Comparison of His-Purkinje Conduction System Pacing with Atrial-Ventricular Node Ablation and Pharmacotherapy in HFpEF Patients with Recurrent Persistent Atrial Fibrillation (HPP-AF study).

BACKGROUND: There is currently no particularly effective strategy for patients with persistent atrial fibrillation accompanying heart failure with preserved ejection fraction (HFpEF), especially with recurrent atrial fibrillation after ablation. In this study, we will evaluate a new treatment strategy for patients with persistent atrial fibrillation who had at least two attempts (≧2 times) of radio-frequency catheter ablation but experienced recurrence, and physiologic conduction was reconstructed after atrioventricular node ablation or drug therapy, to control the patient's ventricular rate to maintain a regular heart rhythm, which is called His-Purkinje conduction system pacing (HPCSP) with atrioventricular node ablation. METHODS AND RESULTS: This investigator-initiated, multicenter prospective randomized controlled trial aimed to recruit 296 randomized HFpEF patients with recurrent atrial fibrillation. All the enrolled patients were randomly assigned to the pacing group or the drug treatment group. The primary endpoint is differences in cardiovascular events and clinical composite endpoints (all-cause mortality) between patients in the HPCSP and drug-treated groups. Secondary endpoints included heart failure hospitalization, exercise capacity assessed by cardiopulmonary exercise tests, quality of life, echocardiogram parameters, 6-minute walk distance, NT-ProBNP, daily patient activity levels, and heart failure management report recorded by the CIED. It is planned to compete recruitment by the end of 2023 and report in 2025. CONCLUSIONS: The study aims to determine whether His-Purkinje conduction system pacing with atrioventricular node ablation can better improve patients' symptoms and quality of life, postpone the progression of heart failure, and reduce the rate of rehospitalization and mortality of patients with heart failure. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR1900027723, URL: http://www.chictr.org.cn/edit.aspx?pid=46128&htm=4.

Prevalence and trend of gonorrhea in female sex workers and men having sex with men in China: a systematic review and meta-analysis.

OBJECTIVES: This systematic review was conducted to estimate the respective prevalence of gonorrhea among two high-risk populations in China and determine the epidemiological features of gonorrhea in them. STUDY DESIGN: Systematic review. METHODS: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched to identify studies published between January 1, 1990, and October 31, 2022, with gonorrhea prevalence tested by polymerase chain reaction among female sex workers (FSWs) and men who have sex with men (MSM). Meta-regression and subgroup analyses were used to investigate potential factors of heterogeneity across studies. Trend analysis of prevalence was conducted by the Jonckheere-Terpstra method. RESULTS: We identified 88 prevalence data points from 49 studies in China, with 30,853 participants of FSWs and 5523 participants of MSM. Pooled prevalence of gonorrhea among FSWs and MSM were 6.9% (95% confidence interval: 4.6-9.7%) and 2.5% (95% confidence interval: 1.5-3.7%), respectively. The subgroup analyses showed there were period, regional, and specimen collection methods diversities among FSWs, and diversities of the regions and specimen collection anatomical sites were found among MSM, in which the prevalence of rectum and pharynx was significantly higher than the urethra. A decreasing trend in the prevalence of gonorrhea was seen among FSWs (z = -4.03) from 1999 to 2021, not found for MSM in China. CONCLUSION: The prevalence of gonorrhea is high in two high-risk groups in China, with extragenital infections requiring particular attention. The findings of this study will provide evidence to formulate national policy and guidance for gonorrhea prevention and control.

[Current status and outlook of medical treatment for KRAS-mutated non-small cell lung cancer].

