[Disease burden of acute viral hepatitis in Guangdong Province, 1990-2019].

Objective: To examine the burden and trends of acute viral hepatitis in Guangdong Province from 1990 to 2019, and provide reference evidences for hepatitis prevention and control in the province. Methods: Data on acute viral hepatitis (hepatitis A, B, C, and E) in Guangdong from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 database. The incidence, prevalence, mortality, and disability-adjusted life years (DALY) data were analyzed by age and gender, and the estimated annual percentage change (EAPC) was calculated to describe the changing trends in disease burden. Results: From 1999 to 2019, the standardized incidence, prevalence, mortality, and DALY of acute viral hepatitis in Guangdong were higher than the national averages. In 2019, 51.43% (2 245 087/4 365 221) of acute viral hepatitis cases in Guangdong Province were mainly attributed to hepatitis B, and 77.18% (106/138) of deaths were due to acute hepatitis B. In different age groups, except for acute hepatitis B, which was more common in adults, the incidence rates of other types of viral hepatitis such as hepatitis A, B, and E showed an overall decreasing trend with age. The mortality rates of different types of acute viral hepatitis, except for the <5 age group, increased with age. The overall incidence and mortality rates of acute viral hepatitis were higher in men than in women. Conclusions: The overall burden of acute viral hepatitis in Guangdong declined in 2019, but remained higher than the national level. Further efforts are needed to strengthen hepatitis prevention and screening in different population in Guangdong Province, especially in children and the elderly.

Triple-negative breast carcinomas of low malignant potential: review on diagnostic criteria and differential diagnoses.

Triple-negative breast carcinomas constitute a wide spectrum of lesions, mostly being highly aggressive. Nevertheless, some special histologic subtypes can have low malignant potential. The purpose of the present paper is to review diagnostic criteria and prognostic parameters of breast neoplasms of special histotypes. Specifically, adenoid cystic carcinoma, adenomyoepithelioma, acinic cell carcinoma, mucoepidermoid carcinoma, tall cell carcinoma with reverse polarity, and secretory carcinoma will be discussed. For each tumour, definition and morphological and molecular features, together with prognostic parameters, will be presented. Paradigmatic cases will be illustrated.

Development of Integrated Device of Trace Bloodstains Imaging and Age Analysis.

ABSTRACT: Objective To develop a device of trace bloodstains imaging and age analysis, so as to provide a non-destructive, simple and objective method for age estimation of bloodstains at the crime scene. Methods Based on the principle of digital imaging and color pattern analysis, the mobile terminal of the device was used to collect images of bloodstains of different ages. The time-dependent pattern of 6 parameters （R, G, B, C, Y, M） reflecting the changes of color of images of different ages was obtained by computer image analysis. A multiparameter comprehensive inference equation of bloodstains age was established and embedded into the device software to realize the intelligent inference of the bloodstains age. Then the capability and reliability of the device was verified. Results This integrated device of bloodstains imaging and age analysis could quickly collect bloodstains at the crime scene and automatically analyze and infer the age of bloodstains combined with related intelligence software. In the blind test, the detection accuracy of this device was 95% in both natural light airtight group and dark airtight group, and 80% in the natural light ventilation group. Conclusion The integrated device of trace bloodstains imaging and age analysis can be used in a simple manner, which provides a new objective method for bloodstains age estimation.

Neoadjuvant chemotherapy with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable esophageal squamous cell carcinoma: a prospective nonrandomized trial for short-term outcomes.

Neoadjuvant chemotherapy (NAC) significantly extends survival in advanced esophageal squamous cell carcinoma (ESCC), but the short-term outcomes for cT4 ESCC remain controversial. Many NAC regimens have been previously reported, although no study has reported a regimen of irinotecan and nedaplatin for cT4 potential resectable ESCC. We evaluated the short-term outcomes of NAC with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable ESCC. A total of 51 patients with cT4 potentially resectable ESCC were eligible for this study. Twenty of these patients underwent NAC, and the other 31 patients underwent surgery alone. The toxicities and response of NAC were evaluated. The clinicopathologic characteristics, responses, toxicities, surgical outcomes, postoperative complications, and survival time between the two groups were analyzed. No significant differences were found in clinicopathologic characteristics between the groups (P > 0.05). The response rate of NAC was 75% (15/20). The differences in the long-axis diameter of the tumor and cT stage between pre- and post-NAC were significant (P < 0.05). Twenty-four toxic events occurred in 11 patients of the NAC group, and 20/24 of these were mild. The R0 resection rates in the NAC group and the surgery alone group were 85% and 64.5%, with no statistically significant difference (P > 0.05). Differences in the pathological T stage and pathological tumor-node-metastasis (TNM) stage were significant (P < 0.05). The overall survival (OS) time and mortality in the NAC group versus the surgery alone group were 31.57 ± 3.06 months versus 15.24 ± 1.46 months and 25% versus 61.3%, respectively. The differences in OS and mortality were significant (P < 0.05). The NAC group and R0 resection were significant and independent predictors of positive prognosis. NAC with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable ESCC as a new NAC is safe and effective.

