[A multicenter prospective study on early identification of refractory Mycoplasma pneumoniae pneumonia in children]

Objective: To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods: The prospective multicenter study was conducted in Zhejiang, China from May 1st, 2019 to January 31st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results: A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95%CI 0.593-0.771, P<0.01). Conclusion: In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

[Prevalence of medicare antiviral drugs use and related factors in HIV-infected people in Ningbo]

Objective: To analyze the use of medicare antiviral drugs (ART) and related factors among HIV-infected people in Ningbo City. Methods: The retrospective data was collected related to infection and treatment of HIV-infected people in ART in Ningbo up to February 2023 through the National Infectious Disease Surveillance System. Binary logistic regression was used to analyze the factors related to medicare antiviral drug use in HIV-infected people. R 4.2.2 software was used for statistical analysis. Results: A total of 6 433 HIV-infected people with ART records were collected, among which 5 783 were in ART. The prevalence of medicare drugs use among people in ART was 24.8% (1 435/5 783, 95%CI: 23.7%-25.9%). Beilun District (8.7%, 43/497) and Fenghua District (5.7%, 14/247) had the lowest level in medicare drugs use. Among people in ART using medicare or out-of-pocket drugs, the prevalence of those who had at least one viral load test in the last year (84.9%, 1 352/1 593) was significantly lower than that of those using free drugs (91.4%, 3 829/4 190) (χ2=52.50, P<0.001). The results of multivariate logistic analysis showed that the factors influencing medicare drug use included low educational level (junior high school and below: aOR=0.24, 95%CI:0.17-0.34), farmer or worker (farmer: aOR=0.60, 95%CI: 0.39-0.91; worker: aOR=0.42, 95%CI: 0.27-0.64), low monthly income (<3 000 Yuan: aOR=0.29, 95%CI: 0.18-0.45), the longer interval time between diagnosis and treatment (≥21 days: aOR=0.47, 95%CI: 0.30-0.74). Conclusions: Significant regional differences on the prevalence of medicare antiviral drugs use in HIV-infected people exist in Ningbo City. Follow-up management program of patients should be improved to strengthen patient compliance to mobilize medicare drug promotion. Meanwhile, publicity of medicare drugs should be strengthened for farmers or workers with low education level and patients with delayed treatment.

[Effect of calcium-independent phospholipase A2 on the expression of glycerol 3-phosphate dehydrogenase in human non-alcoholic fatty liver disease cells]

Objective: To explore the effect of calcium-independent phospholipase A2 (iPLA2) on the expression of mitochondrial glycerol 3-phosphate dehydrogenase (mGPDH) in human non-alcoholic fatty liver disease cells. Methods: Oleic acid was used to construct a non-alcoholic fatty liver disease cell model by inducing lipid deposition in THLE-2 cells in vitro. Simultaneously, intracellular triglyceride content, iPLA2 expression levels, and mGPDH levels were determined at various induction times (0, 24, 48, and 72 h) using a triglyceride assay kit, quantitative RT-PCR, and western blotting. The model cells were treated with bromelenol lactone, an iPLA2 inhibitor, and N-acetylcysteine, a ROS inhibitor, respectively. Following continuous culture for 24 and 48 hours, the cells were harvested, and the mRNA and protein expression levels of mGPDH were measured. Statistical analysis was performed using the t-test, one-way analysis of variance, and linear correlation. Results: The intracellular triglyceride content gradually increased (P < 0.01), the mGPDH mRNA and protein expression decreased (P < 0.01), and the iPLA2 mRNA and protein expression increased (P < 0.01) in THLE-2 cells with the prolonging time effect of oleic acid therapy. In addition, the mGPDH mRNA expression level was negatively correlated with the iPLA2 mRNA level (r = -0.878, P = 0.002). The expression levels of mGPDH mRNA and protein in the iPLA2 inhibitor group and ROS inhibitor group were increased compared with the model control group (P < 0.01). The expression of mGPDH mRNA was increased at 24 h compared with 48 h in the iPLA2 inhibitor group (P < 0.01). The expression of mGPDH mRNA was gradually increased in the ROS inhibitor group with the prolongation of inhibitor action time (P < 0.01). Compared with the two inhibitor groups, the increase in mGPDH mRNA was significantly higher in the ROS inhibitor group than that in the iPLA2 inhibitor group, and the difference was statistically significant (P < 0.01). Conclusion: iPLA2 can inhibit the expression of mGPDH in non-alcoholic fatty liver cells to a certain extent.

[Quantitative analysis of lipid metabolism-related differential proteins in patients with alcoholic liver disease]

Objective: To screen and identify differential proteins, analyze lipid metabolism-related proteins and pathways, and explore their functions and biological processes in liver tissue of patients with alcoholic liver disease using tandem mass tag (TMT) labeling technology. Methods: Liver tissues that met the inclusion criteria were collected. Eight samples from patients with alcoholic cirrhosis and three samples from the normal control group were screened out. The TMT technique was used to screen differential proteins, perform signaling pathway enrichment analysis, and analyze protein interaction networks to explore the biological processes involved in them. Results: Proteomic analysis identified 2 741 kinds of differentially expressed proteins in the two groups of data with statistical significance (P < 0.05). The standard criteria of P < 0.05 and |log2(foldchange)| > 1 had screened out 106 kinds of differentially expressed proteins. Compared with the control group, the alcoholic liver disease group had 12 kinds of up-regulated proteins and 94 kinds of down-regulated proteins. Among them, there were 2 kinds of up-regulated differential proteins related to lipid metabolism and 14 kinds of down-regulated differential proteins. The results of bioinformatics analysis showed that these proteins were primarily involved in biological processes such as lipid transport, regulation of lipase activity, fatty acid binding, and cholesterol metabolism in lipid metabolism and also had a close link to signal pathways related to lipid metabolism such as peroxisome proliferator-activated receptor signaling pathways, cholesterol metabolism, triglyceride metabolism, and regulation of lipolysis in adipocytes. Conclusion: The 16 kinds of lipid metabolism-related differential proteins may be the key proteins in the pathogenesis of alcoholic liver disease.

CT-guided Radioactive 125I Seed Implantation for Abdominal Incision Metastases of Colorectal Cancer: Safety and Efficacy in 17 Patients

INTRODUCTION

To retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided iodine-125 (¹²⁵I) seed implantation for patients with abdominal incision metastases from colorectal cancer.

MATERIALS AND METHODS

Data of patients with abdominal incision metastases of colorectal cancer from November 2010 to October 2020 were retrospectively reviewed. Each incisional metastasis was percutaneously treated with ¹²⁵I seed implantation under CT guidance. Follow-up contrast-enhanced CT was reviewed, and the outcomes were evaluated in terms of objective response rate, complications, and overall survival.

RESULTS

A total of 17 patients were enrolled in this study. The median follow-up was 18 months (range, 2.7-22.1 months). At 3, 6, 12, and 18 months after the treatment, objective response rate was 52.9%, 63.6%, 33.3%, and 0%, respectively. A small amount of local hematoma occurred in two patients and resolved spontaneously without any treatment. Two patients experienced a minor displacement of radioactive seeds with no related symptoms. Severe complications, such as massive bleeding and radiation injury, were not observed. No ≥ grade 3 adverse events were identified. By the end of follow-up, 14 patients died of multiple hematogenous metastases. The one-year overall survival rate was 41.6%, and the median overall survival was 8.6 months.

CONCLUSION

CT-guided ¹²⁵I seed implantation brachytherapy is safe and feasible for patients with abdominal incision metastases from colorectal cancer.

Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion

BACKGROUND AND PURPOSE

Net water uptake is qualified as an imaging marker of brain edema. We aimed to investigate the ability of net water uptake to predict 90-day functional outcome in patients with acute ischemic stroke and large-vessel occlusion.

MATERIALS AND METHODS

A total of 295 consecutive patients were retrospectively enrolled. Automated ASPECTS-net water uptake was calculated on the admission CT. The relationship between ASPECTS-net water uptake and 90-day neurologic outcome was assessed. The independent predictors of favorable outcome (mRS score ≤2) were assessed using multivariate logistic regression analysis and receiver operating characteristic curves and stratified by the ASPECTS.

RESULTS

Favorable 90-day outcomes were observed in 156 (52.9%) patients. ASPECTS-net water uptake (OR, 0.79; 95% CI, 0.70-0.90), NIHSS scores (OR, 0.91; 95% CI, 0.87-0.96), age (OR, 0.96; 95% CI, 0.94-0.99), and vessel recanalization (OR, 7.78; 95% CI, 3.96-15.29) were independently associated with favorable outcomes at 90 days (all, P < .01). A lower ASPECTS-net water uptake independently predicted a good prognosis, even in the subgroup of patients with low ASPECTS (≤5) (P < .05). An outcome-prediction model based on these variables yielded an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.814-0.899; sensitivity, 76.3%; specificity, 81.3%).

CONCLUSIONS

ASPECTS-net water uptake could independently predict 90-day neurologic outcomes in patients with acute ischemic stroke and large-vessel occlusion. Integrating ASPECTS-net water uptake with clinical models could improve the efficiency of outcome stratification.

