Journal articles on the topic 'Événement 7.15 au Xinjiang'

We assessed trends in physical fitness by age group and nutrition status among children and adolescents in Xinjiang during 1985–2014. The data of 49,357 participants aged 7–18 were extracted in 1985, 1995, 2005, and 2014. Growth and nutritional status were defined using World Health Organization definitions. A physical fitness indicator (PFI) was calculated as the sum of six components measured in every survey. The relationship between body mass index (BMI) and PFI was investigated using nonlinear regression. Taking 1985 as a reference, PFI increased to 2 in 1995 and then fell sharply to −2.8 in 2005 and −3.8 in 2014. The prevalence of normal weight increased from 87.5% in 1985 to 89.4% in 1995 and then decreased to 75.2%, consistent with the change in PFI. The relationship between BMI and PFI showed an inverted U-shaped curve. The largest increment occurred in boys aged 13–15 and girls aged 16–18 during 1985–1995; the largest decline occurred in boys and girls aged 10–12 during 1995–2005. Our research provides a reference for local governments providing nutrition subsidies and projects in southern Xinjiang, indicating that greater attention is needed for children aged 7–12.

Grapevine leafroll disease (GLD) is one of the most economically important diseases of cultivated grapevines (Vitis vinifera), causing decrease in yield, as well as decreasing the sugar levels and increasing the acidity of the berries (1). There are currently at least 10 serologically distinct viruses, referred to as grapevine leafroll-associated viruses (GLRaVs), from the family Closteroviridae that are associated with leafroll disease (4). China is one of the world's leading grape producers, and nearly 75% of the vineyards in China are located in Xinjiang Uygur Autonomous Region, and Hebei, Shandong, Gansu, Ningxia, and Yunnan provinces. Grapevine leafroll-associated virus 7 (GLRaV-7) isolates have been reported so far in Liaoning (GQ849392, GQ849393, and JF927943) and Henan (EF093187) provinces in China (3). The four Chinese isolates were isolated respectively from grape varieties, Cabernet Sauvignon (GQ849392, GQ849393), Centennial Seedless (JF927943), and Semillon (EF093187), and these grape varieties are introduced from abroad. Cow's Nipple and Dragon's Eye are old grape varieties native to China. Cow's nipple is extensively cultivated in Xinjiang Uygur Autonomous Region, while Dragon's Eye is widely planted in Heibei Province. To determine if GLRaV-7 was present in these two varieties, six samples (three per variety) were collected from six individual grapevines showing GLD-like symptoms in two vineyards in Xinjiang Uygur Autonomous Region and Hebei Province, respectively, in September 2011. Total RNA extracts obtained from phloem scrapings of samples using the RNeasy plant mini kit (QIAGEN) were tested by reverse transcription (RT)-PCR with primers F1 (5′-TATATCCCAACGGAGATGGC-3′) and R1 (5′-ATGTTCCTCCACCAAAATCG-3′) (2) specific to the heat shock protein 70 homologue (HSP-70 gene) of GLRaV-7. All samples produced a single band of the expected size of 502 bp. One GLRaV-7-specific amplicon per variety was cloned into pMD 18-T simple vector (TaKaRa). Plasmid DNA was purified using Column Plasmid DNAOUT (TIANDZ, Beijing, China) from three individual clones and sequenced from both directions. The sequence of the two isolates (GenBank Accession Nos. JX494722 and JX494723) shared 97.81% identity at the nucleotide level and 100% identity at the amino acid level. A pairwise comparison of HSP-70 sequences of the two isolates from this report with nine corresponding sequences of GLRaV-7 isolates (including four previously reported Chinese isolates) showed nucleotide sequence identities ranging from 91.24% (EF093187) to 98.80% (GQ849392). These samples were further analyzed by double antibody sandwich (DAS)-ELISA using antibody specific to GLRaV-7 (NEOGEN Europe, Ayr, Scotland) according to the manufacturer's instructions, and the results confirmed the presence of the virus in these samples that were positive by RT-PCR. To our knowledge, this is the first report of GLRaV-7 occurring in native grape varieties in China. These results could be helpful in developing sound diagnostic systems for implementing efficient disease management strategies. References: (1) B. Akbas et al. Hort. Sci. 36:97, 2009. (2) E. Engel et al. Plant Dis. 92:1252, 2008. (3) X. Fan et al. Acta Hortic. Sinica 39:949, 2012. (4) G. P. Martelli. Extended Abstr. 16th Meet. International Council for the Study of Virus and Virus-like Diseases of Grapevines (ICVG). 15-23, 2009.

Background:Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease. Epidemiological studies in SLE have been reported in the literature in many countries and ethnic groups. Although SLE in China has been described in the past, there has not been a detailed evaluation of SLE patients in Xinjiang of China, a largely Uygur population.Objectives:To describe the clinical featuresand immunological features of 484 SLE subjects.Methods:484 adult patients followed in the The People’s Hospital of the Xinjiang Uygur Autonomous Region, 211 patients with Uygur SLE as welI as 273patients with Han SLE.Results:Of the 211 Uygur SLE patients, 195 (92.4%) were female and 16 (7.6%) were male (female:male=12.2:1),the mean age at SLE onset was 34.67±11.57 years, mean disease duration was 20.77±35.16 months.Of the 273 Han SLE patients,247(90.5%)were female and 26(9.5%) were male,the mean age at SLE onset was 36.68±14.44 years,mean disease duration was 41.64±61.89 months.(2)between the Uygur and Han SLE patients,the Raynaud phenomenon(χ2=6.066 P=0.014), Chest pain(χ2=7.906 P=0.005), headache(χ2=4.572 P=0.029)has obvious differences(table 1).(3)The anti-nuclear (χ2=8.108 P=0.004), anti-AHA (χ2=4.952 P=0.026)were higer in Uygur SLE patients than those in Han SLE patients;the Uygur SLE patients has been anemia(χ2=6.904,P=0.009), high level of immunoglobulin (χ2=8.939,P=0.003),decrease of complement(χ2=6.330 P=0.012).(table 2)figure 1. Clinical manifestationsClinical manifestationsUygur SLE patients(n=211)Han SLE (n=273)χ2Prash106(50.2%)157(57.5%)2.5370.111Photosensitivity40(19%)56(20.5%)0.1810.670Alopecia73(34.6%)101(37.0%)0.2980.585Oral ulcers49(23.2%)64(23.5%)0.0060.937Raynaud phenomenon28(13.3%)60(22%)6.0660.014livedo reticularis5(2.4%)7(2.6%)0.0200.866arthralgia/arthritis105(49.8%)159(58.5%)3.6230.057abnormal liver-function8(3.8%)7(2.6%)0.5970.440Chest pain28(13.3%)16(5.9%)7.9060.005Suffocation49(23.2%)52(19%)1.2560.262palpitation27(12.8%)41(15%)0.4870.485Shortness of breath24(11.4%)35(12.8%)0.2330.630Ophthalmia2(0.9%)6(2.2%)1.1540.283Visual impairment1(0.5%)3(1.1%)0.5670.457hemiplegia1(0.5%)0(0.0%)1.2970.436Mental disorder4(1.9%)11(4.0%)1.8040.179headache14(6.6%)7(2.6%)4.5720.029Lower Limb Edem36(17.1%)34(12.5%)2.0420.153pleurisy37(17.5%)43(15.8%)0.2560.613pericarditis38(18%)33(12.1%)3.2730.070pulmonary fibrosis7(3.3%)9(3.3%)0.0000.982figure 2. immunological manifestationsmanifestationsUygur SLE patients(n=211)Han SLE (n=273)χ2Pantinuclear antibodies185(87.7%)212(77.7%)8.1080.004anti-dsDNA115(54.5%)144(52.7%)0.1470.701anti-SSA101(47.9%)149(54.6%)2.1470.143anti-SSB45(21.3%)63(23.1%)0.2100.647anti-Sm44(21%)68(25%)1.0880.297ACL29(13.8%)26(9.5%)2.1610.142antiU1-RNP74(35.1%)100(36.6%)0.1260.723anti-AHA60(28.4%)54(19.8%)4.9520.026Low white blood cell46(22.1%)79(29%)2.9380.087anemia90(42.9%)85(36.3%)6.9040.009Thrombocytopenia36(17.1%)51(18.7%)0.2120.645Urine protein positive84(39.8%)114(41.9%)0.2170.641Rise of urine RBC29(13.7%)35(12.8%)0.0880.766Increased immunoglobulin82(38.9%)71(26.1%)8.9390.003Complement decline120(57.1%)124(45.6%)6.3300.012Conclusion:The Uygur SLE patients have their own clinical and immunological characteristics, which has guiding significance in the diagnosis, treatment and prognosis of SLE.References:[1]Martyna TS,Hanna SS, Marek F. Clinical and immunological characteristics of Polish patients with systemic lupus erythematosus. Adv Clin Exp Med. 2018;27(1):57–61[2]Maloney K C, Ferguson T S, Stewart H D, et al. Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: A comparative analysis[J]. Lupus, 2017, 26(13):961203317707828.[3]Ching K H, Burbelo P D, Christopher T, et al. Two Major Autoantibody Clusters in Systemic Lupus Erythematosus[J]. PLoS ONE, 2012, 7(2):e32001.Disclosure of Interests:None declared

