Observation of High-Frequency Transverse Phonons in Metallic Glasses

Using inelastic neutron scattering and molecular dynamics simulations on a model Zr-Cu-Al metallic glass, we show that transverse phonons persist well into the high-frequency regime, and can be detected at large momentum transfer. Furthermore, the apparent peak width of the transverse phonons was found to follow the static structure factor. The one-to-one correspondence, which was demonstrated for both Zr-Cu-Al metallic glass and a three-dimensional Lennard-Jones model glass, suggests a universal correlation between the phonon dynamics and the underlying disordered structure. This remarkable correlation, not found for longitudinal phonons, underscores the key role that transverse phonons hold for understanding the structure-dynamics relationship in disordered materials.

[The phenotypes and genotypes in 314 patients with isolated methylmalonic acidemia]

Objectives: To summarize the clinical and genetic characteristics of the patients with isolated methylmalonic acidemia and investigate the strategies for the diagnosis, treatment and prevention. Methods: Three hundred and fourteen patients (180 males, 134 females) with isolated methylmalonic acidemia were ascertained from 26 provinces or cities across the mainland of China during January 1998 to March 2020. Genetic analysis was performed by Sanger sequencing, gene panel sequencing, whole exome sequencing, multiplex ligation-dependent probe amplification or quantitative PCR. According to the age of onset, the patients were divided to early-onset group (≤12 months of age) and the late-onset group (>12 months of age). They were treated by cobalamin, L-carnitine and (or) special diet and symptomatic treatment. Statistical analysis was done using Chi-square test. Results: Fifty-eight of 314 (18.5%) patients were detected by Newborn screening using liquid chromatography tandem mass spectrometry. Five cases (1.6%) had a postmortem diagnosis. Two hundred and fifty-one patients (79.9%) were clinically diagnosed with an age of onset ranged from 3 hours after birth to 18 years. One hundred and fifty-nine patients (71.0%) belonged to early-onset groups, 65 patients (29.0%) belonged to the late-onset group. The most common symptoms were metabolic crises, psychomotor retardation, epilepsy, anemia and multiple organ damage. Metabolic acidosis and anemia were more common in early-onset patients than that in late-onset patients (20.8%(33/159) vs. 9.2% (6/65), 34.6% (55/159) vs. 16.9% (11/165), χ(2)=4.261, 6.930, P=0.039, 0.008). Genetic tests were performed for 236 patients (75.2%), 96.2%(227/236) had molecular confirmation. One hundred and twenty-seven variants were identified in seven genes (MMUT, MMAA, MMAB, MMADHC, SUCLG1, SUCLA2, and MCEE), of which 49 were novel. The mut type, caused by the deficiency of methylmalonyl-CoA mutase, was the most common (n=211, 93%) cause of this condition. c.729_730insTT, c.1106G>A and c.914T>C were the three most frequent mutations in MMUT gene. The frequency of c.914T>C in early-onset patients was significantly higher than that in late-onset patients (8.3% (18/216) vs. 1.6% (1/64), χ(2)=3.859, P=0.037). Metabolic crisis was more frequent in mut type than the other types (72.6% (114/157) vs. 3/13, χ(2)=13.729, P=0.001),developmental delay and hypotonia were less frequent in mut type (38.2% (60/157) vs. 9/13, 25.5% (40/157) vs. 8/13, χ(2)=4.789, 7.705, P=0.030, 0.006). Of the 58 patients identified by newborn screening, 44 patients (75.9%) who were treated from asymptomatic phase developed normally whereas 14 patients (24.1%) who received treatment after developing symptoms exhibited varying degrees of psychomotor retardation. Conclusions: The characteristics of phenotypes and genotypes among Chinese patients with isolated methylmalonic acidemia were analyzed. Expanded the mutation spectrum of the associated genes. Because of the complex clinical manifestations and severe early onset of isolated methylmalonic acidemia, Newborn screening is crucial for early diagnosis and improvement of prognosis. MMUT gene is recommended for carrier screening as an effort to move the test earlier as a part of the primary prevention of birth defects.

[Investigation and analysis on characteristics of a cluster of COVID-19 associated with exposure in a department store in Tianjin]

Objective: To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development. Methods: The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed. Results: A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19 (47.50%) were customers and 15 (37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days. Conclusion: This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.

[The keypoints in treatment of the critical coronavirus disease 2019 patient(1)]

COVID-19 has been prevalent in Wuhan and spread rapidly to all of our country. Some cases can develop into ARDS, or even death. We will share the treatment experience of severe COVID-19 with the first-line treatment experience. The best respiratory support mode should be selected, but the timing of intubation and protection during intubation are two difficulties; patients with high level peep and poor effect in prone position can be given ECMO support. For COVID-19 patients with mechanical ventilation, reasonable sedation and analgesia strategies should be formulated; delirium should not be ignored. In addition, there is up regulation of inflammatory factors in patients with severe COVID-19, but the effect of renal replacement therapy needs to be further confirmed by clinical research.

Constraining the External Capture to the ^{16}O Ground State and the E2 S Factor of the ^{12}C(α,γ)^{16}O Reaction

The ^{12}C(α,γ)^{16}O reaction is one of the most crucial reactions in nuclear astrophysics. The E2 external capture to the ^{16}O ground state (GS) has not been emphasized in previous analyses but may make a significant contribution to the ^{12}C(α,γ)^{16}O cross section depending on the value of the GS asymptotic normalization coefficient (ANC). In the present work, we determine this ANC to be 337±45  fm^{-1/2} through the ^{12}C(^{11}B,^{7}Li)^{16}O reaction using a high-precision magnetic spectrograph. This sheds light on the existing large discrepancy of more than 2 orders of magnitude between the previously reported ANC values. Based on the new ANC, we experimentally constrain the GS external capture and show that through interference with the high energy tail of the 2^{+} subthreshold state, a substantial enhancement in the GS S_{E2}(300) factor can be obtained (70±7  keV b) compared to that of a recent review (45 keV b), resulting in an increase of the total S factor from 140 to 162 keV b, which is now in good agreement with the value obtained by reproducing supernova nucleosynthesis calculations with the solar-system abundances. This work emphasizes that the external capture contribution for the ground state transition cannot be neglected in future analyses of the ^{12}C(α,γ)^{16}O reaction.

[The keypoints in treatment of the critical coronavirus disease 2019 patient(2)]

The treatment of critically ill patients with coronavirus disease 2019(COVID-19) faces compelling challenges. In this issue, we'd like to share our first-line treatment experience in treating COVID-19. Hemodynamics need be closely monitored and different types of shock should be distinguished. Vasoconstrictor drugs should be used rationally and alerting of complications is of the same importance. The risk of venous thromboembolism (VTE) needs to be assessed, and effective prevention should be carried out for high-risk patients. It is necessary to consider the possibility of pulmonary thromboembolism (PTE) in patients with sudden onset of oxygenation deterioration, respiratory distress, reduced blood pressure. However, comprehensive analysis of disease state should be taken into the interpretation of abnormally elevated D-Dimer. Nutritional support is the basis of treatment. It's important to establish individual therapy regimens and to evaluate, monitor and adjust dynamically. Under the current epidemic situation, convalescent plasma can only be used empirically, indications need to be strictly screened, the blood transfusion process should be closely monitored and the curative effect should be dynamically evaluated.

[Research on the characteristics of the formation and inheritance of Lei's medicine in Quzhou from the perspective of regional medicine]

Lei's medicine is the main school of traditional Chinese medicine in Quzhou, Zhejiang Province. It originated from Xin'an medical school. It has been passed on for more than 200 years, but it is still lack of in-depth study. From the perspective of regional medicine, combined with the regional characteristics of Quzhou, absorbing the research results of local social history and environmental history, starting with the historical materials such as Lei's medical works, local chronicles literature and so on, the school characteristics are summarized as: the formation of "treatment in accordance with three types of disease causes" , the academic inheritance of "inheriting the past and integrating the present" , the inheritance mode of "multiple integration" , the cultural connotation of "combining medicine with Confucianism" , and the school characteristics of "integration and innovation" . The purpose of this paper is to provide reference for the research of academic schools and the inheritance of traditional Chinese medicine.

