Intraoral Radiographic Interpretation Agreement Between Veterinary Students, Veterinary Dental Residents and Veterinary Dental Specialists

This study evaluated observer variations in the interpretation of radiographic evidence for periodontal disease, tooth resorption, and endodontic disease in dogs. Forty dental radiographs were evaluated for 12 different parameters (periapical destruction of bone, wider than expected root canal, narrower than expected root canal, apical root resorption, loss of alveolar bone, external surface resorption, external replacement resorption, external inflammatory resorption, external cervical root resorption, internal surface resorption, internal replacement resorption, internal inflammatory resorption). Interpretations by 20 veterinary dentists, 10 veterinary dental residents, and 10 veterinary students were analyzed for consistency within groups and between groups by intraclass correlation coefficients (ICCs [95% CI]). Additionally, the agreement rate between groups compared to histopathological diagnosis, when available, and to a consensus group were evaluated. The results showed fair to good interobserver agreement for all participants when looking at all questions simultaneously (0.578 [0.515-0.635]) and with the consensus group (0.483 [0.451-0.517]). However, questions pertaining to various types of tooth resorption scored the lowest ICCs ranging from 0.005 (-0.311 to 0.321) to 0.189 (-0.105 to 0.402) across individual groups. Students had the lowest agreement compared to the consensus group for all questions (0.383 [0.347-0.421]) with fair to good agreement involving groups of residents (0.501 [0.465-0.538]), recently boarded diplomates (0.541 [0.506-0.578]), and more experienced diplomates (0.545 [0.510-0.582]). While dental radiographs are essential for clinical decision making, this study shows that interpretation of radiographs is highly subjective.

Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery

BACKGROUND

Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort.

METHODS

Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups.

RESULTS

The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status.

CONCLUSION

The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.

Complement Deficiencies Result in Surrogate Pathways of Complement Activation in Novel Polygenic Lupus-like Models of Kidney Injury

Lupus nephritis (LN) is a major contributor to morbidity and mortality in lupus patients, but the mechanisms of kidney damage remain unclear. In this study, we introduce, to our knowledge, novel models of LN designed to resemble the polygenic nature of human lupus by embodying three key genetic alterations: the Sle1 interval leading to anti-chromatin autoantibodies; Mfge8-/- , leading to defective clearance of apoptotic cells; and either C1q-/- or C3-/- , leading to low complement levels. We report that proliferative glomerulonephritis arose only in the presence of all three abnormalities (i.e., in Sle1.Mfge8 -/- C1q -/- and Sle1.Mfge8 -/- C3 -/- triple-mutant [TM] strains [C1q -/-TM and C3-/- TM, respectively]), with structural kidney changes resembling those in LN patients. Unexpectedly, both TM strains had significant increases in autoantibody titers, Ag spread, and IgG deposition in the kidneys. Despite the early complement component deficiencies, we observed assembly of the pathogenic terminal complement membrane attack complex in both TM strains. In C1q-/- TM mice, colocalization of MASP-2 and C3 in both the glomeruli and tubules indicated that the lectin pathway likely contributed to complement activation and tissue injury in this strain. Interestingly, enhanced thrombin activation in C3-/- TM mice and reduction of kidney injury following attenuation of thrombin generation by argatroban in a serum-transfer nephrotoxic model identified thrombin as a surrogate pathway for complement activation in C3-deficient mice. These novel mouse models of human lupus inform the requirements for nephritis and provide targets for intervention.

The early local and systemic Type I interferon responses to ultraviolet B light exposure are cGAS dependent

Most systemic lupus erythematosus (SLE) patients are photosensitive and ultraviolet B light (UVB) exposure worsens cutaneous disease and precipitates systemic flares of disease. The pathogenic link between skin disease and systemic exacerbations in SLE remains elusive. In an acute model of UVB-triggered inflammation, we observed that a single UV exposure triggered a striking IFN-I signature not only in the skin, but also in the blood and kidneys. The early IFN-I signature was significantly higher in female compared to male mice. The early IFN-I response in the skin was almost entirely, and in the blood partly, dependent on the presence of cGAS, as was skin inflammatory cell infiltration. Inhibition of cGAMP hydrolysis augmented the UVB-triggered IFN-I response. UVB skin exposure leads to cGAS-activation and both local and systemic IFN-I signature and could contribute to acute flares of disease in susceptible subjects such as patients with SLE.

[The interpretation of Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer]

For a long time, the diagnosis and treatment of pediatric thyroid nodules and cancer (PTNC) are mainly referred to adults. In recent years, it has been found that there are great differences between PTNC and TNC in adults. In 2015, the American Thyroid Association released the first Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. In the guidelines, the characteristics of PTNC were described, and clear management strategies were provided. In this paper, we mainly interpret the surgical part of the guidelines and also review the associated research progress in recent years.

[The prevalence of snoring and its related family factors of children from 3 to 14 years old in Beijing]

Objective: To investigate the snoring status and related family factors of children from 3 to 14 years old in Beijing. Methods: From May to July, 2015, data of children from 3 to 14 years old were obtained from a status survey from 7 districts(Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing. A total of 11 420 children from 25 primary and middle schools were randomly selected. Pediatric Sleep Questionnaire (PSQ) and a self-administered questionnaire were carried out for the adopted children. Self-administered questionnaire included the snoring related family factors. Logistic regression was used to estimate the odd ratio(OR) with 95% confidence intervals for variables. Results: A total of 9 198 children meet the inclusion criteria and are analyzed in the study, of whom 901 (9.80%) were found with snoring behavior. The incidence of boys is higher than girls. Obese children take higher risk of snoring. Compared with younger children (≤6 years old), older children (≥12 years old) have a significantly lower risk of snoring (OR=0.464, 95%CI 0.368-0.585). There is no statistical association between full-term infants, infant feeding pattern, parental cigarette smoking and child snoring.The children with family history of snoring have a significantly higher risk of snoring occurrence. The educational background of mother is statistically related to children snoring (OR=1.241, 95%CI 1.058-1.457). Conclusions: The incidence of children snoring in Beijing is 9.80%, male gender, obesity, and young age are all risk factors for children snoring. There is a significantly statistical relationship between snoring and related family factors, such as family snoring history and education experience.

