Multidimensional Refinement Graph Convolutional Network With Robust Decouple Loss for Fine-Grained Skeleton-Based Action Recognition

Graph convolutional networks (GCNs) have been widely used in skeleton-based action recognition. However, existing approaches are limited in fine-grained action recognition due to the similarity of interclass data. Moreover, the noisy data from pose extraction increase the challenge of fine-grained recognition. In this work, we propose a flexible attention block called channel-variable spatial-temporal attention (CVSTA) to enhance the discriminative power of spatial-temporal joints and obtain a more compact intraclass feature distribution. Based on CVSTA, we construct a multidimensional refinement GCN (MDR-GCN) that can improve the discrimination among channel-, joint-, and frame-level features for fine-grained actions. Furthermore, we propose a robust decouple loss (RDL) that significantly boosts the effect of the CVSTA and reduces the impact of noise. The proposed method combining MDR-GCN with RDL outperforms the known state-of-the-art skeleton-based approaches on fine-grained datasets, FineGym99 and FSD-10, and also on the coarse NTU-RGB + D 120 dataset and NTU-RGB + D X-view version. Our code is publicly available at https://github.com/dingyn-Reno/MDR-GCN.

[Survey on monkeypox knowledge awareness, risk perception and vaccination intention in men who have sex with men in five cities in northeast China]

Objective: To understand the monkeypox knowledge awareness, risk perception and vaccination intention in men who have sex with men (MSM) in five cities in northeast China. Methods: A cross-sectional study was conducted by using electronic questionnaire in MSM selected by convenience sampling in five cities in northeast China (Shenyang, Panjin, Changchun, Harbin and Jiamusi) from June 28 to July 8, 2023 by local centers for disease control and prevention and MSM communities. The sample size was estimated to be 220. Information about their demographics, monkeypox-related knowledge awareness, perceived concern about epidemic risk perception, and monkeypox vaccination intention were collected. Logistic regression model was used to analyze related factors for MSM's monkeypox vaccination intention. Results: In 355 MSM, 63.9% (227/355) had monkeypox vaccination intentions, and 55.5% (197/355) had high awareness of monkeypox related knowledge with a mean knowledge awareness score of 3.7±1.5. MSM with education level of high-school and above (aOR=1.93, 95%CI:1.01-3.69), higher knowledge awareness score (aOR=1.19, 95%CI:1.02-1.40) and higher risk perception of monkeypox infection (aOR=1.82, 95%CI:1.15-2.88), were more willing to receive monkeypox vaccination. The main reasons for willingness to receive monkeypox vaccine were preventing monkeypox (86.3%, 196/227) and worrying about appearance being affected (62.1%, 141/227). The main reasons for unwillingness for the vaccination included concerns about vaccine safety (53.1%, 68/128), clinical progression of AIDS being affected (46.1%, 59/128) and efficacy of antiretroviral therapy being affected (44.5%, 57/128). Conclusions: The levels of knowledge awareness and vaccine intentions still need to be improved among MSM in five cities of northeast China. It is necessary to improve the awareness of monkeypox and intention of monkeypox vaccination, promote protected sex behavior and self-assessment of infection risk, reduce vaccine hesitancy and increase monkeypox vaccination intention in MSM in 5 cities in northeast China.

[The characteristics and citation analysis of the publications in the National Medical Journal of China from 2017 to 2019]

Objective: To analyze the characteristics and citation of National Medical Journal of China (NMJC) from 2017 to 2019, and provide reference for the development of the journal. Methods: All the literature published in NMJC during the period 2017 to 2019 was selected as the research objects, and the citation frequency data in Chinese core periodicals of science and technology from January 2018 to December 2021 were obtained through Institute of Scientific and Technical Information of China. The main indicators included the citation rate of published articles, average citation frequency of articles, citation status of individual papers, high citation authors and their affiliations from 2017 to 2019. Results: A total of 2 694 articles were published in 21 columns of NMJC from 2017 to 2019. The total number of published pages was 11 689, and the average number of articles was 4.34 pages. The total number of cited papers was 1 849, accounting for 68.63%. Among them, 845 papers were not cited, accounting for 31.37%. The total citation times was 6 578, with an average citation of 2.44 times. The highest citation frequency of a single paper was 217 times. A total of 54.27% articles obtained fund support, and the cited rate (72.78%) was slightly higher than that of articles without fund support (63.72%). Standard and specification articles were cited 1 817 times, with a citation rate of 96.67%, and 66 articles were cited more than 10 times. The columns with more than 30 articles but all cited less than 1 time included case report and difficult case analysis. The first author was from 31 provinces (autonomous regions, municipalities directly under the Central Government) in China. There were 21 corresponding authors whose papers have been cited more than 30 times, and 18 of them were from major hospitals and science academies in Beijing. Conclusions: NMJC has a wide coverage of contributions and strong academic influence during the period 2017 to 2019. The cited frequency of standard and specification articles is high, while case report and difficult case analysis evaluation column articles have very low cited frequencies. Therefore, NMJC should further adjust column setting, improve the academic quality, reduce the number of zero cited papers, and thus enhance the influence of the magazine.

[Clinical phenotype and genetic analysis of patients with left ventricular noncompaction caused by the biallelic mutation of MYBPC3 and MYH7]

Objective: To explore the relationship between pathogenic gene, mutation and phenotype of left ventricular noncompaction (LVNC) patients and their family members. Methods: The subjects were the proband with LVNC and her family members. The medical history including electrocardiogram, echocardiography and cardiac magnetic resonance examination of the proband and family members were collected. Whole exome sequencing of the proband was performed, bioinformatics analysis focused on the genes related to hereditary cardiomyopathy. Candidate pathogenic sites were validated by Sanger sequencing. The clinical interpretation of sequence variants were classified according to American College of Medical Genetics and Genomics (ACMG) guidelines. Results: The proband carried a heterozygous variation of the MYBPC3 gene c.C2827T and the MYH7 gene c.G2221C. The proband's sister carried heterozygous variation of MYBPC3 gene c.C2827T. According to the ACMG guidelines, the variant was determined to be pathogenic. Conclusion: The missense variant of MYBPC3 gene c.C2827T and MYH7 gene c.G2221C are identified from the proband with LVNC and her family member, which provides a genetic basis for clinical diagnosis and genetic counseling of the patients and the family members with LVNC.

[Clinical features and related factors of invasive pulmonary aspergillosis in patients with acute exacerbation of chronic obstructive pulmonary disease]

Objective: To study the clinical features and related factors of invasive pulmonary aspergillosis (IPA) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: This retrospective study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with IPA were included as case group, AECOPD patients without IPA were randomly selected as control group from the same hospitals and same hospitalization period as the patients with IPA using the random function in the software of Microsoft Excel 2003, at a ratio of 2∶1. The clinical characteristics, treatment and outcome were compared between the two groups. Binary logistic regression model was used to analyze the factors associated with IPA in AECOPD patients. Results: A total of 14 007 inpatients with AECOPD were included in this study, and 300 patients were confirmed to have IPA, with an incidence rate of 2.14%. According to the above matching method, 600 AECOPD patients without aspergillus infection were enrolled as the control group. The age of the case group and the control group were (72.5±9.7) and (73.5±10.3) years old, with 78.0%(n=234) male and 76.8%(n=461) male, respectively. There were no significant differences in age and gender composition between the two groups (all P>0.05). The prognosis of case group was significantly worse than that of the control group, with longer hospital stay [M(Q₁,Q₃)], [14 (10-20) d vs 11 (8-15) d, P<0.001], higher ICU admission rate [16.3% (49 case) vs 10.0% (60 case), P=0.006], higher in-hospital mortality [4.0% (12 cases) vs 1.3% (8 cases), P=0.011], and higher hospitalization costs (28 000 ¥ vs 13 700 ¥, P<0.001). The smoking index of the case group and proportions of patients with diabetes mellitus, chronic pulmonary heart disease in the case group were significantly higher than those in control group (all P<0.05). In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, hemoptysis and fever in the case group were higher than those in the control group, the serum albumin was significantly lower than that in the control group, and the proportions of patients with bronchiectasis and pulmonary bullae on imaging were significantly higher than those in the control group (all P<0.05). Diabetes (OR=1.559, 95%CI: 1.084-2.243), chronic pulmonary heart disease (OR=1.476, 95%CI: 1.075-2.028), bronchiectasis (OR=1.506, 95%CI: 1.092-2.078), pulmonary bullae (OR=1.988, 95%CI: 1.475-2.678) and serum albumin<35 g/L (OR=1.786, 95%CI: 1.325-2.406) were the related factors of IPA in patients with AECOPD. Conclusions: The incidence of IPA in AECOPD patients is relatively high and the prognosis of these patients is worse. Diabetes, chronic pulmonary heart disease, bronchiectasis, pulmonary bulla, hypoproteinemia are the related factors of IPA in patients with AECOPD.

