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To assess the feasibility of fetoscopy-guided bipolar umbilical cord coagulation for selective fetal reduction in complicated monochorionic diamniotic (MCDA) twin pregnancies.MCDA twins undergoing fetoscopy-guided bipolar cord coagulation (BCC) were enrolled prospectively between December 2015 to March 2020 in a fetal medicine center.Twenty-three cases undergoing fetoscopy-guided BCC were finally analyzed, including 11 cases for type 2 selective intrauterine growth restriction, 4 cases for twin-twin transfusion syndrome, and 8 cases for a severe discordant anomaly. The overall survival rate was 78.3% (18/23).Fetoscopy-guided BCC is effective for selective fetal reduction in complicated monochorionic twin pregnancies.

Background Regulatory T (Treg) cells play an essential role in peripheral immune tolerance. Bullous pemphigoid (BP) is the most common blistering disease and is caused by autoantibodies to two BP antigens: type XVII collagen and BP230. Recently, we reported that Treg cell dysfunction may cause the production of autoantibodies to BP antigens. Several studies have suggested an association between Treg cells and BP pathogenesis. However, Treg cells are heterogeneous in humans, leading to inconsistent results in previous studies. Objective To assess functional Treg subsets in BP. Methods We examined three distinct Treg subsets in conventional BP (cBP) patients before versus after systemic corticosteroid treatment, dipeptidyl peptidase-4 inhibitor-associated BP (DPP-4i-BP) patients, younger controls and older controls. Results We found that total Treg cells and all Treg cell subsets were increased in cBP patients before treatment and decreased by systemic corticosteroid treatment. In contrast, neither total Treg cells nor all Treg subsets were increased in DPP-4i-BP. Notably, CD45RA− Foxp3hi effector Treg cells positively correlated with disease severity in cBP, whereas CD45RA+Foxp3lo naive Treg cells positively correlated with the disease severity in DPP-4i-BP. Conclusion These findings suggest that Treg cells are differently involved in the pathogeneses of cBP and DPP-4i-BP.

To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population.This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015 and 2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence.The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 14,287 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category.Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.

Objective This investigation assessed the profibrotic role that extracellular histones play in the pathogenesis of coal workers' pneumoconiosis (CWP). Methods The correlation of extracellular histones with small opacity profusion (SOP) and transforming growth factor-β (TGF-β) was analyzed. The stimulating effect of extracellular histones on pulmonary fibroblast was assessed in vitro. Results The levels of extracellular histones in plasma were positively correlated with SOP and TGF-β in the coal miners investigated. Plasma collected from patients with CWP caused apparent lung fibroblast proliferation, while anti-H4 antibody antagonized the stimulating effect of the patient plasma by blocking histone H4. In vitro experiments showed that extracellular histones directly stimulated fibroblast proliferation. Conclusion Consistent with our hypothesis, the concentrations of extracellular histones were indices of the severity of pulmonary fibrosis in simple CWP, and extracellular histones-targeted intervention could inhibit the proliferation of lung fibroblast.

BACKGROUND Venous thromboembolism (VTE) post lung transplantation is common and has been associated with worse post transplant survival . We report a comprehensive single center review of VTE incidence in the first post transplant year, investigate modifiable risk factors and assess impact on short term outcomes. METHODS Retrospective review of all lung transplant recipients between August 2016 to 2018 at Temple University Hospital. Patients were followed for 1 year post transplant. All patients were screened for deep venous thrombosis (DVT) within the first 2 weeks with a venous duplex study. Pre transplant, intra operative, post operative variables, and peri-operative practice patterns were compared between VTE positive and VTE negative groups. Logistic regression modeling was used to identify risk factors for early VTE (VTE within 30 days after transplant). RESULTS A total of 235 patients were included in the study, 58 patients (24.7%) developed a VTE in the first post transplant year. Median time to diagnosis was 17 days. Of the patients with VTE, 76% had an isolated DVT, 13.5 % had an isolated pulmonary embolism (PE), and 10.3% had concomitant DVT and PE. In a multivariate logistic regression model, cardiopulmonary bypass (CPB) (OR 1.93 p = 0.015) and interruption of VTE prophylaxis (OR 4.42 p CONCLUSION VTE post lung transplant is common despite the use of prophylactic anticoagulation . CPB use and interruption of DVT prophylaxis are risk factors for early post transplant VTE. Measures to ensure consistent and uninterrupted prophylaxis may help decrease VTE incidence after lung transplantation.

