Effects of smoking and alcohol consumption on lipid profile in male adults in northwest rural China

OBJECTIVES

To determine the individual and combined influences of smoking and alcohol consumption on lipid profile in male adults in northwest rural China.

DESIGN

Cross-sectional study.

METHODS

In total, 4614 subjects were enrolled in the cross-sectional study, performed between 2008 and 2012. The present study examined males aged ≥18 years from northwest rural China (n = 707). Data on current smoking and drinking status were collected. Logistic regression was used to estimate the individual and combined influences of smoking and alcohol consumption on lipid profile. Age, ethnic group, educational background, smoking (or alcohol consumption), waist circumference, body mass index, blood pressure and fasting blood glucose were adjusted as confounders.

RESULTS

Total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides (TG)/HDL-C ratio, low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio and visceral adiposity index (VAI) were significantly higher in smokers than in non-smokers, whereas HDL-C was lower in smokers. TG/HDL-C ratio, LDL-C/HDL-C ratio, TG, lipid accumulation product and VAI were significantly higher in drinkers than non-drinkers. After adjustment for confounders, significant relationships were observed between smoking status and any dyslipidemia, low HDL-C and high VAI (odds ratios [ORs]: 2.53 [95% confidence interval {CI}: 1.25-5.15], 6.13 [95% CI: 2.84-13.25] and 4.39 [95% CI: 2.02-9.54], respectively). The OR for any dyslipidaemia was 1.94 (95% CI: 1.09-3.48) for subjects who smoke and drank alcohol compared with subjects who did not smoke or drink alcohol.

CONCLUSIONS

Abnormalities in lipid profile are correlated with smoking and alcohol consumption, which calls for intervention strategies to prevent dyslipidaemia and control risk factors for cardiovascular disease.

[Expressions and clinical significances of paired box gene 2 and cyclin D1 in advanced ovarian serous carcinoma]

Objective: To investigate the expressions and clinical significances of paired box gene 2 (Pax2) and cyclin D1 protein in advanced ovarian serous carcinoma. Methods: From January 2003 to December 2013, the pathologic tissues of 202 patients with advanced ovarian serous cancer (Ⅲ-Ⅳ) who underwent initial cytoreductive surgery were collected. The expressions of Pax2 and cyclin D1 protein were detected by immunohistochemistry in tissue microarray. The relationships of their expressions with the clinicopathological features and prognosis of the patients were analyzed. Results: The positive rate of Pax2 protein expression of the 202 patients with ovarian serous adenocarcinoma was 24.8% (50/202) and that of cyclin D1 was 25.2% (51/202). The expressions of Pax2 and cyclin D1 were not significantly related with age, clinical stage and pathological grade of ovarian serous adenocarcinoma patients (P>0.05). The median overall survival (OS) time of Pax2-negative patients was 53 months and the progression-free survival (PFS) time was 29 months. The median OS time of Pax2-positive patients was 66 months and PFS time was 33 months, the OS of Pax2-negative patients was significant different from that of Pax2-positive patients (χ(2)=4.06, P=0.04). The median PFS time of Pax2-negative patients was not significant different from that of Pax2-positive patients (χ(2)=2.43, P=0.11). The median OS time of cyclin D1-negative patients was 62 months and PFS time was 30 months. The median OS time of cyclin D1-positive patients was 48 months and PFS time was 22 months. The median OS time of cyclin D1-negative patients was significantly different from that of cyclin D1-positive patients (χ(2)=4.71, P=0.03), while the median PFS time of cyclin D1-negative patients was marginally different from that of cyclin D1-positive patients (χ(2)=0.59, P=0.41). Multivariate analysis showed that the expression of Pax2 was an independent factor of the prognosis for patients with ovarian serous adenocarcinoma (RR=0.597, 95% CI 0.371-0.962, P<0.034). Conclusion: The expressions of Pax2 and cyclin D1 are associated with the prognosis of patients with advanced ovarian serous adenocarcinoma while Pax2 is an independent prognostic factor.

[Comparison between continuous noninvasive hemoglobin monitoring and venous blood hemoglobin monitoring in children with kidney disease]

OBJECTIVE

To assess the correlation and consistency between continuous noninvasive hemoglobin detection and venous blood hemoglobin detection in children with kidney disease, and try to analyze the affecting factors. Try to provide a reference for the monitoring of hemoglobin in children with kidney disease by continuous noninvasive hemoglobin detection technique.

METHODS

Eighty-five inpatient children with kidney disease, 50 boys (58.8%) and 35 girls (41.2%), aged from 3 years old to 18 years old (9.35±4.29) were included finally. Noninvasive hemoglobin monitoring by spectrophotometry (SpHb) was stably read by PRONTO-7, selecting the ring finger of the non handedness as the detection site. And then the venous blood hemoglobin of the same patient was collected in 5 minutes as the true hemoglobin (tHb) by Beckman coulter DXH-800. The data of SpHb and tHb were compared and analyzed using SPSS 17.0 and MedCalc.

RESULTS

Correlation analysis showed data of SpHb and tHb were with significant correlation, the correlation coefficient between SpHb and tHb was 0.85 (P<0.05). Bland-Altman plot points suggested that the mean of differences between SpHb and tHb was -1.3 g/dL. The 95% CI of agreement of SpHb-tHb was -4.2-1.5 g/dL, suggesting that the average measurement result of SpHb was lower than that of tHb. The mean of differences as percent between SpHb and tHb was -9.8%, 95% CI of agreement was (-35.9%, 16.2%) exceeding the acceptable range of true value ±6%. The consistent rate of non-invasive hemoglobin detection and venous blood hemoglobin detection was 31.8%, the 95% CI of consistent rate was (21.7%, 41.9%). The chi square test of the fourfold table showed that the diagnosis of anemia with SpHb was of high sensitivity, but the specificity was low, the false positive rate was high, and the difference was statistically significant (P=0.000).

CONCLUSION

There was a significant correlation between SpHb and tHb in the children with kidney disease. Noninvasive hemoglobin measurement can be used for monitoring of changes of hemoglobin in children with kidney diseases. But the consistency between SpHb and tHb needs to be improved. Noninvasive hemoglobin measurement could not replace the venous hemoglobin measurement. It could not be used for the diagnosis of anemia, and the accuracy of hemoglobin concentration measurement in children with kidney disease should be further explored.

[Cause analysis of spinal surgery in ankylosing spondylitis]

OBJECTIVE

To investigate the common cause of spinal surgery in ankylosing spondylitis (AS) and to develop reasonable and effective treatment programs for rhematologists.

METHODS

In this study, 79 AS patients (72 males, 7 females) hospitalized in the Department of Orthopedic and received spinal surgery in Peking University Third Hospital from January 2007 to July 2013 were investigated retrospectively. The causes of the spinal surgery were analyzed.

RESULTS

The majority of the surgery were of cervical vertebra surgery for 59 cases (74.7%), followed by the thoracolumbar vertebra, thoracic vertebra, cervicothoracic vertebra, and lumbar vertebra. The common causes of AS spinal surgery were instability (53.2%) including fracture and dislocation caused by trauma mostly, followed by compression symptoms (34.1%). However, the orthopaedic surgery (12.7%) was not the predominant surgery causes. The most common cause of cervical surgery was cervical spondylosis (25 cases), followed by cervical fracture (22 cases) and cervical dislocation (10 cases). For cervical fracture, the most common site was C7 (8 cases). Atlanto-axial vertebral lesions (13 cases) induced by dislocation, subluxation, instability and fracture were common in cervical vertebra surgery. The age and disease duration of atlantoaxial surgical patient's were less than other parts of the cervical surgery. Thoracolumbar vertebra surgery included thoracolumbar kyphosis orthopaedic surgery (10 cases), and fractures (6 cases), which mainly occurred in T11-12 vertebrae. According to the time of admission for surgery, the cases of AS that received spinal surgery were 34 from 2007 to 2008. The number of the cases that accepted the surgery decreased gradually year by year.

CONCLUSION

The majority surgery section was cervical vertebra, and atlanto-axial vertebral lesions were not rare as we thought. The main etiology of spinal surgery for AS patients was instability, e.g. fracture and compression symptoms. Of course, trauma accounted for the relative percentage of this phetonomenon. Although, the annual number of patients who receives spinal surgery is decreasing, to go to make early diagnosis and treatment, and to standardize patient education for AS patients are still important.

[Clinical characteristics of glucocorticoid-induced eye adverse reactions in children with primary nephrotic syndrome]

OBJECTIVE

To investigate the clinical features and side effects, with regard to glucocorticoid-induced ocular hypertension, glaucoma or cataract in children with primary nephrotic syndrome.

METHODS

Clinical data were collected and analyzed from 71 cases of primary nephrotic syndrome with glucocorticoid-induced ocular hypertension, glaucoma or cataract from Jun. 2014 to Jun. 2016. These children were hospitalized in Peking University First Hospital.

RESULTS

Totally 1 580 children with primary nephrotic syndrome were collected, glucocorticoid-induced complications in eyes were found in 71 cases, and the incidence was 4.5%. There were 66 cases with ocular hypertension, 2 cases with glucocorticoid glaucoma, 2 cases with glucocorticoid glaucoma combined with cataract, 1 case with high intraocular pressure combined with cataract. There were 41 boys and 30 girls with eye-related side effects caused by glucocorticoid. The average age of onset of glucocorticoid-induced eye adverse reactions in children with primary nephrotic syndrome in our research were 8 (2, 16) years. The average duration or interval time from glucocorticoid medication use to eye adverse effects was 157 (6, 420) days. No statistical significance was found in intraocular pressure between different genders, types of glucocorticoid, different route of glucocorticoid and whether methylprednisolone pulse treatment (P>0.05). There was no significant correlation between age, body mass index, blood pressure, cumulative dosage, duration time of glucocorticoid, mean daily dosage and glucocorticoid-induced ocular hypertension (P>0.05). The ocular hypertension was controlled after treatment.

CONCLUSION

Children with nephrotic syndrome after treatment of glucocorticoid are susceptible to ocular complications, and the occurrence of ocular hypertension is closely related to glucocorticoid susceptibility of the nephrotic children. Regular eye monitor is indispensable for the children suffering from primary nephrotic syndrome.