Purification of produced water (PW) from polymer/surfactant flooding is a challenge for the petroleum industry due to the high emulsion stability. Demulsification using chemical demulsifiers has been expected to be an effective way to treat PW. In this paper, five cationic (branched quaternary ammonium chloride) and four nonionic (copolymer of propylene oxide and ethylene oxide) demulsifiers with different molecular weights were employed to test their respective demulsification performance in the treatment of PW from polymer/surfactant flooding. The cationic demulsifiers, in general, exhibited better performance than the nonionic ones and one cationic demulsifier (CP-1) exhibiting the best demulsification efficiency was further employed for a pilot experiment in the Xinjiang Oilfield. The oil content of PW could be successfully reduced from 128~7364 to less than 10 mg/L with a dosage of CP-1 for 350 mg/L and polyaluminum chloride (PAC, 30% w/w Al2O3) for 500 mg/L under ambient temperature (14~22 °C). At the same time, partially hydrolyzed polyacrylamide (HPAM) was removed from 176.9~177.1 to 2.8~3.9 mg/L while petroleum sulfonate was not removed too much (from 35.5~43.8 to 25.5~26.5 mg/L). The interfacial rheology analysis on simulated PW from HPAM/petroleum sulfonate flooding revealed that the addition of CP-1 led to a significant increase of the oil-water interfacial tension (from 7 to 15~20 mN/m) and zeta potential (from −32.5 to −19.7 mV). It was, thus, assumed that the decreased net charge on the dispersed oil droplets surface and weakened oil/water film due to the formation of complex between the cationic demulsifier and HPAM may have facilitated the destabilization of the emulsion. The result of this study is useful in better understanding the demulsification processes as well as selecting suitable demulsifiers in the treatment of PW from polymer/surfactant flooding.

A novel coccoid, halotolerant actinobacterium, designated strain YIM 70085T, was isolated from a soil sample that was collected in Xinjiang Province, China, and characterized by using a polyphasic approach. Optimum growth temperature was 28 °C and growth occurred optimally in culture media that contained 10 % KCl. The peptidoglycan type was A4α, l-lys–gly–l-Glu. Whole-cell sugars consisted of xylose, mannose and galactose. Phospholipids were diphosphatidylglycerol, phosphatidylglycerol, one unknown phospholipid, one unknown glycolipid and traces of phosphatidylinositol. Menaquinones were MK-8 (83 %), MK-7 (12 %) and MK-9 (15 %). Predominant fatty acids were i-C15 : 0 (44·29 %), ai-C15 : 0 (35·60 %) and ai-C17 : 0 (9·74 %). The DNA G+C content was 53·5 mol%. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain YIM 70085T occupies a branch that is distinct from, although very close to, the family Micrococcaceae in the suborder Micrococcineae. Based on its phenotypic characteristics, phylogenetic position (as determined by 16S rRNA gene sequence analysis) and 16S rDNA signature nucleotide data, it is concluded that the isolate represents a novel member of the suborder Micrococcineae, for which the name Yania halotolerans gen. nov., sp. nov. is proposed. The type strain is YIM 70085T (=CCTCC AA001023T=DSM 15476T).

ObjectiveTo describe the incidence and epidemiological characteristics of child pulmonary tuberculosis (PTB) notified to the Chinese Center for Disease Control and Prevention (CDC) Tuberculosis Information Management System (TBIMS) from 2009 to 2015.Study designA database of child PTB for 31 provinces in mainland China over 7 years was retrospectively analysed. The spatiotemporal distribution of child PTB was described.ResultsIn total, 35,710 child PTB cases were notified to the TBIMS, representing only 0.60% of all 5,991,593 PTB case notifications. The average annual notified incidence of child PTB was 2.44/ per 100,000 children (95% CI: 1.77–3.10) and decreased by 52.53% in all age groups during the study period. Tibet had the highest incidence (15.95/ per 100,000 children), followed by Guizhou and Xinjiang. However, the case numbers were the most in Guizhou. The 0-1 year and 12–14 years of age groups exhibited the most cases. The positive rates of sputum smears, bacteriology and chest X-rays abnormality were 21.5%, 21.7% and 98.1%, respectively, which were lower than those 15 years of age and older (all p-values<0.0001).ConclusionThe notified incidence of child PTB in mainland China decreased substantially over 7 years. Future prevention and control of PTB in children should focus on the 0–1 and 12–14 years of age groups, and Tibet and Guizhou provinces. However, the notified incidence is still low, relative to adults, suggesting substantial under-reporting. Thus, more effective care seeking, identification and registration of children with TB are crucial.

