Partial denitrification granular sludge (PDGS) providing NO2--N for the anaerobic ammonia oxidation process was effective and efficient because of its excellent NO2--N accumulation and settling performance. However, current studies mainly focused on the granulation process but overlooked the stability of PDGS in the long-term operation. In this study, three kinds of PDGSs cultured by acetate, glucose and glycerol were successfully developed with the nitrate-to-nitrite transformation ratio (NTR) of 90.19 %, 55.47 % and 73.06 %, respectively. All the three PDGSs were firstly formed in 45 d with the mean size of 1201.8, 1338.8 and 956.5 mu m. Filamentous bacteria (i.e. Thiothrix) played a connecting role in the formation of acetate- and glucose-PDGS, which also enhanced the particle strength. The glucose- and glycerol-PDGS were found broken after 45 d, extracellular polymeric substances and confocal laser scanning microscope analysis found that it was because the substrate diffusion limitation lowered the strength inside the PDGS. Glycerol-PDGS stabilized at a smaller mean size (532.3 mu m), maintaining efficient substrate transfer and sustained performance, while glucose-PDGS entered repeated "breakage-regrowth" cycles. This study provides a mechanistic elucidation of the complete life-cycle dynamics in PDGS, revealing carbon source-dependent pathways governing granule stability through EPS composition, rheological properties, and microbial selection.

This study investigated the reduction of methane (CH4) and nitrous oxide (N2O) emissions from stormwater bioretention cells through microbial electrolytic cell (MEC), showing the largest reduction of 32.21 % (CH4) at 9.2 μA/m2 of current density and 56.16 % (N2O) at 3.5 μA/m2 of current density, compared with the corresponding in the control (0 μA/m2 of current density). Kinetic of CH4 and N2O emissions could be well fitted by Logistic model with high correlation coefficient (R2 > 0.9500) and model efficiency (ME > 0.95) but low relative root mean square error (RRMSE < 7.88). The increase of pmoA and polysaccharide (PS) were responsible for CH4 reduction, while N2O reduction was attributed to the decrease of nirS and the increase for nosZ and protein (PN), which could explain the lowest GWPd (10.67 mgCO2-eq/m2/h) at 3.5 μA/m2 of current density, suggesting that MEC could be promising for the reduction of CH4 and N2O emissions from bioretention cells.

Road-deposited sediments (RDS) in urban underlying surfaces are essential environmental pollution contributors to downstream through the migration of stormwater runoff. However, no available literature could be found on greenhouse gases (GHGs, like methane (CH4) and nitrous oxide (N2O)) emissions from RDS associated with stormwater runoff. In this study, sediments from commercial public squares (fresh) and stormwater pipe networks (old) around Nanjing (China) were collected for the investigation of the emissions for both CH4 and N2O under varying environmental factors, showing that CH4 emission could be observed after 7 days of the operation, while N2O emission concentrated at the first 7 days, furthermore the cumulative yields for both CH4 and N2O were the largest at air temperature of 35 °C and moisture of 15 %, and high UV radiation intensity (14 mW/cm2) was beneficial to CH4 emission but not to N2O emission. Effects of particle size on the production of CH4 and N2O indicted that CH4 emission for RDS with sizes < 75 μm was the largest (0.0058 mg/g) with the highest average variation rate (5.9×10-5 mg/g d), however N2O emission for RDS with size of 75-150 μm was the most obvious at 5th day of the operation with cumulative yield of 0.060 mg/g, which could be related to the distribution of organic carbon and nitrogen in RDS. The evaluation of RDS contributions to CH4 and N2O emissions in stormwater pipe network implied that the cumulative yield of CH4 was the largest (0.2359 mg/g) for 2:1 of the ratio of fresh to old sediments (F/O), while initial N2O output was the highest with more than 3×10-3 mg/g under the F/O of 3:1. Furthermore, both 50 mg/L CaO and 30 mg/L of K2S2O8 could be effective for blocking the emissions of CH4 and N2O from RDS.

