[Torque control of anterior teeth by clear aligners]

Appropriate torque control of anterior teeth is of great significance to obtain ideal orthodontic treatment outcome. Clear aligners are less effective in torque control of anterior teeth due to their special application mode and material properties. Therefore, it is important to investigate how to improve the torque control of anterior teeth by using clear aligners, with the expectation of providing guidance for clinicians. This article discussed the methods to control the torque of anterior teeth by using traditional fixed appliances, the efficiency of clear aligner in controlling the torque of anterior teeth, the difficult points of clear aligner in controlling the torque of anterior teeth and the therapeutic methods to better control the torque of anterior teeth by using clear aligners.

[Automated cephalometric landmark identification and location based on convolutional neural network]

Objective: To develop an automated landmark location system applicable to the case of landmark missing. Methods: Four and eighty-one lateral cephalograms, which contained 240 males and 241 females, with an average age of (24.5±5.6) years, taken from January 2015 to January 2021 in the Department of Orthodontics, Capital Medical University School of Stomatology, and met the inclusion criteria were collected. Five postgraduate orthodontic students were the annotators to manually locate 61 possible landmarks in 481 lateral cephalograms. Two assistant professors in the department as reviewers performed calibration. Two professors as arbitrators, made final decision. Data sets were established (341 were used as training set, 40 as validation set, and 100 as test set). In this paper, an automatic landmarks identification and location model based on convolutional neural networks (CNN), CephaNET, was developed. The model was trained by feeding the original image into the feature extraction module and convolutional pose machine (CPM) module to locate landmarks with high accuracy using deep supervision. Training set was enhanced to 1 684 images by histogram equalization, cropping, and adjustment of brightness. The model was trained to compare the Gaussian heat maps output from the network with the set threshold to identify landmark missing cases. Test set of 100 lateral cephalograms was used to test the accuracy of the model. The evaluation criteria used were success detection rate of missing landmark, mean radial error (MRE) and success detection rate (SDR) in the range of 2.0, 2.5, 3.0, 3.5 and 4.0 mm. Results: The model identified and located 61 commonly used landmarks in 0.13 seconds on average. It had an average accuracy of 93.5% in identifying missing landmarks. The MRE of our testing set was (1.19±0.91) mm. SDR of 2.0, 2.5, 3.0, 3.5 and 4.0 mm were 85.4%, 90.2%, 93.5%, 95.4%, 97.0% respectively. Conclusions: The model proposed in this paper could adapt to the absence of landmark in lateral cephalograms and locate 61 commonly used landmarks with high accuracy to meet the requirements of different cephalometric analysis methods.

[Automated diagnostic classification with lateral cephalograms based on deep learning network model]

Objective: To establish a comprehensive diagnostic classification model of lateral cephalograms based on artificial intelligence (AI) to provide reference for orthodontic diagnosis. Methods: A total of 2 894 lateral cephalograms were collected in Department of Orthodontics, Capital Medical University School of Stomatology from January 2015 to December 2021 to construct a data set, including 1 351 males and 1 543 females with a mean age of (26.4± 7.4) years. Firstly, 2 orthodontists (with 5 and 8 years of orthodontic experience, respectively) performed manual annotation and calculated measurement for primary classification, and then 2 senior orthodontists (with more than 20 years of orthodontic experience) verified the 8 diagnostic classifications including skeletal and dental indices. The data were randomly divided into training, validation, and test sets in the ratio of 7∶2∶1. The open source DenseNet121 was used to construct the model. The performance of the model was evaluated by classification accuracy, precision rate, sensitivity, specificity and area under the curve (AUC). Visualization of model regions of interest through class activation heatmaps. Results: The automatic classification model of lateral cephalograms was successfully established. It took 0.012 s on average to make 8 diagnoses on a lateral cephalogram. The accuracy of 5 classifications was 80%-90%, including sagittal and vertical skeletal facial pattern, mandibular growth, inclination of upper incisors, and protrusion of lower incisors. The acuracy rate of 3 classifications was 70%-80%, including maxillary growth, inclination of lower incisors and protrusion of upper incisors. The average AUC of each classification was ≥0.90. The class activation heat map of successfully classified lateral cephalograms showed that the AI model activation regions were distributed in the relevant structural regions. Conclusions: In this study, an automatic classification model for lateral cephalograms was established based on the DenseNet121 to achieve rapid classification of eight commonly used clinical diagnostic items.

[Research on multi-class orthodontic image recognition system based on deep learning network model]

