[Treatment and prognosis analysis of perineural invasion on sinonasal adenoid cystic carcinoma]

Objective: To analyze the efficacy of sinonasal adenoid cystic carcinoma (ACC) with perineural invasion (PNI), and explore the prognostic value of PNI on sinonasal adenoid cystic carcinoma. Methods: The clinical data of 105 patients with sinonasal ACC admitted to Cancer Hospital, Chinese Academy of Medical Sciences from January 2000 to December 2016 were retrospectively reviewed. All patients were restaged according to American Joint Committee on Cancer 8th edition. Follow-up visits were conducted to obtain information of treatment failure and survival outcome. The Log rank test was used for univariate analysis of prognostic factors, and Cox regression model was used for multivariate prognostic analysis. Results: The maxillary sinus (n=59) was the most common primary site, followed by the nasal cavity (n=38). There were 93 patients with stage Ⅲ-Ⅳ. The treatment modalities included surgery alone (n=14), radiotherapy alone (n=13), preoperative radiotherapy plus surgery (n=10), and surgery plus postoperative radiotherapy (n=68). The median follow-up time was 91.8 months, the 5-year local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 72.6%, 73.0%, 52.9% and 78.0%, respectively. There were 33 patients (31.4%) with PNI-positive. The 5-year DMFS, PFS, and OS rates of PNI-positive group were 53.7%, 29.4% and 56.5%, respectively, which were significantly inferior to those of PNI-negative group (80.8%, 63.0% and 86.8%, respectively, P<0.05), while there was no significant difference in the 5-year LC rate between both groups (64.5% vs 76.5%, P=0.273). The multivariate Cox regression analysis showed PNI was one of the poor prognostic factors of DMFS (HR=3.514, 95%CI: 1.557-7.932), PFS (HR=2.562, 95%CI: 1.349-4.866) and OS (HR=2.605, 95%CI: 1.169-5.806). Among patients with PNI-positive, the 5-year LC, PFS and OS rates of patients received surgery combined with radiotherapy were 84.9%, 41.3% and 72.7%, respectively, which were significantly higher than 23.3%, 10.0% and 26.7% of patients receiving surgery or radiotherapy alone (P<0.05). Conclusion: The presence of PNI increases the risk of distant metastasis in patients with sinonasal ACC. Compared with patients with PNI-negative, the prognosis of patients with PNI-positive is relatively poor, and surgery combined with radiotherapy for PNI-positive sinonasal ACC results in good clinical outcomes.

Echinacoside inhibited cardiomyocyte apoptosis and improved heart function in heart failure rats induced by isoproterenol via suppressing nadph/ros/atf6/chop associated endoplasmic reticulum stress

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Shaanxi Provincial Key Research and Development Projects (2019SF-218)

Background

Endoplasmic reticulum (ER) stress played an essential role in the development and progression of HF due to it could induce cardiomyocyte apoptosis, ATF6/CHOP was regulated by NADPH and ROS and was the crucial pathway to link ER stress and apoptosis in HF. Our previous study indicated that ECH reversed cardiac remodeling and improves heart function, but the underlying mechanisms are still unclear.

Objectives

To investigate the effect of ECH on cardiomyocyte apoptosis and endoplasmic reticulum stress and the underlying mechanisms.

Methods

In vitro, we cultured AC-16 cells and induced cell damage and ER stress by ISO, treated by ECH, the cell apoptosis and biomarkers of ER stress (GRP78, ATF6α, IRE1α, PERK) were detected. In vivo, we induced HF rat model by ISO and treated by ECH, indexes of heart function, cardiomyocyte apoptosis, biomarkers of ER stress and NADPH/ROS/ATF6/CHOP pathway were measured.

Results

In vitro, we confirmed that ECH inhibited ER stress and apoptosis. In vivo, we demonstrated that ECH inhibited cardiomyocyte apoptosis and improved heart function, it significantly decreased GRP78, ATF6α, IRE1α, PERK, and down-regulated NADPH/ROS/ATF6/CHOP pathway.

Conclusions

ECH inhibited cardiomyocyte apoptosis and improved heart function via suppressing NADPH/ROS/ATF6/CHOP pathway associated ER stress.

[Gasless submental-transoral combined appoach endoscopic thyroidectomy for papillary thyroid carcinoma: a series of 41 cases]

Objective: To examine the safety and feasibility of gasless submental-transoral combined appoach endoscopic thyroidectomy for papillary thyroid carcinoma (PTC). Methods: A retrospective analysis of the clinical data of 41 patients with PTC who underwent the gasless submental-transoral combined appoach endoscopic thyroidectomy at the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from November 2020 to April 2021. There were 5 males and 36 females with the age of (35.0±8.7) years (range: 19 to 58 years). A horizontal incision with a length of 2.0 cm is made under the chin as an observation hole, a 10 mm Trocar and a self-developed retractor are inserted, and two 5 mm longitudinal incisions are made on the labial side in the vestibule of the oral cavity as an operation hole, each inserting a 5 mm Trocar, the operation direction is from the cranial side to the caudal side. The sensation of the lower lip and chin was measured on the first day and one month postoperative. The operation time, hospital stay, the number of lymph nodes dissected and postoperative complications were recorded. Results: Surgical procedures in all cases were successfully completed under endoscopic approach without transfering to open surgery. The operation time was (99±34) minutes (range: 50 to 180 minutes) and the postoperative hospital stay was (3.4±2.2) days (range: 2 to 16 days). The maximum diameter of PTC was (7.6±5.8) mm (range: 2 to 30 mm), and the number of lymph nodes of the central compartment dissection was 6(5) (M(IQR)) (range: 1 to 25). The duration of follow-up is 1 month after operation, and the follow-up method is adopted in outpatient clinic. Postoperation complications included 2 cases of transient hypoparathyroidism, One case of recurrent laryngeal nerve injury (continue to follow up to assess whether it is a temporary injury). Postoperative minor chyle leak, seroma, and local redness and swelling in 1 case each were cured after conservative treatment. 1 case of transient minor numbness of the lower lip was observed. No permanent hypoparathyroidism, postoperative bleeding and numbness of the chin was observed. Conclusion: The gasless submental-transoral combined appoach endoscopic thyroidectomy is a feasible approach in selected PTC patients and has clinical application value.

[A short half-life of cccDNA offer or ignite hope for hepatitis B cure under nucleos(t)ide analogues treatment]

Covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV) is the template for HBV replication. Currently, there is a lack of therapeutic drugs that directly target cccDNA. Therefore, blocking cccDNA supplements as fast as possible and reducing the existing cccDNA is the key to achieving a complete cure of chronic hepatitis B. Previous studies have suggested that cccDNA had a long half-life, but a recent study showed that it only took a few months to update cycle of cccDNA pool, and its number was much less than previously predicted. In the future, with the advent of new antiviral drugs that can completely inhibit HBV replication, it is expected that the cccDNA pool will be completely cleared due to its supplement complete blockade, so as to achieve virological cure of chronic hepatitis B.

