[A cross-sectional study on the association between frailty and muscular performances in hospitalized elder patients with coronary artery disease]

Objective: To explore the association between frailty and muscle performances of hospitalized elder adults with coronary artery disease. Methods: A total of 122 hospitalized patients aged 65-85 years old with coronary artery disease from Department of Geriatrics and Cardiology, Peking Union Medical College Hospital between December 2017 and March 2018 were enrolled in the study. A comprehensive geriatric assessment was performed to evaluate existing comorbidity and geriatric syndromes of the patients. Frailty was assessed using the Clinical Fraity Scale. The patients were classified as frail and non-frail, according to the scale. Muscle performances were assessed using grip strength, gait speed, etc. Whole body and appendicular skeletal muscle mass was detected with bioelectrical impedance analysis in patients with reduced grip strength or slowed gait speed. Appendicular skeletal muscle index (ASMI) was calculated. Results: Among all subjects, 28 were with frailty (23.0%) and 94 were without (77.0%). The frail patients were older [(76.7±5.4) years vs. (72.2±5.6)years], had higher Charlson comorbidity index [2.0(1.0,2.75)vs. 1.0(0,2.0)], and higher proportion of malnutrition (14.29% vs. 1.06%), urinary incontinence (39.29% vs. 15.96%), using walking-aid (28.57% vs. 6.38%), and more kinds of taken drugs (8.1±3.0 vs. 6.6±2.7), than the non-frail patients. Prealbumin levels [(207.8±60.0)mg/L vs.(234.3±45.4)mg/L] were lower, and highly sensitive C-reactive protein levels [(5.89±9.57)mg/L vs.(1.89±2.49)mg/L] were higher in the frail patients than in the non-frail patients (all P<0.05). Compared with non-frail patients, the frail patients had poorer grip strength [(19.67±7)kg vs.(29.23±8.29)kg] and slower gait speed [(0.54±0.2)m/s vs.(0.91±0.22)m/s] (all P<0.001). Spearman rank correlation analyses showed that grip strength was positively correlated with the appendicular skeletal muscle mass(r=0.811), whole body skeletal muscle mass(r=0.74) and the ASMI (r=0.783), respectively. Conclusions: The incidence of frailty among hospitalized older adults with coronary artery disease is high. Poor muscle performances were common in these patients. Assessment of frailty and muscle performances can help to evaluate the overall function of older adults with cardiovascular disease in a comprehensive way.

Pseudokabatana alburnus n. gen. n. sp., (Microsporidia) from the liver of topmouth culter Culter alburnus (Actinopterygii, Cyprinidae) from China

We describe the type species of a novel genus of microsporidian parasite, Pseudokabatana alburnus n. gen. n. sp., infecting the liver of topmouth culter, Culter alburnus Basilewsky, 1855, from Lake Poyang off Xingzi county, Jiangxi Province, China. The parasite elicits formation of spherical xenomas of up to 1.2 mm in diameter containing all observed life stages from early merogonal plasmodia to mature spores contained within the cytoplasm of host hepatocytes. Merogonal plasmodia existed in direct contact with the host cytoplasm and contained up to 20 visible nuclei. Plasmotomy of the multinucleate plasmodium led to formation of uninucleate cells in which the nucleus underwent further division to form bi-nucleate presporonts, sporonts (defined by cells with a thickened endospore) and eventually sporoblasts (containing pre-cursors of the spore extrusion apparatus). Mature spores were pyriform and monokaryotic, measuring 2.3 ± 0.19 μm long and 1.3 ± 0.10 μm wide. Spores possessed a bipartite polaroplast and 5-6 coils of a polar filament, in a single rank. The obtained partial SSU rRNA gene sequence, 1383 bp in length, did not match any of microsporidia available in GenBank. SSU rDNA-based phylogenetic analysis indicated a new taxon branching with Kabatana rondoni, a parasite infecting the skeletal muscle of Gymnorhamphichthys rondoni from the Amazon River. Due to different host and tissue tropism, the novel taxon did not fit the diagnostic criteria for the genus Kabatana. Further, based on SSU rDNA-inferred phylogenetic analyses, different ultrastructural features of developmental stages, and ecological considerations, a new genus Pseudokabatana and type species Pseudokabatana alburnus n. sp. was erected for the parasite in topmouth culter.

[Ikaros family zinc finger 1 mutation is a poor prognostic factor for adult Philadelphia chromosome positive acute lymphoblastic leukemia]

Objective: To analyze the prognostic impact of Ikaros family zinc finger 1(IKZF1) mutation on adult Philadelphia chromosome (Ph1) positive acute lymphoblastic leukemia (ALL) patients. Methods: IKZF1 mutation was detected in 63 adult Ph1 positive ALL patients at diagnosis using capillary electrophoresis. Recruited patients were treated in our center and other three hospitals in Ningbo from January 2014 to January 2017. Clinical data were collected and retrospectively analyzed. Results: Thirty-nine (61.9%) patients were positive IKZF1 mutation in this cohort. The white blood cell (WBC) count in IKZF1 mutation group was significantly higher than that of mutation negative group [(64.6±11.3)×10(9)/L vs. (33.7±5.6)×10(9)/L, P<0.05]. Patients with WBC count over 30×10(9)/L accounted for 56.4% in IKZF1 mutation group. Complete remission (CR) rate in the IKZF1 mutation group was also lower than that of negative group after induction chemotherapy (64.1% vs. 75.0%, P>0.05). IKZF1 was a negative prognostic factor but not independent factor for survival by univariate and multivariate analyses. Patients were divided into chemotherapy and allogeneic transplantation groups. The 3-year overall survival (OS) rate and 3-year leukemia-free survival (LFS) rate in IKZF1 mutation group were significantly lower than those of negative group in both transplantation group (42.3% vs. 59.3%; 31.2% vs. 50.0%; respectively, both P<0.05) and chemotherapy group (24.8% vs. 40.0%; 19.0% vs. 34.3%; respectively, both P<0.05). Conclusion: IKZF1 mutation is a poor prognostic factor for adult Ph1 positive ALL patients.

[Relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases]

Objective: To observe the relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases (AD). Methods: In this retrospective study, 95 AD patients (27 males, (38.6±14.2) years old) were enrolled as AD group and 71 gender and age matched healthy subjects (24 males, (37.6±12.2) years old) were enrolled as control group, all underwent transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (STE) in our hospital between January 2014 and June 2018. Left ventricular untwisting and diastolic function parameters were measured. Multiple logistic regression analysis was used to identify related factors of left ventricular diastolic dysfunction in AD patients. Receiver operating characteristic (ROC) curve was used to identify the diagnosis value of untwisting parameters for left ventricular diastolic dysfunction in AD patients. Results: Compared with control group, left ventricular ejection fraction was lower (58(47, 66)% vs. 67 (62, 71) %, P<0.001), E/e' was higher (10.78 (7.28, 13.65) vs. 6.30 (5.55, 7.25) , P<0.001), isovolumic relaxation time was longer (73.5 (56.5, 88.0) ms vs. 62.0 (58.0, 68.5) ms, P<0.001),and untwist slope during isovolumic relaxation period (USIR) was lower (31.92 (14.09, 54.92) °/s vs. 59.90 (40.09, 87.18) °/s, P<0.001) in AD group than in control group. Multiple logistic regression analysis showed heart rate (OR=0.885, 95%CI 0.840-0.931, P<0.001), E/e' (OR=0.655, 95%CI 0.537-0.798, P<0.001) and USIR (OR=0.986, 95%CI 0.974-0.998, P=0.020) were independently related with left ventricular diastolic dysfunction in AD patients. ROC curve showed that area under the curve (AUC) was 0.919 (P<0.001), sensitivity was 87.6%, and specificity was 88.7%, when combining the heart rate, E/e', and USIR as assessment parameters for the diagnosis of left ventricular diastolic dysfunction in AD patients at a cutoff of 0.51. Conclusions: Impairment of myocardial untwisting indicates the presence of early stage left ventricular diastolic dysfunction in AD patients. USIR may be a sensitive parameter to evaluate early stage left ventricular diastolic dysfunction in AD patients.

