Initial evaluation of an environment-based intervention for participation of autistic children: a randomized controlled trial

PURPOSE

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children.

MATERIALS AND METHODS

Twenty-one autistic children 6-10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables.

RESULTS

The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found.

CONCLUSIONS

Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research.

Investigating the impact of probiotic on neurological outcomes in Rett syndrome: A randomized, double-blind, and placebo-controlled pilot study

LAY ABSTRACT

Rett syndrome often involves gastrointestinal symptoms and gut microbiota imbalances. We conducted a study to explore the feasibility of probiotic Lactobacillus plantarum PS128 and the impact on neurological functions in Rett syndrome. The results of our investigation demonstrated that the supplementation of probiotic L. plantarum PS128 was feasible and well tolerated, with 100% retention rate and 0% withdrawal rate. In addition, there was only one participant who had loose stool after taking L. plantarum PS128. Further, there was a tendency to enhance overall cognitive developmental level, as assessed using Mullen Scales of Early Learning. In addition, it significantly improved dystonia, as assessed using the Burke-Fahn-Marsden Movement Scale, in comparison with the placebo group. This study provides a strong foundation for future research and clinical trials exploring the potential of L. plantarum PS128 probiotics as a complementary therapy for individuals with Rett syndrome.

[Impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity and pulse pressure on all-cause mortality]

Objective: To evaluate the impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity (baPWV) and pulse pressure (PP) on all-cause mortality. Methods: This study is a prospective cohort study. Individuals participated in the Kailuan Study and completed baPWV measurements between 2010 and 2016 were included in this study. After stratifying by sex, 75th percentile baPWV and PP values for different age group were calculated at five years interval. BaPWV and PP values below the 75th percentile were defined as normal, and those above or equal to the 75th percentile were defined as increased. The participants were allocated to four groups according to their PP and baPWV status: normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group. The primary outcome was all-cause mortality during the follow-up period. Cox proportional hazards models were used to explore the impact of individual and combined assessment of baPWV and PP on all-cause mortality events. Results: A total of 39 339 participants were enrolled in this study, aged (49.3±12.8) years, of which 28 731 (73.03%) were males. There were 23 268, 6 025, 6 210 and 3 836 cases in the normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group, respectively. The average follow-up duration was (4.98±2.53) years. During the follow-up period, all-cause mortality occurred in 998 individuals. Multivariate Cox regression analysis showed increased risk of all-cause mortality in the high baPWV/normal PP group (HR=1.27, 95%CI 1.07-1.50), and in the high baPWV/PP group (HR=1.33, 95%CI 1.08-1.65) compared to the normal baPWV/PP group. Increased pulse pressure alone had no impcat on all-cause death (HR=1.06, 95%CI 0.87-1.29). Conclusions: The risk of all-cause mortality significantly increases with increased age-and sex-specific baPWV and PP values. BaPWV may be a better predictor of all-cause mortality than PP in this cohort.

[Regulatory effects of bio-intensity electric field on microtubule acetylation in human epidermal cell line HaCaT]

Objective: To investigate the regulatory effects of bio-intensity electric field on directional migration and microtubule acetylation in human epidermal cell line HaCaT, aiming to provide molecular theoretical basis for the clinical treatment of wound repair. Methods: The experimental research methods were used. HaCaT cells were collected and divided into simulated electric field group (n=54) placed in the electric field device without electricity for 3 h and electric field treatment group (n=52) treated with 200 mV/mm electric field for 3 h (the same treatment methods below). The cell movement direction was observed in the living cell workstation and the movement velocity, trajectory velocity, and direction of cosθ of cell movement within 3 h of treatment were calculated. HaCaT cells were divided into simulated electric field group and electric field treatment 1 h group, electric field treatment 2 h group, and electric field treatment 3 h group which were treated with 200 mV/mm electric field for corresponding time. HaCaT cells were divided into simulated electric field group and 100 mV/mm electric field group, 200 mV/mm electric field group, and 300 mV/mm electric field group treated with electric field of corresponding intensities for 3 h. The protein expression of acetylated α-tubulin was detected by Western blotting (n=3). HaCaT cells were divided into simulated electric field group and electric field treatment group, and the protein expression of acetylated α-tubulin was detected and located by immunofluorescence method (n=3). Data were statistically analyzed with Kruskal-Wallis H test,Mann-Whitney U test, Bonferroni correction, one-way analysis of variance, least significant difference test, and independent sample t test. Results: Within 3 h of treatment, compared with that in simulated electric field group, the cells in electric field treatment group had obvious tendency to move directionally, the movement velocity and trajectory velocity were increased significantly (with Z values of -8.53 and -2.05, respectively, P<0.05 or P<0.01), and the directionality was significantly enhanced (Z=-8.65, P<0.01). Compared with (0.80±0.14) in simulated electric field group, the protein expressions of acetylated α-tubulin in electric field treatment 1 h group (1.50±0.08) and electric field treatment 2 h group (1.89±0.06) were not changed obviously (P>0.05), while the protein expression of acetylated α-tubulin of cells in electric field treatment 3 h group (3.37±0.36) was increased significantly (Z=-3.06, P<0.05). After treatment for 3 h, the protein expressions of acetylated α-tubulin of cells in 100 mV/mm electric field group, 200 mV/mm electric field group, and 300 mV/mm electric field group were 1.63±0.05, 2.24±0.08, and 2.00±0.13, respectively, which were significantly more than 0.95±0.27 in simulated electric field group (P<0.01). Compared with that in 100 mV/mm electric field group, the protein expressions of acetylated α-tubulin in 200 mV/mm electric field group and 300 mV/mm electric field group were increased significantly (P<0.01); the protein expression of acetylated α-tubulin of cells in 300 mV/mm electric field group was significantly lower than that in 200 mV/mm electric field group (P<0.05). After treatment for 3 h, compared with that in simulated electric field group, the acetylated α-tubulin of cells had enhanced directional distribution and higher protein expression (t=5.78, P<0.01). Conclusions: Bio-intensity electric field can induce the directional migration of HaCaT cells and obviously up-regulate the level of α-ubulin acetylation after treatment at 200 mV/mm bio-intensity electric field for 3 h.

Cognitive and motor development in preterm children from 6 to 36 months of age: Trajectories, risk factors and predictability

BACKGROUND

Although numerous studies have examined the development of preterm children born very low birth weight (VLBW, birth body weight < 1500 g), variations of developmental progress within individuals have rarely been explored. The aim of this research was to examine the cognitive and motor trajectories in preterm children born VLBW at early ages and to assess the risk factors and predictability of these trajectories.

METHOD

Five hundred and eighty preterm infants born VLBW from three cohort studies (2003 to 2014) were prospectively assessed their mental and motor development using the Bayley Scales at 6, 12, 24, and 36 months, and cognitive, motor and behavioral outcomes using the Movement Assessment Battery for Children and the Child Behavior Checklist for Ages 1.5-5 at 4 years of age.

RESULTS

Preterm children born VLBW manifested three cognitive patterns (stably normal [64.0 %], deteriorating [31.4 %], and persistently delayed [4.6 %]) and four motor patterns (above average [6.3 %], stably normal [60.0 %], deteriorating [28.5 %], and persistently delayed [5.2 %]) during 6-36 months. Low birth body weight, stage III-IV retinopathy of prematurity and low parental socio-economic status were associated with the deteriorating patterns; prolonged hospitalization and major brain damage were additionally associated with the persistently delayed patterns. Furthermore, the cognitive and motor deteriorating pattern was each predictive of cognitive and motor impairment at 4 years of age; whereas, the persistently delayed patterns were predictive of multiple impairments.

CONCLUSION AND IMPLICATIONS

Preterm children born VLBW display heterogeneous trajectories in early cognitive and motor development that predict subsequent developmental and behavioral outcomes.

