Development and internal validation of a prediction model for patients with hematologic diseases of fall risk: a cohort study

BACKGROUND

To develop and internally validate a prediction model for identifying patients with hematologic diseases of fall risk.

RESEARCH DESIGN AND METHODS

This is a prospective cohort study from a prospective collection of data for 6 months. We recruited 412 patients with hematologic diseases in medical institutions and home environment of China. The outcome of the prediction model was fall or not. These variables were filtered via univariable logistic analysis, LASSO, and multivariable logistic analysis. We adopt an internal validation method of K-fold cross validation. The area under the ROC curve and the H-L test were used to evaluate the discrimination and calibration of the model.

RESULTS

Five influencing factors were identified multivariable logistic regression analysis. The established model equation is as follows: the H-L goodness-of-fit test of the model p > 0.05. The area under the ROC curve of train is 0.957 (95% CI: 0.936 ~ 0.978), and the area under the ROC curve of test is 0.962 (95% CI: 0.884 ~ 1), so the model calibration and discriminant validity are good.

CONCLUSION

Our equation has good sensitivity and specificity in predicting the fall risk of patients with hematologic diseases, and has certain positive significance for clinical assessment of their fall risk.

TRIAL REGISTRATION NUMBER

ChiCTR2200063940.

Immature central tumor tertiary lymphoid structures are associated with better prognosis in non-small cell lung cancer

BACKGROUND & AIMS

Tertiary lymphoid structures (TLSs) are predictive biomarkers of favorable clinical outcomes and immunotherapy response in several solid malignancies, including non-small cell lung cancer (NSCLC). However, the relationship between TLSs and NSCLC prognosis has not been eludicated from the aspects of location, density, and maturity. This study aimed to investigate the clinicopathological and prognostic significance of TLSs in NSCLC.

METHODS

A collection of 151 resected pulmonary nodules in patients with NSCLC was retrospectively analyzed. Two experienced pathologists reviewed hematoxylin-eosin (H&E) slides and assessed TLS scores at different anatomic subregions. Then, we analyzed their correlation with clinicopathologic parameters and CD8 staining intensity and assessed multiple clinicopathological factors affecting patient prognosis.

RESULTS

CD8 expression was correlated with total (TLS-CT) (P = 0.000), aggregates (Agg) (TLS-CT) (P = 0.001), follicles (FOL)-I (TLS-CT) (P = 0.025), and TLS(overall) (P = 0.013). TLS scores in the central tumor (CT) and invasion margin (IM) areas were negatively correlated with distant metastasis and Union for International Cancer Control (UICC) stage in NSCLC patients, while TLS score in the CT area was positively correlated with CD8 expression. TLS (overall), Agg (TLS-CT), and FOL-I (TLS-CT) were positively correlated with distant metastasis, UICC stage, and CD8 expression in NSCLC patients. Agg (TLS-IM) was positively correlated with distant metastasis and UICC stage. FOL-I (TLS-IM) was positively correlated with UICC stage. FOL-II (TLS-IM) was positively correlated with distant metastasis (P < 0.05). Multivariate Cox regression analysis showed that unfavorable independent prognostic factors were associated with metastasis status and UICC stage. Independent prognostic factors with protective effects included Agg (TLS-CT), FOL-I (TLS-CT), total (TLS-CT), and overall TLS (P < 0.05).

CONCLUSION

Histological score assessment of H&E sections of Agg (TLS-CT), FOL-I (TLS-CT), total (TLS-CT), and overall TLS levels in NSCLC has prognostic value.

Potential effects of different cell death inhibitors in protecting against ischemia-reperfusion injury in steatotic liver

Liver ischemia-reperfusion injury (IRI) remains a common issue and with the increasing incidence of Nonalcoholic fatty liver disease (NAFLD), which are more sensitive to IRI, it is crucial to explore the possible strategy to alleviate the steatotic liver IRI. Several modes of cell death are involved in hepatocytes and immune cells during hepatic IRI, and the effects of different cell death inhibitors including apoptosis, necroptosis, pyroptosis, and ferroptosis in steatotic liver IRI have not been investigated. We established 70% IRI model on steatotic liver in mice. Apoptosis, necroptosis, pyroptosis and ferroptosis inhibitors were used to evaluate their effects on liver injury, inflammatory response, and immune cell infiltration. Immunofluorescence and immunohistochemical results demonstrated that there were apoptosis, necroptosis, pyroptosis, and ferroptosis in the progression of IRI in steatotic liver. All four types of cell death inhibitors showed protective effects, but ferroptosis inhibitor Fer-1 and pyroptosis inhibitor VX765 exerted better protective effects compared the apoptosis inhibitor Z-VAD and necroptosis inhibitor Nec-1. Further, we found that pyroptosis occurred mainly in macrophages and ferroptosis occured primarily in hepatocytes during steatotic liver IRI. Ferroptosis in heaptocytes and pyroptosis in macrophages are two major cell death types involved in steatotic liver IRI and inhibiting these cell death exerted good protective effects.

The effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid ophthalmopathy

PURPOSE

To evaluate the effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy.

METHODS

This retrospective study enrolled 55 eyes of 33 patients treated in our hospital for restrictive strabismus caused by thyroid-associated ophthalmopathy. We performed muscle recession for the obviously restricted extraocular muscles, with 6 weeks of follow-up. Surgical outcomes were compared between the orbital decompression group (DG, n=15) and non-orbital decompression group (NDG, n=18).

