Nano-hydroxyapatite/Polyamide 66 cage in anterior cervical corpectomy and fusion: a comprehensive systematic review and meta-analysis

OBJECTIVE

This study aimed to conduct a meta-analysis to compare the effectiveness and safety between titanium mesh cage (TMC) and nano-hydroxyapatite/polyamide 66 cage (n-HA/PA66) in the surgical treatment of cervical spondylotic myelopathy (CSM) through anterior cervical corpectomy and fusion (ACCF).

MATERIALS AND METHODS

We implemented a comprehensive search strategy across multiple databases, including Wanfang, China Knowledge Network, China Biomedical Literature Database, Wipu, PubMed, Cochran, Embase, and Web of Science. To ensure a thorough examination of available literature, the databases were searched from their inception to January 2023. Two independent researchers evaluated the quality of the included studies by using established criteria. We used RevMan 5.4 (Review Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to facilitate data extraction and analysis.

RESULTS

This analysis included seven controlled clinical studies. The meta-analysis results showed no statistically significant differences between the two groups in terms of operating time, intraoperative bleeding, preoperative Japanese Orthopedic Association (JOA) score, preoperative visual analog scale (VAS) score, preoperative and final follow-up C2-7 Cobb angles, and intervertebral fusion rate (p > 0.05). However, a significant difference was observed between the two groups in terms of the final follow-up JOA [MD = 0.77, 95% CI (0.58, 0.97), p < 0.00001], VAS [MD = -0.50, 95% CI (-0.71, -0.30), p < 0.00001], and sedimentation rate [RR = 0.30, 95% CI (0.18, 0.48), p < 0.00001].

CONCLUSIONS

The use of n-HA/PA66 in ACCF for treating CSM is safe and effective treatment with positive clinical efficacy. In addition, n-HA/PA66 has both effective clinical efficacy and significantly lower fusion settling rates compared to TMC.

[Association between cardiometabolic diseases and quality of life and the mediation effect of perceived stress]

Objective: To explore the association between cardiometabolic diseases (CMD) and quality of life, the association between CMD and perceived stress, and the mediation effect of perceived stress on the association between CMD and quality of life, and to provide evidence for the prevention and treatment of CMD and the improvement of quality of life in these patients. Methods: This is a cross-sectional study. Data were collected by the employees' physical examination of a company in Xi'an in 2021. Multiple linear regression models were used to analyze the association between the status of CMD (divided into three categories: no CMD, presence of one kind of CMD, and with≥2 kinds of CMD (≥2 kinds of CMD were defined as cardiometabolic multimorbidity (CMM)), quality of life, and perceived stress. Mediation analysis with a multi-categorical independent variable was conducted to determine the mediation effect of perceived stress on the association between CMD and quality of life. Results: Among all 4 272 participants, 1 457 (34.1%) participants had one kind of CMD and 677 (15.8%) participants had CMM. The average scores for quality of life and perceived stress were (57.5±15.7) and (16.9±7.9), respectively. Compared with participants without CMD, after adjusting for demographic and lifestyle factors, no statistically significant associations were observed between one kind of CMD and perceived stress or quality of life (both P>0.05). Perceived stress did not mediate the association between one kind of CMD and quality of life. However, participants with CMM had lower quality of life and higher perceived stress than participants without CMD. The relative total effect coefficient c (95%CI) and the relative direct effect coefficient c' (95%CI) between CMM and quality of life were -3.71 (-5.04--2.37) and -2.52 (-3.81--1.24) (both P<0.05), respectively. The relative indirect effect coefficient a₂b (95%CI) of perceived stress on the association between CMM and quality of life was -1.18 (-1.62--0.77) (P<0.05). The mediation effect size was 31.8%. Conclusions: CMM is negatively associated with quality of life and positively associated with perceived stress. Perceived stress partially mediates the association between CMM and quality of life. Our results suggest that, in addition to preventing and treating CMM actively, efforts should be taken to relieve the perceived stress of people with CMM to improve their quality of life.

Ultrasonic bone curette in thoracic spinal decompression: a comprehensive systematic review and meta-analysis

OBJECTIVE

The aim of this study was to compare the efficacy and safety of ultrasonic bone curette (UBC) and conventional surgical instruments in thoracic laminectomy decompression (TLD) for the treatment of thoracic spinal stenosis (TSS) by meta-analysis.

MATERIALS AND METHODS

Two authors independently searched Medline via PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, and China National Knowledge Infrastructure for the period from the establishment of the database until January 2023 to identify the studies on the safety and efficacy of UBC vs. conventional instruments for TSS. Data extraction and quality assessment were performed by two researchers independently. We used RevMan 5.4 software (Review Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to analyze the data.

RESULTS

Eight retrospective studies were included in the present work. This meta-analysis revealed that no significant differences in the preoperative JOA scores, the JOA scores at the last follow-up, the improvement rate of JOA scores, and the incidence of cerebrospinal fluid leakage/dura injury were detected between the two groups (p>0.05). However, there were significant differences in the operative time and intraoperative blood loss during single-level TLD [operative time: MD=-1.47, 95% CI (-1.86, -1.09), p<0.001; intraoperative blood loss: MD=-46.62, 95% CI (-53.83, -39.40), p<0.001], total operative time [MD=-56.88, 95% CI (-69.66, -44.10), p<0.001], total intraoperative blood loss [MD=-143.52, 95% CI (-212.49, -74.54), p<0.001], the incidence of neurological deterioration/nerve root injury [RR= 0.29, 95% CI (0.09, 0.91), p=0.03] between the groups.

CONCLUSIONS

The application of UBC in TLD to treat TSS is safe and effective. UBC can significantly shorten operation time and reduce intraoperative blood loss compared to traditional surgical instruments. Moreover, it has the advantage of reducing perioperative nerve injury.

[Progress in research of genomic epidemiology of pathogenic fungi]

Genomic epidemiology, based on whole-genome sequencing technology and bioinformatics analysis, can make up for the shortcomings of traditional molecular typing methods and provide a novel insight for the genetic evolution and transmission of pathogenic fungi. The combination of genetic information and epidemiological methods of pathogenic fungi can predict fungi transmission routes and risks, and provide a theoretical basis for the development of public health strategies for fungi infection prevention and control. This paper summarizes the development of molecular epidemiology and genomic epidemiology, as well as the application of genomic epidemiology methods in the analyses of genetic relationship, origin, evolution, drug resistance, virulence, and genome-wide association of pathogenic fungi, and discusses the development of pathogenic fungi genomic epidemiology.

[Evaluation of demand of resources for laboratory testing and prevention and control of COVID-19 in the context of global pandemic]

Objective: To rapidly evaluate the level of healthcare resource demand for laboratory testing and prevention and control of corona virus disease 2019 (COVID-19) in different epidemic situation, and prepare for the capacity planning, stockpile distribution, and funding raising for infectious disease epidemic response. Methods: An susceptible, exposed, infectious, removed infectious disease dynamics model with confirmed asymptomatic infection cases and symptomatic hospitalized patients was introduced to simulate different COVID-19 epidemic situation and predict the numbers of hospitalized or isolated patients, and based on the current COVID-19 prevention and control measures in China, the demands of resources for laboratory testing and prevention and control of COVID-19 were evaluated. Results: When community or local transmission or outbreaks occur and total population nucleic acid testing is implemented, the need for human resources is 3.3-89.1 times higher than the reserved, and the current resources of medical personal protective equipment and instruments can meet the need. The surge in asymptomatic infections can also increase the human resource demand for laboratory testing and pose challenge to the prevention and control of the disease. When vaccine protection coverage reach ≥50%, appropriate adjustment of the prevention and control measures can reduce the need for laboratory and human resources. Conclusions: There is a great need in our country to reserve the human resources for laboratory testing and disease prevention and control for the response of the possible epidemic of COVID-19. Challenges to human resources resulted from total population nucleic acid testing and its necessity need to be considered. Conducting non-pharmaceutical interventions and encouraging more people to be vaccinated can mitigate the shock on healthcare resource demand in COVID-19 prevention and control.

