Therapeutic drug monitoring of cycloserine and linezolid during anti-tuberculosis treatment in Beijing, China

SETTING

Plasma concentrations of cycloserine (CS) and linezolid (LZD) in tuberculosis (TB) patients are largely unknown.

OBJECTIVE

To measure the plasma concentrations of CS and LZD after drug ingestion in drug-resistant TB patients.

DESIGN

Patients who received CS and LZD as part of their treatment between 1 July 2012 and 1 July 2016 were studied retrospectively. CS and LZD plasma levels were determined using high-pressure liquid chromatography-tandem mass spectrometry. Plasma drug concentration, age, sex, liver disease, renal disease, administered doses and diabetes mellitus status were recorded.

RESULTS

Based on 390 samples, CS plasma concentrations were below the lower limit of normal (54.87%, 214/390). There was a statistically significant difference between the low concentration group (14.0 ± 3.71 μg/ml) and the target concentration group (25.2 ± 3.73 μg/ml, P < 0.01). The mean plasma concentration of LZD was 15.6 ± 4.91 μg/ml, which was within the target concentration (12-26 μg/ml) in 65 patients. Variables that correlated with CS and LZD concentrations were not found in this retrospective study.

CONCLUSION

Low plasma CS concentrations were common, while 83.1% (54/65) of plasma LZD concentrations were within the target range. Therapeutic drug monitoring is essential to maintain appropriate plasma drug concentrations in the era of precision medicine.

Minimally Invasive Approach for Diagnosing TMJ Osteoarthritis

This study's objectives were to test correlations among groups of biomarkers that are associated with condylar morphology and to apply artificial intelligence to test shape analysis features in a neural network (NN) to stage condylar morphology in temporomandibular joint osteoarthritis (TMJOA). Seventeen TMJOA patients (39.9 ± 11.7 y) experiencing signs and symptoms of the disease for less than 10 y and 17 age- and sex-matched control subjects (39.4 ± 15.2 y) completed a questionnaire, had a temporomandibular joint clinical exam, had blood and saliva samples drawn, and had high-resolution cone beam computed tomography scans taken. Serum and salivary levels of 17 inflammatory biomarkers were quantified using protein microarrays. A NN was trained with 259 other condyles to detect and classify the stage of TMJOA and then compared to repeated clinical experts' classifications. Levels of the salivary biomarkers MMP-3, VE-cadherin, 6Ckine, and PAI-1 were correlated to each other in TMJOA patients and were significantly correlated with condylar morphological variability on the posterior surface of the condyle. In serum, VE-cadherin and VEGF were correlated with one another and with significant morphological variability on the anterior surface of the condyle, while MMP-3 and CXCL16 presented statistically significant associations with variability on the anterior surface, lateral pole, and superior-posterior surface of the condyle. The range of mouth opening variables were the clinical markers with the most significant associations with morphological variability at the medial and lateral condylar poles. The repeated clinician consensus classification had 97.8% agreement on degree of degeneration within 1 group difference. Predictive analytics of the NN's staging of TMJOA compared to the repeated clinicians' consensus revealed 73.5% and 91.2% accuracy. This study demonstrated significant correlations among variations in protein expression levels, clinical symptoms, and condylar surface morphology. The results suggest that 3-dimensional variability in TMJOA condylar morphology can be comprehensively phenotyped by the NN.

[Effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand]

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.

High expression of LncRNA CASC15 is a risk factor for gastric cancer prognosis and promote the proliferation of gastric cancer

OBJECTIVE

To investigate the expression of long non-coding RNA CASC15 in gastric cancer tissue and its effect on the proliferation of gastric cancer cell line MKN28.

MATERIALS AND METHODS

We found that expression of lncRNA CASC15 in gastric cancer tissue was higher than normal gastric epithelium through the TCGA and Gene Expression Omnibus (GEO) database. Then, we detect the RNA level of CASC15 from clinical samples of 42 normal gastric epithelial tissues and 60 gastric cancer tissues. In order to explore the function of CASC15 in gastric cancer, we perform gain-function and loss-function assay in gastric cancer cell lines.