Association between Dietary Theobromine and Cognitive Function in a Representative American Population: A Cross-Sectional Study

BACKGROUND

Despite reports on neuroprotective effects of dietary theobromine intake, whether dietary theobromine has beneficial effects on cognitive function is unclear.

OBJECTIVES

To investigate the association between dietary theobromine and cognitive function.

DESIGN

A cross-sectional study.

SETTING

Data were collected from the 2011-2014 cycles of the National Health and Nutrition Examination Survey conducted by the Centers for Disease Control and Prevention of the USA.

PARTICIPANTS

A representative American population aged ≥60 years.

MEASUREMENTS

L-theobromine was treated as a log transform and dichotomous form (the highest quantile vs. others). Cognitive function was measured using four tests: Consortium to Establish a Registry for Alzheimer's Disease Word Learning tests, Consortium to Establish a Registry for Alzheimer's Disease delayed recall test, animal fluency test, and digit symbol substitution test. We conducted multiple regression analyses and subgroup analyses to study the association between theobromine and cognitive performance. Basic characteristics, lifestyle factors, disease history, and nutritional intake were adjusted for in these models.

RESULTS

A total of 2,845 participants were included in the study. The highest quantile of L-theobromine intake was positively associated with sores of delayed recall, animal fluency, and digit symbol substitution tests (β, 95% confidence interval, P: 0.11, -0.00-0.30, 0.049; 0.50, 0.02-0.99, 0.043; 1.55, 0.33-2.77, 0.015; respectively) in the fully adjusted model, but not with immediate recall score (β=0.13, 95% confidence interval -0.16-0.43, P=0.361). Subgroup analyses showed that L-theobromine intake was associated with cognitive performance in the highest quantile of caffeine intake.

CONCLUSIONS

Daily theobromine intake was associated with cognitive performance in a large nationally representative population. However, further research is needed to corroborate our findings.

Optofluidic Resonance of a Transparent Liquid Jet Excited by a Continuous Wave Laser

We report a new optofluidic resonating phenomenon that naturally links the optical radiation pressure, total internal reflection, capillary wave, and Rayleigh-Plateau instability together. When a transparent liquid jet is radiated by a focused continuous wave laser beam, the highly ordered periodic jet breakup is unexpectedly triggered and maintained. The capillary wave enables the liquid-gas interface to serve as a rotating mirror reflecting the laser beam in a wide range of angles, including the critical angle for total internal reflection. The liquid jet acts as an optical waveguide to periodically transmit the laser beam to the upstream of the jet. The periodic optical beam transmittance inside the liquid jet exerts time-dependent optical pressure to the jet that triggers the Rayleigh-Plateau instability. The jet breakup process locks in at the frequency corresponding to the peak growth rate of the Rayleigh-Plateau instability of the liquid jet, which agrees with the prediction from the dispersion relation of a traveling liquid jet.

[Microscopic observation of the enamel microstructures of SD rats with different degrees of fluorosis]

Objective: To establish a dental fluorosis model of SD rats with various degrees, to observe the microstructures of enamel samples under scanning electron microscope and to clarify the changes of enamel microstructures with various degrees of dental fluorosis, so as to provide clinical reference for the treatment of patients with moderate and severe dental fluorosis. Methods: Thirty male SD rats (6 weeks of age) were randomly divided into 3 groups with 10 rats in each group. The control group was fed with deionized water without fluoride, the low fluoride group was fed with 50 mg/L NaF deionized water and the high fluoride group was fed with 100 mg/L NaF deionized water in order to establish the dental fluorosis model of rats. After feeding for 6 weeks, the rats were sacrificed and the mandibular incisor teeth were collected and recorded. The surface and sagittal plane of each tooth were observed by scanning electron microscopy and the enamel thickness was measured. Results: In the control group, the enamel color was brown yellow. Enamel color discoloration occurred both in low-fluoride group and high-fluoride group. The enamel color in low-fluoride group was mostly yellow and white striped while in high-fluoride group was mostly chalky white. Under electronic microscope, the enamel rods were alternately arranged and their structure was clear and plump in the control group. The enamel rods of moderate fluorosis were arranged in a straight orientation like tips of bamboo shoots. The enamel rods of severe fluorosis, however, became thinner and the tips of rods were broken. In the control group, sagittal images of enamel turned out to be a dense outer structure with clear boundaries among the inner. The structure of the middle layer was reticulated showing a clear boundary with middle and outer layers. The structure of enamel rods in the inner layers was arranged vertically and horizontally. In the moderate fluorosis group, the outer layer of the enamel became thinner and the middle layer disappeared although the boundary between the outer and middle layers was still clear. In the inner layer, the vertically arranged enamel rods seemed still clear, however the horizontal enamel rods disappeared. In the severe fluorosis group, the outer layer could not be traced. The middle layer was exposed to the air and the inner enamel rods contracted. The inner layers of the enamel had gradually become thinner with the development of the dental fluorosis. The thicknesses of inner layers in control, moderate and the severe groups were (180.71±7.01), (157.10±11.04) and (121.10±12.56) μm respectively. As for the thicknesses of the full layers in the above mentioned three groups, the same trend was observed. The thicknesses, in order of the severity of dental fluorosis, were (241.54±7.76), (207.42±14.36) and (143.79±14.60) μm. Conclusions: With the development of dental fluorosis, the outer enamel layers became thinner or disappeared and the inner enamel layers became thinner or lost its normal structure as well. It is highly recommended that the resin penetration could be used for the proper treatment of moderate and severe dental fluorosis and the strong bleaching and the micro-grinding should be used cautiously.

Integrated Multiomics Analyses Revealing Different Molecular Profiles Between Early- and Late-Stage Lung Adenocarcinoma

The molecular differences in genetic and epigenetic profiling between early-stage (ES) and late-stage (LS) lung adenocarcinoma (LUAD), which might help to understand cancer progression and biomarker guided precision treatment, need further be investigated. In this study, we performed comprehensive analysis using multi-omics next-generation sequencing (NGS) on tissue samples from 7 ES (stage I) and 10 LS (stage III/IV) LUAD patients to study molecular characteristics between the two groups. Characterization of the genomic and transcriptomic profiles showed stage-specific somatic mutations, copy number variations (CNVs) and differentially expressed genes (DEGs). LS samples tend to have more TP53, ERBB2 and CHD4 mutations. Gene copy number loss occurs in immune-related gene pathways in the late stage of LUAD. ATAC-seq analysis showed that LS samples harbored more open chromatin peaks around promoter regions and transcription start sites (TSS) than ES samples. We then identified the known transcription factor (TF) binding motifs for the differentially abundant ATAC-seq peaks between the ES and LS samples and found distinct regulatory mechanisms related to each stage. Furthermore, integrative analysis of ATAC-seq with WGS and RNA-seq data showed that the degree of chromatin accessibility is related to copy number changes, and the open chromatin regions could directly regulate the expression of some DEGs. In conclusion, we performed a comprehensive multi-omics analysis of the early and late stages of LUAD and highlighted some important molecular differences in regulatory mechanisms during cancer progression. Those findings help to further understand mechanism and biomarker related targeted therapy.

