[Literature data mining on the current research status of uveitis in China]

Objective: To analyze the current research status of uveitis in China. Methods: It was a bibliometric analysis study. Using search formulas covering uveitis and its multiple subtypes, uveitis-related literature in English with publication dates from 2013 to 2022 was retrieved in Web of Science core databases through certain search strategies. This study used the latent Dirichlet allocation (LDA) algorithm to build topic models and analyzed the trends of research topics in recent years. Bibliometric analysis was used to analyze and visualize the bibliometric indicators (e.g., number of publications, citations, and H-index) of the included literature using tools such as VOSviewer software. Results: Over the past decade, China has published 1 657 papers on uveitis, ranking second globally. However, there is still room for improvement in terms of the H-index (58) and citation (12.28 per publication). Countries such as the USA (43.04%) and the United Kingdom (62.54%) were engaged in more international collaboration. We identified ten optimal LDA topics for uveitis literature in China such as immunotherapy, Behçet's disease, and Vogt-Koyanagi-Harada syndrome. Research on uveitis in China was mostly published in Ocular Immunology and Inflammation (92). Conclusions: China has made remarkable progress in uveitis research. Nonetheless, there is still untapped potential to enhance our global academic influence. It is encouraged to promote international collaborations, harness our expertise in areas like Behçet's disease and VKH syndrome, and publish our scientific achievements in high-impact journals.

[Electromyographic signals and the starting threshold voltage of orbicularis oris muscle in healthy rhesus monkeys]

Objective: To investigate the characteristics of electromyography (EMG) signals and the starting threshold voltages of the orbicularis oris muscles (OOM) in healthy rhesus monkeys under different muscle movement conditions. Methods: The EMG signals and the starting threshold voltages at different time points in 4 healthy rhesus monkeys were acquired and recorded with EMG device and evoked potentiometer. The voltage amplitude variation of EMG signals was analyzed, and the voltage amplitude range of EMG signals at the beginning of OOM contraction was established. The data were statistically analyzed by one-way ANOVA. Results: The EMG of OOM in healthy monkeys in the quiet, natural and continuous mouth-closed state was linear and relatively stable, and the absolute value fluctuated between 15 and 50 μV. The EMG waveform increased rapidly during the natural lip contraction movement, and its amplitude fluctuated greatly, with the highest absolute value of the peak value reaching hundreds of microvolts. The amplitude of EMG induced by continuous mouth closure was more than thousands of microvolts. There was no significant difference in EMG amplitudes of OOM in the healthy rhesus monkey under quiet and continuous lip closure at different time points (P>0.05). There was no significant difference in threshold voltages in the state of natural lip contraction of bilateral OOM at different time points (average range: 57.17-57.47 μV) in the healthy rhesus monkeys (P>0.05). There was no significant difference in threshold voltages of OOM induced by bilateral OOM at different time points(average range: 55.38-55.99 μV) in the healthy rhesus monkeys(P>0.05). There were significant differences in the absolute values of EMG amplitudes of OOM between the three lip movement modes: (30.67±8.72) μV in quiet and natural continuous lip closure (475.12±54.72) μV in natural lip contraction, and (921.22±312.79) μV in the induced persistent lip closure, with t values of -8.48, -9.35 and -5.01 respectively, all P<0.001. Conclusions: The EMG signals of OOM show different characteristics under different muscle movement conditions, which can be used as a basis for computer to judge and recognize the movement conditions of OOM. The upper limits of the EMG threshold voltage values of OOM under different motion states are 55-60 μV.

Prediction of ameloblastoma recurrence using random forest-a machine learning algorithm

The purpose of this study was to investigate whether ameloblastoma with a high likelihood of recurrence can be predicted using random forest model, a machine learning algorithm. Data were collected from patients treated for ameloblastoma between 1999 and 2019 at the University of Hong Kong. Fourteen clinical parameters were used to grow the decision trees to classify patients with or without ameloblastoma recurrence in the follow-up period. The random forest algorithm was computed 100 times in the training cohort (n = 100) and verified in the testing cohort (n = 50). The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used as the performance measurement of separability. One hundred and fifty patients (76 female, 74 male) were recruited, with a mean follow-up time of 103 months. Recurrence occurred in a total of 25 cases (16.7%) over the 20-year period. The AUC were calculated for the median and mean ROC curves; these were 0.777 and 0.825, respectively. The results showed that random forest model was able to predict recurrence of ameloblastoma with reliable accuracy. The four most important variables influencing ameloblastoma recurrence were the time elapsed from treatment, initial surgical treatment, tumour size, and radiographic presentation. This study provides insights into the detection of high-risk patient groups to monitor recurrence. Further application of random forest to other diseases could greatly benefit clinical decisions.

Prognostic value of a novel index: computational pressure-flow dynamics derived fractional flow reserve in patients with stable coronary artery disease treated with optimal medical therapy alone

Background

The use of fractional flow reserve (FFR) is limited due to the need of invasive pressure wire and hyperaemic stimulus. Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel non-invasive index to determine the FFR in patients with stable coronary artery disease (CAD).

Purpose

The clinical value of caFFR remains uncertain. The aim of the study is to evaluate the prognostic role of caFFR in patients with stable CAD who were treated by optimal medical therapy alone.

Methods

A total of 558 stable CAD patients (mean age=64.5±11.2, 59.0% male) with ≥1 coronary lesion detected during conventional coronary angiogram were included. All of them did not undergo percutaneous coronary intervention and were treated with optimal medical therapy alone. Patients were then classified into 4 groups according to their caFFR value; caFFR ≤0.70 (n=40), caFFR = 0.71–0.80 (n=28), caFFR = 0.81–0.90 (n=292), caFFR = 0.91–1.00 (n=198), with a lower caFFR indicating a greater magnitude of myocardial ischemia. The primary endpoint was 3-year major adverse cardiac events (MACE), defined as a composite of all-cause mortality, myocardial infarction or any unplanned revascularization.

Results

During a median follow-up of 36 months, a total of 49 composite events occurred, including 27 all-cause mortality, 4 myocardial infarction and 18 unplanned revascularization.

After multivariate adjustment, caFFR was an independent predictor of MACE (adjusted hazard ratio [HR] = 0.97 per 0.01 increase in caFFR; 95% confidence interval [Cl], 0.95–0.99; P&lt;0.01), all-cause mortality (adjusted HR = 0.96 per 0.01 increase in caFFR; 95% Cl, 0.94–0.99; P&lt;0.01), and stroke (adjusted HR = 0.95 per 0.01 increase in caFFR; 95% Cl, 0.90–0.99; P=0.03).

The area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC) is 0.70 (95% Cl, 0.62–0.78; P&lt;0.01). The optimal cut-off of caFFR defined by ROC analysis for predicting MACE is 0.80, concluding that patients with caFFR ≤0.80 have significantly higher adverse event rate, which is consistent with the cut-off from wire-based FFR.

Using caFFR = 0.91–1.00 as reference, the risk of MACE was highest in patients with caFFR ≤0.70 (adjusted HR = 4.65; 95% Cl, 1.81–11.94; P&lt;0.01), followed by caFFR = 0.71–0.80 (adjusted HR = 3.67; 95% Cl, 1.12–11.33; P=0.02). The risk of MACE was nonetheless similar among patients with caFFR &gt;0.8 (adjusted HR = 1.39; 95% Cl, 0.61–3.19, P=0.44).

Conclusion

In patients with stable CAD who were treated with optimal medical therapy alone, those with more significant myocardial ischemia, indicated by lower caFFR, had higher risks of adverse outcomes. The finding thus supports the use of this non invasive index to quantify the severity of myocardial ischemia, improve risk-stratification, and predict adverse outcomes in patients with stable CAD.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): The University of Hong Kong, Queen Mary Hospital

Prognostic value of longitudinal assessment of hepatorenal function and nutritional status in patients undergoing valvular heart surgery

Background

Hepatorenal dysfunction and malnutrition are frequent extracardiac consequences of valvular heart disease (VHD) and have emerged as prominent drivers of adverse prognosis in selected valvular interventions. Nonetheless, data in a general VHD population is sparse, and their interaction and changes following valvular surgery remain unexplored.

Purpose

We aim to characterise the temporal changes, interaction, and prognostic implications of hepatorenal dysfunction and malnutrition before and after valvular surgery.

Methods

Baseline and temporal changes in hepatorenal dysfunction (assessed by the modified model for end-stage liver disease [MELD-XI] score) and nutritional status (assessed by Controlling Nutritional Status [CONUT] score) were correlated with adverse events (composite of all-cause mortality and hospitalisation for heart failure) using Cox proportional hazards model, adjusted with clinical and echocardiographic covariates, medications, type of valvular procedure, and cardiac surgery risk-stratification models (EuroSCORE II and STS score).

Results

Our study included 909 patients who underwent valvular surgery. At baseline, 216 (24%) and 554 (61%) had hepatorenal dysfunction (MELD-XI &gt;12.43) and malnutrition (CONUT ≥2), respectively. MELD-XI scores were modestly correlated with CONUT scores (R=0.36, p&lt;0.001), with concomitant hepatorenal dysfunction and malnutrition present in 177 (19%) patients.

