Vacuum Sealing Drainage Therapy for Refractory Infectious Wound on 16 Renal Transplant Recipients

BACKGROUND

Refractory infectious wounds on renal transplantation (RT) recipients significantly prolong hospital stay, increase medical costs, and threaten allograft survival. Vacuum sealing drainage (VSD) therapy is a new technique for managing wounds based on the principle of application of controlled negative pressure. The aim of this study was to summarize the efficacy and safety of VSD therapy in the management of refractory infectious wounds following RT.

MATERIALS AND METHODS

This is a retrospective study of a cohort of 661 consecutive patients who received renal transplants over a period of 3 years in which the data were collected and analyzed retrospectively.

RESULTS

Out of the 661 patients, 16 (2.4%) developed refractory wound infection following RT. Nineteen organisms were identified by culture from all patients, including 10 patients infected with 1 or more bacteria, 2 patients with fungal infection, and 4 patients with both. Specifically, mucormycosis was demonstrated in 4 patients, pan-resistant Klebsiella pneumoniae in 2 patients, and Acinetobacter baumannii in 2 patients. All 16 patients were treated with VSD therapy for a median of 37 days (range, 6-111 days). The number of VSD sets used ranged from 4 to 28 sets (mean, 11.1 sets). A combination of antibiotics, debridement, and VSD therapy lead to 100% (16 of 16) wound healing. No VSD-relevant adverse events were observed.

CONCLUSIONS

VSD therapy is an effective and safe adjunct to conventional treatment modalities for the management of refractory wound infection following RT.

Successful Transplantation of "Black Kidneys" Due to Myoglobin Nephropathy

Four kidneys from 2 young donors suffering from rhabdomyolysis were rejected for transplantation at the time of procurement because of their severely bruised and black gross appearance. A frozen section revealed a focal tubular injury filled with granular pigmented casts which an immunohistochemistry confirmed to be myoglobin. The 4 kidneys were transplanted successfully and all recipients recovered normal renal function with no delay. These cases indicate that kidneys with patchy black gross appearance caused by myoglobin casts secondary to rhabdomyolysis is not a contraindication for transplantation.

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

Background

The median effective dose (ED₅₀) of sedative dexmedetomidine adjuvant to peripheral nerve block (PNB) has not yet been verified in elderly patients. This study assessed the ED₅₀ of intravenous dexmedetomidine for sedation in elderly patients who were undergoing total knee arthroplasty (TKA) with PNB.

Methods

Forty‐two patients aged 65–85 years were included and stratified into two groups according to age: young‐old group (aged 65–74 years) and middle‐old group (aged 75–85 years). After the PNB was performed, a pre‐calculated dose of dexmedetomidine was administered for 10 min. The Observer's Assessment of Alertness/Sedation scale, bispectral index score, blood pressure and heart rate were recorded. ED₅₀ values of dexmedetomidine for adequate sedation were estimated by the up‐and‐down method of Dixon and probit regression.

Results

The ED₅₀ of single‐dose dexmedetomidine adjuvant to PNB was 0.57 μg/kg (95% confidence interval [CI], 0.47–0.65) in the young‐old group and 0.38 μg/kg (95% CI, 0.28–0.46) in the middle‐old group. The ED₅₀ of dexmedetomidine differed significantly between the two groups (P < 0.001). In addition, no significant adverse hemodynamic or hypoxemic effects were noted.

Conclusion

We determined the ED₅₀ for sedation using intravenous dexmedetomidine adjuvant to PNB in elderly patients. The ED₅₀ of dexmedetomidine in the middle‐old group decreased by 33% compared with that in the young‐old group with a mean age difference of 11 years between the two groups.

Analysis of cases managed by the otolaryngology service in the Chinese military peacekeeping level 2 medical treatment facility in Mali

OBJECTIVES

As part of the UN peacekeeping mission in Mali, the People's Republic of China have deployed a level 2 medical treatment facility (CHN L2). The aim of this study was to review the cases managed by the otolaryngology service within this facility.

METHODS

The medical records of all patients treated by the otolaryngology service at the CHN L2 from 1 March 2015 to 1 March 2018 were retrospectively assessed.

RESULTS

614/10189 (6%) of all cases seen in the hospital during this period were referred to the otolaryngology service. 7/614 cases required admission to hospital (1.14%) and 40/614 cases required surgery (6.51%). 3/40 cases requiring surgery (7.5%) were performed under general anaesthesia and 37 cases (92.5%) were under local anaesthesia. The most common surgical treatment was facial soft-tissue injury debridement and closure. Acute rhinosinusitis was the most common diagnosis, followed by acute pharyngitis and allergic rhinitis. Four patients required medical evacuation to a level 3 medical treatment facility.

CONCLUSIONS

Disease non-battle injury in the form of ear disease was the most common presentation. Maxillofacial soft-tissue injury was the most common cause of traumatic injury. There were limits that the service could provide in terms of medical equipment and consumables, necessitating increased training of otolaryngologists prior to deployment.

A cardioid oscillator with asymmetric time ratio for establishing CPG models

Nonlinear oscillators are usually utilized by bionic scientists for establishing central pattern generator models for imitating rhythmic motions by bionic scientists. In the natural word, many rhythmic motions possess asymmetric time ratios, which means that the forward and the backward motions of an oscillating process sustain different times within one period. In order to model rhythmic motions with asymmetric time ratios, nonlinear oscillators with asymmetric forward and backward trajectories within one period should be studied. In this paper, based on the property of the invariant set, a method to design the closed curve in the phase plane of a dynamic system as its limit cycle is proposed. Utilizing the proposed method and considering that a cardioid curve is a kind of asymmetrical closed curves, a cardioid oscillator with asymmetric time ratios is proposed and realized. Through making the derivation of the closed curve in the phase plane of a dynamic system equal to zero, the closed curve is designed as its limit cycle. Utilizing the proposed limit cycle design method and according to the global invariant set theory, a cardioid oscillator applying a cardioid curve as its limit cycle is achieved. On these bases, the numerical simulations are conducted for analyzing the behaviors of the cardioid oscillator. The example utilizing the established cardioid oscillator to simulate rhythmic motions of the hip joint of a human body in the sagittal plane is presented. The results of the numerical simulations indicate that, whatever the initial condition is and without any outside input, the proposed cardioid oscillator possesses the following properties: (1) The proposed cardioid oscillator is able to generate a series of periodic and anti-interference self-exciting trajectories, (2) the generated trajectories possess an asymmetric time ratio, and (3) the time ratio can be regulated by adjusting the oscillator's parameters. Furthermore, the comparison between the simulated trajectories by the established cardioid oscillator and the measured angle trajectories of the hip angle of a human body show that the proposed cardioid oscillator is fit for imitating the rhythmic motions of the hip of a human body with asymmetric time ratios.

Prospective plasma efavirenz concentration assessment in Chinese HIV-infected adults enrolled in a large multicentre study

OBJECTIVES

Few studies have explored the optimal dosing for efavirenz in individuals from China. We investigated plasma efavirenz concentrations and their association with efficacy and tolerance of efavirenz 600 mg daily in Chinese HIV-infected adults.

METHODS

An analysis was performed using plasma samples from 455 patients enrolled in a prospective multicentre trial in China. A total of 1198 plasma samples collected at weeks 4, 24 and 48 following antiretroviral therapy initiation were analysed. The mid-dose interval efavirenz concentrations (C12 ) were determined using high-performance liquid chromatography.

