Superparamagnetic Iron Oxide-Erastin-Polyethylene Glycol Nanotherapeutic Platform: A Ferroptosis-Based Approach for the Integrated Diagnosis and Treatment of Nasopharyngeal Cancer.

Erastin can induce ferroptosis in tumor cells as an effective small molecule inhibitor. However, its application is hampered by a lack of water solubility. This study investigated the effects of superparamagnetic iron oxide (SPIO)-erastin-polyethylene glycol (PEG) nanoparticles prepared by loading SPIO-PEG nanoparticles with erastin on ferroptosis. SPIO-erastin-PEG nanoparticles exhibited square and spherical shapes with good dispersibility. The zeta potential and hydrodynamic size of SPIO-erastin-PEG were measured as (-37.68 ± 2.706) mV and (45.75 ± 18.88) nm, respectively. On T2-weighted imaging, the nanosystem showed significant contrast enhancement compared to no-enhancement magnetic resonance imaging (MRI). SPIO-erastin-PEG induced ferroptosis by increasing reactive oxygen species and iron content and promoting the accumulation of lipid peroxides and the degradation of glutathione peroxidase 4. Pharmacokinetic experiments revealed a half-life of 1.25 ± 0.05 h for the SPIO-erastin-PEG solution in circulation. Moreover, significant antitumorigenic effects of SPIO-erastin-PEG have been demonstrated in 5-8F cells and mouse-bearing tumors. These results indicated that the synthesized SPIO-erastin-PEG nanoplatform could induce ferroptosis effects in vitro and in vivo while exhibiting favorable physical characteristics. This approach may provide a new strategy for theranostic nanoplatform for nasopharyngeal cancer.

[Genetic analysis of a Chinese pedigree affected with atypical Charcot-Marie-Tooth disease type 1A due to duplication of PMP22 gene].

OBJECTIVE: To explore the clinical manifestations and genetic basis for a Chinese pedigree affected with atypical Charcot-Marie-Tooth disease type 1 A (CMT1A). METHODS: A patient admitted to the Department of Neurology, Xijing Hospital Affiliated to Air Force Medical University in June 2022 was selected as the study subject. Clinical data of the patient was collected, and 17 family members from four generations of this pedigree were traced based on pes arcuatus and atypical clinical symptoms. Neuroultrasound and genetic testing were carried out on available family members. Whole exome sequencing and multiple ligation-dependent probe amplification assay were carried out for the proband and some of the affected members of the pedigree. RESULTS: The proband, a 15-year-old male, had presented with paroxystic limb pain with weakness, accompanied by pes cavus and hypertrophy of gastrocnemius muscles, without stork leg sign caused by muscles atrophy in the distal lower extremities. MRI has revealed no sign of fat infiltration in the muscles of both legs. Nerve conduction examination had indicated damages of the sensory and motor nerves of the limbs, mainly with demyelinating changes. Seven members of the pedigree had pes arcuatus, including 5 presenting with paroxysmal neuropathic pain and myasthenia in the limbs, whilst 2 were without any clinical symptoms. Neurosonography of the proband, his brother, father and aunt showed thickened peripheral nerves of the extremities with unclear bundle structure. Genetic analysis revealed a large repeat encompassing exons 1 to 5 of the PMP22 gene and flanking regions (chr17: 15133768_15502298) in some of the affected members, which was predicted to be pathogenic. CONCLUSION: The duplication of PMP22 gene was considered to be pathogenic for this CMT1A pedigree.

Temperature-Responsive Nanocarrier-Regulated Alternative Release of "Cargos" for a Multiplex Photoelectrochemical Bioassay of Antibiotic-Resistant Genes.

