[Clinicopathological features and BRAF V600E and MYD88 L265P mutation status of nodal marginal zone lymphoma]

Objective: To investigate the clinicopathological features as well as BRAF V600E and MYD88 L265P mutation status of nodal marginal zone B cell lymphoma (NMZL). Methods: Thirty-two cases of NMZL were diagnosed from September 2009 to February 2021 at the Henan Provincial People's Hospital and Peking University School of Basic Medical Sciences. The clinicopathologic characteristics were obtained and analyzed. BRAF V600E and MYD88 L265P mutation status were identified using PCR and Sanger sequencing, respectively. Results: There were 20 males and 12 females patients with a median age of 69 years (ranging 36-82 years). The most prevalent clinical manifestation was multiple lymph nodes enlargement in head and neck (22/32, 68.8%), followed by inguinal (12/32, 37.5%), axillary (11/32, 34.4%), mediastinum (5/32, 15.6%) and retroperitoneal lymph nodes (4/32, 12.5%). Most of the patients were in Ann Arbor stage Ⅰ/Ⅱ (21 cases). The morphologic features included diffuse (24/32, 75.0%), nodular (5/32, 15.6%), interfollicular (2/32,6.3%) and perifollicular (1/32,3.1%) types. The tumor cells showed monocyte-like, centrocyte-like, small lymphocyte-like and plasma cell-like differentiation. Immunophenotyping revealed diffuse expression of CD20 in all tumor cells, whereas CD43 (11/32, 34.4%), bcl-2 (20/32, 62.5%), MNDA (13/32, 40.6%) and CD5 (2/32, 6.3%) were partially expressed. Ki-67 proliferation index varied from 10% to 40%. BRAF V600E mutation was found in two cases (2/32, 6.3%), but MYD88 L265P mutation was not detected. Eighteen patients survived and three died at the end of follow-up period which ranged 6 to 110 months. Conclusions: The morphologic features of NMZL varies across individuals, it should be differentiated from various B-cell lymphomas; however immunological biomarkers with high specificity for NMZL are still lacking. No MYD88 L265P mutation is found in NMZL. Some cases may harbor BRAF V600E mutation and yet the prevalence remains indeterminate; further researches are warranted.

Value of pseudopod sign on high-frequency ultrasound in predicting the pathological invasion of extramammary Paget's disease lesions

BACKGROUND

Vertical invasion of extramammary Paget's disease (EMPD) is associated with poor prognosis. The usual vertical invasion route is directly downward or along the skin appendages. High-frequency ultrasound (HFUS) can be used to measure the EMPD lesion thickness, and visualize the pseudopod extensions due to skin appendage involvement. It is a non-invasive method for evaluating the extent of vertical invasion in EMPD.

OBJECTIVE

To investigate the value of HFUS in predicting the extent of vertical invasion in EMPD.

METHODS

In this retrospective study, 85 patients with EMPD were divided into two groups based on the pathology: invasive EMPD (iEMPD) group (n = 13) and in situ EMPD group (n = 72). The clinical and HFUS features of both the groups were analyzed. The different types of pseudopodia morphology on HFUS were as follows: no pseudopodia, irregular bottom, small sphere, short strip, long strip, vase shape, and nodular convex. These were further stratified into low-risk and high-risk levels.

RESULTS

The clinical features were comparable between the two groups (P > .05). There were significant differences between the two groups in the HFUS features (lesion thickness, lesion shape, bottom shape, layer involvement, pseudopodia morphology, and color Doppler blood flow signal; all P < .05). The distribution of the pseudopodia morphology types in the in situ EMPD and iEMPD groups, was as follows: no pseudopodia, 30/72 and 0/13; irregular bottom, 5/72 and 0/13; small sphere, 5/72 and 0/13; short strip, 21/72 and 0/13; long strip, 8/72 and 3/13; vase shape, 3/72 and 3/13; and nodular convex, 0/72 and 7/13 (P < .05 for all). The sensitivity and specificity of high-risk pseudopodia in identifying iEMPD were 100% and 84.7%, respectively.

CONCLUSIONS

HFUS provides morphological information regarding EMPD lesions. Risk stratification for pseudopodia can help to distinguish between iEMPD and in situ EMPD lesions.

[The preliminary study of Neuroform EZ stent in the treatment of severe intracranial atherosclerotic stenosis]

Objective: To evaluate the safety and clinical efficacy of Neuroform EZ stent in the treatment of severe intracranial atherosclerotic stenosis (ICAS). Methods: A total of 36 patients with severe ICAS receiving Neuroform EZ stent angioplasty were retrospectively analyzed at Beijing Anzhen Hospital from July 2018 to January 2020. Digital subtraction angiography (DSA) before endovascular intervention confirmed the diagnosis. Follow-up information was reviewed by neurologists at 30 days and 6 months after the procedure. The primary endpoints were transient ischemic attack (TIA), ischemic or hemorrhagic stroke and death caused by any reason within 30 days. Results: The overall technical success rate was 100%. The median stenosis rate was reduced from 93.6%±4.5% to 18.8%±11.2% (t=37.36,P<0.001).Primary endpoint event was not reported. During follow-up, one patient developed TIA and no death or ischemic stroke was observed. No in-stent restenosis at six months occurred. Conclusion: Neuroform EZ stent is safe and effective in patients with severe ICAS. However, perspective studies need to be operated for further validation via long-term follow-up.

