Study Shows Higher Rate of Unruptured Cerebral Aneurysm.

A large survey of adult residents of China has determined that the prevalence of unruptured cerebral aneurysms (UCAs) is 7%, that UCAs increase with age, and that they seem to be more common in women.

This prevalence rate is higher than in previous research, in some cases more than twice as high, probably at least in part because researchers used high-resolution magnetic resonance angiography (MRA) to detect UCAs, said lead author Ming-Hua Li, MD, PhD, professor and chairman of Neuro-radiology, Shanghai Jiao Tong University, China.

Of these, though, only about 8.7% were judged to be at any imminent risk for rupture, they note.

The study was published in the October 15 issue of the Annals of Internal Medicine.

High Diagnostic Accuracy

This new analysis included 4813 residents aged 35 to 75 years from 2 Shanghai districts: Changning, an economically well-developed urban area, and Zhabei, a less developed suburban area. This age group represents the range that is most clinically significant in terms of screening, said Dr. Li. Those younger than 35 years are less likely to have UCAs and those older than 75 have a shorter life expectancy, he said.

Participants completed a standard questionnaire to provide demographic information, personal and family medical history, and lifestyle risk factors, and they underwent a physical examination.

The researchers used 3-dimensional (3D) time-of-flight MRA with a voxel size of less than 0.7 mm. To evaluate UCAs, they applied 3D volume rendering and single artery highlighting. This imaging modality was proven in a previous study by the same research group to have very high diagnostic accuracy for detecting intracranial aneurysms compared with 3D digital subtraction angiography (DSA), said Dr. Li.

In the current study, 3 radiologists who were blinded to participants’ information determined the location and size of the UCAs.

UCAs were defined as abnormal focal dilatations of a cerebral artery with attenuation of the vessel wall or an infundibulum in patients without a history of subarachnoid hemorrhage (SAH). Aneurysms were categorized as less than 3 mm, 3 mm to less than 5 mm, 5 mm to less than 10 mm, or 10 mm or more.

The survey excluded UCAs with a diameter of less than 2 mm because, as Dr. Li explained, aneurysms with such a small diameter are difficult to diagnose with the spatial resolution of the imaging modality used.

Aneurysm Sites

Aneurysms were morphologically classified as regular (saccular), irregular (lobular), or fusiform. Sites were classified as internal carotid artery (including the posterior communicating artery), anterior cerebral artery (including the anterior communicating artery), middle cerebral artery (including the MI-2 bifurcation), and vertebrobasilar artery.

The researchers found that 130 men and 206 women had UCAs, with excellent interobserver agreement. The prevalence of UCAs was 7.0% (95% confidence interval, 6.3% to 7.7%).

This is a higher prevalence than in other studies, probably because the researchers used 3D high-resolution MRA, which enabled them to detect small UCAs, Dr. Li speculated. “Those small UCAs could possibly be missed on 2D invasive angiography due to overlapping,” he said. “In addition, we excluded volunteers younger than 35, who are less likely to have UCAs. This could potentially lead to higher prevalence in our survey compared to studies with a wider age range.”

The prevalence of unruptured UCAs in North America is still unknown, said Dr. Li.

The prevalence was higher in women (8.6%) than in men (5.5%) (P < .001). “We hypothesized that decreases in estrogen concentration and estrogen-receptor density may contribute to an increased risk of cerebral aneurysm development in women,” said Dr. Li.

The prevalence of UCAs increased with age and peaked at ages 55 to 64 years in both men and women. This, said Dr. Li, is in line with a meta-analysis published in Lancet Neurology in 2011.

The majority (90.2%) of the UCAs were less than 5 mm in diameter. The mean maximum diameter of the aneurysm sac was 3.5 mm, and the diameter was larger in women.

Most aneurysms (81%) were located in the internal carotid artery (ICA), with more than half (53.9%) in the C5–C6 segments of the ICA. A possible explanation for this, said the authors, is that the study excluded ruptured aneurysms, which are most often located in the anterior or posterior communicating arteries. In addition, the MRA technology allowed for visualization of more UCAs in the siphon segment of the internal carotid artery.

