[Comparison of robotic-assisted single-incision-plus-one-port laparoscopic pyeloplasty and single-incision laparoscopic pyeloplasty in the treatment of pediatric ureteropelvic junction obstruction]

Objective: To compare the efficacy of robotic-assisted single-incision-plus- one-port laparoscopic pyeloplasty (R-SILP+1) with single-incision laparoscopic pyeloplasty (SILP) in pediatric ureteropelvic junction obstruction (UPJO). Methods: The clinical data of 47 children with UPJO who underwent surgery from October 2020 to September 2022 in the Department of Pediatric Surgery of Fujian Provincial Hospital were retrospectively analyzed. According to the surgical method chosen by parents, the children were divided into R-SILP+1 group and SILP group. Baseline data, operative time, intraoperative anastomosis time, volume of blood loss, postoperative hospitalization time, complications, total costs, preoperative and postoperative renal parenchymal thickness (PT), anterior posterior diameter of renal pelvis (APD), and differential renal function (DRF) before and after operation were compared between the two groups, and the clinical efficacy of the two kinds of operation was evaluated. Results: Among the 47 children, 27 were in R-SILP+1 group, including 16 males and 11 females, aged (6.6±3.5) years; 20 were in SILP group, including 12 males and 8 females, aged (6.5±3.5) years. The operations were successful in both groups without conversion to open operation. There were no significant differences between the two groups in baseline data, volume of blood loss, complications, APD and PT at postoperative 6 months, APD, PT and DRF at postoperative 12 months (all P>0.05). Compared with the SILP group, the operative time [(153.0±14.4) vs (189.9±32.6) minutes, P<0.001], intraoperative anastomosis time [(68.8±16.8) vs (97.5±12.0) minutes, P<0.001], postoperative hospitalization time [(6.0±1.3) vs (9.0±1.3) d, P<0.001] were shorter, but the total cost was higher[(57 390±7 664) vs (30 183±4 219) yuan RMB, P<0.001]. Conclusions: Compared with the SILP group, R-SILP+1 can achieve considerable efficacy in treating pediatric UPJO, and has certain advantages in shortening operative time, intraoperative anastomosis time, and postoperative hospitalization time. However, the cost is high.

[Application of the theory of equal emphasis on muscle and bone in percutaneous vertebroplasty of lumbar osteoporotic compression fracture]

OBJECTIVE

To explore the clinical efficacy of percutaneous vertebroplasty(PVP) combined with nerve block in the treatment of lumbar osteoporotic vertebral compression fractures under the guidance of traditional chinese medicine "theory of equal emphasis on muscle and bone".

METHODS

Total of 115 patients with lumbar osteoporotic vertebral compression fractures were treated by percutaneous vertebroplasty from January 2015 to March 2022, including 51 males and 64 females, aged 25 to 86 (60.5±15.9) years. Among them, 48 cases were treated with PVP operation combined with erector spinae block and joint block of the injured vertebral articular eminence (intervention group), and 67 cases were treated with conventional PVP operation (control group). The visual analogue scale(VAS) and Oswestry disability index(ODI) before operation, 3 days, 1 month and 6 months after operation between two groups were evaluated. The operation time, number of punctures and intraoperative bleeding between two groups were compared.

RESULTS

The VAS and ODI scores of both groups improved significantly after operation compared with those before operation(P<0.05). Moreover, the VAS and ODI scores of 3 days and 1 month after operation of the intervention group improved more significantly than that of the control group(P<0.05). The difference of VAS and ODI scores before operation and 6 months after operation between two groups had no statistical significances(P>0.05). There was no statistically significant difference in the number of punctures and intraoperative bleeding between the two groups (P>0.05).

CONCLUSION

Based on the theory of "equal emphasis on muscles and bones", PVP combined with nerve block can effectively relieve paravertebral soft tissue spasm and other "muscle injuries", which can significantly improve short-term postoperative low back pain and lumbar spine mobility compared to conventional PVP treatment, and accelerate postoperative recovery, resulting in satisfactory clinical outcomes.

Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

BACKGROUND

The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus (PLWH) who accepted primary treatment with the efavirenz (EFV) plus lamivudine (3TC) plus tenofovir (TDF) (EFV + 3TC + TDF) regimen are unclear and warrant investigation.

AIM

To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV + 3TC + TDF regimen for 156 wk.

METHODS

This study was designed using a follow-up design. Sixty-one male treatment-naive PLWH, including 50 cases with normal glucose tolerance and 11 cases with prediabetes, were treated with the EFV + 3TC + TDF regimen for 156 wk. The glucose metabolism dynamic characteristics, the main risk factors and the differences among the three CD4+ count groups were analyzed.

RESULTS

In treatment-naive male PLWH, regardless of whether glucose metabolism disorder was present at baseline, who accepted treatment with the EFV + 3TC + TDF regimen for 156 wk, a continuous increase in the fasting plasma glucose (FPG) level, the rate of impaired fasting glucose (IFG) and the glycosylated hemoglobin (HbA1c) level were found. These changes were not due to insulin resistance but rather to significantly reduced islet β cell function, according to the homeostasis model assessment of β cell function (HOMA-β). Moreover, the lower the baseline CD4+ T-cell count was, the higher the FPG level and the lower the HOMA-β value. Furthermore, the main risk factors for the FPG levels were the CD3+CD8+ cell count and viral load (VL), and the factors contributing to the HOMA-β values were the alanine aminotransferase level, VL and CD3+CD8+ cell count.

CONCLUSION

These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased islet β cell function during antiretroviral therapy with the EFV + 3TC + TDF regimen for long-term application.

[Feasibility of enlarging the ventral space by using a drill under spinal endoscopy in the treatment of severe free lumbar disc herniation]

OBJECTIVE

To evaluate the clinical efficacy of spinal endoscopy in the treatment of severe free lumbar disc herniation and explore the feasibility and application of microscopic drills to expand ventral space.