[Non/hypo-response to hepatitis B vaccination and influencing factors in HIV-infected patients in the context of different immunization schedules]

Objective: To study the non/hypo-response to hepatitis B vaccination in HIV-infected patients, identify the influencing factors and provide evidence for the development of hepatitis B prevention and control strategies and measures for special population. Methods: On the basis of the randomized controlled trial of 20 µg hepatitis B vaccine immunization at 0-1-6 month, 0-1-2-6 month and 60 µg hepatitis B vaccine immunization at 0-1-2-6 month, the HIV-infected patients who completed one-month follow-up after the full course vaccination were selected as study subjects. Quantification of antibody to hepatitis B surface antigen (anti-HBs) in serum samples was performed by using chemiluminescent microparticle immunoassay (CMIA) and demographic characteristics, disease history, HIV infection and treatment status of the study subjects were collected. Statistical analysis was conducted by χ² test, t test, unconditional logistic regression and interaction analyses. Results: The non/hypo-response rates to hepatitis B vaccination were 34.65% (35/101), 24.49% (24/98) and 10.99% (10/91) in 20 µg group at 0-1-6 month or 0-1-2-6 month and 60 µg group at 0-1-2-6 month (P<0.001), respectively. Logistic regression analysis showed that after controlling for confounding factors, the risk for non/hypo-response was 0.22 times higher in HIV-infected patients receiving 60 µg hepatitis B vaccine at 0-1-2-6 month than in patients receiving 20 µg hepatitis B vaccine at 0-1-6 month (95%CI: 0.10-0.50), the risk for non/hypo-response was higher in men than in women (OR=3.65, 95%CI: 1.88-7.07), and the risk for non/hypo-response was 2.64 times higher in those without hepatitis B vaccination history than in those with hepatitis B vaccination history (95%CI: 1.10-6.32). Moreover, there were multiplicative interactions between immunization schedule and gender (OR=2.49, 95%CI: 1.24-5.00). Conclusion: The non/hypo-response rate to hepatitis B vaccination was significantly lower in HIV-infected patients receiving 60 µg hepatitis B vaccine at 0-1-2-6 month than in those receiving 20 µg hepatitis B vaccine at 0-1-6 month and 0-1-2-6 month. Gender, vaccination schedule and history of hepatitis B vaccination were the influencing factors of the non/hypo-response to hepatitis B vaccination. There was a multiplicative interaction between vaccination schedule and gender, and men receiving 20 µg hepatitis B vaccines had a higher risk for non/hypo-response to hepatitis B vaccination.

[Regulatory effects of bio-intensity electric field on transformation of human skin fibroblasts]

Objective: To investigate the regulatory effects of bio-intensity electric field on the transformation of human skin fibroblasts (HSFs). Methods: The experimental research methods were used. HSFs were collected and divided into 200 mV/mm electric field group treated with 200 mV/mm electric field for 6 h and simulated electric field group placed in the electric field device without electricity for 6 h. Changes in morphology and arrangement of cells were observed in the living cell workstation; the number of cells at 0 and 6 h of treatment was recorded, and the rate of change in cell number was calculated; the direction of cell movement, movement velocity, and trajectory velocity within 3 h were observed and calculated (the number of samples was 34 in the simulated electric field group and 30 in 200 mV/mm electric field group in the aforementioned experiments); the protein expression of α-smooth muscle actin (α-SMA) in cells after 3 h of treatment was detected by immunofluorescence method (the number of sample was 3). HSFs were collected and divided into simulated electric field group placed in the electric field device without electricity for 3 h, and 100 mV/mm electric field group, 200 mV/mm electric field group, and 400 mV/mm electric field group which were treated with electric fields of corresponding intensities for 3 h. Besides, HSFs were divided into simulated electric field group placed in the electric field device without electricity for 6 h, and electric field treatment 1 h group, electric field treatment 3 h group, and electric field treatment 6 h group treated with 200 mV/mm electric field for corresponding time. The protein expressions of α-SMA and proliferating cell nuclear antigen (PCNA) were detected by Western blotting (the number of sample was 3). Data were statistically analyzed with Mann-Whitney U test, one-way analysis of variance, independent sample t test, and least significant difference test. Results: After 6 h of treatment, compared with that in simulated electric field group, the cells in 200 mV/mm electric field group were elongated in shape and locally adhered; the cells in simulated electric field group were randomly arranged, while the cells in 200 mV/mm electric field group were arranged in a regular longitudinal direction; the change rates in the number of cells in the two groups were similar (P>0.05). Within 3 h of treatment, the cells in 200 mV/mm electric field group had an obvious tendency to move toward the positive electrode, and the cells in simulated electric field group moved around the origin; compared with those in simulated electric field group, the movement velocity and trajectory velocity of the cells in 200 mV/mm electric field group were increased significantly (with Z values of -5.33 and -5.41, respectively, P<0.01), and the directionality was significantly enhanced (Z=-4.39, P<0.01). After 3 h of treatment, the protein expression of α-SMA of cells in 200 mV/mm electric field group was significantly higher than that in simulated electric field group (t=-9.81, P<0.01). After 3 h of treatment, the protein expressions of α-SMA of cells in 100 mV/mm electric field group, 200 mV/mm electric field group, and 400 mV/mm electric field group were 1.195±0.057, 1.606±0.041, and 1.616±0.039, respectively, which were significantly more than 0.649±0.028 in simulated electric field group (P<0.01). Compared with that in 100 mV/mm electric field group, the protein expressions of α-SMA of cells in 200 mV/mm electric field group and 400 mV/mm electric field group were significantly increased (P<0.01). The protein expressions of α-SMA of cells in electric field treatment 1 h group, electric field treatment 3 h group, and electric field treatment 6 h group were 0.730±0.032, 1.561±0.031, and 1.553±0.045, respectively, significantly more than 0.464±0.020 in simulated electric field group (P<0.01). Compared with that in electric field treatment 1 h group, the protein expressions of α-SMA in electric field treatment 3 h group and electric field treatment 6 h group were significantly increased (P<0.01). After 3 h of treatment, compared with that in simulated electric field group, the protein expressions of PCNA of cells in 100 mV/mm electric field group, 200 mV/mm electric field group, and 400 mV/mm electric field group were significantly decreased (P<0.05 or P<0.01); compared with that in 100 mV/mm electric field group, the protein expressions of PCNA of cells in 200 mV/mm electric field group and 400 mV/mm electric field group were significantly decreased (P<0.05 or P<0.01); compared with that in 200 mV/mm electric field group, the protein expression of PCNA of cells in 400 mV/mm electric field group was significantly decreased (P<0.01). Compared with that in simulated electric field group, the protein expressions of PCNA of cells in electric field treatment 1 h group, electric field treatment 3 h group, and electric field treatment 6 h group were significantly decreased (P<0.01); compared with that in electric field treatment 1 h group, the protein expressions of PCNA of cells in electric field treatment 3 h group and electric field treatment 6 h group were significantly decreased (P<0.05 or P<0.01); compared with that in electric field treatment 3 h group, the protein expression of PCNA of cells in electric field treatment 6 h group was significantly decreased (P<0.01). Conclusions: The bio-intensity electric field can induce the migration of HSFs and promote the transformation of fibroblasts to myofibroblasts, and the transformation displays certain dependence on the time and intensity of electric field.

Multidimensional Development and Adaptive Behavioral Functioning in Younger and Older Children With Rett Syndrome

OBJECTIVE

The purpose of this study was to examine clinical severity, multidimensional development, and adaptive behavioral functioning in younger and older children with Rett syndrome (RTT) in the pseudostationary stage (stage III).

METHODS

Fourteen younger (≤10 years of age) and 15 older (11-18 years of age) children with confirmed stage III RTT (assigned to young-RTT and old-RTT groups, respectively) participated in this study. Clinical severity was determined using the Clinical Severity Score (CSS) scale for RTT. The children's cognitive, language, motor, and sociocommunicative development was assessed using the Mullen Scales of Early Learning (MSEL) and the Early Social Communication Scale (ESCS). Their adaptive behavioral and daily functional skills were assessed using the Vineland Adaptive Behavior Scales-Chinese version (VABS-C) and Pediatric Evaluation of Disability Inventory-Chinese version (PEDI-C).

RESULTS

Compared with the young-RTT group, the old-RTT group had higher severity of scoliosis on the CSS scale, poorer fine motor scores on the MSEL, reduced eye contact, reduced alternating eye gaze, and reduced turn-taking during social interaction on the ESCS. However, none of the VABS-C or PEDI-C subscale scores differed significantly between the groups. Higher CSSs were significantly correlated with lower scores in several subscales of MSEL, ESCS, VABS-C, and PEDI-C, especially for gross motor, mobility, and socialization functioning in all children with RTT.

CONCLUSION

Age-related differences in fine motor and sociocommunicative skills were observed between the young-RTT and old-RTT group, as measured using standardized assessments. Greater severity of RTT was correlated with poor motor, sociocommunicative, adaptive behavioral, and daily functional skills in stage III RTT.

IMPACT

Practitioners should be aware of clinical severity and the differences of developmental and adaptive behavioral functioning between younger and older children in the pseudostationary stage of RTT to provide specific age-related treatments.

LAY SUMMARY

With an understanding of severity and differences of developmental and adaptive behavioral functioning between younger and older children, clinical professionals can provide specific age-related treatments.

