[Research progress on AMPK activation in nonalcoholic fatty liver disease]

Nonalcoholic fatty liver disease (NAFLD) occurrence and progression are associated with lipid accumulation, insulin resistance, inflammation, liver damage, fibrosis, and other factors. AMP-dependent protein kinase (AMPK) is a key molecule that regulates bioenergy metabolism and participates in multiple biological processes, including lipid metabolism, autophagy, inflammation, and cell apoptosis. Promoting AMPK activation can reduce hepatic lipid accumulation and insulin resistance, alleviate the development of NAFLD, reduce liver inflammation and fibrosis, and inhibit the progression of NAFLD to nonalcoholic steatohepatitis.

[Characteristics and clinical significance of wideband tympanometry of otitis media with effusion in young children]

Objective: To study the characteristics of wideband tympanometry(WBT) and its application value in the diagnosis of otitis media with effusion(OME) in young children. Methods: We compared wideband acoustic energy absorbance(EA) under peak pressure in young children with OME(190 ears) and healthy control subjects(121 ears) from Ninth People's Hospital of Shanghai Jiaotong University School of Medicine between January 2018 and June 2020. Both groups were divided into three groups, 1-6 months, 7-36 months and 37-72 months. SPSS 20.0 statistical software was used to analyze and compare the EA parameters between OME children of different months and the control group. Receiver operating characteristic (ROC)curve was used to analyze the diagnostic value of WBT in young children with OME. Results: There were significant differences in EA among three OME groups from 500 Hz to 2 000 Hz(P<0.05).Compared with the control groups, EA of 1-6 m OME group decreased significantly below 4 000 Hz(P<0.05), EA of 7-36 m OME group decreased significantly at 545-1 600 Hz(P<0.05), EA of 37-72 m OME group decreased significantly above 545 Hz(P<0.05).ROC curve indicated that EA at 1 000 Hz had the greatest diagnostic value (AUC was 0.890), followed by 1 500 Hz and the range of 500-2 000 Hz (AUC was 0.883 and 0.881, respectively).EA at 1 000 Hz with a cutoff value of 0.55 had the best diagnostic sensitivity of 90.8%, which was higher than conventional tympanometry (85.8%). The maximum AUC (0.932) could be obtained by combining EA, peak pressure and admittance amplitude of 226 Hz tympanometry as predictors. Conclusions: EA is significantly decreased in young children with OME. Compared with the conventional single frequency tympanometry, WBT is more accurate in the diagnosis of OME in young children, and the prediction accuracy would be better if combined with 226 Hz tympanometry.

Upper esophageal sphincter abnormalities on high-resolution esophageal manometry and treatment response of type II achalasia

BACKGROUND

Little is known about the clinical significance of upper esophageal sphincter (UES) motility disorders and their association with the treatment response of type II achalasia. None of the three versions of the Chicago Classification of Esophageal Motility Disorders has defined UES abnormality metrics or their function. UES abnormalities exist in some patients and indicate a clinically significant problem in patients with achalasia.

AIM

To demonstrate the manometric differentiation on high-resolution esophageal manometry between subjects with abnormal UES and normal UES, and the association between UES type and the treatment response of type II achalasia.

METHODS

In total, 498 consecutive patients referred for high-resolution esophageal manometry were analyzed retrospectively. The patients were divided into two groups, those with normal and abnormal UES function. UES parameters were analyzed after determining lower esophageal sphincter (LES) function. Patients with type II achalasia underwent pneumatic dilation for treatment. Using mixed model analyses, correlations between abnormal UES and treatment response were calculated among subjects with type II achalasia.

RESULTS

Of the 498 consecutive patients, 246 (49.40%) were found to have UES abnormalities. Impaired relaxation alone was the most common UES abnormality (52.85%, n = 130). The incidence rate of type II achalasia was significantly higher in subjects with abnormal UES than those with normal UES (9.77% vs 2.58%, P = 0.01). After pneumatic dilation, LES resting pressure, LES integrated relaxation pressure, and UES residual pressure were significantly decreased (41.91 ± 9.20 vs 26.18 ± 13.08, 38.94 ± 10.28 vs 16.71 ± 5.65, and 11.18 ± 7.93 vs 5.35 ± 4.77, respectively, P < 0.05). According to the Eckardt score, subjects with type II achalasia and abnormal UES presented a significantly poorer treatment response than those with normal UES (83.33% vs 0.00%, P < 0.05).