METHODS

Thirty patients with severe free lumbar intervertebral disc herniation treated by spinal endoscopic technique from April 2019 to March 2021 were collected, including 19 males and 11 females;aged from 19 to 76 years with an average of (44.03±16.92) years old. All patients had a single segmental lesion with prolapse of the nucleus pulposus. Among them, there were 3 cases on L_2,3, 3 cases on L_3,4, 15 cases on L_4,5, and 9 cases on L₅S₁. During operation, posterior bone of vertebral body and pedicle notch were removed by a drill under the endoscope to enlarge the ventral space. And the free nucleus pulposus was exposed and completely removed. The intraoperative blood loss, operation time, hospital stay and postoperative neurological complications were recorded, and Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were compared before operation, 2 days, 3 months and 1 year after operation, and Macnab standard was used to evaluate clinical efficacy.

RESULTS

All operations were successful and the free nucleus pulposus was completely removed. Pain in the lower back and legs was significantly relieved on the day after operation. Two patients experienced transient pain and numbness in lower limbs after operation, and no serious nerve injury complications occurred. ODI and VAS at each time point after surgery were significantly lower than those before surgery (P<0.01), and JOA score was significantly higher than before surgery (P<0.01). The excellent and good rates of Macnab were 66.67% (20/30), 83.33% (25/30) and 90.00% (27/30) on 2 days, 3 months and 1 year after operation, respectively.

CONCLUSION

For severe free lumbar intervertebral disc herniation, using of a drill under endoscope to expand the ventral space can smoothly remove the free nucleus pulposus and avoid nerve damage.

[Mini-incision with endoscope-assisted surgery for bilateral congenital second branchial cleft fistula and a pedigree report]

Objective: To investigate the feasibility and efficacy of mini-incision with endoscope-assisted resection for bilateral congenital second branchial cleft fistula, and to report on a rare pedigree. Methods: The clinical data of 5 patients with bilateral congenital second branchial fistula admitted in Fujian Provincial Hospital from April 2007 to December 2018 were retrospectively reviewed, including 2 males and 3 females, aged from 3 to 31 years old. The surgical strateges and clinical experience of single mini-incision with endoscope-assisted fistulectomy were summarized, and a rare pedigree was reported. Results: In five patients, Case 1 to Case 4 were treated with bilateral endoscopic-assisted fistula high ligation with titanium clips and removal through a single small incision under general anesthesia. No obvious complications occurred after the operation. The patients were followed up for 40-164 months with no fistula recurrence. Case 5 gave up surgical resection and was followed up for 24 months with acute infection attack once. Case 2 and Case 4 came from the same family. In this family, 7 out of 31 members of four generations had second branchial cleft fistulas, of which 4 were bilateral and 3 were right. Pedigree analysis was consistent with autosomal dominant inheritance. No deafness, preauricular tag, external and middle ear deformity and kidney malformation were found in the family members. Conclusions: Bilateral congenital second branchial cleft fistula is rare. Surgical resection is the preferred treatment. Mini-incision with endoscopic-assisted fistula high ligation with titanium clip and resection has clear operative field, ideal cosmetic effect and definite curative effect.

[The application of transumbilical single incision plus one robotic-assisted surgery in choledochal cyst excision and hepaticojejunostomy in children]

To explore the effectiveness and summarize the experiences of transumbilical single incision plus one robotic-assisted surgery surgery in the treatment of pediatric choledochal cyst. We retrospectively reviewed the medical records of 10 children who underwent choledochal cyst excision and hepaticojejunostomy from June to December 2020 at Fujian Provincial Hospital. The mean age was (4.6±1.7) years (range from 2 years to 8 years). The mean weight was (17.1±3.8) kg (range from 12.3 kg to 25.0 kg). The Todani classifications were type I (n=6) and type Ⅳ(n=4).The clinical symptoms were asymptomatic (n=4), abdominal pain (n=3), and abdominal pain with jaundice (n=3). Ten cases of transumbilical SILS+1 robotic-assisted choledochal cyst excision and hepaticojejunostomy were completed successfully. The average duration of operation was 204-227 min ((220.0±7.2) min), the mean intraoperative bleeding was (7.67±0.86) ml (range, 6-9 ml) without blood transfusion, average fasting time was (2.30±0.48) days (range, 2-3 days), the average hospitalization time was (4.70±0.67) days (range, 4-6 days) and the medical expense was (5.30±0.42) ten thousand yuan (range, 4-6 ten thousand yuan). Ten patients did not develop early complications such as acute cholangitis, ranging from 3 months to 6 months. Ultrasonography showed no dilation of ductuli hepaticus communis and intrahepatic bile duct occurred at the third month after surgery. With the development of minimally invasive techniques and enhanced recovery, the da Vinci robotic surgical system will be extensively used. Transumbilical SILS+1 robotic-assisted surgery has equal effect with routine robotic-assisted surgery. The incision is more subtle and excellent, but the operation should be taken by sophisticated surgeon.

[Percutaneous endoscopic translaminar lumbar interbody fusion for the treatment of L5S1 intervertebral disc herniation]

OBJECTIVE

To observe the effeicacy and safety of percutaneous endoscopic translaminar lumbar interbody fusion (PE-TLIF) in the treatment of L₅S₁ intervertebral disc herniation.

METHODS

The clinical data of 37 patients with L₅S₁ intervertebral disc herniation underwent PE-TLIF from January 2018 to December 2019 were retrospectively analyzed. There were 16 males and 21 females, aged from 30 to 68 years old, with a mean of (45.62±13.57) years;body mass index was from 19.5 to 28.8 kg/m², with a mean of (24.33±3.51) kg/m²;the course of disease was from 18 to 48 months, with a mean of (27.18±6.65) months. Operation time, intraoperative blood loss, postoperative drainage and complication rate were recorded; visual analogue scale(VAS), Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index(ODI) before operation, 1 week, 6 months, 1 year after operation were observed.

RESULTS

The operation time ranged from 78 to 171 min, with a mean of (120.74±41.19) min;intraoperative blood loss ranged from 61 to 102 ml, with a mean of (85.26±25.44) ml;and postoperative drainage ranged from 35 to 98 ml, with a mean of (40.75±12.17) ml. Complications occurred in 8 patients, including 2 cases of nerve injury, 4 cases of pain aggravated, 1 case of internal fixation loosening, and 1 case of intervertebral space nonfusion. The VAS, JOA score and ODI significantly improved after 1 week, 6 months, and 1 year after operation (P<0.05).

