Characterization of bacteriophage HN48 and its protective effects in Nile tilapia Oreochromis niloticus against Streptococcus agalactiae infections

Streptococcus agalactiae is a causative agent responsible for massive mortalities of tilapia that has led to catastrophic losses to tilapia culture globally. Bacteriophages represent a new class of antimicrobials against bacteria. In this study, we characterized the bacteriophage HN48, which formed small and round-transparent plaques on a double-layer plate. With a hexagonal head and a long tail, this phage may belong to the Caudovirales according to the International Committee on Taxonomy of Viruses. HN48 was found to have a relatively wide and highly specific host range, to be sensitive to high temperature (60-80°C) and low pH (3-5), and to be relatively stable at alkaline pH (8-10). Intraperitoneal injection with HN48 had no adverse effects on tilapia and effectively inactivated the bacteria in the kidney. Fish that received phage therapy had 60% ± 3.3% survival rates and a delayed mean death time of about 3 days when compared to the control group. To the best of knowledge, this is the first study of tilapia streptococcal phage. Overall, the results indicated that phage HN48 could prevent tilapia from experimental S. agalactiae infection, suggesting it has the potential to control this disease.

Clinical Efficacy of Combination Intravenous and Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer With Peritoneal Carcinomatosis

Background: Gastric cancer (GC) is prone to metastasis that typically resulted in peritoneal carcinomatosis (PC). GC patients with PC have an extremely poor clinic prognosis. Although GC is sensitive to chemotherapy, PC causes chemotherapy failure. Recent studies showed the combination of intravenous and intraperitoneal chemotherapy can significantly improve the survival rates in GC patients with PC. Aim: To identify the clinical and adverse effects of intravenous chemotherapy combined with intraperitoneal perfusion chemotherapy in the treatment of abdominal peritoneal carcinomatosis arising from gastric cancer. Methods: Retrospective analysis was performed on 49 patients with abdominal peritoneal carcinomatosis from gastric cancer who were treated at the Fujian Medical University Union Hospital between September 2010 and September 2015. The patients were divided into 2 groups based on treatment method: patients subjected to intravenous chemotherapy (n = 27), referred to as the simple group and patients subjected to combined intravenous and intraperitoneal chemotherapy (n = 22), referred to as the combination group. The short-term effects and adverse effects were evaluated based on treatment method, in conjunction with a related review of the results. The long-term effect was evaluated based on the survival rate and median survival time of both groups of patients at 12, 18, 24, 30, 36, and 60 months, as determined through follow-up. Results: Gender, age, ECOG scores before treatment, clinical stages, and the pathologic data of advanced GC patients of the 2 groups were equally distributed. The objective efficacy evaluation results showed that the objective response rate (ORR) and disease control rate (DCR) of the simple group after treatment were significantly lower than in the combination group. The median survival time (MST) of the simple group was (6.57 ± 0.75) months, which was significantly shorter than in the combination group (15.03 ± 2.31) months ( P < 0.05). In addition, the 12-, 18-, 24-, 30-, 36-, and 60-month survival rates of the simple group were all significantly lower than those of the combination group. Furthermore, combined therapy improved the physical condition of the patients. The incidence of adverse reactions in the 2 groups was not statistically significant; neither of the treatments resulted in severe complications. Conclusion: Compared with intravenous chemotherapy alone, the combined intravenous and intraperitoneal perfusion chemotherapy was more effective in improving quality of life and extending survival in time patients with abdominal peritoneal carcinomatosis from gastric cancer. In addition, the treatment produced only mild adverse effects, showing that it is tolerable and therefore worth further clinical study.

Enteric motor dysfunctions in experimental chronic pancreatitis: Alterations of myenteric neurons regulating colonic motility in rats

BACKGROUND

The mechanism underlying gastrointestinal (GI) dysmotility associated with chronic pancreatitis (CP) has not been fully elucidated, and enteric nervous system (ENS) has an important regulatory role in gastrointestinal motor function. The aim of this study is to investigate the effect of ENS in the colonic hypomotility induced by trinitrobenzene sulfonic acid (TNBS) infusion which mimics CP.