Effects of medical graphic narratives (patient comic) on Patient Reported Outcome Measures (PROMs) in patients undergoing coronary angiography and PCI

Background/Introduction

Increasing evidence suggests that patients scheduled for invasive cardiac procedures such as coronary angiography / PCI feel insufficiently informed about the planned procedure.

Purpose

To improve the Patient Informed Consent (IC) before coronary angiography by using “medical graphic narratives” (patient comic) that illustrate central IC-related aspects in a simple and understandable manner.

Methods

A patient comic illustrating central steps of the procedure, risks, treatment alternatives and behavioural measures was created in collaboration with professional scientific visual communicators. In a randomised, controlled, prospective trial, we included 121 patients undergoing coronary angiography/PCI. Patients were randomised to a group that was informed about the procedure using the usual Patient IC approach (official consent form and conversation with physician; Control group) or a group that additionally obtained a patient comic for reading (graphic illustrations of central IC aspects based on the official consent form; Comic group). Patient Reported Outcome Measures (PROMs), i.e. satisfaction with and perceived quality of the patient IC, were tested in both groups comparing single items of the Client Satisfaction Questionnaire-8 (CSQ-8) and self-designed single items in both IC groups. Differences were compared using the Fisher's exact test. A p-value &lt;0.05 was considered statistically significant.

Results

PROMs showed significant benefits in favour of the Comic group: Quality of the patient IC was perceived to be “very good” in 45.0% of the Comic group compared to 24.9% of patients in the Control group (p=0.023). Only 23.0% of the patients in the Control group, compared to 40.0% in the Comic group, stated that the IC procedure completely met their expectations (p=0.012). 57.4% in the Control group and 76.7% in the Comic group stated that all of their questions were satisfactorily adressed before the procedure (p=0.015). 43.3% in the Comic group, in contrast to 18.0% in the Control group, declared to feel “very satisfied” with the obtained IC procedure (p=0.002). The acceptance of the patient comic was very high: no patient (0%) expressed feelings of not being taken seriously by reading the patient comic.

Conclusions

Our data confirm pronounced limitations of the usual Patient IC practice before coronary angiography. The use of a patient comic that narratively illustrates central steps of the procedure positively impacts on patient-centered endpoints and significantly improves the patient IC procedure.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Friede Springer Herz Stiftung

Design and expected performance of a variable-radii sinusoidal spiral x-ray spectrometer for the National Ignition Facility

A novel high-resolution x-ray spectrometer for point-like emission sources has been developed using a crystal shape having both a variable major and a variable minor radius of curvature. This variable-radii sinusoidal spiral spectrometer (VR-Spiral) allows three common spectrometer design goals to be achieved simultaneously: 1. reduction of aberrations and improved spectral (energy) resolution, 2. reduction of source size broadening, and 3. use of large crystals to improve total throughput. The VR-Spiral concept and its application to practical spectrometer design are described in detail. This concept is then used to design a spectrometer for an extreme extended x-ray absorption fine structure experiment at the National Ignition Facility looking at the Pb L₃ absorption edge at 13.0352 keV. The expected performance of this VR-Spiral spectrometer, both in terms of energy resolution and spatial resolution, is evaluated through the use of a newly developed raytracing tool, xicsrt. Finally, the expected performance of the VR-Spiral concept is compared to that of spectrometers based on conventional toroidal and variable-radii toroidal crystal geometries showing a greatly improved energy resolution.

[Interference of long noncoding RNA FOXCUT inhibits epithelial-mesenchymal transformation and induces mitochondrial injury in nasopharyngeal carcinoma cells]

OBJECTIVE

To investigate the effects of RNA interference of long noncoding RNA FOXCUT on epithelial mesenchymal transformation and mitochondrial function in nasopharyngeal carcinoma (NPC) cells.

METHODS

FOXCUT expression levels were detected by RT-PCR in tumor tissues and adjacent tissues from 50 patients with NPC and in NP69, CNE1, CNE2, SUNE2, HER2 and 5-8F cell lines. CNE1 cells were transfected with a short hairpin RNA (shRNA) targeting FOXCUT or a negative control RNA construct (shRNA-NC), and the changes in cell proliferation and morphology were assessed with CCK8 assay, clone formation assay and microscopic observation. An immunofluorescence assay was used to examine the vimentin-positive cells, and the levels of SOD, MDA and LDH in the cells were detected. The changes of mitochondrial membrane potential were detected with flow cytometry, and the expression levels of E-cad, N-cad, vimentin, Bax, Bcl-2, caspase-3 and c-Myc in the cells were detected with Western blotting.

RESULTS

The expression level of FOXCUT was significantly increased in NPC tissues as compared with the adjacent tissues (P < 0.001). Compared with NP69 cells, CNE1, CNE2, SUNE2, HER2 and 5-8F cells all exhibited significantly increased expressions of FOXCUT (P < 0.001). In CNE1 cells, transfection with FOXCUT shRNA significantly inhibited cell proliferation and clone formation (P < 0.001), and caused obvious changes in cell morphology. FOXCUT knockdown significantly decreased the expressions of N-cad and vimentin, increased E- cad expression and the contents of MDA and LDH (P < 0.05), reduced vimentin- positive cells and the activity of SOD, and caused a shift of red fluorescent cells to green fluorescent cells and an increased percentage of green fluorescent cells. FOXCUT knockdown also resulted in significantly increased expressions of Bax/Bcl2 and cleaved Cas3/Cas3 and a lowered expression of c-Myc.

CONCLUSIONS

Interference of FOXCUT can inhibit the proliferation and epithelial-mesenchymal transformation, enhance oxidative stress, induce mitochondrial function injury, and promote apoptosis in NPC cells, suggesting the potential of FOXCUT interference for targeted treatment of NPC.

[Research and application progress of mechanical measures for oral plaque control]

Effective removal of dental plaque is a key measure to prevent and control common oral diseases and to maintain the long-term effect of dental prostheses. The methods of oral plaque control are mainly depending on mechanical measures, including regular toothbrushing, interdental cleaning and oral irrigation. Toothbrushing is the most common and effective method for mechanical removal of dental plaque.How ever the effect of toothbrushing alone to remove dental plaque is limited. It is necessary to control the interdental plaque using tools such as dental floss and interdental brushes. Oral irrigation is an assistant method to improve oral hygiene. Toothbrushing combined with the use of oral irrigator can significantly improve the removal rate of dental plaque. The present article reviews the research progress of the mechanical plaque control methods and their application results.