[Quality of case report of Japanese Encephalitis after the establishment of surveillance on acute meningitis and encephalitis syndrome in Baoji]

Objective: To evaluate the quality of Japanese Encephalitis (JE) case reports based on the establishment of surveillance on acute meningitis and encephalitis syndrome (AMES) in Baoji. Methods: A surveillance network on AMES cases was set up in Baoji city of Shaanxi province between July 2013 and December 2016. All the cases met the surveillance definition of AMES cases were conducted a questionnaire, collected serum and/or cerebrospinal fluid (CSF) specimens to test JE immunoglobulin M antibodies by using enzyme-linkedimmunosorbent assay methods.The information of the incidence of JE in Shaanxi and Baoji from 2009 to 2016 originated from the China information system for disease control and prevention. Chi square test was used to compare the difference in JE incidence in Baoji, Shaanxi before and after the implementation of AMES monitoring project. Results: 75 out of 855 collected cases were laboratory confirmed as JE, Including 42 suspected JE cases and 33 other suspected cases diagnosed after hospitalization. Except 1 case occurring in December, all the other cases occurred between July and October, especially in August with a peak of 55 cases (73.3%), and 6 cases (8.0%) in July, 11 cases (14.7%) in September, 2 cases (2.7%) in October. The proportion of patients aging 0-6, 7-14 and ≥15 years old were respectively 4.0% (3 cases), 8.0% (6 cases) and 88.0% (66 cases). The biochemical test showed the cerebrospinal fluid in 13 cases (17.3%) were slightly turbid, the white blood cell in 31 cases (41.3%) elevated, the glucose levels in 24 cases (32.0%) were abnormal, and the chloride level in 23 cases (30.7%) were abnormal. A total of 103 cases of JE were diagnosed in Baoji from 2009 to 2016, with an average annual incidence rate at 0.34/100 000. The average incidence of JE in 2009-2012 and 2013-2016 was 0.21/100 000 and 0.48/100 000 respectively. From 2013 to 2016, the proportion of JE cases in Baoji, Shaanxi was 19.3% (71/369), and it was 8.9% (32/362) between 2009 and 2012 (χ(2)=4.15, P=0.040). Conclusion: The AMES surveillance project improved the quality of the JE case report in Baoji. Changes appeared in biochemistrical and epidemiological characteristics of cerebrospinal fluid. The incidence of JE was seriously underestimated in Shaanxi province and therefore the sensitivity of Japanese encephalitis surveillance cases should be further improved.

[Interaction between family history of diabetes and hyperlipidemia on risk of diabetes in population with normotension in Harbin: a cross-sectional study]

Objective: To explore the interaction between family history of diabetes and hyperlipidemia on the risk of diabetes in population with normotension. Methods: A multistage stratified probability random sampling was conducted to select a representative sample of urban residents aged 20-74 years in Harbin. A total of 376 diabetes patients with normotension and 3 692 residents with normal blood pressure, normal fasting glucose, and normal 2 hours glucose from OGTT were surveyed. The interaction was evaluated by using crossover analysis and additive model. Results: Multivariate logistic regression analysis indicated that there was a possible additive interaction between family history of diabetes and hyperlipidemia on the risk of diabetes. The relative excess risk due to the interaction, the attributable proportion due to the interaction, and the synergy index were 1.97 (95%CI:-0.32-4.26), 0.30 (95%CI: 0.03-0.57), and 1.54 (95%CI: 0.96-2.47), respectively. There were significant combination effects between family history of diabetes and high both total cholesterol and triglyceride, isolated high total cholesterol, and isolated high triglyceride levels; the ORs were 10.55 (95%CI: 5.62-19.80), 7.81 (95%CI: 3.65-16.71) and 5.13 (95%CI: 3.22-8.16), respectively. Conclusion: There might be synergistic effect between family history of diabetes and hyperlipidemia on the risk of diabetes in population with normotension.

[Refractory kaposiform hemangioendothelioma with Kasabach-Merritt syndrome: clinical analysis of 10 cases]

Objective: To analyze the clinical value of sirolimus plus prednisone for the treatment of the refractory kaposiform hemangioendothelioma(RKHE) and Kasabach-Merritt syndrome(KMS). Method: Clinical retrospective analysis was carried out for 10 patients recruited in Children's Hospital Affiliated to Capital Institute of Paediatrics from January 2014 to January 2017 who were non responders to or relapsers after the treatment of propranolol, prednisone, pingyangmycin and lauromacrogol(5 cases RKHE, 5 cases RKHE plus KMS, age ranged from 6 days to 9 years); patients were treated with sirolimus at the dosage of 0.035 ml/(kg·d), once a day, for 6-410 days; the diagnosis of 10 patients were confirmed by pathological biopsy and immunohistochemical examination(IHC); the difference of the coagulation parameters and the platelet counts, the size of tumor and ecchymosis at different stages of treatment were recorded and measured by scale and ultrasonography; the side effects of sirolimus were recorded as well. Result: Clinical characteristics of 10 cases (6 male and 4 female) RKHE with KMS were refractory dark red hard hemangioma or ecchymosis, the platelet counts were lower than 30.0×10(9)/L, (15±7)×10(9)/L, coagulation tests were obviously abnormal, fibrinogens were significantly decreased(0.8±0.5)g/L, the fibrin lysates and D-dimer were significantly increased(100±23)mg/L, (10 000±2 200)ng/L, the prothrombin time and activated partial thromboplastin time were prolonged(25.0±2.1)s, (58.0±3.4)s. The pathologic characteristics of the tumors were similar: spindle tumor cells, mass distribution and deeply stained nuclei tumor cells. IHC revealed positive staining for D2-40, CD31 and CD34. Stainings for factor Ⅷ and GLUT-1 were negative. In five cases RKHE plus KMS were treated with sirolimus and prednisone, after (6.5±0.7) days treatment, the platelet counts were obviously increased(72.0±0.6)×10(9)/L, coagulation parameters were obviously improved, fibrinogen significantly increased(1.5±0.2)g/L, the fibrinlysates and D-dimer significantly decreased(7±3)mg/L, (2 300±200)ng/L, the prothrombin time and activated partial thromboplastin time were prolonged(15±2.3)s, (42±3.4) s, and the sizes of tumor and ecchymosis were slightly shrunken 18%±3%, 38%±5%; after (30±5.7) days treatment, the platelet counts and coagulation parameters returned to normal(146±36)×10(9)/L, and the size of tumor and ecchymosis were obviously shrunken 73%±3%, 97%±3%; after (3±0.4) months treatment, the tumor was obviously shrunken by 93%±2% and no longer palpable. In five cases with RKHE without KMS manifested stubborn dark red hard hemangiomatous plaques, coagulation tests and platelet were obviously normal, these patients were treated with sirolimus, after (2.0±0.6) months treatment, the tumor became shrunken 8%±3%, with continuous treatment the tumor shrunk gradually, after (4.0±3.2)months(2-18 mouths) the tumor was not eliminated 51%±7%. Conclusion: RKHE and KMS have typical clinical, laboratory and pathological characteristics, sirolimus plus prednisone have remarkable efficacy and minor side effects, it should be recommended for the treatment of KHE with KMS.

[Expression of CXCL16/CXCR6 in fibroblast-like synoviocytes in rheumatoid arthritis and its role in synoviocyte proliferation]

OBJECTIVE

It has been found that serum CXCL16 concentration in rheumatoid arthritis (RA) patients are significantly higher than those in osteoarthritis (OA) and normal subjects, and are positively correlated with disease activity and bone erosion. However, how is CXCL16 involved in the pathogenesis of RA is unclear. To evaluate the expression of CXCL16 and its receptor CXCR6 in fibroblast-like synoviocytes (FLS) of rheumatoid arthritis (RA) patients, and to explore the role of CXCL16 in the proliferation of RA-FLS.

METHODS

FLS were isolated from knee synovial tissues obtained from 8 patients of RA, 7 osteoarthritis (OA) and 3 normal controls. The diagnosis of RA was in line with the 1987 American Rheumatology Association (ACR) RA classification criteria, osteoarthritis met the 1996 ACR revised knee osteoarthritis classification criteria. Control synovium were obtained from trauma caused knee joint injury in healthy individuals who required surgery. Human knee FLS were cultured by tissue explants adherent method.FLS between passages 3 and 5 were used in the experiment. Expression of CXCL16 and its receptor CXCR6 were performed in Western blot analysis. FLS proliferation following stimulation with TNF-α and different concentrations of CXCL16 was examined by cell counting kit-8 (CCK-8). Expression of phosphorylated AKT (pAKT) in RA-FLS stimulated by CXCL16 was quantified by Western blot. Different concentrations of recombinant human CXCL16 were added to the culture medium of RA-FLS. After 48 h culture, supernantants were collected, and TNF-α, IL-6, RANKL and MMP3 in culture supernatants of RA-FLS were determined by enzyme-linked immunosorbent assays (ELISA) operated following the kit instructions.

RESULTS

Expression of CXCL16 and CXCR6 in RA-FLS was significantly higher than that of OA and controls (P<0.05), but no significant difference was found between OA-FLS and control FLS. Proliferation of RA-FLS was markedly up-regulated after stimulation of CXCL16 (P <0.05). In the case of the CXCL16 stimulated OA-FLS and control FLS, the FLS proliferation remained basically unchanged. Expression of phosphorylated AKT in RA-FLS increased remarkably in condition of CXCL16 (50,100, 200 μg/L) stimulation. The levels of IL-6 and RANKL in culture supernatants of RA-FLS were obviously increased under CXCL16 (200 μ g/L) stimulation, while TNF-α and MMP-3 levels in the culture supernatants remained unchanged after CXCL16 (200 μg/L) stimulation.

CONCLUSION

This study shows that the expression of CXCL16 and its receptor was highly elevated in RA-FLS. Recombinant CXCL16 promoted RA-FLS proliferation and activation in vitro. All these indicate that CXCL16 play an important role in the pathogenesis of RA, anti-CXCL16 treatment may help to relieve inflammation and bone damage of RA patients. However, due to the limitations of this study, the role of CXCL16 and its receptors in RA-FLS remains to be elucidated by further research.

Comparisons of magnetic charge and axial charge meson cloud distributions in the PCQM

The meson cloud distributions in r-space are extracted from the nucleon electromagnetic and axial form factors which are derived in the perturbative chiral quark model. The theoretical results indicate that the magnetic charge and axial charge distributions of the three-quark core have the similar distributions in r-space, the magnetic charge distributions of the meson cloud and three-quark core are more or less in the same region and peak at distances of around 0.4 fm, which is in good agreement with the finding of works in the framework of chiral perturbation theory, but the axial charge meson cloud distributes mainly inside the three-quark core.

[Clinical characteristics of bronchopulmonary foregut malformation]

Objective: To analyze the clinical characteristics, diagnosis and treatment of bronchopulmonary foregut malformation(BPFM). Method: The clinical manifestations, imaging findings and treatment of 8 patients with BPFM were analyzed retrospectively from January 2006 to May 2016 in Beijing Children's Hospital. Result: The age of children varied from 2 months to 7 years and 3 children were male while 5 female. Symptoms showed cough in 6 cases, fever in 4 cases, bucking when intaking of fluids or foods in 3 cases, tachypnea in 1 case, wheezing in 1 case, vomiting in 1 case, haematemesis in 1 case Pulmonary signs were decreased breath sounds in 4 cases, phlegm rale in 3 cases, shortness of breath in 2 cases, wheeze in 1 case, and retraction in 1 case. The upper gastrointestinal series showed abnormal fistulous tracts arising from the esophagus or the gastric fundus and extending into the mass in the lung. CT showed pulmonary sequestration and prompted the tube between lung and esophagus. Six children underwent pneumonectomy and esophageal fistula repair. They were discharged and their symptoms were improved. Two cases of children were discharged from a hospital without surgery. Conclusion: Bronchopulmonary foregut malformation usually has its onset in early stage of life. The most common symptoms include recurrent pneumonia or bucking when intaking of fluids or foods. CT can demonstrate the bronchopulmonary sequestration and evaluate the communication with the gastrointestinal tract. The upper gastrointestinal series can demonstrate the abnormal tract directly. Pneumonectomy and esophageal fistula repair are the treatment of this disease.