[Pharmacotherapeutics for the new coronavirus pneumonia]

The new coronavirus pneumonia (NCP), also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. The number of diagnosed cases is more than 40,000 until the submission of this manuscript. Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new coronavirus is unprecedentedly fulminating. The published cohorts of 2019 new coronavirus (n-Cov) are single-center studies, or retrospective studies. We here share the therapeutic experiences of NCP treatment with literature review. Combination of Ribavirin and interferon-α is recommended by the 5(th) edition National Health Commission's Regimen (Revised Edition) because of the effect on Middle East respiratory syndrome (MERS), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. Systemic glucocorticosteroid is recommended as a short term use (1~2 mg·kg(-1)·d(-1), 3~5 d) by the 5(th) edition National Health Commission's Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.

[CD7 expression and its prognostic significance in acute myeloid leukemia patients with wild-type or mutant CEBPA]

目的

分析CD7在初治急性髓系白血病（AML）患者中的表达和预后价值，进一步探讨CD7表达情况与CEBPA突变的相关性，明确其在CEBPA野生型和突变型AML患者中与预后的关系。

方法

回顾性分析2010年1月至2016年12月收治的298例初治AML患者（除外M₃亚型）的临床资料，在全部患者以及CEBPA野生型和突变型组中，分别比较CD7阳性（CD7⁺）和CD7阴性（CD7⁻）患者的临床特征及预后差异，并联合CD7表达情况和CEBPA突变状态初步建立新的危险分层模型。

结果

在CD7⁺组中，CEBPA单位点和双位点突变的发生率分别为10.1%和33.9%，显著高于CD7⁻组（5.3%和4.2%），差异具有统计学意义（P=0.000）。在CEBPA野生型患者中，CD7⁺组患者相较CD7⁻组患者完全缓解率低（P=0.001）、复发率高（P=0.023），而两组总生存（OS）期和无病生存（DFS）期差异无统计学意义（P值均>0.05）；在CEBPA突变患者中，CD7⁺组显示有更长的OS期（P=0.019）和DFS期（P=0.010）。根据CD7表达和CEBPA突变与否将AML患者分为三个亚组：CD7⁺伴CEBPA突变组、CD7⁻组和CD7⁺伴CEBPA野生型组。三组患者的3年OS率分别为80.2%、48.0%和30.6%（P<0.001），3年的DFS率分别为74.1%、37.4%和22.2%（P<0.001）。

结论

CD7⁺组中CEBPA突变率显著高于CD7⁻组，CD7⁺在CEBPA野生型组和突变组AML中存在截然相反的预后意义。根据CD7表达情况和CEBPA突变与否建立新的危险分层模型，有助于指导临床个体化治疗。

Effects of Bacillus subtilis and antibiotic growth promoters on the growth performance, intestinal function and gut microbiota of pullets from 0 to 6 weeks

The development of digestive organs and the establishment of gut microbiota in pullets play an important role throughout life. This study was conducted to investigate the effects of Bacillus subtilis (BS) on growth performance, intestinal function and gut microbiota in pullets from 0 to 6 weeks of age. Hy-line Brown laying hens (1-day-old, n = 504) were randomly allotted into four diets with a 2 × 2 factorial design: (1) basal diet group (control); (2) antibiotics group (AGP), the basal diet supplemented with 20 mg/kg Bacitracin Zinc and 4 mg/kg Colistin Sulphate; (3) BS group, the basal diet supplemented with 500 mg/kg BS and (4) mixed group, the basal diet supplemented with both AGP and BS. As a result, when BS was considered the main effect, BS addition (1) reduced the feed conversion ratio at 4 to 6 weeks (P < 0.05); (2) decreased duodenal and jejunal crypt depth at 3 weeks; (3) increased the villus height : crypt depth (V : C) ratio in the duodenum at 3 weeks and jejunal villus height at 6 weeks and (4) increased sucrase mRNA expression in the duodenum at 3 weeks as well as the jejunum at 6 weeks, and jejunal maltase and aminopeptidase expression at 3 weeks. When AGP was considered the main effect, AGP supplementation (1) increased the V : C ratio in the ileum at 3 weeks of age; (2) increased sucrase mRNA expression in the duodenum at 3 weeks as well as the ileum at 6 weeks, and increased maltase expression in the ileum. The BS × AGP interaction was observed to affect average daily feed intake at 4 to 6 weeks, and duodenal sucrase and jejunal maltase expression at 3 weeks. Furthermore, dietary BS or AGP addition improved caecal microbial diversity at 3 weeks, and a BS × AGP interaction was observed (P < 0.05) for the Shannon and Simpson indexes. At the genus level, the relative abundance of Lactobacillus was found to be higher in the mixed group at 3 weeks and in the BS group at 6 weeks. Moreover, Anaerostipes, Dehalobacterium and Oscillospira were also found to be dominant genera in pullets with dietary BS addition. In conclusion, BS could improve intestinal morphology and change digestive enzyme relative expression and caecum microbiota, thereby increasing the efficiency of nutrient utilization. Our findings suggested that BS might have more beneficial effects than AGP in the study, which would provide theoretical evidence and new insight into BS application in layer pullets.

[Clinical analysis of 7 cases with anti-Caspr2 antibody-associated autoimmune encephalitis]

Objective: To investigate the clinical features, laboratory tests, imaging features, electroencephalogram (EEG) manifestations, treatment and prognosis of anti-CASPR2 antibody-associated autoimmune encephalitis with the purpose to improve the understanding of the disease. Methods: Seven patients diagnosed with CASPR2 antibody-associated encephalitis in the Fifth and first Affiliated Hospital of Zhengzhou University from January 2017 to January 2019 were selected. The clinical manifestations, course of disease, imaging, treatment plan and prognosis of the patients were retrospectively analyzed. Results: Of the 7 patients, 4 were male and 3 were female. The median age of onset was 34 years old (range, 11-66 years). Seizures (6/7), memory decline(5/7), and neuropsychiatric disorders (4/7) were common clinical manifestations. CASPR2 antibody was detected in the CSF of 3 patients (3/7) and the serum of all patients (7/7). Notable imaging changes were observed in 5 patients (5/7). All patients received immunotherapy and were followed up for 1 month to 2 years. One patient was diagnosed with rectal cancer with a poor prognosis; all the others got a good prognosis. Conclusions: CASPR2 antibody-related encephalitis is a rare autoimmune disease. It is considered to present with seizures, memory loss, psychiatric symptoms, dizziness and sleep disorders as the main clinical manifestations. Early identification and treatment of the disease can help the patients achieve a good prognosis.

[The clinicopathologic features and prognostic analysis of pancreatic metastasis from clear cell renal cell carcinoma]

Objective: To investigate the clinicopathologic features and prognosis of the patients who had clear cell renal cell carcinoma (CCRCC) with metastasis to the pancreas. Methods: From Jan, 2000 to Dec, 2018, 18 patients with clear cell renal cell carcinoma (CCRCC) and had pathologically diagnosed metastasis to the pancreas were enrolled at Peking Union Medical College Hospital. The clinical and pathological data were retrospectively analyzed. Results: 11 out of 18 patients were male, and the other 7 were female. The average age of onset of CCRCC was 51.4 years. 8 cases (44.4%) occurred in the left kidney, and the other 10 cases (55.6%) with right kidney tumor. Three patients had synchronous pancreatic metastasis, and the other 15 patients had metachronous pancreatic metastasis. The median time from CCRCC onset to pancreas metastasis was 156 months. The main complaints of pancreas metastasis were abdominal pain, jaundice, gastrointestinal bleeding, nausea, weakness, loss of weight and so on. Seven patients (38.9%) had single lesion of pancreas, while 11 patients (66.1%) had multiple lesions of pancreas. Nine patients (50%) had other organs metastasis besides pancreatic metastasis at the same time. Five patients underwent pancreatic metastasis resection, while 15 patients received oral tyrosine kinase inhibitor(TKI). The mean follow-up was 171.7 months(1~361.5 months) and 5 patients died. The median overall survival (mOS) was 122 months, and the 5 year-survival rate was 81.4%. In univariate analysis, synchronous metastasis to the pancreas, relapse after 10 years, Memorial Sloan Kettering Cancer Center prognostic index, International Metastatic Renal Cell Carcinoma Database Consortium index were all significant parameters for patients'survival. Conclusions: Metastasis to the pancreas from clear cell renal cell carcinoma were rare. These patients had better survival outcomes, especially those relapsing after ten years. Pancreatic metastasis resection had no significant benefit on patient's survival.

