[The diagnostic value of genetic testing in familial hypercholesterolemia in patients with premature myocardial infarction]

Objective: To evaluate the diagnostic value of gene testing in familial hypercholesterolemia (FH) in patients with premature myocardial infarction(PMI). Methods: This study was a single center cross-sectional study. A retrospective analysis was made on PMI patients who visited the People's Hospital of Peking University from May 1, 2015 to March 31, 2017. Clinical data of patients was collected and gene testing of FH related genes low density lipoprotein receptor (LDLR), proprotein convertase subtilisin/kexin type 9 (PCSK9), apolipoprotein B(APOB) and low density lipoprotein receptor adaptor protein 1(LDLRAP1) was carried out. Clinical diagnosis of FH patients was performed using Simon Broome criteria, DLCN criteria, and FH Chinese expert consensus. Results: There were 188 males (83.6%) among 225 PMI patients, and the age of the first myocardial infarction was (46.6±7.2) years old. Ten patients carried FH pathogenic or possibly pathogenic mutations (4.4%). Compared with Simon Broome standard, DLCN standard and FH Chinese expert consensus, gene testing increased the diagnostic rate of FH by 53.3%, 33.3% and 42.1% respectively. Conclusion: Gene testing is helpful to improve the diagnosis of FH, and it is important to start the standard treatment of FH as early as possible in patients with premature myocardial infarction.

Clinical Characteristics, Diagnosis, and Therapeutics of COVID-19: A Review

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that suddenly emerged at the end of December 2019 and caused coronavirus disease 2019 (COVID-19) continues to afflict humanity, not only seriously affecting healthcare systems but also leading to global social and economic imbalances. As of August 2022, there were approximately 580 million confirmed cases of COVID-19 and approximately 6.4 million confirmed deaths due to this disease. The data are sufficient to highlight the seriousness of SARS-CoV-2 infection. Although most patients with COVID-19 present primarily with respiratory symptoms, an increasing number of extrapulmonary systemic symptoms and manifestations have been associated with COVID-19. Since the outbreak of COVID-19, much has been learned about the disease and its causative agent. Therefore, great effort has been aimed at developing treatments and drug interventions to treat and reduce the incidence of COVID-19. In this narrative review, we provide a brief overview of the epidemiology, mechanisms, clinical manifestations, diagnosis, and therapeutics of COVID-19.

Differential diagnosis of lymphoma with 18F-FDG PET/CT in patients with fever of unknown origin accompanied by lymphadenopathy

PURPOSE

To investigate the value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the differential diagnosis of lymphoma in patients with fever of unknown origin (FUO) accompanied by lymphadenopathy and to develop a simple scoring system to distinguish lymphoma from other etiologies.

METHODS

A prospective study was conducted on patients with classic FUO accompanied by lymphadenopathy. After standard diagnostic procedures, including PET/CT scan and lymph-node biopsy, 163 patients were enrolled and divided into lymphoma and benign groups according to the etiology. The diagnostic utility of PET/CT imaging was evaluated, and beneficial parameters that could improve diagnostic effectiveness were identified.

RESULTS

The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT in diagnosing lymphoma in patients with FUO accompanied by lymphadenopathy were 81.0, 47.6, 59.3, and 72.7%, respectively. The lymphoma prediction model combining high SUVmax of the "hottest" lesion, high SUVmax of the retroperitoneal lymph nodes, old age, low platelet count, and low ESR had an area under the curve of 0.93 (0.89-0.97), a sensitivity of 84.8%, a specificity of 92.9%, a PPV of 91.8%, and an NPV of 86.7%. There was a lower probability of lymphoma for patients with a score < 4 points.

CONCLUSIONS

PET/CT scans show moderate sensitivity and low specificity in diagnosing lymphoma in patients with FUO accompanied by lymphadenopathy. The scoring system based on PET/CT and clinical parameters performs well in differentiating lymphoma and benign causes and can be used as a reliable noninvasive tool.

REGISTRATION NUMBER

This study on FUO was registered on http://www.

CLINICALTRIALS

gov on January 14, 2014, with registration number NCT02035670.

[Rosuvastatin acts on the lymphatic system to improve atherosclerosis]

Objective: To investigate whether rosuvastatin acts on lymphatic system and influences lymphatic system-mediated reverse cholesterol transport to play an anti-atherosclerosis role. Methods: Forty-eight apolipoprotein E^-/- mice fed a high fat diet were used to construct the atherosclerosis model. They were randomly divided into 4 groups with 12 rats in each group. They were treated with rosuvastatin, vascular endothelial growth factor-C (VEGF-C) and rosuvastatin+VEGF-C inhibitors as experimental group, and no intervention measures were given in control group. After 8 weeks, aortic plaque area, high density lipoprotein cholesterol (HDL-C) content in lymph fluid, the function of popliteal lymphatic drainage of peripheral Evans blue, and the ability of lymphatic system to transport peripheral cell membrane red fluorescent probes to label high-density lipoprotein (HDL) were detected. Subsequently, the effects of rosuvastatin on proliferation, migration and tubular function of lymphoendothelial cells and the expression of scavenger receptor class B type 1 (SR-B1) on lymphoendothelial cells at different concentrations were detected. Results: Compared with the control group, Rosuvastatin and VEGF-C could reduce the area of aortic atherosclerotic plaque (P<0.05). In addition to rosuvastatin plus VEGF-C inhibitor, the intra-aortic plaque area increased (P<0.05). Compared with the control group, Rosuvastatin could increase the content of HDL-C in lymphatic fluid (P<0.05), enhance the drainage function of lymphatic vessels, and enhance the capacity of HDL in the transport tissue fluid of lymphatic system. Compared with the control group, VEGF-C increased the content of HDL-C in mouse lymph fluid (P<0.01), enhanced the drainage function of popliteal lymphatic canal, and enhanced the ability of lymphatic system to transport HDL. With the addition of VEGF-C inhibitor on the basis of rosuvastatin, the content of HDL-C in lymph fluid was reduced, the drainage of popliteal lymphatic canal was interrupted, and the ability of lymphatic system to transport HDL was reduced. Western blotting showed that rosuvastatin increased the protein expression of SR-B1. Conclusion: Rosuvastatin can promote the proliferation, migration and tube formation of lymphatic endothelial cells. At the same time, SR-B1 expression on lymphatic endothelial cells is promoted, thus enhancing the lymphatic system mediated cholesterol reversal transport and playing the role of anti-atherosclerosis.

Diagnostic models for fever of unknown origin based on 18F-FDG PET/CT: a prospective study in China

Background

This study aims to analyze the 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) characteristics of different causes of fever of unknown origin (FUO) and identify independent predictors to develop a suitable diagnostic model for distinguishing between these causes. A total of 524 patients with classical FUO who underwent standard diagnostic procedures and PET/CT were prospectively studied. The diagnostic performance of PET/CT imaging was analyzed, and relevant clinical parameters that could improve diagnostic efficacy were identified. The model was established using the data of 369 patients and the other 155 patients comprised the validation cohort for verifying the diagnostic performance of the model.

