Search for Light Weakly-Interacting-Massive-Particle Dark Matter by Annual Modulation Analysis with a Point-Contact Germanium Detector at the China Jinping Underground Laboratory

We present results on light weakly interacting massive particle (WIMP) searches with annual modulation (AM) analysis on data from a 1-kg mass p-type point-contact germanium detector of the CDEX-1B experiment at the China Jinping Underground Laboratory. Datasets with a total live time of 3.2 yr within a 4.2-yr span are analyzed with analysis threshold of 250 eVee. Limits on WIMP-nucleus (χ-N) spin-independent cross sections as function of WIMP mass (m_{χ}) at 90% confidence level (C.L.) are derived using the dark matter halo model. Within the context of the standard halo model, the 90% C.L. allowed regions implied by the DAMA/LIBRA and CoGeNT AM-based analysis are excluded at >99.99% and 98% C.L., respectively. These results correspond to the best sensitivity at m_{χ}<6  GeV/c^{2} among WIMP AM measurements to date.

LncRNA H19 promotes glioma angiogenesis through miR-138/HIF-1α/VEGF axis

Glioma is one of the most common and aggressive malignant primary brain tumors with high recurrence rate and mortality rate and heavily depends on the angiogenesis. LncRNA H19 has many diverse biological functions, including the regulation of cell proliferation, differentiation and metabolism. Here, we aimed to investigate the molecular mechanism of lncRNA H19 affecting angiogenesis in glioma, which could help to uncover potential target for glioma therapy. RT-qPCR analysis was performed to detect the expression of lncRNA H19 and miR-138 in HEB, U87, A172 and U373 cell lines. MTT assay was used to evaluate the cell viability. To evaluate the migration and invasion after lncRNA H19 knockdown, Transwell and wound healing assay were employed. After lncRNA H19 knockdown, protein expression of HIF 1α and VEGF was detected by western blot and tube formation was assessed. For the prediction and validation of the interaction between lncRNA H19 and miR-138, bioinformatics and luciferase assay were performed. We investigated the regulatory roles and downstream molecular mechanisms of lncRNA H19 in glioma by knockdown H19, which inhibited the proliferation, migration and angiogenesis of glioma cells. Moreover, miR-138 acted as a target of H19 as detected by luciferase reporter assays. Meanwhile, HIF-1α was also a target of miR-138 and miR-138 could also regulate the proliferation, migration and angiogenesis of glioma cells by targeting HIF-1α and affecting the expression of VEGF in turn. Our findings identified an upregulated lncRNA H19 in glioma cells, which could promote proliferation, migration, invasion and angiogenesis via miR-138/HIF-1α axis as a ceRNA. This study provided a new opportunity to advance our understanding in the potential mechanism of lncRNA in glioma angiogenesis.

Constraints on Spin-Independent Nucleus Scattering with sub-GeV Weakly Interacting Massive Particle Dark Matter from the CDEX-1B Experiment at the China Jinping Underground Laboratory

We report results on the searches of weakly interacting massive particles (WIMPs) with sub-GeV masses (m_{χ}) via WIMP-nucleus spin-independent scattering with Migdal effect incorporated. Analysis on time-integrated (TI) and annual modulation (AM) effects on CDEX-1B data are performed, with 737.1 kg day exposure and 160 eVee threshold for TI analysis, and 1107.5 kg day exposure and 250 eVee threshold for AM analysis. The sensitive windows in m_{χ} are expanded by an order of magnitude to lower DM masses with Migdal effect incorporated. New limits on σ_{χN}^{SI} at 90% confidence level are derived as 2×10^{-32}∼7×10^{-35}  cm^{2} for TI analysis at m_{χ}∼50-180  MeV/c^{2}, and 3×10^{-32}∼9×10^{-38}  cm^{2} for AM analysis at m_{χ}∼75  MeV/c^{2}-3.0  GeV/c^{2}.