[Pharmacotherapeutics for the New Coronavirus Pneumonia]

The New Coronavirus Pneumonia (NCP, also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. The number of diagnosed cases is more than 40,000 until the submission of this manuscript. Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new Coronavirus is unprecedentedly fulminating. The published cohorts of 2019 new Coronavirus (n-Cov) are single-center studies, or retrospective studies. We here share the therapeutic experiences of NCP treatment with literature review. Combination of Ribavirin and Interferon-α is recommended by the 5(th) edition National Health Commission's Regimen (Revised Edition) because of the effect on MERS (Middle East Respiratory Syndrome), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. Systemic glucocorticosteroid is recommended as a short term use (1~2 mg.kg(-1).d(-1), 3~5d ) by the 5(th) edition National Health Commission's Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.

Expression of Raptor and Rictor and their relationships with angiogenesis in colorectal cancer

Mammalian target of rapamycin (mTOR) has two subtypes, i.e., mTORC1 and mTORC2, which contain the Raptor and Rictor core molecules, respectively. The effect of Raptor and Rictor on hypoxia inducible factor (HIF)-1α, HIF-2α, and vascular endothelial growth factor (VEGF) in colorectal cancer (CRC) is unclear. In this work, we investigated the correlations among Raptor, Rictor, HIF-1α, HIF-2α, and VEGF expression in CRC. We subsequently analyzed the clinicopathological features of patients. Immunohistochemistry, western blot, and RT-PCR analyses were performed to detect the expression of Raptor, Rictor, HIF-1α, HIF-2α, and VEGF in 120 cases of CRC and 60 cases of normal colorectal mucosa. CD34 was used to label microvascular density (MVD), which was found to be higher in patients with positive Raptor or Rictor than in those with negative Raptor or Rictor. The positive rates of Raptor, Rictor, HIF-1α, HIF-2α, and VEGF in CRC were significantly higher than in normal colorectal mucosa. Raptor expression was positively correlated with HIF-1α and VEGF but not with HIF-2α expression. By contrast, Rictor expression was positively correlated with HIF-2α and VEGF but not with HIF-1α expression. Survival analysis further indicated that Raptor, Rictor, HIF-1α, HIF-2α, VEGF and lymph node metastasis were independent prognostic factors in CRC. To conclude, Raptor and Rictor expression was related to the initiation and development of CRC and angiogenesis in different ways. The combined detection of Raptor and Rictor is important for patients with colorectal carcinoma in prognosis and optimal therapy.

[Meta-analysis on tetanus antibody protection rate of healthy population born after 1978 in China]

Objective: Meta-analysis was conducted on the tetanus antibody protection rate of healthy population born after 1978 in China (data from Hong Kong, Macao and Taiwan was excluded, the same below). Methods: Search the data on China's tetanus antibody level which were published in China National Knowledge Infrastructure, Wanfang data, VIP, SinoMed database, PubMed and the Cochrane Library. The Chinese search keywords were "Tetanus Antitoxin", "Tetanus Antibody", "Healthy Population" and "Mainland China". English search terms include "tetanus antitoxin", "tetanus vaccine", "tetanus vaccine", "general population" and "mainland of China". The time limit for inclusion in literature research was 2010-2019. Stata software was used to conduct meta-analysis on the protection rate of tetanus antibody. Results: A total of 24 articles were included. There was no obvious publication bias in the included articles. The total number of respondents was 23 530, the antibody protection rate was 49.5%-99.0%. A total of 20 817 people got effective antibody protection, which meant the antibody level reached and exceeded 0.1 IU/ml, and the combined protection rate was 78.6% (95%CI: 75.0%-88.2%). The combined protection rates of antibody in 0-7 years old and 8-15 years old groups were 88.9% (95%CI: 86.9%-91.0%) and 79.3% (95%CI: 72.9%-86.2%) respectively. The combined protection rates of antibodies in 16-20 years old, 21-30 years old and 31-40 years old groups were 58.9% (95%CI: 46.5%-71.2%), 47.7% (95%CI: 16.8%-78.7%) and 63.8% (95%CI:32.6%-95.1%) respectively. The combined protection rate of tetanus antibody for 0-15 years old people was 85.6% (95%CI: 83.1%-88.1%), and the combined protection rate of antibody for 16-40 years old people was 52.9% (95%CI: 39.3%-66.6%). Conclusion: With the increase of age, the protection rate of tetanus antibody among the healthy population aged 16-40 years in our country decreases. An individualized vaccination plan should be formulated according to the previous tetanus vaccination history and the tetanus antibody level when necessary.

[Therapeutic evaluation of modified supraglottoplasty for laryngomalacia]

Objective:To evaluate the therapeutic effect of modified supraglottoplasty for laryngeal malacia in children. Method: All 22 children with laryngomalacia underwent modified supraglottoplasty were retrospectively analyzed. Surgical correction of type Ⅰ involved the ablation of redundant mucosal tissue over the arytenoids, keep the part below anesthetic intubation. Type Ⅱ was treated by ablation of the shortened aryepiglottic folds and/or ablation of the lateral edge of the epiglottis, separate the epiglottis with epiglottis to enlarge the laryngeal inlet. Type Ⅲ was corrected by ablating wound surfaces on the base of the tongue and epiglottic vallecula but no more than 1/2 area of lingual surface of epiglottis. All patients were kept intubated for 5 days after surgery in the intensive care unit （ICU）. Evaluate the severity of laryngomalacia before and after surgery （extubation）, 1 month after surgery, and 6 months after surgery. Visual analogue scale （VAS） was used to score the symptoms, including stridor, reflux or feeding difficulties, aspiration, dyspnea and frequency or severity of pneumonia. Clinical score was determined by the physician on the child's laryngeal obstruction, supraglottic morphology in laryngoscope, swallowing function, weight and the result of polysomnography. Result:All 22 children with laryngomalacia were followed up for 6 months after surgery, statistically significant differences in scores before, after, 1 month after and 6 months after surgery （P<0.01）. The symptoms of stridor, dyspnea and feeding difficulties were improved in different degrees. Conclusion:Modified supraglottoplasty for children with laryngomalacia simplified the surgical procedure, and the therapeutic effect is safe and reliable. The evaluation system designed in this study is more intuitive and objective to evaluate the severity of laryngomalacia and the operative effect, which may has certain reference value for the evaluation of the condition and the treatment process.

Change in the structural and functional properties of goat milk protein due to pH and heat

This study was carried out to investigate the effects of pH and heat on the structure and function of milk proteins by comparing goat milk treated under different pH and temperature conditions. The results showed that pH had a significant effect on the thermal stability of goat milk proteins, and the proteins were least thermally stable at pH 7.7. Except for the pH 6.9 goat milk, the surface hydrophobicities of the milk proteins at various pH values reached their maxima at 85°C. The particle size, zeta potential, and content of regular secondary structure also decreased significantly at 85°C, and the turbidity of milk proteins under alkaline pH conditions was lower than that under acidic conditions. It was concluded that alkaline conditions resulted in better emulsion stability and oil-holding capacity, and acidic conditions offered better foaming ability, foam stability, and water-holding capacity for goat milk protein during heat processing. It can also be seen that 85°C was the key temperature for milk proteins after changing the pH of the milk. This paper provides a theoretical basis for optimizing the processing conditions for goat milk and the applications of goat milk proteins.

