[Clinical and genetic analysis of a patient with HUPRA syndrome due to missense variants of SARS2 gene and literature review]

Objective: To explore the clinical manifestations and genotype of an infant with hyperuricemia, pulmonary hypertension, renal failure in infancy, and alkalosis syndrome (HUPRAS). Methods: Clinical data of the patient were collected. Peripheral blood samples from the patient and his parents were acquainted for whole exome sequencing. The filtrated variants were verified by Sanger sequencing. The pathogenicity of the variants was predicted by bioinformatic tools. Results: The patient is a male infant of 6 months old, carrying two missense variants in the SARS2 allele: a paternal inherited c.1205G>A (p. Arg402His) and a maternal inherited c.680G>A (p. Arg227Gln). The two variants were in extremely low population frequencies. The pathogenetic prediction tools categorized them as deleterious. Arg402 and Arg227 were highly conserved in evolution. The variants led to changes in the hydrogen bonds and hydrophobicity of seryl-tRNA synthetase encoded by SARS2. Conclusions: c.1205G>A (p. Arg402His) and c.680G>A (p. Arg227Gln) are the possible causative variants of the HUPRA syndrome.

[Clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage in treating diabetes mellitus complicated with necrotizing fasciitis]

Objective: To explore the clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage (VSD) in treating diabetes mellitus complicated with necrotizing fasciitis. Methods: The retrospective observational study approach was used. From January 2020 to March 2022, 12 patients with type 2 diabetes complicated with necrotizing fasciitis who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 7 males and 5 females, aged 27 to 76 years. The initial diagnosis of lesions was in the lower limbs. After admission, bedside incision and drainage were performed timely, and a sample of wound exudate was collected for microbial cultivation. At the same time, the comprehensive supportive treatment was performed. At stage Ⅰ, debridement was performed, and the skin and soft tissue defect area was 40 cm×15 cm to 80 cm×25 cm after debridement. The dead space was filled with bone cement containing gentamicin and vancomycin and VSD was performed. After there was no obvious infection on the wound, the antibiotic bone cement was removed and wound repair surgery was performed at stage Ⅱ. The times of debridement, amputation, infection control, wound treatment method and wound healing at stage Ⅱ, total hospitalization day, and recurrence of necrotizing fasciitis during follow-up after the stage Ⅱ surgery. At the last follow-up, the walking function of patients was evaluated according to the scoring standards of American Orthopedic Foot and Ankle Association (AOFAS). Results: Eleven patients had wound infection control with one debridement surgery and did not undergo amputation surgery; one patient had significant foot gangrene, and the infection was controlled after one debridement and amputation of the gangrenous limb. Blood routine and infection indicators gradually returned to normal within 7 days after surgery. At stage Ⅱ, the wounds in 4 patients were sutured directly, the wounds in 6 patients were repaired with full-thickness inguinal skin graft, while the wounds in 2 patients were repaired with pedicled or tongue-shaped flaps at the wound edge. The wounds healed well after surgery, with no ulceration. The total hospitalization day of patients was 20 to 45 days. Follow-up for 3 to 24 months after stage Ⅱ surgery showed no recurrence of necrotizing fasciitis in any patient. At the last follow-up, the walking function was evaluated as excellent in 10 cases and good in 2 cases according to the AOFAS scoring standard. Conclusions: Antibiotic bone cement combined with VSD used in treating type 2 diabetes complicated with necrotizing fasciitis can effectively control infection and reduce the times of debridement, with good wound healing and walking function after surgery.

[Effects of pedicled flap combined with membrane induction technique in repairing foot and ankle wounds in diabetic patients]

Objective: To explore the effects of pedicled flap combined with membrane induction technique in repairing foot and ankle wounds in diabetic patients. Methods: A retrospective observational study was conducted. From March 2019 to July 2021, 12 patients with diabetic foot and ankle wounds who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 7 males and 5 females, aged 20 to 92 years. The wound area before debridement was 4.0 cm×2.5 cm to 16.0 cm×12.5 cm. The patients underwent debridement+antibiotic cement tamponade in stage Ⅰ; according to the wound site, peroneal artery perforator flap or posterior tibial artery perforator flap was chosen to repair the wound in stage Ⅱ, with the area of the resected flap ranging from 4.5 cm×3.0 cm to 18.5 cm×14.0 cm. The donor site was directly closed in 4 patients or covered by full-thickness inguinal skin graft in 8 patients. After the operation of stage Ⅱ, the survival of flap and skin graft, the scar in donor and recipient sites of flap, the appearance of flap, and the function of ankle joint of affected extremity were followed up. The recovery of foot and ankle function was evaluated and rated by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scoring System at the last follow-up. Results: During the follow-up of 4 to 15 months after the operation of stage Ⅱ, both the flap and skin graft survived, without obvious infection recurrence. Linear scars were left in donor and recipient sites of flap, with good appearance in flap. The function of ankle joint in the affected extremity was nearly normal. At the last follow-up, the AOFAS scores of patients were 79 to 93, with excellent in 8 cases and good in 4 cases. Conclusions: The pedicled flap combined with membrane induction technique for repairing foot and ankle wounds in diabetic patients has the advantage of simple operation, preserved ankle joint function, and less postoperative infection recurrence, which is worth popularizing in clinical practice.