Over a median follow-up of 4.1 years, 101 (11%) patients died and 119 (13%) were hospitalised for heart failure. There was a stepwise increase in mortality (χ2 89.1, p&lt;0.001) and adverse events (χ2 92.9, p&lt;0.001) from patients with normal hepatorenal function and nutrition to concomitant hepatorenal dysfunction and malnutrition (Figure 1). This association remained consistent in fully adjusted models. MELD-XI and CONUT scores significantly improved the discriminatory accuracy of EuroSCORE II (area under the curve [AUC]: 0.80 vs 0.73, p&lt;0.001) and STS score (AUC: 0.79 vs 0.72, p=0.004) for all-cause mortality.

In patients with MELD-XI and CONUT scores 1 year after surgery (n=707), ΔMELD-XI (follow-up MELD-XI minus baseline MELD-XI score) and ΔCONUT scores were significantly associated with adverse events (HR 1.08, 95% CI 1.03–1.14, p=0.001 for ΔMELD-XI; HR 1.18, 95% CI 1.02–1.35, p=0.02 for ΔCONUT). Patients remaining with hepatorenal dysfunction and malnutrition experienced worse survival (log-rank χ2 65.2, p&lt;0.001) and adverse events (log-rank χ2 90.4, p&lt;0.001) (Figure 2).

Conclusions

In patients undergoing valvular surgery, hepatorenal function and nutritional status at baseline, and their temporal changes, are strongly linked to clinical outcomes. These results highlight the role of hepatorenal and nutritional assessment for risk-stratification in valvular surgery.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Association between non-wire based computational angiography fractional flow reserve treatment threshold and major adverse cardiac events in patients with stable coronary artery disease

Introduction

Despite class IA guideline recommendations, the use of fractional flow reserve (FFR) in guiding percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD) patients remains low due to limitations including the need of guidewire placement and hyperaemic stimulus. A novel non-invasive index, computational pressure-flow dynamics derived FFR (caFFR), was developed for measuring functional myocardial ischemia and overcoming the limitations of FFR. However, the clinical relevance of caFFR remains to be investigated. In the present study, we aim at evaluating the prognostic value of caFFR among stable CAD patients.

Methods

We retrospectively included patients with stable CAD who underwent coronary angiography during 2014–2016 at our center. Based on the caFFR value, patients were considered to be ischemic (caFFR ≤0.8) and non-ischemic (caFFR &gt;0.8). Further, we recombined the patients to form the adherence cohort, where patients were defined as adherent-to-caFFR if they were ischemic with PCI or non-ischemic without PCI, and nonadherent-to-caFFR if they were ischemic without PCI or non-ischemic with PCI. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction, and any revascularization. Inverse probability of treatment weighting was used to account for treatment selection bias (PCI vs without PCI, or adherent vs non-adherent), and Cox proportional hazard model was used to evaluate the association with MACE.

Results

A total of 1322 patients, 782 patients in the ischemic cohort and 540 patients in the non-ischemic cohort respectively, were included in our analysis. PCI was associated with a lower risk of MACE in the ischemic cohort (hazard ratio [HR] 0.52; 95% confidence interval [CI], 0.34–0.80; P=0.002), but was not associated with MACE in the non-ischemic cohort. In the adherence cohort, adherent-to-caFFR group (n=803) had a lower risk of MACE compared with nonadherent-to-caFFR group (n=566) (HR, 0.61; 95% CI, 0.44–0.85; P=0.003).

Conclusion

Our study is the first to demonstrate the prognostic value of caFFR, a non-wire based assessment of myocardial ischemia, in patients with stable CAD undergoing PCI. These findings support the use of caFFR that bears the potential of a wider adoption compared with wire-based FFR through a reduction in procedure time, risk and costs.

Funding Acknowledgement

Type of funding sources: None. Weighted Kaplan-Meier curvesWeighted Cox proportional hazards model

Prognostic value of per-vessel treatment adherence in stable coronary artery disease based on novel computational pressure-flow dynamics derived fractional flow reserve

Background

Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to evaluate the extent of myocardial ischemia in patients with coronary artery disease (CAD), which eliminates the need of invasive pressure guidewire and hyperaemic stimulus in conventional fractional flow reserve (FFR) measurement. Studies have shown improved clinical outcomes associated with adherence to functional myocardial ischemia assessment when deciding to perform percutaneous coronary intervention (PCI) at a per-patient level. However, the clinical significance of such treatment adherence at a per-vessel level remains uncertain.

Methods

A total of 928 patients (mean age 66.2±10.5, male 72.7%) with stable CAD were included in this study. The caFFR of all three major coronary vessels were obtained for every patient, and the FFR threshold of 0.8 was adopted as the threshold for caFFR to indicate functionally significant artery stenosis which warrants PCI, and vice versa. Based on the caFFR of each major coronary vessel and whether PCI was performed to the respective vessel, patients were stratified into 0–1 vessel with treatment adherence group (group 1) (n=105), 2 vessels with treatment adherence group (group 2) (n=338), and 3 vessels with treatment adherence group (group 3) (n=485). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and any subsequent revascularization.

Results

The severity of CAD based on SYNTAX score assessment was 18.6±10.2 in group 1, 14.6±8.9 in group 2, and 11.5±9.9 in group 3 (P&lt;0.001). The rates of MACE at 3 years were significantly different across groups 1, 2 and 3 (17.1% vs. 12.1% vs. 7.4%; P=0.004). With reference to group 3, the risk of MACE at 3 years was increased in group 2 (adjusted hazard ratio [HR]=1.597; 95% confidence interval [CI]=1.020–2.501; P=0.041), and further increased in group 1 (adjusted HR=1.933; 95% CI=1.081–3.457; P=0.026).

Conclusion

In stable CAD patients, the risk of MACE is incremental when fewer major coronary vessels are treated with adherence to caFFR threshold of 0.8. Per-vessel treatment adherence significantly affects clinical outcomes in terms of MACE.

Funding Acknowledgement

Type of funding sources: None.

Long-term prognostic implications of PCI in ACS patients without ischemia on the basis of computational pressure-flow dynamics derived fractional flow reserve

Background

A substantial proportion of patients with acute coronary syndrome (ACS) may have intermediate lesion that are non-ischemic during emergency coronary angiography. The prognosis of such patients, compared to those with stable ischemic heart disease (SIHD) without ischemic lesion is however uncertain. Recently, a novel index, computational pressure-flow dynamics derived fractional flow reserve (caFFR), has been developed to assess myocardial ischemia, without the need of invasive pressure wire and hyperaemic stimulus as required in conventional fractional flow reserve (FFR). By utilizing caFFR to assess for ischaemic status during coronary angiography, the aim of our study is first to assess the prognostic difference between ACS and SIHD with non-ischaemia intermediate lesions. Second, we ascertain whether PCI in patients with ACS with non-ischaemia intermediate lesions provides survival benefit in addition to medical therapy.

Methods

We retrospectively recruited 551 patients (mean age 64.4 years; male 59.9%) with absence of myocardial ischaemia, defined as caFFR ≥0.80 in all vessels, from our Hospital. Patients were stratified into those with index presentation of ACS (n=132) and those with SIHD (n=491). Among the ACS cohort, patients were further divided into those with PCI (n=83) and with medical therapy alone (n=49). The SIHD cohort (n=491), all of whom were treated with medical therapy alone, was considered as referent group. The primary end point was major adverse cardiovascular events (MACE) at 3 years, which was defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and any unplanned revascularization.

Results

During a median follow-up of 36 months, 54 composite events occurred, including 38 all-cause mortality, 5 MI, and 14 unplanned revascularization. Compared to those with SIHD, patients with ACS was independently associated with MACE even in the absence of myocardial ischaemia (adjusted Hazard Ratios=2.531; 95% confidence interval=1.397–4.586; P=0.002). The 3-year incidence rate of MACE was the highest in ACS patients with medical therapy alone, followed by ACS patients with immediate PCI; the SIHD cohort had the lowest incidence rates (30.6% vs 12.0% vs 5.9%, P&lt;0.001). This was mainly driven by the rate of all-cause death (26.5% vs 12.0% vs 3.1%; P&lt;0.001). Similar findings were observed for hospitalisation due to heart failure (14.3% vs 6.0% vs 3.1%, P=0.031) and cardiac death (8.2% vs 4.8% vs 0.4%, P&lt;0.001) at 3 years.

Conclusion

In patients with intermediate lesion without myocardial ischaemia (defined as caFFR ≥0.8), those presented with ACS had a higher risk of MACE at 3 years compared to SIHD. Among ACS patients with intermediate lesion without myocardial ischaemia, PCI significantly reduces the rate of MACE. In patients with ACS, our finding suggests that PCI should be advocated to intermediate lesion even without myocardial ischaemia.

Funding Acknowledgement

Type of funding sources: None. Kaplan-Meier curve for MACECumulative Events at 3 Years

[Study on the matching feature of current parameters for inducing contraction of orbicularis oris muscle by artificial facial nerve in rabbit with peripheral facial paralysis]

Objective: To explore the optimal matching of the current parameters about artificial facial nerve (AFN) for inducing contraction of the orbicularis oris muscle (OOM) in rabbit with peripheral facial paralysis. Methods: According to the combinations of different stimulus parameters, at different time points, we used AFN to induce contraction of the affected side OOM of the paralyzed rabbit in waking state. We recorded the current amplitudes of the threshold stimulation and peak stimulation under each combination, then compared the total charge of the stimulus consumption under different combinations. Results: Compared the total stimulus charge consumption of the AFN threshold stimulation and that in the peak stimulation respectively under different stimulus frequency and pulse width matching combinations, we found that the frequency, the pulse width and the interaction of the frequency and pulse width among different groups could affect the total charge, the differences were statistically significant (P<0.05). Conclusions: When AFN stimulus frequency is 60 Hz and the stimulus pulse width is 100 μs, the output current intensity is relatively lowest and the total consumed charge is the lowest under the premise of effectively inducing the paralytic side OOM contraction. Thus we recommend this stimulus parametric combination as the optimal combination for meeting the low power consumption of AFN.