[Cost-effectiveness prediction of AIDS interventions among men who have sex with men in Ningbo]

Objective: To provide information reference for resource allocation and decision-making in related fields, the cost-effectiveness of HIV input among men who have sex with men (MSM) in Ningbo. Different intervention coverages were compared. Methods: Taking MSM as the target population, data were collected and modeled by Optima HIV for the corresponding HIV health output and the budget under different intervention coverages. Results: According to the estimated size of the MSM population, which was 19 584 in Ningbo in 2020, if the coverage of 2020 baseline intervention is maintained in the next ten years, the number of HIV cases, new HIV infections, and HIV-related deaths among this population will show an upward trend. It is estimated that from 2021 to 2030, 7.9% of new infections and 1.7% of deaths can be avoided and the relevant funding investment comed to 2.4 time the baseline if the intervention coverage rate expanded to 3.0 times the 2020 baseline. After the coverage rate of intervention expanded to 3 times the baseline, it continued to grow, the health effect did not increase. Conclusions: At present, expanding the baseline coverage of HIV-related intervention projects among MSM in Ningbo and increasing capital investment will still reverse HIV-related death and reduce new infections. Moreover, there is a saturation point of the intervention effect. Researchers and policymakers must explore more effective interventions/combinations to obtain more significant health outcomes.

[Status of HVPG clinical application in China in 2021]

Objective: The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China. Methods: This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems. Results: According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%). Conclusion: Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

[Role of lymphocytes in the pathogenesis of autoimmune hepatitis]

In recent years, the number of autoimmune hepatitis cases in the world has shown a significant upward trend, but its etiology and pathogenesis is still unclear. At present, it is generally considered to be caused by abnormal immune regulation mechanism of the body, especially the lymphocytes and their cytokines, which has attracted widespread concern and thus is reviewed here.

[Characteristics and influencing factors of newly HIV infection among newly confirmed HIV/AIDS cases in Ningbo city, 2017-2020]

Objective: To identify the characteristics and influencing factors of local HIV infection among newly confirmed cases in Ningbo from 2017 to 2020 to provide evidence for traceability investigations on critical cases and facilitate the detection procedures and reduce new HIV infection. Methods: From January 1, 2017, to December 31, 2020, the newly confirmed HIV/AIDS in Ningbo were recruited. An epidemiological questionnaire was used to collect relevant information, including demography, sexual behaviors, results of HIV antibody tests, and the route of HIV transmission. According to the HIV testing, history of risk behaviors, and the level of CD4⁺ lymphocytes after confirmation, the HIV infection was acquired in the previous year, or the place was in Ningbo. The EpiData 3.1 and SPSS 23.0 software were used for input, sorting database and statistical analysis. Results: A total of 2 044 HIV/AIDS on-site investigations were completed. The average age of the subjects was (40.6±15.3) years old, including 1 684 males (82.4%), 758 unmarrieds (37.1%), 1 072 (52.5%) registered as permanent residents in Ningbo, 1 253 (61.3%) with junior high school education or below, 979 (47.9%) lived in Ningbo for more than five years. The proportion of local, new HIV infections was 34.34% (702/2 044). Multivariate logistic analysis showed that the proportion of local newly HIV infection was higher among those who were confirmed in 2020 (compared with the 2017 confirmed cases, OR=1.422, 95%CI:1.092-1.851), whose occupations were students/teachers/cadres/retirees (compared to commercial service/catering/public place service personnel, OR=1.682, 95%CI: 1.307-2.165), meeting sex partners via male social software locally in the last year (compared with without using related dating software, OR=1.353, 95%CI: 1.073-1.706). Conclusions: The proportion of local HIV infection of newly confirmed HIV/AIDS was relatively high in Ningbo city from 2017 to 2020. Meeting gay sex partners through local male social software appeared a risk factor for local newly HIV infection. Traceability investigations and internet intervention should be carried out for MSM. While male social software should be focused on identifying and controlling the risk of local newly HIV infection.

[HIV infection and related factors of traceability efficiency among sex partners of HIV positive men who have sex with men]

Objective: To investigate the situation related to HIV infection and influencing factors of traceability efficiency among sex partners of HIV positive men who have sex with men (MSM). Methods: A cross-sectional survey was conducted to investigate the traceability among sex partners of HIV-positive MSM in Ningbo from 2018 to 2020. Limiting-antigen avidity enzyme immunoassay determined recent HIV infection. The classified data was evaluated by chi-square test, and factors of traceability efficiency were analyzed by multivariate logistic regression. Results: A total of 374 newly confirmed HIV-positive MSM were recruited to participate in the HIV test in Ningbo from 2018 to 2020.HIV positive rate of sex partner was 15.7% (75/479,95%CI:12.4%-18.9%). HIV positive rates of sex partner of recent HIV infection MSM was 31.8% (21/66,95%CI:20.3%-43.4%). The proportion of newly confirmed HIV-positive sex partners of recent HIV infection MSM (76.2%) was higher than that of long-term HIV infection MSM (48.1%). The difference was statistically significant (P=0.028). Results from the multivariate logistic regression analysis showed that HIV traceability efficiency was higher in the following subpopulations as; HIV positive MSM who were 36-45 years old (compared with 18-25 years old, OR=3.973,95%CI:1.364-11.569), HIV active detection (compared with HIV passive detection, OR=1.896, 95%CI:1.083-3.319), recent HIV infection MSM (compared with long-term HIV infection MSM, OR=3.733, 95%CI:1.844-7.556). Conclusions: HIV positive rate among partners of HIV positive MSM was very high. The traceability efficiency, which was recent HIV infection MSM and HIV active detection, was high. It is suggested to strengthen the traceability and focus on the newly confirmed HIV-positive MSM in VCT clinics.

Hepatic Artery Infusion Pump Combined With Systemic Chemotherapy for Patients With Liver Metastases From Breast Carcinoma

Background: When liver metastasis in patients with breast cancer is diagnosed, treatment is generally palliative and usually consists of systemic therapies only. This study aimed to evaluate the efficacy and safety of hepatic arterial infusion (HAI) combined with systemic chemotherapy in patients with breast carcinoma liver metastases (BCLM). Methods: From January 2012 to December 2019, HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 19 patients with BCLM. All patients received systemic chemotherapy and HAI gemcitabine plus floxuridine (FUDR). Methods: The overall response rate (ORR) of intrahepatic lesions was 73.7%, including 2 patients (10.5%) with complete remission (CR) and 12 patients (63.2%) with partial remission (PR). Additionally, we found that young patients (age < 55 years) had a higher ORR than the older (100% vs 44.4%, P = .011). The median overall survival (mOS) was 13.1 months. Kaplan-Meier survival curves demonstrated that the mOS was not significantly different between patients with < 9 intrahepatic lesions and those with ≥ 9 lesions (13.7 months vs 10.9 months, P = .225). The mOS was 14.3 and 10.6 months for patients without extrahepatic metastases and with extrahepatic metastases, respectively (P = .016). None of the patients had grade 4 toxicity. The grade 3 toxicities included leucopenia, neutropenia and diarrhea. Conclusions: HAI gemcitabine plus FUDR combined with systemic chemotherapy is effective in achieving a high local response and prolonging mOS for patients with BCLM and is associated with a relatively low rate of toxicity.

[Efficacy evaluation of vestibular rehabilitation based on mobile internet in patients with otogenic vertigo]

Twenty-five patients diagnosed with otogenic vertigo at the outpatient clinic of the Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January to June 2020 were selected. Among them, 8 cases were male and 17 cases were female, aged (48±13) years. All the patients underwent internet combined with offline follow-up vestibular rehabilitation for 12 weeks, which included vestibulo-ocular reflex exercises, proprioceptive exercises and static/dynamic balance exercises. Computerized dynamic posturography (CDP) and dizziness handicap inventory (DHI) scores were compared before and after rehabilitation. The DHI score improved significantly after 12 weeks of vestibular rehabilitation (48.3±15.9 vs 26.7±17.9, t=5.319, P<0.001). Meanwhile, the sensory organization test (SOT) score was also improved (73.3±8.1 vs 76.1±6.6, t=2.066, P=0.050), while the difference of motor control test (MCT) latent stage score before and after rehabilitation was not statistically significant (140±13 vs 141±16, t=0.791, P=0.436). The current study demonstrates that vestibular rehabilitation based on mobile internet is convenient, economical and effective, and patients can benefit from it.

[Expression and clinicopathological significance of Bcl - 2 and Bax genes in colorectal cancer patients complicated with schistosomiasis]

OBJECTIVE

To investigate the expression and clinicopathological significance of Bcl-2 and Bax genes in colorectal cancer (CRC) patients complicated with schistosomiasis.

METHODS

The CRC patients receiving surgical treatment in the First Affiliated Hospital of Dali University from June 2016 to June 2020 were recruited as the study subjects, and 30 subjects were randomly sampled from the CRC patients complicated with schistosomiasis (CRC-S group) and 30 subjects were randomly sampled from the CRC patients without schistosomiasis (CRC group) using a random number table method. The cancer specimens were sampled from subjects in the CRC-S and CRC groups, and the peri-cancer specimens were sampled from subjects in the CRC group. The Bcl-2 and Bax expression was quantified in cancer and peri-cancer specimens using a real-time fluorescent quantitative PCR (qPCR) assay and immunohistochemistry at transcriptional and translational levels, and the cell apoptosis was detected in cancer specimens using HE staining.

