Biallelic truncating TTN variants in M-band encoding exons cause a fetal lethal titinopathy

To report two novel TTN variants associated with fetal recessive titinopathy, thereby broadening the range of TTN variants that can lead to titinopathy. Clinical information on the fetus and parents was gathered, and genomic DNAs were extracted from the fetal tissue and family members' peripheral blood samples. Exome sequencing on fetal DNA was performed and following bioinformatics analysis, the suspected pathogenic variants were confirmed through Sanger sequencing. Prenatal ultrasound performed at 29 weeks of gestation revealed hydrops fetalis, decreased fetal movements, multiple joint contractures and polyhydramnios. Intrauterine fetal death was noted in the third trimester. Exome sequencing revealed compound heterozygous variants in the TTN gene: a paternally inherited allele c.101227C>T (p.Arg33743Ter) and a maternally inherited c.104254C>T (p.Gln34752Ter) allele. These variants have not been previously reported and are evaluated to be likely pathogenic according to the American College of Medical Genetics and Genomics guidelines. We report a fetus with hydrops fetalis and arthrogryposis multiplex congenita associated with a compound heterozygote in the TTN gene. Our report broadens the clinical and genetic spectrum associated with the TTN-related conditions.

Risk factors for diabetic foot ulcers: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the risk factors for developing diabetic foot ulcers (DFU).

METHODS

The Cochrane Library, PubMed, Web of Science, SinoMed, CNKI, VIP, and Wanfang Data were searched for relevant studies on DFU risk factors, and the search time frame was from database creation to March 2022. Meta-analysis was performed using RevMan 5.3.

RESULTS

A total of 26 publications were included, including 3 cohort studies, 22 case-control studies, and one cross-sectional study. Meta-analysis showed that advanced age [MD = 6.04, 95% CI (3.92, 8.16)], male [OR = 1.84, 95% CI (1.48, 2.29)], elevated body mass index [MD = 1.58, 95% CI (0.47, 2.69)], prolonged duration of diabetes [MD = 2.72, 95% CI (2.33, 3.11)], comorbid nephropathy [OR = 3.15, 95% CI (2.68, 4.60)], comorbid neuropathy [OR = 4.80, 95% CI (2.79, 8.27)], comorbid retinopathy [OR = 3.37, 95% CI (2.26, 5.02)], elevated systolic blood pressure [OR = 8.19, 95% CI (6.33, 10.05)], elevated fasting glucose [MD = 1.60, 95% CI (0.21, 3.00)], elevated glycated hemoglobin [MD = 1.24, 95% CI (0.94, 1.54)], elevated triglycerides [MD = 0.44 (95% CI (0.15, 0.73)], elevated fibrinogen [MD = 1.35, 95% CI (0.62, 2.08)], elevated white blood cell count [MD = 2.56, 95% CI (2.24, 2.88)], elevated C-reactive protein [MD = 15.08, 95% CI (8.03, 22.13)], decreased ankle-brachial ratio [MD = -0.26, 95% CI (-0.36, -0.16)], and decreased total protein levels [MD = -4.58, 95% CI (-6.91, -2.25)] were risk factors for developing DFU (p < 0.05), and increased HDL cholesterol levels [MD = -0.22, 95% CI (-0.36, -0.08)] were protective factor for developing DFU (p < 0.05).

CONCLUSION

There are many risk factors for developing of ulcers in the diabetic feet, and early prevention and intervention should be performed as early as possible to assess the risk of developing diabetic foot patients.

[Current status and thoughts of non-surgical treatment of knee osteoarthritis]

Knee osteoarthritis (KOA) is a worldwide disease, and also the main cause of pain and disability in the motor system. Due to the aging population in China, extension of life expectancy and increased number of obese people, the number of people affected by KOA continues to surge. Neither surgical nor non-surgical treatment can change the disease process, but these interventions can reduce pain and disability. The treatment principle of KOA is to start with non-surgical treatment, which has been considered as the first choice for KOA patients due to its advantages of less complications, minimal invasiveness, and low medical cost. This article describes the non-surgical treatment of KOA, aiming to provide new insights into the clinical treatment of KOA.

Extracellular histones stimulate collagen expression in vitro and promote liver fibrogenesis in a mouse model via the TLR4-MyD88 signaling pathway

BACKGROUND

Liver fibrosis progressing to liver cirrhosis and hepatic carcinoma is very common and causes more than one million deaths annually. Fibrosis develops from recurrent liver injury but the molecular mechanisms are not fully understood. Recently, the TLR4-MyD88 signaling pathway has been reported to contribute to fibrosis. Extracellular histones are ligands of TLR4 but their roles in liver fibrosis have not been investigated.