[Clinical analysis of head and neck neurogenic tumor in childhood]

Objective:To investigate the clinical characteristics, imaging features and treatment of neurogenic tumor in chilehood and to improve the experience in diagnosis and treatment for the disease. Method:The twenty-nine inpatients of histopathologically proven neurogenic tumor from January 2015 to December 2018 were retrospectively analyzed. The pathological types, clinical characteristics, imaging findings, and management were analyzed. Result: There were five cases of schwannoma aged from 9 years to 14 years, five cases of neurofibroma aged from 9 months to 9 years, and nineteen cases of neuroblastic tumor aged from 3 months to 5 years in our series. The chief manifestations were soft tissue masses, snore, and Honer syndrome. As the tumors had different components pathologically, on scans they presented as masses with heterogeneous density. Schwannoma showed as oval masses with clear margins, with the characteristic of"tail sign". The imaging findings of neurofibromas showed unclear boundaries and plexiform neurofibromas showed multiple clumps with visible separation. The ultrasonography of neuroblastic tumor was characterized by hypoechoic, heterogeneous and spotty calcification. All the cases underwent surgical resections. In 5 cases of schwannoma, it was confirmed that the tumors originated from the vagus nerve during the operation, which could be completely removed without postoperative complications. Two cases of neurofibromas were completely resected, 2 cases were only partially resected, and 1 case which located at the entrance of the esophagus was resected under supportive laryngoscopic for three times. Thirteen of 19 children with neuroblastogenic tumors underwent resection in our department after chemotherapy, and 2 patients with postoperative recurrence underwent another operation. Conclusion:Neuroblastoma is the most common neurogenic tumor in the head and neck of children. Most neurogenic tumors have their corresponding characteristics on imaging and should be differentiated. Schwannoma has clear boundary and intact capsule, so it is easier to complete resection. The neurofibroma is commonly difficult to remove with safety margin because of its unclear boundaries. Neuroblastoma should be treated according to the lesion range and stage. Most of the lesions are difficult to remove completely due to the wide range, peripheral blood vessels and important nerves. So preoperative chemotherapy is generally required.

[Analysis of sleep quality and related factors among children in Beijing]

Objective: To investigate the sleep quality of children in Beijing and to analyze the related factors. Methods: The data were collected from the survey of 3-14 years old children in 7 urban districts of Beijing in 2015. By using multi-stage stratified cluster random sampling method, 26 kindergartens and primary and secondary schools in 7 districts and counties, including Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou, were randomly selected, with a total of 11 420 children. Children's sleep status was investigated with Children's Sleep Questionnaire (PSQ), and the proportion of children with sleep quality problems when the PSQ score was greater than 7. Various sleep related factors were investigated with self-made questionnaire. A multilevel model was used to analyze the relationship between PSQ score and related factors. Results: The average PSQ score of the children was 3.60±2.69. The proportion of children with sleep quality problems was 8.87%(816/9 198). Multilevel model analysis showed that the younger the children, the higher the PSQ score (<6 years old vs. 6~12 years old vs. >12 years old: 3.94±2.58 vs. 3.58±2.66 vs. 3.30±2.84, F=33.015, P<0.001); male PSQ score higher than female (3.89±2.75 vs. 3.30±2.60, t=10.560, P<0.001); and snoring, obesity, father/mother snoring, playing games before bed, surfing the internet, eating and other factors were statistically related to PSQ. Conclusions: Sleep quality of children in Beijing should not be neglected, especially preschool children with high PSQ scores. Parents should pay attention to children's snoring problems and try to reduce some pre-sleep behaviors that may affect sleep quality.

[Diagnosis and treatment of lymphatic malformations]

More than seventy percent of lymphatic malformations (LMs) occur in head and neck region. The management of head and neck LMs is challenging,especially for diffuse and infiltrative cases.It can cause deformity and death in severe patients. Surgical resection is the main method to treat LMs in the past and sclerotherapy has also greatly improved the treatment out come of LMs over the past 20 years. However, it is still hardly to achieve satisfactory prognosis for the patients with extensively infiltrative lesions, regardless of surgical resection or sclerotherapy. In the past five years, some scholars have made a preliminary exploration of new treatment methods, such as oral medicine, to diversify the treatment options of head and neck LMs. This article will review the general situation, biological properties, clinical characteristics, diagnostic methods, and current treatment strategies for LMs as well as trends in management of LMs.