Cytokine signal transduction inhibitor 3 (SOCS3) negatively regulates Janus kinases (JAK) - signal transducer and activator of transcription (STAT) pathway. Bioinformatics analysis revealed a targeted relationship between miR-203 and SOCS3 mRNA. This study investigated the role of miR-203 in ovarian cancer cell proliferation and apoptosis.Ovarian cancer tissues and adjacent tissues were collected to detect the expression of miR-203 and SOCS3. Ovarian cancer HO8910 cells were divided into miR-NC group, miR-203 inhibitor group, and miR-203 mimic group followed by the analysis of the expression of miR-203 and SOCS3 mRNA by quantitative Reverse Transcription-PCR (qRT-PCR), protein expression of p-JAK2 and p-STAT3 by Western blot, cell apoptosis by flow cytometry, and proliferation by 5-Ethynyl-2'-deoxyuridine (EdU) staining chronologically.Compared with adjacent tissues, miR-203 expression was significantly increased in tumor tissues and SCOS3 mRNA expression was decreased. Compared with those with lower miR-203 expression, the prognosis of patients with higher expression of miR-203 was significantly worse. There was a targeted regulatory relationship between miR-203 and SOCS3 mRNA. Compared with IOSE80 cells, miR-203 expression in HO8910 and SKOV3 cells was increased, and its expressions of SOCS3 mRNA and protein were decreased. Compared with miR-NC group, the transfection of miR-203 inhibitor significantly increased SOCS3 expression, and decreased the expression of p-JAK2 and p-STAT3 protein. We draw the conclusion that miR-203 increased cell apoptosis and decreased cell proliferation. However, opposite results were observed after the transfection of miR-203 mimic.Abnormal miR-203 and SOCS3 expression are related to the pathogenesis of ovarian cancer. MiR-203 affects the proliferation of JAK-STAT pathway and regulates the proliferation and apoptosis of ovarian cancer cells by targeting the inhibition of SOCS3 expression.

Iodine nutrition surveillance of vulnerable population was conducted in 18 cities of Henan Province in 2015. The medians and quartiles of urinary iodine concentration in women of reproductive-age (2015年在河南省18个省辖市开展重点人群碘营养监测，育龄妇女（3 318名）、孕妇（36 366名）、哺乳期妇女（4 153名）、0~2岁婴幼儿（10 127名）、8~10岁儿童（4 806名）的尿碘

畸胎瘤约占卵巢肿瘤的20%，其中99%卵巢畸胎瘤为成熟畸胎瘤。不同于未成熟畸胎瘤，成熟畸胎瘤多以囊性为主，成熟型实性畸胎瘤罕见。腹膜神经胶质瘤病（gliomatosis peritonei，GP）是以腹膜内成熟神经胶质结节为特征的病变，常与卵巢畸胎瘤（尤其不成熟畸胎瘤）有关，属于非常少见的一类疾病。GP多发生于10~20岁，多与体积较大畸胎瘤伴发，其成分以神经为主，主要分布于畸胎瘤周围腹膜及大网膜。该病例为37岁女性卵巢肿瘤患者，术前及术中临床及影像学提示卵巢癌可能。经充分取材，术后病理诊断为卵巢巨大实性成熟型畸胎瘤伴GP。.

Endometriosis (Ems) is one benign disorder that frequently leads to chronic pelvic pain, dysmenorrhea or even infertility. Featured as the ectopic growth of active endometrial tissues on tissues beyond the muscular layer, Ems has complicated pathogenesis mechanisms that are not fully illustrated. Long non-coding (lnc) RNA MALAT1 participates in various biological activities, including cell growth, proliferation, apoptosis, organogenesis, inflammation, and tumors. However, its expression and function in Ems are not clear yet.Real-time PCR measured differential expression of MALAT1 in normal and ectopic endometrial tissues. Cultured endometrial cells were transfected with siRNA for MALAT1, whose expression was measured by real-time PCR. MTT assay measured endometrial cell proliferation, whose invasion was measured by transwell assay. Western blot tested the expression and NF-κB/iNOS, and MMP9 proteins.LncRNA MALAT1 showed upregulation in ectopic endometrial tissues (p0.05 comparing to control group). Transfection of MALAT1 siRNA suppressed its expression in endometrial cells, inhibited cell proliferation or invasion, enhanced caspase 3 activity, decreased NF-κB/iNOS or MMP-9 expression (p0.05 comparing to control group).LncRNA MALAT1 can facilitate endometrial cell apoptosis and modulate MMP-9 expression via NF-κB/iNOS pathway, thus, mediating Ems pathogenesis.

