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Objectives: The therapeutic regimen of submandibular gland carcinoma (SGC) has not reached consensus, especially for the neck treatment of patients with cN0. Materials and methods: Patients with SGC were identified from the medical database of Shanghai Ninth People's Hospital. Kaplan–Meier analysis, univariate and multivariate Cox regression were employed to evaluate the survival and independent prognostic factors. Results: Two hundred and fifteen patients with SGC were retrospectively reviewed. The 5‐year disease‐free survival (DFS) and overall survival (OS) rates were 71.5% and 77.8%, respectively. Multivariate analysis revealed that histological grade, cT classification, cN classification, and perineural invasion (PNI) were independent prognostic factors for DFS, while histological grade, cT classification, cN classification, and age were those for OS. The neck dissection showed no significant survival benefit for patients with cN0. Lung was the most common site of distant metastasis (16.7%). Conclusions: Histological grade, cT classification, cN classification, age, and PNI were independent prognostic factors of patient with SGC, which should be the main considerations for making therapeutic regimens. Our study also verifies the neck dissection of patient with cN0 is unnecessary, and postoperative radiotherapy (PORT) is vital for patients with pN+. [ABSTRACT FROM AUTHOR]

Background: Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score is a good parameter for evaluating bone quality. We aimed to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after oblique lumbar interbody fusion (OLIF) surgery. Methods: Patients (n = 102) who had undergone single-level OLIF with a minimal follow-up for 1 year were reviewed in this study. Demographic and radiographic data of these patients were collected. Cage subsidence was defined as ≥ 2 mm of cage migration into the inferior endplate, superior endplate, or both. Further, the MRI-based VBQ score was measured on T1-weighted images. Moreover, univariable and multivariable binary logistic regression analyses were performed. Meanwhile, Pearson analysis was used to evaluate the correlation among the VBQ score, average lumbar dual-energy X-ray absorptiometry (DEXA) T-score, and degree of cage subsidence. Furthermore, ad-hoc analysis was used along with receiver operating characteristic curve analysis to assess the predictive ability of the VBQ score and average lumbar DEXA T-score. Results: Of 102 participants, cage subsidence was observed in 39 (38.24%) patients. According to the univariable analysis, patients with subsidence had older age, higher antiosteoporotic drug use, larger disk height change, a more concave morphology of inferior and superior endplates, higher VBQ score, and lower average lumbar DEXA T-score compared to patients without subsidence. In the multivariable logistic regression analysis, a higher VBQ score was significantly associated with an increased risk of subsidence (OR = 23.158 ± 0.849, 95% CI 4.381–122.399, p < 0.001), and it was the only significant and independent predictor of subsidence after OLIF. Moreover, the VBQ score was moderately correlated with the average lumbar DEXA T-score (r = − 0.576, p < 0.001) and the amount of cage subsidence (r = 0.649, p < 0.001). Furthermore, this score significantly predicted cage subsidence with an accuracy of 83.9%. Conclusions: The VBQ score can independently predict postoperative cage subsidence in patients undergoing OLIF surgery. [ABSTRACT FROM AUTHOR]

Drought indices have been widely used in drought monitoring and assessments, but it is difficult to select a uniform index suitable for different geographical and climatic conditions. In addition, the statistical parameters of drought index also vary with fitting reference period, which brings more challenges to the practicality of drought index under climate change. In this study, a new multitimescale and more robust integrated drought index, the EDI was constructed by integrating the common components of seven single drought indices (including SPI, PDSI_th, PDSI_pm, scPDSI_th, scPDSI_pm, SPEI_th and SPEI_pm). The EDI was compared with the single drought index over China in terms of the occurrence ability of historical drought events, the dependence of statistical parameters on reference periods, the goodness-of-fit of standard normal distribution and the correlation with soil moisture and runoff. We find that the EDI could more accurately reproduce the location and intensity of historical drought events, reduce the uncertainty caused by both potential evapotranspiration estimation and the reference period, has higher goodness-of-fit of standard normal distribution, higher correlation with soil moisture, more robust performance in hydrologic drought monitoring and less affected by the difference of geographical and climatic conditions. Moreover, the EDI improved the accuracy of drought monitoring in arid and semiarid regions of China, where assessment is always complex. Furthermore, the available evidence supports that a long-term stationary climate variables series could provide more accurate drought assessment. [ABSTRACT FROM AUTHOR]

This study aims to establish a machine learning (ML) model for predicting the risk of liver and/or lung metastasis in colorectal cancer (CRC). Using the National Institutes of Health (NIH)'s Surveillance, Epidemiology, and End Results (SEER) database, a total of 51265 patients with pathological diagnosis of colorectal cancer from 2010 to 2015 were extracted for model development. On this basis, We have established 7 machine learning algorithm models. Evaluate the model based on accuracy, and AUC of receiver operating characteristics (ROC) and explain the relationship between clinical pathological features and target variables based on the best model. We validated the model among 196 colorectal cancer patients in Beijing Electric Power Hospital of Capital Medical University of China to evaluate its performance and universality. Finally, we have developed a network-based calculator using the best model to predict the risk of liver and/or lung metastasis in colorectal cancer patients. 51265 patients were enrolled in the study, of which 7864 (15.3 %) had distant liver and/or lung metastasis. RF had the best predictive ability, In the internal test set, with an accuracy of 0.895, AUC of 0.956, and AUPR of 0.896. In addition, the RF model was evaluated in the external validation set with an accuracy of 0.913, AUC of 0.912, and AUPR of 0.611. In this study, we constructed an RF algorithm mode to predict the risk of colorectal liver and/or lung metastasis, to assist doctors in making clinical decisions. [ABSTRACT FROM AUTHOR]

