Polyketides with anti-inflammatory activity from Rhodiola tibetica endophytic fungus Alternaria sp. HJT-Y7

Seven undescribed polyketides with particular ortho-trisubstituted benzo[c]furan and benzo[c]oxepin spiro structures were isolated from Rhodiola tibetica endophytic fungus Alternaria sp. HJT-Y7. Structural elucidations of these compounds were determined mainly by NMR and HR-ESI-MS analysis. An assumed polyketide biosynthetic pathway of these isolates was proposed. Two undescribed compounds and four known compounds showed significant inhibitory effects on LPS-induced NO production in RAW 264.7 cells without cytotoxicity at their effective concentrations.

Processed electroencephalography: impact of patient age and surgical position on intraoperative processed electroencephalogram monitoring of burst-suppression

We previously reported that processed EEG underestimated the amount of burst suppression compared to off-line visual analysis. We performed a follow-up study to evaluate the reasons for the discordance. Forty-five patients were monitored intraoperatively with processed EEG. A computer algorithm was used to convert the SedLine® (machine)-generated burst suppression ratio into a raw duration of burst suppression. The reference standard was a precise off-line measurement by two neurologists. We measured other potential variables that may affect machine accuracy such as age, surgery position, and EEG artifacts. Overall, the median duration of bust suppression for all study subjects was 15.4 min (Inter-quartile Range [IQR] = 1.0-20.1) for the machine vs. 16.1 min (IQR = 0.3-19.7) for the neurologists' assessment; the 95% limits of agreement fall within - 4.86 to 5.04 s for individual 30-s epochs. EEG artifacts did not affect the concordance between the two methods. For patients in prone surgical position, the machine estimates had significantly lower overall sensitivity (0.86 vs. 0.97; p = 0.038) and significantly wider limits of agreement ([- 4.24, 3.82] seconds vs. [- 1.36, 1.13] seconds, p = 0.001) than patients in supine position. Machine readings for younger patients (age < 65 years) had higher sensitivity (0.96 vs 0.92; p = 0.021) and specificity (0.99 vs 0.88; p = 0.007) for older patients. The duration of burst suppression estimated by the machine generally had good agreement compared with neurologists' estimation using a more precise off-line measurement. Factors that affected the concordance included patient age and position during surgery, but not EEG artifacts.

Synthesis, Structure Determination, and Characterizations of a Polar Salt-Inclusion Scandium Germanate, Rb10Li3Sc4Ge12O36F

A noncentrosymmetric salt-inclusion germanate, Rb₁₀Li₃Sc₄Ge₁₂O₃₆F, was grown through spontaneous crystallization from a LiF-RbF flux. It crystallizes in the polar space group P31c with cell parameters of a = 10.7587(3) Å, c = 21.6691(10) Å, and Z = 2. Its structure features a complex 3D framework composed of helical [Ge₄O₁₂] chains from condensed [GeO₄] tetrahedra running along the c axis, which are interconnected by the [ScO₆] octahedra. Voids of the 3D net are filled with Rb⁺ ions, Li⁺ ions, and isolated trigonal-bipyramidal [Rb₃Li₂F] superalkali clusters. The title compound has a large band gap of 5.6 eV, a moderate powder second-harmonic-generation response of 0.9KDP, and an extremely small birefringence of 0.001, as was further unraveled by theoretical calculations.

Preparation and characterization of sodium cellulose sulfate/chitosan composite films loaded with curcumin for monitoring pork freshness

Colorimetric films were prepared by incorporating curcumin into a sodium cellulose sulfate/chitosan composite. The morphology mechanical, and water vapor properties of the films were investigated, and their practical use in pork preservation was evaluated. The formula with the same charge ratio of sodium cellulose sulfate and chitosan had the highest tensile strength (TS). After the addition of curcumin, the tensile strength increased, whereas the water vapor permeability (WVP) decreased. The colorimetric film showed distinguishable color changes between the pH ranges of 3–10. The colorimetric film packaging extended the shelf life of the pork samples by 4 days. Moreover, the composite films were able to effectively monitor pork freshness. In conclusion, curcumin incorporated into sodium cellulose sulfate/chitosan composite films may have great potential in food packaging.

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Sodium cellulose sulfate/chitosan/curcumin films were produced for food packaging.

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The properties of composite films were enhanced due to electrostatic interaction.

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The composite films changed their colors in response to the change of pH.

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The composite films could monitor the freshness and extend shelf life of pork.

