[Hemodynamics-based analysis of factors associated with aneurysm rupture in different sides of the internal carotid artery]

Objective: To explore the influence of hemodynamics, morphological and clinical characteristics on rupture risk of the dorsal and non-dorsal internal carotid artery aneurysms (ICAAs). Methods: A total of 111 patients diagnosed with aneurysm by digital subtraction angiography (DSA) or surgery, underwent cranial CT angiography (CTA) were retrospectively collected from January 2010 to December 2016 at the Department of Diagnostic Radiology, Jinling Clinical College of Xuzhou Medical University (General Hospital of Eastern Theater Command). Among them, 41 were males and 70 were females, ranging in age from 32 to 83 (56±11) years old. The patients were divided into the ruptured group (n=54) and unruptured group (n=57) based on the hemorrhagic manifestation on non-enhanced CT images or DSA or surgery of the head. Demographics and the morphological characteristics of the aneurysms were evaluated. Hemodynamic parameters, including wall share stress, wall share stress gradient, and others were obtained in overall using computational fluid dynamics simulation technique. Characteristics were compared between the ruptured and unruptured groups. Logistic regression analysis was applied to evaluate the independent risk factors for rupture, and the hemodynamic characteristics associated with dorsal and non-dorsal aneurysms were analyzed, respectively. Results: Compared with the unruptured group, patients in the ruptured group were younger ((54.2±11.4) years and (58.3±9.9) years, P=0.033), mostly female (74.1% vs 52.6%, P<0.05), with a higher proportion of hypertension (46.3% vs 22.8%, P=0.009). The ruptured internal carotid artery aneurysms (ICAAs) were more frequently located at the dorsal of an arterial arch (57.4% vs 36.8%, P<0.05), and the flow of the blood was more complex, concentrated, unstable, and with a smaller impingement zone (68.5% vs 33.3%,55.6% vs 10.5%,72.2% vs 26.3% and 79.6% vs 36.8%, respectively, all P<0.05). Logistic regression demonstrated that women, hypertension, dorsal, concentrated flow pattern, and unstable flow pattern were an independent risk factors for ICAAs rupture [OR=3.551 (1.080-11.679), 3.900 (1.172-12.976), 4.966 (1.504-16.401), 51.893 (7.913-340.296) and 50.015 (8.423-296.985), respectively, all P<0.05]. The ruptured ICAAs located at non-dorsal had more concentrated, unstable, and with smaller impingement zone (P<0.05), while those at dorsal had more complex, concentrated, and unstable flow patterns, and with smaller impingement zone (all P<0.05). Conclusion: Women, hypertension, dorsal concentration, and unstable flow pattern are independent risk factors for the rupture of ICAAs. The dorsal locations of ICAAs could have a higher risk of rupture.

Effects of rearing systems on production performance, antioxidant capacity and immune status of meat ducks at different ages

As potential substitutes for traditional free-range rearing system, floor-rearing system (FRS) and net-rearing system (NRS) are the current predominant dryland duck rearing systems. However, the influence of these two systems on production performance and duck health is poorly understood. In this study, a 2 × 3 factorial arrangement with two rearing systems (FRS and NRS) and three ages (4w, 8w and 13w) was conducted to study the effects of FRS and NRS on production, antioxidant capacity and immune status of Nonghua ducks. The production performance was mainly affected by the effect of rearing systems at 8w. Body weight, average daily gain, eviscerated weight and semi-eviscerated weight were higher in NRS ducks at 8w, but carcass yield at 8w and 13w was decreased (P < 0.05). Lipid deposition was enhanced in NRS and higher sebum and abdominal fat yields were seen at 8w and 13w (P < 0.05). NRS resulted in developmental retardation of the liver at 4w and decreased gizzard index at all ages (P < 0.05). Antioxidant capacity indicators were unaffected by rearing systems (P > 0.05), however, in NRS, slightly better antioxidant capacity was seen at 4w, while glutathione peroxidase (GSH-Px) activity was higher at 13w (P < 0.05). NRS ducks had higher thymus weight at 8w and higher spleen weight at 13w (P < 0.05). Immune cytokines were extensively affected by rearing system (P < 0.05) and higher levels of interferon-γ, interleukin-1β, interleukin-4 and immunoglobulins were seen in NRS ducks. Serum biochemical parameters (aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP)) showed that NRS was better for liver health, and in the liver of FRS ducks, ALP was higher at 13w, and both ALP and interferon-γ were higher at 13w than at 4w and 8w (P < 0.05). In conclusion, this study showed that NRS was, to an extent, conducive to production performance and duck liver health, but compared to FRS, defects were seen in visceral organ development and lipid deposition. Although antioxidant capacity was not significantly affected, NRS ducks may have better antioxidant capacity at the early breeding stage, and GSH-Px activity was increased for scavenging excess free radicals at the later one. NRS increased serum levels of interferon-γ, interleukin-1β, interleukin-4 and immunoglobulins and promoted thymus and spleen development, thus improving duck immune function. These findings will provide a reliable reference for selecting a rearing system.

Pediatric allergic rhinitis with functional gastrointestinal disease: Associations with the intestinal microbiota and gastrointestinal peptides and therapeutic effects of interventions

Children are susceptible to allergic rhinitis (caused by external allergens) accompanied by functional gastrointestinal disease, which seriously affects physical and mental health. Antihistamines and nasal spray hormones are commonly used in clinical treatment, but these drugs often have unsatisfactory efficacy and result in high recurrence rates. Therefore, understanding the pathogenesis of allergic rhinitis with functional gastrointestinal disease and seeking safer treatment and prevention methods is essential. Herein, molecular ecology and immunoassays were used to analyze correlations between pediatric allergic rhinitis with functional gastrointestinal disease and both the intestinal microbiota and gastrointestinal peptide levels. Fifty healthy children (healthy group) and 80 children with allergic rhinitis with functional gastrointestinal disease (case group: evenly divided into a control group (conventional drug therapy) and an intervention group (conventional drug therapy + glutamine+probiotics)), were enrolled. Bifidobacterium and Lactobacillus counts and the gastrin and motilin levels were lower in the case group than in the healthy group, whereas Enterobacter, yeast, and Enterococcus counts and the somatostatin, serotonin, and vasoactive intestinal peptide levels were higher. Post treatment, intestinal microbiota indices, gastrointestinal peptide levels, and intestinal barrier function were better in the intervention group than in the control group (p < 0.05). The intervention group had a significantly higher total therapeutic response rate (95.00%) than the control group (77.50%). The intestinal microbiota was closely associated with gastrointestinal peptide levels. Treatment with glutamine and probiotics regulated these levels, re-established balance in the intestinal microbiota, and restored intestinal barrier function.

Machine Learning-Based Prediction of Small Intracranial Aneurysm Rupture Status Using CTA-Derived Hemodynamics: A Multicenter Study

BACKGROUND AND PURPOSE

Small intracranial aneurysms are being increasingly detected while the rupture risk is not well-understood. We aimed to develop rupture-risk models of small aneurysms by combining clinical, morphologic, and hemodynamic information based on machine learning techniques and to test the models in external validation datasets.