[Clinical analysis of 4 acute ischemic stroke children treated with endovascular thrombectomy]

Objective: To assess the feasibility of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) in children. Methods: Clinical data and follow-up information of 4 AIS children who received EVT in the Department of Intervention & Hemangioma at the Children's Hospital of the Capital Institute of Pediatrics from December 2020 to June 2021 were collected retrospectively. The vascular recanalization after EVT was assessed by the modified thrombolysis in cerebral infarction (mTICI) score. Efficacy outcomes were assessed with initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and the modified Rankin scale (mRS) score at 3 and 6 months after treatment. Safety assessments included perioperative complications and intracranial hemorrhage post-treatment. Results: A total of 5 EVT treatment were performed on 4 children with AIS, of whom 3 were male. The age of onset was 4.6, 13.8, 7.8, 8.0, 8.9 years, respectively. The time from symptom onset to initiation of EVT was 19.0, 25.0, 22.0, 4.0, 16.5 hours, respectively and all patients achieved successful recanalization of the vessel after EVT (mTICI≥2b). The PedNIHSS score was 39, 14, 25, 39, 24 before treatment and decreased to 8, 1, 12, 39, 5 at discharge. All the procedures were performed with no perioperative complications. Only 1 patient with congenital heart disease had a recurrent AIS with malignant brain oedema and brain hernia. Although the occluded vessels were successfully recanalized,the symptoms were not improved and this patient died after treatment abandonment. The other 3 patients achieved good recovery at 6 months postoperatively. The mRS score of 3 patients was 3, 1, 2 at 3 months after EVT and decreased to 2, 1, 1 at 6 months. Conclusion: EVT treatment may be feasible and safe for pediatric AIS due to large vessel occlusion even when the treatment was initiated 6 hours post stroke, but children with heart disease may have a dismal prognosis.

[Analysis of early recurrence within 6 months in patients of esophageal squamous cell carcinoma after neoadjuvant therapy followed by surgery]

Objectives: To examine the prognosis factors of recurrence of esophageal carcinoma within 6 months after neoadjuvant therapy followd by surgery. Methods: The clinical data of 187 patients with esophageal squamous cell carcinoma who underwent neoadjuvant therapy followed by curative esophagectomy between January 2018 and April 2020 at Department of Thoracic Surgery, Shanghai Chest Hospital were analyzed retrospectively. There were 160 males and 27 females, aging (63.0±7.1) years (range:43 to 76 years). The t test, χ2 test and rank-sum test were used for univariate analysis of the prognosis factors for recurrence within 6 months postoperative, while the Logistic regression was used for multivariate analysis. Results: There were 30 patients (16.0%) developed recurrence within 6 months after operation, including local recurrence in 1 case, regional recurrence in 11 cases, hematogenous recurrence in 13 cases, and combined recurrence in 5 cases. Univariate analysis suggested that there was a significant difference in T staging of tumor before neoadjuvant therapy (cT), tumor regression grade, circumferential resection margin, pathological T stage (ypT) and pathological N stage (ypN) between the recurrence patients and non-recurrence patients (all P<0.05). Logistic regression analysis suggested that the cT3-4 (OR=2.701, 95%CI: 1.161 to 6.329, P=0.021) and ypN(+)(OR=1.654, 95%CI: 1.045 to 2.591, P=0.032) were the independent prognosis factors for recurrence within 6 months. Conclusion: The combination of neoadjuvant therapy and surgery is not effective in reducing early postoperative recurrence in patients who have invaded the epineurium before treatment, and still have positive lymph nodes after neoadjuvant therapy.

[Prone position thoracoscopic esophagectomy:preliminary experiences of thirty cases in Shanghai Chest Hospital]

Objective: To examine the safety and short-term outcomes of prone position thoracoscopic esophagectomy. Methods: Clinical data of consecutive thirty patients who accepted prone position thoracoscopic esophagectomy at Department of Thoracic Surgery, Shanghai Chest Hospital between July and December 2020 was analyzed retrospectively. There were 25 males and 5 females, aging 65.5(29.0) years (M(QR))(range: 48 to 82 years). Patients with cT3-4a accounted for 73.3%(22/30) and cN(+) accounted for 43.4%(18/30). All the patients in this study had no serious comorbidity, accepted prone position thoracoscopic esophagectomy. Results: No conversion to thoracotomy occurred. The overall time of operation was 210 (105) minutes (range: 130 to 268 minutes), the time of thoracic procedures was 92 (46) minutes (range: 72 to 136 minutes), the time of abdominal procedures was 32 (14) minutes (range: 20 to 48 minutes), respectively. R0 resection accounted for 93.3%(28/30), the negative ratio of circumferential margin was 96.7%(29/30). The number of lymph nodes dissection was 21.5(7.2) (range: 16.0 to 28.0) in total, 12.0(6.5) (range: 9.0 to 18.0) in thoracic lymph nodes, 2.0(1.5) (range: 1.0 to 5.0) in left recurrent laryngeal nerve lymph nodes, and 1.0(1.0) (range: 1.0 to 3.0) in right recurrent laryngeal nerve lymph nodes, respectively. There was no perioperative death, and the overall postoperative complication rate was 43.3%(13/30). The incidence of anastomotic leakage was 10.0%(3/30), recurrent laryngeal nerve paralysis was 26.7%(8/30), and respiratory complication was 6.7%(2/30). The postoperative hospital stay was 10 (9) days (range: 5 to 42 days). Conclusion: Prone position thoracoscopic esophagectomy is safe and feasible, and the short-term outcomes is satisfactory.

