[Study on the best entry region and trajectory of anterior transpedicular root screws]

Objective: To evaluate the best entry region and trajectory of anterior transpedicular root screws (ATPRS). Methods: From January 2018 to May 2019, 50 cervical CT date integral of healthy people were selected from Ningbo No. 6 Hospital and were confirmed no obvious defect. Of these, 24 cases were males and 26 were females, aged 20-49 (32±5) years. The CT data was imported into Mimics by DICOM format, then 3D reconstruction was performed. In the coronal plane, the area from the centreline of the anterior of C(3-7) to the left Z-line(marked a line through the intersection of the anterior of the luschak joint and upper endplates, parallel to the centralline of the anterior of the vertebral body) was divided into nine areas. Then virtual screw with diameter of 3.5 mm was inserted. Record the length of screw of each area (L), the angle between screw and the posterior of the vertebral body in horizontal plane(α), the angle between screw and the anterior of the vertebral body in sagittal plane (β), individually. The data between groups were compared by independent sample t test. Results: The best regions were zone 9 of C(3), C(4); zone 8, 9 of C(5); zone 2-3, 5-9 of C(6); zone 1-9 of C(7) in men. And these were zone 9 of C(3); zone 3, 6, 8 and 9 of C(4), C(5); zone 2-3, 5-9 of C(6); zone 1-9 of C(7) in women. The distribution of best region was almost the same in men and women, zone 9 of each segment was the best region, and the screw length was the longest. It increased gradually from C(3) to C(7). C(3) had the least region, C(4) and C(5) had less, while C(6) and C(7) had the most. The horizontal angle of C(3-7) in men and women were 44.0°-47.2°, 40.2°-45.3° in zone 1, 4 and 7, respectively; 35.1°-41.4°, 34.6°-38.7° in zone 2, 5 and 8, respectively; 30.0°-37.2°, 30.2°-34.5° in zone 3, 6 and 9, respectively; and it demonstrated a gradually decreased trend. The sagittal angle of C(3-7) in men and women was 85.3°-97.4°, 80.5°-88.9° in zone 1-3, respectively; 101.2°-113.7°, 101.0°-109.3° in zone 4-6, respectively; 116.6°-128.8°, 119.9°-125.3° in zone 7-9, respectively; and it demonstrated a gradually increased trend. There was no significant difference in the horizontal and sagittal angle between men and women (both P>0.05). Conclusions: Anterior transpedicular root screw is a feasible internal fixation technique. It has wide region and the Z-line can be used as a reference for screw placement.

The Association of Cerebrovascular Disease with Adverse Outcomes in COVID-19 Patients: A Meta-Analysis Based on Adjusted Effect Estimates

Objective

The aim of this study was to address the association between cerebrovascular disease and adverse outcomes in coronavirus disease 2019 (COVID-19) patients by using a quantitative meta-analysis based on adjusted effect estimates.

Method

A systematic search was performed in PubMed, Web of Science, and EMBASE up to August 10th, 2020. The adjusted effect estimates were extracted and pooled to evaluate the risk of the unfavorable outcomes in COVID-19 patients with cerebrovascular disease. Subgroup analysis and meta-regression were also carried out.

Results

There were 12 studies with 10,304 patients included in our meta-analysis. A significant trend was observed when evaluating the association between cerebrovascular disease and adverse outcomes (pooled effect = 2.05, 95% confidence interval (CI): 1.34–3.16). In addition, the pooled effects showed that patients with a history of cerebrovascular disease had more likelihood to progress fatal outcomes than patients without a history of cerebrovascular disease (pooled effect = 1.78, 95% CI: 1.04–3.07).

Conclusion

This study for the first time indicated that cerebrovascular disease was an independent risk factor for predicting the adverse outcomes, particularly fatal outcomes, in COVID-19 patients on the basis of adjusted effect estimates. Well-designed studies with larger sample size are needed for further verification.

Arabidopsis CK2 family gene CKB3 involved in abscisic acid signaling

CKB3 is a regulatory (beta) subunit of CK2. In this study Arabidopsis thaliana homozygous T-DNA mutant ckb3 was studied to understand the role of CKB3 in abscisic acid (ABA) signaling. The results shown: CKB3 was expressed in all organs and the highest expression in the seeds, followed by the root. During seed germination and root growth the ckb3 mutant showed reduced sensitivity to ABA. The ckb3 mutant had more stomatal opening and increased proline accumulation and leaf water loss. The expression levels of number of genes in the ABA regulatory network had changed. This study demonstrates that CKB3 is an ABA signaling-related gene and may play a positive role in ABA signaling.