Lung cancer remains the leading cause of cancer-related deaths in men and women worldwide, and 85% of these patients have non-small cell lung cancer. In recent years, the clinical use of targeted drug therapy and immune checkpoint inhibitors has dramatically changed the treatment landscape for advanced NSCLC. The mechanism and the value of targeted therapies have been a hot topic of research, as KRAS is one of the earliest discovered and most frequently mutated oncogenes, which is activated by binding to GTP and triggers a series of cascade reactions in cell proliferation and mitosis. The KRAS protein acts as a molecular switch and is activated by binding to GTP, triggering a series of cascade responses in cell proliferation and mitosis. Clinically, patients with KRAS mutated NSCLC have poor response to systemic medical therapy and poor prognosis. Since the first report of KRAS gene in 1982, research on KRAS targeted therapeutics has been slow, and previous studies such as farnesyltransferase inhibitors and downstream protein inhibitors of KRAS signaling pathway have not achieved the expected results, making KRAS long defined as a "non-druggable target". The deeper understanding of the crystal structure of KRAS has led to the discovery of potential therapeutic sites for KRAS and the development of several drugs directly targeting KRAS, especially KRAS G12C inhibitors such as AMG510 (sotorasib) and MRTX849 (adagrasib), which have shown encouraging results in clinical trials. In recent years, studies on the therapeutic efficacy of immune checkpoint inhibitors for KRAS-mutated NSCLC have made some progress. In this review, we systematically introduce the basic understanding of RAS gene and clinical characteristics of KRAS mutated NSCLC patients, summarize the medical treatments for KRAS mutated NSCLC, including chemotherapy, anti-vascular drug therapy and tumor immunotherapy, and focus on the review and outlook of the research progress of KRAS targeted therapy.

[Clinical and pathological characteristics of gastric adenocarcinoma of fundic gland type].

To analyze the clinical, endoscopic and pathological feature of gastric adenocarcinoma of fundic gland type (GA-FG) (18 cases) collected from Sir Run Run Shaw Hospital, affiliated with Zhejiang University School of Medicine and Taizhou Hospital of Zhejiang Province from January 2019 to July 2022. There were 18 cases of patient of GA-FG, including male 12 cases, female 6 cases, aged from 38 to 78 years old, with average age of 60.5 years old. Gastroscopy showed that bulging or flat lesions of gastric fundus were 0.2-5.5 cm in size, and the mucosal surface was smooth, redness or rough. Histologic examination showed that tumor cells were dominated by chief cells and scattered with a few oxyntic cells, formed a complex gland that anastomoses each other, and infiltrated to the submucosa. The results of immunohistochemistry showed that tumor cells were positive for the expression of mucin-6 (MUC6) and Pepsinogen 1, and partial expression of synaptophysin (Syn). GA-FG is a rare type of gastric adenocarcinoma with good differentiation, and currently only a few cases have been reported, and often easily been misdiagnosed or missed. Therefore, to master the characteristics of clinic and pathology is helpful to improve the ability of clinical pathologists in differential diagnosis.

[Pediatric myofibroma/myofibromatosis of the soft tissue and bone: a clinicopathological analysis of 28 cases].

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of pediatric myofibroma/myofibromatosis of the soft tissue and bone. Methods: All cases of pediatric myofibroma/myofibromatosis of the soft tissue and bone diagnosed between January 2011 and December 2018 were retrieved from the surgical pathology records in the Department of Pathology, Beijing Jishuitan Hospital, Beijing, China. Clinical and radiological data were collected. H&E and immunohistochemistry were used to examine histological and immunophenotypic features and to make the diagnosis and differential diagnosis. The relevant literature was also reviewed. Results: Twenty-eight cases of pediatric myofibroma/myofibromatosis of the soft tissue and bone were respectively collected. The patients' ages ranged from 2 months to 14 years, with a mean age of 7 years. There were 7 females and 21 males. There were 12 cases located in soft tissue, including the finger (n=9), upper arm (n=1) and foot (n=2). There were 14 cases located in the bone of limb, including the femur (n=8), tibia (n=4), clavicle (n=2), fibula (n=2) and radius (n=1). There were 2 cases of myofibromatosis involving multiple bones. Radiology showed lytic lesions in the bone. The proliferation of spindle-shaped myofibroblasts arranged in fascicles with indistinct eosinophilic cytoplasm and bland nuclei, with no pleomorphism and cytological atypia. The characteristic histologic structure was the biphasic nodular growth pattern with cellular and paucicellular regions. The tumors might arrange in a hemangiopericytoma-like pattern. The stroma varied between dense fibrosis and myxoid changes. The reactive new bone formation and inflammatory cell infiltration also existed. Immunohistochemical study showed that the SMA was positive. The surgical resections were performed. One of the patients had tumor recurrence as a result of 11-month follow-up. Conclusions: The pediatric myofibroma/myofibromatosis of the soft tissue and bone is a very rare benign tumor and has a good prognosis. It has a characteristic morphology and its differential diagnosis from other spindle cell tumors could be made with the immunohistochemical analysis.

