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The ecology of soil fungi is poorly understood, and recent comprehensive reports on Trichoderma are unavailable for any region, including the Zoige alpine wetland ecological region in China. One hundred soil samples were collected from different soil types and soil layers in Zoige alpine wetland ecological regions. Using the traditional suspension plating method, 80 Trichoderma strains were chosen to analyze species diversity. After a preliminary classification of morphological characteristics and the genes glyceraldehyde-3-phosphate dehydrogenase (gpd), 57 representative strains were selected and eventually identified as seven species via phylogenetic analyses of multilocus sequences based on the genes transcription elongation factor 1 alpha (tef1), encoding RNA polymerase II subunit B (rpb2) and ATP citrate lyase (acl1). Among them, T. harzianum was the dominant species isolated from five soil layers and four soil types, and had the highest isolation frequency (23%) in this zone, while T. polysporum and T. pyramidale were rare species, with isolation frequencies of less than 1%. Our detailed morphological observation and molecular phylogenetic analyses support the recognition of Trichoderma zoigense was described for the first time as a new species, while T. atrobrunneum as a new record for China was found. Our results will be used as a reference for a greater understanding of soil microbial resources, ecological rehabilitation and reconstructions in the Zoige alpine wetland.

Compared with commercial polyolefin membranes, polyacrylonitrile (PAN) membrane prepared by electrostatic spinning has higher porosity, electrolyte uptake, thermal stability, and lithium-ion conductivity, etc. However, poor mechanical performance has largely limited the application of electrospun PAN separators. In this study, PAN/polyimide (PI) composite membrane is prepared by electrostatic spinning to improve the mechanical and electrochemical performances. Scanning electron microscopy, thermal analysis method, and electrochemical methods were used for evaluation of the electrospun composite membrane. The results show that the composite membrane possesses good thermal stability and exhibits better mechanical performance than pristine PAN membrane (increasing by 1.1 times in tension strength). The addition of PI can increase porosity and fluid absorption rate obviously. In addition, the composite membrane has high ionic conductivity (18.77 × 10−4 S/cm), wide electrochemical window (about 4.0 V), and excellent cycling performance. It can retain a discharge specific capacity of 153 mA h/g even after 50 cycles at 0.5 C. The electrospun PAN/PI membrane may be a promising candidate for lithium-ion battery separators.

Platelets are believed to promote tumor growth and metastasis in several tumor types. The prognostic role of blood platelets in pancreatic ductal adenocarcinoma (PDAC) remains controversial, and the prognostic value of tumor-infiltrating platelets (TIPs) remains unknown.A total of 303 patients who underwent curative pancreatectomy for PDAC were enrolled from two independent centers in China and divided into three cohorts. Paired preoperative blood samples and surgical specimens from all patients were analyzed. The correlations between patient outcomes and preoperative blood platelet counts and the presence of TIPs, respectively, were analyzed. TIPs were identified by immunohistochemical staining of CD42b. Prognostic accuracy was estimated by concordance index (C-index) and Akaike information criterion (AIC).TIPs, but not preoperative blood platelet counts, were associated with overall survival (OS; all P 0.001) and recurrence-free survival (RFS; all P 0.001) in the training, testing, and validation sets. Positive CD42b expression predicted poor postsurgical survival. Incorporation of TIPs improved the predictive accuracy of the 8th edition American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system for OS in each of the three cohorts (C-index: 0.7164, 0.7569, and 0.7050, respectively; AIC: 472, 386, and 1019, respectively). The new predictor system was validated by incorporating TIPs with the 7th edition AJCC TNM staging system (C-index: 0.7052, 0.7623, and 0.7157; AIC: 476, 386, and 1015).TIPs were an independent prognostic factor that could be incorporated into the AJCC TNM staging system to refine risk stratification and predict surgical outcomes of patients with PDAC.

Pancreatic cancer is one of the most lethal malignancies worldwide. Although the standard of care in pancreatic cancer has improved, prognoses for patients remain poor with a 5-year survival rate of

The role of N classification is controversial in several prognostication systems proposed for pancreatic neuroendocrine neoplasms (pNENs). The widely accepted modified European Neuroendocrine Tumor Society (mENETS) system suggests this contradiction may be related to T classification.Data were collected retrospectively from 981 patients in the Surveillance, Epidemiology, and End Results (SEER) database (1973-2012; cohort 1) and 140 patients from the Pancreatic Cancer Institute of Fudan University (2006-2016; cohort 2). All patients had resected well- to moderately differentiated locoregional pNENs, whereby the mENETS system was adopted. Factors related to N1 classification and the association between N and T classifications were analyzed, and N classification prognosis based on T classification was assessed.In cohorts 1 and 2, tumor size (2-4 cm: p 0.001 and p = 0.037, respectively; 4 cm: p 0.001 and p = 0.012, respectively) and tumors extending beyond the pancreas (p 0.001 and p = 0.016, respectively), which are factors for T classification, affected N1 classification. For tumors limited to the pancreas, the N1 classification was associated with tumor size (p 0.001 and p = 0.046, respectively) and predicted poor disease-specific survival (DSS), while for tumors extending beyond the pancreas, the N1 classification did not affect patient outcomes. Findings obtained with data from the SEER database were reproducible with our institutional data.N classification is associated with T classification, limiting the value of N1 classification for the pNENs tumor-node-metastasis system. A new risk model is necessary to predict patient outcomes and guide clinical practice for the prognosis of pNENs.