RESULTS

The median efavirenz concentration (interquartile range) steadily increased over time from 3.02 (2.28-4.23) to 3.71 (2.91-4.91) mg/L from week 4 to 48 (P < 0.001). The proportion of patients with C12 > 4.0 mg/L also rose from 28.0% to 34.2% and 43.8%, measured at 4, 24 and 48 weeks, respectively (P < 0.001). Five patients had efavirenz concentrations < 1.0 mg/L at week 4, 24 or 48. In the multivariable regression analysis, lower body weight and non-Han ethnicities were associated with higher efavirenz concentrations over time. At each time-point, patients with a body weight < 60 kg had significantly higher efavirenz C12 compared with those with body weight ≥ 60 kg (P < 0.05).

CONCLUSIONS

Efavirenz concentrations increased steadily over 48 weeks, and a substantial proportion of participants had efavirenz C12 above the upper limit of the proposed therapeutic window, especially those with low body weight (< 60 kg). Based upon these findings, a dosage reduction of efavirenz to 400 mg daily may warrant consideration in this population, especially for those with lower body weight.

Effect of Early Immunosuppression Therapy on De Novo Anti-Human-Leukocyte-Antigen Antibody After Kidney Transplantation

The aim of the study was to investigate the effect of immunosuppression therapy early after kidney transplantation, particularly exposure of mycophenolic acid (MPA) and calcineurin inhibitor (CNI), on posttransplantation de novo HLA antibody production.

METHODS

A single-center retrospective cohort study was performed at the First Affiliated Hospital of Sun Yat-sen University, enrolling the kidney transplant or pancreas-kidney transplant recipients who had surgery between January 2010 and February 2016.

RESULTS

A total of 214 recipients were included in the study with a median follow-up period of 1.06 years. A total of 30 recipients (14.0%) were positive in HLA antibody detection posttransplant with a median follow-up period of 1.46 years. Ten recipients (4.7%) lost their allograft function during follow-up, and 6 of them (60%) developed de novo HLA antibody after graft failure. Multivariate analysis showed that acute rejection significantly increased the risk of de novo HLA antibody (hazard ratio [HR], 2.732). Intensified MPA dosing therapy reduced the risk by 59.8% (HR, 0.402); low-dose CNI therapy increased the risk by 33.3% (HR, 1.333), and the effect of extremely low-dose CNI therapy was even larger (HR, 2.242).

CONCLUSION

The risk of de novo HLA antibody can be decreased by reducing the risk of acute rejection. A tendency was seen in low-dose CNI therapy to increase the risk of de novo HLA antibody, but intensified MPA dosing therapy may provide an umbrella protection effect by reducing the risk. Prospective study was required to confirm the effects.

Higher Incidence of Renal Allograft Glomerulonephritis in Living-Related Donor Kidney Transplantation

Glomerulonephritis recurrence has emerged as one of the leading causes of allograft loss. We aimed to investigate the effect of living-related and deceased donation on the incidence of renal allograft glomerulonephritis and its effect on renal allograft survival.

METHODS

Adult renal allograft recipients with primary glomerulonephritis were enrolled. Transplantation date was from Feb 2004 to Dec 2015. Exclusion criteria included combined organ transplantation, structural abnormality, diabetic nephropathy, hypertension nephropathy, obstructive nephropathy, and primary uric acid nephropathy. The incidence of biopsy-proven allograft glomerulonephritis was compared between the living-related donor group and the deceased donor group. Graft survival was assessed with Kaplan-Meier method, and Cox proportional hazard model was used to evaluate the effect of posttransplant glomerulonephritis on graft outcome.

RESULTS

There were 525 living-related donor kidney transplant recipients (LRKTx) and 456 deceased donor kidney transplant recipients (DDKTx) enrolled. The incidence of IgA nephropathy was 8.8% in the LRKTx group and 1.3% in the DDKTx group (P < .001); the incidence of focal segmental glomerulosclerosis (FSGS) was 3.8% in the LRKTx group and 1.5% in the DDKTx group (P = .03). FSGS increased the risk of graft failure compared with non-FSGS (hazard ratio [HR], 3.703 [1.459-9.397]; P = .006). IgA nephropathy increased the risk of graft failure by over 5 times 5 years after kidney transplantation compared with non-IgA nephropathy, but it did not affect early allograft survival (HR for ≥5 years, 6.139; 95% CI, 1.766-21.345; P = .004; HR for <5 years, 0.385 [0.053-2.814]; P = .35).

CONCLUSIONS

Higher incidence of IgA nephropathy and FSGS in renal allograft was observed in living-related donor kidney transplantation compared with deceased donor kidney transplantation. De novo or recurrent IgA nephropathy and FSGS impaired long-term renal allograft survival.

Role of miR-449a in the Activation and Metabolism of CD4+ T Cells

BACKGROUND

Acute rejection is a significant challenge after organ transplantation. The CD4⁺ T-cell‒mediated immune response plays an important role in acute transplant rejection. It was also found that miR-449a microRNA regulates the alloimmune response in a model of heart transplantation in mice. Our goal was to determine the role of miR-449a in the regulation of CD4⁺ T cells.

METHODS

We examined miR-449a expression in peripheral blood mononuclear cells (PBMCs) and graft-infiltrating lymphocytes (GILs) between syngeneic transplant and allogeneic transplant groups on day 7 post‒heart transplantation. We also examined miR-449a expression in CD4⁺ T-cell activation and mixed-lymphocyte reactions (MLRs) in vitro. To evaluate the effect of miR-449a on CD4⁺ T-cell metabolism, we analyzed key metabolic parameters using XFp extracellular flux analyses.

RESULTS

Our in vivo heart transplant models showed that the expression of miR-449a in PBMCs and in GILs significantly increased in the allogeneic groups in comparison to the syngeneic groups (P < .01). Furthermore, in vitro analysis confirmed that the expression of miR-449a was significantly elevated in activated CD4⁺ T cells. Reduction of miR-449a expression in CD4⁺ T cells decreased the mitochondrial respiration in the same CD4⁺ T cells.

CONCLUSION

Our results reveal that miR-449a microRNA was elevated in allogeneic heart allografts. This correlated with an increased miR-449a expression in activated CD4⁺ T cells. Inhibition of miR-449a in activated CD4⁺ T cells coincided with reduced mitochondrial respiration, suggesting that miR-449a influences CD4⁺ T-cell activation during the alloimmune response by regulating metabolic status.

miR-296-3p Negatively Regulated by Nicotine Stimulates Cytoplasmic Translocation of c-Myc via MK2 to Suppress Chemotherapy Resistance

This study aimed to identify mechanisms by which microRNA 296-3p (miR-296-3p) functions as a tumor suppressor to restrain nasopharyngeal carcinoma (NPC) cell growth, metastasis, and chemoresistance. Mechanistic studies revealed that miR-296-3p negatively regulated by nicotine directly targets the oncogenic protein mitogen-activated protein kinase-activated protein kinase-2 (Mapkapk2) (MK2). Suppression of MK2 downregulated Ras/Braf/Erk/Mek/c-Myc and phosphoinositide-3-kinase (PI3K)/Akt/c-Myc signaling and promoted cytoplasmic translocation of c-Myc, which activated miR-296-3p expression by a feedback loop. This ultimately inhibited cell cycle progression, epithelial-to-mesenchymal transition (EMT), and chemoresistance of NPC. In addition, nicotine as a key component of tobacco was observed to suppress miR-296-3p and thus elevate MK2 expression by inducing PI3K/Akt/c-Myc signaling. In clinical samples, reduced miR-296-3p as an unfavorable factor was inversely correlated with MK2 and c-Myc expression. These results reveal a novel mechanism by which miR-296-3p negatively regulated by nicotine directly targets MK2-induced Ras/Braf/Erk/Mek/c-Myc or PI3K/AKT/c-Myc signaling to stimulate its own expression and suppress NPC cell proliferation and metastasis. miR-296-3p may thus serve as a therapeutic target to reverse chemotherapy resistance of NPC.