Vitamin D does not improve lung function decline in COPD: a meta-analysis

OBJECTIVE

Vitamin D deficiency plays an important role in chronic obstructive pulmonary disease (COPD). However, the effects of vitamin D supplementation on lung function decline in COPD were inconsistently reported and a meta-analysis is thus needed.

MATERIALS AND METHODS

Eligible cohort and randomized controlled trials (RCTs) were searched from databases including PubMed, Embase, and Web of Science. Pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated in a random or fixed effects model.

RESULTS

Eight studies reaching the inclusion criteria and involving 687 COPD patients were included. Pooled effect size showed vitamin D treatment resulted in no significant improvements in FEV1 (SMD: 0.38, 95% CI: -0.13 to 0.88, p= 0.144), FVC (SMD: 0.55, 95% CI: -0.49 to 1.58, p=0.299), and FEV1/FVC (SMD: 0.00, 95% CI: -0.27-0.27, p=0.995) in COPD patients. Subgroup analysis revealed neither short-term (<6 months) (SMD: 0.10, 95% CI: -0.17 to 0.37, p=0.479) nor long-term (≥6 months) (SMD: 0.52, 95% CI: -0.23 to 1.27, p=0.172) vitamin D exposure could significantly benefit lung function decline in COPD.

CONCLUSIONS

This meta-analysis shows neither short-term nor long-term additional supplementation of vitamin D can benefit the lung function decline in COPD. Moreover, large scale RCTs focusing on COPD smokers with low level of vitamin D should be considered.

[Tap-hammer elicited vestibular-evoked myogenic potentials system: its design and preliminary application]

Objective: The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system. Methods: A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)μV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)μV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs (P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio(P>0.05). Conclusion: The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.

[Effect of high-titer plasma in pediatric patients with severe adenovirus pneumonia]

Objective: To explore the efficacy and safety of high-titer plasma in the treatment of pediatric patients with severe adenovirus pneumonia. Methods: The clinical data of 92 pediatric patients with severe adenovirus pneumonia admitted to pediatric intensive care unit (PICU) in Guangzhou Women and Children's Medical Center from January 2016 to October 2019 were retrospectively collected. According to the treatment with or without high-titer plasma, the patients were divided into plasma treatment group (n=41) and non-plasma treatment group (n=51). The 51 patients with chest radiograph showing more than half the lungs involved were divided into plasma treatment group (n=29) and non-plasma treatment group (n=22). According to fever duration before plasma treatment, patients were divided into early group (≤5 days, n=5), middle group (>5-10 days, n=14), and late group (>10 days, n=22). Baseline data, therapeutic effects, and prognosis of patients in each group were analyzed with t test, non-parametric rank sum test, one-way ANOVA and chi-square test. Results: Ninety-two patients were included. There were no significant differences in age, gender, body weight, fever duration, sequential organ failure assessment, and Murray lung injury score between plasma treatment group and non-plasma treatment group before admission (all P>0.05). The proportion of patients whose temperature drop to normal within 5 days was higher in plasma treatment group than that in non-plasma treatment group (88% (36/41) vs. 69% (35/51), χ(2)=4.745, P=0.029). However, there were no significant differences between the two groups in the proportions of invasive ventilator weaning within 14 days (63% (26/41) vs. 76% (39/51), χ(2)=1.868, P=0.172), transfer out from PICU within 14 days (49% (20/41) vs. 69% (35/51), χ(2)=3.724, P=0.054), discharge within 28 days (51% (21/41) vs. 61%(31/51), χ(2)=0.846, P=0.358) and survived patients (85% (35/41) vs. 76%(39/51), χ(2)=1.143, P=0.285). Among patients with severe chest radiograph, the proportions of patients whose temperature drop to normal within 5 days and survived patients were higher in plasma treatment group than those in non-plasma treatment group (86% (25/29) vs. 59% (13/22), χ(2)=4.843, P=0.028; 83% (24/29) vs. 55%(12/22), χ(2)=4.796, P=0.029, respectively). However, there were no significant differences between the two groups in the proportions of invasive ventilator weaning within 14 days (52% (15/29) vs. 59% (13/22), χ(2)=0.274, P=0.601), transfer out from PICU within 14 days (34% (10/29) vs. 45% (10/22), χ(2)=0.632, P=0.427), and discharge within 28 days (45% (13/29) vs. 45% (10/22), χ(2)=0.002, P=0.964). Among early, middle and late group, the proportions of invasive ventilator weaning within 14 days were 2/5, 13/14 and 50% (11/22), respectively, with statistically significant difference (χ(2)=8.119, P=0.017). There were no significant differences in the proportions of patients whose temperature drop to normal within 5 days (4/5, 14/14, 82% (18/22), χ(2)=2.965, P=0.227), transfer out from PICU within 14 days (2/5, 10/14, 36%(8/22), χ(2)=4.386, P=0.112), discharge within 28 days (2/5, 8/14, 50% (11/22), χ(2)=0.462, P=0.794) and survived patients (4/5, 13/14, 82% (18/22), χ(2)=0.966, P=0.617) in the three groups. Only one case with high-titer plasma therapy had rash in the course of infusing plasma and no other adverse reactions were observed. Conclusions: High-titer plasma can shorten the fever time and improve the proportion of survival patients in pediatric severe adenovirus pneumonia. The clinical effect of high-titer plasma is better in 5-10 days of fever course. High-titer plasma is an effective and safe treatment.

[WITHDRAWN: Potential false-positive rate among the 'asymptomatic infected individuals' in close contacts of COVID-19 patients]

Editor office’s response for Ahead of Print article withdrawn The article “Potential false-positive rate among the ‘asymptomatic infected individuals’ in close contacts of COVID-19 patients” was under strong discussion after pre-published. Questions from the readers mainly focused on the article’s results and conclusions were depended on theoretical deduction, but not the field epidemiology data and further researches were needed to prove the current theory. Based on previous discussions, the article was decided to be offline by the editorial board from the pre-publish lists. Objective: As the prevention and control of COVID-19continues to advance, the active nucleic acid test screening in the close contacts of the patients has been carrying out in many parts of China. However, the false-positive rate of positive results in the screening has not been reported up to now. But to clearify the false-positive rate during screening is important in COVID-19 control and prevention. Methods: Point values and reasonable ranges of the indicators which impact the false-positive rate of positive results were estimated based on the information available to us at present. The false-positive rate of positive results in the active screening was deduced, and univariate and multivariate-probabilistic sensitivity analyses were performed to understand the robustness of the findings. Results: When the infection rate of the close contacts and the sensitivity and specificity of reported results were taken as the point estimates, the positive predictive value of the active screening was only 19.67%, in contrast, the false-positive rate of positive results was 80.33%. The multivariate-probabilistic sensitivity analysis results supported the base-case findings, with a 75% probability for the false-positive rate of positive results over 47%. Conclusions: In the close contacts of COVID-19 patients, nearly half or even more of the 'asymptomatic infected individuals' reported in the active nucleic acid test screening might be false positives.

MiR-378 promotes the cell proliferation of non-small cell lung cancer by inhibiting FOXG1

OBJECTIVE

To identify the functioning mode of miR-378 on non-small cell lung cancer (NSCLC) and provide therapeutic targets for NSCLC.

PATIENTS AND METHODS

Expression levels of miR-378 in human NSCLC tissue samples and NSCLC-derived cell lines were measured by using quantitative Real-time polymerase chain reaction (PCR). Cell proliferation capacity was assessed by methyl thiazolyl tetrazolium (MTT) assay and colony formation assay. Cell apoptosis and cell cycle distribution were identified by flow cytometry. Downstream target gene was confirmed by using luciferase and Western blotting assays.

RESULTS

MiR-378 was significantly elevated in NSCLC tissues when compared with para-carcinoma tissues (n=42). Decreased-miR-378 could attenuate cell proliferation capacity, as well as promoted cell apoptosis and induced cell cycle arrest at G0/G1 phase. FOXG1 was chosen as the target gene of miR-378 by bioinformatics analysis and luciferase reporter assay. Moreover, restoration of miR-378 could impair the tumor suppression role of downregulated-miR-378 on NSCLC growth.

