[The role of intravoxel incoherent motion diffusion-weighted imaging in distinguishing diabetic nephropathy from non-diabetic renal disease in diabetic patients]

Objective: To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM). Methods: A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student's t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman's correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results: A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10-3 mm2/s vs. 7.35×10-3 mm2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score (r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score (r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion: IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.

[The Origin and Academic Characteristics of Xujiang School]

Xujiang School of acupuncture and moxibustion has a long history with distinctive academic characteristics and regional influence. Xujiang School, originated from Xi Hong in Song Dynasty, is the oldest acupuncture and moxibustion school recorded in Chinese history. Later, it was passed down from family to family for more than ten generations. The tenth generation Xi Xinqing passed it on to Chen Honggang and gradually evolved into a school of acupuncture and moxibustion with regional characteristics and a certain national influence. In terms of academic characteristics, doctors in Xujiang School kept innovating based on the Classics.Its acupuncture and moxibustion academic ideas including reinforcement and reduction , point selection and searching for the primary cause of disease in treatment have had an important impact on contemporary acupuncture in clinic.

Comparative study on the inhibiting effect of dissolvable tiny-foam extinguishing agent and chlorine salts on coal spontaneous combustion

Coal spontaneous combustion (CSC) is a global disaster and detrimental to the ecological environment. This study aims to better apply environmentally friendly dissolvable tiny-foam extinguisher (DTE) to CSC and look further into the inhibition mechanism. Thermogravimetric analysis and differential scanning calorimetry (TG-DSC) were employed to test the oxidation properties of coal samples treated with DTE, NaCl, MgCl2, and CaCl2 inhibitors, and the reaction mechanisms and kinetic parameters in the high-temperature stage of coal oxidation were determined. The results revealed that the inhibition of the four inhibitors was similar in the initial period of the coal oxidation, DTE increased the cracking temperature of the coal by 37 °C, mass loss was a minimum when reaching the ignition temperature, and inhibition was better than the other inhibitors at the low temperature. DTE had higher thermal stability and played a stable role in suppression at the high temperature, while chlorine salt inhibitors promoted the oxidative exothermic reaction. DTE coal sample absorbed forty times more heat during the endothermic stage than raw coal, ten times more than MgCl2, and released a minimum of heat. In the decomposition and combustion stages, the reaction mechanism of coal and oxygen conformed to the three-dimensional diffusion Z.-L.-T. equation, and the apparent activation energy of the DTE-treated coal sample was about 40 kJ/mol higher than raw coal.

[Visceral leishmaniasis in Xinjiang Uygur Autonomous Region during the COVID-19 pandemic: a case report]

OBJECTIVE

To perform an epidemiological investigation on a case of visceral leishmaniasis reported from Shule County, Kashi Prefecture, Xinjiang Uygur Autonomous Region in 2021, so as to provide insights into differential diagnosis of visceral leishmaniasis during the COVID-19 pandemic.

METHODS

The epidemiological history of this case was collected, and the case was diagnosed for Leishmania infection with the immunochromatographic (rK39) strip test, bone marrow smear microscopy and PCR assay.

RESULTS

The patient had typical clinical symptoms of leishmaniasis, including irregular fever, hepatosplenomeg- aly, low serum albumin and elevated globulin. Bone marrow smear microscopy identified L. donovani amastigotes, and both rK39 strip test and PCR assay were positive, while the case was tested negative for SARS-CoV-2. COVID-19 was therefore excluded and visceral leishmaniasis was diagnosed. Standard full-dose treatment with sodium stibogluconate was given, and no Leishmania was found on blood smears during the reexamination. No recurrence was found during the followup after discharge for hospital.

CONCLUSIONS

During the COVID-19 pandemic, it is recommended to increase the perception of differential diagnosis of visceral leishmaniasis among first-contact doctors, and reinforce the capability of differential diagnosis and health education of visceral leishmaniasis among medical and healthcare institutions at all levels, to prevent missed diagnosis and misdiagnosis of visceral leishmaniasis.

A method for evaluating the coal spontaneous combustion index by the coefficient of variation and Kruskal-Wallis test: a case study

Focusing on the precise prediction of coal spontaneous combustion (CSC), temperature-programmed experiment was conducted to identify the coal spontaneous combustion indexes. Based on a conception that there should be no significant difference between the coal temperatures determined by different coal spontaneous combustion indexes with sufficient accuracy, an approach for evaluating the coal spontaneous combustion index by statistical analysis was developed. After mining data screening by the coefficient of variation (C_v), the arrays of coal temperature determined by different indexes were calculated with the curve fitting. The Kruskal-Wallis test was employed to analyze the differences between the arrays of coal temperature. Finally, the weighted grey relational analysis method was used to optimize the coal spontaneous combustion indexes. The results show that the production of gaseous compounds is positively correlated with coal temperature. In this case, O₂/CO₂ and CO₂/CO were selected as the primary indexes, and CO/CH₄ was used as the alternative index of coal at low-temperature stage (≤ 80 °C). The detecting of C₂H₄ and C₂H₆ were the confirmation indexes when the coal temperature reaches 90 °C ~ 100 °C. It could provide a reference to the determination of grading index of coal spontaneous combustion during mining and utilization.

