[Purpose]To analyze the diagnostic yield of quantitative fecal immunochemical test(FIT)at different cut-offs in colorectal cancer(CRC)screening.[Methods]The sequential screening method was adapted in Jiashan CRC screening program for local residents aged 40～74 years old,which included a quantitative FIT and high-risk factor questionnaire for primary screening and subsequent colonoscopy for the diagnostic screening.Subjects who participated in quantitative FIT were included in this study between September,2021 and August,2023.The positive predictive values(PPVs)for colorectal neoplasms were calculated at the cut-offs of 100,120,140,160,180 and 200 ng/mL of FIT.The Cochran-Armitage trend test was performed to compare the trend of PPVs at different cut-offs.The effects of different starting age and FIT cut-offs on requirement of colonoscopy and advanced neoplasia detection were assessed.[Results]A total of 58 256 individuals completed the quantitative FIT,and 3 106 had fecal hemoglobin concentrations＞100 ng/mL,among whom 2 186 underwent colonoscopic examination with a compliance rate of 70.38％.The colonoscopy detected 588 cases of non-advanced adenomas and 355 cases of advanced neoplasms(AN),in-cluding 30 cases of CRC and 325 cases of advanced adenomas.Progressively increasing the cut-off showed a decrease in PPVs of non-advanced adenomas and an increase of AN.The ratio of the rate of reduced requirement of colonoscopy to the missed rate of the progressive lesions was the smallest when the screening start age was 45 years old and the positive FIT threshold was set at 100 ng/mL.[Conclusion]There were significant differences in the diagnostic yield at different cut-offs of FIT.Increasing the cut-offs of FIT will elevate PPVs for the advanced neoplasms.

[Purpose]To analyze the diagnostic yield of quantitative fecal immunochemical test(FIT)at different cut-offs in colorectal cancer(CRC)screening.[Methods]The sequential screening method was adapted in Jiashan CRC screening program for local residents aged 40～74 years old,which included a quantitative FIT and high-risk factor questionnaire for primary screening and subsequent colonoscopy for the diagnostic screening.Subjects who participated in quantitative FIT were included in this study between September,2021 and August,2023.The positive predictive values(PPVs)for colorectal neoplasms were calculated at the cut-offs of 100,120,140,160,180 and 200 ng/mL of FIT.The Cochran-Armitage trend test was performed to compare the trend of PPVs at different cut-offs.The effects of different starting age and FIT cut-offs on requirement of colonoscopy and advanced neoplasia detection were assessed.[Results]A total of 58 256 individuals completed the quantitative FIT,and 3 106 had fecal hemoglobin concentrations＞100 ng/mL,among whom 2 186 underwent colonoscopic examination with a compliance rate of 70.38％.The colonoscopy detected 588 cases of non-advanced adenomas and 355 cases of advanced neoplasms(AN),in-cluding 30 cases of CRC and 325 cases of advanced adenomas.Progressively increasing the cut-off showed a decrease in PPVs of non-advanced adenomas and an increase of AN.The ratio of the rate of reduced requirement of colonoscopy to the missed rate of the progressive lesions was the smallest when the screening start age was 45 years old and the positive FIT threshold was set at 100 ng/mL.[Conclusion]There were significant differences in the diagnostic yield at different cut-offs of FIT.Increasing the cut-offs of FIT will elevate PPVs for the advanced neoplasms.

Sarcopenia is a progressive and systemic skeletal muscle disease and an important extrapulmo-nary complication of chronic obstructive pulmonary disease(COPD).Multiple studies have confirmed that COPD patients with sarcopenia have more severe airflow obstruction and emphysema,higher dyspnea index scores,reduced quality of life and exercise capacity,frequent acute exacerbations,and increased mortality.Although sarcopenia has been mentioned as a complication of COPD for many years,current clinical practice has received insufficient attention and insufficient intervention.The main reason is that its pathogenesis is unknown and drug treatment regi-mens are ineffective.As more and more research has been done on COPD combined with sarcopenia in recent years,this article reviews the current research progress to pay attention to further research and early intervention,including new mechanisms,diagnostic criteria,and drug treatment progress.