MATERIALS AND METHODS

From January 2010 to December 2016, five hundred four consecutive patients with only small aneurysms (<5 mm) detected by CTA and invasive cerebral angiography (or surgery) were retrospectively enrolled and randomly split into training (81%) and internal validation (19%) sets to derive and validate the proposed machine learning models (support vector machine, random forest, logistic regression, and multilayer perceptron). Hemodynamic parameters were obtained using computational fluid dynamics simulation. External validation was performed in other hospitals to test the models.

RESULTS

The support vector machine performed the best with areas under the curve of 0.88 (95% CI, 0.85-0.92) and 0.91 (95% CI, 0.74-0.98) in the training and internal validation datasets, respectively. Feature ranks suggested hemodynamic parameters, including stable flow pattern, concentrated inflow streams, and a small (<50%) flow-impingement zone, and the oscillatory shear index coefficient of variation, were the best predictors of aneurysm rupture. The support vector machine showed an area under the curve of 0.82 (95% CI, 0.69-0.94) in the external validation dataset, and no significant difference was found for the areas under the curve between internal and external validation datasets (P = .21).

CONCLUSIONS

This study revealed that machine learning had a good performance in predicting the rupture status of small aneurysms in both internal and external datasets. Aneurysm hemodynamic parameters were regarded as the most important predictors.

MiR-181a-5p inhibits goose granulosa cell viability by targeting SIRT1

1. Granulosa cells (GCs) are involved in folliculogenesis, follicular development, and atresia. Previous studies have shown that microRNA-181a-5p (miR-181a-5p) and sirtuin 1 (SIRT1) are involved in GC proliferation and apoptosis, and SIRT1 has been predicted as one target of miR-181a-5p. However, there are few studies with poultry.2. Quantitative real-time PCR (qRT-PCR) was used to detect the expression level of miR-181a-5p in granulosa layers during geese ovarian follicular development. A methyl thiazolyl tetrazolium (MTT) assay was performed to assess the viability of geese granulosa cells treated with miR-181a-5p mimic or inhibitor. The binding sites between the SIRT1 3'-UTR region and miR-181a-5p were evaluated using a luciferase reporter assay system. SIRT1 mRNA levels were detected using qRT-PCR after transfection with miR-181a-5p mimic and inhibitor.3. The miR-181a-5p suppressed geese GC viability and regulated the mRNA expression of viability-related genes in geese GCs. SIRT1 was a target gene of miR-181a-5p and miR-181a-5p suppressed its mRNA expression.4. The miR-181a-5p may target and inhibit SIRT1 expression, thus suppressing GC viability by regulating viability-related key genes.

The role of structure and function changes of sensory nervous system in intervertebral disc-related low back pain

Low back pain (LBP) is a common musculoskeletal symptom, which can be developed in multiple clinical diseases. It is widely recognized that intervertebral disc (IVD) degeneration (IVDD) is one of the leading causes of LBP. However, the pathogenesis of IVD-related LBP is still controversial, and the treatment means are also insufficient to date. In recent decades, the role of structure and function changes of sensory nervous system in the induction and the maintenance of LBP is drawing more and more attention. With the progress of IVDD, IVD cell exhaustion and extracellular matrix degradation result in IVD structural damage, while neovascularization, innervation and inflammatory activation further deteriorate the microenvironment of IVD. New nerve ingrowth into degenerated IVD amplifies the impacts of IVD-derived nociceptive molecules on sensory endings. Moreover, IVDD is usually accompanied with disc herniation, which could injure and inflame affected nerves. Under mechanical and pro-inflammatory stimulation, the pain-transmitting pathway exhibits a sensitized function state and ultimately leads to LBP. Hence, relevant pathogenic factors, such as neurotrophins, ion channels, inflammatory factors, etc., are supposed to serve as promising therapeutic targets for LBP. The purpose of this review is to comprehensively summarize the current evidence on 1) the pathological changes of sensory nervous system during IVDD and their association with LBP, and 2) potential therapeutic strategies for LBP targeting relevant pathogenic factors.

[Analysis on clinical efficacy, safety and economy of Shaobei injection and elastic band ligation in the treatment of grade II or III hemorrhoids]

Objective: Currently, various treatments such as hemorrhoidectomy, ligation and sclerotherapy injection can be applied in grade II or III hemorrhoids. This study aims to compare the clinical efficacy, safety and economy between Shaobei injection and elastic band ligation in treating patients with grade II or grade III hemorrhoids. Methods: A retrospective cohort study was used. Clinical data of 60 patients with grade II or grade III hemorrhoids at Department of Anorectal Surgery of the Sixth Affiliated Hospital, Sun Yat-sen University between January 2019 and October 2019 were collected. Patients were divided into two groups according to surgical methods. Patients in the Shaobei group received Shaobei injection (n=28), and those in the ligation group received elastic band ligation (n=32). Inclusion criteria: (1) diagnosis of grade II or III hemorrhoid; (2) application of Shaobei injection or elastic band ligation; (3) age between 18-75 years old. Exclusion criteria: (1) comorbidity with anal fissure, anal fistula, anal sinusitis or other perianal diseases; (2) patients with mental disorder or poor compliance; (3) incomplete clinical or follow-up data. Recurrent rate, postoperative pain, anal edema, anal distension, total cost of hospitalization, length of hospitalization, and postoperative life quality EQ-5D-3L score were compared between the two groups at postoperative 6-month. Results: No significant difference was observed in the baseline data (including Nystrom hemorrhoid symptom score) between the two groups (all P>0.05), except gender ratio [male proportion: Shaobei 75% (21/28) vs. ligation 37.5%(12/32), χ(2)=8.485, P=0.004]. No significant difference in recurrent rate was found between the two groups [14.3% (4/28) vs. 9.4% (3/32), χ(2)=0.035, P=0.851]. Compared to the ligation group, Shaobei group showed less pain at postoperative day 1 [VAS median (range): 2 (1-6) vs. 3 (1-7), Z=2.814, P=0.005] and postoperative day 7 [VAS median (range): 0 (0-2) vs. 1 (0-4), Z=3.149, P=0.002]; lower anal edema ratio at postoperative day 1 [10.7% (3/28) vs. 34.4% (11/32), Z=4.673, P=0.037]; lower anal distension ratio at postoperative day 1 [7.1% (2/28) vs. 28.1% (9/32), Z=4.391, P=0.048]; less hospitalization cost [(6343.5±1444.1) yuan vs. (10 587.1± 1719.0) yuan, t=12.515, P<0.001] and shorter postoperative hospital stay [median (range): 1 (1-5) days vs. 3 (1-6) days, Z=5.879, P<0.001]. The EQ-5D-3L scores of two groups were significantly improved six months after treatment [Shaobei group: (0.90±0.16) vs. (0.73±0.14); ligation group: (0.91±0.13) vs. (0.74±0.10); both P<0.001], while there was no statistically significant difference between the two groups (t=0.130, P=0.897). No complications such as massive hemorrhage, infection, iatrogenic anal fistula, rectal stricture and local induration occurred after the injection. Conclusions: Shaobei injection is effective and safe in treating grade II or III hemorrhoids. Compared with elastic band ligation, it can reduce morbidity of complications and hospitalization expenses.

