Objective To observe impact factors of average glandular dose(AGD)of full field digital mammography(FFDM)and digital breast tomosynthesis(DBT)under breast Combo mode.Methods Totally 169 subjects who received FFDM and DBT under Combo mode were collected retrospectively.The breast compression thickness,tube voltage,tube current and AGD of FFDM and DBT exposure at cranio-caudal(CC)and mediolateral oblique(MLO)positions of bilateral breast were recorded.FFDM or DBT exposure conditions and AGD among different breast compression thickness and breast types were compared,and their correlations were analyzed.The impacts of breast compression thickness and breast density on AGD of FFDM or DBT were observed.Results There were significant differences in tube voltage,tube current and AGD of FFDM or DBT among different breast compression thicknesses(all P＜0.001).With the increase of breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT all increased(all P＜0.001).There were statistical differences in breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT among different types breast(all P＜0.001).Hierarchical analysis showed that,when breast compression thickness was＜50 mm,50-59 mm and＞59 mm respectively,statistical differences in AGDFFDM and AGDDBT among different breast types at CC or MLO positions were found(all P＜0.001).Under the same breast compression thickness,tube current,AGDFFDM and AGDDBT of FFDM or DBT all increased with the increase of breast density(all P＜0.001),while tube voltage of FFDM or DBT had no obvious change(all P＞0.05).Breast compression thickness and breast density were both independent factors of AGD of FFDM or DBT(all P＜0.001).Conclusion Under breast Combo mode,breast compression thickness and gland density both had impacts on AGD of FFDM or DBT,and the former had more significant impact on AGD.

Objective To observe impact factors of average glandular dose(AGD)of full field digital mammography(FFDM)and digital breast tomosynthesis(DBT)under breast Combo mode.Methods Totally 169 subjects who received FFDM and DBT under Combo mode were collected retrospectively.The breast compression thickness,tube voltage,tube current and AGD of FFDM and DBT exposure at cranio-caudal(CC)and mediolateral oblique(MLO)positions of bilateral breast were recorded.FFDM or DBT exposure conditions and AGD among different breast compression thickness and breast types were compared,and their correlations were analyzed.The impacts of breast compression thickness and breast density on AGD of FFDM or DBT were observed.Results There were significant differences in tube voltage,tube current and AGD of FFDM or DBT among different breast compression thicknesses(all P＜0.001).With the increase of breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT all increased(all P＜0.001).There were statistical differences in breast compression thickness,tube voltage,tube current and AGD of FFDM or DBT among different types breast(all P＜0.001).Hierarchical analysis showed that,when breast compression thickness was＜50 mm,50-59 mm and＞59 mm respectively,statistical differences in AGDFFDM and AGDDBT among different breast types at CC or MLO positions were found(all P＜0.001).Under the same breast compression thickness,tube current,AGDFFDM and AGDDBT of FFDM or DBT all increased with the increase of breast density(all P＜0.001),while tube voltage of FFDM or DBT had no obvious change(all P＞0.05).Breast compression thickness and breast density were both independent factors of AGD of FFDM or DBT(all P＜0.001).Conclusion Under breast Combo mode,breast compression thickness and gland density both had impacts on AGD of FFDM or DBT,and the former had more significant impact on AGD.

Objective:To analyze the clinical characteristics and diagnosis and treatment of children with Kasabach-Merritt phenomenon (KMP).Methods:A retrospective analysis was conducted on the clinical data and follow-up data of 8 patients diagnosed KMP in Beijing Children′s Hospital, Capital Medical University from January 2016 to January 2019.The clinical data included laboratory examination, diagnosis, treatment and prognosis.Results:Among the 8 children with KMP, 6 cases were male and 2 cases were female.The median onset age was 4 (0-17) months, 2 cases of neonatal onset.The median onset to the diagnosis time was 59 (34-140) days; 6 cases with bone destruction; 6 cases had misdiagnosis and mistreatment history, they were misdiagnosed as idiopathic thrombocytopenic purpura, Evans syndrome, abnormal bone and joint development; 4 cases were Kaposiform hemangioendothelioma; 8 cases were used alone or combined with the application of hormones, Sirolimus, and Vincristine, 7 patients underwent interventional therapy.All patients survived with a median follow-up period of 487 (112-1 033) days.Median time of platelet count returned to normal was 24.5 (7-60) days, and median time of fibrinogen returned to normal was 20 (7-30) days.Median time of D-dimer dropped to a normal was 105 (40-240) days.Conclusions:Children with concurrent platelet count and coagulation abnormalities should be considered with KMP.Doctors need to identify the potential visceral vascular lesions.Early diagnosis and treatment are important, which can improve the clinical prognosis of patients.