[Characteristics of HIV-infected persons without long term disease progress and related factors in Guangxi Zhuang Autonomous Region]

Objective: To understand the characteristics of HIV infected persons without long term disease progress [also known as long term non-progressors (LTNPs)], and related factors in Guangxi Zhuang Autonomous Region (Guangxi). Methods: Data of persons living with HIV and receiving no antiretroviral therapy in Guangxi by the end of 2016 were collected from the national HIV/AIDS comprehensive control and prevention information system of China. Results: By the end of 2016, there were 313 LTNPs in Guangxi, accounting for 2.3% of those being reported for more than 10 years, 5.4% of those being reported for more than 10 years and surviving, and 26.6% of those being reported for more than 10 years, surviving and receiving no antiretroviral therapy. Among the LTNPs, 87.2%(273) were men, 94.9% (297) were aged ≤ 40 years, 32.3% (101) were farmers, 55.6% (174) were single, divorced or widowed, 69.3% (217) were of Han ethnic group, 68.1% (213) were injecting drug users, and 52.1% (163) were from custody facilities. Multiple logistic regression analysis indicated that factors associated with delayed disease progression included age ≤40 years (compared with age >40 years, aOR=1.55, 95%CI: 1.31-3.12) and injection drug use (compared with sexual transmission, aOR=1.23, 95%CI: 1.10-1.74). Conclusions: A number of LTNPs existed in HIV-infected individuals in Guangxi. Further research are needed to identify the related factors, and it is necessary to conduct large sample size studies on host immunology, genetics and the virology of HIV to explore the related mechanism.

[Effect of FLT3-ITD with DNMT3A R882 double-mutation on the prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

目的

探讨FLT3-ITD和DNMT3A R882双突变对急性髓系白血病（AML）患者allo-HSCT预后的影响。

方法

使用直接测序法检测206例接受allo-HSCT的AML患者（M₃和使用分子靶向药物索拉菲尼的病例除外）初诊时骨髓中常见的基因突变组套（包括FLT3-ITD、DNMT3A、c-kit、CEBPA、FLT3-TKD、NPM1），回顾性分析患者的临床资料，比较各基因突变组的移植预后。

结果

①206例AML患者中男104例，女102例，中位年龄38（3~63）岁。FAB分型：M₀ 6例，M₁ 24例，M₂ 56例，M₄ 39例，M₅ 63例，M₆ 6例，不能分类12例。②全部206例患者根据初诊时的突变基因情况分为4组：FLT3-ITD⁺ DNMT3A R882⁺组（A组）19例，FLT3-ITD⁺ DNMT3A R882⁻组（B组）38例，FLT3-ITD⁻DNMT3A R882⁺组（C组）21例，FLT3-ITD⁻DNMT3A R882⁻组（D组）128例。四组间性别、年龄、初诊时白细胞计数、FAB分型、移植前疾病状态、染色体核型、供者类型、预处理方案及GVHD发生率比较，差异无统计学意义（P>0.05）。③A组和B、C、D组比较，2年累积复发率较高[分别为（72.2±2.6）%、（38.6±0.6）%、（36.8±1.6）%、（27.8±0.1）%，P值均<0.05]，总生存率较低[分别为（30.9±13.3）%、（67.5±7.8）%、（61.4±12.4）%、（80.1±3.7）%，P值均<0.05]，无白血病生存率较低[分别为（11.3±10.2）%、（47.9±8.4）%、（56.8±12.5）%、（79.7±3.6）%，P值均<0.05]。

结论

伴有FLT3-ITD与DNMT3A R882双突变的AML患者移植后累积复发率较高，总生存率和无白血病生存率较差。

[Effect of non-vitamin K antagonist oral anticoagulants on left atrial or atrial appendage thrombi in patients with nonvalvular atrial fibrillation]

Objective: To investigate the effect of non-vitamin K antagonist oral anticoagulants (NOAC) on left atrial or atrial appendage (LA/LAA) thrombi in patients with nonvalvular atrial fibrillation (NVAF). Method: Data from 3 042 patients with atrial fibrillation(AF), who underwent transesophageal echocardiography (TEE) examination before cardioversion or catheter ablation for the detection of LA/LAA thrombus in our department from March 2016 to January 2018 were prospectively analyzed. Among these patients, LA/LAA thrombus was detected by TEE in 57 patients. A total of 19 patients who received dabigatran or rivaroxaban for ≥3 weeks and underwent repeated TEE were included, 38 patients were excluded (7 patients with rheumatic heart disease, 1 patient treated with pericardial decortication, 1 patient treated with surgical repair of endocardial cushion defect, 1 patient with LA thrombus associated with the atrial septal occluder device, 14 patients received warfarin therapy, 14 patients did not receive repeated TEE). Results: First repeated TEE results showed that LA/LAA thrombus was not completely resolved in 4 out of 4 patients treated with dabigatran (110 mg bid) for a median time of 119 (47, 258) days, whereas LA/LAA thrombus was completely resolved in 5 out of 11 patients treated with dabigatran (150 mg bid) for a median time of 80 (58, 147) days. Thrombus was completely resolved in 2 out of 2 patients treated with rivaroxaban (15 mg qd) for 110 days and 95 days respectively, and in 1 out of 2 patients treated with rivaroxaban (20 mg qd) for 91 days. Second repeated TEE was performed in 8 patients. Thrombus was resolved completely in 2 out of 3 patients with undissolved thrombus treated by dabigatran (110 mg bid) after increasing the dabigatran dosage (150 mg bid). Thrombus was resolved in 3 (1 patient prolonged treatment with dabigatran 150 mg bid and 2 patients switched to rivaroxaban 20 mg qd) out of 4 patients with undissolved thrombus under the dabigatran 150 mg bid regimen, whereas the thrombus remained unresolved in 1 patient switched to rivaroxaban (15 mg qd). After receiving rivaroxaban 15 mg bid treatment, the thrombus was finally resolved in 1 patient with undissolved thrombus treated by rivaroxaban 20 mg qd. There was no clinical thromboembolism or major bleeding events during the median follow up time of 462 (305, 558) days. Conclusions: Our data show that NOAC is an effective therapeutic option for the treatment of LA/LAA thrombi. When eligible, a higher NOAC dosage may be preferred due to the higher efficacy on thrombus resolvement.

[Value of 18F-FDG PET/CT and PET in diagnosing and staging extranodal nasal type natural killer/T-cell lymphoma:A Meta-analysis]

Objective:The aim of this study is to comprehensively evaluate the values of 18F-FDG PET/CT and PET in diagnosing extranodal nasal type natural killer/T cell lymphoma (ENKTL). Method:Studies about ENKTL diagnosed by 18F-FDG PET/CT and PET until June 2018 were searched in the databases such as PubMed, Embase, Cochrane, Web of Science, CNKI, CBM, VIP and Wanfang. Two reviewers independently screened literature and extracted data strictly according to included and excluded criterion, and assessed bias risk by 11 items using QUADAS-2 gulidline. Meta-analysis was performed by Revmann 5.3 and Stata 12.0 software. The pooled weighted Sentivity (Sen), Specificity (Spe), Diagnostic odds ratio (DOR) were calculated,summary receiver operator curve (SROC) and area under SROC curve (AUC) were also drawn. Result:Ten studies with 457 patients and 5 092 foci on 18F-FDG PET/CT and 4 studies with 169 patients and 384 foci on PET were finally included in our Meta-analysis.Our research showed that pooled Sen, Spe, DOR and AUC of 18F-FDG PET/CT diagnosing ENKTL were 0.97 (95%CI 0.93-0.99), 0.97(95%CI 0.88-0.99), 1 131.07(95%CI 167.77-7 625.28), 0.99(95%CI 0.98-1.00), and they were 0.81 (95%CI 0.70-0.89), 0.90(95%CI 0.66-0.98), 39.63(95%CI 6.41-244.85), 0.86(95%CI 0.82-0.89), respectively. Z test result reveled that 18F-FDG PET/CT had better diagnostic value in detecting ENKTL compared to PET: AUC=0.99(95%CI 0.98-1.00) vs AUC=0.86(95%CI 0.82-0.89), Z=2.95, P=0.003. Conclusion:In comparasion with PET, 18F-FDG PET/CT had excellent diagnostic value in detecting and staging ENKTL and may served as a non-invasive imaging in diagnosing and staging ENKTL.