BACKGROUND China has accumulated large amount of cancer-related data from multiple sources. Studies have thoroughly reviewed Chinese healthcare systems and emphasized the importance to promote data utilization while there is no study illustrating the utilization status of cancer-related databases. OBJECTIVE To understand data utilization of major cancer-related databases in China and promote further researches in healthcare data systems. METHODS A bibliometric analysis was applied on peer-reviewed publications using 15 representative cancer-related databases classified as cancer registry, medical insurance database, hospital-based database, and publicly accessible database according to source of data collection in China. Peer-reviewed articles written in English or Chinese, indexed in PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wanfang Data (in Chinese), and published since database inception to December 2021 were included. Data was analysed in November 2022. Bibliometric parameters were extracted to describe the numbers, quality, and research contents of published articles. The quality of the publications was described by total citation, journal impact factors (2020 edition) and Journal Citation Reports quartile (JCR, 2020 edition). Research contents were demonstrated by cancer sites and research topics. Between-group comparisons were made using Kruskal-Wallis H test or Fisher-Freeman-Halton exact test, as appropriate. RESULTS Of 1037 articles included, 637 was from cancer registries, 313 from hospital-based databases, 65 from medical insurance databases and 22 from public databases. An upward trend in annul number of publications was observed. Articles published in Chinese were nearly two-fold of those in English. Papers based on cancer registry, publicly accessible databases and the joint exploration of medical insurance databases were mainly published in journals of JCR Q2. The distribution of JCR quartiles and total citations were significantly different for the four data sources (P<0.0001). Lung, stomach, colorectal were most studied cancer sites while cancer incidence, mortality and prognosis were most focused research interests. CONCLUSIONS The upward trend in publication number was mainly contributed by articles from registries. The limited number of publications in English might weaken the impact of sharing research findings generated from Chinese data, in the international community. It highlights the importance of promoting data accessibility and utilization from various sources in China. CLINICALTRIAL None

目的 探讨肺结核患者在抗结核治疗早期炎症细胞因子水平对其治疗结束后继发慢性疾病的预测作用.方法 依托2013年5月—2015年8月连续纳入的活动性肺结核患者治疗队列,于2019和2020年进行电话随访.用双抗体夹心ELISA法检测治疗前、治疗2个月末细胞因子IFN-γ、IL-2、IL-4以及IL-10的水平及变化特点.结果 根据随访结果分为继发慢性病组(n=27)和健康状态组(n=122),分析发现,两组人群接受抗结核治疗后IL-2较治疗前明显下降,IL-10水平却有所上升,治疗前后差异显著(P<0.05).两组人群的IFN-γ、IL-4水平在治疗前后未表现出显著差异(P>0.05).多因素Logistic回归分析显示,治疗前IFN-γ越低(OR=0.980,95％CI:0.964～0.996,P=0.016)、IL-10越高(OR=1.015,95％CI:1.002～1.029,P=0.026),患者继发其他慢性病的可能性就越高.治疗前IFN-γ和IL-10联合预测慢性病发生风险的AUC为0.67(95％CI:0.56-0.78).结论 治疗前IFN-γ降低伴IL-10升高对结核病患者继发其他慢性疾病具有一定的预测价值.

目的:掌握社区老年常见慢性病患者服药依从性,探讨其对生命质量的影响,为更好防治老年慢性病提供参考依据.方法:2021年4—6月,选取上海市5家社区卫生服务中心管理的≥65岁人群中至少患有1种慢性病疾病(糖尿病或高血压)的老年人作为研究对象,调查分析慢性病患者服药依从性的影响因素及其与生命质量的相关性.结果:老年慢性病患者服药依从性总得分为(7.20±1.30)分,生命质量总得分为(0.96±0.10)分,服药依从性越高的患者生命质量越高;高血压、非独居、劳动时间≥3h的慢性病患者服药依从性较高.结论:应重点关注高血压和糖尿病的共病患者以及独居、劳动时间较少的慢性病患者的服药依从性,并及时给予干预,从而改善其生命质量.

