[Analysis of iodine nutritional status of children aged 8-10 years in Zhejiang Province from 2016 to 2021].

Objective: To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021. Methods: A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children. Results: The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M (Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 (χ2trend=111.427, P<0.001). The median of urinary iodine concentration M (Q1, Q3) in children was 182.50 (121.00, 261.00) µg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [M (Q1, Q3): 190.90 (128.80, 269.00) µg/L] was significantly higher than that in children in coastal areas [M (Q1, Q3): 173.00 (113.00, 250.30) µg/L] (P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95%CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95%CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95%CI: 2.64%-3.10%), 588/20 530] (P=0.001). Conclusion: From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.

Using CT imaging features to predict visceral pleural invasion of non-small-cell lung cancer.

AIM: To examine the diagnostic performance of different models based on computed tomography (CT) imaging features in differentiating the invasiveness of non-small-cell lung cancer (NSCLC) with multiple pleural contact types. MATERIALS AND METHODS: A total of 1,573 patients with NSCLC (tumour size ≤3 cm) were included retrospectively. The clinical and pathological data and preoperative imaging features of these patients were investigated and their relationships with visceral pleural invasion (VPI) were compared statistically. Multivariate logistic regression was used to eliminate confounding factors and establish different predictive models. RESULTS: By univariate analysis and multivariable adjustment, surgical history, tumour marker (TM), number of pleural tags, length of solid contact and obstructive inflammation were identified as independent risk predictors of pleural invasiveness (p=0.014, 0.003, <0.001, <0.001, and 0.017, respectively). In the training group, comparison of the diagnostic efficacy between the combined model including these five independent predictors and the image feature model involving the latter three imaging predictors were as follows: sensitivity of 88.9% versus 77% and specificity of 73.5% versus 84.1%, with AUC of 0.868 (95% CI: 0.848-0.886) versus 0.862 (95% CI: 0.842-0.880; p=0.377). In the validation group, the sensitivity and specificity of these two models were as follow: the combined model, 93.5% and 74.3%, the imaging feature model, 77.4% and 81.3%, and their areas under the curve (AUCs) were both 0.884 (95% CI: 0.842-0.919). The best cut-off value of length of solid contact was 7.5 mm (sensitivity 68.9%, specificity 75.5%). CONCLUSIONS: The image feature model showed great potential in predicting pleural invasiveness, and had comparable diagnostic efficacy compared with the combined model containing clinical data.

[Two cases of airway dysfunction related to diacetyl exposure].

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.

22q11.2 deletion syndrome complicated with pulmonary alveolar proteinosis in a child: a case report.

BACKGROUND: To analyze the clinical data and next generation sequencing (NGS) results from a child with 22q11.2 deletion syndrome (22q11DS) complicated with pulmonary alveolar proteinosis (PAP) who was admitted to the Department of Pediatrics of Fuyang People's Hospital and to present a review of the literature. CASE PRESENTATION: A 9-year-old male child, whose face had a small mandible and high-arched palate, but lacked a cleft palate, had repeated respiratory tract infections and bronchiectasis. Clinical examination, computer tomography, and electronic bronchoscopy were performed. Genetic testing via NGS was undertaken. PAP was confirmed by Periodic Acid Schiff staining of milky white alveolar lavage fluid isolated by electronic bronchoscopy. A deletion of approximately 2.46 Mbp on chromosome 22q11.2 was confirmed by NGS. During hospitalization, anti-infection, nebulization, alveolar lavage, and regular application of thymosin were administered to the patient. The condition of the patient stabilized following treatment. CONCLUSIONS: 22q11DS and PAP are both rare diseases, and the manifestation of 22q11DS combined with PAP has not been previously reported. The diagnosis and treatment of this case will be a reference for future clinical work.

[Analysis of dust hazard characteristics in 59 ferrous metal foundry enterprises in Ningbo City].