RESULTS

We found that expression of lncRNA CASC15 in gastric cancer tissue was higher than normal gastric epithelium through the TCGA database and the related microarray data set was searched from Gene Expression Omnibus (GEO) database.  Then, we extracted total RNA from clinical samples of 42 normal gastric epithelial tissues and 60 gastric cancer tissues. The results of quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) were consistent with those of TCGA analysis. Clinical data analysis showed that the expression of LncRNA CASC15 was correlated with the total survival, tumor size and TMN staging in clinical patients. Clinical data analysis showed that the expression level of CASC15 was correlated with tumor size and TNM stage in clinical patients. Compared with the negative control group, the proliferation and cell cloning ability of MKN28 cells overexpressing LncRNA CASC15 significantly increased (p<0.001), indicating that overexpression of LncRNA CASC15 promoted the proliferation of MKN28 cells.

CONCLUSIONS

The expression of LncRNA CASC15 was significantly higher in gastric cancer tissues and its expression was negatively correlated with the overall survival of clinical patients. It was positively correlated with the tumor size and TMN stage. LncRNA CASC15 could promote the proliferation of gastric cancer cells and was expected to become the molecular marker for prediction and prognosis of gastric cancer, as well as a potential therapeutic target.

Noninvasive fetal genotyping in pregnancies at risk for PKU using a comprehensive quantitative cSMART assay for PAH gene mutations: a clinical feasibility study

OBJECTIVE

To assess the diagnostic performance of a novel circulating single molecule amplification and re-sequencing technology (cSMART) method for noninvasive prenatal testing (NIPT) of Phenylketonuria (PKU).

DESIGN

Blinded NIPT analysis of pregnancies at high risk for PKU.

SETTING

Shanghai Xinhua Hospital and Hunan Jiahui Genetics Hospital, China.

POPULATION

Couples (n = 33) with a child diagnosed with PKU.

METHODS

Trio testing for pathogenic PAH mutations was performed by Sanger sequencing. In second pregnancies, invasive prenatal diagnosis (IPD) was used to determine fetal genotypes. NIPT was performed using a PAH gene-specific cSMART assay. Based on the plasma DNA mutation ratio relative to the fetal DNA fraction, fetal genotypes were assigned using a maximum-likelihood algorithm.

MAIN OUTCOME MEASURES

Concordance of fetal genotyping results between IPD and NIPT, and the sensitivity and specificity of the NIPT assay.

RESULTS

Compared with gold standard IPD results, 32 of 33 fetuses (96.97%) were accurately genotyped by NIPT. The sensitivity and specificity of the NIPT assay was 100.00% (95% CI 59.04-100.00%) and 96.15% (95% CI 80.36-99.90%), respectively.

CONCLUSIONS

The novel cSMART assay demonstrated high accuracy for correctly calling fetal genotypes. We propose that this test has useful clinical utility for the rapid screening of high-risk and low-risk pregnancies with a known history of PKU on one or both sides of the family.

TWEETABLE ABSTRACT

NIPT of couples at high risk for PKU using a full-coverage cSMART PAH gene test.

[Evalution of life quality of children with intermittent exotropia one year after the effective surgical treatment]

Objective: To investigate the changes of life quality in children with intermittent exotropia (IXT) and their parents 1 year after surgical treatment. Methods: Retrospective study. The scores of Chinese version of the intermittent exotropia questionnaire (CIXTQ) and follow-up visits at 1 week preoperatively and 3 months, 12 months postoperatively were collected from 122 IXT children with successful eye positions 3 months postoperatively and their parents in Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University from December 2015 to July 2016. The CIXTQ scores of children with different eye positions 1 year postoperatively, the impact of parent CIXTQ scores and 1-year postoperative eye positions on children's CIXTQ scores and parents' proxy CIXTQ scores, were analyzed. Repeated measures anova was used for the analysis. Results: A total of 122 IXT children were collected in this study, there were 64 boys and 58 girls, age (2-15) years, mean (7±3) year. The eye positions of 88 (72.1%) children were successful 1 year postoperatively, and 34 (27.9%) were undercorrected 1 year postoperatively. The CIXTQ scores of children with different eye positions 1 year postoperatively were significantly higher than that at 1 week preoperatively and at 3 months postoperatively(scores of all children, 83.27±9.49 vs. 57.30±8.37 and 69.19±7.95; successful children, 84.12±8.80 vs. 57.36±8.16 and 69.99±7.85; undercorrected children, 81.07±10.95 vs. 57.14±9.04 and 67.10±7.98), with statistical significance (compared with 1 week preoperatively, t=22.44, 22.13, 8.73; compared with 3 months postoperatively, t=12.42, 11.40, 5.49; all P<0.001). However, the parent' CIXTQ scores of children with recurrent strabismus showed no significant differences when compared to those at 3 months postoperatively (P>0.05). The CIXTQ scores of parents and eye positions 1 year postoperatively showed no impact on children's CIXTQ and parents' proxy CIXTQ scores (all P>0.05). Conclusion: The orthodontic surgery can effectively improve the life quality of children with IXT and their parents 1 year after surgical treatment, and there is no correlation between the life quality of children and their parents. (Chin J Ophthalmol, 2019, 55:31-36).