[Comparison of 5-year follow-up outcomes between"one-stop"procedure and long-term oral anticoagulants after radiofrequency catheter ablation in patients with atrial fibrillation].

Objective: To compare the 5-year follow-up outcomes of radiofrequency catheter ablation (RFCA) combined with left atrial appendage closure (LAAC) and long-term oral anticoagulant (OAC) after RFCA in patients with atrial fibrillation. Methods: This retrospective cross-sectional study included patients with atrial fibrillation who underwent"one-stop"procedure in the First Affiliated Hospital of Ningbo University from September 2015 to December 2017 (RFCA+LAAC group). Baseline data of patients were collected. Propensity score matching at the ratio of 1∶1 was used to select patients with atrial fibrillation who took long-term OAC after RFCA (RFCA+OAC group). The maintenance rate of sinus rhythm and the incidence of adverse events during follow-up were compared between the two groups. Results: A total of 110 patients were enrolled in the RFCA+LAAC group and RFCA+OAC group, respectively. Age of patients was (67.4±8.8) years in RFCA+LAAC group, and there were 42 (38.2%) female patients. Age of patients was (67.3±7.9) years in RFCA+OAC group, and there were 47 (42.7%) female patients. The patients were followed up for mean of (5.3±1.1) years. There was no significant difference in the maintenance rate of sinus rhythm (log-rank: χ2=0.277, P=0.602) and incidence of ischemic stroke events (2.7% (3/110) vs. 4.5% (5/110), P=0.719) during follow-up between the two groups. The incidence of bleeding events (6.4% (7/110) vs. 18.2% (20/110), P=0.008) and major bleeding events (1.8% (2/110) vs. 8.2% (9/110), P=0.030) was significantly higher in the RFCA+OAC group than in the RFCA+LAAC group. Conclusion: There is no significant difference between RFCA+LAAC group and RFCA+OAC group in maintenance rate of sinus rhythm and incidence of ischemic stroke events. Patients in the RFCA+LAAC group have a lower risk of bleeding events compared to the RFCA+OAC group.

[Analysis of dust monitoring results of dust exposure enterprises in Shenxian from 2017 to 2020].

Objective: In order to understand the dust concentration in the workplace of dust exposure enterprises in Shenxian. To evaluate the degree of occupational hazard factors of dust exposure enterprises. And provide basis for the formulation of occupational protection standards and management system of dust exposure enterprises. Methods: In February 2022, the dust concentration monitoring data of 89 dust exposure enterprises from 2017 to 2020 by the Shenxian Center for Disease Control and Prevention were collected, and the qualified rates of dust concentration detection of dust exposure enterprises in different years, dust types and enterprise sizes were analyzed. Results: A total of 89 dust enterprises were monitored from 2017 to 2020, 2132 dust samples were collected, and 1818 qualified samples were taken, with a total qualified rate of 85.3%. From 2017 to 2020, the dust detection qualified rates showed a year-by-year increase trend, 78.7% (447/568), 84.1% (471/560), 88.6% (418/472) and 90.6% (482/532), respectively, with statistically significant differences (χ(2)=36.27, P=0.003). The differences in the qualified rates of dust detection samples of silicon dust (66.1%, 41/62), grain dust (86.7%, 1549/1786), cotton dust (84.1%, 106/126) and wood dust (77.2%, 122/158) were statistically significant (χ(2)=29.66, P=0.002). The qualified rate of dust samples in large and medium-sized enterprises (95.1%, 1194/1256) was higher than that of small-sized enterprises (71.2%, 624/876), and the difference was statistically significant (χ(2)=1584.40, P=0.001) . Conclusion: The qualified rate of dust concentration monitoring results of dust exposure enterprises in Shenxian showed an increase trend year by year, while the pualified rate of dust concentration monitoring in small-sized enterprises was low, and the occupational hazard of silica dust was still severe.