Dual roles of miR-374a by modulated c-Jun respectively targets CCND1-inducing PI3K/AKT signal and PTEN-suppressing Wnt/β-catenin signaling in non-small-cell lung cancer

MiR-374a appears to play a complex role in non-small-cell lung cancer (NSCLC). Here, we demonstrate a dual role for miR-374a in NSCLC pathogenesis. The effects and modulatory mechanisms of miR-374a on cell growth, migration, invasion, and in vivo tumorigenesis and metastasis in nude mice were also analyzed. The expression of miR-374a was examined in NSCLC and non-cancerous lung tissues by quantitative real-time reverse transcription-PCR (qRT-PCR), and in situ hybridization, respectively. miR-374a directly targets CCND1 and inactivates PI3K/AKT and Ras-mediated cell cycle signalings, as well as epithelial–mesenchymal transition (EMT). This not only dramatically suppressed cell growth, migration, invasion,and metastasis, but also elevated A549 and pc-9 NSCLC cell sensitivity to cisplatin (DDP) while increasing survival time of tumor-bearing mice. Interestingly, miR-374a serves an inverse function in SPCA-1 and H1975 NSCLC cells by directly targeting PTEN to activate Wnt/β-catenin and Ras signalings and its downstream cascade signals. Surprisingly, transcription factor c-Jun bound to the promoter region of human miR-374a and suppressed miR-374a in A549 and pc-9 cells while inducing it in SPCA-1 and H1975 cells. Increased levels of miR-374a appeared to serve a protective role by targeting CCND1 in early-stage NSCLC (Stages I and II). Inversely, increased miR-374a was an unfavorable factor when targeting PTEN in more advanced staged NSCLC patients. Our studies are the first to demonstrate that miR-374a plays divergent roles in NSCLC pathogenesis at different stages of the disease and implicate the potential application of miR-374a targeting for cancer therapy.

microRNA-374a suppresses colon cancer progression by directly reducing CCND1 to inactivate the PI3K/AKT pathway

microRNA-374a (miR-374a) exhibits oncogenic functions in various tumor types. Here we report that miR-374a suppresses proliferation, invasion, migration and intrahepatic metastasis in colon adenocarcinoma cell lines HCT116 and SW620. Notably, we detected that PI3K/AKT signaling and its downstream cell cycle factors including c-Myc, cyclin D1 (CCND1), CDK4 and epithelial-mesenchymal transition (EMT)-related genes including ZEB1, N-cadherin, Vimentin, Slug, and Snail were all significantly downregulated after miR-374a overexpression. Conversely, cell cycle inhibitors p21 and p27 were upregulated. Expression of E-cadherin was only decreased in HCT116, without any obvious differences observed in SW620 cells. Furthermore, luciferase reporter assays confirmed that miR-374a could directly reduce CCND1. Interestingly, when CCND1 was silenced or overexpressed, levels of pPI3K, pAkt as well as cell cycle and EMT genes were respectively downregulated or upregulated. We examined miR-374a levels by in situ hybridization and its correlation with CCND1 expression in CRC tumor tissues. High miR-374a expression with low level of CCND1 was protective factor in CRC. Together these findings indicate that miR-374a inactivates the PI3K/AKT axis by inhibiting CCND1, suppressing of colon cancer progression.

[Risk factors analysis and prognosis of renal pelvis dilatation in high-risk infants in monocenter]

Objective: To explore the prognosis and risk factors of pyelectasis in high-risk infants. Methods: This was a retrospective study. Totally 960 high-risk infants, who accepted type B ultrasonic examination for fetus at 28th week of gestation and for newborns in 48 hours after birth, were included in the study in departments of obstetrics and eonatology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital during May 2012 to April 2013. The degree of pyelectasis was classified using Grignon grade and the paients were followed up for 3 years. The factors of epidemiology, high risk pregnant women, fetus and high-risk newborns that relate to pyelectasis were summarized. High-risk factors were analyzed by using logistic multivariate regression analysis. Results: Of 960 high-risk infants, 103 had abnormal urinary ultrasound results, 87 (9.1% of high-risk infants) were diagnosed with pyelectasis, 16 (1.7% of high-risk infants) were diagnosed with congenital anomalies of the kidney and urinary tract. According to the degree of pyelectasis, 68 infants were Grignon grade Ⅰ, male:female ratio=5.8∶1, left side:right side ratio=1.91∶1; 19 infants were Grignon grade Ⅱ, male:female ratio=5.33∶1, left side:right side ratio=2.12∶1. Postnatal follow-up results showed that pyelectasis disappeared in 48 cases (55% of pyelectasis cae), 40 infants were Grignon grade Ⅰ (59% of all Grignon grade Ⅰ patients), 8 infants were Grignon grade Ⅱ (42% of all Grignon grade Ⅱ patients); The result of risk factors analysis showed that the risk of pyelectasis in males was 4.368 times that of females (95%CI: 2.33-8.189, P<0.05); the risk of pyelectasis in low birth weight infants was 22.434 times that of non low birth weight infants (95% CI: 5.883-85.547, P<0.05). Conclusion: The incidence of pyelectasis in high-risk infants was 9.1%. The mitigation rate of pyelectasis in Grignon grade Ⅰ to Ⅱ in fetal or newborn period is high. Patients in Grignon grade Ⅲ and above in fetal or new born period had high risk of congenital anomalies of the kidney and urinary tract. The risk of pyelectasis of male was higher than that of female; the risk of pyelectasis of low birth weight infant was higher than appropriate for gestational age infants.

[Investigation of the cognition and behavior on drug safety in Beijing middle school students]

OBJECTIVE

To understand the cognition and behavior of drug safety in Beijing middle school students and provide advice for relevant education.

METHODS

A cross-sectional survey using paper questionnaires was carried out on the student body of nine Beijing middle schools. Multi-stage proportionate stratified cluster sampling was adopted to enroll participants. In addition to demographic questions, the questionnaire included 17 questions assessing the cognition and behavior of safe drug use, prioritizing questions that aligned with the health education guideline for primary and secondary school students from Chinese Ministry of Education. Descriptive statistical methods were applied using the SAS 9.2 software.

RESULTS

Of the 4 220 students investigated, 2 097(49.7%) were males and 2 123(50.3%) were females. The average age was (14.3±1.7) years. 2 030(48.1%) students were from downtown areas, 1 511(35.8%) were from urban-rural linking areas and 679(16.1%) were from rural areas. Half (51.5%) of the respondents were junior high school students, and the others were from senior high schools (34.2%) and vocational high schools (14.3%). Most of the students (89.6%) lived off campus. The awareness rate of drug safety knowledge was 74.4%, the median score of drug safety behavior was 4 points (full score was 5 points) and there was a statistically positive correlation between the two (Spearman's correlation coefficient was 0.156, P<0.001). Both the awareness rates and the drug safety behavior scores were statistically different among the students in different regions, different school types and different residence types (P<0.001). Multiple factors analysis demonstrated the correlation between the cognition degrees of both drug safety knowledge, behavior and the above factors. Of all the students, 80.4% agreed that any drug could have adverse drug reactions; 40.5% were aware that antibiotics couldn't kill viruses; as many as 49.6% mistook aspirin as antibiotic; 97.4% would read drug instructions before taking them; Only 42.4% put expired drugs into special recycling bins; 49.8% would deviate from the suggested dosage and frequency of their medication when they were sick with common diseases.

CONCLUSION

Overall, the cognition of drug safety in Beijing middle school students is good, but problems still exist in medication adherence, the management of expired drugs and the antibiotics cognition, which need to be fixed through specific, pointed way of education. And more efforts should be made to improve the cognition in rural regions, vocational high schools and on campus students.