ObjectiveTo understand the quality of life in patients with pulmonary tuberculosis within three years after treatment， determine its related factors， and make suggestions for improving the short-term quality of life in patients with pulmonary tuberculosis after treatment.MethodsA telephone survey was used to investigate registered tuberculosis patients in Shanghai in 2018 using the short form 12 （SF-12） and the chronic obstructive pulmonary disease （COPD） assessment test questionnaire （CAT）.ResultsA total of 975 patients with pulmonary tuberculosis who had completed the treatment were included in the study. The total physiological score was determined to be 49.18±10.25， and the total psychological score was 50.27±8.03 （t=5.62，P<0.000 1）. The average CAT score was 13.31±6.08. Multivariate linear regression analysis showed that quality of life was positively associated with high educational level， high monthly family income， and frequent physical exercise， whereas negatively associated with comorbidities， low self-care ability， and changing jobs.ConclusionWe should pay more attention to the patients with pulmonary tuberculosis coexistent with COPD and other lung diseases. Measures should be implemented for the improvement in the quality of life， including providing financial support， encouraging regular exercise， and improving lung function.

目的:了解上海市结核病密切接触者中结核潜伏感染(latent tuberculosis infection, LTBI)者的结核病发病风险及其时间特征。方法:采用前瞻性观察性研究方法，以2009至2010年上海市7个区户籍人口中确诊肺结核患者的密切接触者为研究对象，采用结核感染T淋巴细胞斑点试验(T-cell spot test of tuberculosis infection，T-SPOT.TB)判断结核分枝杆菌感染情况以识别LTBI，同时采用问卷调查的方法收集研究对象的基本信息和结核病密切接触史。通过结核病登记报告系统识别LTBI者在检测后连续9年内的发病情况，计算其结核病发病率和发病密度。采用 χ2检验对不同性别和年龄分组的发病率进行分层分析。 结果:2009年至2010年，共纳入376例确诊肺结核患者的982名密切接触者，其中287名密切接触者经T-SPOT.TB检测为LTBI。接受基线调查时感染者中位年龄为54岁，36.6%(105/287)的LTBI者为男性。截至2019年12月287名LTBI者中共发现5例新发结核病患者，2年累积发病率为0.35%，5年累积发病率为1.05%，9年累积发病率为1.74%(95%可信区间0.57%～4.02%)，中位发病时间为3.67年；研究期间共观察了2 666.75人年，结核病发病密度为1.875/1 000人年。不同年龄( χ2＝0.600， P>0.05)和性别( χ2<0.001， P>0.05)的LTBI者的结核病9年累积发病率差异均无统计意义。 结论:结核病患者密切接触者中的LTBI者的结核病发病集中在接触后前5年左右。

PURPOSE:To investigate the dysregulated pathways and identify reliable diagnostic biomarkers for tuberculosis using integrated analysis of metabolomics and transcriptomics.METHODS:Three groups of samples, untargeted metabolomics analysis of healthy controls (HC), latent tuberculosis infection patients (LTBI), and active tuberculosis patients (TB), were analyzed using gas chromatography time-of-flight mass spectrometry (GC-TOF MS) and ultra-high performance liquid chromatography-quantitative mass spectrometry (UHPLC-QE-MS). Both univariate and multivariate and statistical analyses were used to select differential metabolites (DMs) among group comparison, and LASSO regression analysis was employed to discover potential diagnostic biomarkers. Metabolite set enrichment analysis was performed to identify the altered metabolic pathways specifically in patients with TB. Meanwhile, a transcriptomic dataset GSEG4992 was downloaded from the GEO database to explore the differentially expressed genes (DEGs) between TB and HC identified in significantly enriched pathways. Finally, an integrative analysis of DMs and DEGs was performed to investigate the possible molecular mechanisms of TB.RESULTS:Thirty-three specific metabolites were significantly different between TB and HC, of which 7 (5-hydroxyindoleacetic acid, isoleucyl-isoleucine, heptadecanoic acid, indole acetaldehyde, 5-ethyl-2,4-dimethyloxazole, and 2-hydroxycaproic acid, unknown 71) were chosen as combinational potential biomarkers for TB. The area under the curve (AUC) value of these biomarkers was 0.97 (95% CI: 0.92-1.00). Metabolites set enrichment analysis (MSEA) displayed that there were 3 significantly enriched pathways among all. The genes in 3 significantly enriched pathways were further analyzed, of which 9(ALDH3B1, BCAT1, BCAT2, GLYAT, GOT1, IL4I1, MIF, SDS, SDSL) were expressed differentially. The area under the curve (AUC) values of these DEGs enriched in pathways mostly were greater than 0.8. As a result, a connected network of metabolites and genes in the pathways were established, which provides insights into the credibility of selected metabolites.CONCLUSION:The newly identified metabolic biomarkers display a high potential to be developed into a promising tool for TB screening, diagnosis, and therapeutic effect monitoring.

