[Medical viewpoints of Foshuo Wenshi Xiyu Zhongseng Jing]

Foshuo Wenshi Xiyu Zhongseng Jing (, Sutra on Bathing the Sangha in the Bathhouse) as an early Scripture of Han Buddhism, introduced the concept, methods and medical & health care function of bathhouse bathing in detail.The most prominent feature of it, was its distinct medical viewpoints. The medical thoughts were closely related to famous ancient Indian physician Jīvaka and Buddhism's thoughts "Mahābhūta(■, great element)" and "Nidāna (■, cause, motivation or occasion)" .It focused on the good concept of personal life, physical and mental health, objectively benefited human health.Even from the viewpoints of modern medicine, it is also very reasonable.In particular, its noble medical ethics and benevolence, is instructive for the return of humanistic spirit in the medical profession today.

[Application value of dual channel dual curved endoscope in the endoscopic submucosal dissection for gastric angle mucosal lesions]

Objective: To evaluate the clinical value of dual channel dual curved endoscope in the endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions. Methods: A descriptive cohort study was carried out. Clinicopathological data of 20 cases with gastric angle mucosal lesions undergoing ESD by dual channel dual curved endoscope in our center from October 2016 to August 2018 were collected and analyzed retrospectively. Inclusion criteria: (1) the lesion was located in the gastric angle confirmed by gastroscopy before ESD. (2) CT examination showed no distant metastasis. (3) pathological biopsy confirmed precancerous lesion or early cancerous lesion without submucosal invasion. (4) the whole operation was performed by the same endoscopist with ESD experience of about 2000 cases. Patients with previous ESD history of gastric angle and other serious diseases were excluded. The dual channel dual curved endoscopy (Olympus, GIF-2TQ260M) and other conventional endoscopic surgical instruments were used in all the cases. Complete tumor resection rate, pathological results, intraoperative and postoperative complications, operation time and hospitalization time were observed. Follow - up parameters included residual tumor, local recurrence and heterogeneous lesion. Results: Of 20 patients, 14 were male and 6 were female with an average of 55.6 years (range, 37 to 75). All the tumors located in gastric angle. Specimen size ranged from 1.2 to 5.5 (average 2.9) cm. Operation time ranged from 50 to 120 (average 85.8) minutes. Hospital stay ranged from 3 to 7 (average 5.1) days. The en bloc excision was performed successfully in all 20 cases. There was no perforation or bleeding during or after operation. Pathological results showed curative or nearly curative resection stage in all the cases. No tumor residual or recurrence was found during follow-up for 8 to 30 (average 18.5) months. Conclusion: Dual channel dual curved endoscope can provide good vision and easy control in removing the lesion completely and avoiding complications during the ESD procedure in gastric angle mucosal lesions with good long-term efficacy.

SOX2 mediates crosstalk between Sonic Hedgehog and the Wnt/β-catenin signaling pathway to promote proliferation of pituitary adenoma cells

The Sonic hedgehog (Shh) and Wnt/β-catenin signaling pathways are important regulators of early tissue patterning and stem cell propagation, and aberrant regulation of these two signaling pathways has been associated with a number of types of cancer. The identification of adult stem cells in the pituitary raised the question of whether these two signaling pathways are involved in pituitary adenoma formation. In the present study, it was identified that treating a human pituitary adenoma cell line with Shh was not able to promote the proliferation of cancer cells, but Shh was able to upregulate the expression of sex-determining region Y box 2 (SOX2) which is characteristic of stem cells. The addition of Shh into β-catenin-expressing cells also promoted cell proliferation. On the other hand, addition of Wnt3a into or overexpression of β-catenin in SOX2-expressing cancer cells was able to promote cell proliferation, Further investigation revealed that SOX2 is required to mediate crosstalk between the Shh and Wnt/β-catenin signaling pathways to promote the proliferation of pituitary adenoma cells.

Systematic review of randomized controlled trials on antibiotic treatment for osteomyelitis in diabetes

AIM

To evaluate the efficacy of antibiotic therapy in osteomyelitis treatment among people with diabetes.

