[Interpretation of clinical practice guideline for anorectal day surgery 2019 edition]

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.

[Prenatal and postnatal ultrasound assessment and clinical prognostic analysis for Ebstein anomaly]

Objective: To investigate the echocardiographic features of fetal Ebstein's anomaly (EA) and to analyze its clinical outcome and prognosis. Methods: A retrospective case-control study was conducted to analyze the echocardiographic features in fetus with EA. Thirty-five EA fetuses (EA group) and 35 normal fetuses matched for gestational age (control group) were enrolled. The main echocardiographic parameters of the two groups were collected and compared. According to the direction of blood flow in the ductus arteriosus (DA),fetuses in EA group were divided into DA reverse perfusion subgroup (n=11) and normal DA blood flow subgroup (n=24). The echocardiographic parameters and GOSE scores were compared between the two subgroups. The echocardiographic features of EA and the difference of fetal hemodynamics were summarized,and the clinical outcome of EA fetus was evaluated by GOSE score. Chi-square test Rank sum test or t test were used for comparison between groups. Results: Nineteen (54%) of the 35 patients terminated the pregnancy and 16 (46%) continued pregnancy until delivery during follow-up. Compared with the normal fetus group,the cardiothoracic ratio was significantly higher (0.47±0.11 vs. 0.34±0.01, t=6.640, P<0.01) and the transverse diameter ratio of right atrium to left atrium was significantly greater (1.42±0.38 vs. 1.08±0.11, t=5.030, P<0.01) in the EA group, and the ratio of pulmonary artery diameter to aortic diameter was significantly lower in the EA group (1.04±0.21 vs. 1.20±0.15, t=-3.770, P<0.01). Compared with the normal DA blood flow subgroup,the GOSE scores ≥ 1.5 was more frequently seen (7/11 vs. 3/24, P=0.004) and the ratio of pulmonary artery diameter to aortic diameter was significantly lower (0.91±0.18 vs. 1.24±0.20, t=-4.696, P=0.002) in the DA reverse perfusion subgroup. Six of the 16 delivery cases underwent EA corrective surgery after birth with 100% successful rate of operation. Among the 6 cases,two had preoperative GOSE score of ≥1.5 who were considered as severe cases,and four had low GOSE score of<1.5. The remaining ten cases who had not undergone the corrective surgery were followed up routinely. Conclusion: Prenatal hemodynamics of EA combined with GOSE score can more accurately evaluate the severity and prognosis of fetal EA, reduce unnecessary labor induction, and improve postpartum cure rate and clinical outcomes.

[Summary of the 15th Syposium on Chinese Burn Medicine and the 2nd Congress of Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare]

The 15th Syposium on Chinese Burn Medicine and the 2nd Congress of Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare (CPAM) was successfully held in Suzhou, from June 20th to 22th in 2019. A total of 400 specialists and scholars across the country attended the meeting. Focusing on the theme of " Guide and consensus: exploration and consideration " , with form of one main meeting place and two branch meeting places, the related hot and difficult problems were discussed warmly. During the conference, Working Conference of Editorial Committee of Chinese Journal of Burns, Standing Committee of the Chinese Burn Association, and the Congress of Burn Medicine Branch of CPAM were held.

Metformin exhibits its therapeutic effect in the treatment of pre-eclampsia via modulating the Met/H19/miR-148a-5p/P28 and Met/H19/miR-216-3p/EBI3 signaling pathways

Metformin (Met) has been found to modify the methylation of H19 and to alter its expression. In addition, IL-27, one of the downstream factors in the H19 signaling pathway, plays an important role in the pathogenesis of pre-eclampsia (PE). In this study, we investigated the molecular mechanism underlying the therapeutic effect of Met in the management of PE both in vivo and in vitro. The role of H19 signaling pathway in PE was validated using online bioinformatics tools, luciferase assays, real-time PCR and Western Blot. A tail-cuff method was used to examine the blood pressures in PE rats with or without Met treatment. Cells exhibited a dose-dependent increase of H19 methylation, which inhibited the expression of H19. Additionally, upon the Met treatment, levels of miR-148-5p and miR-216-3p were both elevated in a dose-dependent manner while levels of p28 mRNA and EBI3 mRNA were both inhibited by Met treatment. Also, H19 was found to regulate the expression of miR-148a-5p and miR-216-3p, while P28 and EBI3 were respectively identified as target genes of miR-148a-5p and miR-216-3p. Therefore, the Met/H19/miR-148a-5p/P28 and Met/H19/miR-216-3p/EBI3 signaling pathways were implicated in the pathogenesis of PE. Met was implicated in the pathogenesis of PE via modulating the H19 signaling pathway. The methylation of H19 reduced H19 expression, which in turn could up-regulate the expression of miR-148-5p/miR-216-3p. And the expressions of subunits of IL-27, P28 and EBI3, were thus suppressed. Therefore, Met-induced inhibition of H19 also led to the reduction of IL-27 expression, TNF-α and IL-6 in vivo.

