Challenges for room temperature operation of electrically pumped GeSn lasers

Recent demonstrations of room-temperature lasing in optically pumped GeSn show promise for future CMOS compatible lasers for Si-photonics applications. However, challenges remain for electrically pumped devices. Investigation of the processes that limit device performance is therefore vital in aiding the production of future commercial devices. In this work, a combined experimental and modelling approach is utilised to explore the dominant loss processes in current devices. By manipulating the band structure of functioning devices using high hydrostatic pressure techniques at low temperature, the dominant carrier recombination pathways are identified. This reveals that 93± 5% of the threshold current is attributable to defect-related recombination at a temperature, T = 85 K. Furthermore, carrier occupation of L-valley states (carrier leakage) is responsible for 1.1± 0.3% of the threshold current, but this sharply increases to 50% with a decrease of just 30 meV in the L- Γ separation energy. This indicates that thermal broadening of a similar order may reproduce these adverse effects, limiting device performance at higher temperatures. Temperature dependent calculations show that carrier occupation of indirect valley L-states strongly affects the transparency carrier density and is therefore very sensitive to the Sn composition, leading to an effective operational temperature range for given Sn compositions and strain values. Recommendations for future device designs are proposed based on band structure and growth optimisations.

Aconine attenuates osteoclast-mediated bone resorption and ferroptosis to improve osteoporosis via inhibiting NF-κB signaling

Osteoporosis (OP), a prevalent public health concern primarily caused by osteoclast-induced bone resorption, requires potential therapeutic interventions. Natural compounds show potential as therapeutics for postmenopausal OP. Emerging evidence from in vitro osteoclastogenesis assay suggests that aconine (AC) serves as an osteoclast differentiation regulator without causing cytotoxicity. However, the in vivo functions of AC in various OP models need clarification. To address this, we administered intraperitoneal injections of AC to ovariectomy (OVX)-induced OP mice for 8 weeks and found that AC effectively reversed the OP phenotype of OVX mice, leading to a reduction in vertebral bone loss and restoration of high bone turnover markers. Specifically, AC significantly suppressed osteoclastogenesis in vivo and in vitro by decreasing the expression of osteoclast-specific genes such as NFATc1, c-Fos, Cathepsin K, and Mmp9. Importantly, AC can regulate osteoclast ferroptosis by suppressing Gpx4 and upregulating Acsl4, which is achieved through inhibition of the phosphorylation of I-κB and p65 in the NF-κB signaling pathway. These findings suggest that AC is a potential therapeutic option for managing OP by suppressing NF-κB signaling-mediated osteoclast ferroptosis and formation.

[Progress of researches on developmental processes and reproduction mode of Pneumocystis]

Pneumocystis, an important opportunistic fungal pathogen that parasitizes in multiple mammalian lungs, may cause life-threatening Pneumocystis pneumonia (PCP) and even death among immunocompromised individuals. With the rapid development of high-throughput sequencing and multi-omics technologies, systematic comparative analyses of genome, transcriptome, and whole-genome sequencing results demonstrate that Pneumocystis is a type of obligate biotrophic fungi, and requires obtaining nutrition from hosts. In addition, sexual reproduction is an essential process for Pneumocystis survival, production and transmission, and asexual reproduction facilitates Pneumocystis survival, which provides new insights into understanding of the whole developmental process of Pneumocystis in the host lung and inter-host transmission of Pneumocystis. This review summarizes the advances in the reproduction mode of Pneumocystis and underlying mechanisms, which provides insights into prevention and treatment of PCP, notably for the prophylaxis against nosocomial transmission of PCP.

[Effects of heat exposure and vitamin C intervention on oxidative stress and blood pressure changes in treadmill rats]

Objective: To investigate the effect of oxidative stress caused by heat exposure on the blood pressure increase of treadmill rats and the intervention of antioxidants. Methods: In June 2021, Twenty-four healthy SD male rats were randomly divided into four groups: normal temperature feeding, normal temperature treadmill, high temperature treadmill and high temperature treadmill supplementation with vitamin C groups, 6 rats in each group. The rats run on the platform in normal temperature or heat exposure environment for 30 min in the morning and in the afternoon daily, 6 days per week. The daily vitamin C supplement dose of high temperature treadmill supplementation with vitamin C group was 10 mg/kg. BP recordings were done at the end of the week. The rat vascular lipofuscin (LF) was detected by ELISA, the rat serum nitric oxide (NO) was detected by nitrate reductase method, the serum malondialdehyde (MDA) was detected by thibabituric acid method, the serum glutathione peroxidase (GPx) and superoxide dismutase (SOD) were detected by chemiluminescence method, and the serum catalase (CAT) was detected by ammonium molybdate method. The total antioxidant capacity (T-AOC) of serum was measured by iron reduction/antioxidant capacity method, and the content of nuclear erythroid 2-related factor 2 (Nrf2) in vascular tissue was measured by Western blot. The intra-group mean was compared by repeated measurement analysis of variance, and the inter-group mean was compared by single-factor analysis of variance and post-event LSD-t test. Results: Compared with the previous time point, the systolic BP and diastolic BP of the high temperature treadmill group were significantly increased at 7, 14 and 21 d, and decreased at 28 d which were higher than the initial level (P<0.05), and the systolic BP and diastolic BP values at each experimental time point were significantly higher than those of normal temperature treadmill group (P<0.001). The changes of thickening of the artery wall, no smoothing of the endodermis and irregular arrangement of muscle cells in high temperature treadmill group were observed. Compared with the normal temperature treadmill group, the content of MDA in serum, and LF in vascular tissue were significantly increased, the activities of SOD, CAT, T-AOC, the content of NO in serum, and the expression of Nrf2 in vascular tissue were significantly decreased in high temperature treadmill group (P<0.05). Compared with the high temperature treadmill group, the systolic BP and diastolic BP values at 7, 14, 21 and 28 d, the content of serum MDA and LF in vascular tissue were significantly decreased, the activities of CAT and T-AOC, and the expression of Nrf2 in vascular tissue significantly increased (P<0.05), the histopathological changes of the artery wall improved in high temperature treadmill supplementation with vitamin C group. Conclusion: Heat exposure has effect on oxidative stress, which may be related to the increase of BP. Vitamin C as an anti-oxidative enhancer can prevent those negative effects, which could alleviate the pathological changes of vessel intima in heat-exposed rats. And the Nrf2 may be a regulated factor to vascular protection.