[Risk factors of recurrence or metastasis in patients with medullary thyroid carcinoma].

Objective: To analyze the risk factors of recurrence or metastasis of medullary thyroid carcinoma (MTC) and the influencing factors of disease-free survival (DFS). Methods: The clinicopathological data of MTC patients who visited Tianjin Medical University Cancer Institute and Hospital and underwent surgery from August 2014 to August 2019 were retrospectively analyzed. The patients were divided into recurrence or metastasis group and no recurrence or metastasis group. Multivariate logistic regression analysis was used to analyze the risk factors for recurrence or metastasis. Kaplan-Meier survival analysis and Cox regression analysis were used to determine the risk factors of DFS. Results: A total of 158 MTC patients were enrolled in final analysis, including 83 females and 75 males, with a median age of 52 (19-74) years. There were 146 cases of sporadic MTC (92.4%) and 12 cases of familial MTC (7.6%), respectively. Bilateral thyroid lesions presented in 33 cases (20.9%) and multiple lesions presented in 57 cases (36.1%), respectively. The median follow-up time was 59.7 (10.0-93.0) months and the median DFS was 55.5 (0-92.9) months. Presence of multifocality, the largest tumor size>2 cm, T3/4, N1b, clinical stage Ⅲ/Ⅳ, lymph node metastasis ratio (LNR)>0.3, preoperative calcitonin>2 000 ng/L, postoperative calcitonin>40 ng/L and no biochemical cure were significantly correlated with the recurrence or metastasis and DFS of MTC (all P<0.05). Clinical stage Ⅲ/Ⅳ (OR=36.57, 95%CI: 1.33-1 006.98, P=0.033), the largest tumor size>2 cm (OR=5.81, 95%CI: 1.01-33.33, P=0.049), multifocality (OR=3.64, 95%CI: 1.03-12.88, P=0.045) and postoperative calcitonin>40 ng/L (OR=15.03, 95%CI: 1.39-162.61, P=0.026) were independent risk factors of recurrence or metastasis. Clinical stage Ⅲ/Ⅳ (HR=19.39, 95%CI:1.40-268.19, P=0.027), the largest tumor size>2 cm (HR=3.64, 95%CI: 1.02-13.02, P=0.047) and postoperative calcitonin>40 ng/L (HR=10.68, 95%CI: 1.34-84.95, P=0.025) were influencing factors for DFS (all P<0.05). Conclusion: The larger tumor size, advanced clinical stage and higher postoperative calcitonin at the initial treatment of MTC are risk factors for recurrence or metastasis and influencing factors for DFS.

[Feasibility and safety of closing large left atrial appendage using the LAmbre device].

Objective: To evaluate the feasibility and safety of the LAmbre occluder for large-diameter left atrial appendage occlusion. Methods: This study was a retrospective cohort study. Patients with large orifice of the left atrial appendage (≥31 mm) and occlusion with the LAmbre device in the Arrhythmia Center of Ningbo First Hospital were included from June 2018 to March 2020. Baseline data were collected and major perioperative complications of left atrial appendage occlusion (including death, stroke, instrumental embolism, cardiac tamponade, and major bleeding events) were recorded. Patients were followed up 45 days, 6 months and 12 months after surgery. The shunt and device-related thrombosis were recorded by esophageal cardiac ultrasound or pulmonary vein CT, and the occurrence of postoperative thromboembolism, bleeding events, death and other serious adverse events were recorded. Results: The average age and left atrial appendage ostial dimension of 32 patients (37.5% women) included in this research were (70.4±8.4) years old and (34.4±2.9) mm. The LAmbre device was successfully implanted in 31(96.9%) patients. No major complications occurred during the perioperative period. During the 12-month follow-up, pericardial tamponade occurred in 1(3.2%) patient and was recovered after treatment. There was no occluder edge shunt>5 mm in patients followed up by esophageal echocardiography. No significant peri-device leak, device-related thrombus, thromboembolism or death event has occurred. Conclusion: The LAmbre occluder may be feasible and safe for large-diameter left atrial appendage occlusion.