[Research progress on the role of adipose-derived stem cell exosomes in skin scar formation]

The adipose-derived stem cell exosomes are subcellular structures of adipose stem cells. They are nano-sized membrane vesicles that can transport various cell components and act on target cells by paracrine, and they play an important role in the exchanges of substance and information between cells. Scar healing is the commonest way of healing after skin tissue injury. Pathological scar can not only cause movement dysfunction, but also lead to deformity, which affects the appearance of patients and brings life and mental pressure to the patients. In recent years, many researches have shown that the adipose-derived stem cell exosomes contain a variety of bioactive molecules, which play an important role in reducing scar formation and scar-free wound healing, by affecting the proliferation and migration of fibroblasts and the composition of extracellular matrix. This article reviewed the recent literature on the roles and mechanisms of adipose-derived stem cell exosomes in scar formation, and prospected the future application and development of adipose-derived stem cell exosomes in scar treatment.

[Characteristics of mortality density of HIV/AIDS cases after diagnosis in Jiamusi of Heilongjiang province, 2010-2020]

Objective: To analyze characteristics of mortality density and the influencing factors of HIV/AIDS after diagnosis in Jiamusi of Heilongjiang province. Methods: The data were retrieved from HIV/AIDS Comprehensive Response Information System and selected cases diagnosed with HIV/AIDS in Jiamusi of Heilongjiang province during 2010-2020 and aged 15 years or older as the study objects. The method of retrospective cohort study was used to collect baseline and follow-up information, and characteristics of mortality density after HIV diagnosis were described. Death after HIV diagnosis was divided into 1-6 months, 7-12 months, and ≥13 months after HIV diagnosis. The Cox proportional hazards model was used to analyze the associated factors of mortality density within six months after HIV diagnosis. Excel 2019 and SPSS 22.0 software were used for data processing and statistical analysis. Results: A total of 953 HIV/AIDS with 173 deaths were included during the study period. Most HIV/AIDS were men (89.19%, 850/953), single or divorced or widowed (76.50%, 729/953), educated in middle school and lower level (51.84%, 494/953), and men who have sex with men (77.02%, 734/953). There was a cumulative follow-up of 3 944.59 person-years, with an overall mortality density of 4.39 (95%CI: 3.79-5.07)/100 person- years. The mortality density was highest in 21.60 (95%CI: 18.04-25.86) 100 person-years within the first six months after diagnosis, then decreased to 2.02 (95%CI: 1.59-2.58)/100 person-years over 13 months or more after HIV diagnosis. HIV/AIDS who died within the first six months after diagnosis had a higher proportion of first CD4⁺T lymphocytes (CD4) counts untested (51.61%, 48/93) and AIDS-related deaths (32.26%, 30/93). In the multivariate analysis of the Cox proportional hazards regression model, mortality density within the first six months after HIV diagnosis was greater among HIV/AIDS who were older at diagnosis, detected by medical institutions, with lower first CD4 counts or no testing, and never receiving antiretroviral therapy (ART). Conclusions: Mortality density was generally low in Jiamusi of Heilongjiang province during 2010-2020 and declined over the follow-up time. However, early diagnosis and immediate ART initiation should be strengthened. Attention should also be paid to follow-up care management and referral services for HIV/AIDS within the first six months after HIV diagnosis to reduce the risk of death after HIV diagnosis.

[Related factors and prognosis analysis of esophagorespiratory fistula after esophageal cancer surgery]

Objective: To explore the factors associated with the development of esophagorespiratory fistula (ERF) after esophageal cancer surgery and its relationship with patient survival. Methods: A total of 241 patients with esophageal cancer after surgery, who received postoperative sputum suction through bronchoscope from West China Hospital of Sichuan University between January and December 2021 were included. The clinical data and airway features under bronchoscope of these patients were collected. Of the 241 patients, 203 were males (84.2%) and 38 were females (15.8%), aged (63.63±8.05) years. The related factors of ERF were analyzed by multivariate logistic regression analysis, and Kaplan-meier was used to analyze the relationship between bronchoscopic specific manifestations, treatment modality and patient survival. Results: Of the 241 postoperative patients with esophageal cancer, 21 (8.7%) developed ERF. There were 39 (16.2%) patients with bronchoscopic specific manifestations, including 16 cases (6.6%) of hyperemia, 13 cases (5.4%) of congestion, and 15 cases (6.2%) of erosion. Bronchoscopic specific manifestations of tracheal mucosa (OR=13.734, 95%CI: 3.535-29.074, P<0.001) and thoracotomy (OR=9.121, 95%CI 1.843-44.237, P=0.007) were independent risk factors for the development of ERF, and preoperative chemotherapy (OR=0.128, 95%CI: 0.052-0.607, P=0.006) was a protective factor in the occurrence of ERF. The median survival time was 224 (95%CI: 95-353)d in the stent-treated group (14 patients) after the onset of ERF, and the median survival time of patients in the supportive care group (7 patients) was 29 (95%CI: 8-50)d, and the survival difference was statistically significant (χ²=5.69, P=0.017). Conclusions: Bronchoscopic specific manifestations are independent risk factors for the development of ERF in postoperative patients with esophageal cancer and are useful in assessing the risk of developing ERF. After the occurrence of postoperative ERF, timely intervention by insertion of tracheal stents to seal the fistula may prolong the survival time of the patients.

[Analysis of the relationship between syncope and poor prognosis in patients with acute pulmonary embolism and related factors]

Objective: To explore the association between syncope and poor prognosis and related factors of syncope in patients with acute pulmonary embolism (APE). Methods: A total of 740 patients with first diagnosed APE treated in West China Hospital of Sichuan University from September 1, 2016 to December 30, 2019 were enrolled. The basic information and clinical information (including clinical manifestations, complications, auxiliary examination, treatment and prognosis, etc.) of the patients were obtained from inpatient medical records. The patients were divided into the syncope group and the non-syncope group according to whether they had syncope or not. The basic and clinical conditions of the two groups were compared, and the factors related to syncope in APE patients were analyzed by multiple logistic regression model. Results: The proportion of APE patients with syncope was 12.6% (93/740). Age was (59±16) years in the syncope group (93 cases) and (59±17) years in the non-syncope group (647 cases), with 57.0% (53/93) and 60.4% (391/647) males, respectively. The body mass index, in-hospital mortality, proportions with high risk APE and mechanical ventilation of the syncope group were higher than those of the non-syncope group [(24.5±4.0) kg/m² vs (23.3±3.8) kg/m², 16.1% vs 7.7%, 4.4% vs 1.3% and 9.7% vs 2.5%, respectively]. The length of hospital stay [M (Q₁, Q₃)] of the syncope group was longer than that of the non-syncope group [15 (10, 22) d vs 14 (9, 22) d], and the proportions with chest pain and hemoptysis were lower than those of the non-syncope group (19.4% vs 36.8% and 14.0% vs 27.2%, respectively) (all P values<0.05). Multivariate logistic regression analysis showed that enlargement of the right heart [OR (95%CI): 2.46 (1.07, 5.64)] was a factor associated with syncope in APE patients. Conclusion: The proportion of APE patients with syncope is relatively high and is associated with poor prognosis, while enlargement of the right heart is associated with syncope in APE patients.

Roles of sirtuin family members in chronic obstructive pulmonary disease

The globally increasing annual incidence of chronic obstructive pulmonary disease (COPD), a common chronic disease, poses a serious risk to public health. Although the exact mechanism underlying the pathogenesis of COPD remains unclear, a large number of studies have shown that its pathophysiology and disease course are closely related to oxidative stress, inflammation, apoptosis, autophagy, and aging. The key players involved in COPD include the sirtuin family of NAD-dependent deacetylases that comprise seven members (SIRT1-7) in mammals. Sirtuins play an important role in metabolic diseases, cell cycle control, proliferation, apoptosis, and senescence. Owing to differences in subcellular localization, sirtuins exhibit anisotropy. In this narrative review, we discuss the roles and molecular pathways of each member of the sirtuin family involved in COPD to provide novel insights into the prevention and treatment of COPD and how sirtuins may serve as adjuvants for COPD treatment.