METHODS

Male Sprague-Dawley rats were submitted to CP which was induced by pancreatic infusion of 2% TNBS, or sham group with treatment of equal saline. Three weeks after induction of CP, we pathologically examined the inflammation of pancreas and counted the number of withdrawal events stimulated by Von Frey filaments to evaluate hyperalgesia. The gastrointestinal transit rate was measured using Carbon inkl driving test, and the contraction activities of colonic muscle strip were studied in an organ bath system. The expression of choline acetyltransferase (ChAT) and nitric oxide synthase (NOS) in colonic myenteric plexus (MP) of ENS were investigated by Western blotting and double immunofluorescence staining.

KEY RESULTS

In TNBS-treated group, rats had the signs of chronic pancreatitis 3 weeks after intraductal infusion and had increased sensitivity to mechanical stimulation of the abdomen. For rats with CP, the gastrointestinal transit rate was reduced; in addition, the contractile activities of longitudinal muscle (LM) and circular muscle (CM) strips of distal colon in TNBS group were lower than those in sham group. Immunofluorescence demonstrated that the percentage of ChAT-immunoreactive (IR) neurons in the MP was decreased, but the proportion of NOS-IR neurons in the MP was increased when compared with sham-operated group. Western blotting proved that TNBS infusion down-regulated ChAT but up-regulated NOS expression in the colon MP.

CONCLUSIONS & INFERENCES

Decreased ChAT-IR neurons and increased NOS-IR in the MP of colon ENS may contribute to the pathogenesis of colonic dysmotility in CP.

Clinical Outcomes of Endovascular Treatment within 24 Hours in Patients with Mild Ischemic Stroke and Perfusion Imaging Selection

BACKGROUND AND PURPOSE

Endovascular thrombectomy has been accepted as the standard of care for patients with acute ischemic stroke. Our aim was to investigate the clinical outcomes of patients with mild ischemic stroke with acute proximal large-vessel occlusion after endovascular treatment within 24 hours of symptom onset.

MATERIALS AND METHODS

Between January 2014 and August 2017, ninety-three Chinese patients with mild ischemic stroke (NIHSS scores, 0-8) and large-vessel occlusion with endovascular treatment were retrospectively enrolled from 7 comprehensive stroke centers. They were divided into 2 groups: ≤6 hours and 6-24 hours from symptom onset to groin puncture. We analyzed their modified Rankin Scale scores at 90 days, symptomatic intracranial hemorrhage at 48 hours, and mortality during 90 days. Multivariable linear regression analysis was used to identify predictors for NIHSS shift after discharge.

RESULTS

Twenty-nine patients received endovascular treatment within 6-24 hours after symptom onset and had an imaging mismatch based on perfusion CT or diffusion-weighted MR imaging. There were no substantial differences between the 2 groups in 90-day functional independence (P = .54) and the risks of the combination of symptomatic intracranial hemorrhage and death (P = .72). Two significant indicators of NIHSS shift were 48-hour symptomatic intracranial hemorrhage (unstandardized β = 7.28; 95% CI, 3.48-11.1; P < .001) and baseline systolic blood pressure (unstandardized β = 0.08; 95% CI, 0.03-0.14; P = .005).

CONCLUSIONS

Patients with mild ischemic stroke and large-vessel occlusion in the anterior circulation, an imaging mismatch, and endovascular treatment within 6-24 hours of initial symptoms showed no heterogeneity in the efficacy and safety outcome compared with those treated ≤6 hours from symptom onset.

[Development of a novel absorbable nanofiber chitosan-collagen membrane by electrospinning and the preliminary study on guided bone regeneration]

Objective: To evaluate the application effect of nanofiber chitosan-collagen membrane (NCM) on guided bone regeneration (GBR). Methods: The mixture of collagen, chitosan, polyethylene oxide was used to make up the NCM by electrospinning, then the NCM was crosslinked by glutaraldehyde vapor. The physical property of the NCM was measured by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). MC3T3-E1 osteoblasts were cultured on NCM to characterize the biocompatibility. The effectiveness of four groups [contrast group, Bio-gide membrane (BGM), compressed chitosan-collagen menbrane (CCM), NCM/CCM] on bone regeneration were evaluated in critical-sized defects (diameter=5 mm) in SD rats. Results: When the mixed solution consists of 4.0% collagen, 1.0% chitosan and 3.5% polyethylene oxide, the NCM could be validly fabricated by electrospinning. After cross-linking by glutaraldehyde vapor, the tensile strength and the stability of NCM in damp was enhanced. No cytotoxicity of the NCM was detected on MC3T3-E1 osteoblasts. In vivo study showed that the new bone regeneration ratio of NCM/CCM group was [(43.10±1.49)%], and this was similar to that of the group of BGM [(41.36±2.60)%] (P>0.05), but higher than that of the CCM group [(33.10±1.41)%] and the contrast group [(7.22±2.46)%] (P<0.05). Conclusions: The NCM can promote new bone regeneration effectively in GBR procedure.

