The rise in non-communicable diseases reflects declines in maternal and child mortality over nearly three decades, largely the result of economic growth and increasing levels of education. In addition, China has instituted national programs targeting infectious diseases.

“Like many countries, China has reached a tipping point over the past three decades,” said Dr. Maigeng Zhou, a lead author on the study and Deputy Director, National Center for Chronic Non-Communicable Disease Control and Prevention at the Chinese Center for Disease Control and Prevention. “Going forward, the burden of chronic health problems, especially among the elderly, will far exceed infectious diseases.”

A part of the Global Burden of Disease (GBD), the study spans 1990 to 2017, filling a major gap in understanding health problems at the local level. The analysis, published today in the international medical journal The Lancet, provides comparable estimates of mortality, disability, and associated risk factors for 34 provinces by age and sex. The GBD produces estimates for 359 diseases and injuries and 84 risk factors.

Zhou and co-authors found stroke and ischemic heart disease replaced lower respiratory infections and neonatal disorders as the leading causes of disease burden between 1990 and 2017.

In addition to stroke, ischemic heart disease, and lung cancer, the top five causes of premature death include chronic obstructive pulmonary disease (COPD) and liver cancer.

Compared to countries with similar levels of development, such as Russia, China has unusually high levels of stroke, COPD, lung cancer, liver cancer, neck pain, and stomach cancer. All provinces had higher-than-expected cases of liver cancer, with rates of disability-adjusted life years (DALYs) between two and seven times higher than would be expected based on their level of development.

The analysis demonstrates considerable variation in health problems at the provincial level, confirming that one’s health depends on where one lives. People in urban, coastal, and wealthier provinces in eastern China generally are healthier than those in rural and poorer areas in the west.

“We are committed to achieving the goals of the Healthy China 2030 Plan,” said Dr. Xiaofeng Liang, Deputy Director at the Chinese Center for Disease Control and Prevention, referring to an initiative announced in 2016 to improve health, control risk factors, and improve and enlarge the nation’s health care system. “These detailed provincial findings will help us tailor evidence-based policies to the health needs of local communities.”

Liver cancer ranked among the top five causes of DALYs in seven provinces, but in 11 provinces it did not rank in the top 10. The rank order for road injuries ranged from third to 20th leading cause of DALYs across all provinces; whereas hypertensive heart disease saw variation in rank order from seventh to 56th leading cause.

Nationally, smoking is the top risk factor in 21 provinces, and is ranked the second- or third-leading risk in all remaining provinces. Exposure to some risk factors is rising, particularly high blood sugar, high blood pressure, high body mass index (BMI), and, in many provinces, outdoor air pollution.

Additional findings include:

• The suicide rate for females fell from 21.5 deaths per 100,000 people in 1990 to 7.5 deaths in 2017. This trend is partly explained by urbanization and development as well as improved opportunities for women and young people. Males also saw a decline, but to a lesser degree, dropping from 17.0 deaths per 100,000 to 10.7 deaths over the same time period.
• After 2000, rates of diabetes increased more rapidly due to changing lifestyles, including increased consumption of red meat and decreased levels of physical activity. National diabetes rates increased by more than 50%, from 4,206 prevalent cases per 100,000 in 2000 to 6,336 prevalent cases in 2017.
• The maternal mortality ratio declined by 86% during the study period, falling from 95 to 14 maternal deaths per 100,000 live births. At the same time, the under-5 mortality rate decreased by 76%, from 50 to 12 child deaths per 1,000 live births.
• The top three disabling conditions in 1990 and 2017 were musculoskeletal disorders, mental disorders, and sense organ diseases (e.g., vision loss, hearing loss).
• High blood pressure accounted for 2.5 million Chinese deaths in 2017, with nearly all (96%) resulting from cardiovascular diseases (CVD).
• Beijing had significantly lower rates of premature death (age-adjusted) than the national average across all top 20 causes.
• Ten provinces in mainland China had DALYs rates (age-adjusted) at least 30% lower than would be expected given their level of development. They include Chongqing (37%), Anhui (35%), Zhejiang (34%), Fujian (33%), Shanghai (33%), Guizhou (32%), Ningxia (31%), Jiangsu (30%), Hainan (30%), and Beijing (30%).

“The goal is to store and release single photons on demand by simultaneously ensuring the stability of data,” said Andrea Alù, founding director of the ASRC Photonics Initiative and Einstein Professor of Physics at The Graduate Center. “Our work demonstrates that is possible to confine and preserve a single photon in an open cavity and have it remain there until it’s prompted by another photon to continue propagating.”

The research team used quantum electrodynamics techniques to develop their theory. They investigate a system composed of an atom and a cavity — the latter of which is partially open and therefore would normally allow light trapped in the system to leak out and be quickly lost. The research team showed, however, that under certain conditions destructive interference phenomena can prevent leakage and allow a single photon to be hosted in the system indefinitely. This embedded eigenstate could be very helpful for storing information without degradation, but the closed nature of this protected state also creates a barrier to exterior stimuli, so that single photons also cannot be injected into the system. The research team was able to overcome this limitation by exciting the system at the same time with two or more photons.

