Low-temperature behaviors of the dipolar magnet Dy3Sb3Zn2O14with a strongly site-mixing disordered kagome lattice

Interesting behaviors may emerge in the magnetic frustrated materials with significant site-mixing disorder. We present the results of the structural, magnetic susceptibility, and specific heat measurements of Dy3Sb3Zn2O14with ∼20%Dy/Zn site-mixing disorder, which results in either a diluted 2D triangular lattice, or an intermediate structure between the kagome and pyrochlore lattice. In addition to the sharp anomaly of the temperature dependence of specific heat atT∼0.35 K, which was attributed to the emergent charge order state for the sample with less disorder, a broad peak atT∼1.5 K, and a small hump belowT∼0.1 K are observed. The measured temperature dependence of specific heat and the Monte Carlo simulation suggest that the magnetic frustration persists despite of a strong site-mixing disorder.

Concentration and composition of odd-chain fatty acids in phospholipids and triacylglycerols in Chinese human milk throughout lactation

Human milk represents the gold standard for infant nutrition, with approximately 50% of the energy in human milk derived from lipids. Odd-chain fatty acids (OCFAs) have been recognized as a category of bioactive milk fatty acids in recent research; however, limited data exist on OCFAs in human milk. This study collected human milk samples spanning the postpartum period from 0 to 400 days. Phospholipids containing OCFAs (PL-OCFAs) were determined in 486 human milk samples using hydrophilic liquid chromatography-electrospray ionization-triquadrupole-mass spectrometry. Triacylglycerols containing OCFAs (TAG-OCFAs) were analyzed in 296 human milk samples using ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. The average total concentration of PL-OCFA ranged from 30.89 ± 14.27 mg L-1 to 93.48 ± 36.55 mg L-1 during lactation, and the average total TAG-OCFA content ranged from 103.1 ± 147.15 mg L-1 to 965.41 ± 651.67 mg L-1. Despite the lower absolute concentration of PL-OCFA, its relative concentration (8.75%-11.75%) was significantly higher than that of TAG-OCFA (0.37%-1.85%) throughout lactation. PC-OCFA, SM-OCFA and PE-OCFA are major sub-classes of PL-OCFA. Furthermore, C17:0 was the major chain length in both PL-OCFA and TAG-OCFA, followed by C15:0. C17:1 was characteristic of TAG-OCFA, while long-chain fatty acids C19:0, C21:0 and C23:0 were characteristic of PL-OCFA. Our findings highlighted the importance of bioactive lipids in human milk, suggesting that OCFAs could be targeted in future studies in relation to the health and development of infants.

Corrigendum: Identification of ACKR4 as an immune checkpoint in pulmonary arterial hypertension

[This corrects the article DOI: 10.3389/fimmu.2023.1153573.].

[Analysis of parainfluenza virus infection in acute respiratory tract infection adult cases in Shanghai, 2015-2021]

Objective: To study the infection status and epidemiological characteristics of parainfluenza virus (PIV) in acute respiratory tract infection adult cases in Shanghai from 2015 to 2021, and to provide a scientific basis for preventing and controlling PIV. Methods: Acute respiratory tract infections were collected from 13 hospitals in Shanghai from 2015 to 2021. Relevant information was registered, and respiratory specimens were sampled to detect respiratory pathogens by multiplex PCR. Results: A total of 5 104 adult acute respiratory tract infection cases were included; the overall positive rate of the respiratory pathogens was 29.37% (1 499/5 104). The positive rate of PIV was 2.61% (133/5 104), compared with 2.32% (55/2 369) and 2.85% (78/2 735) in influenza-like cases (ILI) and severe acute respiratory infection (SARI) cases, respectively. Among them, PIV3 accounted for the highest proportion (62.41%, 83/133), followed by PIV1 (18.80%, 25/133), PIV2 (9.77%, 13/133), and PIV4 (9.02%, 12/133). The incidence of PIV-positive cases was mainly distributed in the first and second quarters, accounting for 62.41% (83/133). The difference in the incidence in each quarter was significant (χ2=24.78, P<0.001). Mixed infection accounted for 18.80% (25/133) of 133 PIV-positive cases, the mixed infection rates of ILI and SARI were 18.18% (10/55) and 19.23% (15/78), respectively, and the main mixed pathogen of PIV was coronavirus 229E. Conclusions: There are a certain proportion of PIV-positive acute respiratory tract infection cases in Shanghai. It is necessary to strengthen the etiological surveillance in acute respiratory tract infection cases, especially the mixed infection of PIV and other pathogens.

[Changes in epidemic intensity of influenza during 2014-2020 in Shanghai]

Objective: To evaluate the performance of the influenza surveillance network and compare the epidemic intensity of influenza during 2014-2020 in Shanghai. Methods: Based on the weekly reports of influenza-like illness (ILI) and laboratory-confirmed influenza cases from January 1, 2014 to December 31, 2020. This study first evaluated the data reporting and specimen collection of ILI cases for each sentinel hospital, and then calculated the percentage of ILI (ILI%), the proportion of specimens tested positive for influenza, and the incidence of influenza among all ILI outpatient and emergency visits to measure the epidemic intensity of influenza. Finally, seasonal autoregressive integrated moving average (ARIMA) model was applied to quantify the changes in epidemic intensity of influenza in 2020. Results: The proportion of influenza surveillance sentinel hospitals with a score of less than 5 in the evaluation of ILI data reporting and samples collection were 9.68% and 21.05% in 2020 in Shanghai, respectively. ILI% was estimated to be 1.51% (95%CI: 1.50%-1.51%) and 2.31% (95%CI: 2.30%-2.32%), respectively for 2014-2019 and 2020; the proportion of specimens tested positive was 24.27% (95%CI: 24.02%- 24.51%) and 7.15% (95%CI: 6.78%-7.54%), respectively; and the incidence of influenza was 3.66‰ (95%CI: 3.62‰-3.70‰) and 1.65‰ (95%CI: 1.57‰-1.74‰), respectively. ARIMA model showed that ILI% was increased by 45.25% in 2020 in Shanghai, and the proportion of specimens tested positive and the incidence of influenza were reduced by 78.45% and 51.80%, respectively. Conclusions: In 2020, the performance of influenza surveillance system has changed, ILI% has increased, the proportion of specimens tested positive and the incidence of influenza has decreased in Shanghai. The change in the quality of influenza surveillance is also a potential factor affecting the epidemic intensity of influenza. In the future, the quality control of influenza surveillance network still needs to be further strengthened.

Identification of ACKR4 as an immune checkpoint in pulmonary arterial hypertension

Objective

Inflammation is recognized as a contributor in the development of pulmonary arterial hypertension (PAH), and the recruitment and functional capacity of immune cells are well-orchestrated by chemokines and their receptors. This study is aimed at identification of critical chemokines in the progression of PAH via transcriptomic analysis.

Methods

Differentially expressed genes (DEGs) from lungs of PAH patients were achieved compared to controls based on Gene Expression Omnibus (GEO) database. Gene set enrichment analysis (GSEA) was applied for functional annotation and pathway enrichement. The abundance of immune cells was estimated by the xCell algorithm. Weighted correlation network analysis (WGCNA) was used to construct a gene expression network, based on which a diagnostic model was generated to determine its accuracy to distinguish PAH from control subjects. Target genes were then validated in lung of hypoxia-induce pulmonary hypertension (PH) mouse model.

Results

ACKR4 (atypical chemokine receptor 4) was downregulated in PAH lung tissues in multiple datasets. PAH relevant biological functions and pathways were enriched in patients with low-ACKR4 level according to GSEA enrichment analysis. Immuno-infiltration analysis revealed a negative correlation of activated dendritic cells, Th1 and macrophage infiltration with ACKR4 expression. Three gene modules were associated with PAH via WGCNA analysis, and a model for PAH diagnosis was generated using CXCL12, COL18A1 and TSHZ2, all of which correlated with ACKR4. The ACKR4 expression was also downregulated in lung tissues of our experimental PH mice compared to that of controls.

Conclusions

The reduction of ACKR4 in lung tissues of human PAH based on transcriptomic data is consistent with the alteration observed in our rodent PH. The correlation with immune cell infiltration and functional annotation indicated that ACKR4 might serve as a protective immune checkpoint for PAH.

