Optimal Glycated Hemoglobin Cutoff for Diagnosis of Diabetes and Prediabetes in Chinese Breast Cancer Women.

Purpose: Glycated hemoglobin (HbA1c) is widely used in diabetes management and now recommended for diagnosis and risk assessment. Our research focused on investigating the optimal cutoff points of HbA1c for diagnosis of diabetes and prediabetes in Chinese breast cancer women, aiming to enhance early detection and tailor treatment strategies. Patients and Methods: This study involved 309 breast cancer women without diabetes history in China. Patients were categorized into groups of newly diagnosed diabetes, prediabetes, and normal glucose tolerance using oral glucose tolerance test (OGTT) according to the 2010 ADA criteria. HbA1c data were collected from all patients. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the HbA1c screening. Results: Among the 309 breast cancer women without diabetes history, 96 (31.0%) were identified with diabetes and 130 (42.1%) had prediabetes according to OGTT, and the incidence of normal glucose tolerance was only 26.9% (83). ROC curve analysis, using OGTT as a reference, revealed that the area under the curve of 0.903 (P<0.001, 95% CI, 0.867-0.938) for HbA1c alone, indicating high accuracy. The optimal HbA1c cutoff for identifying diabetes was determined to be 6.0%, with a sensitivity of 78.1% and specificity of 86.4%. For prediabetes, the ROC curve for HbA1c alone showed that the area under the ROC curve of 0.703 (P<0.001, 95% CI, 0.632-0.774), with an optimal cutoff of 5.5% (sensitivity of 76.9% and specificity of 51.8%). Conclusion: The prevalence of undiagnosed diabetes is very high in breast cancer women without diabetes history in China. The optimal cutoff points of HbA1c for identifying diabetes and prediabetes are 6.0% and 5.5% in Chinese breast cancer women, respectively.

Prevalence and risk factors of thyroid nodules in breast cancer women with different clinicopathological characteristics: a cross-sectional study.

BACKGROUND: Association between breast cancer (BC) and thyroid nodules (TNs) is still unclear. This research was to estimate the prevalence and risk factors of TN in Chinese BC women at initial diagnosis. METHODS: 1731 Chinese early-stage BC women at initial diagnosis underwent thyroid ultrasound and 1:1 age-matched Chinese healthy women underwent health examination in corresponding period were enrolled for analysis. RESULTS: Prevalence of TN and TI-RADS ≥ 4 TN in BC patients (56.27% and 9.76%) were higher than healthy people (46.04% and 5.49%), respectively, P < 0.001. Among BC patients, prevalence of TN and TI-RADS ≥ 4 TN in hormone receptor (HR)-positive patients (59.57% and 11.81%) were higher than HR-negative patients (48.77% and 5.10%), respectively, P < 0.001, while without difference between HR-negative patients and healthy people. After adjusting for age and BMI, HR-positive patients had higher risk of TN (OR = 1.546, 95%CI 1.251-1.910, P < 0.001) and TI-RADS ≥ 4 TN (OR = 3.024, 95%CI 1.943-4.708, P < 0.001) than HR-negative patients. Furthermore, the risk of TI-RADS ≥ 4 TN was higher in patients with estrogen receptor (ER) positive (OR = 2.933, 95%CI 1.902-4.524), progesterone receptor (PR) positive (OR = 1.973, 95%CI 1.378-2.826), Ki-67 < 20% (OR = 1.797, 95%CI 1.280-2.522), and tumor size < 2 cm (OR = 1.804, 95%CI 1.276-2.552), respectively, P < 0.001. CONCLUSIONS: Prevalence of TN, especially TI-RADS ≥ 4 TN, in Chinese early-stage BC women was higher than healthy people. HR-positive patients had higher prevalence and risk of TN, while without difference between HR-negative patients and healthy people. The increased risk of TN was correlated with ER-positive, PR-positive, lower Ki-67 expression, and smaller tumor size.

Effect of chemotherapy and different chemotherapy regimens on bone health among Chinese breast cancer women in different menstrual status: a self-control study.