METHODS

A systematic search of PubMed, EMBASE, AMED, Web of Science, the WHO trial registry, Cochrane library databases, and ClinicalTrials.gov, in addition to hand-searching, was undertaken in July 2018. Two reviewers independently extracted data. The studies' methodological quality was assessed using the modified Jadad scale. Descriptive analysis was performed.

RESULTS

Seven randomized controlled trials, with 393 participants in total, were included. The antibiotic regimens, treatments and follow-up durations varied among the trials. The total scores showed that the overall methodological quality of the seven studies was high, despite two studies showing some flaws in double-blinding and withdrawals/drop-outs. Of four studies comparing different antibiotic regimens, three implied a similar remission effect, while one implied that ertapenem ± vancomycin treatment showed a higher remission rate than tigecycline treatment; this conclusion was not robust because of low power and small sample size. In the other three studies, which included two different doses of ciprofloxacin, an antibiotics group and a conservative surgical group, and two durations of the same antibiotic strategy, no significant differences in remission were reported between the groups. No difference was observed in the analyses of microbiological outcomes, superinfections and relapse, except adverse events.

CONCLUSIONS

There is no definitive evidence supporting the superiority of any particular antibiotic agent, dose, or administration duration in the treatment of osteomyelitis in diabetes. As the included studies had some flaws and limitations, further research is necessary.

Compact laser system for a laser-cooled ytterbium ion microwave frequency standard

The development of a transportable microwave frequency standard based on the ground-state transition of ¹⁷¹Yb⁺ at ∼12.6 GHz requires a compact laser system for cooling the ions, clearing out of long-lived states and also for photoionisation. In this paper, we describe the development of a suitable compact laser system based on a 6U height rack-mounted arrangement with overall dimensions 260 × 194 × 335 mm. Laser outputs at 369 nm (for cooling), 399 nm (photoionisation), 935 nm (repumping), and 760 nm (state clearout) are combined in a fiber arrangement for delivery to our linear ion trap and we demonstrate this system by cooling of ¹⁷¹Yb⁺ ions. Additionally, we demonstrate that the lasers at 935 nm and 760 nm are close in frequency to water vapor and oxygen absorption lines, respectively; specifically, at 760 nm, we show that one ¹⁷¹Yb⁺ transition is within the pressure broadened profile of an oxygen line. These molecular transitions form convenient wavelength references for the stabilization of lasers for a ¹⁷¹Yb⁺ frequency standard.

Vapour Pressure above the Glassy Trehalose Solution and Glass Relaxation

BACKGROUND

Data are scarce on thermophysical properties of the glassy trehalose solution at low temperatures.

OBJECTIVE

Water vapor pressure above the glassy trehalose solution and the relaxation behavior were studied at temperatures from -57°C to -40°C and at concentrations from 71% to 78% (w/w).

MATERIALS AND METHODS

Glassy trehalose solutions were prepared by quenching in liquid nitrogen. Vapour pressure was measured using the static method.

RESULTS

Vapour pressure above the glassy trehalose solution was slightly lower than above the glassy sucrose solution. The relaxation of the glassy state can be described by the stretched exponential Kohlrausch-Williams-Watts (KWW) function. The characteristic times of water relaxation (Τ_p) were compared with those of enthalpy relaxation (Τ_e). When the difference (∆T) between the glass transition temperature (T_g) and ageing temperature was relatively small, i.e. ∆T ≤ 10 K, Τ_p is close to Τ_e. If ∆T ≥ 15 K, Τ_e will be much greater than Τ_p.

CONCLUSION

The difference of water vapor pressure above the trehalose glassy solution and sucrose glassy solution could lead to significant distinction between their drying kinetics.

Is lower low-density lipoprotein cholesterol associated with lower androgen and erectile dysfunction in men?

BACKGROUND AND AIMS

Therapeutic possibilities now exist to lower low-density lipoprotein cholesterol (LDL-C) to very low levels. However, substantial controversy remains in clinical practice with regard to its safety, and the question of whether low LDL-C levels per se may provoke adverse effects in humans arises. We aimed to explore the association of LDL-C with androgen and erectile dysfunction (ED) in a general population of men.

