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Total dissolved gas (TDG) supersaturation, which can be caused by flood discharge, results in gas bubble disease (GBD) in fish and threatens their survival downstream of dams. TDG supersaturation has become a serious environmental problem in the Yangtze River. Few studies have evaluated the effect of TDG supersaturation on fish in natural rivers during periods of flood discharge. To estimate fish tolerance to TDG supersaturation under natural conditions, juvenile Myxocyprinus asiaticus and juvenile Procypris rabaudi were exposed to TDG-supersaturated water for 96 h at various depths (0–0.3 m, 0.3–1.3 m, 1.3–2.3 m and 0–2.3 m) during periods of flood discharge of Dagangshan hydropower station. The results showed that juvenile Procypris rabaudi and juvenile Myxocyprinus asiaticus exhibited obvious GBD signs. An increase in exposure time decreased survival probability of the two species. Deeper water depths can increase the tolerance of juvenile Procypris rabaudi to TDG supersaturation in natural rivers during periods of flood discharge while it cannot improve the survival of juvenile Myxocyprinus asiaticus. Compared with juvenile Myxocyprinus asiaticus, juvenile Procypris rabaudi showed weaker tolerance of TDG supersaturation in shallow water, and juvenile Procypris rabaudi were more vulnerable to TDG supersaturation than juvenile Myxocyprinus asiaticus even if the TDG level (116%) was low.

This study aimed to examine effect modification of maternal risk factor exposures and congenital heart disease (CHD) by maternal folic acid supplementation (FAS)/non-FAS. We included 8379 CHD cases and 6918 CHD-free controls from 40 clinical centers in Guangdong Province, Southern China, 2004–2016. Controls were randomly chosen from malformation-free fetuses and infants and frequency matched to the echocardiogram-confirmed cases by enrollment hospital and year of birth. We used multiple regression models to evaluate interactions between FAS/non-FAS and risk factors on CHDs and major CHD categories, adjusted for confounding variables. We detected statistically significant additive and multiplicative interactions between maternal FAS/non-FAS and first-trimester fever, viral infection, and threatened abortion on CHDs. An additive interaction on CHDs was also identified between non-FAS and living in a newly renovated home. We observed a statistically significant dose-response relationship between non-FAS and a greater number of maternal risk factors on CHDs. Non-FAS and maternal risk factors interacted additively on multiple critical CHDs, conotruncal defects, and right ventricular outflow tract obstruction. Maternal risk factor exposures may have differential associations with CHD risk in offspring, according to FAS. These findings may inform the design of targeted interventions to prevent CHDs in highly susceptible population groups.

Loss and waste of postharvest vegetables are the main challenges facing the world’s vegetable supply. In this study, an innovative method of value-added transformation was provided: production of bacteriocin from vegetable waste, and then its application to preservation of vegetables. Antibacterial activity to soft rot pathogen Pectobacterium cartovorum (Pcb BZA12) indicated that tomato performed best in the nutrition supply for bacteriocin production among 12 tested vegetables. Moreover, the antibacterial activity was from Lactobacillus paracasei WX322, not components of vegetables. During a fermentation period of 10 days in tomato juice, L. paracasei WX322 grew well and antibacterial activity reached the maximum on the tenth day. Thermostability and proteinase sensitivity of the bacteriocin from tomato juice were the same with that from Man-Rogosa-Sharpe broth. Scanning electron microscope images indicated that the bacteriocin from tomato juice caused great damage to Pcb BZA12. At the same time, the bacteriocin from tomato juice significantly reduced the rotten rate of Chinese cabbage from 100% ± 0% to 20% ± 8.16% on the third day during storage. The rotten rate decrease of cucumber, tomato, and green bean was 100% ± 0% to 0% ± 0%, 70% ± 14.14% to 13.33% ± 9.43%, and 76.67% ± 4.71% to 26.67% ± 4.71%, respectively. Bacteriocin treatment did not reduce the rotten rate of balsam pear, but alleviated its symptoms.

Abstract Background The metagenome contains plenty of genetic resources and can be used to search for the novel gene or mutant. Results In this study, the bacterial laccase gene (cueO) with single or multiple mutations was directly cloned based on the metagenome of a chemical plant sludge. An interesting mutation (G276R) was identified from those cloned mutants. The other mutants (G276N, G276Y, and G276K) with improved catalytic efficiency were identified by the saturation mutagenesis on residue G276. The optimal temperature for wild-type CueO enzyme activity was about 70 °C, compared to 60 °C, 50 °C, 50 °C, and 30 °C for the G276R, G276N, G276Y, and G276K mutant enzymes, respectively. The catalytic efficiency (k cat/K m) with 8 mmol Cu2+ of the G276R, G276N, G276Y, and G276K mutants was 1.2-, 2.7-, 1.3-, and 2.7-fold, respectively, compared to the wild-type enzyme. In addition, the mutants G276R, G276N, G276Y, and G276K oxidized the carcinogen benzo[α]pyrene more efficiently compared to the wild-type enzyme. Conclusion All of the results indicate that G276 of CueO plays an important role in enzyme activity, and the useful mutants can be identified based on the metagenome.

Prenatal exposure to toxic trace elements, including heavy metals, is an important public health concern. Few studies have assessed if individual and multiple trace elements simultaneously affect cardiac development. The current study evaluated the association between maternal blood lead (Pb), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), and selenium (Se) levels and congenital heart defects (CHDs) in offspring. This hospital-based case-control study included 112 case and 107 control infants. Maternal peripheral blood draw was made during gestational weeks 17–40 and used to determine trace element levels by inductively coupled plasma mass spectrometry. Multivariable logistic regression was used to assess associations and interactions between individual and multiple trace elements and fetal CHDs, adjusted for maternal age, parity, education, newborn gender, migrant, folic acid or multivitamin intake, cigarette smoking, maternal prepregnancy body mass index, and time of sample collection. Control participants had medians of 2.61μg/dL Pb, 1.76μg/L Cd, 3.57μg/L Cr, 896.56μg/L Cu, 4.17μg/L Hg, and 186.47μg/L Se in blood. In a model including all measured trace elements and adjusted for confounders, high levels of maternal Pb (OR=12.09, 95% CI: 2.81, 51.97) and Se (OR=0.25, 95% CI: 0.08, 0.77) were harmful and protective predictors of CHDs, respectively, with positive and negative interactions suggested for Cd with Pb and Se with Pb, respectively. Similar associations were detected for subgroups of CHDs, including conotruncal defects, septal defects, and right ventricle outflow tract obstruction. Our results suggest that even under the current standard for protecting human health (10μg/dL), Pb exposure poses an important health threat. These data can be used for developing interventions and identifying high-risk pregnancies. Keywords: Heart anomalies, Teratogen, Trace elements, Risk factor, Environment