Objective: To develop a multi-classification orthodontic image recognition system using the SqueezeNet deep learning model for automatic classification of orthodontic image data. Methods: A total of 35 000 clinical orthodontic images were collected in the Department of Orthodontics, Capital Medical University School of Stomatology, from October to November 2020 and June to July 2021. The images were from 490 orthodontic patients with a male-to-female ratio of 49∶51 and the age range of 4 to 45 years. After data cleaning based on inclusion and exclusion criteria, the final image dataset included 17 453 face images (frontal, smiling, 90° right, 90° left, 45° right, and 45° left), 8 026 intraoral images [frontal occlusion, right occlusion, left occlusion, upper occlusal view (original and flipped), lower occlusal view (original and flipped) and coverage of occlusal relationship], 4 115 X-ray images [lateral skull X-ray from the left side, lateral skull X-ray from the right side, frontal skull X-ray, cone-beam CT (CBCT), and wrist bone X-ray] and 684 other non-orthodontic images. A labeling team composed of orthodontic doctoral students, associate professors, and professors used image labeling tools to classify the orthodontic images into 20 categories, including 6 face image categories, 8 intraoral image categories, 5 X-ray image categories, and other images. The data for each label were randomly divided into training, validation, and testing sets in an 8∶1∶1 ratio using the random function in the Python programming language. The improved SqueezeNet deep learning model was used for training, and 13 000 natural images from the ImageNet open-source dataset were used as additional non-orthodontic images for algorithm optimization of anomaly data processing. A multi-classification orthodontic image recognition system based on deep learning models was constructed. The accuracy of the orthodontic image classification was evaluated using precision, recall, F1 score, and confusion matrix based on the prediction results of the test set. The reliability of the model's image classification judgment logic was verified using the gradient-weighted class activation mapping (Grad-CAM) method to generate heat maps. Results: After data cleaning and labeling, a total of 30 278 orthodontic images were included in the dataset. The test set classification results showed that the precision, recall, and F1 scores of most classification labels were 100%, with only 5 misclassified images out of 3 047, resulting in a system accuracy of 99.84%(3 042/3 047). The precision of anomaly data processing was 100% (10 500/10 500). The heat map showed that the judgment basis of the SqueezeNet deep learning model in the image classification process was basically consistent with that of humans. Conclusions: This study developed a multi-classification orthodontic image recognition system for automatic classification of 20 types of orthodontic images based on the improved SqueezeNet deep learning model. The system exhibitted good accuracy in orthodontic image classification.

[Ability and inability of artificial intelligence in orthodontics]

With the development of artificial intelligence (AI) technology, it has a wide range of explorations in orthodontics. AI has greater application prospects in precise measurement, multidimensional diagnosis, treatment planning and efficacy prediction. At the same time, there are certain limitations in the application of AI, such as risks caused by individual variability, black box properties and unclear delineation of medical responsibilities. This paper summarized the history and current status of AI applications in orthodontics and discussed future development trends, to provide reference for clinical orthodontics.

[Development and validation of prognostic nomogram for malignant pleural mesothelioma]

Objective: To development the prognostic nomogram for malignant pleural mesothelioma (MPM). Methods: Two hundred and ten patients pathologically confirmed as MPM were enrolled in this retrospective study from 2007 to 2020 in the People's Hospital of Chuxiong Yi Autonomous Prefecture, the First and Third Affiliated Hospital of Kunming Medical University, and divided into training (n=112) and test (n=98) sets according to the admission time. The observation factors included demography, symptoms, history, clinical score and stage, blood cell and biochemistry, tumor markers, pathology and treatment. The Cox proportional risk model was used to analyze the prognostic factors of 112 patients in the training set. According to the results of multivariate Cox regression analysis, the prognostic prediction nomogram was established. C-Index and calibration curve were used to evaluate the model's discrimination and consistency in raining and test sets, respectively. Patients were stratified according to the median risk score of nomogram in the training set. Log rank test was performed to compare the survival differences between the high and low risk groups in the two sets. Results: The median overall survival (OS) of 210 MPM patients was 384 days (IQR=472 days), and the 6-month, 1-year, 2-year, and 3-year survival rates were 75.7%, 52.6%, 19.7%, and 13.0%, respectively. Cox multivariate regression analysis showed that residence (HR=2.127, 95% CI: 1.154-3.920), serum albumin (HR=1.583, 95% CI: 1.017-2.464), clinical stage (stage Ⅳ: HR=3.073, 95% CI: 1.366-6.910) and the chemotherapy (HR=0.476, 95% CI: 0.292-0.777) were independent prognostic factors for MPM patients. The C-index of the nomogram established based on the results of Cox multivariate regression analysis in the training and test sets were 0.662 and 0.613, respectively. Calibration curves for both the training and test sets showed moderate consistency between the predicted and actual survival probabilities of MPM patients at 6 months, 1 year, and 2 years. The low-risk group had better outcomes than the high-risk group in both training (P=0.001) and test (P=0.003) sets. Conclusion: The survival prediction nomogram established based on routine clinical indicators of MPM patients provides a reliable tool for prognostic prediction and risk stratification.

[Comparison of the efficacy and safety of 2 low-dose rituximab regimens in the second-line treatment of primary immune thrombocytopenia in children]

Objective: To compare the efficacy and safety of 2 low-dose rituximab regimens in the treatment of children with primary immune thrombocytopenia (ITP). Methods: A total of 90 ITP children admitted to the Hematology Oncology Center of Beijing Children's Hospital from January 2018 to March 2021 were enrolled in this prospective cohort study. In the single-dose group, rituximab was given with a single dose of 375 mg/m² (maximum dose 600 mg). In the 4-dose group, rituximab was given with a dose of 100 mg weekly (if body weight of the patient ≥ 30 kg, increase dosage to 200 mg weekly) for 4 weeks. Wilcoxon Mann-Whitney test, Chi-square test and Fisher's exact test were used to analyze the difference in efficacy, safety and treatment burden between two groups. Results: Among the 90 children, 41 were male and 49 were female, and the age of medication was 6.8 (4.1,10.0) years. There were 27 cases in the single-dose group and 63 cases in the 4-dose group.There were no significant differences in overall response rate, complete response rate and partial response rate between the single-dose group and 4-dose group (41% (11/27) vs. 33% (21/63), 26% (7/27) vs. 19% (12/63), 15% (4/27) vs. 14%(9/63), χ²=0.45, 0.54, 0.00, all P>0.05). The single-dose group was earlier to get overall response than the 4-dose group (1 (1, 1) vs. 3 (2, 6) weeks, Z=-3.24, P=0.001). There were no significant differences in the sustained response rate, the overall response rate in 1 year, the complete response rate in 1 year, and the partial response rate in 1 year between the single-dose group and the 4-dose group (33% (9/27) vs. 30% (19/63), 30% (8/27) vs. 24% (15/63), 19% (5/27) vs. 14% (9/63), 11% (3/27) vs. 10% (6/63), χ²=0.09, 0.34, 0.04, 0.00, all P>0.05). There were no significant differences in the duration of overall response, recurrence rate within half a year and one year, recurrence time and rate of adverse events between the single-dose group and 4-dose group (all P>0.05). The number of hospitalizations, the duration of hospital stays and the dosage of the single-dose group were significantly lower than those of the 4-dose group (1 (1, 1) vs. 4 (4, 4) times, 5 (4, 7) vs. 8 (5, 8) d, 400 (250, 500) vs. 400 (400, 800) mg, Z=-8.67, -3.03, -4.05, all P<0.05). Conclusions: The single-dose rituximab regimen is comparable to 4-dose rituximab regimen in effectiveness and safety for treatment of children ITP, but more economical and convenient. The single-dose rituximab regimen is more suitable for the second-line treatment of children ITP.

