Population seroprevalence of antibody to influenza A(H7N9) virus, Guangzhou, China

BACKGROUND: Since the identification in early 2013 of severe disease caused by influenza A(H7N9) virus infection, there have been few attempts to characterize the full severity profile of human infections. Our objective was to estimate the number and severity of H7N9 infections in Guangzhou, using a serological study. METHODS: We collected residual sera from patients of all ages admitted to a hospital in the city of Guangzhou in southern China in 2013 and 2014. We screened the sera using a haemagglutination inhibition assay against a pseudovirus containing the H7 and N9 of A/Anhui/1/2013(H7N9), and samples with a screening titer ≥10 were further tested by standard hemagglutination-inhibition and virus neutralization assays for influenza A(H7N9). We used a statistical model to interpret the information on antibody titers in the residual sera, assuming that the residual sera provided a representative picture of A(H7N9) infections in the general population, accounting for potential cross-reactions. RESULTS: We collected a total of 5360 residual sera from December 2013 to April 2014 and from October 2014 to December 2014, and found two specimens that tested positive for H7N9 antibody at haemagglutination inhibition titer ≥40 and a neutralization titer ≥40. Based on this, we estimated that 64,000 (95 % credibility interval: 7300, 190,000) human infections with influenza A(H7N9) virus occurred in Guangzhou in early 2014, with an infection-fatality risk of 3.6 deaths (95 % credibility interval: 0.47, 15) per 10,000 infections. CONCLUSIONS: Our study suggested that the number of influenza A(H7N9) virus infections in Guangzhou substantially exceeded the number of laboratory-confirmed cases there, albeit with considerable imprecision. Our study was limited by the small number of positive specimens identified, and larger serologic studies would be valuable. Our analytic framework would be useful if larger serologic studies are done.published_or_final_versio

Next-generation sequencing with a myeloid gene panel in core-binding factor AML showed KIT activation loop and TET2 mutations predictive of outcome

Clinical outcome and mutations of 96 core-binding factor acute myeloid leukemia (AML) patients 18-60 years old were examined. Complete remission (CR) after induction was 94.6%. There was no significant difference in CR, leukemia-free-survival (LFS) and overall survival (OS) between t(8;21) (N=67) and inv(16) patients (N=29). Univariate analysis showed hematopoietic stem cell transplantation at CR1 as the only clinical parameter associated with superior LFS. Next-generation sequencing based on a myeloid gene panel was performed in 72 patients. Mutations in genes involved in cell signaling were associated with inferior LFS and OS, whereas those in genes involved in DNA methylation were associated with inferior LFS. KIT activation loop (AL) mutations occurred in 25 patients, and were associated with inferior LFS (P=0.003) and OS (P=0.001). TET2 mutations occurred in 8 patients, and were associated with significantly shorter LFS (P=0.015) but not OS. Patients negative for KIT-AL and TET2 mutations (N=41) had significantly better LFS (P<0.001) and OS (P=0.012) than those positive for both or either mutation. Multivariate analysis showed that KIT-AL and TET2 mutations were associated with inferior LFS, whereas age ⩾40 years and marrow blast ⩾70% were associated with inferior OS. These observations provide new insights that may guide better treatment for this AML subtype.published_or_final_versio

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

<div><h3>Background</h3><p>Patients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity.</p> <h3>Methodology/ Principal Findings</h3><p>A combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p = 0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p = 0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p = 0.03).</p> <h3>Conclusions/ Significance</h3><p>In the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty.</p> </div

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

A novel sol-gel-derived calcium silicate cement with short setting time for application in endodontic repair of perforations

