BackgroundAlthough laparoscopic surgery has been recommended as an optional therapy for patients with early gastric cancer, whether patients with locally advanced gastric cancer (AGC) could benefit from laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy remains elusive due to a lack of comprehensive clinical data. To evaluate the efficacy of LADG, we conducted a multi-institutional randomized controlled trial to compare laparoscopy-assisted versus open distal gastrectomy (ODG) for AGC in North China.MethodsIn this RCT, after patients were enrolled according to the eligibility criteria, they were preoperatively assigned to LADG or ODG arm randomly with a 1:1 allocation ratio. The primary endpoint was the morbidity and mortality within 30 postoperative days to evaluate the surgical safety of LADG. The secondary endpoint was 3-year disease-free survival. This trial was registered at ClinicalTrial.gov as NCT02464215.ResultsBetween March 2014 and August 2017, a total of 446 patients with cT2-4aN0-3M0 (AJCC 7th staging system) were enrolled. Of these, 222 patients underwent LADG and 220 patients underwent ODG were included in the modified intention-to-treat analysis. The compliance rate of D2 lymph node dissection was identical between the LADG and ODG arms (99.5%, P = 1.000). No significant difference was observed regarding the overall postoperative complication rate in two groups (LADG 13.1%, ODG 17.7%, P = 0.174). No operation-related death occurred in both arms.ConclusionsThis trial confirmed that LADG performed by credentialed surgeons was safe and feasible for patients with AGC compared with conventional ODG.

Objective. To examine the roles of specific genetic polymorphisms as predictors of response to treatment of early rheumatoid arthritis (RA).Methods. Subjects included 457 patients with early RA (duration of <3 years) who participated in a randomized controlled trial comparing weekly methotrexate and 2 dosages of etanercept (10 mg twice weekly and 25 mg twice weekly). Our primary outcome measure was achievement of 50% improvement in disease activity according to the criteria of the American College of Rheumatology (ACR50 response) after 12 months of treatment. Subjects were genotyped for HLA-DRB1 alleles and polymorphisms in the following genes: TNF, LTA, TNFRSF1A, TNFRSF1B, FCGR2A, FCGR3A, and FCGR3B. Univariate and multivariate analyses were performed to define the impact of specific polymorphisms and haplotypes on response to treatment. Covariates for the multivariate analyses included sex, ethnicity, age, disease duration, and baseline values for rheumatoid factor and the tender and swollen joint counts.Results. The presence of 2 HLA-DRB1 alleles encoding the shared epitope (SE) (compared with 1 or 0 copies) was associated with response to treatment with standard-dose etanercept (odds ratio [OR] 4.3, 95% confidence interval [95% CI] 1.8-10.3). Among Caucasian patients, 2 extended haplotypes that included the HLA-DRB1 alleles *0404 and *0101 (both of which encode the SE) and 6 single-nucleotide polymorphisms in the LTA-TNF region were associated with response to treatment. In a multivariate model that included treatment received and the aforementioned covariates, the ORs for the association of these haplotypes with achievement of an ACR50 response at 12 months were 2.5 (95% CI 0.8-7.3) and 4.9 (95% CI 1.5-16

Abstract. GPS data indicate 30-40 mm yr -I present-day crustalshortening across the Andes, whereas geological evidence shows crustal shortening concentrated in the sub-Andean thrust belt at a much lower rate (<15 mm yr-l). We reconcile the discrepancy between the geodetic and the geological crustal shortening using geodynamic modeling that includes timescale-dependent crustal deformation. The GPS velocities reflect the instantaneous deformation in the Andes that includes both permanent deformation and elastic deformation that will be recovered during future earthquakes, whereas the lower geological rates reflect only the permanent deformation. The three-dimensional viscoelastic model predicts nearly uniform short-term velocity gradients across the Andes, similar to the GPS results, and concentrated long-term crustal shortening in the sub-Andean thrust zone, consistent with geological observations.

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Coronavirus disease 2019 (COVID-19) has become a worldwide public health threat. Many associated factors including population movement, meteorological parameters, air quality and socioeconomic conditions can affect COVID-19 transmission. However, no study has combined these various factors in a comprehensive analysis. We collected data on COVID-19 cases and the factors of interest in 340 prefectures of mainland China from 1 December 2019 to 30 April 2020. Moran's I statistic, Getis-Ord Gi ⁎ statistic and Kulldorff's space-time scan statistics were used to identify spatial clusters of COVID-19, and the geographically weighted regression (GWR) model was applied to investigate the effects of the associated factors on COVID-19 incidence. A total of 67,449 laboratory-confirmed cases were reported during the study period. Wuhan city as well as its surrounding areas were the cluster areas, and January 25 to February 21, 2020, was the clustering time of COVID-19. The population outflow from Wuhan played a significant role in COVID-19 transmission, with the local coefficients varying from 14.87 to 15.02 in the 340 prefectures. Among the meteorological parameters, relative humidity and precipitation were positively associated with COVID-19 incidence, while the average wind speed showed a negative correlation, but the relationship of average temperature with COVID-19 incidence inconsistent between northern and southern China. NO 2 was positively associated, and O 3 was negatively associated, with COVID-19 incidence. Environment with high levels of inbound migration or travel, poor ventilation, high humidity or heavy rainfall, low temperature, and high air pollution may be favorable for the growth, reproduction and spread of SARS-CoV-2. Therefore, applying appropriate lockdown measures and travel restrictions, strengthening the ventilation of living and working environments, controlling air pollution and making sufficient preparations for a possible second wave in the relatively cold autumn and winter months may be helpful for the control and prevention of COVID-19.