Comparison of overfeeding effects on gut physiology and microbiota in two goose breeds

To have a better understanding of how the “gut–liver axis” mediates the lipid deposition in the liver, a comparison of overfeeding influence on intestine physiology and microbiota between Gang Goose and Tianfu Meat Goose was performed in this study. After force-feeding, compared with Gang Goose, Tianfu Meat Goose had better fat storage capacity in liver (397.94 vs. 166.54 for foie gras weight (g), P < 0.05; 6.37 vs. 2.92% for the ratio of liver to body, P < 0.05; 60.01 vs. 46.64% for fat content, P < 0.05) and the less subcutaneous adipose tissue weight (1240.96 g vs. 1440.46 g, P < 0.05). After force-feeding, the digestion–absorption capacity of Tianfu Meat Goose was higher than that of Gang Goose (5.56 vs. 3.64 and 4.63 vs. 3.68 for the ratio of villus height to crypt depth in duodenum and ileum, respectively, P < 0.05; 1394.96 vs. 782.59 and 1314.76 vs. 766.17 for the invertase activity (U/mg-prot), in duodenum and ileum, respectively, P < 0.05; 6038.36 vs. 3088.29 and 4645.29 vs. 3927.61 for the activity of maltase (U/mg-prot), in duodenum and ileum, respectively, P < 0.05). Force-feeding decreased the gene expression of Escherichia coli in the ileum of Tianfu Meat Goose; force-feeding increased the number of gut microbiota Enterobacterial Repetitive Intergenic Consensus-Polymerase Chain Reaction band in Tianfu Meat Goose and decreased the number in Gang Goose. In conclusion, compared with Gang Goose, the lipid deposition in the liver and the intestine digestion–absorption capacity and stability were higher in Tianfu Meat Goose. Thereby, Tianfu Meat Goose is the better breed for foie gras production for prolonged force-feeding; Gang Goose possesses better fat storage capacity in subcutaneous adipose tissue. However, Gang Goose has lower gut stability responding to force-feeding, so Gang Goose is suited to force-feeding in a short time to gain the body weight and subcutaneous fat as an overfed duck for roast duck.

[Methodological considerations in the design of clinical trial for innovative hepatitis B drugs]

The research and development of innovative drugs targeting the clinical cure of chronic hepatitis B has become active in recent years. In the clinical trials of new drugs for hepatitis B, the use of new design concepts, new methods, and new technologies to evaluate the efficacy of innovative drugs is expected to shorten the clinical research process of candidate new drugs and reduce the cost of new drug development. However, the new designs such as seamless adaptive design and master plan design have few practical applications in clinical trials of innovative hepatitis B drugs. This article will focus on the methodological factors in the design of phase II/III clinical trials of innovative hepatitis B drugs, and introduce the key points of the new clinical trial design in order to provide methodological references for the development of innovative hepatitis B drugs.

Identification and iterative combinatorial mutagenesis of a new naringinase-producing strain, Aspergillus tubingensis MN589840

Naringinase was mainly obtained by microbial fermentation, and mutagenesis was a major way for obtaining excellent mutants. The aim of this study was to screen out a high naringinase yielding mutant to enhance the potential application value of its industrialization and compare the effects of different mutagenic methods on the enzyme activity of the strain. A novel producing naringinase strain, Aspergillus tubingensis MN589840, was isolated from mildewed pomelo peel, later subjected to mutagenesis including UV, ARTP and UV-ARTP. After five rounds iterative mutagenesis, the mutants U1, A6 and UA13 were screened out with 1448·49, 1848·71, 2475·16 U mg^-1 enzyme activity, the naringinase productivity raised by 79·08, 123·56 and 206%, respectively. In addition, the naringinase activity of three mutants rose after each round of iterative mutagenesis. These results indicated that the mutagenesis efficiency of UV-ARTP was higher than that of single ARTP, and both are better than UV. In summary, the iterative UV-ARTP mutagenesis is an effective strategy for screening high naringinase-producing strains.

Associations of grip strength with cardiovascular disease and all-cause mortality in people with and without hypertension: findings from the Prospective Urban Rural Epidemiology (PURE) China Study

Background

Hypertension and grip strength (GS) are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to affect both CVD and all-cause mortality is unknown. The study aimed to examine whether the associations between hypertension and GS with the risk of major CVD incidence, CVD mortality, and all-cause mortality differed between people with and without hypertension.

Methods

GS was measured using a Jamar dynamometer in participants aged 35–70 years from 12 provinces in the Prospective Urban Rural Epidemiology (PURE) China study. Hypertension was defined as a baseline systolic and diastolic blood pressure of at least 140/90 mm Hg, a self-reported history of hypertension, or treatment with antihypertensive medications. Cox proportional hazards models were used to examine the associations of GS and hypertension and with the outcomes of all-cause mortality and CVD incidence/mortality, and to test the multiplicative interactions between hypertension and GS.

Results

Among 39,862 participants included in this study, 15,964 reported having hypertension at baseline and 9095 had high GS. After a median follow-up of 8.9 years [interquartile range (IQR) 6.7–9.9 years], 1822 participants developed major CVD, and 1250 deaths occurred (388 as a result of CVD). Compared with normotensive participants with high GS, hypertensive patients with high GS had a higher risk of major CVD incidence (HR 2.36 [95% CI: 1.84–3.02]; P&lt;0.0001) or CVD mortality (HR 3.05 [95% CI: 1.56–5.95]; P&lt;0.0001) but did not have a significantly increased risk of all-cause mortality (HR 1.23 [95% CI: 0.91–1.67]; P=0.181); these risks were further increased if hypertensive participants whose GS level was low (major CVD incidence (HR 3.33 [95% CI: 2.61, 4.24]; P&lt;0.0001), CVD mortality (HR: 5.20 [95% CI: 2.76, 9.82]; P&lt;0.0001), and all-cause mortality (HR 2.00 [95% CI: 1.53, 2.62]; P&lt;0.0001)).

Conclusions

The present study demonstrates that hypertensive patients with low GS are associated with the highest risk of major CVD incidence, CVD mortality, and all-cause mortality. High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.

Association of adverse outcomes

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies. Besides funding from global PURE, this work was also sponsored by CAMS Innovation Fund for Medical Sciences (CIFMS): 2016-I2M-2-004, Construction of Basic Information Technology Support System and Platform for National Prevention and Treatment of Cardiovascular Diseases.

[Characteristics and diversity of infectious diarrheal caused by various pathogens]

Objective: To understand the characteristics and differences of diarrhea-related symptoms caused by different pathogens, and the clinical features of various pathogens causing diarrhea. Methods: Etiology surveillance program was conducted among 20 provinces of China from 2010 to 2016. The acute diarrhea outpatients were collected from clinics or hospitals. A questionnaire was used to survey demographics and clinical features. VFeces samples were taken for laboratory detection of 22 common diarrhea pathogens, to detect and analyze the clinical symptom pattern characteristics of the patient's. Results: A total of 38 950 outpatients were enrolled from 20 provinces of China. The positive rates of Rotavirus and Norovirus were the highest among the five diarrhea-causing viruses (Rotavirus: 18.29%, Norovirus: 13.06%). In the isolation and culture of 17 diarrhea-causing bacterial, Escherichia coli showed the highest positive rates (6.25%). The clinical features of bacterial diarrhea and viral diarrhea were mainly reflected in the results of fecal traits and routine examination, but pathogenic Vibrio infection was similar to viral diarrhea. Conclusion: Infectious diarrhea presents different characteristics due to various symptoms which can provide a basis for clinical diagnosis.