Clinical observation and retrospective study of the influential factors of liver metastasis in 306 cases of colon cancer

PURPOSES/OBJECTIVES

By observing and analyzing the clinical features of the colon cancer and the influence factors of liver metastasis, we try to find out independent risk factors with significant influence on colon cancer liver metastasis as well as to provide reference for clinical treatment.

MATERIALS AND METHODS

A total of 306 cases of colon cancer patients' clinical data, including gender, age, primary focal size, primary focal intestinal segment, degree of differentiation, infiltration depth, level of serum carcinoembryonic antigen (CEA) before surgery, lymph node metastasis, liver basic diseases were collected and recorded. Single-factor Chi-square analysis and multifactor logistic regression analysis (SPSS 16.0 software) were used to retrospectively study the possible influence factors of colon liver metastases and to preliminary discuss the potential risk factors of liver metastasis in colon cancer patients.

RESULTS

The Chi-square analysis showed that patients' primary focal segment, degree of differentiation, infiltration depth, level of serum CEA before surgery, and states of hepatitis B does 2 half-and-half had significant effect on the incidence of liver metastasis. However, in the further logistic regression analysis, it showed that only the infiltration depth and the states of hepatitis B does 2 half-and-half were the independent risk factors that influence the hepatic metastases. What was more, the both subgroups of positive hepatitis B with infection and vaccine showed significant statistical differences when comparing with hepatitis B all negative in the event of the probability of liver metastases (P = 0.011 and 0.004).

CONCLUSIONS

The infiltration depth and the states of hepatitis B does 2 half-and-half were the independent risk factors on colon cancer patients' hepatic metastases. Those with the infiltration depth of T4 had a higher rate of hepatic metastases. Patients with does 2 half-and-half-positive hepatitis B (whether subgroup of hepatitis B virus infection or subgroup hepatitis B vaccine related) had a lower incidence rate of liver metastasis than those with hepatitis B all negative.

[Computer Aided Diagnosis system of breast ultrasound based on support vector machine: a clinical analysis]

Objective: To investigate the value of based on support vector machine (SVM) breast ultrasonography technology of Computer-Assisted diagnosis (CAD) for differential diagnosis of benign and malignant breast masses. Methods: Total of 143 patients who had 151 breast masses were collected in Fujian Maternity and Children Health Hospital or The Fist Affiliated Hospital of Fujian Medical University from June 2014 to December 2015. Based on pathological results as the gold standard, the diagnostic efficiency of CAD and ultrasonography were compared. Results: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasonography were 80.1%, 71.0%, 76.8%, 80.0% and 72.1%, respectively. And the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CAD were 96.6%, 90.3%, 94.0%, 93.5% and 94.9%, respectively. The specificity, accuracy, positive predictive value and negative predictive of CAD technology were significantly higher than those of ultrasonography (P<0.05). The area under the receiver operator characteristic curve of ultrasonography and CAD were 0.759 and 0.935 respectively, with significant difference (P<0.05). Conclusions: CAD has a higher specificity and accuracy rate than ultrasonography in the diagnosis of breast masses. It could help to differentiate benign from malignant breast masses.

[Study of epidemiological characteristics and viral sources of dengue fever outbreak in Guangxi Zhuang Autonomous Region, 2014]