Maintaining or increasing grain yields while also reducing the emissions of field agricultural greenhouse gases is an important objective. To explore the multifactor effects of nitrogen fertilizer on nitrous oxide (N2O) emissions and the yield of potato fields and to verify the applicability of the denitrification–decomposition (DNDC) model when used to project the N2O emission load and yield, this research chooses a potato field in Shenyang northeast China from 2017 to 2019 as the experiment site. The experiment includes four nitrogen levels observing the emission of N2O by static chamber/gas chromatograph techniques. The results of this study are as follows: (1) DNDC has a good performance regarding the projection of N2O emissions and yields. The model efficiency index EFs were 0.45 ~ 0.88 for N2O emissions and 0.91, 0.85, and 0.85 for yields from 2017 to 2019. (2) The annual precipitation, soil organic carbon, and soil bulk density had the most significant influence on the accumulated N2O emissions during the growth period of potatoes. The annual precipitation, annual average temperature, and CO2 mass concentration had the most significant influences on yield. (3) Under the premise of a normal water supply, sowing potatoes within 5 days after the 5-day sliding average temperature in this area exceeds 10℃ can ensure the temperature required for the normal growth of potatoes and achieve the purpose of maintaining and increasing yield. (4) The application of 94.5 kg·hm−2 nitrogen and 15 mm irrigation represented the best results for reducing N2O emissions while also maintaining the yield in potato fields. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) is a declared global pandemic, causing a lot of death. How to quickly screen risk population for severe patients is essential for decreasing the mortality. Many of the predictors might not be available in all hospitals, so it is necessary to develop a simpler screening tool with predictors which can be easily obtained for wide wise.Methods: This retrospective study included all the 813 confirmed cases diagnosed with COVID-19 before March 2nd, 2020 in a city of Hubei Province in China. Data of the COVID-19 patients including clinical and epidemiological features were collected through Chinese Disease Control and Prevention Information System. Predictors were selected by logistic regression, and then categorized to four different level risk factors. A screening tool for severe patient with COVID-19 was developed and tested by ROC curve.Results: Seven early predictors for severe patients with COVID-19 were selected, including chronic kidney disease (OR 14.7), age above 60 (OR 5.6), lymphocyte count less than < 0.8 × 109 per L (OR 2.5), Neutrophil to Lymphocyte Ratio larger than 4.7 (OR 2.2), high fever with temperature ≥ 38.5℃ (OR 2.2), male (OR 2.2), cardiovascular related diseases (OR 2.0). The Area Under the ROC Curve of the screening tool developed by above seven predictors was 0.798 (95% CI 0.747-0.849), and its best cut-off value is > 4.5, with sensitivity 72.0% and specificity 75.3%.Conclusions: This newly developed screening tool can be a good choice for early prediction and alert for severe case especially in the condition of overload health service. [ABSTRACT FROM AUTHOR]

The safe and efficient mining of deep coal resources is severely restricted by the dynamic disasters caused by high gas and high ground stress. Taking a deep mine in China as the research background, a mechanical model of the front supporting stress with the working face was constructed through theoretical calculations. Based on the limit equilibrium theory, the stress distribution in the plastic zone and the elastic zone of the lateral working face was derived; based on semi-infinite plane mechanics model, the floor vertical and horizontal stress distribution was deduced. Then, the roadway surrounding rock stress and displacement field distribution evolution characteristics were revealed through numerical simulation. On this basis, the reasonable floor gas drainage roadway (FGDR) layout was determined: internal staggered layout was used with FGDR, the vertical distance to the working face is 20 m, and the horizontal distance to the working face end is 15 m; the open-off cut of FGDR was arranged in an external staggered layout, the vertical distance to the working face is 20 m, and the horizontal distance to the open-off cut of the working face is 15 m. It is an important practical significance for the layout of FGDR, the control of surrounding rocks, and the improvement of gas drainage effects under similar conditions through the research results. [ABSTRACT FROM AUTHOR]

Beijing, as the capital of China, suffers severe subsidence caused by groundwater withdrawal. In this paper, the SBAS-InSAR technique was used to detect surface deformations in the Beijing plain. 47 scenes Envisat ASAR images obtained during June 2003 to August 2010, and 24 Radarsat-2 images obtained during November 2010 to December 2013 were employed to retrieve vertical deformation characteristic over this area. The deformation magnitude, evolution process and spatial distribution of representative targets that occurred during 11 years were retrieved. The vertical surface displacement rates during two periods were validated via leveling observations, which have an RMSE =1.15mm/a, which indicates that the two types of subsidence matched very well. The interferometric results revealed that the subsidence during the two periods show similar special distributions and have an uneven spatial-temporal trend. The scope and deformation rates of funnels continuously increased with from 2003 to 2013. Meanwhile, multiple expressways and urban ring roads spanned the subsidence funnel with sharp deformation rate, and showed different subsidence properties along their paths. Additionally, the spatial and temporal correlation analyses between the deformation measurements and the dynamic variation of groundwater pumping was also performed to explore the response relationship. [ABSTRACT FROM AUTHOR]

To form a kind of support technology that was universally applicable to all kinds of dynamic pressure roadways, This paper proposes asymmetrical support technology for dynamic pressure roadway. Firstly, the asymmetry characteristics of surrounding rock structure and stress distribution in dynamic pressure roadway were analyzed. The mechanism of asymmetric support technology for dynamic pressure roadway was preliminarily explored. Taking the 1303 dynamic pressure roadway in Guotun Coal Mine as the engineering background, the coal pillar width and support parameter were determined by numerical simulation and theoretical analysis. In the asymmetric support scheme, the roof bolts and the side bolts are respectively Φ20 × 2200 and Φ20 × 2000 mm, the spacing-discharge distance of roof bolts, coal pillar side bolts and coal body side bolts are respectively 800 × 900, 600 × 900 and 800 × 900 mm. Through field observation, the overall deformation of roadway surrounding rock supported by the asymmetric support scheme was not large and the deformation of the roof, coal pillar side and coal body side were basically equal. So, this asymmetric support technology can effectively control the deformation of surrounding rock in dynamic pressure roadway. [ABSTRACT FROM AUTHOR]

In the present study, the polymorphism in the 5′‐upstream regulation region (5′‐URR), coding region (exons 2‐4), and the 3′‐untranslated region (3′‐UTR) of MICB gene were investigated for 150 healthy unrelated Jing individuals in Guangxi Zhuang Autonomous Region, by using PCR‐SBT method. A total of 14 variation sites in the 5′‐URR, 9 in coding region, and 6 in the 3′‐UTR were detected in the Jing population. The MICB gene seems to present two different lineages showing functional variations mainly in nucleotides of the promoter region. Nineteen different MICB extended haplotypes (EHs) encompassing the 5′‐URR, exons 2‐4, and 3′‐UTR were found in this population, and the most frequent was EH2 (20.33%). The findings here are of importance for future studies on the potential role of regulation region of MICB gene in disease association, transplantation, viral infection, and tumor progression among Jing population. [ABSTRACT FROM AUTHOR]