Thulium-fiber-laser-pumped, high-peak-power, picosecond, mid-infrared orientation-patterned GaAs optical parametric generator and amplifier

We report a high-peak-power, picosecond, mid-infrared optical parametric generator (OPG) and optical parametric amplifier (OPA) based on orientation-patterned gallium arsenide pumped by a thulium:fiber master-oscillator-power-amplifier employing direct diode-seeded amplification. An OPG tuning range of 2550-2940 nm (signal) and 5800-8300 nm (idler) is demonstrated with peak powers as high as 3 (signal) and 2 kW (idler), and with pulse energies of 0.26 and 0.16 μJ, respectively. When seeded with a 0.6  cm^-1 linewidth tunable Cr:ZnSe laser, the OPA idler linewidth is narrowed to 1.4  cm^-1 and a small-signal parametric gain of 60 dB is achieved. A maximum peak power of 13.3 (signal) and 3.2 kW (idler) is obtained at an overall conversion efficiency of 36%. The corresponding maximum pulse energies for the signal and idler are 1.07 and 0.26 μJ, respectively.

Radiation reduction of minimally invasive transforaminal lumbar interbody fusion with localisation system in overweight patients: practical technique

AIMS

Minimally invasive transforaminal lumbar interbody fusion (MITLIF) has been well validated in overweight and obese patients who are consequently subject to a higher radiation exposure. This prospective multicentre study aimed to investigate the efficacy of a novel lumbar localisation system for MITLIF in overweight patients.

PATIENTS AND METHODS

The initial study group consisted of 175 patients. After excluding 49 patients for various reasons, 126 patients were divided into two groups. Those in Group A were treated using the localisation system while those in Group B were treated by conventional means. The primary outcomes were the effective radiation dosage to the surgeon and the exposure time.

RESULTS

There were 62 patients in Group A and 64 in Group B. The mean effective dosage was 0.0217 mSv (standard deviation (sd) 0.0079) in Group A and 0.0383 mSv (sd 0.0104) in Group B (p < 0.001). The mean fluoroscopy exposure time was 26.42 seconds (sd 5.91) in Group A and 40.67 seconds (sd 8.18) in Group B (p < 0.001). The operating time was 175.56 minutes (sd 32.23) and 206.08 minutes (sd 30.15) (p < 0.001), respectively. The mean pre-operative localisation time was 4.73 minutes (sd 0.84) in Group A and 7.03 minutes (sd 1.51) in Group B (p < 0.001). The mean screw placement time was 47.37 minutes (sd 10.43) in Group A and 67.86 minutes (sd 14.15) in Group B (p < 0.001). The pedicle screw violation rate was 0.35% (one out of 283) in Group A and 2.79% (eight out of 287) in Group B (p = 0.020).

CONCLUSION

The study shows that the localisation system can effectively reduce radiation exposure, exposure time, operating time, pre-operative localisation time, and screw placement time in overweight patients undergoing MITLIF. Cite this article: Bone Joint J 2017;99-B:944-50.

Comparative proteomic analysis of different developmental stages of swamp buffalo testicular seminiferous tubules

With ageing, many protein components change markedly during mammalian spermatogenesis. Most of these proteins have yet to be characterized and verified. Here, we have employed two-dimensional electrophoresis coupled to tandem mass spectrometry to explore the different proteins from pre-pubertal, pubertal and post-pubertal swamp buffalo testicular seminiferous tubules. The results showed that 25 protein spots were differentially expressed among developmental stages, and 13 of them were successfully identified by mass spectrometry. Of which four proteins were up-regulated and three proteins were down-regulated with age, and the remaining six proteins were fluctuated among developmental stages. Bioinformatics analysis indicates that these proteins were probably related to cellular developmental process (53.8%), cell differentiation (53.8%), spermatogenesis (15.4%), apoptotic process and cell death (30.8%). Expression profiles of calumenin (CALU) and galectin-1 (LGALS1) were further verified via Western blotting. In summary, the results help to develop an understanding of molecular mechanisms associated with buffalo spermatogenesis.

miRomics and Proteomics Reveal a miR-296-3p/PRKCA/FAK/Ras/c-Myc Feedback Loop Modulated by HDGF/DDX5/β-catenin Complex in Lung Adenocarcinoma

Purpose: This study was performed to identify the detailed mechanisms by which miR-296-3p functions as a tumor suppressor to prevent lung adenocarcinoma (LADC) cell growth, metastasis, and chemoresistance.Experimental Design: The miR-296-3p expression was examined by real-time PCR and in situ hybridization. MTT, EdU incorporation, Transwell assays, and MTT cytotoxicity were respectively performed for cell proliferation, metastasis, and chemoresistance; Western blotting was performed to analyze the pathways by miR-296-3p and HDGF/DDX5 complex. The miRNA microarray and luciferase reporter assays were respectively used for the HDGF-mediated miRNAs and target genes of miR-296-3p. The ChIP, EMSA assays, and coimmunoprecipitation combined with mass spectrometry and GST pull-down were respectively designed to analyze the DNA-protein complex and HDGF/DDX5/β-catenin complex.Results: We observed that miR-296-3p not only controls cell proliferation and metastasis, but also sensitizes LADC cells to cisplatin (DDP) in vitro and in vivo Mechanistic studies demonstrated that miR-296-3p directly targets PRKCA to suppress FAK-Ras-c-Myc signaling, thus stimulating its own expression in a feedback loop that blocks cell cycle and epithelial-mesenchymal transition (EMT) signal. Furthermore, we observed that suppression of HDGF-β-catenin-c-Myc signaling activates miR-296-3p, ultimately inhibiting the PRKCA-FAK-Ras pathway. Finally, we found that DDX5 directly interacts with HDGF and induces β-catenin-c-Myc, which suppresses miR-296-3p and further activates PRKCA-FAK-Ras, cell cycle, and EMT signaling. In clinical samples, reduced miR-296-3p is an unfavorable factor that inversely correlates with HDGF/DDX5, but not PRKCA.Conclusions: Our study provides a novel mechanism that the miR-296-3p-PRKCA-FAK-Ras-c-Myc feedback loop modulated by HDGF/DDX5/β-catenin complex attenuates cell growth, metastasis, and chemoresistance in LADC. Clin Cancer Res; 23(20); 6336-50. ©2017 AACR.

Molecular characterization, expression analysis and RNAi knock-down of elongation factor 1α and 1γ from Nilaparvata lugens and its yeast-like symbiont

In the present paper, four cDNAs encoding the alpha and gamma subunits of elongation factor 1 (EF-1) were cloned and sequenced from Nilaparvata lugens, named NlEF-1α, NlEF-1γ, and its yeast-like symbiont (YLS), named YsEF-1α and YsEF-1γ, respectively. Comparisons with sequences from other species indicated a greater conservation for EF-1α than for EF-1γ. NlEF-1α has two identical copies. The deduced amino acid sequence homology of NlEF-1α and NlEF-1γ is 96 and 64%, respectively, compared with Homalodisca vitripennis and Locusta migratoria. The deduced amino acid sequence homology of YsEF-1α and YsEF-1γ is 96 and 74%, respectively, compared with Metarhizium anisopliae and Ophiocordyceps sinensis. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis revealed that the expression level of NlEF-1α and NlEF-1γ mRNA in hemolymph, ovary, fat body and salivary glands were higher than the midgut and leg tissue. YsEF-1α and YsEF-1γ was highly expressed in fat body. The expression level of NlEF-1α was higher than that of NlEF-1γ. Through RNA interference (RNAi) of the two genes, the mortality of nymph reached 92.2% at the 11th day after treatment and the ovarian development was severely hindered. The RT-qPCR analysis verified the correlation between mortality, sterility and the down-regulation of the target genes. The expression and synthesis of vitellogenin (Vg) protein in insects injected with NlEF-1α and NlEF-1γ double-stranded RNA (dsRNA) was significantly lower than control groups. Attempts to knockdown the YsEF-1 genes in the YLS was unsuccessful. However, the phenotype of N. lugens injected with YsEF-1α dsRNA was the same as that injected with NlEF-1α dsRNA, possibly due to the high similarity (up to 71.9%) in the nucleotide sequences between NlEF-1α and YsEF-1α. We demonstrated that partial silencing of NlEF-1α and NlEF-1γ genes caused lethal and sterility effect on N. lugens. NlEF-1γ shares low identity with that of other insects and therefore it could be a potential target for RNAi-based pest management.