PURPOSE: Although the therapy-related bone loss attracts increasing attention nowadays, the differences in chemotherapy-induced bone loss and bone metabolism indexes change among breast cancer (BC) women with different menstrual statuses or chemotherapy regimens are unknown. The aim of the study is to explore the effects of different regimens of chemotherapy on bone health. METHOD: The self-control study enrolled 118 initially diagnosed BC women without distant metastasis who underwent dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) screening and (or) bone metabolism index monitoring during chemotherapy at Chongqing Breast Cancer Center. Mann-Whitney U test, Cochran's Q test, and Wilcoxon sign rank test were performed. RESULTS: After chemotherapy, the BMD in the lumbar 1-4 and whole lumbar statistically decreased (- 1.8%/per 6 months), leading to a significantly increased proportion of osteoporosis (27.1% vs. 20.5%, P < 0.05), which were mainly seen in the premenopausal group (- 7.0%/per 6 months). Of the chemotherapeutic regimens of EC (epirubicin + cyclophosphamide), TC (docetaxel + cyclophosphamide), TEC (docetaxel + epirubicin + cyclophosphamide), and EC-T(H) [epirubicin + cyclophosphamide-docetaxel and/or trastuzumab], EC regimen had the least adverse impact on BMD, while the EC-TH regimen reduced BMD most (P < 0.05) inspite of the non-statistical difference between EC-T regimen, which was mainly seen in the postmenopausal group. Chemotherapy-induced amenorrhea (estradiol 94 pg/ml vs, 22 pg/ml; FSH 9.33 mIU/ml vs. 61.27 mIU/ml) was proved in premenopausal subgroup (P < 0.001). Except the postmenopausal population with calcium/VitD supplement, the albumin-adjusted calcium increased significantly (2.21 mmol/l vs. 2.33 mmol/l, P < 0.05) after chemotherapy. In postmenopausal group with calcium/VitD supplement, ß-CTX decreased significantly (0.56 ng/ml vs. 0.39 ng/ml, P < 0.05) and BMD were not affected by chemotherapy (P > 0. 05). In premenopausal group with calcium/VitD supplement, PTH decreased significantly (52.90 pg/ml vs. 28.80 pg/ml, P = 0. 008) and hip BMD increased after chemotherapy (0.845 g/m2 vs. 0.952 g/m2, P = 0. 006). As for both postmenopausal and premenopausal group without calcium/VitD supplement, there was a significant decrease in bone mass in hip and lumbar vertebrae after chemotherapy (0.831 g/m2 vs. 0.776 g/m2; 0.895 g/m2 vs. 0.870 g/m2, P < 0.05). CONCLUSION: Chemotherapy might induce lumbar vertebrae BMD loss and spine osteoporosis with regimen differences among Chinese BC patients. Calcium/VitD supplementation could improve bone turnover markers, bone metabolism indicators, and bone mineral density. Early interventions on bone health are needed for BC patients during chemotherapy.

Down-Regulation of CEND1 Expression Contributes to The Progression and Temozolomide Resistance of Glioma.

OBJECTIVE: This study was conducted to clarify the expression characteristics of cell cycle exit and neuronal differentiation 1 (CEND1) in glioma and its effects on the proliferation, migration, invasion, and resistance to temozolomide (TMZ) of glioma cells. MATERIALS AND METHODS: In this experimental study, CEND1 expression in glioma tissues and its relationship with patients' survival were analyzed through bioinformatics. Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry were performed to detect CEND1 expression in glioma tissues. The cell counting kit-8 (CCK-8) method was adopted to detect cell viability and the effects of different concentrations of TMZ on the inhibition rate of glioma cell proliferation, and the median inhibitory concentration of TMZ (IC50 value) was calculated. 5-Bromo- 2'-deoxyuridine (BrdU), wound healing and Transwell assays were performed to evaluate the impacts of CEND1 on glioma cell proliferation, migration, and invasion. Besides, the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, Gene Ontology (GO) analysis, and Gene Set Enrichment Analysis (GSEA) were applied to predict the pathways regulated by CEND1. Nuclear factor-kappa B p65 (NF-κB p65) and phospho-p65 (p-p65) expression were detected by Western blot. RESULTS: CEND1 expression was reduced in glioma tissues and cells, and its low expression was significantly associated with the shorter survival of glioma patients. CEND1 knockdown promoted glioma cell growth, migration, and invasion, and increased the IC50 value of TMZ, whereas up-regulating CEND1 expression worked oppositely. Genes co-expressed with CEND1 were enriched in the NF-κB pathway, and knocking down CEND1 facilitated p-p65 expression, while CEND1 overexpression suppressed p-p65 expression. CONCLUSION: CEND1 inhibits glioma cell proliferation, migration, invasion, and resistance to TMZ by inhibiting the NF- κB pathway.

