Four hundreds and ninety sheep sera from seven breeds raised at eight counties and one city of Aksu region in Xinjiang were tested by ELISA for the presence of antibodies against hepatitis E virus (HEV), and the positive rate differences were compared based on administrative areas, breeds and age by Chi-square test. The result showed that the general positive rate was 28.98% (142/490), the positive rate were 35.44% (28/79), 29.67% (27/91), 20% (4/20), 40% (12/30), 32.5% (26/80), 38% (19/50), 22.5% (9/40), 8% (4/50) and 26% (13/50) respectively in eight counties and one city, there was a significant difference between Xayar and other administrative areas (P<0.01); there was also a significant difference among age ranges (P<0.01), being 38.75% (31/80) over 2 years old, 15.45% (17/110) below 1 year old; The seroprevalence was still related to breeds, i. e. there was a significant difference between Mongolia sheep and other breeds (P<0.01). From these data, it is confirmed that there is a possibility of previous and potential infection of sheep HEV in Aksu region of Xinjiang Autonomous.
Animals ; Antibodies, Viral ; blood ; China ; epidemiology ; Hepatitis E ; epidemiology ; transmission ; veterinary ; virology ; Hepatitis E virus ; physiology ; Seroepidemiologic Studies ; Sheep ; blood ; virology ; Sheep Diseases ; epidemiology ; transmission ; virology

OBJECTIVE: Patients with nonvalvular atrial fibrillation (AF) and renal disease (RD) who receive anticoagulation therapy appear to be at greater risk of major bleeding (MB) than AF patients without RD. As observed in past studies, anticoagulants are frequently withheld from AF patients with RD due to concerns regarding bleeding. The objective of this study was to evaluate the incidence and pattern of MB in those with RD, as compared to those without RD, in a population of rivaroxaban users with nonvalvular AF. METHODS: Electronic medical records of over 10 million patients from the Department of Defense Military Health System were queried to identify rivaroxaban users with nonvalvular AF. A validated algorithm was used to identify MB-related hospitalizations. RD was defined through diagnostic codes present within 6 months prior to the bleeding date for MB cases and end of study participation for non-MB patients. Data were collected on patient characteristics, comorbidities, MB management, and outcomes. RESULTS: Overall, 44,793 rivaroxaban users with nonvalvular AF were identified. RD was present among 6,921 patients (15.5%). Patients with RD had a higher rate of MB than those without RD, 4.52 per 100 person-years versus 2.54 per 100 person-years, respectively. The fatal bleeding outcome rate (0.09 per 100 person-years) was identical between those with and without RD. CONCLUSION: In this post-marketing study of 44,793 rivaroxaban users with nonvalvular AF, RD patients experienced a higher MB rate than those without RD. The higher rate of MB among those with RD may be due to the confounding effects of comorbidities.
Anticoagulants ; Atrial Fibrillation* ; Comorbidity ; Electronic Health Records ; Hemorrhage* ; Hospitalization ; Humans ; Incidence* ; Military Personnel ; Rivaroxaban*

Introduction: Elective implant removal following healed extremity fractures remains controversial. This study aimed to evaluate the reasons and outcomes of implant removal after uneventful healing of limb fractures. Materials and methods: This is a prospective single-centre observational cohort study. Patients who sustained upper or lower extremity fractures that were fixed and healed uneventfully were included in the study when they elected to remove the implants. Patients were followed for six months post-operatively. Outcomes were assessed with patient satisfaction, symptoms resolution, and complications. Results: A total of 43 patients were recruited from October 2016 to March 2019. Thirty-six patients (37 implants) were symptomatic. Pain and prominence were the most common complaints, present in 59.5% and 33.3% of patients, respectively. Cold weather pain was also not uncommon (19.0%). Pain improved in 91.3% of the patients who complained of pain. The 94.6% symptomatic patients had at least partial resolution of pre-operative symptoms. All the patients who completed follow-up were satisfied with the procedure. In two patients, there were broken and retained screws intra-operatively. Post-operative complication rate was 23.8%, although no major complications occurred. Conclusions: Implant removal after uneventful healing of extremity fractures is a safe procedure that conferred a predictable relief of symptoms and satisfactory outcomes in most.

