[Prospective cohort study on the outcomes of sacrospinous ligament fixation using conventional instruments in treating stage Ⅲ-Ⅳ pelvic organ prolapse]

Objective: To evaluate the medium and long term safety and efficacy of sacrospinous ligament fixation (SSLF) performed with conventional instruments in treating stage Ⅲ-Ⅳ pelvic organ prolapse (POP). Methods: A prospective cohort analysis was conducted in the Peking Union Medical College Hospital, between May 2007 and June 2015, enrolling 55 women with stage Ⅲ-Ⅳ POP who intended to receive SSLF. Primary end points were objective success rates using pelvic organ prolapse quantitation system (POP-Q) and subjective satisfaction rates with questionnaires after surgery according to vaginal examination and related questionnaires for all patients who received SSLF eventually. Exploratory outcomes included perioperative parameters and complications. Results: Of these 55 POP patients enrolled, 52 (95%, 52/55) received SSLF using conventional surgical instruments, the other 3 cases converted to ischial spinous fascia fixation due to difficulty exposing. Medium blood loss during operation was 100 ml (20-300 ml) and operative time 60 minutes (20-165 minutes). Pelvic hematoma with diameters of 5 cm and 7 cm were observed in two patients, both recovered fully with conservative methods. All patients were able to micturate spontaneously after catheter withdrawal. One patient reported right thigh pain after operation which remained till 3-month follow-up and relieved after physiotherapy. The objective success rate was 100% (52/52) at 3 months. With a medium follow-up time of 23.7 months, the objective success rate was 98% (51/52), the recurrence rate was 2% (1/52) and the satisfactory rate was 94% (49/52). De novo urinary incontinence occurred in 6% (3/52) of patients. Conclusion: Most POP could be corrected with SSLF using conventional instruments which is a feasible, economic and effective procedure for Asian patients with medium compartment prolapse.

Aggravated nausea and vomiting induced by fat emulsion for hyperemesis gravidarum: A case report

WHAT IS KNOWN AND OBJECTIVE

Total parental nutrition (TPN) for hyperemesis gravidarum (HG) is generally effective and well-tolerated. We report a case of aggravated nausea and vomiting caused by fat emulsion.

CASE DESCRIPTION

A 40-year-old pregnant woman through IVF was admitted to the hospital at 11-week gestation and diagnosed with HG. During TPN treatment, the patient suffered from aggravated nausea and vomiting. We identified fat emulsion as the most likely culprit using challenge, dechallenge and rechallenge.

WHAT IS NEW AND CONCLUSION

This is the first report of fat emulsion aggravating nausea and vomiting in such situation.

[Impact of blood pressure control on coronary flow reserve in hypertensive patients]

OBJECTIVE

To investigate the impacts of blood pressure control on coronary flow reserve (CFR) in hypertensive patients.

METHODS

A total of 236 patients without significant coronary stenosis (defined as <50% luminal narrowing which was confirmed by coronary angiography or coronary artery CT scan) between January 2011 to July 2015 were retrospectively enrolled in this study. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by transthoracic Doppler echocardiography. Patients were divided into hypertension group (n=173) and non-hypertension group (n=63). The hypertension patients were further divided into ideally controlled (n=31, defined as SBP <120 mmHg (1 mmHg=0.133 kPa) and DBP <80 mmHg), controlled (n=82, defined as SBP 120 to 139 mmHg and DBP <90 mmHg) and uncontrolled groups (n=60, defined as SBP≥140 mmHg and/or diastolic DBP≥90 mmHg) based on their blood pressure after systematic antihypertensive therapy and CFR values were compared among the 4 groups. Multivariate regression analyses were performed to identify the independent determinants of CFR in patients with hypertension.

RESULTS

Compared with non-hypertension group, the CFR was significantly lower in controlled (3.27±0.71 vs. 2.87±0.56, P<0.001) and uncontrolled groups (3.27±0.71 vs. 2.61±0.71, P<0.001), but was similar in ideally controlled group (3.27±0.71 vs. 3.21±0.85, P=0.68). Furthermore, the CFR was significantly lower in uncontrolled group than that of the other two hypertension groups and was significantly lower in controlled group than that of ideally controlled group. Higher blood pressure (β=-0.17, P=0.03) and age(β=-0.02, P=0.03) were independent predictors of lower CFR in patients with hypertension.

CONCLUSIONS

Higher blood pressure is an independent predictor of decreased CFR in patients with hypertension. Hypertensive patients with ideally controlled blood pressure have similar CFR level as patients without hypertension.