[Research advances on signaling pathways affecting sweat gland development and their involvement in the reconstitution of sweat adenoid cells in vitro]

The damage of sweat glands in patients with extensive deep burns results in the loss of thermoregulation, which seriously affects the quality of life of patients. At present, there are many researches on the repair of sweat gland function, but the mechanism of human sweat gland development has not been fully clarified. More and more studies have shown that the cascaded pathways of Wnt/β-catenin, ecto- dysplasin A/ectodysplasin A receptor/nuclear factor-κB, sonic hedgehog, and forkhead box transcription factor jointly affect the development of sweat glands, and it has been reported that the cascaded signaling pathways can be used to achieve the reconstruction of sweat adenoid cells in vitro. This article reviews the signaling pathways that affect the development of sweat glands and their involvement in the reconstruction of sweat adenoid cells in vitro.

The association of genetic polymorphisms in interleukin-1 receptors type 1 and type 2 with sudden sensorineural hearing loss in a Taiwanese population: a case control study

Background

Sudden sensorineural hearing loss (SSNHL) is a disease with an unknown etiology; damage to the auditory nerve from inflammation due to viral infection or vascular incidents has been implicated. According to several studies, cytokines, including interleukins, are associated with SSNHL in terms of serum expression and genetic polymorphisms. Interleukin-1 (IL-1) plays a key role in inflammation and may be associated with SSNHL. This study analyzed the association of single nucleotide polymorphisms (SNPs) of IL-1 receptor (IL-1R) genes with SSNHL in Taiwan.

Methods

We conducted a case–control study involving 401 patients with SSNHL and 730 healthy controls. Four SNPs (IL-1R type 1 gene [IL1R1] [rs3917225 and rs2234650] and IL-1R type 2 gene [IL1R2] [rs4141134 and rs2071008]) were selected. The genotypes were determined using the TaqMan assay. The Hardy–Weinberg equilibrium (HWE) was tested for each SNP, and genetic effects were evaluated.

Results

The TT genotype of rs2234650 had an adjusted odds ratio (OR) of 2.988 (95% confidence interval [95% CI] 1.27–6.82) (P = 0.012) compared with the CC genotype in patients with SSNHL. The SNP rs2234650 was associated with SSNHL in the recessive model (TT vs. CC + CT, P = 0.0206, OR = 2.681). The CT genotype of rs4141134 had an adjusted OR of 3.860 (95% CI 2.01–7.44; P < 0.0001) compared with the TT genotype, in patients with SSNHL. The SNP rs4141134 was associated with SSNHL under the dominant model (CC + CT vs. TT, P < 0.0001, OR = 4.087).

Conclusion

These findings suggest that IL1R1 and IL1R2 gene polymorphisms may contribute to an increased risk of SSNHL in Taiwan.

Improving Voice Outcomes After Thyroid Surgery - Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery.

LGE-cMRI assessment of volume controlled reperfusion method in primary percutaneous coronary intervention in patients with ST elevated myocardial infarction

Objectives

We create a procedure based on postconditioning and gradual reperfusion, “Volume Controlled Reperfusion Revascularization” method (VCR)in primary percutaneous coronary intervention. The aim of this experimental study is to assess feasibility and effect of VCR and if this method will attenuate reperfusion injury in microvascular obstruction.

Methods

VCR method, Basically, contemporaneous forward blood flow balloon inflation blocking at the occlusion site and prolonged distal reperfusion via aspiration catheter. Active NC balloon inflation at occlusion site, while keeping NC balloon inflation, aspiration catheter was positioned 10–15mm advanced of NC balloon, intra-aspiration catheter infusion of mixture solution (artery blood 10ml+ heparin NS 10ml), 20ml/min for 10mins, adjust volume and speed according to blood pressure and heart rate variation. Stent or DCB as usual. After several successful operation on RCA, 10 patients with acute ST-segment elevation myocardial infarction (STEMI)with angiography confirmed proximal complete occlusion on dominant blood vessel were non-randomly enrolled (symptom to angiography &lt;12h). 5 cases in VCR group with volume-controlled reperfusion revascularization method, 5 cases in control group with conventional PCI method. Microvascular obstruction (MVO) has been calculated by late gadolinium-enhanced cardiovascular magnetic resonance (LGE-cMRI). Base line information, angiographic features before and after procedure, in-hospital status and MVO were compared.

Results

Successful PCI procedure, safe in-hospital treatment and LGE-cMRI assessment for MVO. Group difference were found in age group and PCI to MRI interval (53.8±7.6 vs 70.2±4.44, P=0.0031; 7.4±2.3 vs 10.4±1.67, P=0.046) between VCR and control group, respectively. There was no statistic difference in other base line information, peak myocardial enzyme, and BNP. MVO and MVO mass ratio was significantly lower in VCR group (0.78±0.96 vs 2.80±1.37, P=0.0317; 0.00585±0.00080 vs 0.02493±0.01501, P=0.0372). TIMI III blood flow found in VCR group. Re-myocardial infraction nor target vessel revascularization was documented in-hospital or 30-days follow up.