Abstract T-SPOT.TB didn’t perform a perfect diagnosis for active tuberculosis (ATB), and some factors may influence the results. We did this study to evaluate possible factors associated with the sensitivity and specificity of T-SPOT.TB, and the diagnostic parameters under varied conditions. Patients with suspected ATB were enrolled prospectively. Influencing factors of the sensitivity and specificity of T-SPOT.TB were evaluated using logistic regression models. Sensitivity, specificity, predictive values (PV), and likelihood ratios (LR) were calculated with consideration of relevant factors. Of the 865 participants, 205 (23.7%) had ATB, including 58 (28.3%) microbiologically confirmed TB and 147 (71.7%) clinically diagnosed TB. 615 (71.7%) were non-TB. 45 (5.2%) cases were clinically indeterminate and excluded from the final analysis. In multivariate analysis, serous effusion was the only independent risk factor related to lower sensitivity (OR = 0.39, 95% CI: 0.18–0.81) among patients with ATB. Among non-TB patients, age, TB history, immunosuppressive agents/glucocorticoid treatment and lymphocyte count were the independent risk factors related to specificity of T-SPOT.TB. Sensitivity, specificity, PV+, PV−, LR+ and LR− of T-SPOT.TB for diagnosis of ATB were 78.5%, 74.1%, 50.3%, 91.2%, 3.0 and 0.3, respectively. This study suggests that influencing factors of sensitivity and specificity of T-SPOT.TB should be considered for interpretation of T-SPOT.TB results.

Abstract Fluorine is ubiquitous and the most active non-metal element in nature. While many microorganisms have developed fluoride resistance as a result of the widespread and prolonged application of oral hygiene products, the mechanisms used by these organisms to overcome fluoride toxicity are incompletely understood. In this study, a fluoride-resistant strain, Enterobacter cloacae FRM, was identified which could grow well at a fluoride concentration of 4,000 mg/L. According to comparative genomics, transcriptome under fluoride stress, and sequence analyses of two fluoride-resistant fosmid clones, the genomic island GI3 was found to be important for fluoride resistance. The result of quantitative RT-PCR indicated that six genes on GI3, ppaC, uspA, eno, gpmA, crcB, and orf5249, which encode a fluoride transporter, fluoride-inhibited enzymes, and a universal stress protein, reside in an operon and are transcribed into two mRNAs activated by fluoride with a fluoride riboswitch. The results of knockout and complementation experiments indicated that these genes work together to provide high fluoride resistance to E. cloacae FRM. This study clarified the resistance mechanism of this high fluoride-resistant organism and has expanded our understanding of the biological effects of fluoride.

Background and objective Treatment options for patients with squamous cell carcinoma of the lung (SCC) are limited in chemotherapy. However, not all patients could benefit form standard platinum regimen. Considering the dismal prognosis of patients with advanced SCC, a greater focus on selecting sensitive chemotherapy regimens remains of upmost importance to improve outcomes in this disease. In this study, we used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to detect pre-chemotherapy serum peptides in advanced lung squamous cell carcinoma patients accepting paclitaxel combined with platinum chemotherapy and to analyze the correlation between serum peptides and chemotherapy efficacy. Methods Patients with advanced lung squamous cell carcinoma received paclitaxel combining with platinum chemotherapy and evaluated the efficacy every two cycles. Evaluation of complete response (CR) or partial response (PR) patients defined as sensitive group, progressive disease (PD) patients defined as resistant group. Serum samples were collected from patients with lung squamous cell carcinoma. Eighty-one patients were randomly divided into training group (sensitive group I and resistant group I) and validation group (sensitive group II and resistant group II) according to the ratio of 3:1. Serum samples were pretreated and Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to detect serum peptide fingerprints. ClinProTools software was used to analyze the differences between the sensitive group I and the resistant group I. Three kinds of biological algorithms (SNN, GA, QC) built in CPT software were used to establish the curative effect prediction model respectively and the optimal algorithm was selected. The validation group was used for blind verification. Results Thirty sensitive patients and 31 resistant patients were enrolled in the training group. Ten sensitive patients and 10 resistant patients were included in the validation group. The training group had 96 differentially expressed peptides in the sensitive and resistant patients, with 16 statistically significant peptides (P

Air passenger travel forecasting is necessary and becomes very valuable for airline company, because accurately obtaining practical requirements of air passenger, which can not only help airline company to improve air passenger satisfaction degree and enhance user experience so as to gain huge revenue, but also can help air passengers discover suitable travel plan quickly. In order to generate the air passenger travel forecasting model, this paper aims to analyze the internal driving force and social affect factor simultaneously, which was based on dynamical personal behaviors and air passenger social relationship exactly. In particular, three aspects in terms of dynamical personal behaviors, effect of fellow air passenger, and influence of similar air passenger are all considered simultaneously, and then the data from these aspects are further trained so as to obtain weight allocation in many different scenarios. Besides, workday and non-workday are separately considered in order to make the forecasting model feasible and effective.

Objectives: Tumor pathology examination especially epidermal growth factor receptor (EGFR) mutations molecular testing has been integral part of lung cancer clinical practices. However, the EGFR mutations spatial distribution characteristics remains poorly investigated, which is critical to tumor heterogeneity analysis and precision diagnosis. Here, we conducted an exploratory study for label-free lung cancer pathology diagnosis and mapping of EGFR mutation spatial distribution using ambient mass spectrometry imaging (MSI).Materials and Methods: MSI analysis were performed in 55 post-operative non-small cell lung cancer (NSCLC) tumor and paired normal tissues to distinguish tumor from normal and classify pathology. We then compared diagnostic sensitivity of MSI and ADx-amplification refractory mutation system (ARMS) for the detection of EGFR mutation in pathological confirmed lung adenocarcinoma (AC) and explored EGFR mutations associated biomarkers to depict EGFR spatial distribution base on ambient MSI.Results: Of 55 pathological confirmed NSCLC, MSI achieved a diagnostic sensitivity of 85.2% (23/27) and 82.1% (23/28) for AC and squamous cell carcinoma (SCC), respectively. Among 27 AC, there were 17 EGFR-wild-type and 10 EGFR-mutated-positive samples detected by ARMS, and MSI achieved a diagnostic sensitivity of 82.3% (14/17) and 80% (8/10) for these two groups. Several phospholipids were specially enriched in AC compared with SCC tissues, with the higher ions intensity of phospholipids in EGFR-mutated-positive compared with EGFR-wild-type AC tissues. We also found EGFR mutations distribution was heterogeneous in different regions of same tumor by multi-regions ARMS detection, and only the regions with higher ions intensity of phospholipids were EGFR-mutated-positive.Conclusion: MSI method could accurately distinguish tumor pathology and subtypes, and phospholipids were reliable EGFR mutations associated biomarkers, phospholipids imaging could intuitively visualize EGFR mutations spatial distribution, may facilitate our understanding of tumor heterogeneity.

