[Swyer syndrome with gonadal non-dysgerminoma malignant germ cell tumors: a report of 15 cases in a national medical center]

Objective: To evaluate the incidence, treatment, and survival outcomes of Swyer syndrome with gonadal non-dysgerminoma malignant germ cell tumor (MGCT-NDG). Methods: A retrospective study was performed on Swyer syndrome patients with MGCT-NDG between January 2011 and December 2022 in Peking Union Medical College Hospital to investigate their characteristics and outcomes. Results: A total of 15 patients (4.9%, 15/307) with Swyer syndrome were identified in 307 MGCT-NDG patients. The average age at diagnosis of MGCT-NDG and Swyer syndrome were (16.8±6.7) and (16.7±6.6) years, respectively. Six cases were preoperatively diagnosed as Swyer syndrome, of which 4 cases received bilateral gonadectomy with or without hysterectomy, while the other 2 cases underwent removal of gonadal tumor and unilateral gonadectomy with hysterectomy, respectively. Of the 9 patients postoperatively diagnosed as Swyer syndrome, unilateral gonadectomy, removal of gonadal tumor, and unilateral gonadectomy with hysterectomy were performed in 6 patients, 2 patients, and 1 patient, respectively. Mixed malignant germ cell tumor (MGCT;10 cases), yolk sac tumor (4 cases), and immature teratoma (1 case) were the pathological subtypes, in the descending order. There were International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ in 6 cases, stage Ⅱ in 3 cases, stage Ⅲ in 5 cases, and stage Ⅳ in 1 case, respectively. Eleven patients received reoperation for residual gonadectomy after a average delay of (7.9±6.2) months, including 8 MGCT-NDG patients and 1 gonadoblastoma patient, no tumor involved was seen in the remaining gonads in the other 2 cases. Ten patients experienced at least one recurrence, with a median event free survival of 9 months (5, 30 months), of which 2 patients received surgery only at the time of initial treatment. All patients with recurrence received surgery and combined with postoperative chemotherapy. After a median follow-up of 25 months (15, 42 months), 10 patients were disease-free, 3 patients died of the tumor, 1 died of side effects of leukemia chemotherapy, and 1 survived with disease. Conclusion: The incidence rate of Swyer syndrome in patients with MGCT-NDG is about 4.9%; timely diagnosis and bilateral gonadectomy should be emphasized to reduce the risk of reoperation and second carcinogenesis in this population.

[Prognostic comparison of active surveillance and adjuvant chemotherapy in the treatment of patients with stage Ⅰ ovarian immature teratoma after fertility-sparing surgery]

Objective: To compare the survival outcomes between surveillance and adjuvant chemotherapy in patients with stage Ⅰ ovarian immature teratoma (IMT) underwent fertility-sparing surgery. Methods: Clinical and pathological records of patients with stage Ⅰ ovarian IMT between Jan. 2011 to Feb. 2023 were collected from Peking Union Medical College Hospital, except stage Ⅰa grade 1. The consultation of risks and benefits regarding adjuvant chemotherapy was conducted by gynecologic oncologists. A shared decision about surveillance or chemotherapy was made by physician and patients or their guardians. Patients who finally decided to undergo surveillance were included in the surveillance group (n=40), the others were included in the adjuvant chemotherapy group (n=63). Clinical characteristics, treatment and survival outcomes were analyzed and compared between two groups. Results: A total of 103 patients were included. The median age of initial diagnosis was 20 years old (range: 3-39 years old), and the median follow-up time was 31 months (range: 1-254 months). The age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathological grade, surgical method, and preoperative and postoperative alpha-fetoprotein levels in the surveillance group and the adjuvant chemotherapy group were similar (all P>0.05). The surgical approach and maximum tumor diameter between two groups were significantly different (all P<0.05). Forty patients of the surveillance group were identified, only one patient with stage Ⅰa grade 2 IMT who underwent cystectomy had malignant recurrence on the same ovary. Another 63 patients received adjuvant chemotherapy after surgery, five patients had malignant recurrence, and two of them died of disease progression after relapsed. There were no significant differences in disease-free survival (DFS;20 vs 36 months) and overall survival (OS; 23 vs 39 months) between the surveillance group and the adjuvant chemotherapy group (follow-up time censored at 72 months; DFS: P=0.325, OS: P=0.278). Conclusions: There are no differences in survival outcomes between patients with stage Ⅰ ovarian IMT underwent adjuvant chemotherapy or not. Active surveillance might be safe and preferable in stage Ⅰ IMT patients underwent complete resection of tumor.

[Value of postoperative radiotherapy and analysis of prognostic factors in early-stage neuroendocrine carcinoma of cervix]

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.

[Influences of leukocytes in patients with type 2 diabetes and periodontitis to the effects of periodontal treatment on glycemic control]

Objective: To analyze the influences of leukocytes on improving blood glucose control in patients with type 2 diabetes mellitus (T2DM) and periodontitis after periodontal mechanical therapy. Methods: Thirty-five patients visiting Peking University Third Hospital from March 2011 to August 2012, as well as thirty-four patients visiting Peking University Hospital of Stomatology from March 2011 to August 2012 and December 2016 to December 2018 were selected in this research. These subjects were non-smokers, and with moderate to severe chronic periodontitis and T2DM. The full set of periodontal examinations including probing depth (PD), attachment loss (AL), bleeding index (BI) and plaque index (PLI) were conducted. Besides, counts of white blood cells (WBC), parameters of glucose and lipids metabolites such as fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) in serum were examined before treatment. Then, oral hygiene instruction, scaling and root planing (SRP) were carried out. Three months after SRP, the baseline examinations were repeated in all patients. According to the baseline leukocyte counts, the patients were divided into subgroups: low WBC group (WBC<6.19×109/L) and high WBC group (WBC≥6.19×109/L). Paired t-test for comparison of changes after treatment, analysis of co-variance for comparing the intervention effects between subgroups, and multifactor Iogistic regression analysis were performed. Results: Three months after SRP, all periodontal indexes were significantly improved in both groups. Leukocyte counts decreased significantly in high WBC group (7.64±1.51 vs. 6.89±1.53, P=0.008). In high WBC group, HbA1c (7.67±1.35 vs. 7.18±1.09, P=0.001) and LDL (3.28±0.76 vs. 2.67±0.85, P=0.042) decreased significantly, while there were no such differences in low WBC group. Influence of leukocyte level on HbA1c (OR=0.12, P=0.038) and LDL (OR=0.15, P=0.001) improvement was statistically significant. Hierarchical analysis showed such improvement notably perform in female [HbA1c (OR=0.30, P=0.021), LDL (OR=0.34, P=0.001)] and severe periodontitis group [HbA1c (OR=0.15, P=0.025), LDL (OR=0.24, P=0.017)]. Through interaction test, female and leukocyte counts at baseline had relative excess risk affecting the effect of periodontal intervention on HbA1c (P=0.036) and LDL (P=0.005). Conclusions: SRP could significantly improve the blood glucose and lipid control in patients who had T2DM and chronic periodontitis with relative higher leukocytes level. Female patients with severe periodontitis showed more obviously effects.