[Ferroptosis in laryngeal squamous cell carcinoma and its regulation by M2 macrophage-derived exosomes]

Objective: To investigate ferroptosis in laryngeal squamous cell carcinoma (LSCC) and its regulation by M2 macrophage-derived exosomes. Methods: LSCC and adjacent noncancerous tissue samples were collected from 32 patients treated in the Department of Otorhinolaryngology, Head and Neck Surgery of the Second Affiliated Hospital of Harbin between September 2018 and April 2021, including 26 males and 6 females, aged 43-79 years. The expressions of ferroptosis marker glutathione peroxidase 4(GPX4) in LSCC and adjacent noncancerous tissues were detected by immunohistochemistry and reverse transcriptase-polymerase chain reaction(RT-PCR). The correlations between GPX4 expression and clinicopathological factors in LSCC were analyzed. Biological changes of TU212 cells after treated with ferroptosis-induced agent erastin were detected by transmission electron microscope, cell counting kit-8(CCK-8), clone test, reactive oxygen species(ROS), malondialdehyde(MDA), glutathione(GSH), JC-1, RT-PCR and western blot. Exosomes were isolated from the supernatant of M0/M2 macrophages (M0-exos/M2-exos) and co-incubated with erastin-treated TU212 cells to detect the change of ferroptosis in cells of each group. The data were analyzed by SPSS software of version19.0. Results: GPX4 expression in LSCC tissues was significantly higher than that in adjacent noncancerous tissues (2.04±0.65 vs. 0.99±0.09, F=30.36, P<0.001), and was closely related to T stage and clinical stage (Ⅰ-Ⅱvs.Ⅲ-Ⅳ: 1.75±0.39 vs. 2.18±0.71, F=2.25, P<0.05; T1-2 vs. T3-4: 1.71±0.42 vs. 2.20±0.69, F=2.06, P<0.05). In TU212 cells treated with erastin, mitochondrial crest became smaller, membrane density increased, proliferation rate decreased, intracellular ROS level increased, mitochondrial membrane potential depolarized, GSH content decreased, intracellular MDA level increased and expressions of GPX4 mRNA and protein decreased. Change of M0 into M2 macrophages was induced by IL-4 stimulation. When erastin-treated TU212 cells were incubated with M2-exos, cell proliferation was partially restored and GPX4 expression was enhanced, and also with the recoveries of levels of ROS, MDA and GSH (all P<0.05). Conclusions: Ferroptosis is one of the cell death ways of LSCC. M2-exos may inhibit ferroptosis of LSCC cells.

[A survey on human resources of dentists who deal with periodontal disease in Beijing]

Objective: To investigate the status quo of human resources of dentists who deal with periodontal disease in Beijing area through an online survey, which may hopefully provide a preliminary basis for the decision-making of administrative departments and the formulation of periodontal professional development plan. Methods: The dentists who deal with periodontal disease at least half a day per week in Beijing area were investigated. A questionnaire was designed by the chairman of the Periodontology Committee of Beijing Stomatological Association. The questionnaire was sent to and finished by the dentists via "WenJuanXing" online survey software. The contents of the survey included general condition, the property of practice unit, title and position of the dentist, membership of professional society, time and content of periodontal treatment, adoption of new technology and new method of periodontal therapy during the past one year, status of periodontal treatment in the local population and reasons, understanding and influencing factors of periodontal professional development. Results: A total of 1 255 dentists completed the survey, who came from all 16 districts in Beijing, mainly Haidian, Chaoyang, Dongcheng and Xicheng Districts [The total percentage of these four main districts was 70.3% (882/1 255)]. The mean age of the dentists was (36.1±8.3) years. Among the dentists, 71.1% (892/1 255) were females, 88.1% (1 106/1 255) got a Bachelor's degree or above. It was estimated that 35.4% (444/1 255) of the dentists had received standardized periodontal training ever. The percentage of dentists carrying out new technology in the past one year was as high as 68.1% (855/1 255). There were only 163 periodontal specialists (13.0%) out of the dentists in the survey. Only 15.9% (200/1 255) of the dentists routinely performed periodontal surgery. The majority of the dentists [82.8% (1 039/1 255)] were from the state-owned hospitals. Fifty-four point seven percemt (686/1 255) of the dentists thought that lack of knowledge was the main reason why the general public failed to receive periodontal treatment. As for the biggest bottleneck affecting periodontal professional development, fifty-one point zero percent (640/1 255) of the dentists attributed it to the public neglect. Conclusions: The periodontal practitioners in Beijing are young, highly educated, unevenly distributed in 16 districts and mostly females. State-owned oral health institutions are an important force in periodontal diagnosis and treatment services in Beijing. The number of periodontal specialists need to be improved. Promotion of standardized periodontal surgery and the popularization of healthcare knowledge on periodontal disease should also be the focus in the future.

[Relationship between emotional apathy and motor symptoms, sleep and cognitive function in patients with early Parkinson's disease]

Objective: To study the relationship between emotional apathy and motor symptoms, sleep, and cognitive function in patients with early Parkinson's disease (PD). Methods: One hundred and twenty-nine early PD patients who were treated in the Second Affiliated Hospital of Soochow University from June to October 2020 were included, including 82 male and 47 female patients. The emotional apathy was assessed by modified apathy rating scale (MAES). The above 129 patients were divided into 67 patients in the PD with emotional apathy group (MAES>14 points) and 62 patients in the PD without emotional apathy group (MAES≤ 14 points). Age, gender, course of disease and levodopa equivalent dose were also collected. Hoehn-Yahr stage and unified Parkinson's disease rating scale PartⅢ(UPDRS-Ⅲ), Pittsburgh Sleep Quality Index (PSQI), polysomnography, and Montreal Cognitive Assessment Scale (MoCA) were used to evaluate the motor symptoms, sleep and cognitive functions of patients with early PD, and the clinical characteristics of patients with early PD with apathywere determined. Results: Compared with PD patients without apathy, those with apathy had longer disease duration [M(Q₁,Q₃)][5.0 (3.0, 7.0) years vs 3.0 (2.0, 5.0) years, P=0.006] and severer motor symptoms [20.0 (10.0, 28.0) vs 14.0 (8.5, 23.0), P=0.047]. There was no significant difference in PSQI score between the two groups. Among the 33 patients who completed polysomnography, compared with PD patients without apathy (n=16), those with apathy (n=17) had a longer rapid eye movement (REM) sleep latency [150 (124, 184) min vs 87 (57, 133) min, P=0.035)] and more frequent periodic limb movements in the REM phase(P=0.042).The REM sleep ratio (r=0.373, P=0.042), apnea-hypopena index (AHI)(r=0.374, P=0.046) and oxygen deficit index (r=0.409, P=0.025) were positively correlated with the degree of apathy in PD patients. PD patients with apathy had relatively poorer performance in cognition assessment than those without apathy and total MoCA score was inversely correlated with the degree of apathy (r=-0.231, P=0.017). Conclusion: Early PD patients with apathy have objective sleep disorders dominated by REM sleep disorders, which can have a negative impact on cognitive function.

