[Adult-onset immunodeficiency induced by anti-interferon-γ autoantibodies: report of 13 cases].

Objective: To investigate the clinical characteristics of a group of patients with adult-onset immunodeficiency (AOID) induced by anti-interferon-γ autoantibodies (AIGA). Methods: Thirteen cases of AOID in a northern China medical center (Peking Union Medical College Hospital) from October 2020 to April 2022 were included. Data comprising clinical manifestations, laboratory results, infection sites and pathogens were collected. Results: Among the 13 patients, 5 were male. The median age of disease onset was 47 (14 to 71) years. The median time from symptom onset to diagnosis was 4 years (1 to 8 years). Four patients were from northern China, and 9 from southern China. Common symptoms included lymphadenopathy (13/13), fever (12/13), respiratory tract symptoms (12/13), and weight loss (11/13). Laboratory tests showed increased levels of white blood cell count (9/13), neutrophil count and proportion (9/13), erythrocyte sedimentation rate (ESR) (12/13), and C reactive protein (CRP) (11/13). The median plasma titers of AIGA upon diagnosis were 5681(3194, 13246). Sites of infection included lungs (12/13), lymph nodes (9/13), bones and joints (9/13), skin and soft tissue (7/13), blood flow and bone marrow (4/13), and glands (3/13). Most patients had nontuberculous mycobacteria (NTM) (12/13) infection. Seven patients had more than one pathogen. Conclusions: AOID also affects patients visiting northern China hospitals. AIGA screening is recommended among patients with disseminated NTM infections or recurrent infections.

[Hypomethylation of DAPL1 associated with prognosis of lung cancer patients with EGFR Del19 mutation].

Objective: To investigate the effect of apoptosis-associated protein kinase-like 1 (DAPL1) hypomethylation on prognosis of lung cancer patients with epidermal growth factor receptor gene exon 19 deletion (EGFR Del19) mutation. Methods: The clinicopathological data of lung cancer patients in databases of genomic data sharing (GDC) TCGA lung adenocarcinoma, TCGA lung adenocarcinoma, and TCGA lung cancer were collected to analyze the effect of DAPL1 methylation level on the prognosis of patients with EGFR Del19 mutation. Linear regression model was used for correlation analysis, Kaplan-Meier method was used to draw the survival curve, and the difference of survival curve between the two groups was tested by Log rank. Results: In GDC TCGA lung adenocarcinoma, TCGA lung adenocarcinoma and TCGA lung cancer databases, the 5-year survival rates of lung cancer patients with high DAPL1 expression (31.9%, 27.5% and 33.0%, respectively) were higher than those with low DAPL1 expression (11.0%, 11.6% and 13.8%, respectively). The differences were statistically significant (P=0.006, 0.028 and 0.025, respectively). The median expression levels of DAPL1 in patients with EGFR Del19 mutation (12.8, 2.75 and 2.9, respectively) were higher than those in patients with other EGFR mutations (11.6, 1.75 and 1.8, respectively, P<0.05). In TCGA lung adenocarcinoma and TCGA lung cancer database, the 5-year survival rate of lung cancer patients with lower DAPL1 methylation levels (22.4% and 16.4%, respectively) were higher than those of lung cancer patients with higher DAPL1 methylation levels (15.1% and 14.2%, respectively), with statistical significance (P<0.05). The expression level of DAPL1 was positively correlated with the EGFR mutant subtype (r=0.909, P<0.05), and negatively correlated with DNA methylation (r=-0.891, P<0.05). The expression of DAPL1 in lung cancer patients was regulated by DNA methylation, which affected the prognosis of lung cancer patients. Conclusion: High DAPL1 expression, or hypomethylation, is associated with lung cancer EGFR Del19 mutation subtype, and DAPL1 hypomethylated lung cancer patients have longer overall survival.

[Gender differences in cardiovascular risk factors in patients with acute myocardial infarction in China].