[Analysis of differences in epidemiology and clinical features of Guillain-Barré syndrome between rural and urban areas of southern China]

Objective: To explore the differences in epidemiology and clinical features of Guillain- Barré syndrome (GBS) between rural and urban areas of southern China. Methods: The clinical data of 759 hospitalized GBS patients from 31 hospitals of 13 provinces/cities in southern China, between January 1st, 2013 and September 30th, 2016, were collected and analyzed retrospectively. Results: The risk of GBS was higher for males than females in rural and urban areas and the median age was 49 and 48 years, respectively. Seasonal clustering in winter and spring was noted in both rural and urban areas, and the seasonal trend was more markedly in rural areas, but the differences showed no statistical significance. There were 70.37% of patients in rural areas and 73.69% in urban areas who had antecedent respiratory infection. The median time from onset to nadir was 7 days, and Hughes Disability Scale at admission, nadir and discharge were (2.95±1.10 vs 2.84±1.15), (3.25±1.11 vs 3.14±1.21), (2.02±1.24 vs 2.00±1.31) in rural and urban areas respectively. Albuminocytologic dissociation was present in 84.34% of patients in rural areas and 84.62% of cases in urban areas. There were 8.65% and 10.94% of cases in rural and urban areas who required mechanical ventilation during hospitalization, respectively. Demyelinating GBS accounted for 53.29% and 48.77%, respectively, in patients with findings of nerve conduction studies available in rural and urban areas. Conclusions: GBS in rural areas of southern China showed male predominance and a peak of spring and winter occurrence, with respiratory infection as the predominated preceding events and demyelinating GBS being main clinical subtype. Winter and spring showed a higher incidence of GBS in rural and urban areas. There were no significant differences of sex, age, preceding events, season trend, progression of disease, clinical subtypes and cerebrospinal fluid investigations in GBS patients between rural and urban areas.

An innovative method based on cloud model learning to identify high-risk pollution intervals of storm-flow on an urban catchment scale

Identifying high-risk storm-flow pollution intervals in an urban watershed is critical for watershed pollution control decision-making. High-risk pollution intervals of storm-flow are defined as storm-flow intervals that contribute more than the background pollutant load, and whose load contribution rank in the top 20%. However, the identification of high-risk pollution intervals is difficult due to variations in the flow-concentration relationship among rain events, uncertainty inherent in stormwater quality data, and physically-based stormwater models requiring a substantial number of parameters. A new method for identifying high-risk pollution intervals during different rain events is proposed. A dataset of the urban watershed located in Shenzhen, southern China, was used to demonstrate the proposed method. A "cut-pool" strategy was initially used to pre-process the dataset for maximizing valuable information hidden in existing datasets and to investigate the impact of rainfall on flow-concentration relationships. Gaussian cloud distribution was then introduced to capture the trend, dispersing extent and randomness of stormwater quality data at any flow interval. Interval Overlapping Ratio (IOR) and Load contribution of storm-flow high-risk pollution intervals was used to assess the performance of the method. Results show that storm-flow high-risk Chemical Oxygen Demand (COD) pollution intervals of the Shiyan watershed was 0.5-1.5 mm under light rain (0-13 mm), 1-3 mm under moderate rain (13-27 mm) and 5-7 mm under heavy rain (27-43 mm). The accuracy of the identified high-risk pollution intervals (IOR) was 63-66% under light rain, 64-67% under moderate rain. Moreover, COD load can be reduced by 44-48% with high-risk storm-flow under light rain; 43-49% under moderate rain; 32% under heavy rain. This method is very useful for effectively controlling storm-flow pollution on an urban catchment scale.

[High level of hemoglobin during the first trimester of pregnancy associated with the risk of gestational diabetes mellitus]

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

[The effect and mechanism of 2-methoxyestradiol on human laryngeal papilloma cell line]

Objective:To explore the signal pathway that mediates the effect of 2-methoxyestradiol（2ME2） on human laryngeal papilloma cell line, in terms of cell proliferation and neovascularization. Method:HIF-1α expression of human laryngeal papilloma cell line（Hs840. T） was interfered using siRNA, and the cells were then processed by 2ME2 in two concentrations. RT-PCR and ELISA were performed to detect the difference of HIF-1α in cells with normal or lower HIF-1α mRNA level, with ELISA test of excretory VEGF level and CCK8 test of cell viability. Result:The IC50of 2ME2 in Hs840. T was 0.309 μmol/L in terms of the inhibition effect of cell proliferation（P<0.01）. Baseline level of intracellular HIF-1α was detectable, and procession of Hs840. T cells by 2ME2 of 0.4 μmol/L inhibited the transcription and expression of HIF-1α by（76.8±2.0）% and（68.6±3.5）% [vs blank group（100.0±2.7）% and（100.0±6.9）%, P<0.01]. VEGF excretion decreased to（50.8±2.1） and（28.1±4.0）% [vs blank group（100.0±3.1）%, P<0.01]after procession by 2ME2 of 0.2 μmol/L and 0.4 μmol/L. After the successful interference of HIF-1α by siRNA, the inhibition effect on cell proliferation by 2ME2 of 0.4 μmol/L decreased to（51.5±3.8）% [vs control group（65.7±1.7）%, P<0.01]. siRNA interference of HIF-1α lead to a decrease of HIF-α mRNA and protein level to（16.3±0.9）% and（7.4±0.8）% [vs cells not interfered（76.8±2.0）% vs（68.6±3.5）%, P<0.01]. Secretory VEGF dropped to（41.0±2.9）% [vs cells not interfered（28.1±4.0）%, P<0.05]. Conclusion:2ME2 has a significant inhibitory effect on human laryngeal cell line. The inhibition of cell proliferation was mediated by a lower level of HIF-1α and therefore lower VEGF. 2ME2 might serve as a novel potential therapy for patients of recurrent respiratory papillomatosis.

[Effect of lead exposure on the accumulation of copper and iron in central nervous system of rats]

Objective: To investigate the dynamic changes of copper and iron contents in brain tissue, body fluids and barriers of rats exposed to lead at different periods in order to provide a theoretical basis for the study of the mechanism of lead nerve injury. Methods: Sixty-four healthy adult SPF male SD rats were randomly divided into control group and lead exposure group, after one week of adaptive feeding, rats in the lead exposure group were treated with 250 mg/L lead acetate, and rats in control group were treated with ordinary drinking water, the experimental period was 12 weeks. After exposure for 3, 6, 9 and 12 weeks, the samples including blood, choroid plexus, cerebrospinal fluid, cortex, hippocampus, striatum, hypothalamus, amygdala, substantia nigra and cerebellum were obtained. Lead, copper and iron content in all kinds of samples were detected by Inductively Coupled Plasma Mass Spectrometry(ICP-MS). The measurement data were presented as Mean±SD, Comparison of metal contents in different tissues of rats at different time analyzed using repeated measurement analysis of variance, Two-variable correlation analysis using Spearman correlation test.The relationship between lead exposure experiod and copper and iron in samples was studied by using trend test. Results: After 12 weeks of lead exposure compared with the control group, lead contents in cortex, hippocampus, striatum, hypothalamus, amygdala, substantia nigra and cerebellum of rats were 2.21, 2.44, 2.95, 3.53, 4.01, 1.85 and 2.86 folds of control group, and the differences were statistically significant(P<0.05). At the same time, lead content in blood, cerebrospinal fluid,choroid plexus, brain microvessels and bones increased. The increase rate in the amygdala and cerebrospinal fluid ranked first among brain tissue or barrier,which were 4.01 and 3.0 folds respectively. Compared with the control group, Compared with the control group, copper content in cortex,hippocampus, striatum, hypothalamus,amygdala, cerebellum,blood,cerebrospinal fluid,choroid plexus and cerebral microvasculature showed an increasing trend among rats following 3,6,9,12 weeks of lead exposure. Copper content change in the striatum was highest among all brain tissue. The increase rate of copper content in the striatum was at the top among brain tissues. After 12 weeks of lead exposure,copper content in brain microvessels was 4.98 folds higher than that of the control group (P<0.05). After lead exposure at different periods,the iron content in the cortex, hippocampus, striatum,cerebrospinal fluid,choroid plexus and brain microvessels of experimental rats all increased(P<0.05). And the iron increase rate in the hypothalamus or cerebrospinal fluid increase ranked first among brain tissues or body fluid the most obviously. Conclusion: With the increase of exposure time, lead exposure can changes in the contents of copper and iron in different brain tissues,body fluids and barriers in rats,among which, the contents of copper and iron in the amygdala,cerebrospinal fluid and brain microvessels increase significantly. This may be related to nerve damage from lead exposure.

[Advances in the research of smart dressings]

Smart dressings, which show obvious advantage and potential in wound treatment and real-time monitoring, attract widespread attention in recent years. Real-time and dynamic acquiring wound information is vital to the treatment and prognosis of wound. Further research on smart dressings is helpful for wound management, personalized treatment, and realization of medical application translation of health monitoring technology. In the article, we categorize smart dressings and conclude their functions according to the type of micro-environment information of wound gathered by smart dressings.