[The effect of transforming growth factor β(1) in the transition of bone marrow-derived macrophages into myofibroblasts during renal fibrosis]

To study which subgroup of bone marrow derived cells formed myofibroblasts and the mechanism that transforming growth factor β(1)(TGFβ(1)) regulates the formation of bone marrow derived macrophages into myofibroblasts during renal fibrosis. Chimeric mice were generated by lethally irradiation of C57 mice followed by transfusion of green fluorescent protein (GFP) labeled bone marrow cells. Complete marrow reconstitution was developed until 12 weeks after transplantation. The mice were randomly divided into Sham operation group, unilateral ureteral obstruction (UUO) 3 days group, UUO5 days group, UUO7 days group and UUO7 with TGFβ(1) treatment group. Each group had four mice. Flow cytometry was used to evaluate cell components. Compared with Sham operation group the proportions of GFP(+) CD(14)(+)α-smooth muscle actin(α-SMA)(+) cells, GFP+ CD(44)(+)CD(105)(+)α-SMA(+) cells and GFP(+) F4/80(+) α-SMA(+) cells in each UUO group were progressively increased and the transformation rate in UUO7 day group was the highest. The GFP(+) F4/80(+) α-SMA(+) cells accounted for the largest population. TGFβ(1) promoted the transformation of bone marrow derived macrophages into myofibroblasts. Compared with Sham operation group or UUO7 day group, the proportion of GFP(+) F4/80(+) α-SMA(+) cells increased in UUO7 day TGFβ(1) treatment group. Compared with Sham operation group (or UUO7 days group) the protein expressions of F4/80, α-SMA, Collagen Ⅰ increased in UUO7 with TGFβ(1) group. Bone marrow derived macrophages are considered as the main type of myofibroblast precursors during the development of renal fibrosis. TGFβ(1) regulates the transformation of bone marrow-derived macrophages into myofibroblasts. This process contributes to progressive renal fibrosis and deterioration of renal function.

The isolation and functional characterization of three liverwort genes encoding cinnamate 4-hydroxylase

The plant phenylpropanoid pathway is responsible for the synthesis of a wide variety of secondary metabolites. The second step in phenylpropanoid synthesis is carried out by the cytochrome P450 monooxygenase enzyme cinnamate 4-hydroxylase (C4H), which catalyzes the p-hydroxylation of trans-cinnamic acid to p-coumarate. Genes encoding C4H have been characterized in many vascular plant species, but as yet not in any bryophyte species. Here, a survey of the transcriptome sequences of four liverwort species was able to identify eight putative C4Hs. The three liverwort C4H genes taken forward for isolation and functional characterization were harbored by Plagiochasma appendiculatum (PaC4H) and Marchantia paleacea (MpC4H1 and MpC4H2). When the genes were heterologously expressed in yeast culture, an assay of enzyme activity indicated that PaC4H and MpC4H1 had a higher level of activity than MpC4H2. The favored substrate (trans-cinnamic acid) of all three liverwort C4Hs was the same as that of higher plant C4Hs. The co-expression of PaC4H in yeast cells harboring PaPAL (a P. appendiculatum ene encoding phenylalanine ammonia lyase) allowed the conversion of L-phenylalanine to p-coumaric acid. Furthermore, the expression level of PaC4H was enhanced after treatment with abiotic stress inducers UV irradiation or salicylic acid in the thallus of P. appendiculatum. The likelihood is that high activity C4Hs evolved in the liverworts and have remained highly conserved across the plant kingdom.

[Clinical and genetic characteristics and detection of urinary pipecolic acid in pyridoxine dependent epilepsy]

OBJECTIVE

To analyze the clinical and genetic characteristics of patients with pyridoxine dependent epilepsy (PDE), and build a method to detect and analyze the concentration of urinary pipecolic acid in PDE patients receiving pyridoxine treatment.

METHOD

Twelve patients (8 were male, 4 were female) were diagnosed as PDE in Peking University First Hospital between April 2012 and September 2015. The clinical manifestations, diagnosis and treatment process, video-electroencephalogram, magnetic resonance imaging were retrospectively analyzed. ALDH7A1 gene was detected using Sanger sequencing or targeted next-generation sequencing. The concentration of urinary pipecolic acid in PDE patients was detected with gas chromatography-mass spectrometry (GC-MS), as well as in some non-PDE children served as normal control. All controls, 58 cases totally, were neonates born in our hospital or children came to our hospital for reasons such as syncope (without disturbing pipecolic acid metabolism) from November 2015 to January 2016. Of them, 25 were ≤6 months old(14 were male, 11 were female), 33 were >6 months old(14 were male, 19 were female). The Student's t-test or Mann-Whitney U test was used for comparing the pipecolic acid between the two groups. Correlation analysis was conducted using Pearson or Spearman test.

RESULT

Of the 12 patients, seven of them were abnormal at birth. The age of epilepsy onset was from 5 h to 5 months, within 10 d in 8 patients. After a diagnostic delay time of 15 d to 20 months, seizures in all patients were controlled by pyridoxine monotherapy, at a dose of higher than 10.0 mg/(kg·d) in 10 patients, and 8.5 and 2.5 mg/(kg·d) in the other 2 patients respectively. The range of maintenance dose was 2.5-20.0 mg/(kg·d) during the follow up. Interictal electroencephalogram showed nonspecific abnormality in 10, normal in 2. Brain magnetic resonance imaging showed nonspecific abnormality in 7, normal in 5. ALDH7A1 mutations were found in all patients, including 15 different mutation sites, four of which were never reported before. Splicing mutation IVS11+ 1G>A was carried in 6 patients, with a frequency of 25% (6/24). At the last follow-up, eleven patients were in various degree of psychomotor development delay, including the 4 patients with severe delay in whom birth abnormalities presented, and no significant delay was found in one patient. The concentration of urinary pipecolic acid in control: age ≤6 months, median 8.47 (0.46-35.33) mmol/mol creatinine; age >6 months, median 0.66 (0.12-3.52) mmol/mol creatinine. The concentration of urinary pipecolic acid was different between two groups of control (Z=-5.464, P<0.01). Twelve patients were all older than 6 months when they were tested, and the concentration was only mildly elevated in one patient, the range of 12 patients was 0.14-4.08 mmol/mol creatinine. The concentration was not significantly different between the control with age >6 months and our PDE patients (Z=-0.655, P>0.05). There were no significant correlations between the concentration of urinary pipecolic acid and the initial dose or maintenance dose at last follow-up of pyridoxine (r=0.418 and 0.166, P=0.176 and 0.607).

CONCLUSION

Seizures start in early infancy in most PDE patients. The splicing mutation IVS11+ 1G>A is supposed to be a probable"hotspot"mutation with a high frequency in Chinese PDE patients. Most patients have different levels of psychomotor development delay after seizures are controlled, and the patients with birth abnormalities may have worse outcomes. No relationships between the diagnostic delay time and the development outcome are found. The concentration of urinary pipecolic acid can return to normal during treatment with pyridoxine.

[Solitary fibrous tumor/hemangiopericytoma of central nervous system: a clinicopathologic analysis of 71 cases]

Objective: As solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) share the same molecular genetics features, the 2016 WHO classification of central nervous system (CNS) tumors had created the combined term SFT/HPC and assigns three grades. This study aims to investigate the clinicopathologic characteristics, diagnosis, differential diagnosis and prognosis of CNS SFT/HPC. Methods: Seventy-one cases of CNS SFT and HPC were retrospectively reclassified and studied. Histopathological, immunohistochemical and imaging features were analyzed. The follow-up data were analyzed. Results: There were 37 male and 34 female patients. The median age was 48 years (range, 3-77 years). Twelve cases (17%) were WHO grade Ⅰ, 26 (37%) were WHO grade Ⅱ and 33 (46%) were WHO grade Ⅲ. Microscopically the tumor could show traditional SFT phenotype, HPC phenotype or mixed phenotype. Immunochemically, 97%(69/71) were positive for STAT6, with 96%(66/69)showing diffuse strong staining. Approximately 90% were diffusely positive for bcl-2, CD99 and vimentin. The expression rate of CD34 decreased with increasing tumor grade, and the mean expression rate was 78%. SSTR2a was variably expressed in 10% (7/71) of cases including one case showing strong cytoplasmic staining. A few cases expressed EMA, CD57 and S-100 focally. The Ki-67 index ranged from 1% to 50%. Thirty four patients were followed up for 8-130 months; 12 patients(35%)had recurrences, and two (6%) had liver metastases. Conclusions: CNS SFT/HPC is relatively uncommon. There was significant morphological overlap or transition between different grades. STAT6 is a specific marker for the diagnosis of this tumor. Surgical resection is the preferred treatment. WHO grade Ⅱ and Ⅲ SFT/HPC show rates of local recurrence and systemic metastasis, with liver being the most common site of extracranial metastasis.

[Comparison of paired box genes 8 and 2 expression in epithelium tissues and the related tumors]

Objective: To explore the expressional differences between paired box genes 2(Pax2) and 8 (Pax8) protein in different kinds of epitheliums and tumors, and to investigate the clinicopathologic significance. Methods: Expression levels of Pax2 and Pax8 protein were detected in 75 cases of different human epithelium tissues and 255 cases of different tumors on tissue microarray by immunohistochemistry. Results: Pax2 and Pax8 selectively expressed in different tissues. The positive rates of Pax8 protein expressed in the normal epithelium of the thyroid, urinary system and female reproductive system were 100% (2/2), 60.0% (3/5) and 76.9% (10/13), respectively. The positive rates of Pax2 expressed in the epithelium tissues of urinary system and the female reproductive system were 40.0% (2/5) and 38.5% (5/13) respectively. However, the expression of Pax2 protein was not detected in the normal thyroid epithelium. The positive rate of Pax8 protein expressing in the epithelium of reproductive system was significantly higher than that of Pax2 protein (P<0.05). The tumors derived from different tissues also expressed different levels of protein Pax2 and Pax8. The positive rates of Pax8 in renal cell carcinoma, thyroid carcinoma and endometrial adenocarcinoma were 65.2% (15/23), 66.7% (10/15) and 80.0% (4/5), respectively. The positive rates of Pax2 in renal cell carcinoma, thyroid carcinoma and endometrial adenocarcinoma were 34.8% (8/23), 13.3% (2/15) and 20.0% (1/5), respectively. The positive rates of Pax8 protein expressed in renal cell carcinoma, thyroid carcinoma and endometrial adenocarcinoma were significantly higher than those of Pax2 protein (P<0.05). The positive rates of Pax8 in ovarian serous carcinoma, endometrial carcinoma and clear cell carcinoma were 92.9% (26/28), 81.8% (9/11) and 82.4% (14/17), respectively. The positive rates of Pax2 in ovarian serous carcinoma, endometrial carcinoma and clear cell carcinoma were 28.6% (8/28), 9.1% (1/11) and 17.6% (3/17), respectively. The positive rates of Pax8 protein expressed in ovarian serous carcinoma, endometrial carcinoma and clear cell carcinomawere significantly higher than those of Pax2 protein (P<0.05). Conclusions: Pax2 and Pax8 are specifically expressed in female reproductive system and uritany system. However, the positive expression of Pax8 is superior to that of Pax2. The combined expression of Pax8 and Pax2 can be used in the differential diagnosis of epithelial tumors derived from different origins.

