The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study

OBJECTIVES

The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH).

METHODS

Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications.

RESULTS

The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence.

CONCLUSIONS

The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.

[Ewing's sarcoma of central nervous system: a clinicopathological analysis of six cases]

Objective: To investigate the clinicopathological characteristics, pathological diagnosis of Ewing's sarcoma of the central nervous system. Methods: Six cases of Ewing's sarcoma of the central nervous system diagnosed at the First Affiliated Hospital of Nanjing Medical University, Nanjing, China from 2015 to 2022 were collected. The clinical manifestations, histological morphology, immunophenotype and molecular genetics of these cases were analyzed. The related literature was reviewed. Results: There were four males and two females, with a male to female ratio of 2∶1. The onset age was 17-40 years, with a median age of 23 years. All 6 tumors were located in the spinal cord (2 cases of cervical vertebra, 1 case of thoracic vertebra, 2 cases of lumbar vertebra, and 1 case of sacral vertebra). The patients' clinical manifestations were mostly lumbago, weakness and numbness of lower limbs/limbs. In 1 case, the tumor recurred and metastasized to the suprasellar region and the third ventricle. Microscopically, the tumor showed diffuse infiltrative growth. In some cases, the tumor was closely related to the spinal meninges. The tumor cells were arranged in sheet, lobular, thin-rope, and nest-like patterns. Homer-Wright rosette was visible. The tumor cells were small to medium in size, and most of them had scant cytoplasm. A few cells had clear cytoplasm. Some areas were rhabdoid. The tumor cell nuclei showed focal mild pleomorphism. The chromatin was uniform and delicate while the nucleoli were not obvious. Mitosis was commonly seen. The tumor was separated by fibrous connective tissue and may be accompanied by mucinous degeneration. Immunohistochemistry showed that all tumors were positive for CD99, NKX2.2, Fli1, ERG. ATRX, H3K27me3, INI1 and BRG1 were all retained. Immunohistochemical stains for EMA, GFAP and Olig2 were negative. The Ki-67 proliferation index was 30%-70%. EWSR1 break-apart FISH test was positive. Conclusions: Ewing's sarcoma is rare in the central nervous system and needs to be distinguished from a variety of neoplasms with primitive undifferentiated small cell morphology. Immunohistochemistry and molecular genetics may be required for a proper diagnosis.

Generalized granuloma annulare in an infant clinically manifested as papules and atrophic macules: A case report

BACKGROUND

Granuloma annulare (GA) has diverse clinical manifestations including papules, plaques, and nodules on the extremities that are skin-colored, pink, or purple. Approximately 15% of all GA cases are considered generalized GA.

CASE SUMMARY

Herein, we describe the case of a pediatric patient who initially presented with papules and later developed generalized atrophic macules. Upon examination, two different morphologic lesions were histopathologically confirmed: Epithelioid nodular GA and scattered histiocytic infiltrative GA. This patient exhibited rare clinical manifestations that differed throughout the course of the disease. The varying histopathological types and clinical manifestations of GA may be linked to the different stages of the disease.

CONCLUSION

This rare case demonstrates the different histopathological features of different stages and clinical manifestations of granuloma annulare in an infant.

[Research and development of an intelligent platform for respiratory therapy]

In recent years, the incidence of respiratory diseases has increased year on year. This has become a major global public health issue. To effectively treat respiratory diseases and improve the quality of life and prognosis of patients, the intelligent platform of respiratory therapy was established. Through real-time monitoring patients' important physiological indicators and integrating medical information, visual management, and intelligent decision making can be realized to provide personalized respiratory treatment and rehabilitation programs for critically ill patients. The platform can also provide reliable data support for medical research and further promote the development of the field of respiratory disease treatment. In the future, the platform will continue to improve the level and efficiency of clinical treatment, and truly solve practical problems for patients.

Elastic fiber degradation in the development of pediatric granuloma annulare: Report of 39 cases

BACKGROUND

Granuloma annulare (GA) has diverse clinical manifestations, multiple subtypes, and unknown etiology and pathogenesis. Existing studies regarding GA in children are scarce.

AIM

To examine the correlation between clinical manifestation and histopathology of pediatric GA.

METHODS

A total of 39 patients under 18 years of age with both a clinical and pathological diagnosis of GA at Kunming Children's Hospital from 2017 to 2022 were retrieved. Their medical records were consulted, and clinical data of the children were recorded and summarized, including gender, age, disease site, etc. Existing wax blocks of skin lesion specimens of children and pathological films were retrieved for further study and relevant histology, including hematoxylin-eosin, Alcian blue, elastic fiber (Victoria blue-Lichon red method), and antacid staining. Finally, the children’s clinical manifestations, histopathological results, and special staining characteristics were analyzed.

RESULTS

The clinical manifestations of granuloma annulare in children were diverse: 11 cases presented with a single lesion, 25 with multiple lesions, and 3 with generalized lesions. The pathological typing comprised histiocytic infiltration, palisading granuloma, epithelioid nodular, and mixed types in 4, 11, 9, and 15 cases, respectively. Thirty-nine cases were negative for antacid staining. The positive rate of Alcian blue staining was 92.3%, and that of elastic fiber staining was 100%. The degree of elastic fiber dissolution and granuloma annulare histopathological typing were positively correlated (r = 0.432, P < 0.05). No correlation was found between clinical presentation and histopathological typing of the granuloma annulare in children. In the pathological diagnosis of granuloma annulare, the positive elastic fiber staining rate was higher than that of Alcian blue staining. A correlation was found between elastic fiber dissolution degree and histopathological staging. However, the differences in pathological staging may have been related to the pathological manifestation of granuloma annulare at different periods.

CONCLUSION

Elastic fiber degradation may be a critical step in the pathogenesis of pediatric granuloma annulare. This is also one of the first studies focused on granuloma annulare in children.

[Diffuse midline glioma with H3K27 alteration in adults: a clinicopathological analysis]

Objective: To investigate the clinicopathological characteristics, pathological diagnosis and prognosis of diffuse midline glioma (DMG) with H3K27 alteration in adults. Methods: Twenty cases of H3K27-altered adult DMG diagnosed in the First Affiliated Hospital of Nanjing Medical University were enrolled from 2017 to 2022. All cases were evaluated by clinical and imaging presentations, HE, immunohistochemical staining and molecular genetics; and the relevant literature was reviewed. Results: The ratio of male to female was 1∶1, and the median age was 53 years (range from 25 to 74 years); the tumors were located in the brainstem (3/20, 15%) and non-brainstem (17/20, 85%; three in thoracolumbar spinal cord and one in pineal region). The clinical manifestations were non-specific, mostly dizziness, headache, blurred vision, memory loss, low back pain, limb sensation and/or movement disorders, etc. Microscopically, the tumors showed infiltrative growth, with WHO grade 2 (3 cases), grade 3 (12 cases), and grade 4 (5 cases). The tumors showed astrocytoma-like and oligdendroglioma-like, pilocytic astrocytoma-like and epithelioid-like patterns. Immunohistochemically, the tumor cells were positive for GFAP, Olig2 and H3K27M, and H3K27me3 expression was variably lost. ATRX expression was lost in four cases, p53 was strongly positive in 11 cases. Ki-67 index was about 5%-70%. Molecular genetics showed p. k27m mutation in exon 1 of H3F3A gene in 20 cases; BRAF mutation in two cases: V600E and L597Q mutation in one case each. Follow up intervals ranged from 1 to 58 months, and the survival time for brainstem (6.0 months) and non-brainstem (30.4 months) tumors was significantly different (P<0.05). Conclusions: DMG with H3K27 alteration is uncommonly found in adults, mostly occurs in non-brainstem, and can present in adults of all ages. Owing to the wide histomorphologic features, mainly astrocytic differentiation, routine detection of H3K27me3 in midline glioma is recommended. Molecular testing should be performed on any suspected cases to avoid missed diagnosis. Concomitant BRAF L597Q mutation and PPM1D mutation are novel findings. The overall prognosis of this tumor is poor, with tumors located in the brainstem showing worse outcome.