[Safety and efficacy of percutaneous left atrial appendage closure in nonvalvular atrial fibrillation patients with left atrial spontaneous echocardiographic contrast].

Objective: To investigate the safety and efficacy of percutaneous left atrial appendage closure (LAAC) in nonvalvular atrial fibrillation patients (NVAF) with left atrial spontaneous echocardiographic contrast (LA SEC). Methods: A total of 95 NVAF patients treated in the Department of Cardiology of Ningbo First Hospital from July 2018 to June 2019 were enrolled in this study. The study population was divided into two group according to the presence or absence of LA SEC detected by transesophageal echocardiography (TEE). TEE was scheduled 45 days post-procedure to detect device-related thrombus (DRT). Stroke and bleeding events were recorded during follow-up. Periprocedural complications and follow-up results were compared between the two groups. Results: LA diameters were smaller in non-LA SEC group than LA SEC group ((44.0±7.4)mm vs (47.3±6.6)mm, P=0.033). Watchman device was successfully implanted into all the enrolled patients. No death, transient ischemic attack (TIA)/stroke, device embolization and major bleeding events occurred. Fifty patients (90.2%) in LA SEC group and 31 patients (91.2%) in non-LA SEC group finished TEE follow-up 45 days post-procedure. No device-related thrombus was detected in non-LA SEC group, while 2 cases (6.5%) were detected in LA SEC group, but there was no significant differences in the incidence between the two groups (P=0.127). The LA SEC group and non-LA SEC group were followed-up for (12.3±3.8) months and (12.9±3.3) months, respectively; and there was no significant differences in the incidence of death, TIA/stroke, major and minor bleeding events between two groups during the follow-up (all P>0.05). Conclusion: LAAC in NVAF patients with LA SEC was safe and effective. However, the incidence of DRT was slightly higher.

[Preliminary results of surgical treatment of fibrous dysplasia of proximal femur in children].

Objective: To investigate the surgical treatment, clinical effect and revision reasons of children with proximal femoral fibrous dysplasia(FD). Methods: The clinical data of 26 children with polyostotic FD of proximal femur who underwent surgery at Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital from June 2016 to June 2018 were retrospectively analyzed. There were 18 males and 8 females with a mean age of 9.2 years (range:5 to 16 years).One of them was McCune Albright syndrome. Fifteen cases were in first operation and 11 cases were in revision operation. The operation methods and results were reviewed,and the causes of revision were analyzed. Results: Among the 15 children who underwent the first operation,13 cases underwent osteotomy or fracture reduction and interlocking intramedullary nail(IMN) fixation;One case underwent valgus osteotomy and pediatric hip plate(PHP)internal fixation;One case underwent valgus osteotomy+lesion curettage+allogeneic bone graft+PHP fixation. Among the 11 children who underwent revision surgery,9 cases were treated with IMN fixation,1 case with PHP fixation,and 1 case with PHP fixation+allogeneic bone graft. The causes of revision included distal fixation failed in 6 cases,proximal fixation failed in 3 cases,plate fixation failed in 5 cases,and recurrence occurred after curettage and artificial bone graft in 2 cases. Patients were followed up for 1.4 years(range:1.0 to 3.5 years) after recent operation. The osteotomy or fracture healed well with good deformity correction. Postoperative complications included infection in 1 case and local bone partial resorption in 1 case. Conclusions: Osteotomy combined with rigid internal fixation is an effective surgical treatment for fibrous dysplasia of proximal femur in children. Internal fixation should cover the whole length of lesion. Intramedullary nail is the most common choice. Because the growth of height and the progress of the disease itself,this deformity is prone to recur in children,needing closely follow-up after operation.

[Factors affecting the recovery of cholinesterase activity in patients with acute chlorpyrifos poisoning].