[Preoperative evaluation of sentinel lymph node biopsy using contrast-enhanced ultrasonography in early breast cancer patients and the involved disturbing factors]

Objective: To explore the preoperative evaluation of sentinel lymph node (SLN) biopsy using contrast-enhanced ultrasonography (CEUS) in early breast cancer patients and the involved disturbing factors. Methods: Eighty-three female early breast cancer patients who underwent concurrent surgery in the Affiliated Cancer Hospital of Zhengzhou University between January 2017 and May 2018 were enrolled. CEUS was used to seek SLN and determine lymph node metastasis after signature of preoperative informed consent. Rapid pathological examination was used to determine whether metastasis existed in SLN. The sensitivity, specificity, accuracy, the differences between CEUS and pathological results, and the involved disturbing factors were evaluated. Results: A total of 212 SLNs were detected by CEUS and SLN biopsy with an average of 2.6 SLNs detected per patient, including 39 SLNs with cancer metastasis (18.4%) and 173 SLNs without cancer metastasis (81.6%). Among the 83 patients, 29 patients were predicted SLN-positive preoperatively utilizing CEUS (including 21 cases with SLN pathological metastasis and 8 cases with non-metastasis), 54 patients were predicted SLN-negative (including 5 cases with SLN pathological metastasis and 49 cases with non-metastasis). The preoperative evaluation of SLN utilizing CEUS were performed with a sensitivity of 80.8% (21/26), specificity of 86.0% (49/57), positive predictive value of 72.4% (21/29), and negative predictive value of 90.7% (49/54), positive likelihood ratio of 5.75, negative likelihood ratio of 0.22, and the accuracy of 84.3% (70/83), respectively. The area under the ROC curve (AUC) was 0.834 (95% CI: 0.736-0.906). The primary tumor mean size of SLN-negative group predicted preoperatively utilizing CEUS was (1.78±0.14) cm, and that of the SLN positive group was (2.64±0.19) cm. The difference between the two groups was (0.86±0.24) cm with statistical significance (P=0.000 6). The SLN mean size of SLN-negative group (141 SLNs) was (1.41±0.05) cm and that of SLN-positive group (71 SLNs) was (1.69±0.07) cm. The difference between the two groups was (0.28±0.09) cm with statistical significance (P=0.002 8). Conclusions: Preoperative CEUS possesses the predictive value for SLN metastasis in early breast cancer. The predicted results may be influenced by the primary tumor size and the SLN size.

An Adaptive Framework to Tune the Coordinate Systems in Nature-Inspired Optimization Algorithms

The performance of many nature-inspired optimization algorithms (NIOAs) depends strongly on their implemented coordinate system. However, the commonly used coordinate system is fixed and not well suited for different function landscapes, NIOAs thus might not search efficiently. To overcome this shortcoming, in this paper we propose a framework, named ACoS, to adaptively tune the coordinate systems in NIOAs. In ACoS, an Eigen coordinate system is established by making use of the cumulative population distribution information, which can be obtained based on a covariance matrix adaptation strategy and an additional archiving mechanism. Since the population distribution information can reflect the features of the function landscape to some extent, NIOAs in the Eigen coordinate system have the capability to identify the modality of the function landscape. In addition, the Eigen coordinate system is coupled with the original coordinate system, and they are selected according to a probability vector. The probability vector aims to determine the selection ratio of each coordinate system for each individual, and is adaptively updated based on the collected information from the offspring. ACoS has been applied to two of the most popular paradigms of NIOAs, i.e., particle swarm optimization and differential evolution, for solving 30 test functions with 30D and 50D at the 2014 IEEE Congress on Evolutionary Computation. The experimental studies demonstrate its effectiveness.

[Application of preventive flap-placement of terminal ileostomy in laparoscopic radical resection of low rectal cancer]

Objective: To evaluate the value of preventive flap placement of terminal ileostomy in laparoscopic radical resection of low rectal cancer. Methods: A retrospective analysis was conducted in the patients (n=63) who received preventive terminal ileostomy in laparoscopic radical resection of low rectal cancer in our institution from April 2016 to March 2018, including 33 patients who underwent ileostomy with flap-placement (flap group), and 30 patients who underwent ileostomy with stent (stent group). Clinical data were collected from both groups and statistically analyzed. Results: All patients were successfully completed laparoscopic radical resection with preventive ileostomy. All patients of stent group received stoma-closure surgery one month later after rectal resection. There were significantly statistical differences in operating time of ileostomy (28.9±4.3 vs 36.3±2.3, t=11.73, P<0.001) and overall stoma-related complications (1 vs 7, χ(2)=4.155, P=0.042), but no difference in anastomosis leakage, operating time of stoma-reversal, parastomal infection, parastomal hernia and parastomal prolapse. Conclusions: Preventive flap placement of terminal ileostomy represents a secure and feasible approach to laparoscopic low rectal cancer resection. Patients can be released from the discomfort of removing the stent and may suffer fewer stoma-related complications.

