[Thoughts and suggestions on digital services to enhance the level of vaccination management]

With the development of information technology and the increasing demand for vaccination services among the people, it is a definite trend to enhance the quality of vaccination services through digitization. This article starts with a clear concept of digital services for vaccination, introduces the current development status in China and abroad, analyzes the advantages and disadvantages of existing models in leading regions, takes a glean from the summation, and proposes targeted solutions. This study suggests establishing a departmental coordination mechanism for data interconnection and sharing, formulating data standards and functional specifications, enhancing the functionalities of the immunization planning information system, strengthening data collection and analytical usage, and intensifying appointment management and science and health education to provide expert guidance for the construction of digital vaccination services across the country in the future.

[Seroepidemiological analysis of hepatitis B virus infection among adolescents aged 0-14 years in Henan Province and preliminary evaluation of the effectiveness of childhood hepatitis B vaccine immunization program]

Objective: To analyze the seroepidemiological characteristics of hepatitis B virus (HBV) infection among adolescents aged 0-14 years in Henan Province and to evaluate the effectiveness of the childhood hepatitis B vaccine (HepB) immunization program. Methods: From September 2021 to March 2022, a total of 4 883 adolescents aged 0-14 years were selected from 25 villages or communities of 18 provincial-level cities in Henan Province by using the multi-stage random cluster sampling method. Demographic data were collected through questionnaires. The 3 ml of blood samples were collected from individuals aged 0-4 years and 5 ml of blood samples were collected from individuals aged 5-14 years to test HBsAg, HBcAb and HBsAb. Data on vaccination were collected through Henan Provincial Immunization Information System and hepatitis B cases in Henan Province were collected through China Infectious Disease Reporting System. The effectiveness of the childhood HepB immunization program was analyzed. Results: The average age of 4 883 subjects was (7.32±2.81) years old. The positive rates of HBsAg and HBcAb were 0.1% (7/4 883) and 1.0% (50/4 883), and the population standardized rates were 0.3% and 1.7%. In 2002, the positive rate of HBsAg among adolescents aged 0-14 years in Henan Province was 3.39%. Compared with that in 2002, the number of chronic HBV infections among adolescents in Henan Province in 2022 decreased by about 0.7 million. In 2002, the vaccination rate of newborns who completed all three doses of vaccine was 6.26%. In 2003, the vaccination rate of the hepatitis B vaccine rose rapidly, reaching 90% in 2013 for the first time. After 2014, the vaccination rate in Henan Province continued to remain above 95%. The proportion of cases among children aged 1-4 years in clinical reports decreased from 0.43% (1 108/256 566) in 2006 to 0.01% (78/80 655) in 2021. The proportion of cases among adolescents aged 5-19 years decreased from 18.21% (46 710/256 566) in 2006 to 1.1% (827/80 655) in 2021. Conclusions: From 2002 to 2022, the positive rate of HBsAg among adolescents aged 0-14 years has decreased significantly in Henan Province. The effectiveness of the HepB immunization program for children is good.

Prediction of Parkinson's disease by transcranial sonography-based deep learning

OBJECTIVES

Transcranial sonography has been used as a valid neuroimaging tool to diagnose Parkinson's disease (PD). This study aimed to develop a modified transcranial sonography (TCS) technique based on a deep convolutional neural network (DCNN) model to predict Parkinson's disease.

METHODS

This retrospective diagnostic study was conducted using 1529 transcranial sonography images collected from 854 patients with PD and 775 normal controls admitted to the Second Affiliated Hospital of Soochow University (Suzhou, Jiangsu, China) between September 2019 and May 2022. The data set was divided into training cohorts (570 PD patients and 541 normal controls), and the validation set (184 PD patients and 234 normal controls). Using these datasets, we developed four different DCNN models (ResNet18, ResNet50, ResNet152, and DenseNet121). We then assessed their diagnostic performance, including the area under the receiver operating characteristic (AUROC) curve, specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and F1 score and compared with traditional diagnostic criteria.

RESULTS

Among the 1529 TCS images, 570 PD patients and 541 normal controls from 4 of 6 sonographers of the TCS team were selected as the training cohort, and 184 PD patients and 234 normal controls from the other 2 sonographers were chosen as the validation cohort. There were no sex and age differences between PD patients and normal control subjects in the training and validation cohorts (P values > 0.05). All DCNN models achieved good performance in distinguishing PD patients from normal control subjects on the validation datasets, with diagnostic AUROCs and accuracy of 0.949 (95% CI 0.925, 0.965) and 86.60 for the RestNet18 model, 0.949 (95% CI 0.929, 0.971) and 87.56 for ResNet50, 0.945 (95% CI 0.931, 0.969) and 88.04 for ResNet152, 0.953 (95% CI 0.935, 0.971) and 87.80 for DenseNet121, respectively. On the other hand, the diagnostic accuracy of the traditional diagnostic method was 82.30. The accuracy of all DCNN models was higher than that of traditional diagnostic method. Moreover, the 5k-fold cross-validation results in train datasets showed that these DCNN models are robust.

CONCLUSION

The developed transcranial sonography-based DCNN models performed better than traditional diagnostic criteria, thus improving the sonographer's accuracy in diagnosing PD.

Correlation Between Substantia Nigra Hyperechogenicity and Iron Metabolism in the Postural Instability Gait Difficulty Subtype of Parkinson's Disease

OBJECTIVE

The correlation between substantia nigra (SN) hyperechogenicity on transcranial sonography (TCS) and serum iron metabolism parameters in patients with the postural instability gait difficulty (PIGD) subtype of Parkinson's disease (PD) was investigated so as to explore the pathological mechanism of SN hyperechogenicity.

METHODS

The study enrolled 95 PIGD patients recruited by the Parkinson's Disease Specialty in the Second Affiliated Hospital of Soochow University during June 2019-2021. On the basis of the TCS results, the PIGD patients were assigned to the PD with SN hyperechogenicity (SN+) group (n = 60) and PD without SN hyperechogenicity (SN-) group (n = 35). Meanwhile, 49 sex- and age-matched healthy individuals were included in the control group. All participants underwent blood tests. Differences in the iron metabolism parameters among the three groups and the correlation between SN hyperechogenicity and serum iron metabolism parameters were analyzed.

RESULTS

Serum ferritin, ceruloplasmin and transferrin levels were lower in the SN+ and SN- groups than in the control group (all p values <0.001). The serum ceruloplasmin level was lower in the SN+ group (0.23 [0.20, 0.25] g/L) than in the SN- group (0.25 [0.22, 0.29] g/L) (p = 0.001), and the proportion of patients with an abnormal ceruloplasmin level was higher in the SN+ group than in the SN- group (43.3% [26/60] vs. 14.3% [5/35], χ2 = 8.484, p = 0.004). Moreover, the SN hyperechogenicity area was negatively correlated with the serum transferrin level (r = -0.428, p < 0.001).