Objective: To analyze the post distribution of dust concentration in ferrous metal foundry enterprises and evaluate the occupational health risks, and provide basis for policies of the formulation of pneumoconiosis prevention and control. Methods: From August to September in 2020, the basic information, dust hazard information and occupational health management information of 59 ferrous metal casting enterprises were investigated, the dust concentration distribution was analyzed, and the risk assessment was carried out by using the quantitative assignment model. The dust concentration is tested by LSD method after logarithmic treatment. The 3 times time weighted average allowable exposure concentration of dust is taken as the peak concentration limit of dust; The time weighted average allowable exposure concentration of dust converted by exposure time is taken as the time weighted average exposure concentration limit of dust, and whether the time weighted average exposure concentration and peak concentration of dust at the same post exceed the limit is taken as the basis for exceeding the limit of dust post concentration to calculate the post exceeding the limit rate. Results: The dust hazards were mainly distributed in the posts of sand treatment, molding, sand falling, sand cleaning and cutting and grinding. Dust exposure time weighted average concentration was 0.44 (0.03, 5.11) mg/m(3), peak exposure concentration was 1.30 (0.18, 10.94) mg/m(3), and the over standard rate of Posts was 38.92% (79/203) . Weighted average exposure concentration of other dust (total dust) in the cutting and grinding post is 1.50 (0.15, 7.40) mg/m(3), peak exposure concentration is 0.90 (0.07, 12.48) mg/m(3), and the post exceedance rate is 4.88% (2/41) . Weighted average exposure concentration of silica dust (exhaling dust) in dust operation posts of investment casting enterprises is 0.43 (0.05, 6.35) mg/m(3), peak exposure concentration is 0.90 (0.12, 8.28) mg/m(3), and the post over standard rate is 35.77% (49/137) ; Weighted average exposure concentration of other dust (total dust) at the cutting and grinding post is 2.00 (11.00, 21.00) mg/m(3), and the post exceedance rate is 2.50% (2/80) . There was no significant difference in the concentration of respirable dust between sand casting and investment casting (P>0.05) . The concentration of respirable dust in sand casting was higher than that in sand treatment, molding and sand cleaning posts (P<0.05) . The concentration of silica dust in investment casting was higher than that in sand treatment and molding posts, and that in sand cleaning posts was higher than that in sand treatment posts (P<0.05) . 98.48% (454/461) of the dust operation posts have an occupational health risk value greater than or equal to 400, and 1.52% (7/461) of the dust operation posts have an occupational health risk value of 200~399. Conclusion: there is a high rate of exceeding the standard in the dust work posts in the ferrous metal foundry enterprises in Ningbo, and the workers have a high occupational health risk of pneumoconiosis or metal and its compound pneumoconiosis. Targeted measures should be taken to reduce the occupational health risk.

[Analysis of incidence characteristics and trend of pneumoconiosis in Ningbo City from 1967 to 2019].

Objective: To understand the incidence of pneumoconiosis in Ningbo city from 1967 to 2019, and to analyze the distribution characteristics and change trend of pneumoconiosis. Methods: In February 2021, the data of pneumoconiosis patients in Ningbo city from 1967 to 2019 were sorted out. The data from 1967 to 1987 were from historical case files of Zhejiang Center for Disease Control and Prevention, the data from 1988 to 2005 were from the historical case files of Ningbo Center for Disease Control and Prevention, and the data from 2006 to 2019 were from the pneumoconiosis report card in China Disease Prevention and Control Information System; Followed up and supplement relevant information, including basic information, basic information of employers and information related to pneumoconiosis diagnosis, and comprehensively analyze the composition and development trend, population characteristics and industry characteristics of pneumoconiosis. Results: From 1967 to 2019, a total of 1715 cases of pneumoconiosis were reported in Ningbo City, including 1254 cases of stageⅠpneumoconiosis, 258 cases of stageⅡpneumoconiosis, 172 cases of stage Ⅲpneumoconiosis. 1202 cases of silicosis (70.09%) , 296 cases of asbestosis (17.26%) , 40 cases of welder's pneumoconiosis (2.33%) , 32 cases of graphite pneumoconiosis (1.87%) were reported. There were 1296 male cases (75.57%) and 419 female cases (24.43%) were reported. Silicosis (91.15%, 1102/1209) and welder's pneumoconiosis (100.00%, 40/40) were the most common pneumoconiosis in males, while asbestosis (90.24%, 268/297) and graphite pneumoconiosis (87.50%, 28/32) were the most common pneumoconiosis in females. The average age was (49.71±10.90) years old and the average length of service was (10.98±6.96) years. The top three reported pneumoconiosis cases were construction industry (336 cases, 19.59%) , ferrous metal smelting and rolling industry (317 cases, 18.48%) and non-metallic mineral products industry (315 cases, 18.37%) . The top three reported pneumoconiosis cases were 414 cases (24.14%) in Ninghai County, 294 cases (17.14%) in Yuyao City and 272 cases (15.86%) in Yinzhou District. Conclusion: With the development of industries in Ningbo City, government departments should strengthen supervision and management of enterprises involving silica dust and welding fume to curb the high incidence of pneumoconiosis.