Rationale Sarcoidosis progresses to end stage fibrotic lung disease in 10% of patients and may necessitate lung transplantation. Organ allocation is currently determined by the Lung Allocation Score (LAS), but its performance in a sarcoidosis population has not been evaluated. Objectives To determine sarcoidosis-specific wait list mortality and identify predictive factors of death on the transplantation wait list. Methods This was a single-center retrospective study of all sarcoidosis patients listed for lung transplant from March 2012 to February 2019. We compared patients who were transplanted to those who died awaiting organs. We collected baseline listing characteristics, physiologic testing, and outcomes data. Statistical analysis was performed by 2-tailed Student's t-test, Mann-Whitney U test, and Chi-Square analysis (where appropriate). Receiver-operating characteristic curves were constructed for variables reaching statistical significance. Results Twenty eight sarcoidosis patients were included in analysis. Mortality among wait listed patients was 18%, which exceeded the mortality of COPD and IPF. LAS scores did not differ at initial listing (41 vs. 46, p = 0.35) or at transplant/death (41 vs. 41, p = 0.91); wait list times also did not statistically differ (307 days vs. 177 days, p = 0.19). We identified bilirubin (AUC = 0.92), DLCO (AUC = 0.84), FEV1/FVC at transplant/death (AUC = 0.85), and composite physiologic index (AUC = 0.86) as predictors of death on the transplant list. Pulmonary hypertension was not associated with death. Conclusion Unexpected sudden death was common in our cohort and was associated with markers of advanced fibrotic disease, not pulmonary hypertension.

This study aimed to investigate the effect of T cell subsets with different proportions on renal function and blood lipids in patients with preeclampsia (PE). Ninety pregnant women were included in this experiment and classified into 3 groups: group A (30 with severe PE), group B (30 with mild PE) and group C (30 healthy pregnant women). Clinical characteristics were examined. The ratio of T cell subsets in the three groups was detected by flow cytometry. The relationship between PE and T cell subsets was determined. The results showed that no significant difference was found in age or gestational age (P0.05). The number of CD4+ T cells (CD4 is mainly expressed in helper T cells, referred to as TH) in group A increased significantly compared with group B and group C (P less than 0.05), while the number of CD8+ T cells (CD8+ T cell, also known as cytotoxic T cell (CTL) in group A decreased noticeably in comparison to group C (P less than 0.05). The ratio of CD4+ cell number to CD8+ cell number (TH/CTL) in group A was elevated significantly compared with group B and group C (P less than 0.05). The uric acid (UA) concentration of group A was noticeably elevated compared to group C (P less than 0.05), which differed insignificantly between group B and C (P0.05). Glomerular filtration rate (GFR) of group A was obviously impaired in comparison to group B and group C (P less than 0.05), which differed insignificantly between group B and C (P0.05). Total cholesterol (TC) concentrations in group A, C and B were examined. TC concentrations in the former two groups were slightly higher compared to the latter (P less than 0.05), and those in the former two groups were also higher than the normal range (P less than 0.05). Mean triglyceride (TG) concentrations in all 3 groups were above the normal range, and those in group A and B were significantly higher compared to group C (P less than 0.05). TG concentrations differed insignificantly between group B and C (P0.05). Serum TG, UA and TC in PE patients were positively related to TH/CTL (P less than 0.05). In conclusion, PE is related to T cell subsets, and T cell subsets are closely related to kidney injury and dyslipidemia.

Background This phase 3 trial is the first to evaluate the efficacy and safety of treatment with the systemic TNF-α inhibitor, adalimumab, for Chinese patients with moderate-to-severe plaque psoriasis. Methods In the 12-week, double-blind, placebo-controlled Period A, patients were randomized 4 : 1 to receive adalimumab 40 mg every-other-week (following a single 80 mg dose), or placebo every-other-week. In the subsequent 12-week, open-label, Period B, all patients received adalimumab 40 mg every-other-week starting at week 13, following a single, blinded dose at week 12 of adalimumab 80 mg or matching placebo (for patients receiving placebo or adalimumab in Period A respectively). In Period A, efficacy was analysed for all randomized patients and safety for all patients receiving ≥1 dose of the study drug. Results For the 425 patients in this study (87 placebo; 338 adalimumab), a higher percentage randomized to adalimumab achieved the primary endpoint of ≥75% improvement from baseline in PASI score (PASI 75) at week 12: placebo 11.5% (10/87); adalimumab 77.8% (263/338; P < 0.001). Physician's Global Assessment of clear to minimal was achieved at week 12 by 14.9% placebo (13/87) and 80.5% adalimumab (272/338; P < 0.001). For patients who received adalimumab at any time during the study (All-adalimumab Population), treatment-emergent adverse events (AEs) were reported by 63.4%; the most common was upper respiratory infection (16.1%). Serious AEs were reported by 3.5% of the All-adalimumab Population, and serious infectious AEs by 1.2%, which include lung infection, pneumonia and tuberculosis [2 (0.5%) patients each]. There was one death (chronic heart failure). Conclusion In these Chinese patients with moderate-to-severe psoriasis, a significantly greater percentage treated with adalimumab compared with placebo achieved efficacy endpoints at week 12 and efficacy was sustained to week 24. Safety results were consistent with the known adalimumab safety profile; no new safety signals were identified in the 24 weeks of treatment.

