[Pulmonary nuclear protein of the testis midline carcinoma:a case report]

Nuclear protein of the testis (NUT) midline carcinoma (NMC) is a rare malignant epithelial tumor that typically occurs in the midline regions such as the head, neck, and mediastinum. This tumor is characterized by rapid development, aggressive growth, and strong invasiveness. Due to its short duration, most patients are diagnosed at advanced stages, often leading to rapid mortality. Although reports on pulmonary NUT carcinoma are uncommon, this article presents a case of pulmonary NUT carcinoma in which the patient repeatedly expectorated bronchial casts and tumor tissue. Additionally, a comprehensive review of relevant literature from recent years is provided to enhance understanding of this disease.

[Epidemiological trend of early-onset gastric cancer and late-onset gastric cancer in China from 2000 to 2019]

Objective: In order to understand the changing trends of gastric cancer incidence and mortality in early-onset and late-onset in China from 2000 to 2019. Methods: The Global Burden of Disease research data was collected, and Excel and R 4.2.1 softwares were used to examine the incidence rate, mortality rate, and disability-adjusted life years (DALY) of Chinese people from 2000 to 2019, with a focus on gender, age, and year. Results: In 2019, the crude incidence rates were 7.06/100 000 (95%UI: 6.63/100 000-7.59/100 000) and 114.52/100 000 (95%UI: 108.79/100 000-121.63/100 000) for early- and late-onset gastric cancer, respectively. The crude mortality rate for early-onset gastric cancer was 3.29/100 000 (95%UI: 3.11/100 000- 3.50/100 000), while the crude mortality rate for late-onset gastric cancer was 81.88/100 000 (95%UI: 78.15/100 000-86.04/100 000). Additionally, the crude DALY rates for these two types of gastric cancer were 156.48/100 000 (95%UI: 148.82/100 000-165.84/100 000) and 1 750.13/100 000 (95%UI: 1 661.21/100 000-1 852.99/100 000). The standardized incidence of early-onset gastric cancer decreased from 5.49/100 000 in 2000 to 4.76/100 000 in 2019, and that of late-onset gastric cancer decreased from 143.45/100 000 in 2000 to 123.02/100 000 in 2019.The standardized mortality rate of early-onset gastric cancer decreased from 4.16/100 000 in 2000 to 2.18/100 000 in 2019, and that of late-onset gastric cancer decreased from 140.82/100 000 in 2000 to 91.49/100 000 in 2019. The standardized DALY rate for early-onset gastric cancer in 2019 was 105.87/100 000 (95%UI: 87.98/100 000 -125.60/100 000), lower than 198.84/100 000 (95%UI: 179.47/100 000- 219.83/100 000) in 2000. The standardized DALY rate for late onset gastric cancer in 2019 was 1 821.11/100 000 (95%UI: 1 509.42/100 000-2 158.53/100 000), lower than 2 932.52/100 000 (95%UI: 2 665.92/100 000-3 252.60/100 000) in 2000. Conclusions: The standardized mortality rate of early-onset gastric cancer in China showed a decreasing trend from 2000 to 2019. The standardized mortality rate of late onset gastric cancer showed a trend of first increasing and then decreasing. Notably, the incidence, mortality, and DALY of late-onset gastric cancer were significantly higher than those of early-onset gastric cancer during this period. Additionally, male incidence, mortality, and crude DALY rates were higher than female.

[Clinical observation of spontaneous brain activity in children with congenital cortical cataract amblyopia]

Objective: To investigate the characteristics of spontaneous brain activity in children with congenital cortical cataract amblyopia. Methods: A cross-sectional study was conducted. Twenty cases of unilateral congenital cortical cataract amblyopia (unilateral amblyopia group) and 14 cases of bilateral congenital cortical cataract amblyopia (bilateral amblyopia group) were enrolled from January 2022 to December 2022 at the First Affiliated Hospital of Zhengzhou University. Seventeen age and gender matched children with normal visual acuity were recruited as the healthy control group. Resting-state functional MRI (fMRI) was performed on all participants, and the amplitude of low-frequency fluctuations (ALFF) technique was used to analyze their spontaneous brain activities. The original ALFF value of each voxel was divided by the average ALFF value of the whole brain to obtain the standardized ALFF value (referred to as ALFF value), which reflected the intensity of spontaneous brain activity in different brain regions. General demographic data were compared using one-way analysis of variance, Kruskal-Wallis test, and chi-square test. Comparison of ALFF values was conducted using one-way analysis of variance. Results: There were no significant differences in age, gender, distribution of amblyopic eye or non-dominant eye, and degree of refractive error among the three groups (all P>0.05). Compared to the healthy control group, the unilateral amblyopia group showed higher ALFF values in the right posterior lobe of the cerebellum (67 voxels, t=3.48) and left posterior lobe of the cerebellum (71 voxels, t=4.09), and lower ALFF values in the right postcentral gyrus (91 voxels, t=-3.91), right inferior parietal lobule (73 voxels, t=-4.88), right inferior frontal gyrus (78 voxels, t=-4.09), left inferior parietal lobule (556 voxels, t=-4.82), and left inferior frontal gyrus (122 voxels, t=-4.27) (all P<0.01). The bilateral amblyopia group showed higher ALFF values in the right insula (60 voxels, t=3.54), right Rolandic operculum (69 voxels, t=3.73), right posterior lobe of the cerebellum (54 voxels, t=3.43), and left posterior lobe of the cerebellum (143 voxels, t=3.69), and lower ALFF values in the left inferior frontal gyrus (99 voxels, t=-4.39), left postcentral gyrus (231 voxels, t=-4.28), and right inferior parietal lobule (54 voxels, t=-3.77) (all P<0.01). Compared to the unilateral amblyopia group, the bilateral amblyopia group showed higher ALFF values in the left middle frontal gyrus (52 voxels, t=3.15, P=0.029), left posterior lobe of the cerebellum (77 voxels, t=3.39, P=0.001), and right Rolandic operculum (53 voxels, t=3.59, P=0.007). Conclusion: Children with congenital cortical cataract amblyopia exhibit altered spontaneous brain activity in multiple brain regions, and there are differences in spontaneous brain activity changes between unilateral and bilateral amblyopia.

