Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

[Clinical presentation of acute primary angle-closure glaucoma during the 2019-nCoV epidemic of Omicron variants: a single-center retrospective study]

Objective: To investigate the clinical presentation pattern of acute primary angle-closure glaucoma (PACG) during the 2019 novel coronavirus (2019-nCoV) pandemic over the past three years, and its relationship with 2019-nCoV infections of Omicron variants in Guangdong province. Methods: Ecological study.Patients who were newly diagnosed with acute PACG from February 2020 to January 2023 at the Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study, and their basic information was collected. Patients were divided into the 2020 group (diagnosed between February 1st, 2020 and January 31st 2021), the 2021 group (diagnosed between February 1st, 2021 and January 31st 2022), and the 2022 group (diagnosed between February 1st, 2022 and January 31st 2023). The clinical presentation pattern of newly diagnosed acute PACG was observed and compared between groups. The daily number of newly diagnosed 2019-nCoV infections in Guangdong province was obtained from the Chinese Center for Disease Control and Prevention. The correlation between the daily number of newly diagnosed acute PACG and that of newly diagnosed 2019-nCoV infections during the epidemic period of Omicron variants between December 2022 and January 2023 was assessed. Results: The study included 1 048 patients with newly diagnosed acute PACG, with 235 for the 2020 group, 274 for the 2021 group, and 539 for the 2022 group. Our results showed that the average weekly number of newly diagnosed acute PACG patients in 2022 [8 (5, 11)] was significantly larger than that in 2020 (4.52±1.95, P<0.05) and 2021 (5.27±2.76, P<0.05). The average weekly number increased to 22.11±20.84 between December 2022 and January 2023. The total number of newly diagnosed acute PACG patients during this period was 199, which was 36.9% (199/539) of the total number of the same year and was 6.63 and 6.42 times as many as that in the same period (December and January) of 2020 and 2021. The proportion of patients with bilateral eye involvement during this period in 2022 was significantly higher than that in 2020 and 2021 (P<0.05). Further analysis found that 88.6% (109/123) of cases had a history of 2019-nCoV infection 2 (0, 3) days before the onset of acute PACG symptoms in average. The estimated daily number of acute PACG onset increased rapidly, peaked on December 23th, 2022, and then dropped gradually. This trend was similar to that of the daily number of new 2019-nCoV infections in Guangdong province. Changes of the daily number of new 2019-nCoV infections in Guangdong province had a positive correlation with the estimated daily number of acute PACG onset (r=0.84, P<0.001). Conclusion: A dramatic increase in the clinical presentation of acute PACG was observed at Zhongshan Ophthalmic Center between December 2022 and January 2023, which was the epidemic period of Omicron variants. There is a correlation between the trend of the estimated daily number of acute PACG onset and that of new 2019-nCoV infections of Omicron variants in Guangdong province, but the exact reason remains to be further studied. (This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on August 31, 2023).

Fungal Planet description sheets: 1478-1549

Novel species of fungi described in this study include those from various countries as follows: Australia, Aschersonia mackerrasiae on whitefly, Cladosporium corticola on bark of Melaleuca quinquenervia, Penicillium nudgee from soil under Melaleuca quinquenervia, Pseudocercospora blackwoodiae on leaf spot of Persoonia falcata, and Pseudocercospora dalyelliae on leaf spot of Senna alata. Bolivia, Aspicilia lutzoniana on fully submersed siliceous schist in high-mountain streams, and Niesslia parviseta on the lower part and apothecial discs of Erioderma barbellatum on a twig. Brazil, Cyathus bonsai on decaying wood, Geastrum albofibrosum from moist soil with leaf litter, Laetiporus pratigiensis on a trunk of a living unknown hardwood tree species, and Scytalidium synnematicum on dead twigs of unidentified plant. Bulgaria, Amanita abscondita on sandy soil in a plantation of Quercus suber. Canada, Penicillium acericola on dead bark of Acer saccharum, and Penicillium corticola on dead bark of Acer saccharum. China, Colletotrichum qingyuanense on fruit lesion of Capsicum annuum. Denmark, Helminthosphaeria leptospora on corticioid Neohypochnicium cremicolor. Ecuador (Galapagos), Phaeosphaeria scalesiae on Scalesia sp. Finland, Inocybe jacobssonii on calcareous soils in dry forests and park habitats. France, Cortinarius rufomyrrheus on sandy soil under Pinus pinaster, and Periconia neominutissima on leaves of Poaceae. India, Coprinopsis fragilis on decaying bark of logs, Filoboletus keralensis on unidentified woody substrate, Penicillium sankaranii from soil, Physisporinus tamilnaduensis on the trunk of Azadirachta indica, and Poronia nagaraholensis on elephant dung. Iran, Neosetophoma fici on infected leaves of Ficus elastica. Israel, Cnidariophoma eilatica (incl. Cnidariophoma gen. nov.) from Stylophora pistillata. Italy, Lyophyllum obscurum on acidic soil. Namibia, Aureobasidium faidherbiae on dead leaf of Faidherbia albida, and Aureobasidium welwitschiae on dead leaves of Welwitschia mirabilis. Netherlands, Gaeumannomycella caricigena on dead culms of Carex elongata, Houtenomyces caricicola (incl. Houtenomyces gen. nov.) on culms of Carex disticha, Neodacampia ulmea (incl. Neodacampia gen. nov.) on branch of Ulmus laevis, Niesslia phragmiticola on dead standing culms of Phragmites australis, Pseudopyricularia caricicola on culms of Carex disticha, and Rhodoveronaea nieuwwulvenica on dead bamboo sticks. Norway, Arrhenia similis half-buried and moss-covered pieces of rotting wood in grass-grown path. Pakistan, Mallocybe ahmadii on soil. Poland, Beskidomyces laricis (incl. Beskidomyces gen. nov.) from resin of Larix decidua ssp. polonica, Lapidomyces epipinicola from sooty mould community on Pinus nigra, and Leptographium granulatum from a gallery of Dendroctonus micans on Picea abies. Portugal, Geoglossum azoricum on mossy areas of laurel forest areas planted with Cryptomeria japonica, and Lunasporangiospora lusitanica from a biofilm covering a biodeteriorated limestone wall. Qatar, Alternaria halotolerans from hypersaline sea water, and Alternaria qatarensis from water sample collected from hypersaline lagoon. South Africa, Alfaria thamnochorti on culm of Thamnochortus fraternus, Knufia aloeicola on Aloe gariepensis, Muriseptatomyces restionacearum (incl. Muriseptatomyces gen. nov.) on culms of Restionaceae, Neocladosporium arctotis on nest of cases of bag worm moths (Lepidoptera, Psychidae) on Arctotis auriculata, Neodevriesia scadoxi on leaves of Scadoxus puniceus, Paraloratospora schoenoplecti on stems of Schoenoplectus lacustris, Tulasnella epidendrea from the roots of Epidendrum × obrienianum, and Xenoidriella cinnamomi (incl. Xenoidriella gen. nov.) on leaf of Cinnamomum camphora. South Korea, Lemonniera fraxinea on decaying leaves of Fraxinus sp. from pond. Spain, Atheniella lauri on the bark of fallen trees of Laurus nobilis, Halocryptovalsa endophytica from surface-sterilised, asymptomatic roots of Salicornia patula, Inocybe amygdaliolens on soil in mixed forest, Inocybe pityusarum on calcareous soil in mixed forest, Inocybe roseobulbipes on acidic soils, Neonectria borealis from roots of Vitis berlandieri × Vitis rupestris, Sympoventuria eucalyptorum on leaves of Eucalyptus sp., and Tuber conchae from soil. Sweden, Inocybe bidumensis on calcareous soil. Thailand, Cordyceps sandindaengensis on Lepidoptera pupa, buried in soil, Ophiocordyceps kuchinaraiensis on Coleoptera larva, buried in soil, and Samsoniella winandae on Lepidoptera pupa, buried in soil. Taiwan region (China), Neophaeosphaeria livistonae on dead leaf of Livistona rotundifolia. Türkiye, Melanogaster anatolicus on clay loamy soils. UK, Basingstokeomyces allii (incl. Basingstokeomyces gen. nov.) on leaves of Allium schoenoprasum. Ukraine, Xenosphaeropsis corni on recently dead stem of Cornus alba. USA, Nothotrichosporon aquaticum (incl. Nothotrichosporon gen. nov.) from water, and Periconia philadelphiana from swab of coil surface. Morphological and culture characteristics for these new taxa are supported by DNA barcodes. Citation: Crous PW, Osieck ER, Shivas RG, et al. 2023. Fungal Planet description sheets: 1478-1549. Persoonia 50: 158- 310. https://doi.org/10.3767/persoonia.2023.50.05.