RNAi of Grp78 may disturb the fusion of ICR mouse palate cultured in vitro

RNA interference (RNAi) is a powerful tool to silence or minimize gene expression, and palate culture in vitro is an important technique for study of the palate development. Our previous study demonstrated that the gene expression of glucose-regulated protein-78 (Grp78) was downregulation in the all-trans retinoic acid-induced mouse models of cleft palate (CP) during embryogenesis. To find the role of Grp78, the small interfering RNA (siRNA) of this gene carried by fluorescent vector was injected with a microinjector, through which about 30 pmol siRNA was injected into the Institute of Cancer Research (ICR) mouse palate explants. After 6, 12, 24, 48, and 72 h, these palate explants were removed from culture to observe their fluorescent and Alcian blue-staining phenotypes, and the expression of the unfolded protein response (UPR) key members (Grp78, Inositol-responsive enzyme 1, protein kinase RNA-like endoplasmic reticulum kinase, activating transcription factor-6 and X-box binding protein-1) was measured. After cultured for 72 h, the partially or completely fused bilateral palates were observed in the control siRNA group, while CPs were found in the Grp78 siRNA group. In the Grp78 siRNA group, the relatively mRNA abundance of the key genes belonged to UPR at each time point was lower than that of the control siRNA group, and their protein expression also displayed the same change. By the system of RNAi strategies with mouse palate culture, we found the siRNA of Grp78 disturbed the fusion of mouse palate cultured in vitro.

Preparation, Biochemical Analysis, and Structure Determination of the Bromodomain, an Acetyl-Lysine Binding Domain

The bromodomain (BrD) represents an evolutionarily conserved protein domain whose function mostly is to recognize acetylated lysine residues in histones and nuclear proteins in regulation of gene transcription in chromatin. The highly conserved BrD structure features an unusual left-handed, antiparallel four-helix bundle and a hydrophobic pocket between the interhelical ZA and BC loops important for acetyl-lysine binding. Many proteins, particularly transcriptional activators, contain BrDs, and mutation or deletion of the BrDs impairs the protein function, implying their critical role in human biology and disease. In this chapter, we provide general protocols of the preparation, biochemical analysis, and structure determination of BrDs, aiming to offer a general guideline for structural and biochemical functional characterization of BrD-containing proteins.

The effectiveness of low-level laser therapy as an adjunct to non-surgical periodontal treatment: a meta-analysis

Background and Objectives

Although low‐level laser therapy (LLLT) has been demonstrated to have a biomodulatory effect on periodontal tissue, no systematic review has exclusively addressed its effectiveness as an adjunct to non‐surgical periodontal treatment. This study aimed to evaluate whether an additional benefit exists for the application of LLLT compared with scaling and root planing (SRP) alone.

Material and Methods

An extensive search was conducted in the Cochrane Library (Issue 8, 2015), PubMed (1997) and EMBASE (1947) before August 2015 for randomized controlled trials (RCTs). The bias risk was assessed with the Cochrane tool for risk of bias evaluation. A meta‐analysis was performed using REVMAN 5.3.

Results

After independent screening of 354 initial records, eight publications (seven RCTs) were included. However, six were rated as ‘having a high risk of bias’ as a result of major methodological weakness in ‘allocation concealment’ and ‘blinding of key personnel’. Meta‐analysis showed that LLLT‐mediated SRP demonstrated significant short‐term benefits over SRP monotherapy in the improvement of the probing pocket depth (p = 0.0009 at 1 mo; p = 0.03 at 2 mo) and the level of interleukin‐1β in the gingival crevicular fluid (p = 0.01 at 1 mo). Nevertheless, LLLT failed to show significant additional intermediate‐term (3 and 6 mo) effects in terms of clinical parameters and alveolar bone density.

Conclusion

These findings indicated that LLLT showed only short‐term additional benefits after conventional SRP. Its long‐term effects remain unclear due to substantial methodological weaknesses and an insufficient number of current studies. Future RCTs with better designs and longer follow‐up periods are required to assess the effectiveness of LLLT as an adjunctive treatment strategy in patients with periodontal disease.

Disorder-enhanced spin polarization of the Zn1−xCoxO1−v concentrated magnetic semiconductor

Amorphous concentrated magnetic semiconductor Zn_0.32Co_0.68O_1−v (v refers to oxygen vacancies) thin film was investigated by magnetic and electrical transport measurements as well as Andreev reflection spectroscopy.

Association between non-alcoholic fatty liver disease and autonomic dysfunction in a Chinese population

BACKGROUND

Autonomic dysfunction (AD) accompanying with chronic liver disorders led to an increased risk of mortality. However, researches that investigated the association between non-alcoholic fatty liver disease (NAFLD) and AD were insufficient.