Human alveolar echinococcosis (AE), caused by the metacestode of the fox tapeworm Echinococcus multilocularis, is the most pathogenic zoonosis in temperate and arctic regions of the northern hemisphere. Prospective collection of human cases in some areas and mass screenings using ultrasound imaging and confirmation with serological techniques have markedly improved our knowledge of the epidemiology of the disease in humans during the past two decades. Transmission occurs when eggs of the tapeworm, excreted by the final hosts (usually foxes but also dogs, wolves and cats), are ingested accidentally by humans or during normal feeding by a variety of rodents and small lagomorphs. However, the species of host animals differ according to regional changes in mammalian fauna. This review mostly focuses on epidemiology of alveolar echinococcosis in those parts of the world where new and more accurate epidemiological data are now available, i.e. China and Europe, as well as on new epidemiological trends that can be suspected from recent case reports and/or from recent changes in animal epidemiology of E. multilocularis infection. The People's Republic of China (PRC) is a newly recognized focus on AE in Asia. Human AE cases were firstly recognized in Xinjiang Uygur Autonomous Region and Qinghai Provinces at the end of 1950s and infected animals were first reported from Ningxia in central China and north-east of Inner Mongolia in the 1980s. E. multilocularis (and human cases of AE) appears to occur in three areas: (1) Northeastern China (northeast focus): including Inner Mongolia Autonomous region and Heliongjiang Province (2) Central China (central focus): including Gansu Province, Ningxia Hui Autonomous Region, Sichuan Province, Qinghai Province and Tibet Autonomous Region and (3) Northwestern China: including Xinjiang Uygur Autonomous Region, bordered with Mongolia, Russia, Kazakhstan and Kyrgyzstan. The highest prevalence of the disease, up to 15 per cent of the population in some villages, is reached in China. In Europe, data from the European Echinococcosis Registry (EurEchinoReg: 1982–2000) show 53 autochthonous cases of AE in Austria, 3 in Belgium, 235 in France, 126 in Germany, 1 in Greece, and 112 in Switzerland, and 15 ‘imported’ cases, especially from central Asia; 14 cases were collected in Poland, a country not previously considered endemic for AE. Improved diagnostic technology, as well as a real increase in the infection rate and an extension to new areas, can explain that more than 500 cases have been reported for these 2 decades while less than 900 cases were published for the previous 7 decades. New epidemiological trends are related to an unprecedented increase in the fox population in Europe, to the unexpected development of urban foxes in Japan and in Europe, and to changes in the environmental situation in many countries worldwide due to climatic or anthropic factors which might influence the host–predator relationship in the animal reservoir and/or the behavioural characteristics of the populations in the endemic areas.

Contexte: L’incidence du carcinome épidermoïde anal a nettement augmenté au cours des dernières décennies. Il n’existe actuellement aucun traitement validé pour le carcinome épidermoïde anal de stade avancé. Par conséquent, nous avons cherché à valider l’activité clinique et l’innocuité de la chimiothérapie à base de docétaxel, de cisplatine et de 5-FU (DCF) chez des patients atteints d’un carcinome épidermoïde anal récurrent, métastatique ou non résécable.Méthodes: Nous avons mené une étude de phase 2 multicentrique monobras, ayant inclus des patients de 25 CHU, centres de lutte contre le cancer et CHG en France, âgés de 18 ans ou plus atteints d’un carcinome épidermoïde anal métastatique ou récidivant non résécable confirmé histologiquement ; avec un indice de performance de 0 ou 1 ECOG et avec au moins une lésion évaluable selon les critères RECIST (version 1.1). Les patients, naïfs de chimiothérapie, ont reçu soit six cycles de DCF standard (75 mg/m2de docétaxel et 75 mg/m2de cisplatine à j1 et 750 mg/m2par jour de 5-FU pendant cinq jours, toutes les trois semaines), soit huit cycles de DCFmodifié (docétaxel à 40 mg/m2et cisplatine à 40 mg/m2à j1 et 1 200 mg/m2par jour de fluoro-uracile pendant deux jours, toutes les deux semaines), administrés par voie intraveineuse. Le choix entre les schémas standard et modifiés a été recommandé en fonction, mais sans s’y limiter, de l’âge (≤ 75 vs > 75 ans) et de l’indice de performance ECOG (0 vs 1). Le critère d’évaluation principal était la survie sans progression évaluée par l’investigateur 12 mois après le premier cycle de DCF. Pour que le critère d’évaluation principal soit atteint, au moins 11 (17 %) des 66 patients inclus devaient être en vie sans progression tumorale à 12 mois. Des analyses d’efficacité et de tolérance ont été réalisées dans une population en intention de traiter modifiée, définie comme l’ensemble des patients évaluables pour la progression à 12 mois et qui avaient reçu au moins un cycle de DCF. Cet essai est enregistré à ClinicalTrials.gov, numéro NCT02402842, et les résultats finaux sont présentés ici.Résultats: Entre le 17 septembre 2014 et le 7 décembre 2016, nous avons inclus 69 patients. Parmi ces patients, trois n’ont pas reçu de DCF. Sur les 66 patients qui ont reçu un traitement, 36 ont reçu le schéma DCF standard, et 30 ont reçu un DCF modifié. Le critère d’évaluation principal a été atteint : 31 (47 %) des 66 patients étaient en vie et sans progression à 12 mois. Vingt-deux (61 %) des 36 patients ayant reçu le schéma DCF standard et 18 (60 %) des 30 patients ayant reçu le DCF modifié ont présenté une progression de la maladie à la date de point. Quarante-six (70 %) des 66 patients ont eu au moins un événement indésirable de grade 3 ou 4 (30 [83 %] sur 36 traités par DCF standard et 16 [53 %] sur 30 traités par DCF modifié). Les effets indésirables de grade 3 ou 4 les plus fréquents étaient la neutropénie (15 [23 %], 8 [22 %] pour le DCF standard vs 7 [23 %] pour le DCF modifié), la diarrhée (12 [18 %], 9 [25 %] vs 3 [10 %]), l’asthénie (10 [15 %], 8 [22 %] vs 2 [7 %]), l’anémie (10 [15 %], 6 [17 %] vs 4 [13 %]), la lymphopénie (8 [12 %], 3 [8 %] vs 5 [17 %]), la mucite (7 [11 %], 7 [19 %] vs 0) et les vomissements (7 [11 %], 5 [14 %] vs 2 [7 %]). Aucun effet indésirable non hématologique de grade 4 ni neutropénie fébrile n’a été observé avec le DCF modifié, alors que trois (8 %) effets indésirables non hématologiques de grade 4 et cinq (14 %) neutropénies fébriles ont été rapportés avec du DCF standard. Quatre-vingt-dix-sept événements indésirables graves ont été rapportés (69 chez les patients recevant le DCF standard [61 liés au médicament] et 28 chez ceux ayant reçu le DCF modifié [14 liés au médicament]). Aucun décès lié au traitement n’a été enregistré.Conclusion: Comparé au DCF standard, le DCF modifié a permis, en première ligne, une réponse durable avec une bonne tolérance chez les patients ayant un carcinome épidermoïde anal métastatique ou récidivant non résécable, avec indice de performance ECOG de 0–1, et pourrait donc être considéré comme un nouveau traitement standard de soins chez ces patients. En raison du risque élevé d’événements indésirables graves, de toxicité sévère et de neutropénie fébrile, le DCF standard ne peut pas être recommandé dans cette situation.

