Resource allocation of rural institutional elderly care in China's new era: spatial-temporal differences and adaptation development.

OBJECTIVES: In the new era of China, to ensure that rural residents can get the corresponding institutional elderly services equally, it is necessary to investigate the current situation of resource allocation of rural institutional elderly care and make corresponding adaptation suggestions. STUDY DESIGN: This research discusses the characteristics and evolution pattern of rural aging, the resource allocation of rural elderly care institutions, and the adaptation degree of rural institutional elderly care resource and aging. METHODS: The research methodology consists of the following stages: entropy-based Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS), kernel density estimation, coupling coordination, spatial autocorrelation, and Theil index decomposition. RESULTS: The degree of aging in rural areas of China is rising, and the whole population has entered a moderate aging society, showing the spatial characteristics of 'high in the east and low in the west'. The resource allocation of rural institutional elderly care in China is at a low level, and the absolute differences among provinces tend to reduce over time, and the overall resource allocation level tends to decline. The provinces that were in the mismatched adaptation relationship in the early stage have improved; however, the number of provinces with mismatched adaptability has continued to increase. The local spatial autocorrelation of resource adaptation verifies that the middle and lower reaches of the Yangtze River as the core form a hot spot, and during the observation period, the spatial agglomeration effect of the core is strengthened. The Theil index decomposition of resource adaptation indicates that the within-group differences between the eastern and western regions is significantly higher than that between the northeastern and central regions. CONCLUSIONS: First, special attention should be paid to preventing the resource allocation of rural institutional elderly care in the eastern and western regions from falling again. Second, to avoid more and more low-adapted provinces falling into the 'mismatch dilemma' with the deepening of the aging degree. Third, strengthen cooperation among regions and promote the coordinated development of resource allocation of institutional elderly care in various regions. Fourth, the priority of institutional elderly care balanced development should be given to the eastern region and western region, thus weakening the overall difference.

[Evaluation of peripheral blood T-lymphocyte subpopulations features in patients with hepatitis B virus-related acute-on-chronic liver failure based on single-cell sequencing technology].

Objective: T lymphocyte exhaustion is an important component of immune dysfunction. Therefore, exploring peripheral blood-exhausted T lymphocyte features in patients with hepatitis B virus-related acute-on-chronic liver failure may provide potential therapeutic target molecules for ACLF immune dysfunction. Methods: Six cases with HBV-ACLF and three healthy controls were selected for T-cell heterogeneity detection using the single-cell RNA sequencing method. In addition, exhausted T lymphocyte subpopulations were screened to analyze their gene expression features, and their developmental trajectories quasi-timing. An independent sample t-test was used to compare the samples between the two groups. Results: Peripheral blood T lymphocytes in HBV-ACLF patients had different differentiation trajectories with different features distinct into eight subpopulations. Among them, the CD4(+)TIGIT(+) subsets (P = 0.007) and CD8(+)LAG3(+) (P = 0.010) subsets with highly exhausted genes were significantly higher than those in healthy controls. Quasi-time analysis showed that CD4(+)TIGIT(+) and CD8(+)LAG3(+) subsets appeared in the late stage of T lymphocyte differentiation, suggesting the transition of T lymphocyte from naïve-effector-exhausted during ACLF pathogenesis. Conclusion: There is heterogeneity in peripheral blood T lymphocyte differentiation in patients with HBV-ACLF, and the number of exhausted T cells featured by CD4(+)TIGIT(+)T cell and CD8(+)LAG3(+) T cell subsets increases significantly, suggesting that T lymphocyte immune exhaustion is involved in the immune dysfunction of HBV-ACLF, thereby identifying potential effective target molecules for improving ACLF patients' immune function.

[Re-discussion on the comprehensive treatment strategy of complex ventral hernia from the perspective of intraperitoneal pressure].

Complex ventral hernia refers to a large hernia that is complicated by a series of concurrent conditions. Change in intra-abdominal pressure is one of the main pathways through which various factors exert an impact on perioperative risk and postoperative recurrence. Taking abdominal pressure reconstruction as the core, the treatment strategy for complex abdominal hernia can be formulated from three aspects: improving patients' tolerance, expanding abdominal cavity volume, and reducing the volume of abdominal contents. Improving patients' tolerance includes abdominal wall compliance training and progressive preoperative pneumoperitoneum. To expand the volume of the abdominal cavity, implanting hernia repair materials, component separation technique, autologous tissue transplantation, component expend technique, and chemical component separation can be used. Initiative content reduction surgery and temporary abdominal closure may be performed to reduce the volume of abdominal contents. For different cases of complex ventral hernia, personalized treatment measures can be safely and feasibly adopted depending on the condition of the patients and the intra-abdominal pressure situation.