Correlations of IL-18 and IL-6 gene polymorphisms and expression levels with onset of glioma.

OBJECTIVE:   The aim of this study was to explore the correlations of interleukin (IL)-18 and IL-6 gene polymorphisms and expression levels with the onset of glioma. PATIENTS AND METHODS: The differences in the expression levels of IL-18 and IL-6 between glioma patients and normal people in the Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases were analyzed. A total of 200 glioma patients and 200 healthy people were taken as the research subjects. Peripheral blood was collected to extract deoxyribonucleic acids (DNAs). IL-18 and IL-6 gene polymorphisms were detected and analyzed combined with haplotype analysis and gene expression levels of IL-18 and IL-6, as well as their levels in serum. RESULTS: Both IL-18 and IL-6 were highly expressed in tumor tissues of glioma patients, whereas they were lowly expressed in normal cerebral tissues, with statistically significant differences (p<0.05). Statistically significant differences in the allele distributions of IL-18 gene polymorphisms rs371411440 (p=0.041) and rs371828055 (p=0.002) and IL-6 gene polymorphisms rs201211345 (p=0.000) and rs201439472 (p=0.003) were observed between disease group and control group (p<0.05). Genotype distributions of IL-18 gene polymorphism rs371828055 (p=0.005) and IL-6 gene polymorphisms rs201211345 (p=0.000) and rs201439472 (p=0.019) in disease group were significantly different from those in control group (p<0.05). Disease group exhibited significantly higher frequencies of genotype GG of IL-18 gene polymorphism rs371828055, genotype AA of IL-6 gene polymorphism rs201211345 and genotype TT of IL-6 gene polymorphism rs201439472 than control group (p<0.05). There were statistically significant differences in the distributions of the dominant model AA+AC of IL-6 gene polymorphism rs201211345 (p=0.016) and the recessive model GT+TT of IL-18 gene polymorphism rs371828055 (p=0.010) between the two groups (p<0.05). Differences in the distributions of haplotypes CC (p=0.001) and GT (p=0.027) of IL-18 gene polymorphisms rs371411440 and rs371828055 and haplotypes AC (p=0.009), AT (p=0.000) and CT (p=0.000) of IL-6 gene polymorphisms rs201211345 and rs201439472 were observed between disease group and control group (p<0.05). In addition, a high degree of linkage disequilibrium was detected between IL-6 gene polymorphisms rs201211345 and rs201439472 (D'=0.583). The genotypes of IL-18 gene polymorphism rs371828055 were evidently correlated with the gene expression of IL-18 (p=0.000). Meanwhile, patients with genotype GT had a distinctly lower expression level of IL-18 (p<0.05). The genotypes of IL-6 gene polymorphism rs201211345 were obviously associated with the expression of IL-6 (p=0.002). The expression of IL-6 was markedly down-regulated in patients carrying genotype AA (p<0.05). Consistent with the expression levels of IL-18 and IL-6, the genotypes of IL-18 gene polymorphism rs371828055 were associated with the content of serum IL-18 (p<0.05). Moreover, patients carrying genotype GT had distinctly lower content of serum IL-18 (p<0.05). Additionally, the genotypes of IL-6 gene polymorphism rs201211345 were evidently correlated with the content of serum IL-6 (p<0.05), and the content of serum IL-6 declined distinctly in patients with genotype AA (p<0.05). CONCLUSIONS: IL-18 and IL-6 gene polymorphisms and expression levels are significantly correlated with the onset of glioma.

Bedaquiline for multidrug-resistant TB in paediatric patients.