Measurement of the magnetic resonance imaging of the area supratentorial and infratentorial mid-sagittal plane of the normal Tibetan adults / 解剖学报

[Abstract] Objective To explore the relationship between supratentorial area (STA), posterior fossa area (PFA) and intracranial area (ICA) of normal adult Tibetans with age and gender. Methods The subjects of this study were native Tibetan adults living in Lhasa. Totally 158 sample populations were between the ages of 20 and 59 years, with an average age (36. 60 ± 10. 75) years, including 64 males and 94 females. Siemens MAGNETOM ESSENZA 1. 5T magnetic resonance scanner was used to scan with 3D-fSPGR sequence, and the images obtained by scanning were stored in DICOM format and imported into 3D Medical medical image processing software, and region of interest was delineated by using the software’s own toolkit. STA, PFA and ICA were measured on T1WI mid-sagittal imaging, and the ratios of PFA / STA, STA / ICA and PFA / ICA were calculated. In order to eliminate the influence of individual differences in skull size on brain structure, this paper corrected the STA and PFA with the same level of ICA, and obtained the relativity of supratentorial area (RSTA) and relativity of posterior fossa area (RPFA). Results The STA was (127. 91 ± 9. 84) cm

A narrative review on vaccination rate and factors associated with the willingness to receive pneumococcal vaccine in Chinese adult population.

The 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is the only approved vaccine for pneumococcal diseases in elderly Chinese population. Though regional studies explored the PPSV-23 vaccination coverage rates and influencing factors in China, a large-scale, nation-wide epidemiological surveillance studies to understand the different factors impeding pneumococcal vaccination rate are required. Hence, this review summarized PPSV-23 coverage rate, analyzed and identified vaccination influencing factors among elderly population across China by exploring articles published in CNKI, Wanfang and PubMed databases. Pneumococcal vaccination coverage rate was found to be low at around 1.23%~42.10% in China. Co-morbidities, knowledge, attitude, perception toward pneumonia and PPSV-23, education level, socio-economic disparities, health education and local policies were some of the factors associated with vaccination willingness among elderly Chinese population. Interventions or policies like government funding, subsidies, inclusion of PPSV-23 in medical insurance, or systematic encouragement from HCPs as key strategies should be implemented to encourage vaccination.

Electrospun Polyacrylonitrile Silver(I,III) Oxide Nanoparticle Nanocomposites as Alternative Antimicrobial Materials.

Infectious microbial diseases can easily be transferred from person to person in the air or via high contact surfaces. As a result, researchers must aspire to create materials that can be implemented in surface contact applications to disrupt pathogen growth and transmission. This study examines the antimicrobial properties of polyacrylonitrile (PAN) nanofibers coated with silver nanoparticles (AgNPs) and silver(I,III) oxide. PAN was homogenized with varied weight concentrations of silver nitrate (AgNO3) in N,N-dimethylformamide solution, a common organic solvent that serves as both an electrospinning solvent and as a reducing agent that forms AgNPs. The subsequent colloids were electrospun into nanofibers, which were then characterized via various analysis techniques, including scanning electron microscopy, transmission electron microscopy, energy-dispersive X-ray analysis, dynamic light scattering, and X-ray photoelectron spectroscopy. A total of 10 microbes, including 7 strains of Gram-positive bacteria, 2 strains of Gram-negative bacteria, and Candida albicans, were incubated with cutouts of various PAN-AgNP nanocomposites using disk diffusion methods to test for the nanocomposites' antimicrobial efficiency. We report that our electrospun PAN-AgNP nanocomposites contain 100% AgO, a rare, mixed oxidation state of silver(I,III) oxide that is a better sterilizing agent than conventional nanosilver. PAN-AgNP nanocomposites also retain a certain degree of antimicrobial longevity; samples stored for approximately 90 days demonstrate a similar antimicrobial activity against Escherichia coli (E. coli) and Lactobacillus crispatus (L. crispatus) when compared to their newly electrospun counterparts. Moreover, our results indicate that PAN-AgNP nanocomposites successfully display antimicrobial activity against various bacteria and fungi strains regardless of their resistance to conventional antibiotics. Our study demonstrates that PAN-AgNP nanocomposites, a novel polymer material with long-term universal antimicrobial stability, can potentially be applied as a universal antimicrobial on surfaces at risk of contracting microbial infections and alleviate issues related to antibiotic overuse and microbial mutability.