RESULTS

A total of 33 patients with Graves' ophthalmopathy who underwent rectus muscle recession surgery were included. Of these, 15 patients had undergone orbital decompression prior to strabismus surgery, and 18 had not. The two groups did not differ in terms of the preoperative horizontal or vertical ocular deviation, degree of restriction of eye movement, degree of diplopia, or mean number of muscles that underwent surgery (P>0.05). There was no significant difference in the preoperative horizontal or vertical ocular deviation, level of eye movement restriction, degree of diplopia and the success rate of the surgery (P>0.05).

CONCLUSION

Rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy during the quiescent period could improve the ocular deviation and diplopia, and orbital decompression performed before strabismus surgery had no significant effect on surgical technique or outcomes of rectus muscle recession surgery.

Dynamic shape measurement for objects with patterns by Fourier fringe projection profilometry based on variational decomposition and multi-scale Retinex

In practical measurement, we often need to measure the shape of objects with patterns or letters. As far as we know, no paper has ever reported the shape measurement for objects with patterns or letters by Fourier fringe projection profilometry (FPP). In this paper, we propose a method based on the variational decomposition TV-Hilbert-L² model and multi-scale Retinex (MSR) to measure the shape of objects with patterns and letters by Fourier FPP. In this method, we first use the TV-Hilbert-L² model to obtain the fringe part, then perform MSR enhancement on the fringe part, and finally decompose the enhanced fringe part with TV-Hilbert-L² again. We evaluate the performance of this method via application to one computer-simulated noisy fringe projection pattern and two experimental fringe projection patterns with different types of patterns or letters, and comparison with the Fourier transform method, the variational image decomposition TV-Hilbert-L² model. Furthermore, we apply the proposed method to the dynamic three-dimensional shape measurement of hand posture with pattern. The experimental results show that our method can effectively measure the dynamic shape of objects with patterns or letters from a single-frame fringe projection pattern.

Blending Knowledge in Deep Recurrent Networks for Adverse Event Prediction at Hospital Discharge

Deep learning architectures have an extremely high-capacity for modeling complex data in a wide variety of domains. However, these architectures have been limited in their ability to support complex prediction problems using insurance claims data, such as readmission at 30 days, mainly due to data sparsity issue. Consequently, classical machine learning methods, especially those that embed domain knowledge in handcrafted features, are often on par with, and sometimes outperform, deep learning approaches. In this paper, we illustrate how the potential of deep learning can be achieved by blending domain knowledge within deep learning architectures to predict adverse events at hospital discharge, including readmissions. More specifically, we introduce a learning architecture that fuses a representation of patient data computed by a self-attention based recurrent neural network, with clinically relevant features. We conduct extensive experiments on a large claims dataset and show that the blended method outperforms the standard machine learning approaches.

Glochidion ellipticum Wight extracts ameliorate dextran sulfate sodium-induced colitis in mice by modulating nuclear factor kappa-light-chain-enhancer of activated B cells signalling pathway

OBJECTIVES

Glochidion ellipticum Wight is a medicinal plant, rich in polyphenols, frequently used by the indigenous communities of Bangladesh and possess with multiple health benefits. It exerts anti-inflammatory and antidiarrheal properties, but the detailed chemical constituents are yet to be elucidated.

METHODS

Glochidion ellipticum extracts were analyzed using ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometry and then tested by both lipopolysaccharide (LPS) induced inflammation of Raw 264.7 macrophage cells and dextran sulfate sodium (DSS) induced acute colitis model. Blood serum was taken for fluorescein isothiocyanate-dextran (FITC-dextran) measurement and tissue samples were used to perform histology, RT-PCR and Western blotting.

KEY FINDINGS

The extracts could lower the levels of nitric oxide (NO), reactive oxygen species (ROS) and pro-inflammatory cytokines significantly in LPS induced macrophage cells. The extracts could also reduce disease activity index (DAI) score, restore antioxidants and pro-oxidants and improve macroscopic and microscopic features of colonic tissues in DSS induced mice. Expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in protein level was markedly diminished (up to 51.21% and 71.11%, respectively) in the treatment groups compared to the model group of colitic mice.

CONCLUSIONS

Our findings suggested that G. ellipticum extracts ameliorate DSS colitis via blocking nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway, which make them to be potential candidates for further research against inflammation and colitis.

[Evaluation of the role of melatonin in the metastasis of papillary thyroid carcinoma]

Objective:To evaluate the level of melatonin and the role of melatonin in the metastasis of papillary thyroid carcinoma in patients with papillary thyroid carcinoma. Method:We measured serum melatonin levels in 81 patients with papillary thyroid carcinoma（PTC） ,20 patients with multinodular goiter（MNG） and 20 healthy adults using ELISA. The relationship between melatonin and clinicopathological features of PTC were analyzed.The expression of MT1 and MT2 in two subtypes of melatonin receptor in 81 cases of papillary thyroid carcinoma and adjacent tissues were detected by immunohistochemical SP method, and its the mean optical density（MOD） image was analyzed by Image Pro Plusversion（IPP） image processing software. Result:Serum melatonin concentration in patients with PTC was significantly higher than that in MNG patients and normal controls（P<0.05）. The level of melatonin in the primary tumor T≥2 cm group was significantly higher than that in the T<2 cm group. Patients with positive cervical lymph nodes（N≥1） had significantly higher melatonin levels than lymph node negatives（N=0）（P<0.05）. The MT1 and MT2 receptors were expressed in both PTC and paracancerous tissues, mainly in the cell membrane and cytoplasm. The expression of MT1 receptor was low in the two groups, and there was no statistical difference. The expression of MT2 receptor in PTC tissues Significantly higher than the adjacent tissues（P<0.05）, further studies showed that the expression of MT2 receptor in PTC tissues was associated with cervical lymph node metastasis, and the expression of MT2 receptor in PTC tissues with cervical lymph node metastasis was significantly lower than that without metastasis （P<0.05）. Conclusion:Serum melatonin levels in PTC patients were higher than those in MNG and control groups, which may be associated with low malignancy of PTC; melatonin inhibits PTC metastasis, which exerts anti-PTC metastasis mainly through MT2 receptors.