[GnRH-a combined fertility-sparing re-treatment in women with endometrial carcinoma or atypical endomertial hyperplasia who failed to oral progestin therapy]

Objective: To analyze the clinical efficacy and pregnancy outcomes of gonadotropin-releasing hormone agonist (GnRH-a) based fertility-sparing re-treatment in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) who failed with oral progestin therapy. Methods: Forty cases with EC or AEH who failed to respond to oral progestin were included from January 2012 to December 2020 at Peking Union Medical College Hospital. Combination of GnRH-a with levonorgestrel-releasing intrauterine system (group GLI: a subcutaneous injection of GnRH-a every 4 weeks and LNG-IUS insertion constantly) or the combination of GnRH-a with aromatase inhibitor (group GAI: a subcutaneous injection of GnRH-a every 4 weeks and oral letrozole 2.5 mg, daily) were used for these patients. Histological evaluation were performed at the end of each course (every 3-4 months) by hysteroscopy and curettage. After the complete remission (CR), all patients were followed up regularly. Results: (1) Clinical characteristics:among the 40 patients with EC or AEH, the median age at diagnosis was 31 years (range: 22-40 years) and the median body mass index was 24.7 kg/m² (range: 18.9-39.5 kg/m²). (2) Efficacy of fertility-sparing re-treatment: 37 (92%, 37/40) patients achieved CR, 6 (6/7) in AEH and 31 (94%, 31/33) in EC patients. The CR rate was 93% (26/28) and 11/12 in group GLI and GAI, respectively. The median time to CR was 5 months (range: 3-12 months). At the end of the first therapy course, the CR rates in AEH and EC were 5/7 and 42% (14/33), at the second course, the CR rates were 6/7 and 82% (27/33), respectively. (3) Recurrence: after 25 months of median follow-up duration (range: 10-75 months), 8 (22%, 8/37) women developed recurrence, 1/6 in AEH and 7 (23%, 7/31) in EC patients, with the median recurrence time of 18 months (range: 9-26 months). Among them, two cases who had completed childbirth chose to receive hysterectomy directly. Six patients met the criteria of fertility-preserving therapy and received conservative treatment again and 5 (5/6) of them achieved CR. (4) Pregnancy: of the 37 patients with CR, 33 desired to conceive. Ten women attempted to get pregnancy spontaneously and 23 cases with assisted reproductive technology. Fourteen (42%, 14/33) patients became pregnant, including 9 (27%, 9/33) live births, 3 (9%, 3/33) missed abortions, and 2 (6%, 2/33) miscarriages at the second trimester. Conclusions: GnRH-a based fertility-sparing re-treatment in AEH or EC patients who failed with oral progestin therapy achieved good treatment effect and reproductive outcomes. It is an encouraging alternative regime for patients who failed with oral progestin therapy.

[Association of cadmium pollution with liver function of population in mineral polluted areas of Guangxi]

Objective: To investigate the association of cadmium exposure with liver function among adults in a non-ferrous metal mining area in Guangxi. Methods: A total of 310 residents aged 18 and above were recruited from 5 heavy metals polluted villages in a non-ferrous metal mining area in Guangxi from 2013 to 2014. The general demographic characteristics, blood cadmium levels and indicators of liver function index [Total bilirubin (TBIL), Glutamic oxaloacetic transaminase (AST), Alanine transaminase (ALT) and Glutamine transaminase (GGT)] were obtained by using questionnaire, physical examination and laboratory test. The blood cadmium levels were divided into quartiles as Q₁-Q₄ groups (using Q₁ group as the reference).Multivariate logistic regression model was used to analyze the correlation between the blood cadmium level and functional liver index. Results: The age of subjects was (49.2±15.4) years, and 112 (36.1%) subjects were male residents. The prevalence of abnormal rates of TBIL,AST,ALT and GGT were 17.4% (54), 19.7% (61), 10.7% (33) and 11.9% (37), respectively. The geometric mean value of cadmium levels in adults was 3.72(95%CI: 3.43-4.02) μg/L. After adjusting for age, gender, body mass index (BMI), smoking, drinking, total cholesterol, hypertriglyceridemia and other factors, the risk of abnormal AST index in the highest concentration of blood cadmium group (Q₄) was higher than that in the lowest concentration of blood cadmium group (Q₁) (OR=2.92, 95%CI:1.07-7.98). Conclusion: The level of blood cadmium exposure is higher than the reference value of general population in China, and the elevated cadmium exposure is related to the increasing risk of AST abnormality.

[Effects of miR-141-3p on proliferation, migration and NF-κB signaling pathways in gastric cancer cells]

Objective: To investigate the effects of miR-141-3p on proliferation and migration of gastric cancer cells and nuclear factor-κB (NF-κB) signaling pathway. Methods: Human gastric cancer cell line BGC-823 was cultured, and miR-141-3p mimetic (miR-141-3p mimics) was transfected into BGC-823 cells by lipofection. The miR-141-3p overexpressed BGC was constructed. Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the transfection effect. The proliferation of BGC-823 cells was determined by 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Transwell assay was used to detect the effect of miR-141-3p on BGC-823 cell migration. The expressions of NF-κB p65, p-IKK-α and p-IKB-α protein in NF-κB signaling pathway were detected by western blot. Results: Compared with the control group and the negative control group, the expression level of miR-141-3p in BGC-823 cells of the miR-141-3p group was (2.39±0.27), which was higher than (1.00±0.09) of the control group and (1.01±0.10) of the negative control group (P<0.05). The number of migrating cells in the miR-141-3p group was (47.64±5.65), which was lower than (106.22±12.14) in the control group and (110.40±12.26) in the negative control group (P<0.05). The expression levels of NF-κB p65, p-IKK-α and p-IKB-α protein in BGC-823 cells were down-regulated (P<0.05). Conclusion: MiR-141-3p can inhibit the proliferation and migration of human gastric cancer BGC-823 cells, which may be related to the inhibition of NF-κB signaling pathway activation.

Photon quantification in Ho3+/Yb3+ co-doped opto-thermal sensitive fluotellurite glass phosphor

Multi-photon-excited thermal-correlated green and red upconversion (UC) emissions have been quantified in Ho³⁺/Yb³⁺ co-doped fluotellurite (BZLFT) glass phosphor under the 978 nm laser excitation. The temperature dependence of the fluorescence intensity ratio (FIR) originated from UC emissions bands centered at 550 nm and 661 nm has been verified in the range of 303-543 K. The net emission photon numbers of ⁵F₄+⁵S₂→⁵I₈ and ⁵F₅→⁵I₈ transition emissions are up to 40.08×10¹² and 68.51×10¹²cps in the 0.4wt.%Ho₂O₃-0.4wt.%Yb₂O₃ co-doped BZLFT case under the 6.95W/mm² laser power density. Furthermore, the quantum yield (QY) and luminous flux are determined to be dependent on pumping power. When the excitation power increases 874 mW, the QY values for 550 nm and 661 nm emissions are as high as 0.94×10^-5 and 1.60×10^-5. In addition, the high photon producing efficiency is conducive to ensuring high feedback to thermosensitive performance. The temperature thermal sensor can be manipulated steadily in medium temperature range, and the relative sensitivity reaches 0.4%K^-1 at 303 K, which is 1 order of magnitude larger than those in several rare-earth-doped materials. Efficient photon conversion ability and high temperature sensitivity indicate that the rare-earth-ion-doped fluotellurite material has a prospective application in the construction of optical temperature sensors based on the FIR technique allowing for self-referenced temperature determination.

Cardiac arrest in the intensive care unit: An assessment of preventability

AIM

Cardiac arrest in the intensive care unit (ICU-CA) is a common and highly morbid event. We investigated the preventability of ICU-CAs and identified targets for future intervention.

