Fibrocartilaginous lipoma: a clinicopathological analysis of six cases / 中华病理学杂志

Objective: To investigate the clinicopathological characteristics, immunophenotype, molecular genetics and differential diagnoses of fibrocartilaginous lipomas which consist of adipose tissue, fibrocartilage and fibrous elements. Methods: The clinicopathological features, immunohistochemical profiles and molecular profiles in six cases of fibrocartilaginous lipomas diagnosed at Foshan Traditional Chinese Medicine Hospital, Fudan University Shanghai Cancer Center, the Fifth Affiliated Hospital of Zhengzhou University and the Fourth Affiliated Hospital of Harbin Medical University from January 2017 to February 2022 were included. The follow-up information, diagnosis and differential diagnoses were evaluated. Results: There were three males and three females with a median age of 53 years (range 36-69 years) at presentation. Tumors were located in the extremities, the head and neck region and trunk; and presented as painless masses that were located in the subcutaneous tissue or deep soft tissue. Grossly, three cases were well defined with thin capsule, one case was well circumscribed without capsule, two cases were surrounded by some skeletal muscle. The tumors were composed of fatty tissue with intermingled gray-white area. The tumors ranged from 1.50-5.50 cm (mean 2.92 cm). Microscopically, the hallmark of these lesions was the complex admixture of mature adipocytes, fibrocartilage and fibrous element in varying proportions; the fibrocartilage arranged in a nodular, sheet pattern with some adipocytes inside. Tumor cells had a bland appearance without mitotic activity. Immunohistochemical analysis using antibodies to SMA, desmin, S-100, SOX9, HMGA2, RB1, CD34, adipopholin was performed in six cases; the fibrocartilage was positive for S-100 and SOX9, adipocytes were positive for S-100, adipopholin and HMGA2; CD34 was expressed in the fibroblastic cells, while desmin and SMA were negative. Loss of nuclear RB1 expression was not observed. Other genetic abnormalities had not been found yet in four cases. Follow-up information was available in six cases; there was no recurrence in five, and one patient only underwent biopsy of the mass. Conclusions: Fibrocartilaginous lipoma is a benign lipomatous tumor with mature adipocytes, fibrocartilage and fibrous elements. By immunohistochemistry, they show the expression of fat and cartilage markers. No specific molecular genetics changes have been identified so far. Familiarity with its clinicopathological features helps the distinction from its morphologic mimics.

Machine Learning-Based Prediction of COVID-19 Severity and Progression to Critical Illness Using CT Imaging and Clinical Data

Objective@#To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables. @*Materials and Methods@#Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists. @*Results@#Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively. @*Conclusion@#CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.

Machine Learning-Based Prediction of COVID-19 Severity and Progression to Critical Illness Using CT Imaging and Clinical Data

Objective@#To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables. @*Materials and Methods@#Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists. @*Results@#Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively. @*Conclusion@#CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.

Fructose and metabolic diseases: too much to be good / 中华医学杂志(英文版)

Excessive consumption of fructose, the sweetest of all naturally occurring carbohydrates, has been linked to worldwide epidemics of metabolic diseases in humans, and it is considered an independent risk factor for cardiovascular diseases. We provide an overview about the features of fructose metabolism, as well as potential mechanisms by which excessive fructose intake is associated with the pathogenesis of metabolic diseases both in humans and rodents. To accomplish this aim, we focus on illuminating the cellular and molecular mechanisms of fructose metabolism as well as its signaling effects on metabolic and cardiovascular homeostasis in health and disease, highlighting the role of carbohydrate-responsive element-binding protein in regulating fructose metabolism.

