Territorywide Study of Early Coronavirus Disease Outbreak,Hong Kong,China

Initial cases of coronavirus disease in Hong Kong were imported from mainland China. A dramatic increase in case numbers was seen in February 2020. Most case-patients had no recent travel history, suggesting the presence of transmission chains in the local community. We collected demographic, clinical, and epidemiologic data from 50 patients, who accounted for 53.8% of total reported case-patients as of February 28, 2020. We performed whole-genome sequencing to determine phylogenetic relationship and transmission dynamics of severe acute respiratory syndrome coronavirus 2 infections. By using phylogenetic analysis, we attributed the community outbreak to 2 lineages; 1 harbored a common mutation, Orf3a-G251V, and accounted for 88.0% of the cases in our study. The estimated time to the most recent common ancestor of local coronavirus disease outbreak was December 24, 2019, with an evolutionary rate of 3.04 × 10⁻³ substitutions/site/year. The reproduction number was 1.84, indicating ongoing community spread.     

Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease,New Zealand, 2000–2018

We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000–2018 and RHD mortality rates during 2000–2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0–14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9–27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9–3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2–5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3–14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1–13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities.     

Comparison of renal function after open radical cystectomy,extracorporeal robot assisted radical cystectomy,and intracorporeal robot assisted radical cystectomy

PurposeRenal function outcomes following robot-assisted radical cystectomy (RARC) have not been well established. We sought to compare long-term renal function outcomes between open radical cystectomy, RARC with extracorporeal urinary diversion and intracorporeal urinary diversion at a high volume institution.Materials and MethodsWe retrospectively reviewed our institutional bladder cancer database for patients who underwent RC from 2010 to 2019 with pre-operative estimated glomerular filtration rate (eGFR) > 45 ml/min/1.73m². Changes in renal function were assessed through locally weighted scatter plot smoothing and comparison of median eGFR between surgical groups. Chronic Kidney Disease Stage 3B was defined as eGFR < 45 ml/min/1.73m². Renal function decline was defined as a ≥10 ml/min/1.73m² drop in eGFR. Kaplan Meier method with log-rank was used to compare CKD 3B-free survival and renal function decline. Cox Proportional Hazards model was used to identify predictors of CKD 3B.ResultsSix hundred and forty four patients were included with median follow-up of 32 months (IQR 12–56). Preoperative characteristics were similar among the groups with no differences in median pre-operative eGFR (ORC: 74.6, extracorporeal urinary diversion: 74.3, intracorporeal urinary diversion: 71.6 ml/min/1.73m², P = 0.15). Median postoperative eGFR on follow up was not different between groups (P = 0.56). 33% of patients developed CKD 3B. There were no differences in CKD 3B-free survival by surgical approach (P = 0.23) or urinary diversion (P = 0.09). 64% of patients experienced renal function decline with a median time of 2.4 years (P 0.23). Predictors of CKD were pathologic T3 disease or greater (HR: 1.77, P = 0.01), ureteroenteric anastomotic stricture (HR: 2.80, P < 0.001), preoperative CKD Stage 2 (HR: 1.81, P =0.02), and preoperative CKD Stage 3A (HR: 5.56, P < 0.001).ConclusionRenal function decline is common after RC. Tumor stage, pre-operative eGFR, and ureteral stricture development, not surgical approach, influence renal function decline.     

Role for macrophage migration inhibitory factor in acute respiratory distress syndrome

The critical role of macrophage migration inhibitory factor (MIF) in mediating inflammatory lung injury in acute respiratory distress syndrome (ARDS) has been raised recently. The present study has identified enhanced MIF protein expression in alveolar capillary endothelium and infiltrating macrophages in lung tissues from ARDS patients. The possibility that MIF up-regulates its synthesis in an autocrine fashion in ARDS was tested using cultured endothelial cells stimulated with MIF and a murine model of lipopolysaccharide (LPS)-induced acute lung injury. MIF induced significant MIF and tumour necrosis factor (TNF)-alpha synthesis in cultured endothelial cells and the effect was blocked by neutralizing anti-MIF antibody. A similar blocking effect was observed when MIF-stimulated endothelial cells were pretreated with neutralizing anti-TNF-alpha antibody or glucocorticoid, supporting the notion that MIF induced TNF-alpha production via an amplifying pro-inflammatory loop. Treatment with anti-MIF or glucocorticoid effectively attenuated pulmonary pathology and the synthesis of MIF or TNF-alpha in mice with LPS-induced acute lung injury. Mildly augmented expression of aquaporin 1 (AQP1) was also detected in alveolar capillary endothelium in ARDS. In vitro studies revealed that both MIF and TNF-alpha induced a small increase of AQP1 synthesis in cultured endothelial cells. These findings suggest that MIF plays a crucial pathological role leading to alveolar inflammation in ARDS. Anti-MIF and early glucocorticoid therapy may represent a novel therapeutic approach for reducing alveolar inflammation in ARDS.     