[Clinical application of partial cystectomy with augmentation cystoplasty for invasive bladder cancer in elderly patients]

OBJECTIVE

To evaluate the clinical effect and safety of biological patch applied in elderly patients with invasive bladder cancer who underwent massive partial cystectomy with augmentation cystoplasty.

METHODS

The clinical data of 2 patients with invasive bladder cancer from October 2016 to March 2017, who underwent the massive partial cystectomy with augmentation cystoplasty were retrospectively reviewed. Case one was an 87-year-old man, with tumor located on the bladder anterior wall, ranging from 5.5 cm×2.5 cm, and the grade of American Society of Anesthesiologists (ASA) being III. Case two was a 77-year-old female, whose lesion was located on the right anterior wall, ranging from 5.2 cm×4.0 cm, and the grade of ASA being II. Both of the patients received a massive partial cystectomy with augmentation cystoplasty. The operative time, estimated blood loss, perioperative and postoperative data and follow-up data, including cystoscopy and urodynamics were recorded and compared. When the P value was less than 0.05, it was statistically significant.

RESULTS

All the operations were successfully performed. The average operative time was (155.0+35.4) min, mean estimated intraoperative blood loss was 20 to 100 mL, and the mean postoperatively hospital stay was eight days. During the 10 to 14 months' follow-up periods, no local recurrence or distant metastasis occurred. Urodynamic data: the maximum urinary flow rate was 16.5 mL/s, and the maximum bladder capacity was 303 mL. The two patients urinated 3-4 times in the day time, 0 to 3 times in the night, 200-300 mL each time, on average. The American Urological Association symptom score was 3 to 5. Partial cystectomy, applied to aged patients with multiple complications and high risk of surgical anesthesia, was able to reduce surgery related complications. For patients with tumor of small size, the normal bladder wall would be enough to recover functional capacity for urine storing after partial cystectomy. For patients with large lesions range and small normal bladder tissues, augmentation cystoplasty would help recover bladder capacity on the condition of negative margin.

CONCLUSION

Massive partial cystectomy with augmentation cystoplasty is safe and effective. It could decrease perioperative morbidity and keep the quality-of-life benefits of bladder preservation, which is worthy of further application for some selected invasive bladder cancer in elderly patients.

[Vascular endothelial growth factor-loaded microspheres promote dental pulp regeneration and vascularization]

Objective: To evaluate the effect of vascular endothelial growth factor (VEGF)-loaded microspheres on dental pulp tissue regeneration and vascularization in vivo. Methods:In vitro release experiment and human umbilical vein endothelial cell migration experiment were conducted with VEGF loaded microspheres. The dental pulp stem cells (DPSC) were co-cultured with VEGF microspheres to observe the compatibility between the cells and the microspheres. DPSC and VEGF loaded microspheres were injected into the root lumen through the apical foramen, which were then transplanted subcutaneously into nude mice. Histological and immunohistochemical features were observed after nine weeks. Results: DPSCs attached and spread on the surface of the microspheres. HE staining showed that the regenerated pulp-like tissue fulfilled the whole apex and middle third of the root. Differentiated odontoblast-like cells aligned with the existing tubular root dentin. Conclusions: VEGF-loaded microspheres promoted the regeneration of pulp-like tissues and formation of blood vessels.

[Clinicopathologic features of myxoid adrenocortical adenomas]

Objective: To study the clinicopathologic characteristics, immunophenotype, pathologic diagnosis and differential diagnosis of myxoid adrenocortical adenomas. Methods: The clinical data, histological features and immunohistochemical results of 4 cases of myxoid adrenocortical adenomas were analyzed, which were collected from January 2014 to December 2016 at Guangdong General Hospital, with review of literature. Results: Four cases of myxoid adrenocortical adenomas were presented. The patients ages ranged from 26 to 45 years (mean =35 years). Microscopically, it showed a typical morphology, characterized by small-sized tumor cell cords or pseudo-glands embedded in an abundant extracellular myxoid matrix. Immunohistochemical staining showed tumor cells were strongly positive for Melan A, vimentin and focally for α-inhibin, one case showed strong and diffuse positivity for CAM5.2, and two cases showed diffuse positivity for synaptophysin, while negative for CgA, S-100 protein, epithelial antigen, CK7, CK20 and CKpan. Conclusions: Myxoid adrenocortical adenomas are extremely rare, which may cause confusion with metastatic well-differentiated neuroendocrine tumours, sex cord-stromal tumoursor metanephric adenoma. Recognition of this entity would be beneficial for pathologists to avoid misdiagnosis, and unnecessary treatment.

[Dynamic variations of BMI and influencing factors among HIV/AIDS patients receiving highly active antiretroviral therapy in Liuzhou, Guangxi Zhuang Autonomous Region, 2013-2014]

Objective: To understand the dynamic variation of BMI and influencing factors among HIV/AIDS patients receiving highly active anti-retroviral therapy (HAART) in Liuzhou, Guangxi Zhuang Autonomous Region (Guangxi). Methods: HIV/AIDS patients receiving HAART for the first time since 1 January 2013 were selected. Data on BMI was analyzed among patients receiving HAART at baseline,6 months and 12 months after treatment. By using the general linear model repeated measures of analysis of variance, BMI dynamic variations and influencing factors were described and analyzed. Results: The average BMI of 2 871 patients at baseline, 6th months and 12th months appeared as (20.65±3.32), (20.87±3.22) and (21.18±3.20), respectively, with differences all statistically significant (F=18.86, P<0.001). BMI were increasing over time with treatments (F=37.25, P<0.001). Main influencing factors were noticed as: age, sex, marital status, baseline data of CD(4)(+)T cells and the WHO classification on clinical stages. Conclusions: Higher proportion of BMI malnutrition counts was seen among patients before receiving HAART in Liuzhou. BMI of the patients that were on HAART seemed being influenced by many factors. It is necessary to select appropriate treatment protocols on different patients so as to improve the nutritional status of the patients.

[Four cases of acute respiratory distress syndrome patients transported with veno-venous extracorporeal membrane oxygenation]

Objective: To retrospectively review 4 cases diagnosed with pediatric acute respiratory distress syndrome (ARDS) who were transported with veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) from April 2016 to March 2017. Methods: Four patients were transported to Bayi Children's Hospital Afflicted to the PLA Army General Hospital, with V-V ECMO. Their vital signs, blood-gas analysis and chest X-ray before and after transportation were compared. The length of ECMO, pediatric intensive care unit (PICU) stay and hospitalization, and the prognosis were analyzed. Results: All the four cases were transported to our hospital successfully from distances between 1 000 km to 1 210 km. The 4 cases were 4 to 6 years old with the body weight of 19 to 35 kg, of whom 3 were boys and 1 was girl. The catheters were inserted in the right jugular vein and femoral vein. The vital signs and blood-gas analysis after transportation did not change significantly compared to baseline. The length of ECMO for the four patients were 48, 754, 157 and 438 hours. They stayed in the PICU for 10, 32, 14 and 19 days, respectively. At last, 2 of them were successfully discharged from hospital without any complications; however, the other 2 died of multiple organ failure. Conclusion: Transporting ARDS patients with a satisfactory cardiac function under VV-ECMO by an experienced ECMO team is safe.

