[The correlation between burst suppression on electroencephalogram during laparoscopic surgery and emergence delirium in elderly patients]

Objective: To investigate the relationship between intraoperative electroencephalogram burst suppression (BS) and emergence delirium (ED) in elderly patients undergoing elective laparoscopic surgery under total intravenous anesthesia (TIVA). Methods: From October 2017 to September 2019, a total of 358 elderly patients who underwent elective laparoscopic surgery under TIVA at Xiangya Hospital, Central South University, were included. Patients were divided into two groups based on the confusion assessment method for the intensive care unit (CAM-ICU) assessment conducted before leaving the post-anesthesia care unit (PACU): the ED group [n=63, 46 males, 17 females, average age of (70.8±0.6) years] and the non-ED group [n=295, 220 males, 75 females, average age of (69.7±0.2) years]. Preoperative general information, intraoperative conditions, and intraoperative electroencephalogram BS status were collected. A multivariate logistic regression model was employed to identify risk factors associated with ED. Results: In the ED group, the duration of surgery, intraoperative blood loss, the burst suppression ratio (BSR)>10% lasting for more than 1 minute were (224.4±9.6) min, (240.8±33.9) ml, 36.5% (23/63), respectively, which were higher than those of the non-ED group [(204.7±3.6) min, (150.5±9.2) ml, 21.7% (64/295), all P<0.05]. Multivariate logistic regression analysis revealed that a longer duration of education was a protective factor for ED (OR=0.904, 95%CI: 0.833-0.982,P=0.016), whereas increased intraoperative blood loss (OR=1.002, 95%CI: 1.000-1.003, P=0.013) and BSR>10% lasting for more than 1 minute (OR=2.131, 95%CI: 1.004-4.524,P=0.049) were identified as risk factors for ED. Conclusion: In elderly patients undergoing laparoscopic surgery under TIVA, intraoperative electroencephalogram BS may be a risk factor for ED.

[Analysis of factors associated with futile recanalization after endovascular treatment for acute ischemic stroke with large vessels occlusion in anterior intracranial circulation]

Objective: To analyze the related factors of futile recanalization (FR) after emergency endovascular treatment of large artery occlusion in anterior circulation. Methods: Three studies on endovascular treatment of acute anterior circulation large vessels occlusion stroke were selected, and their data were merged for retrospective analysis. Patients were divided into the FR group and favorable prognosis group according to the functional prognosis. Risk factor analysis was conducted using multivariate logistic regression. Results: A total of 1 581 patients were finally included, with 858 (48.9%) patients in favorable prognosis group and 926 (51.91%) patients in FR group. Among them, there were 939 males and 642 females, with a mean age of (65±12) years. Multivariate logistic regression analysis showed that National Institute of Health Stroke Scale (NIHSS) score (OR=1.089,95%CI:1.066-1.113), puncture to recanalization time (OR=0.756, 95%CI:0.586-0.971), age (OR=1.04,95%CI:1.029-1.051), serum glucose (OR=1.101,95%CI:1.062-1.143), systolic blood pressure (OR=1.005,95%CI:1.001-1.010), passes≥3(OR=1.941,95%CI:1.294-2.941)Alberta stroke program early CT (ASPECT) score (OR=0.919,95%CI:0.847-0.996), occlusion site (M1 segment of middle cerebral artery, OR=0.744,95%CI:0.565-0.980) and collateral circulation [(2 points, OR=0.757, 95%CI:0.581-0.985); (3-4 points, adjusted OR=0.640, 95%CI: 0.472-0.866)] were independent factors of FR. Conclusion: The incidence of FR in patients with large artery occlusion in anterior circulation who achieve satisfied reperfusion after endovascular treatment is high. Higher NIHSS score, longer puncture to recanalization time, older age, higher serum glucose and systolic blood pressure are risk factors, while lower ASPECTS, occlusion in cerebral middle M1 segment, better collateral circulation are protective factors.

[Role and clinical significance of MUC4 gene mutations in thrombotic events in patients with classic paroxysmal nocturnal hemoglobinuria]

Objective: This study aimed to investigate the role and clinical significance of MUC4 gene mutations in thrombotic events in patients with classic paroxysmal nocturnal hemoglobinuria (PNH) patients. Methods: A retrospective analysis was conducted on the clinical data and gene sequencing results of 45 patients with classic PNH admitted to the Department of Hematology, Tianjin Medical University General Hospital, from June 2018 to February 2022. MUC4 gene mutations in patients with classic PNH were summarized, and the risk factors for thrombotic events in these patients were analyzed. Additionally, the effects of MUC4 gene mutations on the cumulative incidence and survival of thrombotic events in patients with classic PNH were determined. Results: The detection rate of MUC4 gene mutations in patients with classic PNH who experienced thrombotic events (thrombotic group) was 68.8% (11/16), which was significantly higher than that in the non-thrombotic group [10.3% (3/29) ] (P<0.001). All mutations occurred in exon 2. MUC4 mutation (OR=20.815, P=0.010) was identified as an independent risk factor for thrombotic events in patients with classic PNH. The cumulative incidence of thrombotic events was 78.6% (11/14) in the MUC4 gene mutation group (mutation group) and 16.1% (5/31) in the non-mutation group, showing a statistically significant difference between the two groups (P<0.001). Survival analysis showed a lower overall survival (OS) rate in the thrombotic group compared with that in the non-thrombotic group [ (34.4±25.2) % vs. (62.7±19.3) % ] (P=0.045). The OS rate of patients was (41.7±29.9) % in the mutation group and (59.1±18.3) % in the non-mutation group (P=0.487) . Conclusion: MUC4 gene mutations are associated with an increased incidence of thrombotic events in classic PNH patients, highlighting their role as independent risk factors for thrombosis in this population. These mutations can be considered a novel predictive factor that aids in evaluating the risk of thrombosis in patients with classic PNH.

[Associations between indoor volatile organic compounds and nocturnal heart rate variability of young female adults: A panel study]

OBJECTIVE

To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults.

METHODS

This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results.

RESULTS

The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m². During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m³, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m³, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m³ increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m³. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter.

CONCLUSION

Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.

[Efficacy and safety of intravitreal dexamethasone implant in diabetic macular edema patients with and without prior vitrectomy: a retrospective cohort study]

Objective: To evaluate the effectiveness and safety of intravitreal dexamethasone implant (IDI) in diabetic macular edema (DME) patients with and without prior vitrectomy. Methods: A retrospective cohort study was conducted on DME patients who received IDI treatment at the Aier Eye Hospital, Beijing from March 2018 to August 2020. Patients were divided into two groups according to whether they had undergone vitrectomy or not. Clinical and follow-up data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), occurrence of ocular and systemic complications, and time to DME recurrence and retreatment, were collected before and after IDI injection at 15 days, 1, 2, 3, and 6 months. Statistical analyses were performed using t-test, Mann-Whitney U-test, χ² test or Fisher's exact test, and generalized estimating equations. Results: Thirty-six patients (41 eyes) were included, with 19 patients (21 eyes) in the vitrectomy group and 17 patients (20 eyes) in the non-vitrectomy group. Compared with baseline, BCVA of eyes in the vitrectomy group was significantly improved at 15 days after IDI injection, with values of 1.00 (0.52, 1.31) and 0.61 (0.30, 1.00), respectively (Z=-2.10, P=0.036); BCVA of eyes in the non-vitrectomy group was significantly improved at 1 month after IDI injection, with values of 0.76 (0.60, 1.35) and 0.52 (0.10, 0.70), respectively (Z=-2.24, P=0.025). Compared with baseline, CMT of eyes in both groups was significantly reduced at all follow-up time points after 15 days of IDI injection (all P<0.05). In the vitrectomy group, CMT before and 15 days after injection were 487 (438, 661) μm and 389 (340, 553) μm, respectively (Z=-3.45, P<0.001); in the non-vitrectomy group, CMT before and 15 days after injection were 486 (410, 641) μm and 323 (290, 396) μm, respectively (Z=-4.07, P<0.001). There were no statistically significant differences in BCVA and CMT between the two groups at all follow-up time points (all P>0.05). The time to DME recurrence was 3.0 (3.0, 4.0) months in the vitrectomy group and 5.0 (4.0, 5.0) months in the non-vitrectomy group, with no significant difference between the two groups (P=0.675). Four eyes (19.0%) in the vitrectomy group and three eyes (15.0%) in the non-vitrectomy group had high IOP, with no significant difference (P=0.529). No severe ocular or systemic complications were observed in any patients. Conclusions: IDI treatment is safe and effective in DME patients with and without prior vitrectomy, with similar efficacy, but with faster onset of action in patients with prior vitrectomy. There was no significant difference in DME recurrence within 6 months after IDI injection between the two groups.