The researchers found that 8.7% of the detected lesions were potentially risky in that they were large, lobulated aneurysms or grew during follow-up and so may have been prone to rupture.

The patients with these aneurysms potentially in danger of rupture are being followed closely, said Dr. Li. “We currently follow up those patients annually by 3D MRA if the lesions remain stable — so no growth or daughter-sac formation. If lesion growth is detected at follow-up, we suggest further treatment accordingly.”

The study did not show an association between the prevalence of aneurysms and hypertension or cardiovascular disease. This was a cross-sectional study that mainly focused on the prevalence of UCAs, explained Dr. Li, adding that the association between risk factors such as hypertension and cardiovascular disease and development of UCAs in Chinese adults needs to be explored in other longitudinal studies.

The findings may not apply to the general population or to populations outside of China, said the authors.

No Higher

R. Loch Macdonald, MD, PhD, Keenan Endowed Chair in Surgery and head, Division of Neurosurgery, St. Michael’s Hospital, and professor of surgery, University of Toronto, Ontario, Canada, who has a special research interest in cerebral aneurysms, doesn’t believe that the prevalence of aneurysms is any higher in China than elsewhere in the world.

“I suspect they are not more common compared to other geographic regions and ethnicities or races and that the difference is due to a selected older population and more sensitive screening test,” used in the current study, said Dr. Macdonald when approached by Medscape Medical News for a comment.

He pointed to a previously published meta-analysis that found 3% of the population harbored an aneurysm, adjusted to a population with a mean age of 50 years that was 50% male, and expanded on why the numbers in the current study might be much higher.

“They may have found a higher incidence due to inclusion of only patients aged 35 to 75 years,” he added. “Second, the distribution of aneurysms includes many more very small proximal carotid aneurysms. These may not have been diagnosed as frequently before by other methods, so this new screening study may have detected more due to increased sensitivity of the screening method.”

Li-Fi to replace Wi-Fi in China?

Chinese scientists have successfully developed a new cheaper way of getting connected to internet by using signals sent through light bulbs instead of radio frequencies as in Wi-Fi, a move expected to radically change process of online connectivity.

Four computers can be connected to internet through one- watt LED bulb using light as a carrier instead of traditional radio frequencies, as in Wi-Fi, said Chi Nan, an information technology professor with Shanghai‘s Fudan University.

Under the new discovery dubbed as ‘Li-Fi‘, a light bulb with embedded microchips can produce data rates as fast as 150 megabits per second, which is speedier than the average broadband connection in China, said Chi, who leads a Li-Fi research team including scientists from the Shanghai Institute of Technical Physics of the Chinese Academy of Sciences.

The term Li-Fi was coined by Harald Haas from the University of Edinburgh in the UK and refers to a type of visible light communication technology that delivers a networked, mobile, high-speed communication solution in a similar manner as Wi-Fi.

With Li-Fi cost-effective as well as efficient, netizens should be excited to view 10 sample Li-Fi kits that will be on display at the China International Industry Fair that will kick off on November 5 in Shanghai.

The current wireless signal transmission equipment is expensive and low in efficiency, Chi said.

“As for cell phones, millions of base stations have been established around the world to strengthen the signal but most of the energy is consumed on their cooling systems,” she said.

“The energy utilisation rate is only 5 per cent,” state-run Xinhua news agency quoted her as saying.

Li-Fi was touted as a boon to China netizen community, the highest in the world with about 600 million connections.

Compared with base stations, the number of light bulbs that can be used is practically limitless.

Meanwhile, Chinese people are replacing the old-fashioned incandescent bulbs with LED light bulbs at a fast pace.

“Wherever there is an LED light bulb, there is an internet signal. Turn off the light and there is no signal,” Chi said.

However, there is still a long way to go to make Li-Fi a commercial success.

“If the light is blocked, then the signal will be cut off,” Chi said.

More importantly, according to the scientist, the development of a series of key related pieces of technology, including light communication controls as well as microchip design and manufacturing, is still in an experimental period.

TIP30 Inhibits Lung Cancer Metastasis, Study Suggests. Researchers in Shanghai, China suggest that TIP30 prevents metastatic progression of lung cancer.