Cadmium (Cd) is a heavy metal that is extremely toxic to many organisms; however, microbes are highly adaptable to extreme conditions, including heavy metal contamination. Bacteria can evolve in the natural environment, generating resistant strains that can be studied to understand heavy-metal resistance mechanisms, but obtaining such adaptive strains usually takes a long time. In this study, the genome replication engineering assisted continuous evolution (GREACE) method was used to accelerate the evolutionary rate of the Escherichia coli genome to screen for E. coli mutants with high resistance to cadmium. As a result, a mutant (8mM-CRAA) with a minimum inhibitory concentration (MIC) of 8 mM cadmium was generated; this MIC value was approximately eightfold higher than that of the E. coli BL21(DE3) wild-type strain. Sequencing revealed 329 single nucleotide polymorphisms (SNPs) in the genome of the E. coli mutant 8mM-CRAA. These SNPs as well as RNA-Seq data on gene expression induced by cadmium were used to analyze the genes related to cadmium resistance. Overexpression, knockout and mutation of the htpX (which encodes an integral membrane heat shock protein) and gor (which encodes glutathione reductase) genes revealed that these two genes contribute positively to cadmium resistance in E. coli. Therefore, in addition to the previously identified cadmium resistance genes zntA and capB, many other genes are also involved in bacterial cadmium resistance. This study assists us in understanding the mechanism of microbial cadmium resistance and facilitating the application of heavy-metal remediation.

Background and objective This study aimed at using matrix-assisted laser desorption ionization - time of flight mass spectrometer (matrix-assisted laser desorption ionization time-of-flight mass spectrometry, MALDI-TOF-MS) screening the difference serum peptides during epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) treatment and exploring their significance of advanced NSCLC patients. Methods Collect 102 serum samples from 34 advanced NSCLC patients, which are before TKI treatment, best effect of treatment and after progession. Peptides were extracted from the samples and then detected by MALDI-TOF-MS system to get the mass spectra. The mass spectra data was analyzed by the ClinproToolTM software to identify the different serum peptides, and then analyzed the clinical significance of peptides. Results Among the 34 patients who received TKI treatment, there were none evaluated as complete response (CR), 11 patients evaluated as PR and 23 patients evaluated as stable disease (SD), with the PFS was 8.0 months (95%CI: 6.6-11.2); overall survival (OS) was 11.4 months (95%CI: 10.6-16.5). After detected the serum from three different points of time, the result showed that they were totally different; 87 different peptide peaks were identified after analysis self-paired serum between the time of best effect and baseline, which included one statistically different [P

To assess the effect of TDG on the survival of different sizes of pelagic fish, bighead carp (Hypophthalmichthys nobilis) were subjected to TDG supersaturated water at levels of 125, 130, 135, and 140%. The results showed that apparent abnormal behaviours and symptoms of gas bubble disease (GBD) were observed in bighead carp. The survival probability of large and small juvenile bighead carp declined with increasing TDG levels. The median survival time (ST50) values of large juvenile bighead carp were 74.97 and 31.90 h at 130% and 140% TDG, respectively. While the ST50 of small fish were 22.40 and 6.72 h at the same TDG levels. In comparison to the large juvenile bighead carp, the small juvenile bighead carp showed weaker tolerance to TDG supersaturated water. Furthermore, acute lethality experiments after chronic exposure to TDG were initiated to further investigate the effect of TDG on bighead carp. The juveniles were first subjected to 115% TDG supersaturated water for 96 h. After chronic exposure, live fish were immediately transferred to TDG supersaturated water at levels of 125, 130, 135, and 140%. The results demonstrated that no fish died under chronic exposure and few fish exhibited slight GBD symptoms. The ST50 values for bighead carp subjected to acute exposure after chronic exposure were 61.23 and 23.50 h at 130 and 140%, respectively. Compared with the bighead carp subjected to acute exposure, bighead carp subjected to multiple exposures were more vulnerable to TDG.

To study on the temperature characteristics of the materials by using ANSYS, and establish the heat transfer equation by combining the physical model of the building material, so as to acquire the response characteristics of the internal wall temperature of the simulation wall. Compared with the temperature change of the outer wall, there was no obvious hysteresis in that of the inner wall of conventional building materials. The study on the temperature characteristics of phase-change energy storage building materials can reduce the energy consumption of the buildings, improve the energy utilization rate, and realize the intelligent temperature control of the buildings.

Background and objective Small-cell lung cancer (SCLC) is an aggressive disease for which the mainstay of treatment is cytotoxic chemotherapy. Despite good initial responses most patients will relapse or progress after the first-line therapy. The evidence of a benefit from second-line chemotherapy is limited in patients with relapsed/advanced SCLC. Some drugs are recommended by guidelines, but more regimens are formulated based on experience in clinical. So we conducted this retrospective study in order to compare the efficacy and safety of different second-line treatment regimens. Methods We totally analyzed 309 patients received second-line treatment in our retrospective study. 157 patients received best supportive care (BSC), and the rest 152 patients received second-line chemotherapy. The Kaplan-Meier method survival curves and Log-rank test were used to analysis the differences among different groups. The endpoints were objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Results Patients administered second-line chemotherapy lived significantly longer, with a total OS from first-line therapy of 11.5 mo compared to 6.0 mo in patients with best supportive care alone (P