[Clinical study about anatomical and functional reconstruction for frontolateral vertical partial laryngectomy with ultrathin titanium mesh and fascia flap from the strap muscles]

Objective:To investigate the effect of laryngeal reconstruction in functional and anatomical aspect with ultrathin titanium mesh and myofascial flap in patients underwent frontolateral vertical partial laryngectomy with T2 and T3 glottic laryngeal carcinoma. Method:Ten patients with T2 and T3 glottic laryngeal carcinoma underwent frontolateral vertical partial laryngectomy in different range. The ultrathin titanium mesh was shaped up according to the form of thyroid cartilage in operation while the thyroid perichondrium membrane combined with straped myofascial flap was lined under the titanium mesh to restore the laryngeal cavity space. The pronunciation, swallowing capability and extubation rate were observed after surgery. Result:Nine patients underwent extubation within 2 to 4 weeks after surgery, one patients remove metal tube in two-stage after laryngeal dilation surgery with the Montgomery tube. Swallowing and voice function in these patients recovered well and no deglutition disorder was found. CT scan showed that the Titanium meshs were fixed well without displacement and deformity. Electronic laryngoscopy showed that the mucosa of laryngeal lumen was smooth without laryngeal stenosis, keloid contraction, tissue necrosis or titanium mesh exposure. Conclusion:In the cases of T2, T3 glottic laryngeal cancer patients, laryngeal framework reconstruction with the new type of ultrathin titanium mesh, thyroid cartilage membrane and pedicled fascia plap of strap muscles is a good choice after the vertical frontolateral partial laryngectomy. Even some elective T4 cases with the former part invasion in supra-glottic or infra-glottic region can receive this operation. It can reconstruct the physiological and anatomical structure of the larynx, restore laryngeal function with a sound decanulization rate.

RASSF1 promotes cardiomyocyte apoptosis after acute myocardial infarction and is regulated by miR-125b

Cardiomyocyte apoptosis is a common pathological injury in association with acute myocardial infarction (AMI). In the current study, the relationship between Ras-association domain family 1 (RASSF1) and cardiomyocyte apoptosis was investigated. RASSF1 was significantly over expressed in infarcted myocardial tissues as well as in cardiomyocytes induced by hypoxia. Inhibition of RASSF1 expression alleviated cardiomyocytes apoptosis induced by hypoxia in vitro and reduced cardiomyocytes apoptosis after AMI in vivo. RASSF1 expression was directly modulated by miR-125b, which was further confirmed by luciferase reporter assay. The current study verified that the miR-125b/RASSF1 axis was involved in cardiomyocytes apoptosis. To sum up, these results suggest that RASSF1 downregulation alleviated infarction-induced cardiomyocytes apoptosis and was regulated by miR-125b.

EnDisease: a manually curated database for enhancer-disease associations

Genome-wide association studies have successfully identified thousands of genomic loci potentially associated with hundreds of complex traits in the past decade. Nevertheless, the fact that more than 90% of such disease-associated variants lie in non-coding DNA with unknown functional implications has been appealing for advanced analysis of plenty of genetic variants. Toward this goal, recent studies focusing on individual non-coding variants have revealed that complex diseases are often the consequences of erroneous interactions between enhancers and their target genes. However, such enhancer-disease associations are dispersed in a variety of independent studies, and thus far it is still difficult to carry out comprehensive downstream analysis with these experimentally supported enhancer-disease associations. To fill in this gap, we collected experimentally supported associations between complex diseases and enhancers and then developed a manually curated database called EnDisease (http://bioinfo.au.tsinghua.edu.cn/endisease/). Concretely, EnDisease documents 535 associations between 133 diseases and 454 enhancers, extracted from 199 articles. Moreover, after annotating these enhancers using 649 human and 115 mouse DNase-seq experiments, we find that cancer-related enhancers tend to be open across a large number of cell types. This database provides a user-friendly interface for browsing and searching, and it also allows users to download data freely. EnDisease has the potential to become a helpful and important resource for researchers who aim to understand the molecular mechanisms of enhancers involved in complex diseases.

The distribution of large floating seagrass (Zostera marina) aggregations in northern temperate zones of Bohai Bay in the Bohai Sea, China

Seagrass meadows (Zostera marina) are important coastal ecosystems with high levels of productivity and biodiversity. They often have high biomass turnover and are susceptible to dislodgment, leading to export of biomass from seagrass beds. In September 2016, two cruises covering a total area of 52 km x 15 km (38°57'1.14"–39° 0'41.28" N, 118°45'23.22"–118°47'6.96" E) found floating Z. marina aggregations along 13 km of the transect in the northernmost area of Bohai Bay, in the Bohai Sea, China. This floating seagrass was 6.3–13.4 km northeast (offshore) of the Caofeidian seagrass bed, which is a large (10 km²) seagrass bed discovered in 2015 in the Bohai Sea, China. The modal length of floating intact shoots (from meristem to longest leaf tip) matched samples from the Caofeidian seagrass bed. The dominant individuals lengths were 40–50 cm, with less than 5% of the total number of individuals found in larger size categories (80–90 and 90–100 cm). We concluded that they originated from the nearby Caofeidian seagrass meadows.