Mechanical Properties of Ultra-High Performance Concrete with Coal Gasification Coarse Slag as River Sand Replacement

Coal gasification coarse slag (CGCS) is a by-product of coal gasification. Despite its abundance, CGCS is mostly used in boiler blending, stacking, and landfill. Large-scale industrial applications of CGCS can be environment-friendly and cost saving. In this study, the application of CGCS as a substitute for river sand (RS) with different replacement ratios in ultra-high performance concrete (UHPC) was investigated. The effects of CGCS replacement ratios on the fluidity and mechanical properties of specimens were examined, and the effect mechanisms were explored on the basis of hydration products and the multi-scale (millimetre-scale and micrometre-scale) microstructure analysis obtained through X-ray diffraction (XRD), scanning electron microscopy, and X-ray energy-dispersive spectroscopy. With an increase in the CGCS replacement ratio, the water-binder ratio (w/b), flexural strength, and compressive strength decreased. Specimens containing CGCS of ≤25% can satisfy the strength requirement of non-structural UHPC, with flexure strength of 29 MPa and compressive strength of 111 MPa at day 28. According to the XRD results and multi-scale microstructure analysis, amorphous glass beads in CGCS positively influenced ettringite generation due to the pozzolanic activity. Porous carbon particles in CGCS showed strong interfacial bonding with cement slurry due to internal hydration; this bonding was conducive to improving the mechanical strength. However, CGCS hindered hydration in the later curing stage, leading to an increase in the unreacted cement and agglomeration of fly ash; in addition, at a CGCS replacement ratio of up to 50%, an apparent interfacial transition zone structure was observed, which was the main contributor to mechanical strength deterioration.

Identification and analysis of HD-Zip genes involved in the leaf development of Liriodendron chinense using multidimensional analysis

Homeodomain-leucine zipper (HD-Zip) proteins are plant-specific transcription factors that play important roles in different biological processes, especially leaf development. However, no studies to date have identified the HD-Zip genes in Liriodendron chinense nor characterized their functions. We identified the HD-Zip genes in L. chinense by analysing the phylogeny, chromosome location, structure, conserved motif, cis-regulatory elements, synteny, post-transcriptional regulation and expression patterns of these genes during leaf development. A total of 36 LcHD-Zip genes were identified and divided into four subfamilies (HD-Zip I to IV). Synteny analysis revealed that segmental duplication was the main force driving the expansion of LcHD-Zip genes. These 36 LcHD-Zip genes exhibited 11 different expression patterns. Pattern 1, 2, 3, 4, 6, 7, 8 and 9 genes may play important roles in leaf development, such as leaf initiation, leaf polarity establishment, leaf shape development, phytohormone-mediated leaf growth and leaf epidermal structure formation. Four HD-Zip III genes were targeted by microRNAs (miRNAs), and the miR165/166a-HD-Zip regulatory module formed regulated leaf initiation and leaf polarity establishment. Overall, LcHD-Zip genes play key roles in leaf development of L. chinense. This work provides a foundation for the functional verification of HD-Zip genes identified in this study.

[Analysis and management of delayed cerebrospinal fluid rhinorrhea after invasive pituitary adenoma surgery]

Objective: To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea (CFR) after invasive pituitary adenoma (IPA) surgery. Methods: One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively, including 62 males and 80 females, aging from 38 to 67 years. The clinical data of patients before and after operation were collected. All patients with postoperative CFR underwent endoscopic CFR repair. During the operation, residual or recurrent pituitary adenomas were resected, the dura around the leak was enlarged and the necrotic tissue was removed. For those who still had fluid leakage after repair, the necrotic tissue was cleaned up, the leakage was filled and reinforced under endoscopy. Endoscopic rhinorrhea repair was performed if necessary. The cerebrospinal fluid leak was repaired with multi-layer materials. The related risk factors of delayed CFR after operation were analyzed. SPSS 19.0 software was used for statistical analysis. Results: Among the 142 patients in this group, 64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection. They were followed up for 6 to 72 months. Thirty-one cases had delayed CFR, with an incidence of 21.83%, and occurred between 1 and 5 years postoperatively, with an average of 2.4 years. All 31 patients with delayed CFR underwent endoscopic CFR repair. The nasal endoscopy was rechecked at 2 weeks, 1 month, 3 months and 6 months after operation. Twenty-eight patients were repaired successfully after 1 operation, while 2 patients after 2 operations and 1 patient after 3 operations. These patients were followed up for 6 to 60 months, and no CFR occurred again. Univariate analysis showed that the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and operator experience were the risk factors of delayed CFR (all P<0.05). Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperative CFR, and tumor size, texture, postoperative radiotherapy and operator experience were the independent risk factors in this study. Conclusions: Delayed CFR after IPA is related to the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and the operator experience. It is necessary to completely remove the tumor under endoscope, to expand resection of the dura and necrotic tissue around the leak, to repair the defect with multi-layer materials, to follow-up closely and to repair timely after operation.