Objective: To investigate the status of occupational health examination institutions in Zhejiang Province, so as to provide suggestions for quality control of occupational health examination institutions. Methods: The 312 occupational health examination institutions in Zhejiang Province that have completed filing before September 30, 2023 were selected. The comprehensive capability, service quality, technical capability, and information reporting status were surveyed and evaluated through on-site inspection and skill assessment. Results: There were 161 public hospitals (51.60%), 147 private organizations (47.12%), and 4 centers for disease control and prevention (CDCs)/ occupational disease prevention and control institutes (1.28%). The pass rates of comprehensive capability, service quality, technical capability and information reporting were 90.02%, 69.89%, 84.07% and 86.78%, respectively. Among the indicators of comprehensive capability, the compliance rate for staffing was the highest at 95.06%, while the qualification rate of quality control in occupational health examinations was the lowest at 84.83%. Among the indicators of service quality, the compliance rate of the physical examination report format was the highest at 95.83%, while the accuracy rate of the audiometry examination was the lowest at 76.60%. In terms of technical capabilities, the qualification rates for blood lead testing, pneumoconiosis reading, and audiogram diagnostic ability were 87.92%, 89.42% and 75.34%, respectively. In terms of information reporting, the qualification rates for reporting completeness, reporting timeliness, suspected occupational disease reporting timeliness, and reporting accuracy were 89.10%, 81.09%, 96.47% and 80.45%, respectively. Among the three types of institutions, private institutions had the lowest average qualification rates for comprehensive capability, service quality, and technical capability, which were 89.83%, 69.06% and 80.00%, respectively. Conclusions Public hospitals and private organizations were the main types of occupational health examination institutions in Zhejiang Province. However, there were deficiencies in quality control, audiogram examination and diagnosis, and the accuracy of information reporting among occupational health examination institutions.

Objective To investigate the effect of neuromuscular electrical stimulation(NMES) on muscle atrophy and muscle fiber type conversion in quadriceps muscles of rats with chronic obstructive pulmonary disease(COPD).Methods Forty-eight male SPF Wistar rats were randomly divided into three groups:the healthy control group,COPD model group and NMES treatment group,with sixteen rats in each group.Rats in the NMES treatment group were given alternating electrical stimulation at 100 Hz and 2 Hz,with each stimulation time of 30 min,7 days per week,for 4 weeks.The control group and the COPD model group were only treated with electrode sheets.After the intervention,the endurance running distance measurement,the pathological changes of rat quadriceps muscle detected by HE staining,the mRNA and protein content of MSTN,MyHC(Myosin Heavy Chain)-Ⅰ,MyHC-Ⅱ a and MyHC-Ⅱ x in quadriceps muscles determined by Realtime PCR and Western Blot were performed.Results Compared with the healthy control group,the cross-sectional area,endurance running distance and MyHC-Ⅰ mRNA and protein expressions in the quadriceps muscles were decreased[(654.7±53.7) μm2 vs.(1079.8±117.2) μm2,(396.7±42.4) m vs.(607.4 ±56.3) m,0.407 ± 0.054 vs.0.997 ± 0.069,0.884 ± 0.102 vs.1.723 ± 0.156,t =4.642,3.785,24.723 and 18.640,P =0.008,0.033,0.000 and 0.000,respectively],while MSTN,MyHC-Ⅱ a and MyHC-Ⅱx mRNA and protein expressions were increased in the COPD model group (all P ＜ 0.01)Compared with COPD model,the cross-sectional area (997.5 ± 92.4 μm2),endurance running distance(597.2±65.8 m)and the expression levels of MyHC-Ⅰ mRNA(0.884±0.097)and protein (1.534±0.182)in the quadriceps muscles were increased(t =3.734,3.602,19.988 and 13.666,P =0.035,0.043,0.000,0.000),and the mRNA and protein expression levels of MSTN,MyHC-Ⅱ a and MyHC-Ⅱ x were decreased in the NMES treatment group(all P ＜0.01).Further correlation analysis found that the protein expression of MSTN in the quadriceps muscles was negatively correlated with muscle cross-sectional area,MyHC-Ⅰ protein levels and endurance running distance(r =-0.724,0.426 and-0.536,P =0.002,0.036 and 0.007,respectively),and positively correlated with the protein expressions of MyHC-Ⅱ a and MyHC-Ⅱ x(r=0.408 and 0.392,P =0.042 and 0.048).Conclusions The expression of MSTN is increased in quadriceps muscle of COPD rats,and NMES can inhibit the expression of MSTN in quadriceps muscles.MSTN is associated with muscle atrophy and muscle fiber conversion in COPD.Inhibition of MSTN expression can improve muscle atrophy and reverse muscle fiber transformation.