Results

The metabolic characteristics of the “hottest” lesion, the spleen, bone marrow, and lymph nodes varied for various causes. PET/CT combined with clinical parameters achieved better discrimination in the differential diagnosis of FUO. The etiological diagnostic models included the following factors: multisite metabolic characteristics, blood cell counts, inflammatory indicators (erythrocyte sedimentation rate, C-reactive protein, serum ferritin, and lactate dehydrogenase), immunological indicators (interferon gamma release assay, antinuclear antibody, and anti-neutrophil cytoplasm antibody), specific signs (weight loss, rash, and splenomegaly), and age. In the testing cohort, the AUCs of the infection prediction model, the malignancy diagnostic model, and the noninfectious inflammatory disease prediction model were 0.89 (95% CI 0.86–0.92), 0.94 (95% CI 0.92–0.97), and 0.95 (95% CI 0.93–0.97), respectively. The corresponding AUCs for the validation cohort were 0.88 (95% CI 0.82–0.93), 0.93 (95% CI 0.89–0.98), and 0.95 (95% CI 0.92–0.99), respectively.

Conclusions

18F-FDG PET/CT has a certain level of sensitivity and accuracy in diagnosing FUO, which can be further improved by combining it with clinical parameters. Diagnostic models based on PET/CT show excellent performance and can be used as reliable tools to discriminate the cause of FUO.

Trial registration This study (a two-step method apparently improved the physicians’ level of diagnosis decision-making for adult patients with FUO) was registered on the website http://www.clinical-trials.gov on January 14, 2014, with registration number NCT02035670.

Measurement of the Cosmic Ray Helium Energy Spectrum from 70 GeV to 80 TeV with the DAMPE Space Mission

The measurement of the energy spectrum of cosmic ray helium nuclei from 70 GeV to 80 TeV using 4.5 years of data recorded by the Dark Matter Particle Explorer (DAMPE) is reported in this work. A hardening of the spectrum is observed at an energy of about 1.3 TeV, similar to previous observations. In addition, a spectral softening at about 34 TeV is revealed for the first time with large statistics and well controlled systematic uncertainties, with an overall significance of 4.3σ. The DAMPE spectral measurements of both cosmic protons and helium nuclei suggest a particle charge dependent softening energy, although with current uncertainties a dependence on the number of nucleons cannot be ruled out.

Metal Modulation: An Easy-to-Implement Tactic for Tuning Lanthanide Phototheranostics

Phototheranostics constitute an emerging cancer treatment wherein the core diagnostic and therapeutic functions are integrated into a single photosensitizer (PS). Achieving the full potential of this modality requires being able to tune the photosensitizing properties of the PS in question. Structural modification of the organic framework represents a time-honored strategy for tuning the photophysical features of a given PS system. Here we report an easy-to-implement metal selection approach that allows for fine-tuning of excited-state energy dissipation and phototheranostics functions as exemplified by a set of lanthanide (Ln = Gd, Yb, Er) carbazole-containing porphyrinoid complexes. Femto- and nanosecond time-resolved spectroscopic studies, in conjunction with density functional theory calculations, revealed that the energy dissipation pathways for this set of PSs are highly dependent on the energy gap between the lowest triplet excited state of the ligand and the excited states of the coordinated Ln ions. The Yb complex displayed a balance of deactivation mechanisms that made it attractive as a potential combined photoacoustic imaging and photothermal/photodynamic therapy agent. It was encapsulated into mesoporous silica nanoparticles (MSN) to provide a biocompatible construct, YbL@MSN, which displays a high photothermal conversion efficiency (η = 45%) and a decent singlet oxygen quantum yield (Φ_Δ = 31%). Mouse model studies revealed that YbL@MSN allows for both photoacoustic imaging and synergistic photothermal- and photodynamic-therapy-based tumor reduction in vivo. Our results lead us to suggest that metal selection represents a promising approach to fine-tuning the excited state properties and functional features of phototheranostics.

CAPRL Scoring System for Prediction of 30-day Mortality in 949 Patients with Coronavirus Disease 2019 in Wuhan, China: A Retrospective, Observational Study

Background

Coronavirus disease 2019 (COVID-19) is a serious and even lethal respiratory illness. The mortality of critically ill patients with COVID-19, especially short term mortality, is considerable. It is crucial and urgent to develop risk models that can predict the mortality risks of patients with COVID-19 at an early stage, which is helpful to guide clinicians in making appropriate decisions and optimizing the allocation of hospital resoureces.

Methods

In this retrospective observational study, we enrolled 949 adult patients with laboratory-confirmed COVID-19 admitted to Tongji Hospital in Wuhan between January 28 and February 12, 2020. Demographic, clinical and laboratory data were collected and analyzed. A multivariable Cox proportional hazard regression analysis was performed to calculate hazard ratios and 95% confidence interval for assessing the risk factors for 30-day mortality.

Results

The 30-day mortality was 11.8% (112 of 949 patients). Forty-nine point nine percent (474) patients had one or more comorbidities, with hypertension being the most common (359 [37.8%] patients), followed by diabetes (169 [17.8%] patients) and coronary heart disease (89 [9.4%] patients). Age above 50 years, respiratory rate above 30 beats per minute, white blood cell count of more than10 × 109/L, neutrophil count of more than 7 × 109/L, lymphocyte count of less than 0.8 × 109/L, platelet count of less than 100 × 109/L, lactate dehydrogenase of more than 400 U/L and high-sensitivity C-reactive protein of more than 50 mg/L were independent risk factors associated with 30-day mortality in patients with COVID-19. A predictive CAPRL score was proposed integrating independent risk factors. The 30-day mortality were 0% (0 of 156), 1.8% (8 of 434), 12.9% (26 of 201), 43.0% (55 of 128), and 76.7% (23 of 30) for patients with 0, 1, 2, 3, ≥4 points, respectively.

Conclusions

We designed an easy-to-use clinically predictive tool for assessing 30-day mortality risk of COVID-19. It can accurately stratify hospitalized patients with COVID-19 into relevant risk categories and could provide guidance to make further clinical decisions.

Synthesis, characterization and preliminary biological evaluation of chrysin amino acid derivatives that induce apoptosis and EGFR downregulation

Chrysin amino acid derivatives were synthesized to evaluate for their antiproliferative activities. Among them, N-(7-((5-hydroxy-4-oxo-2-phenyl-4H-chromen-7-yl)oxy)valeryl)-L-leucine (8c) displayed the most remarkable inhibitory activities against MCF-7 cells with IC₅₀ values of 16.6 μM. Preliminary mechanistic studies showed that 8c could inhibit the colony formation and migration of MCF-7 cells. Flow cytometry analysis demonstrated that 8c mediated cell apoptosis and the prolongation of cell cycle progression in G1/S-phase against MCF-7 cells. Besides, 8c displayed the moderate inhibition against EGFR. Western blot assay suggested that 8c significantly inhibited EGFR phosphorylation. Molecular docking showed that 8c can bind the EGFR kinase well.