Summary: Molten salt reactor (MSR) as 1 candidate of the generation IV advanced nuclear power systems attracted more attention in China due to its top ranked in fuel cycle and thorium utilization. Two types of MSR concepts were studied and developed in parallel, namely the MSR with liquid fuel and that with solid fuel. Abundant fundamental research including the neutronics modeling, thermal‐hydraulics modeling, safety analysis, material investigation, molten salts technologies etc. were carried out. Some analysis software such as COUPLE and FANCY were developed. Several experimental facilities like high‐temperature fluoride salt experiment loop have been constructed. Some passive residual heat removal systems were designed, and 1 test facility is under construction. The key MSR techniques including the extraction and separation of molten salt and construction of N‐base alloy have been mastered. Based on these fundamental research, Chinese Academy of Sciences has completed the design of thorium‐based MSRs with solid fuel and liquid fuel and is promoting their construction in the near future. In China, future efforts should be paid to the material, online fuel processing, Th‐U fuel cycle, component design, and construction and thermal‐hydraulic experiments for MSR, which are rather challenging nowadays. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of valproic acid (VPA) and genetic polymorphism of the major metabolizing enzyme (UGT1A4, UGT2B7) of lamotrigine (LTG) and VPA on LTG concentration in Chinese epileptic children. Methods: Three single nucleotide polymorphisms (UGT1A4*3, UGT2B7 -161C > T and UGT2B7*2) were analyzed by polymerase chain reaction-restriction fragment length polymorphism or direct DNA sequencing. The concentrations of LTG and VPA were measured by high-performance liquid chromatography (HPLC) and fluorescence polarization immunoassay, respectively. The adjusted concentration of LTG was defined as the concentration-to-dose-ratio (CDR). Data analysis was performed using IBM SPSS Statistics 21.0. Results: A total of 56 patients treated with LTG as monotherapy and 158 patients treated with LTG plus VPA were included in this study. In the polytherapy group, LTG concentration showed a good linear relationship with gender, age, daily LTG dose, VPA concentration, and UGT1A4*3 polymorphism, but had no relationship with the polymorphism of UGT2B7 -161C > T or UGT2B7*2. Moreover, LTG concentration and CDR for the UGT1A4*3 were higher compared to UGT1A4*1 (LTG: 7.24 ± 3.51 vs 5.26 ± 3.27 μg/mL, p = 0.001; CDR 2.75 ± 1.02 vs 2.14 ± 0.96 μg/mL per mg/kg, p < 0.001, respectively). In the monotherapy group, there was no statistical difference between UGT1A4*3 and UGT1A4*1 in LTG concentration or CDR. The patients in the polytherapy group were divided into two subgroups according to VPA concentration (lower/higher: 10-50/50-125 μg/mL). CDR values of the patients carrying the UGT1A4*3 genotype were higher compared to UGT1A4*1*1 (2.86 ± 1.03 vs 2.22 ± 0.94 μg/mL per mg/kg, p = 0.001) only when the VPA concentration was higher. Conclusions: UGT1A4*3 polymorphism had an effect on LTG concentration only with VPA co-administration, and the effect was remarkable when VPA concentration was higher. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prevalence and risk factors of diabetes and diabetic retinopathy (DR) in northeast area of China with a population-based study. Methods: A population of 3173 (aged from 20 to 80 years old) was stratified by geographical location and age in Liaoning province, China. Prediabetes and diabetes were diagnosed according to the guideline of American Diabetes Association. Retinal photographs were obtained by using digital non-mydriatic camera for the presence and grading of DR according to the modified ETDRS Airlie house classification. Blood samples and comprehensive questionnaires were obtained for evaluation of laboratory results and risk factors. Results: The prevalence of prediabetes and diabetes was 20.7% and 10.4%, respectively. Among diabetes patients, DR prevalence was 11.9%. Age, obesity, total cholesterol, triglycerides, hypertension, living in rural areas and diabetes family history are all risk factors for prediabetes and diabetes. Waist-to-hip circumference rate served as a better obesity index to estimate diabetes risk compared with body mass index and waist circumference. Among all risk factors that we investigated, only the length of diabetes history was associated with the incidence of DR. However, DR prevalence in the newly discovered patients in rural areas was significantly higher than that in urban areas. Conclusion: According to this study, 1 in 10 people has diabetes, 2 in 10 people have prediabetes, and 1 in 10 diabetics has DR in Liaoning province. In rural areas, diabetes was poorly recognized with limited medical resources, which probably resulted in more diabetes patient at a high risk of DR. [ABSTRACT FROM AUTHOR]

Over the past decade, China has undertaken a significant institutional reform of its admission system in elite higher education (namely, Independent Freshman Admission, IFA), adopting a multistage selection strategy characterized by recommendation and interviews as an alternative channel of admission to the national college entrance examination (gaokao). Using IFA administrative data from Peking University, we reveal the mechanism of educational inequality through criterion transformations from standard test scores to comprehensive evaluations on competence. Significant associations were found between students' socioeconomic status origins, prior academic credentials, and whether they passed the selection process. This study contributes a unique and representative case of Chinese elite universities explaining why privileged groups maintained their advantages in this reform as well as in a rapidly expanded system of higher education. It also provides a better understanding of social stratification and elite reproduction in contemporary China. [ABSTRACT FROM AUTHOR]

Background: In light of the health poverty alleviation policy, we explore whether the New Rural Cooperative Medical System (NRCMS) has effectively reduced the economic burden of medical expenses on rural middle-aged and elderly people and other impoverished vulnerable groups. The study aims to provide evidence that can be used to improve the medical insurance system. Methods: Data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The method of calculating the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME) was adopted from the World Health Organization (WHO). The treatment effect model was used to identify the determinants of CHE for rural middle-aged and elderly people. Results: The incidence of CHE in rural China for middle-aged and elderly people is 21.8%, and the IME is 8.0%. The households that had enrolled in the NRCMS suffered higher CHE (21.9%) and IME (8.0%), than those that had not enrolled (CHE: 20.6% and IME: 7.7%). The NRCMS did not provide sufficient economic protection from CHE for households with three or more chronic diseases, inpatients, or households with members aged over 65 years. Key risk factors for the CHE included education levels, households with inpatients, households with members aged over 65 years, and households with disabilities. Conclusions: Although the NRCMS has reduced barriers to the usage of household health services by reducing people's out-of-pocket payments, it has not effectively reduced the risk of these households falling into poverty. Our research identifies the characteristics of vulnerable groups that the NRCMS does not provide enough support for, and which puts them at a greater risk of falling into poverty due to health impoverishment. [ABSTRACT FROM AUTHOR]