Regulation of murine Ada gene expression in the placenta by transcription factor RUNX1.

The formation of the trophoblast cell lineage of the placenta is one of the first developmental events to occur in mammalian embryogenesis. To understand the mechanisms of gene regulation in the trophoblast cell lineage we have used the murine adenosine deaminase gene (Ada) as a model. Ada is highly expressed in trophoblast cells of the placenta and is critical for embryo development. A 770bp fragment of the mouse Ada 5' flanking region is capable of directing trophoblast cell-specific expression in a transgenic model system. Earlier studies identified several critical portions of this fragment, including three footprinting regions that are necessary for correct gene expression in the placenta. Using electromobility shift assays (EMSA), we identified a 5bp sequence within footprint 3 that computer databases predicted bound to the transcription factor RUNX1 (also known as acute myeloid leukemia 1). This prediction was confirmed by supershift analysis using antibodies specific for RUNX1. The functional importance of this binding was demonstrated by both transient transfections and transgenic approaches. A significant reduction in expression of the reporter gene in the placenta was seen when the 5bp RUNX1 binding site was mutated. The findings reported here indicate that the RUNX1 transcription factor plays a significant role in regulating Ada gene expression in the trophoblast cell lineage.

mTOR: a placental growth signaling sensor.

The proliferation and differentiation of trophoblast cells is under the control of a variety of hormones and growth factors and is influenced by nutrient availability. The intracellular signaling pathways acting downstream of these mitogenic factors and nutrients to regulate trophoblast proliferation and placental development are poorly understood. Immortalized human trophoblast cells were used (HTR-8/SVneo) to investigate trophoblast proliferation in response to angiopoietin-2 (Ang-2), a major angiogenic factor and glucose (a major nutrient). Trophoblast cell proliferation was induced through activation of the phosphatidylinositol-3 (PI-3) kinase and the mammalian target of rapamycin (mTOR) signaling pathways, following Tie-2 receptor activation. Glucose also stimulated trophoblast cell proliferation through mTOR signaling. Ang-2 activated mTOR via PI-3 kinase-dependent signaling; whereas glucose-mediated mTOR activation was PI-3 kinase-independent and involved a novel nutrient sensor, glutamine fructose-6-phosphate amidotransferase (GFAT). Metabolites of the GFAT reaction acted upstream of mTOR and functioned as a nutrient sensor to regulate trophoblast cell proliferation in response to glucose. Overall, the results show that growth factor and nutrient signaling converge at tuberin, an upstream regulator of mTOR and that mTOR functions as an important placental growth signaling sensor. These results are the first to link mTOR with GFAT metabolites as nutrient sensors for trophoblast cell proliferation.

Surgical treatment of recurrent carotid artery stenosis and carotid artery stenosis after neck irradiation: evaluation of operative risk.

Surgical treatment of recurrent carotid artery stenosis after endarterectomy and carotid artery stenosis after neck irradiation purportedly has a higher complication rate than primary carotid endarterectomy (CEA). Accordingly, carotid angioplasty has been proposed as a safer alternative. The purpose of this study was to evaluate operative risks on the basis of our experience with these lesions. A series of 679 carotid revascularizations (CRV) performed over a period of 9 years was retrospectively reviewed. Immediate outcome and operative technique was analyzed in three groups: group 1 included 549 "routine" CRV, group 2 included 8 CRV for recurrent stenosis after CEA, and group 3 consisted of 11 CRV for stenosis after neck irradiation. No difference in revascularization techniques was found between groups 1 and 2. In contrast there were fewer CEA and resection-anastomosis procedures in group 2 than in group 1 (62.5% vs. 98.2%; p < 0.0006) and more bypass procedures (37.5% vs. 1.8%; p = 0.0015). The cumulative neurological morbidity/mortality rate (CMMR) was 0% in groups 2 and 3 as compared to 4.4% in group 1. In comparison with group 1, early and permanent neurological morbidity rates were significantly higher in both group 2 (2.2% vs. 25.0%; p = 0.015 and 0.2% vs. 12.5%; p = 0.028, respectively) and group 3 (2.2% vs. 18.2%; p = 0.028 and 0.2% vs. 9.1%; p = 0.039, respectively). Surgical treatment of recurrent stenosis after CEA and stenosis after neck irradiation is not associated with a higher CMMR. The only potentially valid justification for using percutaneous transluminal angioplasty in these patients would be a higher risk of cervical neurological morbidity.

The adenylosuccinate synthetase-1 gene is activated in the hypertrophied heart.