[The role of neoadjuvant therapy in multimodality treatment of locally advanced esophageal squamous cell carcinoma: perspective from the NEOCRTEC5010 trial]

The efficacy of surgery alone for locally advanced esophageal cancer is poor, which requires the active participation of multimodality treatment. Neoadjuvant therapy, especially neoadjuvant chemoradiotherapy, could significantly lead to tumor downstage, bring higher radical resection rate and improve the prognosis. The NEOCRTEC5010 trial, a multicenter prospective randomized controlled trial on neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma has provided sufficient and valuable evidence for us, especially for some key questions after neoadjuvant chemoradiotherapy, such as perioperative complications, value of systemic lymphadenectomy, the post-operation recurrence pattern, pathological complete response, long-term prognosis and survival. In addition, the current development of tumor immunotherapy is so rapid that the role of immunotherapy in the first line treatment of advanced or relapsed/metastatic esophageal cancer has been confirmed. In the near future, neoadjuvant therapy based on immunnology-led combined with traditional chemoradiotherapy or chemotherapy is expected to become a new theraputic strategy to further improve the treatment efficacy of locally advanced esophageal squamous cell carcinoma. This paper focused on the classical research of neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma and the development of immunotherapy for esophageal cancer, aiming to improve the understanding of neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma. This will help to carry out optimal clinical work and to design better clinical study.

Using mixed silages of sweet sorghum and alfalfa in total mixed rations to improve growth performance, nutrient digestibility, carcass traits and meat quality of sheep

Combining sweet sorghum (SS) with alfalfa for ensiling has the potential to make a high-quality silage with relatively a better nutrient balance. However, the existing data are insufficient about how changes in ratios of SS to alfalfa in different silage mixtures affect animal performance and meat quality. Therefore, the objective of this study was to determine the effect of feeding total mixed rations containing mixed silages of SS and alfalfa on growth performance, nutrient digestibility, carcass traits and meat quality of Karakul sheep. Five total mixed rations were formulated with different SS proportions at 100%, 80%, 60%, 40%, and 20% on a fresh weight basis. Thirty 4-month old male Karakul sheep with 25.5 ± 1.4 kg BW were randomly allocated into five treatment groups, each with six lambs for this experiment. The results indicated that the Karakul sheep consuming total mixed rations containing SS-Alfalfa (SS-AF) silage mixtures with a lower proportion of SS tended to increase nutrient digestibility, growth performance, carcass traits, and meat quality. Feeding diets with SS at 40% and 20% inclusion rate showed a significant linear increase in the apparent digestibility of DM, CP and NDF, as well as subcutaneous fat thickness and water holding capacity (P < 0.5). Moreover, reduction in SS inclusion rate in these diets caused significant (P < 0.05) linear and quadratic increases in DM intake, final BW, average daily gain, carcass weight, and the amino acid contents of meat (P < 0.05). Conversely, feeding diet with lower SS inclusion rate led to decrease in feed conversion ratio and shear force significantly (P < 0.05) for these sheep. It appears that 40% inclusion of SS was the optimal rate in making the SS-AF silage mixture for lambs to achieve a superior production performance and high-quality meat products in Karakul sheep. However, further research is needed to investigate the effect of feeding SS-AF silage mixtures alongside contrasting ingredients on rumen function, ruminal microorganisms and digestive enzyme activity of sheep and other ruminant animals.

[Preliminary results of Chinese magnetic sphincter augmentation in treating gastroesophageal reflux disease]

Objective: To examine the preliminary clinical efficacy of Chinese magnetic sphincter augmentation (MSA) in the treatment of gastroesophageal reflux disease (GERD). Methods: According to the enrollment criteria for the MSA developed by ShengJieKang Co. and Shanghai Chest Hospital (SS-MSA) clinical trial, a total of 19 GERD patients were treated with SS-MSA from August 2018 to January 2020 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University. The majority of registered cases were male patients with age of (32.2±7.3) years (range: 22 to 50 years), height of (170.7±6.2) cm (range: 160 to 179 cm) and weight of (65.2±10.3) kg (range: 47.5 to 90.0 kg). SS-MSA was implanted via laparoscopy. The major evaluation indexs of postoperative efficacy were the total time of acid exposure within 24 hours and the total number of reflux. Secondary efficacy indicators included: (1) evaluation of the average daily dose of proton pump inhibitor medications; (2) the score of GERD health related quality of life questionnaire (GERD-Q) before and after MSA implantation. Paired design t-test was used to evaluate the efficacy of the SS-MSA. Results: A total of 19 patients underwent SS-MSA surgery successfully. The history of the GERD were 19 (54) months (M(Q(R))). The operation time was 63 (22) minutes and the in-hospital stay was 3 (2) days. No obvious surgical complications occurred. Postoperative adverse events included 14 cases with mild to moderate dysphagia exited after surgery, gradually eased within 1 to 3 months, 1 case with the removal of the device after 1 month of severe swallowing difficulties, 1 case of diarrhea. No corrosion, perforation, displacement occurred. The GERD-Q score (11.0(4.5) vs. 6(1.0), t=4.274, P=0.013), 24-hour acid exposure time (6.2(4.8)% vs. 0.1(0.9)%, t=5.814, P=0.004), and Demeester score (23.72(16.20) vs. 0.96(3.10), t=6.678, P=0.003) were significantly decreased 1 year after surgery(n=5). Proton pump inhibitor reuse rates were 6/18, 5/15, 3/10, and 1/5 in 1, 3, 6 and 12 months after the operation, respectively. Conclusions: SS-MSA implantation is feasible and safe with short hospital stay and rare perioperative complications. The preliminary results is good after 1 year follow-up. It could be expected to be an ideal substitutive for future GERD treatment.