[A prospective randomized controlled study of antibiotic bone cement in the treatment of diabetic foot ulcer]

Objective: To investigate the clinical effects and related mechanism of antibiotic bone cement in treating diabetic foot ulcer (DFU). Methods: A prospective randomized controlled study was conducted. From August 2020 to August 2022, 24 patients with DFU who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. According to the block randomization, the patients were divided into 2 groups, with 12 patients in each group. In antibiotic bone cement group, there were 7 male and 5 female patients, aged (64±8) years, with the ulcer area of (41±21) cm2. In silver sulfadiazine group, there were 8 male and 4 female patients, aged (62±8) years, with the ulcer area of (38±19) cm2. Under the condition of ensuring the patency of at least one main inferior genicular artery in each patient, the continuous vacuum sealing drainage was performed for 3-5 days after thorough debridement. Thereafter, the wounds in antibiotic bone cement group were treated with gentamicin-laden bone cement, and the wounds in silver sulfadiazine group were treated with silver sulfadiazine cream for dressing change. After 3 weeks of dressing change, the wound was covered with split-thickness skin graft from the lateral thigh on the affected side. Before debridement and after 3 weeks of dressing change, the blood flow intensities of wound tissue and normal skin tissue in foot were measured using laser Doppler flowmeter, and then, the percentage of relative blood flow intensity of wound and the change rate of blood flow intensity were calculated. After 3 weeks of dressing change, the wound margin tissue was taken, the number of CD31-positive neovascular and the vascular morphology were observed and detected by immunohistochemical staining, the morphology of blood vessels surrounded by CD31 and α-smooth muscle actin (α-SMA) double-positive cells was observed by immunofluorescence staining, the cell proliferation activity was evaluated by immunofluorescence staining (denoted as the ratio of Ki67 positive cells), and the protein expression of vascular endothelial growth factor receptor 2 (VEGFR2) was detected by Western blotting. The skin graft survival was observed 3-5 days after skin grafting, and the wound healing time was recorded. Data were statistically analyzed with independent sample t test and Fisher's exact probability test. Results: The percentages of relative blood flow intensity of wounds of patients before debridement were similar between the two groups (P>0.05). After 3 weeks of dressing change, the percentage of relative blood flow intensity of wounds and the change rate of blood flow intensity of patients in antibiotic bone cement group were (44.7±2.0)% and (129±12)%, respectively, which were significantly higher than (28.3±1.2)% and (41±8)% in silver sulfadiazine group (with t values of 24.15 and 20.97, respectively, P<0.05). After 3 weeks of dressing change, compared with those in silver sulfadiazine group, the number of CD31-positive neovascular in the wound margin tissue of patients in antibiotic bone cement group was significantly increased (t=33.81, P<0.05) with larger diameter and more regular arrangement, the vascular wall continuity surrounded by CD31 and α-SMA double-positive cells was better, and the ratio of Ki67 positive cells and protein expression of VEGFR2 were significantly increased (with t values of 40.97 and 47.38, respectively, P<0.05). On post skin grafting day 3-5, all the patients in antibiotic bone cement group and 8 patients in silver sulfadiazine group had good skin graft survival, while 4 patients in silver sulfadiazine group showed spotted/patchy skin graft necrosis, which were cured after corresponding treatment. The wound healing time of patients in antibiotic bone cement group was (47.1±2.9) d, which was significantly shorter than (58.8±2.3) d in silver sulfadiazine group (t=10.86, P<0.05). Conclusions: Compared with silver sulfadiazine, clinical application of antibiotic bone cement for treating DFU has the characteristics of accelerating wound healing and better reconstruction of local blood flow, which may be closely related to the fact that antibiotic bone cement promoted the local angiogenesis effectively in the wound through enhancing the expression of VEGFR2.

[Research advances in classifications and functions of retinal ganglion cells]

Retinal ganglion cells (RGCs) are the most important type of neurons in the visual pathway. RGC axons exit the eye to form the optic nerve, which connects with the brain. The visual signals carried by RGC axons establish the only link between the outside world and our internal perception of sight. Researches on the morphological, physiological, molecular, and mosaic features of RGCs are of great significance. This article reviews the research advances of RGC classifications, definitive types of RGCs, and selective vulnerability of specific RGC types after various injuries.

[Preliminary efficacy of ab interno canaloplasty combined with micro-incision cataract surgery in primary open angle glaucoma combined with cataract: one-year results]