Establishment of a prognostic model related to tregs and natural killer cells infiltration in bladder cancer

BACKGROUND

Regulatory T cells (Tregs) and natural killer (NK) cells play an essential role in the development of bladder urothelial carcinoma (BUC).

AIM

To construct a prognosis-related model to judge the prognosis of patients with bladder cancer, meanwhile, predict the sensitivity of patients to chemotherapy and immunotherapy.

METHODS

Bladder cancer information data was obtained from The Cancer Genome Atlas and GSE32894. The CIBERSORT was used to calculate the immune score of each sample. Weighted gene co-expression network analysis was used to find genes that will have the same or similar expression patterns. Subsequently, multivariate cox regression and lasso regression was used to further screen prognosis-related genes. The prrophetic package was used to predict phenotype from gene expression data, drug sensitivity of external cell line and predict clinical data.

RESULTS

The stage and risk scores are independent prognostic factors in patients with BUC. Mutations in FGFR3 lead to an increase in Tregs percolation and affect the prognosis of the tumor, and additionally, EMP1, TCHH and CNTNAP3B in the model are mainly positively correlated with the expression of immune checkpoints, while CMTM8, SORT1 and IQSEC1 are negatively correlated with immune checkpoints and the high-risk group had higher sensitivity to chemotherapy drugs.

CONCLUSION

Prognosis-related models of bladder tumor patients, based on Treg and NK cell percolation in tumor tissue. In addition to judging the prognosis of patients with bladder cancer, it can also predict the sensitivity of patients to chemotherapy and immunotherapy. At the same time, patients were divided into high and low risk groups based on this model, and differences in genetic mutations were found between the high and low risk groups.

[Roles of the CXCR1/CXCL8 axis in abnormal proliferation of bile duct epithelial cells in primary biliary cholangitis]

Objective: To investigate the role of the CXC chemokine receptor 1 (CXCR1)/CXC chemokine ligand 8 (CXCL8) axis in the abnormal proliferation of bile duct epithelial cells in primary biliary cholangitis (PBC). Methods: 30 female C57BL/6 mice were randomly divided into the PBC model group (PBC group), reparixin intervention group (Rep group), and blank control group (Con group) in an in vivo experiment. PBC animal models were established after 12 weeks of intraperitoneal injection of 2-octanoic acid coupled to bovine serum albumin (2OA-BSA) combined with polyinosinic acid polycytidylic acid (polyI:C). After successful modelling, reparixin was injected subcutaneously into the Rep group (2.5 mg · kg(-1) · d(-1), 3 weeks). Hematoxylin-eosin staining was used to detect histological changes in the liver. An immunohistochemical method was used to detect the expression of cytokeratin 19 (CK-19). Tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ) and interleukin (IL)-6 mRNA expression were detected by qRT-PCR. Western blot was used to detect nuclear transcription factor-κB p65 (NF-κB p65), extracellularly regulated protein kinase 1/2 (ERK1/2), phosphorylated extracellularly regulated protein kinase 1/2 (p-ERK1/2), Bcl-2-related X protein (Bax), B lymphoma-2 (Bcl-2), and cysteine proteinase-3 (Caspase- 3) expression. Human intrahepatic bile duct epithelial cells were divided into an IL-8 intervention group (IL-8 group), an IL-8+Reparicin intervention group (Rep group), and a blank control group (Con group) in an in vitro experiment. The IL-8 group was cultured with 10 ng/ml human recombinant IL-8 protein, and the Rep group was cultured with 10 ng/ml human recombinant IL-8 protein, followed by 100 nmol/L Reparicin. Cell proliferation was detected by the EdU method. The expression of TNF-α, IFN-γ and IL-6 was detected by an enzyme-linked immunosorbent assay. The expression of CXCR1 mRNA was detected by qRT-PCR. The expression of NF-κB p65, ERK1/2 and p-ERK1/2 was detected by western blot. A one-way ANOVA was used for comparisons between data sets. Results: The results of in vivo experiments revealed that the proliferation of cholangiocytes, the expression of NF-κB and ERK pathway-related proteins, and the expression of inflammatory cytokines were increased in the Con group compared with the PBC group. However, reparixin intervention reversed the aforementioned outcomes (P<0.05). In vitro experiments showed that the proliferation of human intrahepatic cholangiocyte epithelial cells, the expression of CXCR1 mRNA, the expression of NF-κB and ERK pathway-related proteins, and the expression of inflammatory cytokines were increased in the IL-8 group compared with the Con group. Compared with the IL-8 group, the proliferation of human intrahepatic cholangiocyte epithelial cells, NF-κB and ERK pathway-related proteins, and inflammatory indicators were significantly reduced in the Rep group (P < 0.05). Conclusion: The CXCR1/CXCL8 axis can regulate the abnormal proliferation of bile duct epithelial cells in PBC, and its mechanism of action may be related to NF-κB and ERK pathways.

[Effect of Xijiao Dihuang Combined Prescription on Human Dendritic Cell Function Induced by Lipopolysaccharide]

OBJECTIVE

To observe the effects of drug-containing serum of Xijiao Dihuang combined prescription(XJDH) on the related functions of dendritic cells(DCs) induced in vitro, and to explore the mechanisms underlying the effectiveness of XJDH treatment on primary immune thrombocytopenia(ITP).

METHODS

Peripheral blood samples were colle-ted from 6 healthy volunteers. Mononuclear cells were isolated by density gradient centrifugation, and CD14⁺ mononuclear cells were collected by the magnetic separation technique. CD14+ mononuclear cells were induced into immature DCs by recombinant human granulocyte-macrophage colony stimulating factor (GM-CSF) and recombinant human interleukin 4 (IL-4). Immature DCs were divided into three groups: control group, model group and XJDH group. CCK-8 assay was used to determine the intervention concentration and time of drug-containing serum. Lipopolysaccharide(LPS) with the final concentration of 1 μg/ml was added to model group and XJDH group respectively for 24 h to induce DCs maturation. Normal rat serum was added to control group and model group, and XJDH was added to XJDH group for 24 h. Flow cytometry was used to detect the levels of CD80, CD83 and HLA-DR on the surface of DCs. Western blot was used to detect the expression of TLR4 and NF-κB, and levels of IL-6, IL-12 and TNF-α in cell supernatant was detected by ELISA.

RESULTS

Compared with the control group, LPS stimulation increased the expression of CD80, CD83 and HLA-DR, with subsequent increasing expression of TLR4 and NF-κB, as well as IL-6, IL-12 and TNF-α increased(P<0.05). In comparison with model group, the expression of DCs surface molecules CD80, CD83 and HLA-DR, DCs' expression of TLR4 and NF-κB protein, and the levels of IL-6, IL-12 and TNF-α in the cell supernatant of XJDH group decreased after the intervention of XJDH (P<0.05).