[Prognostic value of perioperative change of neutrophil elastase and myeloperoxidase in coronary circulation on perioperative myocardial injury and clinical outcome of patients underwent surgical valve replacement]

Objective: To investigate the clinical value of observing perioperative changes of myeloperoxidase (MPO) and neutrophil elastase (NE) in coronary artery circulation in patients underwent valve replacement surgery. Methods: This perspective cohort study was performed in patients who underwent valvular surgery in Nanjing Drum Tower Hospital and Fuwai Hospital from June 2021 to June 2022. Patients were divided into perioperative myocardial injury group and age-, sex- and type of cardiac procedure-matched non-perioperative myocardial injury control group in the ratio of 1∶1. Perioperative myocardial injury was defined as cardiac troponin T (cTnT)>0.8 μg/L on the first postoperative day (POD), and the cTnT level on the second POD increased by more than 10% compared with the cTnT level on the first POD. During the operation, blood samples were collected from the coronary sinus before clamping ascending aorta, and within 5 minutes after de-clamping ascending aorta. Then, the levels of MPO and NE on coronary sinus were continuously measured. The death, severe ventricular arrhythmia, pneumonia, re-intubation, repeat cardiac surgery, extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), mechanical ventilation time and the duration of intensive care unit (ICU) were recorded. The levels of MPO and NE and the incidence of clinical outcomes were compared between the myocardial injury group and the control group. The independent risk factors of myocardial injury were analyzed by multivariate logistic regression. Results: A total of 130 patients were enrolled, aged (60.6±7.6) years old, with 59 males (45.4%). There were 65 patients in the myocardial injury group and 65 patients in the control group. During hospitalization, there was no death, ECMO, IABP and CRRT cases in both groups. Compared with the control group, the incidence of severe ventricular arrhythmia (13.8%(9/65) vs. 3.1%(2/65), P=0.03), pneumonia (20.0%(13/65) vs. 3.1%(2/65), P=0.03), re-intubation (6.2%(4/65) vs. 0, P=0.04) was significantly higher in myocardial injury group. The mechanical ventilation time (16.8(10.7, 101.7) h vs. 7.5(4.7, 15.1) h, P<0.01), and the duration of ICU (3.7(2.7, 18.9) vs. 2.7(1.8, 6.9)d, P<0.01) were significantly longer in myocardial injury group compared with the control group. There was no significant difference in the levels of MPO and NE in coronary sinus blood between the two groups before aortic clamping (all P>0.05). However, MPO ((551.3±124.2) μg/L vs. (447.2±135.9) μg/L, P<0.01) and NE ((417.0±83.1)μg/L vs. (341.0±68.3)μg/L, P<0.01) after 5 min aortic de-clamping were significantly higher in myocardial injury group than in the control group. Multivariate logistic regression analysis showed that the levels of NE (OR=1.02, 95%CI: 1.01-1.02, P<0.01), MPO (OR=1.00, 95%CI: 1.00-1.01, P=0.02) and mechanical ventilation time (OR=1.03, 95%CI: 1.01-1.06, P=0.02) were independent risk factors of myocardial injury in patients after surgical valvular replacement. Conclusion: Perioperative myocardial injury is related poor clinical outcomes, perioperative NE and MPO in coronary artery circulation are independent risk factors of perioperative myocardial injury in patients undergoing valve replacement surgery.

[Application of high-density polyethylene implants in adult cleft lip and palate nasal deformity and dysfunction]

Objective: Through the use of high-density polyethylene implants in adults with cleft lip and palate nasal deformities and abnormal functions, to evaluate the clinical effect of postoperative patients on improving nasal shape and symptoms. Methods: A retrospective study of 12 patients with nasal deformities after cleft lip and palate surgery in the Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine from January 2018 to January 2022 was completed, including 7 males and 5 females, with the age ranging from 18 to 29 years. All the patients underwent nasal deformity correction, and nasal septum correction was performed if necessary. High-density polyethylene implants (MEDPOR/Su-Por) were used intraoperatively. Follow-up for at least 6 months was performed to measure the relevant appearance indicators and subjective Visual Analog Scale (VAS) scores, and to compare the clinical effects before and after surgery. SPSS 22.0 software was used for statistical analysis. Results: Before and after surgery, the average VAS score of nasal obstruction decreased by (4.83±0.94) points; the average VAS score of appearance satisfaction increased by (3.92±1.08) points; the height of nasal columella was increased by (1.79±0.78)mm; the height of nasal tip was increased by (2.79±1.50)mm; the height of ipsilateral nostril was increased by (1.83±0.62)mm; the width of the ipsilateral nasal floor was reduced by (0.42±0.47)mm. All of above were statistically significant (all P<0.05). Conclusion: High-density polyethylene implants can effectively improve the shape and function of the nose in operations related to cleft lip and palate nasal deformity and abnormal functions, and are an ideal synthetic material.

The low-dose colchicine in patients after non-CABG cardiac surgery: a randomized controlled trial

BACKGROUND

Recent high-quality trials have shown that the anti-inflammatory effects of colchicine reduce the risk of cardiovascular events in patients suffering post-myocardial infarction and chronic coronary disease. The effect of colchicine in patients undergoing non-coronary artery bypass grafting (non-CABG) with cardiopulmonary bypass remains unclear. We aim to evaluate the effect of colchicine on myocardial protection in patients who underwent non-CABG cardiac surgery.

METHOD

Patients were randomly assigned to colchicine or placebo groups starting 72 h before scheduled cardiac surgery and for 5 days thereafter (0.5 mg daily).The primary outcome was the level of cardiac troponin T (cTnT) at postoperative 48 h. The secondary outcomes included troponin I (cTnI) and creatine kinase-MB (CK-MB), inflammatory biomarkers (procalcitonin and interleukin-6, etc.), and adverse events (30-day mortality, stroke, ECMO and IABP use, etc.).

RESULTS

A total of 132 patients underwent non-CAGB cardiac surgery, 11were excluded because of diarrhea (n = 6) and long aortic cross-clamp time > 2 h (n = 5), 59 were assigned to the colchicine group and 62 to the placebo group. Compared with the placebo group, cTnT (median: 0.3 μg/L, IQR 0.2-0.4 μg/L vs. median: 0.4 μg/L, IQR 0.3-0.6 μg/L, P < 0.01), cardiac troponin I (median: 0.9 ng/ml, IQR 0.4-1.7 ng/ml vs. median: 1.3 ng/ml, IQR 0.6-2.3 ng/ml, P = 0.02), CK-MB (median: 1.9 ng/ml, IQR 0.7-3.2 ng/ml vs. median: 4.4 ng/ml, IQR 1.5-8.2 ng/ml, P < 0.01), and interleukin-6 (median: 73.5 pg/ml, IQR 49.6-125.8 pg/ml vs. median: 101 pg/ml, IQR 57.5-164.7 pg/ml, P = 0.048) were significantly reduced in colchicine group at postoperative 48 h. For safety evaluation, the colchicine (n = 65) significantly decreased post-pericardiotomy syndrome (3.08% vs. 17.7%, P < 0.01) and increased the rate of diarrhea (9.23% vs. 0, P = 0.01) compared with the placebo group (n = 62). No significant difference was observed in other adverse events between the two groups.

CONCLUSION

A short perioperative course of low-dose colchicine was effective to attenuate the postoperative biomarkers of myocardial injury and inflammation, and to decrease the postoperative syndrome compared with the placebo. Trial registration ChiCTR2000040129. Registered 22nd Nov. 2020. This trial was registered before the first participant was enrolled. http://www.chictr.org.cn/showproj.aspx?proj=64370 .

The neutrophil elastase inhibitor, sivelestat, attenuates acute lung injury in patients with cardiopulmonary bypass

Background

The sivelestat is a neutrophil elastase inhibitor thought to have an effect against acute lung injury (ALI) in patients after scheduled cardiac surgery. However, the beneficial effect of sivelestat in patients undergoing emergent cardiovascular surgery remains unclear. We aim to evaluate the effect of sivelestat on pulmonary protection in patients with ALI after emergent cardiovascular surgery.

Methods

Firstly, a case-control study in 665 patients undergoing emergent cardiovascular surgery from January 1^st, 2020 to October 26^th, 2022 was performed. 52 patients who received sivelestat (0.2mg/kg/h for 3 days) and 613 age- and sex-matched controls. Secondly, a propensity-score matched cohort (sivelestat vs control: 50 vs 50) was performed in these 665 patients. The primary outcome was a composite of adverse outcomes, including 30-day mortality, ECMO, continuous renal replacement therapy (CRRT) and IABP, etc. The secondary outcome included pneumonia, ventricular arrhythmias and mechanical ventilation time, etc.

Results

In propensity-matched patients, the 30-day mortality (16% vs 24%, P=0.32), stroke (2% vs 8%, P=0.17), ECMO(6% vs 10%, P=0.46), IABP(4% vs 8%, P=0.40) and CRRT(8% vs 20%, P=0.08) had no differences between sivelestat and control group; sivelestat could significantly decrease pneumonia (40% vs 62%, P=0.03), mechanical ventilation time (median: 96hours, IQR:72-120hours vs median:148hours, IQR:110-186hours, P<0.01), bilateral pulmonary infiltrates (P<0.01), oxygen index (P<0.01), interleukin-6(P=0.02), procalcitonin(P<0.01) and C-reactive protein(P<0.01).

Conclusion

Administration of sivelestat might improve postoperative outcomes in patients with ALI after emergent cardiovascular surgery. Our results show that sivelestat may be considered to protect pulmonary function against inflammatory injury by CPB.

Registration

http://www.chictr.org.cn/showproj.aspx?proj=166643, identifier ChiCTR2200059102.

Corrigendum: The neutrophil elastase inhibitor, Sivelestat, attenuates acute lung injury in patients with cardiopulmonary bypass

[This corrects the article DOI: 10.3389/fimmu.2023.1082830.].