[Annual update of pulmonary infectious diseases in 2022]

In 2022, coronavirus disease 2019 (COVID-19) remains rampant across the world. Several remarkable studies concerning pulmonary infectious diseases have been published during this pandemic. This review summarized the representative academic and translational medical progress over the past year (from October 1, 2021, to September 30, 2022), including COVID-19, community/hospital-acquired pneumonia, tuberculosis, and other respiratory viral infections.

[Expression and regulatory role of ultraconserved long non-coding RNA uc.77 in lung cancer]

Objective: To investigate the effect and molecular mechanism of ultra-conservative long non-coding RNA uc.77 in lung cancer. Methods: Lung cancer tissues and adjacent normal tissues were obtained from 61 patients with lung cancer who were diagnosed with lung cancer and underwent surgery from 2014 to 2016 in the General Hospital of the Southern Theater Command of the People's Liberation Army. Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the uc.77 relative expressions in normal human bronchial epithelial cells 16HBE, lung cancer cell lines, and 61 pair lung cancer tissues. Uc.77 siRNA was transfected into lung cancer cells to interfere with the expression of uc.77, qRT-PCR was used to verify the interference effect, CCK8 method and clone formation experiment were used to detect cell proliferation ability, flow cytometry was used to detect apoptosis and cell cycle changes. H1299 cells transfected with uc.77 siRNA were injected into the subcutaneous right side of BALB/c nude mice to construct a tumor-bearing model for exploring the role of uc.77 on tumor growth. Western blot and qRT-PCR methods were used to detect the protein and mRNA expressions of p21. Results: The relative expression levels of uc.77 in lung cancer cell lines 95D, H1299, A549, H460, H446 and 16HBE-T were significantly higher than that of 16HBE cells (P<0.05). The uc.77 RNA expression levels of lung cancer tissues was significantly higher than that of the adjacent normal tissues (P<0.001). In addition, increased lncRNA uc.77 expression was significantly associated with big tumor size, lymph node metastasis and advanced TNM stage (P<0.05). After transfection with uc.77 siRNA, the expressions of uc.77 in H1299, 95-D and 16HBE-T cells were reduced (P<0.05), and the cell proliferation capacities were reduced at 48 hours and 72 hours (P<0.05). After transfection with uc.77 siRNA-1, the G(0)/G(1) phase cell ratio of H1299 siRNA-1 group [(71.86±3.46)%] was higher than those of H1299-control group [(47.62±5.48)%] and H1299 siRNA-NC group [(61.38±5.62)%, P<0.05], S phase cell ratio of H1299 siRNA-1 group [(14.99±3.61)%] was lower than those of H1299-control group [(34.95±7.05)%] and H1299 siRNA-NC group [(23.75±5.87)%, P<0.05], the apoptosis rate of H1299 siRNA-1 group [(4.90±1.80)%] was higher than those of H1299-control group [(3.30±0.80)%] and H1299 siRNA-NC group [(2.80±1.20)%, P<0.05], the colony formation rate of H1299 siRNA-1 group [(19.20±2.00)%] was lower than those of H1299 control group [(32.60±2.00)%] and H1299 siRNA-NC group [(34.40±1.00)%, P<0.05]. The results of the nude mice tumor formation experiment showed that the tumor volume of the H1299 siRNA-1 group was significantly lower than those of the H1299-control group and the H1299-negative control group (P<0.05), the average tumor weight of H1299 siRNA-1 group was significantly lower than those of H1299-control group and H1299-negative control group (P<0.05), tumor cell growth marker Ki-67 in the H1299 siRNA-1 group showed weak positive, and Ki-67 in the H1299-control group and H1299-negative control group showed positive. The result of qRT-PCR analysis showed that the mRNA expression level of p21 in H1299 siRNA-1 group (2.57±0.45) was higher than those in H1299 control group (1.00±0.00, P=0.001) and H1299 siRNA-NC group (1.52±0.37, P=0.009). The result of western blotting analysis also showed that the expression of p21 protein level in H1299 siRNA-1 group increased. Conclusions: The expression of ultraconserved long non-coding RNA uc.77 is elevated in lung cancer cell lines and lung cancer tissues. Silencing the expression of ultraconservative long noncoding RNA uc.77 can inhibit tumor growth, and blocking uc.77 expression may be a potential therapeutic target for lung cancer.

[QUADAS-C-A tool for assessing risk of bias regarding Quality Assessment of Diagnostic Accuracy Studies-Comparative]

This paper introduced the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C), illustrated the comparison with the QUADAS-2, and using QUADAS-C together with QUADAS-2 to present QUADAS-C results through systematic reviews. Like the domain for QUADAS-2, QUADAS-C retained four domains, including patient selection, index test, reference standard, flow, and timing, and comprised additional questions for each QUADAS-2 part. Unlike the QUADAS-2 tool, the starting question of each domain for QUADAS-C was designed to summarize the risk of biased information captured by QUADAS-2. QUADAS-C only dealt with the risk of bias but did not include the part of concerns regarding applicability. The answers to signaling questions for each domain of QUADAS-C would lead to a 'low''high' or 'unclear' risk of biased judgment for the original study.

[Clinicopathological features of clear cell carcinoma of salivary gland in the head and neck]

Objective: To investigate the clinical, histologic, immunohistochemical (IHC) and molecular genetic features of clear cell carcinoma (CCC) of salivary gland in the head and neck regions. Methods: Seven cases of CCC diagnosed in the Department of Pathology, the First Affiliated Hospital of Nanjing Medical University from 2018 to 2021 were included. The clinical and pathologic data, HE sections and IHC staining were reviewed, and EWSR1 gene translocation was detected by fluorescence in situ hybridization (FISH). The relevant literature was also reviewed. Results: There were five males and two females, with an age range of 32 to 71 years (mean 50 years). The tumors were located in the palate, base of tongue, subglottic, right submaxillary and nasopharynx. Histologically the tumors were composed of sheets, nests, and trabecular of large, monomorphic cells which possessed abundant clear and eosinophilic cytoplasm. The stroma was characterized by abundant hyalinized fibrous strands admixed with cellular fibrous (desmoplastic) tissue. The tumor growth was infiltrative. IHC staining revealed positivity for CKpan and squamous cell immunophenotypic markers (CK5/6, p63 and p40), but negativity for myoepithelial markers (SMA, calponin, GFAP and CD10). The EWSR1 gene translocation was detected by FISH. The prognosis was excellent, with the follow-up periods ranging from 8 months to 33 months. During this period, six patients survived without tumor, only one patient with cervical lymph node metastasis. Conclusions: CCC of salivary gland is rare and needs to be differentiated from various other types of tumors containing clear cells. Awareness of the histopathologic characteristics, and combined with IHC and molecular genetic examination can avoid misdiagnosis. The biological behavior of the tumor is indolent with a good overall prognosis.