Digital scanned laser light-sheet fluorescence lifetime microscopy with wide-field time-gated imaging

We develop a multidimensional fluorescence imaging technique by implementing a wide-field time-gated fluorescence lifetime imaging into digital scanned laser light-sheet microscopy (FLIM-DSLM) to measure 3D fluorescence lifetime distribution in mesoscopic specimens with high resolution. This is achieved by acquiring a series of time-gated images at different relative time delays with respect of excitation pulses at different depths. The lifetime is determined for each voxel by iteratively fitting to single exponential decay. The performance of the developed system is evaluated with the measurements of a lifetime reference Rhodamine 6G solution and a subresolution fluorescent bead phantom. We also demonstrate the application performances of this system to ex vivo and in vivo imaging of Tg(kdrl:EGFP) transgenic zebrafish embryos, illustrating the lifetime differences between the GFP signal and the autofluorescence signal. The results show that FLIM-DSLM can be used for sample size up to a few millimetres and can be utilised as a powerful and robust method for biomedical research, for example as a readout of protein-protein interactions via Förster resonance energy transfer.

[Clinical safety and efficiency of ultrasonic bone curette used in anterior cervical discectomy and fusion surgery]

Objective: To investigate the safety and efficiency of ultrasonic bone curette used in anterior cervical discectomy and fusion surgery. Methods: As a retrospective study, we collected and analyzed the clinical data of 47 patients receiving anterior cervical discectomy and fusion surgery in Luohe Central Hospital from January 2014 to January 2017, there were 26 males and 21 females with a mean age of (52±9) years. According to the different surgical tools used in the process of decompression by resecting osteophytes or bone like an inverted Chinese character "" located at the posterior margin of the vertebral body, the patients were divided into two groups: ultrasonic bone curette group (group A) and traditional tools group (group B). The operating time, volume of intraoperative blood losing, complications, Japanese Orthopedic Association (JOA) score before and after the operation and improvement rate were recorded in the two groups. The t test was used to compare the data between the two groups. Results: In group A, the operating time was (47±7) min, blood loss was (49±4) ml, 1 case experienced urinary tract infection and there was no cerebrospinal fluid leakage or spinal cord injury. In group B, the operating time was (54±12) min and the blood loss was (117±16) ml, cerebrospinal fluid leakage occurred in 2 patients and the incision healed one-stage by local compression, hoarseness happened in 1 case and it disappeared after 2 weeks, 2 patients had swallowing discomfort and recovered in one month, no spinal cord injury occurred in this group. The operating time and blood loss in group A were lower than those in group B (t=2.691, 20.704, both P<0.05). And the incidence of complications in group A were lower than that in group B (χ(2)=4.157, P=0.041). The JOA score of group A at 3 days after surgery was improved for 39.0% when compared with that before the surgery, and it was improved for 71.6% at one year after the surgery. The JOA score in group B at 3 days after surgery was elevated for 38.7% from that before the surgery, and it increased for 69.4% at one year after the surgery. There was no significant different in JOA score before the surgery, 3 days and one year after the surgery between the two groups (t=0.611, 1.076, 0.061, all P>0.05). Conclusion: In the process of decompression by resecting osteophytes or bone located at the posterior margin of the vertebral body in the anterior cervical discectomy and fusion surgery, ultrasonic bone curette is safe and effective, and it can effectively shorten the operating time, decrease the blood loss and cut down the incidence of complications.

Responses of hemocyanin and energy metabolism to acute nitrite stress in juveniles of the shrimp Litopenaeus vannamei