A coupled hybrid ensemble square root filter and three-dimensional ensemble-variational (EnSRF-En3DVar) radar data assimilation system, developed for the Weather Research and Forecasting model, was applied to a mesoscale convective system (MCS) that occurred over southeastern China on 5 June 2009. This hybrid system uses the extended control variable method to combine the static and ensemble flow-dependent forecast error covariance. The potential of the hybrid EnSRF-En3DVar system was first explored by comparing the derived results with those obtained using 3DVar and EnSRF approaches alone. Assimilation results showed the hybrid EnSRF-En3DVar system reduces the root mean square innovations for reflectivity and radial velocity, and better represents the pattern of the MCS than either 3DVar or EnSRF. This successful analysis improved quantitative reflectivity and precipitation forecasting skills, and helped forecast the MCS more realistically with regard to location, structure and intensity. Moreover, the root mean square error of the forecast wind, temperature and water vapor mixing ratio were found reduced by the hybrid EnSRF-En3DVar system when compared with the other methods. Diagnoses of the forecast fields showed the hybrid EnSRF-En3DVar system increases low-level cooling and mid-level warming within the convective area. Furthermore, sensitivity experiments testing the ensemble covariance weighting factor effect in the hybrid EnSRF-En3DVar method suggested that a stronger ensemble covariance weighting value led to improved precipitation forecast results. • A new hybrid EnSRF-En3DVar radar data assimilation system is developed and applied to an MCS case. • The improvements of the hybrid approach are found in the forecasting of the MCS comparing with 3DVar and EnSRF. • A stronger ensemble covariance weighting value lead to an improved forecast results. [ABSTRACT FROM AUTHOR]

Abstract: Allele frequencies data for 15 short tandem repeat (STR) loci were obtained from samples of 358 healthy unrelated individuals living in southern area of Liaoning province of Northeast China. The genotype frequencies distribution of the 15 STR loci, detected by the AmpF/STR Identifiler kit, were in the Hardy–Weinberg equilibrium. The obtained frequencies distributions were compared with other previously reported population data. [Copyright &y& Elsevier]

To comprehensively examine the MICB gene polymorphism and identify its differences in Chinese Yao population from other ethnic groups, we investigated the polymorphism in the 5′-upstream regulation region (5′-URR), coding region (exons 2–4), and the 3′-untranslated region (3′-UTR) of MICB gene by using PCR-SBT method in 125 healthy unrelated Yao individuals in Guangxi Zhuang Autonomous Region. Higher polymorphism was observed in the 5′-URR, nine single nucleotide polymorphisms (SNPs) and a two base pairs deletion at position −139/−138 were found in our study. Only five different variation sites, however, were detected in exons 2–4 and three were observed in the 3′-UTR. The minor allele frequencies of all variants were greater than 5%, except for rs3828916, rs3131639, rs45627734, rs113620316, rs779737471, and the variation at position +11803 in the 3′-UTR. The first nine SNPs of 5′-URR and rs1065075, rs1051788 of the coding region showed significant linkage disequilibrium with each other. Ten different MICB extended haplotypes (EH) encompassing the 5′-URR, exons 2–4, and 3′-UTR were found in this population, and the most frequent was EH1 (23.2%). We provided several evidences for balancing selection effect on the 5′-URR of MICB gene in Yao population. [ABSTRACT FROM AUTHOR]

• By comprehensive calculation on catastrophic health expenditure (CHE), it is precisely targeted the weakness of health insurance system for sufficient economic protection for Chinese middle-aged and elderly population in five years. • It is identified the vulnerable characteristics of middle-aged and elderly population prone to CHE in China. • Innovative use of the Generalized linear mixed models (GLMMs) is to find the fixed effect and random effect of the CHE in the five years. Little is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. Data were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. The incidence of CHE of China's middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. The health system needs to control the irrational growth of health expenses and reduce residents' overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources. [ABSTRACT FROM AUTHOR]

Eltrombopag combined with immunosuppressive therapy (IST) was superior to IST alone for severe aplastic anemia (SAA) in the previous studies. But in China, horse antithymocyte globulin (hATG) is not available, instead, we use rabbit ATG (rATG). Here, we compared the efficacy and safety of IST (rATG combined with cyclosporine) combined with or without eltrombopag for the first-line treatment of SAA and very severe aplastic anemia (VSAA). A total of 371 patients in ten institutions in China from April 1, 2017 to December 1, 2022 were enrolled. The overall response (OR) rate at 3 months (54.2% vs. 41%; P = 0.046), the complete response (CR) (31.3% vs. 19.4%; P = 0.041) and OR (78.3% vs. 51.1%; P < 0.0001) rates at 6 months were significantly higher with IST combined with eltrombopag than with IST alone in SAA patients. While in VSAA patients, the addition of eltrombopag to IST only increased the CR rate at 6 months (29.8% vs. 9.43%; P = 0.010). Liver injury increased significantly in groups treated with IST combined with eltrombopag (P < 0.05). Serious treatment-related toxicities were similar (P > 0.05). In patients with SAA, 3-year failure-free survival (FFS) of eltrombopag combined with IST group was significantly higher than that of IST group (70.7 ± 5.3% vs. 50.3 ± 3.9%; P = 0.007). In patients with VSAA, the addition of eltrombopag significantly improved 3-year overall survival (OS) (82.2 ± 5.7% vs. 57.3 ± 7.2%; P = 0.020). Our findings suggested that IST combined with eltrombopag could improve the hematological recovery of newly diagnosed SAA without increasing severe toxicities. But in VSAA, the addition of eltrombopag seemed to show no other improvement to efficacy except the CR rate at 6 months., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Lead (Pb) and cadmium (Cd) in environment can be directly absorbed by drinking water and soil. However, data on human Pb and Cd exposure by drinking water and soil and its long-term consequence for type 2 diabetes mellitus (T2DM) and obesity are lacking. Our study aims to explore the association of typical heavy metals co-exposure in drinking water and soil to the community residents with T2DM and obesity indices in two cities of southern China. A cross-sectional study enrolling total 1,274 participants was performed and the local water and soil samples were collected in two communities in southern China. The average daily dose (ADD) of heavy metals was calculated to assess the exposure. The obesity indices comprise body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC). Binary, multiple logistic and linear regressions were employed for assessing the associations of Pb and Cd exposure with T2DM and obesity. The results showed that there weren't any significant correlations between ADDs of Pb/Cd and T2DM in community residents (all P s>0.05). Compared with those with 18.5 ≤ BMI <24, with 1 μg/kg bw/d ADD of Pb increase in exposure are associated with 49.2-56.1% lower likelihood of overweight. Besides, with ADDs of Pb exposure was increased by 1 μg/kg bw/d and WHR decreasing by 0.01-0.02, and WC decreasing by 2.22-4.67 cm. We speculate that Pb causes weight loss because it damages the absorption function of the gastrointestinal tract as an initial injury. 1μg/kg bw/d ADD of Cd increase is associated with 100.9% upper likelihood of low weight in Model 1. It suggests that Pb/Cd pollution in the local environment was serious and harmful to residents' health. Government should introduce relevant oversight and accountability systems to improve the prevention and management of lifestyle-related chronic diseases in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Qu, Zhou, Guo, Wang, Wang, Liu, Wu, Wang and Liu.)