CONCLUSIONS

Decreased-miR-378 exerted tumor-suppressive effects on NSCLC growth via targeting FOXG1 in vitro, which provided an innovative and candidate target for diagnosis and treatment of NSCLC.

[Evaluation of vestibular evoked myogenic potential, caloric test and cochlear electrogram in the diagnosis of Meniere's disease]

Objective:The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential （cVEMP and oVEMP）, caloric test, and cochlear electrogram （EcochG） in patients with Meniere's disease （MD） and non-Meniere's disease. Method:Sixty-four patients （64 ears） with Unilateral Meniere's disease were enrolled in the study group （MD group）, and 127 cases（254 ears） of non-Meniere's disease patients as non-MD group, including vertigo migraine in 40 cases, benign paroxysmal positional vertigo in 48 cases, benign recurrent vertigo in 13 cases, vestibular paroxysmia in 3 cases, vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases. Both group undertake cVEMP, oVEMP, caloric test and ECochG. Use Medcale software to draw ROC curve of ECochG and calculate the area under curve（AUC）, Jordan index and optimal diagnostic cut-off points. Make the cut-off point as the point of -SP/AP, then evaluate the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and diagnostic accuracy of cVEMP, oVEMP, caloric test and ECochG in MD group and non-MD group. Result:The AUC of ECochG ROC curve was 0.74, the Jordan index was 0.47 and the cut-off point was 0.4. The sensitivity and specificity of cVEMP（62% and 68%）, oVEMP（61% and 53%） and caloric test（53% and 57%） were all below ECochG（65% and 78%）. The positive predictive value and of ECochG was the highest（61.9%）, the negative predictive value of cVEMP was highest（87.5%）. The diagnostic accuracy of ECochG was highest（74%）, followed with cVEMP（67%）, oVEMP（55%） and caloric test（56%）. Conclusion:Compared with the vestibular function tests, the sensitivity, specificity, diagnostic accuracy and NPV were all higher in ECochG, and the diagnostic benefit can be maximized when -SP/AP value>0.4. So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited. The diagnosis of MD still requires a comprehensive evaluation in combination with medical history, audiological tests and vestibular function examinations.

[Preliminary observation of galvanic vestibular stimulation-vestibular evoked myogenic potentials in healthy young people]

Objective: To introduce the method of galvanic vestibular stimulation-vestibular evoked myogenic potentials (GVS-VEMP) as well as to observe and analyze the parameters and elicited rate of GVS-cVEMP and GVS-oVEMP in healthy young people in China. Methods: Twenty six normal young subjects were recruited for conventional examinations of GVS-VEMP. The subjects were 21-37 years old, average age was (25.8±3.7) years old, including 13 males and 13 females. The galvanic stimulation intensity of 3 mA/1 ms was used to evoke cVEMP and oVEMP on the sternocleidomastoid and inferior extraocular muscles respectively, and the intensity of stimulus was decreased until the response disappeared, the threshold, latency, amplitude, interval phase and interaural amplitude ratio(IAR) were calculated. SPSS18.0 software was used for statistical analysis. Results: All subjects were elicited normal GVS-cVEMP and GVS-oVEMP under 3 mA/1 ms, the elicited rate was 100%. The threshold of GVS-cVEMP was (1.18±0.47) mA, p1 latency was (10.43±1.54) ms, n1 latency was (17.91±1.20) ms, the amplitude was (102.47±56.77) uV and IAR was (0.26±0.20). The threshold of GVS-oVEMP was (1.12±0.50) mA, n1 latency was (8.46±1.05) ms, p1 latency was (11.83±1.27) ms, the amplitude was (9.12±6.82) uV and IAR was (0.25±0.20). In terms of gender and lateral comparison, only the GVS-oVEMP amplitude was higher for male than for female, which had significant statistical difference (P<0.05), and there was no statistical difference in the other parameters between GVS-cVEMP and GVS-oVEMP. Conclusion: GVS-cVEMP and GVS-oVEMP could be elicited in healthy youth population, and the parameters could provide reference for subsequent vestibular function evaluation.

[Functional vestibulo-ocular reflex test]

Summary In recent years, the diagnosis and treatment of vertigo and balance disorders have become a hot topic of multidisciplinary attention. The evaluation method of vestibular function has also been improved, providing important evidence for the diagnosis and differential diagnosis of vertigo related diseases. Vestibular rehabilitation is one of the important methods for the treatment of vertigo diseases. Assessing vestibular rehabilitation status in these patients is also the key for guiding treatment. The assessment of vestibulo-ocular reflex (VOR) function is an important part of vestibular functional testing. Currently, the dynamic visual acuity test (DVAT), gaze stabilization test (GST), and head impulse test (HIT) can be used to evaluate the VOR function. Based on these tests, a method of vestibular function testing has emerged internationally: functional head impulse test (fHIT). The article based on the review of relevant literatures and the principle of VOR detection and HIT detection to introduce the test methods and results interpretation of fHIT, DVAT and GST to provide reference for clinical diagnosis and treatment.

[A multicenter, retrospective study of pathogenic bacteria distribution and drug resistance in febrile neutropenic patients with hematological diseases in Shanghai]

目的

了解上海地区中性粒细胞缺乏（粒缺）伴发热血液病患者致病细菌的分布及耐药情况。

方法

回顾性分析2012年1月至2014年12月上海市12家医院血液科粒缺伴发热住院患者的临床分离菌株，用纸片扩散法进行药敏试验，WHONET 5.6软件分析病原菌分布及药敏数据。

结果

从上海地区粒缺伴发热患者中共分离出1 260株细菌，其中革兰阳性菌420株（33.3%），革兰阴性菌840株（66.7%）。排在前七位的分别是肺炎克雷伯菌158株（12.5%）、嗜麦芽窄食单胞菌120株（9.5%）、大肠埃希菌115株（9.1%）、铜绿假单胞菌109株（8.7%）、鲍曼不动杆菌83株（6.6%）、金黄色葡萄球菌70株（5.6%）和屎肠球菌63株（5.0%）。呼吸道分泌物标本中，非发酵菌占56.2%（350/623）。其中嗜麦芽窄食单胞菌占15.3%（95/623）。血液标本中，肠杆菌科细菌占42.3%（104/246），凝固酶阴性葡萄球菌占34.6%（85/246）。脓液标本中肠杆菌科细菌占39.4%（76/193），肠球菌属细菌占28.5%（55/193）。耐甲氧西林金黄色葡萄球菌葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为54.3%和82.5%，未发现耐利奈唑胺、万古霉素、替考拉宁葡萄球菌属菌株，耐万古霉素屎肠球菌的检出率为8.9%，肠球菌属未检出耐利奈唑胺的菌株。肠杆菌科细菌对碳青霉烯类药物高度敏感。铜绿假单胞菌对亚胺培南和美罗培南的耐药率已分别达34.1%和15.8%。嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星、复方磺胺甲恶唑等药物敏感。鲍曼不动杆菌仅对头孢哌酮/舒巴坦的耐药率低于10.0%。肺炎克雷伯菌、嗜麦芽窄食单胞菌、铜绿假单胞菌、鲍曼不动杆菌等革兰阴性菌对大多常用抗菌药物的耐药率低于CHINET监测的数据。

结论

粒缺伴感染患者常见感染部位致病菌株分布有其特点，细菌耐药率整体低于CHINET全国医院大样本监测。

[Clinical diagnosis and treatment of eosinophilic otitis media]

Objective: Eosinophilic otitis media(EOM) is a rare,refractory otitis media.This article summarizes the clinical manifestations and diagnosis and treatment experience of EOM. Method: Retrospective analysis of 3 cases of EOM patients with medical history, clinical manifestations, and related auxiliary examinations.Discuss the EOM clinical features,diagnosis and treatment in conjunction with the literature. Result: The clinical features of 3 patients with EOM were summarized as: a large amount of yellowish white secretions or polyps formation, obvious itching symptoms; polyp biopsy showed a large amount of eosinophil infiltration;topical use of hormone-containing ear drops treatment is effective.Conclusion: EOM is a new type of chronic otitis media.It has characteristic clinical manifestations,a comprehensive treatment based on glucocorticoids should be given..

