[Association between gestational diabetes mellitus and preterm birth subtypes]

Objective: To investigate the association between gestational diabetes mellitus (GDM) and preterm birth subtypes. Methods: Based on the cohort of pregnant women in Anqing Prefectural Hospital, the pregnant women who received prenatal screening in the first or second trimesters were recruited into baseline cohorts; and followed up for them was conducted until delivery, and the information about their pregnancy status and outcomes were obtained through electronic medical record system and questionnaire surveys. The log-binomial regression model was used to explore the association between GDM and preterm birth [iatrogenic preterm birth, spontaneous preterm birth (preterm premature rupture of membranes and preterm labor)]. For multiple confounding factors, the propensity score correction model was used to compute the adjusted association. Results: Among the 2 031 pregnant women with a singleton delivery, the incidence of GDM and preterm birth were 10.0% (204 cases) and 4.4% (90 cases) respectively. The proportions of iatrogenic preterm birth and spontaneous preterm birth in the GDM group (n=204) were 1.5% and 5.9% respectively, while the proportions in non-GDM group (n=1 827) were 0.9% and 3.2% respectively, and the difference in the proportion of spontaneous preterm birth between the two groups was significant (P=0.048). Subtypes of spontaneous preterm were further analyzed, and the results showed that the proportions of preterm premature rupture of membranes and preterm labor in the GDM group were 4.9% and 1.0% respectively, while the proportions in the non-GDM group were 2.1% and 1.1% respectively. It showed that the risk of preterm premature rupture of membranes in GDM pregnant women was 2.34 times (aRR=2.34, 95%CI: 1.16-4.69) higher than that in non-GDM pregnant women. Conclusions: Our results showed that GDM might increase the risk of preterm premature rupture of membranes. No significant increase in the proportion of preterm labor in pregnant women with GDM was found.

Observation of a Strongly Isospin-Mixed Doublet in ^{26}Si via β-Delayed Two-Proton Decay of ^{26}P

β decay of proton-rich nuclei plays an important role in exploring isospin mixing. The β decay of ^{26}P at the proton drip line is studied using double-sided silicon strip detectors operating in conjunction with high-purity germanium detectors. The T=2 isobaric analog state (IAS) at 13 055 keV and two new high-lying states at 13 380 and 11 912 keV in ^{26}Si are unambiguously identified through β-delayed two-proton emission (β2p). Angular correlations of two protons emitted from ^{26}Si excited states populated by ^{26}P β decay are measured, which suggests that the two protons are emitted mainly sequentially. We report the first observation of a strongly isospin-mixed doublet that deexcites mainly via two-proton decay. The isospin mixing matrix element between the ^{26}Si IAS and the nearby 13 380-keV state is determined to be 130(21) keV, and this result represents the strongest mixing, highest excitation energy, and largest level spacing of a doublet ever observed in β-decay experiments.

[Establishment of a rapid risk assessment system for imported COVID-19 cases]

Objective: To develop a rapid risk assessment tool for imported COVID-19 cases and provide reference evidences for prevention and control of COVID-19 at ports. Methods: The information about COVID-19 pandemic and control strategies of 12 concerned countries was collected during July to August 2021, and 12 indexes were selected to assess the importation risk of COVID-19 by risk matrix. Results: The risk for imported COVID-19 cases from 12 countries to China was high or extremely high, and the risk from Russia and the USA was highest. Conclusions: The developed rapid risk assessment tool based on the risk matrix method can be used to determine the risk level of countries for imported COVID-19 cases to China at ports, and the risk of imported COVID-19 was high at Beijing port in August 2021.

[Investigation of epidemiological characteristics and influencing factors on dust-exposed working age of pneumoconiosis cases in a city]

Objective: To investigate epidemiological characteristics and influencing factors on dust-exposed working years of pneumoconiosis cases in Yantai. Methods: In January 2020, By Cluster sampling way, Using descriptive statistics to analyze dust-exposed working years of the reported 3307 new cases of pneumoconiosis from 2009 to 2019 in Yantai. Analyzing the variation trends by the chi-square trend test. Analyzing single fator by chi-square test. Using multiple classification Logistic Regression analysis to analyze multiple influencing factors. Results: The dust-exposed working age of pneumoconiosis cases decreased by years (P<0.05) . The starting age of dust exposure of cases increased year by year, while positively correlated with the dust-exposed working age (r=-0.217, P<0.05) . The years of dust exposure, starting age of dust exposure, industry, type of economy and scale of enterprise were main influence factors on the dust-exposed working age of pneumoconiosis cases. Conclusion: We should strengthen the management on prevention and control condition of pneumoconiosis in metal smelting and processing industry and privately-owned, small and micro enterprises, and pay attention to workers starting exposed to dust in the age of ≥28 years old.

[Fetal cardiac intervention and perioperative management of fetus with hypoplastic right heart syndrome]

Objective: To summarize the experience of perioperative management strategy of fetal pulmonary valvuloplasty (FPV) for hypoplastic right heart syndrome (HRHS). Methods: In the retrospective study of perioperative data, 13 fetuses of HRHS were treated with FPV in Qingdao Women and Children's Hospital from July 2018 to June 2019. Results: (1) The evaluation indexes of the right ventricle in 13 fetuses before FPV: the mean ratio of tricuspid/mitral annulus, right/left ventricular length, pulmonary/aortic annulus, and tricuspid inflow time/cardiac cycle were 0.81±0.04, 0.56±0.14, 0.69±0.06, and 0.35±0.03, respectively. (2) All pregnant mothers underwent general anesthesia. The basic fetal heart rate was (156±12) beats per minutes before FPV, and 9 fetuses showed bradycardia during the operation, and recovered to normal after drug resuscitation. On the first day after FPV, two cases had bradycardia and pregnancy was terminated. The fluctuation of systolic blood pressure of pregnant mother was less than 20%, and there was no significant difference between preoperative and intraoperative pulse pressure [(36.0±5.6) vs (35.8±6.9) mmHg (1 mmHg=0.133 kPa); t=8.102, P=0.951]. (3) All cases of HRHS fetus successfully underwent FPV. The average gestational age was (27.3±0.8) weeks. The average operation time was (23.2±1.0) minutes. The ratio of tricuspid to mitral annulus (t=-2.513, P=0.022) and the ratio of right to left ventricular length (t=-3.373, P=0.003) were significantly improved at 6 weeks postoperatively. Ten fetuses were delivered, and there was no death after early intervention. (4) Of 13 pregnant women, 3 cases were nausea and vomiting on the day of FPV operation, the treatment of the symptoms was improved by tropisetron; one case had tolerable abdominal pain and improved without special treatment. Pregnant women had no major complications such as cardiac failure, abortion and death. (5) Chromosome karyotype analysis and microarray analysis of amniotic fluid was retained during the operation. No typical chromosome abnormality or other abnormal genetic diagnosis was found. Conclusions: FPV colud be used as an effective intervention measure to promote the development of right ventricle in HRHS fetuses. The scientific management of multidisciplinary professional technical team in perioperative period is particularly important to ensure the success of FPV and the safety of pregnant women and fetuses.