The Optimal Surgical Approach Selection for Papillary Thyroid Carcinoma With Pathological N1 Metastases: An Analyses on SEER Database

Background: The definition of large-volume pathologic N1 metastases has been changed in the 2017 version of National Comprehensive Cancer Network (NCCN) guidelines, leading to a controversy over the optimal surgical approach selection for patients with papillary thyroid carcinoma (PTC). Aim: The aim of this study was to investigate the therapeutic efficacy of total thyroidectomy (TT) and thyroid lobectomy (TL) for these patients. Methods: In total 906 consecutive PTC patients with metastases ≤ 5 mm were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and divided into 2 groups (≤2 mm, >2 to 5 mm) based on the size of extend of disease (EOD). The overall survival (OS) was then compared between patients treated with TT and TL, followed by Cox-proportional hazards regression analysis to explore multiple prognostic factors. Results: OS favored TT compared with TL in patients with more than 5 involved nodes and metastases > 2 to 5 mm in largest dimension ( P < 0.05). Meanwhile, Cox analysis showed that the TL was not an independent factor associated with poorer OS than TT in these patients ( P > 0.05). TT showed better survival than TL for patients with metastases > 2 mm to 5 mm. For patients with metastases ≤ 2 mm, either TT or TL should be recommended because of no discrepancy in survival. Conclusion: TT does offer slight survival advantage over TL for PTC patients with metastases > 2 mm to 5 mm; TT may be recommended for these patients to improve disease-special survival and reduce the risk of recurrence.

Roles of Embryonic Field in Neuroblastomas: A New Perspective Study Based on SEER Database

Background: Neuroblastoma is the most prevalent malignancy in children. G. Barry Pierce once suggested the regulatory roles of embryonic field in the carcinoma. However, no related article can be found until now. Aim: To investigate the roles of embryonic field in neuroblastoma. Methods: In the current study, patients with neuroblastoma were initially selected from SEER Database (1973-2014). Demographic information (such as age, gender and race) as well as clinical presentations were collected. Based on the blastoderms (ectoderm/mesoderm/entoderm) of organs, where were the primary sites of tumors, patients were then categorized into 3 different groups (low-risk, intermediate-risk, and high-risk). Differences in the demographic information, therapeutic methods and outcomes were then analyzed among the 3 groups. Results: The analytic cohort included 5623 patients in total. The primary sites which originate from mesoderm accounted for 35.0% of all malignant tumors, and the majority from entoderm was olfactory neuroblastoma (75.3%). Neuroblastoma from entoderm had the smallest tumor size, with the diameter of 43.89 ± 20.84 cm. More lymph nodes were found to be involved when tumors grow along with organs or tissues originating from mesoderm. Radiation seems having little impact on the prognosis of patients. Conclusion: Cellular similarity plays important roles in the prognosis of patients with neuroblastoma, however, radiation treatment has little impact. In addition, enhancing the immune state of patients is very important for the good prognosis during the course of treatment. More attentions should be paid to the relationship between tumorogenesis and embryogenesis.

Use of Oral Sildenafil in Treatment of Pediatric Head and Neck Lymphatic Malformations

Background: Lymphatic malformation (LMs) is a low flow vascular malformation, with a morbidity rate of 1/2000 in neonates. Most of the LMs were found in the head and neck. Compared with the macrocrystic ones, the microcrystic LMs show stronger invasiveness and wider involved range, which leads to higher treatment difficulty and recurrence rate as well as a serious impact on patients´ health and quality of life. Aim: To evaluate the efficacy and safety of oral sildenafil in treatment of pediatric head and neck LMs. Methods: In total, 21 children diagnosed with LMs were given oral sildenafil and stopped at week 24. Therapeutic outcome was evaluated by comparing lesions' volume change with baseline. In addition, symptoms improvement and adverse effects were also recorded during the follow-up period. Results: Eight patients (38.0%) showed excellent improvement (>75%-100%), 1 patient (4.8%) had good (>50%-75%), 2 patients (9.6%) had fair (>25%-50%), 3 patients (14.3%) had minimal (0%-25%), and 7 patients (33.3%) had no improvement. The snoring or stridor completely disappeared in 2 subjects, although there was no apparent decrease in LMs size. Moreover, all 3 patients with macrocystic lesions displayed a positive response to sildenafil treatment, followed by mixed type (9/12, 75%). Only 2 out of 6 patients with microcystic lesions had minimal clearance. Only 4 patients showed transient mild diarrhea, there was no other adverse effect in this series. Conclusion: Our study showed that low-dose oral sildenafil citrate tablets are safe and effective to decrease the lesions volume in some LMs children, especially with macrocystic lesion or mixed type.

[Clinical analysis of thyroid cancer in 62 children]

Objective: To analyze the clinical characteristics and prognosis of thyroid cancer in children. Methods: Clinical data of 164 children (60 boys, 104 girls) with space-occupying lesions of the thyroid who were hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from July 2006 to December 2017 were collected. Sixty-two children with thyroid cancer were reviewed respectively and followed up by telephone. Results: From July 2006 to December 2017, children with thyroid cancer accounted for 37.8% (62/164) of children with space-occupying lesions of the thyroid. The number of children with space-occupying lesions of the thyroid every 2 years was 13, 21, 19, 33, 38, 41, and the number of children with thyroid cancer every 2 years was 2, 5, 3, 8, 21, 23. One out of 62 thyroid cancer was follicular thyroid cancer, the others were papillary thyroid cancer, neck mass was the chief complaint in 60 of 62 patients. Two cases were brought to hospital with respiratory tract oppression as the chief complaint. Forty-eight cases got long-term follow-up by telephone, over 50 percent of cases received follow-up for more than 2 years, the median follow-up time was 2.63 years (0.25-8.67 years), most of these patients had favorable prognoses. Hypothyroidism (98%) and hypocalcemia (33%) were main long-term complication. Hypothyroidism recovered well after thyroxine replacement therapy, and in only 5 children hypocalcemia was spontaneously relieved, the average remission time was 1.9 months, the longest time for recovering from hypocalcemia was 6 months; the other cases responded well when they were treated as secondary hypoparathyroidism, with no hypocalcemia symptoms. Nine children had distant metastasis after operation, the average recurrence time was 12.8 months, and the latest relapsing time was 2 years. The overall prognosis was good, the longest follow-up period was 8 years and no death was found. Conclusions: Pediatric space-occupying lesions of the thyroid and thyroid cancer are rising during the last 12 years. Hypothyroidism and hypocalcemia are main long-term complications after surgery, the children cases recovered well, the remission of hypocalcemia was achieved not later than 6 months. The overall prognosis of childhood thyroid cancer was good, without death within the follow-up period.