Time comparison of artificial airway establishment in operating room and on slope using endotracheal intubation and laryngeal mask / 北京大学学报(医学版)

OBJECTIVE@#To compare the completion time of endotracheal intubation and laryngeal mask implantation in operating room and on slope of ski resort, and to discuss the optimal method of estab-lishing artificial airway on slope of ski resort.@*METHODS@#The simulator was placed with the head under the feet on slope of ski resort. The artificial airway was established by tracheal intubation assisted by video laryngoscope (endotracheal intubation group) and laryngeal mask placement (laryngeal mask group) respectively by an anesthesiologist who wore full set of ski suits, helmets, goggles, gloves and ski boots. Each method was repeated 5 times, and the operation time of artificial airway establishment was recorded. While the simulated human was placed flat on the operating table in an operating room of a hospital, and the artificial airway was established by the same anesthesiologist using the same methods. Time was recorded and repeated for 5 times. The completion time of endotracheal intubation and laryngeal mask placement in the operating room and on the ski slope were compared.@*RESULTS@#The operating time of tracheal intubation in the operating room was longer than that of laryngeal mask placement [(79.8±10.4) s vs. (53.4±2.7) s, P=0.005], and the operating time of endotracheal intubation on the ski slope was longer than that of laryngeal mask placement [(209.2±32.7) s vs. (72.2±3.1) s, P=0.001]. The time of endotracheal intubation group on the slope of the ski resort was longer than that in the opera-ting room(t=-7.851, P=0.001). The time of laryngeal mask group on the slope was longer than that in the operating room (t=-19.391, P < 0.001).@*CONCLUSION@#On ski slope, both of tracheal intubation assisted by video laryngoscope and laryngeal mask placement can quickly complete the establishment of artificial airway, but the time required is longer than that in the operating room. The time of laryngeal mask placement to establish artificial airway is shorter than that of tracheal intubation assisted video laryngoscope, which may have a certain advantage in ski rescue.

[Utilizing Academic Clubs to Foster Practical Research Ability of Medical Students-Volunteer Team of Gastric Cancer Surgery of West China Hospital, Sichuan University].

The cultivation of medical students'research ability promotes in them high-quality career development. In addition to classroom instruction of the theoretical knowledge concerning research, the systematic training and practice of scientific research skills outside the classroom is also vitally important. We established the Volunteer Team of Gastric Cancer Surgery with the features of standardization, progressiveness, and practicality in order to cultivate the thinking skills concerning research and the research ability of medical students. Our team is supported by the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Taking clinical and basic research skills training as the focus of our work, we have organized systematic workshops focused on theoretical knowledge and research skills practice programs of divers forms. Our work helps improve the research ability of medical students, suggesting that research-oriented clubs play an active role in the cultivation of practical research ability of medical students and should be widely promoted.

Effect of Acupuncture on Ovary Morphology and Function in DHEA-Induced Polycystic Ovary Syndrome Model Rats / 中国结合医学杂志

OBJECTIVE@#To investigate the effects of acupuncture on ovary morphology and function in dehydroepiandrosterone (DHEA)-induced polycystic ovary syndrome (PCOS) model rats.@*METHODS@#A total of 40 adult female Wistar rats were randomly allocated to 4 groups by a random number table, including control, model, metformin and acupuncture groups, 10 rats in each group. PCOS rat model was developed by injecting with DHEA (6 mg/100 g body weight) in 0.2 mL of oil subcutaneously. Electrical stimulation (2 Hz, 3 mA) was applied to Guanyuan (CV 4), Zigong (EX-CA1) and Qihai (CV 6) acupoints for 30 min daily in the acupuncture group, and metformin (200 mg/kg) was given to rats in the metformin group, both once per day for 21 consecutive days, and rats in the normal group was fed with normal saline and fed regularly. After 21 days of administration, the rat blood samples were collected for detecting the reproductive hormonal levels [luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E@*RESULTS@#Compared with the model group, rats in the acupuncture and metformin groups were significantly lower in weight gain, FSH, LH and T levels, and E@*CONCLUSION@#Acupuncture might improve ovary morphology and its function in DHEA-induced PCOS model rats.