CONCLUSION

Drug containing serum of Xijiao Dihuang combined prescription can down-regulate TLR4/NF-κB signaling pathway related protein expression, inhibit DCs maturation, and reduce proinflammatory factor secretion, which may be one of the mechanisms of drug-containing serum of Xijiao Dihuang combined prescription in the treatment of immune thrombocytopenia.

[The short-term and long-term prognostic analysis in patients with chronic total occlusion acute non-ST segment elevation myocardial infarction]

Objectives: To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI). Methods: A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding. Results: Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease (HR 7.28, 95%CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age (HR 1.04, 95%CI 1.01-1.07, P<0.01), and low levels of ejection fraction (HR 0.95, 95%CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO (HR1.67, 95%CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions: Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.

Exploring optimal heart team protocol to improve decision-making stability for complex coronary artery disease: a sequential explanatory mixed method study

Background

Although heart team was recommended by guideline for decision-making in patients with complex coronary artery disease (CAD), the decision-making stability was lack of evaluation and optimal protocol remained unknown.

Purpose

We aimed to assess inter-team agreement for revascularization decision-making and related influencing factors, so as to provide recommendations for optimal protocol.

Methods

A sequential, explanatory mixed method study was conducted, including (1) a cross-sectional study retrospectively enrolling patients with complex CAD and four heart teams to assess the inter-team decision-making agreement and (2) a qualitative study that semi-structurally interviewed all heart team members to analyze the potential factors associated with decision-making discrepancy. Primary outcome was kappa value of inter-team decision-making agreement. Inductive thematic analysis was used to generate themes and subthemes attributing to decision-making discrepancy. Integrating qualitative and quantitative data, we explained how each subtheme affected decision-making agreement and provided corresponding recommendations based on these explanations. Finally, we provided a detailed heart team protocol by integrating our recommendations, published experience and guideline. Patient sample size was precalculated and interviewee sample size was identified by theoretical saturation.

Results

A total of 101 patients with complex CAD were randomly enrolled from a consecutive angiography registry. Sixteen specialists were invited and randomly established four heart teams to make decisions for enrolled patients. Inter-team decision-making agreement was moderate (kappa 0.582) (Table 1). Decision-making may be influenced at three themes (specialist quality; team composition; meeting process) and ten subthemes (decision thought; understanding of disease and evidence; understanding of other discipline; personality; learning curve; personnel quality; number of team members; discipline selection; ratio of different disciplines and meeting form). Recommendations at five levels were provided, including (1) specialist selection, (2) specialist training, (3) team composition, (4) team training and (5) meeting process. A detailed implementation protocol to establish and deploy a qualified heart team was generated.

Conclusions

Agreement between heart teams for revascularization decision-making in patients with complex CAD was moderate. Five recommendations to improve heart team modality were provided based on factors associated with decision-making discrepancy. A detailed heart team implementation protocol came into being. Randomized controlled trial was warranted to further confirm the protocol.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the national key research and development program;Beijing municipal commission of science and technology project Table 1. Inter-team agreement of decision making

[The acute and long-term outcome of patients with ST segment elevation myocardial infarction concurrent with chronic total occlusion]

Objective: To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction (STEMI) concurrent with chronic total occlusion (CTO) undergoing primary percutaneous coronary intervention (PCI). Methods: 11 905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI. 1∶3 propensity score matching was used to match the patients between the two groups. The primary endpoint was in-hospital mortality and mortality at 1-year post PCI. The secondary endpoint was major adverse cardiovascular events (MACE) including death, re-myocardial infarction, revascularization, heart failure associated readmission, stroke and major bleeding at 1-year post PCI. Results: There were 931 CTO patients (7.8%) in this cohort (male=755 (81.1%), mean age (62.2±11.4 years)). The rest 10 974 patients were STEMI without CTO (male=8 829 (80.5%),mean age (60.0±11.8) years). After propensity score matching, 896 patients were enrolled in CTO group and 2 688 in non-CTO group. In-hospital mortality was significantly higher in the CTO group than in non-CTO group (4.2% vs. 2.4%, P=0.006). The ratio of all cause death, cardiac death, and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group (8.5% vs. 4.4%, P<0.001, 5.3% vs. 2.6%, P=0.001, 35.1% vs. 23.3%, P<0.001, respectively). Multiple regression analysis showed that CTO (HR=1.54, 95%CI 1.06-2.22, P=0.022), advanced age (HR=1.06, 95%CI 1.04-1.08, P<0.001), and previous heart failure history (HR=4.10, 95%CI 1.90-8.83, P<0.001) were independent risk factors of 1-year mortality. Conclusions: The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO. CTO, advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.

[Clinical features of patients with hypertrophic obstructive cardiomyopathy combining obstructive sleep apnea]

Objective: To investigate the clinical features of patients with hypertrophic obstructive cardiomyopathy (HOCM) combined with obstructive sleep apnea (OSA). Methods: From 2010 to 2018, a total of 299 patients who were diagnosed with hypertrophic cardiomyopathy and underwent sleep monitoring at Fuwai Hospital were retrospectively analyzed. General clinical features, data of echocardiography, and sleep breathing parameters were recorded. OSA was diagnosed by apnea-hypopnea index ≥ 5 events/hour. Clinical characteristics were compared between patients with and without OSA. Results: A total of 156 (52.2%) HOCM patients were diagnosed with OSA. Compared with patients without OSA, patients with OSA were older((54±10) years vs (45±14) years, P<0.001), had a higher body mass index ((27±3) kg/m(2) vs (25±3) kg/m(2), P<0.001), a higher prevalence of hypertension (54.4% (85/156) vs 21.0% (30/143), P<0.001), hyperlipidemia (37.2% (58/156) vs 13.3% (19/143), P<0.001) and smoking history (48.1% (75/156) vs 35.0% (50/143), P=0.022). Patients with OSA also had a higher incidence of New York Heart Association functional class Ⅱ or Ⅲ (P=0.017), atrial fibrillation (P=0.005), and higher levels of systolic and diastolic blood pressure, fast glucose and high-sensitive c-reactive protein (all P<0.001). Left ventricular end-diastolic diameter as well as ascending aorta diameter in patients with OSA were also greater than those without OSA (both P<0.001). Apnea-hypopnea index (AHI) value positively correlated with left ventricular end-diastolic diameter (r=0.346), ascending aorta diameter (r=0.357) and high-sensitive c-reactive protein (r=0.230) (all P<0.001). Conclusions: A high prevalence of OSA occurs in patients with HOCM. Severity of OSA correlates with cardiac remodeling and serum inflammatory factor level. As for HOCM patients, clinicians should actively monitor the sleep breathing parameters in order to recognize and treat potential OSA, thereby improving the prognosis of patients with HOCM.

[Gender difference in efficacy of intra-aortic balloon pump in acute myocardial infarction patients complicating with cardiogenic shock]