Conclusion

Among the selected small sample cases, volume-controlled reperfusion method procedure was clinical safe and feasible without additional side effect. TIMI III blood flow and less MVO were documented.

Funding Acknowledgement

Type of funding sources: None. LGE-cMRI results in VCR and controlCase illustration of VCR procedure

PSIII-18 Super Dose Phytase and Carbohydrase Cocktail Enhance Ileal Nutrient and Energy Digestibility of Corn-soybean Diets in Nursery Pigs

Feed enzymes may ameliorate reduced nutrient and energy digestibility in nursery pigs. The objective was to test effects of super-dosing phytase and fiber-degrading enzymes on digestibility of DM, GE, CP, AA, and Ca. We tested supplementing a super dose (added 1,500 FYT/kg) of phytase (Ronozyme Hi-Phos) with or without carbohydrase cocktail that contained 85 FXU β-xylanase/kg, 587 U/g endo-1,4-β-glucanase, 513 U/g endo-1,3(4)-β-glucanase, 15,000 U/g hemicellulases, and 3,000 U/g pectinases in corn-soybean meal diets in a 2 × 2 factorial arrangement. Diets included 68% corn, 17% SBM, and a basal level of 500 FTU/kg of phytase, and were formulated to contain 2.50 Mcal/kg NE and 5.10 gSID Lys/Mcal NE. Eight ileal-cannulated nursery pigs (initial BW 10 kg) were fed 4 diets at 3.0 × maintenance DE (110 kcal per kg of BW0.75) for four 9-day periods in a double 4 × 4 Latin square. Apparent hindgut fermentation (AHF) was calculated as apparent total tract digestibility (ATTD) minus apparent ileal digestibility (AID). Interactions between super-dosing phytase and carbohydrase cocktail were observed. Supplementing either carbohydrase cocktail or super dose phytase, but not their combination, increased (P &lt; 0.05) diet AID of DM, GE, CP, and most AA by 4–5%-units. Supplementing super dose phytase increased (P &lt; 0.05) AID of P by 16%-units and ATTD of P by 10%-units. Supplementing super dose phytase or carbohydrase cocktail did not affect AID of Ca and ATTD of GE, CP, and Ca, and diet DE value. Supplementing carbohydrase cocktail without super dose phytase decreased (P &lt; 0.05) diet AHF of DM, GE, and CP. In conclusion, dietary inclusion of super dose phytase or carbohydrase cocktail increased ileal digestibility of nutrients in nursery pigs, and thereby reduced protein entering the large intestine. Additive or synergistic effects of carbohydrase cocktail and super dose phytase were not detected.

PSIII-17 Extrusion Enhances Nutrient and Energy Digestibility of Pulse Grain-based Diets Fed to Growing Pigs

Heat processing may enhance nutrient digestibility of diets based on pulse grains. The objective of this study was to determine nutrient and energy digestibility of extruded lentil-based diets containing either supplemental plant or animal protein source in growing pigs. Two diets were formulated to provide 2.4 Mcal NE/kg and 4.35 g standardized ileal digestible Lys/Mcal NE: 1) soybean meal diet (SBM), containing 50% lentil, 31% wheat, and 12.8% soybean meal; and 2) fish meal diet (FM), containing 40% lentil, 45% wheat, and 10% fish meal. Following mixing, each diet was divided into 2 parts: one part remained mash while the other part was extruded using a single-screw extruder (105°C, 400 rpm, 5 kg water/h). The 2 extruded and 2 non-extruded diets were tested in a 2 × 2 factorial arrangement. Eight ileal-cannulated barrows (32.3 kg) were fed the 4 diets at 2.8 times maintenance DE (110 kcal per kg of BW0.75) for four 9-d periods in a double 4 × 4 Latin square. The FM diets had greater (P &lt; 0.05) AID of DM, GE, and most AA, and ATTD of CP, but lower apparent hindgut fermentation of DM and GE than the SBM diets. The AID of CP and AA were 3.2 and 4.7%-units greater (P &lt; 0.05), respectively, and the ATTD of GE and DE values were 2.1 and 3.1%-units greater (P &lt; 0.05), respectively, for the extruded diets than the non-extruded diets. Interactions between protein source and extrusion were not observed. In conclusion, FM diets had greater ileal digestibility of DM, energy, and AA than SBM diets. Extrusion increased the AID of CP and most AA, and DE value of both plant- and animal-protein diets based on lentil grain, indicating that extrusion can increase the energy and protein value of pulse-grain based diets fed to growing pigs.

PSIII-16 Growth Performance of Weaned Pigs Fed Barley Differing in Fermentable Starch and Fiber Profile