Protective effects of umbilical cord mesenchymal stem cell exosomes in a diabetic rat model through live retinal imaging

AIM

To assess the protective effect of human umbilical cord mesenchymal stem cell exosomes (hucMSC-Exs) in a diabetic rat model by using a variety of retinal bioassays.

METHODS

hucMSCs were subjected to differential ultracentrifugation for the collection of exosomes, and transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA) using a NanoSight analysis system and Western blotting (WB) were used to analyze the expression of surface marker proteins such as CD63, CD9 and Calnexin. Streptozotocin (STZ) was injected into the intraperitoneal cavity to establish a diabetic model. Rats were divided into a normal group, diabetic group and hucMSC-Ex group. Fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and other live imaging methods were used to observe the fundus of the rats. Finally, the eyeballs of rats from each group were collected for hematoxylin-eosin (HE) staining to further analyze the retinal structure.

RESULTS

Through TEM, NTA and WB, we successfully isolated hucMSC-Exs. Subsequent FFA and OCT confirmed that hucMSC-Exs effectively prevented early retinal vascular damage and thickening of the retina. Finally, HE staining of rat retinal sections revealed that exosomes effectively alleviated retinal structure disruption caused by diabetes.

CONCLUSION

hucMSC-Exs have a protective effect on the retina in diabetic rat through FFA, OCT and HE staining.

[Clinicopathological features and prognostic impact of MELF pattern in 512 endometrioid adenocarcinoma]

Objective: To investigate the relationship of microcystic elongated fragmented (MELF) and clinicopathological features of patients with low grade endometrial endometrioid carcinoma, and to analyze its impact on prognosis. Methods: The clinical pathological data of 512 cases with low grade endometrial endometrioid adenocarcinoma were collected. The MELF invasive pattern in all of the sections were reappraised. The correlations between MELF pattern and clinicopathological features were analyzed by chi-square test, and the independent risk factor of lymph node metastasis were evaluated by Logistic multivariate regression analysis. Survival curves was drawn by Kaplan-Meier method, and Log-rank test was used to compare progression free survival (PFS) between patients with or without MELF pattern. Disease progression-related multivariate analysis was carried out by Cox proportional hazards model. Results: MELF pattern was observed in 12.9% (66/512) low grade endometrioid adenocarcinoma. It was significantly associated with cervical stroma invasion, more than half of the depth of myometrial invasion, lymph node metastasis and vessel invasion (P<0.05). In addition, MELF pattern was an independent risk factor for lymph node metastasis (P<0.05). The 5-year PFS of patients with and without MELF pattern were 95.0% and 96.0% respectively (P>0.05). Conclusions: The patients with MELF pattern are more likely accompany with cervical stroma and deeper myometrium invasion, vessel invasion, and lymph node metastasis, and it is an independent risk factor of lymph node metastasis. However, MELF pattern has no significant impact on prognosis of patients with endometrioid carcinoma.

The development of epiretinal membrane following rhegmatogenous retinal detachment repair: incidence, risk factors, and outcomes

PURPOSE

To investigate the incidence, risk factors, and visual outcomes of epiretinal membrane development following rhegmatogenous retinal detachment repair.

METHODS

This was a retrospective study of 309 eyes that underwent initial surgery for primary uncomplicated rhegmatogenous retinal detachment. Examinations were conducted preoperatively and then postoperatively at 1, 3, 6, and 12 months. The study patients were categorized into two groups depending on the presence or absence of the epiretinal membrane.

RESULTS

The incidence of postoperative epiretinal membrane was 28.5%; 42.7% of these patients had severe epiretinal membrane development and therefore underwent the epiretinal membrane removal. Logistic regression analyses revealed that giant retinal tears (OR: 2.66; 95% CI: 1.045-6.792, p=0.040) and horseshoe tears (OR: 0.534; 95% CI: 0.295-0.967, p=0.039) were the significant predictors of postoperative epiretinal membrane. Triamcinolone acetonide staining was significantly associated with the prevention of epiretinal membrane (p=0.022). A total of 34 patients showed a better or an equal final best-corrected visual acuity; of which 4 eyes were evaluated at the final follow-up visit and exhibited a reduced best-corrected visual acuity.

CONCLUSION

Our analysis demonstrated that horseshoe tears and giant retinal tears represent the risk factors for the postoperative epiretinal membrane. Triamcinolone acetonide staining had a significant preventive effect on the postoperative epiretinal membrane. Furthermore, a second round of pars plana vitrectomy, including membrane removal, led to a significant improvement in the final best-corrected visual acuity as per the last follow-up examination, albeit the recovery was limited.

[Logistic regression analysis of risk factors for subretinal fluid after rhegmatogenous retinal detachment repair]

Objective: To identify factors associated with persistent subretinal fluid (SRF) after scleral buckling and to evaluate surgical outcomes of patients with primary rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional study and cohort study. This study included 104 patients (104 eyes) who underwent scleral buckling for repair of RRD between January 2016 and June 2017. Several statistically significant risk factors associated with SRF were screened out with univariate analysis. Then independent risk factors were determined with multivariate stepwise logistic regression analysis. Examinations were taken preoperatively, at 1, 3, 6, and 12 months postoperatively, and thereafter every six months. Patients were divided into two groups depending on the presence or absence of persistent SRF on optical coherence tomography at 1 month. Results: Persistent SRF occurred in 69.2% (72/104) of patients. In multivariate analysis, younger age (OR=32.860, 95%CI=3.636-296.986, P=0.002), high myopia (OR=7.229, 95%CI=1.217-42.94, P=0.03) and macula-involving retinal detachment (OR=357.397, 95%CI=29.761-4292.0, P=0.000) were associated with persistent SRF. Best corrected visual acuity in patients with SRF at 1 month (0.71±0.18 vs. 0.58±0.11; t=4.047, P<0.01) and 3 months (0.55±0.15 vs. 0.43±0.12; t=3.914, P<0.01) was worse than that in patients with absence of SRF. Best corrected visual acuity in patients with SRF was 0.44±0.16 at 6 months, 0.37±0.12 at 12 months and 0.36±0.10 at the last follow-up, with no significant difference from patients without SRF at the three time points (0.39±0.13, 0.38±0.12 and 0.35±0.09; t=1.643, -0.202, 0.464; P>0.05). Conclusions: RRD patients with younger age, high myopia and macular involvement were more likely to develop persistent SRF after scleral buckling. The presence of persistent SRF slowed visual recovery but did not influence the final visual outcomes. (Chin J Ophthalmol, 2021, 57: 426-432).

CDC20 and PTTG1 are Important Biomarkers and Potential Therapeutic Targets for Metastatic Prostate Cancer

INTRODUCTION

Metastatic prostate cancer (mPCa) is responsible for most prostate cancer (PCa) deaths worldwide. The present study aims to explore the molecular differences between mPCa and PCa.

METHODS

The authors downloaded GSE6752, GSE6919, and GSE32269 from the Gene Expression Omnibus and employed integrated analysis to identify differentially expressed genes (DEGs) between mPCa and PCa. Functional and pathway-enrichment analyses were performed, and a protein-protein interaction (PPI) network and modules were constructed. Clinical mPCa specimens were collected to verify the results by performing RT-qPCR. The Cancer Genome Atlas database was used to conduct a survival analysis, and an immunohistochemical assay was performed. The invasion ability of PCa cells was verified by Transwell assay.

RESULTS

One-hundred six consistently DEGs were found in mPCa compared with PCa. DEGs significantly enriched the positive regulation of cell proliferation, cell division, and cell adhesion in small cell lung cancer and PCa. Cell division, nucleoplasm, and cell cycle were selected from the PPI network, and the top 10 hub genes were selected. CDC20 and PTTG1 with genetic alterations were significantly associated with poorer disease-free survival. Immunohistochemical assay results showed that the expression levels of CDC20 and PTTG1 in mPCa were higher than those in PCa. The results of the migration assay indicated that CDC20 and PTTG1 could enhance the migration ability of PCa cells.