Comparison of automated breast volume scanning with conventional ultrasonography, mammography, and MRI to assess residual breast cancer after neoadjuvant therapy by molecular type

AIM

To compare the accuracy of hand-held ultrasonography (US), mammography (MG), magnetic resonance imaging (MRI), and automated breast volume scanning (ABVS) in defining residual breast cancer tumour size after neoadjuvant therapy (NAT).

MATERIALS AND METHODS

Patients diagnosed breast cancer and who received NAT at the Breast Center, Peking University People's Hospital, were enrolled prospectively. Imaging was performed after the last cycle of NAT. The residual tumour size, intraclass correlation coefficients (ICCs), and receiver operating characteristic (ROC) to predict pathological complete response (pCR) were analysed.

RESULTS

A total of 156 patients with 159 tumours were analysed. ABVS had a moderate correlation with histopathology residual tumour size (ICC = 0.666), and showed high agreement among triple-positive tumours (ICC = 0.797). With 5 mm as the threshold, the coincidence rate reached 64.7% between ABVS and pathological size, which was significantly higher than that between US, MG, MRI, and pathological size (50%, 45.1%, 41.4%; p=0.009, p=0.001, p<0.001, respectively). For ROC analysis, ABVS demonstrated a higher area under the ROC curve, but with no statistical difference, except for MG (0.855, 0.816, 0.819, and 0.788, respectively; p=0.183 for US, p=0.044 for MG, and p=0.397 for MRI, with ABVS as the reference).

CONCLUSIONS

The longest tumour diameter on ABVS had a moderate correlation with pathological residual invasive tumour size. ABVS was shown to have good ability to predict pCR and would appear to be a potential useful tool for the assessment after NAT for breast cancer.

Association of Dietary Quality with Cognitive Function in Chinese Adults Aged 55 Years and Above: A Longitudinal Study

OBJECTIVES

Diet is an important modifiable factor for brain health and aging. Present study aimed to explore association of dietary quality with cognitive function and poor cognition in middle-aged and older adults participating in the China Health and Nutrition Survey (CHNS).

DESIGN

A longitudinal study with a twenty-year follow-up.

SETTING AND PARTICIPANTS

Data were drawn from the CHNS 1997, 2000, 2004, 2006, 2015 and 2018. Subjects aged 55 years and more who participated in at least two waves and had completed data on socio-demographics, lifestyle, disease history, anthropometrics, dietary measure and cognitive assessment were eligible in present study.

METHODS

Baseline diet were assessed by 3-day 24-hour dietary recalls and used to evaluate diet quality via China Elderly Dietary Guidelines Index 2022 (CDGI 2022-E). Cognitive function was examined using part items of the Telephone Interview for Cognitive Status-modified. Three-level linear mixed effects models and three-level mixed effects logistic regression models were performed to estimate the association between diet quality and cognitive function and odds of poor cognition, respectively.

RESULTS

At baseline, 4173 subjects with median age of 63.7 years were recruited. Median of CDGI 2022-E total score was 44.7. Median score of global cognition was 16.0, and the proportion of people with poor cognitive function was 13.9%. Difference in global cognitive score was observed by tertiles of CDGI 2022-E (p<0.05). Significant associations of high diet quality with increment in global cognitive score [β (95%CI): 0.704 (0.394~1.015)], composite cognitive z score [0.086 (0.045~0.128)] and standardized verbal memory score [0.221 (0.122~0.320)] were observed in total subjects. Consistent associations were also found in those below 65 years at baseline. The likelihood of poor cognition in the highest tertile of CDGI 2022-E decreased by 18% (95%CI: 0.698~0.965) relative to the lowest tertile group in total population.

CONCLUSIONS

High diet quality may be beneficial for improving cognitive function and delaying cognitive decline in Chinese middle-aged and older population.

A comparative study of three-dimensional airway changes after fibula flap reconstruction for benign and malignant tumours in the anterior mandible

Surgical treatment of tumours in the anterior mandible and surrounding tissues may result in defects which can be restored by a fibula free flap. The upper airway may change during this process. The purpose of this retrospective study was to evaluate upper airway changes after fibula free flap reconstruction. A total of 37 patients who underwent anterior mandibulectomy and fibula free flap reconstruction between 2012 and 2020 were recruited. Patients with benign and malignant tumours involving the anterior mandible were included. Spiral computed tomography was performed 1 week preoperatively, 1 week postoperatively, and at> 1 year (range 12-23 months) after surgery. Cross-sectional areas and volumes of the upper airway were measured. Data were analysed by two-way analysis of variance. The upper airway in the malignant tumour group showed an increasing trend, especially at the soft palate and tongue base levels (P < 0.01). In the benign tumour group, the upper airway showed no significant changes. The location of the minimum cross-sectional area moved downwards in both groups, and the area increased in the malignant tumour group during long-term follow-up. Upper airway obstruction is less likely to occur in the long term after surgical resection of anterior mandible malignancies and fibula free flap reconstruction.

Does mental health mediate the effect of deviant peer affiliation on school adaptation in migrant children: evidence from a nationally representative survey in China

OBJECTIVES

This study aimed to examine the impact of deviant peer affiliation on migrant children's school adaptation in China and explore the mediating role of mental health in the relationship between deviant peer affiliation and school adaptation among migrant children.

STUDY DESIGN

This was a cross-sectional study based on secondary data.

METHODS

This study was based on the nationally representative China Education Panel Survey. Multiple linear regression models were used to quantify the relationship between deviant peer affiliation and school adaptation among 1,012 migrant children aged 12-17 years. Bootstrap test was used to evaluate the mediating effect of children's mental health.

RESULTS

Deviant peer affiliation showed a significant negative impact on the school adaptation of migrant children (β = -0.41, 95% confidence interval = -0.56 to -0.26). The relationship between deviant peer affiliation and school adaptation was partially mediated by children's mental health, resulting in an indirect effect of deviant peer affiliation on their school adaptation through their mental health (β = -0.05, 95% confidence interval = -0.09 to -0.03). The mediating role of mental health could explain 11.4% of the relationship between deviant peer affiliation and school adaptation.