Effect of Oxygen Concentration on the Oxidative Thermodynamics and Spontaneous Combustion of Pulverized Coal

Spontaneous combustion of pulverized coal has become a safety topic and has been extensively researched. This study using differential scanning calorimetry investigated the exothermic characteristics and spontaneous combustion risk of three metamorphic pulverized coal samples during oxidative combustion, for oxygen concentrations of 21, 19, 17, 15, 13, 11, 9, 7, and 5 vol %. Results indicated that decreased oxygen concentrations reduced exothermic intensity and substantially increased ignition temperatures. The oxidative thermal release observed during the combustion stage was conspicuously higher than during the low-temperature oxidation stage. Thermal release during low-temperature oxidation was low during low oxygen concentrations; however, when the oxygen concentration was less than 13.0 vol.%, it had a considerable influence on exothermic combustion. When the oxygen level was lowered from 21.0 to 5.0 vol %, spontaneous combustion risk indexes lessened from 2.07 (sample A), 1.85 (sample B), and 0.81 [J/(mg min °C2)] (sample C) to 1.08 (sample A), 1.13 (sample B), and 0.40 [J/(mg min °C2)] (sample C), respectively. Both apparent activation energy and spontaneous combustion risk indexes of the samples decreased saliently as oxygen concentration decreased. Thus, reducing oxygen concentration would be an effective method of inhibiting or possibly even preventing the spontaneous combustion of pulverized coal.

[Effect analysis on endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base]

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and capsule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.

Combustion Kinetics and Mechanism of Pre-Oxidized Coal with Different Oxygen Concentrations

The phenomenon of spontaneous combustion of "oxidized coal" is common in mining processes of goafs, thick coal seams, and unsealing of closed fire areas. In order to study the reburning characteristics of coal with different oxidation degrees, the oxygen concentration in the pre-oxidation process was selected as the key influencing factor. Thermogravimetric analysis (TGA) and in situ Fourier-transform infrared (FT-IR) spectroscopy were used to study the macro- and microcharacteristics of raw and oxidized coal during the combustion stage. The results showed that the pre-oxidation treatment exhibited a dual effect on promoting and inhibiting the weight loss characteristics of oxidized coal. The apparent activation energy, E a, of the combustion reaction for the utilized coal samples was calculated using the Flynn-Wall-Ozawa (FWO) and Kissinger-Akahira-Sunose (KAS) methods, and it was found that the average apparent activation energy (E a®) values of the oxidized coal samples were less in magnitude than that of the raw coal and that the coal sample with the pre-oxidized oxygen concentration of 15% was more prone to the combustion reaction. Using the correlation determination method of key active groups in the proposed coal combustion reaction, the key active groups affecting the weight change of the tested coal samples during the combustion stage were determined as -CH3 and C-O. The results can be helpful to prevent and control coal spontaneous combustion during re-mining and unsealing of closed fire areas.

Thumb lengthening using a three-dimensional half-ring distraction frame

The purpose of this study was to evaluate the use of a three-dimensional half-ring distraction frame for thumb phalangeal lengthening. From February 2009 to March 2015, 23 patients (23 thumbs) with thumb loss were treated with a half-ring distraction frame. Active movements of the metacarpophalangeal (MCP) joint were measured with a goniometer. These measurements were compared with the opposite hand. Differences were considered statistically significant at p<0.05. Clinical outcome was assessed based on the modified Mayo score. Bone union and good alignment were achieved in all patients. The mean distraction time was 44 days (range, 35-62 days). The mean time to union was 20 days (range, 49-86 days). The mean palmar and radial abduction of the thumb was 60° (range, 53°-65°) and 63° (range, 58°-70°), respectively; on the uninjured side, these measurements were 62° (range, 56°-65°) and 64° (range, 60°-73°), respectively (p>0.05). The mean extension-flexion arc of the MCP joint was 46° (range, 40°-50°); the measurement on the uninjured side was 48° (40°-54°) (p>0.05). The mean follow-up period was 51 months (4.25 years) (range, 48-65 months). The mean modified Mayo Score was 138 (range, 113-145). There were 19 excellent, 3 good, and 1 fair results. The half-ring distraction frame is a viable alternative for thumb lengthening as it provides stable, three-dimensional fixation, resulting in good hand function.

A polarization propagation mechanism of Fe and Cu atoms co-doped in two-dimensional-Si3N4

Fe and Cu atoms doped into two dimensional (2D) Si₃N₄ honeycomb structures exhibit magnetic anisotropy, and planar spin-polarization propagation.