RESULTS

A total of 60 subjects were enrolled, including 30 cases in the CRC group and 30 cases in the CRC-S group. There were no significant differences between the two groups in terms of gender distribution (χ² = 0.271, P > 0.05), mean age (t = -0.596, P > 0.05), tumor growth pattern (χ² = 0.275, P > 0.05), tumor location (χ² = 4.008, P > 0.05), tumor invasion depth (χ² = 0.608, P > 0.05), degree of tumor differentiation (χ² = 0.364, P > 0.05), or presence of vascular metastasis (χ² = 1.111, P > 0.05), while significant differences were seen between the two groups in terms of histological type, presence of lymph node metastasis and TMN staging (χ² = 5.963, 8.297 and 5.711, all P values < 0.05). qPCR assay and immunohistochemistry quantified significantly higher Bcl-2 and Bax expression in cancer specimens from the CRC and CRC-S groups than in the peri-cancer specimens from the CRC group at both translational and transcriptional levels (all P values < 0.05), and higher Bcl-2 and lower Bax expression were seen in the cancer specimens from the CSC-S group than that from the CRC group (all P values < 0.05). In addition, the cell apoptotic rate was significantly greater in the cancer specimens in the CRC group than in the CRC-S group (42.00% vs. 23.35%; χ² = 41.500, P = 0.000).

CONCLUSION

Schistosomiasis may be involved in the development and progression of CRC through affecting Bcl-2 and Bax gene expression in the apoptosis signaling pathway.

[Epidemic dynamic model based evaluation of effectiveness of prevention and control strategies for COVID-19 in Ningbo]

Objective: To evaluate effectiveness of prevention and control strategies for COVID-19 in Ningbo by using an epidemic dynamic model. Methods: The incidence data and epidemic information of COVID-19 reported in Ningbo as of 9 March, 2020 were collected, and based on the implementation of prevention and control strategies, we developed a SEIR epidemic dynamics model. The basic and real-time reproduction numbers were calculated to evaluate effectiveness of prevention and control. Results: A total of 157 cases of COVID-19 were confirmed, without death, in Ningbo. The proportion of severe cases was 12.1%. The mean incubation period was estimated to be (5.7±2.9) days. The mean interval from illness onset to diagnosis was (5.4±3.7) days. The mean duration from diagnosis to hospital discharge was (16.6±6.5) days. A total of 105 339 contacts had been under medical observation. The infection rates in contacts with home quarantine and centralized quarantine were 0.1% and 0.3%, respectively. In the confirmed cases, those who had been under medical observation before diagnoses accounted for 63.1%. The basic reproduction number was estimated to be 4.8. With the strengthening of prevention and control measures, real-time reproduction number showed a gradual downward trend, dropping to below 1.0 on 4 February, and then continued to drop to 0.2 in mid-February. Conclusion: The effectiveness of the prevention and control measures for COVID-19 in Ningbo can be evaluated by using epidemic dynamic model to provide scientific evidence for the development of the prevention and control strategies.

[Study of the effect of CHOP signaling molecule in PPARα activation and inhibition with response to inflammation in mice with acute liver failure]

Objective: To investigate the mechanism of action of peroxisome proliferator-activated receptor α (PPARα)-mediated CCAAT/enhancer binding protein homologous protein (CHOP) signaling molecule with response to inflammation in mice with acute liver failure. Methods: C57BL/6 mice were used as the research subjects, and D-galactose (D-GalN) combined with lipopolysaccharide (LPS) was injected intraperitoneally to establish a mouse model of acute liver failure. PPARα was activated by Wy-14643. CHOP expression was promoted by plasmids. Liver pathological changes and serum transaminases (ALT and AST) were detected in mice to evaluate liver function. The mRNA expression level of inflammatory factors in liver tissue was detected by real-time fluorescence quantitative PCR. LPS-stimulated macrophage was used to establish an inflammation model. PPARα and CHOP expression was inhibited by siRNA. The mRNA expression level of inflammatory factors in the cells was detected by real-time fluorescence quantitative PCR. Results: Promoted PPARα activation had inhibited liver hemorrhage and inflammation in mice with acute liver failure induced by D-GalN/LPS. In addition, the serum level of transaminases and genetic level of inflammatory factors in liver tissues were reduced (P < 0.01). CHOP accelerated expression had reversed the hepatoprotective effect of PPARα activation, aggravated liver injury, and increased inflammatory factors expression (P < 0.01). At the cellular level, the inhibition of PPARα activation had accelerated the increase of inflammatory factors (P < 0.01), while the inhibition of CHOP activation had all over again decreased the inflammatory factors (P < 0.01). Conclusion: PPARα and CHOP are important signaling molecules to regulate the inflammatory response in acute liver failure and liver injury. PPARα acceleration can down-regulate CHOP to inhibit inflammatory factors, which might play a protective role in mice with acute liver failure.

Short communication: The antilipogenic effect of trans-10,cis-12 conjugated linoleic acid in bovine mammary epithelial cells is associated with proteasome activity and ATP production

Proteasomes play a widespread role in the control of protein abundance via degrading ubiquitinated proteins. Activity of proteasomes is regulated by constitutive ATPases that respond to intracellular concentrations of ATP. Although recent data suggest a role of proteasomes in fatty acid metabolism, whether lipogenic activity in mammary cells is responsive to ATP concentrations and proteasome activity is unknown. To investigate whether proteasomes play a role in milk fat depression induced by trans-10,cis-12 conjugated linoleic acid (t10,c12 CLA), a bovine mammary epithelial cell line was treated with t10,c12 CLA for 24 h before analysis of lipogenic protein abundance. Western blot analysis of inactive sterol response element-binding protein-1 (pSREBP1) and active (nSREBP1) fragments indicated a decrease in abundance induced by exogenous t10,c12 CLA. At 150 nM t10,c12 CLA, abundance of both pSREBP1 and nSREBP1 was lowest, and decreased from basal levels by 16 and 64%, respectively. Exogenous t10,c12 CLA had no effect on abundance of peroxisome proliferator-activated receptor-gamma (PPARγ), but at 150 and 300 nM it decreased abundance of SREBF chaperone (SCAP). Inhibition of proteasome activity via incubation with MG-132 (a proteasome inhibitor) alone had no effect on pSREBP1, nSREBP1, PPARγ, or SCAP abundance. However, when cells were pre-incubated with MG-132, treatment with t10,c12 CLA reduced pSREBP1 (∼27%) and nSREBP1 (∼41%) abundance without affecting PPARγ or SCAP. Compared with the control, exogenous t10,c12 CLA increased ATP concentrations, and MG-132 alone had no effect. However, ATP concentration decreased markedly in cells incubated with both MG-132 and t10,c12 CLA. Combined with the alteration of SCAP and nSREBP1, the increase of ATP concentrations with t10,c12 CLA suggested that this fatty acid influenced the function of the SREBP1-SCAP complex through altering proteasome activity. Collectively, the current data highlight a role of proteasomes and intracellular ATP concentrations in the antilipogenic effect induced by t10,c12 CLA that leads to milk fat depression.

[Relations between high risk sexual behavior and HIV infection among men who have sex with men in ways of meeting male partners]

Objective: To understand the relations between high risk sexual behavior and HIV infection among MSM in ways of finding male partners in Ningbo. Methods: A cross-sectional study was conducted in Ningbo between April and November in 2018. Data related to socio-demographics, ways of finding male partners, adoption of gay apps and sexual behaviors were collected by snowball method. Blood samples were drawn for HIV antibody testing. Classified data was evaluated by chi-square test. Related factors on HIV infection were analyzed by multivariate logistic regression. Results: A total of 735 participants were included in this study. Ways of finding male partners would through gay apps (60.8%, 447/735), QQ/Wechat (32.3%, 237/735) and gay-places (6.9%, 51/735). Related information on high risk sexual behavior and HIV infection among gay apps users were found as: 16.8%(75) had sexual behavior once per week in the past 6 months, 41.8% (187/447) had multiple sexual partners, 12.1% (54/447) had unprotected anal intercourse in the last time, 52.3% (234/447) having had unprotected anal intercourse in the past 6 months. The overall HIV prevalence rate was 12.1%(54/447). Among the HIV cases who got infected within the two years, 68.6%(24/35) of them had used gay apps for less than two years. Results from the, multivariate logistic regression analysis showed that gay apps users were more susceptible to infected HIV than those who used the QQ/Wechat (OR=3.03, 95%CI: 1.30-7.07). Conclusions: Gay apps was popularly known among the Ningbo MSM, and was associated with the high risk sexual behaviors and HIV infection. HIV control and prevention programs should be strengthened in the MSM population who used the gay apps. Related surveillance and intervention programs for MSM, who use the gay apps, need to be further reinforced.

[Auditory health effects induced by noise exposure]

SummaryNoise is one of the most common environmental and occupational exposures, and noise-induced hearing loss （NIHL） has become the leading occupational disease, secondary to the age-related hearing impairment. It is a significant cause of disability and a major cost to the society. Three characteristics of NIHL have been thoroughly established through numerous studies. First, noise-induced threshold changes increases with noise intensity and duration of exposure. Second, difficulties in speech discrimination and temporal processing even in the presence of normal behavioral thresholds in the subjects with a history of noise exposure. Third, individual susceptibility to noise along with the degree of hearing loss varies greatly among population. NIHL is a complex disease resulting from the interaction between environmental and genetic factors. And much of the literature on NIHL is derived from cross-sectional studies, providing limited evidence for the natural history of the noise exposure. Then, it is urgent to explore the development tendency and identify the susceptible frequencies of NIHL through large-scaled longitudinal study, and provide a new method for estimating individual susceptibility to NIHL.