Objective: To understand the epidemiological characteristics and viral sources of dengue fever outbreak in Guangxi Zhuang Autonomous Region (Guangxi) in 2014. Methods: A combined analysis of epidemiological characteristics and genetic characteristics were performed in this study. The time, population and area distributions of the cases were analyzed. Serum samples were collected from dengue fever cases to detect NS1 antigen by using commercial ELISA kits according to the guideline of the manufacture. RT-PCR assay was conducted to detect dengue virus in NS1 positive samples. Phylogenetic tree based on E gene sequence of dengue virus were further analyzed. Results: During September-December 2014, an outbreak of dengue fever caused by dengue virus type 1 and 2 occurred in Guangxi, a total of 854 cases were reported without death, including 712 laboratory confirmed cases and 142 clinical diagnosed cases, in which 79.63% (680/854) occurred during 22 September-21 October 2014. All the cases had typical dengue fever symptoms. Most cases occurred in Nanning and Wuzhou, in which 83.61% (714/854) were in age group 15-59 years; 46.60% (398/854) were staff or people engaged in commercial service. A total 526 serum samples were tested for dengue virus serotype by RT-PCR assay. Among 414 positive samples, 345 were positive for dengue virus type 1 (DENV-1) and 69 were positive for dengue virus type 2 (DENV-2), no DENV-3 and DENV-4 were detected. The results of phylogenetic analysis of E gene sequence indicated that the sequences of 99.12%(113/114) of DENV-1 strains in Nanning in China shared 100.00% homology with the isolate (SG EHI D1/529Y13) from Singapore in 2013, which belonged to the genotype Ⅰ; All the DENV-2 isolates from Wuzhou shared 99.80% homology with the isolate (D14005) from Guangdong province, which belonged to genotype Cosmopolitan. Conclusions: The outbreak was caused by DENV-1 from Singapore and DENV-2 from Guangdong province in China. It is necessary to strengthen the surveillance and early warning for imported dengue fever, conduct vector control and improve the diagnosis of suspected dengue fever cases for the effective control of dengue fever outbreak.

[The study of wideband acoustic immittance normative data of young people]

Objective:To explore the normative data of wideband acoustic absorption rate of young people with normal hearing, and the related factors of wideband acoustic immittance.Method:Eighty six cases of young people with normal hearing (43 cases of male, 43 cases of female) were collected in the clinical audiology centers of Beijing Tongren Hospital, Capital University of Medical. The average age is (22.0±1.5) years. Pure tone audiometry in the range of 250 to 8 000 Hz in each octave is carried out, and the air conduction thresholds are less than 25 dB HL; 226 Hz tympanometry were type A. For all subjects, the wideband acoustic immittance measurement was conducted at 226-8 000 Hz, and a total of 107 frequency points were carried out.Result:The test results of 172 ears were statistically analyzed.①In the range of 250-8 000 Hz,acoustic absorption rate in the low frequency range increases gradually, and the peak is found in the range of 1 000 to 3 000 Hz;getting along with the increase of frequency and acoustic absorption rate gradually decreases slowly.②The acoustic absorption rate in the range of 4 200-4 900 Hzin female subjects was significantly higher than that in male subjects.③There was no significant relationship between gender, compliance, peak pressure, and width in 226 Hz tympanometry (P=0.319, 0.831, 0.786), however there was a significant relationship between gender and the ear canal volume (P<0.01).④There was no significant relationship between gender and the resonance frequency (P>0.05).⑤There was a significant correlation between height/weight and ear canal volume (P<0.05), and there was a significant relationship between the ear canal volume and the resonance frequency (P<0.05).Conclusion:The acoustic absorption rate of young people in the low frequency range was lower, then increases gradually, and the peak was found in the range of mid-high frequency. The difference in the wideband absorption rate between genders was significant. The height and weight had influence on the results of wideband acoustic immittance.

The MNS glycophorin variant GP.Mur affects differential erythroid expression of Rh/RhAG transcripts

BACKGROUND

The band 3 macrocomplex (also known as the ankyrin-associated complex) on the red cell membrane comprises two interacting subcomplexes: a band 3/glycophorin A subcomplex, and a Rh/RhAG subcomplex. Glycophorin B (GPB) is a component of the Rh/RhAG subcomplex that is also structurally associated with glycophorin A (GPA). Expression of glycophorin B-A-B hybrid GP.Mur enhances band 3 expression and is associated with lower levels of Rh-associated glycoprotein (RhAG) and Rh polypeptides. The goal of this study was to determine whether GP.Mur influenced erythroid Rh/RhAG expression at the transcript level.

MATERIALS AND METHODS

GP.Mur was serologically determined in healthy participants from Taitung County, Taiwan. RNA was extracted from the reticulocyte-enriched fraction of peripheral blood, followed by reverse transcription and quantitative PCR for RhAG, RhD and RhCcEe.

RESULTS

Quantification by real-time PCR revealed significantly fewer RhAG and RhCcEe transcripts in the reticulocytes from subjects with homozygous GYP*Mur. Independent from GYP.Mur, both RhAG and RhD transcript levels were threefold or higher than that of RhCcEe. Also, in GYP.Mur and the control samples alike, direct quantitative associations were observed between the transcript levels of RhAG and RhD, but not between that of RhAG and RhCcEe.