METHODS

This was a prospective, observational study of ICU-CAs at a tertiary care center in the United States. For each arrest, the clinical team was surveyed regarding arrest preventability. An expert, multi-disciplinary team of physicians and nurses also reviewed each arrest. Arrests were scored 0 (not at all preventable) to 5 (completely preventable). Arrests were considered 'unlikely but potentially preventable' or 'potentially preventable' if at least 50% of reviewers assigned a score of ≥1 or ≥3 respectively. Themes of preventability were assessed for each arrest.

RESULTS

43 patients experienced an ICU-CA and were included. A total of 14 (32.6%) and 13 (30.2%) arrests were identified as unlikely but potentially preventable by the expert panel and survey respondents respectively, and an additional 11 (25.6%) and 10 (23.3%) arrests were identified as potentially preventable. Timing of response to clinical deterioration, missed/incorrect diagnosis, timing of acidemia correction, timing of escalation to a more senior clinician, and timing of intubation were the most commonly cited contributors to potential preventability. Additional themes identified included the administration of anxiolytics/narcotics for agitation later identified to be due to clinical deterioration and misalignment between team and patient/family perceptions of prognosis and goals-of-care.

CONCLUSIONS

ICU-CAs may have preventable elements. Themes of preventability were identified and addressing these themes through data-driven quality improvement initiatives could potentially reduce CA incidence in critically-ill patients.

[Clinicopathological features and prognosis of patients in endometrial cancer with bone metastases]

Objective: To analyze the clinicopathological features and prognosis of patients in endometrial cancer with bone metastases. Methods: A retrospective review of medical records was performed to analyze patients with endometrial cancer who developed bone metastases at Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2017, including patients with bone metastases at the diagnosis of endometrial cancer and at recurrence of endometrial cancer. The patient's clinicopathological features, bone metastasis characteristics, treatment process and prognoses were also analyzed. Results: The incidence of bone metastasis of endometrial cancer in PUMCH from 2004 to 2017 was 0.57% (14/2 458). (1) General clinical pathological features: the median age of the 7 patients with bone metastases diagnosed at the time of initial diagnosis was 50 years old, and the main pathological type was endometrioid carcinoma (n=5). The median age of the other 7 patients was 57 years old, with no significant difference comparing to the former groups (P=0.559). (2) The majority site of bone metastasis in endometrial cancer were discovered in pelvic bones, followed by the tibia. (3) Treatment: according to the staging of endometrial cancer, a comprehensive treatment based on surgery was performed, and one patient with isolated bone metastases underwent resection of bone metastasis. (4) Prognosis: nine out of the 14 patients died during the follow-up period. The median over all survival time was 25.5 months (range: 7.7-258.0 months). The median survival of population after diagnosis of bone metastases was 15.0 months (range: 3.0-51.0 months). The survival rate of endometrial cancer at 1-year after diagnosis of bone metastasis was 71.4%. The 2-year survival rate was 40.8%. (5) No independent prognostic factors affecting survival was found (P>0.05). Conclusions: The incidence of bone metastasis in endometrial cancer is less than 1%. Bone metastasis could occur at the diagnosis of endometrial cancer or recurrence of endometrial cancer. Bone metastasis suggests a poor prognosis. There is no standard follow-up and treatment protocols so that individualized treatment is needed.

Long non-coding RNA homeobox (HOX) A11-AS promotes malignant progression of glioma by targeting miR-124-3p

Glioma is the most common and serious form of primary tumor in adult central nervous system. HOXA11-AS is a LncRNA located in the HOXA gene cluster. In the present study, we investigated the expression and function of LncRNA HOXA11-AS in glioma tissues and cells. We found that LncRNA HOXA11-AS expression was markedly elevated in glioma tissues compared to normal brain tissues. The LncRNA HOXA11-AS expression in cases of high-grade glioma was significantly higher than that in cases of low-grade. Patients with high LncRNA HOXA11-AS expression had shorter OS time than those with low LncRNA HOXA11-AS expression. Moreover, silencing LncRNA HOXA11-AS inhibited cell proliferation, increased apoptosis, and inhibited invasion and migration of glioma cells. Overexpression of LncRNA HOXA11- AS increased cell proliferation, decreased apoptosis, and increased invasion and migration of glioma cells. miR-124-3p has relevant binding sites in HOXA11-AS. Silencing HOXA11-AS significantly increased miR-124-3p expression. The miR-124-3p overexpression decreased the luciferase activity of the pMIR luciferase reporter containing HOXA11-AS-WT but not HOXA11-AS-MUT. Moreover, miR-124-3p was pulled down by HOXA11-AS probe. miR-124-3p mimics inhibited cell proliferation, increased apoptosis, and inhibited invasion and migration of glioma cells. miR-124-3p mimics significantly suppressed overexpression of HOXA11-AS-induced increase of proliferation, decrease of apoptosis and increase of invasion and migration. miR-124-3p inhibitors suppressed the effect of siHOXA11-AS on proliferation, apoptosis, invasion and migration. In summary, the findings highlight the importance of LncRNA HOXA11-AS/miR-124-3p axis in the regulation of glioma progression. LncRNA HOXA11-AS/miR-124-3p might serve as a potential therapeutic target in glioma treatment in the future.

On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists

BACKGROUND

Transthoracic echocardiograms (TTE) performed and interpreted by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on their interpretive accuracy. Our aims were to determine the discordance rate between TTEs performed and interpreted by cardiology fellows and National Board of Echocardiography certified attending cardiologists and to identify factors associated with discordance.

METHODS

Consecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by attending cardiologists. Fellow interpretations were classified as concordant or discordant with the attending interpretation. We assessed the association of patient, imaging and fellow characteristics with discordance.

RESULTS

A total of 777 TTE interpretations (730 patients) were performed/interpreted by 40 first year fellows and overread by 13 attendings. The most common indications were assessment of left ventricular function (40.9%) and pericardial effusion (37.3%). There was a major or minor discordance in 4.1 and 17.4% of studies, respectively with 42.1% of disagreements occurring in assessment of left ventricular size and function. The indication to assess left ventricular function [OR 2.19, 95% CI (1.32, 3.62), P = 0.002 vs. pericardial effusion] and greater duration of echocardiographic image acquisition (OR 1.02, 95% CI 1.01, 1.03, P = 0.004) were independently associated with overall discordance.

CONCLUSIONS

In this large prospective study we found that attending cardiologists disagreed with 1 in 5 fellow TTE interpretations. Standardized tools for evaluation of echocardiograms performed by fellows are needed to ensure quality of training and patient safety.

Praseodymium ion doped K+-Na+ thermal ion-exchangeable waveguide-adaptive aluminum germanate glasses

Intense multi-peak red fluorescence and effective near-infrared (NIR) ultra-broadband emission have been observed in Pr³⁺ doped ion-exchangeable aluminum germanate (NMAG) glasses. The maximum emission cross section for P₀3→F₂3 red emission is up to 100.58×10^-21  cm², and the NIR emission corresponding to D₂1→G₄1 transition possesses a full-width at half-maximum (FWHM) of 210 nm. Although the obvious cross-relaxation (CR) process at high concentration causes a decrease of the quantum efficiency, the CR broadens the spectral FWHM effectively from another perspective. The admirable red fluorescence trace and the NIR single-mode transmission confirm that Pr³⁺ doped NMAG glass planar waveguides can support the generation of visible fluorescence and the amplification of infrared signal. For a waveguide channel ion-exchanged in molten KNO₃ for 2 h, the single-mode field diameters at 1.55 μm are identified to be 10.4 μm in the horizontal direction and 6.5 μm in the vertical direction, implying an acceptable overlap with a standard single-mode fiber. Effective red fluorescence and broad NIR emission demonstrate that Pr³⁺ doped NMAG glasses are a promising substrate in developing irradiative luminescence sources and ultra-broadband waveguide amplifiers, especially operating at the entire S-, C-, and L- bands.