[Application of percutaneous dilatation tracheotomy in patients with difficult airway]

Objective:To explore the application of percutaneous dilatation tracheotomy for patients with difficult airway. Method:Retrospectively analyzed the clinical data of percutaneous dilatation tracheotomy in difficult airway patients, summarized the difficulties, technical points and advantages. Result:Collecting the clinical data of 28 patients with difficult airway, 20 cases were head and neck tumor recurrence after surgery, radiation and chemotherapy, 3 cases were cervical hematoma, 2 cases were laryngeal neoplasm with heart failure, 2 cases were mandatory spondylitis, and 1 case was airway stenosis. The difficult points for tracheotomy were unable to lie down, neck stiffness, displacement of the trachea, coagulation disorder, unclear neck structure, etc. All patients accepted percutaneous dilatation tracheotomy, including cone and forceps dilatation tracheotomy, with none complication. Conclusion:Percutaneous dilatation tracheotomy was a safe, rapid and minimally invasive surgical method for patients with difficult airway requiring tracheotomy, and could be used as the preferred solution.

Thermogravimetric and infrared spectroscopic studies of the spontaneous combustion characteristics of different pre-oxidized lignites

It is extremely important to prevent spontaneous combustion of coal in mines by studying the secondary oxidation of lignite at different pre-oxidation temperatures. The characteristic parameters of the spontaneous combustion of lignite were analyzed by simultaneous thermal analysis-Fourier transform infrared spectroscopy and in situ infrared spectroscopy experiments from the perspective of coal oxidizing, exothermicity and structural functional groups. The results show that the critical temperature and total heat absorption of pre-oxidized coal are lower than those of raw coal. For the coal a with pre-oxidation temperature of 120 °C, the critical temperature and total heat of the endothermic reaction were the lowest, which resulted in increased CO release and CO₂ gas production. In the low temperature stage, the pre-oxidation step weakens some functional groups in coal; however, the participation amount of –CH₃ structures increases. Kinetic analysis was performed on –OH and –CH₃ groups during the secondary oxidation of coal. After pre-oxidation, the activation energy of coal was lower than that of raw coal; it was the lowest when the pre-oxidation temperature was 120 °C. In summary, the risk of spontaneous combustion of pre-oxidized coal increases during secondary oxidation, and the risk is greatest when the pre-oxidation temperature climbs to 120 °C.

The characteristic parameters of the spontaneous combustion of raw coal and pre-oxidized coal were analyzed by STA, FTIR and in situ FTIR spectroscopy.

[Sublingual immunotherapy of Dermatophagoides farinae drops in nasal cavity local allergy]

Objective:To investigate treatment effect of Sublingual immunotherapy of Dermatophagoides farinae drops in nasal cavity local allergy.MethodSelecting 60 patients as observation group,who had only nasal local allergy symptoms,allergen skin prick test and serum allergen specific IgE test were negative, but nasal secretions allergen specific IgE test and nasal mucous membrane excitation test were positive.Sublingual immunotherapy of Dermatophagoides farinae drops for three years were given to them.To detect symptom scores and VAS scores,eosinophilia counts in nasal secretion,nasal secretions allergen specific IgE test,nasal mucous membrane excitation test before treatment,after two years treatment,and three years treatment,the data of pre-therapy and post-therapy was taken for statistical analysis.ResultThere was difference(P<0.05) in the symptom scores and VAS scores of patients in observation group before treatment and after two years treatment.There was difference(P<0.05) in the eosinophilia counts in nasal secretion of patients before treatment and after two years treatment. There was difference(P<0.05) in the nasal secretions allergen specific IgE test of patients before treatment and after two years treatment. There was difference(P<0.05) in the nasal mucous membrane excitation test of patients before treatment and after two years treatment.There was no difference(P>0.05) Symptom scores and VAS scores in the patients after two years treatment and after three years treatment.Conclusion：For patients with the typical medical history and symptoms of AR,but with allergen SPT and serum allergen SIgE test negative,there was local specific hypersensitivity in nasal mucosa,but there was not accompanied by systemic sensitization.Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive,local allergic rhinitis can be diagnosed.Sublingual immunotherapy of Dermatophagoides farinae drops in nasal cavity local allergy was effective.

[Clinical symptoms and immunology inspection characteristics of nasal cavity local allergy]

Objective:To investigate the clinical symptoms and immunology inspection characteristics of nasal cavity local allergy. Method:Selected 60 patients as observation group, who had only nasal local allergy symptoms, allergen skin prick test and serum allergen specific IgE (SIgE) test were negative, 40 allergic rhinitis (AR) patients and 40 healthy volunteers as control groups. To detect Symptom scores and VAS scores, and eosinophilia counts in venous blood, allergen skin prick test (SPT), serum allergen SIgE test, nasal secretions allergen SIgE test, nasal mucous membrane excitation test in both observation group and AR group, eosinophilia counts in nasal secretion, taked the data for statistical analysis.Result:There was no difference (P> 0.05) in the symptom scores and VAS scores of observation group and the AR group. The eosinophilia counts in venous blood in the AR group were higher than in the observation group (P< 0.05). The eosinophilia counts in venous blood in the observation group were higher than in the healthy volunteers group (P< 0.05). The positive rate of nasal secretions dust mites and pollen allergen was 90% (54/60) in observation group. There was no significant difference (P> 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the AR group. There was significant difference (P< 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the healthy volunteers group. There were 6 patients in observation group whose nasal secretions allergen SIgE test and nasal mucous membrane excitation test were both negative, could be diagnosised as non-allergic rhinitis (NAR). According to eosinophilia counts in venous blood and nasal secretions, 4 patients were diagnosised as vasomotor rhinitis and 2 patients were diagnosised as NAR with eosinophilia syndrome. There were 54 patients in observation group whose nasal secretions allergen SIgE test and (or) nasal mucous membrane excitation test were positive, could be diagnosised as local allergic rhinitis. After three years, all of the observation group patients were detected with SPT and serum allergen SIgE test. Five patients diagnosed as local allergic rhinitis before three years were positive. Six patients diagnosed as NAR before three years were negative.Conclusion:For patients with the typical medical history and symptoms of AR, but allergen SPT and serum allergen SIgE test were negative, there was local specific hypersensitivity in nasal mucosa, but the reaction was not accompanied by systemic sensitization. Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive, could be diagnosed as local allergic rhinitis.

