Objective To substantiate the relationship between connective tissue diseases and lung bullae. Method In 10 years, 70 patients with lung bullae were admitted to internal medicine inpatient wards of Peking Union Medical College Hospital, among which 12 connective tissue diseases were diagnosed. Two cases were excluded because their lung bullae was secondary. Results Six cases were Sj?觟gren′s syndrome (SS), two cases were vasculitis [one Takayasu disease and one was polyarteritis nodosa (PAN)], one was rheumatoid arthritis (RA) and one was undifferentiated connective tissue disease (UCTD). Symptoms of respiratory system were present in the patients with pulmonary interstitial fibrosis (five cases) and pulmonary amyloidosis (one case). Pulmonary function tests showed restrictive ventilatory dysfunction and obstriction of small airway (two cases), diffusion dysfunction (one case), restrictive ventilatory dysfunction (one case). A trans-bronchial lung biopsy specimen showed thickening of alveolar septa, chronic inflammation, proliferation of fiberous connective tissue and inflammatory cell infiltration. Conclusion Connective tissue diseases may result in lung bullae because they cause narrow of small airways.It is definitive in the relationship between SS and lung bullae, but further study needs to be done to clarify the relationship between other connective tissue diseases and lung bullae.

Objective To evaluate CT characteristics of pulmonary sclerosing hemangioma(PSH) so that to improve the knowledgeof this disease.Methods CT characteristics of PSH pathologically verified were retrospectively analysed.Conventional scan andcontrast-enhanced scan were performed in all the patients.Results 14 lesions were in right lung,while 10 were in left,Diameters of these lesions ranged from 0.8 to 10 cm,and the average diameter was 3.08 cm.3 lesions were located in hilum of lung,while the rest(87.5%)were located in peripheral lung tissue.20 lesions were oval,and 4 were lobulated in morphology.21 lesions were smooth in edge.45.8% of the cases had calcification.All the lesions enhanced obviously on contrast-enhanced scan,and average CT value of(46.62?9.47) HU was increased.The dilated and distorted blood vessels could be detected in 2 large lesions.Conclusion On the basis of general benign tumor features, obvious enhancement and calcification are the characteristics of PSH on CT.

Objective To predict the functions of hsa-miR-1908 promoter using various bioinformatic tools, and to provide clues for further study on transcriptional regulation mechanism of miR-1908 in human adipocytes. Methods The promoter se-quence of miR-1908 was obtained from Ensemble, and then the CpG islands and transcription factor binding sites were pre-dicted by a variety of online bioinformatic tools. Results The length of the miR-1908 promoter sequence was 1 458 bp. The CpG islands, which inhibited the transcription of miR-1908, were located at (438-756) bp, (836-937) bp and (979-1374) bp. Meanwhile, 15 transcription factor binding sites were found in the promoter sequence of miR-1908. Conclusions miRNA up-stream promoter related bioinformatics can not only improve the efficiency of microRNA promoter research, but also provide further important information on transcriptional regulation of miR-1908.

AIM: To study the roles and mechanisms of ERKs and intracellular free calcium in cardiomyocyte hypertrophic response induced by endothelin-1(ET-1). METHODS: (1) Neonatal rat cardiomyocyte hypertrophic response was assayed by measuring cell surface area and protein content; (2) ERKs activity was determined by Whatman Paper Filter method; (3) Intracellular free calcium concentration (［Ca2+］i) was measured using Fura-2/AM as a fluorescent indicator. RESULTS: (1) ET-1 could increase total protein production, surface area, ERKs activity and ［Ca2+］i in cultured cardiomyocyte in dose-dependent manner at concentrations ranging from 10-9 to 10-7 mol/L. And this effect could be abolished by BQ123, an antagonist of ETA receptor, partly inhibited by PTX, but not by BQ788, an antagonist of ETB receptor.（2）The activation of ERKs and the increase of ［Ca2+］i induced by ET-1 were obviously inhibited by PD98059, a selective ERKs kinase inhibitor, and nifedipine, a calcium channel blocker, respectively. Both antagonists partially inhibited ET-1-stimulated cardiomyocyte hypertrophic response. (3) Staurosporine, a selective PKC inhibitor, could inhibit ET-1-stimulated cardiomyocyte hypertrophic response and increase of ［Ca2+］i, but not affect the activation of ERKs. CONCLUSION: Cardiomyocyte hypertrophic response induced by ET-1 is mediated by ETA receptor coupled to PTX-sensitive G-protein, which involves at least two signalling pathways: PKC-mediated increase of ［Ca2+］i , and PKC-independent activation of ERKs.