Cultural Adaptation and Validation of Mullen Scales of Early Learning in Taiwanese children with Autism Spectrum Disorder, Global Developmental Delay, and Typically Developing Children

BACKGROUND

The Mullen Scales of Early Learning (MSEL) is a standardized comprehensive developmental assessment tool for children aged 0-68 months. However, few Asia-based studies have explored cultural and linguistic adaptations of the MSEL or investigated its psychometric properties in populations with autism spectrum disorder (ASD).

AIMS

This study evaluated the reliability and validity of the MSEL-Taiwan version (MSEL-T) for Taiwanese children with ASD, global developmental delay (GDD), and typical development (TD).

METHODS AND PROCEDURES

The MSEL items were translated and modified according to the language and culture in Taiwan. In total, 191 children (ASD, 69; GDD, 36; and TD, 86) aged 19-68 months were assessed using the MSEL-T and Peabody Developmental Motor Scales 2 (PDMS-2) at enrollment, followed by the assessments of Vineland Adaptive Behavior Scale-Chinese version (VABS-C) at the age of 36 months or later.

OUTCOMES AND RESULTS

All subscales were verified to have good interrater reliability and internal consistency, and subscale scores indicated moderate to high correlations with PDMS-2 and VABS-C scores. Significant differences in MSEL-T scores were observed between same-aged pairs of children with TD and GDD and between pairs of children with TD and ASD.

CONCLUSIONS AND IMPLICATIONS

The findings provide evidence of validity and reliability of the MSEL-T. And it is suggested that the culturally and linguistically adapted MSEL-T is a good tool for the clinical assessment of children with and without ASD.

[Immunity persistence of 60 μg high dose hepatitis B vaccine and influencing factors in maintained hemodialysis patients]

Objective: To compare the anti-HBs level in maintained hemodialysis patients one year after receiving 20 μg and 60 μg hepatitis B vaccination at 0, 1 and 6 months, and explore the influence factors for the immunity persistence and their interactions. Methods: Based on a randomized controlled trial of 20 μg and 60 μg hepatitis B vaccine immunization in maintained hemodialysis patients at 0, 1, and 6 months, follow up was conducted for the patients for one year after the completion of the vaccination for the quantitative detection of anti-HBs, and χ² test, t test, unconditional logistic regression and interaction analyses were used for statistical analysis. Results: One year after the vaccination, 125 and 124 patients in the 20 μg and 60 μg groups were tested for anti-HBs, respectively. The positive rate of anti-HBs in the 60 μg group (77.42%, 96/124) was significantly higher than that in the 20 μg group (65.60%, 82/125) (P<0.05). After adjusting for the confounding factors, the positive probability of anti-HBs in the 60 μg group was 1.925 times higher than that in the 20 μg group (95%CI: 1.068-3.468). Patients with hemodialysis duration ≥5 years (OR=0.523, 95%CI: 0.293-0.935) and diabetes mellitus (OR=0.376, 95%CI: 0.173-0.818) had lower positive probability of anti-HBs. Moreover, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus. Conclusions: The immunity persistence after one year in 60 μg hepatitis B vaccination group was longer than that in 20 μg hepatitis B vaccination group in maintained hemodialysis patients, vaccine dose, hemodialysis duration and diabetes mellitus were the influencing factors for the immunity persistence, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus.

Relationship Between Motor Skills and Language Abilities in Children With Autism Spectrum Disorder

OBJECTIVES

Few studies have examined the relationship between language abilities and specific motor skills in toddlers with autism spectrum disorder (ASD). The aim of this study was to compare the relationship of receptive language (RL) and expressive language (EL) abilities with motor functioning in toddlers with ASD aged 24 to 36 months and their peers with typical development (TD). Furthermore, the study compared multidimensional motor functioning in toddlers with ASD with delayed RL and EL development and toddlers with ASD and typical RL and EL development. The predictive powers of the motor skills were examined for the group with delayed RL and EL development.

METHODS

The language abilities of 38 toddlers with ASD and 38 age-matched toddlers with TD were evaluated using the Receptive and Expressive Language Subscales of the Mullen Scale of Early Learning, and their motor skills were assessed using the Peabody Developmental Motor Scales, Second Edition.

RESULTS

Significant correlations between language ability and motor functioning were observed in the ASD and TD groups. The ASD group with delayed RL and EL development had lower scores for multidimensional motor functioning than the ASD group with typical RL and EL development and the TD group. Moreover, the risks of delayed EL and RL development could be predicted by the lower motor scores in toddlers with ASD.

CONCLUSIONS

The positive correlation between language abilities and motor functioning in toddlers with ASD indicated potential connections between the early onsets of motor and speech-language impairments in these toddlers.

IMPACT

The results may have implications for the development of motor-based interventions targeting language development in young children with ASD.

[Related factors and interaction on hepatitis C virus infection in patients receiving methadone maintenance treatment in Taiyuan]

Objective: To explore the prevalence of hepatitis C virus (HCV) infection, influence factors and interaction on HCV infection in patients receiving methadone maintenance treatment (MMT) in Taiyuan. Methods: Between April-June 2019, three MMT clinics in Taiyuan were selected to conduct a face-to-face questionnaire survey among MMT patients to collect the information about their socio-demographic characteristics, drug use, MMT, sexual behavior and health status. Software EpiData 3.1 was used for real-time double entry to establish the database. Software SAS 9.4 was used to analyze the data, and χ² test was used for univariate analysis and logistic regression model was used for multivariate and interaction analyses. Results: A total of 903 subjects were surveyed among MMT patients, the male to female ratio of was 7.21∶1(743∶103), and the rate of HCV infection was 12.53% (106/846). After adjusting for the confounding factors, being women (OR=1.936, 95%CI: 1.023-3.662), having sex with drug users (OR=2.073, 95%CI: 1.110-3.871) and injection drug use (OR=7.737, 95%CI: 4.614-12.973) might be the risk factors for HCV infection in patients receiving MMT. The results showed that there were multiplicative interactions among women, having sex with drug user and injection drug use on HCV infection. Conclusions: Being women, having sex with drug user and injection drug use were associated with higher risk for HCV infection in patients receiving MMT in Taiyuan. There were multiplication interactions between being women and having sex with drug user, being female and injection drug use, and having sex with drug use and injection drug use on HCV infection.

Effects of Protein Supplementation Combined with Exercise Training on Muscle Mass and Function in Older Adults with Lower-Extremity Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Trials

Aging and osteoarthritis (OA) are associated with a high risk of muscle mass loss, which can lead to physical disability. This study investigated the effectiveness of protein supplementation combined with exercise training (PS + ET) in improving muscle mass and functional outcomes in older adults with lower-limb OA. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) on the effectiveness of PS + ET in older adults with hip or knee OA. Meta-analysis and risk of bias assessment of the included RCTs were conducted. Six RCTs were included in this systemic review; they had a median (range/total) Physiotherapy Evidence Database (PEDro) score of 7 (6-9) out of 10, respectively. Five RCTs that enrolled patients who underwent total joint replacement were included in this meta-analysis. The PS + ET group exhibited significant improvements in muscle mass (standard mean difference [SMD] = 1.13, p < 0.00001), pain (SMD = 1.36, p < 0.00001), and muscle strength (SMD = 0.44, p = 0.04). Our findings suggest that PS + ET improves muscle mass, muscle strength, and functional outcomes and reduces pain in older adults with lower-limb OA, particularly in those who have undergone total joint replacement.

[A cohort study on the association between resting heart rate and the risk of new-onset heart failure]