Background and objective Gemcitabine and taxanes are effective agents commonly used in advanced squamous lung cancer. The best treatment sequence, however, is unclear to our knowledge. So we conducted this retrospective study in order to compare the efficacy and toxicities of first-line Gemcitabine +/- platinum followed by second-line taxanes +/- platinum with the reverse sequence. Methods We totally analyzed 105 patients with stage IIIb-IV squamous lung cancer in our retrospective study. There were 49 patients receiving gemcitabine +/- platinum first-line followed by taxanes +/- platinum second-line (G-T group), and 56 patients receiving taxanes +/- platinum first-line followed by gemcitabine +/- platinum second-line (T-G group). The primary endpoint of the study was overall survival (OS), and the secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) and toxicities. Results The median OS were 18.5 mo in G-T group and 19.0 mo in T-G group (P=0.520). The median PFS1 was 5.0 mo and 4.0 mo with first-line gemcitabine +/- platinum and taxanes +/- platinum, respectively (P=0.584). The median PFS2 was 2.7 mo and 2.5 mo with second-line gemcitabine +/- platinum and taxanes +/- platinum (P=0.432). The ORR1 of G-T group and T-G group were 36.73% and 33.92% (P=0.577), and DCR1 were 79.59% and 89.29% (P=0.186); the ORR2 of G-T group and T-G group were 4.08% and 5.36% (P=0.085), and DCR2 were 51.02% and 66.07%, respectively (P=0.118). Hematologic toxicities was more frequent in G-T group, the patients experienced more grade 3-4 lower hemoglobin (P=0.027) and thrombocytopenia (P=0.002). Conclusion The efficacy of first line gemcitabine +/- platinum followed by second line taxanes +/- platinum and the reverse sequence was similar, and the toxicities was tolerable. Both sequential patterns were effective in advanced squamous lung cancer.

Background and objective Distant metastasis was common in lung cancer, especially patients with bone marrow metastasis had poor prognosis and there were few effective methods. Crizotinib had been confirmed to be used in anaplastic lymphoma kinase (ALK) positive lung adenocarcinoma, but the efficacy in lung cancer with bone marrow metastasis was unknown. In the present study, we reported one case of ALK-positive lung adenocarcinoma with bone marrow matastasis given crizotinib treatment, the safety and efficacy was summarized. Methods ALK fusion was tested by fluorescence in situ hybridization (FISH). Crizotinib was given with dose of 250 mg, bid. Objective response was evaluated by Response Evaluation Criteriation in Solid Tumours (RECIST) v1.1 and bone marrow response was evaluated by bone marrow puncture and biopsy. Adeverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTC AE) v4.0. Results The patient achieved partial response (PR) after 6 weeks of crizotinib, especially the objective response of bone marrow metastasis was complete response (CR). The patient stopped crizotinib because of pneumonia. The progression free survival (PFS) and overall survival (OS) was 20 weeks and 22 weeks respectively. Conclusion Crizotinib could be an effective method for ALK-positive lung cancer with bone marrow metastasis and showed good tolerance.

Cracks and crack propagation in cement-based materials are key factors leading to failure of structures, affecting safety in construction engineering. This work investigated the application of terahertz (THz) non-destructive imaging to inspections on structures of cement-based materials, so as to explore the potential of THz imaging in crack detection. Two kinds of disk specimens made of plain cement mortar and UHMWPE fiber concrete were prepared respectively. A mechanical expansion load device was deployed to generate cracks and control the whole process of cracking. Experimental tests were carried out on cracked specimens by using a commercial THz time domain spectroscopy (THz-TDS) during loading. The results show that crack opening and propagation could be examined by THz clearly and the material factors influence the ability of crack resistance significantly. It was found that the THz imaging of crack initiation and propagation agrees with the practical phenomenon and supplies more information about damage of samples. It is demonstrated that the damage behavior of structures of cement-based materials can be successfully detected by THz imaging.

The glutamate-dependent acid-resistance system is the most effective acid tolerance pathway in Shigella, allowing survival in extremely acidic environments. However, the regulation of this system in Shigella remains elusive. In the current study, we identified significant differences in the levels of glutamate decarboxylase between three Shigella flexneri strains with different levels of acid resistance using blue native-polyacrylamide gel electrophoresis (PAGE) and isoelectric focusing (IEF)/sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis. The results showed that the degree of acid resistance and the levels of GadA/B were significantly lower in strain 2457T compared with two other S. flexneri strains. It has been reported that plasmid pSf-R27 is expressed in strain 2457T but not in the other 142 sequenced S. flexneri isolates. pSf-R27 encodes protein Sfh, which belongs to a family of histone-like nucleoid-structuring (H-NS) proteins that participate in the transcriptional control of glutamate-dependent acid resistance, implicating pSf-R27 in the lower acid resistance of strain 2457T. Transformation of pSf-R27 or sfh alone into strain 301 resulted in decreased expression of GadA/B in the recombinant strains. Thus, we confirmed that H-NS family protein Sfh, bound to the gadA/B regulatory region and regulates the expression of glutamate decarboxylase at the transcriptional level. We also examined the acid tolerance of the wild-type and recombinant strains using flow cytometry and determined that the acid tolerance of S. flexneri is closely related to the expression of GadA/B. These findings further our understanding of the acid tolerance of S. flexneri, especially via the glutamate-dependent pathway.

Orobanchaceae is the largest family among the parasitic angiosperms. It comprises non-parasites, hemi- and holoparasites, making this family an ideal test case for studying the evolution of parasitism. Previous phylogenetic analyses showed that holoparasitism had arisen at least three times from the hemiparasitic taxa in Orobanchaceae. Until now, however, not all known genera of Orobanchaceae were investigated in detail. Among them, the unknown phylogenetic positions of the holoparasites Gleadovia and Phacellanthus are the key to testing how many times holoparasitism evolved. Here, we provide clear evidence for the first time that they are members of the tribe Orobancheae, using sequence data from multiple loci (nuclear genes ITS, PHYA, PHYB, and plastid genes rps2, matK). Gleadovia is an independent lineage whereas Phacellanthus should be merged into genus Orobanche section Orobanche. Our results unambiguously support the hypothesis that there are only three origins of holoparasitism in Orobanchaceae. Divergence dating reveals for the first time that the three origins of holoparasitism were not synchronous. Our findings suggest that holoparasitism can persist in specific clades for a long time and holoparasitism may evolve independently as an adaptation to certain hosts.

Cadmium (Cd) is one of the most dangerous heavy metal pollutants in the environment and is toxic to animal and plant cells. On the other hand, iron (Fe) is an essential element for plant growth and development. The chlorosis of plant leaves under cadmium stress is similar to the typical symptom of iron deficiency. Recently, several Arabidopsis basic/helix-loop-helix (bHLH) transcription factors have been identified that are involved in the interactions between Cd and Fe. In the present study, over-expression the ORG3-like gene GmORG3, a bHLH transcription factor OBP3-responsive gene (ORG), enhanced Cd tolerance and stabilized Fe homeostasis. The domain analysis of GmORG3 showed that the protein contains a conserved 61-residue bHLH domain belonging to subfamily II. Moreover, subcellular localization experiments showed that GmORG3 is a nucleoprotein. GmORG3 was transcribed only in soybean roots and was significantly induced by external Cd stress in soybean plants. Heterologous expression of GmORG3 enhanced Cd tolerance in yeast. Furthermore, the overexpression of GmORG3 in soybean mosaic seedlings using a hairy root system showed that overexpressing plants increased the translocation ratio of Fe but reduced Cd translocation from the roots to shoots. In addition, the ectopic expression of GmORG3 in tobacco reduced phytotoxic effects induced by Cd stress and Fe deficiency, including the blockage of root elongation and decreased chlorophyll content. By integrating all these results, we found that GmORG3 plays an important role in response to Cd stress. The results provide new insights into the molecular mechanisms of Cd tolerance in soybean.

