Case report: Cutaneous anthrax diagnosed using mNGS of a formalin-fixed paraffin-embedded tissue sample.

The metagenomic next-generation sequencing (mNGS) method is preferred for genotyping useful for the identification of organisms, illumination of metabolic pathways, and determination of microbiota. It can accurately obtain all the nucleic acid information in the test sample. Anthrax is one of the most important zoonotic diseases, infecting mainly herbivores and occasionally humans. The disease has four typical clinical forms, cutaneous, gastrointestinal, inhalation, and injection, all of which may result in sepsis or meningitis, with cutaneous being the most common form. Here, we report a case of cutaneous anthrax diagnosed by mNGS in a butcher. Histopathology of a skin biopsy revealed PAS-positive bacilli. Formalin-fixed paraffin-embedded (FFPE) tissue sample was confirmed the diagnosis of anthrax by mNGS. He was cured with intravenous penicillin. To our knowledge, this is the first case of cutaneous anthrax diagnosed by mNGS using FFPE tissue. mNGS is useful for identifying pathogens that are difficult to diagnose with conventional methods, and FFPE samples are simple to manage. Compared with traditional bacterial culture, which is difficult to cultivate and takes a long time, mNGS can quickly and accurately help us diagnose anthrax, so that anthrax can be controlled in a timely manner and prevent the outbreak of epidemic events.

Weekly phototherapy is an effective therapy for patients with vitiligo.

The current strategies for the treatment of vitiligo using phototherapy usually involve treatment for two-three times per week; however, in practice, the number of patient sessions does not meet this standard. The present study found that phototherapy once a week was also effective. The present study was designed to examine the efficacy of weekly light therapy. For this purpose, 296 patients with vitiligo were included and divided into five sub-samples of the neck, face, trunk, extremities and scalp according to the site of phototherapy, and were treated once or twice weekly with phototherapy. The difference in efficacy between phototherapy performed once and twice weekly was observed using a Chi-squared test. It was concluded that there was a minimal difference between phototherapy performed twice weekly compared to once weekly for the treatment of vitiligo on the face, neck, torso, limbs and scalp. Thus, phototherapy once a week is valid for the treatment of vitiligo, although weekly light therapy takes longer to restore color for the first time.

Flexible response and rapid recovery strategies of the plateau forage Poa crymophila to cold and drought.

Cold and drought stress are the two most severe abiotic stresses in alpine regions. Poa crymophila is widely grown in the Qinghai-Tibet Plateau with strong tolerance. Here, by profiling gene expression patterns and metabolomics-associated transcriptomics co-expression network, the acclimation of Poa crymophila to the two stresses was characterized. (1) The genes and metabolites with stress tolerance were induced by cold and drought, while those related with growth were inhibited, and most of them were restored faster after stresses disappeared. In particular, the genes for the photosynthesis system had strong resilience. (2) Additionally, cold and drought activated hypoxia and UV-B adaptation genes, indicating long-term life on the plateau could produce special adaptations. (3) Phenolamines, polyamines, and amino acids, especially N',N″,N'″-p-coumaroyl-cinnamoyl-caffeoyl spermidine, putrescine, and arginine, play key roles in harsh environments. Flexible response and quick recovery are strategies for adaptation to drought and cold in P. crymophila, accounting for its robust tolerance and resilience. In this study, we presented a comprehensive stress response profile of P. crymophila and provided many candidate genes or metabolites for future forage improvement.

Soil Microbial Communities Altered by Titanium Ions in Different Agroecosystems of Pitaya and Grape.