[Photochemical induced vestibular ischemiawith icy water test in guinea pigs]

Objective:To ascertain the effects of a new method of photochemical reaction in vestibular function in guinea pigs.Method:Local photochemical reaction was initiated by systemic injection of rose bengal(20mg), photoillumination of the vestibule through medial wall of epitympanum for 30 minutes was started immediately after the injection of rose bengal, with a optic fiber connected to a xenon light (wavelength, 540nm; photointense, 500-600 mW/cm ²). There were 20 guinea pigs divided random equally into 2 groups. Group 1 was injected with rose bengal. Group 2 was control, injected with physiological saline solution. The ice caloric tests were performed on the second day.Result:The test group (7 ears) and the control group (6 ears) with test nystagmus showed mean frequencies were（2.0±0.33）times/s and（3.7±0.33）times/s,the mean amplitude were (3.1±0.39)mm and (3.5±0.54)mm,and the mean duration were (44.7±17.22)s and (62.0±7.22)s respectively.The nystagmus frequency difference was statistically significant, but the amplitude and the duration of the nystagmus were not significantly different. There was no obvious spontaneous nystagmus in the two groups, and there were negative results of ice water test (3 ears in the test group and 4 ears in the control group).Conclusion:Photochemical reaction can induce the ischemic state of the vestibule system in guinea pig, and produce an acute vestibular dysfunction, and ice water test shows that the frequency of nystagmus is reduced.

Outbreak of mass mortality of yearling groupers of Epinephelus (Perciformes, Serranidae) associated with the infection of a suspected new enteric Sphaerospora (Myxozoa: Myxosporea) species in South China Sea

A suspected new enteric Sphaerospora species was believed to be directly associated with the mass mortality of yearling groupers of Epinephelus spp. in South China. The epizootic generally emerged from late September to late April of the following year. The infection prevalence and mortality rate were significantly negatively correlated with fish size. Clinical signs included anorexia, cachexia and extrusion of white pulp-like substance from anus after gentle pressure on the abdomen. Upon necropsy, severe intestinal oedema, thin and transparent intestinal wall, swollen spleen, kidney and gall bladder could be observed. Wet preparation of the infected samples showed large amount of typical disporous plasmodia of the genus Sphaerospora, but no mature spores were observed. Epidemiological investigation showed that this parasite exclusively infected Epinephelus groupers. Histopathologically, this species mainly infected the epithelium of intestine and kidney tubules and caused severe epithelia sloughing and the collapse of intestinal villus. Interestingly, this enteric myxosporidiosis did not cause severe emaciation of infected fish for mass mortality usually emerged within 2-3 days after appearance of clinical signs. The species was most genetically related to Sphaerospora fugu (89% sequence identity) and phylogenetically positioned within marine Sphaerospora lineage. This is the first report of enteric sphaerosporosis of groupers.

[Comparative results of non-operative and operative treatment of humeral shaft fractures]

OBJECTIVE

To compare the difference between non-operative and operative treatment of humeral shaft fractures.

METHODS

From March 2005 to October 2012, 252 cases of humeral shaft fractures were treated and were adequately followed up. According to the treatment methods, the patients were divided into 2 groups: the non-operative group and the operative group. In the non-operative group, there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with internal fixation either by plating or by nailing in the operative group. The follow-up parameters included: fracture healing rate, fracture union time, complications rate, Constant- Murley shoulder score and Mayo elbow score.

RESULTS

The mean follow-up period was (31.24±20.06) months (ranging 6 to 103 months). There were no statistical differences in age, open fracture number, fracture site and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification between the non-operative group and the operative group. The fracture healing rate: the non-operative group: 96.1%(72/76), the operative group: 97.7%(172/176), P=0.46; the fracture union time: the non-operative group: (10.24±2.93) weeks, the operative group: (10.69±2.51) weeks, P=0.22; the complication rate: the non-operative group: 5.3%(4/76),the operative group: 15.3%(27/176), P=0.03. The complications included: nonunion: the non-operative group: 3.95%(3/76), the operative group: 2.3%(4/176), P=0.434; radial nerve palsies: the non-operative group: 0%(0/76), the operative group: 5.7%(10/176), P=0.035; bone split: the non-operative group: 0%(0/76), the operative group: 1.7%(3/176), P=0.556; elbow stiffness: the non-operative group:1.3%(1/76), the operative group: 0.6%(1/176), P=1.000; shoulder pain: the non-operative group:0%(0/76), the operative group: 5.1%(9/176), P=0.061. The Constant-Murley shoulder score: the non-operative group: 97.37±4.94, the operative group: 96.34±6.88, P=0.244. The Mayo elbow score: the non-operative group: 99.80±1.72, the operative group: 99.49±2.73,P=0.923.

CONCLUSION

The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.

[Gene mutation and clinical phenotype analysis of patients with Noonan syndrome and hypertrophic cardiomyopathy]

Objective: To analyze the gene mutations and clinical features of patients with Noonan syndrome and hypertrophic cardiomyopathy. Method: Determined the mutation domain in five cases diagnosed with Noonan syndrome and hypertrophic cardiomyopathy and identified the relationship between the mutant domain and hypertrophic cardiomyopathy by searching relevant articles in pubmed database. Result: Three mutant genes (PTPN11 gene in chromosome 12, RIT1 gene in chromosome 1 and RAF1 gene in chromosome 3) in five cases all had been reported to be related to hypertrophic cardiomyopathy. The reported hypertrophic cardiomyopathy relevant genes MYPN, MYH6 and MYBP3 had also been found in case 1 and 2. Patients with same gene mutation had different clinical manifestations. Both case 4 and 5 had RAF1 mutation (c.770C>T). However, case 4 had special face, low IQ, mild pulmonary artery stenosis, and only mild ventricular hypertrophy. Conclusion: Noonan syndrome is a genetic heterogeneity disease. Our study identified specific gene mutations that could result in Noonan syndrome with hypertrophic cardiomyopathy through molecular biology methods. The results emphasize the importance of gene detection in the management of Noonan syndrome.

[Analysis of outcomes of tension-free mid-urethral sling procedure in women with mixed urinary incontinence]

OBJECTIVE

To evaluate the medium and long term outcomes of tension-free mid-urethral sling in the treatment of female patients with mixed urinary incontinence (MUI).

METHODS

Twenty-six patients who underwent the tension-free mid-urethral sling procedure for MUI from April, 2010 to September, 2016, were followed up. Four of the 26 patients underwent retropubic tension free mid-urethral sling (TVT), and 22 of them underwent transurethral middle obturator sling (TOT). Scales were used in the follow-up, such as urinary incontinence severity score (UISS), detrusor instability score (DIS), incontinence quality of life scale evaluation (I-QOL), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared.

RESULTS

The mean age was 62 years, with a range of 42-80 years. The mean body mass index (BMI) was 26.82 kg/m², with a range of 21.48-31.14 kg/m². The mean follow-up time was 26 months, with a range of 8-69 months. Twelve patients never took M-blockers and the rest 14 patients took M-blockers within two weeks. None of the patients had complications, including dysuria, injury of bladder, urethra, obturator vessel or nerve during the surgery. After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination. The overall cure rate for stress urinary incontinence (SUI) was 96.15% with 25 patients cured, and for urge urinary incontinence (UUI) was 76.92% with 20 patients cured. The patients' life quality also improved significantly (P<0.05).

CONCLUSION

Ten of the 26 patients showed an overactive bladder according to urodynamic study, from whom all of the six failed patient were. And 16 patients didn't show an overactive bladder, which may due to two reasons. One is that their sense of urge is not so serious, the other one is that their sense of urge is from urethra. Proximal urethra is full of nerve, which plays a role in sense and urine control. The sense of urge may come from urethra instead of bladder. tension-free mid-urethral sling procedure is an effective treatment for women with mixed urinary incontinence. Even without taking the M-blockers, the cure rate for urge incontinence reached 76.92%. The efficacy of surgery remained stable in medium and long term, and the patients' quality of life improved significantly.