Objective: To investigate the related factors affecting the recovery of cholinesterase (ChE) activity in patients with acute chlorpyrifos poisoning. Methods: In February 2020, the clinical data of acute chlorpyrifos poisoning patients admitted in our hospital from January 2016 to December 2019 were retrospectively analyzed. The outcome variable was the time of ChE activity recovered to 50% lower limit of normal value, and multivariate linear regression analysis was performed to explore its influencing factors. Results: A total of 78 patients, 43 males and 35 females, with an average age (39.58±14.77) years were enrolled in this study. The average time of serum ChE activity recovered to 50% lower limit of normal value was (24.45±2.64) days. There was a correlation between hemoperfusion (r=-0.644) , atropine dosage (r=0.498) , chlorophosphorus dosage (r=0.432) and the time of serum ChE activity recovered to 50% lower limit of normal value, in which hemoperfusion was significantly negatively correlated with the time of serum ChE activity recovered to 50% lower limit of normal value (ß=-4.222, P<0.05) . Conclusion: The recovery of serum ChE activity in patients with acute chlorpyrifos poisoning is very slow. Hemoperfusion can quickly remove chlorpyrifos, its metabolites and inflammatory mediators in the blood, thus effectively promoting the recovery of ChE activity.

Dual roles of misshapen/NIK-related kinase (MINK1) in osteoarthritis subtypes through the activation of TGFß signaling.

OBJECTIVE: To identify the role of misshapen/NIK-related kinase (MINK1) in age-related Osteoarthritis (OA) and injury-induced OA, and the effects of enhanced TGFß signaling in these progresses. DESIGN: The effect of MINK1 was analyzed with MINK1 knock out (Mink1-/-) mice and C57BL/6J mice. OA progress was studied in age-related OA and instability-associated OA (destabilization of the medial meniscus, DMM) models. The murine knee joint was evaluated through histological staining, Osteoarthritis Research Society International (OARSI) scores, immunohistochemistry, and µCT analysis. Primary chondrocytes were isolated from wild type and Mink1-/- mice and subjected to osteogenic induction and Western blot analysis. RESULTS: MINK1 is highly expressed during cartilage development and in normal cartilage. Mink1-/- mice displayed markedly lower OARSI scores, aggrecan degradation neoepitope positive cells and increased Safranin O and pSMAD2 staining in aging-related OA model. However, in injury-induced OA, loss of MINK1 accelerates extracellular matrix (ECM) destruction, osteophyte formation, and subchondral bone sclerosis. Accelerated subchondral bone remodeling in Mink1-/- mice was accompanied with increased numbers of nestin-positive mesenchymal stem cells (MSCs) and osterix-positive osteoprogenitors. pSMAD2 staining was increased in the subchondral bone marrow of Mink1-/- mice and overexpression of MINK1 inhibited SMAD2 phosphorylation in vitro. CONCLUSIONS: This study shows for the first time that activation of TGFß/SMAD2 by MINK1 deficiency plays opposite roles in aging-related and injury-induced OA. MINK1 deficiency protects cartilage from degeneration in aging joints through increased SMAD2 activation in chondrocytes, while accelerating OA progress in injury-induced model through enhanced osteogenesis of MSCs in the subchondral bone. These findings provide insights for developing precision OA therapeutics targeting TGFß/SMAD2 signaling.

A mathematical model for HIV prevention and control among men who have sex with men in China.

In recent years, men who have sex with men (MSM) constitute a major group of HIV transmission in China. High primary drug-resistance (PDR) rate in MSM also represents a serious challenge for the Chinese antiretroviral therapy (ART) program. To assess the efficiency of ART in controlling HIV/AIDS infection among MSM, we developed a compartmental model for the annually reported HIV/AIDS MSM from 2007 to 2019 in the Zhejiang Province of China. R0 was 2.3946 (95% CI (2.2961-2.4881)). We predict that 90% of diagnosed HIV/AIDS individuals will have received treatment till 2020, while the proportion of the diagnosed remains as low as 40%. Even when the proportion of the diagnosed reaches 90%, R0 is still larger than the level of AIDS epidemic elimination. ART can effectively control the spread of HIV, even in the presence of drug resistance. The 90-90-90 strategy alone may not eliminate the HIV epidemic in Chinese MSM. Behavioural and biologic interventions are the most effective interventions to control the HIV/AIDS epidemic among MSM.