[The prevalence of snoring and its association with academic performance among school-aged children in Beijing]

Objective: To investigate the snoring status of school-aged children in Beijing and explore the association of snoring and academic performance. Methods: A total of 7 925 children aged from 6 to 14 were selected from 15 primary and middle schools at 7 districts (Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing in 2015, using multi-stage stratified cluster random sampling method. The recruited children were asked to complete the Pediatric Sleep Questionnaire (PSQ) and a questionnaire related to sleep behavior. The multiplelogistic regression was used to analyze the association of snoring and academic performance. Results: A total of 794 (12.44%) children showed a decline in academic performance among 6 383 eligible respondentsfor data analysis. 580 (9.08%) children with snoring was identified, of which 333 and 247 were in frequency of 1-2 times per week and frequency of ≥3 times per week, respectively; 357, 170 and 53 were in snoring grade Ⅰ, grade Ⅱ and grade Ⅲ, respectively. Compared with the children without snoring, the OR (95%CI) for children with 1-2 times per week and ≥3 times per week was 1.363 (1.000-1.857) and 1.605 (1.135-2.269), respectively; and the OR (95%CI) for children with grade Ⅰ, grade Ⅱ and grade Ⅲ of snoring was 1.226 (0.893-1.683), 1.595 (1.062-2.397) and 2.31 (1.17-4.565), respectively. Conclusion: There is a statistical relationship between snoring and the decline of academic performance. The decline of academic performance positively associated with increased frequency and grade of snoring.

Efficacy and safety of sublingual immunotherapy with Dermatophagoides farinae drops in pre-school and school-age children with allergic rhinitis

BACKGROUND

The safety and efficacy of sublingual immunotherapy (SLIT) have been confirmed by many studies. However, in China, the research on efficacy and safety in young and older children with allergic rhinitis (AR) is still rare.

OBJECTIVE

The aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae drops in pre-school and school-age children with AR.

METHODS

A total of 282 subjects aged 2-13 years with AR received a two-year course of sublingual immunotherapy along with pharmacotherapy. According to the age, patients were defined as the pre-school group (2-6 years old, n=116) and school-age group (7-13 years old, n=166). Total nasal rhinitis symptom scores (TNSS), visual analogue score (VAS) and total medication scores (TMS) were evaluated at four time points: baseline, after SLIT for half a year, one year and two years. The adverse events (AEs) were evaluated at each visit.

RESULTS

After two-year SLIT, the four rhinitis symptom scores, TNSS, VAS and TMS scores were significantly lower than baseline (all P<0.05). The comparison of efficacy between one and two-year duration showed no significant difference in global clinical outcomes (all P>0.05). In addition, there were no significant differences between the pre-school and school-age group in TNSS (all P>0.05), VAS (all P>0.05) and TMS scores (P>0.05) after SLIT for half a year, one year and two years. No severe systemic AEs were reported.

CONCLUSION

SLIT with D. farinae drops is clinically effective and safe in pre-school and school-age patients with house dust mites (HDMs)-induced AR.

[The validity and reliability of simplified Chinese version of the pediatric sleep questionnaire for screening children with obstructive sleep apnea syndrome in Beijing]

Objective: To evaluate the validity and reliability of the simplified Chinese version of pediatric sleep questionnaire (PSQ) used in screening obstructive sleep apnea syndrome (OSAS) of children in Beijing. Methods: Children with snoring who presented to the Sleep Center of Beijing Children's Hospital between August 2014 and July 2015 and healthy children were included in the study. All children underwent PSG and then were divided into OSAS group and control group based on the PSG and their guardians were asked to complete the simplified Chinese version of PSQ that was formed by both translation from PSQ and retroversion to PSQ. Structure validity evaluation included confirmatory factor analysis which used Amos structural equation model and exploratory factor analysis which used principal component analysis. Predictive validity were measured with Logistic regression model. Internal reliability and test-retest reliability were evaluated by Cronbach 's alpha coefficient and intra-class correlation coefficient (ICC), respectively. The screening efficiency was evaluated by the receiver operating characteristic curve (ROC). Results: The study included 235 children aged 3-16 years old, 145 children of them with the age of (5.8±2.1) in OSAS group and 90 children with the age of (7.7±3.3) in control group. Confirmatory factor analysis indicated most items belonging to individual factors with load coefficient ≥ 0.5. Predictive validity analysis revealed 13 items positively related to the diagnosis of OSAS (all OR>1, all P<0.05). Cronbach's alpha coefficients were respectively 0.703 (overall reliability), 0.767 (breathing factor), 0.849 (sleepiness factor) and 0.689 (behavior factor). The test-retest ICC reliability was 0.986 (PSQ), 0.991 (breathing factor), 0.727 (sleepiness factor), and 0.870 (behavior factor) with P<0.05. In receiver operating characteristic curve, the area under curve of simplified Chinese version PSQ score was 0.922 with P<0.05 and the cutoff value of PSQ score was 7 in 22 items with the sensitivity of 0.776, specificity of 0.867, positive predictive value of 0.868 and negative prediction value of 0.774. Conclusions: The simplified Chinese version of PSQ is suitable to the screen of OSAS for the children in Beijing area with good reliability and validity. It also has acceptable sensitivity and specificity for screening children with OSAS when the cutoff score is 7 points.