Titanium (Ti) is an element beneficial to plant growth. Application of titanium to roots or leaves at low concentrations can improve crop yield and performance. However, the effect of titanium ions on the bulk soil microbial community of planted crops remains unclear. This study aimed to explore the effects of titanium on soil bacterial and fungal communities. Field surveys were conducted to determine the effect of titanium ions on bulk soil microbial communities in pitaya and grape plantations of Panzhihua and Xichang areas, respectively. Full-length 16S rRNA and internal transcribed spacer (ITS) amplicon sequencing were performed using PacBio Sequel to further explore the composition and structure of soil microbiota. The application of titanium ions significantly altered the composition and structure of soil microbiota. Root irrigation with titanium ions in pitaya gardens reduced the diversity of soil fungi and bacteria. However, the decline in bacterial diversity was not statistically significant. Meanwhile, foliar spray of titanium ions on grapes greatly reduced the soil microbial diversity. The bulk soil microbiota had a core of conserved taxa, and titanium ions significantly altered their relative abundances. Furthermore, the application of titanium increased the interaction network of soil fungi and bacteria compared with the control group. Thus, titanium ions potentially improve the stability of the soil microbial community. IMPORTANCE Pitaya and grape are important cash crops in the Panzhihua and Xichang areas, respectively, where they are well adapted. Titanium is a plant growth-promoting element, but the interaction between titanium and soil microorganisms is poorly understood. Titanium ions are still not widely used for growing pitaya and grape in the two regions. Thus, we investigated the effects of titanium ions on soil microbial communities of the two fruit crops in these two regions. Microbial diversity decreased, and the community structure changed; however, the addition of titanium ions enhanced cooccurrence relationships and improved the stability of the community. This study provides a basis for the importance of titanium ion application in crop cultivation.

[Magnetic Resonance Imaging for Diagnosis of Idiopathic Pediatric Meningiomas].

Objective To analyze the radiological features of idiopathic pediatric meningiomas and explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery.Methods We retrospectively reviewed 29 cases of pathologically confirmed pediatric meningiomas with pre-operative magnetic resonance imaging in Beijing Tiantan Hospital from November 2014 to July 2018.We assessed the imaging features to explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery. Results Among the 29 cases,7 intraparenchymal meningiomas,5 extraparenchymal meningiomas,4 ventricular meningiomas,and 1 transcranial meningioma were misdiagnosed.Tumor location was significantly associated with possibility of misdiagnoses(P=0.021),and intraparenchymal tumors were most likely to be misdiagnosed.Twelve patients had positive dural tail sign,and 4 of them were misdiagnosed;16 patients did not have dural tail sign,and 12 of them were misdiagnosed.Fisher exact test showed that positive dural tail sign was associated with decreased possibility of misdiagnoses(one-sided P=0.034).Univariable regression analysis showed that the feature of tumor surrounding arteries or interfering with veins(P=0.020)and the tumor maximum diameter(P=0.001)had positively linear relationships with blood loss volume during surgery.Combining these two variables,the multivariable regression model showed better fitting performance($R_{ad}^2$=0.468).Conclusions Pediatric meningiomas are extremely rare,with scarce radiological characteristics.They are hard to diagnose,and the intraparenchymal meningiomas are very likely to be misdiagnosed and therefore should be treated with extra caution.Among all the radiological features,tumor surrounding arteries or interfering with veins and tumor maximum diameter were associated with increased blood loss during surgery.

The Regulation of Adaptation to Cold and Drought Stresses in Poa crymophila Keng Revealed by Integrative Transcriptomics and Metabolomics Analysis.

Poa crymophila Keng is highly adaptable to long-term low temperature and drought conditions, making it a desirable foraging grass of the Qinghai-Tibet Plateau. Here, the widely targeted metabolomics and comparative transcriptome analyses were utilized for the discovery of metabolites and genes in P. crymophila in response to cold and drought stresses. P. crymophila were exposed to -5°C for 24 h and recovered to 22°C for 48 h, as well as drought for 10 days followed by re-watering for 1 day. In total, 779 metabolic features were assigned to metabolites and 167,845 unigenes were generated. Seventeen compounds showed significant up-regulation (variable importance in project >1) under both stresses in the metabolic profiling, mainly annotated as carbohydrates, flavones, and phenylpropanoids. The genes which were positively correlated with these metabolites were assigned to pathways (sucrose-starch, raffinose, phenylpropanoid, and flavone metabolism) using the Mapman software package. Alpha-amylase, beta-fructofuranosidase, and sugar transport genes degraded the glucose and starch to small molecule sugars for the purpose of osmotic adjustment and to provide more energy for the growth of P. crymophila in an adverse environment. The induction of cinnamoyl-CoA reductase (CCR) and the MYB gene as well as the sharp increase in schizandrin, a kind of lignan, showed that this likely has the closest connection with the tolerance to both stresses. Four significantly induced flavone compounds are probably involved in reducing oxidative damage. Our results indicated that activation of the phenlypropanoid pathway plays the primary role in P. crymophila adapting to harsh environments. This study showed the mechanism of P. crymophila responding to both cold and drought stresses and showed the discovery of a new biological regulator against stresses.

Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: image quality, radiation dose and diagnostic performance.

OBJECTIVES: To evaluate the clinical feasibility of dual-source dual-energy CT angiography (DSDECTA) with virtual non-enhanced images and iodine map for active gastrointestinal bleeding (GIB). METHODS: From June 2010 to December 2012, 112 consecutive patients with clinical signs of active GIB underwent DSDECTA with true non-enhanced (TNE), arterial phase with single-source mode, and portal-venous phase with dual-energy mode (100 kVp/230 mAs and Sn 140 kVp/178 mAs). Virtual non-enhanced CT (VNE) image sets and iodine map were reformatted from 'Liver VNC' software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNE and VNE image sets. Two radiologists, blinded to clinical data, interpreted images from DSDECTA with TNE (protocol 1), and DSDECTA with VNE and iodine map (protocol 2) respectively, with discordant interpretation resolved by consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Receiver-operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated for CT protocols 1 and 2, respectively. RESULTS: There was no significant difference in mean CT numbers of all organs (including liver, pancreas, spleen, kidney, abdominal aorta, and psoas muscle) (P>0.05). Lower noise and higher SNR were found on VNE images than TNE images (P<0.05). Image quality of VNE was lower than that of TNE without significant difference (P>0.05). The active GIB source was identified in 84 patients, 83 (83/84, 98.8%) of which were confirmed by one or more reference standard. The AUC was 0.935±0.027 and 0.947±0.026 for protocols 1 and 2, respectively. There was no significant difference between protocols 1 and 2 for diagnostic performance (Z=1.672, P>0.05). The radiation dose reduction achieved by omitting the TNE acquisition was (30.11±6.32)%. CONCLUSION: DSDECTA with arterial phase with single-source mode, portal-venous phase with dual-energy mode and post-processing VNE image sets and iodine map could act as an accurate screening method for detection and localization of active GIB with lower radiation dose.

Perihematomal perfusion typing and spot sign of acute intracerebral hemorrhage with multimode computed tomography: a preliminary study.

UNLABELLED: OBJECTIVE To explore the perihematomal perfusion typing and spot sign on computed tomography angiography (CTA) source images in order to assist in individualizing therapeutic decisions for patients with intracerebral hemorrhage by possibly forecasting perihematomal ischemia and hematoma enlargement. METHODS We examined 58 patients with spontaneous intracerebral hemorrhage by computed tomography perfusion and CTA within 6 hours after symptom onset. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images. The perfusion of hematoma region and perihematoma region was evaluated for presence or absence of the perihematomal penumbra. Three kinds of perihematoma perfusion typing were defined according to the perfusion of hematoma region and perihematoma region. CTA source images was reviewed to make sure presence or absence of the spot sign. RESULTS Finally, 53 patients (34 males, 19 females) were enrolled in our study according to exclusion criteria. Finally, 21 patients were classified into the normal group, 23 patients were classified into the mild group, and 9 patients were classified into the severe group. There were significant differences in hematoma size between the presence and absence of the perihematomal penumbra group (P<0.05). Thirteen (24.5%) patients presented with spot sign. Hematoma expansion occurred in 15 (28.3%) patients on follow-up. In which 12 patients were with spot sign. Sensitivity, specificity, positive predictive value, and negative predictive value for expansion were 80.0%, 97.4%, 92.3%, and 92.5%, respectively. CONCLUSION: In acute intracerebral hemorrhage patients, the perihematoma perfusion typing and CTA spot sign provide more radiological information that might assist in individualizing therapeutic decisions for patients by possibly forecasting perihematomal ischemia and hematoma enlargement.