Left atrial appendage mechanical dispersion assessed by speckle-tracking echocardiography as a determinant of left atrial appendage stasis in patients with non-valvular atrial fibrillation

Background

We sought to investigate the relationship of left atrial appendage (LAA) mechanical dispersion (MD) with LAA dense spontaneous echo contrast (SEC) or thrombus, and to compare its usefulness in the identification of thrombogenesis with left atrial (LA) MD or LA/LAA strain parameters in patients with nonvalvular atrial fibrillation (AF).

Methods

We conducted a cross-sectional study of 493 consecutive patients with AF (median age 65, male 66.9%) who underwent echocardiography prior to catheter ablation. We measured the LAA and LA global longitudinal strain (GLS) using speckle-tracking echocardiography (STE). LAA MD and LA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.

Results

Patients with LAA dense SEC/thrombus (n=70) had significantly higher LAA MD than controls (n=423) (median 14.20% vs 9.35%). Areas under the receiver-operating curve for CHA2DS2-VASc score plus LAA MD, LAA GLS or LA GLS were comparable (0.830, 0.843 and 0.809) and superior to that combined with LA MD (0.762, all p&lt;0.01). Multivariable analysis showed that LAA MD was an independent determinant of LAA dense SEC/thrombus in four different models (Odds ratio, 1.23–1.24; P&lt;0.001), and provided additional diagnostic value over clinical and standard echocardiographic parameters. Whereas LA MD was not independently associated with LAA dense SEC/thrombus and had no incremental predictive value.

Conclusion

LAA mechanical dispersion provided incremental information over conventional risk factors in the identification of LAA dense SEC or thrombus in AF patients and is superior to LA mechanical dispersion.

Funding Acknowledgement

Type of funding sources: None.

Profiling of triacylglycerol composition in the breast milk of Chinese mothers at different lactation stages

Triacylglycerol (TAG) is the primary constituent of human milk fat and plays a vital role in the healthy development of infants. But few studies reported the sophisticated profile of TAG molecular species in human breast milk and its temporal changes during a prolonged lactation period. An efficient ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) method was adopted to examine TAGs. A total of 128 TAGs in 296 human breast milk samples collected during postnatal 0 to 400 days were identified. The changes in the human milk TAG profile mainly took place in the early stages of lactation (postnatal 0-45 days), and the TAG profile became stable in mature milk after 200 days of lactation. Odd chain fatty acids (OC-FAs) may be important markers for identifying human breast milk of different lactation stages. This study could provide evidence for developing safe and efficacious human-milk substitutes for children without access to human breast milk.

Comparison of left atrial and atrial appendage mechanics to stratify the risk of left atrial/atrial appendage stasis in patients with non-valvular atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial appendage (LAA) and left atrial (LA) dysfunction are associated with the presence of thrombus and spontaneous echo contrast (SEC) within LAA. However, the role of LAA mechanical dispersion (MD) in contributing to thrombogenesis has not been fully addressed and compared with LA MD or LA/LAA GLS. We sought to investigate the relationship of LAA MD with LAA dense SEC or thrombus, and to compare its additional value with other LA/LAA mechanical parameters in patients with nonvalvular atrial fibrillation (AF).

Methods

We conducted a cross-sectional study of 493 consecutive patients with AF (median age 65, male 66.9%) who underwent echocardiography prior to catheter ablation. Of these, 70(14.2%) patients had dense SEC or thrombus in LAA. We measured the LAA and LA longitudinal strain using speckle-tracking echocardiography (STE). LAA MD and LA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.

Results

Patients with LAA dense SEC/thrombus (n=70) had significantly higher LAA MD (median 14.20% (11.60%,16.80%) vs 9.35 % (6.23%,12.07%)) than controls (n = 423). Areas under the receiver-operating curve (AUC) for CHA2DS2-VASc score plus LAA MD, LAA GLS or LA GLS were comparable (0.843,0.830 and 0.809) and superior to that combined with LA MD (0.762, p&lt;0.01). Multivariable analysis showed that LAA MD was an independent determinant of LAA dense SEC/thrombus in four different models (Odds ratio, 1.23-1.24; P &lt; 0.001), and provided additional diagnostic value over clinical and standard echocardiographic parameters. Whereas LA MD was not significantly associated with LAA dense SEC/thrombus and had no incremental predictive value.

Conclusion

LAA mechanical dispersion provided incremental information over conventional risk factors in the identification of LAA dense SEC or thrombus in AF patients and is superior to LA mechanical dispersion.

[Progress of circulating tumor DNA in diagnosis and prognosis of pancreatic cancer]

Circulating tumor DNA(ctDNA) is the DNA fragment released into blood by tumor cells.Wheather it presents or not and its plasma concentration are closely related to the prognosis of patients. The common detection methods of ctDNA include digital polymerase chain reaction,second-generation sequencing,methylation detection technology and so on. Detecting specific point mutations or methylation of ctDNA can not only assist in the diagnosis of pancreatic cancer,but also be expected to identify pancreatic cancer at an early stage. Detecting ctDNA after operation can help predicting tumor recurrence and metastasis effectively,so that patients with high recurrence and metastasis risks can be intervened in advance. Accordingly,this article intends to review detection technology of ctDNA and its clinical applications in the early diagnosis of pancreatic cancer,the prediction of tumor recurrence and metastasis after surgery,and the evaluation of patient prognosis.

[Epidemiological investigation on an imported cutaneous anthrax case in Shanghai]

Objective: To discuss the challenges and problems of the prevention and control of emerging infectious diseases in Shanghai as a megacities. Methods: An imported case of cutaneous anthrax occurred in Shanghai on May 30, 2019. Shanghai Municipal Center for Disease Control & Prevention conducted an epidemiological investigation and treatment of the cases; after this case, the data of patients with cutaneous anthrax were collected, and an epidemiological study was conducted. Meanwhile, the wound and blood samples of the patient were collected for laboratory testing. Results: Of the seven wound samples of the patient, 6 were positive for the Bacillus anthracis nucleic acid test, and the double serological test results showed a 4-fold increase in the titer of anthrax antibodies. Shanghai CDC conducted an epidemiological investigation of the confirmed cases and observed its contacts. After treatment, the patients recovered, and no other issues appeared among the 19 contacts. Conclusions: Shanghai must strengthen the training of clinicians on emerging infectious diseases to achieve early detection, diagnosis, and treatment of imported infectious diseases and reduce the incidence, spread, and death of the diseases. At the same time, multi-department joint prevention and control are needed to prevent and control secondary cases.

[Evaluation of the effects auricular reconstruction with Medpor combined with hearing rehabilitation]

Objective: To investigate the clinical effects of single-stage auricular reconstruction and hearing rehabilitation in children with microtia and external auditory canal atresia. Methods: Sixty eight cases of microtia with external auditory canal atresia (53 males and 15 females, age from 7 to 12 years, with a median age of 8.8 years), who received operations in Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from July 2017 to December 2019 were collected.A total of 28 cases received auricle reconstruction with high-density polyethylene (Medpor) framework and hearing reconstructions, among which 20 patients received the traditional external auditory canal and middle ear repair (EACR), and eight patients were implanted bone conduction device bone bridge(BB) simultaneously.In the control group, 40 patients only received Medpor frame implantation for auricle plasty. Postoperative changes in auricle morphology and auditory function and postoperative complications were evaluated. Results: After three to thirty months follow-ups, the auricles shape recovered well in all three groups. The average scores of 14 fine structures in the auricles were 9.43(EACR) and 10.67(BB) points. The average score of auricle symmetry were 6.83(EACR) and 6.00(BB) points. There was no significant difference compared to the auricle reconstruction group (8.23/6.20 points). P>0.05. After surgery, the average hearing improvement in the BB group was 43.33 dB HL and the average speech recognition threshold declined 42.28 dB HL. In the EACR group, the average hearing improvement was 4.13 dB HL and the average speech recognition threshold declined 11.36 dB HL. No vertigo, tinnitus, cerebrospinal fluid leakage and other complications occurred in all the patients. In the EACR group, sensorial hearing loss, auricle stent fracture, ear canal restenosis and ear canal atresia occurred in one patient respectively. In the auricle group, one auricle stent exposure and one facial branch nerve injury occurred. Nearly ten patients had difficulty in hair growth at scalp incisions. Conclusions: The operation of single-stage auricular reconstruction and hearing rehabilitation for microtia is feasible. The methods of hearing reconstruction should be determined by evaluating the development of the inner and middle ear of the patients. For those with poor mastoid development, bone bridge implantation is recommended to achieve a stable and significant hearing effect.