Fragrant pear, Pyrus sinkiangensis Yu, is widely cultured in northern China, and is typically sweeter and of higher economic value than other pears. (2,3). In early October 2012, a fruit rot affecting approximately 30% of 300 kg of P. sinkiangersis produced in Korla orchards of Xinjiang was observed in a market of Zhengzhou, Henan Province, China. Early symptoms appeared as small, round, pale yellow-brown lesions on the fruit, which expanded from 10 to 20 mm diameter in 7 days. Later, affected fruit completely rotted and were covered with grey-white mycelium after 20 days. On the surface of mycelium, branched, septate conidiophores (2.0 mm tall and 13 to 15 μm thick) were produced. These were melanized at the base and hyaline near the apex. Conidia were hyaline, aseptate, ellipsoidal to obovoid, with a slightly protuberant hilum and ranged from 7 to 13.5 × 5.5 to 8.5 μm. One isolate of the pathogen (zm120286) was made by dispersing conidia on the potato dextrose agar (PDA) medium, directly removed from the sporulating tissue with thin needle. The colony was gray to white and produced blackish sclerotia at the edge of the colonies, which was 3.0 to 4.0 × 2.0 to 3.0 mm after 2 weeks of incubation at 22°C. The pathogen was identified as Botrytis cinerea Pers.:Fr on the basis of the morphology and ITS sequencing of rDNA (1,4). The sequence (GenBank Accession No. KF010847) was 100% identical to the sequences of two Botryotinia fuckeliana (anamorph: Botrytis cinerea) (e.g., GenBank Accession Nos. KC683713, HM849615). Koch's postulates were performed by placing a 5 mm diameter mycelia plug removed from the periphery of a 7-day-old colony of zm120286 on 10 surface-sterilized fresh fragrant pears collected from Korla orchards. An equal number of fresh fragrant pears were inoculated with 5 mm diameter plugs of PDA medium to serve as controls. All fragrant pears were incubated in clear plastic boxes with a dish of sterile distilled water at 25°C under ambient light. Symptoms identical to those described in the outbreak above were observed after 3 days. From each of the symptomatic pears, B. cinerea was recovered, whereas controls remained symptom-free. To our knowledge, this is the first outbreak of B. cinerea on P. sinkiangersis in China, which may necessitate the development of pre-harvest management practices. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes. Commonwealth Mycological Institute, Kew, England, 1971. (2) X.W. Li et al. Chinese Agricultural Science Bulletin, 26(15):100-102, 2010. (3) T. Yu and K. Kuan. Acta Phytotaxon. Sin. 8: 202, 1963. (4) Z. Y. Zhang. Flora Fungorum Sinicorum. Vol. 26. Botrytis, Ramularia. Science Press, Beijing, 2006.

Phytophthora sansomeana E.M. Hansen & Reeser is a newly described species and infects Douglas-fir, alfalfa, and soybean (1). Soybean production is an important part of the local economy in Yili State in Xinjiang Uygur Autonomous Region, northwest China. Unfortunately since 2005, root and stem rot disease has emerged on a number of farms. To identify the causal agent, plant samples with symptoms, including whole plant wilting or yellowing and stunting, were collected from fields during 2005 and 2008. Tissue from the edges of stem lesions was placed on selective lima bean agar (LBA) at 20°C for 3 to 4 days (2,3). Four single zoospore isolates of Phytophthora were obtained and maintained on LBA or 10% V8 juice liquid medium for examination of morphological and physiological characteristics. The colonies on LBA were aerial and rosaceous. The isolates were homothallic, and oogonia and oospores were readily produced in culture after 7 days on LBA plates. Oogonia averaged 38 μm and oospore width ranged from 23 to 48 μm and averaged 31 μm. Antheridia were approximately 15 × 12 μm and predominantly amphigynous in V8 juice. Sporangia were terminal or paragynous on persistent sporangiophores, nonpapillate, ovoid to obpyriform, and measured 52 × 35 μm with an average length/breadth ratio of 1.5. Hyphal swellings were produced in V8 juice 2 days after inoculation. The optimum temperature for growth was approximately 25°C and none occurred at 0 or 35°C. The internal transcribed spacer (ITS) sequence of this Phytophthora species (GenBank FJ966880) agreed 100% with sequences of P. sansomeana isolates deposited in GenBank (GQ853880 and EU925375). Pathogenicity tests were performed by hypocotyl inoculation method (2) using isolate Yili71 and potted soybean cv. Williams. Plants were grown in a growth chamber for 10 days before inoculation in 16-cm-diameter pots (2). Plants were inoculated with 2- × 2-mm plugs of mycelium grown for 4 days on LBA at 25°C, the plugs were adhered to the sides of wounded lower hypocotyls. As controls, plants were inoculated with LBA agar plugs without mycelium (2). Inoculated plants were maintained in a growth chamber at approximately 25°C with a 10-h dark/14-h light cycle and 50% relative humidity and symptom development was monitored daily for 1 week. Wounded stems inoculated with mycelium developed water-soaked lesions, which were similar to those seen on naturally infected plants. A Phytophthora sp. was reisolated from the margins of expanding lesions on wounded stems. To our knowledge, this is the first report of P. sansomeana infection of soybean in China and the threat it may pose to soybean production is unclear. References: (1) E. M. Hansen et al. Mycologia 101:129. 2009. (2) Z. Y. Wang et al. Fungal Genet. Biol. 43:826, 2006. (3) X. B. Zheng. Methods in Phytophthora. Chinese Agriculture Press. Beijing, China, 1995.

Tall fescue (Festuca arundinacea Schreb), a predominant cool-season perennial grass, is widely used as forage and turf grasses in China. In July 2013, powdery mildew was observed on 10 F. arundinacea lawns (about 0.5 ha in total) in Urumchi, Xinjiang Province, China, with 20 to 30% of the area being infected. Signs of the disease initially appeared as irregular white mycelial colonies on the adaxial surface of infected leaves. As the disease progressed, the colonies covered the whole adaxial surface and white patches appeared on the abaxial surface of infected leaves. Conidiophores were unbranched and cylindrical with swollen bases, measuring 13.3 to 15 × 16.7 to 20 μm, and borne vertically on hyphae. Each conidiophore produced 10 to 18 conidia in a chain. The conidia were oval, one-celled, and colorless, measuring 8.1 to 9.8 × 26 to 29.7 μm. Cleistothecia were black, spherical, and 164.3 to 207.3 μm in diameter, each of which contained 9 to 26 asci. Asci were oblong or ovate, measuring 32.1 to 40 × 85.7 to 96.4 μm. Asci were petiolate, containing eight ascospores. Ascospores were round to oval, colorless, one-celled, measuring 19.1 to 22.5 × 11.7 to 13.6 μm. Based on morphological characteristics of the anamorph and the teleomorph, the fungus was identified as Blumeria graminis (DC.) Speer. Additionally, the internal transcribed spacer (ITS) of 563 bp was amplified from DNA of conidia using ITS1 and ITS4 primers (4). The ITS sequence was deposited in GenBank (Accession No. KF545644). The ITS sequence showed 100% homogeneity with those of B. graminis on Poa pratensis in Swizerland (AB273540) and on P. bulbosa in Iran (AB273551) (1), which further confirmed the identification. Ten 3-week-old healthy plants were inoculated by spraying a spore suspension (1 × 105 conidia ml−1) made from conidia brushed from infected plants, and 10 plants sprayed with sterile distilled water were served as controls. All the plants were placed in the same growth chamber at 20°C, 80% humidity, and 16-h photoperiod. Twenty days after inoculation, typical signs and symptoms of powdery mildew were observed on all the inoculated plants, whereas no symptoms were observed on the controls. Microscopic and ITS analysis showed that the fungus on the inoculated plants is identical to that on diseased field plants. B. graminis on F. arundinacea has been observed in a few European countries (1), Israel (3), and the United States (2). To our knowledge, this is the first report of powdery mildew caused by B. graminis on F. arundinacea in China, which will increase the difficulty to prevent powdery mildew on grasses including cereals. References: (1) U. Braun. The Powdery Mildews (Erysiphales) of Europe. Gustav Fischer Verlag, Jena-Stuttgart-New York, 1995. (2) F. M. Dugan and G. Newcombe. Pacific Northwest Fungi. 2:1-5, 2007. (3) S. O. Voytyuk et al. Biodiversity of the Powdery Mildew Fungi (Erysiphales, Ascomycota) of Israel Vol. 7. Biodiversity of Cyanoprocaryotes, Algae and Fungi of Israel. Koeltz Scientific Books, 2009. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, 1990.