CONCLUSION

Decreased serum ceruloplasmin levels may be associated with SN hyperechogenicity development in PIGD patients. The SN hyperechogenicity area is negatively correlated with the serum transferrin level.

[Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases]

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ² test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ²=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

Association Between Asymmetry of Substantia Nigra Hyperechogenicity and Clinical Characteristics in Different Parkinson Disease Subtypes: A 5-Year Follow-up Study

Our study focused on three aspects to determine whether bilateral substantia nigra hyperechogenicity (SN+) is asymmetrical, whether the asymmetry of SN+ is related to the clinical features and whether there is variation in SN+ asymmetry during the progression of Parkinson disease (PD). This follow-up study included 234 patients with PD, who were divided into tremor PD (TD, n = 67) and non-tremor PD (NTD, n = 167) groups based on the Unified Parkinson's Disease Rating Scale (UPDRS) Part III. All participants underwent transcranial sonography (TCS) and clinical assessment. In both the TD and NTD groups, the initial SN+ was larger than the non-initial SN+. The initial SN+ was associated with Hoehn and Yahr (H&amp;Y) stage, PD duration and initial UPDRS III, and the SN+ asymmetry index was associated with motor asymmetry index in the TD group. In the NTD group, the initial SN+ was associated only with initial UPDRS III. After a 5-year follow-up, the area of SN+ on both sides was gradually inclining to symmetry in the NTD group. Our study determined that SN+ asymmetry could reflect asymmetrical characteristics of PD. Furthermore, we inferred that the dynamic change in SN+ asymmetry might reflect a dynamic change in motor asymmetry in the NTD group.

[Short-term efficacy of anti-IgE monoclonal antibody in patients with recurrent chronic rhinosinusitis with nasal polyps combined with asthma]

Objective: To investigate the short-term efficacy of anti-IgE monoclonal antibody (Omalizumab) in the treatment of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) complicated with asthma. Methods: Patients with recurrent CRSwNP and comorbid asthma in Beijing TongRen Hospital from May to December of 2020 were continuously recruited and received a 4-month therapy of stable background treatment plus Omalizumab. Results of visual analog scales (VAS) of nasal symptoms, sino-nasal outcome test-22 (SNOT 22) and nasal polyp scores were collected at baseline and post-treatment (1, 2, 3 and 4 months after treatment). Blood routine tests, total nasal resistances (TNR), minimum cross-sectional areas (MCA), total nasal cavity volumes (NCV), forced expiratory volumes in one second (FEV1)/forced vital capacity (FVC) and adverse events were collected at baseline and 4 months after treatment. All results were evaluated for short-term efficacy of Omalizumab. GraphPad Prism 8.2.1 was used for statistic analysis. Results: Ten patients were collected, including 3 males and 7 females, aged (41.13±12.64) years old (x¯±s). Compared to results at baseline, the VAS scores of nasal obstruction, rhinorrhea, hyposmia and headache after 4 months treatment were significantly decreased (1.80±1.48 vs 6.70±2.83, 2.40±1.27 vs 6.40±3.44, 2.70±2.91 vs 8.20±2.25, 0.60±1.08 vs 3.60±2.72, t value was 5.045, 4.243, 5.312, 3.402, respectively, all P<0.01). The scores of SNOT-22 (25.6±20 vs 61.3±33.32, t=4.127, P=0.002 6), nasal polyp scores (2.20±0.92 vs 4.60±0.84, t=9.000, P<0.01) and the count and percentage of eosinophils in peripheral blood were significantly decreased ((94.10±97.78)×10⁹/L vs (360.00±210.80)×10⁹/L, (32.90±27.06)% vs (64.40±20.73)%, t value was 3.678, 2.957, respectively, all P<0.05). NCV (0-5 cm and 0-7 cm) of patients were improved from baseline ((12.62±2.84) cm³ vs (10.40±2.09) cm³, (27.50±14.15) cm³ vs (16.81±6.40) cm³, t value was 2.371, 2.445, respectively, all P<0.05). Conclusions: The 4-month treatment of Omalizumab can significantly improve the nasal symptoms and quality of life of patients with recurrent CRSwNP complicated with asthma, shrink nasal polyps size and reduce the number of peripheral blood eosinophils. Omalizumab can be used as an alternative therapy for refractory CRSwNP patients in the future.

Association between homocysteine and third ventricle dilatation, mesencephalic area atrophy in Parkinson's disease with cognitive impairment

OBJECTIVES

This study aimed to explore the association of homocysteine (Hcy) with third ventricle (V3) dilatation and mesencephalic area (MA) atrophy as determined by transcranial sonography (TCS) in Parkinson's disease (PD) with cognitive impairment.

METHODS

The final statistical analysis included 101 PD patients and 20 age- and sex-matched controls. Using the Movement Disorder Society (MDS) level II criteria for PD with cognitive impairment, we categorized the PD patients into PD with normal cognition group (PD) and PD with cognitive impairment group (PDC). All subjects underwent TCS and laboratory analysis.

RESULTS

The V3 width (r = 0.349, P = 0.005) and the MA (r = -0.484, P < 0.001) were significantly correlated with the Hcy concentration in the PDC patients. Binary logistic regression analysis revealed that age (OR [95% CI] = 1.114 [0.991-1.251], P = 0.002), and Hcy level (OR [95% CI] = 0.931 [0.752-1.153], P = 0.411) were independent risk factors for V3 dilatation. Hcy level (OR [95% CI] = 0.557 [0.323-0.967], P = 0.035) were independent risk factors for MA atrophy. After adjustment for confounding factors, the odds ratio of V3 dilatation was 3.50 (95% CI 1.054-11.399, P = 0.031) and the odds ratio of MA atrophy was 4.67 (95% CI 1.395-15.602, P = 0.012) in the patients with higher Hcy level compared with the lower level.

CONCLUSIONS

The results revealed a close association between the V3 width, MA and Hcy concentration in PD patients with cognitive impairment. We hypothesized that increased Hcy concentration played a significant role in the development of brain atrophy in PD with cognitive impairment.

Shear wave elastography characteristics of upper limb muscle in rigidity-dominant Parkinson's disease

BACKGROUND

Rigidity is one of the major manifestations of Parkinson's disease (PD), but no quantitative and objective imaging method has been developed to measure rigidity. Ultrasound shear wave elastography (SWE) can reflect the stiffness of tissue by providing a quantitative index. Thus, we conducted this study to evaluate the potential clinical value of SWE in assessing rigidity in PD.

METHODS

A total of 63 subjects (44 patients with rigidity-dominant PD and 19 right-dominant-hand normal controls with matched age) were enrolled, and each underwent ultrasound SWE testing. The tests were conducted on the brachioradialis (BR) and biceps brachii (BB) on the more affected side in patients with PD and on the right side in normal controls. Differences in quantitative shear wave velocity (SWV) between patients with PD and normal controls were determined. The relationship of muscle SWV with joint rigidity, UPDRSIII, disease duration, sex, and age in patients with PD was analyzed. The intraclass correlation coefficient (ICC) was used to evaluate the reliability of SWE in assessing muscle stiffness in patients with PD.