[Pretreatment evaluation of 18F-FDG PET-CT in extranodal NK/T-cell lymphoma].

Objective: To investigate the clinical value of pretreatment 18F-fluorodeoxy glucose positron emission tomography/computed tomography (18F-FDG PET-CT) in extranodal NK/T-cell lymphoma. Methods: Eighty-one patients with pathologically confirmed extranodal NK/T-cell lymphoma and pretreatment with PET-CT scan in Cancer Hospital, Chinese Academy of Medical Sciences from August 2006 to December 2017 were enrolled in the study. The clinical, follow-up and imaging data were analyzed retrospectively. The relationship between maximum standard uptake value (SUVmax) and prognosis were evaluated by Mann-Whitney U test and Spearman rank correlation analysis. Results: Among the 81 patients, 98.8% (80/81) were upper aerodigestive tract (UAT) involved. Lesions at extra-UAT sites were detected in 7 cases, involving parotid gland (n=1), breast (n=1), spleen (n=1), pancreas (n=1), skin and subcutaneous soft tissue (n=1), muscle (n=1), lung (n=2) and bone (n=3). Lymph node involvement were demonstrated in 33 cases. All of the lesions had increased uptake of PET, the median SUVmax was 8.6. PET-CT changed staging in 15 cases, and 12 cases were adjusted treatment methods. 21 cases were changed radiotherapy target because of PET-CT. The 1-, 2-year progression-free survival (PFS) rates were 88.7% and 80.3% while 1-, 2-year overall survival (OS) rates were 97.2% and 94.4% respectively. The median SUVmax of patients with local lymph nodes involvement was significantly higher than those without local lymph nodes involvement (P=0.007). The SUVmax was positively associated with Ann Arbor stage (r=0.366, P=0.001), lactate dehydrogenase (r=0.308, P=0.005) and Ki-67 level (r=0.270, P=0.017). The SUVmax was inversely associated with lymphocyte count (r=-0.324, P=0.003) and hemoglobin content (r=-0.225, P=0.043). Conclusions: Extranodal NK/T-cell lymphoma predominantly occurs in extra-nodal organs, mainly in the upper respiratory and gastrointestinal tracts, with marked FDG-addiction. Compared with conventional imaging, 18F-FDG PET-CT is sensitive and comprehensive in detecting extra-nodal NK/T-cell lymphoma involvement, assisting in accurate clinical staging and treatment planning. Pretreatment SUVmax is potential for prognosis evaluation since it is correlated with prognostic factors.

Local glutamate-mediated dendritic plateau potentials change the state of the cortical pyramidal neuron.

Dendritic spikes in thin dendritic branches (basal and oblique dendrites) are traditionally inferred from spikelets measured in the cell body. Here, we used laser-spot voltage-sensitive dye imaging in cortical pyramidal neurons (rat brain slices) to investigate the voltage waveforms of dendritic potentials occurring in response to spatially restricted glutamatergic inputs. Local dendritic potentials lasted 200-500 ms and propagated to the cell body, where they caused sustained 10- to 20-mV depolarizations. Plateau potentials propagating from dendrite to soma and action potentials propagating from soma to dendrite created complex voltage waveforms in the middle of the thin basal dendrite, comprised of local sodium spikelets, local plateau potentials, and backpropagating action potentials, superimposed on each other. Our model replicated these voltage waveforms across a gradient of glutamatergic stimulation intensities. The model then predicted that somatic input resistance (Rin) and membrane time constant (tau) may be reduced during dendritic plateau potential. We then tested these model predictions in real neurons and found that the model correctly predicted the direction of Rin and tau change but not the magnitude. In summary, dendritic plateau potentials occurring in basal and oblique branches put pyramidal neurons into an activated neuronal state ("prepared state"), characterized by depolarized membrane potential and smaller but faster membrane responses. The prepared state provides a time window of 200-500 ms, during which cortical neurons are particularly excitable and capable of following afferent inputs. At the network level, this predicts that sets of cells with simultaneous plateaus would provide cellular substrate for the formation of functional neuronal ensembles.NEW & NOTEWORTHY In cortical pyramidal neurons, we recorded glutamate-mediated dendritic plateau potentials with voltage imaging and created a computer model that recreated experimental measures from dendrite and cell body. Our model made new predictions, which were then tested in experiments. Plateau potentials profoundly change neuronal state: a plateau potential triggered in one basal dendrite depolarizes the soma and shortens membrane time constant, making the cell more susceptible to firing triggered by other afferent inputs.