[Early orthodontic treatment of malocclusion in the mixed dentition]

Children in the mixed dentition grow rapidly, and various types of malocclusion often appear in this period. At the same time, there are many environmental factors affecting the development of the occlusion at this stage. Functional abnormalities related to lip, tongue, articulation and breathing, and impacted teeth should be actively intervened and blocked to avoid the continued development of the deformity. Appropriate orthopedic devices should be used in patients with skeletal malocclusion, if necessary, for growth modification and the influence of congenital factors and the prognosis of treatment should be fully evaluated. Over-intervention of the temporary malocclusions in the mixed dentition should be avoided. In conclusion, early orthodontic treatment in the mixed dentition requires a comprehensive assessment of the treatment need, risks, timing, cost and the ultimate benefit of the patient. The timing of orthodontic treatment is not the sooner the better. The indications must be strictly controlled, and the necessity and limitations must be carefully considered.

Time Frame Analysis of Potassium Nitrate and Hydrogen Peroxide Diffusion into the Pulp Chamber

OBJECTIVES

The primary objective of this study was to evaluate the effect of an innovative double-layer, single-application desensitizing/whitening technique of potassium nitrate (PN) and hydrogen peroxide (HP) diffusion at different time points.

METHODS AND MATERIALS

Specimens were prepared from extracted caries-free human molars (n=90). Teeth were randomly assigned into four groups: Group A (HP CTRL) treated with 25% HP for 45 minutes, group B (PN CTRL) received a single-layer treatment of 5% PN for 45 minutes, group C received the double-layer treatment of 5% PN and 25% HP for 45 minutes, and group D received a 3% PN incorporated in a 40% HP gel for 45 minutes. PN and HP concentrations were measured at 5, 15, 30, and 45 minutes using standard chemical kits. Group comparisons were made using a repeated measures analysis of variance (ANOVA) test. Pairwise tests for differences in diffusion were done, using the Tukey adjustment of p values for multiple comparisons. A significance level of 5% was used.

RESULTS

Group A showed no significant difference in HP diffusion rates between the 5- and 15- minute, 15- and 30-minute, or 30- and 45-minute time points; group D showed a similar trend; however, group C differed significantly at the 5-and 15-minute time points (p=0.0004), at the 15-and 30-minute time points (p=0.0026), and the 30- and 45-minute time points (p=0.0014). For PN diffusion, groups B and C had significantly different levels at the 15-, 30-, and 45-minute time points (p=0.0005, p=0.0002, and p<0.0001, respectively); and at the 15-, 30-, and 45-minute time points, groups D and C had significantly different PN diffusion (p=0.0327, p=0.0004, and p< 0.0001, respectively). Group C had significantly different PN diffusion at the 5- and 15-minute time points (p=0.0004), the 15- and 30-minute time points (p=0.0026), and at the 30- and 45-minute time points (p=0.0014).

CONCLUSION

The double-layer technique showed superior diffusion of PN into the pulp chamber and did not affect the diffusion of HP when compared to other techniques. The double-layer technique may be suggested as an alternative tooth-whitening treatment to minimize tooth sensitivity.

Hopes and Wishes of Clients with Mentally Illness in Hong Kong

Recovery is a progressive process involving support to people with mental illness to take control of their life through the enhancement of motivation, self-drive, and responsibility. Drawing on qualitative interviews with 61 patients with mental illness aged between 40 and 75 in the community or residential settings, this study examined the wishes and hopes of clients who were in recovery. Participants described wishes and hopes for autonomy and independence in finances, accommodation, and health; stable housing or accommodation; meaningful occupation or employment; 'giving back' to society by serving others; intimate relationships; and gaining back 'lost time.' Wishes and hopes were motivating factors contributing to physical, mental, and social health over time, motivating clients with mental illness to live happily. To foster recovery, mental health practitioners should consider the identification and fulfilment of wishes and hopes in health and social care programs for this unique client group.

Electronic dental record-based surveillance of non-communicable conditions

OBJECTIVE

The objective of the study is to demonstrate that electronic dental records (EDRs) can be used to mine meaningful public health information.

STUDY DESIGN

Retrospective electronic dental chart-based reporting of disease prevalence.

METHODS

Using dental EDRs (N = 104,768), the authors assessed the prevalence of common non-communicable medical conditions among unique patients seen at a United States (U.S.) dental college.

RESULTS

The prevalence of following conditions in patients visiting a U.S. dental college increased steadily with increasing age: hypertension, angina, stroke, myocardial infarction, congestive heart failure, diabetes, cancer, kidney disease, thyroid disease, and allergies. Prevalence of these conditions was several-fold higher in the 66+ years group than among younger adults. Prevalence of many of the assessed conditions approximated published national estimates.