[Clinical features and gene mutations in epilepsy of infancy with migrating focal seizures]

Objective: To summarize the clinical features and gene mutations of epilepsy of infancy with migrating focal seizures (EIMFS). Method: Clinical features and electroencephalograms(EEG)of 9 patients with EIMFS of Peking University First Hospital from May 2015 to January 2016 were analyzed. Candidate gene mutations were screened by next generation sequencing. Result: Among the 9 patients, 3 were males and 6 were females. Two patients had family history. Seizure onset age was 2 days to 3 months after birth (median age 35 days). Migrating focal seizure was presented. Seizures manifested as eyes and(or)head deviation, involuntary blinking, swallowing, trembling or stiffness of limbs, hand clenching, flushing and cyanosis of lips, etc. Four patients had a history of status epilepticus. All 9 patients had psychomotor delay. EEG of all patients presented relatively slow background; during interictal phase, there were multi-focal epileptic discharges, which dominated one hemisphere or brain region; seizures were recorded in all 9 cases, which manifested eyes or(and)head deviation, stiffening or trembling of limbs, lip smacking, etc. Corresponding EEG showed low-medium-amplitude fast waves that originated from some brain regions and migrated to other regions. Cranial magnetic resonance imaging (MRI) was abnormal in 4 cases, which predominantly showed white matter dysplasia and enlargement of subarachnoid spaces. Two cases carried heterozygous missense mutations of SCN1A gene, while 3 cases carried heterozygous missense mutations of KCNT1 gene, all of which were de novo. One case carried compound heterozygous mutation of TBC1D24 gene(p.Gln207*, p. Ala289Va). Gene mutation was not found in 3 cases. All patients used multiple antiepileptic drugs (AED) and their seizures were not controlled. Follow-up ranged from 2 months to 5 years and 8 months, during which 4 were found dead. Two were lost to follow-up. Conclusion: EIMFS is clinically characterized by early onset, which is usually within 3 months after birth, migrating focal seizures, psychomotor delay, bad response to AED and high death rate. The interictal EEG showed multi-focal discharges, while ictal EEG shows migrating multifocal discharges. Genetic analysis can assist in diagnosis and genetic counseling.

[Feasibility of using amplitude-integrated electroencephalogram to identify epileptic seizures by pediatric intensive care unit medical staff independently]

Objective: To evaluate the feasibility of using amplitude-integrated electroencephalogram (aEEG) to identify epileptic seizures by physicians and nurses in pediatric intensive care unit (PICU) independently. Method: Six testees (two PICU physicians versus one EEG physician and two PICU nurses versus one EEG technician) accepted a short-term training, then interpreted aEEG in a single blinded way. These aEEG recordings with synchronous VEEG monitoring were done from January 2013 to May 2015 in PICU. The testees should recognize and mark both the seizure type and the seizure duration from the two-channel recorder (C3/C4) of aEEG (short-term seizure or status epilepticus (SE)). Using raw VEEG monitoring as a gold standard to determine a seizure, the accuracy, missing and error rate of each testees were confirmed, and the reasons of the latter two situations were analyzed by rank sum test and inter-testee agreement (k) . Result: Eighty-two aEEG recordings from 56 patients were interpreted. Thirty-two recordings had 141 epileptic seizures confirmed by VEEG, including 119 short-term seizures and 22 SE. There were 50 recordings without seizure. As for the short-term seizures, the average accuracy of 6 testees by aEEG alone was (66±4)%. The accuracy for SE was 100% in three testees and 95% in the other three. Missing rate of the seizures were 24.1%-32.6% in all 6 testees. Those missed seizures were all short-term (duration less than 20 seconds) but one SE. The average error rate was (19±9) times (P=0.000). These false interpretations were misunderstanding, many kinds of artifacts were regarded as epileptic seizures. The accuracy and missing rate among the testees had no significance(P=0.930, 0.996), but the error rate had(P=0.000). The inter-testee agreement (k) between two physicians in PICU and the EEG doctor were 0.700 and 0.687 respectively (P<0.01), which is good. As for two nurses and the EEG technician, the inter-testee agreement (k) was 0.705 and 0.396 respectively (P<0.01). Conclusion: Most of the seizures especially status epilepticus can be detected by PICU staff after short term training. The accuracy of identification of epileptic seizures was similar among observers from PICU and EEG, although some short-term seizures may be missed, and artifacts are mistaken.It's necessary to communicate with EEG doctors and compare with the row VEEG when physicians in PICU find suspicious events.

Aggravated nausea and vomiting induced by fat emulsion for hyperemesis gravidarum: A case report

WHAT IS KNOWN AND OBJECTIVE

Total parental nutrition (TPN) for hyperemesis gravidarum (HG) is generally effective and well-tolerated. We report a case of aggravated nausea and vomiting caused by fat emulsion.

CASE DESCRIPTION

A 40-year-old pregnant woman through IVF was admitted to the hospital at 11-week gestation and diagnosed with HG. During TPN treatment, the patient suffered from aggravated nausea and vomiting. We identified fat emulsion as the most likely culprit using challenge, dechallenge and rechallenge.

WHAT IS NEW AND CONCLUSION

This is the first report of fat emulsion aggravating nausea and vomiting in such situation.

[Distribution of electroencephalograph power density in patients with severe obstructive sleep apnea during different sleep stages]

Objective: To investigate the variation of electroencephalograph(EEG) power density during different sleep stages in OSA for understanding of the mechanisms underlying the brain dysfunction in OSA as well as its earlier diagnosis and treatment. Methods: Sixteen-channel EEGs from OSA patients and normal controls in stage wake, sleep stage 1, sleep stage 2, sleep stage 3 and rapid eye movement stage were analyzed by time-frequency analysis method. The EEG power density in different frequency bands (including δ, θ, α, σ, β and γ) was respectively compared between the 2 groups. The correlation between the variation in the EEG power and primary indices of polysomnography was further analyzed. Results: The EEG power density in δ band in stage wake [OSA: (0.82±0.13) μV(2)/Hz, Control: (0.66±0.02) μV(2)/Hz, t=4.309, P<0.05], stage 1 [OSA: (1.28±0.07) μV(2)/Hz, Control: (0.92±0.04) μV(2)/Hz, t=-3.369, P<0.05] and stage 3 [OSA: (2.74±0.22) μV(2)/Hz, Control: (2.04±0.07) μV(2)/Hz, t=-2.669, P<0.05] was significantly higher in OSA, compared with that in the control. Statistical analysis showed that the EEG power density was significantly higher in frontal and central regions in stage wake [frontal: OSA: (0.90±0.02) μV(2)/Hz, Control: (0.66±0.02) μV(2)/Hz, t=8.539, P<0.01; central: OSA: (1.15±0.06) μV(2)/Hz, Control: (0.72±0.02) μV(2)/Hz, t=6.669, P<0.01] and stage 1 [frontal: OSA: (1.23±0.03) μV(2)/Hz, Control: (0.99±0.03) μV(2)/Hz, t=5.983, P<0.01; central: OSA: (1.52±0.05) μV(2)/Hz, Control: (1.14±0.04) μV(2)/Hz, t=5.714, P<0.01], as well as central region in stage 3 [OSA: (3.24±0.17) μV(2)/Hz, Control: (2.71±0.08) μV(2)/Hz, t=2.707, P<0.05]. The correlation analysis showed that the power density in central region in stage 1 and stage 3 was positively correlated with arousal index (r=0.877 in stage 1, 0.656 in stage 3), implying that sleep fragmentation was closely related to the variation of EEG power density during nocturnal sleep in OSA. Conclusions: The feature stages for OSA are stage wake, stage 1 and stage 3. The EEG power density in OSA (δ band) was significantly higher than that in the control. The EEG power density in OSA and the control shows differences in frontal and central regions in stage wake and stage 1, as well as in central region in stage 3. The results indicate that low-frequency EEG power density giving priority to frontal area and central area has improved in severe OSA, which may be related to the neurologic deficits in corresponding brain areas.

[Clinical and neuroimaging features of acute encephalopathy after status epilepticus in Dravet syndrome]

Objective: To investigate the clinical and neuroimaging characteristics of acute encephalopathy (AE) after status epilepticus (SE) of patients with Dravet syndrome (DS). Method: The clinical data of DS patients who had AE (coma ≥24 h) after SE were retrospectively collected from February 2005 to August 2016 in Peking University First Hospital and SCN1A gene tests were performed.The clinical and neuroimaging features were summarized. Result: Twenty-two patients (9 males and 13 females) with AE were collected among 412 DS patients during follow-up.Of which 18 patients had SCN1A gene mutations while the remaining 4 patients had no SCN1A gene mutations.The onset age of AE was between 6 months and 10 years.The duration of SE varied between 40 minutes and 9 hours.Prior to the onset of SE, twenty-one patients had high fever, and one patient had normal temperature.Coma lasted from 2 days to 20 days.Nine patients died after the AE, and 13 patients survived with massive neurological regression.From AE to the last visit, the median time of follow-up was 2 years and 3 months (from 7 months to 4 years and 4 months). Nine of 13 survivors had varied improvement in motor, language and cognition, while the remaining 4 patients had no significant improvement.After AE, there were 6 patients with seizure-free, 4 patients with reduced seizures, and 3 patients with no change in seizure frequency, moreover, spasm occurred in 2 patients.Six patients had brain magnetic resonance imaging (MRI) in acute phase and showed bilateral (2 patients) or unilateral (4 patients) hemisphere edema, accompanied by subcortical white matter hyperintense signal in T1 and T2 weighted images in two patients.The neuroimaging of 13 survivors demonstrated diverse cortical atrophy during recovery phase, among which 4 patients showed cerebellar atrophy, one patient had right pontine atrophy, 4 patients accompanied by signal abnormalities in subcortical and periventricular white matter, 2 patients showed right hippocampal sclerosis, and one patient showed signal abnormalities in bilateral basal ganglia. Conclusion: SE is more prone to occur in Dravet patients who have high fever.It may result in AE or even death in severe cases.Survivors will leave severe neurological sequelae.The neuroimaging shows brain edema in acute phase.In recovery phase the neuroimaging shows diverse brain atrophy, moreover, a few patients may be associated with cerebellar or pontine atrophy, hippocampal sclerosis or abnormal signals in white matter or basal ganglia.