[Clinical characteristics and treatment options of hearing impairment caused by hyperbilirubinemia]

SummaryNeonatal hyperbilirubinemia is the most common clinical symptom in neonates. When the concentration of free bilirubin in blood is too high, it crosses through the blood-brain barrier and selectively deposits in specific brain nuclei to cause neurotoxicity and bilirubin neurological dysfunction. The auditory nervous system is highly sensitive to bilirubin. Therefore, auditory neuropathy is the most important or even the only clinical symptom of bilirubin neurological dysfunction. Chronic bilirubin encephalopathy can be classified to three types as mild, moderate and severe，according to the audiological manifestations and other neurological sequelae. Early recognition and intervention of bilirubin-induced hearing impairment is of great significance to improve the speech recognition rate of the referred children. This article reviews the most important studies about the clinical characteristics, pathogenesis and treatment of bilirubin-induced hearing impairment.

[Study of endoplasmic reticulum stress role in hepatic failure induced by severe hepatitis B]

Objective: To investigate the endoplasmic reticulum stress (ERS) role in the course of liver failure induced by severe hepatitis B virus (HBV) infection and its related mechanism. Methods: Liver tissue samples and clinical data [chronic hepatitis B patients (12 cases, chronic hepatitis B group), hepatic failure induced by severe hepatitis B virus (12 cases, severe hepatitis B virus liver failure group), and normal subjects (8 cases, control group)] were collected from the Beijing You'an Hospital affiliated to Capital Medical University between 2009 to 2011. Statistical analysis was performed on the clinical indicators of each group. The structure of endoplasmic reticulum in liver tissue was observed by transmission electron microscopy. Western blot and qRT-PCR were used to detect the expression of endoplasmic reticulum stress and apoptosis-related factors, including glucose-regulated protein (Grp), and C/EBP homologous protein (CHOP). Frozen sections of liver tissues were prepared for immunofluorescence test. All data were expressed as mean ± standard deviation. LSD-t test was used to compare the results between groups. A p value < 0.05 was considered as statistically significant. Results: Transmission electron microscopy showed that the morphological structure of the endoplasmic reticulum was damaged in both groups (chronic hepatitis B and liver failure induced by severe hepatitis B virus), and liver failure induced by severe hepatitis B virus group was more critical. Western blot and qRT-PCR showed that Grp78, Grp94 and Caspase-4 were highly expressed in normal group and chronic hepatitis B group, and the relative protein expressions were 1.20 ± 0.13 and 0.78 ± 0.11, 0.90 ± 0.06 and 0.11 ± 0.01, 0.15 ± 0.02 and 0.22 ± 0.04, respectively. The expression of protein was weakened in liver failure induced by severe hepatitis B virus group (relative protein expression was 0.01 ± 0, 0.01 ± 0, and 0.11 ± 0.02, respectively).There was a statistically significant difference between the two groups (P < 0.05). The expression of CHOP was consistent with the results of immunofluorescence, and increased with the stressing of injury. Conclusion: During the course of severe hepatitis B infection, dysregulated endoplasmic reticulum stress activated mild stress in chronic hepatitis B group, while severe stress in hepatic failure induced by severe hepatitis B virus group. Therefore, endoplasmic reticulum stress plays an important and complex role in the pathogenesis of hepatic failure induced by severe hepatitis B virus.

Risk of Acute Kidney Injury with Consecutive, Multidose Use of Iodinated Contrast in Patients with Acute Ischemic Stroke

Currently, CTA is the imaging technique most frequently used to evaluate acute ischemic stroke, and patients with intracranial large-vessel occlusion usually undergo endovascular treatment. This single-center, prospective, cohort study showed that consecutive, multidose use of contrast during CTA and DSA does not increase the incidence of acute kidney injury in patients with acute ischemic stroke, though acute kidney injury tended to have a higher incidence in the contrast multiexposure group (P = .172).

[Characteristics of Dix-Hallpike test induced nystagmus]

Objective:To retrospectively analyze the characteristics of 100 cases with Dix-Hallpike test induced nystagmus, especially the vertical downward component.Method:One hundred cases with positive Dix-Hallpike test between December 2017 and January 2018 were included in this study. Dix-Hallpike test and roll test were performed in all patients, and the max slow phase velocity (SPV), latency and duration of positional nystagmus were analyzed with SPSS 22.0 software.Result:According to the difference in the direction and duration of the nystagmus in the head-hanging position on Dix-Hallpike test, 100 patients were classified into 9 types. When only the vertical components were considered, 56 cases presented with bilateral or unilateral vertical upward component, among which 52 cases had unilateral torsional with vertical upward component, 4 cases had bilateral torsional with vertical upward component; 7 cases presented with vertically upward in one side and the vertically downward in the other side; 47 cases presented with bilateral or unilateral vertical downward component. In addition, 8 cases showed the reverse phase nystagmus. Of the 100 patients with positive Dix-hallpike, 20 cases were positive in roll test and 5 cases showing horizontal nystagmus and 15 cases showing torsional and vertical nystagmus.Conclusion:Vertical component in the positional nystagmus was common, and care should be taken to interpret the nystagmus into the underlying disorder.

[Classification of acute vestibular syndrome]

Objective:To explore the epidemiological characteristics and to help accomplish accurate diagnosis and treatment strategies by analyzing the composition and clinical features of various diseases with acute constant vertigo.Method:We retrospectively analyzed medical records (including name, sex, age, diabetes, hypertension, history of vertigo, family history, etc.),otoneurological examination, vestibular function tests and radiological examination of patients with acute vestibular syndrome.We classified various diseases according to diagnostic criteria, and then analyze the clinical data.Result:A total of 77 patients with acute vestibular syndrome were enrolled in this study. It included 34 patients with vestibular neuritis, 18 patients with sudden sensorineural deafness with vertigo, 1 with vestibular schwannoma, 6 with acute vestibular syndrome with migraine, 3 with Hunter syndrome with vertigo, 1 with vertigo after trauma,1 with acute bilateral vestibulopathy, 9 with acute vertigo syndrome with other etiology, 3 with acute labyrinthitis, and 1 with posterior circulation infarction. There were no significant differences in the age and course of disease between different etiologies (P>0.05). There were statistical differences between vestibular neuritis and sudden sensorineural deafness with vertigo among head impulse test and hearing loss (P<0.05). There was significant difference in hearing between sudden sensorineural deafness with vertigo and acute vertigo syndrome (P<0.05).Conclusion:Most of the acute vestibular syndrome patients attending the otorhinolaryngology head and neck surgery clinic were peripheral acute vestibular syndrome, vestibular neuritis, and sudden sensorineural deafness with vertigo.Patients with acute vestibular syndrome with migraine are not rare, and central vertigo can also be seen.

Fatty acid elongase 5 (ELOVL5) alters the synthesis of long-chain unsaturated fatty acids in goat mammary epithelial cells

Increased production of long-chain unsaturated fatty acids (LCUFA) can have a positive effect on the nutritional value of ruminant milk for human consumption. In nonruminant species, fatty acid elongase 5 (ELOVL5) is a key enzyme for endogenous synthesis of long-chain unsaturated fatty acids. However, whether ELOVL5 protein plays a role (if any) in ruminant mammary tissue remains unclear. In the present study, we assessed the mRNA abundance of ELOVL5 at 3 stages of lactation in goat mammary tissue. Results revealed that ELOVL5 had the lowest expression at peak lactation compared with the nonlactating and late-lactating periods. The ELOVL5 was overexpressed or knocked down to assess its role in goat mammary epithelial cells. Results revealed that ELOVL5 overexpression increased the expression of perilipin2 (PLIN2) and decreased diacylglycerolacyltransferase 2 (DGAT2) and fatty acid desaturase 2 (FADS2) mRNA, but had no effect on the expression of DGAT1, FADS1, and stearoyl-CoA desaturase 1 (SCD1). Overexpression of ELOVL5 decreased the concentration of C16:1n-7, whereas no significant change in C18:1n-7 and C18:1n-9 was observed. Knockdown of ELOVL5 decreased the expression of PLIN2 but had no effect on DGAT1, DGAT2, FADS1, FADS2, and SCD1 mRNA expression. Knockdown of ELOVL5 increased the concentration of C16:1n-7 and decreased that of C18:1n-7. The alterations of expression of genes related to lipid metabolism after overexpression or knockdown of ELOVL5 suggested a negative feedback regulation by the products of ELOVL5 activation. However, the content of triacylglycerol was not altered by knockdown or overexpression of ELOVL5 in goat mammary epithelial cells, which might have been due to the insufficient availability of substrate in vitro. Collectively, these are the first in vitro results highlighting an important role of ELOVL5 in the elongation of 16-carbon to 18-carbon unsaturated fatty acids in ruminant mammary cells.