Objective　By exploring the function of sulfakinin (SK) and sulfakinin receptor (SKR) of Aedes aegypti, it laid a certain experimental basis and theoretical basis for the research and development of new insecticides targeting neuropeptides and their receptors. Methods　This study investigated the roles of SK and its receptor gene in Ae. aegypti using bioinformatics analysis and Clustered Regularly Interspaced Short Palindromic Repeats(CRISPR)/Cas9 knockout technology. Subsequently, RNA interference technology was employed to suppress the expression of SK or its receptor in adult mosquitoes. Lastly, transcriptome sequencing technology was utilized to identify and analyze differentially expressed genes between the interference group and the control group in order to gain insights into their functions. Results　It was found that there is only one SK receptor in Ae. aegypti. In addition, during the construction of mutant strains of Ae. aegypti SK and its receptor gene, it was found that only 2% of the G0 generation mutant strains mutated to form chimeras, with a large number of male chimeras dying, and only 14% of female chimeras being able to lay eggs, ultimately resulting in no effective G1 generation mutants. Transcriptome data showed, compared to the control group, 181 genes were significantly differentially expressed after interfering with the SK gene, with 62 genes significantly upregulated and 119 genes significantly downregulated. In addition, after interference with the sulfakinin receptor, 110 genes exhibited significant differential expression, including 20 upregulated and 90 downregulated genes. Cross-analysis of the two datasets identified 46 genes with significant expression changes after interference with sulfakinin or its receptor, with only 4 genes upregulated and the remaining 42 genes significantly downregulated, and the differentially expressed genes were mainly enriched in the metabolic pathway, endocrine system, and digestive system. Conclusions　The SK and its receptor gene are highly conserved and may primarily play roles in regulating the energy metabolism and digestion functions in Ae. aegypti, thus playing an important role in regulating insect growth and development.

{L-End}Objective To explore the interaction between social psychology and workload factors on neck work-related musculoskeletal disorders (WMSDs) in manual workers. {L-End}Methods Manual workers in Henan Province and Hubei Province were selected as the research subjects using typical sampling method. The Chinese Musculoskeletal Questionnaire was used to investigate the prevalence of neck WMSDs in the research subjects. A total of 4 327 workers with neck WMSDs were selected as the case group, and 4 327 workers without neck WMSDs were selected as the control group in a 1∶1 pairing. Conditional logistic regression analysis was used to compare the relevant risk factors in the two groups, and the additive interaction model was established to analyze the interactions between the risk factors. {L-End}Results The univariate conditional logistic analysis results showed that dynamic load, static load, power load and psychosocial factors increased the risk of neck WMSDs in manual workers (all P<0.05). In terms of the social psychological factors, insufficient rest time had the greatest impact workers, with the odds ratio (OR) and 95% confidence interval (CI) of 1.799 (1.647-1.965). In terms of dynamic load, static load and power load, repeated similar movements of the head per minute (bending, twisting), forward bending of the neck or maintaining this posture for a long time, and lifting heavy objects>20 kg had the greatest impact, with the OR and 95%CI of 1.599 (1.470-1.739), 1.984 (1.805-2.181) and 1.241 (1.093-1.408), respectively. There was a synergistic interaction between insufficient rest time and forward bending of the neck or maintaining this posture for a long time, and the relative excess risk due to interaction (95%CI) and attributable proportion (95%CI) were 0.420 (0.187-0.652) and 0.171 (0.066-0.276), respectively. There is no interaction between insufficient rest time and repeated similar movements of the head per minute (bending, twisting), and lifting heavy objects >20 kg. {L-End}Conclusion The interaction between insufficient rest time and forward bending of the neck or maintaining this posture for a long time (static load) can increase the risk of neck WMSDs in manual workers, which is an additive synergistic effect.

Objective To report the clinical management of the first case of human infection with influenza A (H7N4) in the world ,and to explore the clinical characteristics and therapeutic regimen of H7N4 infection in humans .Methods A case of confirmed human infection with influenza A (H7N4) virus was hospitalized in the Third People′s Hospital of Changzhou in Jiangsu Province on January 1st ,2018 . The clinical characteristics and treatment were analyzed by reviewing the clinical data and management of the patient ,and compared with the clinical characteristics of human infection with H 7N9 cases .Results The patient was an elderly woman with hypertension ,who had an exposure history of live poultry before onset .The patient had flu-like symptoms including fever , cough and expectoration . The symptoms worsened in the fifth day and presented as respiratory failure and circulatory disturbance .The count of white blood cells ,lymphocytes and platelets counts declined ,while the levels of aspartate aminotransferase and c-reactive protein slightly increased .The levels of creatine kinase and lactate dehydrogenase deformity increased .The pulmonary lesions manifested as exudation and consolidation of both side in a short period of time after the onset . Treatment was initiated according to the epidemiology history , clinical manifestations ,laboratory and imaging characteristics . The primary diagnosis was human infection of avian influenza virus .The patient was treated with oxygen therapy ,antivirus ,anti-infection and short-duration corticosteroids treatment . Early and timely throat swab specimens were tested . The patient recovered and discharged from hospital after active treatment .It was confirmed by the Chinese Center for Disease Control and prevention that the patient was infected with avian influenza A (H7N4) virus ,and no close contact was infected .Conclusions There are many similarities of clinical features between case of human infection with H7N4 and that of H7N9 . The early treatment of neuraminidase inhibitors is recommended according to the diagnosis and treatment of human infection with H 7N9 .In the clinical practice ,the avian influenza nucleic acid should be tested in time to determine the cause of the disease in those patients with suspected viral pneumonia ,especially in those who has an avian contact history .