Objective: To prospectively explore the relationship between resting heart rate (RHR) and risk of new-onset heart failure. Methods: It was a prospective cohort study. People who attended the physical examination of Kailuan Group Company in 2006 and with complete electrocardiography (ECG) recordings were eligible for this study. A total of 88 879 participants aged 18 years old or more who were free of arrhythmia, a prior history of heart failure and were not treated with β-blocker were included. Participants were divided into 5 groups according to the quintiles of RHR at baseline (Q(1) group, 40-60 beats/minutes (n=18 168) ; Q(2) group, 67-70 beats/minutes (n=18 970) ; Q(3) group, 71-74 beats/minutes (n=13 583) ; Q(4) group, 75-80 beats/minutes (n=22 739) ; and Q(5) group,>80 beats/minutes (n=15 419) ) .The general clinical data and laboratory test results were collected. The outcome was the first occurrence of heart failure at the end of follow-up (December 31, 2016) .We used Cox regression model to examine the association between RHR and the risk of new-onset heart failure. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results: Among the included patients 68 411 participants were male, mean age was (51.0±12.3) years old, and RHR was (74±10) beats/minutes. Statistically significant differences among the RHR quintiles were found for the following variables: age, gender, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, body mass index, the level of high-sensitivity C-reactive protein, education status, physical activity, smoking status, drinking status, history of diabetes, history of hypertension and history of use antihypertensive drugs (all P<0.01) . Higher RHR was linked with higher prevalence of diabetes, hypertension history, and higher systolic blood pressure, diastolic blood pressure and FBG levels (all P<0.01). After a mean follow-up of 9.5 years, the incidence of new-onset heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.60%(290/18 168), 1.36%(258/18 970), 1.80%(245/13 583), 1.76%(400/22 739) and 2.35%(362/15 419),respectively (P<0.01) . The person-year incidence of heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.7, 1.5, 1.9, 1.9 and 2.6 per 1 000 person-years respectively. Compared with the Q(2) group, multivariate analysis with adjustment for major traditional cardiovascular risk factors showed that HRs of Q(3),Q(4),and Q(5) group were 1.23 (95%CI 1.03-1.48, P<0.05) , 1.19 (95%CI 1.01-1.41, P<0.05) , 1.39 (95%CI 1.18-1.65, P<0.01) , respectively. In the absence of hypertension, diabetes, smoking and acute myocardial infarction, the Cox regression model showed that compared with Q(2) group, the HR of new-onset heart failure in Q(5) group was 1.58 (95%CI 1.02-2.45, P<0.05) . Conclusion: Increased RHR is associated with increased risk of new-onset heart failure in this cohort.

[Impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging]

Objective: To investigate the impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging(HVA). Methods: This study was a multi-center cross-sectional survey. Six thousand three hundred and sixteen participants who underwent at least 2 healthy examinations from 2006 to 2015 at 11 hospitals, including Kailuan Hospital and so on, and examined brachial-ankle pulse wave velocity (baPWV) during 2010 and 2016, with available information about cardiovascular behavior and factors were included. The cardiovascular health score (CHS) was calculated. Basic CHS was collected from the first examination. The second CHS derived from the healthy examination in the same year of baPWV examination. Change of cardiovascular health score (ΔCHS) was calculated. Participants were defined into 5 groups according to ΔCHS, namely ΔCHS≤-2 (n=2 166), ΔCHS=-1 (n=1 284), ΔCHS=0 (n=1 187), ΔCHS=1 (n=860), and ΔCHS≥2 (n=819). Participants' characteristics, value of baPWV and proportion of HVA were compared among different groups. Multiple logistic regression analysis was used to investigate the association between ΔCHS and HVA. The ΔCHS was recalculated and included in multiple logistic regression analysis model again after each component of the cardiovascular health metrics was removed separately in order to investigate effects of removal factors on HVA by observing changes in effect values. Results: The percentage of the participants with HVA in the group of ΔCHS≤-2, ΔCHS=-1, ΔCHS=0, ΔCHS=1 and ΔCHS≥2 were 23.3%(505/2 166), 27.8%(357/1 284), 28.7%(341/1 187),31.9%(274/860) and 33.9%(278/819), respectively. After adjustment for age, sex, income, education, alcohol consumption and the basic CHS, a significant positive association between ΔCHS and proportion of participants with HVA was observed (OR=1.50, 95%CI 1.44-1.56). Multiple regression analysis after removing each single cardiovascular behavior or factor showed that the OR value decreased as follow systolic blood pressure (OR=1.04, 95%CI 1.00-1.09), fasting blood glucose (OR=1.14, 95%CI 1.09-1.18), physical exercise (OR=1.16, 95%CI 1.11-1.21), salt intake (OR=1.17, 95%CI 1.12-1.22), body mass index (OR=1.18, 95%CI 1.13-1.23), smoking(OR=1.18, 95%CI 1.13-1.23) and total cholesterol (OR=1.20, 95%CI 1.16-1.24). Conclusion: The improvement of every ideal cardiovascular behavior and factor is associated with the increase of the proportion of HVA population.

The emission of γ-Ray beams with orbital angular momentum in laser-driven micro-channel plasma target

We investigated the emission of multi-MeV γ-Ray beams with orbital angular momentum (OAM) from the interaction of an intense circularly polarized (CP) laser with a micro-channel plasma target. The driving laser can generate high energy electrons via direct laser acceleration within the channel. By attaching a plasma foil as the reflecting mirror, the CP laser is reflected and automatically colliding with the electrons. High energy gamma-photons are emitted through inverse Compton scattering (ICS) during collision. Three-dimensional particle-in-cell simulations reveal that the spin angular momentum (SAM) of the CP laser can be transferred to the OAM of accelerated electrons and further to the emitted gamma-ray beam. These results may guide future experiments in laser-driven gamma-ray sources using micro-structures.

Multidimensional Developments and Free-Play Movement Tracking in 30- to 36-Month-Old Toddlers With Autism Spectrum Disorder Who Were Full Term

BACKGROUND

Few studies have investigated multidimensional developments and free-play movement performance in toddlers with an early diagnosis of autism spectrum disorder (ASD).

OBJECTIVE

This study compared cognitive, motor, and behavioral developments and free-play movement performance in toddlers with ASD who were full term (FT-ASD), toddlers who were full term and are typically developing (FT-TD), and toddlers who were born preterm and had a very low birth weight (VLBW-PT).

DESIGN

This was a prospective cross-sectional study.

METHODS

Forty-five 30- to 36-month-old age-matched toddlers were recruited and divided into FT-ASD, FT-TD, and VLBW-PT groups. Their developments were examined using the Mullen Scales of Early Learning; the Peabody Developmental Motor Scales, Second Edition; the Child Behavior Checklist for Ages 1.5 to 5; and the Repetitive Behavior Scale-Revised. In addition, the toddlers' free-play movements were tracked in laboratory settings using an automatic movement tracking system.

RESULTS

Toddlers with FT-ASD exhibited lower cognitive and motor scores and a higher degree of behavioral problems compared with toddlers with FT-TD or VLBW-PT. Furthermore, the movement tracking data in a free-play setting revealed that toddlers with FT-ASD displayed a higher degree of turning velocity, a higher moving time, and a higher frequency of moving toward the peripheral region compared with toddlers with FT-TD or VLBW-PT. Moreover, several motor developmental and movement-tracking indicators were found to correlate with behavioral problems and cognitive scores in toddlers with FT-ASD.

LIMITATIONS

The study results may have been affected by the small sample size, the cross-sectional design, and tracking only the whole body without subtle movements or segmental motions.

CONCLUSIONS

The findings suggest varied aspects of co-occurring developmental conditions and movement-based problems in toddlers with FT-ASD. Using standardized and sensitive measures for the early assessment of perceptuo-motor impairments is necessary for timely early intervention for such toddlers.

[Suprapubic-assisted laparoendoscopic single-site surgery in nephroureterectomy A case series of 4 patients]

Objective: To evaluate the feasibility and clinical value of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in nephroureterectomy using method of transvaginal natural orifice specimen extraction (NOSE) (SA-LESS+TV-NOSE NU). Methods: Four patients (three cases of renal pelvic carcinoma and one case of ureteral carcinoma) undergoing SA-LESS+TV-NOSE NU were enrolled between April 2015 and January 2016. After general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. Two trocars were inserted at the medial margin of umbilicus, and the third one was inserted into abdominal cavity at the superior margin of pubic symphysis. The operation was performed under a direct vision with a 5.4 mm 0° flexible-tip laparoscope. Firstly, the distal ureter was isolated completely and blocked by a Hem-O-lok clip. Then, the laparoscopic nephrectomy was performed according to the standard method. Finally, the bladder cuff excision was executed and the incision was sutured. The intact specimen was placed inside a homemade bag and removed through the incision at posterior vaginal fornix. Results: All the procedures were successfully performed. The median operative time was 150 (range: 120 to 210) minutes, and the median estimated blood loss was 180 (range: 80 to 350) ml. No major perioperative complications occurred. The mean visual analogue score (VAS) of 24 hours and 48 hours after operation were 3.25 (range: 2 to 5) and 2.25 (range: 2 to 3). All the patients resumed ambulation on postoperative day 1. Pelvic drainage tube was removed on postoperative day 2-4. On postoperative day 7, urethral catheter was removed. The patients were discharged on postoperative day 7-9. During the follow-up of 20-29 months, the patient recovered well with no case of incisional hernia and pelvic, abdominal infections. The vaginal fornix incision healed well, and the umbilical and suprapubic puncture scars were not obvious. All the patients completed the patient-assessed acromegaly symptom questionnaire PASQ. The average PSAQ score of 3 months after surgery was 34.5. Three of them restarted their sex lives, with an average female sexual function index score of 16.0, which was not significantly different with that of preoperation (15.6). There was no tumor recurrence, metastasis and implantation in all cases. Conclusion: SA-LESS+TV-NOSE NU is safe and feasible for upper tract urothelial carcinoma with faster postoperative recovery, less pain, shorter hospitalization time, better cosmetic results, and does not cause negative effect on the female sexual function.