[Expression changes of Notch and nuclear factor-κB signaling pathways in the rat heart with myocardial infarction]

Objective: To observe the expression changes of Notch and nuclear factor-κB (NF-κB) signaling pathways in rat myocardium post myocardial infarction. Methods: Myocardial infarction was established by ligation of the left anterior descending coronary artery(MI group), sham rats (similar surgical procedure without coronary artery ligation) served as control, the rats were sacrificed at first week, 4th and 8th week after operation, the non-infarct myocardial tissue in both groups was obtained to detect the mRNA expression of Notch1, Dll4 and Hes1 by RT-PCR, the protein expression of NICD1 was detected by Western blot, the nuclear protein p65 content was detected to reflect the activation degree of NF-κB signaling in the cardiomyocytes. Results: The myocardial mRNA expression of Notch1 in MI group was significantly higher than in control group (1.68±0.35 vs. 0.47±0.12, P<0.05) at first week, and tended to be higher at the 4th week and 8th week (P>0.05). The mRNA expression of Dll4 and Hes1 was similar between the two groups at the three time points. NICD1 protein level was increased at the first week in MI group as compared with control group (1.31±0.33 vs.0.45±0.11, P<0.05), which tended also to be higher at the 4th week and 8th week post operation (P>0.05). For NF-κB activation study, the nuclear protein p65 content was higher at first week, 4th week and 8th week in MI group as compared with respective control groups (0.286±0.052 vs.0.049±0.016 (P<0.01), 0.247±0.056 vs. 0.043±0.018 (P<0.01), 0.120±0.033 vs. 0.044±0.009 (P<0.05)), the most significant increase was found in the first week. Conclusions: Notch and NF-κB signaling pathways are actively involved in the process of ventricular remodeling after myocardial infarction. Notch1 and NF-κB signaling pathways are both activated at the first week after myocardial infarction, NF-κB signaling pathway activation after myocardial infarction continues up to 8 weeks. These two signal transduction pathways may thus serve as new targets for future intervention studies to prevent heart failure.

[Antagonism of lovastatin on oxidative stress and apoptosis in primary rat hippocampal neurons induced by β-amyloid peptide]

Objective: To investigate the effect of lovastatin on oxidative stress and apoptosis in neurons induced by β-amyloid peptide (Aβ). Methods: Primary culture of rat hippocampal neuron was treated with Aβ oligomers alone or combined with lovastatin. The levels of OH(-), H(2)O(2), O(2)·(-), malondialdehyde, superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) activities were measured by biochemical methods and protein expression of caspase-3 and bcl-2 was detected by Western blot. Results: As compared with the control group, treatment of 0.5 μmol/L Aβ oligomers for 48 h led to significant increase of OH(-), H(2)O(2), O(2)·(-) and malondialdehyde content, inhibition of SOD and GSH-PX activities, enhanced caspase-3 expression and decreased bcl-2 expression. Interestingly, these neurotoxic modifications on the levels of OH(-), H(2)O(2), O(2)·(-) and malondialdehyde content, SOD and GSH-PX activities, and the protein expression of cleaved caspase-3 and bcl-2 were significantly attenuated when the cells were pretreated with 0.1 μmol/L lovastatin for 24 h before exposure of Aβ oligomers. Conclusion: Lovastatin may play an important role in antagonizing the neurotoxicity of Aβ through a mechanism likely related to the inhibition of oxidative stress.

[The impact of red blood cell distribution width on outcome of elective percutaneous coronary intervention in non-anemia patients]

Objective: Previous studies have revealed that the red blood cell distribution width (RDW) was associated with long-term prognosis in patients undergoing percutaneous coronary intervention (PCI). However, they did not exclude patients with anemia. This study, thus, investigated the association between RDW and prognosis in non-anemia patients. Methods: A total of 2 732 patients underwent elective PCI from July 2009 to September 2011 were enrolled in the study. These patients were divided into two groups based on their baseline median RDW levels: low RDW group (RDW<12.1%) and high RDW group (RDW≥12.1%). All the subjects were followed up for an average period of 18 months and the associations between baseline RDW levels and postoperative mortality were analyzed. Results: Patients in the high RDW group were elder and had more women than those in low RDW group. Most of them had prior history of hypertension, stroke, myocardial infarction, but few of them were current smokers. Subjects in the high RDW group had higher systolic blood pressure and total cholesterol levels, and lower erythrocyte mean corpuscular volume, hemoglobin level, estimated glomerular filtration rate level, and left ventricular ejection fraction. Moreover, more subjects in the high RDW group were combined with left main, ostial and chronic total occlusion lesion, and had a lower complete revascularization rate. The postoperative mortality was significantly higher in the high RDW group than that in the low RDW group (2.4% vs 0.6%, P<0.001). Multivariate Cox regression analysis revealed that preoperative high RDW level was an independent risk factor for postoperative mortality after adjustment of other factors (HR 3.930, 95%CI 1.600-9.656, P=0.003). Conclusion: High RDW might be a marker for the postoperative mortality in non-anemic patients undergoing elective PCI.

[Relative analysis of endolymphatic imaging and clinical manifestations in Meniere's patients]

Objective:The research aimed to study the relationship between endolymphatic imaging and clinical manifestations(duration of last attack period to MRI scan) of Meniere's patients.Method:Twenty-six Meniere's patients and 29 affected ears were enrolled in this research. According to clinical manifestations, when performing MRI scan, patients who were not in attack period and the duration of last attach period to MRI scan was longer than 14 days were divided to Group A; and patients who were in attack period or the duration of last attach period to MRI scan was shorter than or equal to 14 days were divided to Group B. Administrate gadolinium to mid-ear affected by MD via non-invasive method through Eustachian tube, and then perform 3D-FLAIR MRI scan the next day. After measurement and calculation, compare RV and RC (area of endolymphatic space divided by total lymphatic space in vestibule and cochlea, respectively) of the two groups. Result:Twenty-nine affected ears of 26 patients were administrated successfully.The endolymphatic spaces were distinct from perilymphatic spaces in vestibule and cochlea in 26 ears. In the images of B6, B12, B14, the cochlea and semicircular canals were enhanced, but the vestibules were not enhanced. For Group A ,the average of RV was 0.37±0.06; the average of RC was 0.15±0.04. As to Group B ,the average of RV was 0.52±0.26; the average of RC was 0.18±0.06. According to ANOVA test,RV of the two groups had significant difference（P<0.05）, RC had no significant difference（P>0.05）. The positive RC and RV in Group A were 7.1% and 42.9% respectively. The positive RC and RV in Group B were 13.3% and 66.7%, respectively. As to 4 patients who were during attack period in Group B, the positive RC and RV were 50% and 100%, respectively. The positive RV of Group B was higher than that of Group A. Conclusion:The clinical manifestations(duration of last attack period to MRI scan) of Meniere's patients had relationship with positive rate of MRI scan. The possibility of positive RV was higher when the duration of attack period to MRI scan was shorter.

Redescription of Chloromyxum ellipticum Li & Nie, 1973 (Myxosporea: Chloromyxidae) infecting the gall bladder of grass carp Ctenopharyngodon idellus Valenciennes, 1844, supplemented by morphological and molecular characteristics

The traditional taxonomy of the genus Chloromyxum Mingazzini, 1890 has been intensively challenged to be paraphyletic by recent ribosomal DNA (rDNA)-based phylogenetic analysis. Undersampling to get rich sequence data to infer more scientific phylogenetic relationships makes scientists conservatively assign all non-marine elasmobranch-infecting species as Chloromyxum sensu lato. Although complex ridge pattern on the spore surface observed by scanning electron microscopy was thought to be critical for the identification of Chloromyxum species, insufficient data also prevent this ultrastructural data to be a valid taxonomic feature for this genus. It is especial for Chloromyxum species to be reported in China. Molecular and ultrastructural characteristics are yet available for all 22 Chloromyxum species recorded in China. During the investigation of the diversity of coelozoic fish myxosporeans, Chloromyxum ellipticum Li & Nie, 1973 was found to highly infect the gall bladder of Ctenopharyngodon idellus Valenciennes, 1844 in Poyang Lake watershed of Jiangxi province, Eastern China. Here, we redescribed it by the currently recommended holistic approach of combining morphological, ultrastructural, and molecular characteristics. Mature spores were found floating free in the gall bladder, but no plasmodium observed. Spores are typical freshwater teleost-infecting Chloromyxum species, spherical or subspherical in lateral view, measuring 7.7 ± 0.08 μm (6.9-9.1) in length, 6.3 ± 0.09 μm (5.6-7.6) in width, and 5.8 ± 0.20 μm (5.2-6.3) in thickness. Four pyriform polar capsules, located at the anterior end of the spores, were equal in size, 3.3 ± 0.06 μm (2.2-4.1) long and 2.1 ± 0.03 μm (1.7-2.5) wide. Polar filaments coiled with four to five turns. Two equal spore valves are symmetrical, with 10-16 surface extrasutural ridges per valve, aligned along the longitudinal axis. The obtained partial 18S rDNA of C. ellipticum did not match any sequences available in GenBank. Phylogenetic analysis showed that C. ellipticum clustered firstly with Chloromyxum legeri with robust nodal support and grouped then with urinary system of freshwater teleost-infecting Chloromyxum clade, rather than other gall bladder of freshwater teleost-infecting clade.