Peroxisome proliferator-activated receptor delta regulates lipid droplet formation and transport in goat mammary epithelial cells

Even though recent evidence in goat mammary epithelial cells (GMEC) suggest a role of peroxisome proliferator-activated receptor delta (PPARD) in regulating lipid homeostasis, its role is not fully understood. Our hypothesis was that PPARD regulates lipid transport processes in GMEC and, thus, plays a crucial role in regulating fat formation. The PPARD was overexpressed using an adenovirus system (Ad-PPARD) with recombinant green fluorescent protein (Ad-GFP) as the control. Results revealed that overexpression of PPARD markedly upregulated the mRNA abundance of PPARD. Compared with the control (Ad-GFP+dimethyl sulfoxide), overexpression of PPARD alone had no effect on mRNA expression of CD36, SCD1, FABP4, ACSL1, and ADRP. The cultures overexpressing PPARD with the PPARD ligand GW0742 (GW) upregulated the expression of CD36, FABP3, FABP4, ACSL1, and ADRP. Overexpression of PPARD in GMEC plus GW increased the concentration of 16:1 and 18:1-trans and was associated with upregulation of SCD1. Compared with the control (Ad-GFP+dimethyl sulfoxide), the decrease of triacylglycerol concentration coupled with upregulation of genes related to lipid droplet secretion (e.g., ADRP and ACSL1) induced by PPARD overexpression suggests a role in lipid droplet (LD) secretion. Luciferase assay revealed that GW increased the ADRP promoter activity in a dose-dependent manner. Knockdown of PPARD impaired the increase of ADRP promoter activity induced by GW, whereas GW enhanced the activity of ADRP promoter in GMEC overexpressing PPARD. Data with the ADRP 5'-flanking truncated luciferase reporter suggest a core region (-1,444 to -990 bp) response element for the induction of GW. This core region contains a known PPARG response element (PPRE) at -1,003 to -990 bp. When the PPRE was mutated, the overexpression of PPARD had no effect on ADRP promoter activity. Collectively, these results reveal a novel role for PPARD in lipid homeostasis via promoting fatty acid transport and LD formation through a mechanism of direct binding to the promoter of key genes. Hence, PPARD activity may contribute to fatty acid transport and LD formation during lactation.

[Protective effect of glycogen synthase kinase 3β inhibition via peroxisome proliferator-activated receptor alpha activation in mice with acute liver failure]

Objective: To investigate the role of the glycogen synthase kinase 3β (GSK3β) and the peroxisome proliferator-activated receptor alpha (PPARα) signaling pathway in acute liver failure and related mechanisms in a mouse model of acute liver failure induced by D-galactosamine/lipopolysaccharide (D-GalN/LPS). Methods: C57BL/6 mice were given intraperitoneal injection of D-GalN/LPS to establish a mouse model of acute liver failure. SB216763 was used to inhibit the activity of GSK3β and PPARα siRNA was used to inhibit the expression of PPARα. Western blotting was used to measure the expression of PPARα protein. The changes in liver pathology were observed to evaluate liver injury, and the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured to assess liver function. Quantitative real-time PCR was used to measure the mRNA expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-12p40 (IL-12p40), and PPARα. A one-way analysis of variance was used for comparison of means between multiple groups; the least significant difference test was used for data with homogeneity of variance, and the Games-Howell method was used for data with heterogeneity of variance. Results: In the mice with liver failure induced by D-GalN/LPS, GSK3β inhibition promoted the mRNA and protein expression of PPARα (F = 13.18 and 301.36, P = 0.00 and 0.00). In the mice with acute liver failure induced by D-GalN/LPS, GSK3β inhibition alleviated liver bleeding, inflammation, and necrosis and reduced the serum levels of ALT (F = 25.16, P = 0.000) and AST (F = 12.96, P = 0.001), as well as the mRNA expression of TNF-α (F = 32.17, P = 0.00), IL-1β (F = 11.57, P = 0.005), and IL-12p40 (F = 14.17, P = 0.015) in liver tissue. The inhibition of PPARα expression reversed the liver-protecting effect of GSK3β inhibition, which manifested as aggravation in liver bleeding, inflammation, and necrosis, increases in the serum levels of ALT (F = 25.16, P = 0.001) and AST (F = 12.96, P = 0.000), and an increase in the mRNA expression of TNF-α (F = 32.17, P = 0.00), IL-1β (F = 11.57, P = 0.024), and IL-12p40 (F = 14.17, P = 0.001) in liver tissue. Conclusion: In mice with acute liver failure induced by D-GalN/LPS, the GSK3β-PPARα-inflammatory factor signaling pathway may play an important role. GSK3β inhibition has a protective effect in mice with acute liver failure possibly by activating the inhibitory inflammatory factor of PPARα.

Characterization of the liver X receptor-dependent regulatory mechanism of goat stearoyl-coenzyme A desaturase 1 gene by linoleic acid

Stearoyl-coenzyme A desaturase 1 (SCD1) is a key enzyme in the biosynthesis of palmitoleic and oleic acid. Although the transcriptional regulatory mechanism of SCD1 via polyunsaturated fatty acids (PUFA) has been extensively explored in nonruminants, the existence of such mechanism in ruminant mammary gland remains unknown. In this study, we used goat genomic DNA to clone and sequence a 1,713-bp fragment of the SCD1 5' flanking region. Deletion assays revealed a core region of the promoter located between -415 and -109 bp upstream of the transcription start site, and contained the highly conserved PUFA response region. An intact PUFA response region was required for the basal transcriptional activity of SCD1. Linoleic acid reduced endogenous expression of SCD1 and sterol regulatory element binding factor-1 (SREBF1) in goat mammary epithelial cells. Further analysis indicated that both the sterol response element (SRE) and the nuclear factor Y (NF-Y) binding site in the SCD1 promoter were responsible for the inhibition effect by linoleic acid, whereas the effect was abrogated once NF-Y was deleted. In addition, SRE and NF-Y were partly responsible for the transcriptional activation induced via the liver X receptor agonist T 4506585 (Sigma-Aldrich, St. Louis, MO). When goat mammary epithelial cells were cultured with linoleic acid, addition of T 4506585 markedly increased SCD1 transcription in controls, but had no effect on cells with a deleted SRE promoter. These results demonstrated that linoleic acid can regulate SCD1 expression at the transcriptional level through SRE and NF-Y in a liver X receptor-dependent fashion in the goat mammary gland.

[The correlation analysis of the cochlear hydrops degree found by MRI angiography with Meiniere's disease classification]

Objective:To investigate the correlation between the levels of cochlear hydrops with the clinic classification of Meniere's disease(MD).Method:3D-FlAIR MRI was performed 24 hours after intratympanic injection of 8-fold diluted Gadopentetate Dimeglumine in 31 patients with unilateral MD. We evaluated the levels of cochlear hydrops and further analyzed the correlation between the levels of cochlear hydrops and thresholds of pure tone audiometry and clinic classification of MD. Result:MRI image clearly distinguished perilymph from endolymph in the labyrinth. The images showed different levels of enhancement of perilymphatic fluid spaces. In the 31 patients, obvious signs of endolymphatic hydrops were found, including 4 cases of level 0, 6 cases of level 1, 11 cases of level 2 and 10 cases of level 3. Their average hearing threshold was(54.37±3.88)dB HL. The levels of cochlear hydrops were significantly correlated with pure tone audiometry thresholds （r=0.636，P<0.01） and MD classification(r=0.516,P<0.01). None of the patients after intratympanic injection complained about discomfort or happened with any complications such as eardrum perforation, infection, and so on. Conclusion:The degree of endolymphatic hydrops based on MRI in MD patient has significant correlation with the pure tone audiometry and classification of disease. The examination can act as an objective index for MD diagnosis.

Fatty acid elongase 6 plays a role in the synthesis of long-chain fatty acids in goat mammary epithelial cells

In nonruminants, it is well established that elongation of very long-chain fatty acid-like fatty acid elongase 6 (ELOVL6) catalyzes the synthesis of C18:0 from C16:0 in lipogenic tissues like adipose and liver. However, the role of ELOVL6 in regulating lipid metabolism in ruminant mammary gland remains unknown. In the present study, ELOVL6 was overexpressed or knocked down via adenoviral transfection to assess its role in goat mammary epithelial cells. Results revealed that ELOVL6 overexpression had a weak effect on the expression of genes related to triacylglycerol (TAG) synthesis and desaturation. Overexpression of ELOVL6 increased the content of C18:0 at the expense of C16:0, and increased the elongation index of C16:0. Overexpression of ELOVL6 had no significant effect on the elongation index of C16:1n-7 and the desaturation indices of C16:0 and C18:0. Knockdown of ELOVL6 had a negative effect on mRNA expression of the esterification genes GPAM and diacylglycerolacyltransferase 2 (DGAT2) and TAG concentration; however, it increased the concentration of C16:0 and decreased C18:1n-7 and C18:1n-9 in goat mammary epithelial cells. Accordingly, downregulation of ELOVL6 significantly decreased the elongation indices of C16:0 and C16:1n-7. The lack of change in the desaturation indices of C16:0 and C18:0 upon knockdown of ELOVL6 was consistent with the minor change in SCD1 expression. In conclusion, these are the first results highlighting an important role of ELOVL6 in long-chain fatty elongation and TAG synthesis in ruminant mammary cells.