Comparison of MESA of and Framingham risk scores in the prediction of coronary artery disease severity.

BACKGROUND: The correlation between cardiovascular risk scoring systems and the severity of coronary artery diseases (CAD) is not clear. The present research aimed to evaluate the Multi-Ethnic Study of Atherosclerosis (MESA) risk score and Framingham risk score (FRS), using the Gensini score (GS) system as reference, so as to determine which model is better for the prediction of CAD severity. METHODS: This research was a single-center and cross-sectional observational study. In total, 1423 patients were included in our study. Three different groups were formed according to GS: 0 < GS ≤ 22 (low GS group, n = 484); 22 < GS ≤ 42 (intermediate GS group, n = 468); GS > 42 (high GS group, n = 471). Logistic and linear regression analyses were carried out to explore the relationship between the risk score models and the GS. The performance of the risk models was determined by receiver operating characteristic curve (ROC) analysis. RESULTS: The MESA risk score and the FRS both had a statistically significant power for the prediction of CAD severity (MESA area under curve: 0.630; FRS area under curve: 0.613). Furthermore, the MESA had a better performance in predicting the severity (p < 0.05) of CAD compared with the FRS. In the subgroup analysis, the MESA showed a better performance in the male (p < 0.05), diabetes mellitus (p < 0.05), and smoking subgroups (p < 0.05) compared with the FRS. CONCLUSION: The MESA and FRS predicted the severity of CAD in the Chinese population of this study. Moreover, the MESA had a better performance than the FRS model in predicting the severity of CAD in the overall population as well as in the male, smoking, diabetes, and non-diabetes subgroups.

[Effects of physeal bar resection in treating post-traumatic distal radius partial physeal arrest].

Objective: To evaluate the effects of treatment of post-traumatic distal radius partial physeal arrest with physeal bar resection. Methods: From February 2007 to November 2017, 11 children with distal radius physeal arrest received physeal bar resection in the Department of Pediatric Orthopedics, Beijing Jishuitan Hospital. There were 2 females and 9 males. The average age of the patients was (10.1±1.8) years (range,7-13 years). All cases had previous history of distal radius trauma. The average duration from the previous fracture to the physeal bar resection operation was (22.8±3.2) months (range,22 to 41 months). Clinical and radiological evidence of distal radius physeal arrest were suggested in all patients. A CT or MRI scan was performed preoperatively to assess the size of the physeal bridge. Inclusion criteria were patients with a physeal bridge<30% of the physeal area,and with at least 2 years of growth remaining. The physeal bar resection operation was performed with the assistance of either fluoroscopy (5 cases) or intraoperative three dimensional navigation (6 cases). After resection, the void was then filled with bone wax in all cases and distal ulnar epiphysiodesis was conducted in 5 cases. The mean follow-up duration was (3.7±1.6) years (range,1-9 years). The clinical examination data and X ray were obtained during the follow up. Results: Four cases obtained fully recovery from the operation and the deformity got fully correction. The X ray showed no bone bridge recurred. The deformity did not aggravate in 1 case. The deformity aggravated and subsequent osteotomy was conducted in the left 6 cases. Three cases in the navigation group obtained fully recovery. One case in the fluoroscopy group obtained fully recovery. Conclusions: The intraoperative three dimensional navigation can precisely locate the bone bridge. The physeal bar resection is an effective technique in some post-traumatic distal radius partial physeal arrest.

Genome-wide analysis of GRAS transcription factor gene family in Gossypium hirsutum L.