Clinical Practice Guideline for Allergic Rhinitis Treatment with Acupuncture / 中国结合医学杂志

With reference to international guidelines for the development of tools-Grading of Recommendations Assessment, Development and Evaluation (GRADE) system approach and reasoning, this practice guideline has been drafted reflecting the characteristics of acupuncture to improve effectiveness and safety of acupuncture treatment for allergic rhinitis. This guideline includes outlining the acupuncture diagnosis and treatment principles for allergic rhinitis, suggesting recommendations and related evidence for the acupuncture treatment of allergic rhinitis, and defining operating methods and precautions for the acupuncture treatment of allergic rhinitis.

Risk factors for 10-year mortality in patients with stable chronic obstructive pulmonary disease / 中华全科医师杂志

Objective:To explore the independent risk factors that predict 10-year mortality in patients with stable chronic obstructive pulmonary disease(COPD).Methods:The baseline data from a prospective cohort study were analyzed and long-term follow-up were performed. Patients with confirmed diagnosis of stable COPD were consecutively enrolled in the outpatient clinic from January 2010 to December 2010, and were followed up until December 31, 2020. Cox regression analysis was used to determine the independent risk factors for all-cause mortality and mortality from respiratory causes in stable COPD patients.Results:A total of 182 stable COPD patients were enrolled and followed up for a median of 89 months. The 10-year mortality was 51.1%(93/182), and 9 patients died within one year. The leading cause of death was respiratory disorder, followed by cardiovascular and cerebrovascular diseases. The risk factors independently associated with all-cause mortality included old age( HR=1.936,95% CI: 1.610~2.328, P<0.01), increased baseline COPD Assessment Test(CAT)( HR=1.331,95% CI: 1.049-1.689, P=0.02) and the increased CAT in one year( HR=1.314,95% CI: 1.197-1.420, P<0.01). The risk factors independently associated with respiratory cause mortality included increased baseline CAT( HR=1.719,95% CI: 1.026-2.880, P=0.04), emphysema index(LAA%)( HR=1.062,95% CI: 1.007-1.120, P=0.03), and one year inecreased CAT( HR=1.342,95% CI: 1.198-1.505, P<0.01)was a protective factor. Conclusions:Old age, baseline CAT, one year increased in CAT and LAA% were independent influencing factors for 10-year mortality of stable COPD patients.

Effect of different shunt strategies on cerebral infarction after carotid endarterectomy / 北京大学学报(医学版)

OBJECTIVE@#The key point of anesthesia management in carotid endarterectomy (CEA) is to maintain adequate cerebral perfusion during carotid artery occlusion. Placement of shunt is one of the common surgical methods. This study analyzed the effects of different shunt strategies on cerebral infarction after carotid endarterectomy.@*METHODS@#A total of 443 patients who underwent CEA under general anesthesia within 2 years were divided into imaging group (based on preoperative imaging data as the basis for shunt) and stump pressure group (based on intraoperative stump pressure as the basis for shunt). The preoperative demographic data, past medical history, degree of cervical vascular stenosis, blood pressure at each time point during the perioperative period, vascular blocking time, whether to place the shunt, postoperative hospital stay, cerebral infarction during hospitalization, and other adverse events were collected and compared between the two groups. On this basis, the preoperative and intraoperative conditions with significant differences were matched with propensity scores, and the influence of different shunt strategies on postoperative cerebral infarction was analyzed.@*RESULTS@#In the study, 268 patients in the imaging group and 175 patients in the stump pressure group underwent CEA under general anesthesia. There were statistically significant differences in basic conditions and blood pressure at each time point between the two groups. After matching the propensity scores, 105 patients in each of the two groups were matched. The basic conditions of the patients before surgery and the difference in blood pressure of the two groups at each time point were not statistically significant. There was no significant diffe-rence in the incidence of postoperative cerebral infarction between the two groups (1.9% vs. 1.0%, P>0.999). The intraoperative shunt rate in the imaging group was lower than that in the stump pressure group (0 vs. 22.9%, P < 0.001). The postoperative hospital stay in the imaging group was 8 (7, 8) days, which was longer than the stump pressure group 5 (4, 6) days (P < 0.001).@*CONCLUSION@#The rate of the shunt was lower according to preoperative imaging examination than that according to the residual pressure in our hospital. There is no significant difference in the incidence of cerebral infarction during the postoperative hospital stay. The effect of different shunt strategies on cerebral infarction needs further study.