[Effect of calcium-independent phospholipase A(2) inhibitor in reducing hepatocyte lipoapoptosis and improving insulin resistance]

Objective: To investigate the effect of calcium-independent phospholipase A(2) (iPLA(2)) inhibitor in reducing hepatocyte lipoapoptosis and improving insulin resistance. Methods: A total of 28 male Sprague-Dawley rats were randomly divided into the following three groups: 12 rats in group I (normal control group) were given normal diet for 18 weeks; 8 rats in group II (non-alcoholic fatty liver disease model group) were given high-fat diet for 18 weeks; 8 rats in group III (iPLA(2) inhibitor group) were given high-fat diet for 18 weeks and intraperitoneal injection of the iPLA(2) inhibitor bromoenol lactone 150 μg/kg once every other day since week 15 (14 times of injection in total). All the rats were sacrificed at the same time, and body weight and liver weight were measured. Blood lipids, serum enzymes, fasting blood glucose, fasting insulin, free fatty acid, and serum iPLA(2) concentration were measured in each group, and liver pathological changes were evaluated. The terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was used to measure the level of hepatocyte apoptosis and the apoptotic index was calculated. Quantitative PCR was used to measure the mRNA expression of iPLA(2). The Student-Newman-Keuls test and the chi-square test were used for comparison of parameters between groups I, II, and III. P < 0.05 was considered statistically significant. Results: Compared with group I, group II had significant increases in triglyceride (0.75±0.05 mmol/L vs 1.20±0.13 mmol/L, P < 0.05), cholesterol (1.50±0.12 mmol/L vs 2.94±0.34 mmol/L, P < 0.05), low-density lipoprotein (0.65±0.06 mmol/L vs 1.30±0.16 mmol/L, P < 0.05), free fatty acid (0.58±0.09 mEq/L vs 0.80±0.20 mEq/L, P < 0.05), fasting blood glucose (4.85±0.22 mmol/L vs 6.94±0.65 mmol/L, P < 0.05), and fasting insulin (0.89±0.52 mmol/L vs 1.29±0.52 mmol/L, P < 0.05), and a significant reduction in the insulin sensitivity index (0.52±0.21 vs 0.27±0.11, P < 0.05); group II also had significant inflammation and fatty degeneration shown by liver pathology, and compared with group I, group II had significant increases in apoptotic cells and apoptotic index (0.58%±0.17% vs 39.69%±4.96%, P < 0.05). Compared with group I, group II had significant increases in serum iPLA(2) concentration (2.92±0.08 ng/ml vs 3.28±0.14 ng/ml, P < 0.05) and the mRNA expression of iPLA(2) in the liver (1.07±0.18 vs 7.68±0.49, P < 0.05). Compared with group II, group III had a lower level of hepatocyte apoptosis, a significant reduction in apoptotic index (39.69%±4.96% vs 24.80%±2.53%, P < 0.05), significant reductions in serum iPLA(2) concentration (3.28±0.14 ng/ml vs 2.64±0.24 ng/ml, P < 0.05) and the mRNA expression of iPLA(2) in the liver (7.68±0.49 vs 2.60±0.36, P < 0.05), significant reductions in fasting insulin (1.29±0.52 mmol/L vs 0.80±0.09 mmol/L, P < 0.05) and fasting blood glucose (6.94±0.65 mmol/L vs 5.18±0.35 mmol/L, P < 0.05), and a significant increase in insulin sensitivity index (0.27±0.11 vs 0.45±0.09, P < 0.05). Conclusion: There is a significant increase in the expression of iPLA(2) in rats with non-alcoholic fatty liver disease, and iPLA2 inhibitor can reduce hepatocyte lipoapoptosis and improve insulin resistance.

[Augmenter of liver regeneration promotes the proliferation of HL-7702 cells in carbon tetrachloride-induced acute liver injury via increasing autophagy]

Objective: To investigate the protective effect of augmenter of liver regeneration (ALR) against acute liver injury and related mechanisms. Methods: HL-7702 cells were divided into normal control group, carbon tetrachloride (CCl₄)-induced acute liver injury group, ALR+CCl₄ intervention group, 3-methyladenine (3-MA)+CCl₄ intervention group, and ALR+3-MA+CCl₄ intervention group. The ALR+CCl₄ and ALR+3-MA+CCl₄ intervention groups were transfected with ALR plasmids at 8 hours before CCl₄ treatment. All groups except the normal control group were treated with CCl₄, and 30 minutes later, the 3-MA+CCl₄ and ALR+3-MA+CCl₄ intervention groups were treated with 3-MA. The cells were collected at 24 hours after CCl₄ treatment. The HL-7702 cells and supernatant were collected to measure the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (IU/L). Western blot was used to measure the levels of ALR, cyclin D, cyclin E, proliferating cell nuclear antigen (PCNA), autophagy-related gene 7 (Atg7), and autophagy genes LC3, p62, and Beclin-1. Quantitative real-time PCR was used to measure the mRNA expression of ALR. A one-way analysis of variance was used for comparison of means between any two groups. Results: The ALR+CCl₄ intervention group had significant increases in the protein and mRNA expression of ALR compared with the acute liver injury group (both P < 0.05). The CCl₄-induced acute liver injury group had significant increases in the protein and mRNA expression of ALR compared with the normal control group (both P < 0.05). Compared with the CCl₄-induced acute liver injury group, the ALR+CCl₄ intervention group had significant reductions in ALT (0.73±0.17 IU/L vs 1.43±0.38 IU/L, P < 0.05) and AST (19.85±1.83 IU/L vs 56.73±6.25 IU/L, P < 0.05) in supernatant, significantly increased expression of cyclin D, cyclin E, PCNA, LC3, Atg7, and Beclin-1 in hepatocytes, and significantly reduced expression of p62, which suggested that ALR protected the liver against acute liver injury, promoted the regeneration of hepatocytes, and enhanced the autophagy of hepatocytes. The ALR+3-MA+CCl₄ intervention group had a significant reduction in the expression of regeneration-associated proteins compared with the ALR+CCl₄ intervention group, while there was no significant difference between the ALR+3-MA+CCl₄ intervention group and 3-MA+CCl₄ intervention group, which suggested that after the inhibition of autophagy, there were significant reductions in the regeneration of hepatocytes and liver regeneration promoted by ALR. Conclusion: ALR can promote the regeneration of hepatocytes in liver parenchyma, which is achieved by the regulation of autophagy.

[Role of autophagy in acute liver failure induced by D-galactosamine/lipopolysaccharide in mice]

Objective: To investigate the expression and role of autophagy in the progression of acute liver failure (ALF) using the mouse model of ALF induced by D-galactosamine/LPS (D-GalN/LPS). Methods: The C57BL/6 mice were used, and intraperitoneal injection of D-galactosamine (D-GalN) and lipopolysaccharide (LPS) was performed to establish the mouse model of ALF. The mice were divided into control group and 2-, 4-, and 6-hour D-GalN/LPS-induced ALF model groups. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured to assess liver function, and the pathological changes in liver tissue were observed to evaluate the status of liver injury. Quantitative real-time PCR was used to measure the expression of autophagy-related genes, Western blot was used to measure the expression of autophagy-related proteins in liver tissue, and a fluorescence microscope was used to observe the expression of autophagosome in the progression of liver failure. A one-way ANOVA was used for comparison of means of multiple samples between any two groups (LSD-t test for data with homogeneity of variance and Games-Howell method for data with heterogeneity of variance).P< 0.05 was considered statistically significant. Results: The ALF model groups showed gradual liver impairment over the time of D-GalN/LPS stimulation. There were significant increases in ALT and AST after 4 hours; the pathological injury of liver tissue gradually aggravated over the time of D-GalN/LPS stimulation and fulfilled the criteria for ALF at 6 hours. The mRNA and protein expression of autophagy-related genes (ATG-7, ATG-5, Beclin-1, Lamp-1, and LC3a) increased in the early and medium stages of ALF (2 and 4 hours) and decreased after ALF progressed to liver failure (6 hours). As was observed via the fluorescence microscope, the 4-hour D-GalN/LPS-induced ALF model group showed the highest expression of autophagosome. Conclusion: The expression of autophagy gradually increases in the early and medium stages of ALF and decreases when ALF progresses to liver failure. Therefore, autophagy plays an important role in the pathogenesis of ALF.

[Clinical characteristics of sudden low-tone hearing loss]

Objective:We aimed to investigate the prognosis and clinical characteristics of patients with acute low-tone sensorineural hearing loss(ALHL) and the patients with sudden low-tone loss who were not classified in the audiometric definition ALHL of(non-ALHL).Method:Two hundred and seven patients diagnosed at the university hospital with idiopathic sudden low-tone loss of sensorineural hearing loss including 48 ALHL and 159 non- ALHL from Jan 2010 to Dec 2015.The patients were followed up in the long term with three months to 5 years.The rates of recurrence and/or progression to Ménière's disease for patients with ALHL were compared with those for non-ALHL patients.Result:The recurrence rate was 26.4% for non-ALHL and 16.7% for ALHL.There was statistically significant difference between the two patient groups.In ALHL patients,8.8% patients progressed to Ménière's disease,1.9% was diagnosised with acoustic neuroma and 5.7% with vestibular migraine.In non-ALHL patients,4.2% patients progressed to Ménière's disease.Conclusion:In clinical practice,sudden low-tone loss other than ALHL shows a potential for recurrence and progressed to Ménière's disease.

Liver X receptor α promotes the synthesis of monounsaturated fatty acids in goat mammary epithelial cells via the control of stearoyl-coenzyme A desaturase 1 in an SREBP-1-dependent manner

Stearoyl-coenzyme A desaturase 1 (SCD1) is a pivotal enzyme in the biosynthesis of monounsaturated fatty acids (MUFA). It is tightly regulated by transcription factors that control lipogenesis. In nonruminants, liver X receptor α (LXRα) is a nuclear receptor and transcription factor that acts as a key sensor of cholesterol and lipid homeostasis. However, the mechanism whereby LXRα regulates the expression and transcriptional activity of SCD1 in ruminant mammary cells remains unknown. In this study with goat mammary epithelial cells (GMEC), the LXRα agonist T 4506585 (T09) markedly enhanced the mRNA expression of SCD1 and sterol regulatory element binding factor 1 (SREBF1). The concentrations of C16:1 and C18:1 and their desaturation indices also were increased by LXRα activation. However, knockdown of LXRα did not alter the mRNA expression of SCD1. Although SCD1 was repressed by SREBF1 knockdown, T09 significantly increased SCD1 expression. Further analysis revealed that the SCD1 promoter activity was activated by LXRα overexpression. The goat SCD1 promoter contains 2 LXR response elements (LXRE), 1 sterol response element (SRE), and 1 nuclear factor Y (NF-Y) binding site. Site-directed mutagenesis of LXRE1, LXRE2, or SRE alone did not eliminate the upregulation of SCD1 when LXRα was overexpressed. In contrast, when NF-Y alone or in combination with SRE was mutated simultaneously, the basal transcriptional activity of the SCD1 promoter was markedly decreased and did not respond to LXRα overexpression. Furthermore, when SREBF1 was knocked down, overexpression of LXRα did not affect the promoter activity of SCD1. Together, these data suggest that LXRα regulates the expression of SCD1 through increasing SREBP-1 abundance to promote interaction with SRE and NF-Y binding sites. The present study provides evidence that LXRα is involved in the synthesis of MUFA in the goat mammary gland through an indirect mechanism.