[The application value of suppression head impulse paradigm in vestibular neuritis]

Objective:To study the parameters of the suppression head impulse paradigm of vestibular neuritis and explore the application value of suppression head impulse paradigm in vestibular neuritis.Method:Twenty patients with vestibular neuritis in our outpatient clinic were selected. The HIMP and SHIMP gain of unilateral vestibular neuritis patients were detected by video pulse detector.Result:All patients with HIMP examination in the affected side can elicit compensatory saccade, the healthy side with no compensatory saccade; SHIMP examination in the healthy side can elicit anti-compensatory saccade, the affected side without compensatory saccade or weak saccades. The HIMP gain of affected side and healthy side of patients with vestibular neuritis were 0.56±0.15 and 0.99±0.13 respectively, and the SHIMP gain of affected side and healthy side of patients with vestibular neuritis were 0.45±0.13 and 0.9±0.13 respectively. The gain of the affected side and the healthy side of HIMP was larger than those of SHIMP, and the difference was statistically significant (P<0.05).The differences of HIMP and SHIMP gain between the affected side and the healthy side were statistically significant (P<0.01).Conclusion:Video head impulse test combined with suppression head impulse paradigm can evaluate vestibular function injury and residual retention in vestibular neuritis, and can also dynamically monitor vestibular compensation in patients.

[Suppression head impulse paradigm in healthy adult population: the values and features of the parameters]

Objective: To observe the parameters of the results of suppression head impulse paradigm (SHIMP) in healthy adults, and to provide reference for evaluating vestibular oculomotor reflex function in patients with peripheral vertigo. Methods: Fifty healthy adults, 22 males and 28 females, aged from 23-65 years, with an average age of (38.5±11.6) years, were recruited from January to March 2018. Parameters provided by the video head pulse software included the gains, the latency and the peak velocity of saccades, and comparison was made with head impulse paradigm (HIMP). Results: All subjects were elicited anti-compensatory saccades in SHIMP. The normal values of left and right gains were 1.02 and 1.10 in HIMP, and 0.93 and 1.01 in SHIMP respectively. The left and right saccades latency were (201.1± 50.8)ms and (187.0± 42.9)ms, and the peak saccadic velocity were (302.7±58.5)°/s and (291.5±46.5)°/s in SHIMP; there were small but significant difference between two sides about gains in HIMP and SHIMP, as well as latency in SHIMP(P<0.05); there were small but significant difference between HIMP and SHIMP about gains in ipsilateral(P<0.01); there were no significant difference between two sides about peak saccadic velocity in SHIMP(P>0.05). Conclusions: SHIMP can be used for the examination of vestibular oculomotor reflex function in adult population. It is easy to be operated and is convenient for clinical application. Combined with head pulse test, the function of the semicircular canal can be evaluated together.

[Vestibular-evoked myogenic potentials in healthy guinea pigs]

Objective:To establish detection methods of air-conducted sound elicited vestibular-evoked myogenic potentials (ACS-VEMPs) in guinea pigs, including cervical vstibular-evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP). Method:Eleven healthy (250-350 g) guinea pigs (22 ears) were selected and underwent conventional ACS-cVEMP and ACS-oVEMP examinations. Parameters of waveforms were recorded. Result:The ACS-cVEMP and ACS-oVEMP could be elicited in 77.27% and 59.09% guinea pigs,respectively；threshold was (107.1±14.6)dB SPL and (115.5±15.6)dB SPL for ACS-cVEMP and ACS-oVEMP；n1,p1 latency for cVEMP was (7.4±1.5)ms and (9.3±1.6)ms，(6.4±1.4)ms and (8.1±1.8)ms for oVEMP；amlipude was (15.4±8.6)μV and (11.4±6.0)μV for cVEMP and oVEMP respectively. No statistical difference could be found in above parameters between ACS-cVEMP and ACS-oVEMP (P>0.05). Conclusion:Both ACS-cVEMP and ACS-oVEMP could be elicited in guinea pigs.

Effect of polydatin on expression of p53 and Notch1 in brain tissue of ischemic cerebrovascular disease

Secondary injury of brain tissue following cerebral infarction exhibits a complicated pathogenesis that is attributed to the induction of apoptosis and inflammatory response. The present study aimed to investigate the polydatin neuroprotective effects and their mode of action in cerebral ischemic injury. A total of 80 healthy adult male Sprague-Dawley rats were randomly divided into a Sham operated group, a permanent middle cerebral artery occlusion (MCAO) group, a Polydatin low dose group and a Polydatin high dose group. A total of 20 rats were used in each group. The right MCAO model of rats was established using the modified Longa suture method. The animals in the intervention group were injected intraperitoneally with 12.5mg/kg and/or 50mg/kg of polydatin following infarction. The expression levels of p53 and Notch 1 were measured by immunohistochemical techniques. The degree of left limb hemiplegia in the MCAO group was different compared with that of the low and high dose group of polydatin. The score for the neurological function in the high-dose group of polydatin was lower than that in the MCAO group (High vs MCAO: 2.4±0.31 vs 3.9±0.23, P less than0.05). The results indicated that high dose polydatin could reduce brain edema following cerebral infarction and improve the behavioral score in rats.

[Forensic Analysis for 54 Cases of Suxamethonium Chloride Poisoning]

OBJECTIVES

To observe and analyze the performance of forensic science in the cases of suxa- methonium chloride poisoning, and to improve the identification of suxamethonium chloride poisoning.

METHODS

Fifty-four cases of suxamethonium chloride poisoning were collected. The rules of determination of suxamethonium chloride poisoning were observed by the retrospective analysis of pathological and toxicological changes as well as case features.

RESULTS

The pathological features of suxamethonium chloride poisoning were similar to the general changes of sudden death, which mainly included acute pulmonary congestion and edema, and partly showed myocardial disarray and fracture. Suxamethonium chloride could be detected in the heart blood of all cases and in skin tissue of part cases.

CONCLUSIONS

Suxa-methonium chloride poisoning has the characteristics with fast death and covert means, which are difficult to rescue and easily miss inspection. For the cases of sudden death or suspicious death, determination of suxamethonium chloride should be taken as a routine detection index to prevent missing inspection.

A point-prevalence survey of healthcare-associated infection in fifty-two Chinese hospitals

BACKGROUND

Healthcare-associated infection (HCAI) represents a major problem for patient safety worldwide.

AIM

To demonstrate the prevalence, causative agents, and risk factors for HCAI in Chinese hospitals.

METHODS

A one-day point-prevalence survey was conducted in 52 Chinese hospitals between October 2014 and March 2015. A web-based software system was developed for data entry and management.

FINDINGS

Among 53,939 patients surveyed, the prevalence of patients with at least one HCAI was 3.7%. Of 2182 HCAI episodes, the most frequently occurring types were lower respiratory tract infections (47.2%), followed by urinary tract infection (12.3%), upper respiratory tract infection (11.0%), and surgical site infection (6.2%). The prevalence of patients with at least one HCAI in critical care units was highest (17.1%). Device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central catheter-associated bloodstream infection, accounted for only 7.9% of all HCAIs. The most frequently isolated micro-organisms were Pseudomonas aeruginosa [206 infections (9.4%)], Acinetobacter baumannii [172 infections (7.9%)], Klebsiella pneumoniae [160 infections (7.3%)], and Escherichia coli [145 infections (6.6%)]. Of the survey patients (18,206/53,939), 33.8% were receiving at least one antimicrobial agent at the time of the survey. Risk factors for HCAI included older age (≥80 years), male gender, days of hospital admission, admission into a critical care unit, and device utilization.

CONCLUSION

Our study suggests that the overall prevalence of HCAI in surveyed Chinese hospitals was lower than that reported from most European countries and the USA. More attention should be given to the surveillance and prevention of non-device-associated HCAI in China.