A smart temperature stimuli-driven multiplex photoelectrochemical (PEC) assay was constructed for antibiotic resistance genes (ARGs) detection, where the stimuli-responsive gatekeeping by regulating the alternative release of "cargo" allowed for the simultaneous detection of multiple tetracycline resistance gene, using tetA (TDNA1) and tetC (TDNA2) as the model. Dual temperature-responsive nanoassemblies were embedded in the PEC bioassay as signal DNA tages: one thermoresponsive polymer (poly(N-isopropylacrylamide), PNIPAM)-capped mesoporous silica nanoparticles (MSN) with loading the "cargo" of HgO nanoparticles as signal DNA1 tags (SDNA1-PNIPAM@MSN@HgONPs) and the other antimony tartrate (SbT)-anchored silica nanospheres as signal DNA2 tags (SDNA2-SbT@SiO2NSs). At 20 °C, below the lower critical solution temperature (LCST) of PNIPAM, the "gatekeeper" PNIPAM in SDNA1-PNIPAM@MSN@HgONPs was in an ON state, igniting Hg2+ release through the pore of SiO2. While at above LCST (40 °C), it was in an OFF state. Likewise, the thermo-dependent dissociation of SbT endowed the grafted SDNA2 tags switching from the OFF (at 20 °C) to ON state (at 40 °C), igniting SbO+ release. The released Hg2+ and SbO+ triggered the amplified photocurrents due to the structure evolution of the photoactive layer into HgS/ZnS or Sb2S3/ZnS heterostructure, thus achieving sensitive detection of multiple ARGs: tetA, tetC, tetG, tetM, tetO, tetZ, tetX, and tetW. Combined with heat map analysis, rapid screening of the ARGs profiles in 12 samples could be realized. This bioassay is simple and accessible for multiple genes analysis with the detection limit down to 0.50 nM. And it was successfully applied for measuring tetracycline ARGs in real sludge samples.

Polyethylene glycol-coated ultrasmall superparamagnetic iron oxide nanoparticles-coupled sialyl Lewis X nanotheranostic platform for nasopharyngeal carcinoma imaging and photothermal therapy.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a type of head and neck malignant tumor with a high incidence in specific regional distribution, and its traditional therapies face some challenges. It has become an urgent need to seek new therapeutic strategies without or with low toxicity and side effects. At present, more and more researchers has been attracting attention by nanotheranostic platform. Therefore, our team synthesized the polyethylene glycol-coated ultrasmall superparamagnetic iron oxide nanoparticles-coupled sialyl Lewis X (USPIO-PEG-sLex) nanotheranostic platform with high temperature pyrolysis. RESULTS: The USPIO-PEG-sLex nanoparticles had excellent photothermal conversion property, and the temperature of USPIO-PEG-sLex nanoparticles solution increased with its concentration and power density of near-infrared (NIR) on 808 nm wavelengths. Five USPIO-PEG-sLex nanoparticles with different concentrations of 0 mg/ml, 0.025 mg/ml, 0.05 mg/ml, 0.1 mg/ml and 0.2 mg/ml were prepared. The biological toxicity results showed that the viability of NPC 5-8F cells is related to the concentration of USPIO-PEG-sLex nanoparticles and the culture time (P < 0.001). The results of photothermal therapy (PTT) in vitro indicated that the viability of 5-8F cells decreased significantly with the concentration of USPIO-PEG-sLex nanoparticles increases (P < 0.001), and the viability of NPC 5-8F cells were 91.04% ± 5.20%, 77.83% ± 3.01%, 73.48% ± 5.55%, 59.50% ± 10.98%, 17.11% ± 3.14%, respectively. The USPIO-PEG-sLex nanoparticles could target the tumor area, and reduce the T2* value of tumor tissue. The T2* values of tumor pre- and post-injection were 30.870 ± 5.604 and 18.335 ± 4.351, respectively (P < 0.001). In addition, USPIO-PEG-sLex nanoparticles as a photothermal agent for PTT could effectively inhibit tumor progression. The ratio of volume change between tail vein injection group, control group, nanoparticles without laser irradiation group and blank group after 5 treatments were 3.04 ± 0.57, 5.80 ± 1.06, 8.09 ± 1.96, 7.89 ± 2.20, respectively (P < 0.001). CONCLUSIONS: Our synthesized USPIO-PEG-sLex nanotheranostic platform, and it may be become a new strategy for the treatment of NPC.

Caspase-12 is involved in stretch-induced apoptosis mediated endoplasmic reticulum stress.