CONCLUSION

PE-TLIF for the treatment of L₅S₁ intervertebral disc herniation has the advantages of less intraoperative blood loss, less trauma, and satisfactory short-term curative effect. It can effectively improve the symptoms of patients. However, the incidence of complications in the actual clinical practice is frequent, and surgical indications need to be strictly grasped.

Comparison of Two Different Natural Oil Body Emulsions: in vitro Gastrointestinal Digestion

The surface compositions and structure of oil bodies (OBs) are dependent on the oil crop, and these factors affect in vitro gastrointestinal digestion behaviors. Herein, a comparative study was conducted to examine the in vitro gastrointestinal digestion characteristics of two natural emulsions prepared with soybean seeds and rapeseed OBs during gastrointestinal digestion process. The average particle size of soybean OBs and rapeseed OBs emulsions was 0.46 and 5.02 µm, respectively. The droplet size of soybean seed and rapeseed OBs emulsions was large with relatively low zeta-potentials at 30 min digestion time in simulated gastric fluid condition. The droplet size of two natural OBs emulsions decreased with increasing digestion time in simulated gastric fluid condition. The average droplet size of both emulsions gradually decreased with increasing digestion time in simulated intestinal fluid conditions. The zeta-potential of the two emulsions increased with increasing digestion time in simulated intestinal fluid conditions. The extent of free fatty acids of soybean OBs emulsions was significantly higher than rapeseed after 20 min digestion time in simulated intestinal fluid conditions. The obtained results suggested that plant OBs could be useful as natural emulsifiers in the development of functional food and achieve controlled release of bioactive compounds from emulsions during gastrointestinal digestion.

Very high baseline HIV viremia impairs efficacy of non-nucleoside reverse transcriptase inhibitor-based ART: a long-term observation in treatment-naïve patients

BACKGROUND

It is not completely clear whether a very high pre-therapy viral load (≥ 500 000 copies/ml) can impair the virological response. The aim of this study was to examine the influence of very high baseline HIV-RNA levels on long-term virological responses under one type of regimen.

METHODS

A retrospective study was performed based on data from two multicenter cohorts in China from January to November 2009, and from May 2013 to December 2015. Untreated HIV infected adults between 18 and 65 years old were recruited before receiving non-nucleoside reverse transcriptase inhibitor-based regimen. All patients had baseline HIV-RNA levels over 500 copies/ml, good adherence, and were followed for at least 24 weeks. Virological suppression was defined as the first HIV-RNA < 50 copies/ml. Virological failure was defined as any of incomplete viral suppression (HIV-RNA ≥ 200 copies/ml without virological suppression within 24 weeks of treatment) and viral rebound (confirmed HIV-RNA level ≥ 50 copies/ml after virological suppression). Chi-square test, Kaplan-Meier analysis, Cox proportional hazards model and Logistic regression were used to compare virological response between each pretreated viral load stratum.

RESULTS

A total of 758 treatment-naïve HIV patients in China were enlisted. Median follow-up time (IQR) was 144 (108-276) weeks. By week 48, rates of virological suppression in three groups (< 100 000, 100 000-500 000 and ≥ 500 000 copies/ml) were 94.1, 85.0, and 63.8%, respectively (P < 0.001). Very high baseline HIV viremia over 500 000 copies/ml were found to be associated with delayed virological suppression (≥ 500 000 vs <  100 000, adjusted relative hazard = 0.455, 95% CI: 0.32-0.65; P < 0.001) as well as incomplete viral suppression (≥ 500 000 vs < 100 000, adjusted odds ratio [aOR] = 6.084, 95% CI: 2.761-13.407; P < 0.001) and viral rebound (≥ 50 000 vs < 100 000, aOR = 3.671, 95% CI: 1.009-13.355, P = 0.048).

CONCLUSIONS

Very high levels of pre-treatment HIV-RNA were related with delayed efficacy of NNRTI-based ART and increased risk of treatment failure. More potent initial regimens should be considered for those with this clinical character.

[Analysis on clinical effects of two surgical approaches in percutaneous spinal endoscopy for L5S1 disc herniation]

OBJECTIVE

To analyze the clinical effects, complications and operational key points of the percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating L₅S₁ disc herniation.

METHODS

The clinical data of 158 patients with L5S1 disc herniation treated from July 2015 to March 2018 were restospectively analyzed. According to different surgical approaches, the patients were divided into PETD group or PEID group, 79 cases in each group. In PETD group, there were 41 males and 38 females, with an average age of (41.38±6.25) years and course of disease of (10.06±3.14) months. In PEID group, there were 43 males and 36 females, with an average age of (41.18±5.78) years and course of disease of (9.99±2.83) months. The operation length, intraoperative blood loss, intraoperative fluoroscopy times, days of hospital stay, and complications were recorded between two groups. Visual analogue score (VAS), Japanese Orthopedic Association(JOA) score, Oswestry Disability Index(ODI), modified Macnab criteria were used to assessed clinical effects after operation.

RESULTS

All patients completed surgery and were followed up for more than 1 year. (1) There were no significant differences in the intraoperative blood loss or hospitalization length between two groups(P>0.05). The operation length and intraoperative fluoroscopy times in PETD group were significantly higher than in PEID group (P<0.05). (2)VAS, JOA scores, ODI at 1 week, 6 months, or 12 months after operation were significantly improved between two groups (P<0.05), but there was no statistical significance between two groups(P>0.05). (3)The excellence rate was 89.87% (71 / 79) in PETD group and 87.34% (69 / 79) in PEID group at the latest follow-up, with no statistical significance(P>0.05). (4)Complications occurred in 2 cases in PETD group and in 3 cases in PEID group, with no significant differences between two groups.

CONCLUSION

The short term efficacy of the PETD is equal to that of the PEID for the L₅S₁ disc herniation, but PEID is superior in the operation length, the access of stereotaxic puncture and intraoperative fluoroscopy times. The complications can be effectively reduced by following the indications, mastering the endoscopic technique, operating carefully and being familiar with the key points of common complications.