[Phosphatase and tensin homolog deleted on chromosome ten deficiency sensitizes tumor cells to lithium chloride treatment]

Objective: To identify the therapeutic efficacy of lithium chloride (LiCl) on phosphatase and tensin homolog deleted on chromosome ten (PTEN)-deficient tumors. Methods: First, the Catalogue of Somatic Mutations in Cancer for mutation spectrum of human endometrial carcinoma samples was analyzed. Second, the relationship between PTEN abundance and LiCl inhibition of endometrial cancer cell lines using Pten(+/+) and Pten(-/-) mouse embryonic fibroblast (MEF) lines was investigated. Moreover, potential alterations of mammalian target of rapamycin (mTOR) signaling pathway after treatment with LiCl were checked.Last,LiCl's efficacy on PTEN null tumors was studied. Results: PTEN was mutated in 39% of endometrial carcinomas. LiCl preferentially inhibited the proliferation of PTEN-deficient endometrial carcinoma cells and MEFs. Furthermore, LiCl blocked PTEN-deficient tumor development. Mechanistically, LiCl down-regulated mTOR signaling. Conclusions: PTEN is the most frequently mutated gene in endometrial carcinoma.By targeting mTOR signaling pathway,LiCl is a promising regimen for the treatment of tumors with PTEN deficiency.

Cognition and Evolution of Movement Disorders of FOXG1-Related Syndrome

FOXG1-related syndrome is a rare neurodevelopmental encephalopathy characterized by early onset hyperkinetic movement disorders, absent language, autistic features, epilepsy, and severe cognitive impairment. However, detailed evaluation of cognition and evolution of movement disorders over time have not been clearly described before. In this study, we performed whole-exome sequencing in a cohort with unknown severe encephalopathy and movement disorders, with/without autistic behaviors. We identified FOXG1 mutations in three patients. One of them had a novel mutation that has not been described before. The neuropsychological test by Mullen Scales of Early Learning (MSEL) showed severe psychomotor impairments in all patients. There were uneven cognitive abilities in terms of verbal and non-verbal cognitive domains in all of them, with approximately 2 months differences. Gross motor skills and expressive language were more severely affected than the other domains in all the patients. All individuals had early onset hyperkinetic movement disorders. The movement disorders in one of our patients changed from predominantly hyperkinetic in early childhood to more hypokinetic in adolescence with the development of dystonia. To the best of our knowledge, this evolution had never been described before. In conclusion, individuals with FOXG1-related syndrome may show clinical progression from hyperkinetic to hypokinetic features over time. There were also uneven cognitive abilities in verbal and non-verbal cognitive domains. The FOXG1 mutation should be considered in individuals with a history of hyperkinetic movements, microcephaly, and uneven cognitive abilities with characteristic brain images.

Validation of the modified checklist for autism in toddlers, revised with follow-up in Taiwanese toddlers

BACKGROUND

The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) is a two-stage screening scale for determining the risk of autism spectrum disorder (ASD) in toddlers. However, the validity of the M-CHAT-R/F for Asian populations has not yet been established.

AIMS

This study investigated the psychometric properties of the M-CHAT-R/F, Taiwan version (M-CHAT-R/F-T), among low- and high-risk Taiwanese toddlers aged 16-30 months. The associations among M-CHAT-R/F-T scores, developmental performance at 24 and 30 months, and ASD diagnosis prediction at 36 months were examined.

METHODS AND PROCEDURES

A two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprising 25 toddlers with ASD and 71 atypically developing (ATD) and 221 typically developing (TD) toddlers.

OUTCOMES AND RESULTS

The M-CHAT-R/F-T exhibited acceptable internal consistency and test-retest reliability. The M-CHAT-R/F-T scores were significantly correlated with several syndrome scores of the Child Behavior Checklist for Ages 1.5-5 and were significantly higher among toddlers with ASD than among ATD or TD toddlers. Furthermore, M-CHAT-R/F-T scores were negatively correlated with developmental scores in the Mullen Scales of Early Learning at 24 and 30 months. Moreover, the screening exhibited acceptable predictive validity (sensitivity = 0.86; specificity = 0.96) for ASD diagnosis at 36 months.

CONCLUSIONS AND IMPLICATIONS

The findings indicate that the M-CHAT-R/F-T is a valid and reliable tool for the developmental screening of low- and high-risk Taiwanese toddlers in community and clinical settings.

[Advances in research on echinococcus shiquicus tapeworm]

Echinococcosis is an age-old disease that causes serious damage to the animal husbandry and the human health perennially. As a newly discovered species of Echinococus, E. shiquicus has the potential public health significance and could be a potential parasitic zoonosis. In this review, its etiology, life cycle, epidemiology, detection and diagnoses, public health etc. are discussed or summarized. Also, a series of comparisons among E. granulosus, E. multilocularis and E. shiquicus are made.

[A comparison study of cognitive-behavioral therapy alone versus combination with tapered hypnotic agents in patients with chronic insomnia]

Objective: To investigate the efficacy of cognitive-behavioral therapy for insomnia (CBT-i) or combination with tapered hypnotic agents. Methods: Seventy-five patients were randomized into either CBT-i group (n=37) or combination group (n=38). The duration of treatment lasted for 8 weeks. The efficacy was evaluated by Pittsburgh sleep quality index (PSQI), Beck depression index (BDI) , Beck anxiety inventory (BAI) and sleep diary variables at baseline, middle and end of treatment. Results: (1)Compared with the results at baseline, the total scores of PSQI,BDI and BAI in both groups significantly decreased at the end of treatment: CBT-i group, PSQI (4.7±2.5) vs. (12.9±3.5); BDI (3.2±4.4) vs. (9.7±6.4); BAI (4.2±5.6) vs. (10.7±8.1); and combination group, PSQI (5.8±2.8) vs. (13.9±3.1); BDI (4.5±4.8) vs. (13.8±8.7); BAI (4.4±4.0) vs. (14.1±6.3) (all P<0.01). (2) Compared with the results at baseline, subjective sleep quality (SQ), sleep onset latency (SOL), sleep efficiency (SE), sleep disturbance (SD) and used sleep medication (USM) in PSQI in combination group significantly decreased at week 4 and 8 (all P<0.05) . The total sleep time (TST) and daytime dysfunction (DF) in PSQI significantly decreased at week 8 (both P<0.05) . (3) Compared with combination group, improvement of SOL and SE in CBT-i group was superior (both P=0.01). Conclusions: CBT-i for chronic insomnia is effective in both CBT-i alone and combination with tapered hypnotic agents. CBT-i group is superior in improving SOL and SE. Combination regimen in our study can significantly reduce the doses of medication.

[The efficacy of cognitive behavioral therapy in insomnic patients with or without comorbidities: a pilot study]

Objectives: To evaluate the effectiveness of cognitive behavior therapy for insomnia (CBT-i) in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters. Methods: Patients who met the diagnostic criteria of chronic insomnia, were divided into primary group or comorbid group. Both groups received standard CBT-i interventions. Psychological scales and sleep diaries were used to evaluate participants' severity of insomnia and psychological conditions related to insomnia at four time points: before intervention (baseline), immediate after intervention, 4 weeks and 16 weeks after intervention. Results: Both groups achieved significant improvements after intervention on psychological measurements and sleep diary parameters. Such improvements were maintained at 4-week and 16-week follow-ups. The sleep diary data indicated that by the end of the intervention, there were significant differences on sleep onset latency (51.72 min to 10.53 min in primary group, P<0.01; 59.26 min to 15.67min in comorbid group, P<0.01) and sleep efficiency (71% to 95% in primary group, P<0.01; 68% to 90% in comorbid group, P<0.01). There were differences on sleep onset latency (10.00 min vs. 13.93 min, P<0.05), total sleep time (355.71 min vs. 327.85 min, P<0.05) and sleep efficiency (95% vs. 91%, P<0.01) in primary group and comorbid group respectively. No differences were found on wake after sleep onset in the two groups. Conclusions: Chronic insomnia patients with or without comorbidities both have improvements after CBT-i. Sleep diary parameters rather than psychological measurements are different in two groups. Thus, CBT-i is an effective non-pharmaceutical therapy inpatients with chronic insomnia.