Trend of epidemics and variation of pathogens of hand, foot and mouth disease in China: a dynamic series analysis, 2008-2017 / 中华流行病学杂志

Objective: To understand the trend of epidemics and variation of pathogens on hand, foot and mouth diseases (HFMD) in China for setting up appropriate intervention measures. Methods: Data related to reported cases and outbreaks of HFMD from the National Notifiable Disease Surveillance Reporting System of China, 2008 to 2017, was collected and analyzed. Based on the geographical location and types of climate, the total 31 provinces, autonomous regions and municipalities in the mainland of China, were divided into seven regions: north-west, north, mid-north, east, mid-south, south, and south-west regions, with epidemic trends and variation of pathogens analyzed. The average speed of growth on the dynamic series from 2008 to 2017 was calculated, using the Geometric Average method. Results: The overall reported incidence rate of HFMD during 2008-2017 was 134.59 per 100 000 population with an average increase of 15.92%. The proportion of severe cases was 0.84%, with 9.56% increase. The reported mortality rate of HFMD was 0.03/100 000, with an average decrease of 3.49%. The case fatality rate was 0.02% and with a decrease of 16.86%. A total of 6 000 outbreaks were reported during the decade. Except for 1.09% decrease on the incidence rate in the north region, all the other regions showed an increase on the morbidity rates, with the highest as25.20% in the south region. Mortality rates showed 27.53% and 0.60% increases in both the south-west and mid-north regions, respectively. Mortality rates in the other regions all showed a decreasing trend. In terms of case fatality rate, it increased 4.15% in the south-west region while all decreased in the other regions. Two higher age-special morbidity rates appeared in the 1 year olds as 3 184.19/100 000 and in the 2 year olds as 2 547.47/100 000, with the most increase seen in both 0 year (26.08%) and 1 year age groups (23.35%). High age-specific mortality rates were noticed in both the 1-year group as 0.86/100 000 and the 2-year group as 0.54/100 000, however with reductions as 1.21% and 10.70% respectively. As for the case fatalities, the 0 year olds and 1 year olds accounted for 0.039% and 0.027% but both of them had decreased by 19.12% and 19.91%, respectively. Case fatality rates decreased by 16.93% and 16.75%, in males and females. Proportions of EV71 and Cox A16 decreased by 4.28% and 3.07%, but the proportion of other entero-viruses increased by 16.07%. EV71 was responsible for the high frequency of epidemics in both mid-north and the mid-south regions. However, in other five regions, other strains of EV's were responsible for the epidemics. Conclusions: The characteristics of HFMD in China showed that the morbidity of HFMD and proportion of severe cases were both in increasing trends but both the mortality and case fatality of HFMD were decreasing. Children younger than 3 years old showed both high infection and death rates for HFMD. Epidemics caused by other enteroviruses of non-EV71 and non-Cox A16 were seen more. Variance and pathogens related to the epidemic cycles appeared different in the seven regions.

Application of miniSTR Loci and Its Detection System for Degraded Materials in Forensic Medicine / 法医学杂志

OBJECTIVES@#To establish multiplex system of 16 miniSTR loci, and explore its application value for the degraded materials in forensic medicine.@*METHODS@#The multiplex system of 16 miniSTR loci was established using a six-dye fluorescence labeling technology and its application value in forensic medicine was assessed.@*RESULTS@#A six-dye fluorescence labeling miniSTR amplification kit was developed, which enabled 15 autosomal STR loci, Amelogenin locus and DYS391 to be typed simultaneously. This method showed good specificity and could provide stable and accurate typing results with a sensitivity of 50 pg. This system also provided a good test result for the normal biological sample of actual cases.@*CONCLUSIONS@#The multiplex system of 16 miniSTR loci has application value for degraded and trace materials with the advantages of high sensitivity and database compatibility, which can be used for forensic casework.

Temporal-spatial analysis of bacillary dysentery in the Three Gorges Area of China, 2005-2016 / 中华流行病学杂志

