Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery:A case report

BACKGROUND With the popularization of various cerebrovascular imaging methods and increased attention to the field,more cerebrovascular diseases are being detected in asymptomatic patients.Different cerebrovascular diseases are typically isolated but occasionally occur simultaneously,causing difficulties in diagnosis and treatment.Morphological changes in the collateral circulation of blood vessels in chronic cerebral artery occlusion patients are slow and dynamic,intercepting morphological development at a specific moment.Excessive reliance on single imaging tests such as digital subtraction cerebral angiography(DSA)can lead to misdiagnosis.CASE SUMMARY We report a 52-year-old male who was admitted to our department for treatment of an unruptured aneurysm during a follow-up examination for brain trauma after 1 mo.Computed tomography(CT)scan was negative,but CT angiography(CTA)revealed a sac-like bulge at the bifurcation of the left middle cerebral artery.DSA revealed an unruptured aneurysm with unique scapular morphology.The stump of a middle cerebral artery occlusion was observed during exposure during aneurysm clipping surgery,and the diagnosis of chronic cerebral artery occlusion was confirmed intraoperatively.This case was confusing because of the peculiar morphology of the arterial stump and compensatory angiogenesis due to multiple cerebral artery stenoses observed on preoperative CTA and DSA.The surgery did not cause secondary damage to the patient,and medical treatment for risk factors was continued postoperatively.CONCLUSION Multiple cerebral arterial stenoses can occur in conjunction with aneurysms or arteriovenous malformations,and their unique morphology can lead to misdiagnosis.

Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

Virus load and virus shedding of SARS-CoV-2 and their impact onpatient outcomes

BACKGROUND Understanding a virus shedding patterns in body fluids/secretions is importantto determine the samples to be used for diagnosis and to formulate infectioncontrol measures.AIM To investigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)shedding patterns and its risk factors.METHODS All laboratory-confirmed coronavirus disease 2019 patients with completemedical records admitted to the Shenzhen Third People’s Hospital from January28, 2020 to March 8, 2020 were included. Among 145 patients (54.5% males;median age, 46.1 years), three (2.1%) died. The bronco-alveolar lavage fluid(BALF) had the highest virus load compared with the other samples. The viralload peaked at admission (3.3 × 108 copies) and sharply decreased 10 d afteradmission.RESULTS The viral load was associated with prolonged intensive care unit (ICU) duration.Patients in the ICU had significantly longer shedding time compared to those inthe wards (P < 0.0001). Age > 60 years [hazard ratio (HR) = 0.6;95% confidenceinterval (CI): 0.4-0.9] was an independent risk factor for SARS-CoV-2 shedding,while chloroquine (HR = 22.8;95%CI: 2.3-224.6) was a protective factor.CONCLUSION BALF had the highest SARS-CoV-2 load. Elderly patients had higher virus loads,which was associated with a prolonged ICU stay. Chloroquine was associatedwith shorter shedding duration and increased the chance of viral negativity.

FREQUENT ALLELIC IMBALANCE AND CYTOGENETIC DELETION ON THE SHORT ARM OF CHROMOSOME 1 IN NASOPHARYNGEAL CARCINOMA

Objective: To construct a fine map of the loss of chromosome lpter-p36.11 region in nasopharyngeal carcinoma (NPC) using PCR-LOH technique. Methods: DNA extracted from separated cancerous cells and their mated noncancerous lymphocytes from 47 cases of NPC biopsies were analyzed by means of PCR-LOH to detect 20 loci spanning chromosome lpter-p36.11 region in NPC. Results: In 47 NPC cases, 37 (82.2%) cases showed at least one loci LOH. The highest frequency of less of heterozygosity (LOH) at all 20 loci was found at loci DIS234 (50. 0%) on lp36.13 and loci DlS2644 (37.5%) on lp36.22. There was a statistically significant difference between DlS234 LOH frequency (60%, 9/15) in early stage and that (50. 0%, 8/16) in advanced stage (P>0.05). Of all 20 STSs (sequence tqgged-site, STS), DIS243 (37.5%) and DIS199 (30.2%) showed the highest frequency of MI (microsatellite instability) on lp36.33 and lp36.21, respectively. In addition, several cases showed a contiguous stretch of allelic loss in a different level. Conclusion: Two minimal deletion regions (MDR) on the short arm of chromosome 1 were seated at lp36.13 (DIS234, 2.0 cm) and lp36.22 (DIS436-DIS2644, 6.3 cm) respectively, indicating that one or more candidate tumor suppressor gene (TSG) in the two regions may be involved in NPC pathogenesis in an early clinical stage.