BACKGROUND:Although pemetrexed plus cis/carboplatin has become the most effective chemotherapy regimen for patients with advanced lung adenocarcinoma, predictive biomarkers are not yet available, and new tools to identify chemosensitive patients who would likely benefit from this treatment are desperately needed. In this study, we constructed and validated predictive peptide models using the serum peptidome profiles of two datasets. METHODS:One hundred eighty-three patients treated with first-line platinum-based pemetrexed treatment for advanced lung adenocarcinoma were retrospectively enrolled and randomized into the training (n = 92) or validation (n = 91) set, and pre-treatment serum samples were analyzed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and ClinProTools software. Serum peptidome profiles from the training set were used to identify potential predictive peptide biomarkers and construct a predictive peptide model for accurate group discrimination; which was then used to classify validation samples into "good" and "poor" outcome groups. The clinical outcomes of objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were analyzed based on the classification result. RESULTS:Eight potential peptide biomarkers were identified. A predictive peptide model based on four distinct m/z features (2,142.12, 3,316.19, 4,281.94, and 6,624.02 Da) was developed based on the clinical outcomes of training set patients after first-line pemetrexed plus platinum treatment. In the validation set, the good group had significantly higher ORR (49.1% vs. 8.3%, P

[This corrects the article DOI: 10.1371/journal.pone.0164235.].

Currently available Interferon-γ release assay (IGRA) cannot reliably differentiate active TB (ATB) from non-active TB (non-ATB). A study was performed to evaluate the value of Mycobacterium tuberculosis (MTB) specific Th1 cell immune responses which test IFN-γ and IL-2 simultaneous for differentiating ATB from non-ATB. Forty-nine newly diagnosed inpatients with ATB (26 pulmonary TB and 23 extrapulmonary TB) were enrolled as the ATB group. Forty-five volunteers with latent tuberculosis infection (LTBI) and twenty with evidence of previous TB were enrolled during the same period as the non-ATB group. Clinical examination and MTB specific Th1 cell immune responses were performed for all participants. After being stimulated with ESAT-6 and CFP-10, the median frequencies of single IL-2-, single IFN-γ-, and dual IFN-γ/IL-2-secreting T-cells were all higher in the ATB group than in the non-ATB group (20(8-45) vs. 7(3-13), P

Immunosuppression is common even in the early stage of severe sepsis. Interleukin-10 (IL-10) secretion and lymphocyte exhaustion are the main features of sepsis-induced immunosuppression. However, the relationship between IL-10 and the lymphocyte is still unclear. We investigated if IL-10/lymphocyte ratio (IL10LCR) were associated with mortality in severe septic patients.Adult patients with severe sepsis admitted to ICU of the First Affiliated Hospital of Guangzhou Medical University were identified from October 2012 to August 2013. Within 24 hours of ICU admission, peripheral whole blood was collected for the measurement of IL-10 using commercial multiplex bead-based assay kits and determination of lymphocyte count from laboratory data. The primary outcome was 28-day mortality.A total of 63 severe sepsis patients were identified. There were 20 (32%) patients died within 28 days. IL10LCR in non-survival patients was significantly higher than survival patients (median (IQR) 36.78 (12.34-79.63) ng/ml2 versus 11.01(5.41-27.50) ng/ml2, P = 0.002). Correlation analysis showed that IL10LCR was significantly correlated with APACHE II score (Spearman's rho = 0.424, P

At present, the treatment recommendations of advanced non-small cell lung cancer (NSCLC) with clear epidermal growth factor receptor (EGFR) gene status has reached a consensus: patients with EGFR mutation-positive NSCLC can give priority to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), which can maximize the benefit from the treatment; while the patients with wild-type EGFR gene should regard chemotherapy as first choice whether the first-line or second-line therapy. A large proportion of patients, however, have not received EGFR gene test for various reasons. In the paper, we will thoroughly review the related clinical trial from the point of view of evidence-based medicine, and suggest that the treatment of advanced NSCLC with unknown EGFR gene status should be distinguished according to their race and pathological characters in order to find out the patients who are most likely to benefit from EGFR-TKIs, and thus arrange the treatment sequence scientifically and rationally.

For the power minimization problem in multi-user cooperative relay communications,a resource allocation algorithm based on joint subcarrier pairing and assignment was proposed.Firstly,according to the average channel gain and the target rates of user,the assignment of subcarrier numbers was addressed.Then,in order to choose the subcarrier with best channel condition,a multi-user iterative algorithm for joint subcarrier pairing and assignment was proposed,which could achieve the subcarrier pairing in the cooperative transmissions and virtual pairing in the direct transmission,respectively.Finally,the power allocation was conducted by the water-filling algorithm,so that each user could use the minimum power for transmission.The simulation results indicate that the proposed algorithm can conduct subcarrier pairing and assignment effectively to minimize the total transmission power while meeting the users' target rate requirement.

Recently, several studies have been carried about maintenance therapy in non-small cell lung cancer, and some chemotherapy agents have been approved for clinical practice. But there are still a lot of questions about maintenance therapy that we have to consider. For example, the defects of design in maintenance therapy trials; how to choose gold standard of maintenance therapy for evaluation; who benefit from the maintenance therapy and how to estimate pharmaceutical economics. In this paper, we will make deep analysis about these issues.

In this study, a novel dental composite based on the unsaturated bismethylene spiroorthocarbonate expanding monomer 3,9-dimethylene-1,3,5,7-tetraoxa-spiro[5,5]undecane (BMSOC) and bisphenol-S-bis(3-meth acrylate-2-hydroxypropyl)ether (BisS-GMA) was prepared. CQ (camphorquinone) of 1 wt % and DMAEMA (2-(dimethylamino)ethyl methacrylate) of 2 wt % were used in a photoinitiation system to initiate the copolymerization of the matrix resins. Distilled water contact angle measurements were performed for the wettability measurement. Degree of conversion, volumetric shrinkage, contraction stress and compressive strength were measured using Fourier Transformation Infrared-FTIR spectroscopy, the AccuVol and a universal testing machine, respectively. Within the limitations of this study, it can be concluded that the resin composites modified by bismethylene spiroorthocarbonate and BisS-GMA showed a low volumetric shrinkage at 1.25% and a higher contact angle. The lower contraction stress, higher degree of conversion and compressive strength of the novel dental composites were also observed.