[Characteristics of sleep apnea events in non-snoring children]

Objective: To investigate the characteristics of sleep-related respiratory events in normal children and to provide normal polysomnographic parameters for diagnosing sleep-disordered breathing in children. Methods: Normal subjects between 3 and 14 years old were enrolled from 1 July 2014 to 31 December 2015 and the subjects received overnight polysomnography at the sleep center of our hospital. They were children of our hospital employees or were recruited from the communities who did not have sleep and respiratory disorders. The children were divided into preschool group (3-5 years) and school-age group (6-14 years). Apnea index (AI), obstructive apnea index (OAI), central apnea index (CAI), and mixed apnea index (MAI) were compared between the two groups. Data for continuous variables that showed normal distribution were expressed as x ±s. M(P₂₅, P₇₅) were used when data were not normally distributed. Continuous variables that showed normal distribution were compared by using an independent-sample t-test. Wilcoxon-test was performed when data exhibited non-normal distribution. Differences in categorical data were tested with Chi-square test. Pearson correlation test was applied for the correlation analysis. P<0.05 was considered statistically significant. Results: A total of 115 normal children took part in the study including 40 in preschool group and 75 in school-age group. Children in both groups had a few sleep apnea events, most of which were central apneas, accounting for 80% and 70% of the total respiratory events respectively. Central apnea index in preschool children were significantly higher than that of school-age children (P<0.001), with median of 0.6 times/h and 0.1 times/h, respectively. Median OAI of both groups were 0.0 times/h without significant difference (P=0.748). Obstructive apnea events occurred mainly in the supine position in both groups. Conclusions: Normal children may have a few apnea events in sleep that were predominantly central apnea. CAI of preschool children is significantly higher than that of school-age children. Obstructive sleep apnea is rare in normal children, and sleep apnea occurs mainly in the supine position.

Wearable multi-channel microelectrode membranes for elucidating electrophysiological phenotypes of injured myocardium

Understanding the regenerative capacity of small vertebrate models has provided new insights into the plasticity of injured myocardium. Here, we demonstrate the application of flexible microelectrode arrays (MEAs) in elucidating electrophysiological phenotypes of zebrafish and neonatal mouse models of heart regeneration. The 4-electrode MEA membranes were designed to detect electrical signals in the aquatic environment. They were micro-fabricated to adhere to the non-planar body surface of zebrafish and neonatal mice. The acquired signals were processed to display an electrocardiogram (ECG) with high signal-to-noise-ratios, and were validated via the use of conventional micro-needle electrodes. The 4-channel MEA provided signal stability and spatial resolution, revealing the site-specific electrical injury currents such as ST-depression in response to ventricular cryo-injury. Thus, our polymer-based and wearable MEA membranes provided electrophysiological insights into long-term conduction phenotypes for small vertebral models of heart injury and regeneration with a translational implication for monitoring cardiac patients.

Quantitative proteomics of delirium cerebrospinal fluid

Delirium is a common cause and complication of hospitalization in older people, being associated with higher risk of future dementia and progression of existing dementia. However relatively little data are available on which biochemical pathways are dysregulated in the brain during delirium episodes, whether there are protein expression changes common among delirium subjects and whether there are any changes which correlate with the severity of delirium. We now present the first proteomic analysis of delirium cerebrospinal fluid (CSF), and one of few studies exploring protein expression changes in delirium. More than 270 proteins were identified in two delirium cohorts, 16 of which were dysregulated in at least 8 of 17 delirium subjects compared with a mild Alzheimer's disease neurological control group, and 31 proteins were significantly correlated with cognitive scores (mini-mental state exam and acute physiology and chronic health evaluation III). Bioinformatics analyses revealed expression changes in several protein family groups, including apolipoproteins, secretogranins/chromogranins, clotting/fibrinolysis factors, serine protease inhibitors and acute-phase response elements. These data not only provide confirmatory evidence that the inflammatory response is a component of delirium, but also reveal dysregulation of protein expression in a number of novel and unexpected clusters of proteins, in particular the granins. Another surprising outcome of this work is the level of similarity of CSF protein profiles in delirium patients, given the diversity of causes of this syndrome. These data provide additional elements for consideration in the pathophysiology of delirium as well as potential biomarker candidates for delirium diagnosis.

Antiproliferation activity of Devil's club (Oplopanax horridus) and anticancer agents on human pancreatic cancer multicellular spheroids

Devil's club (DC, Oplopanax horridus) is an important medicinal herb of the Pacific Northwest which has significant antiproliferation activity against a variety of human tumor cell lines in vitro. This study compared the antiproliferation activity of DC extract alone, and in combination with chemotherapeutic agents gemcitabine (GEM), cisplatin (CDDP), and paclitaxel (PTX) on human pancreatic cancer PANC-1 3D spheroids and 2D monolayer cells. 3D tumor spheroids were prepared with a rotary cell culture system. PANC-1 3D spheroids were significantly more resistant to killing by DC extract, GEM and PTX compared to 2D cells, with IC50 levels closer to that observed in vivo. DC extract significantly enhanced the antiproliferation activity of CDDP and GEM at some concentrations. The bioactive compound identified as a polyacetylene showed strong antiproliferation activity against PANC-1 2D cells and 3D spheroids with IC50 at 0.73±0.04 and 3.15±0.16μM, respectively. 3D spheroids and 2D cells differentially expressed a number of apoptosis related genes. Cell cycle analysis showed that the proportion of cells in S phase was increased and in G2/M phase reduced in 3D spheroids compared to 2D cells. DC extract can potentially be used to enhance the activity of chemotherapeutic agents against pancreatic cancer cells. Use of 3D spheroid model for screening of natural products can potentially increase the efficiency in discovering in vivo bioactive compounds.