[Brief introduction of surgical development of esophageal cancer in Japan]

Esophageal cancer surgery originated in the early 20(th) century. However, the true meaning of trans-thoracic esophagectomy and digestive tract reconstruction began in the 1930s. Almost at the same time, Japan and Western countries began the surgical exploration of esophageal cancer. Based on the pathological type of esophageal cancer in Asia, squamous cell carcinoma is the majority, and its biological characteristics and treatment strategies are different from those of European and American patients. After more than eighty years of development, the surgical treatment of esophageal cancer in Japan has been developed from the initial attempt, deep cultivation practice to the pursuit of excellence, and explored a set of more advanced surgical techniques and diagnostic strategies, which is unique in the world. On the basis of the establishment of the Japanese Society of Esophagus, Japanese scholars have developed and irregularly updated the Japanese Classification of Esophageal Cancer and published the professional academic journal Esophagus. The Japanese Clinical Oncology Group organized a number of phase Ⅲ clinical studies on esophageal cancer, providing strong evidence for the diagnosis and treatment of esophageal squamous carcinoma. Focused on the origin, development, current situation and future of esophageal cancer surgery in Japan, this paper summarized the development of esophageal cancer surgery in Japan through literature review, interviews with senior experts and Hot topics of esophageal cancer surgery-questionnaire survey of Japanese experts.

[Dose-response relationship between maternal hemoglobin concentration and preterm birth, in pregnant women]

Objective: To investigate the dose-response relationship between hemoglobin concentration and preterm birth, during pregnancy. Methods: With Zhuang ethnicity, a total of 12 780 pregnant women and their infants that admitted to Wuming、Pingguo、Jingxi、Debao、Longan and Tiandong hospitals, were recruited, in Guangxi Zhuang Autonomous Region, from January 2015 to December 2017. Non-conditional logistic regression method was used to analyze the effect of anemia on preterm birth during pregnancy. Dose-response relationship between hemoglobin concentration and preterm birth was explored, using the restrictive cubic spline model. Results: After excluding 2 053 pregnant women with hypertension or aged 35 years and over, results from the non-conditional logistic regression analysis showed that the risk of preterm birth in the anemia group was 1.29 times (OR=1.29, 95%CI: 1.04-1.59, P=0.019) of the non-anemia group in the first trimester. Data from the restricted cubic sample showed that there appeared nonlinear "L" dose-response relationship between hemoglobin concentration and preterm birth in the first trimester and "U" shape in the third trimester (non-linearity test P<0.001). Conclusion: There appeared nonlinear dose-response relationship between the hemoglobin concentration and preterm birth, both in the first and third trimesters.

[Progress in the application of robot assisted minimally invasive esophagectomy]

Robotic assisted surgery system is the most advanced minimally invasive surgical platform in the world, and this system has been widely used in cardiac surgery, urology surgery, gynecology surgery and general surgery. Although the application of this system was relative late in esophageal surgery, it has been developing vigorously. According to the research progress and practical experience in the world, robot assisted minimally invasive esophagectomy (RAMIE) has the same safety and effectiveness as traditional open esophagectomy (OE) and thoracoscopic laparoscopic esophagectomy (TLE). In this paper, several aspects on this novel operation were demonstrated, including the origin, safety evaluation, lymph node dissection, learning curve, prognosis of RAMIE, comparison among RAMIE, OE and TLE and the role of RAMIE in multidisciplinary treatment of esophageal cancer, in order to promote the rational application of RAMIE in esophagectomy.

[Experiences of esophageal replacement with ileocolon graft: a series of 34 cases]

Objective: To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft. Methods: Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed. Results: The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017. Conclusion: Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.

[Increased receptor activator of nuclear factor kappa B ligand expressed on B10 cells in rheumatoid arthritis]

OBJECTIVE

To detect receptor activator of nuclear factor kappa B ligand (RANKL) expressed on B10 cells in rheumatoid arthritis (RA) and to evaluate the correlation between RANKL-producing B10 cells in RA and clinical features and laboratory parameters, trying to reveal the possible role of B10 cells in the pathogenesis of RA and the potential mechanism of impaired immunosuppressive capacities.

METHODS

25 RA patients and 20 healthy volunteers were enrolled. These RA patients did not received treatment with glucocorticoids, disease-modifying anti-rheumatic drug and biologics during the recent half of a year. The levels of RANKL-producing B10 cells were measured by flow cytometry (FCM) and polymerase chain reaction (PCR). The correlation between the frequencies of RANKL-producing B10 cells in RA and clinical data, laboratory parameters were analyzed. The role of tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) in inducing RANKL expression in B10 cells was evaluated by in vitro stimulation assay. Independent samples t test, Pearson and Spearman correlation were used for statistical analysis.

RESULTS

B10 cells were capable of producing RANKL at a low level in health controls. The frequencies of RANKL-producing B10 cells were markedly higher in RA patients than in health controls (3.65%±1.59% vs. 2.25%±0.68%, P<0.01). The frequencies of these cells correlated positively with RA tender joint counts, swollen joint counts and disease activity score in 28 joints (DAS28) (r=0.479, P=0.035; r=0.519, P=0.008; r=0.526, P=0.019). However, no correlation was found between these cells and RA patient age, disease duration, or the levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA). After in vitro stimulation by TNF-α, but not IL-1β, B10 cells isolated from healthy donors demonstrated fundamentally upregulated expression of RANKL.

CONCLUSION

Our studies showed the frequencies of RANKL-producing B10 cells were markedly higher in RA patients, and their frequencies were positively correlated with RA tender joint counts, swollen joint counts and DAS28. These findings suggested that B10 cells might be involved in RA bone destruction.