[Review of survey method for human time-activity pattern and its application in the exposure assessment of air pollutants]

Time activity pattern refers to the time and behavior of people at different locations. The knowledge of time-activity pattern is essential for air pollution exposure assessment when direct personal exposure monitoring can't not be conducted, because air pollutant concentrations may vary significantly by location and activity. This review is focused on the survey method for human time-activity pattern and its application in the exposure assessment of air pollutants. After comparing the diary-reported trips and Global Positioning System (GPS) recording method, we believed that diary-reported trips were more reliable in describing comprehensive and detail records of the behavior and environmental circumstances while GPS-recorded trend to maintain sound information of time, location and transportations. Meanwhile, according to different subjects, the air pollution exposure model could be divided for population and individuals. There were great difference between two types of model in many areas, including the required information about time, activity and microenvironment.

The socio-economic impact of multidrug-resistant nosocomial infections: a qualitative study

The burden of healthcare-associated infections (HCAIs) has traditionally been measured using clinical and economic outcomes. We conducted semi-structured interviews with 18 patients or their caregivers affected by HCAI caused by multidrug-resistant organisms to better understand the human impact of HCAI. Most patients had misconceptions about HCAI and antimicrobial resistance, leading to strong negative feelings towards HCAIs despite positive views of their healthcare providers. Communication issues across power imbalances need to be addressed to help deal with trauma of HCAIs. A holistic approach to HCAIs incorporating patient perspectives will likely help guide policymakers developing solutions to improve patient outcomes.

Long noncoding RNA lncARSR promotes epithelial ovarian cancer cell proliferation and invasion by association with HuR and miR-200 family

Epithelial ovarian cancer (EOC) is the fifth leading cause of female cancer-related deaths worldwide. Long non-coding RNAs (lncRNAs) are emerging as crucial regulators in various biological processes through diverse mechanisms. Recently, lncRNA Activated in RCC with Sunitinib Resistance (lncARSR) has been reported to be upregulated and involved in sunitinib resistance of renal cell carcinoma cells. However, the functional roles in EOC have not yet been explored. In the current study, we detected the expression levels of lncARSR in 76 paired EOC tissues and adjacent normal tissues, and observed that lncARSR expression was significantly increased in EOC tissues and correlated with FIGO stage, histological grade, lymph nodes metastasis and worse survival. Loss- and gain-of-function assays demonstrated that lncARSR promoted EOC cell proliferation and invasion. Further investigations showed that lncARSR interacted with HuR, upregulated β-catenin expression and then activated Wnt/β-catenin signaling pathway to regulate cell proliferation. Moreover, lncARSR increased ZEB1 and ZEB2 expression by competitively binding the miR-200 family to induce EMT and invasion. Our findings suggest that the lncARSR may provide a novel therapeutic strategy for EOC treatment.

Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke

OBJECTIVES

To determine whether chronic hyperglycaemia predisposes patients to dehydration, which may promote neurological deterioration, and to investigate whether dehydration control improves functional outcome.

PATIENTS AND METHODS

This study included 355 patients hospitalized with acute ischaemic stroke and diabetes mellitus who fulfilled the glycaemic gap ≤0. We used the following cut-offs: (i) no chronic hyperglycaemia (glycated haemoglobin A1c [HbA1c] < 7%) and (ii) chronic hyperglycaemia (HbA1c ≥ 7%). The chronic hyperglycaemic patients were randomly divided into the control group and the hydration group. Hydration therapy was only initiated in the hydration group. The blood urea nitrogen (BUN)/creatinine (Cr) ratio was used as an indicator of dehydration. Stroke severity on admission and discharge was assessed by means of National Institutes of Health Stroke Scale (NIHSS).

RESULTS

The mean baseline BUN/Cr ratios were higher in the control group and hydration group than in the no chronic hyperglycaemia group. The mean BUN/Cr ratio decreased from 91.22 ± 29.95 on the first day to 77.03 ± 18.23 on the third day (P < .001) in the hydration group. On the third day after admission, there was no significant difference in the BUN/Cr ratio between the hydration group and the no chronic hyperglycaemia group (P = .831). Moreover, neurological deterioration was highest in the control group (33.6%, 36/107), followed by the hydration group (10.5%, 11/105) and the no chronic hyperglycaemia group (5.6%, 8/143).

CONCLUSIONS

Chronic hyperglycaemia was associated with the admission NIHSS score and neurological deterioration after excluding the effect of stress hyperglycaemia. Furthermore, hydration therapy may help prevent neurological deterioration.

[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.

[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.

Decreased epithelial and plasma miR-181b-5p expression associates with airway eosinophilic inflammation in asthma

BACKGROUND

Airway eosinophilic inflammation is a pivotal feature of asthma. Epithelial cells play critical roles in airway eosinophilia. We hypothesized that epithelial microRNAs (miRNAs) are involved in airway eosinophilia.

OBJECTIVE

This study investigated the associations between epithelial and plasma miR-181b-5p and airway eosinophilic inflammation, and the possible mechanism by which miR-181b-5p participates in eosinophilic inflammation.