molecular typing of Legionella pneumophila strains isolated from environment in Morocco

Legionella pneumophila is a common cause of hospital and community-acquired pneumonia, being transmitted by inhalation of aqueous aerosols. Most legionellosis outbreaks are linked to contaminated hot water systems or cooling towers. The aim of this study was to determine the genetic diversity of (n= 55) environmental strains of L. pneumophila recovered from the hot water distribution systems of 16 establishments in seven Moroccan towns during the period 2009-2011. Thirteen chromosomal restriction patterns determined by Pulsed field gel electrophoresis were detected. The strains of L. pneumophila serogroup1 exhibited in 6/13 different PFGE patterns, while the strains of L. pneumophila serogroups 2-14 showed 7/13 PFGE patterns. The PFGE showed the existence of various patterns in Morocco, The pattern -XI- have tree similar profiles with the endemic L. pneumophila Paris&apos;s strain. This technique also allowed to conclude that the same pulsotype was found for many strains isolated from different establishments. Moreover, different pulsolypes were found for strains isolated from the same establishment. These results showed that PFGE analysis is a powerful tool to reveal the clonal nature and genetic differences among L. pneumophila strains.

Active myogenic tone: a requisite for hemoglobin mediated vascular contraction?

Acellular free hemoglobin (Hb), when intravenously administered to animals and humans, elicits vascular contraction. A primary mechanism for the Hb mediated vasoconstriction is Hb scavenging of nitric oxide (NO), a potent relaxation factor, constitutively secreted by the vascular endothelium. However, in the isolated rat thoracic aorta in basal state, Hb does not elicit contraction. To investigate this apparent paradox, we assessed isolated rat aortic ring isometric contraction responses to Hb under different myogenic tone states: (1) following equilibration at a submaximal tension, (2) following agonist induced contraction, or (3) following a passive mechanical stretch. In vessel rings at basal state, Hb as high as 4 microM did not elicit any measurable contractions. In contrast, in vessel rings tone enhanced with norepinephrine, Hb as low as 0.1 microM Hb elicited a significant additional contraction. In vessel rings with passively induced tone, 4 microM Hb did not elicit a notable contraction. Similarly, in vessel rings in basal state, 0.17-1 mM acetylcholine, a NO dependent vasodilator, did not elicit relaxation. In these vessel rings, exogenous 8-Br-cGMP, a membrane permeable cGMP analog, did not elicit relaxation. In conclusion, in the isolated rat thoracic aorta, Hb mediated contraction may be contingent upon the state of myogenic tone.

Letter detection in very familiar texts

In the present study, we investigated whether patterns of letter detection for function and content words in texts are affected by the familiarity of the material being read. In Experiment 1, subjects searched for target letters in sentences that had been rehearsed prior to performing the letter detection on them as well as on unfamiliar sentences. In Experiment 2, subjects searched for target letters in highly familiar verses (e.g., nursery rhymes) and in unfamiliar sentences that were matched to the familiar verses. A disadvantage in letter detection for function as compared with content words consistently found with unfamiliar passages was reduced significantly with the familiar material in both experiments. Specifically, letter detection for content words grew worse in familiar text, but letter detection for function words showed a contrasting modest, though nonsignificant, improvement. The results are consistent with the proposition that in very familiar texts, parafoveal analysis permits the identification of generally less familiar content words. Simultaneously, the normal pattern of weighing the structure and content elements of text changes so that more fixations on function words occur than when one is reading unfamiliar texts.

Alpha adrenergic activation and hemoglobin mediated contraction in the isolated rat thoracic aorta

A primary mechanism for Hb mediated vascular contraction appears to be Hb scavenging of endothelium derive nitric oxide (NO), a potent vasodilator. In isolated rat thoracic aorta, however, Hb elicits contraction only after precontraction. The present study investigated a possible role of the alpha adrenergic activation in the Hb mediated contraction. Thoracic aortic rings harvested from normal male SD rats were prepared in a tissue bath and isometric tension changes were evaluated. In vessel rings precontracted with 50nM norepinephrine (NE), 1 microM Hb produced an additional 21.8+/-13.2% increase in tension. Pretreatment with 70nM phentolamine, an alpha adrenergic antagonist, prevented the 50nM NE induced contraction. In these vessels, subsequent treatment with 2-4 microM Hb did not elicit contraction. In vessel rings precontracted with 37mM KCl, 2 microM Hb produced an additional 21.8+/-20.1% tension increase (P<0.05). Pretreatment with phentolamine did neither prevent KCl induced contraction nor affect subsequent Hb mediated additional contraction. To test whether there is a threshold level of basal tension for Hb to trigger contraction, a group of vessel rings were passively stretched to match the tension generated by NE before Hb treatment. In these passively stretched vessel rings, Hb did not produce a significant contraction. Pretreatment with 10mM EGTA, a Ca++ chelator, significantly reduced NE induced contraction (9.7+/-5.9 vs 137.7+/-60.0%, P<0.01) but did not prevent it. EGTA also significantly reduced 2 microM Hb induced contraction (27.2+/-29.3% vs 8.9+/-7.7%, P<0.05). In contrast, pretreatment with verapamil, a Ca++ channel blocker, did not completely block NE and Hb induced contractions. In conclusion, alpha adrenergic activation is not a requisite for the Hb mediated contraction in isolated rat aortic rings. The mechanism how prior tone enhancement allows Hb mediated contraction remains unclear but results from this study suggest a factor that controls cytosolic Ca++ levels may be involved.