[Application of arterial duct stent in ductus-dependent hypoplastic right heart syndrome]

Objective: To summarize the experience of arterial duct (AD) stenting in children with ductus-dependent hypoplastic right heart syndrome (HRHS). Methods: Seven children including 4 cases of pulmonary atresia with intact ventricular septum (PA-IVS) with HRHS and 3 cases of critical pulmonary stenosis (CPS)-IVS with HRHS underwent AD stenting in Qingdao Women and Children's Hospital between January 2012 and January 2019. During the same period, 9 patients of PA-IVS with HRHS received Blalock Taussig (B-T) shunt. Two groups of children on the operation time, hospital stay time, intensive care time and mortality were compared.T test or Mann-Whitney U test was used for comparison between the two groups. Results: There was no significant difference in the age (18 (7-100) vs. 17 (1-142) d, U=31.000, P>0.05) and weight ((3.8±1.1) vs. (3.7±1.3) kg, t=0.272, P>0.05) between the AD stenting group and the B-T group.The operation time ((108±7) vs. (160±49) min, t=-4.304), intensive care time ((3.4±1.0) vs. (6.3±4.5) d, t=-8.692) and total hospitalization time ((10.3±1.0) vs. (26.3±1.0) d, t=-7.822) in the AD stenting group were differed significantly compared with the B-T group (all P<0.05). The transcutaneous oxygen saturation improved significantly (0.723±0.125 vs. 0.926±0.005, t=-6.044, P<0.05) after AD stenting. The diameter of AD stent ranged from 3.5 to 4.0 mm, and the length of AD stent was 16-21 mm. There were no complications such as vascular injury, acute thrombus, catheter spasm and death in the AD stenting group. The mortality of children in the B-T group was 3 in 9 cases. Three cases in the AD stenting group received pulmonary valvulotomy and bilateral Glenn operation at 6, 9 and 9 months after AD stenting, respectively. Conclusions: AD stenting is a feasible, effective, safe and minimally invasive procedure for children with ductus-dependent HRHS. It can even be used as an alternative to B-T shunt.

Tunable Magnetoelastic Effects in Voltage-Controlled Exchange-Coupled Composite Multiferroic Microstructures

The magnetoelectric properties of exchange-coupled Ni/CoFeB-based composite multiferroic microstructures are investigated. The strength and sign of the magnetoelastic effect are found to be strongly correlated with the ratio between the thicknesses of two magnetostrictive materials. In cases where the thickness ratio deviates significantly from one, the magnetoelastic behavior of the multiferroic microstructures is dominated by the thicker layer, which contributes more strongly to the observed magnetoelastic effect. More symmetric structures with a thickness ratio equal to one show an emergent interfacial behavior which cannot be accounted for simply by summing up the magnetoelastic effects occurring in the two constituent layers. This aspect is clearly visible in the case of ultrathin bilayers, where the exchange coupling drastically affects the magnetic behavior of the Ni layer, making the Ni/CoFeB bilayer a promising next-generation synthetic magnetic system entirely. This study demonstrates the richness and high tunability of composite multiferroic systems based on coupled magnetic bilayers compared to their single magnetic layer counterparts. Furthermore, because of the compatibility of CoFeB with present magnetic tunnel junction-based spintronic technologies, the reported findings are expected to be of great interest for the development of ultralow-power magnetoelectric memory devices.

Bacillus licheniformis, a potential probiotic, inhibits obesity by modulating colonic microflora in C57BL/6J mice model

AIMS

This study evaluated the effects of a potential probiotic, Bacillus sp., on the growth, serum and hepatic triglyceride, histological features of liver tissues and colonic microflora in high-fat diet-induced obese mice.

METHODS AND RESULTS

Sixty male C57BL/6J mice were randomly divided into five groups: mice fed a low-fat diet (Cont), mice fed a high-fat diet (Hf), Hf and orally challenged with Bacillus subtilis (Bs), B. licheniformis (Bl) and a mixture of B. subtilis and B. licheniformis (Bls). Gavage feeding was provided at week 9 and the experiment was continued for 8 weeks. Treatment with B. licheniformis and a mixture of Bacillus sp. attenuated body weight gain at the end of study and enhanced glucose tolerance by sensitizing insulin action in the Hf-fed mice. Lower serum and hepatic triglyceride and epididymal fat weight were observed in Bl and Bls groups than that of Hf group. Lesser hepatic fat deposition was observed in the Bl and Bls groups than in the Hf group. High-throughput sequencing showed that Bacillus sp. supplementation dramatically changed the colonic bacterial community in obese mice.

CONCLUSIONS

Bacillus licheniformis reduced body weight and improved glucose tolerance, obesity and insulin resistance in Hf-fed mice by changing colonic microbiota composition.

SIGNIFICANCE AND IMPACT OF THE STUDY

Orally administration of Bacillus licheniformis may reduce body weight and decrease fat deposition by modulating colonic bacterial community in Hf model.

Effect of CoFe dusting layer and annealing on the magnetic properties of sputtered Ta/W/CoFeB/CoFe/MgO layer structures

We explored the effect of a CoFe wedge inserted as a dusting layer (0.2 nm-0.4 nm thick) at the CoFeB/MgO interface of a sputtered Ta(2 nm)/W(3 nm)/CoFeB(0.9 nm)/MgO(3 nm)/Ta(2 nm) film-a typical structure for spin-orbit torque devices. Films were annealed at temperatures varying between 300 °C and 400 °C in an argon environment. Ferromagnetic resonance studies and vibrating sample magnetometry measurements were carried out to estimate the effective anisotropy field, the Gilbert damping, the saturation magnetization and the dead layer thickness as a function of the CoFe thickness and across several annealing temperatures. While the as-deposited films present only easy-plane anisotropy, a transition along the wedge from in-plane to out-of-plane was observed across several annealing temperatures, with evidence of a spin-reorientation transition separating the two regions.