Objective: To evaluate the preliminary efficacy and safety of ab interno canaloplasty (ABiC) combined with micro-incision cataract surgery for treating primary open angle glaucoma (POAG) combined with cataract. Methods: Prospective case series study. Patients diagnosed with POAG and concurrent cataract were enrolled to receive ABiC combined with micro-incision phacoemulsification and intraocular lens implantation in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2018 to October 2019. Intraocular pressure (IOP), use of hypotensive medications, visual acuity, visual field, and optic nerve at baseline as well as at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively were assessed. Subgroup analyses were further performed to evaluate these data between controlled and uncontrolled POAG, as well as among mild, moderate, and advanced POAG. Success rate and complications were analyzed. Results: A total of 68 eyes in 42 patients completed a follow-up of 12 months. Compared to the baseline IOP under medical control [(18.25±2.65) mmHg (1 mmHg=0.133 kPa)], the mean postoperative IOP at 1 month [(14.31±3.25) mmHg], 3 months [(14.00±3.09) mmHg], 6 months[ (14.58±2.93) mmHg], and 12 months[ (14.84±2.73) mmHg] was all significantly reduced (P<0.05). The median (upper quadrant, lower quadrant) of the hypotensive medication number was 2.5 (2, 3) at baseline, which was significantly reduced to 0 (0, 1) at 1 month, and 0 (0, 0) at 3, 6, and 12 months (P<0.05). The complete success rate and qualified success rate at 12 months were 80.88%(55/68) and 89.71%(61/68), respectively. No deterioration in the visual field or optical coherence tomography scan of the optic nerve was observed at 12 months compared to the baseline status. Hyphema (26 eyes, 38.24%) and transient IOP spike (23 eyes, 33.82%) were the most common complications, but no severe case was present. Conclusion: ABiC combined with micro-incision cataract surgery is considerably effective and safe in the treatment of POAG combined with cataract in the Chinese population.

[Effects of exosomes from human adipose-derived mesenchymal stem cells on pulmonary vascular endothelial cells injury in septic mice and its mechanism]

Objective: To investigate the effects of exosomes from human adipose-derived mesenchymal stem cells (ADSCs) on pulmonary vascular endothelial cells (PMVECs) injury in septic mice and its mechanism. Methods: The experimental research method was adopted. The primary ADSCs were isolated and cultured from the discarded fresh adipose tissue of 3 patients (female, 10-25 years old), who were admitted to the First Affiliated Hospital of Air Force Medical University undergoing abdominal surgery, and the cell morphology was observed by inverted phase contrast microscope on the 5th day. The expressions of CD29, CD34, CD44, CD45, CD73, and CD90 of ADSCs in the third passage were detected by flow cytometry. The third to the fifth passage of ADSCs were collected, and their exosomes from the cell supernatant were obtained by differential ultracentrifugation, and the shape, particle size, and the protein expressions of CD9, CD63, tumor susceptibility gene 101 (TSG101), and β-actin of exosomes were detected, respectively, by transmission electron microscopy, nano-particle tracking analysis and Western blotting. Twenty-four adult male BALB/c mice were adopted and were divided into normal control group, caecal ligation perforation (CLP) alone group, and CLP+ADSC-exosome group with each group of 8 according to random number table (the same grouping method below) and were treated accordingly. At 24 h after operation, tumor necrosis factor (TNF-α) and interleukin 1β (IL-1β) levels of mice serum were detected by enzyme-linked immunosorbent assay, and lung tissue morphology of mice was detected by hematoxylin-eosin and myeloperoxidase staining, and the expression of 8-hydroxy-deoxyguanosine (8-OHdG) of mouse lung cells was detected by immunofluorescence method. Primary PMVECs were obtained from 1-month-old C57 mice regardless gender by tissue block method. The expression of CD31 of PMVECs was detected by immunofluorescence and flow cytometry. The third passage of PMVECs was co-cultured with ADSCs derived exosomes for 12 h, and the phagocytosis of exosomes by PMVECs was detected by PKH26 kit. The third passage of PMVECs were adopted and were divided into blank control group, macrophage supernatant alone group, and macrophage supernatant+ADSC-exosome group, with 3 wells in each group, which were treated accordingly. After 24 h, the content of reactive oxygen species in cells was detected by flow cytometry, the expression of 8-OHdG in cells was detected by immunofluorescence, and Transwell assay was used to determine the permeability of cell monolayer. The number of samples in above were all 3. Data were statistically analyzed with one-way analysis of variance and least significant difference t test. Results: The primary ADSCs were isolated and cultured to day 5, growing densely in a spindle shape with a typical swirl-like. The percentages of CD29, CD44, CD73 and CD90 positive cells of ADSCs in the third passage were all >90%, and the percentages of CD34 and CD45 positive cells were <5%. Exosomes derived from ADSCs of the third to fifth passages showed a typical double-cavity disc-like structure with an average particle size of 103 nm, and the protein expressions of CD9, CD63 and TSG101 of exosomes were positive, while the protein expression of β-actin of exosomes was negative. At 24 h after operation, compared with those in normal control group, both the levels of TNF-α and IL-1β of mice serum in CLP alone group were significantly increased (with t values of 28.76 and 29.69, respectively, P<0.01); compared with those in CLP alone group, both the content of TNF-α and IL-1β of mice serum in CLP+ADSC-exosome group was significantly decreased (with t values of 9.90 and 4.76, respectively, P<0.05 or P<0.01). At 24 h after surgery, the pulmonary tissue structure of mice in normal control group was clear and complete without inflammatory cell infiltration; compared with those in normal control group, the pulmonary tissue edema and inflammatory cell infiltration of mice in CLP alone group were more obvious; compared with those in CLP alone group, the pulmonary tissue edema and inflammatory cell infiltration of mice in CLP+ADSC-exosome group were significantly reduced. At 24 h after operation, endothelial cells in lung tissues of mice in 3 groups showed positive expression of CD31; compared with that in normal control group, the fluorescence intensity of 8-OHdG positive cells of the lung tissues of mice in CLP alone group was significantly increased, and compared with that in CLP alone group, the fluorescence intensity of 8-OHdG positive cells in the lung tissues of mice in CLP+ADSC-exosome group was significantly decreased. The PMVECs in the 3rd passage showed CD31 positive expression by immunofluorescence, and the result of flow cytometry showed that CD31 positive cells accounted for 99.5%. At 12 h after co-culture, ADSC-derived exosomes were successfully phagocytose by PMVECs and entered its cytoplasm. At 12 h after culture of the third passage of PMVECs, compared with that in blank control group, the fluorescence intensity of reactive oxygen species of PMVECs in macrophage supernatant alone group was significantly increased (t=15.73, P<0.01); compared with that in macrophage supernatant alone group, the fluorescence intensity of reactive oxygen species of PMVECs in macrophage supernatant+ADSC-exosome group was significantly decreased (t=4.72, P<0.01). At 12 h after culture of the third passage of PMVECs, and the 8-OHdG positive fluorescence intensity of PMVECs in macrophage supernatant alone group was significantly increased; and compared with that in blank control group, the 8-OHdG positive fluorescence intensity of PMVECs in macrophage+ADSC-exosome supernatant group was between blank control group and macrophage supernatant alone group. At 12 h after culture of the third passage PMVECs, compared with that in blank control group, the permeability of PMVECs monolayer in macrophage supernatant alone group was significantly increased (t=6.34, P<0.01); compared with that in macrophage supernatant alone group, the permeability of PMVECs monolayer cells in macrophage supernatant+ADSC-exosome group was significantly decreased (t=2.93, P<0.05). Conclusions: Exosomes derived from ADSCs can ameliorate oxidative damage in mouse lung tissue, decrease the level of reactive oxygen species, 8-OHdG expression, and permeability of PMVECs induced by macrophage supernatant.