AIMS

To study the association of NAFLD with AD in middle-aged and elderly Chinese adults.

DESIGN

Four thousand nine hundred seventy-four adults aged 40 years or older were enrolled in this cross-sectional study. NAFLD was diagnosed by hepatic B-mode ultrasonography. Autonomic function was assessed using a simple EZSCAN test by measuring sudomotor function, with an AD index > 50% defined as a manifestation of AD.

METHODS

Pearson correlation, multiple stepwise linear regression, univariate and multivariate logistic regression was employed to examine the relationship between NAFLD and AD, controlling for potential confounders.

RESULTS

The prevalence of AD was significantly higher in participants with NAFLD than those without (40.75 vs. 26.86%, P < 0.0001). Age, body mass index, status of diabetes, sex, diastolic blood pressure and prevalent NAFLD, were positively correlated with AD index in multiple stepwise linear regression analysis (all P < 0.05), whereas total cholesterol was negatively related to it (P = 0.0043). Compared with the participants without NAFLD, those with NAFLD had an increased odds of the prevalent AD (odds ratio 1.38; 95% confidence interval 1.15-1.64; P = 0.0004) after controlling for multiple confounders.

CONCLUSIONS

The presence of NAFLD was significantly associated with AD, as indicated by abnormal sudomotor function. The association was independent from various conventional risk factors.

Knockdown of ST6Gal-I inhibits the growth and invasion of osteosarcoma MG-63 cells

The upregulation of alpha-2,6-sialyltranferase 1 (ST6Gal-I) has been observed in several malignant tumors, including colon, ovarian and liver cancers, where its expression correlates with the invasion and metastasis of these tumors. However, the roles and molecular mechanisms by which ST6Gal-I mediates the growth and invasion of osteosarcoma cells still remain poorly unknown. In this study, we investigated the expression of ST6Gal-I in osteosarcoma MG-63 and Saos-2 cells which have different metastatic potential, and found that ST6Gal-I was highly expressed in MG-63 cells compared to Saos-2 cells. Downregulation of ST6Gal-I by shRNA in MG-63 cells significantly inhibited their malignant behaviors, including in cell proliferation and soft agar colony formation, as well as migration and invasion properties. In addition, we found that ST6Gal-I knockdown inhibited the expression levels of N-cadherin, vimentin, a-SMA, MMP-2, MMP-9 and VEGF. Together, our results suggest a role for ST6Gal-I to promote the growth and invasion of osteosarcoma cells through modulation of EMT-related molecules, and might be a promising marker for the prognosis and therapy of osteosarcoma.

[Relationship between serum histamine levels and ST-segment resolution in patients with acute myocardial infarction treated with primary percutaneous coronary intervention]

OBJECTIVE

To investigate the dynamic changes in serum histamine levels and their association with ST-segment resolution in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

METHODS

A total of 84 consecutive STEMI patients who received primary PCI were enrolled in this study. The dynamic changes in serum histamine levels were observed from before PCI to 1 week after PCI. Factors associated with ST-segment resolution were identified by multivariate regression analysis.

RESULTS

The serum histamine levels of STEMI patients decreased during the first week after PCI. Multivariate regression analysis showed that the factors associated with ST-segment resolution 2 h after PCI were: the histamine level 2 h after PCI (r=-0.361, P=0.001), pain to balloon time, infarct related artery, and thrombolysis in myocardial infarction (TIMI) flow grade after PCI.

CONCLUSION

The higher histamine level 2 h after PCI was independently associated with poor myocardial reperfusion in STEMI patients.

Placental miR-106a∼363 cluster is dysregulated in preeclamptic placenta

Preeclampsia (PE) is the leading cause of maternal and perinatal mortality and morbidity. MicroRNAs are strongly implicated in the pathogenesis of this syndrome. In current study, we performed a microarray assay to explore miRNA expression profile in the placenta, and found 11 upregulated and 7 downregulated miRNAs in preeclampsia. miR-363, plus other 5 member of miR-106a∼363 cluster was further examined and validated. These findings would facilitate further investigation of aberrant expression of miRNAs in the pathology of preeclampsia.