Bor-Shiunn Lee,1,2 Hong-Ping Lin,3 Jerry Chun-Chung Chan,4 Wei-Chuan Wang,2 Ping-Hsuan Hung,2 Yu-Hsin Tsai,4 Yuan-Ling Lee1,2 1Graduate Institute of Oral Biology, 2Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University and Hospital, Taipei, 3Department of Chemistry, National Cheng Kung University, Tainan, 4Department of Chemistry, National Taiwan University, Taipei, Taiwan, Republic of China Abstract: Mineral trioxide aggregate (MTA) is the most frequently used repair material in endodontics, but the long setting time and reduced mechanical strength in acidic environments are major shortcomings. In this study, a novel sol-gel-derived calcium silicate cement (sCSC) was developed using an initial Ca/Si molar ratio of 3, with the most effective mixing orders of reactants and optimal HNO3 catalyst volumes. A Fourier transform infrared spectrometer, scanning electron microscope with energy-dispersive X-ray spectroscopy, and X-ray powder diffractometer were used for material characterization. The setting time, compressive strength, and microhardness of sCSC after hydration in neutral and pH 5 environments were compared with that of MTA. Results showed that sCSC demonstrated porous microstructures with a setting time of ~30 min, and the major components of sCSC were tricalcium silicate, dicalcium silicate, and calcium oxide. The optimal formula of sCSC was sn200, which exhibited significantly higher compressive strength and microhardness than MTA, irrespective of neutral or pH 5 environments. In addition, both sn200 and MTA demonstrated good biocompatibility because cell viability was similar to that of the control. These findings suggest that sn200 merits further clinical study for potential application in endodontic repair of perforations. Keywords: acidic environment, compressive strength, mesoporous, mineral trioxide aggregate, mixing order, sol-gel reactio

K-rich glass-bearing wehrlite xenoliths from Yitong, northeastern China: Petrological and chemical evidence for mantle metasomatism

Ultramafic xenoliths in Cenozoic alkali basalts from Yitong, northeast China comprise three types in terms of their modal mineralogy: lherzolite, pyroxenite and wehrlite. The wehrlite suite always contains interstitial pale/brown glass which occupies several per cent by volume of the whole rock. The texture of the wehrlites is porphyroclastic with some large strained grains of olivine (0.5-1 mm) scattered in a very fine grained matrix (0.1 mm), implying a metamorphic origin for the protolith rather than an igneous origin. The host minerals are compositionally zoned, showing evidence of reaction with a melt. Petrological evidence for resorption of spinel (lherzolite) and orthopyroxene (wehrlite) by infiltrating melt further supports the hypothesis that the wehrlites result from interaction between a partial melting residue and a melt, which preferentially replaced primary spinel, Cr-diopside and enstatite to produce secondary clinopyroxene (cpx) + olivine (ol) +/- chromite +/- feldspar (fd). The composition of the mineral phases supports this inference and, further indicates that, prior to melt impregnation, the protoliths of these wehrlites must have been subjected to at least one earlier Fe-enrichment event. This explanation is consistent with the restricted occurrence of glasses in the wehrlite suite. The glass is generally associated with fine-grained (0.1 mm) minerals (cpx + ol + chromite +/- fd). Electron microprobe analyses of these glasses show them to have high SiO2 content (54-60 wt%), a high content of alkalis (Na2O, 5.6-8.0%; K2O, 6.3-9.0%), high Al2O3 (20-24%), and a depletion in CaO (0.13-2.83%), FeO (0.89-4.42%) and MgO (0.29-1.18%). Ion probe analyses reveal a light rare earth element-enrichment in these glasses with chondrite normalised (La)(n) = 268-480. The high K2O contents in these glasses and their mode of occurrence argue against an origin by in-situ melting of pre-existent phases. Petrographic characteristics and trace element data also exclude the possibility of percolation of host-basalt related melts for the origin of these glasses. Thus the glasses must have resulted from local penetration of mantle metasomatic melts which may have been produced by partial melting of peridotites with involvement of deep-seated fluids. Such melts may have been significantly modified by subsequent fractional crystallization of ol, cpx and sp, extensive reaction with the mantle conduit and the xenolith transport process