[High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma]

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

Application of artificial intelligence in diagnosis of osteoporosis using medical images: a systematic review and meta-analysis

Artificial intelligence (AI) is a potentially reliable assistant in the diagnosis of osteoporosis. This meta-analysis aims to assess the diagnostic accuracy of the AI-based systems using medical images. We searched PubMed and Web of Science from inception to June 15, 2020, for eligible articles that applied AI approaches to diagnosing osteoporosis using medical images. Quality and bias of the included studies were evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The main outcome was the sensitivity and specificity of the performance of the AI-based systems. The data analysis utilized the R Foundation packages of "meta" for univariate analysis and Stata for bivariate analysis. Random effects model was utilized. Seven studies with 3186 patients were included in the meta-analysis. The overall risk of bias of the included studies was assessed as low. The pooled sensitivity was 0.96 (95% CI 0.93-1.00), and the pooled specificity was 0.95 (95% CI 0.91-0.99). However, high heterogeneity was found in this meta-analysis. The results supported that the AI-based systems had good accuracy in diagnosing osteoporosis. However, the high risk of bias in patient selection and high heterogeneity in the meta-analysis made the conclusion less convincing. The application of AI-based systems in osteoporosis diagnosis needs to be further confirmed by more prospective studies in multi-centers including more random samples from complete patient types.

Perioperative management of a morbidly obese patient undergoing right upper lobectomy with poor pulmonary function: a case report

The incidence and prevalence of obesity is drastically increasing worldwide. Clinical surgeons treating cancer patients often encounter obese patients. However, cases of surgical lung cancer patients with morbid obesity and poor pulmonary function undergoing lobectomy have not been reported. A 75-year-old woman was referred to our hospital on June 25, 2014 with a cough with blood in phlegm for 1 week. Staging positron emission tomography revealed an abnormal lesion indicating malignancy under the pleura of the upper lobe of the right lung. As the patient had chronic obstructive pulmonary disease (COPD) and was morbidly obese [body mass index (BMI): 40.1 kg/m2], she had preoperative poor pulmonary function with a forced expiratory volume in 1s (FEV1) of 1.06l and diffusing lung capacity for carbon monoxide of 52.2. After 2 weeks of rehabilitation and treatment, respiratory function improved before surgery. The patient required thoracotomy so that right upper lobectomy with lymph node dissection under general anesthesia could be performed. However, on postoperative day 3, the patient was diagnosed with postoperative severe pneumonia with respiratory failure and cardiac insufficiency, and was transferred to the intensive care unit (ICU). After 72 postoperative days, the patient was discharged from hospital. The pathological diagnosis was invasive adenocarcinoma. Although the patient experienced severe postoperative complications, this case is useful for surgeons treating cancer patients because there are few reports discussing the perioperative management of morbidly obese patients with poor pulmonary function undergoing lung cancer radical resection. Further studies on lobectomy for morbidly obese lung cancer patients with poor pulmonary function are warranted to improve the treatment methods of these patients.

The multi-optics high-resolution absorption x-ray spectrometer (HiRAXS) for studies of materials under extreme conditions

We report the development of a high-resolution spectrometer for extended x-ray absorption fine structure (EXAFS) studies of materials under extreme conditions. A curved crystal and detector in the spectrometer are replaceable such that a single body is employed to perform EXAFS measurements at different x-ray energy intervals of interest. Two configurations have been implemented using toroidal crystals with Ge 311 reflection set to provide EXAFS at the Cu K-edge (energy range 8.9-9.8 keV) and Ge 400 reflection set to provide EXAFS at the Ta L3-edge (9.8-10.7 keV). Key performance characteristics of the spectrometer were found to be consistent with design parameters. The data generated at the National Ignition Facility have shown an ≃3 eV spectral resolution for the Cu K-edge configuration and ≃6 eV for the Ta L3-edge configuration.

[Correlation analysis between serum ferritin level and liver damage in acute stage of dengue fever]

Objective: To investigate the correlation between serum ferritin (SF) level and liver damage in the acute stage of dengue fever. Methods: A retrospective study was conducted to analyze 171 cases diagnosed with dengue fever as dengue fever group and 130 healthy patients as control group in Hangzhou 3A grade hospital from July to December 2017. Clinical data, SF and liver function related indicators were collected from both groups: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) to analyze the correlation between liver damage and SF in patients with dengue fever. Results: ALT, AST, and SF levels were significantly higher in the dengue fever group than those in the healthy control group (Z = 11.553, 15.054 and 15.163, P < 0.001). SF levels were higher in the dengue fever combined with liver damage group than those without the liver damage group (z = 6.930, P < 0.001). However, there was no statistically significant differences in age, gender, peak body temperature, and history of liver disease (P > 0.05). In addition, Spearman's correlation analysis showed that SF was positively correlated with ALT, AST, and TBIL (r = 0.464, 0.531 and 0.315, P < 0.001). Among dengue patients with different SF levels, there were significant difference in ALT, AST levels and incidence of liver damage (H = 14.240 and 17.584, χ(2) = 49.547, P < 0.001). Patients with higher SF levels had higher ALT, AST levels and incidence of liver damage. Binary logistic regression analysis showed that hyperferritinemia (SF≥500 ng/ml) was the risk factor for dengue fever combined with liver damage (OR = 8.120, P < 0.001). Furthermore, ROC curve analysis showed that the AUC for SF to judge dengue fever combined liver damage was 0.846 (95% CI: 0.785-0.908), and the sensitivity and specificity when the SF cut-off value was 1 506 ng/ml were 74.8% and 83.3%. Conclusion: There is a certain correlation between the SF level and the degree of liver damage in acute stage of dengue fever patients, and hyperferritinemia is a risk factor for dengue fever combined with liver damage.

Development of the gas puffing imaging diagnostic on J-TEXT tokamak

Edge turbulence is important for plasma confinement, so the gas puffing imaging (GPI) diagnostic was proposed on the J-TEXT tokamak for the two-dimensional measurement of turbulence in the edge region. GPI is a diagnostic of plasma turbulence that uses a puff of neutral gas at the plasma edge to increase the local visible light emission for improved space-time resolution of plasma fluctuations. Considering the conditions of J-TEXT, the observation area is 21° away from the position of the optical system in the toroidal direction, and the observation area is 10 cm × 10 cm inside and outside the last closed flux surface. To have a lower divergence of the gas flow, the gas puff nozzle is specially designed. An interface has been developed for operation. To photograph the line radiation generated by the neutral gas cloud along the magnetic field lines, the optical system is designed. It is composed of a quartz glass, mirrors, commercial lenses, filters, and high-speed cameras. The high-speed camera can capture the line radiation with a speed up to 180 000 frames/s with 256 pixels × 256 pixels and an exposure time of 5 µs. In a recent experiment, the new GPI diagnostic has obtained some preliminary pictures.

