal Free Hospital-Nutritional Prioritizing Tool is best for nutritional screening and the Skeletal Muscle Index is also a good nutritional assessment tool.

Potential impact of industrial transfer on PM2.5 and economic development under scenarios oriented by different objectives in Guangdong, China.

For sustainable regional development, industrial transfer is an important trend that will potentially change the spatial and temporal pattern of air pollution and economic development. Aiming to better regulate industrial transfer and guide policy-making, this study proposes an assessment framework for industrial transfer that combines precise enterprise data, GIS technology and a 3-D air quality model. Taking Guangdong Province as an example, this study simulates the redistribution of 4015 high-pollution and high-energy-consumption (double-high) enterprises in the Pearl River Delta (PRD) to surrounding areas, and the potential impact on air quality is further evaluated. Three mutually independent transfer scenarios with different objectives are designed-ENV (ENVironment), ENT (ENTerprise), and GOV (GOVernment)-which aim to maximize benefits from the standpoint of the residents of Guangdong, the enterprises themselves, and local governments, respectively. Results show that Western Guangdong (WG), Northern Guangdong (NG), and Eastern Guangdong (EG) would be the primary transfer-in regions under the ENV, ENT, and GOV scenarios due to different resource endowment. Controlled by the different scenarios, the redistribution of enterprises presented different characteristics regarding the transport of pollutant emissions and economic added value between the PRD and surrounding areas. The average concentration of PM2.5 and the related population-weighted concentrations (PWC) showed a slight decrease over the PRD (-0.75 to -0.62 µg/m3 and -0.35 to -0.49 µg/m3 per person) but increased dramatically in surrounding areas under the three scenarios (0.46-7.68 µg/m3 and 0.07-4.44 µg/m3 per person). The transfer of double-high enterprises could potentially decrease the industrial fossil fuel consumption intensity (fossil energy consumption per unit of industrial GDP) of most of the cities while exacerbating pollution intensity (concentration of PM2.5 per unit of industrial GDP), reflecting the huge gap in the regional industrial development pattern in Guangdong Province at this stage, and illustrating the importance of emission control of these enterprises for improvement of regional air quality in the future. The research perspective on industrial transfer proposed in this study could provide a reference for future studies.

The effect of different dietary structure on gastrointestinal dysfunction in children with cerebral palsy and epilepsy based on gut microbiota.

BACKGROUND: Gastrointestinal (GI) difficulties are very common among children with cerebral palsy (CP) and comorbid epilepsy. GI function is influenced by dietary structure on gut microbiota. The aim of this study was to compare gut microbiota differences in two dietary groups of this population and examine whether such differences are related to GI dysfunction. METHODS: Forty children with CP and epilepsy were recruited from a social welfare center, including 23 consuming a fluid diet (liquid diet group) and 17 consuming a normal diet (general diet group). Bacterial DNA was extracted from feces, the V3-V4 region of the 16S rRNA gene was amplified from the DNA, and high-throughput sequencing of the amplified sequences was performed. Microbe prevalence levels were compared on multiple phylogenic levels. RESULTS: Gut microbial populations differed substantially between the liquid diet group and general diet group. The only two phyla that differed significantly between the two groups were Bacteroidetes (p = 0.034) and Actinobacteria (p = 0.013). Regarding representation of genera, Prevotella species were selectively predominant in the general diet group (25.849% vs. 3.612% in the liquid diet group, p < 0.001), while Bifidobacterium species were selectively predominant in the liquid diet group (24.929% vs. 12.947% in the general diet group, p = 0.013). The gut microbiota of children in the general diet group contained more butyric acid-producing microbiota which was also common in healthy people (e.g. Lachnoclostridium, Dorea, Ruminococcus, Faecalibacterium, Roseburia, and Coprococcus). The gut microbiota of children in liquid diet group however, were rich in symbiotic pathogenic bacteria (e.g. Collinsella, Alistipes, and Eggerthella). CONCLUSION: The gut microbiota of children with CP and epilepsy consuming a liquid diet had elevated levels of symbiotic pathogens and diminished intestinal barrier protection bacteria, relative to a general diet group. These differences in bacterial microbiota were associated with GI dysfunction symptoms.