Observation of Light-by-Light Scattering in Ultraperipheral Pb+Pb Collisions with the ATLAS Detector

This Letter describes the observation of the light-by-light scattering process, γγ→γγ, in Pb+Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is conducted using a data sample corresponding to an integrated luminosity of 1.73  nb^{-1}, collected in November 2018 by the ATLAS experiment at the LHC. Light-by-light scattering candidates are selected in events with two photons produced exclusively, each with transverse energy E_{T}^{γ}>3  GeV and pseudorapidity |η_{γ}|<2.4, diphoton invariant mass above 6 GeV, and small diphoton transverse momentum and acoplanarity. After applying all selection criteria, 59 candidate events are observed for a background expectation of 12±3 events. The observed excess of events over the expected background has a significance of 8.2 standard deviations. The measured fiducial cross section is 78±13(stat)±7(syst)±3(lumi)  nb.

Do pediatricians routinely perform genitourinary examinations during well-child visits? A review from a large tertiary pediatric hospital

BACKGROUND

The male genital examination is a common source of discomfort for the patient and medical provider. Performance of male genital examination is imperative; however, as many treatable diagnoses can be made. Undescended testicles (UDTs), hernias, testicular tumors, and urethral abnormalities are all potentially concerning findings which can be discovered on routine examination.

OBJECTIVE

The objectives of this study are to determine the rate at which general pediatricians perform routine genitourinary (GU) examinations in the pediatric population and to determine the rate at which UDT are diagnosed or documented in the patient's history. The authors hypothesize the rate of pediatric GU examination during routine well-child visits to be in line with the previously reported rates in the adult literature.

STUDY DESIGN

Nine hundred ninety-six consecutive male well-child visits conducted by general pediatricians at the study institution were reviewed. These visits were evaluated for documentation of a detailed GU examination as well as the presence of UDT from these examinations. In addition, past medical and surgical histories were reviewed to determine if a diagnosis of UDT was noted.

RESULTS

Pediatricians at the study institution documented GU examinations 99.1% of the time during male well-child visits. Only 1.1% of the cohort had a documentation of UDT at any time point. Of the 11 patients with UDT, 6 boys (54.5%) had spontaneous descent with no referral to urology, whereas 5 (45.5%) required orchidopexy.

DISCUSSION

Prior reports suggest 70-75% of routine office visits include a genital examination. None of these reports reviewed the pediatric population, thus making this review novel in this respect. In addition, the results are vastly different from these prior studies as the authors demonstrated over 99% of male well-child examinations included documentation of a thorough genital examination. A limitation of the study is its retrospective nature, which creates a lack of standardization across the data set. In addition, without being physically present in the examination room, one cannot discern whether an examination is simply being documented without actual performance because of the template format of the electronic medical record (EMR). Furthermore, the study was not designed to best evaluate the true rate of UDTs; therefore, the reported rate of 1.1% cannot be accurately associated with a particular age at diagnosis.

CONCLUSIONS

Pediatricians do, in fact, document GU examinations on a routine basis. This finding cannot be taken with complete certainty as verification of actual examination performance is impractical. While the data demonstrated a lower than expected rate of UDT, depending upon age at diagnosis, this could indicate that although examinations are being documented, their accuracy may be diminished because of various factors at play in the healthcare system as a whole, including improper exam performance and EMR templates. Follow-up studies are required to verify these potentially changing rates of UDT and to determine if there is discordance between documentation and performance of GU examinations.

Comparison of Fragmentation Functions for Jets Dominated by Light Quarks and Gluons from pp and Pb+Pb Collisions in ATLAS

Charged-particle fragmentation functions for jets azimuthally balanced by a high-transverse-momentum, prompt, isolated photon are measured in 25  pb^{-1} of pp and 0.49  nb^{-1} of Pb+Pb collision data at 5.02 TeV per nucleon pair recorded with the ATLAS detector at the Large Hadron Collider. The measurements are compared to predictions of Monte Carlo generators and to measurements of inclusively selected jets. In pp collisions, a different jet fragmentation function in photon-tagged events from that in inclusive jet events arises from the difference in fragmentation between light quarks and gluons. The ratios of the fragmentation functions in Pb+Pb events to that in pp events are used to explore the parton color-charge dependence of jet quenching in the hot medium. In relatively peripheral collisions, fragmentation functions exhibit a similar modification pattern for photon-tagged and inclusive jets. However, photon-tagged jets are observed to have larger modifications than inclusive jets in central Pb+Pb events.