[The safety study of percutaneous dilational tracheostomy in a large sample]

Objective:The aim of this study is to analyze the safety of a large number cases of percutaneous dilatation tracheostomy. Method: Retrospective analyzed the clinical data of PDT (1 200 cases) and TT (326 cases) patients which were recruited. The postoperative complications were analyzed statistically. PDT and TT randomized controlled trials (PDT and TT) were conducted with 80 cases in each group. The intraoperative conditions (including operative time, intraoperative bleeding volume and incision size) and postoperative complications in the two groups were statistically analyzed. The data were analyzed by SPSS 17.0 software. Result:①Randomized controlled study: The blood loss, incision size and operative time of two groups have significant difference. Comparison of postoperative complications: the number of postoperative bleeding and the total number of complications were statistically significant difference (P<0.05). However, granulation formation, incision infection and subcutaneous emphysema showed no significant difference (P>0.05). ②Large sample study: The postoperative follow-up results showed that there were significant differences in postoperative bleeding, postoperative infection, subcutaneous emphysema and the total number of complications (P<0.05), but there was no significant difference in the formation of tracheal granulation (P>0.05). Conclusion:This study further validates that PDT is a safe method to establish long-term artificial airway through large sample and randomized controlled study, which accords with the direction of modern minimally invasive surgery. PDT not only short operation time, and is easy to grasp, but also safe and reliable. If there is no obvious operation contraindication, we can choose PDT first for critically ill patients who need tracheotomy, and the success rate and safety are high after mastering the operation skills.

Abstract P3-12-09: CYP2D6*10 genotype was associated with worse outcome of premenopausal breast cancer patients receiving adjuvant tamoxifen but not toremifene: A single institution expericence

Background: Tamoxifen(TAM), a selective estrogen receptor modulator(SERM), is the most widely used adjuvant endocrine therapy for premenopausal breast cancer patients. Cytochrome P-450(CYP450) enzyme, CYP2D6, is involved in the conversion of tamoxifen to endoxifen which is one of the main active metabolites of tamoxifen in vivo. Variants of CYP2D6 gene may result in a decreased enzyme activity and lead to poor prognosis of the patients. Different from caucasians, the most common polymorphism among Chinese women is allelic variant *10, which generates a 188 C to T transition, resulting in a lower activity of the enzyme. Based on some retrospective studies, tamoxifen-treated patients with the CYP2D6*10 T/T genotype have a worse clinical outcome. Toremifene(TOR), another kind of SERM is not metabolited by CYP2D6 enzyme thus may not be influenced by its polymorphism. We conducted this study to validate the association between CYP2D6*10 genotype and the outcomes of patients receiving TAM and TOR respectively.

Methods: A total of 276 patients with primary early-stage ER-positive breast cancer received adjuvant tamoxifen (n=169) or toremifene (n=107) therapy at Natinal Cancer Center from 2004-2012 were analyzed. All patients had received 5-year endocrine therapy after completion of surgery. TaqMan SNP genotyping assays was performed on CYP2D6*10 from blood samples. The association of CYP2D6 *10 genotype with disease free survival (DFS) and clinicopathological characteristics was analyzed in patients receiving tamoxifen and toremifen.

Results: 32.6% (90 of 276) of the patients were homozygous for wild-type C/C genotype, 47.1% (130 of 276) were heterozygous for C/T genotype, and 20.3% (56 of 276) were homozygous for variant T/T genotype. The frequency of CYP2D6 *10 allele in our study was 43.8%. The 5-year DFS rate for tamoxifen and toremifene treatment group were 81.6% and 83.2% respectively. There was no significant difference of DFS between the two groups(P=0.274). Among 169 patients in tamoxifen group, 5-year DFS rate was considerably lower in patients with homozygous variant T/T genotype than those with wild-type C/C or C/T genotype (73.4% versus 83.2%, P=0.004). And the T/T genotype was found to be a significant prognostic marker for DFS in multivariate analysis (hazard ratio = 4.7; P&lt;0.001) after adjusting for patient's characteristics mentioned above. For the toremifene group, there was no difference of DFS between T/T genotype and the others(P=0.332). For all the 56 homozygous variant T/T genotype patients, patients receiving toremifene treatment had a much higher 5-year DFS rate than those receiving tamoxifen but unfortunately it was not statistically significant (90.0% versus 73.4%, P=0.192).