Objective: To analyze the spatial and temporal distributions of bacillary dysentery in Chongqing, Yichang and Enshi (the Three Gorges Area) from 2005 to 2016, and provide evidence for the disease prevention and control. Methods: The incidence data of bacillary dysentery in the Three Gorges Area during this period were collected from National Notifiable Infectious Disease Reporting System. The spatial-temporal scan statistic was conducted with software SaTScan 9.4 and bacillary dysentery clusters were visualized with software ArcGIS 10.3. Results: A total of 126 196 cases were reported in the Three Gorges Area during 2005-2016, with an average incidence rate of 29.67/100 000. The overall incidence was in a downward trend, with an average annual decline rate of 4.74%. Cases occurred all the year round but with an obvious seasonal increase between May and October. Among the reported cases, 44.71% (56 421/126 196) were children under 5-year-old, the cases in children outside child care settings accounted for 41.93% (52 918/126 196) of the total. The incidence rates in districts of Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nanan, Yubei, Chengkou of Chongqing and districts of Xiling and Wujiagang of Yichang city of Hubei province were high, ranging from 60.20/100 000 to 114.81/100 000. Spatial-temporal scan statistic for the spatial and temporal distributions of bacillary dysentery during this period revealed that the temporal distribution was during May-October, and there were 12 class Ⅰ clusters, 35 class Ⅱ clusters, and 9 clusters without statistical significance in counties with high incidence. All the class Ⅰ clusters were in urban area of Chongqing (Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nanan, Beibei, Yubei, Banan) and surrounding counties, and the class Ⅱ clusters transformed from concentrated distribution to scattered distribution. Conclusions: Temporal and spatial cluster of bacillary dysentery incidence existed in the three gorges area during 2005-2016. It is necessary to strengthen the bacillary dysentery prevention and control in urban areas of Chongqing and Yichang.

Bibliometrics and visualization analysis of land use regression models in ambient air pollution research / 中华流行病学杂志

Objective: To quantitatively analyze the current status and development trends regarding the land use regression (LUR) models on ambient air pollution studies. Methods: Relevant literature from the PubMed database before June 30, 2017 was analyzed, using the Bibliographic Items Co-occurrence Matrix Builder (BICOMB 2.0). Keywords co-occurrence networks, cluster mapping and timeline mapping were generated, using the CiteSpace 5.1.R5 software. Relevant literature identified in three Chinese databases was also reviewed. Results: Four hundred sixty four relevant papers were retrieved from the PubMed database. The number of papers published showed an annual increase, in line with the growing trend of the index. Most papers were published in the journal of Environmental Health Perspectives. Results from the Co-word cluster analysis identified five clusters: cluster#0 consisted of birth cohort studies related to the health effects of prenatal exposure to air pollution; cluster#1 referred to land use regression modeling and exposure assessment; cluster#2 was related to the epidemiology on traffic exposure; cluster#3 dealt with the exposure to ultrafine particles and related health effects; cluster#4 described the exposure to black carbon and related health effects. Data from Timeline mapping indicated that cluster#0 and#1 were the main research areas while cluster#3 and#4 were the up-coming hot areas of research. Ninety four relevant papers were retrieved from the Chinese databases with most of them related to studies on modeling. Conclusion: In order to better assess the health-related risks of ambient air pollution, and to best inform preventative public health intervention policies, application of LUR models to environmental epidemiology studies in China should be encouraged.

Incidence of fall related injury in people aged 50 and above and risk factors in 8 provinces in China: a cross-sectional study / 中华流行病学杂志

Objective: To estimate the incidence and distribution characteristics of fall related injury in people aged ≥50 years in 8 provinces in China and related physiological, psychological and social risk factors. Methods: Cross-sectional data were collected from adults aged ≥50 years participating in the World Health Organization (WHO) study on global ageing and adult health (SAGE) round 1 in China. Two-level hierarchical logistic model was used to identify the related factors for fall-related injury. All the models were stratified by living area (urban/rural). Results: Estimated incidence of fall related injury (road traffic injury was not included) was 3.2%. Ageing and multiple chronic conditions (OR=2.55, 95%CI: 1.41-4.64) was significantly associated with the incidence of fall related injury in urban area. In rural area, depression (OR=4.33, 95% CI: 2.52-7.42) and multiple chronic conditions (OR=2.46, 95%CI: 1.37-4.41) were associated with the incidence of fall related injury. Conclusions: This study estimated the incidence of fall related injury in adults aged ≥50 years in 8 provinces in China. A significant association between multiple chronic conditions and fall related injury were found in both urban and rural residents. Targeted measures should be taken for the prevention and control of chronic diseases in elderly population.

Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases / 中华流行病学杂志

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention (OR=6.591, 95%CI: 5.188-8.373), salt reduction (OR=1.352, 95%CI: 1.151-1.589), oil reduction (OR=1.477, 95%CI: 1.249-1.746) and recommendation on physical activities (OR=1.975, 95%CI: 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local platform for the control and prevention of non-communicable diseases, and thus become an important 'carrier' for chronic disease prevention and control programs in China.