[Effectiveness and safety of idarucizumab in the management of perioperative complications of atrial fibrillation catheter ablation in atrial fibrillation patients under dabigatran therapy]

Objective: To investigate the efficacy and safety of idarucizumab in the treatment of perioperative cardiac tamponade and thromboembolic events during catheter ablation in atrial fibrillation (AF) patients under dabigatran therapy. Methods: This study was a retrospective analysis enrolling patients under dabigatran therapy, who underwent catheter ablation for AF at Beijing Anzhen Hospital from January 2019 to December 2020 and developed perioperative cardiac tamponade or acute ischemic stroke (AIS) and received idarucizumab to reverse the anticoagulant effect of dabigatran. Patients' age, sex, renal function, coagulation test and safety events at 30 d after idarucizumab administration were collected and analyzed. The clinical presentation and prognosis were also analyzed. Results: A total of 7 patients were included, 2 (2/7) were male, mean age was (66.3±11.2) years, serum creatinine level was (66.3±13.6) μmol/L, estimated glomerular filtration rate was (89.4±11.2) ml·min-1·1.73 m-2, CHA2DS2-VASc and HAS-BLED scores were (3.2±1.9) and (1.3±1.3), respectively. Five patients (5/7) developed cardiac tamponade during the perioperative period and the time interval to the last dose of dabigatran was (6.3±2.6) h. Idarucizumab was given at (36.4±16.7) min after the definitive diagnosis of cardiac tamponade. A significant decrease of activated partial thromboplastin time was achieved after idarucizumab administration in all five cases. Pericardial puncture and drainage were applied to all patients (5/5) with cardiac tamponade, the drainage volume was (1 037.0±846.9) ml, the retention time of pericardial drainage catheter was (27.9±13.9) h, and the recovery time of anticoagulation was (28.4±13.2) h. One patient (1/5) underwent thoracotomy for hemostasis due to excessive blood loss with the aim of ensuring complete hemostasis. Bleeding occurred in 1 patient (1/5) after the first restart of anticoagulation. AIS occurred in 2 patients (2/7) after operation. One case (1/2) received intravenous thrombolysis after receiving 5.0 g idarucizumab, no hemorrhagic transformation was observed, and the recovery process was satisfactory. Another patient in this group experienced significantly prolonged onset time and 5.0 g idarucizumab was applied before intravascular thrombectomy, there was no bleeding complication in this patient after thrombectomy. At the time of discharge, the consciousness was not significantly improved, and the muscle strength of the right lower limb was recovered somehow compared with that before operation. No hypersensitivity reactions or thrombotic events occurred in these patients within 30 days of the administration of idarucizumab. Conclusion: In AF catheter ablation-associated cardiac tamponade and AIS, idarucizumab is safe and effective in rapidly reversing the anticoagulant effect of dabigatran, use of thrombectomy saves valuable time for timely hemostasis and improvement of cerebral blood circulation.

[Expert consensus on the treatment of oral and maxillofacial space infections]

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Mitochondrial DNA Heteroplasmy of Hair Shaft Using HID Ion GeneStudioTM S5 Sequencing System

Objective To study the heteroplasmy of the whole mitochondrial genome genotyping result of hair shaft samples using HID Ion GeneStudio^TM S5 Sequencing System. Methods The buccal swabs and blood of 8 unrelated individuals, and hair shaft samples from different parts of the same individual were collected. Amplification of whole mitochondrial genome was performed using Precision ID mtDNA Whole Genome Panel. Analysis and detection of whole mitochondrial genome were carried out using the HID Ion GeneStudio^TM S5 Sequencing System. Results The mitochondrial DNA sequences in temporal hair shaft samples from 2 individuals showed heteroplasmy, while whole mitochondrial genome genotyping results of buccal swabs, blood, and hair samples from the other 6 unrelated individuals were consistent. A total of 119 base variations were observed from the 8 unrelated individuals. The numbers of variable sites of the individuals were 29, 40, 38, 35, 13, 36, 40 and 35, respectively. Conclusion Sequence polymorphism can be fully understood using HID Ion GeneStudio^TM S5 Sequencing system.

Decellularized adipose tissue: A key factor in promoting fat regeneration by recruiting and inducing mesenchymal stem cells

BACKGROUND

Decellularized adipose tissue (DAT) has attracted much attention due to its wide range of sources and adipose regeneration capacity. However, the lipogenic efficiency of DAT is still controversial due to its unclear mechanism. To this point, it is crucial to clarify the mechanism of DAT in promoting adipose regeneration Objective: This study aims to explore the mechanism of DAT promoting adipose regeneration and survival mechanism of DAT transplantation in vivo.

METHODS

DAT preparation by repeated freeze-thaw, enzymatic digestion, and isopropanol degreasing. Histology, DAPI, immunohistochemistry, immunofluorescence and scanning electron microscopy confirmed the efficacy and reproducibility of these approaches. BM-MSCs, ADSCs and UCMSCs were cocultured with DAT for 14 days and then stained with oil red O. Adipogenic genes of three MSCs were detected by RT-PCR. DAT and adipose tissue were transplanted subcutaneously into the back of nude mice to observe medium and long-term morphological changes, vascularization, and lipid-forming efficiency. Mass spectrometry (MS)-based proteomic to analyze the adipogenic protein contents of DAT and adipose tissue.

RESULTS

The DAT without any cellular components but with an abundance of collagen; neither DNA nor lipids were detected. Seeding experiments with MSCs indicated that the DAT provided an inductive microenvironment for adipogenesis, supporting the expression of the master regulators PPARγ. Within four months after transplantation, HE morphology of DAT was identical to adipose cells. Immunofluorescence markers CD31 and perilipin were increased in DAT, while the retention rate gradually decreased over time, eventually accounting for 33.7% of the original volume. MS-based proteomic analyses identified 1013 types of proteins in adipose tissue and 29 proteins in the DAT. Analyses of GO and KEGG databases suggested that DAT contained a variety of proteins involved in fat metabolism.

CONCLUSIONS

DAT can interact with different types of MSCs and ultimately achieve adipose regeneration. The presence of multiple adipogenic proteins in DAT make it play a vital role in adipose regeneration. DAT is expected to be an ideal bio-derived scaffold for adipose tissue engineering.

Thickness-induced band-gap engineering in lead-free double perovskite Cs2AgBiBr6 for highly efficient photocatalysis

In recent years, two-dimensional (2D) lead-free double perovskites have been attracting much attention because of their unique performance in photovoltaic solar cells and photocatalysis. Nonetheless, how thickness affects the photoelectric properties of lead-free double perovskite remains unclear. In this work, by means of density functional theory (DFT) with a spin orbit coupling (SOC) effect, we have investigated the electronic and optical properties systemically, including band structures, carrier mobility, optical absorption spectra, exciton-binding energies, band edges alignment and molecule adsorption performance of Cs2AgBiBr6 with different thicknesses. The calculated results revealed the thickness-induced band gap and optical performance for Cs2AgBiBr6. It shows a low band gap and outstanding optical absorption of visible and ultraviolet light. When the thickness is reduced to a monolayer, Cs2AgBiBr6 moves from an indirect band gap to a direct band gap. Moreover, the carrier mobility of Cs2AgBiBr6 is excellent and the exciton-binding energy increases with the decreased thickness. Importantly, an analysis of molecule adsorption and band edge alignment indicates that Cs2AgBiBr6 is prone to H2O adsorption and H2 desorption theoretically, which is conducive to the photocatalytic water splitting for hydrogen generation and other photovatalytic reactions. Our work suggests that Cs2AgBiBr6 is a potential candidate as a solar cell or a photocatalyst, and we provide theoretical explorations into reducing the layers of lead-free double perovskite materials to 2D atomic thickness for a better photocatalytic application, which can serve as guidelines for the design of excellent photocatalysts.

[Application of rigid curved laryngoscope in the examination of hypopharynx and the treatment of early hypopharyngeal cancer]

Objective: To evaluate the efficacy of curved suspension laryngoscope assistant transoral surgery (CLATOS) in the examination of hypopharynx, and diagnosis and surgery of early hypopharyngeal carcinoma. Methods: Thirty-four patients who underwent detailed examination for lower part of hypopharynx and surgery for early hypopharyngeal carcinoma with CLATOS technique in the Second Affiliated Hospital of Harbin Medical University from January 2019 to January 2020 were analyzed retrospectively. The age ranged from 42 to 74 years old including 28 males and 6 females. Among them, 25 patients complaining of foreign body sensation in the pharynx for more than half a year with a poor exposure of the lower pharynx in the examination with flexible laryngoscope in the outpatient department were admitted to the hospital for the further examination with rigid curved laryngoscopy and 9 patients with stage T1-2 hypopharyngeal squamous cell carcinoma were operated with CLATOS technique. Preoperative, intraoperative and postoperative data were analized. Results: One case of squamous cell carcinoma in esophageal entrance (T1N0M0) and one case of carcinoma in pyriform sinus (T1N0M0) with cervical esophageal carcinoma (T1N0M0) were found in the 25 patients with foreign body sensation in the pharynx. En bloc resection of cancer was obtained in 9 patients with stage T1-2 hypopharyngeal carcinomas and 2 of them underwent tracheotomy. One patient with T1 retrocricoid carcinoma was found to have a carcinoma in situ at the lower part of posterior hypopharyngeal wall in the examination during follow-up, which was resected simultaneously. Postoperatively this patient developed a stenosis in the esophageal entrance, which was dilated twice until swallowing normally. Two patients of T2N0M0 and one of T2N1M0 underwent bilateral neck lymph node dissection just after the removal of primary tumors. During follow-up, none of the 9 patients showed tumor recurrence and complications such as dysphonia and dyspnea. Conclusion: CLATOS technique can provide a promising way in the examination of hypopharynx and the detection of early lesions of hypopharynx and esophageal entrance, and this technique has also the advantages such as full visual angle and easy operation for the resection of early hypopharyngeal carcinoma. The quality of life of patients can be improved while the tumor is removed en bloc with this technique.