BACKGROUND: TMC207-C211 (NCT02354014) is a Phase 2, open-label, multicentre, single-arm study to evaluate pharmacokinetics, safety/tolerability, antimycobacterial activity and dose selection of bedaquiline (BDQ) in children (birth to <18 years) with multidrug-resistant-TB (MDR-TB).METHODS: Patients received 24 weeks' BDQ with an anti-MDR-TB background regimen (BR), followed by 96 weeks of safety follow-up. Results of the primary analysis are presented based on data up to 24 weeks for Cohort 1 (≥12-<18 years; approved adult tablet at the adult dosage) and Cohort 2 (≥5-<12 years; age-appropriate 20 mg tablet at half the adult dosage).RESULTS: Both cohorts had 15 patients, of whom respectively 53% and 40% of Cohort 1 and Cohort 2 children had confirmed/probable pulmonary MDR-TB. Most patients completed 24 weeks´ BDQ/BR treatment (Cohort 1: 93%; Cohort 2: 67%). Geometric mean BDQ area under the curve 168h values of 119,000 ng.h/mL (Cohort 1) and 118,000 ng.h/mL (Cohort 2) at Week 12 were within 60-140% (86,200-201,000 ng.h/mL) of adult target values. Few adverse event (AE) related discontinuations or serious AEs, and no QTcF >460 ms during BDQ/BR treatment or deaths occurred. Of MGIT-evaluable patients, 6/8 (75%) Cohort 1 and 3/3 (100%) Cohort 2 culture converted.CONCLUSION: In children and adolescents aged ≥5-<18 years with MDR-TB, including pre-extensively drug-resistant-TB (pre-XDR-TB) or XDR-TB, 24 weeks of BDQ provided a comparable pharmacokinetic and safety profile to adults.

[Population genetics of invasive Pomacea spp. in Hangzhou City, Zhejiang Province].

OBJECTIVE: To investigate the distribution and identify the genetic genetics of invasive Pomacea species in Xihu District, Hangzhou City, so as to understand the spread tendency of Pomacea species. METHODS: The specimens of Pomacea species were collected from five sites in water systems (lakes, rivers and wetlands) and its costal lands in Xihu District, Hangzhou City in 2017 for morphological identification. Total DNA was isolated from the foot tissues of adult snails for amplification of the COI gene, and haplotype diversity and nucleic acid diversity analyses were performed. In addition, a phylogenetic tree was created based on the haplotype captured from GenBank and those from this study to investigate the phylogenetic relationships. RESULTS: Pomacea specimens, which were preliminarily characterized as Pomacea, were found in ponds, rivers and wetlands in Xihu District of Hangzhou City. A total of 16 sequences were captured from the DNA samples of Pomacea specimens, which belonged to 3 haplotypes, including Hap1, Hap2 and Hap3. A high frequency was seen in Hap1 and Hap3, and a low frequency was found in Hap2. The Pomacea specimens collected from the 5 sites in Xihu Districts included P. canaliculata and P. maculate. The Pomacea specimens with a Hap1 had a close genetic relationship with the P. canaliculata from Argentina, Guangdong Province and Hong Kong Special Administrative Region of China, and the Pomacea specimens with a Hap2 had a close genetic relationship with the P. canaliculata from Argentina, Japan and Guangzhou City of Guangdong Province, China, while the Pomacea specimens with a Hap2 had a close genetic relationship with the P. maculate from Argentina and Brazil. CONCLUSIONS: P. canaliculata and P. maculata are present in Xihu District of Hangzhou City. P. maculata may spread to Xihu District through multiple introductions or water flow.

Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic function in cardiac surgical patients: a randomised controlled trial.

Whether third-generation hydroxyethyl starch solutions provoke kidney injury or haemostatic abnormalities in patients having cardiac surgery remains unclear. We tested the hypotheses that intra-operative administration of a third-generation starch does not worsen postoperative kidney function or haemostasis in cardiac surgical patients compared with human albumin 5%. This triple-blind, non-inferiority, clinical trial randomly allocated patients aged 40-85 who underwent elective aortic valve replacement, with or without coronary artery bypass grafting, to plasma volume replacement with 6% starch 130/0.4 vs. 5% human albumin. Our primary outcome was postoperative urinary neutrophil gelatinase-associated lipocalin concentrations, a sensitive and early marker of postoperative kidney injury. Secondarily, we evaluated urinary interleukin-18; acute kidney injury using creatinine RIFLE criteria, coagulation measures, platelet count and function. Non-inferiority (delta 15%) was assessed with correction for multiple comparisons. We enrolled 141 patients (69 starch, 72 albumin) as planned. Results of the primary analysis demonstrated that postoperative urine neutrophil gelatinase-associated lipocalin (median (IQR [range])) was slightly lower with hydroxyethyl starch (5 (1-68 [0-996]) ng.ml-1 ) vs. albumin (5 (2-74 [0-1604]) ng.ml-1 ), although not non-inferior [ratio of geometric means (95%CI) 0.91 (0.57, 1.44); p = 0.15] due to higher than expected variability. Urine interleukin-18 concentrations were reduced, but interleukin-18 and kidney injury were again not non-inferior. Of 11 individual coagulation measures, platelet count and function, nine were non-inferior to albumin. Two remaining measures, thromboelastographic R value and arachidonic acid-induced platelet aggregation, were clinically similar but with wide confidence intervals. Starch administration during cardiac surgery produced similar observed effects on postoperative kidney function, coagulation, platelet count and platelet function compared with albumin, though greater than expected variability and wide confidence intervals precluded the conclusion of non-inferiority. Long-term mortality and kidney function appeared similar between starch and albumin.