The injury resistant ability of melanopsin-expressing intrinsically photosensitive retinal ganglion cells

Neurons in the mammalian retina expressing the photopigment melanopsin have been identified as a class of intrinsically photosensitive retinal ganglion cells (ipRGCs). This discovery more than a decade ago has opened up an exciting new field of retinal research, and following the initial identification of photosensitive ganglion cells, several subtypes have been described. A number of studies have shown that ipRGCs subserve photoentrainment of circadian rhythms. They also influence other non-image forming functions of the visual system, such as the pupillary light reflex, sleep, cognition, mood, light aversion and development of the retina. These novel photosensitive neurons also influence form vision by contributing to contrast detection. Furthermore, studies have shown that ipRGCs are more injury-resistant following optic nerve injury, in animal models of glaucoma, and in patients with mitochondrial optic neuropathies, i.e., Leber’s hereditary optic neuropathy and dominant optic atrophy. There is also an indication that these cells may be resistant to glutamate-induced excitotoxicity. Herein we provide an overview of ipRGCs and discuss the injury-resistant character of these neurons under certain pathological and experimental conditions.

MicroRNA-207 enhances radiation-induced apoptosis by directly targeting Akt3 in cochlea hair cells

MicroRNAs (miRNAs) have important roles in various types of cellular biological processes. Our study aimed to determine whether miRNAs function in the regulation of ionizing radiation (IR)-induced cell death in auditory cells and to determine how they affect the cellular response to IR. Microarray and qRT-PCR were performed to identify and confirm the differential expression of miRNAs in the cochlea hair cell line HEI-OC1 and in vivo after IR. Upregulation or downregulation of miRNAs using miRNA mimics or inhibitor were detected to characterize the biological effects of the indicated miRNAs. Bioinformatic analyses, luciferase reporter assays and mRNA knockdown were performed to identify a miRNA target gene. We determined that miR-207 was significantly upregulated after IR. MiR-207 enhances IR-induced apoptosis and DNA damage in HEI-OC1 cells. Furthermore, Akt3 was confirmed to be a direct target of miR-207. Downregulation of Akt3 mimics the effects of miR-207. MiR-207 enhances IR-induced apoptosis by directly targeting Akt3 and anti-miR-207 may have a potential role in protecting cochlea hair cells from IR.

A five-microRNA panel in plasma was identified as potential biomarker for early detection of gastric cancer

BACKGROUND

Circulating microRNAs (miRNAs) have been implicated as novel biomarkers for gastric cancer (GC) diagnosis. However, the mixture of GC subtypes may have led to the inconsistent circulating miRNA profiles, and the clinical performance of circulating miRNAs has not yet been evaluated independently on early detection of GC.

METHODS

A four-phase study was designed with a total of 160 cancer-free controls, 124 patients with gastric non-cardia adenocarcinoma (GNCA) and 36 patients diagnosed gastric cardia adenocarcinoma (GCA). In the discovery phase, we screened the miRNA expression profile in plasma of 40 GNCA patients (stage I) and 40 matched controls by TaqMan low density array (TLDA) chips with pooled samples. Differentially expressed miRNAs were further validated in individual sample using quantitative reverse-transcriptase PCR (qRT-PCR) in the training phase. Subsequently, in an independent validation phase, the identified miRNAs were evaluated in 48 GNCA patients (stage I) and 102 matched controls. Finally, the identified miRNAs were further assessed in an external validation phase including advanced GNCA and GCA patients. Additionally, the expression levels of identified miRNAs were measured in the media of BGC823 and MGC803 cell lines.

RESULTS

Five miRNAs (miR-16, miR-25, miR-92a, miR-451 and miR-486-5p) showed consistently elevated levels in plasma of the GC patients as compared with controls, and were identified to be potential markers for GNCA with area under the receiver operating characteristic (ROC) curves (AUCs) ranging from 0.850 to 0.925 and 0.694 to 0.790 in the training and validation phases, respectively. The five-miRNA panel presented a high diagnostic accuracy for the early-stage GNCA (AUCs=0.989 and 0.812 for the training and validation phases, respectively). Three miRNAs (miR-16, miR-25 and miR-92a) were excreted into the culture media of GC cell lines.

CONCLUSIONS

The five-miRNA panel in plasma may serve as a potential non-invasive biomarker in detecting the early-stage GC.

Tumour-initiating capacity is independent of epithelial-mesenchymal transition status in breast cancer cell lines

Background:

Epithelial–mesenchymal transition (EMT) and cancer stem cells (CSCs) are considered to be crucial for cancer biology. The purpose of this study was to determine whether EMT directly led to the acquisition of tumour-initiating capacity in breast cancer cell lines.

Methods:

Epithelial–mesenchymal transition was induced in five breast cancer cell lines and one normal breast cell line by EMT-related cytokine stimulation. Mesenchymal–epithelial transition (MET) was induced by stably overexpressing miR-200c in three mesenchymal-like breast cancer cell lines. Molecular expression and cell function analysis were performed to evaluate the effect of EMT or MET on tumour-initiating capacity and other biological characteristics.