Tunable spin Hall shift of light from graphene-wrapped spheres

Graphene has taken impressive roles in light manipulation and optical engineering. The most attractive advantage of graphene is its tunable conductivity that could be dynamically modulated by various means. In this paper, we show that the spin Hall shift of light is dynamically tunable via changing the Fermi level of the graphene-wrapped spheres. Such tunability is prominent when different modes interfere with each other, such as at the interference of electric and magnetic dipolar modes or at the interference of electric dipolar and electric quadrupole modes. The circular polarization degree in the near field clearly demonstrates the strength of spin-orbit interaction, which is associated with spin Hall shift of light in the far-field. In addition, the spin Hall effect is shown in far-field detection plane and should be observed in experiment. Our results provide insights into how the spin Hall effect could be tuned and add new perspective in designing optical super-resolution imaging techniques.

[Correlation between midpalatal suture stage on cone-beam CT images and its cervical vertebral maturation stage for 1 076 Chinese children and youth]

Objective: To investigate the correlation between cone-beam CT (CBCT) morphological stage of midpalatal suture (MPS) and cervical vertebral maturation stage (CS) of Chinese children and youth. Methods: This study was a retrospective observational study. A total of 1 076 CBCT images (male: 401, female: 675, age≥ 6.0 years old and<21.0 years old) taken from January 2013 to April 2018 in Peking University School and Hospital of Stomatology were included. MPS and CS of each sample were recorded according to previous studies. MPS included five stages: MPS 1, MPS 2, MPS 3, MPS 4s1 (substage), MPS 4s2 (substage), and MPS 5. CS included six stages: CS 1-6. Correlation between MPS and CS (ordinal categorical variables) was investigated by Spearman correlation coefficient and diagnostic test analysis. Results: Spearman coefficient between CS and MPS was 0.803. Diagnostic pairs with the best diagnostic performance include: CS 6-MPS 5, CS 5-MPS 4s2, CS 1-MPS 1, CS 4-MPS 4s1, CS 2-MPS 1, CS 3-MPS 3. The 90.9% (309/340) of individuals at CS 1-3 were at MPS 1-3 and 9.1% (31/340) were at MPS 4s1. The 33.0% (107/324) of individuals at CS 4 were at MPS 3 and 46.6% (151/324) were at MPS 4s1. Conclusions: CS has a close relationship with MPS. Individuals at CS 4 are recommended to take pre-treatment CBCT, so as to estimate feasibility of skeletal expansion with traditional tooth-borne rapid maxillary expansion.

The synergistic antifungal activity of resveratrol with azoles against Candida albicans

Candida albicans is one of the most common clinical pathogenic microorganisms and it is becoming a serious health threat, particularly to immunocompromised populations. Drug resistance of Candida species has also frequently emerged, and combination therapy for fungal infections has attracted considerable attention. In this study, we established the Qinling Mountains myxobacterial secondary metabolites library and a synergic assay in combination with ketoconazole against C. albicans was introduced for metabolites screening. Two active compounds with synergic anticandidal activities were obtained, which were identified as trans-resveratrol and cis-resveratrol. According to our study, resveratrol can reduce the dosage to 1/64 of ketoconazole as well as itraconazole. Furthermore, synergistic anticandidal activity of resveratrol combined with azoles was verified against a panel of clinical C. albicans isolates, and the combination strategy enhanced the azoles susceptibility of three fluconazole-resistant isolates. These findings suggest that resveratrol enhances the efficacy of azoles and provides a promising application in therapy of C. albicans infection.

Curcumin suppresses tumor growth of gemcitabine-resistant non-small cell lung cancer by regulating lncRNA-MEG3 and PTEN signaling

BACKGROUND

Lung cancer is one of the most aggressive malignancies and the efficacy of chemotherapy or concurrent chemoradiation is limited in clinical application. Curcumin has been reported to block cancer development by modulating multiple signaling pathways. However, whether curcumin can inhibit gemcitabine-resistant non-small cell lung cancer through regulation of lncRNA and the involved molecular mechanisms are rarely reported.

MATERIALS AND METHODS

MTT assay, clonogenic assay, apoptosis assay, qRT-PCR, Western blotting, immunohistochemistry, xenograft experiment were carried out in the present study.

RESULTS

The results showed that curcumin suppressed gemcitabine-resistant non-small cell lung cancer cell proliferation and induced apoptosis. Curcumin upregulated the expression of lncRNA-MEG3 and PTEN, and MEG3 overexpression could increase the level of PTEN expression, while MEG3 knockdown decreased the level of PTEN expression in gemcitabine-resistant non-small cell lung cancer cells. Curcumin treatment failed to inhibit the proliferation and induce apoptosis in MEG3 knockdown or PTEN knockdown cells.

CONCLUSIONS

These findings show the antitumor activity of curcumin for potential clinical application in gemcitabine-resistant non-small cell lung cancer treatment.

[The clinical observation of sirolimus combined with calcineurin inhibitors for steroid-resistant/steroid-dependent extensive cGVHD]

Objective: To observe the efficacy and safety of sirolimus combined with calcineurin inhibitor (CNI) in the treatment of glucocorticoid resistant/dependent extensive chronic graft-versus-host disease (cGVHD) . Methods: A total of 27 patients with steroid-resistant/steroid-dependent extensive cGVHD from November 2015 to January 2019 were enrolled and given sirolimus capsules combined with cyclosporine or tacrolimus to observe the clinical efficacy and adverse events. Results: The median duration of medication was 14.2 months and the mean duration was 16.7 months. The median follow-up time was 20.1 months (12.9-46.1 months) . Following the 6-month follow-up, 3 cases achieved complete response (CR) and 12 cases partial response (PR) . The overall response rate (ORR) was 55.6% ; for progression-free survival (PFS) , PFS-6 reached 88.9% (24/27) , and for overall survival (OS) , OS-6 was 100% . At the 1-year follow-up, there were 5 cases of CR and 11 cases of PR, ORR was 59.3% , PFS-12 reached 62.9% (17/27) , and OS-12 was 100% . The subgroup analysis found that the program was more effective for cGVHD in male donors and the target organ analysis had an advantage in the treatment of oral cavity, skin, and liver rejection. Adverse events were observed: hyperlipidemia 11.1% , oral ulcer 7.4% , fungal infection 11.1% , liver injury 3.7% , renal insufficiency 0, and no new CMV and EB viremia. Conclusion: Sirolimus combined with calcineurin inhibitors is effective in treating steroid-resistant/steroid-dependent extensive cGVHD, especially because adverse reactions (renal toxicity, CMV, EBV infection) are low in number, which is suitable for long-term treatment of cGVHD.