CONCLUSION

Erythroid RhD and RhCcEe were differentially expressed at the transcript levels, which could be related to their different degrees of interaction or sensitivity to RhAG. Further, the reduction or absence of glycophorin B in GYP.Mur erythroid cells affected transcript expressions of RhAG and RhCcEe. Thus, GPB and GP.Mur differentially influenced Rh/RhAG expressions prior to protein translation.

Circulating tumour cells as a biomarker for diagnosis and staging in pancreatic cancer

BACKGROUND

Current diagnosis and staging of pancreatic ductal adenocarcinoma (PDAC) has important limitations and better biomarkers are needed to guide initial therapy. We investigated the performance of circulating tumour cells (CTCs) as an adjunctive biomarker at the time of disease presentation.

METHODS

Venous blood (VB) was collected prospectively from 100 consecutive, pre-treatment patients with PDAC. Utilising the microfluidic NanoVelcro CTC chip, samples were evaluated for the presence and number of CTCs. KRAS mutation analysis was used to compare the CTCs with primary tumour tissue. CTC enumeration data was then evaluated as a diagnostic and staging biomarker in the setting of PDAC.

RESULTS

We found 100% concordance for KRAS mutation subtype between primary tumour and CTCs in all five patients tested. Evaluation of CTCs as a diagnostic revealed the presence of CTCs in 54/72 patients with confirmed PDAC (sensitivity=75.0%, specificity=96.4%, area under the curve (AUROC)=0.867, 95% CI=0.798-0.935, and P<0.001). Furthermore, a cut-off of ⩾3 CTCs in 4 ml VB was able to discriminate between local/regional and metastatic disease (AUROC=0.885; 95% CI=0.800-0.969; and P<0.001).

CONCLUSION

CTCs appear to function well as a biomarker for diagnosis and staging in PDAC.

Expression and characterization of a codon-optimized blood coagulation factor VIII

Essentials Recombinant factor VIII (FVIII) is known to be expressed at a low level in cell culture. To increase expression, we used codon-optimization of a B-domain deleted FVIII (BDD-FVIII). This resulted in 7-fold increase of the expression level in cell culture. The biochemical properties of codon-optimized BDD-FVIII were similar to the wild-type protein.

SUMMARY

Background Production of recombinant factor VIII (FVIII) is challenging because of its low expression. It was previously shown that codon-optimization of a B-domain-deleted FVIII (BDD-FVIII) cDNA resulted in increased protein expression. However, it is well recognized that synonymous mutations may affect the protein structure and function. Objectives To compare biochemical properties of a BDD-FVIII variants expressed from codon-optimized and wild-type cDNAs (CO and WT, respectively). Methods Each variant of the BDD-FVIII was expressed in several independent Chinese hamster ovary (CHO) cell lines, generated using a lentiviral platform. The proteins were purified by two-step affinity chromatography and analyzed in parallel by PAGE-western blot, mass spectrometry, circular dichroism, surface plasmon resonance, and chromogenic, clotting and thrombin generation assays. Results and conclusion The average yield of the CO was 7-fold higher than WT, whereas both proteins were identical in the amino acid sequences (99% coverage) and very similar in patterns of the molecular fragments (before and after thrombin cleavage), glycosylation and tyrosine sulfation, secondary structures and binding to von Willebrand factor and to a fragment of the low-density lipoprotein receptor-related protein 1. The CO preparations had on average 1.5-fold higher FVIII specific activity (activity normalized to protein mass) than WT preparations, which was attributed to better preservation of the CO structure as a result of considerably higher protein concentrations during the production. We concluded that the codon-optimization of the BDD-FVIII resulted in significant increase of its expression and did not affect the structure-function properties.

Determination of the excitation rate of quantum dots mediated by momentum-resolved Bloch-like surface plasmon polaritons

When light emitters are being placed in close proximity to a plasmonic system, not only the emission but also the excitation can be strongly enhanced and both yield the surface plasmon polariton (SPP) mediated fluorescence enhancement. Here, we combine the rate equation model and coupled mode theory to formulate the excitation rate of light emitters located on a periodic metallic array. The rate is expressed in terms of quantities that can be measured by angle- and polarization-resolved reflectivity and photoluminescence spectroscopy. As a demonstration, we have studied the excitation rate of CdSeTe quantum dots deposited on a 2D Au nanohole array as a function of the propagation direction of the (-1,0) Bloch-like SPPs. At the excitation wavelength of 633 nm, we find the rate remains almost constant at ~44 ps^-1 regardless of the propagation direction of SPPs, which move from the Γ-X towards the Γ-M direction in the first Brillouin zone, and the crossing of the (-1,0) and (0,-1) SPPs along the Γ-M direction where two bright and dark modes are formed. The results are supported by the finite-difference time-domain simulations. We conclude the excitation rate is an intrinsic parameter and the enhanced excitation of the quantum dots arises entirely from field enhancement.