CONCLUSION

Impaired relaxation alone is the most common UES abnormality. The incidence of type II achalasia is associated with abnormal UES. Type II achalasia with abnormal UES has a poorer treatment response, which is a potentially prognostic indicator of treatment for this disease.

Effects of milk powder intervention on bone mineral density and indicators related to bone metabolism in Chinese adolescents

The study is to determine the effects of milk powder on bone density and metabolism in healthy adolescents. Vitamin D and calcium supplements increased IGF-1 but did not affect bone mineralization or turnover. Higher vitamin D in combination with sufficient calcium supplementation in such populations requires attention.

INTRODUCTION

Both calcium and vitamin D play an important role in bone mineralization in adolescents.

METHODS

In this one and a half-year randomized controlled trial, 232 participants (aged 12-15 years) were randomly assigned to three intervention groups receiving milk powder fortified with vitamin D 400 IU plus calcium 300, or 600, or 900 mg [Ca3D (n = 54), Ca6D (n = 56), and Ca9D (n = 49)], or one control group maintaining habitual diet [control (n = 73)]. Bone turnover markers, serum intact PTH, 25(OH)D, and IGF-1 levels were measured at baseline and one and a half years, and bone mineral contents and bone areal mineral density were measured by Dual-energy X-ray absorptiometry (DXA) at baseline, one year, and one and a half years.

RESULTS

Baseline average serum 25(OH)D level and calcium intake were 29.4 nmol/L and 363.5 mg/day, respectively. There was a significant increase in bone turnover, total body, hip, lumbar spine bone mineral density (BMD), and total body BMC as well as slight fluctuations in 25(OH)D levels over one and a half years without between-group differences. Significantly decreased serum PTH level was only observed in the Ca6D group (31%, p < 0.0001), in which the intervention effect was also significant (p = 0.0029) compared with the control group. IGF-1 levels increased significantly in all intervention groups (18.5 to 22.8%, p < 0.05) but decreased in the control group (16.5%, p < 0.05), and the group by time interaction was also significant (p = 0.0029).

CONCLUSIONS

Our study showed that in healthy adolescents with low vitamin D status and calcium intake, mild vitamin D and mild to modest calcium supplements increased IGF-1 but did not affect bone mineralization or turnover. Higher vitamin D in combination with sufficient calcium supplementation in such populations requires attention.

[Effects of bimodal intervention on the development of auditory and speech ability in infants with unilateral cochlear implantation]

Objective: To explore the effects of bimodal intervention on the development of auditory and speech ability in the infants with unilateral cochlear implantation(CI). Methods: Total 35 bilateral profound sensorineural hearing loss infants with unilateral CI, aged 0.7 to 2.8 years old, were selected. The subjects were divided into two groups: the group with unilateral CI(cochlear implant alone, n= 15), and the bimodal group with CI and contralateral fitting hearing aid(n= 20). Their auditory and speech abilities were estimated at the different time points after switch-on(the 0th, 0.5th, 1st, 3rd, 6th, 12th, 18th, and 24th month, respectively) using Infant Toddler-Meaningful Auditory Integration Scale(IT-MAIS), Meaningful Use of Speech Scale(MUSS), Categories of Auditory Performance(CAP), and Speech Intelligibility Rating(SIR) scores. Results: The IT-MAIS scores of bimodal group after switch-on were higher than unilateral CI group(the 0.5th, 1st, 3rd, 6th, 12th, and 18th month), the statistical significances were identified at the 0.5th, 1st, 3rd, 6th, and 12th month, respectively(P<0.05). The CAP scores of bimodal group before CI operation and after switch-on(the 0.5th, 1st, 3rd, 6th, 12th, 18th and 24th month)were higher than unilateral CI group, the statistical significances were seen at the 3rd, 6th, 12th, 18th and 24th month after switch-on(P<0.05). The MUSS scores of bimodal group after switch-on were higher than unilateral CI group(the 1st, 3rd, 6th, 12th, 18th and 24th month), the statistical significances were found at the 12th, 18th and 24th month, respectively(P<0.05). The SIR scores of bimodal group after switch-on were higher than unilateral CI group(the 3rd, 6th, 12th, 18th and 24th month), and significant differences appeared at the 12th, 18th and 24th month after switch-on(P<0.05). Conclusion: Bimodal intervention could be helpful to the development of auditory and speech ability of infants.