Alzheimer's disease (AD) is one of the most common causes of dementia. Although the exact mechanisms of AD are not entirely clear, the impairment in adult hippocampal neurogenesis has been reported to play a role in AD. To assess the relationship between AD and neurogenesis, we studied APP/PS1/nestin-green fluorescent protein (GFP) triple transgenic mice, a well-characterized mouse model of AD, which express GFP under the control of the nestin promoter. Different ages of AD mice and their wild-type littermates (WT) were used in our study. Immunofluorescent staining showed that neurogenesis occurred mainly in the subgranular zone (SGZ) of the dentate gyrus (DG) and subventricular zone (SVZ) of the lateral ventricles (LVs). The expression of neural stem cells (NSCs) (nestin) and neural precursors such as doublecortin (DCX) and GFAP in AD mice were decreased with age, as well as there being a reduction in 5-bromo-2-deoxyuridine (BrdU)-positive cells, when compared to WT. However, the number of maturate neurons (NeuN) was not significantly different between AD mice and wild-type controls, and NeuN changed only slightly with age. By Golgi-Cox staining, the morphologies of dendrites were observed, and significant differences existed between AD mice and wild-type controls. These results suggest that AD has a far-reaching influence on the regulation of adult hippocampal neurogenesis, leading to a gradual decrease in the generation of neural progenitors (NPCs), and inhibition of the differentiation and maturation of neurons.

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group.ConclusionHFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" . The main updates in this version include: epidemiology, disease burden, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, IIV3 and IIV4 immune response, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The influenza vaccine TWG provided the recommendations for influenza vaccination for the 2018-2019 influenza season based on existing scientific evidence. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2017-2018 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels.接种流感疫苗是预防流感病毒感染及其严重并发症的最有效手段。目前，我国国内批准上市的灭活流感疫苗为三价（IIV3）和四价（IIV4），包括裂解疫苗和亚单位疫苗。除个别地区外，流感疫苗在我国大多数地区属于第二类疫苗，实行自愿、自费接种。为指导我国流感预防控制和疫苗应用工作，中国疾病预防控制中心国家免疫规划技术工作组流感疫苗工作组综合国内外最新研究进展，对2014年版指南进行了更新和修订，形成了《中国流感疫苗预防接种技术指南（2018—2019）》。本指南主要更新了以下内容：流感的流行病学、疾病负担，流感疫苗的种类、2018—2019年度流感疫苗抗原组份、IIV3和IIV4的免疫反应、免疫持久性、免疫原性、效力、效果、安全性、成本效果和成本效益等新的科学证据，并基于现有的科学证据，提出了2018—2019年度流感疫苗预防接种的建议。本指南建议：原则上，接种服务单位应为≥6月龄所有愿意接种流感疫苗且无禁忌证的人提供接种服务。对可接种不同类型、厂家疫苗产品的人群，可由受种者自愿选择接种任一种流感疫苗，无优先推荐。为降低高危人群罹患流感及感染后发生严重临床结局的风险，指南推荐6月龄至5岁儿童、60岁及以上老人、慢性病患者、医务人员、6月龄以下婴儿的家庭成员和看护人员以及孕妇或准备在流感季节怀孕的女性为优先接种对象。首次接种流感疫苗的6月龄至8岁儿童应接种两剂次，间隔≥4周；2017—2018年度或以前接种过1剂及以上流感疫苗的儿童，建议接种1剂。9岁及以上儿童和成人仅需接种1剂。建议各地在疫苗供应到位后尽快安排接种工作，最好在10月底前完成免疫接种；对10月底前未接种的对象，整个流行季节都可以提供接种服务。孕妇在孕期的任一阶段均可接种流感疫苗。本指南适用于从事流感防控相关的各级疾病预防控制机构工作人员，预防接种点的接种人员，各级医疗机构儿科、内科、感染科等医务人员，以及各级妇幼保健机构的专业人员。.

Desmoglein-2 (Dsg2) plays a crucial role in the assembly and adhesion of desmosomes. The absent or aberrant expression of Dsg2 was reported to be associated with the progression of varies human cancers. However, the expression of Dsg2 in hepatocellular carcinoma (HCC) and its association with tumor prognosis is still unknown. The aim of this study was to evaluate the expression level of Dsg2 in HCC and of the correlation between Dsg2 expression and clinicopathological variables.A total of 104 patients diagnosed with HCC were enrolled in this study. Real time-quantitative PCR (RT-qPCR) and Western blot were performed to determine the expression level of Dsg2 in HCC tumor tissues and matched noncancerous tissues. Cell proliferation and cell cycle were measured by cell counting kit-8 (CCK-8) assay and flow-cytometry assay, respectively.Our results revealed that Dsg2 expression was significantly higher in HCC tumor tissues than in matched noncancerous tissues (p0.01), positively correlated with tumor size (p = 0.035) and tumor stage (p = 0.021). Univariate and multivariate analyses demonstrated Dsg2 expression was an independent prognostic factor for overall survival. Meanwhile, we found knockdown the expression of Dsg2 using small interfering RNA (siRNA) could efficiently impaired HCC cell proliferation rate and cell cycle progression (p0.05).Taken together, our results suggest that increased Dsg2 expression was associated with tumor progression in HCC and may function as a promising biomarker for unfavorable prognosis of HCC.