Researchers in Shanghai, China suggest that TIP30 prevents metastatic progression of lung cancer.

They report these findings in the May 2009 issue of The American Journal of Pathology.

TIP30 is a putative tumor suppressor with decreased expression in numerous cancers including melanoma, breast cancer, and colon cancer. Lung cancer is the most common cancer worldwide, both in terms of incidence and of mortality.

To determine if TIP30 plays a role in lung cancer progression and metastasis, Tong et al examined TIP30 expression in paired cancerous and non-cancerous lung tissue. TIP30 expression was decreased in a third of non-small cell lung cancers compared with normal controls, and reduced TIP30 expression correlated with lymph node metastasis. In addition, inhibition of TIP30 expression promoted lung cancer metastasis and angiogenesis in mice,

Tong et al conclude that “TIP30 may function as a tumor suppressor gene and play important roles in suppressing the progression and metastasis of lung cancer.” These findings highlight TIP30 as a potential new therapeutic for metastatic lung cancer.

They report these findings in the May 2009 issue of The American Journal of Pathology.

TIP30 is a putative tumor suppressor with decreased expression in numerous cancers including melanoma, breast cancer, and colon cancer. Lung cancer is the most common cancer worldwide, both in terms of incidence and of mortality.

To determine if TIP30 plays a role in lung cancer progression and metastasis, Tong et al examined TIP30 expression in paired cancerous and non-cancerous lung tissue. TIP30 expression was decreased in a third of non-small cell lung cancers compared with normal controls, and reduced TIP30 expression correlated with lymph node metastasis. In addition, inhibition of TIP30 expression promoted lung cancer metastasis and angiogenesis in mice,

Tong et al conclude that “TIP30 may function as a tumor suppressor gene and play important roles in suppressing the progression and metastasis of lung cancer.” These findings highlight TIP30 as a potential new therapeutic for metastatic lung cancer.



H7N9 Seems to Readily Develop Resistance to Neuraminidase Inhibitors.

The novel influenza A virus H7N9 has shown a “concerning” ability to develop resistance to neuraminidase inhibitors such as Tamiflu (oseltamivir) and Relenza (zanamivir), according to a Lancet study.

Researchers studied 14 patients admitted to a Shanghai hospital with H7N9 influenza. In tracking patients’ viral loads, they noted that two showed persistently high loads after starting neuraminidase inhibitors. Both had also received steroid treatment. A mutation in the virus’s neuraminidase gene was associated with persistent high viral loads and poor clinical outcome.

The researchers wonder what, if any, role the steroid therapy had in the emergence of resistance. They advise early treatment with neuraminidase inhibitors.

Meanwhile, China has reported no new H7N9 cases for 2 weeks. The case count now stands at 131, with 32 deaths.

Source: Lancet

Tobacco smoke biomarkers and cancer risk among male smokers in the Shanghai Cohort Study.

Tobacco smoke constituent metabolites are established biomarkers of cigarette smoke exposure. ► This paper demonstrates that some of these metabolites are also biomarkers of cancer risk in male smokers from Shanghai. ► The biomarkers of cancer risk are total cotinine, total NNAL, PheT, and total NNN.


Metabolites of tobacco smoke constituents can be quantified in urine and other body fluids providing a realistic measure of carcinogen and toxicant dose in a smoker. Many previous studies have demonstrated that these metabolites – referred to as biomarkers in this paper – are related to tobacco smoke exposure. The studies reviewed here were designed to answer another question: are these substances also biomarkers of cancer risk? Using a prospective study design comparing biomarker levels in cancer cases and controls, all of whom were smokers, the results demonstrate that several of these biomarkers – total cotinine, total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), r-1-,t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene (PheT), and total N′-nitrosonornicotine (NNN) – are biomarkers of cancer risk. Therefore, these biomarkers have the potential to become part of a cancer risk prediction algorithm for smokers.


Source: cancer letters




Emerging risk of H7N9 influenza in China.