[Comparative study of ultrasound-guided percutaneous microwave ablation and surgical resection for colorectal cancer with liver metastasis]

Objective: To study the clinical efficacy of ultrasound-guided percutaneous microwave ablation and surgical resection for liver metastases from colorectal cancer. Methods: Retrospective analysis of 184 patients with liver metastases from colorectal cancer in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2012 to June 2017.Percutaneous microwave ablation or surgical resection for liver metastases were selected under ultrasound guidance. Subgroup analysis was performed according to the treatment of liver metastases. There were 98 patients in the microwave-only group (56 males and 42 females, aged (59±11) years) and 86 cases in the surgery-only group (56 males and 30 females, aged (56±11) years). The baseline data of the two groups were compared, and the results showed that the size of the metastatic lesions in the microwave-only group was smaller than that in the surgery-only group, and the remaining data didn't had statistical differences.The survival time of the two groups of patients was analyzed separately.According to the size of the metastases, the metastases were divided into groups with a diameter of<3 cm and a group of ≥3 cm. The survival time of patients in the microwave-only group and the surgery-only group were analyzed respectively.According to the different primary tumor grades of colorectal cancer, the survival time of patients in the simple microwave-only group and the surgery-only group in the primary tumors Duck A, Duck B, and Duck C were analyzed. Results: In the microwave-only group, the overall survival rates at 1, 3, and 5 years were 100%, 50.9%, and 20.9%; in the surgery-only group, the overall survival rates at 1, 3, and 5 years were 100%, 42.8%, and 20.8%, respectively. There was no significant difference in overall survival between the groups (P=0.972).Metastatic focus diameter ≥3 cm: the overall survival rates of 1, 3, and 5 years with microwave-only were 100%, 65.4%, and 12.1%; the overall survival rates of 1, 3, and 5 years with surgery-only were 100%, 59.5%, and 30.9%. There was no significant difference in overall survival between the groups (P=0.067). The long-term survival rate of the surgery-only group was greater than that of the microwave-only group (P=0.018).Metastasis diameter<3 cm: there was no significant difference in overall survival between the surgery-only group and the microwave-only group (P=0.103).In the treatment of Duck B and C liver metastases of primary colorectal cancer, there was no significant difference in overall survival between microwave alone and surgery alone (P=0.376, P=0.385).Multivariate analysis showed that the size of colorectal cancer metastases was an independent risk factor affecting the prognosis of patients with colorectal cancer liver metastases. Conclusions: Percutaneous microwave ablation has a good effect on colorectal cancer liver metastases and has a similar survival prognosis as surgery.For livers with color ≥ 3 cm in colorectal cancer, the long-term survival rate of the surgery-only group is greater than that of the microwave-only group.

[Clavien-Dindo classification of complications after complete mesocolic excision in laparoscopic radical resection of right hemicolon cancer and analysis on its influencing factors]

Objective: To investigate the Clavien-Dindo (CD) classification of complications after complete mesocolic excision (CME) in laparoscopic radical resection of right-sided hemicolon cancer and its influencing factors. Methods: A retrospective case-control study was performed. Inclusion criteria: (1) the adenocarcinoma located at colon from cecum to hepatic flexure; (2) laparoscopic right hemicolectomy with CME was completed. Exclusion criteria: (1) patients had severe organ dysfunction before operation; (2) tumor invaded adjacent organs or developed distant organ metastasis; (3) emergency surgery; (4) failure of laparoscopic surgery, and conversion to laparotomy; (5) without complete clinical data. Finally, clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed. CD grading standard was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications. Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis. Kaplan-Meier method was used to draw the survival curve and log-rank test was used to analyze the difference. Results: Of the 141 patients, 89 were male and 52 were female with mean age of (61.8±11.0) years. All the operations completed successfully. A total of 37 postoperative complications were developed in 26 (18.4%) patients had postoperative 37 cases of complications, mainly including 7 delayed incision healing, 6 diarrhea, and 5 respiratory dysfunction. According to CD classification standard, grade I, II, and IV a complication rates were 40.5% (15/37), 56.8% (21/37), and 2.7% (1/37) respectively. Univariate analysis showed that age ≥ 65 years (χ(2)=4.338, P=0.037), BMI ≥ 28 kg/m(2) (χ(2)=5.971, P=0.015), and preoperative hemoglobin < 100 g/L (χ(2)=3.985, P=0.046) were risk factors of postoperative complications. Multivariate analysis testified that age ≥ 65 years (OR=7.991, 95%CI: 2.203 to 28.983, P=0.002) and body mass index (BMI) ≥ 28 kg/m(2) (OR=4.231, 95%CI: 1.034 to 17.322, P=0.045) were independent risk factors for complications after laparoscopic CME surgery for right-sided hemicolon cancer. All the patients were followed up for median time of 24 (1-48) months. The log-rank test showed that there were no significant differences in the cumulative survival rate between patients of age < 65 years and age ≥ 65 years (χ(2)=0.986, P=0.321), and between those with BMI < 28 kg/m(2) and BMI ≥ 28 kg/m(2) (χ(2)=0.370, P=0.543). Conclusions: The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II. Elderly and obesity are independent risk factor for postoperative complications. Before the operation, reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.

Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised host: A retrospective observational study

BACKGROUND

Community-acquired pneumonia (CAP) in autoimmune diseases (AID)-induced immunocompromised host (ICH) had a high incidence and poor prognosis. However, only a few studies had determined the clinical characteristics of these patients. Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH.

METHODS

From 2013 to 2018, a total of 94 CAP patients accompanied with AID-induced ICH, admitted to Emergency Department of Zhongshan Hospital, Fudan University, were enrolled in this study. Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations (GEEs) analysis. An open-cohort approach was used to classify patient's outcomes into the survival or non-survival group.

RESULTS

The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%. No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups, while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients (P<0.05). Both noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were performed more frequently in non-survival group (P< 0.05). By the multivariate GEEs analysis, the repeated measured longitudinal indices of neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]=1.055, 95% confidence interval [95%CI] 1.025-1.086), lactate dehydrogenase (LDH) (OR=1.004, 95%CI 1.002-1.006) and serum creatinine (sCr) (OR=1.018, 95%CI 1.008-1.028), were associated with a higher risk of mortality.

CONCLUSION

The CAP patients in AID-induced ICH had a high mortality. A significant relationship was demonstrated between the factors of NLR, LDH, sCr and mortality risk in these patients.

[Study on the method of microelectrodes implantation of artificial facial nerve prosthesis in closed mouth of orbicularis oris muscle in monkeys with facial nerve paralysis]

Objective: To explore the optimal method of microelectrode implantation that can produce efficient mouth closure with microelectrode for orbicularis oris muscle (OOM) in rhesus monkeys with unilateral peripheral facial paralysis (UPFP) in order to provide basis for the research and development of artificial facial nerve prosthesis (AFNP). Methods: Right lateral peripheral facial paralysis model on four healthy rhesus monkeys (two males and two femles, aged 5-6 years, weighed 2.0-3.0 kg) were prepared. AFNP electric stimulation was used to induce closed-mouth reaction of the affected OOM with a one-way rectangular pulse, 50 Hz frequency and 0.2 ms pulse width in vitro. Around the affected lateral OOM, four stimulus electrodes implantation positions were selected at the upper lip (position A), the lower lip (position B), the connection with the corner of the mouth to the ipsilateral tragus (position C), and the horizontal line of the mouth angle (position D). According to the different implantation positions of three stimulation electrodes on the stimulation side of AFNP and the results of our previous study, six groups of microelectrode implantation methods were designed. In Group A, two microelectrodes were implanted at position A and one microelectrode was implanted at position B; in Group B, one microelectrode was implanted at position A, B and C respectively; in Group C, one microelectrode was implanted at position A and two microelectrodes were implanted at position B; in Group D, one microelectrode was implanted at position A, B and D respectively; in Group E, one microelectrode was implanted at position A, C and D respectively; in Group F, one microelectrode was implanted at position B, C and D respectively. The minimum stimulating current (threshold current) required for effective mouth closure were recorded. The threshold and peak current values were compared using one-way ANOVA and LSD-t multiple comparisons. Results: The microelectrodes of the AFNP stimulating side in Group E and F failed to induce a smooth mouth closure. The microelectrodes in A, B, C and D group induced smooth mouth closure. The threshold current value of OOM contraction on affected side in the Group A, B, C, and D were (1.35±0.05), (1.02±0.04), (1.40±0.04) and (1.10±0.02) mA, respectively (F=295.302, P<0.001), with the lowest value in Group B and there was significant difference between the current value in Group B and those in the other groups (all P<0.05). The peak current value of OOM contraction on affected side in the four groups were (3.95±0.02), (2.95±0.03), (3.99±0.05) and (3.51±0.01) mA, respectively (F=1 014.985, P<0.001). Group B showed the best lip-closure morphology observed with naked eyes. Conclusions: When three output microelectrode of the AFNP stimulated side are separately imbedded into the upper lip, the lower lip and the connection with the corner of the mouth to the ipsilateral tragus, AFNP can sufficiently induce closed-mouth reaction. These positions are suitable as priority options microelectrodes implantation positions for the microelectrodes of the AFNP stimulated side.