Objective: To understand gender differences of cardiovascular risk factors in patients with acute myocardial infarction (AMI) in China. Methods: A total of 26 592 patients with AMI from 107 hospitals in 31 provinces in China from January 1, 2013 to September 30, 2014 were included. Self-designed questionnaire was used to collect patients' age, gender, height, weight, type of AMI, medical history of cardiovascular and cerebrovascular diseases, medication history, lifestyle and AMI risk factors, including high blood pressure, diabetes, dyslipidemia, overweight and/or obesity, smoking history and family history of early onset coronary artery disease. A total of 24 394 patients with complete clinical data were included in the analysis, and gender differences in cardiovascular risk factors were analyzed in all and subgroups with different characteristics. Results: The patients were (62.2±13.8) years old, including 18 162 (74.5%) males and 18 209 (74.6%) ST-segment elevation myocardial infarction (STEMI). The age of male patients was (60.2±13.7) years, which was younger than that of female patients [(68.2±12.3) years]. The body mass index of male patients was (24.2±3.0) kg/m2, which was higher than that of female patients [(23.8±3.4) kg/m2]. The proportions of patients with overweight and/or obesity, smoking history, dyslipidemia, family history of early onset coronary heart disease, fatty diet and history of AMI were 51.8%, 55.2%, 7.2%, 3.8%, 80.4% and 7.7%, which were higher than those of females (45.9%, 9.9%, 5.8%, 2.3%, 65.0% and 5.9%, respectively]. The proportions of hypertension, diabetes, physical inactivity and stroke history were 46.5%, 17.2%, 77.8% and 8.5%, respectively, which were lower than those in female patients [61.4% (3 829 cases), 24.8%, 81.7% and 11.1%, respectively] (all P values<0.05).The proportions of peripheral vascular diseases history in male and female patients were 0.6% and 0.7%, respectively, with no statistical significance in difference (P>0.05). Subgroup analysis showed inconsistent results comparing to analysis of all patients: there were no statistical significance in gender differences as for the proportion of dyslipidemia in the non-ST-segment elevation MI group, the proportion of family history of early onset coronary heart disease in the young and middle aged groups, the proportion of overweight and/or obesity, and the proportion of physical inactivity in the elderly group (all P values>0.05). Conclusions: There are gender differences in cardiovascular risk factors among Chinese patients with acute myocardial infarction. Hypertension and diabetes are more common in women, and overweight and/or obesity, fatty diet and smoking are more common in men.

Microstructural visual pathway abnormalities in patients with primary glaucoma: 3 T diffusion kurtosis imaging study.

AIM: To evaluate microstructural visual pathway damage in patients with primary glaucoma (PG) by using 3 T diffusion kurtosis imaging (DKI). MATERIALS AND METHODS: The study was approved by the ethics committee, and all participants provided written informed consent. Ten patients with PG were examined. Twenty healthy individuals served as control subjects. DKI was performed with a GE Silent 3 T magnetic resonance imaging (MRI) unit. Mean diffusivity (MD), fractional anisotropy (FA), and mean kurtosis (MK) maps were automatically created. Mean MK, MD, and FA values were calculated for each part of the visual pathway. RESULTS: No abnormalities in the shape and signal intensity were observed along the entire visual pathway in patients and the control group on the conventional MRI. Higher MD, and lower MK and FA were observed in the optic nerves (ON), lateral geniculate nucleus (LGN), optic radiations (OR), and visual cortex (VCx) of PG patients, as compared with control subjects. A significantly higher MD was observed in the ON (p<0.01), and significantly lower FA was observed in OR (p<0.05). Additionally, significantly lower MK was observed in the ON, LGN, and VCx, except for OR (p<0.01). Changes of DKI parameters in the ON were the most distinct. CONCLUSION: Glaucoma is a complex neurological disease that affects the entire visual pathway. MK derived from DKI would be a better biomarkers than FA and MD in detecting microstructural damage.

[Acute respiratory failure due to Pneumocystis pneumonia in connective tissue disease patients: clinical manifestation and prognostic factors related to hospital mortality].