Barley grain containing more fermentable starch or fiber might be an attractive energy source in weaned pig diets due to benefits on gut health. Barley rapidly-fermentable carbohydrates may serve as prebiotic and slowly-fermentable fiber may decrease diarrhea in weaned pigs. Steam-explosion processing may disrupt the fiber matrix of hulls, increasing slowly-fermentable fiber of barley. To explore, 220 pigs were fed 1 of 5 diets containing 60% cereal grain: 1) low-fermentable hulled barley (LFB); 2) LFB steam-exploded (LFB-E; 1.2 MPa, 120 s); 3) high β-glucan (10% DM) hull-less barley (HFB); 4) high amylose (17% DM) hull-less barley (HFA); or 5) low-fermentable wheat (LFW). Diets were fed starting 1-week post-weaning and formulated to provide 2.4 and 2.3 Mcal net energy (NE)/kg, 5.5 and 5.1 g standardized ileal digestible lysine/Mcal NE for phase 1 (day 1–14) and phase 2 (day 15–35), respectively. For the entire trial (day 1–35), average daily feed intake (ADFI) and average daily gain (ADG) of pigs did not differ among diets. Gain:feed (G:F) did not differ between LFB and LFW diets, but steam-explosion of hulled barley reduced (P &lt; 0.05) G:F. Feces consistency did not differ between LFB and LFW diets, but was better (P &lt; 0.05) for LFB than HFB, HFA and LFB-E diets. For phase 1, G:F of pigs was lower (P &lt; 0.05) for LFB-E diet than LFW diet. For days 22–28, LFB-E diet had greater (P &lt; 0.01) ADFI than HFA diet and tended (P = 0.09) to have a greater ADG than HFB diet. In conclusion, hulled or hull-less barley grain replaced wheat grain without affecting growth performance in weaned pigs. Hulled barley increased feces consistency. Steam-explosion of hulled barley did not increase growth performance of weaned pigs. Barley grain is an attractive energy source for weaned pigs for managing growth and feces consistency.

Effects of the circadian rhythm on milk composition in dairy cows: Does day milk differ from night milk?

Metabolism in most organisms can show variations between the day and night. These variations may also affect the composition of products derived from livestock. The aim of the present study was to investigate the difference in composition between the day milk and night milk of dairy cows. Ten multiparous Holstein cows (milk yield = 25.2 ± 5.00 kg/d) were randomly selected during mid lactation. Milk samples were collected at 0500 h ("night milk") and 1500 h ("day milk") and analyzed to determine their composition. Mid-infrared spectroscopy was used to analyze macronutrient content of milk. Metabolomics and lipidomics were used to detect and analyze small molecules and fatty acids, respectively. An automatic biochemical analyzer and ELISA kits were used to determine biochemical indicators, as well as antioxidant and immune parameters in the milk. Though milk fat, protein, lactose, and total milk solids were not different between day milk and night milk, small molecules, metabolites and lipids, and hormones and cytokines differed between day milk and night milk. Regarding biochemical and immune-related indicators, the concentrations of malondialdehyde, HSP70, and HSP90 in night milk were lower than that in day milk. However, interferon-γ levels were higher in night milk. Additionally, night milk was naturally rich in melatonin. Lipidomics analyses showed that the levels of some lipids in night milk were higher than those in day milk. Metabolomics analyses identified 36 different metabolites between day milk and night milk. Higher concentrations of N-acetyl-d-glucosamine, cis-aconitate, and d-sorbitol were observed in day milk. However, the other 33 metabolites analyzed, including carbohydrates, lipids, AA, and aromatic compounds, showed lower concentrations in day milk than in night milk. The present findings show that the composition of night milk differs considerably from that of day milk. Notable changes in the circadian rhythm also altered milk composition. These results provide evidence to support the strategic use and classification of day milk and night milk.

Association of sudden sensorineural hearing loss with dementia: a nationwide cohort study

BACKGROUND

Impaired cochlear blood perfusion and microvascular damage can cause sudden sensorineural hearing loss (SSHL), which is a potential risk factor for dementia. This study explored the association between SSHL and dementia.

METHODS

This retrospective cohort study used a random sample of 1000,000 individuals from Taiwan's National Health Insurance Research Database. We identified 3725 patients newly diagnosed with SSHL between January 1, 2000, and December 31, 2009, and propensity score matching according to age, sex, index year, comorbidities, and medications was used to select the comparison group of 11,175 patients without SSHL. Participants were stratified by age (<65 and ≧65 years) and sex for the subgroup analyses. The outcome of interest was all cause dementia (ICD-9-CM codes 290.0, 290.4, 294.1, 331.0). Both groups were followed up until December 31, 2010, for diagnoses of dementia. Cox regression models were used to estimate the hazard ratio (HR) of dementia.

RESULTS

During the average 5-year follow-up period, the incidence rate of dementia in the SSHL cohort was 6.5 per 1000 person-years compared with 5.09 per 10,000 person-years in the comparison group. After adjustment for potential confounders, patients with SSHL were 1.39 times more likely to develop dementia than those without SSHL (95% confidence interval = 1.13-1.71). When stratified by patients' age and sex, the incidence of dementia was 1.34- and 1.64-fold higher in patients with SSHL aged ≥65 years (P = .013) and in women (P = .001), respectively, compared with the comparison group. Women with SSHL who were < 65 years old had the highest risk (2.14, 95% CI = 1.17-4.11, P = .022). In addition, a log-rank test revealed that patients with SSHL had significantly higher cumulative incidence of dementia than those without SSHL (P = .002).

CONCLUSIONS

Patients with SSHL, especially women aged < 65 years, were associated with higher risk of dementia than those without SSHL. Thus, clinicians managing patients with SSHL should be aware of the increased risk of dementia.