Blood glucose is a representative of the clustered indicators of multi-organ injury for predicting mortality of COVID-19 in Wuhan, China

BackgroundConcomitance with diabetes is associated with high mortality in critical conditions. Patients with previous diabetes are more vulnerable to COVID-19. However, new-onset COVID-19-related diabetes (CRD) and its relevance have scarcely been reported. This study investigates new-onset CRD and its correlation with poor outcomes or death in patients with COVID-19. MethodsWe performed a single center, retrospective case series study in 120 patients with laboratory confirmed COVID-19 at a university hospital. Fasting blood glucose (FBG) [≥]7.0 mmol/L for two times during hospitalization and without a history of diabetes were defined as CRD. The Critical status was defined as admitted to intensive care unit (ICU) or death. ResultsAfter excluding patients with a history of diabetes, chronic heart, kidney, and liver disease, 69 patients with COVID-19 were included in the final analysis. Of the 69 patients, 23 were Moderate, 20 were Severe, and 26 were Critical (including 16 deceased patients). The prevalence of CRD in Critical and Moderate+Severe patients was 53.85% and 13.95%, respectively. Kaplan-Meier survival analysis revealed a significantly higher mortality rate in patients with CRD (P=0.0019). Multivariable analysis indicated that CRD was an independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Cluster analysis suggested that indicators for multi-organ injury were interdependent, and more proximities of FBG with indicators for multi-organ injury was present. ConclusionOur results suggest that new onset COVID-19-related diabetes is an indicator of multi-organ injury and predictor for poor outcomes and death in COVID- 19 patients. As it is easy to perform for clinical practices and even self-monitoring, glucose testing will be much helpful for predicting poor outcomes to facilitate appropriate intensive care in patients with COVID-19. FundingNational Key Research and Development Program of China; The Beijing Science and Technology Project. Significance of this studyO_ST_ABSEvidence before this studyC_ST_ABSConcomitance with diabetes is associated with high mortality in critical conditions. Patients with previous diabetes are more vulnerable to COVID-19. However, new-onset COVID-19-related diabetes (CRD) and its relevance have scarcely been reported. Recently, an international group of leading diabetes researchers participating in the CoviDIAB Project have established a global registry of patients with Covid-19-related diabetes (covidiab.e-dendrite.com). Added value of this study?New-onset diabetes in COVID-19 defined as CRD was investigated. Correlation between CRD and poor outcomes or death in patients with COVID-19 was found. About half of the Critical patients have new onset CRD. CRD is the representative of the clustered indicators of multi-organ injury and is the predictor for poor outcomes and death. How might these results change the focus of research or clinical practice?Our results suggest that new onset diabetes is an indicator of multi-organ injury and predictor for poor outcomes and death in COVID-19 patients. The study of CRD may also uncover novel mechanisms of disease.

Higher severity and mortality in male patients with COVID-19 independent of age and susceptibility

ImportanceThe recent outbreak of Novel Coronavirus (SARS-CoV-2) Disease (COVID-19) has put the world on alert, that is reminiscent of the SARS outbreak seventeen years ago. ObjectiveWe aim to compare the severity and mortality between male and female patients with both COVID-19 and SARS, to explore the most useful prognostic factors for individualized assessment. Design, Setting, and ParticipantsWe extracted the data from a case series of 43 hospitalized patients we treated, a public data set of the first 37 cases died of COVID-19 in Wuhan city and 1019 survived patients from six cities in China. We also analyzed the data of 524 patients with SARS, including 139 deaths, from Beijing city in early 2003. Main Outcomes and MeasuresSeverity and mortality. ResultsOlder age and high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. The percentages of older age ([≥]65 years) were much higher in the deceased group than in the survived group in patients with both COVID-19 (83.8 vs. 13.2, P<0.001) and SARS (37.4 vs. 4.9, P<0.001). In the case series, men tend to be more serious than women (P=0.035), although age was comparable between men and women. In the public data set, age was also comparable between men and women in the deceased group or the survived group in patients with COVID-19. Meanwhile, gender distribution was exactly symmetrical in the 1019 survivors of COVID-19. However, the percentage of male were higher in the deceased group than in the survived group (70.3 vs. 50.0, P=0.015). The gender role in mortality was also observed in SARS patients. Survival analysis showed that men (hazard ratio [95% CI] 1.47 [1.05-2.06, P= 0.025) had a significantly higher mortality rate than women in patients with SARS. Conclusions and RelevanceOlder age and male gender are risk factors for worse outcome in patients with COVID. While men and women have the same susceptibility to both SARS-CoV-2 and SARS-CoV, men may be more prone to have higher severity and mortality independent of age and susceptibility. Key PointsO_ST_ABSQuestionC_ST_ABSAre men more susceptible to getting and dying from COVID-19? FindingsIn the case series, men tend to be more serious than women. In the public data set, the percentage of men were higher in the deceased group than in the survived group, although age was comparable between men and women. MeaningMale gender is a risk factor for worse outcome in patients with COVID independent of age and susceptibility.