INTRODUCTION: To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions. METHOD: Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period-from 2015 to 2021-were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only. RESULTS: A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02-7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85-12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01-180.59) and a lower body mass index (OR 0.89, 95% CI 0.79-0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis. CONCLUSION Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.
Female ; Humans ; Endometriosis/surgery* ; Adenomyosis/surgery* ; Dysmenorrhea/etiology* ; Risk Factors ; Databases, Factual

Agriculture ; China ; Dermatitis ; Humans ; Universities

Objective: To investigate the clinicopathological features and treatment of gastric alpha-fetoprotein (AFP)-producing adenocarcinoma with SWI/SNF complex deletion. Methods: Four cases of gastric AFP-producing adenocarcinoma with SWI/SNF complex deletion diagnosed in Zhongshan Hospital of Fudan University from January 2021 to December 2022 were collected, and their histomorphological characteristics, immunohistochemical (IHC), in situ hybridization of Epstein-Barr virus-encoded RNA (EBER), next-generation sequencing results, clinicopathological features and treatment were summarized, and literature review was conducted. Results: Among the 4 patients, there were three males and one female. They presented with abdominal pain, belching and melena. Serum AFP was significantly elevated in three patients, and endoscopy showed ulcerative lesions. Microscopically, the tumor cells showed mainly diffuse flaky or nest-like growth and typical characteristics of hepatoid adenocarcinoma. In two cases there were adenoid growth, and the tumor cells in these areas possessed clear cytoplasm, suggesting enteroblastic differentiation. The tumor cell nuclei were pleomorphic with large nucleoli and brisk mitoses. The IHC results showed that the tumor cells expressed AFP, GPC3 and SALL4, and there was retained expression of broad-spectrum keratin (CKpan) and E-cadherin. IHC detection of SWI/SNF complex subunits, namely INI1 (SMARCB1), BRG1 (SMARCA4), BRM (SMARCA2), ARID1A protein was performed. In all four cases the hepatoid adenocarcinoma region and enteroblastic differentiation region showed SMARCA2 deletion, and one case with enteroblastic differentiation also showed ARID1A deletion. SMARCB1 and SMARCA4 deletions were not seen. All the four cases were diffusely positive for p53 protein, and the Ki-67 proliferation index was 80%-90%. There were no mismatch repair deletion detected; one cases showed HER2 was strongly positive (3+), and EBER was negative. None of the four cases had mutations in the SWI/SNF complex-related subunits detected by next-generation sequencing. Among the four patients, two underwent palliative surgery due to distant metastasis at the time of surgery, two underwent radical resection. Postoperative adjuvant chemotherapy was given to three patients. Conclusions: AFP-producing adenocarcinoma is a rare subtype of gastric cancer, which can be combined with SWI/SNF complex deletion, and the pathomorphological manifestations are different from the classical SWI/SNF complex deletion of undifferentiated carcinoma with rhabdoid phenotype.
Male ; Humans ; Female ; alpha-Fetoproteins ; Stomach Neoplasms/genetics* ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Adenocarcinoma/pathology* ; Biomarkers, Tumor/genetics* ; DNA Helicases/genetics* ; Nuclear Proteins ; Transcription Factors/genetics* ; Glypicans

Objective To investigate the clinical characteristics and risk factors of intra- and post-operative reperfusion injury following surgical evacuation of epidural hematoma. Methods Clinical and radiographic data of 206 patients with cerebral herniation presented with an epidural hematoma and underwent surgical evacuation in our hospital from June 2009 to June 2015, were retrospectively analyzed; risk factors of intra- and post-operative reperfusion injury were analyzed by multi-factor and non-conditional Logistic regression analyses. Results A total of 12 patients with acute epidural hematoma and concurrent cerebral herniation developed reperfusion injury after hematoma evacuation; 7 patients (58.3%) were within 15-30 min after surgical evacuation intraoperatively and 5 patients (41.7%) were at an early stage within 6 h after operation. Local vascular cerebral edema, effusion, or even spot and patchy hemorrhage in the compressed cerebral parenchyma underneath the epidural hematoma were depicted by craniocerebral CT/MR imaging examination and further CT perfusion examination confirmed the local hyperperfusion-induced lesions. These 12 patients had an unsatisfactory clinical outcome with a high ratio of bad prognosis (58.3%, 7/12). Regression analyses indicated that the described surgical complication was significantly associated with duration of preoperative cerebral herniation (≥120 min, odds ratio [OR]=61.617, P=0.001), hematoma thickness (≥40 mm, OR=10.051, P=0.018). Conclusions Cerebral herniation longer than 120 min and hematoma thickness greater than 40 mm are high-risk factors associated with intra- and post-operative reperfusion injury. Controlled decompressive surgical strategy is helpful for a good recovery of cerebrovascular autoregulation function and thereby reduces the occurrence of reperfusion injury.