Trithiocarbonates as intrinsic photoredox catalysts and RAFT agents for oxygen tolerant controlled radical polymerization

In this study, we reported on the discovery that trithiocarbonates (RAFT agents) can act as intrinsic photocatalyst to significantly reduce the oxygen level in a controlled radical polymerization under visible light irridation.

Comparison of tacrolimus and cyclosporin A in CYP3A5 expressing Chinese de novo kidney transplant recipients: a 2-year prospective study

AIMS

To assess the efficacy and safety of tacrolimus and cyclosporin A (CsA)-based immunosuppressive regimens in Chinese de novo kidney transplant recipients who are CYP3A5 expressers.

METHODS

The CYP3A5 (6986 A>G, rs776746) polymorphism of eligible patients was determined before transplantation. De novo kidney transplant recipients enrolled in this study were assigned to tacrolimus (Tac group) or CsA (CsA group) based therapy. The follow-up period was 2 years. The incidence of acute rejection, patient and graft survival rates, renal allograft function and post-transplant complications were compared. The intra-individual variability (IIV) of Tac and CsA blood concentrations was analysed. Medication costs were also compared. The analysis was conducted on the intention-to-treat principle.

RESULTS

A total of 72 CYP3A5 expressers were enrolled, with 36 patients in each group. AR incidence was higher in the Tac group (11.1% vs. 5.6%), but there was no significant difference (p > 0.05). The 2-year patient and graft survival was comparable, and renal function was comparable in the two groups. Notably, the Tac group presented a significantly higher incidence of BK viremia (22.2% vs. 5.6%, p < 0.05) and BK viruria (38.9% vs. 16.7%, p < 0.05) than the CsA group. The CsA IIV at 1 and 3 months post-transplant was significantly lower than the Tac IIV (p < 0.05). The medical costs of both immunosuppressive drugs and management of complications was significantly lower in the CsA group.

CONCLUSIONS

Cyclosporin A-based maintenance therapy is safe for Chinese de novo kidney transplant recipients who are CYP3A5 expressers. CsA significantly reduced medication costs and decreased BKV infection, suggesting that it is more beneficial for this specific population.

[Focal segmental glomerulosclerosis after renal transplantation in a child with ANCA-associated glomerulonephritis: case report and literature review]

Objective: To study the clinical features and treatment of focal segmental glomerulosclerosis (FSGS) after renal transplantation in a child with ANCA-associated glomerulonephritis. Method: The clinical and pathological data of the patient treated in the Department of Pediatrics as well as in the Department of Organ Transplantation in November 2015 in the First Affiliated Hospital of Sun Yat-sen University, who was diagnosed with de novo FSGS after renal transplantation with a primary disease ANCA-associated glomerulonephritis, was analyzed retrospectively. Reports on "ANCA-associated glomerulonephritis" "(renal OR kidney) transplantation" "focal segmental glomerular sclerosis" were searched and reviewed. Result: A ten years old female was definitely diagnosed with ANCA-associated glomerulonephritis on the 81^st day after the onset of primary ANCA associated glomerulonephritis. Because of progressive decline of renal function, a hemodialysis period for 7 months was administered following the pulsed methylprednisolone as well as cyclophosphamide treatment. The renal transplantation was then carried out 18 months later, the renal function recovered 7 days later while proteinuria reappeared 28 days after renal transplantation. Based on the anti-rejection treatment, 3 times pulsed methylprednisolone administration did not make difference on reducing the proteinuria and then a renal biopsy was conducted and the transplanted kidney proved to be a newly developed FSGS. Consequently, plasma exchange therapy was administrated. When the plasma exchange course finished, the proteinuria decreased significantly (from 3.270 g/24 h to 0.370 g/24 h). No reports were retrieved either in Chinese databases or at PubMed as well as Medline databases. Conclusion: FSGS appears in transplanted kidney in patient with a primary renal disease as ANCA associated glomerulonephritis with early proteinuria after transplantation as well as negative P-ANCA and MPO. Pathology of renal biopsy revealed FSGS while the pathology of other recipient was not FSGS. The patient had no response to pulsed methylprednisolone therapy. Instead, plasma exchange therapy was an alternative also effective treatment for de novo FSGS in transplanted kidney.

Clinical significance of changes of expression of the Wnt/β-catenin signaling pathway in renal clear cell carcinoma

OBJECTIVE

To explore the changes and clinical significance of expression of β-catenin in renal carcinoma.

PATIENTS AND METHODS

We selected 46 patients with renal clear cell carcinoma who were hospitalized from May 2013 to March 2016 and healthy adults (controls) matched for age and body weight, who were hospitalized in the physical examination center of our hospital during the same period. Peripheral blood of patients and controls was drawn for ELISA. After surgery, renal carcinoma and normal peritumoral tissue samples were harvested for immunohistochemical staining, Western blot analysis and qRT-PCR was used to observe changes of β-catenin expression in renal carcinoma tissues.

RESULTS

Compared with controls, ELISA showed that there were significant differences in β-catenin levels in peripheral blood of patients with renal carcinoma (p<0.05). Western blot and qRT-PCR showed that the expression levels of β-catenin in renal carcinoma tissues were higher than in normal peritumoral tissues and the differences were statistically significant (p<0.05). Immunohistochemical staining showed that β-catenin was increased significantly in renal carcinoma tissue compared with normal peritumoral tissues (p<0.05).

CONCLUSIONS

β-catenin expression was significantly increased in the tumor tissues of patients with renal carcinoma. The measurement of β-catenin expression levels in peripheral blood from patients could be used for early diagnosis of renal carcinoma, which is of great clinical significance.

Dynamic effects of CYP3A5 polymorphism on dose requirement and trough concentration of tacrolimus in renal transplant recipients

WHAT IS KNOWN AND OBJECTIVE

Tacrolimus is a widely used immunosuppressive drug with marked pharmacokinetic variability partly due to CYP3A5 polymorphism. Our study aimed to investigate the dynamic effects of CYP3A5 genotypes on dose requirement and trough concentration (C₀ ) of tacrolimus in renal transplant recipients.

METHODS

A total of 194 Chinese renal transplant recipients received oral tacrolimus twice daily. Whole-blood C₀ of tacrolimus were measured on the 3rd day, 7th day, 14th day, 1st month, 3rd month and 6th month post-transplantation. CYP3A5 genotypes were determined and the recipients were categorized as CYP3A5 expressers (CYP3A5*1 allele carriers) and non-expressers (homozygous CYP3A5*3). The correlated serum creatinine, haematocrit and albumin were also detected.