Results:

The induction of EMT did not enhance tumour-initiating capacity but, instead, conferred a CD44⁺/CD24^−/low phenotype as well as cell proliferation, migration, and resistance to doxorubicin and radiation on breast cancer cell lines. Furthermore, MET did not lead to inhibition or loss of the tumour-initiating capacity in mesenchymal-like breast cancer cell lines, but it markedly attenuated other malignant properties, including proliferation, invasion, and resistance to therapy.

Conclusions:

Epithelial–mesenchymal transition does not alter tumour-initiating capacity of breast cancer cells but some other biological characteristics. Therefore, EMT and tumour-initiating capacity may not be directly linked in breast cancer cell lines.

A Randomized, Double Blind Study to Evaluate the Efficacy of Palonosetron with Dexamethasone Versus Palonosetron Alone for Prevention of Post-Operative Nausea and Vomiting in Subjects Undergoing Bariatric Surgeries with High Emetogenic Risk

Introduction:

Postoperative (PONV) and postdischarge (PDNV) nausea and vomiting are common (60-70%) after bariatric surgery. Palonosetron (Pal), a novel 5-HT3 antagonist, is an effective antiemetic with a prolonged duration of action in the setting of PDNV. We hypothesized that combination therapy with Palonosetron (Pal) and dexamethasone (Dex) would improve treatment in comparison to Palonosetron alone in patients at high risk for PONV.

Methods:

In this study, patients undergoing bariatric laparoscopic surgery under general anesthesia, a subgroup of a larger Phase IV clinical trial of patients who had laparoscopic surgery, were randomized to 8 mg Dex + 0.075mg Pal or saline + 0.075mg Pal. Data was collected postoperatively at 2, 6, 24 and 72 hrs. A Functional Living Index-Emesis (QOL-FLIE) test was administered at 96 hrs.

Results:

We enrolled 76 ASA 1-2 patients with at least 3 PONV risk factors. Both randomization groups had a low incidence of vomiting in the PACU (Pal, 0.0%; Pal + Dex, 5.4%) as well as at 72 hours (0.0% both groups). Complete response (no vomiting, no rescue medication) was not different between treatment groups at any time intervals. Cumulative success rates over the entire 72 hrs were 60.4% (Pal alone) vs. 60.0% (Pal + Dex). Nausea scores (4 point ordinal scale) were not different between groups for any time intervals. Cumulative success scores for nausea (score = “none”; 0-72 hrs) were 41.9% for the Pal group, and 55.2% for the Pal+ Dex group. The Pal + Dex group showed a trend toward greater satisfaction on the QOL-FLIE scores with the greatest differences in the “nausea domain”.

Discussion:

The combination therapy (Pal + Dex) did not significantly reduce the incidence of PONV or PDNV when compared with Pal alone although a trend was observed indicating the possible increased efficacy of multi-drug therapy. There was no change in comparative efficacy over 72 hrs, possibly due to the low incidence of PDNV in both groups.

Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

This article describes the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of the volar defects at the proximal interphalangeal joint. The flap was based on the first dorsal branch of the proper digital artery. From January 2007 to March 2009, 14 digits in 14 patients (10 males and 4 females) were treated. There were 5 index, 6 middle, 2 ring, and 1 little finger. All patients underwent surgery 2-9 hours (mean 5 hours) after injury. Soft tissue defects ranged in size from 1.2 × 1.7 cm to 2.1 × 2.3 cm (mean 1.7 × 2 cm). Flap size ranged from 1.5 × 1.7 cm to 2.4 × 2.7 cm (mean 2 × 2.4 cm). Mean pedicle length was 1.1 cm (range 0.8-1.4 cm). All flaps completely survived. At final follow-up from 24-29 months (mean 26 months), mean active motion arcs of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 84° (range 75-91°), 86° (range 65-100°) and 54° (range 32-80°), respectively. Our technique is useful and reliable for coverage of a palmar defect over the proximal interphalangeal joint.

Laser hosing in relativistically hot plasmas

Electron response in an intense laser is studied in the regime where the electron temperature is relativistic. Equations for laser envelope and plasma density evolution, both in the electron plasma wave and ion acoustic wave regimes, are rederived from the relativistic fluid equations to include relativistic plasma temperature effect. These equations are used to study short-pulse and long-pulse laser hosing instabilities using a variational method approach. The analysis shows that relativistic electron temperatures reduce the hosing growth rates and shift the fastest-growing modes to longer wavelengths. These results resolve a long-standing discrepancy between previous nonrelativistic theory and simulations or experiments on hosing.