RESULTS

The mean SWVs of the BB and BR were higher in the PD group (3.65±0.46 and 4.62±0.89 m/s, respectively) than in normal controls (2.79±0.37 and 3.26±0.40 m/s, respectively). Stiffness in BR and BB was correlated with the upper-limb joint rigidity, UPDRSIII, and disease duration but not with sex or age in the PD group. The intraobserver correlation coefficients (ICCs) for interobserver and intraobserver variations in measuring SWV were 0.85 (95% confidence interval 0.56-0.95) and 0.85 (95% confidence interval 0.58-0.95), respectively, for BR and 0.90 (95% confidence interval 0.73-0.97) and 0.86 (95% confidence interval 0.61-0.95), respectively, for BB.

CONCLUSIONS

SWV is associated with joint rigidity and disease duration, indicating that SWE can be potentially used as an objective and quantitative tool for evaluating rigidity.

[Comparison of myotomy and coronary artery bypass grafting in surgical treatment of symptomatic left anterior descending myocardial bridges]

Objective: To compare the effect of myotomy and coronary artery bypass grafting (CABG) to treat symptomatic myocardial bridges (MBs) of the left anterior descending artery (LAD). Methods: From January 2009 to December 2017, a total of 54 eligible patients [34 males, 20 females, with a median age of 60 (51, 64) years old] with symptomatic MBs of LAD who underwent myotomy (31 patients) or CABG (23 patients) at the Department of Cardiovascular Surgery of Zhongshan Hospital, Fudan University were included in the study. Surgical effect of the two groups were compared and multivariate logistic regression models were used to analyze the risk factors of major adverse cardiac events (MACE). Results: No significant differences between the two groups were observed with respect to age, gender, risk factors of coronary artery disease (CAD), symptoms, angiographic findings of MBs and preoperative cardiac status, and 0 surgery-associated death was observed. Among the 31 myotomy patients, 4 patients underwent off-pump myotomy (including one patient who underwent urgent conversion from off-pump to on-pump surgery due to massive hemorrhaging secondary to the right ventricular perforation), and the remaining 27 cases received myotomy under cardiopulmonary bypass with cardiac arrest. All 23 bypass surgery patients underwent off-pump CABG surgery with in situ left internal mammary artery (LIMA) grafting to the distal LAD. After LIMA grafting, the median graft flow was 14 (11, 20) ml/min. During a median follow-up of 26 months, 11 patients developed MACEs (7.4% for myotomy vs 40.9% for bypass surgery, P=0.007). Surgical strategy (CABG surgery vs myotomy) was an independent risk factor for MACE (OR=3.681, 95% CI: 1.812-8.685, P=0.011). Compared with myotomy, CABG surgery had a significantly higher incidence of adverse angiographic results (3.7% of residual compression vs 40.9% of LIMA graft failure, P=0.003). Among 10 CABG surgery patients with LAD-MBs and proximal coronary obstruction, all LIMA grafts were patent, though one case reported recurrent angina pectoris 2 years after the surgery which was relieved after drug therapy. Conclusions: For patients with symtomatic LAD-MBs, myotomy may be associated with favorable mid-term outcomes and angiographic results. However, CABG surgery should be recommended for those with concomitant proximal obstruction of LAD.

[Short-term outcomes of minimally invasive reoperation for tricuspid regurgitation after left-sided valve surgery]

Objective: To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery. Methods: From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization. Results: All patients received minimally invasive isolated tricuspid valve replacement (n=81) or tricuspid valve repair (n=8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure (n=1) and low cardiac output associated with postoperative bleeding (n=2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days (M(Q(R))). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation. Conclusions: For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.

[Surgical treatment for tricuspid regurgitation after left-sided valve surgery]

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.

[Problems and thoughts of preserving femoral head treatment of osteonecrosis of femoral head]

By literature review and experience summary, some problems are found in conservative treatment of osteonecrosis of femoral head(ONFH): lacking in researches of natural history of ONFH, disunion in classfication and the standard of outcome evaluation, lacking in high-level-evidence study and standard of treatment methods. It is necessary to improve the study on natural history of ONFH, unify the classfications and the standard of outcome evaluations, normalize the treatment methods, and design impeccable multi-centre study for improving the effect of conservative treatment of ONFH.

[Advances in the study of gastroesophageal varices with portal vein thrombosis in liver cirrhosis]

Portal vein thrombosis (PVT) is one of the serious complications in the decompensated stage of liver cirrhosis, which is often accompanied by the aggravation of liver cirrhosis and other complications and in severe cases; it may induce gastroesophageal variceal hemorrhage and endanger the lives of patients. Furthermore, the most common complication in decompensated stage of cirrhosis is history of gastroesophageal variceal hemorrhage and the formation of PVT that may be a risk factor to promote each other. Presently, there are guidelines for diagnosis and treatment of gastroesophageal variceal hemorrhage in liver cirrhosis, but there is still a lack of in-depth understanding of cirrhosis complicated with PVT. This paper summarizes advances in the study of gastroesophageal variceal hemorrhage complicated with PVT in liver cirrhosis in order to enhance the understanding of risk factors for diagnosis and treatment.

[Effect of clinical characteristics on relapse of alcohol dependence: a prospective cohort study]

OBJECTIVE

To investigate whether craving and demographic factors to predict relapse in alcohol dependence.

METHODS

This study was a prospective cohort study. From August 2017 to August 2018, 158 Han male inpatients who met the diagnositic and statistical manual disorders-fourth version(DSM-IV) alcohol dependence diagnostic criteria were recruited from three mental hospitals in China. The participants were interviewed at baseline and followed up by telephone after 3 months for assessment. The baseline assessment after the acute withdrawal period included demographic data and alcohol-related data, clinical institute withdrawal assessment-advanced revised (CIWA-Ar), withdrawal and cue-induced craving on visual analog scale (VAS), Michigan alcoholism screening test (MAST), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and alcohol urge questionnaire (AUQ). According to the follow-up results, "relapse" was defined as the consumption of beverages containing ethanol at any time during the follow-up study, and "time to relapse" was defined as the number of days from the first drinking to the baseline. Whether relapse occurred and the time to relapse were the primary endpoints. Cox proportional hazard regression model was used to analyze the factors affecting the relapse of alcohol dependence.

RESULTS

In the study, 158 alcohol dependence patients were finally included, age from 21 to 60 years, with the mean age of (40.31±9.14) years. The relapse rate was 63.7% three months after baseline assessment. According to Cox univariate analysis and multivariate analysis, the age (OR=0.975, P=0.030) and CIWA-Ar scores (OR=1.126, P=0.010) significantly predicted relapse. And there was no significant difference in education level, marital status, withdrawal and cue-induced craving on VAS, SAS and SDS between the relapse group and the non-relapse group (P>0.05).