[Analysis of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope]

Objective: To investigate the efficacy and safety of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope. Methods: One hundred patients undergoing radical resection of lung cancer under thoracoscope in Affiliated Cancer Hospital of Zhengzhou University from March to September in 2019, were randomly divided into control group (group C) and sugammadex group (group S). All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion of propofol and remifentanil, and intermittent intravenous injection of the neuromuscular block of rocuronium. During the operation, the bispectral index (BIS) was used to monitor the depth of anesthesia, and the neuromuscular block was assessed with TOF. Single-lung mechanical ventilation and double-lumen endotracheal intubation were carried out, and patient-controlled analgesia after operation were enforced. Patients in group C received neostigmine (2 mg) combined with atropine (0.5-1.0 mg) after thoracic closure, while patients in group S received sugammadex (2 mg/kg) at TOF count (≥2) after thoracic closure, and then double-lumen endotracheal tubes were extubated according to extubation indications. At these time points: T(0) (immediate before anesthesia induction), T(1) (immediate before tracheal intubation), T(2) (immediately after thoracic closure), T(3) (1 h after operation), T(4) (6 h after operation), T(5) (24 h after operation), T(6)(48 h after operation), the heart rate(HR) and mean arterial pressure (MAP) were recorded, QT interval (V3 ECG) were measured and calculated, indicators of liver function [alanine transaminase (ALT), aspartate transaminase(AST)], renal function [blood urea nitrogen (BUN), creatinine (Cre)] and clotting function [thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB)] were detected. The duration of operation, postoperative conditions within 48 hours after operation(the time of tracheal tube extubation, respiratory suppression/dysfunction, allergy, nausea and vomiting, itching of skin, abnormal sensation), pathological types and the postoperative hospital stay were recorded. Results: There were no significant differences of the age, sex ratio, body mass index (BMI), American Society of Anesthesiologists (ASA) grading ratio, duration of operation, pathological types and the postoperative hospital stay, HR, MAP and QT interval between two groups (all P>0.05). There were no remarkable differences of the levels of serum histamine, ALT, AST, BUN, Cre, TT, PT, APTT and FIB before and after administration of neuromuscular blockade antagonists (neostigmine or Sugammadex) in the same group patients (all P>0.05), also no significant differences between group C and group S at the same time points (all P>0.05). Average time of tracheal tube extubation in group S [(3.7±1.3) min] was sharply shorter than that in group C [(14.5±4.4) min, t=2.266, P<0.05)]. There were no patients with allergy, skin itching, sensory abnormality in these two groups. There were no significant difference of the incidence of postoperative nausea and vomiting between these two groups. There were 5 patients with respiratory depression in group C and no respiratory depression patient in group S, the difference was statistically significant between these two groups (χ(2)=5.263, P<0.05). Conclusion: Sugammadex is effective for antagonizing the neuromuscular blockade of rocuronium in patients with radical resection of lung cancer under thoracoscope, and can shorten the time of tracheal tube extubation after surgery.

Effects of long-term exposure to tenofovir disoproxil fumarate-containing antiretroviral therapy on renal function in HIV-positive Chinese patients

BACKGROUND

The regimen containing tenofovir disoproxil fumarate (TDF)+lamivudine or emtricitabine + efavirenz remains the recommended first-line antiretroviral therapy (ART) by the WHO. Limited studies, however, have been conducted on the incidence of renal impairment among Chinese patients with long-term exposure to TDF-containing ART regimens.

METHODS

We retrospectively analyzed 269 eligible patients who had no comorbidities and received TDF-containing ART from July 2014 to April 2015. TDF-related renal impairment was defined as a decrease of eGFR by >25% from baseline or eGFR <90 ml/min/1.73 m². Decreased renal function was defined as a decrease of eGFR by > 10 mL/min/1.73 m² from baseline.

RESULTS

97.0% of study patients were male (median age 29, eGFR 124.0 ml/min/1.73 m²). After 168-week of ART, renal impairment occurred in 7 patients (2.7%). The incidence of decreased renal function was significantly higher at Week 168 compared with that observed at Week 12 (24.8% vs 3.7%, p < 0.001). In generalized estimating equation analysis, patients receiving ART for 144-week (aOR4.1, 95%CI 2.0-8.4) and 168-week (aOR8.4, 95%CI 4.2-16.4) were more likely to develop decreased renal function compared with those receiving ART for 12-week, so were the patients with a weight <58 kg (aOR2.3, 95%CI 1.2-4.3) and 58-66 kg (aOR2.0, 95%CI 1.0-3.8) compared to those with a weight ≥67 kg. At 168-week, 41.0% of 100 patients examined had elevated urine β2-microglobulin levels, which were negatively correlated with eGFR (r = -0.22, p = 0.02).

CONCLUSIONS

TDF-related renal impairment remained rare in HIV-positive Chinese patients with a median age of 29 years who had no comorbidities. A lower weight and duration of ART were associated with decreased renal function.

[Factors associated with adherence of highly active antiretroviral therapy among 386 HIV/AIDS patients in 3 provinces of China]

OBJECTIVE

To investigate adherence and the influence factors among patients who are on antiretrovirus therapy (ART) of 3 provinces in China.

METHODS

This study selected 18-year-old and older AIDS patients as the survey objects who initiated anti-retrovirus therapy between April and September of 2014 and kept on the treatment for one year in Yunnan,Sichuan,and Hu'nan province. Information of demography, treatment and social support was collected by questionnaires. Adopt SSRS questionnaire to calculate the information of objective support, subjective support and utilization of social support. χ(2) test and logistic regression were performed to examine relationships between factors and adherence.

RESULTS

A total of 386 patients with medication were investigated. Among them, there were 365 (94.6%) cases who were compliant to the ART, and 357 (92.5%) cases can take their pills on time, and 29 (7.5%) cases take their medication in excess of the prescribed time more than two hours. Social support score was 27.2 ± 7.3, including objective support score (5.6 ± 2.7), subjective support score (16.1 ± 4.8), and utilization of social support (5.5 ± 1.9). Multivariate logistic regression analysis revealed that adherence was significantly associated with the correct cognition of medication (OR (95%CI): 3.24 (1.17-9.00)), the self-awareness of the drug regimen was not complexity (OR (95%CI): 9.34 (3.27-26.68)), taking medication 1 time a day (OR (95%CI): 4.00 (1.35-11.84)), and the batter utilization of social support (OR (95%CI): 1.49 (1.06-2.01)). Married/cohabiting or farmers tend to be nonadherenced, while the OR (95%CI) was 0.24 (0.08-0.67) and 0.23 (0.08-0.69), respectively.