Objective:To investigate the use of contraceptives among postpartum women in the urban areas of Shanghai and to understand women's demands and utilization of contraceptive service.Methods:A cross-sectional survey was conducted using questionnaires in postpartum women in the clinics for 42-day postpartum follow-up and child health care in 4 districts in Shanghai (including Changning District, Jingan District, Putuo District and Yangpu District) from August 2019 to December 2019. Data were analyzed using frequency description and logistic regression.Results:In total, 1170 postpartum women were enrolled. Among them, 420 women resumed sexual intercourse at an average length of (3.6±1.5) months postpartum and the proportions of consistent contraceptive use were 69.4%(43/62), 77.2% (186/241), 79.2% (57/72) and 71.1% (32/45), at periods of 1 to 3 months, 4 to 6 months, 7 to 9 months and 10 to 12 months after delivery respectively. Planned pregnancy, willingness to reproduce, and postpartum contraceptive guidance were associated with contraceptive behavior. Condom was the main approach used by postpartum women, while long-acting reversible contraceptive method was seldom used. The proportion of receiving guidance on contraception during postpartum home visits and 42-day postpartum follow-up were 43.3% (395/913) and 34.6% (369/1067) respectively. Totally, 37.6% (420/1117) of the total considered that the best time for contraceptive health education was at the 42-day postpartum follow-up, while 30.5% (341/1117) of them preferred health education during pregnancy.Conclusion:About one-quarter of postpartum women do not adhere to contraception in the urban areas of Shanghai. The proportion of using long-acting reversible contraceptive methods, such as intrauterine devices and subcutaneous, remains low. It is necessary to strengthen postpartum contraceptive services, to provide professional training, and strengthen guidance on the proper selection and use of contraceptive methods, especially for long-acting contraceptive methods. Meanwhile, the guidance for contraception should be advanced during pregnancy.

Background::China incurs an extremely low treatment coverage of multidrug-resistant tuberculosis (MDR-TB). This study aimed to understand the experience of MDR-TB patients on quality of health care, and the clinical impact through an up to six-year follow-up.Methods::Cohorts of MDR-TB patients were built in TB/MDR-TB designated hospitals in four regions of China from 2014 to 2015. Patients were followed up during treatment course, and yearly confirmation afterward until 2019. Delay in MDR-TB diagnosis and treatment was calculated upon bacteriological confirmation and treatment initiation. Risk factors for unfavourable outcomes were identified by multivariate logistic regression.Results::Among 1168 bacteriological-positive TB patients identified from a 12-million population, 58 (5.0%) MDR-TB cases were detected. The median delay for MDR-TB diagnosis was 90.0 days, with 13.8% having a delay above 180.0 days. MDR-TB treatment was only recommended to 19 (32.8%) participants, while the rest continued with regimen for drug-susceptible TB. In MDR-TB treatment group, 36.8% achieved treatment success, while the others had incomplete treatment (21.1%), loss to follow-up (36.8%) and TB relapse (5.3%). For non-MDR-TB treatment group, 33.3% succeeded, 25.6% relapsed, 2.6% failed, 23.1% died, and 15.4% were lost to follow-up. Overall, only 35.7% (20/56) of detected MDR-TB patients had favourable outcomes and higher education level was positively associated with it (adjusted odds ratio [a OR]: 3.60, 95% confidence interval [ CI]: 1.04-12.5). Conclusions::A large proportion of patients did not receive MDR-TB treatment and had unfavourable outcomes. Delayed MDR-TB diagnosis resulted in poor quality of MDR-TB care. Rapid diagnosis, regulated patient management and high-quality MDR-TB treatment should be enhanced in China.