Objective: To investigate the effect of gender on the efficacy of intra-aortic balloon pump(IABP) applied in patients with cardiogenic shock complicated by acute myocardial infarction(AMI). Methods: A total of 209 patients diagnosed as cardiogenic shock complicated by AMI admitted in Fuwai Hospital from June 2012 to May 2018 were enrolled in our study. We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support, as well as 28-day (from diagnosis of cardiogenic shock) mortality retrospectively. Kaplan-Meier survival analysis was used to compare the 28-day survival rates of patients of different genders/with or without IABP treatment. Adjustment for age, systolic blood pressure, ST segment elevation myocardial infarction, dual antiplatelet, coma, APACHEⅡ score and SAPSⅡ score, Cox regression analysis was used to detect the affect of IABP treatment on the risk of all-cause mortality in different crowd, and using Z test to evaluate the modification effect of gender on IABP treatment efficacy. Results: A total of 209 patients were included in this study, with 148 males (80 (54.05%) cases received IABP support) and 61 females (22 (36.06%) cases received IABP support). A total of 102 patients received IABP treatment. The 28-day survival rate of male patients was higher than that of females (39.2% (58/148) vs. 26.2% (16/61), Log-rank P=0.034). The 28-day survival rate of patients receiving IABP was significantly higher than that of non-IABP groups (46.1% (47/102) vs. 25.2% (27/107), Log-rank P=0.001 7). Among female patients, there was no statistically significant difference in 28-day survival rate between those who received IABP and those who did not receive IABP (P=0.889). While in male patients, the 28-day survival rate of those who received IABP was higher than that of those who did not receive IABP (51.2% (41/80) vs. 25.0% (17/68), P=0.001). The survival rate of male patients treated with IABP was higher than that of male patients who did not receive IABP, female patients who did not receive IABP and female patients who received IABP (all P<0.05). After multiple regression analysis and adjustment of confounding factors, it was found that IABP implantation can significantly reduce the 28-day mortality risk in male patients (HR=0.44, 95%CI 0.25-0.77 P=0.004). While it had no inpact on the death risk in female patients(P= 0.401). The impact of IABP implantation in patients of different genders was significantly different (Z=-2.32, P=0.020). Conclusion: In AMI patients complicating cardiogenic shock, there is a gender difference in the impact of IABP implantation on the 28-day mortality risk, and protective effects are seen only in men.

The practice and safety profile of endotracheal intubation in an emergency department: A single-center study in Shenzhen, China

Objectives:

Endotracheal intubation is an essential skill of every emergency department clinician. The current practice of emergency intubation in the emergency departments in China and its safety is largely unknown. This study aimed at evaluating the practice and the safety profile of emergency intubation in an emergency department in Shenzhen.

Methods:

This study was of retrospective design. It was conducted in the emergency department of a university affiliated hospital. All patients requiring emergency intubation from 1 January 2017 to 30 June 2018 were recruited. Data on demographic and clinical characteristics of patients and characteristics of intubations were collected and analyzed.

Results:

A total of 128 patients were analyzed. Patients with spontaneous intracerebral hemorrhage were most common. Airway protection for patency was the most common indication of intubation. Most intubations were performed by emergency department staff with direct laryngoscopy. The first attempt success rate was 93.8%. Serious adverse events were rare.

Conclusion:

The practice of endotracheal intubation in the emergency department is in line with international ones. The safety profile is good. A national registry of emergency airway management is recommended.

[Analysis on the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease]

Objective: To investigate the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease. Methods: A total of 24 patients with acute myocardial infarction complicating cardiogenic shock due to left main artery disease hospitalized in Fuwai hospital from June 2012 to May 2018 were included. The clinical data were analyzed,and the patients were divided into survivor group (11 cases) and death group (13 cases) according to survival status at 28 days post the diagnosis of shock. The patients were further divided into thrombolysis in myocardial infarction(TIMI) flow grade 0-2 group (11 cases) and TIMI flow grade 3 group (13 cases) according to TIMI flow grade after the procedure. The patients were then divided into non-three-vessel lesions group (14 cases) and three-vessel lesions group (10 cases) according to coronary angiography results. Results: Compared with survivor group, patients in death group presented with lower worst systolic blood pressure within 24 hours after admission (50(48, 70) mmHg (1 mmHg=0.133 kPa) vs. 73(70, 80) mmHg, P<0.01), lower worst diastolic blood pressure with in 24 hours after admission ((33.5±12.4) mmHg vs. (48.9±9.4) mmHg, P<0.01), higher respiratory rates ((27.3±2.5) times/min vs. (21.5±4.0) times/min, P<0.01), less 24 hours urine output ((422±266) ml vs. (1 680±863) ml, P<0.01), lower platelet counts ((161.9±81.9)×10(9)/L vs. (241.6±94.0)×10(9)/L, P=0.03), higher serum creatinine ((250.0±36.8) μmol/L vs. (132.7±34.2) μmol/L, P<0.01), higher alanine aminotransferase (288(76,846) IU/ml vs. 81(42, 109) IU/ml, P=0.04), lower artery pH (7.11±0.17 vs. 7.39±0.09, P<0.01), higher lactic acid ((10.29±3.62) mmol/L vs. (4.21±2.85) mmol/L, P<0.01), higher incidence of invasive ventilation (7/13 vs. 2/11, P=0.02), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱ (35.4±6.8 vs. 18.7±1.7, P<0.01) and simplified acute physiology score (SAPS) Ⅱ (73.5±17.4 vs. 47.0±4.3, P<0.01), and higher incidence of target vessel TIMI flow grade 0-2 (10/13 vs. 1/11, P<0.01). Kaplan-Meier survival curve analysis showed that survival rate at 28 days post the diagnosis of shock in TIMI flow grade 3 group was higher than that in TIMI flow grade 0-2 group (76.9% vs. 9.1%, log-rank test, P<0.01), and mortality rate was similar at 28 days post the diagnosis of shock between non-three-vessel lesions group and three-vessel lesions group (35.7% vs. 60.0%, log-rank test, P=0.14). Multivariate logistic regression analysis showed that compared with TIMI flow grade 0-2 group, the OR value of death at 28 days post the diagnosis of shock in TIMI flow grade 3 patients with acute myocardial infarction complicating cardiogenic shock due to left main disease was 0.030(95%CI 0.003-0.340, P<0.01). Conclusion: Short-term outcomeof patients with acute myocardial infarction complicating cardiogenic shock due to left main disease remains poor, and final flow of TIMI grade 3 is confirmed as independent protective factor of death at 28 days post the diagnosis of shock in these patients.

[Comparison on the predictive value of different scoring systems for risk of short-term death in patients with acute myocardial infarction complicating cardiogenic shock]

Objective: To compare predictive value of the current 7 scoring systems and CADILLAC-plus scoring system for risk of short-term deathin patients with acute myocardial infarction complicating cardiogenic shock. Methods: A total of 126 acute myocardial infarction patients complicating cardiogenic shock hospitalized in Fuwai hospital from June 2014 to January 2018 were enrolled in this study, the clinical data were retrospectively analyzed. The patients were divided into survival group(49 cases) and death group(77 cases) according to survival or not at 28 days after diagnosis of cardiogenic shock.The scores of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC were calculated within 24 hours in coronary care unit (CCU),and scores of CADILLAC-plus, which is an improved score derived from CADILLAC, was also calculated. The predictive value of the different scoring systems for 28 day smortality of acute myocardial infarction patients complicating cardiogenic shock were compared in this patient cohort. Results: Scores of APACHEⅡ,APACHEⅢ,SAPSⅡ,PAMI,TIMI-STEMI, TIMI-NSTEMI,CADILLAC,and CADILLAC-plus were all significantly higher in death group than in survival group: (28.9±10.2 vs. 21.8±8.3,94.0 (57.0,114.0) vs. 57.0 (45.4,81.5) ,62.0 (46.0,81.0) vs. 47.0 (41.5,60.5) ,7.0 (6.0,9.0) vs. 6.0 (6.0,7.5) ,10.0 (9.0,11.0) vs. 9.0 (8.0,10.0) ,4.0 (3.0,5.0) vs. 3.0 (3.0,4.0) ,10.0 (7.0,12.0) vs. 7.0 (5.0,9.0) ,and 10.0 (8.0,14.0) vs. 7.0 (5.0,10.0) , respectively, all P<0.01).The area under the curve(AUC) of receiver operating characteristic(ROC) curve for predicting 28 days death of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC scoring systems were 0.820,0.797,0.785,0.667,0.657,0.711,and 0.821,respectively and cut-off value was 27.5,79.5,66.0,8.5,10.5,3.5,and 8.5, respectively and the sensitivity was 0.766,0.844,0.649,0.494,0.494,0.740,and 0.753, respectively and specificity was 0.816,0.755,0.837,0.204,0.796,0.571,and 0.755,respectively.The AUC of ROC of CADILLAC-plus scoring system was 0.885,cut-off value was 9.5, sensitivity was 0.896,and specificity was 0.735. The predicting efficacy of CADILLAC-plus scoring system was superior to other scoring systems. Conclusion: The 7 current scoring systems are all suitable for predicting theshort-term death in acute myocardial infarction patients complicating cardiogenic shock, and the predicting efficacy of the improved CADILLAC-plus score is superior to other scoring systems in this patient cohort.