Abstract Background As one of the critical indicators of obesity, the interaction between visceral fat content and lung disease is the focus of current research. However, the exact relationship between Visceral adipose index (VAI) and lung function is not fully understood. The purpose of this study was to evaluate the relationship between VAI and lung function, Methods Our study included all participants from the baseline survey population in Xinjiang in the Natural Population Cohort Study in Northwest China. A field survey was conducted in rural areas of Moyu County, Xinjiang, China, between 35 and 74 years old from June to December 2018. We collected standard questionnaires and completed physical examinations, visceral fat tests, and lung function measurements. Results The study included 2367 participants with a mean VAI of 10.35 ± 4.35, with males having a significantly higher VAI than females: 13.17 ± 3.91 vs. 7.58 ± 2.65. The piecewise linear spline models indicated a significant threshold effect between lung function and VAI in the general population and the males population, showing an inverted U-shaped curve. But there was no significant association between VAI and lung function in females. FEV1% predicted and FVC% predicted increased with the increase of VAI (β 0.76; 95% CI 0.30, 1.21) and (β 0.50; 95% CI 0.06, 0.94) in males with VAI ≤ 14, while FEV1% predicted and FVC% predicted decreased with the increase of VAI (β − 1.17; 95% CI − 1.90, − 0.45) and (β − 1.36; 95% CI − 2.08, − 0.64) in males with VAI ≥ 15. Conclusions The relationship between lung function and VAI in male participants showed an inverted U-shaped curve, with the turning point of VAI between 14 and 15. The association between visceral fat and lung function was more robust in males than in females.

The prevalence and related factors of mental health impact among medical staffs who experienced the second wave of the COVID-19 pandemic in China is unknown. Therefore, this survey was conducted to investigate the prevalence and related factors of depressive, anxiety, acute stress, and insomnia symptoms in medical staffs in Kashi, Xinjiang, China during the second wave of the COVID-19 pandemic. A cross-sectional online survey was conducted among medical staffs working in First People's Hospital of Kashi, Xinjiang. The questionnaire collected demographic data and self-design questions related to the COVID-19 pandemic. The Impact of Events Scale-6, the Insomnia Severity Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder Scale-7, the Perceived Social Support Scale, the Chinese Big Five Personality Inventory-15, and the Trait Coping Style Questionnaire were used to measure psychological symptoms or characteristics. Binary logistic regression was carried out to examine the associations between socio-demographic factors and symptoms of depression, anxiety, stress, and insomnia. In total, data from 123 participants were finally included, among which the prevalence rate of depressive, anxiety, acute stress, and insomnia symptoms is 60.2, 49.6, 43.1, and 41.1%, respectively. The regression model revealed that minority ethnicity, being worried about infection, spending more time on following pandemic information, and neurotic personality were positively associated with the mental health symptoms, while extraversion personality, higher education level, and better social support were negatively associated. In our study, the prevalence of mental health impact was high among medical staffs in Kashi, China who experienced the second wave of the COVID-19 pandemic. Several factors were found to be associated with mental health conditions. These findings could help identify medical staffs at risk for mental health problems and be helpful for making precise mental health intervention policies during the resurgence. Our study may pave way for more research into Xinjiang during the COVID-19 pandemic.

Xinjiang Province accounts for nearly 20% of the total grape (Vitis Vinifera L.), proles orientalis) (wine, table and raisin combined) production, being the largest production area in China. Fruit rot is the most common disease that impacts grape quality and yield. A new disease where the ripe grape berry surfaces were coated with brownish mildew was observed, and the disease mainly occurred on whole clusters or most of the berries in the cluster. In September 2019 and 2020, 125 diseased grape clusters were collected from 10 locations in northern Xinjiang where the disease incidence was 15.3% − 27.4% ((diseased clusters/ total clusters)*100). To identify the pathogen, symptomatic grape berries were disinfected with 1% NaClO for 2 min, followed by 70% ethanol for 30 s, and rinsed thrice in sterile distilled water. Three pieces of ~0.5 cm2 diseased grape skin with partial exocarp were placed on potato dextrose agar (PDA) amended with streptomycin sulfate and kanamycin (50 µg/mL each). The PDA plates were then incubated at 25℃ under light condition with the luminous intensity 3500 Lux for 7 days. Fungal colonies emerging from the plated tissue were subcultured and single-spored three times to obtain pure cultures. From 20 strains with similar colony phenotype and grey olive hue, flocculent, felt-like surface, six (Cc-Vivi-3, 7, 9, 11, 13 and 19) isolates were chosen for further characterization after 7 days of incubation. Conidia were either single or grew in chains, with around 4 conidia per chain. Conidia were ovoid, nearly spindle or globose with slightly smooth or irregular reticulate surface. Conidiophores were solitary, smooth, septate, erect or geniculate. These characteristics were consistent with the descriptions for Cladosporium cladosporioides. To confirm this identification, PCR was performed on the genomic DNA of the selected strains using primers for internal transcribed spacer (ITS) region ITS1/ITS4, actin (ACT) and translation elongation factor (TEF) (Schubert et al., 2007; Braun et al., 2003). Amplified ITS sequences provided a 100% match to C. cladosporioides (AY213641) in NCBI. Homology of ACT sequences to C. cladosporioides (HM148527 and MH047330) was 99.57% and 100%, respectively; and the homology of TEF sequences with C. cladosporioides (HM148258, HM148289, HM148260 and HM148266) was 97.56% ~ 100%. To further confirm the evolutionary relationship of strains from grapes with Cladosporium spp., phylogenetic analyses based on ITS, ACT and TEF conjoint sequences from the six experimental isolates, five C. cladosporioides strains, eight proximal Cladosporium species were analyzed. The phylogenetic tree showed that the six isolates from grapes clustered with C. cladosporioides strains, but not other proximal Cladosporium species. This confirmed that all six isolates evaluated were C. cladosporioides. Pathogenicity tests with one C. cladosporioides isolate (Cc-Vivi-3; accession No. ITS: MW556429, ACT: MW567144, TEF: MW567143) were carried out as follows: ripe and healthy grape clusters from cultivars Xinyu and Munag when total soluble solids were 20-21°Bx and 19-20 °Bx, respectively, were detached from the vines. Five berries of three clusters of each cultivar were punctured with a sterile syringe, then inoculated with a 20 μL conidial suspension (107 conidia/mL). And uninoculated, punctured berries in clusters treated with sterilized water served as controls. The experiment was repeated three times. Symptoms were recorded 15 days after incubation at 80% relative humidity and 25℃ with a 14 h light/10 h dark cycle. The olive green or blackish green mildew layer was produced on all inoculated berries. No symptoms were observed on the uninoculated berries. Koch’s postulates were fulfilled by reisolating C. cladosporioides from all symptomatic tissues and identifying them by PCR targeting the ACT gene. This is the first description of C. cladosporioides causing grape fruit rot in Xinjiang, China. In recent years, worldwide reports of Cladosporium spp. damaging crops are increasing (Briceño et al., 2008; Walker et al., 2016; Meneses et al., 2018; Robles-Yerena et al., 2019; Ding et al., 2019; Yang et al., 2021). However, relatively few methods of management including some fungicides and biocontrol agents are available in different crops (Wang et al., 2018; Addrah et al., 2019). In view of the important role of Xinjiang in China agricultural production, that should arouse strong attention.