[Clinical analysis of leiomyomatosis peritonealis disseminate after laparoscopic uterine myomectomy in ten cases]

Objective: To investigate the clinicopathological features, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD). Methods: A total of 10 patients suffered from LPD after laparoscopic uterine myomectomy were collected in the First Affiliated Hospital of Zhengzhou University from September 2012 to September 2016, and all clinical database were retrospectively analyzed. Results: (1)Clinical features: the age of 10 cases was 25-50 years old, and 8 cases of them were in child-bearing age, while 2 cases were in perimenopausal period. Of 10 cases, 2 cases manifested as discontinuous lower abdominal pain, and the other cases were seen the doctor for the examinations found tumors of pelvis or abdomen. All 10 cases had a history of laparoscopic uterine myomectomy under went power morcellation with an average of (4.0±2.2) years (range 1.3 to 8.1 years), 2 cases of them had a history of oral hormone treatment after the first myoma morcellation. (2) Treatment methods and postoperative pathologic diagnosis: during intraoperative exploration, LPD nodules were most distributed in Douglas pouch (10 cases), and next in mesentery (7 cases), abdominal peritoneum (6 cases) and omentum majus (4 cases), etc. Seven of the 8 cases of child-bearing age were performed laparoscopic LPD nodules removal, 1 case gone combined with laparotomy and resecting LPD nodules; 2 cases in perimenopausal period done laparotomy oophorotomy and resected all LPD nodules and omentum. (3) Postoperative relapse and reproductive outcomes: the follow-up time of all cases was 2.8 years, and no recurrence was found during the follow-up period; 2 cases had natural conception and term vaginal birth during the follow-up period. Conclusions: LPD is mainly related to iatrogenic planting and spreading, which is a benign disease and characterized by multiple smooth muscle nodules throughout abdominopelvic cavity, and the nodules of LPD is commonly located in Douglas pouch, mesenteric and omentaum majus, etc. The preferred method of LPD should be individual operative treatment according to different situations, and in which patients may be have better prognosis.

[Statistical parametric mapping analysis of 18F-FDG PET in Parkinson's disease with mild cognitive impairment]

Objective: To investigate the characteristics of cerebral metabolism associated with mild cognitive impairment (MCI) Parkinson's disease (PD), cognitive normal PD and normal control to find a PET biomarker for the diagnose and estimate of PD-MCI. Methods: Forty-seven patients diagnosed with PD (included 15 with mild cognitive impairment) and 20 control subjects were enrolled. All the subjects were evaluated with FDG-PET and clinical scale. The statistical parametric mapping (SPM) were analyzed to determine metabolic patterns that may be useful in differentiating between the three groups. Results: SPM analysis showed that significant hypometabolism were observed in both side of front lobe, parietal lobe, left temporal lobe and left occipital lobe; in the contrast, the relative hypermetabolism had been observed in the cerebellum, vermis, hippocampus and supplement motor area (SMA) in patients with PD-MCI. PD without MCI showed hypometabolism in both side of front lob, caudate and putamen. PD-MCI showed that the significant hypermetabolism were in the insular and cerebellum while hypometabolism were in the both side of occipital compared to PD without MCI. Conclusion: A voxel-by-voxel based SPM method i. e. SPM8 analysis by PET scan is an effective way to analysis the FDG uptake pattern of PD patients. The hypermetabolism in the insula and cerebellum and hypometabolism in the both side of occipital may be a biomarker for make a diagnosis of PD-MCI.

[Ecophysiological responses of Camellia japonica (Naidong) to different light and water conditions]

Camellia japonica (Naidong), a Tertiary relict species with abundant morphological characteristics and special genetic characteristics, is the northernmost distributed population of C. japonica. The seedlings of Naidong were subjected to two light regimes (65%, 15% of full sunlight, respectively) and three water supply regimes (75%, 50% and 25% of field capacity, respectively). Our objectives were to reveal the ecophysiological responses of Naidong under different drought and shade conditions and to examine the four existing hypotheses explaining the responses of Naidong seedlings to the interactions of shade and drought. The results showed that 15% of full sunlight reduced the growth of seedlings. Compared with those under 65% of full sunlight condition, the net photosynthetic rate, transpiration rate and chlorophyll content of seedlings under 15% of full sunlight condition were decreased by 63.3%, 82.9% and 17.5%, respectively. In contrast, the specific leaf area, leaf water content and maximal quantum yield under 15% of full sunlight condition were enhanced by 60.3%, 8.3% and 6.4%, respectively. Drought limited the growth of seedlings,decreased their height and basal diameter. The net photosynthetic rate, transpiration rate and stomatal conductance of seedlings significantly decreased with the increases of drought stress, with their minimum values being 0.83 μmol·m^-2·s^-1, 0.30 μmol·m^-2·s^-1 and 11.56 mmol·m^-2·s^-1, respectively. With the increases of drought stress, the contents of peroxidase and catalase showed a general declining trend, but the contents of malondialdehyde and proline significantly increased. The treatment 15% of full sunlight alleviated the negative effects of drought on Naidong seedlings, which supported the above-ground facilitation hypothesis. Our results indicated that Naidong seedlings could respond and acclimate to environmental changes through various mechanisms, and the seedlings might normally grow under broad ranges of light and water stresses. In addition, providing ideal light and water conditions for the Naidong seedlings could facilitate its application in gardening.

Interface electronic structure at the topological insulator-ferrimagnetic insulator junction

An interface electron state at the junction between a three-dimensional topological insulator film, Bi₂Se₃, and a ferrimagnetic insulator film, Y₃Fe₅O₁₂ (YIG), was investigated by measurements of angle-resolved photoelectron spectroscopy and x-ray absorption magnetic circular dichroism. The surface state of the Bi₂Se₃ film was directly observed and localized 3d spin states of the Fe³⁺ in the YIG film were confirmed. The proximity effect is likely described in terms of the exchange interaction between the localized Fe 3d electrons in the YIG film and delocalized electrons of the surface and bulk states in the Bi₂Se₃ film.

Stretchable and compressible strain sensors based on carbon nanotube meshes

Flexible strain sensors have promising applications in healthcare and human movement detection. Herein, we report stretchable and compressible strain sensors based on carbon nanotube meshes (CNTMs) with unique structures consisting of macroscopic grids and microscopic spider-web networks. The stretchable strain sensor shows good reliability for long cyclic tests and can be used for weak stimuli and large motion detection. The compressible strain sensor also shows good reliability after long cyclic tests and can be used to detect large strains induced by walking or running motion. Both the stretchable and compressible CNTM strain sensors are reliable and stable at detecting large stretching and compressing deformation.