[Neuroendoscopy assisted microneurosurgery for posterior cranial fossa lesion]

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

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

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

Nontraumatic Acute Anterior Cord Syndrome Caused by Cervical Disc Herniation after Napping with Neck Extension

Nontraumatic acute anterior cord syndrome caused by disc herniation occurring in the cervical spine is rare. A 39-year-old man presented with a sharp burning pain in bilateral upper limbs and progressive paraplegia after a nap with neck extension. He had impaired sensation of pain and temperature with preservation of proprioception and light touch below the C6 level. The magnetic resonance imaging showed focal hyperintensity of the anterior cord at the C5-C7 level and central herniation of C5-6 and C6-7 discs. An anterior discectomy of C5-6 and C6-7 was conducted because of the poor response to a high dose of steroid. A postoperative intensive rehabilitation treatment was also performed. The patient showed significant improvement in motor and sensory function three months postoperatively. Long-term repetitive neck extension should be avoided because it may be a risk for degenerative spondylotic change and cord compression disorders. Surgical intervention should be considered in a patient with anterior cord syndrome associated with nontraumatic cervical disc herniation. (Hong Kong j.emerg.med. 2013;20:389-391)

Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis

Background: Overweight and obese older people face a high risk of muscle loss and impaired physical function, which may contribute to sarcopenic obesity. Resistance exercise training (RET) has a beneficial effect on muscle protein synthesis and can be augmented by protein supplementation (PS). However, whether body weight affects the augmentation of muscular and functional performance in response to PS in older people undergoing RET remains unclear.Objective: This study was conducted to identify the effects of PS on the body composition and physical function of older people undergoing RET.Design: We performed a comprehensive search of online databases to identify randomized controlled trials (RCTs) reporting the efficacy of PS for lean mass gain, strength gain, and physical mobility improvements in older people undergoing RET.Results: We included 17 RCTs; the overall mean ± SD age and body mass index (BMI; in kg/m²) in these RCTs were 73.4 ± 8.1 y and 29.7 ± 5.5, respectively. The participants had substantially greater lean mass and leg strength gains when PS and RET were used than with RET alone, with the standard mean differences (SMDs) being 0.58 (95% CI: 0.32, 0.84) and 0.69 (95% CI: 0.39, 0.98), respectively. The subgroup of studies with a mean BMI ≥30 exhibited substantially greater lean mass (SMD: 0.53; 95% CI: 0.19, 0.87) and leg strength (SMD: 0.88; 95% CI: 0.42, 1.34) gains in response to PS. The subgroup of studies with a mean BMI <30 also exhibited relevant gains in response to PS.Conclusions: Compared with RET alone, PS combined with RET may have a stronger effect in preventing aging-related muscle mass attenuation and leg strength loss in older people, which was found in studies with a mean BMI ≥30 and in studies with a mean BMI <30. Clinicians could use nutrition supplement and exercise strategies, especially PS plus RET, to effectively improve the physical activity and health status of all older patients.

Gross Motor Trajectories During the First Year of Life for Preterm Infants With Very Low Birth Weight

BACKGROUND

Early identification of motor dysfunction in preterm infants with very low birth weight (VLBW) is important in order to provide early intervention.

OBJECTIVE

This study was to examine the motor trajectories of preterm infants with VLBW during their first year of life and to investigate the predictive ability and influencing factors of the trajectories.

DESIGN AND METHODS

A total of 342 preterm infants with VLBW were prospectively assessed for motor development by the Alberta Infant Motor Scales at 4, 6, 9, and 12 months and for developmental outcomes using the Bayley Scales of Infant and Toddler Development, second edition, at 24 months. Perinatal and socio-environmental factors were collected at baseline. Growth mixture modeling was used to explore the patterns of infants' motor trajectories during their first year of life. Logistic regression analyses were applied to examine the influencing factors associated with motor trajectories and their predictability of 24-month developmental outcomes.

RESULTS

Preterm infants with VLBW showed 3 distinct motor trajectories: stably normal (55%), deteriorating (32%), and persistently delayed (13%). Furthermore, the motor trajectories were predictive of 24-month cognitive and motor outcomes. Perinatal factors including lower birth weight, male gender, moderate to severe bronchopulmonary dysplasia, stage III to IV retinopathy of prematurity, and major brain damage were associated with a risk of deteriorating and persistently delayed trajectories (all P < .05). Socio-environmental factors had no association with motor trajectories.

LIMITATIONS

The small sample size of the infants with a persistently delayed trajectory may have limited the assessment of some influencing factors.

CONCLUSION

The identified early motor trajectories, predictive values, and influencing factors provide insightful implications for early detection and prevention of motor -disorders in preterm infants with VLBW.

[Association between the office, visit-to-visit and 24-hour ambulatory systolic blood pressure and vascular damages in the elderly]

OBJECTIVE

To investigate the association between different kinds of systolic blood pressure (SBP, including office, visit-to-visit, 24-hour ambulatory) and vascular damages (represented by carotid intima-media thickness, CIMT; brachial-ankle pulse wave velocity, baPWV) in the elderly.

METHODS

A total of 2 814 participants aged of ≥60 years old and retired employees were selected with random sampling method from the individuals who took part in 2006-2007, 2008-2009, 2010-2011 health examination in Tangshan Kailuan Hospital, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital and with 24-hour ambulatory blood pressure monitoring data, CIMT and baPWV.Finally, 2 146 participants (1 438 males, average age (67.3±6.0) years old) were included to the analysis.Multivariable regression analysis was used to analyze association between the office, visit-to-visit, 24-hour, day-time, night-time SBP and CIMT and baPWV, respectively.

RESULTS

(1) The average SBP, DBP, CIMT and baPWV were (137.0±20.4) mmHg(1 mmHg=0.133 kPa), (83.5±11.0) mmHg, (0.92±0.18)mm and (1 781.7±353.2)cm/s.(2) The participants were divided into high and low level groups according to the median of different SBPs, respectively.The results indicated that CIMT and baPWV were significantly higher in high level groups than in low level groups (all P<0.01). (3) After adjusting for gender and age, the partial correlate analysis showed that the office, visit-to-visit, 24-hour, day-time, night-time SBP positively associated with CIMT and baPWV (all P<0.01). (4) After adjusting for confounding factors, multivariable regression analysis showed that the office, visit-to-visit, 24-hour, day-time, night-time SBP were positively and linearly associated with CIMT and baPWV in total cohort, and standard regression coefficients were 0.157, 0.208, 0.175, 0.169, 0.163, 0.479, 0.420, 0.401, 0.389 and 0.354, respectively.In addition, similar results were observed in male and female participants but there was no significance between night-time SBP and CIMT in female participants.

CONCLUSIONS

Office, visit-to-visit, 24-hour, day-time, night-time SBP are associated with vascular damages, and the best associations are observed between visit-to-visit SBP and vascular function damage.

CLINICAL TRIAL REGISTRY

Chinese CLINICAL TRIAL REGISTRY, ChiCTR-TNC-1100 1489.

Retention of autism spectrum disorder diagnosis: The role of co-occurring conditions in males and females

This study examined associations between ASD diagnosis retention and non-ASD co-occurring conditions (CoCs) by child sex. The sample included 7077 males and 1487 females who had an ASD diagnosis documented in their school or health records in a population-based ASD surveillance system for 8-year-old children. ASD diagnosis retention status was determined when an initial ASD diagnosis was not later ruled out by a community professional. We found that ASD diagnosis remains fairly stable, with only 9% of children who had an initial documented ASD diagnosis later being ruled-out. Although most of the associations between the ASD diagnosis retention status and CoCs are similar in both sexes, the co-occurrence of developmental diagnoses (e.g., intellectual disability or sensory integration disorder) was predictive of ASD diagnostic changes in males, whereas the co-occurrence of specific developmental (e.g., personal/social delay) and neurological diagnosis (e.g., epilepsy) was associated with ASD diagnostic change in females. More ASD-related evaluations and less ASD-related impairment were associated with later ASD rule outs in both sexes. Our findings highlight that CoCs can complicate the diagnostic picture and lead to an increased likelihood of ambiguity in ASD diagnosis. Using sensitive and appropriate measures in clinical practice is necessary for differential diagnosis, particularly when there are co-occurring developmental conditions.

[Influencing factors of orthostatism brachial-ankle pulse wave velocity and ankle brachial index in the elderly]

OBJECTIVE

To investigate the distribution and influencing factors of orthostatism brachial-ankle pulse wave velocity(baPWV) and ankle brachial index(ABI) in the elderly.

METHODS

Participants were selected with random sampling from ≥60 years old retired workers, who underwent 2010 to 2011 health check-up in the Tangshan Kailuan Hospital, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital. Multivariate linear regression analysis was used to analyze the influencing factors of orthostatism and supine baPWV and ABI in the elderly.