This paper assesses the uncertainties in the projected future runoff resulting from climate change and downscaling methods in the Biliu River basin (Liaoning province, Northeast China). One widely used hydrological model SWAT, 11 Global Climate Models (GCMs), two statistical downscaling methods, four dynamical downscaling datasets, and two Representative Concentration Pathways (RCP4.5 and RCP8.5) are applied to construct 22 scenarios to project runoff. Hydrology variables in historical and future periods are compared to investigate their variations, and the uncertainties associated with climate change and downscaling methods are also analyzed. The results show that future temperatures will increase under all scenarios and will increase more under RCP8.5 than RCP4.5, while future precipitation will increase under 16 scenarios. Future runoff tends to decrease under 13 out of the 22 scenarios. We also found that the mean runoff changes ranging from −38.38% to 33.98%. Future monthly runoff increases in May, June, September, and October and decreases in all the other months. Different downscaling methods have little impact on the lower envelope of runoff, and they mainly impact the upper envelope of the runoff. The impact of climate change can be regarded as the main source of the runoff uncertainty during the flood period (from May to September), while the impact of downscaling methods can be regarded as the main source during the non-flood season (from October to April). This study separated the uncertainty impact of different factors, and the results could provide very important information for water resource management.

This paper studies the optimal order decisions for the loss-averse newsvendor problem with backordering and contributes to the risk hedging issue in the newsvendor model. The Conditional Value-at-Risk (CVaR) measure is applied to quantify the potential risks for the loss-averse newsvendor in a backordering setting, and we obtain the optimal order quantity for a loss-averse newsvendor to maximize the CVaR of utility. It is found that the optimal order quantity to maximize the CVaR objective could be bigger or smaller than the expected profit maximization (EPM) order quantity, which provides an alternative explanation on decision bias in the newsvendor model. This study also reveals that the optimal order quantity for a loss-averse newsvendor to maximize expected utility with backordering is smaller than the EPM order quantity, which implies that backordering encourages the loss-averse newsvendor to order fewer items. Sensitivity analyses are performed to investigate the properties of the optimal order quantities and managerial insights are suggested. This paper provides a novel method for the risk management of the loss-averse newsvendor model and presents several new ordering policies for the retailers in practice.

The simultaneous wireless information and power transfer (SWIPT) technique has been considered as a promising approach to prolong the lifetime of energy-constraint wireless sensor networks (WSNs). In this paper, a multiple-input multiple-output (MIMO) full-duplex (FD) bidirectional wireless sensor network (BWSN) with SWIPT is investigated. Based on minimum total mean-square-error (total-MSE) criterion, a joint optimization problem for source and relay beamforming and source receiving subject to transmitting power and harvesting energy constraints is established. Since this problem is non-convex, an iterative algorithm based on feasible point pursuit-successive convex approximation (FPP-SCA) is derived to obtain a local optimum. Moreover, considering the scenarios in which source and relay nodes equipped with the same and different numbers of antennas, a low-complexity diagonalizing design-based scheme is employed to simplify each non-convex subproblem into convex problems and to reduce the computational complexity. Numerical results of the total-MSE and bit error rate (BER) are implemented to demonstrate the performance of the two different schemes.

We consider a multiple-input multiple-output amplify-and-forward wireless multiple-hop sensor network (WMSN). The simultaneous wireless information and power transfer technology is deployed to potentially achieve an autonomous system. We investigate two practical receiver schemes, which are the power splitting (PS) and the time switching (TS). The power splitting receiver splits received signals into two streams, one for information decoding (ID) and the other for energy harvesting (EH). On the other hand, the time switching receiver only serves in ID mode or energy harvesting mode during a certain time slot. Subject to transmit power constraints and destination harvested energy constraint, we aim to obtain a joint beam-forming solution of source and relay precoders to maximize the maximum achievable rate of the WSN. In order to make the non-convex problem tractable, diagonalization-based alternating optimization algorithms are proposed. Numerical results show the convergence and good performance of the proposed algorithms under both PS and TS protocols.

Background and objective For advanced non-small cell lung cancer (NSCLC) patients who benefited from prior epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy, the choice of a second TKI therapy has gradually become a new strategy for the treatment. Some investigators recommend that the second therapy should be continued with the original TKI; however, other investigators recommend the administration of another TKI. The aim of this study is to explore which choice is more reasonable. Methods In retrospect, patients with advanced NSCLC or with postoperative relapse of advanced NSCLC achieved complete response (CR), partial response (PR) or stable disease (SD) in prior Gefitinib therapy, progression free survival (PFS) ≥3 months. They received repeated Gefitinib or Erlotinib at an interval of at least one month. The analysis was carried out with respect to efficacy and optimal population of the two groups. Results A total of 61 patients were enrolled into the study, 30 in Gefitinib group and 31 in Erlotinib group. Baseline characteristics of the two groups were comparable. In the comparison between patients treated with Gefitinib and with Erlotinib, no statistical differences were seen for response rate (10% vs 22.6%, P=0.300,6), disease control rate (60% vs 74.2%, P=0.237,8), median PFS (3.0 vs 3.5 months, P=0.494,5), or median OS (8.3 vs 8.5 months, P=0.140,8). Multivariate analysis showed that in the initial dose of Gefitinib, PFS≥6 months (HR=0.317, 95%CI: 0.102-0.984, P=0.046,9). With an interval ≥3 months (HR=0.224, 95%CI: 0.071-0.713, P=0.011,3) between two doses of TKI, the risk of disease progression was reduced; but if with an interval ≥3 months (HR=0.262, 95%CI: 0.097-0.705, P=0.008,0), the risk of death was reduced. Conclusion Advanced NSCLC patients who benefited from prior Gefitinib therapy can benefit again either with the original drug Gefitinib or the alternative drug Erlotinib when a second TKI therapy is resumed. Such benefit is related to PFS of initial TKI therapy and time interval between two doses of TKI.