Ten-year clinical evaluation of posterior fixed-movable resin-bonded fixed partial dentures

OBJECTIVES

Two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) offer long-term retention for anterior and premolar-sized spans. At this center, molar and longer spans have been restored with fixed-movable (FM) RBFPDs to overcome the lower retention rates of fixed-fixed RBFPDs. This retrospective study aimed to evaluate the long-term longevity and the patient-reported outcomes of posterior FM-RBFPDs.

METHODS

Posterior FM-RBFPDs that had been inserted at least five years were reviewed. Survival was "retention of the original prosthesis in mouth" and success was "survival of prosthesis and absence of complications requiring treatment intervention". Prosthesis location, number of units, insertion year, tooth/teeth replaced and operator experience were collected. Patients' acceptance to FM-RBFPDs were assessed using prosthesis satisfaction questionnaire and Oral Health Impact Profile (OHIP-49). Results were analyzed using log-rank and cox-regression tests at significance level α = 0.05.

RESULTS

One-hundred-and-one prostheses were examined. The mean observation time was 126.4 ± 32.2 months. Thirty-six (35.6%) and 63 (62.4%) FM-RBFPDs were rated as success and survival respectively. Prostheses inserted after year 2001 (n = 69) experienced 42.0% (n = 29) success and 75.4% (n = 52) survival, and its survival rate was significantly better than those inserted in or before 2001 (p = 0.01). Five- and ten-year cumulative survival probability of FM-RBFPDs inserted after year 2001 were 82.3% and 74.1% respectively. The most frequent complications were debonding among 34 (33.7%) prostheses. Patients' acceptance were high.

CONCLUSIONS

More recently inserted prostheses showed improved longevity and patients' acceptance to posterior FM-RBFPDs were high.

CLINICAL SIGNIFICANCE

Fix-Movable RBFPDs are a viable tooth replacement option in the posterior region.

[Establishment of pharyngeal 3-dimensional finite element model of patients with isolated cleft palate]

PURPOSE

The aim of this study was to provide basis for future design and selection of cleft palate surgery through establishing finite element model of pharyngeal cavity which was suitable for biomechanical analysis.

METHODS

One patient with isolated cleft palate and 1 normal child underwent multilayer head CT examination. The scanned data of pharyngeal cavity were imported into Mimics software for a 3-D geometric model reconstruction. The model was divided into a grid, so it can be further processed for subsequent finite element analysis.

RESULTS

After applying 5cm water column pressure load of 0.0005 MPa at the back edge of the soft palate in the two models respectively, the results showed that the maximum stress of the abnormal nasopharyngeal cavity model was 0.025 MPa, greater than the normal model (0.017 MPa). The same pressure loading was applied to different parts of the two models, the stress change area in the posterior margin of the soft palate and the middle of the palate was the same, and the stress in the front of the hard palate was smaller.

CONCLUSIONS

Finite element model has good biomechanical characteristics and geometric similarity. It can be used in isolated cleft palate with preoperative biomechanical analysis, for repairing and functional reconstructive surgery to provide ideal biomechanical model predicts.

Clinical characteristics and prognosis of serous body cavity effusions in patients with sepsis: a retrospective observational study

Background

Cavity effusion is common in patients with infectious diseases. However, the incidence rate and characteristics of serous cavity effusions (SCE) in septic patients are not clear to date. The objective of this study was to investigate the incidence and characteristics of SCE in septic patients and to explore the correlations between the bloody effusions and the illness severity/prognosis in septic patients.

Methods

From January 2010 to January 2015, a total of 214 patients with severe sepsis and septic shock were enrolled in this retrospective observational study. Thoracentesis or abdominal paracentesis was performed in 45 septic patients because of massive pleural effusions or ascites. The serum concentrations of VEGF, VEGFR, Ang, sICAM-1, sVCAM-1, E-selectin, Serpine1 and VE-cadherin in 45 septic patients underwent paracentesis were measured by enzyme-linked immunosorbent assay (ELISA).

Results

Of the 214 septic patients, 155 (72.4%) had SCE according to imaging or ultrasound manifestations. 45 subjects with SCE underwent therapeutic thoracentesis or abdominal paracentesis. Effusion laboratory analysis showed that exudates were predominant when compared with transudates (95.6% vs. 4.4%), and 16 (35.6%) patients suffered bloody effusions. Compared with patients with non-bloody effusions, those with bloody effusions showed higher critical illness scores (13 vs. 17 for APACHE II; 7 vs. 9 for SOFA), and higher mortality (6.9% vs. 62.5%). Moreover, patients with bloody effusions had delayed TT and APTT, increased D-dimer concentration, and higher serum levels of CRP and PCT (P < 0.05). In addition, the serum levels of Ang2, sVCAM-1 and E-selectin were significantly higher in patients with bloody effusions than in those with non-bloody effusions (P < 0.05). However, the serum level of VEGFR2 was lower in patients with bloody fluids (P = 0.025).

Conclusions

The incidence of serous cavity effusion is high in patients with sepsis. The septic patients with bloody effusions suffer a more inflammatory burden and a worse prognosis compared to septic patients with non-bloody effusions.

Does the use of amoxicillin/amoxicillin-clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis

The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin-clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin-clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin-clavulanic acid was found to be effective (RR 0.21, P<0.001). The risk of adverse effects was significantly higher in the amoxicillin-clavulanic acid group (RR=4.12, P=0.023) than in the amoxicillin group (RR 1.57, P=0.405). In conclusion, amoxicillin-clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.

A Clinical Trial of Homoharringtonine in the Treatment of Advanced Breast Cancer

Two combination chemotherapy protocols, CMF (cyclophosphamide, methotrexate, fluorouracil) and CMFH (CMF plus homoharringtonine), were tested in advanced breast cancer patients. The response rate of CMF was 50% in 44 cases, and that of CMFH was 54.16% in 48 cases; the difference was not significant. There was also no difference between the median duration of response and the median survival of the two protocols. It was concluded that the addition of homoharringtonine to the CMF protocol gave no additional benefit.

Effectiveness of supplementary irrigant agitation with the Finisher GF Brush on the debridement of oval root canals instrumented with the Gentlefile or nickel titanium rotary instruments

AIM

To examine the efficacy of a novel supplementary irrigant agitating brush (Finisher GF Brush, MedicNRG, Kibbutz Afikim, Israel) on the debridement of root canals prepared with a novel stainless steel rotary instrumentation system (Gentlefile; MedicNRG), or nickel titanium rotary instruments in oval root canals.

METHODOLOGY

Mandibular premolars (n = 72) were selected and divided randomly into three experimental groups (n = 24) after microCT scanning: group 1, canal preparation to rotary NiTi size 20, .04 taper (R20); group 2, rotary NiTi to size 25, .04 taper (R25) and group 3, Gentlefile size 23, .04 taper (GF). Specimens were subdivided into two subgroups: subgroup A, syringe-and-needle irrigation (SNI); subgroup B, Finisher GF Brush (GB). Ten untreated canals served as controls. Specimens were processed for histological evaluation, and the remaining pulp tissue (RPT) was measured. Data were analysed using Mann-Whitney and Kruskal-Wallis tests (P = 0.05).

RESULTS

All experimental groups had significantly less RPT than the control (P < 0.05). Group 3B (GF-GB) had significantly less RPT than groups 1B (R20-GB) and 2B (R25-GF; P < 0.05). When irrigated with SNI, there was no significant difference in the RPT between the three groups (P > 0.05). When instrumented with R20, there was no significant difference between SNI and GF (P < 0.05) whilst GB had significantly less RPT than SNI for R25 (P < 0.05).

CONCLUSIONS

Supplementary irrigant agitation with the Finisher GF Brush improved the debridement of canals prepared with Gentlefile and size 25, .04 taper rotary NiTi. Root canal debridement did not significantly differ between the instruments when syringe irrigation was used.

Is Poisoning by Oral Therapeutic Drugs more Severe? a Retrospective Study on Unintentional Paediatric Poisoning in a Local Emergency Hospital

Introduction

Paediatric unintentional poisoning is a common presenting problem in the emergency department. Our study aim to determine whether poisoning caused by oral therapeutic drugs was more severe and causing longer hospital stay. We also aim to review the recent local epidemiology of unintentional paediatric poisoning in Hong Kong.

Methods

We conducted a retrospective review on all consecutive cases of patients aged 0-9 who presented to the emergency department during a study period from 1st January 2006 to 31st December 2007 with unintentional poisoning. Demographic data, clinical presentation, poisoning agent involved, intervention performed and the clinical outcome were analysed. The clinical outcomes of poisoning due to oral therapeutic drugs versus other chemicals were compared.