Use of speckle-tracking echocardiography to stratify risk of atrial fibrillation-related stroke: comparison of left atrial and atrial appendage mechanics

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): the National Natural Science Foundation of China

onbehalf

Sir Run Run Shaw Hospital,Zhejiang University,School of Medicine

Background

Left atrial (LA) and appendage (LAA) dysfunction were associated with increased risk of stroke in atrial fibrillation. However, usefulness of LA and LAA mechanics has not been fully compared. Methods:201 AF patients were prospectively enrolled. 42(20.8%) had previous stroke/TIA.  Speckle tracking was used to measure LA and LAA peak postive strain. LA and LAA MD was defined as the SD of time to peak positive strain corrected by the R-R interval. Results:LA MD and LAA MD were independently associated with stroke/TIA. The model based on CHA2DS2-VASc score for discrimination of stroke was significantly improved by adding LA MD or LAA MD (P &lt; 0.01). Diagnostic value of LA MD was better than LAA MD in patients with normal LA volumes, while LAA MD was more useful in patients with LA enlargement.Conclusion:Both LA and LAA mechanics had incremental value over CHA2DS2VASc score. However, priorities of strain assessment depend on patients’ LA volume.

Variables Univariate analysis Multivariate analysis Model 1 Model 2 Model 3 OR (95% CI) P value OR (95% CI) P value OR (95% CI) p value OR (95% CI) P value Clinical parameters Age 1.09(1.04-1.14) &lt;0.001 1.11(1.04-1.17) 0.001 1.11(1.05-1.17) 0.001 1.11(1.04-1.17) 0.001 BMI 0.988(0.89-1.10) 0.84 1.07(0.92-1.25) 0.40 1.07(0.91-1.25) 0.40 CHA2DS2-VASc score 1.52(1.15-2.00) 0.003 1.08(0.67-1.74) 0.76 1.08(0.65-1.80) 0.77 1.10(0.69-1.76) 0.69 Persistent AF 1.88(0.94-3.74) 0.07 0.75(0.23-2.40) 0.63 0.87(0.27-2.81) 0.82 Therapeutic anticoagulation 0.56(0.28-1.11) 0.10 0.22(0.09-0.57) 0.002 0.23(0.09-0.59) 0.002 0.22(0.09-0.57) 0.002 LA parameters LAEF 0.96(0.94-0.99) 0.002 0.982(0.953-1.01) 0.26 iLAVmin 1.03(1.01-1.05) 0.006 0.98(0.94-1.02) 0.27 LA MD 1.22(1.10-1.36) &lt;0.001 1.16(1.02-1.32) 0.02 1.18(1.03-1.34) 0.02 1.16(1.02-1.32) 0.02 LA GLS 0.935(0.893-0.98) 0.005 1.0(0.953-1.14) 0.36 1.02(0.94-1.12) 0.59 1.02(0.94-1.10) 0.72 LAA parameters LAAEV 0.12(0.02-0.74) 0.02 3.34(0.31-36.06) 0.32 LAA EF 0.98(0.96-1.00) 0.06 1.01(0.98-1.04) 0.65 LAA GLS 0.85(0.77-0.94) 0.001 0.96(0.86-1.07) 0.46 0.97(0.87-1.08) 0.59 0.96(0.87-1.06) 0.44 LAA dense SEC/thrombus 3.12(1.39-6.99) 0.006 2.02(0.75-5.45) 0.167 LAA MD 1.19(1.09-1.29) &lt;0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 Univariable and multivariable logistic regression analyses of associations between clinical and echocardiographic covariates with stroke Abstract Figure.

P1360Association between left atrial appendage dysfunction and thromboembolic risk in nonvalvular atrial fibrillation

Abstract

Background/Introduction:  Atrial fibrillation (AF) is associated with higher risk for thromboembolism , and the discriminative ability of the widely used CHA2DS2-VASc scores for risk stratification is modest. Although the presence of thrombus in the LAA is the most powerful predictors for thromboembolic risk, they are often absent in patients with AF and prior stroke. AF may be related to myocardial fibrosis, and even though left atrial fibrosis is associated with mechanical dispersion, this phenomenon is not well studied in LAA. We hypothesized that detection of LAA dysfunction and mechanical dispersion using strain echocardiography is useful in the identification of cardiac thromboembolism.

Purpose

The aim of this study was to determine the association of LAA mechanics assessed using strain analysis with previous thromboembolic events in patients with nonvalvular AF and to assess the potential incremental significance of LAA mechanical dispersion over the traditional risk stratification scheme.

Methods

A group of 116 patients with AF referred for TEE was prospectively analyzed. LAA strain and mechanical dispersion in parallel with other conventional TEE parameters were analyzed in terms of their association with previous embolic stroke and peripheral embolization.

Results

Patients with embolic events had a higher mean CHA2DS2-VASc score, higher incidence of LAA dense SEC or thrombi, and other clinical data were comparable. Patients with embolic events had greater impairment in the LA standard parameters, and lower global and regional LAA longitudinal strain than those of the controls. LAA MD was significantly higher in patients with embolization than in those without it (18.91 ± 7.19 %vs 13.8 ± 5.54%; P &lt; .001). In ROC analysis, cut-off values for LAA MD,LAEF, LAA GLS for the presence of dense SEC/ thrombus were &gt;20.21 % (p = 0.0076), ≤31.11 % (p = 0.017), and ≤ 7.31 % (p = 0.014), respectively. LAA MD, LAEF, LAA thrombus and CHA2DS2-VASc scores were independently associated with the presence of thromboembolism in multivariate analyses, and LAA MD had additional significance over the CHA2DS2-VASc score.

Conclusion

LAA MD, LAA thrombi and LAEF had statistically significant meaning for the presence of prior embolism that was independent of the standard planimetric and volumetric measurements. What’s more, LAA MD had an incremental value over CHA2DS2-VASc score in risk stratification and warrants testing in a larger study.

Abstract Figure. ROC curves for LAA parameters

[Analysis of adenovirus infection in acute respiratory tract infection cases in Shanghai from 2015 to 2019]

Objective: To study the epidemiological characteristics and mixed infection of adenovirus in acute respiratory tract infections in Shanghai from 2015 to 2019, and to provide scientific basis for the prevention and control of adenovirus. Methods: Acute respiratory tract infections were collected from 3 hospitals in Shanghai from 2015 to 2019. Relevant information was registered and respiratory specimens were sampled for detection of respiratory pathogens by multiplex PCR. Results: A total of 1 543 cases of acute respiratory tract infection were included. The positive rate of adenovirus was 2.92%(45/1 543), the positive rates of influenza like illness (ILI) and severe acute respiratory illness (SARI) were 2.74%(29/1 058) and 3.30%(16/485), respectively. The positive rate of ILI during January-May 2019 was 5.43%(7/129), higher than that in the same period of 2015- 2018 (0.52%-4.48%) (Fisher's exact test value=8.92, P=0.036). The incidence of adenovirus-positive cases was mainly distributed in the first and second quarters, accounting for 62.22% (28/45). The difference of the incidence of adenovirus-positive cases in each quarter was significant (χ(2)= 12.52, P=0.006). The positive rate in the second quarter was highest (6.03%), which was higher than that in other quarters (1.89%-2.93%). There were significant differences among different age groups (χ(2)=16.94, P=0.001), and the positive rate decreased with age (χ(2)=10.16, P=0.001). The positive rate of 13-19 years old group (9.43%) was higher than that of other age groups (1.48%-4.81%). The positive rate of student group (12.07%) was higher than that of other occupations (2.61%). The difference was systematic (χ(2)=11.53, P=0.001). Mixed infection accounted for 31.11% (14/45) of 45 adenovirus positive cases. The mixed infection rates of ILI and SARI were 34.48% (10/29) and 25.00% (4/16), respectively. Among 14 cases of mixed infection, the main mixed infection pathogens of adenovirus were influenza A virus and coronavirus. Conclusion: Adenovirus surveillance should be further strengthened in adolescents with a focus on students and other key groups in the second quarter.

[Investigation of an epidemic cluster caused by COVID⁃19 cases in incubation period in Shanghai]

Objective: To analyze the epidemiological characteristics of a cluster of 5 confirmed COVID⁃19 cases related with the transmission in incubation period of initial case, and find out the infection source and transmission chain.. Methods: According to "The Prevention and Control Protocol for Coronavirus Disease 2019 (Third Edition)" issued by the National Health Commission, a field epidemiological survey was conducted for the 5 cases in January 2020. Nasopharyngeal swabs and sputum samples were collected from them for the detection of 2019-nCoV by real time RT-PCR. Multi prevention and control measures were taken, such as tracking and screening close contacts, medical isolation observation, investigating the epidemiological link, analyzing transmission chain. Results: Case 1, who had common environmental exposure with other COVID⁃19 cases, got sick on 20 January, 2020 and was confirmed on 1 February. Case 2 became symptomatic on 22 January and was confirmed on 27 January. Case 3 got sick on 25 January and was confirmed on 30 January. Case 4 had illness onset on 20 January and was confirmed on 1 February. Case 5 got sick on 23 January and was confirmed on 31 January. Among the 5 cases, case 2 died and the illness of other cases were effectively controlled. After exclusion of other common exposure factors, case 1 had a 6-hour meeting with case 2 and case 3 on 19 January. Case 2 and case 3 might be infected by case 1 during the incubation period. It is the key point for epidemiological investigation. Conclusion: The epidemiological investigation indicates that the transmission might occur in the incubation period of COVID-19 case, close attention should be paid to it in future COVID-19 prevention and control.