CONCLUSION

The patients among these provinces were compliant to the ART, and most of them can take their pills on time. The social support score of these patients was lower than normal person. Participants who have correct cognition of medication, thinking their drug regimen was not complexity; Taking medication 1 time a day or have high level of utilization of social support showed a significantly higher level of self-reported adherence.

Complete mitochondrial genome of a natural triploid crucian carp mutant, Carassius auratus var. pingxiangnensis, and phylogenetic analysis of different ploidies in crucian carp

Carassius auratus var. pingxiangnensis is a natural triploid crucian carp mutant. In order to understand its placement and genetic background at the gene level, the characteristics of mitochondrial DNA sequences and phylogenetic relationship were examined. The results showed that the mitochondrial DNA is a circular double-stranded DNA molecule that is 16,576 bp in length with 13 protein-coding genes, 22 transfer RNA genes, 2 ribosomal RNA genes, and a non-coding control region. Mitochondrial genes overlapped by a total of 40 bp in 11 different locations from 1 to 14 bp. The base composition of the C. auratus mitogenome was estimated to be 29.70% A, 26.74% C, 15.35% G, and 28.21% T. The central conserved blocks and the conserved blocks were compared and were similar among C. auratus var. pingxiangnensis and six other cyprinids with different ploidies. The origin of light strand replication was similar to that of other vertebrates; it was 33 bp, but the characteristic sequence motif 5ꞌ-GCCGG-3ꞌ at the base of the stem within tRNA(Cys) was mutated to 5ꞌ-GGCGG- 3ꞌ. Our phylogenetic analysis based on whole mitogenome sequences indicated that C. auratus var. pingxiangnensis was clustered with C. auratus and then sister-grouped with Carassius gibelio. The systemic developmental tree of crucian carp with different chromosome ploidies showed that diploid C. auratus auratus was clustered with triploid C. auratus auratus, sister-grouped with tetraploid C. auratus auratus, and clustered with other diploid, triploid, and tetraploid C. auratus.

Metabolic syndrome and risk for ED: a meta-analysis

There are many recent observational studies on metabolic syndrome (MS) and the risk for ED, and it is still inconclusive whether MS increases the risk for ED. This meta-analysis aims to detect a relationship between MS and ED. We identified eligible studies by searching PubMed, Embase and the Cochrane Library for articles published before August 2013. Adjusted relative risks (RR) with 95% confidence interval (CI) were calculated using random-effects or fixed-effects models. A total of 10 studies involving 4092 participants were included in the meta-analysis. MS was associated with an increased incidence of ED (RR=1.60, 95% CI=1.27-2.02, P<0.001), with significant evidence of heterogeneity among these studies (P for heterogeneity <0.001, I(2)=92.9%). The subgroup and sensitivity analyses confirmed the stability of the results and no publication bias was detected. The present meta-analysis suggests that MS is significantly associated with the risk for ED. Large-scale and well-designed prospective studies are required to further investigate the association between MS and risk for ED.

[Percutaneous endoscpic lumbar discectomy for the treatment of upper lumbar disc herniation]

OBJECTIVE

To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with upper lumbar disc herniation and failing to respond to conservative treatment.

METHODS

From December 2008 to June 2011, 12 patients with upper lumbar disc herniation and failing to respond to conservative treatment were treated, including 8 males and 4 females, aged from 28 to 82 years old (averaged, 50.67 years old). Duration of upper lumbar disc herniation was 3 to 10 months, with an average of 5.75 months. MRI exam revealed 12 "degeneration discs" low in signal on T2 image, including 1 discs of T12L1, 1 of L1,2, 3 of L2,3 and 7 of L3,4. Discography showed positive response, fluoroscopy confirmed annulus fibrosus tears of posterior intervertebral disc in 12 discs. PELD was performed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before operation and after operation. The clinical outcome was determined by modified Macnab criteria at the final follow-up.

RESULTS

The average operation time of each patient was 1.45 h (ranged, 1.0 to 2.5 h), and the mean length of postoperative hospital stay was 5.83 days (ranged,4 to 9 days). There was no happening in ruptured meninges and nerve damage. Twelve patients were followed up,and the duration ranged from 1 to 12 months (averaged, 5.5 months). The VAS score decreased from preoperative 8.00 +/- 1.21 to postoperative 1.92 +/- 0.79 (P < 0.01). The ODI decreased from preoperative (78.81 +/- 13.65)% to the final follow-up (16.19 +/- 3.52)% (P < 0.01). According to the modified Macnab criteria, 3 patients got an excellent result, 8 good, 1 fair.

CONCLUSION

PELD is effective in treating patient with upper lumbar disc herniation failing to respond to conservative treatment.

Thymic stromal lymphopoietin: a promising therapeutic target for allergic diseases

Thymic stromal lymphopoietin (TSLP), an interleukin 7-like cytokine, can trigger dendritic cell (DC)-mediated T-helper type 2 (Th2) inflammatory responses. Recent evidence demonstrates that cytokines TSLP and OX40 (CD134)/OX40 ligand seem to be important players in the maintenance of Th2 memory pool in the pathogenesis of asthma. Accumulating data reveal that the pathogenic T cells involved in asthma are likely to be inflammatory Th2 cells. TSLP is involved in the development of asthma through crosstalk with nuclear factor NF-ĸB. Progression of skin fibrosis in atopic dermatitis occurs via TSLP/TSLP receptor. TSLP-mediated dermal inflammation aggravates experimental allergic asthma. Also, TSLP polymorphisms are associated with susceptibility to asthma, atopic dermatitis, and eczema herpeticum. These findings suggest a master switch of TSLP in the initiation of allergic and adaptive inflammation through innate pathways at the epithelial cell-DC interface. The TSLP pathway is therefore a promising target for immunotherapy of allergic diseases.

Malnutrition in hospitalized people living with HIV/AIDS: evidence from a cross-sectional study from Chengdu, China

OBJECTIVES

Nutrition support has long been ignored in China's HIV/AIDS treatment and care. The objectives of this project were to evaluate the prevalence of malnutrition among Chengdu urban HIV positive patients, and to provide evidence for further nutritional intervention.