RESULTS

The allele frequencies for CYP3A5*1/*1, *1/*3 and *3/*3 were 7·7%, 44·8% and 47·4%, respectively. There were no significant variability in serum creatinine, haematocrit and albumin values between CYP3A5 expressers and non-expressers. Larger doses were administered to CYP3A5 expressers than to non-expressers after surgery except the initial dose. C₀ were much lower in CYP3A5 expressers than in non-expressers on the 3rd day, 7th day, 14th day and 1st month post-transplantation (P < 0·01); however, no significant differences were found on the 3rd and 6th months post-transplantation. All of the dose-adjusted C₀ in CYP3A5 expressers were significantly lower than non-expressers (P < 0·01). Less of the recipients achieving target C₀ (4-8 ng/mL) were found in CYP3A5 expressers than in non-expressers after initial dose (35·7% vs. 50%). Meanwhile, CYP3A5 non-expressers were detected having higher C₀ (>8 ng/mL) during 3 months post-transplantation. Besides, the proportions in the two groups both increased gradually over time and up to 91·8% and 94% on the 6th month, respectively.

WHAT IS NEW AND CONCLUSION

There are no significant differences in serum creatinine, haematocrit and albumin values between CYP3A5 expressers and non-expressers. CYP3A5 expressers have decreased dose-adjusted tacrolimus C₀ when compared to non-expressers. Dose-adjusted C₀ of tacrolimus increases in a time-dependent manner in both groups.

Kidney Transplantation From Brain-Dead Donors: Initial Experience in China

BACKGROUND

Experience with kidney transplantation from brain-dead donors remains limited in China. Our objective was to evaluate the outcomes of kidney transplantation from brain-dead donors (group 1), compared with those from living ones of the same age (group 2).

METHODS

Clinical data of kidney transplantation from brain-dead donors and living donors in the same age range (18-45 years) performed between May 2007 and December 2011 were analyzed retrospectively. Recipients were analyzed for posttransplantation serum creatinine, creatinine clearance (calculated by the Cockcroft-Gault formula), the number of acute rejection episodes and delayed graft function, and patient/graft survival.

RESULTS

Mean donor age was comparable between the 2 groups (31.9 ± 6.5 vs 32.8 ± 7.0 years; P = .268). The terminal serum creatinine level of donors was 125.5 ± 63.5 μmol/L in group 1 (n = 30) and 65.1 ± 13.7 μmol/L in group 2 (n = 110; P = .000). Recipient creatinine clearance was comparable between the 2 groups 1 month posttransplantation and thereafter. Acute rejection episodes were seen in 7 cases in recipients of group 1 (15.9%) and in 15 cases in recipients of group 2 (13.6%; P = .716). The incidence of delayed graft function was higher in recipients of group 1 (18.2%) than that of group 2 (3.6%; P = .002). The 1-, 3-, and 5-year patient/graft survival rate was comparable between the 2 groups.

CONCLUSIONS

Our study demonstrated kidney transplantation from brain-dead donors achieved acceptable graft function and patient/graft survival in the 5-year follow-up, encouraging the use of this approach.

Study on the levels of uric acid and high-sensitivity C-reactive protein in ACS patients and their relationships with the extent of the coronary artery lesion

OBJECTIVE

We evaluated uric acid (UA) and high-sensitivity C-reactive protein (hs-CRP) levels in different clinical types of acute coronary syndromes (ACS) and in relationship with the severity of coronary artery lesions. Furthermore, we explored its clinical significance.

PATIENTS AND METHODS

From June 2013 to January 2015, we studied patients in their first onset of symptoms and hospitalization for coronary angiography. According to coronary angiography results, we divided patients into two groups: 93 patients with ACS and 30 patients with normal coronary arteries as the control group. ACS patients were divided further into three subgroups: patients with ST-segment elevation myocardial infarction (STEMI) (n=34); patients with non-ST segment elevation myocardial infarction (NSTEMI) (n=29); and patients with unstable angina (n=30). According to their Gensini scores, patients were divided into mild, moderate and severe groups. We compared UA and hs-CRP levels and the relationship with Gensini scores between different groups.

RESULTS

UA and hs-CRP levels in the ACS group were higher than those in the control group (p < 0.05). UA and hs-CRP levels in the STEMI group were higher than those in the NSTEMI, unstable angina and control groups (p < 0.05). UA and hs-CRP levels in the NSTEMI patients were higher than those in the unstable angina and control groups (p < 0.05). UA and hs-CRP levels in the unstable angina patients were higher than those in the control group (p < 0.05). hs-CRP levels in the STEMI patients were higher than the other groups (p < 0.05). hs-CRP levels in the NSTEMI patients were higher than the unstable angina and the control groups (p < 0.05) while hs-CRP levels in the unstable angina patients were higher than the control group (p < 0.05). Additionally, according to the Gensini score group, we discovered that ACS patients in the severe group had higher hs-CRP levels than the other three groups (p < 0.05) while the moderate group had higher levels than the other two groups (p < 0.05). The mild group had higher levels than the control group (p < 0.05). Correlation analysis suggested that UA levels and Gensini scores had a positive correlation (p < 0.05). hs-CRP levels and Gensini scores also showed a positive correlation (p < 0.05).

CONCLUSIONS

UA and hs-CRP levels should be considered as factors to use in the risk stratification in ACS patients.

[Simultaneous Determination of Three Kinds of Effective Constituents in Cannabis Plants by Reversed-phase HPLC]

OBJECTIVES

To establish a high performance liquid chromatographic （HPLC） method for simultaneous determination of three effective constituents, including tetrahydrocannabinol （THC）, cannabidiol （CBD） and cannabinol （CBN） in Cannabis plants.

METHODS

A C₁₈ column was used in this study, and acetonitrile-phosphate buffer （0.015 mol/L KH₂PO₄） was used as mobile phase at a flow rate of 1.0 mL/min. At a detection wavelength of 220 mm, UV absorption spectra were collected at the wavelength range of 190-400 nm, and the spectra and retention time were counted as qualitative evidence.

RESULTS

THC, CBD and CBN could be well separated by this method. Three components had good linear relationship in the range of 0.4-40 μg/mL （R²≥0.999 3）. The recoveries were over 87%. The limits of detection were 1.8 ng, 2.0 ng and 1.3 ng, respectively. The relative standard deviation （RSD） were less than 5% for both inter-day and intra-day precisions.

CONCLUSIONS

Reversed-phase HPLC method is simple, rapid and accurate, and it is suitable for the qualitative and quantitative detection of THC, CBD and CBN in Cannabis plants.

Kinetic analysis of RNA editing of Newcastle disease virus P gene in the early period of infection

As a paramyxovirus, Newcastle disease virus (NDV) has the ability to edit its P (phosphoprotein) gene to synthesize three kinds of viral protein (P, V and W). It is technically very difficult to differentiate P, V and W mRNAs, and little was known about NDV regulation of RNA-editing frequency. To investigate the rules of NDV RNA editing, the ratio of the P gene-derived transcripts (P, V and W) was determined by sequencing at different time points post-infection. The results showed unstable ratio of V and W mRNA at different time points, and the frequency of NDV editing was significantly increased at the early period of infection (P 

KEYWORDS

Newcastle disease virus; phosphoprotein; RNA editing; G insertion.

miR-374a-CCND1-pPI3K/AKT-c-JUN feedback loop modulated by PDCD4 suppresses cell growth, metastasis, and sensitizes nasopharyngeal carcinoma to cisplatin

miR-374a has been reported to function as an oncogene during tumor pathogenesis. In this study, miR-374a is observed to reduce nasopharyngeal carcinoma (NPC) cell proliferation, migration, invasion, metastasis and cisplatin (DDP) resistance in vitro and in vivo. Mechanistic analyses indicate that miR-374a directly targets CCND1 to inactivate pPI3K/pAKT/c-JUN forming a negative feedback loop, as well as suppressing downstream signals related to cell cycle progression and epithelial-mesenchymal transition (EMT). Interestingly, we also observed that miR-374a direct targeting of CCND1 is modulated by tumor suppressor PDCD4 via suppressing pPI3K/pAKT/c-JUN signaling. In clinical specimens, miR-374a was positively and negatively correlated with expression of PDCD4 and CCND1, respectively. Our studies are the first to demonstrate that the miR-374a-CCND1-pPI3K/AKT-c-JUN feedback loop induced by PDCD4 supresses NPC cell growth, metastasis and chemotherapy resistance.