Analysis of clinical features of 58 patients with severe or critical 2019 novel coronavirus pneumonia / 中华急诊医学杂志

Objective:To analyze the clinical features of severe or critical 2019 novel coronavirus pneumonia (NCP) patients.Methods:Clinical data of 58 patients with severe or critical NCP in Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 29 to February 26, 2020 were collected. The general information, clinical symptoms, results of blood test and chest computed tomography (CT) imagings, treatments and outcomes of patients were analyzed retrospectively.Results:Among the 58 patients, 36 patients (62.1%) were severe and 22 (37.9%) were critical, 28 (48.3%) were male and 30 (51.7%) female, with an average age of (62.12±12.95) years. Twenty-eight patients (48.2%) had previous underlying diseases, including 21 patients (36.2%) with hypertension, 11 patients (19.0%) with diabetes mellitus, 6 patietns (10.3%) with coronary heart disease, 2 patients (3.4%) with chronic renal failure, and 1 patient (1.7%) with malignant tumor. The symptoms included fever (54 cases, 93.1%), dyspnea (48 cases, 82.8%), cough (46 cases, 79.3%), muscle soreness (32 cases, 55.2%), sore throat (15 cases, 25.9%), and diarrhea (6 cases, 10.3%). Decreased or increased white blood cell count was found in 7 patients (12.1%) and 6 patietns (10.3%). Decreased percent of lymphocyte, increased percent of neutrophil, and decreased hemoglobin level were found in 35 patients (60.3%), 27 patients (46.6%), and 24 patients (41.4%), respectively. Elevated CRP, PCT and D-dimmer level were demonstrated in 38 patients (65.5%), 36 patients (62.1%), and 45 patients (77.5%). Increased level of ALT, AST, LDH and decreased serum albumin were found in 32 patients (55.2%), 25 patients (43.1%), 39 patietns (67.2%) and 43 patietns (74.1%), respectively. The main features of CT imaging were diffuse lesion in both lungs, which were mainly manifested as multiple patchy shadows and ground-glass shadows, bilateral and peripheral distribution, consolidation and interlobular septal thickening. Twenty-nine patients (50.0%) were treated with antibiotics, and 14 patients (24.1%) with systemic glucocorticoid. In addition to supportive and antivirus treatment, oxygen therapy methods including nasal catheter (9 cases, 15.5%), oxygen mask (33 cases, 56.9%), high-flow nasal catheter (8 cases, 13.3%) and invasive mechanical ventilation were adopted. Twenty-one patients (36.2%) were discharged from the hospital, 27 patients (46.6%) in remission were still in the isolation wards, 3 patients (5.2%) were transferred to the ICU for further treatment, and 7 patients (12.1%) died.Conclusions:Severe and critical NCP are at higher risk in the elderly and those having underlying diseases. Severe/critical NCP patients often show extrapulmonary abnormity as well as lung dysfunction. Comprehensive treatment as early as possible is the key to improve the prognosis and reduce the mortality.