It is well recognized that mandibular growth, which is caused by a variety of functional appliances, is considered to be the result of both neuromuscular and skeletal adaptations. Accumulating evidence has demonstrated that apoptosis plays an important role in the adaptation of skeletal muscle function. However, the underlying mechanism of apoptosis that is induced by stretch continues to be incompletely understood. Endoplasmic reticulum stress (ERS), a newly defined signaling pathway, initiates apoptosis. This study seeks to determine if caspase-12 is involved in stretch-induced apoptosis mediated endoplasmic reticulum stress in myoblast and its underlying mechanism. Apoptosis was assessed by Hochest staining, DAPI staining and annexin V binding and PI staining. ER chaperones, such as GRP78, CHOP and caspase-12, were determined by reverse transcription polymerase chain reaction (RT-PCR) and Western blot. Furthermore, caspase-12 inhibitor was used to value the mechanism of the caspase-12 pathway. Apoptosis of myoblast, which is subjected to cyclic stretch, was observed in a time-dependent manner. We found that GRP78 mRNA and protein were significantly increased and CHOP and caspase-12 were activated in myoblast that was exposed to cyclic stretch. Caspase-12 inhibition reduced stretch-induced apoptosis, and caspase-12 activated caspase-3 to induce apoptosis. We concluded that caspase-12 played an important role in stretch-induced apoptosis that is associated by endoplasmic reticulum stress by activating caspase-3.

Effects of agricultural land types on microplastic abundance: A nationwide meta-analysis in China.

Microplastics (MPs) accumulation in agricultural land that possibly poses threats to food security and human health has recently attracted increasing attention. Land use type probably is a key factor that drives the contamination level of soil MPs. Nevertheless, few studies have performed large-scale systematic analysis of the effects in different agricultural land soils on the MPs abundance. In this study, we constructed a national MPs dataset comprising 321 observations from 28 articles, summarised the current status of microplastic pollution in five agricultural land types in China through meta-analysis, and investigated the effects and key factors of agricultural land types on microplastic abundance. The results showed that among the existing soil microplastic research, vegetable soils maintained a higher environmental exposure distribution than other agricultural lands, and with the most common trend being vegetable land > orchard land > cropland > grassland. By combining agricultural practices, demographic economic factors and geographical factors, a potential impact identification method based on subgroup analysis was established. The findings demonstrated that agricultural film mulch significantly increased soil MPs abundance, especially in orchards. Increased population and economy (carbon emissions and PM2.5 concentrations) add MPs abundance in all kinds of agricultural lands. And the significant changes of effect sizes in high-latitude and mid-altitude areas suggested that geographical space differences exerted a certain degree of impact on the soil distribution of MPs. By the proposed method, different levels of MPs risk areas in agricultural soils can be more reasonably and effectively identified, which will provide type-specific policies technical and theoretical support for the precise management of MPs in agricultural land soils.

Enhancing thermal conductivity and chemical protection of bacterial cellulose/silver nanowires thin-film for high flexible electronic skin.

Silver nanowires (AgNWs) thin films have emerged as a promising next-generation flexible electronic device. However, the current AgNWs thin films are often plagued by high AgNWs-AgNWs contact resistance and poor long-term stability. Here, to enhance the AgNWs stability on the surface of bacterial cellulose (BC), a novel flexible high conductivity thin-film was prepared by spin-coating a layer of polyvinyl alcohol (PVA) on the BC/AgNWs (BA) film. Firstly, BC film with high uniformity to better fit the AgNWs was obtained. It is observed that inadequately protected AgNWs can be corroded when AgNWs together with PVA were attached to the BC surface (BAP film), Yet, a layer of PVA was spin-coated on the surface of BA film, the BC/AgNWs/spin-coated 0.5 % PVA (BASP) thin-film (10.1 µm) exhibits that the PVA interfacial protective layer effectively mitigated the intrinsic incompatibility of BC with AgNWs as well as external corrosion (Na2S for 3 h) and immobilization of AgNWs, thus having a low conductive sheet resistance of 0.42 Ω/sq., which was better than most of the AgNWs-containing conductive materials reported so far. In addition, the resistance of the BASP thin-film changed little after 10,000 bending cycles, and the conductivity remained stable over BC directly immersed in 0.5 % PVA/AgNWs. This "soft" conductive material can be used to manufacture a new generation of electronic skin.

Preoperative bowel preparation promotes intestinal functional recovery after esophagectomy.