CONCLUSIONS

In addition to the indispensable use of EDRs in dental education and patient management, EDRs can be mined to report on prevalence of non-communicable medical conditions among patients/population receiving dental care. Completeness and accuracy of entered information will significantly improve the usefulness of EDR for disease surveillance and research applications.

The experience of growing old in chronic mental health patients

Objectives: Research evidence has demonstrated disparities and barriers associated with mental illness, which creates challenges for individuals with mental illness to maintain physical, mental, and social health as they age. The aim of this study was to examine the meaning of aging from the perspective of individuals with mental illness and explore their motivations and challenges to adopting healthy aging lifestyles and practices.Method: Using a qualitative narrative inquiry approach, interviews were conducted with 61 aging patients with mental illness aged 40 and older in community and institutional settings in Hong Kong.Results: Participants discussed the meaning of healthy aging in terms of meaningful occupation and use of time, and independence and autonomy. Motivating factors included a desire to avoid 'burdening' other people, to 'give back' to society, and gain back 'lost time'. These were connected to strategies for healthy aging, including social relationships and activities, spirituality, and healthy lifestyles. Challenges to adopting healthy aging practices included physical health difficulties and medication side effects, lack of purpose and boredom associated with daily routines and use of time, and conflicts and loss affecting family and peer relationships.Conclusion: Social and health services should be tailored to support aging individuals with mental illness and their families, addressing motivations and barriers to adopting healthy lifestyles. Promoting healthy aging practices to enable individuals with mental illness to achieve healthy aging is important for preparing for the aging of this population.

[Clear aligner technique in early treatment of malocclusion]

The application of clear aligner technique in the preventive and interceptive treatment of children with malocclusion is a new hot spot in orthodontics, which has an extensive application prospect. However, the main advantage of this technique is the ability of predictable tooth movements. Early treatment of malocclusion often involves many aspects, such as muscle function adjustment, orthopedic treatment, and dentition replacement monitoring, etc. Therefore, the indications should be strictly controlled to avoid abusing the technique. The digital treatment planning, clinical monitoring also should be deliberated. The key point is how to avoid the shortcomings of the technique, and to provide a more comfortable and effective early treatment method for children.

[The analysis of the curative effect of low-temperature plasma cauterization on the treatment of 146 cases of congenital pyriform sinus fistula]

Objective:To investigate the therapeutic effect of low-temperature plasma cauterization on the treatment of congenital pyriform sinus fistula(CPSF).Method:All the 146 patients with CPSF received imaging examination, and the low-temperature plasma cauterization under laryngoscope was performed in the stage of inflammation control.Result:After 6-59 months of follow-up, all patients did not have pharynx fistula, and no massive hemorrhage occurred during and after operation. Nine cases of hoarseness after operation 2 d-1 months to restore normal. Thirty cases were suspected of recurrence, of which 8 cases were cured after incision and drainage, and 4 cases were cured after two cauterization.Conclusion:Low-temperature plasma cauterization is the preferred treatment for the microinvasive, simple, beautiful and repeatable operation of PSF, which can be sugessted as the first-line choice for the treatment of sinus and fistula.

Copy number variation identification and analysis of the chicken genome using a 60K SNP BeadChip

Copy number variation (CNV) is an important source of genetic variation in organisms and a main factor that affects phenotypic variation. A comprehensive study of chicken CNV can provide valuable information on genetic diversity and facilitate future analyses of associations between CNV and economically important traits in chickens. In the present study, an F2 full-sib chicken population (554 individuals), established from a cross between Xinghua and White Recessive Rock chickens, was used to explore CNV in the chicken genome. Genotyping was performed using a chicken 60K SNP BeadChip. A total of 1,875 CNV were detected with the PennCNV algorithm, and the average number of CNV was 3.42 per individual. The CNV were distributed across 383 independent CNV regions (CNVR) and covered 41 megabases (3.97%) of the chicken genome. Seven CNVR in 108 individuals were validated by quantitative real-time PCR, and 81 of these individuals (75%) also were detected with the PennCNV algorithm. In total, 274 CNVR (71.54%) identified in the current study were previously reported. Of these, 147 (38.38%) were reported in at least 2 studies. Additionally, 109 of the CNVR (28.46%) discovered here are novel. A total of 709 genes within or overlapping with the CNVR was retrieved. Out of the 2,742 quantitative trait loci (QTL) collected in the chicken QTL database, 43 QTL had confidence intervals overlapping with the CNVR, and 32 CNVR encompassed one or more functional genes. The functional genes located in the CNVR are likely to be the QTG that are associated with underlying economic traits. This study considerably expands our insight into the structural variation in the genome of chickens and provides an important resource for genomic variation, especially for genomic structural variation related to economic traits in chickens.

Insulin receptor binding motif tagged with IgG4 Fc (Yiminsu) works as an insulin sensitizer to activate Akt signaling in hepatocytes

Insulin resistance is a key feature of obesity and type 2 diabetes mellitus (T2DM). Interaction of insulin with the insulin receptor (IR) leads to both its auto-phosphorylation and phosphorylation of tyrosine residues on the IR substrate (IRS) proteins, initiating the activation of intracellular signaling cascades. The metabolic effects of IRS are known to be mediated through pathways involving phosphatidyl-inositol 3-kinase (PI-3K), which result in the activation of Akt signaling. The C-terminal region of the IR ectodomain is required to facilitate the conformational changes that are required for high-affinity binding to insulin. Furthermore, the CH2 and CH3 domains in the Fc fragments of immunoglobulins are responsible for their binding to the Fc receptor, which triggers transcytosis. In this study, we created a fusion peptide of the C-terminal end of the human IR ectodomain with the IgG4 Fc fragment, including an intervening polyG fragment to ensure enough space for insulin binding. We named this new peptide "Yiminsu", meaning an insulin sensitizer. The results of our analyses show that Yiminsu significantly facilitates insulin signaling via the activation of Akt in hepatocytes in a dose- and time-dependent manner. Further studies are required to determine whether Yiminsu can act as an insulin sensitizer.