[Expression of serum interleukin-13 and significance of gene polymorphism on the patients with bronchiectasis in acute exacerbation period]

Objective: To explore the expression of serum interleukin-13 (IL-13) and significance of its gene polymorphism on the patients with acute exacerbation of bronchiectasis in acute exacerbation period. Methods: Forty-three patients with bronchiectasis in acute exacerbation period admitted into the respiratory ward of Fujian Provincial Hospital from December, 2014 to March, 2016 were included as bronchiectasis group. Thirty-three healthy controls from normal people of health examination were included as control group during the corresponding period. A total of 5 ml fasting peripheral blood sample was extracted from each individual. The IL-13 levels were determined by enzyme-linked immunosorbent assay (ELISA). IL-13 gene polymorphisms in+ 1923 C/T site and+ 2044 site were genotyped in these two groups by using polymerase chain reaction (PCR) combined with gene sequencing methods. About 7 days after admission, thirty patients with improved condition among the 43 patients were included as bronchiectasis improvement group, all had the extraction of 3 ml peripheral blood for IL-13 detection determined by ELISA. The expression of serum IL-13 and gene polymorphisms between bronchiectasis group and control group were analyzed statistically. The changes of serum IL-13 between bronchiectasis group and bronchiectasis improvement group were also analyzed statistically. Results: The serum IL-13 level was lower in the bronchiectasis group in acute exacerbation period than that of the healthy controls [(31.1±26.3) vs (70.6±53.6) μg/L, P<0.05]. There was no significant difference of the genotype distribution in + 1923C/T site of IL-13 gene between the two groups (χ(2)=0.915, P>0.05). In the bronchiectasis group, the C and T allele frequencies at+ 1923 site of IL-13 gene were 79.1% and 20.9%, respectively, and its single nucleotide polymorphism (SNP) was in strong linkage disequilibrium with the SNP IL-13+ 2044G/A site (R(2)=0.835, P<0.001). There was no significant difference of the serum IL-13 between allele T_ groups and allele CC group, and also no significant difference between allele A_ groups and allele GG group (P>0.05). Conclusion: The IL-13 levels decreased specifically in the bronchiectasis group in acute exacerbation period, but IL-13+ 1923C/T and+ 2044G/A polymorphisms are not significantly related to the susceptibility of bronchiectasis.

Development of a nomogram for predicting the risk of anastomotic leakage after a gastrectomy for gastric cancer

AIMS

To investigate the incidence of and factors associated with anastomotic leakage (AL) following gastrectomy for gastric cancer.

METHODS

We retrospectively analyzed 3632 patients who underwent a laparoscopic gastrectomy or open gastrectomy for gastric cancer. A logistic regression model was used to identify the determinant variables, and a nomogram for AL was developed.

RESULTS

A total of 3632 patients were included in the study, 50 of whom (1.4%) developed AL. Postoperative deaths occurred in 6 (0.2%) patients with AL failure to rescue. Esophagojejunal AL (27/50) and Billroth I AL (20/50) were the most common types of AL. Gastrografin swallow was the main diagnostic method. The diagnosis was made a median of 9 days postoperatively. The median healing time for AL was 34.5 days. Of the 50 AL patients, 56% of patients could be managed nonsurgically, whereas 28% of patients required percutaneous radiologic drainage, 6% of patients were treated by endoscopy, and 10% of patients required a second surgery. A multivariate analysis showed the following adverse risk factors for AL: age ≥65 years, hemoglobin ≤8.0 g/dL and malnourishment. A multivariable model for AL showed a strong optimism-adjusted discrimination (concordance index, 0.675). The 5-year overall survival rates for patients without or with AL were 59.4% and 67.4%, respectively (p = 0.354).

CONCLUSIONS

AL was infrequent but was more prevalent in patients with age ≥65 years, hemoglobin ≤8.0 g/dL and malnourishment. We created a novel nomogram that can provide individualized prediction of AL in patients after a gastrectomy for gastric cancer, which may help clinicians in making treatment decisions.