Intestinal adaptation is a spontaneous compensation of the remanent bowel after extensive enterectomy, which improves the absorption capacity of the remanent bowel to energy, fluid and other nutrients. Intestinal adaptation mainly occurs within 2 years after enterectomy, including morphological changes, hyperfunction and hyperphagia. Intestinal adaptation is the key factor for patients with short bowel syndrome to weaning off parenteral nutrition dependence and mainly influenced by length of remanent bowel, type of surgery and colon continuity. In addition, multiple factors including enteral feeding, glucagon-like peptide 2 (GLP-2), growth hormone, gut microbiota and its metabolites regulate intestinal adaptation via multi-biological pathways, such as proliferation and differentiation of stem cell, apoptosis, angiogenesis, nutrients transport related protein expression, gut endocrine etc. Phase III clinical trials have verified the safety and efficacy of teduglutide (long-acting GLP-2) and somatropin (recombinant human growth hormone) in improving intestinal adaptation, and both have been approved for clinical use. We aim to review the current knowledge about characteristics, mechanism, evaluation methods, key factors, clinical strategies of intestinal adaptation.
Humans ; Adaptation, Physiological ; Glucagon-Like Peptide 2/therapeutic use* ; Intestines/surgery* ; Parenteral Nutrition ; Short Bowel Syndrome/surgery*

Objective: To investigate the biological behavior spectrum of platelet-derived growth factor alpha receptor (PDGFRA)-mutant gastrointestinal stromal tumor (GIST), and to compare the clinical values of the Zhongshan method of benign and malignant evaluation with the modified National Institutes of Health (NIH) risk stratification. Methods: A total of 119 cases of GIST with PDGFRA mutation who underwent surgical resection at Zhongshan Hospital, Fudan University from 2009 to 2020 were collected. The clinicopathological data, follow-up records, and subsequent treatment were reviewed and analyzed statistically. Results: There were 79 males and 40 females. The patients ranged in age from 25 to 80 years, with a median age of 60 years. Among them, 115 patients were followed up for 1-154 months, and 13 patients progressed to disease. The 5-year disease-free survival (DFS) and overall survival (OS) were 90.1% and 94.1%, respectively. According to the modified NIH risk stratification, 8 cases, 32 cases, 38 cases, and 35 cases were very-low risk, low risk, intermediate risk, and high risk, and 5-year DFS were 100.0%, 95.6%, 94.3%, and 80.5%, respectively. There was no significant difference in prognosis among the non-high risk groups, only the difference between high risk and non-high risk groups was significant (P=0.029). However, the 5-year OS was 100.0%, 100.0%, 95.0% and 89.0%, and there was no difference (P=0.221). According to the benign and malignant evaluation Zhongshan method, 43 cases were non-malignant (37.4%), 56 cases were low-grade malignant (48.7%), 9 cases were moderately malignant (7.8%), and 7 cases were highly malignant (6.1%). The 5-year DFS were 100.0%, 91.7%, 77.8%, 38.1%, and the difference was significant (P<0.001). The 5-year OS were 100.0%, 97.5%, 77.8%, 66.7%, the difference was significant (P<0.001). Conclusions: GIST with PDGFRA gene mutation shows a broad range of biological behavior, ranging from benign to highly malignant. According to the Zhongshan method, non-malignant and low-grade malignant tumors are common, the prognosis after surgery is good, while the fewer medium-high malignant tumors showed poor prognosis after surgical resection. The overall biological behavior of this type of GIST is relatively inert, which is due to the low proportion of medium-high malignant GIST. The modified NIH risk stratification may not be effective in risk stratification for PDGFRA mutant GIST.
Male ; Female ; Humans ; Middle Aged ; Adult ; Aged ; Aged, 80 and over ; Gastrointestinal Stromal Tumors/surgery* ; Receptor, Platelet-Derived Growth Factor alpha/genetics* ; Retrospective Studies ; Mutation ; Prognosis ; Proto-Oncogene Proteins c-kit/genetics*

Objective: To explore the spatio-temporal epidemic trends and related driving effects of meteorological factors on brucellosis in Datong city, Shanxi province, from 2005 to 2015. Methods: We collected the surveillance data on brucellosis and related meteorological data in Datong city from 2005 to 2015, to describe the epidemic characteristics of the disease. Quasi-Poisson distribution lag non-liner model (DLNM) was built to explore the driving effect of monthly meteorological data on the disease. Results: From 2005 to 2015, Datong city reported a total of 17 311 cases of brucellosis including one death, with the annual average incidence as 47.43 per 100 000 persons. A rising trend was seen during the study period. The monthly incidence of Brucellosis presented an obvious curve with a major peak from March to June, accounted for 48.40% of the total cases. The high incidence areas in the city gradually expanded from the northeast and southeast to the western areas. Results from the DLNM studies suggested that seasonality of brucellosis in Datong was significantly affected by metrological factors such as evaporation, rainfall and temperature. The peak of delayed effect appeared the highest when the monthly cumulative evaporation capacity was 140-260 mm and the monthly cumulative rainfall was 20-60 mm with lag less than 1 month or the monthly temperature was -13 ℃ with lag of 4-5 months. Conclusions: The incidence of human brucellosis in Datong city increased significantly from 2005 to 2015. Meteorological factors such as evaporation, rainfall, temperature all showed significant driving effects on the disease.
Brucellosis/epidemiology* ; China/epidemiology* ; Cities ; Climate ; Humans ; Incidence ; Meteorological Concepts ; Space-Time Clustering ; Spatio-Temporal Analysis ; Temperature