[Occupational Health Risk Assessment of Low Concentrations Benzene Toluene and Xylenes].

Objective: To Assess occupational health risks of exposuring to low concentrations (lower than occupational exposure limit, OEL) benzene, toluene and Xylenes. Methods: Qualitative evaluation, semi-quantitative evaluation and quantitative evaluation from guidelines for occupational health risk assessment of chemicals in the workplace were conducted to assess occupational health risks exposure to benzene compounds in different workplaces of 5 manufacturing enterprises, respectively. Results: Concentrations of benzene, toluene and Xylenes in all workplaces were lower than OEL. Qualitative evaluation showed that occupational health risk level was 4 exposure to benzene and Xylenes in all workpalces, while 2 exposure to toluene. Semi-quantitative evaluation showed low level (2 of 5) risks in all workplaces exposured to benzene compounds excepted 4 workpalces exposured to benzene, the latter was moderate (3 of 5) . Quantitative evaluation gave unacceptable carcinogenic risk (higher than 10(-4)) of benzene in the wood toy manufactory, and the highest risk was (1.48~5.26) ×10(-4). The occupational health risks of benzene and Xylenes were all unacceptable (HQ>1) in 9 workplaces. Conclusion: There still need more attention to occupational health risks exposure to benzene, toluene and Xylenes lower than OEL.

[Analysis on occupational health surveillance to workers exposed to toxic environment in Ningbo].

Objective: To analyze the occupational health surveillance data of toxic and harmful workers in Ningbo, and provide scientific basis for making protective measures. Methods: To export the occupational health surveillance data of toxic and harmful workers reported by occupational health examination institutions in Ningbo during the January 1, 2011 to December 31, 2017 from the China Information System for Disease Control and Prevention, and analyze the trend of the suspected occupational disease and occupational contraindication detection rate, and compare the the health status of workers in different industry nature, economic type, enterprise scale and occupational hazards. Results: From 2011 to 2017, the number of occupational health surveillance of toxic and harmful workers in Ningbo was increasing year by year. The detection rates of suspected occupational diseases and occupational contraindications generally showed a downward trend (P<0.05) . In 2017, the distribution of occupational health care for toxic and harmful workers in Ningbo was mainly based on manufacturing (187 681/220 895, 84.96%) , private economic enterprises (103 960/220 895, 47.06%) and small enterprises (100 357/220 895, 45.43%) , Workers exposed to chemical poisons had the largest number of physical examinations (101 813/220 895, 46.09%) . The highest detection rates of suspected occupational diseases were mining industry (2/1225, 0.16%) , collective economic enterprises (4/2622, 0.15%) and small enterprises (88/100 357, 0.09%) . The highest detection rates of occupational contraindications were rental and business services (16/1 320, 1.21%) , private economic enterprises (1 190/103 960, 1.14%) and small enterprises (995/100 357, 0.99%) . In addition, workers exposed to dust had the highest detection rate of suspected occupational diseases (57/46 740, 0.12%) and workers exposed to physical factors had the highest detection rate of occupational contraindications (1207/69 567, 1.74%) . There were significant differences between the detection rate of suspected occupational disease and occupational contraindication in different industries, economic types, enterprise scale and occupational hazards (P<0.05) . Conclusion: The occupational health surveillance of toxic and harmful workers in Ningbo has been strengthened year by year, attention should be paid to small, private enterprises, and strengthen the supervision of occupational health and further standardize the work of occupational health examination so as to effectively protect the health of the occupational population.