CONCLUSION

The present study revealed that CDC20 and PTTG1 contribute more to migration, progression, and poorer prognoses in mPCa compared with PCa. CDC20 and PTTG1 could represent therapeutic targets in mPCa medical research and clinical studies.

Anti-inflammatory effects of ginsenoside Rg3 on the hypertrophic scar formation via the NF-κB/IκB signaling pathway in rabbit ears

The anti-inflammatory effects of Rg3 on the hypertrophic scar (HS) formation remain relatively obscure. Hence, this study aimed to explore the anti-inflammatory effects of Rg3 on the HS formation using a rabbit ear model and we assessed the involvement of the NF-κ B/IκB signaling pathway in this process. We constructed the Newland white rabbit ear HS model and treated it with Rg3. Using histological analyses, we evaluated scar hypertrophy based on the hematoxylin and eosin staining. The degree of scarring was evaluated using the scar elevation index (SEI). In addition, collagen I and collagen III expression levels were assessed by immunohistochemistry, while fibroblast apoptosis was examined using TUNEL assays. While MPO, IL-1β, IL-6, and TNF-α concentrations were quantified using ELISA, NF-κB and p-IκB activities were respectively measured using electrophoretic mobility shift assays (EMSAs) and western blots. SEI measurements and histological characteristics revealed that Rg3 could suppress the HS formation. Moreover, Rg3 could inhibit the HS formation by decreasing collagen I and collagen III synthesis and inducing fibroblast apoptosis. Besides, Rg3 treatment markedly inhibited the inflammatory cytokine production and ameliorated neutrophil infiltration. Notably, this study revealed that Rg3 inhibited NF-κB activation and the activity of p-IκB. Furthermore, this study suggested that the ability of Rg3 to decrease the scar formation might result from its ability to inhibit inflammation by modulating the NF-κB/IκB signaling. Overall, the findings of this study could support the use of Rg3 to prevent the HS formation.

Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment

AIM

To provide a detailed description of the natural history of persistent subretinal fluid (SRF) after successful repair of rhegmatogenous retinal detachment (RRD) and its association with visual outcome.

METHODS

This was a prospective long-term follow-up for eyes undergoing scleral buckling (SB) surgery for macula-off RRD. Examinations were carried out preoperatively and postoperatively at 1, 3, 6, 9 and 12mo, until persistent SRF had completely resolved. One month postoperatively, optical coherence tomography (OCT) was used to classify SRF into three patterns: bleb-like loculated (BL), shallow-diffused (SD), and multiple blebs (MB). Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance. Patients were divided into two groups depending on the presence or absence of persistent SRF.

RESULTS

A total of 59 patients (59 eyes) were included. There were no statistical differences between two groups at baseline, except for the proportion of patients with high myopia and a younger age. One month after surgery, OCT detected persistent SRF in 49 eyes (83.1%). The 3 morphological patterns of SRF were observed in 27 eyes (55.1%) with BL, 13 eyes (26.5%) with SD, and 9 eyes (18.4%) with MB. The mean time for complete absorption differed significantly across the three SRF patterns (F=8.097, P=0.001), which was 8.8±6.1, 20.1±12.1, and 16.7±10.2mo in BL, SD, and MB, respectively. In 9 of the 13 eyes with SD, the pattern transformed into MB type. In cases involving MB, the size and number of blebs decreased gradually until they had been completely absorbed. Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone (49.0% vs 10%, P=0.034). The final best-corrected visual acuity of two groups was 0.37±0.11 (with SRF) vs 0.34±0.12 (without SRF) logMAR (P=0.499), respectively.

CONCLUSION

High preoperative myopia and younger age are associated with persistent SRF. BL is the most commonly observed pattern with the shortest duration and gradually disappeared. Most cases involving SD SRF transform into MB type during resolution. The size and number of the MBs decrease gradually until they were completely absorbed. The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.

Total glucosides of paeony (Paeonia lactiflora) alleviates blood-brain barrier disruption and cerebral ischemia/reperfusion injury in rats via suppressing inflammation and apoptosis

At present it remains uncertain as to whether total glucosides of paeony (TGP) are able to mediate neuroprotection in the context of cerebral ischemia/reperfusion (CIR) injury, and if so, what mechanisms underlie such protection. We employed a rat model of middle cerebral artery occlusion and reperfusion, and then Evans blue (EB), hematoxylin and eosin, Nissl staining, TUNEL staining, ELISAs and immunohistochemistry were used. We observed marked reductions in infarct volume, neurological deficits, and CIR-associated histopathological changes following TGP treatment. We further found that TGP was associated with restoration of the BBB integrity, a reduction in levels of cerebral IL-1β, IL-6 and TNF-α, and a decrease in overall neuronal apoptotic death that coincided with reduced Cleaved Caspase-3 and Bax expression, and elevated Bcl-2. These results demonstrate that TGP treatment is capable of reducing neurons damage and associated BBB dysfunction via anti-apoptotic and anti-inflammatory mechanisms in a rodent model of CIR injury.

The clinical significance of long non-coding RNA ANRIL level in diabetic retinopathy

AIM

To analyse the expression of lncRNA-ANRIL and other related factors in different human body fluids, explore the clinical significance of ANRIL and validate whether ANRIL is interrelated with the renin-angiotensin system and NF-κB signalling pathway.

METHODS

Ninety-one patients were included in this cross-sectional study and were divided into the NDM group (20 patients), DM group (25 patients), NPDR group (21 patients) and PDR group (25 patients). Basic information and samples of serum, aqueous fluid and vitreous fluid were collected before vitrectomy or intravitreal injection. The transcription and levels of ANRIL and other related factors were detected by RT-PCR and ELISA. Statistical Package for Social Sciences software was used for statistical analysis.

RESULTS

ANRIL expression varied among different groups and body fluids. There was no difference in ANRIL expression between the NDM and DM groups, but the level of ANRIL was significantly lower in the DM group than in the NPDR and PDR group. In vitreous fluid, ANRIL expression was positively correlated with Ang II, p65 and VEGF expression in the PDR group. The expression of ANRIL in serum was not significantly correlated with age or the random blood sugar but was positively correlated with diabetic duration and HbAc1 level.

CONCLUSIONS

Levels of lncRNA-ANRIL are higher in DR patient and correlated with the progression of DR that may be used as an indicator to predict the development of DR. The activation of the RAS and the NF-κB pathway may be closely related to the upregulation of ANRIL. Clinical trial number ChiCTR1800017500. Registry Chinese Clinical Trial Registry.

[The correlation between gastric bubble size and laryngopharyngeal reflux pattern in patients with laryngopharyngeal reflux disease]

Objective: To investigate the correlation between gastric bubble size and laryngopharyngeal reflux pattern in patients with laryngopharyngeal reflux disease(LPRD). Methods: A total of 52 LPRD patients who underwent Dx-pH monitoring and anteroposterior chest radiography at the same time from February 2016 to November 2018 were retrospectively studied. Patients were devided into three position-related groups according to the Ryan score of upright and supine: isolated upright reflux(IUR), isolated supine reflux(ISR) and bipositional reflux(BR) groups. In addition, 13 healthy volunteers with negative pH monitoring were selected as the control group. Gastric bubble size and pH monitoring data among the four groups were compared. SPSS 24.0 was used for statistical analysis. Results: In all the 52 patients, 35 cases (67.3%) were classified as IUR, 9 cases (17.3%) as ISR, and 8 cases (15.4%) as BR. The height of gastric bubbles in the four groups were: IUR (26±14) mm, ISR (9±8) mm, BR (20±13) mm, control (17±15) mm, and statistical difference was found among the four groups(P=0.004). Post Hoc Multiple Comparisons found that IUR group had statistical difference between ISR group and control group (P=0.001, P=0.034 respectively). There was no statistical difference of gastric bubble width and area among the four groups(P=0.340, P=0.186 respectively). The ROC curve of the gastric bubble height with isolated upright and supine reflux patterns was obtained, and the optimal cutoff value of the gastric bubble height was 11 mm. Accordingly, we divided the patiens into two groups with high and low gastric bubble. LPRD reflux pattern distribution was significantly different between the two groups(P<0.001). The comparison of reflux parameters in pH monitoring also showed that the supine reflux parameters in the lower group were significantly higher than those in the higher group, and the upright reflux parameters in the higher group were significantly higher than those in the lower group(P<0.001). Conclusions: The height of gastric bubble is significantly correlated with the reflux patterns in LPRD patients. The gastric bubble of patients with IUR is significantly higher than that of patients with ISR. Taking 11 mm as the cutoff value, patients with higher gastric bubble are more prone to upright laryngopharyngeal reflux, while those with lower gastric bubble are more prone to supine laryngopharyngeal reflux.