Elevated serum complement C3 levels are related to the development of prediabetes in an adult population: the Tianjin Chronic Low-Grade Systematic Inflammation and Health Cohort Study

AIMS

To investigate whether serum complement C3 is related to the prevalence and incidence of prediabetes in an adult population.

METHODS

A cross-sectional (n = 10 206) and prospective cohort study (n = 3333), with a mean (range; 95% CI) follow-up of 2.63 (1-6; 2.58-2.68) years, was conducted in people recruited from the Health Management Centre of Tianjin Medical University General Hospital in Tianjin, China. Measurement of serum C3 concentration, blood fasting glucose, oral glucose tolerance, HbA1c and other potential confounding factors was performed at baseline and each year during the follow-up. Prediabetes was defined according to the criteria of the American Diabetes Association. Adjusted logistic and Cox proportional hazards regression models were used to assess the relationships between C3 quintiles and prediabetes.

RESULTS

The prevalence and incidence of prediabetes were 38.5% and 119 per 1000 person-years, respectively. In cross-sectional analysis, after adjustment for potential confounders, the odds ratios of prediabetes for increasing quintiles of C3 were 1.00 (reference), 1.32 (95% CI 1.14-1.53), 1.37 (95% CI 1.18-1.59), 1.75 (95% CI 1.51-2.03), 2.25 (95% CI 1.93-2.62; P for trend < 0.0001). In the cohort analysis, the multiple-adjusted hazard ratio of prediabetes in the highest quintile of baseline C3 was 1.43 (95% CI 1.15, 1.78; P for trend < 0.001), when compared with the lowest quintile.

CONCLUSIONS

These findings indicate that elevated serum C3 levels are significantly related to an increased risk of developing prediabetes in an adult population, suggesting that C3 can be used as a biomarker in high-risk individuals to improve primary prevention of prediabetes and diabetes.

Thyroid hormone responsive (THRSP) promotes the synthesis of medium-chain fatty acids in goat mammary epithelial cells

In nonruminants, thyroid hormone responsive (THRSP) is a crucial protein for cellular de novo lipogenesis. However, the role of THRSP in regulating the synthesis of milk fatty acid composition in goat mammary gland remains unknown. In the present study, we compared gene expression of THRSP among different goat tissues. Results revealed that THRSP had the highest expression in subcutaneous fat, and expression was higher during lactation compared with the dry period. Overexpression of THRSP upregulated the expression of fatty acid synthase (FASN), stearoyl-coenzyme A desaturase 1 (SCD1), diacylglycerol acyltransferase 2 (DGAT2), and glycerol-3-phosphate acyltransferase (GPAM) in goat mammary epithelial cells. In contrast, overexpression of THRSP led to downregulation of thrombospondin receptor (CD36) and had no effect on the expression of acetyl-coenzyme A carboxylase α (ACACA) and sterol regulatory element binding transcription factor1 (SREBF1). In addition, overexpressing THRSP in vitro resulted in a significant increase in triacylglycerol (TAG) concentration and the concentrations of C12:0 and C14:0. Taken together, these results highlight an important role of THRSP in regulating lipogenesis in goat mammary epithelial cells.

Association of polymorphism in ICAM-1 (K469E) and cytology parameters in patients' initial blood test with acute ischemic stroke

Acute ischemic stroke (AIS) has become a serious health problem in many countries because of its poor outcome and worsening epidemic trend. Early identification of genetic risk factors and physiological indicators for stroke occurrence may help to reduce the incidence of stroke. Therefore, we conducted a case-control study including 50 AIS patients and 50 healthy individuals from a Chinese population to explore the association between AIS and patient complete blood profiles and the association between AIS and the genetic polymorphism K469E in intercellular adhesion molecule-1 (ICAM-1). Compared to the control group, AIS patients showed a high percentage of mononuclear cells, low platelet count, low ratio of platelet to lymphocyte count, high frequency of the 469K allele, and low frequency of the 469E allele. White blood cell count, percentage of neutrophils, percentage of lymphatic cells, platelet distribution width, mean platelet volume, and platelet hematocrit levels showed no significant differences between the 2 groups and between different genotypes. Our results suggested an association of elevated levels of mononuclear cells and reduced platelet count with higher AIS risk. Our results also supported the hypothesis that the KK genotype at the K469E locus in ICAM-1 is a risk factor for AIS.

Adipocyte differentiation-related protein promotes lipid accumulation in goat mammary epithelial cells

Milk fat originates from the secretion of cytosolic lipid droplets (CLD) synthesized within mammary epithelial cells. Adipocyte differentiation-related protein (ADRP; gene symbol PLIN2) is a CLD-binding protein that is crucial for synthesis of mature CLD. Our hypothesis was that ADRP regulates CLD production and metabolism in goat mammary epithelial cells (GMEC) and thus plays a role in determining milk fat content. To understand the role of ADRP in ruminant milk fat metabolism, ADRP (PLIN2) was overexpressed or knocked down in GMEC using an adenovirus system. Immunocytochemical staining revealed that ADRP localized to the surface of CLD. Supplementation with oleic acid (OA) enhanced its colocalization with CLD surface and enhanced lipid accumulation. Overexpression of ADRP increased lipid accumulation and the concentration of triacylglycerol in GMEC. In contrast, morphological examination revealed that knockdown of ADRP decreased lipid accumulation even when OA was supplemented. This response was confirmed by the reduction in mass of cellular TG when ADRP was knocked down. The fact that knockdown of ADRP did not completely eliminate lipid accumulation at a morphological level in GMEC without OA suggests that some other compensatory factors may also aid in the process of CLD formation. The ADRP reversed the decrease of CLD accumulation induced by adipose triglyceride lipase. This is highly suggestive of ADRP promoting triacylglycerol stability within CLD by preventing access to adipose triglyceride lipase. Collectively, these data provide direct in vitro evidence that ADRP plays a key role in CLD formation and stability in GMEC.

Serum ferritin is elevated in advanced non-small cell lung cancer patients and is associated with efficacy of platinum-based chemotherapy

AIM

The aim of this study was to determine the expression levels of serum ferritin (SF) and investigate the correlation between SF expression levels and clinical characteristics as well as the efficacy to platinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC) patients.

MATERIALS AND METHODS

Electrochemiluminescence method was used to determine the expression levels of SF in the peripheral blood of 46 advanced NSCLC patients and 63 healthy subjects.

RESULTS

The expression levels of SF in healthy subjects were significantly lower than those in patients with advanced NSCLC patients (t = -3.279,P = 0.001). There was a statistically significant difference between SF expression levels and distant metastasis, regional lymph node metastasis, respectively (P < 0.05). However, there was no correlation between SF expression levels and sex, age, eastern cooperative oncology group performance status, smoking history, pathological type, tumor location and tumor-node-metastasis stage (All P > 0.05). The overall response rate to platinum-based chemotherapy was 57.1% (12/21) in normal SF expression levels group, which was significantly higher than that was 28% (7/25) in high SF expression levels group (χ² = 3.998,P = 0.046).

CONCLUSIONS

SF may be a valuable blood marker for predicting the tumor progression and the efficacy of platinum-based therapies for advanced NSCLC patients.

Short communication: Effect of inhibition of fatty acid synthase on triglyceride accumulation and effect on lipid metabolism genes in goat mammary epithelial cells

The role of fatty acid synthase (FASN) on de novo fatty acid synthesis has been well established. In monogastrics, unlike acetyl-coenzyme A carboxylase, FASN is primarily controlled at the transcriptional level. However, no data exist on ruminant mammary cells evaluating effects of FASN knockdown on mRNA expression of lipogenic genes. Inhibition of FASN in mammary cells by C75-mediated interference, a synthetic inhibitor of FASN activity, and short hairpin RNA-mediated interference markedly reduced cellular triglyceride content at least in part by decreasing the expression of genes related to triglyceride synthesis (GPAT, AGPAT6, and DGAT2) and enhancing the expression of lipolysis-related genes (ATGL and HSL). Consistent with the markedly lower expression of genes related to lipid droplet formation and secretion (TIP47, ADFP, BTN1A1, and XDH), cellular lipid droplets also were reduced sharply after incubation with C75 or adenovirus-short-hairpin-RNA. The results underscored the essential role of FASN in the overall process of milk-fat formation in goat mammary epithelial cells.

CD40 mutant expression and its clinical significance to prognosis in gastric cancer patients

Background

We aimed to detect CD40 mutant expression and evaluate its clinical significance in gastric cancer.