Results

Sixty one poisoning episodes were included. The most common type of agents involved was oral therapeutic drugs (52.5%); followed by cleaning products and detergents (14.8%). Most cases were benign, 63.9% of the cases showed no clinical and biochemical poisoning effect without any treatment. Poisoning due to oral therapeutic drugs were more severe, 12.5% were classified as poisoning with major effect that required active treatment while no cases of severe poisoning were found in poisoning caused by other chemicals. Significantly fewer cases (40.6%) were classified as no or mild effect in the group caused by oral drugs, compared with those caused by other chemicals (86.2%) (p=0.001). The mean length of stay was also significantly longer in the group with oral drugs (1.7 days) compared with 0.9 days in other chemicals (p=0.047).

Conclusions

In our locality, severe unintentional poisonings were usually due to oral therapeutic drugs. For prevention planning, we should focus on the safety placement of oral medications of family members.

Cisplatin plus norcantharidin alter the expression of TGF-β1/Smads signaling pathway in hepatocellular carcinoma

PURPOSE

To investigate the effects of cisplatin plus norcantharidin on transforming growth factor (TGF)-β1/Smads signaling pathway in hepatocellular carcinoma cells.

METHODS

Hepatocellular carcinoma cells (Hep3B) were divided into four groups: control group, cisplatin 2.0 μg/ml group, norcantharidin 10 μg/ml group, and cisplatin 2.0 μg/ml plus norcantharidin 10 μg/ml group. All cells were incubated for 24 hours. Cells proliferation was assessed using cell counting kit-8. Relative mRNA expression of TGF-β1, Smad4 and Smad7 were assessed by quantitative RT-PCR. Protein expression of TGF-β1 and Smad4 were investigated by western blotting.

RESULTS

Cisplatin, norcantharidin and cisplatin plus norcantharidin significantly inhibited the proliferation of cells, significantly attenuated both the mRNA and protein expression of TGF-β1 and Smad7, and significantly up-regulated the mRNA and protein expression of Smad4 in Hep3B (all p < 0.05), and cisplatin plus norcantharidin exhibited powerful effects than cisplatin and norcantharidin.

CONCLUSIONS

Cisplatin, norcantharidin and cisplatin plus norcantharidin can significantly alter the expression of TGF-β1/Smads signaling pathway and inhibit the proliferation of Hep3B cells. Cisplatin plus norcantharidin exhibited powerful effects than cisplatin and norcantharidin (Fig. 4, Ref. 23).

[Positions of the implanted stimulating electrodes for artificial facial nerve for inducing contraction of the orbicularis oris muscle in rabbit with peripheral facial paralysis]

Objective: To explore the optimal positions of the implanted stimulating eletrodes for artificial facial nerve (AFN) for inducing contraction of the orbicularis oris muscle (OOM) in rabbit with peripheral facial paralysis. Methods: According to the four microelectrodes of the AFN stimulating side, four modes of the implanted positions were divided. In line with different modes, the electrodes were implanted into the affected OOM of the rabbits with unilateral peripheral facial paralysis. AFN output electric stimulation to induce contraction of the affected OOM with uniform stimulating frequency and pulse length in vitro. Then compared the stimulus threshold amplitude and the peak amplitude separately among different modes by SAS 9.3 version statistical software. Results: The differences of the stimulus threshold amplitude and the peak amplitude had no statistically significant separately between the first mode and the second mode (P>0.05), but there were statistically significant differences between the third mode and the fourth mode (P<0.05). Both kinds of the amplitudes were approximated between the first mode and the second mode respectively, and higher than those in the third mode or the fourth mode. Furthermore, both kinds of the amplitudes in the fourth mode were higher than those in the third mode. Conclusions: The microelectrodes of the AFN stimulating lateral are implanted into the upper lip with a public microelectrode and an output microelectrode, into the lower lip with an output microelectrode, and into the way, which is located to the angle 40° to 45° about the line joining between the midpoint of the ipsilateral auricle root and the corner of the mouth with an output microelectrode. This is the third positional mode which requires lowest effective stimulus current intensity. Thus the mode is suitable as the optimal placement programme.

[Characteristics of postviral olfactory disorder]

Objective: To explore the clinical characteristics of patients with olfactory dysfunction after upper respiratory tract infection. Methods: Through clinical specialist examination and imaging examination, 95 cases of patients with olfactory dysfunction after upper respiratory tract infection were confirmed, 58 cases in anosmia group and 37 cases in hyposmia group. All were performed by a subjective olfactometry (Sniffin'Sticks test) and a subjective taste function tests. The results were statistically analyzed by SPSS 17.0 software. Results: In 58 cases of anosmia group, 21 cases of male, 37 cases of female; Twenty-six cases of youth, 23 cases of middle age, 9 cases of old age; Twenty-seven cases occurs in spring, 11 cases in summer, 12 in autumn and 8 in winter. Among 37 cases of hyposmia group, 12 cases of male, 25 cases of female; Eighteen cases of youth, 16 cases of middle age, 3 cases of old age; Fourteen cases occurs in spring, 8 cases in summer, 7 in autumn and 8 in winter. There was no statistically significant difference in gender, age and the onset season between the two groups(χ²=0.142, P>0.05; χ²=1.124, P>0.05; χ²=1.335, P>0.05). In anosmia group, with 4 cases of ageusia, 22 cases of hypogeusia, 32 cases of normal taste; in hyposmia group, with 0 cases of ageusia, 10 cases of hypogeusia, 27 cases of normal taste. There were significant differences between the two groups with different types of taste disorder(Pearson correlation coefficient r=0.210, P<0.05), it was positive correlation. Conclusions: It is suggested that after the upper respiratory tract infection, the olfactory dysfunction is often accompanied by the sense of taste dysfunction, the more severe the damage of olfactory function, the degree of damage to the taste function is also increased. Olfactory impairment degree exhibited no relationship with gender, age or onset seasons.

[Differentially expression p21 and p53 in laryngeal squamous cell carcinoma]

AbstractObjective:To investigate the role of the methylation of p21 and p53 gene in laryngeal cancer and laryngeal cancer cell line Hep-2.Method: Methylation of p21 and p53 gene were detected by methylation specific PCR(MSP) in 46 cases with paired cancer tissues and adjacent tissues. Hep-2 cell line was treated with 5-azacytidine at different time points, and Hep-2 cell growth was detected using the MTT assay. Hep-2 cell line was treated with 5-azacytidine at different time points, and then apoptosis was detected by the TUNEL assay. The expression difference of p21 mRNA was detected by RT-PCR method before and after intervention. p21 promoter CpG island methylation status was tested by MSP before and after intervention.Result: The incidence was 45.7% of p21 gene promoter CpG island methylation in 46 cases of laryngeal cancer, while methylation rate in adjacent tissues was 10.9%. There were significant differences between cancer tissues and adjacent tissues(P<0.05).The incidence was 6.5% of p53 gene promoter CpG island methylation in 46 cases of laryngeal cancer, while methylation rate was 4.3% in adjacent tissues,no significant difference of p53 gene methylation was found in laryngeal cancer and counterparts adjacent tissues(P>0.05). The effect of Hep-2 proliferation inhibition interfered by 5-azacytidine was gradually increased over time in a time-dependent manner. Meanwhile, interfered by 5-azacytidine increased the apoptosis in a time-dependent manner. After interference by 5-azacytidine, p21 gene is activated. The expression of p21 mRNA was significantly higher. The p21 gene methylation degree in laryngeal cancer cell line Hep-2 was 43.13%±0.79%. After 5-azacytidine intervention, the degree of methylation was obviously decreased and even showed unmethylation.Conclusion:There was p21 gene promoter CpG island hypermethylation in laryngeal cancer and laryngeal cancer cell line Hep-2, which was a molecular event distinguished laryngeal cancer from normal laryngeal tissue. There was p53 gene promoter CpG island hypomethylation in laryngeal cancer and laryngeal cancer cell line Hep-2.Inactivation of the gene may occur by gene mutation forms and others. Demethylation of drug 5-azacytidine can induce p21 gene promoter CpG island demethylation modification, change the regulation of tumor cell cycle genes in cells and promote tumor cell apoptosis.

Microglial Acid Sensing Regulates Carbon Dioxide-Evoked Fear

BACKGROUND

Carbon dioxide (CO2) inhalation, a biological challenge and pathologic marker in panic disorder, evokes intense fear and panic attacks in susceptible individuals. The molecular identity and anatomic location of CO2-sensing systems that translate CO2-evoked fear remain unclear. We investigated contributions of microglial acid sensor T cell death-associated gene-8 (TDAG8) and microglial proinflammatory responses in CO2-evoked behavioral and physiological responses.

METHODS

CO2-evoked freezing, autonomic, and respiratory responses were assessed in TDAG8-deficient ((-/-)) and wild-type ((+/+)) mice. Involvement of TDAG8-dependent microglial activation and proinflammatory cytokine interleukin (IL)-1β with CO2-evoked responses was investigated using microglial blocker, minocycline, and IL-1β antagonist IL-1RA. CO2-chemosensitive firing responses using single-cell patch clamping were measured in TDAG8(-/-) and TDAG8(+/+) mice to gain functional insights.