Objective: To investigate the clinical manifestations and prognostic factors of hospital death in connective tissue disease patients with acute respiratory failure caused by pneumocystis pneumonia (PCP) admitted to two medical intensive care units(MICU). Methods: A retrospective review was conducted for all connective tissue disease (CTD) patients with acute respiratory failure from PCP in MICU of 2 academic medical centers between 2010 and 2015. The patients were divided into survivors and non-survivors. Demographic and clinical data, including laboratory, radiological and microbiological findings, as well as therapy, clinical course, mortality and prognostic factors of hospital mortality were included in the analysis. Logistic regression models were used to determine the effect of prognostic factors on hospital death after adjusting for covariates of which the p values were less than 0.1. Results: A total of 41 patients with connective tissue disease were identified. The PaO(2)/FiO(2) ratio (PFR) on ICU admission was 120 mmHg(55-180 mmHg, 1 mmHg=0.133 kPa). Common clinical features included dyspnea (90.2%, 37/41), fever (87.8%, 36/41) and dry cough(65.9%, 30/41). 58.5%(24/41) and 17.1%(7/41) patients were co-infected by CMV and aspergillus, respectively. The overall mortality rate was 75.6%(31/41). Compared with survivors, the age, APACHEⅡ score and incidence of barotrauma in non-survivors were higher (39±17 vs 58±15, t=3.018, P=0.002), (15±6 vs 19±5, t=2.528, P=0.019), (0/10 vs 12/31, χ(2)=5.473, P=0.021), while PFR on ICU admission was lower in non-survivors (172±68 vs 116±49, t=-1.893, P=0.007). Logistic analysis showed that PFR on ICU admission was the independent risk factor for hospital death (OR=1.004, 95%CI: 1.002-1.006, P=0.048). Conclusions: Mortality rate among patients with acute respiratory failure secondary to CTD related PCP is still high, and the poor prognostic factors of hospital mortality included PFR on ICU admission and barotrauma.

[Clinical features of acute respiratory failure due to pneumocystis pneumonia in non-HIV immunocompromised patients].

Objective: To examine the clinical features of patients with acute respiratory failure (ARF) caused by pneumocystis pneumonia (PCP) admitted into two medical intensive care units (ICU) in non- human immunodeficiency virus (HIV) infected immunocompromised patients. Methods: A retrospective review was conducted among 92 non-HIV patients with ARF caused by PCP in medical ICU of Peking Union Medical College Hospital and China-Japan Friendship Hospital between Jan 2010 and Dec 2015. Patient characteristics, clinical presentation, laboratory and radiological findings, complications, as well as therapy and mortality were included in the analysis. Results: All patients were immunocompromised before PCP, among which 69.6% (64/92) patients were suffered from autoimmune disease. The diagnosis of PCP was made by the identification of P. jiroveci organisms with Giemsa or polymerase chain reaction in specimens of bronchoalveolar lavage, sputum or tracheal aspiration. The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ was high (19±5) and the partial pressure of oxygen/ fraction of inspiration oxygen(PaO2/FiO2) ratio was low[(139.6±65.4) mmHg]on ICU admission, with all patients diagnosed as acute respiratory failure during ICU stay. Radiologic findings showed bilateral diffused ground glass opacity (94.6%, 87/92). All patients received Compound Sulfamethoxazole (SMZ/TMP) and only 3.3% (3/92) patients were not given conjunctive corticosteroid. 57.6% (53/92) and 21.7% (20/92) patients were coinfected by cytomegalovirus (CMV) and aspergillos. Invasive ventilatory support was required in 90% (81/90) patients. 22% (18/82) patients used non-invasive positive pressure ventilation (NPPV) on ICU admission but most of them (83.3%, 15/18) failed and switched to invasive positive pressure ventilation (IPPV). Median ICU and hospital length of stay were 11 and 17 days, respectively. The overall hospital mortality rate was 76.1% (70/92). Conclusions: Among patients with ARF secondary to non-HIV related PCP, autoimmune system diseases are the most common primary diagnosis. The clinical manifestations were severe and coinfections are common, with poor prognosis.

Impact of three-dimensional endoanal ultrasound on the outcome of anal fistula surgery: a prospective cohort study.