[Modified memory sub-test of Syndrom Kurz test in middle-aged and elderly Chinese]

Objective: To investigate the applicability of the modified memory sub-test of syndrom kurz test (SKT-M) in middle-aged and elderly Chinese. Methods: Between March 1, 2017, and October 31, 2017, at HwaMei Hospital, 132 patients receiving elective great saphenous vein high ligation and stripping operation and 96 their accompanying dependents, 55-75 years old, were randomly divided into the SKT-M group (n=121) and auditory verbal learning test -huashan version (AVLT-H) group (n=107) using random numeral method. The two groups underwent two corresponding neuropsychological tests respectively on the day before surgery and the second day after surgery. Results: There was no significant difference in the baseline characteristics and all the neuropsychological indices at the two time points between patients and dependents (P>0.05). As a consequence, the data of the patients and dependents were integrated to compare the applicability of SKT-M and AVLT-H. The "low-score" ratio of SKT-M immediate recall (2.4%) was lower than that of AVLT-H test (12.1%) (χ(2)=8.138, P<0.01). Besides, the "low-score" ratio of SKT-M delayed recall (5.7%) was also lower than that of AVLT-H test (20.5%) (χ(2)=11.167, P<0.01). The influence factors of SKT-M were less than that of AVLT-H test. However, the learning effect of SKT-M immediate recall was more significant, for its first testing sore (23.1±5.4) was significantly higher than the second one (21.9±5.1) (t=-3.971, P<0.001). Conclusion: The SKT-M has better applicability to 55-75 years old Chinese than AVLT-H test, but its learning effect should be noted.

[Reliability and validity of the chronic obstructive pulmonary disease morning symptom diary Chinese version]

Objective: To describe the development of the Chronic Obstructive Pulmonary Disease Morning Symptom Diary (COPD-MSD) Chinese version and to test its reliability and validity. Methods: The COPD-MSD Chinese version was developed by the standard cross-cultural translation principle. A hundred and eight patients with COPD in stable condition from the Second Xiangya Hospital were assessed by interview with COPD-MSD Chinese version, and underwent mMRC, CAT scores and pulmonary function test.The reliability and validity were evaluated by performing correlation analysis.The stages of COPD determined by lung function were compared to observe the value of COPD-MSD Chinese version in determining disease severity. Results: The Cronbach's alpha and retest reliability of the total scale were 0.908 and 0.927, respectively.The explanatory factor analysis was conducted using orthogonal rotation through the maximum variation principle components extraction which revealed the presence of 5 components with eigen values exceeding 1, explaining totally 74.257% of the variance, and the total score of the COPD-MSD Chinese version was significantly correlated with the mMRC and CAT scores (r=0.44 and 0.56,P<0.01), indicating that the scale of the convergence validity was good. The COPD-MSD Chinese version scores varied significantly in patients with different severity of COPD(χ(2)=9.808, P<0.05). Conclusion: The COPD-MSD Chinese version showed good reliability and validity and could be used in clinical assessment of morning symptoms in Chinese COPD patients.

[Hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome]

OBJECTIVE

To explore the hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome (POTS) and to compare hemodynamic parameters of POTS patients with decreased cardiac index (CI) and those with not-decreased CI.

METHODS

A retrospective study was conducted to show the trends of CI, total peripheral vascular resistance index (TPVRI), heart rate and blood pressure in standing-up test of 26 POTS patients and 12 healthy controls, and to compare them between the two groups. The POTS patients were divided into two groups based on CI decreasing or not in standing-up test, namely decreased CI group (14 cases) and not-decreased CI group (12 cases). The trends of the above mentioned hemodynamic parameters in standing-up test were observed and compared between decreased CI group and not-decreased CI group.

RESULTS

In standing-up test for all the POTS patients, CI (F=6.936, P=0.001) and systolic blood pressure (F=6.049, P<0.001) both decreased significantly, and heart rate increased obviously (F=113.926, P<0.001). However, TPVRI (F=2.031, P=0.138) and diastolic blood pressure (F=2.018, P=0.113) had no significant changes. For healthy controls, CI (F=3.646, P=0.016), heart rate (F=43.970, P<0.001), systolic blood pressure (F=4.043, P=0.020) and diastolic blood pressure (F=8.627, P<0.001) all increased significantly in standing-up test. TPVRI (F=1.688, P=0.190) did not change obviously. The changing trends of CI (F=6.221, P=0.001), heart rate (F=6.203, P<0.001) and systolic blood pressure (F=7.946, P<0.001) over time were significantly different between the patients and healthy controls, however, no difference was found in TPVRI and diastolic blood pressure (P > 0.05). Among the POTS patients, CI was significantly different between decreased CI group and not-decreased CI group (F=14.723, P<0.001). Systolic blood pressure of the former decreased obviously (F=8.010, P<0.001), but it did not change obviously in the latter (F=0.612, P=0.639). Furthermore, none of the changes of TPVRI, heart rate and diastolic blood pressure in standing-up test were significantly different between the two groups (P > 0.05). Age was an independent factor for decreased CI patients (P=0.013, OR=2.233; 95% CI, 1.183 to 4.216).

CONCLUSION

POTS patients experience vital hemodynamic changes in standing-up test, part of them suffering from decreased CI, but others from not-decreased CI. Age is an independent factor for patients suffering from decreased CI.

TT genotype of rs10036748 in TNIP1 shows better response to methotrexate in a Chinese population: a prospective cohort study

BACKGROUND

Methotrexate (MTX) is an efficacious treatment for psoriasis; however, its widespread application is limited by its unpredictable efficacy.

OBJECTIVES

To investigate the association of clinical factors and variants of psoriasis susceptibility genes with clinical responses to MTX in a prospective cohort.

METHODS

A total of 221 patients with psoriasis were recruited. Patients who achieved Psoriasis Area and Severity Index (PASI) improvement ≥ 75% at week 12 were defined as responders, whereas those with PASI improvement < 50% were defined as nonresponders. In 90 screening patients, genetic variants for 18 single-nucleotide polymorphisms in 14 susceptibility genes, and HLA-Cw6 status were initially compared for responders and nonresponders. Statistically significant associations in genetic variants were verified in all 221 patients.

RESULTS

Overall, 49% and 45% of patients achieved PASI 75 improvement during screening and verification stages, respectively. Concomitant arthritis with psoriasis and high body mass index (BMI) negatively affect the efficacy of MTX. TT genotype of rs10036748 in TNIP1 was significantly associated with PASI 75 response at week 12 (54% and 37%, P < 0·05). A significantly higher PASI 90 response was observed in patients with TT genotype of rs10036748 (27% vs. 12%, P < 0·01) and TC/TT genotype of rs4112788 in LCE3D (25% vs. 13%, P < 0·05) at week 12 compared with those who had other genotypes. After adjustment for all confounding factors, only BMI (P < 0·05), arthritis (P < 0·05) and genotype of rs10036748 (P < 0·05) were significantly associated with clinical responses to MTX.

CONCLUSIONS

Patients with psoriasis with TT genotype of rs10036748 in TNIP1, with lower BMI, without arthritis will achieve a better response to MTX.

[China Hainan Centenarian Cohort Study: study design and preliminary results]

Objective: To investigate the health status, functional ability, mental psychology, health care and other longevity-related characteristics of individuals aged ≥100 years as well as risk factors in Hainan province, China. Methods: China Hainan Centenarian Cohort Study (CHCCS) is a community-based, prospective cohort study to establish multi-dimensional database consisting of questionnaire findings, anthropometric parameters and biological specimens as well as imaging features. With the household registration information provided by the Department of Civil Affairs of Hainan province, a baseline survey was conducted in centenarians in 18 counties in Hainan with the oldest old in 5 counties as controls between 2014 and 2017. The survey included face to face interview, physical examination and biological specimen collection. After the baseline survey, the participants of CHCCS were followed up at an interval of 2 years to collect the information about their living status, disease status or major death causes. Results: According to the information provided by the Department of Civil Affairs of Hainan province in 2014, the survey found that 1 473 centenarians were still living. By December 2016, 1 002 of them had agreed to be surveyed. The average age of 722 centenarians with complete information in the baseline survey was (102.7±2.7) years, the majority of them were females (83.0%), widows (88.8%), in Han ethnic group (84.5%), lived with family members (87.8%), illiterates (89.7%) and farmers (81.0%). Conclusion: CHCCS has provided longevity-related information of the large longevity population and collected the valuable and rare biological specimens with great urgency to establish an interdisciplinary platform and base for longevity, senility and healthy aging research.