The clinical and laboratory data of a patient with chronic refractory immune thrombocytopenia (ITP) who had a significant increase in the proportion of inhibitory T cells in the hematological oncology center of Beijing Children′s Hospital Affiliated to Capital Medical University in February 2018 and regularly followed up in the outpatient department received a retrospective analysis.This 8-year-old patient′s clinical features were 6 years of skin and mucous membrane bleeding spots and petechiae recurring, with occasionally nasal epistaxis.Physical examination: cardiopulmonary abdomen and nervous system examinations are normal, and no superficial lymphadenopathy is touched.Blood routine indicated that the platelets were 2.00×10 9/L, and white blood cell count and hemoglobin level were normal.Bone marrow suggested that hyperplasia was significantly active, with more than 300 megakaryocytes.The patient was diagnosed with ITP, and he was treated with first-line treatment with gamma globulin and oral Corticosteroids.The first-line treatment with high-dose Dexamethasone therapy was repeated, and the second-line treatment was low-dose Rituximab combined with high-dose Dexamethasone.Evaluations had been conducted with every relapsed course, and Cyclosporine was administered orally on the basis of the highly suppressive T cells.After half a month, the child achieved partial remission and continued for 3 months, and then reached a complete remission of 6 months (till this paper). It is suggested that, with ITP as an immunological disease with high heterogeneity, the immune abnormality index is expected to become a breakthrough in the development of precise treatment.

Objective:To explore the clinical diagnosis and treatment of common bile duct stones (CBDS) in military pilots and the aeromedical assessment.Methods:The detailed diagnosis and treatment process, as well as the aeromedical assessment of 3 military pilots diagnosed as CBDS in Air Force Medical Center, PLA from June 2009 to March 2015 were collected. Then it was analyzed by the new technology.Results:Three pilots were diagnosed as CBDS and obstructive jaundice due to long term cholecystolithiasis or calculus of intrahepatic duct. Case 1 was secondary to cholecystolithiasis, and received laparoscopic cholecystectomy and common bile duct exploration. Case 2 was secondary to intrahepatic cholelithiasis and underwent left lateral lobectomy and common bile duct exploration. Case 3 recurred after cholecystolithotomy and then underwent open cholecystectomy, choledochoplasty and T-tube drainage because of biliary stricture. All 3 cases recovered well. The aeromedical assessment conclusions were as follows: case 1 was qualified to flight 5 months after operation, case 2 was grounded due to hypertension after the operation, case 3 was qualified after 6 months of the operation.Conclusions:CBDS of military pilots is often secondary to cholecystolithiasis or intrahepatic bile duct stones. The operation should be performed as early as possible, and minimally invasive methods should be adopted. The pilots with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To investigate the clinical characteristics, treatment and prognosis of children with acquired thrombotic thrombocytopenic purpura (TTP).Methods:The clinical manifestations, laboratory examination, treatment and prognosis of 5 children with acquired TTP hospitalized in Beijing Children′s Hospital, Capital Medical University from January 2016 to July 2019 were analyzed retrospectively.Results:There were 5 children with acquired TTP including 2 males and 3 females, with the onset age of 8.9(0.8-14.5) years, while 11 children with TTP in the same period. Thrombocytopenia and microangiopathic hemolytic anemia were found in all 5 patients. Only one patient had typical pentalogy of TTP, 3 patients had nervous system symptoms and 3 patients had fever, while renal impairment was relatively rare (1 case). Laboratory examination showed severe thrombocytopenia (7(4-14) ×10 9/L) and low level of hemoglobin (70(58-100)g/L) in all 5 children. Blood biochemical examination showed that total bilirubin (mainly indirect bilirubin) increased in 3 patients, lactate dehydrogenase increased in 5 patients, and urea nitrogen increased in 1 patient. Bone marrow smear showed megakaryocyte did not decrease. Plasma ADAMTS13 activity was 0 in all 5 patients while ADAMTS13 inhibitor was positive in 4 patients and negative in 1 patient. All 5 children received glucocorticoid therapy, rituximab was added in the early stage of the disease, and 3 children received plasma exchange. The time of platelet recovery to normal was 19 (9-29) days. One child had TTP recurrence after 9 months of treatment. The condition was stable after being treated with glucocorticoid and rituximab again. This case was finally diagnosed as systemic lupus erythematosus after more than 3 years followed up. By December 1, 2020, the follow-up time was 24(16-57) months.The clinical symptoms of all patients disappeared and the platelet level was stable at 159(125-269) ×10 9/L. Conclusions:Childhood acquired TTP is relatively rare, which can occur in all age groups. The clinical manifestations are mainly thrombocytopenia and microangiopathic hemolytic anemia, the plasma ADAMTS 13 activity and inhibitor test are helpful for the diagnosis of acquired TTP. Plasma exchange and rituximab are effective treatment. This disease requires long-term follow-up.