Metformin reduces SATB2-mediated osteosarcoma stem cell-like phenotype and tumor growth via inhibition of N-cadherin/NF-kB signaling

OBJECTIVE

To investigate the role of SATB2 in stem cell-like properties of osteosarcoma and identify new strategies to eliminate cancer stem cells of osteosarcoma.

MATERIALS AND METHODS

Osteosarcoma cancer stem cells were derived by sarcosphere generation or chemo drug enrichment. SATB2 and pluripotency-associated gene expression in osteosarcoma CSCs were analyzed using qRT-PCR and Western blotting. The sphere formation assay, cell counting kit-8 assay and anti-chemotherapy proteins were used to measure the effects of altered SATB2, N-cadherin expression or metformin treatment in CSCs. Nude mice were injected with SATB2-deficient U2OS/MTX cells to assess the role of SATB2 in osteosarcoma growth and chemoresistance in vivo. Bioinformatics analyses were performed to identify SATB2 downstream target genes and immunochemistry to determine the correlation between SATB2 expression and patient outcome. Western blotting and luciferase reporter assays were used to examine the effects of N-cadherin and SATB2 inhibition on the NF-kB pathway.

RESULTS

SATB2 was upregulated in osteosarcoma stem cells. Knockdown of SATB2 decreased sarcosphere formation, cell proliferation and stem cell-like gene expression in vitro, meanwhile reduced tumor growth and chemoresistance in vivo. High SATB2 expression in osteosarcoma patient samples was associated with poor clinical outcome. N-cadherin was one critical downstream target gene of SATB2 that mediated the stem cell-like phenotype. Reduction of SATB2 or N-cadherin resulted in NF-kB inactivation, which led to impaired osteosarcoma sphere formation and tumor cell proliferation. Metformin treatment of osteosarcoma cells enhanced the effects of chemotherapy via suppression of N-cadherin.

CONCLUSIONS

SATB2 plays an important role in regulating osteosarcoma stem cell-like properties and tumor growth. The combination of conventional chemotherapy and metformin may be a promising therapeutic strategy for osteosarcoma patients.

[Risk factors and clinical characteristics of gastroesophageal reflux disease: analysis based on a prospective database of functional gastrointestinal disease]

OBJECTIVE

To explore the risk factors and clinical characteristics of non-erosive reflux disease (NERD) based on a prospective single disease database of functional gastrointestinal disease.

METHODS

Using a customized case report form, we collected the personal and clinical data of all study participants in an online database for further analysis. High-resolution manometry and multichannel intraluminal impedance-pH monitoring were performed in some cases.

RESULTS

A total of 504 NERD cases and 152 control cases were included in our database. The NERD patients consisted of 266 (52.8%) female patients and 238 (47.2%) male patients; 32.7% of the patients were from rural areas and 67.3% from urban areas; 23.1% of the patients worked in the line of business, 19.6% were civil servants, 19.2% were unemployed, and 17.1% were workers; the mean disease duration of the patients was 27.88∓16.33 month. Our analysis showed that adverse events in life (P=0.045, OR=1.954), frequent drinking (P=0.040, OR=3.957), snoring (P=0.002, OR=2.334), late meals (P=0.002, OR=2.752), and anxiety or depression (P=0.003, OR=2.723) were all independent risk factors for NERD. Of these patients, 60.81% had varying degrees of ineffective contraction of the esophageal body. The total liquid reflux events differed significantly between NERD patients with hiatal hernia and those without (P<0.05).