Background and objective The improved survival of patients with lung cancer depends on early diagnosis of lung cancer. However, the traditional diagnostic techniques have several limitations. Mass spectrometry (MS) has been applied as a core technology for cancer diagnosis in preliminary proteomic studies. The aim of this study is to explore the differences in the serum peptide levels of patients with non-small cell lung cancer (NSCLC) and healthy individuals using matrix-assisted laser desorption/ionization (MALDI)-time-of-flight (TOF)-MS. A NSCLC serum classification model was then established. Methods One hundred and thirty three cases of patients with NSCLC serum specimens and 132 cases of healthy human serum specimens were randomly divided into two groups in accordance with the ratio of three to one without age and gender differences. The training group was used to establish the classification model, this group included serum samples from 100 NSCLC cases and 100 healthy individuals. The test group for validating the proposed model was composed of the remaining serum samples from 33 NSCLC cases and 32 healthy individuals. Peptides were extracted from the samples using magnetic beads- immobilized metal affinity capture - copper, and their mass spectra were obtained using an automated MALDI-TOF-MS system. The MS data from the training group was analyzed using the ClinproToolTM software to identify the individual peptide fragments and establish the classification model. The sensitivity and specificity of the model were verified by blind testing with the test group. Results Among the 131 different peptide peaks, ranging from m/z 1,000 Da to 10,000 Da, 14 peaks were significantly different in the NSCLC samples of the training group, as compared with the controls (P

In wireless environment，the increases in the number of users and the demand for a higher rate have triggered rapidly booming energy consumption at the base station.Therefore，energy efficient design in wireless network has become very essential.An energy efficient multi-user OFDM downlink resource allocation scheme was studied，using the distributed way.Firstly，according to user’s average channel gain and the minimum requirements of user’s bits，subcarriers were allocated，combined with the idea of proposed energy-efficient criterion.Then better channels were assigned to each user in accordance with each user’s allocated subcarrier numbers.Again each user’s average bits were assigned on the user’s allocated subcarriers and optimal adjustment using energy-efficient criterion had to be made to ensure the minimum power.The simulation results show that under the conditions of satisfying bit-error rate and transmission rate for users，the power can be reduced by 5～6 dB in the proposed algorithm，compared with the power in the static frequency division multiple access resource allocation.Furthermore，the power can be reduced by 2～4 dB，compared with the power in a existing classical distributed algorithm.

For orthogonal frequency division multiple access-based decode-and-forward（OFDMA-DF）relay uplinks communication system，a new algorithm with proportional fairness constraints of users’ rate was presented.The new algorithm was divided into two steps.Firstly，under equal power distribution，the user with the lowest proportional capacity had the option to pick which subcarrier and relay to use.Then，based on this basis，power allocation was optimized on subcarriers and the power allocation results were given.Analysis results demonstrate that the new algorithm can not only obtain high system capacity，but also guarantee fairness between users.

The role of dynamic processes on self-assembled structures of 4'-([2,2':6', 2''-terpyridin]-4'-yl)-[1,1'-biphenyl]-4-carboxylic acid (l) molecules on Au(III) has been studied by scanning tunneling microscopy. The as-deposited monolayer is closed-packed and periodic in a short-range due to dipole forces. A thermal annealing process at 110 degrees drives such disordered monolayer into ordered chain-like structures, determined by the combination of the dipole forces and hydrogen bonding. Further annealing at 130 degrees turns the whole monolayer into a bowknot-like structure in which hydrogen bonding plays the dominant role in the formation of assembled structures. Such dependence of an assembled structure on the process demonstrates that an assembled structure can be regulated and controlled not only by the molecular structure but also by the thermal process to form the assembled structure.

Background and objective The incidence of young non-small cell lung cancer (NSCLC) annually increases. The aim of this study is to analyze the clinical pathological characteristics of young (less than 40 years old) NSCLC patients. Methods The data of 102 young NSCLC were retrospectively analyzed. Results Among the 102 patients, 43.1% were women and 29.4% were smokers. The male-to-female ratio was 1.32:1. The most frequent histologic type was adenocarcinoma (77.5%). Tumor differentiation was mostly poor (64.1%), and 87.8% had stages IIIb and IV diseases. The median recurrence time of 6 patients who had tumor resection was 13.5 months. The objective response rate (ORR) of 87 patients who received first-line chemotherapy was 46.0%, the disease control rate (DCR) was 79.3%, and the median time to progression (TTP) was 5.0 months. The ORR of 38 patients who received epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) therapy was 40.0%, with a DCR of 65.7% and a median TTP of 5.5 months. The DCR of 12 patients who received EGFR-TKI twice or more times was 66.7%, with a median TTP of 3.0 months. Conclusion The time from the first presenting symptom until diagnosis was usually long. The female proportion presented an upward trend and the correlation became attenuated between young NSCLC patients and smoking. Most of the young NSCLC patients had adenocarcinoma and poor tumor differentiation. Multidisciplinary and systematic therapies were needed to improve the poor prognosis of the young NSCLC patients.

Background and objective CD147, a type of transmembrane glycoprotein embedded on the surface of tumor cells, can promote tumor invasion and metastasis. This aim of this study is to construct a CD147 lentiviral expression vector, establish its stably transfected A549 cell line, and observe the effect of CD147 on MMP-9 proliferation as well as on the invasive ability of human lung adenocarcinoma cells. Methods Full-length CD147 gene was amplified by real-time polymerase chain reaction (RT-PCR), inserted into a pEGFP vector to construct pEGFP-CD147 and pEGFP vectors, and then transfected into 293FT cells to precede the lentivirus equipment package. Subsequently, we collected the lentivirus venom to infect the A549 cells and establish a stable, overexpressed cell line named A549-CD147. The mRNA expression of MMP-9 was examined by RT-PCR. The proliferation and invasive ability of the human lung cancer cells before and after transfection were examined by the CCK-8 and Transwell methods. Results A CD147 lentiviral expression vector (pEGFP-CD147) was successfully constructed by restrictive enzyme digestion and plasmid sequencing. RT-PCR and Western blot analyses revealed increased mRNA and protein expression of CD147 gene in cells transfected with pEGFP-CD147 compared with the control groups. Therefore, the A549-CD147 cell line was successfully established through the experiment. The mRNA expression of MMP-9 also significantly increased after the upregulation of CD147 expression. Meanwhile, CCK-8 and Transwell assays indicated that the proliferation and invasive ability significantly increased in the A549-CD147 cells. Conclusion A lentiviral CD147 expression vector and its A549 cell line (A549-CD14) were successfully constructed. CD147 overexpression upregulated the protein expression of MMP-9, and strengthened the proliferation and invasive ability of human lung adenocarcinoma cells.