Transforaminal Endoscope for the Treatment of Thoracic Disc Herniation

Objective:Transforaminal endoscope was used in the treatment of thoracic disc herniation and the therapeutic effect was discussed.Methods:Sixteen patients with thoracic disc herniation admitted to our hospital from October 2018 to May 2019 were divided into control group and observation group according to the random number table method,with 8 patients in each group.The control group was treated with posterior laminectomy approach,and the observation group was treated with transforaminal endoscope.The surgery-related conditions(intraoperative blood loss,surgery time,and postoperative drainage volume),VAS score,JOA score and postoperative complications were compared and analyzed.Results:There was no statistically significant difference between the two groups in the total effective rate and preoperative VAS score(P>0.05).Compared with the control group,the observation group had shorter surgery time and incision length,less postoperative drainage volume,and higher VAS score 3 days after surgery,JOA score on day 7 after surgery,and JOA score 3 months after surgery,showing statistically significant differences(P<0.05).There was no significant difference in the complications between the two groups(X2=1.067,P=0.833).Conclusions:Transforaminal endoscope had a good clinical effect with small incision and injury in the treatment of patients with thoracic disc herniation.

Preliminary study of transforaminal endoscope in the treatment of spinal metastasis

Objective:To investigate the therapeutic effect of transforaminal endoscope in patients with spinal metastases.Methods:Clinical data of 28 patients with spinal metastases admitted to our hospital from May 2015 to May 2019 were retrospectively collected.According to different surgical methods,they were divided into control group(20 cases)and experimental group(8 cases),among which control group was treated with traditional open palliative decompression,while the experimental group was treated with transforaminal endoscopic decompression.The surgery and recovery indicators were compared between the two groups,including surgery time,incision length,postoperative drainage volume,out of bed activity time,length of hospital stay,the Japanese Orthopaedic Association(JOA)scores of 7 days after surgery,pain degree,complications(wound infection,transient reduction of muscle strength,hypoproteinemia with wound drainage and delayed healing),and activity of daily living.Results:The surgery time,incision length,postoperative drainage volume,out of bed activity time,and postoperative length of hospital stay of the experimental group were all less than those of the control group,and the JOA score of 7 days after surgery was higher than that of the control group,showing statistically significant differences(P<0.05).VAS scores of the experimental group on the day 1 and day 7 after surgery were lower than those of the control group,with statistically significant differences(P<0.05).The incidence of complications in the experimental group was slightly lower than that in the control group,but the difference was not significant(P>0.05).Conclusions:Transforaminal endoscope used in suitable patients with spinal metastases can greatly reduce the incision length,soft tissue and bone tissue damages,and postoperative drainage,promote early mobilization and early discharge,and reduce a series of complications due to hemorrhage and hypoproteinemia,which has a better early clinical effect in comparison with the traditional open palliative decompression.

In situ immunomodulation of tumors with biosynthetic bacteria promote anti-tumor immunity

Immune checkpoint blockade(ICB)therapy potently revives T cell’s response to cancer.However,patients suffered with tumors that had inadequate infiltrated immune cells only receive limited therapeutic benefits from ICB therapy.Synthetic biology promotes the alternative strategy of harnessing tumor-targeting bacteria to synthesize therapeutics to modulate immunity in situ.Herein,we engineered attenuated Salmonella typhimurium VNP20009 with gene circuits to synthetize granulocyte-macrophage colony-stimulating factor(GM-CSF)and interleukin 7(IL-7)within tumors,which recruited dendritic cells(DCs)and enhanced T cell priming to elicit anti-tumor response.The bacteria-produced GM-CSF stimulated the maturation of bone marrow-derived dendritic cells(BMDCs),while IL-7 promoted the proliferation of spleen isolated T cells and inhibited cytotoxicity T cell apoptosis in vitro.Virtually,engineered VNP20009 prefer to colonize in tumors,and inhibited tumor growth by enhancing DCs and T cell infiltration.Moreover,the tumor-toxic GZMB^(+)CD8^(+)T cell and IFN-γ^(+)CD8^(+)T cell populations conspicuously increased with the treatment of engineered bacteria.The combination of GM-CSF-IL-7-VNP20009 with PD-1 antibody synergistically stunted the tumor progress and metastasis.