Objective To analyze the pathologically confirmed pulmonary Actinomycosis in the 11 patients in focusing on clinical features and mis-diagnostic reasons so as to improve physicians' awareness of this rare disease and reduce the misdiagnosis.Methods We retrospectively reviewed the medical records of 11 cases with pathologically confirmed pulmonary Actinomycosis during January 2003-August 2015.The clinical data and main causes of misdiagnosis in these cases were collected and analyzed.Results The study included 11 patients with a mean age of(53.0 ± 11.6.0)years.Among the 11 cases,8 (72.7 ％) patients had complications,6 (54.5 ％) were current or ex-smokers.Main clinical manifestations of 11 cases were cough(11/11,100.0 ％),sputum(11/11,100.0 ％),hemoptysis (7/11,63.6％),chest pain(6/11,54.5％)and fever(3/11,27.3％).Ten patients presented with one lobe of lung lesions,including 4 patients in the lower lobe and 3 in the upper lobe of the left lung,2 in the upper lobe and 1 in the lower lobe of the right lung.While,the remained one case presented with lesion locating in right main bronchus.Iconography often presented as pulmonary mass shadow,consolidation shadow,spicule sign,lobulation sign,hilar and/or mediastinal lymphadenopathy and pleural effusion.Vacuolar lesions were observed in some of the focuses.Flexible bronchoscopy was performed in 8 (72.7％)patients.Among them,7 patients showed mucosal swelling and congestion,luminal occlusion with purulence secretion,2 cases with polypoid neoplasm.Initial misdiagnosis rate were 100％ (11/11),among which 7 cases were misdiagnosed as lung cancer,2 cases as fungus infection,and 1 case as pulmonary tuberculosis and 1 case as pneumonia,respectively.All patients were definitely diagnosed by biopsy finding an evidence of hyphae of Actinomycosis in lung tissue specimens.The definitive diagnosis was made by CT-guided percutaneous lung biopsy in 4 cases,by transbronchial lung biopsy (TBLB)in 5 cases and by thoracotomy or video-assisted thoracoscopic surgery(VATS) in 1 case respectively.Actinomycosis in most patients was cured with high-dose penicillin administration over a prolonged period.Conclusions The diagnosis of pulmonary Actinomycosis remains challenging via its non-specific clinical symptoms and iconography features,and the presence of comorbidity may further increase the difficulty and complexity of diagnosis,leading to delaying-or mistaking-diagnosis.Obtaining positively pathological specimens is diagnostic key.Transbronchial lung biopsy through a bronchoscope and CT-guided percutaneous needle biopsy are the priority methods.

AIM:To investigate the maturation of mice immature myeloid dendritic cells (mDCs) induced by antigen(Ag)85B of mycobacterium tuberculosis, and the expression of TSLPR and OX40L mediated by TSLP in vitro. METHODS:Recombinant mouse GM-CSF ( rmGM-CSF) and rmIL-4 were used to induce bone marrow precursor cells of C57BL/6 mice to differentiate into immature mDCs in vitro.mDCs were identified followed by purification using CD 11c binding magnetic beads .The morphological characteristic of mDCs was observed under inverted phase-contrast microscope and scanning electron microscope .The surface phenotypes of mDCs were determined by flow cytometry .To obtain the opti-mal concentrations of Ag85B and TSLP, immature mDCs were cultured with different concentrations of Ag 85B or TSLP at 0 (control group), 50, 100 and 200 μg/L for 24 h, and the expression of cell surface molecules CD 80, CD86, TSLPR and OX40L was detected by flow cytometry.In addition, the expression of TSLPR and OX40L in Ag85B and TSLP-co-stimula-ted mDCs was determined by flow cytometry .RESULTS:After 7 d of culture in vitro, the cells showed irregular dendritic protrusions under the inverted-phase contrast microscope , and had wrinkles and dendritic splits under scanning electron mi-croscope , conformed to the morphological characteristics of immature mDCs .The mDCs cells expressed higher level of spe-cific marker CD11c, lower level of co-stimulatory molecules CD80 and CD86, which conformed to the phenotype of imma-ture mDCs.The CD80 +and CD86 +cell ratios of mDCs displayed significant increases in 50, 100 and 200μg/L Ag85B or TSLP groups compared with control group (P<0.05).The ratios of TSLPR +and OX40L+cells did not differ among dif-ferent concentrations of Ag 85B groups.The ratios of TSLPR +and OX40L+cells were significantly increased in 100 μg/L and 200μg/L TSLP groups compared with control group and 50μg/L TSLP group (P<0.05).Under the circumstance of optimal Ag85B or TSLP treatment concentration at 200 μg/L, there was significantly decreased in TSLPR and OX 40L cell ratio of mDCs in Ag85B group or Ag85B combined with TSLP group when compared with TSLP group (P<0.05), and no significant difference among Ag85B group, Ag85B combined with TSLP group and control group was observed .CONCLU-SION: Ag85B enhances mDCs maturation by up-regulating the expression of co-stimulatory molecules CD80 and CD86, and inhibit the expression of pro-inflammatory specific molecules TSLPR and OX40L on TSLP-activated mDCs, indicating that Ag85B modifies the development of asthmatic airway inflammation through the pathway of TSLP -activated mDCs.