Objectives: Numerous studies investigate the advantages of rapid molecular drug susceptibility testing (DST) in comparison to phenotypic DST, but the clinical impact on treating multi/extensively drug resistant TB(M/XDR-TB) is less studied. Therefore, we examined how molecular DST testing may improve MDR-TB treatment management and outcome in Chinese settings. Methods: We performed a comparative study of patient cohorts before and after the implementation of molecular DST diagnosis with Genotype MTBDRsl/MTBDRplus assay in two Chinese hospitals. We collected clinical information including time to sputum culture conversion and final treatment outcome. Results: In total, 242 MDR-TB patients were studied including 114 before (pre-implementation group) and 128 after the implementation (post-implementation group) of molecular DST. Time to MDR-TB diagnosis was significantly reduced for patients in the post-implementation group, as compared to the pre-implementation group (median,16 vs 62 days; P < 0.001). Patients with early available molecular DST results had a more rapid culture conversion (aHR1.94 95% CI: 1.37-2.73; median,12 vs 24 months, respectively; P < 0.001) and higher rate of treatment success (68% vs 47%, P < 0.01). Conclusions: The use of molecular DST in routine care for MDR-TB diagnosis as compared to phenotypic DST was associated with a decreased time to culture conversion and improved treatment outcome, highlighting its important clinical value.

Abstract The authors have removed this preprint from Research Square.

Objective: To assess the health status and health service utilization of children born to syphilis infected mothers during pregnancy, in order to prevent mother-to-child transmission of syphilis to the newborns. Methods: Women with maternal syphilis were studied by trained researchers via phone calls, in Shanghai during 2014-2015. Data related to demographics, status of infection and health care, utilization by both mothers and their children were collected through specifically designed questionnaires. Non-parametric tests including chi-square were used to assess the health status and health service utilization of children born to mothers with different demographic and socioeconomic characteristics. Results: A total of 495 children born to mothers with maternal syphilis were recruited from 1 000 syphilis infected parturient women. A total of 61 out of the 495 children were diagnosed as having congenital syphilis (57 children were diagnosed at birth and another 4 were diagnosed during the follow-up period). Children born to women who received syphilis treatment during pregnancy were at lower risk on congenital syphilis (χ(2)=7.214, P=0.027). 37.8% of the children were reported to have had different illnesses in the past three months, mainly involving upper respiratory infections (32.3%) or diarrhea (3.6%). Children diagnosed with congenital syphilis showed a higher prevalence of different kinds of diseases, compared to those without congenital syphilis (47.5% vs. 36.6%). 81.6% of the children had received regular child health care services. Subjects with the following factors as: being immigrant, with lower education, unemployed, unmarried and multipara, were related to the less use of regular child healthcare services. Only 39.7% of the parents would inform the care-takers about the risk of congenital syphilis infection of their own children at the child health care centers. Mothers with residency of Shanghai, having higher education level and employed, were less willing to inform doctors about the risk of congenital syphilis infection of their children. Conclusions: Loss to follow-up among children born to syphilis infected pregnant women remained a serious problem. Few parents would be willing to inform the healthcare takers that their children are at risk of syphilis, when receiving child health care services at the centers. It was necessary to integrate the congenital syphilis follow-up programs into the routine child care services so as to timely diagnose and treat the patients with congenital syphilis.