Influenza can be prevented through annual appropriate vaccination against the virus concerned. In China, influenza vaccine is categorized as "Class Ⅱ" infectious diseases which the cost is paid out of the user's pockets. The annual coverage of influenza vaccination had been 2%-3%. The main reasons for the low coverage would include the following factors: lacking awareness on both the disease and vaccine, poor accessibility of vaccination service, and the cost of vaccination. To reduce the health and economic burden associated with influenza, comprehensive policies should be improved, targeting the coverage of seasonal influenza vaccination. These items would include: ① Different financing reimbursement schemes and mechanisms to improve the aspiration on vaccination and on the vaccine coverage in high-risk groups, as young children, elderly, people with underlying medical conditions; ② to ameliorate equality of vaccination services; ③ to improve knowledge of the health care workers (HCWs) and the public on influenza and related vaccines; ④ to improve clinical and preventive medical practice and vaccination among HCWs through revising clinical guidelines, pathway and consensus of experts; ⑤ to provide more convenient, accessible and normative vaccination service system; ⑥ to strengthen research and development as well as marketing on novel influenza vaccines; ⑦ to revise items regarding the contraindication for influenza vaccine on pregnancy women, stated in the Chinese Pharmacopoeia.流感是一种疫苗可预防性疾病，每年接种流感疫苗是预防流感及其并发症的最有效手段。流感疫苗在我国是二类疫苗，年平均接种率仅2%~3%。接种率低的原因包括公众对流感和流感疫苗认知不足、医务人员极少推荐、接种服务可及性和费用等。为促进我国流感疫苗的预防接种，降低流感对公众的健康危害和经济负担，应考虑采取综合政策措施积极推动流感疫苗预防接种工作，包括采用不同筹资方式和机制，提高重点人群的接种意愿和接种率、改进免疫服务公平性的效果和效率；提高医务人员和公众对流感和疫苗预防的认识，改进临床预防实践，通过制订临床指南、路径、专家共识等多种渠道，推动临床医生对流感疫苗预防接种建议的推荐；加快预防接种工作体系建设，为公众提供更方便、可及和规范的预防接种；加大新型流感疫苗研发支持力度，加快新型流感疫苗上市应用；修订我国药典中"妊娠期妇女为流感疫苗接种禁忌"的条款。.

Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease. BP180 is the primary autoantigen of BP, and in a portion of BP cases, BP230 is the only target of autoantibodies. Such BP is called BP230-type BP. BP230-type BP tends to show milder clinical phenotypes than conventional BP, but the reason is unclear. The pathogenic roles of autoantibodies and complement activation have been shown in conventional BP, but the distribution of IgG subclasses and the degree of complement deposition in BP230-type BP remain unclear. Objective To compare the distribution of IgG subclasses and the degree of complement deposition in BP230-type BP with those in conventional BP with autoantibodies to BP180 and BP230 (BP180-BP230-type BP). Methods The diagnosis of BP was confirmed by the histopathology of the lesions, the deposition of IgG and complement in the perilesional skin and the presence of circulating autoantibodies to BP180 and BP230. The disease severity was determined by bullous pemphigoid disease area index. The deposition of IgG subclasses and complement deposition were examined by direct immunofluorescence of the perilesional skin in 6 BP230-type BP cases and 11 BP180-BP230-type BP cases. Results Sixty seven percent of BP230-type BP cases show a mild clinical phenotype. All BP230-type BP cases and 82% of BP180-BP230-type BP cases were found to demonstrate the clear deposition of IgG4 at the basement membrane zone of skin specimens. Notably, the deposition of IgG1 and IgG3 was faint or negative in all of the BP230-type BP cases, whereas they were clearly detected in 91% and 64% of the BP180-BP230-type BP cases, respectively. The deposition of complement C3 tended to be weaker in BP230-type BP than in BP180-BP230-type BP. Conclusion The mild clinical phenotype of BP230-type BP may correlate with the weaker deposition of IgG1, IgG3 and complement in the skin lesions.