Conclusions: About one fifth of Chinese breast cancer patients had homozygous T/T genotype which might get less benefit from TAM adjuvant treatment. Toremifene may be a better option for this kind of patients. Further large-scale prospective clinical studies are warranted to validate this concept.

Citation Format: Lan B, Ma F, Fan Y, Zhai X, Xu B. CYP2D6*10 genotype was associated with worse outcome of premenopausal breast cancer patients receiving adjuvant tamoxifen but not toremifene: A single institution expericence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-09.

Quality of meta-analyses in major leading orthopedics journals: A systematic review

BACKGROUND

Meta-Analyses are the basis of professional and healthcare agencies recommendations and have a growing importance. Quality of meta-analyses has been investigated in some medical fields but to our best knowledge this issue remains under investigated in orthopedics. Therefore, we performed a systematic analysis to: 1) after the introduction of PRISMA statement as a comprehensive guideline and the use of the AMSTAR tool as the standard for sufficient review methodology, has the quality of MAs improved because of that? 2) have some general characteristics influenced the quality of MAs (country, funding source, number of authors)?

MATERIAL AND METHODS

We systematically searched the meta-analyses in the top four journals with the impact factor (2015) as following: JBJS, Osteoarthritis Cartilage Arthroscopy and Clin Orthop Relat Res from 2005 to 2008 and from 2012 to 2015. Likewise from 2012-2015, we also analyzed the meta-analyses from OTSR. Characteristics were extracted based on the PRISMA statement and the AMSTAR tool. Country, number of authors, funding source were also extracted.

RESULTS

A total of 154 meta-analyses were included in the present study. Score with PRISMA statement and the AMSTAR checklist were 20.86±3.04 out of a maximum of 27 and 7.86±1.55 out of a maximum of 11. The best journal was OTSR according to the PRISMA (23.06±1.92) and AMSTAR (9.13±0.87) scores. And the worst journal was Clin Orthop Relat Res according to the PRISMA score (19.4±2.70) and JBJS according to the AMSTAR score (6.78±1.65). Twelve items showed significant difference in the PRISMA statement, and five items in the AMSTAR checklist. Integral score of PRISMA statement and AMSTAR checklist has a significant difference between 2005-2008 and 2012-2015. The MAs reported from U.S. (56, 36.4%) were more than any other region in the world. And the MAs published by Asia/Oceania increased remarkably between these two period times [from (4, 10.8%) to (45, 38.5%)].

CONCLUSION

This study showed that methodological reporting quality of meta-analyses in the major orthopedics journals has improved after the publication of the PRISMA statement.

LEVEL OF EVIDENCE

Level III.

Enzyme activation through the utilization of intrinsic dianion binding energy

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We consider 'the proposition that the intrinsic binding energy that results from the noncovalent interaction of a specific substrate with the active site of the enzyme is considerably larger than is generally believed. An important part of this binding energy may be utilized to provide the driving force for catalysis, so that the observed binding energy represents only what is left over after this utilization' [Jencks,W.P. (1975) Adv. Enzymol. Relat. Areas. Mol. Biol. , , 219-410]. The large ~12 kcal/mol intrinsic substrate phosphodianion binding energy for reactions catalyzed by triosephosphate isomerase (TIM), orotidine 5'-monophosphate decarboxylase and glycerol-3-phosphate dehydrogenase is divided into 4-6 kcal/mol binding energy that is expressed on the formation of the Michaelis complex in anchoring substrates to the respective enzyme, and 6-8 kcal/mol binding energy that is specifically expressed at the transition state in activating the respective enzymes for catalysis. A structure-based mechanism is described where the dianion binding energy drives a conformational change that activates these enzymes for catalysis. Phosphite dianion plays the active role of holding TIM in a high-energy closed active form, but acts as passive spectator in showing no effect on transition-state structure. The result of studies on mutant enzymes is presented, which support the proposal that the dianion-driven enzyme conformational change plays a role in enhancing the basicity of side chain of E167, the catalytic base, by clamping the base between a pair of hydrophobic side chains. The insight these results provide into the architecture of enzyme active sites and the development of strategies for the de novo design of protein catalysts is discussed.

The relationship between intracranial pressure and neurocognitive function before and after the repair of a skull injury

OBJECTIVE

This study examines the relationship between intracranial pressure (ICP) changes after skull injury repair and neurocognitive function before and after the repair.

PATIENTS AND METHODS

Sixty patients undergoing skull injury repair participated in the study. A non-invasive detection analyzer was used to detect the ICP 2 days before operation, 10 days after the operation and one month after the operation in all patients. Additionally, the mean cerebral blood flow velocities (MV) in the internal carotid and the medial cerebral arteries were detected using a transcranial Doppler ultrasound (TCD). The neurological and cognitive functions were assessed using the NIHSS and the MMSE scales, respectively. And finally, an ELISA assay was used to detect the plasma insulin-like growth factor (IGF)-1 and beta-amyloid peptide (Ab) levels.