Chest Pain During Chemotherapy: A Case of Severe Myocardial Bridging

A cancer patient presented with acute chest pain at rest 40 hours after IV fluorouracil infusion. Angiography showed evidence of myocardial bridging.

Long non-coding RNA DANCR facilitates glioma malignancy by sponging miR-33a-5p

Glioma is among the most fatal brain tumors characterized by a highly malignancy and rapid progression and early metastasis. Dysregulation of long non-coding RNA differentiation antagonizing non-protein coding RNA (LncRNA DANCR) is associated with the development, progression and metastasis of various cancers. In the present study, we investigated functional role of LncRNA DANCR in the malignancy of glioma. The results showed that LncRNA DANCR was increased in glioma tissues and cells compared with normal brain tissues and cells. DANCR expression was positively correlated with the malignancy and poor prognosis of glioma patients. DANCR contained a binding site of miR-33a-5p. miR-33a-5p was decreased in glioma tissues and cells compared with normal brain tissues and cells. Downregulation of miR-33a-5p was positively correlated with the malignancy and poor prognosis of glioma patients. In glioma tissues, the expression of DANCR was negatively correlated with the expression of miR-33a-5p. Downregulation of DANCR increased miR-33a-5p expression. miR-33a-5p mimic reduced the luciferase of DANCR-WT but not DANCR-MUT. DANCR pull-down showed the expression of miR-33a-5p. miR-33a-5p mimic enhanced knockdown of DANCR -induced inhibition of cell proliferation, migration, and EMT, and increase of apoptosis. Anti-miR-33a-5p reversed the effects of si- DANCR on cell malignancy. Knockdown of DANCR remarkably reduced the increase of tumor volumes in xenograft mouse models. In tumor tissues, knockdown of DANCR increased the expression of miR-33a-5p, reduced EMT and increased apoptosis. Our study provides novel insights in the functions of LncRNA DANCR-miR-33a-5p axis in tumorigenesis of glioma.

Safety and effectiveness of zotarolimus-eluting stents for percutaneous coronary intervention: a systematic review

Drug-eluting stents revolutionized the treatment of coronary artery disease with vastly improved outcomes compared with bare metal stents. As stent technology has evolved, a wide variety of antiproliferative drugs have been developed to prevent stent restenosis and stent thrombosis. The Resolute stent system (Medtronic, CA, USA) elutes zotarolimus from a multipolymer blend to prevent early and late stent-related complications. The Resolute stents have evolved from the initial Resolute stent, to the Resolute Integrity™ and most recently, the Resolute Onyx™. These stents have been studied across a wide range of patients and coronary syndromes. They compare similarly in performance to their contemporary second generation stents. We present a review of the major trials involving these zotarolimus-eluting stents.

[A preliminary study on the application of two-point traction with guidewire method in percutaneous transhepatic sinus tract dilation]

Objective: To explore the feasibility and effectiveness of the two-point traction with guidewire method to improve the safety of percutaneous transhepatic sinus tract dilation. Methods: The clinical data of 18 patients underwent the two-point traction guided by percutaneous transhepatic sinus dilation between January 2013 and July 2017 in Shengjing Hospital of China Medical University were analyzed retrospectively. The operation time, volume of intraoperative blood loss and postoperative complications were recorded. Results: All of the 18 patients were treated successfully. The mean size of the percutaneous transhepatic sinus tract was (18.6±2.3) Fr. The operation time was 15-45 min, with an average of 30 minutes, and the average intraoperative blood loss was about 11.7 ml. The incidence of postoperative complications was 22.2% (4/18), including cholangitis in 3 patients, pancreatitis in 1 case. All the complications were relieved after symptomatic treatment, no severe complications (biliary tract perforation or severe haemorrhage) occurred. A total of (3.3 ± 2.6) times cholangioscopic explorations for stone extraction were performed, with a overall clearance rate of 64.7% (11/17). Conclusions: From the results of limited patient data in this group, the two-point traction with guidewire can provide the exact guidance for percutaneous transhepatic sinus tract dilation, which is effective and easily conducted, but still need further clinical study to confirm.

Long non-coding RNA SNHG16 contributes to glioma malignancy by competitively binding miR-20a-5p with E2F1

Glioma is among the most fatal and highly aggressive primary malignant tumors in the central nervous system. Small nucleolar RNA host gene 16 (SNHG16) is identified to play an oncogenic role in several cancers. However, the exact mechanism of SNHG16 action in the regulation of glioma development remains unknown. LncRNA SNHG16 was increased in glioma tissues and cells compared with normal brain tissues and cells. SNHG16 expression was correlated with the malignancy and poor prognosis of glioma patients. SNHG16 and E2F1 contained a binding site of miR-20a-5p. miR-20a-5p was decreased in glioma tissues and cells compared with normal brain tissues and cells. Downregulation of miR-20a-5p was correlated with the malignancy and poor prognosis of glioma patients. In glioma tissues, the expression of SNHG16 was negatively correlated with miR-20a-5p. Downregulation of SNHG16 increased miR-20a-5p expression. miR-20a-5p mimic reduced the luciferase activity of SNHG16 and E2F1; miR-20a-5p mimic enhanced the inhibition of cell proliferation, invasion, migration, and EMT, and increase of apoptosis induced by SNHG16 knockdown. Anti-miR-20a-5p reversed the effects of shSNHG16. We also found that SNHG16 may act as a ceRNA for miR-20a-5p, enhancing the expression of E2F1. Additionally, knockdown of SNHG16 remarkably reduced the increase of tumor volumes in xenograft mouse models. In tumor tissues, knockdown of SNHG16 increased the expression of miR-20a-5p, reduced EMT and increased apoptosis. In conclusion, SNHG16 promotes glioma tumorigenesis by sponging miR-20a-5p, leading to the enhancement of its endogenous targets E2F1. The data provides a new clue for the role of SNHG16/miR-20a-5p/E2F1 in the development of glioma.

Effects of phyto-oestrogen quercetin on productive performance, hormones, reproductive organs and apoptotic genes in laying hens

Quercetin, a polyphenolic flavonoid with diverse biological activities including anti-inflammatory and antiviral, inhibits lipid peroxidation, prevents oxidative injury and cell death. The purpose of the research was to investigate the effect of quercetin on productive performance, reproductive organs, hormones and apoptotic genes in laying hens between 37 and 45 weeks of age, because of the structure and oestrogenic activities similar to 17β-oestradiol. The trial was conducted using 240 Hessian laying hens (37 weeks old), housed in wire cages with two hens in each cage. These hens were randomly allotted to four treatments with six replicates, 10 hens in each replicate and fed with diets containing quercetin as 0, 0.2, 0.4 and 0.6 g/kg feed for 8 weeks. The results showed that dietary quercetin significantly increased (p < .05) the laying rate and was higher in group supplemented with 0.4 g/kg, and feed-egg ratio was decreased (p < .05) by quercetin. Dietary quercetin has no effect (p > .05) on average egg weight and average daily feed intake. Compared with control, secretion of hormones, oestradiol (E₂ )_, progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin-like growth factors-1 (IGF-1) and growth hormone (GH), was found to be significantly higher (p < .05) in quercetin-supplemented groups. Also ovary index, uterus index and oviduct index were not significantly influenced (p > .05) by quercetin, whereas magnum index, isthmus index, magnum length, isthmus length and follicle numbers were significantly increased (p < .05) with quercetin supplementation. Additionally, expression of apoptotic genes was significantly (p < .05) up-regulated or down-regulated by quercetin. These results indicated that quercetin improved productive performance, and its mechanism may be due to the oestrogen-like activities of quercetin.