[Predictive value of neutrophil/lymphocyte ratio on myocardial injury in severe COVID-19 patients]

Objective: To explore the predictive value of neutrophil/lymphocyte ratio (NLR) on myocardial injury in severe COVID-19 patients. Methods: In this single-center retrospective cohort study, we collected and analyzed data form 133 severe COVID-19 patients admitted to Renmin Hospital of Wuhan University (Eastern District) from January 30 to February 18, 2020. Patients were divided into myocardial injury group (n=29) and non-myocardial injury group (n=104) according the presence or absence of myocardial injury. The general information of patients was collected by electronic medical record database system. All patients were followed up for 30 days, the organ injury and/or dysfunction were monitored, the in-hospital death was compared between the two groups, and the disease progression was reevaluated and classified at 14 days after initial hospitalization. Logistic regression analysis was performed to identify risk factors of myocardial injury in severe COVID-19 patients. The ROC of NLR was calculated, and the AUC was determined to estimate the optimal cut-off value of NLR for predicting myocardial injury in severe cases of COVID-19. Results: There was statistical significance in age, respiratory frequency, systolic blood pressure, symptoms of dyspnea, previous chronic obstructive pulmonary disease, coronary heart disease history, white blood cells, neutrophils, lymphocytes, platelets, C-reactive protein, platelet counting, aspartate transaminase, albumin, total bilirubin, direct bilirubin, urea, estimated glomerular filtration rate, total cholesterol, low-density lipoprotein cholesterol, D-dimer, CD3⁺, CD4⁺, partial pressure of oxygen, partial pressure of CO₂, blood oxygen saturation, other organ injury, clinical outcome and prognosis between patients with myocardial injury and without myocardial injury (all P<0.05). Multivariate logistic regression analysis showed that NLR was a risk factor for myocardial injury (OR=1.066，95%CI 1.021-1.111，P=0.033). ROC curve showed that NLR predicting AUC of myocardial injury in severe COVID-19 patients was 0.774 (95%CI 0.694-0.842), the optimal cut-off value of NLR was 5.768, with a sensitivity of 82.8%, and specificity of 69.5%. Conclusion: NLR may be used to predict myocardial injury in severe COVID-19 patients.

[Predictive analysis of distant metastasis after primary treatment of papillary thyroid cancer in patients under 18 years old]

Objective: To investigate the distant metastasis after primary treatment of papillary thyroid cancer (PTC) in children and adolescents. Methods: A retrospective analysis of 180 cases (54 boys and 126 girls, with an age range of 6-18 years) with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1, 2001 to December 31, 2014 was performed. Patients' clinical and pathological data were collected. The follow-up results were statistically analyzed. The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method. Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis. Results: Twenty-four cases (13.3%) had distant metastases during following-up with a median of 92 months. The Log-Rank test showed that the younger age ≤15 years old (χ(2)=11.803, P=0.001), the larger tumor diameter >20 mm (χ(2)=5.776, P=0.016), multifocal (χ(2)=11.205, P=0.001), bilateral tumor distribution (χ(2)=19.804, P=0.001), invaded capsule (χ(2)=10.808, P=0.001), and bilateral lymph nodes metastasis (χ(2)=6.278, P=0.012) were risk factors for distant metastasis after initial treatment. The Cox regression analysis showed that age ≤15 years (hazard ratio [95% confidence interval]: 4.08[1.504-11.111], P=0.006) and bilateral tumor distribution (hazard ratio [95% confidence interval]: 4.77[1.903-11.966], P=0.001) were independent risk factors for distant metastasis after initial treatment. The risk factors for local recurrence and distant metastasis were similar, but the local recurrence could not be a significant predictor for distant metastasis. It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups (χ(2)=5.891, P=0.015). Conclusions: Age, tumor size, invaded capsule, bilateral lymph nodes metastasis, multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents. Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.