AIM

To investigate the roles and potential mechanisms of extracellular histones in liver fibrosis.

METHODS

In vitro, LX2 human hepatic stellate cells (HSCs) were treated with histones in the presence or absence of non-anticoagulant heparin (NAHP) for neutralizing histones or TLR4-blocking antibody. The resultant cellular expression of collagen I was detected using western blotting and immunofluorescent staining. In vivo, the CCl4-induced liver fibrosis model was generated in male 6-week-old ICR mice and in TLR4 or MyD88 knockout and parental mice. Circulating histones were detected and the effect of NAHP was evaluated.

RESULTS

Extracellular histones strongly stimulated LX2 cells to produce collagen I. Histone-enhanced collagen expression was significantly reduced by NAHP and TLR4-blocking antibody. In CCl4-treated wild type mice, circulating histones were dramatically increased and maintained high levels during the duration of fibrosis-induction. Injection of NAHP not only reduced alanine aminotransferase and liver injury scores, but also significantly reduced fibrogenesis. Since the TLR4-blocking antibody reduced histone-enhanced collagen I production in HSC, the CCl4 model with TLR4 and MyD88 knockout mice was used to demonstrate the roles of the TLR4-MyD88 signaling pathway in CCl4-induced liver fibrosis. The levels of liver fibrosis were indeed significantly reduced in knockout mice compared to wild type parental mice.

CONCLUSION

Extracellular histones potentially enhance fibrogenesis via the TLR4-MyD88 signaling pathway and NAHP has therapeutic potential by detoxifying extracellular histones.

[Misdiagnosis analysis: 120 patients with nasal extranodal NK/T cell lymphoma in head and neck]

Objective:The Clinicopathological characteristics and the reason of misdiagnosis about nasal extranodal NK/T cell lymphoma in head and neck（ENKTL） are analysised to raise awareness and reduce misdiagnosis. Method:One hundred and twenty patients with ENKTL, diagnosed pathologically in head and neck from May 2010 to April 2018, were analyzed retrospectively. All cases were divided into misdiagnosed group and non-misdiagnosed group according to whether there were misdiagnosis and mistreatment before diagnosis. The differences of clinicopathological characteristics between the two groups before and after diagnosis were compared. The differences of overall survival（OS） between the two groups after treatment were also compared. Result:The misdiagnosis rate of this study was 71.7%, and they were misdiagnosed as sinusitis, nasal polyps, upper respiratory tract infection and so on. On the whole, the 1-year OS, 3-year OS and 5-year OS were 77.8%, 65.9% and 49.3% respectively. There was no significant difference in sex, age, first symptom, initial site, B symptom, superficial lymph node enlargement and weight loss between two groups before diagnosis（P>0.05）, however, there were significant differences in relative specific signs, hospital grade and time from first visit to definite diagnosis（P<0.05）. The proportion of the high-level hospitals in the first visit hospital was significantly lower than that in the non-misdiagnosed group, while the time from the first visit to the final diagnosis was significantly longer than that in the non-misdiagnosed group. There was no significant difference in international prognostic index（IPI） score, expression of Ki-67, therapeutic schedule, chemotherapy regimen for patients receiving chemotherapy, and radiation dose for patients receiving radiotherapy after diagnosis between the two groups（P>0.05）, but there was a significant difference in the clinical stages of Ann Arbor between the two groups（P<0.05）. The clinical staging of the misdiagnosed group was later than that of the non-misdiagnosed group. The 1-year OS, 3-year OS and 5-year OS were 73.6%, 59.3% and 43.2% in the misdiagnosed group respectively, and 88.2%, 82.4% and 64.2% in the non-misdiagnosed group respectively. The overall survival rate in the misdiagnosis group was lower than that in the non-misdiagnosed group, and the overall survival time was lower than that in the non-misdiagnosed group. However, there was no significant difference in the overall survival rates between the early stage（Ⅰ and Ⅱ） and the advanced stage（Ⅲ and Ⅳ） of Ann Arbor（P>0.05）. Conclusion:The non-specific clinical and the complexity of pathological features of ENKTL in head and neck might cause misdiagnosis, which leads to prolonged time from first visit to definite diagnosis, thus results in disease progression, and ultimately may lead to decreased overall survival rate. To avoid the misdiagnosis and early diagnosis is very important.