New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery

A recurrent laryngeal nerve (RLN) injury resulting in vocal fold paralysis and dysphonia remains a major source of morbidity after thyroid and parathyroid surgeries. Intraoperative neural monitoring (IONM) is increasingly accepted as an adjunct to the standard practice of visual RLN identification. Endotracheal tube (ET) surface recording electrode systems are now widely used for IONM; however, the major limitation of the clinical use of ET-based surface electrodes is the need to maintain constant contact between the electrodes and vocal folds during surgery to obtain a high-quality recording. An ET that is malpositioned during intubation or displaced during surgical manipulation can cause a false decrease or loss of electromyography (EMG) signal. Since it may be difficult to distinguish from an EMG change caused by a true RLN injury, a false loss or decrease in EMG signal may contribute to inappropriate surgical decision making. Therefore, researchers have investigated alternative electrode systems that circumvent common causes of poor accuracy in ET-based neuromonitoring. Recent experimental and clinical studies have confirmed the hypothesis that needle or adhesive surface recording electrodes attached to the thyroid cartilage (transcartilage and percutaneous recording) or attached to the overlying neck skin (transcutaneous recording) can provide functionality similar to that of ET-based electrodes, and these recording methods enable access to the EMG response of the vocalis muscle that originates from the inner surface of the thyroid cartilage. Studies also indicate that, during surgical manipulation of the trachea, transcartilage, percutaneous, and transcutaneous anterior laryngeal (AL) recording electrodes could be more stable than ET-based surface electrodes and could be equally accurate in depicting RLN stress during IONM. These findings show that these AL electrodes have potential applications in future designs of recording electrodes and support the use of IONM as a high-quality quantitative tool in thyroid and parathyroid surgery. This article reviews the major recent developments of newly emerging transcartilage, percutaneous, and transcutaneous AL recording techniques used in IONM and evaluates their contribution to improved voice outcomes in modern thyroid surgery.

Barriers to early diagnosis and treatment of severely immunosuppressed patients with HIV-1 infection: A quantitative and qualitative study

OBJECTIVES

To explore the barriers to early diagnosis of HIV infection and timely initiation of antiretroviral therapy (ART).

METHODS

We assessed the annual number and proportion of ART-naïve people living with HIV infection (PLWH) with severe immunosuppression in Shenzhen, China, from 2008 to 2019. Selected ART-naïve PLWHs with severe immunosuppression who were seeking treatment for the first time in the hospital in 2019 were subjected to an in-depth interview.

RESULTS

The proportion of severely immunosuppressed, ART-naïve PLWH decreased from 36.73% in 2008 to 8.94% in 2015, and then plateaued at approximately 10% from 2015 to 2019. Overall, 55 patients, 70% of whom were men who had sex with men, participated in the qualitative interviews. Ten of them delayed treatment after diagnosis, with a median [interquartile range (IQR)] interval of 5.83 (3.98-8.54) years between diagnosis and ART. More than 80% of the patients reported casual sexual contact within a median period of 6 years and with a median (IQR) of nine (4-20) casual sex partners. The major barriers to HIV testing and diagnosis included lack of knowledge about HIV and high-risk behaviours, low awareness about HIV testing, and resistance to HIV testing. The major barriers to ART initiation included lack of knowledge about the importance of ART and change of national ART eligibility policy, and HIV-related stress.

CONCLUSIONS

The number of PLWHs with severe immunosuppression who seek treatment remains high in Shenzhen, China. Thus, current HIV-related care programmes targeting access to early diagnosis and treatment need to be improved.

[Long-term outcomes of Bryan artificial cervical disc replacement for degenerative cervical spondylosis]

Objective: To compare the long-term clinical effect and imaging results of Bryan artificial cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) and to explore whether ACDR can reduce the occurrence of postoperative adjacent segment degeneration (ASD) in the treatment of degenerative cervical spondylosis. Methods: It was a retrospective study. Total of 60 patients with degenerative cervical spondylosis, who had received operations by Bryan ACDR (n=27) and ACDF (n=33) in the Third Hospital of Hebei Medical University between January 2005 and December 2009 were enrolled in this study. The Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), visual analogue scale (VAS), Odom's scale, cervical range of motion (ROM), surgical segment ROM, heterotopic ossification (HO) and ASD were used to evaluate the clinical and radiologic results. The indices abovementioned were compared between the two groups. Results: The VAS, NDI and JOA scores at each follow-up node in both ACDR and ACDF group were all significantly improved when compared with those before operation (all P<0.05), but there was no significant differences between the two groups (all P>0.05). Of all, 88.9%(24/27) of patients in ACDR group and 84.8%(28/33) of patients in ACDF group achieved excellent or good results, however, there was no significant difference in Odom's scale between the two groups (P>0.05). At the last follow-up, the cervical ROM in ACDR group was 43.2°±8.8°, which was slightly lower than that before operation (45.7°±10.4°), the difference was not statistically significant (t=0.954, P=0.345); the surgical segment ROM in ACDR group was 5.9°±3.6°, which was significantly reduced when compared with that before operation (8.8°±3.4°, t=3.043, P<0.01). However at the last follow-up, the cervical ROM in ACDF group was 36.4°±8.4°, which was significantly reduced when compared with that before operation (43.9°±11.1°), the difference was statistically significant (t=3.095, P<0.01). Although, there was no significant difference in the cervical ROM between the two groups before operation (t=0.643, P=0.523), and the difference was statistically significant at the last follow-up (t=3.054, P<0.01). At the last follow-up, the incidence of HO in ACDR group was 92.6%, and the high-grade HO was 37.0%. The incidence of ASD in ACDR group was 39.5%, which was much lower than that in ACDF group (61.1%, χ(2)=4.462, P=0.035). Conclusion: At minimum follow-up of 10 years, Bryan ACDR achieves a satisfactory clinical effect consistent with ACDF. In terms of advantages, ACDR could maintain the ROM of cervical and retain the ROM of the surgical segment, which reduces the occurrence of ASD by preserving motion.