MATERIALS AND METHODS

HIV-infected adults admitted to an infectious diseases inpatient unit were eligible for this study. Nutritional status was evaluated using Subject Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST), body mass index (BMI), food frequency questionnaire and dietary records.

RESULTS

94 hospitalized HIV positive patients were enrolled from April 2009 to May 2010. The median CD4 T cell count was 44.0/mm3. The prevalence of malnutrition is measured by three tools and ranged from 37.2% (by BMI) to 77.2% (by SGA class B/C or MUST scores ≥ 2). Chi-square test showed significant relationship between opportunistic infections and MUST score (OR=5.67, p<0.005, 95% CI=1.96-16.4). Of patients, 59.6% had insufficient total energy intake; while 54.3% had insufficient protein intake.

CONCLUSIONS

Malnutrition is highly prevalent among Chengdu urban HIV/AIDS patients who underwent inpatient treatment. Calorie and protein deficiency should be given more attention in HIV/AIDS care programs. Nutrition evaluation and support should be considered an integral parts of national and community HIV/AIDS treatment and care guidelines.

The fabrication and characteristics of indium-oxide covered porous InP

Uniform and vertical indium-oxide nanotube (IONT) arrays embedded well in n-type InP single crystal have been successfully prepared in situ by porous InP-template-assisted chemical vapor deposition (CVD). This IONT/InP nanostructure reveals high sensitivity to humidity at room temperature, which is ascribed to the ultrahigh surface-to-volume ratio of this nanostructure and the large number of oxygen defected states in IONTs. Such a nanostructure of IONT arrays embedded in a III-V semiconductor substrate could be expected to have potential applications, such as superior gas sensors. This work provides a novel approach for fabricating low-melting metal oxide semiconductor nanotubes.

Chaotic synchronization in large map networks

The chaotic synchronization in n-dimensional large map networks with local coupling and their size stabilities in the node number N-->infinity are studied analytically and numerically. The analytical results show that the chaotic synchronization is stable for N-->infinity in the presence of the external driving or global coupling. The numerical calculations show that, as the driving or global interaction strength increases from zero, the network states have the whole route: spatiotemporal chaotic state --> cluster chaotic synchronous state --> complete chaotic synchronous state --> spatiotemporal pattern --> spatiotemporal chaotic state.

[Clinical study on effect of tongyu no. I in improving prethrombotic state of senile diabetes mellitus]

OBJECTIVE

To explore the therapeutic mechanism of Tongyu No. I (TY-1) in improving prethrombotic state of senile diabetes mellitus.

METHODS

Sixty-two patients of diabetes mellitus with prethrombotic state and blood-stasis Syndrome were selected and divided randomly into two groups, 32 in the treated group and 30 in the control group. The two groups were treated by conventional therapy, combined with additional TY-1 (treated group) and aspirin (control group) respectively for 2 months. And the clinical effect as well as relevant criteria in both groups before and after treatment were observed.

RESULTS

In the treated group, treatment showed markedly effective in 14 cases, effective in 16 and ineffective in 2, the total effective rate being 93.8%. In the control group, the corresponding values were 6, 14, 10 and 66.7% respectively. Comparison of the total effective rate in the two groups showed significant difference (P < 0.01). After treatment, the treated group showed lowering in plasma TXB2 similar to that in the control group, while the decrease of GMP-140 and fasting blood glucose levels was significant as compared with before treatment (P < 0.01) and the difference was significant between the two groups (P < 0.05) after treatment.

CONCLUSION

TY-1 could improve the prethrombotic state and blood-stasis Syndrome in patients of diabetes mellitus, the main therapeutic mechanism might be correlated to the lowering of GMP-140 content.

[Study on the relationship between nitric oxide and allergic rhinitis]

OBJECTIVE

To investigate the relationship between nitric oxide (NO) and allergic rhinitis (AR).

METHOD

NO in the serum of 50 patients with AR and 40 healty control were measured by nitrate reductase.

RESULT

The level of serum NO in AR group was higher than that in healthy control group (P < 0.001).

CONCLUSION

There is a relationship between the level of NO in serum and AR. The results suggest that the NO may play an important role in the pathogenesis of AR.

Identity elements and aminoacylation of plant tRNATrp

Mutation of the Arabidopsis thaliana tRNA (Trp)(CCA) anticodon or of the A73 discriminator base greatly diminishes in vitro aminoacylation with tryptophan, indicating the importance of these nucleotides for recognition by the plant tryptophanyl-tRNA synthetase. Mutation of the tRNA (Trp)(CCA) anticodon to CUA so as to translate amber nonsense codons permits tRNA (Trp)(CCA) to be aminoacylated by A.thaliana lysyl-tRNA synthetase. Thus, translational suppression by tRNA (TRP)(CCA) observed in plant cells includes significant incorporation of lysine into protein.

Resonance Raman studies of iron-only hydrogenases

The nature of the iron-sulfur clusters in oxidized and reduced forms of Fe-only hydrogenases from Desulfovibrio vulgaris, Thermotoga maritima, and Clostridium pasteurianum has been investigated by resonance Raman spectroscopy. The results indicate the presence of ferredoxin-like [4Fe-4S]2+,+ and [2Fe-2S]2+,+ clusters in both T. maritima hydrogenase and C. pasteurianum hydrogenase I, but only [4Fe-4S]2+,+ clusters in D. vulgaris hydrogenase. This necessitates a reevaluation of the iron-sulfur cluster composition of C. pasteurianum hydrogenase I and indicates that the resonance Raman bands in the oxidized hydrogenase that were previously attributed to the hydrogen activating center [Macor, K. A., Czernuszewicz, R. S., Adams, M. W. W., & Spiro, T. G. (1987) J. Biol. Chem. 262, 9945-9947] arise from an indigenous [2Fe-2S]2+ cluster. No resonance Raman bands that could be uniquely attributed to the oxidized or reduced hydrogen activating center were observed. This suggests that the hydrogen activating center is a novel Fe center that is unrelated to any known type of Fe-S cluster.