[Cold resistance of four evergreen broad-leaved tree species]

The leaves of four evergreen plants, i.e., Fatsia japonica, Nerium indicum, Mahonia bealei and Acer cinnamomifolium were used as the experimental materials. By measuring the changes of in vitro leaf in soluble sugar, soluble protein, free proline, POD activity, chlorophyll content and relative electrolytic conductivity under aritificial simulated low temperature, combining the measurements of SPAD, leaf surface features and anatomical changes in organizational structure in the process of natural wintering, the cold resistance of four evergreen tree species was evaluated comprehensively. The results showed that in the process of artificial low temperature stress, the chlorophyll content of the leaves of four evergreen species decreased, the content of soluble protein pea-ked at -20 ℃, and the soluble sugar, free proline, POD activity and relative electrolytic conductivity showed an overall upward trend. The semilethal temperatures of four species were -8.0, -13.4, -19.4 and -14.8 ℃, respectively. During the winter, the leaf SPAD of the four species changed markedly, reflecting that the change of relative chlorophyll content was related to the change of temperature. Meanwhile, the leaf thickness, cutin layer thickness, stockade tissue thickness and tightness of four species increased and the plasmolysis occurred thereafter. Also the content of starch grains and calcium oxalate cluster crystal increased. The typical stomatal pits and the intensive non-glandular trichome within the pits of N. indicum and the sclerenchyma of M. Bealei could improve the cold resistance of plants to some extent. In addition, the phenomena like the breakage of wax layer in leaf surface, the fracture of epidermal hair and the deformation of palisade tissue indicated that plants were damaged to a certain extent by low temperature.

[Adaptability of Camellia sasanqua leaf morphology during natural changes in temperature.]

In this study, the adaptability of leaf shape, structure and stomata characteristics of Camellia sasanqua to temperature variation in natural process was investigated by field morphological observation, conventional paraffin section and scanning electron microscopy methods. The results showed that, as the temperature decreased, the leaf color changed from green to dark green, toge-ther with white and purple spots on the leaves. The relative conductivity and the percentage of wi-thered leaves increased initially and then decreased during this period. The highest percentages of relative conductivity and withered leaves in March 2015 were 56.0% and 25.4%, respectively. Different leaf tissue structure indexes, including middle vein thickness, leaf thickness, upper and lower epidermis thickness, upper and lower cuticle thickness, palisade tissue thickness, spongy tissue thickness, ratio of palisade tissue to spongy tissue, cell tense ratio and vein protuberant degree were also determined during the natural temperature change from September 2014 to April 2015. Gradually, these parameters increased initially and then decreased with the decrease of temperature except spongy ratio, which showed the opposite trend. These indicators above changed significantly in different months. Stomata length and width were not significantly changed in October 2014, December 2014 and March 2015, while the percentage of completely closed stomata was higher in March 2015, compared with other months. Taken together, we proposed that the improved adaptability of cold tolerance of C. sasanqua relies on the changes of leaf structure and stomatal closure.

Electric-field-driven magnetization switching and nonlinear magnetoelasticity in Au/FeCo/MgO heterostructures

Voltage-induced switching of magnetization, as opposed to current-driven spin transfer torque switching, can lead to a new paradigm enabling ultralow-power and high density instant-on nonvolatile magnetoelectric random access memory (MeRAM). To date, however, a major bottleneck in optimizing the performance of MeRAM devices is the low voltage-controlled magnetic anisotropy (VCMA) efficiency (change of interfacial magnetic anisotropy energy per unit electric field) leading in turn to high switching energy and write voltage. In this work, employing ab initio electronic structure calculations, we show that epitaxial strain, which is ubiquitous in MeRAM heterostructures, gives rise to a rich variety of VCMA behavior with giant VCMA coefficient (~1800 fJ V(-1)m(-1)) in Au/FeCo/MgO junction. The heterostructure also exhibits a strain-induced spin-reorientation induced by a nonlinear magnetoelastic coupling. The results demonstrate that the VCMA behavior is universal and robust in magnetic junctions with heavy metal caps across the 5d transition metals and that an electric-field-driven magnetic switching at low voltage is achievable by design. These findings open interesting prospects for exploiting strain engineering to harvest higher efficiency VCMA for the next generation MeRAM devices.

[Analysis of the reliability and validity of the Chinese version of Pittsburgh sleep quality index among medical college students]

OBJECTIVE

To evaluate the reliability and validity of the Chinese version of Pittsburgh sleep quality index (PSQI) among the medical students.

METHODS

A total of 603 undergraduate students were selected from a medical school in Beijing using a stratified-cluster random-sampling strategy, who were assessed by using the Chinese version of PSQI. Then 171 subjects were randomly selected to retest about 1 month later, using a variety of psychometric properties to evaluate reliability and validity of the scale.

RESULTS

The average of global PSQI scores was 5.38±2.34, the overall Cronbach's α coefficient of all the scale items was 0.734, the half-split reliability coefficient was 0.655; the test-retest correlation coefficient was 0.530 for global PSQI score, and there was no statistically significant difference before and after (P>0.05). As for the construct validity, confirmatory factor analysis results indicated that the two factor model (containing sleep efficiency factor and sleep quality factor) was the optimal model (goodness-of-fit index 0.949, root of the mean square residual 0.083, comparative fit index 0.699), and the factor loading for "hypnotic drug use" was the lowest. Using subjective sleep quality of the students as the criteria, the global PSQI score was statistically different between the criteria-based groups (P<0.001). And the area under the receiver operating characteristics (ROC) curve which was plotted using the global score of PSQI was 0.908 (95%CI: 0.880-0.936).

CONCLUSION

The Chinese version of PSQI has been verified, having good reliability and validity among the medical students, and is an effective tool to investigate and screen the sleep quality of medical students in China.

[Analysis for serological diagnostic results of syphilis among entry personnel in Beijing port during 2012-2014]

OBJECTIVE

To analyze the results of syphilis specific serological tests among entry personnel in Beijing port during year 2012-2014 in order to provide evidence for the prevention and control of syphilis.

METHODS

Demographics data and syphilis specific test results of entry personnel were obtained from the information system of Beijing International Travel Healthcare Center and input into Excel 2016. Database for entry personnel was built up accordingly and was analyzed by IBM SPSS22.0.

RESULTS

The number of entry personnel in Beijing port during year 2012-2014 was 106 302 person-time. According to the evaluation criteria, 71 308 persons were recruited and analyzed, of whom 277 were tested serologically positive and the total prevalence was 0.39% (95% CI: 0.34%-0.43%). The prevalence was highest in the persons aged 40-49 years (0.81%) and was higher in males (0.50%) than in females (0.23%). The persons from Africa held higher prevalence (1.27%) than from other five regions. As multivariate logical regression analysis indicated that the risk of syphilis infection was 10.38 times more in the persons aged 40-49 years than in the persons <20 years (95%CI:5.59-19.28), and 1.85 times more in males than in females (95%CI: 1.40-2.44). For the people from Africa, South America and Asia, the infection risks were respectively 4.89 times (95%CI: 2.97-8.06), 4.82 times (95%CI: 2.39-9.74) and 1.72 times (95%CI: 1.15-2.59) more than that for the people from North America. Rising trend of the prevalence was observed in both genders by age groups (P value for trend χ(2)<0.05). Except for Asia, the prevalences of the people from other five regions were rising slightly by years, however there were no obvious trends (P value for trend χ(2)>0.05). Twenty-seven seropositive cases were found within 6 246 entry persons who were tested repeatedly during the research period, 9 of which were seroconversion cases so that the cumulative conversion rate was 0.14% (9/6 228). The average conversion time was (6.3±3.0) months. There was no statistical significance between the cumulative seroconversion rates of the persons with different genders and nationalities (P of Fisher's exact test>0.05).