Yuan-Hu Zhi Tong Prescription Mitigates Tau Pathology and Alleviates Memory Deficiency in the Preclinical Models of Alzheimer's Disease

Alzheimer's disease (AD) is characterized by memory dysfunction, Aβ plaques together with phosphorylated tau-associated neurofibrillary tangles. Unfortunately, the present existing drugs for AD only offer mild symptomatic cure and have more side effects. As such, developments of effective, nontoxic drugs are immediately required for AD therapy. Present study demonstrates a novel role of Chinese medicine prescription Yuan-Hu Zhi Tong (YZT) in treating AD, and it has substantiated the in vivo effectiveness of YZT in two different transgenic mice models of AD, namely P301S tau and 3XTg-AD mice. Oral treatment of YZT significantly ameliorates motor dysfunction as well as promotes the clearance of aggregated tau in P301S tau mice. YZT improves the cognitive function and reduces the insoluble tau aggregates in 3XTg-AD mice model. Furthermore, YZT decreases the insoluble AT8 positive neuron load in both P301S tau and 3XTg-AD mice. Using microarray and the "Connectivity Map" analysis, we determined the YZT-induced changes in expression of signaling molecules and revealed the potential mechanism of action of YZT. YZT might regulate ubiquitin proteasomal system for the degradation of tau aggregates. The research results show that YZT is a potential drug candidate for the therapy of tau pathogenesis and memory decline in AD.

Plasma metabolomic and lipidomic alterations associated with COVID-19

The pandemic of the coronavirus disease 2019 (COVID-19) has become a global public health crisis. The symptoms of COVID-19 range from mild to severe, but the physiological changes associated with COVID-19 are barely understood. In this study, we performed targeted metabolomic and lipidomic analyses of plasma from a cohort of patients with COVID-19 who had experienced different symptoms. We found that metabolite and lipid alterations exhibit apparent correlation with the course of disease in these patients, indicating that the development of COVID-19 affected their whole-body metabolism. In particular, malic acid of the TCA cycle and carbamoyl phosphate of the urea cycle result in altered energy metabolism and hepatic dysfunction, respectively. It should be noted that carbamoyl phosphate is profoundly down-regulated in patients who died compared with patients with mild symptoms. And, more importantly, guanosine monophosphate (GMP), which is mediated not only by GMP synthase but also by CD39 and CD73, is significantly changed between healthy subjects and patients with COVID-19, as well as between the mild and fatal cases. In addition, dyslipidemia was observed in patients with COVID-19. Overall, the disturbed metabolic patterns have been found to align with the progress and severity of COVID-19. This work provides valuable knowledge about plasma biomarkers associated with COVID-19 and potential therapeutic targets, as well as an important resource for further studies of the pathogenesis of COVID-19.

Design, synthesis, and preliminary biological evaluation of chrysin amino acid derivatives that induce apoptosis and suppress cell migration

Amino acid derivatives containing chrysin were synthesized for evaluating their anticancer effects. Among them, compound N-(7-((5-hydroxy-4-oxo-2-phenyl-4H-chromen-7-yl)oxy)heptanoyl)-L-isoleucine (6e) displayed the most potent antiproliferative activity against MGC-803 cells with IC₅₀ value of 20.0 μM. Preliminary mechanistic studies showed that compound 6e could inhibit the colony formation and migration of MGC-803 cells. Flow cytometry analysis demonstrated that compound 6e mediated cell apoptosis of MGC-803 cells and arrested cell cycle in G2/M-phase. Moreover, 6e treatment in MGC-803 cells downregulated anti-apoptotic protein Bcl-2 and upregulated pro-apoptotic gene Bax in a concentration-dependent manner. Our studies suggest that compound 6e may sever as an effective chemotherapeutic candidate. [Formula: see text].

Combined clinical parameters improve the diagnostic efficacy of 18F-FDG PET/CT in patients with fever of unknown origin (FUO) and inflammation of unknown origin (IUO): A prospective study in China

OBJECTIVES

To improve the diagnostic efficacy of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for Chinese patients with fever of unknown origin (FUO) and inflammation of unknown origin (IUO), with combined clinical parameters.

MATERIALS AND METHODS

FUO/IUO patients who underwent a standard diagnostic work-up and ¹⁸F-FDG PET/CT scanning were enrolled and divided into a local uptake lesion subgroup and a non-specific abnormal uptake subgroup. Beneficial clinical parameters for improving the diagnostic efficacy of PET/CT were identified.

RESULTS

From January 2014 to January 2019, 253 FUO/IUO patients were studied. In total, 147 patients had local uptake lesions and 106 patients had non-specific abnormal uptake. In the local uptake lesion group, the positioning accuracy of PET/CT was 37.2% in grades 1 and 2, and 66.3% in grades 3 and 4. With the following combination of clinical parameters, the positioning accuracy increased to 75.0% and 90.0%, respectively: time from admission to performing PET/CT scanning <6.5 days and C-reactive protein level >95 mg/l. In the non-specific abnormal uptake group, the combination of sex (male), bicytopenia, and lactic dehydrogenase improved the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignancy from 64.3%, 69%, 60%, and 72.7%, respectively, to 83.3%, 81%, 81.4%, and 82.9%, respectively. With the combination of sex (male), white blood count, serum ferritin level, and hepatosplenomegaly, the infection prediction model had a sensitivity, specificity, PPV, and NPV of 78%, 76.2%, 76.6%, and 77.6%, respectively.

CONCLUSIONS

Combined clinical parameters improved the localization diagnostic value of ¹⁸F-FDG PET/CT in the local uptake lesion subgroup and the etiological diagnostic value in the non-specific abnormal uptake subgroup.

[Nutritional support therapy during treatment of chronic critical illness]

Chronic critical illness (CCI) refers to a group of critically ill patients who survive the acute phase of intensive care, but with persistent organ dysfunction, thus entering a chronic period of continuous dependence on life support system, and still need to stay in intensive care unit (ICU) for a long time. Persistent inflammatory response-immunosuppression-catabolic syndrome (PICS) is the main pathophysiological feature of CCI. Three factors interact to form a vicious circle, leading to poor prognosis. Nutritional support therapy is a key link in the comprehensive treatment of CCI. Enteral nutrition (EN) should be started as soon as possible if conditions permit. If EN can not be implemented, temporary or transitional parenteral nutrition (PN) should be used, and EN should be added gradually in time. At the same time, the amount of PN should be gradually reduced. When EN meets more than 60% of patients' energy and protein requirements, PN can be considered to be discontinued. The main strategies and functions of CCI nutritional support therapy are as follows: strengthening high protein supply to correct negative nitrogen balance and inhibit catabolism, selecting branched chain amino acids (BCAA) to promote anabolism, using immunomodulators (arginine, ω3 polyunsaturated fatty acids) to improve immune suppression and inflammatory response, supplementing micronutrients (vitamins and trace elements) to counteract the decrease in intake and the increase in consumption, and adding probiotics to maintain the intestinal microecological balance, and so on. Reasonable nutritional support therapy not only improve malnutrition of CCI patients, but also help to reduce complications, thus speeding up rehabilitation, improving prognosis, shortening ICU hospitalization time, and even reducing mortality.