RESULTS

(1) A total of 2 464 participants were included, and 1 601 participants (1 065 males(66.5%) and (67.5±6.1) years old) with integral data were analyzed. Orthostatism baPWV was (3 885.4±1 503.5)cm/s and Supine baPWV was (1 761.2±371.4)cm/s.Orthostatism ABI was 1.54±0.21 and supine ABI was 1.10±0.12. Orthostatism baPWV increased with increasing age, while orthostatism ABI decreased with aging(trend test, both P<0.01)in <65, 65-69, 70-74, and ≥75 years old participants.(2) Multiple linear regression analysis showed that the age(β=0.19, P<0.01), lower limbs orthostatism systolic blood pressure(β=0.18, P<0.01), lower limbs supine systolic blood pressure (β=0.14, P<0.01), orthostatism heart rate (β=0.30, P<0.01), supine heart rate (β=0.23, P<0.01), body mass index (β=-0.18, P<0.01) were associated with orthostatism baPWV, and female(β=-0.055, P=0.01), upper limb orthostatism systolic blood pressure (β=-0.834, P<0.01), lower limbs orthostatism systolic blood pressure (β=0.708, P<0.01), lower limbs supine systolic blood pressure (β=0.099, P<0.01) and fasting blood glucose(β=-0.085, P<0.01) were associated with orthostatism ABI.

CONCLUSIONS

Orthostatism baPWV and ABI were significantly higher than those of supine's. Age, lower limbs orthostatism and supine systolic blood pressure, orthostatism and supine heart rate, body mass index were associated with orthostatism baPWV. Female, upper limb orthostatism systolic blood pressure, lower limbs orthostatism, supine systolic blood pressure and fasting blood glucose were associated with orthostatism ABI in the elderly.

Alterations in white matter micro-integrity of the superior longitudinal fasciculus and anterior thalamic radiation of young adult patients with depression

BACKGROUND

This study surveyed the characteristics of white matter (WM) micro-integrity in patients who were diagnosed with major depressive disorder (MDD) without co-morbidities.

METHOD

A total of 44 patients with MDD and 27 normal controls were enrolled in our study. Diffusion tensor imaging images of patients and controls were pre-processed and analysed to estimate differences in WM micro-integrity between patients and controls by performing comparisons of the values obtained from fractional anisotropy (FA). FA outputs of patients and controls were compared by a non-parametric permutation-based method with global brain volume, age and gender as covariates. In addition, the between-group differences of radial diffusivity (RD) and axial diffusivity (AD) were assessed to explain the alterations in FA values. Correlations between clinical variables (such as depression severity, anxiety severity, illness duration) and FA values were also estimated in each group and across both groups.

RESULTS

The patients with MDD had significantly lower FA values than the controls, for the left superior longitudinal fasciculus (SLF) and the right anterior thalamic radiation (ATR). The reductions in FA values occurred in combination with elevated RD values in the bilateral SLF and decreased AD values in the bilateral ATR. FA values were negatively correlated with depression severity in the SLF and with illness duration in the right SLF and ATR.

CONCLUSIONS

MDD patients had significant alterations in the WM micro-integrity of the left SLF and the right ATR.

A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: effects and mediators

This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.

Modulated expression of human peripheral blood microRNAs from infancy to adulthood and its role in aging

Accumulating evidence suggests a role for microRNAs (miRNAs) in regulating various processes of mammalian postnatal development and aging. To investigate the changes in blood-based miRNA expression from preterm infants to adulthood, we compared 365 miRNA expression profiles in a screening set of preterm infants and adults. Approximately one-third of the miRNAs were constantly expressed from postnatal development to adulthood, another one-third were differentially expressed between preterm infants and adults, and the remaining one-third were not detectable in these two groups. Based on their expression in infants and adults, the miRNAs were categorized into five classes, and six of the seven miRNAs chosen from each class except one with age-constant expression were confirmed in a validation set containing infants, children, and adults. Comparing the chromosomal locations of the different miRNA classes revealed two hot spots: the miRNA cluster on 14q32.31 exhibited age-constant expression, and the one on 9q22.21 exhibited up-regulation in adults. Furthermore, six miRNAs detectable in adults were down-regulated in older adults, and four chosen for individual quantification were verified in the validation set. Analysis of the network functions revealed that differentially regulated miRNAs between infants and adults and miRNAs that decreased during aging shared two network functions: inflammatory disease and inflammatory response. Four expression patterns existed in the 11 miRNAs from infancy to adulthood, with a significant transition in ages 9–20 years. Our results provide an overview on the regulation pattern of blood miRNAs throughout life and the possible biological functions performed by different classes of miRNAs.

Maternal-reported behavioral and emotional problems in Taiwanese preschool children

There has been limited epidemiologic information concerning preschoolers' behavioral and emotional problems in Eastern societies. This study was therefore aimed to investigate behavioral and emotional problems in a large sample of Taiwanese preschoolers using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). The CBCL/1.5-5 was scored by mothers of 645 Taiwanese preschoolers aged 24-71 months. Psychometric features of the scale as well as the raw scores and prevalence rates of behavioral problems of Taiwanese preschoolers were compared with those of American counterparts. Several demographic variables with the Total Problems and syndromes scores were also examined. The CBCL/1.5-5 was found to have good to excellent levels of reliability (internal consistency, test-retest reliability and inter-parent agreement) and an acceptable model fit of seven-syndrome factor structure (root mean square error of approximation=0.055) when used with Taiwanese preschoolers. The prevalence rate of Total Problems, Internalizing syndrome and Externalizing syndrome score in the clinical range was 25.1%, 11.2% and 25.4%, respectively. Cross-cultural comparisons showed that Taiwanese preschoolers had higher scores in six narrow-band syndromes (effect size d=0.17-0.43, all p's<0.005) and prevalence rates of four Internalizing-related syndromes and Sleep Problems than American sample (odds ratio=2.4-4.9, all p's<0.005). Analyses of behavioral correlates revealed associations of first birth order with higher Internalizing, Externalizing and Total Problems scores (all p's<0.05). Furthermore, younger ages (24-47 months) and male gender were associated with higher Externalizing and Total Problems scores (all p's<0.05). Our data have provided important epidemiologic information to assist in clinical assessment and management of preschoolers' behavioral and emotional problems in an Eastern society.

Reliability of the assessment of mother-infant sensitivity-chinese version for preterm and term taiwanese mother-infant dyads

PURPOSE

The objectives of this study were to translate and modify the Assessment of Mother-Infant Sensitivity scale into a Chinese version (modified AMIS-C) and to examine its reliability with preterm and term Taiwanese mother-infant dyads.

METHOD

A total of 241 mother-infant pairs (179 preterm dyads and 62 term dyads) were prospectively recorded and their behaviour in feeding assessed using the modified AMIS-C when infants were at 4 and 6 months corrected age. A subset of the sample was used for interrater reliability testing, and the whole sample was used for assessment of internal consistency.

RESULTS

Interrater reliability was high for the modified AMIS-C section and total scores (intra-class correlation coefficients=0.91-0.99). Internal consistency was good to excellent for the maternal section and total score (α=0.71-0.86) and was fair to good for the infant and dyadic section score (α=0.44-0.75).

CONCLUSIONS

The modified AMIS-C scale is a clinically feasible and reliable instrument for assessing mother-infant interaction of preterm and term dyads during early infancy.

International comparisons of behavioral and emotional problems in preschool children: parents' reports from 24 societies

International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½-5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders-oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3-12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0-198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

Preschool psychopathology reported by parents in 23 societies: testing the seven-syndrome model of the child behavior checklist for ages 1.5-5

OBJECTIVE

To test the fit of a seven-syndrome model to ratings of preschoolers' problems by parents in very diverse societies.

METHOD

Parents of 19,106 children 18 to 71 months of age from 23 societies in Asia, Australasia, Europe, the Middle East, and South America completed the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). Confirmatory factor analyses were used to test the seven-syndrome model separately for each society.

RESULTS

The primary model fit index, the root mean square error of approximation (RMSEA), indicated acceptable to good fit for each society. Although a six-syndrome model combining the Emotionally Reactive and Anxious/Depressed syndromes also fit the data for nine societies, it fit less well than the seven-syndrome model for seven of the nine societies. Other fit indices yielded less consistent results than the RMSEA.

CONCLUSIONS

The seven-syndrome model provides one way to capture patterns of children's problems that are manifested in ratings by parents from many societies. Clinicians working with preschoolers from these societies can thus assess and describe parents' ratings of behavioral, emotional, and social problems in terms of the seven syndromes. The results illustrate possibilities for culture-general taxonomic constructs of preschool psychopathology. Problems not captured by the CBCL/1.5-5 may form additional syndromes, and other syndrome models may also fit the data.