CONCLUSIONS

Among migrant children, deviant peer affiliation showed unique effects on their school adaptation. Taking care of their mental health might help improve their school adaptation.

Early on-treatment tumor growth rate (EOT-TGR) determines treatment outcomes of advanced non-small-cell lung cancer patients treated with programmed cell death protein 1 axis inhibitor

BACKGROUND

Tumor growth rate (TGR), denoted as percentage change in tumor size per month, is a well-established indicator of tumor growth kinetics. The predictive value of early on-treatment TGR (EOT-TGR) for immunotherapy remains unclear. We sought to establish and validate the association of EOT-TGR with treatment outcomes in patients with advanced non-small-cell lung cancer (aNSCLC) undergoing anti-PD-1/PD-L1 (programmed cell death protein 1/programmed death-ligand 1) therapy.

PATIENTS AND METHODS

This bicenter retrospective cohort study included a training cohort, a contemporaneously treated internal validation cohort, and an external validation cohort. Computed tomography images were retrieved to calculate EOT-TGR, denoted as tumor burden change per month during a period between baseline and the first imaging evaluation after immunotherapy. Kaplan-Meier methodology and Cox regression analysis were conducted for survival analyses.

RESULTS

In the pooled cohort (n = 172), 125 patients (72.7%) were males; median age at diagnosis was 58 (range 28-79) years. Based on the training cohort, we determined the optimal cut-off value for EOT-TGR as 10.4%/month. Higher EOT-TGR was significantly associated with inferior overall survival [OS; hazard ratio (HR) 2.93, 95% confidence interval (CI) 1.47-5.83; P = 0.002], worse progression-free survival (PFS; HR 2.44, 95% CI 1.46-4.08; P = 0.001), and lower objective response rate (3.3% versus 20.9%; P = 0.040) and durable clinical benefit rate (6.7% versus 41.9%; P = 0.001). Results were reproducible in the two validation cohorts for OS and PFS. Among 43 patients who had a best response of progressive disease in the training cohort, those with high EOT-TGR had worse OS (HR 2.64; P = 0.041) and were more likely to progress due to target lesions at the first tumor evaluation (85.2% versus 0.0%; P <0.001).

CONCLUSIONS

Higher EOT-TGR was associated with inferior OS and immunotherapeutic response in patients with aNSCLC undergoing anti-PD-1/PD-L1 therapy. This easy-to-calculate radiologic biomarker may help evaluate the abilities of immunotherapy to prolong survival and assist in tailoring patients' management.

TRIAL REGISTRATION

ClinicalTrials.govNCT04722406; https://clinicaltrials.gov/ct2/show/NCT04722406.

[Meta analysis of rock salt aerosol therapy for respiratory tract diseases]

Objective: To systematically evaluate the efficacy and safety of rock salt aerosol in the treatment of respiratory tract diseases. Methods: In June 2021, the clinical randomized controlled trial literatures of rock salt aerosol therapy for respiratory tract diseases were searched from CNKI, Wanfang, VIP, Cochrane Library, PubMed database and EMBASE database. Cochrane risk bias evaluation tool was used to evaluate risk bias, Revman 5.4 and Stata16 were used to conduct meta-analysis, TSA 0.9 was used to conduct sequential analysis of trials, and gradepro was used to evaluate evidence quality. Results: A total of 21 literatures were included. According to whether the subjects received rock salt aerosol therapy, they were divided into the experimental group (1125 people) and the control group (973 people) . Compared with the control group, the total clinical effective rate (RR=1.22, 95%CI: 1.15~1.29, P<0.001) , forced expiratory volume in one second (FEV(1)) (WMD=0.20, 95%CI: 0.09~0.31, P<0.001) , percentage of FEV(1) in the predicted value (FEV(1)%) (WMD=5.06, 95%CI: 3.47~6.65, P<0.001) , forced vital capacity (FVC) (WMD=0.22, 95% CI: 0.16~0.27, P<0.001) , maximum expiratory flow (PEF) (WMD=21.312, 95%CI: 9.189~33.435, P=0.004) of experimental group were higher. TSA test shows that the difference conclusions of total effective rate, FEV(1), FEV(1)%, FVC and PEF were reliable, but the conclusion of FEV(1)% needs to be treated with caution; Three literatures reported the adverse reactions in the experimental group; GRADE evidence quality evaluation showed 3 very low-quality evidences and 2 low-quality evidences. Conclusion: Rock salt aerosol therapy combined with conventional therapy has a certain effect on the treatment of respiratory tract diseases, which needs to be further confirmed by high-quality evidence.

[Analysis of factors affecting revitrectomy in patients with proliferative diabetic retinopathy]

Objective: To identify prognostic factors for revitrectomy in patients who underwent pars plana vitrectomy (PPV) for complications with proliferative diabetic retinopathy (PDR). Methods: This study was a retrospective case-control study. Clinical data of PDR patients (290 eyes) at Peking University People's Hospital from December 2019 to December 2020 were retrospectively collected.According to the number of operations, patients were divided into two groups: single PPV group (227 eyes) and revitrectomy PPV group (63 eyes). Follow-up will be conducted up to 6 months postoperatively. The BCVA was compared before and after PPV between the two groups, and postoperative complications of revitrectomy PPV group were analyzed. Quantitative data are presented as medians [M (Q₁, Q₃)]. Results: The age of single PPV group patients was 55.0 (47.0, 63.0), and the age of revitrectomy PPV group patients was 49.0 (38.0, 57.0). This difference was statistically significant (P=0.027). The LogMAR visual acuity of two groups were 1.7 (1.0, 2.4) and 2.1 (1.4, 2.4) (P=0.026) preoperative; the visual acuity of single PPV group was 0.75 (0.43, 1.00) (P<0.001), and revitrectomy PPV group was 0.95 (0.60, 1.65) (P<0.001) at 6 months postoperative. The visual acuity improvement of single PPV group was better than revitrectomy PPV group (P=0.021). Age (P=0.043, OR=0.97, 95%CI: 0.95-1.00), preoperative BCVA (P=0.024, OR=1.82, 95%CI: 1.08-3.05), tractional retinal detachment (TRD) (P=0.033, OR=2.16, 95%CI:1.06-4.37), silicone oil tamponade (P=0.028, OR=0.48, 95%CI: 0.25-0.92) were prognostic factors of revitrectomy. Conclusion: Young age, low preoperative BCVA, TRD, and silicon oil tamponade were the potential prognostic factors of revitrectomy for PDR patients.