Screening of differentially expressed microRNA in ulcerative colitis related colorectal cancer

Objective:To investigate the differential expression of microRNA(miRNA)in colon between ulcerative colitis(UC)and ulcerative colitis related colorectal cancer(UCRCC).Methods:An UC mouse model was built by dextran sodium sulfate,and an UCRCC mouse model by dextran sodium sulfate and 1,2-diformylhydrazine.RNAs were extracted from the colon,purified and hybridized with fluorescence-labeled miRNA oligonucleotide gene chip.Real-time fluorescence quantitative PCR was used to verity the expression variation of miRNA.SAM was employed for the data analysis.Results:The up-regulated miRNA in colon cancer included has-miR-194,hasmiR-215,has-miR-93,has-miR-192,has-miR-92a,has-miR-29b,and has-miR-20a(median false discovery rate<5%),while the down-regulated miRNAs were has-miR-1231,has-miR-195,has-miR-143,and has-miR-145(median false discovery rate<5%).Conclusions:Significant differential expression of miRNA was found between the UC mouse and UCRCC mouse,which may be related to the onset,erosion and transfer of colorectal cancer.

EXPRESSION OF P53 PROTEIN AND PROLIFERATING CELL NUCLEAR ANTIGEN IN HUMAN GESTATION TROPHOBLASTIC DISEASE

To study the relationship between p53 protein, proliferating cell nuclear antigen (PCNA) expression and benign or malignant gestational trophoblastic disease (MGTD). Methods: The histotomic sections of 48 patients with gestational trophoblastic disease and 24 patients of normal chorionic villi were stained using immunohistochemistry. The monoclonal antibodies were used to determine p53 protein and PCNA. Results: The frequency of p53 and PCNA positive expression were significantly different among the chorionic villi of normal pregnancy, hydratidiform mole (HM) and MGTD. But neither p53 nor PCNA has any relation with the clinical staging or metastasis of MGTD. Conclusion: Both P53 and PCNA are valuable in diagnosis of human gestational trophoblastic disease.

Clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei infection

Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei (PM) infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results (1) The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture. All the 12 cases (100%) had irregular fever (38-41 ) and enlarged lymph nodes, 8 cases (66%) had skin rashes; 8 cases (66%) had hepatomegaly; 9 cases (75%) had splenomegaly while 8 cases (66%) had anemia. (2) Imaging manifestation: Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 cases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung, and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS (CD4 T lymphocytes <50/ u L) with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver, spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of "cakes".

Effects of glycemic control on refraction in diabetic patients

AIMTo evaluate the effects of glycemic control on refraction in diabetic patients.

Clinical diagnosis of severe COVID-19:A derivation and validation of a prediction rule

BACKGROUND The widespread coronavirus disease 2019(COVID-19)has led to high morbidity and mortality.Therefore,early risk identification of critically ill patients remains crucial.AIM To develop predictive rules at the time of admission to identify COVID-19 patients who might require intensive care unit(ICU)care.METHODS This retrospective study included a total of 361 patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction between January 19,2020,and March 14,2020 in Shenzhen Third People’s Hospital.Multivariate logistic regression was applied to develop the predictive model.The performance of the predictive model was externally validated and evaluated based on a dataset involving 126 patients from the Wuhan Asia General Hospital between December 2019 and March 2020,by area under the receiver operating curve(AUROC),goodness-of-fit and the performance matrix including the sensitivity,specificity,and precision.A nomogram was also used to visualize the model.RESULTS Among the patients in the derivation and validation datasets,38 and 9 participants(10.5%and 2.54%,respectively)developed severe COVID-19,respectively.In univariate analysis,21 parameters such as age,sex(male),smoker,body mass index(BMI),time from onset to admission(>5 d),asthenia,dry cough,expectoration,shortness of breath,asthenia,and Rox index<18(pulse oxygen saturation,SpO2)/(FiO2×respiratory rate,RR)showed positive correlations with severe COVID-19.In multivariate logistic regression analysis,only six parameters including BMI[odds ratio(OR)3.939;95%confidence interval(CI):1.409-11.015;P=0.009],time from onset to admission(≥5 d)(OR 7.107;95%CI:1.449-34.849;P=0.016),fever(OR 6.794;95%CI:1.401-32.951;P=0.017),Charlson index(OR 2.917;95%CI:1.279-6.654;P=0.011),PaO2/FiO2 ratio(OR 17.570;95%CI:1.117-276.383;P=0.041),and neutrophil/lymphocyte ratio(OR 3.574;95%CI:1.048-12.191;P=0.042)were found to be independent predictors of COVID-19.These factors were found to be significant risk factors for severe patients confirmed with COVID-19.The AUROC was 0.941(95%CI:0.901-0.981)and 0.936(95%CI:0.886-0.987)in both datasets.The calibration properties were good.CONCLUSION The proposed predictive model had great potential in severity prediction of COVID-19 in the ICU.It assisted the ICU clinicians in making timely decisions for the target population.