[Clinical-pathological analysis of 71 cases of dermatosis papulosa nigra of Han Chinese people]

Objective: To analyze and summarize the clinical-pathological features of dermatosis papulosa nigra of Han Chinese people. Methods: We collected 71 cases of dermatosis papulosa nigra in the Third people's Hospital of Hangzhou Affiliated to Zhejiang Chinese Medical University of Department of Dermatology from January 2010 to January 2019 which were confirmed clinically and pathologically. The clinical and histopathological data of all patients were analyzed and summarized, and relevant literature were reviewed. Results: Among the 71 patients, 51 were female and 25 were male, their average age was (44±13) years, the average age of onset was (39±14) years, and the average time of diagnosis was (65±51) months. The lesions were multiple dark brown papules with smooth surface, and mostly distributed in the chest and abdomen, 46 cases (64.8%), followed by the back and neck. The mean diameter of the lesions was (1.76±0.99) mm. Meanwhile, the initial onset of pruritus was observed in 15 patients. The pathological features of all lesions were similar to seborrheic keratosis. According to pathological classification, there were 49 (69.0%) cases of the acanthotic type, 11(15.5%) cases of the hyperkeratotic type, 6 (8.5%) cases of spiroid type, 4 (5.6%) cases of irritated type, and 1 (1.4%) case of clonal type. Epidermal pigmentation and/or dermal papillary pigmented granules were observed in 56 cases (78.9%), of which 46 cases (64.8%) had basal layer pigmentation. In addition, inflammatory cell infiltration was found in the superficial dermis of lesions of 10 patients (14.1%) with symptom of itching. Conclusion: Dermatosis papulosa nigra of Han Chinese people has some unique clinical and pathological features.

[Study on corneal biomechanical properties of suspicious keratoconus patients in corneal topography]

Objective: To explore the characteristics and significance of corneal biomechanics in patients with suspicious total deviation value in Belin/Ambrosio Enhanced Ectasia Display of Pentacam corneal topography. Methods: In this cross-sectional study, 206 patients (325 eyes) with myopia or myopic astigmatism were collected from refractive surgery center of Tianjin Eye Hospital. Among them, 110 males(213 eyes) and 96 females (153 eyes) were aged (22.68±5.20) years. 57 patients (71 eyes) with a total deviation value of 1.6-3.0 in the Pentacam corneal topography were included in the suspicious group, and 149 patients (254 eyes) of<1.6 were included in the control group. The values of the first applanation time (A1-Time), first applanation length (A1-Length), first applanation velocity (A1-Velocity), second applanation time (A2-Time), second applanation length (A2-Length), second applanation velocity(A2-Velocity), highest concavity time (HC-time), highest concavity deformation amplitude (DA), highest concavity peak distance (PD), highest concavity radius (HC-Radius, RoC), intraocular pressure were measured using the corneal visualization Scheimpflug technology. The total deviation value in Belin/Ambrosio Enhanced Ectasia Display were measured with a Pentacam. The biomechanical parameters of the suspicious group were compared with the normal group by the two independent samples t test and the identity regression analyses. The data correlation was performed using Pearson linear correlation analysis. Results: Compared with the D normal group, the K1, K2 and Km of D suspicious group were significantly increased (P<0.001). A1-Velocity [(0.152±0.015) m/s] and DA[(1.050±0.090) mm] were significantly increased (t=4.348, 2.708; P<0.001, 0.007), while the CCT, A1-Length, A2-Length and RoC were significantly decreased (P<0.01) in suspicious group. In suspicious group, there was a significant correlation between A1-Time, A1-Length, A2-Length, A2-Velocity, IOP and CCT(r=0.305, 0.324, 0.238, 0.346, 0.316; P<0.05). There was a significant correlation between the anterior surface refractive power K1 and the A1-Length (r=-0.361, P=0.002), and there was a significant correlation between the A1-Length, RoC and anterior surface refractive power K2 (r=-0.369, -0.242; P=0.002, 0.043). There was a significant correlation between anterior surface refractive power Km and A1-Length (r=-0.373, P=0.001). After adjusting the confounding factors between two groups by the identity regression analyses, the A1-Length (P=0.003), A1-Velocity (P<0.001) and DA (P=0.002) were still significant differences. Conclusions: In total deviation value suspicious group, the corneal thickness was thinner, corneal curvature became steeper and the corneal biomechanical properties were weaker. It is important to screen keratoconus before corneal refractive surgery and choose a reasonable surgical procedure to reduce corneal dilatation after refractive surgery. (Chin J Ophthalmol,2019, 55: 442-447).

Molecular Typing of Cryptosporidium Species Identified in Fecal Samples of Yaks ( Bos grunniens) of Qinghai Province, China

The frequency of Cryptosporidium infection in yaks from Qinghai province, People's Republic of China, was determined from examination of 1,027 fecal samples collected from 979 adult yaks and 48 yak calves during 4 seasons from 7 geographic areas within the province. PCR amplification of extracted DNA was used to characterize the different species of Cryptosporidium oocysts isolated by fecal examination. Twenty-six (2.53%) positive samples were identified and successfully sequenced: 17 Cryptosporidium ryanae (65.38%), 8 Cryptosporidium bovis (30.77%), and 1 Cryptosporidium baileyi (3.85%). The results of the study indicate that autumn is the primary season for transmission of Cryptosporidium to susceptible yak calves given the favorable temperatures and higher altitude of Qinghai province. To our knowledge, C. baileyi, a species predominately associated with birds (avian hosts), is described for the first time in yaks.

[Analysis of chromosome in 1 324 patients with oligozoospermia or azoosperm]

OBJECTIVE

To explore the incidience of chromosome abnormality of the patients with oligozoospermia or azoospermia and male infertility, to discuss the relationship between the quantitative and structural abnormality of chromosome and to lay the foundation for the clinical diagnosis and consultation.

METHODS

A retrospective analysis was conducted from January 1, 2015 to May 1, 2016, in the Center for Reproduction Medicine, the Second Hospital of Jilin University, with male reproductive abnormalities history excluded. In the study, 1 324 cases were included with 448 cases of azoospermia and 876 cases of oligozoospermia. All the patients through ultrasound examination, color Doppler ultrasonography, the seminal plasma Zn determination, their hormone level determination, chromosome karyotype (the perinatal blood samples were obtained from the 1 324 patients with oligozoospermia or azoospermia for lymphocyte culture, then chromosomal specimens were prepared, G-banding analyses combined with clinical data were used to statistically analyze the incidence of chromosomal abnormality), Y chromosome azoospermia factor [PCR technique was used to detect SY157 locus, SY254 locus, and SY255 locus in male Y chromosome azoospermia factor (AZF) gene of the patients with oligozoospermia or azoospermia]. The relationship between chromosome abnormalities and oligozoospermia or azoospermia were analyzed.

RESULTS

Among the 876 cases of oligospermia patients, 78 cases were chromosome number abnormality and chromosomal structural abnormality, the abnormal number of sex chromosomes in 22 cases, and sex chromosomes and chromosome structural abnormalities in 56 cases; in the 448 cases of azoospermia patients, 91 cases were chromosomal structural abnormality and chromosome number abnormality, of them, 78 cases were of abnormal number of sex chromosomes, and 13 cases were of abnormal structure. In addition, 137 cases were of chromosome polymorphism in all the 1 324 patients, The incidence of Y chromosome abnormality in azoospermatism was higher than that of the 43 patients with Y chromosome AZF microdeletion. In addition, the asthenospermia and recurrent spontaneous abortion were closely related to Y chromosome abnormality and the chromosome translocations and inversions.