RESULTS

TDAG8 expression was localized in microglia enriched within the sensory circumventricular organs. TDAG8(-/-) mice displayed attenuated CO2-evoked freezing and sympathetic responses. TDAG8 deficiency was associated with reduced microglial activation and proinflammatory cytokine IL-1β within the subfornical organ. Central infusion of microglial activation blocker minocycline and IL-1β antagonist IL-1RA attenuated CO2-evoked freezing. Finally, CO2-evoked neuronal firing in patch-clamped subfornical organ neurons was dependent on acid sensor TDAG8 and IL-1β.

CONCLUSIONS

Our data identify TDAG8-dependent microglial acid sensing as a unique chemosensor for detecting and translating hypercapnia to fear-associated behavioral and physiological responses, providing a novel mechanism for homeostatic threat detection of relevance to psychiatric conditions such as panic disorder.

Carrier transport in quantum dot quantum well microstructures of the self-assembled CdTe/CdS/ligand core-shell system

The study on the quantum dot quantum well (QDQW) microstructure modified by choosing different ligands containing a sulfhydryl group is of significance because it enables one to regulate photoexcited free charge carriers' (FCCs') transport behaviours in high-quality CdTe/ligand QDs via a self-assembled way. The photoelectron characteristics of ligand-capped CdTe nanoparticles were probed by a combination of surface photovoltaic (SPV) and photoacoustic technologies, supplemented by a computer simulation method of the CASTEP module. The experiment reveals that the D-value ΔEWi obtained by the associated two parameters of the SPV spectroscopy was closely related to the quantum confinement energy in the self-assembled CdTe/CdS/ligand core-shell system. In the paper the D-value was termed the depth of QWs, which were buried in the space charge regions located in the graded-band-gap and on either side of the shell-CdS. Obvious resonance quantum tunnelling may occur in the energy band structure with deep QWs on using certain ligands, resulting in an extended diffusion length of the FCCs on illumination of the photon energy hν ≥ Eg, core-CdTe, and in a strong SPV response at a specific wavelength region. In addition, the carrier-longitudinal optical phonon interaction is the reciprocal of the carriers' lifetime. The d-frontier orbital in the graded-band-gap plays an important role in both the microstructure and the resonance quantum tunnelling of the QDQW system according to the CASTEP calculations.

Clinical applications of internal heat source analysis for breast cancer identification

Nondestructive preoperative breast imaging techniques are widely used for breast cancer testing and diagnosis. This study aimed to evaluate the feasibility and efficacy of quantitative diagnosis via the thermal analysis of abnormal metabolism. Nine hundred forty-eight women who underwent breast biopsy from 2009 to 2013 were investigated. Thermal analysis was used to calculate the internal heat source (i.e., tumor) thermal power for each participant. The applicability and effectiveness of our approach were estimated using the chi-square test, kappa statistics (k), and odds ratios (OR). Breast density and tumor size were considered during this estimation. A thermal power q = 0.2 w was determined as the optimal separation threshold between breast cancer and benign disease. Moreover, good agreement (k = 0.837) with the gold-standard assessment (breast biopsy) was confirmed in 93.2% of the patients (N = 884/948), and the sensitivity and specificity were 94.2 and 92.9%, respectively. The results also found no significant differences in methodological accuracy between the fatty and dense breasts (OR = 1.194, P = 0.524). Furthermore, after dividing the cohort into three groups according to tumor size (T1: <2 cm; T2: 2 to 5 cm; T3: >5 cm), the tumor size had no effect on the proposed method (ORs = 1, P = 0.724). Internal heat source analysis can feasibly and efficiently distinguish between breast cancer and benign disease.

Fluoxetine elevates allopregnanolone in female rat brain but inhibits a steroid microsomal dehydrogenase rather than activating an aldo-keto reductase

Background and Purpose

Fluoxetine, a selective serotonin reuptake inhibitor, elevates brain concentrations of the neuroactive progesterone metabolite allopregnanolone, an effect suggested to underlie its use in the treatment of premenstrual dysphoria. One report showed fluoxetine to activate the aldo-keto reductase (AKR) component of 3α-hydroxysteroid dehydrogenase (3α-HSD), which catalyses production of allopregnanolone from 5α-dihydroprogesterone. However, this action was not observed by others. The present study sought to clarify the site of action for fluoxetine in elevating brain allopregnanolone.

Experimental Approach

Adult male rats and female rats in dioestrus were treated with fluoxetine and their brains assayed for allopregnanolone and its precursors, progesterone and 5α-dihydroprogesterone. Subcellular fractions of rat brain were also used to investigate the actions of fluoxetine on 3α-HSD activity in both the reductive direction, producing allopregnanolone from 5α-dihydroprogesterone, and the reverse oxidative direction. Fluoxetine was also tested on these recombinant enzyme activities expressed in HEK cells.

Key Results

Short-term treatment with fluoxetine increased brain allopregnanolone concentrations in female, but not male, rats. Enzyme assays on native rat brain fractions and on activities expressed in HEK cells showed fluoxetine did not affect the AKR producing allopregnanolone from 5α-dihydroprogesterone but did inhibit the microsomal dehydrogenase oxidizing allopregnanolone to 5α-dihydroprogesterone.

Conclusions and Implications

Fluoxetine elevated allopregnanolone in female rat brain by inhibiting its oxidation to 5α-dihydroprogesterone by a microsomal dehydrogenase. This is a novel site of action for fluoxetine, with implications for the development of new agents and/or dosing regimens to raise brain allopregnanolone.

Electrowetting on liquid-infused film (EWOLF): complete reversibility and controlled droplet oscillation suppression for fast optical imaging

Electrowetting on dielectric (EWOD) has emerged as a powerful tool to electrically manipulate tiny individual droplets in a controlled manner. Despite tremendous progress over the past two decades, current EWOD operating in ambient conditions has limited functionalities posing challenges for its applications, including electronic display, energy generation, and microfluidic systems. Here, we demonstrate a new paradigm of electrowetting on liquid-infused film (EWOLF) that allows for complete reversibility and tunable transient response simultaneously. We determine that these functionalities in EWOLF are attributed to its novel configuration, which allows for the formation of viscous liquid-liquid interfaces as well as additional wetting ridges, thereby suppressing the contact line pinning and severe droplet oscillation encountered in the conventional EWOD. Finally, by harnessing these functionalities demonstrated in EWOLF, we also explore its application as liquid lens for fast optical focusing.

Transient outwardly rectifying A currents are involved in the firing rate response to altered CO2 in chemosensitive locus coeruleus neurons from neonatal rats

The effect of hypercapnia on outwardly rectifying currents was examined in locus coeruleus (LC) neurons in slices from neonatal rats [postnatal day 3 (P3)-P15]. Two outwardly rectifying currents [4-aminopyridine (4-AP)-sensitive transient current and tetraethyl ammonium (TEA)-sensitive sustained current] were found in LC neurons. 4-AP induced a membrane depolarization of 3.6 ± 0.6 mV (n = 4), while TEA induced a smaller membrane depolarization of 1.2 ± 0.3 mV (n = 4). Hypercapnic acidosis (HA) inhibited both currents. The maximal amplitude of the TEA-sensitive current was reduced by 52.1 ± 4.5% (n = 5) in 15% CO2 [extracellular pH (pHo) 7.00, intracellular pH (pHi) 6.96]. The maximal amplitude of the 4-AP-sensitive current was reduced by 34.5 ± 3.0% (n = 6) in 15% CO2 (pHo 7.00, pHi 6.96), by 29.4 ± 6.8% (n = 6) in 10% CO2 (pHo 7.15, pHi 7.14), and increased by 29.0 ± 6.4% (n = 6) in 2.5% CO2 (pHo 7.75, pHi 7.35). 4-AP completely blocked hypercapnia-induced increased firing rate, but TEA did not affect it. When LC neurons were exposed to HA with either pHo or pHi constant, the 4-AP-sensitive current was inhibited. The data show that the 4-AP-sensitive current (likely an A current) is inhibited by decreases in either pHo or pHi. The change of the A current by various levels of CO2 is correlated with the change in firing rate induced by CO2, implicating the 4-AP-sensitive current in chemosensitive signaling in LC neurons.

Parylene-based implantable platinum-black coated wire microelectrode for orbicularis oculi muscle electrical stimulation

A novel and simple process was proposed to fabricate a parylene-based platinum-black coated wire microelectrode for orbicularis oculi muscle electrical stimulation. Compared with conventional microelectrodes, wire microelectrodes would enable smaller wounds, increased ease of implantation, and improved cosmesis. Meanwhile, the circumferential electrode sites of this wire microelectrode fabricated by lift-off process would contribute to fully contact with tissue and reduction of electrode-tissue interface impedance. The width and the amount of electrode sites could be decided by the thickness and the amount of sacrificial layer, respectively. The platinum-black coatings were electroplated on electrode sites by applying a current pulse train in chloroplatinic acid solution with ultrasonic bath for further electrode-tissue interface impedance reduction and good mechanical stability of coatings. Electrode impedance at 1 kHz has been significantly reduced by 90%, and the cathodic charge storage capacity (CSCc) has been increased by 13 times. In addition, hematoxylin-eosin (HE) staining section of muscle demonstrated the good biocompatibility of this electroplated platinum-black. By applying a charge imbalanced biphasic stimulation waveform for orbicularis oculi muscle stimulation, the rabbits with facial paralysis rehabilitated the function of closing eyes. This kind of microelectrode will be promising for neuromuscular applications.