METHODS

Epithelial miRNAs expression was profiled by miRNA array in eight subjects with asthma and four healthy controls. Epithelial miR-181b-5p expression was confirmed by quantitative PCR in the subjects for array experiment and another cohort including 21 subjects with asthma and 10 controls. Plasma miR-181b-5p was determined by quantitative PCR in 72 subjects with asthma and 35 controls. Correlation assays between epithelial and plasma miR-181b-5p expression and airway eosinophilia were performed. The target of miR-181b-5p, SPP1, was predicted by online algorithms and verified in BEAS-2B cells. The role of miR-181b-5p in epithelial proinflammatory cytokine expression was examined in an in vitro system.

RESULTS

Epithelial miR-181b-5p expression was decreased in subjects with asthma. Epithelial miR-181b-5p levels were inversely correlated with sputum and bronchial submucosal eosinophilia. Plasma miR-181b-5p was decreased and correlated with epithelial miR-181b-5p in subjects with asthma. There was a strong inverse correlation between plasma miR-181b-5p and airway eosinophilia in subjects with asthma. Plasma miR-181b-5p was increased after inhaled corticosteroids treatment. We verified that SPP1 is a target of miR-181b-5p. In human bronchial epithelial cells, miR-181b-5p regulated IL-13-induced IL-1β and CCL11 expression by targeting SPP1. Dexamethasone restored IL-13-induced miR-181b-5p down-regulation and suppressed IL-13-induced SPP1, IL-1β and CCL11 expression.

CONCLUSIONS AND CLINICAL RELEVANCE

Epithelial and plasma miR-181b-5p are potential biomarkers for airway eosinophilia in asthma. MiR-181b-5p may participate in eosinophilic airway inflammation by regulating proinflammatory cytokines expression via targeting SPP1.

Lymphoepithelial carcinoma of the salivary gland: morphologic patterns and imaging features on CT and MRI

BACKGROUND AND PURPOSE

Lymphoepithelial carcinoma is a rare salivary gland lesion. We retrospectively reviewed CT and MR imaging features of salivary gland lymphoepithelial carcinoma to determine their imaging features and morphologic patterns.

MATERIALS AND METHODS

The clinical data, CT, and MR imaging findings of 28 patients with histologically proved lymphoepithelial carcinoma of the salivary gland were retrospectively reviewed. Morphologic patterns of the lesions were categorized into 3 types on the basis of margin and shape.

RESULTS

There were 17 men and 11 women with a mean age of 39.3 years; 96.4% of patients were positive for Epstein-Barr virus both on histologic staining and Epstein-Barr virus serology. Tumors were parotid in 18 patients, submandibular in 8 patients, sublingual in 1 patient, and palatal in 1 patient. Most tumors (57.1%) manifested as a partially or ill-defined mass with a lobulated or plaque-like shape. Homogeneous enhancement was found in 16 patients, while heterogeneous enhancement was found in 12, including 4 patients with intratumoral necrosis. Invasion into adjacent structures was found in 5 patients; 60.7% of patients exhibited abnormal lymph nodes, with nodal necrosis in 3 patients.

CONCLUSIONS

The characteristic lobulated or plaque-like shape, with a partially or ill-defined margin, of a salivary gland mass associated with ipsilateral lymphadenopathy may suggest a preoperative diagnosis of lymphoepithelial carcinoma.

Temporal and spatial expression of podocyte-associated molecules are accompanied by proteinuria in IgA nephropathy rat model

We used a rat model to assess the role of nephrin, podocin, and desmin in the pathogenesis of IgA nephropathy (IgAN). A rat IgAN model was established by administration of BSA, CCl(4), and lipopolysaccharide (LPS) and compared with healthy control rats. Urinary protein, urine red blood cells, and biochemical parameters were measured for 12 weeks. Renal morphology and ultrastructure were examined by light and electron microscopy. Immunofluorescence was used to assess IgA deposition in the glomeruli and to measure expression of nephrin, podocin, and desmin. Real-time quantitative PCR was used to measure expression of nephrin, podocin, and desmin mRNAs. IgAN rats developed proteinuria at week-6 and this worsened over time. Pathological changes were evident under light microscopy at week-8 and under electron microscopy at week-4. Immunofluorescence analysis showed deposition of IgA in the kidneys of IgAN rats, but not control rats. IgAN rats had increased expression of glomerular podocin, nephrin, and desmin mRNAs and proteins at week-4. The expression of nephrin, podocin and desmin proteins and the expression of podocin and desmin mRNAs preceded the increase in urinary protein. Taken together, our study of a rat model of IgAN indicates that changes in the expression and distribution of nephrin, podocin, and desmin precede and may cause foot process fusion and proteinuria.

Effects of residual gas exposure on the field emission properties of ZnO nanorods

We compare the effects of O2, CO2, N2, H2, and Ar residual gas exposure on the field emission (FE) properties of ZnO nanorods. In contrast to carbon nanotubes and Mo metal microtips, we find that O2 and CO2 exposures do not significantly degrade the FE properties of ZnO nanorods. However, N2 exposure significantly degrades the FE properties. We propose that this could be due to the dissociation of N2 into atomic nitrogen species and the reaction of such species with ZnO. H2 and Ar exposures are not observed to significantly degrade the FE properties.