CONCLUSION

Oligozoospermia and azoospermia patients with abnormal chromosome karyotype have high incidence rate, and chromosome karyotype analyses were carried out on it, which is conducive to clinical diagnosis for the patients with abnormal chromosome karyotype. There is a close relationship between male infertility and abnormal karyotype. It is conducive to clinical diagnosis for the patients with infertility through chromosome karyotye analysis, which also provides evidence for genetic counseling.

Transport paths and vertical exchange characteristics of haze pollution in Southern China

Transport paths and vertical exchange characteristics are important factors for understanding the long-term transport, dispersion capability for haze prediction. Many previous studies revealed that the Pearl River Delta (PRD) region, one of the major polluted areas in China, is largely affected by the long-range pollution transport. However, mostly of these studies focused on the source apportionment or horizontal transport path of pollutants by using short-term data, and the vertical exchange characteristics had been rarely analyzed. In this study, using HYSPLIT model, the transport paths and the vertical exchange characteristics of haze episodes over four sub-region of Guangdong (GD) Province in southern China of dry season and wet season were analyzed by using 10years data from 2005 to 2014. Three major transport paths can be statistically summarized based on the long-term data. The haze episodes in PRD and North-GD were distinguished by the characteristics of high frequency and long duration, while the West-GD and East-GD are relatively clean. The haze over North-GD and PRD were mainly influenced by the airflows from northern path, which could bring the pollution from Jiangxi, Anhui, and also influenced by the airflows from coastal path, which could bring the pollution of eastern coastal from Zhejiang and Fujian to Guangdong, while regional transport contributions from Guangdong province and adjacent areas can also be clearly observed. The haze pollution from the identified two major transport paths were mainly transported within the mixing layer (>80% trajectories, <500m), whereas the probability of haze trajectories across mixing layer was relatively low and generally associated with much longer transport distance and higher terrain height over Western China. Combing the vertical exchange analysis, results also show that Wuyi Mountains and Nanling Mountains played a role as barrier to obstruct the haze airflows from other regions of China to the Guangdong province.

Gold Nanoparticles Grafted with PLL-b-PNIPAM: Interplay on Thermal/pH Dual-Response and Optical Properties

Narrowly distributed poly(l-lysine-b-N-isopropylacrylamide) (PLL-b-PNIPAM) was prepared through ring-opening polymerization of ε-benzyloxycarbonyl-l-lysine N-carboxy-α-amino anhydride and atom transfer radical polymerization of NIPAM, followed with the removal of ε-benzyloxycarbonyl group. Then gold nanoparticles (AuNPs) grafted with PLL-b-PNIPAM (PNIPAM-PLL-AuNPs) were obtained by the reduction of chloroauric acid with sodium citrate in the presence of PLL-b-PNIPAM. PNIPAM-PLL-AuNPs and its precursors were thoroughly characterized by proton magnetic resonance spectroscope, Fourier transform infrared spectroscope, UV-vis spectroscope, transmission electron microscopy, dynamic light scattering, thermogravimetric analysis, and circular dichroism. The obtained PNIPAM-PLL-AuNPs exhibited high colloid stability even at strong alkaline (pH = 12) and acidic (pH = 2) conditions. The thermal and pH dual-responsive behaviors of the grafting PLL-b-PNIPAM chains was observed to be affected by AuNPs, while not for the secondary structure of PLL chains. Correspondingly, the surface plasmon resonance (SPR) of AuNPs was found to be sensitive to both pH value and temperature. A blue shift in the SPR happened both with increasing pH value and increasing temperature. The stimuli-response was reversible in heating-cooling cycles. The gold nanoparticles with both pH and temperature response may have potential applications in biomedical areas and biosensors.

Polyketides with different post-modifications from desert endophytic fungus Paraphoma sp

Three new polyketides 4,6,8-trihydroxy-5-methyl-3,4-dihydronaphthalen-1(2H)-one (1), 5,7-dihydroxy-3-(1-hydroxyethyl)-3,4-dimethylisobenzofuran-1(3H)-one (2) and 1-(4-hydroxy-6-methoxy-1,7-dimethyl-3-oxo-1,3-dihydroisobenzofuran-1-yl) ethyl acetate (3) together with seven known analogues (4-10) were isolated from desert endophytic fungus Paraphoma sp. The structures of these compounds were elucidated by analysis of NMR data. The absolute configuration of (1-3) was established on the basis of CD experiments. The possible biosynthetic pathway of compounds (1-10) was suggested, which implied that these secondary metabolites might be originated from polyketide biosynthesis with different post-modification reactions. Compounds 2, and 5-8 were evaluated for bioactivities against plant pathogen A. solani, whereas none of them displayed any biological effects. In addition, compounds 1, 2 and 5-10 were also tested for cytotoxic activities against three human cancer cell lines (HepG2 cells, MCF-7 cells and Hela cells) without biological effects.

Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis

INTRODUCTION

Prior studies show promising results of the gastric peroral endoscopic pyloromyotomy (G-POEM) procedure for treatment of refractory gastroparesis. One major technical challenge involved in this procedure is identifying the pyloric muscular ring (PMR). The aim of this study is to establish a reliable method for identification of the PMR during G-POEM.

METHODS

Fluoroscopy-guided G-POEM was performed by placing an endoclip at the 9 to 11'o clock position at the pylorus for identification of PMR. Conventional G-POEM was performed by observation of blue colored mucosa at the pylorus area as an indirect marker for PMR. The degree of the PMR identification was graded into well identified, identified, and not identified based on the appearance of the PMR. Procedure times were accurately documented. Gastroparesis cardinal symptoms index and gastric emptying scintigraphy were evaluated before and after the procedure.

RESULTS

Fourteen patients were studied, seven underwent fluoroscopy-guided G-POEM, and seven patients underwent conventional G-POEM. All procedures achieved technical success and no adverse events occurred. In the seven patients who underwent fluoroscopy-guided G-POEM, the PMR was well identified in four patients and identified in three patients. In the seven patients who underwent conventional G-POEM, the PMR was identified in four patients and not identified in three patients. The average time to complete the fluoroscopy-guided G-POEM was significantly shorter than that of the conventional G-POEM.

CONCLUSIONS

Fluoroscopy-guided G-POEM by placement of an endoclip at the pylorus was a reliable and safe method to direct the orientation of the submucosal tunnel, to facilitate the location of the PMR, and to shorten the procedure time.

[Clinical outcome and placenta characteristics of spontaneous twin anemia-polycythemia sequence]

Objective: To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods: Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed, retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results: (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks (31-37 weeks) . The pregnancies were terminated because 3 cases were sIUGR type Ⅰ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1 797 g (940-2 620 g) , 1 648 g (980-2 500 g) ; P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient (P=0.000) and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). Conclusions: The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.

[Effect of optical zone diameter on corneal biomechanical properties after small incision lenticule extraction]

Objective: To investigate the effect of optical zone diameter on corneal biomechanical properties after small incision lenticule extraction (SMILE). Methods: In this prospective case-control study, 62 eyes of 42 patients with myopia and myopic astigmatism that had undergone SMILE procedure were divided into 2 groups according to the optical zone (OZ) diameter: group A, 31 eyes of 19 patients, OZ= 6.5 mm; group B, 31eyes of 23 patients, OZ=6.0 mm. These patients were examined for corneal hysteresis (CH) and corneal resistance factor (CRF) with the Ocular Response Analyzer (ORA) preoperatively and at 1 week, 1 month and 3 months postoperatively; at the same time, the central corneal thickness-corrected indices of DifCH and DifCRF were calculated. Pearson correlation was applied to analyze the correlation between CH and CRF and central corneal thickness. Independent-samples t test was utilized to compare CH and CRF between the two groups. Repeated ANOVA was used to compare the difference of corneal biomechanical properties at different follow-up timepoints. Results: The preoperative mean CRF and CH values were (10.13±1.19) mmHg and (9.65±1.12) mmHg in group A and (10.34±0.89) mmHg and (10.04± 1.05) mmHg in group B, respectively, and no significant differences were found in CRF and CH between the two groups (CRF: t=-0.807, P=0.423. CH: t=-1.405, P=0.165). The mean CRF values in group A at postoperative 1 week and 3 months were (6.62 ± 1.09) mmHg and (6.83 ± 1.07) mmHg, respectively, which were significantly lower than the relevant mean CRF values in group B (t=-2.703, P=0.009. t=-3.733, P= 0.001). Meanwhile, the mean CH values at 1 week, 1 month and 3 months postoperatively in group A were (7.31±1.06) mmHg, (7.37±0.96) mmHg and (7.82±0.97) mmHg, respectively, which were significantly lower than those in group B (t=-2.415, P=0.019. t=-2.113, P=0.039. t=-2.67, P=0.01). Moreover, the DifCRF and DifCH values in group A were significantly lower than those in group B at 3 months postoperatively (t=-3.409, P=0.001. t=-2.064, P=0.044). The CRF and CH values in both groups showed a significant reduction at 1 week, 1 month and 3 months postoperatively (P<0.05). Conclusions: The size of optical zone has some effects on corneal biomechanical properties after SMILE. The smaller optical zone diameter has a relatively smaller effect. (Chin J Ophthalmol, 2017, 53:182-187).