Plasma exosomal miR-125a-5p and miR-141-5p as non-invasive biomarkers for prostate cancer

Predictive biomarkers for early diagnosis of prostate cancer are important for its treatment. The functional microRNAs in the exosomes of plasma and serum samples are of interest as stable and non-invasive biomarkers for recurrence in cancer patients. The present study aimed to clarify the value of plasma exosomal miRNA-125a-5p and miR-141-5p as biomarkers for the diagnosis of prostate cancer. The study included 19 healthy individuals and 31 prostate cancer patients. In comparison to the levels in healthy controls, exosomal miR-141-5p levels showed a slight increase in prostate cancer patients (p=0.085), and miR-125a-5p levels that showed a significant decrease in patients with prostate cancer than in healthy controls (p=0.032). As a derived parameter, the miR-125a-5p/miR-141-5p ratio was significantly higher in patients with prostate cancer than in healthy controls (p<0.001). We found that exosomal miR-141-5p in plasma showed a promise in distinguishing prostate cancer patients with the AUC of 0.652, and for miR-125a-5p, the AUC was 0.691. For the miR-125a-5p/miR-141-5p ratio, the AUC value was 0.793. We found that miR-125a-5p has a weak positive correlation with PSA (correlation coefficient = 0.3413). Moreover, miR-141-5p has been found to hold a negatively no-significant correlation with PSA, with the correlation coefficient is -0.1102. We speculate that, as diagnostic markers for prostate cancer, miR-125-5p and miR-141-5p might be independent of the PSA. In summary, the results of this study suggest that high plasma exosomal expression of miR-141-3p and low expression of miR-125a-5p in plasma exosomes from prostate cancer patients might be useful markers of specific tumor traits associated with prostate cancer. Moreover, the miR-125a-5p/miR-141-5p ratio seems to perform better than either of the single values alone.

[Initial exploration of choice of the donor site of flap and its repair strategy]

Objective: To explore the choice of the donor site of flap and the repair method of secondary wound of flap donor site in tissue repair and reconstruction operation. Methods: From January 2014 to September 2018, 62 cases of scar contracture deformity, 15 cases of skin tumor, 20 cases of skin and soft tissue injury, and 25 cases of chronic wound were admitted to the Burn Center of People's Liberation Army of First Affiliated Hospital of Air Force Medical University, with 84 males and 38 females, aged from 3 to 89 years. Four repair strategies adopted for tissue repair and reconstruction and good repair of the donor site of flap were as follows: designing the flap rationally according to the condition around the wound or the size and shape of wound, choosing pre-expanded technique of the donor site of flap for repair of scar deformity optimally, making full use of the surrounding condition of flap donor site, and repaired with the distal flap, i. e. replacing the important site with secondary site. The donor site of flap was repaired by direct suture or peripheral flap and distal flap. The wound size of patients ranged from 3.0 cm×2.0 cm to 20.0 cm×18.0 cm, and the flap area ranged from 3.5 cm×2.0 cm to 25.0 cm×22.0 cm. The survival condition of flap, healing condition of donor site and recipient site, and follow-up condition of donor site and recipient site were recorded. Results: Wounds of 122 patients were repaired with a total of 148 flaps designed by the above four repair strategies. All the flaps survived well, and the wound and flap donor site healed well. Follow-up for 3 to 36 months showed that the shape and function of recipient site and flap donor site were satisfactory. Conclusions: According to the specific condition of the wound and anatomical structure of the surrounding tissue of flap donor site, overall surgical design with flexibility and personalization can achieve effects of good repair of the wound and reduce the secondary damage of flap donor site.

[Establishing reference intervals of thyroid hormone based on a laboratory information system]

Objective: To establish reference intervals (RIs) of thyroid hormone based on data from healthy subjects in laboratory information system (LIS) by indirect methods. Methods: Data were selected from the physical examination center in LIS of the First Hospital of Jilin University from May 2014 to December 2018. The normal distribution of the original data was checked by the Kolmogorov-Smirnov test. Skewed data were transformed into normal distribution using BOX-COX techniques, and outliers were identified by the Turkey method. The continuous percentile curve was established by coefficient of skewness-median-coefficient of variation(LMS) methods. Cut-off value of age was determined by decision trees, and the differences between groups were verified by Z-tests. P(2.5) and P(97.5) in the RIs were analyzed by non-parametric methods. Results: A total of 45 742 subjects were included in the study. There were no differences in the RI for thyroid stimulating hormone (TSH) among age groups or between men and women (Z<Z*), and the RI was 0.60-4.41mIU/L (20-79 years old). However, the levels of free triiodothyronine(FT(3)) decreased with age in males and females under 35-year-old. The RIs for FT(3) were 4.47-6.44pmol/L (20-44 years old), 4.19-6.21pmol/L (45-64 years old) and 3.90-5.85pmol/L (65-79 years old) in males, and 4.04-6.13pmol/L (20-34 years old) and 3.87-5.76pmol/L (35-79 years old) in females, respectively. The levels of free thyroxine(FT(4)) in men were higher than those in women from 20 to 49 years old, and no gender and age differences could be viewed in subjects after 50 years old (Z<Z*). The RIs for FT(4) were 13.69-21.76pmol/L (male, 20-49 years old), 12.99-20.83pmol/L (female, 20-49 years old) and 12.98-21.21pmol/L (50~79 years old). Conclusion: Establishment of RIs of thyroid hormone based on the data from LIS is simple and reliable, which is suitable for clinical laboratory application.

P1925Machine learning versus classic electrocardiographic criteria for left ventricular hypertrophy in a young pre-participation cohort: results from the SAFE protocol study

Background/Introduction

Classic electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) have been well studied in Western populations, particularly in hypertensive patients. However, their utility in Asian populations is not well studied, and their applicability to young pre-participation cohorts is unclear. We sought to evaluate the performance of classical criteria against that of machine learning models.

Aims

We sought to evaluate the performance of classical criteria against the performance of novel machine learning models in the identification of LVH.

Methodology

Between November 2009 and December 2014, pre-participation screening ECG and subsequent echocardiographic data was collected from 13,954 males aged 16 to 22, who reported for medical screening prior to military conscription.