[Correlation between thyroid function and glucolipid metabolism in type 1 diabetic adults]

To assess the correlation between thyroid function and glucolipid metabolism in type 1 diabetic adults. A retrospective analysis was conducted in 230 type 1 diabetic adults who were hospitalized in the Department of Endocrinology of Shandong Provincial Hospital Affiliated to Shandong University from January 2008 to January 2020. It showed that thyroid stimulating hormone(TSH) was significantly positively correlated with total cholesterol (TC) (r=0.239), triglycerides (TG) (r=0.166) and low-density lipoprotein cholesterol (LDL-C) (r=0.249), respectively (all P<0.05). Free triiodothyronine (FT₃) was significantly negatively correlated with fasting plasma glucose (FPG) (r=-0.272), glycated hemoglobin (HbA1c) (r=-0.240), TC (r=-0.197) and LDL-C (r=-0.220), respectively (all P<0.05). Free thyroxine (FT₄) was negatively correlated with TC (r=-0.171) and LDL-C (r=-0.170), respectively (all P<0.05). TC was an independent predictor of TSH, FT₃ and FT₄, FT₃ and FT₄ were independent predictors of HbA1c. TSH was an independent predictor of TC, TG and LDL-C. Thyroid function is closely related to glucolipid metabolism in type 1 diabetic adults.

Correlation between Sarcopenia and Arteriosclerosis in Elderly Community Dwellers: A Multicenter Study

BACKGROUND

Evidence suggests that arteriosclerosis and sarcopenia (decreased muscle mass) share some of their many causes. However, after controlling for confounding factors, it is unclear whether the presence of arteriosclerosis correlates with sarcopenia.

OBJECTIVES

The aim of this paper is to explore whether sarcopenia is associated with arteriosclerosis.

DESIGN

A multicenter cross-sectional community-based study.

MATERIALS AND METHODS

A total of 2511 elderly subjects from six Chinese community health service centers in Anhui province were surveyed through an e-health promotion system to collect basic data and measurements of brachial-ankle pulse wave (baPWV), body composition, and handgrip strength (HGS). Pearson's correlation and binary logistic regression analyses were performed to identify associations between sarcopenia and high baPWV.

RESULTS

The prevalence rates of sarcopenia were 12.9% in men and 15.3% in women according to the 2019 standard of Asian Working Group for Sarcopenia. Among subjects with high baPWV, the proportion of sarcopenia was higher compared to those with normal baPWV (men: 17.7% vs. 3.7%; women: 20.4% vs. 4.9%, both p<0.001). Binary logistic regression analysis revealed that sarcopenia was associated with high baPWV (p<0.0001, odds ratio=1.619) after adjusting for confounding factors. HGS slightly and negatively correlated with baPWV (-0.19 in men and -0.18 in women).

CONCLUSIONS

The intertwined pathophysiological mechanisms shared by arteriosclerosis and sarcopenia are potential targets for future interventions to reduce morbimortality in subjects with both disorders. Upcoming prospective studies and clinical trials are expected to advance these findings.

Plasma concentration of ZCCHC14 contributes to prognostic efficacy in intracerebral hemorrhage patients

OBJECTIVE

Intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease of the central nervous system. In this study, we aimed to investigate plasma ZCCHC14 expression and its correlation with the diagnosis, prognosis, and clinical features of ICH.

PATIENTS AND METHODS

The plasma levels of ZCCHC14, TNF-α, IL-6, and IL-10 were dynamically detected among 130 ICH patients and 60 corresponding healthy subjects. A receiver operating characteristic (ROC) curve was used for the statistical analysis of the diagnostic and prognostic efficacy of ICH.

RESULTS

Hypertension (p = 0.005), ARB application (p = 0.014), ZCCHC14 level (p < 0.001), TNF-α (p < 0.001), IL-6 (p < 0.001), and IL-10 (p < 0.001) were found to be different between ICH patients and healthy controls. Multiple logistic regression analysis indicated that ZCCHC14 levels at admission were significantly different between the two groups (p = 0.002, OR = 0.440, 95% CI 0.290-0.718). Plasma ZCCHC14 levels dynamically changed, increasing at admission, and peaking on day 7. ZCCHC14 was a potential diagnostic marker for ICH (AUC = 0.953, p < 0.0001, 95% CI: 0.901-1.004) with a specificity and sensitivity of 84.6% and 95.5%, respectively. The plasma ZCCHC14 level was negatively correlated with IL-6 concentration (p = 0.024, r = -0.311) but was positively correlated with IL-10 concentration (p = 0.041, r = 0.298). Furthermore, the plasma ZCCHC14 level was correlated with hypertension (p = 0.005), GOS (p = 0.025), bleeding volume (p < 0.001), midline shift (p = 0.003), and poor outcome (p = 0.006). The low ZCCHC14 expression group had poorer outcomes (death or severe disability) than high ZCCHC14 expression group (Breslow, p < 0.001).

CONCLUSIONS

We found that the plasma ZCCHC14 level might be a potential biomarker for both the early diagnosis of and prediction of outcomes in ICH.

The acquisition of Mycobacterium tuberculosis infection in village doctors in China: a prospective study

BACKGROUND: Occupational exposure-related risk of Mycobacterium tuberculosis infection has been reported for village doctors in China. This prospective study aims to estimate the infection acquisition in this key population.METHODS: At baseline, all village doctors registered in Zhongmu County were tested by QuantiFERON^®-TB Gold In-Tube (QFT) and QuantiFERON^®-TB Gold Plus (QFT-Plus) in parallel. Those negatives for either of the tests were retested to identify conversions at the 2-year follow-up investigation.RESULTS: A total of 367 eligible participants completed the 2-year follow-up survey with frequency of conversion of 5.0% (18/361) for QFT and 6.1% (21/343) for QFT-Plus. The agreement of follow-up results between the tests was 93.2% with a κ coefficient of 0.43 (95%CI 0.20-0.65). Among QFT-Plus convertors, the difference between TB1 and TB2 tubes (TB2-TB1) was significantly increased as compared with baseline results (P = 0.039). Participants from the villages with occurrence of microbiologically confirmed pulmonary TB showed higher frequency of QFT conversions (11.0% vs. 3.2%, P = 0.011) and QFT-Plus conversions (12.3% vs. 4.4%, P = 0.027) than those from the villages without occurrence.CONCLUSION: Our results consistently suggest that capability on occupational protection and M. tuberculosis infection control should be improved in village doctors in China.