Abstract Objective: To investigate homocysteine (Hcy) and folate levels, prevalence of hyperhomocysteinaemia (HHcy) and folate deficiency, which are affected by lifestyles in urban, agricultural and stock-raising populations. Design: This is a cross-sectional study. Setting: Urban, agricultural and stock-raising regions in Emin, China. Participants: Totally 1926 subjects – 885 (45·9 %) from urban, 861 (44·7 %) from agricultural and 180 (9·4 %) from stock-raising regions – were obtained using multistage stratified random sampling. Inclusion criteria encompassed inhabitants aged ≥15 years who resided at the current address for ≥6 months and agreed to participate in the study. Surveys on health behaviour questionnaires and physical examinations were conducted and blood samples collected. Results: The folate level of subjects from the stock-raising region was the lowest, followed by those from the agricultural region, and the highest in those from the urban region (3·48 v. 6·50 v. 7·12 ng/ml, P < 0·001), whereas mean Hcy showed no significant difference across regions. The OR for HHcy in stock-raising regions was 1·90 (95 % CI 1·11, 3·27) compared with the urban region after adjusting for all possible covariates. The OR for folate deficiency in stock-raising and agriculture regions was 11·51 (95 % CI 7·09, 18·67) and 1·91 (95 % CI 1·30, 2·82), respectively, compared with the urban region after adjusting for all possible covariates. Conclusions: HHcy and folate deficiency are highly prevalent in stock-raisers, which is of important reference for HHcy control in Xinjiang, with a possibility of extension to others with approximate lifestyles.

Abstract Background The natural hosts of Shigella are typically humans and other primates, but it has been shown that the host range of Shigella has expanded to many animals. Although Shigella is becoming a major threat to animals, there is limited information on the genetic background of local strains. The purpose of this study was to assess the presence of virulence factors and the molecular characteristics of S. flexneri isolated from calves with diarrhea. Results Fifty-four S. flexneri isolates from Gansun, Shanxi, Qinghai, Xinjiang and Tibet obtained during 2014 to 2016 possessed four typical biochemical characteristics of Shigella. The prevalences of ipaH, virA, ipaBCD, ial, sen, set1A, set1B and stx were 100 %, 100 %, 77.78 %, 79.63 %, 48.15 %, 48.15 and 0 %, respectively. Multilocus variable number tandem repeat analysis (MLVA) based on 8 variable number of tandem repeat (VNTR) loci discriminated the isolates into 39 different MLVA types (MTs), pulsed field gel electrophoresis (PFGE) based on NotI digestion divided the 54 isolates into 31 PFGE types (PTs), and multilocus sequence typing (MLST) based on 15 housekeeping genes differentiated the isolates into 7 MLST sequence types (STs). Conclusions The findings from this study enrich our knowledge of the molecular characteristics of S. flexneri collected from calves with diarrhea, which will be important for addressing clinical and epidemiological issues regarding shigellosis.

Breast milk acts as an intermediary for the transfer of functionally important commensal bacteria from mother to infant, especially for Bifidobacterium that can colonize the infant gut. However, the vast majority of rRNA amplicon-based studies reported the conspicuous intercohort and interindividual variation for the prevalence of Bifidobacterium in breast milk. In order to elucidate whether Bifidobacterium phylotypes persistently co-occured at the species or strain level in mother–breast milk–infant triads, we analyzed collectively the next-generation sequencing (NGS) datasets of bacterial 16S rRNA gene and the Bifidobacterium-specific groEL gene from maternal feces, breast milk, and infant feces in a small yet very homogeneous cohort of 25 healthy Uyghur mother–infant pairs (lactation for 7–720 days) in Kashgar, Xinjiang, China. Overall, 16S rRNA gene analysis showed that microbiome in the newborn gut was closer to that of breast milk in the first 4 months of lactation, and subsequently showed an obvious trend of adulthood at 6–12 months. Based on the BLAST accurate taxonomic result of the representative sequences of all ASVs (amplicon sequencing variants), only three sets of ASVs could be clearly assigned into Bifidobacterium species, whereas the remaining eight sets of ASVs corresponded to four indefinite Bifidobacterium species group. By contrast, the groEL gene dataset was partitioned into 376 ASVs, at least belonging to 13 well-known Bifidobacterium species or subspecies, of which 15 ASVs, annotated to seven well-known Bifidobacterium species or subspecies, showed triadic synchronism in most 23 mother–infant pairs tested. However, several other rare bifidobacterial phylotypes, which were frequently encountered in animals, were found to display no correspondence of the presence between the three ecosystems of mother–infant pairs. Our test results were obviously to support the hypothesis that breast milk acts as an intermediary for the transfer of probiotic commensal bacteria from mother to infant, especially for endosymbiotic Bifidobacterium that can colonize the infant gut. Some oxygen-insensitive exogenous Bifidobacterium phylotypes with a cosmopolitan lifestyle may be indirectly transferred to breast milk and the infant’s intestinal tract through environmental contamination. Thus, the groEL gene proved to be a very effective target for the depth resolution of Bifidobacterium community by high-throughput sequencing technologies.