Single nucleotide polymorphisms in the promoter region of mir-133a-1 and in pre-mir-152 rs1707 may contribute to the risk of asthma in a Chinese Han population

OBJECTIVE

microRNAs (miRNAs) play important roles in the pathogenesis of asthma. Single-nucleotide polymorphisms (SNPs) in the promotor regions of miRNAs or pre-miRNAs are involved in the alteration of miRNA expression levels or their maturation process and can contribute to asthma pathogenesis.

PATIENTS AND METHODS

A total of 591 asthma cases and 621 controls were recruited for this study to evaluate the genetic effects of the following five single nucleotide polymorphisms (SNPs) on the development of asthma: rs8089787 and rs9948906 in the promoter region of mir-133a-1, pre-mir-499 rs37464444, pre-mir-152 rs1707, pre-mir-155 rs5186. The genotypes were determined using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS).

RESULTS

Logistic regression analysis revealed that the CT and CT+TT genotypes in the mir-133a-1 rs8089787 (CT vs. CC, OR = 0.413, 95% CI: 0.315-0.541; CT+TT vs. CC, OR = 0.443, 95% CI: 0.342-0.574, respectively) were significantly associated with a decreased risk for asthma in sample of the Chinese Han population, compared with CC genotype. Similarly, the CT and CT+TT genotypes in the mir-133a-1 rs9948906 (CT vs. CC, OR = 0.398, 95% CI: 0.300-0.528; CT+TT vs. CC, OR = 0.403, 95% CI: 0.306-0.532, respectively) were associated with a decreased risk of asthma. However, the C alleles of both mir-133a-1 rs8089787 (C vs. T, OR = 1.867, 95% CI: 1.486-2.345) and rs9948906 (C vs. T, OR = 2.177, 95% CI: 1.690-2.804) were significantly associated with an increased risk for asthma. The CT genotype frequencies of pre-mir-152 rs1707 (CT vs. TT, OR = 4.730, 95% CI: 2.425-9.223) were significantly associated with an increased risk for asthma in a Chinese Han population (p < 0.001). The C allele frequencies of pre-mir-152 rs1707 (C vs. T, OR = 6.671, 95% CI: 3.146-14.147) was also significantly associated with an increased risk of asthma in a Chinese Han population (p < 0.001). However, the genotype and allele frequencies of rs5186, located in pre-miR-155, did not significantly differ between the cases and the controls; as well as those of rs3746444 in pre-miR-499.

CONCLUSIONS

Our study provided evidence that polymorphisms of rs8089787 and rs9948906 in the promotor region of mir-133a-1 and pre-mir-152 rs1707 may contribute to the risk of asthma in a Chinese Han population.

Distribution and Characteristics of Colletotrichum spp. Associated with Anthracnose of Strawberry in Hubei, China

Anthracnose caused by Colletotrichum spp. is a serious disease of strawberry. The etiology of anthracnose of strawberry is complex, and several Colletotrichum spp. have been regarded as causal agents. In the present study, multilocus (actin, β-tubulin, calmodulin, glyceraldehyde-3-phosphate dehydrogenase, and chitin synthase) phylogenetic analysis revealed that 100 isolates of Colletotrichum associated with anthracnose of strawberry in central China belong to five species. In total, 97 isolates were identified belonging to the Colletotrichum gloeosporioides species complex, with C. murrayae, C. gloeosporioides, C. fructicola, and C. aenigma accounting for 81, 8, 4, and 4% of the total isolates, respectively. Three isolates belonging to the C. acutatum complex were identified as C. nymphaeae. On inoculated strawberry plants, isolates of C. fructicola and C. murrayae species showed strong pathogenicity to both leaves and petioles of strawberry, with plant mortality 30 days after inoculation of 77.8 and 55.6%, respectively. C. gloeosporioides, C. aenigma, and C. nymphaeae showed strong pathogenicity to leaves but weak pathogenicity to petioles, with plant mortality 30 days after inoculation of 5.6, 16.7, and 11.1%, respectively. The five species were divided into four classes based on their maximum growth temperatures. Isolates of C. murrayae and C. gloeosporioides were more tolerant to high temperature (>34°C) than isolates of other species, followed by C. fructicola and C. aenigma. Isolates of C. nymphaeae, which are only distributed in areas of higher altitude (1,100 m), were highly sensitive to higher temperature. These results indicate that pathogenicity and adaptation to temperature are important factors in the distribution of Colletotrichum spp. on strawberry plants. This research may increase our understanding of how Colletotrichum spp. emerge and spread to geographical regions with different latitudes or elevations.

DNA sequence polymorphism within the bovine adenosine monophosphate deaminase 1 (AMPD1) is associated with production traits in Chinese cattle

The objectives of the present study were to detect an 18-bp deletion mutation in the bovine adenosine monophosphate deaminase 1 (AMPD1) gene and analyze its effect on growth traits in 2 Chinese cattle breeds using DNA sequencing and agarose electrophoresis. The five 19-bp polymerase chain reaction products of the AMPD1 gene exhibited 3 genotypes and 2 alleles: WW: homozygote genotype (wild-type); DD: homozygote genotype (mutant-type); WD: heterozygote genotype. Frequencies of the W allele varied from 66.15-70.35%. The associations between the 18-bp deletion mutation in the AMPD1 gene with production traits in 226 Jia-Xian red cattle was analyzed. The animals with genotype WW showed significantly higher heart girth and body weight than those with genotypes WD and DD at 24 months (P < 0.01). Our results indicate that the deletion mutation in the AMPD1 gene is associated with production traits, and may be used for marker-assisted selection in beef cattle breeding programs.

Evaluating environmental performance using new process capability indices for autocorrelated data

Traditionally, the process capability index is developed by assuming that the process output data are independent and follow normal distribution. However, in most environmental cases, the process data are autocorrelated. The autocorrelated process, if unrecognized as an independent process, can lead to erroneous decision making and unnecessary quality loss. In this paper, three new capability indices with unbiased estimators are proposed to relieve the independence assumption for the-nominal-the-best and the-smaller-the-better cases. Furthermore, we use mean squared error (MSE) and mean absolute percent error (MAPE) to compare the accuracy of our proposed indices to previous autocorrelated indices. The results show that our proposed capability indices outperform the predecessors.

Pathway enrichment analysis of human osteosarcoma U-2 OS bone cells expose to dexamethasone

OBJECTIVE

Osteosarcoma is the second highest cause of cancer-related death in children, mainly due to development of often fatal metastasis, usually in the lungs. Glucocorticoids play an important role in the treatment of a number of inflammatory diseases and immune diseases. The objective of this study was to explore the molecular mechanism of osteosarcoma in response to dexamethasone (DEX, a kind of synthetic glucocorticoid), with a view to obtain information on the pathways activated by DEX.

MATERIALS AND METHODS

By using the GSE6711 Affymetrix microarray data accessible from Gene Expression Omnibus database, we first identified the differentially expressed genes (DEGs) among different time course treatment with dexamethasone of each isoform, and the DEGs among cells expressing different GR isoforms, followed by the pathway enrichment analysis of the DEGs.

RESULTS

The results indicated that DEX could inhibit osteosarcoma cell proliferation and promote osteosarcoma cell apoptosis through induction of lots of related genes expression at the transcription level.

CONCLUSIONS

Our data provide a comprehensive bioinformatics analysis of pathways which may be involved in the response to glucocorticoids.