Enhanced molybdenum(VI) removal using sulfide-modified nanoscale zerovalent iron: kinetics and influencing factors.

The overall goal of this study is to investigate the effect of sulfidated nanoscale zerovalent iron (S-nZVI) on the removal of hexavalent molybdate (MoO42-) under different aquatic chemistry conditions. Surface analysis suggests that Mo(VI) is removed mainly by adsorption and co-precipitation onto the surface of S-nZVI and a small amount of Mo(VI) can be reduced to Mo(V) species. The results of batch tests show that Mo(VI) removal by S-nZVI are well described with the pseudo-second-order adsorption model. The removal rate increases with a decrease in solution pH (4.0-9.0) and is significantly affected by the S/Fe ratio of S-nZVI, with the optimal S/Fe ratio being 0.5. The presence of anions WO42- or CrO42- can reduce the Mo(VI) removal, which is likely because they compete for adsorption sites on the solid surfaces. The divalent cations Ni2+, Cu2+ and Co2+ also inhibit the removal of Mo(VI) whereas Zn2+, Ca2+ and Mg2+ enhance it. After being aged for 35 d in water, S-nZVI still exhibits high reactivity towards Mo(VI) removal (57.39%). The study demonstrates that S-nZVI can be used as an environmentally friendly material for effectively removing Mo(VI) from contaminated water.

[GnRH-a combined fertility-sparing re-treatment in women with endometrial carcinoma or atypical endomertial hyperplasia who failed to oral progestin therapy].

Objective: To analyze the clinical efficacy and pregnancy outcomes of gonadotropin-releasing hormone agonist (GnRH-a) based fertility-sparing re-treatment in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) who failed with oral progestin therapy. Methods: Forty cases with EC or AEH who failed to respond to oral progestin were included from January 2012 to December 2020 at Peking Union Medical College Hospital. Combination of GnRH-a with levonorgestrel-releasing intrauterine system (group GLI: a subcutaneous injection of GnRH-a every 4 weeks and LNG-IUS insertion constantly) or the combination of GnRH-a with aromatase inhibitor (group GAI: a subcutaneous injection of GnRH-a every 4 weeks and oral letrozole 2.5 mg, daily) were used for these patients. Histological evaluation were performed at the end of each course (every 3-4 months) by hysteroscopy and curettage. After the complete remission (CR), all patients were followed up regularly. Results: (1) Clinical characteristics:among the 40 patients with EC or AEH, the median age at diagnosis was 31 years (range: 22-40 years) and the median body mass index was 24.7 kg/m2 (range: 18.9-39.5 kg/m2). (2) Efficacy of fertility-sparing re-treatment: 37 (92%, 37/40) patients achieved CR, 6 (6/7) in AEH and 31 (94%, 31/33) in EC patients. The CR rate was 93% (26/28) and 11/12 in group GLI and GAI, respectively. The median time to CR was 5 months (range: 3-12 months). At the end of the first therapy course, the CR rates in AEH and EC were 5/7 and 42% (14/33), at the second course, the CR rates were 6/7 and 82% (27/33), respectively. (3) Recurrence: after 25 months of median follow-up duration (range: 10-75 months), 8 (22%, 8/37) women developed recurrence, 1/6 in AEH and 7 (23%, 7/31) in EC patients, with the median recurrence time of 18 months (range: 9-26 months). Among them, two cases who had completed childbirth chose to receive hysterectomy directly. Six patients met the criteria of fertility-preserving therapy and received conservative treatment again and 5 (5/6) of them achieved CR. (4) Pregnancy: of the 37 patients with CR, 33 desired to conceive. Ten women attempted to get pregnancy spontaneously and 23 cases with assisted reproductive technology. Fourteen (42%, 14/33) patients became pregnant, including 9 (27%, 9/33) live births, 3 (9%, 3/33) missed abortions, and 2 (6%, 2/33) miscarriages at the second trimester. Conclusions: GnRH-a based fertility-sparing re-treatment in AEH or EC patients who failed with oral progestin therapy achieved good treatment effect and reproductive outcomes. It is an encouraging alternative regime for patients who failed with oral progestin therapy.

Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China.

BACKGROUND: Cancer patients are regarded as a highly vulnerable group in the current Coronavirus Disease 2019 (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain largely unknown. PATIENTS AND METHODS: In this retrospective cohort study, we included cancer patients with laboratory-confirmed COVID-19 from three designated hospitals in Wuhan, China. Clinical data were collected from medical records from 13 January 2020 to 26 February 2020. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death. RESULTS: A total of 28 COVID-19-infected cancer patients were included; 17 (60.7%) patients were male. Median (interquartile range) age was 65.0 (56.0-70.0) years. Lung cancer was the most frequent cancer type (n = 7; 25.0%). Eight (28.6%) patients were suspected to have hospital-associated transmission. The following clinical features were shown in our cohort: fever (n = 23, 82.1%), dry cough (n = 22, 81%), and dyspnoea (n = 14, 50.0%), along with lymphopaenia (n = 23, 82.1%), high level of high-sensitivity C-reactive protein (n = 23, 82.1%), anaemia (n = 21, 75.0%), and hypoproteinaemia (n = 25, 89.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 21, 75.0%) and patchy consolidation (n = 13, 46.3%). A total of 15 (53.6%) patients had severe events and the mortality rate was 28.6%. If the last antitumour treatment was within 14 days, it significantly increased the risk of developing severe events [hazard ratio (HR) = 4.079, 95% confidence interval (CI) 1.086-15.322, P = 0.037]. Furthermore, patchy consolidation on CT on admission was associated with a higher risk of developing severe events (HR = 5.438, 95% CI 1.498-19.748, P = 0.010). CONCLUSIONS: Cancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 coinfection.

Environmental Exposure-Associated Human Health Risk of Dioxin Compounds in the Vicinity of a Municipal Solid Waste Incinerator in Shanghai, China.

In order to assess environmental exposure-associated human health risk of dioxin compounds for the population in the vicinity of a municipal solid waste incinerator (MSWI) in Shanghai, the atmospheric samples (n = 24) and soils samples (n = 96) were collected and analyzed to obtain the concentration level, pollution characteristics and seasonal changes of dioxin compounds in environmental medias. The toxicity equivalent concentration range of 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) was 30.9-409 fg WHO-TEQ·m-3 in atmosphere and 0.362-8.55 ng WHO-TEQ·kg-1 in soil. The non-carcinogenic health risk and carcinogenic health risk from PCDD/Fs environmental exposure of people living in the vicinity of the MSWI in Shanghai were all within the allowable range of the US Environmental Protection Agency, which implied that the MSWI in Shanghai did not produce additional risk for the population living in its vicinity.

[Management strategies for three patients with gynecological malignancies during the outbreak of COVID-19].

Objective: To explore the management strategies for patients with gynecological malignant tumors during the outbreak and transmission of COVID-19. Methods: We retrospectively analyzed the clinical characteristics, treatment, and disease outcomes of three patients with gynecological malignancies associated with COVID-19 in Renmin Hospital of Wuhan University, and proposed management strategies for patients with gynecological tumors underriskof COVID-19. Results: Based on the national diagnosis and treatment protocol as well as research progress for COVID-19, three patients with COVID-19 were treated. Meanwhile, they were also appropriately adjusted the treatment plan in accordance with the clinical guidelines for gynecological tumors. Pneumonia was cured in 2 patients, and one patient died of COVID-19. Conclusions: Patients with gynecological malignant tumors are high-risk groups prone to COVID-19, and gynecological oncologists need to carry out education, prevention, control and treatment according to specific conditions. While, actively preventing and controlling COVID-19, the diagnosis and treatment of gynecological malignant tumors should be carried out in an orderly and safe manner.

[Clinical characteristics and outcome of 64 patients with severe COVID-19].

Objective: To investigate the causes of death in patients with severe COVID-19. Methods: A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables. Results: The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) µg/L, which was significantly higher than that in the survival group (0.02, 0.03) µg/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) µg/L, which was higher than 33.1 (25.7, 54.5) µg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3). Conclusions: ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.

[Initial implantation experience and short-term follow-up results of implanting leadless intracardiac transcatheter pacing system].

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.

[Report of breast cancer incidence and mortality in China registry regions, 2008-2012].