CONCLUSION

Age and severity of alcohol-dependent withdrawal symptoms during hospitalization are significantly related to relapse for alcohol in alcohol-dependent patients. To be exact, the older age is a protective factor, that is to say, the younger patients are prone to relapse, while the risk of relapse is raised by the higher severity of withdrawal symptoms. However, neither cue-induced nor withdrawal craving can predict relapse of alcohol-dependent patients.

[Clinical outcomes of total arterial off-pump coronary revascularization in patients with left ventricular dysfunction]

Objective: To compare the advantages and disadvantages of total arterial revascularization (TAR) and conventional off-pump coronary artery bypass (OPCAB) grafting in patients with left ventricular dysfunction (LVD). Methods: Between January 2008 and March 2015, 76 patients who were scheduled to undergo selective OPCAB were selected for cardiac surgery in Zhongshan Hospital, Fudan University. The left ventricular ejection fraction of enrolled patients was less than 35%. Among those patients, 38 patients in TAR group underwent total arterial OPCAB with bilateral internal mammary artery, left and/or right radial artery, and another 38 patients in control group underwent conventional OPCAB with left internal mammary artery and great saphenous vein. The clinical data of all patients were collected. The follow-up was performed within 36 months. Results: There was no significant difference in preoperative clinical data between the two groups (all P>0.05). Additionally, there was no significant difference in the application rate of internal mammary artery, positive inotropic drugs and intra-aortic balloon pump (IABP) use between the two groups (all P>0.05). The operation time of TAR group was longer than that of control group [(278.3±31.2) min vs (196.7±19.1) min, P<0.01]. There was no significant difference in perioperative mortality between the two groups (5.3% vs 7.9%, P=0.64). The volume of operative drainage and blood transfusion in TAR group increased significantly at 24 hours after operation [(895.0±236.2) ml vs (585.4±172.5) ml, (656.3±84.4) ml vs (433.3±62.9) ml, both P<0.01]. There was no significant difference in perioperative complications such as heart, kidney and lung failure between the two groups (all P>0.05). At 12 months after operation, there were no significant differences in survival rate, cardiac death rate, angina recurrence, myocardial infarction, re-treatment rate of revascularization, re-hospitalization rate from cardiac insufficiency, graft patency rate, cardiac function and echocardiographic data between the two groups (all P>0.05). From 24 to 36 months after operation, all the above indexes in TAR group were better than those in control group except for echocardiographic data (all P<0.05). Conclusions: For LVD patients, the early clinical efficacy of the two surgical methods is similar, but for the long-term outcomes, the whole arterial OPCAB operation is obviously superior. However, the shortcomings of total arterial OPCAB are that operative drainage and the use of blood products increased significantly after operation.

[A progress of macrolides therapy for chronic rhinosinusitis]

Macrolides are a type of antibiotics with macrocyclic lactone ring, which have been commonly used in the treatment of diffuse panbronchiolitis, chronic obstructive pulmonary disease, bronchial asthma, cystic fibrosis and other diseases. Macrolides not only have effect on antibacterial, but also effect on anti-inflammatory and immunoregulation. Chronic rhinosinusitis (CRS) is a common disease entity of infectious and inflammatory diseases that involved in nasal cavity and nasal sinuses, with various clinical phenotypes. With the high prevalence of CRS, it seriously affects the quality of patients' life. In recent years, a large number of studies have shown that long-term low-dose macrolides are effective in parts of patients with CRS. Although the mechanism of macrolides for CRS has not yet been clarified. According to recent studies, it might be related with anti-inflammatory or immunoregulation of macrolides and the different phenotypes of CRS. The safety and mechanism of long-term macrolides are needed further clarification.

[Long-term efficacy of house dust mite subcutaneous immunotherapy in allergic rhinitis patients]

Objective:This study was aimed to compare the long-term effects of house dust mite (HDM) subcutaneous immunotherapy (SCIT) in a cohort of Chinese pediatric and adult patients with allergic rhinitis (AR).Method:Total of 48 AR patients received standardized HDM-SCIT for 3 years, and they received 3 years of standardized dust mite-specific subcutaneous immunotherapy, followed by 2 years after treatment. Prior to treatment (baseline) and at the end of the 3-year and 5-year treatment periods, all patients were evaluated for total nasal symptom scores(TNSS),total combined score (TCS;symptoms(nasal+ocular)+daily medication score),and rhinoconjunctivitis quality of life questionnaire(RQLQ).Safety of HDM-SCIT was assessed according to adverse events reported.Result:Fifteen pediatric and 33 adult AR patients completed the study.HDM-SCIT significantly improved symptoms and RQLQ scores at the 3 rd year and 5th year in both children and adults. Superior efficacy was observed at the 3-year and 5-year timepoints in children compared to adults. The safety of HDM-SCIT was comparable in children and adults with AR.Conclusion:A 3-year course of HDM-SCIT is an effective, safe and sustainable long-term treatment in both pediatric patients and adults with AR, although children appear to achieve better long-term efficacy compared to the adults.

[Minimum battery of test inhalant allergens needed in screeningallergic rhinitis patients in Beijing]

Objective:The aim was to assess the prevalence of sensitized inhalant allergens in patients with allergic rhinitis (AR), analyze the differences of aeroallergen sensitization rates (SRs) in different areas, and define the minimal number and the type of aeroallergens required to identify patients as sensitized. Method:Six thousand two hundred and eighty five patients suffering from AR symptoms in Beijing, Heilongjiang, Inner Mongolia, Hebei and Shandong areas underwent standardized skin prick test (SPT) with 20 common aeroallergens during the period from Jan 2011 to Jul 2013 when seeking medical help in Beijing Tongren Hospital. The differences of aeroallergen sensitization rates in different areas were compared. Chi square was used in statistical analysis. Conditional approach allowed to determine the aeroallergen selection. Result:Among the 6 285 self-reported AR patients investigated, 5 575 (88.7%) patients had at least one positive skin prick reaction. The most common aeroallergen in Beijing, Heilongjiang, Hebei and Shandongwere house dust mites (HDMs). SRs of HDMs in these four areas decreased with latitude increment, whereas SRs of mugwort, ragweed and dandelion in these four areas increased with latitude increment. The three most prevalent aeroallergens in Inner Mongolia were mugwort (59.86%), ragweed (47.62%) and dandelion (46.26%), respectively. Overall, 8 allergens allowed identification ≥95% of sensitized subjects in Beijing. Conclusion:Der f was the most prevalent allergen in patients with AR in Beijing, Heilongjiang, Hebei and Shandong Areas, whereas SR of mugwort was highest in Inner Mongolia. Sensitization pattern of aeroallergens varied with areas. Eight allergens allowed identification of the majority of sensitized subjects in screening panels for allergy in Beijing.