A new cave-dwelling loach, Triplophysa xichouensis sp. nov. (Teleostei Nemacheilidae) from Yunnan, China

A new cave-dwelling loach of the genus Triplophysa, T. xichouensis, is described from an outlet of a subterranean river in Xisa Town, Xichou County, Yunnan Province, China. It can be distinguished from its congeners by the following characters: dorsal-fin rays iii, 8; anal-fin rays ii, 6; pectoral-fin rays i, 9 or 10; pelvic-fin rays i, 5 or 6; branched caudal-fin rays 16(8+8); eyes highly degenerated to a very tiny black dot; dorsal-fin origin closer to snout tip than to caudal-fin base and anterior to vertical line of pelvic-fin origin; pectoral fin length about two-thirds the distance between pectoral-fin origin to pelvic-fin origin; caudal peduncle slender, its length about three times its depth; caudal fin emarginate; body smooth and scaleless; lateral line complete and straight; anterior chamber of air bladder wrapped in dumbbell-shaped bony capsule and the posterior one well developed, long, oval; intestine short, bending in zigzag shape behind stomach. A key for the cave-dwelling species of Triplophysa is provided. urn:lsid:zoobank.org:pub:9162FFB1-7911-47C3-AE50-6A00E9590327.

[Clinical-based study of ovarian cancer patients with and without BRCA1/2 genes mutation: clinical features and pedigree analysis]

Objective: To compare the clinical and histological features and prognosis of patients with ovarian cancer from different genetic background, and to make further understanding of the genetic model of BRCA genes used pedigree analysis. Methods: There were 71 patients from 67 independent families enrolled in our study from Apr. 2000 to Jun. 2009 in Peking Union Medical College Hospital. All exons of BRCA1/2 genes were analyzed using denaturing high-performance liquid chromatography(DHPLC) followed by direct sequencing, and clinical features of patients were compared by statistical analysis. Pedigree analysis of two families with BRCA genes mutation were performed. Results: The mutation rate of BRCA genes was 28% (20/71). The frequency of BRCA1 and BRCA2 gene mutation was 23% (16/71) and 6% (4/71), respectively (P=0.004). Histology types of patients with and without BRCA genes mutation were different. The onset age between patients with and without BRCA genes mutation was similar (52.6 versus 54.6 years old, P=0.393), and tend to be early-onset breast or ovarian cancer in high-risk group. There was no significant difference of platinum-resistant rate, disease free survival and overall survival rate between patients with and without BRCA genes mutation (all P>0.05). According to the pedigree analysis, up to 100% of female offspring inherited pathogenic mutations, and male offspring could be a mutation carrier. Conclusions: The genetic screening and clinical intervention should be performed as early as possible for the members from families at risk of hereditary ovarian cancer. Genetic consulting is important for patients with high-grade papillary serous adenocarcinoma of ovary. It is still unknown that whether the patients with BRCA gene mutations have better prognosis than sporadic ones, and further perspective, randomized controlled trial is still needed.

[Clinical analysis of hypersensitivity reaction of platinum in ovarian cancer and cervical cancer patients]

Objective: To investigate the incidence, risk factors, management and prognosis of hypersensitivity reaction (HSR) of platinum-based chemotherapy in patients of ovarian cancer and cervical cancer. Methods: Cases from Peking Union Medical College Hospital from Jan. 2013 to Jan. 2016 were checked for patients' data of epithelial ovarian cancer treated with carboplatin/paclitaxel (every 3 weeks) and patients of cervical cancer treated with concurrent radiochemotherapy using cisplatin (every week). General characters, pathological features, treatment and prognosis of patients were analyzed to determine the severity, symptoms, outcomes and risk factors of HSR. Results: (1) Prevalence of HSR: there were 860 cases of ovarian cancer and 580 cases of cervical cancer, among which HSR occurred in 8.8% (76/860) and 5.9% (34/580) patients, respectively. (2) Grading for HSR: most HSR were grade 1 or 2, with 78.9%(60/76) in ovarian cancer and 82.4%(28/34) in cervical cancer patients. In ovarian cancer patients, there were 7 cases of grade 1 HSR and 53 cases of grade 2 HSR, and in cervical cancer patients, there were 11 cases of grade 1 HSR and 17 cases of grade 2 HSR. (3) Symptoms of HSR: most of HSR happened during intravenous infusion of platinum agents, with 98.7% (75/76) in ovarian cancer and 97.1% (33/34) in cervical cancer patients. In ovarian and cervical cancer patients, most common symptom were tight chest and dyspnea, which happened in 92.1% (70/76) and 97.1% (33/34) patients, respectively. Secondary common symptom were skin reactions, which happened in 53.9% (41/76) and 88.2% (30/34) patients respectively. (4) Treatment after HSR: of 76 ovarian cancer cases with HSR, there were no significant difference in the ratio of HSR recurrence among patients of different treatment after HSR (χ²=0.517, P=0.915): 1 of 4 patients applying prior chemotherapy, 4 of 13 cases receiving desensitization, 3 of 11 cases separating medicine, 2 of 11 patients switching to cisplatin. In 34 cervical cancer cases of HSR, there were also no significant difference in the ratio of HSR recurrence among patients of different treatment after HSR (χ²=0.079, P=1.000): 2 of 9 patients applying prior chemotherapy, 3 of 17 cases receiving desensitization. (5) Risk factors of HSR and patients prognosis: in ovarian cancer patients of HSR, risk factors included relapse (P=0.010), courses of chemotherapy reaching seven or nine for patients of primary treatment or reaching six or seven for recurrent patients (all P<0.05). There were no significant risk factors for cervical cancer patients of HSR (all P>0.05). HSR had no impact on the progression- free survival for ovarian cancer (P=0.144) or cervical cancer (P=0.782). Conclusions: In ovarian cancer patients treated with carboplatin and cervical cancer patients treated with concurrent radiochemotherapy using cisplatin, most HSR of platinum are mild and favorable outcomes. Relapse and longer chemotherapy courses are risk factors for HSR of carboplatin for epithelial ovarian cancer.