Healing High-Loading Sulfur Electrodes with Unprecedented Long Cycling Life: Spatial Heterogeneity Control

Self-healing capability helps biological systems to maintain their survivability and extend their lifespan. Similarly, self-healing is also beneficial to next-generation secondary batteries because high-capacity electrode materials, especially the cathodes such as oxygen or sulfur, suffer from shortened cycle lives resulting from irreversible and unstable phase transfer. Herein, by mimicking a biological self-healing process, fibrinolysis, we introduced an extrinsic healing agent, polysulfide, to enable the stable operation of sulfur microparticle (SMiP) cathodes. An optimized capacity (∼3.7 mAh cm^-2) with almost no decay after 2000 cycles at a high sulfur loading of 5.6 mg_(S) cm^-2 was attained. The inert SMiP is activated by the solubilization effect of polysulfides whereas the unstable phase transfer is mediated by mitigated spatial heterogeneity of polysulfides, which induces uniform nucleation and growth of solid compounds. The comprehensive understanding of the healing process, as well as of the spatial heterogeneity, could further guide the design of novel healing agents (e.g., lithium iodine) toward high-performance rechargeable batteries.

[Role of glucose-6-phosphate dehydrogenase in hepatitis B virus replication and its possible mechanism of action]

OBJECTIVE

To investigate the role of glucose-6-phosphate dehydrogenase (G6PD) in hepatitis B virus (HBV) replication and its possible mechanism of action.

METHODS

Tissue microarray, quantitative real-time PCR, and Western blot were performed to analyze the differences in G6PD expression levels in the HBV-positive and HBV-negative liver tissues, HepG2.2.15 cells, and HepG2 cells. The siRNA transfection technique was used to knock down G6PD gene in HepG2.2.15 cells for 48 hours. Chemiluminescence was used for HBsAg and HBeAg quantification in supernatant, and quantitative real-time PCR was used to measure HBV DNA, type I interferon (IFN), and downstream IFN-stimulated genes. The t-test was used for comparison between groups.

RESULTS

G6PD expression was significantly upregulated in the HBV-positive liver tissues and cells compared with HBV-negative liver tissues and cells, and the stain intensity and immunohistochemical scores were 89.69±54.92 and 31.90±18.62, respectively (P < 0.05). After G6PD expression in HepG2.2.15 cells was interfered by siRNA, the quantitative levels of HBV DNA, HBsAg, and HBeAg in supernatant were reduced significantly, and the mRNA expression levels of IFNα1, IFNβ1, and five downstream IFN-stimulated genes (OAS1, ISG15, OAS3, EIF2α, and PKR) increased significantly (all P < 0.05).

CONCLUSION

G6PD plays a vital role in HBV replication, and its mechanism of action in regulating HBV replication may be related to type I IFN signaling pathway.

[Assess the diagnostic value of MicroPure system with ultrasonography combined with mSMI in diagnosing thyroid nodules in TI-RADS 3 and 4]

Objective:To assess the diagnostic value of MicroPure system with ultrasonography combined with mSMI in diagnosing thyroid nodules inTI-RADS3 and 4; to compare the testing capability in thyroid nodules micro salcifications between MicroPure system and grey-scale ultrasonography; and to compare the diagnostic efficiency between mSMI and color doppler flow imaging (CDFI).Method:Exerting gery-scale ultrasonography and CDFI to choose 86 patients with 106 nodules (64 TI-RADS3 class nodules; 42 TI-RADS4 class nodules). These thyroid nodules were detected by grey-scale ultrasonography, CDFI, MicroPure system with ultrasonography, mSMI, and they were graded by TI-RADS. Then the ultrasound diagnosis value were compared with their FNA and surgical pathology results by gery-scale ultrasonography and CDFI; grey-scale ultrasonography and CDFI and MicroPure system; grey-scale ultrasonography and mSMI and MicroPure system, and diagnostic efficiency between mSMI and CDFI were compared, and the detectability of thyroid nodules micro salcifications between MicroPure system and grey-scale ultrasonography.Result:The results showed that combination of MicroPure system and mSMI had a higher sensitivity (91.44%, P< 0.05); The MicroPure system showed a higher testing capability compare to grey-scale ultrasonography in thyroid nodules micro salcifications (P< 0.05); The mSMI showed a higher sensitivity compared to the CDFI (P< 0.05).Conclusion:Combining mSMI and MicroPure system could improve the discreminability of TI-RADS3, 4 class thyroid nodules, then provide evidence to assess,diagnosis and treat the patients in clinical.

Serum total bilirubin levels are negatively correlated with metabolic syndrome in aged Chinese women: a community-based study

We evaluated serum total bilirubin levels as a predictor for metabolic syndrome (MetS) and investigated the relationship between serum total bilirubin levels and MetS prevalence. This cross-sectional study included 1728 participants over 65 years of age from Eastern China. Anthropometric data, lifestyle information, and previous medical history were collected. We then measured serum levels of fasting blood-glucose, total cholesterol, triglycerides, and total bilirubin, as well as alanine aminotransferase activity. The prevalence of MetS and each of its individual component were calculated per quartile of total bilirubin level. Logistic regression was used to assess the correlation between serum total bilirubin levels and MetS. Total bilirubin level in the women who did not have MetS was significantly higher than in those who had MetS (P<0.001). Serum total bilirubin quartiles were linearly and negatively correlated with MetS prevalence and hypertriglyceridemia (HTG) in females (P<0.005). Logistic regression showed that serum total bilirubin was an independent predictor of MetS for females (OR: 0.910, 95%CI: 0.863-0.960; P=0.001). The present study suggests that physiological levels of serum total bilirubin might be an independent risk factor for aged Chinese women, and the prevalence of MetS and HTG are negatively correlated to serum total bilirubin levels.

Methylation of SOX1 and VIM promoters in serum as potential biomarkers for hepatocellular carcinoma

Aberrant methylation of tumor-related genes has been identified as a promising biomarker for hepatocellular carcinoma (HCC). This study aimed to investigate the diagnostic value of SRY (sex determining region Y)-box 1 (SOX1) and Vimentin (VIM) promoter methylation for HCC. The study included 360 subjects, 240 patients with HCC, 29 with liver cirrhosis (LC), 66 with chronic hepatitis B (CHB) and 25 healthy controls (HCs). The methylation status of SOX1 and VIM promoters in the serum was detected by methylation-specific polymerase chain reaction (MSP). The methylation frequencies of SOX1 and VIM promoters in HCC patients were significantly higher than those in LC (p<0.001 and p<0.001), CHB (p<0.001 and p<0.001) and HC (p<0.001 and p<0.001) subjects. Furthermore, hypermethylation of SOX1 and VIM promoters were found in patients with advanced TNM stage (III-IV) and larger tumor size (≥5 cm) compared with early stage (I-II) (p<0.001 and p=0.004) patients with smaller tumor size (<3 cm) (p=0.018 and p=0.001). Moreover, the VIM promoter methylation frequency was higher in patients with portal vein tumor thrombosis (PVTT) (p=0.006) and vascular invasion (p=0.003). In addition, the combination of α-fetoprotein (≥20 ng/ml) with SOX1 and VIM promoter methylation significantly improved their diagnostic value. In conclusions, aberrant methylation of SOX1 and VIM promoters may be potential biomarkers for noninvasive detection of HCC and HCC metastasis.

[Diagnostic significance of anti-collectin 11 in systemic lupus erythematosus]

OBJECTIVE

To analyze the role of anti-collectin 11 in the diagnosis of systemic lupus erythematosus (SLE) and in the evaluation of disease activity.

METHODS

This was a cross-sectional study. Five groups of patients were enrolled: SLE active (SLE disease activity index-2000,SLEDAI-2000≥9), SLE remission (SLEDAI-2000≤4 and there was no organ involvement), rheumatoid arthritis (RA), primary Sjogren Syndrome (SS) and healthy control (HC). Serum anti-collectin 11 was detected in all the groups by ELISA. One-way ANOVA analysis and LSD-t-test as post-hoc analysis were used to compare the levels of anti-collectin 11 among all the groups. Receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to analyze the value of anti-collectin 11 in the diagnosis of SLE.

RESULTS

In the study, 30 patients were enrolled in each group, including 13 males and 137 females with an average age of (34±14) years (18-77 years). The age and gender of the other three groups were comparable to the two SLE groups. The difference of serum anti-collectin 11 between the SLE active group and SLE remission group was not statistically significant (88.8±16.8 vs. 89.7±24.7, P=0.896). The level of serum anti-collectin 11 was significantly higher in SLE group (as a whole) (89.1±19.4) than in RA group (49.1±22.0), SS group (56.9±30.1) and HC group (72.7±24.6) (P<0.001, P<0.001, P=0.007, respectively). The AUC was 0.806 for the diagnosis of SLE by serum anti-collectin 11. Further descriptive analysis showed that the positive rate of anti-collectin 11 was very high in the patients of SLE in whom both anti-double-stranded DNA (dsDNA) and Sm antibody were negative. The nervous system and gastrointestinal system involvement were the most common in the patients with positive anti-collectin 11.

CONCLUSION

The level of serum anti-collectin 11 was significantly higher in SLE than in RA, SS and HC. anti-collectin 11 antibody had a relatively high value in the diagnosis of SLE and it might have some complementary function in the diagnosis of SLE. It might be a relatively specific autoantibody for SLE.

[Role of galectin-1 in regulation of umbilical cord mesenchymal stem cells on T cells of rheumatoid arthritis]

OBJECTIVE

The therapeutic potential of umbilical cord mesenchymal stem cells (UC-MSCs) in rheumatoid arthritis (RA) has attracted more and more attention, because of it can suppress the various inflammatory effects of T cells. Galectin-1 is highly expressed in UC-MSCs, as the first lectin mediating the immunomodulatory effect of MSCs. Our study will investigate the effects of galectin-1 in regulation of UC-MSCs on rheumatoid arthritis T cells.

METHODS

Lentivirus transfected shRNA technique was used to knock down the expression of galectin-1 in UC-MSCs to construct UC-MSCs(Gal-1^-). The effects of UC-MSCs and UC-MSCs(Gal-1^-) on CD4⁺ T cells in RA patients were investigated by contact system, including negative control group (CD4⁺ T cells), positive control group [CD4⁺ T-phytohemagg lutinin (PHA)], UC-MSCs-CD4⁺ T cells co-culture group, UC-MSCs(control shRNA)-CD4⁺ T cells co-culture group, and UC-MSCs(Gal-1^-)-CD4⁺ T cells co-culture group. The proliferation of CD4⁺ T cells was detected by MTS assay. The level of tumor necrosis factors α (TNF-α) in cells supernatant was detected by enzyme linked immunosorbent assay (ELISA). The effect of UC-MSCs on helper T cell (Th) subset was detected by flow cytometry.