Clinical Application of PES Membrane Dialyzer

Objective The dialysate membrane can be classified into acetate membrane and synthetic membrane,while the latter can be further divided into polysulfone,polyacrylonitrile,etc.Polyethersulfone membrane is high molecular membrane material with excellent biocompatibility,stable mechanical properties,high temperature and pressure resistance,and good cleaning performance,which has been applied for more than 10 years.This trial is to assess the safety and efficacy of hollow polysulfone membrane fiber dialyzer with pattern number Enttex^(TM)-16LF(E60)for hemodialysis in patients with acute or chronic renal failure due to multiple factors.Methods Totally 76 patients receiving maintenance hemodialysis were included in a two-site,random,open label,two-stage,positive crossover and non inferiority validation study.The clinical efficacy and safety of the test device were observed,which was a hollow fiber dialyzer produced by Guangzhou Enttex Medical Products Co.,Ltd.,with polyethersulfone membrane imported from Germany.It was a low flux dialyzer with the pattern number of EnttexTM-16LF(E60).Inclusion criteria:①patients with acute or chronic renal failure due to various reasons who needed hemodialysis;②18 to 80 years old,gender unlimited;③patients who received stable dialysis for more than 3 months,regular hemodialysis 3 times a week,4 h at each time,blood flow rate of 200~350ml/min;④using bicarbonate dialysate at a flow rate of 500ml/min;⑤patients with arteriovenous fistula or who received artificial blood vessel puncture dialysis;received anticoagulation by heparin or low molecular weight heparin.Exclusion criteria:①patients needing heparin free dialysis for severe anemia,tumor and active bleeding;②patients with severe cardiac(gradeⅢcardiac function),hepatic(severe hepatitis and cirrhosis)and pulmonary diseases(severe respiratory failure).Results Comparison of parameters,including the changes of Kt/V,general creatinine and urea clearance rates and URR(urea reduction rate)shows no statistical significance in differences between the two devices,indicating that the test and control devices can equally and effectively eliminate toxins including creatinine and urea,etc.PPP and MITTP results are consistent.Comparison of ultrafiltration rates between two groups of patients shows no statistical difference.PPP and MITTP results are consistent,indicating that both the test device and control device can effectively eliminate water.In MITTP,electrolytes including K^+,Na^+,Cl^-,Ca^2+,HCO3^-,etc.show no statistical significance in difference between the test and control devices before and after dialysis(P>0.05).After treating by using test and control devices,body weight,serum potassium and phos-phorus all significantly decrease(P<0.001);serum Ca^2+,PO2,PCO2and HCO3^-all significantly increase(P<0.001).These results indicate that both the test and control devices can effectively eliminate serum potassium and phosphorus,and eliminate excess water in body,maintain the balance between liquid and electrolytes in patients.PPP and MITTP results are consistent.Conclusion This clinical trial confirms that hollow polyethersulfone membrane fiber dialyzer can be safely and effectively used in hemodialysis therapy.