CONCLUSION

Serological detection of syphilis for entry personnel in Beijing port and syphilis-related health education should be reinforced to reduce the risk of disease importing and spreading, protect susceptible subjects and promote health.

Association of thymidylate synthase polymorphisms with the tumor response to preoperative chemoradiotherapy in rectal cancer: a systematic review and meta-analysis

Preoperative chemoradiotherapy (pCRT) followed by surgery is currently the standard therapy for patients with locally advanced rectal cancer. It is very important to develop biomarkers to prior identify the patients who have a higher likelihood of responding to pCRT. Recently, a series of studies have been conducted to investigate the association of thymidylate synthase (TYMS) polymorphisms with the tumor response to pCRT in rectal cancer, but the results were not consistent and conclusive. In the present study, we performed a systematic literature search for relevant studies up to 30 March 2015 and conducted a meta-analysis to summarize and clarify the association between the TYMS polymorphisms and the tumor response to pCRT in rectal cancer. Finally, 7 studies containing 892 cases for TYMS 2R/3R polymorphism, 7 studies involving 715 cases for TYMS 1494del6 polymorphism and 6 studies containing 616 cases for TYMS 5' untranslated region (UTR) expression allele polymorphism were analyzed in the meta-analysis. The results suggested that TYMS 2R/3R was associated with the response and the patients with 2R/2R or 2R/3R genotype with rectal cancer might benefit more from pCRT than others. On the contrary, neither 1494del6 nor 5'UTR expression allele polymorphisms was associated with the response to pCRT.

[Selection of reference genes for quantitative real-time PCR in six oil-tea camellia based on RNA]

qRT-PCR is becoming a routine tool in molecular biology to study gene expression. It is nec- essary to find stable reference genes when performing qRT-PCR. The expression of genes cloned in oil-tea camellia currently can't be accurately analyzed because of a lack of suitable reference genes. We collected different tissues (including roots, stems, leaves, flowers and seeds) from six oil-tea camellia species to determine stable reference genes. Five novel and ten traditional reference gene sequences were selected from the RNA-seq database of Camellia oleifera C. Abel seeds and specific PCR primers were designed for each. Cycle threshold (Ct) data were obtained from each reaction for all samples. Three different software tools, geNorm, NormFinder and BestKeeper were applied to calculate the expression stability of the candidate reference genes according to the Ct values. The results were similar between analyzed by the three software packages, and indicated that the traditional gene TUBa-3, AC17a and the novel gene CESA were relatively stable in all species and tissues. However, no genes were sufficiently stable across all species and tissues, thus the optimal number of reference genes required for accurate normalization varied from two to six. Finally, the relative expression ofsqualene synthase (SQS) and squalene epoxidase (SQE) genes related to important ingredients squalene and tea saponin in oil-tea camellia seeds were compared by using stable to less stable reference genes. The comparison results validated the selection of reference genes in the current study. In summary, different optimal numbers of suitable reference genes were found for the different tissues of six oil-tea camellia species.

High quality InAs quantum dots grown on patterned Si with a GaAs buffer layer

Ordered and dense InAs quantum dots grown on patterned Si(100) with a thin GaAs buffer layer have been investigated by transmission electron microscopy and electron energy loss spectroscopy. {111} faceted InAs quantum dots with good crystallinity were observed on top of the underlying GaAs buffer layer. It was revealed that the GaAs buffer layer and the lateral expansion of InAs have played key roles in releasing the misfit strain between InAs and Si and suppressing the formation of lattice defects in InAs quantum dots. These results suggest a possible pathway for the strain relaxation in the formation of quantum dots.

Angle-dependent light emission from aligned multiwalled carbon nanotubes under CO(2) laser irradiation

This paper reports the light emission from aligned multiwalled carbon nanotubes (MWNTs) under continuous wave CO(2) laser (λ = 10.6 µm) irradiation. Results indicate that the light emission is dependent on the angle θ between the laser incident direction and the nanotube axis. The relative intensity of the light emission at certain wavelengths shows a Lorentzian feature when θ varies from 0° to 90°. The Lorentzian fitting curve displays a distinct tendency between shorter (λ<600 nm) and longer wavelength (λ>700 nm). A minimum intensity was observed at θ(m) close to 67° under shorter wavelength, whereas a maximum intensity was shown at θ(m) of about 60° at longer wavelength. These results show the anisotropic property of aligned MWNTs.

MHC class I chain-related gene A (MICA) polymorphism and the different histological types of cervical cancer

Cervical cancer has been one of the most important gynecologic cancer in Taiwan with incidence of 24/100,000 and mortality of 8.7/100,000 annually. About 70-80% are squamous cell carcinoma; the remainder are composed of various types of adenocarcinoma, adenosquamous carcinoma and undifferentiated carcinoma. The Major Histocompatibility Complex (MHC) class I chain-related gene A (MICA) is expressed by keratinocytes and epithelial cells and interacts with gamma-delta T cells. Although MICA was not associated with cervical cancer in the study of Northern Sweden, there are no further studies about the association of MICA polymorphism and the different histological types of cervical cancer. We analyzed the MICA polymorphism in 110 cervical cancer cases (88 squamous cell carcinoma, 12 adenocarcinoma and 10 adenosquamous carcinoma) and 82 randomly selected unrelated controls from 1994 to 2000 in the Mackay Memorial Hospital, Taipei, Taiwan. DNA was extracted part from leukocytes of peripheral blood, part from tumor tissue and 5 polymorphic microsatellite alleles (A4,A5,A5.1,A6,A9) of MICA were identified by a polymerase chain reaction-based (PCR) technique using ABI Prism 377-18 DNA sequencer (Applied Biosystems, Foster City, CA, USA). The phenotypes, alleles and genotypes of MICA gene were calculated. There was no association with cervical cancer patients and non-cervical cancer patients (p=0.337, 0.356 and 0.414). After dividing the cervical cancer patients into 3 major histological types (squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma), the result was still the same (p=0.598, 0.172 and 0.617) in our study. We found no association between MICA gene polymorphism and cervical cancer in Taiwan. Different histological types of cervical cancer also have no significant correlation with MICA gene polymorphism. It demonstrates that polymorphism of MICA gene bears no relation to cervical cancer and the different histological types of cervical cancer in Taiwan. We need further studies for identifying the factors causing the differentiation of cancer cells of the uterine cervix.