First Report of Pestalotiopsis mangiferae and P. vismiae Causing Twig Dieback of Myrica rubra in China

Chinese bayberry (Myrica rubra Siebold & Zucc.), an evergreen fruit tree, is widely grown in southern China. In 1999, severe twig dieback was observed on M. rubra in Taizhou and it spread to several major M. Rubra-producing areas of Zhejiang covering more than 6,000 ha by 2011. Symptoms were usually observed from June to November and first appeared as chlorosis of leaves and leaf drop, followed by the formation of dark brown lesions covered with white mycelia surrounding leaf scars. The lesions can extend to the whole twig and tree causing discoloration of the xylem. In most cases, infected trees die within 1 to 4 years. Two distinct fungi totaling 46 isolates were isolated from the surface-disinfested diseased twigs and cultured on potato dextrose agar (PDA) at 28°C. An isolate of each fungus, designated as C1 and B1, was characterized further following 10 days of growth on PDA at 28°C. C1 formed zonate, white colonies and black, acervular conidiomata with the conidia aggregated on acervuli as a creamy mass. Isolate B1 formed nonzonate, white colonies and black, acervular conidiomata with the conidia aggregated on acervuli as droplets. Conidia for each isolate were fusiform with five cells; one hyaline apical cell, one hyaline basal cell, and three, dark brown median cells. Conidia ranged from 17.8 to 25.2 × 6.7 to 9.2 μm for C1 and 21.2 to 27.8 × 4.3 to 7.5 μm for B1. There were two to three hyaline, filamentous appendages (9.8 to 23.5 μm long for C1 and 10.5 to 25.5 μm long for B1) attached to each apical cell, and one hyaline appendage (3.5 to 7.2 μm long for C1 and 3.0 to 6.8 μm long for B1) attached to each basal cell. The cultural and morphological characteristics of C1 (16 isolates) matched the description for Pestalotiopsis mangiferae while B1 (27 isolates) matched the description for P. vismiae (2). The PCR-amplified and sequenced internal transcribed spacer (ITS) region of the ribosomal DNA (ITS1-5.8S-ITS2) for isolate C1 (GenBank Accession No. JQ281542) and B1 (GenBank Accession No. JQ281543) were 99 and 100% homologous to that of the P. mangiferae isolate MM 102 (GenBank Accession No. GU722595) and P. vismiae isolate xsd08116 (GenBank Accession No. FJ481027), respectively. For pathogenicity tests, nine healthy detached leaves and 12 potted plants of M. rubra were wound inoculated with sterile water (control) or conidial suspensions (10⁵ conidia per ml; 20 μl on each site) of C1 and B1, respectively, and maintained with relative humidity of more than 90% under fluorescent light at 28°C. Tests were performed twice. Necrotic lesions, resembling those that occurred in the field, were observed on all inoculated detached leaves and 33.3% of C1 and 25% of B1 inoculated potted plants 10 and 30 days following inoculation, respectively, while the controls remained healthy. Two fungi were reisolated from the lesions with identical morphology to the initial C1 and B1 inoculums. Therefore, P. mangiferae and P. vismiae were determined to be the causal agent for twig dieback of M. rubra in China. Pestalotiopsis spp. were previously reported as pathogens of loquat (4), mango (3), and blueberry (1) causing economic loss. To our knowledge, this is the first report of twig dieback disease of M. rubra caused by P. mangiferae and P. vismiae. References: (1) J. G. Espinoza et al. Plant Dis. 92:1407, 2008. (2) Q. X. Ge et al. Flora Fungorum Sinicorum. Vol. 38, Pestalotiopsis. Science Press, Beijing, 2009. (3). Y. Ko et al. Plant Dis. 91:1684, 2007. (4). A. E. Perelló and S. Larran. Plant Dis. 83:695, 1999.

Avian leukosis virus p27 inhibits tumor necrosis factor alpha expression in RAW264.7 macrophages after stimulation with lipopolysaccharide

Avian leukosis is a widely distributed disease caused by Avian leukosis virus (ALV). ALV p27 is a capsid protein and group specific antigen, whose role in host immune response is poorly understood. To explore ALV p27, we developed a RAW264.7 macrophage cell line stably expressing p27-GFP fusion protein. The cells of this line and control cell line expressing GFP protein only were compared in production of tumor necrosis factor alpha (TNF-alpha), interleukins IL-1beta, IL-6, IL-12, and in proliferative activity stimulated by the lipopolysaccharide (LPS). It was found that the ALV p27 expression markedly reduced the production of TNF-alpha, but did not affect the production of IL-1beta, IL-6, and 12, and cell proliferative activity. These results demonstrate that ALV p27 specifically inhibits TNF-alpha expression in the macrophages stimulated by LPS, suggesting a possible contribution of ALV p27 to immunosuppression detected in ALV-infected hosts.

KEYWORDS

Avian leukosis virus; p27; tumor necrosis factor alpha; interleukins; macrophages; lipopolysaccharide.

Residual stresses of sputtering titanium thin films at various substrate temperatures

This work seeks to characterize the residual stresses of titanium thin films as they are affected by various substrate temperatures during the sputtering process. The titanium thin films are deposited on silicon wafers by a RF magnetron sputter while different substrate temperatures are considered. The residual stresses are measured by both X-ray diffraction and a substrate curvature method, and consistent results are obtained by both methods. The results show that the residual stress decreases as the substrate temperature increases, in which the stress changes from tensile to compressive when the substrate temperature increases from 25 to 50 degrees C. Furthermore, the elastic modulus and hardness of the titanium thin films are tested with a nanoindenter using a standard Berkovich probe. Correlations between the residual stresses and mechanical properties measured by nanoindentation are also discussed.

Co-existent de novo myelodysplastic syndrome and T-cell non-Hodgkin lymphoma: a common origin or not?

The co-existence of de novo myelodysplastic syndrome (MDS) and non-Hodgkin lymphoma (NHL) prior to therapy is an extremely unusual finding. We report here a case of co-existent de novo MDS-refractory cytopenia with multilineage dysplasia and T-cell NHL, including clinical features, histopathological findings, molecular assessment, treatment course and outcomes. Other cases from the literature showing co-existence of both disorders are also reviewed; to date 19 similar cases have been reported. Among all cases (including the present patient), eight cases were diagnosed with de novo MDS and NHL simultaneously, which were considered to be true coincidences. The mechanisms responsible for the appearance of co-existence have not yet been ascertained, however in the present case a common chromosomal abnormality (20q deletion) was found in bone marrow and lymph node preparations. We conclude, therefore, that the co-existent de novo MDS and T-cell NHL seen in the present case may have a common origin.

Expression of Newcastle disease virus (NDV) M protein from a recombinant plasmid prolongs the survival of NDV-infected chicken embryos and enhances the virus replication

To explore the role of M protein in the replication of NDV in chicken embryos, the M gene was cloned and inserted into plasmid pcDNA4.0. Western blot analysis showed that the M protein was expressed in DF-1 cells after transfection with M gene plasmid. Chicken embryonated eggs inoculated with the M gene plasmid and 2 days later infected with NDV showed 10 times higher hemagglutination (HA) titers and an increased survival of the embryos as compared with the embryos inoculated with the empty plasmid. These data indicated that the expression of M protein in the NDV-infected chicken embryos primarily prolonged their survival and consequently enhanced virus replication.

Functional magnetic resonance mapping of motor cortex in patients with mass lesions near primary motor and sensory cortices

PURPOSE

To study motor cortex mapping in patients with mass lesions near primary motor and sensory cortices with BOLD-fMRI.

MATERIAL AND METHODS

18 patients with mass lesions near primary motor and sensory cortices, and 8 healthy volunteers were investigated with fMRI using a 1.5 T GE Signa scanner. The specific task was repetitive selfpaced index finger to thumb opposition with a frequency of approximately 2 Hz. Each task paradigm consisted of twelve 20-second blocks alternating between rest and activation. All functional data was sent to SUN GE Advanced Workstation 4.0 for post processing.

RESULTS

14 patients showed functional activation near mass lesion, 4 patients failed to show, and one patient with meningeoma was excluded because of heavy head movement. Of 14 patients, the functional activation of eloquent cortex was different between the group with declination of muscle force and the group with normal muscle force, generally the activated areas of the former were more scattered, dislocated, relative smaller than that of the latter.

CONCLUSION

fMRI is a valuable method for pre-operative evaluation of neurosurgical patients and probably can evaluate the muscle force pre- and post-operation approximately.