Evaluation of optimized continuous venovenous hemodiafiltration therapy efficiency in severe burn patients with sepsis

As an initial factor,sepsis and multiple organ dysfunction syndrome(MODS)caused by sepsis are the principal causes of death in burned patients. In this report, we measured the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in severely burned patients with sepsis after the initiation of continuous vein-vein hemodiafiltration (CVVHDF) to evaluate the clinical usefulness of CVVHDF on the removal of key mediators. The vital sign indices, such as the heart rate (HR), respiration (R) and central venous pressure (CVP), were recorded at 0 and 42 h in each group. Further, the laboratory examinations indexes, such as the white blood cel count, blood sugar, se-rum sodium, blood urea nitrogen and serum creatinine, were detected in venous blood samples. Twenty-two severely burned patients suffering from sepsis were randomized into the control group (A, n = 11) and the experimental group (B, n = 11). The patients in group A underwent conventional treatment, and those in group B received conventional+CVVHDF treatment. The vital signs, such as the HR, R, and CVP, and laboratory examination indices, such as the blood cel count, blood sugar, serum sodium, blood urea nitrogen, and serum creatinine, dropped significantly in group B compared with those in group A at 42 h (P < 0.05). The plasma levels of TNF-α, IL-6 and IL-8 were measured at 0, 12, 18, 24, 36 and 42 h after the start of CVVHDF and at the same time points after the patients were diagnosed with sepsis in group A. The plasma levels of TNF-α in group B decreased by 32% at 18 h after the start of CVVHDF and decreased by 43%at 42 h after the start of CVVHDF;however, these levels were increased compared with the normal values (P < 0.01). The plasma levels of IL-6 decreased at 18 h after the start of CVVHDF (0.274 ± 0.137 ng/ml). Fol owing a brief increase at 24 h, the plasma levels of IL-6 again decreased continuously until the end of the investigation (0.192 ± 0.119 ng/ml). The plasma levels of IL-8 in group B decreased by 56% at 18 h after the start of CVVHDF, but they were increased compared with the normal values (P < 0.01). The plasma levels of IL-8 in group B decreased by 70% at 42 h after the start of CVVHDF, but they were increased compared with the normal values (P < 0.01). The MODS incident was 4 of 11 in group A compared with 1 of 11 in group B (P < 0.01). In conclusion, CVVHDF can effectively reduce the levels of TNF-α, IL-6 and IL-8 as wel as the MODS incidence in patients with serious burns.

Successful management of seven cases of critical COVID-19 with early noninvasive-invasive sequential ventilation algorithm and bundle pharmacotherapy

We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019(COVID-19)requiring mechanical ventilation(MV).The patients were diagnosed based on epidemiological history,clinical manifestations,and nucleic acid testing.Upon diagnosis with COVID-19 of critical severity,the patients were admitted to the intensive care unit,where they received early noninvasive-invasive sequential ventilation,early prone positioning,and bundle pharmacotherapy regimen,which consists of antiviral,anti-inflammation,immune-enhancing,and complication-prophylaxis medicines.The patients presented fever(n=7,100%),dry cough(n=3,42.9%),weakness(n=2,28.6%),chest tightness(n=1,14.3%),and/or muscle pain(n=1,14.3%).All patients had normal or lower than normal white blood cell count/lymphocyte count,and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs.Nucleic acid testing confirmed COVID-19 in all seven patients.The median MV duration and intensive care unit stay were 9.9 days(interquartile range,6.5-14.6 days;range,5-17 days)and 12.9 days(interquartile range,9.7-17.6 days;range,7-19 days),respectively.All seven patients were extubated,weaned off MV,transferred to the common ward,and discharged as of the writing of this report.Thus,we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive-invasive sequential ventilation and bundle pharmacotherapy.

Total Synthesis and Biological Evaluation of Wewakazole

The total synthesis of Wewakazole was achieved on a gram scale, unambiguously confirming its structure. Three different substituted oxazoles present in this natural product were prepared efficiently. Biological evaluation indicated that Wewakazole significantly inhibited cancer cell proliferation in a dose-dependent manner.