Frequency-dependent electromechanics of aqueous liquids: electrowetting and dielectrophoresis

Electrowetting on dielectric and dielectrophoretic electromechanical mechanisms dominate microfluidic actuation in the low- and high-frequency limits, respectively. The frequency-dependent relationship between these two mechanisms has been clarified by the Maxwell stress tensor and a simple RC circuit model. In this paper, we report extensive height-of-rise measurements obtained with vertical, parallel, dielectrically coated electrodes to test this relationship using deionized water and solutions containing sugar and salt. For DC and AC (20 Hz to 20 kHz) voltage magnitudes up to approximately 150 V-rms, the data are highly reproducible and, within experimental error, consistent with the square-law predictions of the model. Eventually as voltage is increased, a saturation phenomenon is observed which exhibits a weak dependence on frequency and is probably correlated to contact angle saturation.

Microsatellite alterations in exfoliated cervical epithelia deoxyribonucleic acid as a marker for high-grade dysplasia

OBJECTIVE

The purpose of this study was to evaluate the feasibility of the use of deoxyribonucleic acid microsatellite alterations in cervical epithelia in the prediction of high-grade dysplasia and to compare it with a strategy based on human papillomavirus testing.

STUDY DESIGN

Our prospective study subjects were from a cohort of 498 women with minimally abnormal Papanicolaou test results including atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion who had documented repeated Papanicolaou and human papillomavirus tests. Of these, 52 eligible patients having conizations or hysterectomies as their histologic outcomes were subjected to tests of loss of heterozygosity on a panel of 5 microsatellites (D3S1110, THRB, D3S1228, D6S291, D3S1289) within the deoxyribonucleic acid of exfoliated cervical epithelia. These genetic alterations were analyzed through fluorescence polymerase chain reaction by comparison of allele ratios of exfoliated cells with those of normal control tissue. Predictive values for high-grade cervical dysplasia and cancer between this deoxyribonucleic acid marker and human papillomavirus status were compared.

RESULTS

With the use of loss of heterozygosity in at least one locus for predicting high-grade cervical neoplastic lesion, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 59.1%, 76.3%, and 92.9%, which were superior to those of the human papillomavirus test (80%, 59.1%, 72.7%, and 92.9%). As a triage for atypical squamous cells of undetermined significance, its sensitivity and negative predictive value were up to 100%.

CONCLUSION

The promising results on determining microsatellite alteration in dysplastic lesions might imply that it is possible to detect the earliest changes by potential molecular markers with exfoliated cervical epithelial cells.

Meniscus and synovial membrane: an electronmicroscopic study on rabbits

Seven healthy mature rabbits were used to study both the surface morphology of the meniscus using both transmission electronmicroscopy (TEM) and scanning electronmicroscopy (SEM) and articular cartilage of the femoral condyle using SEM. Results showed that the membrane covering the meniscus was structurally the extension of synovial membrane of the knee joint capsule. Additionally, the presence of canal-like openings over the membranes surface to the meniscus was noted, which were absent over the articular cartilage surface.

Multiple globules in a cystic ovarian teratoma

OBJECTIVE

To describe the characteristic imaging findings of multiple globules and globules-fluid level in a cystic ovarian teratoma.

DESIGN

Descriptive case study.

SETTING

Mackay Memorial Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China.

PATIENT(S)

A 20-year-old woman with left abdominal discomfort and a palpable mass on the left side of the distended abdomen.

INTERVENTION(S)

Surgical removal of a 10-cm cystic ovarian teratoma that contained chocolate-like fluid and multiple spheroid mobile globules consisting of yellowish sebaceous debris and fine hair shafts.

MAIN OUTCOME MEASURE(S)

Plain abdominal radiography, ultrasonography, and computed tomography (CT).

RESULT(S)

Plain abdominal radiography revealed no calcification in the mass. The first sonographic examination showed no movement by positional change of multiple rounded echogenic masses ranging from 0.5 cm to 2 cm in diameter, but the second CT examination done after the patient had spent some time lying down showed that the rounded masses arrayed in the upper portion of the cyst and displayed the characteristic level of globules-fluid. Thus, the differential diagnosis was multiple mobile globules in a cystic ovarian tumor.

CONCLUSION(S)

This case indicates that fatty masses need time to float upward in the fluid matrix of a cystic ovarian teratoma. This delayed effect should be considered when an ovarian cyst with multiple rounded echogenic masses is diagnosed by ultrasonography, CT, or magnetic resonance imaging.

Involvement of nervous system in maternally inherited diabetes and deafness (MIDD) with the A3243G mutation of mitochondrial DNA

OBJECTIVES

The A3243G mutation of mitochondrial DNA (mtDNA) has been associated with maternally inherited diabetes and deafness (MIDD) in a number of reports; however, the involvement of the nervous system has rarely been mentioned, prompting this exploration of the manifestation of neurological disorders in MIDD cases.

MATERIAL AND METHODS

We investigated four generations of a large Taiwanese family in which MIDD is manifest. We conducted a series of clinical examinations, including computed tomography (CT) and magnetic resonance imaging (MRI) of the head, brain 99mTc-HMPAO single photon emission computed tomography (SPECT), cognitive function tests, and nerve conduction velocity (NCV) studies. Blood levels of creatine kinase (CK) and lactate, pathology of muscle biopsy samples and proportions of mutant mtDNA in blood cells, hair follicles, muscle and skin were also analyzed. Mean follow-up period was 4 years.

RESULTS

The patients exhibited the clinical features of diabetes mellitus including sensorineural hearing loss, short stature, and/or histories of spontaneous abortion. No stroke-like episodes were reported. Analysis for mtDNA revealed that the A3243G mutation existed in 11 members (6 symptomatic and 5 asymptomatic members) of this MIDD-prone family, with the proportion of mutant mtDNA ranging from 21% to 47% in leukocytes. Head CT revealed diffuse brain atrophy for all 6 (100%) patients examined and bilateral basal ganglia calcification in 4 of 6 (67%) patients. Brain 99mTc-HMPAO SPECT revealed diminished uptake in the bilateral parieto-occipital or occipital regions for all 6 tested patients, cognitive function for these patients was normal. Results of head CT and SPECT were normal in one asymptomatic member of the family. One muscle biopsy revealed abundant ragged-red fibers with modified Gomori-trichrome stain. Muscle-enzyme activity and serum-lactate levels were normal.

CONCLUSION

We have demonstrated that a wide spectrum of sub clinical pathologies of the central nervous system and muscle are present for this MIDD-prone family, none of whom developed typical MELAS during the 4-year period of follow-up study.