Platelet Surface CD62p and Serum Vitamin D Levels are Associated with Clopidogrel Resistance in Chinese Patients with Ischemic Stroke

BACKGROUND

To explore the association of platelet activation markers, vitamin D, and antiplatelet drugs resistance in ischemic stroke patients.

METHODS

A total of 230 patients with ischemic stroke were enrolled in this study. Platelet aggregation, platelet activation marker (CD62p), and vitamin D were measured after 7-14 days of dual antiplatelet treatment (aspirin + clopidogrel). All individuals were divided into a drug resistance group and a drug sensitive group according to the platelet maximum aggregation rate induced by antagonist adenosine diphosphate or arachidonic acid.

RESULTS

In this study, the prevalence of aspirin resistance was low (1.2%), while the prevalence of clopidogrel resistance (CR) was 24.8%, so we focused on CR. The percentage of CD62p on activated platelet [(25.74 ± 4.61) versus (12.41 ± 3.93), P < .001] and the prevalence of hypertension [93.0% (53) versus 79.8% (138), P = .021] in CR group were significantly higher than those in clopidogrel sensitive (CS) group, while the vitamin D concentration [(8.96 ± 4.41) versus (13.9 ± 4.84) ng/mL, P = .003] in CR group was significantly lower compared with the CS group. No significant difference was found in soluble P-selectin between these 2 groups [(56.2 ± 16.13) versus (54.2 ± 14.87) ng/mL, P = .258], neither in calcium [(2.29 ± .12) versus (2.33 ± .13) mmol/L, P = .821]. Logistic regression analysis showed that hypertension (odds ratio [OR] = 5.348, 95% confidence intervals [CI] 1.184-23.350, P = .026), expression of platelet CD62p (OR = 1.095, 95% CI 1.052-1.201, P = .018) and vitamin D level (OR = .832, 95% CI .763-.934, P = .005) were associated with CR in ischemic stroke patients.

CONCLUSIONS

CR in ischemic stroke patients is associated with several independent predictors, including increased platelet activation marker CD62p, decreased vitamin D level, and hypertension.

[Analysis of predictive effect of Androgen receptor on the response to neoadjuvant chemotherapy in breast cancer patients]

Objective: To explore the expression of androgen receptor (AR) in the tissues as well as its association with the clinicopathological factors of primary breast cancer patients treated with neoadjuvant chemotherapy (NAC), and analyze the effect of AR in the prediction of pathologic complete response (PCR) rate. Method: A total of 668 breast cancer patients treated with NAC in Henan Cancer Hospital between March 2014 and June 2017 were retrospectively reviewed. The relationship of AR expression and clinicopathological characteristics was calculated using chi square test. Multivariate analysis using binary Logistic regression was used to analyze correlations of different factors with PCR. Result: All patients were female, with the age of 20-76 years old. AR was detected in 74.6% of tumors, and significantly correlated with hormone receptor (HR), human epidermalgrowth factor receptor-2 (HER-2), Ki-67, CK5/6, epidermal growth factor receptor (EGFR) and molecular subtypes (all P<0.05). Multivariate analysis showed that AR, HR and HER-2 were independent predictors for PCR (all P<0.05). Conclusions: The expressions of AR were more frequently in HR positive breast cancer tissues (86.7%), and lowest in triple-negative breast cancer (TNBC) group (23.2%). AR was independent predictor for PCR.