[Letrozole versus gonadotropin-releasing hormone antagonist during luteal phase in the prevention of ovarian hyperstimulation syndrome: a randomized controlled trial]

Objective: To explore and compare the preventive effect of using letrozole and gonadotropin-releasing hormone (GnRH) antagonist during luteal phase of patients at high risk for ovarian hyperstimulation syndrome (OHSS). Methods: A total of 99 infertile women undergoing in vitro fertilization and embryo transfer or intracytoplasmic sperm injection with high risk for OHSS were enrolled in this randomized controlled trial.The letrozole group (n=51) received letrozole of 7.5 mg daily for 3 days;the GnRH antagonist group (n=48) were given cetrorelix of 0.25 mg subcutaneously daily for 3 days. Both groups received support therapy combined with embryo cryopreservation. The incidence of OHSS was surveyed. And the serum concentration of estradiol, LH and progesterone on days 3, 5 and 8 after oocytes retrieval were measured. Results: There were no statistical differences in terms of baseline characteristics of patients and outcomes of controlled ovarian hyperstimulation between the two groups.The incidence of moderate and severe OHSS was found no significantly difference between letrozole group [11.8%(6/51)] and GnRH antagonist group [10.4%(5/48);P>0.05]. The estradiol concentration of the indicated days on days 3,5 and 8 after oocytes retrieval in letrozole group and GnRH antagonist group were (1 417±3 543) versus (15 210±9 921) pmol/L, (1 692±4 330) versus (18 680±11 567) pmol/L, (239±336) versus (3 582±5 427) pmol/L, respectively;compared with GnRH antagonist group, the estradiol level was significantly lower in the letrozole group (all P<0.01). The luteinizing hormone level in the letrozole group were (0.46±0.40), (0.56±0.55)and (0.67±0.58) U/L on days 3,5 and 8 after oocytes retrieval, which were significantly higher than those of GnRH antagonist group [(0.28±0.28), (0.30±0.19) and (0.45±0.37) U/L, respectively; all P<0.05]. There was no obvious differences on progesterone levels between letrozole group and GnRH antagonist group (all P>0.05),and on days 8 after oocytes retrieval,the level of progesterone in each group were significantly lower than those on day 3 and 5 after oocytes retrieval (P<0.05). Conclusion: Letrozole has the same efficiency as GnRH antagonist for the prevention of OHSS, faster and cheaper to use, but its efficacy seems not to be related to the suppression of steroidogenic during the luteal phase.

[Association of vitamin D receptor and its genetic polymorphisms with nasopharyngeal carcinoma]

Objective:To investigate the gene expression and polymorphisms of vitamin D receptor (VDR) in nasopharyngeal carcinoma. Method:The expression of VDR mRNA was detected by fluorescent quantitative PCR in PBMC from 48 patients with nasopharyngeal carcinoma and 48 controls. The FokI and ApaI loci of all subjects were detected by TaqMan-MGB fluorescent probe PCR. Result:The VDR mRNA △Ct value was 9.32±0.91 and 7.31±1.04 in nasopharyngeal carcinoma patients and controls, respectively. Using multivariate Logistic regression analysis, the results showed that the distribution of FokI point Ff genotype in the case group was significantly higher than that in the control group (adjusted OR=1.97, 95%CI=1.33-2.91). No difference was found between the control group and the patient group at ApaI loci. Further haplotype analysis was used to find that compared with fa haplotypes, the distribution of FokI Ff genotype in the case group was significantly higher than that in the healthy control group (adjusted OR=0.65, 95%CI=0.48-0.87). There were significant differences in the gene expression level of VDR among the patients with the different genotypes of FokI loci (F=194.5, P<0.01). Conclusion:Genetic variants of the VDR gene are closely associated with nasopharyngeal carcinoma.

Anti-site-induced diverse diluted magnetism in LiMgPdSb-type CoMnTiSi alloy

The effect of three kinds of anti-site disorder to electronic structure and magnetic properties of the LiMgPdSb-type CoMnTiSi alloy are investigated. It was found the Mn-Ti anti-site disorder can induce the diluted magnetism in CoMnTiSi matrix. The magnetic structure has an oscillation between the ferromagnetic and antiferromagnetic states with the different degree of Mn-Ti anti-site disorder. Two novel characteristics: the diluted antiferromagnetic half-metallicity and the diluted zero-gap half-metallity are found in the different degree range of the Mn-Ti anti-site disorder. The Co-Mn and Co-Ti anti-site disorder have little effect on the magnetic properties. The width of energy gap and the intensity of DOS at the Fermi level can be adjusted by the degree of Co-Mn or Co-Ti anti-site disorder. The independent control to the carrier concentration and magnetization can be realized by introducing the different anti-site disorder.