Objective:To summarize and analyze of the clinical and genetic characteristics of children with nonmuscle myosin heavy chain 9 (MYH9)-related disease (MYH9-RD).Methods:To screen the patients who were first diagnosed as "chronic/refractory immune thrombocytopenia (ITP) " from April 2016 to May 2019 in Beijing Children′s Hospital by genetic and clinical examinations, then the clinical manifestation, laboratory examination and genetics results of 7 children diagnosed with MYH9-RD were collected and summarized retrospectively.Results:Among 7 children diagnosed with MYH9-RD, 3 were males and 4 females. The age of onset was 1.25 (0.41-6.16) years. The course of disease was 2.16 (0.41-8.59) years. The automatic platelet count was (9 (5-30))×10 9/L. All the cases were found with giant platelets under microscope,and the manual platelet count was (70 (30-100))×10 9/L. Four cases had skin hemorrhage or epistaxis and 3 cases had no bleeding. All 7 patients had received first-or second-line therapy of ITP, of whom 1 case received splenic embolization, and all the treatments mentioned above were ineffective. Finally, it was confirmed that all 7 patients had heterozygous missense mutations of MYH9 gene by next generation sequencing (NGS), including 2 pedigrees and 5 sporadic cases. Four sporadic mutations occurred in N-terminal globular head domain (HD), and 1 sporadic case with p.D1424N mutations occurred in the C-terminal tail domain (TD). One of the pedigrees also had p.D1424N mutation. The other familial case had a novel variant with one missense variant p.A44D caused by the c.131C>A transition. One of the two p.R702 mutations had kidney damage, and several relatives of the new p.A44D mutations had deafness. Conclusions:In this study, the spontaneous mutations of seven MYH9-RD were common, and all patients were misdiagnosed as ITP, whereas the bleeding was mild and immunotherapy was ineffective. The suspected disease can be identified earlier by manual visual platelet volume and count, which can be confirmed by genetic testing. It is more important to monitor the development of other organs damage instead of thrombocytopenia. For cases with p.R702 mutations the doctor should be aware of kidney damage, and for the cases with novel mutations p.A44D the doctor should be aware of hearing loss.