Anisotropic thermal conductivity of Ge quantum-dot and symmetrically strained Si/Ge superlattices

We report the first experimental results on the temperature dependent in-plane and cross-plane thermal conductivities of a symmetrically strained Si/Ge superlattice and a Ge quantum-dot superlattice measured by the two-wire 3 omega method. The measured thermal conductivity values are highly anisotropic and are significantly reduced compared to the bulk thermal conductivity of the structures. The results can be explained by using heat transport models based on the Boltzmann transport equation with partially diffusive scattering of the phonons at the superlattice interfaces.

Analytical systematic approximate method of a two-state dissipative system

Occupation probability and changes of the environment in a dissipative two-state system have been investigated using a systematic approximate method. This method explores the tunneling dynamics through a system state vector with manifest physical meanings and provides a deep microscopic insight into the dynamical behaviors of the system.

Ca2+/calmodulin stimulates GTP binding to the ras-related protein ral-A

Ral-A is a Ras-related GTP-binding protein that has been suggested to be the downstream target of Ras proteins and is involved in the tyrosine kinase-mediated, Ras-dependent activation of phospholipase D. We reported recently that Ral-A purified from human erythrocyte membrane binds to calmodulin in a Ca2+-dependent manner at a calmodulin binding domain identified near its C-terminal region (Wang, K. L., Khan, M. T., and Roufogalis, B. D. (1997) J. Biol. Chem. 272, 16002-16009). In this study we show the enhancement of GTP binding to Ral-A by Ca2+/calmodulin. The stimulation up to 3-fold by calmodulin was Ca2+-dependent, with half-maximum activation occurring at 180 nM calmodulin and 80 nM free Ca2+ concentration. The present work supports a regulatory role of Ca2+/calmodulin for the activation of Ral-A and suggests a possible direct link between signal transduction pathways of Ca2+/calmodulin and Ral-A proteins.

Androgen receptor gene mutations in 46,XY females with germ cell tumours

We present clinical findings and molecular characterization in two patients previously diagnosed as 46,XY female gonadal dysgenesis with germ cell tumour. Both patients showed a female general phenotype with unambiguously female external genitalia and primary amenorrhoea compatible with complete androgen insensitivity syndrome. The first patient, at the age of 31 years, developed a dysgerminoma measuring 8 x 13 x 10 cm in one abdominal testis. Genetic analysis revealed a single nucleotide substitution on exon 4 in the hormone-binding domain of the androgen receptor (AR) gene, resulting in a change of codon 681 GAG (glutamic acid) to AAG (lysine). The second patient, at the age of 17 years, developed a dysgerminoma measuring 12 x 10 x 7 cm in one abdominal testis and gonadoblastoma in the other testis. Genetic analysis showed a point mutation on exon 3 in the DNA-binding domain of the AR gene resulting in a change of codon 607 CGA (arginine) to CAA (glutamine). Arg607-Gln and Arg608-Lys point mutations in the DNA-binding domain of the AR gene have been associated with male breast cancer in partial androgen insensitivity syndrome. A codon 607 mutation in the DNA-binding domain of the AR gene in our patient 2 is associated with early development of germ cell tumour. We suggest regular molecular genetic analysis of the AR gene in 46,XY females with germ cell tumour and androgen insensitivity syndrome to detect differences in the specific regions of AR gene involved in early progression toward oncogenesis of the dysgenetic gonads.

Positive and negative autoregulation of REB1 transcription in Saccharomyces cerevisiae

Reb1p is a DNA binding protein of Saccharomyces cerevisiae that has been implicated in the activation of transcription by polymerase (Pol) II, in the termination of transcription by Pol I, and in the organization of nucleosomes. Studies of the transcriptional control of the REB1 gene have led us to identify three Reb1p binding sites in the 5' region of the its gene, termed A, B, and C, at positions -110, -80, and +30 with respect to transcription initiation. In vitro, Reb1p binds to the three sites with the relative affinity of A >/= C > B. Kinetic parameters suggest that when both A and C sites are present on the same DNA molecule, the C site may recruit Reb1p for the A site. In vivo the A and B sites each contribute to the transcription activity of REB1 in roughly additive fashion. Mutation of both A and B sites abolishes transcription. On the other hand, the C site is a negative element, reducing transcription by 40%. In cells overexpressing Reb1p, the C site reduces transcription by more than 80%. This effect can be transposed to another transcription unit, demonstrating that the effect of Reb1p binding at the C site does not depend on interaction with upstream Reb1p molecules. Relocation of the C site to a position 105 bp downstream of the transcription initiation site abolishes its effect, suggesting that it does not act as a conventional attenuator of transcription. We conclude that binding of Reb1p at the C site hinders formation of the initiation complex. This arrangement of Reb1p binding sites provides a positive and negative mechanism to autoregulate the expression of REB1. Such an arrangement could serve to dampen the inevitable fluctuation in Rep1p levels caused by the intermittent presence of its mRNA within an individual cell.

Identification and characterization of a calmodulin-binding domain in Ral-A, a Ras-related GTP-binding protein purified from human erythrocyte membrane

A 28-kDa protein (p28) has been purified from Triton X-100 extracts of human erythrocyte plasma membrane by calmodulin affinity chromatography. Based on internal peptide sequencing and its protein amino acid composition, this protein has been shown to be highly related, if not identical to, Ral-A, a Ras-related GTP-binding protein. This protein assignment is consistent with the findings that p28 binds [32P]GTP specifically and has low GTPase activity. In this study we describe the identification and characterization of a calmodulin-binding domain in Ral-A. The Ca2+-dependent interaction of p28 with calmodulin was first detected by a calmodulin affinity column. Gel overlay experiments of both p28 and recombinant Ral-A with biotinylated calmodulin provided strong evidence that Ral-A is a calmodulin-binding protein. A peptide of 18 residues (P18) with the sequence SKEKNGKKKRKSLAKRIR has been identified as a putative calmodulin-binding domain in Ral-A, because it comprises a basic/hydrophobic composition with the propensity to form an amphiphilic helix. P18 was synthesized, and its interaction with calmodulin by gel overlay was shown to be Ca2+-dependent. Circular dichroism analysis demonstrated that this interaction results in less alpha-helical content upon calmodulin complex formation. These results indicate that Ral-A is a calmodulin-binding protein, raising the possibility that it may be associated with Ca2+-dependent intracellular signaling pathways.