Experimental investigation on drag effect of sprinkler spray to adjacent horizontal natural smoke venting

Discharge rate of a horizontal adjacent smoke vent under sprinkler spray is experimentally investigated. Temperature of smoke layer and velocity of smoke venting were measured, under different sprinkler operating pressures and smoke venting areas. CO concentration at the smoke vent center and velocity of vent flow with fresh air outside were recorded in tests under different smoke venting conditions. Experimental results have shown that efficiency of smoke venting is controlled by a combination of smoke buoyancy and drag force of sprinkler spray. Only when buoyancy is greater than drag force the smoke could be extracted by venting. Velocity of smoke venting has shown to decrease as the operating pressure increases. Smoke venting logging, which represents the failure of smoke venting, was experimentally found from certain operating pressure called initial logging pressure. The CO concentration was found to increase after sprinkler was operated as the smoke is constrained in the spray region with horizontal momentum decreased. Negative pressure difference is caused at the vent when there is smoke venting logging, which might practically bring the exterior fresh air into the fire building. Additionally, experiments results have shown that the venting area has little influence on smoke flow under smoke venting logging.

[Effect of neonatal exposure to environmental pollutants on the DNA methylation of rat testis]

OBJECTIVE

To investigate the effects of neonatal exposure of DNA methylation inhibitor, Cadmium and PCB153 on DNA methylation, apoptosis and spermatogenesis in SD rats.

METHODS

Neonatal SD rats were randomly divided into 10 groups and received oral administrations of PCB153 (0.025, 0. 250, 2.500 mg/kg), or Cadmium (1, 2, 4 mg/kg), or positive control 5-Aza-CdR (0.025, 0.250 mg/kg), or vehicle control for five days from PND3. Half of the rats were killed 24 h after the last administration. The remains were fed until 12 weeks. Sperm numbers, apoptosis and DNA methylation levels in testis were investigated.

RESULTS

The daily sperm production was significantly decreased in each neonatal exposed group (P < 0.05). Neonatal rats exposed to 5-Aza-CdR and Cadmium reduced the global DNA methylation level, increased apoptosis, while PCB153 exposure did not significantly change DNA methylation and apoptosis.

CONCLUSION

Neonatal rats exposed to chemicals could reduce spermatogenesis via multiple pathways. Lower DNA methylation and increased neonatal apoptosis were suggested as one of the causes.

Brain-derived neurotrophic factor facilitates maturation of mesenchymal stem cell-derived dopamine progenitors to functional neurons

The generation of dopamine (DA) neurons from stem cells holds great promise in the treatment of Parkinson's disease and other neural disease associated with dysfunction of DA neurons. Mesenchymal stem cells (MSCs) derived from the adult bone marrow show plasticity with regards to generating cells of other germ layers. In addition to reduced ethical concerns, MSCs could be transplanted across allogeneic barriers, making them desirable stem cells for clinical applications. We have reported on the generation of DA cells from human MSCs using sonic hedgehog (SHH), fibroblast growth factor 8 and basic fibroblast growth factor. Despite the secretion of DA, the cells did not show evidence of functional neurons, and were therefore designated DA progenitors. Here, we report on the role of brain-derived neurotrophic factor (BDNF) in the maturation of the MSC-derived DA progenitors. 9-day induced MSCs show significant tropomyosin-receptor-kinase B expression, which correlate with its ligand, BDNF, being able to induce functional maturation. The latter was based on Ca2+ imaging analyses and electrophysiology. BDNF-treated cells showed the following: increases in intracellular Ca2+ upon depolarization and after stimulation with the neurotransmitters acetylcholine and GABA and, post-synaptic currents by electrophysiological analyses. In addition, BDNF induced increased DA release upon depolarization. Taken together, these results demonstrate the crucial role for BDNF in the functional maturation of MSC-derived DA progenitors.

Ethanol facilitates glutamatergic transmission to dopamine neurons in the ventral tegmental area

The cellular mechanisms underlying alcohol addiction are poorly understood. In several brain areas, ethanol depresses glutamatergic excitatory transmission, but how it affects excitatory synapses on dopamine neurons of the ventral tegmental area (VTA), a crucial site for the development of drug addiction, is not known. We report here that in midbrain slices from rats, clinically relevant concentrations of ethanol (10-80 mM) increase the amplitude of evoked EPSCs and reduce their paired-pulse ratio in dopamine neurons in the VTA. The EPSCs were mediated by glutamate alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptors. In addition, ethanol increases the frequency but not the amplitude of spontaneous EPSCs. Furthermore, ethanol increases extracellular glutamate levels in the VTA of midbrain slices. The effects of ethanol are mimicked by SKF 38393, a dopamine D(1) receptor agonist, and by GBR 12935, a dopamine reuptake inhibitor, and they are blocked by SKF 83566, a D(1) antagonist, or by reserpine, which depletes dopamine stores. The enhancement of sEPSC frequency reaches a peak with 40 mM ethanol and declines with concentrations >or=80 mM ethanol, which is quite likely a result of D(2) receptor activation as raclopride, a D(2) receptor blocker, significantly enhanced 80 mM ethanol-induced enhancement of sEPSCs. Finally, 6, 7-dinitroquinoxaline-2, 3-dione (DNQX), an AMPA receptor antagonist, attenuates ethanol-induced excitation of VTA DA neurons. We therefore conclude that, acting via presynaptic D(1) receptors, ethanol at low concentrations increases glutamate release in the VTA, thus raising somatodendritic dopamine release, which further activates the presynaptic D(1) receptors. Enhancement of this positive feedback loop may significantly contribute to the development of alcohol addiction.

Optical properties of Au/Ag core/shell nanoshuttles

Au/Ag nanoshuttles with sharp tips at both ends have been synthesized in glycine solution by chemically depositing silver on gold nanorods. Strong local field in the Au/Ag nanoshuttles enhanced by longitudinal surface plasmon resonance (LSPR) were investigated by theoretical calculations and experimental measurements. At the corresponding LSPR wavelengths, the extinction cross section and nonlinear refraction of the Au/Ag nanoshuttles are about 1.5 and 8.0 times of those of the original Au nanorods, respectively.

Interpopulation and intrapopulation maternal lineage genetics of the Lanyu pig (Sus scrofa) by analysis of mitochondrial cytochrome b and control region sequences

The Lanyu pig is an indigenous breed from the Lanyu Islet, which is southeast of Taiwan. Two herds of Lanyu pigs were introduced from the Lanyu Islet into Taiwan in 1975 and 1980. The current population of conserved Lanyu pigs consists of only 44 animals with unknown genetic lineage. The Lanyu pig possesses a distinct maternal genetic lineage remote from Asian and European pigs. The present study aimed to understand the phylogenetic relationship among conserved Lanyu, Asian, and European type pigs based on the cytochrome b coding gene, to ascertain the maternal lineage and genetic diversity within the conserved Lanyu pigs, and to address whether genetic introgression from exotic or Formosan wild pigs had occurred in the conserved Lanyu pigs. Entire mitochondrial genomes of both types of Lanyu pig comprised 2 ribosomal RNA, 22 transfer RNA, and 13 protein-coding genes. Only 2 haplotypes of the mitochondrial DNA (mtDNA) control region and cytochrome b were identified in the conserved Lanyu pig herds. When maximum likelihood trees were constructed, the Type I Lanyu mitochondrial genes formed a unique clade with a large pairwise distance of both cytochrome b and the control region from Asian and European type breeds, Formosan wild pigs, and exotic breeds. Significant loss of genetic diversity of mtDNA within the conserved Lanyu pigs was demonstrated by low haplotype and nucleotide diversities, supported by Fu and Li's D* neutrality test (1.44055; P < 0.05). The mtDNA control region sequences of extant pigs in the Lanyu Islet, however, showed high haplotype and nucleotide diversity, and clustered with exotic pigs. These results indicate no maternal lineage mtD-NA gene introgression from Formosan wild pigs and introduced exotic pigs to conserved Type I Lanyu pigs, and a severe loss of heterozygosity of mtDNA in conserved Lanyu pigs. The remaining extant pigs on the Lanyu Islet have been introgressed with exotic breeds. Strategies for future conservation of native Lanyu pigs are now even more urgent and important.

Nanomolar propofol stimulates glutamate transmission to dopamine neurons: a possible mechanism of abuse potential?

Anesthesiologists among physicians are on the top of the drug abuse list, and the mechanism is unclear. Recent studies suggest occupation-related second-hand exposure to i.v. drugs, including propofol, may play a role. Growing evidence indicates that propofol is one of the choices of drugs being abused. In this study, we show that propofol at minute concentrations increases glutamatergic excitatory synaptic transmission and discharges of dopamine neurons in the ventral tegmental area (VTA). We found that acute application of propofol (0.1-10 nM) to the VTA in midbrain slices of rats increased the frequency but not the amplitude of spontaneous excitatory postsynaptic currents (EPSCs) mediated by alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors. We observed that propofol increased the amplitude but decreased the paired-pulse ratio of EPSCs evoked by stimulation in the absence and the presence of gabazine (SR 95531), a GABA(A) receptor antagonist. Moreover, the propofol-induced facilitation of EPSCs was mimicked by 6-phenyl-4-azabicyclo[5.4.0]undeca-7,9,11-triene-9,10-diol (SKF38393), an agonist of dopamine D(1) receptor, and by 1-[2-(diphenylmethoxy)ethyl]-4-(3-phenylpropyl)piperazine dihydrochloride (GBR 12935), a dopamine reuptake inhibitor, but blocked by (+/-)-7-bromo-8-hydroxy-3-methyl-1-phenyl-2,3,4, 5-tetrahydro-1H-3-benzazepine hydrochloride (SKF83566), a D(1) antagonist, or by depleting dopamine stores with reserpine. Finally, 1 nM propofol increased the spontaneous discharge rate of dopamine neurons. These findings suggest that propofol at minute concentrations enhances presynaptic D(1) receptor-mediated facilitation of glutamatergic synaptic transmission and the excitability of VTA dopamine neurons, probably by increasing extracellular dopamine levels. These changes in synaptic plasticity in the VTA, an addiction-related brain area might contribute to the development of propofol abuse and the increased susceptibility to addiction of other drugs.