The energy band engineering for the high-performance infrared photodetectors constructed by CdTe/MoS2 heterojunction

Recently, the traditional infrared photodetectors (PDs) shows limited application in various areas, due to the narrow band-gap, high cost and even complex manufacturing process. In this situation, scientist have paid much attention to achieve the ultra broadband PDs from the deep ultraviolet to the near infrared. The energy band engineering for two-dimensional (2D) van der Waals heterojunction with free chemical dangling bonds is an effective method to fabricate High-performance Photodetectors. In this work, we employ density functional calculation to construct a type-II CdTe/MoS₂ heterostructure and calculate its electronic properties. The results reveal that the CdTe/MoS₂ has the narrow band gap of 0.64 eV and electrons transfer from the CdTe to MoS₂ layer, which promotes the separation of photogenerated carriers and enhance the photoelectron conversion efficiency. Driven by the smaller band gap, it can respond to near infrared, visible and ultraviolet light, demonstrating it the promising application for solar cell. Furthermore, the analysis of molecules adsorption and band edge alignment indicates that the CdTe/MoS₂ is prone to capture H₂O and release the H₂ molecules, which is conductive to the photocatalytic water splitting for hydrogen generation. Our work suggests that the CdTe/MoS₂ heterostructure is a potential candidate as a solar cell and even photocatalyst, and also provides a new sight for experimental and theoretical research to design a highly efficient device.

[Analysis of genes related to hypothyroidism during pregnancy]

Objective: By comparing and analyzing the differential sites of single nucleotide polymorphisms (SNP) between pregnant women with hypothyroidism and normal controls, the possible pathogenesis of hypothyroidism during pregnancy was explored. Methods: A total of 53 pregnant women with hypothyroidism during pregnancy from January 2018 to October 2018 were enrolled. A total of 50 pregnant women who underwent concurrent delivery and matched age with the case group were selected. Whole blood scans were performed on blood samples from two groups of subjects using the Illumina ASA chip to analyze the SNP with significant differences between the two groups. The human genome database hg19_dbsnp_version150 was employed to locate related genes. The association of related genes with thyroid dysfunction and pregnancy complications were analyzed. Results: A total of 13 SNPs were found in the study: rs4668077 (P=2.87E-05) in CERS6, rs6717546 (P=5.92E-05) in UGT1A1, rs1965358(P=7.78E-05) in CASR, rs916801 (P=9.22E-05) near CXCL14, rs6886845 (P=8.67E-05)near MAT2B, rs76245053 in GRIK2 (P=2.07E-05), rs6977642 (P=2.10E-05)in HDAC9, rs6949597 (P=3.68E-05) near ATXN7L1, rs11186331 (P=2.08E-05) in HTR7, rs2415551 (P=4.53E-05) near FBXO33, rs75850124 (P=9.24E-05) and rs76519339 (P=9.24E-05)in MIR4527, rs1014971 (P=3.24E-05) near CBX6 were statistically significant in the hypothyroidism group compared with the control group. Conclusions: The related gene UGT1A1 is related to the metabolism of thyroxine in the liver. CASR, CXCL14 and CBX6 are related to reproductive ability. CXCL14, CASR, HBAC9 and CERS6 are related to metabolic syndrome, and GRIK2, HTR7 and FBOX33 are related to neuropsychiatric diseases. Abnormal serum thyroxine levels during pregnancy may be associated with abnormal metabolism of thyroxine caused by UGT1A1 mutation. Genes associated with reproduction, metabolism, and neuropsychiatric disorders suggest a pathogenic link between hypothyroidism and infertility, metabolic syndrome, and neuropsychiatric disorders.

[Ganglioneuroma in poststyloid space removed under endoscope through transoral approach: a case report]

Parapharyngeal space refers to the potential space under skull base between masticatory muscles and pharyngeal muscles, ranging from skull base at the top to hyoid bone at the bottom. The outer lateral wall consists of medial pterygoid muscle, deep parotid lobe and lower jawbone, lateral pharyngeal wall, medial pterygoid, deep lobe of parotid gland and mandible constitute the lateral wall, lateral pharyngeal wall forms medial wall, and prevertebral fascia constitutes the posterior wall, generally forming an inverted pyramid lacuna. Parapharyngeal space is divided into prestyloid space and poststyloid space by stylopharygeal fascia. Prestyloid space is relatively small and contains levator veli palatinetensor veli palatine, branches of maxillary artery, mandibular nerve and its branches. Poststyloid space is relatively large. It includes internal jugular vein, internal carotid artery, posterior cranial nerves, etc. Poststyloid space tumors are relatively rare. In this report, a case of ganglioneuroma wrapping right internal carotid artery is described, which is resected through oral approach.

[Analysis of adverse events of clinical blood use except for the adverse reactions of blood transfusion]

Objective: To reduce the occurrence of adverse events of clinical blood use by analyzing the clinical adverse events of blood use except for the adverse reactions of blood transfusion. Methods: A retrospective analysis was performed on 294 cases of adverse events of clinical blood use other than adverse blood transfusion reactions in Shijitan hospital from January 2014 to December 2017, and a statistical analysis was made on the types of adverse events of clinical blood use, blood transfusion related departments, and internal and surgical blood use. Results: The incidence of adverse events of clinical blood use was 10.3‰, 9.6‰, 4.2‰ and 4.6‰ in these 4 years respectively, and there were 216 cases (73.5%) of external departments, 49 cases (16.7%) of internal departments, 8 cases (2.7%) of nursing departments, and 21 cases of others(7.1%), which includes 12 cases of errand department, 4 cases of the clinical laboratory and 5 cases of transfusion department. The adverse events of clinical blood use were divided into 4 types: 71 cases (24.1%) of transfusion process problems, 36 cases (12.2%) of clinical communication between departments, 182 cases (61.9%) of clinical unreasonable transfusion and 5 others (1.8%). There were statistically significant differences in the occurrence of adverse events of different types of blood use in external and internal departments based on the property of the department, among which there were significant differences in unreasonable transfusion between them. According to the purpose of blood use, there were statistically significant differences in the occurrence of different types of adverse events between the two departments, and the incidence of different types of external departments were higher than that of internal departments. Conclusions: The incidence of adverse events of blood use in external departments is higher than that in internal departments. Reasonable transfusion should be strengthened to avoid the occurrence of adverse events of clinical blood use, so as to ensure the safety of blood transfusion.

Theoretical study on the intrinsic properties of In2Se3/MoS2 as a photocatalyst driven by near-infrared, visible and ultraviolet light

Two-dimensional photocatalysts with full optical absorption have attracted widespread attention for water splitting and pollutant degradation, but only few single materials can meet this criterion.

Correlation between secreted protein acidic and rich in cysteine protein expression and the prognosis of postoperative patients exhibiting esophageal squamous cell carcinoma

The aim of the present study was to investigate the association between the expression level of secreted protein acidic and rich in cysteine (SPARC) and the prognosis of postoperative patients with esophageal squamous cell carcinoma (ESCC). The expression level of SPARC was detected in the 89 ESCC tissue cases and 100 healthy esophageal mucosa cases, which served as the controls. Immunohistochemistry and reverse transcription‑polymerase chain reaction (RT‑PCR) were employed to evaluate the SPARC expression in cases with ESCC. RT‑PCR demonstrated that the positive rates of SPARC mRNA expression in ESCC were 71.91% (64/89). The positive rates of normal esophageal mucosa mRNA expression were 15.00% (15/100), which were significantly lower than that in the ESCC tissue samples. The difference was statistically significant (P<0.001). Immunohistochemical staining indicated that the positive expression rate of SPARC protein in the ESCC tissue samples was significantly higher than that in the esophageal mucosa tissue samples (65.17 vs. 8.00%; P<0.001). The expression of SPARC protein was negatively correlated with lymph node metastasis (P<0.05), which was not associated with the pathologic gross morphology, tumor differentiation degree or other clinical features. The survival of patients with ESCC was not associated with the expression level of SPARC protein (P>0.05), but was associated with the tumor location (P<0.05), differentiation (P<0.001) and staging (P<0.05). Thus, SPARC mRNA and protein were highly expressed in ESCC, and negatively correlated with lymph node metastasis, which was not associated with postoperative survival of ESCC patients. Thus, detection of SPARC mRNA and protein expression levels may facilitate early diagnosis and prognosis assessment of ESCC.