δ34S and δ18O of dissolved sulfate as biotic tracer of biogeochemical influences on arsenic mobilization in groundwater in the Hetao Plain, Inner Mongolia, China

Environmental isotopology of sulfur and oxygen of dissolved sulfate in groundwater was conducted in the Hetao Plain, northwestern China, aiming to better understand the processes controlling arsenic mobilization in arsenic-rich aqueous systems. A total of 22 groundwater samples were collected from domestic wells in the Hetao Plain. Arsenic concentrations ranged from 11.0 to 388 μg/L. The δ(34)S-SO4 and δ(18)O-SO4 values of dissolved sulfate covered a range from +1.48 to +22.4‰ and +8.17‰ to +14.8‰ in groundwater, respectively. The wide range of δ(34)S-SO4 values reflected either an input of different sources of sulfate, such as gypsum dissolution and fertilizer application, or a modification from biogeochemical process of bacterial sulfate reduction. The positive correlation between δ(34)S-SO4 and arsenic concentrations suggested that bacteria mediated processes played an important role in the mobilization of arsenic. The δ(18)O-SO4 values correlated non-linearly with δ(34)S-SO4, but within a relatively narrow range (+8.17 to +14.8‰), implying that complexities inherent in the sulfate-oxygen (O-SO4(2-)) origins, for instance, water-derived oxygen (O-H2O), molecular oxygen (O-O2) and isotope exchanging with dissolved oxides, are accounted for oxygen isotope composition of dissolved sulfate in groundwater in the Hetao Plain.

[Developmental expression of Arabidopsis methyltransferase genes MET1, DRM2 and CMT3]

Cytosine methylation is an epigenetic mark found in the genome of fungi, plants, and animals. DNA methylation is catalyzed by DNA methyltransferases. The function of DNA methyltransferases was shown to be highly conversed, but biological role of these enzymes has not been clearly defined. We generated transgenic plants expressing METHYLTRANSFERASES::GUS reporter genes for three major DNA methyltransferases (MET1, DRM2 and CMT3) to gain insight into the potential physiological relevance of the distinct members of the DNA methyltransferase family in Arabidopsis thaliana, and to investigate the expression patterns in detail. We found that METHYLTRANSFERASE::GUS genes display unique tissue, cell-type, and temporal patterns of expression throughout normal development, particularly in the flower. Our findings are supported by semi-quantitative reverse-transcription PCR, as well as by analyses of microarray databases. These data suggest that DNA methyltransferase may contribute to morphogenesis at every developmental stage and in every plant organ.

Differentiation of colonic polyps by confocal laser endomicroscopy

BACKGROUND AND STUDY AIM

The real-time identification and removal of adenomas is a cost-effective strategy to improve the prognosis of colorectal cancer. Confocal laser endomicroscopy (CLE) could provide real-time histological-level observation. We aimed to evaluate the efficacy of CLE diagnosis using a simple classification system that differentiates adenomas from non-neoplastic polyps with intravenous fluorescein staining alone.

PATIENTS AND METHODS

An endoscope integrated confocal laser microscopy system was used in this study. CLE images of 35 colonic polyps, including 15 hyperplastic polyps and 20 adenomas confirmed by histology, were first evaluated to develop criteria for diagnosis of neoplastic and non-neoplastic polyps. The diagnostic criteria included goblet cell depletion, villous architecture, and microvascular alterations. We then performed a prospective study of colonic polyps found during CLE and classified them according to the established criteria. A total of 115 patients with 115 colonic polyps were included. The real-time CLE diagnosis was compared with that from histology. The stored CLE images were evaluated later by a blinded observer.

RESULTS

The sensitivity, specificity, positive predictive value, and negative predictive value of real-time CLE in identifying colonic adenomas were 93.9 % (95 % confidence interval [CI] 85.4 - 97.6), 95.9 % (95 % CI 86.2 - 98.9), 96.9 % (95 % CI 89 - 99), and 92.2 % (95 % CI 81 - 97), respectively, compared with histological results. Interobserver agreement between real-time and post-CLE still-image evaluation was excellent (kappa = 0.929). Goblet cell depletion alone had a sensitivity of 84.9 % (95 % CI 73 - 92) and a specificity of 87.8 % (95 % CI 75 - 95), as well as excellent interobserver agreement (kappa = 0.824).

CONCLUSIONS

Endoscope integrated CLE with fluorescein staining may reliably assist in the real-time identification of colonic adenomas. Among three diagnostic categories, goblet cell depletion can be used to distinguish adenomas and hyperplastic polyps.

An epidemiological survey of low back pain and axial spondyloarthritis in a Chinese Han population

OBJECTIVE

To investigate the prevalence of low back pain (LBP) and axial spondyloarthritis (SpA) in a Chinese Han population.

METHODS

A face-to-face investigation was performed in the Han population of Dalang Town, Yangshan County, Guangdong Province, China, using a questionnaire established in France in 1999. First the clinical features associated with SpA were investigated, then the human leucocyte antigen (HLA)-B27 and sacroiliac joint radiographic examinations were carried out. Finally, the diagnosis of SpA was determined by rheumatologists.