Final diagnosis of LVH was made on echocardiography, with LVH defined as a left ventricular mass index >115g/m2. The continuous and binary forms of classical criteria were compared against machine learning models using receiver-operating characteristics (ROC) curve analysis. An 80:20 split was used to divide the data into training and test sets for the machine learning models, and three fold cross validation was used in training the models. We also compared the important variables identified by machine learning models with the input variables of classical criteria.

Results

Prevalence of echocardiographic LVH in this population was 0.91% (127 cases). Classical ECG criteria had poor performance in predicting LVH, with the best predictions achieved by the continuous Sokolow-Lyon (AUC = 0.63, 95% CI = 0.58–0.68) and the continuous Modified Cornell (AUC = 0.63, 95% CI = 0.58–0.68). Machine learning methods achieved superior performance – Random Forest (AUC = 0.74, 95% CI = 0.66–0.82), Gradient Boosting Machines (AUC = 0.70, 95% CI = 0.61–0.79), GLMNet (AUC = 0.78, 95% CI = 0.70–0.86). Novel and less recognized ECG parameters identified by the machine learning models as being predictive of LVH included mean QT interval, mean QRS interval, R in V4, and R in I.

ROC curves of models studies

Conclusion

The prevalence of LVH in our population is lower than that previously reported in other similar populations. Classical ECG criteria perform poorly in this context. Machine learning methods show superior predictive performance and demonstrate non-traditional predictors of LVH from ECG data. Further research is required to improve the predictive ability of machine learning models, and to understand the underlying pathology of the novel ECG predictors identified.

P308Utility of a prominent R wave in lead V1 of a resting electrocardiogram for detecting significant cardiac pathology in an unselected population of young males

Background

Pre-participation electrocardiogram (ECG) screening is proposed as a means to detect cardiac pathology in asymptomatic individuals, and to select individuals for further cardiac investigation. Isolated ECG finding of Right Ventricular Hypertrophy (RVH) does not require further investigation based on the recent 2017 International Criteria. However, a prominent R wave in V1 has been described in cardiac abnormalities such as Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, cardiomyopathy in Duchenne muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy (ARVC), atrial septal defect and pulmonary hypertension.

Purpose

We sought to examine the utility of a prominent R wave in V1 as a screening criterion in an asymptomatic young male population of predominantly non-athletes, to detect significant structural cardiac pathology.

Methods

As part of the Singapore Armed Forces Electrocardiographic and Echocardiographic (SAFE) Protocol Study, pre-military enlistment screening ECG data was collected from 144,346 males between the ages of 16 to 22 from November 2009 to December 2014. Patients with ECGs with a prominent R wave, defined as an R wave ≥0.5mV in lead V1 with an R/S ratio of ≥1, were sent to a tertiary medical facility for a detailed transthoracic echocardiogram and subsequent cardiologist review. Any cardiac pathology identified was deemed significant if it led to the patient being excluded from participation in vigorous physical activity.

Results

1,144 patients with an isolated prominent R wave in V1 were studied. The mean age was 18.2±1.09 years and 81% were of Chinese ethnicity. None of the patients had echocardiographic evidence of RVH, 5 patients had a dilated right ventricle and 3 individuals had an elevated pulmonary artery systolic pressure. 11 patients (0.96%) had significant structural heart disease known to be associated with a prominent R wave in V1 that excluded them from participation in physical activity. These included large atrial septal defects (n=8), pulmonary stenosis (n=1), total anomalous pulmonary venous return (n=1) and hypertrophic cardiomyopathy (n=1). The test has a sensitivity of 21.6%, specificity of 93.4%, positive predictive value of 0.96% and negative predictive value of 99.8%,

Performance As Screening Criteria Number of Patients With Cardiac Pathology In Those Tested Positive Number of Patients With Cardiac Pathology In Those Tested Negative Positive Predictive Value (%) Negative Predictive Value (%) Sensitivity (%) Specificity (%) 11 40 0.96 99.8 21.6 93.4

Significant Cardiac Pathology Identified

Conclusion

A prominent R in V1 is not associated with echocardiographic RVH, or ARVC even in a large predominantly non-athletic male population. However, 0.96% of such patients would have other significant cardiac pathologies such as a large atrial septal defect.

Broadband reflective lens in visible band based on aluminum plasmonic metasurface

We demonstrate a flat optical lens based on plasmonic reflectarray metasurface, which consists of a planar array of hyperbolic-shaped aluminum (Al) nanoantenna separated from an Al ground plane by a SiO₂ spacer. The gradual change in the width of the Al nanoantenna enables unique broadband (400-700 nm) to focus on the visible band because of its hyperbolic reflection-phase profile. The focal length of metalens is quickly decreased with the increase of wavelength in the short wavelength region (400-550 nm), compensating the chromatic aberration in traditional lenses. In long wavelength region (550-700 nm), the focal length has only a slight change, thereby minimizing chromatic aberration. Furthermore, the proposed metalens creates a small focal spot beyond diffraction limit, while maintaining high focusing efficiency. Our method of simple and anisotropic nanoantenna is used to realize wide phase tuning range offers a novel strategy to design braodband metalens, and our metalens has widespread applications in compact camera, telescope, and microscope.