The efficacy and safety of intensified enteric-coated mycophenolate sodium with low exposure of calcineurin inhibitors in Chinese de novo kidney transplant recipients: a prospective study

AIMS

The aim of this study was to investigate the efficacy and safety of a transient intensified enteric-coated mycophenolate sodium (EC-MPS) dosing regimen with low exposure of calcineurin inhibitors (CNIs) in Chinese de novo kidney transplantation.

METHODS

In a 6-month prospective study, a total of 97 recipients were enrolled and assigned to either an intensified EC-MPS dosing (IS) regimen or a standard EC-MPS dosing (SD) regimen. The area under the curve (AUC) of MPA was assessed at week 1 post transplant. The incidences of acute rejection, patient and graft survival, renal allograft function and adverse events were analysed.

RESULTS

The IS regimen displayed a trend of acute rejection risk reduction (IS 2.7% vs. SD 13.3%, p = 0.061) and allograft function improvement (IS 62.8 ± 14.0 ml/min per 1.73 m(2) vs. SD 56.6 ± 18.3 ml/min per 1.73 m(2) , p = 0.084) after 6-month follow-up. MPA-AUC0-12 h was substantially higher in the intensified EC-MPS group than the standard EC-MPS group, though without a significant difference (71.4 ± 41.7 vs. 53.0 ± 27.0 mg·h/l, p = 0.107). The IS regimen did not increase the incidence of adverse effects (IS 54.1% vs. 45.0%, p = 0.39), including diarrhoea or leucopenia.

CONCLUSIONS

The intensified EC-MPS dosing regimen maintaining low-dose CNIs in this study may be beneficial for Chinese adult de novo kidney transplant recipients in terms of acute rejection and allograft function and is safe within 6 months post transplant.

Clinical effects of treatment with Tirofiban on patients with high-risk NSTE-ACS after PCI

OBJECTIVE

To explore clinical effects of Tirofiban treatment on patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

107 patients with high-risk NSTE-ACS after PCI were selected and were divided into two groups. One group of 56 patients was treated with Tirofiban and a second group of 51 patients was taken as control. The occurrence conditions of creatine kinase-myoglobin (CK-MB), cardiac troponin1 (cTnI) level, hemorrhage incidents and major adverse cardiac events (MACE) incidents after treatments were compared.

RESULTS

After 24 h operation, CK-MB and cTnI level in Tirofiban group were both significantly lower than those in control group (p < 0.05), while the difference of hemorrhage incidents between two groups is of no statistical significance (p < 0.05); and the differences in overall occurrence rate of MACE incidents and the occurrence rate of angina pectoris after infarct between two groups were statistically significant (p < 0.05).

CONCLUSIONS

Tirofiban could improve the blood supply condition of hearts of patients with high-risk NSTE-ACS after emergent PCI, lower the occurrence rate of MACE incidents, and decrease the risk of hemorrhage.

The use of reduced copper metal–organic frameworks to facilitate CuAAC click chemistry

A reduced copper metal–organic framework (rCu-MOF) containing Cu^I ions was prepared and employed as a catalyst for ‘Click’ reactions. The rCu-MOF presents higher catalytic activity, good structural stability as well as facile recyclability compared to traditional copper halide catalysts.

Relationship between B-type natriuretic peptide and short-term prognosis in non-diabetic patients with ST-segment elevation myocardial infarction

OBJECTIVE

To investigate the differences of the B-type natriuretic peptide (BNP) levels in serum or plasma of the STEMI patients with different infarction sites. To explore the relationship between the BNP level and the short-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI).

PATIENTS AND METHODS

A total of 216 STEMI patients were enrolled in this study from June 2012 to June 2014. All patients received coronary angiography (CAG). Based on electrocardiography (ECG) and CAG results, patients were divided into three groups. Group A included 80 patients with anterior/lateral wall myocardial infarction, group B included 76 patients with inferior/posterior wall myocardial infarction and group C included 60 patients with right ventricular myocardial infarction. We enrolled 53 patients with normal CAG results as Group D. BNP levels were compared among these groups. and according to BNP levels, all patients were subdivided into normal BNP group (< 100 ng/mL, n = 53), mild-higher BNP group (100-400 ng/mL, n = 105) and marked-higher BNP group (≥ 400 ng/mL, n = 58). The occurrence of major adverse cardiovascular events (MACE) including secondary heart failure, severe arrhythmia, post-infarction angina, recurrent myocardial infarction, and cardiac death within 6 months after disease onset were assessed.

RESULTS

BNP levels showed a gradually decreasing trend in groups A, B, C and D (p < 0.05). Significant differences in left ventricular ejection fraction (LVEF) were found among normal BNP group, mild-high BNP group and marked-higher BNP group (p < 0.05). The MACE occurrence presented no statistical differences between normal BNP group and mild-higher BNP group (p > 0.05). The MACE prevalence in marked-higher BNP group was significantly higher than normal BNP group and mild-higher BNP group (p < 0.05).

CONCLUSIONS

BNP levels can be used as a clinical indicator to predict short-term prognosis in STEMI patients.

Investigation into the photolytic stability of RAFT agents and the implications for photopolymerization reactions

The photolytic stability of RAFT agents under blue LED irradiation has been investigated with regard to photopolymerization reactions.

Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial

BACKGROUND

Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures.

METHOD

In this prospective, multi-centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors.

RESULTS

A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO2 % than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters.

CONCLUSION

Non-nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.

High-mobility group box 1 induces neuron autophagy in a rat spinal root avulsion model

Autophagy, a tightly regulated lysosome-dependent catabolic pathway, is implicated in various pathological states in the nervous system. High-mobility group box 1 (HMGB1) is an inflammatory mediator known to be released into the local microenvironment from damaged cells. However, whether autophagy is induced and exogenous HMGB1 is involved in the process of spinal root avulsion remain unclear. Here, we investigated the induction effect of autophagy and the possible role of HMGB1 during spinal root avulsion. It was found that autophagy was activated in the anterior horn of the spinal cord as represented by the increased expression of the autophagic marker microtubule-associated protein light chain 3-II (LC3-II), degradation of sequestosome 1 (p62), and formation of autophagosomes, and that autophagy was inhibited after intraperitoneal injection of anti-HMGB1-neutralizing antibodies in the rat spinal root avulsion model. In addition, HMGB1-induced autophagy and activated mitogen-activated protein kinases (MAPKs) in primary spinal neurons, including c-Jun N-terminal kinase (JNK), extracellular-signal-regulated kinase (ERK), and p38MAPK. Inhibition of JNK or ERK activity significantly blocked the effect of HMGB1-induced autophagy in primary spinal neurons. Finally, HMGB1-induced autophagy increased cell viability in primary spinal neurons under oxygen-glucose deprivation conditions. The above results suggest that HMGB1 is a critical regulator of autophagy and HMGB1-induced autophagy plays an important role in protecting spinal neurons against injury, which may provide new insights into the pathophysiological process of spinal root avulsion.