Maintaining or increasing grain yields while also reducing the emissions of field agricultural greenhouse gases is an important objective. To explore the multifactor effects of nitrogen fertilizer on nitrous oxide (N 2 O) emissions and the yield of potato fields and to verify the applicability of the denitrification-decomposition (DNDC) model when used to project the N 2 O emission load and yield, this research chooses a potato field in Shenyang northeast China from 2017 to 2019 as the experiment site. The experiment includes four nitrogen levels observing the emission of N 2 O by static chamber/gas chromatograph techniques. The results of this study are as follows: (1) DNDC has a good performance regarding the projection of N 2 O emissions and yields. The model efficiency index EFs were 0.45 ~ 0.88 for N 2 O emissions and 0.91, 0.85, and 0.85 for yields from 2017 to 2019. (2) The annual precipitation, soil organic carbon, and soil bulk density had the most significant influence on the accumulated N 2 O emissions during the growth period of potatoes. The annual precipitation, annual average temperature, and CO 2 mass concentration had the most significant influences on yield. (3) Under the premise of a normal water supply, sowing potatoes within 5 days after the 5-day sliding average temperature in this area exceeds 10℃ can ensure the temperature required for the normal growth of potatoes and achieve the purpose of maintaining and increasing yield. (4) The application of 94.5 kg·hm -2 nitrogen and 15 mm irrigation represented the best results for reducing N 2 O emissions while also maintaining the yield in potato fields., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: The authors have no conflicts of interests to disclose.

Background: Nonsustained ventricular tachycardia (NSVT) is an independent risk factor for sudden cardiac death (SCD) in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, data concerning the correlations of cardiac biomarkers and NSVT in HOCM are rather limited., Hypothesis: Our study aimed to investigate the associations between the occurrence of NSVT and circulating biomarkers representing myocardial injury (cardiac troponin I, cTnI), cardiac function (N-terminal pro-brain natriuretic peptide, NT-pro BNP), and inflammation (high-sensitivity C-reactive protein) in a large Chinese HOCM cohort., Methods: A total of 755 consecutive HOCM patients were recruited. Systematic cardiac evaluations and circulating biomarkers were examined routinely in all subjects under the clinically stable status. According to the results of 24-hour Holter monitoring, patients were divided into the NSVT group (n = 138) and the nonventricular tachycardia (non-VT) group (n = 617)., Results: Compared with the non-VT group, circulating levels of both cTnI and NT-pro BNP elevated significantly in patients with positive NSVT episodes (P < .001). Multivariable analyses demonstrated that cTnI was independently associated with the presence of NSVT (OR = 1.675, 95% CI: 1.406-1.994, P < .001). Concentrations of cTnI increased progressively not only with the aggravation of ventricular arrhythmic events (P < .001), but also with the growing risk of SCD in HOCM patients (P < .001). Serum cTnI ≥ 0.0265 ng/mL indicated predictive value for the occurrence of NSVT in the HOCM cohort (area under the curve = 0.707, 95% CI: 0.660-0.754, P < .001)., Conclusions: Elevated cTnI was an independent determinant of NSVT, and it seemed to be valuable for assessing the clinical status of ventricular arrhythmias and the risk of SCD in patients with HOCM., (© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Purpose: To investigate diabetic optic neuropathy (DON) prevalence and risk factors in Chinese diabetic retinopathy (DR) patients., Methods: This retrospective study included 1067 eyes (550 patients) that underwent ocular imaging. The diabetes duration, systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and high-density lipoprotein (HDL) were also recorded simultaneously., Results: A total of 410 eyes with DON and 657 eyes without DON were included (38.4% DON prevalence). DON eyes were classified as having diabetic papillopathy (DP), optic disc neovascularization (NVD), anterior ischemic optic neuropathy (AION), or optic atrophy (OA). Proliferative DR eyes had a higher DON prevalence than nonproliferative DR eyes (P < 0.001). Diabetes duration, SBP, and HbA1c were higher in DON patients than in non-DON patients (all P < 0.001). Additionally, HDL was lower in patients with DON (0.74 ± 0.13 mM) than in those without DON (1.00 ± 0.24 mM, P < 0.001). HbA1c levels were greater in AION patients (10.00 ± 1.53% [85.76 ± 16.71 mmol/mol]) than in DP patients (8.78 ± 1.97% [72.45 ± 21.55 mmol/mol], P = 0.017); central foveal thickness (CFT) significantly varied among groups (P < 0.001). Increased age, diabetes duration, SBP, CFT, and DR severity were risk factors for DON; and increased HbA1c was a risk factor for NVD, AION, and OA (all P < 0.05)., Conclusions: Our study results strengthen the argument that increased age, diabetes duration, SBP, CFT, DR severity, and HbA1c are all risk factors for DON in patients with DR.

Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Data regarding the correlations of biomarkers and AF in HCM patients are rather limited. We sought to explore the associations between the presence of AF and circulating biomarkers reflecting cardiovascular function (N-terminal pro-brain natriuretic peptide, NT-pro BNP), endothelial function (big endothelin-1, big ET-1), inflammation (high-sensitivity C-reactive protein), and myocardial damage (cardiac troponin I, cTnI) in HCM patients with and without left ventricular outflow tract obstruction (LVOTO).In all, 375 consecutive HCM in-hospital patients were divided into an AF group (n = 90) and a sinus rhythm (SR) group (n = 285) according to their medical history and electrocardiogram results.In comparison with the SR group, peripheral concentrations of big ET-1, NT-pro BNP, and cTnI were significantly higher in patients with AF. Only the biomarker of big ET-1, together with palpitation and left atrial diameter (LAD), was independently associated with AF in HCM patients. Ln big ET-1 was positively related to Ln NT-pro BNP, LAD, and heart rate, but negatively related to left ventricular ejection fraction. Combined measurements of big ET-1 ≥ 0.285 pmol/L and LAD ≥ 44.5 mm indicated good predictive values in the presence of AF, with a specificity of 94% and a sensitivity of 85% in HCM patients.Big ET-1 has been identified as an independent determinant of AF, regardless of LVOTO, and is significantly related to parameters representing cardiac function and remodeling in HCM. Big ET-1 might be a valuable index to evaluate the clinical status of AF in HCM patients.

Aim: Rheumatoid arthritis (RA) as an inflammatory autoimmune disease affects the synovial joints as well as other organs and tissues. Since aberrant expression of MIC molecules has been observed in RA patient, MIC genotypes might play certain roles in the development of RA., Method: To explore the association of MICA and MICB polymorphisms with RA in a Han Chinese population in Hainan Island, samples from 172 RA and 137 healthy controls were genotyped for MICA and MICB., Results: Our results indicated that MICB*002 and MICB*014 were less frequent in RA patients than in controls (P = 0.000, 0.005) while there were higher percentages of RA patients carrying MICA*009 and MICA*A6 (P = 0.005)., Conclusion: Different MIC variants might modulate the autoimmune reaction differently in RA disease and therefore serve as protective or risk factors., (© 2018 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

The purpose of this study is to describe the effects and complications of photodynamic therapy (PDT) on Chinese patients with circumscribed choroidal hemangioma (CCH). In this retrospective study, 22 CCH patients who underwent PDT performed 15 min after the injection of intravenous verteporfin (6 mg/m2)with multiple 83-second laser spots at 689 nm (50 J/cm2) were studied. Fluorescein angiography and/or indocyanine green angiography, B-scan ultrasonography and optical coherence tomography were performed in all patients. Follow-up was performed until 12 months post-treatment. All patients were treated with one session, except 1 case with prior transpupillary thermotherapy history. At the 12-month follow-up, the mean of the best corrected visual acuity (BCVA) increased from 0.40 ± 0.38 to 0.56 ± 0.42 (p < 0.05), tumors became thinner (1.96 ± 2.65 mm vs. 4.31 ± 2.04 mm) (p < 0.05), and exudative detachment were diminished. The mean fovea center thickness (FCT) decreased from 540.1 ± 470.6 to 171.6 ± 79.3 μm at the 3-month follow-up. The 12-month BCVA was correlated with prior laser treatment, symptom duration, baseline CCH diameter and thickness, baseline FCT and cystoid macular edema. One patient developed a branch retinal artery occlusion. In conclusion, PDT is an effective and safe treatment for CCH. Specific PDT protocols for CCH should be standardized. The retinal arteriole should be spared during the treatment., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Medical school education plays an important role in promoting patient safety. In this study, we assess medical students' perceptions of patient safety culture, identify their educational needs and provide evidence on the most important content relating to patient safety for the medical school curriculum., Method: This cross-sectional study was conducted in four medical universities in Heilongjiang province. Medical students in the first through five years completed an anonymous questionnaire-the Attitudes toward Patient Safety Questionnaire III. We analysed the differences in responses across the four universities and their cohorts., Results: The overall perceptions of patient safety culture across the four medical universities were positive. The highest positive response rate was for 'I have a good understanding of patient safety issues as a result of my undergraduate medical training' (range: 58.4%-99.8%), whereas the lowest positive response rate was for 'medical errors are a sign of incompetence' (14.7%-47.9%). Respondents in the earlier years of school tended to have more positive responses for items concerning working hours and team work; however, fourth and fifth year students had more positive responses for error inevitability. Items with the lowest positive response rates across the cohorts included items related to 'professional incompetence as a cause of error' and 'disclosure responsibility'., Conclusions: While students generally had positive views of patient safety culture, none of them had been exposed to any formal curriculum content on patient safety. Policymakers should focus more on how educational needs vary across schools and cohorts in order to establish appropriate curricula., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Cholelithiasis is a kind of common and multiple diseases. In recent years, traditional laparotomy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. (1) For intrahepatic bile duct stones, the operation may be selected by laparoscopic liver resection, laparoscopic common bile duct exploration (LCBDE), or percutaneous transhepatic cholangioscopy. (2) For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows: laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. (3) For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.

Background: Major histocompatibility complex class I chain-related gene (MIC) polymorphisms have been associated with many autoimmune diseases. To explore the correlation between MIC polymorphisms and systemic lupus erythematosus (SLE), we compared the sequence of the MIC gene in Han Chinese patients with SLE from Hainan Island, China, with healthy individuals., Methods: In this study, the MIC polymorphisms in 296 subjects (159 patients with SLE and 137 healthy volunteers) of Han ethnicity from Hainan Island were characterized. A chi-square test was performed to evaluate the differences in the allelic frequency of the MIC genes between patients with SLE and the control subjects., Results: The genotyping results indicated that the frequencies of the MICA*010, MICB*014, and MICB*002 alleles were significantly higher in the control subjects than the patients with SLE. Additionally, the results also indicated that the frequency of the MICB*009N in the SLE group was significantly increased compared to that in the matched control subjects., Conclusions: The results of this study suggested that the MICB*009N allele might be a risk factor for SLE, whereas the MICB*014, MICA*010 and MICB*002 alleles were associated with reduced incidence of SLE in the study population., (Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine affecting millions of children. As a complex disease, the genetic aetiology of AIS remains obscure. Here we report the results of a four-stage genome-wide association study (GWAS) conducted in a sample of 4,317 AIS patients and 6,016 controls. Overall, we identify three new susceptibility loci at 1p36.32 near AJAP1 (rs241215, Pcombined=2.95 × 10(-9)), 2q36.1 between PAX3 and EPHA4 (rs13398147, Pcombined=7.59 × 10(-13)) and 18q21.33 near BCL-2 (rs4940576, Pcombined=2.22 × 10(-12)). In addition, we refine a previously reported region associated with AIS at 10q24.32 (rs678741, Pcombined=9.68 × 10(-37)), which suggests LBX1AS1, encoding an antisense transcript of LBX1, might be a functional variant of AIS. This is the first GWAS investigating genetic variants associated with AIS in Chinese population, and the findings provide new insight into the multiple aetiological mechanisms of AIS.