BACKGROUND: Cotton is a major fiber and oil crop worldwide. Cotton production, however, is often threatened by abiotic environmental stresses. GRAS family proteins are among the most abundant transcription factors in plants and play important roles in regulating root and shoot development, which can improve plant resistance to abiotic stresses. However, few studies on the GRAS family have been conducted in cotton. Recently, the G. hirsutum genome sequences have been released, which provide us an opportunity to analyze the GRAS family in G. hirsutum. RESULTS: In total, 150 GRAS proteins from G. hirsutum were identified. Phylogenetic analysis showed that these GRAS protins could be classified into 14 subfamilies including SCR, DLT, OS19, LAS, SCL4/7, OS4, OS43, DELLA, PAT1, SHR, HAM, SCL3, LISCL and G_GRAS. The gene structure and motif distribution analysis of the GRAS members in G. hirsutum revealed that many genes of the SHR subfamily have more than one intron, which maybe a kind of form in the evolution of plant by obtaining or losing introns. Chromosomal location and duplication analysis revealed that segment and tandem duplication maybe the reasons of the expension of the GRAS family in cotton. Gene expression analysis confirmed the expression level of GRAS members were up-regulated under different abiotic stresses, suggesting that their possible roles in response to stresses. What's more, higher expression level in root, stem, leaf and pistil also indicated these genes may have effect on the development and breeding of cotton. CONCLUSIONS: This study firstly shows the comprehensive analysis of GRAS members in G. hirsutum. Our results provide important information about GRAS family and a framework for stress-resistant breeding in G. hirsutum.

Evaluation of a Novel Single-Tube Method for Extended Genotyping of Human Papillomavirus.

The use of high-risk human papillomavirus (HPV) testing for surveillance and clinical applications is increasing globally, and it is important that tests are evaluated to ensure they are fit for this purpose. In this study, the performance of a new HPV genotyping test, the Papilloplex high-risk HPV (HR-HPV) test, was compared to two well-established genotyping tests. Preliminary clinical performance was also ascertained for the detection of CIN2+ in a disease-enriched retrospective cohort. A panel of 500 cervical liquid-based cytology samples with known clinical outcomes were tested by the Papilloplex HR-HPV test. Analytical concordance was compared to two assays: a Linear Array (LA) HPV genotyping test and an Optiplex HPV genotyping test. The initial clinical performance for the detection for CIN2+ samples was performed and compared to that of two clinically validated HPV tests: a RealTime High-Risk HPV test (RealTime) and a Hybrid Capture 2 HPV test (HC2). High agreement for HR-HPV was observed between the Papilloplex and LA and Optiplex HPV tests (97 and 95%, respectively), with kappa values for HPV16 and HPV18 being 0.90 and 0.81 compared to the LA and 0.70 and 0.82 compared to the Optiplex test. The sensitivity, specificity, positive predictive value, and negative predictive value of the Papilloplex test for the detection of CIN2+ were 92, 54, 33, and 96%, respectively, and very similar to the values observed with RealTime and HC2. The Papilloplex HR-HPV test demonstrated a analytical performance similar to those of the two HPV genotyping tests at the HR-HPV level and the type-specific level. The preliminary data on clinical performance look encouraging, although further longitudinal studies within screening populations are required to confirm these findings.

Magnetic graphene enabled tunable microwave absorber via thermal control.

By synthesizing nitrogen-doped graphene (NG) via a facile thermal annealing method, a fine control of the amount and location of doped nitrogen as well as the oxygen-containing functional groups is achieved with varying annealing temperature. The favorable magnetic properties have been achieved for N-doped rGO samples obtained at two temperatures of all NG samples, i.e., 500 °C and 900 °C with saturation magnetization of 0.63 emu g-1 and 0.67 emu g-1 at 2 K, respectively. This is attributed to the optimized competition of the N-doping and reduction process at 500 °C and the dominated reduction process at 900 °C. NG obtained at 300 °C affords the best overall absorbing performance: when the absorber thickness is 3.0 mm, the maximum absorption was -24.6 dB at 8.51 GHz, and the absorption bandwidth was 4.89 GHz (7.55-12.44 GHz) below -10 dB. It owes its large absorbing intensity to the good impedance match and significant dielectric loss. The broad absorption bandwidth benefits from local fluctuations of dielectric responses contributed by competing mechanisms. Despite the significant contribution from materials loss to the absorption, the one quarter-wavelength model is found to be responsible for the reflection loss peak positions. Of particular significance is that an appropriate set of electromagnetic parameters associated with reasonable reduction is readily accessible by convenient control of annealing temperature to modulate the microwave absorbing features of graphene. Thus, NG prepared by thermal annealing promises to be a highly efficient microwave absorbent.