CONCLUSION

Unhealthy eating habits and lifestyle, history of adverse events, anxiety and depression, snoring, poor esophageal motor function and hiatal hernia are significant factors contributing to NERD, which is related with occupation and living areas and occurs most commonly at 30-50 years of age.

Expression of immediate-early genes in the inferior colliculus and auditory cortex in salicylate-induced tinnitus in rat

Tinnitus could be associated with neuronal hyperactivity in the auditory center. As a neuronal activity marker, immediate-early gene (IEG) expression is considered part of a general neuronal response to natural stimuli. Some IEGs, especially the activity-dependent cytoskeletal protein (Arc) and the early growth response gene-1 (Egr-1), appear to be highly correlated with sensory-evoked neuronal activity. We hypothesize, therefore, an increase of Arc and Egr-1 will be observed in a tinnitus model. In our study, we used the gap prepulse inhibition of acoustic startle (GPIAS) paradigm to confirm that salicylate induces tinnitus-like behavior in rats. However, expression of the Arc gene and Egr-1 gene were decreased in the inferior colliculus (IC) and auditory cortex (AC), in contradiction of our hypothesis. Expression of N-methyl d-aspartate receptor subunit 2B (NR2B) was increased and all of these changes returned to normal 14 days after treatment with salicylate ceased. These data revealed long-time administration of salicylate induced tinnitus markedly but reversibly and caused neural plasticity changes in the IC and the AC. Decreased expression of Arc and Egr-1 might be involved with instability of synaptic plasticity in tinnitus.

Comparative analysis of time-scaling properties about water pH in Poyang Lake Inlet and Outlet on the basis of fractal methods

Detrended fluctuation analysis (DFA) and multifractal methods are applied to the time-scaling properties analysis of water pH series in Poyang Lake Inlet and Outlet in China. The results show that these pH series are characterised by long-term memory and multifractal scaling, and these characteristics have obvious differences between the Lake Inlet and Outlet. The comparison results suggest that monofractal and multifractal parameters can be quantitative dynamical indexes reflecting the capability of anti-acidification of Poyang Lake. Furthermore, we investigated the frequency-size distribution of pH series in Poyang Lake Inlet and Outlet. Our findings suggest that water pH is an example of a self-organised criticality (SOC) process. The results show that it is different SOC behaviours that result in the differences of power-law relations between pH series in Poyang Lake Inlet and Outlet. This work can be helpful to improvement of modelling of lake water quality.

A cumulative embryo scoring system for the prediction of pregnancy outcome following intracytoplasmic sperm injection

INTRODUCTION

The ability to select the embryos that would lead to pregnancy would help to reduce multiple pregnancy rates. The objective was to evaluate the use of a cumulative embryo scoring system (CES) based on a five-point embryo scoring system for the prediction of pregnancy outcome following intracytoplasmic sperm injection (ICSI).

METHODS

A retrospective cohort study was performed on 364 triple embryo transfers from fresh ICSI cycles only. Embryo quality was assessed using a five-point scoring system. The CES was the summation of the individual scores. For the purpose of analysis, these were categorised into three groups: CES group one (score 9-10), CES group two (score 11-13) and CES group three (score 14-15). Main outcome measures were clinical pregnancy, implantation, live-births and multiple birth rates.

RESULTS

There was a trend towards better outcome with increasing CES scores. This trend was significant with CES groups one, two and three, corresponding with increasing pregnancy rates (30.3 vs. 45.1 vs. 51.7 percent), increasing implantation rates (12.4 vs. 20.5 vs. 21.8 percent), and increasing live-birth rates (12.4 vs. 26.4 vs. 31.0 percent). Age was also a significant independent predictor of clinical pregnancy. However, only CES group score was significant in predicting live-births, while age was significant in predicting multiple births.

CONCLUSION

CES based on the proposed five-point scoring system is useful for the prediction of pregnancy outcome in triple embryo transfers. In younger patients, a policy of transferring fewer embryos to reduce multiple births should be adopted.