261 Increasing dietary amylose reduces rate of starch digestion and increases microbial fermentation in weaned pigs

Beneficial effects of SCFA in modulating gut health stimulated interest on dietary strategies to increase intestinal microbial activity and digesta SCFA. Amylose has lower apparent ileal digestibility (AID) than amylopectin. In the large intestine, undigested starch is fermented by microbes producing SCFA. The objective was to determine effects of increasing dietary amylose on starch flow and metabolite profile along the intestinal tract in weaned pigs. Weaned pigs (n=32; initial BW, 8.4 kg) were randomly allocated to 4 diets containing 67% starch with 0, 20, 35, or 70% amylose in a randomized complete block design. On day 21, pigs were euthanized to collect digesta and feces for evaluating starch digestion and metabolite profiles. Apparent hindgut fermentation (AHF) was calculated as apparent total tract digestibility minus AID. Feed intake was 12% lower (P &lt; 0.05) and growth rate was 18% lower (P &lt; 0.05) for pigs fed 70% amylose than pigs fed 0, 20, or 35% amylose. Feed efficiency was greatest (P &lt; 0.05) for pigs fed with 35% amylose. The AID of starch was 44% lower (P &lt; 0.05) in pigs fed 70% amylose. Starch was completely digested by the proximal colon in pigs fed 0, 20, or 35% amylose, but AHF of starch was 14% greater (P &lt; 0.05) in pigs fed 70% amylose. Increasing dietary amylose did not alter digesta SCFA in the small intestine, but increased (P &lt; 0.05) digesta SCFA in the cecum, specifically acetate and total SCFA, and increased (P &lt; 0.05) propionate and valerate in all sections of the colon. In conclusion, increasing dietary amylose in weaned pigs stimulated hindgut fermentation of starch with a corresponding increase in digesta total SCFA in the cecum and colon. Optimizing dietary amylose may exert its effect as dietary prebiotic while promoting an optimal growth rate in young pigs.

172 Increasing inclusion of fermentable fiber decreases nutrient digestibility in grower pigs

Fermentable fiber may increase endogenous losses of P and AA, thereby reducing apparent nutrient digestibility. Acacia gum fiber with medium-to-high fermentability and low viscosity was used to investigate its effect on apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of nutrients, and standardized total tract digestibility (STTD) of P in grower pigs. A P-free basal diet (49% corn starch; 18% bovine plasma protein) was formulated to measure basal endogenous P losses (EPL). Three diets were formulated to include 2.5, 5.0, or 7.5% acacia gum fiber at the expense of corn starch in the P-free basal diet. Diets contained 16.1–17.4% CP and 0.31–0.33% total P (DM-basis). The 4 diets were fed to 8 ileal-cannulated barrows (initial BW, 54.6 kg) for four 9-d periods in a double 4 × 4 Latin square. Apparent hindgut fermentation (AHF) was ATTD minus AID. Increasing inclusion of acacia gum quadratically decreased (P &lt; 0.01) AID of DM (∆ 11.1%), linearly decreased (P &lt; 0.05) ATTD of DM (∆ 1.7%) CP (∆ 1.2%), and quadratically increased (P &lt; 0.05) AHF of DM (∆ 9.4%). Basal EPL were 391 and 377 mg/kg DM intake (DMI) for ileum and total tract, respectively. Increasing inclusion of fiber linearly increased (P &lt; 0.05) ileal EPL (∆ 184 mg/kg DMI), and tended to linearly increase (P &lt; 0.10) EPL for total tract (∆ 243 mg/kg DMI). Dietary inclusion of acacia gum tended to linearly decrease (P &lt; 0.10) AID of P, but did not affect (P &gt; 0.10) ATTD, or STTD of P. In conclusion, increasing inclusion of fermentable, low viscous acacia gum fiber decreased diet digestibility of DM and ATTD of CP, but did not affect total tract P digestibility, indicating that increasing fermentable fiber did not increase specific endogenous losses of P in the total tract.

[Assessment of schistosomiasis transmission risk in Nanjian County of Yunnan Province in 2019]

OBJECTIVE

To assess the schistosomiasis transmission risk in Nanjing County, so as to provide the scientific evidence for the development of the schistosomiasis control strategy and consolidation of the control achievements.

METHODS

On May 2019, the Deqiu Village in Deqiu Town and Baiyun Village in Nanjing Town of Yunnan Province, where schistosomiasis were historically relatively highly endemic, were selected to assess the risk of transmission of schistosomiasis by means of a retrospective review of the data pertaining to the historical endemic situation and schistosomiasis control, combined with a cross-sectional survey of snail and wild feces distribution.