[Outcomes of pregnancy among women with alpha-thalassemia minor: A retrospective study of Pingguo county in Guangxi Zhuang Autonomous Region]

Objective: To investigate the association between the value of α-thalassemia minor and the outcomes in pregnant women. Methods: A total of 445 pregnant women with α-thalassemia minor were selected as thalassemia group in the Pingguo County Maternal and Child Health Hospital of Guangxi from January 2011 to December 2015, with ratio of 1∶4 healthy pregnant women was randomly recruited as non-thalassemia group. Clinical characteristics and pregnancy outcomes of the two groups were retrospectively analyzed using methods including t test, χ(2) test, and logistic regression model and ROC curve. Results: There were no significant differences noticed in factors as age, BMI, gestational age and educational level of the two groups. Hemoglobin of the thalassemia group was significantly lower than that of the non-thalassemia group (P<0.001). Differences on parity, ethnicities or occupation were statistically significant. Results from univariate analysis showed that the proportions of low birth weight, small for date infant and 1 min Apgar score<7 were higher in the thalassemia group, but the ratio of adverse pregnancy outcomes was comparable on parameters as preterm birth, stillbirth, macrosomia. Findings from the unconditional logistic regression showed that pregnancy complicated with α-thalassemia minor appeared a risk for both newborns with low birth weight (aOR=2.29, 95%CI: 1.32-3.95) and small for date infant (aOR= 2.11, 95%CI: 1.16-3.84). The ROC curve showed that α-thalassemia minor combined with multiple indicators presented a certain predictive value on neonatal birth weight. Conclusion: Pregnancy complicated with α-thalassemia minor was likely to increase the risk of birth weight loss in newborns, suggesting that prenatal care for pregnant women with thalassemia be strengthened, in order to reduce the incidence of adverse pregnancy outcomes.

[Effect of obstructive sleep apnea hypoxia on learning memory capacity after cerebral ischemia-reperfusion in rats]

OBJECTIVE

To investigate the effect of obstructive sleep apnea hypoxia on learning memory capacity in rat after ischemia.

METHODS

Eighty healthy male wister rats were randomly divided into: sham operation group (SO group, n=20), merely ischemia group (I/R group, n=20), and obstructive sleep apnea hypoxia for 7 days ischemia group (IH7+ I/R group, n=20), obstructive sleep apnea hypoxia for 21 days ischemia group (IH21+ I/R group, n=20). Obstructive sleep apnea hypoxia ischemia groups were respectively given obstructive sleep apnea hypoxia for 7 days and 21 days. Ischemia animals were prepared cerebral ischemia-reperfusion model by improved pulsinelli four vessels block (4-VO), the morphological changes of hippocampus nerve cells of rat brain were detected with HE, neuron pathology in hippocampal regin was observed using electron microscope, and learning memory capacity of rats were assessed by the Morris water maze test.

RESULTS

Compared with the SO group, the I/R group demonstrated shortened escaping latency, increased frequency of crossing the platform in the water maze test, decreased survival rate of neurons, and increased apoptotic cells and ultrastructure damages(P<0.05). Compared with the I/R group, obstructive sleep apnea hypoxia ischemia groups showed shortened escaping latency, increased frequency of crossing the platform, decreased survival rate of neurons, and increased apoptotic cells and ultrastructure damages(P<0.05), especially in the IH21+ I/R group(P<0.05).

CONCLUSIONS

Obstructive sleep apnea hypoxia can increase the damage of learning memory capacity. This damage is related to hippocampus nerve loss and ultrastructure injury from obstructive sleep apnea hypoxia.

[Expression of mTOR/autophagy pathway in the hippocampus following cerebral ischemia/reperfusion injure in intermittent hypoxia rats]

Objective: To compare the changes in the expression of mTOR and beclin1 in the hippocampus of normal rats and intermittent hypoxia rats with cerebral ischemia/reperfusion, so as to explore the roles of mTOR/autophagy pathway in global cerebral ischemia/reperfusion injure aggravated by intermittent hypoxia. Methods: One hundred healthy male Wistar rats were randomly divided into: sham operation group(SO group, n=20), intermittent hypoxia group(IH group, n=20), merely ischemia/reperfusion group(I/R group, n=20), intermittent hypoxia ischemia/reperfusion group(IH+ I/R group, n=20), intermittent hypoxia ischemia/reperfusion+ mTOR inhibitor group(Inhibitor group, n=20). IH group, IH+ I/R group and inhibitor group were respectively given intermittent hypoxia for 21 days before ischemia/reperfusion. Ischemia animals were prepared cerebral ischemia-reperfusion model by improved pulsinelli four vessels block (4-VO), the morphological changes of hippocampus nerve cells of rat brain were detected with HE respectively 6, 24 h after ischemia, and the expressions of mTOR protein and beclin1 protein in hippocampus of rat brain was detected with immunohistochemistry and RT-PCR respectively 6, 24 h after ischemia.SPSS 17.0 software was used to analyze the data. Results: Compared with the SO group, the IH group increased the never cells morphology damages and the empression of mTOR and beclin1 (q value was 32.94, 47.31, 63.68, 78.45, all P<0.05); the I/R group increased the never cells morphology damages and the empression of mTOR and beclin1 (mTOR in I/R group: 22.38±0.46, 24.16±0.60; mTOR in SO group: 14.65±0.48, 15.40±0.58; beclin1 in I/R group: 8.58±0.58, 10.58±0.49; beclin1 in SO group: 2.06±0.23, 2.10±0.30; the differences were significant, q value was 90.59, 106.83, 95.88, 119.44, all P<0.05). Compared with the IH group, IH+ I/R group increased the never cells morphology damages and the empression of mTOR and beclin1 (q value was 152.23, 165.61, 135.01, 156.48, all P<0.05). Compared with the I/R group, IH+ I/R group increased the never cells morphology damages and the empression of mTOR and beclin1(q value was 94.35, 106.99, 102.79, 115.49, all P<0.05). Compared with the IH+ I/R group, the inhibitor group decreased the never cells morphology damages and the expression of mTOR, increased the expression of beclin1(mTOR in IH+ I/R group: 30.40±0.43, 32.86±0.50; mTOR in inhibitor group: 26.60±0.37, 28.51±0.52; beclin1 in IH+ I/R group: 15.57±0.57, 18.78±0.43; beclin1 in inhibitor group: 21.74±0.51, 24.32±0.49; the differences were significant, q value was 44.71, 53.05, 90.74, 78.03, all P<0.05). Conclusion: Intermittent hypoxia can aggravate the damage on nerve cells by activating mTOR/autophagy pathway after ischemia.