[Human papillomavirus infection and sinonasal inverted papilloma]

Sinonasal inverted papilloma is the most common seen benign disease of nasal cavities and paranasal sinuses area characterized by great recurrence rate and malignancy tendency. The infection of human papillomavirus is considered as a risk factor playing a role underneath the mechanism. However, the association between the infection of HPV and the recurrence or malignancy of SNIP remains controversial. By summarizing the existing research results, this paper further explores the association between HPV infection and SNIP.

[Myocardial revascularization among patients with severe left ventricular dysfunction: a comparison between on-pump beating-heart and off-pump coronary artery bypass grafting]

Objective: To evaluate the impacts of an on-pump beating-heart versus an off-pump coronary artery bypass grafting (CABG) technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (EF) of 35% or less. Methods: A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study and were divided into either an OBCAB group (patients who received on-pump beating-heart CABG surgery, n=88) or an OPCAB group (patients who received off-pump CABG surgery, n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t-test, χ² test or Fisher's exact test, when appropriate. Results: No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo-diastolic diameter in the OBCAB group. Patients in the OBCAB group compared to the OPCAB group had a similar in-hospital mortality (3.4% vs. 4.7%, P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge), significantly improved from (31.0±2.8)% to (35.6±2.9)% (t=10.61, P=0.000) in the OBCAB group and from (31.0±2.9)% to (34.8±3.3)% (t=9.68, P=0.000) in the OPCAB group, respectively. The improvement of mean LVEF in the OBCAB group was significantly higher than that in the OPCAB group ((4.7±0.2)% vs. (3.6±0.3)%, t=29.53, P=0.000). Patients in the OBCAB group compared to the OPCAB group had a significant higher early postoperative EF ((35.6±2.9)% vs.(34.8±3.3)%, t=1.892, P=0.034) but shared a similar baseline EF ((31.0±2.8)% vs. (31.0±2.9)%, t=0.012, P=0.930). Patients in the OBCAB group compared to the OPCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7±0.8 vs. 2.8±0.6, t=9.442, P=0.000; (715±187) ml vs. (520±148) ml, t=8.544, P=0.000, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Conclusion: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated EF of 35% or less.

[Neovascularization aggravated hepatic fibrosis in combined hypoxia NASH rat model]

Objective: To optimize the construction of combined hypoxia NASH rat model on the basis of preliminary work, and to explore the role of neovascularization in the process of hepatic fibrosis. Methods: 32 rats were divided randomly to four groups that were null control group(A group ), hypoxia group(B group), high fat diet group(C group ) and high fat diet plus hypoxia group (D group ),treated with null , Intraperitoneal injection of NaNO(2), high fat diet and high fat diet plus Intraperitoneal injection of NaNO(2) respectively. Every group was observed for 16 weeks, B and D group was treated with Intraperitoneal injection of NaNO(2) 20 mg/kg.d at the laster 8 weeks. Liver histology NASH activity score(NAS) and Fibro score(FibroS), biochemical index were detected in this combined hypoxia NASH rat model(D group), meanwhile the changes of HIF1α, inflammatory factor and neovascularization were measured by ELISA, realtime PCR and immunohistochemistry. Results: Liver tissue NAS > 4 was seen in C and D group. D group showed NASH characteristics, including significantly steatosis at liver acinar 3 area(mostly a microvesicular type fat droplets mixed with macrovesicular type), hepatocyte balloon degeneration, obvious lobular inflammation, while fibrosis score increased significantly, including visible hepatic sinusoid fibrosis, fibrosis around portal vein, and bridging fibrosis in a considerable portion of the rats. Compared with C group, biochemical indicators of aspartate aminotransferase (AST), HIF1α, neovascularization-related VEGFA, VEGFR2 mRNA level increased obviously and the expression of immunohistochemistry VEGFR2, CD34 enhanced markedly in D group(p < 0.05). Conclusion: A combined hypoxia NASH rat model can be established throught feeding 16 weeks' high-fat diet then intraperitoneal injection of NaNO(2) 20 mg / kg.d at the laster 8 weeks, meanwhile chronic hypoxia can accelerate this combined hypoxia NASH model liver fibrosis process. In this process neovascularization promoted the formation of hepatic fibrosis in this model.

Porcine Cloned Embryos Reconstructed with the Cell Nuclei of Tetraploid M-phase Fibroblast Cells Can Restore Normal Diploidy at the Blastocyst Stage

The cell cycle of donor cells as a major factor that affects cloning efficiency remains debatable. G2/M phase cells as a donor can successfully produce cloned animals, but a minimal amount is known regarding nuclear remodeling events. In this study, porcine fetal fibroblasts (PFFs) were carefully synchronized at G1 or M phase as donor cells. Most of the cloned embryos reconstructed from PFFs at G1 (G1-embryos) or M (M-embryos) phase formed a pronucleus-like nucleus (PN) within 6-h post fusion (hpf), but the M-embryos formed PN earlier than the G1-embryos did. Moreover, 77.4% of the M-embryos formed two PNs, whereas the G1-embryos formed a single PN. The rate of extrusion of polar body-like structures by the M-embryos was significantly lower than that extruded by the G1-embryos (26.3% vs. 37.1%, P < 0.05), and DNA synthesis in most embryos in both groups was initiated at 9-12 hpf. Most of the M-embryos were octoploid before the first cleavage. Furthermore, 81.25% of the blastomeres of blastocysts developed from the M-embryos showed abnormal ploidy compared with those developed from the G1-embryos (22.55%). However, some of the blastomeres remained diploid in all the M-embryos tested. A portion of the blastomeres restored normal diploidy in some of the M-embryos at the blastocyst stage. This finding provides an explanation for M-embryos developing to term.

Ulnar Osteotomy with 2-Pin Unilateral Gradual Distraction for Treatment of Chronic Monteggia Fracture: A Case Report

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.

[The multicenter study on the registration and follow-up of low anticoagulation therapy for the heart valve operation in China]

OBJECTIVE

To investigate the optimal anticoagulation methods and monitoring strategy for Chinese patients undergoing heart valve replacement, which is potentially quite different from western populations.

METHODS

In this multicenter prospective cohort study, the anticoagulation and monitoring strategy data was acquired from 25 773 in-hospital patients in 35 medical centers and 20 519 patients in outpatient clinic in 11 medical centers from January 1st, 2011 to December 31th, 2015.