Resection of liver metastases from breast cancer: a multicentre analysis

BACKGROUND

Surgery is becoming more practical and effective than conservative treatment in improving the poor outcomes of patients with breast cancer liver metastasis (BCLM). However, there is no generally acknowledged set of standards for identifying BCLM candidates who will benefit from surgery.

METHODS

Between January 2011 and September 2018, 67 female BCLM patients who underwent partial hepatectomy were selected for analysis in the present study. Prognostic factors after hepatectomy were determined. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and intrahepatic recurrence-free survival (IHRFS).

RESULTS

The 1-, 3- and 5-year OS of patients treated with surgery was 93.5%, 73.7% and 32.2%, respectively, with a median survival time of 57.59 months. The Pringle manoeuvre [hazard radio (HR) = 0.117, 95% CI0.015-0.942, p = 0.044] and an increased interval between breast surgery and BCLM diagnosis (HR0.178, 95% CI 0.037-0.869, p = 0.033) independently predicted improved overall survival for BCLM patients. The 1-, 2- and 3-year IHRFS of patients who underwent surgery was 62.8, 32.6% and 10.9%, respectively, with a median intrahepatic recurrence-free survival time of 13.47 months. Moderately differentiated tumours (HR  0.259, 95% CI 0.078-0.857, p = 0.027) and the development of liver metastasis more than 2 years after breast surgery (HR  0.270, 95% CI 0.108-0.675, p = 0.005) might be predictors of increased IHRFS.

CONCLUSIONS

An interval of more than 2 years between breast cancer surgery and liver metastasis seems to be an indication of liver surgery in BCLM patients. The Pringle manoeuvre and moderately differentiated tumours are potential predictors associated with OS and IHRFS, respectively, as benefits from liver resection. Studies with increased sample sizes are warranted to validate our results.

[The effect of surgical methods and postoperative eye position on the quality of life in patients with intermittent exotropia]

Objective: To evaluate the effects of different surgical methods and postoperative eye positions on the quality of life of children with intermittent exotropia (IXT) and their parents 3 months following strabismus surgery. Methods: Clinical observation. One-hundred and eighty children aged 2 to 17 years with IXT who received surgical treatment were recruited. One parent of each child was investigated by using 2 kinds of the Chinese version of the Intermittent Exotropia Questionnaires (CIXTQ) within 1 weeks before and at 3 months after surgery: the parent proxy scale (for parents to assess children's health related quality of life (HRQoL)) and the parent scale (containing functional, psychosocial and surgery subscales; for parents to assess their HRQoL). One hundred and eighty children were divided into different groups according to the surgical. Methods Monocular surgery group, binocular surgery group and eye position after 3 months: undercorrection group, successful group, overcorrection group, to explore: (1) the change of scores before and after surgery. (2) the difference of score changes after surgery between monocular and binocular surgery groups. (3) the difference of score changes after surgery between different postoperative eye position groups. Results: Significant improvement in median scores was seen from pre-operation to 3months post-operatively for all the proxy scale (t=-9.585, P<0.001), the functional (t=-11.361, P<0.001), psychosocial (t=-10.856, P<0.001) and surgery subscale (t=-11.622, P< 0.001) of parent scale. The change values from pre-operation to 3months post-operatively were not significantly different between monocular and binocular surgery groups for all the proxy scale (t=0.242, P=0.330), the functional (t=0.462, P=0.050), psychosocial (t=0.781, P=0.582) and surgery subscale (t=0.009, P=0.355) of parent scale, but significantly different between undercorrection, successful and overcorrection groups for the proxy scale (F=21.527, P<0.001), the functional (F=54.236, P<0.001), psychosocial (F=41.784, P<0.001) and surgery subscale (F=31.943, P<0.001). The scores of proxy scale and 3 parent subscales were all significantly improved (t=-13.639 to -6.059, P<0.05) after operation in both the undercorrection and successful groups, while significantly decreased in the overcorrection group (t=1.350-4.391, P<0.05). Conclusions: HRQoL can be improved significantly in both the undercorrection and successful groups, while decreased in the overcorrection group. (Chin J Ophthalmol, 2017, 53: 924-930).