[The effect of pre-operation (125)I seed activity measuring on dose accuracy]

Objective: To measure the activity of (125)I seed and compare the dose difference of ten patients treated with seed implantation in pre-plan with actual seed activity and calibrate activity. Method: The activity of 100 seeds from company A and B was measured with a well-type ionization chamber 1 day before operation and named group A and B. The activity of two groups was compared and the error between actual and calibrate activity (22.2 MBq, group C) was calculated. Ten patients implanted with (125)I seeds from November 1 st to 30 th, 2017, solstice 30 were selected in Hebei General Hospital. Firstly, pre-plans were designed with 22.2 MBq, prescribed dose were 100-140 Gy. The dose parameters of 90% volume absorbed dose (D(90)), 150% volume fraction (V(150)) and 100% volume fraction (V(100)) were calculated. Then changed 22.2 MBq to actual activity of group A and B, calculated the dose parameters above again. Then dose parameters of D(90), V(150), V(100) in group C were compared with those in group A and B respectively. Result: The actual activity 1 day before the operation was(22.6±0.7)and(23.9±0.9)MBq in group A and B respectively. Compared with 22.2 MBq, the difference was statistically significant(t=5.7, P<0.05 and t=19.2, P<0.05), and the activity error of group B was greater than 5%. The D(90) of group A, B and C were (124.3±9.7) , (131.2±10.2) and (121.9±9.5) Gy respectively.The V(150) were 58.4%±9.4%, 63.7%±8.9% and 56.5%±9.2% respectively. The V(100) were 88.9%±5.0%, 92.0%±4.1%, 88.1%±5.2% respectively.The difference of D(90) between calibrate activity(group C) and actual activity(group A and B) were statistically significant (t=40.2, P<0.05 and t=40.3, P<0.05). The difference of V(150) between group C and group A and B were statistically significant (t=7.5, P<0.05 and t=24.7, P<0.05). The difference of V(100) between group C and group A and B were statistically significant (t=6.6, P<0.05 and t=7.3, P<0.05). Conclusion: There is difference between the actual activity and calibration activity. The difference affects the dose parameters in pre-plan.The seed activity should be measured before operation strictly and the pre-plan should be designed with the actual activity.

[Long non-coding RNA RAB11B-AS1 prevents osteosarcoma proliferation via its sense gene RAB11B]

Objective: To detect the expression of lncRNA RAB11B-AS1 in osteosarcoma and investigate its role in osteosarcoma cells proliferation and the responsible mechanisms. Methods: Osteosarcoma and corresponding adjacent normal tissues were collected from 24 patients subjected to operations from October 2015 to October 2017 in the Third Affiliated Hospital of Southern Medical University.RAB11B-AS1 expression was detected in osteosarcoma specimens by quantitative real-time polymerase chain reaction (qRT-PCR). Lentiviral vectors that stably over-expressing RAB11B-AS1 were constructed and transfected into U2OS osteosarcoma cell line.The effect of RAB11B-AS1 on osteosarcoma cell proliferation and apoptosis was investigated by cell counting kit (CCK-8) assay and flow cytometry.U2OS osteosarcoma xenograft model of nude mice was established to observe the effect of RAB11B-AS1 on xenograft growth in mice, and the role of RAB11B-AS1 in proliferation and apoptosis of osteosarcoma cells was investigated by immunohistochemistry and TUNEL staining of osteosarcoma slices.The relationship between RAB11B-AS1 and RAB11B was explored using luciferase reporter assay.The data were compared with t test between the two groups. Results: Expression of RAB11B-AS1 was significantly down-regulated in osteosarcoma (0.010±0.015) versus their paired non-neoplastic tissues (0.022±0.030) (t=2.117, P=0.045). Up-regulation of RAB11B-AS1 resulted in decreased proliferative rate of U2OS cells (F=15.659, P<0.001). The ratios of cells in G0-G1 phase, S phase, G2-M phase were 62.6%±6.3%, 21.4%±2.2%, 16.3%±1.6% respectively in RAB11B-AS1 up-regulated group versus 59.4%±5.9%, 25.9%±2.6%, 15.5%±1.1% respectively in control group, and cell ratio in G0-G1 and S phase were increased significantly by RAB11B-AS1 up-regulation (t=17.124, 17.321, both P<0.05). Apoptosis rate was significantly elevated in RAB11B-AS1 over-expressed cells (12.7%±1.3%) when compared with that in control (10.3%±1.0%)(t=17.321, P=0.003). Mice transplanted with osteosarcoma cells that overexpressed RAB11B-AS1 exhibited lower growth rate of tumor (F=8.798, P=0.009). Mechanistically, RAB11B-AS1 expression correlated negatively with RAB11B expression (r=-0.356, P=0.044). Conclusions: lncRNA RAB11B-AS1 expression is down-regulated significantly in osteosarcoma tissues.RAB11B-AS1 may suppress the progression of osteosarcoma via down-regulating RAB11B.