[Tobacco use rate and associated factors in middle school students in China]

Objective: To understand tobacco use rate and explore the factors associated with tobacco use in middle school students in China. Methods: A self-administered questionnaire survey was conducted among 155 117 eligible middle students selected through multi-stage stratified cluster sampling from 31 provinces of China. The questionnaire consists of the following topics: tobacco use and cessation, passive smoking, access to tobacco products, tobacco control and tobacco advertisement, and knowledge about and attitudes to tobacco. Software SAS 9.3 was used for sample weighting and data analysis. Results: Current tobacco use rate was 6.9% in middle school students in China. The rate was higher in boys (11.2%) than in girls (2.2%), and in rural area (7.8%) than in urban area (4.8%). Students in western area had the highest tobacco use rate (10.3%), followed by the students in middle area (6.4%), and the rate in students in eastern area was lowest (4.5%). Parent smoking (especially mother smoking), friend smoking, teacher smoking, pocket money for a week>20 yuan, tobacco advertisement or promotion, passive smoking, misconception of tobacco addiction, active attitude to smoking behavior were the risk factors for tobacco use. Conclusions: Smoking rate in boys in China was higher than the average global level. A comprehensive intervention strategy by Framework Convention on Tobacco Control should be used to reduce tobacco use in adolescents, including health education, increasing cigarette price, banning tobacco advertisement and promotion, and smoke-free legislation.

[Research on the correlation and regulation of bone metabolism related biochemical indexes in different gestational ages]

Objective: To investigate the correlation and metabolic characteristics of the growth hormone (GH) and other bone metabolism related biochemical markers in pregnancy women serum. Methods: Determination of GH, 25 hydroxy vitamin D(25(OH)D), osteocalcin n-terminal fragments (N-MID), total propeptide of type 1 procollagen (TP1NP) and alkaline phosphatase (ALP) levels in different gestation women serum, the experimental group involving 75 cases of early pregnancy women(11-14 weeks), 135 cases of pregnancy women(15-21 weeks), 62 cases of late pregnancy women(31-40 weeks) and 28 cases of postpartum women(1-3 days). All cases were selected from prenatal screening patients in hospital from February 2016 to February 2017. The control group involving 55 cases of physically healthy nulliparous. The indicators of GH, 25(OH)D, TPINP and N-MID were detected by electrochemiluminescence and ALP were detected by rate method. All data were processed by SPSS. Variance analysis and Pearson correlation analysis were employed. Results: Serum GH level in early pregnancy, pregnancy, late pregnancy and control group were (4.54±2.26), (9.04±3.23), (20.16±4.89), (0.55±0.49)μg/L, respectively. The difference was statistically significant (F=270.037, P<0.01). Serum GH in each group of pregnant women were more higher than those in control group (all P<0.01), and there was statistical difference in different gestational stages(all P<0.01). Serum 25 (OH)D expression in early pregnancy, pregnancy and late pregnancy were (25.60±14.48), (27.10±12.05), (25.45±9.85)nmol/L. Compared with the control group(39.93±14.88)nmol/L, the difference was statistically significant (all P<0.01). Serum TP1NP level in early pregnancy, pregnancy, late pregnancy and control group were (44.44±11.80), (48.41±20.87), (102.63±41.73), (54.73±24.07)μg/L, respectively. The difference was significantly significant (F=54.027, P<0.01) and TP1NP in late pregnancy group was obvious higher than in early pregnancy group, pregnancy group and control group apart(all P<0.01). Serum N-MID level in early pregnancy, pregnancy, late pregnancy and control group were (5.91±2.64), (7.45±2.27), (17.24±6.47), (18.52±6.95)μg/L, and the difference was significantly significant(F=55.699, P<0.01). N-MID in early and middle pregnancy group were apparent lower than that in late pregnancy and control group (all P<0.01). Serum ALP level in early pregnancy, pregnancy, late pregnancy and control group were (49.74±10.14), (77.76±26.90), (168.34±45.15), (52.81±10.33) U/L, and the difference was significantly significant(F=180.349, P<0.01). However, there was noticeable difference in ALP level between late pregnancy and other pregnant group(P<0.01 or P<0.05). The serum GH, TP1NP and N-MID in postpartum women (1-3 days) were (1.44±0.99), (73.41±34.27), (12.10±5.64) μg/L, respectively. Compare with late pregnancy groups, the difference was significantly significant(all P<0.01). The content of GH in serum of 272 cases pregnant women was positively correlated with the concentration of TP1NP, N-MID and ALP, the gestational age and body weight of pregnant women(r=0.509, 0.720, 0.862, 0.827, 0.324, all P<0.01). The content of TP1NP, N-MID and ALP were positively correlated with gestational age, respectively(r=0.603, 0.722, 0.901, all P<0.01). Moreover, TP1NP expression was positively correlated with N-MID (r=0.849, P<0.01), and there was no correlation between other indexes. Conclusions: These findings have revealed that there are different metabolic character of the GH and bone metabolism related biochemical indexes during different pregnancy period. And there is a positive correlation between gestational age and the index of GH, N-MID, TP1NP, ALP, respectively. Finally, the bone metabolism is more active and Vitamin D deficiency is severe throughout pregnancy.

Fucoxanthin prevents H2O2-induced neuronal apoptosis via concurrently activating the PI3-K/Akt cascade and inhibiting the ERK pathway

Background: As a natural carotenoid abundant in chloroplasts of edible brown algae, fucoxanthin possesses various health benefits, including anti-oxidative activity in particular.

Objective: In the present study, we studied whether fucoxanthin protected against hydrogen peroxide (H₂O₂)-induced neuronal apoptosis.

Design: The neuroprotective effects of fucoxanthin on H₂O₂-induced toxicity were studied in both SH-SY5Y cells and primary cerebellar granule neurons.

Results: Fucoxanthin significantly protected against H₂O₂-induced neuronal apoptosis and intracellular reactive oxygen species. H₂O₂ treatment led to the reduced activity of phosphoinositide 3-kinase (PI3-K)/Akt cascade and the increased activity of extracellular signal-regulated kinase (ERK) pathway in SH-SY5Y cells. Moreover, fucoxanthin significantly restored the altered activities of PI3-K/Akt and ERK pathways induced by H₂O₂. Both specific inhibitors of glycogen synthase kinase 3β (GSK3β) and mitogen-activated protein kinase kinase (MEK) significantly protected against H₂O₂-induced neuronal death. Furthermore, the neuroprotective effects of fucoxanthin against H₂O₂-induced neuronal death were abolished by specific PI3-K inhibitors.

Conclusions: Our data strongly revealed that fucoxanthin protected against H₂O₂-induced neurotoxicity via concurrently activating the PI3-K/Akt cascade and inhibiting the ERK pathway, providing support for the use of fucoxanthin to treat neurodegenerative disorders induced by oxidative stress.

[A prospective study on the effects of levonorgestrel-releasing intrauterine system for adenomyosis with menorrhagia]

OBJECTIVE

To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with menorrhea in a prospective study.

METHODS

From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients' parameters were recorded prospectively, including scores of menstruation blood loss, carrying status of IUS, symptoms and scores of dysmenorrhea, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Changes of pictorial chart scores of menstruation and distribution of anemia during follow-up were analyzed.