Predictive Modeling of the Hospital Readmission Risk from Patients' Claims Data Using Machine Learning: A Case Study on COPD

Chronic Obstructive Pulmonary Disease (COPD) is a prevalent chronic pulmonary condition that affects hundreds of millions of people all over the world. Many COPD patients got readmitted to hospital within 30 days after discharge due to various reasons. Such readmission can usually be avoided if additional attention is paid to patients with high readmission risk and appropriate actions are taken. This makes early prediction of the hospital readmission risk an important problem. The goal of this paper is to conduct a systematic study on developing different types of machine learning models, including both deep and non-deep ones, for predicting the readmission risk of COPD patients. We evaluate those different approaches on a real world database containing the medical claims of 111,992 patients from the Geisinger Health System from January 2004 to September 2015. The patient features we build the machine learning models upon include both knowledge-driven ones, which are the features extracted according to clinical knowledge potentially related to COPD readmission, and data-driven features, which are extracted from the patient data themselves. Our analysis showed that the prediction performance in terms of Area Under the receiver operating characteristic (ROC) Curve (AUC) can be improved from around 0.60 using knowledge-driven features, to 0.653 by combining both knowledge-driven and data-driven features, based on the one-year claims history before discharge. Moreover, we also demonstrate that the complex deep learning models in this case cannot really improve the prediction performance, with the best AUC around 0.65.

[The anatomic characteristics and surgical treatment of congenital pyriform sinus fistula]

Objective:To discuss the clinical anatomic characteristics of congenital pyriform sinus fistula and summarize the experiences of open neck surgery. Method：The clinical data of 12 patients with congenital pyriform sinus fistula were retrospectively analyzed.Result:During the operation, all lesions were located below of superior laryngeal nerve. All fistulas were closely related with the supperior part of thyroid gland and laterally passed over the left recurrent laryngeal nerve just before merging into the apex of piriform sinus or beginning of aesophagus. Follow-up periods were ranging between 8 to 65 months. Two months after surgery,one patient showed lateral neck abscess again. After open drainage procedures and antibiotics treatment, there was no recurrence signs during 3 years of follow-up.Conclusion:We found that the congenital pyriform sinus fistula was closely related to the superior thyroid gland and recurrent laryngeal nerve,which was different from the popular theory.We had not encountered types descending into mediastinum and thoracic cavity or ascending along common carotid artery sheath. All fistulas passed over the left recurrent laryngeal nerve，and then merged into the apex of pyriform sinus or beginning of aesophagus.The key point for successful resection of fistulas in block was to remove the superior involvement part of the thyroid gland and exposure the recurrent laryngeal nerve. Based on our practical findings, the neck dissection procedure should not be taken in some patients that the anatomical structure is not clear for repeated infections.

Chain Trajectory, Chain Packing, and Molecular Dynamics of Semicrystalline Polymers as Studied by Solid-State NMR

Chain-level structure of semicrystalline polymers in melt- and solution-grown crystals has been debated over the past half century. Recently, 13C⁻13C double quantum (DQ) Nuclear Magnetic Resonance (NMR) spectroscopy has been successfully applied to investigate chain-folding (CF) structure and packing structure of 13C enriched polymers after solution and melt crystallization. We review recent NMR studies for (i) packing structure, (ii) chain trajectory, (iii) conformation of the folded chains, (iv) nucleation mechanisms, (v) deformation mechanism, and (vi) molecular dynamics of semicrystalline polymers.

Chromatin accessibility prediction via convolutional long short-term memory networks with k-mer embedding

Motivation

Experimental techniques for measuring chromatin accessibility are expensive and time consuming, appealing for the development of computational approaches to predict open chromatin regions from DNA sequences. Along this direction, existing methods fall into two classes: one based on handcrafted k-mer features and the other based on convolutional neural networks. Although both categories have shown good performance in specific applications thus far, there still lacks a comprehensive framework to integrate useful k-mer co-occurrence information with recent advances in deep learning.

Results

We fill this gap by addressing the problem of chromatin accessibility prediction with a convolutional Long Short-Term Memory (LSTM) network with k-mer embedding. We first split DNA sequences into k-mers and pre-train k-mer embedding vectors based on the co-occurrence matrix of k-mers by using an unsupervised representation learning approach. We then construct a supervised deep learning architecture comprised of an embedding layer, three convolutional layers and a Bidirectional LSTM (BLSTM) layer for feature learning and classification. We demonstrate that our method gains high-quality fixed-length features from variable-length sequences and consistently outperforms baseline methods. We show that k-mer embedding can effectively enhance model performance by exploring different embedding strategies. We also prove the efficacy of both the convolution and the BLSTM layers by comparing two variations of the network architecture. We confirm the robustness of our model to hyper-parameters by performing sensitivity analysis. We hope our method can eventually reinforce our understanding of employing deep learning in genomic studies and shed light on research regarding mechanisms of chromatin accessibility.

Availability and implementation

The source code can be downloaded from https://github.com/minxueric/ismb2017_lstm.

Supplementary information

Supplementary materials are available at Bioinformatics online.

Crystal structure of Psb27 from Arabidopsis thaliana determined at a resolution of 1.85 Å

Proper biogenesis and maintenance of photosynthetic thylakoid membrane complexes are essential for the photosynthetic light reactions. A thylakoid lumenal protein, Psb27, plays a vital role in assembly or/and maintenance of photosystem II (PSII). In cyanobacteria, it is a small lipoprotein docked to the lumenal side of PSII, and functions in the assembly of the Mn₄Ca cluster and in the PSII repair cycle. However, Psb27 from Arabidopsis thaliana is not a lipoprotein, and it is involved in PSII repair and acclimation to fluctuating light stress, suggesting a functional divergence between Arabidopsis Psb27 and cyanobacterial Psb27s. To gain a better understanding of Psb27 from higher plants, we determined the crystal structure of Arabidopsis Psb27 by X-ray crystallography at a resolution of 1.85 Å. The structure of Arabidopsis Psb27 is a four-helix bundle, similar to its orthologues from cyanobacteria. However, there are several structural differences between Arabidopsis Psb27 and cyanobacterial Psb27s concerning the overall molecular shape, the N- and C-terminal structures, and the surface charge. These differences suggest that Psb27 from higher plants and cyanobacteria may function differently.