AIM: The aim of the study was to evaluate the impact of three-dimensional endoanal ultrasound (3D-EAUS) on postoperative outcome in patients with anal fistula. METHOD: This prospective study compared clinical and functional outcomes of patients with and without preoperative 3D-EAUS examination 1 year after anal fistula surgery. Patients were prospectively followed and evaluated by a standardized protocol including physical examination, the Wexner Incontinence Score (WIS) and anorectal manometry, at baseline and 1 year after surgery. RESULTS: A total of 196 patients were enrolled. There were no significant differences in demographic and operative parameters, except for operation time, between the two groups. At 1 year follow-up, the overall recurrence rates were 8.8% (9/102) in the 3D-EAUS group and 13.8% (13/94) in the examination under anaesthesia (EUA) group. In the subgroup of patients with complex fistulae, the recurrence rate was numerically lower in the 3D-EAUS group (12.8% vs 22.5%; P = 0.26). The WIS in the EUA group significantly worsened (0.35 ± 0.94 vs 1.07 ± 1.59; P = 0.003) with a decreased the number of fully continent patients (82.5% vs 55%; P = 0.008) while neither the WIS nor the proportion of fully continent patients changed in the 3D-EAUS group. Fewer patients in the 3D-EAUS group developed incontinence postoperatively (6.7% vs 33.3%; P = 0.012) and they had better maximum resting pressure and maximum squeeze pressure than the EUA group. CONCLUSIONS: Preoperative use of 3D-EAUS had a favourable impact on the outcome of surgical treatment for anal fistulae, especially in those with complex anal fistula. It should be routinely used in the clinical setting.

Loop-locked coherent population trapping magnetometer based on a fiber electro-optic modulator.

We have set up a coherent population trapping (CPT)-based magnetometer prototype with the D1 line of 87Rb atoms. The dichromatic light field is derived from a fiber electro-optic modulator (FEOM) connected to an external cavity laser diode. A CPT resonance signal with a 516 Hz linewidth is observed. By feeding back the derivative of the resonance curve to the FEOM with a proportional integral controller, of which the voltage output is directly converted to the measured magnetic field intensity, the resonance peak is locked to the environmental magnetic field. The measurement data we have achieved are well matched with the data measured by a commercial fluxgate magnetometer within 2 nT, and the sensitivity is better than 8 pT/√Hz in a parallel B field.

Genetic variants of the genes encoding zinc finger protein 313 and interleukin-13 confer a risk for psoriasis in a Chinese Uygur population.

BACKGROUND: Recent work using genome­wide association studies (GWAS) in Chinese Han and white populations have discovered several novel psoriasis susceptibility genes. AIM: To examine whether the risk loci for psoriasis identified in previous GWAS in a white population are also associated with psoriasis in a Chinese Uygur population in Xinjiang. METHODS: Genotyping analysis of eight single-nucleotide polymorphisms (SNPs) associated with psoriasis was performed for 539 patients with psoriasis and 749 controls, all of Chinese Uygur descent, using a commercial assay. RESULTS: Two SNPs had an association with psoriasis in this Chinese Uygur population: SNP rs495337 in the gene encoding for zinc finger protein 313 (P < 0.001; OR = 0.80) and SNP rs20541 of the gene encoding for interleukin-13 (P < 0.001; OR = 0.82). In subgroup analyses, the two SNPs were significantly associated (P < 0.05) with type I psoriasis, Rs495337 showed statistically difference between positive family history of psoriasis patients and controls whereas rs20541 might preferentially associated with negative family history psoriasis patients. Interestingly, using multifactor dimensionality reduction, a significant two-locus interaction was seen between rs495337 and rs20541, with a crossvalidation consistency of 4/5 and average balanced prediction (accuracy 55.5%, P < 0.001). CONCLUSIONS: ZNF313 and IL-13 are associated with risk for psoriasis in a Chinese Uygur population, and there is an effect of interaction between the two genes on this risk.

Phenanthrene biodegradation by halophilic Martelella sp. AD-3.