[Advances of the treatments for thyroid carcinoma patients with laryngotracheal invasion]

Thyroid carcinoma is one of the most common cancer in the head and neck and its incidence shows an increasing tendency. Due to the special anatomical location of thyroid carcinoma, patients will have a bad prognosis outcome when cancer invades larynx and trachea. Surgical treatment is still a preferred therapy for thyroid carcinoma with laryngotracheal invasion, because it has the advantages such as high survival rate, low recurrence rate, relieving of airway obstruction, improving of postoperative quality of life. Other therapies including radiotherapy, chemotherapy, ¹³¹I and molecular targeted therapy can also be used for treatments of thyroid carcinoma. This article reviews the current treatments for thyroid carcinoma with laryngotracheal invasion.

Gastric peroral endoscopic pyloromyotomy (G-POEM) as a salvage therapy for refractory gastroparesis: a case series of different subtypes

BACKGROUND

Gastroparesis is a poorly understood, chronic, debilitating motility disorder with very limited medical therapeutic options. Gastric peroral endoscopic pyloromyotomy (G-POEM) is an emerging novel endoscopic technique as an incisionless pyloroplasty for refractory cases. Effective information of G-POEM on different types of gastroparesis is sparse.

METHODS

Cases of G-POEM using selective circular myotomy as a salvage therapy for refractory symptoms were retrospective studied. The G-POEM procedures were performed by a single expert endoscopist under a certain protocol. Gastroparesis Cardinal Symptoms Index (GCSI) and gastric emptying scintigraphy (GES) were evaluated before and after the procedure. Procedures related adverse event were also recorded.

KEY RESULTS

All procedures were successfully completed without complications. Each case in this series was different in demography and etiology of gastroparesis, namely postsurgical, postinfectious, and idiopathic gastroparesis in an elderly male and two young female adults. All cases were refractory to conventional treatment but demonstrated obvious success after G-POEM as a salvage therapy both clinically and on GES.

CONCLUSIONS & INFERENCES

G-POEM as a salvage therapy improves symptoms and gastric emptying in patients with different types of refractory gastroparesis. Our cases are also the firsts to show success of G-POEM in postinfectious gastroparesis and in elderly male patient. More data are needed to determine which subgroup of patients would benefit most from this novel procedure.

Screening and identification of quorum sensing degraders from live feed Artemia

Quorum sensing (QS) is bacterial cell-to-cell communication with small signal molecules such as acyl-homoserine lactones (AHL) that control a number of phenotypes including the regulation of virulence determinants in pathogenic bacteria. Therefore, quorum sensing degrader has been suggested as one of the biocontrol strategies to fight bacterial infections. In the present study, different bacterial QS degrader strains were isolated from Artemia and screened using Chromobacterium violaceum CV026 bioassay. The results showed that six bacterial strains (four Gram-positive and two Gram-negative) isolated from Artemia were able to degrade AHL in two different in vitro assays. All the strains were later identified through 16S rRNA gene sequencing as Rhodococcus opacus, Strepsporangium roseum, Streptomyces alboniger, Enterobacter clocae and Bacillus litoralis. Highest bacterial AHL degrader, Bacillus litoralis BP-ART/6 fully degraded 10 ppm AHL in 9 hrs. The present study showed that bacterial strains isolated from Artemia can act as a QS degrader. ?

[Evaluation and analysis of the tibial coronal alignment after total knee replacement with the extramedullary tibial cutting guided by the tibial tubercle and anterior tibial tendon in Chinese patients]

OBJECTIVE

To evaluate the efficiency of the tibial coronal alignment after total knee arthroplasty with the extramedullary cutting system guided by the tibial tubercle and anterior tibial tendon, and to discuss the potential risk factors for the postoperative malalignment.

METHODS

A retrospective study of 212 primary unilateral TKA surgeries (in 188 patients) in our hospital between June to December in 2014 had been analysed. All the cases were performed by one surgical group. An extramedullary tibial cutting guide system had been used, with a landmark of one third inner-medial tibial tubercle as a proximal anatomy reference, and anterior tibial tendon as a distal marker. The mechanical axis of lower extremity in full-length X-ray was measured before surgery, and the tibial prosthetic coronal alignment was checked two weeks postoperation, evaluating the accuracy of this extramedullary cutting system guided by our method.

RESULTS

Since good alignment was defined as an angle within 3 degrees of the perpendicular to the mechanical axis, the tibial component positions were acceptable in 191 knees (90.1%), five knees were in valgus postoperative, and sixteen knees were in varus. There were seventeen(8.7%) in 179 knees with a preoperative varus presented malalignment after surgery, and four in 12 preoperative valgus kneess howed malalignment also, no statistical difference was found by Chi-square test(χ(2)=2.778,P=0.096), which cannot define the relationship between the varus or valgus deformity preoperation and the malalignmentposition in tibial prosthesis after surgery. Twenty-two knees suffered a severe preoperative deformity as a varus or valgus angle larger than 20 degrees with absolute value of mechanical axis before surgery and tibial prosthetic coronal alignment were 21.95 °(20.00°,26.90°)and 1.85°(0.10°, 7.10°), showed a significant difference (Z=2.11,P=0.035) compared with the data [10.65°(0.50°,19.80°)in preoperative mechanical axis and 1.10°(0.00°,4.60°)in the tibial prosthetic coronal alignment]of 190 knees who presented a mild deformity before surgery(less than 20 degrees), the result indicated the severe preoperative deformity might be a potential mal-alignment risk factor within this cutting system in TKA surgery.

CONCLUSION

The tibial coronal alignment after total knee arthroplasty could achieve good results with extramedullary cutting guide, by using one third inner-medial tibial tubercle and anterior tibial tendon as a proximal and distal anatomy marker. Postoperative varus might occur in this system, and tibial prosthetic malalignment appeared more often in the patients who suffered a severe deformity before surgery.

Isolation and analysis of cell-free fetal DNA from maternal peripheral blood in Chinese women

Non-invasive prenatal diagnosis is used to detect the genetic material of the fetus by isolating the cell-free fetal DNA (cffDNA) from maternal peripheral blood. In order to establish an isolation method for cffDNA from maternal peripheral blood in Chinese women, the cffDNA was acquired with a two-step centrifugation using a QlAamp DNA Blood mini kit. The SRY gene of plasma DNA was amplified by polymerase chain reaction (PCR). Real-time quantitative PCR was used to measure the concentration of cffDNA in maternal peripheral blood in different pregnant women. The results of the SRY gene amplification of plasma DNA from pregnant women was the same as that of the amniocyte DNA. The average concentration of cffDNA in maternal peripheral blood of pregnant women in different gestational stages was 0.98 ng/mL (0.26-1.49 ng/mL), 1.43 ng/mL (0.46- 2.34 ng/mL), and 1.95 ng/mL (0.65-6.81 ng/mL) from early, middle, and late gestational stages, respectively. The mean of cffDNA from total DNA in plasma in different stages of gestation was 22.28% (9.86-27.81%). The lowest concentration of DNA amplified by nested-PCR in our research was 10-4-10-3 ng/μL. The isolation method for cffDNA from maternal peripheral blood was successfully established and further research into its applications will be conducted.