[Effect of application of pulse contour cardiac output monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty]

OBJECTIVE

To investigate the effect of the application of pulse contour cardiac output (PiCCO) monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty.

METHODS

The clinical data of 41 patients injured in Kunshan dash explosion hospitalized in the First Affiliated Hospital of Soochow University, the 100th Hospital of the People's Liberation Army, and Suzhou Municipal Hospital were retrospectively analyzed. The patients were divided into traditional monitoring group (T, n=22) and PiCCO monitoring group (P, n=19) according to the monitoring technic during delayed resuscitation. The input volumes of electrolyte, colloids, and water of patients in the two groups within 2 hours after admission, the first, second, and third 8 hours post injury (HPI), and the first 24 HPI were recorded. The fluid infusion coefficients of patients in the two groups within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were calculated. The urine volume, mean arterial pressure (MAP), and central venous pressure (CVP) of patients in the two groups at post injury hour (PIH) 8, 16, 24, 48, 72, and 96 were recorded. The blood lactate, base excess, hematocrit (HCT), and platelet count of patients in the two groups at PIH 24, 48, 72, and 96 were recorded. Complications and death of patients in the two groups were recorded. Data were processed with analysis of variance for repeated measurement, Chi-square test, t test, and Wilcoxon test. The deviations between figure 2 and the fluid infusion coefficients of the first or second 24 HPI, and the deviations between figure 1 and the fluid infusion coefficients of the second, third or fourth 24 HPI were calculated, and the three groups deviations were analyzed by Pearson correlation analysis.

RESULTS

(1) The input volumes of electrolyte of patients in group P were significantly more than those in group T within the first 8 and 24 HPI (with Z values respectively -3.506 and -2.654, P<0.05 or P<0.01), and the input volumes of electrolyte of patients in the two groups were similar within the other time periods (with Z values from -1.871 to -0.680, P values above 0.05). The input volumes of colloid of patients in group P were significantly less than those in group T within the second, third 8 HPI, and the first 24 HPI (with Z values from -4.720 to -2.643, P<0.05 or P<0.01), and the input volumes of colloid of patients in the two groups were similar within the other time periods (with Z values respectively -2.376 and -2.303, P values above 0.05). The input volumes of water of patients in the two groups were similar within each time period (with Z values from -1.959 to -0.241, P values above 0.05). (2) The fluid infusion coefficients of patients in group T within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were respectively (0.59±0.18), (0.70±0.23), (0.94±0.24), (0.74±0.14), (2.38±0.44), (1.70±0.56), (1.35±0.67), and (0.92±0.46) mL·kg(-1)·%TBSA(-1,) and the values in group P were respectively (0.59±0.29), (0.82±0.37), (0.86±0.38), (0.59±0.24), (2.27±0.85), (2.13±0.68), (1.59±3.78), and (1.46±0.56) mL·kg(-1)·%TBSA(-1). The fluid infusion coefficients of patients in the two groups were similar within 2 hours after admission, the first, second 8 HPI, and the first, third 24 HPI (with t values from -1.262 to 0.871, P values above 0.05). The fluid infusion coefficient of patients in group P was significantly lower than that in group T within the third 8 HPI (t=2.456, P<0.05), and the fluid infusion coefficient of patients in group P were significantly higher than that in group T within the second and fourth 24 HPI (with t values respectively -2.234 and -3.370, P<0.05 or P<0.01). There was obviously negative correlation between the deviations of figure 2 and the fluid infusion coefficient of the first 24 HPI and that of the second 24 HPI (r=-0.438, P<0.01). There was no obvious correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the third 24 HPI (r=0.091, P>0.05). There was obviously positive correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the fourth 24 HPI (r=0.695, P<0.01). (3) The urine volumes and MAP of patients in the two groups were similar at each time point (with Z values from -1.884 to 0, P values above 0.05). The CVP of patients in group P were significantly higher than that in group T at PIH 16, 24, 48, and 72 (with Z values from -4.341 to -2.213, P<0.05 or P<0.01), and the CVP of patients in the two groups were similar at the other time points (with Z values respectively -0.132 and -1.208, P values above 0.05). The blood lactate of patients in group P was significantly higher than that in group T at PIH 72 (Z= -2.958, P<0.01) , and the blood lactate of patients in the two groups were similar at the other time points (with Z values from -1.742 to -0.433, P values above 0.05). The base excess of patients in group P were significantly lower than that in group T at PIH 24, 48, 72, and 96 (with Z values from -4.970 to -4.734, P values below 0.01). The HCT of patients in the two groups were similar at PIH 24, 48, 72, and 96 (with Z values from -2.239 to -0.196, P values above 0.05). There were significant differences in the platelet count of patients in the two groups at PIH 24, 72, and 96 (with Z values from -4.578 to -2.512, P<0.05 or P<0.01). (4) There were 15 cases in group T accompanied by complications, and 7 cases died, while 13 cases in group P accompanied by complications, and 9 cases died. The occurrence of complications and death of patients in the two groups were similar (with χ(2) values respectively <0.001 and 1.306, P values above 0.05).

CONCLUSIONS

On the basis of traditional burn shock monitoring index, the effect of fluid resuscitation in patients with severe burn monitored by PiCCO technology is not so good and still needs further clinical research.

Perceptual pitch deficits coexist with pitch production difficulties in music but not Mandarin speech

Congenital amusia is a musical disorder that mainly affects pitch perception. Among Mandarin speakers, some amusics also have difficulties in processing lexical tones (tone agnosics). To examine to what extent these perceptual deficits may be related to pitch production impairments in music and Mandarin speech, eight amusics, eight tone agnosics, and 12 age- and IQ-matched normal native Mandarin speakers were asked to imitate music note sequences and Mandarin words of comparable lengths. The results indicated that both the amusics and tone agnosics underperformed the controls on musical pitch production. However, tone agnosics performed no worse than the amusics, suggesting that lexical tone perception deficits may not aggravate musical pitch production difficulties. Moreover, these three groups were all able to imitate lexical tones with perfect intelligibility. Taken together, the current study shows that perceptual musical pitch and lexical tone deficits might coexist with musical pitch production difficulties. But at the same time these perceptual pitch deficits might not affect lexical tone production or the intelligibility of the speech words that were produced. The perception-production relationship for pitch among individuals with perceptual pitch deficits may be, therefore, domain-dependent.