RESULTS

In vitro, UC-MSCs were capable of inhibiting PHA induced proliferation of CD4⁺ T cells from RA patients, but UC-MSCs(Gal-1^-) did not show the significant inhibitory effect. Galectin-1 affect the TNF-α level of CD4⁺ T cells regulated by UC-MSCs. UC-MSCs and UC-MSCs(control shRNA) significantly inhibited the expression of TNF-α in PHA-induced CD4⁺ T cells. However, UC-MSCs(Gal-1^-) had no significant inhibitory effect. Furthermore, the Th1 cells were also significantly suppressed by UC-MSCs and UC-MSCs(control shRNA) (4.83%±1.37% and 5.13%±0.87%,P=0.012 and P=0.018). These was no significant difference in the proportion of the Th1 cells between the control group and UC-MSCs(Gal-1^-) group (8.51%±2.04% and 6.41%±0.96%,P=0.101). The Th2 cells were protected after silence galectin-1 in UC-MSCs, whereas there was no significant difference. The proportion of Th17 was decreased by co-culture with UC-MSCs and UC-MSCs (control shRNA), but these was also no significant difference.

CONCLUSION

UC-MSCs can inhibit the proliferation and differentiation of CD4⁺ T cells from RA patients, but these effect declined after knocking down the expression of galectin-1. Galectin-1 maybe take part in the regulation of UC-MSCs on rheumatoid arthritis CD4⁺ T cells.

[Role of hypoxia-inducible factor in the pathogenesis of rheumatoid arthritis]

Rheumatoid arthritis (RA) is a destructive chronic autoimmune disease characterized by synovium inflammation, cartilage destruction, bone erosion and the presence of autoantibodies. Hypoxia is a prominent micro-environmental feature in a range of disorders including RA. A combination of increased oxygen consumptionby inflamed resident cells and infiltrating immune cells along with a disrupted blood supply due to vascular dysfunction contribute to tissue hypoxia in RA. Hypoxia in turn regulates a number of key signaling pathways that help adaptation. The primary signaling pathway activated by hypoxia is the hypoxia-inducible factor (HIF) pathway. It has been shown that HIFs are highly expressed in the synovium of RA. HIFs mediate the pathogenesis of RA through inducing inflammation, angiogenesis, cell migration, and cartilage destruction, and inhibiting the apoptosis of synovial cells and inflammatory cells. HIF expressed in RA can be regulated in both oxygen-dependent and independent fashions, like inflammatory cytokines, leading to the aggravation of this disease. Considering the vital role of HIF in the pathogenesis of RA, we reviewed the new advances about hypoxia and RA. In this review, we firstly discussed the hypoxia-inducible factor and its regulation, and then, the pathologic role of hypoxia in RA, mainly elucidating the role of hypoxia in synovitis and cartilage destruction and immune cells. Finally, we provided evidence about the potential therapeutic target for treating RA.

[Significance of antibodies to the citrullinated glucose-6-phosphate isomerase peptides in rheumatoid arthritis]

OBJECTIVE

To detect the anti-citrullinated glucose-6-phosphate isomerase (GPI) 70-88 peptide antibody (anti-C-GPI(70-88) antibody), anti-citrullinated GPI 435-453 peptide antibody (anti-C-GPI(435-453) antibody), anti-GPI 70-88 peptide antibody (anti-GPI(70-88) antibody) and anti-GPI 435-453 peptide antibody(anti-GPI(435-453) antibody) in the serum of rheumatoid arthritis (RA) patients, and examine the diagnostic values of the anti-C-GPI peptide antibodies in RA.

METHODS

The anti-C-GPI(70-88) antibody, anti-C-GPI(435-453) antibody, anti-GPI(70-88) antibody and anti-GPI(435-453) antibody were detected by enzyme-linked immunosorbent assay (ELISA) in 191 RA patients, 129 other rheumatic diseases and 74 healthy controls. The clinical and laboratory data of the patients with RA were collected, and the values of anti-C-GPI peptide antibodies in the diagnosis of RA and the relationships of anti-C-GPI peptide antibodies with the clinical and laboratory parameters analyzed.

RESULTS

(1) The mean titers of the anti-C-GPI(70-88) antibody and the anti-C-GPI(435-453) antibody in the RA patients (respectively, 68.71 ± 4.20 and 51.78 ± 3.13) were significantly higher than those with other rheumatic diseases and healthy individuals (P <0.05). However, the mean titers of the anti-GPI(70-88) antibody and anti-GPI(435-453) antibody in the RA patients were similar to those with other rheumatic diseases and healthy individuals. (2) The diagnostic sensitivity and specificity of the anti-C-GPI(70-88) antibody for RA were 41.88% and 84.50% respectively; and the diagnostic sensitivity and specificity of the anti-C-GPI(435-453) antibody for RA were 46.05% and 86.05% respectively. The sensitivity of combined detection of the two anti-C-GPI peptide antibodies was 50.79%, and the specificity was 81.40%. (3) The positive rates of the anti-C-GPI(70-88) antibody and the anti-C-GPI(435-453) antibody were 35% and 45% respectively in those patients with negative anti-cyclic citrullinated peptide antibody, anti-keratin antibody, and rheumatoid factor. (4) There was no significant difference in clinical and laboratory indicators between the anti-C-GPI(70-88) antibody or anti-C-GPI(435-453) antibody positive group and negative group.

CONCLUSION

The anti-C-GPI(70-88) antibody and anti-C-GPI(435-453) antibody can be detected in the serum of RA patients, and C-GPI may be involved in the pathogenesis of RA. There is a certain diagnostic significance for the sera-negative RA.

[Significance of v-raf murine sarcoma viral oncogene homologue B1 in rheumatoid arthritis]

OBJECTIVE

To detect serum v-raf murine sarcoma viral oncogene homologue B1 (BRAF) protein levels and to investigate their clinical significance in rheumatoid arthritis (RA) patients.

METHODS

Serum samples were obtained from 78 RA patients, 32 osteoarthritis (OA) patients, 16 systemic lupus erythematosus (SLE) patients, 16 gout patients, 16 ankylosing spondylitis (AS) patients, 16 Sjogren syndrome (SS) patients and 30 healthy controls. BRAF protein in the sera was examined by enzyme-linked immunosorbent assay (ELISA). The associations between BRAF levels and the clinical features including age, sex, disease duration, swelling joints, tenderness joints, duration of moning stiffness, joint deformity, visual assessment scale (VAS) and extra articular manifestations and laboratory parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), disease activity score in 28 joints (DAS28), anti-cyclic citrullinated peptide (CCP) antibody, antikeratin antibody, antnuclear antibody (ANA), immunoglobulin and cytokines, such as TNF-α, IL-1β, IL-6 and IL-17A in RA patients were evaluated. Data analyses were performed by using SPSS 19.0 program.

RESULTS

The serum BRAF protein levels in the RA patients were significantly higher than those of other rheumatic diseases groups including OA, SLE, AS, SS, gout patients and healthy controls, the P value was 0.002, <0.001, <0.001, <0.001, 0.001 and <0.001 respectively. The level of serum BRAF protein in the RA patients showed a positive correlation with the rheumatoid factor (P=0.009) and IgA levels (P=0.006), but no correlation with clinical features, such as age and duration or other laboratory parameters, including CRP, ESR, anti-CCP antibody, IgM, IgG, TNF-α, IL-1β, IL-6 and IL-17A. The RA patients were further divided into normal levels of BRAF protein group and elevated levels of BRAF protein group. Compared with the clinical features and laboratory indexes of normal and elevated levels of BRAF protein groups in the RA patients, there was no significant difference between the two groups in age, duration, DAS28, CRP, ESR, RF, anti-CCP, IgA, IgG, IgM, TNF-α or IL-6.

CONCLUSION

The elevated level of BRAF protein in the RA patients showed that BRAF might play a role in the pathogenesis of RA. Further researches on BRAF gene expression may help to clarify the role of BRAF in RA.

Cloning and functional characterization of a phenolic acid decarboxylase from the liverwort Conocephalum japonicum

Some commercially important vinyl derivatives are produced by the decarboxylation of phenolic acids. Enzymatically, this process can be achieved by phenolic acid decarboxylases (PADs), which are able to act on phenolic acid substrates such as ferulic and p-coumaric acid. Although many microbial PADs have been characterized, little is known regarding their plant homologs. Transcriptome sequencing in the liverworts has identified seven putative PADs, which share a measure of sequence identity with microbial PADs, but are typically much longer proteins. Here, a PAD-encoding gene was isolated from the liverwort species Conocephalum japonicum. The 1197 nt CjPAD cDNA sequence was predicted to be translated into a 398 residue protein. When the gene was heterologously expressed in Escherichia coli, its product exhibited a high level of PAD activity when provided with either p-coumaric or ferulic acid as substrate, along with the conversion of caffeic acid and sinapic acid to their corresponding decarboxylated products. Both N- and C-terminal truncation derivatives were non-functional. The transient expression in tobacco of a GFP/CjPAD fusion gene demonstrated that the CjPAD protein is expressed in the cytoplasm. It is first time a PAD was characterized from plants and the present investigation provided a candidate gene for catalyzing the formation of volatile phenols.

3D-QSAR analysis of a series of S-DABO derivatives as anti-HIV agents by CoMFA and CoMSIA

In this study, we retrieved a series of 59 dihydroalkylthio-benzyloxopyrimidine (S-DABO) derivatives, which is a class of highly potent HIV-1 non-nucleoside reverse transcriptase inhibitors (NNRTIs) reported from published articles, and analysed them with comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA). Statistically significant three-dimensional quantitative structure-activity relationship (3D-QSAR) models by CoMFA and CoMSIA were derived from a training set of 46 compounds on the basis of the rigid body alignment. Further, the predictive ability of the QSAR models was validated by a test set of 13 compounds. Based on the information derived from CoMFA and CoMSIA contour maps, we have identified some steric and electrostatic features for improving the activities of these inhibitors, and we validated the 3D-QSAR results by a molecular docking method. On the basis of the obtained results, we designed a new series of S-DABO derivatives with high activities. Therefore, this study could be utilized to design more potent S-DABO analogues as anti-HIV agents.