P3613J-shaped relationship between cardiac mortality risk and admission systolic blood pressure in patients aged 65 years and over with acute coronary syndrome

Objective

To observe the effects of different admission systolic blood pressure (SBP) levels on the in-hospital and long-term prognosis of elderly patients with acute coronary syndrome (ACS).

Methods

This retrospective cohort study included 5812 ACS patients aged 65 and over admitted from January, 2013 to September, 2018. Their blood pressure, medical history and laboratory examinations were recorded. The patients were divided into 5 groups according to the level of admission SBP (<100, 100–119, 120–139, 140–159, and ≥160 mmHg). The main endpoint of this study was cardiac death and all-cause death in hospital and during 6-year follow-up.

Results

Among the participants, the number of patients admitted with SBP <100, 100–119, 120–139, 140–159, and ≥160 mmHg were 143 (2.5%), 1014 (17.4%), 2456 (42.3%), 1607 (27.6%), and 592 (10.2%), respectively. The highest in-hospital cardiac mortality and all-cause mortality rate were found in the group with admission SBP <100 mmHg and the lowest were found in the group with SBP 140–159 mmHg (9.1% vs. 3.2% vs. 1.1% vs. 0.8% vs. 1.5%, P=0.000; 9.8% vs. 3.4% vs. 1.1% vs. 0.8% vs. 1.7%, P=0.000). Kaplan-Meier curve showed that patients with SBP 120–139 mmHg at admission had better prognosis (cardiac mortality: 3.9% vs. 10.9%, 5.6%, 5.1%, and 6.7% respectively, P=0.000; all-cause mortality: 7.6% vs. 14.7%, 9.7%, 9.1%, and 11.0%, respectively, P=0.000). Multivariate analysis showed that admission SBP <120 mmHg or ≥160 mmHg was a independent predictors of follow-up cardiac death (HR 1.747, 95% CI 1.066–2.861, P=0.027; HR 1.496, 95% CI 1.092–2.050, P=0.012; HR 1.630, 95% CI 1.120–2.372, P=0.011) compared with patients admitted with SBP 120–139 mmHg.

In-hospital and 6-year follow-up outcomes of ACS patients ≥65y by admission SBP Admission SBP Level <100mmHg ≥100mmHg and <120mmHg ≥120mmHg and <140mmHg ≥140mmHg and <160mmHg ≥160mmHg P In-hospital (n=143) (n=1014) (n=2456) (n=1607) (n=592)   Cardiac mortality, n (%) 13 (9.1) 32 (3.2) 28 (1.1) 13 (0.8) 9 (1.5) 0.000   All-cause mortality, n (%) 14 (9.8) 34 (3.4) 28 (1.1) 13 (0.8) 10 (1.7) 0.000 Follow-up (n=129) (n=980) (n=2428) (n=1594) (n=582)   Cardiac mortality, n (%) 14 (10.9) 55 (5.6) 94 (3.9) 81 (5.1) 39 (6.7) 0.000   All-cause mortality, n (%) 19 (14.7) 95 (9.7) 185 (7.6) 144 (9.1) 64 (11.0) 0.000

Kaplan-Meier analyses

Conclusion

In ACS patients ≥65 y, a “J” relationship between admission SBP and cardiac mortality is observed. For ACS patients aged 65 years and over, admission SBP <120 mmHg or ≥160mmHg is a independent risk factor for long-term cardiac death.

Acknowledgement/Funding

National Natural Science Foundation of China (No. 81300333))

[Etiologic and epidemiologic features of acute respiratory infections in adults from Shanghai, during 2015-2017]

Objective: To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017. Methods: Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens. Results: A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001). Conclusions: In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.

Analysis of Characteristics and Relevant Factors of 1 340 Cases of Intentional Injury Cases in Southwest China

Abstract

Objective To investigate the characteristics and patterns of factors such as victims' information, injury tools and time of occurrence of intentional injury cases in southwest China. Methods One thousand three hundred and forty intentional injury cases from several places in southwest China from 2014 to 2016 assessed as minor injury level Ⅱ and above had been randomly selected. Data on victims' information, motives, injury tools, sites of occurrence, time of occurrence, injured parts and degrees of injury were classified and gathered, and then association analyses of motives and types of injury tools as well as degrees of injury and injury tools were made. Results Most of the victims were young adults between 20-50 years （65.2%）, male （82.3%）, rural household registration （62.8%）; the motives were mainly dispute （45.8%）. Injury tools were mostly blunt （54.6%） or sharp （36.0%）. Specifically, injuries were mostly made bare-handed （36.9%） and by cutting tools （33.2%）; the cases mainly occurred in public areas （59.0%）. Cases occurred more frequently in January （11.3%）, February （13.1%）, March （11.6%） and from 22：00 to 01：00 every night. Injuries mainly involved the craniofacial region. The wounds were mainly assessed as minor injury level Ⅱ （61.6%）. There was statistical significance in the difference of types of injury tools among cases with different motives （P<0.05）. There was statistical significance in the difference of the distribution of injury tools among cases with different degrees of injury （P<0.05）. Conclusion The occurrence of intentional injury cases in southwest China has potential patterns and relevant influencing factors. Prevention and analysis of such cases need to be comprehensively considered from the aspects such as victims' information, injury tools and time of occurrence.

Improving polarized neutron imaging for visualization of the Meissner effect in superconductors

The polarized neutron imaging technique provides a non-invasive method of characterizing localized magnetic fields inside superconductors. However, complete understanding of the magnetic field distribution has yet to be realized experimentally due to the complexity of the interaction between neutron polarization and magnetic field. In this article, we show that a well-defined and controlled magnetic field through the neutron path contributes to simplify the data analysis and makes future quantitative polarized neutron imaging possible. This is demonstrated in a set of experiments that visualize the magnetic field distribution inside and around the superconductors. The experimental results demonstrate that proper guide field setup allows the visualization of the magnetic field expulsion at the surface of the superconductor in the zero-field cooling condition, as well as the magnetic field trapped inside the superconductor under field cooling condition.

[Minocycline inhibits formalin-induced inflammatory pain and the underlying mechanism]

OBJECTIVE

To unravel the underlying mechanism of minocycline in formalin-induced inflammatory pain, and to investigate the effects of minocycline on synaptic transmission in substantia gela-tinosa (SG) neurons of rat spinal dorsal horn.

METHODS

Behavioral and immunohistochemistry experiments: 30 male Sprague-Dawley (SD) rats (3-5 weeks old) were randomly assigned to control (n=8 rats), model (n=8 rats), saline treatment model (n=6 rats) and minocycline treatment model (n=8 rats) groups. The control group was subcutaneously injected with normal saline on the right hindpaws. Acute inflammatory pain model was established by injecting 5% (volume fraction) formalin into the right hindpaws. The rats in the latter two groups received intraperitoneal injection of saline and minocycline 1 h before the formalin injection, respectively. The time of licking and lifting was recorded every 5 min within 1 h after the subcutaneous injection of normal saline or formalin for all the groups, which was continuously recorded for 1 h. One hour after the pain behavioral recording, the spinal cord tissue was removed following transcardial perfusion of 4% paraformaldehyde. The expression of c-Fos protein in spinal dorsal horn was observed by immunohistochemistry. Electrophysiological experiment: In vitro whole-cell patch-clamp recordings were performed in spinal cord parasagittal slices obtained from 26 male SD rats (3-5 weeks old). Two to five neurons were randomly selected from each rat for patch-clamp recording. the effects of minocycline, fluorocitrate and doxycycline on spontaneous excitatory postsynaptic currents (sEPSCs) or spontaneous inhibitory postsynaptic currents (sIPSCs) of SG neurons were investigated.

RESULTS

Compared with the control group, both the licking and lifting time and the expression of c-Fos protein in ipsilateral spinal dorsal horn of the model group were significantly increased. Intraperitoneal injection of minocycline largely attenuated the second phase of formalin-induced pain responses (t=2.957, P<0.05). Moreover, c-Fos protein expression was also dramatically reduced in both the superficial lamina (I-II) and deep lamina (III-IV) of spinal dorsal horn (t_I-II=3.912, t_III-IV=2.630, P<0.05). On the other side, bath application of minocycline significantly increased the sIPSCs frequency to 220%±10% (P<0.05) of the control but did not affect the frequency (100%±1%, t=0.112, P=0.951) and amplitude (98%±1%, t=0.273, P=0.167) of sEPSCs and the amplitude (105%±3%, t=0.568, P=0.058) of sIPSCs. However, fluorocitrate and doxycycline had no effect on the frequency [(99%±1%, t=0.366, P=0.099); (102%±1%, t=0.184, P=0.146), respectively] and amplitude [(98%±1%, t=0.208, P=0.253); (99%±1%, t=0.129, P=0.552), respectively] of sIPSCs.

CONCLUSION

Minocycline can inhibit formalin-induced inflammatory pain and the expression of c-Fos protein in spinal dorsal horn. These effects are probably due to its enhancement in inhibitory synaptic transmission of SG neurons but not its effect on microglial activation or antibiotic action.