Association of phosphodiesterase 4D gene and interleukin-6 receptor gene polymorphisms with ischemic stroke in a Chinese hypertensive population

Genetic factors have been shown to be associated with the risk of stroke. However, due to individual differences, the extent of the association between genetic factors and stroke varies widely. Hypertension is considered one of the most important risk factors for stroke, but it remains unknown whether the genetic association with stroke in a hypertensive population is the same as that in a non-hypertensive population. The aim of the present study was to explore the association between the phosphodiesterase 4D gene (PDE4D) and interleukin-6 receptor gene (IL6R) single nucleotide polymorphisms and ischemic stroke in a hypertensive population. The study included 307 ischemic stroke cases with hypertension and 227 controls (simple hypertension). The polymorphic loci rs12188950 and rs918592 in PDE4D, and rs4075015 and rs4537545 in IL6R were selected for analyzing the genotype and allele frequencies between cases and controls. rs12188950 was not found in the study population. In the univariate analysis, the rs918592 polymorphism in PDE4D was found to be significantly associated with ischemic stroke with the recessive model (P = 0.02), whereas no association with ischemic stroke was observed for rs4075015 and rs4537545 in IL6R. Following adjustment for binary logistic regression, the rs918592 polymorphism was not found to be associated with ischemic stroke. While prior studies have found an association between PDE4D and IL6R polymorphisms and ischemic stroke, our results suggest that this association may be different in a hypertensive population. Therefore, the association between PDE4D and IL6R polymorphisms and ischemic stroke among a hypertensive population requires further investigation.

Lenalidomide affect expression level of cereblon protein in multiple myeloma cell line RPMI8226

We investigated the mechanisms of action of immuno-modulatory drug (lenalidomide) on the protein expression of cereblon (CRBN) and their therapeutic targets in the multiple myeloma cell line RPMI8226. The multiple myeloma cell line RPMI8226 was cultured and treated with different concentrations of lenalidomide and bortezomib to determine the proliferation inhibition rate, apoptosis rate, and protein expression of CRBN. The results revealed that both lenalidomide and bortezomib inhibited the proliferation of RPMI8226 and promoted cell apoptosis. However, the protein expression of CRBN decreased signifi-cantly after treatment with lenalidomide, while bortezomib had no effect on the expression of CRBN. We confirmed that CRBN may be a target of lenalidomide.

CIAPIN1 gene silencing enhances chemosensitivity in a drug-resistant animal model in vivo

Overexpression of cytokine-induced apoptosis inhibitor 1 (CIAPIN1) contributes to multidrug resistance (MDR) in breast cancer. This study aimed to evaluate the potential of CIAPIN1 gene silencing by RNA interference (RNAi) as a treatment for drug-resistant breast cancer and to investigate the effect of CIAPIN1 on the drug resistance of breast cancer in vivo. We used lentivirus-vector-based RNAi to knock down CIAPIN1 in nude mice bearing MDR breast cancer tumors and found that lentivirus-vector-mediated silencing of CIAPIN1 could efficiently and significantly inhibit tumor growth when combined with chemotherapy in vivo. Furthermore, Western blot analysis showed that both CIAPIN1 and P-glycoprotein expression were efficiently downregulated, and P53 was upregulated, after RNAi. Therefore, we concluded that lentivirus-vector-mediated RNAi targeting of CIAPIN1 is a potential approach to reverse MDR of breast cancer. In addition, CIAPIN1 may participate in MDR of breast cancer by regulating P-glycoprotein and P53 expression.

Phytotreatment of sewage sludge contaminated by heavy metals and PAHs by co-planting Sedum alfredii and Alocasia marorrhiza

High concentrations of heavy metals and organic pollutants in municipal sewage sludge are key factors limiting its use in agriculture. The objectives of this study were to decrease the heavy metal and polycyclic aromatic hydrocarbon concentrations in sewage sludge by phytotreatment and to determine, in a field experiment, whether co-planting is more effective than using a mono-crop of Sedum alfredii. Four treatments were used in the plot experiment: no sludge, no plants, S. alfredii and co-planting S. alfredii and Alocasia marorrhiza. The results showed that co-planting produced tubers and shoots of A. marorrhiza that were suitable as a safe animal feed and good organic K fertilizer, respectively. Co-planting was more effective than mono-planting at reducing concentrations of total Zn and diethylenetriaminepentaacetic acid (DTPA)-extractable Zn, Cd, and Cu in the sludge. Co-planting decreased the concentrations of DTPA-extractable heavy metals and benzo[a]pyrene (B[a]P) in the sludge significantly compared with the unplanted sludge. Decreases of 87, 75, 85, 31, and 64% were obtained for B[a]P and DTPA-extractable Zn, Cd, Cu, and Pb, respectively, compared with the fresh sludge. These results indicate that co-planting can reduce significantly the environmental risks associated with heavy metals and B[a]P in sewage sludge for further disposal.