Human biological reactions at the interface between bone tissue and polymethylmethacrylate cement

This study investigated cytotoxicity of cement fragments harvested from two prosthesis revisions by the MTT test using L929 fibroblasts and human osteoblasts. The results did not show any toxicity of the extracts prepared after 48 and 78 months implantation. We consider that no MMA monomer has been released from the cement fragments. Histological studies on undecalcified samples harvested around revising prosthesis from 11 patients were used to evaluate tissue reactions at the bone-cement interface after 2-168 months implantation. Cement and prosthesis particles (5-35 microm) either dispersed or forming a layer were observed. A fibrous tissue layer, osteolysis, and osteonecrosis areas were observed at the interface. Besides, fibroblasts, macrophages, and multinucleated giant cells were also observed. New bone formation with osteoid, osteoblasts, and endochondral ossification with fibrocartilaginous tissue has been observed. The tissue reactions seemed to decrease with time. However, osseous trabeculae fractures were observed in the samples after 19 months. Although we consider that monomer toxicity, exothermic reaction, and particles formation may cause short-term prosthesis loosening; the trabeculae fractures may be due to prosthesis and bone cement micromovements. This fractures and particles formation may cause long-term prosthesis loosening.

Diagnosis of hepatocellular carcinoma by quantitative detection of hepatoma-specific bands of serum gamma-glutamyltransferase

Tissues of hepatocellular carcinoma (HCC) can express hepatoma-specific gamma-glutamyltransferase (GGT) and secrete GGT into circulating blood. Serum GGT was separated into several bands (up to 11), including hepatoma-specific bands (HSBs, I', II, and II') by a vertical slab electrophoresis assay of polyacrylamide stage gradient gel. In the present study, the HSBs of serum GGT were separated, and the HSB activity was quantitatively measured in 91 patients with HCC and compared with that of 106 patients with benign liver disease, 16 patients with extrahepatic tumors, and 30 healthy control subjects. Significant differences of the HSB activity were observed between the HCC group and each study group. An HSB activity greater than 5.5 U/L seems to be diagnostic of HCC. The quantitative method has a sensitivity of 85.3%, a specificity of 97.2%, a positive predictive value of 95.1%, a negative predictive value of 91.2%, and an accuracy of 92.5% for detecting HCC. No correlation was found between HSB activity and the serum alpha-fetoprotein (AFP) level or tumor size in patients with HCC. The quantitative analysis of HSB activity of GGT is superior to detection of the AFP concentration and is useful in early diagnosis of small HCC or AFP-negative HCC.

Alterations in average spectrum of cochleoneural activity by long-term salicylate treatment in the guinea pig: a plausible index of tinnitus

Salicylate, one of the most widely used drugs, produces at repetitive high doses reversible tinnitus and hearing loss. Neural correlates of hearing loss have long been established, whereas they remain elusive for tinnitus. The average spectrum of electrophysiological cochleoneural activity (ASECA), a measure of spontaneous auditory nerve activity, was monitored in guinea pigs over weeks of salicylate administration. Auditory nerve compound action potential (CAP) was also recorded to monitor acoustic sensitivity. In the first days of treatment, ASECA decreased acutely during hours after salicylate administration; after several days this decrease could be reduced. Over weeks of treatment the level of ASECA increased progressively. No change in CAP threshold was observed. The ASECA decrease induced by a contralateral broadband noise remained unchanged. At the end of treatment, acoustic tuning of ASECA showed a partially decreased sensitivity. After cessation of treatment the ASECA level returned progressively to initial values. In control animals delivery of an ipsilateral acoustic noise could reproduce the ASECA increase observed in long-term salicylate-treated animals. This white noise was of moderate sound pressure level and it elevated slightly CAP thresholds at high frequencies. These data provide evidence for salicylate-induced ASECA alterations without changes in CAP thresholds, in accord with clinical reports of tinnitus being the first subjective sign of salicylate ototoxicity. The similarities in occurrence, development, reversibility, frequency content, and acoustic level support the idea that ASECA changes, which indicates alterations of spontaneous eighth nerve activity and reflects the presence of salicylate-induced high-pitch tinnitus.