Background: Patients are prone to intestinal dysfunction after esophagectomy. The value of preoperative bowel preparation before esophagectomy is controversial. There is a lack of evidence as to whether preoperative bowel preparation can help patients improve bowel function and shorten the recovery time of bowel function. Objectives: The objectives of this study were to explore whether preoperative bowel preparation can promote the recovery of intestinal function after esophagectomy. Methods: We analysed 139 patients who underwent elective radical esophagectomy in the Department of Thoracic Surgery at the Second Affiliated Hospital of Xi'an Jiaotong University from May 2016 to December 2018. The enrolled patients were divided into the study group (bowel preparation group) and the control group (no bowel preparation group) of 71 cases and 68 cases. Patients in the study group were given dissolved polyethylene glycol electrolyte powder and a cleansing enema the day before surgery. Patients in the control group were neither given polyethylene glycol electrolyte powder nor cleansing enemas before surgery. The postoperative recovery of the two groups were compared. Results: Postoperative bed rest time, bowel function recovery time and the time of first flatus and defecation after surgery were significantly shorter in patients with bowel preparation than in those without bowel preparation, and the differences were statistically significant. (P=0.038, P<0.001, P<0.001, P<0.001; respectively). Conclusions: Preoperative bowel preparation can promote the recovery of patients with esophageal cancer, especially the recovery of bowel function, which can reduce the pain caused by abdominal distension and improve the quality of life of patients.

In Situ Fermentation of an Ultra-Strong, Microplastic-Free, and Biodegradable Multilayer Bacterial Cellulose Film for Food Packaging.

Cellulose-based food packaging has a significant importance in reducing plastic pollution and also ensuring our safety from microplastics. Nonetheless, lignocellulose necessitates sophisticated physical and chemical treatments to be fashioned into a satisfactory food packaging, thus leading to extra consumption and operations. Here, we present a gel-assisted biosynthesis approach for the in situ production of bacterial cellulose (BC) that can be directly applied to food packaging. Komagataeibacter sucrofermentans is homogeneously distributed in the gellan gum (GG)-assisted culture system, and the BC/GG film with an even surface is attained. Then, the BC/GG film is integrated with an antibacterial layer containing a quaternary ammonium chitosan microsphere (QM) through an in situ spray biosynthesis method. The resulting BC/GG/QM multilayer film combines the barrier properties and antibacterial activity. The method for in situ biosynthesis is green, efficient, and convenient to endow the multilayer film with excellent barrier capacity (1.76 g·mm·m-2·d-1·KPa-1 at RH 75%), high mechanical properties (strength 462 MPa), and antibacterial activity (>90% against Escherichia coli O157:H7 and Staphylococcus aureus). In terms of food preservation, the overall performance of the BC/GG/QM multilayer film is better than the commercial petroleum-based film and lignocellulose-derived film. This work proffers a novel strategy to produce a more beneficial and eco-friendly multilayer film via in situ biosynthesis, which manifests great utility in the field of food packaging.

Epidemiological and Molecular Study on Tick-Borne Pathogens in Argun Port Area Near the Chinese-Russian Border.

Objective: We aim to investigate the species composition of ticks and the pathogen characteristics they carry in the Argun port area of the China-Russia border. Materials and Methods: Ticks were collected in surrounding grassland, mixed forest land, and other different habitats around the Argun port area at the Sino-Russian Border of Inner Mongolia in China in April 2019. The presence of 16 potential pathogens, including Yersinia Pestis, Francisella tularensis, Coxiella burnetii (Cb), Anaplasma sp. (Ap), spotted fever group rickettsiae (SFG Rk), Borrelia sp. (Bl), Leptospira, Bartonella spp., Babesia, Crimean-Congo hemorrhagic fever virus, tick-borne encephalitis virus, Bhanja virus, West Nile Virus, severe fever with thrombocytopenia syndrome bunyavirus, Hantaan virus, and bocavirus (boca) was analyzed by polymerase chain reaction. The DNA and amino acid sequences of tick-borne pathogens were compared for homology, and the phylogenetic trees were constructed by using Mega and Lasergene software. Results: A total of 210 ticks were collected and they belonged to three species: Dermacentor nuttalli, Ixodes persulcatus, and Haemaphysalis verticalis. Among them, 165 (78.57%) ticks tested positive for 5 pathogens, namely Ap, SFG Rk, Cb, Bl, and boca. Fifteen (7.14%) ticks were detected coinfection with two pathogens, and none were coinfected with three or more pathogens. Conclusion: This study shows the prevalence of at least five tick-borne pathogens in Argun, and there is a risk of coinfection by two pathogens in one tick. This study reveals the great importance of controlling tick-borne diseases in this region.