RESULTS

A total of 13 315 subjects participated in the study and 10 921 were aged >16 years; of these, 787 (7.21%) had LBP. There were 92 axial SpA patients (0.782% in subjects >16 years old and 11.96% in subjects with LBP). There were 29 (0.253%) cases of ankylosing spondylitis (AS), 60 (0.507%) undifferentiated axial SpA (USpA), and three (0.022%) psoriatic arthritis (PsA). Patients in the SpA groups had higher percentages in onset <40 years, insidious onset, morning stiffness, and affected for >3 months compared with those in other LBP groups. Simultaneous symptoms associated with spondylitis, such as buttock pain, heel pain, psoriasis, and SpA family history, were more commonly present. Of the axial SpA patients, 82.67% were HLA-B27 positive, clearly a greater percentage than those (11.65%) in other LBP groups.

CONCLUSIONS

The survey questionnaire for SpA in this study is useful for axial SpA screening in China. In southern China, the prevalence of LBP is 7.21%. The prevalence of axial SpA is 0.782%. USpA is the most common subtype of SpA, followed by AS.

Cyclosporin A pre-incubation attenuates hypoxia/reoxygenation-induced apoptosis in mesenchymal stem cells

Although mesenchymal stem cells (MSCs) are being tested for cardiac repair, the majority of transplanted cells undergo apoptosis in the ischaemic heart because of the effects of ischaemia/reperfusion, poor blood supply and other pro-apoptotic factors. Several experimental and clinical studies have suggested that cyclosporin A (CsA) treatment reduces apoptosis in human endothelial cells and neurocytes. However, the effect of CsA on the apoptosis in MSCs is still unclear. In this study, we investigated whether CsA could inhibit hypoxia/ reoxygenation (H/R)-induced apoptosis in MSCs. MSCs pre-incubated with or without CsA were subjected to 6 h of hypoxia followed by 12 h of reoxygenation. Our data showed that pre-incubation with 0.5-5 microM CsA dose-dependently protected the MSCs from H/R injury, as evidenced by decreased apoptosis and increased cell viability. CsA inhibited the H/R-induced translocation of cytochrome c, increased bcl-2 expression and restored mitochondrial membrane potential. CsA also increased the expression of p-BAD. We propose that preincubation MSCs with CsA inhibits MSC apoptosis through the mitochondrial and BAD pathway.

Nutritional homeostasis in carnivorous southern catfish (Silurus meridionalis): is there a mechanism for increased energy expenditure during carbohydrate overfeeding?

In previous growth experiments with carnivorous southern catfish (Silurus meridionalis), the non-fecal energy lose was positively related to dietary carbohydrate level. To test whether metabolic energy expenditure accounts for such energy loss, an experiment was performed with southern catfish juveniles (33.2-71.9 g) to study the effect of dietary carbohydrate level on fasting metabolic rate and specific dynamic action (SDA) at 27.5 degrees C. The fasting metabolic rate in this catfish was increased with dietary carbohydrate level, and the specific dynamic action (SDA) coefficient (energy expended on SDA as percent of assimilated energy) was not affected by dietary carbohydrate level. The results suggest that in southern catfish, carbohydrate overfeeding increases metabolic rate to oxidize unwanted assimilated carbohydrate. A discussion on the poor capacity of intermediate metabolism for adapting dietary carbohydrate in carnivorous fish and its possible relationship with facultative component of SDA was also documented in this paper.

Effect of meal size on postprandial metabolic response in southern catfish (Silurus meridionalis)

Effect of relative meal size (0.6-24%) on specific dynamic action (SDA) was assessed in southern catfish juveniles (48.2+/-3.2 g) at 27.5 degrees C. Cutlets of freshly killed loach species were used as test diet. Energy expended during SDA was linearly correlated with relative meal size (r=0.949, p<0.001, N=47). There was no significant difference in SDA coefficient (energy expended on SDA quantified as a percentage of the energy content of the meal) among different relative meal size groups. Factorial metabolic scope increased from 1.47 to 4.08 when the relative meal size increased from 0.6% to 24%. The peak V O2 increased with meal size, but levelled when relative meal size gradually increased to the maximum. SDA duration showed a S-type (slow-fast-slow) increase course with increased meal size. The results of this study suggest that the high postprandial factorial metabolic scope and a trapezoid SDA curve might be the adaptation strategy of warm water sit-and-wait fish under the natural selection of evolution related to long-term food resources.

Field studies on 32P movement and P leaching from flooded paddy soils in the region of Taihu Lake, China

Field experiments were done in two sites, Yixing and Changshu, Jiangsu province, China, to study P movement and leaching in flooded paddy soils. P movement in soil was investigated by using the KH2 32PO4 tracker method, and the amount of P leached from the soil layer in different depths was estimated by measuring P concentrations in the soil solution and saturated hydraulic conductivities in field. Determination was done about one month after P application. There was 46% and 42% of total 32P retained in the 0-5cm layer of soil in the Yixing site and in the Changshu site respectively. The 32P retained in the 25-30 cm layer was only about 1-2% of the total 32P added. Furthermore, 8.01% of 32P in the soil of Yixing site and 16.8% of 32P in the soil of Changshu site was lost from the layer 0-30 cm soil. The seasonal amounts of P leached from the top soil layer and from bottom layer are about 4.5-5.8% and 1.6-2.1% of the total P application, respectively. Changes of total P concentrations in soil solutions during rice growth showed that the fertilizer P applied before flooding of the paddy fields suffered a flash leaching loss and a slow leaching loss. We concluded that the fertilizer P could quickly move in the flooded paddy rice field and parts of it can enter into surface water and ground water. Unless the P application is well managed the risk of P loss and consequently environmental pollution exist.