[Relationship between UGT1A1 gene polymorphisms and irinotecan-induced severe adverse events]

Objective: To investigate the relationship between UGT1A1*6, UGT1A1*28, UGT1A1*60 and UGT1A1*93 polymorphisms and irinotecan-induced severe adverse reactions(grade 3-4 delayed diarrhea and neutropenia) in Chinese cancer patients. Methods: A total of 141 cancer patients treated with irinotecan were enrolled in this study. Peripheral venous blood was collected and genomic DNA was extracted. The genetic polymorphisms of UGT1A1*6, UGT1A1*28, UGT1A1*60 and UGT1A1*93 were analyzed by PCR and direct sequencing. The adverse reactions during chemotherapy were observed and recorded. The incidence of severe adverse reactions was compared among patients with different genotypes. Results: Among 141 patients, the cases with UGT1A1*6 GG, GA and AA genotypes were 71, 54 and 16, while those with UGT1A1*28 TA6/6, TA6/7 and TA7/7 genotypes were 105, 33 and 3, respectively. The cases with UGT1A1*60 AA, AC and CC genotypes were 52, 80 and 9, while those with UGT1A1*93 GG, GA and AA genotypes were 105, 32 and 4, respectively. The patients with grade 3-4 delayed diarrhea and neutropenia were 23 and 56, respectively. Multivariate logistic regression analysis showed that UGT1A1*6 and UGT1A1*60 genetic polymorphisms were independent factors influencing the occurrence of grade 3-4 delayed diarrhea. The risk of grade 3-4 delayed diarrhea in homozygous AA carriers of UGT1A1*6 increased 3.79 times compared with that in wild-type GG carriers (95%CI: 1.35-10.67). Moreover, the risk of grade 3-4 delayed diarrhea in homozygous CC carriers of UGT1A1*60 was 20.42 times compared with that in wild-type AA carriers (95%CI: 3.52-118.33). In addition, UGT1A1*28 genetic polymorphism was an independent factor of the occurrence of grade 3-4 neutropenia. The patients with homozygous TA7/7 carriers of UGT1A1*28 had an 1.61 times higher risk of grade 3-4 neutropenia compared with those with wild-type TA6/6 carriers (95%CI: 1.44-12.65). There was no correlation between UGT1A1*93 genetic polymorphism and severe adverse reactions caused by irinotecan. Conclusion: The cancer patients who carried UGT1A1*6, UGT1A1*28 and UGT1A1*60 gene polymorphisms have high risk of severe adverse events caused by irinotecan-based chemotherapy.

[Planned neck dissection in the treatment of locally advanced head and neck squamous cell carcinoma]

Objective: To investigate the value of planned neck dissection combined with induction chemotherapy and concurrent chemoradiotherapy in regional control and the outcome of locally advanced head and neck squamous cell carcinoma. Methods: A prospective randomized controlled study totally enrolled sixty-four patients of head and neck squamous cell carcinomas(include oropharynx, hypopharynx, and larynx) in stages Ⅳa-Ⅳb with lymph node metastase was were N2-N3. All patients firstly received 2-3 cycles of induction chemotherapy(ICT), then divided into two groups randomly, according to the efficacy of ICT. Group A(the study group) received planned neck dissection(PND) and concurrent chemoradiotherapy(CCRT). Group B(the control group) received concurrent chemoradiotherapy(CCRT). The differences in clinicopathologic features, local recurrence(LR), regional recurrence(RR), disease-free survival(DFS), and overall survival(OS) between the two groups were estimated. SPSS 19.0 software was used to analyze the data. Results: Group A enrolled twenty-one patients, and group B enrolled forty-three patients.The follow-up of all patients were 4-55 months, median follow-up time was 22 months. In study group, two-year OS and DFS were 80.9% and 68.3%, respectively. In control group, two-year OS and DFS were 90.7% and 67.1%, respectively. There was no significant difference in gender(P=0.215), age(P=0.828), primary tumor site(P=0.927), LR(P=0.126), DFS(P=0.710), and OS(P=0.402) between the two groups, while the RR(χ(2)=5.640, P<0.05) and distant metastasis(χ(2)=10.363, P<0.01) showed significant differences between the two groups. Conclusion: The ICT+ PND+ CCRT treatment model has benefit on regional control of locally advanced head and neck squamous cell carcinoma.

Association between single nucleotide polymorphisms in AKT1 and the risk of prostate cancer in the Chinese Han population

AKT1, also known as v-akt murine thymoma viral oncogene homolog 1, is involved in the regulation of cell-survival and anti-apoptotic activities, which may affect the pathogenesis of various cancers. However, the association between genetic variants of AKT1 and the risk of developing prostate cancer has not been investigated before. This study investigated the associations between three polymorphisms (rs1130214, rs3730358, and rs2494732) in AKT1 and the risk of development of prostate cancer in the Chinese Han population. Sequenom MassARRAY & iPLEX technology were used to genotype these polymorphisms in 493 Chinese Han patients with prostate cancer and 309 age-matched healthy individuals. Compared to the CC genotype of the rs3730358 polymorphism, the CT genotype of the same polymorphism was strongly associated with a decreased risk of prostate cancer (OR = 0.617, 95%CI = 0.390-0.976, P = 0.037). However, there was no significant difference between the allele frequency of the rs3730358 polymorphism and those of the other two polymorphisms (P > 0.05). Moreover, no significant difference was found in the haplotype analysis (P > 0.05). Our study found that the variant genotype CT of rs3730358 of AKT1 was associated with a decreased risk of prostate cancer, which suggested that this polymorphism could play an important role in the development of the disease.