[Perioperative management and surgical treatment of neurosurgical critical patients with thrombocytopenia]

OBJECTIVE

To study the perioperative management and surgical treatment of patients with neurosurgical critical diseases and thrombocytopenia.

METHODS

Eleven patients with the diagnosis of neurosurgical critical diseases and thrombocytopenia who received surgical treatment in Department of Neurosurgery, Peking Union Medical College Hospital from 2010 to 2015 were reviewed retrospectively. All eleven patients received platelet transfusions preoperatively. The safety and efficacy of surgical treatment were analyzed by GOS score at 6 months after operations.

RESULTS

Platelet counts of six patients who received minimally invasive surgery reached 80×10(9) /L by platelet transfusions preoperatively. Platelet counts of five patients who received Craniotomy and ventriculoperitoneal shunt reached 100×10(9) /L by platelet transfusions preoperatively. Eight patients received platelet transfusions postoperatively according to a low platelet count 24 hours after operations. Two patients died after surgery and one died after discharge. All other eight survival patients got well recovery with an average GOS score of 4.5 at six months after operations.

CONCLUSIONS

Patients with neurosurgical critical diseases and thrombocytopenia could receive surgical treatment in collaboration with relative departments.

[Analysis of outcomes and learning curve of endoscopic transsphenoidal surgeries for 124 patients with pituitary adenomas]

OBJECTIVE

To investigate the outcomes of the Endoscopic transsphenoidal surgery for patients with pituitary adenomas, analyze the learning curve and provide reference for future surgeries.

METHODS

Retrospective analysis was carried out on 124 patients by endoscopic transsphenoidal surgery with a single neurosurgeon over a period spanning from January 2010 to January 2014 at Peking Union Medical College Hospital.The changes of endocrine and tumor imaging before and after surgery were analysed. Operative time and complication rates of one surgeon in the early period of learning curve were compared with that in later period.

RESULTS

There were significant differences in Gross total resection (GTR) rate of pituitary adenomas with different sizes and different Knosp classifications (P<0.01, P<0.01). GTR rate of huge adenomas was significantly lower than that of macroadenoma and adenomas (P<0.05). GTR rate of Knosp 4 grade adenoma was significantly lower than that of Knosp 0-3 level (P<0.05). No significant difference in GTR among all types of functional pituitary adenomas and hormone levels after surgery was observed (P>0.05). In addition, no significant difference (P>0.05) in complications among different sizes, Knosp grade and type of pituitary adenomas was observed.GTR of Knosp 4 adenoma in later period of the learning curve was significantly higher than that in early period (P<0.05). Meanwhile the operative time was significantly lower than early period (P<0.05).

CONCLUSIONS

Endoscopic transsphenoidal pituitary adenoma resection has the advantages of wider surgical field, higher GTR rate, less trauma, fewer complications and better life quality of patients.Through standardized learning, the GTR rate of the invasive pituitary adenomas can be improved.

[Characterization of cortical auditory evoked potential (P1-N1-P2) in normal hearing young adults]

Objective:To explore the normal value and characteristic of cortical auditory evoked potential (P1-N1-P2) in normal hearing young adults.Method:Thirty normal hearing young people were recruited for this study. Cortical auditory evoked potential (P1-N1-P2) was performed at three different speech stimuli (/m/, /t/, /g/) and three different sound intensity (55, 65, 75 dB SPL) using the Australia HEARLab test system. Analysis of Variance (ANOVA) was used to evaluate the influence of speech stimuli and sound intensity and gender to latency and amplitude of P1-N1-P2.Result:①The normal range of latency and amplitude of P1-N1-P2 for three different speech stimuli and stimuli intensity were established. ②There were significant differences among three different speech stimuli for latency (P< 0.05) and amplitude (P< 0.05) of N1 and the latency of wave P2 (P< 0.05). ③There were no significant differences among three different stimulus intensity for the amplitude and latency of P1-N1-P2 (P> 0.05). ④There were significant differences between gender for amplitude of the wave N1 and P2 and the latency of N1 (P> 0.05).Conclusion:We initially acquired the normal range of cortical auditory evoked potential (P1-N1-P2) with different speech stimuli and different stimulus intensities in normal hearing young adults. It is also found that P1-N1-P2 values evoked by different speech stimuli showed diffrenent characteristics and stimulus frequency had a significant influence on N1 and P2 wave characteristics. This study provides reference and experience for the further application of this technology in clinical practice.

[Application of Gene Xpert Mycobacterium tuberculosis DNA and resistance to rifampicin assay in the rapid detection of tuberculosis in children]

OBJECTIVE

To detect Mycobacterium tuberculosis (MTB) and rifampin resistance of the clinical specimens in children by Xpert MTB DNA and resistance to rifampicin(MTB/RIF) detection system, and evaluate the application value of this method in children with tuberculosis.

METHOD

Data of 109 children cases of clinically suspected tuberculosis were collected (including 46 gastric lavage aspirate, 19 sputum, 10 fine needle aspiration biopsy, 4 pus, 14 cerebrospinal fluid, 11 Serous membrance fluid, 1 marrow, 3 stool, 1 urine specimens)between April 2014 and March 2015. All specimens were detected by smear fluorescence staining microscopy, MGIT 960 BACTEC liquid culture, Xpert MTB/RIF assay and T-SPOT.TB test respectively. The sensitivity and specificity of Xpert MTB/RIF assay were analyzed in those clinical specimens.

RESULT

The sensitivity and specificity of the Xpert MTB/RIF assay for MTB detection in childhood tuberculosis clinical specimen were 28.6% and 87.5%. The sensitivity of 65 pulmonary tuberculosis(46 gastric lavage aspirate, 19 sputum) which included gastric lavage aspirates and sputum was 33.3% and 57.1%, the specificity of the two was 100.0%. In 44 extrapulmonary tuberculosis, the sensitivity of the pus and the puncture fluid was higher and approached 100.0%. The detection rate of the cerebrospinal fluid and serous cavity effusion was very low. The sensitivity was 100.0% in smear-positive and culture-positive samples and only 30.8% to 50.0% in smear-negative and culture-positive samples. The sensitivity and specificity of Xpert MTB/RIF assay to detect rifampin resistance were 100.0%. In clinical samples, the sensitivity of Xpert MTB/RIF assay was higher than that of smear fluorescence staining microscopy, but the difference was not statistically significant (χ(2)=0, P>0.05). The result was equivalent to that of MGIT 960 BACTEC liquid culture (28.6% vs. 27.3%, χ(2)=2.50, P>0.05), and far below that of T-SPOT.TB(28.6% vs 59.7%, χ(2)=13.92, P<0.05).

CONCLUSION

Xpert MTB/RIF assay did not show obvious advantage in childhood tuberculosis, especially in serous cavity effusion and cerebrospinal fluid, but the advantages of detecting tuberculosis rapidly and resistance to rifampin can provide help for the clinical diagnosis and treatment in childrenhood tuberculosis.