Morphological classification and clinical significance of medial malleolus based on computed tomography three-dimensional reconstruction

BACKGROUND

Internal malleolus fractures and postoperative functional limitations are serious complications of deltoid ligament repair, reconstruction, while studies on conducting beak. Anatomical structure classification of medial malleolus at home and abroad is reported rarely. Hence, this morphological study is mainly designed to investigate the anatomical morphological classification and clinical significance of medial malleolus based on computed tomography (CT) three-dimensional reconstruction.

MATERIALS AND METHODS

From October 2018 to January 2021, 373 patients who underwent CT examination of malleolus medialis joint in the Jiang'an Hospital of Traditional Chinese Medicine were observed. The medial malleolus was observed and classified; then, geometric parameters were measured according to different medial malleolus types.

RESULTS

According to the results of 373 cases, medial malleolus can be divided into four types: omega type (66%), radical sign type (16%), inverted triangle type (14%), and wave type (4%).

CONCLUSIONS

There are four main shapes: omega, inverted triangle, radical sign, and wave in the medial malleolus of all normal ankles. The measurement of medial malleolus parameters according to medial malleolus in different shapes was of importance to guide smooth operation of medial malleolus fixation and deltoid ligament reconstruction and epidemiological.

57 A Closed Loop Audit of Post-Operative Driving Advice Documentation

Aim

The Driving and Vehicle Licensing Agency state post-operatively it is between the patient and doctor to establish when would be safe to resume driving, providing recovery does not exceed three months. This audit aimed to assess and improve the documentation rate of driving advice in the discharge summaries given to patients post abdominal surgery.

Method

Retrospective data collection from electronic records over the months of August and September 2020. 132 discharge summaries were screened to assess the baseline rate of verbal/documented driving advice given on discharge. Following the 1st cycle, posters encouraging the inclusion of driving advice and demonstrating how to access driving advice to discharge summaries were developed and distributed across the surgical wards. A 2nd cycle re-audit was conducted in October 2020 to measure the effect of change, and a further 3rd cycle audit was conducted in November 2020.

Results

1st cycle included 132 patients. 62% had documented advice on their discharge summaries, while 38% had no proof of driving advice. After intervention, 2nd cycle included 30 patients. Results showed a significant increase in advice documentation (80%). A 3rd cycle was carried out with 47 patients. This showed a reduction in advice documentation (66%).

Conclusions

Driving advice on discharge in post-operative patients is crucial part of patient safety. Implementation of intervention has increased the documentation of driving advice showing enhancing patient safety. However, 3rd cycle after registrar’s changeover showed a decrease in the rate of documentation. A teaching session is planned for new doctors followed by 4th cycle.

[Evaluation of classification of petroclival meningiomas and proposed selection of microsurgical approach: a single center experience of 179 cases]

Objective: To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes. Methods: Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom(M(QR)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results: The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS(t=-1.356,P=0.125). As for each type, there were statistically significant differences in brain stem edema(χ2=3.482,P=0.038), gross total resection(χ2=9.127,P=0.001), surgical duration(F=8.954, P=0.013), postoperative length of stay(F=3.652, P=0.025), postoperative complications(χ2=1.550,P=0.024), postoperative KPS(F=2.856, P=0.042) and tumor recurrence/progress(χ2=4.824,P=0.013). Conclusion: The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

[Relapse of ankylosing spondylitis and its predictors after withdrawal of tumor necrosis factor-α inhibitors: a 52-week follow-up study]

OBJECTIVE

To investigate the recurrence of ankylosing spondylitis (AS) that has been relieved by standard-dose adalimumab (ADA) after dose reduction or withdrawal of tumor necrosis factor-α inhibitor (TNFi) and explore the factors that predict AS occurrence.

OBJECTIVE

This study was conducted among 63 patients with AS who reduced the dose of or discontinued TNFi after completing at least 12 treatment cycles with ADA (40 mg/2 weeks) to achieve ASAS20 improvement with a BATH disease activity index (BASDAI) < 4 for more than 8 weeks. The patients were followed up every 12 weeks for a total of 52 weeks, and the recurrence of AS, changes of BASDAI, C-reactive protein (CRP)-based disease activity score (ASDASCRP), low back pain (LBP) score, Bath Ankylosing Spondylitis Metrology Index (BASMI), CRP and ESR were recorded and analyzed. Cox regression model and ROC curve analyses were performed to analyze the risk factors of AS relapse after dose reduction or discontinuation of TNFi.