RESULTS

During the period between 2017 and 2018, the mean sero-prevalence rates of Schistosoma japonicum infections were 6.76% (202/2 990) and 2.86% (142/4 971) in humans and 0 (0/1 160) and 10.65% (31/291) in bovines in Deqiu and Baiyun villages of Nanjian County, respectively; however, no egg-positives were identified; in addition, there were 21.06 hm² snail habitats found, but no S. japonicum infections were detected in snails. In 2019, there was 6.17 hm² snail habitats detected, with 2.17% (245/11 298) occurrence of frames with snails and a 0.06 snails/0.1 m² density of living snails; however, no positives for nucleic acid detection were seen in snails; among the 136 wild fecal samples captures from 23 settings, no S. japonicum infections were identified.

CONCLUSIONS

The risk of schistosomiasis transmission remains at a low level in Nanjian County; however, the factors affecting the transmission of schistosomiasis have not been completed eliminated. The integrated schistosomiasis control strategy with an emphasis on the control of the source of S. japonicum infections requires to be reinforced to consolidate the control achievements.

[Neuroprotective effect of ginsenoside Rb-1 on a rat model of Alzheimer's disease]

Objective: To investigate the protective mechanism of ginsenoside Rb-1 on the brain in a rat model of Alzheimer's disease. Methods: Fifty-six male Sprague-Dawley rats were randomly divided into control group, model group, low-dose Rb-1 group (Rb-1: 25 mg•kg(-1)•d(-1)) and high-dose Rb-1 group (Rb-1:50 mg•kg(-1)•d(-1)). Morris water maze was designed to observe the changes of learning and memory ability in rats. Flow cytometry was used to detect the apoptosis of hippocampal neurons. Immunohistochemistry and Western blot were employed to detect the expression levels of apoptosis-related genes (p53, Bax, cytochrome C (Cyto C), Caspase-3 and caspase-9) and anti-oxidative stress-associated genes (nuclear Factor-E2-related factor 2 (Nrf2), kelch-like ECH-associated protein 1 (keap-1), heme oxygenase 1(HO-1) and NADPH quinone dehydrogenase 1 (NQO1)).The activities of catalase (CAT), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were detected by relevant kits. ANOVA and Tukey-Kramer test were used for statistical analysis. Results: The learning and memory ability of rats in the model group was lower than that of the control group (P<0.01).The learning and memory ability of rats in the high-dose Rb-1 treatment group was significantly higher than that of the model group [(80±8) s vs (100±11) s, t=5.390, P<0.01]. The expression levels of apoptosis-related genes (p53, Bax, Cyto C, caspase-3 and caspase-9) in the model group were significantly higher than those in the control group (P<0.01), while the expression levels of these genes in low-dose and high-dose Rb-1 groups were significantly lower than those of the model group (P<0.01). The expression levels of Nrf2, HO-1 and NQO1 genes in the model group were significantly lower than those in the control group (P<0.05), while the expression of these genes in low-dose and high-dose Rb-1 groupswere significantly higher than those of the model group (P<0.01). The activities of CAT, GSH-Px and SOD in the model group were lower than those in the control group (P<0.01), however the activities of CAT, GSH-Px and SOD in low-dose and high-dose Rb-1 groups were higher than those of model group (P<0.05). Conclusions: Both low-dose and high-dose Rb-1 have protective effect on memory and cognitive function of Alzheimer's disease rats by reducing the damage and apoptosis of hippocampal neurons, down-regulating the expression levels of p53, Bax, Cyto C, caspase-3 and caspase-9, up-regulating the expression of Nrf2, HO-1 and NQO1 genes, and increasing the activities of CAT, GSH-Px and SOD. Moreover, the protective effect of Rb-1 on rat brain may be dose-dependent.

Direct Binding of Cisplatin to p22phox, an Endoplasmic Reticulum (ER) Membrane Protein, Contributes to Cisplatin Resistance in Oral Squamous Cell Carcinoma (OSCC) Cells

Prolonged treatment with cisplatin (CDDP) frequently develops chemoresistance. We have previously shown that p22phox, an endoplasmic reticulum (ER) membrane protein, confers CDDP resistance by blocking CDDP nuclear entry in oral squamous cell carcinoma (OSCC) cells; however, the underlying mechanism remains unresolved. Using a fluorescent dye-labeled CDDP, here we show that CDDP can bind to p22phox in both cell-based and cell-free contexts. Subsequent detection of CDDP-peptide interaction by the Tris-Tricine-based electrophoresis revealed that GA-30, a synthetic peptide matching a region of the cytosolic domain of p22phox, could interact with CDDP. These results were further confirmed by liquid chromatography–mass spectrometry (LC–MS) analysis, from which MA-11, an 11-amino acid subdomain of the GA-30 domain, could largely account for the interaction. Amino acid substitutions at Cys50, Met65 and Met73, but not His72, significantly impaired the binding between CDDP and the GA-30 domain, thereby suggesting the potential CDDP-binding residues in p22phox protein. Consistently, the p22phox point mutations at Cys50, Met65 and Met73, but not His72, resensitized OSCC cells to CDDP-induced cytotoxicity and apoptosis. Finally, p22phox might have binding specificity for the platinum drugs, including CDDP, carboplatin and oxaliplatin. Together, we have not only identified p22phox as a novel CDDP-binding protein, but further highlighted the importance of such a drug-protein interaction in drug resistance.