Limits on Light Weakly Interacting Massive Particles from the First 102.8 kg×day Data of the CDEX-10 Experiment

We report the first results of a light weakly interacting massive particles (WIMPs) search from the CDEX-10 experiment with a 10 kg germanium detector array immersed in liquid nitrogen at the China Jinping Underground Laboratory with a physics data size of 102.8 kg day. At an analysis threshold of 160 eVee, improved limits of 8×10^{-42} and 3×10^{-36}  cm^{2} at a 90% confidence level on spin-independent and spin-dependent WIMP-nucleon cross sections, respectively, at a WIMP mass (m_{χ}) of 5  GeV/c^{2} are achieved. The lower reach of m_{χ} is extended to 2  GeV/c^{2}.

Broadband full-color multichannel hologram with geometric metasurface

Due to the abilities of manipulating the wavefront of light with well-controlled amplitude, and phase and polarization, optical metasurfaces are very suitable for optical holography, enabling applications with multiple functionalities and high data capacity. Here, we demonstrate encoding two- and three-dimensional full-color holographic images by an ultrathin metasurface hologram whose unit cells are subwavelength nanoslits with spatially varying orientations. We further show that it is possible to achieve full-color holographic multiplexing with such kind of geometric metasurfaces, realized by a synthetic spectrum holographic algorithm. Our results provide an efficient way to design multi-color optical display elements that are ready for fabrication.

[The influence of lumpectomy on the axillary lymph node status of breast cancer patients]

Objective: To investigate the influence of lumpectomy on axillary lymph node status of breast cancer patients. Methods: The clinical data of 738 invasive breast cancer patients with non-palpable axillary lymph node and sentinel lymph node (SLN) biopsy from November 2011 to August 2013 in Henan Provincial Cancer Hospital were collected and retrospectively analyzed. Among them, 136 patients underwent preoperative lumpectomy (lumpectomy group) and 602 patients underwent puncture biopsy only (biopsy group). The difference of axillary lymph node status and positive ratio of SLN detected by color Doppler ultrasound were compared between these two groups. Results: Among the 738 breast cancer patients, the axillary lymph nodes of 444 (60.2%) cases could be detected by ultrasound. Among them, 92 cases belonged to lumpectomy group, significantly less than 352 cases of biopsy group (P=0.048). Among the patients with ultrasound-visible lymph nodes, the proportion of the biggest diameter of axillary lymph node >1 cm of lumpectomy group or biopsy group was 58.7% (54/92) or 52.8% (186/352), respectively, without significant difference (P=0.316). The proportion of patients with the ratio of long diameter to short diameter <2 of lumpectomy group or biopsy group was 37.0% (34/92) or 38.6% (136/352), respectively, with marginal difference (P=0.768). The positive rate of SLN of lumpectomy group or biopsy group was 23.5% (32/136) or 26.9% (162/602), respectively, without significant difference (P=0.419). The incidence rate of the ultrasound visible axillary lymph nodes of patients whose postoperative time ≤ 7 days or > 7days was 71.1% (64/90) or 60.9% (8/46), respectively, without significant difference (P=0.227). However, the positive rate of SLN of these two groups was 28.9% (26/90) and 13.0% (6/46), respectively, with significant difference (P=0.039). The number of ultrasound visible axillary lymph nodes, the biggest diameter of axillary lymph nodes and the ratio of the long diameter to short diameter <2 were substantially correlated with the positive rate of SLN (P<0.05). Conclusions: The incidence rate of ultrasound visible axillary lymph node in the patients with lumpectomy is higher than that of patients with puncture biopsy only. The positive rate of SLN of the patients with a long postoperative time is lower than that of patients with a short postoperative time, even though the axillary lymph nodes are ultrasound visible.

Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial

INTRODUCTION

Provisional stenting (PS) for simple coronary bifurcation lesions is the mainstay of treatment. A systematic two-stent approach is widely used for complex bifurcation lesions (CBLs). However, a randomised comparison of PS and two-stent techniques for CBLs has never been studied. Accordingly, the present study is designed to elucidate the benefits of two-stent treatment over PS in patients with CBLs.

METHODS AND ANALYSIS

This DEFINITION II study is a prospective, multinational, randomised, endpoint-driven trial to compare the benefits of the two-stent technique with PS for CBLs. A total of 660 patients with CBLs will be randomised in a 1:1 fashion to receive either PS or the two-stent technique. The primary endpoint is the rate of 12-month target lesion failure defined as the composite of cardiac death, target vessel myocardial infarction (MI) and clinically driven target lesion revascularisation. The major secondary endpoints include all causes of death, MI, target vessel revascularisation, in-stent restenosis, stroke and each individual component of the primary endpoints. The safety endpoint is the occurrence of definite or probable stent thrombosis.

ETHICS AND DISSEMINATION

The study protocol and informed consent have been approved by the Institutional Review Board of Nanjing First Hospital, and accepted by each participating centre. Written informed consent was obtained from all enrolled patients. Findings of the study will be published in a peer-reviewed journal and disseminated at conferences.

TRIAL REGISTRATION NUMBER

NCT02284750; Pre-results.

[Clinical effect of preservation of the left colonic artery in laparoscopic anterior resection for rectal cancer]

Objective: To evaluate the value and feasibility of preservation of the left colonic artery (LCA) in laparoscopic anterior resection for rectal cancer. Methods: The clinical data of 97 patiens who received laparoscopic anterior resection of rectal cancer from 2009.3 to 2015.3 were randomly divided into two groups, including 52 cases with preservation of LCA and 45 cases without preservation of LCA. The operation time, quantity of bleeding, number of lymph nodes removed around the root of inferior mesenteric artery (IMA), the rate of lymph node metastasis around the root of IMA, the incidence of transverse colostomy and anastomotic leak were compared between the two groups. Results: All 97 operations were successfully completed by laparoscopic operation. There were significantly statistical differences in operation time, quantity of bleeding and transverse colon stoma between two groups(P<0.05), but no difference in the number of lymph nodes removed and the rate of lymph node metastasis. Conclusions: The preservation of the left colonic artery in laparoscopic anterior resection of rectal cancer can preserve more supplying vessels for anastomosis and prevent anastomotic leak.

[Prognosis and its risk factors in ANCA-associated glomerulonephritis patients treated with initial renal replacement therapy]

Objective: To explore the prognosis and its risk factors in anti-neutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) patients who needed initial renal replacement therapy (RRT). Methods: One hundred patients [54 females, 46 males, with a median age of 54(41, 60) years] with biopsy-proven AAGN and requiring initial RRT between January 1996 and December 2016 in Nanjing Jinling Hospital were included. Intensive immunotherapy indicated that the patients received corticosteroids in combination with cyclophosphamide or mycophenolate mofetil, or immunoadsorption (IA) or double filtration plasmapheresis (DFPP). The clinical and histological risk factors for renal survival were analyzed. Results: Forty-one patients were free of RRT after a median time of 1 (0.5, 2) month treatment (dialysis-independent group), and the remaining 59 patients were on maintenance dialysis (dialysis-dependent group). The multivariate logistic analysis revealed that the proportion of normal glomeruli <8% (OR=5.95, P=0.002) and global sclerotic glomeruli ≥50% (OR=4.87, P=0.003), and not receiving intensive immunotherapy (OR=7.81, P=0.004) were the risk factors for the renal recovery in these patients. During a median follow-up time of 22 (10, 50) months, 15 patients(36.6%) in the dialysis-independent group progressed into maintenance dialysis, and the 1 and 3 year renal survival rate were 86% and 60%, respectively. During a median follow-up time of 6 (2, 24) months, 12 (12%) patients died, among whom four patients died of therapy. The multivariate Cox regression analysis revealed that IA/DFPP treatment (HR=10.85, P=0.034) and low albumin level (HR=1.26, P=0.009) significantly associated with a higher risk of therapy-related death. Conclusions: The renal recovery rate in AAGN patients with initial RRT was low. The proportion of normal and global sclerotic glomeruli, receiving intensive immunotherapy or not were associated with renal outcome, and IA/DFPP treatment as well as lower albumin level were independently associated with therapy-related death.