Objective To estimate the potential value of fetal assessment for the cardiac axis (CAx) and V-sign angle (VSA) in the first trimester in the prediction of fetal major cardiac defects. Methods A cohort study was conducted from December 2015 to June 2016. Patients with singleton pregnancies and crown-rump length from 45 to 84 mm were recruited to undergo nuchal translucency sonography. The CAx on the 4-chamber view and the VSA on the 3-vessel and trachea view with Doppler mapping were measured. The estimated performance of different combinations of increased fetal nuchal translucency, CAx, and VSA in screening for major cardiac defects was examined. Results The study population of fetuses included 30 fetuses with major cardiac defects and 1538 normal fetuses. The CAx and VSA were 30° to 60° and 30° to 40°, respectively, according to the 2.5th and 97.5th percentiles in normal fetuses. When cases of isolated septal wall defects and an isolated right aortic arch were excluded, nuchal translucency above the 95th percentile, an abnormal CAx, and an abnormal VSA were observed in 63.3% (19 of 30), 63.3% (19 of 30), and 66.7% (20 of 30) of fetuses with major cardiac defects, respectively, and in 4.6% (71 of 1538), 2.0% (30 of 1538), and 5.6% (86 of 1538) of those without cardiac defects. Either an abnormal CAx or VSA was found in 93.3% (28 of 30) of the fetuses with cardiac defects and in 7.3% (113 of 1538) of those without cardiac defects. Conclusion Assessment of the CAx and VSA is helpful in defining a population at risk for major cardiac defects in the first trimester.

This study aimed at exploring the expression and prognostic values of a novel long noncoding RNA RUSC1-AS-N in hepatocellular carcinoma (HCC), and to investigate the biological roles of RUSC1-AS-N in HCC cells.RUSC1-AS-N expression in public available microarray data was analyzed. The expression of RUSC1-AS-N in our cohort containing 66 HCC tissues and paired adjacent non-cancerous hepatic tissues was measured by qRT-PCR. The correlation between RUSC1-AS-N expression and clinicopathological characteristics was evaluated by Pearson χ2-test. The prognostic value of RUSC1-AS-N was analyzed by Kaplan-Meier survival analysis. The biological roles of RUSC1-AS-N on HCC cell viability were evaluated by Glo cell viability assays and Ethynyl deoxyuridine incorporation assays. The effects of RUSC1-AS-N on HCC cell cycle were evaluated by fluorescence-activated cell sorting (FACS) analyses of propidium-iodide (PI) stained cells. The effects of RUSC1-AS-N on HCC cell apoptosis were evaluated by TdT-mediated dUTP nick end-labeling (TUNEL) assays.RUSC1-AS-N is upregulated in HCC tissues and associated with poor prognosis of HCC patients from GSE54238 and GSE40144. In our cohort, we further confirmed the upregulation of RUSC1-AS-N in HCC tissues. High expression of RUSC1-AS-N associates with large tumor size, vein invasion, encapsulation incompletion, advanced BCLC stage, and poor recurrence-free survival and overall survival. Functional assays revealed that RUSC1-AS-N knockdown markedly decreases cell viability, induces cell-cycle arrest and apoptosis of HCC cells.RUSC1-AS-N is upregulated and acts as an oncogene in HCC. RUSC1-AS-N may be a promising prognostic biomarker and therapeutic target for HCC.

Objective To report our experience with an improved technique of laparoscopic radical cystectomy (LRC) and orthotopic ileal neobladder reconstruction, evaluating the perioperative and pathological outcomes. Methods We retrospectively reviewed the data of 56 cases who underwent radical cystoprostatectomy followed by construction of an orthotopic U-shaped ileal neobladder between August 2010 and December 2014. These data include intraoperative data, early and long-term postoperative complications, neobladder function, urinary continence and oncologic results. Also the key innovative procedure was introduced with details. Results The median time of the overall procedure was 212 min. The median estimated blood loss was 171 ml. The median hospitalization time after the operation was 21 days. Complications included two cases of unilateral ureter-pouch anastomotic strictures, one case of bilateral ureteral stricture, three cases of vesicourethral anastomotic strictures and three cases of vesicourethral leakage. The mean maximum pouch capacity was 446 ± 32 ml, and pouch pressure at capacity was 18.1 ± 2.6 cm H2O. The Qmax was 14 ± 1.2 ml/s, and the mean postvoid residual was 25 ± 10 ml. There were 9 cases of night-time incontinence at 3 months post-operatively. Negative surgical margins of the bladder specimens were achieved in all patients. During a follow-up period of 3–44 months (average 32.6 months), local recurrence was found in two patients and distant metastasis was occurred in another 3 patients. Conclusions Our preliminary experience showed that pure LRC with nonabsorbable titanium staples assisted orthotopic U-shape ileal neobladder reconstruction is feasible based on perioperative data and oncologic features.