Objective: The registration data of local cancer registries from 2008 to 2012 were collected by National Central Cancer Registry to estimate the incidence and mortality of female breast cancer in China. Methods: Data from 135 registries were qualified and selected in the final analysis, and each registry at least has submitted data from 2010 to 2012. Cancer incidence and mortality analyses were stratified by area (urban/rural, eastern/middle/western areas) and age group. The age composition of standard population of Chinese census in 2000 and Segi's population were used for age-standardized incidence and mortality in China and worldwide, respectively. Results: A total of 135 registries were recruited in the analysis, covering 629 333 910 person-years (382 669 450 in urban and 246 664 460 in rural). About 13, 258 cases of female breast cancer were diagnosed and 32 205 cases were dead between 2008 and 2012. Female breast cancer incidence was 42.67/100, 000 and age-standardized rate calculated by worldwide standard population was 28.87/100, 000. The crude incidence of urban area was 51.85/100, 000, higher than 28.29/100, 000 of rural area, and the crude incidence of eastern area was 46.35/100, 000, higher than 36.38/100, 000 of middle area and 27.60/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age 55-59 (96.36/100, 000), and declined at age 60. The age-standardized incidence rate by Chinese standard population increased 30.56% from 2003 to 2012. The increase rate of rural area was 72.32%, faster than 23.48% of urban area. Female breast cancer mortality was 10.36/100, 000 and the age-standardized rate calculated by worldwide standard population was 6.61/100, 000. The crude mortality of urban area was 11.64/100, 000, higher than 8.36/100, 000 of rural area, and the crude mortality of eastern area was 10.81/100, 000, higher than 7.38/100, 000 of middle area and 9.90/100, 000 of western area. The age-specific incidence increased with age and reached the peak at age above 85 (61.25/100, 000). Age-standardized incidence rate by Chinese standard population remained stable during the period of 2003-2012 (6.23%). The mortality rate mainly increased in rural area (54.94%), while decreased 2.32% in urban area over the 10 years. Conclusions: Although the incidence and mortality of breast cancer in China are comparatively low worldwide, in China the incidence and mortality of female breast cancer have rose to the first and sixth place respectively among all the female cancers. The disease burden of breast cancer is very different between urban and rural area. Therefore, the targeted measure and strategy of control and prevention according to the area difference are needed.

[Resting-state functional MRI studies of amyotrophic lateral sclerosis patients with various levels of cognitive impairment].

Objective: To characterize the brain functional changes of amyotrophic lateral sclerosis (ALS) patients with various levels of cognitive impairment as measured by resting-state functional MRI (RS-fMRI). Methods: From September 2013 to March 2017, a total of 55 patients diagnosed with ALS in Peking Union Medical College Hospital and 20 healthy controls (HCs) were included in this study, and all participants underwent neuropsychological assessments and diffusion tensor imaging scans. According to their cognitive performance, ALS patients were further subclassified into ALS with normal cognition (ALS-Cn, n=27), those with cognitive impairment (ALS-Ci, n=17) and ALS-FTD (n=11). Comparisons of fractional amplitude of low frequency fluctuation (fALFF) value and regional homogeneity (ReHo) value were conducted among the 4 subgroups. Results: The fALFF showed significant differences in bilateral frontal lobe, left temporal lobe and cingulate gyrus, (P<0.001, uncorrected) and the ReHo showed significant differences in left frontal lobe, right temporal lobe and left cingulate gyrus (P<0.001, FDR corrected). The differences mainly stemmed from that patients with ALS-FTD showed decreased fALFF and ReHo in these areas when compared to the other three groups, especially in relation to HCs, mainly locating in left prefrontal lobe and anterior cingulate cortex. The whole-brain comparisons of fALFF and ReHo between ALS-Ci, ALS-Cn and HCs revealed no significant difference (P<0.001, uncorrected). Conclusion: Hypoactivities are detected in extramotor areas in patients with ALS-FTD. RS-fMRI is helpful in investigating the pathophysiologic mechanism of cognitive impairment in ALS.

[Role of BoBs technology in early missed abortion chorionic villi].