[The influence factors of quality-of-life in patients with thyroid-associated ophthalmopathy]

Objective: To assess the risk factors associated with decreased quality-of-life in patients with thyroid-associated ophthalmopathy (TAO). Methods: Cross-sectional study. One hundred and twelve patients with TAO and 68 controls were recruited to answer the Graves' ophthalmopathy quality-of-life questionnaire (GO-QOL) from January 2014 to April 2016. The GO-QOL included two subscales: the visual functioning and the psychosocial consequences. The differences in the GO-QOL scores between TAO patients and controls were analyzed. The influences of multiple factors on the GO-QOL scores among TAO patients were explored. Results: Among 112 TAO patients, 63 were male and 49 were female, with an average age of (45.4±13.1) years. Among 68 controls, 36 were male and 32 were female, with an average age of (39.5±10.8) years. Independent sample t test showed that TAO patients had significantly lower scores than controls in the visual functioning subscale and the psychosocial consequences subscale (55.63±29.02 vs 97.48±6.96, t=-14.58, P<0.01; 57.61±29.97 vs100±0.00, t=-14.97, P<0.01). Among TAO patients, smokers were associated with significantly lower psychological subscale scores than non-smokers (t=-2.284, P=0.024). Patients with abnormal primary position of eye scored significantly lower than those with normal alignment in functional (t=-3.979, P<0.001) and psychological subscales (t=-2.154, P=0.034) Patients with abnormal eye movement had significantly lower functional scores than those without (t=-2.975, P=0.004). One-way analysis of variance showed that higher CAS scores were significantly related to lower psychological subscale scores (F=3.178, P=0.018). Patients with upper eyelid retraction had significantly lower psychological subscale scores than those without (F=3.562, P=0.032). Pearson correlation analysis showed that age was negatively correlated with functional subscale scores (r=-0.366; P<0.01). TAO course was negatively correlated with functional (r=-0.235, P<0.05) and psychological subscale scores (r=-0.320, P<0.01). The degree of exophthalmos was negatively correlated with psychological subscale scores (r=-0.209, P<0.01). Multivariable linear regression analysis showed that only primary position of eye (P=0.013) and TAO course (P=0.007) were negatively correlated with functional subscale scores and only CAS scores (P=0.022) and TAO course (P=0.024) were negatively correlated with psychological subscale scores. Conclusion: Risk factors associated with lower quality-of-life among TAO patients included abnormal primary position of eye, higher CAS scores, and longer TAO course.(Chin J Ophthalmol,2017,53: 575-582).

Combination of Searches for Invisible Higgs Boson Decays with the ATLAS Experiment

Dark matter particles, if sufficiently light, may be produced in decays of the Higgs boson. This Letter presents a statistical combination of searches for H→invisible decays where H is produced according to the standard model via vector boson fusion, Z(ℓℓ)H, and W/Z(had)H, all performed with the ATLAS detector using 36.1  fb^{-1} of pp collisions at a center-of-mass energy of sqrt[s]=13  TeV at the LHC. In combination with the results at sqrt[s]=7 and 8 TeV, an exclusion limit on the H→invisible branching ratio of 0.26(0.17_{-0.05}^{+0.07}) at 95% confidence level is observed (expected).

Glucocorticoid receptor involvement in goose (Anas cygnoides) pituitary somatotroph differentiation induced by glucocorticoids during embryonic development

1. In this study, geese (Anas cygnoides) embryonic pituitary cells were cultured in vitro to determine if glucocorticoids could induce growth hormone (GH) expression and to investigate the molecular mechanisms involved in this process. 2. On embryonic day 15 (e15) and e20 the pituitary cells were treated with corticosterone (CORT), membrane impermeable bovine serum albumin-conjugate corticosterone (CORT-BSA), dexamethasone (DEX), and a glucocorticoid receptor (GR) antagonist (RU486) to detect responsiveness of somatotrophs to glucocorticoids. 3. Treatment with CORT, CORT-BSA, and DEX for as little as 6 h increased the percentage of GH-positive cells (P < 0.01) and increased GH mRNA expression (P < 0.01) in e15 goose pituitary cells compared to the control. CORT significantly increased the level of GH protein secreted from cultured e15 goose embryonic pituitary cells, and CORT-BSA increased GH secretion from e20 goose embryonic pituitary cells. 4. A significant increase was observed in the glucocorticoid receptor in GR transcription levels (P < 0.01) with CORT, CORT-BSA, and DEX treatment. Furthermore, the CORT-stimulated GH mRNA expression was completely negated by pre-treatment with RU486. 5. These findings demonstrate that glucocorticoids can stimulate somatotroph differentiation in vitro, as characterised by enhanced GH protein secretion andmRNA expression in cultured geese embryonic pituitary cells. The membrane GR was involved in pituitary somatotroph differentiation induced by glucocorticoids during the embryonic development of geese.

