A novel avian influenza A(H7N9) virus causing human infection emerged in February 2013 in China. To elucidate the mechanism of interspecies transmission, we compared the signature amino acids of avian influenza A(H7N9) viruses from human and non-human hosts and analysed the reassortants of 146 influenza A(H7N9) viruses with full genome sequences. We propose a genetic tuning procedure with continuous amino acid substitutions and reassorting that mediates host adaptation and interspecies transmission. When the early influenza A(H7N9) virus, containing ancestor haemagglutinin (HA) and neuraminidase (NA) genes similar to A/Shanghai/05 virus, circulated in waterfowl and transmitted to terrestrial poultry, it acquired an NA stalk deletion at amino acid positions 69 to 73. Then, receptor binding preference was tuned to increase the affinity to human-like receptors through HA G186V and Q226L mutations in terrestrial poultry. Additional mammalian adaptations such as PB2 E627K were selected in humans. The continual reassortation between H7N9 and H9N2 viruses resulted in multiple genotypes for further host adaptation. When we analysed a potential association of mutations and reassortants with clinical outcome, only the PB2 E627K mutation slightly increased the case fatality rate. Genetic tuning may create opportunities for further adaptation of influenza A(H7N9) and its potential to cause a pandemic. www.eurosurveillance.org Methods Virus sampling and isolation Specimens as well as clinical and epidemiological information were collected from human cases. Environmental samples and avian samples were collected in the area where human cases identified. Virus isolation was conducted by Chinese National Influenza Center (CNIC) in a biosafety level 3 facility using nineday-old specific pathogen-free (SPF) embryonated chicken eggs and incubated at 37 °C for 48-72 hours. The allantoic fluid was harvested, aliquoted and stored at-80 ºC until use. RNA extraction and genome sequencing Viral RNA was extracted using QIAamp Viral RNA Mini Kit (Qiagen, Hilden, Germany). Gene segments were amplified using the Qiagen OneStep RT-PCR Kit. A total of 48 primer pairs were used to generate PCR amplicons between 378 and 1,123 bp in length for full genome sequencing. Primer sequences are available from the authors on request. Amplified PCR products were purified using ExoSAP-IT reagent (USB, Cleveland, US). Complete genome sequencing was performed with an ABI 3730XL automatic DNA analyser (Applied Biosystems, Foster City, US) using the ABI BigDye Terminator v3.1 cycle sequencing kit (Applied Biosystems; Foster City, US). HA: haemagglutinin; NA: neuraminidase. Red dots represent the common ancestor of the novel H7N9 virus. A/Shanghai/5/2013 and A/Shanghai/1/2013 are highlighted in pink and green, respectively. Schematic unrooted trees of HA and NA genes are shown in lower left boxes. The authors gratefully acknowledge the originating and submitting laboratories who contributed sequences used in the phylogenetic analysis to GISAID, and recognise in ...

These two cases of sphenoid fungal ball in conjunction with vision loss suggest that the otolaryngologist should keep this disease in mind even when symptoms are nonspecific. Endoscopic surgery can be a safe and viable therapeutic approach for this condition.

Retina, located in the innermost layer of the eye of human, holds the decisive role in visual perception. Dissecting the heterogeneity of retina is essential for understanding the mechanism of vision formation and even the development of central nervous system (CNS). Here, we performed single cell RNA-seq, analyzed 57,832 cells from human infant donors, resulting in 20 distinct clusters representing major cell types in retina: rod photoreceptors, cone photoreceptors, bipolar cells, horizontal cells, amacrine cells, Muller glia cells and microglia. We next constructed extensive networks of intercellular communication and identified ligand-receptor interactions playing crucial roles in regulating neural cell development and immune homeostasis in retina. Though re-clustering, we identified known subtypes in cone PRs and additional unreported subpopulations and corresponding markers in rod PRs as well as bipolar cells. Additionally, we linked inherited retinal disease to certain cell subtypes or subpopulations through enrichment analysis. Intriguingly, we found that status and functions of photoreceptors changed drastically between early and late retina. Overall, our study offers the first retinal cell atlas in human infants, dissecting the heterogeneity of retina and identifying the key molecules in the developmental process, which provides an important resource that will pave the way for retina development mechanism research and regenerative medicine concerning retinal biology.

Objective This study aimed to analyse the differences between underwater continuous drilling and traditional intermittent drilling for attic cholesteatoma. Methods The clinical data of 61 patients with attic cholesteatoma who underwent an endoscopic approach procedure were analysed. Forty patients underwent underwater continuous drilling (group A), and 21 patients underwent traditional intermittent drilling (group B). Results The operation time was 64.61 ± 12.90 minutes in group A and 79.60 ± 16.81 minutes in group B (p < 0.05). The anaesthesia time was 102.69 ± 17.93 minutes in group A and 119.82 ± 19.28 minutes in group B (p < 0.05). The dry ear time, the hearing improvement rate and the post-operative complications were no different in the two groups. Conclusion Group A and group B had no differences in surgical outcome or hearing recovery. However, treatment in the former group resulted in a significantly shortened operation and anaesthesia time.

Voice behavior has been widely recognized as having various benefits for organizations, while researchers seldom notice its consequences in construction projects. Against this context, this study empirically explores the impact path of team voice on project performance in construction projects from a multi-team system (MTS) perspective. Considering the essence of voice behavior is to provide information, this study introduces the input–process–outcome (IPO) framework to verify how team voice can affect project performance by influencing project learning and project reflexivity. The online survey method, monetary incentive method, and chain-referral sampling method are adopted to distribute the designed questionnaire. A total of 184 data points from completed construction projects in China supported the research conclusion by adopting the partial least squares structural equation modeling (PLS-SEM) technique. Project learning and project reflexivity positively mediate the relationship between team voice and project performance in construction projects. Specifically, team voice can first positively influence project learning and project reflexivity, which both have a positive relationship with project performance. For theory, this study opens the black box between team voice and project performance in the context of construction projects by unveiling the mediating path of project learning and project reflexivity, which also enriches the literature on voice behavior and expands its application. Furthermore, this study provides one new perspective for MTS knowledge by adopting the IPO framework to explore the underlying mechanism between the focal team and the overall team performance of the MTS. For practice, this study has a directive function for construction project management and MTS management, while providing reminders for policymakers, researchers, and practitioners about the significance of project learning and project reflexivity on project performance.