The distribution of refraction by age and gender in a non-myopic Chinese children population aged 6-12 years

Background

The Prevalence of myopia is increasing in China. This study aimed to explore the distribution of spherical equivalent (SE) and its association with age, body mass index (BMI), gender in a non-myopic Chinese children population aged 6 to 12 years.

Methods

A total of 6362 students were recruited for ophthalmological investigation. Demographic and myopia related behavioral information was collected. SE value was measured by the Topcon RM-8900 or KR-800autorefractors. Potential independent risk factors were determined with Odds Ratio (OR) and 95% Confidence Interval (CI) by logistic regression analysis. We further constructed the nomogram model to predict future onset of myopia.

Results

Among the study population, 3900 (61.3%) were non-myopic. The prevalence of myopia is 38.0% for boys and 39.5% for girls. The average SE values were 0.50 ± 0.70 D for boys and 0.60 ± 0.80 D for girls. The mean SE values decreased with age, and the value of height and BMI took on a stable trend. Threshold values for myopia varied across age groups and gender. Paternal myopia (OR: 1.22, 95%CI: 1.01–1.48), near-work activities on weekends (2.56, 1.17–5.61), and outdoor activities (0.68, 0.54–0.86) were associated with potential myopic in students.

Conclusion

A series of age-gender based SE threshold values were established to predict myopia in Chinese children aged 6 to 12 years. High risk factors for myopia included paternal myopia, near-work activities on weekends, and outdoor activities. Countermeasures are encouraged to reverse the increasing trend of myopia in children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-020-01709-1.

[Clinical analysis of 126 patients with coronavirus disease 2019 with pharyngeal symptoms]

Objective: To investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with pharyngeal symptoms. Methods: From January 10 to May 15, 2020, clinical data of 1 228 patients with COVID-19 in Renmin Hospital of Wuhan University was collected (554 males and 674 females, with the range of age from 10 to 95 years old, the average age was 55.2 years old). The patients were divided into pharyngeal symptoms group (PS, 126 cases) and non-pharyngeal symptoms group (Non-PS, 1 102 cases) according to the presence or absence of pharyngeal symptoms such as pharyngalgia, pharyngeal dryness, pharyngeal itching, and pharyngeal foreign body sensation. The clinical data in terms of age, sex, medical history, duration of symptoms, treatment time, clinical classification, pulmonary imaging findings, whole blood cell count, serum hypersensitivity C-reactive protein, C-reactive protein, procalcitonin were statistically analyzed between the two groups. Chi-square, Fisher's exact test and Mann-Whitney U test were used for statistical analysis. Results: The most common pharyngeal symptoms were pharyngalgia (59.52%, 75/126), followed by foreign body sensation (23.02%, 29/126), pharyngeal dryness (8.73%, 11/126), and itching (8.73%, 11/126). The median age of the patients in the PS group was 51.50 years old, which was less than 57.50 years old in the non-PS group, showing a significant difference (P<0.05). The female cases accounted for 65.08% (82/126), which was higher than 53.72% (592/1 102) of the non-PS group (P<0.05). The incidence of bilateral lung inflammation confirmed by CT images was 73.81% (93/126), which was significantly lower than 83.48% (920/1 102) in the non-PS group (P<0.05). No significant differences were shown in the proportion of patients with clinical types, treatment days, duration of symptoms, white blood cell count, lymphocyte count, lymphocyte percentage, eosinophil count, eosinophil percentage, hypersensitive C-reactive protein, C-reactive protein, D-dimer, procalcitonin and other indicators (P>0.05). Conclusions: The incidence of pharyngeal symptoms in patients with COVID-19 is 10.26%. Most of these symptoms occur before or at the same time as the common symptoms of the disease. Therefore, patients with such symptoms may bring a greater risk of infection to otolaryngologist. According to the current clinical classification criteria, pharyngeal symptoms have no obvious correlation with the degree of the disease; but the presence of pharyngeal symptoms may suggest a milder clinical presentation and a better prognosis.

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.

[Isolation and Identification of two Escherichia albertii strains in Shanxi Province, China]

Objective: To investigate the prevalence of Escherchia albertii in Shanxi province. Methods: The chicken intestines were enriched in EC broth. The eae gene was detected by PCR, and the eae-positive EC enrichments were inoculated in MacConkey agar plate. The eae-positive lactose non-fermenting isolates were presumed as Escherchia albertii, and then analyzed by triplex-PCR, 16S rDNA sequencing and MLST. Results: Two suspected Escherchia albertii were isolated from 250 samples of chicken intestines. It was identified as Escherchia albertii by phenotypic, specific genes,16S rDNA sequencing, and MLST analyses. The cytolethal distending toxin B (cdtB) showed positive by PCR,and they were clusted to Ⅱ/Ⅲ/Ⅴ group by sequencing. Conclusion: This study showed that the Escherchia albertii was existed in Shanxi province, China.

[Clinical analysis of children with cardiac syncope caused by anomalous origin of the left coronary artery from the right sinus]

Objective: To analysis the clinical characteristics and to summarize therapy experience of pediatric patients with cardiac syncope caused by anomalous origin of the left coronary artery from the right sinus (ALCA-R). Methods: We retrospectively analyzed the clinical data including clinical manifestations, myocardial injury biomarkers, radiological features, treatments and prognoses of pediatric patients with ALCA-R who were admitted to Beijing Children's Hospital from November 2015 to June 2018. Results: Four female patients were included in this analysis, age of onset was 7 to 14 years. All the patients presented with exercise-induced syncope and acute myocardial infarction. During the course, three patients presented with acute left heart failure, and one patient had history of sudden cardiac arrest. Laboratory data showed significant elevation of both the creatine kinase and troponin levels in four patients. All electrocardiogram (ECG) showed left main coronary artery occlusion, echocardiography suggested the possible anomalous origin of the left coronary artery in one child. Coronary CT angiography (CTA) revealed there was no coronary ostium in the left coronary sinus, and the left coronary artery had an anomalous origin from the right sinus. The left main coronary artery passed between the ascending artery and the root of the main pulmonary artery, which was compressed by these two large vessels. Two patients underwent cardiac magnetic resonance examination, which detected late gadolinium enhancement in ALCA-R with an interarterial course. Unroofing of the left coronary ostium (cut-back procedure) was performed in two patients, and the other two patients who were not operated were recommended to restrict their physical activities. During a regular follow-up period of 12-43 months, all the children survived without recurrent cardiovascular event. Conclusion: If an adolescent presents with exercise-induced syncope, acute myocardial infarction and even sudden death, and ECG shows left main coronary artery occlusion characteristics, we should consider the possibility of developmental abnormality of coronary artery, particularly the ALCA-R. Once diagnosed as ALCA-R, patients should be recommended to avoid strenuous activities，early recognition and surgical treatment are imperative for these patients.