We aimed to evaluate clinical therapeutic effects of human umbilical cord-derived mesenchymal stem cell (UCMSC) transplantation in the treatment of end-stage liver diseases. The human UCMSCs were cultured and prepared, and then transplanted into the hepatic tissues of 50 patients with decompensated cirrhosis. The liver function, thrombin function, Model for End-Stage Liver Disease (MELD) score, and hemodynamic index value were detected during a 24-week follow-up period, with the addition of hepatoprotective, antiviral, and other conventional treatments. No complications or serious side effects were observed. In the first 2-3 weeks after surgery, symptoms including abdominal distension, oliguria, edema, and others decreased significantly, with increased appetite compared with before surgery. In the 24-week follow-up period, the levels of serum albumin and prealbumin increased significantly compared with the preoperative levels; the decrease of coagulation indicators was not significant. The MELD scores were also markedly increased. Alpha-fetoprotein levels increased without significance after treatment. There was no significant difference in the hemodynamic changes in the portal and splenic veins according to ultrasound. Moreover, no significant differences in the liver and thrombin functions between the hepatitis B virus group and the other-etiology group were observed.

Objectives To evaluate the performance of the maxilla in the axial view in detection of orofacial clefts (OC) compared with the retronasal triangle (RNT) in the coronal view and palatine line in the sagittal view at the early stage of gestation. Methods A total of 2982 fetuses (including 315 twins) were enrolled for the first-trimester screening in this prospective study. The maxilla in the axial view, palatine line in the sagittal view, and RNT in the coronal view were scanned by 2-dimensional ultrasound. Results Excluded 103 cases lost to follow-up, 2879 fetuses were analyzed in our study. Obtaining rates of the satisfactory image of the maxilla in the axial view, RNT in the coronal view, and palatine line in the sagittal view were 95.2%, 93.8%, and 98.2% respectively. Abnormal axial view of the maxilla, coronal view of the RNT, and sagittal view of the palatine line were observed in 100% (8/8), 75% (6/8), and 50% (4/8) of the CLP cases respectively. Conclusions The study demonstrates that using the axial view of maxilla in the diagnosis of OC is feasible and improved the detection of OC compared with the sagittal view of the palatine line and coronal view of the RNT in the first trimester.

To investigate risk factors related to kidney injury in children with Henoch-Schonlein purpura (HSP) and to study the therapeutic effects of hemoperfusion (HP) on kidney injury in HSP children, providing clinical evidence for early prevention and treatment of HSP.Children who suffered from HSP for the first time were selected as study objects and they were followed up for 12 months. Single factor analysis and multi-factor Logistic regression analysis were performed for children's demographic characteristics (age, gender), clinical manifestations (rash duration time, rash recurrence times, digestive tract hemorrhage, abdominal pain, arthralgia, HSP recurrence) and laboratory indexes (peripheral blood WBC, PLT, ESR, CRP, serum IgG, serum IgA, IgM, serum C3, serum C4, TC, TG, HDL, LDL). Meanwhile, participants were divided into treatment group (HP treatment) and control group, and the protective effects of HP on renal function of HSP children were discussed.Single factor analysis indicated age ≥ 6 years, rash recurrence ≥ 3 times, rash duration time ≥ 1 month, digestive tract hemorrhage, peripheral blood PLT, WBC, serum TC and serum LDL levels had statistically significant differences between the two groups. Multi-factor Logistic regression analysis indicated rash recurrence ≥ 3 times, digestive tract hemorrhage, decline of peripheral blood PLT count, and increases of serum TC and LDL were closely related to kidney injury of HSP children. After discharge, kidney injury comparison between treatment group and control group in follow-up had a statistical difference.Rash recurrence ≥ 3 times, digestive tract hemorrhage, decline in peripheral blood PLT count, increases of serum TC and LDL, are risk factors of kidney injury in HSP children. HP can protect renal function of HSP children.

To determine the diagnostic potential of transluminal attenuation gradients (TAG) with exclusion of stented coronary segments (TAG-ExS) and TAG-corrected contrast opacification (CCO) excluding stented coronary segments (TAG-CCO-ExS) for the assessment of in-stent restenosis (ISR).TAG-ExS and TAG-CCO-ExS were calculated in 93 coronary arteries with 190 stents. The diagnostic performances and the incremental values of the two metrics to coronary computed tomography angiography (CCTA) were analysed and compared.For all stents and stents3 mm in diameter, TAG-ExS and TAG-CCO-ExS were significantly lower in ≥50% than that in50% of ISR (both p0.05). For stent diameters ≤3 mm, significantly lower TAG-CCO-ExS (p=0.000), but not TAG-ExS (p=0.059), was found in ≥50% than in50% of ISR. Addition of TAG-ExS or TAG-CCO-ExS to CCTA, did not improve the diagnostic accuracy of CCTA significantly (all p0.05). Only TAG-CCO-ExS had a significant impact on CCTA for the reclassifications of ISR (p=0.046) in stent diameters ≤3 mm.TAG-ExS and TAG-CCO-ExS did not provide incremental diagnostic value over CCTA in assessing ISR. TAG-CCO-ExS slightly enhanced the reclassifications of ISR for stents ≤3 mm in diameter.