Design and Synthesis of Piperazine Sulfonamide Cores Leading to Highly Potent HIV-1 Protease Inhibitors

Using the HIV-1 protease binding mode of MK-8718 and PL-100 as inspiration, a novel aspartate binding bicyclic piperazine sulfonamide core was designed and synthesized. The resulting HIV-1 protease inhibitor containing this core showed an 60-fold increase in enzyme binding affinity and a 10-fold increase in antiviral activity relative to MK-8718.

Predicting enhancers with deep convolutional neural networks

Background

With the rapid development of deep sequencing techniques in the recent years, enhancers have been systematically identified in such projects as FANTOM and ENCODE, forming genome-wide landscapes in a series of human cell lines. Nevertheless, experimental approaches are still costly and time consuming for large scale identification of enhancers across a variety of tissues under different disease status, making computational identification of enhancers indispensable.

Results

To facilitate the identification of enhancers, we propose a computational framework, named DeepEnhancer, to distinguish enhancers from background genomic sequences. Our method purely relies on DNA sequences to predict enhancers in an end-to-end manner by using a deep convolutional neural network (CNN). We train our deep learning model on permissive enhancers and then adopt a transfer learning strategy to fine-tune the model on enhancers specific to a cell line. Results demonstrate the effectiveness and efficiency of our method in the classification of enhancers against random sequences, exhibiting advantages of deep learning over traditional sequence-based classifiers. We then construct a variety of neural networks with different architectures and show the usefulness of such techniques as max-pooling and batch normalization in our method. To gain the interpretability of our approach, we further visualize convolutional kernels as sequence logos and successfully identify similar motifs in the JASPAR database.

Conclusions

DeepEnhancer enables the identification of novel enhancers using only DNA sequences via a highly accurate deep learning model. The proposed computational framework can also be applied to similar problems, thereby prompting the use of machine learning methods in life sciences.

Association of the neoadjuvant chemotherapy cycle with survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma: a propensity-matched analysis

Neoadjuvant chemotherapy (NAC) is widely used to treat locoregionally advanced nasopharyngeal carcinoma (NPC). To determine the optimal number of NAC cycles, we assessed the effect of NAC cycle on survival outcomes of locoregionally advanced NPC patients receiving NAC before concurrent chemotherapy and intensity-modulated radiotherapy. Clinical data from 1,188 non-metastatic NPC patients were retrospectively reviewed. All received ≥2 cycles of NAC added to concurrent chemoradiotherapy. Propensity score matching (PSM) was used to identify paired patients according to various covariates. In total, 297 pairs were selected. After a median follow-up time of 57 months (range: 7 to 104 months), the 5-year locoregional relapse-free survival, distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival rates in patients treated with 2 cycles vs. 3 to 4 cycles of NAC were 91.3% vs. 87.2% (P=0.149), 93.3% vs. 88.5% (P=0.043), 88.7% vs. 81.7% (P=0.037), and 94.0% vs. 92.6% (P=0.266), respectively. On multivariate analysis, 2 cycles of NAC were associated with improved DMFS (hazard ratio, 0.499; P=0.038) and PFS (hazard ratio, 0.585; P=0.049). NAC cycle was an independent prognosticator of DMFS and PFS in univariate and multivariate analyses. Thus, 2 cycles of NAC appear sufficient, as additional cycles were not associated with added survival benefit for locoregionally advanced NPC.

The correlation between renal transplantation and liver carcinoma: a meta-analysis

OBJECTIVE

Much of the related researches have reported the correlation between renal transplantation and different tumors in the post transplant recipients. However, there are not exact essays revealed that renal transplantation is definite causation for liver carcinoma, thus we systematically evaluated the association between renal transplantation and the risk of liver carcinoma in this meta-analysis from all available researches.

METHODS

All useful data were collected through searching of PubMed and Web of Science until the date of 31 September 2015. Random-effects model were adopted to calculate the standardized incidence ratio and 95% confidence interval (CIs) of the risk of liver carcinoma among renal transplant recipients. Other statistical analyses like heterogeneity tests, sensitivity analysis and publication bias were also performed in this meta-analysis.

RESULTS

Among 17,4256 kidney transplant cases and 25,6736 patients-years observation, 9136 post-transplant cancers were diagnosed. We identified a 2.08-fold higher standardized incidence rate (SIR) (95% confidence interval (CI): 1.24-3.47, P=0.005) of liver carcinoma following renal transplantation compared with the general population. Observation and publication bias were not observed in this study.

CONCLUSION

This study suggested that the risk of liver carcinoma among renal transplant recipients with chronic hepatic disease is higher than general population. Such results alert clinical doctors the importance of anti-virus therapy with chronic virus hepatitis and enough attention of periodic liver screening with chronic liver diseases in renal transplant recipients.

[Primary malignant tumor of uvula: report of 3 cases and review of the literature]

We retrospectively analyzed 3 middle-aged male patients of primary malignant tumor of uvula. There was a long history of smoking and drinking for the patients. All of them came to the hospital with the syptoms of pharyngeal foreign body sensation and two of them had pharyngeal sore. The patients appeared well, new neoplasm at the apex of the uvula. Diameter of 2 cases were less than 1 cm without invading the midline of the soft palate. Another patient's diameter was more than 1 cm with invading the midline of the soft palate. Preoperative pathology diagnosis of 3 patients was squamous cell carcinoma of uvula. The pharyngeal CT of the patient with invading the midline of the soft palate showed nodules at the end of the soft palate, obviously enhancement and small lymph node in left neck.