RESULTS

As for in-hospital patients, mean age of study population was (48.6±11.2) years old; main etiology of valve pathology was rheumatic (87.5%) origin among study cohort; 94.8% of study population received mechanical valve implantation; international normalized ratio (INR) monitoring (in all the study centers) and low-intensity anticoagulation strategy (31 hospitals chose target INR range of 1.5-2.5, and actual values of INR among 89.2% of 100 069 in-hospital monitoring samples were 1.5-2.5), with mean actual INR values of 1.84±0.53, and warfarin dosage of (2.82±0.93) mg/d were widely adopted among the study centers; strategies of in-hospital warfarin administration were similar in all the study centers; complication rates of low-intensity anticoagulation strategy were low in severe hemorrhage (0.02%), thrombosis (0.05%), and thromboembolism (0.05%) events, without anticoagulation-related death.As for 18 974 outpatient clinic patients, the follow-up rate was 92.47%, with a total of 30 012 patient-years (Pty). Anticoagulation-related morbidity and mortality rates were 0.67% and 0.15% Pty; major hemorrhage morbidity and mortality rates were 0.25% and 0.13% Pty; thromboembolism morbidity and mortality rates were 0.45% and 0.03% Pty.The mean dosage of warfarin daily dosage was (2.85±1.23) mg/d and INR value was 1.82±0.57.No significant regional difference in the intensity of anticoagulation therapy was noted during the study.

CONCLUSIONS

INR can be used as a normalized indicator for intensity of anticoagulation therapy in China.The optimal anticoagulation intensity with INR range from 1.5 to 2.5 is safe and effective for Chinese patients with heart valve replacement, and there is no significant regional difference in the intensity of anticoagulation therapy.

[Predictive significance of tissue eosinophilia for nasal polyp recurrence]

OBJECTIVE

To evaluate the association between clinical parameters, especially tissue eosinophilia, and chronic sinusitis with nasal polyps (CRSwNP) recurrence. To identify optimal criteria of tissue eosinophilia as a predictor for recurrence.

METHODS

Two hundred and forty-eight CRSwNP patients were enrolled in this study. The demographic and clinical features were compared between recurrence and no recurrence groups. Mucosal specimens were assessed for the presence of tissue inflammatory cells. Factors associated with polyp recurrence were analyzed by Logistic regression analysis and optimal cutoff point of the predictor for nasal polyp recurrence was determined by receiver operating characteristic curve. SPSS 19.0 software was used to analyze the data.

RESULTS

The recurrence rate was 55.6%(138/248 patients) in this cohort. Tissue and peripheral eosinophilia, comorbid asthma, olfactory score and Lund-Mackay score were significantly correlated with polyp recurrence(all P<0.01). As a predictor for recurrence, tissue eosinophil accumulation outweighed other parameters. A cutoff value of 27% for tissue eosinophil percentage was able to predict recurrence with 96.4% sensitivity and 92.7% specificity (AUC=0.971, P<0.001).

CONCLUSIONS

Tissue eosinophilia provides valuable information regarding to polyp recurrence. Tissue eosinophil proportion equal to or over 27% may be regarded as the prognostic criterion for nasal polyp recurrence.

Immunocytochemical characterisation of neural stem-progenitor cells from green terror cichlid Aequidens rivulatus

In this study, cultures of neural stem-progenitor cells (NSPC) from the brain of green terror cichlid Aequidens rivulatus were established and various NSPCs were demonstrated using immunocytochemistry. All of the NSPCs expressed brain lipid-binding protein, dopamine- and cAMP-regulated neuronal phosphoprotein 32 (DARPP-32), oligodendrocyte transcription factor 2, paired box 6 and sex determining region Y-box 2. The intensity and localisation of these proteins, however, varied among the different NSPCs. Despite being intermediate cells, NSPCs can be divided into radial glial cells, oligodendrocyte progenitor cells (OPC) and neuroblasts by expressing the astrocyte marker glial fibrillary acidic protein (GFAP), OPC marker A2B5 and neuronal markers, including acetyl-tubulin, βIII-tubulin, microtubule-associated protein 2 and neurofilament protein. Nevertheless, astrocytes were polymorphic and were the most dominant cells in the NSPC cultures. By using Matrigel, radial glia exhibiting a long GFAP⁺ or DARPP-32⁺ fibre and neurons exhibiting a significant acetyl-tubulin⁺ process were obtained. The results confirmed that NSPCs obtained from A. rivulatus brains can proliferate and differentiate into neurons in vitro. Clonal culture can be useful for further studying the distinct NSPCs.

Association between DNA hypomethylation at IL13 gene and allergic rhinitis in house dust mite-sensitized subjects

BACKGROUND

Allergic rhinitis (AR) is a complex disease, in which gene-environment interactions contribute to its pathogenesis. Epigenetic modifications such as DNA methylation play an important role in the regulation of gene function. As IL13, a pleiotropic cytokine, may be important in conferring susceptibility to AR, the aim of the present work was to assess the relationship between a CpG island methylation status at the upstream of IL13 gene and house dust mite (HDM)-sensitized AR in Han Chinese subjects.

METHODS

A total of 60 patients with HDM-sensitized AR and 65 control subjects were enrolled as two independent cohorts from Beijing and Liaoning. MassARRAY EpiTYPER and pyrosequencing was used to systematically screen the status of DNA methylation in peripheral blood leucocytes. IL13 mRNA expression was measured by real-time quantitative PCR. Electrophoretic mobility shift assay was used to assess the function of methylation site.

RESULTS

The mean level of methylation was decreased in the AR patient group compared with the control group (P = 0.01). Two of a total of 33 IL13CpG units analysed (CpG units 24 : 25 : 26 and 38 : 39) showed significant differences in methylation status between the AR patient group and the control group, with DNA hypomethylation at CpG38 significantly associated with higher risk of HDM-sensitized AR in both independent cohorts and a combined cohort (Beijing: OR = 1.24, 95%CI = 1.01-1.52, P = 0.036; Liaoning: OR = 1.62, 95%CI = 1.11-2.38, P = 0.013; Combined: OR = 1.31, 95%CI = 1.10-1.56, P = 0.002). Methylation level of CpG38 correlated negatively with both IL13 mRNA expression and serum total IgE level and affected the binding affinity of SP1.

CONCLUSIONS

DNA hypomethylation of IL13 gene may be associated with increased risk of AR from HDM sensitization.

[Transapical transcatheter aortic valve replacement for high risk elderly patients with predominant aortic incompetence]

OBJECTIVES

To introduce the application of the J-Valve™ system in elderly patients with predominant aortic incompetence without significant valve calcification, and to evaluate its feasibility.

METHODS

From April 2014 to July 2015, 33 cases of transapical implantation of J-Valve™ were performed in Department of Cardiac Surgery, Zhongshan Hospital, Fudan University. Sixteen of these patients were diagnosed as predominant aortic incompetence without significant valve calcification. There were 11 male and 5 female patients aged from 61 to 84 years, with a mean age of (76±6) years. All patients had symptoms of left ventricular dysfunction for at least 3 months. They were considered to be prohibitive for surgical valve replacement (logistic European system for cardiac operative risk evaluation: 22.2% to 44.4%, mean 27%±6% after evaluation by an interdisciplinary heart team. The J-Valve™ system was applied in transapical transcatheter aortic valve replacement for patients. The multi-slice CT was performed before discharge. Clinical evaluation including patients' history, symptoms and New York Heart Association classification and echocardiogram evaluation were performed before discharge, 1(st) month, 3(th) month and 12(th) month after the operation respectively.