Methods

CD40 mutant expression in 78 cases of gastric cancer tissues, 10 cases of normal gastric tissues, and 10 cases of gastric adenoma tissues by immunohistochemical test. Survival analyses were also performed.

Results

The positive CD40 mutant rate in gastric cancer was 55.1% (43/78). No positive CD40 mutant staining was observed in the normal gastric tissue or the gastric adenoma. CD40 mutants expression was significantly correlated with invasive depth, lymph metastasis, and TNM stage (P <0.05). Cases with negative CD40 mutant expression had a significantly longer median survival time than those with positive CD40 mutant expression (40 vs. 14 months, P <0.05). A lower death risk in negative CD40 mutant cases was observed comparing with positive CD40 mutant cases.

Conclusions

Positive CD40 mutant expression suggests a poorer prognosis of gastric cancer cases.

Acute bleeding in the head and neck: angiographic findings and endovascular management

BACKGROUND AND PURPOSE

Life-threatening bleeding in the head and neck requires urgent management. This study evaluated the angiographic findings related to head and neck bleeding and presents endovascular management techniques.

MATERIAL AND METHODS

Sixty-one consecutive patients who presented with acute bleeding in the head and neck areas and subsequently underwent endovascular therapy between January 2002 and October 2012 were included in our study. We evaluated the angiographic findings, techniques, and results of endovascular management.

RESULTS

Contrast leakage (n = 10), pseudoaneurysm (n = 20), or both (n = 10) were the most common life-threatening angiographic findings (66%) and were the foci of immediate embolization or endoluminal vessel reconstruction. Seventeen patients (28%) had hypervascular staining of the tumor or mucosa, and 4 patients (6%) did not have any abnormal findings. The acute bleeding was successfully controlled by endovascular management according to the bleeding foci. Carotid arterial lesions, so-called "carotid blowout," required reconstructive or deconstructive therapy. Bleeding of the external carotid artery required specific branch embolization by a combination of various embolic materials. No procedure-related complications occurred except in 1 patient who experienced acute infarction caused by thromboemboli from the covered stent. Seventeen patients (28%) were retreated due to rebleeding after the mean 20-month follow-up.

CONCLUSIONS

Contrast leakage or a pseudoaneurysm or both seen on angiography are active bleeding foci and targets for therapy in patients with acute bleeding in the head and neck area. Despite different bleeding-control strategies according to vessel involvement, endovascular treatment is safe and effective for controlling hemorrhage.

Characteristic analysis of α-fetoprotein-producing gastric carcinoma in China

α-Fetoprotein-producing gastric cancer (AFPGC) is a rare type of gastric cancer. The largest population of patients with AFPGC is found in China. In the present study, a total of 4,779 GC patients, including 317 AFPGC patients, from 11 clinical studies in China with a general AFPGC/GC ratio of 6.63% were summarized and analyzed. On the basis of analysis of the clinical data, the patients with AFPGC had larger tumor size, weaker cell differentiation, worse histopathological types, deeper serosal infiltration, more lymph node and liver metastases, poorer stages, shorter survival time and more positive expression of vascular endothelial growth factors than the patients without AFPGC. Our observation is consistent with previous results reported in studies of AFPGC. Overall, AFPGC is a subtype of GC with a poor prognosis.

Effect of lysed Enterococcus faecalis FK-23 on allergen-induced immune responses and intestinal microflora in antibiotic-treated weaning mice

BACKGROUND

Recent epidemiological studies have indicated that early life receipt of antibiotics may be associated with an increased risk of developing atopic disorder. Lysed Enterococcus faecalis FK-23 (LFK), a probiotic product of E faecalis, has been shown to have inhibitory effects on allergen-induced immune responses in mice.

OBJECTIVE

The purpose of this study was to evaluate the effects of LFK on immune responses and intestinal microflora in antibiotic-treated, and allergen-sensitized weaning mice.

METHODS

Three-week-old BALB/c mice were sensitized with cedar pollen allergen to establish the experimental model. The allergen-induced peritoneal accumulation of eosinophils, serum levels of total and allergen-specific immunoglobulin (Ig) E and IgG2a, and the intestinal bacterial flora were determined in the control, antibiotic, LFK and antibiotic-LFK groups (n = 7 in all groups). Orally administered erythromycin, one kind of macrolide antibiotic, was used for the experiments.

RESULTS

There was no significant difference in the allergen-induced peritoneal accumulation of eosinophils and serum specific IgE and IgG2a levels in erythromycin-treated mice compared to a control group. However, the ratio of serum total IgE to IgG2a levels was significantly increased in erythromycin-treated mice relative to that found either in LFK-treated mice or in erythromycin-treated mice with LFK supplementation. The total aerobes, total anaerobes and Enterococcus species of intestinal microflora were not significantly different among all groups. Lactobacillus species were distinctly eliminated in the mice exposed to erythromycin on day 7 and totally recovered in erythromycin-treated mice with LFK intervention on day 28, but could not be recovered in the erythromycin-treated mice without LFK intervention.

CONCLUSIONS

Our results suggest that LFK may improve the intestinal ecosystem disturbed by antibiotic use, and thereby prevent subsequent development of atopy. However, whether different antibiotics have different effects on immune responses needs to be addressed further.

[Analysis of the spectrum of damage effects of low energy N+ ions on cytosine aqueous solution]

Low energy N+ ions were produced by gas arc-discharge and the ions were accelerated into cytosine (C) aqueous solution. Changes in UV and infrared spectra of C after this kind of ions' action were investigated. UV spectra showed that absorption at 259 nm gradually decreased and lambda max of C solution moved toward the longer wavelength with the time. Thus, it was deduced that C was damaged and some fragments including -NO2 and -NH2 groups might have been produced. Judging from the IR spectra, the disappearance of the peak of 3,005 cm-1 confirmed the formation of -NO2 groups. All these results revealed that N+ ions caused various damages on C molecules and many new substances were formed. These new substances were not synthesized only by combination of the damage fragments in the solution, but also by "deposition" of N+ from outside.

Change of spontaneous reaction of glue and lipiodol mixture during embolization after the addition of tungsten powder: in vitro study

BACKGROUND AND PURPOSE

We have noted that glue-Lipiodol mixtures harden prematurely in the catheter during embolization of brain arteriovenous malformations. However, we observed that hardening of this embolic material does not occur when tungsten powder is added to the glue mixture. In order to clarify the effect of tungsten powder on the glue mixture, we evaluated the reaction time and hardness of the glue mixture in vitro after the addition of tungsten powder. We also measured the pH of the tungsten solution.

METHODS

Six lots of Lipiodol and three lots of Histoacryl Blue were mixed in a 5-cc bottle with a 50% to 25% glue concentration (glue:Lipiodol = 1:1 to 1:3) and this mixture was observed for 2 weeks. The hardness of the polymerized glue mixture was categorized as liquid, gel, semi-solid, or solid. Various series of experiments were performed after the addition of tungsten powder (0.2 g) and blood (a drop) into the glue mixture. We also separately mixed tungsten and tantalum powder in tubes, each with 5 mL of distilled water, and then measured the pH of these three times. The mixed amounts of tungsten and tantalum ranged from 0.1 to 0.5 mg.

RESULTS

In a 50% glue concentration, the glue mixture turned into a solid cast within 48 hours. In a 25% concentration, the glue mixture turned into gel within 24 hours. The casts became solid in the 50% and gelled in the 25% concentration, and solid or gel in 28% and 33% glue mixture concentrations. The addition of tungsten powder to 50% and 25% glue mixture concentrations caused the glue mixtures to remain in a liquid state for 2 weeks regardless of the Lipiodol products used. Measurement of acidity achieved using a pH meter in 5 cc of distilled water with tungsten powder (0.1 to 0.5 g) revealed a change of pH from 3.5 to 2.6 according to the amount of tungsten added. Tantalum revealed weak acidity, with a pH range from 6.4 to 5.7. The addition of blood immediately caused the mixture to become solid in 50% and semi-solid in 25% glue concentrations.

CONCLUSION

The reaction time of the glue mixture differed according to the lot number of the Lipiodol. The addition of tungsten powder appeared to prevent premature cast formation by decreasing the pH with a mechanism similar to that of adding acetic acid.

Preoperative transarterial embolization of spinal tumor: embolization techniques and results

BACKGROUND AND PURPOSE

The techniques of preoperative embolization of hypervascular spinal tumors, which has been known to be helpful for completing tumor resection, have not been described in detail. The purpose of this study was to analyze the technique and to evaluate the safety and value of preoperative transarterial embolization of hypervascular spinal tumors.

METHODS

Eighteen patients with hypervascular spinal tumors underwent transarterial embolization before surgery. The lesions were located between the upper cervical and lower lumbar spine: C1-T1 (n = 6), T5-L3 (n = 11), and L5 (n = 1); they arose intradurally in six patients and extradurally in 12. Thirty-one arteries were embolized with polyvinyl alcohol (PVA) particles (150-500 microm), and, in 18 of these, pieces of gelatin sponge were added for proximal pedicular embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery.

RESULTS

Tumor embolization was total in eight patients, nearly total in seven, subtotal in one, and partial in two. There were no symptomatic complications associated with embolization. Tumors were totally removed in 17 patients and nearly totally removed in one. The average estimated blood loss during surgery was 1100 mL (range, 200-6000 mL) for all 18 patients, and 1540 mL in patients with extradural tumors.

CONCLUSION

Preoperative embolization of hypervascular spinal tumors is safe and effective. It can make complete resection of a tumor possible and can make an unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.