Driving magnetostructural transitions in layered intermetallic compounds

We report the dramatic effect of applied pressure and magnetic field on the layered intermetallic compound Pr(0.5)Y(0.5)Mn(2)Ge(2). In the absence of pressure or magnetic field this compound displays interplanar ferromagnetism at room temperature and undergoes an isostructural first order magnetic transition (FOMT) to an antiferromagnetic state below 158 K, followed by another FOMT at 50 K due to the reemergence of ferromagnetism as praseodymium orders (T(C)(Pr)). The application of a magnetic field drives these two transitions towards each other, whereas the application of pressure drives them apart. Pressure also produces a giant magnetocaloric effect such that a threefold increase of the entropy change associated with the lower FOMT (at T(C)(Pr)) is seen under a pressure of 7.5 kbar. First principles calculations, using density functional theory, show that this remarkable magnetic behavior derives from the strong magnetoelastic coupling of the manganese layers in this compound.

The magnetocaloric effect and critical behaviour of the Mn(0.94)Ti(0.06)CoGe alloy

Structural, magnetic and magnetocaloric properties of the Mn(0.94)Ti(0.06)CoGe alloy have been investigated using x-ray diffraction, DC magnetization and neutron diffraction measurements. Two phase transitions have been detected, at T(str) = 235 K and T(C) = 270 K. A giant magnetocaloric effect has been obtained at around T(str) associated with a structural phase transition from the low temperature orthorhombic TiNiSi-type structure to the high temperature hexagonal Ni(2)In-type structure, which is confirmed by neutron study. In the vicinity of the structural transition, at T(str), the magnetic entropy change, -ΔS(M) reached a maximum value of 14.8 J kg(-1) K(-1) under a magnetic field of 5 T, which is much higher than that previously reported for the parent compound MnCoGe. To investigate the nature of the magnetic phase transition around T(C) = 270 K from the ferromagnetic to the paramagnetic state, we performed a detailed critical exponent study. The critical components γ, β and δ determined using the Kouvel-Fisher method, the modified Arrott plot and the critical isotherm analysis agree well. The values deduced for the critical exponents are close to the theoretical prediction from the mean-field model, indicating that the magnetic interactions are long range. On the basis of these critical exponents, the magnetization, field and temperature data around T(C) collapse onto two curves obeying the single scaling equation M(H,ε) = ε(β)f ± (H/ε(β+γ)).

Iron doped hexagonal ErMnO3: structural, magnetic, and dielectric properties

The single phase ErFe(x)Mn1-xO3 (0 < or = x < or = 0.15) compounds were synthesized by the solid-state reaction method. The doping effects on the crystal structural, magnetic, thermal, and dielectric properties were systematically investigated. The XRD patterns show all samples crystallize in the hexagonal structure with P6(3)cm space group. The lattice parameters a and c first decrease with doping, which is followed by a subsequent increase at higher doping levels. Although both the Fe3+ and Mn3+ ions remain stable in high spin trivalent states in all samples, the magnetization is weakened with increasing Fe contents. The heat capacity data shows the antiferromagnetic transition slightly shifts from 77 K for ErMnO3 to 80 K for ErFe015Mn0.85O3, which can not be observed in the magnetic susceptibility data. The real part of complex impedance of these samples rises as the doping level increases, indicating the enhancement of insulativity of doped samples.

Transportation of sulfur mustard (HD) in alkyd coating

The kinetics of absorption, desorption, and degradation of sulfur mustard (HD) in alkyd coating was experimentally studied, and a one-dimension mass transfer model for the transportation of HD molecule in alkyd coating was established on the experimental data. The obtained results indicated that the persistence of HD molecule could be greatly increased due to the absorption of HD droplets by alkyd coating, and there still occurred the desorption of HD as vapor from coating for more than 3 days even after decontamination of HD droplets onto coating. It was also experimentally shown that the majority of HD both absorbed and desorbed was accomplished at an early stage, less than 10 h, and HD molecule was able to be degraded within the alkyd coating probably through the reactions of hydrolysis and elimination. The diffusion coefficient and degradation rate constant of HD in alkyd coating were determined to be practically around 10(-9) cm2/s and 2.4 x 10(-5) min(-1), respectively.