Co-detection in the pathogenesis of severe hand-foot-mouth disease.

It still needs to be elucidated whether co-detection of EV71 with other intestinal tract viruses plays a role in the pathogenesis of severe hand-foot-mouth disease (HFMD). A total of 680 stool specimens collected from clinically diagnosed mild and severe-HFMD patients were tested for EV71, CA16, norovirus, bocavirus and rotavirus. The results showed that EV71 was significantly associated with severe-HFMD patients. Co-detection of EV71 with norovirus and rotavirus was also significantly associated with severe-HFMD patients: The OR (95 % CI) value was 6.466 (2.735, 15.283) and 7.561 (3.560, 16.057), p < 0.001, respectively. Co-detection of EV71 with rotavirus or norovirus is probably associated with severe HFMD.

Bifunctional Carbon Dots Derived From an Anaerobic Bacterium of Porphyromonas gingivalis for Selective Detection of Fe3+ and Bioimaging.

In this study, for the first time, Porphyromonas gingivalis, an anaerobic bacterium, was selected to synthesize carbon dots. The achieved P. gingivalis-carbon dots (Pg-CDs) exhibited strong fluorescence and high stability with capability for dual function as Fe3+ sensor and intracellular imaging agent. The detection limit for Fe3+ was as low as 1.85 µm. On the other hand, the prepared Pg-CDs were an excellent candidate for biosensor with high biocompatibility.

Effect of Fenton pretreatment combined with bacteria inoculation on humic substances formation during lignocellulosic biomass composting derived from rice straw.

The goal of this work was to explore the effect of Fenton pretreatment combined with bacteria inoculation on the formation of humic substances (HS) during rice straw composting. In this study, the compound bacterial agents were inoculated after Fenton pretreatment during rice straw composting. The results suggested that the coupling effects of Fenton pretreatment and bacteria inoculation promoted the humification process, which might be the reason of organic fractions degradation and transformation. In addition, the bacterial communities structure and diversity were changed by Fenton pretreatment and inoculation. Key microbial genera linking to the transformation of organic fractions were determined by network analysis. Redundancy analysis and structural equation model analysis indicated that Fenton pretreatment, inoculation, amino acid, soluble sugar and beta-diversity as the key factors affecting organic fractions transformation during composting. Therefore, the combined application Fenton pretreatment with bacteria inoculation provided a new method to promote the HS amount.

Ultrasmall superparamagnetic nanoparticles targeting E-selectin: synthesis and effects in mice in vitro and in vivo.

Purpose: We developed a contrast agent for targeting E-selectin expression. We detected the agent using magnetic resonance imaging (MRI) in vivo in nude mice that had undergone nasopharyngeal carcinoma (NPC) metastasis. Methods: Sialyl Lewis X (sLeX) was conjugated with ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles. Hydrodynamic size, polydispersity index, and ζ-potential of USPIO-polyethylene glycol (PEG) nanoparticles and USPIO-PEG-sLeX nanoparticles were measured. Component changes in nanoparticles of USPIO, USPIO-PEG, and USPIO-PEG-sLeX were analyzed by thermogravimetric analysis and Fourier-transform infrared spectroscopy. A model of NPC metastasis to inguinal lymph nodes in nude mice was used to investigate characteristics of the USPIO-PEG-sLeX nanoparticles in vivo. We investigated the ability of the T2* value, change in T2* value (ΔT2* value), and enhancement rate (ER) to assess accumulation of USPIO-PEG-sLeX nanoparticles quantitatively in mice of a metastasis group and control group. Four MRI scans were undertaken for each mouse. The first scan (t0) was done before administration of USPIO-PEG-sLeX nanoparticles (0.1 mL) via the tail vein. The other scans were carried out at 0 (t1), 1 (t2), and 2 hours (t3) postinjection. The mean optical density was used to reflect E-selectin expression. Results: sLeX was labeled onto USPIO successfully. In vivo, there were significant interactions between the groups and time for T2* values after administration of USPIO-PEG-sLeX nanoparticles. Six parameters (T2* at t2, ΔT2* at t1, ΔT2* at t2, ER at t1, ER at t2, and ER at t3) were correlated with the mean optical density. Conclusion: USPIO-PEG-sLeX nanoparticles can be used to assess E-selectin expression quantitatively. Use of such molecular probes could enable detection of early metastasis of NPC, more accurate staging, and treatment monitoring.