Nitric oxide scavenging modulates an experimental vasoplesia in-vitro

Endogenous overproduction of nitric oxide (NO) is believed to be a primary cause of refractory hypotension in septic shock. Under this condition, effectiveness of vasopressors is diminished due to hyporeactivity of blood vessels, a condition termed as vasoplesia. Effective reduction of NO levels should alleviate the condition. In this study, we investigated whether NO scavenging could modulate the endotoxin mediated vasoplesia in-vitro. Further, we explored whether NO scavenging in combination with a moderate NO synthase (NOS) inhibition would also be effective in modulating NO mediated vasoplesia. Experimental vasoplesia was produced in-vitro by incubating isolated rat thoracic aortic rings with lipopolysaccharide (LPS). Vessel rings were then treated with N(omega)-nitro-L-arginine methyl ester (L-NAME; a NOS inhibitor), human hemoglobin (Hb; a NO scavenger), or both L-NAME and Hb. Vascular reactivity was assessed by measuring vessel ring isometric tension changes to norepinephrine (NE) doses; the median effective doses (logEC50) of NE before and after each experimental treatment were compared. Following a 6-hour LPS treatment, vascular reactivity logEC50 values for NE were significantly increased compared with control vessel rings incubated without LPS. Treatment with either L-NAME alone or Hb alone significantly improved the vessel ring reactivity to NE. When both L-NAME and Hb were used concomitantly, vascular reactivity was also significantly improved. These results indicate that NO scavenging with Hb is as effective as NO synthesis inhibition with NAME in modulating the endotoxin induced vasoplesia. In conclusion, NO scavenging, alone or in combination with a moderate NOS inhibition, may render an alternative therapeutic approach to NOS synthesis inhibition in modulating the vasoplesia in septic shock.

Melatonin replacement therapy in a child with a pineal tumor

The case report of a child with the diagnosis of a pineal tumor and severe, chronic sleep disorder is reported. Due to treatment of her lesion, the nighttime melatonin secretion was markedly suppressed. For 4(1/2) years, she has been receiving oral melatonin, which has greatly improved her sleep, without any adverse effects. Sleep difficulties should be considered in the management of pineal lesions. Melatonin replacement therapy is beneficial for those patients who have deficient melatonin synthesis.

Alterations of the actin polymerization status as an apoptotic morphological effector in HL-60 cells

The alterations of the cytoskeletal actin network have been implicated as a morphological effector in apoptosis. However, studies directly linking actin change to the morphological events in apoptosis are lacking. This study quantitatively examined the effect of actin alteration on the camptothecin (CPT)-induced apoptotic process in HL-60 cells. Actin alteration was induced by two distinctive types of agent: the polymerization-stimulating agent, Jasplakinolide (Jas), and the polymerization-blocking agent, cytochalasin B (CB). The actin polymerization status was measured by two complementary methods: the cell pellet-based DNase I inhibition method, and the individual cell-based quantitative fluorescence image analysis (QFIA) assay. Actin polymerization induced by Jas caused apoptosis directly. By contrast, CB, an actin polymerization-blocking agent, partially inhibited CPT-induced apoptosis. A similar inhibition of the CPT-induced apoptosis response was observed with a more specific actin depolymerization agent, cytochalasin E. The alterations of the actin polymerization status occurred in three sequential steps during the apoptotic process: first polymerization, followed by depolymerization, and finally degradation. However, compared with CPT-induced apoptosis, Jas-induced apoptosis was characterized by pronounced actin polymerization that corresponded morphologically with prominent membrane blebbing, but less apoptotic body formation. Furthermore, DNase I activity, which is normally inhibited by G-actin, was specifically detected in Jas-treated cells. These results show that the regulation of actin polymerization is an important apoptotic morphological effector, whereas the alterations of the actin polymerization status by chemicals have profound effects not only on altering the morphology of apoptotic cells, but on apoptosis induction in HL-60 cells as well.

Direct selection for mutators in Escherichia coli

We have constructed strains that allow a direct selection for mutators of Escherichia coli on a single plate medium. The plate selection is based on using two different markers whose reversion is enhanced by a given mutator. Plates containing limiting amounts of each respective nutrient allow the growth of ghost colonies or microcolonies that give rise to full-size colonies only if a reversion event occurs. Because two successive mutational events are required, mutator cells are favored to generate full-size colonies. Reversion of a third marker allows direct visualization of the mutator phenotype by the large number of blue papillae in the full-size colonies. We also describe plate selections involving three successive nutrient markers followed by a fourth papillation step. Different frameshift or base substitution mutations are used to select for mismatch-repair-defective strains (mutHLS and uvrD). We can detect and monitor mutator cells arising spontaneously, at frequencies lower than 10(-5) in the population. Also, we can measure a mutator cascade, in which one type of mutator (mutT) generates a second mutator (mutHLS) that then allows stepwise frameshift mutations. We discuss the relevance of mutators arising on a single medium as a result of cells overcoming successive growth barriers to the development and progression of cancerous tumors, some of which are mutator cell lines.