CircABCB10 silencing inhibits the cell ferroptosis and apoptosis by regulating the miR-326/CCL5 axis in rectal cancer

Circular ATP binding cassette subfamily B member 10 (circABCB10) has been identified to have oncological functions in several tumors. However, the roles of circABCB10 in rectal cancer remain unknown. The expression of circABCB10, microRNA (miR)-326 and C-C motif chemokine ligand 5 (CCL5), and apoptosis related-protein was detected using quantitative real-time polymerase chain reaction or western blot, respectively. Cell survival or apoptosis was measured using cell counting kit-8 assay or flow cytometry. The accumulations of intracellular lipid reactive oxygen species (ROS) and Fe2+ were analyzed using C11-BODIP dye or iron kit assay, respectively. In vivo experiments were conducted using the murine xenograft model. The interaction between miR-326 and circABCB10 or CCL5 was confirmed by dual-luciferase reporter assay and RNA immunoprecipitation assay. CircABCB10 and CCL5 were upregulated but miR-326 was downregulated in rectal cancer. The knockdown of circABCB10 promoted rectal cancer cell ferroptosis and apoptosis in vitro as well as inhibited tumor growth in vivo. miR-326 was a target of circABCB10, and the miR-326 inhibition could partially attenuate circABCB10 deletion-induced cell ferroptosis and apoptosis. miR-326 directly interacted with CCL5, and the miR-326 inhibition suppressed cell ferroptosis and apoptosis by targeting CCL5. Besides, we observed that miR-326 was negatively regulated by circABCB10, while CCL5 was positively regulated by it, and circABCB10 served as a sponge of miR-326 to regulate the CCL5 expression in rectal cancer cells. CircABCB10 silence promoted rectal cancer cell ferroptosis and apoptosis by regulating the miR-326/CCL5 axis, suggesting a potential therapeutic target for rectal cancer therapy.

Simulation of the Multiphysical Coupling Behavior of Active Hearing Mechanism Within Spiral Cochlea

Nobel Laureate von Békésy first presented traveling wave theory, which explains the vibration mechanism of the basilar membrane (BM) of cochlea in 1960, and thus the mysterious veil of passive phonoreceptive mechanism of human cochlea was unveiled. However, the interpretation of active phonoreceptive mechanism of human cochlea has been a major medical problem for mankind. The active mechanism can be reflected in structures and the perilymph where a series of complex coupling nonlinear motion process is observed in the cochlea. Because the cochlea is small and complex, vibration data of the whole BM are not yet available from existing experiments. To address the problem, first, the motion equations of the organ of Corti (OHC) are established, and the circuit equations of the outer hair cells (OHCs) in the perilymph and the relationship between the motion of the outer hair cells and the electromotile force are derived. Then the active feedback force on the BM is obtained. Finally, an analytical–numerical combination model, where both macrostructures and microstructures of cochlea are included, is established. The model not only vividly depicts the spatial helical body and biological materials of the cochlea but also reflects the fluid–solid coupling nonlinear motion of cochlear structures in the electrical environment. Thus, the active hearing mechanism of cochlea is revealed.

Artificial Intelligence in the Management of Intracranial Aneurysms: Current Status and Future Perspectives

Intracranial aneurysms with subarachnoid hemorrhage lead to high morbidity and mortality. It is of critical importance to detect aneurysms, identify risk factors of rupture, and predict treatment response of aneurysms to guide clinical interventions. Artificial intelligence has received worldwide attention for its impressive performance in image-based tasks. Artificial intelligence serves as an adjunct to physicians in a series of clinical settings, which substantially improves diagnostic accuracy while reducing physicians' workload. Computer-assisted diagnosis systems of aneurysms based on MRA and CTA using deep learning have been evaluated, and excellent performances have been reported. Artificial intelligence has also been used in automated morphologic calculation, rupture risk stratification, and outcomes prediction with the implementation of machine learning methods, which have exhibited incremental value. This review summarizes current advances of artificial intelligence in the management of aneurysms, including detection and prediction. The challenges and future directions of clinical implementations of artificial intelligence are briefly discussed.

Function of agricultural waste montmorillonite-biochars for sorptive removal of 17β-estradiol

Agricultural wastes of cow manure and wheat straw were used to prepare montmorillonite (Mt)-biochars (CMt and WMt) for sorptive removal of 17β-estradiol (E2) from aqueous solution. The E2 adsorption performance of the two Mt-biochars was investigated using systematic adsorption kinetics and isotherms. The results exhibited that the maximum E2 adsorption amount of CMt was 41.02 mg/g, while it was 62.89 mg/g for WMt. Meanwhile, intraparticle diffusion model demonstrated that intraparticle diffusion was not the only rate-limiting step, both film diffusion and intraparticle diffusion were involved in the diffusion process. Higher pH levels (>10) decreased the adsorption capacities of Mt-biochars for E2. However, the ionic strength and the background electrolytes did not significantly affect adsorption process. Moreover, the two Mt-biochars both exhibited excellent regeneration and reusability. These results provided a potential solution to the recycling of agricultural wastes and the problem of estrogen contaminant.

Loss of IGF2R indicates a poor prognosis and promotes cell proliferation and tumorigenesis in bladder cancer via AKT signaling pathway

The insulin growth factor 2 receptor (IGF2R) belongs to insulin growth factor (IGF) pathway and has been proposed as the tumor suppressor in many cancers. However, its role in bladder cancer is unknown. In the current study, we reported that IGF2R expression was decreased in bladder cancer tissues (p<0.05). Immunohistochemistry (IHC) and Cox regression analysis showed that low IGF2R expression was significantly associated with more advanced histological grade; high clinical stage; lymph node metastasis and poorer overall survival for patients with bladder cancer. Moreover, silencing IGF2R promoted cell proliferation of bladder cancer cells in vitro and in vivo (p<0.05). Furthermore, knockdown IGF2R resulted in higher phosphorylation level of AKT. The findings of this study indicated that IGF2R played a tumor suppressor role in bladder cancer. Downregulation IGF2R may promote tumor growth by activating AKT signaling pathway. IGF2R could be considered as a promising candidate for novel biomarker and therapeutic target for human bladder cancer.

