The World Health Organization redefined the type 2 vaccine-derived poliovirus (VDPV) in 2010. To study the genetic characteristics and evolution of type 2 VDPV under this new definition, we conducted genome sequencing and analyses of type 2 VDPVs isolated from one patient with acute flaccid paralysis in Shanxi province (China) in 2014. Nucleotide sequencing revealed that the full-length of type 2 VDPV is 7439 bases encoding 2207 amino acids with no insertion or deletion of nucleotides compared with Sabin2. One nucleotide substitution identified as a key determinant of the attenuated phenotype of the Sabin 2 strain (A-G reversion at nucleotide nt 481 in the 5-end of the untranslated region) had reverted in the Shanxi type 2 VDPV. The other known key determinant of the attenuated phenotype of the Sabin 2 strain (U-->C reversion at nt2909 in the VP1 coding region that caused a Ile143Thr substitution in VP1) had not reverted in the Shanxi VDPV. The Shanxi type 2 VDPV was S2/S1 recombinant, the crossover site of which mapped to the 3-end of the 3D region (between nt 6247 and nt 6281). A phylogentic tree based on the VP1 coding region showed that evolution of the Shanxi type 2 VDPV was independent of other type 2 VDPVs detected worldwide. We estimated that the strain circulated for approximately = 11 months in the population according to the known evolution rate. The present study confirmed that the Chinese Polio Laboratory Network could discover the VDPV promptly and that it played an important part in maintenance of a polio-free China.
Amino Acid Sequence ; Base Sequence ; Capsid Proteins ; chemistry ; genetics ; China ; Humans ; Infant ; Male ; Molecular Sequence Data ; Phylogeny ; Poliomyelitis ; virology ; Poliovirus ; chemistry ; genetics ; metabolism ; Poliovirus Vaccines ; adverse effects ; chemistry ; genetics ; metabolism ; Sequence Alignment

Objective To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS)and minimally invasive percutaneous nephrolithotripsy (MPCNL)for the pediatric renal calculi (≥ 1.5 cm).Methods In the retrospective study,97 patients with renal calculi (≥ 1.5 cm) underwent operation which is conducted by the same operative team from March 2011 to March 2016.Among them,40 patients were treated with RIRS,including 29 male and 11 female patients.57 patients were treated with minimally invasive percutaneous nephrolithotripsy,including 45 males and 12 female patients.The mean stone size was (1.9 ± 0.4) cm (ranging 1.5-3.0 cm) in the RIRS group and (2.1 ± 0.5) cm(ranging 1.5-3.5 cm) in the MPCNL group.In RIRS group,3 stones were stag-horn calculi.The diameter in 44 stones was more than 1.5 cm.Among them,33 stones located in the renal pelvis and upper middle calyces.11 stones located in the lower calyces.Multiple stones were found in 30 cases and single stone was found in 10 cases.7 cases had the history of unilateral urolithiasis.3 cases had the positive results of urine culture before operation.In MPCNL group,7 stones were stag-horn calculi.The diameter in 60 stones was more than 1.5 cm.Among them,56 stones located in the renal pelvis and upper middle calyces.4 stones located in the lower calyces.Multiple stones were found in 41 cases and single stone was found in 16 cases.4 cases had the history of unilateral urolithiasis.2 cases had the positive results of urine culture before operation.The mean stone size in MPCNL was larger,but the difference was not statistically significant (P ＞ 0.05).No statistical significance was found between the two groups in sex,age,preoperative urine,positive culture,patients with renal staghorn calculi,percentage of multiple calculi,stones in lower calyx and operation history of the same side(P ＞ 0.05).The urine white blood cells between the two groups were statistically significant (P ＜0.01),but the urine white blood cells in RIRS before placing double J stent had no significant difference with those in MPCNL.Results In RIRS group,The mean operative time was(90.2 ± 17.8) minutes.The mean hemoglobin deficit was (7.9 ± 7.9)g/L.The complication rate was 7.5％ (3/40).The postoperative hospital stay was (5.0 ± 2.3) days.The hospitalization cost was (42 994.1 ± 9 747.8) yuan.Stone-free rates after one session was 72.5％ (29/40).After second procedure,stone-free rates were up to 90.0％ (36/40).In MPCNL group,the mean operative time was (77.8 ± 15.6) min.The mean hemoglobin deficit was (10.0 ± 7.1) g/L.The complication rate was 24.6％ (14/57).The postoperative hospital stay was (8.0 ±2.5) days.The hospitalization cost was (24 626.3 ± 6 324.7) yuan.The stone-free rate after one session was 82.5％ (47/57).After second procedure,stone-free rates were up to 94.7％ (54/57).In statistics,there was no significant difference in hemoglobin drop,the stone-free rate on one session and the final stone-free rates(P ＞ 0.05).But significant difference existed in operative time,complications rate,postoperative hospitalization time and hospitalization cost (P ＜ 0.05).Conclusion Both RIRS and MPCNL are feasible,safe and minimally invasive way to treat renal calculi(≥ 1.5 cm) in pediatric patients.The stone-free rates between the two groups are comparable.RIRS has an advantage in postoperative hospitalization time and postoperative complications.MPCNL takes the advantage of operation time,hospitalization cost and needn't routinely places the double-J ureteral stent.