腹腔镜意外胆囊癌外科治疗体会

目的总结意外胆囊癌腹腔镜胆囊切除的经验。方法回顾性分析连续1037例腹腔镜胆囊切除术中的4例意外胆囊癌患者的临床特征、病理分期、手术及术后处理措施。结果术后病理分期2例为T1aNM,1例为00T1bNM,1例为TisNM,其中3例肿瘤位于体部,1例位于胆囊颈部息肉癌变。术后随访1～3年,无切口种植,腹腔0000及远处转移。结论LC只要注意技术操作,勿分破胆囊,并不会增加肿瘤扩散的机会;术后应根据PTNM分期及肿瘤部位决定是否行淋巴清扫。

Inhibition of squamous cancer growth in a mouse model by Staphylococcal enterotoxin B-triggered Th9 cell expansion

Currently, therapy for squamous cancer （SqC） is unsatisfactory. Staphylococcal enterotoxin B （SEB） has strong immune regulatory activity. This study tests the hypothesis that SEB enforces the effect of immunotherapy on SqC growth in a mouse model. C3H/HeN mice and the SqC cell line squamous cell carcinoma VII were used to create an SqC mouse model. Immune cell assessment was performed by flow cytometry. Real-time RT-PCR and western blotting were used to evaluate target molecule expression. An apoptosis assay was used to assess the suppressive effect of T helper-9 （Th9） cells on the SqC cells. The results showed that immunotherapy consisting of SEB plus SqC antigen significantly inhibited SqC growth in the mice. The frequency of Th9 cells was markedly increased in the SqC tissue and mouse spleens after treatment. SEB markedly increased the levels of signal transducer and activator of transcription 5 phosphorylation and the expression of histone deacetylase-1 （HDAC1） and PU.1 （the transcription factor of the interleukin 9 （IL-9） gene） in CD4^＋ T cells. Exposure to SqC-specific Th9 cells markedly induced SqC cell apoptosis both in vitro and in vivo. In conclusion, the administration of SEB induces Th9 cells in SqC-bearing mice, and theseTh9 cells inhibit SqC growth.

Influence of lesion ratio on diagnostic performance of in-phase/opposed-phase imaging and apparent diffusion coefficient for differentiating acute benign vertebral fractures and metastases

Background The usefulness of in-phase/opposed-phase imaging and diffusion weighted imaging （DWI） in differentiating benign and neoplastic vertebral fractures has been described. In this study, we aimed to evaluate the influence of the severity of vertebral damage on the diagnostic performance of these two technologies. Methods Totally 59 patients with 68 acute benign vertebral fractures and 43 patients with 79 vertebral metastases were included in this study. The MR protocol included DWls and sagittal in-phase/opposed-phase gradient recalled sequence. The severity of vertebral damage was expressed by lesion ratio （LR, the ratio of lesion area to vertebral area on the slices of largest abnormal signal area in the Tl-weighted sequence）. Quantitative （signal intensity ratio （SIR） defined as signal intensity （SI） on opposed-phase gradient recalled echo （GRE） images divided by SI on in-phase; apparent diffusion coefficient （ADC） value derived from DWl analysis was performed, the relationships between LR and the measurements of these two technologies were analyzed using linear regression. The covariate-specific receiver operating characteristic （ROC） curves were also fitted to evaluate the influence of LR on the diagnostic performance of ADC and SIR. Results The difference in both SIR and ADC for vertebral metastasis and acute benign vertebral fractures was significant （P 〈0.001）. A positive correlation between the LR and the SIR was found in benign fractures （P 〈0.05）. The severity of vertebral damage had a significant influence on the AUC （area under ROC curve） for SIR （P 〈0.05） but ADC （P 〉0.05）. More severe cases were associated with increased AUC for SIR. Conclusions LR is capable of affecting the diagnostic performances of chemical shift imaging. Thus, when applying these tests to make diagnoses on vertebral fractures, the severity of the vertebral damage should be taken into account. The covariate-specific ROC model is recommended because it substantially improves the ability to avoid bias when evaluating tests.

Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected patients

Dear Editor,In late December 2019,an outbreak of severe pneumonia caused by an unknown etiological agent was initially reported in Wuhan,China,and then quickly spread throughout China and even abroad(Zhu et al.,2020).Swift control measures and etiological investigations were conducted by the Chinese government,physicians and researchers,and by using high throughput sequencing and virological testing,the mysterious pneumonia pathogen was shown to be a novel coronavirus(SARS-CoV-2)capable of person-to-person transmission(Zhu et al.,2020).Coronaviruses are a group of non-segmented,enveloped and positive-sense RNA viruses that belong to the subfamily of Coronavirinae in the family of Coronavirdiae and order of Nidovirales.