[Clinical study on locking plate for the treatment of non-osteoporotic complex proximal humeral fractures]

OBJECTIVE

To describe long-term results of locking plate used for the treatment of non-osteoporotic fresh three- and four-part proximal humeral fractures with at least 2 years follow-up.

METHODS

The functional outcomes and the complications of non-osteoporotic three- and four-part fresh proximal humeral fractures treated with locking plate were assessed retrospectively. The active range of motion, the Constant score, the University of California at Los Angeles (UCLA) shoulder score, the visual analogue score (VAS) were employed to evaluate the postoperative shoulder function, and the radiographic images were taken to evaluate the neck-shaft angle of the proximal humeral and postoperative implant-related complications.

RESULTS

From January 2007 to October 2014, 107 consecutive fresh three- and four-part non-osteoporotic fresh proximal humeral fractures were treated with a locking plate in our department. Among them, 67 patients completed at least 2 years follow-up. The average follow-up time was (43.9±23.3) months (range: 24-108 months). The mean Constant score was 87.1±11.7 (range: 51-100), the mean UCLA score was 30.5±3.9 (range: 18-35), the mean VAS score was 1±2 (range: 0-7). The mean active forward flexion was 159.0°±19.3° (range: 80°-180°), the mean external rotation was 36.8°±19.5°(0°-80°) and the mean internal rotation was T11 level (T2-LS level). There were 11 patients who suffered from complications. Screw perforations were observed in 5 (7.5%) patients, avascular necrosis of the humeral head was observed in 9 (13.4%) patients and traumatic osteoarthritis was observed in 5 (7.5%) patients. Six patients showed two or more complications. There was no significant difference in outcomes when comparing the patients with three- part fractures (31 patients) with those with four-part fractures (36 patients). The rates of complications and avascular necrosis were significantly higher in the four-part fracture group than in the three-part fracture group.

CONCLUSION

The locking plate is an effective method in treating three- and four-part non-osteoporotic fresh proximal humeral fractures. Strict surgical indication and precise surgical skill are the key points for successful treating non-osteoporotic fresh proximal humeral fractures. There is a higher rate of complications and avascular necrosis of the humeral head in the four-part fractures than in the three-part fractures.

Setup for polarized neutron imaging using in situ 3He cells at the Oak Ridge National Laboratory High Flux Isotope Reactor CG-1D beamline

In the present study, we report a new setup for polarized neutron imaging at the ORNL High Flux Isotope Reactor CG-1D beamline using an in situ ³He polarizer and analyzer. This development is very important for extending the capabilities of the imaging instrument at ORNL providing a polarized beam with a large field-of-view, which can be further used in combination with optical devices like Wolter optics, focusing guides, or other lenses for the development of microscope arrangement. Such a setup can be of advantage for the existing and future imaging beamlines at the pulsed neutron sources. The first proof-of-concept experiment is performed to study the ferromagnetic phase transition in the Fe₃Pt sample. We also demonstrate that the polychromatic neutron beam in combination with in situ ³He cells can be used as the initial step for the rapid measurement and qualitative analysis of radiographs.

[Spinal analgesic mechanism of minocycline in formalin-induced inflammatory pain]

Objective: To investigate the spinal analgesic mechanism of minocycline in formalin-induced inflammatory pain. Methods: Behavioral test: Male Sprague-Dawley rats(3-5-week old) were randomly assigned into four groups: control, model, vehicle-controlled and minocycline group. Ten percent neutral formalin was injected subcutaneously into the right hind paw dorsum of the rats in model, vehicle-controlled and minocycline group. Normal saline was injected subcutaneously into the right hind paw dorsum of the rats in control group. Before 1 h of formalin injection, the rats in vehicle-controlled and minocycline group received intraperitoneal injection of saline and minocycline, respectively. Licking and lifting time was observed as the behavior results of inflammatory pain. Electrophysiologic experiment: In vitro spinal cord parasagittal slices were prepared from the same rats as above. The effect of minocycline on spontaneous inhibitory postsynaptic currents(sIPSCs) of substantia gelatinosa(SG) neurons was observed using whole-cell patch-clamp technique. Results: Compared with the control group, the licking and lifting time in the model group was significantly increased. Compared with the vehicle-controlled group, the licking and lifting time in the minocycline group was significantly decreased. Minocycline significantly increased the frequency(t=9.32, P<0.05)but not the amplitude(t=1.54, P>0.05) of sIPSCs of SG neurons, the frequency of sIPSCs of control and minocycline group were (2.5±0.3)Hz and (5.2±0.6)Hz, respectively. When calcium was removed from the extracellular solution, the frequency before and after minocycline perfusion were (0.9±0.1)Hz and (0.9±0.1)Hz, respectively, the amplitude before and after minocycline perfusion were (18.2±0.7)pA and (18.5± 0.6)pA, respectively, the difference of frequency or amplitude was not statistically significant(t=0.32, 0.82, all P>0.05). However, minocycline still increased the frequency of sIPSCs when glutamate receptor antagonists 6-Cyano-7-nitroquinoxaline-2, 3-dione(CNQX) and D-(-)-2-Amino-5-phosphonopentanoic acid(APV) were included in extracellular solution(t=13.51, P<0.05), the frequency of sIPSCs were (2.0±0.1)Hz and (4.3±0.4)Hz, respectively. Minocycline still increased the frequency of IPSCs when voltage-gated sodium channel blocker tetrodotoxin(TTX) were included in extracellular solution(t=8.67, P<0.05), the frequency of IPSCs were (2.2±0.2)Hz and (5.2±0.5)Hz. Conclusion: Minocycline can attenuate formalin-induced inflammatory pain which may be associated with its increase in the inhibitory synaptic transmission of SG neurons.

Porous MOF with Highly Efficient Selectivity and Chemical Conversion for CO2

A new Co(II)-based MOF, {[Co₂(tzpa)(OH)(H₂O)₂]·DMF}_n (1) (H₃tzpa = 5-(4-(tetrazol-5-yl)phenyl)isophthalic acid), was constructed by employing a tetrazolyl-carboxyl ligand H₃tzpa. 1 possesses 1D tubular channels that are decorated by μ₃-OH groups, uncoordinated carboxylate O atoms, and open metal centers generated by the removal of coordinated water molecules, leading to high CO₂ adsorption capacity and significantly selective capture for CO₂ over CH₄ and CO in the temperature range of 298-333 K. Moreover, 1 shows the chemical stability in acidic and basic aqueous solutions. Grand canonical Monte Carlo simulations identified multiple CO₂-philic sites in 1. In addition, the activated 1 as the heterogeneous Lewis and Brønsted acid bifunctional catalyst facilitates the chemical fixation of CO₂ coupling with epoxides into cyclic carbonates under ambient conditions.

New generation high performance in situ polarized 3He system for time-of-flight beam at spallation sources

Modern spallation neutron sources generate high intensity neutron beams with a broad wavelength band applied to exploring new nano- and meso-scale materials from a few atomic monolayers thick to complicated prototype device-like systems with multiple buried interfaces. The availability of high performance neutron polarizers and analyzers in neutron scattering experiments is vital for understanding magnetism in systems with novel functionalities. We report the development of a new generation of the in situ polarized ³He neutron polarization analyzer for the Magnetism Reflectometer at the Spallation Neutron Source at Oak Ridge National Laboratory. With a new optical layout and laser system, the ³He polarization reached and maintained 84% as compared to 76% in the first-generation system. The polarization improvement allows achieving the transmission function varying from 50% to 15% for the polarized neutron beam with the wavelength band of 2-9 Angstroms. This achievement brings a new class of experiments with optimal performance in sensitivity to very small magnetic moments in nano systems and opens up the horizon for its applications.

[Prognostic factors of postoperative incisional surgical site infections for colorectal cancer]

Objective: To explore the prognostic factors of postoperative incisional surgical site infections (I-SSI) for colorectal cancer. Methods: Clinical data of 2 385 colorectal cancer patients undergoing resection by the same surgical team in Department of Colon and Rectum Surgery, Fujian Medical University Union Hospital from January 2000 to February 2014 was analyzed retrospectively. There were 1 421 male and 964 female patients, with a mean age of (59±13) years. Univariate analysis and multivariate Logistic regression analysis were performed for independent prognostic factors of I-SSI. Results: The I-SSI occurred in 77 patients (3.23%). The results of univariate analysis showed that there were statistical differences in body mass index (t=-3.356), operation time (t=-3.609), length of incision (t=-5.492), radical operation (χ²=8.963), laparoscopic surgery (χ²=25.884), combined evisceration (χ²=6.349) and intraoperative blood infusion (χ²=4.176) between two groups (all P<0.05) . The results of multivariate Logistic regression analysis showed that independent prognostic factors of I-SSI were identified to be body mass index (OR=1.087, 95%CI: 1.023 to 1.155, P=0.007), operation time (OR=1.007, 95%CI: 1.002 to 1.012, P=0.006), preoperative chemoradiotherapy (OR=2.434, 95%CI: 1.099 to 5.393, P=0.028) and combined evisceration (OR=2.596, 95%CI: 1.060 to 6.357, P=0.037). The independent protective prognostic factor of I-SSI was identified to be the laparoscopic surgery (OR=0.386, 95%CI: 0.170 to 0.877, P=0.023). Conclusions: Body mass index, operation time, preoperative chemoradiotherapy and combined evisceration are identified to be independent prognostic factors for I-SSI. High-risk patients should receive individualized perioperative intervention. Nevertheless, the laparoscopic surgery can decrease the incidence of I-SSI.

[Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures]

OBJECTIVE

To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures.

METHODS

From January 2013 to December 2014, 8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were retrospectively reviewed after the final follow-up. There were 1 man and 7 women with a mean age of (58.5±6.4) years, of whom 3 left shoulders and 5 right shoulders were involved. There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures, and 6 patients with humeral head necrosis as well as implant-associated infection after open reduction internal fixation for proximal humeral fractures with the locking plate. The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery. At the first-stage surgery, all the patients underwent a thorough debridement, and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate. During the second-stage surgery, the cement spacer was removed, and then a revision shoulder arthroplasty with the reverse shoulder prosthesis was performed in all the patients who were routinely followed up after the second-stage surgery. The visual analogue score (VAS), Constant score and University of California Los Angeles (UCLA) score were employed to evaluate the postoperative shoulder function.

RESULTS

The mean follow-up time was (19.9±8.0) months (range 12 to 35 months). At the end of the follow-up, the median forward elevation [100° (60°, 140°) vs. 25° (0°, 90°), P=0.011], the median external rotation [15° (0°, 50°) vs. 5° (0°, 20°), P=0.048], and the median internal rotation [L4 (buttock, T12) vs. buttock (buttock, L3), P=0.041] were all significantly improved postoperatively. The median Constant score [53.5 (32, 74) vs. 29.0 (10, 57), P=0.012], the median UCLA score [20.5 (9, 26) vs. 9.5 (5, 15), P=0.012], and the median VAS score [1.5 (0, 5) vs. 5.0 (0, 8), P=0.018] were all significantly improved after the surgery. No recurrence of infection, prosthetic loosening or neurovascular injury was noted by the last follow-up.

CONCLUSION

two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures. The shoulder function was postoperatively improved to a certain degree.

[Intraarticular injection of bevacizumab in treatment of osteoarthritis: a laboratory research on a rabbit model]

OBJECTIVE

To evaluate the effects of intraarticular injection of bevacizumab, sodium hyaluronate (SH) and 0.9% sodium chloride injection in the treatment of osteoarthritis (OA) in a rabbit model.

METHODS

Twenty-four male rabbits were randomly divided into bevacizumab group,SH group and control group after the model of OA had been made. The bevacizumab group and control group received intraarticular bevacizumab (4 mg) and 0.9% saline injection respectively once per three weeks for 2 times. The SH group received intraarticular SH once a week for 6 weeks. After 6 weeks, the histological examinations of cartilage and synovium,electron microscopy and expression of vasculan endothelial growth factorl (VEGF), for the synovium, expression of MMP-1, Mankin's scale, macroscopic observation for cartilage were performed.

RESULTS

The histological observation of the bevacizumab group and the SH group showed that bevacizumab could decrease the synoviocytes and inhibit fibrous hyperplasia in synovial underlayer compard with the control group. Reduced apoptosis of chondrocytes and more integrated structure of matrix and more glycosaminoglycan were also found in the bevacizumab group and the SH group compared with control group. The expression of VEGF and MMP-1, Mankin's scale, macroscopic observation were significantly decreased in the bevacizumab group compared with the SH group and the control group (P<0.05).

CONCLUSION

Intraarticular injection of bevacizumab and SH can relieve inflammation of OA and alleviate the pathologic process of OA. The Bevacizumab was better than the SH in therapeutic effect, which maybe implicate a better choice for the treatment of OA.

[Modified arthroscopic Latarjet procedure for the treatment of anterior shoulder instability]

OBJECTIVE

To present the surgical technique and to evaluate the results of the modified arthroscopic Latarjet procedure.

METHODS

Arthroscopic Latarjet procedure has proven to be a reliable method of treatment for difficult anteroinferior instability of the shoulder joint. However, there is no anterior capsule reattachment and too much subscapularis damage for the classic procedure. From February 2013, we modified the classic procedure with reattachment of anterior joint capsule and muscle-tendon junction splitting of subscapularis. Coracoid graft position was evaluated using CT scanning.

RESULTS

From March 2012 to August 2014, 51 modified Latarjet procedures were successfully performed arthroscopically for patients with anterior shoulder instability. According to the CT scanning at the final follow up, the graft was flush with the glenoid in 94.1%, and medially placed in 5.9%. Vertical positioning was perfect in 96.0% (2 to 5 o'clock), too high in 2.0%, and too low in 2.0%. There were no cases of recurrent dislocation or subluxation.

CONCLUSION

The modified arthroscopic Latarjet procedure has shown satisfactory results with good graft positioning. It is a minimal invasive and accurate approach, which combines the advantages of the open procedure.

[Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint dislocations:comparison of curative effect]

OBJECTIVE

To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dislocations.

METHODS

From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up. There were 49 men and 14 women with a mean age of (40.3±10.6) years. The mean time from injury to surgery was (10.3±5.3) d. According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with type III injury. All the patients with type III injury claimed high level of sport activity. The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken. All the patients were routinely followed up after the surgery. The visual analogue score (VAS), American shoulder and elbow surgeons(ASES) score and University of California Los Angeles(UCLA) score were employed to evaluate the postoperative shoulder function. The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.

RESULTS

The mean follow-up time was (29.6±6.0) months (range: 24 to 43 months). No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient's age [(41.0±10.5) years vs. (38.0± 10.8) years], gender (male/female,24/8 vs.25/6), classification (V/III,22/10 vs.23/8), time from injury to surgery [(10.6±4.9) d vs.(10.1±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8±6.4) months vs.(29.5±5.5) months], P>0.05. At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward elevation [(164.4±17.2) degrees vs.(162.6±12.9) degrees], mean external rotation [(60.9±17.0) degrees vs.(57.3±15.8) degrees], mean internal rotation [(T12±3 vertebrae) vs.(T12±3 vertebrae)], mean ASES scores (96.0±5.1 vs. 94.5±3.8)and UCLA scores (34.2±1.5 vs. 33.7±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).

CONCLUSION

Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function. The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.

[Clinical follow-up study after open Latarjet procedure in patients with recurrent anterior shoulder dislocation]

OBJECTIVE

To investigate the results of treating patients with recurrent anterior shoulder dislocation using open Latarjet technique in a retrospective study, and to discuss the detail of the surgical technique and the results of the procedure.

METHODS

In the study, 22 patients with recurrent anterior shoulder dislocation treated with open Latarjet technique were followed up. The average duration of the follow-up was 66.0 months. An X-ray film and a CT scan were performed before the surgery to evaluate the degenerative change of the gleno-humeral joint and the bony defect of the glenoid. An X-ray film and a CT scan were repeated at the end of the final follow-up to find out if there was any progression of the degenerative change of the gleno-humeral joint and if the transferred coracoid process united. Physical examinations, American Shoulder & Elbow Surgeons (ASES) score, Constant-Murley score and Rowe questionnaire were used to evaluate the patients' shoulder function before the surgery and at the end of the final follow-up.

RESULTS

Before the surgery the average forward elevation, external rotation and internal rotation were 158.2°±28.7°, 55.3°±15.2° and T10 (T3-buttock) respectively. The average ASES score, Constant-Murley score and Rowe score were 77.6±17.5, 88.3±12.5 and 40.2±12.0, respectively. At the end of the final follow-up, no redislocation happened. The average forward elevation, external rotation and internal rotation were 167.7°±12.7°, 54.3°±16.5° and T10 (T3-L3), respectively(P=0.138, P=0.765, P=0.439).No sigificant restriction was detected after the surgery regarding forward elevation,external rotation and internal rotation. The mean ASES score, Constant-Murley score, and Rowe score significantly improved to 93.7±9.1 (P=0.001), 95.6±5.6 (P=0.008) and 96.4 ±4.4 (P<0.001) respectively after the surgery. A progression of the degenerative change of the gleno-humeral joint was detected in 3 patients. A non-union of the transferred coarcoid was detected in 1 patient.

CONCLUSION

Open Latarjet procedure is effective in treating the recurrent anterior shoulder dislocation patient with severe glenoid defect. No significant progression of the degenerative change of the gleno-humeral joint is detected in average 5-year follow-up.

Development of a compact in situ polarized ³He neutron spin filter at Oak Ridge National Laboratory

We constructed a compact in situ polarized (3)He neutron spin filter based on spin-exchange optical pumping which is capable of continuous pumping of the (3)He gas while the system is in place in the neutron beam on an instrument. The compact size and light weight of the system simplifies its utilization on various neutron instruments. The system has been successfully tested as a neutron polarizer on the triple-axis spectrometer (HB3) and the hybrid spectrometer (HYSPEC) at Oak Ridge National Laboratory. Over 70% (3)He polarization was achieved and maintained during the test experiments. Over 90% neutron polarization and an average of 25% transmission for neutrons of 14.7 meV and 15 meV was also obtained.