[Clinicopathological features of ectopic meningothelial hamartoma]

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of ectopic meningothelial hamartoma (EMH). Methods: Three cases of EMH diagnosed in the First Affiliated Hospital of Nanjing Medical University from January 2014 to December 2020 were enrolled. All cases were evaluated by clinical and imaging features, HE and immunohistochemical staining, and the relevant literature was reviewed. Results: There were one male and two female patients, aged 2, 67 and 19 years, respectively. Clinically, they presented as skin masses in the head and face region (two cases) and sacro-coccygeal region (one case). Grossly, the lesions ranged in size from 1.6 cm to 8.9 cm. Microscopically, the lesions were ill-defined, and located in the dermis and subcutis, and showed pseudovascular channels lined by monolayer of cuboidal to flattened epithelium with mild atypia, with variable cystic cavity formation. There was prominent interstitial fibrosis. Concentric, lamellated, onion skin-like arrangement with short spindle or ovoid cells and psammoma bodies were noted. Immunohistochemically, these cells were strongly positive for SSTR2, EMA, vimentin and progesterone receptor. Ki-67 positive index was low, approximately 1%. Conclusions: EMH is uncommon. Definitive diagnosis relies on histopathologic examination. The importance in recognizing the lesions is to differentiate from other more aggressive tumors.

[Comparative analysis on seroprevalence of hepatitis B in Guangzhou in 2008 and 2018]

Objective: To compare the seroprevalence of hepatitis B in Guangzhou in 2008 and 2018. Methods: According to the proportion of Guangzhou population size, two-stage cluster sampling was used to select the residents aged 1-59 years in the two surveys. Results: 4 989 and 3 980 people aged 1-59 years were involved in 2008 and 2018, respectively. HBsAg prevalence was 9.50% (95%CI:7.34%-11.66%) in 2018 and 12.45% (95%CI:10.58%-14.33%) in 2008 among the people aged 1-59 years, with no significant difference statistically (χ²=18.302, P=0.075). The decrease of HBsAg prevalence was mainly in the population aged 7-16 years. For the people aged 7-16 years, the HBsAg prevalence was 0.88% (95%CI: 0.35%-1.42%) in 2018 and decreased by 80.62% as compared with the rate 4.54% (95%CI:2.71%-6.36%) in 2008, with statistically significant difference (χ²=34.144,P=0.000). Anti-HBs prevalence was 72.30% (95%CI:69.56%-75.04%) in 2018 and ascended by 11.35% as compared with the rate of 64.93% (95%CI:61.65 %-68.22%) in 2008 among the people aged 1-59 years, with statistically significant difference (χ²=51.618, P=0.001). The rise of anti-HBs prevalence was mainly in the population aged 17-59 years. For the people aged 17-59 years, the anti-HBs prevalence was 71.93% (95%CI: 68.90%-74.96%) and risen by 12.80% as compared with the rate of 63.77% (95%CI: 60.16%-67.37%) in 2008, with a statistically significant difference (χ²=28.422, P=0.001). HBV infection rate was 48.10% (95%CI: 43.20%-53.00%) in 2018 and decreased by 22.76% as compared with the rate of 62.27% (95%CI: 59.11%-65.44%) in 2008, with statistically significant difference (χ²=167.138, P=0.000). The HBV infection rates in the population aged 1-6 years, 7-16 years, and 17-59 years were 4.58%, 5.13%, and 56.56% (a decrease of 81.83%, 85.91%, and 18.47%), respectively. The infection rate of HBV was 48.87% (a decrease of 24.70%) in high epidemic areas and 28.81% (a decrease of 38.75%) in people with a history of hepatitis B immunization. Conclusion: The prevention and control of hepatitis B in Guangzhou have achieved remarkable results it already reached the national goal of reducing HBsAg prevalence to less than 1% among children under five years since 2008. However, the target goal of reducing the hepatitis B mortality rate is quite demanding. The neonatal hepatitis B vaccination and monitoring and screening in adults are still needed.

Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors

BACKGROUND

Natural orifice specimen extraction surgery is a novel technique of minimally invasive surgery. The purpose of this study was to compare the safety of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) and abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectum tumors.

METHODS

MEDLINE (PubMed), Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, and ClinicalTrials databases were systematically searched for related articles up to August 2019. The primary outcomes included postoperative complications (overall postoperative complication, incision-related complication, anastomotic fistula, and severe complication) and pathologic results (lymph nodes harvested, proximal resection margin, and distal resection edge). The statistical analysis was performed on STATA 12.0 software.

RESULTS

Ten studies comprising 1787 patients were used for meta-analysis. Compared with AISE-LAR, NOSE-LAR had more advantages in terms of overall postoperative complication (odds ratio (OR) = 0.65 (95% CI, 0.46 to 0.90; P = 0.01)), incision-related complication (OR = 0.13 (95% CI, 0.05 to 0.35; P < 0.01)), distal resection edge (weighted mean difference (WMD) = 0.17 cm (95% CI, 0.02 to 0.33 cm; P = 0.02)), recovery of gastrointestinal function (WMD = - 0.38 day (95% CI, - 0.70 to - 0.06 day; P = 0.02 )), pain scores in postoperative day 1 (WMD = - 1.64 (95% CI, - 2.31 to - 0.98; P < 0.01)), additional analgesics usage (OR = 0.21 (95% CI, 0.11 to 0.40; P < 0.01)) and hospital stay (WMD = - 0.71 day (95% CI, - 1.10 to - 0.32 day; P < 0.01)), while the operation time of NOSE-LAR was prolonged (WMD = 7.4 min (95% CI, 0.17 to 14.64 min; P = 0.04)). The anastomotic fistula, severe complication, lymph nodes harvested, proximal resection margin, intraoperative blood loss, and long-term outcomes in NOSE-LAR were comparable with AISE-LAR.

CONCLUSIONS

The safety of NOSE-LAR was demonstrated, and it could be an alternative to conventional surgery in laparoscopic anterior resection for sigmoid and rectal tumors. However, further randomized and multi-center trials are required.

[Current status and prospects of population exposure assessment of nanomaterials consumer products]

With the wide application of nanomaterials in consumer products in the market, it is necessary to understand the existence and release of nanomaterials in consumer products, as well as the current situation of exposure assessment of consumers. China has been a large industrial producer with a huge consumer market, but the supervision of consumer goods with nanomaterials is almost blank. This article summarized and classified the existing consumer products of nanomaterials in the international market, and discussed the release of key nanomaterials in consumer products and the exposure assessment methods of consumers, in order to provide a scientific basis for the establishment of a regulatory system for consumer products of nanomaterials in China in the future.

[Clinical and immunological characteristics of a case with activated phosphoinositide 3-kinase δ syndrome 2]

Objective: To analyze the clinical and immunological characteristics of a patient with activated phosphoinositide 3-kinase δ syndrome 2 (APDS2). Methods: A retrospective analysis of clinical data, immune-related gene sequencing, imaging and laboratory findings of a patient with APDS2 admitted to Children's Hospital of Chongqing Medical University was performed. The absolute and relative numbers of peripheral lymphocyte subsets, immune cell subsets and phenotypes were detected by flow cytometry with the age matched healthy child or the patient's father as a control. Results: A female patient aged 6 years and 4 months old was firstly admitted due to paleness over one month and cough for 7 days in June 2017. The IgA (<0.067 g/L) decreased while the IgM (2.55 g/L) increased. The abdominal ultrasound found hepatomegaly (subcostal 1.7 cm) and splenomegaly (subcostal 3.6 cm), and gene sequencing revealed a heterozygous mutation in the PIK3R1 gene c.1425+1G>A. After the treatment with prednisone which was initiated with a dose of 10 mg/times, 3 times/d and continued and tapered over 7 months, the IgM decreased to normal (1.72 g/L), and the hepatomegaly (subcostal 0 cm) and splenomegaly (subcostal 0.5 cm) were improved. The patient was readmitted due to pale and sallow complexion for half a month in July 2019. The percentage of naive CD4(+)T (0.386) and naive CD8(+)T cells (0.271) were decreased while the percentage of terminally differentiated effector memory CD8(+)T cells (0.377) and transitional B cells (0.223) were increased. The mean fluorescence intensity (MFI) of phosphorylated protein kinase B (AKT) in CD3(+)T, CD4(+)T and CD8(+)T cells were higher in the patient (4 125, 5 213, 3 497) than those in her father (3 434, 3 312, 3 058). The percentage of follicular helper T cell (Tfh) (0.299), Th1 (0.491) and Th1-like cells (0.438) in the patient were higher than those in the healthy control (0.156,0.313,0.303), while the percentage of Th17 (0.126) and Th17-like cells (0.188) were lower than those in the healthy control (0.198, 0.315). And the percentage of CD57 in the patient (0.306) was also higher than that in the healthy control (0.246). Conclusions: The humoral immunity and cellular immunity of APDS2 patient are impaired to varying degrees. The steroid can improve the lymphoproliferation and autoimmune hemolytic anemia in this case.