[Clinical features and prognostic analysis of high-risk acute promyelocytic leukemia patients]

目的

分析高危急性早幼粒细胞白血病（APL）的临床特征及预后。

方法

回顾性分析2003年1月至2015年4月连续收治的APL患者352例，其中高危组（WBC≥10×10⁹/L) 118例，中低危组（WBC<10×10⁹/L）234例。比较两组患者的临床特征及预后差异。

结果

高危组APL患者初诊PLT水平明显低于中低危组（P=0.003）；高危组患者PML-RARα融合基因异构体S型比例高于中低危组（51.8％对28.2%，P<0.001）；高危组患者早期死亡率为20.3%，显著高于中低危组患者的2.6%（P<0.001），其完全缓解（CR）率及预计5年总生存（OS）率均低于中低危组（76.3％对94.9%，P<0.001；74.2％对93.7%，P<0.001）；若除去早期死亡患者，则两组CR率与5年预计OS率差异均无统计学意义（P值分别为0.682、0.481）。高危组患者预计5年无复发生存率与中枢神经系统白血病（CNSL）发生率分别为82.7%、9.4%，与中低危组的87.8%、1.4％相比差异均有统计学意义（P值分别为0.048、0.002）；中剂量阿糖胞苷化疗及增加鞘内注射次数能降低高危组APL的CNSL发生率。

结论

高危组APL因有较高的早期死亡率和CNSL发生率，其预后明显较中低危组患者差；因此对于高危组APL患者的治疗更应重视降低早期死亡率及加强CNSL的预防性化疗。

Successful treatment of very PPROM caused by bipolar cord coagulation in acardiac twin

The authors report management of a woman with an acardiac twin pregnancy complicated by preterm premature rupture of the membrane (PPROM) for more than two months after intrauterine treatment with bipolar cord coagulation at 24 weeks of gestation.

[The value and comparison of plasma adrenocorticotropic hormone and urinary free cortisol in predicting long-term outcome after operation of Cushing's disease]

Objective: To study and the value of morning plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (24 h UFC) within 3 days after operation in patients with Cushing's disease in predicting the long-term outcome. Methods: The clinical data of 140 patients with Cushing's disease who were treated in Department of Neurosurgery of PUMCH from 2012 to 2014 were analyzed retrospectively.The univariate analysis, multivariate Logistic analysis, ROC curve analysis and other statistical methods were used to study the predicting value of morning plasma ACTH and 24 h UFC in 3 days post operation. Results: Univariate analysis showed that in the two groups of the early remission and no remission, there was significant statistical difference between the preoperative ACTH, preoperative 24 h UFC, postoperative ACTH and postoperative 24 h UFC (P<0.05, <0.01, <0.01). Logistic analysis showed that ACTH and 24 h UFC after operation of two groups had significant difference (P<0.01, <0.05). ROC curve analysis showed that postoperative cutoff values of ACTH and 24 h UFC were 4.11 pmol/L (18.7 pg/ml) and 281.42 nmol (102 μg)/24 h. ROC analysis was performed to evaluate the predicting performance of postoperative ACTH, resulting in an area under the curve (AUC) of 0.917 (95%CI: 0.858-0.957, P<0.01). In comparison, 24 h UFC had an AUC of 0.814 (95%CI: 0.739-0.875, P<0.01). The predicting value of ACTH is significantly better than that of 24 h UFC (P=0.005). Conclusion: Early morning 24 h UFC and ACTH within 3 days after operation both showed considerable accuracy in predicting the long-term outcome of Cushing's disease, and the significance of ACTH was even greater than that of 24 h UFC.

Symmetry breaking induced excitations of dark plasmonic modes in multilayer graphene ribbons

Multilayer graphene can support multiple plasmon bands. If structured into graphene ribbons, they can support multiple localized plasmonic modes with interesting optical properties. However, not all such plasmonic modes can be excited directly due to the constrains of the structural symmetry. We show by numerical simulations that by breaking the symmetry all plasmonic modes can be excited. We discuss the general principles and properties of two-layer graphene ribbons and then extend to multilayer graphene ribbons. In multilayer graphene ribbons with different ribbon widths, a tunable broadband absorption can be attained due to the excitations of all plasmonic modes. Our results suggest that these symmetry-broken multilayer graphene ribbons could offer more degrees of freedom in designing photonic devices.

[Use early morning serum cortisollevel to evaluate the effect of Cushing's disease after transsphenoidal surgery]

OBJECTIVE

To predict the therapeutic effect of Cushing's disease after transsphenoidal surgery by using morning serum cortisol level.

METHODS

The clinical data of 275 cases that had transsphenoidal surgery in Peking Union Medical College Hospital from 2010 to 2014 were analyzed retrospectively.Early morning serum cortisol level less than 140 nmol/L 3 days postoperation was usedto predict endocrinological remission. And long-term efficacy was evaluated by follow-up.

RESULTS

Of the 275 patients, there were 49 males and 226 females; average age was 36.5 years old.Remission wasconfirmed in 201 cases, the remission rate was 73.1%, and 8 cases recurrent duringfollow-up.There were 17 macroadenomas, theremission rate was 47.1%; 258 microadenomas and MRI negative adenomas, the remission rate was 74.8%.And 43 recurrent cases had reoperations; the remission rate was 46.5%.

CONCLUSION

Early morningserum cortisol 3 days post operation can evaluate the effectof transsphenoidal surgery, but even if the level of cortisol is less than 140 nmol/L, there is still tumor recurrence.Patients should be follow-up for a lifetime.

[Effect of radiotherapy and indomethacin together in the prevention of recurrence of ectopic ossification around the elbow after resection]

OBJECTIVE

To discuss the effect of single low dose local radiotherapy and indomethacin together in the prevention of recurrence of ectopic ossification around the elbow after resection.

METHODS

From Jun. 2009 to Dec. 2011, we performed excision of ectopic ossification around the elbow in 78 stiff elbows. For each case, we used both medial and lateral approaches, and we performed both anterior and posterior capsulectomies and removal of ectopic ossification. In the lateral approach, we started proximally, the lateral supracondylar ridge of the humerus was exposed from the interval between extensor carpi radialis longus (ECRL) and triceps, and then distally passed the interval between ECRL and extensor carpi radialis brevis (ECRB). With the medial approach, after releasing the ulnar nerve, the pronator teres muscle origin was reflected from the medial epicondyle, and then the common flexor-pronator tendon was split longitudinally distally and the brachalis and the anterior portion of the flexor-pronator group were dissected off the anterior humerus. If there was forearm rotation dysfunction, we used extensive lateral approach, the anconeus muscle was reflected from the ulna and the scar tissue and ectopic ossification around the proximal radioulnar joint were resected. The important structures, such as the lateral ulnar collateral ligament (LUCL) and the anterior part of the medial collateral ligament (AMCL), should be carefully protected, because they were important for the elbow stability. Anterior transposition of the ulnar nerve depended on the patients' condition. We performed low dose radiotherapy 4 hours before operation, and we used indomethacin for 6 weeks after operation. In these patients, there were 46 males and 32 females, whose age averaged (35.8±7.9) years (16-65 years). According to Hastings-Graham classification, there were 56 IIA, 5 IIB, 6 IIC and 11 III before operation.

RESULTS

We followed up these patients for 26 months with an average of 24-36 months, all the patients improved their elbow function, and no recurrence of ectopic ossification appeared except for 1 patient. For this patient, his elbow function was excellent, and according to Hastings-Graham classification, his ectopic ossification was of type I.

CONCLUSION

Single low dose local radiotherapy and indomethacin together are effective in the prevention of recurrence of ectopic ossification around the elbow after excision.

Supplemental description and molecular characterization of Myxobolus miyarii Kudo, 1919 (Myxosporea: Myxobolidae) infecting intestine of Amur catfish (Silurus asotus)

Myxobolus miyairii Kudo, 1919 was first reported from the intestines of the Amur catfish (Silurus asotus) in Japan and then in China and Russia, but with incomplete description. During the investigation of fish myxosporean diversity in Poyang Lake, the biggest lake along the Yangtze River, China, two Amur catfish highly infected with M. miyairii in the intestine wall were sampled. So, the complete description of this species with morphological and molecular data was presented here. A large number of whitish, round or ellipsoidal pseudocysts 0.32-0.78 mm in diameter could be found in the external intestinal wall after dissecting the infected fish. Mature spores of M. miyairii were elongated and ellipsoidal in the frontal view and narrow fusiform in the lateral view, with a slightly pointed anterior end and a bluntly rounded posterior end and measured 13.3 ± 0.49 (12.5-14.7) μm × 6.6 ± 0.27 (6.2-7.4) μm × 5.0 ± 0.26 (4.4-5.7) μm in size. Spore surface was smooth and two spore valves symmetrical, with a thin and straight sutural ridge. Interestingly, two types of caudal appendage (single or bifurcated) were occasionally present on the posterior end of some spores which has not previously been reported. The two equal pyriform polar capsules measured 6.5 ± 0.30 (6.2-7.5) μm long and 1.9 ± 0.14 (1.5-2.3) μm wide and situated at the anterior end of the spore. Polar filaments coiled with eight to nine turns, perpendicularly to the longitudinal axis of the polar capsules. Histopathological analysis showed that the plasmodium developed in the circular muscle layer of intestinal wall of Amur catfish, but no obvious inflammatory responses were observed. Phylogenetic analysis based on the partial 18S small subunit ribosomal DNA sequences indicates that M. miyairii cluster within a clade of Siluriforme-infecting Henneguya species with the support of a high bootstrap value, but also evolutionarily independent from the Henneguya clade infecting the epithelium of fish of the Ictaluridae family. Additionally, Myxobolus species reported with caudal processes dispersed within the Henneguya-Myxobolus clade.