Growth factor progranulin blocks tumor necrosis factor-α-mediated inhibition of osteoblast differentiation

Tumor necrosis factor-α (TNF-α) stimulates osteoclast differentiation and suppresses osteoblast differentiation, leading to bone loss and decreased bone mass in local inflammation areas in patients with rheumatoid arthritis. The growth factor progranulin (PGRN) is expressed in various types of cells and play crucial roles in the pathogenesis of atherosclerosis and arthritis by blocking TNF-α. Here, we investigated the role of PGRN in blocking TNF-α-mediated inhibition of osteoblast differentiation and the regulatory mechanism. C2C12 stem cell was induced by bone morphogenetic protein-2 (BMP-2) for osteoblast differentiation. A significant increase in ALP activity (P < 0.001), as well as the expression of ColI, Ocn, and Bsp in the induced cells (P < 0.01 and P < 0.001) were observed; the marker gene expression and ALP activity were inhibited by TNF-α (P < 0.01 and P < 0.001). PGRN significantly blocks the TNF-α-mediated inhibition of osteoblast differentiation, evidenced by the ALP activity (P < 0.05 and P < 0.01), Alizarin red staining, the expression of ColI, Ocn, and Bsp (P < 0.05 and P < 0.01) and the osteoblast key transcription factor gene Runx2 (P < 0.01), Osx (P < 0.05), and ATF4 (P < 0.05). Mechanical study indicated that PGRN significantly blocks the TNF-α-mediated stimulation of NF-kB signaling (P < 0.01 and P < 0.001). PGRN exerts a protective effect on osteoblast differentiation in an inflammatory environment. Thus, we concluded that the treatment of osteoblasts with PGRN could be used in the future to prevent or treat rheumatoid arthritis-associated bone loss.

Improving value-add work and satisfaction in medical residents training: a resident-led quality improvement project employing the lean method to improve hospital supply usage

PURPOSE

Our hospital has a Housestaff Quality Council that fosters education and mentorship of medical residents for quality improvement methodologies. Medical residents on our council identified non-standardised storage rooms as a source of medical resident inefficiency and dissatisfaction. To improve value-add work, medical residents implemented and evaluated a quality improvement project of storage room supplies using the lean method.

METHODS

Using 5S principle and lean methodology, we designed and implemented a standardised supply cart with physician specific supplies. Between April 2014 and April 2015, 40 random observations (20 residents and 20 nurses) both before and after the standardised supply cart implementation were made. The duration time to locate an item was measured in seconds. The paths taken to locate items were drawn as spaghetti diagrams. Nurses served as our control group given that their supplies were not moved in the implementation. Fifty residents were surveyed to assess their satisfaction.

RESULTS

Implementation of the standardised supply cart reduced the time for residents to locate an item per visit from 50.8 to 30.2 s in one unit (p<0.05) and 127 to 28.3 s in the second unit (p<0.05). Mean time savings per day per resident were 5 min. The spaghetti diagrams indicated that finding supplies became more efficient after the intervention for residents. After the intervention, 92% of residents reported finding supplies more rapidly and 86% reported less frustration with finding supplies.

CONCLUSIONS

Residents applied the 5S principles and lean methodology to identify and solve a problem that created inefficiency and dissatisfaction.

Red mud (RM)-Induced enhancement of iron plaque formation reduces arsenic and metal accumulation in two wetland plant species

Human activities have resulted in arsenic (As) and heavy metals accumulation in paddy soils in China. Phytoremediation has been suggested as an effective and low-cost method to clean up contaminated soils. A combined soil-sand pot experiment was conducted to investigate the influence of red mud (RM) supply on iron plaque formation and As and heavy metal accumulation in two wetland plant species (Cyperus alternifolius Rottb., Echinodorus amazonicus Rataj), using As and heavy metals polluted paddy soil combined with three rates of RM application (0, 2%, 5%). The results showed that RM supply significantly decreased As and heavy metals accumulation in shoots of the two plants due to the decrease of As and heavy metal availability and the enhancement of the formation of iron plaque on the root surface and in the rhizosphere. Both wetland plants supplied with RM tended to have more Fe plaque, higher As and heavy metals on roots and in their rhizospheres, and were more tolerant of As and heavy metal toxicity. The results suggest that RM-induced enhancement of the formation of iron plaque on the root surface and in the rhizosphere of wetland plants may be significant for remediation of soils contaminated with As and heavy metals.

Benefits of fluorine-18 fludeoxyglucose positron emission tomography in secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer

OBJECTIVE

To investigate the benefits of fluorine-18 fludeoxyglucose positron emission tomography ((18)F-FDG-PET) in patients undergoing secondary cytoreductive surgery (SCRS) for recurrent epithelial ovarian cancer.

METHODS

Patients were identified, and their clinical information was extracted by review of the gynaecologic oncology database of Peking Union Medical College Hospital. (18)F-FDG-PET scan and analysis were performed by nuclear medicine experts at our hospital.

RESULTS

The PET group and the control group of patients evaluated by conventional imaging methods differed significantly with respect to the proportion of patients who underwent complete SCRS and the number of residual lesions (p = 0.002 and 0.006, respectively). A Cox model showed that longer progression-free survival (PFS) correlated significantly with (18)F-FDG-PET evaluation [relative risk (RR) = 0.432; p = 0.001], sensitivity to platinum-based chemotherapies (RR = 0.604; p = 0.034) and resection completeness (RR = 0.679; p = 0.039). Longer overall survival (OS) correlated significantly with sensitivity to platinum-based chemotherapy (RR = 0.317; p = 0.000) and the CA-125 level after two cycles of chemotherapy (RR = 2.663; p = 0.003). Surgical safety and complications did not significantly differ between the two groups of patients.

CONCLUSION

(18)F-FDG-PET is useful for evaluating patients with recurrent epithelial ovarian carcinoma. Patients who undergo PET-guided SCRS have a greater chance of complete tumour resection and a longer PFS.

ADVANCES IN KNOWLEDGE

SCRS guided by PET results in fewer residual lesions. PET-guided SCRS is safe and can prolong PFS and OS in patients with recurrent ovarian cancer.

Evaluation of complication rates of pediatric cranial procedures in which a polyethylene glycol sealant was used

OBJECT

Polyethylene glycol (PEG) sealant in conjunction with standard closure techniques is effective in preventing CSF leaks after cranial procedures in adult patients, but the safety of PEG sealant in the pediatric population has not been shown.

METHODS

The authors performed a retrospective analysis of pediatric neurosurgery patients (0-18 years of age) treated from 2005 to 2010 at The Johns Hopkins Hospital. There were 163 patients who underwent cranial surgery with the use of PEG sealant as an adjunct to standard closure techniques. There were 92 males and 71 females with an average age of 10.2 years. The incidences of revision surgery, CSF leak, meningitis, and neurological deficit were recorded.

RESULTS

In the cohort's 90-day postoperative clinical course, the authors found that 4 patients (2.5%) required revision surgery, 2 patients (1.2%) developed a CSF leak, 4 patients (2.5%) developed a superficial skin infection, and 1 patient developed meningitis (0.6%) with no deaths or neurological deficits observed.

CONCLUSIONS

PEG sealant appears to be a safe adjunct to standard dural closure in pediatric cranial surgery patients to augment dural closure.

Evaluation of complication rates of pediatric spinal procedures in which a polyethylene glycol sealant was used

OBJECT

Cerebrospinal fluid leakage following durotomy in spinal surgery can lead to significant patient morbidity and mortality, including meningitis and even death. Usage of a polyethylene glycol (PEG) sealant in combination with standard closure techniques has been shown to be effective in preventing CSF leaks in animal models and adult patients, but the results of its use have not been reported in the pediatric population.

METHODS

A retrospective analysis was performed of pediatric neurosurgery patients (0-18 years of age) treated at The Johns Hopkins Hospital from 2003 to 2010. There were 93 spinal surgery patients identified in whom PEG was applied. The incidence of CSF leakage, meningitis, and neurological injury was recorded. There were 54 males and 39 females in this study with an average age of 8.7 years. Of the identified patients, 16.1%, 28%, and 55.9% underwent surgery in the cervical region, thoracic region, and lumbar region, respectively.