Cervical cancer in young women in Taiwan: prognosis is independent of papillomavirus or tumor cell type

The objective of this study was to address the hypotheses that younger patients with cervical cancer have a uniquely worse clinical outcome and/or are more likely to have adverse tumor cell types or specific human papillomaviruses (HPV). Cases of stage Ib-IIa cervical cancer among women 35 years of age or younger (82) and over 35 (54) were analyzed and compared with respect to the following: (1) histologic type (squamous vs nonsquamous), (2) human papillomavirus (HPV) type via polymerase chain reaction, and (3) clinical parameters, including tumor size, nodal metastases, and recurrence/persistence. Patients 35 years of age or younger had a survival similar (71.2% vs 72.4%) to that of older women from the same institution. In the younger group, outcome was not correlated with the presence or absence of HPV or HPV type. Nonsquamous carcinomas, including adenocarcinoma and small cell carcinoma, were strongly associated with HPV18, were more prevalent in the younger group, and had a slightly higher risk of recurrence/persistence; however, these differences were not significant and 71% of the recurrences were squamous cell carcinomas. Thus, in young Taiwanese women with stage Ib-IIa cervical cancer, the majority of deaths cannot be attributed to a specific HPV type or unique tumor morphology.

Cultured urothelium in sheep bladder augmentation

In search of alternatives for urothelial-lined augmentation or reconstruction of the urinary bladder, this study combined the application of seromuscular gastrointestinal (GI) segments with the use of in-vitro cultured, autologous urothelial cells in a sheep model. A cell culture system was set up for establishment and expansion of urothelial cells out of small biopsies from bladder mucosa. A biodegradable carrier made of lactidcaprolactoncopolymer was introduced, allowing upside-down transplantation of cell cultures in vivo. Bladder mucosal biopsies were taken from 14 sheep (mean weight 13.3 kg) with an average yield of 3.5×10(5) viable cells/cm(2) after trypsinization. Primary low-density cultures grew to confluence within 5-7 days. Secondary cultures were established on the biodegradable film and were available a week later. They were transplanted onto demucosalized segments of stomach (group 1) or colon (group 2) in 5 animals each, followed by bladder incorporation in clam fashion. The earliest specimens, demonstrating survival and some proliferation of the cultured urothelium in both groups, were obtained 13 days postoperatively. To exclude urothelial regrowth, a temporary pouch grafted with cultured urothelium was created in 2 more sheep of each group. Biopsies were taken after 2 and 3 weeks, respectively, when the reopened pouch was integrated into the bladder (delayed augmentation). In these pouches, adherence and proliferation of urothelial cells could not be demonstrated. Limited radiologic and urodynamic investigations after 5-6-month follow-up revealed good shape, capacity, and compliance of the primarily augmented bladders only. The results indicate that urothelial cell cultures can be established and applied in vivo. Despite upside-down transplantation, they are able to survive on seromuscular segments in an autologous setting. The bladder environment is necessary to promote complete covering of the seromuscular segments. Based on our histologic findings, the share of both resident bladder urothelium and transplanted cells in the formation of the final urothelial lining remains uncertain. Morphologic and urodynamic follow-up data indicate that this process can be accelerated by the transplanted urothelial cells, reducing fibrotic changes of the GI segments. The functional quality of the augmented bladder seemed to improve compared to results after seromuscular augmentation alone.

Coincidence of congenital cystic adenomatoid malformation and extralobar sequestration of the lung in a newborn

We present a rare case of coincidence of an extralobar sequestration with a congenital cystic adenomatoid malformation of the lung in a newborn. The symptoms, diagnostic features, and therapy are described and the etiology and classification are briefly discussed.

Intestinal malrotation and midgut volvulus: a 15-year review

The records of 54 pediatric patients with symptomatic malrotation of the intestine seen over a 15-year period from 1978 to 1992 were reviewed. Bilious vomiting and bloody stools were the two most common clinical presentations in neonates, while bilious vomiting, recurrent abdominal pain and failure to thrive were the most common symptoms after the newborn period. Obscure symptoms, usually of appreciable duration, were common in many patients beyond infancy. Upper gastrointestinal radiologic examination is the preferred and more accurate method of diagnosing malrotation as it has greater sensitivity than barium enema study. Laparotomy showed 24 cases with midgut volvulus. The incidence of midgut volvulus in symptomatic malrotation was 42.1% in the neonatal period, and 50% beyond the neonatal period. The majority of patients were treated by Ladd's operation. Massive gangrene of the small bowel due to volvulus was noted in five neonatal cases. Three patients subsequently died of this complication. Four patients developed a bowel obstruction secondary to adhesions, which was relieved by enterolysis. This study reiterates that newborns with symptomatic malrotation require emergency laparotomy in order to prevent catastrophic massive bowel resection.

Endoscopic injection sclerotherapy for esophageal variceal bleeding in children with extrahepatic portal vein obstruction

From October 1989 to March 1994, 30 endoscopic injection sclerotherapies were performed in four consecutive female children who had extrahepatic portal vein obstruction complicated with esophageal variceal bleeding. Eradication of varices was achieved in three patients. However, bleeding occurred again in two of these patients due to esophageal varix recurrence. One patient, who discontinued sclerotherapy because of hemoptysis during treatment, also had 12 episodes of esophageal bleeding which were controlled by shunt therapy. In addition to hemoptysis, other complications were bleeding during sclerotherapy and fever. The sclerotherapy complication rate in this study was 17%. Our results suggest that endoscopic injection sclerotherapy is an effective and safe method for the prevention of variceal bleeding in children with extrahepatic portal vein obstruction. Long-term regular endoscopy follow-up and even repeated sclerotherapy are needed to prevent bleeding due to recurrence of esophageal varices.

Intussusception in infants and children: risk factors leading to surgical reduction

Intussusception is commonly the etiology of intestinal obstruction in infants and children. To investigate demographic data, clinicopathologic features and therapeutic prognosis of patients with intussusception, we reviewed 361 intussusceptions in 333 patients over an 11-year period. Most patients were below two years of age and there was a male preponderance of 1.6:1. There was no seasonal difference between the number of cases. The clinical triad of vomiting, abdominal colicky pain and bloody stools was manifested in only one-third of our patients. Secondary intussusception contributed to 6.6% of cases and Meckel's diverticulum was the most common pathologic cause. Positive findings were recorded in 82% of 67 patients undergoing sonographic examination. Intussusception of the ileo-colic type was most frequently encountered. Most patients (79%) were diagnosed within 48 hours and almost all cases underwent primary barium enema reduction. The success rate was 45%. Laparotomy was performed in 207 patients (57%) refractory to enema reduction or with critical illness, and intestinal resection was required in 28 (14%). Long-standing duration of illness (> 24 hours), positive clinical triad, positive pathologic lead point, and radiologic finding of bowel obstruction were identified as risk factors leading patients to surgical reduction (p < 0.001). Postoperative complications and recurrent intussusception developed in some patients, and the overall mortality was 0.6%. The clinical characteristics of intussusception in children generally remained unchanged as compared to previous reports. Early identification of patients with risk factors for surgical treatment is important to decrease the need for intestinal resection.