Objective: To explore the feasibility and the value of CT enterography (CTE) in the quantitative evaluation of Crohn's disease (CD). Methods: Retrospectively analyzed 49 patients diagnosed as CD by clinical, enteroscopy, pathology, and imaging from April 2016 to June 2017 in Zhongnan Hospital of Wuhan University. All patients underwent routine enteroscopy and standardized CTE. The interval between the two examinations was less than 2 weeks. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured at intervals. The ESR ranged from 2.0 to 97.0 mm/1 h, with an average of (30.6±26.5) mm/1 h, CRP from 0.3 to 143.3 mg/L, and a median of 27.7 mg/L. CD patients were classified into inactive, mild and moderate-severe according to Crohn's disease simplified endoscopic activity score(SES-CD) after enteroscopy. CTE evaluated the site of lesion, the thickness and enhanced patterns of the most severe lesions of the bowel wall, mural enhanced CT value in the portal vein phase, ΔCT value, stenosis, perienteric inflammation, mesenteric hypervascularity (comb sign), enlarged lymph nodes, abdominal abscesses, fistulas, etc. The Chi-square test was used to compare the differences of enhanced patterns among different groups. ANOVA (Analysis of Variance) was used to compare the differences in bowel wall thickness, plain CT values, mural enhanced CT value in the portal vein phase and ΔCT values among different groups. The correlation between CTE parameters and SES-CD or laboratory data was analyzed by Pearson (normal distribution data) or Spearman (skewed distribution data). Results: SES-CD ranged from 1 to 15, with an average of 5.1±2.6. Among 49 cases, 13 were inactive, 19 were mild, and 17 were moderate-severe. There were 25 cases of intestinal obstruction or stenosis, including 24 cases in the active group and 1 case in the non-active group, and the difference was statistically significant (χ²=13.3, P<0.01). The short diameter of lymph nodes was more than 10 mm in 7 patients, all of them were active patients; 32 cases were mesenteric hypervascularity, manifested as "comb sign" , among them, 28 cases were active and 4 cases were non-active, and the difference was statistically significant (χ²=9.3, P<0.01). Perienteric inflammation was manifested in 30 cases, including 27 cases in the active group and 3 cases in the non-active group, and the difference was statistically significant (χ²=10.8, P<0.01). The enhanced patterns of thickened bowel wall in the non-active was dominated by C and D types, while A and B types was mainly in the active group, and the difference was statistically significant (P<0.05); There were significant differences in bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values between different groups (P<0.05), however, the difference of plain CT values between different groups was not significant (P>0.05). Bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values were all moderately correlated with SES-CD (r were 0.564, 0.585, 0.533, respectively; P all <0.01). Bowel wall thickness was positively correlated with ESR and CRP(r were 0.542, 0.452, respectively; P all <0.01). Mural enhanced CT value in the portal vein phase and ΔCT values were not correlated with ESR or CRP (P>0.05). Conclusion The bowel wall thickness, mural enhanced CT value in the portal vein phase and the ΔCT value can be used to accurately assess the activity of CD lesions.