Identification of the origin of marker chromosomes by two-color fluorescence in situ hybridization and polymerase chain reaction in azoospermic patients

Y chromosomal microdeletions at the azoospermia factor locus and chromosome abnormalities have been implicated as the major causes of idiopathic male infertility. A marker chromosome is a structurally abnormal chromosome in which no part can be identified by cytogenetics. In this study, to identify the origin of the marker chromosomes and to perform a genetic diagnosis of patients with azoospermia, two-color fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) techniques were carried out. The marker chromosomes for the two patients with azoospermia originated in the Y chromosome; it was ascertained that the karyotype of both patients was 46,X, ish del(Y)(q11)(DYZ3+, DXZ1-). The combination of two-color FISH and PCR techniques is an important method for the identification of the origin of marker chromosomes. Thus, genetic counseling and a clear genetic diagnosis of patients with azoospermia before intracytoplasmic sperm injection or other clinical managements are important.

Genetic structure and genetic diversity of single-variety Lonicera macranthoides populations in China, as indicated by SCoT markers

Lonicera macranthoides is an important traditional Chinese herb. The lack of information regarding the genetic structure and genetic relationships among its cultivars has hindered the conservation and utilization of this resource. This study used start codon targeted markers to assess the genetic diversity and other genetic characteristics of five single-variety L. macranthoides populations in China. Using 22 primers produced a total of 266 bands, of which 227 were polymorphic, indicating a high level of polymorphism. At the species level, genetic diversity was high: percentage of polymorphic loci (PPB) = 85.34%, effective number of alleles (NE) = 1.3479, Nei's gene diversity (H) = 0.2075, and Shannon's information index (Hsp, species level) = 0.3198. However, at the varietal population level, genetic diversity was lower, with averages of: PPB = 19.74%, NE = 1.0946, H = 0.0561, Hpop = 0.0850 (population level). Nei's genetic differentiation coefficient was 0.7319, which is consistent with Shannon's population genetic differentiation coefficient (0.7324). This indicates that most of the genetic variation in this species exists among the varietal populations. The differentiation among varieties may have been caused by artificial selection, mode of reproduction, and barriers to gene flow (0.1831). The genetic similarity coefficient ranged from 0.7222 to 0.9419. Phylogenetic analysis showed the five varieties to form two major clades. Results suggest that cultivar breeders should strengthen the exchange of germplasm and increase the mutual penetration of useful genes, which would broaden the hereditary basis of L. macranthoides.

Deciphering the spectrum of somatic mutations in the entire mitochondrial DNA genome

The mitochondrion is a crucial intracellular organelle responsible for regulating cellular energy metabolism, producing free radicals, initiating and executing the apoptotic pathways. Previous studies have shown that somatic mutations in mitochondrial DNA are associated with various tumors, which may be involved during carcinogenesis and tumor progression. To examine the mutation pattern in cancer, 625 reported somatic mutations in the mitochondrial DNA genome were analyzed. We found that, except for deletions and insertions, most somatic mutations were point mutations, accounting for 89.44% of somatic mutations. Transition was the predominant form of somatic mutation in the entire mitochondrial DNA genome, accounting for 87.12% of point mutations, most of which were homoplastic. Frequency statistics analysis of point mutations indicated that, except for 3 tRNA genes, the mutations were distributed on all resting genes and in the D-loop region, with the latter showing the highest frequency of somatic mutation (19.34%), followed by the tRNA leucine 2 gene and non-coding regions between base pairs 5892 and 5903, while 13 coding-region genes and 2 rRNA genes showed a relatively lower frequency of somatic point mutations. Nonsynonymous mutations and terminal amino acid changes were the primary point somatic mutations detected from 13 coding-region genes, which may cause mitochondrial dysfunction in cancer cells. We found that the somatic mutations may affect the mitochondrial DNA genome; the non-coding region should be examined to identify somatic mutations as potential diagnostic biomarkers for early detection of cancer.

Effects of dietary supplementation with ferulic Acid or vitamin e individually or in combination on meat quality and antioxidant capacity of finishing pigs

This study aimed to evaluate the effects of vitamin E (VE), ferulic acid (FA) and their combination supplementation on meat quality and antioxidant capacities of finishing pigs. Sixty barrows were randomly allocated to four experimental diets using a 2×2 factorial arrangement with 2 VE supplemental levels (0 or 400 mg/kg) and 2 FA supplemental levels (0 or 100 mg/kg) in basal diets. After 28 days, six pigs per treatment were slaughtered. The results showed that VE supplementation increased loin eye area of pigs (p<0.05) and FA supplementation increased pH_45min value (p<0.05). The interaction of FA×VE was observed in shear force of longissimus dorsi muscle (p<0.05). Moreover, supplementation with VE decreased hepatic and sarcous malondialdehyde (MDA) content, increased hepatic glutathione (GSH) content and sarcous glutathione peroxidase (GSH-Px) activity (p<0.05). Additionally, supplementation with FA increased hepatic GSH-Px activity and decreased sarcous MDA content (p<0.05). However, dietary treatment did not affect the expression of genes related to nuclear factor, erythroid 2-like 2 (NFE2L2) pathway. These results suggest that dietary FA and VE could partially improve meat quality and antioxidant capacity of finishing pigs, but not by activating NFE2L2 pathway under the normal conditions of farming.

Pathologic characteristics and prognosis of a rare advanced cervical cancer treated with radical surgery and radiotherapy

OBJECTIVE

To assess the prognosis of rare advanced.cervical carcinoma with post-radical-radiation surgery and to compare the clinic value between further surgery treatment group and non-surgery group after radical radiation therapy.

MATERIALS AND METHODS

From January 2002 to July 2010 there were 68 patients with advanced stage cervical carcinoma retrospectively analysed in Maternal and Child Health Hospital of Jiangxi Province. All patients were confirmed by histopathology before treatment, and clinical staging was based on updated 2009 FIGO staging. All patients were Stage Ib2 (local advanced) and more severe. There were 36 patients (29 adenocarcinoma (AC), six adenosquamous carcinoma (ASC), and one undifferentiated carcinoma) classified into observation group that was treated with radical radiation therapy + surgery (total hysterectomy + bilateral salpingo-oophorectomy); other 32 patients (26 AC, five ASC, and one undifferentiated carcinoma) classified into control group that was treated with radical radiation therapy with no further surgery. The radical radiation therapy included external-beam radiation and intracavitary therapy, standard point A dose added up to 85 Gy (these doses are recommended for most patients based on summation of conventional external-beam fractionation and low-dose rate 40-70 cGy/h brachytherapy equivalents), and 45-55 Gy was given to point B. All of the patients were followed up. The average follow-up time was 65.6 months and the survival rate between two groups were compared and analyzed whether there was residual lesion, metastasis, lymph vascular space invasion (LVSI) in the observation group.

RESULTS

In observation group there were 15 patients found positive. The positive rate was 41.7% (15/36), in which there nine cases with LVSI and residual foci, four cases with uterus invasion, and one case with only residual foci. Both of the two groups were followed up and the average follow-up time was 65.6 months (range 36-136). In observation group there were 25 cases that have survived until now and the average survival time was 66.6 months (range 36-136). Eleven patients died with an average survival time of 10.4 months (range 2-37). In control group there are 22 cases that survived until now (July 2013); the average survival time was 64.4 months (range 36-136). Ten patients died with an average survival time of 10.3 months (range 3-28). Three cases experienced serious complication in observation group and two cases in control group. There was no significant difference in survival time between the two groups.

CONCLUSION

Due to low efficacy results, post-radical-radiation surgery is not a feasible treatment regimen for rare advanced cervical carcinoma.