[The relationship between fragmented QRS complex and coronary collateral circulation in patients with chronic total occlusion lesion without prior myocardial infarction]

Objective: To explore the relationship between fragmented QRS complex(fQRS) and coronary collateral circulation(CCC) in patients with chronic total occlusion(CTO)lesion without prior myocardial infarction. Methods: This retrospective study analyzed 238 consecutive patients with CTO lesion in one of the major coronary arteries from May 2014 to October 2015 in our department. Patients were divided into poor CCC group (grade 0 and 1, 58 cases) and good CCC group(grade 2 and 3, 180 cases) based on Rentrop's classification of CCC. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous electrocardiogram leads corresponding to a major coronary artery territory. Multivariate logistic regression was used to analyze the relationship between CCC and fQRS on electrocardiogram. Results: Compared with good CCC group, patients in poor CCC group had older age((65.2±8.9)years old vs. (60.3±10.1) years old, P=0.03), higher plasma glucose ((7.22±3.00) mmol/L vs.(6.31±1.83)mmol/L, P=0.04), and lower left ventricular ejection fraction ((45.2±11.4)% vs. (51.2±13.5)%, P=0.02). None of patients had Rentrop grade 0, the presence of fQRS on ECG in patients with Rentrop grade 1, grade 2, and grade 3 CCC was 69.0% (40/58), 48.6% (35/72) , and 19.4% (21/108), respectively (P<0.01). The presence of fQRS were higher in poor CCC group than in good CCC group (69.0%(40/58)vs. 31.1%(56/180), P<0.01), and number of leads with fQRS were higher in poor CCC group than in good CCC group (3(0, 4)vs.0(0, 3), P<0.01). Multivariate logistic regression analysis demonstrated that poor CCC growth in patients with CTO lesion without prior myocardial infarction was independently related to the presence of fQRS (OR=3.659, 95%CI 1.619-8.217, P<0.01). Conclusion: Poor CCC in patients with CTO lesion without prior myocardial infarction is independently related to the presence of fQRS on electrocardiogram.

Mesangial proliferative lupus nephritis with podocytopathy: a special entity of lupus nephritis

Mesangial proliferative lupus nephritis may coexist with podocytopathy, but its clinical-morphological features, treatment response and outcomes have not been compared with mesangial proliferative lupus nephritis without podocytopathy. In this study, 125 biopsies of lupus nephritis patients showing mesangial proliferation with mesangial immune deposits were collected and divided into podocytopathy group (defined as podocyte foot process effacement (FPE) >50% with nephrotic syndrome (NS)) and mesangial group (FPE ≤50%, or FPE >50% without NS). Mesangial proliferation and tubular- interstitial lesions were semi-quantitatively analyzed. We found that the incidence of renal involvement as the onset symptoms ( P < .001), nephrotic syndrome ( P < .001), acute kidney injury ( P < .001), the degree of acute tubular- interstitial lesions ( P < .001), and renal relapse (51.6% vs. 23.7%, P = .005) were significantly higher in the podocytopathy group than in the mesangial group. In contrast, the incidence of arthritis ( P < .001), fever ( P = .042), low serum C4 ( P = .008) and hematuria ( P = .033) was significantly lower in the podocytopathy group than in the mesangial group. No patients developed end stage renal disease or death during a median follow-up of 64 (interquartile range (IQR) 37-103) months in the podocytopathy group and 53 (IQR 30-83) months in the mesangial group. In conclusion, mesangial proliferative lupus nephritis with and without podocytopathy should be subdivided into two separate classes of lupus nephritis.