RESULTS

Implantations were successful in all patients. One patient died from moderate paravalvular leak which led to multi-organ failure during the hospital stay. The mean time of postoperative hospital stay of the other 15 patients was (6.1±1.3) days. The 15 patients were followed by 174 to 410 days, with a median time of 188 days. Only two patients had trivial prosthetic valve incompetence, the other 13 patients had no prosthetic valve incompetence; two patients had no paravavular leak and the other 13 patients had paravavular leak of no more than moderate grade. There were no major complication or mortality during the follow-up.

CONCLUSIONS

The transapical implantation of the J-Valve™ system in high risk elderly patients with predominant aortic incompetence is feasible.The early postoperative outcome is satisfactory.

[Comparison of anterolateral minithoracotomy versus partial upper hemisternotomy in aortic valve replacement]

OBJECTIVE

To compare the results of aortic valve replacement through anterolateral minithoracotomy (RT) and partial upper hemisternotomy (PS) approaches.

METHODS

This was a retrospective, observational, cohort study of collected data on 297 patients undergoing isolated primary aortic valve replacement between July 2009 and March 2016 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 174 male and 123 female patients, aging from 15 to 73 years with a mean age of (51±13) years. Of these, 132 were performed through right RT and 165 through PS. Outcomes of the two groups were compared by t test, t' test, rank-sum test and χ(2) test, respectively.

RESULTS

The overall in-hospital mortality was 1.7% (5/297), with no difference between the 2 groups (3.0%, 4/132 vs. 0.6%, 1/165, P=0.175 ). Patients in the RT group had longer cardiopulmonary bypass ((92±27) minutes vs. (76±18) minutes, t'=5.848, P=0.000)and crossclamping ((56±21) minutes vs. (43±12) minutes, t'=6.333, P=0.000)times. Three patients in the RT group and two patients required intraoperative conversion. Patients by way of RT was associated with a lower incidence of blood transfusions (20.4% vs. 39.4%, χ(2)=12.303, P=0.001) and less drainage (250 (307) ml vs. 570 (370) ml, Z=8.161, P=0.000). In addition, patients in RT group had a shorter postoperative length of stay (5(4) days vs. 9(10) days, Z=4.548, P=0.000).

CONCLUSIONS

Aortic valve replacement via RT and PS are both safe and feasible. The approach through PS is associated with better exposure, more extensive indication for surgery, and more suitable to heart centers which intend to carry out miminally invasive aortic valve replacement. While, for an experienced surgeon, the approach through right RT is worthy of clinical selective application for patients concern more about good cosmetic result, and patients have faster recovery by avoid sternotomy through RT approach.

[Transcatheter aortic valve replacement: the new era, new opportunity and new challenge of cardiac surgery]

Conventional surgical aortic valve replacement is still the current "gold standard" in treatment of aortic valve disease, but part of the high-risk elder patients couldn't tolerate the surgical trauma. Now those people could receive timely and effective treatment with the application of transcatheter aortic valve replacement, and the related guidelines have been published in recent years. With its wide use in recent 10 years, different implantation systems, such as SAPIEN, CoreValve, Lotus, ACURATE neo, have been gradually improved and provened in several large clinical trials. Transfemoral, transapical and transaortic approaches are approved for the access and used according to different indications. Bleeding, vascular events, Ⅲ grade atrioventricular block, coronary obstruction, valve malpositioning, valve degeneration are the major complications for this skill, but would be overcome with the improvement of the system. The transcather aortic valve replacement brings not only the opportunity to develop new treatment protocols, but the challenge for cardiac surgeons to learn new skills to control.

[Management of chronic rhinosinusitis]

Chronic rhinosinusitis(CRS) is a common upper respiratory tract disorder that involves chronic inflammation of the nasal and paranasal sinus mucosa.CRS can be subdivided into two categories: CRS with nasal polyps(CRSwNP) and without nasal polyps(CRSsNP).The management of CRS usually involves medical treatment and surgical treatment.A long-term anti-inflammatory treatment is the key for curing CRS.On the other hand,surgery should be considered when there is persistence the symptomatology despite a maximal medical treatment.For those repeatedly recurrence cases,the surgery usually as an adjunct to the medical treatment.On the basis of distinct phenotypes and endotypes of CRS,the management of CRS is extremely individual and must be discussed case by case in the future.

Isolation of a novel polyomavirus, related to Japanese eel endothelial cell-infecting virus, from marbled eels, Anguilla marmorata (Quoy & Gaimard)

Marbled eels, Anguilla marmorata (Quoy & Gaimard), cultured in Taiwan exhibited haemorrhage and mortality in January 2012. The severely diseased eels bled from the gills and showed congestion of the central venous sinus of the gill filaments and haemorrhage throughout the body similar to viral endothelial cell necrosis of eel. In this study, a novel polyomavirus (AmPyV) was isolated from the diseased eels using the AMPF cell line established from the pectoral fin of healthy marbled eels. AmPyV was found to encode a long T-antigen orthologous gene. Phylogenetic analysis showed that AmPyV was closely related to Japanese eel endothelial cell-infecting virus. PCR assays revealed AmPyV infection throughout the systemic organs. AmPyV proliferated in the AMPF, EK-1 and EO-2 cells at temperatures 25-30 °C, and the progeny virus yields were 10(7.0) , 10(7.4) and 10(7.7) TCID50  mL(-1) , respectively. The purified virions were icosahedral particles, 70-80 nm in diameter. No clinical signs or mortality was observed among the eels injected with the virus; however, the virus was reisolated from the brain, eyes, kidneys, fins and gills of infected eels 2 month after injection. Our results suggest that AmPyV exhibits a latent infection. Pathogen of the disease needs to study further.

Lipid metabolism in patients with chronic renal failure in the predialytic phase

CRF is accompanied by characteristic alterations of lipoprotein metabolism with a retarded catabolism of triglyceride-rich lipoproteins as a prominent feature. Further investigation of the lipoprotein profile of CRF could provide information on the fundamental pathophysiological processes responsible for these disturbances and their possible clinical significance.