Meta-analysis of the association between the rs7903146 polymorphism at the TCF7L2 locus and type 2 diabetes mellitus susceptibility

Type 2 diabetes mellitus (T2DM) is a chronic disease caused by genetic and environmental factors. T2DM has been associated with specific polymorphisms in the TCF7L2 gene. This study evaluates the relationship between the rs7903146 locus polymorphism of the TCF7L2 gene and T2DM susceptibility through meta-analysis; the overall aim is to provide a basis for evidence-based medicinal treatment of T2DM. Cohort and case-control studies from Medline, PubMed, EMBASE, CBM, CNKI, and academic conferences/dissertations that examined the correlation between T2DM and rs7903146 polymorphisms were evaluated. We determined whether the TCF7L2 rs7903146 locus was associated with T2DM susceptibility by comparing alleles and genotypes. The Stata 11.0 software was applied for meta-analysis, and a random-effects model was adopted for heterogeneity testing and odds ratio (OR) calculation. A fixed-effect model was used for quantitative analysis of the heterogeneity between different studies, and for calculating the percentage of variability I(2). A total of 10 studies related to the rs7903146 loci and T2DM susceptibility were enrolled; this included 3404 cases of T2DM patients and 6473 control cases. Meta-analysis showed that the T allele of rs7903146 was significantly correlated with the risk of T2DM, with both a dominant fixed-effect model (OR = 1.653, 95%CI = 1.416-1.653) and a co-dominant-fixed effect model (OR = 1.525, 95%CI = 1.350-1.723). Meta-analysis revealed that the T allele of rs7903146 was also correlated with T2DM susceptibility.

Quantitative trait locus analysis for kernel width using maize recombinant inbred lines

Maize (Zea mays L.) kernel width is one of the most important traits that is related to yield and appearance. To understand its genetic mechanisms more clearly, a recombinant inbred line (RIL) segregation population consisting of 239 RILs was used for quantitative trait locus (QTL) mapping for kernel width. We found four QTLs on chromosomes 3 (one), 5 (two), and 10 (one). The QTLs were close to their adjacent markers, with a range of 0-23.8 cM, and explained 6.2-19.7% of the phenotypic variation. The three QTLs on chromosomes 3 and 5 had positive additive effects, and to a certain extent increased kernel width, whereas the one on chromosome 10 exhibited negative additive effects and decreased kernel width. These results can be used for gene cloning and marker-assisted selection in maize-breeding programs.

A retrospective clinical study of bevacizumab combined with gemcibabine or paclitaxel in the treatment of recurrent ovarian cancer

BACKGROUND

Bevacizumab, a recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor A, was described to be effective in the treatment of recurrent or platinum-resistance ovarian cancer. The present retrospective study was performed to further evaluate the clinical efficacy and toxicity of bevacizumab in the treatment of Chinese recurrent ovarian cancer patients who had been previously treated by platinum-based chemotherapy.

MATERIALS AND METHODS

We reviewed the hospital database and finally included 26 recurrent ovarian cancer patients who were treated with bevacizumab combined with gemcibabine or paclitaxel or single agent. All included patients received >3 cycle of bevacizumab treatment. The tumor response, overall survival, and toxicities were documented.

RESULTS

Under the treatment of bevacizumab combined with gemcibabine or paclitaxel, 2 complete response (7.7%), 8 partial response (30.8%), 7 stable disease (26.9%) and 9 progression disease (34.6%) was documented with the objective response rate of 38.5% and disease control rate of 65.4%. The median overall survival from the first application of bevacizumab was 15.3 months [Figure 1] for all of the 26 patients. The median overall survival time was 16.2 and 14.0 months for bevacizumab + gemcitabine and bevacizumab + paclitaxel treatment schedule respectively. The overall survival was not different between bevacizumab + gemcitabine and bevacizumab + paclitaxel treatment regimen hazard ratio = 0.80 (95% confidence interval: 0.32-2, P = 0.64). The hypertension and proteinuria were the major bevacizumab related toxicities.

CONCLUSIONS

Bevacizumab combined with gemcibabine or paclitaxel was a promising treatment schedule for platinum-resistance recurrent ovarian cancer.

Genetic analysis of maize kernel thickness by quantitative trait locus identification

Kernel thickness is one of the most important traits in kernel structure, and is related to yield. To ascertain its genetic information more clearly, an immortal recombinant inbred line segregation population was used to map the quantitative trait loci (QTLs) for kernel thickness. As a result, two QTLs were identified on chromosome 9; both of them had negative additive effects, and could decrease kernel thickness to some extent. The QTLs explained 25.8% of the total phenotypic variation. These results advance our understanding of the genetic basis of kernel thickness in maize-breeding programs.

Scanning electron microscopy of antennal sensory organs of the cattle grub, Hypoderma lineatum (Diptera: Oestridae)

Hypoderma lineatum (Villers, 1789) (Diptera: Oestridae) is a hypodermosis fly that has resulted in great economic losses worldwide. The antennae of cattle grub males and females were examined through stereoscopic microscopy and scanning electron microscopy to reveal the general morphology, combined with distribution, type, size, and ultrastructure of the antennal sensilla. All of the three antennal segments (antennal scape, pedicel, and funiculus) possess microtrichiae on their surface. Mechanoreceptors only exist on the antennal scape and pedicel. The antennal funiculus presents four types of antennal sensilla: trichoid, basiconic, coeloconic, and clavate sensilla. Three distinctive characters of H. lineatum are obvious: (1) the relatively slender, flexible, and equal-height mechanoreceptors; (2) the enlarged antennal pedicel, and numerous antennal sensory pits and pit sensilla on the antennal funiculus; and (3) all types of antennal sensilla clustered in sensory pits, respectively. Additionally, the enlarged antennal pedicel and abundant sensory pits and pit sensilla might facilitate odor detection, enhance olfactory sensitivity and accuracy, and also protect the fragile antennal sensilla from mechanical irritation or damage.

Ultrastructure of antennal sensory organs of horse nasal-myiasis fly, Rhinoestrus purpureus (Diptera: Oestridae)

Rhinoestrus purpureus (Brauer, 1858) (Diptera: Oestridae) is an economically important parasite that can cause severe nasal myiasis in equids or even attacking humans. The antennae of R. purpureus were examined using stereoscopic microscopy and scanning electron microscopy. The general morphology was provided detailedly, together with distribution, type, size, and ultrastructure of antennal sensilla. All the three antennal segments, antennal scape, pedicel, and funiculus, are interspersed by microtrichiae. Only mechanoreceptors are detected on antennal scape and pedicel. On antennal funiculus, three types of sensilla were observed, including basiconic sensilla, coeloconic sensilla and clavate sensilla. Two features are characterized of this host-specific bot fly: (1) numerous sensory pits with branched basiconic sensilla on antennal funiculus and (2) the absence of trichoid sensilla. The function of these distinctive traits are discussed in association with the life history. We suggest that more sensory pits with branched sensilla could increase the sensitivity of olfactory system for host orientation, while the capability of pheromone identification might be reduced due to the absence of trichoid sensilla. Besides, we support both thermo- and chemo-functions of coeloconic sensilla.