To investigate the occurrence and progression of outer retinal tubulation (ORT) in Chinese patients after intravitreal ranibizumab injections, using spectral domain optical coherence tomography (SD-OCT) with eye tracking function. 15 age related macular degeneration (AMD) and 6 polypoidal choroidal vasculopathy (PCV) eyes of 21 patients were enrolled and assessed by SD-OCT. One patient received photodynamic therapy (PDT) previously, and all patients received intravitreal injections of ranibizumab. At baseline, only one AMD eye (4.8%) showed ORT, which appeared as round or ovoid hyporeflective spaces with hyperreflective borders. During the follow ups, ORT was identified in nine of 15 AMD eyes (60.0%) and one of six PCV eyes (16.7%). These new ORTs in 10 eyes were originated from the intraretinal fluid. Inner nuclear layer (INL), outer plexiform layer (OPL) and outer nuclear layer (ONL) were pulled down to form "cynapsis", separating each ORT. However, ORT in 3 eyes disappeared after intravitreal ranibizumab injections. This is the first observation on the occurrence and progression of ORT in Chinese AMD and PCV patients, in a point to point manner. The ORT could become stable or disappear after ranibizumab injections, and outer retina involved in the process of ORT formation.

To develop a cost-effective technique for single-nucleotide polymorphism (SNP) genotyping and improve the efficiency to analyze degraded DNA, we have established a novel multiplex system including 21-locus autosomal SNPs and amelogenin locus, which was based on allele-specific amplification (ASA) and universal reporter primers (URP). The target amplicons for each of the 21 SNPs arranged from 63 base pair (bp) to 192 bp. The system was tested in 539 samples from three ethnic groups (Han, Mongolian, and Zhuang population) in China, and the total power of discrimination (TPD) and cumulative probability of exclusion (CPE) were more than 0.99999999 and 0.98, respectively. The system was further validated with forensic samples and full profiles could be achieved from degraded DNA and 63 case-type samples. In summary, the multiplex system offers an effective technique for individual identification of forensic samples and is much more efficient in the analysis of degraded DNA compared with standard STR typing., (© 2013 American Academy of Forensic Sciences.)

Background: BRM (Brahma homologue) is well known for its critical role in tumor suppression and cancer development. Genetic variations in the promoter region of BRM have been suggested to be associated with loss of BRM expression and lung cancer risk. To the authors' knowledge, no study on the role of BRM genetic polymorphisms in hepatocellular carcinoma (HCC) risk has been performed., Methodology/principal Findings: In two independent case-control studies containing 796 HCC cases and 806 cancer-free individuals, we genotyped two putative functional insertion/deletion (indel) polymorphisms [BRM-1321 (rs3832613) and BRM-741 (rs34480940)] within promoter region of BRM in Chinese populations using a PCR-based method. Real-time RT-PCR analysis was used to explore the genotype-phenotype correlation between these polymorphisms and BRM expression in both tissue samples and HCC cell lines. Logistic regression analysis showed that compared to BRM-1321del/del genotype, the ins/del and ins/ins variant genotypes had an increased HCC risk [adjusted odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.19-1.82; adjusted OR = 2.55, 95% CI = 1.75-3.72, respectively]. No significant association between BRM-741 and HCC incidence was observed. However, stratification analysis revealed a significant association between ins/ins genotype of BRM-741 and increased HCC susceptibility in smokers (adjusted OR = 2.07, 95% CI = 1.33-3.22). Quantitative PCR analyses demonstrated that the genotypes of BRM-1321 and the corresponding haplotypes were significantly correlated with BRM expression in vivo. Compared with ins/ins genotype, subjects carrying ins/del and del/del genotype had 2.30 and 4.99 fold higher BRM expression in HCC tissue samples, respectively. Similar trends were observed in western blot analysis at protein level., Conclusions/significance: Our findings suggest that BRM promoter polymorphism (BRM-1321) could regulate BRM expression and may serve as a potential marker for genetic susceptibility to HCC.

Background: Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first meta-analysis to investigate the pooled prevalence of DR in mainland China., Methodology/principal Findings: We conducted a search of all English reports on population-based studies for the prevalence of DR using Medline, EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the pooled general population was 1.3% (95%CI: 0.5%-3.2%), 1.1% (95%CI: 0.6%-2.1%), and 0.1% (95%CI: 0.1%-0.3%), respectively, but was 23% (95%CI: 17.8%-29.2%), 19.1% (95%CI: 13.6%-26.3%), and 2.8% (95%CI: 1.9%-4.2%) in the diabetic group. The prevalence rate of DR in the pooled rural population was higher than that in the urban population, 1.6% (95%CI: 1.3%-2%), and the diabetic population, 29.1% (95%CI: 20.9%-38.9%). The prevalence of DR was higher in the Northern region compared with the Southern region., Conclusions/significance: The prevalence of DR in mainland China appeared a little high, and varied according to area. NPDR was more common. This study highlights the necessity for DR screening in the rural areas of China.