Effective Resistance to Wheat Stripe Rust in a Region with High Disease Pressure

Stripe rust is a major fungal disease of wheat. It frequently becomes epidemic in southeastern Gansu province, a stripe rust hot spot in China. Evaluations of wheat germplasm response are crucial for developing cultivars to control the disease. In total, 57 wheat cultivars and lines from Europe and other countries, comprising 36 cultivars with documented stripe rust resistance genes and 21 with unknown genes, were tested annually with multiple races of Puccinia striiformis f. sp. tritici in the field at Tianshui in Gansu province from 1993 to 2013. Seven wheat lines were highly resistant, with infection type (IT) 0 during the entire period; 16 were moderately resistant (IT 0;-2); and 26 were moderately susceptible (IT 0;-4), with low maximum disease severity compared with the susceptible control Huixianhong. 'Strampelli' and 'Libellula', with three and five quantitative trait loci, respectively, for stripe rust resistance have displayed durable resistance in this region for four decades. Ten cultivars, including 'Lantian 15', 'Lantian 26', and 'Lantian 31', with stripe rust resistance derived from European lines, were developed in our breeding program and have made a significant impact on controlling stripe rust in southeastern Gansu. Breeding resistant cultivars with multiple adult-plant resistance genes seems to be a promising strategy in wheat breeding for managing stripe rust in this region and other hot spots.

Shoulder impingement, an uncommon complication of distal clavicle fracture treated arthroscopically: a case report

Clavicle fracture is commonly treated conservatively. However uncommon complication can arise causing impingement. We report a patient who sustained distal clavicle fracture and was treated conservatively. However he developed persistent shoulder pain that affected his daily life. Shoulder impingement was diagnosed and arthroscopic subacromioclavicular decompression was done. Following early physiotherapy the early recovery was good with full range of motion of the shoulder.

KEY WORDS

Clavicle fracture, shoulder impingement, arthroscopic subacromioclavicular decompression.

First Report of Bark Cracking of Koelreuteria bipinnata var integrifoliola Caused by Lasiodiplodia theobromae in China

Koelreuteria bipinnata var integrifoliola is becoming a popular urban green tree in Ningbo City, Zhejiang Province, China, because of its adaptation ability to local conditions, fast growth, and beautiful appearance. A survey conducted from 2007 to 2010 revealed serious bark cracking on greenbelt trees approximately 15 to 16 years old that had been transplanted 5 to 6 years ago. Bark cracks increased in size over time, extending into the phloem and leading to extensive areas of bark loss with discoloration of the underlying xylem. Symptomatic trees had fewer new shoots in spring; many wilted and died in summer. Root rot was not observed in the withered trees but large light brown lesions were observed on cross sections of the main stem, each with a dark brown outer margin. In a September 2009 survey, 95% of symptomatic trees had stem lesions more than 50 cm long. Pieces of xylem (2 × 2 × 1 mm thick) were obtained from the margin of lesions surface sterilized using 0.1% mercuric chloride for 30 s, washed in sterile distilled water, and placed on 2% potato dextrose agar (PDA) at 28°C for 2 days. The fungus was then isolated and 12 colonies were obtrained. Three isolates KL-1-2, KL-3-2, and KL-4-3 were incubated on 2% PDA at 28°C for 30 days to produce spores. On PDA, the colonies were circular or near circular with irregular gray edges turning black green or black. The fungus also produced abundant aerial hyphae that were villous, septate, and irregular branched. Conidia were elliptical (or rounded) and hyaline when immature, becoming dark brown and septate longitudinally when mature and ranged from 23.2 to 27.0 × 10.8 to 16.2 μm (average 25.3 × 13.6 μm), similar to Lasiodiplodia theobromae (Patouillard) Griffon =Botryodiplodia theobromae Pa.t, Botryosphaeria rhodina (Berkeley & Curtis) von Arx (2). DNA extraction directly from the mycelium of KL-1-2, KL-3-2, and KL-4-3 was performed after 10 days' growth on PDA (1). The identities of the three isolates were confirmed by ITS1-5.8S-ITS2 rDNA sequence (GenBank Accession Nos. JN681172, JQ894322, and JQ894323, respectively) analysis that showed 99%, 100%, and 100% sequence similarity to L. theobromae xsd08006 (Accession No. FJ478102), L. theobromae PD20 (Accession No. GU251120), and L. theobromae xsd08008 (Accession No. EU918707), respectively. Pathogenicity tests were performed on 20 five-year-old K. bipinnata var integrifoliola plants by placing mycelia plugs of isolate KL-1-2 (10 × 10 mm) on the main trunk after wounding with a metal needle. Control plants received PDA plugs without mycelium. After inoculation, humidity was maintained using wet absorbent cotton and PE wrap film. Stem bark and phloem cracking was observed after 60 days on 85% of inoculated plants; 30% of those trees also had xylem discoloration. Symptoms were similar to those with natural infection. Control plants remained symptomless. The same fungus was reisolated from the brown xylem of inoculated plants. To our knowledge, this is the first report of bark cracking of K. bipinnata var integrifoliola caused by L. theobromae in China. References: (1) M.-J. Côté et al. Plant Dis. 88:1219, 2004. (2) G. Fu et al. Australas. Plant Dis. Notes 2:75, 2007.

Intravenous fentanyl is exhaled and the concentration fluctuates with time

Previous studies have reported that fentanyl is eliminated predominantly by hepatic biotransformation, and that some is eliminated unchanged in urine and stools. No reports have described the elimination of fentanyl via the lungs. In this study, exhaled gas samples from eight anaesthetized patients undergoing cardiac surgery were analysed using solid-phase microextraction (SPME) coupled with gas chromatography-mass spectrometry (GC-MS). Results confirmed that fentanyl was exhaled by patients after intravenous administration, that the concentration of exhaled fentanyl fluctuated with time and peak concentrations were reached approximately 15 - 20 min after intravenous fentanyl administration. Thus, in addition to hepatic biotrans formation and elimination via urine and faeces, fentanyl is also eliminated unchanged by the lungs. The potential risk to operating theatre personnel from long-term exposure to low levels of exhaled anaesthetic agents following intravenous administration to patients during surgery warrants further research.

PCR amplification and sequence analysis of the major capsid protein gene of megalocytiviruses isolated in Taiwan

Viruses belonging to the genus Megalocytivirus in the family Iridoviridae are one of the major agents causing mass mortalities in marine and freshwater fish in Asian countries. Outbreaks of iridovirus disease have been reported among various fish species in Taiwan. However, the genotypes of these iridoviruses have not yet been determined. In this study, seven megalocytivirus isolates from four fish species: king grouper, Epinephelus lanceolatus (Bloch), barramundi perch, Lates calcarifer (Bloch), silver sea bream, Rhabdosargus sarba (Forsskal), and common ponyfish, Leiognathus equulus (Forsskal), cultured in three different regions of Taiwan were collected. The full open reading frame encoding the viral major capsid protein gene was amplified using PCR. The PCR products of approximately 1581 bp were cloned and the nucleotide sequences were phylogenetically analysed. Results showed that all seven PCR products contained a unique open reading frame with 1362 nucleotides and encoded a structural protein with 453 amino acids. Even though the nucleotide sequences were not identical, these seven megalocytiviruses were classified into one cluster and showed very high homology with red sea bream iridovirus (RSIV) with more than 97% identity. Thus, the seven iridovirus strains isolated from cultured marine fish in Taiwan were closer to the RSIV genotype than the infectious spleen and kidney necrosis virus genotype.