RESULTS

Totally 1 100 women meets inclusion criteria, among which 618 cases (56.18%, 618/1 100) had severe menorrhea, with median follow-up period of 28 months (range 1- 60 months), and accumulative carrying rate of 66% at 60 months follow-up. After placement of LNG-IUS, compared with baselines, pictorial chart scores and ratio of menorrhea had decreased significantly (all P<0.01), the scroes of menstruation were 157±34, 94±35, 70±33, 67±18, 67±20, 65±19, 66±19, 65±21 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 24 months after placement of LNG-IUS, pictorial chart scores and distribution of anemia had improved significantly compared with preceding period (all P<0.01). We found no dependent factors predicting improvement of pictorial chart scores of menorrhea, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05).

CONCLUSIONS

LNG-IUS is effective for adenomyosis of menorrhea. Improvement of menstruation blood loss is independent on patients characters, menstruation patterns or adverse effects.

[A prospective cohort study on effects of levonorgestrel-releasing intrauterine system for adenomyosis with severe dysmenorrhea]

OBJECTIVE

To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with severe dysmenorrhea in a prospective cohort study.

METHODS

From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients' parameters were recorded prospectively, including symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, carrying status of LNG-IUS, menstruation patterns and adverse effects. Changes of scores and patterns of pain during follow-up were analyzed.

RESULTS

Totally 1 100 women meets inclusion criteria, among which 640 cases (58.18%, 640/1 100) had severe dysmeorrhea, with median follow-up period of 35 months (range 1-60 months), and accumulative carrying rate of 65% at 60 months follow-up. After placement of LNG-IUS, scores of pain and ratio of severe dysmenorrhea had decreased significantly compared with baselines (all P<0.01), the scroes of visual analog scale (VAS) were 8.1±0.9, 5.5±2.4, 4.6±2.4, 3.3±2.2, 2.2±2.1, 2.2±1.8, 1.4±1.6 and 1.3±1.3 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 36 months after placement of LNG-IUS, scores of pain had improved significantly compared with preceding period (all P<0.01). We found no universal dependent factors predicting improvement of pain, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05).

CONCLUSION

LNG-IUS is effective for adenomyosis of severe dysmenorrhea. Improvement of pain is independent on patients characters, menstruation patterns or adverse effects.

Electronic transport in NbSe₂ two-dimensional nanostructures: semiconducting characteristics and photoconductivity

The electronic transport properties of two-dimensional (2D) niobium diselenide (NbSe2) layer materials with two-hexagonal single-crystalline structures grown by chemical vapor transport were investigated. Those NbSe2 nanostructures isolated simply using mechanical exfoliation were found to exhibit lower conductivity and semiconducting properties, compared with their bulk metallic counterparts. Benefiting from lower dark conductivity, NbSe2 nanoflakes exhibit a remarkable photoresponse under different wavelengths and intensity excitations. The photocurrent responsivity and photoconductive gain can reach 3.8 A W(-1) and 300, respectively; these values are higher than those of graphene and MoS2 monolayers and are comparable with those of GaS and GaSe nanosheets. The presence of electron trap states at the surface was proposed as an explanation for the reduced dark conductivity and enhanced photoconductivity in the 2D NbSe2 nanostructures. This work identifies another possibility for the application of a metallic layer material as an optoelectronic component in addition to an ultrathin transparent conducting material.

Efficacy of different treatment strategies for stage Ⅱ-Ⅲ rectal cancer

AIM: To compare the efficacy of four treatment strategies for stage Ⅱ-Ⅲ rectal cancer and analyze prognostic factors.

METHODS: A retrospective study was conducted on 230 patients who were pathologically diagnosed with stage Ⅱ-Ⅲ rectal cancer and underwent pelvic intensity modulated radiotherapy and concurrent fluorouracil based chemotherapy between January 2010 and December 2013 at Affiliated Tumor Hospital of Xinjiang Medical University, including 68 cases receiving neoadjuvant chemoradiotherapy combined with surgery (group A), 70 cases receiving postoperative chemoradiation (group B), 51 cases receiving neoadjuvant chemoradiotherapy without surgery (group C), and 41 cases receiving radical chemoradiation (group D). (Neo-) adjuvant radiotherapy was delivered at 50 Gy in 25 fractions, and radical radiotherapy was delivered at 60-66 Gy in 30-33 fractions. Surgical patients were treated by total mesorectal excision. Time interval between radiotherapy and surgery was 4-8 wk.

RESULTS: The follow-up rate was 93.4%, and 144 patients completed the 3-year follow-up. Local recurrence in 3 years was noted in 53 cases, and 44 cases had distant metastasis in the four groups; both the 3-year recurrence rate and distant metastasis rate had no statistical significance among different groups. The 3-year overall survival (OS) and disease-free survival (DFS) rates were statistically different (P = 0.001, 0.004). The rates of OS (86.76%) and DFS (76.27%) in group A were significantly higher than those in the other groups. Complete (R0) tumor resectability was 98.5% in group A and 78.5% in group B. Main toxicities were grade 1-2 adverse events. Multivariate analysis demonstrated that neoadjuvant chemoradiotherapy without surgery (P = 0.002), age (P = 0.021) and circumferential tumor (P = 0.029) were prognostic factors.

CONCLUSION: Neoadjuvant chemoradiotherapy combined with surgery can achieve a higher R0 resection rate and higher OS and DFS than other treatments, representing an effective method for stage Ⅱ-Ⅲ rectal cancer. Neoadjuvant chemoradiotherapy without surgery, age and circumferential tumor are prognostic factors.

Association Between Smoking and p53 Mutation in Oesophageal Squamous Cell Carcinoma: A Meta-analysis

AIMS

Several studies have evaluated the association between smoking and p53 mutation in oesophageal squamous cell carcinoma (ESCC), but the conclusions are inconsistent. The aim of the present study was to carry out a meta-analysis evaluating the relationship between smoking and p53 mutation in patients with ESCC.

MATERIALS AND METHODS

Eligible studies were identified through searches in PubMed and EMBASE. The odds ratio with 95% confidence interval was used to assess the association. In total, 20 studies were identified that met the selection criteria; these studies were analysed using STATA 12.0 software.

RESULTS

The 20 studies identified comprised 1524 ESCC patients, of whom 72.97% were smokers and 27.03% were non-smokers. The pooled odds ratio of p53 mutation in ESCC for any cigarette smoking versus no smoking was 1.28 (95% confidence interval=0.88-1.88). The estimated odds ratios were 1.06 (95% confidence interval=0.56-2.00, based on five studies, 129 light smokers and 70 non-smokers) for light smoking and 2.01 (95% confidence interval=1.12-3.60, based on five studies, 223 heavy smokers and 73 non-smokers) for heavy smoking.

CONCLUSION

The results of our meta-analysis indicate an overall positive relationship between heavy smoking and p53 mutation in ESCC. Heavy smokers with ESCC have a higher risk for p53 mutation than non-smokers. Large-scale clinical studies are still needed to draw a more precise conclusion.

Molecular characterization, phylogenetic analysis and expression profiling of myoglobin and cytoglobin genes in response to heat stress in channel catfish Ictalurus punctatus

To understand the function of myoglobin (Mb) and cytoglobin (Cygb) in channel catfish Ictalurus punctatus in response to heat stress, mb and cygb genes were identified and characterized in this study. These genes were widely expressed in all the tested tissues, but strong tissue preferences were observed, with the mb gene being expressed most highly in the heart, cygb1 most highly expressed in the intestine and cygb2 most highly expressed in the brain. After heat-stress challenge, mb and cygb genes were up-regulated in almost all tested tissues. In general, such up-regulation was more dramatic in the tolerant group than in the intolerant group, suggesting that higher expression of mb and cygb genes contributed to greater tolerance of I. punctatus to heat stress.

Impact of interval between preoperative chemotherapy and surgery on therapeutic effects in patients with stage ⅢA and ⅢB rectal cancer

AIM: To assess whether the time interval between neoadjuvant chemoradiotherapy and surgery affects the pathologic complete response (pCR) rate, disease-free survival (DFS), disease recurrence and overall survival (OS) in patients with stage ⅢA and ⅢB rectal cancer.

METHODS: We retrospectively studied 93 patients diagnosed with stage ⅢA and ⅢB rectal cancer by pathological examination who underwent neoadjuvant therapy followed by total mesorectal excision (TME) between March 2009 and March 2011 at our hospital. They were divided into two groups according to the interval between neoadjuvant therapy and surgery: A (≤7 wk, n = 49) and B (>7 wk, n = 44). The primary endpoints were reported as pCR rate, DFS, disease recurrence and OS. Secondary endpoints were type of surgery, postoperative complications, operative time and length of hospital stay.