Lapatinib, a dual inhibitor of epidermal growth factor receptor and human epidermal growth factor receptor 2, potentiates the antitumor effects of cisplatin on esophageal carcinoma

Epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) overexpression occurs in over 30% of esophageal carcinomas. Combination therapies of EGFR- and HER2-targeting agents with cytotoxic agents are considered a potential therapeutic strategy for esophageal cancer. The antitumor effects of lapatinib, a dual tyrosine kinase inhibitor of EGFR and HER2, cisplatin alone, and the combination of the two drugs on esophageal cancer cells were evaluated. The growth inhibition activity of lapatinib, cisplatin, and lapatinib plus cisplatin was measured by 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) assays, and the combination index values were calculated. Additionally, cell cycle distribution and cell apoptosis treated with lapatinib or cisplatin alone and the combination of the two drugs were detected by flow cytometry analysis. The activation of EGFR and HER2 signaling pathways was monitored by Western blot analysis. These experimental data showed that the combination of lapatinib and cisplatin synergistically inhibited cell proliferation and exhibited an enhanced pro-apoptotic effect on esophageal cancer cells. The underlying mechanisms of potentiated effects of combined treatment were associated with reduced phosphorylation of EGFR and HER2, and the downstream signaling molecules AKT and extracellular regulated protein kinases (ERK). Our findings indicated that the combination of lapatinib and cisplatin is one of the promising treatment strategies for esophageal carcinomas with EGFR and HER2 overexpression.

Phytoextraction of heavy metals from contaminated soil by co-cropping with chelator application and assessment of associated leaching risk

Phytoextraction using hyperaccumulating plants is generally time-consuming and requires the cessation of agriculture. We coupled chelators and a co-cropping system to enhance phytoextraction rates, while allowing for agricultural production. An experiment on I m3 lysimeter beds was conducted with a co-cropping system consisting of the hyperaccumulator Sedum alfredii and low-accumulating corn (Zea Mays, cv. Huidan-4), with addition ofa mixture of chelators (MC), to assess the efficiency of chelator enhanced co-crop phytoextraction and the leaching risk caused by the chelator. The results showed that the addition of MC promoted the growth of S. alfredii in the first crop (spring-summer season) and significantly increased the metal phytoextraction. The DTPA-extractable and total metal concentrations in the topsoil were also reduced more significantly with the addition of MC compared with the control treatments. However, mono-cropped S. alfredii without MC was more suitable for maximizing S. alfredii growth and therefore phytoextraction of Zn and Cd during the autumn-winter seasons. No adverse impact to groundwater due to MC application was observed during the experiments with three crops and three MC applications. But elevated total Cd and Pb concentrations among subsoils compared to the initial subsoil concentrations were found for the co-crop + MC treatment after the third crop.

Crystalline nanotubes of gamma-AlOOH and gamma-Al2O3: hydrothermal synthesis, formation mechanism and catalytic performance

Crystalline nanotubes of gamma-AlOOH and gamma-Al(2)O(3) have been synthesized. An anionic surfactant-assisted hydrothermal process yields gamma-AlOOH nanotubes, and appropriate calcination treatment of the gamma-AlOOH nanotubes yields gamma-Al(2)O(3) nanotubes. The nanotubes were characterized by XRD, SEM, TEM, TG-DSC, FTIR and nitrogen adsorption-desorption techniques. Both the gamma-AlOOH and gamma-Al(2)O(3) nanotubes are crystalline, with a representative length of approximately 500 nm and diameters of 20-40 nm. The gamma-Al(2)O(3) nanotubes exhibit a very high mesoporous specific surface area (SSA) of 201.0 m(2) g(-1) and a high mesopore volume of 0.68 cm(3) g(-1) with an average mesopore size of 27.7 nm, as well as a high microporous SSA of 186.0 m(2) g(-1) and a micropore volume of 0.08 cm(3) g(-1) with an average micropore size of 0.53 nm. The formation process was discussed and a possible mechanism was proposed, in which a lamellar phase was first formed by camphorsulfonic anions and Al(III) species, and then rolled up to form the crystalline nanotubes under the hydrothermal condition. The catalytic performance of the obtained gamma- Al(2)O(3) nanotubes was tested by using the dehydration of ethanol to ethylene as a probe reaction and it was shown that the obtained gamma- Al(2)O(3) nanotubes catalyst possesses a higher catalytic activity compared with the gamma- Al(2)O(3) nanoparticles.

Effects of exogenous spermidine on subcellular distribution and chemical forms of cadmium in Typha latifolia L. under cadmium stress

The effects of foliar spraying with spermidine (Spd) on the subcellular distribution and chemical speciation of Cd in Typha latifolia L. in hydroponic system were investigated. Increased Cd concentration in the medium caused an increase of Cd concentration in all tissues and all subcellular fractions, with the highest Cd level occurring in roots, followed by rhizomes and leaves and the greatest accumulation was in cell walls, soluble fraction and organelle containing fractions ranked next, respectively. The greatest amount of Cd was found in the extraction of 1 mol.L(-1) NaCl, followed by 2% HAC, deionized water, 80% ethanol, residues and the least in 0.6 mol.L(-1) HCl. The subcellular distribution and different chemical forms of Cd both decreased after Spd application and were more inhibited by 0.25 than 0.50 mmol.L(-1) Spd, especially in roots at 0.10 mmol.L(-1) Cd treatment. It could be suggested that the retention of Cd in roots, cell walls binding with metal, metal ion compartmentation in vacuoles and Cd forms existing in undissolved and integrated with pectates and protein play an important role in Cd detoxification and Spd could enhance the tolerance of cattail to Cd stress.

[Examination and significance of ABR in non-deafness tinnitus patients]

OBJECTIVE

Research on examination and significance of the auditory brain stem response (ABR) in non-hearing loss tinnitus patients.

METHOD

Recording from forehead-mastoid comparing ABR of non-hearing loss tinnitus patients with normal hearing youths.

RESULT

In the tinnitus patients, the prolongate latency percentage of wave I was 51.6%; the wave III was 20.9%; wave V was 17.9%.

CONCLUSION

Although hearing-loss was not founded in the patients, but the cochlea of some patients had been damaged.

Heart hypertrophy induced by levothyroxine aggravates ischemic lesions and reperfusion arrhythmias in rats

AIM

To develop a cardiac hypertrophic model in rats.