High platelet reactivity affects the clinical outcomes of patients undergoing percutaneous coronary intervention

Background

The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so clear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug eluting stents (DESs) implantation.

Methods

All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially platelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at 2 years. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all cause death, spontaneous myocardial infarction (MI), target vessel revascularization (TVR), and ischemic stroke.

Results

A total of 1331consecutive patients were enrolled at our center. There were 91 patients (6.8 %) identified with high platelet reactivity (HPR) on aspirin, and 437 patients (32.9 %) with HPR on clopidogrel. At 2-year follow-up, the incidence of stent thrombosis was significantly higher in patients with HPR on aspirin (9.9 % vs. 0.4 %, p < 0.001), and HPR on clopidogrel (3.0 % vs. 0.1 %, p < 0.001). There were increased MACCE in the HPR on aspirin group (16.5 % vs. 8.5 %, p = 0.021), mainly driven by the higher all cause death (7.7 % vs. 1.6 %, p = 0.002) and MI (9.9 % vs. 1.9 %, p < 0.001) in the HPR on aspirin group. Similarly, the rate of MACCE was higher in the HPR on clopidogrel group (12.4 % vs. 7.4 %, p = 0.004). No differences in all bleeding and hemorrhagic stroke were observed.

Conclusions

The present study demonstrated that high platelet reactivity on both aspirin and clopidogrel were associated with incremental stent thrombosis following DESs implantation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-016-0394-0) contains supplementary material, which is available to authorized users.

Identification of key biomarkers involved in osteosarcoma using altered modules

The aim of this study was to screen for key biomarkers of osteosarcoma (OS) by tracking altered modules. Protein-protein interaction (PPI) networks of OS and normal groups were constructed and re-weighted using the Pearson correlation coefficient (PCC), respectively. The condition-specific modules were explored from OS and normal PPI networks using a clique-merging algorithm. Altered modules were identified by a maximum weight bipartite-matching method. The important biological pathways in OS were identified by a pathway-enrichment analysis using genes from disrupted modules. The most important genes in these pathways were selected as key biomarkers. Finally, the mRNA and protein expressions of hub genes in OS bone tissues were analyzed using reverse transcription-polymerase chain reaction and western blotting, respectively. We identified 703 and 2270 modules in normal and disease networks, respectively; 150 altered modules were identified from among these and explored. We identified 10 important pathways based on gene pairs with altered PCC > 1 in the disrupted modules (P < 0.01), and PCNA, ATP6V1C2, ATP6V1G3, FEN1, CDC7, and RPA3 (expressed in these pathways) were selected as key genes of OS. We observed that these genes (and the proteins they encoded) were differentially expressed between normal and OS samples (P < 0.01) (excluding ATP6V1C2, whose protein expression did not differ significantly). Therefore, we identified 5 gene signatures that may be potential biomarkers for the detection and effective therapy of OS.

[A prospective study on the effects of levonorgestrel-releasing intrauterine system for adenomyosis with menorrhagia]

OBJECTIVE

To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with menorrhea in a prospective study.

METHODS

From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients' parameters were recorded prospectively, including scores of menstruation blood loss, carrying status of IUS, symptoms and scores of dysmenorrhea, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Changes of pictorial chart scores of menstruation and distribution of anemia during follow-up were analyzed.

RESULTS

Totally 1 100 women meets inclusion criteria, among which 618 cases (56.18%, 618/1 100) had severe menorrhea, with median follow-up period of 28 months (range 1- 60 months), and accumulative carrying rate of 66% at 60 months follow-up. After placement of LNG-IUS, compared with baselines, pictorial chart scores and ratio of menorrhea had decreased significantly (all P<0.01), the scroes of menstruation were 157±34, 94±35, 70±33, 67±18, 67±20, 65±19, 66±19, 65±21 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 24 months after placement of LNG-IUS, pictorial chart scores and distribution of anemia had improved significantly compared with preceding period (all P<0.01). We found no dependent factors predicting improvement of pictorial chart scores of menorrhea, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05).

CONCLUSIONS

LNG-IUS is effective for adenomyosis of menorrhea. Improvement of menstruation blood loss is independent on patients characters, menstruation patterns or adverse effects.