Background: Canadian residency programs have adopted competency-based medical education, where time-based learning systems are replaced with core competency “milestones” that must be achieved before a student progresses. Assessment tools must be developed to predict performance prior to high-stakes milestones, so interventions can be targeted to improve performance.Objectives: 1. To characterize how well each of three practice written exams predicts passing the Canadian Internal Medicine Royal College (RC) exam. 2. To determine if writing practice exams is perceived to improve performance on the RC exam.Methods: Three 105-question multiple choice question exams were created from a range of internal medicine topics, and offered one month apart to 35 residents. Percentile ranks on each practice exam were compared to the result (pass/fail) on the RC exam. Surveys were completed within 1 month after the RC exam.Results: There were 35 residents invited to participate. Practice exams (PE) 1, 2, and 3 were taken by 33, 26, and 22 residents, for an exam participation rate of 94.3, 74.3, and 62.9%, respectively. Failure on the RC exam could be predicted by percentile ranking <15% on PE1 (OR 19.5, p=0.017) or PE2 (OR 63.0, p=0.006), and by percentile ranking <30% on PE1 (OR 28.8, p=0.003), PE2 (OR 24.0, p=0.010) or PE3 (OR 15.0, p=0.046). The survey was sent out to the 33 participants. Of those, the total number of respondents was 25, with a response rate of 75.5%. Survey takers agreed that practice written exams improved performance on the RC exam (18/25, 88%).Conclusions: Performance in the Canadian Internal Medicine RC Exam can be predicted by performance on any of three practice written exams. This tool can therefore identify trainees for whom additional resources should be invested, to prevent failure of a high-stakes milestone within the competency based medical education framework.RÉSUMÉContexte : Les programmes canadiens de résidence ont choisi de diffuser un enseignement médical axé sur les compétences dans lequel les systèmes d’apprentissage structurés en fonction du temps sont remplacés par des « jalons » liés aux compétences fondamentales que l’étudiant doit atteindre pour aller de l’avant. Il faut élaborer des outils d’évaluation pour prédire la probabilité de résultats escomptés par un étudiant avant que celui-ci ne se présente à certains événements dont les enjeux sont élevés. Ainsi, il devient possible d’intervenir de manière à améliorer les résultats escomptés.Objectifs : 1. Déterminer dans quelle mesure chacun des trois examens de pratique écrits prédit la réussite à l’examen du Collège royal des médecins et chirurgiens du Canada (CRMCC) en médecine interne; 2. Évaluer si le fait de se soumettre à des examens de pratique écrits est perçu comme un élément qui améliore les résultats à l’examen du CRMCC.Méthodologie : Trois examens écrits comportant chacun 105 questions à choix de réponses portant sur un éventail de sujets relatifs à la médecine interne ont été préparés et proposés à 35 résidents à intervalle d’un mois. Les rangs-centiles de chaque examen de pratique ont été comparés avec le résultat obtenu à l’examen du CRMCC (succès/échec). Les sondages ont été effectués dans le mois suivant l’examen du CRMCC.Résultats : Trente-cinq résidents ont été invités aux examens de pratique écrits (EP) 1, 2 et 3. La participation a été respectivement de 33, 26 et 22 résidents, soit de 94,3 %, 74,3 % et 62,9 %. L’échec à l’examen du CRMCC pouvait être prédit par un rang-centile < 15 % à l’EP1 (OR 19,5 et p = 0,017) ou à l’EP2 (OR 63,0 et p = 0,006) et un rang-centile < 30 % à l’EP1 (OR 28,8 et p = 0,003), à l’EP2 (OR 24,0 et p = 0,010) ou à l’EP3 (OR 15,0, et p = 0,046). Le sondage a été envoyé aux 33 participants. Le nombre total de répondants a été de 25, pour un taux de réponse de 75,5 %. La majorité des répondants (18/25, 88 %) sont d’avis que les examens de pratique écrits leur ont permis d’obtenir de meilleurs résultats à l’examen du CRMCC.Conclusions : Les résultats à l’examen du Collège royal des médecins et chirurgiens du Canada (CRMCC) en médecine interne peuvent être prédits par les résultats obtenus à l’un des examens de pratique écrits. Par conséquent, cet outil peut être utilisé dans le cadre de l’enseignement de la médecine axé sur les compétences pour identifier sur qui l’on devrait investir des ressources additionnelles en vue d’éviter un échec à cet événement aux enjeux élevés.Competency-based medical education (CBME) has generated increased attention over the last decade,1–3 and become entrenched within several national medical education frameworks including Canada.4 Proponents of CBME suggest that older medical education models focus on medical knowledge rather than skills, or higher order aspects of practice. 5 Focus on time spent in training can take away from the abilities acquired during that time frame.6 Furthermore, flexible time periods may be more efficient and focused, compared to time-based curriculum.3,6,7 In light of these advantages, the Royal College of Physicians and Surgeons of Canada (RCPSC) has committed to transform medical education to a CBME model for all residency programs by 2017.4While residency programs reorganize toward the CBME model, residents will still be required to perform oral and written exams. It is thus essential that CBME-based programs incorporate assessment tools to predict performance on high-stakes milestones, such as RC exams.We created three written PEs, and evaluated how well each predicted performance on a high-stakes milestone, the RCPSC Internal Medicine exam (RC exam). We also evaluated how well PE were perceived to improve performance on the same high-stakes milestone RC exam.METHODSSetting and ParticipantsThe RC exam contains both written and oral components. All residents sitting both components of the RC exam, within 12 months, who were post-graduate medical residents at Western University (London, Ontario, Canada), were invited to participate. The study was conducted in 2013-2014.Western University Health Sciences Research Ethics Board provided an ethics waiver for this study, since the study was performed as part of the standard operations of an educational program.Intervention: ExamsTwo authors (HS, BT) separately created multiple choice questions (MCQ) reflecting all areas of internal medicine, based on the Objectives of Training of the RC Internal Medicine exam. RC exam questions are not available for purchase, and examinees are forbidden to share RC exam questions. Therefore, PE content and question style was informed by questions purchased for American Board of Internal Medicine (ABIM) course reviews.8,9 MCQ creators had each completed the RC exam within 3 years, and were thus familiar with MCQ and exam format.All authors independently reviewed each PE question to assure quality of content, grammar, spelling, and syntax. Each PE covered all subspecialty areas within internal medicine, including allergy and immunology ( n=4), cardiology (n=13), dermatology (n=2), endocrinology (n=8), gastroenterology (n=10), hematology (n=10), infectious diseases (n=15), nephrology ( n=9), neurology (n=6), oncology (n=4), respiratory and critical care medicine (n=7), rheumatology ( n=14) and statistics (n=3). This topic allocation included 7 questions for JAMA Rational Clinical Exam, and 5 for interpretation of medical images (e. g., chest X-ray, electrocardiogram). PE size (105 questions) and length (3 hours) were chosen to reflect the RC exam.Each PE was offered at two separate times, to assure flexibility within ongoing clinical responsibilities. PE1, PE2, and PE3 were offered approximately 7, 6, and 5 months prior to RC exam, respectively. This timing was chosen so that trainees had sufficient time to improve their performance before the RC exam if a poor PE result was found.Examinees were provided a personalized report for each exam, within 7 days of completing the PE. The personalized report included the examinee’s overall mark, average within each subspecialty, and percentile rank within the entire cohort of examinees. Two separate 1-hour periods were available to review each PE results, with the questions and key, supervised by BT.Intervention: SurveyAll study participants were invited to participate in a survey. The survey assessed how well PE simulated the RC exam, whether the PE were recommended to the next year’s cohort of examinees, and whether the PE improved performance on the RC exam.Outcomes: ExamsEach study participant agreed to provide the RC exam result (“pass” or “fail”) once he or she had received it. Each candidates verbally communicated RC exam result was confirmed online 3 months