Aclarubicin and low-dose Cytosine arabinoside in combination with granulocyte colony-stimulating factor in treating acute myeloid leukemia patients with relapsed or refractory disease and myelodysplastic syndrome: a multicenter study of 112 Chinese patients

One hundred twelve patients with geriatric acute myeloid leukemia (AML), refractory or relapsed AML, or myelodysplastic syndrome and refractory anemia with excess of blasts in transformation (MDS-RAEBt) were entered into this study to receive CAG (aclarubicin and low-dose cytosine arabinoside [Ara-C]in combination with granulocyte colony-stimulating factor [G-CSF]) with the objective of evaluating the efficacy and tolerance of this regimen. Low-dose Ara-C was given subcutaneously at a dosage of 10 mg/m2 every 12 hours on days 1 to 14. Aclarubicin was administered intravenously at a dosage of 14 mg/m2 per day on days 1 to 4 (CAG regimen A) or 7 mg/m2 on days 1 to 8 (CAG regimen B). Recombinant G-CSF was given subcutaneously at a dosage of 200 3g/m2 per day on days 1 to 14. We demonstrated comparable overall complete remission rates for the 4 groups of patients: 30.8% (8/26) in the elderly patients, 48.4% (30/62) in the refractory AML patients, 44.4% (8/18) in the relapsed AML patients, and 38.5% (5/13) in the MDS-RAEBt patients. Of the 52 patients followed up, the 12-month progression-free survival (PFS) and overall survival (OS) rates estimated by the Kaplan-Meier method were 40.73% 3 8.15% and 42.85% 3 8.23%, respectively. The median PFS and OS times were 9.0 3 2.2 months and 11.0 3 1.6 months, respectively. Toxic effects were very rare and mainly consisted of neutropenia and thrombocytopenia due to myelosuppression; approximately 70% to 80% of patients had neutropenia or thrombocytopenia that exceeded National Cancer Institute grade II. Nonhematologic toxicities were not observed in this study. The CAG regimen seems promising, with acceptable toxicity, for the treatment of various categories of poor-prognosis AML and MDS-RAEBt.

The brain mapping on reinforcement acupuncture stimulation at ST36 (zusanli) evidenced by fMRI

To characterize the brain mapping on reinforcement acupuncture stimulation at ST36 (zusanli), and to discuss the mechanisms of acupuncture to treat diseases. fMRI was performed on 26 healthy Chinese student volunteers. Sixteen subjects were acupunctured at the acupoint ST36, while 10 others at sham-acupoint (lateral from ST36 about 3 cm). The fMRI studies were performed using a gradient echo-EPI sequence. Brain mapping were generated using GE Functool program. Cerebral blood flow and correlation coefficient (CC) of ROl were analyzed. Stimulation at the right ST36 elicited 13 brain functional areas, and 10 of these areas were the same with the sham-acupoint group. However, only the temporal gyrus was specificity while by using reinforcement manual acupuncture (MA) at ST36 (Fisher's Exact test, P=0.022), and the contralateral hemisphere activation was prominent (McNemer test, P=0.020). Our results support the theory of acupuncture about meridian distribution overlapping on the whole body. The special transmission channel of meridian may exists, and it may be consist of spinal nerve and autonomic nerve. However, our results may oppose the theory concerning on stomach meridian walking lateral.

Catalytic mechanism of a family 3 beta-glucosidase and mutagenesis study on residue Asp-247

A family 3 beta-glucosidase (EC 3.2.1.21) from Flavobacterium meningosepticum has been cloned and overexpressed. The mechanistic action of the enzyme was probed by NMR spectroscopy and kinetic investigations, including substrate reactivity, secondary kinetic isotope effects and inhibition studies. The stereochemistry of enzymic hydrolysis was identified as occurring with the retention of an anomeric configuration, indicating a double-displacement reaction. Based on the k(cat) values with a series of aryl glucosides, a Bronsted plot with a concave-downward shape was constructed. This biphasic behaviour is consistent with a two-step mechanism involving the formation and breakdown of a glucosyl-enzyme intermediate. The large Bronsted constant (beta=-0.85) for the leaving-group-dependent portion (pK(a) of leaving phenols >7) indicates substantial bond cleavage at the transition state. Secondary deuterium kinetic isotope effects with 2,4-dinitrophenyl beta-D-glucopyanoside, o-nitrophenyl beta-D-glucopyanoside and p-cyanophenyl beta-D-glucopyanoside as substrates were 1.17+/-0.02, 1.19+/-0.02 and 1.04+/-0.02 respectively. These results support an S(N)1-like mechanism for the deglucosylation step and an S(N)2-like mechanism for the glucosylation step. Site-directed mutagenesis was also performed to study essential amino acid residues. The activities (k(cat)/K(m)) of the D247G and D247N mutants were 30000- and 200000-fold lower respectively than that of the wild-type enzyme, whereas the D247E mutant retained 20% of wild-type activity. These results indicate that Asp-247 is an essential amino acid. It is likely that this residue functions as a nucleophile in the reaction. This conclusion is supported by the kinetics of the irreversible inactivation of the wild-type enzyme by conduritol-B-epoxide, compared with the much slower inhibition of the D247E mutant and the lack of irreversible inhibition of the D247G mutant.

[Effect of indomethacin on natural killer(NK) cell and T lymphocyte subsets from patients with hepatocellular carcinoma]

Twenty-one patients with advanced hepatocellular carcinoma were randomly divided into two groups. They were orally given tegafur 200 mg three times a day with(Group I, n = 11) or without(Group II, n = 10) indomethacin 25 mg three times a day for 7 days. Before and after the therapies the NK cell and T-lymphocyte subset activity in peripheral blood were measured. The results showed that NK cell activity in Group I was significantly higher than that in Group II(P < 0.01) and that before the treatment as well(P < 0.05). T-lymphocyte subsets had no significant difference between the two groups and before or after the therapy. It is suggested that the indomethacin might improve the NK activity of the patients with advanced hepatocellular carcinoma.

Order-disorder transition in bilayers of diphytanoyl phosphatidylcholine

A comparative study on bilayers of diphytanoyl phosphatidylcholine (DPhPC) and bilayers of dimyristoyl phosphatidylcholine (DMPC) was made by X-ray lamellar diffraction as a function of temperature and the degree of hydration. An order-disorder phase transition of DPhPC reveals an interesting contrast to the standard model of DMPC. Electron density profiles allow us to deduce the conformational changes which occur in the headgroup-glycerol region and in the chain region. The important conclusion is that the lipid headgroup may have different conformational energetics in lipids of different chains. We explain why this is important to protein-membrane interactions.

Switching transient analysis of a metal/ferroelectric/semiconductor switch diode with high speed response to infrared light

A thin PbTiO(3)-n-p(+) silicon switch diode has been developed, in which the switching voltage (the turned-on voltage) changes in proportion to the infrared light power. The diode has a rapid response time of 0.65 mus compared with other conventional infrared sensors. It is attributed to the rapid switching device structure and the smaller pyroelectric layer thickness, 50 nm. In this paper, we have analyzed the rapid switching transient response by using heat conduction and switching theory successfully. The experimental results are in agreement with the theoretical analysis.

Mitral valve repair in cardiomyopathy

BACKGROUND

Volume overload secondary to mitral regurgitation (MR) in cardiomyopathy is considered critical in the pathogenesis of subsequent ventricular dysfunction. Open mitral valve repair (OMVP) is hypothesized to improve symptomatology and ventricular function by reducing the volume overload of the left ventricle.

METHODS AND RESULTS

All patients who underwent OMVP with a left ventricular ejection fraction (EF) of < 0.30 (n = 81) from 1984 through 1997 were reviewed (1 patient was lost to follow-up). Fifteen operations (18.5%) were repeat operations after previous coronary artery bypass graft surgery. Preoperative and postoperative EFs and NYHA class were compared. Survival probabilities were calculated, and multivariate analysis was performed. The average age of all patients was 67.1 years (range, 41 to 83 years). Mean follow-up was 1.7 years (range, 2 months to 8.5 years). The most common mitral repair was ring annuloplasty. Sixty-two patients (77%) had concomitant coronary artery bypass graft surgery. The surgery mortality rate was 11% (9 of 81); 6 of these 9 patients were > 70 years old. The overall Kaplan-Meier survival probability rate at 1, 2, 3, 4, and 5 years was 0.73, 0.68, 0.58, 0.50, and 0.38, respectively. EF improved significantly (0.24 to 0.32; P < 0.0001), as did the NYHA class (3.2 to 1.6; P < 0.0001), at follow-up. There was no difference in late survival between patients with an EF of < 0.20 (21 patients) and those with an EF between 0.20 and 0.30 (P = NS). Risk factors for death included heart failure and old age.