A Diagnostic Tool for Identification of Etiologies of Fever of Unknown Origin in Adult Patients

The diagnosis and treatment of fever of unknown origin (FUO) are huge challenges to clinicians. Separating the etiologies of FUO into infectious and non-infectious disease is conducive to clinical physicians not only on making decisions rapidly concerning the prescription of suitable antibiotics but also on further analysis of the final diagnosis. In order to develop and validate a diagnostic tool to efficiently distinguish the etiologies of adult FUO patients as infectious or non-infectious disease, FUO patients from the departments of infectious disease and internal medicine in three Chinese tertiary hospitals were enrolled retrospectively and prospectively. By using polynomial logistic regression analysis, the diagnostic formula and the associated scoring system were developed. The variables included in this diagnostic formula were from clinical evaluations and common laboratory examinations. The proposed tool could discriminate infectious and non-infectious causes of FUO with an area under receiver operating characteristic curve (AUC) of 0.83, sensitivity of 0.80 and specificity of 0.75. This diagnosis tool could predict the infectious and non-infectious causes of FUO in the validation cohort with an AUC of 0.79, sensitivity of 0.79 and specificity of 0.70. The results suggested that this diagnostic tool could be a reliable tool to discriminate between infectious and non-infectious causes of FUO.

Effects of storage culture media, temperature and duration on human adipose‑derived stem cell viability for clinical use

Adipose-derived stem cells (ADSCs) are mesenchymal stem cells that are often used in regenerative medicine. Maintaining ADSC viability is important, as this optimizes the curative effects of cell therapy. However, the optimal conditions for cell viability preservation remain unknown. The present study aimed to acquire a better protocol for ADSC storage by comparing the effects of various solutions and temperatures for ADSC preservation, in order to suggest the most effective methods of short-term ADSC preservation for clinical use. ADSCs from passage 2 were suspended in solutions comprising 0.9% NaCl, 10% human serum (HS) or 10% platelet-rich plasma (PRP). Suspended cells were maintained at 4°C or room temperature (~26°C) for 2, 4 and 6 h. The differentiation capacity, apoptosis and proliferation of ADSCs were determined by oil red O/alizarin red S staining, flow cytometry, and a cell counting kit-8 cell proliferation assay, respectively. In addition, reverse transcription-quantitative polymerase chain reaction and western blot analysis was performed. The results revealed that proliferation of ADSCs decreased with time. The optimal time for ADSC use was ~2 h, and 4 h was determined to be the latest time that ADSCs should be used. The 10% HS group had the highest survival rate, followed by the 10% PRP group; these two groups had higher survival rates than the 0.9% NaCl group (P<0.05). HS and PRP at 4°C enhanced the ADSC proliferation rate (P<0.05), although the difference between these two groups was insignificant (P>0.05). In conclusion, the optimal time to use ADSCs was <2 h, and should not exceed 4 h. It was recommended that, for the transportation and short-term storage of ADSCs during clinical use, they should be stored with 10% HS at 4°C to maintain ADSC viability. In addition, this was a cost-effective and safe method.

Applied value of monitoring serum hepcidin in differential diagnosis of infection versus tumor fevers

The applied value of serum hepcidin in differential diagnosis of infection fevers versus tumor fevers was explored. A total of 432 fever patients were selected according to the domestic fever of unknown origin (FUO) diagnostic criteria from our hospital between June 2010 and November 2013. Venous blood samples were taken on the day 1, 5, 10 after admission. The infection group (98 cases) and the tumor group (50 cases) were set up based on the clinical and laboratory findings. ELISA was used to determine the serum hepcidin and IL-6 levels. SPSS 13.0 was used for statistical analysis. Hepcidin showed obvious descending trend on the 10th day in both the bacterial infection group (66 cases) and the virus infection group (32 cases), and the descending trend was similar to that of inflammatory indexes such as procalcitonin (PCT), hypersensitive C-reactive protein (h-CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), and ferritin. Serum hepcidin showed no obvious differences in the tumor group on the day 1, 5, 10 after admission. In the infection groups, serum hepcidin was positively correlated with IL-6 (r=0.687, P=0.000) and CRP (r=0.487, P=0.026), but had a poor correlation with blood sedimentation, ferritin, PCT and WBC (P>0.05). Monitoring dynamic changes of hepcidin and related inflammatory factors in patients with fever is expected to be used for clinical identification of infection fever and tumor fever.

Baseline HBV load increases the risk of anti-tuberculous drug-induced hepatitis flares in patients with tuberculosis

Hepatitis associated anti-tuberculous treatment (HATT) has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus (HBV). Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of >3, 5, and 10 times the upper limit of normal (ULN) were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin (TBil) levels that were more than 10 times the ULN (>171 μmol/L) with or without decreased (<40%) prothrombin activity (PTA) were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8% (n=52) and 25.3% (n=22), respectively. The following variables were correlated with the severity of hepatotoxicity: albumin (ALB) levels, PTA, platelet counts (PLT), and the use of antiretroviral therapies (P<0.05). Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio (OR) of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.

Targeted exome sequencing reveals novel USH2A mutations in Chinese patients with simplex Usher syndrome

BACKGROUND

Usher syndrome (USH) is an autosomal recessive disorder characterized by hearing impairment and vision dysfunction due to retinitis pigmentosa. Phenotypic and genetic heterogeneities of this disease make it impractical to obtain a genetic diagnosis by conventional Sanger sequencing.

METHODS

In this study, we applied a next-generation sequencing approach to detect genetic abnormalities in patients with USH. Two unrelated Chinese families were recruited, consisting of two USH afflicted patients and four unaffected relatives. We selected 199 genes related to inherited retinal diseases as targets for deep exome sequencing. Through systematic data analysis using an established bioinformatics pipeline, all variants that passed filter criteria were validated by Sanger sequencing and co-segregation analysis.

RESULTS

A homozygous frameshift mutation (c.4382delA, p.T1462Lfs*2) was revealed in exon20 of gene USH2A in the F1 family. Two compound heterozygous mutations, IVS47 + 1G > A and c.13156A > T (p.I4386F), located in intron 48 and exon 63 respectively, of USH2A, were identified as causative mutations for the F2 family. Of note, the missense mutation c.13156A > T has not been reported so far.