“We proposed a system that acts as a closed box when excited by a single photon, but it opens up very efficiently when we hit it with two or more photons,” said Michele Cotrufo, first author of the paper and a postdoctoral fellow with the ASRC Photonics Initiative. “Our theory shows that two photons can be efficiently injected into the closed system. After that, one photon will be lost and the other will be trapped when the system closes. The stored photon has the potential to be preserved in the system indefinitely.”

In realistic systems, additional imperfections would prevent perfect confinement of photons, but the research team’s calculations showed that their protocol outperforms previous solutions based on a single cavity.

The authors also showed that the stored excited photon can later be released on demand by sending a second pulse of photons.

The team’s finding has the potential to solve critical challenges to quantum computing, including the on-demand generation of entangled photonic states and quantum memories. The group is now exploring avenues to experimentally verify their theoretical work.

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Inspired by ideas from the physics of phase transitions and polymer physics, researchers in the Divisions of Physical and Biological Sciences at UC San Diego set out specifically to determine the organization of DNA inside the nucleus of a living cell. The findings of their study, recently published in Nature Communications, suggest that the phase state of the genomic DNA is “just right” — a gel poised at the phase boundary between gel and sol, the solid-liquid phase transition.

Think of pudding, panna cotta — or even porridge. The consistency of these delectables must be just right to be ideally enjoyed. Just as the “sol-gel” phase transition, according to the scientists, seems just right for explaining the timing of genomic interactions that dictate gene expression and somatic recombination.

“This finding points to a general physical principle of chromosomal organization, which has important implications for many key processes in biology, from antibody production to tissue differentiation,” said Olga Dudko, a theoretical biophysicist and professor in the Department of Physics at UC San Diego, who collaborated with colleague Cornelis Murre, a distinguished professor in the Section of Molecular Biology, on the study.

Along with Dudko’s former graduate student Yaojun Zhang, now a postdoctoral researcher at Princeton, and Murre’s postdoctoral scholar Nimish Khanna, the team collected and analyzed data on DNA motion inside live mammalian B-cells from mice to understand how remote genomic interactions generate a diverse pool of antibodies by the adaptive immune system.

In mammals, such as rodents and humans, immunoglobin gene segments are arranged in groups of variable (V), diversity (D) and joining (J) segments. These V, D and J segments randomly combine through the process of somatic recombination. This occurs before antigen contact and during B-cell development in the immune system’s lymphoid tissue, or bone marrow. These random genetic interactions result in diverse protein codes that match up with antigens which activate lymphocytes.

The scientists examined the various interactions between V and DJ gene segments. While how exactly these interactions occur remains unknown, the UC San Diego researchers developed a strategy to track V and DJ motion in B-lymphocytes. They found that V and DJ segments were trapped in configurations that allowed local motion only — in other words, the segments remained spatially proximal if they were initially close or they remained separate if they were initially spatially distant. The researchers also observed, within a subset of cells, abrupt changes in V and DJ motion, plausibly caused by temporal changes in chromatin.

By comparing experimental and simulated data, the scientists concluded that constrained motion is imposed by a network of cross-linked chromatin chains, or a mesh of bridges between the DNA strands that are characteristic of a gel phase. Yet, the amount of these cross-links is “just right” to poise the DNA near the sol phase — a liquid phase describing a solution of uncross-linked chains.

This pattern suggested to the scientists that a certain organizational principle of genomic DNA exists — proximity to the sol-gel phase transition — which explains how the genome can simultaneously possess stability and responsiveness within the nucleus.

These results indicate that the packing pattern of DNA within a cell’s nucleus has consequences for a cell’s fate — whether it becomes a live or diseased cell.

“We have rigorous theories from physics — abstract principles and mathematical equations. We have state-of-the-art experiments on biology — innovative tracking of gene segments in live mammalian cell nuclei,” noted Zhang. “It really amazes and excites me when the two aspects merge coherently into one story, where physics is not just a tool to describe the dynamics of gene segments, but helps to pinpoint the physical state of the genome, and further sheds light on the impact of the physical properties of this state on its biological function.”

C. auris is an emerging fungal pathogen that can cause large outbreaks in healthcare facilities. Understanding how C. auris spreads in healthcare facilities is essential for infection control. Because C. auris can be present on the skin without causing symptoms, it has been hypothesized that the spread of C. auris occurs as patients naturally shed their skin cells. This process could lead to substantial contamination of the surrounding environment and therefore increase chances of transmitting C. auris.

To test this hypothesis, the researchers developed methods to count C. auris in samples collected from patients’ skin and their rooms. We found that patients can have very high concentrations of C. auris on their skin, and higher levels of C. auris on their skin were correlated with higher levels of C. auris on the patient’s bed.