RESULTS

The results showed that all parameters studied improved significantly and continuously after surgery.

CONCLUSIONS

We suggest that the improvement in the ICP values and the neurocognitive functions are related to the resulting decreased expression levels of IGF-1 and Abeta after the repair.

Hippocampal UCP2 is essential for cognition and resistance to anxiety but not required for the benefits of exercise

Uncoupling protein-2 (UCP2) reduces oxidative stress by facilitating the influx of protons into mitochondrial matrix, thus dissociating mitochondrial oxidation from ATP synthesis. UCP2 is expressed abundantly in brain areas and plays a key role in neuroprotection. Here, we sought to determine if UCP2 deficiency produces cognitive impairment and anxiety in young mice, and to determine if hippocampal UCP2 is essential for the beneficial effects of voluntary exercise. Antisense oligonucleotide (ASO) was used to produce UCP2 knockdown in mice. Our results firstly showed that UCP2-targeted ASO significantly reduced UCP2 mRNA and protein expression in the hippocampus. ASO treatment impaired learning and memory of the mice in Y-maze, T-maze, and object recognition tests (ORT). ASO-treated mice exhibited more anxiously in OPT, light/dark box test, and elevated plus maze (EPM) than the control mice. We also found that wheel running ameliorated cognitive dysfunction and anxiety-like behaviors in ASO-treated mice. Furthermore, voluntary exercise reversed ASO-induced changes in hippocampal levels of serotonin (5-HT), dopamine (DA), and norepinephrine (NE). However, UCP2 protein in the hippocampus was not correlated with cognitive and anxiolytic benefits of exercise. These findings suggest that hippocampal UCP2 is essential for cognitive function and the resistance to anxiety of mice, but not required for the beneficial effects of exercise.

Selective inhibition of protein kinase C β2 attenuates the adaptor P66 Shc-mediated intestinal ischemia-reperfusion injury

Apoptosis is a major mode of cell death occurring during ischemia–reperfusion (I/R) induced injury. The p66^Shc adaptor protein, which is mediated by PKCβ, has an essential role in apoptosis under oxidative stress. This study aimed to investigate the role of PKCβ₂/p66^Shc pathway in intestinal I/R injury. In vivo, ischemia was induced by superior mesenteric artery occlusion in mice. Ruboxistaurin (PKCβ inhibitor) or normal saline was administered before ischemia. Then blood and gut tissues were collected after reperfusion for various measurements. In vitro, Caco-2 cells were challenged with hypoxia–reoxygenation (H/R) to simulate intestinal I/R. Translocation and activation of PKCβ₂ were markedly induced in the I/R intestine. Ruboxistaurin significantly attenuated gut damage and decreased the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Pharmacological blockade of PKCβ₂ suppressed p66^Shc overexpression and phosphorylation in the I/R intestine. Gene knockdown of PKCβ₂ via small interfering RNA (siRNA) inhibited H/R-induced p66^Shc overexpression and phosphorylation in Caco-2 cells. Phorbol 12-myristate 13-acetate (PMA), which stimulates PKCs, induced p66^Shc phosphorylation and this was inhibited by ruboxistaurin and PKCβ₂ siRNA. Ruboxistaurin attenuated gut oxidative stress after I/R by suppressing the decreased expression of manganese superoxide dismutase (MnSOD), the exhaustion of the glutathione (GSH) system, and the overproduction of malondialdehyde (MDA). As a consequence, ruboxistaurin inhibited intestinal mucosa apoptosis after I/R. Therefore, PKCβ₂ inhibition protects mice from gut I/R injury by suppressing the adaptor p66^Shc-mediated oxidative stress and subsequent apoptosis. This may represent a novel therapeutic approach for the prevention of intestinal I/R injury.

Coordinated evolution of the hepatitis B virus polymerase

The detection of compensatory mutations that abrogate negative fitness effects of drug-resistance and vaccine-escape mutations indicates the important role of epistatic connectivity in evolution of viruses, especially under the strong selection pressures. Mapping of epistatic connectivity in the form of coordinated substitutions should help to characterize molecular mechanisms shaping viral evolution and provides a tool for the development of novel anti-viral drugs and vaccines. We analyzed coordinated variation among amino acid sites in 370 the hepatitis B virus (HBV) polymerase sequences using Bayesian networks. Among the HBV polymerase domains the spacer domain separating terminal protein from the reverse-transcriptase domain, showed the highest network centrality. Coordinated substitutions preserve the hydrophobicity and charge of Spacer. Maximum likelihood estimates of codon selection showed that Spacer contains the highest number of positively selected sites. Identification of 67% of the domain lacking an ordered structure suggests that Spacer belongs to the class of intrinsically disordered domains and proteins whose crucial functional role in the regulation of transcription, translation and cellular signal transduction has only recently been recognized. Spacer plays a central role in the epistatic network associating substitutions across the HBV genome, including those conferring viral virulence, drug resistance and vaccine escape. The data suggest that Spacer is extensively involved in coordination of HBV evolution.