Interleukin-3 induces antimicrobial activity against Leishmania amazonensis and Trypanosoma cruzi and tumoricidal activity in human peripheral blood-derived macrophages

The ability of interleukin-3 (IL-3) to induce antimicrobial and tumoricidal activity was evaluated. Macrophages infected with two intracellular protozoa, Leishmania amazonensis or Trypanosoma cruzi, were treated with cytokines. IL-3 induced a dose-dependent enhancement of microbistasis against leishmanias, and the activity of IL-3 (100 ng/ml) was comparable to that of gamma interferon (IFN-gamma) (1,000 U/ml). In addition, IL-3 in combination with either granulocyte-macrophage colony-stimulating factor (GM-CSF) or macrophage CSF (M-CSF) or with IFN-gamma reduced infection and lowered the required dose. IL-3 similarly activated macrophages to inhibit intracellular replication of T. cruzi. Furthermore, IL-3 induced antibody-independent tumoricidal activity against melanoma cells that was dose dependent and comparable to that of lipopolysaccharide and GM-CSF. The mechanisms by which IL-3 induced antimicrobial activity may involve at least the augmentation of oxidative capacity. IL-3, at concentrations of 0.5 ng/ml or greater, led to a significantly increased oxidative burst which paralleled the inhibition of protozoan replication. The enhancement of oxidative capacity by IL-3 (5 ng/ml or higher) was comparable to that of IFN-gamma. The induction of tumoricidal activity was associated with the production of tumor necrosis factor alpha (TNF-alpha), which in this system may feed back to enhance the macrophage inhibition of leishmanias, as demonstrated by neutralization of IL-3 activation by anti-TNF-alpha antibody. Thus, peripheral blood macrophages remain responsive to IL-3, as demonstrated by enhanced antimicrobial and tumoricidal activity. IL-3 may have potential clinical applications because of these properties and its effect on myelopoiesis.

Interleukin-4 inhibits human macrophage activation by tumor necrosis factor, granulocyte-monocyte colony-stimulating factor, and interleukin-3 for antileishmanial activity and oxidative burst capacity

Interleukin (IL)-4 has been implicated in the pathogenesis of leishmaniasis in a murine model. Experiments were done to examine the effect of IL-4 on cytokine activation of macrophages. Interferon (IFN)-gamma, granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor-alpha (TNF alpha), and IL-3 activate macrophages to inhibit replication of leishmaniae. IL-4 abrogated in a dose- and time-dependent manner the induction of antileishmanial activity by these cytokines. The depression of oxidative burst capacity is one mechanism by which IL-4 inhibits macrophage activation. IL-4 diminished in a dose- and time-dependent manner the TNF alpha enhancement of oxidative capacity. Pretreatment with IL-4 for 48, 24, or 0 h, respectively, inhibited the generation of superoxide induced by TNF alpha by 90%, 60%, and 40%. Furthermore, IL-4 abrogated the enhancement of oxidative capacity by IFN-gamma, GM-CSF, and IL-3. These data suggest that IL-4 is a potent deactivator of macrophage antimicrobial functions and may contribute to the pathogenesis of visceral leishmaniasis.

Diversity and origin of Desulfovibrio species: phylogenetic definition of a family

The different nutritional properties of several Desulfovibrio desulfuricans strains suggest that either the strains are misclassified or there is a high degree of phenotypic diversity within the genus Desulfovibrio. The results of partial 16S rRNA and 23S rRNA sequence determinations demonstrated that Desulfovibrio desulfuricans ATCC 27774 and "Desulfovibrio multispirans" are closely related to the type strain (strain Essex 6) and that strains ATCC 7757, Norway 4, and El Agheila Z are not. Therefore, these latter three strains of Desulfovibrio desulfuricans are apparently misclassified. A comparative analysis of nearly complete 16S rRNA sequences in which we used a least-squares analysis method for evolutionary distances, an unweighted pair group method, a signature analysis method, and maximum parsimony was undertaken to further investigate the phylogeny of Desulfovibrio species. The species analyzed were resolved into two branches with origins deep within the delta subdivision of the purple photosynthetic bacteria. One branch contained five deep lineages, which were represented by (i) Desulfovibrio salexigens and Desulfovibrio desulfuricans El Agheila Z; (ii) Desulfovibrio africanus; (iii) Desulfovibrio desulfuricans ATCC 27774, Desulfomonas pigra, and Desulfovibrio vulgaris; (iv) Desulfovibrio gigas; and (v) Desulfomicrobium baculatus (Desulfovibrio baculatus) and Desulfovibrio desulfuricans Norway 4. A correlation between 16S rRNA sequence similarity and percentage of DNA relatedness showed that these five deep lineages are related at levels below the minimum genus level suggested by Johnson (in Bergey's Manual of Systematic Bacteriology, vol. 1, 1984). We propose that this branch should be grouped into a single family, the Desulfovibrionaceae. The other branch includes other genera of sulfate-reducing bacteria (e.g., Desulfobacter and Desulfococcus) and contains Desulfovibrio sapovorans and Desulfovibrio baarsii as separate, distantly related lineages.

Effects of acetylene on hydrogenases from the sulfate reducing and methanogenic bacteria

The effect of acetylene on the activity of the three types of hydrogenase from the anaerobic sulfate reducing bacteria has been investigated. The (Fe) hydrogenase is resistant to inhibition by acetylene while the nickel-containing hydrogenases are inhibited by acetylene with the (NiFe) hydrogenase being 10-50 fold more sensitive than the (NiFeSe) hydrogenase. In addition the Ni(III) EPR signal (g approximately 2.3) of the "as isolated" (NiFe) hydrogenase was significantly decreased in intensity upon exposure to acetylene.

EPR studies with 77Se-enriched (NiFeSe) hydrogenase of Desulfovibrio baculatus. Evidence for a selenium ligand to the active site nickel

The periplasmic hydrogenase containing equivalent amounts of nickel and selenium plus non-heme iron [NiFeSe) hydrogenase) has been purified from cells of the sulfate reducing bacterium Desulfovibrio baculatus (DSM 1748) grown on a lactate/sulfate medium containing natural Se isotopes and the nuclear isotope, 77Se. Both the 77Se-enriched and unenriched hydrogenases were shown to be free of other hydrogenases and characterized with regard to their Se contents. EPR studies of the reduced nickel signal generated by redox titrations of the enriched and unenriched (NiFeSe) hydrogenases demonstrated that the gx = 2.23 and gy = 2.17 resonances are appreciably broadened by the spin of the 77Se nucleus (I = 1/2). This observation demonstrates unambiguously that the unpaired electron is shared by the Ni and Se atoms and that Se serves as a ligand to the nickel redox center of the (NiFeSe) hydrogenase.