“This finding supported our hypothesis that patients are actively shedding C. auris cells into their environment,” said Joe Sexton, ORISE post-doctoral fellow in the Mycotic Diseases Branch at the Centers for Disease Control and Prevention, who designed and led the study. The researchers were able to culture live C. auris from the beds of all patients who tested positive, and even beds that were previously, but no longer, occupied by patients with C. auris.

“These results should be considered in developing more effective strategies for infection control efforts during a C. auris outbreak,” said Dr. Sexton.

Patient and environmental samples were processed in the Mycotic Diseases Branch laboratory in Atlanta by Joe Sexton, Meghan Bentz, and Rory Welsh and Anastasia Litvintseva, who served as a principal investigator (PI). These samples were collected by the City of Chicago’s Public Health Department led by Massimo Pacilli.

Additional groups within CDC also supported this work including the Department of Scientific Resources and the Division of Healthcare Quality and Promotion, and the Oak Ridge Institute for Science and Education. This work will be presented at American Society of Microbiology (ASM) Microbe 2019 conference in San Francisco, California (June 20-24, 2019).

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Epidemiologists from the local public health department and the California Department of Public Health (CDPH) collaborated with laboratory scientists from the CDPH Microbial Diseases Laboratory (MDL) to characterize the strain and identify potential transmission pathways in combination with epidemiologic information.

The bacterial strain persisted in the hospital for over 3 years, potentially due to transmission from patient to patient combined with lengthy stays in the hospital intensive care unit (ICU). “Our investigation highlights the importance of regular epidemiological and microbiological monitoring of resistant strains in hospitals and the use of the advanced molecular technologies to track their spread,” said Varvara Kozyreva, Ph.D. Genotyping Unit Chief, Microbial Diseases Laboratory Program, California Department of Public Health.

Between 2013 and 2015, the hospital identified eight patients who were positive for a strain of Klebsiella pneumoniae bacteria that produced an enzyme conferring resistance to carbapenems. The initial four patients identified with the resistant strain had overlapping stays in the ICU over a one-month period. One of these initial patients remained in the ICU for two years, during which time an additional four patients with the resistant bacterial strain were found in the facility. WGS analyses of the bacteria from the eight different patients demonstrated they were all highly related genetically.

“WGS allowed us to understand and demonstrate connections among the patients over a multiple year time period, which would not have been possible using epidemiologic information alone,” said Dr. Kozyreva. WGS also showed that this particular bacterial strain’s carbapenem-resistance gene appeared to be located on the chromosome. Normally, such resistance genes are located on additional “mobile” DNA pieces called plasmids, that can be transferred between different strains (and even different species) of bacteria.

“Since this particular strain had less means to efficiently share its carbapenem-resistance genes with other bacteria in the hospital environment, it is all the more likely that this one antibiotic-resistant clone of bacteria persisted in the hospital over multiple years,” said Dr. Kozyreva. Using WGS to track resistant bacterial strains can help hospitals and public health officials target infection control interventions to halt transmission sooner.

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A kitchen sponge is exposed to all kinds of different microbes, which form a vast microbiome of bacteria. Phages are the most abundant biological particles on the planet and are typically found wherever bacteria reside. With this understanding, kitchen sponges seemed a likely place to find them.

Students in a research class isolated bacteria from their own used kitchen sponges and then used the bacteria as bait to find phages that could attack it. Two students successfully discovered phages that infect bacteria living in their kitchen sponges. “Our study illustrates the value in searching any microbial environment that could harbor potentially useful phages,” said Brianna Weiss, a Life Sciences student at New York Institute of Technology.

The researchers decided to “swap” these two phages and see if they could cross-infect the other person’s isolated bacteria. Consequently, the phages did kill the other’s bacteria. “This led us to wonder if the bacteria strains were coincidentally the same, even though they came from two different sponges,” said Weiss.

The researchers compared the DNA of both isolated strains of bacteria and discovered that they were both members of the Enterobacteriaceae family. These bacteria belong to a rod-shaped group of microbes commonly found in feces, where some cause infections in hospital settings. Although the strains are closely related, when performing biochemical testing they found chemical variations between them.

“These differences are important in understanding the range of bacteria that a phage can infect, which is also key to determining its ability to treat specific antibiotic-resistant infections,” said Weiss. “Continuing our work, we hope to isolate and characterize more phages that can infect bacteria from a variety of microbial ecosystems, where some of these phages might be used to treat antibiotic-resistant bacterial infections.”

This project began as part of an undergraduate research class with seven students at the New York Institute of Technology (NYIT) in Old Westbury, New York. The course was funded through internal grants provided by (NYIT), which also supported our later work to further characterize the isolated bacteria and bacteriophages. This second phase of our work will be presented on a poster at ASM Microbe on Sunday, June 23rd.

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