CtBP2 promotes proliferation and reduces drug sensitivity in non-small cell lung cancer via the Wnt/ß-catenin pathway.

The C-terminal binding protein 2 (CtBP2) is crucial for the activation of the Wnt/ß-catenin pathway and regulates significant cellular processes in multiple cancer cells. However, the role of CtBP2 in non-small cell lung cancer (NSCLC) remains uncertain. Our western blotting and immunohistochemistry assays revealed that CtBP2 expression was obviously increased in NSCLC tissues and cells. In addition, the chi-square test and Kaplan-Meier analysis showed that over-expression of CtBP2 correlates with more invasive tumor phenotype and poor prognosis. In vitro studies with serum starvation-refeeding and CtBP2-shRNA transfection assay demonstrated that CtBP2 expression facilitates NSCLC cell proliferation and reduces sensitivity to cis-diamminedichloroplatinum (CDDP). The possible signaling transduction pathways were investigated, and the immunoprecipitation assay revealed that CtBP2 interacts directly with DvL1. Depletion of CtBP2 resulted in inhibited DvL1 expression and decreased expression of downstream genes. Moreover, our study showed that CtBP2 knockdown enhanced NSCLC cell sensitivity to CDDP through inhibition of the Wnt/ß-catenin pathway. These results suggest that CtBP2 plays a crucial role in NSCLC progression and CDDP sensitivity, and that CtBP2 depletion can provide a new target for NSCLC treatment.

[The current situation of ophthalmologic examination and treatment of diabetic patients in a community of Fushun].

Objective: To investigate the attainment of therapeutic targets for glycosylated hemoglobin and blood pressure, ophthalmologic examination, diagnosis and treatment of diabetic retinopathy (DR) with type 2 diabetes mellitus. Methods: A cross-sectional study in type 2 diabetic patients was conducted in a community of Fushun between July 2012 and May 2013. Questionnaire, detailed ophthalmic examination and laboratory tests were completed to collect the information about sociodemographic and healthcare characteristics. Results: A total of 2 033 eligible patients with complete information were screened from 2 224 type 2 diabetic patients. Of them, the control rates of glycosylated hemoglobin(<7.0%), blood pressure[<140/80 mmHg (1 mmHg=0.133 kPa)] and serum lipid were 39.7%, 31.0% and 2.6%, respectively. Only 22.3% of the participants had ophthalmologic examination after the diagnosis of diabetes mellitus, and 72.2% of the participants in the study reported never receiving any recommendation for eye examinations from their physicians. The prevalence of DR was 44.3% in the study population, 27.1% receiving ophthalmologic examination ever. Among them, 213 patients had vision-threatening DR and required laser treatment or vitreous surgery, but 82.2% had not been treated. Conclusions: The investigation of the type 2 diabetic patients in a community of Fushun indicated that more than 60% of patients did not attain therapeutic targets for glycosylated hemoglobin, and 70% for blood pressure; 78% had not received ophthalmologic examination after the diagnosis of diabetes mellitus; 82% of vision-threatening DR patients had not been treated. Educational efforts should be aimed at improving knowledge of and compliance with these guidelines among both internists and eye care providers. (Chin J Ophthalmol, 2018, 54: 599-604).

The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis.

Intra-operative hypotension is associated with acute postoperative kidney injury. It is unclear how much hypotension occurs before skin incision compared with after, or whether hypotension in these two periods is similarly associated with postoperative kidney injury. We analysed the association of mean arterial pressure < 65 mmHg with postoperative kidney injury in 42,825 patients who were anaesthetised for elective non-cardiac surgery. Intra-operative hypotension occurred in 30,423 (71%) patients: 22,569 (53%) patients before skin incision; and 24,102 (56%) patients after incision. Anaesthetised patients who were hypotensive had mean arterial pressures < 65 mmHg for a median (IQR [range]) of 5.5 (0.0-14.7 [0.0-60.0]) min.h-1 before skin incision, compared with 1.7 [0.3-5.1 [0.0-57.5]) min.h-1 after incision: a median (IQR [range]) of 36% (0%-84% [0%-100%]) of hypotensive readings were before incision. We diagnosed postoperative kidney injury in 2328 (5%) patients. The odds ratio (95%CI) for acute kidney injury was 1.05 (1.02-1.07) for each doubling of the duration of hypotension, p < 0.001. Postoperative kidney injury was associated with the product of hypotension duration and severity, that is, area under the curve, before skin incision and after, odds ratio (95%CI): 1.02 (1.01-1.04), p = 0.004; and 1.02 (1.00-1.04), p = 0.016, respectively. A substantial fraction of all hypotension happened before surgical incision and was thus completely due to anaesthetic management. We recommend that anaesthetists should avoid mean arterial pressure < 65 mmHg during surgery, especially after induction, assuming that its association with postoperative kidney injury is, at least in part, causal.