Exerimental method and preliminary studies of the passive containment water film evaporation mass transfer

For larger containments and higher operation parameters, characteristics of the outside cooling of the PCCS are very important for the analysis on the containment integrity. A preliminary analysis was made and a four-step experimental method was used to numerically analyze the falling water film evaporation for the advanced passive containment. Then, the water flow stability along the outside wall of the containment was studied. The results fit well with those correlations without airflow when the air velocity is less than 5.0 m/s. However, when the air velocity is larger than 5.0 m/s, the influence of the air velocity on the water film will appear and the mean water film thickness will be thicker. Based on the prototype operation parameters, experimental studies were carried and the results were compared with the Dittus-Boelter correlation within the operation ranges. A modification factor was proposed for the conservative application of this correlation for nuclear safety analysis.

[Clinical analysis of 10 cases with extramedullary plasmacytoma of the head and neck]

Objective: To explore the clinical characteristics, treatment methods and outcomes of extramedullary plasmacytoma of the head and neck. Methods: A retrospective analysis was conducted on 10 cases with extramedullary plasmacytoma of the head and neck who were admitted to Henan Tumor Hospital from January 2005 to January 2020. Among the 10 patients, 6 were male and 4 were female. The average age at diagnosis was 56.3 years old (34-74 years old). Among them, 3 cases were located in the nasal cavity, 2 cases in the nasopharynx, 1 case in the sinuses, 2 cases in the larynx, 1 case in the oropharynx, and 1 case in the cervical lymph nodes. Treatments were administered according to tumor size and resection extent. Complete surgical excision (negative margins) was preferred, followed by adjuvant radiotherapy or radiotherapy alone. The clinical characteristics, diagnosis, treatment and prognosis of EMP were analyzed. Results: The patients' symptoms were not specific, frequently with local obstruction symptom and localized masses. All patients were confirmed pathologically as suffering from monoclonal plasmacytoma, with negative bone marrow biopsy and negative skeletal survey. Five patients received surgery, 3 received radiotherapy, and 2 received surgery with additional radiation. The follow-up time was 16-125 months, with a median of 92 months. Two patients developed into multiple myeloma. One patient who received radiotherapy after surgery relapsed after 7 years of follow-up and again received surgical treatment, with no evidence of second recurrence. The remaining patients had no recurrence or progression. Conclusion: Extramedullary plasmacytoma of the head and neck has a good prognosis. Surgical treatment can be considered for completely resectable lesions.

457 NUTRITION, SARCOPENIA AND FRAILTY

 

Many older people admitted to hospital are malnourished/at risk of malnourishment (30%), have swallowing problems (55%), are frail (25%), have sarcopenia (50%) or a combination of these. On admission to hospital frail older people are at significant risk of worsening nutritional status and prolonged hospital stay. Nutritional status should be identified, documented, food intake monitored and where appropriate they should be referred to the dietitian.

The question remains, do staff recognise that frail older people may not eat their food increasing their risk of poor nutrition and outcome.

Methods

Older people admitted to a ‘Frailty’ Ward were directly observed during lunchtime by WD. The Minimal Eating Observation Form –Version II (MEOF-II) was used to document how much they ate. Frailty status (CFS), presence of Sarcopenia (Sarc-F) and whether a referral to dietetics or speech and language therapy (SLT) was completed.

Results

39 patients were observed. Mean age was 82.38 years; median CFS 6 (3–8); median Sarc-F 4(0–9). Median MEOF II was 0 (0–5). Two patients were referred to dietetics and 4 to SLT. 7/40 (17,5%) were at high risk for undernutrition, a further 8/40(20%) were at moderate risk. 82% were severely frail, the remaining were mildly frail. 94% (16/17) exhibited sarcopenia. There was significant correlation between MEOF II and CFS (r = 0.4887, p = 0.00162); MEOFII and Sarc-F (r = 0.4395, p = 0.00512). There was correlation between CFS and Sarc-F (r = 0.80296, p &lt; 0.00001). Only one (6%) was referred to the dietitian.

Conclusion

Frail older adults are often undernourished on admission to hospital. Nutritional intake is often poor with acute illness. Screening, observation and monitoring of nutritional intake should highlight concerns and needs for intervention. These study high lights that a significant number of older people are frail, fail to complete meals, are at significant risk of under nutrition, yet proactive intervention does not occur.

OP0042 BLOCKING OF CD103+ TISSUE RESIDENT MEMORY T CELLS (TRM) AS A THERAPEUTIC STRATEGY IN SJOGREN’S SYNDROME

Background:

Tissue-resident memory T cells (TRM), are a recently identified T cells population featuring tissue localization and expression of markers of tissue homing, CD69 and CD103. Recently, the expansion of CD8+ TRMs and their involvement in the sialadenitis was described in a murine model of SS. However, CD4+ and CD8+ TRM’s functional relevance in pSS is still not fully understood, and the TRM therapeutic targeting unexplored.

Objectives:

The study aimed to address the role of CD4+ and CD8+ TRMs in the pathogenesis of pSS and to explore the therapeutic targeting of the tissue residency marker of TRM CD103.

Methods:

An animal model of experimental (ESS) obtained by immunization of female C57BL/6 mice (n=10) with salivary glands (SG) protein extract and Freund’s complete adjuvant used to investigate the dynamic of infiltration of SG by CD4+ and CD8+ TRMs, their frequency, and the impact of CD103 blockade. For the therapeutic intervention, at 10-weeks post-immunization, the salivary gland was cannulated via Wharton’s duct, and an anti-CD103 neutralizing antibody or vehicle-injected. The mice’s saliva flow rate was assessed, and SGs were analyzed by Flow-cytometry and immunohistochemistry (IHC).