METHODS AND RESULTS

A total of 4203 men without hormone replacement therapy were enrolled from 22 sites in East China. Total testosterone (T) and Free T were assessed. Free androgen index (FAI) was calculated. The IIEF-5 questionnaire was used to assess ED. We found that free T and FAI gradually and markedly increased with increasing LDL-C levels. Using linear regression, after adjusting for age, educational level, economic status, smoking status, drinking status, BMI, diabetes, and use of lipid-lowering medication, LDL-C was positively associated with free T (B = 0.175, 95% CI: 0.084, 0.266) and FAI (B = 0.064, 95% CI: 0.016, 0.112). Meanwhile, there was a U-shaped curvilinear relationship between LDL-C and prevalence of ED. In the logistic regression analysis, compared to those with LDL-C among the 10th-90th percentile, the ORs of ED in men in the lowest and highest deciles were 1.938 (95% CI: 1.121, 3.349) and 1.804 (95% CI: 1.117, 2.916), respectively.

CONCLUSION

Lower LDL-C levels were significantly associated with lower free T and lower FAI in a general population of men. Moreover, both low and high levels of LDL-C might be risk factors for ED.

Successful Transplantation of "Black Kidneys" Due to Myoglobin Nephropathy

Four kidneys from 2 young donors suffering from rhabdomyolysis were rejected for transplantation at the time of procurement because of their severely bruised and black gross appearance. A frozen section revealed a focal tubular injury filled with granular pigmented casts which an immunohistochemistry confirmed to be myoglobin. The 4 kidneys were transplanted successfully and all recipients recovered normal renal function with no delay. These cases indicate that kidneys with patchy black gross appearance caused by myoglobin casts secondary to rhabdomyolysis is not a contraindication for transplantation.

Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose-response study in young healthy men

Testosterone dose-dependently increases appendicular muscle mass. However, the effects of testosterone administration on the core muscles of the trunk and the pelvis have not been evaluated. The present study evaluated the effects of testosterone administration on truncal and pelvic muscles in a dose-response trial. Participants were young healthy men aged 18-50 years participating in the 5α-Reductase (5aR) Trial. All participants received monthly injections of 7.5 mg leuprolide acetate to suppress endogenous testosterone production and weekly injections of 50, 125, 300, or 600 mg of testosterone enanthate and were randomized to receive either 2.5 mg dutasteride (5aR inhibitor) or placebo daily for 20 weeks. Muscles of the trunk and the pelvis were measured at baseline and the end of treatment using 1.5-Tesla magnetic resonance imaging. The dose effect of testosterone on changes in the psoas major muscle area was the primary outcome; secondary outcomes included changes in paraspinal, abdominal, pelvic floor, ischiocavernosus, and obturator internus muscles. The association between changes in testosterone levels and muscle area was also assessed. Testosterone dose-dependently increased areas of all truncal and pelvic muscles. The estimated change (95% confidence interval) of muscle area increase per 100 mg of testosterone enanthate dosage increase was 0.622 cm² (0.394, 0.850) for psoas; 1.789 cm² (1.317, 2.261) for paraspinal muscles, 2.530 cm² (1.627, 3.434) for total abdominal muscles, 0.455 cm² (0.233, 0.678) for obturator internus, and 0.082 cm² (0.003, 0.045) for ischiocavernosus; the increase in these volumes was significantly associated with the changes in on-treatment total and free serum testosterone concentrations. In conclusion, core muscles of the trunk and pelvis are responsive to testosterone administration. Future trials should evaluate the potential role of testosterone administration in frail men who are predisposed to falls and men with pelvic floor dysfunction.