[Efficacy of thrombolytic therapy using reteplase in cases with acute ST-segment elevation myocardial infarction: results from a multicenter clinical trial]

Objective: To evaluate the efficacy and safety of intravenous thrombolytic therapy using reteplase in patients with acute ST-segment elevation myocardial infarction (STEMI). Method: A total of 73 hospitals from Henan province took part in this clinical trials during October 2012 to October 2014, 1 226 cases (1 014 male (82.7%), mean age 59.0 (51.0, 66.0) years) with acute STEMI received reteplase as thrombolytic agent.Reperfusion rate was judged according to the clinical symptoms, electrocardiogram, myocardial enzymes and heart rhythm, and the rate of cardiovascular events and bleeding events during hospitalization was also observed.Bleeding events were evaluated with global utilization of streptokinase and tissues plasminogen activator for occluded coronary arteries (GUSTO) criteria.Subgroup analysis was performed to compare the effects of various thrombolysis timing (time from onset to thrombolysis≤6 h or 6-12 h) on reperfusion rate, cardiovascular events and bleeding events rate. Results: The reperfusion rate was 89.3% (1 089/1 219) at 120 minutes after the thrombolysis, average recanalization time was (59.96±26.86) minutes.The reperfusion rate of ≤6 h thrombolysis group was significantly higher than in 6-12 hours group (90.3% (988/1094) vs. 80.8% (101/125), P=0.001), while in-hospital mortality (2.6%(28/1 094) and 0.8% (1/125), P=0.352) and rate of bleeding (5.9%(64/1 094) and 5.6%(7/125), P=0.910) were similar between the two groups. The total in-hospital mortality after thrombolysis was 2.4% (29/1219), which was significantly higher in failed recanalization group than in recanalization group (10.8%(14/130) vs. 1.4%(15/1089), P< 0.001). The total rate of bleeding after thrombolysis was 5.8% (71/1219), there were 3 severe bleeding cases according to GUSTO classification (0.2%), all of them were cerebral hemorrhage, and 2 out of 3 cases died. Conclusions: Reteplase use is related to high recanalization rate and low cardiovascular events and bleeding rate and our results thus show that reteplase is a safe and effective thrombolytic agent for STEMI patients.

Correlation of the TCF7L2 (rs7903146) polymorphism with an enhanced risk of type 2 diabetes mellitus: a meta-analysis

Increasing evidence has demonstrated that a transcription factor 7-like 2 (TCF7L2) polymorphism (rs7903146) is significantly associated with type 2 diabetes mellitus (T2DM); however, limited sample size and variance of ethnicity in the studies investigating this association have led to conflicting reports regarding its role. Therefore, a comprehensive meta-analysis was conducted to quantitatively assess the association between the TCF7L2 polymorphism (rs7903146) and T2DM including published case-control studies in global populations. We searched the PubMed, EMbase, CNKI, and Wanfang databases for publications that studied correlation between TCF7L2 polymorphism (rs7903146) and risk of T2DM. Thirty-six studies from 30 eligible papers were identified. After data extraction and reference quality assessment, summary odds ratio and 95% confidence intervals (95%CI) of the TCF7L2 (rs7903146) polymorphism were calculated and combined using the fixed-effect model. Hardy-Weinberg equilibrium was evaluated to determine selection bias of the control subjects. Heterogeneity among studies was examined using the Q-test and the I² test. Publication bias in studies was assessed using Begg's plots and the Egger test. The results showed that the rs7903146 T allele of the TCF7L2 gene was positively correlated with an enhanced risk of T2DM in the allelic, heterozygote, homozygote, dominant, and recessive models, with odds ratios of 1.35 (T vs C, 95%CI = 1.31-1.39), 1.32 (CT vs CC, 95%CI = 1.27-1.38), 1.74 (TT vs CC, 95%CI = 1.63-1.87), 1.40 (TT+CT vs CC, 95%CI = 1.35-1.46), and 1.59 (TT vs CT+CC, 95%CI = 1.49-1.69), respectively. No obvious publication bias was observed using the Egger linear test.

High-dose calcium channel blocker (CCB) monotherapy vs combination therapy of standard-dose CCBs and angiotensin receptor blockers for hypertension: a meta-analysis

In this study, we evaluated the efficacy and safety of high-dose calcium channel blocker (CCB) monotherapy and standard-dose CCBs combined with angiotensin receptor blockers (ARBs) for patients with hypertension. A comprehensive search of PubMed, Embase and the Cochrane Central Register of Controlled Trials was performed in December 2015. Randomized controlled trials designed to identify the above goal were included. Thirteen trials including 2371 patients were identified. The standard-dose CCB/ARB combination resulted in a greater reduction of systolic blood pressure (WMD -2.52, 95% confidence interval (CI): -3.76 to -1.28) and diastolic blood pressure (weighted mean difference (WMD) -2.07, 95% CI: -3.73 to -0.42) compared to high-dose CCB monotherapy. The overall hypertension control rate for the CCB/ARB combination was higher than that for CCB monotherapy (relative risk (RR): 1.17, 95% CI: 1.08-1.26). Furthermore, the CCB/ARB combination treatment yielded significantly fewer overall adverse events (RR: 0.84, 95% CI: 0.74-0.95), oedema (RR: 0.31; 95% CI: 0.18-0.52) and rash (RR: 0.27, 95% CI: 0.08-0.96, P=0.04) than did CCB monotherapy. The standard-dose CCB/ARB combination is superior to high-dose CCB monotherapy for lowering blood pressure and reducing adverse events in hypertensive patients. Future research should focus on the cost-effectiveness and long-term effects of these two treatment strategies for patients with hypertension.

[Clinical analysis of preimplantation genetic diagnosis with HLA matching for beta-thalassemia]

OBJECTIVE

To investigate the efficacy and feasibility of preimplantation genetic diagnosis(PGD)with human leukocyte antigen(HLA)matching for beta-thalassemia.

METHODS

A total of 43 referred beta-thalassemia couples, with at least on child in need of hematopoietic stem cell transplantation(HSCT), underwent PGD for HLA matching at the First Affiliated Hospital of Sun Yat-sen University from 2010 to 2015. PGD cycles of these couples were retrospectively analyzed, and 15 infants born from PGD-HLA were followed up.

RESULTS

A total of 84 oocyte retrieval cycles were performed, providing 14±7 oocytes per cycle. Fifty nine embryos biopsied cycles were done, including 24 cleavage stage and 35 blastocyst stage biopsy cycles. In cleavage stage, 259 embryos were biopsied, 93.4%(242/259)of them with conclusive molecular diagnosis, and the percentage of unaffected embryos(normo-homozygote and heterozygote)was 71.4%(185/259). The percentage of HLA matched unaffected embryos was 9.3%(24/259). In blastocyst stage, 306 embryos were biopsied, while 93.8%(287/306)of them were conclusive, and the percentage of unaffected embryos was 70.6%(216/306). The percentage of HLA matched unaffected embryos in blastocyst stage biopsy was 14.4%(44/306), which was higher than in cleavage stage biopsy(P< 0.05). Forty three female carriers underwent 48 embryo transfer cycles including 3 fresh and 45 frozen-thawed embryo transfer cycles. Three fresh embryo transfer cycles were done after cleavage stage biopsy, resulted in a birth of healthy twins born at 36 weeks' gestation. All the embryos were frozen after blastocyst biopsied. Totally, 54 frozen-thawed embryos that were transferred in 45 frozen-thawed embryo transfer cycles included 25 embryo from cleavage stage biopsy and 29 embryo from blastocyst stage biopsy, and 42 of them were HLA matched. Clinical pregnancy rate and implantation rate per cycle in frozen-thawed embryo transfer were 38%(17/45)and 37%(20/54)respectively. A total of 15 infants were born, 2 were from a fresh embryo transfer cycle, and 13 were from frozen-thawed embryo transfer cycles. RESULTS of prenatal diagnosis from delivered cases were matched to that of PGD. Four sick children have been cured by HSCT from these HLA matched born siblings.

CONCLUSION

PGD with HLA matching is an established method for conceiving a child who may donate hematopoietic stem cells to save an ill sibling.

[Composition of potassium channels in normal rat coronary smooth muscle cells and activation effects of docosahexaenoic acid]

OBJECTIVE

To investigate the composition of potassium channels in normal rat coronary smooth muscle cells (CASMCs) and the activation effects of docosahexaenoic acid (DHA).

METHODS

CASMCs were isolated by enzyme digestion.Effects of different types of potassium channel blockers and/or DHA on potassium channels currents were studied by whole-cell patch clamp technique.

RESULTS

Potassium currents were significantly increased with 5 μmol/L DHA perfusion (P<0.05). The current density was increased from (52.80±6.68) pA/pF to (110.09±13.39) pA/pF (P<0.05) after DHA perfusion when the stimulation voltage was 100 mV.Compared with baseline, potassium currents were significantly decreased by various inhibitor perfusion (tetraethylammonium: (49.63±5.75) pA/pF vs. (13.96±2.18) pA/pF; ibritoxin: (50.67±7.89) pA/pF vs. (26.53±4.68) pA/pF; TRAM-34: (52.60±7.02) pA/pF vs. (46.05±7.60) pA/pF; apamin: (51.97±3.83) pA/pF vs. (44.89±5.04) pA/pF; 4-aminopyridine: (51.19±3.44) pA/pF vs. (29.92±2.81) pA/pF; glyburide: (49.67±1.77) pA/pF vs. (49.61±1.87) pA/pF, all P<0.05). In presence of different inhibitors, potassium channel current densities were increased after DHA perfusion except tetraethylammonium (tetraethylammonium: ( 12.79±1.89) pA/pF; ibritoxin: (67.08±5.54) pA/pF; TRAM-34: (117.91±21.79) pA/pF; apamin: (108.33±7.06) pA/pF; 4-aminopyridine: (127.73±20.56) pA/pF; glyburide: (121.53±13.83) pA/pF, all P<0.05 compared with baseline).

CONCLUSIONS

Large-conductance calcium-activated potassium channel and voltage-gated potassium channel are the major constituents of potassium channels in CASMCs.DHA can activate potassium channels in CASMCs, mainly the large conductance calcium-activated potassium channel, thus dilate coronary arteries.

Relationship between Intrauterine Bacterial Infection and Early Embryonic Developmental Arrest

Background:

Early embryonic developmental arrest is the most commonly understudied adverse outcome of pregnancy. The relevance of intrauterine infection to spontaneous embryonic death is rarely studied and remains unclear. This study aimed to investigate the relationship between intrauterine bacterial infection and early embryonic developmental arrest.

Methods:

Embryonic chorion tissue and uterine swabs for bacterial detection were obtained from 33 patients who underwent artificial abortion (control group) and from 45 patients who displayed early embryonic developmental arrest (trial group).

Results:

Intrauterine bacterial infection was discovered in both groups. The infection rate was 24.44% (11/45) in the early embryonic developmental arrest group and 9.09% (3/33) in the artificial abortion group. Classification analysis revealed that the highest detection rate for Micrococcus luteus in the early embryonic developmental arrest group was 13.33% (6/45), and none was detected in the artificial abortion group. M. luteus infection was significantly different between the groups (P < 0.05 as shown by Fisher's exact test). In addition, no correlation was found between intrauterine bacterial infection and history of early embryonic developmental arrest.