AIMS: To investigate the phenanthrene-degrading abilities of the halophilic Martelella species AD-3 under different conditions and to propose a possible metabolic pathway. METHODS AND RESULTS: Using HPLC and GC-MS analyses, the phenanthrene-degrading properties of the halophilic strain AD-3 and its metabolites were analysed. This isolate efficiently degraded phenanthrene under multiple conditions characterized by different concentrations of phenanthrene (100-400 mg l(-1) ), a broad range of salinities (0·1-15%) and varying pHs (6·0-10·0). Phenanthrene (200 mg l(-1) ) was completely depleted under 3% salinity and a pH of 9·0 within 6 days. The potential toxicity of phenanthrene and its generated metabolites towards the bacterium Vibrio fischeri was significantly reduced 10 days after the bioassay. On the basis of the identified metabolites, enzyme activities and the utilization of probable intermediates, phenanthrene degradation by strain AD-3 was proposed in two distinct routes. In route I, metabolism of phenanthrene was initiated by the dioxygenation at C-3,4 via 1-hydroxy-2-naphthoic acid, 1-naphthol, salicylic acid and gentisic acid. In route II, phenanthrene was metabolized to 9-phenanthrol and 9,10-phenanthrenequinone. Further study indicated that strain AD-3 exhibited a wide spectrum of substrate utilization including other polycyclic aromatic hydrocarbons (PAHs). CONCLUSIONS: The results suggest that strain AD-3 possesses a high phenanthrene biodegradability and that the degradation occurs via two routes that remarkably reduce toxicity. SIGNIFICANCE AND IMPACT OF THE STUDY: To the best of our knowledge, this work presents the first report of phenanthrene degradation by a halophilic PAH-degrading strain via two routes. In the future, the use of halophilic strain AD-3 provides a potential application for efficient PAH-contaminated hypersaline field remediation.

[Back pain and social status among the working population: what is the association? Results from a German general population survey]. / Rückenschmerz und Sozialschicht bei Berufstätigen: ergebnisse einer deutschen Bevölkerungsstichprobe.

BACKGROUND: Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain. METHODS: In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression. RESULTS: Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence. DISCUSSION: Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.

[Clinical application of self-made drainage tubes in different layers of soft tissue for negative-pressure wound therapy in 33 patients].

From January 2014 to June 2018, 28 patients with different types of deep soft tissue injury or infection were admitted to the Affiliated Jiangyin Hospital of Medical College of Southeast University; 5 patients were admitted to the Zhengzhou First People's Hospital. There were 24 males and 9 females, aged 18-89 (40±20) years. Disposable suction tubes with holes cut on side walls were used as self-made drainage tubes. The authors placed the self-made drainage tubes on different deep soft tissue layers and wound surfaces after debridement. The effective drainage sections of the wound surface drainage tubes were wrapped with silver ion antimicrobial functional active dressings. Bio-permeable membrane was used to close the operative area. The drainage tubes in the deep layer of wound and wound surface were connected in parallel by a tee and connected to wall-hanging medical negative-pressure suction device to conduct negative-pressure wound treatment at -20.0 to -10.6 kPa. The deep drainage tubes were usually removed or changed 4 or 5 days after surgery.The drainage tubes in the wound surface were synchronously replaced when removing or replacing he drainage tubes in the deep layer of wound. On 4 to 15 days after surgery, the deep drainage tubes were removed. On 8 to 25 days after surgery, the wound surface drainage tubes were removed. Then the treatment was changed to a conventional dressing change until the wounds were completely healed or the wound bed was ready for skin grafts or tissue flaps. The indwelling time of deep drainage tubes in this group of patients was (6.2±2.8) days, and the indwelling time of wound surface drainage tubes was (12.0±3.0) days. The wound healing time was (22±5) days, the hospital stay time was (29±7) days, and wound bacteria were reduced from 6 species and 11 strains before treatment to 3 species and 4 strains after treatment. No adverse events such as wound bleeding, irritative pain, and chronic sinus occurred during treatment. Twenty-three patients were followed up for 13 to 28 months, no treatment-related complications were observed.

[Epidemiological and virus molecular characterization of dengue fever outbreak in Hunan province, 2018].