Reversible hearing impairment induced by lithium in the guinea pig

Lithium salts remain one of the most widely used treatments for depressive illness. The mechanisms involved probably include reduction in free inositol. Visual perceptive disturbances can be a side effect of the treatment. We report here for the first time that chronic lithium treatment in the guinea pig induces a predominantly low frequency hearing loss and, in the longer term, loss of sensitivity is observed across the whole audiogram. The changes are reversed when treatment is arrested. The observations could be accounted for, at least partially, by a lithium-induced perturbation of the phosphoinositide cascade within the inner ear.

Average spectrum of cochlear activity: a possible synchronized firing, its olivo-cochlear feedback and alterations under anesthesia

Average spectrum of electrophysiological cochlear activity (ASECA) recorded from the cochlea or the eighth nerve is related to firing of auditory neurons and has been used recently in search of an objective measure of tinnitus both in animal models and in humans. Little is known about neuro-sensory processes underlying the spectral features of ASECA. The present study used awake and/or anesthetized animals and investigated effects of various sounds presented contralaterally and ipsilaterally. Contralateral stimulation with noise bands at frequencies above about 8 kHz and below acoustic interaural cross-talk decreased the amplitude of the 1 kHz peak of ASECA. When presented ipsilaterally noises produced either an increase or a decrease of this spectral peak when the acoustic bandwidth was respectively above or below 1.5 kHz. Pure tones when presented contralaterally had no detectable effect. When presented ipsilaterally pure tones with frequencies higher than about 4 kHz decreased the 1 kHz peak of ASECA. The detailed time course of sound-induced variations of the 1 kHz peak was measured by time averaging. The resulting response patterns resemble PST histograms of the auditory nerve. Sedation and anesthesia deepened the 500 Hz trough of ASECA and shifted it towards 400 Hz. Sedation induced a diminution and anesthesia an almost complete suppression of the decrease of the 1 kHz peak induced by contralateral noise. Overall these data indicate that ASECA would reflect synchronized firings and they provide evidence for an influence of olivo-cochlear feedback sensitive to the state of awakeness.

Indoor burning coal air pollution and lung cancer--a case-control study in Fuzhou, China

A case-control study on risk factors for lung cancer was carried out in Fuzhou, China. One-hundred and two newly-diagnosed primary lung cancer cases in urban Fuzhou (78 male and 24 female cases) were matched with 306 population-based controls. The primary histological types were adenocarcinomas (57 cases, 55.9%) and squamous cell carcinomas (39 cases, 38.2%). Controls were obtained from the general population by random, stratified sampling and consisted of noncancer cases matched for sex, ethnicity and age. Cases and controls were interviewed by trained professionals using a standardized questionnaire. Information was obtained on: smoking habits, living conditions, history of respiratory diseases, air pollution, and 40 other variables. The data were evaluated by conditional logistic regression analysis. The major risk factors for lung adenocarcinoma were: indoor air pollution from burning coal, chronic bronchitis, and high economic income. The risk factors for lung squamous cell carcinoma were: amount of cigarettes smoked per day, "deep inhalation", a history of exposure to environmental tobacco smoke (ETS) before 20 years of age, burning coal indoors, and high economic income. The results showed that the major risk factors for lung cancer in Fuzhou were: burning coal indoors, smoking, exposure to ETS before 20 years of age, chronic bronchitis, and high economic income. Cigarette smoking significantly increased the risk of lung squamous cell carcinoma, but had no significant association with the risk of lung adenocarcinoma. In summary, our research supports the hypothesis that smoking and indoor air pollution are the major risk factors for lung cancer in Fuzhou. Burning coal indoors and smoking were associated with lung cancer mortality in a major city in southern China.

[Prognosis decision system for acute myocardial infarction]

Prognosis Decision System (PDS) is a program that analyzes the prognosis of AMI basing on the presented prognostic risk-factors after the onset of symptoms in patients with AMIs. The model is represented by using both pattern recognition and logical judgement. The forecast exact rate of PDS reached 90% by analysis of 100 retrospective cases and 125 prospective cases. It is useful in reduction of early case fatality rate and prevention of sudden death during convalescence.