RESULTS

At 90-day follow-up, 5 patients (5.4%) had a CSF leak, 4 patients (4.3%) required a reoperation, and 1 patient (1.1%) had meningitis within this time period. No deaths or associated neurological deficits were observed.

CONCLUSIONS

The use of a PEG sealant to augment dural closure in pediatric spine surgery appears to be a safe adjunct to standard dural closure in pediatric spine patients.

Glycerol rhizotomy via a retrosigmoid approach as an alternative treatment for trigeminal neuralgia

OBJECTIVES

Trigeminal neuralgia is a sensory nerve disorder characterized by lancinating pain and treated most commonly with carbamazepine, rhizotomy treatment, or open surgical management with microvascular decompression. We describe a novel technique to complement surgical treatment for trigeminal neuralgia via direct injection of the trigeminal nerve with glycerin in the cisternal portion of the nerve.

PATIENTS AND METHODS

We performed a retrospective analysis of patients who received standard microvascular decompression and injection of glycerin to the inferior third of the cisternal portion of the nerve anterior to the root entry zone with lack of a compressive vessel on MRI as the primary indication. Fourteen patients were identified and demographic information, post-operative course and complications were recorded.

RESULTS

There were eleven females and three males with an average age at time of surgery of 54.8 years. 100% of patients reported that their trigeminal pain was significantly improved following surgical intervention. Four out of fourteen patients reported a 50-80% decrease from the pre-surgery baseline pain at one month and three month follow up. One patient developed a CSF leak, and no surgical site infections or motor deficits were observed.

CONCLUSION

Intra-operative glycerin rhizotomy in conjunction with microvascular decompression can be used to safely treat patients suffering from trigeminal neuralgia.

Individualized managing strategies of aggressive angiomyxoma of female genital tract and pelvis

AIMS

To investigate and evaluate the clinical management strategies of aggressive angiomyxoma (AA) in female genital tract and pelvis.

METHODS

A cohort of 13 patients with AA diagnosed and treated in Peking Union Medical College Hospital in the last 12 years was reported focusing on the results of the managements and prognosis.

RESULTS

The mean age at initial presentation was 36.9 years. The commonest site of tumor was perineum. Only two cases were accurately diagnosed as AA preoperatively by biopsy and fine needle aspiration of the tumors respectively. MRI helpfully reveals the location, relationship and degree of infiltration between tumors and pelvic organs. Surgery is the mainstay treatment. 11 of 12 patients had complete resection and majority of the operations were finished successfully through trans-perineum and trans-vagina approaches. Three cases with positive expression of ERs and PRs in the tumors received GnRHa injections which were useful preoperatively but not postoperatively. One repeatedly-recurrent case was treated with radiotherapy effectively. The recurrence rate in our study was 41.7% (5/12), with a median recurrence interval of 20.9 months. No patient developed distant metastases and died of the disease.

CONCLUSIONS

AA preferentially involves the pelvic and perineal regions of women in reproductive age. Tumor biopsy and fine-needle aspiration cytology are conducive to the preoperative diagnosis. The individualized operative strategy and awareness to protect and rebuild structure and function of the organs should be emphasized during the management of AA. Long-term follow-up is mandatory because of the high rate of recurrence.

Preliminary Experience of Assessment of Intracranial Lesions by Ultrasound in Multiple Trauma Patients Undergoing Craniectomy

Objective

To explore the feasibility and reliability of B-mode ultrasound for assessment of intracranial lesions in multiple trauma patients who had undergone craniectomy.

Design

ingle-centre study.

Setting

A 16-bed emergency intensive care unit (ICU) in the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine from July 2006 to June 2010.

Methods

We retrospectively analysed 13 multiple trauma patients with severe head injury admitted to the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine. All 13 patients were admitted to the ICU after craniectomy and received mechanical ventilation. Computed tomography (CT) were conducted when patients' consciousness, pupillary size, light reflex changed apparently, or if the bone window tension and the intracranial pressure increased unexpectedly. Head ultrasonography was performed within 2 hours of CT scanning.

Results

Ultrasonography revealed 18 pathological changes in the 13 patients. CT and a second operation helped to identify 23 pathological changes. The results of B-mode ultrasound were compared with those of CT and the coincidence rate was 78.3%, with no significant difference in the diagnosis of delayed haematoma or midline shift (Kappa=0.898, p<0.05).

Conclusions

Transcranial ultrasonography may be a useful tool for monitoring post-operation intracranial lesions in multiple trauma patients with severe head injury. It is an effective supplement to CT.

A new species of Triplophysa (Nemacheilidae: Cypriniformes), from Guangxi, southern China

A new species, Triplophysa huapingensis, is described from the Hongshuihe River, Guangxi, China. The new species is distinguished from other species of Triplophysa by the following combination of characters: body covered with scales, lateral line complete, eyes not degenerate, dorsal fin truncate, caudal fin forked, tip of pelvic fin not reaching anus, eight branched rays of dorsal fin, six branched rays of pelvic fin, 16 branched rays of caudal fin, grey and black diffused blotches on dorsal and lateral head and body. A key to all recorded species of Triplophysa in the Xijiang River system is provided.

In vivo biocompatibility and degradation behavior of Mg alloy coated by calcium phosphate in a rabbit model

This study is conducted to investigate the biocompatibility and biodegradation behavior of calcium phosphate-coated Mg alloy in vivo. Calcium phosphate (Ca-P) was coated on the Mg alloy (AZ31) by a chemical process. Samples of Ca-P coated rods, the naked alloy rods, and degradable polymer as controls were implanted into the thighbone of rabbits to investigate the bone response at the early stage. The reduction in implant volume was determined by micro-computed tomography and three-dimensional reconstruction of the remaining Mg alloy segmented from the bone matrix. It was observed that the biodegradation rate of naked Mg implant is faster than that of the coated ones. The bone-implant interface was characterized in sections by scanning electron microscopy with energy-dispersive spectroscopy. Biodegradation or reaction layer was formed on the surface of Mg alloy implants and direct contact with the surrounding bone. The layer was mainly composed of Ca, P, O, and Mg. After 8 weeks of post-operation, paraffin sections were generated for histomorphologic analysis; 100% implants were fixed and no inflammation was observed. Histological analysis showed that new bone tissue is formed around the Mg implants, and no fibrous capsule was found. Blood examination showed that the biodegradation of the Mg implant caused little change to blood composition. Ca-P coating on Mg alloy substrate might be an effective method to reduce the biodegradation rate of Mg alloy in vivo and improve the surface bioactivity of Mg alloy implants.

Characterization and anti-fouling performance of nano-Al₂O₃/PVDF membrane for Songhua river raw water filtration

Polyvinylidene fluoride (PVDF) flat ultrafiltration membranes modified by nano-sized alumina (Al₂O₃) particles were prepared by phase inversion process and their properties and anti-fouling performances were examined. The influence of three types of natural organic matters on the modified membrane fouling was also studied. Raw water was taken from two different locations, i.e., Harbin and Zhaoyuan, of Songhua River. Dissolved organic compounds in the raw water were fractionated using XAD resins into three fractions, i.e., hydrophobic fraction, transphilic fraction, and hydrophilic fraction (HPI). The three adsorbed compounds were further eluted and dissolved into distilled water respectively to prepare the feed for the fouling tests. All solutions were adjusted to a concentration of 10.6 mg C/L, which equals to the total organic carbon (TOC) of the raw water. Results show that the addition of nano-Al₂O₃ particulars did not affect the inherent traits of the PVDF membranes, however, its surface hydrophilic properties were improved significantly with the addition of nanoparticles and anti-fouling performance was enhanced as well. The HPIs in the Songhua River were the main foulant, causing more fouling to membrane than hydrophobic and transphilic matters.