[Analysis of acute pesticide poisoning in Ningbo city from 2011 to 2016].

Objective: To analyze the characteristics of acute pesticide poisoning in Ningbo, and to provide scientific basis for the prevention and control strategy. Methods: In February 2017, the pesticide poisoning report card of Ningbo from 2011 to 2016 was drawn from the China Disease Control and prevention information system. The data of the report card was organized by Excel and analyzed by SPSS19.0 software. Results: 2593 cases of acute pesticide poisoning were reported in Ningbo from 2011 to 2016, 125 deaths, and the case fatality rate was 4.82%. The productive pesticide poisoning and unproductive pesticide poisoning were 299 and 2294, respectively, the ratio was 1: 7.67. The case fatality rate were 0.33% and 5.41%, respectively. The difference was statistically significant (χ(2)=14.83, P<0.01). The productive Pesticide poisoning mainly occurred from July to September (55.85%) , the unproductive pesticides mainly occurred from April to June (30.64%) and July to September (30.34%). The seasonal distribution of the pesticide poisoning in the two groups was statistically significant (χ2=82.21, P<0.01). The productive pesticide poisoning in male (80.27%) was significantly higher than the proportion of unproductive pesticide poisoning (52.09%) , the differences in gender composition between the two types of pesticide poisoning was significant (χ2=84.97, P<0.01). The productive pesticide poisoning from 55 to 65 years old group was in the largest number (35.45%) , and the distribution of unproductive pesticide poisoning was uniform in each age group including 25 years old and above, the difference in age composition between two types of pesticide poisoning was statistically significant (χ2=177.84, P<0.01). All of the 10 counties of Ningbo had reports of pesticide poisoning. The counties with more reports were Ninghai county (18.28%) , Fenghua district (14.69%) and Yuyao (12.42%). The acute pesticide poisoning was mainly caused by pesticides and herbicides, mainly in organophosphorus (45.74%) and paraquat (16.81%) . Conclusions: At present, the pesticide poisoning in Ningbo is given priority to unproductive pesticide poisoning currently, seasonal distribution characteristics was obvious, and occurred both in different sex and age groups, suggesting that the relevant departments should carry out targeted health education, and strengthen the management of high toxic and highly toxic pesticides.

Clinical analysis of combined revascularization in treating ischemic Moyamoya disease in adults.

OBJECTIVE: The aim of this study was to investigate the clinical efficacy of superficial temporal artery-middle cerebral artery anastomosis (STA-MCA)+encephalo-duro-myo-synangiosis (EDMS) in treating ischemic Moyamoya disease (IMD) in adults. METHODS: A total of 30 adult patients with IMD were selected to be included in the study; they underwent STA-MCA+EDMS and were followed up for 3 months to 2 years. The digital subtraction angiography findings, modified Rankin scale (mRs) score, and complications of all the patients were compared. RESULTS: Thirty patients successfully completed the surgery. Three patients had postoperative complications (two patients with cerebral infarction on the surgical side and one patient with poor scalp healing). The postoperative morbidity rate was 10%. Angiography conducted at 3 to 6 months postoperatively showed 28 cases of anastomotic patency; the anastomotic patency rate was 93.3%. The mRs scores of the patients' neurological function 3 months after surgery were lower than those before surgery. CONCLUSION: STA-MCA+EDMS is effective in treating Moyamoya disease.

The correlation between the expression of ADAM17, EGFR and Ki-67 in malignant gliomas.