Objective: To investigate the value of bacterial artificial chromosome-on-beads (BoBs) technology in the genetic analysis of early missed abortion chorionic villi. Methods: Early missed abortion chorionic villi were detected with both conventional karyotyping method and BoBs technology in Peking Union Medical Hospital from July 2014 to March 2015. Compared the results of BoBs with conventional karyotyping analysis to evaluate the sensitivity, specificity and accuracy of this new method. Results: (1) A total of 161 samples were tested successfully in the technology of BoBs, 131 samples were tested successfully in the method of conventional karyotyping. (2) All of the cases obtained from BoBs results in (2.7±0.6) days and obtained from conventional karyotyping results in (22.5±1.9) days. There was significant statistical difference between the two groups (t=123.315, P<0.01) . (3) Out of 161 cases tested in BoBs, 85 (52.8%, 85/161) cases had the abnormal chromosomes, including 79 cases chromosome number abnormality, 4 cases were chromosome segment deletion, 2 cases mosaic. Out of 131 cases tested successfully in conventional karyotyping, 79 (60.3%, 79/131) cases had the abnormal chromosomes including 62 cases chromosome number abnormality, 17 cases other chromosome number abnormality, and the rate of chromosome abnormality between two methods was no significant differences (P=0.198) . (4) Conventional karyotyping results were served as the gold standard, the accuracy of BoBs for abnormal chromosomes was 82.4% (108/131) , analysed the normal chromosomes (52 cases) and chromosome number abnormality (62 cases) tested in conventional karyotyping, the accuracy of BoBs for chromosome number abnormality was 94.7% (108/114) . Conclusion: BoBs is a rapid reliable and easily operated method to test early missed abortion chorionic villi chromosomal abnormalities.

Beam-Target Helicity Asymmetry for γ[over →]n[over →]→π

We report the first beam-target double-polarization asymmetries in the γ+n(p)→π^{-}+p(p) reaction spanning the nucleon resonance region from invariant mass W=1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN^{*} resonance photocouplings.

Inhibition of NMDA receptor function with an anti-GluN1-S2 antibody impairs human platelet function and thrombosis.

GluN1 is a mandatory component of N-methyl-D-aspartate receptors (NMDARs) best known for their roles in the brain, but with increasing evidence for relevance in peripheral tissues, including platelets. Certain anti-GluN1 antibodies reduce brain infarcts in rodent models of ischaemic stroke. There is also evidence that human anti-GluN1 autoantibodies reduce neuronal damage in stroke patients, but the underlying mechanism is unclear. This study investigated whether anti-GluN1-mediated neuroprotection involves inhibition of platelet function. Four commercial anti-GluN1 antibodies were screened for their abilities to inhibit human platelet aggregation. Haematological parameters were examined in rats vaccinated with GluN1. Platelet effects of a mouse monoclonal antibody targeting the glycine-binding region of GluN1 (GluN1-S2) were tested in assays of platelet activation, aggregation and thrombus formation. The epitope of anti-GluN1-S2 was mapped and the mechanism of antibody action modelled using crystal structures of GluN1. Our work found that rats vaccinated with GluN1 had a mildly prolonged bleeding time and carried antibodies targeting mostly GluN1-S2. The monoclonal anti-GluN1-S2 antibody (from BD Biosciences) inhibited activation and aggregation of human platelets in the presence of adrenaline, adenosine diphosphate, collagen, thrombin and a protease-activated receptor 1-activating peptide. When human blood was flowed over collagen-coated surfaces, anti-GluN1-S2 impaired thrombus growth and stability. The epitope of anti-GluN1-S2 was mapped to α-helix H located within the glycine-binding clamshell of GluN1, where the antibody binding was computationally predicted to impair opening of the NMDAR channel. Our results indicate that anti-GluN1-S2 inhibits function of human platelets, including dense granule release and thrombus growth. Findings add to the evidence that platelet NMDARs regulate thrombus formation and suggest a novel mechanism by which anti-GluN1 autoantibodies limit stroke-induced neuronal damage.

[Analysis of the patterns of female breast cancer incidence in Shanghai, 2003-2012].