Impact of haematologic deficiencies on recurrent aphthous ulceration: a meta-analysis

BACKGROUND

Recurrent aphthous ulceration (RAU) is one of the most common oral mucosal diseases, some of which may be secondary to haematologic deficiencies. This meta-analysis aims to evaluate the association between haematologic deficiencies and RAU.

MATERIALS AND METHODS

Case control studies were identified using a predefined search strategy that compared the difference in haematologic deficiencies between a RAU group and a control group. A meta-analysis was performed to estimate the combined odds ratios (ORs) and 95% confidence intervals (95% CIs) in a fixed-effects model and a random-effects model, as appropriate.

RESULTS

In this meta-analysis, nine case control studies, including total 710 cases in RAU groups and 602 cases in control groups, were considered eligible for inclusion. Overall, the combined results based on all studies showed that the rate of haematinic deficiencies was significantly high in the RAU group (vitamin B12: OR=3.75, 95% CI: 2.38-5.94; folic acid: OR=7.55, 95% CI: 3.91-14.60; ferritin: OR=2.62, 95% CI: 1.69-4.06; and haemoglobin: OR=1.77, 95% CI: 1.12-2.80).

CONCLUSION

This meta-analysis suggests that haematologic deficiencies could be a significant risk factor for RAU. Thus, screening and treating any haematologic deficiencies may play an important role in preventing the occurrence of RAU.

Angry Versus Furious: A Comparison Between Valence and Arousal in Dimensional Models of Emotions

The present study compared the roles of valence and arousal, proposed by the dimensional models of emotions, in recognizing emotional expressions. It was hypothesized that the dimension of valence, due to its functional significance, would be more salient in the recognition of emotional expressions than the dimension of arousal would be. The results of the current study supported this hypothesis. The participants in all age groups were more accurate and quicker in recognizing an emotion when the expression was paired up with another emotional expression that was different in the polarity of the valence dimension than with this similar polarity difference in the arousal dimension. The insignificant difference in recognizing the positive and negative emotional expressions in the group of elders also rejected the Socio-Emotional Selectivity Theory.

[Surgical outcomes after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for patients with advanced gastric cancer: a case-control study using a propensity score method]

Objective: To investigate the surgical outcomes after the laparoscopy-assisted distal gastrectomy (LADG) for patients with advanced gastric cancer. Methods: The data of 213 patients who underwent LADG and 213 treated by open distal gastrectomy (ODG) were selected using the propensity score matching method from a prospectively constructed database of 641 patients who underwent radical distal gastrectomy between January 2005 and June 2012 in Department of Gastric Surgery, Fujian Medical University Union Hospital. The baseline characteristics and surgical outcomes were compared using a paired t-test or the Wilcoxon signed ranks test for continuous variables. The cumulative survival rates were compared using the Kaplan-Meier method and log-rank test. Results: Among all patients, there were significant differences in tumor location, digestive tract reconstruction, histologic type, pT stage, and pTNM stage between LADG and ODG group (P<0.05). After propensity score matching, patient distributions were closely balanced. There was no significant difference in clinicopathologic characteristics between the two groups (P>0.05). Regarding perioperative characteristics, the time to first flatus, and time to resumption of diet, did not differ between the two groups (P>0.05), while there were significant differences in the operation time (t=-11.28, P=0.000), blood loss (t=-5.674, P=0.000), number of dissected lymph nodes (t=4.727, P=0.000), and post-operative hospital stay (t=-2.193, P=0.038). LADG group has less morbidity than ODG group (χ²=4.777, P=0.029). Multivariate analysis revealed that the laparoscopic surgery (RR=0.392, P=0.009) was the protected factor for determining postoperative complications. There was no significant difference in the cumulative survival rate at total and each UICC stage between the two groups, either (P>0.05). Conclusion: LADG is an oncological safe minimally invasive procedure for advanced gastric cancer yields comparable oncological outcomes with ODG.