Addition of 5-fluorouracil to first-line induction chemotherapy with docetaxel and cisplatin before concurrent chemoradiotherapy does not improve survival in locoregionally advanced nasopharyngeal carcinoma

Although a multicenter, randomized study indicated that induction chemotherapy (IC) with docetaxel/cisplatin/fluorouracil (TPF) before concurrent chemoradiotherapy (CCRT) improves survival outcomes, it remains unclear whether TPF is the best IC regimen for treating locoregionally advanced nasopharyngeal carcinoma (NPC). Our aim was to compare the efficacy and toxicities of TPF vs. docetaxel/cisplatin (TP) IC followed by CCRT in patients with locoregionally advanced NPC. One hundred thirty-two patients with locoregionally advanced NPC received 21-day cycles of IC with either TPF or TP. Both were followed by intensity-modulated radiotherapy concurrent with the cisplatin treatment every 3 weeks. Three-year rates of locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were respectively 96.4%, 87.7%, 86.0%, and 94.7% for patients in the TPF arm patients and 90.3%, 91.9%, 85.2%, and 92.0% for patients in the TP arm. There were no differences in survival between the two arms. Multivariate analysis revealed the IC regimen was not an independent prognostic factor for any survival outcome. However, patients in the TP arm experienced fewer grade 3/4 toxicities. In sum, IC with docetaxel and cisplatin is associated with similar efficacy and less toxicity than the TPF regimen. Addition of fluorouracil to docetaxel plus cisplatin IC is therefore not recommended for patients with locoregionally advanced NPC.

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Background

The application of mycophenolate mofetil (MMF) in treating patients with immunoglobulin A nephropathy (IgAN) remains uncertain. This update meta-analysis was performed to re-evaluate the therapeutic potential of MMF in IgAN.

Methods

Articles were obtained by searching the electronic databases without language restriction. Randomized controlled trials studying the role of MMF in treating IgAN were collected. The quality of included studies was critically evaluated. Data analyses were performed by using RevMan 5.3 software.

Results

A total of 297 articles were screened and eight articles were finally included. Among the eight randomized controlled trials, five and three were high quality and low quality, respectively. Both fixed-effect and random-effect model were used. Pooled results by combining all the eight studies suggested that IgAN patients in MMF group had a higher remission rate than that in control group. Compared to placebo or corticosteroid monotherapy, MMF monotherapy exerted a higher remission rate and side effect rate in both main analysis and subgroup analysis by human race. Compared to corticosteroid plus other immunosuppressive agent therapy, corticosteroid plus MMF therapy had a higher remission rate, lower serum creatinine doubling rate, progression to end-stage renal disease rate and side effects rate. Subgroup analysis by therapeutic regimen further confirmed these results between corticosteroid plus MMF therapy and corticosteroid plus cyclophosphamide therapy. Funnel-plot displayed a symmetrical figure, indicating no publication bias existed.

Conclusions

MMF has the potential in treatment of IgAN, especially for Asians. The evidence currently available shows that MMF monotherapy has a more efficacy but higher side effects when compared to placebo or corticosteroid monotherapy in treatment of Asians with IgAN. While MMF combined with corticosteroid regimen has a more efficacy and lower side effects when compared with corticosteroid plus cyclophosphamide regimen.

Gemcitabine/cisplatin induction chemotherapy before concurrent chemotherapy and intensity-modulated radiotherapy improves outcomes for locoregionally advanced nasopharyngeal carcinoma

Addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CC) is an encouraging first-line treatment strategy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We evaluated the clinical efficacy and toxicity of addition of gemcitabine plus cisplatin (GP) IC to intensity-modulated radiotherapy (IMRT) and CC for patients with locoregionally advanced NPC. At a median follow-up duration of 48 months (10-59 months), 4-year local relapse-free survival (LRFS) was 86.9%, regional relapse-free survival (RRFS) was 90.6%, distant metastasis-free survival (DMFS) was 79.8%, progression-free survival (PFS) was 77.0%, and overall survival (OS) was 81.9%. Univariate analysis revealed that T stage, N stage, clinical stage, and CC correlated with OS, while N stage and clinical stage correlated with PFS. In multivariate analysis, T4 was a prognostic indicator of poor OS and PFS, and N3 was a prognostic indicator of poor OS. Having received ≥ 2 cycles of IC was prognostic of better RRFS. During IC, grade 3-4 thrombocytopenia occurred in 10 patients, and grade 3-4 leukocytopenia was observed in 16 patients. Two patients developed mild liver dysfunction. These findings indicate that GP-based IC followed by CC has promising efficacy with acceptable toxicities.

Anatomical structure of the coracohumeral ligament and its effect on shoulder joint stability

BACKGROUND

In this study, coracohumeral ligament (CHL) specimens were carefully dissected to observe its length, width, thickness and tension at different positions of the shoulder joint, thereby elucidating its effects on shoulder joint stability.

MATERIALS AND METHODS

Fresh frozen shoulder joints from 40 normal adult cadaveric specimens were dissected to reveal the CHL. With the shoulder joints placed at different positions, the length of the CHL and the width and thickness of the middle part of the ligament were measured. The changes in tension of the CHL were also observed. When the shoulder joint maintained the neutral position, the length of the CHL was 52.23 ± 1.02 mm and the width and thickness of the middle part of the ligament were 15.95 ± 0.59 mm and 1.46 ± 0.06 mm, respectively.