Effect of smear layer on root demineralization adjacent to resin-modified glass ionomer

The cariostatic effect of resin-modified glass ionomer (RMGI) on secondary root caries is well-documented. However, this beneficial effect may be dependent upon the mode of cavity surface treatment. To investigate this relationship, we studied 4 cavity surface treatments prior to the placement of RMGI: no treatment (None), polyacrylic acid (PAA), phosphoric acid (H(3)PO(4)), and Scotchbond Multi-Purpose adhesive (SMP) as a control. Specimens were aged for two weeks in synthetic saliva, thermocycled, and subjected to an artificial caries challenge (pH 4.4). Polarized light microscopy (PLM) and microradiography (MRG) showed significantly less demineralization with the H(3)PO(4) cavity surface treatment as revealed by ANOVA and Tukey's multiple comparisons (p < or = 0.05). Dentin fluoride profiles determined by electron probe microanalysis (EPMA) supported PLM and MRG findings. It may be concluded that removal of the smear layer with phosphoric acid provides significantly enhanced resistance to secondary root caries formation adjacent to RMGI restorations.

Endoscopic screening and determination of p53 and proliferating cell nuclear antigen in esophageal multistage carcinogenesis: a comparative study between high- and low-risk populations in Henan, northern China

The objective of this study was to characterize the histologic changes from endoscopic screening for early esophageal cancer (EC) on subjects at high-incidence area (HIA) and low-incidence area (LIA) in Henan, China, and to further compare the changes in p53 and proliferating cell nuclear antigen (PCNA) in the multistage of human esophageal carcinogenesis from these two populations. The detection rate of basal cell hyperplasia (BCH) and dysplasia (DYS) was higher in the subjects from HIA than in those from LIA. Out of the 1568 symptom-free subjects examined at HIA, 10 (0.6%) cases with early squamous cell carcinoma (SCC) were identified. Immunoreactivity of p53 and PCNA was observed in cell nuclei of esophageal biopsies and surgically resected esophageal cancer specimens both in HIA and LIA. With the lesions progressed from normal epithelium to BCH to DYS to SCC, the positive-immunostaining cells expanded from basal layer to superficial layer, and the number of positive cells/mm2 for p53 and PCNA increased, and was significantly higher in HIA than in LIA among the similar morphological lesions (P < 0.01). The number of p53 positive cells/mm2 in SCC from HIA was almost fivefold higher than SCC from LIA (P < 0.01). The remarkable difference was also observed between HIA and LIA in DYS and BCH. The present results indicate that p53 protein accumulation is an important early biomarker for identifying high-risk subjects for EC.

Immunogene therapy of tumors with vaccine based on Xenopus homologous vascular endothelial growth factor as a model antigen

Overcoming immune tolerance of the growth factors associated with tumor growth should be a useful approach to cancer therapy by active immunity. We used vascular endothelial growth factor (VEGF) as a model antigen to explore the feasibility of the immunogene tumor therapy with a vaccine based on a single xenogeneic homologous gene, targeting the growth factors associated with angiogenesis. To test this concept, we constructed a plasmid DNA encoding Xenopus homologous VEGF (XVEGF-p) and control vectors. We found that immunogene tumor therapy with a vaccine based on XVEGF was effective at both protective and therapeutic antitumor immunity in several tumor models in mice. VEGF-specific autoantibodies in sera of mice immunized with XVEGF-p could be found in Western blotting analysis and ELISA assay. The purified immunoglobulins were effective at the inhibition of VEGF-mediated endothelial cell proliferation in vitro, and at antitumor activity and the inhibition of angiogenesis by adoptive transfer in vivo. The elevation of VEGF in the sera of the tumor-bearing mice could be abrogated with XVEGF-p immunization. The antitumor activity and production of VEGF-specific autoantibodies, significantly elevated IgG1 and IgG2b, could be abrogated by the depletion of CD4(+) T lymphocytes. The observations may provide a vaccine strategy for cancer therapy through the induction of autoimmunity against the growth factors associated with tumor growth in a cross reaction with single xenogeneic homologous gene and may be of importance in the further exploration of the applications of other xenogeneic homologous genes identified in human and other animal genome sequence projects in cancer therapy.

Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly

Poor dietary habits and inadequate nutrient intakes are of concern in the elderly. The nutritional characteristics of those who survive to become the oldest are not well defined. Our goal was to describe dietary habits, nutrient intakes and nutritional risk of community-dwelling, rural Iowans, 79 y of age and older. Subjects were interviewed (n = 420) using a standardized format on one occasion in their homes and instructed to complete 3-d diet records (n = 261) after the in-home interview. Standardized interviews assessed demographic information, cognitive function and dietary habits (Nutrition Screening Initiative Checklist). Adequate nutrient intake was defined as consumption of the nutrient's estimated average requirement, 67% adequate intake or 67% recommended dietary allowance. Mean age was 85.2 y, 57% lived alone and 58% were widowed. Subjects completing 3-d diet records were younger, more cognitively intact and less likely to be at nutritional risk than subjects not completing diet records. The percentage of subjects with inadequate intakes of selected nutrients was 75% for folate, 83% for vitamin D and 63% for calcium. Eighty percent of subjects reported inadequate intakes of four or more nutrients. Diet variety was positively associated with the number of nutrients consumed at adequate intakes (r = 0.498), total energy (r = 0.522) and dietary fiber (r = 0.421). Our results suggest that rural, community-dwelling old have inadequate intakes of several nutrients. Recommendations to increase diet variety and consume a nutrient supplement may be necessary for elderly people to achieve adequate nutrient intakes.

A molybdenum complex with 4,7-diphenyl-1,10-phenanthroline

In the title compound, tetracarbonyl(4,7-diphenyl-1,10-phenanthroline-N,N')molybdenum(0), [Mo(C24H16N2)(CO)4], the Mo-atom coordination is distorted octahedral, with two CO groups cis to each other, but each trans to an N atom of the 4,7-diphenyl-1,10-phenanthroline (dpphen) ligand, and with the other two CO groups trans to each other and on the axis position. The complex has better solubility than [Mo(phen)(CO)4], where phen is 1,10-phenanthroline.