"Dynamic spot sign" on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage.

OBJECTIVES: To evaluate the association between dynamic progressive enhancing foci ("dynamic spot sign") in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion. METHODS: One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed. RESULTS: Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386-590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123-1295.488), P < 0.0001. CONCLUSIONS: The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign. KEY POINTS: • It is important to identify potential progression of spontaneous intracerebral haemorrhage. • Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion. • The CTP dynamic spot sign may be present throughout arterial to venous phase imaging. • The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.

[Application of 1H-magnetic resonance spectroscopy in differential diagnosis of brain low-grade gliomas and demyelinating diseases].

OBJECTIVE: To study the clinical value of 1H-magnetic resonance spectroscopy (1H-MRS) in differential diagnosis of brain low-grade gliomas and demyelinating diseases. METHODS: 1H-MRS was performed in 24 patients with low-grade gliomas and 22 patients with demyelinating diseases and the results were retrospectively reviewed. The metabolites including N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) were detected in different areas including lesions and the normal brain. The ratios of NAA/Cr, NAA/Cho, and Cho/Cr were also computed. RESULTS: Compared with the normal brain tissue, low-grade gliomas and demyelinating diseases had significantly different ratios of NAA/Cr, NAA/Cho, and Cho/Cr (P < 0.05). The ratios of NAA/Cho and Cho/Cr were significantly different between low-grade gliomas and demyelinating diseases (P < 0.05), while the ratio of NAA/Cr was not significantly different (P > 0.05). CONCLUSIONS: The ratio of NAA/Cho and Cho/Cr is remarkably different between low-grade gliomas and demyelinating diseases. It can a useful indicator for differential diagnosis of these two diseases by 1H-MRS.

[Clinical and imaging features of hypothalamic hamartoma in children].

OBJECTIVE: To study clinical and imaging features of hypothalamic hamartoma in children. METHODS: Imaging findings and clinical manifestations of 38 children with hypothalamic hamartomas were retrospectively reviewed. The patients included 25 boys and 13 girls, ranging in age of onset from 1 month to 15 years. All the 38 patients were examined with pre-contrast and post-contrast T1 weighted MR imaging and with non-contrast T2 weighted MR imaging. Meanwhile, 10 patients received CT scan. Hypothalamic hamartomas were confimed by pathologic examinations in the 38 patients. RESULTS: Gelastic epilepsy, precocious puberty, other types of epilepsy and disturbance of intelligence were main manifestations in the 38 patients. Gelastic epilepsy was found as an initial clinical symptom in 17 cases, precocious puberty in 13 cases and other types of epilepsy in 8 cases. All masses were located in the suprasellar and interpeduncular cistern. They showed iso-density on CT scan, and homogeneous signal iso-intense to gray matter on T1 and T2 weighted MR images. With contrast MR images, there was no enhancement in the mass. The size or pedunculation of the mass was not correlated with clinical features. CONCLUSIONS: Hypothalamic hamartoma may be characterized by precocious puberty and/or gelastic epilepsy and specific imaging findings mentioned above.

[Epidemiological features of the injured in road traffic accidents in Shanghai].

OBJECTIVE: To provide reference data for enacting and revising the laws and regulations of the disability expertise. METHODS: The epidemiological features of the disabled caused by road traffic accident in Shanghai during 2005 were retrospectively analyzed. RESULTS: The most common injuries were in extremities (53.3%), followed by head (23.3%), spine (9.7%), thorax (5.8%), and abdomen (4.4%). The cumulative incidence rate of disability due to traffic injuries was 414.8 cases per 100,000 inhabitants, higher for men (505.7/100,000) than women (318.7/100,000). The highest incidence rate of disability was between age 35 and 59 (538.2/100,000). The most disabled was bicyclist, followed by pedestrian. CONCLUSION: The incidence rate of disability among 35-59 age group was the highest in Shanghai during 2005. It has resulted in loss of labor force with a negative effect on the economic development.