[Spatial distribution of cancer-related burden in Guangzhou from 2010 to 2013]

Objective: To evaluate the burden and to describe the characteristics of spatial distribution caused by malignant tumors among different administrative areas in Guangzhou from 2010- 2013. Methods: Based on data from the Cancer Registry system and population in Guangzhou in 2010- 2013, disability-adjusted life year (DALY) was assessed on the disease burden of cancer, in accordance with the method used in the Global Burden of Disease study. Results: The crude incidence rates of cancer appeared as 256.22/10(5) in 2010-2011 and 270.04/10(5) in 2012-2013, with the crude mortality rates as 143.17/10(5) and 148.01/10(5), respectively, in Guangzhou. Cancers caused 606 238.95 DALYs in 2010-2011 and 623 763.80 DALYs in 2012-2013 for both sexes and 37.63 and 37.81 person year per 1 000 persons, with the standardized DALY rates as 34.51‰, 34.00‰ respectively. Three administrative districts (Yuexiu, Haizhu and Liwan) were with the largest disease burden of cancers that accounted for 45% of the DALYs for the whole Conghua district, with liver cancer was the leading cancer on DALYs, and tracheal, bronchus and lung cancer ranked the first in the other districts. Conclusions: In Guangzhou, disease burden caused by cancers was both prominently seen in the newly developed urban area and the old districts. It remains an arduous task to continue programs on control and prevention of cancers in this city.

[Association between interleukin-17A and 17F single nucleotide polymorphisms and knee osteoarthritis]

Objective: To investigate the association between single nucleotide polymorphisms (SNP) of IL-17A (rs2275913) and IL-17F (rs763780) genes and susceptibility to knee osteoarthritis (KOA) in Chinese Han and Tibetan populations. Methods: A case-control study was conducted. Total of 122 Han KOA patients and 124 Han healthy controls and 76 Tibetan KOA patients and 68 Tibetan healthy controls in Qinghai Province were selected between 2015 and 2017. SNP typing was performed on four groups of rs2275913 and rs763780 polymorphisms by polymerease chain reaction (PCR)-sequencing to detect IL-17A and IL-17 F genotype frequencies and allele frequencies. The t test was used to compare data between groups. Results: The genotype AA frequency of IL-17A (rs2275913) was significantly different between the Han KOA and the control group (OR=2.625, P=0.016). Compared with the frequency of allele A in healthy control group, the allele A frequency in Han KOA group was significantly higher(OR=1.445, P=0.047); the genotype frequency of IL-17A,however,was comparable between the KOA and the healthy control in Tibetan population (OR=1.696, 1.355, both P>0.05); there were also not difference in the IL-17F (rs763780) genotype frequency and allele frequency between the Han KOA and Tibetan KOA groups and two control groups,respectively (OR=1.346, 1.126, both P>0.05). Conclusion: It is highly likely that the pathogenesis of KOA in Chinese Han population is positively related to the genotype AA and allele A of IL-17A (rs2275913).

[Effects of percutaneous nephrolithotomy in the treatment of medullary sponge kidney with calculi]

Objective: To evaluate the effects of percutaneous nephrolithotomy (PNL) in the treatment of medullary sponge kidney with calculi. Methods: A total of 77 patients (91 renal units) of medullary sponge kidney with calculi (MSK group) and 77 patients (77 renal units) with common kidney stone (control group) received PNL at Department of Urology in Peking University People's Hospital from September 2006 to February 2016 were analyzed retrospectively. The MSK group included 33 males and 44 females with a mean age of (42.1±13.2) years, the mean stone burden was (3.9±1.8) cm. The control group included 36 males and 41 females with a mean age of (45.3±13.0) years, the mean stone burden was (3.6±1.5) cm. The numbers of tracts, the time of operation, the drop of hemoglobin, the change of creatine, the time of hospitalization, the stone free rate and major complications were compared between the two groups. The measurement data and numeration data were compared with t test and χ(2) test. Results: There were no significant differences in sex, age, preoperative urinary tract infection, stone type, and stone burden between the two groups (all P>0.05). The proportion of bilateral renal calculus in MSK group was higher (18.2% vs. 0, χ(2)=15.400, P=0.000). There were 159 percutaneous channels were established in MSK group while 90 percutaneous channels were established in control group. Compared with the control group, the operation time ((88.1±37.5) minutes vs. (68.5±30.1) minutes, t=3.543, P=0.000) and hospitalization time ((15.1±8.3) days vs. (10.1±3.6) days, t=4.816, P=0.000) were longer, the creatinine level increased ((101.2±62.6) μmol/L vs. (71.3±23.6) μmol/L, t=3.777, P=0.000), the rate of stone free decreased (27.5% vs. 83.1%, χ(2)=51.840, P=0.000) and the rate of complications increased (29.9% vs. 11.7%, χ(2)=8.114, P=0.004) in MSK group. There was no statistically difference in hemoglobin drop ((12.5±13.2) g/L vs. (13.0±10.9) g/L, t=-0.260, P=0.795). Conclusions: Using PNL for patients of MSK with calculi has a lower stone free rate and a higher complications. It is an effective method for patients of MSK with large and complex calculi.

A combustion method to synthesize nanoporous graphene

In this paper, we introduce a combustion method which is rapid, low cost, mass-producing and environmentally friendly to produce nanoporous graphene. After loading a graphene oxide aerogel (GOA)/paper (GOP) on a preheated hot plate (as the heat source, with a temperature as low as 200 °C) under an ambient environment, in a few seconds, the GOA/GOP would self-combust and change into reduced graphene oxide (RGO) with nanopores mainly concentrated in the 0.4-2.0 nm range and a large specific surface area of 536 m2 g-1. Supercapacitors fabricated with the synthesized porous RGO (P-RGO) showed a high specific capacitance of 245 F g-1 at 0.1 A g-1, and a retention rate of about 96.9% after 12 000 cycle tests with respect to the initial specific capacitance with a scan rate of 10.0 A g-1. The production yield of this method was as high as 77.0%.

Dose- and type-dependent effects of long-chain fatty acids on adipogenesis and lipogenesis of bovine adipocytes

Differentiation and lipid metabolism of adipocytes have a great influence on milk performance, health, and feed efficiency of dairy cows. The effects of dietary long-chain fatty acids (FA) on adipogenesis and lipogenesis of dairy cows are often confounded by other nutritional and physiological factors in vivo. Therefore, this study used an in vitro approach to study the effect of dose and type of long-chain FA on adipogenesis and lipogenesis of bovine adipocytes. Stromal vascular cells were isolated from adipose tissue of dairy cows and induced into mature adipocytes in the presence of various long-chain FA including myristic, palmitic, stearic, oleic, or linoleic acid. When concentrations of myristic, palmitic, and oleic acids in adipogenic mediums were 150 and 200 μM, the induced mature adipocytes had greater lipid content compared with other concentrations of FA. In addition, mature adipocytes induced at 100 μM stearic acid and 300 μM linoleic acid had the greatest content of lipid than at other concentrations. High concentrations of saturated FA were more toxic for cells than the same concentration of unsaturated FA during the induction. When commitment stage was solely treated with FA, the number of differentiated mature adipocytes was greater for oleic and linoleic acids than other FA. When the maturation stage was treated with FA, the number of mature adipocytes was not affected, but the lipid content in adipocytes was affected and ranked oleic > linoleic > myristic > stearic > palmitic. In summary, this study showed that adipogenesis and lipogenesis of bovine adipocytes were differentially affected by long-chain FA, with unsaturated FA more effective than saturated FA.