Lack of association between the ESR1 rs9340799 polymorphism and age at menarche: a meta-analysis

It has been reported that the estrogen receptor alpha (ESR1) rs9340799 polymorphism is associated with age at menarche (AAM). However, recent investigations have generated inconsistent results. This study aimed to establish a more precise estimation of the association between this polymorphism and AAM. A meta-analysis was conducted based on an in silico literature search using PubMed. Six studies presenting continuous data, including ESR1 rs9340799 genotype frequencies, were selected. Effect size was estimated using Hedges' adjusted g with 95% confidence intervals (CIs), which were calculated based on the standardized mean difference between groups of subjects and different genotypes. No evidence of an association between the ESR1 rs9340799 polymorphism and AAM was found in the pooled continuous data under any genotype comparison (AA vs GG+AG: Hedges' g = -0.085, 95%CI = -0.202-0.032, P = 0.156; GG vs AA+AG: Hedges' g = 0.143, 95%CI = -0.041-0.327, P = 0.129; A vs G: Hedges' g = 0.187, 95%CI = -0.032-0.406, P = 0.095). Moreover, a funnel plot generated using this data was found to be symmetrical using the Egger (P = 0.797) and Begg tests (P = 0.851), indicating the absence of publication bias. In summary, our meta-analysis shows that the ESR1 rs9340799 polymorphism is not a significant, independent contributing factor to AAM. To validate this finding, further studies involving larger numbers of participants are needed.

[The role of smoking and metabolic enzyme polymorphisms in the organic solvent induced chronic encephalopathy]

OBJECTIVE

The organic solvents and other exogenous compounds of metabolic enzymes genetic variation may affect the risk of the toxic effect of organic solvents exposure. Therefore, this research we observed the glutathione transferase M1 and T1 (GSTM1, GSTT1) deletion mutation genotype, two kinds of microsomal epoxide hydrolase (mEPHX) genetic polymorphism, organic solvents exposure and smoking effection in chronic cases of toxic encephalopathy (CTE) correlation.

METHODS

The object was 115 patients who had a long history of organic solvents exposure, were divieded into two groups: CTE (n=83) , no CET (n=32) according to clinical diagnosis. DNA was isolated from patients in white blood cells through the multiple-polymerase chain reaction to determine the loss of GSTM1 and GSTT1 genotype. two kinds of mEPHX polymorphism were analysised through the PCR-RFLP (restriction fragment length polymorphism).

RESULTS

The relative risk has obviously improved when lack of GSTM1 genotypes to CTE (RR=2.35, 95% CI 2.35 0.96). in according to the patient's Smoking condition and classify genotype, patients lack of GSTM1 genotypes had a significantly higher risk CTE than GSTM1+genotype patients (RR=3.13, 95% CI 3.13 1.2) , both mEPHX polymorphisms had nothing to do with an increased risk of CTE.

CONCLUSION

The GSTM1 genotypes played an important role in the organic solvent induced the CTE of susceptibility.it was Influenced by the interaction between smoking at the same time.

Melt Elongation Strength and Drawability of LDPE/LLDPE Blends

The melt strength behavior and drawability during elongation flow of low density polyethylene (LDPE)/linear low density polyethylene (LLDPE) blends were investigated using the Rheotens test method under temperature ranging from 160 to 200 °C and die extrusion velocity varying from 9 to 36 mm/s. It was found that the blend melt strength decreased with a rise of temperature while increased with increasing the LDPE weight fraction when the extension rate or drawing ratio is constant; the dependence of the blend melt strength on the melt extension temperature roughly obeyed the Arrhenius equation; the dependence of the blend melt strength on the die extrusion velocity roughly obeyed the index equation. The drawing ratio at the melt fracture decreased with increasing the LDPE weight fraction and the die extrusion velocities, while increased with a rise of the melt extension temperature.

Enhanced anaerobic digestion of waste activated sludge of low organic content in a novel digester

A novel digester, termed an internal circulation anaerobic digester (ICAD), was developed to intensify sludge digestion. It consists of reaction zone, settling zone, thickening zone, riser and downcomer. Internal circulation in the digester is intensified by backflow biogas. The mesophilic ICAD treating thermal pretreated waste activated sludge with volatile suspended solids (VSS)/suspended solids (SS) of 0.45-0.49 was conducted in this study to reduce and stabilize the low organic content sludge. The results showed that the VSS removal rate and biogas rate reached 46.0% and 0.72 m(3)/kg VSS(fed) at hydraulic retention time (HRT) of 15 days. VSS/SS and soluble chemical oxygen demand (SCOD) of the effluent sludge ranged from 0.39 to 0.41 and 274 mg/L to 473 mg/L, respectively, under various HRTs from 10 to 27 days. The degradation ability of ICAD derived from the improved mass transfer by internal circulation and long solid retention time at short HRT is compared with continuous stirred tank reactor.

CD44v6 expression in patients with stage II or stage III sporadic colorectal cancer is superior to CD44 expression for predicting progression

BACKGROUND

Currently, it is difficult to predict the prognosis of patients exhibiting stage II or stage III colorectal cancer (CRC) and to identify those patients most likely to benefit from aggressive treatment. The current study was performed to examine the clinicopathological significance of CD44 and CD44v6 protein expression in these patients.

STUDY DESIGN

We retrospectively investigated 187 consecutive patients who underwent surgery with curative intent for stage II to III CRC from 2007 to 2013 in the Beijing Civil Aviation Hospital. CD44 and CD44v6 protein expression levels were determined using immunohistochemistry and compared to the clinicopathological data.

RESULTS

Using immunohistochemical detection, CD44 expression was observed in 108 (57.75%) of the CRC patients; and its detection was significantly associated with greater invasion depth, lymph node metastasis, angiolymphatic invasion, and a more advanced pathological tumor-lymph node-metastasis (TNM) stage. CD44v6 expression was observed in 135 (72.19%) of the CRC patients; and its expression was significantly associated with a poorly differentiated histology, greater invasion depth, lymph node metastasis, angiolymphatic invasion, and a more advanced pathological TNM stage. Expression of CD44v6 was higher than that of CD44 in stage II and stage III sporadic CRC.

CONCLUSION

CD44v6 is a more useful marker for predicting a poor prognosis in stage II and stage III sporadic CRC as compared to CD44.