METHODS

Rats were i.p. levothyroxine 0.5 mg.kg-1.d-1 x 10 d. The action potentials of right papillary muscles were recorded by standard glass-microelectrode technique. The left coronary artery was ligated followed by reperfusion and the apparent infarcted zone (AIZ) was determined by tetracycline fluoresence, and the superoxide dismutase (SOD) activity and malondialdehyde (MDA) product in myocardium were also measured.

RESULTS

In the rats treated by levothyroxine, the heart was hypertrophic and the action potential duration (APD) and effective refractory period (ERP) were prolonged, the APD20, APD50, APD90, and ERP were prolonged by 80%, 79%, 74%, and 68%, respectively. No changes in resting potential (RP), action potential amplitude (APA), and Vmax were produced. The incidence of heart arrest (8/8) and the risk of death (67 +/- 0) induced by ischemia-reperfusion in rats with hypertrophic heart was higher than those in normal rats (4/10 and 44 +/- 19, respectively). The AIZ was expanded markedly in hypertrophic heart, and attenuated by lidocaine and propranolol.

CONCLUSION

Levothyroxine-induced heart hypertrophy is a suitable model for severe ischemia and arrhythmias in rats.

Lower activation energy for sliding of F-actin on a less thermostable isoform of carp myosin

We have examined the temperature-dependence of sliding velocity of fluorescent F-actin on myosins isolated from 10 degrees C- and 30 degrees C-acclimated carp. Activation energies for the sliding of F-actin were 63 and 111 kJ/mol for the 10 degrees C- and 30 degrees C-acclimated carp myosins, respectively. Arrhenius plots of the sliding velocity from 10 degrees C- and 30 degrees C-acclimated carp myosin were shown to intersect at high temperature (about 30 degrees C). The thermostability estimated by measuring the Ca(2-)-ATPase activity was less for myosin from 10 degrees C- than 30 degrees C-acclimated carp. We suggest that a less thermostable structure in cold-acclimated carp myosin results in a reduced activation energy for the contractile process, which allows the F-actin to slide fast even at low temperatures.

Cervical lymph node metastatic patterns of squamous carcinomas in the upper aerodigestive tract

The radical neck dissection specimens of 384 ethnically Chinese patients with different primary squamous carcinomas in the head and neck region were studied. Over 50 per cent of the specimens showed metastatic disease at one level in the neck. For oral cavity carcinoma, the levels of metastasis frequently involved were I, II and III while for carcinoma of the oropharynx, hypopharynx and larynx the levels were II, III and IV. Extracapsular spread was present in 112/384 of patients (29 per cent) and this increased with advancing N-stages. Based on these findings, different selective neck dissections could be used for patients harbouring different primary head and neck carcinomas with limited neck disease.

Myosin subfragment-1 isoforms having different heavy chain structures from fast skeletal muscle of thermally acclimated carp

Three heavy chain isoforms of chymotryptic myosin subfragment-1 (S1) with different molecular sizes of 96 kDa (H1), 94 kDa (H2), and 92 kDa (H3), were detected in the fast skeletal muscle from thermally acclimated carp. In total, six S1 isoforms were present, including two S1 isoforms for each heavy chain due to associated A1 and A2 light chains. H1 heavy chain was dominant in the 10 degrees C-acclimated carp and responsible for high acto-S1 Mg(2+)-ATPase activity and low thermostability. In contrast, H3 heavy chain predominating in the 30 degrees C-acclimated carp showed low acto-S1 Mg(2+)-ATPase activity and high thermostability. H2 heavy chain was found in the 10- and 20 degrees C-acclimated fish. H3 heavy chain featured three tryptic fragments with normal molecular masses of 25, 50, and 20 kDa in order from the N-terminus. However, H1 heavy chain contained an unusual, longer "20 kDa" peptide whose molecular size was estimated to be about 23 kDa.

Fast skeletal myosin isoforms in thermally acclimated carp

Fast skeletal myosins were isolated from carp acclimated to 10 and 30 degrees C, and their structural and enzymatic properties were compared. Myosins in 0.5 M KCl were subjected to limited proteolysis by using various proteases including alpha-chymotrypsin, trypsin, and papain, and different SDS-PAGE patterns were seen for the 10- and 30 degrees C-acclimated myosins in all cases. Myosin subfragment-1 (S1) prepared from the 10 degrees C-acclimated myosin by alpha-chymotryptic digestion in 0.12 M NaCl showed higher acto-S1 Mg(2+)-ATPase activity and lower thermostability than S1 from the warm-acclimated myosin. The peptide maps and ATP-induced spectral changes of tryptophan fluorescence also showed an obvious difference between the two types of S1. Temperature acclimation further caused changes in the rod region of myosin, since the apparent sizes of light meromyosin were different from each other for the two types of myosin. Myosin from carp acclimated to 20 degrees C showed intermediate properties between those of the 10- and 30 degrees C-acclimated myosins. Myosin isoforms might be expressed in a temperature-dependent manner to compensate for the effect of seasonal environmental temperature variation on swimming ability.

Androgen receptors in laryngeal carcinoma and their clinical significance

Specific radioligand [3H] methyltestosterone incubation and dextran-coated charcoal absorption technique (DCC) were used to test cytosol androgen receptors (AR) of laryngeal carcinoma in 33 patients. In all specimens, high level AR ranged from 3 to 16.9 fmol/mg of cytosol protein (mean 10 +/- 3.9 fmol/mg), and dissociation constant was 1.7 x 10(-9) mole. Laryngeal carcinoma is considered a sex hormone-dependent tumor. High level of AR in laryngeal carcinoma may indicate a super-demand on androgen; when the content of AR increases the tumor proliferates perniciously. Antiandrogen endocrine therapy may be helpful in treating laryngeal carcinoma.