Open peroral endoscopic myotomy for the treatment of achalasia: a case series of 82 cases

During peroral endoscopic myotomy (POEM), creation of the tunnel is highly technically demanding and mucosal injury is one of the most common potential complications. We explored a method without a submucosal tunnel, which we call open peroral endoscopic myotomy (O-POEM). This study aimed to assess the feasibility and safety of O-POEM. O-POEM was performed on 82 patients with achalasia. Treatment success was defined as an Eckardt score of less than or equal to 3 after the myotomy. Adverse events including operative and postoperative adverse events were recorded. Treatment success and procedure-related adverse events were analyzed. After a median follow-up of 18 months (range: 6-26 months), the treatment success (Eckhart score ≤3) was achieved in 96.3% of cases (mean score pre- vs. post-treatment (7.4 vs. 1.8); P < 0.001) with a recurrence of 3 cases. Ten patients (12.2%) had adverse events consisting of 2 cases of mediastinitis, 1 case of post-O-POEM bleeding, 1 case of subcutaneous emphysema, 6 cases of pleural effusion. Two cases of mediastinitis required intraprocedural drainage, and other patients were managed by endoscopy and conservative medical treatment. There were no deaths. No patients required surgical conversion. Clinical reflux occurred in 15.9% of patients (13/82). O-POEM was reliable and effective for the treatment of achalasia. In addition, O-POEM might be a better option for patients with severe submucosal fibrosis.

Adsorption of 17β-estradiol onto humic-mineral complexes and effects of temperature, pH, and bisphenol A on the adsorption process

The long-term use of animal manure in agriculture has resulted in estrogen pollution, which poses risks to facility vegetable soils. Owing to the complex soil composition, estrogen may exhibit a variety of behaviors at the water/soil interface. This study demonstrated the role of humic acid (HA) on the 17β-estradiol (E2) adsorption by clay minerals (montmorillonite, kaolinite, and hematite). The interfacial behaviors were investigated using adsorption kinetics and isotherms data. Then, the effects of temperature, pH, and bisphenol A (BPA) on the interactions between humic-mineral complexes and E2 were explored. The adsorption of E2 is an exothermic and spontaneous process, and the addition of HA to minerals significantly promoted their E2 adsorption capacities. Higher pH levels (>10) and the presence of BPA decreased the adsorption capacities of minerals and mineral complexes for E2. Moreover, intercalation, hydrophobic partitioning, π-π interactions and hydrogen bonding could dominate the E2 adsorption onto complexes. These results provided insight into the interfacial behaviors of E2 on the surfaces of humic-mineral complexes and promoted the understanding of the migration and transport of estrogens in soils.

Diverse expression regulation of Hsp70 genes in scallops after exposure to toxic Alexandrium dinoflagellates

Heat shock proteins 70KD (Hsp70s) are highly conserved molecular chaperones with essential roles against biotic and abiotic stressors. Marine bivalves inhabit highly complex environments and could accumulate paralytic shellfish toxins (PSTs), the well-noted neurotoxins generated during harmful algal blooms. Here, we systematically analyzed Hsp70 genes (CfHsp70s) in Zhikong scallop (Chlamys farreri), an important aquaculture mollusk in China. Sixty-five CfHsp70s from eight sub-families were identified, and 47 of these genes showed expansion in the Hspa12 sub-family. After exposure to different PST-producing dinoflagellates, Alexandrium minutum and Alexandrium catenella, diverse CfHsp70s regulation presented in scallop hepatopancreas, mainly accumulating incoming PSTs, and kidneys, transforming PSTs into higher toxic analogs. All the up-regulated CfHsp70s were from CfHsp70B2, CfHspa12, and CfHspa5 sub-families. CfHsp70B2 sub-family was mainly induced in the hepatopancreas, and CfHspa12 sub-family was highly induced in the kidneys. CfHsp70s up-regulation under two dinoflagellates exposure was stronger in the kidneys (log₂FC: 19.5 and 18.6) than that in hepatopancreas (log₂FC: 4.3 and 6.1). Exposure to different Alexandrium species had varying effects, that in hepatopancreas, CfHsp70B2s were chronically induced only after A. catenella exposure, whereas in kidney, CfHspa12s were more acutely induced after exposure of A. minutum than A. caenella. Moreover, in Yesso scallops (Patinopecten yessoensis), only Hspa12s were up-regulated in hepatopancreas after A. catenella exposure, and all the Hsp70B2s were down-regulated. These organ-, toxin-, and species-dependent Hsp70 regulation suggested the functional diversity of duplicated Hsp70s in response to the stress by PST-producing algae. Our findings provide insights into the evolution and functional characteristics of Hsp70s in scallops.

SPOP suppresses osteosarcoma invasion via PI3K/AKT/NF-κB signaling pathway

OBJECTIVE

Speckle-type POZ protein (SPOP), is an E3 ubiquitin ligase adaptor that is frequently mutated in prostate and endometrial cancers. SPOP has been shown to be responsible for oncogene SRC-3 ubiquitination and proteolysis in prostate cancers.  However, whether SPOP plays a role in osteosarcoma (OS) is unknown. In this study, we investigated the inhibitory effect of SPOP on invasion and migration of OS cells.

PATIENTS AND METHODS

Real-time PCR and Western blot were used to detect the expression of SPOP in human OS samples and cell lines. Short hairpin RNA (shRNA) was used to silencing the expression of SPOP. Small scale Real-time PCR screen was used to identify the matrix metalloproteases (MMP) family members responsible for the phenotype caused by SPOP depletion. Matrigel-coated invasion chambers were used to detect the invasion ability of SPOP in OS cells.

RESULTS

We found that SPOP was down-regulated in clinic OS samples and cultured OS cells. Furthermore, we showed that silencing of SPOP promoted cell migratory and invasive ability of OS cells in vitro, whereas restored the expression of SPOP achieved the opposite effects. At the molecular level, we found that SPOP regulated the activity of "PI3K/Akt/NF-κB" signaling pathway in OS cells.

CONCLUSIONS

Our results suggested that down-regulation of SPOP promoted OS cells migratory and invasive ability via modulating the "PI3K/Akt/NF-κB" signaling pathway. Thus, SPOP could be a promising drug target for the treatment of OS invasion.

Machine learning algorithms can classify outdoor terrain types during running using accelerometry data

BACKGROUND

Running is a popular physical activity that benefits health; however, running surface characteristics may influence loading impact and injury risk. Machine learning algorithms could automatically identify running surface from wearable motion sensors to quantify running exposures, and perhaps loading and injury risk for a runner.

RESEARCH QUESTION

(1) How accurately can machine learning algorithms identify surface type from three-dimensional accelerometer sensors? (2) Does the sensor count (single or two-sensor setup) affect model accuracy?

METHODS

Twenty-nine healthy adults (23.3 ± 3.6 years, 1.8 ± 0.1 m, and 63.6 ± 8.5 kg) participated in this study. Participants ran on three different surfaces (concrete, synthetic, woodchip) while fit with two three-dimensional accelerometers (lower-back and right tibia). Summary features (n = 208) were extracted from the accelerometer signals. Feature-based Gradient Boosting (GB) and signal-based deep learning Convolutional Neural Network (CNN) models were developed. Models were trained on 90% of the data and tested on the remaining 10%. The process was repeated five times, with data randomly shuffled between train-test splits, to quantify model performance variability.

RESULTS

All models and configurations achieved greater than 90% average accuracy. The highest performing models were the two-sensor GB and tibia-sensor CNN (average accuracy of 97.0 ± 0.7 and 96.1 ± 2.6%, respectively).