RESULTS: The overall pCR rate was 10.75% (pCR: group A vs group B, 8.2% vs 13.6%; P = 0.027), and the overall 3-year DFS was 39.8% (DFS: group A vs group B, 28.6% vs 52.3%; P = 0.013). Disease recurrence was 20.4% in group A vs 4.5% in group B (P = 0.023). There were no significant differences in OS, type of surgery, postoperative complications, operative time or length of hospital stay between the two groups.

CONCLUSION: A neoadjuvant-surgery interval > 7 wk increases the rates of pCR and DFS and decreases disease recurrence in patients with stage ⅢA and ⅢB rectal cancer, with no effect on type of surgery, postoperative complications, operative time, length of hospital stay or oncologic outcome.

Clinical significance of methylation of E-cadherin and p14ARF gene promoters in skin squamous cell carcinoma tissues

Epigenetic regulation of genes by DNA methylation contributes to cancer. The present study sought to identify methylation changes in the promoters of E-cadherin and p14ARF, two genes with potential cancer roles promoting in skin squamous cell carcinoma. Skin squamous cell carcinoma specimens were collected from 40 patients and normal skin tissues were collected from 30 individuals as controls. Promoter methylation was detected for E-cadherin and p14ARF by methylation-specific PCR. Correlations between E-cadherin or p14ARF methylation and clinicopathological parameters were analyzed by the Spearman rank test. Methylation of E-cadherin (37.5%) and p14ARF (60.0%) was significantly more common in skin squamous cell carcinoma than in normal skin tissue (10.0 and 6.7%, respectively; P < 0.05). Additionally, E-cadherin and p14ARF methylation were positively correlated within skin squamous cell carcinoma (r = 0.422, P = 0.007). Furthermore, methylation of these gene promoters in skin squamous cell carcinoma was correlated with differentiation, lymph node metastasis, and clinical stage (P < 0.05). Aberrant methylation in promoters of E-cadherin and p14ARF may promote occurrence and progression of skin squamous cell carcinoma.

Large in-plane deformation of RuO6 octahedron and ferromagnetism of bulk SrRuO3

SrRuO3 is a ferromagnetic metal with several unusual physical properties such as zero thermal expansion below Tc, so-called Invar behavior. Another anomalous feature is that the a-axis lattice constant is larger than the b-axis lattice constant, a clear deviation from the predictions of the Glazer structural description with rigid RuO6 octahedron motion. Using high resolution neutron diffraction techniques, we show how these two structural anomalies arise from the irregular in-plane deformation, i.e. plastic behavior of the RuO6 octahedron, a weak band Jahn-Teller distortion. We further demonstrate that the ferromagnetic instability of SrRuO3 is related to the temperature-induced localization of Ru 4d bands.

Meta-analysis of temporary ileostomy versus colostomy for colorectal anastomoses

BACKGROUND/AIMS

Defunctioning stoma is a common surgical procedure, it is now generally acknowledged that defunctioning stoma significantly reduce the rates of complications in colorectal surgery, but the choice of temporary ileostomy or temporary colostomy for defunctioning colorectal anastomoses remains controversial. This meta-analysis evaluated two types of defunctioning stoma to determine whether one is superior to the other.

METHODOLOGY

Studies and relevant literatures comparing temporary ileostomy with temporary colostomy for defunctioning colorectal anastomoses were searched though PubMed, Embase and The Cochrane Library. The rates of complications were pooled and compared using a meta-analysis. The risk ratios were calculated with 95% confidence intervals to evaluate the safety and efficacy of each technique.

RESULTS

Five randomized controlled trials and seven non-randomized studies were included, with 1687 patients in total. The meta-analysis of the RCTs demonstrated a lower risk of stoma prolapse (RR 0.15; 95% CI: 0.04-0.48, p = 0.001) in the temporary ileostomy group. Meta-analysis of the non-randomized studies showed a lower risk of stoma prolapse (RR 0.26; 95% CI 0.10-0.67, p = 0.005) and wound infection after stoma closure (RR 0.28; 95% CI 0.5-0.52, p < 0.0001) in the temporary ileostomy group. No other statistically significant difference was observed for complications.

CONCLUSIONS

Each type of defunctioning stoma has its advantages and disadvantages, and there is not a strong evidence for the superiority of one temporary stoma over another for colorectal anastomoses. According to this, large scale RCTs and high quality studies are needed to conduct.

Value of the frontal planar QRS-T angle on cardiac dysfunction in patients with old myocardial infarction

OBJECTIVES

To explore a method of surface electrocardiogram for assessing cardiac dysfunction in patients with old myocardial infarction.

METHODS

1000 patients with old myocardial infarction in Anzhen hospital were analyzed retrospectively. The planar QRS-T angle was calculated automatically according to QRS-wave and T-wave vectors by the electrocardiogram machine.

RESULTS

Among these 1000 patients, 822 (82.2%) were male and 178 (17.8%) were female, the mean age was 59.3±10.5 years (34~89 years). The average planar QRS-T angle was 88.5±50.6°. The planar QRS-T angle and LVEF was negative correlation (r=-0.406, p<0.01), the lower the LVEF, the better the relationship with planar QRS-T angle. QRS-T angle>90° had optimal sensitivity and specificity (76%, 74%) in diagnosis of cardiac dysfunction.

CONCLUSION

The planar QRS-T angle and LVEF of patients with old myocardial infarction is negative correlation, the larger the planar QRS-T angle, the lower the LVEF. The planar QRS-T angle may be an easier and more feasible index for assessing cardiac dysfunction in patients with old myocardial infarction.

First evidence for the contribution of the genetic variations of BRCA1-interacting protein 1 (BRIP1) to the genetic susceptibility of cervical cancer

BRIP1 (BRCA1-interacting protein 1), a DNA-dependent ATPase and a DNA helicase, is critical for BRCA-associated DNA damage repair functions, and may be involved in the development of cervical cancer. Genetic markers in different regions of the BRIP1 gene have a plausible role in modulating the risk of cervical cancer. In this study, we evaluate the association between the BRIP1 variations and the risk of cervix cancer. We examined the potential association between cervical cancer and eighteen single nucleotide polymorphisms (SNPs, rs2048718, rs16945692, rs4968451, rs6504074, rs4988344, rs8077088, rs10515211, rs9897121, rs9906313, rs2159450, rs4986764, rs11871785, rs4986763, rs11079454, rs7213430, rs34289250, rs4988345 and rs12937080) of the BRIP1 gene using the MassARRAY system. The participants enrolled in this study included 298 patients with cervical cancer and 286 healthy women as the healthy controls from a Chinese Han population. The results showed that rs16945692 (intron 1), rs4968451 (intron 4), rs4986764 (exon 18) and rs7213430 (3'UTR) were significantly associated with cervical cancer (P<0.05). Furthermore, strong linkage disequilibrium (LD) was observed in three blocks (D'>0.9), and significantly more T-A-C-A haplotypes (block 1) (P=0.001) were found in the patients with cervical cancer. Significantly higher frequencies of C-A-T haplotypes (block 2) (P=0.018) and A-A haplotypes (block 3) (P=0.009) were detected in the healthy controls than in the patients with cervical cancer, suggesting that they may show protective effects against cervical cancer. These findings point to a role for the BRIP1 gene polymorphisms in cervical cancer in a Chinese Han population, and may be informative for future genetic or biological studies on cervical cancer.

An SNP in the MyoD1 gene intron 2 associated with growth and carcass traits in three duck populations

Myogenic differentiation 1 (MyoD1) genes belong to the MyoD gene family and play key roles in growth and muscle development. This study was designed to investigate the effects of variants in the MyoD1 gene on duck growth and carcass traits. Three duck populations (Cherry Valley, Jingjiang, and Muscovy) were sampled, their growth and carcass traits were measured, and they were genotyped using the PCR-RFLP method. The results showed one novel polymorphism, an alteration in intron 2 of the MyoD1 gene (A to T). It was associated with the traits of weight at 8 weeks, carcass weight, breast muscle weight, leg muscle weight, eviscerated percentage, percentage of leg muscle weight, dressing percentage, and lean meat percentage. This alteration in intron 2 of MyoD1 may be linked with potential major loci or genes affecting some growth and carcass traits.