The frequency and localization of TRMs was analyzed in minor SG of sicca syndrome (nSS) and pSS patients (n=39) by flow cytometry and IHC. The expression of genes involved in the tissue retention of TRMs was assessed in SG by RT-PCR.

Results:

Upon the ESS progression, a significant progressive increase in CD45+CD103+ cells frequency was observed from 5wk to 20wk post-immunization (p<0.001), where the CD8+ were the most abundant, followed by CD4+. Consistently, CD103+CD8+ T cells were detected within the lymphocytic infiltration of SG from ESS mice. Sorted purified SG CD10+CD3+CD8+ T cells showed higher Granzyme B, TNF-alpha expression compared to CD103-CD3+CD8+ at both mRNA and protein levels. Notably, ESS mice treated with anti-CD103 showed improvement in salivary function (p<0.05) and reduced lymphocytic infiltrations measured as focus score (FS) (p<0.01) and area-fraction (p<0.01). Consistently, anti-CD103 treatment consistently reduced CD103+ cells and IFN-gamma+, Granzyme B+, and TNFa+ CD8+ cells. We next performed phenotypic analysis of CD45+CD103+ immune cells in the SG of pSS patients observing an increase in both with CD8+CD103+CD69+ and CD4+CD103+CD69+ (p<0.05). Finally, IHC showed that the expansion of TRMs in pSS salivary glands was accompanied by a down-regulation of E-cadherin glandular expression and their migration outside the epithelium in the context of inflammatory infiltrates. SG of patients with pSS showed a significant up-regulation of BLIMP1, KFL-2, and S1PR1 and down-regulation of ITGB2. CXCL9 and CXCL10, and IL-15 involved in the tissue recruitment and long-term survival of TRMs were significantly modulated in pSS salivary glands.

Conclusion:

TRM are expanded and activated in the SG of pSS and ESS, participating in the organization of tissue inflammation. Although the mechanisms behind this expansion are still not fully understood, CD103 could be a valuable novel therapeutic target to prevent lymphocytic infiltrations and glandular destruction in Sjogren syndrome.

Disclosure of Interests:

None declared

Ulinastatin improves myocardial ischemia-reperfusion injury in rats through endoplasmic reticulum stress-induced apoptosis pathway

OBJECTIVE

To investigate the protective role of ulinastatin (UTI) on myocardial ischemia-reperfusion (I/R) injury in rats via endoplasmic reticulum stress (ERS)-induced apoptosis pathway.

MATERIALS AND METHODS

A total of 60 rats were randomly divided into normal group (n=20), myocardial I/R model group (model group, n=20), and myocardial I/R model+UTI treatment group (treatment group, n=20). The myocardial function indicators [creatinine (Scr) and creatine kinase (CK)] were detected. Enzyme-linked immunosorbent assay (ELISA) was performed to measure serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9). Meanwhile, the contents of reactive oxygen species (ROS), superoxide dismutase (SOD), and malondialdehyde (MDA) in rat left ventricular tissues were determined by ELISA as well. The cardiac function indexes were determined via magnetic resonance imaging (MRI) and echocardiography (ECG). Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) staining assay was carried out to detect the apoptosis of myocardial tissues. Additionally, the expression levels of endoplasmic reticulum stress and apoptosis genes were measured through quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) assay and Western blotting analysis, respectively.

RESULTS

Serum levels of alanine aminotransferase (ALT), CK, and Scr in model group were significantly higher than those in normal group (p<0.05). Besides, rats in model group had significantly lowered SOD, ejection fraction (EF, %), and fractional shortening (FS, %) than those in normal group (p<0.05). In addition, remarkably increased contents of TNF-α, IL-6, MMP-9, MDA, and ROS, as well as higher left ventricular end-diastolic diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) were observed in model group in comparison with normal group (p<0.05). TUNEL staining results revealed that there were more apoptotic cells in model group than that in the other two groups (p<0.05). Expression levels of cysteine aspartic acid-specific protease 12 (Caspase-12) and glucose-regulated protein 78 (GRP78) were evidently higher in model group than those in normal group (p<0.05), while the expression level of B-cell lymphoma 2 (Bcl-2) was clearly lower in model group than that in normal group (p<0.05). UTI treatment partially reversed the above expression changes (p<0.05).

CONCLUSIONS

UTI has a protective effect against myocardial I/R injury in rats by repressing the occurrence of ERS-induced apoptosis.

RBMS3 delays disc degeneration by inhibiting Wnt/β-catenin signaling pathway

OBJECTIVE

To study the effect of RBMS3 on nucleus pulposus cells and its effect on the Wnt/β-catenin signaling pathway.

PATIENTS AND METHODS

We measured the expression of RBMS3 in human nucleus pulposus tissues with different degrees of degeneration. Recombinant human IL-1β is used to stimulate the degeneration of human nucleus pulposus cells. We used Wnt/β-catenin signaling pathway inhibitors and cell transfection to study the effect of RBMS3 on nucleus pulposus cells and its mechanism.

RESULTS

RBMS3 was less expressed in the nucleus pulposus tissue of people with higher degeneration degree. IL-1β reduced the expression of RBMS3 in nucleus pulposus cells. Overexpression of RBMS3 can promote the proliferation of nucleus pulposus cells and reduce the apoptosis and inflammation of cells. In addition, RBMS3 can reduce the expression of β-catenin and c-myc in nucleus pulposus cells, and inhibit the activity of the Wnt/β-catenin signaling pathway.

CONCLUSIONS

RBMS3 inhibits the Wnt/β-catenin signaling pathway, improves the proliferation ability of nucleus pulposus cells, inhibits their apoptosis and inflammation, and thus delays the degeneration of the intervertebral disc.