Nitrite is a common toxic substance in culture systems of Litopenaeus vannamei, and the stress may disturb hemocyanin synthesis and energy metabolism and result in shrimp death. In the present study, nitrite at concentrations of 0 (control), 3.3 (46.2 NO₂-N mg/L), 6.6 (92.4) and 9.9 mM (138.6) was used to evaluate the responses of hemocyanin level and energy metabolism in L. vannamei (5.80 ± 0.44 cm, 1.88 ± 0.38 g) for 96 h. The mortality rate at 96 h increased with nitrite concentration (50% at 9.9 mM, 40% at 6.6 mM, 30% at 3.3 mM, and 10% at 0 mM). In general, HIF-1α and hemocyanin mRNA expression in the nitrite stress groups was upregulated from 6 to 12 h and downregulated from 24 to 96 h. In the hemolymph, nitrite levels were significantly elevated in a dose-dependent manner, and exposure to nitrite stress significantly decreased the oxyhemocyanin content from 24 to 96 h. The glucose and lactate levels in the hemolymph in the nitrite stress groups were higher than those in the control group from 12 to 96 h. Compared with the control group, the shrimp in the nitrite stress groups exhibited decreased glycogen concentrations in the hepatopancreas. The triglyceride (TG) levels in the nitrite stress groups were all higher than those in the control group from 48 to 96 h. The hexokinase (HK) activity in the hepatopancreas and muscle increased in the nitrite stress groups from 48 to 96 h. In general, nitrite stress enhanced the activities of pyruvate kinase (PK), phosphofructokinase (PFK) and lactate dehydrogenase (LDH) in muscle from 24 to 96 h. In addition, nitrite stress decreased the activities of succinate dehydrogenase (SDH) and fatty acid synthase (FAS) from 24 to 96 h in the hepatopancreas and muscle. This study indicates that exposure to nitrite stress can enhance the accumulation of nitrite in the hemolymph and then reduce oxygenation and hemocyanin synthesis, leading to tissue hypoxia and thereby resulting in accelerated anaerobic metabolism and the inhibition of aerobic metabolism. The effects of nitrite stress on hemocyanin synthesis and energy metabolism may be one of the reasons for the mortality of L. vannamei in culture systems.

Cloning and expression analysis of PRL and PRLR genes in black Muscovy duck

1. Prolactin hormone (governed by the PRL gene) is secreted by the anterior pituitary of animals, which combines with its receptor (prolactin receptor, PRLR) to act on target cells. Both PRL and PRLR are mainly associated with reproductive performance. The genetic mechanism of nesting in poultry is not yet clear, and so the aim of the current study was to determine expression patterns of PRL and PRLR at different times across the breeding stages of black Muscovy ducks.2. In this study, the CDS regions of PRL and PRLR were determined by RACE sequencing. The expression levels of PRL and PRLR in the pituitary, ovary and uterus from the black Muscovy duck were compared and analysed during the pre-laying, laying and nesting periods.3. The results showed that PRL and PRLR are highly homologous in a variety of poultry species. The expression of the PRL gene in the pituitary was the highest, which was significantly higher than seen in the ovary and uterus. This trend ran through the entire prenatal period, i.e. the laying period and the nesting period. The expression level of the PRLR gene in the pituitary and ovary was generally low, and expression in the uterus was the highest. There was no significant difference in expression of the PRLR gene between pituitary and ovary during different periods, but the expression level of the PRLR gene in the uterus reached its highest level during the nesting stage, which was significantly higher than seen in the early laying period.

[The efficacy and safety of tiotropium/olodaterol fixed-dose combination in Chinese patients with chronic obstructive pulmonary disease: a pooled subgroup analysis of TONADO 1+2]

Objective: To compare the efficacy and safety profiles of tiotropium/olodaterol with the mono-components in Chinese and total study population from TONADO trial. Methods: In the replicate, double-blind, parallel-group, active-controlled, randomized, 52-week, Phase Ⅲ TONADO studies (TONADO 1+2), patients received tiotropium/olodaterol, tiotropium, or olodaterol via the Respimat(®) Inhaler (Boehringer Ingelheim, Germany). Primary end points were forced expiratory volume in 1 second (FEV(1)) area under the curve from 0 to 3 hours (AUC(0-3h)) response and trough FEV(1) response, and St George's respiratory questionnaire (SGRQ) total score at 24 weeks. Adverse events were also collected. This subgroup analysis only focused on the efficacy and safety of the drug at the approved dose in China. Results: 548 Chinese patients were randomized, aged 41 to 82 years [mean age, (63±8) years] and most were male (526, 96%), 111 received tiotropium/olodaterol 5/5 μg, and 127 received tiotropium 5 μg and 95 received olodaterol 5 μg. The baseline characteristics of these groups were similar. After 24 weeks, treatment with tiotropium/olodaterol 5/5 μg, tiotropium 5 μg and olodaterol 5 μg resulted in an adjusted mean FEV(1) AUC(0-3h) response of 0.240, 0.157 and 0.079 L, and trough FEV(1) response of 0.117, 0.068 and-0.001 L, respectively. Tiotropium/olodaterol 5/5 μg significantly improved SGRQ scores in Chinese patients compared with olodaterol 5 μg (32.729 and 37.202, respectively). Generally, the safety profile of tiotropium/olodaterol was comparable with mono-components in 52 weeks. Conclusion: Compared with tiotropium or olodaterol, tiotropium/olodaterol in Chinese patients provided significant improvement in lung function and quality of life, and the safety profiles were similar.