CONCLUSION

In conclusion, targeted exome sequencing precisely and rapidly identified the genetic defects in two Chinese USH families and this technique can be applied as a routine examination for these disorders with significant clinical and genetic heterogeneity.

siRNA-mediated gene silencing of MexB from the MexA-MexB-OprM efflux pump in Pseudomonas aeruginosa

To gain insights into the effect of MexB gene under the short interfering RNA (siRNA), we synthesized 21 bp siRNA duplexes against the MexB gene. RT-PCR was performed to determine whether the siRNA inhibited the expression of MexB mRNA. Changes in antibiotic susceptibility in response to siRNA were measured by the E-test method. The efficacy of siRNAs was determined in a murine model of chronic P. aeruginosa lung infection. MexB-siRNAs inhibited both mRNA expression and the activity of P. aeruginosain vitro. In vivo, siRNA was effective in reducing the bacterial load in the model of chronic lung infection and the P. aeruginosa-induced pathological changes. MexB-siRNA treatment enhanced the production of inflammatory cytokines in the early infection stage (P ＜ 0.05). Our results suggest that targeting of MexB with siRNA appears to be a novel strategy for treating P. aeruginosa infections. [BMB Reports 2014; 47(4): 203-208]

[microRNA-126 delivered by microparticles mediates intercellular signal transmission]

OBJECTIVE

To investigate the role of microRNAs (miRNAs) in mediating intercellular signaling.

METHODS

Microparticles (MP) from HUVEC and 293T were isolated by sequential centrifugation. THP-1 was co-cultured with microparticles. And then the migration of THP-1 was measured by transwell. real-time PCR and Western blotting were used to study the related mechanisms.

RESULTS

Compared with the microparticles from 293T, MP from HUVEC could promote the migration of monocytes (P<0.05) and upregulate the expression of CXCR4 mRNA and protein (P<0.05). MiRNA-126 deficient MP could downregulate the migration of monocytes (P<0.05) and the expression of CXCR4 mRNA and protein (P<0.05) compared with miRNA-126 abundant MP.

CONCLUSION

Microparticles from HUVEC could promote the migration of monocytes. As carriers, microparticles could mediate intercellular signaling.

Catalysis of μ-oxo-bis[porphyriniron(III)] for toluene oxidation with molecular oxygen

Toluene oxidation with molecular oxygen as the sole oxidant, and μ-oxo-bis[tetraphenylporphinatoiron(III)] as the catalyst, are reported. Under the reaction conditions of 438 K and 0.8 MPa, the molar total yields for the products benzaldehyde and benzyl alcohol and the turnover number of the catalyst are 4.35% and 21,830 (based on the metal ion), respectively. Compared with the reaction catalyzed by the corresponding monometalloporphyrin TPPFe III Cl , the total yields of the oxidation products and the catalyst turnover number by the dimeric iron porphyrin were almost twice those by the former. A possible reaction mechanism of the toluene oxidation by μ-oxo-bis[tetraphenylporphinatoiron(III)] is proposed.

Synthesis, characterization and fluorescence properties study of meso-tetrakis(1-arylpyrazole-4-yl)porphyrins

Five new meso-tetrakis(1-arylpyrazol-4-yl)porphyrins were synthesized to investigate their fluorescence properties. Preparation of these porphyrins was carried out by cyclization of tetramethoxypropane with substituted phenylhydrazine, followed by formylation to give the corresponding aldehydes, which reacted with pyrrole under the Adler reaction condition to get the target porphyrins (1a-1e). All the porphyrins were characterized by 1 H NMR, elemental analysis, UV-vis spectra and mass spectra. Red fluorescence emission of these porphyrins was observed in fluorescence spectra. Compared with meso-tetraphenylporphyrin (TPPH2), these meso-tetrakis(1-arylpyrazol-4-yl) porphyrins had a significant red shift in UV-vis and fluorescence spectra with increased fluorescence quantum yields.

Aerobic liquid-phase oxidation of p-xylene over metalloporphyrins

The five metalloporphyrins ( T (p- Cl ) PPM , M = Fe , Mn , Co , Cu , Zn ) with different metal nuclei were synthesized, and their catalytic aerobic liquid-phase oxidations of p-xylene into p-toluic acid, p-toluic aldehyde and terephthalic acid using a low concentration of acetic acid as solvent without any halide additives, were studied. The p-xylene conversions and the oxidation product distributions were found to be affected by the structures and concentration of the metalloporphyrins as well as the reaction parameters such as time, temperature and air pressure. The formation of some intermediate oxidation products in the oxidation process also influenced the reaction conversions and the product distribution. Among the metalloporphyrins used, tetrakis(p-chlorophenylporphinato)manganese chloride ( T (p- Cl ) PPMnCl ) was the most efficient catalyst for the oxidation of p-xylene. Under the conditions of 180 °C and 2.0 MPa, 44% conversion of p-xylene and 85% selectivity of p-toluic acid were obtained. Based on the results obtained, a preliminary mechanism of the oxidation of p-xylene over metalloporphyrins was proposed.

Substituted tetrapyrazolylporphyrins: application in organic light-emitting diodes

Six substituted tetrapyrazolylporphyrins ( TAPyPH 2), meso-tetrakis(1-phenylpyrazol-4-yl)porphyrin ( TPPyPH 2), meso-tetrakis[1-(p-tolyl)pyrazol-4-yl] porphyrin ((p- CH 3) TPPyPH 2), meso-tetrakis[1-(p-methoxyphenyl)pyrazol-4-yl]porphyrin ((p- CH 3 O ) TPPyPH 2), meso-tetrakis[1-(p-chlorophenyl) pyrazol-4-yl]porphyrin ((p- Cl ) TPPyPH 2), meso-tetrakis[1-(p-bromophenyl)pyrazol-4-yl]porphyrin ((p- Br ) TPPyPH 2) and meso-tetrakis[1-(m-tolyl)pyrazol-4-yl]porphyrin ((m- CH 3) TPPyPH 2), were synthesized by the condensation of pyrrole with the corresponding substituted formylpyrazole and used as the doping materials in the Organic Light-Emitting Diodes (OLEDs) with hole-transport materials of N , N '-diphenyl- N , N '-bis (4-methylphenyl)-[1,1'-biphenyl]-4,4'-diamine (TPD) within a tris(8-hydroxyquinoline) aluminum ( Alq 3) host layer. Both the electroluminescence properties of these OLEDs and effects of the peripheral substituents of the tetrapyrazolylporphyrins on EL properties of the OLEDs were studied. The tests found that the OLEDs using substituted tetrapyrazolylporphyrins ( TAPyPH 2) as the dopants had the saturated red emission at a concentration of 1.5 wt.%. The electron-donating groups of tetrapyrazolylporphyrins (for example, p- CH 3 and p- CH 3 O ) increased the luminance of OLEDs, while the electron-drawing groups (for example, p- Cl and p- Br ) decreased the luminance. The OLEDs using meso-tetrakis(1-phenylpyrazol-4-yl)porphyrin ( TPPyPH 2) as a dopant showed saturated red emission at 680 nm (CIE coordinates of x = 0.65, y = 0.31) with a luminance of 305 cd/m2 at a driving voltage of 25 V at concentration of 1.5 wt.%. Compared with OLEDs doped by the free-base tetraphenylporphyrin (TPPH2), the OLEDs doped by the tetrapyrazolylporphyrins had better luminance and higher emission efficiency. An explanation for these results was given based on the molecular structure and spectral properties of the porphyrin compounds.

Bullet migration from the knee to the heart after a gunshot injury: a case report

Migration of a bullet to a distant part of the body after a gunshot is rarely observed in the clinical setting, and migration to the heart is even rarer. There are usually no clear symptoms or signs from migration of a bullet. The bullet can be easily missed and sometimes identified in a review examination. A case of bullet migration to the heart 2 months after a gunshot to the left knee was reported.