RESULTS

When the shoulder joint moved from the neutral position to 90° external rotation, from the neutral position to 30° adduction or from the neutral position to 30° flexion/extension or when the shoulder joint is pulled down with a 5 kg weight, the CHL was elongated and thinned, maintaining a strained state. When the shoulder joint moved from the neutral position to 90° internal rotation, from the neutral position to 90° abduction or from the neutral position to 30° flexion/ extension, the CHL was shortened and thickened, maintaining a relaxed state.

CONCLUSIONS

The CHL may limit the external rotation, adduction and downward movement of the shoulder joint and the process from the neutral position to the 30° flexion/extension, maintaining shoulder joint stability.

Therapy of tacrolimus combined with corticosteroids in idiopathic membranous nephropathy

We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4–8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.

Role of Nuclear Factor Erythroid 2-Related Factor 2 in Diabetic Nephropathy

Diabetic nephropathy (DN) is manifested as increased urinary protein level, decreased glomerular filtration rate, and final renal dysfunction. DN is the leading cause of end-stage renal disease worldwide and causes a huge societal healthcare burden. Since satisfied treatments are still limited, exploring new strategies for the treatment of this disease is urgently needed. Oxidative stress takes part in the initiation and development of DN. In addition, nuclear factor erythroid 2-related factor 2 (Nrf2) plays a key role in the cellular response to oxidative stress. Thus, activation of Nrf2 seems to be a new choice for the treatment of DN. In current review, we discussed and summarized the therapeutic effects of Nrf2 activation on DN from both basic and clinical studies.

[Oncomelania hupensis snail distribution in working areas of Yangtze River hydrologic agencies located in middle and lower reaches of Yangtze River in 2016]

OBJECTIVE

To understand the Oncomelania hupensis snail distribution in the working areas of Yangtze River hydrologic agencies located in the middle and lower reaches of the Yangtze River in 2016, so as to provide the evidence for assessing the risk of schistosome infection of hydrological workers and establishing the control strategies.

METHODS

The suspicious environments with O. hupensis snails in the above working areas were selected as study areas, and the snail situation was surveyed by the system sampling method combined with the environmental sampling method. The survey data were collected and analyzed statistically.

RESULTS

Totally 19 working areas from 17 hydrological agencies were selected as the investigation sites, among which, 10 working areas from 9 agencies were found with O. hupensis snail distribution. The constituent ratio of the areas with snails reached to 38.81% of the investigation areas, the occurrence rate of frames with snails was 3.08%, and the average density of living snails was 0.07 /0.1 m². By comparison, the average density of living snails and occurrence rate of frames with snails in hydrological agencies under the jurisdiction of the Middle Reaches Administrative Bureau were the most serious among three administrative bureaus of the Yangtze River Water Resources Commission.

CONCLUSIONS

There are various degrees of O. hupensis breeding in the working areas of hydrological agencies located in the middle and lower reaches of the Yangtze River, and the hydrological workers are facing with the risk of schistosome infection.

A starfish robot based on soft and smart modular structure (SMS) actuated by SMA wires

This paper describes the design, fabrication and locomotion of a starfish robot whose locomotion principle is derived from a starfish. The starfish robot has a number of tentacles or arms extending from its central body in the form of a disk, like the topology of a real starfish. The arm, which is a soft and composite structure (which we call the smart modular structure (SMS)) generating a planar reciprocal motion with a high speed of response upon the actuation provided by the shape memory alloy (SMA) wires, is fabricated from soft and smart materials. Based on the variation in the resistance of the SMA wires during their heating, an adaptive regulation (AR) heating strategy is proposed to (i) avoid overheating of the SMA wires, (ii) provide bending range control and (iii) achieve a high speed of response favorable to successfully propelling the starfish robot. Using a finite-segment method, a thermal dynamic model of the SMS is established to describe its thermal behavior under the AR and a constant heating strategy. A starfish robot with five SMS tentacles was tested with different control parameters to optimize its locomotion speed. As demonstrated in the accompanying video file, the robot successfully propelled in semi-submerged and underwater environments show its locomotion ability in the multi-media, like a real starfish. The propulsion speed of the starfish robot is at least an order of magnitude higher than that of those reported in the literature-thanks to the SMS controlled with the AR strategy.

Discovery of MK-8718, an HIV Protease Inhibitor Containing a Novel Morpholine Aspartate Binding Group

A novel HIV protease inhibitor was designed using a morpholine core as the aspartate binding group. Analysis of the crystal structure of the initial lead bound to HIV protease enabled optimization of enzyme potency and antiviral activity. This afforded a series of potent orally bioavailable inhibitors of which MK-8718 was identified as a compound with a favorable overall profile.

Environmental context for the terminal Ediacaran biomineralization of animals

In terminal Ediacaran strata of South China, the onset of calcareous biomineralization is preserved in the paleontological transition from Conotubus to Cloudina in repetitious limestone facies of the Dengying Formation. Both fossils have similar size, funnel-in-funnel construction, and epibenthic lifestyle, but Cloudina is biomineralized, whereas Conotubus is not. To provide environmental context for this evolutionary milestone, we conducted a high-resolution elemental and stable isotope study of the richly fossiliferous Gaojiashan Member. Coincident with the first appearance of Cloudina is a significant positive carbonate carbon isotope excursion (up to +6‰) and an increase in the abundance and (34) S composition of pyrite. In contrast, δ(34) S values of carbonate-associated sulfate remain steady throughout the succession, resulting in anomalously large (>70‰) sulfur isotope fractionations in the lower half of the member. The fractionation trend likely relates to changes in microbial communities, with sulfur disproportionation involved in the lower interval, whereas microbial sulfate reduction was the principal metabolic pathway in the upper. We speculate that the coupled paleontological and biogeochemical anomalies may have coincided with an increase in terrestrial weathering fluxes of sulfate, alkalinity, and nutrients to the depositional basin, which stimulated primary productivity, the spread of an oxygen minimum zone, and the development of euxinic conditions in subtidal and basinal environments. Enhanced production and burial of organic matter is thus directly connected to the carbon isotope anomaly, and likely promoted pyritization as the main taphonomic pathway for Conotubus and other soft-bodied Ediacara biotas. Our studies suggest that the Ediacaran confluence of ecological pressures from predation and environmental pressures from an increase in seawater alkalinity set the stage for an unprecedented geobiological response: the evolutionary novelty of animal biomineralization.