Objective:To investigate the characteristics of urinary stones composition in children and the differences in their distribution among different sexes and age groups.Methods:The clinical data of 592 children with urinary stones who underwent stone composition analysis using infrared spectroscopy at Hunan Children's Hospital from October 2015 to October 2019 were retrospectively analyzed. There were 430 males and 162 females.The median age was 4.0 (0.3 to 18.0) years old. The stone composition and the differences in its distribution in different sex and age groups were analyzed.Results:A total of 643 urinary stones were analyzed in 592 cases, with 419 (65.2%) single-component stones and 224 (34.8%) mixed-component stones. The main stone components were calcium oxalate in 361 cases (56.1%), ammonium hydrogen urate in 130 cases (20.0%), cystine in 56 cases (8.7%), calcium phosphate in 33 cases (5.1%), uric acids in 33 cases (5.1%), magnesium ammonium phosphate in 25 cases (3.9%), and xanthine in 5 cases (0.8%). The percentage of calcium oxalate stones was higher in women than in men [65.6% (118/180) vs. 52.5% (243/463), P<0.05]. The proportion of upper urinary tract stones was higher in girl than in boy[93.4%(168/180) vs. 73.2%(339/463), P<0.05]. The differences in the composition ratios of calcium oxalate stones, ammonium hydrogen urate, cystine, and magnesium ammonium phosphate stones in different age groups were statistically significant ( P<0.05), with the highest proportion of calcium oxalate stones (35.6%) at 6 to 10 years of age, ammonium hydrogen urate and cystine stones at 1 to 2 years of age (45.4% and 42.9%), and magnesium ammonium phosphate stones at 3 to 5, 6 to 10, and 11 to 18 years of age, the percentage of urinary stones in children was 24%. Conclusions:The main component of urinary stones in children is calcium oxalate, followed by ammonium hydrogen urate and cystine. Age and gender correlate with the distribution of stone components. Calcium oxalate stones are common in females and in children aged 6 to 10 years, ammonium hydrogen urate and cystine stones are common in children aged 1 to 2 years, and magnesium ammonium phosphate stones are more common in children aged 3 to 5 years, 6 to 10 years, and 11 to 18 years.

Objective:To evaluate the effect of reactivated ultrasound contrast agent on prevention of ischemia-reperfusion (IR) injury in rat hindlimb ischemia model.Methods:Microbubbles were compressed into nanodroplets (NDs) and the particle size range was determined.In vitro experiments were carried out to observe the acoustic phase transition of nanodroplets in the ultrasound field and the change of dissolved oxygen (DO) concentration in the surrounding solution. Forty-one male Sprague Dawley rats were divided into 5 groups: acoustic nanodroplet vaporization treatment group (NDs+ US group, n=9), saline+ ultrasound treatment group (Saline+ US group, n=8), nanodroplet without ultrasound treatment group (NDs group, n=8), ischemia/reperfusion injury group (IRI group, n=8) and sham operation group (Sham group, n=8). Ultrasound imaging was performed before operation and 12 hours after reperfusion to evaluate the improvement of hemodynamics of criminal artery under different treatments. Tissue injury were evaluated by analyzing immunohistochemistry staining results. Results:The formed NDs ranged in size from approximately 68.0-295.4 nm and the highest concentration in the 100 nm range. In vitro studies, a decrease in DO was measured during the phase transition.In the animal experiment, after ischemia/reperfusion, NDs+ US, Saline+ US, NDs and IRI groups demonstrated a significantly higher resistance index (RI) and pualsatility index (PI) of the right common iliac artery compared with before operation (NDs+ US group: PI 1.79±0.17 vs 1.57±0.23, P=0.014; RI 0.80±0.02 vs 0.75±0.04, P=0.002. Saline+ US group: PI 2.29±0.16 vs 1.57±0.16, P<0.001; RI 0.90±0.06 vs 0.74±0.03, P<0.001. NDs group: PI 2.17±0.14 vs 1.53±0.15, P<0.001; RI 0.91±0.04 vs 0.75±0.04, P<0.001. IRI group: PI 2.12±0.22 vs 1.58±0.20, P<0.001; RI 0.88±0.04 vs 0.75±0.04, P<0.001). The increases of PI and RI (ΔPI, ΔRI) in NDs+ US group were higher than those in sham group (all P<0.05), but significantly lower than those in saline+ US group, NDS group and IRI group (all P<0.05). Immunohistochemical results indicated the percentages malondialdehyde (MDA) positive cells in Saline+ US, NDs and IRI groups were higher than those in NDs+ US and sham groups (all P<0.05). Conclusions:The acoustic phase transition of nanodroplets in the ultrasound field can reduce ischemia/reperfusion injury and improve hemodynamics abnormality after reperfusion.