肢端型系统性硬皮病误诊1例

1　病例报告　女 ,45岁 ,因吞咽困难 16 mo伴发热 15 d,于1999- 0 7- 12入院 .于 16 mo前与人争吵后出现吞咽困难 ,以进食馒头、面条为著 ,剑突下有时出现梗噎感 ,随即呕吐 ,呕出所进食物及粘液 ,情绪波动可诱发症状加重 ,伴食欲减退、返酸 .15 d前无诱因出现不规则发热 ,T38～ 39℃ ,上腹痛加重 ,全身酸困不适 ,乏力、头晕、消瘦 .追问病史 ,患者 5 a前双手、足疼痛麻木 ,尤以受凉、精神刺激后明显 ,手指初发白 ,继而发紫 ,变红 ,且麻木疼痛加重 ,手足小关节渐僵硬、畸形 .曾到多家医院就诊 ,诊断 :“雷诺病、类风湿性关节炎”.2 a前出现…     

Localization of expression of fibroblast growth-factors and their receptors in pancreatic adenocarcinoma by in-situ hybridization

Growth factors may play a role in autocrine or paracrine growth control of tumour cells. We have now examined the expression pattern in vivo by in situ hybridization (ISH) on a series of 13 ductal adenocarcinomas of the pancreas using the non-radioactive digoxigenin system to generate specific antisense orientated riboprobes for FGF-1 and FGF-2, and the four FGFRs (FGFR-1, -2, -3 and -4). We confirmed the expression of both FGF/FGFR by tumour cells, with the potential of a potential autocrine loops in 46% of the cases studied. FGF-2 and FGFR-3 were the most commonly expressed ligand and receptor (46% and 76% respectively). Endothelial cells lining vessels within an around invasive tumours were frequently positive for expression of FGFR-1 and/or FGFR-3. In the normal pancreas remote from the tumour, the acinar cells were found to have a heterogeneous expression pattern for FGFRs while duct cells, islet cells and stromal components including nerves and vascular endothelium were negative. The data suggest a role for FGFs and their high affinity receptors in the control of growth of human pancreatic adenocarcinoma and its supporting stroma.     

Computed tomographic angiography: historical perspective and new state-of-the-art using multi detector-row helical computed tomography

Since its clinical introduction in 1991, volumetric computed tomography scanning using spiral or helical scanners has resulted in a revolution for diagnostic imaging. In addition to new applications for computed tomography, such as computed tomographic angiography and the assessment of patients with renal colic, many routine applications such as the detection of lung and liver lesions have substantially improved. Helical computed tomographic technology has improved over the past eight years with faster gantry rotation, more powerful X-ray tubes, and improved interpolation algorithms, but the greatest advance has been the recent introduction of multi detector-row computed tomography scanners. These scanners provide similar scan quality at a speed gain of 3-6 times greater than single detector-row computed tomography scanners. This has a profound impact on the performance of computed tomography angiography, resulting in greater anatomic coverage, lower iodinated contrast doses, and higher spatial resolution scans than single detector-row systems.     

Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging

PURPOSE: To study the morphologic characteristics of late radiation injury to the temporal lobes of the brain on magnetic resonance (MR) images. MATERIALS AND METHODS: This was a prospective study involving 34 patients (age range, 37-72 years) with known radiation injury to the temporal lobes from radiation therapy administered 2-10 years previously for nasopharyngeal carcinoma MR imaging was performed with T2-weighted gradient- and spin-echo, gradient-recalled echo, T1-weighted spin-echo, fluid-attenuated inversion-recovery, and T1-weighted postcontrast spin-echo sequences. RESULTS: Radiation injury was present in 57 of the 68 temporal lobes. The white matter lesions in radiation-induced injury were predominantly hyperintense on T2-weighted images, but in 37 (65%) of the 57 lobes, foci with heterogeneous signal intensity consistent with necrosis were detected. In the 57 involved lobes, gray matter lesions were detected in 50 (88%); blood-brain barrier disruption based on parenchymal contrast enhancement, in 51 (89%); and hemosiderin deposits, in 30 (53%). There was a significant correlation between white matter necrosis, gray matter lesions, and blood-brain barrier disruption, all of which were located mainly in the inferior temporal lobes that received the highest radiation dose. CONCLUSION: The lesion components of radiation-induced injury to the temporal lobes at MR imaging were more varied than have been previously described. In addition to the classic white matter lesions, gray matter lesions, blood-brain barrier disruption, and hemosiderin deposition also were frequently seen.     

Mammographic Screening Downstages Breast Carcinomas at Time of Diagnosis: A Community-Based Experience

Abstract: To determine the effectiveness of screening mammography in a community medical setting, data from a population-based, retrospective study was analyzed. Medical records of 827 patients with newly diagnosed breast cancer in California between October 1994 and March 1996 were reviewed. The primary care physician's record was abstracted for clinical history, including recommendation of screening mammography. The facility records where final diagnosis was made were abstracted for stage and treatment data. Among the patients who did not have previous screening mammography, 65.7% were diagnosed with "advanced" breast cancer (stages II, III, IV), while only 39.9% who had previous screening mammography were diagnosed with advanced breast cancer (p < 0.001). This study has reaffirmed that screening mammography of adult females generates downstaging at the time of diagnosis of breast cancer. Despite possession of a health insurance program and receiving educational materials, only 65% of patients over 50 years of age had screening mammography. As opposed to the once-a-year mailing of general reminders to all women 40 years old and older, developing a longitudinal electronic medical record in the managed care setting will support a more coordinated and individualized intervention based on age, date of last mammogram, and relative risk, among other factors. Continuing education efforts must also be directed to referring physicians, who may not yet recognize the value of screening mammography.