CONCLUSIONS

OMVP for MR in the setting of ischemic cardiomyopathy and low EF appear to improve ventricular function, medium-term patient symptomatology, and survival.

An engineering model of dynamic cardiomyoplasty. II. Clinical applications

Previously, a modification to the Sunagawa engineering model for the isolated left ventricle and arterial system was proposed and validated for dynamic cardiomyoplasty in an acute goat preparation. To test the hypothesis that this model may be applied to the clinical scenario in cardiomyoplasty patients, we predicted human stroke volume using the model with human clinical data from the literature. Predicted stroke volume correlated well with published stroke volume in patients who have had the dynamic cardiomyoplasty procedure. These results suggest that the modest hemodynamic improvement commonly reported after the procedure is performed may be due to diminished latissimus dorsi strength after transformation. The validity of both the original Sunagawa model and the previously proposed modification for dynamic cardiomyoplasty is further supported with these results. A nomogram methodology for predicting stroke volume after dynamic cardiomyoplasty for any particular patient is presented.

An engineering model of dynamic cardiomyoplasty. I

Dynamic cardiomyoplasty (DCM) is an emerging surgical procedure for heart failure in which the patient's latissimus dorsi (LD) muscle is wrapped around the heart and stimulated to contract in synchrony with the heartbeat as a cardiac assist measure. A 6 week training protocol of progressive electrical stimulation renders the normally fatigueable skeletal muscle fatigue-resistant and suitable for chronic stimulation. To date, over 500 procedures have been performed in worldwide clinical trials. Investigators typically report symptomatic improvement and modest hemodynamic improvement in patients. Controversy exists regarding the exact mechanism of DCM. To test the hypothesis that DCM augments cardiac stroke volume through improvement in systolic function, we formulated an engineering model of dynamic cardiomyoplasty to predict stroke volume. The heart and the LD were modeled as nested (series) elastance chambers, and the vasculature was represented by a two-element Windkessel model. Using five healthy goats, we verified model predictions of stroke volume for both stimulator ON beats (y = 1.00x-0.08, r = 0.87, p < 0.0001) and OFF beats (y = 1.01x+1.06, r = 0.91, p < 0.0001), where x and y are the measured and predicted stroke volumes, respectively. The model confirms that using untrained latissimus dorsi applied to the normal myocardium produces only moderate increases in stroke volume and suggests that future research should focus on increasing LD strength after training.

Issues involved in assessing competency

A psychiatric competency assessment entails more than merely conducting a few clinical tests to diagnose the cause of a cognitive impairment. The psychiatrist may need to explore other aspects of the patient's life, including his or her interpersonal relationships and functional abilities. To provide a truly useful consult for other physicians, legal professional, family members, and the patient, the psychiatrist must be able to integrate the medical findings along with all relevant personal information and apply this information to the legal standards of the particular jurisdiction. By being able to apply both medical and legal knowledge of proxy decision making, the psychiatrist will be better prepared to make recommendations that will facilitate the proper care and services for the cognitively impaired patient.

Right latissimus dorsi cardiomyoplasty improves left ventricular energetics

BACKGROUND

The mechanism by which cardiomyoplasty appears to enhance left ventricular (LV) function is not well understood. We applied the time-varying elastance model to study the effect of cardiomyoplasty on LV function, ventriculovascular coupling, and LV energetics in an acute canine model.

METHODS

Right latissimus dorsi cardiomyoplasty was performed in 5 dogs. The end-systolic pressure-volume relation was generated by using brief caval occlusions. End-systolic elastance, effective arterial elastance, stroke work, internal work, total mechanical work, and stroke work efficiency (stroke work/total mechanical work) were calculated from these pressure-volume data. Myocardial oxygen consumption and overall mechanical efficiency (stroke work/myocardial oxygen consumption) were predicted using the myocardial oxygen consumption-total mechanical work relation.

RESULTS

Skeletal muscle contraction significantly increased end-systolic elastance, an index of contractility. Although stroke work did not change significantly, the increase in end-systolic elastance led to a 29% decrease in total mechanical work, a 50% decrease in internal work, and an increase in stroke work efficiency from 53% to 66%. This was consistent with the observed 29% decrease in effective arterial elastance/end-systolic elastance, an indicator of ventriculovascular coupling that is related inversely to stroke work efficiency. Predicted myocardial oxygen consumption decreased by at least 22%, and predicted overall mechanical efficiency increased at a minimum from 16.1% to 18.4%.

CONCLUSIONS

These results support the theory that cardiomyoplasty unloads the LV by decreasing LV volumes and increasing contractility. These effects appear to improve LV energetics by decreasing total mechanical work without significantly affecting stroke work, resulting in improved stroke work efficiency. The decrease in total mechanical work strongly suggests a decrease in myocardial oxygen consumption and an increase in overall mechanical efficiency.

Thoracoscopic transmyocardial laser revascularization

BACKGROUND

Transmyocardial laser revascularization is a promising surgical technique used to treat nonreconstructable ischemic heart disease. Recent clinical data show that this technique improves the regional perfusion of ischemic myocardium and reduces angina. Presently, transmyocardial laser revascularization requires an open, lateral thoracotomy. We report here the use of thoracoscopic techniques to perform transmyocardial laser revascularization in a closed chest fashion.

METHODS

Five Yorkshire farm pigs underwent left chest thoracoscopic exploration and pericardiotomy. A specialized laser handpiece then was introduced into the chest and thoracoscopic transmyocardial laser revascularization was performed (one channel per square centimeter) using an 800-W CO2 laser.

RESULTS

Video analysis and gross pathology revealed that the anatomic area accessible to thoracoscopic transmyocardial laser revascularization included the entire left ventricular free wall distributions of the left anterior descending, left circumflex, and posterior descending arteries, from base to apex. Standard hematoxylin and eosin staining confirmed the creation of complete and patent 1-mm-diameter transmural channels throughout these distributions.

CONCLUSION

We have shown that transmyocardial laser revascularization can be performed effectively and safely by thoracoscopy, and that this less invasive technique may reduce morbidity and provide a more cost-effective alternative therapy for nonreconstructable ischemic heart disease.

Cytoplasmic sequestration of an O6-methylguanine-DNA methyltransferase enhancer binding protein in DNA repair-deficient human cells

O6-Methylguanine-DNA methyltransferase (MGMT), an enzyme that repairs adducts at O6 of guanine in DNA, is a major determinant of susceptibility to simple methylating carcinogens or of tumor response to anticancer chloroethylating drugs. To investigate the mechanisms underlying cellular expression of this DNA repair enzyme, we focused on the role of a 59-bp enhancer of the human MGMT gene in the regulation of its expression. By using chloramphenicol acetyltransferase reporter assays, we found that the enhancer activity, which was present in both MGMT-expressing (Mer+) and -deficient (Mer-) cells, correlated with the endogenous MGMT activity in Mer+ cell lines. Band-shift assays and deletion analysis of the 59-bp sequence defined a minimal 9-mer cis element (5'-CTGGGTCGC-3') for specific trans factor binding. The MGMT enhancer binding protein (MEBP), 45 kDa by Southwestern blot analysis, was present in the nuclei of all Mer+ cells tested but was apparently restricted to the cytoplasm of Mer- cells. We conclude that the MEBP-enhancer interaction plays an important role in regulating constitutive MGMT expression in Mer+ cells and that MEBP exclusion from the nucleus may account for the down-regulation of MGMT in Mer- cells.