Comparative Study of Endoscopic and Microscopic Type I Tympanoplasty in Terms of Delayed Facial Palsy

OBJECTIVE

Delayed facial palsy is a complication of otologic surgery. Tympanoplasty is commonly employed in chronic otitis media. We compared the incidence and characteristics of delayed facial palsy and hearing restoration between endoscopic and microscopic tympanoplasty for the treatment of simple chronic otitis media.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary medical center.

SUBJECTS AND METHODS

We retrospectively analyzed 468 patients who underwent type I tympanoplasty from January 2009 to April 2017. Patients were divided into transcanal endoscopic ear surgery and microscopic ear surgery groups. Their epidemiological profiles were reviewed and the outcomes of tympanoplasty were analyzed. Blood sample tests for herpes simplex virus and varicella-zoster virus immunoglobulin M and immunoglobulin G were arranged in patients with delayed facial palsy.

RESULTS

Transcanal endoscopic ear surgery exhibited similar benefits to microscopic ear surgery in graft-taking rate and hearing restoration but had a shorter operation time (P < .01). Eight patients (1.71%) developed delayed facial palsy, but no statistically significant difference was observed between the 2 surgical approaches. All patients tested negative for varicella-zoster virus and herpes simplex virus immunoglobulin M and positive for immunoglobulin G of the same viruses; however, the titer did not exhibit a 4-fold increase, implying that patients did not have active viral infections.

CONCLUSION

Transcanal endoscopic ear surgery is an ideal alternative for simple tympanoplasty. The incidence of delayed facial palsy was not significantly different between the 2 approaches. Because of the favorable prognosis and the absence of direct serological evidence supporting viral reactivation, treatment with antivirals may not be required.

[Efficacy comparison of primary percutaneous coronary intervention by drug-coated balloon angioplasty or drug-eluting stenting in acute myocardial infarction patients with de novo coronary lesions]

Objective: To compare the safety profile, angiographic and clinical outcomes between drug-coated balloon(DCB) only strategy versus drug eluting stent(DES) implantation in primary percutaneous coronary intervention(PCI) for acute myocardial infarction(AMI) patients. Methods: A total of 380 AMI patients who underwent primary PCI in Beijing Chaoyang Hospital from January 2016 to May 2019 were enrolled. They were allocated into DEB group(n=180) or DES group(n=200). The Primary endpoint was the major adverse cardiac events(MACE) in hospital and within 3 months after discharge, the composite event of cardiac death, non-fatal myocardial infarction(MI), target vessel revascularization(TVR) and in stent thrombosis. The secondary endpoints included: (1)TIMI blood flow grade and myocardial perfusion grade (TMP grade) of infarct-related vessels before and after PCI. (2)The degree of ST segment resolution(STR) between half hour and two hours after PCI, and STR was represented by percentage of summed ST-segment reduction between baseline and post-PCI. Using the most significant lead of ST segment elevation, calculating the rate of decline in the ST segment after treatment; or the most significant lead of the ST segment depression, to calculate the rate of recovery in the ST segment after treatment. STR<50% was defined as incomplete STR. (3)The occurrence of coronary artery dissection during operation. (4)The peak value of myocardial enzymes. (5)The incidence of bleeding in hospital and within 3 months after discharge. The inverse probability weighting method based on propensity score (IPTW) was used to compare the effects of the two treatments on MACE occurrence in the logistic regression model. Results: There was no significant difference in sex, age, risk factors of coronary heart disease, type and site of AMI, interventional therapy data(P>0.05) between the two groups. The ratio of bifurcation lesions in DCB group was significantly higher than that in DES group, and the diameter of the DCB was smaller while the length was longer than that of DES (all P<0.05). One death occurred in each group during hospitalization. Compared with the DES group, the incidence of MI ［2.8%(5/180) vs. 0.5% (1/200), P=0.10］ and TVR ［2.8%(5/180) vs. 0.5%(1/200), P=0.10］ in the DCB group during hospitalization showed an increasing trend, and were mostly associated with delayed coronary dissection. The incidence of MACE was similar between the two groups (3.3%(6/180) and 1.0%(2/200), P=0.15) during hospitalization. There was no MACE occurred in the two groups within 3 months after discharge. There was no significant difference between the two groups in TIMI grade, TMP grade, incomplete STR rate and peak value of myocardial enzyme (all P>0.05). The incidence of coronary artery dissection was significantly higher in DCB group than in DES group (8.3%(15/180) and 3.0%(6/200), P=0.02), but most of them were type B or A dissection and did not need special treatment. There was no significant difference in bleeding event between the two groups(P=0.91). Logistic regression analysis showed that there was no difference in the risk of MACE during hospitalization between DES and DCB groups for AMI patients receiving PCI (compared with DCB, OR=0.35, 95%CI 0.08-1.43, P=0.13). Conclusions: The initial safety and efficacy profiles of DCB are similar with those of DES for the AMI patients during PCI. The study highlights that the incidence of coronary dissection (type A or B) is higher post DCB treatment than post DES, but it does not affect blood flow. However, the incidence of in-hospital MI due to delayed coronary dissection trends to be higher post DCB. So we should pay close attention to the risk of delayed coronary dissection after DCB in AMI patients with de novo lesion.