[A new simple scoring system to determine the timing and efficacy of entecavir therapy in hepatitis B-related acute-on-chronic liver failure]

Objective: To determine the timing and efficacy of entecavir (ETV) therapy in hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) using a new simple scoring system. Methods: A total of 212 patients with HBV-ACLF were treated with ETV 0.5 mg daily besides the routine treatment. The severity of illness was scored by the HBV-ACLF prognostic scoring system. Hepatic failure severity scores, hepatitis B virus DNA (HBV DNA) load, and length of hospital stay were recorded at the time of initiation of treatment, and the time of survival to hospital discharge/end of life. Results: Patiens were divided into four groups by the admission severity scores according to the percentile table: low score group (score≤ 4), medium-low score group (score: 5-7), medium-high score group (score: 8-11), and high score group (score ≥12). As the scores increased, the mortality rate increased. There were significant differences among different groups (χ(2)=310.662, P<0.001). There were significant difference of the admission and discharge/death severity scores in the low score group (P=0.003). There were significant differences of the comparison of HBV DNA load at admission and death/discharge using ETV in low-, medium-low, and medium-high score groups (P<0.001). There were no significant differences of HBV DNA load at admission and death/discharge using ETV for dead and survival patients in the medium-low, and medium-high score groups. Conclusions: The efficacy of ETV in the rescue treatment of HBV-ACLF is related to the severity of ACLF when starting medication. The HBV-ACLF prognostic scoring system can clearly determine the timing and efficacy of ETV treatment of HBV-ACLF.

Proteomics and microstructure profiling of goat milk protein after homogenization

This study investigated the protein changes in goat milk during the homogenization process using label-free quantification. We quantified 310 and 315 proteins in the control group (CG) and homogenized group (HG), respectively, and 16 proteins were significantly different between the 2 groups. For HG, the goat milk protein particle sizes were smaller and more evenly distributed and exhibited an increase in the regular arrangement of the secondary structures. Proteomics analysis verified that xanthine dehydrogenase and asparaginase-like 1 expression in CG were higher than in HG, whereas the opposite was observed for fructose-bisphosphate aldolase, κ-casein, and β-casein. Significant changes were found in the homogenization-treated goat milk proteome that were related to goat milk glycolysis/gluconeogenesis metabolism. This work provides updated information on the current proteome characteristics of homogenized goat milk, which may be important for applying the protein component of goat milk to human nutrition and health.

[Impact of discontinuation of aspirin and clopidogrel before off-pump coronary artery bypass grafting on postoperative bleeding and transfusion requirement]

Objective: To investigate the influence of different discontinuation time of aspirin and clopidogrel before off-pump coronary artery bypass grafting (OPCABG) on postoperative bleeding and blood products transfusion requirement. Methods: Three hundred and fifty-three coronary artery disease patients who underwent OPCABG from January 2017 to January 2018 at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University were retrospectively analysed. There were 268 males and 85 females, aged (66.0±9.1)years. All patients were divided into three groups: (1) guideline-recommended group: patients who discontinued clopidogrel for >5 days without discontinuing aspirin before surgery; (2) without discontinuing group: patients who discontinued clopidogrel for ≤5 days without discontinuing aspirin before surgery; (3) discontinuing group: patients who discontinued clopidogrel for >5 days with discontinuing aspirin before surgery. Postoperative bleeding recorded as chest tube drainage (CTD) volume and blood products transfusion requirement and perioperative complications were recorded. CTD volumes within 12 hours after surgery between groups were compared by Mann-Whitney U tests, CTD volumes after 12 hours postoperatively were compared by repeated measures analysis of variance and blood products transfusion and complications incidence were compared by χ(2) test or Fisher's precise test. Results: The 12 hours CTD volumes of guideline-recommended group, without discontinuing group, discontinuing group after surgery were 280(153) ml (M(Q(R))), 291(229) ml, 225(161) ml, respectively. There were no significant differences in postoperative 12 hours CTD volumes (P=0.865), red blood cells transfusion incidence (χ(2)=2.626, P=0.149) and fresh frozen plasma (FFP) transfusion incidence (χ(2)=1.258, P=0.324) between guideline-recommended group and without discontinuing group. However, the 12 hours CTD volumes were significantly higher in guideline-recommended group patients compared with disconutinuing group patients (U=5 247, P=0.002). No significant differences were observed in red blood cells (χ(2)=0.182, P=0.757) and FFP (χ(2)=0.083, P=0.839) transfusion rate between these two groups. Repeated measures analysis of variance indicated that when patients began to take antiplatelet drugs (aspirin and clopidogrel) after 12 hours postoperatively, the change of CTD volumes beyond 12 hours after surgery didn't differ either between guideline-recommended group and without discontinuing group (F=0.019, P=0.941) or between guideline-recommended group and discontinuing group (F=2.447,P=0.113). Besides, the incidence of perioperative arrhythmia was significantly higher in guideline-recommended group patients compared with without discontinuing group patients (4.8% vs. 0, χ(2)=5.073, P=0.038). Conclusions: OPCABG patients who discontinued aspirin before surgery had lower postoperative 12 hours CTD volumes but similar blood products transfusion rate and CTD volumes beyond 12 hours postoperatively compared with patients adhering to the current guideline-recommended protocol. And for patients who discontinued clopidogrel for ≤5 days, postoperative CTD volumes and blood products transfusion requirement were similar but the incidence of perioperative arrhythmia was significantly lower compared with guideline-treated patients.

[A retrospective analysis of CO(2) laser and microdebrider for the treatment of severe juvenile on-set recurrent respiratory papillomatosis]

Objective: Juvenile on-set recurrent respiratory papillomatosis (JORRP) can be an aggressive and potentially life-threatening disease. To emphasize the importance of complication prevention in local excision surgery, the single-center experience of RRP treatment in a group of patients with relatively short recurrence-free-interval (>4 times/yrs) was reported. Methods: Data of 49 patients underwent papilloma resection during 2002-2013 were retrospectively analyzed. Combined techniques of laser microsurgery and microdebriders were used to remove papillomas, prevent the formation of scar tissue and improve respiratory distress. Forty-nine cases were followed up for 99.0[74.5; 121.0]months, ranging from 39 to 185 months. The age of disease onset was 2[1; 3] years old. Most of the patients had difficulty in breathing(42 of 49 cases). Seven patients had hoarseness.53.0% patients had subglottic or trachea papillomatosis spreading. The rate of complications, synechia formation, tracheal stenosis, needing for tracheostomy, mortality was recorded. Patients were followed up for at least three years. The characteristics of the patients, improvement in symptoms, recurrence-free interval, and the rate of tracheal extubation were evaluated. Wilcoxon signed ranks test and chi-square test were used for data comparation. Results: Long-term relieve in disease(≤2 surgeries were needed/year) were achieved in 29(59.1%) subjects, in which 8(16.3%) of the subjects did not need surgical treatment for at least 3 years. Long-term relieve had been achieved in 25 of subjects who did not accept tracheostomy. Seven subjects did not need surgical treatment for at least 3 years. The rate of successful tracheal extubation was 53.8% in 13 patients who had undergone tracheostomy. Three cases dead of intrapulmonary spread. Conclusions: Combined techniques of laser microsurgery and microdebriders are effective in improvement in both respiratory distress and voice quality. The combined technique are helpful to avoid inevitable long-term stenotic complications, ultimately affecting the quality of life.