Application of modified closed biopsy in rabbit model of VX2 transplanted bone tumor / 解放军医学杂志

Objective To explore the application value of modified closed biopsy technique in puncture biopsy of rabbit model of VX2 transplanted bone tumor. Methods VX2 tumor tissue was cut from rabbit with VX2 tumor and transplanted into the bilateral tibia of 30 rabbits through the tibial plateau to make the model of VX2 transplanted bone tumor. Seven days after modeling, the proximal tibia puncture biopsy was performed under the guidance of X-ray, and the biopsy specimen was examined pathologically. The left leg was biopsied with modified closed biopsy technique (experimental group), and the right leg was biopsied with hollow needle (control group). On the 14th day after modeling, all rabbits were executed after X-ray examination around the puncture hole, and the soft tissue around the puncture hole was taken for pathological examination. Results By the end of the experiment, a total of 3 rabbits died, and finally 27 rabbits were included in the study. Tumor cells were detected in all the intramedullary specimens obtained by puncture biopsy. On the 14th day after modeling, X-ray examination showed that, compared with control group, the incidence of periosteal reaction and extraosseous high density shadow around the puncture hole, and the tumor cell metastasis rate were lower [14.81%(4/27) vs. 40.74%(11/27); 29.63%(8/27) vs. 100.00%(27/27)], the differences were statistically significant (P<0.05). Conclusions Both the modified closed biopsy technique and puncture needle aspiration biopsy can provide sufficient biopsy tissue for diagnosis of VX2 transplanted bone tumor in rabbits. Meanwhile, the improved closed biopsy technique can prevent local metastasis of tumor cells along the puncture channel to some extent.

Diagnostic value of JNET classification in blue-laser imaging magnifying endoscopy for colorectal neoplastic lesions / 中华消化内镜杂志

Objective:To investigate the diagnostic value of Japan NBI Expert Team (JNET) classification with blue-laser imaging magnifying endoscopy (BLI-ME) for colorectal neoplastic lesions.Methods:Data of 40 colorectal neoplastic lesions in 34 patients that received BLI-ME from September 2016 to December 2018 in Peking University International Hospital were reviewed and endoscopic images from those lesions were selected. Four senior endoscopists analyzed and classified these images according to the JNET criteria and determined the possible pathologic type. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of JNET classification under BLI-ME system were calculated with final pathologic results as the golden standard.Results:Of all the 40 lesions, there were 3 non-cancerous lesions, 20 adenoma, 10 high grade intraepithelial neoplasia/submucosal-superficial lesions and 7 submucosal-deep lesions. The accuracy of 4 endoscopists was 75.00%-87.50%, and 65.38%-95.89% for different JNET types. For each JNET type, the sensitivity was 60.71%-91.67%, specificity was 84.17%-97.73%, PPV was 63.46%-95.89%, and NPV was 88.51%-99.31%. For the 4 endoscopists, the assurance rate of surface pattern was 73.08%-100.00%, 80.77%-100.00% for deciding vascular pattern, and 67.31%-100.00% for deciding final JNET type. The Kappa value between any two endoscopists was 0.630-0.887, and the interclass correlation coefficient for all results was 0.880. Conclusion:JNET classification shows significant diagnostic value under BLI-ME system for colorectal neoplastic lesions.

Comparison of gene expression in cynomolgus monkeys with preclinical type II diabetes induced by different high energy diets.

BACKGROUND: Cynomolgus disease models that are similar to the preclinical stage of human type 2 diabetes mellitus (T2DM) were established by feeding middle-aged cynomolgus monkeys different high energy diets to study the differential expression of diabetes-related genes. METHODS: A total of 36 male monkeys were randomly divided into four groups and fed human diets with high sugar, high fat, double high sugar and fat, and a normal diet. The preclinical diabetes phase was determined by monitoring the metabolic characteristic indices and the results of oral glucose tolerance tests (OGTT). The mRNA expression of 45 diabetes-related genes in peripheral blood leukocytes was analyzed using real-time PCR. RESULTS: A total of 22, 25, and 21 genes were significantly up-regulated (P < 0.05) and 5, 7, and 5 genes were significantly down-regulated (P < 0.05) in the above three induced groups, respectively, compared with the control group. Of the 45 tested genes, the expression profiles of 21 genes were consistent. Most of the expression levels in the double high sugar-and-fat individuals were slightly lower than those in the high glucose and high fat groups, although the expression patterns of the three groups were essentially similar. CONCLUSION: The different high energy diets all induced diabetes and shared some phenotypic properties with human T2DM. Most of the expression patterns of the related genes were identical. The gene expression profiles could be used as references for the study of early diagnostic indicators and T2DM pathogenesis.