Comparison of the combination therapy of bacillus Calmette-Guérin and mitomycin C with the monotherapy for non-muscle-invasive bladder cancer: a meta-analysis

Urinary bladder cancer is one of the most frequent cancers worldwide. Non-muscle-invasive bladder carcinoma (NMIBC) has a very low curative rate after resection. The meta-analysis aims to compare efficiency of the combination therapy of bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) with each monotherapy on NMIBC treatment. Articles were retrieved in relevant databases up to May, 2016. The Cochrane Collaboration Risk of Bias Tool was used to assess quality of the included studies. Risk ratio (RR) and the 95% confidence interval (CI) were used as the effect size to calculate pooled result. Funnel plot and Egger's test were applied to examine publication bias. Sensitive analysis was performed. Eight randomized controlled trials were included in this meta-analysis. As a result, the BCG+MMC combination therapy had a significantly decreased recurrence rate in NMIBC patients, compared with monotherapy of BCG or MMC (RR = 0.81, 95% CI: 0.72 to 0.92, P < 0.001). However, there were no obvious differences between the two regimens regarding to progression rate, overall mortality and disease-specific mortality (P > 0.050). Subgroup analysis indicated the combination therapy was more advantageous than BCG (RR = 0.73, 95% CI: 0.61 to 0.87) but not MMC monotherapy (P > 0.050), on the reduced recurrence rate. 81mg/week BCG + 30 mg/week MMC had a significant lower progression rate than BCG (RR = 0.44, 95%CI: 0.24 to 0.82). In conclusion, BCG+MMC combination therapy is more advantageous than BCG to NMIBC patients with reduced recurrence rate.

Worldwide variation in hip fracture incidence weakly aligns with genetic divergence between populations

This study investigates the influence of genetic differentiation in determining worldwide heterogeneity in osteoporosis-related hip fracture rates. The results indicate that global variation in fracture incidence exceeds that expected on the basis of random genetic variance.

INTRODUCTION

Worldwide, the incidence of osteoporotic hip fractures varies considerably. This variability is believed to relate mainly to non-genetic factors. It is conceivable, however, that genetic susceptibility indeed differs across populations. Here, we present the first quantitative assessment of the effects of genetic differentiation on global variability in hip fracture rates.

METHODS

We investigate the observed variance in publically reported age-standardized rates of hip fracture among 28 populations from around the world relative to the expected variance given the phylogenetic relatedness of these populations. The extent to which these variances are similar constitutes a "phylogenetic signal," which was measured using the K statistic. Population genetic divergence was calculated using a robust array of genome-wide single nucleotide polymorphisms.

RESULTS

While phylogenetic signal is maximized when K > 1, a K value of only 0.103 was detected in the combined-sex fracture rate pattern across the 28 populations, indicating that fracture rates vary more than expected based on phylogenetic relationships. When fracture rates for the sexes were analyzed separately, the degree of phylogenetic signal was also found to be small (females: K = 0.102; males: K = 0.081).

CONCLUSIONS

The lack of a strong phylogenetic signal underscores the importance of factors other than stochastic genetic diversity in shaping worldwide heterogeneity in hip fracture incidence.

Evaluation of clinicopathological factors related to the prognosis of gastric neuroendocrine carcinoma

BACKGROUND

Research on the clinicopathology and prognosis of gastric neuroendocrine carcinoma (GNEC) is rare, and a uniform standard for treatment has not been established. Therefore, we retrospectively analyzed the clinical data of 132 cases of GNEC to investigate the factors influencing prognosis.

METHODS

A total of 132 patients diagnosed with GNEC at Fujian Medical University Union Hospital from January 2006 to December 2013 were enrolled. This study was performed to analyze the factors related to patient prognosis.

RESULTS

In total, 58 men and 74 women whose ages ranged from 38 to 83 years old (62 ± 10) were enrolled. The 1- and 3-year survival rates for these patients were 83.9% and 47.6%, respectively. Of these patients, 100 underwent radical resection, 22 underwent palliative resection, and 10 received chemotherapy alone. The median survival times following radical resection, palliative resection and chemotherapy alone were 48, 20 and 12 months, respectively (P < 0.01). Univariate and multivariate survival analyses of patients who underwent radical resection showed that tumor size, N stage, Ki-67 labeling index, mitotic index and the application of postoperative adjuvant chemotherapy were independent factors affecting patient prognosis. The correlation analysis of the Ki-67 labeling index and mitotic index with prognosis showed that patient survival decreased significantly when the Ki-67 labeling index increased (P < 0.05).

CONCLUSIONS

Patients who underwent radical resection had the best prognosis among GNEC. For these patients, tumor size, N stage, Ki-67 labeling index, mitotic index and the application of postoperative adjuvant chemotherapy were the clinicopathological factors significantly associated with patient prognosis.