Immunotherapy of tumors with xenogeneic endothelial cells as a vaccine

The breaking of immune tolerance against autologous angiogenic endothelial cells should be a useful approach for cancer therapy. Here we show that immunotherapy of tumors using fixed xenogeneic whole endothelial cells as a vaccine was effective in affording protection from tumor growth, inducing regression of established tumors and prolonging survival of tumor-bearing mice. Furthermore, autoreactive immunity targeting to microvessels in solid tumors was induced and was probably responsible for the anti-tumor activity. These observations may provide a new vaccine strategy for cancer therapy through the induction of an autoimmune response against the tumor endothelium in a cross-reaction.

A cGMP-dependent protein kinase gene, foraging, modifies habituation-like response decrement of the giant fiber escape circuit in Drosophila

The Drosophila giant fiber jump-and-flight escape response is a model for genetic analysis of both the physiology and the plasticity of a sensorimotor behavioral pathway. We previously established the electrically induced giant fiber response in intact tethered flies as a model for habituation, a form of nonassociative learning. Here, we show that the rate of stimulus-dependent response decrement of this neural pathway in a habituation protocol is correlated with PKG (cGMP-Dependent Protein Kinase) activity and foraging behavior. We assayed response decrement for natural and mutant rover and sitter alleles of the foraging (for) gene that encodes a Drosophila PKG. Rover larvae and adults, which have higher PKG activities, travel significantly farther while foraging than sitters with lower PKG activities. Response decrement was most rapid in genotypes previously shown to have low PKG activities and sitter-like foraging behavior. We also found differences in spontaneous recovery (the reversal of response decrement during a rest from stimulation) and a dishabituation-like phenomenon (the reversal of response decrement evoked by a novel stimulus). This electrophysiological study in an intact animal preparation provides one of the first direct demonstrations that PKG can affect plasticity in a simple learning paradigm. It increases our understanding of the complex interplay of factors that can modulate the sensitivity of the giant fiber escape response, and it defines a new adult-stage phenotype of the foraging locus. Finally, these results show that behaviorally relevant neural plasticity in an identified circuit can be influenced by a single-locus genetic polymorphism existing in a natural population of Drosophila.

Blockade of neuromuscular transmission by huwentoxin-I, purified from the venom of the Chinese bird spider Selenocosmia huwena

Huwentoxin-I (HWTX-I) is a neurotoxic peptide purified from the venom of the Chinese bird spider Selenocosmia huwena. The effects of HWTX-I on neuromuscular transmission of vertebrate skeletal muscle have been investigated by means of twitch tension and electrophysiological techniques. On isolated mouse phrenic nerve-hemidiaphragm preparations, HWTX-I blocked the twitch responses to indirect, but not to direct, muscle stimulation. The time needed for complete block of the neuromuscular transmission was dose dependent. The transmission could be mostly restored by prolonged repeated washing with Tyrode's solution. If the preparation was pretreated with D-tubocurarine and then immersed in a mixed solution of D-tubocurarine and HWTX-I, the washout time necessary to restore the neuromuscular transmission was significantly decreased. Intracellular recording at the end-plate region of frog sartorius muscle revealed that HWTX-I could synchronously reduce the amplitude of the acetylcholine potential induced by ionophoretic application of acetylcholine as well as the amplitude of the end-plate potential evoked by nerve stimulation. Both of these effects eventually disappeared; however, both could be restored by prolonged washing. Experiments on Xenopus embryonic myocytes indicated that HWTX-I reduced the open probability of acetylcholine-induced channel activity, and finally blocked the channel. All of these results demonstrated that HWTX-I was a peptide neurotoxin and the postsynaptic nicotinic acetylcholine receptor was its site of action.

[Preliminary study on the treatment of diabetic retinopathy utilizing with nourishing yin, tonifying kidney and blood-activating herbs]

23 cases including 45 eyes of diabetic retinopathy treated with nourishing Yin, tonifying Kidney and blood-activating herbs were presented. The results showed that the serum viscosity and cholesterol were markedly decreased (P less than 0.01), and the implicit times of a-wave and b-wave in flash electroretinogram(F-ERG) were significantly advanced than those of themselves before treatment (P less than 0.01 and P less than 0.05 respectively). The visual acuity in most cases was improved and the effective rate was 64.44%. The therapeutical mechanism for diabetic retinopathy used by nourishing Yin, tonifying Kidney and blood-activating herbs were discussed. The authors suggested that the Chinese herbs probably could change the chemical and physical properties of blood, promote the ocular circulation and the absorption of sludged blood and decrease the retinal ischemia.

[Transdermal permeability of l- and dl-norgestrel through human skin in vitro]

Transdermal permeability of l-norgestrel (l-NG) and dl-norgestrel (dl-NG) at 6 skin regions with and without stratum corneum was investigated by using Valia-Chien double-compartment permeation cells. The permeation rates and accumulative amounts within 72 h in vitro were measured by HPLC. The results showed that the permeation rates of dl-NG through intact skin were significantly higher than those of l-NG (P less than 0.01). For the skins without stratum corneum, the permeation rates and permeation amounts of l-NG and dl-NG were higher than those for the intact skin (P less than 0.01), but no significant difference was seen between l-NG and dl-NG. Hence the stratum corneum played an important role of rate-limiting barrier in the skin permeation of l-NG and dl-NG. It is possible that the difference in permeability between l-NG and dl-NG is related to their partition coefficients.