First Report of Alternaria alternata Causing Blight on Zanthoxylum piperitum in China

Since 2009, brown leaf spot and panicle blight of Zanthoxylum piperitum (L.) DC. ("liujin," commonly known as Japanese pepper and Japanese pricklyash) has been observed on 40% of the plants in the test field of Foresty Academy of Science in Hebei Province of China. When symptoms formed on leaves, a thick yellow spot appeared, which then turned brown. When on the spikes, brown lesions were observed initially on the grain, which then spread down to fruit stem, and finally the whole spike wilted and dried up. Yield and quality losses were considerable. A fungus was isolated consistently from the diseased tissues using potato dextrose agar (PDA) (1). Three representative isolates were chosen for further characterization. All the isolates grew at 28°C on PDA and potato carrot agar (PCA) medium. Fungal colonies were initially white, then became olivaceous with some white mycelium on the top of the colony, and turned brown with age. When observed with the microscope, crineous septate hypha appeared, and conidiophore peduncles were upright or slightly curved, with a few branches, 33.0 to 75.0 μm long and 4.0 to 5.5 μm wide. Conidia were crineous short clubs or near oval in shape, 22.5 to 40.0 μm long and 8.0 to 13.5 μm wide, with a short conical beak, and had one to four longitudinal cross walls. On PCA, condia had three to seven transepta and one to five longisepta, and were produced in a branched, long chain with more than five conidia. The pathogen was identified based on morphological characteristics as Alternaria alternata (Fr.:Fr.) Keissl. (3). DNA was extracted from mycelium and PCR was performed on the internal transcribed spacer (ITS) region with primers ITS1 and ITS4. A 570-bp fragment was amplified and sequenced (GenBank Accession No. JQ973810). BLASTn analysis revealed there was 100% sequence identity with A. alternata strains (GU566303 and GQ121322). To further identify the fungus, A. alternata species-specific primers AAF2/AAR3 (2) were used to generate an amplicon which was then sequenced (JX308287). Sequence comparison showed there was 100% sequence identity with A. alternata (JQ927300 and JQ907485). Pathogenicity tests were performed by spraying with a cultured suspension (10⁶ spores/ml) of approximately 100 μl onto healthy leaves in 15-cm-diameter glass dishes containing sterilized filter paper soaked with sterilized water at room temperature. Control plants were inoculated with sterile distilled water. Ten days after inoculation, symptoms were observed in all inoculated leaves and appeared to be identical to those observed in the field. No symptoms were noted on the control leaves. Identical results were also obtained when spikes were inoculated. The fungi reisolated from symptomatic plants were A. alternata. To our knowledge, this is the first report of A. alternata causing leaf spots and panicle blight of Z. piperitum in China. References: (1) O. D. Dhingra and J. B. Sinclair. Basic Plant Pathology Methods. CRC Press, Boca Raton, FL, 1995. (2) P. Konstantinova. et al. Mycol. Res. 106:23, 2002. (3) T. Y. Zhang. China fungi records (Alternaria) (Volume 16) (in Chinese). Beijing: Science Press, 2003.

Laparoscopically-assisted radical vaginal hysterectomy with five years follow-up: a case control study

OBJECTIVE

To compare a novel surgical approach, laparoscopically-assisted radical vaginal hysterectomy (LARVH) with abdominal radical hysterectomy in women with cervical cancer, and to investigate whether selected women benefit from the minimally-invasive approach without high recurrence rate and complications.

MATERIALS AND METHODS

Forty women undergoing LARVH were included and compared with 40 women undergoing abdominal radical hysterectomy. The control group was matched for age and disease stage. Retrospective chart review was performed and patients were followed for an average of 2.5 years.

RESULTS

Blood loss was significantly increased in the control group (343.3 vs 606.3 ml, p = 0.012). Transfusions were given in 42.5% of women in the control group and 17.5% in the LARVH group. Mean operative time was longer in the control group (151 vs 240 minutes p = 0.0001). Mean nodal counts did not show a significant difference (27.3 in control vs 21.4 in LARVH, p = 0.886). Recurrence group was 7.5% at mean follow up of 30.1 months in LARVH group and in 30.8 months follow-up.

CONCLUSIONS

The LARVH procedure was comparable in terms of safety (recurrence and complication rates) meanwhile LARVH showed minimally-invasive advantages in terms of blood loss, operative time, and shorter hospital stay.

Seedling and Slow Rusting Resistance to Leaf Rust in Chinese Wheat Cultivars

Identification of resistance genes is important for developing leaf rust resistant wheat (Triticum aestivum) cultivars. A total of 102 Chinese winter wheat cultivars and advanced lines were inoculated with 24 pathotypes of Puccinia triticina for postulation of leaf rust resistance genes effective at the seedling stage. These genotypes were also planted in the field for characterization of slow rusting responses to leaf rust in the 2006-07 and 2007-08 cropping seasons. Fourteen leaf rust resistance genes-Lr1, Lr2a, Lr3bg, Lr3ka, Lr14a, Lr16, Lr17a, Lr18, Lr20, Lr23, Lr24, Lr26, Lr34, and LrZH84-either singly or in combinations, were postulated in 65 genotypes, whereas known resistance genes were not identified in the other 37 accessions. Resistance gene Lr26 was present in 44 accessions. Genes Lr14a and Lr34 were each detected in seven entries. Lr1 and Lr3ka were each found in six cultivars, and five lines possessed Lr16. Lr17a and Lr18 were each identified in four lines. Three cultivars were postulated to possess Lr3bg. Genes Lr20, Lr24, and LrZH84 were each present in two cultivars. Each of the genes Lr2a and Lr23 may exist in one line. Fourteen genotypes showed slow leaf rusting resistance in two cropping seasons.

Molecular mapping of leaf rust resistance gene LrZH84 in Chinese wheat line Zhou 8425B

Leaf rust, caused by Puccinia triticina, is one of the most widespread diseases in common wheat (Triticum aestivum L.) worldwide. With the objective of identifying and mapping new genes for resistance to leaf rust, F(1), F(2) plants and F(3) lines from a cross between resistant line Zhou 8425B and susceptible line Chinese Spring were inoculated with Chinese P. triticina races THTT and MBHP in the greenhouse. A total of 793 pairs of SSR primers were used to test the parents and resistant and susceptible bulks. Seven polymorphic chromosome 1B markers were used for genotyping the F(2) and F(3) populations. Zhou 8425B carried a single dominant resistance gene, temporarily designated LrZH84, linked to SSR markers gwm582 and barc8 with genetic distances of 3.9 and 5.2 cM, respectively. The Xbarc8 allele co-segregated with Lr26 in the F(3) population. The Xgwm582 allele associated with LrZH84 was identified as a leaf rust resistance gene and shown to be present in the Predgornaia 2 parent of Zhou 8425B. The seedling reaction pattern of LrZH84 was different from those of lines with Lr26, Lr33, Lr44 and Lr46, all of which are located in chromosome 1B. It was concluded that LrZH84 is likely to be a new leaf rust resistance gene.

Inhibitory role of GDP on saikosaponin (I) stimulated enzymes secretion and rising of [Ca2+]i in rat pancreatic acini

AIM

To study the role of guanosine diphosphate (GDP) on enzyme secretion and rising of [Ca2+]i in saikosaponin (I) [SA(I)] stimulated rat pancreatic acini.

METHODS

Cell membrane of isolated rat pancreatic acini were permeabilized using streptolysin O (SLO). Enzymes secretions were indicated by detecting total protein secretions. Intracellular Ca2+ ([Ca2+]i) was measured using Fluo-3 in SPEX spectrofluorimeter.

RESULTS

The inhibition of GDP on SA(I) stimulated enzymes secretion increased with increasing GDP concentration. There were two peaks in the time course of increase in [Ca2+]i evoked by SA(I) 10 micromol/L. After adding GDP 5 mmol/L, [Ca2+]i rose gradually without the two peaks. In permeabilized acini, the accumulation of enzymes stimulated by SA(I) in 30 min reduced by 57 % compared with intact acini. GDP 5 mmol/L decreased the initial rate of secretion.

CONCLUSION

Inhibition of GDP on increase in [Ca2+]i reduces SA(I) stimulated enzymes secretion in pancreatic acini.

Saikosaponin v-1 from roots of Bupleurum chinense DC

Three triterpenoidal saponins, saikosaponin v-1(1), 6"-O-acetyl-saikosaponin b2 (2) and 6"-O-acetyl-saikosaponin d(3) were isolated from the roots of the title plant and the structures were identified on the basis of spectral analysis. Saikosaponin v-1 is a new compound, which was identified as 3beta,16alpha,23,28-tetrahydroxy-olean-11,13(18)-dien-30-oic acid-3-O-beta-D-glucopyranosyl-(1-->3)-beta-D-fucopyranosyl-30-O-xylitol ester.