[Development of a method to detect serum unmethylated insulin DNA]

Objective: To develop a specific and sensitive method to detect serum unmethylated insulin (INS) DNA for monitoring pancreatic beta cell death and evaluate its clinical practice value. Methods: This study validated and modified the Akirav method and the Husseiny method. Six type 1 diabetes mellitus (T1DM) patients, who were diagnosed with T1DM in the Second Xiangya Hospital, Central South University between February 2014 and February 2015, and another 8 sex- and age-matched healthy controls, were enrolled in the study. Patients' serum samples were examined by the modified Akirav method. Results: Methylation-independent PCR of the Akirav method cannot amplify the specific product. The efficiency of primers for quantitative methylation-specific PCR used in Husseiny method was (76.98±2.88)%, which was lower than 80% (recommend efficiency), resulting in poor reliability. This study applied primers for the Husseiny method into the procedures of the Akirav method.The results showed that the level of unmethylated INS DNA in T1DM group is significantly higher than that in the healthy controls[demethylation index: 0.039(0.028-0.083) vs 0.016(0.003-0.029), P=0.005]. Conclusions: The modified Akirav method can effectively detect the level of unmethylated INS DNA. The level of unmethylated INS DNA in T1DM patients is higher than that in the healthy controls.

Obesity, osteoarthritis and genetic risk: The rs182052 polymorphism in the ADIPOQ gene is potentially associated with risk of knee osteoarthritis

Objectives

Given the function of adiponectin (ADIPOQ) on the inflammatory condition of obesity and osteoarthritis (OA), we hypothesized that the ADIPOQ gene might be a candidate gene for a marker of susceptibility to OA.

Methods

We systematically screened three tagging polymorphisms (rs182052, rs2082940 and rs6773957) in the ADIPOQ gene, and evaluated the association between the genetic variants and OA risk in a case-controlled study that included 196 OA patients and 442 controls in a northern Chinese population. Genotyping was performed using the Sequenom MassARRAY iPLEX platform.

Results

The single nucleotide polymorphism (SNP) rs182052 was found to be potentially associated with knee OA risk (additive model: odds ratio = 1.38; 95% confidence interval 1.07 to 1.76; p = 0.012). Furthermore, a non-significant association was observed for rs182052 and body mass index with regard to OA risk in interaction analyses (p = 0.063). Similarly, no significant interaction was detected for rs182052 and age with regard to OA risk (p = 0.614).

Conclusion

These findings suggest that the SNP rs182052 in the ADIPOQ gene may potentially modify individual susceptibility to knee OA in the Chinese population. Further studies are warranted to investigate our findings in more depth.

Cite this article: L. Jiang, X. Zhu, J. Rong, B. Xing, S. Wang, A. Liu, M. Chu, G. Huang. Obesity, osteoarthritis and genetic risk: The rs182052 polymorphism in the ADIPOQ gene is potentially associated with risk of knee osteoarthritis. Bone Joint Res 2018;7:494–500. DOI: 10.1302/2046-3758.77.BJR-2017-0274.R1.

EEG time-warping to study non-strictly-periodic EEG signals related to the production of rhythmic movements

BACKGROUND

Many sensorimotor functions are intrinsically rhythmic, and are underlined by neural processes that are functionally distinct from neural responses related to the processing of transient events. EEG frequency tagging is a technique that is increasingly used in neuroscience to study these processes. It relies on the fact that perceiving and/or producing rhythms generates periodic neural activity that translates into periodic variations of the EEG signal. In the EEG spectrum, those variations appear as peaks localized at the frequency of the rhythm and its harmonics.

NEW METHOD

Many natural rhythms, such as music or dance, are not strictly periodic and, instead, show fluctuations of their period over time. Here, we introduce a time-warping method to identify non-strictly-periodic EEG activities in the frequency domain.

RESULTS

EEG time-warping can be used to characterize the sensorimotor activity related to the performance of self-paced rhythmic finger movements. Furthermore, the EEG time-warping method can disentangle auditory- and movement-related EEG activity produced when participants perform rhythmic movements synchronized to an acoustic rhythm. This is possible because the movement-related activity has different period fluctuations than the auditory-related activity.

COMPARISON WITH EXISTING METHODS

With the classic frequency-tagging approach, rhythm fluctuations result in a spreading of the peaks to neighboring frequencies, to the point that they cannot be distinguished from background noise.

CONCLUSIONS

The proposed time-warping procedure is as a simple and effective mean to study natural non-strictly-periodic rhythmic neural processes such as rhythmic movement production, acoustic rhythm perception and sensorimotor synchronization.

Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia

BACKGROUND

Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group.

METHODS

Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments.

RESULTS

Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team.

CONCLUSION

Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.