[A cross-sectional study of seroepidemiology of viral hepatitis among Uighurs in Shufu of Xinjiang]

Objective: To explore the status of seroepidemiology on hepatitis A, B and C among students and residents aged equal or greater than 18 years in south Xinjiang, and to provide scientific evidence for prevention and control of viral hepatitis. Methods: Uyghur students in four towns and villages were selected by cluster random sampling from Feb to May, 2015, and Uyghur residents aged 18 to 69 years were selected by stratified cluster sampling from May to September, 2016. 4 507 middle and primary Uygur students and 4 833 Uyghur resides equal or greater than 18 years attended this survey. Self-designed questionnaire was used to collect the demographic information. And Elisa test was adopted to detect HAV-IgG, HBsAg, HBsAb and HCV-IgG. Chi-square test was used to calculate the difference on antibody positive rate of three types of hepatitis among the participants. Results: The overall HAV-IgG positive rate was 99.45% (9 289/9 340). The positive rates were 99.70% (4 006/4 018) in male and 99.27% (5 283/5 322) in female (χ(2)=7.95, P=0.005). The HAV-IgG positive rate among people aged 10 to 14 years was the highest (99.91%, 2 233/2 235), and the difference between the age specific HAV-IgG positive rates was statistical significant (χ(2)=38.21, P<0.001). The overall HBsAg positive rate was 4.11% (384 cases), with 4.55% (183 cases) for male and 3.78% (201 cases) for female. The HBsAg positive rate among participants 19 to 24 years old was the highest (9.46%, 21/222) and the differences between the age specific HBsAg was statistically significant (χ(2)=116.22, P<0.001). The HBsAb positive rate was 35.03% (3 272 cases), with 35.59% (1 430 cases) for male and 34.61% (1 842 cases) for female, and the HBsAb positive rate among participants aged 15 to 18 years was the highest, which was 69.12% (696/1 007). The differences between the age specific HBsAb rates appeared statistically significant (χ(2)=671.80, P<0.001). The overall HCV-IgG positive rate was 0.65%(61 cases). The HCV-IgG positive rate in female was 0.86% (46 cases) and 0.37% (15 cases) in male (χ(2)=8.51, P=0.004).The HCV-IgG positive rate among participants aged over 70 years was the highest (3.78%,9/238) , and the difference between the age specific HCV-IgG positive rates had statistic significance (χ(2)=70.30, P<0.001). The HAV-IgG positive rate in hepatitis A vaccinees (100%, 876/876) was higher than that among the non-vaccinees (99.40%, 8 413/8 464) (χ(2)=4.26, P=0.039). The HBsAb positive rate in hepatitis B vaccinees was 39.32% (1 816/4 619) which was higher than that among the non-vaccinees (30.84%, 1 456/4 721) (χ(2)=73.68, P<0.001). Conclusion: The positive rate of overall HAV-IgG was high, male and participants aged between 10 to 14 had higher probability to be infected. But the infection rates of hepatitis B and C were low, with the low vaccination rate and the poor protective effectiveness of hepatitis B.

[Status of seroepidemiology of hepatitis A, B and C in primary and middle school students in Shufu county, Xinjiang Uygur Autonomous Region of China]

Objective: To explore the status of seroepidemiology on hepatitis A, B and C in primary and middle school students in Shufu county, Xinjiang Uygur Autonomous Region of China (Xinjiang) and to evaluate the effect of related immunization. Methods: Students in four towns and villages were selected by cluster random sampling method. HAV-IgG, HBsAg, HBsAb and HCV-IgG were detected in Feb to May, 2015. Results: The overall HAV-IgG positive rate was 99.75%, among 4 830 primary and middle school students. The positive rates were seen 99.92% in boys and 99.57% in girls, with difference statistically significant (χ²=5.798, P=0.016). The overall HBsAg positive rate appeared as 3.02%, with 3.55% for boys and 2.47% for girls, with difference statistically significant (χ²=4.782, P=0.029). The difference between age specific HBsAg positive rates also showed statistically significant (χ²=71.990,P=0.000). HBsAg positive rate in the students in rural area (3.28%) was higher than that in the students in urban area (1.61%, χ²=6.019, P=0.014). HBsAb positive rate was 38.84%, and the differences between the age specific HBsAb positive rates appeared statistically significant (χ²=837.699, P=0.000). HBsAg positive rate in students from the urban area (42.36%) was higher than those from the rural area (38.20%, χ²=4.598, P=0.032). 2 815 students, accounting for 58.28% of the total students, showed negative on both HBsAg and HBsAb. The overall HCV-IgG positive rate was 0.19%, and all appeared in students from the rural areas, with ethnicity solely as Uygur. Conclusions: The effect of hepatitis A vaccine was satisfactory in primary and middle school students in Shufu county but quiet a number of the students missed the vaccination. The infection rate of hepatitis C was low. Publicity and health education on hepatitis immunization and control should be revved up. Programs regarding primary and supplementary immunization on hepatitis, should be carried out timely for children of school age.

[Dynamic maternal measles antibody level in infants: a longitudinal study]

OBJECTIVE

To understand the dynamic maternal measles antibody level in infants in Guangzhou.

METHOD

Women who delivered babies in a maternal and child health care hospital in Guangzhou and their infants who were never affected by measles were included in our study. All the serum samples collected from mothers and infants were tested by using enzyme linked immunosorbent assay(ELISA)for the quantitative measurement of measles IgG antibodies. A longitudinal sero-epidemiological study was conducted to investigate the duration of the presence of measles maternal antibodies in infants based on the measurement at different time points(0, 3, 5, 7 month).

RESULT

A total of 689 mothers and their 691 infants(two pairs of twins)were included in the study. The concentration and the sero-positivity rate of measles antibody in mothers was 513.8 mIU/ml and 81.6% respectively. The concentration and the sero-positivity rate of measles antibody in infants was 732.8 mIU/ml and 87.3%, respectively. The measles antibody levels of newborns were positively associated with those of mothers(r=0.917 5, P<0.001), which declined rapidly at 3 months after birth and mostly turned to be negative at 7 months after birth. Measles antibody turned be negative at 3 months after birth in low, middle level groups, but remained to be positive in high level group at 5 months after birth.

CONCLUSION

The maternal measles antibody could rarely protect infants at age of 8 months even though mother had been vaccinated or acquired natural immunity. It is suggested to adjust the time of the first dose measles vaccination in infants and increase the measles antibody level of child bearing aged women to reduce the incidence of measles in infants.