Objective: To analyze the epidemiological and etiological characteristics of a dengue fever outbreak in Hunan province in 2018. Methods: Real-time PCR assay was performed for the laboratory diagnosis of 8 suspected dengue fever cases. Etiological surveillance was performed in 186 suspected dengue fever cases and fever cases who had close contacts with dengue fever patients. C6/36 cells was used for the virus isolation from acute phase serum. By sequencing the full length of E genes of 15 dengue virus strains, phylogenetic analysis was performed based on the sequences obtained, including reference sequences from the NCBI GenBank database, the serotypes and gene subtypes of the virus were analyzed to trace the possible source of transmission. An emergency monitoring of vector density and a retrospective survey of sero-epidemiology in healthy population were conducted in the epidemic area. Results: In the serum samples of 8 suspected patients, 6 were dengue virus RNA positive, and 4 were NS1 antigen positive. In 186 suspected patients, 96 were dengue virus nucleic acid, NS1 antigen or antibody positive in etiological test. A total of 64 dengue virus strains were isolated. The phylogenetic analysis showed that all the dengue virus strains belonged to type 2, which might be from Guangdong or Zhejiang provinces. The Bretub index was up to 65, indicating an extremely high risk of transmission. The positive rate of the dengue virus IgG antibody was 0.53%(2/377) in retrospective survey of 377 healthy people. Conclusion: The field epidemiologic and the molecular genetics analyses showed the outbreak of dengue fever in Hunan in 2018 was caused by imported cases and dengue virus 2.

Transparent Tiger barb Puntius tetrazona, a fish model for in vivo analysis of nocardial infection.

Nocardiosis afflicts multiple species of cultured fish, resulting in substantial economic losses to the aquaculture industry, however, lack of detailed knowledge on disease pathogenesis has hampered the development of effective prevention and control strategies. In this study, we injected a green fluorescent protein (GFP)-labeled Nocardia seriolae strain into a transparent mutant strain of Tiger barb (Puntius tetrazona) to monitor tissue pathogen accumulation and tissue damage in vivo, and to clarify the relationship between pathogenic processes and overt symptoms. GFP-labeled bacteria were phagocytized by leukocytes and could proliferate within these cells, which in turn led to leukocyte aggregation, leukocyte death, and granuloma formation. In addition, intracellular bacteria could permanently colonize various tissues via leukocyte circulation, causing multi-organ infection as revealed by changes of tissue transparency. Histology revealed granulomatous lesions in organs such as muscle, kidney, and spleen that was corresponded to the tissue opacities in vivo. Confocal microscopy confirmed massive accumulations of GFP-labeled bacteria within these granulomas, which often contained a necrotic core. Tiger barb transparency allows for real-time observation of in vivo pathological changes within the same animal, and the pathogenic process can be evaluated based on the shape and size of body opacities. Thus, transparent Tiger barb is a promising model to study the pathogenesis of nocardiosis.

Photoreactivation of Escherichia coli following medium-pressure ultraviolet disinfection and its control using chloramination.

Ultraviolet (UV) disinfection is becoming increasingly popular as an alternative disinfection technology to chlorination in recent years. In this study, we investigated the photoreactivation of Escherichia coli following medium-pressure (MP) UV disinfection of synthetic water by a bench-scale collimated beam apparatus. The UV doses ranged from 1.6 -19.7 mWs/cm2 and photoreactivation was investigated for 6 hours under fluorescent light. In addition, chloramination was applied after UV disinfection to investigate its ability to control photoreactivation. It was found that photoreactivation occurred for all UV doses tested and the increase in bacteria numbers ranged from 0.04 to 1.35 log10. However, the degree of photoreactivation decreased with increased UV doses. Chloramination experiments revealed that the addition of 0.5 mg/l of monochloramine resulted in suppression of photoreactivation for 1 hour only. An increased monochloramine dose of 1 mg/l was found to prevent photoreactivation for the entire duration of the experiment. The results of this study have shown that photoreactivation occurs even after MP UV disinfection, although it is of a lesser extent at higher UV doses. This study has also established that secondary chloramination can effectively suppress and eliminate photoreactivation with a chloramine dose of 1 mg/l.