4 years after the global pandemic of H1N1 influenza, a new type of avian influenza, H7N9, is emerging in mainland China. It was first reported in Shanghai on Feb 19, 2013. As of April 17, 2013, a total of 77 cases of H7N9 human infection have been confirmed, including 16 deaths. 30 cases, including 11 deaths, have been confirmed in Shanghai; 20 cases, including two deaths, in Jiangsu province; 21 cases, including two deaths, in Zhejiang province; three cases, including one death, in Anhui province; one case in Beijing; and two cases in Henan province.12

The H7N9 virus is a new influenza virus subtype, and it has not been included in the statutory infectious disease surveillance reporting system of China. No vaccine has been launched yet. The source of H7N9 human infections is unclear, but based on past experience and epidemiological investigation, H7N9 virus might be carried by poultry, in their secretions or excretions. About 40% of the patients have not been in contact with poultry before. China’s official media, quoting Gregory Hartl (a WHO spokeperson), stated that although transmission of H7N9 virus between human beings has not been reported yet, there is a risk that mutations in the virus could ease the spread. Moreover, men who are smokers are a susceptible group because of their pulmonary dysfunction associated with smoking.3

The incubation period of the H7N9 virus is generally less than 7 days. Patients usually present with flu-like symptoms, such as fever, and cough with little phlegm, which can be accompanied by headache, muscle aches, and general malaise. Patients with severe progression of the disease manifest severe pneumonia, with body temperature over 39°C and difficulty breathing. The disease can progress rapidly, accompanied by acute respiratory distress syndrome, mediastinal emphysema, septic shock, disturbance of consciousness, and acute kidney injury.

H7N9 virus has attracted much attention. Chinese officials have actively responded to the infection, and introduced prevention and control measures. Shanghai, Nanjing, and some other places have suspended live poultry transactions and prohibited the entry of exotic live poultry. However, it is still a great challenge for the Chinese Government to control the infection. Unlike the SARS (severe acute respiratory syndrome) epidemic 10 years ago, H7N9 virus does not show signs of human-to-human transmission, and isolation of patients would not limit the transmission. Immediate culling of infected poultry is an effective measure. But more efforts must be made to prevent further spread of the infection.

Source: lancet

Why Chinese Couples Are Divorcing Before Buying a Home.

Long queues of happy couples waiting to get married might be a common sight in Las Vegas. But lines of happily married couples waiting to get divorced? Only in China.

In major cities across the country last month, thousands of couples rushed to their local divorce registry office to dissolve their marriages in order to benefit from fast-expiring tax breaks on property investments for unmarried individuals. Local media reported long waits at registries in Beijing, Shanghai, Guangzhou and elsewhere as savvy investors sought to buy or sell a second home before the government introduced strict new regulations that would force married homeowners to pay hefty taxes on the sale of second properties.

The new regulations are designed to cool speculation in China’s feverish property market and are part of a package of measures that would require couples to pay up to 20% capital gains tax on the sale of second homes. But for determined investors, nothing gets in the way of a good bargain, and some quickly noticed that the 20% impost didn’t apply if the second home was bought before the couple were married — or after they got divorced.

China’s marriage law allows for divorce if couples simply sign an agreement to divorce, present themselves at the registry office and pay a fee of just $1.50. Weighed against the prospect of tens or even hundreds of thousands of dollars of profit from property investments, many couples are deciding the $1.50 charge is worth it.

According to media reports, in March the number of couples getting divorced in Tianjin, a large city on the eastern seaboard, soared to 300 per day — more than triple the normal amount. In Beijing, too, realtors reported a boom in divorcing couples seeking out new houses. “Half of the deals I made last month were cases where the couples were getting divorced,” a Mr. Jin, who works as an agent at one of the biggest realtors in Beijing, tells TIME. “These were all young couples between 25 and 35 years old, and all of them were looking to buy another house as an investment.”

As an emerging middle class accumulates wealth, more and more young families are finding that they have limited options to make good use of their money. With overseas investment options closed off by complex regulatory barriers, banks offering measly interest-rate returns on deposits and the stock markets on a never ending losing streak, there aren’t many attractive investment choices.