Objective:To analyze the distribution of ages at the interhospital transfer of outborn very preterm infants in China and to compare their perinatal characteristics and outcomes at discharge and neonatal intensive care unit (NICU) treatment.Methods:A total of 3 405 outborn very premature infants with a gestational age of 24-31 +6 weeks who were transferred to the NICUs of the Chinese Neonatal Network (CHNN) in 2019 were included in this retrospective study. According to the age at transfer, they were divided into three groups: early transfer (≤1 d), delayed transfer (>1-7 d) and late transfer (>7 d) groups. Analysis of variance, t-test, Chi-square test (Bonferroni correction), Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare the general clinical condition, treatment, and outcomes at discharge among the three groups. Results:The median gestational age was 29.7 weeks (28.3-31.0 weeks) and the average birth weight was (1 321.0 ± 316.5) g for these 3 405 infants. There were 2 031 patients (59.6%) in the early transfer group, 406 (11.9%) in the delayed transfer group and 968 (28.4%) in the late transfer group. Infants who received continuous positive airway pressure ventilation and tracheal intubation in the delivery room accounted for 8.4% (237/2 806) and 32.9% (924/2 805), respectively. A total of 62.7% (1 569/2 504) of the mothers received antenatal glucocorticoid therapy and the ratio in the early transfer group was 68.7% (1 121/1 631), which was higher than that in the delayed transfer group [56.1% (152/271), χ2=16.78, P<0.017] and the late transfer group [49.2% (296/602), χ2=72.56, P<0.017]. The total mortality rate of very premature infants was 12.7% (431/3 405), and the mortality rates in the early, delayed and late transfer groups were 12.4% (252/2 031), 16.3% (66/406) and 11.7% (113/968), respectively ( χ2=5.72, P=0.057). The incidences of severe intraventricular hemorrhage, late-onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge were all higher in the delayed and late transfer groups than in the early transfer group, respectively. The incidences of retinopathy of prematurity, retinopathy of prematurity requiring treatment and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge in the late transfer group were significantly higher than that in the delayed transfer group (Bonferroni correction, all P<0.017). In the late transfer group, the median age of very premature infants at discharge was 66.0 d (51.0-86.0 d), and the corrected gestational age at discharge was 38.9 weeks (37.1-41.2 weeks), and both were greater than those in the early transfer [48.0 d (37.0-64.0 d), Z=260.83; 36.9 weeks (35.7-38.3 weeks), Z=294.32] and delayed transfer groups [52.0 d (41.0-64.0 d), Z=81.49; 37.4 weeks (36.1-38.7 weeks), Z=75.97] (all P<0.017). Conclusions:Many very premature infants need to be transferred to higher-level hospitals after birth. The later the very premature infants are transferred, the higher the incidence of complications will be. It is suggested that intrauterine or early postnatal transport may improve the prognosis of very premature infants.

{L-End}Objective To investigate the influencing factors of work-related musculoskeletal disorders (WMSDs) that affect neck-shoulder-back among manufacturing workers. {L-End}Methods A total of 8 250 front-line workers from 27 manufacturing enterprises in Henan Province and Hubei Province were selected as the research subjects using cluster sampling method. The Musculoskeletal Disorders Questionnaire was used to investigate the prevalence of neck-shoulder-back (include neck, shoulder, upper back, and lower back) WMSDs in the past year. The log-binomial model, principal component analysis (PCA) and multivariate logistic regression analysis were used to analyze the influencing factors of WMSDs in the neck-shoulder-back. {L-End}Results The prevalence of WMSDs was 77.2%. The prevalence of neck-shoulder-back WMSDs was 50.9%. The prevalence ratios of WMSDs were relatively higher among the neck, shoulder, and upper back (all P<0.05). The results of PCA improved logistic regression analysis showed that the influencing factors of neck-shoulder-back WMSDs were individual factors, biomechanical factors, psychosocial factors and environmental factors. In terms of individual factors, the risk of neck-shoulder-back WMSDs was higher in females than in males (P<0.05). With the increase of age, length of service, and education level, the risk of neck-shoulder-back WMSDs increased among manufacturing workers (all P<0.05). The risk of neck-shoulder-back WMSDs of workers in textile, clothing, shoes and hats manufacturing industry was relatively lower than that in the other nine industries (all P<0.05). In terms of the biomechanical factors, spending a lot of effort to operate tools/machines, sitting for a long time at work,bending greatly bending and turning at the same time, neck leaning forward or maintaining this posture for a long time, neck twisting or maintaining this posture for a long time and uncomfortable position resulting in difficulty exerting exertion were all risk factors of neck-shoulder-back WMSDs among manufacturing workers (all P<0.05) Bending slightly for a long time was a protective factor for neck-shoulder-back WMSDs among manufacturing workers (P<0.05). In terms of the psychosocial factors, doing the same work every day, self-determination in resting time between works staff shortage, and frequent overtime work were risk factors for neck-shoulder-back WMSDs among manufacturing workers (all P<0.05). Adequate resting time was a protective factor for neck-shoulder-back WMSDs among manufacturing workers (P<0.01). In terms of environmental factors, working under cold or fluctuating temperature, having nothings to lean on, and soles slipping or falling at work were all risk factors for neck-shoulder-back WMSDs among manufacturing workers (all P<0.05). {L-End}Conclusion Manufacturing workers are prone to suffer from neck-shoulder-back WMSDs. The influencing factors include individual factors, biomechanical factors (force load and static load), psychosocial factors and environmental factors.