[Long-term outcomes of Bryan artificial cervical disc replacement for degenerative cervical spondylosis]

Objective: To compare the long-term clinical effect and imaging results of Bryan artificial cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) and to explore whether ACDR can reduce the occurrence of postoperative adjacent segment degeneration (ASD) in the treatment of degenerative cervical spondylosis. Methods: It was a retrospective study. Total of 60 patients with degenerative cervical spondylosis, who had received operations by Bryan ACDR (n=27) and ACDF (n=33) in the Third Hospital of Hebei Medical University between January 2005 and December 2009 were enrolled in this study. The Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), visual analogue scale (VAS), Odom's scale, cervical range of motion (ROM), surgical segment ROM, heterotopic ossification (HO) and ASD were used to evaluate the clinical and radiologic results. The indices abovementioned were compared between the two groups. Results: The VAS, NDI and JOA scores at each follow-up node in both ACDR and ACDF group were all significantly improved when compared with those before operation (all P<0.05), but there was no significant differences between the two groups (all P>0.05). Of all, 88.9%(24/27) of patients in ACDR group and 84.8%(28/33) of patients in ACDF group achieved excellent or good results, however, there was no significant difference in Odom's scale between the two groups (P>0.05). At the last follow-up, the cervical ROM in ACDR group was 43.2°±8.8°, which was slightly lower than that before operation (45.7°±10.4°), the difference was not statistically significant (t=0.954, P=0.345); the surgical segment ROM in ACDR group was 5.9°±3.6°, which was significantly reduced when compared with that before operation (8.8°±3.4°, t=3.043, P<0.01). However at the last follow-up, the cervical ROM in ACDF group was 36.4°±8.4°, which was significantly reduced when compared with that before operation (43.9°±11.1°), the difference was statistically significant (t=3.095, P<0.01). Although, there was no significant difference in the cervical ROM between the two groups before operation (t=0.643, P=0.523), and the difference was statistically significant at the last follow-up (t=3.054, P<0.01). At the last follow-up, the incidence of HO in ACDR group was 92.6%, and the high-grade HO was 37.0%. The incidence of ASD in ACDR group was 39.5%, which was much lower than that in ACDF group (61.1%, χ(2)=4.462, P=0.035). Conclusion: At minimum follow-up of 10 years, Bryan ACDR achieves a satisfactory clinical effect consistent with ACDF. In terms of advantages, ACDR could maintain the ROM of cervical and retain the ROM of the surgical segment, which reduces the occurrence of ASD by preserving motion.

Cell-free Mycobacterium tuberculosis DNA test in pleural effusion for tuberculous pleurisy: a diagnostic accuracy study

OBJECTIVES

Tuberculous pleurisy (TP) diagnosis remains difficult, with the sensitivity of Xpert MTB/RIF (Xpert) and mycobacterial culture (culture) only about 30-50%. We aimed to assess the diagnostic performance of a cell-free Mycobacterium tuberculosis DNA test (cf-TB) in pleural effusion for TP.

METHODS

Adults (≥18 years) with suspected TP presenting with pleural effusion were consecutively recruited, and pleural effusion specimens were prospectively collected in Beijing Chest Hospital, Beijing, China. After centrifuging pleural effusion, sediments were used for culture, Xpert and T-SPOT.TB assay, whereas supernatants were used for cf-TB and adenosine deaminase assay. The diagnostic performance was assessed against a composite reference standard.

RESULTS

From June 2015 to December 2018, we prospectively evaluated 286 adults with suspected TP. One hundred twenty-two participants were classified as definite TP based on the prespecified composite reference standard. The cf-TB produced a sensitivity of 79.5% (97/122, 95% confidence interval (CI) 72.4- 86.7) for definite TP, which was superior to Xpert (38.5% (29.9-47.2); 47/122; p < 0.001) and culture (27.1% (19.2-34.9); 33/122; p < 0.001). With pleural effusion Xpert and/or culture as the reference standard, cf-TB showed 96.6% (57/59, 95% CI 92.0-100.0) sensitivity, which was also significantly higher than Xpert (79.7%, 95% CI 69.4-89.9; 47/59; p 0.004) and culture (55.9%, 95% CI: 43.3-68.6; 33/59; p < 0.001).

CONCLUSIONS

The cf-TB clearly showed improved sensitivity compared with Xpert and culture. We recommend cf-TB as the first-line test for TP diagnosis.

[Clinical study of FibroTouch and six serological models for assessing the degree of liver fibrosis in patients with chronic hepatitis B]

Objective: To evaluate the using value of FibroTouch and six serological models in detecting the degree of liver fibrosis in patients with chronic hepatitis B, in an attempt to provide reference for accurate diagnosis. Methods: Two hundred and fifty-eight cases with chronic hepatitis B admitted to Xixi Hospital of Hangzhou from September 1, 2015 to September 1, 2017 were selected. All patients underwent liver histopathological examination and FibroTouch measurement to determine liver stiffness (LSM). Serum biochemical parameters were detected and the scoring values of six serological models were calculated. SAS 9.4 statistical software was used for statistical analysis, and the correlation between FibroTouch and the six serological models was analyzed by Spearman correlation. The diagnostic value of FibroTouch and six serological models was analyzed by receiver operating characteristic curve (ROC) based on liver histopathological findings. Results: The median LSM of 258 cases with chronic hepatitis B was 9.4 (6.5-13.8) kPa. In the six serological models, the median value of aspartate transaminase to platelet ratio index (APRI), FIB-4 index, S-index, Forn's index, PRPindex, and FIB-5 were 0.42 (0.28-0.62), 1.27 (0.78-2.03), 0.11 (0.07-0.20), 6.95 (5.89-8.51), 0.000 8 (0.000 6-0.000 9),and 38.59 (36.28-40.97). FibroTouch had positive correlation with APRI, FIB-4, S-index, Forn's index, PRP, fibrosis stage (r= 0.73,P< 0.001) and inflammation grade, and had negative correlation with FIB-5, and both had statistical significance. The area under curve (AUC) of FT-LSM at S≥2, S≥3, S = 4 were 0.89, 0.90 and 0.85, respectively, which was significantly higher than serological models (P< 0.001). The AUC of S-index model at S≥2, S≥3, S = 4 were higher than other five serological models. Conclusion: The diagnostic performance of FibroTouch is significantly better than serological model. S-index model has the best diagnostic performance in the six serological models, and the combination of S-index and FT-LSM may better diagnose the grading of liver fibrosis, and thus can be applied and promoted in clinic.