目的 调查江苏省徐州市和江西省赣州市耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者的纳入治疗现状,分析患者拒绝治疗的原因,为提高患者纳入治疗率提供科学依据.方法 选择江苏省徐州市和江西省赣州市作为研究现场,对MDR-TB管理信息库以及实验室数据库进行合并、清理后,对匹配成功的MDR-TB患者进行电话随访,主要调查内容包括:患者目前存活情况、拒绝治疗的原因、患者目前的家庭经济状况.采用定性访谈方式,对医务人员和患者进行深入访谈,了解MDR-TB患者拒绝治疗的原因.结果 2011-2017年徐州市和赣州市共有MDR-TB患者474例,其中纳入治疗360例,总体纳入治疗率75.95％.全球基金项目期间患者纳入治疗率为82.97％,高于项目结束后69.39％,差异有统计学意义(x2 =11.953,P=0.001);多因素分析结果显示,项目实施期间,随着年龄增加(OR=1.08,P=0.002)患者未纳入治疗的可能性增加;全球基金项目结束后,高龄(OR=1.03,P=0.011)、家庭经济状况差(OR=2.28,P=0.035)和新发患者(OR=2.93,P=0.006)未纳入治疗的比例较高.MDR-TB患者拒绝治疗的原因主要是经济困难和主观拒绝,如对结核病认知不够、不信任医生、交通等原因.结论 徐州市和赣州市MDR-TB患者纳入治疗率较高,但全球基金项目结束后,纳入治疗率有所下降.经济负担重、对结核病认知不足、不信任医生、交通等原因影响MDR-TB患者接受治疗.

Heavy metals and microcystins commonly co-exist in water bodies with cyanobacteria, and have been shown to affect aquatic plants. However, their combined effects remain largely unknown. In this study, the toxic effects of copper (Cu) and cadmium (Cd) on Ceratophyllum demersum L. were characterized in the presence of microcystin-LR (MC-LR). The results showed that the bioaccumulation of MC-LR and Cu/Cd in C. demersum was significantly increased by the interaction between MC-LR and Cu/Cd. The combined toxicity assessment results suggested that the toxicities of Cu or Cd to C. demersum would be largely exacerbated by MC-LR, which could be the results of increased bioaccumulation of the pollutants. Cu, Cd and MC-LR, as well as their mixture, significantly decreased plant fresh weight and total chlorophyll content of C. demersum, especially at their high concentrations. The antioxidative system was activated to cope with the adverse effects of oxidative stress. Antioxidant enzyme activities were significantly stimulated by Cu, Cd and MC-LR, as well as their mixture. However, the decreased superoxide dismutase (SOD) and glutathione reductase (GR) activities were observed when exposed to relative high concentrations of Cu or Cd together with MC-LR of 5 mu g L-1. MC-LR brought more stress to the antioxidative system, which is another possible explanation for the synergistic effect. Our findings highlight increased ecological risks of the co-contamination of heavy metals and harmful cyanobacteria.

土壤-作物系统中微囊藻毒素的生物富集会对人类健康造成潜在威胁.本研究通过生菜(Lactuca sativa L.var.ramosa Hort.)种植实验比较了土壤添加不同比例的3种粘土矿物(凹凸棒石、蒙脱石和沸石)对微囊藻毒素-LR(microcystin-LR,MC-LR)生物富集的影响,分析含10μg·L-1 MC-LR溶液灌溉土壤50 d后,不同处理的MC-LR在生菜中累积量及土壤中的有效态含量和总含量.结果表明,3种粘土矿物能够不同程度有效减少MC-LR在生菜根系和叶片中的富集.5％的凹凸棒石和蒙脱石处理的生菜叶片中MC-LR含量分别较空白处理降低53.0％和52.3％,使得摄入量降低到WHO组织要求的日允许摄入限量范围.添加粘土矿物显著降低了土壤中MC-LR有效态含量.相关分析发现,生菜根系和叶片中MC-LR的含量与土壤MC-LR有效态含量均呈显著正相关.实验结果为蓝藻污染地区削减微囊藻毒素的作物富集提供了科学依据.