[Efficacy and associated factors of olfactory training in the treatment of olfactory dysfunction]

Objective: To explore the clinical effects and the influence factors of olfactory training in the treatment of olfactory dysfunction. Methods: A total of 86 patients with olfactory dysfunction (49 post-infectious and 37 post-traumatic) in Beijing Anzhen Hospital during Dec 2016 to May 2017 were recruited in this prospective study. The clinical data of patients were analyzed, including gender, age, body mass index (BMI), course of disease, smoking history, drinking history, diabetes history, hypertension history, hyperlipidemia history, and anxiety visual analogue score (VAS). All patients were treated with olfactory training for 16 weeks, and all of them underwent Sniffin' Sticks olfactory test before and after treatment, which was evaluated by composite threshold-discrimination-identification score (TDI). SPSS 23.0 software, paired t test and univariate and multivariate Logistic regression analysis were used to analyze the data. Results: Eighty patients received treatment, including 46 post-infectious olfactory dysfunction and 34 post-traumatic olfactory dysfunction. After olfactory training, the total scores of TDI increased with statistically significant (18.3±8.6 vs 13.6±7.4, t=-6.158, P<0.05). The overall efficacy was 40% (32/80). The effective rate were 45.7% (21/46) in post-infectious olfactory dysfunction and 32.4% (11/34) in post-traumatic olfactory dysfunction respectively, with no statistically significant difference (χ(2)=1.441, P=0.230). Logistic regression analysis showed that the course of disease was an influence factor in the clinical curative effect (OR=0.881, 95%CI: 0.799-0.973, P=0.012). In patients with less than a year of olfactory dysfunction, the olfactory function improved obviously with the efficiency of 50.9% (29/57). Conclusion: Sixteen weeks of olfactory training provides a significant therapeutic effect on the post-infectious and post-traumatic olfactory dysfunction, and the olfactory training can achieve better therapeutic effects at the early stage.

Robust regression for optimal individualized treatment rules

Because different patients may respond quite differently to the same drug or treatment, there is an increasing interest in discovering individualized treatment rules. In particular, there is an emerging need to find optimal individualized treatment rules, which would lead to the "best" clinical outcome. In this paper, we propose a new class of loss functions and estimators based on robust regression to estimate the optimal individualized treatment rules. Compared to existing estimation methods in the literature, the new estimators are novel and advantageous in the following aspects. First, they are robust against skewed, heterogeneous, heavy-tailed errors or outliers in data. Second, they are robust against a misspecification of the baseline function. Third, under some general situations, the new estimator coupled with the pinball loss approximately maximizes the outcome's conditional quantile instead of the conditional mean, which leads to a more robust optimal individualized treatment rule than the traditional mean-based estimators. Consistency and asymptotic normality of the proposed estimators are established. Their empirical performance is demonstrated via extensive simulation studies and an analysis of an AIDS data set.

The changing landscape of phase II/III metastatic sarcoma clinical trials-analysis of ClinicalTrials.gov

Background

Well-designed clinical trials are of great importance in validating novel treatments and ensuring an evidence-based approach for sarcoma. This study aimed to provide a comprehensive landscape of the characteristics of metastatic or advanced sarcoma clinical trials using the substantial resource of the ClincialTrials.gov database.

Methods

We identified 260,755 trials registered with ClinicalTrials.gov in the last 20 years, and 277 of them were eligible for inclusion. The baseline characteristics were ascertained for each trial. The trials were systematically reviewed to validate their classification into 96 trials registered before 2008 and 181 trials registered between 2008 and 2017.

Results

We found that in the last decade, metastatic and advanced sarcoma trials were predominantly phase II-III studies (p = 0.048), were more likely to be ≥2 arms (17.7% vs 35.3%, respectively; p = 0.007), and were more likely to use randomized (13.5% vs 30.4%; p = 0.002) and double-blinded (2.1% vs 9.4%; p = 0.024) assignment than trials registered before 2008. Furthermore, in the last 10-year period, metastatic sarcoma trials were more likely to be conducted in Asia. Treatment involving target therapy and immunotherapy were more common (71.8% vs 37.5%; p < 0.001) than in previous years.

Conclusions

Our data showed provocative changes in the sarcoma landscape and demonstrated that the incidence of clinical trials with target therapy and immunotherapy is increasing. These findings emphasize the desperate need for novel strategies, including target therapy and immunotherapy, to improve the outcomes for patients with advanced sarcoma.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5163-2) contains supplementary material, which is available to authorized users.