Association of CYP1A1 MspI polymorphism with oral cancer risk in Asian populations: a meta-analysis

Numerous studies regarding the association between the CYP1A1 MspI polymorphism and oral cancer risk in Asian populations have shown controversial results. To get a more precise estimation of this relationship, we conducted a comprehensive meta-analysis. PubMed, the Cochrane Library, Elsevier Science Direct, Web of Knowledge, the Chinese National Knowledge Infrastructure, VIP, and Wan Fang Med Online were searched. Pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated using fixed-effects or random-effects models. Heterogeneity among studies was assessed using the Cochran Q test and I(2) statistics. Twelve articles including 1925 oral cancer patients and 2335 controls were ultimately included in the meta-analysis. Overall, the meta-analysis showed that the CYP1A1 MspI polymorphism was associated with oral cancer risk in Asians (m1/m1 vs m2/m2: OR = 0.46, 95%CI = 0.30-070, POR = 0.000; m1/m1 vs m1/m2+m2/m2: OR = 0.70, 95%CI = 0.51-0.98, POR = 0.037; m1/m1+m1/m2 vs m2/m2: OR = 0.48, 95%CI = 0.35-0.65, POR = 0.000). Subgroup analyses showed that the control source (hospital-based or population-based), the genotyping method [polymerase chain reaction (PCR) or PCR-restriction fragment length polymorphism], the country in which the study was conducted, and Hardy-Weinberg equilibrium (Yes or No) were positively related to the association. Sensitivity analysis suggested that the overall results showed no significant change in three genetic models when any one study was removed, and publication bias was undetected by the Egger test. The CYP1A1 MspI polymorphism may be associated with oral cancer risk in Asian populations.

[The resection of a giant recurrent parotid gland tumor]

This paper report a case of a giant recurrent tumor arising in the parotid gland. The patient presents as a tumor for 20 years on her left parotid region showing a rapid increase in the dimensions during the latest 3 months. The computed tomography scan and fine needle aspiration cytology (FNAC) showed it most likely to be a pleomorphic adenoma. The tumor was completely resected with preservation of the facial nerve under general anesthesia. Macroscopically, the excised tumor was measured 21 cm×13 cm×10 cm in scale, and weighed 1.730 kg. Histopathological examination of the excised tumor revealed a recurrent pleomorphic adenoma. Postoperatively, the facial nerve function was normal with an excellent aesthetic outcome.

Effect of oral contraceptive use on the incidence of dry socket in females following impacted mandibular third molar extraction: a meta-analysis

The aim of this comprehensive meta-analysis was to provide evidence-based data to test whether oral contraceptive (OC) use can promote the incidence of dry socket (DS) in females following impacted mandibular third molar extraction. PubMed, the Cochrane Library, and Elsevier Science Direct databases were searched. The pooled risk ratio (RR) with 95% confidence interval (CI) was calculated using fixed-effects or random-effects model analysis. Heterogeneity among studies was evaluated with the Cochran test and I(2) statistic. Study quality was assessed with the Newcastle-Ottawa scale. Of 70 articles identified in the search, 12 reporting 16 clinical controlled trials were included in this study. The incidence of DS was significantly greater in the OC groups than in the control groups (RR 1.80, 95% CI 1.33-2.43). Subgroup analyses showed that the unit assessed (tooth or patient), the region in which the study was conducted, and the intervention were not related to the incidence of DS in females taking OC after impacted mandibular third molar extraction. The sensitivity analysis showed no significant change when any one study was excluded. Publication bias was also not detected. This study suggests that OC use may promote the incidence of DS in females following impacted mandibular third molar extraction.

Effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury

AIM

To investigate the effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury.

MATERIAL AND METHODS

A retrospective analysis was performed in 186 hospitalized patients from January, 2008 to January, 2012 in the Affiliated Hospital of Jiangsu University. Demographic data, the abnormality of pupils, and Glasgow Coma Scale (GCS) before operation, and gradient decompression measures, and intraoperative hypotension during operation, and mortality after operation were recorded. Gradient decompression measures were mannitol, hyperventilation, graded craniotomy, and Chi-square test was conducted to evaluate the association of gradient decompression with intraoperative hypotension and prognosis.

RESULTS

All the gradient decompression measures were shown non-significantly associated with the occurrence of intraoperative hypotension and prognosis, including mannitol (p=0.852, p=0.328), hyperventilation (p=0.484, p=0.619) and graded craniotomy (p=0.326, p=0.605). Mannitol with hyperventilation (p=0.733, p=0.758), mannitol with graded craniotomy (p=0.319, p=1.000), hyperventilation with graded craniotomy (p=0.269, p=0.685) and all the three measures (p=0.135, p=0.589) were also non-significantly associated with the occurrence of intraoperative hypotension and prognosis. The abnormality of pupils (p=0.006), GCS (p<0.001) and hypotension (p=0.006) were closely associated with the prognosis.

CONCLUSION

Gradient decompression is not effective in avoiding the occurrence of intraoperative hypotension and improving the prognosis. It provides a new insight into clinical measures for curing patients with severe traumatic brain injury (sTBI).