[Investigation into the relationship between mitochondrial 12 S rRNA gene, tRNA gene and cytochrome oxidase Ⅱ gene variations and the risk of noise-induced hearing loss]

Objective: To explore the relationship between mitochondrial 12 S rRNA gene variation, tRNA gene variation and cytochrome oxidase Ⅱ gene point mutations and the risk of noise-induced hearing loss (NIHL). Methods: A nested case-control study was performed that followed a cohort of 7 445 noise-exposed workers in a steel factory in Henan province, China, from January 1, 2006 to December 31, 2015. Subjects whose average hearing threshold was more than 40 dB(A) in high frequency were defined as the case group, and subjects whose average hearing threshold was less than 35 dB(A) in high frequency and less than 25 dB (A) in speech frequency were defined as the control group. Subjects was recruited into the case group (n=286) and the control group (n=286) according to gender, age, job category and time of exposure to noise, and a 1∶1 case-control study was carried out. We genotyped eight single nucleotide polymorphisms in the mitochondrial 12 S rRNA gene, the mitochondrial tRNA gene and the mitochondrial cytochrome oxidase Ⅱ gene using SNPscan high-throughput genotyping technology from the recruited subjects. The relationship between polymorphic sites and NIHL, adjusted for covariates, was analyzed using conditional logistic regression analysis, as were the subgroup data. Results: The average age of the recruited subjects was (40.3±8.1) years and the length of service exposure to noise was (18.6±8.9) years. The range of noise exposed levels and cumulative noise exposure (CNE) was 80.1- 93.4 dB (A) and 86.8- 107.9 dB (A) · year, respectively. For workers exposed to noise at a CNE level<98 dB (A) · year, smokers showed an increased risk of NIHL of 1.88 (1.16-3.05) compared with non-smokers; for workers exposed to noise at a CNE level ≥98 dB(A) · year, smokers showed an increased risk of NIHL of 2.53 (1.49- 4.30) compared with non-smokers. For workers exposed to noise at a CNE level<98 dB (A) · year, the results of univariate analysis and multifactor analysis, adjusted by smoking and CNE, suggested that the risk of NIHL in workers exposed to noise carrying the GG genotype (G827A) was lower than that of NIHL workers exposed to noise carrying the AA genotype (G827A) [OR (95% CI) were 0.18 (0.04- 0.82) and 0.19 (0.04- 0.88), respectively]. Conclusion: Smoking increased the risk of NIHL in the present study. For workers subjected to a CNE<98 dB(A)·year, the mitochondrial genetic variant G827A was found to be significantly associated with the risk of NIHL.

[Correlation between EGLN1 gene, protein express in lung tissue of rats and pulmonary artery pressure at different altitude]

OBJECTIVE

To investigate the correlation between pulmonary artery pressure (PAP) and the expression level of Egl nine homologue 1 (EGLN1) gene or its protein in lung tissue of rats at different altitudes.

METHODS

Totally 121 male Wistar rats were randomly divided into low altitude group (n=11), moderate altitude group and high altitude group, the rats in moderate altitude and high altitude group were further divided into 1(st) day, 3(rd) days, 7(th) days, 15(th) day and 30(th) day group according to the exposure time to hypoxic environment, each group 11 rats. The low altitude group, the PAP of rats were determined by physiological signal acquisition system, and tissue samples were collected in liquid nitrogen container for storage at an altitude of 498 m area. Moderate altitude group rats were placed in altitude of 2 260 meters of natural environment, 5 high altitude groups rats were placed in the hypobaric hypoxic chamber, simulating altitude of 4 500 meters. The PAP of rats in moderate altitude group and high altitude group were also determined by physiological signal acquisition system, and tissue samples were collected when rats were exposed to hypoxia at 1(st), 3(rd), 7(th), 15(th) and 30(th) day; Western blot was used to determine expression levels of EGLN1 protein, and person correlation analysis was used to analyze whether the protein was related to the formation of pulmonary arterial hypertension (PH) under hypoxia. Real-time quantitive PCR method determined expression levels of EGLN1 mRNA in lung tissues, and the relative expression method was used to analyze PCR data, and finally assess whether the EGLN1 gene was the initial cause of the formation of PH during hypoxia.

RESULTS

The mean PAP of rats was (20.0±3.2) mmHg (1 mmHg=0.133 kPa) in low altitude group; in moderate altitude group, mean PAP began to increase slightly when rats were exposed to hypoxia on the 15(th) day and reached at (22.7±4.1) mmHg on hypoxic 30(th) day, but compared with the low altitude group, there was no statistical difference (P> 0.05); the mean PAP of rats in high altitude group began to rise on the 7(th) day (28.7±7.7) mmHg, which was higher than that in low altitude group (P<0.05), and significantly increased to (42.3±9.1) mmHg (P<0.001) on hypoxic 30(th) day; it was significantly proportional with exposure to hypoxic time, and compared to low altitude group and moderate altitude group, there was significant difference (P<0.05). EGLN1 protein expression in the lung tissue of rats had no significant difference between the low altitude group and moderate altitude group, and its expression level in the high altitude group were significantly decreased, furthermore, the expression level decreased with the increase of hypoxia exposure time (P<0.05); PAP and EGLN1 protein expression levels showed a negative correlation (r=-0.662). The transcription level of mRNA EGLN1 in high altitude group was significantly increased under hypobaric hypoxia, it was 72 times more than that of the moderate altitude group, and nearly 300 times than that of the low altitude group, respectively (both P<0.001=.

CONCLUSION

EGLN1 gene expression in lung tissue of rat is affected by hypoxia, the expression level increases with the increase of the altitude; but the protein expression level, in contrast with gene expression level, is decreased with the increase of altitude and is significantly negatively correlated with mean PAP.

[Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy]

OBJECTIVE

To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).

METHODS

In this study, 461 patients with type 2 diabetes who received PCNL in Peking University People's Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS.

RESULTS

The SIRS was significantly correlated with the patients' preoperative white blood cell counting (×10⁹/L) [7.76 (4.00-17.96) vs. 6.31 (2.00-17.40), P<0.001], preoperational blood glucose level (mmol/L) [7.30 (3.08-19.90) vs. 6.40 (3.42-16.78), P<0.001], operative time (min) [75 (20-270) vs. 60 (20-200), P<0.001], length of stay (d) [12 (2-46) vs. 11 (3-29), P=0.019], staghorn stones [38.8% (33/85) vs. 27.7% (104/376), P=0.042], and preoperational urinary tract infection [36.8% (50/136) vs. 26.6% (81/304), P=0.032]. There was no significant correlation between the SIRS and the patients' age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting (OR=3.194, 95% CI: 1.531-6.666, P=0.002), operative time longer than 60 min (OR=1.635, 95% CI: 1.088-2.456, P=0.018), and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS.

CONCLUSION

The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

[Association between grainyhead-like 2 gene polymorphisms and noise-induced hearing loss]

OBJECTIVE

To investigate association between genetic polymorphism in the grainyhead-like 2 gene (GRHL2) and noise-induced hearing loss (NIHL) in the Chinese population.

METHODS

A matched case-control association study was employed, In which, 3 790 workers exposed to continuous and steady-state occupational noise in a steel factory participated. The questionnaires were adopted to collect individual features and audiometry tests performed. In the sstudy, 286 subjects were diagnosed as cases, Which were each designated on the basis of the matched criterion, and 286 paired samples were selected finally. Noise intensity was measured according to the standards given in 'Measurement of Noise in the Workplace'(Occupational Health Standard of the People's Republic of China, GBZ/T189.8-2007). Cumulative noise exposure (CNE) was calculated, according to monitoring data on A-weighed sound pressure level and employment time. Genomic DNA was obtained from peripheral blood samples using 2 mL DNA extraction Kit following the manufacturer's protocol. Five single nucleotide polymorphisms (SNPs) of GRHL2 were genotyped by multiplex SNP genotyping kit. The continuous variables and categorical variables were analyzed by t-test and chi-square test respectively. Multivariate Logistic regression was used to test the association between genetic frequency and disease status, with adjustments for the possible confounding variables. The haplotypes were established and their frequencies in the two groups were assessed by haploview and phase softwares.