Quantitative assessment of the association of polymorphisms in the metallothionein 2A gene with cancer risk.

OBJECTIVE: The aim of the study was to quantitatively assess the association of metallothionein 2A (MT2A) polymorphisms rs28366003 and rs1610216 with cancer risk. METHODS: Crude odd ratios (OR) with 95% confidence intervals (CI) were used to estimate associations of the polymorphisms with cancer risk. RESULTS: Six eligible case-control studies with 1899 cases and 2437 controls focused on rs28366003, and three of those six studies, with 548 cases and 926 controls, additionally focused on rs1610216. Pooled analysis showed that MT2A rs28366003 and rs1610216 were associated with cancer risk: (AG + GG) vs. AA, OR = 2.67; GG vs. (AG + AA), OR = 5.97; GG vs. AA, OR = 6.80; AG vs. AA, OR = 2.46; G vs. A, OR = 2.67 for rs28366003; and CC vs. (TC+TT), OR = 2.51; CC vs. TT, OR = 2.42 for rs1610216. Subgroup analysis based on ethnicity showed a significant association of rs28366003 with cancer risk in Asian and Caucasian populations. However, a significant association of rs1610216 with cancer risk was found only in the Asian population. CONCLUSION: MT2A rs28366003 and rs1610216 polymorphisms were associated with cancer risk and might serve as genetic biomarkers for predicting cancer risk. However, larger studies are needed to confirm these findings.

Effect of hypoglycemic anti-deafness capsules in diabetic patients with deafness and toxicological assessment in rats.

OBJECTIVE: Through experiment on animals and clinical trials to explore the safety and efficacy of hypoglycemic anti-deafness capsules on diabetic patients with deafness. METHODS: Total 296 patients with non-insulin dependent diabetes mellitus (NIDDM) were randomly divided into two groups. A treatment group of 164 patients (208 ears) was treated with hypoglycemic anti-deafness capsules based on TCM syndrome differentiation. A control group of 132 patients (184 ears) was treated with glibenclamide and conventional drug treatment for deafness. The following were observed: hearing, fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2hPG), 24 h urine glucose (24hUG), improvement of main symptoms, platelet function, and changes in superoxide dismutase (SOD) and lipid peroxide (LPO) levels. In animal studies, Kunming mice, weighing 18-22 g were used. Half of the mice were males and half were females. Wistar rats, weighing 80-120 g were used. Half of the rats were males and half were females. Male Wistar rats, weighing 200-220 g, were also used. Their acute and chronic toxicity was studied. RESULTS: The hearing improvement was 56.7% in the treatment group and 26.6% in the control group. FPG, 2hPG, and 24hUG were improved significantly (P < 0.05, P < 0.01, P < 0.01, respectively) in the treatment group and 2hPG and 24hUG improved significantly in the control group (P < 0.05, P < 0.05). The improvement in 2hPG and 24hUG in the treatment group was significantly greater than that in the control group P < 0.01).There was no significant difference in FPG between the two groups (P < 0.05). Main symptoms in the treatment group were significantly more improved than those in the control group (P < 0.05, P < 0.01). In the treatment group, platelet adhesion and aggregation, SOD, and LPO were all significantly improved from before treatment (P < 0.05, P < 0.01). However, in the control group, except LOP (P < 0.05), there were no significant differences from before treatment to after (P < 0.05). In animal studies, no obvious acute or long-term toxicity was observed from capsule administration. CONCLUSION: Through experiment on animals and clinical trials, we can found that hypoglycemic anti-deafness capsules could decrease blood glucose and serum triglycerides of alloxan-induced diabetic rats. This herbal capsule is effective for safely treating diabetic patients with deafness.