Estimating mercury emissions from a zinc smelter in relation to China's mercury control policies

Mercury concentrations of flue gas at inlet/outlet of the flue gas cleaning, electrostatic demister, reclaiming tower, acid plant, and mercury contents in zinc concentrate and by-products were measured in a hydrometallurgical zinc smelter. The removal efficiency of flue gas cleaning, electrostatic demister, mercury reclaiming and acid plant was about 17.4%, 30.3%, 87.9% and 97.4% respectively. Flue gas cleaning and electrostatic demister captured 11.7% and 25.3% of the mercury in the zinc concentrate, respectively. The mercury reclaiming tower captured 58.3% of the mercury in the zinc concentrate. About 4.2% of the mercury in the zinc concentrate was captured by the acid plant. Consequently, only 0.8% of the mercury in the zinc concentrate was emitted to the atmosphere. The atmospheric mercury emission factor was 0.5 g t(-1) of zinc produced for the tested smelter, indicating that this process offers the potential to effectively reduce mercury emissions from zinc smelting.

[Effects of human bone marrow mesenchymal stem cells on cytokines secretion from allogeneic dendritic cell activated cytokine-induced killer cells]

AIM

to study the effect of human bone marrow derived mesenchymal stem cells (hMSCs) on cytokines secretion (IFN-γ, TNF-α, IL-10, IL-6, IL-4 and IL-2) of allogeneic DC-CIK cells (in co-culture of CIK cells with DC), which investigate the mechanism of immunoregulation induced by hMSCs.

METHODS

the hMSCs from bone marrow were isolated, expanded and identified by cell morphology, differentiation into neuron-like cells with NSE, fat-like cells with red-oil stain, and expression of CD29, CD44. The DC and CIK cells from peripheral blood were isolated, expanded and identified by CD1α, HLA-DR or CD3(+);CD56(+);. The hMSCs were co-cultured with DC-CIK cells according to ratio 1:10. The expression of the six cytokines in supernatant was evaluated by flow cytometry after 4 days of DC-activated CIK cells in co-culture with hMSCs.

RESULTS

the hMSCs displayed a fibroblast-like morphology and the positive cells of CD29 and CD44 were 96.6%, 94.6%, which have the capacity of differentiation into neuron-like cells with expressed NSE as well as fat-like cells with red-oil stain positive. The expression of CD1α, HLA-DR in DC was (91.9 ± 10.04)% and (88.8 ± 8.92)%. The CD3(+);CD56(+); double positive cells in DC-CIK cells was (29.23 ± 12.23)% compared to CIK cells with (15.98 ± 2.49)%. The cytokines secretion of DC-CIK cells in co-culture with hMSCs was IFN-γ (135.05 ± 48.19) ng/L; TNF-α (11.33 ± 1.42) ng/L; IL-10 (10.15 ± 2.25) ng/L; IL-6 (494.63 ± 235.222) ng/L; IL-4 (7.07 ± 2.30) ng/L and IL-2 (1074.6 3 ± 303.74) ng/L. In control group (DC-CIK cells) the secretion of IFN-γ, TNF-α, IL-10, IL-6, IL-4 and IL-2 was (717.6 ± 248.15) ng/L; (17.78 ± 7.52) ng/L; (29.95 ± 12.76) ng/L; (8.03 ± 0.21) ng/L, (9.08 ± 3.07) ng/L as well as IL-2 1 250 ng/L.

CONCLUSION

the secretion of IFN-γ and IL-10 were down-regulated. It probably implied that hMSCs had the effect of immunoregulation on DC-CIK cells.

Effect and mechanism of andrographolide on the recovery of Pseudomonas aeruginosa susceptibility to several antibiotics

Effectiveness and mechanism of action of andrographolide on the recovery of Pseudomonas aeruginosa susceptibility to antibiotics was investigated. In the presence of andrographolide, the Mueller-Hinton broth dilution method measured minimal inhibitory concentrations (MIC) of ceftazidine, cefpirome, chloramphenicol, L-ofloxacin, kanamycin, imipenem and meropenem. Real-time fluorescence quantitative polymerase chain reaction was used to determine mexB mRNA expressions in P. aeruginosa PAO1 strain and MexAB-OprM overexpressing strain. Relative mexB mRNA expression was detected in both strains incubated for 3 and 9 h. When andrographolide-treated groups were compared with controls, the MIC of ceftazidine, cefpirome, L-ofloxacin and meropenem for both strains decreased, and the relative mexB mRNA expression was significantly lower, although between andrographolide groups there were no significant differences. Compared with the inactivated quorum-sensing system, relative amounts of mexB mRNA in the PAO1 strain and MexAB-OprM overexpressing strain in the activated quorum-sensing system increased 10- and 30-fold, respectively. Andrographolide recovered P. aeruginosa susceptibility to antibiotics and reduced the MexAB-OprM efflux pump expression level.

Role of andrographolide in the permeability of intestinal tract of cirrhosis rats and its clinical significance

AIM: To detect the impact of andrographolide on the permeability of intestinal tract of cirrhosis rats by high performance liquid chromatography and to probe its clinical significance.

METHODS: The discharge rate of mannitol (M) and lactulose (L) in cirrhosis rats was detected by high performance liquid chromatography (HPLC) and compared with the standard curve.

RESULTS: The lactulose/mannitol (L/M) discharge rate in cirrhosis rats was significantly higher than that in normal rats (0.036 ± 0.012 vs 0.026 ± 0.009, P < 0.05) and significantly lower in the andrographolide and norfloxacin intervention group than that in the control group (0.022 ± 0.010, 0.022 ± 0.007 vs 0.036 ± 0.012, P < 0.05).

CONCLUSION: The permeability of intestinal tract of cirrhosis rats is significantly higher than that of normal rats and significantly lower in the andrographitis and norfloxacin intervention group than that in the control group.

Relationship between variations in peripheral T-lymphocyte subsets and viral replication levels in Chinese chronic HBV carriers with normal liver function tests

AIM: To investigate the correlations between the variations in peripheral T-cell subpopulations and HBV replication levels in Chinese chronic HBV carriers (HBVc) with normal liver function tests.

METHODS: The relative percentage of T-cell subpopulations in peripheral blood was measured by flow cytometry in 216 HBVc and 100 normal controls. HBV markers were detected by ELISA. Serum viral load was measured by real-time RT-PCR. The relationship between HBV replication level and variations in peripheral T-cell subpopulations was analyzed.