Objective: To analyze the patterns of female breast cancer and their incidence in Shanghai during 2003-2012, and to compare them with international data. Methods: The data of female breast cancer cases diagnosed between 2003 and 2012 were collected from the Shanghai Cancer Registry. The record of cancer cases included the patient's name, gender, date of birth, permanent and residential address, diagnosis site or name, histological type, date of first diagnosis, diagnostic basis and diagnostic stage, etc. Data source of cancer incidence of World, Developed Countries, Developing Countries, East Asia and China in 2012 sourced from GLOBOCAN 2012 database of the WHO International Agency for Research on Cancer (IARC); and the data of USA during 2008-2012 was collected from SEER 18 database from Surveillance, Epidemiology, and End Results Program of the National Cancer Institute (NCI). Incidence indicators of Shanghai female breast cancer were calculated, including the average cases, median age, average age, proportion, crude rate, age-specific rate and age-standardized rate. Results: During 2003-2012, 41 991 new cases of female breast cancer were diagnosed in Shanghai, with an average of 4 199 cases per year, accounting for 17.23% among total new female cancer cases, ranking first in female cancer incidence in Shanghai during 2003-2012, with a crude incidence rate of 60.90 per 100 000 and an age-standardized incidence rate of 33.90 per 100 000. During 2008-2012, an average 4 528 new cases of female breast cancer was diagnosed per year in Shanghai, with 16.97% among total female cancer cases. The median age was 56 years old and the mean age was 57.73 years old. The crude rate was 64.23 per 100 000 and the age-standardized rate was 35.00 per 100 0000, which was higher than those of China (22.1 per 100 000), Eastern Areas (27.0 per 100 000) and Developing Counties (31.3 per 100 000), and lower than that of World (43.1 per 100 000), and Yellow Race Population of USA (68.77 per 100 000). During 2003-2007, on average, 3 869 new cases of female breast cancer were diagnosed per year in Shanghai, accounting for 17.54% of total female cancer cases. The median age was 53 years old and the mean age was 56.44 years old. The crude rate was 57.42 per 100 000 and the age-standardized rate was 32.69 per 100 000. There was a continuing peak stage spanned 25 years old from 50 to 74 years old, during 2008-2012. Compared with those of 2003-2007, the beginning age group of the continuing peak stage was delayed for 5 years old and the ending age group was delayed for 10 years old. Conclusion: The age-standardized incidence rate in Shanghai was higher than those of China, Eastern Areas and Developing Counties, and lower than that of World, and that of Yellow Race Population of USA; Compared with 2003-2007, the crude rate and age-standardized rate increased, the median age, mean age and the beginning and ending age group of the continuing peak stage were delayed.

[Early imaging diagnosis of primary liver cancer].

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, and in the process of HCC development, early identification and timely treatment can significantly improve patient survival rate. Imaging techniques play an important role in the monitoring of chronic liver diseases, evolution of cirrhotic nodules, and early diagnosis of HCC. Multi-phase or dynamic contrast-enhanced computed tomography and magnetic resonance imaging (MRI) reflect the changes in blood supply during the evolution of liver cirrhotic nodules. Functional MRI can reflect the structure and function of living organisms at the molecular level. The application of liver-specific contrast agents can improve the detection rate and identification of early-stage HCC. With the development of MRI techniques and the accumulation of clinical experience in functional imaging will further improve the diagnostic rate of early-stage HCC.

Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China.

BACKGROUND: Breast cancer incidence rates are increasing among Asian women, likely due to the changes in risk factors caused by globalization. Trends in breast cancer rates among Chinese women may differ from other Asian regions due to the implementation of a nationwide family planning program and resulting changes in women's reproductive practices. Appraisal of cancer trends can direct cancer control and public health planning, but relevant studies in China are scarce due to a lack of long-term data. We sought to evaluate secular time trends in breast cancer incidence and mortality using 40 years of cancer registry data for women in urban Shanghai. MATERIALS AND METHODS: Data on invasive breast cancer incidence and mortality were collected by the Shanghai Cancer Registry. Age-standardized rates (ASRs) for incidence and mortality were calculated using the Segi/Doll 1960 world standard population. Age, period, and birth cohort effects were evaluated using age-period-cohort (APC) Poisson regression models. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age-drift models. RESULTS: A total of 53 885 breast cancer cases and 17 235 breast cancer-specific deaths were documented among women in urban Shanghai between 1 January 1973 and 31 December 2012. Breast cancer incidence and mortality ASRs increased by 141.2% and 26.6%, respectively. Significant age, cohort, and period effects were identified in both incidence and mortality APC models; cohort effects were pronounced. Overall, a substantial increase in breast cancer incidence (EAPC = 2.96%/year) and a moderate increase in breast cancer mortality (EAPC = 0.87%/year) was observed. A notable downward trend in mortality was identified among younger women born after 1960. CONCLUSIONS: Forty years of cancer registry data document a tremendous increase in incidence and a slight increase in mortality for breast cancer among women in Shanghai. Effective, appropriate, and affordable breast cancer prevention and control strategies are urgently needed in China.