Brief Report: Taiwanese Infants' Mental and Motor Development 6 24 Months

OBJECTIVES

To establish the normative data of the Bayley Scales of Infant Development-Second Edition (BSID-II) on Taiwanese infants from age 6 to 24 months and to explore the factors that relate to their mental and motor development.

METHODS

Five hundred and seven Taiwanese full-term infants were prospectively examined with the BSID-II at 6, 12, 18, and 24 months of age.

RESULTS

Taiwanese infants' Bayley mental and motor raw scores were lower than the United States norms from age 6 to 24 months, however, the discrepancy gradually declined with increasing age. Gender, intrauterine growth status, birth order, region of residence, maternal education, and paternal occupation were shown to have longitudinal associations with their mental and/or motor scores.

CONCLUSIONS

Differences existed in the mental and motor development among Taiwanese and American infants. Our preliminary norms of the BSID-II may be more appropriate than the United States norms for Taiwanese children.

Generation of a velogenic Newcastle disease virus from cDNA and expression of the green fluorescent protein

Newcastle disease virus (NDV) is a pathogen that is important in the poultry industry worldwide. Specifically, the virulent (velogenic) NDV is a particular threat because it has now occurred frequently worldwide. The outbreaks caused by highly virulent NDV in waterfowl and especially in goose flocks, have led to greater concern in recent years as aquatic birds were previously resistant to most virulent NDV strains from chickens. The molecular determinants of host tropism, virulence and emergence of NDV isolated from diseased goose flocks are poorly understood. In the present study, we rescued a highly virulent NDV isolated from a goose using the reverse genetics approach. Infectious virus was successfully generated by cotransfection of a full-length cDNA clone of the NDV strain ZJ1 with helper plasmids. The recombinant NDV was indistinguishable from the parental wild-type virus with respect to its growth kinetics in cell culture as well as its biological properties. A recombinant NDV expressing green fluorescent protein (GFP) was generated, and GFP was subsequently detected in cells and various organs from the infected chickens.

High performance liquid chromatographic determination of a new antifungal compound, ADKZ in rat plasma

A high performance liquid chromatography (HPLC) method was developed and validated for the determination of ADKZ (1-(1H-1,2,4-triazole)-2-(2,4-diflurophenyl) -3-[N-methyl-N-(4-iodo-benzyl)amino]-2-propanol) in rat plasma. The compound was extracted from plasma samples by liquid-liquid extraction, and an isomeric compound of ADKZ (1-(1H-1,2,4-triazole)-2-(2,4-diflurophenyl)-3-[N-methyl-N -(3-iodo-benzyl)amino]-2-propanol) was used as the internal standard (IS), which were analyzed on a reversed-phase C18 column (5 microm, 200 mm x 4.6 mm i.d.). The extracted plasma samples were eluted with acetonitrile-0.018 M triethylamine solution adjusted to pH 3.2 with phosphoric acid (35:65, v/v). The effluent was monitored by a UV detector at 230 nm. The retention time of ADKZ was 7.1 min and IS 8.2 min. The calibration curves were linear in the concentration range of 0.02-2.00 microg/ml with the correlation coefficients greater than 0.999. The quantification limit of ADKZ in rat plasma was 0.02 microg/ml. Intra- and inter-day precision ranged from 2.6 to 7.9% and 3.1 to 9.6%, respectively. The extraction recovery from plasma was no less than 80%. No endogenous interferences were observed with either ADKZ or IS. The method has been successfully used to support the pre-clinical pharmacokinetic studies of ADKZ in rats.

Chiral liquid chromatography resolution and stereoselective pharmacokinetic study of tetrahydropalmatine enantiomers in dogs

A selective chiral high performance liquid chromatographic (HPLC) method coupled with achiral column was developed and validated to separate and quantify tetrahydropalmatine (THP) enantiomers in dog plasma. Chromatography was accomplished by two steps: (1) racemic THP was separated from biological matrix and collected on a Kromasil C18 column (150 mmx4.6 mm, 5 microm) with the mobile phase acetonitrile-0.1% phosphoric acid solution, adjusted with triethylamine to pH 6.15 (47:53); (2) enantiomeric separation was performed on a Chiralcel OJ-H column (250 mmx4.6 mm, 5 microm) with the mobile phase anhydrous ethanol. The detection wavelength was set at 230 nm. (+)-THP and (-)-THP were separated with a resolution factor (Rs) of at least 1.6 and a separation factor (alpha) greater than 1.29. Linear calibration curves were obtained over the range of 0.025-4 microg/ml in plasma for each of (+)-THP and (-)-THP (R2>0.999) with a limit of detection (LOD) of 0.005 microg/ml and the recovery was greater than 88% for each enantiomer. The relative standard deviation (R.S.D.) and relative error values were less than 10% at upper and lower concentrations. The method was used to determine the pharmacokinetics of THP enantiomers after oral administration of racemic THP. The results presented herein showed the stereoselective disposition kinetics of THP in dogs and were a further contribution to the understanding of the kinetic behavior of THP analogues.

Study of stereoselective pharmacokinetics of anisodamine enantiomers in rabbits by capillary electrophoresis

The purpose of this study was to determine the pharmacokinetics of anisodamine enantiomers in plasma after oral and intravenous administration of racemic anisodamine in rabbits. A capillary electrophoresis method for the simultaneous separation of two pairs of enantiomers in plasma has been firstly developed and validated. Using a 75 mM phosphate buffer containing 25 mM carboxymethylated-gamma-cyclodextrin at pH 2.5, good resolution was achieved on a 45-cm uncoated fused-silica capillary at the voltage of 20 kV and 25 degrees C. The pharmacokinetics of individual anisodamine enantiomers were characterized using the CE assay, the sole method of enantiomeric separation for anisodamine. Pharmacokinetic analysis of results indicated that anisodamine enantiomers showed non-stereoselective disposition or stereoselective disposition in different rabbits. For the rabbits with non-stereoselective disposition, similar pharmacokinetic characteristics were observed between (6S, 2'S)- and (6R, 2'R)-, or (6S, 2'R)- and (6R, 2'S)-anisodamine. For the rabbits with stereoselective disposition, (6S, 2'S)- and (6R, 2'S)-anisodamine were below the established LOD, while the two remaining enantiomers also had similar pharmacokinetic profiles. Further investigations remain necessary to find out the underlying mechanism about the stereoselective disposition of (6S, 2'S)- and (6R, 2'S)-anisodamine.

Alteration of the copy number and deletion of mitochondrial DNA in human hepatocellular carcinoma

Somatic mutations in mitochondrial DNA (mtDNA) have been detected in hepatocellular carcinoma (HCC). However, it remains unclear whether mtDNA copy number and mitochondrial biogenesis are altered in HCC. In this study, we found that mtDNA copy number and the content of mitochondrial respiratory proteins were reduced in HCCs as compared with the corresponding non-tumorous livers. MtDNA copy number was significantly reduced in female HCC but not in male HCC. Expression of the peroxisome proliferator-activated receptor γ coactivator-1 was significantly repressed in HCCs (P<0.005), while the expression of the mitochondrial single-strand DNA-binding protein was upregulated, indicating that the regulation of mitochondria biogenesis is disturbed in HCC. Moreover, 22% of HCCs carried a somatic mutation in the mtDNA D-loop region. The non-tumorous liver of the HCC patients with a long-term alcohol-drinking history contained reduced mtDNA copy number (P<0.05) and higher level of the 4977 bp-deleted mtDNA (P<0.05) as compared with non-alcohol patients. Our results suggest that reduced mtDNA copy number, impaired mitochondrial biogenesis and somatic mutations in mtDNA are important events during carcinogenesis of HCC, and the differential alterations in mtDNA of male and female HCC may contribute to the differences in the clinical manifestation between female and male HCC patients.

Genomic sequence of an isolate of Newcastle disease virus isolated from an outbreak in geese: a novel six nucleotide insertion in the non-coding region of the nucleoprotein gene. Brief Report

We have completely sequenced the genome of an isolate of Newcastle disease virus (NDV) obtained following an outbreak in geese. The genomic sequence consists of 15192 nt, which is six nt longer than the published full length genome of the NDV strains La Sota, B1, Clone-30, Beaudette C and HB V4. The six nt insertion was located in the non-coding region of the nucleoprotein (NP) gene between nt 1646 and nt 1647 of the NDV genome (numbered according to the genomic sequence of the La Sota strain). An additional 22 NDV strains were searched for the existence of this six nt insertion. NDVs in genotypes VI, VII, VIII and IX had this insertion while NDV's in genotypes I, II, III, IV, and V did not. The significance of this insertion in NDV evolution is discussed.