RESULTS: HBVc had a decreased number of CD3⁺ and CD4⁺ cells, a decreased CD4⁺/CD8⁺ ratio, and an increased number of CD8⁺ cells compared with normal controls (P < 0.01). The levels of CD3⁺ and CD4⁺ cells and the CD4⁺/CD8⁺ ratio decreased 20.4%, 17.8% and 35.7%, respectively (P < 0.01), and there was a 21.9% increase in the level of CD8+ cells in HBV DNA (+) HBVc as compared with HBV DNA(-) HBVc (P < 0.01). The level of HBeAg(+) HBVc decreased 19.5%, 14.0% and 28.6% in CD3⁺ and CD4⁺ cells and CD4⁺/CD8⁺ ratio, respectively (P < 0.01), and over 19.6% in CD8⁺ cells, compared with HBeAg (-) HBVc (P < 0.01). There were negative correlations between the levels of CD3⁺ and CD4⁺ cells and the CD4⁺/CD8⁺ ratio and viral load (r = -0.67, -0.54, -0.67, P < 0.01), and a positive correlation between the level of CD8+ cells and viral load (r = 0.61, P < 0.01). Compared with the HBV DNA (+) and HBV DNA(-) groups, the number of CD3⁺ and CD4⁺ cells and the CD4⁺/CD8⁺ ratio were significant lower, and the number of CD8+ cells was significant higher in the HBV DNA (+)/HBeAg (+) group. A similar pattern was seen in HBVc with maternal HBV-infection (MH) status compared with non-MH HBVc (P < 0.01). The percentages of MH HBVc that were HBV DNA (+) and HBeAg (+), and the number with a viral load > 1 × 10¹⁰ copies/L, were significantly higher than those of non-MH HBVc fulfilling these criteria (82.2% vs 34.5%), OR = 8.65, 95% CI: [4.45, 17.33]; (75.2% vs 28.7%), OR = 7.44, 95% CI: [3.91, 14.56]; (65.1% vs 10.3%), OR = 15.94, 95% CI: [7.13, 39.66]. Among the HBVc with MH, the number of CD3⁺ and CD4⁺ cells and the CD4⁺/CD8⁺ ratio were obviously lower, while the number of CD8+ cells was significant higher in HBV DNA(+) and HBeAg (+) patients than in HBV DNA(-) and HBeAg (-) patients, respectively (P < 0.05, P < 0.01). A similar pattern was also seen in non-MH HBVc.

CONCLUSION: Our results suggest that disorders of cellular immunity in Chinese HBVc with normal liver function tests could be caused by HBV infection, and are significantly associated with viral replication level, including viral load and HBeAg expression.

TMVA, a snake C-type lectin-like protein from Trimeresurus mucrosquamatus venom, activates platelet via GPIb

TMVA is a C-type lectin-like protein with potent platelet activating activity from Trimeresurus mucrosquamatus venom. In the absence of von Willebrand factor (vWF), TMVA dose-dependently induced aggregation of washed platelets. Anti-GP Ib monoclonal antibodies (mAbs), HIP1, specifically inhibited TMVA-induced aggregation in a dose-dependent manner. The aggregation was also inhibited by mAb P2 (an anti-GP IIb mAb). Flow cytometric analysis revealed that FITC-TMVA bound to human formalin-fixed platelets in a saturable manner, and its binding was specifically blocked by HIP1 in a dose-dependent manner. Flow cytometric analysis showed that TMVA did not bind to platelet GPIX, GPIIb, GPIIIa, GPIa, GPIIa and GPIV. Moreover, the platelet aggregation induced by TMVA was partially inhibited when platelet was pretreated with mocarhagin, a snake venom protease that specifically cleaves human GPIb. These results suggest that TMVA is a strong platelet agonist via GPIb and it might have multiple functional binding-sites on GPIb molecule or on other unknown receptor.

Depression and posttraumatic stress disorder at three months after mild to moderate traumatic brain injury

To investigate the frequency and risk factors of major depressive disorder (MDD) after mild to moderate traumatic brain injury (TBI), 69 TBI and 52 general trauma (GT) patients were prospectively recruited and studied at 3-months postinjury. There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups. Therefore, a composite MDD group (TBI and GT patients) was compared to patients who were nondepressed. Female gender was related to MDD, but no other risk factors were identified. MDD was associated with disability (Glasgow Outcome Scale, Community Integration Questionnaire) and cognitive impairment. MDD was comorbid with posttraumatic stress disorder. Implications for postacute management of mild to moderate TBI are discussed.

Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities

Previous studies of postconcussional disorder (PCD) have utilized a dimensional approach (i.e., number and/or severity ratings of symptoms) to study postconcussional symptoms. This study used a syndromal approach (modified form of the DSM-IV criteria) for investigating risk factors for developing PCD, 3-months postinjury. The head trauma requirement was waived in order to determine specificity of symptoms to traumatic brain injury. Preliminary results from this ongoing study indicated significant risk factors including female gender, poor social support, and elevated self-reported depressive symptoms at 1-month postinjury. Comorbidities included concurrent diagnosis of major depressive disorder and/or posttraumatic stress disorder. Hispanics were significantly less likely to develop PCD than other racial/ethnic groups. PCD resulted more frequently from motor vehicle accidents and assaults. Screening tests for PCD risk factors/comorbidities performed shortly after injury (i.e., during routine follow-up clinic appointments) coupled with appropriate referrals for psychoeducational interventions and support groups may avoid prolonged loss of productivity and poor perceived quality of life in these patients.

[Comparative study of microvascular anastomotic clips and suture in small vessel anastomosis]

OBJECTIVE

To explore an ideal way of small vessel anastomosis for microsurgery.

METHODS

Anastomosis of both carotid arteries were performed in 20 rabbits. One side of the arteries were anastomosed with anastomotic clips, the other side of the arteries, as comparison, were anastomosed with suture. The vessels were harvested at first and 14th day after operation and were evaluated using operating microscope, light microscope and electronic microscope.

RESULTS

The average anastomotic time for suture was about 15 minutes, while for the clips was 2 to 5 minutes. There were no difference in patency between the two techniques. Endothelialization at the anastomotic sites were both completed 14 days postoperatively. However, for the anastomotic clips, there were no endothelia damage and foreign bodies formation inside the vessels.

CONCLUSION

This experiment has confirmed that the anastomotic clip's procedure provides a very safe and easy way to perform anastomosis and reduce the incidence of thromboses.

[Reconstruction of digital avulsion with pre-fabricated subdermal vascular network skin flap by ultrasonic liposuction]

OBJECTIVE

To investigate the clinical application of subdermal vascular network skin flap pre-fabricated by ultrasonic liposuction in reconstruction of digital avulsion.

METHODS

Forty-seven injured fingers of 23 cases were treated from June 1997 to February 2000. Conventional abdominal skin flap was elevated, according to the size of digital avulsion, and subcutaneous fat was removed with scissors. Ultrasonic liposuction technology was adopted, in order to minimize the injury of subdermal vascular vessels, to remove the fat particles close to the vascular network. Finally, the pre-fabricated skin flap was used to repair the digital avulsion. The vascular pedicle was severed in 5 to 7 days after operation. The range of skin flap was 4 cm x 3 cm to 8 cm x 7 cm, and the ratio of length and width was (2 to 3) to 1.

RESULTS

All the skin flaps were survived. Twenty-one patients were available for postoperative follow-up for 6 to 24 months. The motion of interphalangeal joint achieved functional recovery, and the sensation of pain, temperature and taction recovered well.