Using tongue depressors to aid cord localization during collagenase injection for Dupuytren disease

The aim of this paper was to introduce a simple and effective method to aid in isolation and stabilization of Dupuytren cords for collagenase injection. Tongue depressors were used to isolate and stabilize the cord during the injection procedure. The area to be injected was sterilely prepared. An assistant was then directed to place a tongue depressor on both sides of the cord. A total of 35 patients with Dupuytren disease were treated. Follow-up lasted two years. Post-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores was 4±2. Health-related quality of life measured with the EQ-5D index was 0.89±0.4. Recurrence rates of metacarpophalangeal joint and proximal interphalangeal joint were 11% and 14% respectively, using a flexion contracture of 20° to define recurrence. Collagenase treatment using a modified injection method with the aid of tongue depressors are a safe, effective way to treat Dupuytren contractures of the fingers. The technique can isolate the cord, which improves visualization of the cord. It may allow improved accuracy with needle placement and helps to decrease the complications and recurrence.

Spatiotemporal predictions of obesity prevalence in Chinese children and adolescents: based on analyses of obesogenic environmental variability and Bayesian model

OBJECTIVE

To find variations in Chinese obesogenic environmental priorities from 2000 to 2011, predict spatiotemporal distribution of obesity prevalence aged 7-17 years in 31 provinces, and provide foundations for policy-makers to reduce obesity in children and adolescents.

METHODS

Based on data examination of provincial obesity prevalence aged 7-17 years from three rounds of China Health and Nutrition Surveys (in 9 [2000], 9 [2006], and 12 [2011] provinces) and corresponding years' environments in 31 provinces from China Statistical Yearbooks and other sources, 12 predictors were selected. We used 30 surveyed provinces in three rounds as training samples to fit three analytic models with partial least-square regressions and prioritized predictors by variable importance projection to find variations. And fitted a spatiotemporal prediction model with Bayesian analysis to infer in space-time.

RESULTS

Variations of obesogenic environmental priorities were found at different times. A Bayesian spatiotemporal prediction model with deviance information criterion of 155.60 and statistically significant (P < 0.05) parameter estimates of intercept (-717.0400, 95% confidence intervals [CI]: -1186.0300, -248.0480), year (0.3584, CI: 0.1245, 0.5924), square of food industry level (0.0003, CI: 0.0002, 0.0004), and log (healthcare) (5.3742, CI: 2.5138, 8.2347) was optimized. Totally inferred average obesity prevalence among children and adolescents were 2.23%, 5.11%, 10.77%, 12.20%, 13.99%, and 17.58% in 31 provinces in China in 2000, 2006, 2011, 2015, 2020, and 2030, respectively. Obesity in north and east of China clusters on predicted maps.

CONCLUSIONS

Obesity prevalence in children and adolescents in China is rapidly increasing, growing at 0.3584% annually from 2000 to 2011. From longitudinal observation, prevalence was significantly influenced by food industry ("Amplifier") and healthcare service ("Balancer"). Targeted interventions in north and east of China are pressing. Further researches on the mechanisms underlying the influence of food industry, healthcare service, and so on in children and adolescents are needed.

Adverse drug event-related hospitalisation in persons with neurodevelopmental disorders: a state-wide retrospective cohort study

BACKGROUND

Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD).

OBJECTIVE

The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs.

METHODS

The all-inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE-related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests.

RESULTS

A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE-related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14-year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE-related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio-economic disadvantage and less private insurance coverage, suffered with less severe but different co-morbid clinical conditions and incurred more challenges in the acute hospital care setting.

CONCLUSION

Although the pattern of ADE-related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.

Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry

This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. The postoperative outcome was assessed for facial symmetry and surgical accuracy. All patients were followed up for at least 18 months and their level of satisfaction was investigated. Use of the computer-assisted osteotomy guides and pre-bent titanium plates was successful in all patients. Maxillary canting, mandibular ramus inclination, and mandibular length were corrected on both sides postoperatively. Superimposition of the surgical simulation and postoperative images demonstrated favourable accuracy. Quantitative analysis revealed a mean linear difference of <0.60mm in the maxilla and 1.57mm in the mandible. All patients were satisfied with the surgical outcome; there were no complications or cases of relapse during follow-up. The application of computer-assisted osteotomy guides and pre-bent titanium plates achieved favourable outcomes and accuracy, improving planning for the correction of facial asymmetry.

Treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame

We aimed to describe the treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame. Between March 2010 and January 2016, 41 fractures of the base of the thumb were treated using a cemented bone-K-wire frame. The mean age of the patients was 34 years. The patients' history included a fall onto the hand in 7 cases, direct trauma in 31 cases, and polytrauma with an unclear mechanism of injury in 3 cases. At the final follow-up, hand grip and pinch strength were measured using a dynamometer. All measurements were compared with those of the opposite hand. The patients were assessed functionally using the Smith and Cooney score.All K-wires were left in place until the bone healed. Bone healing was achieved in all thumbs in an average of 5.2 weeks. Follow-up averaged 27 months. The mean hand pinch and grip strength was 8.7 kg ± 2.4 kg and 38.4 kg ± 5.9 kg, respectively. The mean measurements on the opposite side were 9.2 kg ± 2.5 kg and 40.2 kg ± 6.6 kg, respectively. Based on the Smith and Cooney score, we obtained an average score of 87 ± 9.3, with 25 excellent, 9 good, and 2 fair results. The cemented bone-K-wire frame is an external fixator alternative that can be used for treating comminuted intra-articular fractures of the base of the thumb metacarpal. The system is cheap, easy to apply, and provides rigid fixation, resulting in good functional recovery.