[Can urine albumin/creatinine ratio replace 24 hours urinary albumin?]

Objective: To analyze the correlation between urinary albumin/creatinine ratio (ACR) and 24-hour urinary microalbumin (UMA) and evaluate the predictive value of ARC for early diabetic nephropathy. Methods: A total of 368 patients with type 2 diabetes mellitus were retrospectively collected. Early diabetic nephropathy was defined as 24h UMA 30~<300 mg/24h. The correlation between ACR and 24hUMA, and the area under the receiver operating characteristic (ROC) curve of ACR in diagnosis of early diabetic nephropathy were calculated. Gender, age, course of disease, fasting venous blood glucose, glycosylated hemoglobin, blood pressure, triglyceride and total cholesterol were used as adjusting variables to establish univariate and multivariate logistic models of ACR for early diabetic nephropathy, respectively. A regression model was used to evaluate the diagnostic value of ACR for early diabetic nephropathy. Results: The correlation between ACR and 24h UMA was 0.658. The area under ROC curve of ACR for early diabetic nephropathy was 0.907 before and 0.933 after adjustments of gender, age, course of disease, fasting venous blood glucose, glycosylated hemoglobin, blood pressure, triglyceride and total cholesterol, respectively. The OR value of ACR of diabetic nephropathy was 2.016 before and 2.762 after same adjustments. The calibration of Hosmer-Lemeshow chi-square test evaluation model was 19.362 before (P=0.13) and 14.928 after adjustments (P=0.061). Conclusion: ACR is a better predictor for early diabetic nephropathy although its value is influenced by gender, age, course of disease, blood sugar, lipid, and blood pressure.

Search for the Production of a Long-Lived Neutral Particle Decaying within the ATLAS Hadronic Calorimeter in Association with a Z Boson from pp Collisions at sqrt[s]=13 TeV

This Letter presents a search for the production of a long-lived neutral particle (Z_{d}) decaying within the ATLAS hadronic calorimeter, in association with a standard model (SM) Z boson produced via an intermediate scalar boson, where Z→ℓ^{+}ℓ^{-} (ℓ=e, μ). The data used were collected by the ATLAS detector during 2015 and 2016 pp collisions with a center-of-mass energy of sqrt[s]=13  TeV at the Large Hadron Collider and correspond to an integrated luminosity of 36.1±0.8  fb^{-1}. No significant excess of events is observed above the expected background. Limits on the production cross section of the scalar boson times its decay branching fraction into the long-lived neutral particle are derived as a function of the mass of the intermediate scalar boson, the mass of the long-lived neutral particle, and its cτ from a few centimeters to one hundred meters. In the case that the intermediate scalar boson is the SM Higgs boson, its decay branching fraction to a long-lived neutral particle with a cτ approximately between 0.1 and 7 m is excluded with a 95% confidence level up to 10% for m_{Z_{d}} between 5 and 15 GeV.

Hydroxysafflor yellow A attenuates high glucose-induced human umbilical vein endothelial cell dysfunction

High glucose (HG) induces vascular injury in diabetes. Hydroxysafflor yellow A (HSYA) has been used to ameliorate ischemic cardiovascular diseases in China for many years. In the present study, we assessed whether HSYA has a potential protective role in HG-induced human umbilical vein endothelial cell (HUVEC) injury. Cell viability was determined with an 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay. Cell apoptosis was detected by fluorescein isothiocyanate/propidium iodide staining assay. The endothelial cell permeability was measured with a permeability assay. Cell adhesion molecule (CAM) expression, vascular endothelial growth factor, and basic fibroblast growth factor levels were detected with an enzyme-linked immunosorbent assay. Reactive oxygen species (ROS) formation was measured with a DCF-DA assay. Protein expression of NADPH oxidase 4 (NOX4) was measured by Western blotting. Our data indicated that HG increases HUVEC apoptosis, vascular permeability, monocyte adhesion, the level of CAMs, the formation of ROS, and NOX4 expression. Our data revealed that HG increases vascular injury, which is attenuated by HSYA. Because vascular inflammation has a key role in the development of diabetes mellitus, our results implied that HSYA is considered as a potential agent for diabetic vascular injury treatment.