OBJECTIVE: The aim of this study was to analyze the depolymerization in metalloproteinase (ADAM17), epidermal growth factor receptor (EGFR), the expression of Ki-67 of glioma patients and the correlations with malignancy. PATIENTS AND METHODS: 53 brain glioma samples resected from patients who had surgery from April 2015 to May 2016 at Chinese People's Armed Police Force General Hospital were selected. According to the degree of malignancy: 22 patients were divided into a deterioration group (stage I to II); 31 patients in highly deteriorated group (stage III to IV); 14 brain tissue samples of traumatic decompression from the hospital as control group. The immunohistochemical method was used to detect the expression of ADAM17, EGFR, and Ki-67 in three groups, and the correlation between the expression of ADAM17, EGFR, and Ki-67. Thus, the stages of malignancy were analyzed. RESULTS: ADAM17, EGFR, and Ki-67 had no expression or weak expression in the control group, and increased in the low stage of deterioration group; the differences were statistically significant (p < 0.05). The positive expression rates of ADAM17, EGFR, and KI-67 were significantly higher in the high deterioration group than that in the control group (p < 0.05). Moreover, the analysis showed that the expression of ADAM17, EGFR, and Ki-67 were positively correlated with the stage of malignancy (R = 0.823, p = 0.000; R = 0.804, p = 0.000; R = 0.811, p = 0.000). CONCLUSIONS: The results suggested that there was a significant positive correlation between ADAM17, EGFR, and Ki-67 with the stage of malignancy.

Laminin associated with BMP7 as potential secondary astrocytic glioma fiber differentiation targets.

OBJECTIVE: To investigate the activation of the BMP7 and laminin pathway is associated with glioma cell proliferation and differentiation. PATIENTS AND METHODS: We enrolled 65 patients with primary operable glioma. Laminin and BMP7 protein expression and its subcellular localization were studied by immunofluorescence. RESULTS: We detected a higher level of BMP7 expression in glioma tissue in patients with a lower grade of glioma who had a lower eosinophil count. Compared to patients with a higher grade of glioma, we observed a lower level of laminin expression in patients with a lower grade of glioma. CONCLUSIONS: Our data indicated a potential link between eosinophil counts and the expression levels of laminin and BMP7 in glioma differentiation.

Dysregulation of PLDN (pallidin) is a mechanism for platelet dense granule deficiency in RUNX1 haplodeficiency.

Essentials Platelet dense granule (DG) deficiency is a major abnormality in RUNX1 haplodeficiency patients. The molecular mechanisms leading to the platelet DG deficiency are unknown. Platelet expression of PLDN (BLOC1S6, pallidin), involved in DG biogenesis, is regulated by RUNX1. Downregulation of PLDN is a mechanism for DG deficiency in RUNX1 haplodeficiency. SUMMARY: Background Inherited RUNX1 haplodeficiency is associated with thrombocytopenia and platelet dysfunction. Dense granule (DG) deficiency has been reported in patients with RUNX1 haplodeficiency, but the molecular mechanisms are unknown. Platelet mRNA expression profiling in a patient previously reported by us with a RUNX1 mutation and platelet dysfunction showed decreased expression of PLDN (BLOC1S6), which encodes pallidin, a subunit of biogenesis of lysosome-related organelles complex-1 (BLOC-1) involved in DG biogenesis. PLDN mutations in the pallid mouse and Hermansky-Pudlak syndrome-9 are associated with platelet DG deficiency. Objectives We postulated that PLDN is a RUNX1 target, and that its decreased expression leads to platelet DG deficiency in RUNX1 haplodeficiency. Results Platelet pallidin and DG levels were decreased in our patient. This was also observed in two siblings from a different family with a RUNX1 mutation. Chromatin immunoprecipitation and electrophoretic mobility shift assays with phorbol ester-treated human erythroleukemia (HEL) cells showed RUNX1 binding to RUNX1 consensus sites in the PLDN1 5' upstream region. In luciferase reporter studies, mutation of RUNX1 sites in the PLDN promoter reduced activity. RUNX1 overexpression enhanced and RUNX1 downregulation decreased PLDN1 promoter activity and protein expression. RUNX1 downregulation resulted in impaired handling of mepacrine and mislocalization of the DG marker CD63 in HEL cells, indicating impaired DG formation, recapitulating findings on PLDN downregulation. Conclusions These studies provide the first evidence that PLDN is a direct target of RUNX1 and that its dysregulation is a mechanism for platelet DG deficiency associated with RUNX1 haplodeficiency.