Effects of Kangfuxin solution on IL-1ß, IL-6, IL-17 and TNF-α in gingival crevicular fluid in patients with fixed orthodontic gingivitis.

Changes of interleukin (IL)-1ß, IL-6, IL-17 and tumor necrosis factor-α (TNF-α) in gingival crevicular fluid in patients with fixed orthodontic gingivitis after treatment with Kangfuxin solution were analyzed to explore the clinical effect of Kangfuxin solution in patients with orthodontic gingivitis. A total of 78 patients diagnosed with fixed orthodontic gingivitis in Weifang People's Hospital from January 2015 to March 2017 were selected. Thirty-nine patients were treated with gingival cleansing as control group, and the other 39 patients were treated with gingival cleansing plus spraying and sublingual administration with Kangfuxin solution as treatment group. The general data of patients were collected, and the changes of IL-1ß, IL-6, IL-17 and TNF-α in gingival crevicular fluid were measured, the bleeding index (BI), probing depth (PD), swelling and pain grades were recorded, and the clinical curative effects were compared between the two groups. The curative effect in treatment group was better than that in control group (p<0.05). After treatment, gingival BI and PD in both groups were lower than those before treatment. The curative effect in treatment group was better than that in control group (p<0.05). The levels of gingival pain and swelling after treatment in treatment group were mainly in grade I. The levels of gingival pain and swelling after treatment in control group were mainly in grade II and III (p<0.05). After treatment, the effective rate of control group was 76.92% and that of treatment group was 97.44% (p<0.05). It was found that the levels of IL-6 and TNF-α in gingival crevicular fluid were positively correlated with PD. The use of Kangfuxin solution in the treatment of patients with orthodontic gingivitis can effectively reduce the levels of IL-1ß, IL-6, IL-17 and TNF-α in gingival crevicular fluid, and improve the periodontal conditions and the effective rate of treatment.

Travel-related infections in mainland China, 2014-16: an active surveillance study.

BACKGROUND: Transmission of infection through international travel is a growing health issue, and the frequency of imported infection is increasing in China. We aimed to quantify the total number of infections imported into mainland China by arriving travellers. METHODS: We actively surveyed arriving travellers at all 272 international entry-exit ports in mainland China. Suspected cases were detected through fever screening, medical inspection, self-declaration, and reporting by on-board staff. Participants completed a standardised questionnaire with questions about demographics, their travel itinerary (including detailed information about all countries or regions visited), and clinical manifestations. Nasopharyngeal swabs, sputum samples, faecal samples, vomitus, blood, and serum were collected as appropriate for diagnoses. Diagnosis was made by specific laboratory tests according to the national technical guidelines. Infections were classified as respiratory, gastrointestinal, vector-borne, blood-transmitted and sex-transmitted, or mucocutaneous. We divided arriving travellers into two groups: travellers coming from countries other than China, and travellers coming from Hong Kong, Macau, and Taiwan. We integrated surveillance data for 2014-16, calculated incidences of travel-related infections, and compared the frequency of infections among subgroups. FINDINGS: Between Jan 1, 2014, and Dec 31, 2016, 22 797 cases were identified among 805 993 392 arriving travellers-an overall incidence of 28·3 per million. 45 pathogens were detected in participants: 18 respiratory (19 662 cases), ten gastrointestinal (189 cases), seven vector-borne (831 cases), seven blood-transmitted and sex-transmitted (1531 cases), and three mucocutaneous (584 cases). Both the overall number and incidence of infection were more than five times higher in 2016 than in 2014. Case numbers and incidences also varied substantially by province, autonomous region, and municipality. Overall, 17 643 (77%) infections were detected by fever screening, but 753 (49%) blood-transmitted and sex-transmitted infections were identified through medical inspection. 14 305 (73%) cases of respiratory infection and 96 (51%) of gastrointestinal infections were in tourists. Tuberculosis, hepatitis A virus, vector-borne, and blood-transmitted and sex-transmitted infections were common among Chinese labourers who worked abroad. Dengue and malaria were most commonly diagnosed in travellers arriving from Africa. 12 126 (93%) of the 12 985 cases arriving from Hong Kong, Macau, or Taiwan were respiratory infections. Hand, foot, and mouth disease accounted for 2·90% of infections in travellers from Hong Kong, Macau, or Taiwan and 0·31% of infections in international travellers. INTERPRETATION: This report is the first to characterise the profile of travel-related infections among arriving travellers in mainland China. Our findings should increase public awareness of the potential risk of imported infections, and help health-care providers to make evidence-based health recommendations to travellers. FUNDING: The Natural Science Foundation of China.