Mixed heavy metals tolerance and radial oxygen loss in mangrove seedlings

The effects of a mixture of heavy metals (Pb, Zn and Cu) on growth, radial oxygen loss (ROL) and the spatial pattern of ROL were investigated in mangrove seedlings of three species: Aegiceras corniculatum, Avicennia marina and Bruguiera gymnorrhiza. Heavy metals inhibited the growth of seedlings and led to decreased ROL and changes in the "tight" barrier spatial pattern of ROL. There was a significant positive correlation between the amount of ROL from the roots of seedlings and metal tolerance. The species with the highest ROL amount, B. gymnorrhiza, were also the most tolerant to heavy metals. The "tight" barrier spatial ROL pattern was also related to metal tolerance in the seedlings. Therefore, we conclude that both ROL amount and "tight" barrier spatial ROL pattern in the roots of the mangrove seedlings play an important role in resistance to heavy metal toxicity.

Antiproliferation of human prostate cancer cells by ethanolic extracts of Brazilian propolis and its botanical origin

Propolis is a resinous substance collected by bees (Apis mellifera) from various tree buds which they then use to coat hive parts and to seal cracks and crevices in the hive. Propolis, a known ancient folk medicine, has been extensively used in diet to improve health and to prevent disease. In the present study, we have evaluated the effects of ethanolic extracts of Brazilian propolis group l2 and bud resins of botanical origin (B. dracunculifolia), and propolis group 3 on proliferation of metastasis (DU145 and PC-3) and primary malignant tumor (RC58T/h/SA#4)-derived human prostate cancer cells. The strongest inhibition was observed in propolis group 3 (sample #3) extracts whereas moderate growth inhibition was observed in human prostate epithelial cells. In the RC58T/h/SA#4 cells, resins of botanical origin of propolis group 12 (sample #1) and propolis group 12 (sample #2) induced growth inhibition that was associated with S phase arrest whereas propolis group 3 (sample #3) induced growth inhibition that was associated with G2 arrest. The mechanisms of cell cycle effects of propolis were investigated. The resins of botanical origin of propolis group 12 and propolis group 12 showed similar inhibition of cyclin D1, CDK4 and cyclin B1 expression. Propolis group 3 showed higher induction of p21 expression but no inhibition of cyclin D1, CDK4 and cyclin B1 expression. The results obtained here demonstrate that the Brazilian propolis extracts have significant inhibitory effect on proliferation of human prostate cancer cells. Inhibition was achieved through regulation of protein expression of cyclin D1, B1 and cyclin dependent kinase (CDK) as well as p21. Our results indicate that the Brazilian propolis extracts show promise as chemotherapeutic agents as well as preventive agents against prostate cancer.

Chinese life cycle impact assessment factors

The methodological basis and procedures for determination of Chinese normalization references and weighting factors according to the EDIP-method is described. According to Chinese industrial development intensity and population density, China was divided into three regions and the normalization references for each region were calculated on the basis of an inventory of all of the region's environmental emissions in 1990. The normalization reference was determined as the total environmental impact potential for the area in question in 1990 (EP(j)90) divided by the population. The weighting factor was determined as the normalization reference (ER(j)90) divided by society's target contribution in the year 2000 based on Chinese political reduction plans, ER(j)T2000. This paper presents and discuss results obtained for eight different environmental impact categories relevant for China: global warming, stratospheric ozone depletion, acidification, nutrient enrichment, photochemical ozone formation and generation of bulk waste, hazardous waste and slag and ashes.

Long-term inhalable particles and other air pollutants related to mortality in nonsmokers

Long-term ambient concentrations of inhalable particles less than 10 microm in diameter (PM10) (1973- 1992) and other air pollutants-total suspended sulfates, sulfur dioxide, ozone (O3), and nitrogen dioxide-were related to 1977-1992 mortality in a cohort of 6,338 nonsmoking California Seventh-day Adventists. In both sexes, PM10 showed a strong association with mortality for any mention of nonmalignant respiratory disease on the death certificate, adjusting for a wide range of potentially confounding factors, including occupational and indoor sources of air pollutants. The adjusted relative risk (RR) for this cause of death as associated with an interquartile range (IQR) difference of 43 d/yr when PM10 exceeded 100 microg/m3 was 1.18 (95% confidence interval [CI]: 1.02, 1.36). In males, PM10 showed a strong association with lung cancer deaths-RR for an IQR was 2.38 (95% CI: 1.42, 3.97). Ozone showed an even stronger association with lung cancer mortality for males with an RR of 4.19 (95% CI: 1.81, 9.69) for the IQR difference of 551 h/yr when O3 exceeded 100 parts per billion. Sulfur dioxide showed strong associations with lung cancer mortality for both sexes. Other pollutants showed weak or no association with mortality.

Gene encoding a human testis Sertoli cell component related to LIM domain protein

The cDNA (HED-2) encoding a 20 kDa protein found in mammalian epididymal fluid was isolated from a human testis expression library. It is composed of 1908 bp, containing a reading frame of 1479 bp, coding a polypeptide consisting of 493 amino acids, and assigned the accession number: U15158 by GenBank (Biochem. Mol. Biol. Int. 34, 1131-1136, 1994). HED-2 has 99% identity with the zyxin gene in amino acid sequence, a component of cell junction matrix and a member of the LIM domain protein family. Northern blot analysis of RNAs prepared from various human tissues showed that the HED-2 gene was expressed in all tissues analyzed. Sertoli cells of human testis expressed the gene as determined by an in situ hybridization method. The present study shows that the HED-2 gene is a member of the LIM domain protein family.

Adenosine diphosphate inhibits the serotonin transporter

Adenosine 5'-diphosphate (ADP) caused rapid and significant reductions in the rates of [3H]serotonin uptake observed for human platelets, human platelet vesicles, and rat brain synaptic vesicles. Estimated Vmax values in platelets (N = 15). platelet vesicles (N = 3), and synaptic vesicles (N = 3) exposed to 100 microM ADP were 42.3 +/- 11.4%, 78.8 +/- 1.4%, and 56.8 +/- 9.9% of control values, respectively. The EC50 values observed for ADP in platelets and platelet vesicles were 10-24 microM. Exposure to 100 microM ADP had small, inconsistent effects on KM values observed for the platelet transporter. ADP (100 microM) caused only a slight competitive inhibition of the platelet membrane binding of [3H]citalopram, a ligand for the 5HT uptake site of the transporter (5.0% displacement of 1.0 nM [3H]citalopram, 13% increase in apparent KD). The ADP analogue 2-methylthioADP caused similar decreases in the rates of platelet [3H]serotonin uptake, while a number of other related compounds had little or no effect on rates of platelet uptake. The ADP-effect on uptake was rapid, occurring in less than 2.5 s. and was additive with reductions produced by protein kinase C (PKC) activation. The ADP-induced decreases in uptake did not appear to occur through the ADP receptor or known platelet second messenger systems. The exact mechanism of the ADP-effect and its functional significance remain to be determined.