Conclusions:

M. luteus infection is related to early embryonic developmental arrest and might be one of its causative factors.

[A comparation of efficacy between unilateral laminectomy approach bilateral decompression and traditional total laminectomy decompression in the treatment of lumbar spinal stenosis]

OBJECTIVES

To compare the efficacy between unilateral laminectomy approach bilateral decompression and traditional total laminectomy decompression in the treatment of graft bone fusion and internal fixation for degenerative lumbar spinal stenosis with the unilateral symptoms.

METHOD

From January 2013 to December 2014, a total of 40 patients with unilateral symptoms of lumbar spinal stenosis were treated in Department of Spinal Surgery Bozhou People's Hospital of Anhui Province. Twenty patients(group A ) were treated by severe symptoms unilateral facetectomy and resection of superior articular and laminectomy and lateral recess decompression, interbody fusion, pedicle screw fixation.Twenty patients(group B ) were treated by total laminectomy interbody fusion and pedicle screw fixation.The time of operation, blood loss of the two groups were recorded.At the same time the visual analog scale (VAS), Oswestry disability index(ODI), Japanese Orthopaedic Association Scores(JOA) before and after operation (3, 6 , 12months) were recorded retrospectively. The effect of surgery were evaluated and compared.

RESULT

The VAS, JOA, and ODI of group A preoperation is respectively have no significant differences with the group B (P>0.05). The operation time, blood loss in operation of group A was respectively(133.2±25.3) min, (415.0±42.1) ml, significant differences with the group B[(491.0±46.3)ml; (156.2±28.5) min, P<0.05)]. The VAS, JOA, ODI of group A had no significant differences with the group B (P>0.05) at 3, 6 months after operation.The VAS, JOA, ODI of group A was respectively (3.0±0.6), (25.3±5.1), (16.5±1.5)scores, had significant differences with the group B and preoperation (P<0.05) at 12 months after operation. The radiographic data showed that the interbody fusion rate of group A was 100%, and group B was 95%, had significant differences by statistical analysis (P<0.05) at 12 months afer operation.

CONCLUSION

The improved unilateral laminectomy approach and bilateral decompression have less operation time and blood loss, more satisfactory for the lumbar spinal stenosis patients with the unilateral severe symptoms, the other side moderate stenosis and mild symptoms.The efficacy of lumbar stability and bilateral decompression is better by operation of improved unilateral approach.

[Genotype and phenotype of female Dravet syndrome with PCDH19 mutations]

OBJECTIVE

To explore the genotype and phenotype of female Dravet syndrome (DS) patients with PCDH19 mutations.

METHOD

Clinical data of all DS patients seen at Pediatric Department of Peking University First Hospital from February 2005 to May 2015 were prospectively collected. Genomic DNAs were extracted from the patients and their family members. Female DS patients without SCN1A mutation were enrolled. PCR and Sanger sequencing were performed to identify PCDH19 mutations. Clinical data of DS patients with PCDH19 mutations were summarized.

RESULT

Five different heterozygous PCDH19 mutations were identified in six unrelated patients of 75 SCN1A-negative female DS patients (8%), among whom five patients had de novo mutations and one patient's mutation was inherited from her affected mother. Three missense mutations and two insertion mutations were all located in exon 1. Mean age of onset of the six patients with PCDH19 mutations was 6.8 months (range 5-9 months). Onset of seizures were triggered by fever in four patients, after vaccination in one and without fever in one. Generalized tonic clonic seizure (GTCS) was the first seizure type in four patients and focal seizure with secondary generalized tonic clonic seizures in the remaining two. During the course, all patients presented multiple seizure types including generalized tonic clonic seizures and focal seizures in all six patients, myoclonic seizures in three, absence seizures and atonic seizures in one respectively. In all patients, seizures manifested fever-sensitive and in clusters. Seizures were always in brief duration, in most less than 5 minutes, except one experienced twice status epilepticus triggered by fever. Six patients had development delay after the seizure onset, two with autism spectrum disorder, three with ataxia.

CONCLUSION

PCDH19 is another important gene of DS after SCN1A, mutations mainly occurred de novo. PCDH19 gene mutation should be routinely screened in female DS patients without SCN1A mutation. The clinical features of female DS patients with PCDH19 mutations include that the main seizures types are generalized tonic clonic seizures and focal seizures, seizures occurr in clusters and fever-sensitive, short seizure duration, rare status epilepticus, common development delay and some may manifest autism spectrum disorders.

[The clinical, radiological and prognostic factor analysis of medullary infarction]

OBJECTIVE

To investigate the clinical and radiological features of medullary infarction (MI), and to compare the clinical characteristics of lateral medullary infarction (LMI) and medial medullary infarction (MMI).

METHODS

Patients diagnosed as acute MI who were treated from January 2009 to December 2014 in Department of Neurology, Peking University Third Hospital, were retrospectively enrolled in the study and data were analyzed including risk factors, clinical features, laboratory findings, radiological characteristics, etiology and outcomes.

RESULTS

A total of 62 cases of MI were enrolled with 48 cases of LMI and 14 cases of MMI , including 2 cases of bilateral MMI. The mean onset age of LMI and MMI was 60.2±12.3 and 56.9±14.2, respectively. The frequently affected location of LMI was the middle and upper part of medulla [40 cases (83.3%)]. The common symptoms and signs of LMI were dizzy (38 cases , 79.2%), sensory disturbance (33 cases , 68.8%), dysarthria ( 32 cases , 66.7%), dysphagia (30 cases , 62.5%), diminished pharyngeal reflex (30 cases, 62.5%), Horner's sign (29 cases, 60.4%), ataxia (26 cases, 54.2%) and nausea or vomiting (25 cases, 52.1%). The frequently affected location of MMI was the upper part of medulla (13 cases, 92.9%). The common symptoms and signs of MMI were motor dysfunction (12 cases, 85.7%), sensory disturbances (11 cases, 78.6%), dizzy (10 cases, 71.4%) and dysarthria (10 cases, 71.4%). Infarctions caused by atherosclerosis were found in 35 cases of LMI (72.9%) and 12 cases of MMI (85.7%). Five cases (10.4%) of LMI died in hospital, while 1 case (7.1%) of MMI died in hospital. No lesion was found in 16 cases (25.8%) by MRI-DWI within the first 24 hours of onset.

CONCLUSIONS

Our study showes that the mean onset age of LMI is older than that of MMI. The lesion of LMI is frequently located in the upper and middle medulla, whereas the lesion of MMI is mostly in the upper medulla. The prognosis of LMI is worse than that of MMI. Atherosclerosis of the vertebral arteries is the predominant vascular pathology in MI.

Differentiating origins of outflow tract ventricular arrhythmias: a comparison of three different electrocardiographic algorithms

Our objective is to evaluate the accuracy of three algorithms in differentiating the origins of outflow tract ventricular arrhythmias (OTVAs). This study involved 110 consecutive patients with OTVAs for whom a standard 12-lead surface electrocardiogram (ECG) showed typical left bundle branch block morphology with an inferior axis. All the ECG tracings were retrospectively analyzed using the following three recently published ECG algorithms: 1) the transitional zone (TZ) index, 2) the V₂ transition ratio, and 3) V₂ R wave duration and R/S wave amplitude indices. Considering all patients, the V₂ transition ratio had the highest sensitivity (92.3%), while the R wave duration and R/S wave amplitude indices in V₂ had the highest specificity (93.9%). The latter finding had a maximal area under the ROC curve of 0.925. In patients with left ventricular (LV) rotation, the V₂ transition ratio had the highest sensitivity (94.1%), while the R wave duration and R/S wave amplitude indices in V₂ had the highest specificity (87.5%). The former finding had a maximal area under the ROC curve of 0.892. All three published ECG algorithms are effective in differentiating the origin of OTVAs, while the V₂ transition ratio, and the V₂ R wave duration and R/S wave amplitude indices are the most sensitive and specific algorithms, respectively. Amongst all of the patients, the V₂ R wave duration and R/S wave amplitude algorithm had the maximal area under the ROC curve, but in patients with LV rotation the V₂ transition ratio algorithm had the maximum area under the ROC curve.

[Distribution of human papillomavirus (HPV) among HPV positive cervical adenocarcinoma cases detected by laser capture microdissection(LCM)]

OBJECTIVE

To investigate the distribution of human papillomavirus (HPV) in the diseased areas cut from HPV-positive cervical adenocarcinoma (ADC) detected by laser capture microdissection (LCM).

METHODS

Paraffin-embedded specimens diagnosed as ADC between 2005 and 2010 were collected from 9 hospitals in 7 regions across China. HPV genotyping was conducted on paraffin sections using sandwich technique and LCM in order to identify HPV infection in the tumor tissues. HE and p16 immunohistochemistry staining were performed to make histological diagnosis.

RESULTS

A total of 169 cervical adenocarcinoma cases were recruited, including 94 cases of mucinous adenocarcinoma (ADC-CX), 9 cases of adenosquamous carcinoma (ASC), 19 cases of minimal deviation adenocarcinoma (ADC-MIN), 14 cases of clear cell adenocarcinoma (ADC-CC), 8 cases of endometrioid adenocarcinoma (ADC-ENDO), 9 cases of serous adenocarcinoma (ADC-SER) and 16 cases of adenocarcinoma not otherwise specified (ADC-NOS). Fourteen types of high risk HPV were detected in the whole tissue section (WTS). HPV16 was the most common type, and the second was HPV18 and HPV52, respectively. Compared with WTS, the HPV-positive rate detected by LCM was lower. The HPV positive rates were significantly different among different subtypes of cervical adenocarcinoma (P<0.001). After LCM, the HPV positive rate was 50.8% and 66.7% in the single infection and multiple, infection groups respectively (P=0.14). The positive rates of p16 was significantly different among different subtypes of cervical adenocarcinoma (P<0.001). p16-positive rate was 73.9% in the HPV-positive samples after LCM, significantly higher than the 38.5% of negative samples (P<0.001).

CONCLUSIONS

Laser capture dissection technique can more precisely reflect the HPV distribution in cervical adenocarcinomas. The etiological association between HPV infection and cervical adenocarcinoma occurrence is not as close as that reported in the literature.

Strong correlation between early stage atherosclerosis and electromechanical coupling of aorta

Atherosclerosis is the underlying cause of cardiovascular diseases that are responsible for many deaths in the world, and the early diagnosis of atherosclerosis is highly desirable. The existing imaging methods, however, are not capable of detecting the early stage of atherosclerosis development due to their limited spatial resolution. Using piezoresponse force microscopy (PFM), we show that the piezoelectric response of an aortic wall increases as atherosclerosis advances, while the stiffness of the aorta shows a less evident correlation with atherosclerosis. Furthermore, we show that there is strong correlation between the coercive electric field necessary to switch the polarity of the artery and the development of atherosclerosis. Thus by measuring the electromechanical coupling of the aortic wall, it is possible to probe atherosclerosis at the early stage of its development, not only improving the spatial resolution by orders of magnitude, but also providing comprehensive quantitative information on the biomechanical properties of the artery.