Some choose to invest in gold and other precious metals. Indeed, when gold prices fell sharply last week, shops in mainland China and Hong Kong quickly reported stock shortages and empty shelves. But China’s savvy purchasers have long had an affinity for putting their money into bricks and mortar, not least because property prices in most cities have soared over the past decade and continue to rise sharply.

With a seemingly endless supply of money flowing into the country’s property sector, and prices on a constant upward trajectory, regulators have long been worried about the frothy market giving rise to major property bubbles, especially in the most populous cities like Beijing and Shanghai. But it seems that canny investors are quick to spot ways around the cooling measures, hence the new vogue for divorce.

It’s not only profiteers who are choosing the divorce route. Many couples who simply want to trade up from their current home have realized that they can save tens of thousands of dollars by splitting up before making their next purchase. According to media reports, one couple in the southern city of Guangzhou, who already owned two apartments, saved $32,000 by getting divorced and selling one of their houses before buying another.

The divorce solution is extreme but it’s the kind of solution to which China’s put-upon middle classes have become accustomed. Civil-servant couples, for example, are subject to a particularly strict version of the one-child policy that would require them to give up their jobs if they had a second child. Some have decided to circumvent those rules by getting divorced and having a second child out of wedlock, registered under either parent’s name as a “first” child.

Of course, the country’s regulators have also taken notice of the long queues outside divorce registries and have acted to put a stop to the practice. In recent weeks, the government revised its regulations to increase the taxes payable by unmarried individuals selling a secondhand property, effectively cutting the most speculative investors out of the market.

Others, though, are still happy to break the knot, if only because they need not stay divorced for long. Realtor Jin advises his clients who are considering the process that they can be back in happy matrimonial bliss within as little as three weeks. “If you pay the full price in cash up front, the whole transaction can be completed in as little as 10 days — and even if you’re taking out a mortgage, it only takes about six weeks,” Jin says. “Once that’s done, you can go and get remarried right away.”



Novel Avian-Origin Influenza A (H7N9) Virus in China.

130418094043-china-bird-flu-0418-horizontal-galleryTesting of throat-swab specimens from three patients who died of severe lower respiratory tract disease revealed infection with a novel reassortant H7N9 virus.


Because of the morbidity and mortality associated with H5N1 influenza, avian influenza virus infection in humans has garnered considerable attention. Now, investigators describe the clinical profile of three patients in China who died from complications of severe lower respiratory tract disease caused by a novel reassortant avian-origin influenza A (H7N9) virus.

Two of the patients (one residing in Shanghai, the other in Anhui Province) had been present at a chicken market within 7 days of illness onset; the third (also from Shanghai) had no known exposure to live birds within the preceding 2 weeks. All three patients had “high” fever, cough, and dyspnea, and all of them developed acute respiratory distress syndrome. All also had leukopenia, lymphocytopenia, and ground-glass opacities and consolidation on chest radiography, and two of them manifested rhabdomyolysis. Two patients died within 10 days of hospital admission, and the third one within 20 days.

Throat-swab specimens obtained from the patients were subjected to viral propagation in pathogen-free embryonated chicken eggs and RNA extraction. Real-time reverse-transcriptase polymerase chain reaction, genome sequencing, and phylogenetic analysis revealed that all three patients had been infected with a novel avian-origin influenza A (H7N9) virus.

Comment: On the basis of the findings from these patients, diagnostic tests for the novel reassortant H7N9 viruses have been developed. Public health officials around the world continue to closely monitor this outbreak, which serves as a reminder of influenza viruses’ unique capacity to evolve and cause respiratory tract infections in humans.

Source: Journal Watch Infectious Diseases

DW-MRI: identifying lymph node metastases.

Diffusion-weighted MRI (DW-MRI) is showing particular promise in aiding the identification of lymph node metastases, according to several recently published studies.

In a review paper published in the journal Radiology earlier this year, specialists summarized data on DW-MRI in the head and neck. This included a detailed section on nodal metastases, noting that “the general consensus appears to be that ADCs [apparent diffusion coefficients] of malignant nodes are significantly lower than those of benign nodes”.