[Percutaneous catheterization for extracorporeal membrane oxygenation: a retrospective case series]

Objective: To review the experience of percutaneous catheterization for extracorporeal membrane oxygenation (ECMO) by respiratory intensivists at a single institution. Methods: A retrospective review of 87 patients undergoing percutaneous catheterization for ECMO in Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital from November 2009 to January 2017. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. Results: The 87 patients consisted of 61 males and 26 females. The average age was (47±16)years (range 15-82 years ). Fifty-six patients were given ECMO therapy because of acute respiratory distress syndrome(ARDS), and 16 were treated as a bridge for lung transplantation and 15 for other causes. Eighty-one cases were given VV-ECMO support, and 6 cases were given VA-ECMO support. The most commonly used cannulas were 15-17 F arterial cannulas and 21-23 F venous cannulas. Preinsertion ultrasound was performed in 62 patients (71%) . Bedside chest radiography was used to help adjust the position of the end of the cannula in 11 patients (13%). Percutaneous catheterization was successful in 85 cases (97%) , while it failed in 2 female patients due to thick subcutaneous fat layer, and open surgical approach was used. Percutaneous femoral artery collateral circulation was established by ourselves in 5 cases. One patient with femoral artery catheterization without collateral circulation had gangrene of limbs. The complications included 9 cases of catheter site hemorrhage, 4 catheter-related bloodstream infection and 1 pulmonary embolism during ECMO weaning. Conclusion: Percutaneous catheterization for ECMO can be performed with a high rate of success and a low rate of complications.

[The evaluation of severity and treatment for OSAHS by acoustic pharyngometry which in different postures]

Objective: To investigate the optimal position in application of acoustic pharyngometry to detect the pharyngeal condition and to assess its therapeutic effect on obstructive sleep apnea hypopnea syndrome(OSAHS). Method: Eight adult males were assigned to the normal group, and 57 male patients with OSAHS diagnosed by polysomnograhy(PSG) were assigned to the snoring group. Of the snoring group, 11 patients who were diagnosed severe OSAHS underwent low-temperature plasma uvulopaltopharyngoplasty(UPPP) and coblationchanneling of the tongue(CCT), were assigned to the operation subgroup; 8 patients underwent continuous positive airway pressure(CPAP), which was assigned to the CPAP subgroup. And remainders underwent conservative treatment, including weight loss and position change. Acoustic pharyngometry (three positions including sitting position, supine position and lateral position) and PSG exam were performed in all participants. Additionally, acoustic pharyngometry under three positions was conducted again in patients in the operation and CPAP subgroups three months after treatment. Result: The minimum cross-sectional area was negatively associated with both AHI and the percentage of time with oxygen saturation below 90%(SIT90)( P<0.01). The correlation coefficient of the minimum crosssectional area insupine position with AHI and SIT90 were r=-0.569,r=-0.478, respectively. Under supine position, the minimum crosssectional area was negatively correlated with body mass index(BMI)(r=-0.265, P=0.033), and the minimum crosssectional area was negatively associated with neck circumference(r=-0.309, P=0.012). The minimum cross-sectional area was significantly increased after treatment of OSAHS(both operation and CPAP), which was statistically different before and after treatment compared to the control group(P<0.01). Conclusion: ①The minimum cross-sectional area is significantly correlated with AHI and SIT90, respectively. The acoustic pharyngometry can be used to screen OSAHS patients. ②In this study, the minimum cross-sectional area under supine position is significantly smaller than that under sitting position. In addition, the minimum cross-sectional area under supine position harbored a better correlation with AHI and SIT90, which could better reflect the narrowness of pharyngeal cavity during sleep. ③Acoustic pharyngometry could be a simple, rapid and non-invasive technique that can objectively evaluate the efficacy of surgical and CPAP methods, and provided a more favorable basis for future clinical work..

Isotopic determination with molecular emission using laser-induced breakdown spectroscopy and laser-induced radical fluorescence

Molecular emission can be used for isotopic analysis in laser-induced breakdown spectroscopy (LIBS) due to its large isotopic shift. However, spectral weakness and interference have become the main flaws in molecular isotopic analysis, causing deterioration of quantitative accuracy and sensitivity. Here, to overcome these problems, laser-induced radical fluorescence (LIRF) was applied to enhance the molecular spectra and eliminate the spectral interference. The root mean square errors of cross validation (RMSECVs) of boron and carbon isotopes (¹¹BO, ¹⁰BO, ¹²CN, and ¹³CN) improved to 2.632, 5.721, 5.990, and 1.543 at.%, as compared with 16.96, 35.79, 57.10, and 13.89 at.%, respectively, obtained in the case without LIRF. The limits of detection (LoDs) of ¹¹BO, ¹⁰BO, ¹²CN, and ¹³CN were 0.9858, 0.8470, 1.606, and 1.193 at.%, respectively. This work demonstrates the feasibility of LIBS-LIRF to achieve isotopic determination with high accuracy and sensitivity.

[Clinical evaluation and comparison of three surgical procedures for treatment of root surface exposure after epulis resection]

Objective: To evaluate and compare the clinical effects of three surgical procedures for the periodontal treatment of root surface exposure after resection of epulis. Methods: Thirty patients with epulis were selected in this study and the exposed root surfaces of the patients' teeth were covered with laterally transposition flap, laterally pedicled transposition flap or coronally advanced flap combined with a connective tissue graft in the treatments of epulis. At the time of follow-up during the operation, 3 months after operation and 6 months after operation, respectively, the color, shape and quality of the gum in the operation area and the coordination of the diaphragm and diaphragm were observed, and the root surface exposure (recession depth, RD) and angle were recorded. Keratinized tissue height (KTH), root coverage rate (RC) and patients' satisfaction with the surgery were also recorded. Results: The flap widths in groups of laterally pedicled transposition flap and coronally advanced flap combined with a connective tissue graft were significantly wider than that in the group of laterally transposition flap at three-month and six-month follow-ups after the surgery. The width of keratoderma [(2.70±1.16) mm] in the group of laterally transposition flap was significantly lower at 6 months postoperatively than that in the other two groups [(4.80±1.14) and (4.90±1.66) mm, respectively] (P<0.01). At the 6th month after surgery, the root flap coverage was at the lowest level [(24±43)%] in the group of laterally transposition flap, and it was significantly lower than that in the other two groups [(80±23)% and (86±24)%, respectively] (P<0.01). There was no significant difference of the root flap coverage between groups of laterally pedicled transposition flap and coronally advanced flap combined with a connective tissue graft. At the time of follow-up, patients were satisfied with the aesthetic effects of the three surgical procedures. Conclusions: After the resection of the gingival tumor, the defect of the gingiva is caused. The laterally pedicled flap and pedicled flap combined with connective tissue transplantations for soft tissue repairing can achieve satisfactory aesthetic effects which are superior to the effect of simple flap technique.

Two agroinfection-compatible fluorescent protein-tagged infectious cDNA clones of papaya leaf distortion mosaic virus facilitate the tracking of virus infection

Papaya leaf distortion mosaic virus (PLDMV, the genus Potyvirus) is an emerging threat to papaya production. Here, agroinfection-compatible fluorescent protein-tagged PLDMV infectious cDNA clones driven by the Cauliflower mosaic virus 35S promoter were successfully constructed using one-step Gibson assembly. The clones were directly transformed into Agrobacterium tumefaciens to prevent potential problems such as plasmid instability during propagation in Escherichia coli. Ninety-five percent of papaya seedlings infected with PLDMV-GFP or PLDMV-mCherry developed systemic symptoms typical of those caused by wild-type PLDMV. Green and mCherry red fluorescence was observed in leaves, stems, and roots of infected papaya plants. The fluorescent protein-tagged agroinfectious PLDMV cDNA clones were stable in papaya for more than 90 days and during six serial passages at 30-day intervals. The availability of these infectious clones will contribute to research on PLDMV-host interactions and can be applied in the papaya breeding program for PLDMV resistance.