Study on photocatalytic degradation of several volatile organic compounds

The gas-phase photolytic and photocatalytic reactions of several aromatics and chlorohydrocarbons were investigated. The experimental results revealed that chlorohydrocarbons like trichloroethylene, dichloromethane and chloroform could be degraded through either photolysis or photocatalysis under irradiation of germicidal lamp, and the elimination rate of chlorohydrocarbons through photolysis was quicker than that through photocatalysis. UV light from a germicidal lamp could directly lead to degradation of toluene but could hardly act on benzene. The photodegradation rate for these volatile organic compounds (VOCs) through photolysis followed an order: trichloroethylene>chloroform>dichloromethane>toluene>benzene>carbon tetrachloride, and through photocatalysis followed: trichloroethylene>chloroform>toluene>dichloromethane>benzene>carbon tetrachloride. Besides, a series of modified TiO2 photocatalysts were prepared by depositing noble metal, doping with transition metal ion, recombining with metal oxides and modifying with super strong acid. Activity of these catalysts was examined upon photocatalytic degradation of benzene as a typical compound that was hard to be degraded. It indicated that these modification methods could promote the activity of TiO2 catalyst to different extent. The apparent zero-order reaction rate constant for degrading benzene over SnO2/TiO2 catalyst had the highest value, which was nearly three times as that over P25 TiO2. But it simultaneously had the lowest rate for mineralizing the objective compound. In spite that Fe3+/TiO2 catalyst behaved slightly less active than SnO2/TiO2 for degradation of benzene, the mineralization rate over Fe3+/TiO2 was the highest one among the prepared catalysts.

Photoassisted reaction of sulfur mustard under UV light irradiation

The photoassisted reaction of sulfur mustard (HD) in both the vapor and droplet states under UV light irradiation was investigated. It was found that HD molecules in either the gas or the condensed phase could be easily converted into other chemicals under the irradiation of a germicidal lamp. The products detected upon reaction suggested that the photoassisted reaction of HD molecules in the gas phase produced a kind of nontoxic heavy polymer, and this method seemed to be applicable for decontamination of air. Nevertheless, the photoassisted reaction of HD droplets would produce a series of products containing -SCH2CH2Cl or -OCH2CH2CI groups, some of which were proven to be even more toxic than HD. Therefore, it was not an effective method forthe decontamination of HD droplets. The obtained experimental results would indicate that two possible pathways might be involved in the destruction of HD molecules: (1) HD molecules may undergo a photochemical reaction upon absorbing photons of sufficient energy, which leads to cleavage the C-S bond in HD molecules at the primary step, or (2) HD molecules could be oxidized by the photogenerated ozone.

Photoassisted Reaction of Chemical Warfare Agent VX Droplets under UV Light Irradiation

A photoassisted reaction of O-ethyl S-[2-(diisopropylamino) ethyl] methylphosphonothioate (VX) droplets in air was carried out. The experimental results indicated that VX droplets could be easily and chemically transformed into other compounds under irradiation of a germicidal lamp over sufficient time. Quantum chemical calculation results demonstrated that UV light less than 278 nm wavelength could possibly initiate photoreaction of VX and that both P-S and P=O bonds in the VX molecule were lengthened. The identification of reaction products by gas and liquid chromatography mass spectroscopy and NMR revealed that the VX molecule in air under UV light irradiation could undergo isomerization of S-esters to O-esters, cleavage of P-S, S-C, and C-N bonds, and ozonation of tertiary amines.

[Classification of the orbital margin fractures]

OBJECTIVE

To study the classification of the orbital margin fractures.

METHODS

There are 65 cases of the orbital margin fractures classified by Reduction-Orbital-Classification from January 1995 to December 1999 in Macau Conde de Sao Juanuario Hospital.

RESULTS

The 65 cases are classified into six type: I Stable orbital fracture, II Orbital floor (blow-out) fracture, III Orbital-zygomatic fracture, IV Orbital-naso-maxillary fracture, V Comminuted fracture of the inferior orbital rim, VI Complex orbital fractures.

CONCLUSION

The Reduction-Orbital-Classification are a complete, precise, practical, simple way for the orbital fractures; It not only presents the exist of the orbital margin fractures but also means the Classification for convenience of the treatment and treatment guiding the classification.