Azimuthal Anisotropy of Heavy-Flavor Decay Electrons in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Angular correlations between heavy-flavor decay electrons and charged particles at midrapidity (|η|<0.8) are measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is carried out for the 0%-20% (high) and 60%-100% (low) multiplicity ranges. The jet contribution in the correlation distribution from high-multiplicity events is removed by subtracting the distribution from low-multiplicity events. An azimuthal modulation remains after removing the jet contribution, similar to previous observations in two-particle angular correlation measurements for light-flavor hadrons. A Fourier decomposition of the modulation results in a positive second-order coefficient (v_{2}) for heavy-flavor decay electrons in the transverse momentum interval 1.5<p_{T}<4  GeV/c in high-multiplicity events, with a significance larger than 5σ. The results are compared with those of charged particles at midrapidity and those of inclusive muons at forward rapidity. The v_{2} measurement of open heavy-flavor particles at midrapidity in small collision systems could provide crucial information to help interpret the anisotropies observed in such systems.

[Diffuse pulmonary meningotheliomatosis: a case report and literature review]

Objective: To analyze the clinical features, diagnosis and differential diagnosis of diffuse pulmonary meningotheliomatosis (DPM), a rare subtype of minute pulmonary meningothelial-like nodules (MPMN), so as to improve the understanding of this disorder. Methods: The clinical data of a patient diagnosed as DPM admitted in department of Respiratory Medicine, Peking University Third Hospital in August 2016 were reported and the related literatures were reviewed. With "pulmonary meningothelial-like nodules" , "minute pulmonary meningothelial-like nodules" or "diffuse pulmonary meningotheliomatosis" as the search terms, and the search time before November 1st 2017 for Wanfangdata, China National Knowledge Infrastructure (CNKI), and PubMed.Twenty-five articles were retrieved, among which 6 English (all case reports) articles were found with the search term "diffuse pulmonary meningotheliomatosis" involving 10 cases, and the other 19 articles (1 Chinese, 18 English) about MPMN mainly discussed non-DPM cases,including 13 case reports and 6 pathological/genetic studies. Results: A 68-year old female was admitted to the hospital because of intermittent cough and expectoration for more than 3 years and aggravation for 3 weeks. Her pulmonary CT showed diffuse minute nodules distributed randomly throughout both lungs, and did not improve after treatment with oral Moxifloxacin for 2 weeks. A video-assisted thoracoscopic biopsy was performed. The specimens showed MPMN and no other lesions, which confirmed the final diagnosis of DPM. She was followed without any medication therapy and her pulmonary CT showed stabilization of the lesions one year later. DPM was considered as a rare type of MPMN. A total of 11 cases were analyzed, including 10 cases reported in the literature. The patients included 1man and 10 women, aged 51 to 75 years, with an average age of (64±8) years. Among the 11 patients, 8 denied a history of smoking or of occupational exposure, 7 presented with dyspnea, shortness of breath, or fatigue, and 8 had mild abnormalities of pulmonary function test. The pulmonary CT of all the patients showed randomly distributed, diffuse bilateral small solid or ground-glass nodules, with the diameters less than 5 millimeters, some of which were cavitated. Only 1 patient had pulmonary thromboembolism, while the other 10 did not have any other lung diseases. All the patients were histologically diagnosed, 8 by open lung biopsies, 2 by transbronchial lung biopsy, and 1 by CT-guided fine needle aspiration. Three patients were followed for 12-92 months and the lung lesions were all stable. Conclusions: As a rare subtype of MPMN, DPM lacks specificity of clinical manifestations, and presents with diffuse bilateral small solid or ground-glass nodules, distributed randomly throughout both lungs. An early correct diagnosis depends on biopsy.