after the RC exam results were reported (cpso.on.ca).Odds ratios were calculated. The adverse outcome was failure on the RC exam. Exposures evaluated included percentile rank < 15% and <30%. Odds ratios of infinity were prevented by adding 1 adverse outcome to any exposure group without any adverse outcomes; this was performed for 3 exposure groups, but did not impact whether statistical significance was attained. Results are detailed in Table 1.Outcome: SurveySurvey results were on a Likert Scale. The proportion of those respondents who agreed or disagreed were calculated.All data was analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0.RESULTSSetting and ParticipantsThere were 35 residents invited to participate, the total number of possible participants. PE1, PE2, and PE3 were taken by 33, 26, and 22 residents, for an exam participation rate of 94.3, 74.3, and 62.9%, respectively. The majority of invitees took 3 (n=17) or 2 ( n=14), while a minority took 1 (n=2) or 0 (n=2) practice exams.ExamsOf all examinees of the RC exam (n=35), 7 failed. RC exam pass rates were lower when PE1 percentile rank was lower than 15% (40.0 vs. 92.9%, p<0.001) or 30% (44.4 vs. 100%, p<0.004), when PE2 percentile rank was lower than 15% (0.0 vs. 100.0%, p <0.001) or 30% (42.9 vs. 100.0%, p=0.038), and when PE3 percentile rank was lower than 30% (50 vs. 93.75%, p=0.046) (Figure 1). Figure 1. License exam practice pass rate versus percentile rate (PR) on practice exams. Examinees were more likely to fail the RC exam if percentile rank was less than 15% (OR 19.5, p=0.017) or 30% (OR 28.8, p=0.003) in PE1, less than 15% (OR 63.0, p=0.006) or 30% (OR 24.0, p =0.010) in PE2, or less than 30% (OR 15.0, p=0.046) in PE3.SurveyOnly residents who had taken at least 1 practice exam were invited to participate. The survey was sent out to the 33 participants, the total number of possible participants. Of those, the total number of respondents was 25, with a response rate of 75.5%. Most survey respondents agreed that the PEs were an accurate simulation of the written component of the RC examination (20/25, 80%) (Figure 2A). Most survey respondents agreed that the PEs improved performance on the RC written examinations (18/25, 72%) (Figure 2B). Most survey respondents recommended future residents to take the PEs (22/25, 88%) (Figure 2C).DISCUSSIONWe describe the creation of a tool to assess performance on a high-stakes milestone examination, the RC exam. This tool is easy to create, affordable, and is administered on a voluntary basis with high uptake amongst candidates writing the RC exam. The assessment tool has been shown to predict performance well so that resources can be invested in those at risk for failing.There is a possibility that mere participation in the assessment tool itself improves performance on this high-stakes exam. There were insufficient numbers of study participants to determine a correlation between number of exams taken and pass rates. Even still, unwillingness to participate in the study may reflect a general unwillingness to prepare, which means the results would be confounded and correlative rather than causative. One way to look into this is to perform a randomized trial in which half of residents take the assessment tool and the other half doesn’t. Unfortunately, almost all invited residents were anxious to participate, rendering such a possible study impossible. On the other hand, exam takers were able to communicate usefulness of the exam and to provide feedback on how it might be improved for future years.As CBME develops and becomes entrenched, there will continue to be a need to prepare for knowledge based written exams. This exam will continue to be considered a core competency between the stages to transition to practice. Thus, tools are needed to assess exam competence. This study confirms that such tools can and should be developed to assure that trainees are prepared.Ideally, residents with low performance would be identified early enough to intervene to change the outcome. It is uncertain what the ideal time frame is or what the intervention should be. It is reasonable to assume that taking the examination earlier in their training may allow candidates to become aware of their performance and implications thereof and implement earlier changes in learning strategies. For example, in past years, candidates contacted their program directors to ease the clinical workload to allow more study time. Others sought counselling and mentorship from staff, while others were self-directed in their learning and became more motivated to study. On the other hand, poor performance on this formative examination could potentially discourage some residents from studying if they felt their studying was futile. Future research efforts should focus on identifying which intervention is optimal to modify exam performance.The failure rate of 20% on the RC exam the year the study was conducted was unusually high for the program; however, this allowed for a correlation to be established between the PEs and the RC exam. The PEs were able to identify all those who failed the RC exam. However, there were those who scored below the 30th percentile on the PEs and still passed the RC exam. It must be kept in mind that the purpose of these formative exams is to identify those at high risk of failure so they can receive remedial support and improve their chances of passing. Thus, it is possible that through increased remedial support, those candidates who did poorly on the in-training exam managed to pass the RC exam.Only 2 trainees chose to write none of the PEs. While both of these trainees ultimately failed the RC exam, statistical significance could not be established due to the small sample size. It thus remains uncertain whether the act of writing PEs predicts passing the RC exam. However, the study objective was to identify candidates at high risk of failing the RC exam; the next step will be to determine which interventions can improve RC exam result. However, it must be acknowledged that PEs could not only identify candidates at risk of failing RC exam, but also improve their performance. This requires future study before any firm conclusions can be found.This study confirms that formative exams’ results can predict failure on the RC exam. The questions were written by authors who had recently written the RC exam, familiar with its format, and knowledgeable of the current Canadian guidelines, which are a focus of the actual RC exam. Because of confidentiality agreements with the RCPSC, actual RC exam questions can’t be shared, and thus can’t be used as part of the practice exams. However, we attempted to overcome this limitation by having all PE questions reviewed by at least 3 physicians who’d recently successfully completed the RC exam, to assure syntax and format was as similar as possible between PE and RC exam. Furthermore, this limitation does not impact the PEs statistically significant prediction of candidates at risk of failing the RC exam. The study objective was to identify candidates at risk of failing the RC exam, and the PEs are indeed a valid predictor of RC exam performance. There are limitations to this study. Firstly, this was a single centre study. However, Western University has a wide range of subspecialty programs available, and the trainees’ demographics resemble that at other Canadian centers. Secondly, new questions need to be created annually to reflect updated literature and guidelines; this requires ongoing commitment and dedication from staff. These “updated” exams could become more difficult to validate if candidates no longer fail the RC exam. However, if the act of taking the PE predicts passing RC, future research could focus on comparing RC pass rates at programs with and without the PEs. Thirdly, it's entirely possible that the use of questions from old RC exam would be more predictive, but these questions cannot be shared or used for PE due to the confidentiality agreement with the RCPSC. Therefore, creation of independent questions is still required. This is the first study of an assessment tool to predict performance on the Canadian internal medicine examination within the CBME framework. This strategy can easily be replicated and feedback is rapidly provided in a time sensitive manner. This could help trainees direct their preparation and identify knowledge gaps more easily.CONCLUSIONWe report an assessment tool to predict performance on the RC exam that can be a valid and useful form of feedback. This strategy can easily be replicated for other subspecialties or internal medicine programs. 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