Probiotic Bacillus enhance the intestinal epithelial cell barrier and immune function of piglets

Bacillus is widely used in the livestock industry. This study was designed to evaluate the effects of probiotic Bacillus amyloliquefaciens SC06 (Ba), originally isolated from soil, in piglets diet as an alternative to antibiotics (aureomycin), mainly on intestinal epithelial barrier and immune function. Ninety piglets were divided into three groups: G1 (containing 150 mg/kg aureomycin in the diet); G2 (containing 75 mg/kg aureomycin and 1×108 cfu/kg Ba in the diet); G3 (containing 2×108 cfu/kg Ba in the diet without any antibiotics). The results showed that, compared with the antibiotic group (G1), villus length, crypt depth and villus length/crypt depth ratio of intestine significantly increased in the G2 and G3 groups. In addition, intestinal villi morphology, goblet-cell number, mitochondria structure and tight junction proteins of intestinal epithelial cells in G2 and G3 were better than in G1. The relative gene expression of intestinal mucosal defensin-1, claudin3, claudin4, and human mucin-1 in G3 was significantly lower, while the expression of villin was significantly higher than in the antibiotic group. Probiotic Ba could significantly decrease serum interferon (IFN)-α, IFN-γ, interleukin (IL)-1β, and IL-4 levels, whereas increase tumour necrosis factor (TNF)-α and IL-6 secretion. Ba could also significantly decrease cytokines TNF-α, IFN-γ, IL-1β, and IL-4 level in liver, whereas it significantly increased IFN-α. Furthermore, replacing antibiotics with Ba also significantly down-regulated gene expression of TNF and IL-1α in intestinal mucosa, but up-regulated IL-6 and IL-8 transcription. Dietary addition of Ba could significantly reduce the gene expression of nuclear factor kappa beta (NFκB)-p50 and Toll-like receptor (TLR)6, while there was no significant difference for that of myeloid differentiation primary response 88, TNF receptor-associated factor-6, nucleotide-binding oligomerisation domain-containing protein 1, TLR2, TLR4, and TLR9. Taken together, our findings demonstrated that probiotic Ba could increase the intestinal epithelial cell barrier and immune function by improving intestinal mucosa structure, tight junctions and by activating the TLRs signalling pathway.

[Neuroendoscopy assisted microneurosurgery for posterior cranial fossa lesion]

Objective: To study the value of neuroendoscopy assisted microneurosurgery technique in the treatment of posterior cranial fossa lesion. Methods: Clinical data of 36 patients with posterior fossa lesions who accepted neuroendoscopy assisted microneurosurgery (NEAM group) in the department of neurosurgery of the First Affiliated Hospital of Chongqing Medical University, from January 2014 to December 2016, were retrospectively enrolled. A total of 113 cases diagnosed with the same lesions and accepted conventional microneurosurgery (non-NEAM group) in the same period were analyzed as control group. The total tumor resection rate, postoperative leakage of cerebrospinal fluid, intracranial infection, operating time and the recovery of facial nerve function were compared between the two groups. Results: Ninety-three patients with acoustic neuroma were analyzed, which were divided into non-NEAM group 78 cases (removed posterior lip of internal auditory canal in different degrees) and NEAM group 15 cases (not removed posterior lip of internal auditory canal). The total tumor resection rate and postoperative facial nerve function had no significant statistical differences between two groups. The operating time of NEAM group was longer than that of non-NEAM group (P=0.048, P<0.05), but the rate of leakage of cerebrospinal fluid and intracranial infection did not increase. Twenty-seven cases were diagnosed with cerebellopontine angle cholesteatoma. These cases were divided into two groups, 17 cases in non-NEAM group and 10 cases in NEAM group. NEAM group have higher total tumor resection rate (P=0.014, P<0.05), better short-term postoperative facial nerve function (P=0.039, P<0.05), and longer operating time (P=0.015, P<0.05), compared with non-NEAM group. No significant statistical differences were observed on long-term postoperative facial nerve function and postoperative complications. Of the 16 cases diagnosed tentorial meningioma, 10 cases were in non-NEAM group and 6 cases in NEAM group. Six cases in non-NEAM group and 4 cases in NEAM group were total removal. For the mean operating time, non-NEAM group was (6.6±1.0) hours and NEAM group was (7.1±0.7) hours. Thirteen cases were with fourth ventricular cholesteatoma, which all were totally resected, and 8 cases were in non-NEAM group and 5 cases in NEAM group. For non-NEAM group, 5 cases dissected cerebellar vermis and the mean operating time is (6.0±0.7) hours. However, NEAM group all did not dissect cerebellar vermis and the mean operating time is (6.4±0.4) hours. Conclusions: Neuroendoscopy assisted microneurosurgery for cranial fossa lesions was benefit to totally resect tumor and reduce unnecessary injury. It needed longer operating time, but not increase postoperative intracranial infection.

[Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas]

Objective: To investigate the effectiveness and clinical significance of dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas. Methods: From January 2011 to December 2016, a cohort of 28 patients with medial tentorial meningiomas were treated by microneurosurgery at the First Affiliated Hospital of Chongqing Medical University. Patients who treated intraoperatively with dynamic retraction surgery from January 2014 to December 2016 were assigned into dynamic retraction group, and those with fixed retractors intraoperatively from January 2011 to December 2013 were assigned into retractor group. The surgical approaches tailored in our patients were based on predominant direction of tumor extension. The extent of tumor resection was scored according to the Simpson's classification scale. Comparisons of tumor size, operation time, hospitalization time, retraction-related injury, tumor Simpson resection grade and Karnofsky Performance Scale(KPS) score six months after surgery were also made between two groups. Results: A total of 12 patients(retractor group) were treated with the use of self-retaining brain retractors intraoperatively and dynamic retraction surgical procedure was performed intraoperatively in 16 patients(dynamic retraction group). The difference between two groups with regard to sex, age, tumor size, operation time and tumor Simpson resection grade was not statistically significant(all P>0.05). The mean duration of hospital time was shorter in the dynamic retraction group than that in the retractor group(18.3 d±1.8 d vs 20.2 d±1.3 d, P=0.004). The dynamic retraction group had lower incidence of retraction-related injury compared with the retractor group(1/16 vs 6/12), P=0.022]. The dynamic retraction group had better neurological recovery rate with KPS >80 evaluated six months after surgery compared with the retractor group(14/16 vs 5/12, P=0.017). Conclusions: Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas is feasible, which can obviate or reduce the amount of brain retraction needed, and may be of help in lowering the risk of postoperative neurological deficits and complications and leading to reduced hospitalization cost and improved surgical outcomes.

[Experts consensus on the management of the right heart function in critically ill patients]

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

Correction to: Role of intestinal microbiome in American ginseng-mediated colon cancer prevention in high fat diet-fed AOM/DSS mice

This article was originally published with the wrong title.