Salivary chromogranin A levels correlate with disease severity but do not reflect anxiety or personality of adult patients with atopic dermatitis.

Stress-induced scratching is an issue in patients with adult atopic dermatitis (AD). Although itching and stress are believed to be intimately related, no objective index is available; therefore, most evaluations are subjective. Using saliva, which is easily collected, we investigated the degree to which AD severity and patient stress levels are reflected in stress proteins in the saliva. Here, we evaluated the severity (Scoring Atopic Dermatitis [SCORAD] score), stress (State-Trait Anxiety Index [STAI] score), personality (Tokyo University Egogram [TEG] II score) and quality of life (Dermatology Life Quality Index [DLQI] score) of 51 patients with AD who were examined in the Department of Dermatology of Shimane University between April and December 2015. We collected saliva and measured salivary chromogranin A (CgA), amylase and cortisol. The amount of salivary CgA per protein in patients with AD was correlated with their SCORAD score (r = 0.458, P < 0.001). There was no correlation between cortisol or amylase levels and SCORAD score. SCORAD score was correlated with DLQI (r = 0.390, P = 0.006). CgA per protein was correlated with DLQI (r = 0.393, P = 0.004). There was no correlation between scores for the anxiety component of the STAI, TEG II or DLQI. Our results suggested that patients with more severe AD may have high stress levels. The personalities of these patients with AD tended to involve elevated anxiety levels.

Circulation of Coxsackievirus A10 and A6 in hand-foot-mouth disease in China, 2009-2011.

Coxsackieviruses A10 (CV-A10) and A6 (CV-A6) have been associated with increasingly occurred sporadic hand-foot-mouth disease (HFMD) cases and outbreak events globally. However, our understanding of epidemiological and genetic characteristics of these new agents remains far from complete. This study was to explore the circulation of CV-A10 and CV-A6 in HFMD and their genetic characteristics in China. A hospital based surveillance was performed in three heavily inflicted regions with HFMD from March 2009 to August 2011. Feces samples were collected from children with clinical diagnosis of HFMD. The detection and genotyping of enteroviruses was performed by real-time PCR and sequencing of 5'UTR/VP1 regions. Phylogenetic analysis and selection pressure were performed based on the VP1 sequences. Logistic regression model was used to identify the effect of predominant enterovirus serotypes in causing severe HFMD. The results showed 92.0% of 1748 feces samples were detected positive for enterovirus, with the most frequently presented serotypes as EV-71 (944, 54.0%) and CV-A16 (451, 25.8%). CV-A10 and CV-A6 were detected as a sole pathogen in 82 (4.7%) and 44 (2.5%) cases, respectively. Infection with CV-A10 and EV-71 were independently associated with high risk of severe HFMD (OR = 2.66, 95% CI: 1.40-5.06; OR = 4.81, 95% CI: 3.07-7.53), when adjusted for age and sex. Phylogenetic analysis revealed that distinct geographic and temporal origins correlated with the gene clusters based on VP1 sequences. An overall ω value of the VP1 was 0.046 for CV-A10 and 0.047 for CV-A6, and no positively selected site was detected in VP1 of both CV-A10 and CV-A6, indicating that purifying selection shaped the evolution of CV-A10 and CV-A6. Our study demonstrates variety of enterovirus genotypes as viral pathogens in causing HFMD in China. CV-A10 and CV-A6 were co-circulating together with EV-71 and CV-A16 in recent years. CV-A10 infection might also be independently associated with severe HFMD.