Immunopathological study on human cartilage allografts

The fate of human cartilage allografts and the mechanism of its kinetical development were studied histopathologically and immunohistologically. After transplantation, the grafts underwent necrosis, calcification and were partially invaded by osteoplastic tissue of the host and eventually replaced by bone tissue. Thus, the contour of the transplanted cartilage was kept partially by the living cartilage and the newly-formed osseous tissue. The grafts were surrounded initially by granular tissue and then by scar tissue, in which numerous T cells and a few macrophage infiltrates were noted. In T cells, T4+ lymphocytes predominated but T8+ cells accounted for a small number. B cells were not found within the infiltrates. Most of the infiltrating cells expressed 12 antigens, indicating that the majority of T cells were activated. It was concluded that T lymphocytes mediated cellular immunity played an important role. The chondrocytes of the cartilage did not express HLA I and II antigens before transplantation, but one month later, the living chondrocytes became HLA I and II antigens positive, and the antigen expression became stronger with the elapse of time; this might be induced by lymphokins, especially by interferon produced by the infiltrating lymphocytes. Such an expression of MHC antigens on chondrocytes might contribute to the further enhancement of immunorejection.

EPR-detectable redox centers of the periplasmic hydrogenase from Desulfovibrio vulgaris

The periplasmic hydrogenase of Desulfovibrio vulgaris (Hildenbourough NCIB 8303) belongs to the category of [Fe] hydrogenase which contains only iron-sulfur clusters as its prosthetic groups. Amino acid analyses were performed on the purified D. vulgaris hydrogenase. The amino acid composition obtained compared very well with the result derived from the nucleotide sequence of the structural gene (Voordouw, G., Brenner, S. (1985) Eur. J. Biochem. 148, 515-520). Detailed EPR reductive titration studies on the D. vulgaris hydrogenase were performed to characterize the metal centers in this hydrogenase. In addition to the three previously observed EPR signals (namely, the "isotropic" 2.02 signal, the rhombic 2.10 signal, and the complex signal of the reduced enzyme), a rhombic signal with resonances at the g-values of 2.06, 1.96, and 1.89 (the rhombic 2.06 signal) was detected when the samples were poised at potentials between 0 and -250 mV (with respect to normal hydrogen electrode). The midpoint redox potentials for each of the four EPR-active species were determined, and the characteristics of each EPR signal are described. Both the rhombic 2.10 and 2.06 signals exhibit spectral properties that are distinct from a ferredoxin-type [4Fe-4S] cluster and are proposed to originate from the same H2-binding center but in two different conformations. The complex signal of the reduced hydrogenase has been shown to represent two spin-spin interacting ferredoxin-type [4Fe-4S]1+ clusters (Grande, H. J., Dunham, W. R., Averill, B., Van Dijk, C., and Sands, R. H. (1983) Eur. J. Biochem. 136, 201-207). The titration data indicated a strong cooperative effect between these two clusters during their reduction. In an effort to accurately estimate the number of iron atoms/molecule of hydrogenase, plasma emission and chemical methods were used to determine the iron contents in the samples; and four different methods, including amino acid analysis, were used for protein determination. The resulting iron stoichiometries were found to be method-dependent and vary over a wide range (+/- 20%). The uncertainties involved in the determination of iron stoichiometry are discussed.

The relationship between activity and the axial g = 2.06 EPR signal induced by CO in the periplasmic (Fe) hydrogenase from Desulfovibrio vulgaris

The effect of exposure to carbon monoxide on the activity of the (Fe) hydrogenase from Desulfovibrio vulgaris has been determined. Concentrations of carbon monoxide which completely inhibit hydrogenase activity and induce formation of the axial g = 2.06 EPR signal up to 0.8 spin/molecule do not cause irreversible inhibition of the (Fe) hydrogenase.

Identification of three classes of hydrogenase in the genus, Desulfovibrio

A comparison of amino-terminal amino acid sequences from the large and small subunits of hydrogenases from Desulfovibrio reveals significant differences. These results, in conjunction with antibody analyses, clearly indicate that the iron, iron + nickel, and iron + nickel + selenium containing hydrogenases represent three distinct classes of hydrogenase in Desulfovibrio.

Isolation of fumarate reductase from Desulfovibrio multispirans, a sulfate reducing bacterium

Fumarate reductase was isolated and purified 100-fold to homogeneity from Desulfovibrio multispirans, a new species of sulfate-reducing bacteria. The enzyme contained 1 mol of non-covalently bound FAD and four subunits with Mr 45,000, 32,000, 30,000 and 27,000. EPR spectroscopy showed the existence of two iron-sulfur clusters. The absorption spectrum showed a broad region of high absorbance from 450 nm to 300 nm with a protein peak at 278 nm. The ratio of A278:A400 was 2.60. The specific activity was 110 mumoles H2/mg of protein. The Km for fumarate was 2.5 mM. The activation energy was 8.7 kcal/mol. Electron transport from H2 to fumarate in intact cells was inhibited by 2-heptyl-4-hydroxy-quinoline-N-oxide, a quinone inhibitor, indicating the participation of quinone (probably menaquinone) in fumarate reduction.

A cytoplasmic nickel-iron hydrogenase with high specific activity from Desulfovibrio multispirans sp. N., a new species of sulfate reducing bacterium

A hydrogenase from a new species of sulfate reducing bacterium has been isolated and characterized. In contrast to other hydrogenases isolated from Desulfovibrio, this enzyme is found in the cytoplasmic fraction rather than in the periplasm. The specific activity of the enzyme, as measured in the hydrogen evolution assay, is twice as high as the specific activity of the hydrogenase from D. gigas. It also differentiates itself from the periplasmic Desulfovibrio hydrogenases by being more active in the hydrogen evolution rather than in the hydrogen uptake assay. The enzyme was shown to contain 0.9 atoms of nickel, 11 atoms of iron and 10 atoms of labile sulfide per mole of enzyme. It exhibits an unusually low intensity of the g = 2.31 nickel EPR signal in the isolated enzyme but shows a normal intensity for the g = 2.19 nickel EPR signal when reduced under hydrogen.