RESULTS

All the five SNPs (rs3735713, rs3824090, rs3735714, rs3735715 and rs611419) were in Hardy-Weinberg equilibrium (HWE) (P>0.05). The subjects carrying rs3735715 GG genotype had a higher NIHL risk than those carrying the GA genotype under the co-dominant model (OR=0.644, 95% CI: 0.442-0.939, P=0.022) after adjustment for height, blood pressure, drinking status and smoking status. After being stratified by CNE, in the CNE ≥ 98 dB (A) group, rs3735715 polymorphism was associated with the NIHL under the co-dominant model (OR=0.509, 95% CI: 0.281-0.923, P=0.026) after adjustment for height, blood pressure, drinking status and smoking status as well. However, no statistical significant difference was found in variant genotypes of the other SNPs between the case and control subjects. Four-locus (rs3735713, rs3824090, rs3735714 and rs3735715) haplotypes were constructed, and no risk or protective haplotypes was identified.

CONCLUSION

It is suggested that GRHL2 polymorphisms may be associated with development of NIHL.

[Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy]

OBJECTIVE

To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).

METHODS

In this study, 461 patients with type 2 diabetes who received PCNL in Peking University People's Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS.

RESULTS

The SIRS was significantly correlated with the patients' preoperative white blood cell counting (×10(9)/L) [7.76 (4.00-17.96) vs. 6.31 (2.00-17.40), P<0.001], preoperational blood glucose level (mmol/L) [7.30 (3.08-19.90) vs. 6.40 (3.42-16.78), P<0.001], operative time (min) [75 (20-270) vs. 60 (20-200), P<0.001], length of stay (d) [12 (2-46) vs. 11 (3-29), P=0.019], staghorn stones [38.8% (33/85) vs. 27.7% (104/376), P=0.042], and preoperational urinary tract infection [36.8% (50/136) vs. 26.6% (81/304), P=0.032]. There was no significant correlation between the SIRS and the patients' age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting (OR=3.194, 95% CI: 1.531-6.666, P=0.002), operative time longer than 60 min (OR=1.635, 95% CI: 1.088-2.456, P=0.018), and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS.

CONCLUSION

The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

The association between BMP4 gene polymorphism and its serum level with the incidence of LVH in hypertensive patients

Background

Bone morphogenic proteins 4 (BMP4) is associated with cardiac remodeling under different conditions. However, the role of BMP4 and its gene polymorphism in the incidence of left ventricular hypertrophy (LVH) in hypertensive patients remains unknown.

Methods

A total of 1265 patients diagnosed with essential hypertension (EH) were recruited. Patients were assigned to LVH+ (n = 420) and LVH- (n = 845) groups. serum BMP4 level was measured and two single nucleotide polymorphism (SNPs) polymorphisms, 6007C > T and -5826G > A of BMP4 gene were genotyped. We also inhibited the BMP4 by small interfering RNA (siRNA). The effect of BMP4 on the hypertrophic response in Human Cardiomyocytes AC16 cells was studied.

Results

We found that the 6007C > T polymorphism of the BMP4 gene and the serum BMP4 level were significantly associated with the risk to develop LVH. With TT as reference, multivariate logistic regression analysis showed the 6007CC genotype carriers had a higher susceptibility to LVH incidence (adjusted OR = 2.65, 95% CI: 1.63-4.31, adjusted P < 0.001). Our in vitro study shows that the BMP4 inhibition in cardiomyocyte by si-RNA technique significantly decreased the Ang II induced cardiomyocyte size and protein content per cell, indicating the importance of BMP4 in the cardiomyocyte hypertrophy.

Conclusion

Collectively, our data suggest that both the 6007C > T of the BMP4 gene and the serum BMP4 level may be used as potential marker for LVH incidence among the EH patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-014-0368-x) contains supplementary material, which is available to authorized users.

MTA1 promotes cell proliferation via DNA damage repair in epithelial ovarian cancer

We examined whether metastasis-associated gene 1 (MTA1) promotes cell proliferation via DNA damage repair in ovarian cancer. MTA1 was successfully down-regulated using small interfering RNA in the epithelial ovarian cancer cell lines SKOV-3 and OVCAR-3. Cell growth was evaluated through MTT and colony formation assays. Fluorescence-activated cell sorting analysis was used to evaluate the distribution of cells in the cell cycle, and cytotoxicity assays were performed to study cell sensitivity to cisplatin. A neutral comet assay was used to measure levels of ionizing radiation-induced DNA damage in SKOV-3 cells, and Western blot analyses were carried out to examine the expression of key proteins involved in DNA damage repair pathways. MTA1 knockdown markedly inhibited cell growth and led to S phase cell cycle arrest. In addition, MTA1 depletion conferred sensitivity of ovarian cancer cells to cisplatin. Moreover, MTA1 depletion increased the level of ionizing radiation-induced DNA damage and caused irreparable damage, which was illustrated by a remarkable increase and persistent existence of a comet tail as well as protein expression levels of γH2AX, pRPA, and pChk1, all of which play critical roles in DNA repair. Thus, MTA1 promotes the proliferation of epithelial ovarian cancer cells by enhancing DNA repair.

First Report of Rust of Plumeria rubra Caused by Coleosporium plumeriae in Guangdong Province, China

Plumeria spp. are ornamental trees commonly planted in parks and gardens, and Plumeria rubra cultivars (Frangipani) is most common in Guangdong Province, China. A rust disease of P. rubra was observed on leaves of susceptible plants from August to December 2013. Ten nurseries were surveyed in September 2013, and 91% (220 of 240) of the plumeria plants were infected with rust. Symptoms first appeared as chlorotic spots (about 1 mm in diameter) appearing on adaxial leaf surfaces and then spread to whole leaf, and infection further resulted in leaf necrosis and abscission. Therefore, the ornamental value of diseased trees was greatly diminished. Bright yellow or yellow-orange uredinia were hypophyllous and produced under the epidermis. Urediniospores were catenulate, globose, ovoid or ellipsoid, and sometimes angular in appearance, ranging from 20.0 to 42.0 μm in length by 14.1 to 25.6 μm in width. Their walls were verrucose and 1.3 to 3.2 μm thick. No teliospores were observed. The rust was identified as Coleosporium plumeriae Pat. based on urediniospore morphology (2). Species identity was confirmed with a 1,551-bp sequence (GenBank Accession No. KF879087) of ITS rDNA amplified with rust-specific primers Rust2inv and LR6 (1). The amplicon had a 100% similarity to C. plumeriae (GU145555). Pathogenicity was confirmed by spraying a urediniospores suspension (15,000 spores ml^-1) on five plants of P. rubra cultivar. Five leaves of each plant were inoculated and sealed in plastic bags, while five control plants were applied with sterile water. Plants were held at 28°C for 36 h in a dew chamber. All inoculated leaves developed typical rust symptoms with the uredinia appearing after 9 days, no symptoms developed on any control plants. Urediniospores were produced on infected leaves and pathogen identity was confirmed by morphology and re-sequencing of the ITS rDNA. Plumeria rust was first found in Hong Kong (4) and then in Hainan and Yunnan Provinces, China (3). However, this is the first report of plumeria rust in Guangdong Province, China. Frangipani has large, colorful flowers in the summer, and this rapidly spreading disease causes severe damage and affects their aesthetic value in the second half of the year. References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) N. Patouillard. Bull. Soc. Mycol. Fr. 18:171, 1902. (3) Q. Wang et al. New Dis. Rep. 23, doi:10.5197/j.2044-0588.2011.023.010, 2011. (4) J. Yan et al. Mycosystema 25:327, 2006 (in Chinese).