Outcomes of laryngectomy in elderly patients with laryngeal carcinoma

Laryngeal carcinoma is a common tumor of the head and neck region. This study aimed to examine the outcomes of laryngectomy in elderly patients with laryngeal carcinoma. One-hundred twenty-two patients (male, 117; female, 5) aged 60 years or older (range, 60-94 years) who underwent laryngectomy between 1996 and 2010 were included. All patients were diagnosed with squamous cell carcinoma of the larynx, and 95 patients (77.9%) had additional concurrent diseases. Tumors were staged according to the TNM categories of the American Joint Committee on Cancer 2002 criteria; there were 16 stage-I, 24 stage-II, 52 stage-III, and 30 stage-IV cases. With regard to treatment modalities, 10 patients underwent transoral laser laryngectomy, 25 underwent partial laryngectomy, and 87 underwent total laryngectomy. When necessary, neck dissection was performed according to the Dalian criteria set in 2004 (a Chinese standard). Of the 122 cases, there were 114 cases of grade I (93.4%), 5 cases of grade II, and 3 cases of grade III (pharyngeal fistula in 2 cases recovered after 2 weeks of care) wound healing. No significant differences were observed in the occurrence or severity of comorbidities. The 1-, 3-, and 5-year actuarial survival rates were 97.5% (119/122), 84.4% (92/109), and 68.4% (67/98), respectively. Age alone should not be used to determine treatment options for elderly patients with squamous cell carcinoma. Presuming that careful pre-treatment evaluations are performed, laryngectomy is a key method for elderly patients with laryngeal carcinoma.

The adipocytokine resistin stimulates the production of proinflammatory cytokines TNF-α and IL-6 in pancreatic acinar cells via NF-κB activation

BACKGROUND

Resistin, an adipocytokine secreted by fat tissues, has been associated with the inflammatory response, though its role in inflammation during acute pancreatitis (AP) remains unclear.

OBJECTIVE

The proinflammatory response following acinar cell injury impacts pancreatitis severity, necessitating better understanding of functional consequences associated with pancreatic acinar cell resistin exposure and resultant effects on proinflammatory signaling.

METHODS

Amylase-secreting rat pancreatic acinar AR42J cells were subjected to 1, 10, or 100 ng/ml recombinant rat resistin treatments. Cytotoxicity was evaluated by amylase secretion and lactate dehydrogenase (LDH) release. Tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) mRNA and protein expressions were determined by real-time real time-PCR and enzyme-linked immunosorbent assay, respectively. Nuclear NF-κB p65 subunit protein level was measured by western blotting.

RESULTS

Significantly increased amylase secretion and LDH release was observed in the 100 ng/ml resistin treatment (p<0.01). Both TNF-α and IL-6 protein expression levels increased in a concentration-dependent manner when treated with resistin. Pretreatment of resistin- treated AR42J cells with the NF-κB inhibitor PDTC, which decreases the NF-κB p65 subunit protein expression levels in the nuclei, produced significantly lower mRNA expression levels for both TNF-α and IL-6 compared with those produced by resistin-treated cells (p<0.01).

CONCLUSIONS

Resistin exhibits some cytotoxic activity in rat pancreatic acinar AR42J cells and stimulates proinflammatory cytokine TNF-α and IL-6 production via NF-κB activation. Thus, overproduction of obesity-related circulating resistin and associated lowgrade inflammation may result in mild injury to pancreatic acini, increasing AP severity and risk.

Spin exchange optical pumping based polarized 3He filling station for the Hybrid Spectrometer at the Spallation Neutron Source

The Hybrid Spectrometer (HYSPEC) is a new direct geometry spectrometer at the Spallation Neutron Source at the Oak Ridge National Laboratory. This instrument is equipped with polarization analysis capability with 60° horizontal and 15° vertical detector coverages. In order to provide wide angle polarization analysis for this instrument, we have designed and built a novel polarized (3)He filling station based on the spin exchange optical pumping method. It is designed to supply polarized (3)He gas to HYSPEC as a neutron polarization analyzer. In addition, the station can optimize the (3)He pressure with respect to the scattered neutron energies. The depolarized (3)He gas in the analyzer can be transferred back to the station to be repolarized. We have constructed the prototype filling station. Preliminary tests have been carried out demonstrating the feasibility of the filling station. Here, we report on the design, construction, and the preliminary results of the prototype filling station.

In situ polarized 3He system for the Magnetism Reflectometer at the Spallation Neutron Source

We report on the in situ polarized (3)He neutron polarization analyzer developed for the time-of-flight Magnetism Reflectometer at the Spallation Neutron Source at Oak Ridge National Laboratory. Using the spin exchange optical pumping method, we achieved a (3)He polarization of 76% ± 1% and maintained it for the entire three-day duration of the test experiment. Based on transmission measurements with unpolarized neutrons, we show that the average analyzing efficiency of the (3)He system is 98% for the neutron wavelength band of 2-5 Å. Using a highly polarized incident neutron beam produced by a supermirror bender polarizer, we obtained a flipping ratio of >100 with a transmission of 25% for polarized neutrons, averaged over the wavelength band of 2-5 Å. After the cell was depolarized for transmission measurements, it was reproducibly polarized and this performance was maintained for three weeks. A high quality polarization analysis experiment was performed on a reference sample of Fe/Cr multilayer with strong spin-flip off-specular scattering. Using a combination of the position sensitive detector, time-of-flight method, and the excellent parameters of the (3)He cell, the polarization analysis of the two-dimensional maps of reflected, refracted, and off-specular scattered intensity above and below the horizon were obtained, simultaneously.

Time-dependent theoretical model for terahertz wave detector using a parametric process

We have presented a time-dependent theoretical model to describe the time behavior of a quasi-monochromatic nanosecond terahertz detector reported by Guo et al. [Appl. Phys. Lett. 93, 021106 (2008)]. The temporal input-output characteristic of the detector is investigated numerically by taking the system parameters close to the experimental ones, and the calculated pulse width for the incident terahertz wave agrees well with the experimental one. Our results demonstrate that the energy and width of an output idler wave pulse are proportional to those of the incident terahertz wave pulse. This study provides a strict theoretical basis and could be used to guide the design and optimization for the highly sensitive coherent terahertz detector.

[Investigation on rapid detection of lead by LIBS based on common spectrograph]

In the present paper, the lead concentrations of samples including glass, soldering tin and so on were determined by LIBS based on a Nd : YAG Q-switched pulse laser with wavelength 1 064 nm as an exciting source and CCD in common spectrograph as the detector. The pulse energy on the surface of samples is about 95 mJ and the pulse width is 12 ns. By the detection of different samples, the detection limit of lead in samples was found to be 0.007 4% and the maximum relative standard deviation of quantitative analysis was about 4.0% based on the LIBS system of the instruments all made in China. The quantitative analysis can be done in two or three minutes and will spend one minute finishing the process by software in the future. The results suggest that the accuracy of determination of lead meets the challenge of quantitative analysis and the CCD can displace the very expensive ICCD as detector. The feasibility and low cost of the method, which uses common spectrometer and CCD to realize the LIBS detection, is proved by the result and our investigation will be beneficial to the LIBS application.

STK11/LKB1 germline mutations are not identified in most Peutz-Jeghers syndrome patients

Germline mutations of the STK11 gene mapped to chromosome 19p13.3 are responsible for Peutz Jeghers syndrome (PJS), a dominant disorder associated with characteristic gastrointestinal hamartomatous polyps and a predisposition to various cancers. We conducted a detailed investigation of germline STK11 alterations by protein truncation test and genomic DNA sequence analysis in ten unrelated PJS families. We identified a novel truncating deletion spanning STK11 exons 2-7 in a single patient and several known polymorphisms. Loss of heterozygosity studies in PJS polyps of four of these patients identified an allelic deletion of D19S886 in another patient. Our results suggest that STK11 mutations account for only a proportion of PJS cases.

Acquired tracheomalacia--a case report

Tracheomalacia is a condition characterized by weakness of the tracheal walls and supporting cartilage. It may be congenital, occurring in association with other lesions, such as vascular ring, tracheoesophageal fistula, dyschondroplasia, congenital cysts or tumors, or it may be acquired, most commonly as a result of protracted endotracheal intubation and less often of irradiation, trauma or neoplasm. We present a case of acquired tracheomalacia in a 15-year-old boy, a victim of Proteus syndrome (hemihypertrophy, subcutaneous tumors, and macrodactyly), who had congenital scoliosis with secondary chronic restrictive pulmonary disease, for which he was admitted to our hospital for surgical correction of the spine. Unfortunately, his conditions, particularly of respiratory, worsened after the operation, which called for an emergent tracheostomy. During the procedure, high airway pressure and CO2 retention developed, and an extreme narrowing of the tracheal lumen was revealed by fiberoptic bronchoscopy. Acquired tracheomalacia was diagnosed. The probable mechanisms, diagnostic tests, and treatments of tracheomalacia are hereunder discussed.