Survey and genetic variation of Spirometra erinaceieuropaei sparganum in frogs and snakes from Guangxi of southern China

The prevalence of sparganum infection in wild frogs (Rana rugulosa and R. temporaria) and snakes (Enhydris chinensis) was investigated in Guangxi Zhuang Autonomous Region of Southern China from June 2013 to August 2013. The results showed that 30.37% (65/214) of the caught wild frogs and 50% (3/6) of examined snakes were found to be infected with plerocercoids (spargana) of the genus Spirometra. To investigate the genetic variation of the collected spargana, three mitochondrial DNA (mtDNA) regions, namely cytochrome c oxidase subunit 1 and 3 (cox1 and cox3), NADH dehydrogenase subunits 4 (nad4) were amplified, sequenced, and analyzed. The sequences of cox1, cox3 and pnad4 are 444, 387 and 585 bp in length, respectively. The base composition of cox1, cox3 and pnad4 were generally AT rich with a mean of 62.7%, 67.2% and 64.9%, respectively. Phylogenetic analyses using Bayesian inference (BI) and maximum parsimony (MP) indicated that all the Spirometra sparganum isolates in Guangxi represented S. erinaceieuropaei.

Genetic diversity and population structure of wild Dipsacus asperoides in China as indicated by ISSR markers

In order to evaluate the genetic diversity and genetic structure of wild Dipsacus asperoides, we surveyed genetic polymorphisms in 288 individuals from 12 populations using ISSR. A total of 240 bands were amplified, among which 190 were polymorphic loci. At the species level, genetic diversity was found to be abundant: PPB = 79.17%, NE = 1.2152, H = 0.1361, and Hsp = 0.2213. At the population level, genetic diversity was lower: PPB = 30.76 %, NE = 1.0786, H = 0.0897, and Hpop = 0.1375. The calculated Nei genetic differentiation coefficient was 0.3406, which is consistent with the calculated Shannon population genetic differentiation coefficient of 0.3787. This is commonly taken to indicate that most of the genetic variation existed within the populations. Gene flow was calculated as Nm = 0.9679, suggesting that gene exchange only occurred at a low level. Based on the Nei genetic distance, the 12 populations were divided into 4 categories. Our results suggest that D. asperoides has abundant genetic diversity and provides a foundation for the protection and improvement of germplasm resources.

Spatio-temporal variation of biogenic volatile organic compounds emissions in China

Aiming to reduce the large uncertainties of biogenic volatile organic compounds (BVOCs) emissions estimation, the emission inventory of BVOCs in China at a high spatial and temporal resolution of 36 km × 36 km and 1 h was established using MEGANv2.1 with MM5 providing high-resolution meteorological data, based on the most detailed and latest vegetation investigations. BVOC emissions from 82 plant functional types in China were computed firstly. More local species-specific emission rates were developed combining statistical analysis and category classification, and the leaf biomass was estimated based on vegetation volume and production with biomass-apportion models. The total annual BVOC emissions in 2003 were 42.5 Tg, including isoprene 23.4 Tg, monoterpene 5.6 Tg, sesquiterpene 1.0 Tg, and other VOCs (OVOCs) 12.5 Tg. Subtropical and tropical evergreen and deciduous broadleaf shrubs, Quercus, and bamboo contributed more than 45% to the total BVOC emissions. The highest biogenic emissions were found over northeastern, southeastern, and southwestern China. Strong seasonal pattern was observed with the highest BVOC emissions in July and the lowest in January and December, with daily emission peaked at approximately 13:00 or 14:00 local time.

The potential of trehalose to replace insect hemolymph in artificial media for Trichogramma dendrolimi (Hymenoptera: Trichogrammatidae)

Insect additives have been shown to improve the value of artificial media for Trichogramma species, but at the same time maintain dependence on parallel cultures of host insects. In the present study, Trichogramma dendrolimi Matsumura was reared in vitro from egg to adult on artificial media with different contents of pupal hemolymph of Chinese oak silkmoth Antheraea pernyi (Guérin-Méneville) and with supplements of distilled water, or of trehalose dissolved in water or in Grace's insect medium. The results indicated insect hemolymph was the key component of artificial medium. Developmental parameters, including rates of parasitism, pupation, adult emergence and normal adults, and numbers of produced adults, were increased on media supplemented with trehalose even when the proportion of pupal hemolymph was reduced. Two artificial media, the first containing 30% hemolymph and 10% trehalose in water with 98.9% parasitism rate, 77.7.0% pupation rate, 77.2% emergence rate, 80.0% normal adult rate and 333 produced adults, and the second containing 25% hemolymph and 15% trehalose in Grace's insect medium with 97.8% parasitism rate, 91.0% pupation rate, 85.2% emergence rate, 76.1% normal adult rate and 757 produced adults, were believed to hold potential to mass produce T. dendrolimi. The use of trehalose to partially replace pupal hemolymph in artificial medium of this and other Trichogramma species may contribute to a significant reduction in their production cost and may as such help to evade problems related to short supplies of lepidopteran eggs, which currently constitute the main factitious host for the mass rearing of the parasitoids.

Effects of microencapsulated Enterococcus fecalis CG1.0007 on growth performance, antioxidation activity, and intestinal microbiota in broiler chickens

We performed a series of trials to assess the effect of dietary supplementation with microencapsulated Enterococcus fecalis CG1.0007 on growth performance, antioxidation activity, and intestinal microbiota in Arbor Acres broiler chickens ("broilers"). A total of 150 1-d-old broilers were assigned randomly to 5 feeding treatments (a control group fed the basal diet, 3 groups fed the basal diet plus various concentrations of microencapsulated CG1.0007, and 1 group fed the basal diet plus an antibiotic). Changes in important genera of intestinal bacteria were studied using 16S rRNA gene-based PCR-denaturing gradient gel electrophoresis (DGGE) profiling and real-time quantitative PCR analysis of fecal samples. During the course of the 42-d experimental period, ADG of the birds fed the high and intermediate concentrations of microcapsules were significantly greater (9.90 and 9.50%, respectively) and the ratios of feed to gain fed were significantly lower (4.40 and 4.00%, respectively) compared with the control group. The total antioxidant capacity and the content of malondialdehyde and superoxide dismutase in the microcapsule-treated groups showed significant changes in terms of antioxidation. The numbers of Lactobacillus and Bifidobacterium were significantly greater in the microcapsule-treated groups than in the control group. Cluster analysis indicated that the DGGE bacterial profiles were related to the feeding treatments and revealing the diversity and richness of the intestinal microbiota associated with supplementation of microcapsules. In summary, our results indicate that dietary addition of microencapsulated E. fecalis CG1.0007 enhanced the growth performance of the broilers and improved their health.

Effect of Saccharomyces boulardii and Bacillus subtilis B10 on intestinal ultrastructure modulation and mucosal immunity development mechanism in broiler chickens

The recent ban on the use of antibiotics as a feed additive has led to the search for alternative sources of antibiotics in the feed industry. Presently, probiotics are considered as a potential substitute for antibiotic as a live biotherapeutic agent to improve animal health and performance. Accordingly, study was focused on evaluating the effect of Saccharomyces boulardii (Sb) and Bacillus subtilis B10 (Bs) on ultrastructure modulation and mucosal immunity development in broiler chickens. A total of three hundred 1-d-old Sanhuang broilers (a Chinese cross breed) were randomized into 3 groups, each group with 5 replications (n = 20). The control group (Ctr) was fed a basal diet containing an antibiotic (virginiamycin, 20 mg/kg). Meanwhile, broilers in experimental groups received Sb and Bs (1 × 10(8) cfu/kg of feed) in addition to the basal diet for 72 d. The results of the experimental groups revealed a significant improvement in live BW and relative weight of bursa of Fabricius and thymus. Also, intestinal villus height, width, and number of goblet cells increased in the Sb and Bs groups. Meanwhile, modulation in the intestinal ultrastructure and increased mRNA expression levels of occluding, cloudin2, and cloudin3 (P < 0.05) were observed in the Sb and Bs groups. Moreover, IgA-positive cells significantly increased in the jejunum of Sb- and Bs-supplemented groups (P < 0.05). Intestinal cytokines interleukin-6, tumor necrosis factor-α, interleukin-10, transforming growth factor-β, and secretory IgA concentrations were (P < 0.05) improved in the probiotic groups; however, Sb induced inflammatory and antiinflammatory cytokines (P < 0.05) in comparison with the Ctr group. The present findings conclusively revealed that Sb and Bs increased IgA-positive cells in the lumen of the intestinal villus and revealed that Sb and Bs could modulate intestinal ultrastructure through increasing occluding, cloudin2, and cloudin3 mRNA expression levels in broiler intestine.