GABAergic neurons innervating the preganglionic cardiac vagal neurons in the dorsal motor nucleus receive tonic glutamatergic control

The glutamatergic innervations and the GABAergic innervations are respectively the major excitatory and inhibitory inputs of preganglionic cardiac vagal neurons (CVNs). Whether and how these two kinds of innervations interact in the regulation of CVNs is unknown. Using retrograde fluorescent labeling of CVNs and voltage patch-clamp technique, we demonstrated that mixed global application of glutamatergic NMDA and non-NMDA antagonists AP(5) and CNQX, while had no effect on the GABAergic synaptic events of the CVNs in the nucleus ambiguus (NA), significantly decreased the GABAergic synaptic events of the CVNs in the dorsal motor nucleus of the vagus (DMNX). These results suggest that the GABAergic neurons preceding the CVNs in the DMNX receive tonic glutamatergic control, whereas the GABAergic neurons preceding the CVNs in the NA receive little, if any, glutamatergic innervations. This differential central regulation of the CVNs in the DMNX from those in the NA might be a possible mechanism that enables the CVNs in the DMNX play different roles from those in the NA in the parasympathetic control of heart rate and cardiac functions.

Differential sensitivity of GABAergic and glycinergic inputs to orexin-A in preganglionic cardiac vagal neurons of newborn rats

AIM

To test the effect of orexin-A (hypocretin-1), a neuropeptide synthesized in the lateral hypothalamus and the perifornical area, on the glycinergic inputs and the GABAergic inputs of cardiac vagal neurons (CVN).

METHODS

The effects of orexin-A at three concentrations (20 nmol/L, 100 nmol/L, 500 nmol/L) on the glycinergic inputs and the GABAergic inputs were investigated by using retrograde fluorescent labeling of cardiac neurons (CVN) in the nucleus ambiguus (NA) and the voltage patch-clamp technique.

RESULTS

Orexin-A dose-dependently increased the frequency of both the glycinergic and the GABAergic spontaneous inhibitory postsynaptic currents (sIPSC). However, at a lower concentration (20 nmol/L) of orexin-A, although the frequency of the glycinergic sIPSC was significantly increased, the frequency of the GABAergic sIPSC was not significantly changed.

CONCLUSION

The glycinergic inputs and the GABAergic inputs have different sensitivities to orexin-A, which suggests that the two kinds of inhibitory inputs might play different roles in the synaptic control of cardiac vagal functions.

Effect of several Chinese natural health products of human cytochrome P450 metabolism

PURPOSE

Traditional Chinese medicines (TCM) are believed by many to be safe and used for self-medication without supervision. Although the risk appears to be low, certain TCM have been associated with a number of serious adverse reactions. A preliminary study was undertaken with 12 products using a human cytochrome P450 (CYP450) isozyme assay to determine if these products could affect human drug metabolism.

METHODS

Aliquots of samples were analyzed directly or as extracts for their potential to affect CYP450 2C9, 2C19, 2D6, and 3A4 mediated-metabolism of marker substrates using an in vitro fluorometric microtiter plate assay.

RESULTS

One product was found to be a Chinese Proprietary Medicine (CPM). Most aqueous extracts inhibited CYP450 mediated-metabolism of at least 3 isozymes (ranging from 25-100%). All liquid samples markedly inhibited the metabolism of all 4 isozymes. De le ke chuan kang and Rensheng dao were the strongest CYP450 inhibitors.

CONCLUSIONS

Our in vitro findings demonstrate that TCM can inhibit CYP450 2C9, 2C19, 2D6 and 3A4 mediated-metabolism. TCM need to be examined further under clinical settings to determine if potential interactions will occur that affect the safety and efficacy of conventional therapeutic products.

[Distribution of cholinergic efferent vestibular neurons]

OBJECTIVE

To investigate the effect and distribution of cholinergic efferent vestibular neurons in normal wistar rat.

METHOD

HPR retrograde tracer and Immunocytochemical techniques were used.

RESULT

Results show that AchT immunoreactive neurons locate in dorsolateral and dorsomedial to genu of the facial. Few neurons scatter in the parvocellular nucleus.

CONCLUSION

As a neural transmitter, acetylcholine distribute in efferent vestibular neurons and play an important role.

Study on facial motoneuronal death after proximal or distal facial nerve transection

BACKGROUND

Among the cranial nerves, the facial nerve is most liable to be damaged. Pathologic changes in the facial motor nucleus (FMN) after nerve injury are not well recognized, and the optimal time for facial nerve reconstruction after axotomy is controversial. In this study, to clarify the pathologic change in the FMN after axotomy and to determine the best time for surgery, facial motoneuronal death was investigated after facial nerve injury.

METHODS

Sixty Wistar rats were divided into proximal and distal groups. In the proximal group, the right facial nerve was transected at the porus of internal acoustic meatus. In the distal group, the nerve was cut at the stylomastoid foramen. The animals were sacrificed from day 3 to day 60 after surgery, and the brainstem was fixed with 4% paraformaldehyde. The FMN were then examined in serial sections stained with Cresyl Violet, and facial motoneurons were counted under a light microscope.

RESULTS

The death rate of facial motoneurons in the animals that underwent proximal axotomy was found to be higher and cell death occurred earlier than in the distal axotomy animals at every time point. Moreover, neuron death increased with time and peaked at 15 days after surgery.

CONCLUSIONS

The results indicate that the injury site was correlated with facial motoneuronal death, and suggest that reconstructive surgery should be performed as early as possible.

Relationship between electroacupuncture analgesia and dopamine receptors in nucleus accumbens

AIM

To study the roles of dopamine (DA) D1 and D2 receptors in nucleus accumbens in electroacupuncture analgesia (EAA) and the potentiation of EAA of rats induced by l-tetrahydropalmatine (l-THP), a dopamine receptor antagonist.

METHODS

SK&F-38393 and quinpirole hydrochloride (Qui), highly selective agonists of D1 and D2 receptors, respectively were injected into nucleus accumbens of rats.

RESULTS

SK&F-38393 (5 and 10 micrograms) attenuated the potentiation of EAA induced by l-THP, 10 micrograms SKF38393 attenuated EAA as well, while Qui (10 and 20 micrograms) had no effect on EAA and the potentiation of EAA induced by l-THP.

CONCLUSION

D1 but not D2 receptor in nucleus accumbens play an important role in EAA and the potentiation of EAA induced by l-THP.

Acromegaly in a woman presenting with diabetic ketoacidosis and insulin resistance

A 22-year-old Chinese woman presented with typical features of diabetic ketoacidosis. There was a family history of diabetes but she was not obese. Plasma glucose and bicarbonate levels were 27.0 mmol/l and 5 mmol/l, respectively. Significant insulin resistance was noticed: she needed up to 15 units of insulin per hour. She required up to 120 units daily for her diabetic control even after her acidosis had subsided. She was then noticed to have the clinical features of acromegaly. The diagnosis was confirmed, and a cranial CT scan confirmed the presence of a pituitary macroadenoma. She underwent uneventful trans-sphenoidal resection of the tumour and her insulin requirement gradually lessened. Acromegaly should be considered in the differential diagnosis of unexplained insulin resistance.

A patient with Graves' disease, thrombocytopenia and chronic hepatitis B

A 22-year-old Chinese man, a HBsAg carrier, presented with relapse of thyrotoxic Graves' disease complicated by thrombocytopenia and hepatitis. Platelet count and liver enzymes gradually improved following successful treatment of the thyrotoxicosis with radioactive iodine. Possible pathogenetic links and therapeutic implications are discussed.

Thyrotoxicosis and renal tubular acidosis presenting as hypokalaemic paralysis

A 34-yr-old Chinese woman presented with hypokalaemic periodic paralysis. She had a goitre and was biochemically thyrotoxic. However, she also had urinary potassium loss with a metabolic acidosis and reduced ability to acidify her urine. The co-existence of distal renal tubular acidosis (RTA) was confirmed. There was no evidence of xerostomia or xerophthalmia, although anti-Ro antibody and rheumatoid factor were positive. Paralytic attacks did not recur after the thyrotoxicosis was controlled with radioactive iodine. Possible pathogenic mechanisms for the association of these disorders are discussed. Female patients presenting with thyrotoxic periodic paralysis (TPP) should be thoroughly investigated for possible additional precipitating factors in view of the strong male predominance of TPP, particularly when there are atypical metabolic features.