SIGNIFICANCE

Machine learning algorithms trained on running data from a single- or dual-sensor accelerometer setup can accurately distinguish between surfaces types. Automatic identification of surfaces encountered during running activities could help runners and coaches better monitor training load, improve performance, and reduce injury rates.

MiR-19b Functions as a Potential Protector in Experimental Autoimmune Encephalomyelitis

BACKGROUND

MicroRNA-19b (miR-19b) is essential in determining oligodendroglia proliferation. Phosphatase and tensin homologue on chromosome 10 (PTEN) is considered the target of miR-19b and participates in oligodendrocyte differentiation and proliferation.

METHODS

Murine EAE was induced by myelin oligodendrocyte glycoprotein (MOG35- 55). For EAE reversal, artificially synthesized agomiR-19b was intravenous injected after immunization.

RESULTS

We found that the expression of miR-19b is significantly reduced in an experimental autoimmune encephalomyelitis (EAE) mouse model. This downregulation, which is associated with the neurological scores, can be dramatically ameliorated by agomiR-19b. Our results show that agomiR-19b increases the expression of myelin basic protein (MBP) and cyclic nucleotide phosphodiesterase (CNP), which are regularly utilized as molecular markers of oligodendrocytes. Furthermore, our study also revealed that miR-19b probably affects the expression of PTEN in the EAE model.

CONCLUSION

These results indicate that the restoration of miR-19b probably exerts its therapeutic effect by affecting PTEN in the pathogenesis of EAE.

Seven Novel and Three Known Mutations in FOXL2 in 10 Chinese Families with Blepharophimosis Syndrome

BACKGROUND

Blepharophimosis syndrome (BPES) is characterized by eyelid malformation with occasional premature ovarian failure. Mutations in FOXL2 underlie a fraction of BPES cases.

OBJECTIVE

We aimed to investigate the genetic basis of BPES in 26 Chinese families that included 78 patients.

METHODS

We performed ophthalmological examinations on each family member. We used Sanger sequencing to screen FOXL2 exons and their flanking sequences. We also performed bioinformatics studies, structural modeling and pathogenicity evaluations on all identified variations. Literature was reviewed and genotype-phenotype correlation analysis was performed.

RESULTS

The patients had typical manifestations of BPES. Ten mutations were identified in ten of the twenty-six families. Among these, seven were novel mutations. These included the six truncating mutations, p.Glu69*, p.Gly256Glyfs*14, p.Ala14Serfs*135, p.Pro333Profs*200, p.Pro290Leufs*70, and p.Pro157Profs*91, and one missense mutation, p.Tyr59Cys. The mutations were scattered within the gene, and no mutational hotspots were found. Genotype-phenotype correlation analysis showed that frameshift or nonsense mutations were correlated with type I BPES, while in-frame or missense mutations were associated with type II BPES.

CONCLUSION

We report the largest BPES cohort in China thus far as well as seven novel mutations in FOXL2. The identification of novel mutations has not only expanded the mutational spectrum of the gene (which is valuable for mutation detection-based screening) but also suggests that most mutations within the Chinese population may not have been characterized yet.

Notch Coordinates Periodontal Ligament Maturation through Regulating Lamin A

Tooth eruption is a continuous biological process with dynamic changes at cellular and tissue levels, particularly within the periodontal ligament (PDL). Occlusion completion is a significant physiological landmark of dentition establishment. However, the importance of the involvement of molecular networks engaging in occlusion establishment on the final PDL maturation is still largely unknown. In this study, using rat and mouse molar teeth and a human PDL cell line for RNAseq and proteomic analysis, we systematically screened the key molecular links in regulating PDL maturation before and after occlusion establishment. We discovered Notch, a key molecular pathway in regulating stem cell fate and differentiation, is a major player in the event. Intercepting the Notch pathway by deleting its key canonical transcriptional factor, RBP-Jkappa, using a conditional knockout strategy in the mice delayed PDL maturation. We also identified that Lamin A, a cell nuclear lamina member, is a unique marker of PDL maturation, and its expression is under the control of Notch signaling. Our study therefore provides a deep insight of how PDL maturation is regulated at the molecular level, and we expect the outcomes to be applied for a better understanding of the molecular regulation networks in physiological conditions such as tooth eruption and movement and also for periodontal diseases.

[Clinical characteristics and next generation sequencing of three cases of Listeria monocytogenes meningitis with complications]

Objective: To summarize the clinical characteristics of Listeria monocytogenes meningitis (LMM) with complications, and analyze the outcomes of next generation sequencing. Methods: Clinical characteristics, laboratory findings, imaging features, antibiotics treatment, and next generation sequencing of cerebrospinal fluid were analyzed in 3 LMM patients who were hospitalized in the Department of Infectious Diseases of Beijing Children's Hospital Affiliated to Capital Medical University from July 2015 to November 2017. Results: The three patients were 1-year-old girl, 2-year-old girl, and 9-year-old boy, with normal immune function. They had eaten refrigerated food, milk or dairy products before onset. Symptoms included fever, headache, abdominal pain, diarrhea, vomiting, and convulsions, etc. The complications of two cases (case 2 and 3) were appendicitis and Meckel's diverticulitis. The other one (case 1) was with sepsis and pneumonia. Leukocyte counts in cerebrospinal fluid were elevated in all the three cases, and cranial magnetic resonance imaging showed meningeal or periventricular involvement. All the children were diagnosed with LMM by positive CSF culture. CSF for next generation sequencing was sent after carbapenem antibiotics using, yet all the results were positive. The positive results were returned 2, 9, and 9 days earlier than culture results, respectively. The gene coverage was 5.00%, 7.00%, 0.04%, and the reads was 2 561, 1 011 and 8, respectively. All the three children had recurrent fever despite using cephalosporin. Levels of leukocytes in the blood and CSF further elevated. After using carbapenem antibiotics, patients improved eventually and were discharged from hospital. Conclusions: LMM can occur in children with normal immune function and is usually associated with digestive system symptoms. Listeria monocytogenes can be detected quickly and accurately by the next generation sequencing technology, without being limited to sampling time and antibiotics application.

Comparative Transcriptome Analysis Reveals Molecular Basis Underlying Fast Growth of the Selectively Bred Pacific Oyster, Crassostrea gigas

Fast growth is one of the most desired traits for all food animals, which affects the profitability of animal production. The Pacific oyster, Crassostrea gigas, is an important aquaculture shellfish around the world with the largest annual production. Growth of the Pacific oyster has been greatly improved by artificial selection breeding, but molecular mechanisms underlying growth remains poorly understood, which limited the molecular integrative breeding of fast growth with other superior traits. In this study, comparative transcriptome analyses between the fast-growing selectively bred Pacific oyster and unselected wild Pacific oysters were conducted by RNA-Seq. A total of 1,303 protein-coding genes differentially expressed between fast-growing oysters and wild controls were identified, of which 888 genes were expressed at higher levels in the fast-growing oysters. Functional analysis of the differentially expressed genes (DEGs) indicated that genes involved in microtubule motor activity and biosynthesis of nucleotides and proteins are potentially important for growth in the oyster. Positive selection analysis of genes at the transcriptome level showed that a significant number of ribosomal protein genes had undergone positive selection during the artificial selection breeding process. These results also indicated the importance of protein biosynthesis and metabolism for the growth of oysters. The alternative splicing (AS) of genes was also compared between the two groups of oysters. A total of 3,230 differential alternative splicing events (DAS) were identified, involved in 1,818 genes. These DAS genes were associated with specific functional pathways related to growth, such as “long-term potentiation,” “salivary secretion,” and “phosphatidylinositol signaling system.” The findings of this study will be valuable resources for future investigation to unravel molecular mechanisms underlying growth regulation in the oyster and other marine invertebrates and to provide solid support for breeding application to integrate fast growth with other superior traits in the Pacific oyster.

