SUMMARY Background Avian influenza A(H7N9) virus has caused human infections in China since 2013, and a large epidemic in 2016–17 has prompted concerns of whether the epidemiology has changed to suggest an increasing pandemic threat. Our study aimed to describe the epidemiological characteristics, clinical severity, and time-to-event distributions of A(H7N9) case-patients in the 2016–17 epidemic wave compared with previous waves. Methods We obtained information about all laboratory-confirmed human cases of A(H7N9) virus infection reported in mainland China as of 23 February 2017. We described the epidemiological characteristics across epidemic waves, and estimated the risk for death, mechanical ventilation, and admission to the intensive care unit for patients who required hospitalization for medical reasons. We estimated the incubation periods, and time delays from illness onset to hospital admission, illness onset to initiation of antiviral treatment, and hospital admission to death or discharge. Findings The 2016–17 A(H7N9) epidemic wave began earlier, spread to more counties in affected provinces and had more confirmed cases than previous epidemic waves. There was an increase in the proportion of cases in middle-aged adults and in semi-urban and rural residents. The clinical severity of hospitalized cases in 2016–17 was comparable to the previous epidemic waves. Interpretation Age distribution and case sources changed gradually across epidemic waves, while clinical severity has not changed substantially. Continued vigilance and sustained intensive control efforts are needed to minimize the risk of human infection with A(H7N9) virus. Funding The National Science Fund for Distinguished Young Scholars (grant no. 81525023).

Pediatric traumatic brain injury is a substantial contributor to the health resource burden in the United States, accounting for more than $1 billion in total hospital charges annually.

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BackgroundCurrent knowledge about elder mistreatment is mainly derived from studies done in Western countries, which indicate that this problem is related to risk factors such as a shared living situation, social isolation, disease burden, and caregiver strain. We know little about prevalence and risk factors for elder mistreatment and mistreatment subtypes in rural China where the elder population is the most vulnerable.MethodsIn 2010, we conducted a cross-sectional survey among older adults aged 60 or older in three rural communities in Macheng, a city in Hubei province, China. Of 2245 people initially identified, 2039 were available for interview and this was completed in 2000. A structured questionnaire was used to collect data regarding mistreatment and covariates. Logistic regression analysis was used to identify factors related to elder mistreatment and subtypes of mistreatment.ResultsElder mistreatment was reported by 36.2% (95% CI: 34.1%–38.3%) of the participants. Prevalence rates of psychological mistreatment, caregiver neglect, physical mistreatment, and financial mistreatment were 27.3% (95% CI: 25.3%–29.2%), 15.8% (95% CI: 14.2%–17.4%), 4.9% (95% CI: 3.9%–5.8%) and 2.0% (95% CI: 1.3%–2.6%), respectively. The multivariate logistic regression analysis revealed that depression, being widowed/divorced/single/separated, having a physical disability, having a labor intensive job, depending solely on self-made income, and living alone were risk factors for elder mistreatment. Different types of elder mistreatment were associated with different risk factors, and depression was the consistent risk factor for the three most common mistreatment subtypes.ConclusionOlder adults in rural China self-report a higher rate of mistreatment than their counterparts in Western countries. Depression is a main risk factor associated with most subtypes of mistreatment. Our findings suggest that prevention and management of elder mistreatment is a challenge facing a rapidly aging Chinese population.

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These findings illustrate the considerable morbidity, financial burden, and proximal causes for pediatric eye injury-related hospitalizations. Our data support the need for eye injury prevention efforts that consider the age, gender, and developmental stage of children. Educating parents and children about the potential for eye injuries at home and during hazardous activities is an important public health goal. In addition, promoting the use of appropriate protective eyewear by children during activities with a high risk of ocular trauma will help prevent future eye injuries.

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Purpose: Matrix metalloproteinase 9 (MMP-9) plays critical roles in cancer development and aggression. Nonsynonymous single-nucleotide polymorphisms (SNP) in the functional domain of the MMP-9 gene may influence substrate and inhibitor binding and contribute to cancer predisposition and aggression. Patients and Methods: To test our hypothesis that common nonsynonymous SNPs, R279Q, P574R, and R668Q, in MMP-9 are associated with lung cancer development and metastasis, we conducted a case-control study of 744 patients with incident lung cancer and 747 cancer-free controls in Southeast China. Multivariate logistic regression analysis was used to calculate adjusted odds ratio (OR) and 95% confidence interval (95% CI). Results: We found that compared with the 279QQ genotype, the 279RR genotype was associated with significant elevated risk of lung cancer with metastasis (adjusted OR, 1.79; 95% CI, 1.03-3.08), whereas the 574PR heterozygote and 574PP homozygote had 1.46-fold (95% CI, 0.94-2.26) and 1.69-fold elevated risk (95% CI, 1.10-2.60), respectively, compared with the 574RR genotype. When we examined the combined effect of R279Q and P574R and used the 279R and 574P as the risk alleles, a significantly increased risk of lung cancer was associated with both the genotypes containing ''1 to 2 risk alleles'' (adjusted OR, 2.16; 95% CI, 1.30-3.59) and containing ''>2 risk alleles'' (adjusted OR, 2.44; 95% CI, 1.48-4.03), and it was more pronounced in 290 lung cancer cases with metastasis [adjusted OR, 2.30 (95% CI, 1.09-4.85) for the 1to 2 risk alleles subgroup and adjusted OR, 2.82 (95% CI, 1.35-5.88) for the >2 risk alleles subgroup], compared with those without any risk alleles. However, no overall significant associations were observed between R668Q and lung cancer risk in this study population. Conclusion: These findings indicate that the potentially functional polymorphisms, MMP-9 P574R and R279Q, may confer the biomarker in the occurrence and metastasis of primary lung cancer. Further functional studies including these two genetic variants are warranted to confirm our findings.The extracellular microenvironment is a dynamic entity and provides regulatory signals on an intricate network of pathways that include cell adhesion, differentiation, division, and apoptosis. Therefore, cells with disruption of these pathways may acquire tumorigenic properties, such as loss of contact inhibition, aberrant cell division, and evasion of apoptosis (1). Matrix metalloproteinases (MMP), a family of structurally and functionally related zinc endopeptidases, are essential regulators of the microenvironment of the cell, through their control of extracellular proteolysis, and have been implicated in invasion and metastasis of tumor cells (2 -5). Recent studies on the roles of MMPs revealed that these proteolytic enzymes are involved in the regulation of various cell behaviors, including cancer cell growth, differentiation, apoptosis, migration, invasion, and the regulation of tumor angiogenesis and immune surveillance (6);...