Pre-PCI medication using clopidogrel and ticagrelor in the treatment of patients with acute myocardial infarction

OBJECTIVE

This study aimed to compare preoperative treatment using clopidogrel and ticagrelor for patients with acute myocardial infarction (AMI) undergoing emergent percutaneous coronary intervention (PCI), and to investigate the efficacy and safety of these medications in the management of AMI.

PATIENTS AND METHODS

Between February 2013 and December 2014, 74 patients with AMI admitted for emergent PCI therapy were included in the study and randomly divided into two groups: study group and control group. Patients in the study group received different pre-PCI treatment with a loading dose of 180 mg ticagrelor, and those in the control group received treatments with a loading dose of 600 mg clopidogrel. After PCI procedure, all patients were orally administered 75 mg clopidogrel once a day for maintenance therapy, and patients were monitored for one week at the hospital and further followed up for one month Platelet aggregation rates (PAR) of each patient was measured before medication, at 30 min, 2h, 24h and one week after medication, respectively. PAR, thrombolysis in myocardial infarction (TIMI) flow, clinical outcomes and adverse reactions were compared between groups.

RESULTS

No significant differences were observed in PAR before treatment between groups (p>0.05), whereas PARs were significantly different after treatment between groups (p<0.05), with the efficacy of medications peaking at 2h after the treatment. In addition, PARs were significantly different between different time points after treatment (p<0.05). Evaluation of TIMI flow grade showed that in study group, 6 patients (16.22%) were grade 2 and 31 (83.78%) were grade 3 for the study group; for the control group, 11 patients (27.73%) were grade 2 and 26 (72.27%) were grade 3. No significant differences were observed in TIMI flow grades between different groups (p>0.05). No recurrence of the disease was observed, but one case (2.70%) of mucosal bleeding in the nasal cavity and four cases (10.81%) of vomiting were found in the study group. However, in the control group, four patients (10.81%) presented with recurrent disease, six patients (16.22%) experienced mucosal bleeding in the nasal cavity and 11 patients (29.73%) vomited. Significant differences were observed in the incidence of adverse events between different groups (p<0.05).

CONCLUSIONS

Compared with 600 mg clopidogrel, a loading dose of 180 mg ticagrelor could effectively inhibit platelet reactivity at the early stage of AMI, resulting in more favorable clinical outcomes and lower occurrence of adverse events and, thereby, can be used in clinical practice.

A short-term transition from a high-fat diet to a normal-fat diet before pregnancy exacerbates female mouse offspring obesity

BACKGROUND/OBJECTIVES

Recent findings have highlighted the detrimental influence of maternal overnutrition and obesity on fetal development and early life development. However, there are no evidence-based guidelines regarding the optimal strategy for dietary intervention before pregnancy.

SUBJECTS/METHODS

We used a murine model to study whether switching from a high-fat (HF) diet to a normal-fat (NF) diet (H1N group) 1 week before pregnancy could lead to in utero reprogramming of female offspring obesity; comparator groups were offspring given a consistent maternal HF group or NF group until weaning. After weaning, all female offspring were given the HF diet for either 9 or 12 weeks before being killed humanely.

RESULTS

H1N treatment did not result in maternal weight loss before pregnancy. NF offsprings were neither obese nor glucose intolerant during the entire experimental period. H1N offsprings were most obese after the 12-week postweaning HF diet and displayed glucose intolerance earlier than HF offsprings. Our mechanistic study showed reduced adipocyte insulin receptor substrate 1 (IRS1) and hepatic IRS2 expression and increased adipocyte p-Ser(636/639) and p-Ser(612) of H1N or HF offspring compared with that in the NF offspring. Among all groups, the H1N offspring had lowest level of IRS1 and the highest levels of p-Ser(636/639) and p-Ser(612) in gonadal adipocyte. In addition, the H1N offspring further reduced the expression of Glut4 and Glut2, vs those of the HF offspring, which was lower compared with the NF offspring. There were also enhanced expression of genes inhibiting glycogenesis and decreased hepatic glycogen in H1N vs HF or NF offspring. Furthermore, we showed extremely higher expression of lipogenesis and adipogenesis genes in gonadal adipocytes of H1N offspring compared with all other groups.

CONCLUSIONS

Our results suggest that a transition from an HF diet to an NF diet shortly before pregnancy, without resulting in maternal weight loss, is not necessarily beneficial and may have deleterious effects on offspring.

A survey of outcomes and management of patients post fragility fractures in China

We found that the fragility hip and vertebral fractures caused excess mortality rates in this Chinese female population, which was unexpectedly lower than those in western countries and other Asian countries. This was the first nationwide survey relating to post-fracture outcomes conducted among Chinese population in Mainland China.

INTRODUCTION

This study aimed to investigate the mortality, self-care ability, diagnosis, and medication treatment of osteoporosis following fragility hip and vertebral fractures through a nationwide survey among female patients aged over 50 in Mainland China.

METHODS

This was a multicenter, retrospective cohort study based on medical chart review and patient questionnaire. Female patients aged 50 or older admitted for low-trauma hip or vertebral fractures and discharged from Jan 1, 2008 to Dec 31, 2012 were followed.

RESULTS

Total of 1151 subjects of hip fracture and 842 subjects of vertebral fracture were included. The mean age was 73.4 ± 10.0, and the median of duration from index fracture to interview was 2.6 years. The overall 1-year, 2-year, 3-year, 4-year, and 5-year cumulative mortality rates were 3.5, 7.0, 11.2, 13.1, and 16.9 %, respectively. The first year mortality rates in hip (3.8 %, 95% CI 3.3-4.4 %) and vertebral fracture (3.1 %, 95% CI 2.5-3.7 %) were significantly higher than that in the general population (1.6 %). Impaired self-care ability was observed in 33.2, 40.6, and 23.8 % of overall, hip fracture, and vertebral fracture group, respectively. The overall diagnosis rate of osteoporosis was 56.8 %, and bone mineral density (BMD) measurement had never been conducted in 42.0 % among these women. After the index fracture, 69.6 % of them received supplements and/or anti-osteoporotic medications, among which 39.6 % only received calcium with/without vitamin D supplementation.

CONCLUSIONS

The osteoporotic hip and vertebral fractures caused excess mortality rates in this population of Mainland China. The current diagnosis and medical treatment following the fragility fractures is still insufficient in Mainland China.

Effect of low temperatures on BAX and BCL2 proteins in rats with spinal cord ischemia reperfusion injury

We evaluated changes in BAX and BCL2 expression levels after spinal cord ischemia/reperfusion injury (SCII) and hypothermia during operations in rats. Eighty rats were divided into four groups: Group A (N = 20, 18°C); Group B (N = 20, 28°C); Group C (N = 20, room temperature); and Group D (N = 20, sham operation control). Spinal cord ischemia was induced for 90 min. Hypothermia was induced 15 min before, and maintained during ischemia, followed by heating to normothermia for 30 min after reperfusion. Motor function of the lower limbs was evaluated according to the Tarlov score at 72 and 168 h. For each rat, spinal cord samples were taken at 6, 24, 72 h, and 1 week to evaluate the histopathological changes, neuronal apoptosis, and BAX and BCL2 expression levels. Compared with normothermia, hypothermia significantly improved hind limb function; Group B achieved a higher score than Group A. Group D showed no neurologic deficiency, while the other groups showed various degrees. Group C exhibited greater neuronal apoptosis, higher BAX expression, but lower BCL2 expression than the other groups. Compared with Group A, BAX was expressed less and BCL2 more in Group B, and there was less apoptosis in Group B. Hypothermia preserves hind limb motor function and reduces neuronal death, thereby protecting rats from SCII. The spinal cord may be protected from SCII by inhibition of BAX and activation of BCL2. However, deep hypothermia may inhibit the expression of BCL2, resulting in a worse outcome than mild hypothermia.