通过向土壤中添加水稻秸秆生物质碳(RSB)、玉米秸秆生物质碳(MSB)和鸡粪生物炭(CMB)来减少微囊藻毒素-LR(MC-LR)在生菜中的富集.结果表明,RSB、MSB和CMB在添加量为2％时,生菜叶片中MC-LR含量较空白分别降低了58.0％、49.5％和70.4％,使得每日估计摄入量降低到WHO的每日允许摄入量限值以下.CMB显著降低了土壤中MC-LR的总含量,而其他处理则无显著影响.3种生物质碳均显著降低了有效态MC-LR含量,且生菜根系和叶片中MC-LR的含量与土壤MC-LR有效态含量均呈显著正相关关系,所有添加生物质碳处理均对生菜生长无负面影响.

BACKGROUND:The incidence of lung cancer is reported as age dependent. However, the link between survival and age at diagnosis remains controversial. To date, few studies have examined the relationship between age and the clinicopathologic characteristics of patients with non-small cell lung cancer (NSCLC).METHODS:Using the Surveillance, Epidemiology, and End Results (SEER) database, we included in our analysis 151,919 patients diagnosed with NSCLC between 2004 and 2013. Logistic regression was used to evaluate the associations between age and clinicopathological characteristics. N and M stages were separately assessed in each T stage.RESULTS:Of the patients enrolled, 60,271 patients were diagnosed at the M1 stage, 147,263 patients had lymph node metastasis, and 49,862 patients underwent surgery. Younger age was inversely associated with high N stage and M stage (P<0.001, respectively). For each T stage, the inverse associations with M1 stage and lymph node metastasis were also presented (P<0.001, respectively). Age was an independent risk predictor for NSCLC patients by using univariate and multivariate analyses.CONCLUSIONS:Age at diagnosis is a heterogeneous factor for NSCLC patients: younger patients have an increased risk of lymph node and distant metastases, yet have a better prognosis.

This study aimed to validate the epidemiological significance and temporal stability of Mycobacterial Interspersed Repetitive Units -Variable Number of Tandem Repeats (MIRU-VNTR) typing in a genetically and geographically diverse set of clinical isolates from patients diagnosed with pulmonary tuberculosis in China. Between 2010 and 2013, a total of 982 Mycobacterium tuberculosis isolates were collected from four population -based investigations in China. Apart from the currently applied 24 -locus MIRU-VNTR, six additional hypervariable loci were analyzed in order to validate the MIRU-VNTR combinations in terms of their epidemiological links, clustering time span, and paired geographic distance. In vitro temporal stability was analyzed for both individual MIRU-VNTR loci, and for several combinations of loci. In the present study, four MIRU-VNTR combinations, including the hypervariable loci 3820, 3232, 2163a, and 4120, were evaluated. All of these combinations obtained a Hunter -Gaston discriminatory index (HGDI) value over 0.9900 with a reduced clustering proportion (from 32.0% to 25.6%). By comparing epidemiological links, clustering time span, and paired geographic distance, we found that the performances of the four MIRU-VNTR combinations were comparable to the insertion sequence 6110 restriction fragment length polymorphism (IS6110-RFLP), and significantly better than that of 24 -locus MIRU-VNTR genotyping alone. The proportion of temporally stable loci ranged from 90.5% to 92.5% within the combined MIRU-VNTR genotyping, which is higher than IS6110-RFLP (85.4%). By adding four hypervariable loci to the standard 24 -locus MIRU-VNTR genotyping, we obtained a high discriminatory power, stability and epidemiological significance. This algorithm could therefore be used to improve tuberculosis transmission surveillance and outbreak investigation in China.