LncRNA MEG3 accelerates apoptosis of hypoxic myocardial cells via FoxO1 signaling pathway

OBJECTIVE

To explore the effects of long non-coding ribonucleic acid (lncRNA) maternally expressed gene 3 (MEG3) on the proliferation and apoptosis of hypoxic myocardial cells by regulating the expression of forkhead box O1 (FoxO1).

MATERIALS AND METHODS

The myocardial A10 cell lines were divided into myocardial cell group (group A), hypoxic myocardial cell group (group B), and hypoxic myocardial cell + transfection with lncRNA MEG3 mimic group (group C). The correlations of the adenosine triphosphate (ATP) concentration, the degree of apoptosis, and the proliferation with FoxO1 and FoxO3a proteins in the cells were observed via ATP assay, Cell Counting Kit-8 (CCK-8) assay, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, Western blotting, and quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR), respectively.

RESULTS

The ATP concentration in myocardial cells was the highest in group A (p<0.05), and it was higher in group B than that in group C (p<0.05). The results of the CCK-8 assay showed that the proliferation rate of the myocardial cells was the highest in group A and the lowest in group C (p<0.05), and it was significantly increased in group B compared with that in group C (p<0.05). The results of the TUNEL assay revealed that the normal cells displayed the purple color, and apoptotic cells displayed the green color. The myocardial cells were arranged orderly, and the number of apoptotic cells was smaller in group A, the number of apoptotic cells was significantly larger in group B than that in group A, and it was the largest in group C (p<0.05). Moreover, the results of Western blotting manifested that the concentrations of FoxO1 and FoxO3 proteins in myocardial cells were the lowest in group A (p<0.05), and they were significantly higher in group C than those in group B (p<0.05). According to the results of qRT-PCR, the mRNA expressions of FoxO1 and FoxO3 in myocardial cells were the lowest in group A (p<0.05), and they were remarkably lower in group B than those in group C (p<0.05).

CONCLUSIONS

LncRNA MEG3 can increase the activity of FoxO1 to promote myocardial apoptosis in a hypoxic environment.

Universal structure of dark matter haloes over a mass range of 20 orders of magnitude

Cosmological models in which dark matter consists of cold elementary particles predict that the dark halo population should extend to masses many orders of magnitude below those at which galaxies can form^1-3. Here we report a cosmological simulation of the formation of present-day haloes over the full range of observed halo masses (20 orders of magnitude) when dark matter is assumed to be in the form of weakly interacting massive particles of mass approximately 100 gigaelectronvolts. The simulation has a full dynamic range of 30 orders of magnitude in mass and resolves the internal structure of hundreds of Earth-mass haloes in as much detail as it does for hundreds of rich galaxy clusters. We find that halo density profiles are universal over the entire mass range and are well described by simple two-parameter fitting formulae^4,5. Halo mass and concentration are tightly related in a way that depends on cosmology and on the nature of the dark matter. For a fixed mass, the concentration is independent of the local environment for haloes less massive than those of typical galaxies. Haloes over the mass range of 10^-3 to 10¹¹ solar masses contribute about equally (per logarithmic interval) to the luminosity produced by dark matter annihilation, which we find to be smaller than all previous estimates by factors ranging up to one thousand³.

Differential biomarker profiles between unprovoked venous thromboembolism and cancer

BACKGROUND

The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis.

OBJECTIVE

To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD.

METHODS

A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA.

RESULTS

TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis.

CONCLUSIONS

Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases. Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations.

Overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients and a PCOS-specific predictive model of live birth rate was established

PURPOSE

The clinical outcome after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is diverse in infertility patients with polycystic ovary syndrome (PCOS). The aim of this study was to develop a nomogram based on an association of patients' characteristics to predict the live birth rate in PCOS patients.

METHODS

All women in a public university hospital who attempted to conceive by IVF/ICSI for PCOS infertility from January 2014 to October 2018 were included. The nomogram was built from a training cohort of 178 consecutive patients and tested on an independent validation cohort of 81 patients. PCOS was confirmed in all participants.

RESULTS

Three variates significantly associated with live birth rate of PCOS patients were BMI, total serum cholesterol (TC) and basal FSH. This predictive model built on the basis of BMI, TC, basal FSH, type of embryo transferred and age showed good calibration and discriminatory abilities, with an area under the curve (AUC) of 0.708 (95% CI 0.632-0.785) for the training cohort. The nomogram showed satisfactory goodness-of-fit and discrimination abilities in the independent validation cohort, with an AUC of 0.686 (95% CI 0.556-0.815).

CONCLUSION

Our simple evidence-based nomogram presents graphically risk factors and prognostic models for IVF/ICSI outcomes in patients with PCOS, which can offer useful guidance to clinicians and patients for individual adjuvant therapy.

[Clinical characteristics and survival analysis of 15 cases of HIV-negative plasmablastic lymphoma]

目的

分析HIV阴性的浆母细胞淋巴瘤（PBL）患者的临床病理特征及转归。

方法

回顾性分析海军军医大学附属长海医院2013年1月至2019年8月诊断及治疗的15例HIV阴性PBL患者的临床病理资料及随访结果。

结果

15例HIV阴性PBL患者中男8例，女7例，中位年龄59（17~69）岁，均无明确的免疫抑制状态。所有患者均出现结外受累，Ann Arbor-Cotswolds分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为1例（6.7%）、2例（13.3%）、3例（20.0%）、9例（60.0%）。病理形态表现为类似免疫母细胞的大肿瘤细胞弥漫性增生，免疫组化示肿瘤细胞主要表达浆细胞标志CD38、CD138、Mum-1，B细胞标志CD20、CD10、PAX-5、BCL-6少见，Ki-67中位数为80%（70%~90%）。3例患者行EBER原位杂交检测，1例阳性。15例患者均接受化疗，80%（12/15）联合硼替佐米作为一线治疗。最佳疗效6例完全缓解（其中2例分别于治疗后4.9和26.1个月疾病进展），2例部分缓解（分别于治疗后3.0和6.8个月疾病进展），4例疾病进展，3例无法评估。中位随访时间30.3（4.8~61.1）个月，11例患者中位无进展生存（PFS）期6.8（95%CI 2.5~11.1）个月，预计3年PFS率为21.2%（95%CI 1.4%~56.8%）。所有患者中位总生存（OS）期为17.9（95%CI 5.6~30.2）个月，预计3年OS率为38.5%（95%CI 12.0%~65.0%）。

结论

HIV阴性PBL侵袭性强，结外受累常见，多数患者诊断时分期较晚。通过以硼替佐米为基础的强化疗方案序贯自体造血干细胞移植可望获得长期生存。