Adenylosuccinate synthetase 1 (ADSS1) functions as an important component in adenine nucleotide biosynthesis and is abundant in the heart. Here we report that the Adss1 gene is up-regulated in two in vivo rodent models of surgically induced cardiac hypertrophy. In addition, we examined an in vitro hypertrophy system of rat neonatal cardiomyocytes treated with angiotensin II to study Adss1 gene regulation. We show that this stimulus triggers a signaling cascade that results in the activation of the Adss1 gene. The induction of Adss1 gene expression was blocked by cyclosporin A in vitro, suggesting that calcineurin, a calmodulin activated phosphatase, is involved in this signaling pathway. Consistent with this view we provide evidence that the induction of Adss1 by angiotension II requires the presence of an NFAT binding site located 556 base pairs upstream of the Adss1 transcription start site. We propose that ADSS1 plays a role in the development of cardiac hypertrophy through its function in adenine nucleotide biosynthesis.

Recurrence of pneumococcal meningitis due to primary spontaneous cerebrospinal fluid fistulas.

The authors report a case of pneumococcal meningitis which recurred 3 times in a Taiwanese boy due to spontaneous cerebrospinal fluid (CSF) fistulas. The first time occurred at the age of 2 years, and the second episode presented as meningoencephalomyelitis at the age of 6 years 10 months. Studies including serum levels of immunoglobulin and complements, brain magnetic resonance imaging, and coronal cranial computed tomography (CT) were negative for a specific etiology. The third episode of meningitis developed 2 months after the second episode. Repeated immunological studies and high-resolution CT of paranasal sinuses and temporal bones were negative. Technetium-99m diethylenetriamine pentaacetic acid (Tc-99m-DTPA) radionuclide cisternography revealed abnormal retention of radioactivity over the right mastoid area. Neurosurgery was undertaken to seal the dural tear and pack the petrosal fissure. Two years after surgery, he has had no further CSF leak age or meningitis. Tracing back the history, there was no head injury, cranial surgery, brain tumor, or hydrocephalus, which might have created CSF fistulas. Primary spontaneous CSF fistulas constitute the most reasonable diagnosis. In cases of recurrent bacterial meningitis, underlying anatomic defects should be carefully evaluated if there is no immune defect.

Performance of the annular denuder system with different arrangements for HNO3 and HNO2 measurements in Taiwan.

Experiments on different annular denuder system (ADS) arrangements for sampling nitrous acid (HNO2) and nitric acid (HNO3) gases were conducted in this study to evaluate their sampling artifacts. The evaluation basis is the one that employed one sodium chloride denuder for sampling HNO3 gas and two sodium carbonate (Na2CO3) denuders for sampling HNO2 gas, which is a commonly employed ADS arrangement in many field applications in the United States. A field study was conducted in Hsinchu, Taiwan, and the results indicated that this ADS arrangement may yield over 80% relative errors for HNO3 gas. It also showed that the relative errors for HNO2 gas can be less than 10% as sampled with only one Na2CO3 denuder. This is attributed to the fact that the ambient HNO3 concentration measured in this study was relatively low while the HNO2 concentration was high, as compared to typical concentrations of these two gases measured in the United States. The sampling error of HNO3 gas may be due to high concentrations of N-containing interfering species present in Taiwan's atmosphere. Because the relative sampling errors of HNO3 and HNO2 gases depend mainly on their concentrations in the atmosphere as well as concentrations caused by interfering species, the risk for high error while measuring low HNO2 concentrations by only one Na2CO3 denuder is also possible. As a result, it is suggested that pretests are necessary to evaluate possible sources and degrees of sampling errors before field sampling of HNO2 and HNO3 gases. The sampling errors of these two gases can, therefore, be minimized with a better arrangement of the ADS.

Bioavailability of selenium from veal, chicken, beef, pork, lamb, flounder, tuna, selenomethionine, and sodium selenite assessed in selenium-deficient rats.

The bioavailability of selenium (Se) from veal, chicken, beef, pork, lamb, flounder, tuna, selenomethionine (SeMet), and sodium selenite was assessed in Se-deficient Fischer-344 rats. Se as veal, chicken, beef, pork, lamb, flounder, tuna, SeMet, and sodium selenite was added to torula yeast (TY) basal diets to comprise Se-inadequate (0.05 mg Se/kg) diets. Se as sodium selenite was added to a TY basal diet to comprise a Se-adequate (0.10 mg Se/kg), Se-control diet. The experimental diets were fed to weanling Fischer-344 rats that had been subjected to dietary Se depletion for 6 wk. After 9 wk of the dietary Se repletion, relative activity of liver glutathione peroxidase (GSHPx) from the different dietary groups compared with control rats (100%) was: flounder 106%, tuna 101%, pork 86%, sodium selenite 81%, SeMet 80%, beef 80%, chicken 77%, veal 77%, and lamb 58%. Se from flounder was the most efficient at restoring Se concentrations in the liver and skeletal muscle. Se from sodium selenite, SeMet, beef, veal, chicken, pork, lamb, and tuna was not dietarily sufficient to restore liver and muscle Se after 9 wk of recovery following a 6-wk period of Se depletion.