Xenotransplantation of adult porcine islets in diabetic mice. A study of UVB irradiation, cryopreservation and immunosuppression on graft survival time

The major obstacle for successful xenotransplantation of islets to large animals and human diabetics is the host rejection. To address the rejection problem, we studied the efficacy of UV-B irradiation, cryopreservation and immunosuppression on the in vivo functional time and immunogenicity of adult porcine islets (PI) in outbred CD1 mice. Exposure of PI to UV-B irradiation between 300-1800J/M2 did not affect the cellular viability as assessed by fluorescein diacetate or their daily insulin secretion in vitro. Fresh PI normalized the blood glucose (BG) of diabetic CD1 mice for 3.1+/-0.6 (n = 8, mean+/-SEM) days. Islets treated with 600J/M2 UV-B irradiation or cryopreservation had similar graft functional times to fresh islets upon transplantation in diabetic CD1 mice. Immunosuppression with cyclosporin A (CsA), antilymphocyte serum (ALS) and FK506 prolonged the functional time of fresh pig islets to 7.9+/-0.9 (n = 9), 6.2+/-1.3 (n = 5) and 24.2+/-10.4 (n = 12) days, respectively. However, additional pretransplant treatment with either UV-B irradiation or cryopreservation did not further increase the functional time of pig islets in mice immunosuppressed with CsA. Furthermore, there was no apparent difference in the frequency of appearance of cytotoxic antibodies and antibody titers in the recipients of UV-B irradiated or cryopreserved pig islet compared with non-treated islets. The UV-B irradiation and cryopreservation of PI before transplantation with the present protocols did not appear to have significant effect on the islet immunogenicity when assessed by in vivo survival duration and anti-donor antibody titer production.

Prolongation of pig islet xenograft survival in rats immunosuppressed with FK506

FK506 a new and potent immunosuppressive agent has been shown to be effective in prolonging pancreatic islet allograft survival. The present study was to determine its efficacy in prolonging pig islet xenotransplantation in two different strains of rat recipients. A total of two dosages of FK506 at 1 or 2 mg/kg per day for 2 weeks and then at weekly intervals were tested as monotherapy for their effect on the survival of renal subcapsular xenografts of purified or impure adult pig islets in inbred ACI and outbred Wistar rats. Histological assessment indicated that FK506 at 2 mg/kg per day significantly prolonged purified pig islet xenograft survival and to 7.5 months in two of three ACI recipients. Monotherapy with a lower dosage of FK506 or transplantation with impure pig islets resulted in increased graft survival time over controls, but less than that with the 2 mg/kg per day FK506. The viable pig islet xenografts showed a normal appearance and were readily identified by immunohistochemical staining for insulin and glucagon and further confirmed by immunohistochemical staining with anti-pig islet specific monoclonal antibody clone P44, developed in our laboratory. Mononuclear cell infiltration, mainly of the CD8-positive T-cell subset, increased with the duration of the graft in the recipient. By 7.5 months the majority of the xenografted islet cells were enclosed by the cellular infiltrate. The in vitro perfusion study of pig islets that had survived for 1 or 2 months in vivo showed that they were responsive to glucose stimulation with increase in insulin secretion into the perfusate. The results demonstrated that FK506 significantly prolonged pig islet survival in two rat strains and suggested that it is an effective immunosuppressant for the xenotransplantation model.

Endothelin-1 is not involved in hemoglobin associated vasoactivities

This study tested the hypothesis: is hemoglobin (Hb) associated vasoconstriction mediated by endothelins (ET)? Two millimeter segments of the thoracic aorta with intact endothelium were obtained from Sprague-Dawley rats (200-350g) and suspended in oxygenated Krebs buffer (37C, pH 7.4). The vessels were equilibrated at 2g of imposed tension for 1 hour. After submaximal tone was induced with norepinephrine (50nM), the presence of functional endothelium was verified by an acetylcholine (33uM) dilation test. The vessel rings were then treated with either ET-1 (3nM) or human stroma-free Hb (SFH; 2.2uM) and vascular response characteristics observed. Subsequently, the vessel rings were treated with BQ-123 (15uM), an ET-1 receptor antagonist, to test whether the ET-1 pathway is involved in the Hb associated vasoconstriction. Both ET-1 and SFH elicited contractory responses in aortic rings; the maximal tension increases at the doses tested were 54.8 +/- 8.5% and 39.2 +/- 22.5%, respectively, over the pretreatment values. The contractory response characteristics were, however, distinct; ET-1 caused a slow (time to maximal response; TMR = 28.8 +/- 6.4 min, N = 6) but prolonged contraction (> 30 min) while SFH caused a faster contraction (TMR = 7.2 +/- 1.7 min, N = 6) with a shorter duration (< 30 min). The TMR of ET-1 treated rings were significantly longer than that of SFH (P < 0.0005, t-test). Treatment with BQ-123 caused an immediate reversal of the SFH induced contraction but had no significant effect on the SFH induced contraction. If the Hb associated vasoconstriction were mediated by ET-1, BQ-123 should have also reversed the contraction. These results suggest that ET-1 pathway is not involved in the Hb mediated vasoconstriction.

Enzymatic synthesis of S-adenosyl-L-methionine on the preparative scale

The problems inherent in the enzymatic and chemical synthesis of S-adenosyl-L-methionine (SAM) led us to develop an efficient, simple method for the synthesis of large amounts of labeled SAM. Previously, we reported that the problem of product inhibition of E. coli SAM synthetase encoded by the metK gene was successfully overcome in the presence of sodium p-toluenesulfonate (pTsONa). This research has now been expanded to demonstrate that product inhibition of this enzyme can also be overcome by adding a high concentration of beta-mercaptoethanol (beta ME), acetonitrile, or urea. In addition a recombinant strain of E. coli has been constructed that expresses the yeast SAM synthetase encoded by the sam2 gene. The yeast enzyme does not have the problem of product inhibition seen with the E. coli enzyme. Complete conversion of 10 mM methionine to SAM was achieved in incubations with either the recombinant yeast enzyme and 1 molar potassium ion or the E. coli enzyme in the presence of additives such as beta ME, acetonitrile, urea, or pTsONa. The recombinant yeast SAM synthetase was used to generate SAM in situ for use in the multi-enzymatic synthesis of precorrin 2.