Expression of orphan GPR56 correlates with tumor progression in human epithelial ovarian cancer

G protein-coupled receptor 56 (GPR56) has been demonstrated to be a significant prognostic predictor in several types of malignances, including melanoma, glioblastoma, breast cancer, colon cancer, and pancreatic cancer. GPR56 has a putative mucin-like extracellular domain, indicating functions for this receptor in the cell-cell interactions and triggering different downstream signaling pathways responsible for regulating cell survival, proliferation, adhesion, and migration. But the expression and clinical significance of GPR56 has not been elucidated in epithelial ovarian cancer (EOC). We detected GPR56 expression by immunohistochemistry in 110 samples of ovarian serous carcinoma to explore the correlation between its expression and clinicopathologic characteristics and overall survival. As the result, we found that GPR56 expression is significantly associated with advanced FIGO stage (P = 0.01) and positive lymph node invasion (P = 0.016), and it serves as an independent unfavorable prognostic factor through univariate and multivariate analysis. GPR56 knockdown could dramatically decrease the proliferation and invasion of epithelial ovarian cancer cells through down-regulating the RhoA-GTP level and up-regulating the E-cadherin level, which indicates GPR56 could promote the progression and invasion of EOC. In conclusion, GPR56 expression was demonstrated as an independent prognostic factor in EOC, suggesting that GPR56 may play an oncogenic role through the Rho and E-cadherin pathway and GPR56 could be a novel potential drug target in EOC.

[Haploidentical hematopoietic stem cell transplantation in the treatment of acquired aplastic anemia in children: a single center retrospective analysis]

Objective: To investigate the safety and efficacy of haploidentical hematopoietic stem cell transplantation with different intensity conditioning regimen in the treatment of childhood aplastic anemia (AA) . Methods: Thirty-seven AA patients who underwent haploidentical transplantation in BaYi Children's Hospital Affiliated to PLA Army General Hospital from January 2013 to January 2017 were enrolled. According to the dosage of conditioning regimen, 34 patients excluding 3 other conditioning regimens were divided into high-dosage group (regimen 2, 22 cases) and low-dosage group (regimen 3, 12 cases). The data of Engraftment, graft-vs-host disease (GVHD), hematopoietic reconstitution, relapse, infection, overall survival (OS) were analyzed. The comparison between the two groups was tested by χ(2) test. Results: A total of 35 of 37 patients achieved primary engraftment; 2 cases died of regimen-related toxicity and severe infection before the infusing of the grafts. The activation rate of CMV and EBV was 60% (21/35) . Post-transplant lymphocyte disease (PTLD) of lung occurred in one case. The cumulative incidences of acute GVHD grade Ⅰ-Ⅳ and chronic GVHD were 29% (10/35) and 34% (12/35) respectively and the incidence of extensive chronic GVHD was 6% (2/35) . The median follow-up time was 18.8 (2.9-44.1) months, the OS was 92% (34/37) .All survived patients were no longer dependent on blood transfusion and none of them had recurrence. Comparing the rates of overall survival(86%(19/22) vs.100%(12/12)) and rates of chronic GVHD(40%(8/20) vs. 17%(2/12)) in regimen 2 and regimen 3 group, there were no significant difference (χ(2)=1.742, 1.841, all P>0.05) . Significant difference was found at the incidence of Ⅰ-Ⅳ acute GVHD (10% (2/20) vs. 50% (6/12) ,χ(2)=6.200, P=0.013). Conclusions: Haploidentical hematopoietic stem cell transplantation is effective and safe. It is suitable for patients who are not eligible for matched donor transplantation. Application of reduced dose preconditioning in haploid transplantation is worth exploring.

[Characteristics and drug resistance of non-O157 Shiga toxin-producing E. coli in animal feces, from Shandong Province]

Objective: To understand the infection status, characteristics and drug resistance of non-O157 Shiga toxin-producing E. coli (STEC) in animal feces in Shandong Province. Methods: From 2015 to 2016, convient sampling method was used to collect 1 022 fresh feces of animals in Weishan county and Laizhou city, and 24 non-O157 STEC were isolated. The serotypes of non-O157 STEC strains were confirmed through serum agglutination test. The susceptibility was explored through the antimicrobial sensitivity experiments. ESBLs activity was confirmed by double-disc diffusion. PCR method was used to detect the resistance genes. PFGE typing was operated to assess the relatedness and variability of the strains. The multi-locus sequence typing (MLST) was adopted to get the allelic profile and ST sequence of strains. Analysis was made on the evolutionary relationship between different ST groups was made through CLC Sequence Viewer and Counting Express. Results: A total of 24 non-O157 STEC were isolated from animal feces. 23 strains were from pig feces, and 1 strain was from cow feces, and the serotypes were more dispersed. All of the 24 strains carried stx2 genes. The highest resistance rate was sulfamethoxazole(22 strains), the mount of cotrimoxazole and nalidixic acid was 18 strains, chloramphenicol was 13 strains, tetracycline was 19, and there was a phenomenon of multiple drug resistance. The drug resistance spectrum was sulfamethoxazole tetracycline-compound novammin-naphthidine-chloramphenicol. All strains were sensitive to cefepime and imipenem. The ESBLs confirmatory test showed that 4 strains of non O157 STEC produced beta lactamase. PCR detected 7 resistance genes, and 4 tetracycline resistance genes (Tet A, Tet B, tetC and tetD) were detected. The beta lactamase resistance genes (blaSHV-1, bla CTX-M, bla TEM) were all negative. 24 strains were divided into 15 PFGE types, and their clustering results were more dispersed and no dominant PFGE type. There were 11 kinds of MLST types, most of them are ST540 and ST5133 types, each of which was 4 strains, and clustered into 1 MLST genomes. Conclusion: The serotypes of non-O157 STEC in animal feces O157 STEC were dispersed, and the resistant rate to common antibiotic was high. MLST typing results presents obvious polymorphism. Surveillance and manage ment of these strains should be strengthened.