[Effect of processing contents of saccharides in Danggui]

OBJECTIVE

To explore the effect of processing on the contents of saccharides in Danggui.

METHOD

The contents of reducing saccharides, water-soluble saccharides and poly saccharides in Danggui and its processed products were determined by phenol-H2SO4 method.

RESULTS

The contents of saccharides in the alcohol-broiled product were higher than those in the crude drug.

CONCLUSION

Different processing methods have significant effects on the above saccharides, which administers to the interpreparation of the theory of Danggui processing.

A novel mutation in the NADH-cytochrome b5 reductase gene of a Chinese patient with recessive congenital methemoglobinemia

Recessive congenital methemoglobinemia due to nicotinamide adenine dinucleotide (NADH)-cytochrome b5 reductase (b5R) deficiency is classified into 2 clinical types: type 1 (erythrocyte type) and type 2 (generalized type). We found a Chinese family with type 1 recessive congenital methemoglobinemia, the patients from which were diagnosed according to clinical symptoms and b5R enzyme activity in the blood cells. To learn the molecular basis of type 1 recessive congenital methemoglobinemia in this Chinese family, we isolated total RNA from the peripheral leukocytes of the propositus and b5R complementary DNA (cDNA) by reverse transcription- polymerase chain reaction (RT-PCR). The coding region of the b5R cDNA was analyzed by sequencing the cloned PCR products. The results showed that the propositus was homozygous for a G-->A transition at codon 203 in exon 7, changing a cysteine to a tyrosine (Cys203Tyr). To characterize the mutant enzyme, both glutathione S-transferase (GST)-fused wild-type b5R and GST-fused mutant Cys203Tyr b5R were expressed in Escherichia coli and affinity purified. The results showed that the catalytic activity of the enzyme was not much affected by this amino acid substitution, but the mutant enzyme exhibited decreased heat stability and increased susceptibility to trypsin. These properties of the mutant enzyme would account for the restricted b5R deficiency and mild clinical manifestations of these type 1 patients. The finding of this novel mutation makes codon 203 the only position within the b5R gene at which more than 1 mutation has been found.

Chinese herbal formula XQ-9302: pilot study of its clinical and in vitro activity against human immunodeficiency virus

OBJECTIVES: To evaluate the effectiveness of XQ-9302--a purified, precise mixture of 20 Chinese herbs--against infection with human immunodeficiency virus in vitro and in the clinic. DESIGN: In vitro cell culture assay, heavy metal content analysis, and pilot non-randomised clinical trial. SETTING: Drug rehabilitation centre and municipal surveillance centre, Shanghai, China. PATIENTS: Forty-eight patients who had various clinical histories, such as drug abuse, cancer, and infection with human immunodeficiency virus, participated in the clinical study. INTERVENTION: During the clinical trial, multiple 15-day courses of XQ-9302 10.8 g/d were given to participants. MAIN OUTCOME MEASURES: CD4 count, P24 antigen level, level of antibody against human immunodeficiency virus, number of copies per millilitre of human immunodeficiency virus in the plasma (viral load), and any side effects. RESULTS: XQ-9302 protected cultured MT4 cells from infection with human immunodeficiency virus in vitro. Clinical tests showed that the herbal formula relieved the symptoms of acquired immunodeficiency syndrome and enhanced CD4 counts in patients infected by the human immunodeficiency virus. There were no observable side effects, even after taking the drug for several months. In three patients who had acquired immunodeficiency syndrome, treatment with XQ-9302 reduced the magnitude of the viral load by more than 1 log. CONCLUSION: XQ-9302 not only improves the immune function of patients infected with the human immunodeficiency virus, but also interrupts viral replication and slows the progression of the disease without detectable side effects. In addition, the heavy metal content of XQ-9302 is well within safety levels set by the Government of China.

The protective effects of traditional Chinese medicine prescription, han-dan-gan-le, on CCl4-induced liver fibrosis in rats

Han-Dan-Gan-Le, a Chinese medicine preparation composed of Salvia miltorrhiza, Radix paeoniae, Astragalus membranaceus, Stephania tetrandra, and dried leaves of Ginkgo biloba, has been used successfully to treat human liver fibrosis and cirrhosis for years. This study was designed to examine the mechanisms of the protection. Male Wistar rats were given CCl4 (1.2 ml/kg, 2 times/week), 20% fat diet, and 30% alcohol in drinking water (every other day) for 6 weeks. Han-Dan-Gan-Le (0.5 and 1.0 g/kg, p.o., daily for 6 weeks) was administered to rats simultaneously to examine the protective effects against CCl4-induced liver fibrosis. The experimentally-induced liver fibrosis and other morphological alterations were significantly ameliorated by Han-Dan-Gan-Le. Han-Dan-Gan-Le treatments decreased CCl4-induced hepatic collagen accumulation by more than 50%, and significantly increased urinary excretion of hydroxyproline. The CCl4-induced lipid peroxidation in liver and serum was ameliorated as a result of Han-Dan-Gan-Le treatment, possibly by restoring the activity of superoxide dismutase activity in liver and erythrocytes, In conclusion, Han-Dan-Gan-Le is effective in protecting against liver fibrosis. The mechanisms of the protection appear to be due to its antioxidant properties and the modulation of hepatic collagen metabolism.

Retrograde transport of intact poliovirus through the axon via the fast transport system

Intramuscularly inoculated poliovirus is thought to spread to the central nervous system through neural pathways in humans, monkeys, and the transgenic (Tg) mice carrying the human poliovirus receptor (PVR) gene. To gain insight into molecular mechanisms for the retrograde axonal transport of poliovirus, resulting in the expression of neurovirulence, a poliovirus-sensitive ICR-PVRTg21 mouse line (Tg21) was used as an animal model for poliomyelitis. We detected poliovirus antigens in axons of the sciatic nerve. All of the Tg21 mice, which had been inoculated into the calves with 1 x 10(6) pfu of the Mahoney strain of type 1 poliovirus, showed symptoms of paralysis in the inoculated limbs (initial paralysis) within 48 h after the inoculation. The appearance of this initial paralysis was observed in mice whose sciatic nerves were transected at various times after virus inoculation. The results were indicators of the velocity of poliovirus transportation through the sciatic nerves under analysis. Poliovirus-related materials recovered from the sciatic nerve were mainly composed of intact 160S virion particles. The amount of 160S particle recovered was greatly reduced by coinjection with anti-PVR monoclonal antibody. These results suggest that one of the fast retrograde axonal transport systems is involved in poliovirus dissemination through the sciatic nerve and that IM-inoculated poliovirus is incorporated into the sciatic nerve as intact particles in a PVR-dependent manner, as it is in humans.

Efficient delivery of circulating poliovirus to the central nervous system independently of poliovirus receptor

The transgenic (Tg) mice carrying the human gene for poliovirus receptor (PVR) are susceptible to poliovirus intravenously (i.v.) inoculated as well as intracerebrally or intraspinally inoculated. Thus, i.v.-inoculated poliovirus may invade the central nervous system (CNS) through the blood-brain barrier (BBB). To know the contribution of PVR to tissue distribution and BBB permeability of i.v.-inoculated polioviruses, these dissemination processes were investigated and compared between the Tg mice and non-Tg mice. Distribution profile of i.v.-inoculated poliovirus in various tissues of the Tg mice is similar to that in non-Tg mice. The data suggest that tissue distribution of the virus occurs independently of the transgene for PVR. The amount of poliovirus delivered to the CNS suggested the existence of a specific delivery system of the virus to the CNS. Virus accumulation in the CNS of the Tg mice was measured up to 7.5 hr after the i.v. inoculation. The viruses, regardless of whether the virulent or attenuated strain, seem to accumulate at a constant rate of approximately 0.2 microliter/min/g tissue. Similar phenomena were observed when the viruses were inoculated into non-Tg mice. The rates of the virus accumulation in the CNS are more than 100 times higher than that of albumin, which is considered not to permeate through the BBB via a specific transport system, and only three times lower than that of monoclonal antibody against transferrin receptor (OX-26), which is a potential candidate as a drug delivery vehicle specific to the CNS. These data suggest that polioviruses permeate through the BBB at a fairly high rate, independently of PVR and virus strains.