Background The frequent movement of population between countries brings an increasing number of travel-related infections. This study aims to define the spectrum and dynamics of imported infections observed from international travel in the Chinese mainland. Methods Sick travellers were screened by inbound sentinel surveillance and post-travel clinic visits from 2014 to 18. The infections were classified as respiratory, gastrointestinal, vector-borne, blood/sexually transmitted and mucocutaneous. The analysed variables included the place of origin of the travellers (Chinese or foreign) and the time when travel-related infection was present (at the time of return, during travel and post-travel visits to the clinic). Results In total, 58 677 cases were identified amongst 1 409 265 253 travellers, with an incidence of 41.64/million, comprising during-travel incidence of 27.44/million and a post-travel incidence of 14.20/million. Respiratory infections constituted the highest proportion of illnesses during travel (81.19%, 31 393 of 38 667), which mainly came from Asian countries and tourists; with influenza virus and rhinovirus infections being mainly diagnosed. Vector-borne diseases constituted the highest proportion of post-travel illnesses (98.14%, 19 638 of 20 010), which were mainly diagnosed from African countries and labourers; with malaria and dengue fever being mainly diagnosed. The differential infection spectrum varied in terms of the traveller’s demography, travel destination and travel purpose. As such, a higher proportion of foreign travellers had blood/sexually transmitted diseases (89.85%, 2832 of 3152), while Chinese citizens had a higher prevalence of vector-borne diseases (85.98%, 19 247 of 22 387) and gastrointestinal diseases (79.36%, 1115 of 1405). The highest incidence rate was observed amongst travellers arriving from Africa, while the lowest was observed amongst travellers arriving from Europe. Conclusions The findings might help in preparing recommendations for travellers and also aid in primary care or other clinics that prepare travellers before trips abroad. The findings will also help to identify locations and the associated types of infections that might require attention.

Archaea can respond to changes in the environment by altering the composition of their membrane lipids, for example, by modification of the abundance and composition of glycerol dialkyl glycerol tetraethers (GDGTs). Here, we investigated the abundance and proportions of polar GDGTs (P-GDGTs) and core GDGTs (C-GDGTs) sampled in different seasons from Tengchong hot springs (Yunnan, China), which encompassed a pH range of 2.5-10.1 and a temperature range of 43.7-93.6°C. The phylogenetic composition of the archaeal community (reanalysed from published work) divided the Archaea in spring sediment samples into three major groups that corresponded with spring pH: acidic, circumneutral and alkaline. Cluster analysis showed correlation between spring pH and the composition of P- and C-GDGTs and archaeal 16S rRNA genes, indicating an intimate link between resident Archaea and the distribution of P- and C-GDGTs in Tengchong hot springs. The distribution of GDGTs in Tengchong springs was also significantly affected by temperature; however, the relationship was weaker than with pH. Analysis of published datasets including samples from Tibet, Yellowstone and the US Great Basin hot springs revealed a similar relationship between pH and GDGT content. Specifically, low pH springs had higher concentrations of GDGTs with high numbers of cyclopentyl rings than neutral and alkaline springs, which is consistent with the predominance of high cyclopentyl ring-characterized Sulfolobales and Thermoplasmatales present in some of the low pH springs. Our study suggests that the resident Archaea in these hot springs are acclimated if not adapted to low pH by their genetic capacity to effect the packing density of their membranes by increasing cyclopentyl rings in GDGTs at the rank of community.

Marine diesel engines produce exhaust gas including a lot of SO x and particulate matter (PM), and laws have been promulgated to regulate ship exhaust emissions. This paper proposes a U-type exhaust gas cleaning (EGC) system that is capable of removing SO 2 and particulate matter (PM) simultaneously. The purpose of this study was to find the relationships between removing efficiency and parameters of EGC system, then get the optimal structural and operational parameters. The experimental results show that the SO 2 absorption rate in the scrubber was mainly influenced by liquid−gas ratio, pH value, and temperature in the range of experimental operating conditions. With the system stable running, when the liquid−gas ratio and temperature were determined, the pH value must be in a fixed range of 6.5−7.5. The further research was also carried on for the EGC system applicable to ships. On the basis of SO 2 removal efficiency, the prediction and experimental validation of particulate matter (PM) were studied. When comparing the results of prediction and experiment, the data show good agreement. PM removal efficiency was related to liquid−gas ratio, droplet size, and height of chamber. The height of spray chamber was the key structure factor, and the droplet size was the operational parameter affecting PM removing efficiency. The increasing of liquid−gas ratio both could lead to an increase in the SO 2 and PM removal efficiencies. Thus, according to this study, the usage of EGC system can removed SO 2 and PM at same time, and it can satisfy future ships emissions regulations. The theoretical analysis and experimental results of scrubber can be extended to apply in marine exhaust gas after-treatment technologies.