[Survey of current status of prevention of venous thromboembolism after thoracic surgery in China]

Objective: To investigate the current status of prevention and treatment of venous thromboembolism (VTE) after thoracic surgery in China. Method: Chinese thoracic surgeons were investigated by the online questionnaire which was based on the Chinese version of International VTE questionnaire added with 6 extra questions with Chinese characteristics. Results: A total of 1 150 valid questionnaires were retrieved, accounting for about 20% of all the Chinese thoracic surgeons. The surgeons participating in this survey came from all over the country, most of whom were experienced professionals with high academic titles.For lung cancer patients, 66.96% (770/1 150) of the surgeons suggested that VTE prophylaxis should start 1 day after lung cancer resection, and 64.61% (743/1 150) of the surgeons suggested extending after discharge. For esophagestomy patients, and 48.35% (514/1 063) of the surgeons suggested that there was no need for patients to extend VTE prophylaxis after discharge. More than half of the surgeons participating in this survey made decision of the method and duration of VTE prophylaxis after lung cancer resection (53.91% (620/1 150)) or esophagectomy (52.49% (558/1 063)) depending on the clinical experience.Low molecular weight heparin was the common choice of most surgeons in VTE prophylaxis. More than half of the surgeons thought that previous history of VTE, advanced age, complicated with thrombophilia, obesity (body mass index>30 kg/m²), duration of surgery longer than 6 hours and family history of VTE were key risk factors of the occurrence of postoperative VTE. Conclusions: The results of this survey are highly credible and are a good reflection of the current status of VTE prevention and treatment after thoracic surgery in China. This survey will play an important role in promoting VTE prevention and treatment in Chinese thoracic surgery department, it will also provide data support for government setting new policies, hospital construction of VTE prevention and control as well as raising physicians' awareness.

THE VALIDITY OF THE STUDY OF OSTEOPOROTIC FRACTURES (SOF) INDEX FOR ASSESSING COMMUNITY-BASED OLDER ADULTS IN TAIWAN

Taiwan’s Ten-Year Long-Term Care Project (TLTCP) version 2.0 has expanded to include frail adults in late 2017; however, tools for measuring frailty remain controversial. On the one hand, it has become common to use Fried’s Frailty Phenotype index to measure older adults’ frailty in Taiwan and advanced countries. On the other hand, the Taiwanese government uses the Study of Osteoporotic Fractures index (SOF index) to assess the degree of frailty and whether to receive publicly-funded exercise programs. This study aimed at assessing properties of tools of the SOF index and Fried’s Frailty Phenotype index among general, community-dwelling older adults in Taiwan. In this cross-sectional survey study, purposive sampling was employed to collect data, with 471 older adults. The participants were older than 65 years and lived in Taipei City. To analyze the data, Spearman’s Rank Correlation Coefficient was employed to understand the association between frailty as measured by the two indexes and area under the curve (AUC) statistics was used to test the respective models by measuring the predictive validity from the two indexes. Study findings showed a moderate association between Fried’s Frailty Phenotype index and the SOF index (p<0.001). However, these two frailty indexes were inconsistent in their ability to predict validity. The result of AUC showed that while the SOF predicted falls better (p <0.001), Fried’s Frailty Phenotype index predicted disability better (p <0.001). Similar to the results from advanced countries, SOF index is a valid tool to evaluate frailty, especially for general, community-dwelling older adults in Taiwan.

[Clinical and pathological features of 13 children with Epstein-Barr virus-positive lymphoproliferative disease]

Objective: To summarize the clinical characteristics, virological and histopathological features, clinical outcome of Epstein-Barr virus-positive lymphoproliferative disease (EBV(+)LPD) in children. Methods: The clinical and follow-up data of 13 children histopathologically diagnosed as EBV(+)LPD in the Department of Infectious Disease of Beijing Children's Hospital between January 2011 and December 2016 were summarized. Results: Of the 13 patients, 5 were males and 8 females. The median age of disease onset was 6.0 years (range 1.3 to 15.0 years). The median duration between disease onset and diagnosis was 3 months (range 1 to 24 months). All the 13 patients had fever, 9 cases had hepatosplenomegaly and lymphoadenopathy, 4 cases had only lymphoadenopathy, 7 cases had reduced peripheral blood cells, 7 cases had lung involvement, 3 cases had central nervous system involvement, 3 cases had cardiac involvement, 3 cases had intestinal involvement, 2 cases had skin involvement and 1 case had abdominal mass. All the 13 patients underwent whole blood EBV-DNA PCR examination and the copies ranged from 1×10(8)/L to 1×10(11)/L. Pathology of lymph node confirmed 6 cases, skin pathology confirmed 2 cases, lung pathology, ileum mucosa pathology, liver pathology, abdominal mass pathology and bone marrow pathology confirmed 1 case each. Among 13 patients, 9 cases presented with EBV-positive T cell lymphoproliferative disease(EBV(+) T-LPD), 2 cases with hydroa vacciniforme (HV) and 2 cases with EBV-positive diffuse large B-cell lymphoma (EBV(+) DLBCL) . All the patients were followed up for 2 days to 65 months after discharge. Among 9 cases of EBV(+)T-LPD, 1 case died in a short time, 1 case died after evolved to T-cell lymphoma, 2 cases recovered after hematopoietic stem cell transplantation, 1 case recovered after the chemotherapy of hemophagocytic lymphohistiocytosis(HLH) 2004 protocol and 4 cases were stable now. Of 2 cases of HV patients, 1 case died after evolved to HV like lymphoma and the other still have symptoms. Among 2 cases of EBV(+) DLBCL, 1 case died shortly after discharge and the other was still stable after chemotherapy. Conclusions: Chronic recurrent fever, lymphadenopathy and hepatosplenomegaly are the most common clinical manifestations in children with EBV(+)LPD. Involvement of lung, central nervous system, intestinal tract, skin and other organs are also involved frequently. For children with chronic fever of unknown cause and accompanied by lymphadenopathy and (or) hepatosplenomegaly, EBV (+) LPD should be considered highly when the whole blood EBV-DNA load continues to increase significantly, early biopsy of the proliferative lesion should be performed to make a definite diagnosis. The prognosis of EBV (+) LPD is poor, and some evolve to lymphoma, hematopoietic stem cell transplantation is an effective way to treat this disease.

Molecular characterization, expression pattern and metabolic activity of flavin-dependent monooxygenases in Spodoptera exigua

Enhanced detoxification is one of the important mechanisms for insecticide resistance. Most research in this field to date has focused on the role of cytochrome P450s. Our previous work revealed that flavin-dependent monooxygenases (FMOs) were involved in metabolic resistance of Spodoptera exigua. In the present study we investigated the molecular characteristics, expression patterns and oxidative activities of SeFMO on insecticides. Three FMO genes, which encode proteins with the typical FMO motifs, were cloned from S. exigua. The oxidative activities of eukaryotically expressed SeFMO enzymes were verified with the model substrate of FMO. Importantly, the SeFMOs had significantly higher oxidative activities on metaflumizone and lambda-cyhalothrin than on model substrates and other insecticides tested. The three SeFMOs were mainly expressed in the midgut, fat body and Malpighian tubules. The tissues responsible for xenobiotic metabolism and their expression characteristics were similar to those of P450s acting as detoxification genes. The study also revealed that the expression of SeFMOs could be induced by insecticide exposure, and that SeFMOs were over-expressed in a metaflumizone-resistant strain of S. exigua. These results suggest that SeFMOs are important insecticide detoxifying enzymes, and that over-expression of FMO genes may be one of the mechanisms for metabolic resistance in S. exigua.