[Diagnosis and treatment of antiphospholipid antibody-related recurrent spontaneous abortion and analysis of therapeutic drugs and pregnancy outcome in 75 patients with antiphospholipid syndrome]

Recurrent spontaneous abortion is one of the common complications in women of childbearing age during pregnancy. The immune factor accounts for a large proportion of many causes. Antiphospholipid antibody syndrome is the most common type of acquired thrombophilia disease. Autoimmune diseases that cause thrombosis and obstetric complications under the action of antibodies are also the most common type of immune-related recurrent abortion. At present, there is no unified opinion on the treatment of this disease, especially the treatment of immunoglobulins and other drugs like glucocorticoid. Here we reviewed the progress of diagnosis and treatment of antiphospholipid antibody-related recurrent abortions and retrospectively analyzed and summarized the drug regimens and pregnancy outcomes of this disease with pregnancy patients in our hospital. A total of 75 patients were included. According to their clinical manifestations and laboratory results, these patients were basically divided into two categories: classical antiphospholipid syndrome and non-classical antiphospholipid syndrome. The latter was further divided into serum-negative antiphospholipid syndrome and antiphospholipid antibody-related recurrent abortion patients based on their clinical manifestations and antiphospholipid antibody results. The patients were divided into four categories: aspirin + hydroxychloroquine, aspirin + low molecular weight heparin, aspirin + low molecular weight heparin + hydroxychloroquine, aspirin + hydroxychloroquine + low molecular weight heparin + low dose glucocorticoids. Among them, aspirin + hydroxychloroquine + low molecular weight heparin + low dose glucocorticoid treatment regimen was most commonly used. Most of the patients who received the above different treatment regimens achieved full-term infants, and a small number of patients had adverse pregnancy outcomes, such as premature delivery, placental abruption, eclampsia, and fetal malformation. And adverse pregnancy outcomes also occurred in this group. It might be related to the severity of the disease and the potential adverse effects of maternal fetal. However, further statistical analysis is needed for the risk factors affecting the pregnancy outcome of this part of patients.

[Establishment and preliminary application of a laryngomalacia larynx three-dimension model]

Objective:To establish and preliminarily apply a laryngomalacia larynx three-dimension finite element model. Method:The MIMCS software was employed to deal with the Dicom images of larynx CT scan by means of distinguishing material gray threshold of different tissues. 3D visualization model of larynx was also built by this software. Hyermesh software was used to handle the grid layout of larynx finite element model. Laryngeal structure parameter were added, and laryngeal mechanical analysis were carried out by Abaqus software in order to get von Mises stress. Result:A 3D model，which finely represent the morphological characteristics of laryngomalacia larynx was built using the finite element technology. Peak von Mises stress was observed to be higher in more severe laryngomalacia case. Conclusion:The 3D finite element model of the laryngomalacia larynx provides the foundation for further study．Peak von Mises stress may be a useful indicator of laryngomalacia severity assessment.

[A preliminary study on the relationship between laryngopharyngeal reflux and chronic rhinosinusitis]

Objective:To study the relationship between laryngopharyngeal reflux and chronic rhinosinusitis. Method:A total of 46 patients were enrolled in this study including 25 cases with chronic rhinosinusitis with nasal polyps, 10 cases with chronic rhinosinusitis without nasal polyps and 11 cases underwent surgery due to abnormal nasal anatomy such as nasal septum deviation, bubble in the turbinate, etc. as control group. The expression of pepsin was detected using immunohistochemistry in three groups. The intensity of pepsin expression and CT score of sinus, blood eosinophils percentage, blood neutrophils percentage, blood basohils percentage, blood mononuclear percentage, blood lymphocytes percentage were analyzed. Result:There were 8 strong positive cases (32%, 8/25), positive in 8 cases (32%, 8/25), 2 weakly positive cases (8%,2/25), 7 negative cases (28%, 7/25) in chronic rhinosinusitis with nasal polyps group. In the chronic rhinosinusitis without nasal polyps group, the expression of pepsin was strong positive in 4 cases (40%, 4/10), positive in 3 cases (30%, 3/10), weakly positive in 1 cases (10%, 1/10), negative in 2 cases (20%, 2/10). There were no strong positive expression in the control group, positive in 2 cases (18.2%, 2/11), weakly positive in 3 cases (27.3%, 3/11), negative in 6 cases (54.5%, 6/11), chronic rhinosinusitis with nasal polyps group and chronic rhinosinusitis without nasal polyps group higher than the control group (P<0.05). There was no significant difference in pepsin expression between chronic rhinosinusitis with nasal polyps group and without group (P=0.617). Spearman correlation analysis indicated that the intensity of pepsin was positively correlated with the score of Lund-Markay (r=0.349,P=0.017), there was no correlation with the percentage of various inflammatory cells. Conclusion:The positive expression intensity of pepsin in chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps is significantly higher than that in normal control group, suggested that there is a correlation between laryngopharyngeal reflux and chronic rhinosinusitis. Laryngopharyngeal reflux is positively correlated with the severity of nasal polyps. Chronic nasal inflammation caused by laryngopharyngeal reflux is not mediated by a certain kind of inflammatory cells.

[One case report of nasal kaposiform hemangioendothelioma in adult]

A female patients，25-year-old，with the rigth nasal cavity bleeding 3 months as the main complaint to the hospital，physical examination indicated a soya bean size red mass at the surface of rigth inferior turbinate，and completely removaled of the mass under nasal endoscope，the pathologic results of the kaposiform hemangioendothelioma．.

[Nystagmus characteristics of the horizontal semicircular canal light cupula]

Objective:To analyze the nystagmus characteristics of 9 patients with horizontal semicircular canal light cupula.Method:Patients who visited the department of otolaryngology of Shanghai sixth people's hospital from September 2017 to December 2017 with a typical history of positional vertigo and roll test evoked horizontal geotropic direction changing nystagmus that lasted more than one minute were enrolled in the study.Nystagmus was monitored using the videonystagmoscopy (VNG), and parameters of nystagmus,including latency, duration and the intensity of nystagmus were analyzed. Barbecue maneuvers were tried for all patients and no other treatment was performed.Result:Nine patients were enrolled,DixHallpike test had no nystagmus, Roll test showed a persistent geotropic DCPN, the recorded average duration of nystagmus was (64.2±13.7)s (longer actually), and averaged latency was (5.3±4.7)s.In some cases, positional nystagmus increased rapidly in intensity and then declined slowly as seen in patients with canalolithiasis. Immediate effectiveness is 0 after barbecue maneuver,but 4 patients recovered within one week,2 patients improved within 1 week,and recovered within 2 weeks, 1 patient transferred into posterior semicircular canal BPPV, and 2 cases had not been followed up.Conclusion:Nystagmus of horizontal canal light cupula has a latency of several seconds,with a crescendodecrescendo pattern of intensity.Barbecue maneuver may be not effective in resolving nystagmus,but the prognosis is good for those patients.

First co-infection case of melioidosis and Japanese encephalitis in China

BACKGROUND

Melioidosis is endemic in Southeast Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation or ingestion of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in endemic regions. Japanese encephalitis (JE) is a vector-borne viral zoonosis caused by Japanese encephalitis virus (JEV), leading to epidemic encephalitis in Southeast Asia. Both B. pseudomallei and JEV have spread dominantly in the Hainan and Guangdong provinces in China. Here we reported the first case of co-infection of B. pseudomallei and JEV, which was discovered in Huizhou in the Guangdong province in June 2016.

CASE PRESENTATION

A 52-year-old man was admitted to the hospital with acute febrile illness and headache, diagnosed as respiratory infection, central nervous system (CNS) infection, septicemia, and hepatic dysfunction. Based on B. pseudomallei-positive blood and cerebrospinal fluid (CSF) cultures, the patient was diagnosed with melioidosis and treated aggressively with antibiotics. However, the patient failed to make a full recovery. Further laboratory tests focused on CNS infection were conducted. The co-infection of B. pseudomallei and JEV was confirmed after the positive IgM antibodies of JEV were detected in both CSF and blood. After diagnosis of co-infection with B. pseudomallei and JEV, the patient was provided supportive care in hospital and recovered after approximately 3 weeks.

CONCLUSION

Given the possibility of co-infection of B. pseudomallei and JEV, as well as variable case presentations, it is critical to enhance the awareness, detection, and treatment of co-infection in regard to melioidosis.

One-point and multi-line calibration method in laser-induced breakdown spectroscopy

The calibration-free laser-induced breakdown spectroscopy (CF-LIBS) and its variations are low cost, short time consumption, and high adaptability. However, seeking a more flexible and simple quantitative analysis method remains a challenge. A one-point and multi-line calibration (OP-MLC) was presented as a simple quantitative analysis method of LIBS. The results showed that OP-MLC-LIBS method can achieve quantitative analysis using only one standard sample, and the average relative errors (AREs) are 9, 22, 21 and 36% for Mn, Cr, Ni and Ti elements in six tested low-alloy steel samples, respectively. The method requires neither a large number of standard samples nor complicated calculations, which provides a flexible and low-cost quantitative analysis approach for development and application of LIBS.