Study Design: A retrospective study to analyze the effect of decompressive extent on the posterior shift of spinal cord after expansive open-door laminoplasty (ELAP)., Objective: To investigate the effect of decompressive extent on cord shift distance after ELAP, and determine the morphologic limitations of posterior approach when the cervical alignment is lordotic or straight., Summary of Background Data: It is still controversial on the effect of space available for spinal cord at the level cephalad to the decompression with cord shift. Moreover, there is less understanding regarding the significance of decompressive extent of laminoplasty in relation to spinal cord shift and clinical outcome., Methods: Preoperative and postoperative MRIs of 76 patients with a straight or lordotic cervical spine who had undergone cervical laminoplasty were reviewed and evaluated retrospectively. Radiographic parameters including cervical sagittal alignment, space available at the level cephalad, the thickness of compressive mass, and the average anterior subarachnoid space were measured. Laminoplasty was performed from C1 to C7 in 11 cases (CI group), C2 to C7 in 30 cases (CII group), and C3 to C7 in 35 cases (CIII group). According to whether the anterior indirect decompression was adequate or not, CII and CIII groups were further divided into two subgroups, the noncontact group in which the spinal cord was completely separated from the anterior compressive mass after laminoplasty, and the contact group in which there was residual cord compression after laminoplasty. The recovery rate that based on the Japanese Orthopedic Association score was calculated for each patient., Results: There were statistically significant differences in the average anterior subarachnoid space among CI, CII, and CIII groups (P < 0.05);the average anterior subarachnoid space was the largest in CI group, and the smallest in CIII group. The space available at the level cephalad had strong sigmoidal correlation with cord postoperative shift in CIII group (R = 0.91). A higher neurologic recovery rate (69% ± 20% vs. 29% ± 11%; P < 0.05) in the noncontact group after surgery than in the contact group, with a similar follow-up period., Conclusion: The posterior decompression extent is a main factor affecting cord shift distance after laminoplasty in the context of a straightened or lordotic cervical curvature. The space available at the levels cephalad is a key factor to predict cord shift distance in laminoplasty from C3 to C7. Neurologic recovery rate after ELAP is affected by whether the anterior indirect decompression was adequate or not.

The prevalence of cardiac abnormalities in patients with adolescent idiopathic scoliosis in an Asian population has not been reported. A retrospective study was conducted to evaluate the incidence of cardiac abnormalities in these patients. From January 2007 to April 2009, echocardiography and pulmonary function tests were performed in 80 adolescent idiopathic scoliosis patients who required surgical intervention. A thorough analysis of cardiopulmonary functions and cardiac structures was performed. The risk factors, types of cardiac abnormalities, and associations between severity of scoliosis or pulmonary function and cardiac abnormalities were assessed. Cardiac abnormalities were detected by echocardiogram in 25 patients, including 14 with structural abnormalities and 11 with functional abnormalities. The most common functional abnormality was tricuspid regurgitation (9 of 80; 11.3%), whereas atrial septal defect was the most common structural abnormality (7 of 80). Altered hemodynamics occurred in 5 patients, including 3 with ventricular septal defect and 2 with mitral valve dysplasia. Abnormal electrocardiographic findings presented in only 9 of the 25 patients with cardiac abnormalities. No significant associations were found between severity of scoliosis or pulmonary function and cardiac abnormalities. A high incidence of cardiac abnormality exists in patients with adolescent idiopathic scoliosis in this region. Although most patients tolerated surgery, some patients were at risk of decompensation postoperatively. Electrocardiography is of limited value for detecting cardiac problems in patients with adolescent idiopathic scoliosis, we recommend echocardiography as a routine modality in the preoperative evaluation of patients with adolescent idiopathic scoliosis., (Copyright 2010, SLACK Incorporated.)

To analyze the clinical features of patients with spinal injuries and to better cope with future disasters, we retrospectively reviewed 78 patients' medical records after the 2008 Sichuan, China, earthquake. All patients survived, and the mean time patients spent under rubble was 12.2 hours. The largest number of victims were in the 30- to 39-year age group (24.3%), followed by the 20- to 29-year age group (21.8%) and the 40- to 49-year age group (20.5%). Isolated spinal injuries occurred in 55 patients (71.5%). Multilevel spinal injuries occurred in 23 patients (29.5%). The most common region for spinal injuries was the lumbar spine (38.5%), followed by the thoracic spine and the cervical spine. Nearly 53.8% of these spinal injuries resulted in some form of neurologic disability. Thoracic injury contributed to the majority of the neurologic injury. Lumbar injury seldom resulted in neurologic damage. Almost all cervical injuries were associated with severe spinal cord injury. The majority of patients sustained injuries in addition to their spinal injuries. More than one-third of patients (35.7%) had upper extremity fractures, 12.1% had pelvic fractures, and 44.5% had lower extremity fractures. The most commonly injured bone in the upper extremity was the humerus and in the lower extremity, the femur. Other associated injuries included head (19.6%), thoracic (39.8%), abdominal (8.9%), and urologic (2.56%) injuries. The high frequency of multilevel injuries of the spine and additional injuries reaffirms the need for vigilance in patient assessment.

Objective: To analyze the spinal injury in Wenchuan earthquake and to investigate its clinical features., Methods: Data of 146 patients in Wenchuan earthquake with spinal injuries (79 males, 67 females; aged 11-88 years old, average 51 years old) were collected and analyzed epidemiologically. Two patients under 16 years of age, 15 patients with the fractures of spinous process, transverse process or vertebra lamina, 1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification, and 9 patients with upper cervical injuries were excluded. The remaining 119 patients were divided into two groups according to their age: group A in which 78 patients were under 60 years of age, including 40 males and 38 females aged 18-58 years old (average 41 years old), and group B in which 41 patients were 60 years of age or above, including 24 males and 17 females aged 60-88 years old (average 71 years old). Analyses for the two groups were compared., Results: The leading causes of spinal injuries were fall from high places (27.40%) and crush by heavy objects (67.81%). According to Denis classification, the major types of spinal injuries were burst fracture (54.62%) and compression fracture (33.61%). Serious nerve injury, defined as grade A, B and C in ASIA neurological function assessment, occurred in 31.51% of patients. The most common injured site was in thoracic or lumbar vertebrae (78.77%), and 52.74% of patients had combined injuries, among which the fractures of limb (30.14%) and rib (19.86%) were the most common. Multi-level spinal fractures happened to 22.60% of patients. Comparative analysis revealed the rate of injury caused by fall from high places in group A (34.62%) was much higher than that in group B (12.20%). The commonest type of fracture in group A was burst fracture (58.97%), and it was compression fracture in group B (48.78%). The rate of serious nerve injury in group B (24.39%) was much lower than that in group A (44.87%). The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%, respectively, which was much higher than that in group A (combined injury 43.59%; multilevel vertebral body injury 21.79%). There were significant differences between two groups in all the indicators derived from clinical data (P < 0.05)., Conclusion: In Wenchuan earthquake, the leading causes of spinal injuries are fall from high places and crush by heavy objects, the major types of fracture are compression fracture and burst fracture, and the occurrence rates of spinal injury, combined injury and multilevel vertebral body injury are high.