Objective:To explore the clinical diagnosis and treatment of common bile duct stones (CBDS) in military pilots and the aeromedical assessment.Methods:The detailed diagnosis and treatment process, as well as the aeromedical assessment of 3 military pilots diagnosed as CBDS in Air Force Medical Center, PLA from June 2009 to March 2015 were collected. Then it was analyzed by the new technology.Results:Three pilots were diagnosed as CBDS and obstructive jaundice due to long term cholecystolithiasis or calculus of intrahepatic duct. Case 1 was secondary to cholecystolithiasis, and received laparoscopic cholecystectomy and common bile duct exploration. Case 2 was secondary to intrahepatic cholelithiasis and underwent left lateral lobectomy and common bile duct exploration. Case 3 recurred after cholecystolithotomy and then underwent open cholecystectomy, choledochoplasty and T-tube drainage because of biliary stricture. All 3 cases recovered well. The aeromedical assessment conclusions were as follows: case 1 was qualified to flight 5 months after operation, case 2 was grounded due to hypertension after the operation, case 3 was qualified after 6 months of the operation.Conclusions:CBDS of military pilots is often secondary to cholecystolithiasis or intrahepatic bile duct stones. The operation should be performed as early as possible, and minimally invasive methods should be adopted. The pilots with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To construct a prediction model for the prognosis of breast cancer patients with long non-coding RNA expression characteristics.Methods:To construct a long non-coding RNA(LncRNA) model for predicting the prognosis of breast cancer patients.Methods Analyzing LncRNA expression profiles and clinical characteristics of 1 081 breast cancer patients in the cancer genome atlas (TCGA) database.Performing differential expression analysis and univariate analysis on 112 paired breast cancer and normal breast tissues′ transcriptome sequencing data in the TCGA database, and screened for differentially expressed (DELncRNAs) that significantly correlated with the prognosis of BRCA (To reduce batch effects, sequencing data has been normalized using the DESeq function). One thousand eighty-one breast cancer patients were randomly divided into two groups: training set (541) and validation set (540). Performing Cox proportional hazard regression using DELncRNAs and establishing a multi-LncRNA prognosis model in the training set, followed by proportional hazards assumption test(PH assumption test). Patients were divided into high-risk and low-risk groups based on calculated risk score.Kaplan-Meier method was used for survival analysis, and 540 patients′ data were used for validation.To evaluate the prognostic value of the model in patients with squamous cell carcinoma of the lung and hepatocarcinoma in TCGA database.Gene Set Enrichment Analysis (GSEA) was used to analyze the specific mechanism of lncrna affecting the survival of patients.Results:There were 2815 differentially expressed genes screened by transcriptome sequencing, 91 of which were significantly related to the prognosis of breast cancer patients ( P<0.05). Based on the Cox regression analysis of 91 delncrna expression data from 541 breast cancer patients in training set, a Cox proportional risk regression model was constructed based on 5 LncRNA (training set AUC=0.746, validation set AUC=0.650): AC004551.1, MTOR-AS1, KCNAB1-AS2, FAM230G and LINC01283, and PH assumption test( P=0.388). K-M survival analysis showed that the survival time of high-risk group was significantly worse than that of low-risk group (median survival time: 7.049 and 12.21 years, HR 0.367, 95% CI0.228-0.597, P<0.001), and the survival time of high-risk group was significantly shorter than that of low-risk group (median survival time: 7.57 and 10.85 years, HR 0.412, 95% CI0.214-0.793, P<0.001). Similar prediction results were also obtained in other cancer species of TCGA: lung squamous cell carcinoma ( HR 0.604, 95% CI0.383-0.951, P=0.007) and liver cell carcinoma ( HR 0.551, 95% CI0.307-0.987, P=0.011). GSEA results suggested that the expression patterns of the above five LncRNA were related to the cell cycle regulation of tumor cells. Conclusion:The prognostic model constructed based on expression profile of AC004551.1, MTOR-AS1, KCNAB1-AS2, FAM230G and LINC01283 can be used to predict the prognosis of breast cancer patients, which is helpful to further guide clinical treatment.

On January 22, 2020, China National Center for Bioinformation (CNCB) released the 2019 Novel Coronavirus Resource (2019nCoVR), an open-access information resource for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 2019nCoVR features a comprehensive integra-tion of sequence and clinical information for all publicly available SARS-CoV-2 isolates, which are manually curated with value-added annotations and quality evaluated by an automated in-house pipeline. Of particular note, 2019nCoVR offers systematic analyses to generate a dynamic landscape of SARS-CoV-2 genomic variations at a global scale. It provides all identified variants and their detailed statistics for each virus isolate, and congregates the quality score, functional annotation,and population frequency for each variant. Spatiotemporal change for each variant can be visualized and historical viral haplotype network maps for the course of the outbreak are also generated based on all complete and high-quality genomes available. Moreover, 2019nCoVR provides a full collection of SARS-CoV-2 relevant literature on the coronavirus disease 2019 (COVID-19), including published papers from PubMed as well as preprints from services such as bioRxiv and medRxiv through Europe PMC. Furthermore, by linking with relevant databases in CNCB, 2019nCoVR offers data submission services for raw sequence reads and assembled genomes, and data sharing with NCBI. Collectively, SARS-CoV-2 is updated daily to collect the latest information on genome sequences, variants, hap-lotypes, and literature for a timely reflection, making 2019nCoVR a valuable resource for the global research community. 2019nCoVR is accessible at https://bigd.big.ac.cn/ncov/.