Search for doubly charged scalar bosons decaying into same-sign W boson pairs with the ATLAS detector

A search for doubly charged scalar bosons decaying into W boson pairs is presented. It uses a data sample from proton-proton collisions corresponding to an integrated luminosity of 36.1 fb - 1 collected by the ATLAS detector at the LHC at a centre-of-mass energy of 13 TeV in 2015 and 2016. This search is guided by a model that includes an extension of the Higgs sector through a scalar triplet, leading to a rich phenomenology that includes doubly charged scalar bosons H ± ± . Those bosons are produced in pairs in proton-proton collisions and decay predominantly into electroweak gauge bosons H ± ± → W ± W ± . Experimental signatures with several leptons, missing transverse energy and jets are explored. No significant deviations from the Standard Model predictions are found. The parameter space of the benchmark model is excluded at 95% confidence level for H ± ± bosons with masses between 200 and 220 GeV.

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Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

[Effect of HIF-2α mediated FoxM1 expression on proliferation of pulmonary artery smooth muscle cells in hypoxic rats]

Objective: To investigate the effect of hypoxia-inducible factor 2α (HIF-2α) gene on the expression of Forkhead box M1 (FoxM1) protein in the proliferation of hypoxic rat pulmonary artery smooth muscle cells (PASMC). Methods: HIF-2α overexpression lentiviral vector (LV-HIF-2α) and silencing RNA (siRNA) were constructed and transfected into rat PASMC under normoxia and hypoxia, respectively. The PASMC under normoxia were classified into normoxic control group, normoxia + LV-HIF-2α empty group, normoxia + LV-HIF-2α group; the PASMC under hypoxia were classified into hypoxic control group, hypoxia + siRNA-HIF-2α empty group, hypoxia + siRNA-HIF-2α group. The expression of HIF-2α and its downstream proteins FoxM1, cyclin D1 and Aurora A expressions were detected by Western blot. 5-Ethyny-2'-deoxyuridine (EdU) cell proliferation assay was used to evaluate the effect of overexpression and inhibition of HIF-2α expression on the proliferation of rat PASMC. Results: The expression of HIF-2α in normoxia + LV-HIF-2α group was significantly higher than that in normoxic control group and normoxia+LV-HIF-2α empty group (0.17±0.02 vs 0.09±0.01 and 0.07±0.00), while the expression of HIF-2α in PASMC of hypoxia + siRNA-HIF-2α group was significantly lower than that of hypoxic control group and hypoxia + siRNA-HIF-2α empty group (0.28±0.01 vs 0.35±0.02 and 0.30±0.01) (all P<0.05); the expression of FoxM1 protein, cyclinD1 and cell proliferation-related Aurora A protein in normoxia+LV-HIF-2α group were significantly higher than that in normoxic control group and normoxia+LV-HIF-2α empty group (0.40±0.03 vs 0.24±0.01 and 0.30±0.01, 0.22±0.02 vs 0.09±0.01 and 0.08±0.02, 0.29±0.02 vs 0.04±0.01 and 0.07±0.01, respectively) (all P<0.05); the expressions of FoxM1 protein, cyclinD1 and Aurora A protein in hypoxia + siRNA-HIF-2α group were significantly lower than those in hypoxic control group and hypoxia + siRNA-HIF-2α empty group (0.23±0.01 vs 0.36±0.02 and 0.32±0.01, 0.15±0.01 vs 0.31±0.01 and 0.28±0.03, 0.14±0.02 vs 0.33±0.03 and 0.27±0.02, respectively) (all P<0.05); the positive expression rate of EdU in the normoxic control group was significantly lower than that in the normoxia+LV-HIF-2α group [(30.77±2.43)% vs (55.56±3.01)%], while the hypoxic control group was significantly higher than the hypoxic+siRNA-HIF-2α group [(65.28±3.21)% vs (44.64±2.78)%] (both P<0.05). Conclusion: HIF-2α up-regulates the expression of FoxM1 and promotes the proliferation of pulmonary artery smooth muscle cells in hypoxic rats.

Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project

BACKGROUND

Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care.

METHODS

All 175 acute hospital switchboards in England were contacted six times. Call contents and duration were recorded. No clinician calls or bleeps were connected.

RESULTS

The mean delay before contacting a switchboard operative was 55±46 seconds. 115 hospitals (66%) used automated switchboards; 34 of these (30%) had infection control messages. Robot operators introduced an additional 40 second delay versus humans (mean 70.3±28 versus 29.8±23 seconds, p<0.0001). Multivariate analysis identified robot operators (HR 5.1, p<0.0001) and infection control messages (HR 2.9, p=0.003) as predictors of delays over 60 seconds.

CONCLUSIONS

There are significant avoidable delays in contacting switchboard operatives across England. Quality improvement is underway.