Interfacial ferromagnetism and exchange bias in CaRuO3/CaMnO3 superlattices

We have found ferromagnetism in epitaxially grown superlattices of CaRuO(3)/CaMnO(3) that arises in one unit cell at the interface. Scanning transmission electron microscopy and electron energy loss spectroscopy indicate that the difference in magnitude of the Mn valence states between the center of the CaMnO(3) layer and the interface region is consistent with double exchange interaction among the Mn ions at the interface. Polarized neutron reflectivity and the CaMnO(3) thickness dependence of the exchange bias field together indicate that the interfacial ferromagnetism is only limited to one unit cell of CaMnO(3) at each interface. The interfacial moment alternates between the 1 μ(B)/interface Mn ion for even CaMnO(3) layers and the 0.5 μ(B)/interface Mn ion for odd CaMnO(3) layers. This modulation, combined with the exchange bias, suggests the presence of a modulating interlayer coupling between neighboring ferromagnetic interfaces via the antiferromagnetic CaMnO(3) layers.

Participation of haemocytes in fat body degradation via cathepsin L expression

Insect haemocytes are known to participate in innate immunity via the phagocytosis of pathogens. However, the function of haemocytes in tissue remodelling is less understood. We report here that haemocytes play roles in fat body degradation by expressing a cysteine proteinase cathepsin L in the lepidopteran Helicoverpa armigera. During metamorphosis, haemocytes undergo morphological changes by increasing their cell size and transforming their granulocytes into macrogranulocytes. The population of haemocytes also changes with increased number of granulocytes and decreased plasmatocytes. The expression level of cathepsin L in haemocytes, mainly in granulocytes and plasmatocytes, increases. The steroid hormone 20-hydroxyecdysone is able to promote the transformation of granulocytes into macrogranulocytes, and up-regulate the expression level of cathepsin L. The knock-down of the cathepsin L gene by RNA interference in haemocytes in vitro results in deficient granulocytes transforming into macrogranulocytes. Haemocytes are able to enter the decomposed fat body during metamorphosis. The over-expression of the proteinase domain C1A of cathepsin L results in cell apoptosis. Haemocytes, especially macrogranulocytes, undergo apoptosis and cathepsin L is released into haemolymph and the fat body during metamorphosis for fat body decomposition and degradation. These results suggest that cathepsin L is related to the transformation of granulocytes to macrogranulocytes to enter the fat body, and induce haemocyte apoptosis for further tissue degradation.

Involvement of fatty acid metabolism in the hepatotoxicity induced by divalproex sodium

Divalproex sodium is an antiepileptic drug. Hepatotoxicity is one of the most common side effects induced by divalproex sodium. Impaired fatty acid metabolism is considered to play an important role in the drug-induced hepatotoxicity. The sterol regulatory element-binding protein 1c (SREBP-1c) and peroxisome proliferator-activated receptor α (PPARα) are two key transcription factors involved, respectively, in fatty acid synthesis and degradation in liver. In the present study, we investigated the hepatotoxicity induced by divalproex sodium and its potential mechanism. The results indicated that divalproex sodium significantly decreased the cell viability and increased lactate dehydrogenase leakage in hepatocytes. The activities of alanine aminotransferase and aspartate transaminase were increased in hepatocytes treated with divalproex sodium. Furthermore, divalproex sodium activated SREBP-1c and increased the mRNA expressions of acetyl-CoA carboxylase 1, fatty acid synthase and stearoyl-CoA desaturase 1. Divalproex sodium also inhibited PPARα and decreased the messenger RNA expressions of 3-hydroxy-3-methylglutaryl-CoA synthase 2 and carnitine palmitoyltransferase 1A. These results suggest that the hepatotoxicity induced by divalproex sodium may be related with fatty acid synthesis and degradation mediated by SREBP-1c and PPARα in hepatocytes.

Human islet distribution program for basic research at a single center

The Clinical Islet Laboratory at the University of Alberta/Alberta Health Services distributes human islets for basic research when islet preparations fail to meet defined release criteria for transplantation. This report highlights our islet distribution activity for diabetes research over a 3-year period. Shipments of the acinar-enriched fraction for research were not included in this report. In 2010, we distributed 6.3 million islet equivalents (IEQs) of islets through 127 shipments to 8 researchers, locally, nationally, and internationally. The number of preparations for research use was stable over the 3-year period (26, 23, and 29 preparations in 2008, 2009, and 2010, respectively). Islet yield distributed for research per isolation was 201, 212, and 218 × 10(3) IEQs, respectively. The number of basic researchers was stable as well, although there were only 2 researchers before 2007. Recently, each researcher has received fewer islets per shipment (49,820 IEQs in 2010 vs 75,635 IEQs in 2008) but more frequently (21.5 in 2010 vs 11.2 times per year in 2008). This paradigm shift would be desirable for researchers, because in our experience, most require <30,000 IEQs per shipment, and more frequent islet shipments results in a larger sample size for experimentation. After an initial expansion in the number of researchers requesting islets, our islet distribution activity has remained stable over the years in terms of total productivity of islets utilized for research. The current supply-versus-demand ratio in our program appears to be appropriate.