The quantitative real-time polymerase chain reaction (qRT-PCR) approach has become a widely used method to analyze expression patterns of target genes. The selection of an optimal reference gene is a prerequisite for the accurate normalization of gene expression in qRT-PCR. The present study constitutes the first systematic evaluation of potential reference genes in Rhododendron molle G. Don. Eleven candidate reference genes in different tissues and flowers at different developmental stages of R. molle were assessed using the following three software packages: GeNorm, NormFinder and BestKeeper. The results showed that EF1-α (elongation factor 1-alpha), 18S (18s ribosomal RNA) and RPL3 (ribosomal protein L3) were the most stable reference genes in developing rhododendron flowers and, thus, in all of the tested samples, while tublin (TUB) was the least stable. ACT5 (actin), RPL3, 18S and EF1-α were found to be the top four choices for different tissues, whereas TUB was not found to favor qRT-PCR normalization in these tissues. Three stable reference genes are recommended for the normalization of qRT-PCR data in R. molle. Furthermore, the expression profiles of RmPSY (phytoene synthase) and RmPDS (phytoene dehydrogenase) were assessed using EF1-α, 18S, ACT5, and RPL3 and their combination as internals. Similar trends were found, but these trends varied when the least stable reference gene TUB was used. The results further prove that it is necessary to validate the stability of reference genes prior to their use for normalization under different experimental conditions. This study provides useful information for reliable qRT-PCR data normalization in gene studies of R. molle.

There are 16.5 million newborns in China annually. However, the incidence of congenital heart disease (CHD) has not been evaluated. In 2004, we launched an active province-wide hospital-based CHD registry in the Guangdong Province of southern China. In this study, we examined the incidence of CHD and its subtypes from 2004 to 2012 and compared our findings to the literature. Our results indicate there is an increasing trend of CHD incidence. The increase in incidence occurred mainly for single lesion and the most common subtypes (e.g., ventricular or atrial septal defect, patent ductus arteriosus). There were no increases found for multiple lesions or more complex subtypes. The proportion of CHD cases that were detected early (e.g., 1 week) increased over time. The incidence of CHD stabilized in 2010-2012 with the average cumulative incidences of 9.7, 9.9, and 11.1 per 1,000 live births at 1 week, 1 month, and 1 year, respectively. The incidences of CHD subtypes were comparable with recent international results. The data did not support previous reports that Asian children have a higher incidence of pulmonary outflow obstructions and lower incidence of transposition of the great arteries. However, there was a lower incidence of left ventricular outflow tract obstructions observed in our series. The increase in CHD incidence observed over time was due to improved detection and diagnosis. The true incidence of CHD in China was approximately 11.1 per 1,000 live births, which is higher than previously reported.

Pseudostellaria heterophylla (Miq.) Pax is a mild tonic herb widely cultivated in the Southern part of China. The tuberous roots of P. heterophylla accumulate high levels of secondary metabolism products of medicinal value such as saponins, flavonoids, and isoquinoline alkaloids. Despite numerous studies on the pharmacological importance and purification of these compounds in P. heterophylla, their biosynthesis is not well understood. In the present study, we used Illumina HiSeq 4000 sequencing platform to sequence the RNA from flowers, leaves, stem, root cortex and xylem tissues of P. heterophylla. We obtained 616,413,316 clean reads that we assembled into 127, 334 unique sequences with an N50 length of 951 bp. Among these unigenes, 53,184 unigenes (41.76%) were annotated in a public database and 39, 795 unigenes were assigned to 356 KEGG pathways; 23,714 unigenes (8.82%) had high homology with the genes from Beta vulgaris. We discovered 32, 095 DEGs in different tissues and performed GO and KEGG enrichment analysis. The most enriched KEGG pathway of secondary metabolism showed up-regulated expression in tuberous roots as compared with the ground parts of P. heterophylla. Moreover, we identified 72 candidate genes involved in triterpenoids saponins biosynthesis in P. heterophylla. The expression profiles of 11 candidate unigenes were analyzed by quantitative real-time PCR (RT-qPCR). Our study established a global transcriptome database of P. heterophylla for gene identification and regulation. We also identified the candidate unigenes involved in triterpenoids saponins biosynthesis. Our results provide an invaluable resource for the secondary metabolites and physiological processes in different tissues of P. heterophylla.

Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning from ECMO. Furthermore, multiple logistic regression analysis indicated that both barotrauma pre-ECMO and underlying lung disease were independent predictors of hospital mortality. In conclusion, for severe ARDS patients treated with ECMO, barotrauma prior to ECMO and underlying lung disease may be major predictors of ARDS prognosis based on multivariate analysis.

BACKGROUND:Tuberculosis (TB), especially extrapulmonary TB is still the leading cause of fever of unknown origin (FUO) in China. However, diagnosis of TB still remains a challenge. The aim of this study was to evaluate the diagnostic value of T-SPOT.TB for etiological diagnosis of classic FUO in adult patients in a high TB endemic area. METHODS:We prospectively enrolled patients presenting with classic FUO in a tertiary referral hospital in Beijing, China, to investigate the diagnostic sensitivity, specificity, predictive values and likelihood ratio of T-SPOT.TB. Clinical assessment and T-SPOT.TB were performed. Test results were compared with the final confirmed clinical diagnosis. RESULTS:387 hospitalized patients (male n = 194, female n = 193; median age 46 (range 29-59) yrs) with classic FUO were prospectively enrolled into this study. These FUOs were caused by infection (n = 158, 40.8%), connective tissue disease (n = 82, 21.2%), malignancy (n = 41, 10.6%) and miscellaneous other causes (n = 31, 8.0%), and no cause was determined in 75 (19.4%) patients. 68 cases were diagnosed as active TB eventually. The sensitivity of T-SPOT.TB for the diagnosis of active TB was 70.6% (95%CI 58.9-80.1%), while specificity was 84.4% (95%CI 79.4-88.4%), positive predictive value was 55.8% (95%CI 45.3-65.8%), negative predictive value was 91.2% (95%CI 86.7-94.2%). Among these 68 active TB patients, 12 cases were culture or histology confirmed (11 cases with positive T-SPOT.TB, sensitivity was 91.7%) and 56 cases were clinically diagnosed (37 cases with positive T-SPOT.TB, sensitivity was 66.1%); 14 cases were pulmonary TB (13 cases with positive T-SPOT.TB, sensitivity was 92.9%) and 54 cases were extrapulmonary TB (35 cases with positive T-SPOT.TB, sensitivity was 64.8%). CONCLUSIONS:For patients presenting with classic FUO in this TB endemic setting, T-SPOT.TB appears valuable for excluding active TB, with a high negative predictive value.