In one study there was a clear lack of any overlap between the higher ADCs of benign lesions and the lower ADCs of malignant lesions. However, the variety of head and neck lesions that can occur means it is often impractical to establish a single ADC threshold for distinguishing between benign and malignant lesions.

The specialists wrote: “Although these results show the potential of DW imaging for characterization of head and neck lesions, given the heterogenous group of benign and malignant lesions that arise in the head and neck, there will clearly be exceptions and overlap in ADC results.” Future research should include the establishment of ADC thresholds for specific sites and for specific pathologic processes , they argued.1

Meta-analysis: squamous cell carcinoma
Meanwhile, the diagnostic accuracy of standard and DW-MRI in detecting lymph node metastases in patients with head and neck squamous cell carcinoma (HNSCC) was the subject of a meta-analysis recently published in the journal Academic Radiology.

Using data from 16 studies, the researchers in Shanghai, China, calculated that the sensitivity and specificity of standard MRI for determining cervical lymph node status were 76% and 86% respectively. MRI was similar to other diagnostic tools such as PET, CT, and ultrasound, in terms of performance, they added.

A subgroup analysis, however, showed that DW-MRI had a significantly higher sensitivity (86%) than standard MRI. The researchers noted that more data are needed, concluding: “A limited number of small studies suggest DW imaging is superior to conventional imaging for nodal staging of HNSCC”.2

Prospective study in breast cancer
Finally, in the October issue of the Journal of Magnetic Resonance Imaging, specialists reported the findings of a prospective study of the accuracy of DW-MRI in distinguishing between metastatic and benign axillary lymph nodes in patients with breast cancer.

The researchers compared two groups, divided according to histology findings: 19 lymph nodes with a metastasis at least 5 mm in diameter and 24 lymph nodes with no malignant cells (nodes with metastases smaller than 5 mm were excluded from the study).

Overall, the ADC values were significantly lower for the lymph nodes with metastases, compared with the benign lymph nodes (p < 0.001). The researchers identified a threshold for ADC values that resulted in a high sensitivity, specificity, and accuracy (94.7%, 91.7%, and 93%, respectively) for this series of patients.

They concluded: “From these preliminary data, DW imaging seems a promising method in the differential diagnosis between metastatic and benign axillary lymph nodes in patients with breast cancer.”3

1. Thoeny HC, et al. Radiology. 2012;263:19-32.
2. Wu LM, et al. Acad Radiol. 2012;19:331-40.
3. Fornasa F, et al. J Magn Reson Imaging. 2012;36:858-64.



C-reactive protein (CRP) gene polymorphisms, CRP levels and risk of incident essential hypertension: findings from an observational cohort of Han Chinese.

C-reactive protein (CRP), an acute phase reactant and marker of inflammation, has been shown to be associated with CRP genetic variants and incident hypertension, but it is unclear whether this link is causal. We therefore conducted a prospective, nested case–control study to examine the relationship between single-nucleotide polymorphisms (SNPs) within the CRP gene, circulating CRP levels and the development of hypertension. Plasma CRP levels and the genotypes of eight SNPs were determined in 2000 unrelated Shanghai residents, including 908 hypertensive individuals and 1092 normotensive individuals. Among the 1092 normotensives, 968 subjects were followed up for 2 years, during which 71 developed hypertension. Plasma CRP levels were independently associated with the development of hypertension in the follow-up study (odds ratio per quartile=1.64; 95% confidence interval: 1.18–2.26; P<0.001). The minor alleles of rs1130864 (P<0.001) and rs3093059 (P<0.001) were significantly associated with elevated CRP levels, and the minor alleles of rs1205, rs1800947 and rs2246469 (all P<0.001) were associated with decreased CRP levels. A haplotype-based analysis strengthened the results of single-locus analysis. However, none of the SNPs or haplotypes was significantly associated with blood pressure, incident hypertension or changes between baseline and follow-up blood pressure levels. Taken together, our findings demonstrated that plasma CRP levels were substantially associated with common genetic variants in the CRP gene and could predict the development of hypertension. However, the relationship between genotype and CRP levels was not associated with a change in hypertension risk.

Source: Hypertension Research/nature.