CONCLUSION

Ultrasonic liposuction does not obviously injure the subdermal vascular network skin flap, it is a simple and safe method for treatment of digital avulsion.

Volume of focal brain lesions and hippocampal formation in relation to memory function after closed head injury in children

OBJECTIVES

(1) A study of verbal learning and memory in children who had sustained a closed head injury (CHI) at least 3 months earlier. (2) To relate memory function to focal brain lesion and hippocampal formation volumes using morphometric analysis of MRI.

METHODS

A group of 245 children who had been admitted to hospital for CHI graded by the Glasgow coma scale (GCS), including 161 patients with severe and 84 with mild CHI completed the California verbal learning test (CVLT) and underwent MRI which was analysed for focal brain lesion volume independently of memory test data. Brain MRI with 1.5 mm coronal slices obtained in subsets of 25 patients with severe and 25 patients with mild CHI were analysed for hippocampal formation volume. Interoperator reliability in morphometry was satisfactory.

RESULTS

Severity of CHI and age at study significantly affected memory performance. Regression analysis showed that bifrontal, left frontal, and right frontal lesion volumes incremented prediction of various learning and memory indices after entering the GCS score and age into the model. Extrafrontal lesion volume did not contribute to predicting memory performance.

CONCLUSIONS

Prefrontal lesions contribute to residual impairment of learning and memory after severe CHI in children. Although effects of CHI on hippocampal formation volume might be difficult to demonstrate in non-fatal paediatric CHI, further investigation using functional brain imaging could potentially demonstrate hippocampal dysfunction.

Increased norepinephrine levels during catheterization in patients with spinal cord injury

The hypothesis for this study was that catecholamine levels increase during urinary catheterization in human patients with spinal cord injury. Catecholamine levels, blood pressure, and pulse were measured prospectively in 40 subjects at baseline and during urinary catheterization. Results showed a significant increase in norepinephrine levels from baseline 245 +/- 240 pg (standard deviation (SD)) to 314 +/- 311 pg (SD) during catheterization (P = 0.018, Wilcoxon's). Results also showed a nonsignificant increase in epinephrine levels from baseline (56 +/- 70 pg, SD) to catheterization (84 +/- 125 pg, SD; P = 0.35, Wilcoxon's). Systolic blood pressure increased from 114 to 124 mm Hg (P = 0.004, paired t test). Diastolic blood pressure increased from 75 to 78 mm Hg (P = 0.11, paired t test). There was no significant change in diastolic blood pressure or pulse (P = 0.11 and P = 0.29, respectively, paired t test). In conclusion, norepinephrine levels increased during catheterization in patients with spinal cord injury. Knowledge of catecholamine levels in this process may assist in determining both pathophysiology and potential pharmacologic treatment options in future studies.

Cultural differences in Canadian-Chinese nursing

The Schools of Nursing of Tianjin Medical College and the University of Ottawa have been partners in a Canadian-Chinese linkage project funded by the Canadian International Development Agency (CIDA) and the Chinese Government since 1989, at teh instigation of Canadian faculty member Nancy Johnson who saw the need for academic support for the Chinese nursing community.

[Evaluation of anastomotic effect with esophagogastrostomy covered by tongue-like sero-muscular flap of gastric wall in 1515 cases]

Esophagogastrostomy covered by tongue-like sero-muscular flap of gastric wall has already been performed in 1515 cases with esophageal cancer of middle or lower third segment over the last three years. All cases were of squamous cell carcinoma. The same anastomotic procedure was done in all cases by authors in different hospitals. In this series the operative mortality was 0.07%, there were 5 anastomotic leaks (0.33%), and no anastomotic stricture and reflux esophagitis happened within 6 months to 3 years after surgery. The operative procedure is described again in detail. The authors believe that this new anastomotic procedure is satisfactory and prospectively beneficial for improving the therapeutic effect and patients' living quality after operation.

[Antiviral activity of mangiferin against herpes simplex virus type 2 in vitro]

The effect of mangiferin, a tetrahydroxy pyrrolidone saponin extracted from the leaves of mango (Mangifera indica), against herpes simplex virus type 2 (HSV-2) in vitro was studied. The 50% effective concentration (EC50) of it against HSV-2 plaque formation in HeLa cells was 111.7 micrograms.ml-1, and the concentrations of 33 and 80 micrograms.ml-1 reduced the virus replicative yields by 90% (EC90) and 99% (EC99), respectively. The therapeutic index (IC50/EC50) was 8.1. Mangiferin did not directly inactivate HSV-2. The results of the drug addition and removal tests suggest that mangiferin inhibits the late event in HSV-2 replication.

[Microcirculation in unphysiological flaps at early stage after operation: an experimental study]

Microcirculation and blood perfusion in unphysiological flaps were observed with rabbit ear microcirculation chamber. The microcirculation of the venous flap in two days after operation was reestablished mainly by diversion of blood flow through the "to and fro" movement of venous blood. Arteriovenous anastomoses were gradually opened, resulting in the microcirculation to restore normal perfusion, venous blood through the anastomoses into arteriole then to capillaries. The microcirculation of arterialized venous flaps was almost the same as that of the venous flaps. In two days after operation, the diversion of blood flow perfused the capillaries under high pressure, so that the flow velocity and rate were much faster and larger than those of the venous flaps. The microcirculation of venouslized arterial flap, nourished by venous blood through the arterial system, was the same as that of the physiological flap. But the capillaries were perfused venous blood flow, and the blood flow velocity and rate were much slower and smaller than those of the physiological flap.

[Effects of CCK-8 of hypothalamus on antral motility in rats]

Cholecystokinin-octapeptide (CCK-8) of 10 ng were injected into lateral hypothalamus (LH) and ventromedial hypothalamus (VMH) in conscious rats, both of which brought about inhibition of antral motility recorded by a strain gauge, the actions were partly antagonised by bilateral vagotomy, but blocked by intravenous infusion of atropine or regitine. It is suggested that both vagus and sympathetic nerves be involved in mediation of function of central CCK-8. In addition, the unit spontaneous discharges of neurons in vagal nuclei were attenuated while CCK-8 injected into LH. On the contrary, the antral motility was stimulated markedly by injection CCK-8-antiserum into LH, indicating that the endogenous CCK-8 in this area exercises a continuous restraint on antral motility in the basal state. CCK-8 cells both in LH and VMH were visualized by PAP method. It may be reasonable to refer this as the histological basis of the identical function on antral motility exercised by CCK-8 both in LH and VMH.

[Clinical observation of cryotherapy in 242 cases of ocular and facial neoplasms]

242 patients of ocular and facial hemangioma, nevi, papilloma, etc. were treated with liquid nitrogen cryotherapy which satisfactorily removed the neoplasms in 97.2% of the cases, leaving essentially no scars, and the rest (2.8%) were improved. Pathological examinations confirmed that the neoplasms had been necrotized. There were no relapses in 97.7% of the cases after a follow-up of over 5 years. The author's experience was summarized in 9 points for good results of the treatment.