To investigate the association between different kinds of systolic blood pressure (SBP, including office, visit-to-visit, 24-hour ambulatory) and vascular damages (represented by carotid intima-media thickness, CIMT; brachial-ankle pulse wave velocity, baPWV) in the elderly.A total of 2 814 participants aged of ≥60 years old and retired employees were selected with random sampling method from the individuals who took part in 2006-2007, 2008-2009, 2010-2011 health examination in Tangshan Kailuan Hospital, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital and with 24-hour ambulatory blood pressure monitoring data, CIMT and baPWV.Finally, 2 146 participants (1 438 males, average age (67.3±6.0) years old) were included to the analysis.Multivariable regression analysis was used to analyze association between the office, visit-to-visit, 24-hour, day-time, night-time SBP and CIMT and baPWV, respectively.(1) The average SBP, DBP, CIMT and baPWV were (137.0±20.4) mmHg(1 mmHg=0.133 kPa), (83.5±11.0) mmHg, (0.92±0.18)mm and (1 781.7±353.2)cm/s.(2) The participants were divided into high and low level groups according to the median of different SBPs, respectively.The results indicated that CIMT and baPWV were significantly higher in high level groups than in low level groups (all P0.01). (3) After adjusting for gender and age, the partial correlate analysis showed that the office, visit-to-visit, 24-hour, day-time, night-time SBP positively associated with CIMT and baPWV (all P0.01). (4) After adjusting for confounding factors, multivariable regression analysis showed that the office, visit-to-visit, 24-hour, day-time, night-time SBP were positively and linearly associated with CIMT and baPWV in total cohort, and standard regression coefficients were 0.157, 0.208, 0.175, 0.169, 0.163, 0.479, 0.420, 0.401, 0.389 and 0.354, respectively.In addition, similar results were observed in male and female participants but there was no significance between night-time SBP and CIMT in female participants.Office, visit-to-visit, 24-hour, day-time, night-time SBP are associated with vascular damages, and the best associations are observed between visit-to-visit SBP and vascular function damage.Chinese CLINICAL TRIAL REGISTRY, ChiCTR-TNC-1100 1489.

To analyze the reported data of national rural cervical cancer screening project from 2012 to 2013 and to evaluate the project implementation condition.Data of the national breast carcinoma and cervical cancer (two-cancer) screening project for rural women were collected from the online report system of key women and children's public health service programs.The screening items included: preliminary screening of cervical lesions (cervical cytology, using Traian Bethesda System(TBS) or Pap grading for classification and reporting), acetate/iodide staining (VIA/VILI), colposcopy, histopathological examination, and pathological diagnosis. The study collected the quarterly reported data from 1 183 counties of 30 provinces in 2014 and 1 130 counties of 30 provinces in 2013. Chi-square test was used to test the difference of positive detection rate, as well as precancerous cervical lesions, and cervical cancer detection rates among difference preliminary screening methods in 2012 and 2013.In 2012 and 2013, the number of cervical cancer screening was 10 621 482 and 10 321 835. The percentage of using ThinPrep cytological test as the screening method was 77.17% (n=8 196 627) and 77.07% (n=7 954 949) in 2012 and 2013, respectively. Among these ThinPrep cytological tests in these two years, 65.49% (n=5 368 194) and 71.67% (n=5 701 033) used TBS report system. The abnormality rate of colposcopy increased from 27.29% (170 063/623 161) to 31.15% (203 397/652 935) (χ(2)=2 295.94,P0.001). The abnormality rate of histopathology test increased from 19.54% (37 992/194 394) to 35.43% (59 004/166 518) (χ(2)=11 523.58, P0.001). All together, 27 341 cervical cancer or precancerous lesions have been detected in these two years. The detection rate of invasive cervical cancer increased from 18.02/100 000 in 2012 to 19.71/100 000 (χ(2)=7.90,P=0.005) in 2013 and that of precancerous lesions rose from 106.85/100 000 to 119.26/100 000 (χ(2)=70.82,P0.001). The early detection rate was 89.60% (11 883/13 263), and 89.57% (12 609/14 078), respectively in 2012 and 2013. In these two years, the rank of the detection rate of each cervical lesion were CIN1, CIN2, CIN3, invasive carcinoma, adenocarcinoma in situ, and microinvasive carcinoma, from the highest rate to the lowest rate.The program has achieved certain screening effect and the screening method has been improved. However, the quality of colposcope and histopathology should be enhanced.