The effects of head flexion on airway seal, quality of ventilation and orogastric tube placement using the ProSeal laryngeal mask airway

This prospective self-controlled study was designed to evaluate the influences of head flexion on airway seal, quality of ventilation, and orogastric tube placement through the ProSeal laryngeal mask airway (ProSeal LMA) in 80 anaesthetised, paralysed adult patients. After the ProSeal LMA was inserted and the cuff pressure was set at 5.9 kPa, ventilation quality, airway seal pressure, fibreoptic positions of the cuff and the drainage tube, orogastric tube placement and efficacy of intermittent positive pressure ventilation (IPPV) were assessed in two randomly selected positions: neutral and flexed position. When compared to the neutral head position, the head flexed significantly improved the airway seal pressure and the quality of ventilation of the ProSeal LMA (p < 0.05). Fibreoptic scores of the cuff position did not correlate with either the ability to obtain excellent or adequate ventilation through the ProSeal LMA or the ability to generate an airway seal pressure of >or= 2 kPa. Orogastric tube placement via the drainage tube was successful on the first attempt in all patients in the neutral position compared with seven failures following three attempts in the flexed position (p < 0.05). There were no significant differences between the two head positions in the volume of air required to obtain an intracuff pressure of 5.9 kPa, fibreoptic score of the drainage tube position, and expiratory tidal volume and peak inspiratory pressure during IPPV (p > 0.05). In conclusion, head flexion improves airway seal and ventilation quality of the ProSeal LMA. However, placement of an orogastric tube via the drainage tube is impaired in the flexed position compared to the neutral position. Fibreoptic scoring of the ProSeal cuff position is not an accurate test to assess the airway seal and ventilation function.

Different small-dose sufentanil blunting cardiovascular responses to laryngoscopy and intubation in children: a randomized, double-blind comparison

BACKGROUND

Sufentanil is a potent opioid analgesic frequently used in clinical anaesthesia. This prospective, randomized, double-blind study was designed to assess the efficacy of different small-dose sufentanil attenuating the cardiovascular intubation response in healthy children, aiming at determining the optimal dose of sufentanil for this purpose.

METHODS

A total of 165 children aged 3-9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), sufentanil 0.1 microg kg(-1) (Group 2), sufentanil 0.2 microg kg(-1) (Group 3), and sufentanil 0.3 microg kg(-1) (Group 4). Anaesthesia was induced with propofol 2.5 mg kg(-1) and vecuronium 0.1 mg kg(-1). Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction of anaesthesia (baseline value), at immediately before intubation (post-induction values), at intubation, and at 1 min intervals for 5 min after intubation. The per cent changes of systolic blood pressure (SBP) and HR during the observation were calculated.

RESULTS

Except for Group 4, tracheal intubation caused significant increases in BP and HR in Groups 1, 2, and 3 compared with baseline values. BP and HR at intubation and their maximum values during the observation were significantly different among the four groups. The maximum per cent increases of SBP and HR during the observation were 20 and 28% of baseline values, respectively, in Group 2, 13 and 13% in Group 3, and 0 and 4% in Group 4 compared with 24 and 37% in Group 1. Except for the Group 3 vs Group 4 comparison, the incidences of SBP and HR per cent increases >30% of baseline values were also significantly different among the four groups.

CONCLUSIONS

In combination with propofol for induction of anaesthesia in children, the bolus administration of sufentanil can produce a dose-related attenuation of the cardiovascular intubation response and sufentanil 0.3 microg kg(-1) can completely abolish the cardiovascular intubation response.

Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children: a randomized double-blind comparison

BACKGROUND

The available data provide inconsistent results on the efficacy of small-dose remifentanil attenuating the cardiovascular response to intubation in children. Therefore, this randomized double-blind study was designed to assess the ability of different small doses of remifentanil on the cardiovascular intubation response in children, with the aim of determining the optimal dose of remifentanil for this purpose.

METHODS

One hundred and twenty-four children aged 3-9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), remifentanil 0.75 microg kg(-1) (Group 2), remifentanil 1 microg kg(-1) (Group 3) and remifentanil 1.25 microg kg(-1) (Group 4). Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and at 1 min intervals for 5 min after intubation.

RESULTS

Tracheal intubation caused significant increases in systolic blood pressure and heart rate in Groups 1-3 compared with the baseline values. The maximum percent increases of systolic blood pressure and heart rate were 10% and 26% of the baseline values, respectively, in Group 2; 5% and 14% in Group 3; and 1% and 8% in Group 4 compared with 27% and 37% in Group 1. Except for the Group 3 vs. Group 4 comparison, there were significant differences among the four groups in the maximum percent increases of systolic blood pressure and heart rate.

CONCLUSIONS

When used as part of anaesthesia induction with propofol and vecuronium in children, bolus administration of remifentanil resulted in a dose-related attenuation of the cardiovascular intubation response.

The clinical assessment of Glidescope in orotracheal intubation under general anesthesia

AIM

The aims of this study were to further evaluate the efficacy and safety of the GlideScope as a device to aid orotracheal intubation, and to further determine whether the GlideScope can provide a better laryngeal view in patients predicted to have a difficult laryngoscopy compared to the Macintosh laryngoscope.

METHODS

Ninety-one adult patients, ASA physical status I-II, scheduled for elective plastic and intraoral surgery under general anesthesia requiring orotracheal intubation were included in this study. The laryngeal view was estimated by the classification of Cormack-Lehane and the orotracheal intubation was then performed using a GlideScope. The times required for full visualization of the glottis and for the successful tracheal intubation were recorded, respectively. Noninvasive blood pressure and heart rate were also recorded before (baseline values) and immediately after induction (postinduction values), at intubation and every minute for 5 min after intubation. In patients preoperatively predicted to have a difficult laryngoscopy, the laryngeal views obtained by a GlideScope and a Macintosh laryngoscope were also compared.

RESULTS

All patients were successfully intubated using a GlideScope, of which 97% (88/91) required only one attempt. In the patients with successful intubation at one attempt, the times required for full visualization of the glottis and for successful tracheal intubation were 21+/-9 s and 38+/-11 s, respectively. The orotracheal intubation caused significant increases in blood pressure and heart rate compared to the postinduction values, and the maximal values of blood pressure and heart rate during the observation were significantly higher than the baseline values. In 27 patients preoperatively predicted to have a difficult laryngoscopy, the laryngeal views in using the GlideScope were significantly better than those in using the Macintosh laryngoscope. The incidence of minor upper airway trauma was 3.4% in all patients.

CONCLUSION

The orotracheal intubation using a GlideScope had advantages of easy and simple operation, excellent laryngeal view, and the ability to provide an improved laryngeal view in the patients with a difficult laryngoscopy. The general anesthesia of clinical standard depth was able to suppress the pressor response, but not temporary tachycardiac response to the orotracheal intubation using a GlideScope.

The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes

The circulatory responses to laryngoscopic tracheal intubation in 62 healthy children undergoing surgery requiring tracheal intubation were studied. They were randomly assigned to receive either the oral or nasal route for intubation. Baseline non-invasive blood pressure and heart rate were recorded following induction of anaesthesia, at intubation and then every minute for 5 min. The percentage changes of systolic blood pressure and heart rate during the measurement period were calculated. The results demonstrated that intubation time was significantly longer in the nasal group. Both oral and nasal intubation caused significant increases in blood pressure and heart rate compared to baseline and postinduction values. However, there were no significant differences found between the two groups in relation to blood pressure and heart rate. The two groups were similar with respect to the percentage changes of systolic blood pressure and heart rate during the observation period. It is concluded that oral and nasal intubation using a direct laryngoscopy can result in a similar circulatory response in anaesthetised children.