Hepatitis B immune globulin (HBIg) in combination with a nucleos(t)ide analog is the mainstay of prophylactic regimen to prevent recurrence of hepatitis B following orthotopic liver transplantation (OLT). HBIg therapy is costly and inconvenient for the patients. There is a growing experience converting HBIg/nucleos(t)ide to combination nucleotide/nucleoside analogs from. Twenty-six patients that underwent OLT between March 2001 and July 2011 who had received at least 12 months of HBIg and single nucleos(t)ide were enrolled. HBsAg and HBV DNA were undetectable, and anti-HBs were detectable at the time of switch. HBV DNA and HBsAg were measured every 3 months following discontinuation of HBIg and addition of nucleos(t)ide. Patients included 23 Asians/3 Caucasian, 21 males/5 females. Mean time of conversion from HBIg/nucleos(t)ide to nucleoside/nucleotide combination was 77.5 (range 11–132) months after OLT. Mean duration of follow-up after conversion was 31.9 (range 14–70) months. All patients had undetectable HBV DNA, and 24 patients remained HBsAg negative during follow-up. Two patients recurred 7 and 9 months later, respectively, with detectable HBsAg. Both patients continued to have undetectable HBV DNA and normal ALT. HBsAg was neutralized by reinfusion of HBIg. Nucleoside/nucleotide combination is an effective alternative to HBIg/nucleos(t)ide to prevent recurrence of hepatitis B after OLT.

To the Editor, Insulin autoimmune syndrome (IAS) showed hypoglycemia, hyperinsulinemia, positive insulin antibodies without insulin injection history. Some patients with diabetes, treated with insulin, also showed these signs. The first case of IAS was reported in 1970s. [1, 2]. IAS can be induced by autoimmune diseases, some drugs, such as methimazole [3]. Here we report one case of special IAS, who suffered from type 2 diabetes concomitant with Graves’ disease. This an 85-year-old woman diagnosed with type 2 diabetes 30 years ago. She accepted oral antidiabetic drugs initially, and switched to insulin injection therapy (Novolin 30R 12 u/day) 5 years ago. About 1 year ago, she began to experiencing recurrent cold sweat, hunger, palpitation, and other symptoms of hypoglycemia, with her peripheral blood glucose ranged from 3.0–4.0 mmol/L during the night and morning. Hypoglycemia episodes still occurred after insulin treatment was suspended. Meanwhile she appeared weight loss, palpitation, chest tightness, fatigue, and lower extremity edema. One month prior to admission, the patient began to appearing eyelid edema, proptosis, photophobia, tearing, redness and pain of eye, polyphagia, heat intolerance, sweating, irritability, and stool frequency. She has hypertension and dyslipidemia history. Physical examination revealed a thinly built woman, BMI 20.7 kg/m, BP 160/70 mmHg, pulse 106/min. Her skin appeared sweeting and hot. She appeared wider palpebral fissures, proptosis, limited eye movements, conjunctival edema, and hyperemia. The movements of the lids were jerky and spasmodic, and the lightly closed lids tremor. Thyroid examination revealed II degrees of goiter with marked tremor and vascular murmur. Thyroid function tests revealed that TSH 0.01 lU/mL, T4 223.18 nmol/l, FT4 34.8 pmol/l, rT3 0.58 ng/ml, thyroglobulin 27.73 ng/ml, Anti-Tg 906.1 IU/ml, TPO [ 600 IU/ml, TRAB 20.8 IU/ml, ESR 64 mm/h. Serum total insulin concentration was 552.3 uU/ml, free insulin concentration 394.4 uU/ml, and Iab binding rate 70.6 %. Scatchard analysis revealed that the serum Iab constituted by two types binding sites which were high-affinity with low capacity (k1 = 3.125 9 10 mol/l, b1 = 37.5 9 10 mol/l) and low-affinity with high capacity (k2 = 1.0 9 10 mol/l, b2 = 5.918 9 10 mol/l), (Fig. 1). Insulin binding antibodies analysis suggested that it was IgG with k light chains. Ultrasound showed bilateral thyroid swelling, diffuse lesions. Abdominal magnetic resonance imaging revealed no abnormalities. The patient was diagnosed with Grave’s diseases, Grave’s ophthalmopathy and IAS, and start receiving prednisone (20 mg/day) and methimazole (10 mg qd) treatment. The insulin injection treatment (Novolin 30R) continued and the dose increased along with blood glucose change. After treatment for 1 month, symptoms including palpitation, heat intolerance, fatigue relieved, photophobia and tearing relieved, meanwhile hypoglycemia attack disappeared. After 2 months of treatment, her serum insulin levels returned to normal range and insulin antibody became X. Wang X. Xu X. Zhao X. Ma H. Yu H. Gong F. Chen (&) No. 3 People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China 280# MoHe Road, Shanghai 201900, People’s Republic of China e-mail: 903561138@qq.com; fengling_chen@hotmail.com