Objective:To investigate the risk factors associated with mortality in patients with severe traumatic liver injury (TLI) and to establish and validate an early prediction model for mortality.Methods:A retrospective cohort study was conducted to analyze the clinical data of 273 patients with severe TLI admitted to the ICU from the medical information mart for the intensive care-IV (MIMIC-IV) database. The cohort consisted of 176 males and 97 females, with age ranging from 18 to 83 years [35.6 years(25.7,57.5)years]. The patients were divided into two groups based on in-hospital mortality: the survival group (253 patients, 92.7%) and the death group (20 patients, 7.3%). The two groups were compared with regards to gender, age, cause and type of injury, treatment method, massive blood transfusion, comorbidities as well as vital signs and laboratory tests measured within 24 hours of ICU admission. Univariate analysis was used to screen for risk factors associated with mortality in severe TLI patients. Independent risk factors for mortality were determined using multivariate Logistic regression analysis. Lasso regression was used to screen for predictors of mortality, and a nomogram prognostic model was then established through a multivariate Logistic regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the model, while the Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the model. The model′s clinical applicability was evaluated through decision curve analysis (DCA). Internal validation was performed by the 200 Bootstrap samples, and external validation was performed by using 163 patients with severe TLI from the emergency ICU collaborative research database (eICU-CRD). Finally, the predictive efficacy of the nomogram model was compared to other trauma or severity scores.Results:Univariate analysis showed that the age, cause of injury, massive blood transfusion, chronic liver disease and laboratory tests measured within 24 hours of ICU admission, including temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, shock index, platelets, red blood cell distribution width (RDW), mean red blood cell hemoglobin concentration (MCHC), blood glucose, blood urea nitrogen, creatinine, anion gap, bicarbonate, prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were associated with the mortality of severe TLI patients ( P<0.05 or 0.01). Multivariate Logistic regression analysis revealed that age ( OR=1.08, 95% CI 1.03, 1.12, P<0.01), body temperature <36 ℃ ( OR=8.00, 95% CI 2.17, 29.53, P<0.01), shock index ( OR=9.59, 95% CI 1.76, 52.18, P<0.01) and anion gap ( OR=1.32, 95% CI 1.15, 1.53, P<0.01) were significantly associated with mortality in severe TLI patients. Lasso regression analysis selected 7 predictors, including age, body temperature<36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT. Based on these 7 predictors, a nomogram prediction model was developed. The AUC of the nomogram for predicting mortality was 0.96 (95% CI 0.94, 0.99), and the Hosmer-Lemeshow goodness-of-fit test indicated a good fit ( P>0.05). The calibration curve demonstrated excellent consistency between the predicted and actual probabilities, and DCA demonstrated that the model had good clinical net benefit at all risk threshold probability ranges. Internal validation confirmed the stability of the model ( AUC=0.96, 95% CI 0.92, 0.98), and external validation demonstrated good generalization ability ( AUC=0.95, 95% CI 0.91, 0.98). Moreover, the nomogram exhibited superior predictive efficacy compared with injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS), sequential organ failure score (SOFA), acute physiological score III (APS III), Logistic organ dysfunction score (LODS), Oxford acute severity of illness score (OASIS) and simplified acute physiological score II (SAPS II). Conclusions:Age, body temperature <36 ℃, shock index and anion gap are independent risk factors for mortality in severe TLI patients. A nomogram prognosis model based on 7 predictors, namely age, body temperature <36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT exhibits good predictive efficacy and robustness, and is contributive to accurately assess the risk of mortality in severe TLI patients at an early stage.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.