Objective To investigate the activation of nuclear factor-B (NF-B)and hypoxia-inducible factor-1 (HIF-1)in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Subjects were classified into mild-to-moderate OSHAS group (n = 16), severe OSAHS group (n = 14) and the matched control group (n=30). Gene and protein expressions of NF-B and HIF-1 were measured by RT-PCR, Western blot in peripheral blood mononuclear cells (PBMC). Results NF-κB p65 mRNA and NF-κB p65 protein,HIF-1α mRNA and HIF-1α protein in PBMC were significantly higher in severe OSAHS group than those in mild–to-moderate group and control group (P<0.01). But there were no significant difference in NF-κB p65 mRNA and NF-κB p65 protein between mild-to-moderate group and control group (P=0.068, P=0.254 respectively). Only gene (P<0.05) not the protein (P=0.777) of HIF-1αwas higher in mild-to-moderate as compared with control group. Both NF-κB p65 mRNA and HIF-1αmRNA were positively correlated with AHI (r=0.493, P=0.006, r=0.508, P=0.004), while negatively correlated with nighttime lowest blood oxygen saturation (LSaO2)(r=-0.488, P=0.006, r=-0.46, P=0.011). There was a positive correlation between NF-κB p65 protein level and AHI (r=0.669, P<0.001). HIF-1αprotein level was positively correlated with AHI, ODI (r=0.628, P=0.001;r=0.480, P=0.018). There were positive correlations between NF-κBp65mRNA and HIF-1αmRNA (r=0.543, P=0.002), NF-κBp65 and HIF-1αprotein respectively (r=0.716, P<0.001). Conclusions As the gene and protein of NF-κB and HIF-1 were up-regulated in patients with OSAHS, and also positively correlated with the severity of sickness. We conclude that both NF-κB and HIF-1 were involed in the pathogenesis of OSAHS.

A 69-year-old man with fever,pulmonary nodules,joint pain and superficial lymphadenopathy was admitted to our hospital.The patient had a history of ten year hypertension.She smoked a pack of cigarettes daily for forty years and quitted for fifteen years.Family history of coronary heart disease,diabetes,cancer or other diseases was negative.Chest CT showed a nodule in the left lung lower lobe.Percutaneous lung biopsy revealed a large number of atypical B cell proliferation and infiltration which involved the vessel wall.The atypical B-cell phenotype and genotype was EBERs (+),CD20 (+),CD30 (+),CD15 (-).The patient was diagnosed as pulmonary lymphomatoid granulomatosis (LYG),an angiodestructive and angioinvasive lymphoproliferative disorder which is an Epstein-Barr virus associated B cell disorder with reactive T lymphocytes.The patient received six courses of chemotherapy.In this rare case,misdiagnosis of LYG often occurred due to the complex clinical presentation and non-specific imaging.Percutaneous or open lung biopsy is the main choice in the diagnosis of LYG.

Objective To increase the ultimate yield of periplocin in Periploca sepium adventitious root cultures by a two-stage culture based on nitrogen source.Methods Firstly,the effects of nitrogen source(NH<'+><,4>-NO<'-><,3>-)at different ratios and different total initial nitrogen amounts on the accumulation of biomass and secondary metabolites in adventitious root cultures of P sepium were investigated,and growth and production media for the two-stage culture based on the above results were established.Results The highest biomass and periplocin content were obtained in the culture medium of 15 mmol/L total nitrogen amount with NH<'+><,4>-NO<,3>(1:2)and 30 mmol/L total nitrogen amount with nitrate as the sole nitrogen source.By adopting a fed-batch cultivation strategy,the dry weight adventitious root,periplocin content and yield were increased by 136%,108%,and 389%,respectively when compared with those of the control,reaching up to 8.13 g/L,157.15 μg/g,and 1277.63 μg/L,respectively.Furthermore,it was found that in the process of two-stage culture,the adventitious roots grew thicker significantly after they were transferred into production medium directly.Conclusion The ultimate yield of periplocin in P.sepium adventitious root cultures could be significantly increased by a two-stage culture based on nitrogen source.