Host range phenotype induced by mutations in the internal ribosomal entry site of poliovirus RNA

Most poliovirus strains infect only primates. The host range (HR) of poliovirus is thought to be primarily determined by a cell surface molecule that functions as poliovirus receptor (PVR), since it has been shown that transgenic mice are made poliovirus sensitive by introducing the human PVR gene into the genome. The relative levels of neurovirulence of polioviruses tested in these transgenic mice were shown to correlate well with the levels tested in monkeys (H. Horie et al., J. Virol. 68:681-688, 1994). Mutants of the virulent Mahoney strain of poliovirus have been generated by disruption of nucleotides 128 to 134, at stem-loop II within the 5' noncoding region, and four of these mutants multiplicated well in human HeLa cells but poorly in mouse TgSVA cells that had been established from the kidney of the poliovirus-sensitive transgenic mouse. Neurovirulence tests using the two animal models revealed that these mutants were strongly attenuated only in tests with the mouse model and were therefore HR mutants. The virus infection cycle in TgSVA cells was restricted by an internal ribosomal entry site (IRES)-dependent initiation process of translation. Viral protein synthesis and the associated block of cellular protein synthesis were not observed in TgSVA cells infected with three of four HR mutants and was evident at only a low level in the remaining mutant. The mutant RNAs were functional in a cell-free protein synthesis system from HeLa cells but not in those from TgSVA and mouse neuroblastoma NS20Y cells. These results suggest that host factor(s) affecting IRES-dependent translation of poliovirus differ between human and mouse cells and that the mutant IRES constructs detect species differences in such host factor(s). The IRES could potentially be a host range determinant for poliovirus infection.

[Effects of sennosides on cellular electric activities in smooth muscle cells of guinea pig taenia coli]

The effects of sennosides (Sen, an extract of Chinese rhubarb) on cellular spontaneous electric activities of guinea pig taenia coli were studied by intracellular microelectrode technique. Sen 0.1-20 mmol.L-1 improved the depolarization of cell membrane, quickened the burst of slow wave potential, and increased notably the frequency of spike potentials. Sen (20 mmol.L-1) induced spontaneous spike potentials. These results provide direct evidence for the enhancing effect of Sen on intestinal peristalsis at cellular level.

[Effect of processing on the extraction of alkaloids from Strychnos]

Results of experiments showed that the contents of strychnine and brucine were about the same in decoction of Strychnos nux-vomica and S. pierriana, but the contents of vomicine, strychnine N-oxide and brucine N-oxide were greater in the former than in the latter. The contents of strychnine and brucine were greater under scalding with hot sand than deep-frying with sesame oil.

[Effects of dachengqi decoction and rhubarb on cellular electrical activities in smooth muscle of the guinea-pig taenia coli]

The effects of Dachengqi decoction (DCQ) and Rhubarb (Rb) on spontaneous cellular electrical activities of guinea-pig's taenia coli has been studied by intracellular microelectrode technique. DCQ and Rb could both improve depolarization of cell membrane, speed up the burst of slow wave potential (when drug concentration was 1%, P > 0.05; 10% or 20%, P < 0.05), which was dose dependent. At the same concentration, the effects of Rb were more significant than that of DCQ. These results suggested that DCQ and Rb enhanced directly the cellular electrical excitability so as to strengthen the contraction of colon, is one of the mechanisms of these drugs in cellular level on diarrhea action. The ionic basis of the effects might be that DCQ and Rb reduced the K+conductance of cell membrane in rest state.

[Exposure level of N-nitrosamines in the gastric juice and its inhibition by vitamin C in high risk areas of esophageal cancer]

A total of 391 gastric juice samples was collected from Ji Yuan and An Shi counties, high and medium risk areas of esophageal carcinoma in Henan province. NDMA, NDEA, NMBzA, NPip and unknown compounds were assayed in the fasting gastric juice. Among these nitrosamines, NMBzA, NPyr and NPip were specific in inducing esophageal cancer in animals. The amount of nitrosamines in the gastric juice collected from Ji Yuan county was higher than that from An Shi county. The exposure level of nitrosamines of subjects from these two localities were significantly different (P < 0.001). There was a positive relationship between the nitrosamines exposure level and esophageal cancer mortality rate. The amount of gastric N-nitrosamines from An Shi subjects as treated with vitamin C was reduced. It is evident that vitamin C can inhibit N-nitrosamine formation in the stomach, thereby, reducing the N-nitrosamines exposure level.

A prospective study of esophageal cytological atypia in Linxian county

Between 1975 and 1986, in Linxian county (LX), a prospective study of esophageal cytological hyperplasia and atypia was conducted on 3 groups of subjects: 294 with marked atypia, 328 with mild hyperplasia and 336 normal controls; all were diagnosed by cytology. Results showed that no significant difference in incidence of esophageal cancer (EC) appeared between subjects with mild hyperplasia and controls, while the incidence of EC in subjects with marked atypia was 1,178.92/100,000 which was 2.39 (after age-adjustment 2.90) times higher than that found in the control group and was of statistical significance (chi 2 = 8.92, p less than 0.01). In all groups, the relatively high risk of contracting EC was closely associated with drinking ground water, smoking and a low standard of living. These results suggest that early treatment should be given to subjects with marked atypia, accompanied by preventive measures against carcinoma of the esophagus, such as hygienic drinking water, abstention from smoking and better living conditions.

[Smooth muscle tumors of the alimentary tract--a review of 397 cases]

397 cases of smooth muscle tumor of the alimentary tract were analysed. 385 were collected from the domestic literature in the recent 10 years and 12 are added by the authors. The tumor occurred more frequently in patients 40-60 years old. Diameter of the tumor ranged from 0.5-35 cm. The diameter of leiomyosarcoma was larger than that of leiomyoma on an average. The ratio of benign to malignant incidence was 3.2:1. Exclusive of 204 (51.4%) cases which occurred in the esophagus, the ratio was 1.1:1 in the other 193. In the 12 cases reported by the authors, it was 1:3. In the 193 cases of the GI tract, the lesion occurred in the stomach in 50.8%, in the small intestine in 29.0%, in the colon 1.0% and in the rectum 19.2%. The three most common clinical symptoms of those in the stomach and small intestine were abdominal mass (54.3%), bleeding (49.1%) and abdominal pain (45.7%). These 12 cases reported comprised 0.019% of 62, 088 patients admitted into our hospital, 0.09% of 12,678 tumor inpatients during the same period and 0.61% of 1,983 of malignant tumors in the alimentary tract. The preoperative diagnostic accuracy of this tumor was low, only 7.7% of all the GI neoplasms. On basis of the present data, improving the preoperative diagnostic accuracy is stressed.

Trends in morbidity and mortality for oesophageal cancer in Linxian County, 1959-1983

Data on morbidity and mortality from oesophageal cancer (EC) over the 25 years from 1959-1983 indicate that this malignancy has been the commonest cause of death in Linxian (LX) county during that period, accounting for 16% of deaths from all causes and 65% of deaths from cancer. Whereas incidence and mortality of EC were high but stable during this period, a decline in mortality has been noted recently in younger age groups, coinciding with an improvement in nutritional standards. Cohort analysis for the period 1879-1954 demonstrates mortality peaks among individuals born late in the last century and early in the present one. It also shows that a decline in mortality appears to have started among natives of the county born during the period 1935-1954.