OBJECTIVE

Of the 63 patients enrolled, 57 completed the follow-up study, among whom 22 (38.6%) patients experienced AS relapse within 52 weeks, with a median clinical recurrence time of 31 weeks. The recurrence rate of AS was significantly higher in patients with complete withdrawal of medications (89.0%) than in those with TNFi dose reduction and TNFi discontinuation (P < 0.001), and did not differ significantly between the latter two groups of patients (χ²= 0.071, P=0.791). The Cox regression model showed that a high baseline LBP score (HR=1.438, P=0.027) and a high BASMI score (HR=1.29, P=0.049) were the risk factors for AS recurrence after TNFi dose reduction or discontinuation, while maintenance of medication during follow-up was a protective factor (HR=0.209, P=0.001). ROC curve analysis showed that the combination of baseline LBP score, BASMI and medication during follow-up had a good predictive value for AS relapse (AUC=0.819) with a sensitivity of 0.772 and a specificity of 0.718.

OBJECTIVE

Dose reduction or discontinuation of TNFi is associated with a high recurrence rate of AS that has been relieved by TNFi treatment. A high LBP score, a high BASMI score and discontinuation of maintenance medication are the risk factors for AS recurrence in patients after dose reduction or withdrawal of TNFi.

Effect modification of the association between diurnal temperature range and hospitalisations for ischaemic stroke by temperature in Hefei, China

OBJECTIVES

Diurnal temperature range (DTR) is an important indicator of global climate change. Many epidemiological studies have reported the associations between high DTR and human health. This study investigated the association between DTR and hospitalisations for ischaemic stroke in Hefei, China.

STUDY DESIGN

This is an ecological study.

METHODS

Data of daily hospital admissions for ischaemic stroke and meteorological variables from 1 January 2009 to 31 December 2017 were collected in Hefei, China. A generalised additive model combined with distributed lag non-linear model was used to quantify the effects of DTR on ischaemic stroke. The interactive effect between DTR and temperature was explored with a non-parametric bivariate response surface model.

RESULTS

High DTR was associated with hospitalisations for ischaemic stroke. The adverse effect of extremely high DTR (99th percentile [17.1 °C]) occurred after 8 days (relative risk [RR] = 1.021, 95% confidence interval [CI] = 1.002, 1.041) and the maximum effect appeared after 12 days (RR = 1.029, 95% CI = 1.011, 1.046). The overall trend of the effect of DTR on ischaemic stroke was decreasing. In addition, there was a significant interactive effect of high DTR and low temperature on ischaemic stroke.

CONCLUSIONS

This study suggests that the impact of high DTR should be considered when formulating targeted measures to prevent ischaemic stroke, especially for those days with high DTR and low mean temperature.

CNN-based qualitative detection of bone mineral density via diagnostic CT slices for osteoporosis screening

The features extracted from diagnostic computed tomography (CT) slices were used to qualitatively detect bone mineral density (BMD) through neural network models, and the evaluation results indicated that it may be a promising approach to perform osteoporosis screening in clinical practice.

INTRODUCTION

The purpose of this study is to design a novelty diagnostic method for osteoporosis screening by using the convolutional neural network (CNN), which can be incorporated into the procedure of routine CT diagnostic in medical examination thereby improving the osteoporosis diagnosis and reducing the patient burden.

METHODS

The proposed CNN-based method mainly comprises two functional modules to perform qualitative detection of BMD by analyzing the diagnostic 2D CT slice. The first functional module aims to locate and segment the ROI of diagnostic 2D CT slice, called Mark-Segmentation-Network (MS-Net). The second functional module is used to determine the category of BMD by the features of ROI, called BMD-Classification-Network (BMDC-Net). The diagnostic 2D CT slice of pedicle level in lumbar vertebrae (L1) was selected from 3D CT image in our experiments firstly. Then, the trained MS-Net can get the mark image of input original 2D CT slice, thereby obtain the segmentation image. Finally, the trained BMDC-Net can obtain the probability value of normal bone mass, low bone mass, and osteoporosis by inputting the segmentation image. On the basis of network results, the radiologists can provide preliminary qualitative diagnosis results of BMD.

RESULTS

Training of the network was performed on diagnostic 2D CT slices of 150 patients. The network was tested on 63 patients. Each patient corresponds to a 2D CT slice. The proposed MS-Net has an excellent segmentation precision on the shape preservation of different lumbar vertebra. The dice index (DI), pixel accuracy (PA), and intersection over union (IOU) of segmentation results are greater than 0.8. The proposed BMDC-Net achieved an accuracy of 76.65% and an area under the receiver operating characteristic curve of 0.9167.

CONCLUSIONS

This study proposed a novel method for qualitative detection of BMD via diagnostic CT slices and it has great potential in clinical applications for osteoporosis screening. The method can potentially reduce the manual burden to radiologists and diagnostic cost to patients.